Carbogen inhalation increases oxygen transport to hypoperfused brain tissue in patients with occlusive carotid artery disease: increased oxygen transport to hypoperfused brain

DEFF Research Database (Denmark)

Ashkanian, Mahmoud; Gjedde, Albert; Mouridsen, Kim

2009-01-01

to inhaled oxygen (the mixture known as carbogen). In the present study, we measured CBF by positron emission tomography (PET) during inhalation of test gases (O(2), carbogen, and atmospheric air) in healthy volunteers (n = 10) and in patients with occlusive carotid artery disease (n = 6). Statistical...... and Sa(O2) are readily obtained with carbogen, while oxygen increases only Sa(O2). Thus, carbogen improves oxygen transport to brain tissue more efficiently than oxygen alone. Further studies with more subjects are, however, needed to investigate the applicability of carbogen for long-term inhalation...

Formation Mechanism of Carbogenic Nanoparticles with Dual Photoluminescence Emission

KAUST Repository

Krysmann, Marta J.; Kelarakis, Antonios; Dallas, Panagiotis; Giannelis, Emmanuel P.

2012-01-01

pyrolysis temperatures while the carbogenic core starts forming at higher temperatures, the PL behavior of CNPs strongly depends on the conditions used for their synthesis. © 2011 American Chemical Society.

Early Effects of Combretastatin A4 Phosphate Assessed by Anatomic and Carbogen-Based Functional Magnetic Resonance Imaging on Rat Bladder Tumors Implanted in Nude Mice

Directory of Open Access Journals (Sweden)

Carole D. Thomas

2006-07-01

Full Text Available Combretastatin A4 phosphate (CA4P causes rapid disruption of the tumor vasculature and is currently being evaluated for antivascular therapy. We describe the initial results obtained with a noninvasive multiparametric magnetic resonance imaging (MRI approach to assess the early effects of CA4P on rat bladder tumors implanted on nude mice. MRI (4.7 T comprised a fast spin-echo sequence for growth curve assessment; a multislice multiecho sequence for T2 measurement before, 15 minutes after, 24 hours after CA4P (100 mg/kg; and a fast T2W* gradient-echo sequence to assess MR signal modification under carbogen breathing before, 35 minutes after, 24 hours after CA4P. The tumor fraction with increased T2W* signal intensity under carbogen (T+ was used to quantify CA4P effect on functional vasculature. CA4P slowed tumor growth over 24 hours and accelerated necrosis development. T+ decrease was observed already at 35 minutes post-CA4P. Early T2 increase was observed in regions becoming necrotic at 24 hours post-CA4P, as confirmed by high T2 and histology. These regions exhibited, under carbogen, a switch from T2W* signal increase before CA4P to a decrease postCA4P. The combination of carbogen-based functional MRI and T2 measurement may be useful for the early follow-up of antivascular therapy without the administration of contrast agents.

Early effects of combretastatin A4 phosphate assessed by anatomic and carbogen-based functional magnetic resonance imaging on rat bladder tumors implanted in nude mice.

Science.gov (United States)

Thomas, Carole D; Walczak, Christine; Kaffy, Julia; Pontikis, Renée; Jouanneau, Jacqueline; Volk, Andreas

2006-07-01

Combretastatin A4 phosphate (CA4P) causes rapid disruption of the tumor vasculature and is currently being evaluated for antivascular therapy. We describe the initial results obtained with a noninvasive multiparametric magnetic resonance imaging (MRI) approach to assess the early effects of CA4P on rat bladder tumors implanted on nude mice. MRI (4.7 T) comprised a fast spin-echo sequence for growth curve assessment; a multislice multiecho sequence for T2 measurement before, 15 minutes after, and 24 hours after CA4P (100 mg/kg); and a fast T2w* gradient-echo sequence to assess MR signal modification under carbogen breathing before, 35 minutes after, and 24 hours after CA4P. The tumor fraction with increased T2w* signal intensity under carbogen (T+) was used to quantify CA4P effect on functional vasculature. CA4P slowed tumor growth over 24 hours and accelerated necrosis development. T+ decrease was observed already at 35 minutes post-CA4P. Early T2 increase was observed in regions becoming necrotic at 24 hours post-CA4P, as confirmed by high T2 and histology. These regions exhibited, under carbogen, a switch from T2w* signal increase before CA4P to a decrease postCA4P. The combination of carbogen-based functional MRI and T2 measurement may be useful for the early follow-up of antivascular therapy without the administration of contrast agents.

[Experimental branch vein occlusion: the effect of carbogen breathing on preretinal PO2].

Science.gov (United States)

Pournaras, J-A C; Poitry, S; Munoz, J-L; Pournaras, C J

2003-10-01

To evaluate the variations in preretinal PO2 in normal and in ischemic postexperimental branch vein occlusion (BRVO) retinal areas during normoxia, hyperoxia (100% O2) and carbogen (95% O2, 5% CO2) breathing. Preretinal PO2 measurements were obtained in intervascular retinal areas far from the retinal vessels of 13 anesthetized miniature pigs with oxygen-sensitive microelectrodes (10 microm tip diameter) introduced through the vitreous cavity by a micromanipulator. The microelectrode tip was placed at 50 microm from the vitreoretinal interface in the preretinal vitreous. PO2 was measured continuously for 10 minutes in systemic normoxia, hyperoxia (100% O2 breathing) and carbogen (95% O2, 5% CO2) breathing. A BRVO was induced with an argon green laser, and oxygen measurements were repeated in normoxia, hyperoxia and carbogen breathing. In hyperoxia, preretinal PO2 remained almost constant in both normal retinas (DeltaPO2=1.33 mmHg +/- 3.39; n=13) and ischemic retinas (DeltaPO2=3.73 mmHg +/- 2.84; n=8), although systemic PaO2 significantly increased. Carbogen breathing induced a significant increase in systemic PaO2 and PaCO2. Furthermore, it significantly increased preretinal PO2: DeltaPO2=23.05 mmHg +/- 17.06 (n=12) in normal retinas, and DeltaPO2=22.54 mmHg +/- 5.96 (n=6) in ischemic retinal areas. Systemic hyperoxia does not increase preretinal PO2 significantly in normal and ischemic post-BRVO retinal areas of miniature pigs, as hyperoxia induces a decrease in the retinal blood flow. Carbogen breathing significantly increases preretinal PO2 in normal and in ischemic post-BRVO retinal areas. This effect is probably due to the vasodilatation of the retinal arterioles induced by the intravascular PaCO2 increase.

Effect of carbogen on tumor oxygenation: combined fluorine-19 and proton MRI measurements

International Nuclear Information System (INIS)

Fan Xiaobing; River, Jonathan N.; Zamora, Marta; Al-Hallaq, Hania A.; Karczmar, Gregory S.

2002-01-01

Purpose: Blood oxygen level dependent (BOLD) contrast in magnetic resonance imaging (MRI) has been widely used for noninvasive evaluation of the effects of tumor-oxygenating agents. However, there have been few tests of the validity of this method. The goal of the present work was to use the T 1 of fluorine-19 in perfluorocarbon (PFC) emulsions as a 'gold standard' for comparison with BOLD MRI. Methods and Materials: Rats bearing R3230AC tumors implanted in the hind limb were injected with an emulsion of perfluoro-15-crown-5-ether for 2-3 days before experiments, which ensured that the PFC emulsion concentrated in the tumors. We correlated changes in tumor oxygenation caused by carbogen inhalation measured by 1 H BOLD MRI with quantitative 19 F measurements. The 19 F spin-lattice relaxation rate R 1 (= 1/T 1 ) was measured to determine initial oxygen tension (pO 2 ) in each image pixel containing the PFC, and changes in pO 2 during carbogen (95% O 2 , 5% CO 2 ) breathing. In a second carbogen breathing period, changes in water signal linewidth were measured using high spectral and spatial resolution imaging. 19 F and 1 H measurements were used to classify pixels as responders to carbogen (pixels where oxygen increased significantly) or nonresponders (no significant change in tumor oxygenation). Results: The 19 F and 1 H measurements agreed in 65% ± 11% of pixels (n = 14). Agreement was even stronger among pixels where 1 H showed increased oxygenation; 19 F measurements agreed with 1 H measurements in over 79% ± 11% of these pixels. Similarly, there was strong agreement between the two modalities in pixels where 19 F reported no change in pO 2 ; 1 H also showed no changes in 76% ± 18% of these pixels. Quantitative correlation of changes T 2 * (ΔT 2 *) in 1 H and changes R 1 (ΔR 1 ) in 19 F was weak during carbogen breathing, and averaged over the whole tumor was ∼0.40 for 14 experiments. However, the spatial patterns of 1 H and 19 F changes were qualitatively

Comparison of CO2 in air versus carbogen for the measurement of cerebrovascular reactivity with magnetic resonance imaging.

Science.gov (United States)

Hare, Hannah V; Germuska, Michael; Kelly, Michael E; Bulte, Daniel P

2013-11-01

Measurement of cerebrovascular reactivity (CVR) can give valuable information about existing pathology and the risk of adverse events, such as stroke. A common method of obtaining regional CVR values is by measuring the blood flow response to carbon dioxide (CO2)-enriched air using arterial spin labeling (ASL) or blood oxygen level-dependent (BOLD) imaging. Recently, several studies have used carbogen gas (containing only CO2 and oxygen) as an alternative stimulus. A direct comparison was performed between CVR values acquired by ASL and BOLD imaging using stimuli of (1) 5% CO2 in air and (2) 5% CO2 in oxygen (carbogen-5). Although BOLD and ASL CVR values are shown to be correlated for CO2 in air (mean response 0.11±0.03% BOLD, 4.46±1.80% ASL, n=16 hemispheres), this correlation disappears during a carbogen stimulus (0.36±0.06% BOLD, 4.97±1.30% ASL). It is concluded that BOLD imaging should generally not be used in conjunction with a carbogen stimulus when measuring CVR, and that care must be taken when interpreting CVR as measured by ASL, as values obtained from different stimuli (CO2 in air versus carbogen) are not directly comparable.

Early Effects of Combretastatin A4 Phosphate Assessed by Anatomic and Carbogen-Based Functional Magnetic Resonance Imaging on Rat Bladder Tumors Implanted in Nude Mice1

Science.gov (United States)

Thomas, Carole D.; Walczak, Christine; Kaffy, Julia; Pontikis, Renée; Jouanneau, Jacqueline; Volk, Andreas

2006-01-01

Abstract Combretastatin A4 phosphate (CA4P) causes rapid disruption of the tumor vasculature and is currently being evaluated for antivascular therapy. We describe the initial results obtained with a noninvasive multi-parametric magnetic resonance imaging (MRI) approach to assess the early effects of CA4P on rat bladder tumors implanted on nude mice. MRI (4.7 T) comprised a fast spin-echo sequence for growth curve assessment; a multislice multiecho sequence for T2 measurement before, 15 minutes after, and 24 hours after CA4P (100 mg/kg); and a fast T2w* gradient-echo sequence to assess MR signal modification under carbogen breathing before, 35 minutes after, and 24 hours after CA4P. The tumor fraction with increased T2w* signal intensity under carbogen (T+) was used to quantify CA4P effect on functional vasculature. CA4P slowed tumor growth over 24 hours and accelerated necrosis development. T+ decrease was observed already at 35 minutes post-CA4P. Early T2 increase was observed in regions becoming necrotic at 24 hours post-CA4P, as confirmed by high T2 and histology. These regions exhibited, under carbogen, a switch from T2w* signal increase before CA4P to a decrease post-CA4P. The combination of carbogen-based functional MRI and T2 measurement may be useful for the early follow-up of antivascular therapy without the administration of contrast agents. PMID:16867221

Carbogen Enhanced Femto Oximetry Breast Cancer Diagnosis Method with High Specificity

Science.gov (United States)

Maglich, Bogdan C.; Shultis, J. K.; Solomon, C. J.

2011-03-01

As large malignant tumors are oxygen deficient (hypoxic), cancer could be diagnosed in vivo and online, by non-invasive measurement of oxygen difference between tumor and adjacent tissue. Computer simulations of noninvasive diagnosis by Femto Oximetry (FO) of hypoxia in 1 cm tumor in 10 cm breast shows that background γ 's from non hypoxic tissue will mask hypoxia. To amplify the hypoxic-to-normal O difference, air breathing will be replaced with carbogen (O2 95 % , CO2 5 %) using vasco-constrictive property whereby carbogen breathing increases O in normal tissue, while not in malignant hypoxic tumors. 90% hypoxia will be detectable by FO with specificity 99%. Our method will be tested on R3230 tumors in Fischer rats at UCI.

Late course accelerated fractionation in radiotherapy of esophageal carcinoma

International Nuclear Information System (INIS)

Shi, X.-H.; Yao, W.; Liu, T.

1999-01-01

Purpose: To evaluate the efficacy of adding accelerated fractionation after completing two thirds of routine fractionated radiotherapy in esophageal carcinoma.Methods and materials: From April 1988 to April 1990, 85 patients with histologically confirmed carcinoma of the esophagus were randomized into two groups. (1) The conventional fractionation (CF) group, received 1.8 Gy per day five times a week to a total dose of 68.4 Gy in 7-8 weeks, and (2) the late course accelerated hyperfractionated (LCAF) group which received the same schedule as the CF group during the first two thirds of the course of radiotherapy to a dose of 41.4 Gy/23 fx/4 to 5 weeks. This was then followed by accelerated hyperfractionation using reduced fields. In the LCAF portion of the radiotherapeutic course, the irradiation schedule was changed to 1.5 Gy twice a day, with an interval of 4 h between fractions, to a dose of 27 Gy/18 fx. Thus the total dose was also 68.4 Gy, the same as the CF group, but the course of radiotherapy was shorter, being only 6.4 weeks. The same Cobalt 60 teletherapy unit was used to treat all the cases.Results: The 5 year actuarial survival and disease-free survival rates in the LCAF group were 34% and 42%, as compared to 15% and 15% respectively in the CF group, all statistically significant. Better local control was seen in the LCAF group than in the CF group, the 5 year control rates being 55% versus 21% (P=0.003). The acute reactions were increased but acceptable in the LCAF patients, the radiation treatments could be completed without any breaks. The late reactions as observed after 5 years were not increased in comparison with the CF patients.Conclusions: The results from this study show that the late course accelerated hyperfractionated radiotherapy regime can improve results in esophageal carcinoma, with acceptable acute reactions as compared to conventional radiotherapy. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

Clinical Experience With Image-Guided Radiotherapy in an Accelerated Partial Breast Intensity-Modulated Radiotherapy Protocol

International Nuclear Information System (INIS)

Leonard, Charles E.; Tallhamer, Michael M.S.; Johnson, Tim; Hunter, Kari C.M.D.; Howell, Kathryn; Kercher, Jane; Widener, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Carter, Dennis L.

2010-01-01

Purpose: To explore the feasibility of fiducial markers for the use of image-guided radiotherapy (IGRT) in an accelerated partial breast intensity modulated radiotherapy protocol. Methods and Materials: Nineteen patients consented to an institutional review board approved protocol of accelerated partial breast intensity-modulated radiotherapy with fiducial marker placement and treatment with IGRT. Patients (1 patient with bilateral breast cancer; 20 total breasts) underwent ultrasound guided implantation of three 1.2- x 3-mm gold markers placed around the surgical cavity. For each patient, table shifts (inferior/superior, right/left lateral, and anterior/posterior) and minimum, maximum, mean error with standard deviation were recorded for each of the 10 BID treatments. The dose contribution of daily orthogonal films was also examined. Results: All IGRT patients underwent successful marker placement. In all, 200 IGRT treatment sessions were performed. The average vector displacement was 4 mm (range, 2-7 mm). The average superior/inferior shift was 2 mm (range, 0-5 mm), the average lateral shift was 2 mm (range, 1-4 mm), and the average anterior/posterior shift was 3 mm (range, 1 5 mm). Conclusions: This study shows that the use of IGRT can be successfully used in an accelerated partial breast intensity-modulated radiotherapy protocol. The authors believe that this technique has increased daily treatment accuracy and permitted reduction in the margin added to the clinical target volume to form the planning target volume.

Accelerated Deformable Registration of Repetitive MRI during Radiotherapy in Cervical Cancer

DEFF Research Database (Denmark)

Noe, Karsten Østergaard; Tanderup, Kari; Kiritsis, Christian

2006-01-01

Tumour regression and organ deformations during radiotherapy (RT) of cervical cancer represent major challenges regarding accurate conformation and calculation of dose when using image-guided adaptive radiotherapy. Deformable registration algorithms are able to handle organ deformations, which can...... be useful with advanced tools such as auto segmentation of organs and dynamic adaptation of radiotherapy. The aim of this study was to accelerate and validate deformable registration in MRI-based image-guided radiotherapy of cervical cancer.    ...

Clinical study of 89Sr therapy with radiosensitization by nicotinamide and carbogen in multiple bone metastasis of malignant neoplasms

International Nuclear Information System (INIS)

Liu Yajie; Wang Shubin; Guo Yiling; Chen Zuowei; Zhang Yingnan

2005-01-01

Objective: To evaluate the curative effect and side effects of 89 Sr therapy with radiosensitization by nicotinamide and carbogen in multiple bone metastasis of malignant neoplasms. Methods: Ninety-seven patients were divided into 4 groups respectively: group A, 89 Sr + nicotinamide + carbogen (24 patients); group B, 89 Sr + nicotinamide(22 patients); group C, 89 Sr + carbogen (25 patients); group D, 89 Sr, (26 patients). 89 SrCl was intravenously injected at a dose of 1.48-2.22 MBq/kg. Nicotinamide was taken orally 1 hour before 89 SrCl injection, 6 g/day, tid, d1-d5. Aspiration of carbogen(95%O 2 + 5%CO 2 ) gases, 6 L/min, 10 minutes, qd, d1-d5. Results: The effective rate of pain control and QOL improvement in A group were higher than in groups B, C and D (91.7% VS 77.3%, 76.0% and 69.2%, P=0.048). The lesions assessed by SPECT imaging in every group was not significantly different at three months after treatment. I to II degree toxic effect on bone marrow appeared in every group and there were no significantly inter-group differences. Conclusions: Combinative therapy using 89 Sr + nicotinamide + carbogen is more effective to treat multiple metastatic bone pain and for improvement of QOL. The side effects are not increased. (authors)

Adult and newborn rat inner retinal oxygenation during carbogen and 100% oxygen breathing. Comparison using magnetic resonance imaging delta Po2 mapping.

Science.gov (United States)

Berkowitz, B A

1996-09-01

To test the hypothesis that breathing carbogen (95% O2-5% CO2) oxygenates the inner retina better than breathing 100% oxygen using an magnetic resonance imaging (MRI) method that noninvasively measures inner retinal oxygenation in normal adult and newborn rats. Urethane-anesthetized adult and newborn (day 18) rats were studied. Sequential images were acquired in room air combined with either 100% oxygen or carbogen breathing. Normalized vitreous signal intensity changes were converted to oxygen tension changes (delta PO2) either on a pixel-by-pixel basis or in specific regions of interest. Systemic levels of hyperoxia during carbogen or 100% oxygen breathing were not significantly different (P > 0.05). In the adult rat, a significant difference (P = 0.017) was found in the preretinal vitreous delta PO2 during the breathing of either carbogen (130 +/- 9 mm Hg, mean +/- SEM; n = 5) or 100% oxygen (88 +/- 16 mm Hg; n = 5). Agreement was found between the MRI-determined delta PO2 values and literature oxygen microelectrodes data. In the newborn rat, significant differences (P delta PO2 were found during carbogen (164 +/- 23 mm Hg; n = 3) and oxygen breathing (91 +/- 8 mm Hg; n = 3). MRI delta PO2 mapping demonstrated for the first time that in the normal adult and newborn rat eye, carbogen breathing oxygenates the inner retina better than 100% oxygen breathing.

Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme

Energy Technology Data Exchange (ETDEWEB)

Guckenberger, Matthias; Mayer, Mario; Sweeney, Reinhart A.; Flentje, Michael [University Hospital Wuerzburg (Germany). Dept. of Radiation Oncology; Buttmann, Mathias [University Hospital Wuerzburg (Germany). Dept. of Neurology; Vince, Giles H. [University Hospital Wuerzburg (Germany). Dept. of Neurosurgery

2011-09-15

The goal of this study was to evaluate accelerated radiotherapy with and without temozolomide (TMZ) for glioblastoma multiforme (GBM). This retrospective analysis evaluated 86 patients with histologically proven GBM who were treated with accelerated radiotherapy of 1.8 Gy twice daily to a total dose of 54 Gy within 3 weeks. Median age was 62 years and median Karnofsky index was 90. A total of 41 patients received radiotherapy only from 2002-2005 and 45 patients were treated with TMZ concomitantly and after radiotherapy from 2005-2007. Median overall survival (OS) was 12.5 months and 2-year OS was 15.4%. Patient characteristics were well balanced between the two groups except for better performance status (p = 0.05) and higher frequency of retreatment for the first recurrence (p = 0.02) in the TMZ group. Age at diagnosis (HR 2.83) and treatment with TMZ (HR 0.60) were correlated with OS in the multivariate analysis: treatment with and without TMZ resulted in median OS of 16 months and 11.3 months, respectively. Hematological toxicity grade > II was observed in 2/45 patients and 5/37 patients during simultaneous radiochemotherapy and adjuvant TMZ. TMZ added to accelerated radiotherapy for GBM resulted in prolonged overall survival with low rates of severe hematological toxicity. (orig.)

Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme

International Nuclear Information System (INIS)

Guckenberger, Matthias; Mayer, Mario; Sweeney, Reinhart A.; Flentje, Michael; Buttmann, Mathias; Vince, Giles H.

2011-01-01

The goal of this study was to evaluate accelerated radiotherapy with and without temozolomide (TMZ) for glioblastoma multiforme (GBM). This retrospective analysis evaluated 86 patients with histologically proven GBM who were treated with accelerated radiotherapy of 1.8 Gy twice daily to a total dose of 54 Gy within 3 weeks. Median age was 62 years and median Karnofsky index was 90. A total of 41 patients received radiotherapy only from 2002-2005 and 45 patients were treated with TMZ concomitantly and after radiotherapy from 2005-2007. Median overall survival (OS) was 12.5 months and 2-year OS was 15.4%. Patient characteristics were well balanced between the two groups except for better performance status (p = 0.05) and higher frequency of retreatment for the first recurrence (p = 0.02) in the TMZ group. Age at diagnosis (HR 2.83) and treatment with TMZ (HR 0.60) were correlated with OS in the multivariate analysis: treatment with and without TMZ resulted in median OS of 16 months and 11.3 months, respectively. Hematological toxicity grade > II was observed in 2/45 patients and 5/37 patients during simultaneous radiochemotherapy and adjuvant TMZ. TMZ added to accelerated radiotherapy for GBM resulted in prolonged overall survival with low rates of severe hematological toxicity. (orig.)

Evaluation and Immunohistochemical Qualification of Carbogen-Induced ΔR{sub 2}* as a Noninvasive Imaging Biomarker of Improved Tumor Oxygenation

Energy Technology Data Exchange (ETDEWEB)

Baker, Lauren C.J., E-mail: lauren.baker@icr.ac.uk [Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey (United Kingdom); Boult, Jessica K.R.; Jamin, Yann; Gilmour, Lesley D.; Walker-Samuel, Simon; Burrell, Jake S. [Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey (United Kingdom); Ashcroft, Margaret [Division of Medicine, Centre for Cell Signalling and Molecular Genetics, University College London, London (United Kingdom); Howe, Franklyn A. [St. George' s, University of London, London (United Kingdom); Griffiths, John R. [Cancer Research UK Cambridge Institute, Cambridge (United Kingdom); Raleigh, James A. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Kogel, Albert J. van der [University of Nijmegen Medical Centre, Nijmegen (Netherlands); Robinson, Simon P. [Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey (United Kingdom)

2013-09-01

Purpose: To evaluate and histologically qualify carbogen-induced ΔR{sub 2}* as a noninvasive magnetic resonance imaging biomarker of improved tumor oxygenation using a double 2-nitroimidazole hypoxia marker approach. Methods and Materials: Multigradient echo images were acquired from mice bearing GH3 prolactinomas, preadministered with the hypoxia marker CCI-103F, to quantify tumor R{sub 2}* during air breathing. With the mouse remaining positioned within the magnet bore, the gas supply was switched to carbogen (95% O{sub 2}, 5% CO{sub 2}), during which a second hypoxia marker, pimonidazole, was administered via an intraperitoneal line, and an additional set of identical multigradient echo images acquired to quantify any changes in tumor R{sub 2}*. Hypoxic fraction was quantified histologically using immunofluorescence detection of CCI-103F and pimonidazole adduct formation from the same whole tumor section. Carbogen-induced changes in tumor pO{sub 2} were further validated using the Oxylite fiberoptic probe. Results: Carbogen challenge significantly reduced mean tumor R{sub 2}* from 116 ± 13 s{sup −1} to 97 ± 9 s{sup −1} (P<.05). This was associated with a significantly lower pimonidazole adduct area (2.3 ± 1%), compared with CCI-103F (6.3 ± 2%) (P<.05). A significant correlation was observed between ΔR{sub 2}* and Δhypoxic fraction (r=0.55, P<.01). Mean tumor pO{sub 2} during carbogen breathing significantly increased from 6.3 ± 2.2 mm Hg to 36.0 ± 7.5 mm Hg (P<.01). Conclusions: The combined use of intrinsic susceptibility magnetic resonance imaging with a double hypoxia marker approach corroborates carbogen-induced ΔR{sub 2}* as a noninvasive imaging biomarker of increased tumor oxygenation.

Carbogen Breathing Differentially Enhances Blood Plasma Volume and 5-Fluorouracil Uptake in Two Murine Colon Tumor Models with a Distinct Vascular Structure

Directory of Open Access Journals (Sweden)

Hanneke W.M. van Laarhoven

2006-06-01

Full Text Available For the systemic treatment of colorectal cancer, 5-fluorouracil (FU-based chemotherapy is the standard. However, only a subset of patients responds to chemotherapy. Breathing of carbogen (95% O2 and 5% CO2 may increase the uptake of FU through changes in tumor physiology. This study aims to monitor in animal models in vivo the effects of carbogen breathing on tumor blood plasma volume, pH, and energy status, and on FU uptake and metabolism in two colon tumor models C38 and C26a, which differ in their vascular structure and hypoxic status. Phosphorus-31 magnetic resonance spectroscopy (MRS was used to assess tumor pH and energy status, and fluorine-19 MRS was used to follow FU uptake and metabolism. Advanced magnetic resonance imaging methods using ultrasmall particles of iron oxide were performed to assess blood plasma volume. The results showed that carbogen breathing significantly decreased extracellular pH and increased tumor blood plasma volume and FU uptake in tumors. These effects were most significant in the C38 tumor line, which has the largest relative vascular area. In the C26a tumor line, carbogen breathing increased tumor growth delay by FU. In this study, carbogen breathing also enhanced systemic toxicity by FU.

Temporal variation in the response of tumors to hyperoxia with breathing carbogen and oxygen

Science.gov (United States)

Hou, Hua-gang; Khan, Nadeem; Du, Gai-xin; Hodge, Sassan; Swartz, Harold M.

2016-01-01

The effect of hyperoxygenation with carbogen (95% O2 + 5% CO2) and 100% oxygen inhalation on partial pressure of oxygen (pO2) of radiation-induced fibrosarcoma (RIF-1) tumor was investigated. RIF-1 tumors were innoculated in C3H mice, and aggregates of oximetry probe, lithium phthalocyanine (LiPc), was implanted in each tumor. A baseline tumor pO2 was measured by electron paramagnetic resonance (EPR) oximetry for 20 minutes in anesthetized mice breathing 30% O2 and then the gas was switched to carbogen or 100 % oxygen for 60 minutes. These experiments were repeated for 10 days. RIF-1 tumors were hypoxic with a baseline tissue pO2 of 6.2–8.3 mmHg in mice breathing 30% O2. Carbogen and 100% oxygen significantly increased tumor pO2 on days 1 to 5, with a maximal increase at approximately 32–45 minutes on each day. However, the extent of increase in pO2 from the baseline declined significantly on day 5 and day 10. The results provide quantitative information on the effect of hyperoxic gas inhalation on tumor pO2 over the course of 10 days. EPR oximetry can be effectively used to repeatedly monitor tumor pO2 and test hyperoxic methods for potential clinical applications. PMID:27867481

Temporal variation in the response of tumors to hyperoxia with breathing carbogen and oxygen

Directory of Open Access Journals (Sweden)

Hua-gang Hou

2016-01-01

Full Text Available The effect of hyperoxygenation with carbogen (95% O 2 + 5% CO 2 and 100% oxygen inhalation on partial pressure of oxygen (pO 2 of radiation-induced fibrosarcoma (RIF-1 tumor was investigated. RIF-1 tumors were innoculated in C3H mice, and aggregates of oximetry probe, lithium phthalocyanine (LiPc, was implanted in each tumor. A baseline tumor pO 2 was measured by electron paramagnetic resonance (EPR oximetry for 20 minutes in anesthetized mice breathing 30% O 2 and then the gas was switched to carbogen or 100 % oxygen for 60 minutes. These experiments were repeated for 10 days. RIF-1 tumors were hypoxic with a baseline tissue pO 2 of 6.2-8.3 mmHg in mice breathing 30% O 2 . Carbogen and 100% oxygen significantly increased tumor pO 2 on days 1 to 5, with a maximal increase at approximately 32-45 minutes on each day. However, the extent of increase in pO 2 from the baseline declined significantly on day 5 and day 10. The results provide quantitative information on the effect of hyperoxic gas inhalation on tumor pO 2 over the course of 10 days. EPR oximetry can be effectively used to repeatedly monitor tumor pO 2 and test hyperoxic methods for potential clinical applications.

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)

The HYP-RT Hypoxic Tumour Radiotherapy Algorithm and Accelerated Repopulation Dose per Fraction Study

Directory of Open Access Journals (Sweden)

W. M. Harriss-Phillips

2012-01-01

Full Text Available The HYP-RT model simulates hypoxic tumour growth for head and neck cancer as well as radiotherapy and the effects of accelerated repopulation and reoxygenation. This report outlines algorithm design, parameterisation and the impact of accelerated repopulation on the increase in dose/fraction needed to control the extra cell propagation during accelerated repopulation. Cell kill probabilities are based on Linear Quadratic theory, with oxygenation levels and proliferative capacity influencing cell death. Hypoxia is modelled through oxygen level allocation based on pO2 histograms. Accelerated repopulation is modelled by increasing the stem cell symmetrical division probability, while the process of reoxygenation utilises randomised pO2 increments to the cell population after each treatment fraction. Propagation of 108 tumour cells requires 5–30 minutes. Controlling the extra cell growth induced by accelerated repopulation requires a dose/fraction increase of 0.5–1.0 Gy, in agreement with published reports. The average reoxygenation pO2 increment of 3 mmHg per fraction results in full tumour reoxygenation after shrinkage to approximately 1 mm. HYP-RT is a computationally efficient model simulating tumour growth and radiotherapy, incorporating accelerated repopulation and reoxygenation. It may be used to explore cell kill outcomes during radiotherapy while varying key radiobiological and tumour specific parameters, such as the degree of hypoxia.

Commercial Prospect of Hadronic Radiotherapy Using Ion Accelerator in Indonesia

International Nuclear Information System (INIS)

Kunto-Wiharto; N-Supriana; R-Susworo; G-Suyitno

2000-01-01

In order to anticipate the construction of accelerator based laboratory of which one of its applications is for radiotherapy of cancer patients at Research and Development Center for Advanced Technology belonging to National Nuclear Energy Agency, Yogyakarta, in the next 7th. Five Year Development Plan (Repelita VII), it is considered important to perform a study on its commercial prospect. It is found, through calculations based on the available data and realistic assumptions, that patients from neighboring countries are needed to make the operation of radiotherapy facility effective and efficient. (author)

Effectiveness of perfluorochemical emulsions and carbogen breathing with fractionated irradiation

International Nuclear Information System (INIS)

Moulder, J.E.; Fish, B.L.

1987-01-01

Oxygen-carrying perfluorochemical emulsions have been shown to enhance the response of experimental tumors to large single doses of radiation. Clinically, however, perfluorochemical emulsions will be used with only some fractions of multiple fraction radiation courses. To test the efficacy of a perfluorochemical emulsion (Fluosol-DA 20%, supplied by Alpha Therapeutic Co) under these conditions, BA1112 rat sarcomas were treated with three fractions/week of 6.25 Gy/fraction. Once a week, animals were given Fluosol-DA at 15 ml/kg, and allowed to breathe 95% O/sub 2/:5% CO/sub 2/ (carbogen) for 30 min prior to and during irradiation. The tumor regression rate during treatment was significantly greater in the Fluosol arm than in the control arm. Preliminary data analysis shows a 50% tumor control dose of 86.0 Gy (95% cl:78.0 - 94.3 Gy) in the control arm compared to 69.1 Gy (95% cl:58.3 - 77.3 Gy) in the Fluosol arm. The dose modification factor for intermittent Fluosol and carbogen breathing is 1.26 (95% cl:1.08 - 1.50). In the same fractionated schedule 0.4 mg/kg misonidazole, given once per week, gave a sensitizer enhancement ratio of 1.15 (95% cl:1.03 - 1.33)

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.

Linear accelerator Dynaray-CH: a central component of the BBC radiotherapy system

International Nuclear Information System (INIS)

Vogt, H.

1983-01-01

The author describes the newly developed range of linear accelerators Dynaray-CH 4 to 20. These modern installations for radiotherapy are used to generate photon and electron beams. The accelerators employ the proven BBC control system PROCONTIC (registered trademark), innovatory systems for movement control and actual-value display as well as the new radiation monitor system. (Auth.)

BOLD contrast fMRI of whole rodent tumour during air or carbogen breathing using echo-planar imaging at 1.5 T

International Nuclear Information System (INIS)

Landuyt, W.; Bogaert, W. van den; Lambin, P.; Hermans, R.; Bosmans, H.; Sunaert, S.; Beatse, E.; Farina, D.; Meijerink, M.; Zhang, H.; Marchal, G.

2001-01-01

The aim of this study was to evaluate the feasibility of functional MR imaging (fMRI) at 1.5 T, exploiting blood oxygenation level-dependent (BOLD) contrast, for detecting changes in whole-tumour oxygenation induced by carbogen (5% CO 2 +95% O 2 ) inhalation of the host. Adult WAG/Rij rats with rhabdomyosarcomas growing subcutaneously in the lower flank were imaged when tumours reached sizes between 1 and 11 cm 3 (n=12). Air and carbogen were alternatively supplied at 2 l/min using a snout mask. Imaging was done on a 1.5-T MR scanner using a T2*-weighted gradient-echo, echo-planar imaging (GE-EPI) sequence. Analysis of the whole-tumour EPI images was based on statistical parametric maps. Voxels with and without signal intensity changes (SIC) were recorded. Significance thresholds were set at p<0.05, corrected for multiple comparisons. In continuous air breathing condition, 3 of 12 tumours showed significant negative SIC and 1 tumour had a clear-cut positive SIC. The remaining tumours showed very little or no change. When switching to carbogen breathing, the SIC were significantly positive in 10 of 12 tumours. Negative SIC were present in 4 tumours, of which three were simultaneously characterised by positive SIC. The overall analysis indicated that 6 of the 12 tumours could be considered as strong positive responders to carbogen. Our research demonstrates the applicability of fMRI GE-EPI at 1.5 T to study whole-tumour oxygenation non-invasively. The observed negative SIC during air condition may reflect the presence of transient hypoxia during these measurements. Selection of tumours on the basis of their individual response to carbogen is possible, indicating a role of such non-invasive measurements for using tailor-made treatments. (orig.)

Parotid gland function following accelerated and conventionally fractionated radiotherapy

International Nuclear Information System (INIS)

Leslie, M.D.; Dische, S.

1991-01-01

The function of parotid glands in patients treated by 3 different schedules of radiotherapy was studied 9 months or more after its conclusion. All had received radiotherapy for a malignancy confined to 1 side of the head and neck region and only the gland on the side of the lesion was in the treatment volume; the contralateral gland acted as an internal control. Saliva was selectively collected from the parotid glands and the stimulated flow rate and pH of the saliva determined. Flow rates were expressed in each case as a percentage of that of the contralateral ('untreated') gland. Twelve glands that had received conventionally fractionated radiotherapy to a dose of 60-66 Gy showed a mean percentage flow of 20 percent and a significant fall in the pH of the saliva produced. Six glands that had received CHART (Continuous Hyperfractionated Accelerated RadioTherapy) and 8 conventionally fractionated radiotherapy to a dose of 35-40 Gy showed mean percentage flows of 57 and 65 percent respectively, with only slight and non-significant falls in saliva pH. The results show that in the treatment of squamous cell carcinoma in the head and neck the use of CHART can lead to considerable less late change in the function of the parotid gland. (author). 26 refs.; 5 figs.; 2 tabs

Monitoring Oxygen Levels in Orthotopic Human Glioma Xenograft Following Carbogen Inhalation and Chemotherapy by Implantable Resonator Based Oximetry

Science.gov (United States)

Hou, Huagang; Nemani, Venkata Krishnamurthy; Du, Gaixin; Montano, Ryan; Song, Rui; Gimi, Barjor; Swartz, Harold M.; Eastman, Alan; Khan, Nadeem

2014-01-01

Hypoxia is a critical hallmark of glioma, and significantly compromises treatment efficacy. Unfortunately, techniques for monitoring glioma pO2 to facilitate translational research are lacking. Furthermore, poor prognoses of patients with malignant glioma, in particular glioblastoma multiforme, warrant effective strategies that can inhibit hypoxia and improve treatment outcome. EPR oximetry using implantable resonators was implemented for monitoring pO2 in normal cerebral tissue and U251 glioma in mice. Breathing carbogen (95% O2 + 5% CO2) was tested for hyperoxia in the normal brain and glioma xenografts. A new strategy to inhibit glioma growth by rationally combining gemcitabine and MK-8776, a cell cycle checkpoint inhibitor, was also investigated. The mean pO2 of left and right hemisphere were approximately 56 – 69 mmHg in the normal cerebral tissue of mice. The mean baseline pO2 of U251 glioma on the first and fifth day of measurement was 21.9 ± 3.7 and 14.1 ± 2.4 mmHg, respectively. The mean brain pO2 including glioma increased by at least 100% on carbogen inhalation, although the response varied between the animals over days. Treatment with gemcitabine + MK-8776 significantly increased pO2 and inhibited glioma growth assessed by MRI. In conclusion, EPR oximetry with implantable resonators can be used to monitor the efficacy of carbogen inhalation and chemotherapy on orthotopic glioma in mice. The increase in glioma pO2 of mice breathing carbogen can be used to improve treatment outcome. The treatment with gemcitabine + MK-8776 is a promising strategy that warrants further investigation. PMID:25111969

Monitoring oxygen levels in orthotopic human glioma xenograft following carbogen inhalation and chemotherapy by implantable resonator-based oximetry.

Science.gov (United States)

Hou, Huagang; Krishnamurthy Nemani, Venkata; Du, Gaixin; Montano, Ryan; Song, Rui; Gimi, Barjor; Swartz, Harold M; Eastman, Alan; Khan, Nadeem

2015-04-01

Hypoxia is a critical hallmark of glioma, and significantly compromises treatment efficacy. Unfortunately, techniques for monitoring glioma pO2 to facilitate translational research are lacking. Furthermore, poor prognosis of patients with malignant glioma, in particular glioblastoma multiforme, warrant effective strategies that can inhibit hypoxia and improve treatment outcome. EPR oximetry using implantable resonators was implemented for monitoring pO2 in normal cerebral tissue and U251 glioma in mice. Breathing carbogen (95% O2 + 5% CO2 ) was tested for hyperoxia in the normal brain and glioma xenografts. A new strategy to inhibit glioma growth by rationally combining gemcitabine and MK-8776, a cell cycle checkpoint inhibitor, was also investigated. The mean pO2 of left and right hemisphere were ∼56-69 mmHg in the normal cerebral tissue of mice. The mean baseline pO2 of U251 glioma on the first and fifth day of measurement was 21.9 ± 3.7 and 14.1 ± 2.4 mmHg, respectively. The mean brain pO2 including glioma increased by at least 100% on carbogen inhalation, although the response varied between the animals over days. Treatment with gemcitabine + MK-8776 significantly increased pO2 and inhibited glioma growth assessed by MRI. In conclusion, EPR oximetry with implantable resonators can be used to monitor the efficacy of carbogen inhalation and chemotherapy on orthotopic glioma in mice. The increase in glioma pO2 of mice breathing carbogen can be used to improve treatment outcome. The treatment with gemcitabine + MK-8776 is a promising strategy that warrants further investigation. © 2014 UICC.

Novel applications of particle accelerators to radiotherapy

International Nuclear Information System (INIS)

Kreiner, A.J.; Burlon, A.A.; Universidad Nacional de San Martin, Villa Ballester

2002-01-01

Charged hadrons (protons and heavier ions) have very definite advantages over photons as far as radiotherapy applications are concerned. They allow for much better spatial dose localization due to their charge, relatively high mass and nature of the energy deposition process. In the frame of an attempt to promote the introduction of hadrontherapy in Argentina an external beam facility has been installed at our tandem accelerator TANDAR. The advantages of heavy ions can only be fully exploited for tumors of well defined localization. In certain types of malignancies, however, the region infiltrated by tumor cells is diffuse, with no sharp boundaries and with microscopic ramifications. In such cases (particularly in certain brain cancers) a more sophisticated scheme has been suggested called boron neutron capture therapy (BNCT). In this work, the use of the Tandar accelerator to produce neutrons for feasibility studies for BNCT through low-energy proton beams on a thick LiF target is being briefly described. Studies on the 13 C(d,n) reaction and a comparison with other neutron-producing reactions are also mentioned. Simulation work to optimize an accelerator-based neutron production target is discussed. A project is being prepared to develop a small proton accelerator in Argentina. Technical specifications of this machine are briefly discussed. (author)

Assessment of long-term quality of life of esophageal carcinoma patients treated with continuous accelerated hyperfractionated and late-course accelerated hyperfractionated radiotherapy

International Nuclear Information System (INIS)

Wang Yang; He Shaoqin; Shi Xuehui; Jiang Kaida; Yao Weiqiang; Wang Ying

2002-01-01

Objective: To compare the long-term quality of life in esophageal carcinoma patients treated with continuous accelerated hyperfractionated (CAHF) and late-course accelerated hyperfractionated (LCAF) radiotherapy. Methods: Subjective and Objective Management Analysis (SOMA) scale, Symptom Checklist 90 (SCL-90) and Life Satisfaction Index A (LSIA) questionnaire were mailed to the long survivors in both CAHF and LCAF groups to assess the long-term quality of life including symptoms, psychological status and life satisfaction. Results: There was no significant difference between the two groups in the score of quality of life such as late radiation reaction, SCL-90 and LSI-A. Conclusions: 1. It is reasonable to assess the quality of life with these scales for esophageal carcinoma patients treated with radiotherapy, 2. Preliminary results demonstrate that there is no significant difference in long-term quality of life between the CAHF and LCAF radiotherapy groups, 3. Methods of evaluating the long-term quality of life for esophageal carcinoma patients treated with radiotherapy needs further investigation, preferably involving more patients and setting on control arm

TLD Intercomparison in accelerators for radiotherapy in three Latin american countries

International Nuclear Information System (INIS)

Gaona, E.; Azorin N, J.; Perez, M.A.; Picon, C.; Castellanos, E.; Plazas, M.C.; Murcia, G.; Archundia, L.

1998-01-01

In Radiotherapy one of the objectives is to establish and to give follow up to quality assurance programs which make sure that the doses administered to the patients with cancer are a high probability of a success in external radiation. Likewise, one of the present preoccupations of the United Nations Agencies as well as the International Atomic Energy Agency and the Pan-American Health Organization is the optimal employment of the radiations in the treatment of cancer patients since the administered dose in Radiotherapy suffers considerable variations by the lack of quality assurance programs. The use of Electron linear accelerators requires a program of quality assurance that includes expert personnel, equipment and adequate facilities. The more used methodology for the dosimetry calibration and characterization of X-ray beams and high energy electrons for radiotherapy use is using a ionization chamber dosemeter calibrated in a regional secondary standardization laboratory. However, to establish and give follow up to the quality assurance programs it is necessary the dosimetric intercomparison through TLD. In this study it was designed plastic phantoms with TLD crystals and it was made its characterization to realize an absorbed dose analysis in the crystals exposed at X-ray beams 6 MV and high energy electrons 10 and 12 MeV to standardize the dosimetric procedures and proceeding to realize an International Pilot intercomparison of absorbed doses in TLD crystals in three Latin American countries: Mexico, Peru and Colombia with the participation of accelerators of five different institutions. The found results show that the majority of the measured doses with TLD in the different accelerators were in the 0.95-1.05 range though it had two cases outside of this range. The use of the phantoms with TLD crystals shows that they are of excellent aid to make analysis of the doses administered to the patients and an intercomparison of results to standardize procedures at

Concurrent radiotherapy and carboplatin in non small-cell lung cancer: a pilot study using conventional and accelerated fractionation

International Nuclear Information System (INIS)

Ball, D.; Bishop, J.; Crennan, E.; Olver, I.

1991-01-01

Thirteen patients with unresectable non small cell lung cancer were treated with radical radiotherapy and carboplatin administered in order to ascertain the toxicity of concurent carboplatin/radiotherapy. The first 6 patients were treated to a total dose of 60 Gy in 30 fractions in 6 weeks, with carboplatin 70 mg/m 2 /day on days 1 to 5 during weeks 1 and 5 of radiotherapy. The remaining 7 patients were given 60 Gy in 30 fractions in 3 weeks, treating twice a day (accelerated fractionation). Carboplatin was given as above but only during week 1 of radiotherapy. Twelve patients completed radiotherapy without interruption but 2 patients developed grade 3 neutropenia. Major toxicity was oesophagitis, one patient requiring nasogastric feeding. Average duration of dysphagia (any grade) in the accelerated fractionation group was 21 weeks. Four patients achieved good partial responses even though initial tumour volume was large. It is concluded that this treatment is associated with increased but acceptable early mucosal toxicity. 6 refs., 1 tab., 1 fig

WE-G-BRD-09: Novel MRI Compatible Electron Accelerator for MRI-Linac Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Whelan, B; Keall, P [University of Sydney, Sydney (Australia); Gierman, S; Schmerge, J [SLAC National Accelerator Laboratory, Palo Alto, CA (United States); Holloway, L [Ingham Institute, Sydney, NSW (Australia); Fahrig, R [Stanford University, Stanford, CA (United States)

2015-06-15

Purpose: MRI guided radiotherapy is a rapidly growing field; however current linacs are not designed to operate in MRI fringe fields. As such, current MRI- Linac systems require magnetic shielding, impairing MR image quality and system flexibility. Here, we present a bespoke electron accelerator concept with robust operation in in-line magnetic fields. Methods: For in-line MRI-Linac systems, electron gun performance is the major constraint on accelerator performance. To overcome this, we propose placing a cathode directly within the first accelerating cavity. Such a configuration is used extensively in high energy particle physics, but not previously for radiotherapy. Benchmarked computational modelling (CST, Darmstadt, Germany) was employed to design and assess a 5.5 cell side coupled accelerator with a temperature limited thermionic cathode in the first accelerating cell. This simulation was coupled to magnetic fields from a 1T MRI model to assess robustness in magnetic fields for Source to Isocenter Distance between 1 and 2 meters. Performance was compared to a conventional electron gun based system in the same magnetic field. Results: A temperature limited cathode (work function 1.8eV, temperature 1245K, emission constant 60A/K/cm{sup 2}) will emit a mean current density of 24mA/mm{sup 2} (Richardson’s Law). We modeled a circular cathode with radius 2mm and mean current 300mA. Capture efficiency of the device was 43%, resulting in target current of 130 mA. The electron beam had a FWHM of 0.2mm, and mean energy of 5.9MeV (interquartile spread of 0.1MeV). Such an electron beam is suitable for radiotherapy, comparing favourably to conventional systems. This model was robust to operation the MRI fringe field, with a maximum current loss of 6% compared to 85% for the conventional system. Conclusion: The bespoke electron accelerator is robust to operation in in-line magnetic fields. This will enable MRI-Linacs with no accelerator magnetic shielding, and minimise

Monte Carlo based simulation of LIAC intraoperative radiotherapy accelerator along with beam shaper applicator

Directory of Open Access Journals (Sweden)

N Heidarloo

2017-08-01

Full Text Available Intraoperative electron radiotherapy is one of the radiotherapy methods that delivers a high single fraction of radiation dose to the patient in one session during the surgery. Beam shaper applicator is one of the applicators that is recently employed with this radiotherapy method. This applicator has a considerable application in treatment of large tumors. In this study, the dosimetric characteristics of the electron beam produced by LIAC intraoperative radiotherapy accelerator in conjunction with this applicator have been evaluated through Monte Carlo simulation by MCNP code. The results showed that the electron beam produced by the beam shaper applicator would have the desirable dosimetric characteristics, so that the mentioned applicator can be considered for clinical purposes. Furthermore, the good agreement between the results of simulation and practical dosimetry, confirms the applicability of Monte Carlo method in determining the dosimetric parameters of electron beam  intraoperative radiotherapy

On the Detectability of Acoustic Waves Induced Following Irradiation by a Radiotherapy Linear Accelerator.

Science.gov (United States)

Hickling, Susannah; Leger, Pierre; El Naqa, Issam

2016-02-11

Irradiating an object with a megavoltage photon beam generated by a clinical radiotherapy linear accelerator (linac) induces acoustic waves through the photoacoustic effect. The detection and characterization of such acoustic waves has potential applications in radiation therapy dosimetry. The purpose of this work was to gain insight into the properties of such acoustic waves by simulating and experimentally detecting them in a well-defined system consisting of a metal block suspended in a water tank. A novel simulation workflow was developed by combining radiotherapy Monte Carlo and acoustic wave transport simulation techniques. Different set-up parameters such as photon beam energy, metal block depth, metal block width, and metal block material were varied, and the simulated and experimental acoustic waveforms showed the same relative amplitude trends and frequency variations for such setup changes. The simulation platform developed in this work can easily be extended to other irradiation situations, and will be an invaluable tool for developing a radiotherapy dosimetry system based on the detection of the acoustic waves induced following linear accelerator irradiation.

Dose characteristics of in-house-built collimators for stereotactic radiotherapy with a linear accelerator

International Nuclear Information System (INIS)

Norrgaard, F. Stefan E.; Kulmala, Jarmo A.J.; Minn, Heikki R.I.; Sipilae, Petri M.

1998-01-01

Dose characteristics of a stereotactic radiotherapy unit based on a standard Varian Clinac 4/100 4 MV linear accelerator, in-house-built Lipowitz collimators and the SMART stereotactic radiotherapy treatment planning software have been determined. Beam collimation is constituted from the standard collimators of the linear accelerator and a tertiary collimation consisting of a replaceable divergent Lipowitz collimator. Four collimators with isocentre diameters of 15, 25, 35 and 45 mm, respectively, were constructed. Beam characteristics were measured in air, acrylic or water with ionization chamber, photon diode, electron diode, diamond detector and film. Monte Carlo simulation was also applied. The radiation leakage under the collimators was less than 1% at 50 mm depth in water. Specific beam characteristics for each collimator were imported to SMART and dose planning with five non-coplanar converging 140 deg. arcs separated by 36 deg. angles was performed for treatment of a RANDO phantom. Dose verification was made with TLD and radiochromic film. The in-house-built collimators were found to be suitable for stereotactic radiotherapy and patient treatments with this system are in progress. (author)

Monitoring Tumor Response to Carbogen Breathing by Oxygen-Sensitive Magnetic Resonance Parameters to Predict the Outcome of Radiation Therapy: A Preclinical Study

International Nuclear Information System (INIS)

Cao-Pham, Thanh-Trang; Tran, Ly-Binh-An; Colliez, Florence; Joudiou, Nicolas; El Bachiri, Sabrina; Grégoire, Vincent; Levêque, Philippe; Gallez, Bernard; Jordan, Bénédicte F.

2016-01-01

Purpose: In an effort to develop noninvasive in vivo methods for mapping tumor oxygenation, magnetic resonance (MR)-derived parameters are being considered, including global R_1, water R_1, lipids R_1, and R_2*. R_1 is sensitive to dissolved molecular oxygen, whereas R_2* is sensitive to blood oxygenation, detecting changes in dHb. This work compares global R_1, water R_1, lipids R_1, and R_2* with pO_2 assessed by electron paramagnetic resonance (EPR) oximetry, as potential markers of the outcome of radiation therapy (RT). Methods and Materials: R_1, R_2*, and EPR were performed on rhabdomyosarcoma and 9L-glioma tumor models, under air and carbogen breathing conditions (95% O_2, 5% CO_2). Because the models demonstrated different radiosensitivity properties toward carbogen, a growth delay (GD) assay was performed on the rhabdomyosarcoma model and a tumor control dose 50% (TCD50) was performed on the 9L-glioma model. Results: Magnetic resonance imaging oxygen-sensitive parameters detected the positive changes in oxygenation induced by carbogen within tumors. No consistent correlation was seen throughout the study between MR parameters and pO_2. Global and lipids R_1 were found to be correlated to pO_2 in the rhabdomyosarcoma model, whereas R_2* was found to be inversely correlated to pO_2 in the 9L-glioma model (P=.05 and .03). Carbogen increased the TCD50 of 9L-glioma but did not increase the GD of rhabdomyosarcoma. Only R_2* was predictive (P<.05) for the curability of 9L-glioma at 40 Gy, a dose that showed a difference in response to RT between carbogen and air-breathing groups. "1"8F-FAZA positron emission tomography imaging has been shown to be a predictive marker under the same conditions. Conclusion: This work illustrates the sensitivity of oxygen-sensitive R_1 and R_2* parameters to changes in tumor oxygenation. However, R_1 parameters showed limitations in terms of predicting the outcome of RT in the tumor models studied, whereas R_2* was found to be

A randomized study of accelerated fractionation radiotherapy with and without mitomycin C in the treatment of locally advanced head and neck cancer

DEFF Research Database (Denmark)

Ezzat, M.; Shouman, T.; Zaza, K.

2005-01-01

Objectives: This single-institution study evaluates the feasibility of accelerated fractionation radiotherapy (AF) with and without mitomycin C (MMC) in the treatment of locally advanced head and neck cancer. Patients and Methods: Between May 1998 and October 2001, sixty patients with locally...... advanced stage III and IV of head and neck cancer were randomized into three treatment arms: (1) conventional fractionation radiotherapy (CF) (5 fractions per week); (2) accelerated fractionation radiotherapy (AF) (6 fractions per week); and (3) AF plus Mitomycin C (MMC). Results: The 2-year overall....... Key Words: Head and Neck cancer , Radiotherapy , Altered fractionation , Mitomycin C....

Hyperfractionated chemoradiation with carbogen breathing, with or without erythropoietin: A stepwise developed treatment schedule for advanced head-and-neck cancer

International Nuclear Information System (INIS)

Martinez, Jose Carlos; Villar, Alfonso; Cabezon, Maria Auxiliadora; Serdio, Jose Luis de; Fuentes, Claudio; Espineira, Manuel; Perez, Maria Dolores; Gil, Jose; Artazkoz, Juan Jose; Borque, Carlos; Suner, Marcos; Saavedra, Juan Antonio

2001-01-01

Purpose: To investigate the influence of carbogen breathing on chemoradiation and the effects of erythropoietin on transfusions. Methods and Materials: From March 1996 to April 2000, 42 (4 Stage III and 38 Stage IV) patients with head and neck cancer were treated with a twice-a-day hyperfractionated schedule. Each fraction consisted of 5 mg/m 2 of carboplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days per week up to total doses of 350 mg/m 2 of carboplatin plus 8050 cGy in 7 weeks. Anemia was treated either by transfusion or by erythropoietin. Results: Forty-one patients tolerated the treatment as scheduled. All patients tolerated the planned radiation dose. Five transfusions were given in the first group, but no transfusion was needed in the erythropoietin group. Local toxicities remained at the level expected with irradiation alone. Chemotherapy toxicity was moderate. Forty-two complete responses were achieved. At two years actuarial local control, cause-specific survival and overall survival are respectively 85%, 69%, and 68%. At four years estimated probabilities of local control, cause-specific survival and overall survival are also 85%, 69%, and 68%. Conclusions: These results compare favorably with those of most reported studies. The addition of carbogen breathing appears to improve the results of chemoradiation alone. Erythropoietin therapy avoided transfusions

Physical-dosimetric enabling a dual linear accelerator 3D planning systems for radiotherapy

International Nuclear Information System (INIS)

Alfonso, Rodolfo; Martinez, William; Arelis, Lores; Morales, Jorge

2009-01-01

The process of commissioning clinical linear accelerator requires a dual comprehensive study of the therapeutic beam parameters, both photons Electron. All information gained by measuring physical and dosimetric these beams must be analyzed, processed and refined for further modeling in computer-based treatment planning (RTPS). Of professionalism of this process will depend on the accuracy and precision of the calculations the prescribed doses. This paper aims to demonstrate availability clinical linear accelerator system-RTPS with late radiotherapy treatments shaped beam of photons and electrons. (author)

Nicotinamide and carbogen: relationship between pO2 and radiosensitivity in three tumour lines

International Nuclear Information System (INIS)

Martin, L.M.; Thomas, C.D.; Guichard, M.

1994-01-01

The effects of carbogen breathing, nicotinamide injection and their combination on tumour radiosensitivity were correlated with changes in tumour O 2 tension to determine the relationship between radiosensitivity and measured pO 2 . The radiosensitivity (in vivo-in vitro colony assay) and O 2 tension (computerized pO 2 histograph KIMOC 6650) of two human xenografted tumours (HRT18 and NA11 +) and one murine tumour (EMT6) were measured under similar experimental conditions. (author)

Monitoring Tumor Response to Carbogen Breathing by Oxygen-Sensitive Magnetic Resonance Parameters to Predict the Outcome of Radiation Therapy: A Preclinical Study

Energy Technology Data Exchange (ETDEWEB)

Cao-Pham, Thanh-Trang; Tran, Ly-Binh-An; Colliez, Florence; Joudiou, Nicolas [Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels (Belgium); El Bachiri, Sabrina [Université Catholique de Louvain, IMMAQ Technological Platform, Methodology and Statistical Support, Louvain-la-Neuve (Belgium); Grégoire, Vincent [Université Catholique de Louvain, Institute of Experimental and Clinical Research, Center for Molecular Imaging, Radiotherapy and Oncology, Brussels (Belgium); Levêque, Philippe; Gallez, Bernard [Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels (Belgium); Jordan, Bénédicte F., E-mail: benedicte.jordan@uclouvain.be [Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels (Belgium)

2016-09-01

Purpose: In an effort to develop noninvasive in vivo methods for mapping tumor oxygenation, magnetic resonance (MR)-derived parameters are being considered, including global R{sub 1}, water R{sub 1}, lipids R{sub 1}, and R{sub 2}*. R{sub 1} is sensitive to dissolved molecular oxygen, whereas R{sub 2}* is sensitive to blood oxygenation, detecting changes in dHb. This work compares global R{sub 1}, water R{sub 1}, lipids R{sub 1}, and R{sub 2}* with pO{sub 2} assessed by electron paramagnetic resonance (EPR) oximetry, as potential markers of the outcome of radiation therapy (RT). Methods and Materials: R{sub 1}, R{sub 2}*, and EPR were performed on rhabdomyosarcoma and 9L-glioma tumor models, under air and carbogen breathing conditions (95% O{sub 2}, 5% CO{sub 2}). Because the models demonstrated different radiosensitivity properties toward carbogen, a growth delay (GD) assay was performed on the rhabdomyosarcoma model and a tumor control dose 50% (TCD50) was performed on the 9L-glioma model. Results: Magnetic resonance imaging oxygen-sensitive parameters detected the positive changes in oxygenation induced by carbogen within tumors. No consistent correlation was seen throughout the study between MR parameters and pO{sub 2}. Global and lipids R{sub 1} were found to be correlated to pO{sub 2} in the rhabdomyosarcoma model, whereas R{sub 2}* was found to be inversely correlated to pO{sub 2} in the 9L-glioma model (P=.05 and .03). Carbogen increased the TCD50 of 9L-glioma but did not increase the GD of rhabdomyosarcoma. Only R{sub 2}* was predictive (P<.05) for the curability of 9L-glioma at 40 Gy, a dose that showed a difference in response to RT between carbogen and air-breathing groups. {sup 18}F-FAZA positron emission tomography imaging has been shown to be a predictive marker under the same conditions. Conclusion: This work illustrates the sensitivity of oxygen-sensitive R{sub 1} and R{sub 2}* parameters to changes in tumor oxygenation. However, R{sub 1

ACCELERATED REGIMENS OF ADJUVANT RADIOTHERAPY IN THE TREATMENT OF BREAST CANCER

Directory of Open Access Journals (Sweden)

G. V. Afonin

2017-01-01

Full Text Available Treatment of breast cancer (BC is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug

Hyperfractionated Accelerated Radiotherapy (HART) for Anaplastic Thyroid Carcinoma: Toxicity and Survival Analysis

Energy Technology Data Exchange (ETDEWEB)

Dandekar, Prasad [Head and Neck/Thyroid Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey (United Kingdom); Harmer, Clive; Barbachano, Yolanda [Department of Clinical Research and Development, Royal Marsden NHS Foundation Trust, Sutton, Surrey (United Kingdom); Rhys-Evans, Peter; Harrington, Kevin; Nutting, Christopher [Head and Neck-Thyroid Unit, Royal Marsden NHS Foundation Trust, Chelsea, London (United Kingdom); Newbold, Kate [Head and Neck/Thyroid Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey (United Kingdom); Consultant Clinical Oncologist, Royal Marsden NHS Foundation Trust, Chelsea, London (United Kingdom)

2009-06-01

Purpose: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive cancers, and the current protocol of hyperfractionated accelerated radiotherapy was initiated to improve survival while limiting toxicities. Methods and Materials: All patients with ATC from 1991 to 2002 were accrued and received megavoltage radiotherapy from the mastoid processes to the carina up to 60 Gy in twice-daily fractions of 1.8 and 2 Gy, 6 hours apart. Results: Thirty-one patients were accrued with a median age of 69 years, and 55% were women. Debulking was performed in 26%, and total thyroidectomy, in 6%, whereas 68% received radical radiotherapy alone. Local control data were available for 27 patients: 22% had a complete response, 26% had a partial response, 15% showed progressive disease, and 37% showed static disease. Median overall survival for all 31 patients was 70 days (95% confidence interval, 40-99). There was no significant difference in median survival between patients younger (70 days) and older than 70 years (42 days), between men (70 days) and women (49days), and between patients receiving postoperative radiotherapy (77 days) and radical radiotherapy alone (35 days). Grade III or higher skin erythema was seen in 56% patients; desquamation in 21%; dysphagia in 74%; and esophagitis in 79%. Conclusion: The current protocol failed to offer a significant survival benefit, was associated with severe toxicities, and thus was discontinued. There is a suggestion that younger patients with operable disease have longer survival, but this would require a larger study to confirm it.

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.

Vertical mammaplasty associated with accelerated partial breast radiotherapy: how oncoplastic surgery techniques associated with modern techniques of radiotherapy can improve the aesthetic outcome in selected patients

International Nuclear Information System (INIS)

Couto, Henrique Lima; Amorim, Washington Cancado; Guimaraes, Rodrigo

2014-01-01

Breast cancer is the second most common type of cancer in the world, being the most common among women, responsible for 22% of new cases each year. It's surgical and radiation treatment evolved from radical procedures (Halsted radical mastectomy and total external breast radiotherapy) to less radical and more conservative procedures. With the use of modern oncoplastic surgery techniques and accelerated partial breast radiotherapy, selected patients can benefit with better aesthetic results, fewer side effects, and more comfortable and brief treatments. (author)

Vertical mammaplasty associated with accelerated partial breast radiotherapy: how oncoplastic surgery techniques associated with modern techniques of radiotherapy can improve the aesthetic outcome in selected patients

Energy Technology Data Exchange (ETDEWEB)

Couto, Henrique Lima, E-mail: enriquecouto@hotmail.com [Santa Fe Women' s and Maternity Hospital, Belo Horizonte, MG (Brazil); Amorim, Washington Cancado; Guimaraes, Rodrigo [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Hospital Geral; Ramires, Leandro Cruz; Castilho, Marcus Simoes [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Fac. de Medicina; Dominguez, Lorena Lima Coto [Universidade Estacio de Sa (UNESA), Rio de Janeiro, EJ (Brazil)

2014-07-15

Breast cancer is the second most common type of cancer in the world, being the most common among women, responsible for 22% of new cases each year. It's surgical and radiation treatment evolved from radical procedures (Halsted radical mastectomy and total external breast radiotherapy) to less radical and more conservative procedures. With the use of modern oncoplastic surgery techniques and accelerated partial breast radiotherapy, selected patients can benefit with better aesthetic results, fewer side effects, and more comfortable and brief treatments. (author)

Present state of studies on FFAG accelerator for radiotherapy of cancer in National Institute of Radiological Sciences

International Nuclear Information System (INIS)

Misu, Toshiyuki

2003-01-01

From 2001, developmental contract studies with Ministry of Education, Culture, Sports, Science and Technology for a compact accelerator for heavy ion radiotherapy of cancer started in National Institute of Radiological Sciences (NIRS) with use of fixed field alternating gradient (FFAG) accelerator, which had been developed in High Energy Accelerator Research Organization (KEK). This paper describes the present state of those studies. Described are FFAG accelerator design for repeated acceleration for 200 Hz or more toward the carbon ion at 400 MeV/u with the range of 25 cm in water, FFAG optical systems for these purposes by linear analyses, and the present situation of the design. Technological problems yielded and future study plan are also commented. (N.I.)

Visual Outcome in Meningiomas Around Anterior Visual Pathways Treated With Linear Accelerator Fractionated Stereotactic Radiotherapy

International Nuclear Information System (INIS)

Stiebel-Kalish, Hadas; Reich, Ehud; Gal, Lior; Rappaport, Zvi Harry; Nissim, Ouzi; Pfeffer, Raphael; Spiegelmann, Roberto

2012-01-01

Purpose: Meningiomas threatening the anterior visual pathways (AVPs) and not amenable for surgery are currently treated with multisession stereotactic radiotherapy. Stereotactic radiotherapy is available with a number of devices. The most ubiquitous include the gamma knife, CyberKnife, tomotherapy, and isocentric linear accelerator systems. The purpose of our study was to describe a case series of AVP meningiomas treated with linear accelerator fractionated stereotactic radiotherapy (FSRT) using the multiple, noncoplanar, dynamic conformal rotation paradigm and to compare the success and complication rates with those reported for other techniques. Patients and Methods: We included all patients with AVP meningiomas followed up at our neuro-ophthalmology unit for a minimum of 12 months after FSRT. We compared the details of the neuro-ophthalmologic examinations and tumor size before and after FSRT and at the end of follow-up. Results: Of 87 patients with AVP meningiomas, 17 had been referred for FSRT. Of the 17 patients, 16 completed >12 months of follow-up (mean 39). Of the 16 patients, 11 had undergone surgery before FSRT and 5 had undergone FSRT as first-line management. Tumor control was achieved in 14 of the 16 patients, with three meningiomas shrinking in size after RT. Two meningiomas progressed, one in an area that was outside the radiation field. The visual function had improved in 6 or stabilized in 8 of the 16 patients (88%) and worsened in 2 (12%). Conclusions: Linear accelerator fractionated RT using the multiple noncoplanar dynamic rotation conformal paradigm can be offered to patients with meningiomas that threaten the anterior visual pathways as an adjunct to surgery or as first-line treatment, with results comparable to those reported for other stereotactic RT techniques.

Accelerated Hyperfractionated Radiotherapy for Locally Advanced Uterine Cervix Cancers

International Nuclear Information System (INIS)

Seo, Young Seok; Cho, Chul Koo; Yoo, Seong Yul

2008-01-01

To assess the efficacy of the use of accelerated hyperfractionated radiotherapy (AHRT) for locally advanced uterine cervix cancers. Between May 2000 and September 2002, 179 patients were identified with FIGO stage IIB, IIIB, and IVA cancers. Of the 179 patients, 45 patients were treated with AHRT (AHRT group) and 134 patients were treated with conventional radiotherapy (CRT group), respectively. Patients undergoing the AHRT regimen received a dose of 30 Gy in 20 fractions (1.5 Gyx2 fractions/day) to the whole pelvis. Subsequently, with a midline block, we administered a parametrial boost with a dose of 20 Gy using 2 Gy fractions. Patients also received two courses of low-dose-rate brachytherapy, up to a total dose of 85∼90 Gy to point A. In the CRT group of patients, the total dose to point A was 85∼90 Gy. The overall treatment duration was a median of 37 and 66 days for patients that received AHRT and CRT, respectively. Statistical analysis was calculated by use of the Kaplan-Meier method, the log-rank test, and Chi-squared test. For patients that received cisplatin-based concurrent chemotherapy and radiotherapy, the local control rate at 5 years was 100% and 79.2% for the AHRT and CRT group of patients, respectively (p=0.028). The 5-year survival rate for patients with a stage IIB bulky tumor was 82.6% and 62.1% for the AHRT group and CRT group, respectively (p=0.040). There was no statistically significant difference for severe late toxicity between the two groups (p=0.561). In this study, we observed that treatment with AHRT with concurrent chemotherapy allows a significant advantage of local control and survival for locally advanced uterine cervix cancers

An original accelerated radiotherapy schedule in stage III to IV head and neck cancers. Results in a multicenter setting

International Nuclear Information System (INIS)

Allal, A.S.

2000-01-01

Background: Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting. Patients and Methods: Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.9 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days). Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2x1.6 Gy to 1.66 Gy/day) to a larger head and neck volume. Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles). Results: Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%). Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases. The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71). The 5-year overall actuarial survival was 32% (95% CI: 18 to 46). Induction chemotherapy was not associated with a more favorable outcome. Conclusions: This study demonstrates the feasibility of this schedule in a multicenter setting. The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable. Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials. (orig.) [de

Accelerated Intensity-Modulated Radiotherapy to Breast in Prone Position: Dosimetric Results

International Nuclear Information System (INIS)

De Wyngaert, J. Keith; Jozsef, Gabor; Mitchell, James; Rosenstein, Barry; Formenti, Silvia C.

2007-01-01

Purpose: To report the physics and dosimetry results of a trial of accelerated intensity-modulated radiotherapy to the whole breast with a concomitant boost to the tumor bed in patients treated in the prone position. Methods and Materials: Patients underwent computed tomography planning and treatment in the prone position on a dedicated treatment platform. The platform has an open aperture on the side to allow for the index breast to fall away from the chest wall. Noncontrast computed tomography images were acquired at 2.5- or 3.75-mm-thick intervals, from the level of the mandible to below the diaphragm. A dose of 40.5 Gy was delivered to the entire breast at 2.7-Gy fractions in 15 fractions. An additional dose of 0.5 Gy was delivered as a concomitant boost to the lumpectomy site, with a 1-cm margin, using inverse planning, for a total dose of 48 Gy in 15 fractions. No more than 10% of the heart and lung volume was allowed to receive >18 and >20 Gy, respectively. Results: Between September 2003 and August 2005, 91 patients were enrolled in the study. The median volume of heart that received ≥18 Gy was 0.5%, with a maximal value of 4.7%. The median volume of ipsilateral lung that received ≥20 Gy was 0.8%, with a maximum of 7.2%. Conclusion: This technique for whole breast radiotherapy is feasible and enables an accelerated regimen in the prone position while sparing the lung and heart

Historical review of radiotherapy

International Nuclear Information System (INIS)

Onai, Yoshio

1993-01-01

The techniques of radiotherapy have been improved by development of particle accelerators, radionuclides and computers. This paper presents a historical review of the physical and technical aspects of radiotherapy in Japan. Changes in the kinds of radiation, such as X-rays, gamma rays, electrons, neutrons and protons used for external radiotherapy, and the equipment involved are described chronologically, and historical changes in the quality of radiotherapy apparatus are outlined. Patient data acquisition equipment, such as X-ray simulator and X-ray CT, beam modifying devices, patient setup devices, and devices to verify treatment fields and patient doses are reviewed historically. Radiation sources for brachytherapy and internal radiotherapy, and remotely controlled afterloading systems are reviewed chronologically. Historical changes in methods to evaluate absorbed doses, dose monitor systems and beam data acquisition systems are outlined. Changes in methods of calculating dose distributions for external X-ray and electron therapy, brachytherapy and internal radiotherapy by unsealded radionuclides are described and calculation techniques for treatment planning system are reviewed. Annual figures in the numbers of radiotherapy equipment, such as telecobalt and telecesium units, linear accelerators, betatrons, microtrons, stereotactic gamma units, conformation radiotherapy units, remotely controlled afterloading systems, and associated equipment such as X-ray simulators and treatment planning systems are provided, as are changes in the number of accelerators by maximum X-ray energy and maximum electron energy, and in the number of licensed hospitals and clinics using small sealed sources. Changes in techniques of external radiotherapy and brachytherapy are described briefly from the point of view of dose distributions. (author)

Toxicity and cosmetic outcome of three-dimensional conformal radiotherapy for accelerated partial breast irradiation

International Nuclear Information System (INIS)

Gatti, M.; Bresciani, S.; Ponzone, R.; Panaia, R.; Salatino, A.; Stasi, M.; Gabriele, P.

2011-01-01

Full text of publication follows: Purpose.- To analyse the incidence and severity of acute and late normal tissue toxicity and cosmetic outcome using three - dimensional conformal radiotherapy to deliver accelerated partial breast irradiation. Patients and Methods.- 70 patients with stage I disease were treated with three-dimensional conformal radiotherapy for accelerated partial breast irradiation, in an approved protocol. The prescribed dose was 34 Gy in all patients delivered in 10 fractions over 5 consecutive days. On all CT scans gross tumor volume (GTV ) was defined around surgical clips. A 1.5 cm margin was added in order to account for clinical target volume (CTV) . A margin of 1 cm was added to CTI to define the planning target volume (PTV). The dose-volume constraints were followed in accordance with the specifications as dictated in the NSABP/RTOG protocol. After treatment, patients underwent a clinical and cosmetic evaluation every 3 months. Late toxicity was evaluated according to the RTOG grading schema. The cosmetic assessment was performed by the physicians using the controlateral untreated breast as the reference (Harvard scale). Results.- Median patient age was 66 years (range 51-80). Median follow-up was 15 months (range 6-46). Tumor size was 2 cm in 4(6%). The mean value of the ratio between the PTV and the whole ipsilateral breast volume was 38 % and the median percentage whole breast volume that received 95 % of prescribed dose was 34% (range 16%-55%). The rate of G1 and G2 acute skin toxicity was 28% and 2% respectively and the late toxicity was 17% (G1). G2 or greater toxicities were not observed. The most pronounced G1 late toxicity was subcutaneous fibrosis, developed in 3 patients. The cosmetic outcome was excellent in 83% and good in 17%. Conclusion.- Accelerated partial breast irradiation using three-dimensional conformal radiotherapy is technically feasible with very low acute and late toxicity. Long-term results are needed to assess

Accelerated partial breast irradiation using robotic radiotherapy: a dosimetric comparison with tomotherapy and three-dimensional conformal radiotherapy.

Science.gov (United States)

Rault, Erwann; Lacornerie, Thomas; Dang, Hong-Phuong; Crop, Frederik; Lartigau, Eric; Reynaert, Nick; Pasquier, David

2016-02-27

Accelerated partial breast irradiation (APBI) is a new breast treatment modality aiming to reduce treatment time using hypo fractionation. Compared to conventional whole breast irradiation that takes 5 to 6 weeks, APBI is reported to induce worse cosmetic outcomes both when using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). These late normal tissue effects may be attributed to the dose volume effect because a large portion of the non-target breast tissue volume (NTBTV) receives a high dose. In the context of APBI, non-coplanar beams could spare the NTBTV more efficiently. This study evaluates the dosimetric benefit of using the Cyberknife (CK) for APBI in comparison to IMRT (Tomotherapy) and three dimensional conformal radiotherapy (3D-CRT). The possibility of using surgical clips, implanted during surgery, to track target movements is investigated first. A phantom of a female thorax was designed in-house using the measurements of 20 patients. Surgical clips of different sizes were inserted inside the breast. A treatment plan was delivered to the mobile and immobile phantom. The motion compensation accuracy was evaluated using three radiochromic films inserted inside the breast. Three dimensional conformal radiotherapy (3D-CRT), Tomotherapy (TOMO) and CK treatment plans were calculated for 10 consecutive patients who received APBI in Lille. To ensure a fair comparison of the three techniques, margins applied to the CTV were set to 10 mm. However, a second CK plan was prepared using 3 mm margins to evaluate the benefits of motion compensation. Only the larger clips (VITALITEC Medium-Large) could be tracked inside the larger breast (all gamma indices below 1 for 1 % of the maximum dose and 1 mm). All techniques meet the guidelines defined in the NSABP/RTOG and SHARE protocols. As the applied dose volume constraints are very strong, insignificant dosimetric differences exist between techniques regarding the PTV

Accelerated partial breast irradiation using robotic radiotherapy: a dosimetric comparison with tomotherapy and three-dimensional conformal radiotherapy

International Nuclear Information System (INIS)

Rault, Erwann; Lacornerie, Thomas; Dang, Hong-Phuong; Crop, Frederik; Lartigau, Eric; Reynaert, Nick; Pasquier, David

2016-01-01

Accelerated partial breast irradiation (APBI) is a new breast treatment modality aiming to reduce treatment time using hypo fractionation. Compared to conventional whole breast irradiation that takes 5 to 6 weeks, APBI is reported to induce worse cosmetic outcomes both when using three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). These late normal tissue effects may be attributed to the dose volume effect because a large portion of the non-target breast tissue volume (NTBTV) receives a high dose. In the context of APBI, non-coplanar beams could spare the NTBTV more efficiently. This study evaluates the dosimetric benefit of using the Cyberknife (CK) for APBI in comparison to IMRT (Tomotherapy) and three dimensional conformal radiotherapy (3D-CRT). The possibility of using surgical clips, implanted during surgery, to track target movements is investigated first. A phantom of a female thorax was designed in-house using the measurements of 20 patients. Surgical clips of different sizes were inserted inside the breast. A treatment plan was delivered to the mobile and immobile phantom. The motion compensation accuracy was evaluated using three radiochromic films inserted inside the breast. Three dimensional conformal radiotherapy (3D-CRT), Tomotherapy (TOMO) and CK treatment plans were calculated for 10 consecutive patients who received APBI in Lille. To ensure a fair comparison of the three techniques, margins applied to the CTV were set to 10 mm. However, a second CK plan was prepared using 3 mm margins to evaluate the benefits of motion compensation. Only the larger clips (VITALITEC Medium-Large) could be tracked inside the larger breast (all gamma indices below 1 for 1 % of the maximum dose and 1 mm). All techniques meet the guidelines defined in the NSABP/RTOG and SHARE protocols. As the applied dose volume constraints are very strong, insignificant dosimetric differences exist between techniques regarding the PTV

Late course accelerated hyperfractionated radiotherapy of nasopharyngeal carcinoma (LCAF)

International Nuclear Information System (INIS)

He Xiayun; Liu Taifu; He Shaoqin; Huan Sulan; Pan Ziqiang

2007-01-01

Background and purpose: To study the efficacy of late course accelerated fractionated (LCAF) radiotherapy in the treatment of nasopharyngeal carcinoma (NPC). The end-points were local control, radiation-induced complications, and factors influencing survival. Patients and methods: Between December 1995 and April 1998, 178 consecutive NPC patients were admitted for radiation treatment. The radiation beam used was 60 Co γ or 6 MV X rays. For the first two-thirds of the treatment, two daily fractions of 1.2 Gy were given to the primary lesion, with an interval of ≥6 h, 5 days per week to a total dose of 48 Gy/40 fractions, over a period of 4 weeks. For the last third of the treatment, i.e., beginning the 5th week of treatment, an accelerated hyperfractionated schedule was carried out. The dose per fraction was increased to 1.5 Gy, 2 fractions per day with an interval of ≥6 h, the total dose for this part of the protocol was 30 Gy/20 fractions over 2 weeks. Thus the total dose was 78 Gy in 60 fractions in 6 weeks. Results: All patients completed the treatment. Acute mucositis: none in 2 cases, Grade 1 in 43 cases, Grade 2 in 78 cases, Grade 3 in 52 cases, and Grade 4 in 3 cases. Local control rate: the 5 year nasopharyngeal local control rate was 87.7%, and the cervical lymph nodes local control rate was 85.7%. The 5-year distant metastasis rate was 26.1%, and 5 year survivals were 67.9%, 16 (9%) patients had radiation-induced cranial nerve palsy, 7(4%) patients had temporal lobe or brainstem damage. Conclusions: With this treatment schedule, patients' tolerance was good, local control and 5 year survivals were better than conventional fractionation schedules, and radiation-related late complications did not increase, as 5-year survival rates of conventional fractionation radiotherapy were only 58%. Randomized clinical trials are being carried out to further confirm the efficacy of LCAF for nasopharyngeal carcinoma

Establishment of a radiotherapy service with a linear accelerator (photons): acceptance tests, dosimetry and quality control

International Nuclear Information System (INIS)

Berdaky, Mafalda Feliciano

2000-01-01

This work presents the operational part of the final process of the establishment of a radiotherapy service with a linear accelerator (6 MeV photon beams), including the acceptance tests, commissioning tests and the implementation of a quality control program through routine mechanical and radiation tests. All acceptance tests were satisfactory, showing results below the allowed limits of the manufacturer, the commissioning tests presented results within those of the international recommendations. The quality control program was performed during 34 months and showed an excellent stability of this accelerator. (author)

Breast cancer radiotherapy: controversies and prospectives

Institute of Scientific and Technical Information of China (English)

YU Jin-ming; WANG Yong-sheng

2008-01-01

@@ Despite consensus on breast cancer radiotherapy, there are still some controversies over post-mastectomy radiotherapy (PMRT) in patients with 1-3 positive lymph nodes, accelerated partial breast irradiation (APBI), appropriate sequence of radiotherapy, chemotherapy and hormonal treatment, and radiotherapy after preoperative systemic therapy.

Measurement of differences in pO2 in response to perfluorocarbon/carbogen in FSa and NFSa murine fibrosarcomas with low-frequency electron paramagnetic resonance oximetry.

Science.gov (United States)

Halpern, H J; Yu, C; Peric, M; Barth, E D; Karczmar, G S; River, J N; Grdina, D J; Teicher, B A

1996-05-01

We have used very low-frequency electron paramagnetic resonance (EPR) oximetry to measure the change in oxygen concentration (delta pO2) due to change in breathing atmosphere in FSa and NFSa fibrosarcomas implanted in the legs of C3H mice infused with perfluoro-octylbromine (PFOB). Measurements in each tumor were made before and after the administration of the high-density (47% v/v) perfluorocarbon PFOB, perflubron (Alliance Pharmaceutical Corporation, San Diego, CA). Measurements in each tumor were also made, after the administration of the PFOB, both before (PFOB/air) and after the administration of carbogen (95% O2 + 5% CO2, PFOB/carbogen). Large changes (delta p02) relative to PFOB/air oxygenation were seen with the administration of PFOB/carbogen. No significant difference in oxygen concentration was seen between air-breathing mice with and without PFOB. The mean delta pO2 for FSa tumors was 13 +/- 6 torr, while the mean for NFSa fibrosarcomas was 28 +/- 7 torr. There were such large intertumor differences that the trend toward a smaller change in the more hypoxic FSa tumors was not significant (P = 0.13). This paper describes a novel method of measuring differences in oxygenation in tumor tissues. The results of such measurements indicate large differences in pO2 response to different breathing atmospheres in PFOB-infused tumors of similar histology. The intertumor delta pO2 differences may correlate with differences in radiation response.

Photoneutron intensity variation with field size around radiotherapy linear accelerator 18-MeV X-ray beam

Energy Technology Data Exchange (ETDEWEB)

Al-Ghamdi, H.; Fazal-ur-Rehman [Physics Department, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia); Al-Jarallah, M.I. [Physics Department, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia)], E-mail: mibrahim@kfupm.edu.sa; Maalej, N. [Physics Department, King Fahd University of Petroleum and Minerals, Dhahran 31261 (Saudi Arabia)

2008-08-15

In X-ray radiotherapy accelerators, neutrons are produced mainly by ({gamma},n) reaction when high energy X-rays interact with high Z materials of the linear accelerator head. These materials include the lead (Pb) used as shielding in the collimator, tungsten (W) target used for the production of X-rays and iron (Fe) in the accelerator head. These unwanted neutrons contaminate the therapeutic beam and contribute to the patient dose during the treatment of a cancer patient. Knowing the neutron distribution around the radiotherapy accelerator is therefore desired. CR-39 nuclear track detectors (NTDs) were used to study the variation of fast and thermal neutron relative intensities around an 18 MeV linear accelerator X-ray beam with the field sizes of 0, 10x10, 20x20, 30x30 and 40x40cm{sup 2}. For fast neutron detection, bare NTDs were used. For thermal neutron detection, NTDs were covered with lithium tetra borate (Li{sub 2}B{sub 4}O{sub 7}) converters. The NTDs were placed at different locations in the direction perpendicular to the treatment couch (transversal) and in the direction parallel to the treatment couch (longitudinal) with respect to the isocenter of the accelerator. The fast neutron relative intensity is symmetrical about the beam axis and exhibits an exponential-like drop with distance from the isocenter of the accelerator for all the field sizes. At the primary beam (isocenter), the relative fast neutron intensity is highest for 40x40cm{sup 2} field size and decreases linearly with the decrease in the field size. However, fast neutron intensities do not change significantly with beam size for the measurements outside the primary beam. The fast neutron intensity in the longitudinal direction outside the primary beam decreases linearly with the field size. The thermal neutron intensity, at any location, was found to be almost independent of the field size.

Dynamic changes in oxygenation of intracranial tumor and contralateral brain during tumor growth and carbogen breathing: A multisite EPR oximetry with implantable resonators

Science.gov (United States)

Hou, Huagang; Dong, Ruhong; Li, Hongbin; Williams, Benjamin; Lariviere, Jean P.; Hekmatyar, S.K.; Kauppinen, Risto A.; Khan, Nadeem; Swartz, Harold

2013-01-01

Introduction Several techniques currently exist for measuring tissue oxygen; however technical difficulties have limited their usefulness and general application. We report a recently developed electron paramagnetic resonance (EPR) oximetry approach with multiple probe implantable resonators (IRs) that allow repeated measurements of oxygen in tissue at depths of greater than 10 mm. Methods The EPR signal to noise (S/N) ratio of two probe IRs was compared with that of LiPc deposits. The feasibility of intracranial tissue pO2 measurements by EPR oximetry using IRs was tested in normal rats and rats bearing intracerebral F98 tumors. The dynamic changes in the tissue pO2 were assessed during repeated hyperoxia with carbogen breathing. Results A 6–10 times increase in the S/N ratio was observed with IRs as compared to LiPc deposits. The mean brain pO2 of normal rats was stable and increased significantly during carbogen inhalation in experiments repeated for 3 months. The pO2 of F98 glioma declined gradually, while the pO2 of contralateral brain essentially remained the same. Although a significant increase in the glioma pO2 was observed during carbogen inhalation, this effect declined in experiments repeated over days. Conclusion EPR oximetry with IRs provides a significant increase in S/N ratio. The ability to repeatedly assess orthotopic glioma pO2 is likely to play a vital role in understanding the dynamics of tissue pO2 during tumor growth and therapies designed to modulate tumor hypoxia. This information could then be used to optimize chemoradiation by scheduling treatments at times of increased glioma oxygenation. PMID:22033225

Toxicity and cosmetic outcome of three-dimensional conformal radiotherapy for accelerated partial breast irradiation

Energy Technology Data Exchange (ETDEWEB)

Gatti, M.; Bresciani, S.; Ponzone, R.; Panaia, R.; Salatino, A.; Stasi, M.; Gabriele, P. [IRCC, Candiolo (Italy)

2011-10-15

Full text of publication follows: Purpose.- To analyse the incidence and severity of acute and late normal tissue toxicity and cosmetic outcome using three - dimensional conformal radiotherapy to deliver accelerated partial breast irradiation. Patients and Methods.- 70 patients with stage I disease were treated with three-dimensional conformal radiotherapy for accelerated partial breast irradiation, in an approved protocol. The prescribed dose was 34 Gy in all patients delivered in 10 fractions over 5 consecutive days. On all CT scans gross tumor volume (GTV ) was defined around surgical clips. A 1.5 cm margin was added in order to account for clinical target volume (CTV) . A margin of 1 cm was added to CTI to define the planning target volume (PTV). The dose-volume constraints were followed in accordance with the specifications as dictated in the NSABP/RTOG protocol. After treatment, patients underwent a clinical and cosmetic evaluation every 3 months. Late toxicity was evaluated according to the RTOG grading schema. The cosmetic assessment was performed by the physicians using the controlateral untreated breast as the reference (Harvard scale). Results.- Median patient age was 66 years (range 51-80). Median follow-up was 15 months (range 6-46). Tumor size was < 10 mm in 33 patients (53%) and > 2 cm in 4(6%). The mean value of the ratio between the PTV and the whole ipsilateral breast volume was 38 % and the median percentage whole breast volume that received 95 % of prescribed dose was 34% (range 16%-55%). The rate of G1 and G2 acute skin toxicity was 28% and 2% respectively and the late toxicity was 17% (G1). G2 or greater toxicities were not observed. The most pronounced G1 late toxicity was subcutaneous fibrosis, developed in 3 patients. The cosmetic outcome was excellent in 83% and good in 17%. Conclusion.- Accelerated partial breast irradiation using three-dimensional conformal radiotherapy is technically feasible with very low acute and late toxicity. Long

Study on the photoneutrons produced in 15 MV medical linear accelerators : Comparison of three dimensional conformal radiotherapy and intensity modulated radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Yang, Oh Nam [Gangneung Asan Hospital, Gangneung (Korea, Republic of); Yang, Oh Nam; Lim, Cheong Hwan [Hanseo Univ., Seosan (Korea, Republic of)

2012-12-15

Intensity-modulated radiotherapy(IMRT) have the ability to provide better dose conformity and sparing of critical normal tissues than three-dimensional radiotherapy(3DCRT). Especially, with the benefit of health insurance in 2011, its use now increasingly in many modern radiotherapy departments. Also the use of linear accelerator with high-energy photon beams over 10 MV is increasing. As is well known, these linacs have the capacity to produce photoneutrons due to photonuclear reactions in materials with a large atomic number such as the target, flattening filters, collimators, and multi-leaf collimators(MLC). MLC-based IMRT treatments increase the monitor units and the probability of production of photoneutrons from photon-induced nuclear reactions. The purpose of this study is to quantitatively evaluate the dose of photoneutrons produced from 3DCRT and IMRT technique for Rando phantom in cervical cancer. We performed the treatment plans with 3DCRT and IMRT technique using Rando phantom for treatment of cervical cancer. An Rando phantom placed on the couch in the supine position was irradiated using 15 MV photon beams. Optically stimulated luminescence dosimeters(OSLD) were attached to 4 different locations (abdomen, chest, head and neck, eyes) and from center of field size and measured 5 times each of locations. Measured neutron dose from IMRT technique increased by 9.0, 8.6, 8.8, and 14 times than 3DCRT technique for abdomen, chest, head and neck, and eyes, respectively. When using IMRT with 15 MV photon beams, the photoneutrons contributed a significant portion on out-of-field. It is difficult to prevent high energy photon beams to produce the photoneutrons due to physical properties, if necessary, It is difficult to prevent high energy photon beams to produce the photoneutrons due to physical properties, if necessary, it is need to provide the additional safe shielding on a linear accelerator and should therefore reduce the out-of-field dose.

Study on the photoneutrons produced in 15 MV medical linear accelerators : Comparison of three dimensional conformal radiotherapy and intensity modulated radiotherapy

International Nuclear Information System (INIS)

Yang, Oh Nam; Yang, Oh Nam; Lim, Cheong Hwan

2012-01-01

Intensity-modulated radiotherapy(IMRT) have the ability to provide better dose conformity and sparing of critical normal tissues than three-dimensional radiotherapy(3DCRT). Especially, with the benefit of health insurance in 2011, its use now increasingly in many modern radiotherapy departments. Also the use of linear accelerator with high-energy photon beams over 10 MV is increasing. As is well known, these linacs have the capacity to produce photoneutrons due to photonuclear reactions in materials with a large atomic number such as the target, flattening filters, collimators, and multi-leaf collimators(MLC). MLC-based IMRT treatments increase the monitor units and the probability of production of photoneutrons from photon-induced nuclear reactions. The purpose of this study is to quantitatively evaluate the dose of photoneutrons produced from 3DCRT and IMRT technique for Rando phantom in cervical cancer. We performed the treatment plans with 3DCRT and IMRT technique using Rando phantom for treatment of cervical cancer. An Rando phantom placed on the couch in the supine position was irradiated using 15 MV photon beams. Optically stimulated luminescence dosimeters(OSLD) were attached to 4 different locations (abdomen, chest, head and neck, eyes) and from center of field size and measured 5 times each of locations. Measured neutron dose from IMRT technique increased by 9.0, 8.6, 8.8, and 14 times than 3DCRT technique for abdomen, chest, head and neck, and eyes, respectively. When using IMRT with 15 MV photon beams, the photoneutrons contributed a significant portion on out-of-field. It is difficult to prevent high energy photon beams to produce the photoneutrons due to physical properties, if necessary, It is difficult to prevent high energy photon beams to produce the photoneutrons due to physical properties, if necessary, it is need to provide the additional safe shielding on a linear accelerator and should therefore reduce the out-of-field dose

Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

Energy Technology Data Exchange (ETDEWEB)

Rasmussen, Rune, E-mail: rune333@gmail.com [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Claesson, Magnus [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Stangerup, Sven-Eric [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Roed, Henrik [Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); Christensen, Ib Jarle [Finsen Laboratory, Rigshospitalet, Copenhagen (Denmark); Caye-Thomasen, Per [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Juhler, Marianne [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark)

2012-08-01

Objective: To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hearing preservation was also investigated. Methods and Materials: Forty-two patients receiving FSRT between 1997 and 2008 with a minimum follow-up of 2 years were included. All patients received 54 Gy in 27-30 fractions during 5.5-6.0 weeks. Clinical and audiometry data were collected prospectively. From a 'wait-and-scan' group, 409 patients were selected as control subjects, matched by initial audiometric parameters. Radiation dose to the cochlea was measured using the original treatment plan and then related to changes in acoustic parameters. Results: Actuarial 2-, 4-, and 10-year tumor control rates were 100%, 91.5%, and 85.0%, respectively. Twenty-one patients had serviceable hearing before FSRT, 8 of whom (38%) retained serviceable hearing at 2 years after FSRT. No patients retained serviceable hearing after 10 years. At 2 years, hearing preservation rates in the control group were 1.8 times higher compared with the group receiving FSRT (P=.007). Radiation dose to the cochlea was significantly correlated to deterioration of the speech reception threshold (P=.03) but not to discrimination loss. Conclusion: FSRT accelerates the naturally occurring hearing loss in patients with vestibular schwannoma. Our findings, using fractionation of radiotherapy, parallel results using single-dose radiation. The radiation dose to the cochlea is correlated to hearing loss measured as the speech reception threshold.

Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

International Nuclear Information System (INIS)

Rasmussen, Rune; Claesson, Magnus; Stangerup, Sven-Eric; Roed, Henrik; Christensen, Ib Jarle; Cayé-Thomasen, Per; Juhler, Marianne

2012-01-01

Objective: To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hearing preservation was also investigated. Methods and Materials: Forty-two patients receiving FSRT between 1997 and 2008 with a minimum follow-up of 2 years were included. All patients received 54 Gy in 27-30 fractions during 5.5-6.0 weeks. Clinical and audiometry data were collected prospectively. From a “wait-and-scan” group, 409 patients were selected as control subjects, matched by initial audiometric parameters. Radiation dose to the cochlea was measured using the original treatment plan and then related to changes in acoustic parameters. Results: Actuarial 2-, 4-, and 10-year tumor control rates were 100%, 91.5%, and 85.0%, respectively. Twenty-one patients had serviceable hearing before FSRT, 8 of whom (38%) retained serviceable hearing at 2 years after FSRT. No patients retained serviceable hearing after 10 years. At 2 years, hearing preservation rates in the control group were 1.8 times higher compared with the group receiving FSRT (P=.007). Radiation dose to the cochlea was significantly correlated to deterioration of the speech reception threshold (P=.03) but not to discrimination loss. Conclusion: FSRT accelerates the naturally occurring hearing loss in patients with vestibular schwannoma. Our findings, using fractionation of radiotherapy, parallel results using single-dose radiation. The radiation dose to the cochlea is correlated to hearing loss measured as the speech reception threshold.

Determination of the neutron spectra in the treatment room of a linear accelerator for radiotherapy

International Nuclear Information System (INIS)

Vega C, H.R.; Barquero, R.; Mendez, R.; Iniguez, M.P.

2003-01-01

By means of a series of measures and Monte Carlo calculations the dosimetric characteristics of the photoneutrons have been determined that take place in volume to a linear accelerator of radiotherapy of 18 MV, LINAC, mark Siemens Mevatron model. The measures were carried out with thermoluminescent dosemeters TLD 600 and TLD 700 that were naked exposed and confined with cover of Cd and Sn, inside a sphere of paraffin and inside spheres Bonner. (Author)

Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy

International Nuclear Information System (INIS)

Gondi, Vinai; Tolakanahalli, Ranjini; Mehta, Minesh P.; Tewatia, Dinesh; Rowley, Howard; Kuo, John S.; Khuntia, Deepak; Tome, Wolfgang A.

2010-01-01

Purpose: Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. Methods and Materials: Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy (IMRT) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. Results: On average, the hippocampal avoidance volume was 3.3 cm 3 , occupying 2.1% of the whole-brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy 2 using helical tomotherapy and by 81% to 0.73 Gy 2 using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-off with helical tomotherapy. Conclusion: Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.

Hypofractionated Accelerated Radiotherapy Using Concomitant Intensity-Modulated Radiotherapy Boost Technique for Localized High-Risk Prostate Cancer: Acute Toxicity Results

International Nuclear Information System (INIS)

Lim, Tee S.; Cheung, Patrick; Loblaw, D. Andrew; Morton, Gerard; Sixel, Katharina E.; Pang, Geordi; Basran, Parminder; Zhang Liying; Tirona, Romeo; Szumacher, Ewa; Danjoux, Cyril; Choo, Richard; Thomas, Gillian

2008-01-01

Purpose: To evaluate the acute toxicities of hypofractionated accelerated radiotherapy (RT) using a concomitant intensity-modulated RT boost in conjunction with elective pelvic nodal irradiation for high-risk prostate cancer. Methods and Materials: This report focused on 66 patients entered into this prospective Phase I study. The eligible patients had clinically localized prostate cancer with at least one of the following high-risk features (Stage T3, Gleason score ≥8, or prostate-specific antigen level >20 ng/mL). Patients were treated with 45 Gy in 25 fractions to the pelvic lymph nodes using a conventional four-field technique. A concomitant intensity-modulated radiotherapy boost of 22.5 Gy in 25 fractions was delivered to the prostate. Thus, the prostate received 67.5 Gy in 25 fractions within 5 weeks. Next, the patients underwent 3 years of adjuvant androgen ablative therapy. Acute toxicities were assessed using the Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment and at 3 months after RT. Results: The median patient age was 71 years. The median pretreatment prostate-specific antigen level and Gleason score was 18.7 ng/L and 8, respectively. Grade 1-2 genitourinary and gastrointestinal toxicities were common during RT but most had settled at 3 months after treatment. Only 5 patients had acute Grade 3 genitourinary toxicity, in the form of urinary incontinence (n = 1), urinary frequency/urgency (n = 3), and urinary retention (n = 1). None of the patients developed Grade 3 or greater gastrointestinal or Grade 4 or greater genitourinary toxicity. Conclusion: The results of the present study have indicated that hypofractionated accelerated RT with a concomitant intensity-modulated RT boost and pelvic nodal irradiation is feasible with acceptable acute toxicity

An improved method to accurately calibrate the gantry angle indicators of the radiotherapy linear accelerators

International Nuclear Information System (INIS)

Chang Liyun; Ho, S.-Y.; Du, Y.-C.; Lin, C.-M.; Chen Tainsong

2007-01-01

The calibration of the gantry angle indicator is an important and basic quality assurance (QA) item for the radiotherapy linear accelerator. In this study, we propose a new and practical method, which uses only the digital level, V-film, and general solid phantoms. By taking the star shot only, we can accurately calculate the true gantry angle according to the geometry of the film setup. The results on our machine showed that the gantry angle was shifted by -0.11 deg. compared with the digital indicator, and the standard deviation was within 0.05 deg. This method can also be used for the simulator. In conclusion, this proposed method could be adopted as an annual QA item for mechanical QA of the accelerator

The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator.

Science.gov (United States)

Keall, Paul J; Nguyen, Doan Trang; O'Brien, Ricky; Caillet, Vincent; Hewson, Emily; Poulsen, Per Rugaard; Bromley, Regina; Bell, Linda; Eade, Thomas; Kneebone, Andrew; Martin, Jarad; Booth, Jeremy T

2018-04-01

Until now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator. We developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured. Thirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87-100%). The geometric accuracy of the KIM system was -0.1 ± 0.4, 0.2 ± 0.2 and -0.1 ± 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose. The clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option. Copyright © 2018 Elsevier B.V. All rights reserved.

The role of accelerated hyperfractionated radiotherapy in the treatment of inoperable non-small cell lung cancer: a controlled clinical trial

International Nuclear Information System (INIS)

Reinfuss, M.; Kowalska, T.; Glinski, C.

2000-01-01

Radiotherapy remains the basic form of treatment in cases of non-small cell lung cancer (NSCLC) but there still exist controversies concerning optimal radiotherapy regimen and in particular, the total dose and fractionation schedules. To prove whether the question: if using an unconventional dose fractionation regimen (accelerated hyperfractionation) could improve the results of palliative teleradiotherapy patients with NSCLC. Between 1997 and 2000 in the Cancer Centre in Cracow (COOK) a controlled clinical trial was conducted in a group of 150 patients with locally advanced (III Deg) inoperable and unsuitable for radical radiotherapy NSCLC, with no major symptoms of the disease. In 76 patients conventionally fractionated radiotherapy was performed - 50 Gy in 25 fractions during 5 weeks (CF). 74 patients were irradiated twice a day (AHF); the dose per fraction was 1.25 Gy and the minimum interval between fractions - 6 hours. The total dose was 50 Gy in 40 fractions during 26 days. The probability of 12 months survival was 47.4% in the CF arm and 45.9% in the AHF arm; the probability of 24 months survival was 16.2% and 15.8%, respectively. In all 76 patients in CF arm the treatment was carried out in prescribed time without breaks. Out of 74 patients in the A HF group 8 (10,8%) did not complete the treatment and 2 of then died in 3rd and 4th week of treatment. The use of accelerated hyperfractionation does not improve the results of palliative teleradiotherapy in patients with locally advanced NSCLC without severe symptoms related to intrathoracic tumor. The treatment of choice in this group of patients os conventionally fractionated radiotherapy with a total dose of 50 Gy in 25 fractions in 5 week of treatment. (author)

Safety and adverse events of neoadjuvant short-course hyperfractionated accelerated radiotherapy (SC-HART) for rectal cancer

International Nuclear Information System (INIS)

Doi, Hiroshi; Kamikonya, Norihiko; Hirota, Shozo; Beppu, Naohito; Yanagi, Hidenori

2014-01-01

We presented good tolerability and short-term outcomes of neoadjuvant short-course hyperfractionated accelerated radiotherapy (SC-HART; 25 Gy in 10 fractions for 5 days) combined with chemotherapy in a total of 73 patients with lower rectal cancer. Age, gender, tumor differentiation, and the type of surgery seemed to have no apparent effects on toxicity of SC-HART. SC-HART appeared to have a good feasibility for use in further clinical trials. (author)

Correlation between egfr expression and accelerated proliferation during radiotherapy of head and neck squamous cell carcinoma

Directory of Open Access Journals (Sweden)

Pedicini Piernicola

2012-08-01

Full Text Available Abstract Purpose To investigate the correlation between the expression of Epidermal Growth Factor receptor (EGFr and the reduction of the effective doubling time (TD during radiotherapy treatment and also to determine the dose per fraction to be taken into account when the overall treatment time (OTT is reduced in accelerated radiotherapy of head and neck squamous cell carcinoma (HNSCC. Methods A survey of the published papers comparing 3-years of local regional control rate (LCR for a total of 2162 patients treated with conventional and accelerated radiotherapy and with a pretreatment assessment of EGFr expression, was made. Different values of TD were obtained by a model incorporating the overall time corrected biologically effective dose (BED and a 3-year clinical LCR for high and low EGFr groups of patients (HEGFr and LEGFr, respectively. By obtaining the TD from the above analysis and the sub-sites’ potential doubling time (Tpot from flow cytometry and immunohistochemical methods, we were able to estimate the average TD for each sub-site included in the analysis. Moreover, the dose that would be required to offset the modified proliferation occurring in one day (Dprolif, was estimated. Results The averages of TD were 77 (27-9095% days in LEGFr and 8.8 (7.3-11.095% days in HEGFr, if an onset of accelerated proliferation TK at day 21 was assumed. The correspondent HEGFr sub-sites’ TD were 5.9 (6.6, 5.9 (6.6, 4.6 (6.1, 14.3 (12.9 days, with respect to literature immunohistochemical (flow cytometry data of Tpot for Oral-Cavity, Oro-pharynx, Hypo-pharynx, and Larynx respectively. The Dprolif for the HEGFr groups were 0.33 (0.29, 0.33 (0.29, 0.42 (0.31, 0.14 (0.15 Gy/day if α = 0.3 Gy-1 and α/β = 10 Gy were assumed. Conclusions A higher expression of the EGFr leads to enhanced proliferation. This study allowed to quantify the extent of the effect which EGFr expression has in terms of reduced TD and Dprolif for each head and neck

Correlation between egfr expression and accelerated proliferation during radiotherapy of head and neck squamous cell carcinoma

International Nuclear Information System (INIS)

Pedicini, Piernicola; Fiorentino, Alba; Improta, Giuseppina; Storto, Giovanni; Benassi, Marcello; Orecchia, Roberto; Salvatore, Marco; Nappi, Antonio; Strigari, Lidia; Alicia Jereczek-Fossa, Barbara; Alterio, Daniela; Cremonesi, Marta; Botta, Francesca; Vischioni, Barbara; Caivano, Rocchina

2012-01-01

To investigate the correlation between the expression of Epidermal Growth Factor receptor (EGFr) and the reduction of the effective doubling time (T D ) during radiotherapy treatment and also to determine the dose per fraction to be taken into account when the overall treatment time (OTT) is reduced in accelerated radiotherapy of head and neck squamous cell carcinoma (HNSCC). A survey of the published papers comparing 3-years of local regional control rate (LCR) for a total of 2162 patients treated with conventional and accelerated radiotherapy and with a pretreatment assessment of EGFr expression, was made. Different values of T D were obtained by a model incorporating the overall time corrected biologically effective dose (BED) and a 3-year clinical LCR for high and low EGFr groups of patients (H EGFr and L EGFr ), respectively. By obtaining the T D from the above analysis and the sub-sites’ potential doubling time (T pot ) from flow cytometry and immunohistochemical methods, we were able to estimate the average T D for each sub-site included in the analysis. Moreover, the dose that would be required to offset the modified proliferation occurring in one day (D prolif ), was estimated. The averages of T D were 77 (27-90) 95% days in L EGFr and 8.8 (7.3-11.0) 95% days in H EGFr , if an onset of accelerated proliferation T K at day 21 was assumed. The correspondent H EGFr sub-sites’ T D were 5.9 (6.6), 5.9 (6.6), 4.6 (6.1), 14.3 (12.9) days, with respect to literature immunohistochemical (flow cytometry) data of T pot for Oral-Cavity, Oro-pharynx, Hypo-pharynx, and Larynx respectively. The D prolif for the H EGFr groups were 0.33 (0.29), 0.33 (0.29), 0.42 (0.31), 0.14 (0.15) Gy/day if α = 0.3 Gy -1 and α/β = 10 Gy were assumed. A higher expression of the EGFr leads to enhanced proliferation. This study allowed to quantify the extent of the effect which EGFr expression has in terms of reduced T D and D prolif for each head and neck sub-site

Stereotactic Radiotherapy by 6MV Linear Accelerator

Energy Technology Data Exchange (ETDEWEB)

Oho, Yoon Kyeong; Kim, Mi Hee; Gil, Hak Jun [Catholic University College of Medicine, Seoul (Korea, Republic of)] (and others)

1988-12-15

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4 months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngioma (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be performed safely with a radiation dose of 12-30 Gy. So this noninvasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT.

Stereotactic Radiotherapy by 6MV Linear Accelerator

International Nuclear Information System (INIS)

Oho, Yoon Kyeong; Kim, Mi Hee; Gil, Hak Jun

1988-01-01

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4 months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngioma (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be performed safely with a radiation dose of 12-30 Gy. So this noninvasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT

Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years

Science.gov (United States)

2010-01-01

Background Accelerated hypofractionation is an attractive approach for adjuvant whole breast radiotherapy. In this study we evaluated the adverse effects at least 3 years post an accelerated hypofractionated whole breast radiotherapy schedule. Methods From October 2004 to March 2006, 39 consecutive patients aged over 18 years with pTis, pT1-2, pN0-1 breast adenocarcinoma who underwent conservative surgery were treated with an adjuvant accelerated hypofractionated radiotherapy schedule consisting of 34 Gy in 10 daily fractions over 2 weeks to the whole breast, followed after 1 week by an electron boost dose of 8 Gy in a single fraction to the tumour bed. Skin and lung radiation toxicity was evaluated daily during therapy, once a week for one month after radiotherapy completion, every 3 months for the first year and from then on every six months. In particular lung toxicity was investigated in terms of CT density evaluation, pulmonary functional tests, and clinical and radiological scoring. Paired t-test, Chi-square test and non-parametric Wilcoxon test were performed. Results After a median follow-up of 43 months (range 36-52 months), all the patients are alive and disease-free. None of the patients showed any clinical signs of lung toxicity, no CT-lung toxicity was denoted by radiologist on CT lung images acquired about 1 year post-radiotherapy, no variation of pulmonary density evaluated in terms of normalised Hounsfield numbers was evident. Barely palpable increased density of the treated breast was noted in 9 out of 39 patients (in 2 patients this toxicity was limited to the boost area) and teleangectasia (radiotherapy schedule investigated in this study (i.e 34 Gy in 3.4 Gy/fr plus boost dose of 8 Gy in single fraction) is a feasible and safe treatment and does not lead to adjunctive acute and late toxicities. A longer follow up is necessary to confirm these favourable results. PMID:20100335

Altered fractionated radiotherapy has a survival benefit for head and neck cancers. Is it true?

International Nuclear Information System (INIS)

Hatano, Kazuo; Sakai, Mitsuhiro; Araki, Hitoshi; Doi, Katsuyuki; Asano, Takanori; Fujikawa, Akira

2007-01-01

There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3.4% at 5 years. The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at 5 years). The effect was greater for the primary tumor than for nodal disease. The effect was also more pronounced in younger patients and in those with good performance status. Hyperfractionation seemed to yield a more consistent advantage for survival than accelerated fractionated radiotherapy. However, accelerated radiotherapy might be associated with higher non-cancer related death. We have to evaluate whether the benefit of hyperfractionated radiotherapy versus standard radiotherapy persists when combined with concomitant chemotherapy and the benefit of intensity-modulated radiation therapy (IMRT) compared with altered fractionation. (author)

LINEAR ACCELERATOR FOR USE IN RADIOTHERAPY TREATMENT: STUDY OF PROCESS INNOVATION IN A SUS HOSPITAL OF SERRA GAÚCHA

Directory of Open Access Journals (Sweden)

Andréa Cristina Fermiano Fidelis

2017-03-01

Full Text Available The growth of health structures and their complexity have led Clinical Engineering professionals to carry out studies to develop and implement health technology management programs. In this way, employees of this area, integrated with the health system teams, have contributed to make feasible the use of technologies that offer greater security, functionality and reliability. The radiotherapy area, with the increase in the incidence of new cases of cancer, together with the contingency of the financial resources for health, high cost and complexity of the equipment, motivate studies for its adequate management. This research aimed to identify the technologies applied in the radiotherapy treatment, in particular the linear accelerator, as well as the concept of innovation, innovation in services, innovation in processes and the competitiveness acquired with the aid of innovation. The method used in the research has a qualitative approach, with an exploratory and descriptive objective, with semistructured and open questions and involved bibliographic research on the topic of Innovation and on Linear Accelerator, document analysis, Unit of High Complexity in Oncology visit and interviews at the General Hospital of Caxias do Sul South, presenting, finally, the impacts suffered in the hospital and in the community after the arrival of the Line Accelerator. The results showed that there was process and product innovation, incrementally, in the services offered by the hospital.

Cobalt-60 Machines and Medical Linear Accelerators: Competing Technologies for External Beam Radiotherapy.

Science.gov (United States)

Healy, B J; van der Merwe, D; Christaki, K E; Meghzifene, A

2017-02-01

Medical linear accelerators (linacs) and cobalt-60 machines are both mature technologies for external beam radiotherapy. A comparison is made between these two technologies in terms of infrastructure and maintenance, dosimetry, shielding requirements, staffing, costs, security, patient throughput and clinical use. Infrastructure and maintenance are more demanding for linacs due to the complex electric componentry. In dosimetry, a higher beam energy, modulated dose rate and smaller focal spot size mean that it is easier to create an optimised treatment with a linac for conformal dose coverage of the tumour while sparing healthy organs at risk. In shielding, the requirements for a concrete bunker are similar for cobalt-60 machines and linacs but extra shielding and protection from neutrons are required for linacs. Staffing levels can be higher for linacs and more staff training is required for linacs. Life cycle costs are higher for linacs, especially multi-energy linacs. Security is more complex for cobalt-60 machines because of the high activity radioactive source. Patient throughput can be affected by source decay for cobalt-60 machines but poor maintenance and breakdowns can severely affect patient throughput for linacs. In clinical use, more complex treatment techniques are easier to achieve with linacs, and the availability of electron beams on high-energy linacs can be useful for certain treatments. In summary, there is no simple answer to the question of the choice of either cobalt-60 machines or linacs for radiotherapy in low- and middle-income countries. In fact a radiotherapy department with a combination of technologies, including orthovoltage X-ray units, may be an option. Local needs, conditions and resources will have to be factored into any decision on technology taking into account the characteristics of both forms of teletherapy, with the primary goal being the sustainability of the radiotherapy service over the useful lifetime of the equipment

TLD Intercomparison in accelerators for radiotherapy in three Latin american countries; Intercomparacion TLD en aceleradores para radioterapia en tres paises latinoamericanos

Energy Technology Data Exchange (ETDEWEB)

Gaona, E.; Azorin N, J.; Perez, M.A.; Picon, C.; Castellanos, E.; Plazas, M.C.; Murcia, G.; Archundia, L. [Depto. El Hombre y su Ambiente. Universidad Autonoma Metropolitana, Calz. Del Hueso 1100, 04960 Mexico D.F. (Mexico)

1998-12-31

In Radiotherapy one of the objectives is to establish and to give follow up to quality assurance programs which make sure that the doses administered to the patients with cancer are a high probability of a success in external radiation. Likewise, one of the present preoccupations of the United Nations Agencies as well as the International Atomic Energy Agency and the Pan-American Health Organization is the optimal employment of the radiations in the treatment of cancer patients since the administered dose in Radiotherapy suffers considerable variations by the lack of quality assurance programs. The use of Electron linear accelerators requires a program of quality assurance that includes expert personnel, equipment and adequate facilities. The more used methodology for the dosimetry calibration and characterization of X-ray beams and high energy electrons for radiotherapy use is using a ionization chamber dosemeter calibrated in a regional secondary standardization laboratory. However, to establish and give follow up to the quality assurance programs it is necessary the dosimetric intercomparison through TLD. In this study it was designed plastic phantoms with TLD crystals and it was made its characterization to realize an absorbed dose analysis in the crystals exposed at X-ray beams 6 MV and high energy electrons 10 and 12 MeV to standardize the dosimetric procedures and proceeding to realize an International Pilot intercomparison of absorbed doses in TLD crystals in three Latin American countries: Mexico, Peru and Colombia with the participation of accelerators of five different institutions. The found results show that the majority of the measured doses with TLD in the different accelerators were in the 0.95-1.05 range though it had two cases outside of this range. The use of the phantoms with TLD crystals shows that they are of excellent aid to make analysis of the doses administered to the patients and an intercomparison of results to standardize procedures at

Accelerated fractionation radiotherapy for advanced haed and neck cancer

International Nuclear Information System (INIS)

Lamb, D.S.; Spry, N.A.; Gray, A.J.; Johnson, A.D.; Alexander, S.R.; Dally, M.J.

1990-01-01

Between 1981 and 1986, 89 patients with advanced head and neck squamous cancer were treated with a continuous accelerated fractionation radiotherapy (AFRT) regimen. Three fractions of 1.80 Gy, 4 h apart, were given on three treatment days per week, and the tumour dose was taken to 59.40 Gy in 33 fractions in 24-25 days. Acute mucosal reactions were generally quite severe, but a split was avoided by providing the patient with intensive support, often as an in-patient, until the reactions settled. Late radiation effects have been comparable to those obtained with conventional fractionation. The probability of local-regional control was 47% at 3 years for 69 previously untreated patients, whereas it was only 12% at one year for 20 patients treated for recurrence after radical surgery. Fifty-eight previously untreated patients with tumours arising in the upper aero-digestive tract were analysed in greated detail. The probability of local-regional control at 3 years was 78% for 17 Stage III patients and 15% for 31 Stage IV patients. This schedule of continuous AFRT is feasible and merits further investigation. (author). 31 refs.; 4 figs.; 6 tabs

Procedure to measure the neutrons spectrum around a lineal accelerator for radiotherapy

International Nuclear Information System (INIS)

Vega C, H. R.; Hernandez D, V. M.; Letechipia de L, C.; Benites R, J. L.; Salas L, M. A.

2013-10-01

An experimental procedure was developed, by means of Bonner spheres, to measure the neutrons spectrum around Linacs of medical use that only requires of a single shot of the accelerator; to this procedure we denominate Planetary or Isocentric method. One of the problems associated to the neutrons spectrum measurement in a radiotherapy room with lineal accelerator is because inside the room a mixed, intense and pulsed radiation field takes place affecting the detection systems based on active detector; this situation is solved using a passive detector. In the case of the Bonner spheres spectrometer the active detector has been substituted by activation detectors, trace detectors or thermoluminescent dosimeters. This spectrometer uses several spheres that are situated one at a time in the measurement point, this way to have the complete measurements group the accelerator should be operated, under the same conditions, so many times like spheres have the spectrometer, this activity can consume a long time and in occasions due to the work load of Linac to complicate the measurement process too. The procedure developed in this work consisted on to situate all the spectrometer spheres at the same time and to make the reading by means of a single shot, to be able to apply this procedure, is necessary that before the measurements two characteristics are evaluated: the cross-talking of the spheres and the symmetry conditions of the neutron field. This method has been applied to determine the photo-neutrons spectrum produced by a lineal accelerator of medical use Varian ix of 15 MV to 100 cm of the isocenter located to 5 cm of depth of a solid water mannequin of 30 x 30 x 15 cm. The spectrum was used to determine the total flow and the environmental dose equivalent. (Author)

Project of compact accelerator for cancer proton therapy

International Nuclear Information System (INIS)

Picardi, L.; Ronsivalle, C.; Vignati, A.

1995-04-01

The status of the sub-projetc 'Compact Accelerator' in the framework of the Hadrontherapy Project leaded by Prof. Amaldi is described. Emphasis is given to the reasons of the use of protons for radiotherapy applications, to the results of the preliminary design studies of four types of accelerators as possible radiotherapy dedicated 'Compact Accelerator' and to the scenario of the fonts of financial resources

Radioprotection of patients in radiotherapy: the gonadal doses resulting from treatments at electron accelerators

International Nuclear Information System (INIS)

Nuesslin, F.; Hassenstein, E.

1977-01-01

Using LiF-dosemeters in a polystyrene phantom dose profiles have been measured. The influence of the following parameters has been studied: accelerator type, primary beam quality (45 and 8 MV X-rays, 45, 18 and 10 MeV electrons), orientation of the phantom, depth in the phantom (0, 1 and 10 cm) and thickness of additional lead sheets put on the phantom surface. Because the dose distribution of the leakage radiation of the accelerator depends mainly on the mechanism of beam production, i.e. on the accelerator type, different anisotropic isodose-patterns have been found. For instance, in case of the betatron the dose maxima are located at opposite sides within the plane of electron orbits. On the other side, there does not exist any favourable direction femal patients should be positioned at to minimize the gonadal dose, because already at 10 cm depth in the phantom the isodose distributions are nearly isotropic. This is caused by the low penetrating capacity of the leakage radiation (2 to 0.6 mm Pb HVL thickness at 45 MV X-rays, depending on the lateral distance from the field). These findings suggest to cover the gonads of male patients undergoing radiotherapy with lead sheets of 1 or 2 mm thickness

Accelerated superfractionated radiotherapy for inflammatory breast carcinoma: complete response predicts outcome and allows for breast conservation

International Nuclear Information System (INIS)

Arthur, Douglas W.; Schmidt-Ullrich, Rupert K.; Friedman, Richard B.; Wazer, David E.; Kachnic, Lisa A.; Amir, Cyrus; Bear, Harry D.; Hackney, Mary Helen; Smith, Thomas J.; Lawrence, Walter

1999-01-01

Purpose: Chemotherapy and accelerated superfractionated radiotherapy were prospectively applied for inflammatory breast carcinoma with the intent of breast conservation. The efficacy, failure patterns, and patient tolerance utilizing this approach were analyzed. Methods and Materials: Between 1983 and 1996, 52 patients with inflammatory breast carcinoma presented to the Medical College of Virginia Hospitals of VCU and the New England Medical Center. Thirty-eight of these patients were jointly evaluated in multidisciplinary breast clinics and managed according to a defined prospectively applied treatment policy. Patients received induction chemotherapy, accelerated superfractionated radiotherapy, selected use of mastectomy, and concluded with additional chemotherapy. The majority were treated with 1.5 Gy twice daily to field arrangements covering the entire breast and regional lymphatics. An additional 18-21 Gy was then delivered to the breast and clinically involved nodal regions. Total dose to clinically involved areas was 63-66 Gy. Following chemoradiotherapy, patients were evaluated with physical examination, mammogram, and fine needle aspiration x 3. Mastectomy was reserved for those patients with evidence of persistent or progressive disease in the involved breast. All patients received additional chemotherapy. Results: Median age was 51 years. Median follow-up was 23.9 months (6-86) months. The breast preservation rate at the time of last follow-up was 74%. The treated breast or chest wall as the first site of failure occurred in only 13%, and the ultimate local control rate with the selected use of mastectomy was 74%. Ten patients underwent mastectomy, 2 of which had pathologically negative specimens despite a clinically palpable residual mass. Response to chemotherapy was predictive of treatment outcome. Of the 15 patients achieving a complete response, 87% remain locoregionally controlled without the use of mastectomy. Five-year overall survival for

Continuous hyperfractionated accelerated radiotherapy (chart) in localized cancer of the esophagus

International Nuclear Information System (INIS)

Powell, Melanie E.B.; Hoskin, Peter J.; Saunders, Michele I.; Foy, Christopher J.W.; Dische, Stanley

1997-01-01

Purpose: To assess the efficacy and toxicity of continuous hyperfractionated accelerated radiotherapy (CHART) in locoregional control compared with a historical group of patients treated with conventionally fractionated radical radiotherapy. Methods and Materials: Between 1985 and 1994, 54 patients with localized esophageal cancer were treated with CHART. Twenty-eight patients received CHART alone (54 Gy in 36 fractions over 12 consecutive days) and 15 were given intravenous mitomycin C and cisplatin on days 10 and 13, respectively. Eleven patients received 40.5 Gy in 27 fractions over 9 days, followed by a single high-dose-rate intraluminal brachytherapy insertion of 15 Gy at 1 cm. Results: Acute toxicity was well tolerated and dysphagia was improved in 35 patients (65%), with 28 (52%) eating a normal diet by week 12. This compares with an improvement in dysphagia score in 72% of the conventionally treated group. The median duration of relief of dysphagia was 7.8 months (range 0-41.4) in the CHART group compared with 5.5 months (range 0-48) in the controls. Strictures developed in 29 patients (61%) and 18 were confirmed on biopsy to be due to recurrent disease. Median survival was 12 months (range 0.5-112) in the CHART group and 15 months (range 3.6-56) in the control patients. Conclusion: CHART is well tolerated and achieves a high rate of local control. Palliation in the short overall treatment time of esophageal cancer is an advantage in these patients whose median survival is only 12 months

Characteristics of Philips SL-20 linear accelerator used for stereotactic radiosurgery/radiotherapy

International Nuclear Information System (INIS)

D'Souza, Harold; Ganesh, T.; Joshi, R.C.; Julka, P.K.; Rath, G.K.; Chander, Subhash; Pant, G.S.

2002-01-01

Commissioning of a stereotactic radiosurgery/stereotactic radiotherapy (SRS/SRT) facility on a modified linear accelerator requires validation of mechanical parameters and establishment of parameters, such as tissue maximum ratio (TMR), relative output factors (OF), and off axis ratios (OAR). The mechanical and beam characteristics of Philips SL-20 linear accelerator modified for SRS/SRT were evaluated and presented. The SRS/SRT procedure carried on Philips SL-20 linear accelerator with Brown-Robert-Wells (BRW) and relocatable Gill-Thomas-Cosman (GTC) head frames along with the Radionics planning system was evaluated. The tertiary collimator consists of the actual treatment cones and their sizes vary from 12.5 mm to 40 mm diameter. The alignment of the auxillary collimator axis with mechanical axes and stability of the isocenter of Philips SL-20 machine was evaluated using Iso-Align device and mechanical isocenter standard (MIS). All the mechanical errors of the linear accelerator were within 1 mm, except the stability of the isocenter while rotating the couch. Alignment of auxiliary collimator axis with the central axis, gantry and couch axes were achieved. The TMR, OF and OAR for 6 MV x-rays from Philips SL-20 linear accelerator for different cone sizes were deduced using a Multidata water phantom with 0.015 cc ion chamber. The difference between 50% width of profiles in two major axes (x and y) were within ± 0.4 mm. The cone dimensions were accurate up to 0.7 mm. The penumbra width for different cones varies from 3.1 mm to 3.5 mm. Dose linearity of the monitoring system was ≤ 1% above 5 MU. The mechanical and beam characteristics including dose linearity of the SL-20 machine are presented. The beam characteristics of this machine are comparable with the other modified linear accelerators for SRS/SRT. The shift of isocenter during rotation of couch can be nullified by fine adjusting laser target localizing frame to the laser position using micrometer screws

Hyperfractionated-accelerated radiotherapy followed by radical surgery in locally advanced tumors of the oral cavity

International Nuclear Information System (INIS)

Hoeller, U.; Biertz, I.; Tribius, S.; Alberti, W.; Flinzberg, S.; Schmelzle, R.

2006-01-01

Purpose: to evaluate the outcome of hyperfractionated-accelerated radiotherapy and subsequent planned primary tumor resection and radical neck dissection in locally advanced tumors of the oral cavity. Patients and Methods: this retrospective analysis evaluates 126 subsequent patients who were treated between 1988 and 1997 for locally advanced tumors of the oral cavity (with extension into the oropharynx in 17 patients), 34 (27%) AJCC stage III and 92 (73%) stage IV. Primary tumor and nodal metastases were irradiated with 1.4 Gy bid to a median total dose of 72.8 Gy (range 58.8-75.6 Gy). Then, planned radical surgery of the primary site according to the initial tumor extent and cervical nodes was performed. Median follow-up of living patients was 6 years (range 1-11 years). Results: 4 weeks after radiotherapy, 14 patients (11%) had complete tumor remission, 92 (73%) partial remission, 15 (12%) no change, and five (4%) progressive disease. Complete resection was achieved in 117 (93%) patients (nine incomplete resections). 5-year locoregional control rate was 62 ± 9%, overall survival 36 ± 9%. Surgery-related morbidity occurred in 42 patients (33%; mainly delayed wound healing and fistulae), overall severe treatment-related morbidity in 46 patients (36%). 24/84 relapse-free patients (29%) required a percutaneous gastrostomy or nasal tube ≥ 1 year after therapy. Conclusion: in this study, the outcome of combined curative radiotherapy and planned surgery of the primary tumor and neck nodes was comparable to reported results of hyperfractionated radiotherapy with or without salvage surgery of the neck nodes with respect to locoregional control and overall survival. Planned surgery carries a substantial risk of morbidity and seems to offer no benefit in comparison to salvage surgery of the neck nodes only. Therefore, salvage surgery is preferred. (orig.)

IAEA-HypoX. A randomized multicenter study of the hypoxic radiosensitizer nimorazole concomitant with accelerated radiotherapy in head and neck squamous cell carcinoma

DEFF Research Database (Denmark)

Metwally, Mohamed Ahmed Hassan; Ali, Rubina; Kuddu, Maire

2015-01-01

PURPOSE: To test the hypothesis that radiotherapy (RT) of head and neck squamous cell carcinoma (HNSCC) can be improved by hypoxic modification using nimorazole (NIM) in association with accelerated fractionation. MATERIALS AND METHODS: The protocol was activated in March 2012 as an international...

Five Year Outcome of 145 Patients With Ductal Carcinoma In Situ (DCIS) After Accelerated Breast Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Ciervide, Raquel [Department of Radiation Oncology, New York University School of Medicine, NYU Langone Medical Center, New York, New York (United States); Dhage, Shubhada; Guth, Amber; Shapiro, Richard L.; Axelrod, Deborah M.; Roses, Daniel F. [Department of Surgery, New York University School of Medicine, NYU Langone Medical Center, New York, New York (United States); Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, NYU Langone Medical Center, New York, New York (United States)

2012-06-01

Background: Accelerated whole-breast radiotherapy (RT) with tumor bed boost in the treatment of early invasive breast cancer has demonstrated equivalent local control and cosmesis when compared with standard RT. Its efficacy in the treatment of ductal carcinoma in situ (DCIS) remains unknown. Methods and Materials: Patients treated for DCIS with lumpectomy and negative margins were eligible for 2 consecutive hypofractionated whole-breast RT clinical trials. The first trial (New York University [NYU] 01-51) prescribed to the whole breast 42 Gy (2.8 Gy in 15 fractions) and the second trial (NYU 05-181) 40.5 Gy (2.7 Gy in 15 fractions) with an additional daily boost of 0.5 Gy to the surgical cavity. Results: Between 2002 and 2009, 145 DCIS patients accrued, 59 to the first protocol and 86 to the second trial. Median age was 56 years and 65% were postmenopausal at the time of treatment. Based on optimal sparing of normal tissue, 79% of the patients were planned and treated prone and 21% supine. At 5 years' median follow-up (60 months; range 2.6-105.5 months), 6 patients (4.1%) experienced an ipsilateral breast recurrence in all cases of DCIS histology. In 3/6 patients, recurrence occurred at the original site of DCIS and in the remaining 3 cases outside the original tumor bed. New contralateral breast cancers arose in 3 cases (1 DCIS and 2 invasive carcinomas). Cosmetic self-assessment at least 2 years after treatment is available in 125 patients: 91% reported good-to-excellent and 9% reported fair-to-poor outcomes. Conclusions: With a median follow-up of 5 years, the ipsilateral local recurrence rate is 4.1%, comparable to that reported from the NSABP (National Surgical Adjuvant Breast and Bowel Project) trials that employed 50 Gy in 25 fractions of radiotherapy for DCIS. There were no invasive recurrences. These results provide preliminary evidence that accelerated hypofractionated external beam radiotherapy is a viable option for DCIS.

High-energy accelerators in medicine

CERN Document Server

Mandrillon, Pierre

1992-05-04

The treatment of tumours with charged particles, ranging from protons to "light ions" ( Carbon, Oxygen, Neon) has many advantages, but up to now has been little used because of the absence of facilities. After the successful pioneering work carried out with accelerators built for physics research, machines dedicated to this new radiotherapy are planned or already in construction. The rationale for this new radiotherapy, the high energy accelerators and the beam delivery systems are presented in these two lectures.

Accelerated Hypofractionated Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer: Long-Term Results

International Nuclear Information System (INIS)

Soliman, Hany; Cheung, Patrick; Yeung, Latifa; Poon, Ian; Balogh, Judith; Barbera, Lisa; Spayne, Jacqueline; Danjoux, Cyril; Dahele, Max; Ung, Yee

2011-01-01

Purpose: To retrospectively review the results of a single-institution series of accelerated hypofractionated radiotherapy for early-stage non-small-cell lung cancer (NSCLC) in patients who are medically inoperable or who refuse surgery. Methods and Materials: Peripherally located T1 to T3 N0 M0 tumors were treated with 48 to 60 Gy in 12 to 15 fractions between 1996 and 2007. No elective nodal irradiation was delivered. Patient, tumor, and treatment information was abstracted from the medical records. Results: A total of 124 tumors were treated in 118 patients (56 male and 62 female). Median age at diagnosis was 76.3 years (range, 49-90 years). In all, 113 patients (95.8%) were not surgical candidates because of medical comorbidities. The 2- and 5-year overall survival (OS) rates were 51.0% and 23.3%, respectively, and the 2- and 5-year cause-specific survival (CSS) rates were 67.6% and 59.8%, respectively. The 2- and 5-year actuarial local control (LC) rates were 76.2% and 70.1%, respectively. Univariate analysis revealed that tumor size less than 3cm compared with greater than 3 cm resulted in significantly improved OS (40.0% vs. 5.0% at 5 years; p = 0.0002), CSS (69.7% vs. 45.1% at 5 years; p = 0.0461), and a trend toward better LC (82.5% vs. 66.9% at 2 years, 76.6% vs. 60.8% at 5 years; p = 0.0685). Treatment was well tolerated and there were no treatment delays because of acute toxicity. Conclusions: Accelerated hypofractionated radiotherapy with 48 to 60 Gy using fractions of 4 Gy per day provides very good results for small tumors in medically inoperable patients with early-stage NSCLC.

The situation of radiotherapy in 2011

International Nuclear Information System (INIS)

2012-06-01

Published within the frame of the French 2009-2013 cancer plan, this report proposes an analysis of the situation of radiotherapy in France. More particularly, it analyses the French offer in terms of radiotherapy treatments and the French position in Europe. A second part analyses equipment (accelerators and other equipment) and techniques aimed at radiotherapy treatment preparation and delivery. The following techniques are addressed: three-dimensional conformational, intensity modulation, intracranial and extracranial stereotactic, image-guided, total body irradiation, hadron-therapy, and peri-operative radiotherapy. The last parts analyse the activity of radiotherapy centres in terms of treated patients, of patient age structure, of sessions and preparations, and of treated pathologies, the medical and paramedical personnel in charge of radiotherapy, and financial and cost aspects

Randomized phase III trial of concurrent chemoradiotherapy vs accelerated hyperfractionation radiotherapy in locally advanced head and neck cancer

International Nuclear Information System (INIS)

Chitapanarux, Imjai; Kamnerdsupaphon, Pimkhuan; Pukanhapan, Nantaka; Tharavichitkul, Ekkasit; Vongtama, Roy

2013-01-01

The aim of this study was to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) vs accelerated hyperfractionation with concomitant boost (CCB) as a primary treatment for patients with Stage III-IV squamous cell carcinoma of head and neck (SCCHN). A total of 85 non-metastatic advanced SCCHN patients were accrued from January 2003 to December 2007. Of these, 48 and 37 patients received CCRT and CCB, respectively. The patients were randomized to receive either three cycles of carboplatin and 5-fluorouracil plus conventional radiotherapy (CCRT, 66 Gy in 6.5 weeks) or hybrid accelerated radiotherapy (CCB, 70 Gy in 6 weeks). The primary endpoint was determined by locoregional control rate. The secondary endpoints were overall survival and toxicity. With a median follow-up of 43 months (range, 3-102), the 5-year locoregional control rate was 69.6% in the CCRT arm vs 55.0% in the CCB arm (P = 0.184). The 5-year overall survival rate was marginally significantly different (P = 0.05): 76.1% in the CCRT arm vs 63.5% in the CCB arm. Radiotherapy treatment interruptions of more than three days were 60.4% and 40.5% in the CCRT arm and CCB arm, respectively. The median total treatment time was 55.5 days in the CCRT arm and 49 days in the CCB arm. The rate of Grade 3 - 4 acute mucositis was significantly higher in the CCB arm (67.6% vs 41.7%, P = 0.01), but no high grade hematologic toxicities were found in the CCB arm (27.2% vs 0%). CCRT has shown a trend of improving outcome over CCB irradiation in locoregionally advanced head and neck cancer. (author)

The selection of patients for accelerated radiotherapy on the basis of tumor growth kinetics and intrinsic radiosensitivity

International Nuclear Information System (INIS)

Tucker, S.L.; Kang-Sow Chan

1990-01-01

Mathematical modelling was used to reach qualitative conclusions concerning the relative rate of local tumor control that might be achieved by using accelerated fractionation to treat only the patients with the most rapidly growing rumors, compared with the control rated that could be expected from either conventional or accelerated radiotherapy alone. The results suggest that concomitant boost therapy is equally or more effective than conventional dose fractionation for all tumors, regardless of their growth kinetics. For tumors with very short clonogen doubling times, CHART (continuous hyperfractionated accelerated radiotherapy) may be even more effective than concomitant boost treatment, but CHART is less effective than conventional or concomitant boost therapy for tumors with longer clonogen doubling times. Thus, there is a rationale for using a predictive assay of tumor clonogen doubling times to identify the patients who should be treated with CHART. However, improvements in local tumor control resulting from concomitant boost treatment or the selective use of CHART are not likely to be apparent in the population as a whole, because the overall control rated are largely determined by refractory tumors having little chance of control with any of the treatments and by higher responsive tumors that are likely to be controlled regardless of the treatment choice. Differences in control rated with different treatment strategies are most apparent in the stochastic fraction of the population, which excludes those patients for whom there is either very little change (e.g. 99%) of achieving local control with both treatments. The stochastic fraction can be approximated by excluding those patients with the most radioresistant and the most radiosensitive tumors, since intrinsic tumor radiosensitivity appears to be the single most important factor determining treatment outcome. (author). 32 refs.; 4 figs.; 5 tabs

Nelson's syndrome: single centre experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy.

Science.gov (United States)

Wilson, Peter J; Williams, Janet R; Smee, Robert I

2014-09-01

Nelson's syndrome is a unique clinical phenomenon of growth of a pituitary adenoma following bilateral adrenalectomies for the control of Cushing's disease. Primary management is surgical, with limited effective medical therapies available. We report our own institution's series of this pathology managed with radiation: prior to 1990, 12 patients were managed with conventional radiotherapy, and between 1990 and 2007, five patients underwent stereotactic radiosurgery (SRS) and two patients fractionated stereotactic radiotherapy (FSRT), both using the linear accelerator (LINAC). Tumour control was equivocal, with two of the five SRS patients having a reduction in tumour volume, one patient remaining unchanged, and two patients having an increase in volume. In the FSRT group, one patient had a decrease in tumour volume whilst the other had an increase in volume. Treatment related morbidity was low. Nelson's syndrome is a challenging clinical scenario, with a highly variable response to radiation in our series. Copyright © 2014 Elsevier Ltd. All rights reserved.

Quality of life assessment in advanced non-small-cell lung cancer patients undergoing an accelerated radiotherapy regimen: report of ECOG study 4593

International Nuclear Information System (INIS)

Auchter, Richard M.; Scholtens, Denise; Adak, Sudeshna; Wagner, Henry; Cella, David F.; Mehta, Minesh P.

2001-01-01

Purpose: To prospectively evaluate the quality of life (QOL) before, at completion, and after therapy for patients receiving an accelerated fractionation schedule of radiotherapy for advanced, unresectable non-small-cell lung cancer in a Phase II multi-institutional trial. Methods and Materials: The Functional Assessment of Cancer Therapy-Lung (FACT-L) patient questionnaire was used to score the QOL in patients enrolled in the Eastern Cooperative Oncology Group Phase II trial (ECOG 4593) of hyperfractionated accelerated radiotherapy in non-small-cell lung cancer. Radiotherapy (total dose 57.6 Gy in 36 fractions) was delivered during 15 days, with three radiation fractions given each treatment day. The protocol was activated in 1993, and 30 patients had accrued by November 1995. The FACT-L questionnaire was administered at study entry (baseline), on the last day of radiotherapy (assessment 2), and 4 weeks after therapy (assessment 3). The FACT-L includes scores for physical, functional, emotional, and social well-being (33 items), and a subscale of lung cancer symptoms (10 additional items). The summation of the physical, functional, and lung cancer symptom subscales (21 items) constitutes the Trial Outcome Index (TOI), considered the most clinically relevant outcome measure in lung cancer treatment trials. Results: The FACT-L completion rates at the designated study time points were as follows: baseline, 30 of 30 (100%); assessment 2, 29 (97%) of 30; and assessment 3, 24 (80%) of 30. At treatment completion, statistically significant declines in QOL scores were noted, compared with baseline for physical and functional well-being. Emotional well-being scores improved at both assessment 2 and assessment 3. The physical and functional scores returned approximately to baseline values at assessment 3. The change in TOI score was evaluated as a function of the clinical response to treatment, toxicity grade, and survival; no clear association was noted. A trend for the

Preliminary results of a phase I/II study of simultaneous modulated accelerated radiotherapy for nondisseminated nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Lee, Sang-wook; Back, Geum Mun; Yi, Byong Yong; Choi, Eun Kyung; Ahn, Seung Do; Shin, Seong Soo; Kim, Jung-hun; Kim, Sang Yoon; Lee, Bong-Jae; Nam, Soon Yuhl; Choi, Seung-Ho; Kim, Seung-Bae; Park, Jin-hong; Lee, Kang Kyoo; Park, Sung Ho; Kim, Jong Hoon

2006-01-01

Purpose: To present preliminary results of intensity-modulated radiotherapy (IMRT) with the simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Methods and Materials: Twenty patients who underwent IMRT for nondisseminated NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. Intensity-modulated radiotherapy was delivered with the 'step and shoot' SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume, 60 Gy (2 Gy/day) to the clinical target volume and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received cisplatin once per week. Results: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had Radiation Therapy Oncology Group Grade 3 mucositis, whereas 9 (45%) had Grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no Grade 3 or 4 xerostomia. All patients showed complete response. Two patients had distant metastases and locoregional recurrence, respectively. Conclusion: Intensity-modulated radiotherapy with the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and might also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity

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.

Effect of Hyperoxygenation on Tissue pO2 and Its Effect on Radiotherapeutic Efficacy of Orthotopic F98 Gliomas

International Nuclear Information System (INIS)

Khan, Nadeem; Mupparaju, Sriram M.S.; Hekmatyar, Shahryar K.; Hou Huagang; Lariviere, Jean P.; Demidenko, Eugene; Gladstone, David J.; Kauppinen, Risto A.; Swartz, Harold M.

2010-01-01

Purpose: Lack of methods for repeated assessment of tumor pO 2 limits the ability to test and optimize hypoxia-modifying procedures being developed for clinical applications. We report repeated measurements of orthotopic F98 tumor pO 2 and relate this to the effect of carbogen inhalation on tumor growth when combined with hypofractionated radiotherapy. Methods and Materials: Electron paramagnetic resonance (EPR) oximetry was used for repeated measurements of tumor and contralateral brain pO 2 in rats during 30% O 2 and carbogen inhalation for 5 consecutive days. The T 1 -enhanced volumes and diffusion coefficients of the tumors were assessed by magnetic resonance imaging (MRI). The tumors were irradiated with 9.3 Gy x 4 fractions in rats breathing 30% O 2 or carbogen to determine the effect on tumor growth. Results: The pretreatment F98 tumor pO 2 varied between 8 and 16 mmHg, while the contralateral brain had 41 to 45 mmHg pO 2 during repeated measurements. Carbogen breathing led to a significant increase in tumor and contralateral brain pO 2 ; however, this effect declined over days. Irradiation of the tumors in rats breathing carbogen resulted in a significant decrease in tumor growth and an increase in the diffusion coefficient measured by MRI. Conclusions: The results provide quantitative measurements of the effect of carbogen inhalation on intracerebral tumor pO 2 and its effect on therapeutic outcome. Such direct repeated pO 2 measurements by EPR oximetry can provide temporal information that could be used to improve therapeutic outcome by scheduling doses at times of improved tumor oxygenation. EPR oximetry is currently being tested for clinical applications.

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)

Gemcitabine, cisplatin, and hyperfractionated accelerated radiotherapy for locally advanced non-small cell lung cancer.

Science.gov (United States)

Zwitter, Matjaz; Kovac, Viljem; Smrdel, Uros; Strojan, Primoz

2006-09-01

Due to potent radiosensitization and potential serious or fatal toxicity, concurrent gemcitabine and irradiation should only be applied within clinical trials. We here present experience from a phase I-II clinical trial for patients with locally advanced non-small cell lung cancer (NSCLC) treated with hyperfractionated accelerated radiotherapy and concurrent low-dose gemcitabine. Eligible patients had locally advanced inoperable NSCLC without pleural effusion, Eastern Cooperative Oncology Group performance status 0-1, were chemotherapy naïve and had no previous radiotherapy to the chest, and had adequate hematopoietic, liver, and kidney function. Routine brain computed tomography was not performed, and positron emission tomography/computed tomography was not available. Treatment consisted of three parts: induction chemotherapy with gemcitabine and cisplatin in standard doses, local treatment with concurrent chemotherapy and radiotherapy, and consolidation chemotherapy. Patients were irradiated with opposed AP-PA and oblique fields, using 2.5-D treatment planning. Although corrections for inhomogeneous tissue were made, volume of total lung receiving > or =20 Gy (V20) could not be determined. The trial started as phase I, aimed to determine the dose-limiting toxicity and maximal tolerated dose (MTD) for concurrent hyperfractionated radiotherapy (1.4 Gy twice daily) and gemcitabine 55 mg/m twice weekly as a radiosensitizer. Phase II of the trial then continued at the level of MTD. Twenty-eight patients with NSCLC, nine patients with stage IIIA, 16 patients with IIIB, and three patients with an inoperable recurrence after previous surgery, entered the trial. The first 12 patients entered Phase I of the trial at the initial level of 42 Gy in 30 fractions in 3 weeks. Dose-limiting toxicity was acute esophagitis; 47.6 Gy in 34 fractions in 3.5 weeks was the MTD for this regimen of concurrent chemotherapy and radiotherapy. In phase II of the trial, this dose was applied

An original accelerated radiotherapy schedule in stage III to IV head and neck cancers. Results in a multicenter setting

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Allal, A.S. [Geneva Univ. Hospital (Switzerland). Div. of Radiation Oncology; Monney, M.; Rosset, A.; Ozsahin, M. [Hopital Cantonal Universitaire, Lausanne (Switzerland). Inst. de Radiographie; Guillemin, C. [Cantonal Radiotherapy Department Sion (Switzerland)

2000-01-01

Background: Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting. Patients and Methods: Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.9 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days). Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2x1.6 Gy to 1.66 Gy/day) to a larger head and neck volume. Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles). Results: Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%). Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases. The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71). The 5-year overall actuarial survival was 32% (95% CI: 18 to 46). Induction chemotherapy was not associated with a more favorable outcome. Conclusions: This study demonstrates the feasibility of this schedule in a multicenter setting. The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable. Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials. (orig.) [German] Hintergrund: Die Wirksamkeit der akzelerierten Bestrahlung in bezug auf die Bewaeltigung der Tumorzellrepopulation waehrend einer Radiotherapie ist vor kurzem nachgewiesen worden. Das Verhaeltnis zwischen therapeutischem Effekt und Toxizitaet duerfte fuer fuenfwoechige Schemen

Cushing's disease: a single centre's experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy.

Science.gov (United States)

Wilson, P J; Williams, J R; Smee, R I

2014-01-01

Cushing's disease is hypercortisolaemia secondary to an adrenocorticotrophic hormone secreting pituitary adenoma. Primary management is almost always surgical, with limited effective medical interventions available. Adjuvant therapy in the form of radiation is gaining popularity, with the bulk of the literature related to the Gamma Knife. We present the results from our own institution using the linear accelerator (LINAC) since 1990. Thirty-six patients who underwent stereotactic radiosurgery (SRS), one patient who underwent fractionated stereotactic radiotherapy (FSRT) and for the purposes of comparison, 13 patients who had undergone conventional radiotherapy prior to 1990, were included in the analysis. Serum cortisol levels improved in nine of 36 (25%) SRS patients and 24 hour urinary free cortisol levels improved in 13 of 36 patients (36.1%). Tumour volume control was excellent in the SRS group with deterioration in only one patient (3%). The patient who underwent FSRT had a highly aggressive tumour refractory to radiation. Published by Elsevier Ltd.

[Current status and potential perspectives in classical radiotherapy technology].

Science.gov (United States)

Dabić-Stanković, Kata M; Stanković, Jovan B; Radosević-Jelić, Ljiljana M

2004-01-01

After purchase of radiotherapy equipment in 2003, classic radiation therapy in Serbia will reach the highest world level. In order to define the highest standards in radiation technology, we analyzed the current status and potential perspectives of radiation therapy. An analysis of present situation in the USA, assumed as the most developed in the world, was done. Available data, collected in the last 3 years (equipment assortment, therapy modalities, workload and manpower) for 284 radiotherapy centers, out of potential 2050, were analyzed. Results were presented as crude percentage and matched to point current status. The analysis showed that CLINAC accelerators are the most popular (82.7%), as well as, ADAC (43.7%) and Focus (CMS) (27.4%) systems for therapy planning. Movement towards virtual simulation is evident (59.3%), although classic "simulation" is not fully eliminated from the radiotherapy chain. The most popular brachytherapy afterloader is Microselectron HDR (71%). About 64.4% centers use IMPAC communication/verification/record system that seems more open than Varis. All centers practice modern radiotherapy modalities and techniques (CPRT, IMRT, SRS/SRT, TBI, IORT, IVBHRT, HDR BHRT, etc.). CT and MRI availability is out of question, but PET is available in 3% of centers, however this percentage is rapidly growing. Up to 350 new patients per year are treated by one accelerator (about 35 pts. a day). Centers are relatively small and utilize 2-3 accelerators on average. Average FTE staffing norm is 4 radiation oncologists, 2-3 medical radiotherapy physicists, about 3 certified medical dosimetrists and about 6 radiotherapy technologists. In the past 5 years relative stagnation in classic radiotherapy has been observed. In spite of substantial investments in technology and consequent improvements, as well as wide introduction of computers in radiotherapy, radiotherapy results have not changed significantly. Vendor developement strategies do not point that

Stability of electron-beam energy monitor for quality assurance of the electron-beam energy from radiotherapy accelerators

International Nuclear Information System (INIS)

Chida, Koichi; Zuguchi, Masayuki; Saito, Haruo; Takai, Yoshihiro; Mitsuya, Masatoshi; Sakakida, Hideharu; Yamada, Shogo; Kohzuki, Masahiro

2002-01-01

Information on electron energy is important in planning radiation therapy using electrons. The Geske 3405 electron beam energy monitor (Geske monitor, PTW Nuclear Associates, Carle Place, NY, USA) is a device containing nine ionization chambers for checking the energy of the electron beams produced by radiotherapy accelerators. We wondered whether this might increase the likelihood of ionization chamber trouble. In spite of the importance of the stability of such a quality assurance (QA) device, there are no reports on the stability of values measured with a Geske monitor. The purpose of this paper was therefore to describe the stability of a Geske monitor. It was found that the largest coefficient of variation (CV) of the Geske monitor measurements was approximately 0.96% over a 21-week period. In conclusion, the stability of Geske monitor measurements of the energy of electron beams from a linear accelerator was excellent. (author)

Construction of a remote radiotherapy planning system

International Nuclear Information System (INIS)

Ogawa, Yoshihiro; Nemoto, Kenji; Takahashi, Chiaki; Takai, Yoshihiro; Yamada, Shogo; Seiji, Hiromasa; Sasaki, Kazuya

2005-01-01

We constructed a remote radiotherapy planning system, and we examined the usefulness of and faults in our system in this study. Two identical radiotherapy planning systems, one installed at our institution and the other installed at an affiliated hospital, were used for radiotherapy planning. The two systems were connected by a wide area network (WAN), using a leased line. Beam data for the linear accelerator at the affiliated hospital were installed in the two systems. During the period from December 2001 to December 2002, 43 remote radiotherapy plans were made using this system. Data were transmitted using a file transfer protocol (FTP) software program. The 43 radiotherapy plans examined in this study consisted of 13 ordinary radiotherapy plans, 28 radiotherapy plans sent to provide assistance for medical residents, and 2 radiotherapy plans for emergency cases. There were ten minor planning changes made in radiotherapy plans sent to provide assistance for medical residents. Our remote radiotherapy planning system based on WAN using a leased line is useful for remote radiotherapy, with advantages for both radiation oncologists and medical residents. (author)

Particle accelerators in the Czech lands

International Nuclear Information System (INIS)

Janovsky, I.

2007-01-01

The paper is structured as follows: A short look into history of accelerators; Particle accelerators in the Czech lands (Accelerators at the Institute of Nuclear Physics; Accelerators at the Faculty of Mathematics and Physics, Charles University; Czechoslovak betatron, accelerators for non-destructive testing and radiotherapy; Czechoslovak high-frequency linear electron accelerator; Czechoslovak-Soviet microtron; Accelerators at the State Research Institute of Textiles; Accelerators at the Kablo Vrchlabi plant; and Cyclotrons in the medical sector. (P.A.)

Preoperative concurrent CBDCA chemotherapy and accelerated hyperfractionated radiotherapy for squamous cell carcinoma of the maxillary region

International Nuclear Information System (INIS)

Omura, Ken; Harada, Hiroyuki; Suzuki, Haruhiko; Takeuchi, Yosuke; Hatano, Kazuo; Togawa, Takashi

2001-01-01

Between 1994 and 2000, 28 patients with T3/T4 squamus cell carcinoma of the maxillary region (maxillary sinus, 22; maxillary gingiva, 4; maxillary bone, 1; buccal mucosa, 1) had accelerated hyperfractionated radiotherapy combined with simultaneous CBDCA chemotherapy preoperatively, at Chiba Cancer Center Hospital. The protocol consisted of combined therapy with accelerated hyperfractionated irradiation of 1.6 Gy, twice a day, to a total dose of 32.0-51.2 Gy and concurrent intra-arterial or intravenous infusion of CBDCA 20-30 mg/body/day for a cumulative total dose of 270-480 mg. After completion of the preoperative combined therapy, the clinical CR rate was 17.9%, and the good PR·CR rate was 32.1%. According to the initial findings and response to the combined therapy, all patients had maxillectomy (subtotal, 3; total, 16; extended, 9) 4 weeks after completion of the preoperative combined therapy. Postoperatively, the complete pathologic response (Ohboshi and Shimozato's classification, grade III and IV) rate was 28.6%. And the actuarial local control rate was 85.7%, with a mean follow-up of 46.2 months. Based on these results, we believe this preoperative therapy with CBDCA chemotherapy and accelerated hyperfractionated radiation is a significant choice as treatment for squamous cell cancer of the maxillary region. (author)

The application of accelerator for medical therapy in Indonesia

International Nuclear Information System (INIS)

Yunasfi; Mudjiono; Irwati, Dwi; Hanifa

2003-01-01

The study of the application of accelerator for medical therapy in Indonesia was carried out. Accelerator that used for therapy is an electron lintier accelerator (Linac) which can radiate electron beam and X-ray. This study shows that there are 8 unit of Linac distributed at 6 big hospitals in Indonesia, especially in Jakarta. This study also shows that radiotherapy facilities in Indonesia is un sufficient of. Therefore, providing radiotherapy facilities for hospitals, especially the big hospitals in Indonesia is necessary

Effects of breathing a hyperoxic hypercapnic gas mixture on blood oxygenation and vascularity of head-and-neck tumors as measured by magnetic resonance imaging

International Nuclear Information System (INIS)

Rijpkema, Mark; Kaanders, Johannes H.A.M.; Joosten, Frank; Kogel, Albert J. van der; Heerschap, Arend

2002-01-01

Purpose: For head-and-neck tumors, breathing a hyperoxic hypercapnic gas mixture and administration of nicotinamide has been shown to result in a significantly improved tumor response to accelerated radiotherapy (ARCON, Accelerated Radiotherapy with CarbOgen and Nicotinamide). This may be caused by improved tumor oxygenation, possibly mediated by vascular effects. In this study, both blood oxygenation and vascular effects of breathing a hyperoxic hypercapnic gas mixture (98% O 2 +2% CO 2 ) were assessed by magnetic resonance imaging (MRI) in patients with head-and-neck tumors. Methods and Materials: Tumor vascularity and oxygenation were investigated by dynamic gadolinium contrast-enhanced MRI and blood oxygen level dependent (BOLD) MRI, respectively. Eleven patients with primary head-and-neck tumors were each measured twice; with and without breathing the hyperoxic hypercapnic gas mixture. Results: BOLD MR imaging revealed a significant increase of the MRI time constant of transverse magnetization decay (T 2 *) in the tumor during hypercapnic hyperoxygenation, which correlates to a decrease of the deoxyhemoglobin concentration. No changes in overall tumor vascularity were observed, as measured by the gadolinium contrast uptake rate in the tumor. Conclusion: Breathing a hyperoxic hypercapnic gas mixture improves tumor blood oxygenation in patients with head-and-neck tumors, which may contribute to the success of the ARCON therapy

Prospective, longitudinal electroglottographic study of voice recovery following accelerated hypofractionated radiotherapy for T1/T2 larynx cancer

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Kazi, Rehan [Head and Neck Unit, Royal Marsden Hospital, London (United Kingdom); Institute of Cancer Research, Cancer Research UK Centre for Cell and Molecular Biology, London (United Kingdom); Venkitaraman, Ramachandran; Johnson, Catherine; Prasad, Vyas; Clarke, Peter; Newbold, Kate; Rhys-Evans, Peter; Nutting, Christopher [Head and Neck Unit, Royal Marsden Hospital, London (United Kingdom); Harrington, Kevin [Head and Neck Unit, Royal Marsden Hospital, London (United Kingdom); Institute of Cancer Research, Cancer Research UK Centre for Cell and Molecular Biology, London (United Kingdom)], E-mail: kevinh@icr.ac.uk

2008-05-15

Background and purpose: To measure voice outcomes following accelerated hypofractionated radiotherapy for larynx cancer. Materials and methods: Twenty-five patients with T1/T2 glottic cancer underwent serial electroglottographic and acoustic analysis (sustained vowel/i/ and connected speech) before radiotherapy and 1, 6 and 12 months post-treatment. Twenty-five normal subjects served as a reference control population. Results: Pre-treatment measures were significantly worse for larynx cancer patients. Median jitter (0.23% vs 0.97%, p = 0.001) and shimmer (0.62 dB vs 0.98 dB, p = 0.05) and differences in data ranges reflected greater frequency and amplitude perturbation in the larynx cancer patients. Pre-treatment Mean Phonation Time (MPT) was significantly reduced (21 s vs 14.8 s, p = 0.002) in larynx cancer patients. There was a trend towards improvement of jitter, shimmer and normalized noise energy at 12 months post-treatment. MPT improved but remained significantly worse than for normal subjects (21 s vs 16.4 s, p = 0.013). Average fundamental frequency resembled normal subjects, including improvement of the measured range (91.4-244.6 Hz in controls vs 100-201 Hz in post-treatment larynx cancer patients). Conclusions: This non-invasive technique effectively measures post-treatment vocal function in larynx cancer patients. This study demonstrated improvement of many key parameters that influence voice function over 12 months after radiotherapy.

Prospective, longitudinal electroglottographic study of voice recovery following accelerated hypofractionated radiotherapy for T1/T2 larynx cancer

International Nuclear Information System (INIS)

Kazi, Rehan; Venkitaraman, Ramachandran; Johnson, Catherine; Prasad, Vyas; Clarke, Peter; Newbold, Kate; Rhys-Evans, Peter; Nutting, Christopher; Harrington, Kevin

2008-01-01

Background and purpose: To measure voice outcomes following accelerated hypofractionated radiotherapy for larynx cancer. Materials and methods: Twenty-five patients with T1/T2 glottic cancer underwent serial electroglottographic and acoustic analysis (sustained vowel/i/ and connected speech) before radiotherapy and 1, 6 and 12 months post-treatment. Twenty-five normal subjects served as a reference control population. Results: Pre-treatment measures were significantly worse for larynx cancer patients. Median jitter (0.23% vs 0.97%, p = 0.001) and shimmer (0.62 dB vs 0.98 dB, p = 0.05) and differences in data ranges reflected greater frequency and amplitude perturbation in the larynx cancer patients. Pre-treatment Mean Phonation Time (MPT) was significantly reduced (21 s vs 14.8 s, p = 0.002) in larynx cancer patients. There was a trend towards improvement of jitter, shimmer and normalized noise energy at 12 months post-treatment. MPT improved but remained significantly worse than for normal subjects (21 s vs 16.4 s, p = 0.013). Average fundamental frequency resembled normal subjects, including improvement of the measured range (91.4-244.6 Hz in controls vs 100-201 Hz in post-treatment larynx cancer patients). Conclusions: This non-invasive technique effectively measures post-treatment vocal function in larynx cancer patients. This study demonstrated improvement of many key parameters that influence voice function over 12 months after radiotherapy

Challenges in Linear Accelerator Radiotherapy for Chordomas and Chondrosarcomas of the Skull Base: Focus on Complications

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Hauptman, Jason S., E-mail: jhauptman@mednet.ucla.edu [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Barkhoudarian, Garni; Safaee, Michael; Gorgulho, Alessandra [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Tenn, Steven; Agazaryan, Nzhde; Selch, Michael [Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); De Salles, Antonio A.F. [Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States); Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA (United States)

2012-06-01

Purpose: Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that infiltrate the skull base. Currently, consensus therapy includes surgical resection and adjuvant radiotherapy. Radiation delivery is typically limited by the proximity of these tumors to critical skull base structures. Methods: This is a retrospective review of 13 cases of chordomas and 2 cases of chondroid chondrosarcomas of the skull based treated with linear accelerator stereotactic radiotherapy (SRT, n = 10) or stereotactic radiosurgery (SRS, n = 5). The average time to the most recent follow-up visit was 4.5 years. The tumor characteristics, treatment details, and outcomes were recorded. Each radiation plan was reviewed, and the dosage received by the brainstem, optic apparatus, and pituitary was calculated. Results: Of the 10 patients treated with SRT, 6 were found to have unchanged or decreased tumor size as determined from radiographic follow-up. Of the 5 patients treated with SRS, 3 were found to have stable or unchanged tumors at follow-up. The complications included 1 SRT patient who developed endocrinopathy, 2 patients (1 treated with SRS and the other with SRT), who developed cranial neuropathy, and 1 SRS patient who developed visual deficits. Additionally, 1 patient who received both SRS and SRT within 2 years for recurrence experienced transient medial temporal lobe radiation changes that resolved. Conclusions: Where proton beam therapy is unavailable, linear accelerator-based SRT or radiosurgery remains a safe option for adjuvant therapy of chordomas and chondrosarcomas of the skull base. The exposure of the optic apparatus, pituitary stalk, and brainstem must be considered during planning to minimize complications. If the optic apparatus is included in the 80% isodose line, it might be best to fractionate therapy. Exposure of the pituitary stalk should be kept to <30 Gy to minimize endocrine dysfunction. Brainstem exposure should be

Challenges in Linear Accelerator Radiotherapy for Chordomas and Chondrosarcomas of the Skull Base: Focus on Complications

International Nuclear Information System (INIS)

Hauptman, Jason S.; Barkhoudarian, Garni; Safaee, Michael; Gorgulho, Alessandra; Tenn, Steven; Agazaryan, Nzhde; Selch, Michael; De Salles, Antonio A.F.

2012-01-01

Purpose: Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that infiltrate the skull base. Currently, consensus therapy includes surgical resection and adjuvant radiotherapy. Radiation delivery is typically limited by the proximity of these tumors to critical skull base structures. Methods: This is a retrospective review of 13 cases of chordomas and 2 cases of chondroid chondrosarcomas of the skull based treated with linear accelerator stereotactic radiotherapy (SRT, n = 10) or stereotactic radiosurgery (SRS, n = 5). The average time to the most recent follow-up visit was 4.5 years. The tumor characteristics, treatment details, and outcomes were recorded. Each radiation plan was reviewed, and the dosage received by the brainstem, optic apparatus, and pituitary was calculated. Results: Of the 10 patients treated with SRT, 6 were found to have unchanged or decreased tumor size as determined from radiographic follow-up. Of the 5 patients treated with SRS, 3 were found to have stable or unchanged tumors at follow-up. The complications included 1 SRT patient who developed endocrinopathy, 2 patients (1 treated with SRS and the other with SRT), who developed cranial neuropathy, and 1 SRS patient who developed visual deficits. Additionally, 1 patient who received both SRS and SRT within 2 years for recurrence experienced transient medial temporal lobe radiation changes that resolved. Conclusions: Where proton beam therapy is unavailable, linear accelerator-based SRT or radiosurgery remains a safe option for adjuvant therapy of chordomas and chondrosarcomas of the skull base. The exposure of the optic apparatus, pituitary stalk, and brainstem must be considered during planning to minimize complications. If the optic apparatus is included in the 80% isodose line, it might be best to fractionate therapy. Exposure of the pituitary stalk should be kept to <30 Gy to minimize endocrine dysfunction. Brainstem exposure should be

Effectiveness of surgery and individualized high-dose hyperfractionated accelerated radiotherapy on survival in clinical stage I non-small cell lung cancer. A propensity score matched analysis

International Nuclear Information System (INIS)

Jimenez, Marcelo F.; Baardwijk, Angela van; Aerts, Hugo J.W.L.; De Ruysscher, Dirk; Novoa, Nuria M.; Varela, Gonzalo; Lambin, Philippe

2010-01-01

Background and purpose: Surgery is considered the treatment of choice for early-stage non-small cell lung cancer (NSCLC). Patients with poor pulmonary function or other comorbidities are treated with radiotherapy. The objective of this investigation is to compare the 3-year survival of two early-stage NSCLC populations treated in two different hospitals, either by surgical resection (lobectomy) or by individualized high-dose accelerated radiotherapy, after matching patients by propensity scoring analysis. Methods: A retrospective comparative study has been performed on two series of consecutive patients with cytohistological diagnosis of NSCLC, clinically staged IA by means of PET-scan (radiotherapy group) and pathologically staged IA (surgery group). Results: A total of 157 cases were initially selected for the analysis (110 operated and 47 treated by radiotherapy). Patients in the radiotherapy group were older, with higher comorbidity and lower FEV1% with 3-years probability of survival for operated patients higher than that found for patients treated by radiotherapy. After matching by propensity scoring (using age and FEV1%), differences disappear and 3-years probability of survival had no statistical differences. Conclusions: Although this is a non-randomized retrospective analysis, we have not found 3-years survival differences after matching cases between surgery and radiotherapy. Nevertheless, data presented here support the continuous investigation for non-surgical alternatives in this disease.

Adsorbate shape selectivity: Separation of the HF/134a azeotrope over carbogenic molecular sieve

Energy Technology Data Exchange (ETDEWEB)

Hong, A.; Mariwala, R.K.; Kane, M.S.; Foley, H.C. [Univ. of Delaware, Nework, DE (United States)

1995-03-01

Experimental evidence is provided for adsorptive shape selectivity in the separation of the azeotrope between HF and 1,1,1,2-tetrafluoroethane (134a) over pyrolyzed poly(furfuryl alcohol)-derived carbogenic molecular sieve (PPFA-CMS). The separation can be accomplished over coconut charcoal or Carbosieve G on the basis of the differences in the extent of equilibrium adsorption of HF and 134a. On these adsorbents 134a is more strongly bound than HF, thus it elutes much more slowly from the bed. The heat of adsorption for 134a in the vicinity of 200 C on Carbosieve G is {approximately}8.8 kcal/mol. In contrast, when the same azeotropic mixture is separated over PPFA-CMS prepared at 500 C, 134a is not adsorbed. As a result 134a elutes from the bed first, followed by HF. The reversal is brought about by the narrower pore size and pore size distribution of the PPFA-CMS versus that for Carbosieve G. Thus the separation over PPFA-CMS is an example of adsorbate shape selectivity and represents a limiting case of kinetic separation.

First symposium accelerated partial breast irradiation

International Nuclear Information System (INIS)

2012-01-01

The First symposium accelerated partial breast irradiation, was organized by the Marie Curie Foundation, between the 14 to 16 june 2012, in the Cordoba city of Argentina. In this event were presented some papers on the following topics: radiotherapy in breast cancer; interaction between systemic treatments and radiotherapy; interstitial brachytherapy.

Particle-beam accelerators for radiotherapy and radioisotopes

International Nuclear Information System (INIS)

Boyd, T.J.; Crandall, K.R.; Hamm, R.W.

1981-01-01

The philosophy used in developing the new PIGMI technology was that the parameters chosen for physics research machines are not necessarily the right ones for a dedicated therapy or radioisotope machine. In particular, the beam current and energy can be optimized, and the design should emphasize minimum size, simplicity and reliability of operation, and economy in capital and operating costs. A major part of achieving these goals lay in raising the operating frequency and voltage gradient of the accelerator, which shrinks the diameter and length of the components. Several other technical innovations resulted in major system improvements. One of these is a radically new type of accelerator structure named the radio-frequency quadrupole (RFQ) accelerator. This allowed us to eliminate the large, complicated ion source used in previous ion accelerators, and to achieve a very high quality accelerated beam. Also, by using advanced permanent magnet materials to make the focusing elements, the system becomes much simpler. Other improvements have been made in all of the accelerator components and in the methods for operating them. These will be described, and design and costing information examples given for several possible therapy and radioisotope production machines

A phase II study of hyperfractionated accelerated radiotherapy (HART) after induction cisplatin (CDDP) and vinorelbine (VNR) for stage III Non-small-cell lung cancer (NSCLC)

International Nuclear Information System (INIS)

Ishikura, Satoshi; Ohe, Yuichiro; Nihei, Keiji; Kubota, Kaoru; Kakinuma, Ryutaro; Ohmatsu, Hironobu; Goto, Koichi; Niho, Seiji; Nishiwaki, Yutaka; Ogino, Takashi

2005-01-01

Purpose: The purpose was to assess the feasibility and efficacy of hyperfractionated accelerated radiotherapy (HART) after induction chemotherapy for Stage III non-small-cell lung cancer. Methods and materials: Treatment consisted of 2 cycles of cisplatin 80 mg/m 2 on Day 1 and vinorelbine 25 mg/m 2 on Days 1 and 8 every 3 weeks followed by HART, 3 times a day (1.5, 1.8, 1.5 Gy, 4-h interval) for a total dose of 57.6 Gy. Results: Thirty patients were eligible. Their median age was 64 years (range, 46-73 years), 24 were male, 6 were female, 8 had performance status (PS) 0, 22 had PS 1, 9 had Stage IIIA, and 21 had Stage IIIB. All but 1 patient completed the treatment. Common grade ≥3 toxicities during the treatment included neutropenia, 25; infection, 5; esophagitis, 5; and radiation pneumonitis, 3. The overall response rate was 83%. The median survival was 24 months (95% confidence interval [CI], 13-34 months), and the 2-year overall survival was 50% (95% CI, 32-68%). The median progression-free survival was 10 months (95% CI, 8-20 months). Conclusion: Hyperfractionated accelerated radiotherapy after induction of cisplatin and vinorelbine was feasible and promising. Future investigation employing dose-intensified radiotherapy in combination with chemotherapy is needed

Results of fractionated stereotactic radiotherapy with linear accelerator

Energy Technology Data Exchange (ETDEWEB)

Aoki, Masahiko; Watanabe, Sadao [Aomori Prefectural Central Hospital (Japan); Mariya, Yasushi [and others

1997-03-01

A lot of clinical data about stereotactic radiotherapy (SRT) were reported, however, standard fractionated schedules were not shown. In this paper, our clinical results of SRT, 3 fractions of 10 Gy, are reported. Between February 1992 and March 1995, we treated 41 patients with 7 arteriovenous malformations and 41 intracranial tumors using a stereotactic technique implemented by a standard 10MV X-ray linear accelerator. Average age was 47.4 years (range 3-80 years) and average follow-up time was 16.7 months (range 3.5-46.1 months). The patients received 3 fractions of 10 Gy for 3 days delivered by multiple arc narrow beams under 3 cm in width and length. A three-pieces handmade shell was used for head fixation without any anesthetic procedures. Three-dimensional treatment planning system (Focus) was applied for the dose calculation. All patients have received at least one follow-up radiographic study and one clinical examination. In four of the 7 patients with AVM the nidus has become smaller, 9 of the 21 patients with benign intracranial tumors and 9 of the 13 patients with intracranial malignant tumors have shown complete or partial response to the therapy. In 14 patients, diseases were stable or unevaluable due to the short follow-up time. In 5 patients (3 with astrocytoma, 1 each with meningioma and craniopharyngioma), diseases were progressive. Only 1 patient with falx meningioma had minor complication due to the symptomatic brain edema around the tumor. Although, further evaluation of target control (i.e. tumor and nidus) and late normal tissue damage is needed, preliminary clinical results indicate that SRT with our methods is safe and effective. (author)

Theory, simulation and experiments for precise deflection control of radiotherapy electron beams

Energy Technology Data Exchange (ETDEWEB)

Figueroa, R.; Leiva, J.; Moncada, R.; Rojas, L.; Santibanez, M.; Valente, M.; Young, H. [Universidad de la Frontera, Centro de Fisica e Ingenieria en Medicina, Av. Francisco Salazar 1145, Casilla 54-D, Temuco (Chile); Velasquez, J. [Universidad de la Frontera, Departamento de Ciencias Fisicas, Av. Francisco Salazar 1145, Casilla 54-D, Temuco (Chile); Zelada, G. [Clinica Alemana de Santiago, Av. Vitacura 5951, 13132 Vitacura, Santiago (Chile); Astudillo, R., E-mail: rodolfo.figueroa@ufrontera.cl [Hospital Base de Valdivia, C. Simpson 850, XIV Region de los Rios, Valdivia (Chile)

2017-10-15

Conventional radiotherapy is mainly applied by linear accelerators. Although linear accelerators provide dual (electron/photon) radiation beam modalities, both of them are intrinsically produced by a megavoltage electron current. Modern radiotherapy treatment techniques are based on suitable devices inserted or attached to conventional linear accelerators. Thus, precise control of delivered beam becomes a main key issue. This work presents an integral description of electron beam deflection control as required for novel radiotherapy technique based on convergent photon beam production. Theoretical and Monte Carlo approaches were initially used for designing and optimizing devices components. Then, dedicated instrumentation was developed for experimental verification of electron beam deflection due to the designed magnets. Both Monte Carlo simulations and experimental results support the reliability of electrodynamics models used for predict megavoltage electron beam control. (Author)

Theory, simulation and experiments for precise deflection control of radiotherapy electron beams

International Nuclear Information System (INIS)

Figueroa, R.; Leiva, J.; Moncada, R.; Rojas, L.; Santibanez, M.; Valente, M.; Young, H.; Velasquez, J.; Zelada, G.; Astudillo, R.

2017-10-01

Conventional radiotherapy is mainly applied by linear accelerators. Although linear accelerators provide dual (electron/photon) radiation beam modalities, both of them are intrinsically produced by a megavoltage electron current. Modern radiotherapy treatment techniques are based on suitable devices inserted or attached to conventional linear accelerators. Thus, precise control of delivered beam becomes a main key issue. This work presents an integral description of electron beam deflection control as required for novel radiotherapy technique based on convergent photon beam production. Theoretical and Monte Carlo approaches were initially used for designing and optimizing devices components. Then, dedicated instrumentation was developed for experimental verification of electron beam deflection due to the designed magnets. Both Monte Carlo simulations and experimental results support the reliability of electrodynamics models used for predict megavoltage electron beam control. (Author)

Preoperative concurrent CBDCA chemotherapy and accelerated hyperfractionated radiotherapy for squamous cell carcinoma of the maxillary region

Energy Technology Data Exchange (ETDEWEB)

Omura, Ken; Harada, Hiroyuki [Tokyo Medical and Dental Univ. (Japan). Graduate School; Suzuki, Haruhiko; Takeuchi, Yosuke; Hatano, Kazuo; Togawa, Takashi

2001-11-01

Between 1994 and 2000, 28 patients with T3/T4 squamus cell carcinoma of the maxillary region (maxillary sinus, 22; maxillary gingiva, 4; maxillary bone, 1; buccal mucosa, 1) had accelerated hyperfractionated radiotherapy combined with simultaneous CBDCA chemotherapy preoperatively, at Chiba Cancer Center Hospital. The protocol consisted of combined therapy with accelerated hyperfractionated irradiation of 1.6 Gy, twice a day, to a total dose of 32.0-51.2 Gy and concurrent intra-arterial or intravenous infusion of CBDCA 20-30 mg/body/day for a cumulative total dose of 270-480 mg. After completion of the preoperative combined therapy, the clinical CR rate was 17.9%, and the good PR{center_dot}CR rate was 32.1%. According to the initial findings and response to the combined therapy, all patients had maxillectomy (subtotal, 3; total, 16; extended, 9) 4 weeks after completion of the preoperative combined therapy. Postoperatively, the complete pathologic response (Ohboshi and Shimozato's classification, grade III and IV) rate was 28.6%. And the actuarial local control rate was 85.7%, with a mean follow-up of 46.2 months. Based on these results, we believe this preoperative therapy with CBDCA chemotherapy and accelerated hyperfractionated radiation is a significant choice as treatment for squamous cell cancer of the maxillary region. (author)

Accelerated radiotherapy planners calculated by parallelization with GPUs

International Nuclear Information System (INIS)

Reinado, D.; Cozar, J.; Alonso, S.; Chinillach, N.; Cortina, T.; Ricos, B.; Diez, S.

2011-01-01

In this paper we have developed and tested by a subroutine parallelization architectures graphics processing units (GPUs) to apply to calculations with standard algorithms known code. The experience acquired during these tests shall also apply to the MC calculations in radiotherapy if you have the code.

Experimental radiotherapy and clinical radiobiology. Vol. 20. Proceedings

International Nuclear Information System (INIS)

Baumann, Michael; Dahm-Daphi, Jochen; Dikomey, Ekkehard; Petersen, Cordula; Rodemannn, Hans-Peter; Zips, Daniel

2011-01-01

The proceedings include contributions on the following issues: laser driven proton accelerators on the way for radiotherapy, radiobiological evaluation of new radiations; molecular factors of radiation response; biological targeting; EGFR epidermal growth factor receptor/targeting - combined internal and external irradiation, radiobiology of normal tissues; dose-volume histograms for the radiotherapy: curves without radiobiological relevance or important information for the therapy planning; HPV (human papilloma virus) and radiation sensitivity of HNSCC (head and neck squamous cell carcinomas): evidence, radiobiological mechanism, clinical consequences and perspectives; mechanisms of action and intertumoral heterogeneity of response to EGFR inhibition in radiotherapy of solid tumors; evaluation of biomarkers for radiotherapy.

Scattered fractions of dose from 18 and 25 MV X-ray radiotherapy linear accelerators

International Nuclear Information System (INIS)

Shobe, J.; Rodgers, J.E.; Taylor, P.L.; Jackson, J.; Popescu, G.

1996-01-01

Over the years, measurements have been made at a few energies to estimate the scattered fraction of dose from the patient in medical radiotherapy operations. This information has been a useful aid in the determination of shielding requirements for these facilities. With these measurements, known characteriztics of photons, and various other known parameters, Monte Carlo codes are being used to calculate the scattered fractions and hence the shielding requirements for the photons of other energies commonly used in radiotherapeutic applications. The National Institute of Standards and Technology (NIST) acquired a Sagittaire medical linear accelerator (linac) which was previously located at the Yale-New Haven Hospital. This linac provides an X-ray beam of 25 MV photons and electron beams with energies up to 32 MeV. The housing on the gantry was permanently removed from the accelerator during installation. A Varian Clinac 1800 linear accelerator was used to produce the 18 MV photons at the Frederick Memorial Hospital Regional Cancer Therapy Center in Frederick, MD. This paper represents a study of the photon dose scattered from a patient in typical radiation treatment situations as it relates to the dose delivered at the isocenter in water. The results of these measurements will be compared to Monte Carlo calculations. Photon spectral measurements were not made at this time. Neutron spectral measurements were made on this Sagittaire machine in its previous location and that work was not repeated here, although a brief study of the neutron component of the 18 and 25 MV linacs was performed utilizing thermoluminescent dosimetry (TLD) to determine the isotropy of the neutron dose. (author)

Probabilistic safety assessment of the radiotherapy treatment with a linear accelerator for medical use

International Nuclear Information System (INIS)

Vilaragut Llanes, Juan Jose; Ferro Fernandez, Ruben; Rodriguez MartI, Manuel; Ramirez, Maria Luisa; Perez Mulas, Arturo; Barrientos Montero, Marta; Ortiz Lopez, Pedro; Somoano, Fernando; Delgado RodrIguez, Jose Miguel; Papadopulos, Susana B.; Pereira Jr, Pedro Paulo; Lopez Morones, Ramon; Larrinaga Cortina, Eduardo; Rivero Oliva, Jose de Jesus; Alemanny, Jorge

2010-01-01

This paper presents the results of the Probabilistic Safety Assessment to the radiotherapy treatment with an Electron Linear Accelerator for Medical Use, which was conducted in the framework of the Iberian-American Forum of Radiological and Nuclear Regulatory Agencies. Potential accidental exposures during the treatment of patients, workers and members of the public were assessed, although the study was mainly focused on patients. The methodology of failure modes and effects analysis was used to define accident initiating events and methods of event tree and fault tree analysis to determine the accident sequences that may occur. After quantifying the frequency of occurrence of the accident sequences, an important analysis was carried out in order to determine the most significant events from the point of view of safety. The major contributors to risk were identified as well as the most appropriate safety recommendations to reduce it. (author)

A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck

Directory of Open Access Journals (Sweden)

Budach V

2006-01-01

Full Text Available Abstract Background Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX to radiotherapy (RT and to some extent also for the use of hyperfractionated radiation therapy (HFRT and accelerated radiation therapy (AFRT in locally advanced squamous cell carcinoma (SCC of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Methods Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in Results Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p Conclusion RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as single drug or combinations of 5-FU with one of the other drugs results in a large survival advantage irrespective the employed radiation schedule. If radiation therapy is used as single modality, hyperfractionation leads to a significant improvement of overall survival. Accelerated radiation therapy alone, especially when given as split course radiation schedule or extremely accelerated treatments with decreased total dose, does not increase overall survival.

Doses to organs at cerebral risks: optimization by robotized stereotaxic radiotherapy and automatic segmentation atlas versus three dimensional conformal radiotherapy

International Nuclear Information System (INIS)

Bondiau, P.Y.; Thariat, J.; Benezery, K.; Herault, J.; Dalmasso, C.; Marcie, S.; Malandain, G.

2007-01-01

The stereotaxic radiotherapy robotized by 'Cyberknife fourth generation' allows a dosimetric optimization with a high conformity index on the tumor and radiation doses limited on organs at risk. A cerebral automatic anatomic segmentation atlas of organs at risk are used in routine in three dimensions. This study evaluated the superiority of the stereotaxic radiotherapy in comparison with the three dimensional conformal radiotherapy on the preservation of organs at risk in regard of the delivered dose to tumors justifying an accelerated hypo fractionation and a dose escalation. This automatic segmentation atlas should allow to establish correlations between anatomy and cerebral dosimetry; This atlas allows to underline the dosimetry optimization by stereotaxic radiotherapy robotized for organs at risk. (N.C.)

Heavy-ion radiography applied to charged particle radiotherapy

International Nuclear Information System (INIS)

Chen, G.T.Y.; Fabrikant, J.I.; Holley, W.R.; Tobias, C.A.; Castro, J.R.

1980-01-01

The objectives of the heavy-ion radiography research program applied to the clinical cancer research program of charged particle radiotherapy have a twofold purpose: (1) to explore the manner in which heavy-ion radiography and CT reconstruction can provide improved tumor localization, treatment planning, and beam delivery for radiotherapy with accelerated heavy charged particles; and (2) to explore the usefulness of heavy-ion radiography in detecting, localizing, and sizing soft tissue cancers in the human body. The techniques and procedures developed for heavy-ion radiography should prove successful in support of charged particle radiotherapy

Peroperative radiotherapy in the treatment of cancer of the pancreas

International Nuclear Information System (INIS)

Huguier, M.; Schlienger, M.; Houry, S.; Charron, R.

1987-01-01

7 patients presenting with unresected (6 cases) or resected (1 case) cancer of the pancreas were treated peroperatively by radiotherapy. Tumors were treated with 15 to 20 Gy delivered by a particle accelerator. There were no post-operative complications. Three patients who were experiencing pain before radiotherapy no longer had pain after radiotherapy and this effect was maintained. Five patients died during the follow-up period after 5 to 10 months. Two patients are still alive after 4 and 9 months follow-up. This experience with peroperative radiotherapy should be continued [fr

Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis

DEFF Research Database (Denmark)

Bourhis, J.; Overgaard, Jens; Audry, H.

2006-01-01

BACKGROUND: Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival. M...

Cost-benefit analysis on radiotherapy services for cancer treatment, with LINAC type equipments (linear accelerators

Directory of Open Access Journals (Sweden)

Luiz Alberto Blois

2014-12-01

Full Text Available This work consists in analyzing the economic feasibility of the investment to implement a Radiotherapy sector for radiological of cancer treatment by type linear accelerators equipments, based on the case of a public hospital in São Paulo. From technical and financial details of the project and the survey reference values for health care to their procedures, the statistical outcome of treatment on patients' life expectancy and average income indicators of the state's population, were estimated to income (private and social and expenses of this health service and other elements that make up the flow of the investment project box. From these estimates we evaluated public and private investment return, ie, if it fits only on the public sector or if private sector could also implement this projects geared exclusively to free admittance.

The spanish radiotherapy park: past and present

International Nuclear Information System (INIS)

Tormo Ferrero, Manuel J.

2001-01-01

The present article has as objective to provide a general overview on the spanish radiotherapy park, presenting how was its start and evolution until the current state. Considering only the units of teletherapy and the accelerators. Actually in Spain there is 28 units of Cobalt therapy, in functioning during the last two decades, being advised a rapid substitution to accelerators

Modelling of post-irradiation accelerated repopulation in squamous cell carcinomas

International Nuclear Information System (INIS)

Marcu, L; Doorn, T van; Olver, I

2004-01-01

The mechanisms postulated to be responsible for the accelerated repopulation of squamous cell carcinomas during radiotherapy are the loss of asymmetry of stem cell division, acceleration of stem cell division, abortive division and/or recruitment of the non-cycling cell with proliferative capacity. Although accelerated repopulation was observed with recruitment and accelerated cell cycles, it was not sufficient to cause an observable change to the survival curve. However, modelling the loss of asymmetry in stem cell division has reshaped the curve with a 'growth' shoulder. Cell recruitment was not found to be a major contributor to accelerated tumour repopulation. A more significant contribution was provided through the multiplication of surviving tumour stem cells during radiotherapy, by reducing their cell cycle time, and due to loss of asymmetry of stem cell division

TH-302 in Combination with Radiotherapy Enhances the Therapeutic Outcome and Is Associated with Pretreatment [18F]HX4 Hypoxia PET Imaging.

Science.gov (United States)

Peeters, Sarah G J A; Zegers, Catharina M L; Biemans, Rianne; Lieuwes, Natasja G; van Stiphout, Ruud G P M; Yaromina, Ala; Sun, Jessica D; Hart, Charles P; Windhorst, Albert D; van Elmpt, Wouter; Dubois, Ludwig J; Lambin, Philippe

2015-07-01

Conventional anticancer treatments are often impaired by the presence of hypoxia. TH-302 selectively targets hypoxic tumor regions, where it is converted into a cytotoxic agent. This study assessed the efficacy of the combination treatment of TH-302 and radiotherapy in two preclinical tumor models. The effect of oxygen modification on the combination treatment was evaluated and the effect of TH-302 on the hypoxic fraction (HF) was monitored using [(18)F]HX4-PET imaging and pimonidazole IHC stainings. Rhabdomyosarcoma R1 and H460 NSCLC tumor-bearing animals were treated with TH-302 and radiotherapy (8 Gy, single dose). The tumor oxygenation status was altered by exposing animals to carbogen (95% oxygen) and nicotinamide, 21% or 7% oxygen breathing during the course of the treatment. Tumor growth and treatment toxicity were monitored until the tumor reached four times its start volume (T4×SV). Both tumor models showed a growth delay after TH-302 treatment, which further increased when combined with radiotherapy (enhancement ratio rhabdomyosarcoma 1.23; H460 1.49). TH-302 decreases the HF in both models, consistent with its hypoxia-targeting mechanism of action. Treatment efficacy was dependent on tumor oxygenation; increasing the tumor oxygen status abolished the effect of TH-302, whereas enhancing the HF enlarged TH-302's therapeutic effect. An association was observed in rhabdomyosarcoma tumors between the pretreatment HF as measured by [(18)F]HX4-PET imaging and the T4×SV. The combination of TH-302 and radiotherapy is promising and warrants clinical testing, preferably guided by the companion biomarker [(18)F]HX4 hypoxia PET imaging for patient selection. ©2015 American Association for Cancer Research.

The development of radiotherapy in Slovenia

International Nuclear Information System (INIS)

Kuhelj, Janez; Ravnihar, Bozena

1996-01-01

The historical data on the development of radiotherapy in Slovenia are presented from its first use in this county in 1902 until the present. The Institute of Oncology in Ljubljana was established in 1938 with the intention of providing a sound development of radium and roentgen cancer treatment. After World War II, the development of radiotherapy was dynamic, which is evident from the data on new radiation sources in external beam therapy (accelerators, telecobalt units), in brachytherapy (various sealed radioisotopes) as well as in the introduction of therapy with unsealed radioisotopes. In 1947, a Chair of Oncology and Radiotherapy was instituted at the Medical Faculty of the University of Ljubljana (with the seat at the Institute of Oncology). In 1955, radiotherapy and oncology were officially recognized as separate branches of medicine requiring special obligatory postgraduate residency training. Within the Medical Society of Slovenia, the Section for Radiotherapy was established in 1987. The following year, the Section for Radiotherapy of Slovenia became a member of the European Society for Therapeutic Radiology and Oncology. Considering the size of population of Slovenia (nearly 2 million), it was reasonable that by this time radiotherapy became almost completely concentrated in one central institution, the Institute of Oncology, whose core and cohesive activity were represented in the multidisciplinary cancer treatment approach

A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck

International Nuclear Information System (INIS)

Budach, W; Hehr, T; Budach, V; Belka, C; Dietz, K

2006-01-01

Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX) to radiotherapy (RT) and to some extent also for the use of hyperfractionated radiation therapy (HFRT) and accelerated radiation therapy (AFRT) in locally advanced squamous cell carcinoma (SCC) of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in <4 weeks) on SCC of the oral cavity, oropharynx, hypopharynx, and larynx published as full paper or in abstract form between 1975 and 2003 were eligible. Trials comparing RT alone with concurrent or alternating chemoradiation (5-fluorouracil (5-FU), cisplatin, carboplatin, mitomycin C) were analyzed according to the employed radiation schedule and the used CHX regimen. Studies comparing conventionally fractionated radiotherapy (CFRT) with either HFRT or AFRT without CHX were separately examined. End point of the meta-analysis was overall survival. Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p < 0.001). Separate analyses by cytostatic drug indicate a prolongation of survival of 24.0 months, 16.8 months, 6.7 months, and 4.0 months, respectively, for the simultaneous administration of 5-FU, cisplatin-based, carboplatin-based, and mitomycin C-based CHX to RT (each p < 0.01). Whereas no significant gain in overall survival was observed for AFRT in comparison to CFRT, a substantial prolongation of median survival (14.2 months, p < 0.001) was seen for HFRT compared to CFRT (both without CHX). RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as

Radiotherapy equipment for conformal radiotherapy and IMRT in the Czech Republic

International Nuclear Information System (INIS)

Horakova, I.; Irena Pavlikova, I.; Novotny, J. ml.

2005-01-01

The development of the equipment of radiotherapy departments in the Czech Republic is presented here. The data from the special questionnaire from 14 workplaces with linear accelerators with multi-leaf collimators (MLC) and electronic portal imaging device (EPID) are included. They show not only the equipment specification but also the application methods, the quality control, plans for future etc. In the Czech Republic, a great extension of modem irradiation techniques and accessories occurs at present. Together with it, it is necessary to develop quality assurance of the whole process of dose delivery to the patient. It is also necessary to assure further education and training of hospital staff. Modern radiotherapy techniques demand sufficient amount of all sources including personal sources. (authors)

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 ...

Accelerated superfractionated radiotherapy with concomitant boost for locally advanced head-and-neck squamous cell carcinomas

International Nuclear Information System (INIS)

Morris, Monica M.; Schmidt-Ullrich, Rupert K.; DiNardo, L.; Manning, Matthew A.; Silverman, L.; Clay, L.; Johnson, Christopher R.; Amir, Cyrus

2002-01-01

Purpose: A growing body of evidence supports the efficacy of accelerated superfractionated radiotherapy with concomitant boost for advanced head-and-neck carcinomas. This study represents a single-institution experience, performed to identify the factors influencing tumor control, survival, and toxicity. Methods and Materials: Between 1988 and 1999, 133 patients with primary squamous cell head-and-neck carcinoma underwent accelerated superfractionated radiotherapy using a concomitant boost. The concomitant boost in this regimen was delivered using reduced fields delivered 3 times weekly in a twice-daily schedule during the final phase. The total radiation dose ranged from 64.8 Gy to 76.5 Gy (mean 71.1). Patients were evaluated in follow-up for local control and late toxicity. Multivariate analysis of treatment and patient parameters was performed to evaluate their influence on toxicity, local control, and overall survival. Results: With a mean follow-up of 37 months, the actuarial overall survival rate for the entire group at 5 years was 24% and the local control rate was 57%. The tumor volume was the most significant predictor of local control, such that each 1-cm 3 increase in volume was associated with a 1% decrease in local control. For patients with tumor volumes ≤30 cm 3 vs. >30 cm 3 , the 5-year disease-specific survival rate was 52% and 27% (p = 0.004) and locoregional control rate was 76% and 26% (p<0.001), respectively. Seventy-six patients with a minimum of 12 months and median of 39 months toxicity follow-up were studied for late effects. None of these patients experienced Grade 4 or 5 toxicity. The actuarial rate of significant toxicity (Grade III or greater) was 32% at 5 years. Of the toxicities observed, xerostomia (19%) was the most common. Multivariate analysis revealed N stage and dose as independent predictors of Grade 3 effects. Conclusion: The locoregional control and survival for patients in this institutional experience compare favorably to

An analysis of two separate quality audits in UK radiotherapy centres

International Nuclear Information System (INIS)

Aird, E G A

1995-01-01

The CHART quality assurance programme has been used to audit 2 groups of radiotherapy centres for the delivery of radiotherapy: 1. those involved in the CHART Clinical Trial (1991-1995) 2. all London radiotherapy centres (1994-1996) Machinery Tests This paper will seek to illustrate improvements in meeting the criteria set by the QA programme as older linear accelerators are replaced. Phantom Tests The residual errors between measured and calculated doses in anatomical phantoms will be analysed to demonstrate where there are still weaknesses in treatment planning and delivery of radiotherapy

Management of a severe forceful breather with Rett syndrome using carbogen.

Science.gov (United States)

Smeets, Eric E J; Julu, Peter O O; van Waardenburg, Dick; Engerström, Ingegerd Witt; Hansen, Stig; Apartopoulos, Flora; Curfs, Leopold M G; Schrander-Stumpel, Connie T R M

2006-11-01

We have used a novel neurophysiological technique in the NeuroScope system in combination with conventional electroencephalography (EEG) to monitor both brainstem and cortical activity simultaneously in real-time in a girl with Rett syndrome. The presenting clinical features in our patient were severe sleep disturbances, irregular breathing in the awake state dominated by Valsalva's type of breathing followed by tachypnoea and very frequent attacks of seizures and vacant spells. Our novel neurophysiological data showed that the patient was a Forceful Breather according to the breathing categories in Rett syndrome. She had frequent abnormal spontaneous brainstem activation (ASBA) preceded by severe attacks of hypocapnoea, which was caused by a combination of Valsalva's type of breathing and tachypnoea and all these together were responsible for the seizures and non-epileptic vacant spells. The ASBA was not detectable in conventional EEG and there were no epileptiform changes in the EEG during the seizures and vacant spells caused by the hypocapnic attacks, therefore these were pseudo-seizures. The record of brainstem activity confirmed that these were autonomic events, a kind of "brainstem epilepsy". We successfully treated the sleep disturbance with Pipamperone, a 5-hydroxytryptophan antagonist of receptor type 2 and we prevented the severe hypocapnoea during Valsalva's type of breathing and during tachypnoea using carbogen (a mixture of 5% carbon dioxide and 95% oxygen), which we gave by inhalation. Our treatment drastically reduced the autonomic events, promoted whole night sleep and significantly improved the quality of life in our patient. She can now participate in normal family activity which was previously impossible before treatment.

Carbon-ion radiotherapy for marginal lymph node recurrences of cervical cancer after definitive radiotherapy: a case report

International Nuclear Information System (INIS)

Tamaki, Tomoaki; Nakano, Takashi; Ohno, Tatsuya; Kiyohara, Hiroki; Noda, Shin-ei; Ohkubo, Yu; Ando, Ken; Wakatsuki, Masaru; Kato, Shingo; Kamada, Tadashi

2013-01-01

Recurrences of cervical cancer after definitive radiotherapy often occur at common iliac or para-aortic lymph nodes as marginal lymph node recurrences. Patients with these recurrences have a chance of long-term survival by optimal re-treatment with radiotherapy. However, the re-irradiation often overlaps the initial and the secondary radiotherapy fields and can result in increased normal tissue toxicities in the bowels or the stomach. Carbon-ion radiotherapy, a form of particle beam radiotherapy using accelerated carbon ions, offers more conformal and sharp dose distribution than X-ray radiotherapy. Therefore, this approach enables the delivery of high radiation doses to the target while sparing its surrounding normal tissues. Marginal lymph node recurrences in common iliac lymph nodes after radiotherapy were treated successfully by carbon-ion radiotherapy in two patients. These two patients were initially treated with a combination of external beam radiotherapy and intracavitary and interstitial brachytherapy. However, the diseases recurred in the lymph nodes near the border of the initial radiotherapy fields after 22 months and 23 months. Because re-irradiation with X-ray radiotherapy may deliver high doses to a section of the bowels, carbon-ion radiotherapy was selected to treat the lymph node recurrences. A total dose of 48 Gy (RBE) in 12 fractions over 3 weeks was given to the lymph node recurrences, and the tumors disappeared completely with no severe acute toxicities. The two patients showed no evidence of disease for 75 months and 63 months after the initial radiotherapy and for 50 months and 37 months after the carbon-ion radiotherapy, respectively. No severe late adverse effects are observed in these patients. The two presented cases suggest that the highly conformal dose distribution of carbon-ion radiotherapy may be beneficial in the treatment of marginal lymph node recurrences after radiotherapy. In addition, the higher biological effect of carbon

High energy medical accelerators

International Nuclear Information System (INIS)

Mandrillon, P.

1990-01-01

The treatment of tumours with charged particles, ranging from protons to 'light ions' (carbon, oxygen, neon), has many advantages, but up to now has been little used because of the absence of facilities. After the successful pioneering work carried out with accelerators built for physics research, machines dedicated to this new radiotherapy are planned or already in construction. These high energy medical accelerators are presented in this paper. (author) 15 refs.; 14 figs.; 8 tabs

Laser-driven particle acceleration for radiobiology and radiotherapy: where we are and where we are going

Science.gov (United States)

Giulietti, Antonio

2017-05-01

Radiation therapy of tumors progresses continuously and so do devices, sharing a global market of about $ 4 billions, growing at an annual rate exceeding 5%. Most of the progress involves tumor targeting, multi-beam irradiation, reduction of damage on healthy tissues and critical organs, dose fractioning. This fast-evolving scenario is the moving benchmark for the progress of the laser-based accelerators towards clinical uses. As for electrons, both energy and dose requested by radiotherapy are available with plasma accelerators driven by lasers in the power range of tens of TW but several issues have still to be faced before getting a prototype device for clinical tests. They include capability of varying electron energy, stability of the process, reliability for medical users. On the other side hadron therapy, presently applied to a small fraction of cases but within an exponential growth, is a primary option for the future. With such a strong motivation, research on laser-based proton/ion acceleration has been supported in the last decade in order to get performances suitable to clinical standards. None of these performances has been achieved so far with laser techniques. In the meantime a rich crop of data have been obtained in radiobiological experiments performed with beams of particles produced with laser techniques. It is quite significant however that most of the experiments have been performed moving bio samples to laser labs, rather moving laser equipment to bio labs or clinical contexts. This give us the measure that laser community cannot so far provide practical devices usable by non-laser people.

Debate about breast cancer: 'Cons: Intraoperative radiotherapy'; Debats autour du cancer du sein: 'contre' la radiotherapie peroperatoire

Energy Technology Data Exchange (ETDEWEB)

Bourgier, C.; Heymann, S.; Verstraet, R.; Biron, B.; Marsiglia, H. [Departement de radiotherapie, institut Gustave-Roussy, 114, rue edouard-Vaillant, 94800 Villejuif (France)

2011-10-15

Early breast cancer incidence increases owing to mammography screening. Hypo-fractionated radiotherapy is more and more proposed in women with low local relapse risk breast cancer, especially accelerated partial breast irradiation. Various irradiation modalities have been reported: brachytherapy, intraoperative irradiation, 3D-conformal accelerated partial breast irradiation. We describe limitations of intraoperative irradiation and the advantages of alternative techniques. (authors)

Study on the possibility of using a 60 Co therapeutical unity in Intensity Modulated Radiotherapy (IMRT)

International Nuclear Information System (INIS)

Dantas, Samuel Cesar

2009-06-01

With the increasing advances in complex treatment techniques, there is a tendency to obtain more sophisticated equipment to deliver the dose. The use of 3D conformal radiotherapy is now routine in many radiotherapy facilities as well as the utilization of intensity modulated radiotherapy (IMRT). Both are usually implemented using linear accelerators equipped with multi leaves collimators, which create the conformity and the fluence distributions required. However, the complexity of increasingly sophisticated equipment, such as linear accelerators, requires a frequent quality control of their operation, as well as a detailed and constant maintenance. Even carrying out these procedures, the accelerators may present technical problems interrupting for a long time a treatment using the IMRT technique. Despite the clear practical and technological advantages that linear accelerators have on 60 Co irradiators, these devices occupy an important place in radiotherapy, mainly due to the low cost of equipment installation and maintenance when compared to those required by accelerators. Many radiotherapy facilities that work with IMRT have tele therapeutic isocentric 60 Co units. In principle, such equipment would be able to be used for treatment with IMRT using compensating blocks to modulate the beam. This study investigates this possibility and shows that it is feasible. The comparison of treatment plans of a head-and-neck cancer and other of a cancer of the central nervous system, based on a 60 Co irradiator and a Linac 2300 C/D, presented advantages for the 60 Co irradiator. Furthermore; the delivery of dose obtained with the two systems showed themselves equivalent when compared to their respective plans. (author)

Tissue pO2 of Orthotopic 9L and C6 Gliomas and Tumor-Specific Response to Radiotherapy and Hyperoxygenation

International Nuclear Information System (INIS)

Khan, Nadeem; Li Hongbin; Hou, Huagang; Lariviere, Jean P.; Gladstone, David J.; Demidenko, Eugene; Swartz, Harold M.

2009-01-01

Purpose: Tumor hypoxia is a well-known therapeutic problem; however, a lack of methods for repeated measurements of glioma partial pressure of oxygen (pO 2 ) limits the ability to optimize the therapeutic approaches. We report the effects of 9.3 Gy of radiation and carbogen inhalation on orthotopic 9L and C6 gliomas and on the contralateral brain pO 2 in rats using a new and potentially widely useful method, multisite in vivo electron paramagnetic resonance oximetry. Methods and Materials: Intracerebral 9L and C6 tumors were established in the left hemisphere of syngeneic rats, and electron paramagnetic resonance oximetry was successfully used for repeated tissue pO 2 measurements after 9.3 Gy of radiation and during carbogen breathing for 5 consecutive days. Results: Intracerebral 9L gliomas had a pO 2 of 30-32 mm Hg and C6 gliomas were relatively hypoxic, with a pO 2 of 12-14 mm Hg (p 2 of the contralateral brain was 40-45 mm Hg in rats with either 9L or C6 gliomas. Irradiation resulted in a significant increase in pO 2 of the 9L gliomas only. A significant increase in the pO 2 of the 9L and C6 gliomas was observed in rats breathing carbogen, but this effect decreased during 5 days of repeated experiments in the 9L gliomas. Conclusion: These results highlight the tumor-specific effect of radiation (9.3.Gy) on tissue pO 2 and the different responses to carbogen inhalation. The ability of electron paramagnetic resonance oximetry to provide direct repeated measurements of tissue pO 2 could have a vital role in understanding the dynamics of hypoxia during therapy that could then be optimized by scheduling doses at times of improved tumor oxygenation

A New Cancer Radiotherapy System Using Multi Robotic Manipulators

International Nuclear Information System (INIS)

Kim, Seung Ho; Lee, Nam Ho; Lee, Byung Chul; Jeung, Kyung Min; Lee, Seong Uk; Bae, Yeong Geol; Na, Hyun Seok

2013-01-01

The CyberKnife system is state-of-the-art cancer treatment equipment that combines an image tracking technique, artificial intelligence software, robot technology, accelerator technology, and treatment simulation technology. The current CyberKnife System has significant shortcomings. The biggest problem is that it takes a longer time to treat a tumor. A long treatment time gives stress to patients. Furthermore it makes the patients uncomfortable with radiation and thus it is difficult to measure the exact radiation dose rate to the tumor in the processing. Linear accelerators for radiation treatment are dependent on imports, and demand high maintenance cost. This also makes the treatment cost higher and prevents the popularization of radiation. To solve the disadvantages of the existing CyberKnife, a radiation treatment robot system applied to several articulated robots is suggested. Essential element techniques for new radiotherapy robot system are investigated and some problems of similar existing systems are analyzed. This paper presents a general configuration of a new radiation robot treatment system including with a quantitative goal of the requirement techniques. This paper described a new radiotherapy robot system to track the tumor using multiple articulated robots in real time. The existing CyberKnife system using a single robot arm has disadvantages of a long radiotherapy time, high medical fee, and inaccurate measurement of the radiotherapy dose. So a new radiotherapy robot system for tumors has been proposed to solve the above problems of conventional CyberKnife systems. Necessary technologies to configure new the radiotherapy robot system have been identified. Quantitative targets of each technology have been established. Multiple robot arms are adopted to decrease the radiotherapy time. The results of this research are provided as a requisite technology for a domestic radiotherapy system and are expected to be the foundation of new technology. The

A New Cancer Radiotherapy System Using Multi Robotic Manipulators

Energy Technology Data Exchange (ETDEWEB)

Kim, Seung Ho; Lee, Nam Ho; Lee, Byung Chul; Jeung, Kyung Min; Lee, Seong Uk; Bae, Yeong Geol; Na, Hyun Seok [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2013-10-15

The CyberKnife system is state-of-the-art cancer treatment equipment that combines an image tracking technique, artificial intelligence software, robot technology, accelerator technology, and treatment simulation technology. The current CyberKnife System has significant shortcomings. The biggest problem is that it takes a longer time to treat a tumor. A long treatment time gives stress to patients. Furthermore it makes the patients uncomfortable with radiation and thus it is difficult to measure the exact radiation dose rate to the tumor in the processing. Linear accelerators for radiation treatment are dependent on imports, and demand high maintenance cost. This also makes the treatment cost higher and prevents the popularization of radiation. To solve the disadvantages of the existing CyberKnife, a radiation treatment robot system applied to several articulated robots is suggested. Essential element techniques for new radiotherapy robot system are investigated and some problems of similar existing systems are analyzed. This paper presents a general configuration of a new radiation robot treatment system including with a quantitative goal of the requirement techniques. This paper described a new radiotherapy robot system to track the tumor using multiple articulated robots in real time. The existing CyberKnife system using a single robot arm has disadvantages of a long radiotherapy time, high medical fee, and inaccurate measurement of the radiotherapy dose. So a new radiotherapy robot system for tumors has been proposed to solve the above problems of conventional CyberKnife systems. Necessary technologies to configure new the radiotherapy robot system have been identified. Quantitative targets of each technology have been established. Multiple robot arms are adopted to decrease the radiotherapy time. The results of this research are provided as a requisite technology for a domestic radiotherapy system and are expected to be the foundation of new technology. The

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.)

A beam-matching concept for medical linear accelerators

DEFF Research Database (Denmark)

Sjöström, David; Bjelkengren, Ulf; Ottosson, Wiviann

2009-01-01

The flexibility in radiotherapy can be improved if a patient can be moved between any one of the department's medical linear accelerators without the need to change anything in the patient's treatment plan. For this to be possible, the dosimetric characteristics of the various accelerators must...

Pulse-resolved radiotherapy dosimetry using fiber-coupled organic scintillators

DEFF Research Database (Denmark)

Beierholm, Anders Ravnsborg

scintillators and can be perceived as a well characterized, independent alternative to the methods that are in clinical use today. The dosimeter itself does not require a voltage supply, and is composed of water equivalent materials. The dosimeter can be fabricated with a sensitive volume smaller than a cubic...... millimeter, which is small enough to resolve the small radiation fields encountered in modern radiotherapy. The fast readout of the dosimeter enables measurements on the same time scale as the pulsed radiation delivery from the medical linear accelerators used for treatment. The dosimetry system, comprising...... for both standard and small fields. This thesis concludes that the new pulse-resolved dosimetry system holds great potential for modern radiotherapy applications, such as stereotactic radiotherapy and intensity-modulated radiotherapy....

Dosimetry at the location of secondary tumors after radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Baas, H W; Davelaar, J J; Broerse, J J; Noordijk, E M [University Hospital, Leiden (Netherlands). Dept. of Clinical Oncology

1995-12-01

After a latency period of many years the incidence of a secondary tumor is considered a serious late effect of radiotherapy. Analysis of about 200 patients, treated by radiotherapy for Hodgkin`s disease in our hospital, shows an actuarial risk for the incidence of a secondary tumor of about 7% after 10 years. The chance of tumor induction depends on the dose at the location of the tumor and therefore a good dose estimation is mandatory. Radiotherapy was given with Co-60 in the early years and with linear accelerators thereafter, exposing the target areas to 36 - 40 Gy. For dose estimations at the penumbra and outside the beam, where tumor incidence is expected to be high, we used a.o. Monte Carlo calculations. We developed an EGS4 computer simulation for a treatment beam from a linear accelerator irradiating a mathematical phantom representing the patient geometry (GSF ADAM phantom). The isodose curves at certain energies were obtained for a water phantom and fitted quite well with measurements. In addition to Monte Carlo calculations we also used existing treatment planning systems. The dose estimations of a number of patients and the derived risk per unit of dose, which is important for both radiotherapy as well as radiation protection in general, is discussed.

Cost of quality assurance in radiotherapy: human and material requirements

International Nuclear Information System (INIS)

Caudrelier, V.; Garcia, R.; Chauvet, B.; Bourhis, J.

2005-01-01

In 2004, three new important laws were passed concerning radiotherapy services. The first two concerns the internal and external quality control of linear accelerators and the last concerns the role of the medical physicist, whose presence was made mandatory during the whole length of the treatments. These laws, which aim to improve the quality and the security of treatments, represent an increase in price that we have calculated, and which prevents them being implemented, as a joint study realised by the SFRO and the SFPM has shown. The cost of quality in radiotherapy requires investment in material and manpower and improvement in availability of the accelerators which entails a complete reorganization of the services. Cost analysis is included. The difficulties in implementing these laws have also been evaluated and this evaluation already enables us to propose certain elements enabling us to go forward to globally improve the quality and security in radiotherapy. (author)

Effects of continuous hyperfractionated accelerated and conventionally fractionated radiotherapy on the parotid and submandibular salivary glands of rhesus monkeys

International Nuclear Information System (INIS)

Price, R.E.; Ang, K.K.; Stephens, L.C.; Peters, L.J.

1995-01-01

Radiotherapy is a major treatment modality for head and neck cancer. It is often not possible to exclude the salivary glands from the treatment fields. The unique susceptibility of the serous cells of the salivary glands to irradiation often results in xerostomia with ensuing secondary complications and discomfort to the patients. Recent reports have suggested that continuous hyperfractionated accelerated radiotherapy (CHART) can lead to considerably less reduction in salivary flow of the parotid salivary gland than conventional radiotherapy. This study was undertaken to assess histologic changes of salivary glands induced by CHART and conventional radiation fractionation schedules. The parotid and submandibular salivary glands of adult rhesus monkeys were irradiated with cobalt-60 γ radiation at 50 Gy/20 fractions/4 weeks, 55 Gy/25 fractions/5 weeks, or 54 Gy/36 fractions/12 days (CHART). Salivary tissues were harvested at 16 weeks following irradiation and evaluated histopathologically. Microscopically, the glands receiving 50 Gy, 55 Gy, or CHART were virtually indistinguishable. There was severe atrophy and fibrosis of all glands. Quantitative analysis revealed that 50 Gy, 55 Gy, and CHART induced a reduction of serous acini in parotid glands by 86.4%, 84.8%, and 88.8%, respectively. In submandibular glands, serous acini were reduced by 99.4%, 99.0%, and 100%, respectively. The corresponding reduction in mucous acini were 98.4%, 98.4%, and 99.2%, respectively. These histopathologic and quantitative morphologic studies show that the magnitude of serous gland atrophy in the parotid and submandibular salivary glands of rhesus monkeys was similar at 16 weeks after receiving 50 Gy in 20 fractions, 55 Gy in 25 fractions, or CHART

Project of compact accelerator for cancer proton therapy; Progetto di acceleratore compatto per terapia oncologica con protoni (TOP)

Energy Technology Data Exchange (ETDEWEB)

Picardi, L; Ronsivalle, C; Vignati, A [ENEA, Cntro Ricerche Frascati, Rome (Italy). Dip. Innovazione

1995-04-01

The status of the sub-project `Compact Accelerator` in the framework of the Hadrontherapy Project leaded by Prof. Amaldi is described. Emphasis is given to the reasons of the use of protons for radiotherapy applications, to the results of the preliminary design studies of four types of accelerators as possible radiotherapy dedicated `Compact Accelerator` and to the scenario of the fonts of financial resources.

Natural history of intracranial meningioma after radiotherapy

International Nuclear Information System (INIS)

Monzen, Yoshio

1999-01-01

The author examined the natural history of intracranial meningioma after radiotherapy using CT or MR imaging. Twenty patients with intracranial meningioma received radiotherapy from a high-energy linear accelerator (4-10 MV X rays) from 1980 to 1996. The total doses were 50 Gy to the tumor bed in single doses of 2 Gy in 5 weekly fractions. Meningiomas in 10 of 20 patients were reduced within 1 to 38 months after radiotherapy, the average being 11 months. The tumors were controlled for a median of 60 months after radiotherapy (range 19-126 months). Four other patients have shown no change in tumor size after radiotherapy. The tumors were controlled for a median of 70 months after radiotherapy (range 37-127 months). The other six patients have shown tumor growth within 3 to 25 months after radiotherapy, after which the tumors stopped growing for a median of 71 months (range 2-181 months). Neither tumor size nor histological type was related to response. The growth of tumors was controlled by radiotherapy for a median duration of 43 months in the meningothelial type, 52 months in the fibroblastic type, and 61 months in the transitional type. The median duration for all benign tumors was 52 months. A moderate correlation was noted between tumor response and functional outcome after radiotherapy in 9 patients with neurological deficits. The natural histories of intracranial meningiomas after radiotherapy were grouped into three categories. Some tumors showed no change in size over a long period. This was a characteristic response after radiotherapy that differed from that of other brain tumors. The results of this study provide important information for the follow-up of intracranial meningiomas after radiotherapy. (author)

Radiotherapy for breast cancer and pacemaker; Radiotherapie pour un cancer du sein et stimulateur cardiaque

Energy Technology Data Exchange (ETDEWEB)

Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M. [Oncologie-radiotherapie, institut Curie, 26, rue d' Ulm, 75005 Paris (France); Kirov, K.M.; Esteve, M. [Departement d' anesthesie-reanimation-douleur, institut Curie, 75005 Paris (France)

2011-06-15

Purpose. - Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic Irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. Patients and methods. - From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. Results. - Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. Conclusion. - The multidisciplinary work with position change of the pacemaker

Review on heavy ion radiotherapy facilities and related ion sources (invited)

International Nuclear Information System (INIS)

Kitagawa, A.; Fujita, T.; Muramatsu, M.; Biri, S.; Drentje, A. G.

2010-01-01

Heavy ion radiotherapy awakens worldwide interest recently. The clinical results obtained by the Heavy Ion Medical Accelerator in Chiba at the National Institute of Radiological Sciences in Japan have clearly demonstrated the advantages of carbon ion radiotherapy. Presently, there are four facilities for heavy ion radiotherapy in operation, and several new facilities are under construction or being planned. The most common requests for ion sources are a long lifetime and good stability and reproducibility. Sufficient intensity has been achieved by electron cyclotron resonance ion sources at the present facilities.

Costs of conventional radical radiotherapy versus continuous hyperfractionated accelerated radiotherapy (CHART) in the treatment of patients with head and neck cancer or carcinoma of the bronchus. Medical Research Council CHART Steering Committee.

Science.gov (United States)

Coyle, D; Drummond, M F

1997-01-01

The objective of this study was to compare the costs of treatment with continuous hyperfractionated accelerated radiotherapy (CHART) and those of conventional radiotherapy for patients with (1) head and neck cancer and (2) carcinoma of the bronchus. The study was conducted concurrently with two multicentre randomized controlled trials. Data were collected on the use of hospital and community service resources and patients' travel for treatment. Data on resource use up to 3 months after entry to the study were available for 526 head and neck patients (314 receiving CHART and 212 conventional therapy) and 284 bronchus patients (175 CHART and 109 conventional therapy). For patients with head and neck cancer, CHART cost Pounds 1092 (P hostel facilities. The results of this cost analysis will help to facilitate a decision about whether the benefits of CHART, as determined by the clinical trials, are worth the additional costs of hospital-based resource use. The collection of detailed patient-specific resource-use data from a number of centres allows the determination of ways for reducing the cost differential between therapies and making CHART a more cost effective treatment alternative.

Monte Carlo Treatment Planning for Advanced Radiotherapy

DEFF Research Database (Denmark)

Cronholm, Rickard

This Ph.d. project describes the development of a workflow for Monte Carlo Treatment Planning for clinical radiotherapy plans. The workflow may be utilized to perform an independent dose verification of treatment plans. Modern radiotherapy treatment delivery is often conducted by dynamically...... modulating the intensity of the field during the irradiation. The workflow described has the potential to fully model the dynamic delivery, including gantry rotation during irradiation, of modern radiotherapy. Three corner stones of Monte Carlo Treatment Planning are identified: Building, commissioning...... and validation of a Monte Carlo model of a medical linear accelerator (i), converting a CT scan of a patient to a Monte Carlo compliant phantom (ii) and translating the treatment plan parameters (including beam energy, angles of incidence, collimator settings etc) to a Monte Carlo input file (iii). A protocol...

Commissioning and quality assurance of the x-ray volume imaging system of an image-guided radiotherapy capable linear accelerator

International Nuclear Information System (INIS)

Muralidhar, K.R.; Narayana Murthy, P.; Kumar, Rajneesh

2008-01-01

An Image-Guided Radiotherapy-capable linear accelerator (Elekta Synergy) was installed at our hospital, which is equipped with a kV x-ray volume imaging (XVI) system and electronic portal imaging device (iViewGT). The objective of this presentation is to describe the results of commissioning measurements carried out on the XVI facility to verify the manufacturer's specifications and also to evolve a QA schedule which can be used to test its performance routinely. The QA program consists of a series of tests (safety features, geometric accuracy, and image quality). These tests were found to be useful to assess the performance of the XVI system and also proved that XVI system is very suitable for image-guided high-precision radiation therapy. (author)

Commissioning and quality assurance of the X-ray volume Imaging system of an image-guided radiotherapy capable linear accelerator

Directory of Open Access Journals (Sweden)

Muralidhar K

2008-01-01

Full Text Available An Image-Guided Radiotherapy-capable linear accelerator (Elekta Synergy was installed at our hospital, which is equipped with a kV x-ray volume imaging (XVI system and electronic portal imaging device (iViewGT. The objective of this presentation is to describe the results of commissioning measurements carried out on the XVI facility to verify the manufacturer′s specifications and also to evolve a QA schedule which can be used to test its performance routinely. The QA program consists of a series of tests (safety features, geometric accuracy, and image quality. These tests were found to be useful to assess the performance of the XVI system and also proved that XVI system is very suitable for image-guided high-precision radiation therapy.

Normal tissue complication models for clinically relevant acute esophagitis (≥ grade 2) in patients treated with dose differentiated accelerated radiotherapy (DART-bid)

International Nuclear Information System (INIS)

Zehentmayr, Franz; Söhn, Matthias; Exeli, Ann-Katrin; Wurstbauer, Karl; Tröller, Almut; Deutschmann, Heinz; Fastner, Gerd; Fussl, Christoph; Steininger, Philipp; Kranzinger, Manfred; Belka, Claus; Studnicka, Michael; Sedlmayer, Felix

2015-01-01

One of the primary dose-limiting toxicities during thoracic irradiation is acute esophagitis (AE). The aim of this study is to investigate dosimetric and clinical predictors for AE grade ≥ 2 in patients treated with accelerated radiotherapy for locally advanced non-small cell lung cancer (NSCLC). 66 NSCLC patients were included in the present analysis: 4 stage II, 44 stage IIIA and 18 stage IIIB. All patients received induction chemotherapy followed by dose differentiated accelerated radiotherapy (DART-bid). Depending on size (mean of three perpendicular diameters) tumors were binned in four dose groups: <2.5 cm 73.8 Gy, 2.5–4.5 cm 79.2 Gy, 4.5–6 cm 84.6 Gy, >6 cm 90 Gy. Patients were treated in 3D target splitting technique. In order to estimate the normal tissue complication probability (NTCP), two Lyman models and the cutoff-logistic regression model were fitted to the data with AE ≥ grade 2 as statistical endpoint. Inter-model comparison was performed with the corrected Akaike information criterion (AIC c ), which calculates the model’s quality of fit (likelihood value) in relation to its complexity (i.e. number of variables in the model) corrected by the number of patients in the dataset. Toxicity was documented prospectively according to RTOG. The median follow up was 686 days (range 84–2921 days), 23/66 patients (35 %) experienced AE ≥ grade 2. The actuarial local control rates were 72.6 % and 59.4 % at 2 and 3 years, regional control was 91 % at both time points. The Lyman-MED model (D50 = 32.8 Gy, m = 0.48) and the cutoff dose model (D c = 38 Gy) provide the most efficient fit to the current dataset. On multivariate analysis V38 (volume of the esophagus that receives 38 Gy or above, 95 %-CI 28.2–57.3) was the most significant predictor of AE ≥ grade 2 (HR = 1.05, CI 1.01–1.09, p = 0.007). Following high-dose accelerated radiotherapy the rate of AE ≥ grade 2 is slightly lower than reported for concomitant radio-chemotherapy with the

Radiobiological characterization of different energy-photon beams used in radiotherapy from linear accelerator

International Nuclear Information System (INIS)

Elata, A.; Hassan, A. M. E.; Ali, E.; Calzolari, P.; Bettega, D.

2009-02-01

The main objective of this study was to perform a radiobiological characterization of different energy photon beams (6 MV and 15 MV) from linear accelerator used in radiotherapy, and comparison of different treatment modalities, with special regard to late effects of radiation. Using two end points, cell survival and micronucleus induction, in the biological system (Chines hamster V79 cell line). Chromosomes number was counted and found to be 22 chromosomes per cell. Cells were kept in confluent growth for two days and then exposed to two photon beams and immediately after irradiation were counted and re seeded in different numbered for each dose. For evaluation of surviving fraction samples were incubated at 37o C for 6 days, five samples were counted for each dose. At the same time three samples were seeded for the micronuclei frequency and incubated at 37o C after 24 hours cytochalasin-B was added to block cells in cytokinesis. The survival curve showed similar curves for the two beams and decreased with dose. The micronuclei frequency was positively correlated with dose and the energy of the photon. This indicates the presence of low dose of photoneutrons produced by using high energy photon beams. (Author)

A phase ii study of concurrent accelerated hyperfractionated radiotherapy and carboplatin/oral etoposide for elderly patients with stage iii non-small-cell lung cancer

International Nuclear Information System (INIS)

Jeremic, Branislav; Shibamoto, Yuta; Milicic, Biljana; Milisavljevic, Slobodan; Nikolic, Nebojsa; Dagovic, Aleksandar; Aleksandrovic, Jasna; Radosavljevic-Asic, Gordana

1999-01-01

Purpose: To investigate feasibility, toxicity, and efficacy of accelerated hyperfractionated radiation therapy and concurrent carboplatin/oral etoposide in elderly (> 70 years) patients with stage III non-small-cell lung cancer. Methods and Materials: Between January 1988 and June 1993, a total of 58 patients entered a phase II study. Carboplatin (400 mg/m 2 ) was given intravenously on days 1 and 29, and etoposide (50 mg/m 2 ) was given orally on days 1-21 and 29-42. Accelerated hyperfractionated radiotherapy was administered starting on day 1, with a total dose of 51 Gy in 34 fractions over 3.5 weeks. Results: In 55 evaluable patients, the complete response rate was 27% and the overall response rate was 65%. For the 55 patients, the median survival time was 10 months, and the 1-, 2-, and 5-year survival rates were 45%, 24%, and 9.1%, respectively. The median time until relapse was 8 months and the 1-, 2-, and 5-year relapse-free survival rates were 45%, 20%, and 9.1%, respectively. The median time to local recurrence was 14 months and the 5-year local control rate was 13%; the median time to distant metastasis was 18 months and the 5-year distant metastasis-free rate was 15%. Hematological, esophageal, and bronchopulmonary acute grade 3 or 4 toxicities were observed in 22%, 7%, and 4% of the patients, respectively. There was no grade 5 toxicity or late grade ≥ 3 toxicity. Conclusion: Concurrent accelerated hyperfractionated radiotherapy and carboplatin/oral etoposide produced relatively low and acceptable toxicity. The survival results appeared to be comparable to those obtained in nonelderly patients with stage III non-small-cell lung cancer treated by full-dose radiation

Medical uses of accelerators

International Nuclear Information System (INIS)

Bradbury, J.N.

1981-01-01

A variety of particle accelerators have either potential or already demonstrated uses in connection with medically-related research, diagnosis, and treatment. For cancer radiotherapy, nuclear particles including protons, neutrons, heavy ions, and negative pi mesons have advantages compared to conventional radiations in terms of dose localization and/or biological effectiveness. Clinical evaluations of these particles are underway at a number of institutions. Accelerator-produced radionuclides are in widespread use for research and routine diagnostic purposes. Elemental analysis techniques with charged particles and neutrons are being applied to bone, blood, and other tissues. Finally, low-dose medical imaging can be accomplished with accelerated protons and heavy ions. The status and future of these programs are discussed

Dosimetric evaluation of Radiotherapy units wit 60Co

International Nuclear Information System (INIS)

Leon, B. Salinas de; Tovar M, V.; Becerril V, A.

2000-01-01

The SSDL network of the IAEA performs, every year, quality audit tests for radiotherapy services ( 60 Co units and linear accelerators), and for national SSDL as well. Because of the SSDL-Mexico results in these tests and due to our enthusiasm and confidence in our work, a parallel test has been done , which is described in this talk as well as the results. Nowadays, a second parallel test goes up, which could confirm our optimism and open the possibility to our country to start a national dosimetric audit of 60 Co radiotherapy units. (Author)

Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

International Nuclear Information System (INIS)

Rütten, Heidi; Pop, Lucas A.M.; Janssens, Geert O.R.J.; Takes, Robert P.; Knuijt, Simone; Rooijakkers, Antoinette F.; Berg, Manon van den; Merkx, Matthias A.; Herpen, Carla M.L. van; Kaanders, Johannes H.A.M.

2011-01-01

Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence–free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

Energy Technology Data Exchange (ETDEWEB)

Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

2011-11-15

Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

Characteristics of a dedicated linear accelerator-based stereotactic radiosurgery-radiotherapy unit

International Nuclear Information System (INIS)

Das, Indra J.; Downes, M. Beverly; Corn, Benjamin W.; Curran, Walter J.; Werner-Wasik, M.; Andrews, David W.

1996-01-01

A stereotactic radiosurgery and radiotherapy (SRS/SRT) system on a dedicated Varian Clinac-600SR linear accelerator with Brown-Roberts-Wells and Gill-Thomas-Cosman relocatable frames along with the Radionics (RSA) planning system is evaluated. The Clinac-600SR has a single 6-MV beam with the same beam characteristics as that of the mother unit, the Clinac-600C. The primary collimator is a fixed cone projecting to a 10-cm diameter at isocenter. The secondary collimator is a heavily shielded cylindrical collimator attached to the face plate of the primary collimator. The tertiary collimation consists of the actual treatment cones. The cone sizes vary from 12.5 to 40.0 mm diameter. The mechanical stability of the entire system was verified. The variations in isocenter position with table, gantry, and collimator rotation were found to be <0.5 mm with a compounded accuracy of ≤ 1.0 mm. The radiation leakage under the cones was < 1% measured at a depth of 5 cm in a phantom. The beam profiles of all cones in the x and y directions were within ±0.5 mm and match with the physical size of the cone. The dosimetric data such as tissue maximum ratio, off-axis ratio, and cone factor were taken using film, diamond detector, and ion chambers. The mechanical and dosimetric characteristics including dose linearity of this unit are presented and found to be suitable for SRS/SRT. The difficulty in absolute dose measurement for small cone is discussed

Radiotherapy and oncology for technical assistants in the medical professions. 2. rev. and enlarged ed.

International Nuclear Information System (INIS)

Sauer, R.

1993-01-01

Essential subjects presented in this textbook are: conventional X-ray irradiation, Gamma-ray teletherapy, particle accelerators, therapy using sealed radionuclides, irradiation planning, performance of radiotherapy, physical fundamentals of radiotherapy, biological fundamentals of radiotherapy, specific radiotherapy for the treatment of malignant tumors, irradiation of non-malignant disorders. The new edition covers also information on radiation oncology aspects in the context of epidemiological studies, specific knowledge regarding tumor diagnostics and radiological protection, as well as diagnostic signs and interpretation together with indicated therapies and their efficacy. (orig.) [de

High energy particle accelerators as radiation Sources

Energy Technology Data Exchange (ETDEWEB)

Abdelaziz, M E [National Center for Nuclear Safety and Radiation Vontrol, Atomic Energy Authority, Cairo (Egypt)

1997-12-31

Small accelerators in the energy range of few million electron volts are usually used as radiation sources for various applications, like radiotherapy, food irradiation, radiation sterilization and in other industrial applications. High energy accelerators with energies reaching billions of electron volts also find wide field of applications as radiation sources. Synchrotrons with high energy range have unique features as radiation sources. This review presents a synopsis of cyclic accelerators with description of phase stability principle of high energy accelerators with emphasis on synchrotrons. Properties of synchrotron radiation are given together with their applications in basic and applied research. 13 figs.,1 tab.

Radiotherapy for breast cancer and pacemaker

International Nuclear Information System (INIS)

Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M.; Kirov, K.M.; Esteve, M.

2011-01-01

Purpose. - Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic Irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. Patients and methods. - From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. Results. - Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. Conclusion. - The multidisciplinary work with position change of the pacemaker before

HEATHER - HElium Ion Accelerator for RadioTHERapy

Energy Technology Data Exchange (ETDEWEB)

Taylor, Jordan [Huddersfield U.; Edgecock, Thomas [Huddersfield U.; Green, Stuart [Birmingham U.; Johnstone, Carol [Fermilab

2017-05-01

A non-scaling fixed field alternating gradient (nsFFAG) accelerator is being designed for helium ion therapy. This facility will consist of 2 superconducting rings, treating with helium ions (He²⁺ ) and image with hydrogen ions (H + 2 ). Currently only carbon ions are used to treat cancer, yet there is an increasing interest in the use of lighter ions for therapy. Lighter ions have reduced dose tail beyond the tumour compared to carbon, caused by low Z secondary particles produced via inelastic nuclear reactions. An FFAG approach for helium therapy has never been previously considered. Having demonstrated isochronous acceleration from 0.5 MeV to 900 MeV, we now demonstrate the survival of a realistic beam across both stages.

Final report of a randomized trial on altered-fractionated radiotherapy in nasopharyngeal carcinoma prematurely terminated by significant increase in neurologic complications

International Nuclear Information System (INIS)

Teo, Peter Man Lung; Leung, Sing Fai; Chan, Anthony Tak Cheung; Leung, Thomas Wai Tong; Choi, Peter Ho Keung; Kwan, Wing Hong; Lee, Wai Yee; Chau, Ricky Ming Chun; Yu, Peter Kau Wing; Johnson, Philip James

2000-01-01

Purpose: The aim of the present study was to compare the survival, local control and complications of conventional/accelerated-hyperfractionated radiotherapy and conventional radiotherapy in nonmetastatic nasopharyngeal carcinoma (NPC). Methods and Materials: From February 1993 to October 1995, 159 patients with newly diagnosed nonmetastatic (M0) NPC with N0 or 4 cm or less N1 disease (Ho's N-stage classification, 1978) were randomized to receive either conventional radiotherapy (Arm I, n = 82) or conventional/accelerated-hyperfractionated radiotherapy (Arm II, n = 77). Stratification was according to the T stage. The biologic effective dose (10 Grays) to the primary and the upper cervical lymphatics were 75.0 and 73.1 for Arm I and 84.4 and 77.2 for Arm II, respectively. Results: With comparable distribution among the T stages between the two arms, the free from local failure rate at 5 years after radiotherapy was not significantly different between the two arms (85.3%; 95% confidence interval, 77.2-93.4% for Arm I; and 88.9%; 95% confidence interval, 81.7-96.2% for Arm II). The two arms were also comparable in overall survival, relapse-free survival, and rates of distant metastasis and regional relapse. Conventional/accelerated-hyperfractionated radiotherapy was associated with significantly increased radiation-induced damage to the central nervous system (including temporal lobe, cranial nerves, optic nerve/chiasma, and brainstem/spinal cord) in Arm II. Although insignificant, radiation-induced cranial nerve(s) palsy (typically involving VIII-XII), trismus, neck soft tissue fibrosis, and hypopituiturism and hypothyroidism occurred more often in Arm II. In addition, the complications occurred at significantly shorter intervals after radiotherapy in Arm II. Conclusion: Accelerated hyperfractionation when used in conjunction with a two-dimensional radiotherapy planning technique, in this case the Ho's technique, resulted in increased radiation damage to the central

Recommendations: Introducing the quality system into the use of significant ionizing radiation sources in radiotherapy. TLD audit by mail within the quality system in radiotherapy

International Nuclear Information System (INIS)

Ekendahl, D.; Valenta, J.; Horakova, I.

2005-01-01

The publication consists of the following sections: TLD measurement methodology (Description of the TLD system; Dose determination); TLD audit in radiotherapy: methodologies and evaluation of results (Checking the dose calculated by the planning system and beam quality control; Checking the calculated dose distribution using a versatile phantom; Checking the calculated doses for linear accelerators with multilammelar collimators; Evaluation and analysis of results; Organizing a performing audits by mail); and Annexes: Detailed guidelines and protocols for radiotherapy departments. (P.A.)

Clinical application of AcMAR (accelerated multiple-arc radiotherapy) for head and neck tumors. Results of a randomized, two-dose study in Kitami Red-Cross General Hospital

International Nuclear Information System (INIS)

Arimoto, Takuro; Yamazaki, Akira; Yonesaka, Akio; Matsuzawa, Tooru; Kanai, Naoki

2003-01-01

Enhanced acute mucositis is the limiting factor for accelerated, hyperfractionated radiotherapy in head and neck (H and N) squamous cell carcinomas (SCCs). We have developed a simple, new form of conformal radiotherapy, accelerated multiple arc radiotherapy (AcMAR), which covers the target volume by combined, segmental, and rotational arc fields. Two to three rotational fields were placed with CT guidance, each covering the primary tumor and lymph nodes separately. The optimal inter-isocenter distance was determined by 3D dose calculation. The surface area of oro-pharyngeal mucosa irradiated by more than a 50% dose by this method was reduced by 37-73% compared to that with a conventional parallel opposing technic. Dose searching, randomized two-dose study was initiated in Kitami Red-cross General Hospital (KRCGH) in January 1995, and 101 patients were registered and completed AcMAR in Oct 2000. All the patients were followed for up to 96 months (24-96 mo, median 48 mo) at the time of analysis. Fifty-one out of 101 patients were Stage III (17) and IV (34). Primary site of tumors were; 38 larynx, 25 oropharynx, 15 hypopharynx, 13 oral cavity, and 10 other miscellaneous sites. Patients were randomly allocated either to 60 Gy/24 fr/bid/3 wks to gross tumor volume (GTV) (Group A), or 66 Gy/33 fr/bid/4 wks to GTV (Group B). Forty Gy/16 fr/bid/2 wks was given to the volume of prophylactic'' irradiation in both groups of patients. Results were as follows: All the patients, except for one, completed AcMAR without treatment interruption. Acute mucositis at the site of high-dose irradiation was intense; 72% of Group A and 62.5% of Group B experienced World Health Organization (WHO) Grade 3 (confluent) mucositis focally. Fifty-one out of 53 in Group A and 48/48 in Group B, however, could maintain oral food intake (WHO Grade 1 or 2) even at the peak of their mucositis, because of the limited area of severe mucositis. With regard to late morbidity, however, 6/46 (followed >24 mo

Development of an ultrasmall C-band linear accelerator guide for a four-dimensional image-guided radiotherapy system with a gimbaled x-ray head.

Science.gov (United States)

Kamino, Yuichiro; Miura, Sadao; Kokubo, Masaki; Yamashita, Ichiro; Hirai, Etsuro; Hiraoka, Masahiro; Ishikawa, Junzo

2007-05-01

We are developing a four-dimensional image-guided radiotherapy system with a gimbaled x-ray head. It is capable of pursuing irradiation and delivering irradiation precisely with the help of an agile moving x-ray head on the gimbals. Requirements for the accelerator guide were established, system design was developed, and detailed design was conducted. An accelerator guide was manufactured and basic beam performance and leakage radiation from the accelerator guide were evaluated at a low pulse repetition rate. The accelerator guide including the electron gun is 38 cm long and weighs about 10 kg. The length of the accelerating structure is 24.4 cm. The accelerating structure is a standing wave type and is composed of the axial-coupled injector section and the side-coupled acceleration cavity section. The injector section is composed of one prebuncher cavity, one buncher cavity, one side-coupled half cavity, and two axial coupling cavities. The acceleration cavity section is composed of eight side-coupled nose reentrant cavities and eight coupling cavities. The electron gun is a diode-type gun with a cerium hexaboride (CeB6) direct heating cathode. The accelerator guide can be operated without any magnetic focusing device. Output beam current was 75 mA with a transmission efficiency of 58%, and the average energy was 5.24 MeV. Beam energy was distributed from 4.95 to 5.6 MeV. The beam profile, measured 88 mm from the beam output hole on the axis of the accelerator guide, was 0.7 mm X 0.9 mm full width at half maximum (FWHM) width. The beam loading line was 5.925 (MeV)-Ib (mA) X 0.00808 (MeV/mA), where Ib is output beam current. The maximum radiation leakage of the accelerator guide at 100 cm from the axis of the accelerator guide was calculated as 0.33 cGy/min at the rated x-ray output of 500 cGy/min from the measured value. This leakage requires no radiation shielding for the accelerator guide itself per IEC 60601-2-1.

Results of different modes conformal radiotherapy in treatment of cervical cancer

International Nuclear Information System (INIS)

Baranovs'ka, L.M.; Yivankova, V.S.; Khrulenko, T.V.; Skomorokhova, T.V.; Gorelyina, G.L.

2017-01-01

Development of techniques for cytotoxic treatment applying different modes of conformal radiotherapy, brachytherapy and high-energy (high dose rate - HDR) is one of the promising areas of optimization and efficiency of conservative treatment of patients with regional forms of cervical cancer. At Radiation Oncology Department, National Cancer Institute, 89 patients with stage 2b-3b cervical cancer, aged 29 to 70, underwent examination and combined radiotherapy course. The patients were divided into 2 main groups (56 patients) depending on the mode of developed conformal radiation therapy, and a control group made up by 33 patients (classic, default conformal radiotherapy). Results. Along with external beam radiotherapy, the patients of Group 2 were provided with conformal radiotherapy carried out by means of the linear accelerator of electrons in the mode of enhanced multi fractionation of irradiation dose applied to the small pelvis area (tumor and lymph efflux channels) with the single tumor dose 1.3 Gy twice per day once 4-6 hours up to the total radiation dose of 45 Gy applied to the small pelvis lymph nodes. The patients of Group 1 and the ones of the control group underwent conformal radiotherapy in the mode of standard fractionation applied to the small pelvis area with the single tumor dose of 1.8 Gy up to the total radiation dose of 45 Gy. Conformal radiotherapy was carried out for the patients of Group 1 associated with chemoradiomodifiers (tegafur, cisplatin). At the stage 2 of combined radiotherapy course, all patients underwent HDR brachytherapy via Co60 source in the mode of the single tumor dose of 5 Gy at point A up to the total radiation dose of 35-40 Gy. Therefore, employing accelerated mode of multifractiation in conformal radiotherapy of patients with regional cervical cancer makes it possible to enhance canrcinocidal irradiation doses applied to a tumor, and an interval between radiotherapy fractions provides conditions for initiation of

What is the Radiotherapy Quality Program of the Instituto Nacional do Cancer - INCa?

International Nuclear Information System (INIS)

Campos de Araujo, A.M.; Castelo Branco Viegas, C.; Salomon de Souza, R.

2004-01-01

The Radiotherapy Quality Program (PQRT) of Cancer National Institute (INCA) has been functioning since 1999 as a pilot program with only 33 participant institutions. Due to the optimal obtained results the program becomes a part of the INCA National Programs and his activities were extended to all radiotherapy services which attend the Health Unique Systems (SUS), approximately 130 institutions corresponding to 90 percent of the radiotherapy services available in Brazil. The PQRT main objective is to make the radiotherapy to be evaluated as planned, in accordance with quality assurance international standards. The principal activities of the PQRT are: local evaluation, TLD postal evaluation under reference and non-reference conditions, and training and development of research projects. The Local Evaluation System has already evaluated 85 teletherapy equipment (38 Co-60 and 47 linear accelerators), executing dosimetric, electric, mechanic and safety tests. The TLD postal system used for the 33 participants until 2002 was the International Atomic Energy Agency (IAEA) for reference conditions. Five evaluations has already been performed with this simply system. Since 2003, the postal evaluation of the PQRT is using his own system, developed for reference and non-reference conditions, applied to 58 beams (18 Co-60 and 40 linear accelerators). The PQRT ras already performed 400 evaluations under reference conditions (190 Co-60 and 210 linear accelerators). 18 courses have been provided for the participants, covering his main practical problems. In addition, some studies and research has been performed

A decade of investment in radiotherapy in New South Wales: why does the gap between optimal and actual persist?

International Nuclear Information System (INIS)

Barton, Michael B.; Delaney, Geoff P.

2011-01-01

There is a gap between optimal and actual radiotherapy utilization (RTU) rates in New South Wales (NSW). It is uncertain if this is because these investments have been insufficient to meet demand, or demand has been over-estimated. In this study we assess trends in infrastructure, staffing and productivity in NSW over the last 10 years. The NSW Radiotherapy Management Information System reports annually on activity including new patients, new courses, retreatments, attendances, radiotherapy fields and Area Health Service (AHS) of residence. Data are obtained from interstate radiotherapy departments that treat NSW residents. A census of equipment and staffing is reported. RTU was defined as the number of new cases in a year treated by radiotherapy divided by the number of new cases of cancer in that year. From 1999 to 2008, 115 941 NSW residents received at least one course of radiotherapy. During this time period there were 325 965 new diagnoses of cancer reported by the Central Cancer Registry. RTU was 38% in 1999 and in 2008. The number of linear accelerators increased from 34 to 42 between 1999 and 2008 but the number of accelerators per 1000 new cases of cancer remained static at 1.2. For AHSs, there was a significant relationship between more linear accelerators per 1000 patients and higher RTU (P = 0.0023). Radiotherapy utilization in NSW has remained at 38% for the period 1999 to 2008 because investment in new facilities only just kept pace with the increase in the number of new cases of cancer with an indication for radiotherapy. Some regional AHS have shown significant increases in RTU with new facilities.

Towards real-time plan adaptation for MRI-guided radiotherapy

NARCIS (Netherlands)

Kontaxis, Charis

2017-01-01

The introduction of hybrid MRI and linear accelerator (MRI-linac) machines enables the online volumetric imaging during radiation delivery with the superior soft tissue contrast of the diagnostic quality MRI. In this context, conventional radiotherapy workflow will gradually transfer from an offline

Kimura's Disease of the Orbit Successfully Treated with Radiotherapy Alone: A Case Report

Directory of Open Access Journals (Sweden)

Yoshio Monzen

2014-03-01

Full Text Available We performed radiotherapy in a 28-year-old patient with Kimura's disease of the orbit. Irradiation with 21.6 Gy was administered to the tumor bed with a single dose of 1.8 Gy in 5 weekly fractions delivered via a high-energy linear accelerator (6-MV X-ray. Complete remission of the tumor and improvements in the neurological findings were achieved. Neither tumor regrowth nor late complications were detected up to 84 months after radiotherapy. Radiotherapy is an effective treatment for Kimura's disease of the orbit.

Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer

International Nuclear Information System (INIS)

Wopken, Kim; Bijl, Hendrik P.; Schaaf, Arjen van der; Laan, Hans Paul van der; Chouvalova, Olga; Steenbakkers, Roel J.H.M.; Doornaert, Patricia; Slotman, Ben J.; Oosting, Sjoukje F.; Christianen, Miranda E.M.C.; Laan, Bernard F.A.M. van der; Roodenburg, Jan L.N.; René Leemans, C.; Verdonck-de Leeuw, Irma M.; Langendijk, Johannes A.

2014-01-01

Background and purpose: Curative radiotherapy/chemo-radiotherapy for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence 6 months (TUBE M6 ) after definitive radiotherapy, radiotherapy plus cetuximab or concurrent chemoradiation based on pre-treatment and treatment characteristics. Materials and methods: The study included 355 patients with HNC. TUBE M6 was scored prospectively in a standard follow-up program. To design the prediction model, the penalized learning method LASSO was used, with TUBE M6 as the endpoint. Results: The prevalence of TUBE M6 was 10.7%. The multivariable model with the best performance consisted of the variables: advanced T-stage, moderate to severe weight loss at baseline, accelerated radiotherapy, chemoradiation, radiotherapy plus cetuximab, the mean dose to the superior and inferior pharyngeal constrictor muscle, to the contralateral parotid gland and to the cricopharyngeal muscle. Conclusions: We developed a multivariable NTCP model for TUBE M6 to identify patients at risk for tube feeding dependence. The dosimetric variables can be used to optimize radiotherapy treatment planning aiming at prevention of tube feeding dependence and to estimate the benefit of new radiation technologies

Assessment of quality of life in patients treated with accelerated radiotherapy for laryngeal and hypopharyngeal carcinomas.

Science.gov (United States)

Allal, A S; Dulguerov, P; Bieri, S; Lehmann, W; Kurtz, J M

2000-05-01

This study was conducted to evaluate quality of life (QOL) and functional outcome in patients with carcinomas of the larynx and hypopharynx treated with accelerated radiotherapy (RT). Between January 1991 and September 1996, 21 patients treated with accelerated concomitant boost RT schedule (69.9 Gy in 5. 5 weeks) for laryngeal (n = 10) or hypopharyngeal (n = 11) carcinomas and who remained free of disease at 1-year minimum follow-up were evaluated. The functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and general QOL by the European Organization for Research and Treatment of Cancer Core QOL questionnaire (EORTC QLQ-C30). The median length of follow-up was 37 months (range, 13 to 75). The PSSHN scores were 89, 84, and 86, respectively, for eating in public, understandability of speech and normalcy of diet (100 = normal function). Significantly lower scores for understandability of speech were observed in patients with advanced and laryngeal carcinomas. Normalcy of diet was affected negatively by the severity of xerostomia. All mean functional scale scores of the EORTC QLQ-C30 module were 20% to 25% below the higher score. Most of these scale scores were significantly affected by the severity of xerostomia. Patients treated with concomitant boost RT for laryngeal and hypopharyngeal carcinomas appear to have similar QOL and functional outcome to those reported for patients treated with conventional or hyperfractionated RT. As expected, many QOL scales were affected by the severity of xero- stomia.

Stabilisation Evaluation of Medical Linear Accelerator

International Nuclear Information System (INIS)

Nasukha

1996-01-01

Medical linear accelerator are widely used for cancer treatment in radiotherapy. Radiation beam stability of accelerators, Megatron 20 and 12 were evaluated for a month with RMI daily constancy tool. Un stability less than 3 % for 7,10,12,15,18 MeV of electron beam and photon beam 15MV of Megatron 20 and photon beam 12MV of Megatron 12. Electron beam of 5 MeV of Megatron 20 should be set to get better salability, especially its radiofrequency

Applications of Particle Accelerators in Medical Physics

OpenAIRE

Cuttone, G

2008-01-01

Particle accelerators are often associated to high energy or nuclear physics. As well pointed out in literature [1] if we kindly analyse the number of installation worldwide we can easily note that about 50% is mainly devoted to medical applications (radiotherapy, medical radioisotopes production, biomedical research). Particle accelerators are also playing an important indirect role considering the improvement of the technical features of medical diagnostic. In fact the use of radionuclide f...

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)

Intercomparison of quality control procedures in radiotherapy in the Netherlands

International Nuclear Information System (INIS)

Kleffens, H.J. van; Meijer, G.J.; Mijnheer, B.J.

1997-01-01

A grant was received from the Dutch government to accomplish the development and implementation of guidelines for quality control (QC) of radiotherapy equipment in The Netherlands. QC of electron accelerators, simulators, CT scanners, mould room equipment, dosimetry equipment and treatment planning systems will be considered in this project. The project started in September 1994 with an investigation of QC of medical electron accelerators as performed in all 21 radiotherapy institutions in The Netherlands. An extensive questionnaire on QC procedures of electron accelerators was sent to all centres with items related to safety systems, mechanical aspects, radiation leakage, beam data and dosimetry equipment (in total about 60 questions). From the answers the following conclusions can be drawn: There is a large variation in time spent on QC; This QC time strongly depends on the complexity of the linear accelerator; There is a large variation in frequency and tolerance levels of the various tests; The way QC of an item is performed differs considerably (extensive-comprehensive). From these data recommendations specific for the situation in The Netherlands are being prepared and compared with other existing national and international reports. Similar procedures are underway for CT scanners and simulators while for the other equipment minimum guidelines still have to be developed. (author)

Hadrons accelerators in the cancer therapy

International Nuclear Information System (INIS)

Amaldi, U.; Silari, M.

1998-01-01

The use of hadrons accelerators ( protons and light ions) in the cancer therapy is tackled. After shorts introductory words about the medical reasons in favour of using charged heavy particles radiotherapy, an overall idea is given on the accelerators technology and on the guiding and focusing systems. The Italian project of hadron-therapy (the most important project of this kind in Europe) is introduced, with in reference the National Oncological Center of Hadron-therapy and the plans of two kinds of compact protons accelerators in order to introduce the therapy with protons in a great number of hospitals. Finally, the needs in radiation protection are discussed. (N.C.)

Acute toxicity and cost analysis of a phase III randomized trial of accelerated and conventional radiotherapy for squamous carcinoma of the head and neck: a trans- tasman radiation oncology group study

International Nuclear Information System (INIS)

Poulsen, M.; Williamson, S.; Tripcony, L.; Spry, N.; Peters, L.; Penniment, M.; Lamb, D.; Krawitz, H.

1999-01-01

The primary purpose of the present analysis was to assess the feasibility and acute toxicity of a pure accelerated fractionation regimen in a cooperative group setting. This analysis included the first 320 patients entered on to the Trans-Tasman Radiation Oncology Group (TROG) randomized controlled trial which compared accelerated radiotherapy (ART) with conventional radiotherapy (CRT) in stage lIl and IV squamous cell carcinoma (SCC) of the head and neck. Patients were randomized to either 59.4 Gy in 33 fractions over 24 days (ART) or to 70 Gy 35 fractions over 49 days (CRT) after being stratified for site and stage. Accrual began in 1991 and the trial was closed on 3 April 1998 with the targeted 350 patients. The 3-year survival for the whole group was 54%, and the 3-year disease-free survival was 41%. Toxicity data were available on 303 patients (148 ART; 155 CRT). Mucosal toxicity was worse in the accelerated grup, and it peaked ∼ 3 weeks earlier than the conventional grup. Skin toxicity was equivalent but occurred ∼ 7 days earlier in the accelerated grup. Acute effects in both grups healed completely. Hospitalization was more common in the ART grup (71 vs 52 patients; P=0.01) but the total bed days in hospital was not greatly different (1707 bed days for ART and 1607 bed days for CRT). Patients were more likely to require nasogastric (NG) feeding in the ART grup (49 vs 33 patients; P = 0.02). There were 1157 NG feeding days for ART and 1154 NG feeding days for CRT. The average cost of radiation treatment per patient including hospitalisation, NG feeding and accommodation was $11 750 in the ART grup and $11 587 in the CRT grup. The accelerated grup has been shown to be a tolerable, practical and cost-equivalent regimen. The assessment of the therapeutic ratio of this accelerated protocol (ART) will be determined when the analysis of late effects and loco-regional control is made when the data are more mature. Copyright (1999) Blackwell Science Pty Ltd

Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer.

Science.gov (United States)

Staar, S; Rudat, V; Stuetzer, H; Dietz, A; Volling, P; Schroeder, M; Flentje, M; Eckel, H E; Mueller, R P

2001-08-01

To demonstrate the efficacy of radiochemotherapy (RCT) as the first choice of treatment for advanced unresectable head-and-neck cancer. To prove an expected benefit of simultaneously given chemotherapy, a two-arm randomized study with hyperfractionated accelerated radiochemotherapy (HF-ACC-RCT) vs. hyperfractionated accelerated radiotherapy (HF-ACC-RT) was initiated. The primary endpoint was 1-year survival with local control (SLC). Patients with Stage III and IV (UICC) unresectable oro- and hypopharyngeal carcinomas were randomized for HF-ACC-RCT with 2 cycles of 5-FU (600 mg/m(2)/day)/carboplatinum (70 mg/m(2)) on days 1--5 and 29--33 (arm A) or HF-ACC-RT alone (arm B). In both arms, there was a second randomization for testing the effect of prophylactically given G-CSF (263 microg, days 15--19) on mucosal toxicity. Total RT dose in both arms was 69.9 Gy in 38 days, with a concomitant boost regimen (weeks 1--3: 1.8 Gy/day, weeks 4 and 5: b.i.d. RT with 1.8 Gy/1.5 Gy). Between July 1995 and May 1999, 263 patients were randomized (median age 56 years; 96% Stage IV tumors, 4% Stage III tumors). This analysis is based on 240 patients: 113 patients with RCT and 127 patients with RT, qualified for protocol and starting treatment. There were 178 oropharyngeal and 62 hypopharyngeal carcinomas. Treatment was tolerable in both arms, with a higher mucosal toxicity after RCT. Restaging showed comparable nonsignificant different CR + PR rates of 92.4% after RCT and 87.9% after RT (p = 0.29). After a median observed time of 22.3 months, l- and 2-year local-regional control (LRC) rates were 69% and 51% after RCT and 58% and 45% after RT (p = 0.14). There was a significantly better 1-year SLC after RCT (58%) compared with RT (44%, p = 0.05). Patients with oropharyngeal carcinomas showed significantly better SLC after RCT (60%) vs. RT (40%, p = 0.01); the smaller group of hypopharyngeal carcinomas had no statistical benefit of RCT (p = 0.84). For both tumor locations

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

Charged particle accelerators for practice

International Nuclear Information System (INIS)

Arzumanov, A.A.

1988-01-01

Characteristics of some accelerators operating in the world are given, capabilities of accelerator technique are demonstrated. Examples of wide application of accelerators in radiation-chemical technology as well as for defectoscopy of massive metal products and impurity ion implantation when producing semiconductor elements are presented. Works on nuclear filter production are characterized by high efficiency. Wide application of synchrotron radiation is described. Various accelerators can be applied during element analysis in geology, metallurgy, ecology. Application of accelerators ''in particular, cyclotrons for radioisotope production as well as in radiotherapy in medicine appears to be important. An isochronous cyclotron with controlled ion energy, at which applied works concerning a number of considered trends in the field of radiation physics and radiation physical metallurgy, element analysis, radiation resistance of electronic circuits and components are conducted, is in operation at the IYaPh of the Kazakh Academy of Sciences. Production of tallium-201 for cardiologic invstigations deserves a special attention. An electrostatic heavy ion accelerator which allows one to produce the beams of accelerated ions of elements from hydrogen to uranium is under commissioning

Pregnancy and radiotherapy : management options for minimising risk, case series and comprehensive literature review

International Nuclear Information System (INIS)

Luis, S. A.; Christie, D. R. H.; Peres, M. H.; Kaminski, A.

2009-01-01

Full text: This article reviews the efficacy and safety of radiotherapy in patients with cancer who are pregnant. Our review provided extended follow-up results in nine cases, presents a technical discussion on measures taken to minimise foetal radiation exposure and provides a comprehensive summary of the literature. Nine patients who received radiotherapy while pregnant are described. The clinical presentation and outcomes of these and 100 additional cases identified on a systematic literature review are presented. Comparisons of scattered radiation doses from three linear accelerators are presented. The average maternal follow-up in our series was 8.9 years with one patient having a recurrence of their astrocytoma. In terms of foetal outcome, there were one death in utero, one elective termination of pregnancy and one on which no data were available. Six children, on whom long-term follow-up (average 10.3 years) was obtainable, were in good health. Overall, there had been 109 cases of radiotherapy in pregnancy that met our search criteria with 13 adverse outcomes and a median follow-up of 37 months. Comparisons of three linear accelerators demonstrated significant differences in the amount of scattered radiation to the abdominal surface. In summary radiotherapy during pregnancy can be associated with a significant number of adverse outcomes. While it may be difficult for a patient not to attribute these effects to radiotherapy, it is also difficult to define the mechanisms by which radiotherapy would have caused them, if that were the case.

Short-Course Accelerated Radiotherapy in Palliative Treatment of Advanced Pelvic Malignancies: A Phase I Study

Energy Technology Data Exchange (ETDEWEB)

Caravatta, Luciana [Department of Radiation Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Padula, Gilbert D.A. [Department of Radiation Oncology, Lacks Cancer Center Saint Mary' s Health Care, Grand Rapids, MI (United States); Macchia, Gabriella, E-mail: gmacchia@rm.unicatt.it [Department of Radiation Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Ferrandina, Gabriella [Department of Gynecologic Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Bonomo, Pierluigi; Deodato, Francesco; Massaccesi, Mariangela [Department of Radiation Oncology, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Mignogna, Samantha; Tambaro, Rosa [Department of Palliative Therapies, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Rossi, Marco [Department of Anaesthesia, Intensive Care, and Pain Medicine, Fondazione di Ricercae Cura ' Giovanni Paolo II,' Universita Cattolica del S. Cuore, Campobasso (Italy); Flocco, Mariano [' Madre Teresa di Calcutta' Hospice, Larino (Italy); Scapati, Andrea [Department of Radiation Oncology, ' San Francesco' Hospital, Nuoro (Italy); and others

2012-08-01

Purpose: To define the maximum tolerated dose of a conformal short-course accelerated radiotherapy in patients with symptomatic advanced pelvic cancer. Methods and Materials: A phase I trial in 3 dose-escalation steps was designed: 14 Gy (3.5-Gy fractions), 16 Gy (4-Gy fractions), and 18 Gy (4.5-Gy fractions). The eligibility criteria included locally advanced and/or metastatic pelvic cancer and Eastern Cooperative Oncology Group performance status of {<=}3. Treatment was delivered in 2 days with twice-daily fractionation and at least an 8-hour interval. Patients were treated in cohorts of 6-12 to define the maximum tolerated dose. The dose-limiting toxicity was defined as any acute toxicity of grade 3 or greater, using the Radiation Therapy Oncology Group scale. Pain was recorded using a visual analog scale. The effect on quality of life was evaluated according to Cancer Linear Analog Scale (CLAS). Results: Of the 27 enrolled patients, 11 were male and 16 were female, with a median age of 72 years (range 47-86). The primary tumor sites were gynecologic (48%), colorectal (33.5%), and genitourinary (18.5%). The most frequent baseline symptoms were bleeding (48%) and pain (33%). Only grade 1-2 acute toxicities were recorded. No patients experienced dose-limiting toxicity. With a median follow-up time of 6 months (range 3-28), no late toxicities were observed. The overall (complete plus partial) symptom remission was 88.9% (95% confidence interval 66.0%-97.8%). Five patients (41.7%) had complete pain relief, and six (50%) showed >30% visual analog scale reduction. The overall response rate for pain was 91.67% (95% confidence interval 52.4%-99.9%). Conclusions: Conformal short course radiotherapy in twice-daily fractions for 2 consecutive days was well tolerated up to a total dose of 18 Gy. A phase II study is ongoing to confirm the efficacy on symptom control and quality of life indexes.

Short-Course Accelerated Radiotherapy in Palliative Treatment of Advanced Pelvic Malignancies: A Phase I Study

International Nuclear Information System (INIS)

Caravatta, Luciana; Padula, Gilbert D.A.; Macchia, Gabriella; Ferrandina, Gabriella; Bonomo, Pierluigi; Deodato, Francesco; Massaccesi, Mariangela; Mignogna, Samantha; Tambaro, Rosa; Rossi, Marco; Flocco, Mariano; Scapati, Andrea

2012-01-01

Purpose: To define the maximum tolerated dose of a conformal short-course accelerated radiotherapy in patients with symptomatic advanced pelvic cancer. Methods and Materials: A phase I trial in 3 dose-escalation steps was designed: 14 Gy (3.5-Gy fractions), 16 Gy (4-Gy fractions), and 18 Gy (4.5-Gy fractions). The eligibility criteria included locally advanced and/or metastatic pelvic cancer and Eastern Cooperative Oncology Group performance status of ≤3. Treatment was delivered in 2 days with twice-daily fractionation and at least an 8-hour interval. Patients were treated in cohorts of 6-12 to define the maximum tolerated dose. The dose-limiting toxicity was defined as any acute toxicity of grade 3 or greater, using the Radiation Therapy Oncology Group scale. Pain was recorded using a visual analog scale. The effect on quality of life was evaluated according to Cancer Linear Analog Scale (CLAS). Results: Of the 27 enrolled patients, 11 were male and 16 were female, with a median age of 72 years (range 47-86). The primary tumor sites were gynecologic (48%), colorectal (33.5%), and genitourinary (18.5%). The most frequent baseline symptoms were bleeding (48%) and pain (33%). Only grade 1-2 acute toxicities were recorded. No patients experienced dose-limiting toxicity. With a median follow-up time of 6 months (range 3-28), no late toxicities were observed. The overall (complete plus partial) symptom remission was 88.9% (95% confidence interval 66.0%-97.8%). Five patients (41.7%) had complete pain relief, and six (50%) showed >30% visual analog scale reduction. The overall response rate for pain was 91.67% (95% confidence interval 52.4%-99.9%). Conclusions: Conformal short course radiotherapy in twice-daily fractions for 2 consecutive days was well tolerated up to a total dose of 18 Gy. A phase II study is ongoing to confirm the efficacy on symptom control and quality of life indexes.

Establishment of a radiotherapy service with a linear accelerator (photons): acceptance tests, dosimetry and quality control; Implantacao de um servico de radioterapia com acelerador linear (fotons): testes de aceitacao, dosimetria e controle de qualidade

Energy Technology Data Exchange (ETDEWEB)

Berdaky, Mafalda Feliciano

2000-07-01

This work presents the operational part of the final process of the establishment of a radiotherapy service with a linear accelerator (6 MeV photon beams), including the acceptance tests, commissioning tests and the implementation of a quality control program through routine mechanical and radiation tests. All acceptance tests were satisfactory, showing results below the allowed limits of the manufacturer, the commissioning tests presented results within those of the international recommendations. The quality control program was performed during 34 months and showed an excellent stability of this accelerator. (author)

Saliva in relation to dental erosion before and after radiotherapy

DEFF Research Database (Denmark)

Jensdottir, Thorbjorg; von Buchwald, Christian; Nauntofte, Birgitte

2013-01-01

Abstract Objective. Low saliva flow and abnormal saliva composition are common conditions after radiotherapy for oral cavity and pharyngeal cancer. Both conditions increase the susceptibility to dental caries and erosion, which may be further accelerated by changes in food preferences. The aim...... of this study was to determine changes in saliva flow and susceptibility to erosive challenges in pharyngeal cancer patients before and after radiotherapy to the head and neck. Materials and methods: The erosive potential of sucking acidic candies with and without calcium was determined in nine patients (50...

Basis of medical accelerator. Synchrotron

International Nuclear Information System (INIS)

Kawachi, Kiyomitsu

2014-01-01

On the synchrotron as a medical accelerator, this paper introduces the basic principle, basic techniques and the like. The accelerator, when synchrotron is adopted as an ion beam radiotherapy system, is the composite accelerator composed of ion sources, injector, and synchrotron. This paper introduces the overall structure of synchrotron, and conceptually explains the basic behavior of high-frequency waves and magnetic field of synchrotron, as well as the deflection electromagnet of medical synchrotron and the operation pattern of high-frequency acceleration system. The types of synchrotron can be classified to the function combination type and function separation type, and this paper introduces the features of each type and various types of synchrotrons. It also explains beam dynamics important for ensuring the stability of beams, with a focus on the coordinate system, vertical movement, and lateral movement. In addition, it explains the incidence and outgoing of beams that are important for properly operating the accelerator, with a focus on their techniques. (A.O.)

Quality assurance procedures in radiotherapy - IEC specifications for equipment

Energy Technology Data Exchange (ETDEWEB)

Rassow, J; Klieber, E

1986-08-01

The International Electrotechnical Commission (IEC) worked out international standards for requirements and tests of electrical, mechanical and radiation safety as well as for definition and tests of functional performance characteristics of radiotherapy equipments (medical electron accelerators, gamma beam teletherapy and afterloading equipments, simulators and accessories) and for clinical dosimeters and terminology for medical radiology. A survey is given on the actual state of standardization projects. The problems of such standards are shown for the standard for functional performance characteristics of medical electron accelerators as example.

Quality assurance procedures in radiotherapy - IEC specifications for equipment

International Nuclear Information System (INIS)

Rassow, J.; Klieber, E.

1986-01-01

The International Electrotechnical Commission (IEC) worked out international standards for requirements and tests of electrical, mechanical and radiation safety as well as for definition and tests of functional performance characteristics of radiotherapy equipments (medical electron accelerators, gamma beam teletherapy and afterloading equipments, simulators and accessories) and for clinical dosimeters and terminology for medical radiology. A survey is given on the actual state of standardization projects. The problems of such standards are shown for the standard for functional performance characteristics of medical electron accelerators as example. (orig.) [de

Development of electron linear accelerators in SAMEER

International Nuclear Information System (INIS)

Krishnan, R.

2015-01-01

LINear Accelerator (LINAC) based Radiotherapy machine is a key tool for Cancer Treatment. The number of such linac machines available is far less than the actual requirement projected, to suffice the needs of the vast number of Cancer Patients in the country. Development of indigenous state-of-art cancer therapy machine was therefore a crucial achievement under the Jai Vigyan Project of Govt. of India. With the support of Department of Electronics and Information Technology (DeitY), Govt of India, SAMEER has successfully developed 6 MV Radiation Oncology machine at par international standards and is being used to treat cancer patients in the country. SAMEER is also currently developing the dual photon energy and multiple electron energy medical linac machine for radiotherapy and also critical accessories to make a complete oncology system required for advanced state of art treatment. In this paper the work in SAMEER on electron linear accelerators for the medical applications and the related technology and facilities available will be presented. (author)

Quality control programme for radiotherapy

International Nuclear Information System (INIS)

Campos de Araujo, A.M.; Viegas, C.C.B.; Viamonte, A.M.

2002-01-01

A 3 years pilot programme started in January 2000 with 33 philanthropic cancer institutions that provides medical services to 60% of the patients from the national social security system. Brazil has today 161 radiotherapy services (144 operating with megavoltage equipment). These 33 institutions are distributed over 19 Brazilian states. The aim of this programme is: To create conditions to allow the participants to apply the radiotherapy with quality and efficacy; To promote up dating courses for the physicians, physicists and technicians of these 33 Institutions. With the following objectives: To recommend dosimetric and radiological protection procedures in order to guarantee the tumor prescribed dose and safe working conditions; To help in establishing and implementing these procedures. The main activities are: local quality control evaluations, postal TLD audits in reference conditions, postal TLD audits in off axis conditions and training. The local quality control program has already evaluated 22 institutions with 43 machines (25 Co-60 and 18 linear accelerators). In these visits we perform dosimetric, electrical, mechanical and safety tests. As foreseen, we found more problems among the old Co-60 machines i.e., field flatness, size, symmetry and relative output factors; lasers positioning system alignment; optical distance indicator; radiation and light field coincidence; optical and mechanical distance indicators agreement, than among the linear accelerators i.e., field flatness and size; lasers positioning system alignment; tray interlocking and wedge filter factors

Inclusion of molecular biotherapies with radical radiotherapy: modeling of combined modality treatment schedules

International Nuclear Information System (INIS)

Jones, Bleddyn; Dale, Roger G.

1999-01-01

Purpose: The use of molecular biology based therapies concurrently with radical radiotherapy is likely to offer potential benefits, but there is relatively little use of classical radiobiology in the rationale for such applications. The biological mechanisms that govern the outcomes of radiotherapy need to be completely understood before rational application and optimization of such adjuvant biotherapies with radiotherapy. Methods and Materials: Existing biomathematical models of radiotherapy can be used to explore the possible impact of biotherapies that modify tumor proliferation rates and/or radiosensitivity parameters during radiotherapy. Equations that show how to incorporate biotherapies with the linear-quadratic model of radiation cell kill are presented. Also considered are changes in tumor physiology, such as improved blood flow with enhanced delivery of biotherapy to the tumor cells and accelerated clonogen repopulation during radiotherapy. Monte Carlo random sampling methods are used to simulate these effects in heterogenous tumor populations with variation in radiosensitivities, clonogen numbers, and doubling times, as well as variations in repopulation onset rates and in vascular perfusion rates with time. Results: The time onset and duration of exposure of each type of biotherapy during radical radiotherapy can influence the predicted tumor cure probabilities in subtle ways. In general, the efficacy of biotherapies that radiosensitize will depend upon the number of radiotherapy fractions that are sensitized and the change in blood flow with time during radiotherapy. Biotherapies that control repopulation will depend not only on the duration of exposure but also, where accelerated repopulation occurs, on the time at which biotherapy is initiated during radiotherapy. From the ranges of radiobiological parameters and biotherapy efficacies assumed for exploratory examples, large changes of tumor control probability (TCP) are encountered in individual

Properties of the proton therapy. A high precision radiotherapy

International Nuclear Information System (INIS)

Anon.

2005-01-01

The proton therapy is a radiotherapy using protons beams. The protons present interesting characteristics but they need heavy technologies to be used, such particles accelerators, radiation protection wall and sophisticated technologies to reach the high precision allowed by their ballistic qualities (planning of treatment, beam conformation and patient positioning). (N.C.)

A review of ion sources for medical accelerators (invited)a)

Science.gov (United States)

Muramatsu, M.; Kitagawa, A.

2012-02-01

There are two major medical applications of ion accelerators. One is a production of short-lived isotopes for radionuclide imaging with positron emission tomography and single photon emission computer tomography. Generally, a combination of a source for negative ions (usually H- and/or D-) and a cyclotron is used; this system is well established and distributed over the world. Other important medical application is charged-particle radiotherapy, where the accelerated ion beam itself is being used for patient treatment. Two distinctly different methods are being applied: either with protons or with heavy-ions (mostly carbon ions). Proton radiotherapy for deep-seated tumors has become widespread since the 1990s. The energy and intensity are typically over 200 MeV and several 1010 pps, respectively. Cyclotrons as well as synchrotrons are utilized. The ion source for the cyclotron is generally similar to the type for production of radioisotopes. For a synchrotron, one applies a positive ion source in combination with an injector linac. Carbon ion radiotherapy awakens a worldwide interest. About 6000 cancer patients have already been treated with carbon beams from the Heavy Ion Medical Accelerator in Chiba at the National Institute of Radiological Sciences in Japan. These clinical results have clearly verified the advantages of carbon ions. Heidelberg Ion Therapy Center and Gunma University Heavy Ion Medical Center have been successfully launched. Several new facilities are under commissioning or construction. The beam energy is adjusted to the depth of tumors. It is usually between 140 and 430 MeV/u. Although the beam intensity depends on the irradiation method, it is typically several 108 or 109 pps. Synchrotrons are only utilized for carbon ion radiotherapy. An ECR ion source supplies multi-charged carbon ions for this requirement. Some other medical applications with ion beams attract developer's interests. For example, the several types of accelerators are under

Quantitative analysis of results for quality assurance in radiotherapy

International Nuclear Information System (INIS)

Passaro, Bruno Martins

2011-01-01

The linear accelerators represent the most important, practical and versatile source of ionizing radiation in radiotherapy. These functional characteristics influence the geometric and dosimetric accuracy of therapeutic doses applied to patients. The performance of this equipment may vary due to electronic defects, component failures or mechanical breakdowns, or may vary due to the deterioration and aging of components. Maintaining the quality of care depends on the stability of the accelerators and quality control of the institutions to monitor deviations in the parameters of the beam. The aim of this study is to assess and analyze the stability of the calibration factor of linear accelerators, as well as the other dosimetric parameters normally included in a program of quality control in radiotherapy. The average calibration factors of the accelerators for the period of approximately four years for the Clinac 600C and Clinac 6EX were (0,998 ± 0,012) and (0,996 ± 0,014), respectively. For the Clinac 2100CD 6 MV and 15 MV was (1,008 ± 0,009) and (1,006 ± 0,010), respectively, in a period of approximately four years. Statistical analysis of the three linear accelerators was found that the coefficient of variation of calibration factors had values below 2% which shows a consistency in the data. By calculating the normal distribution of calibration factors, we found that for the Clinac 600C and Clinac 2100CD, is an expected probability that more than 90% of cases the values are within acceptable limits according to the TG-142, while for the Clinac 6EX is expected around 85% since this had several exchanges of accelerator components. The values of TPR 20,10 of three accelerators are practically constant and within acceptable limits according to the TG-142. It can be concluded that a detailed study of data from the calibration factor of the accelerators and TPR20,10 from a quantitative point of view, is extremely useful in a quality assurance program. (author)

Conformation radiotherapy with eccentric multi-leaves, (1)

International Nuclear Information System (INIS)

Obata, Yasunori; Sakuma, Sadayuki.

1986-01-01

In order to extend the application of the conformation radiotherapy, the eccentric multi-leaves are equipped with the linear accelerator. The information of the position of the collimators and the dose distribution of the eccentric conformation radiotherapy are calculated by the improved algorism of the treatment planning system. In simple cases, the dose distributions for the distant region from the rotational center are measured and compared with the calculated values. Both distributions are well coincided with the error of about 5 % in the high dose region and 10 % in the low dose region. In eccentric conformation radiotherapy, it is difficult to deliver the planned dose to the lesion. The dose increases with the distance of the target area from the rotational center. And the measured value and the calculated value are well coincided with 1 % error. So after getting the dose ratio of the rotational center to the target area, the calculated dose can be delivered to the rotational center. The advantages of the eccentric conformation radiotherapy are a good coincidence of target area and treated area, a partial shielding and a hollow out technique without absorber. The limitation of the movement of the collimator from center is 5 cm at 1 m SCD. (author)

The physics of radiotherapy X-rays and electrons

CERN Document Server

Metcalfe, Peter; Hoban, Peter

2012-01-01

The Physics of Radiotherapy X-Rays and Electrons is an updated successor to The Physics of Radiotherapy X-Rays from Linear Accelerators published in 1997. This new volume includes a significant amount of new material, including new chapters on electrons in radiotherapy and IMRT, IGRT, and tomotherapy, which have become key developments in radiation therapy. Also updated from the earlier edition are the physics beam modeling chapters, including Monte Carlo methods, adding those mysterious electrons, as well as discourse on radiobiological modeling including TCP, NTCP, and EUD and the impact of these concepts on plan analysis and inverse planning. This book is intended as a standard reference text for postgraduate radiation oncology medical physics students. It will also be of interest to radiation oncology registrars and residents, dosimetrists, and radiation therapists. The new text contains review questions at the end of each chapter and full bibliographic entries. Fully indexed. Selected questions and ans...

Potentials of radiotherapy in inoperable tumours of the central nervous system in childhood

International Nuclear Information System (INIS)

Kocsis, Bela; Horvath, Akos; Varjas, Geza; Bajcsay, Andras; Kaldau, Ferenc; Pap, Lilla

1990-01-01

16 patients under 16 years were irradiated because of inoperable tumours in the central nervous system. Irradiations were performed by cobalt-60 facility and by a Neptun 10-p linear accelerator, and the results were evaluated. In these cases radiotherapy has an important role as it is the only definitive therapeutical intervention. Radiotherapy should be attempted even if the histological verification is impossible and only the clinical course referres to malignant process. Radiotherapy must be carried out on the basis of CT scan controlled irradiation plan. The 3-year survival rate was 14 per cent in the authors' material. (author) 16 refs.; 5 figs.; 3 tabs

Experimental radiotherapy and clinical radiobiology. Vol. 20. Proceedings; Experimentelle Strahlentherapie und Klinische Strahlenbiologie. Bd. 20. Proceedings

Energy Technology Data Exchange (ETDEWEB)

Baumann, Michael; Dahm-Daphi, Jochen; Dikomey, Ekkehard; Petersen, Cordula; Rodemannn, Hans-Peter; Zips, Daniel (eds.)

2011-07-01

The proceedings include contributions on the following issues: laser driven proton accelerators on the way for radiotherapy, radiobiological evaluation of new radiations; molecular factors of radiation response; biological targeting; EGFR epidermal growth factor receptor/targeting - combined internal and external irradiation, radiobiology of normal tissues; dose-volume histograms for the radiotherapy: curves without radiobiological relevance or important information for the therapy planning; HPV (human papilloma virus) and radiation sensitivity of HNSCC (head and neck squamous cell carcinomas): evidence, radiobiological mechanism, clinical consequences and perspectives; mechanisms of action and intertumoral heterogeneity of response to EGFR inhibition in radiotherapy of solid tumors; evaluation of biomarkers for radiotherapy.

A randomised trial of accelerated and conventional radiotherapy for stage III and IV squamous carcinoma of the head and neck: a Trans-Tasman Radiation Oncology Group Study

International Nuclear Information System (INIS)

Poulsen, Michael G.; Denham, James W.; Peters, Lester J.; Lamb, David S.; Spry, Nigel A.; Hindley, Andrew; Krawitz, Hedley; Hamilton, Chris; Keller, Jacqui; Tripcony, Lee; Walker, Quenten

2001-01-01

Purpose: The aims of this randomized controlled trial were to determine whether there were differences in the disease-free survival (DFS) and toxicity between conventional radiotherapy (CRT) and a continuous 3 week accelerated radiotherapy regimen (ART) in stage III and IV squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx. Patients and methods: Patients from 14 centres throughout Australia and New Zealand were randomly assigned to either CRT, using a single 2 Gy/day to a dose of 70 Gy in 35 fractions in 49 days or to ART, using 1.8 Gy twice a day to a dose of 59.4 Gy in 33 fractions in 24 days. Treatment allocation was stratified for site and stage. The accrual began in 1991 and the trial was closed in 1998 when the target of 350 patients was reached. Results: The median potential follow-up time was 53 months (range, 14-101). The DFS at 5 years was 41% (95% CI, 33-50%) for ART and 35% (95% CI, 27-43%) for CRT (P=0.323) and the hazard ratio was 0.87 in favour of ART (95% CI, 0.66-1.15). The 5-year disease-specific survival rates were 40% for CRT and 46% for ART (P=0.398) and the loco-regional control was 47% for CRT vs. 52% for ART (P=0.300). The respective hazard ratios were 0.88 (95% CI, 0.65-1.2) and 0.85 (0.62-1.16), favouring the accelerated arm. In the ART arm, confluent mucositis was more severe (94 vs. 71%; P<0.001) and peaked about 3 weeks earlier than in the CRT arm, but healing appeared complete in all cases. There were statistically significant reductions in the probability of grade 2 or greater late soft tissue effects over time in the ART arm (P<0.05), except for the mucous membrane where late effects were similar in both arms. Conclusions: Differences in DFS, disease-specific survival and loco-regional control have not been demonstrated. ART resulted in more acute mucosal toxicity, but this did not result in greater prolongation of the treatment time compared with the CRT arm. There were less late effects in the ART arm

Recent advances in radiotherapy: Partial Breast Irradiation (PBI) in breast cancer patients after breast conserving surgery

International Nuclear Information System (INIS)

Niwinska, A.

2003-01-01

The interest in accelerated partial breast irradiation (PBI) after conservative surgery has increased over the past decade as a result of many factors, including clinical and pathological data questioning the efficacy of whole breast irradiation in highly selected patients, as well as factors related to patient's convenience. High dose rate and low dose rate brachytherapy, brachytherapy MammoSite, Electron Intraoperative Therapy - ELIOT and Targeted Intraoperative Radiotherapy - TARGIT are the subject of investigation. The tolerability and efficacy of the treatment are of special interest. In this review article, methods of accelerated PBI, eligibility criteria, techniques of radiotherapy, early results and side effects are reviewed. (author)

Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer

International Nuclear Information System (INIS)

Staar, Susanne; Rudat, Volker; Stuetzer, Hartmut; Dietz, Andreas; Volling, Peter; Schroeder, Michael; Flentje, Michael; Eckel, Hans Edmund; Mueller, Rolf-Peter

2001-01-01

Purpose: To demonstrate the efficacy of radiochemotherapy (RCT) as the first choice of treatment for advanced unresectable head-and-neck cancer. To prove an expected benefit of simultaneously given chemotherapy, a two-arm randomized study with hyperfractionated accelerated radiochemotherapy (HF-ACC-RCT) vs. hyperfractionated accelerated radiotherapy (HF-ACC-RT) was initiated. The primary endpoint was 1-year survival with local control (SLC). Methods and Materials: Patients with Stage III and IV (UICC) unresectable oro- and hypopharyngeal carcinomas were randomized for HF-ACC-RCT with 2 cycles of 5-FU (600 mg/m 2 /day)/carboplatinum (70 mg/m 2 ) on days 1-5 and 29-33 (arm A) or HF-ACC-RT alone (arm B). In both arms, there was a second randomization for testing the effect of prophylactically given G-CSF (263 μg, days 15-19) on mucosal toxicity. Total RT dose in both arms was 69.9 Gy in 38 days, with a concomitant boost regimen (weeks 1-3: 1.8 Gy/day, weeks 4 and 5: b.i.d. RT with 1.8 Gy/1.5 Gy). Between July 1995 and May 1999, 263 patients were randomized (median age 56 years; 96% Stage IV tumors, 4% Stage III tumors). Results: This analysis is based on 240 patients: 113 patients with RCT and 127 patients with RT, qualified for protocol and starting treatment. There were 178 oropharyngeal and 62 hypopharyngeal carcinomas. Treatment was tolerable in both arms, with a higher mucosal toxicity after RCT. Restaging showed comparable nonsignificant different CR + PR rates of 92.4% after RCT and 87.9% after RT (p=0.29). After a median observed time of 22.3 months, l- and 2-year local-regional control (LRC) rates were 69% and 51% after RCT and 58% and 45% after RT (p=0.14). There was a significantly better 1-year SLC after RCT (58%) compared with RT (44%, p=0.05). Patients with oropharyngeal carcinomas showed significantly better SLC after RCT (60%) vs. RT (40%, p=0.01); the smaller group of hypopharyngeal carcinomas had no statistical benefit of RCT (p=0.84). For both

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)

Intensity-modulated radiotherapy with simultaneous modulated accelerated boost technique and chemotherapy in patients with nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Fareed, Muhammad M; AlAmro, Abdullah S; Bayoumi, Yasser; Tunio, Mutahir A; Ismail, Abdul S; Akasha, Rashad; Mubasher, Mohamed; Al Asiri, Mushabbab

2013-01-01

To present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Sixty eight patients of NPC were treated between April 2006 and December 2011 including 45 males and 23 females with mean age of 46 (range 15–78). Stage distribution was; stage I 3, stage II 7, stage III 26 and stage IV 32. Among 45 (66.2%) evaluated patients for presence of Epstein-Barr virus (EBV), 40 (88.8%) were positive for EBV. Median radiation doses delivered to gross tumor volume (GTV) and positive neck nodes were 66–70 Gy, 63 Gy to clinical target volume (CTV) and 50.4 Gy to clinically negative neck. In addition 56 (82.4%) patients with bulky tumors (T4/N2+) received neoadjuvant chemotherapy 2–3 cycles (Cisplatin/Docetaxel or Cisplatin/Epirubicin or Cisplatin/5 Flourouracil). Concurrent chemotherapy with radiation was weekly Cisplatin 40 mg/m 2 (40 patients) or Cisplatin 100 mg/m 2 (28 patients). With a median follow up of 20 months (range 3–43), one patient developed local recurrence, two experienced regional recurrences and distant failure was seen in 3 patients. Estimated 3 year disease free survival (DFS) was 94%. Three year DFS for patients with EBV was 100% as compared to 60% without EBV (p = 0.0009). Three year DFS for patients with undifferentiated histology was 98% as compared to 82% with other histologies (p = 0.02). Acute grade 3 toxicity was seen as 21 (30.9%) having G-III mucositis and 6 (8.8%) with G-III skin reactions. Late toxicity was minimal and loss of taste was seen in 3 patients (7.5%) at time of analysis. IMRT with SMART in combination with chemotherapy is feasible and effective in terms of both the clinical response and safety profile. EBV, histopathology and nodal involvement were found important prognostic factors for locoregional recurrence

Improvement of Radiation Safety in Radiotherapy Facilities: Catering for Neutrons Outside Short Mazes in 10MV Linear Accelerators

International Nuclear Information System (INIS)

Severa, R.

2016-01-01

It has been demonstrated that neutron leakage cannot be neglected at 10MV when direct access doors are used or when short mazes, typically less than 7 metres in length, are employed. The majority of radiotherapy facilities in Africa have Co-60 machines installed that are now being replaced by linear accelerators. The in-coming linear accelerators are being installed in the same bunkers that were designed for Co-60 energy ranges albeit with some shielding modifications. The modifications do not alter the length of the maze and where the maze length is less than 7 metres, neutron leakage will occur in 10MV linear accelerators. There is lack of capacity within the regulatory bodies in Africa to handle this changeover from a technical and equipment perspective. The justification of medical exposures ensures that the benefits to the patients substantially outweigh any risks that the patient may incur. As such, the justification process needs to be implemented through the effective use of evidence-based referral guidelines and clinical audits. In the case of most African countries, medical diagnostic exposures of patients are not underpinned by an effective justification system. This, coupled with the scenario where physicians own outpatient diagnostic centres to which they refer patients (self-referral) increases the conflict of physicians due to dual roles as professionals and businessmen, further compromising on patient protection. Nuclear security is the responsibility of the Member State and requires that a number of key stakeholders work closely together. In the case of research reactors and nuclear power plants, this cooperation is evident and functional. However, this does not extend to the use of high-activity radioactive sources in medicine (category 1&2) where in most cases the regulators seem to be the only authority having oversight on the security of these sources without the benefit of direct input and collaboration of other key security stakeholders. This

Effectiveness of accelerated radiotherapy for patients with inoperable non-small cell lung cancer (NSCLC) and borderline prognostic factors without distant metastasis: a retrospective review

International Nuclear Information System (INIS)

Nguyen, Linh N.; Komaki, Ritsuko; Allen, Pamela; Schea, Randi A.; Milas, Luka

1999-01-01

Purpose: The standard treatment for patients with unresectable or medically inoperable non-small cell lung cancer (NSCLC) and good prognostic factors (e.g., weight loss [WL] ≤5% and Karnofsky performance status [KPS] ≥70) is induction chemotherapy followed by definitive radiotherapy to the primary site at 1.8-2.0 Gy per fraction with a total dose of 60-63 Gy to the target volume. Patients with poor prognostic factors usually receive radiotherapy alone, but the fractionation schedule and total dose have not been standardized. To attempt to optimize irradiation doses and schedule, we compared the effectiveness of accelerated radiotherapy (ACRT) alone to 45 Gy at 3 Gy per fraction with standard radiation therapy (STRT) of 60-66 Gy at 2 Gy per fraction in regard to tumor response, local control, distant metastasis, toxicity, and survival. Methods and Materials: Fifty-five patients treated with radiation for NSCLC at The University of Texas M. D. Anderson Cancer Center between 1990 and 1994 were identified. All 55 patients had node-positive, and no distant metastasis (N+, M0) of NSCLC. Two cohorts were identified. One cohort (26 patients) had borderline poor prognostic factors (KPS less than 70 but higher than 50, and/or WL of more than 5%) and was treated with radiotherapy alone to 45 Gy over 3 weeks at 3 Gy/fraction (ACRT). The second cohort (29 patients) had significantly better prognostic factors (KPS ≥70 and WL ≤5%) and was treated to 60-66 Gy over 6 to 6((1)/(2)) weeks at 2 Gy per fraction (STRT) during the same period. Results: In the first cohort treated by ACRT, the distribution of patients by AJCC stage was IIB 8%, IIIA 19%, and IIIB 73%. Sixty-two percent had KPS 5%. The maximum response rate as determined by chest X-ray was 60% among 45 of 55 patients who were evaluable for response: combined complete responses (20%) and partial responses (40%). Overall survival in these patients was 13% at 2 and 5 years, with a locoregional control rate of 42% and a

Success Stories in Radiotherapy Development Projects: Radiotherapy Service in Mauritania. Chapter 28.5

International Nuclear Information System (INIS)

Rosenblatt, E.; Zubizarreta, E.; Djeutie, A.; Meghzifene, A.; Mohamedou, M.M.

2017-01-01

Mauritania, a country of 3.4 million people, did not have any radiotherapy facility until 2009. As is usually the case in countries without radiotherapy services, cancer patients with a need for this treatment travelled to neighbouring countries (Morocco or Tunisia) or to Europe to receive it, or switched to alternative forms of care. Cancer is a rising cause of death in Mauritania. According to WHO estimates, about 2200 people died of cancer in 2011, of whom 1400 were aged below 70 years of age. The number of patients sent abroad for treatment by the National Health Insurance Fund rose to 500 patients in 2007, causing a significant drain on the State budget. Cancer was the main cause of health related travel abroad. The average cost of such travel was two million ouguiya per patient (US $8000). Through a technical cooperation project initiated in 2009 between the Mauritanian Government and the IAEA, the latter assisted the country with the establishment and operation of its first radiotherapy facility. The National Oncology Centre, including a radiotherapy department, was built in Nouakchott in 2010 and began operation in early 2011 with a limited staff, all hired from abroad. Its equipment includes a modern medical linac with a multileaf collimator and portal imaging, a CT simulator, a 3-D CRT TPS and a remote afterloading HDR brachytherapy system. The centre was planned with an additional bunker, where a second accelerator can be installed in the future. Except for the training of the Department Head, the entire professional team has been trained through the IAEA’s technical cooperation fellowship programme. The centre treated a total of 250 patients in 2012 and treated 176 in the first half of 2013. Most patients undergo simulation and computerized radiotherapy treatment planning. The centre ensures the sustainability of the equipment through full maintenance contracts for the major radiation equipment and source replacements for the HDR brachytherapy unit.

Poster — Thur Eve — 28: Enabling trajectory-based radiotherapy on a TrueBeam accelerator with the Eclipse treatment planning system

International Nuclear Information System (INIS)

Mullins, J; Asiev, K; DeBlois, F; Morcos, M; Seuntjens, J; Syme, A

2014-01-01

The TrueBeam linear accelerator platform has a developer's mode which permits the user dynamic control over many of the machine's mechanical and radiation systems. Using this research tool, synchronous couch and gantry motion can be programmed to simulate isocentric treatment with a shortened SAD, with benefits such as smaller projected MLC leaf widths and an increased dose rate. In this work, water tank measurements were used to commission a virtual linear accelerator with an 85 cm SAD in Eclipse, from which several arc-based radiotherapy treatments were generated, including an inverse optimized VMAT delivery. For each plan, the pertinent treatment delivery information was extracted from control points specified in the Eclipse-exported DICOM files using the pydicom package in Python, allowing construction of an XML control file. The dimensions of the jaws and MLC positions, defined for an 85 cm SAD in Eclipse, were scaled for delivery on a conventional SAD linear accelerator, and translational couch motion was added as a function of gantry angle to simulate delivery at 85 cm SAD. Ionization chamber and Gafchromic film measurements were used to compare the radiation delivery to dose calculations in Eclipse. With the exception of the VMAT delivery, ionization chamber measurements agreed within 3.3% of the Eclipse calculations. For the VMAT delivery, the ionization chamber was located in an inhomogeneous region, but gamma evaluation of the Gafchromic film plane resulted in a 94.5% passing rate using criteria of 3 mm/3%. The results indicate that Eclipse calculation infrastructure can be used

Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study

Energy Technology Data Exchange (ETDEWEB)

Cvek, J.; Skacelikova, E.; Otahal, B.; Halamka, M.; Feltl, D. [University Hospital Ostrava (Czech Republic). Dept. of Oncology; Kubes, J. [University Hospital Bulovka, Prague (Czech Republic). Dept. of Radiation Oncology; Kominek, P. [University Hospital Ostrava (Czech Republic). Dept. of Otolaryngology

2012-08-15

Background and purpose: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. Methods and materials: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV{sub tumor}) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV{sub uninvolved}) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. Results: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was {<=} 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. Conclusion: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

Applications of Particle Accelerators in Medical Physics

CERN Document Server

Cuttone, G

2008-01-01

Particle accelerators are often associated to high energy or nuclear physics. As well pointed out in literature [1] if we kindly analyse the number of installation worldwide we can easily note that about 50% is mainly devoted to medical applications (radiotherapy, medical radioisotopes production, biomedical research). Particle accelerators are also playing an important indirect role considering the improvement of the technical features of medical diagnostic. In fact the use of radionuclide for advanced medical imaging is strongly increasing either in conventional radiography (CT and MRI) and also in nuclear medicine for Spect an PET imaging. In this paper role of particle accelerators for medical applications will be presented together with the main solutions applied.

Average accelerator simulation Truebeam using phase space in IAEA format

International Nuclear Information System (INIS)

Santana, Emico Ferreira; Milian, Felix Mas; Paixao, Paulo Oliveira; Costa, Raranna Alves da; Velasco, Fermin Garcia

2015-01-01

In this paper is used a computational code of radiation transport simulation based on Monte Carlo technique, in order to model a linear accelerator of treatment by Radiotherapy. This work is the initial step of future proposals which aim to study several treatment of patient by Radiotherapy, employing computational modeling in cooperation with the institutions UESC, IPEN, UFRJ e COI. The Chosen simulation code is GATE/Geant4. The average accelerator is TrueBeam of Varian Company. The geometric modeling was based in technical manuals, and radiation sources on the phase space for photons, provided by manufacturer in the IAEA (International Atomic Energy Agency) format. The simulations were carried out in equal conditions to experimental measurements. Were studied photons beams of 6MV, with 10 per 10 cm of field, focusing on a water phantom. For validation were compared dose curves in depth, lateral profiles in different depths of the simulated results and experimental data. The final modeling of this accelerator will be used in future works involving treatments and real patients. (author)

An assessment of effective dose to staff in external beam radiotherapy

International Nuclear Information System (INIS)

Rawlings, D.J.; Nicholson, L.

1997-01-01

Radiation safety in external beam radiotherapy is governed by national legislation. Annual doses recorded by radiographers and others associated with external beam radiotherapy are typically much lower than the relevant dose limit. However, it is possible that larger doses might be received as a result of an accidental irradiation. In the event of a significant exposure resulting in a dose at or near a relevant dose limit, an accurate conversion has to be made from the dose meter reading to the limiting quantity. A method was devised to demonstrate ratios of effective dose to personal dose equivalent which might be anticipated in the even of an individual other than the patient being irradiated within a radiotherapy treatment room consisting of a linear accelerator. The variation of ratios obtained under different conditions is discussed. (author)

Magnetic resonance imaging for precise radiotherapy of small laboratory animals

Energy Technology Data Exchange (ETDEWEB)

Frenzel, Thorsten [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Bereich Strahlentherapie; Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Inst. fuer Anatomie und Experimentelle Morphologie; Kaul, Michael Gerhard; Ernst, Thomas Michael; Salamon, Johannes [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie; Jaeckel, Maria [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie; Schumacher, Udo [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Inst. fuer Anatomie und Experimentelle Morphologie; Kruell, Andreas [Universitaetsklinikum Hamburg-Eppendorf, Hamburg (Germany). Bereich Strahlentherapie

2017-05-01

Radiotherapy of small laboratory animals (SLA) is often not as precisely applied as in humans. Here we describe the use of a dedicated SLA magnetic resonance imaging (MRI) scanner for precise tumor volumetry, radiotherapy treatment planning, and diagnostic imaging in order to make the experiments more accurate. Different human cancer cells were injected at the lower trunk of pfp/rag2 and SCID mice to allow for local tumor growth. Data from cross sectional MRI scans were transferred to a clinical treatment planning system (TPS) for humans. Manual palpation of the tumor size was compared with calculated tumor size of the TPS and with tumor weight at necropsy. As a feasibility study MRI based treatment plans were calculated for a clinical 6 MV linear accelerator using a micro multileaf collimator (μMLC). In addition, diagnostic MRI scans were used to investigate animals which did clinical poorly during the study. MRI is superior in precise tumor volume definition whereas manual palpation underestimates their size. Cross sectional MRI allow for treatment planning so that conformal irradiation of mice with a clinical linear accelerator using a μMLC is in principle feasible. Several internal pathologies were detected during the experiment using the dedicated scanner. MRI is a key technology for precise radiotherapy of SLA. The scanning protocols provided are suited for tumor volumetry, treatment planning, and diagnostic imaging.

Comparative evaluation of multiple fractions per day radiotherapy and conventional fractionated radiotherapy in squamous cell carcinoma of esophagus

International Nuclear Information System (INIS)

Andrabi, W.H.; Akhtar, S.; Kharadi, M.Y.; Mushtaq, G.; Zargar, S.A.

1999-01-01

Dose fractionated is important in radiotherapy in order to achieve the desired results. There are regimes which are accepted and followed worldwide. Five fractions per week for a full course of treatment is regarded as standard fractionation regimen. Interest has lately been developed to alter this and try regimes like hyper and accelerated fractionations. In the former, smaller doses per fraction than usual are given in several fractions on each treating day, with no change in overall time. In the latter, conventionally sized fractions are given as two or three per day with a shortening of overall time. As the dose fraction in our case is high, we spilt the full course of treatment introducing a gap of one week between the treatment schedules. The results obtained are fairly good in comparison with conventional radiotherapy regimes. (author)

Intensity modulated radiotherapy for breast cancer

International Nuclear Information System (INIS)

Riou, O.; Fenoglietto, P.; Lemanski, C.; Azria, D.

2012-01-01

Intensity modulated radiotherapy (IMRT) is a technique allowing dose escalation and normal tissue sparing for various cancer types. For breast cancer, the main goals when using IMRT were to improve dose homogeneity within the breast and to enhance coverage of complex target volumes. Nonetheless, better heart and lung protections are achievable with IMRT as compared to standard irradiation for difficult cases. Three prospective randomized controlled trials of IMRT versus standard treatment showed that a better breast homogeneity can translate into better overall cosmetic results. Dosimetric and clinical studies seem to indicate a benefit of IMRT for lymph nodes irradiation, bilateral treatment, left breast and chest wall radiotherapy, or accelerated partial breast irradiation. The multiple technical IMRT solutions available tend to indicate a widespread use for breast irradiation. Nevertheless, indications for breast IMRT should be personalized and selected according to the expected benefit for each individual. (authors)

Determination of the neutron spectra in the treatment room of a linear accelerator for radiotherapy; Determinacion de los espectros de neutrones en la sala de tratamiento de un acelerador lineal para radioterapia

Energy Technology Data Exchange (ETDEWEB)

Vega C, H.R. [Universidad Autonoma de Zacatecas, Cuerpo Academico de Radiobiologia, A.P. 336, 98000 Zacatecas (Mexico); Barquero, R. [Hospital Universitario Rio Hortega, Valladolid (Spain); Mendez, R.; Iniguez, M.P. [Depto. de Fisica Teorica, Atomica, Molecular y Nuclear, Universidad de Valladolid, 47011 Valladolid (Spain)

2003-07-01

By means of a series of measures and Monte Carlo calculations the dosimetric characteristics of the photoneutrons have been determined that take place in volume to a linear accelerator of radiotherapy of 18 MV, LINAC, mark Siemens Mevatron model. The measures were carried out with thermoluminescent dosemeters TLD 600 and TLD 700 that were naked exposed and confined with cover of Cd and Sn, inside a sphere of paraffin and inside spheres Bonner. (Author)

The use of low energy, ion induced nuclear reactions for proton radiotherapy applications

International Nuclear Information System (INIS)

Horn, K.M.; Doyle, B.; Segal, M.N.; Adler, R.J.; Glatstein, E.

1995-01-01

Medical radiotherapy has traditionally relied upon the use of external photon beams and internally implanted radioisotopes as the chief means of irradiating tumors. However, advances in accelerator technology and the exploitation of novel means of producing radiation may provide useful alternatives to some current modes of medical radiation delivery with reduced total dose to surrounding healthy tissue, reduced expense, or increased treatment accessibility. This paper will briefly overview currently established modes of radiation therapy, techniques still considered experimental but in clinical use, innovative concepts under study that may enable new forms of treatment or enhance existing ones. The potential role of low energy, ion-induced nuclear reactions in radiotherapy applications is examined specifically for the 650 keV d( 3 He,p) 4 He nuclear reaction. This examination will describe the basic physics associated with this reaction's production of 17.4 MeV protons and the processes used to fabricate the necessary materials used in the technique. Calculations of the delivered radiation dose, heat generation, and required exposure times are presented. Experimental data are also presented validating the dose calculations. The design of small, lower cost ion accelerators, as embodied in 'nested'-tandem and radio frequency quadrupole accelerators is examined, as is the potential use of high-output 3 He and deuterium ion sources. Finally, potential clinical applications are discussed in terms of the advantages and disadvantages of this technique with respect to current radiotherapy methods and equipment

The use of low energy, ion induced nuclear reactions for proton radiotherapy applications

Science.gov (United States)

Horn, K. M.; Doyle, B.; Segal, M. N.; Hamm, R. W.; Adler, R. J.; Glatstein, E.

1995-12-01

Medical radiotherapy has traditionally relied upon the use of external photon beams and internally implanted radioisotopes as the chief means of irradiating tumors. However, advances in accelerator technology and the exploitation of novel means of producing radiation may provide useful alternatives to some current modes of medical radiation delivery — with reduced total dose to surrounding healthy tissue, reduced expense, or increased treatment accessibility. This paper will briefly overview currently established modes of radiation therapy, techniques still considered experimental but in clinical use and innovative concepts under study that may enable new forms of treatment or enhance existing ones. The potential role of low energy, ion-induced nuclear reactions in radiotherapy applications is examined specifically for the 650 keV d( 3He,p) 4 He nuclear reaction. This examination will describe the basic physics associated with this reaction's production of 17.4 MeV protons and the processes used to fabricate the necessary materials used in the technique. Calculations of the delivered radiation dose, heat generation, and required exposure times are presented. Experimental data is also presented validating the dose calculations. The design of small, lower cost ion accelerators, as embodied in "nested"-tandem and radio frequency quadrupole accelerators is examined, as is the potential use of high-output 3He and deuterium ion sources. Finally, potential clinical applications are discussed in terms of the advantages and disadvantages of this technique with respect to current radiotherapy methods and equipment.

Analysis of quality control protocol implementation of equipment in radiotherapy services

International Nuclear Information System (INIS)

Calcina, Carmen S. Guzman; Lima, Luciana P. de; Rubo, Rodrigo A.; Ferraz, Eduardo; Almeida, Adelaide de

2000-01-01

Considering the importance of the Quality Assurance in the radiotherapy services, there was an interest to make tests' evaluation for a Quality Control for the cobalt equipment, linear accelerator and simulator as a classification and comparison. The work proposed is a suggestion that can serve as tool for medical physicists that are starting to work in the radiotherapy area and for the most experts. The discussions were made by the gathering of local tests and official protocols, resulting in a minimum protocol as a suggestion for a routine work, emphasizing the periodicity and level of tolerance of each one of the tests. (author)

Workshop on the accelerator for particle therapy

International Nuclear Information System (INIS)

Inoue, M.; Ujeno, Y.

1991-02-01

A two-day workshop on the accelerator for particle therapy was held on August 22-23, 1990, with the aim of mutual understanding of medical accelerators among investigators. The state-of-the-art facilities in Japan and medical proton accelerators in Japan and other countries were introduced. This is a compilation of papers presented at the workshop: (1) particle radiotherapy at the National Institute of Radiological Sciences (NIRS); (2) proton therapy; (3) treatment planning, especially for photon and electron therapies; (4) heavy ion synchrotron project at the NIRS; (5) medical proton accelerator project of Tsukuba University and recent status of Loma Linda University Medical Center Proton Beam Facility; (6) inspection report on the Loma Linda University Medical Center Proton Beam Facility; (7) accelerator project of Kyoto University; (8) actual conditions of the 7 MeV proton linear accelerator; (9) design study of superconducting compact cyclotron prototype model; (10) medical superconducting prototype cyclotron; (11) RCNP cyclotron cascade project; (12) beam extraction from synchrotron; (13) radiation safety design in high energy particle accelerator facilities. (N.K.)

Direct costs of radiotherapy for rectal cancer: a microcosting study.

Science.gov (United States)

Hanly, Paul; Céilleachair, Alan Ó; Skally, Máiréad; O'Neill, Ciaran; Sharp, Linda

2015-05-02

Radiotherapy provides significant benefits in terms of reducing risk of local recurrence and death from rectal cancer. Despite this, up-to-date cost estimates for radiotherapy are lacking, potentially inhibiting policy and decision-making. Our objective was to generate an up-to-date estimate of the cost of traditional radiotherapy for rectal cancer and model the impact of a range of potential efficiency improvements. Microcosting methods were used to estimate total direct radiotherapy costs for long- (assumed at 45-50 Gy in 25 daily fractions over a 5 week period) and short-courses (assumed at 25 Gy in 5 daily fractions over a one week period). Following interviews and on-site visits to radiotherapy departments in two designated cancer centers, a radiotherapy care pathway for a typical rectal cancer patient was developed. Total direct costs were derived by applying fixed and variable unit costs to resource use within each care phase. Costs included labor, capital, consumables and overheads. Sensitivity analyses were performed. Radiotherapy treatment was estimated to cost between €2,080 (5-fraction course) and €3,609 (25-fraction course) for an average patient in 2012. Costs were highest in the treatment planning phase for the short-course (€1,217; 58% of total costs), but highest in the radiation treatment phase for the long-course (€1,974: 60% of total costs). By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354). Traditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment.

Lessons learned from radiological accidents at medical exposures in radiotherapy

International Nuclear Information System (INIS)

Fagundes, J.S.; Ferreira, A.F.; Lima, C.M.A.; Silva, F.C.A. da

2017-01-01

An exposure is considered accidental in radiotherapy when there is a substantial deviation in the prescription of treatment. In this work, an analysis of published radiological accidents, both in Brazil and internationally, was performed during medical exposures in radiotherapy treatments, removing the main lessons learned. Of the research carried out, we highlight Brazil with four radiological accidents and one death in the period between 2011 and 2014; the United States of America with 169 accidents with two deaths from 2000 to 2010 and France from 2001 to 2014 had 569 deaths without patients. Lessons learned have been described, for example, that maintenance personnel training should specify limitations or restrictions on the handling or adjustment of critical parts on the accelerator. It is recommended to apply the 10 main lessons learned due to radiological accidents during medical exposures in radiotherapy treatments to avoid future events

Combination radiotherapy and chemotherapy for primary lung cancer

International Nuclear Information System (INIS)

Nishikawa, Kiyoshi; Koga, Kenji; Kusuhara, Toshiyuki; Kodama, Takao; Takeuchi, Midori; Watanabe, Katsushi

1984-01-01

Fifty-six patients with carcinoma of the lung treated with radiotherapy alone or combination of chemotherapy were reviewed. Radiation was given with a 10MV photon beam by a linear accelerator. A fraction dose of 2Gy (200 rad) was given routinely 5 times a week. Combined durgs consist of 5FU or FT-207 in monochemotherapy and METT, MFC, or METVFC in combination chemotherapy. 5 year survival rate of all patients was 3.8%. As for the stage classification, 5 year survival rate is 30% in Stage I and II cancer, but there was no 3 year survivor in Stage III cancer and 2 year survivor in Stage IV cancer. As for the cell types, cases of adenocarcinoma had worse prognosis than them of squamous cell carcinoma and small cell carcinoma. The prognosis of patients treated with combination of radiotherapy and chemotherapy was similar to that of patients treated with radiotherapy alone. These results suggest that combined chemotherapy did not influence tumor control. Some discussion on the treatment modality of chemotherapy are made, emphasizing untoward effect of chemotherapy on immunopotency. (author)

Radiotherapy physics research in the UK: challenges and proposed solutions.

Science.gov (United States)

Mackay, R I; Burnet, N G; Green, S; Illidge, T M; Staffurth, J N

2012-10-01

In 2011, the Clinical and Translational Radiotherapy Research Working Group (CTRad) of the National Cancer Research Institute brought together UK radiotherapy physics leaders for a think tank meeting. Following a format that CTRad had previously and successfully used with clinical oncologists, 23 departments were asked to complete a pre-meeting evaluation of their radiotherapy physics research infrastructure and the strengths, weaknesses, opportunities and threats within their own centre. These departments were brought together with the CTRad Executive Group and research funders to discuss the current state of radiotherapy physics research, perceived barriers and possible solutions. In this Commentary, we summarise the submitted materials, presentations and discussions from the meeting and propose an action plan. It is clear that there are challenges in both funding and staffing of radiotherapy physics research. Programme and project funding streams sometimes struggle to cater for physics-led work, and increased representation on research funding bodies would be valuable. Career paths for academic radiotherapy physicists need to be examined and an academic training route identified within Modernising Scientific Careers; the introduction of formal job plans may allow greater protection of research time, and should be considered. Improved access to research facilities, including research linear accelerators, would enhance research activity and pass on developments to patients more quickly; research infrastructure could be benchmarked against centres in the UK and abroad. UK National Health Service departments wishing to undertake radiotherapy research, with its attendant added value for patients, need to develop a strategy with their partner higher education institution, and collaboration between departments may provide enhanced opportunities for funded research.

Pulsed radiobiology with laser-driven plasma accelerators

Science.gov (United States)

Giulietti, Antonio; Grazia Andreassi, Maria; Greco, Carlo

2011-05-01

Recently, a high efficiency regime of acceleration in laser plasmas has been discovered, allowing table top equipment to deliver doses of interest for radiotherapy with electron bunches of suitable kinetic energy. In view of an R&D program aimed to the realization of an innovative class of accelerators for medical uses, a radiobiological validation is needed. At the present time, the biological effects of electron bunches from the laser-driven electron accelerator are largely unknown. In radiobiology and radiotherapy, it is known that the early spatial distribution of energy deposition following ionizing radiation interactions with DNA molecule is crucial for the prediction of damages at cellular or tissue levels and during the clinical responses to this irradiation. The purpose of the present study is to evaluate the radio-biological effects obtained with electron bunches from a laser-driven electron accelerator compared with bunches coming from a IORT-dedicated medical Radio-frequency based linac's on human cells by the cytokinesis block micronucleus assay (CBMN). To this purpose a multidisciplinary team including radiotherapists, biologists, medical physicists, laser and plasma physicists is working at CNR Campus and University of Pisa. Dose on samples is delivered alternatively by the "laser-linac" operating at ILIL lab of Istituto Nazionale di Ottica and an RF-linac operating for IORT at Pisa S. Chiara Hospital. Experimental data are analyzed on the basis of suitable radiobiological models as well as with numerical simulation based on Monte Carlo codes. Possible collective effects are also considered in the case of ultrashort, ultradense bunches of ionizing radiation.

Probabilistic safety analysis of radiation treatments with linear accelerator (Spanish Ed.)

International Nuclear Information System (INIS)

2012-02-01

This publication addresses the issue of accidental exposures of radiotherapy patients and how to avoid them. More proactive approaches are required to anticipate and thus avoid situations that could lead to accidental exposures. In this context, the International Atomic Energy Agency (IAEA) and the Ibero American Forum of Radiation and Nuclear and Safety Regulatory Agencies (the FORO) have applied proactive methods, such as probabilistic safety assessment to radiotherapy treatments with accelerators. The methodology and results of this exercise are described in this publication.

Neutron fluence produced in medical accelerators

International Nuclear Information System (INIS)

Castro, R.C.; Silva, A.X. da; Crispim, V.R.

2004-01-01

Radiotherapy with photon and electron beams still represents the most diffused technique to control and treat tumour diseases. To increase the treatment efficiency, accelerators of higher energy are used, the increase of electron and photon energy is joined with generation of undesired fast neutron that contaminated the therapeutic beam and give a non-negligible contribution to the patient dose. In this work we have simulated with the MCNP4B code the produced neutron spectra in the interaction between the beam and the head to the accelerator and estimating the equivalent dose for neutrons by x-ray dose for aims far from the targets. (author)

Perspex in the verification routines for accelerator beam

International Nuclear Information System (INIS)

Paredes G, L.; Genis S, R.

1998-01-01

It is analyzed the use of a perspex solid phantom, adequately referred to a water phantom, as an auxiliary alternative for the daily stability verification routines or constance of radiation beam, as an option in the case of radiotherapy installations with high charge of accelerator working and with basic dosimetry equipment. (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

Environmental dose level survey of radiotherapy center in large cancer hospital

International Nuclear Information System (INIS)

Wan Bin; Zhong Hailuo; Wu Dake; Li Jian; Wang Pei; Qi Guohai; Huang Renbing; Lang Jinyi

2009-01-01

Objective: To investigate and analyze the radiation dosage around the working environment in radiotherapy centre affiliated to Sichuan cancer hospital in the western China. Methods: In 60 days, we have continuously monitored the accumulated dose that absorbed by doctors, nurses, technicians, physicists and engineers, and investigated the working environment ( 60 Co unit, accelerator, after loading unit, X-ray simulator, CT simulator, gamma knife, MRI and doctor's office) and external environment by using TLD, and compared our results to those released by relevant departments. Results: The average dosage in the working environment is 1.96 μC ·kg -1 ·month -1 , 1.61 μC ·kg -1 ·month -1 in external environment. Conclusion: In the past 25 years, the radiotherapy center constructed strictly by the criterions of environment and protection departments required, so the radiation dosage in or outside the radiotherapy center has reached the national standard, which is safe for the staff and patients. Its instatement that the radiotherapy sites constructed by the related laws well accorded with the safety standards regulated. (authors)

Cyberknife : how has it changed the radiotherapy practice?

International Nuclear Information System (INIS)

Hukku, S.

2016-01-01

The CyberKnife is a frameless robotic radiosurgery system used for treating benign tumors, malignant tumors and other medical conditions. The system was invented by John R. Adler, a Stanford University professor of neurosurgery and radiation oncology, and Peter and Russell Schonberg of Schonberg Research Corporation. It is the most accurate and flexible tool available for aggressive therapeutic irradiation. It is a method of delivering radiotherapy, with the intention of targeting treatment more accurately than standard radiotherapy. The two main elements of the CyberKnife are: 1. The radiation produced from a small linear particle accelerator (linac) 2. A robotic arm which allows the energy to be directed at any part of the body from any direction. Several generations of the CyberKnife system have been developed since its initial inception in 1990

Phase-space database for external beam radiotherapy. Summary report of a consultants' meeting

International Nuclear Information System (INIS)

Capote, R.; Jeraj, R.; Ma, C.M.; Rogers, D.W.O.; Sanchez-Doblado, F.; Sempau, J.; Seuntjens, J.; Siebers, J.V.

2006-01-01

A summary is given of a Consultants' Meeting assembled to discuss and recommend actions and activities to prepare a Phase-space Database for External Beam Radiotherapy. The new database should serve to disseminate phase-space data of those accelerators and 60 Co units used in radiotherapy through the compilation of existing data that have been properly validated. Both the technical discussions and the resulting work plan are described, along with the detailed recommendations for implementation. The meeting was jointly organized by NAPC-Nuclear Data Section and NAHU-Dosimetry and Medical Radiation Physics Section. (author)

Advanced Accelerator Applications in Medicine

International Nuclear Information System (INIS)

Rimjiaem, Sakhorn

2015-01-01

besides the original purpose on development of particle acceleratora as research tools in nuclear and high-energy physics, there are large variety of accelerators used in various fileds from fundamental research to industrial usesand applications chemistry, biology and medicine. Pratical accelators used in various field of medical applications since serveral decades. Even through, a large fraction of applications is emphasized on cancer therappy, the number of accelerators used in midicine for other diagnostics and treatments has increased steady over the years. Several types of accelerated particles are used including electron, proton, neutron and ions. Presently, relativistic electron beams and radiation from linear accelerators (linas) are widely used. A combination of positron emission tomography (PRT) and radiotherapy is an example of excellent invention early detection and treat of cancer tumors. The most developments for proton and heavy ion therapy as well as a modern boron neutron capture therapy (BNCT) are also great incoming effective systems. This talk will focus on developments of the accelrator systems as well as overview on biophysical properties and medical aspects of the diacnostics and treatments.

Rapidly alternating combination of cisplatin-based chemotherapy and hyperfractionated accelerated radiotherapy in split course for Stage IIIA and Stage IIIB non-small cell lung cancer: results of a Phase I-II study by the GOTHA group

Energy Technology Data Exchange (ETDEWEB)

Alberto, P.; Mermillod, B. [Hopital Cantonal Geneve, Geneva (Switzerland); Mirimanoff, R.O.; Leyvraz, S.; Nagy-Mignotte, H.; Bolla, M.; Wellmann, D.; Moro, D.; Brambilla, E. [Hopital Cantonal Universitaire, Lausanne (Switzerland)

1995-08-01

The prognosis of stage III non-small cell lung cancer (NSCLC) can be improved by a combination of radiotherapy (RT) and chemotherapy (CT). In this study, the GOTHA group evaluated the feasibility, tolerance, tumour response, pattern of failure and effect on survival of a combination alternating accelerated hyperfractionated (AH) RT and CT in patients with tumour stage III NSCLC. Toxic effects were leucopenia, nausea and vomiting, mucositis, diarrhoea, alopecia and peripheral neuropathy. Alternating CT and AHRT, as used in this study, were well tolerated and allowed full dose delivery within less than 12 weeks. Initial response was not predictive of survival. The survival curve is encouraging and the 5 year survival is superior to the 5% generally observed with conventionally fractionated radiotherapy. (author).

Magneto-optics for linear electron accelerator with beam recirculation for radiotherapy

International Nuclear Information System (INIS)

Nagaenko, M.G.; Severgin, Yu.P.; Fedorov, A.S.

1985-01-01

Magneto-optical devices of the 40 MeV LUEhR-40M accelrator designed for radiotherapy, are described. A magnetic mirrow and bending-shaping device are reffered to magnetooptical systems. The both devices do not contain quadrupole lenses and have only dipole magnets with radial-homogeneous field. Axial focusing of particles is carried out by magnetic field boundary skew. The both devices have internal mirror symmetry. Results of optimization of devices parameters with the help of BETRAMF program are presented

Conformal three dimensional radiotherapy treatment planning in Lund

International Nuclear Information System (INIS)

Knoos, T.; Nilsson, P.; Anders, A.

1995-01-01

The use of conformal therapy is based on 3-dimensional treatment planning as well as on methods and routines for 3-dimensional patient mapping, 3-dimensional virtual simulation and others. The management of patients at the Radiotherapy Department at the University Hospital in Lund (Sweden) is discussed. About 2100 new patients are annually treated with external radiotherapy using seven linear accelerators. Three of the accelerators have dual photon energies and electron treatment facilities. A multi-leaf collimator as well as an electronic portal imaging device are available on one machine. Two simulators and an in-house CT-scanner are used for treatment planning. From 1988 to 1992 Scandiplan (Umplan) was used. Since 1992, the treatment planning system is TMS (HELAX AB, Sweden), which is based on the pencil beam algorithm of Ahnesjo. The calculations use patient modulated accelerator specific energy fluence spectra which are compiled with pencil beams from Monte Carlo generated energy absorption kernels. Heterogeneity corrections are performed with results close to conventional algorithms. Irregular fields, either from standard or individual blocks and from multi-leaf collimators are handled by the treatment planning system. The field shape is determined conveniently using the beam's eye view. The final field shape is exported electronically to either the block cutting machine or the multileaf collimator control computer. All patient fields are checked against the beam's eye view during simulation using manual methods. Treatment verification is performed by portal films and in vivo dosimetry with silicon diodes or TL-dosimetry. Up to now, approximately 4400 patients have received a highly individualized 3-dimensional conformal treatment

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

Implementation of a linear mini accelerator for radiotherapy intraoperative

International Nuclear Information System (INIS)

Macias-Verde, D.; Yanez-Lopez, D.; Marti-Asenjo, J.; Sanchez-Carrascal, M.; Torres-Pozas, S.; Godoy-Cazorla, J. I.; Madan-Rodriguez, C.; Martin-Oliva, R.

2013-01-01

Has been defined the status initial reference of the lineal mini-accelerator Intrabeam PRS 500. The alternative worksheet in times of treatment provides an additional verification. The system is validated for clinical use. (Author)

Permanent-magnet energy spectrometer for electron beams from radiotherapy accelerators

Energy Technology Data Exchange (ETDEWEB)

McLaughlin, David J.; Shikhaliev, Polad M.; Matthews, Kenneth L. [Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803-4001 (United States); Hogstrom, Kenneth R., E-mail: hogstrom@lsu.edu; Carver, Robert L.; Gibbons, John P. [Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, Louisiana 70809-3482 and Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803-4001 (United States); Clarke, Taylor; Henderson, Alexander; Liang, Edison P. [Physics and Astronomy Department, Rice University, 6100 Main MS-61, Houston, Texas 77005-1827 (United States)

2015-09-15

Purpose: The purpose of this work was to adapt a lightweight, permanent magnet electron energy spectrometer for the measurement of energy spectra of therapeutic electron beams. Methods: An irradiation geometry and measurement technique were developed for an approximately 0.54-T, permanent dipole magnet spectrometer to produce suitable latent images on computed radiography (CR) phosphor strips. Dual-pinhole electron collimators created a 0.318-cm diameter, approximately parallel beam incident on the spectrometer and an appropriate dose rate at the image plane (CR strip location). X-ray background in the latent image, reduced by a 7.62-cm thick lead block between the pinhole collimators, was removed using a fitting technique. Theoretical energy-dependent detector response functions (DRFs) were used in an iterative technique to transform CR strip net mean dose profiles into energy spectra on central axis at the entrance to the spectrometer. These spectra were transformed to spectra at 95-cm source to collimator distance (SCD) by correcting for the energy dependence of electron scatter. The spectrometer was calibrated by comparing peak mean positions in the net mean dose profiles, initially to peak mean energies determined from the practical range of central-axis percent depth-dose (%DD) curves, and then to peak mean energies that accounted for how the collimation modified the energy spectra (recalibration). The utility of the spectrometer was demonstrated by measuring the energy spectra for the seven electron beams (7–20 MeV) of an Elekta Infinity radiotherapy accelerator. Results: Plots of DRF illustrated their dependence on energy and position in the imaging plane. Approximately 15 iterations solved for the energy spectra at the spectrometer entrance from the measured net mean dose profiles. Transforming those spectra into ones at 95-cm SCD increased the low energy tail of the spectra, while correspondingly decreasing the peaks and shifting them to slightly lower

Permanent-magnet energy spectrometer for electron beams from radiotherapy accelerators.

Science.gov (United States)

McLaughlin, David J; Hogstrom, Kenneth R; Carver, Robert L; Gibbons, John P; Shikhaliev, Polad M; Matthews, Kenneth L; Clarke, Taylor; Henderson, Alexander; Liang, Edison P

2015-09-01

The purpose of this work was to adapt a lightweight, permanent magnet electron energy spectrometer for the measurement of energy spectra of therapeutic electron beams. An irradiation geometry and measurement technique were developed for an approximately 0.54-T, permanent dipole magnet spectrometer to produce suitable latent images on computed radiography (CR) phosphor strips. Dual-pinhole electron collimators created a 0.318-cm diameter, approximately parallel beam incident on the spectrometer and an appropriate dose rate at the image plane (CR strip location). X-ray background in the latent image, reduced by a 7.62-cm thick lead block between the pinhole collimators, was removed using a fitting technique. Theoretical energy-dependent detector response functions (DRFs) were used in an iterative technique to transform CR strip net mean dose profiles into energy spectra on central axis at the entrance to the spectrometer. These spectra were transformed to spectra at 95-cm source to collimator distance (SCD) by correcting for the energy dependence of electron scatter. The spectrometer was calibrated by comparing peak mean positions in the net mean dose profiles, initially to peak mean energies determined from the practical range of central-axis percent depth-dose (%DD) curves, and then to peak mean energies that accounted for how the collimation modified the energy spectra (recalibration). The utility of the spectrometer was demonstrated by measuring the energy spectra for the seven electron beams (7-20 MeV) of an Elekta Infinity radiotherapy accelerator. Plots of DRF illustrated their dependence on energy and position in the imaging plane. Approximately 15 iterations solved for the energy spectra at the spectrometer entrance from the measured net mean dose profiles. Transforming those spectra into ones at 95-cm SCD increased the low energy tail of the spectra, while correspondingly decreasing the peaks and shifting them to slightly lower energies. Energy calibration

Configuration control based on risk matrix for radiotherapy treatment

International Nuclear Information System (INIS)

Montes de Oca Quinnones, Joe; Torres Valle, Antonio

2015-01-01

The incorporation of the science and technique breakthroughs in the application of the radiotherapy represents a challenge so that, the appearance of equipment failure or human mistakes that triggers unfavorable consequences for patients, public, or the occupationally exposed workers; it is also diversified forcing to incorporate besides, as part of the efforts, new techniques for the evaluation of risk and the detection of the weak points that can lead to these consequences. In order to evaluate the risks of the radiotherapy practices there is the SEVRRA code, based on the method of Risk Matrix. The system SEVRRA is the most frequently used code in the applications of risk studies in radiotherapy treatment. On the other hand, starting from the development of tools to control the dangerous configurations in nuclear power plants, it has been developed the SECURE code, which in its application variant of Risk Matrix, has gain a comfortable interface man-machine to make risk analyses to the radiotherapy treatment, molding in this way a lot of combinations of scenarios. These capacities outstandingly facilitate the studies and risk optimization applications in these practices. In the system SECURE-Risk Matrix are incorporated graphic and analytical capacities, which make more flexible the analyses and the subsequent documentation of all the results. The paper shows the the application of the proposed system to an integral risk study for the process of radiotherapy treatment with linear accelerator. (Author)

Radiotherapy physics research in the UK: challenges and proposed solutions

Science.gov (United States)

Mackay, R I; Burnet, N G; Green, S; Illidge, T M; Staffurth, J N

2012-01-01

In 2011, the Clinical and Translational Radiotherapy Research Working Group (CTRad) of the National Cancer Research Institute brought together UK radiotherapy physics leaders for a think tank meeting. Following a format that CTRad had previously and successfully used with clinical oncologists, 23 departments were asked to complete a pre-meeting evaluation of their radiotherapy physics research infrastructure and the strengths, weaknesses, opportunities and threats within their own centre. These departments were brought together with the CTRad Executive Group and research funders to discuss the current state of radiotherapy physics research, perceived barriers and possible solutions. In this Commentary, we summarise the submitted materials, presentations and discussions from the meeting and propose an action plan. It is clear that there are challenges in both funding and staffing of radiotherapy physics research. Programme and project funding streams sometimes struggle to cater for physics-led work, and increased representation on research funding bodies would be valuable. Career paths for academic radiotherapy physicists need to be examined and an academic training route identified within Modernising Scientific Careers; the introduction of formal job plans may allow greater protection of research time, and should be considered. Improved access to research facilities, including research linear accelerators, would enhance research activity and pass on developments to patients more quickly; research infrastructure could be benchmarked against centres in the UK and abroad. UK National Health Service departments wishing to undertake radiotherapy research, with its attendant added value for patients, need to develop a strategy with their partner higher education institution, and collaboration between departments may provide enhanced opportunities for funded research. PMID:22972972

The First Two Electron Linear Accelerators in South Africa | Minnaar ...

African Journals Online (AJOL)

The electron linear accelerator is considered by many leading radiotherapy centres throughout the world as the most suitable equipment for the treatment of cancer. There are good reasons for this opinion, and some physical aspects are summarised here. S. Afr. Med. J., 48, 1004 (1974) ...

In vivo cell kinetic measurements in a randomized trial of continuous hyperfractionated accelerated radiotherapy with or without mitomycin C in head-and-neck cancer

International Nuclear Information System (INIS)

Dobrowsky, Werner; Dobrowsky, Eva; Wilson, George D.

2003-01-01

Purpose: Tumor cell repopulation is still considered to be a major cause of failure in radiotherapy. In this study, we investigated the influence of cell kinetic parameters on the outcome of patients treated in a randomized trial of accelerated fractionation, with or without mitomycin C, vs. conventional fractionation. Methods and Materials: Sixty-two patients were studied using administration of bromodeoxyuridine (BrdUrd), and cell kinetic parameters were measured using flow cytometry. The patients were treated with either 70 Gy for 7 weeks or 55.3 Gy for 17 continuous days (V-CHART) with or without 20 mg/m 2 mitomycin C on day 5. Results: The potential doubling time (Tpot) and labeling index (LI) failed to provide any prognostic information with regard to local control or survival. However, the duration of the S phase (Ts) revealed patients whose tumors had a long Ts had significantly worse local control (p = 0.028) and survival (p = 0.034) irrespective of treatment. A similar trend was evident within the different treatment arms particularly associated with overall survival. Conclusions: The Ts values of head-and-neck squamous cell cancers provided prognostic information that predicted clinical outcome irrespective of treatment schedule in this study. This neglected parameter of the Tpot method might provide information related to redistribution of cells during fractionated radiotherapy

Patient costs associated with external beam radiotherapy treatment for localized prostate cancer: the benefits of hypofractionated over conventionally fractionated radiotherapy.

Science.gov (United States)

Sethukavalan, Perakaa; Cheung, Patrick; Tang, Colin I; Quon, Harvey; Morton, Gerard; Nam, Robert; Loblaw, Andrew

2012-04-01

To estimate the out-of-pocket costs for patients undergoing external beam radiotherapy (EBRT) for prostate cancer and calculate the patient-related savings of being treated with a 5-fraction versus a standard 39-fraction approach. Seventy patients accrued to the pHART3 (n = 84) study were analyzed for out-of-pocket patient costs as a result of undergoing treatment. All costs are in Canadian dollars. Using the postal code of the patient's residence, the distance between the hospital and patient home was found using Google Maps. The Canada Revenue Agency automobile allowance rate was then applied to determine the cost per kilometer driven. The average cost of travel from the hospital and pHART3 patient's residence was $246 per person after five trips. In a standard fractionation regimen, pHART3 patients would have incurred an average cost of $1921 after 39 visits. The patients receiving hypofractionated radiotherapy would have paid an average of $38 in parking while those receiving conventional treatment would have paid $293. The difference in out-of-pocket costs for the patients receiving a standard versus hypofractionated treatment was $1930. Medium term prospective data shows that hypofractionated radiotherapy is an effective treatment method for localized prostate cancer. Compared to standard EBRT, hypofractionated radiotherapy requires significantly fewer visits. Due to the long distance patients may have to travel to the cancer center and the expense of parking, the short course treatment saves each patient an average of $1900. A randomized study of standard versus hypofractionated accelerated radiotherapy should be conducted to confirm a favorable efficacy and tolerability profile of the shorter fractionation scheme.

Conformal radiotherapy by intensity modulation of pediatrics tumors; Radiotherapie conformationnelle par modulation d'intensite des tumeurs pediatriques

Energy Technology Data Exchange (ETDEWEB)

Leseur, J.; Le Prise, E. [Centre Eugene-Marquis, 35 - Rennes (France); Carrie, C. [Centre Leon Berard, 69 - Lyon (France); Bernier, V. [Centre Alexis-Vautrin, 54 - Nancy (France); Beneyton, V. [Centre Paul-Strauss, 67 - Strasbourg (France); Mahe, M.A.; Supiot, S. [Centre Rene-Gauducheau, 44 - Nantes (France)

2009-10-15

The objective of this study is to take stock on the validated and potential indications of the conformal radiotherapy with intensity modulation ( intensity modulated radiotherapy I.M.R.T.) in pediatrics and to propose recommendations for its use as well as the adapted dose constraints. About 40 to 50% of children treated for a cancer are irradiated. The I.M.R.T., by linear accelerator or helical tomo-therapy has for aim to give a homogenous dose to the target volume and to save organs at risk. Its use in pediatrics seems particularly interesting because of the complexity of target volumes and the closeness of organs at risk. In compensation for these positive elements, the importance of low doses irradiation given in big volumes makes fear event consequences on growth and an increased incidence of secondary cancers in children suffering from tumors with high cure rates and long life expectancy. (N.C.)

The Nano-X Linear Accelerator: A Compact and Economical Cancer Radiotherapy System Incorporating Patient Rotation.

Science.gov (United States)

Eslick, Enid M; Keall, Paul J

2015-10-01

Rapid technological improvements in radiotherapy delivery results in improved outcomes to patients, yet current commercial systems with these technologies on board are costly. The aim of this study was to develop a state-of-the-art cancer radiotherapy system that is economical and space efficient fitting with current world demands. The Nano-X system is a compact design that is light weight combining a patient rotation system with a vertical 6 MV fixed beam. In this paper, we present the Nano-X system design configuration, an estimate of the system dimensions and its potential impact on shielding cost reductions. We provide an assessment of implementing such a radiotherapy system clinically, its advantages and disadvantages compared to a compact conventional gantry rotating linac. The Nano-X system has several differentiating features from current radiotherapy systems, it is [1] compact and therefore can fit into small vaults, [2] light weight, and [3] engineering efficient, i.e., it rotates a relatively light component and the main treatment delivery components are not under rotation (e.g., DMLCs). All these features can have an impact on reducing the costs of the system. In terms of shielding requirements, leakage radiation was found to be the dominant contributor to the Nano-X vault and as such no primary shielding was necessary. For a low leakage design, the Nano-X vault footprint and concrete volume required is 17 m2 and 35 m3 respectively, compared to 54 m2 and 102 m3 for a conventional compact linac vault, resulting in decreased costs in shielding. Key issues to be investigated in future work are the possible patient comfort concerns associated with the patient rotation system, as well as the magnitude of deformation and subsequent adaptation requirements. © The Author(s) 2014.

QA programme in external radiotherapy in Romania - status and perspective

International Nuclear Information System (INIS)

Dumitrescu, A.; Milu, C.

2008-01-01

Full text: Recognizing the importance of quality assurance in radiotherapy and the need to make access to radiation standards traceable to the international measurement system for every radiotherapy center, the Romanian national secondary standard dosimetry laboratory (SSDL) has started in 1999 - together with IAEA - a national quality audit programme in all the centers for external radiotherapy from Romania. At present, there are 17 radiotherapy centers in Romania, and a total of 19 teletherapy units and 4 LINCs. The programme has 3 phases: the first phase was to organize a survey in all radiotherapy centers, to collect general information on their radio therapists, medical physicists, type of equipment, dosimeters, etc. Following the survey, a quality assurance network was set up, and on-site dosimetry reviews were arranged according to a suitable timetable. The second phase consisted in performing the reference dosimetry and the calibration of the equipment. Then, a quality audit system based on mailed TLDs has been applied to all radiation beams produced by cobalt-60 therapy units and medical accelerators, in order to identify discrepancies in dosimetry larger than ± 3%. At the same time, the beam calibration performed by the SSDLs was verified. The results of the first survey were analyzed, and corrective actions were taken. A second survey was then organized, based on the mailed TLDs. This paper presents in detail the entire QA programme, its results, and the actions that are to be taken in order to improve the accuracy and consistency of the dosimetry in clinical radiotherapy in Romania. (author)

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.

Medical applications of accelerators

CERN Document Server

Rossi, Sandro

1998-01-01

At Present, about five thousands accelerators are devoted to biomedical applications. They are mainly used in radiotherapy, research and medical radioisotopes production. In this framework oncological hadron-therapy deserves particular attention since it represents a field in rapid evolution thanks to the joint efforts of laboratories with long experiences in particle physics. It is the case of CERN where the design of an optimised synchrotron for medical applications has been pursued. These lectures present these activities with particular attention to the new developments which are scientifically interesting and/or economically promising.

Investigation of linear accelerator pulse delivery using fast organic scintillator measurements

DEFF Research Database (Denmark)

Beierholm, Anders Ravnsborg; Andersen, Claus Erik; Lindvold, Lars René

2010-01-01

Fiber-coupled organic plastic scintillators present an attractive method for time-resolved dose measurements during radiotherapy. Most organic scintillators exhibit a fast response, making it possible to use them to measure individual high-energy X-ray pulses from a medical linear accelerator...... performed on Varian medical linear accelerators, delivering 6 MV X-ray beams. The dose delivery per radiation pulse was found to agree with expectations within roughly 1%, although minor discrepancies and transients were evident in the measurements....

Role of levamisole immunotherapy as an adjuvant to radiotherapy in oral cancer. II

International Nuclear Information System (INIS)

Balaram, P.; Padmanabhan, T.K.; Vasudevan, D.M.

1988-01-01

The effect of radiotherapy and adjuvant levamisole immunotherapy on the lymphocyte subpopulations was investigated. Comparisons were made between groups receiving levamisole, those receiving placebo, and normal healthy controls. The results of a thirty-month follow-up are reported. Radiotherapy caused leukopenia and lymphopenia affecting all the subsets (T, B, T G and T M ); T lymphocytes were affected to a greater extent. This study demonstrates that levamisole does accelerate the restoration of T lymphocytes, with the T M lymphocytes showing a faster repopulation in comparison with the T G lymphocytes. (author). 2 figs., 2 tabs., 39 refs

Norwegian program of quality assurance in radiotherapy (KVIST) - Organisation, benefits and experience feedback;Programme norvegien d'assurance qualite dans la radiotherapie (KVIST) - Organisation, benefices et retour d'experience

Energy Technology Data Exchange (ETDEWEB)

Merete Olerud, H. [Oslo Univ., Autorite Norvegienne de Radioprotection, Osteras, Institut de Physique et Biophysique (Norway); Levernes, S. [Oslo Univ., Centre Hospitalier, Autorite Norvegienne de Radioprotection, Osteras - DNR, Montebello (Norway); Hellebust, T.P. [Autorite Norvegienne de Radioprotection, Osteras, Centre Hospitalier, DNR, Montebello (Norway); Heikkela, I.E. [Autorite Norvegienne de Radioprotection, Osteras D.C., Johannessen, Centre Hospitalier Universitaire - Ulleval, Oslo (Norway); Bjerke, H. [Autorite Norvegienne de Radioprotection, Osteras, Rekstad BL, Centre Hospitalier Universitaire - Ulleval, Oslo (Norway); Sundqvist, E. [Programme Radiographie, Faculte de la Sante, Oslo, College Universitaire, Oslo (Norway); Frykholm, G. [Oslo Univ., Centre Hospitalier Universitaire, Autorite Norvegienne de Radioprotection, Osteras, St.Olav, Trondheim (Norway)

2009-12-15

In 2000, the Norwegian Radiation Protection Authority (N.R.P.A.) initiated work to develop a national quality assurance programme in radiotherapy. The program was named K.V.I.S.T.: i.e. Norwegian abbreviation of Quality Assurance in Radiotherapy (KValitetSikring STraleterapi). The programme is performed by the multidisciplinary K.V.I.S.T. Group and aims to stimulate collaboration by focussing on clinical, technical and administrative problems that can be addressed and solved on a national level. An important objective is to establish a positive attitude towards quality assurance and better communication between centres and the various professions and professionals involved in radiotherapy, i.e. the oncologists, medical physicists and radiation therapy technologists. Information is also provided to other stake holders such as health authorities, hospital administrators and patients. In 2007 radiotherapy in Norway represent 10 departments and forty accelerators. Since radiotherapy is given high priority in cancer care good quality assurance is required. The member of the K.V.I.S.T.-group are part time at N.R.P.A. and part time in different radiotherapy departments. Professionals with competencies within radiotherapy (R.T.) have permanent positions in a national public entity. The K.V.I.S.T.-group is multidisciplinary. The K.V.I.S.T.-group acts as a coordinating group for all type of national Q.A. projects. The recommendations/guidelines are developed by national consensus. The work is performed by the radiotherapy community it self, thus creating an atmosphere of ownership. (N.C.)

The place of conformal radiotherapy in the routine work: national investigation of SFRO members'opinion

International Nuclear Information System (INIS)

Lagrange, J.L.; Lipinski, F.

2001-01-01

National French investigation of the using of conformal radiotherapy in routine work, has been made in 2001, in 180 radiotherapeutic centers. Eighty responses have been obtained and analyzed. Conformal radiotherapy is used in 88% and virtual simulation in 60% of these centers. There is a heterogeneity in the equipment of these institutions, most of them have one or two machines. The accelerator equipment differs, and the availability of multi-leaf collimators and electronic portal imaging is limited. Actually only eleven centers have IMRT, eight have projects to install. Only six centers have CT-scans, used mainly for simulation. In 75% of centers conformal radiotherapy have been used in the treatment of CNS-tumors, head and neck cancers, prostate, and non-small cell lung carcinoma. If there are more equipment and human facilities to use conformal radiotherapy, this treatment can be proposed to patients with breast cancer, rectal and gynecological tumors. According 90% of responses, all prostatic cancers need conformal radiotherapy. The analysis of routine use of conformal radiotherapy in France shows an important heterogeneity but it seems that there is an agreement with objectives of this treatment. (authors)

The use of high-density concretes in radiotherapy treatment room design

International Nuclear Information System (INIS)

Facure, A.; Silva, A.X.

2007-01-01

With the modernization of radiotherapic centers, medical linear accelerators are largely replacing 60 Co teletherapy units. In many cases, the same vault housing the 60 Co teletherapy unit is reused for the linear accelerator and, when space is at a premium, high-density concrete (3.0-5.0 g/cm 3 ) is employed to provide shielding against the primary, scatter and leakage radiation. This work presents a study based on Monte Carlo simulations of transmission of some clinical photon spectra (of 4-10 MV accelerators) through some types of high-density concretes, normally used in the construction of radiotherapy bunkers. From the simulations, the initial and subsequent tenth-value layers (TVL) for these materials, taking into account realistic clinical photon spectra, are presented, for primary radiation

A versatile program for the calculation of linear accelerator room shielding.

Science.gov (United States)

Hassan, Zeinab El-Taher; Farag, Nehad M; Elshemey, Wael M

2018-03-22

This work aims at designing a computer program to calculate the necessary amount of shielding for a given or proposed linear accelerator room design in radiotherapy. The program (Shield Calculation in Radiotherapy, SCR) has been developed using Microsoft Visual Basic. It applies the treatment room shielding calculations of NCRP report no. 151 to calculate proper shielding thicknesses for a given linear accelerator treatment room design. The program is composed of six main user-friendly interfaces. The first enables the user to upload their choice of treatment room design and to measure the distances required for shielding calculations. The second interface enables the user to calculate the primary barrier thickness in case of three-dimensional conventional radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) and total body irradiation (TBI). The third interface calculates the required secondary barrier thickness due to both scattered and leakage radiation. The fourth and fifth interfaces provide a means to calculate the photon dose equivalent for low and high energy radiation, respectively, in door and maze areas. The sixth interface enables the user to calculate the skyshine radiation for photons and neutrons. The SCR program has been successfully validated, precisely reproducing all of the calculated examples presented in NCRP report no. 151 in a simple and fast manner. Moreover, it easily performed the same calculations for a test design that was also calculated manually, and produced the same results. The program includes a new and important feature that is the ability to calculate required treatment room thickness in case of IMRT and TBI. It is characterised by simplicity, precision, data saving, printing and retrieval, in addition to providing a means for uploading and testing any proposed treatment room shielding design. The SCR program provides comprehensive, simple, fast and accurate room shielding calculations in radiotherapy.

Prospective randomized trail on chrono-chemotherapy + late course three dimensional conformal radio-therapy and conventional chemotherapy plus radiotherapy for nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Jin Feng; Ouyang Jinling; Dong Hongmin; Wu Weili; Chen Haixia; He Zhihui

2005-01-01

Objective: To compare the therapeutic effects, toxic side effects of late-course three dimensional conformal radiotherapy plus chrono-chemotherapy (DDP + 5-FU/CF) and conventional radiotherapy plus chemotherapy for nasopharyngeal carcinoma (NPC). Methods: Eighty -six NPC patients admitted from Feb. 2001 to Jan. 2002 were divided randomly into two groups: 1. Chrono-chemotherapy + late course three dimensional conformal radiotherapy(CCR) group-44 patients were treated by late course three dimensional conformal radio-therapy plus chrono-chemotherapy, and 2. Routine-chemotherapy-radiotherapy (RCR) group-42 patients were treated by routine chemotherapy plus radiotherapy. The patients in CCR and RCR group were comparable in age, KPS, stage and pathology. All patients were treated by combined chemotherapy and radiotherapy, with chemotherapy stared 2 weeks ahead of radiotherapy. Chemotherapy: Braun pump was used in all drug infusions; 1. CCR group-DDP 80 mg/ m 2 starting from 10:00 until 22:00, 5-Fu 750 mg/d/m 2 starting from 22:00 until 10:00 next day, CF 200 mg/d/m 2 starting from 10:00 every day, infused at normal speed. These drugs were given for 3 days, 14 days as one cycle, totally 2 cycle, and 2. RCR group-with the same drugs at the same total dose, only with the difference being DDP and CF given QD, starting from 10:00 but at the normal speed. 5-Fu was given through-out the day and continuously for 3 days, totally for 2 cycles. Radiotherapy: linear accelerator irradiation was given to either group. Composite facio-cervical field + anterior cervical tangential field to D T 40 Gy/4w, followed by the coned down per-auricular field plus anterior tangential field or β beam irradiation. In CCR group, after D T 40gy/4w, late course 3-dimensional conformal radiotherapy (3DCRT) was used to add D T 30Gy/3w. In RCR group, routine radiotherapy of 40 Gy/w was supplemented with 30 Gy/3w. The total dose in either group was 70 Gy/7w at the nasopharynx, D T 60-70 Gy/6-7w at the

A record and verify system for radiotherapy treatment

International Nuclear Information System (INIS)

Koens, M.L.; Vroome, H. de

1984-01-01

The Record and Verify system developed for the radiotherapy department of the Leiden University Hospital is described. The system has been in use since 1980 and will now be installed in at least four of the Dutch University Hospitals. The system provides the radiographer with a powerful tool for checking the set-up of the linear accelerator preceeding the irradiation of a field. After the irradiation of a field the machine settings are registered in the computer system together with the newly calculated cumulative dose. These registrations are used by the system to produce a daily report which provides the management of the department with insight into the established differences between treatment and treatment planning. Buying a record and verify system from the manufacturer of the linear accelerator is not an optimal solution especially for a department with more than one accelerator from different manufacturers. Integration in a Hospital Information System (HIS) has important advantages over the development of a dedicated departmental system. (author)

Quantitative analysis of results of quality control tests in linear accelerators used in radiotherapy; Analise quantitativa dos resultados de testes de controle de qualidade em aceleradores lineares usados em radioterapia

Energy Technology Data Exchange (ETDEWEB)

Passaro, Bruno M.; Rodrigues, Laura N. [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Videira, Heber S., E-mail: bruno.passaro@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

2013-04-15

The aim of this study is to assess and analyze the stability of the calibration factor of three linear accelerators, as well as the other dosimetric parameters normally included in a program of quality control in radiotherapy. The average calibration factors of the accelerators for the period of approximately four years for the Clinac 600C and Clinac 6EX were (0.998±0.012) and (0.996±0.014), respectively. For the Clinac 2100CD 6 MV and 15 MV was (1.008±0.009) and (1.006±0.010), respectively, in a period of approximately four years. The data of the calibration factors were divided into four subgroups for a more detailed analysis of behavior over the years. Through statistical analysis of calibration factors, we found that for the 600C and Clinacs 2100CD, is an expected probability that more than 90% of cases the values are within acceptable ranges according to TG-142, while for the Clinac 6EX is expected around 85% since this had several exchanges of accelerator components. The values of TPR20,10 of three accelerators are practically constant and within acceptable limits according to the TG-142. It can be concluded that a detailed study of data from the calibration factor of the accelerators and TPR{sub 20},{sub 10} from a quantitative point of view, is extremely useful in a quality assurance program. (author)

TECHNOLOGIES FOR DELIVERY OF PROTON AND ION BEAMS FOR RADIOTHERAPY

CERN Document Server

Owen, H; Alonso, J; Mackay, R

2014-01-01

Recent developments for the delivery of proton and ion beam therapy have been significant, and a number of technological solutions now exist for the creation and utilisation of these particles for the treatment of cancer. In this paper we review the historical development of particle accelerators used for external beam radiotherapy and discuss the more recent progress towards more capable and cost-effective sources of particles.

Norwegian program of quality assurance in radiotherapy (KVIST) - Organisation, benefits and experience feedback

International Nuclear Information System (INIS)

Merete Olerud, H.; Levernes, S.; Hellebust, T.P.; Heikkela, I.E.; Bjerke, H.; Sundqvist, E.; Frykholm, G.

2009-01-01

In 2000, the Norwegian Radiation Protection Authority (N.R.P.A.) initiated work to develop a national quality assurance programme in radiotherapy. The program was named K.V.I.S.T.: i.e. Norwegian abbreviation of Quality Assurance in Radiotherapy (KValitetSikring STraleterapi). The programme is performed by the multidisciplinary K.V.I.S.T. Group and aims to stimulate collaboration by focussing on clinical, technical and administrative problems that can be addressed and solved on a national level. An important objective is to establish a positive attitude towards quality assurance and better communication between centres and the various professions and professionals involved in radiotherapy, i.e. the oncologists, medical physicists and radiation therapy technologists. Information is also provided to other stake holders such as health authorities, hospital administrators and patients. In 2007 radiotherapy in Norway represent 10 departments and forty accelerators. Since radiotherapy is given high priority in cancer care good quality assurance is required. The member of the K.V.I.S.T.-group are part time at N.R.P.A. and part time in different radiotherapy departments. Professionals with competencies within radiotherapy (R.T.) have permanent positions in a national public entity. The K.V.I.S.T.-group is multidisciplinary. The K.V.I.S.T.-group acts as a coordinating group for all type of national Q.A. projects. The recommendations/guidelines are developed by national consensus. The work is performed by the radiotherapy community it self, thus creating an atmosphere of ownership. (N.C.)

Verification of respiratory-gated radiotherapy with new real-time tumour-tracking radiotherapy system using cine EPID images and a log file.

Science.gov (United States)

Shiinoki, Takehiro; Hanazawa, Hideki; Yuasa, Yuki; Fujimoto, Koya; Uehara, Takuya; Shibuya, Keiko

2017-02-21

A combined system comprising the TrueBeam linear accelerator and a new real-time tumour-tracking radiotherapy system, SyncTraX, was installed at our institution. The objectives of this study are to develop a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine electronic portal image device (EPID) images and a log file and to verify this treatment in clinical cases. Respiratory-gated radiotherapy was performed using TrueBeam and the SyncTraX system. Cine EPID images and a log file were acquired for a phantom and three patients during the course of the treatment. Digitally reconstructed radiographs (DRRs) were created for each treatment beam using a planning CT set. The cine EPID images, log file, and DRRs were analysed using a developed software. For the phantom case, the accuracy of the proposed method was evaluated to verify the respiratory-gated radiotherapy. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker used as an internal surrogate were calculated to evaluate the gating accuracy and set-up uncertainty in the superior-inferior (SI), anterior-posterior (AP), and left-right (LR) directions. The proposed method achieved high accuracy for the phantom verification. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker were  ⩽3 mm and  ±3 mm in the SI, AP, and LR directions. We proposed a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine EPID images and a log file and showed that this treatment is performed with high accuracy in clinical cases.

Conformal three dimensional radiotherapy treatment planning in Lund

Energy Technology Data Exchange (ETDEWEB)

Knoos, T; Nilsson, P [Lund Univ. (Sweden). Dept. of Radiation Physics; Anders, A [Lund Univ. (Sweden). Dept. of Oncology

1995-12-01

The use of conformal therapy is based on 3-dimensional treatment planning as well as on methods and routines for 3-dimensional patient mapping, 3-dimensional virtual simulation and others. The management of patients at the Radiotherapy Department at the University Hospital in Lund (Sweden) is discussed. About 2100 new patients are annually treated with external radiotherapy using seven linear accelerators. Three of the accelerators have dual photon energies and electron treatment facilities. A multi-leaf collimator as well as an electronic portal imaging device are available on one machine. Two simulators and an in-house CT-scanner are used for treatment planning. From 1988 to 1992 Scandiplan (Umplan) was used. Since 1992, the treatment planning system is TMS (HELAX AB, Sweden), which is based on the pencil beam algorithm of Ahnesjo. The calculations use patient modulated accelerator specific energy fluence spectra which are compiled with pencil beams from Monte Carlo generated energy absorption kernels. Heterogeneity corrections are performed with results close to conventional algorithms. Irregular fields, either from standard or individual blocks and from multi-leaf collimators are handled by the treatment planning system. The field shape is determined conveniently using the beam`s eye view. The final field shape is exported electronically to either the block cutting machine or the multileaf collimator control computer. All patient fields are checked against the beam`s eye view during simulation using manual methods. Treatment verification is performed by portal films and in vivo dosimetry with silicon diodes or TL-dosimetry. Up to now, approximately 4400 patients have received a highly individualized 3-dimensional conformal treatment.

Development of a new concept automatic frequency controller for an ultrasmall C-band linear accelerator guide

International Nuclear Information System (INIS)

Kamino, Yuichiro; Tsukuda, Kazuhiro; Kokubo, Masaki; Miura, Sadao; Hirai, Etsuro; Hiraoka, Masahiro; Ishikawa, Junzo

2007-01-01

We are developing a four-dimensional, image-guided radiotherapy system with a gimbaled x-ray head. The system has pursuing irradiation capability in addition to precise irradiation capability, owing to its agile x-ray head. The moving x-ray head requires a very small C-band accelerator guide. The heat intensity of the accelerator guide is much higher than that of conventional S-band medical linear accelerators. The resonance frequency varies over almost 1.0 MHz with a thermal time constant of about 30 s. An automatic frequency controller (AFC) is employed to compensate for this variation in resonance frequency. Furthermore, we noted that fast AFC response is important for step-and-shoot intensity modulation radiotherapy (IMRT), in which the beam is turned on and off frequently. Therefore, we invented a digital AFC, based on a new concept, to provide effective compensation for the thermal characteristics of the accelerator guide and to ensure stable and optimized x-ray treatment. An important aspect of the performance of the AFC is the capture-frequency range over which the AFC can seek, lock on to, and track the resonance frequency. The conventional, analog AFC used in S-band medical linear accelerators would have a capture-frequency range of about 0.9 MHz, if applied to our accelerator guide, and would be inappropriate. Conversely, our new AFC has a capture-frequency range of 24 MHz, which is well suited to our accelerator guide. The design concept behind this new AFC has been developed and verified. A full prototype system was constructed and tested on an existing accelerator guide at the rated x-ray output (500 cGy/min) of our radiotherapy system, with a pulse-repetition frequency of 300 Hz. The AFC acquired the resonance frequency of the accelerator guide within 0.15 s after beam-on, and provided stable tracking and adjustment of the frequency of the microwave source to the resonance frequency of the accelerator guide. With a planned improvement of the

Radiobiological Characterization of Two Photon-Beam Energies 6 and 15 MV used in Radiotherapy From Linear Accelerator

International Nuclear Information System (INIS)

Eltayeb, A.E.H.

2009-02-01

The main objective of this study is to perform radiobiological characterization of two different photon beam energies, 6 MV and 15 MV, from linear accelerator used in radiotherapy, with special regard to late effects of radiation. Two end-points, namely cell survival and micronucleus induction were used for the characterization. Chinese hamster V 79 lung fibroblast cell line to prepare cell culture and to perform the innervate experiments. chromosomes number was counted and found to be 22 chromosomes per cell, this result is in complete agreement with expected 11 pairs of chromosomes representing the genome of this species. Cells were kept in confluent growth for two days and then exposed to two photon beam energies, 6 and 15 MV respectively. Different dose rates were used for the two beam energies, 0.25, 0.5, 1.0, 2.0, 4.0, 7.0 Gy. Cells were counted immediately after irradiation and re seeded, the seeded number of cells was calculated to the dose rate used. Another set of unirradiated cells treated the same as the experimental set was used as a control group. The plating efficiency (PE) was calculated for the control group, then cells were incubated at 37 o C for 6 days to construct the survival curve, five samples were counted per dose and the mean was calculated. The two survival curves are similar for photon beam energies (6 and 15 MV) and the surviving fraction was decreased with dose rate. The two curves showed similar values of α and β parameters, this result is expected for the same radiation type (X-ray). For the micronuclei assay three samples for each dose were seeded and incubated at 37 o C for 24 hours then Cytochalasin-B was added to block cells in cytokinesis phase of the mitosis. The micronuclei number was counted and plotted with dose. A significant positive correlation was found between dose and micronuclei frequency (P=0.00), moreover, the micronuclei frequency is relatively higher with 15 MV compared with 6 MV energy. This indicates the

Palliative and low cost radiotherapy in developing countries

International Nuclear Information System (INIS)

Allen, Barry; Hussein, S.M.A.

2011-01-01

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. In 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 care centre include lower cost and therefore more centres, enabling more patients access to regional palliative care. Simple curative treatments could also be managed. Co60 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 Co60 units and low energy linacs are compared and both are found to be acceptable for palliation. The role of palliative and low cost radiotherapy in Bangladesh is reviewed. 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.

Postal TLD audits in radiotherapy in the Czech Republic: current status, experience and potential

International Nuclear Information System (INIS)

Ekendahl, Daniela; Kapucianova, Michaela; Dufek, Vladimir

2014-01-01

The paper deals with practice and performance of postal TLD audits in radiotherapy with emphasis on the possibilities of application of the advanced versions that were developed following up technological progress in radiotherapy. The new methodologies of the TLD audit are focused specifically on up-to-date linear accelerators, equipped with multileaf collimators, and modern treatment planning systems. The dose is checked by the TLD not only for reference conditions but also in conditions of radiation fields influenced by presence of inhomogeneities in the irradiated volume. As regards small radiation fields, the check also includes dose profile verification using gafchromic films. The methodologies were tested within pilot studies performed in collaboration with some Czech radiotherapy centers. The results and experience gave evidence of the usefulness and appropriateness of the new TLD audit methodologies. (orig.)

Human normal tissue reactions in radiotherapy

International Nuclear Information System (INIS)

Taniike, Keiko

1990-01-01

Acute and late normal tissue reactions in radiotherapy have not been considered to be major problems with conventional fractionation. But they may cause certain problems when newer schedules such as hyperfractionation or accelerated fractionation are used. In opposing parallel radiotherapy, the dose fractionation of skin or subcutaneous connective tissue are different between in one portal and two portals daily. So we examined acute skin erythema and late connective tissue fibrosis in the two groups (one and two portals) of the patients with uterus cancer. Acute skin erythema and late connective tissue fibrosis were slightly stronger in case of one portal daily. In relation to the anatomical site of skin, acute skin erythema was stronger at the buttocks than the lower abdomen, but late fibrosis was reverse to that. So the degree of acute skin erythema did not predict the degree of late connective tissue fibrosis. The number of Time Dose Fractionation Factor could roughly estimate the degree of erythema and fibrosis. Late fibrosis in 36 fractions increased with an increase of abdominal thickness, but acute erythema did not. (author)

Hadron-therapy: applications of accelerator technologies to tumour treatments

CERN Multimedia

CERN. Geneva

2009-01-01

In the second part the technologies of dose delivery are described emphasising the main challenges of modern radiotherapy, in particular the treatment of moving organs. In this framework the properties of the beams produced by conventional accelerators (cyclotrons and synchrotrons) are compared with the ones due to two novel approaches based on fast cycling machines, as FFAGs and cyclinacs.

Fetal dose determination in patients with breast cancer submitted to radiotherapy

International Nuclear Information System (INIS)

Melo, H.C.; Roesler, I.C.; Leon, E.

1985-01-01

The exposure that the fetus receive during radiotherapy treatment for patients with breast cancer submitted to cobalt 60 and linear accelerator of 6 MV is studied. Measurements with a rando-Alderson Phantom and ionization chamber for each individualized irradiation field, at the body level where the fetus is localized during the several stages of pregnancy, are made. (M.A.C.) [pt

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

Laser-driven particle acceleration towards radiobiology and medicine

CERN Document Server

2016-01-01

This book deals with the new method of laser-driven acceleration for application to radiation biophysics and medicine. It provides multidisciplinary contributions from world leading scientist in order to assess the state of the art of innovative tools for radiation biology research and medical applications of ionizing radiation. The book contains insightful contributions on highly topical aspects of spatio-temporal radiation biophysics, evolving over several orders of magnitude, typically from femtosecond and sub-micrometer scales. Particular attention is devoted to the emerging technology of laser-driven particle accelerators and their applicatio to spatio-temporal radiation biology and medical physics, customization of non-conventional and selective radiotherapy and optimized radioprotection protocols.

Toshiba's advanced technologies contributing to heavy-ion radiotherapy for cancer treatment

International Nuclear Information System (INIS)

Iikura, Takahiko

2013-01-01

Toshiba has been focusing effects on cancer treatment in the healthcare field, which is likely to continue to expand in the future. Our objective is to offer healthcare processes from early detection by means of regular cancer examinations, through to precise diagnosis, treatment ensuring the quality of life (QOL) appropriate to individual patients, and aftercare. In particular, we are promoting the development of heavy-ion radiotherapy systems incorporating our range of technologies for particle accelerators, irradiation devices, superconducting magnets, and information processing and networks. By offering heathcare processes with advanced heavy-ion radiotherapy systems as a core, our approach is expected to contribute to high-quality cancer treatment. (author)

Treatment of lymphatic nodes metastasis in advanced cancer with interventional chemotherapy combined radiotherapy

International Nuclear Information System (INIS)

Xia Shian; Guo Weijian; Wu Guohua; Lin Qing; Jiang Mawei; Yao Yuan

2000-01-01

Objective: To evaluate the clinical effects of treatment with interventional chemotherapy combined radiotherapy for lymphatic nodes metastasis in advanced cancer. Methods: Treated with interventional chemotherapy for 27 cases of lymphatic rode metastasis once a month with average 2-3 times totally. Simultaneously treated with linear accelerator radiotherapy with average dose of 40-50 Gy/20-25 times/4-5 weeks. Results: To evaluate the clinical effects after finished the whole treatment program two months later. CR + PR reached 77.8% (24/27). All patients showed tolerance to accept the treatment. Conclusion: Treatment for lymphatic node metastasis in advanced cancer with interventional chemotherapy combined radiation therapy seems to be a valuable way

External radiotherapy. Particle accelerator - Radiation protection: medical sheet ED 4246

International Nuclear Information System (INIS)

2007-06-01

After having indicated the required authorizations for the use of external radiotherapy installations, this document presents the various aspects and measures related to radiation protection of workers when performing such treatments. It presents the concerned personnel, describes the operational process, indicates the associated hazards and the risk related to ionizing radiation, and describes how the risk is to be assessed and how exposure levels are to be determined (elements of risk assessment, delimitation of controlled and monitored areas, personnel classification, and choice of the dose monitoring method). It describes the various components of a risk management strategy (risk reduction, technical measures regarding the installation and the personnel, training and information, prevention and medical monitoring). It briefly presents how risk management is to be assessed, and mentions other related risks

Intraoperative Radiotherapy for Breast Cancer: The Lasting Effects of a Fleeting Treatment

Directory of Open Access Journals (Sweden)

Harriet B. Eldredge-Hindy

2014-01-01

Full Text Available In well-selected patients who choose to pursue breast conservation therapy (BCT for early-stage breast cancer, partial breast irradiation (PBI delivered externally or intraoperatively, may be a viable alternative to conventional whole breast irradiation. Two large, contemporary randomized trials have demonstrated breast intraoperative radiotherapy (IORT to be noninferior to whole breast external beam radiotherapy (EBRT when assessing for ipsilateral breast tumor recurrence in select patients. Additionally, IORT and other PBI techniques are likely to be more widely adopted in the future because they improve patient convenience by offering an accelerated course of treatment. Coupled with these novel techniques for breast radiotherapy (RT are distinct toxicity profiles and unique cosmetic alterations that differ from conventional breast EBRT and have the potential to impact disease surveillance and patient satisfaction. This paper will review the level-one evidence for treatment efficacy as well as important secondary endpoints like RT toxicity, breast cosmesis, quality of life, patient satisfaction, and surveillance mammography following BCT with IORT.

EPR dosimetry for actual and suspected overexposures during radiotherapy treatments in Poland

International Nuclear Information System (INIS)

Trompier, F.; Sadlo, J.; Michalik, J.; Stachowicz, W.; Mazal, A.; Clairand, I.; Rostkowska, J.; Bulski, W.; Kulakowski, A.; Sluszniak, J.; Gozdz, S.; Wojcik, A.

2007-01-01

EPR dosimetry on bone samples was recently used for actual and suspected overexposures during radiotherapy treatments performed in Poland. In 2001 five breast-cancer patients undergoing radiotherapy in the Bialystok Oncology Center, Poland, were overexposed. The overexposure was due to a defective safety interlock and an obsolete safety system of the linear accelerator. For the three most exposed patients, pieces of rib bones removed during surgical reconstruction of the chest wall and skin transplantation allowed an estimation of the accident doses by electron paramagnetic resonance (EPR) spectrometry. The doses delivered during the accident were as high as 60-80 Gy. In 2005, a patient treated in Kielce Holy Cross Cancer Center exhibited similar deep necroses of the chest wall but 6 years following a 'standard upper mantel fields' radiotherapy for Hodgkin's disease. In order to investigate the possible late effect of an overexposure as necrosis origin, the delivered dose was afterward estimated by EPR dosimetry performed on a rib sample

National Observatory of Radiotherapy. Survey report: situation at the end of 2012 and evolution since 2007

International Nuclear Information System (INIS)

2014-05-01

This report presents and discusses the results of a survey on French radiotherapy centres to assess the condition of radiotherapy equipment, on the activity of these centres, on the composition of their medical and paramedical radiotherapy staff. After a presentation of the survey organisation and implementation, and of its methodology, results are presented and discussed, generally illustrated by tables and graphs. These results concern technical platforms and equipment (structure of the linear accelerator stock, additional equipment, operation planning and duration, procedures in case of machine stoppage, treatment preparation, equipment for treatment quality control), the activity (number of treated patients, numbers of treatments and sessions, treatment preparation, applied techniques and tumour locations), and the staff (evolution of the numbers of oncologists radiotherapists, medical physicists, technicians, and dosimetry technicians)

TLD audit in radiotherapy in the Czech Republic

International Nuclear Information System (INIS)

Kroutilikova, D.; Zackova, H.; Judas, L.

1998-01-01

National Radiation Protection Institute in Prague organizes the TLD audit. The aim of the TLD postal audit is to provide control of the clinical dosimetry in the Czech Republic for purposes of state supervision in radiotherapy, to investigate and to reduce uncertainties involved in the measurements of absorbed dose and to improve consistency in dose determination in the regional radiotherapy centers. TLD audit covers absorbed dose measurements under reference conditions for 60 Co and 137 Cs beams, high-energy X-ray and electron beams of of linear accelerators and betatrons. The thermo-luminescence dosemeters are sent regularly to all radiotherapy centers. Absorbed dose measures by the TLD is compared to absorbed dose stated by radiotherapy center. Encapsulated LiF:Mg, Ti powder is used for the measurement. Deviation of 3% between stated and TLD measured dose is considered for photons and ±5% for electron beams. First TLD audit was started in 1997. A total of 135 beams was checked. There were found seven major deviations (more than ±6%), which were very carefully investigated. Medical Physicists from these departments reported a set-up mistake. However, at most of those hospitals with major deviations, an in situ audit in details was made soon after TLD audit. There were found discrepancies of clinical dosimetry but also bad technical state of some of the irradiation units. In 1998, second course TLD audit was started. No major deviation was found. Regular TLD audit seems to be a good way to eliminate big mistakes in the basic clinical dosimetry. Repeated audit in the regional radiotherapy centers that had major deviation during the first audit exhibited improvement of their dosimetry. It is intended to broaden the method and to control also beam parameters by means of a multi-purpose phantom. (authors)

Tomotherapy – a different way of dose delivery in radiotherapy

Science.gov (United States)

Skórska, Małgorzata; Jodda, Agata; Ryczkowski, Adam; Kaźmierska, Joanna; Adamska, Krystyna; Karczewska-Dzionk, Aldona; Żmijewska-Tomczak, Małgorzata; Włodarczyk, Hanna

2012-01-01

Aim of the study Helical tomotherapy is one of the methods of radiotherapy. This method enables treatment implementation for a wide spectrum of clinical cases. The vast array of therapeutic uses of helical tomotherapy results directly from the method of dose delivery, which is significantly different from the classic method developed for conventional linear accelerators. The paper discusses the method of dose delivery by a tomotherapy machine. Moreover, an analysis and presentation of treatment plans was performed in order to show the therapeutic possibilities of the applied technology. Dose distributions were obtained for anaplastic medulloblastoma, multifocal metastases to brain, vulva cancer, tongue cancer, metastases to bones, and advanced skin cancer. Tomotherapy treatment plans were compared with conventional linear accelerator plans. Results Following the comparative analysis of tomotherapy and conventional linear accelerator plans, in each case we obtained the increase in dose distribution conformity manifested in greater homogeneity of doses in the radiation target area for anaplastic medulloblastoma, multifocal metastases to brain, vulva cancer, metastases to bones, and advanced skin cancer, and the reduction of doses in organs at risk (OAR) for anaplastic medulloblastoma, vulva cancer, tongue cancer, and advanced skin cancer. The time of treatment delivery in the case of a tomotherapy machine is comparable to the implementation of the plan prepared in intensity-modulated radiotherapy (IMRT) technique for a conventional linear accelerator. In the case of tomotherapy the application of a fractional dose was carried out in each case during one working period of the machine. For a conventional linear accelerator the total value of the fractional dose in the case of anaplastic medulloblastoma and metastases to bones was delivered using several treatment plans, for which a change of set-up was necessary during a fraction. Conclusion The obtained results

Verification of respiratory-gated radiotherapy with new real-time tumour-tracking radiotherapy system using cine EPID images and a log file

Science.gov (United States)

Shiinoki, Takehiro; Hanazawa, Hideki; Yuasa, Yuki; Fujimoto, Koya; Uehara, Takuya; Shibuya, Keiko

2017-02-01

A combined system comprising the TrueBeam linear accelerator and a new real-time tumour-tracking radiotherapy system, SyncTraX, was installed at our institution. The objectives of this study are to develop a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine electronic portal image device (EPID) images and a log file and to verify this treatment in clinical cases. Respiratory-gated radiotherapy was performed using TrueBeam and the SyncTraX system. Cine EPID images and a log file were acquired for a phantom and three patients during the course of the treatment. Digitally reconstructed radiographs (DRRs) were created for each treatment beam using a planning CT set. The cine EPID images, log file, and DRRs were analysed using a developed software. For the phantom case, the accuracy of the proposed method was evaluated to verify the respiratory-gated radiotherapy. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker used as an internal surrogate were calculated to evaluate the gating accuracy and set-up uncertainty in the superior-inferior (SI), anterior-posterior (AP), and left-right (LR) directions. The proposed method achieved high accuracy for the phantom verification. For the clinical cases, the intra- and inter-fractional variations of the fiducial marker were  ⩽3 mm and  ±3 mm in the SI, AP, and LR directions. We proposed a method for the verification of respiratory-gated radiotherapy with SyncTraX using cine EPID images and a log file and showed that this treatment is performed with high accuracy in clinical cases. This work was partly presented at the 58th Annual meeting of American Association of Physicists in Medicine.

A dose homogeneity and conformity evaluation between ViewRay and pinnacle-based linear accelerator IMRT treatment plans

OpenAIRE

Daniel L Saenz; Bhudatt R Paliwal; John E Bayouth

2014-01-01

ViewRay, a novel technology providing soft-tissue imaging during radiotherapy is investigated for treatment planning capabilities assessing treatment plan dose homogeneity and conformity compared with linear accelerator plans. ViewRay offers both adaptive radiotherapy and image guidance. The combination of cobalt-60 (Co-60) with 0.35 Tesla magnetic resonance imaging (MRI) allows for magnetic resonance (MR)-guided intensity-modulated radiation therapy (IMRT) delivery with multiple beams. This ...

Pulse-resolved radiotherapy dosimetry using fiber-coupled organic scintillators

Energy Technology Data Exchange (ETDEWEB)

Ravnsborg Beierholm, A.

2011-05-15

This PhD project pertains to the development and adaptation of a dosimetry system that can be used to verify the delivery of radiation in modern radiotherapy modalities involving small radiation fields and dynamic radiation delivery. The dosimetry system is based on fibre-coupled organic scintillators and can be perceived as a well characterized, independent alternative to the methods that are in clinical use today. The dosimeter itself does not require a voltage supply, and is composed of water equivalent materials. The dosimeter can be fabricated with a sensitive volume smaller than a cubic millimeter, which is small enough to resolve the small radiation fields encountered in modern radiotherapy. The fast readout of the dosimeter enables measurements on the same time scale as the pulsed radiation delivery from the medical linear accelerators used for treatment. The dosimetry system, comprising fiber-coupled organic scintillators and data acquisition hardware, was developed at the Radiation Research Division at Risoe DTU and tested using clinical x-ray beams at hospitals in Denmark and abroad. Measurements of output factors and percentage depth dose were performed and compared with reference values and Monte Carlo simulations for static square radiation fields for standard (4 cm x 4 cm to 20 cm x 20 cm) and small (down to 0.6 cm x 0.6 cm) field sizes. The accuracy of most of the obtained measurements was good, agreeing with reference and simulated dose values to within 2 % standard deviation for both standard and small fields. This thesis concludes that the new pulse-resolved dosimetry system holds great potential for modern radiotherapy applications, such as stereotactic radiotherapy and intensity-modulated radiotherapy. (Author)

Pulse-resolved radiotherapy dosimetry using fiber-coupled organic scintillators

International Nuclear Information System (INIS)

Ravnsborg Beierholm, A.

2011-05-01

This PhD project pertains to the development and adaptation of a dosimetry system that can be used to verify the delivery of radiation in modern radiotherapy modalities involving small radiation fields and dynamic radiation delivery. The dosimetry system is based on fibre-coupled organic scintillators and can be perceived as a well characterized, independent alternative to the methods that are in clinical use today. The dosimeter itself does not require a voltage supply, and is composed of water equivalent materials. The dosimeter can be fabricated with a sensitive volume smaller than a cubic millimeter, which is small enough to resolve the small radiation fields encountered in modern radiotherapy. The fast readout of the dosimeter enables measurements on the same time scale as the pulsed radiation delivery from the medical linear accelerators used for treatment. The dosimetry system, comprising fiber-coupled organic scintillators and data acquisition hardware, was developed at the Radiation Research Division at Risoe DTU and tested using clinical x-ray beams at hospitals in Denmark and abroad. Measurements of output factors and percentage depth dose were performed and compared with reference values and Monte Carlo simulations for static square radiation fields for standard (4 cm x 4 cm to 20 cm x 20 cm) and small (down to 0.6 cm x 0.6 cm) field sizes. The accuracy of most of the obtained measurements was good, agreeing with reference and simulated dose values to within 2 % standard deviation for both standard and small fields. This thesis concludes that the new pulse-resolved dosimetry system holds great potential for modern radiotherapy applications, such as stereotactic radiotherapy and intensity-modulated radiotherapy. (Author)

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)

Establishing the estimation model on radiation level at the ambience of 60Co radiotherapy treatment room based on NCRP REPORT No.151

International Nuclear Information System (INIS)

Yang Haiyou; Liu Liping; Liang Yueqin; Yu Shui

2009-01-01

Objective: To establish the estimation model to evaluate the radiation level at the ambience of 60 Co radiotherapy treatment room. Methods: The estimation model derives from NCRP REPORT No.151- S tructural Shielding Design and Evaluation for Megavoltage X-and Gamma-Ray Radiotherapy Facilities b y making appropriate adjustment, which presents the calculation methods on radiation level at the ambience of megavoltage medical electron linear accelerator treatment room. Results: The application scope of estimation model from NCRP REPORT No.151 is extended to γ-radiotherapy facilities, and it can be regarded as a new model for calculating the radiation level at the ambience of 60 Co radiotherapy treatment room. Conclusion: The estimation model has certain reference value to evaluate the radiation level at the ambience of 60 Co radiotherapy treatment room. (authors)

Particle radiotherapy for patients with H and N malignant tumor

International Nuclear Information System (INIS)

Murakami, Masao; Demizu, Yusuke; Niwa, Yasue; Terashima, Kazuki; Fujii, Osamu; Mima, Masayuki; Hashimoto, Naoki; Jin, Dongcun

2011-01-01

Particle beams have a characteristic called the Bragg peak, which is a peak formed at a fixed depth in the body depending on the acceleration energy. Utilizing this property, a high dose can be concentrated in the target tumor while minimizing damage to surrounding normal tissues. Proton and carbon ion beams have a higher linear energy transfer (LET) than X-rays. The relative biological effectiveness of proton and carbon ion beams compared with X-rays (=1) is estimated to be 1.1 and 3.0, respectively. Therefore, we can expect particle radiotherapy to be effective for patients with radio-resistant tumors such as malignant melanoma, adenoidcystic carcinoma and adenocarcinoma. As of the end of July 2011, there were 9 particle institutes operating in Japan; the Hyogo Ion Beam Medical Center was established in May 2001 as a leading project of the ''Hyogo Cancer Strategy''. One major characteristic is that the Center can generate both proton and carbon ion beams. Locally advanced nasal, paranasal or salivary gland cell tumors are good candidates for particle radiotherapy. Downsizing of the accelerator, price reduction of the machine, broad use of particle therapy in the field of clinical oncology, and intensity modulated particle therapy are future challenges. (author)

Conformal radiotherapy by intensity modulation of pediatrics tumors

International Nuclear Information System (INIS)

Leseur, J.; Le Prise, E.; Carrie, C.; Bernier, V.; Beneyton, V.; Mahe, M.A.; Supiot, S.

2009-01-01

The objective of this study is to take stock on the validated and potential indications of the conformal radiotherapy with intensity modulation ( intensity modulated radiotherapy I.M.R.T.) in pediatrics and to propose recommendations for its use as well as the adapted dose constraints. About 40 to 50% of children treated for a cancer are irradiated. The I.M.R.T., by linear accelerator or helical tomo-therapy has for aim to give a homogenous dose to the target volume and to save organs at risk. Its use in pediatrics seems particularly interesting because of the complexity of target volumes and the closeness of organs at risk. In compensation for these positive elements, the importance of low doses irradiation given in big volumes makes fear event consequences on growth and an increased incidence of secondary cancers in children suffering from tumors with high cure rates and long life expectancy. (N.C.)

Radiotherapy for prostatic cancer in patients aged 75 or older

International Nuclear Information System (INIS)

Hisada, Tomohiro; Kataoka, Masaaki; Mogami, Hiroshi; Inoue, Takeshi; Uemura, Masahiko; Sumiyoshi, Yoshiteru; Nagao, Shuji

2000-01-01

Thirty-eight patients with prostatic cancer treated with radiotherapy giving a mean dose of 60.7 Gy between 1992 and 1997 at Shikoku Cancer Center Hospital were reviewed and the treatment outcomes were investigated retrospectively. About two-third of the patients were treated with radiation by linear accelerator with 40 to 46 Gy to the whole pelvis and with 20 to 26 Gy boost to the prostate area and the other one-third were treated only to the prostate area. For almost patients, external beam radiotherapy in combination with endocrine therapy was used. The median duration of follow-up was 36 months. Overall 5-year survival and 5-year relapse-free survival rate were 65.8%, and 88.9%, respectively. Severe rectal late morbidity (over grade 3) according to RTOG grading system were seen in one (2.6%). Although the number of cases was rather small and the follow-up duration was rather short, conventional external beam radiotherapy in combination with endocrine therapy may contribute to the survival benefit of patients with prostatic cancer in aged 75 or older. Radiotherapy for elderly prostatic cancer patients should be treated with an effort to decrease the late morbidity and not to deteriorate the QOL of the patients, because many patients were died of other causes than cancer. (author)

The results of radiotherapy for T1 glottic cancers. Influence of radiation beam energy

International Nuclear Information System (INIS)

Yamamoto, Michinori; Joja, Ikuo; Takemoto, Mitsuhiro; Kuroda, Masahiro; Hiraki, Yoshio

1999-01-01

We analyzed the influence of various parameters on the results of radiotherapy for T1 glottic cancer by assessing the outcomes of 60 patients with this cancer who received definitive radiotherapy between 1985 and 1994. Seven patients were treated with a cobalt-60 unit, and the other 53 with a linear accelerator (26 patients at 3-MV, 10 at 6-MV, and 17 at 10-MV). Of the 17 patients treated at 10-MV, 4 also received part of their treatment with a cobalt-60 unit. The total radiation dose ranged from 56 Gy to 70 Gy (mean, 61 Gy). The total radiation dose of 51 patients (85%) was 60 Gy. The factors found to influence local control were the strength of the radiation beam energy and whether or not there was gross tumor invasion of the anterior commissure. The local control rate was 71% in the patients treated with a 10-MV linear accelerator, 56% in those treated with a 6-MV linear accelerator and, 97% in those treated with a cobalt-60 unit or a 3-MV linear accelerator (P=0.0173). The local control rate was 43% in the patients with gross anterior commissure invasion and 88% in those without (P=0.0075). We conclude that low energy photon beams are more suitable for the treatment of early glottic cancers, especially if the lesion grossly invades the anterior commissure. (author)

Principles of laser-plasma accelerators

International Nuclear Information System (INIS)

Malka, V.; Mora, P.

2009-01-01

The continuing development of powerful laser systems has permitted to extend the interaction of laser beams with matter far into the relativistic domain in which extremely high electric and magnetic fields are generated. Thanks to these tremendous fields, that only plasma can support and sustain, new and compact approaches for producing energetic particle beams have been recently achieved (for example the bubble regime and the colliding laser pulses scheme). The incredible progress of these laser-plasma accelerators has allowed physicists to produce high quality beams of energetic radiation and particles. These beams have interesting properties such as shortness, brightness and spatial quality, and could lend themselves to applications in many fields, including medicine (radiotherapy, proton therapy, imaging), radiation biology (short-time-scale), chemistry (radiolysis), physics and material science (radiography, electron and photon diffraction), security (material inspection), and of course accelerator science. Stimulated by the advent of compact and powerful lasers, with moderate costs and high repetition rate, this research field has witnessed considerable growth in the past few years, and the promises of laser-plasma accelerators are in tremendous progress. The recent years in particular have seen spectacular progress in the acceleration of electrons and of ions, both in terms of energy and in terms of quality of the beams. (authors)

Survey of Equipment Quality Control in Radiotherapy Centers in Croatia: First Results

International Nuclear Information System (INIS)

Jurkovic, S.; Diklic, A.; Smilovic Radojcic, Dj.; Svabic, M.; Kasabasic, M.; Ivkovic, A.; Faj, D.

2011-01-01

Implementation of advanced radiation therapy techniques into clinical practice has a huge influence on tumour control as well as normal tissue sparing. Introduction of Conformal Radiation Therapy (CRT) and Intensity Modulated Radiation Therapy (IMRT) into clinical practice results in precise 'tailoring' of dose distributions and according to that in reduction of irradiated volumes. This is not possible without, for the application of advanced radiation therapy techniques constructed, linear accelerators. They must be very precise, well tuned and maintained. In this way the milestone of radiation therapy quality assurance programme is machine quality control (QC). First step in development of quality control programme is existence of written QC protocols. The survey of existence of written QC protocols showed the lack of written protocols for QC procedures in Croatian radiotherapy departments. In this way regular implementation of the procedures are usually left to the conscience of the medical physicists. In the IAEA granted projects CRO6008 and RER9093, we harmonized existing QC protocols between radiation therapy departments at University hospitals Rijeka and Osijek and developed the new ones. The protocols made according to international guidelines are publicly available at websites of the State Office for Radiological and Nuclear Safety and Croatian medical physics society in order to help other radiotherapy departments in Croatia to develop their own ones. Next step was reviewing of QC practices in different centres and exchanging experiences. For that purpose we defined a set of tests, according to the existing QC protocols. Then, on-site measurements were done to check QC parameters of linear accelerators and simulators in six radiation therapy centres in Croatia. In this paper we present the tests preformed, devices and analysing tools used, along with the overall results. Tests were preformed in six radiotherapy centres in Croatia on nine linear

X-ray radiotherapy

International Nuclear Information System (INIS)

Tronc, D.

1995-01-01

Full text: The most common form of radio therapy is X-ray therapy, where a beam of photons or their parent electrons break down hydrogen bonds within the body's cells and remove certain DNA information necessary for cell multiplication. This process can eradicate malignant cells leading to complete recovery, to the remission of some cancers, or at least to a degree of pain relief. The radiotherapy instrument is usually an electron linac, and the electrons are used either directly in 'electrotherapy' for some 10% of patients, or the electrons bombard a conversion target creating a broad beam of high energy photons or 'penetration X-rays'. The simplest machine consists of several accelerating sections at around 3 GHz, accelerating electrons to 6 MeV; a cooled tungsten target is used to produce a 4 Gray/min X-ray field which can be collimated into a rectangular shape at the patient position. This tiny linac is mounted inside a rotating isocentric gantry above the patient who must remain perfectly still. Several convergent beams can also be used to increase the delivered dose. More sophisticated accelerators operate at up to 18 MeV to increase penetration depths and decrease skin exposure. Alternatively, electrotherapy can be used with different energies for lower and variable penetration depths - approximately 0.5 cm per MeV. In this way surface tissue may be treated without affecting deeper and more critical anatomical regions. This type of linac, 1 to 2 metres long, is mounted parallel to the patient with a bending magnet to direct the beam to the radiotherapy system, which includes the target, thick movable collimator jaws, a beam field equalizer, dose rate and optical field simulation and energy controls. There are over 2000 acceleratorbased X-ray treatment units worldwide. Western countries have up to two units per million population, whereas in developing countries such as Bangladesh, the density is only one per 100 million. Several

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

Three-year outcomes of a once daily fractionation scheme for accelerated partial breast irradiation (APBI) using 3-D conformal radiotherapy (3D-CRT)

International Nuclear Information System (INIS)

Goyal, Sharad; Daroui, Parima; Khan, Atif J; Kearney, Thomas; Kirstein, Laurie; Haffty, Bruce G

2013-01-01

The aim of this study was to report 3-year outcomes of toxicity, cosmesis, and local control using a once daily fractionation scheme (49.95 Gy in 3.33 Gy once daily fractions) for accelerated partial breast irradiation (APBI) using three-dimensional conformal radiotherapy (3D-CRT). Between July 2008 and August 2010, women aged ≥40 years with ductal carcinoma in situ or node-negative invasive breast cancer ≤3 cm in diameter, treated with breast-conserving surgery achieving negative margins, were accrued to a prospective study. Women were treated with APBI using 3–5 photon beams, delivering 49.95 Gy over 15 once daily fractions over 3 weeks. Patients were assessed for toxicities, cosmesis, and local control rates before APBI and at specified time points. Thirty-four patients (mean age 60 years) with Tis 0 (n = 9) and T1N0 (n = 25) breast cancer were treated and followed up for an average of 39 months. Only 3% (1/34) patients experienced a grade 3 subcutaneous fibrosis and breast edema and 97% of the patients had good/excellent cosmetic outcome at 3 years. The 3-year rate of ipsilateral breast tumor recurrence (IBTR) was 0% while the rate of contralateral breast events was 6%. The 3-year disease-free survival (DFS), overall survival (OS), and breast cancer-specific survival (BCSS) was 94%, 100%, and 100%, respectively. Our novel accelerated partial breast fractionation scheme of 15 once daily fractions of 3.33 Gy (49.95 Gy total) is a remarkably well-tolerated regimen of 3D-CRT-based APBI. A larger cohort of patients is needed to further ascertain the toxicity of this accelerated partial breast regimen

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

Variation in tumor response to fluosol-DA (20%)

International Nuclear Information System (INIS)

Sasai, K.; Ono, K.; Nishidai, T.; Tsutsui, K.; Shibamoto, Y.; Takahashi, M.; Abe, M.

1989-01-01

The effects of Fluosol-DA 20% (FDA) and carbogen (95% O2/5% CO 2 ) on radiosensitivity of the three experimental tumors, SCC VII tumor, RIF-I tumor, and transplanted mammary tumor of C 3 H/He mouse, subcutaneously inoculated in the leg were examined. The effect of FDA plus carbogen, and carbogen alone on radiosensitivity of SCC VII and RIF-I tumors was tested using the in vivo-in vitro assay. The growth curves were obtained for both SCC VII tumor and transplanted mammary tumor. The effect of the combination of FDA and carbogen was only observed in the transplanted mammary tumor. In the other two tumors, only the effect of inspiring carbogen was observed. We concluded that the effect of FDA on the radiosensitivity of experimental tumors varies with the kind of tumor systems

Study of the radiation scattered and produced by concrete shielding of radiotherapy rooms and its effects on equivalent doses in patients' organs

International Nuclear Information System (INIS)

Braga, K.L.; Rebello, W.F.; Andrade, E.R.; Gavazza, S.; Medeiros, M.P.C.; Mendes, R.M.S.; Gomes, R.G.; Silva, M.G.; Thalhofer, J.L.; Silva, A.X.; Santos, R.F.G.

2015-01-01

Within a radiotherapy room, in addition to the primary beam, there is also secondary radiation due to the leakage of the accelerator head and the radiation scattering from room objects, patient and even the room's shielding itself, which is projected to protect external individuals disregarding its effects on the patient. This work aims to study the effect of concrete shielding wall over the patient, taking into account its contribution on equivalent doses. The MCNPX code was used to model the linear accelerator Varian 2100/2300 C/D operating at 18MeV, with MAX phantom representing the patient undergoing radiotherapy treatment for prostate cancer following Brazilian Institute of Cancer four-fields radiation application protocol (0°, 90°, 180° and 270°). Firstly, the treatment was patterned within a standard radiotherapy room, calculating the equivalent doses on patient's organs individually. In a second step, this treatment was modeled withdrawing the walls, floor and ceiling from the radiotherapy room, and then the equivalent doses calculated again. Comparing these results, it was found that the concrete has an average shielding contribution of around 20% in the equivalent dose on the patient's organs. (author)

A dose-per-pulse monitor for a dual-mode medical accelerator

International Nuclear Information System (INIS)

Galbraith, D.M.; Martell, E.S.; Fueurstake, T.; Norrlinger, B.; Schwendener, H.; Rawlinson, J.A.

1990-01-01

On a radiotherapy accelerator, the dose monitoring system is the last level of protection between the patient and the extremely high dose rate which all accelerators are capable of producing. The risk of losing this level of protection is substantially reduced if two or more dose monitoring systems are used which are mechanically and electrically independent in design. This paper describes the installation of an independent radiation monitor in a dual-mode, computer-controlled accelerator with a moveable monitor chamber. The added device is fixed in the beam path, is capable of monitoring each beam pulse, and is capable of terminating irradiation within the pulse repetition period if any measured pulse is unacceptably high

Evaluation of lens dose in medulloblastoma radiotherapy

International Nuclear Information System (INIS)

Oliveira, F.L.; Vilela, E.C.; Sousa, S.A; Lima, F.F. de

2007-01-01

The improvement of the applied radiotherapy techniques in the cranial-spinal therapy, which is used in the cases of medulloblastoma, aims the reduction of the risks of future damages in enclosed critical agencies in the irradiation fields. This work aims to evaluate the lens doses due two common techniques used in medulloblastoma radiotherapy. For this, thermoluminescent dosimeters, previously calibrated, were located in an anthropomorphic phantom (ALDERSON - RANDON Laboratory), in the tumor and lens positions. The employed techniques were as following: (1) angled fields technique and (2) half-beam block technique. The phantom was irradiated five times in each technique with two lateral opposed fields in the brain with a total prescribed dose of 1.5 Gy, followed of two posterior spinal fields with the same prescribed dose, using a 6MV accelerator. The results showed that the doses in the first technique were 0.10 +- 0,04 Gy and, in second one, 0.09 +- 0,02 Gy. It was observed that, independent of the employed technique, the lens doses practically are the same. (author)

Situation of radiotherapy with linear accelerators in Mexico

International Nuclear Information System (INIS)

Diaz Perches, R.

1991-01-01

It is desirable the existence of supervoltage equipments with energy of photons between 10 to 15 Mv and with electron beams of 15 MeV. It is due to: A greater dose in deep is obtained which simplifies the technique to reach a higher dose. Radiation beam is clearness which permits to protect suitably the neighboring structures. Differential absorption between bone and soft tissue is diminished avoiding necrosis and thus permitting that calculated dose corresponds to administered dose. Integral dose is diminished, thus improving the tolerance to treatment and allowing treatment application with the proper dose in suitable time in order to obtain a better response. Lasting time of each treatment is shorter, which permits to reduce patient inmovilization during the same, that is particularly useful in cases of pain. To have an electron beam permits to concentrate dose in the surface, protecting suitabily the neighboring structures. Owing to, since 1964 we are fighting to improve the technology and implant those equipements in our country. To succeed in, it is necessary to augment the number of persons interested in such activity and for that matter, the creation of academic and monetary stimulus are required. In Spite of, several equipements are already installed in our country which means necessarily a benefit to cancer patients requiring radiotherapy. (Author)

Stereotactic Fractionated Radiotherapy in the Treatment of Juxtapapillary Choroidal Melanoma: The McGill University Experience

Energy Technology Data Exchange (ETDEWEB)

Al-Wassia, Rolina; Dal Pra, Alan; Shun, Kitty; Shaban, Ahmed [Department of Oncology, Division of Radiation Oncology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec (Canada); Corriveau, Christine [Department of Ophthalmology, Notre Dame Hospital, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Edelstein, Chaim; Deschenes, Jean [Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec (Canada); Ruo, Russel; Patrocinio, Horacio [Department of Medical Physics, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec (Canada); Cury, Fabio L.B. [Department of Oncology, Division of Radiation Oncology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec (Canada); DeBlois, Francois [Department of Medical Physics, Jewish General Hospital, McGill University, Montreal, Quebec (Canada); Shenouda, George, E-mail: george.shenouda@muhc.mcgill.ca [Department of Oncology, Division of Radiation Oncology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec (Canada)

2011-11-15

Purpose: To report our experience with linear accelerator-based stereotactic fractionated radiotherapy in the treatment of juxtapapillary choroidal melanoma. Methods and Materials: We performed a retrospective review of 50 consecutive patients diagnosed with juxtapapillary choroidal melanoma and treated with linear accelerator-based stereotactic fractionated radiotherapy between April 2003 and December 2009. Patients with small to medium sized lesions (Collaborative Ocular Melanoma Study classification) located within 2 mm of the optic disc were included. The prescribed radiation dose was 60 Gy in 10 fractions. The primary endpoints included local control, enucleation-free survival, and complication rates. Results: The median follow-up was 29 months (range, 1-77 months). There were 31 males and 29 females, with a median age of 69 years (range, 30-92 years). Eighty-four percent of the patients had medium sized lesions, and 16% of patients had small sized lesions. There were four cases of local progression (8%) and three enucleations (6%). Actuarial local control rates at 2 and 5 years were 93% and 86%, respectively. Actuarial enucleation-free survival rates at 2 and 5 years were 94% and 84%, respectively. Actuarial complication rates at 2 and 5 years were 33% and 88%, respectively, for radiation-induced retinopathy; 9.3% and 46.9%, respectively, for dry eye; 12% and 53%, respectively, for cataract; 30% and 90%, respectively, for visual loss [Snellen acuity (decimal equivalent), <0.1]; 11% and 54%, respectively, for optic neuropathy; and 18% and 38%, respectively, for neovascular glaucoma. Conclusions: Linear accelerator-based stereotactic fractionated radiotherapy using 60 Gy in 10 fractions is safe and has an acceptable toxicity profile. It has been shown to be an effective noninvasive treatment for juxtapapillary choroidal melanomas.

The Use of Linear Accelerator Technology for Health Purpose

International Nuclear Information System (INIS)

Susworo, R.

2003-01-01

Radiotherapy as a treatment modality has been achieved not long after the discovery of X ray at the end of 19th century, aside from other modalities such as surgery and chemotherapy. The development of this treatment modality consistent with the advanced of technology in general. External radiation which commenced with the usage of 10 KV energy, nowadays energy of 15 MV and electron beams, for health purpose, could be produced thanks to the progress of accelerator technology. In the developed world the usage of proton, neutron and heavy particles which produced by accelerator for cancer treatment has been done since several years ago. (author)

Radiological safety aspects of the operation of proton accelerators

International Nuclear Information System (INIS)

Thomas, R.H.; Stevenson, G.R.

1988-01-01

Particle accelerators are finding increased application in both the fundamental and applied sciences and in industry around the world. Positive ion accelerators are being applied in a host of fields, including radiation damage studies, induced activation and dating measurements, radiography, radiotherapy and fusion research. Because these devices can be potent sources of neutrons, it is important that information concerning their safe operation be widely available. This report is conceived as a source book providing authoritative guidance in radioprotection from an important category of radiation sources. It thus supplements other manuals of the IAEA related to the planning and implementation of radiation protection programmes. Refs, figs and tabs

Obstruction of the esophagus 5 months after radiotherapy for a central lung cancer

International Nuclear Information System (INIS)

Zips, D.; Baumann, M.; Herrmann, T.

2001-01-01

Dysphagia after radiotherapy of thoracic tumors may be caused by recurrences or by radiation damage to the esophagus. Case Report: A 75-year-old patient presented with a complete obstruction of the esophagus 5 months after CHARTWEL radiotherapy for a non-small cell lung cancer. During the last week of radiotherapy mild dysphagia (Grade 1 EORTC/RTOG, Grade 2 MRC-CHART-Score) occurred that persisted over the following months. X-ray and endoscopic investigations revealed an easily removable food bolus without evidence of esophageal stricture or ulceration. Conclusion: The case report describes a mild but prolonged early radiation reaction of the esophagus. In comparison with conventional fractionation the incidence of dysphagia is higher after accelerated fractionation schedules. The pathophysiologic mechanisms underlying persistent dysphagia are currently unknown. Beside of recurrences, radiation effects to the esophagus should be considered if dysphagia after irradiation of thoracic tumors occurs, because, as in this case, therapy may rapidly improve the symptoms. (orig.) [de

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

Evaluation of radiation protection of the radiotherapy department in cancer hospital

International Nuclear Information System (INIS)

Feng Ningyuan; Zhang Hongzhi; Yu Yun

1987-01-01

In this paper, the emphases are put on the description of design principle and calculation method for radiation protection in the new radiotherapy department of Cancer Research Institute and Hospital, Chinese Academy of Medical Science, as well as the evaluation of meusaring results. In addition, the problem of photo-neutron contamination among 16 MV X-ray from SL 75-20 Philips Linear Accelerator and its relavent shielding measures have been discussed

Department of Accelerator Physics and Technology: Overview

International Nuclear Information System (INIS)

Pachan, M.

1999-01-01

Full text: As presented at the overview seminar held on December 98, the activities of the Department were shared among several directions of accelerator applications, as well as research and development works on new accelerator techniques and technologies. In the group of proton and ion accelerators, two main tasks were advanced. The first was a further step in the optimization of operational parameters of multicusp ion-source, prepared for axial injection system in C-30 cyclotron. Another one is the participation in important modifications of r.f. acceleration system in heavy-ion accelerator C-200 of Warsaw University. In the broad field of electron accelerators our main attention was directed at medical applications. Most important of them was the designing and construction of a full scale technological model of a high-gradient accelerating structure for low-energy radiotherapy unit CO-LINE 1000. Microwave measurements, and tuning were accomplished, and the technical documentation for construction of radiation unit completed. This work was supported by the State Committee for Scientific Research. Preparatory work was continued to undertake in the year 1999 the design of two new medical accelerators. First is a new generation radiotherapy unit, with 15 MeV electron beam and two selected energies of X-ray photons. This accelerator should in future replace the existing Neptun 10 MeV units. The work will be executed in the frame of the Project-Ordered commissioned by the State Committee for Scientific Research. The next type of accelerators in preparation is the mobile, self-shielded electron-beam unit for inter operative irradiation. The specification of parameters was completed and study of possible solutions advanced. The programme of medical accelerator development is critically dependent on the existence of a metrological and experimental basis. Therefore the building of a former proton linear accelerator was adopted to the new function as electron accelerators

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

Carbon ion radiotherapy in bone and soft tissue sarcomas

International Nuclear Information System (INIS)

Kamada, Tadashi; Imai, Reiko; Kagei, Kenji; Tsuji, Hiroshi; Yanagi, Takeshi; Ishikawa, Hitoshi; Tsujii, Hirohiko

2006-01-01

The Heavy Ion Medical Accelerator in Chiba (HIMAC) is the world's first heavy ion accelerator complex dedicated to medical use in a hospital environment. Heavy ions have superior depth-dose distribution and greater cell-killing capability. In June 1996, clinical research for the treatment of bone and soft tissue sarcomas was begun using carbon ions generated by the HIMAC. As of February 2006, a total of the 278 patients with bone and soft tissue sarcoma had been enrolled into the clinical trial. Most of the patients had locally advanced and/or medically inoperable tumors. The clinical trial revealed that carbon ion radiotherapy provided definite local control and offered a survival advantage without unacceptable morbidity in bone and soft tissue sarcomas that were hard to cure with other modalities. (author)

Three-dimensional intrafractional internal target motions in accelerated partial breast irradiation using three-dimensional conformal external beam radiotherapy.

Science.gov (United States)

Hirata, Kimiko; Yoshimura, Michio; Mukumoto, Nobutaka; Nakamura, Mitsuhiro; Inoue, Minoru; Sasaki, Makoto; Fujimoto, Takahiro; Yano, Shinsuke; Nakata, Manabu; Mizowaki, Takashi; Hiraoka, Masahiro

2017-07-01

We evaluated three-dimensional intrafractional target motion, divided into respiratory-induced motion and baseline drift, in accelerated partial breast irradiation (APBI). Paired fluoroscopic images were acquired simultaneously using orthogonal kV X-ray imaging systems at pre- and post-treatment for 23 patients who underwent APBI with external beam radiotherapy. The internal target motion was calculated from the surgical clips placed around the tumour cavity. The peak-to-peak respiratory-induced motions ranged from 0.6 to 1.5mm in all directions. A systematic baseline drift of 1.5mm towards the posterior direction and a random baseline drift of 0.3mm in the lateral-medial and cranial-caudal directions were observed. The baseline for an outer tumour cavity drifted towards the lateral and posterior directions, and that for an upper tumour cavity drifted towards the cranial direction. Moderate correlations were observed between the posterior baseline drift and the patients' physical characteristics. The posterior margin for intrafractional uncertainties was larger than 5mm in patients with greater fat thickness due to the baseline drift. The magnitude of the intrafractional motion was not uniform according to the direction, patients' physical characteristics, or tumour cavity location due to the baseline drift. Therefore, the intrafractional systematic movement should be properly managed. Copyright © 2017 Elsevier B.V. All rights reserved.

Study of the Accelerator Technology Development for Cancer Radiotherapy

International Nuclear Information System (INIS)

Sudjatmoko; Triyono; E-Supriyatni

2000-01-01

The hadronic particle beams including both protons, neutrons and charged particles have been studied for cancer therapy by a number of research centers in several countries during the past two decades. In this paper is briefly discussed concerning the accelerator type and its applications. The future trends are seen in the new technological developments like the use of proton gantries, beam scanning techniques, improved patient handling system and in the increasing precision of treatment. (author)

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.)

Four-dimensional treatment planning and fluoroscopic real-time tumor tracking radiotherapy for moving tumor

International Nuclear Information System (INIS)

Shirato, Hiroki; Shimizu, Shinichi; Kitamura, Kei; Nishioka, Takeshi; Kagei, Kenji; Hashimoto, Seiko; Aoyama, Hidefumi; Kunieda, Tatsuya; Shinohara, Nobuo; Dosaka-Akita, Hirotoshi; Miyasaka, Kazuo

2000-01-01

Purpose: To achieve precise three-dimensional (3D) conformal radiotherapy for mobile tumors, a new radiotherapy system and its treatment planning system were developed and used for clinical practice. Methods and Materials: We developed a linear accelerator synchronized with a fluoroscopic real-time tumor tracking system by which 3D coordinates of a 2.0-mm gold marker in the tumor can be determined every 0.03 second. The 3D relationships between the marker and the tumor at different respiratory phases are evaluated using CT image at each respiratory phase, whereby the optimum phase can be selected to synchronize with irradiation (4D treatment planning). The linac is triggered to irradiate the tumor only when the marker is located within the region of the planned coordinates relative to the isocenter. Results: The coordinates of the marker were detected with an accuracy of ± 1 mm during radiotherapy in the phantom experiment. The time delay between recognition of the marker position and the start or stop of megavoltage X-ray irradiation was 0.03 second. Fourteen patients with various tumors were treated by conformal radiotherapy with a 'tight' planning target volume (PTV) margin. They were surviving without relapse or complications with a median follow-up of 6 months. Conclusion: Fluoroscopic real-time tumor tracking radiotherapy following 4D treatment planning was developed and shown to be feasible to improve the accuracy of the radiotherapy for mobile tumors

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)

Towards MRI-guided linear accelerator control: gating on an MRI accelerator.

Science.gov (United States)

Crijns, S P M; Kok, J G M; Lagendijk, J J W; Raaymakers, B W

2011-08-07

To boost the possibilities of image guidance in radiotherapy by providing images with superior soft-tissue contrast during treatment, we pursue diagnostic quality MRI functionality integrated with a linear accelerator. Large respiration-induced semi-periodic target excursions hamper treatment of cancer of the abdominal organs. Methods to compensate in real time for such motion are gating and tracking. These strategies are most effective in cases where anatomic motion can be visualized directly, which supports the use of an integrated MRI accelerator. We establish here an infrastructure needed to realize gated radiation delivery based on MR feedback and demonstrate its potential as a first step towards more advanced image guidance techniques. The position of a phantom subjected to one-dimensional periodic translation is tracked with the MR scanner. Real-time communication with the MR scanner and control of the radiation beam are established. Based on the time-resolved position of the phantom, gated radiation delivery to the phantom is realized. Dose distributions for dynamic delivery conditions with varying gating windows are recorded on gafchromic film. The similarity between dynamically and statically obtained dose profiles gradually increases as the gating window is decreased. With gating windows of 5 mm, we obtain sharp dose profiles. We validate our gating implementation by comparing measured dose profiles to theoretical profiles calculated using the knowledge of the imposed motion pattern. Excellent correspondence is observed. At the same time, we show that real-time on-line reconstruction of the accumulated dose can be performed using time-resolved target position information. This facilitates plan adaptation not only on a fraction-to-fraction scale but also during one fraction, which is especially valuable in highly accelerated treatment strategies. With the currently established framework and upcoming improvements to our prototype-integrated MRI accelerator

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.

Comparison of two dimensional and three dimensional radiotherapy treatment planning in locally advanced non-small cell lung cancer treated with continuous hyperfractionated accelerated radiotherapy weekend less

International Nuclear Information System (INIS)

Wilson, Elena M.; Joy Williams, Frances; Ethan Lyn, Basil; Aird, Edwin G.A.

2005-01-01

Background and purpose: Patients with inoperable non-small cell lung cancer being treated with continuous hyperfractionated accelerated radiotherapy weekend less (CHARTWEL) were planned and treated with a three dimensional (3D) conformal protocol and comparison made with two dimensional (2D) planning, as used previously, to compare past practice and methods. Patients and methods: Twenty-four patients were planned initially using 3D and then replanned using a 2D system. The 2D plans were transferred onto the 3D system and recalculated. Dose volume histograms could then be constructed of planning target volumes for phases 1 and 2 (PTV 1 and 2, respectively), lung and spinal cord for the 2D plans and compared with the 3D plans. Results: There was a significantly lower absolute dose to the isocentre with 2D compared to 3D planning with dose reductions of 3.9% for phase 1, 4.4% for phase 2 and 4.7% for those treated with a single phase. Maximum dose to spinal cord was greater in 17 of the 24 2D plans with a median dose reduction of 0.82 Gy for 3D (P=0.04). The percentage volume of whole lung receiving ≥20 Gy (V 20 ) was greater in 16 of the 24 2D plans with a median reduction in V 20 of 2.4% for 3D (P=0.03). Conclusions: A lower dose to tumour was obtained using 2D planning due to the method of dose calculation and spinal cord and lung doses were significantly higher

Advances in conformal radiotherapy using Monte Carlo Code to design new IMRT and IORT accelerators and interpret CT numbers

CERN Document Server

Wysocka-Rabin, A

2013-01-01

The introductory chapter of this monograph, which follows this Preface, provides an overview of radiotherapy and treatment planning. The main chapters that follow describe in detail three significant aspects of radiotherapy on which the author has focused her research efforts. Chapter 2 presents studies the author worked on at the German National Cancer Institute (DKFZ) in Heidelberg. These studies applied the Monte Carlo technique to investigate the feasibility of performing Intensity Modulated Radiotherapy (IMRT) by scanning with a narrow photon beam. This approach represents an alternative to techniques that generate beam modulation by absorption, such as MLC, individually-manufactured compensators, and special tomotherapy modulators. The technical realization of this concept required investigation of the influence of various design parameters on the final small photon beam. The photon beam to be scanned should have a diameter of approximately 5 mm at Source Surface Distance (SSD) distance, and the penumbr...

Protocol for the isotoxic intensity modulated radiotherapy (IMRT) in stage III non-small cell lung cancer (NSCLC): a feasibility study.

Science.gov (United States)

Haslett, Kate; Franks, Kevin; Hanna, Gerard G; Harden, Susan; Hatton, Matthew; Harrow, Stephen; McDonald, Fiona; Ashcroft, Linda; Falk, Sally; Groom, Nicki; Harris, Catherine; McCloskey, Paula; Whitehurst, Philip; Bayman, Neil; Faivre-Finn, Corinne

2016-04-15

The majority of stage III patients with non-small cell lung cancer (NSCLC) are unsuitable for concurrent chemoradiotherapy, the non-surgical gold standard of care. As the alternative treatment options of sequential chemoradiotherapy and radiotherapy alone are associated with high local failure rates, various intensification strategies have been employed. There is evidence to suggest that altered fractionation using hyperfractionation, acceleration, dose escalation, and individualisation may be of benefit. The MAASTRO group have pioneered the concept of 'isotoxic' radiotherapy allowing for individualised dose escalation using hyperfractionated accelerated radiotherapy based on predefined normal tissue constraints. This study aims to evaluate whether delivering isotoxic radiotherapy using intensity modulated radiotherapy (IMRT) is achievable. Isotoxic IMRT is a multicentre feasibility study. From June 2014, a total of 35 patients from 7 UK centres, with a proven histological or cytological diagnosis of inoperable NSCLC, unsuitable for concurrent chemoradiotherapy will be recruited. A minimum of 2 cycles of induction chemotherapy is mandated before starting isotoxic radiotherapy. The dose of radiation will be increased until one or more of the organs at risk tolerance or the maximum dose of 79.2 Gy is reached. The primary end point is feasibility, with accrual rates, local control and overall survival our secondary end points. Patients will be followed up for 5 years. The study has received ethical approval (REC reference: 13/NW/0480) from the National Research Ethics Service (NRES) Committee North West-Greater Manchester South. The trial is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP). The trial results will be published in a peer-reviewed journal and presented internationally. NCT01836692; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

Early versus delayed postoperative radiotherapy for treatment of low-grade gliomas

Science.gov (United States)

Sarmiento, J Manuel; Venteicher, Andrew S; Patil, Chirag G

2015-01-01

Background In most people with low-grade gliomas (LGG), the primary treatment regimen remains a combination of surgery followed by postoperative radiotherapy. However, the optimal timing of radiotherapy is controversial. It is unclear whether to use radiotherapy in the early postoperative period, or whether radiotherapy should be delayed until tumour progression occurs. Objectives To assess the effects of early postoperative radiotherapy versus radiotherapy delayed until tumour progression for low-grade intracranial gliomas in people who had initial biopsy or surgical resection. Search methods We searched up to September 2014 the following electronic databases: the Cochrane Register of Controlled Trials (CENTRAL, Issue 8, 2014), MEDLINE (1948 to Aug week 3, 2014), and EMBASE (1980 to Aug week 3, 2014) to identify trials for inclusion in this Cochrane review. Selection criteria We included randomised controlled trials (RCTs) that compared early versus delayed radiotherapy following biopsy or surgical resection for the treatment of people with newly diagnosed intracranial LGG (astrocytoma, oligodendroglioma, mixed oligoastrocytoma, astroblastoma, xanthoastrocytoma, or ganglioglioma). Radiotherapy may include conformal external beam radiotherapy (EBRT) with linear accelerator or cobalt-60 sources, intensity-modulated radiotherapy (IMRT), or stereotactic radiosurgery (SRS). Data collection and analysis Three review authors independently assessed the trials for inclusion and risk of bias, and extracted study data. We resolved any differences between review authors by discussion. Adverse effects were also extracted from the study report. We performed meta-analyses using a random-effects model with inverse variance weighting. Main results We included one large, multi-institutional, prospective RCT, involving 311 participants; the risk of bias in this study was unclear. This study found that early postoperative radiotherapy is associated with an increase in time to

The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK.

Science.gov (United States)

McAleese, J; Baluch, S; Drinkwater, K

2015-09-01

Lung cancer is the leading cause of cancer-related death in the UK. The quality of curative-intent radiotherapy is associated with better outcomes. National quality standards from the National Institute for Health and Care Excellence (NICE) on patient work-up and treatment selection were used, with guidance from the Royal College of Radiologists on the technical delivery of radiotherapy, to assess the quality of curative-intent non-small cell lung cancer radiotherapy and to describe current UK practice. Radiotherapy departments completed one questionnaire for each patient started on curative-intent radiotherapy for 8 weeks in 2013. Eighty-two per cent of centres returned a total of 317 proformas. Patient selection with positron emission tomography/computed tomography, performance status and Forced Expiratory Volume in 1 second (FEV1) was usually undertaken. Fifty-six per cent had pathological confirmation of mediastinal lymph nodes and 22% staging brain scans; 20% were treated with concurrent chemoradiation, 12% with Stereotactic Ablative Radiotherapy (SABR) and 8% with Continuous Hyperfractionated Accelerated Radiotherapy (CHART). Sixty-three per cent of patients received 55 Gy/20 fractions. Although respiratory compensation was routinely undertaken, only 33% used four-dimensional computed tomography. Seventy per cent of patients were verified with cone beam computed tomography. There was consistency of practice in dosimetric constraints for organs at risk and follow-up. This audit has described current UK practice. The latest recommendations for patient selection with pathological confirmation of mediastinal lymph nodes, brain staging and respiratory function testing are not universally followed. Although there is evidence of increasing use of newer techniques such as four-dimensional computed tomography and cone beam image-guided radiotherapy, there is still variability in access. Efforts should be made to improve access to modern technologies and quality

Ultrashort courses of adjuvant breast radiotherapy: wave of the future or a fool's errand?

Science.gov (United States)

Khan, Atif J; Dale, Roger G; Arthur, Douglas W; Haffty, Bruce G; Todor, Dorin A; Vicini, Frank A

2012-04-15

In accelerated partial breast irradiation (APBI), the most commonly used fractionation schemes include 340 or 385 centigrays delivered in a twice daily administration. A further progression of the APBI literature has been the recent interest in extremely short courses of adjuvant radiotherapy, usually delivered by intraoperative radiotherapy techniques. This newer area of single-fraction radiotherapy approaches remains highly contentious. In particular, the recently reported TARGIT trial has been the subject of both praise and scorn, and a critical examination of the trial data and the underlying hypotheses is warranted. Short-term outcomes of the related Italian ELIOT approach have also been reported. Although the assumptions of linear quadratic formalism are likely to hold true in the range of 2 to 8 grays, equating different schedules beyond this range is problematic. A major problem of current single-fraction approaches is that the treatment doses are chosen empirically, or are based on tolerability, or on the physical dose delivery characteristics of the chosen technology rather than radiobiological rationale. This review article summarizes the current data on ultrashort courses of adjuvant breast radiotherapy and highlights both the promise and the potential pitfalls of the abbreviated treatment. Copyright © 2011 American Cancer Society.

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

Stereotactic Fractionated Radiotherapy in the Treatment of Juxtapapillary Choroidal Melanoma: The McGill University Experience

International Nuclear Information System (INIS)

Al-Wassia, Rolina; Dal Pra, Alan; Shun, Kitty; Shaban, Ahmed; Corriveau, Christine; Edelstein, Chaim; Deschenes, Jean; Ruo, Russel; Patrocinio, Horacio; Cury, Fabio L.B.; DeBlois, François; Shenouda, George

2011-01-01

Purpose: To report our experience with linear accelerator-based stereotactic fractionated radiotherapy in the treatment of juxtapapillary choroidal melanoma. Methods and Materials: We performed a retrospective review of 50 consecutive patients diagnosed with juxtapapillary choroidal melanoma and treated with linear accelerator-based stereotactic fractionated radiotherapy between April 2003 and December 2009. Patients with small to medium sized lesions (Collaborative Ocular Melanoma Study classification) located within 2 mm of the optic disc were included. The prescribed radiation dose was 60 Gy in 10 fractions. The primary endpoints included local control, enucleation-free survival, and complication rates. Results: The median follow-up was 29 months (range, 1–77 months). There were 31 males and 29 females, with a median age of 69 years (range, 30–92 years). Eighty-four percent of the patients had medium sized lesions, and 16% of patients had small sized lesions. There were four cases of local progression (8%) and three enucleations (6%). Actuarial local control rates at 2 and 5 years were 93% and 86%, respectively. Actuarial enucleation-free survival rates at 2 and 5 years were 94% and 84%, respectively. Actuarial complication rates at 2 and 5 years were 33% and 88%, respectively, for radiation-induced retinopathy; 9.3% and 46.9%, respectively, for dry eye; 12% and 53%, respectively, for cataract; 30% and 90%, respectively, for visual loss [Snellen acuity (decimal equivalent), <0.1]; 11% and 54%, respectively, for optic neuropathy; and 18% and 38%, respectively, for neovascular glaucoma. Conclusions: Linear accelerator-based stereotactic fractionated radiotherapy using 60 Gy in 10 fractions is safe and has an acceptable toxicity profile. It has been shown to be an effective noninvasive treatment for juxtapapillary choroidal melanomas.

Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey.

Science.gov (United States)

Grau, Cai; Defourny, Noémie; Malicki, Julian; Dunscombe, Peter; Borras, Josep M; Coffey, Mary; Slotman, Ben; Bogusz, Marta; Gasparotto, Chiara; Lievens, Yolande; Kokobobo, Arianit; Sedlmayer, Felix; Slobina, Elena; Feyen, Karen; Hadjieva, Tatiana; Odrazka, Karel; Grau Eriksen, Jesper; Jaal, Jana; Bly, Ritva; Chauvet, Bruno; Willich, Normann; Polgar, Csaba; Johannsson, Jakob; Cunningham, Moya; Magrini, Stefano; Atkocius, Vydmantas; Untereiner, Michel; Pirotta, Martin; Karadjinovic, Vanja; Levernes, Sverre; Sladowski, Krystol; Lurdes Trigo, Maria; Šegedin, Barbara; Rodriguez, Aurora; Lagerlund, Magnus; Pastoors, Bert; Hoskin, Peter; Vaarkamp, Jaap; Cleries Soler, Ramon

2014-08-01

Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO - the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries. An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 26-29), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO). A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.3-1.5) and 1.4 (range 0.4-4.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear relation between socio-economic status, as

Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey

International Nuclear Information System (INIS)

Grau, Cai; Defourny, Noémie; Malicki, Julian; Dunscombe, Peter; Borras, Josep M.; Coffey, Mary; Slotman, Ben; Bogusz, Marta; Gasparotto, Chiara; Lievens, Yolande; Kokobobo, Arianit; Sedlmayer, Felix; Slobina, Elena; Feyen, Karen; Hadjieva, Tatiana; Odrazka, Karel; Eriksen, Jesper Grau; Jaal, Jana; Bly, Ritva; Chauvet, Bruno

2014-01-01

Background: Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO – the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries. Methods: An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 26–29), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO). Results: A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.3–1.5) and 1.4 (range 0.4–4.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear

Some important applications of accelerators in medicine and industry

International Nuclear Information System (INIS)

Jongen, Y.

1996-01-01

Accelerators, and cyclotrons in particular, have long been dedicated to research. Nowadays, they are industrial devices heavily used in various fields. The Belgian company Ion Beam Applications, probably the largest private company manufacturing cyclotrons, has largely contributed to the dissemination of this technology into the medical and radio-pharmaceutical community. This paper will present different applications of cyclotrons in these fields, from radioisotope production to radiotherapy, based on IBA's experience since 1986, date of construction of the CYCLONE 30 prototype, a cyclotron that revolutionized cyclotron technology for medicine and industry. Possible industrial applications of cyclotrons will also be mentioned, together with applications of another type of accelerator recently introduced in the market by IBA: the Rhodotron. (author)

Conversion coefficients for determination of dispersed photon dose during radiotherapy: NRUrad input code for MCNP.

Science.gov (United States)

Shahmohammadi Beni, Mehrdad; Ng, C Y P; Krstic, D; Nikezic, D; Yu, K N

2017-01-01

Radiotherapy is a common cancer treatment module, where a certain amount of dose will be delivered to the targeted organ. This is achieved usually by photons generated by linear accelerator units. However, radiation scattering within the patient's body and the surrounding environment will lead to dose dispersion to healthy tissues which are not targets of the primary radiation. Determination of the dispersed dose would be important for assessing the risk and biological consequences in different organs or tissues. In the present work, the concept of conversion coefficient (F) of the dispersed dose was developed, in which F = (Dd/Dt), where Dd was the dispersed dose in a non-targeted tissue and Dt is the absorbed dose in the targeted tissue. To quantify Dd and Dt, a comprehensive model was developed using the Monte Carlo N-Particle (MCNP) package to simulate the linear accelerator head, the human phantom, the treatment couch and the radiotherapy treatment room. The present work also demonstrated the feasibility and power of parallel computing through the use of the Message Passing Interface (MPI) version of MCNP5.

Physical properties of charged particle beams for use in radiotherapy

International Nuclear Information System (INIS)

Knapp, E.A.

1975-01-01

The physical properties of the possible charged particle beams used for cancer radiotherapy are reviewed. Each property is discussed for all interesting particles (π, p, α, Ne ion) and the differences are emphasized. This is followed by a short discussion of the several beam delivery systems used in particle therapy today, emphasizing the differences in the problems for the several different radiations, particularly the differences between the accelerated particle beams and those of a secondary nature. Dose calculation techniques are described

Preliminary Determination of Activation Products for a Varian Truebeam Linear Accelerator.

Science.gov (United States)

Waller, Edward; Ram, Rohan; Steadman, Ian

2017-09-01

Medical linear accelerators used to treat various forms of cancers are operated at a number of different energies. A by-product of the high-energy photons produced by accelerators is activation of components within the machine itself and its surrounding bunker. The activation products pose radiological and regulatory challenges during the operation of the accelerator as well as when it is time for final decommissioning. The Varian TrueBeam is a new state-of-the-art linear accelerator now operating in the Canadian market. There is currently limited information on the production of its activation products and the resulting impacts on operation and decommissioning. In this paper, activation products in the Varian TrueBeam accelerator are experimentally determined by performing gamma spectroscopy using a portable high purity germanium detector. A total of 10 isotopes are identified for the conditions tested, which include Na, Al, Mn, Ni, Cu, Cu, Br, Sb, Sb, W. The half-lives of these isotopes range from 2.3 min to 60.2 d. These preliminary results indicate that a decommissioning case similar to other radiotherapy accelerators can be made.

Organ doses can be estimated from the computed tomography (CT) dose index for cone-beam CT on radiotherapy equipment.

Science.gov (United States)

Martin, Colin J; Abuhaimed, Abdullah; Sankaralingam, Marimuthu; Metwaly, Mohamed; Gentle, David J

2016-06-01

Cone beam computed tomography (CBCT) systems are fitted to radiotherapy linear accelerators and used for patient positioning prior to treatment by image guided radiotherapy (IGRT). Radiotherapists' and radiographers' knowledge of doses to organs from CBCT imaging is limited. The weighted CT dose index for a reference beam of width 20 mm (CTDIw,ref) is displayed on Varian CBCT imaging equipment known as an On-Board Imager (OBI) linked to the Truebeam linear accelerator. This has the potential to provide an indication of organ doses. This knowledge would be helpful for guidance of radiotherapy clinicians preparing treatments. Monte Carlo simulations of imaging protocols for head, thorax and pelvic scans have been performed using EGSnrc/BEAMnrc, EGSnrc/DOSXYZnrc, and ICRP reference computational male and female phantoms to derive the mean absorbed doses to organs and tissues, which have been compared with values for the CTDIw,ref displayed on the CBCT scanner console. Substantial variations in dose were observed between male and female phantoms. Nevertheless, the CTDIw,ref gave doses within  ±21% for the stomach and liver in thorax scans and 2  ×  CTDIw,ref can be used as a measure of doses to breast, lung and oesophagus. The CTDIw,ref could provide indications of doses to the brain for head scans, and the colon for pelvic scans. It is proposed that knowledge of the link between CTDIw for CBCT should be promoted and included in the training of radiotherapy staff.

Evaluation of the environmental equivalent dose rate using area monitors for neutrons in clinical linear accelerators

International Nuclear Information System (INIS)

Salgado, Ana Paula; Pereira, Walsan Wagner; Patrao, Karla C. de Souza; Fonseca, Evaldo S. da; Batista, Delano V.S.

2009-01-01

The Neutron Laboratory of the Radioprotection and Dosimetry Institute - IRD/CNEN, Rio de Janeiro, Brazil, initiated studies on the process of calibration of neutron area monitors and the results of the measurements performed at radiotherapy treatment rooms, containing clinical accelerators

A multicentre randomized/controlled trial of a conventional versus modestly accelerated radiotherapy in the laryngeal cancer: influence of a 1 week shortening overall time

International Nuclear Information System (INIS)

Hliniak, A.; Gwiazdowska, B.; Szutkowski, Z.; Kraszewska, E.; Kukolowicz, P.; Jarzabski, A.; Sochacka, B.; Mazurkiewicz, M.; Paprota, K.; Oliskiewicz, W.; Zadrozna, O.; Milecki, P.; Kubiak, M.; Czopkiewicz, L.; Jagas, M.; Gozdz, S.; Wieczorek, A.; Woytowicz, A.; Cisowska, B.; Magdziarz, H.; Nowakowski, S.; Kosniewski, W.; Laskosz, I.; Serafin, A.; Gradon, E.

2002-01-01

Background and purpose: To compare in a phase III study the loco-regional control, disease-free survival and overall survival induced by an accelerated regimen (AF) as compared with conventional regimen (CF) and to analyze the early and late post-radiation morbidity in both arms. Materials and methods: Patients with age≤75, WHO 0-1, suitable for a radical course of radiotherapy T1-T3, N0, M0, stage of glottic and supraglottic laryngeal cancer were randomized to either CF: 66Gy given in 33 fractions over 45 days or AF: 66Gy given in 33 fractions over 38 days (2 fractions every Thursday). A total of 395 patients were included from 05.1995 to 12.1998. Results. Early toxicity: At the end of radiotherapy patients treated with AF complained for more severe reactions than patients treated with CF. In 8 weeks after treatment completion patients treated with AF complained only for more severe pain on swallowing (P=0.027). In 4 months after treatment completion all types of toxicity except for skin teleangiectasia (P=0.001) were similar in the two groups. Loco-regional control: comparison between CF and AF showed no difference in terms of loco-regional control (P=0.37). Conclusions: The improvement in AF in terms of loco-regional control is estimated to be 3-5% in comparison with conventional regimen and is not significant. The intensity of reactions after 4 months was similar in both arms, what suggests the possibility of further shortening of the overall time by few days or enhancing the total dose within the limits of acceptable morbidity

Radiotherapy of esophageal cancer in combination with chemotherapy

International Nuclear Information System (INIS)

Jinnouchi, Shoshi; Koga, Kenji; Nishikawa, Kiyoshi; Kihara, Yasushi; Kusuhara, Toshiyuki; Watanabe, Katuji

1983-01-01

The significance of combination of chemotherapy in radiotherapy for esophageal cancer was evaluated in 32 patients. They were irradiated routinely in 5 times a weeks with a fraction dose of 200 rad by 10MV-X-ray linear accelerator. Combined drugs consist of Bleomycin or Pepleomycin in two-third and 5FU or FT-207 in one-third. There was statistically no significance between the results of radiation alone and combined chemotherapy, and the improvement of survival rate could not be obtained by combining chemotherapy. Some discussion on the causes of this unimprovement were made. (author)

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

Use of a perfluorochemical emulsion to improve the radiation response of BA1112 rat sarcomas

International Nuclear Information System (INIS)

Martin, D.F.; Rockwell, S.; Porter, E.; Fischer, J.J.

1984-01-01

The perfluorochemical emulsion, Fluosol-DA, is being tested in this laboratory as an adjunct to radiation therapy. The authors postulated that the exceptional O/sub 2/-carrying capacity of the perfluorochemicals and the small size of the micelles might permit oxygenation of the normally hypoxic areas of solid tumors. The authors tested the ability of this agent to improve the oxygenation and thus the radiation response of BA1112 rat sarcomas. Tumor-bearing rats were injected with Fluosol and gassed with carbogen (95% O/sub 2//5% CO/sub 2/) for 15 min prior to and during irradiation. Following treatment, the tumors were excised and the cells were suspended and assayed for survival by colony formation in vitro. Fluosol + carbogen significantly increased the radiation cytotoxicity. Although carbogen alone also increased the radiation response, this effect was significantly less than that with Fluosol + carbogen in combination. Unoxygenated Fluosol had no effect on tumor radiosensitivity. Complete radiation dose-response curves indicated that treatment with Fluosol + carbogen reduced the number of hypoxic tumor cells but did not alter the D/sub 0/ of the survival curve. Preliminary results of tumor control experiments suggest that pretreatment with Fluosol + carbogen also lowers the TCD/sub 50/

First results of the federal quality assurance group (''Aerztliche Stelle'') in radiotherapy in Baden-Wuerttemberg. Pt. 1

International Nuclear Information System (INIS)

Hawighorst, Hans; Becker, Gerd; Hodapp, Norbert; Wenz, Frederik

2009-01-01

Purpose: To evaluate the structure quality (medical staff, linear accelerators, and patients) of radiotherapy units based on the clinical audits by the ''Aerztliche Stelle'' (this institution is based on federal German law) in Baden-Wuerttemberg. Material and Methods: External audits (performed by at least two radiation oncologists, one radiation physicist, and a member of the administration) of recently completed charts by designated reviewers using appropriate checklists developed by the federal task group (''Aerztliche Stelle'') were used. Results: In the interval from 2005 to 2007, 60 linear accelerators in 24 radiotherapy units served a population of approximately 10.7 million inhabitants (178,000 inhabitants/linear accelerator). 28,210 people with malignant tumors were treated in these units in 2007. These patients were served by 127 radiation oncologists, 83 radiation physicists, and 235 technologists. The ratio of patients irradiated annually to staff would become 222 (range 85-400) for a radiation oncologist, 339 for a radiation physicist (range 170-538), and 120 for a technologist (range 48-189). In five of seven departments (71%), new staff was employed following the recommendations of the auditors. Conclusion: Clinical audits by the ''Aerztliche Stelle'' are highly effective to evaluate the structure quality of radiotherapy units. Based on these audits realistic data for staff requirements were gained. Making use of these data, guidelines for average minimum personnel necessary for good patient care were calculated. Personnel requirements may vary related to specific needs (teaching, research) of the treatment program and should be accounted for when discussing with the administration. The recommendations of the auditors of the ''Aerztliche Stelle'' resulted in the new employment of additional staff. (orig.)

In vivo dosimetry with diodes in a radiotherapy department in Pakistan

International Nuclear Information System (INIS)

Tunio, M.; Rafi, M.; Ali, S.; Ahmed, Z.; Zameer, A.; Hashmi, A.; Maqbool, S. A.

2011-01-01

The International Commission of Radiological Units (ICRU) sets a tolerance of ±5 % on dose delivery, with more recent data limiting the overall tolerances to ±3 %. One of the best methods for accurate dose delivery and quality check is in vivo dosimetry, while radiotherapy is performed. The present study was carried out to test the applicability of diodes for performing in vivo entrance dose measurements in external photon beam radiotherapy for pelvic tumours and its implementation as quality assurance tool in radiotherapy. During November 2007 to December 2009, in 300 patients who received pelvic radiotherapy on a multi-leaf-collimator-assisted linear accelerator, the central axis dose was measured by in vivo dosimetry by p-Si diodes. Entrance dose measurements were taken by diodes and were compared with the prescribed dose. Totally 1000 calculations were performed. The mean and standard deviation between measured and prescribed dose was 1.26 ± 2.8 %. In 938 measurements (93.8 %), the deviation was 5 % (5.51 ± 2.3 %). Larger variations were seen in lateral and oblique fields more than anteroposterior fields. For larger deviations, patients and diode positional errors were found to be the common factors alone or in combination with other factors. After additional corrections, repeated measurements were achieved within tolerance levels. This study showed that diode-detector-based in vivo dosimetry was simple, cost-effective, provides quick results and can serve as a useful quality assurance tool in radiotherapy. The data acquired in the present study can be used for evaluating output calibration of therapy machine, precision of calculations, effectiveness of treatment plan and patient setup. (authors)

Testicular cancer: seminoma. Stage I. Adjuvant radiotherapy. Results at 3 years

International Nuclear Information System (INIS)

Lione, M.; Ticera, N.; Mandachain, M.

2008-01-01

Full text: Purpose: To evaluate the results achieved with adjuvant radiotherapy. Materials and methods: We analyzed 40 medical records of patients diagnosed with stage I of testicular cancer, all of them received adjuvant radiotherapy between April 1992 and May 2004. The histological type was classical seminoma (95%) and spermatocytes (5%). Diagnosis and staging were performed with testicular ultrasound, determination of tumor markers, computed tomography of abdomen - pelvis and chest radiographs. Radiotherapy: Patients were treated with 60 Co unit and a linear accelerator of 6 MV photons. Volumes: Group I: lumboaortic lymph node region and ipsilateral pelvis. Group II: lumboaortic only. Daily dose: 1.8 Gy, total dose: 30.6 Gy. Patient in supine position, 2 parallel fields and opposed, DFP: 80 cm, calculated from midplane. They were followed for 3 years with chest X-ray, CAT scan of abdomen and pelvis at 12 months and then a full clinical control 1 time per year. Results: We defined the rate of ipsilateral pelvic node recurrence (group I: 0% vs. Group II: 6.25%), progression at distance (group I: 8.3% vs. Group II: 0%) and global survival (GS) (group I: 100% vs. group II: 100%) at 3 years of follow up. Conclusions: Our result is similar to that published in the international literature. Given the small number of patients, no evidence of changes in GS with the addition of radiotherapy to ipsilateral pelvic node. Radiation therapy to lumboaortic lymph nodes is the usual treatment, being necessary to optimize the modality of radiotherapy (RC3D - IRMT) to reduce toxicity in a long term. (authors) [es

Results of the application of the Risk Evaluation System in Radiotherapy (RESRA) in radiotherapy facilities in Mexico

International Nuclear Information System (INIS)

Paz G, A.; Godinez S, V.

2013-10-01

The present work describes the main results of the risk evaluation for some radiotherapy treatments with lineal accelerators, cobalt 60, brachytherapy of high dose rate and brachytherapy of low dose rate that are realize in Mexico. These evaluations were carried out applying the risk matrices method with the tool computer risk evaluation system in radiotherapy, accessible for the national users through internet, and developed by the Comision Nacional de Seguridad Nuclear y Salvaguardias in Mexico, in cooperation with the Forum of Ibero-American regulators. The used methodology is based on the risk matrices method that is a mathematical tool for the risk evaluation, and it was centered in the evaluation from the risk to which are exposed the patients, the occupational exposed personnel and people in general, by the mechanical faults of the treatment equipment s, bad calibrations, human errors, or any other event initiator of accidents. The events initiators of accidents are defined as those undesirable events that can produce and administration of an excessive dose or a sub-dose of the prescribed dose by the doctor, to the planned objective volume, or undesirable dose to the patient's regions or dose to occupational exposed personnel or people in general. The barriers are the actions and systems as mechanical switches, interlocks or alarms, dedicated to avoid that these accidents take place. The evaluation analysis of the risk developed by the members of the Forum for radiotherapy facilities together with the software RESRA has demonstrated to be useful in the prevention of many possible accidents that have happened in the past in other facilities and can avoid many others in the future. (Author)

Chest radiotherapy in limited-stage small cell lung cancer: facts, questions, prospects

International Nuclear Information System (INIS)

De Ruysscher, D.; Vansteenkiste, J.

2000-01-01

Limited-disease small cell lung cancer (LD-SCLC) is initially very sensitive to both radiotherapy and chemotherapy. However, the 5-year survival is generally only 10-15%, with most patients failing with therapy refractory relapses, both locally and in distant sites. The addition of chest irradiation to chemotherapy increases the absolute survival by approximately 5%. We reviewed the many controversies regarding optimal timing and irradiation technique. No strong data support total radiation doses over 50 Gy. According to one phase III trial and several retrospective studies, increasing the volume of the radiation fields to the pre-chemotherapy turnout volume instead of the post-chemotherapy volume does not improve local control. The total time in which the entire combined-modality treatment is delivered may be important. From seven randomized trials, it can be concluded that the timing of the radiotherapy as such is not very important. Some phase III trials support the use of accelerated chest radiation together with cisplatin-etoposide chemotherapy, delivered from the first day of treatment, although no firm conclusions can be drawn from the available data. The best results are reported in studies in which the time from the start of treatment to the end of the radiotherapy was less than 30 days. This has to be taken into consideration when treatment modalities incorporating new chemotherapeutic agents and radiotherapy are considered. (author)

Probabilistic safety assessment (PSA) of the radiotherapy treatment process with an Electron Linear Accelerator (LINAC) for medical uses

International Nuclear Information System (INIS)

Vilaragut Llanes, J.J.; Ferro Fernandez, R.; Rodriguez Marti, M.; Ramirez, M.L.; Perez Mulas, A.; Barrientos Montero, M.; Ortiz Lopez, P.; Somoano, F.; Delgado Rodriguez, J.M.; Papadopulos, S.B.; Pereira, P.P. Jr.; Lopez Morones, R.; Larrinaga Cortinai, E.; Rivero Oliva, J.J.; Alemany, J.

2008-01-01

This paper presents the results of the Probabilistic Safety Assessment (PSA) to the radiotherapy treatment process with an Electron Linear Accelerator (LINAC) for Medical Uses, which was conducted in the framework of the Extra budgetary Programme on Nuclear and Radiological Safety in Iberian-America. The PSA tools were used to evaluate occupational, public and medical exposures during treatment. The study focused on the radiological protection of patients. Equipment Failure Modes and Human Errors were evaluated for each system and treatment phase by FMEA. It was aimed at obtaining an exhaustive list of deviations with a reasonable probability of occurrence and which might produce significant adverse outcomes. Separate events trees were constructed for each initiating event group. Each event tree had a different structure since the initiating events were grouped according to mitigation requirements. Fault tree models were constructed for each top event. The fault trees were developed up to the level of components. In addition to hardware faults, the fault trees included human errors associated with the response to accidents, and human errors associated with the treatment. Each accident sequence was quantified. The combination of the initiating event and top events through one fault tree was the method used to analyse the accident sequences. After combining the appropriate models, a Boolean reduction was conducted by computer software to produce sequence cut sets. Several findings were analysed concerning the treatment process and the study proposed safety recommendations to avoid them. (author)

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials.

Science.gov (United States)

Clark, Catharine H; Aird, Edwin G A; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia A D; Thomas, Russell A S; Venables, Karen; Thwaites, David I

2015-01-01

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Science.gov (United States)

Aird, Edwin GA; Bolton, Steve; Miles, Elizabeth A; Nisbet, Andrew; Snaith, Julia AD; Thomas, Russell AS; Venables, Karen; Thwaites, David I

2015-01-01

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed. PMID:26329469

Effect of PKCbeta on retinal oxygenation response in experimental diabetes.

OpenAIRE

Luan, H.; Leitges, M.; Gupta, R.; Pacheco, D.; Seidner, A.; Liggett, J.; Ito, Y.; Kowluru, R.; Berkowitz, B.

2004-01-01

PURPOSE: To test the hypotheses that, in mice, breathing carbogen (95% O(2)-5% CO(2)) oxygenates the retina better than breathing 100% oxygen, the superior hemiretinal oxygenation response to carbogen inhalation is subnormal early in diabetes, and diabetes-induced elevation of retinal protein kinase C (PKC)-beta contributes to this pathophysiology. METHODS: Retinal oxygenation response (DeltaPO(2)) was measured using functional magnetic resonance imaging (MRI) and either carbogen or 100% oxyg...

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....

A Preliminary Design Of Application Of Wireless Identification And Sensing Platform On External Beam Radiotherapy

Science.gov (United States)

Heranudin; Bakhri, S.

2018-02-01

A linear accelerator (linac) is widely used as a means of radiotherapy by focusing high-energy photons in the targeted tumor of patient. Incorrectness of the shooting can lead normal tissue surrounding the tumor received unnecessary radiation and become damaged cells. A method is required to minimize the incorrectness that mostly caused by movement of the patient during radiotherapy process. In this paper, the Wireless Identification and Sensing Platform (WISP) architecture was employed to monitor in real time the movement of the patient’s body during radiotherapy process. In general, the WISP is a wearable sensors device that can transmit measurement data wirelessly. In this design, the measurement devices consist of an accelerometer, a barometer and an ionizing radiation sensor. If any changes in the body position which resulted in incorrectness of the shooting, the accelerometer and the barometer will trigger a warning to the linac operator. In addition, the radiation sensor in the WISP will detect unwanted radiation and that can endanger the patient. A wireless feature in this device can ease in implementation. Initial analyses have been performed and showed that the WISP is feasible to be applied on external beam radiotherapy.

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.

Procedure to measure the neutrons spectrum around a lineal accelerator for radiotherapy; Procedimiento para medir el espectro de los neutrones en torno a un acelerador lineal para radioterapia

Energy Technology Data Exchange (ETDEWEB)

Vega C, H. R.; Hernandez D, V. M.; Letechipia de L, C. [Universidad Autonoma de Zacatecas, Unidad Academica de Estudios Nucleares, Cipres No. 10, Fracc. La Penuela, 98060 Zacatecas (Mexico); Benites R, J. L. [Servicios de Salud de Nayarit, Centro Estatal de Cancerologia, Calzada de la Cruz 116 Sur, 63000 Tepic, Nayarit (Mexico); Salas L, M. A., E-mail: fermineutron@yahoo.com [Universidad Autonoma de Zacatecas, Unidad Academica de Agronomia, Apdo. Postal 336, 98000 Zacatecas (Mexico)

2013-10-15

An experimental procedure was developed, by means of Bonner spheres, to measure the neutrons spectrum around Linacs of medical use that only requires of a single shot of the accelerator; to this procedure we denominate Planetary or Isocentric method. One of the problems associated to the neutrons spectrum measurement in a radiotherapy room with lineal accelerator is because inside the room a mixed, intense and pulsed radiation field takes place affecting the detection systems based on active detector; this situation is solved using a passive detector. In the case of the Bonner spheres spectrometer the active detector has been substituted by activation detectors, trace detectors or thermoluminescent dosimeters. This spectrometer uses several spheres that are situated one at a time in the measurement point, this way to have the complete measurements group the accelerator should be operated, under the same conditions, so many times like spheres have the spectrometer, this activity can consume a long time and in occasions due to the work load of Linac to complicate the measurement process too. The procedure developed in this work consisted on to situate all the spectrometer spheres at the same time and to make the reading by means of a single shot, to be able to apply this procedure, is necessary that before the measurements two characteristics are evaluated: the cross-talking of the spheres and the symmetry conditions of the neutron field. This method has been applied to determine the photo-neutrons spectrum produced by a lineal accelerator of medical use Varian ix of 15 MV to 100 cm of the isocenter located to 5 cm of depth of a solid water mannequin of 30 x 30 x 15 cm. The spectrum was used to determine the total flow and the environmental dose equivalent. (Author)

Accelerating and focusing structures for PIGMI

International Nuclear Information System (INIS)

Swenson, D.A.; Bush, E.D. Jr.; Holsinger, R.F.; Manca, J.J.; Saito, N.; Stovall, J.E.

1977-01-01

The National Cancer Institute is supporting a program of accelerator development at the Los Alamos Scientific Laboratory aimed at the extension of proton linac technologies to produce the most suitable Pion Generator for Medical Irradiations (PIGMI). An optimized design of a pion generator suitable for a radiotherapy program at a major medical center has been established, consisting of a 250-keV injector, followed by a 35-meter-long drift-tube linac that accelerates the proton beam to 150 MeV, and an 85-meter-long coupled-cavity linac that accelerates the beam to its final energy of 650 MeV, where the average beam current of 100 microamperes impinges on one or more targets producing abundant quantities of π - mesons for radiotherapeutic applications. A number of extensions to proton linac technology are being pursued under the PIGMI program at LASL. A discussion is given of recent developments in three areas relevant to the acceleration and focusing of proton beams, namely, the alternating phase focused (APF) linac structure, the disk and washer linac structure, and small permanent magnet quadrupole lenses. The APF linac structure is being developed for the acceleration and focusing role from the injection energy of 250 keV to a few MeV, where a transition is made to a permanent magnet quadrupole focused linac structure. The disk and washer linac structure is under consideration for the high velocity portion of the design

Neoadjuvant chemotherapy and radiotherapy in locally advanced hypopharyngeal cancer

International Nuclear Information System (INIS)

Kim, Su Zy; Wu, Hong Gyun; Heo, Dae Seog; Park, Cham II

2000-01-01

To see the relationship between the response to chemotherapy and the final outcome of neoadjuvant chemotherapy and radiotherapy in patients with locally advanced hypopharyngeal cancer. A retrospective analysis was done for thirty-two patients with locally advanced hypopharyngeal cancer treated in the Seoul National University Hospital with neoadjuvant chemotherapy and radiotherapy from August 1979 to July 1997. The patients were treated with Co-60 teletherapy unit or 4MV or 6MV photon beam produced by linear accelerator. Daily fractionation was 1.75 to 2 Gy, delivered five times a week. Total dose ranged from 60.8 Gy to 73.8 Gy. Twenty-nine patients received continuous infusion of cisplatin and 5-FU. Other patients were treated with cisplatin combined with bleomycin or vinblastin. Twenty-four (75%) patients received all three prescribed cycles of chemotherapy delivered three weeks apart. Six patients received two cycles, and two patients received only one cycle. The overall 2-year and 5-year survival rates are 65.6% and 43.0, respectively. 5-year local control rate is 34%. Organ preservation for more than five years is achieved in 12 patients (38%). After neoadjuvant chemotherapy, 24 patients achieved more than partial remission (PR); the response rate was 75% (24/32). Five patients had complete remission (CR), 19 patients PR, and 8 patients no response (NR). Among the 19 patients who had PR to chemotherapy, 8 patients achieved CR after radiotherapy. Among the 8 non-responders to chemotherapy, 2 patients achieved CR, and 6 patients achieved PR after radiotherapy, There was no non-responder after radiotherapy. The overall survival rates were 60% for CR to chemotherapy group, 35.1 % for PR to chemotherapy group, and 50% for NR to chemotherapy group. respectively (p=0.93). There were significant difference in five-year overall survival rates between the patients with CR and PR after neoadjuvant chemotherapy and radiotherapy (73.3% vs. 14.7%, p< 0.01). The prognostic

Accelerated proliferation of non-small cell lung cancer cells after induction chemotherapy

International Nuclear Information System (INIS)

El Sharouni, S.Y.; Kal, H.B.

2003-01-01

Induction chemotherapy of non-small cell lung cancer (NSCLC) stage IIIB with gemcitabine and cisplatin for downstaging the tumour with the aim for further treatment with ionising radiation, is one of the treatments for lung cancer employed. The purpose of this study was to investigate the influence of the waiting time for radiotherapy, i.e. the interval between induction chemotherapy and radiotherapy, on the rate of tumour growth. Interval times between end of chemotherapy and day of diagnostic CT, planning CT and first day of radiotherapy were determined. Increase in tumour volume was measured for 23 patients with NSCLC by measuring the primary tumour dimensions on the diagnostic CT made after induction chemotherapy and on the CT used for radiotherapy planning. Volume doubling times were calculated from the time interval between the two CTs and ratio of the volumes on CT planning and CT diagnostic. The mean time interval between end of chemotherapy and day of diagnostic CT was 16 days, till CT planning 66 days and till first day of radiotherapy 76 (29 - 108) days. Tumour doubling times ranged from 9 to 153 days with a mean of 47 days. This is far less than the mean doubling time of NSCL in untreated patients. This study shows that time interval between chemo- and start of radiotherapy varies between 29 to 108 days. The consequence is fast tumour progression as result of accelerated proliferation: mean tumour-doubling times are decreased by a factor of 2 to 4. The gain obtained with induction chemotherapy with regard to volume reduction was practically lost in the waiting time for radiotherapy. We recommend diminishing the time interval between chemo- and radiotherapy to as short as possible

Laser driven particle acceleration

International Nuclear Information System (INIS)

Faure, J.

2009-06-01

This dissertation summarizes the last ten years of research at the Laboratory of Applied Optics on laser-plasma based electron acceleration. The main result consists of the development and study of a relativistic electron source with unique properties: high energy (100-300 MeV) in short distances (few millimeters), mono-energetic, ultra-short (few fs), stable and tunable. The manuscript describes the steps that led to understanding the physics, and then mastering it in order to produce this new electron source. Non linear propagation of the laser pulse in the plasma is first presented, with phenomena such as non linear wakefield excitation, relativistic and ponderomotive self-focusing in the short pulse regime, self-compression. Acceleration and injection of electrons are then reviewed from a theoretical perspective. Experimental demonstrations of self-injection in the bubble regime and then colliding pulse injection are then presented. These experiments were among the first to produce monoenergetic, high quality, stable and tunable electron beams from a laser-plasma accelerator. The last two chapters are dedicated to the characterization of the electron beam using transition radiation and to its applications to gamma radiography and radiotherapy. Finally, the perspectives of this research are presented in the conclusion. Scaling laws are used to determine the parameters that the electron beams will reach using peta-watt laser systems currently under construction. (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.

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

Technical assessment of the Loma Linda University proton therapy accelerator

International Nuclear Information System (INIS)

1989-10-01

In April 1986, officials of Loma Linda University requested that Fermilab design and construct a 250 MeV proton synchrotron for radiotherapy, to be located at the Loma Linda University Medical Center. In June 1986 the project, having received all necessary approvals, commenced. In order to meet a desirable schedule providing for operation in early 1990, it was decided to erect such parts of the accelerator as were complete at Fermilab and conduct a precommissioning activity prior to the completion of the building at Loma Linda which will house the final radiotherapy facility. It was hoped that approximately one year would be saved by the precommissioning, and that important information would be obtained about the system so that improvements could be made during installation at Loma Linda. This report contains an analysis by Fermilab staff members of the information gained in the precommissioning activity and makes recommendations about steps to be taken to enhance the performance of the proton synchrotron at Loma Linda. In the design of the accelerator, effort was made to employ commercially available components, or to industrialize the products developed so that later versions of the accelerator could be produced industrially. The magnets could only be fabricated at Fermilab if the schedule was to be met, but efforts were made to transfer that technology to industry. Originally, it was planned to use a 1.7 MeV RFQ fabricated at the Lawrence Berkeley Laboratory as injector, but LBL would have found it difficult to meet the project schedule. After consideration of other options, for example a 3.4 MeV tandem accelerator, a supplier (AccSys Inc.) qualified itself to provide a 2 MeV RFQ on a schedule well matched to the project schedule. This choice was made, but a separate supplier was selected to develop and provide the 425 MHz power amplifier for the RFQ

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

Spinal cord stimulators and radiotherapy: First case report and practice guidelines

Directory of Open Access Journals (Sweden)

Walsh Lorraine

2011-10-01

Full Text Available Abstract Spinal cord stimulators (SCS are a well-recognised treatment modality in the management of a number of chronic neuropathic pain conditions, particularly failed back syndrome and radiculopathies. The implantable pulse generator (IPG component of the SCS is designed and operates in a similar fashion to that of a cardiac pacemaker. The IPG consists of an electrical generator, lithium battery, transmitter/receiver and a minicomputer. When stimulated, it generates pulsed electrical signals which stimulate the dorsal columns of the spinal cord, thus alleviating pain. Analogous to a cardiac pacemaker, it can be potentially damaged by ionising radiation from a linear accelerator, in patients undergoing radiotherapy. Herein we report our clinical management of the first reported case of a patient requiring adjuvant breast radiotherapy who had a SCS in situ. We also provide useful practical recommendations on the management of this scenario within a radiation oncology department.

Spinal cord stimulators and radiotherapy: First case report and practice guidelines

International Nuclear Information System (INIS)

Walsh, Lorraine; Guha, Daipayan; Purdie, Thomas G; Bedard, Philippe; Easson, Alexandra; Liu, Fei-Fei; Hodaie, Mojgan

2011-01-01

Spinal cord stimulators (SCS) are a well-recognised treatment modality in the management of a number of chronic neuropathic pain conditions, particularly failed back syndrome and radiculopathies. The implantable pulse generator (IPG) component of the SCS is designed and operates in a similar fashion to that of a cardiac pacemaker. The IPG consists of an electrical generator, lithium battery, transmitter/receiver and a minicomputer. When stimulated, it generates pulsed electrical signals which stimulate the dorsal columns of the spinal cord, thus alleviating pain. Analogous to a cardiac pacemaker, it can be potentially damaged by ionising radiation from a linear accelerator, in patients undergoing radiotherapy. Herein we report our clinical management of the first reported case of a patient requiring adjuvant breast radiotherapy who had a SCS in situ. We also provide useful practical recommendations on the management of this scenario within a radiation oncology department

Preoperative hyperfractionated accelerated radiotherapy and radical surgery in advanced head and neck cancer: A prospective phase II study

International Nuclear Information System (INIS)

Lindholm, Paula; Valavaara, Ritva; Aitasalo, Kalle; Kulmala, Jarmo; Laine, Juhani; Elomaa, Liisa; Sillanmaeki, Lauri; Minn, Heikki; Grenman, Reidar

2006-01-01

Background and purpose: To evaluate whether preoperative hyperfractionated accelerated radiotherapy (RT) combined with major radical surgery is feasible and successful in the treatment of advanced primary head and neck cancer. Patients and methods: Ninety four patients with histologically confirmed head and neck squamous cell cancer (HNSCC) in the oral cavity (41/96; 43%), supraglottis (14/96; 15%), glottis (5/96; 5%), oropharynx (16/96; 17%), nasal cavity/paranasal sinuses (8/96; 8%), nasopharynx (3/96; 3%), hypopharynx (7/96; 7%) and two (2%) with unknown primary tumour and large cervical lymph nodes entered into the study. 21/96 patients (22%) had stage II, 17/96 (18%) stage III and 58/96 patients (60%) stage IV disease. The patients received preoperative hyperfractionated RT 1.6 Gy twice a day, 5 days a week to a median tumour dose of 63 Gy with a planned break for 11 days (median) after the median dose of 37 Gy. Then, after a median of 27 days the patients underwent major radical surgery of the primary tumour and metastatic lymph nodes including reconstructions with pedicled or microvascular free flaps when indicated as a part of the scheduled therapy. 12/96 patients had only ipsilateral or bilateral neck dissections. Results: After a median follow-up time of 37.2 mos 77/96 (80.2%) patients had complete locoregional control. All but 2 patients had complete histological remission after surgery. 40/96 pts were alive without disease, two of them after salvage surgery. 32/96 patients had relapsed; 15 had locoregional and 13 distant relapses, 4 patients relapsed both locoregionally and distantly. Fifty patients have died; 29 with locoregional and/or distant relapse, eight patients died of second malignancy, and 19 had intercurrent diseases. Disease-specific and overall survival at 3 years was 67.7 and 51%, respectively. Acute grade three mucosal reactions were common, but transient and tolerable. Late grade 3-4 adverse effects were few. Conclusions: Preoperative

Infrastructure of radiotherapy in the Netherlands: evaluation of prognoses and introduction of a new model for determining the needs

International Nuclear Information System (INIS)

Slotman, Ben J.; Leer, Jan W.H.

2003-01-01

Background and purpose: In the Netherlands, the radiotherapy infrastructure is regulated by a Governmental license system. This requires timely and realistic prognostication of the needs for radiotherapy. In the present study, the latest prognoses (1993) and the realized changes in infrastructure are evaluated and a new prognosis for the period until 2010, which has been calculated using a new model, is presented. Materials and methods: Data on cancer incidence and use of radiotherapy were obtained from various published national reports and from a survey of all radiotherapy departments. Results: The cancer incidence over the period 1993-1997 was about 10% higher than predicted. In 1996 and 1997, the percentage of new cancer patients treated with radiotherapy was 45.6 and 48.2%, respectively. The absolute number of newly irradiated patients was about 10% higher than foreseen in the prognosis. The needs for radiotherapy infrastructure not only depend on epidemiological data and changes in indications for radiotherapy, but also on changes in types of treatment with different workloads. A new model, which uses four categories for teletherapy and four categories for brachytherapy is described and a new prognosis for the required number of linear accelerators and staff up to the year 2010 is presented. Conclusion: The original prognosis on cancer incidence and radiotherapy patients underestimated the actual figures considerably. The new prognosis, based on a model, which not only accounts for an increase in number of patients, but also for changes in treatment techniques, is expected to more accurately predict and acquire the required radiotherapy capacity

The evaluation of results and complications of radiotherapy in children treated for orbital rhabdomyosarcoma

International Nuclear Information System (INIS)

Skowronska-Gardas, A.; Pedziwiatr, K.; Chojnacka, M.

2002-01-01

To analyse treatment results and late complications of radiotherapy in children treated for orbital rhabdomyosarcoma. Between the years 1980 and 2000 34 children (median age 7 yrs. range: 1-15) with orbital RMS, were treated in the 1st Department of the MCCMCC in Warsaw. All but two of the patients received induction chemotherapy; 3 children were treated after ablative surgery (exenteration); 6 children were irradiated due to recurrence after chemotherapy. All the children were treated with megavoltage radiotherapy from a Co-60 unit or linear accelerator. We applied individual lens and lacrimal apparatus shielding in 16 patients. Five children, treated between 1996-2000, received conformal radiotherapy, with CT and 3-D treatment planning system.To obtain information about late side effects, we developed a questionnaire, including questions about the status of the affected eye, appearance of the orbit and facial structures.Thirty one patients (91%) are still living (between 24 and 264 months - median 138 mos) after completion of radiotherapy and 28 (82%) with no recurrence. In six patients treated due to recurrent tumour OS and DFS was 80% and 60%, respectively. Late complications were evaluated in 24 patients. We observed lacrimal duct stenosis in 33%, cataract in 29%, enophtalmos in 20% of patients. Retinopathy developed in 2 children, glaucoma in 2 pts, and facial asymmetry in 3 pts. In one case enucleation of blind eye was performed. Thirteen children have preserved adequate vision in the treated eye. In children treated with conformal radiotherapy we did not observe any late complications. Radiotherapy in orbital RMS allows to obtain good local control and excellent survival rate. Late complications could be limited with the application of individual treatment planning and conformal radiotherapy. (author)

A Dosimetric Comparison of Accelerated Partial Breast Irradiation Techniques: Multicatheter Interstitial Brachytherapy, Three-Dimensional Conformal Radiotherapy, and Supine Versus Prone Helical Tomotherapy

International Nuclear Information System (INIS)

Patel, Rakesh R.; Becker, Stewart J.; Das, Rupak K.; Mackie, Thomas R.

2007-01-01

Purpose: To compare dosimetrically four different techniques of accelerated partial breast irradiation (APBI) in the same patient. Methods and Materials: Thirteen post-lumpectomy interstitial brachytherapy (IB) patients underwent imaging with preimplant computed tomography (CT) in the prone and supine position. These CT scans were then used to generate three-dimensional conformal radiotherapy (3D-CRT) and prone and supine helical tomotherapy (PT and ST, respectively) APBI plans and compared with the treated IB plans. Dose-volume histogram analysis and the mean dose (NTD mean ) values were compared. Results: Planning target volume coverage was excellent for all methods. Statistical significance was considered to be a p value mean dose of 1.3 Gy 3 and 1.2 Gy 3 , respectively. Both of these methods were statistically significantly lower than the supine external beam techniques. Overall, all four methods yielded similar low doses to the heart. Conclusions: The use of IB and PT resulted in greater normal tissue sparing (especially ipsilateral breast and lung) than the use of supine external beam techniques of 3D-CRT or ST. However, the choice of APBI technique must be tailored to the patient's anatomy, lumpectomy cavity location, and overall treatment goals

Monte Carlo simulation of a medical linear accelerator for radiotherapy use

International Nuclear Information System (INIS)

Serrano, B.; Hachem, A.; Franchisseur, E.; Herault, J.; Marcie, S.; Costa, A.; Bensadoun, R. J.; Barthe, J.; Gerard, J. P.

2006-01-01

A Monte Carlo code MCNPX (Monte Carlo N-particle) was used to model a 25 MV photon beam from a PRIMUS (KD2-Siemens) medical linear electron accelerator at the Centre Antoine Lacassagne in Nice. The entire geometry including the accelerator head and the water phantom was simulated to calculate the dose profile and the relative depth-dose distribution. The measurements were done using an ionisation chamber in water for different square field ranges. The first results show that the mean electron beam energy is not 19 MeV as mentioned by Siemens. The adjustment between the Monte Carlo calculated and measured data is obtained when the mean electron beam energy is ∼15 MeV. These encouraging results will permit to check calculation data given by the treatment planning system, especially for small fields in high gradient heterogeneous zones, typical for intensity modulated radiation therapy technique. (authors)

Electron linac design for pion radiotherapy

International Nuclear Information System (INIS)

Loew, G.A.; Brown, K.L.; Miller, R.H.; Walz, D.R.

1977-03-01

The electron linac provides a straightforward, state-of-the-art method of producing the primary beam required for a hospital-based multiport pion radiotherapy facility for cancer treatment. The accelerator and associated beam transport system described are capable of generating an electron beam of about 250 kW and delivering it alternately to one of several pion generators and treatment areas. Each pion generator, a prototype of which now exists at the Stanford W. W. Hansen Laboratory, would contain a target for the electron beam and sixty separate superconducting magnet channels which focus the pions in the patient. The considerations which enter the design of a practical linac are presented together with a possible layout of a flexible beam transport system

Therapeutic Results of Radiotherapy in Rectal Carcinoma -Comparison of Sandwich Technique Radiotherapy with Postoperative Radiotherapy

International Nuclear Information System (INIS)

Huh, Gil Cha; Suh, Hyun Suk; Lee, Hyuk Sang; Kim, Re Hwe; Kim, Chul Soo; Kim, Hong Yong; Kim, Sung Rok

1996-01-01

Purpose : To evaluate the potential advantage for 'sandwich' technique radiotherapy compared to postoperative radiotherapy in respectable rectal cancer. Between January 1989 and May 1994, 60 patients with respectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital.Fifty one patients were available for analysis : 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with postoperative radiotherapy. In sandwich technique radiotherapy(RT), patients were treated with preoperative RT 1500 cGy/5fx followed by immediate curative resection. Patients staged as Astler-Coller B2, C were considered for postoperative RT with 2500-4500 cGy. In postoperative RT, total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-6 weeks was delivered. Patients were followed for median period of 25 months. Results : The overall 5-year survival rates for sandwich technique RT group and postoperative RT group were 60% and 71%, respectively(p>0.05). The 5-year disease free survival rates for each group were 63%. There was no difference in local failure rate between two groups(11% versus 7%). Incidence of distant metastasis was 11%(2/20) in the sandwich technique RT group and 20%(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. Conclusion : The sandwich technique radiotherapy group shows local recurrence and survival similar to those of postoperative RT alone group but reduced distant metastasis compared to postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT

Dedicated Magnetic Resonance Imaging in the Radiotherapy Clinic

International Nuclear Information System (INIS)

Karlsson, Mikael; Karlsson, Magnus G.; Nyholm, Tufve; Amies, Christopher; Zackrisson, Bjoern

2009-01-01

Purpose: To introduce a novel technology arrangement in an integrated environment and outline the logistics model needed to incorporate dedicated magnetic resonance (MR) imaging in the radiotherapy workflow. An initial attempt was made to analyze the value and feasibility of MR-only imaging compared to computed tomography (CT) imaging, testing the assumption that MR is a better choice for target and healthy tissue delineation in radiotherapy. Methods and Materials: A 1.5-T MR unit with a 70-cm-bore size was installed close to a linear accelerator, and a special trolley was developed for transporting patients who were fixated in advance between the MR unit and the accelerator. New MR-based workflow procedures were developed and evaluated. Results: MR-only treatment planning has been facilitated, thus avoiding all registration errors between CT and MR scans, but several new aspects of MR imaging must be considered. Electron density information must be obtained by other methods. Generation of digitally reconstructed radiographs (DRR) for x-ray setup verification is not straight forward, and reliable corrections of geometrical distortions must be applied. The feasibility of MR imaging virtual simulation has been demonstrated, but a key challenge to overcome is correct determination of the skeleton, which is often needed for the traditional approach of beam modeling. The trolley solution allows for a highly precise setup for soft tissue tumors without the invasive handling of radiopaque markers. Conclusions: The new logistics model with an integrated MR unit is efficient and will allow for improved tumor definition and geometrical precision without a significant loss of dosimetric accuracy. The most significant development needed is improved bone imaging.

Dedicated magnetic resonance imaging in the radiotherapy clinic.

Science.gov (United States)

Karlsson, Mikael; Karlsson, Magnus G; Nyholm, Tufve; Amies, Christopher; Zackrisson, Björn

2009-06-01

To introduce a novel technology arrangement in an integrated environment and outline the logistics model needed to incorporate dedicated magnetic resonance (MR) imaging in the radiotherapy workflow. An initial attempt was made to analyze the value and feasibility of MR-only imaging compared to computed tomography (CT) imaging, testing the assumption that MR is a better choice for target and healthy tissue delineation in radiotherapy. A 1.5-T MR unit with a 70-cm-bore size was installed close to a linear accelerator, and a special trolley was developed for transporting patients who were fixated in advance between the MR unit and the accelerator. New MR-based workflow procedures were developed and evaluated. MR-only treatment planning has been facilitated, thus avoiding all registration errors between CT and MR scans, but several new aspects of MR imaging must be considered. Electron density information must be obtained by other methods. Generation of digitally reconstructed radiographs (DRR) for x-ray setup verification is not straight forward, and reliable corrections of geometrical distortions must be applied. The feasibility of MR imaging virtual simulation has been demonstrated, but a key challenge to overcome is correct determination of the skeleton, which is often needed for the traditional approach of beam modeling. The trolley solution allows for a highly precise setup for soft tissue tumors without the invasive handling of radiopaque markers. The new logistics model with an integrated MR unit is efficient and will allow for improved tumor definition and geometrical precision without a significant loss of dosimetric accuracy. The most significant development needed is improved bone imaging.

Radiotherapy-induced aortic valve disease associated with porcelain aorta

International Nuclear Information System (INIS)

Daitoku, Kazuyuki; Fukui, Kozo; Ichinoseki, Ikkoh; Munakata, Mamoru; Takahashi, Shoichi; Fukuda Ikuo

2004-01-01

Mediastinal irradiation has been reported to induce cardiac disease such as pericarditis, valvular dysfunction, conduction abnormalities, accelerated arteriosclerosis of the coronary arteries, and also calcifications of the ascending aorta. We herein describe a case of radiotherapy-induced porcelain aorta and aortic valve disease and their surgical treatment. The patient was diagnosed with myasthenia gravis (MG) in 1965 (Osserman's type II), and mediastinal irradiation was performed in 1970 for treatment of thymic tumor associated with MG. Thirty years after radiation therapy, complete atrioventricular block and aortic valve disease with severe calcification of the ascending aorta and aortic arch (porcelain aorta) were detected on echo cardiogram and cardiac catheterization. A permanent pacemaker was implanted via the left subclavian vein and aortic valve replacement was performed under extracorporeal circulation established by selective cerebral perfusion and balloon occlusion instead of aortic cross-clamping. As no risk factors of arteriosclerosis such as hypercholesterolemia, hyperglycemia and hypertension were apparent, we concluded that the aortic valve disease and porcelain aorta were primarily induced by radiotherapy. (author)

Hypothyroidism in patients treated with radiotherapy for head and neck carcinoma: standardised long-term follow-up study.

Science.gov (United States)

Alba, J R; Basterra, J; Ferrer, J C; Santonja, F; Zapater, E

2016-05-01

Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients. Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma. Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology). Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).

Dosimetric evaluation of Radiotherapy units wit {sup 60}Co; Evaluacion dosimetrica de unidades de radioterapia con {sup 60}Co

Energy Technology Data Exchange (ETDEWEB)

Leon, B. Salinas de; Tovar M, V.; Becerril V, A. [Instituto Nacional de Investigaciones Nucleares, A.P. 18-1027, 11801 Mexico D.F. (Mexico)

2000-07-01

The SSDL network of the IAEA performs, every year, quality audit tests for radiotherapy services ({sup 60} Co units and linear accelerators), and for national SSDL as well. Because of the SSDL-Mexico results in these tests and due to our enthusiasm and confidence in our work, a parallel test has been done , which is described in this talk as well as the results. Nowadays, a second parallel test goes up, which could confirm our optimism and open the possibility to our country to start a national dosimetric audit of {sup 60} Co radiotherapy units. (Author)

Industrial and medicine accelerators and prospects of their development in the 11 five year plan

International Nuclear Information System (INIS)

Vakhrushin, Yu.P.; Glukhikh, V.A.; Svin'in, M.P.

1981-01-01

The data on development and introduction of accelerators into industry and medicine, improvement of their technical-and-econmic factors are presented. A parametric series of high-voltage electron accelerators which includes seven models covering the 0.15-4 MeV energy range, is developed. A common series of linear resonance accelerators for non-destructive testing, radio-therapy, activation analysis and radiation technology cover the 3-40 MeV electron energy range. The series includes 12 modifications of accelerators made of unified modules. A linear induction accelerator with up to 200 kW average beam power for using in an installation for liquid waste decontamination is under development. A parametric series of cyclotrons for industry and medicine using electron beams at 6-220 MeV energy and up to 200 μmA current is developed [ru

Oxygen tension measurements of tumors growing in mice

International Nuclear Information System (INIS)

Adam, Markus F.; Dorie, Mary Jo; Brown, J. Martin

1999-01-01

Purpose: Clinical studies using the Eppendorf histograph have shown that patients whose tumors have a low pO 2 have worse local control after radiotherapy, and have higher metastatic rates. Because preclinical studies of methods of overcoming, or exploiting, hypoxia generally use transplanted tumors in mice, we have compared the oxygenation of mouse tumors with human tumors to determine the appropriateness of the transplanted mouse model for such preclinical studies. Methods and Materials: We evaluated the oxygenation status of subcutaneous (s.c.) tissue and of 12 intradermally (i.d.)- and 7 s.c.-growing mouse or human transplanted tumors in mice using the Eppendorf histograph, and compared the values obtained with measurements of human head and neck nodes. Results: The normal tissue pO 2 profile of air-breathing mice showed a nearly Gaussian distribution (38.2 ± 14.9 mmHg). Breathing 10% O 2 or carbogen resulted in dramatic changes in normal tissue oxygenation. Tumors growing intradermally in the back of air-breathing mice were extremely hypoxic and resistant to expected changes in oxygenation (carbogen breathing, size, and use of anesthetics). Tumors growing s.c. in the foot showed higher oxygen profiles with marked changes in oxygenation when exposing the animals to different levels of oxygen. However, the oxygenation of the mouse tumors transplanted in either site was only a fraction of that of the majority of human tumors. Conclusion: Experimental mouse tumors are markedly hypoxic, with median values of 10-20% of those of human tumors. Hence, mouse tumors are probably good models for the most hypoxic human tumors that respond poorly to radiotherapy; however, caution has to be exercised in extrapolating data from mouse to man

The Physics of Radiotherapy X-Rays and Electrons

International Nuclear Information System (INIS)

Thwaites, David I

2008-01-01

This book is the updated successor to The Physics of Radiotherapy X-Rays from Linear Accelerators, published in 1997 by three well-respected radiotherapy physicists from Australian centres. Time marches on and so does the subject. The last decade has been a time of rapid and exciting change for radiation oncology and radiotherapy physics and this new book aims to update the existing areas and to cover new ones. It is much bigger than the original, up from 492 to 905 pages. The title and content has gained electrons, which always seemed like a major omission from the first version. The title has dropped 'from Linear Accelerators', and the authors have added a short section on kV x-rays and a short section on protons. There is also a nod towards brachytherapy in the beam modelling chapter. The authors have gained in seniority and roles, one becoming a Senior Product Manager at Tomotherapy, a company and a commercial treatment machine not in existence at the time of the last book. This alone gives a direct illustration of pace of change over the period! The immediately obvious changes in content are new chapters: on electron beam properties of course, but also on special procedures covering stereotactic radiosurgery, conventional linac intensity modulated radiation therapy (IMRT) and tomotherapy, on quality assurance in radiotherapy, including IMRT, image-guided radiotherapy (IGRT) and in vivo dosimetry, on patient immobilization and image guidance, and on radiation protection and room shielding. Other chapters have been split or rearranged, e.g., there are now separate chapters on dosimetry of beams and their calibration, whilst the beam modelling chapters have been expanded. There are chapters, or large sub-sections, that at first glance seem the same: on medical linear accelerators, interaction properties of radiation, dosimetry, beam properties, treatment planning, beam modelling, Monte Carlo modelling and tumour and normal tissue response. However, looking in

Proceedings of the 18. international linear accelerator conference. Vol. 2

International Nuclear Information System (INIS)

Hill, C.; Vretenar, M.

1996-01-01

These proceedings cover the whole field of linear accelerators, from its original and continuing role in particle physics research to the wide range of applications found today in many other disciplines and technologies. The contributions were deliberately spread among the different conference sessions in order to maintain a broad interest. The topics covered include: the design, construction and control of linear accelerators and the associated technology; dedicated test facilities, injection, wakefields, bunching, halo, dynamics, radio-frequency (RF), electron and ion accelerators, (laser) ion sources; active alignment, beam steering and spot size; simulation, monitoring and diagnostics; a description of the performance and current status of many machines, including proposed ones such as CLIC, the NLC and TESLA; applications to medical diagnosis and radiotherapy; use in the treatment and sterilisation of materials (including food) and in the reprocessing of radioactive waste; use as potential suppliers of energy. (orig.)

Proceedings of the 18. international linear accelerator conference. Vol. 1

Energy Technology Data Exchange (ETDEWEB)

Hill, C; Vretenar, M [eds.

1996-11-15

These proceedings cover the whole field of linear accelerators, from its original and continuing role in particle physics research to the wide range of applications found today in many other disciplines and technologies. The contributions were deliberately spread among the different conference sessions in order to maintain a broad interest. The topics covered include: the design, construction and control of linear accelerators and the associated technology; dedicated test facilities, injection, wakefields, bunching, halo, dynamics, radio-frequency (RF), electron and ion accelerators, (laser) ion sources; active alignment, beam steering and spot size; simulation, monitoring and diagnostics; a description of the performance and current status of many machines, including proposed ones such as CLIC, the NLC and TESLA; applications to medical diagnosis and radiotherapy; use in the treatment and sterilisation of materials (including food) and in the reprocessing of radioactive waste; use as potential suppliers of energy. (orig.).

Proceedings of the 18. international linear accelerator conference. Vol. 2

Energy Technology Data Exchange (ETDEWEB)

Hill, C; Vretenar, M [eds.

1996-11-15

These proceedings cover the whole field of linear accelerators, from its original and continuing role in particle physics research to the wide range of applications found today in many other disciplines and technologies. The contributions were deliberately spread among the different conference sessions in order to maintain a broad interest. The topics covered include: the design, construction and control of linear accelerators and the associated technology; dedicated test facilities, injection, wakefields, bunching, halo, dynamics, radio-frequency (RF), electron and ion accelerators, (laser) ion sources; active alignment, beam steering and spot size; simulation, monitoring and diagnostics; a description of the performance and current status of many machines, including proposed ones such as CLIC, the NLC and TESLA; applications to medical diagnosis and radiotherapy; use in the treatment and sterilisation of materials (including food) and in the reprocessing of radioactive waste; use as potential suppliers of energy. (orig.).

INEEL Advanced Radiotherapy Research Program Annual Report 2001

International Nuclear Information System (INIS)

Venhuizen, James R.

2002-01-01

This report summarizes the major activities and accomplishments of the Idaho National Engineering and Environmental Laboratory (INEEL) Advanced Radiotherapy Research Program for calendar year 2001. Applications of supportive research and development, as well as technology deployment in the fields of chemistry, radiation physics and dosimetry, and neutron source design and demonstration are described. Contributions in the fields of physics and biophysics include development of advanced patient treatment planning software, feasibility studies of accelerator neutron source technology for Neutron Capture Therapy (NCT), and completion of major modifications to the research reactor at Washington State University to produce an epithermal-neutron beam for NCT research applications

INEEL Advanced Radiotherapy Research Program Annual Report 2001

Energy Technology Data Exchange (ETDEWEB)

Venhuizen, James Robert

2002-04-01

This report summarizes the major activities and accomplishments of the Idaho National Engineering and Environmental Laboratory (INEEL) Advanced Radiotherapy Research Program for calendar year 2001. Applications of supportive research and development, as well as technology deployment in the fields of chemistry, radiation physics and dosimetry, and neutron source design and demonstration are described. Contributions in the fields of physics and biophysics include development of advanced patient treatment planning software, feasibility studies of accelerator neutron source technology for Neutron Capture Therapy (NCT), and completion of major modifications to the research reactor at Washington State University to produce an epithermal-neutron beam for NCT research applications.

INEEL Advanced Radiotherapy Research Program Annual Report 2001

Energy Technology Data Exchange (ETDEWEB)

Venhuizen, James R.

2002-04-30

This report summarizes the major activities and accomplishments of the Idaho National Engineering and Environmental Laboratory (INEEL) Advanced Radiotherapy Research Program for calendar year 2001. Applications of supportive research and development, as well as technology deployment in the fields of chemistry, radiation physics and dosimetry, and neutron source design and demonstration are described. Contributions in the fields of physics and biophysics include development of advanced patient treatment planning software, feasibility studies of accelerator neutron source technology for Neutron Capture Therapy (NCT), and completion of major modifications to the research reactor at Washington State University to produce an epithermal-neutron beam for NCT research applications.

Safty and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors

International Nuclear Information System (INIS)

Zhai Yirui; Feng Qinfu; Li Minghui

2010-01-01

Objective: To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors. Methods: From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy, including 14 patients with breast cancer,19 with pancreatic cancer, 3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors. Fifteen patients were with recurrent tumors. The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy. In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively. The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0). Results: The median duration of surgery was 190 minutes. Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxaemia, all of which were treated conservatively. The median hospitalization time and time to take out stitches was 12 and 13 days, respectively. And the in-hospital mortality was 4% (2/52). Twenty-four patients suffered post-operative adverse events, including 3 postoperative infections. With a median follow-up time of 183 days, 20% of patients suffered from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache. Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively. None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy. Conclusions: Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone. (authors)

Simplified geometric model for the calculation of neutron yield in an accelerator of 18 MV for radiotherapy

International Nuclear Information System (INIS)

Paredes G, L.C.; Balcazar G, M.; Francois L, J.L.; Azorin N, J.

2008-01-01

The results of the neutrons yield in different components of the bolster of an accelerator Varian Clinac 2100C of 18 MV for radiotherapy are presented, which contribute to the radiation of flight of neutrons in the patient and bolster planes. For the calculation of the neutrons yield, a simplified geometric model of spherical cell for the armor-plating of the bolster with Pb and W was used. Its were considered different materials for the Bremsstrahlung production and of neutrons produced through the photonuclear reactions and of electro disintegration, in function of the initial energy of the electron. The theoretical result of the total yield of neutrons is of 1.17x10 -3 n/e, considering to the choke in position of closed, in the patient plane with a distance source-surface of 100 cm; of which 15.73% corresponds to the target, 58.72% to the primary collimator, 4.53% to the levelled filter of Fe, 4.87% to the levelled filter of Ta and 16.15% to the closed choke. For an initial energy of the electrons of 18 MeV, a half energy of the neutrons of 2 MeV was obtained. The calculated values for radiation of experimental neutrons flight are inferior to the maxima limit specified in the NCRP-102 and IEC-60601-201.Ed.2.0 reports. The absorbed dose of neutrons determined through the measurements with TLD dosemeters in the isocenter to 100 cm of the target when the choke is closed one, is approximately 3 times greater that the calculated for armor-plating of W and 1.9 times greater than an armor-plating of Pb. (Author)

Remanent radiation fields around medical linear accelerators due to the induced radionuclides

International Nuclear Information System (INIS)

Sabol, J.; Khalifa, O.; Berka, Z.; Stankus, P.; Frencl, L.

1998-01-01

Radiation fields around two linear accelerators, Saturn 43 and a Saturn 2 Plus, installed at radiotherapy department is Prague, were measured and interpreted. The measurements included the determination of the dose equivalent rate resulting from photons emitted by induced radionuclides produced in reactions of high-energy photons with certain elements present in air and accelerator components as well as in the shielding and building materials in the treatment rooms, which are irradiated by high-energy X-rays, and due to radionuclides formed by capture of photoneutrons. While scattered photons and photoneutrons are only present during the accelerator operation, residual radioactivity creates a remanent radiation field persisting for some time after the instrument shutdown. The activity induced in the accessories is also an important source of exposure. (P.A.)

Mammographic Findings after Intraoperative Radiotherapy of the Breast

International Nuclear Information System (INIS)

Rivera, R.; Holmes, D.R.; Smith-Bronstein, V.S.; Villegas-Mendez, S.; Rayhanabad, J.; Sheth, P.; Rashtian, A.

2012-01-01

Intraoperative Radiotherapy (IORT) is a form of accelerated partial breast radiation that has been shown to be equivalent to conventional whole breast external beam radiotherapy (EBRT) in terms of local cancer control. However, questions have been raised about the potential of f IORT to produce breast parenchymal changes that could interfere with mammographic surveillance of cancer recurrence. The purpose of this study was to identify, quantify, and compare the mammographic findings of patients who received IORT and EBRT in a prospective, randomized controlled clinical trial of women with early stage invasive breast cancer undergoing breast conserving therapy between July 2005 and December 2009. Treatment groups were compared with regard to the 1, 2 and 4-year incidence of 6 post-operative mammographic findings: architectural distortion, skin thickening, skin retraction, calcifications, fat necrosis, and mass density. Blinded review of 90 sets of mammograms of 15 IORT and 16 EBRT patients demonstrated a higher incidence of fat necrosis among IORT recipients at years 1, 2, and 4. However, none of the subjects were judged to have suspicious mammogram findings and fat necrosis did not interfere with mammographic interpretation.

Linear accelerator based stereotactic radiosurgery with micro multi-leaf collimator : technological advancement in precision radiotherapy

International Nuclear Information System (INIS)

Dayananda, S.; Kinhikar, R.A.; Saju, Sherley; Deshpande, D.D.; Jalali, R.; Sarin, R.; Shrivastava, S.K.; Dinshaw, K.A.

2003-01-01

Stereotactic Radiosurgery (SRS) is an advancement on precision radiotherapy, in which stereo tactically guided localized high dose is delivered to the lesion (target) in a single fraction, while sparing the surrounding normal tissue. Radiosurgery has been used to treat variety of benign and malignant lesions as well as functional disorders in brain such as arteriovenous malformation (AVM), acoustic neuroma, solitary primary brain tumor, single metastasis, pituitary adenoma etc

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

Current role and future developments of radiotherapy in early-stage favourable Hodgkin's lymphoma

International Nuclear Information System (INIS)

Eich, H.T.; Mueller, R.P.

2007-01-01

The radiosensibility of Hodgkin's lymphoma (HL) is well established since 1902, when Pusey was one of the first to publish about radiotherapeutical treatment of a HL. In the early years, radiotherapy was the only curative treatment for this systemic disease, but the reports of Kaplan and Rosenberg and Peters in the fifties and seventies showed that irradiation of involved lymph node regions only resulted in high local and distant recurrences. The introduction of linear accelerator based high dose extended field (EF)-radiotherapy by Kaplan in Stanford was a milestone in the evolution of definitive curative radiotherapy strategies. The application of the mantle field for supradiaphragmatic and the inverted Y (with or without including the spleen or splenic pedicle) for infradiaphragmatic disease resulted in a dramatic improvement of survival rates in the early stages I and II (Ann Arbor) from 25-30% in the sixties to 65-80% in the eighties. Kaplan reported about a close relationship between radiation dose and cure rates in the case of definitive radiotherapy. A dose of at least 40 Gy resulted in local recurrences below 5% and is today the standard dose for radiotherapy only outside protocols. Despite complete remission rates after radiotherapy of 90-100%, the overall recurrence rate (including in-field, marginal and distant relapses) was between 20 and 30%. Analysis of the relapses revealed some stage migrating risk factors: large mediastinal mass, extra nodal involvement, number of involved lymph node areas (≥ 3) and high ESR. The possibility of more accurate staging by using new imaging techniques like ultrasonography, CT and MRI as well as PET in the recent years resulted e.g. in the definition of early-favourable, early-unfavourable (intermediate) and high risk stages and more specific, risk adapted treatment strategies. The objective of this article is to show recent achievements and developments in the management of early-stage favourable HL exemplified by

SU-E-T-501: Normal Tissue Toxicities of Pulsed Low Dose Rate Radiotherapy and Conventional Radiotherapy: An in Vivo Total Body Irradiation Study

Energy Technology Data Exchange (ETDEWEB)

Cvetkovic, D; Zhang, P; Wang, B; Chen, L; Ma, C [Fox Chase Cancer Center, Philadelphia, PA (United States)

2014-06-01

Purpose: Pulsed low dose rate radiotherapy (PLDR) is a re-irradiation technique for therapy of recurrent cancers. We have previously shown a significant difference in the weight and survival time between the mice treated with conventional radiotherapy (CRT) and PLDR using total body irradiation (TBI). The purpose of this study was to investigate the in vivo effects of PLDR on normal mouse tissues.Materials and Methods: Twenty two male BALB/c nude mice, 4 months of age, were randomly assigned into a PLDR group (n=10), a CRT group (n=10), and a non-irradiated control group (n=2). The Siemens Artiste accelerator with 6 MV photon beams was used. The mice received a total of 18Gy in 3 fractions with a 20day interval. The CRT group received the 6Gy dose continuously at a dose rate of 300 MU/min. The PLDR group was irradiated with 0.2Gyx20 pulses with a 3min interval between the pulses. The mice were weighed thrice weekly and sacrificed 2 weeks after the last treatment. Brain, heart, lung, liver, spleen, gastrointestinal, urinary and reproductive organs, and sternal bone marrow were removed, formalin-fixed, paraffin-embedded and stained with H and E. Morphological changes were observed under a microscope. Results: Histopathological examination revealed atrophy in several irradiated organs. The degree of atrophy was mild to moderate in the PLDR group, but severe in the CRT group. The most pronounced morphological abnormalities were in the immune and hematopoietic systems, namely spleen and bone marrow. Brain hemorrhage was seen in the CRT group, but not in the PLDR group. Conclusions: Our results showed that PLDR induced less toxicity in the normal mouse tissues than conventional radiotherapy for the same dose and regimen. Considering that PLDR produces equivalent tumor control as conventional radiotherapy, it would be a good modality for treatment of recurrent cancers.

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

Acute mucositis in the stimulated oral mucosa of patients during radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Maciejewski, B.; Zajusz, A.; Pilecki, B.; Swiatnicka, J.; Skladowski, K.; Trott, K.R.

1991-01-01

In 16 patients treated for squamous cell carcinoma of the oral cavity or oropharynx with an accelerated split course regimen, acute mucosal reactions were significantly less in the left buccal mucosa which had been repeatedly painted with 2% silver-nitrate solution for several days before radiotherapy than in the unpainted right buccal mucosa. (author). 8 refs., 3 figs., 1 tab

Image-guided radiotherapy for effective radiotherapy delivery

CERN Document Server

Karlsson, Ulf Lennart

2016-01-01

Image-guided radiotherapy (IGRT) is a new radiotherapy technology that combines the rapid dose fall off associated with intensity-modulated radiotherapy (IMRT) and daily tumor imaging allowing for high precision tumor dose delivery and effective sparing of surrounding normal organs. The new radiation technology requires close collaboration between radiologists, nuclear medicine specialists, and radiation oncologists to avoid marginal miss. Modern diagnostic imaging such as positron emission tomography (PET) scans, positron emission tomography with Computed Tomograpgy (PET-CT), and magnetic resonance imaging (MRI) allows the radiation oncologist to target the positive tumor with high accuracy. As the tumor is well visualized during radiation treatment, the margins required to avoid geographic miss can be safely reduced , thus sparing the normal organs from excessive radiation. When the tumor is located close to critical radiosensitive structures such as the spinal cord, IGRT can deliver a high dose of radiatio...

Comparative study originated photoneutrons different energy linear accelerators, manufacturer and model

International Nuclear Information System (INIS)

Exposito, M. R.; Terron, J. A.; Domingo, C.; Amgarou, K.; Garcia-Fuente, M. J.; Gonzalez-Soto, J.; Legares, J. I.; Gomez, F.; Sanchez-Doblado, F.

2011-01-01

Pollution neutron radiotherapy with photon beams of energy greater than 10 MV represents a major inconvenience for patients in treatment, given the increased likelihood of developing a second radiation-induced cancer. Most of these neutrons are generated in the accelerator head as a result of the interaction of photons with heavy metals. As a result, knowledge of the effect on patients in the fields of neutrons from the accelerator should lead to improvements in design and selection of components from manufacturers. For this purpose, we have performed comparative measurements of the neutron fields present in both the patient (represented by an anthropomorphic phantom) and in the treatment room, considering almost all types of machines currently operating in the world.

Development of C6+ laser ion source and RFQ linac for carbon ion radiotherapy

Science.gov (United States)

Sako, T.; Yamaguchi, A.; Sato, K.; Goto, A.; Iwai, T.; Nayuki, T.; Nemoto, K.; Kayama, T.; Takeuchi, T.

2016-02-01

A prototype C6+ injector using a laser ion source has been developed for a compact synchrotron dedicated to carbon ion radiotherapy. The injector consists of a laser ion source and a 4-vane radio-frequency quadrupole (RFQ) linac. Ion beams are extracted from plasma and directly injected into the RFQ. A solenoid guides the low-energy beams into the RFQ. The RFQ is designed to accelerate high-intensity pulsed beams. A structure of monolithic vanes and cavities is adopted to reduce its power consumption. In beam acceleration tests, a solenoidal magnetic field set between the laser ion source and the RFQ helped increase both the peak currents before and after the RFQ by a factor of 4.

Development of C6+ laser ion source and RFQ linac for carbon ion radiotherapy

International Nuclear Information System (INIS)

Sako, T.; Yamaguchi, A.; Sato, K.; Goto, A.; Iwai, T.; Nayuki, T.; Nemoto, K.; Kayama, T.; Takeuchi, T.

2016-01-01

A prototype C 6+ injector using a laser ion source has been developed for a compact synchrotron dedicated to carbon ion radiotherapy. The injector consists of a laser ion source and a 4-vane radio-frequency quadrupole (RFQ) linac. Ion beams are extracted from plasma and directly injected into the RFQ. A solenoid guides the low-energy beams into the RFQ. The RFQ is designed to accelerate high-intensity pulsed beams. A structure of monolithic vanes and cavities is adopted to reduce its power consumption. In beam acceleration tests, a solenoidal magnetic field set between the laser ion source and the RFQ helped increase both the peak currents before and after the RFQ by a factor of 4

A Phase I Study of Chemoradiotherapy With Use of Involved-Field Conformal Radiotherapy and Accelerated Hyperfractionation for Stage III Non-Small Cell Lung Cancer: WJTOG 3305

Energy Technology Data Exchange (ETDEWEB)

Tada, Takuhito, E-mail: tada@msic.med.osaka-cu.ac.jp [Department of Radiology, Osaka City University Graduate School of Medicine, Osaka (Japan); Department of Radiology, Izumi Municipal Hospital, Izumi (Japan); Chiba, Yasutaka [Department of Environmental Medicine and Behavioural Science, Kinki University Faculty of Medicine, Osaka-sayama (Japan); Tsujino, Kayoko [Department of Radiation Oncology, Hyogo Cancer Center, Akashi (Japan); Fukuda, Haruyuki [Department of Radiology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino (Japan); Nishimura, Yasumasa [Department of Radiation Oncology, Kinki University Faculty of Medicine, Osaka-sayama (Japan); Kokubo, Masaki [Division of Radiation Oncology, Institute of Biomedical Research and Innovation, Kobe (Japan); Negoro, Shunichi [Department of Medical Oncology, Hyogo Cancer Center, Akashi (Japan); Kudoh, Shinzoh [Department of Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka (Japan); Fukuoka, Masahiro [Department of Medical Oncology, Izumi Municipal Hospital, Izumi (Japan); Nakagawa, Kazuhiko [Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka-sayama (Japan); Nakanishi, Yoichi [Research Institute for Disease of the Chest, Graduate School of Medical Science, Kyusyu University, Fukuoka (Japan)

2012-05-01

Purpose: A Phase I study to determine a recommended dose of thoracic radiotherapy using accelerated hyperfractionation for unresectable non-small-cell lung cancer was conducted. Methods and Materials: Patients with unresectable Stage III non-small-cell lung cancer were treated intravenously with carboplatin (area under the concentration curve 2) and paclitaxel (40 mg/m{sup 2}) on Days 1, 8, 15, and 22 with concurrent twice-daily thoracic radiotherapy (1.5 Gy per fraction) beginning on Day 1 followed by two cycles of consolidation chemotherapy using carboplatin (area under the concentration curve 5) and paclitaxel (200 mg/m{sup 2}). Total doses were 54 Gy in 36 fractions, 60 Gy in 40 fractions, 66 Gy in 44 fractions, and 72 Gy in 48 fractions at Levels 1 to 4. The dose-limiting toxicity, defined as Grade {>=}4 esophagitis and neutropenic fever and Grade {>=}3 other nonhematologic toxicities, was monitored for 90 days. Results: Of 26 patients enrolled, 22 patients were assessable for response and toxicity. When 4 patients entered Level 4, enrollment was closed to avoid severe late toxicities. Dose-limiting toxicities occurred in 3 patients. They were Grade 3 neuropathy at Level 1 and Level 3 and Grade 3 infection at Level 1. However, the maximum tolerated dose was not reached. The median survival time was 28.6 months for all patients. Conclusions: The maximum tolerated dose was not reached, although the dose of radiation was escalated to 72 Gy in 48 fractions. However, a dose of 66 Gy in 44 fractions was adopted for this study because late toxicity data were insufficient.

A Phase I Study of Chemoradiotherapy With Use of Involved-Field Conformal Radiotherapy and Accelerated Hyperfractionation for Stage III Non-Small Cell Lung Cancer: WJTOG 3305

International Nuclear Information System (INIS)

Tada, Takuhito; Chiba, Yasutaka; Tsujino, Kayoko; Fukuda, Haruyuki; Nishimura, Yasumasa; Kokubo, Masaki; Negoro, Shunichi; Kudoh, Shinzoh; Fukuoka, Masahiro; Nakagawa, Kazuhiko; Nakanishi, Yoichi

2012-01-01

Purpose: A Phase I study to determine a recommended dose of thoracic radiotherapy using accelerated hyperfractionation for unresectable non–small-cell lung cancer was conducted. Methods and Materials: Patients with unresectable Stage III non–small-cell lung cancer were treated intravenously with carboplatin (area under the concentration curve 2) and paclitaxel (40 mg/m 2 ) on Days 1, 8, 15, and 22 with concurrent twice-daily thoracic radiotherapy (1.5 Gy per fraction) beginning on Day 1 followed by two cycles of consolidation chemotherapy using carboplatin (area under the concentration curve 5) and paclitaxel (200 mg/m 2 ). Total doses were 54 Gy in 36 fractions, 60 Gy in 40 fractions, 66 Gy in 44 fractions, and 72 Gy in 48 fractions at Levels 1 to 4. The dose-limiting toxicity, defined as Grade ≥4 esophagitis and neutropenic fever and Grade ≥3 other nonhematologic toxicities, was monitored for 90 days. Results: Of 26 patients enrolled, 22 patients were assessable for response and toxicity. When 4 patients entered Level 4, enrollment was closed to avoid severe late toxicities. Dose-limiting toxicities occurred in 3 patients. They were Grade 3 neuropathy at Level 1 and Level 3 and Grade 3 infection at Level 1. However, the maximum tolerated dose was not reached. The median survival time was 28.6 months for all patients. Conclusions: The maximum tolerated dose was not reached, although the dose of radiation was escalated to 72 Gy in 48 fractions. However, a dose of 66 Gy in 44 fractions was adopted for this study because late toxicity data were insufficient.

GPU-accelerated automatic identification of robust beam setups for proton and carbon-ion radiotherapy

International Nuclear Information System (INIS)

Ammazzalorso, F; Jelen, U; Bednarz, T

2014-01-01

We demonstrate acceleration on graphic processing units (GPU) of automatic identification of robust particle therapy beam setups, minimizing negative dosimetric effects of Bragg peak displacement caused by treatment-time patient positioning errors. Our particle therapy research toolkit, RobuR, was extended with OpenCL support and used to implement calculation on GPU of the Port Homogeneity Index, a metric scoring irradiation port robustness through analysis of tissue density patterns prior to dose optimization and computation. Results were benchmarked against an independent native CPU implementation. Numerical results were in agreement between the GPU implementation and native CPU implementation. For 10 skull base cases, the GPU-accelerated implementation was employed to select beam setups for proton and carbon ion treatment plans, which proved to be dosimetrically robust, when recomputed in presence of various simulated positioning errors. From the point of view of performance, average running time on the GPU decreased by at least one order of magnitude compared to the CPU, rendering the GPU-accelerated analysis a feasible step in a clinical treatment planning interactive session. In conclusion, selection of robust particle therapy beam setups can be effectively accelerated on a GPU and become an unintrusive part of the particle therapy treatment planning workflow. Additionally, the speed gain opens new usage scenarios, like interactive analysis manipulation (e.g. constraining of some setup) and re-execution. Finally, through OpenCL portable parallelism, the new implementation is suitable also for CPU-only use, taking advantage of multiple cores, and can potentially exploit types of accelerators other than GPUs.

GPU-accelerated automatic identification of robust beam setups for proton and carbon-ion radiotherapy

Science.gov (United States)

Ammazzalorso, F.; Bednarz, T.; Jelen, U.

2014-03-01

We demonstrate acceleration on graphic processing units (GPU) of automatic identification of robust particle therapy beam setups, minimizing negative dosimetric effects of Bragg peak displacement caused by treatment-time patient positioning errors. Our particle therapy research toolkit, RobuR, was extended with OpenCL support and used to implement calculation on GPU of the Port Homogeneity Index, a metric scoring irradiation port robustness through analysis of tissue density patterns prior to dose optimization and computation. Results were benchmarked against an independent native CPU implementation. Numerical results were in agreement between the GPU implementation and native CPU implementation. For 10 skull base cases, the GPU-accelerated implementation was employed to select beam setups for proton and carbon ion treatment plans, which proved to be dosimetrically robust, when recomputed in presence of various simulated positioning errors. From the point of view of performance, average running time on the GPU decreased by at least one order of magnitude compared to the CPU, rendering the GPU-accelerated analysis a feasible step in a clinical treatment planning interactive session. In conclusion, selection of robust particle therapy beam setups can be effectively accelerated on a GPU and become an unintrusive part of the particle therapy treatment planning workflow. Additionally, the speed gain opens new usage scenarios, like interactive analysis manipulation (e.g. constraining of some setup) and re-execution. Finally, through OpenCL portable parallelism, the new implementation is suitable also for CPU-only use, taking advantage of multiple cores, and can potentially exploit types of accelerators other than GPUs.

Non small cells stage I bronchial cancers: three-dimensional radiotherapy and radiotherapy in stereotactic conditions; Cancers bronchiques non a petites cellules de stade I: radiotherapie tridimensionnelle et radiotherapie en conditions stereotaxiques

Energy Technology Data Exchange (ETDEWEB)

Schipman, B.; Bosset, J.F. [CHU, 25 - Besancon (France); Marchesi, V.; Beckendorf, V.; Desandes, E.; Peiffert, D. [CRLCC Alexis-Vautrin, 54 - Vandaeuvre-les-Nancy (France); Bosset, M. [CHU, 26 - Valence (France)

2010-10-15

The authors report a comparison between three-dimensional conformation radiotherapy and robotic irradiation in stereotactic conditions (with CyberKnife) for patients suffering from a bronchial cancer with no small cells of stage I. Acute and late toxicity have been recorded, and the monitoring comprised a clinic examination and a thoracic scanography. The external radiotherapy results in an important local control rate and an acceptable toxicity. Some prospective studies are still needed to compare three-dimensional conformation respiratory-gated radiotherapy and radiotherapy in stereotactic conditions. Short communication

Radiological incidents in radiotherapy

International Nuclear Information System (INIS)

Hobzova, L.; Novotny, J.

2008-01-01

In many countries a reporting system of radiological incidents to national regulatory body exists and providers of radiotherapy treatment are obliged to report all major and/or in some countries all incidents occurring in institution. State Office for Nuclear Safety (SONS) is providing a systematic guidance for radiotherapy departments from 1997 by requiring inclusion of radiation safety problems into Quality assurance manual, which is the basic document for obtaining a license of SONS for handling with sources of ionizing radiation. For that purpose SONS also issued the recommendation 'Introduction of QA system for important sources in radiotherapy-radiological incidents' in which the radiological incidents are defined and the basic guidance for their classification (category A, B, C, D), investigation and reporting are given. At regular periods the SONS in co-operation with radiotherapy centers is making a survey of all radiological incidents occurring in institutions and it is presenting obtained information in synoptic communication (2003 Motolske dny, 2005 Novy Jicin). This presentation is another summary report of radiological incidents that occurred in our radiotherapy institutions during last 3 years. Emphasis is given not only to survey and statistics, but also to analysis of reasons of the radiological incidents and to their detection and prevention. Analyses of incidents in radiotherapy have led to a much broader understanding of incident causation. Information about the error should be shared as early as possible during or after investigation by all radiotherapy centers. Learning from incidents, errors and near misses should be a part of improvement of the QA system in institutions. Generally, it is recommended that all radiotherapy facilities should participate in the reporting, analyzing and learning system to facilitate the dissemination of knowledge throughout the whole country to prevent errors in radiotherapy.(authors)

Comparison between steel and lead shieldings for radiotherapy rooms regarding neutron doses to patients

International Nuclear Information System (INIS)

Silva, M.G.; Rebello, W.F.; Andrade, E.R.; Medeiros, M.P.C.; Mendes, R.M.S.; Braga, K.L.; Gomes, R.G.

2015-01-01

The NCRP Report No. 151, Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities, considers, in shielding calculations for radiotherapy rooms, the use of lead and/or steel to be applied on bunker walls. The NCRP Report calculations were performed foreseeing a better protection of people outside the radiotherapy room. However, contribution of lead and steel to patient dose should be taken into account for radioprotection purposes. This work presents calculations performed by MCNPX code in analyzing the Ambient Dose Equivalent due to neutron, H *(10) n , within a radiotherapy room, in the patients area, considering the use of additional shielding of 1 TVL of lead or 1 TVL of steel, positioned at the inner faces of walls and ceiling of a bunker. The head of the linear accelerator Varian 2100/2300 C/D was modeled working at 18MeV, with 5 x 5 cm 2 , 10 x 10 cm 2 , 20 x 20 cm 2 , 30 x 30 cm 2 and 40 x 40 cm 2 openings for jaws and MLC and operating in eight gantry's angles. This study shows that the use of lead generates an average value of H *(10) n at patients area, 8.02% higher than the expected when using steel. Further studies should be performed based on experimental data for comparison with those from MCNPX simulation. (author)

Assessment of beam stability of high energy and low energy Varian medical linear accelerators

International Nuclear Information System (INIS)

Jayesh, K.; Mohan, R.; Joshi, R.C.; Ganesh, T.; Hegazy, M.; Oubaye, A.J.; AI Idrisi, Maha

2008-01-01

An accurate measurement of the dose delivered to the tumor in external beam radiotherapy is one of the primary responsibilities of a medical physicist. In general, such measurements have been based on the application of a dosimetry protocol and quality assurance procedures. Clinically one must be able to assess the beam quality, flatness and symmetry and variation in the output on daily basis. Flatness and symmetry are the main parameters for determining the pattern of a photon and electron beam produced by linear accelerators. The quality assurance in routine clinical practice of radiotherapy and consequently the treatment-outcome depends definitely on the physical parameters of treatment-delivery. Several recommendations from national and international associations are reported to define the limits for the beam parameters. The review of literature and various reports on quality assurance in radiotherapy show that for flatness, symmetry and output constancy the optimal level of deviation should be within ±3%

Demand for radiotherapy in Spain.

Science.gov (United States)

Rodríguez, A; Borrás, J M; López-Torrecilla, J; Algara, M; Palacios-Eito, A; Gómez-Caamaño, A; Olay, L; Lara, P C

2017-02-01

Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.

Modern possibilities of radiotherapy in the complex and single treatment of panaris

International Nuclear Information System (INIS)

Kolipiliev, V.; Momchev, M.

1979-01-01

Results are reported of the treatment of 282 patients with different forms of panaris: 39 per cent received radiotherapy alone, in the remaining radiotherapy was combined with surgical management, antibiotics and local treatment. Two different radiotherapy schemes were attempted: 49% of the patients received rather high single (50-80 rad) and total (300-600 rad) doses in the local site at a regimen of superficial (100 kV, 4 mm Al) or deep (180-200 kV, 0.5-1 mm Cu) roentgentherapy, with size of field 4/4 cm or 4/6 cm and 30-40 cm distance. In the remaining 51% of patients radiotherapy was characterized by dynamic fractionation and longer duration of procedures with significantly lower single (30-40 rad) and total (160-320 rad) doses. In recent years the second scheme has been preferred and has gain wide acceptance. Irradiation dose and rate invariably conformed to the type of inflammatory process. Patients with panaritium paronychium and panaritium subcutaneum admitted for treatment in the first few days of development of the digital infection required only several procedures on alternate days to achieve complete cure in a week. In the event of pus collection, 1 or 2 irradiation procedures accelerated abscess formation; this was followed by surgical intervention with postoperative radiotherapy to hasten the granulation process. Treatment of bone-and-joint forms of panaris was complex with initially higher single doses, followed by lower ones, applied up to twice weekly. The following advantages of the method are pointed out: shortening of treatment, respectively of the disability period; easy to perform, painless and practically innocuous manipulation. Complete cure could not be achieved only in advanced, torpid cases. (A.B.)

ORANGE: a Monte Carlo dose engine for radiotherapy

International Nuclear Information System (INIS)

Zee, W van der; Hogenbirk, A; Marck, S C van der

2005-01-01

This study presents data for the verification of ORANGE, a fast MCNP-based dose engine for radiotherapy treatment planning. In order to verify the new algorithm, it has been benchmarked against DOSXYZ and against measurements. For the benchmarking, first calculations have been done using the ICCR-XIII benchmark. Next, calculations have been done with DOSXYZ and ORANGE in five different phantoms (one homogeneous, two with bone equivalent inserts and two with lung equivalent inserts). The calculations have been done with two mono-energetic photon beams (2 MeV and 6 MeV) and two mono-energetic electron beams (10 MeV and 20 MeV). Comparison of the calculated data (from DOSXYZ and ORANGE) against measurements was possible for a realistic 10 MV photon beam and a realistic 15 MeV electron beam in a homogeneous phantom only. For the comparison of the calculated dose distributions and dose distributions against measurements, the concept of the confidence limit (CL) has been used. This concept reduces the difference between two data sets to a single number, which gives the deviation for 90% of the dose distributions. Using this concept, it was found that ORANGE was always within the statistical bandwidth with DOSXYZ and the measurements. The ICCR-XIII benchmark showed that ORANGE is seven times faster than DOSXYZ, a result comparable with other accelerated Monte Carlo dose systems when no variance reduction is used. As shown for XVMC, using variance reduction techniques has the potential for further acceleration. Using modern computer hardware, this brings the total calculation time for a dose distribution with 1.5% (statistical) accuracy within the clinical range (less then 10 min). This means that ORANGE can be a candidate for a dose engine in radiotherapy treatment planning

The future of breast cancer radiotherapy: From one size fits all to taylor-made treatment; L'avenir de la radiotherapie du cancer du sein: de la taille unique au sur-mesure

Energy Technology Data Exchange (ETDEWEB)

Hennequin, C. [Service de cancerologie-radiotherapie, hopital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris (France); Azria, D. [Departement de cancerologie radiotherapie, CRLC Val-d' Aurelle-Paul-Lamarque, rue Croix-Verte, 34298 Montpellier cedex 5 (France); Universite de Montpellier I, 5, boulevard Henri-IV, CS 19044, 34967 Montpellier cedex 2 (France); Inserm U896, institut de recherche en cancerologie de Montpellier, CRLC Val-d' Aurelle-Paul-Lamarque, rue Croix-Verte, 34298 Montpellier cedex 5 (France)

2011-10-15

Various subgroups of breast tumours have been identified during the last 10 years according to the risk of local relapse. Prognostic factors for local relapse are age, surgical margins, tumour size, Her2 expression and hormonal receptors status. For tumours with a high risk of local relapse, an increased in boost dose or the addition of new drugs (trastuzumab, anti-angiogenics, PARP inhibitors) could be considered. For low risk tumours, hypo-fractionated, accelerated partial breast and intraoperative radiotherapy are being evaluated. The classical schedule (45-50 Gy to the whole gland followed by a boost dose of 16 Gy) is no longer the universal rule. Treatment individualization, according to clinical and biological characteristics of the tumour and - possibly - to the radiobiological profile of the patient, is likely to be the future of breast cancer radiotherapy. (authors)

Dosimetric Comparison in Breast Radiotherapy of 4 MV and 6 MV on Physical Chest Simulator

Energy Technology Data Exchange (ETDEWEB)

Donato da Silva, Sabrina; Passos Ribeiro Campos, Tarcisio [Nuclear Engineering Department, Federal University of Minas Gerais, Belo Horizonte (Brazil); Batista Nogueira, Luciana [Anatomy and Imaging Department, Federal University of Minas Gerais, Belo Horizonte (Brazil); Lima Souza Castro, Andre [Nuclear Engineering Department, Federal University of Minas Gerais, Belo Horizonte (Brazil); Institute of Radiation San Francisco, Belo Horizonte (Brazil); Alves de oliveira, Marcio; Galvao Dias, Humberto [Cancer Hospital in Uberlandia, Uberlandia (Brazil)

2015-07-01

According to the World Health Organization (2014) breast cancer is the main cause of death by cancer in women worldwide. The biggest challenge of radiotherapy in the treatment of cancer is to deposit the entire prescribed dose homogeneously in the breast, sparing the surrounding tissue. In this context, this paper aimed at evaluating and comparing internal dose distribution in the mammary gland based on experimental procedures submitted to two distinct energy spectra produced in breast cancer radiotherapy. The methodology consisted of reproducing opposite parallel fields used in the treatment of breast tumors in a chest phantom. This simulator with synthetic breast, composed of equivalent tissue material (TE), was previously developed by the NRI Research Group (UFMG). The computer tomography (CT) scan of the simulator was obtained antecedently. The radiotherapy planning systems (TPS) in the chest phantom were performed in the ECLIPSE system from Varian Medical Systems and CAT 3D system from MEVIS. The irradiations were reproduced in the Varian linear accelerator, model SL- 20 Precise, 6 MV energy and Varian linear accelerator, 4 MV Clinac 6x SN11 model. Calibrations of the absorbed dose versus optical density from radiochromic films were generated in order to obtain experimental dosimetric distribution at the films positioned within the glandular and skin equivalent tissues of the chest phantom. The spatial dose distribution showed equivalence with the TPS on measurement data performed in the 6 MV spectrum. The average dose found in radiochromic films placed on the skin ranged from 49 to 79%, and from 39 to 49% in the mammary areola, for the prescribed dose. Dosimetric comparisons between the spectra of 4 and 6 MV, keeping the constant geometry of the fields applied in the same phantom, will be presented showing their equivalence in breast radiotherapy, as well as the variations will be discussed. To sum up, the dose distribution has reached the value expected in

Preliminary comparison of the therapeutic efficacy of accelerated relative to conventional fractionation radiotherapy by treatment of spontaneous canine malignancies

International Nuclear Information System (INIS)

Denman, David L.; Levin, Rebecca; Buncher, C. Ralph; Aron, Bernard S.

1996-01-01

Purpose/Objective: This study's ultimate goals involve development of an accelerated fractionation (AF) regimen with an integrated final concomitant boost (CB) and examination of factors prognostic of the CB's therapeutic efficacy which could be measured during the initial AF portion to determine for which patients CB should be used. These endpoints can be accurately determined quickly by evaluating the treatment (tx) of spontaneous canine veterinary patient tumors. Because surviving tumor clonogen growth rate increases after radiotherapy (RT) begins, this accelerated repopulation (AR) should be reduced by AF. Furthermore, CB using a small field encompassing only the tumor bed, given as a second daily tx during the last week of RT, should further reduce AR. The initial portion of this project which is nearing completion was designed to determine if incidentally treated normal tissues could tolerate the AF regimen and project whether addition of the tumor bed CB would also be tolerated. Materials and Methods: Currently 20 canine patients with biopsy proven localized tumors have received canine AF radiotherapy given as 3.2Gy/fraction(fx) administered 5 days a week (Mon-Fri) to a total of 15 fxs (48Gy) within 18 elapsed days. RT is given with a 60 Co teletherapy unit. Their tumor response, control, survival, and acute normal tissue responses are being directly compared to results we previously obtained from canines receiving a nearly equivalent dose/fx and total dose conventional fractionation (CF) regimen which was given alone or with adjuvant hyperthermia (HT). In that study the canines were stratified by tumor histology and anatomic site and randomly assigned to receive canine CF (3.5Gy/fx, 3 fxs/week [Mon-Wed-Fri] to 14 fxs (49Gy) in an elapsed time of approx. 30 days) either alone or followed weekly by local HT (44 deg. +/- 2 deg. C) for 30 minutes (5 HT fxs). As is currently done, these CF+/-HT patients were followed up to 3 years to quantitate the magnitudes

Optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy: is ultra-early salvage radiotherapy beneficial?

International Nuclear Information System (INIS)

Taguchi, Satoru; Shiraishi, Kenshiro; Fukuhara, Hiroshi; Nakagawa, Keiichi; Morikawa, Teppei; Naito, Akihiro; Kakutani, Shigenori; Takeshima, Yuta; Miyazaki, Hideyo; Nakagawa, Tohru; Fujimura, Tetsuya; Kume, Haruki; Homma, Yukio

2016-01-01

The optimal timing of salvage radiotherapy for biochemical recurrence after radical prostatectomy is controversial. In particular, the prognostic significance of salvage radiotherapy delivered before a current definition of biochemical recurrence, i.e. ultra-early salvage radiotherapy, is unclear. We reviewed 76 patients with pT2-3N0M0 prostate cancer who underwent salvage radiotherapy for post-prostatectomy biochemical recurrence at the following three timings: ultra-early salvage radiotherapy (n = 20) delivered before meeting a current definition of biochemical recurrence (two consecutive prostate-specific antigen [PSA] values ≥0.2 ng/mL); early salvage radiotherapy (n = 40) delivered after meeting the definition but before PSA reached 0.5 ng/mL; and delayed salvage radiotherapy (n = 16) delivered after PSA reached 0.5 ng/mL. The primary endpoint was failure of salvage radiotherapy, defined as a PSA value ≥0.2 ng/mL. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses, respectively. During the follow-up period (median: 70 months), four of 20 (20 %), nine of 40 (23 %) and seven of 16 (44 %) patients failed biochemically in the ultra-early, early and delayed salvage radiotherapy groups, respectively. On univariate analyses, the outcome of delayed salvage radiotherapy was worse than the others, while there was no significant difference between ultra-early and early groups. Multivariate analysis demonstrated the presence of Gleason pattern 5, perineural invasion and delayed salvage radiotherapy as independent predictors of poorer survival. No survival benefit of ultra-early salvage radiotherapy was demonstrated, whereas delayed salvage radiotherapy was associated with worse outcome as reported in previous studies. Our results may support the current recommendations that salvage radiotherapy should be undertaken after two consecutive PSA values ≥0.2 ng/mL and before reaching 0.5 ng/mL

Introduction of audio gating to further reduce organ motion in breathing synchronized radiotherapy

International Nuclear Information System (INIS)

Kubo, H. Dale; Wang Lili

2002-01-01

With breathing synchronized radiotherapy (BSRT), a voltage signal derived from an organ displacement detector is usually displayed on the vertical axis whereas the elapsed time is shown on the horizontal axis. The voltage gate window is set on the breathing voltage signal. Whenever the breathing signal falls between the two gate levels, a gate pulse is produced to enable the treatment machine. In this paper a new gating mechanism, audio (or time-sequence) gating, is introduced and is integrated into the existing voltage gating system. The audio gating takes advantage of the repetitive nature of the breathing signal when repetitive audio instruction is given to the patient. The audio gating is aimed at removing the regions of sharp rises and falls in the breathing signal that cannot be removed by the voltage gating. When the breathing signal falls between voltage gate levels as well as between audio-gate levels, the voltage- and audio-gated radiotherapy (ART) system will generate an AND gate pulse. When this gate pulse is received by a linear accelerator, the linear accelerator becomes 'enabled' for beam delivery and will deliver the beam when all other interlocks are removed. This paper describes a new gating mechanism and a method of recording beam-on signal, both of which are, configured into a laptop computer. The paper also presents evidence of some clinical advantages achieved with the ART system

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.

Assessment of radiotherapy photon beams: A practical and low cost methodology

International Nuclear Information System (INIS)

Reis, C.Q.M.; Nicolucci, P.

2017-01-01

Dosimetric properties of radiation beams used in radiotherapy are directly related to the energy spectrum produced by the treatment unit. Therefore, the development of methodologies to evaluate in a simple and accurate way the spectra of clinical beams can help establishing the quality control of the treatment. The purpose of this study is to present a practical and low cost methodology for determining primary spectra of radiotherapy photon beams from transmission measurements in attenuators of aluminum and using the method of the inverse Laplace transform. Monte Carlo simulation with PENELOPE code was used in order to evaluate and validate the reconstructed spectra by the calculation of dosimetric parameters that characterize the beam. Percentage depth dose values simulated with a 6 MV reconstructed spectrum shows maximum difference of 4.4% when compared to values measured at the corresponding clinical beam. For a 10 MV beam that difference was around 4.2%. Results obtained in this study confirm the adequacy of the proposed methodology for assessing primary photon beams produced by clinical accelerators. - Highlights: • Primary spectra of radiotherapy photon beams are determined from transmission measurements. • Monte Carlo calculations are used to evaluate the method of the inverse Laplace transform. • The proposed methodology is practical and of low cost for clinical purposes. • Results are in fair agreement with literature and clinical data.

ΔOSI: a prototype microstrip dosimeter for characterization of medical radiotherapy and radiosurgery systems

International Nuclear Information System (INIS)

Redondo-Fernandez, I.; Buttar, C.; Walsh, S.; Manolopoulos, S.; Homer, J.M.; Young, S.; Conway, J.

2006-01-01

As the technology for medical radiotherapy and radiosurgery evolves, there is a growing need for dosimeters capable of measuring dose distributions on-line with submillimeter spatial resolution, both for facility commissioning and patient-related quality assurance. We have designed and built a high spatial resolution dosimeter based on silicon micro-strip technology for characterization of small radiotherapy and radiosurgery fields. The aim is to provide relative dosimetry measurement with film-like spatial resolution and to be able to resolve the temporal evolution. Following the description of the prototypes, first beam test results of a 250 μm pitch, 128 channels prototype with X-rays in a clinical 6 MV accelerator are presented. The device demonstrated good dosimetric capabilities when compared to reference measurements made with ionization chambers and agrees with radiographic film in the steep dose gradient region produced by the collimator edge

The radiotherapy affects the cognitive processes; La radiotherapie affecte la cognition

Energy Technology Data Exchange (ETDEWEB)

Anon

2009-10-15

Researchers from the medical center of the free university of Amsterdam report that the radiotherapy can hinder the cognitive functions of patients affected by cerebral tumors treated after a surgery. Even low dose radiation could contribute in their opinion, to the progressive cognitive decline of patients suffering of low grade gliomas, the most commune cerebral tumor. To get these conclusions, 65 patients, whom half of them received a radiotherapy, had a neurological and psychological evaluation twelve years after their treatment. Results: 53% of patients treated by radiotherapy present disorders of attention, memory, execution and speed of information treatment against 27% of these ones that received an only surgery. The researchers conclude to the necessity to take into account this risk in the choice of treatment, or even to avoid radiotherapy in this precise case. (N.C.)

Accelerated Fractionation In The Treatment of Brain Metastasis From Non-Small Cell Carcinoma of The Lung

International Nuclear Information System (INIS)

Hong, Seong Eon

1994-01-01

Purpose: Metastatic cancer to the brain is a major problem for the patients with bronchogenic carcinoma, and most of these patients have a limited survival expectancy. To increase tumor control and/or to decrease late morbidity with possible shortening in over-all treatment period, multiple daily fraction technique for brain metastasis was performed. The author represented the results of accelerated fractionation radiotherapy in patients with brain metastases from non-small cell lung cancer. Materials and Methods: Twenty-six patients with brain metastases from non-small cell lung cancer between 1991 and 1993 received brain radiotherapy with a total dose of 48 Gy, at 2 Gy per fraction, twice a day with a interfractional period of 6 hours, and delivered 5 days a week. The whole brain was treated to 40 Gy and boost dose escalated to 8 Gy for single metastatic lesion by reduced field. Twenty-four of the 26 patients completed the radiotherapy. Radiotherapy was interrupted in two patients suggesting progressive intracerebral disease. Results: This radiotherapy regimen appears to be comparable to the conventional schema in relief from symptoms. Three of the 24 patients experienced nausea and or vomiting during the course of treatment because of acute irradiation toxicity. The author observed no excessive toxicity with escalating dose of irradiation. An increment in median survival, although not statistically significant (p>0.05), was noted with escalating doses(48 Gy) of accelerated fractionation (7 months) compared to conventional treatment(4.5 months). Median survival also increased in patients with brain solitary metastasis(9 months) compared to multiple extrathoracic sites(4 months), and in patients with good performance status(9 months versus 3.5 months), they were statistically significant(p<0.01). Conclusion: The increment in survival in patients with good prognostic factors such as controlled primary lesion, metastasis in brain only, and good performance status