Sample records for comprehensive treatise radiotherapy

  1. Subgame consistent cooperation a comprehensive treatise

    CERN Document Server

    Yeung, David W K


    Strategic behavior in the human and social world has been increasingly recognized in theory and practice. It is well known that non-cooperative behavior could lead to suboptimal or even highly undesirable outcomes. Cooperation suggests the possibility of obtaining socially optimal solutions and the calls for cooperation are prevalent in real-life problems. Dynamic cooperation cannot be sustainable if there is no guarantee that the agreed upon optimality principle at the beginning is maintained throughout the cooperation duration. It is due to the lack of this kind of guarantees that cooperative schemes fail to last till its end or even fail to get started. The property of subgame consistency in cooperative dynamic games and the corresponding solution mechanism resolve this “classic” problem in game theory. This book is a comprehensive treatise on subgame consistent dynamic cooperation covering the up-to-date state of the art analyses in this important topic. It sets out to provide the theory, solution tec...

  2. Black pepper and health claims: a comprehensive treatise. (United States)

    Butt, Masood Sadiq; Pasha, Imran; Sultan, Muhammad Tauseef; Randhawa, Muhammad Atif; Saeed, Farhan; Ahmed, Waqas


    For millennia, spices have been an integral part of human diets and commerce. Recently, the widespread recognition of diet-health linkages bolsters their dietary importance. The bioactive components present in them are of considerable significance owing to their therapeutic potential against various ailments. They provide physiological benefits or prevent chronic ailment in addition to the fundamental nutrition and often included in the category of functional foods. Black pepper (Piper Nigrum L.) is an important healthy food owing to its antioxidant, antimicrobial potential and gastro-protective modules. Black pepper, with piperine as an active ingredient, holds rich phytochemistry that also includes volatile oil, oleoresins, and alkaloids. More recently, cell-culture studies and animal modeling predicted the role of black pepper against number of maladies. The free-radical scavenging activity of black pepper and its active ingredients might be helpful in chemoprevention and controlling progression of tumor growth. Additionally, the key alkaloid components of Piper Nigrum, that is, piperine assist in cognitive brain functioning, boost nutrient's absorption and improve gastrointestinal functionality. In this comprehensive treatise, efforts are made to elucidate the antioxidant, antimicrobial, anti-inflammatory, gastro-protective, and antidepressant activities of black pepper. Moreover, the synergistic interaction of black pepper with different drugs and nutrients is the limelight of the manuscript. However, the aforementioned health-promoting benefits associated with black pepper are proven in animal modeling. Thus, there is a need to conduct controlled randomized trials in human subjects, cohort studies, and meta-analyses. Such future studies would be helpful in recommending its application in diet-based regimens to prevent various ailments.

  3. Critical Review of Rasaratna Samuccaya: A Comprehensive Treatise of Indian Alchemy

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    Dhirajsingh Rajput Sumersingh


    Full Text Available Rasaratna Samuccaya (RRS a 13th century C.E. alchemical treatise, authored by Vāgbhaṭa, is a useful compilation related to preparation and properties of drugs of mineral and metallic origin. This text throws light on the state of Indian expertise in the field of alchemy regarding the extraction, purification, conversion of metals/minerals into therapeutically suitable forms, various instruments developed for alchemical purposes and treatment of numerous diseases by using herbo-mineral preparations. The present work is an attempt to summarize the key features of RRS to highlight its utility and contribution in the development of Indian alchemy. To study and summarize the important, comprehensive and specific points mentioned in RRS and to elaborate the contribution of RRS in the field of Indian alchemy. A critical review of RRS from Suratnojjvalā Hindi commentary by Ambikadatta Shastri was done and the collected information was compared with other available literature of Rasaśāstra. Research of modern science was also utilized to explore some facts mentioned by Vāgbhaṭa. RRS is a precise treatise among available ancient literature. It comprises of all eight branches of Ayurveda, although it mainly deals with therapeutic aspects of Rasaśāstra and emphasizes the use of metals and minerals in treating nearly 68 types of ailments. It contains 30 chapters, 3871 verses and detailed description of 960 formulations. Classification of metals and minerals; description of some new instruments, formulations and averting use of metals and minerals in pregnancy are the key features of RRS.

  4. Treatise on acoustics the first comprehensive English translation of E.F.F. Chladni's traité d’acoustique

    CERN Document Server

    Chladni, E F F


    This is the first comprehensive translation of the expanded French version of E.F.F. Chladni’s Traité d’Acoustique, using Chladni's 1802 Die Akustik for reference and clarification.  Chladni’s experiments and observations with sound and vibrations profoundly influenced the development of the field of Acoustics.  The famous Chladni diagrams along with other observations are contained in Die Akustik, published in German in 1802 and Traité d’Acoustique, a greatly expanded version, published in French in 1809.  The present translation was undertaken by Robert T. Beyer, PhD (1920-2008), noted acoustician, Professor of Physics at Brown University, and Gold Medal recipient of the Acoustical Society of America. Along with many other projects completed over the course of his career, Dr. Beyer translated Von Neumann’s seminal work, Mathematical Foundations of Quantum Mechanics from the original German, spent 30 years translating Russian physics treatises and journals, served as editor of the English t...

  5. Not a Treatise, but a Treatise in Verse...

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    Natalia Gorbaniewska


    Full Text Available Natalia Gorbaniewska, an acclaimed translator of Polish literature into Russian, remembers her first meeting with Miłosz in Paris, and the reading of Traktat poetycki [Treatise on Poetry], which for her became a real translator’s challenge. The memory, in this case, becomes a pre­text for a discussion of the genre characteristic of the Treatise, and of the melody of Miłosz’s language and the literary tradition, which makes it possible to understand his poems.

  6. Learned Treatise and Legal Reform

    DEFF Research Database (Denmark)

    Münster-Swendsen, Mia


    of the royal court from the time of the reign of Cnut the Great to the author's present. In Danish as well as international scholarship this deceptively simple text has frequently been treated either as a ‘law code' or ‘law book' in itself or as a reflection of actual legal practice. Yet here I will contend...... that the Lex castrensis is in fact a political-legal treatise masked as pseudo-history with an explicit didactic purpose as a ‘schoolbook' for future administrators. As a learned ideological construct with a remarkable afterlife, Sven's work may be regarded as part of the intellectual preparation for future...

  7. Radiotherapy. (United States)

    Krause, Sonja; Debus, Jürgen; Neuhof, Dirk


    Solitary plasmocytoma occurring in bone (solitary plasmocytoma of the bone, SBP) or in soft tissue (extramedullary plasmocytoma, EP) can be treated effectively and with little toxicity by local radiotherapy. Ten-year local control rates of up to 90% can be achieved. Patients with multiple myeloma often suffer from symptoms such as pain or neurological impairments that are amenable to palliative radiotherapy. In a palliative setting, short treatment schedules and lower radiation doses are used to reduce toxicity and duration of hospitalization. In future, low-dose total body irradiation (TBI) may play a role in a potentially curative regimen with nonmyeloablative conditioning followed by allogenic peripheral blood stem cell transplantation.

  8. The First Treatise in Comparative Education Rediscovered (United States)

    Lenhart, Volker


    The Latin essay "De re Scholastica Anglica cum Germanica Comparata" (English and German school education compared) published in 1795-1798 by the Freiberg/Saxony grammar school principal Friedrich August Hecht is the first treatise in comparative education. The rediscovery of the text, its earlier mentioning in the history of comparative…

  9. Stereotactic ablative radiotherapy for comprehensive treatment of oligometastatic tumors (SABR-COMET: Study protocol for a randomized phase II trial

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    Palma David A


    Full Text Available Abstract Background Stereotactic ablative radiotherapy (SABR has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control. Survival outcomes for patients with oligometastatic disease treated with SABR appear promising, but conclusions are limited by patient selection, and the lack of adequate controls in most studies. The goal of this multicenter randomized phase II trial is to assess the impact of a comprehensive oligometastatic SABR treatment program on overall survival and quality of life in patients with up to 5 metastatic cancer lesions, compared to patients who receive standard of care treatment alone. Methods After stratification by the number of metastases (1-3 vs. 4-5, patients will be randomized between Arm 1: current standard of care treatment, and Arm 2: standard of care treatment + SABR to all sites of known disease. Patients will be randomized in a 1:2 ratio to Arm 1:Arm 2, respectively. For patients receiving SABR, radiotherapy dose and fractionation depends on the site of metastasis and the proximity to critical normal structures. This study aims to accrue a total of 99 patients within four years. The primary endpoint is overall survival, and secondary endpoints include quality of life, toxicity, progression-free survival, lesion control rate, and number of cycles of further chemotherapy/systemic therapy. Discussion This study will provide an assessment of the impact of SABR on clinical outcomes and quality of life, to determine if long-term survival can be achieved for selected patients with oligometastatic disease, and will inform the design of a possible phase III study. Trial registration identifier: NCT01446744

  10. Magnitude, impact, and management of respiration-induced target motion in radiotherapy treatment: A comprehensive review

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    S A Yoganathan


    Full Text Available Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i motion-encompassing, (ii respiratory gating, and (iii tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.

  11. Avicenna's treatise on otology in Medieval Persia. (United States)

    Hamidi, Sanaz; Sajjadi, Hamed; Boroujerdi, Amin; Golshahi, Bahare; Djalilian, Hamid R


    Avicenna (AD 980-1037) was one of the best-known physicians of his time. Born in Persia, he gained notoriety both in the local and international scenes. Avicenna's best-known book, Canon of Medicine, was the standard textbook of medicine for more than five centuries in Europe and the Persian Empire. Because no English translation of the entire Canon of Medicine exists, the authors have recently translated the treatise on otologic diseases from Persian into English. Correlation was made with the Arabic text as well to ensure accuracy. This study provides a review of Avicenna's significant contributions to the concepts in anatomy and the pathophysiology of ear diseases. Herbal and nonherbal medications used in the treatment of otologic disorders are also discussed.

  12. Radioactive geochronometry from the treatise on geochemistry

    CERN Document Server

    Holland, H D


    The history of Earth in the Solar System has been unraveled using natural radioactivity. The sources of this radioactivity are the original creation of the elements and the subsequent bombardment of objects, including Earth, in the Solar System by cosmic rays. Both radioactive and radiogenic nuclides are harnessed to arrive at ages of various events and processes on Earth. This collection of chapters from the "Treatise on Geochemistry" displays the range of radioactive geochronometric studies that have been addressed by researchers in various fields of Earth science. These range from the age of Earth and the Solar System to the dating of the history of Earth that assists us in defining the major events in Earth history. In addition, the use of radioactive geochronometry in describing rates of Earth surface processes, including the climate history recorded in ocean sediments and the patterns of circulation of the fluid Earth, has extended the range of utility of radioactive isotopes as chronometric and tracer ...

  13. Galen and his treatise on grief

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    John T. Fitzgerald


    Full Text Available Throughout his career, Fika Janse van Rensburg has rightly insisted on the importance of the socio-historical context in interpreting early Christian literature. Although New Testament scholars have given careful attention to many aspects of this context, they have generally neglected writings by physicians. This neglect includes the numerous works of the philosopher-physician Galen (129-ca. 216 or 217 CE, who was one of the Roman Empire’s most prolific writers. As a corrective, this article focuses on Galen, with attention given to his life and to a recently discovered treatise on distress or grief (lype¯, known as De indolentia [Avoiding Distress or On Freedom from Distress]. Galen discusses grief from both a physiological and philosophical perspective, and his treatment of this emotion and common human experience provides an important context for the statements about lype¯ found in the New Testament and other early Christian documents.

  14. Galen and his treatise on grief

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    John T. Fitzgerald


    Full Text Available Throughout his career, Fika Janse van Rensburg has rightly insisted on the importance of the socio-historical context in interpreting early Christian literature. Although New Testament scholars have given careful attention to many aspects of this context, they have generally neglected writings by physicians. This neglect includes the numerous works of the philosopher-physician Galen (129-ca. 216 or 217 CE, who was one of the Roman Empire’s most prolific writers. As a corrective, this article focuses on Galen, with attention given to his life and to a recently discovered treatise on distress or grief (lype¯, known as De indolentia [Avoiding Distress or On Freedom from Distress]. Galen discusses grief from both a physiological and philosophical perspective, and his treatment of this emotion and common human experience provides an important context for the statements about lype¯ found in the New Testament and other early Christian documents.

  15. Dr John Nottingham's 1854 Landmark Treatise on Conical Cornea Considered in the Context of the Current Knowledge of Keratoconus. (United States)

    Gokul, Akilesh; Patel, Dipika V; McGhee, Charles N J


    John Nottingham has been widely credited with the first accurate description of keratoconus in his treatise on conical cornea, published in 1854. Contained within the 270-page treatise are accounts and theories of keratoconus postulated by authors such as Scarpa, von Carion, von Ammon, and Mackenzie, synthesized by Nottingham in a treatise containing his own original observations. Nottingham's work delves deeply into keratoconus, with coverage reminiscent of a modern review, albeit in a far less succinct manner. He extensively describes the epidemiology, clinical presentation, underlying cause, and treatment of keratoconus. However, the concepts put forth are limited largely by the contemporary lack of understanding of the underlying anatomy and physiology of the eye, and the observations, by technological limitations. He postulates a similar treatment algorithm to that used today; optical devices being the management option of choice in the mild stages with surgery being a last resort. None of the surgical methods discussed are used in the modern era, but he does make reference to the possible efficacy of corneal transplantation. Nottingham's treatise was published over 160 years ago, yet his ideas and observations are surprisingly accurate. It is very possible that he was the first person to publish an accurate, comprehensive description of keratoconus.

  16. Complex network model of the Treatise on Cold Damage Disorders (United States)

    Shao, Feng-jing; Sui, Yi; Zhou, Yong-hong; Sun, Ren-cheng


    Investigating the underlying principles of the Treatise on Cold Damage Disorder is meaningful and interesting. In this study, we investigated the symptoms, herbal formulae, herbal drugs, and their relationships in this treatise based on a multi-subnet composited complex network model (MCCN). Syndrome subnets were constructed for the symptoms and a formula subnet for herbal drugs. By subnet compounding using MCCN, a composited network was obtained that described the treatment relationships between syndromes and formulae. The results obtained by topological analysis suggested some prescription laws that could be validated in clinics. After subnet reduction using the MCCN, six channel (Tai-yang, Yang-ming, Shao-yang, Tai-yin, Shao-yin, and Jue-yin) subnets were obtained. By analyzing the strengths of the relationships among these six channel subnets, we found that the Tai-yang channel and Yang-ming channel were related most strongly with each other, and we found symptoms that implied pathogen movements and transformations among the six channels. This study could help therapists to obtain a deeper understanding of this ancient treatise.

  17. Comprehension. (United States)

    Bollenbach, Carolyn


    Teaching comprehension skills requires teaching to intuition with activities such as presenting puzzling situations to introduce a topic, using art to elicit latent feelings, using imagery and improvisations to enhance visualization, and using music and dance to encourage nonverbal expressions. (DB)

  18. Neutron scattering treatise on materials science and technology

    CERN Document Server

    Kostorz, G


    Treatise on Materials Science and Technology, Volume 15: Neutron Scattering shows how neutron scattering methods can be used to obtain important information on materials. The book discusses the general principles of neutron scattering; the techniques used in neutron crystallography; and the applications of nuclear and magnetic scattering. The text also describes the measurement of phonons, their role in phase transformations, and their behavior in the presence of crystal defects; and quasi-elastic scattering, with its special merits in the study of microscopic dynamical phenomena in solids and

  19. Treatises “On Virtues and Vices”: Translation from the Greek into Russian and commentary

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    Alexander Sanzhenakov


    Full Text Available This paper is divided into three sections: an introduction, a translation of Pseudo-Aristotelian treatise “On Virtues and Vices” (De virtutibus et vitiis, and a commentary to this text. In the introduction, the author briefly describes textual tradition, critical editions and available translations of the treatise in European languages. The major issue, discussed in the introduction, concerns the question of authenticity and authorship of the treatise. Arguments by E. Zeller, C. Schuchhardt, F. Susemihl, E. Schmidt, who seriously questioned the authenticity of the text, are contrasted with the opinion of P. Simpson, who insisted on its authenticity. The author of the present work is inclined to think that the treatise is a later composition. Respective arguments are presented in length in the commentary, where the author attempts to place the treatise in the context of the ethical works of the Corpus Aristotelicum, on the one hand, and this of the later Hellenistic developments, on the other.

  20. Neutron fluctuations a treatise on the physics of branching processes

    CERN Document Server

    Pazsit, Imre; Pzsit, Imre


    The transport of neutrons in a multiplying system is an area of branching processes with a clear formalism. This book presents an account of the mathematical tools used in describing branching processes, which are then used to derive a large number of properties of the neutron distribution in multiplying systems with or without an external source. In the second part of the book, the theory is applied to the description of the neutron fluctuations in nuclear reactor cores as well as in small samples of fissile material. The question of how to extract information about the system under study is discussed. In particular the measurement of the reactivity of subcritical cores, driven with various Poisson and non-Poisson (pulsed) sources, and the identification of fissile material samples, is illustrated. The book gives pragmatic information for those planning and executing and evaluating experiments on such systems. - Gives a complete treatise of the mathematics of branching particle processes, and in particular n...

  1. Teleradiotherapy Network: Applications and Feasibility for Providing Cost-Effective Comprehensive Radiotherapy Care in Low- and Middle-Income Group Countries for Cancer Patients. (United States)

    Datta, Niloy Ranjan; Heuser, Michael; Samiei, Massoud; Shah, Ragesh; Lutters, Gerd; Bodis, Stephan


    Globally, new cancer cases will rise by 57% within the next two decades, with the majority in the low- and middle-income countries (LMICs). Consequently, a steep increase of about 40% in cancer deaths is expected there, mainly because of lack of treatment facilities, especially radiotherapy. Radiotherapy is required for more than 50% of patients, but the capital cost for equipment often deters establishment of such facilities in LMICs. Presently, of the 139 LMICs, 55 do not even have a radiotherapy facility, whereas the remaining 84 have a deficit of 61.4% of their required radiotherapy units. Networking between centers could enhance the effectiveness and reach of existing radiotherapy in LMICs. A teleradiotherapy network could enable centers to share and optimally utilize their resources, both infrastructure and staffing. This could be in the form of a three-tier radiotherapy service consisting of primary, secondary, and tertiary radiotherapy centers interlinked through a network. The concept has been adopted in some LMICs and could also be used as a "service provider model," thereby reducing the investments to set up such a network. Teleradiotherapy networks could be a part of the multipronged approach to address the enormous gap in radiotherapy services in a cost-effective manner and to support better accessibility to radiotherapy facilities, especially for LMICs.

  2. Treatise on classical elasticity theory and related problems

    CERN Document Server

    Teodorescu, Petre P


    Deformable solids have a particularly complex character; mathematical modeling is not always simple and often leads to inextricable difficulties of computation. One of the simplest mathematical models and, at the same time, the most used model, is that of the elastic body – especially the linear one. But, notwithstanding its simplicity, even this model of a real body may lead to great difficulties of computation. The practical importance of a work about the theory of elasticity, which is also an introduction to the mechanics of deformable solids, consists of the use of scientific methods of computation in a domain in which simplified methods are still used. This treatise takes into account the consideration made above, with special attention to the theoretical study of the state of strain and stress of a deformable solid. The book draws on the known specialized literature, as well as the original results of the author and his 50+ years experience as Professor of Mechanics and Elasticity at the University o...

  3. "Learned Chaucer" : The evolution of Chaucer's reputation as the author of A Treatise on the Astrolabe


    Rascouailles, Myriam Anne Chrystel


    In 1532, William Thynne printed the first edition of the complete works of Geoffrey Chaucer. It was also the first time his astronomical prose text, A Treatise on the Astrolabe, appeared in print. In his treatise, Chaucer describes the use of an astronomical instrument called the astrolabe. To be able to use such an instrument required knowledge of the Ptolemaic model of the universe. In Thynne's edition, Chaucer aqcuired the soubriquet "learned scientist" and subsequent comments seem ...

  4. Two medieval plague treatises and their afterlife in early modern England. (United States)

    Keiser, George R


    This study of an adaptation of the popular John of Burgundy plague treatise by Thomas Moulton, a Dominican friar, ca. 1475, and a translation of the so-called Canutus plague treatise by Thomas Paynell, printed 1534, shows how the medieval traditions they represent were carried forward, well into the sixteenth century, and also subjected to change in light of religious, moral, and medical concerns of early modern England. The former had a long life in print, ca. 1530-1580, whereas Paynell's translation exists in one printed version. Moulton's adaptation differs from its original and from the Canutus treatise in putting great emphasis on the idea that onsets of plague were acts of divine retribution for human sinfulness. In this respect, Moulton reshaped the tradition of the medieval plague treatise and anticipated the religious and social construction of plague that would take shape in the first half of the sixteenth century. Its long history in print indicates that Moulton's treatise expressed the spirit of that construction and probably influenced the construction as well. The contrasting histories of the two treatises attest not only to the dramatic change brought about by religious and social forces in the sixteenth century, but to a growing recognition of the value of the printing press for disseminating medical information-in forms that served social and ideological ends.

  5. Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center. (United States)

    Almont, Thierry; Delannes, Martine; Ducassou, Anne; Corman, André; Bondil, Pierre; Moyal, Elizabeth; Schover, Leslie; Huyghe, Eric


    Providing early and better care in onco-sexuality and a better understanding of the sexual health care needs of patients before they start treatment is required. To assess sexual quality of life and need for sexology care of patients when they are starting radiotherapy. We performed a cross-sectional study of adult patients with cancer admitted for radiotherapy treatment in a regional comprehensive cancer center. We selected all consecutive adult patients scheduled to start radiotherapy within a 3-month period and excluded patients who could not complete the questionnaires. Patients were asked to complete the Sexual Quality of Life Questionnaire (SQoL) and a needs-assessment questionnaire. Total score on the SQoL and willingness (yes or no) to get help for a sexual problem. The study sample was composed of 77 men and 123 women. The average SQoL scores were 68.4 ± 20.9 and 47.1 ± 13.0 for men and women, respectively (P cancer diagnosis. Half the participants wanted care for their sexual concerns. The proportion desiring specific types of care varied from 28.5% (couple counseling) to 54.5% (sexual physician) with variation by sex or type of cancer. Furthermore, 11.5% of participants declared their willingness to join support groups. Early interventions before radiotherapy could improve sexual quality of life, particularly in women. Strengths are the SQoL validated in men and women, the original window for assessment, and the study location. Limitations are the monocentric design, the potential recall bias for data before cancer diagnosis, and the fact that some patients had treatments before radiotherapy. Our data suggest the need to examine the sexual health trajectory in a prospective fashion from diagnosis to survivorship. Almont T, Delannes M, Ducasson A, et al. Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center. J Sex Med 2017

  6. The Logic of Reflection: Samuel Taylor Coleridge's "treatise on Logic" (United States)

    Land, Janet Sanders

    Though others discuss Coleridge's interest in science, light imagery, the phenomenon of reflection, and his references to Newton and Opticks,^1 this is the first study to examine Coleridge's art in terms of optics, its developing theories, and the nature-of-light debate. This study examines Coleridge's early predilection for visions, illusions, and the supernatural and demonstrates that he gradually shifts from the supernatural to the scientific aspects of "visions" and "illusions," concentrating on causes of illusions and the effects of their deceptive qualities rather than their mystical features. By the 1820's, his preoccupation with illusions had become an interest in optics, fueled, no doubt, by the increasing controversy of the nature-of-light debate and the number of advances in optics resulting from the efforts of its opponents to prove their theories. Tracing the development of the debate, its escalation in the early nineteenth century, and the formation of Coleridge's opinion concerning key issues of the debate, I outline the evolution of Coleridge's theory of reflection and examine the exposition of that theory in his treatise, Logic (1981). Finally, I analyze the relationship between the advances in optics and Coleridge's concepts of thought and knowledge and his notion of the mind as an instrument of knowledge. These ideas in turn, altered his opinions concerning the validity of knowledge resulting from philosophic debate, scientific experiment, and poetic exploration. ftn^1John Beer, "Coleridge and Wordsworth on Reflection," The Wordsworth Circle 20 (1989): 20-29; Coleridge the Visionary. London: Chatto and Windus, 1959; and Coleridge's Poetic Intelligence. London: Macmillan, 1977 and M. H. Abrams Natural Supernaturalism: Tradition and Revolution in Romantic Literature. New York: Norton, 1971; and "Coleridge's 'A Light in Sound': Science, Metascience, and Poetic Imagination." The Correspondent Breeze: Essays on English Romanticism. Eds. M. H. Abrams

  7. Neurocognitive Effects of Radiotherapy (United States)


    investigates the effect of radiotherapy using serial MRI imaging and a series of neuropsychological measurements on two groups of patients; (1) those with...demonstrated a significant change over time in the RT- treated group, although a comprehensive neuropsychological battery of repeatable measures...woman of child -bearing potential, a negative pregnancy test (urine) will be required before participation in this study. ABNORMAL FINDINGS

  8. Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO). (United States)

    Hurkmans, Coen W; Knegjens, Joost L; Oei, Bing S; Maas, Ad J J; Uiterwaal, G J; van der Borden, Arnoud J; Ploegmakers, Marleen M J; van Erven, Lieselot


    Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient's perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients' perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

  9. Early European attitudes towards "good death": Eugenios Voulgaris, Treatise on euthanasia, St Petersburg, 1804. (United States)

    Galanakis, E; Dimoliatis, I D K


    Eugenios Voulgaris (Corfu, Greece, 1716; St Petersburg, Russia, 1806) was an eminent theologian and scholar, and bishop of Kherson, Ukraine. He copiously wrote treatises in theology, philosophy and sciences, greatly influenced the development of modern Greek thought, and contributed to the perception of Western thought throughout the Eastern Christian world. In his Treatise on euthanasia (1804), Voulgaris tried to moderate the fear of death by exalting the power of faith and trust in the divine providence, and by presenting death as a universal necessity, a curative physician and a safe harbour. Voulgaris presented his views in the form of a consoling sermon, abundantly enriched with references to classical texts, the Bible and the Church Fathers, as well as to secular sources, including vital statistics from his contemporary England and France. Besides euthanasia, he introduced terms such as dysthanasia, etoimothanasia and prothanasia. The Treatise on euthanasia is one of the first books, if not the very first, devoted to euthanasia in modern European thought and a remarkable text for the study of the very early European attitudes towards "good death". In the Treatise, euthanasia is clearly meant as a spiritual preparation and reconciliation with dying rather than a physician-related mercy killing, as the term progressed to mean during the 19th and the 20th centuries. This early text is worthy of study not only for the historian of medical ethics or of religious ethics, but for everybody who is trying to courageously confront death, either in private or in professional settings.

  10. Analytical techniques for thin films treatise on materials science and technology

    CERN Document Server

    Tu, K N


    Treatise on Materials Science and Technology, Volume 27: Analytical Techniques for Thin Films covers a set of analytical techniques developed for thin films and interfaces, all based on scattering and excitation phenomena and theories. The book discusses photon beam and X-ray techniques; electron beam techniques; and ion beam techniques. Materials scientists, materials engineers, chemical engineers, and physicists will find the book invaluable.

  11. Jan Šindel and his treatise "Canones pro eclipsibus Solis et Lune" (United States)

    Hadravová, Alena

    Already in the first few decades after its foundation in 1348, the Charles University in Prague achieved remarkable results in astronomy. One of outstanding persons of this period, professor and rector of Prague University Iohannes Andreae, called Šindel (c. 1375-1456/8), will be briefly introduced. M. Jan Šindel is known as the astronomer in collaboration with whom the clockmaker Nicolaus of Kadaň constructed in 1410 the famous astronomical Clock of Prague. The most important Šindel's astronomical treatise "Canones pro eclipsibus Solis et Lune" is added to several manuscripts copies of Albion by Richard of Wallingford (c. 1292-1335), enlarged by M. Johann von Gmunden (1380-1442). This illustrates the connections between Prague and Vienna astronomical schools. In this treatise Šindel describes his version of eclipse instrument, a nomogram for calculation of eclipses of the Moon and Sun, which is a simplification of the more general Wallingford's instrument.

  12. Beautiful Surfaces. Style and Substance in Florentius Schuyl's Illustrations for Descartes' Treatise on Man. (United States)

    Chan, Eleanor


    The assumption that the Cartesian bête-machine is the invention of René Descartes (1596-1650) is rarely contested. Close examination of Descartes' texts proves that this is a concept founded not on the basis of his own writings, but a subsequent critical interpretation, which developed and began to dominate his work after his death. Descartes' Treatise on Man, published posthumously in two rival editions, Florentius Schuyl's Latin translation De Homine (1662), and Claude Clerselier's Traité de l'homme, has proved particularly problematic. The surviving manuscript copies of the Treatise on Man left no illustrations, leaving both editors the daunting task of producing a set of images to accompany and clarify the fragmented text. In this intriguing case, the images can be seen to have spoken louder than the text which they illustrated. This paper assesses Schuyl's choice to represent Descartes' Man in a highly stylized manner, without superimposing Clerselier's intentions onto De Homine.

  13. Pedro Nuñez and the first printed treatise on twilight observation (United States)

    Gadsden, M.

    Pedro Nuñez (the name is also written variously as Nunes, Nonius, Nonnius, and Nunnius) was born at Alcacer do Sol, Portugal, in 1502, and died in 1578. In that period and in that country, it was inevitable that his interests were in cosmography and navigation. His principal claim to fame is as author of the major treatise De Arte Atque Ratione Navigandi, which was published in 1546.

  14. Early Modern “Citation Index”? Medical Authorities in Academic Treatises on Plague (1480–1725)


    Karel Černý


    The paper deals with the problem of early modern scientific citations. It attempts to establish a measure of scientific popularity in a specific area of the academic medicine in a way which resembles a modern evaluation of scientific activity (citation index). For this purpose an analysis of a series of plague treatises written between 1480 and 1725 in Europe was conducted. Citations for various historical medical authorities (Hippocrates, Galen, etc.) are given in Tables which reflect a long...

  15. Curriculum Leadership and Teacher Development : Centering upon Fenwick W. English's Treatises on Curriculum Management


    中野, 和光


    This paper examined the nature of curriculum leadership based on Fenwick W. English's treatises on curriculum management. English studies educational administration as an interpretive human science and not as a positive science. Interpretation and understanding of human affair is important in human science. And criticism is made much of, too. From this standpoint, he approaches to curriculum management emphasizing the importance of quality management and deep alignment. We need understanding ...

  16. The Arthasastra: Assessing the Contemporary Relevance of an Ancient Indian Treatise on Statecraft (United States)


    examined and associated with contemporary vocabulary . Scholars describe the contents of Kautilya’s treatise as rules, doctrines, concepts, models...thought and enables the creation of a “Kautilyan” vocabulary . To assist the reader in understanding the approximate meanings, this paper will include the...Modelski, 551. 74 Liebig, 10. 28 Kautilya’s Concept of Relative Power and Objectives of State Policy Kautilya defines three kinds of power, which

  17. The Ionian Muses learn to write: written law and prose treatise in the milesinad and Heraclitus

    Directory of Open Access Journals (Sweden)

    Raúl Caballero


    Full Text Available Throughout s. VI B. C., the first Ionic investigators of the nature chose as way of expression a procedure practically unexplored at that time: the writing in prose. This technology had been only proved previously in the field of the cities written legislation, which liked to use enormous stone inscriptions to show or advertise the laws and community regulations. This publicity was also good to reinforce with the strenght of the lasting thing the civic authority, from which emanated a compulsory law to be carried out. In this work, we try to show that the production and publication ways of the laws were good in certain extent to the first philosophers as reference models for the publication of their own treatises in prose (συγγραφή. That publication existed without a doubt, but it was not claimed by a demand reader mainly, but rather it pursued to reinforce the message locked in the papyrus roll with the authority associated to the written promulgation of the laws. It was, threrefore, a question of symbolic mediation between the philosopher and the city: comparing their work to the law of the city, he claimed the normative and universal force from the cosmos described in the treatise in prose, that enunciated valid laws for all the men and everywhere. In this work, we will explore this hypothesis studying the sociopolitical background that is outlined after the publication of the treatises of Anaximander, Anaximenes and, mainly, Heraclitus. The offering of Heraclitus book to the temple of Artemis in Ephesus can be interpreted from this new perspective.

  18. Early Modern “Citation Index”? Medical Authorities in Academic Treatises on Plague (1480–1725

    Directory of Open Access Journals (Sweden)

    Karel Černý


    Full Text Available The paper deals with the problem of early modern scientific citations. It attempts to establish a measure of scientific popularity in a specific area of the academic medicine in a way which resembles a modern evaluation of scientific activity (citation index. For this purpose an analysis of a series of plague treatises written between 1480 and 1725 in Europe was conducted. Citations for various historical medical authorities (Hippocrates, Galen, etc. are given in Tables which reflect a long time development of popularity. The authorities from various groups (Ancient, Medieval, Arabic, Early Modern are linked together, and “generic authorities” are explained and discussed.

  19. Early modern "citation index"? Medical authorities in academic treatises on plague (1480-1725). (United States)

    Cerný, K


    The paper deals with the problem of early modern scientific citations. It attempts to establish a measure of scientific popularity in a specific area of the academic medicine in a way which resembles a modern evaluation of scientific activity (citation index). For this purpose an analysis of a series of plague treatises written between 1480 and 1725 in Europe was conducted. Citations for various historical medical authorities (Hippocrates, Galen, etc.) are given in Tables which reflect a long time development of popularity. The authorities from various groups (Ancient, Medieval, Arabic, Early Modern) are linked together, and "generic authorities" are explained and discussed.

  20. The Gramática of Nebrija (1492: a didactic treatise and its typography

    Directory of Open Access Journals (Sweden)

    René Pellen


    Full Text Available This paper intends to show the potential interest for linguistic, cultural and socio-historical research of a detailed analysis of the structure and typography of the GC. The aim of this paper is to show the advantages of a system of reference first proposed in v. LXXXIX/2, 2009, of the RFE. Through close examination of its typography, the main characteristics of the text as a didactic treatise soon appear; it also becomes possible to observe certain features of Renaissance prose as it moves towards modern standards (chapter, paragraph, utterances, syntax.

  1. Preparation and properties of thin films treatise on materials science and technology

    CERN Document Server

    Tu, K N


    Treatise on Materials Science and Technology, Volume 24: Preparation and Properties of Thin Films covers the progress made in the preparation of thin films and the corresponding study of their properties. The book discusses the preparation and property correlations in thin film; the variation of microstructure of thin films; and the molecular beam epitaxy of superlattices in thin film. The text also describes the epitaxial growth of silicon structures (thermal-, laser-, and electron-beam-induced); the characterization of grain boundaries in bicrystalline thin films; and the mechanical properti

  2. Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life. (United States)

    Pottel, L; Lycke, M; Boterberg, T; Pottel, H; Goethals, L; Duprez, F; Van Den Noortgate, N; De Neve, W; Rottey, S; Geldhof, K; Buyse, V; Kargar-Samani, K; Ghekiere, V; Debruyne, P R


    Head and neck (H&N) cancer is mainly a cancer of the elderly; however, the implementation of comprehensive geriatric assessment (CGA) to quantify functional age in these patients has not yet been studied. We evaluated the diagnostic performance of screening tools [Vulnerable Elders Survey-13 (VES-13), G8 and the Combined Screening Tool 'VES-13 + (17-G8)' or CST], the feasibility of serial CGA, and correlations with health-related quality of life evolution [HRQOL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ)-C30 and -HN35] during therapy in hundred patients, aged ≥65 years, with primary H&N cancer undergoing curative radio(chemo)therapy. Respectively 36.8%, 69.0%, 62.1% and 71.3% were defined vulnerable according to VES-13, G8, CST and CGA at week 0, mostly due to presence of severe grade co-morbidities, difficulties in community functioning and nutritional problems. At week 4, significantly more patients were identified vulnerable due to nutritional, functional and emotional deterioration. The CST did not achieve the predefined proportion necessary for validation. Vulnerable patients reported lower function and higher symptom HRQOL scores as compared with fit patients. A comparable deterioration in HRQOL was observed in both groups through therapy. In conclusion, G8 remains the screening tool of choice. Serial CGA identifies the evolution of multidimensional health problems and HRQOL conditions during therapy with potential to guide individualised supportive care. © 2014 John Wiley & Sons Ltd.

  3. Notarial Practice Treatises in the Libraries of XVIII c. Neogranadino Scribes

    Directory of Open Access Journals (Sweden)

    Alfonso Rubio Hernández


    Full Text Available Among the personal libraries of numerary and cabildo scribes during the XVIII c. in the New Kingdom of Granada, we find the presence of forms, treatises or practical manuals inscribed in the tradition of european juridicial “ars notariae” literature, which exercised a fundamental function in the social and economic development of American cities, this task that has been scarcely studied by Colombian historiography. This study analyzes the Post Mortem Inventaries of the scribes Jacobo Facio Lince, Mariano Bueno, Juan Andrés Sandoval and Joaquín Sánchez de la Flor, who exercized their practice in the cities of Medellín, Cartago and Popayán. After a characterization of the personal library archives of these scribes, this study focuses on the individual description of the notarial treatises found, and their circulation in the Indies.

  4. Postmastectomy radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shikama, Naoto; Koguchi, Masahiko; Sasaki, Shigeru; Kaneko, Tomoki; Shinoda, Atsunori; Nishikawa, Atsushi [Shinshu Univ., Matsumoto, Nagano (Japan). School of Medicine


    Since there have been few reports on postmastectomy radiotherapy having a high evidence level in Japan, the significance of postoperative radiotherapy and the irradiation techniques were reviewed based on reports from Western countries. Authors focused on the indications for postoperative irradiation, irradiation methods (irradiation sites, irradiation techniques; prosthetics, methods of irradiating the chest wall and lymph nodes, timing of irradiation), and complications, and discuss them. The factors thought to be adaptable to postmastectomy radiotherapy have been listed. Axillary lymph node metastasis and the size of the primary focus are thought to be important factors in locoregional recurrence. The chest wall and the supraclavicular lymph nodes are the usual sites of irradiation after mastectomy. The irradiation method consists of tangential irradiation of the chest wall and single-field irradiation of the supraclavicular lymph nodes, with 46-50 Gy in fractional doses of 1.8-2 Gy x 5/w is administered for 4.5-5.5 weeks. The timing of irradiation in the West is generally after chemotherapy. Adverse radiation effects include ischemic heart disease, pneumonitis, arm edema, rib fractures, and brachial plexus paralysis. The frequency of these complications is increased by the combined use of chemotherapy or surgery. The breast cancer cure rate in Japan is generally better than in the West. It remains to be determined whether the clinical data from Europe and America are applicable to the treatment of breast cancer in Japan. To address this issue, a clinical investigation should be performed in Japan with close cooperation between surgeons, physicians, pathologists, and radiotherapists. (K.H.)

  5. Radiotherapy Breast Boost With Reduced Whole-Breast Dose Is Associated With Improved Cosmesis: The Results of a Comprehensive Assessment From the St. George and Wollongong Randomized Breast Boost Trial

    Energy Technology Data Exchange (ETDEWEB)

    Hau, Eric, E-mail: [Cancer Care Centre, St. George Hospital, Kogarah, Sydney (Australia); Browne, Lois H.; Khanna, Sam; Cail, Stacy; Cert, Grad; Chin, Yaw; Clark, Catherine; Inder, Stephanie; Szwajcer, Alison; Graham, Peter H. [Cancer Care Centre, St. George Hospital, Kogarah, Sydney (Australia)


    Purpose: To evaluate comprehensively the effect of a radiotherapy boost on breast cosmetic outcomes after 5 years in patients treated with breast-conserving surgery. Methods: The St. George and Wollongong trial (NCT00138814) randomized 688 patients with histologically proven Tis-2, N 0-1, M0 carcinoma to the control arm of 50 Gy in 25 fractions (342 patients) and the boost arm of 45 Gy in 25 fractions to the whole breast followed by a 16 Gy in 8 fraction electron boost (346 patients). Five-year cosmetic outcomes were assessed by a panel subjectively in 385 patients and objectively using pBRA (relative breast retraction assessment). A subset of patients also had absolute BRA measurements. Clinician assessment and patient self-assessment of overall cosmetic and specific items as well as computer BCCT.core analysis were also performed. Results: The boost arm had improved cosmetic overall outcomes as scored by the panel and BCCT.core software with 79% (p = 0.016) and 81% (p = 0.004) excellent/good cosmesis respectively compared with 68% in no-boost arm. The boost arm also had lower pBRA and BRA values with a mean difference of 0.60 and 1.82 mm, respectively, but was not statistically significant. There was a very high proportion of overall excellent/good cosmetic outcome in 95% and 93% in the boost and no-boost arms using patient self-assessment. However, no difference in overall and specific items scored by clinician assessment and patient self-assessment was found. Conclusion: The results show the negative cosmetic effect of a 16-Gy boost is offset by a lower whole-breast dose of 45 Gy.

  6. Peripheral nerve disorders and treatment strategies according to Avicenna in his medical treatise, Canon of medicine. (United States)

    Aciduman, Ahmet; Er, Uygur; Belen, Deniz


    The written transmission of knowledge has played a great part in the advancement of medicine, and historical documents hold the key to a full exploration of the history of medicine. Some fields, including disciplines that deal with peripheral nerve disorders, have received little benefit from such valuable material. In particular, peripheral nerve surgery lacks perspectives from historical data. For many years, physicians have obtained positive results in the surgical treatment of peripheral nerve diseases. Relevant documents reveal that the first author who described the surgical repair of damaged peripheral nerves was Avicenna, a leading figure of the medieval era who lived in the Middle East. In his primary medical work, the Canon, he provides a description, albeit sketchy, of a suture procedure for peripheral nerve transection. This treatise influenced physicians for several centuries. In this presentation, we analyze excerpts from the Canon that concern peripheral nerve disorders and strategies for their management.

  7. Patchwork protein chemistry: a practitioner's treatise on the advances in synthetic peptide stitchery. (United States)

    Verzele, Dieter; Madder, Annemieke


    With the study of peptides and proteins at the heart of many scientific endeavors, the omics era heralded a multitude of opportunities for chemists and biologists alike. Across the interface with life sciences, peptide chemistry plays an indispensable role, and progress made over the past decades now allows proteins to be treated as molecular patchworks stitched together through synthetic tailoring. The continuous elaboration of sophisticated strategies notwithstanding, Merrifield's solid-phase methodology remains a cornerstone of chemical protein design. Although the non-practitioner might misjudge peptide synthesis as trivial, routine, or dull given its long history, we comment here on its many advances, obstacles, and prospects from a practitioner's point of view. While sharing our perspectives through thematic highlights across the literature, this treatise provides an interpretive overview as a guide to novices, and a recap for specialists. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  8. Nicole Oresme's, De visione stellarum (On seeing the stars) a critical edition of Oresme's treatise on optics and atmospheric refraction

    CERN Document Server

    Burton, Dan


    A translation of ""On Seeing the Stars"", Nicole Oresme's 14th-century treatise on atmospheric refraction, in which Oresme uses optics and infinitesimals to help solve the problem of astronomy, while proposing that light travels along a curve through the atmosphere.

  9. Mathematical instrumentation in fourteenth-century Egypt and Syria the illustrated treatise of Najm al-Din al-Misri

    CERN Document Server

    Charette, F


    An illustrated Arabic treatise, with an English translation and detailed commentary, on the construction of over 100 various astronomical instruments, many of which are otherwise unknown to specialists. It was composed by Najm al-Din al-Misri, a rather shadowy figure, in Cairo around 1330 CE.

  10. Erōs and chorasis in Plotinus’ Treatise On Love

    Directory of Open Access Journals (Sweden)

    Sonja Weiss


    Full Text Available The article focuses on the role of Love as the relation of the Soul to the object of its love – supreme Beauty. Since this relation comes into existence as an act of contemplation, the driving force behind the Plotinian emanation process, the study pays particular attention to Plotinus’ contemplation theory, where Eros, as the Soul’s Eye, plays an important role. While the word ‘relation’ normally implies only the existence of the two related realities, Plotinus’ Love-Relation is itself a substance (οὐσία. Secondly, the article confronts the challenge posed by the Plotinian allegorical interpretation of various myths and allegories, especially Plato’s, related to the figure of Eros as god and daemon. The most controversial point of Plotinus’ interpretation is his inclusion of Eros, a ‘mixed’ and imperfect reality, in the emanation process, by representing the god Eros (Love, the son of Afrodite (the Soul, as actively involved in her contemplation of supreme Beauty. By itself, this point would present no problems, had not Plotinus included in his doctrine of the Soul’s contemplation Plato’s allegorical figure of Penia (Poverty, which is, in the Symposium, the cause of the imperfect and dissatisfied nature of Love the daemon. It is no wonder, then, if one of the most eminent experts on Plotinus, A. H. Armstrong, opined (in a single note, which, however, reverberated in other editions of this treatise that Plotinus may have gone beyond all his attested doctrines here. The article tries to dispel this doubt by showing that Plotinus’ symbolism of Penia is supported by his doctrine of noetic matter, adducing precisely his contemplation theory, according to which the unlimited, undefinable quality appears at the very core of the emanation process. Plotinus’ treatise on Eros, which begins as a commentary on one of Plato’s passages, thus develops into a multilayered theory of a substantialised relation of the Soul

  11. Pediatric radiotherapy planning and treatment

    CERN Document Server

    Olch, Arthur J


    "This is a very well-written and -organized book covering the planning and delivery aspects unique to pediatric radiotherapy. The author is a respected and well-known medical physicist with extensive pediatric radiotherapy experience. … a very useful book for any clinical physicist treating pediatric cases and seeking contextual and historical perspective. … a great reference for medical physicists who may not see many pediatric cases and can look to this text as a one-stop shop for not only a comprehensive overview, but detailed explanation for specific pediatric disease sites. Overall, it is a great addition to the reference library of any radiation therapy physicist."-Medical Physics, April 2014.

  12. A Treatise for A New Age in Economic Theory: A Review of George Reisman's Capitalism

    Directory of Open Access Journals (Sweden)

    Wladimir Kraus


    Full Text Available George Reisman’s magnum opus Capitalism: A Treatise on Economics is a monumental attempt at theoretical integration of leading economic phenomena into one unified whole. Few such books have been published in the history of economics. Still fewer of them contain a comparable proportion of path-breaking innovations both in approach and substance that are integrated in a tightly-spun system of thought that Capitalism does. Yet despite its numerous path-breaking contributions to economic theory, the book has attracted virtually zero attention from the scientific community. History shows that for the most part this has been the fate of all great innovations in science. This review attempts (a to point out reasons why the book’s content is revolutionary, and (b to finally start a serious discussion of its substantive ideas. Specifically, the review focuses in some detail on some of Reisman’s most important innovations which all point the way to a wholly new direction in economic theory that promises to provide the hitherto unseen conformity with empirical reality, analytical rigor, and doctrinal integration.

  13. Text recovery from the ultraviolet-fluorescent spectrum for treatises of the Archimedes Palimpsest (United States)

    Bloechl, Kevin; Hamlin, Hugh; Easton, Roger L., Jr.


    It has been reported previously that the readability of text in the original Archimedean treatises in the Archimedes Palimpsest is enhanced by spatially normalizing the images and rendering spectral differences in pseudocolor. Though this method worked well for some of the original texts in the palimpsest, the readability of the original text was improved little or not at all on leaves of a commentary on Aristotle's "Categories" by Alexander of Aphrodisias. This is not very surprising, since the various original works within the palimpsest were written by different scribes at various times and places, so the spectral responses of the inks in different manuscripts may be different. However, there is much scholarly interest in the readings from this text, so different image processing techniques were implemented. It was found that significant text information could be recovered from this manuscript by principal component analysis applied to color images of the fluorescence generated under ultraviolet illumination. This result indicates that useful text information is conveyed by the spectrum of the ultraviolet fluorescence. The success of this technique has changed the protocol used in image collections with other manuscripts.

  14. Radiotherapy for Hodgkin lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Specht, Lena [Rigshospitalet Copenhagen Univ. (Denmark). Depts. of Oncology and Haematology; Yahalom, Joachim (eds.) [Memorial Sloan-Kettering Cancer, New York, NY (United States). Dept. of Radiation Oncology


    This book deals in detail with all aspects of the best practice in modern radiotherapy for Hodgkin lymphoma. It provides the background and rationale for the inclusion of radiotherapy in today's combined-modality approach, including special clinical situations such as Hodgkin lymphoma in children, in the pregnant patient, and in the elderly. Radiotherapy planning using state-of-the-art imaging, target definition, planning software, and treatment equipment is expounded in detail. Acute and long-term side effects of radiotherapy are analyzed, and the implications for modern radiotherapy approaches in Hodgkin lymphomas are explained. (orig.)

  15. [The anti-philosophical anthropology in the Hippocratic treatise De Vetere Medicina (On Ancient Medicine)]. (United States)

    Imai, Masahiro


    The Hippocratic treatise De Vetere Medicina (On Ancient Medicine) has been the focus of attention among classical scholars and historians of medicine. The author attacks in ch. 20 doctors and sophists who base their own medical theories and methods on philosophical anthropology taken from the contemporary natural philosophers. Many attempts have been made to elucidate, as opposed to their philosophical inquiry into human nature, the author's way of understanding it, which still remains unclear. I draw attention to the following points to make it clear that the conceptual framework of the author's medical anthropology is different from theirs. Their philosophical inquiry into human nature has its starting point in fundamental element(s), from which human beings were originally formed. The author focuses on human beings as existent in their present states, whose conditions and functions must be investigated through interrelations between them and their external factors, such as foods and drinks. A medical investigation into the interrelations will give us a scientific idea about human body, whose constituents are taken to be a large number of humors, reacting against some external factors and accordingly making us feel pain. This may presuppose that, in the author's medical anthropology, human body is conceptually demarcated as the physical or material aspect of human being, within which all physiological events depending on external factors and the humors take place. In their philosophical anthropology, however, human body doesn't seem to have been clearly conceptualized as such, because our experience of feeling pain should be judged to take place within the actions of the fundamental element(s), which must be supposed to constitute our cognitive self.

  16. Treatise on skull fractures by Berengario da Carpi (1460-1530). (United States)

    Mazzola, Riccardo F; Mazzola, Isabella C


    Jacopo Berengario was born in Carpi, a medieval city close to Modena (northern Italy), circa 1460. He studied medicine at Bologna University and, in 1489, graduated in philosophy and medicine. He was appointed lecturer in anatomy and surgery at the same university, a position that he maintained for 24 years. Between 1514 and 1523, Berengario published some important anatomic and surgical works, which gave considerable fame to him.Commentaria... supra Anatomiam Mundini (Commentary... on the Anatomy of Mondino), published in 1521, constitutes the first example of an illustrated anatomic textbook ever printed. The anatomic illustrations were intended for explaining the text. Artistically speaking, the plates are typical examples of the Renaissance period and worthy of the greatest consideration.De Fractura Calvae sive Cranei (On Fracture of the Calvaria or Cranium), published in Bologna in 1518, is the first treatise devoted to head injuries ever printed. It is a landmark in the development of cranial surgery that went through numerous editions. The text was prepared in 2 months and dedicated to Lorenzo de' Medici, Duke of Urbino, who experienced a skull injury in the occipital region. Berengario wanted to demonstrate to other physicians his knowledge of anatomy and his expertise on the brain and head traumas. The book includes the illustration of an entire surgical kit or a corpus instrumentorum for performing cranial operations, which appeared for the first time in a printed book. However, Berengario's highly commendable aim was to indicate to the reader the step-by-step procedure of craniotomy for management of skull fractures along with the sequential use of the previously presented instruments.

  17. On Symbol and Symbolism in Origen’s Treatise «Contra Celsum»

    Directory of Open Access Journals (Sweden)

    Kurdybailo Dmitrii


    Full Text Available The article describes a context analysis of terms σUμβολον and τUπος in Origen’s treatise Contra Celsum. The Christian, Gnostic and pagan types of symbolism are distinguished as they are introduced by Origen and his opponent. Each type has its specifi c understanding of symbol in the ontological area, which then is projected onto exegesis of authoritative texts of each tradition. Christian symbolism is traced through various examples of Origen’s commentaries on the Bible to distinguish σUμβολον from τUπος, which are treated as representing “vertical” and “horizontal” relations between referent and denotation. Pagan symbolism is built up from concepts of pagan gods’ veneration and theurgy, with the latter related to the theory of universal sympathy. Gnostic conception of symbols is based on the metaphysical goal of human souls to escape from the fallen universe using symbols (extracted primarily from the text of New Testament and authoritative Gnostic texts as a ‘key’ or ‘password’ for not to be seized by guarding spirits. Finally, a more subtle distinction is proposed to underline ontologic difference between symbol and allegory as they are based on different types of referent– denotation link. As a result, a generalized outline of Origen’s symbolism is formulated as a series of features distinguishing it from concurrent types of symbolism as well as from typology and allegory in Christian discourse.

  18. [Radiotherapy of bone metastases]. (United States)

    Thureau, S; Vieillard, M-H; Supiot, S; Lagrange, J-L


    Radiotherapy plays a major role in palliative treatment of bone metastases. Recent developments of stereotactic radiotherapy and intensity modulated radiation therapy give the possibility to treat oligometastatic diseases. The objective of this paper is to report indications and treatment modalities of radiotherapy in these situations. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  19. Radiotherapy in small countries. (United States)

    Barton, Michael B; Zubizarreta, Eduardo H; Polo Rubio, J Alfredo


    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.

  20. Chinese vegetative materia medica in a venereological treatise by Jean Astruc from 1740. (United States)

    Drobnik, Jacek


    Historical medical sources can be still queried for forgotten cures and remedies. Traditional Chinese medicine has dealt with lues venerea (syphilis) since the Five Dynasties period (10th century). Chinese indigenous materia medica and remedies recorded, studied or imported by the Europeans can reveal known or quite unknown medicinal plants. The studied Jean Astruc's work is a published ethnopharmacological survey carried out in Beijing in the 1730s and it deserves a modern interpretation. This is the first proposal to identify historical Chinese medicinal plants listed in a scarcely known medical treatise De Morbis venereis… ('On venereal diseases…') by Jean Astruc from 1740. I searched for the current uses and position of the taxonomically identified herbal stock in both traditional Chinese and official medical knowledge, with special attention to syphilis. Chinese names of drugs and their botanical identities (originally expressed by means of pre-Linnaean polynomials, and now interpreted as accepted binomials) were independently cross-checked with younger till most recent taxonomical and ethnopharmacological sources. Plants and drugs identified this way were queried for their modern applications in traditional Chinese and official medicine with special attention to sexually transmitted diseases (STD) and other uses which are similar to the 18th-century understanding of venereology. For 24 items of medicinal stock, 34 medicinal plants have been identified or suspected: Acacia catechu, Achyranthes bidentata, Akebia quinata, Angelica dahurica, A. sinensis, Aquilaria sinensis, Aralia cordata, Aristolochia fangchi, Chaenomeles sinensis, Ch. speciosa, Clematis vitalba, Coix lacryma-jobi, Commiphora myrrha, Cydonia oblonga, Daemonorops draco, D. jenkinsiana, Dictamnus dasycarpus, Dryobalanops sumatrensis, Forsythia suspensa, Glycyrrhiza uralensis, Lonicera confusa, L. hypoglauca, L. japonica, Ligusticum striatum (=L. chuanxiong), Piper kadsura, Pterocarpus

  1. From A Treatise on Money to the General Theory: John Maynard Keynes' Departure from the Doctrine of Forced Saving


    Wong, Ho-Po Crystal


    I examine John Maynard Keynes' struggle with the doctrine of the classical forced saving during the period 1924-1936 from when he worked on A Treatise on Money to the completion of his General Theory. The forced saving notion has been developed as a key mechanism of how monetary expansion results in wealth redistribution and change in production in the classical school. I primarily focus on the role of discussion and criticism in the development of Keynes' thought. I investigate what led John...

  2. [Study on processing adjuvant medicines in Lei Gong's treatise on preparation and broiling of materia medica (Leigong Paozhi Lun)]. (United States)

    Zhang, Wei; Zhang, Ruixian


    There were 268 kinds of medicines recorded in the book of Lei Gong's Treatise on preparation and broiling of materia medica (Leigong Paozhi Lun). Among these medicines, 178 medicines were prepared with adjuvant medicines, including general and special compatible adjuvant medicines. These adjuvant medicines used in this book can be explained by the theory of "seven-relation compatibility". The author tried to explain the usage and their compatibility of these adjuvant medicines and put forward that attention should be paid to the changes in functions of medicines and the influences of society should be paid attention.

  3. Parotid gland sparing radiotherapy

    NARCIS (Netherlands)

    Braam, P.M.


    Introduction Radiotherapy is a common form of treatment for head-and-neck malignancies. One of the most prominent complaints after radiotherapy is a dry mouth, which is caused by irradiation of the salivary glands. The main contributors of saliva during stimulation are the parotid glands, which are

  4. Radiotherapy: An Update

    Directory of Open Access Journals (Sweden)

    Vikrant Kasat


    Full Text Available Radiotherapy is the art of using ionizing radiation to destroy malignant cells while minimizing damage to normal tissue. Radiotherapy has become a standard treatment option for a wide range of malignancies. Several new imaging techniques, both anatomical and functional are currently being evaluated as well as practiced for treatment planning of cancer. These recent developments have allowed radiation oncologists to escalate the dose of radiation delivered to tumors while minimizing the dose delivered to surrounding normal tissue. In this update, we attempt to pen down important aspects of radiotherapy.

  5. [Radiotherapy of skin cancers]. (United States)

    Hennequin, C; Rio, E; Mahé, M-A


    The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomised trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and occurring in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60 to 70Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45 to 50Gy), for locally advanced tumours (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radiotherapy (50 to 56Gy) for Merckel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24 to 30Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  6. A Medieval Irish Treatise on Astronomy Recalled, with a Memoir of its Translator and Editor, Maura Power (1887-1916) (United States)

    Bruck, M. T.; Conway-Piskorski, M.


    A 15th century treatise on astronomy in Irish, an adaptation of a Latin translation of an older Arabic text, was transcribed and published together with an English translation and commentaries under the title An Irish Astronomical Tract in 1914. This work is familiar to Celtic language scholars but is little known among astronomers. Here we briefly describe the text, and include a memoir of its editor and translator Maura Power, a young woman who combined a specialist knowledge of the Irish language with an understanding of medieval science. We also recall two other Irish scholars - the geologist Maxwell Close and the astronomer John Ellard Gore - who played their part in recognizing the value of this early Irish scientific text.

  7. [Advantages and disadvantages of postoperative radiotherapy in locally advanced gastric cancer]. (United States)

    Wang, Xin; Jin, Jing


    Gastric cancer is one of the most common cancers worldwide. Radical surgery remains the cornerstone of the treatment, however, outcomes are poor. As an effective, non-invasive treatment modality, radiotherapy constitutes an important part of the comprehensive therapy for locally advanced gastric cancer. The improved target coverage and accuracy of intensity-modulated radiotherapy allow for selective sparing of critical structures and reduce toxicity. With the use of new anti-cancer drugs and the progression of radiotherapy techniques, chemoradiotherapy may be of value in the future. This paper discusses the advantages and disadvantages of adjuvant radiotherapy in gastric cancer based on efficacy and toxicity.

  8. Nanoparticle-guided radiotherapy

    DEFF Research Database (Denmark)


    The present invention relates to a method and nano-sized particles for image guided radiotherapy (IGRT) of a target tissue. More specifically, the invention relates to nano-sized particles comprising X-ray-imaging contrast agents in solid form with the ability to block x-rays, allowing for simult......The present invention relates to a method and nano-sized particles for image guided radiotherapy (IGRT) of a target tissue. More specifically, the invention relates to nano-sized particles comprising X-ray-imaging contrast agents in solid form with the ability to block x-rays, allowing...... for simultaneous or integrated external beam radiotherapy and imaging, e.g., using computed tomography (CT)....

  9. Haemorrhagic cystitis after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)


    Sterile hemorrhagic cystitis may occur during or immediately after radiotherapy; a frequency of 4.6% has been reported at up to four weeks from the completion of 60-80 Gy. It is usually self-limiting. The frequency of late hemorrhagic cystitis is reported to be 2-9%, although less severe bleeding must be commoner. Combination of pelvic radiotherapy with systemic cyclophosphamide greatly increases the risk of serious bleeding, with a frequency of 18% being reported in one series of children. This note outlines the various treatment options, involving both drugs and surgery.

  10. Xerostomia induced by radiotherapy

    Directory of Open Access Journals (Sweden)

    Alimi D


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

  11. Palliative radiotherapy and oncology nursing. (United States)

    McMenamin, Erin; Ross, Nicole; Jones, Joshua


    To describe indications and expected outcomes for palliative radiotherapy and to highlight opportunities for nurse involvement in palliative radiotherapy. Journal articles, clinical guidelines, case studies. Palliative radiotherapy is a safe, effective treatment modality for many symptoms of advanced cancer. Opportunities exist to help patients and families opt for shorter palliative radiotherapy courses when quality of life is the goal. Nurses involved in the care of patients receiving palliative radiotherapy must be aware of the indications and expected outcomes associated with therapy. Nurses can play an important role in the management of symptoms, education, and communication between the team and the patient and family.

  12. [Radiotherapy for intrathoracic metastases]. (United States)

    Giraud, P; Lacornerie, T; Mornex, F


    Indication, doses, and technique of radiotherapy, for intrathoracic metastases are presented. The recommendations for delineation of the target volumes and organs at risk are detailed. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  13. Innovations in Radiotherapy Technology. (United States)

    Feain, I J; Court, L; Palta, J R; Beddar, S; Keall, P


    Many low- and middle-income countries, together with remote and low socioeconomic populations within high-income countries, lack the resources and services to deal with cancer. The challenges in upgrading or introducing the necessary services are enormous, from screening and diagnosis to radiotherapy planning/treatment and quality assurance. There are severe shortages not only in equipment, but also in the capacity to train, recruit and retain staff as well as in their ongoing professional development via effective international peer-review and collaboration. Here we describe some examples of emerging technology innovations based on real-time software and cloud-based capabilities that have the potential to redress some of these areas. These include: (i) automatic treatment planning to reduce physics staffing shortages, (ii) real-time image-guided adaptive radiotherapy technologies, (iii) fixed-beam radiotherapy treatment units that use patient (rather than gantry) rotation to reduce infrastructure costs and staff-to-patient ratios, (iv) cloud-based infrastructure programmes to facilitate international collaboration and quality assurance and (v) high dose rate mobile cobalt brachytherapy techniques for intraoperative radiotherapy. Copyright © 2016 The Royal College of Radiologists. All rights reserved.

  14. [Radiotherapy of oropharynx carcinoma]. (United States)

    Servagi Vernat, S; Tochet, F; Vieillevigne, L; Pointreau, Y; Maingon, P; Giraud, P


    Indication, doses, technique of radiotherapy and concomitant chemotherapy for oropharynx carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  15. The use of animals in medicine of Latin tradition: study of the Tresor de Beutat, a medieval treatise devoted to female cosmetics


    Betlloch Mas, Isabel; Chiner, Eusebi; Chiner Betlloch, Jordi; Llorca Ibi, Francesc Xavier; Martín Pascual, Llúcia


    Zootherapy has belonged to the dermatological treatment in various cultures through the ages. The Tresor de Beutat is a medieval treatise devoted to female cosmetics and health, written from eastern Spain in the 14th century. Many of these treatments were from animal origin. We transcribed the Tresor de Beutat to determine which animals and which parts of animals were used, as well as how they were used and what the therapeutic indications were. A total of 223 elements (animals, plants and mi...

  16. "Was Keynes's Monetary Policy, a outrance in the Treatise, a Forerunnner of ZIRP and QE? Did He Change His Mind in the General Theory?"


    Jan Kregel


    At the end of 1930, as the 1929 US stock market crash was starting to have an impact on the real economy in the form of falling commodity prices, falling output, and rising unemployment, John Maynard Keynes, in the concluding chapters of his Treatise on Money, launched a challenge to monetary authorities to take "deliberate and vigorous action" to reduce interest rates and reverse the crisis. He argues that until "extraordinary," "unorthodox" monetary policy action "has been taken along such ...

  17. Magic squares in the tenth century twoAarabic treatises by Anṭākī and Būzjānī

    CERN Document Server

    Sesiano, Jacques


    This volume contains the texts and translations of two Arabic treatises on magic squares, which are undoubtedly the most important testimonies on the early history of that science. It is divided into the three parts: the first and most extensive is on tenth-century construction methods, the second is the translations of the texts, and the third contains the original Arabic texts, which date back to the tenth century. .

  18. Pigments and dyes of the works of art in Portugal, in the beginning of the 17th century, according to the Filipe Nunes' treatise on painting

    Directory of Open Access Journals (Sweden)

    António João Cruz


    Full Text Available The painting treatise published in 1615 by Filipe Nunes, entitled Arte da Pintura, has great significance for the study of the 17th century Portuguese painting materials and techniques, especially for the first half of the century. However, the mentioned pigments and dyes are not always easy to identify due to the changes in nomenclature that have occurred since then. This study pretends to report those materials and to establish the correspondence between them and the modern names. Whenever the materials identification was not evident, several sources of data were considered: the details provided by the treatise, the studies already published relevant to the subject and several documentary sources, particularly those of the time. Although some doubts still persist about some names, 24 pigments and 10 dyes were identified. This study has provided information that will constitute a reference useful for the analytical study of works of art, the conservation treatments and the interpretation of other technical treatises. It has also brought to light the great diversity of dyes that might have been used in works of art, as opposed to the few cases where they have been identified by analysis. This suggests that redoubled care should be taken in scientific studies of works of art, where the information obtained by conservators-restorers should play an important role.

  19. [Intraoperative radiotherapy. Preliminary results]. (United States)

    Maingon, P; Fraisse, J; Brun, O; Salas, S; Naudy, S; Bernard, A; Goudet, P; Chalencon, J L; Minello, C; Pillet, M


    We report a series of 40 patients treated by intraoperative radiotherapy between 1988 and 1992 (18 primary tumors, 13 local recurrences and 9 nodal extensions). The doses delivered were 15 Gy to 25 Gy, completed by external radiotherapy (15 to 45 Gy) in 13 cases. The local tumor control rate was 61% for initial therapy in primary tumors (70% for adenocarcinoma of the stomach) and 80.9% after complete en bloc surgery. The local control rate after palliative surgery for local recurrences is 38% and 33% for nodal extension. Two patients died (5%) during the postoperative period. We observed 2 hemorrhages and 3 cases of stone-free cholecystitis. The value of this approach must be confirmed in rigorous indications in comparison with surgery alone in controlled and randomised clinical trials.

  20. Radiotherapy of hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Gauwerky, F.


    The findings about the regular, spontaneous and complete regression of cavernous skin hemangiomas occurring in infants and those findings about the damaging effects due to ionising radiation - here particularly local growth disturbances - led to the development of very cautious diagnostic methods and to a considerate individual dosage and radiotherapy, which always takes into consideration the spontaneous regression tendency of the hemangiomas. However, a function-impairing localisation at the orifices, fulminant macrosomia, tendency to hemorrhages and poly-infection with superficial ulceration and even thrombopenic syndromes of the Kasabach-Merritt type may become necessary, urgent and also vital indications for a particular radiotherapy. For the sake of the patients, irradiation methods, which do not provoke any risk of radiation hazards, have to be preserved and applied in practice. Certainly further research and the nosologic nature of hemangiomas is required. A general non-treatment of hemangiomas is refused.

  1. Postoperative radiotherapy for ependymoma

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jin Hong; Ahn, Seung Do; Park, Jin Hong [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); and others


    To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

  2. Radiotherapy of vertebral hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Sakata, Kohichi; Hareyama, Masato; Oouchi, Atushi; Sido, Mitsuo; Nagakura, Hisayasu; Tamakawa, Mituharu; Akiba, Hidenari; Morita, Kazuo [Dept. of Radiology, Sapporo Medical Univ., School of Medicine (Japan)


    Between 1975 and 1996, 14 patients (11 females, 3 males) with vertebral hemangioma received treatment with radiotherapy. Thirteen patients had a history of back pain or lumbago and 2 patients had neurological symptoms such as sensory impairment or paraplegia. The standard dose administered was 36 Gy in 18 fractions (five treatments per week). In the 13 patients with pain, this was completely or partially relieved. The condition of a man with hypesthesia of the legs deteriorated and a woman with paraplegia who was treated with decompressive laminectomy followed by radiotherapy recovered completely after irradiation. CT scan before irradiation showed thickened trabeculae as small punctate areas of sclerosis in all patients. At MR imaging before irradiation, T2-weighted MR images showed areas of high intensity in all patients and MR images demonstrated lesion enhancement. However, none of the patients who were treated successfully with radiation demonstrated any changes of the affected vertebra in the conventional radiographic films, CT scan or MR imaging, even 5 years after irradiation. Radiological imaging is indispensable for the diagnosis of vertebral hemangiomas but does not appear to be useful for evaluating the effects of radiotherapy. (orig.).

  3. Application of Raman microscopy to the characterization of different verdigris variants obtained using recipes from old treatises (United States)

    de la Roja, J. M.; Baonza, V. G.; San Andrés, M.


    Verdigris is an historical pigment of synthetic origin widely used in the artistic scope, from the antiquity to beginning of 19th century. It is a greenish or green-bluish colored product resulting from corrosion of pure copper and alloys caused by the action of different chemical reagents. The preparation recipes are numerous and appear in old texts, such as: treatises of art and texts of alchemy, as well as in books of secrets, natural history and those concerning medicines. A comparative study of these recipes shows significant differences depending on the initial components and the methodology applied in the synthesis of the pigment. Consequently, typical verdigris pigments very likely correspond to a variety of chemical compositions and, in addition, it might contain certain amounts of unknown by-products. To confirm such hypothesis, four different preparation recipes of verdigris have been carefully reproduced in our laboratory, and characterized by Raman microscopy. Our experiments allowed us to establish interesting differences among the studied samples. Some differences are mostly related to the ingredients used in the elaboration of the so-called raw verdigris. In other cases, the observed variations are consequence of the recrystallization treatment of the pigment. In general, all spectra reveal the existence of common component, namely, the copper(II) acetate (hydrated or anhydrous). However, other minority components have been detected in our samples, for instance, copper oxides, copper chlorides, and ammonic salts. In some cases, these compounds allow us to deduce the type of recipe used in the elaboration of the pigment.

  4. Demand for radiotherapy in Spain. (United States)

    Rodríguez, A; Borrás, J M; López-Torrecilla, J; Algara, M; Palacios-Eito, A; Gómez-Caamaño, A; Olay, L; Lara, P C


    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.

  5. Radiotherapy for eyelid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Saika, Kazumi [Yokohama City Univ. (Japan). School of Medicine


    Some studies on radiotherapy for eyelid cancer have been reported, but the optimal radiation doses for different histological types and tumor sizes have not been detailed. So I studied the optimal radiation doses in radiotherapy for eyelid cancer. The patients were fourteen and histological diagnoses were made on the basis of biopsies or surgery before radiotherapy. Surgical cut margins were positive in 10 cases. In 5 of these cases, tumors were visible. There were 9 sebaceous adenocarcinomas (SAC), 4 squamous cell carcinomas (SCC), and 1 basal cell carcinoma (BCC). In 13 of 14 cases, radiation was applied to eyelids in which tumor-surgical cut margin distances were 3 mm or less. The eyeballs were covered with lead or tungsten shields, and the eyelids were irradiated with a total dose of 50 to 66.6 Gy. In 5 cases, radiation was applied prophylactically for ipsilateral pre-auricle lymph node areas. 11 of 13 cases were locally controlled. I gave greater radiation doses for SAC than for SCC or BCC. I also gave greater doses for in visible tumors than for invisible ones. In the acute phase dermatitis, inflammation of the cornea, conjunctivitis, etc. occurred but they were mild. Later reactions were decreased cilia, dry eye, inflammation of cornea, conjunctivitis, discomfort of the scar, etc. Cataracts were also seen, but they were of senile origen. Because 81.8% of the tumors were controlled, this radiation method was useful with salvage therapies to select an optimal radiation dose according to the differences among histological types and tumor sizes. 60% of visible tumors were also controlled so I think that radical therapy using radiation alone is possible. (author)

  6. Bystander effects and radiotherapy. (United States)

    Marín, Alicia; Martín, Margarita; Liñán, Olga; Alvarenga, Felipe; López, Mario; Fernández, Laura; Büchser, David; Cerezo, Laura


    Radiation-induced bystander effects are defined as biological effects expressed after irradiation by cells whose nuclei have not been directly irradiated. These effects include DNA damage, chromosomal instability, mutation, and apoptosis. There is considerable evidence that ionizing radiation affects cells located near the site of irradiation, which respond individually and collectively as part of a large interconnected web. These bystander signals can alter the dynamic equilibrium between proliferation, apoptosis, quiescence or differentiation. The aim of this review is to examine the most important biological effects of this phenomenon with regard to areas of major interest in radiotherapy. Such aspects include radiation-induced bystander effects during the cell cycle under hypoxic conditions when administering fractionated modalities or combined radio-chemotherapy. Other relevant aspects include individual variation and genetics in toxicity of bystander factors and normal tissue collateral damage. In advanced radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT), the high degree of dose conformity to the target volume reduces the dose and, therefore, the risk of complications, to normal tissues. However, significant doses can accumulate out-of-field due to photon scattering and this may impact cellular response in these regions. Protons may offer a solution to reduce out-of-field doses. The bystander effect has numerous associated phenomena, including adaptive response, genomic instability, and abscopal effects. Also, the bystander effect can influence radiation protection and oxidative stress. It is essential that we understand the mechanisms underlying the bystander effect in order to more accurately assess radiation risk and to evaluate protocols for cancer radiotherapy.

  7. [Radiotherapy of bladder cancer]. (United States)

    Riou, O; Chauvet, B; Lagrange, J-L; Martin, P; Llacer Moscardo, C; Charissoux, M; Lauche, O; Aillères, N; Fenoglietto, P; Azria, D


    Surgery (radical cystectomy) is the standard treatment of muscle-invasive bladder cancer. Radiochemotherapy has risen as an alternative treatment option to surgery as part as organ-sparing combined modality treatment or for patients unfit for surgery. Radiochemotherapy achieves 5-year bladder intact survival of 40 to 65% and 5-year overall survival of 40 to 50% with excellent quality of life. This article introduces the French recommendations for radiotherapy of bladder cancer: indications, exams, technique, dosimetry, delivery and image guidance. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  8. A Treatise on Administration. (United States)

    Moore, Thomas R.


    Expands Henri Fayol's definition of the administrative process to include a humanistic approach involving planning, organizing, implementing, controlling, evaluating, and satisfying functions. This empirical definition differs from some theoretical approaches by looking beyond resource consumption to consider ecological effects on the environment…

  9. Treatise on thermodynamics

    CERN Document Server

    Planck, Max Karl Ernst Ludwig

    Great classic, still one of the best introductions to thermodynamics. Fundamentals, first and second principles of thermodynamics, applications to special states of equilibrium, more. Numerous worked examples. 1917 edition.

  10. Functional anatomy of the spine by Avicenna in his eleventh century treatise Al-Qanun fi al-Tibb (The Canons of Medicine). (United States)

    Naderi, Sait; Acar, Feridun; Mertol, Tansu; Arda, M Nuri


    The history of spinal surgery is an important part of the spine-related sciences. The development of treatment strategies for spine-related disorders is acquired from the Western literature. In this article, an Eastern physician, Ibn Sina, who is known as Avicenna in the West, and his treatise, Al-Qanun fi al-Tibb (the Canons of Medicine), are presented. Eight chapters of this book regarding the functional neuroanatomy of the spine were reviewed and are presented to give insight into the development of the understanding of spinal anatomy and biomechanics.

  11. Giovanni Verga (1879-1923), author of a pioneering treatise on pituitary surgery: the foundations of this new field in Europe in the early 1900s. (United States)

    Pascual, José M; Mongardi, Lorenzo; Prieto, Ruth; Castro-Dufourny, Inés; Rosdolsky, María; Strauss, Sewan; Carrasco, Rodrigo; Winter, Eduard; Mazzarello, Paolo


    The field of pituitary surgery was born in the first decade of the twentieth century in Europe, and it evolved rapidly with the development of numerous innovative surgical techniques by some of the founding fathers of neurosurgery. This study investigates the pioneering Italian treatise on pituitary surgery, La Patologia Chirurgica dell'Ipofisi (Surgical Pathology of the Hypophysis), published in 1911 by Giovanni Verga (1879-1923), a surgeon from Pavía and one of Golgi's disciples. This little-known monograph compiles the earliest experience on pituitary surgery through the analysis of the first 50 procedures performed between 1903 and 1911. We conducted a biographical survey of Giovanni Verga and the motivations for his work on pituitary surgery. In addition, a systematic analysis of all original reports and historical documents about these pituitary procedures referenced in Verga's treatise was carried out. Verga's treatise provides a summary of the techniques employed and surgical outcomes for the first 50 attempted procedures of pituitary tumor removal. This monograph is the only scientific source that includes a complete account of the series of 10 pituitary tumors operated on by Sir Victor Horsley in the 1900s. Three major types of surgery were employed: (i) palliative procedures of craniectomy (n = 6); (ii) transcranial approaches to the pituitary gland, either subfrontal or subtemporal (n = 13); and (iii) transphenoidal routes to expose the sella turcica, either using an upper transnasal-transethmoidal approach (n = 19) or a lower sublabial/endonasal-transeptal one (n = 12). An operative mortality rate of 36% (n = 17) was observed in these early series. The pathological nature of the tumors operated on was available in 42 cases. There were 28 adenomas and 15 craniopharyngiomas. Sir Victor Horsley (1857-1916) and the Viennese surgeons Anton von Eiselsberg (1860-1939) and Oskar Hirsch (1877-1965) were the leading European figures in the development

  12. Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution


    Tseng, Chia-Lin; Eppinga, Wietse; Charest-Morin, Raphaele; Soliman, Hany; Myrehaug, Sten; Maralani, Pejman Jabehdar; Campbell, Mikki; Lee, Young K.; Fisher, Charles; Michael G Fehlings; Chang, Eric L; Lo, Simon S; Sahgal, Arjun


    Study Design: A broad narrative review. Objectives: The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques. Methods: A comprehensive review of the literature was conducted on the techniques, outcomes, and deve...

  13. Imaging in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Calandrino, R. [Medical Physics Department, Scientific Institute H. S. Raffaele, Vita-Salute University, Milan (Italy)], E-mail:; Del Maschio, A. [Radiology Department, Scientific Institute H. S. Raffaele, Vita-Salute University, Milan (Italy); Cattaneo, G.M. [Medical Physics Department, Scientific Institute H. S. Raffaele, Vita-Salute University, Milan (Italy); Castiglioni, I. [IBFM-CNR, Nuclear Medicine Department, Scientific Institute H. S. Raffaele, Milan (Italy)


    The diagnostic methodologies used for the radiotherapy planning have undergone great developments in the last 30 years. Since the 1980s, after the introduction of the CT scanner, the modality for the planning moved beyond the planar 2D assessment to approach a real and more realistic volumetric 3D definition. Consequently the dose distribution, previously obtained by means of an overly simple approximation, became increasingly complex, better tailoring the true shape of the tumour. The final therapeutic improvement has been obtained by a parallel increase in the complexity of the irradiating units: the Linacs for therapy have, in fact, been equipped with a full accessory set capable to modulate the fluence (IMRT) and to check the correct target position continuously during the therapy session (IMRT-IGRT). The multimodal diagnostic approach, which integrates diagnostic information, from images of the patient taken with CT, NMR, PET and US, further improves the data for a biological and topological optimization of the radiotherapy plan and consequently of the dose distribution in the Planning Target Volume. Proteomic and genomic analysis will be the next step in tumour diagnosis. These methods will provide the planners with further information, for a true personalization of the treatment regimen and the assessment of the predictive essays for each tumour and each patient.

  14. Proton minibeam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Girst, Stefanie


    The risk of developing adverse side effects in the normal tissue after radiotherapy is often limiting for the dose that can be applied to the tumor. Proton minibeam radiotherapy, a spatially fractionated radiotherapy method using sub-millimeter proton beams, similar to grid therapy or microbeam radiation radiotherapy (MRT) using X-rays, has recently been invented at the ion microprobe SNAKE in Munich. The aim of this new concept is to minimize normal tissue injuries in the entrance channel and especially in the skin by irradiating only a small percentage of the cells in the total irradiation field, while maintaining tumor control via a homogeneous dose in the tumor, just like in conventional broad beam radiotherapy. This can be achieved by optimizing minibeam sizes and distances according to the prevailing tumor size and depth such that after widening of the minibeams due to proton interactions in the tissue, the overlapping minibeams produce a homogeneous dose distribution throughout the tumor. The aim of this work was to elucidate the prospects of minibeam radiation therapy compared to conventional homogeneous broad beam radiotherapy in theory and in experimental studies at the ion microprobe SNAKE. Treatment plans for model tumors of different sizes and depths were created using the planning software LAPCERR, to elaborate suitable minibeam sizes and distances for the individual tumors. Radiotherapy-relevant inter-beam distances required to obtain a homogeneous dose in the target volume were found to be in the millimeter range. First experiments using proton minibeams of only 10 μm and 50 μm size (termed microchannels in the corresponding publication Zlobinskaya et al. 2013) and therapy-conform larger dimensions of 100 μm and 180 μm were performed in the artificial human in-vitro skin model EpiDermFT trademark (MatTek). The corresponding inter-beam distances were 500 μm, 1mm and 1.8 mm, respectively, leading to irradiation of only a few percent of the cells

  15. Brainwave for radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Chalmers, Matthew


    The award of this year's Nobel Prize in Physiology or Medicine for the development of magnetic resonance imaging (MRI) highlights the central role played by physics in medical imaging. Some 30 years after MRI produced its first 'slices' through the human body, researchers are now combining advanced versions of the technique with radiotherapy to improve the treatment of brain tumours. Roberto Garcia-Alvarez, Andy Beavis and Gary Liney at the University of Hull in the UK have developed a novel approach that combines functional MRI (fMRI) and intensity- modulated radiation therapy (IMRT). Their technique significantly reduces the need to expose certain areas of the brain - such as those responsible for motor function - to radiation during treatment, and could help preserve the quality of life of cancer patients (J. Radiotherapy in Practice 3 55). In the November issue of Physics World Matthew Chalmers describes how by combining imaging techniques and radiation therapy leads to safer targeting of tumours. (U.K.)

  16. Adaptive Motion Compensation in Radiotherapy

    CERN Document Server

    Murphy, Martin J


    External-beam radiotherapy has long been challenged by the simple fact that patients can (and do) move during the delivery of radiation. Recent advances in imaging and beam delivery technologies have made the solution--adapting delivery to natural movement--a practical reality. Adaptive Motion Compensation in Radiotherapy provides the first detailed treatment of online interventional techniques for motion compensation radiotherapy. This authoritative book discusses: Each of the contributing elements of a motion-adaptive system, including target detection and tracking, beam adaptation, and pati

  17. Radiotherapy for hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Tokuuye, Koichi; Sumi, Minako; Kagami, Yoshikazu; Murayama, Shigeyuki [National Cancer Center Hospital, Tokyo (Japan). Radiation Oncology Div.; Kawashima, Mitsuhiko; Ikeda, Hiroshi [National Cancer Center Hospital East, Chiba (Japan). Radiation Div.; Ueno, Hideki; Okusaka, Takuji; Okada, Shuichi [National Cancer Center Hospital, Tokyo (Japan). Internal Medicine Div.


    Purpose: To retrospectively evaluate the effectiveness of radiotherapy with or without transarterial embolization (TAE) and/or percutaneous ethanol injection (PEI) in patients with hepatocellular carcinoma who were ineligible for surgery. Patients and Methods: From October 1984 to November 1997, 62 patients underwent radiotherapy receiving 50 to 70 Gy in 25 to 35 treatments with or without transarterial embolization and/or percutaneous ethanol injection and were followed for a median period of 8.6 months (1.5 to 92 months). Results: Overall median survival rates were 9.5 months. Significant prognostic factors were the extent of pretreatment liver function impairment, radiation field size and the existence of tumor thrombosis. Six-month and 1-year local control rates were 67 and 54%, respectively. Seven of the 8 patients who suffered from hepatic failure had poor pretreatment liver functions. Conclusion: Radiotherapy with or without transarterial embolization and/or percutaneous ethanol injection appears effective in controlling hepatocellular carcinoma and prolonged survival. Individualized treatment strategies are presented depending on the tumor presentation and the degree of liver function impairment. (orig.) [German] Hintergrund: Retrospektive Evaluierung der Wirksamkeit einer Bestrahlung mit oder ohne transarterielle Embolisation oder perkutaner Alkoholinjektion bei Patienten mit inoperablem hepatozellulaeren Karzinom. Patienten und Methodik: Von Oktober 1984 bis November 1997 wurden 62 Patienten mit einer Gesamtdosis von 50 bis 70 Gy in 25 bis 35 Fraktionen mit oder ohne transarterielle Embolisation oder perkutane Alkoholinjektion behandelt. Der mediane Follow-up betrug 8,6 Monate (1,5 bis 92 Monate). Ergebnisse: Das mediane Gesamtueberleben betrug 9,5 Monate. Signifikante prognostische Einflussfaktoren waren das Ausmass der praetherapeutischen Leberfunktionseinschraenkung, die Bestrahlungsfeldgroesse und das Vorhandensein von Tumorthrombosen. Nach sechs

  18. Iznīqī and Jābir, Sirr and Miftāḥ: Two Authors, Four Titles, One Alchemical Treatise

    Directory of Open Access Journals (Sweden)

    Paola Carusi


    Full Text Available An alchemical Arabic treatise alternatively entitled Miftāḥ al-ḥikma, Miftāḥ jannāt al-khuld, Sirr al-asrār and Sirr al-sārr wa-sirr al-asrār is attributed in its manuscripts to two different authors: al-Iznīqī and Jābir b. Ḥayyān. In this article I briefly discuss some characteristic aspects of the treatise and its significance for the history of alchemy. These aspects include its ancient and important sources, such as the Muṣḥaf al-jamā‛a (Turba philosophorum and the Kitāb al-Ḥabīb, and its connection with the tradition of the artists and the activity of the workshop and laboratory, which first comes to the fore in Greek alchemy and later in Islamic alchemy. Furthermore, the work includes references to alchemical physical theories in which the influence of Islamic theology may perhaps be traced. This article, which summarises the results of investigations carried out over the last few years, could be considered as a kind of introduction to the edition and translation of the text currently in progress.

  19. [Radiotherapy for nasopharyngeal carcinoma]. (United States)

    Maingon, P; Blanchard, P; Bidault, F; Calmels, L


    Nasapharyngeal carcinoma is a rare disease. Oftenly, the diagnostic is made for advanced disease. Localized tumors, T1 or T2 NO observed a good prognosis and are locally controlled in more than 90 % of the cases by radiotherapy alone. The standard treatment of locally advanced disease is combined chemoradiation. A special vigilance of fast decrease of the volume of the pathological lymph nodes, sometimes associated to loss of weight might indicate an adaptive dosimetric revision. The treatment of recurrent disease is of great importance. Surgical indications are limited but should be discussed in multidisciplinary tumor board when possible. Surgical nodal sampling has to be proposed for nodal recurrence as well as reirradiation, which could be indicated according to the technical issues. Copyright © 2016. Published by Elsevier SAS.

  20. [Radiotherapy during pregnancy]. (United States)

    Mazeron, R; Barillot, I; Mornex, F; Giraud, P


    The diagnostic of cancer during pregnancy is a rare and delicate situation. As the developments of the embryo and the human fetus are extremely sensitive to ionizing radiations, the treatment of these tumors should be discussed. The studies - preclinical and clinical - based mostly on exposure accidents show that subdiaphragmatic treatments are possible during pregnancy. When radiotherapy is used, phantom estimations of the dose to the fetus, confirmed by in vivo measurements are required. Irradiation and imaging techniques should be arranged to decrease as much as possible the dose delivered to the fetus and hold below the threshold of 0.1Gy. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  1. On textual and contextual position of the ophthalmological treatise of bodhisattva nāgārjuna. (United States)

    Kim, Seongsu; Kang, Sungyong


    Medical knowledge in India began to be introduced to China in earliest from the Later Han Dynasty period to the times of Wei-Qin and South & North Dynasties. This is proved by many Buddhist medical books appeared in those days. Of the contents of Indian medicine, the theory of four major elements affected Chinese medicine more than did the theory of body fluids. Based on the theory of four major elements that was began to be introduced in Fú shuō fú yī jīng, an attempt to establish a new medical system was made in Zhŏu hòu băi yīfāng written by Táo Hóng-jĭng and Sūn Sī-miăo who tried to develop etiology further but could not achieve any great outcomes. Unlike the foregoing situation, Indian medicine aroused a large echo in China in the field of ophthalmology with ophthalmological knowledge mentioned in Suśrutasa hitā and 'Jīnzhēn-shù'(cataract couching) introduced as a surgical treatment of cataract. The Suśrutasa hitā which is one of the three major texts of Indian medicine contains additional information on surgical operations not introduced in the Carakasa hitā. The technique of cataract surgery was particularly popular in the Tang and Song dynasty periods in China under the name Lóng shù pú sà yăn lùn(The Ophthalmological Treatise of Bodhisattva Nāgārjuna) or Lóng shù lùn and was even designated as a subject to educate medical officers. While the original text of Lóng shù pú sà yăn lùn was not handed down, the first testimony that show the trace of the introduction of this text into China was the Tiān zhú jīng lùn yăn mentioned in Wài tái mì yào(Arcane Essential from the Imperial Library) written by Wang Tao. Long shàng dào ren who was mentioned as the compiler of the book is assumed to be Lóng shù. Although Tiān zhú jīng lùn yăn introduced anatomical knowledge about the eyeball that could have not been in the traditional Chinese medicine, this book has only limited quantity of information in this

  2. Targeted intraoperative radiotherapy in oncology

    CERN Document Server

    Keshtgar, Mohammed; Wenz, Frederik


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

  3. [Combined radiotherapy of uveal melanoma]. (United States)

    Brovkina, A F; Kesheleva, V V; Fridman, F E; Fishkin, I G


    Fifteen patients with uveal melanoma were exposed to combined radiotherapy: transscleral exposure of melanoma using a ruthenium ophthalmoapplicator and intracorporeal administration of 59Fe. Radiation reaction of the tumor was potentiated by combined exposure.

  4. Bone Health and Pelvic Radiotherapy. (United States)

    Higham, C E; Faithfull, S


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

  5. Radioprotectors in Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nair, C.K.K. [Bhabha Atomic Research Centre, Mumbai (India); Parida, D.K.; Nomura, Taisei


    This review article focuses on clinically relevant radioprotectors and their mechanisms of radioprotection. Radiotherapy is the most common modality of human cancer therapy. Obtaining optimal results requires a judicious balance between the total dose of radiotherapy delivered and the threshold limit of critical surrounding normal tissues, and the normal tissues need to be protected against radiation injury to obtain better tumor control by using a higher dose. For this reason, radiation-protective agents play an important role in clinical radiotherapy. Radiation-protective agents can be classified into three groups: radioprotectors, adaptogens, and absorbents. The first group generally consists of sulfhydryl compounds and other antioxidants. They include several myelo-, entero-, and cerebro-protectors. Adaptogens act as promotors of radioresistance. They are natural protectors that offer chemical protection against low levels of ionizing radiation. Absorbents protect organs from internal radiation and chemicals. They include drugs that prevent incorporation of radioiodine by the thyroid gland and absorption of radionuclides. This article thoroughly describes the properties, mechanisms of action, and perspectives on clinical application of the following categories of radioprotectors: sulfhydryl compounds (e.g., cysteine, cysteamine, glutathione, AET, WR 2127, and other WR-compounds), antioxidants (e.g., tempace, Hoechst 33342, vitamin A, E, and C, TMG, melatonin), angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril, elanopril, penicillamine, pentoxifylline, L-158, 809), cytoprotective agents (mesna, dexrazoxane, and amifostin), metalloelements (e.g., manganese chloride, cadmium salts, bismuth subnitrate), immunomodulators (gamma-interferon, polysaccharides AM5, AM218, heat-killed lactobacillus cells, broncho-vaxom, trehalose dicorynomycolate, and AS101), lipopolysaccharides and prostaglandins, plant extracts and compounds isolated from plants (curcmin

  6. Technological advances in radiotherapy for esophageal cancer (United States)

    Vosmik, Milan; Petera, Jiri; Sirak, Igor; Hodek, Miroslav; Paluska, Petr; Dolezal, Jiri; Kopacova, Marcela


    Radiotherapy with concurrent chemotherapy and surgery represent the main treatment modalities in esophageal cancer. The goal of modern radiotherapy approaches, based on recent technological advances, is to minimize post-treatment complications by improving the gross tumor volume definition (positron emission tomography-based planning), reducing interfraction motion (image-guided radiotherapy) and intrafraction motion (respiratory-gated radiotherapy), and by better dose delivery to the precisely defined planning target volume (intensity-modulated radiotherapy and proton therapy). Reduction of radiotherapy-related toxicity is fundamental to the improvement of clinical results in esophageal cancer, although the dose escalation concept is controversial. PMID:21105188

  7. Patterns of retreatment by radiotherapy. (United States)

    Barton, M B; Allen, S; Delaney, G P; Hudson, H M; Hao, Z; Allison, R W; van der Linden, Y M


    To describe patterns of treatment for those who receive more than one episode of megavoltage radiotherapy (retreatment) by cancer type for better service planning and benchmarking. Institutional databases of all patients who received their first megavoltage radiotherapy for any type of cancer at the Liverpool and Macarthur Cancer Therapy Centres (LM), New South Wales, Australia, Royal Brisbane and Women's Hospital (RBWH), Queensland, Australia and Radiotherapeutic Institution Friesland (RIF), Leeuwarden, the Netherlands, over the period 1991-2009 were examined. Radiotherapy retreatment was defined as any radiotherapy episode, to any body site, after an initial episode of radiotherapy, for the same cancer diagnosis. The total retreatment rate was defined as the number of retreatment episodes of radiotherapy divided by the number of cases in the cohort. In total, 62,270 patients (RBWH 38581, LM 9654, RIF 14035) received 77,762 episodes of radiotherapy, giving a total retreatment rate of 0.25; 52,351 patients (84%) received only one episode of treatment and 9919 (16%) received two or more episodes of treatment. Overall retreatment rates for LM, RBWH and RIF were 0.24, 0.25 and 0.26, respectively. For the five most common cancer types treated, the median time between treatment episodes was longest for breast cancer (11.3 months), then head and neck cancer (9.7 months), colorectal cancer (7.2 months), prostate cancer (4.4 months) and lung cancer (4.1 months). Ninety-one per cent of all fractions were delivered in the first episode of treatment. The retreatment rate was very similar between the three facilities, suggesting agreement about the indications for retreatment. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. De uisu: o mais antigo tratado supérstite de oftalmologia do Ocidente De uisu: the oldest surviving treatise on ophthalmology in the West

    Directory of Open Access Journals (Sweden)

    Henrique Cairus


    Full Text Available Apresenta-se aqui, em língua portuguesa, o tratado mais antigo que o Ocidente nos legou acerca da oftalmologia, "Sobre a visão" ou em latim De uisu, com um estudo introdutório que tem por fim situá-lo na história da medicina, sem, contudo, abdicar da demonstração das dificuldades filológicas que o texto encerra.We present here in Portuguese the oldest treatise that the West has bequeathed us about ophthalmology and eyesight in general, namely "On vision" or De uisu in Latin, with an introductory study that seeks to situate its place in the history of medicine, without, however, failing to dwell on the philological difficulties that the text contains.

  9. Mr. DuHamel's 1728 treatise on the violet root rot of saffron crocus : physical explanation of a disease that perishes several plants in the Gastinois, and saffron in particular

    NARCIS (Netherlands)

    Zadoks, J.C.


    Contains an English translation and a reprint of the original treatise: Explication physique d'une maladie qui fait perir plusieurs plantes dans le Gastinois, et particulierement le Safran / par M. Du Hamel. Memoires de 'l'Academie Royale, 7 Avril 1728

  10. Bayesian network models for error detection in radiotherapy plans. (United States)

    Kalet, Alan M; Gennari, John H; Ford, Eric C; Phillips, Mark H


    The purpose of this study is to design and develop a probabilistic network for detecting errors in radiotherapy plans for use at the time of initial plan verification. Our group has initiated a multi-pronged approach to reduce these errors. We report on our development of Bayesian models of radiotherapy plans. Bayesian networks consist of joint probability distributions that define the probability of one event, given some set of other known information. Using the networks, we find the probability of obtaining certain radiotherapy parameters, given a set of initial clinical information. A low probability in a propagated network then corresponds to potential errors to be flagged for investigation. To build our networks we first interviewed medical physicists and other domain experts to identify the relevant radiotherapy concepts and their associated interdependencies and to construct a network topology. Next, to populate the network's conditional probability tables, we used the Hugin Expert software to learn parameter distributions from a subset of de-identified data derived from a radiation oncology based clinical information database system. These data represent 4990 unique prescription cases over a 5 year period. Under test case scenarios with approximately 1.5% introduced error rates, network performance produced areas under the ROC curve of 0.88, 0.98, and 0.89 for the lung, brain and female breast cancer error detection networks, respectively. Comparison of the brain network to human experts performance (AUC of 0.90 ± 0.01) shows the Bayes network model performs better than domain experts under the same test conditions. Our results demonstrate the feasibility and effectiveness of comprehensive probabilistic models as part of decision support systems for improved detection of errors in initial radiotherapy plan verification procedures.

  11. Bayesian network models for error detection in radiotherapy plans (United States)

    Kalet, Alan M.; Gennari, John H.; Ford, Eric C.; Phillips, Mark H.


    The purpose of this study is to design and develop a probabilistic network for detecting errors in radiotherapy plans for use at the time of initial plan verification. Our group has initiated a multi-pronged approach to reduce these errors. We report on our development of Bayesian models of radiotherapy plans. Bayesian networks consist of joint probability distributions that define the probability of one event, given some set of other known information. Using the networks, we find the probability of obtaining certain radiotherapy parameters, given a set of initial clinical information. A low probability in a propagated network then corresponds to potential errors to be flagged for investigation. To build our networks we first interviewed medical physicists and other domain experts to identify the relevant radiotherapy concepts and their associated interdependencies and to construct a network topology. Next, to populate the network’s conditional probability tables, we used the Hugin Expert software to learn parameter distributions from a subset of de-identified data derived from a radiation oncology based clinical information database system. These data represent 4990 unique prescription cases over a 5 year period. Under test case scenarios with approximately 1.5% introduced error rates, network performance produced areas under the ROC curve of 0.88, 0.98, and 0.89 for the lung, brain and female breast cancer error detection networks, respectively. Comparison of the brain network to human experts performance (AUC of 0.90 ± 0.01) shows the Bayes network model performs better than domain experts under the same test conditions. Our results demonstrate the feasibility and effectiveness of comprehensive probabilistic models as part of decision support systems for improved detection of errors in initial radiotherapy plan verification procedures.

  12. Pulmonary oligometastases : Metastasectomy or stereotactic ablative radiotherapy?

    NARCIS (Netherlands)

    Widder, Joachim; Klinkenberg, Theo J.; Ubbels, Jan F.; Wiegman, Erwin M.; Groen, Harry J. M.; Langendijk, Johannes A.

    Background and purpose: Stereotactic ablative radiotherapy (SABR; or stereotactic body radiotherapy, SBRT) emerges as treatment option for pulmonary oligometastatic disease (OMD), but there are no studies comparing SABR with pulmonary metastasectomy (PME). We analysed consecutive patients referred

  13. Nicole Oresme's 'On Seeing the Stars (De visione stellarum)': A critical edition of Oresme's treatise on optics and atmospheric refraction, with an introduction, commentary, and English translation (United States)

    Burton, Danny Ethus


    In the middle of the fourteenth century, the renowned natural philosopher Nicole Oresme composed a treatise entitled: De visione stellarum (= On Seeing the Stars). This text appears to be the earliest separate treatise devoted to the study of atmospheric refraction and its deeper implications. A major portion of this dissertation is the formulation of the first critical edition and English translation of this work. Accompanying this edition is a commentary explicating its major themes as well as arguments in support of Oresme's authorship. The fundamental question Oresme's De visione attempts to answer is: Utrum stelle videantur ubi sint - ``Are the stars really where they seem to be?'' Using perspectivist optics, Oresme ultimately answered that they are not. Further, he concluded not only the stars but almost nothing is seen where it truly is, calling all visual sense data into doubt. The De visione builds upon the foundations laid by the great perspectivists such as Ptolemy, Alhazen, Bacon, and Witelo on atmospheric optics, but it also goes further. This dissertation argues that one of the more profound scientific discoveries by Oresme is the following. Two centuries before the Scientific Revolution, Oresme proposed the qualitatively correct solution to the problem of atmospheric refraction, that light travels along a curve through a medium of uniformly varying density, and he arrived at this solution using infinitesimals. This solution at this solution using infinitesimals. This solution had even escaped the great 17th century scholar of optics and astronomy, Johannes Kepler, and up to now, the credit for its first discovery has been given to Robert Hooke and its mathematical resolution to Isaac Newton. Oresme's argument concerning the curvature of light is a major milestone in the history of optics and astronomy that was previously unknown to modern scholarship. And it further confirms that Oresme was one of the most innovative scientists of the pre

  14. Publication of Renaissance architectural treatises in the Soviet Union in the 1930s: Alexander Gabrichevsky's contribution to the theory and history of architecture

    Directory of Open Access Journals (Sweden)

    Nadejda Podzemskaia


    Full Text Available : In just a couple of years in the second half of the 1930s, a considerable corpus of architectural treatises, mostly written in the Renaissance, was translated and published with detailed commentaries in the USSR. This great publishing program was conceived of as part of a new system of architectural training. This article formulates the question of the historical and cultural significance of this publishing project in the wider artistic and political context of the 1920s and 1930s. In discussions about the destiny of classical heritage, two majors tendencies, constructivism, represented by Moisei Ginzburg, and classicism, advocated by Ivan Zholtovsky, show not only their differences, but also their shared positions, such as the criticism of eclecticism. The paper concentrates on the collaboration between Zholtovsky and the art historian and theorist Aleksandr Gabrichevsky. This was a true meeting of minds based on profound mutual understanding and common basic notions of art (such as the ambiguous concept of 'classical art’. Because of the language barrier, Gabrichevsky and his works have remained little known to scholars who work in West-European languages. A disciple of Paul Frankl, during the 1920s he researched the problems of space and time in a broader theoretical and philosophical context at the GAKhN. His main work of the time, The Morphology of Art, demonstrates influences of Friedrich Schelling, Johann Wolfgang Goethe, Henri Bergson and, above all, Georg Simmel. This work could not have been completed nor published at the time. Its recent publication revealed the profound philosophical foundations of Gabrichevsky’s studies of architecture as well as of the project of publishing Renaissance architectural treatises that he organized.

  15. Radiotherapy for glomus jugulare paraganglioma. (United States)

    Tran Ba Huy, P


    Surgery has been long considered to be the treatment of choice for glomus jugulare paragangliomas, as it is the only modality able to totally eradicate the tumour. However, despite considerable progress in interventional radiology and nerve monitoring, surgery is associated with an unacceptably high complication rate for a benign tumour, explaining the growing place of radiotherapy in the management of these tumours. This review of the literature confirms the efficacy of conformal radiotherapy with or without intensity modulation and stereotactic radiotherapy, which both achieve tumour control rates ranging from 90% to almost 100% of cases, but for different tumour volumes, almost constant stabilization or even improvement of symptoms, and a considerably lower rate of adverse effects than with surgery. However, radiotherapy remains contraindicated in the presence of intracranial invasion or extensive osteomyelitis. In the light of these results, together with the improved quality of life and a better knowledge of the natural history of this disease, many authors propose radiotherapy as first-line treatment for all glomus jugulare paragangliomas regardless of their size, particularly in patients with no preoperative deficits. Copyright © 2014. Published by Elsevier Masson SAS.

  16. Second Malignant Neoplasms and Cardiovascular Disease Following Radiotherapy (United States)

    Ng, Andrea K.; Allan, James M.; Pui, Ching-Hon; Kennedy, Ann R.; Xu, X. George; Purdy, James A.; Applegate, Kimberly; Yahalom, Joachim; Constine, Louis S.; Gilbert, Ethel S.; Boice, John D.


    Second malignant neoplasms (SMNs) and cardiovascular disease (CVD) are among the most serious and life-threatening late adverse effects experienced by the growing number of cancer survivors worldwide and are due in part to radiotherapy. The National Council on Radiation Protection and Measurements (NCRP) convened an expert scientific committee to critically and comprehensively review associations between radiotherapy and SMNs and CVD, taking into account radiobiology; genomics; treatment (ie, radiotherapy with or without chemotherapy and other therapies); type of radiation; and quantitative considerations (ie, dose–response relationships). Major conclusions of the NCRP include: 1) the relevance of older technologies for current risk assessment when organ-specific absorbed dose and the appropriate relative biological effectiveness are taken into account and 2) the identification of critical research needs with regard to newer radiation modalities, dose–response relationships, and genetic susceptibility. Recommendation for research priorities and infrastructural requirements include 1) long-term large-scale follow-up of extant cancer survivors and prospectively treated patients to characterize risks of SMNs and CVD in terms of radiation dose and type; 2) biological sample collection to integrate epidemiological studies with molecular and genetic evaluations; 3) investigation of interactions between radiotherapy and other potential confounding factors, such as age, sex, race, tobacco and alcohol use, dietary intake, energy balance, and other cofactors, as well as genetic susceptibility; 4) focusing on adolescent and young adult cancer survivors, given the sparse research in this population; and 5) construction of comprehensive risk prediction models for SMNs and CVD to permit the development of follow-up guidelines and prevention and intervention strategies. PMID:22312134

  17. Kombinierte Angiogenese-/Vaskulogenese-Inhibition und Radiotherapie


    Riesterer, O


    Im folgenden Artikel wird die Interaktion von Inhibitoren der Angiogenese oder Vaskulogenese in Kombination mit Radiotherapie vorgestellt und anhand des jeweiligen Interaktionsmechanismus aufgezeigt, wie diese Substanzen in klinische Studien zusammen mit Radiotherapie integriert werden können. Besonders wird dabei auf einen neuen Therapieansatz eingegangen: die ergänzende (adjuvante) Gabe von Angiogenese- oder Vaskulogenese-Inhibitoren nach Abschluss der fraktionierten Radiotherapie.

  18. Stereotactic radiotherapy for vestibular schwannoma

    DEFF Research Database (Denmark)

    Muzevic, Dario; Legcevic, Jelena; Splavski, Bruno


    BACKGROUND: Vestibular schwannomas (acoustic neuromas) are common benign tumours that arise from the Schwann cells of the vestibular nerve. Management options include observation with neuroradiological follow-up, microsurgical resection and stereotactic radiotherapy. OBJECTIVES: To assess...... the effect of stereotactic radiotherapy compared to observation, microsurgical resection, any other treatment modality, or a combination of two or more of the above approaches for vestibular schwannoma. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL......; Web of Science; CAB Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 24 July 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) exploring the efficacy of stereotactic radiotherapy compared with observation alone, microsurgical...

  19. Severe mitral regurgitation after radiotherapy. (United States)

    Cozzarín, Alberto; Cianciulli, Tomás F; Saccheri, María C; Lax, Jorge A; Simonetti, Mario E; Zappi, Andrea; Laguens, Rubén P


    We present the case of a 69-year-old patient with a history of gynecological neoplasia and a pulmonary metastasis, who in 1996 underwent chemotherapy and mediastinal radiotherapy followed by cancer remission. Ten years later she presented with heart failure and her Doppler echocardiogram showed severe mitral regurgitation with pulmonary hypertension. In 2011, she underwent a mitral valve replacement with a biological prosthesis and the pathology exam revealed valve damage consistent with radiotherapy-induced changes. This unusual mechanism of mitral regurgitation can be demonstrated clearly by echocardiography and should be disseminated among cardiology physicians and in patients who have survived for long periods after radiotherapy, it is important to remember that cardiac complications may indeed occur, and the treating physician is responsible for detecting them. © 2013, Wiley Periodicals, Inc.

  20. Clinical quality standards for radiotherapy (United States)


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

  1. A Bayesian network meta-analysis of whole brain radiotherapy and stereotactic radiotherapy for brain metastasis. (United States)

    Yuan, Xi; Liu, Wen-Jie; Li, Bing; Shen, Ze-Tian; Shen, Jun-Shu; Zhu, Xi-Xu


    This study was conducted to compare the effects of whole brain radiotherapy (WBRT) and stereotactic radiotherapy (SRS) in treatment of brain metastasis.A systematical retrieval in PubMed and Embase databases was performed for relative literatures on the effects of WBRT and SRS in treatment of brain metastasis. A Bayesian network meta-analysis was performed by using the ADDIS software. The effect sizes included odds ratio (OR) and 95% confidence interval (CI). A random effects model was used for the pooled analysis for all the outcome measures, including 1-year distant control rate, 1-year local control rate, 1-year survival rate, and complication. The consistency was tested by using node-splitting analysis and inconsistency standard deviation. The convergence was estimated according to the Brooks-Gelman-Rubin method.A total of 12 literatures were included in this meta-analysis. WBRT + SRS showed higher 1-year distant control rate than SRS. WBRT + SRS was better for the 1-year local control rate than WBRT. SRS and WBRT + SRS had higher 1-year survival rate than the WBRT. In addition, there was no difference in complication among the three therapies.Comprehensively, WBRT + SRS might be the choice of treatment for brain metastasis.

  2. Metrological Issues in Molecular Radiotherapy

    Directory of Open Access Journals (Sweden)

    D’Arienzo Marco


    Full Text Available The therapeutic effect from molecular radiation therapy (MRT, on both tumour and normal tissue, is determined by the radiation absorbed dose. Recent research indicates that as a consequence of biological variation across patients the absorbed dose can vary, for the same administered activity, by as much as two orders of magnitude. The international collaborative EURAMET-EMRP project “Metrology for molecular radiotherapy (MetroMRT” is addressing this problem. The overall aim of the project is to develop methods of calibrating and verifying clinical dosimetry in MRT. In the present paper an overview of the metrological issues in molecular radiotherapy is provided.

  3. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sedlmayer, F. [Paracelsus Medical Univ. Hospital, Salzburg (Austria). Dept. of Radiotherapy and Radiation Oncology; Sautter-Bihl, M.L. [Staedtisches Klinium Karlsruhe (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Budach, W. [University Hospital Duesseldorf (Germany)] [and others


    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing

  4. Parotid gland function after radiotherapy

    NARCIS (Netherlands)

    Roesink, Judith Maria


    Radiotherapy is a common treatment for head and neck cancer patients. Unfortunately, it produces serious acute and long-term side effects to the oral cavity. One severe complication is the loss of salivary gland function, which can persists for many years. Saliva has multiple functions relating to

  5. [Bullous lichen sclerosus after radiotherapy]. (United States)

    Tournillac, I; Dandurand, M; Guillot, B


    Bullous lichen sclerosus is an uncommon observation after radiotherapy and can be misdiagnosed as a radiodermitis or recurrence of the neoplasia. Two women developed bullous lichen sclerosus after radiotherapy. The delay after radiotherapy was 4 months and 10 years respectively. Irradiation dose was 60 and 64 grays. The lesions covered more than the irradiated zone in one case. Stabilization or regression of the lesions was obtained with cases I topical corticosteroids, with acitretine in one case. These cases, and similar cases reported in the literature, underline the fact that the condition has only been reported in women. This is probably because of the nature of the neoplasias treated (breast cancer in 20 cases and cervical cancer in 1). The delay to onset of the skin lesions are quite variable. Lichen sclerosus or morphea may be observed in the irradiated zone but may also appear at a distance. These lesions are not associated with recurrence of the initial cancer. As no association between breast cancer and localized sclerodermia has been found, the causal role is probably played by radiotherapy, producing a Koebner phenomena in predisposed tissue.

  6. Thalassaemic osteoarthropathy treated with radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Davies, A.N. (King' s Coll. Hospital, London (United Kingdom))


    Patients with beta thalassaemia may develop a specific osteoarthropathy involving the feet. A number of different treatments for this condition have been tried, including rest, analgesia and hypertransfusion. We report a case of a patient with thalassaemic osteoarthropathy who responded to radiotherapy after failing conventional treatment. (author).

  7. Oral complications of cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dreizen, S.; Daly, T.E.; Drane, J.B.; Brown, L.R.


    Injury to surrounding tissues during radiotherapy for oral cancer can have devastating physical and psychologic consequences for the patient. Oral complications include xerostomia, dental decay, mucositis, taste loss, osteoradionecrosis, infection, and trismus. In many instances, these problems can be eradicated or controlled with appropriate treatment.

  8. [Radiotherapy for primary lung carcinoma]. (United States)

    Giraud, P; Lacornerie, T; Mornex, F


    Indication, doses, technique of radiotherapy and concomitant chemotherapy, for primary lung carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  9. IMRT, IGRT, SBRT - Advances in the Treatment Planning and Delivery of Radiotherapy

    CERN Document Server

    Meyer, JL


    Over the last 4 years, IMRT, IGRT, SBRT: Advances in the Treatment Planning and Delivery of Radiotherapy has become a standard reference in the field. During this time, however, significant progress in high-precision technologies for the planning and delivery of radiotherapy in cancer treatment has called for a second edition to include these new developments. Thoroughly updated and extended, this new edition offers a comprehensive guide and overview of these new technologies and the many clinical treatment programs that bring them into practical use. Advances in intensity-modulated radiothera

  10. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Seong, Jin Sil [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)


    In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.

  11. Radiotherapy-induced thyroid disorders. (United States)

    Jereczek-Fossa, Barbara A; Alterio, Daniela; Jassem, Jacek; Gibelli, Bianca; Tradati, Nicoletta; Orecchia, Roberto


    Despite their specific functional consequences, radiotherapy-induced thyroid abnormalities remain under-estimated and underreported. These sequelae may include primary or central hypothyroidism, thyroiditis, Graves' disease, euthyroid Graves' ophthalmopathy, benign adenomas, multinodular goitre and radiation-induced thyroid carcinoma. Primary hypothyroidism, the most common radiation-induced thyroid dysfunction, affects 20-30% of patients administered following curative radiotherapy to the neck region, with approximately half of the events occurring within the first 5 years after therapy. The relative risk of radiation-induced cancer (mainly well-differentiated tumours) is 15-53-fold higher than in non-irradiated population. The aetiology of radiation-induced thyroid injury includes vascular damage, parenchymal cell damage and auto-immune reactions. Total radiotherapy dose, irradiated volume of the thyroid gland, and the extent of prior thyroid resection are among the most important factors associated with the risk of hypothyroidism. The contribution of other treatment modalities (chemotherapy, endocrine therapy) as well as patient- and tumour-related factors is less clear. Reduction in radiation dose to the thyroid gland and hypothalamic/pituitary complex should be attempted whenever possible. New radiotherapy techniques, such as stereotactic radiosurgery, three-dimensional conformal irradiation, intensity modulated radiotherapy and proton therapy allow generally better dose distribution with lower dose to the non-target organs. The diagnostic approach to thyroid radiation injury includes baseline thyroid function assays in all patients undergoing thyroid or parasellar irradiation. Recommended follow-up procedures include at least annual evaluation with a history for symptoms of thyroid dysfunction, clinical examination, and measurement of thyroid hormones and thyrotropin. Management of overt hypothyroidism is based on hormone replacement therapy. Thyroid hormone

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

    Energy Technology Data Exchange (ETDEWEB)



    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.

  13. The frailties of ‘basileia’ according to John Chrysostom: some remarks on the treatise ‘A comparison between a king and a monk’

    Directory of Open Access Journals (Sweden)

    Gilvan Ventura da Silva


    Full Text Available Living in a society under the threat of Persians and Barbarians, John Chrysostom, differently from his predecessors, like Eusebius of Cesarea, did not devise the Graeco-Roman basileia as an institution that bore any special religious meaning. As for him, the Roman Empire was just a gathering of humans governing other humans due to an election; a government that did not arise from a natural basis and did not exhibit any mystical, supernatural capacity, for such government was not geared to linger on. In his works, John Chrysostom seldom mentions the Imperium Chistianum and the emperors of his time, subjects which did not attract his attention. Truth to tell, according to the author, the basileus did not represent a Christian model that should be followed by his contemporaries. Such honor should be bestowed on the monks instead. In light of these remarks, we intend to discuss, in this article, some characteristics of the monarchy in the Late Antiquity, a time span when we witness the flourishing of the monasticism as well. In order to do that, we deal with one of John’s first works: the treatise A comparison between a king and a monk, written in Antioch, John’s homeland, in the first years of the decade of 370 A. D.

  14. Gel dosimetry for conformal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Gambarini, G. [Department of Physics of the University and INFN, Milan (Italy)]. e-mail:


    With the continuum development of conformal radio therapies, aimed at delivering high dose to tumor tissue and low dose to the healthy tissue around, the necessities has appeared of suitable improvement of dosimetry techniques giving the possibility of obtaining dose images to be compared with diagnostic images. Also if wide software has been developed for calculating dose distributions in the fields of various radiotherapy units, experimental verifications are necessary, in particular in the case of complex geometries in conformal radiotherapy. Gel dosimetry is a promising method for imaging the absorbed dose in tissue-equivalent phantoms, with the possibility of 3D reconstruction of the spatial dose distribution, with milli metric resolution. Optical imaging of gel dosimeters, based on visible light absorbance analysis, has shown to be a reliable technique for achieving dose distributions. (Author)

  15. Proton Radiotherapy for Pediatric Sarcoma

    Directory of Open Access Journals (Sweden)

    Matthew M. Ladra


    Full Text Available Pediatric sarcomas represent a distinct group of pathologies, with approximately 900 new cases per year in the United States alone. Radiotherapy plays an integral role in the local control of these tumors, which often arise adjacent to critical structures and growing organs. The physical properties of proton beam radiotherapy provide a distinct advantage over standard photon radiation by eliminating excess dose deposited beyond the target volume, thereby reducing both the dose of radiation delivered to non-target structures as well as the total radiation dose delivered to a patient. Dosimetric studies comparing proton plans to IMRT and 3D conformal radiation have demonstrated the superiority of protons in numerous pediatric malignancies and data on long-term clinical outcomes and toxicity is emerging. In this article, we review the existing clinical and dosimetric data regarding the use of proton beam radiation in malignant bone and soft tissue sarcomas.

  16. Automated radiotherapy treatment plan integrity verification

    Energy Technology Data Exchange (ETDEWEB)

    Yang Deshan; Moore, Kevin L. [Department of Radiation Oncology, School of Medicine, Washington University in Saint Louis, St. Louis, Missouri 63110 (United States)


    Purpose: In our clinic, physicists spend from 15 to 60 min to verify the physical and dosimetric integrity of radiotherapy plans before presentation to radiation oncology physicians for approval. The purpose of this study was to design and implement a framework to automate as many elements of this quality control (QC) step as possible. Methods: A comprehensive computer application was developed to carry out a majority of these verification tasks in the Philips PINNACLE treatment planning system (TPS). This QC tool functions based on both PINNACLE scripting elements and PERL sub-routines. The core of this technique is the method of dynamic scripting, which involves a PERL programming module that is flexible and powerful for treatment plan data handling. Run-time plan data are collected, saved into temporary files, and analyzed against standard values and predefined logical rules. The results were summarized in a hypertext markup language (HTML) report that is displayed to the user. Results: This tool has been in clinical use for over a year. The occurrence frequency of technical problems, which would cause delays and suboptimal plans, has been reduced since clinical implementation. Conclusions: In addition to drastically reducing the set of human-driven logical comparisons, this QC tool also accomplished some tasks that are otherwise either quite laborious or impractical for humans to verify, e.g., identifying conflicts amongst IMRT optimization objectives.

  17. Technological advances in radiotherapy of rectal cancer

    DEFF Research Database (Denmark)

    Appelt, Ane L; Sebag-Montefiore, David


    PURPOSE OF REVIEW: This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. RECENT FINDINGS: The dosimetric....... Overall results are encouraging, as toxicity levels - although varying across reports - appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment...

  18. Inflammatory Skin Conditions Associated With Radiotherapy. (United States)

    Hernández Aragüés, I; Pulido Pérez, A; Suárez Fernández, R


    Radiotherapy for cancer is used increasingly. Because skin cells undergo rapid turnover, the ionizing radiation of radiotherapy has collateral effects that are often expressed in inflammatory reactions. Some of these reactions-radiodermatitis and recall phenomenon, for example-are very familiar to dermatologists. Other, less common radiotherapy-associated skin conditions are often underdiagnosed but must also be recognized. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. [Stereotactic radiotherapy for prostate cancer]. (United States)

    Quero, L; Hennequin, C


    Stereotactic radiotherapy is a new option in the treatment of prostate cancer. However, only retrospective series and a few prospective phase II trials are available at this moment, including a few thousands of patients with a short follow-up. Most of the protocols delivered 33 to 38 Gy in four or five fractions. Acute toxicity seems to be similar to the one observed after conventional radiotherapy. Late toxicity is less evaluable because of the short follow-up: the rate of radiation-induced proctitis seems low in the published series. Urinary toxicities are not properly evaluated: some series reported a high incidence of urinary complications grade or higher. Most of the patients belong to the D'Amico's favourable group: biochemical controls are equivalent to those observed after conventional irradiation, but the follow-up is often shorter than 5 years and no definitive conclusion could be made about the efficiency of the technique. Data for the intermediate and high risk groups are not mature. In conclusion, stereotactic radiotherapy could strongly modified the management of prostate cancer: some phase III trials have started to confirm the good results reported in preliminary series. Copyright © 2014. Published by Elsevier SAS.

  20. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer

    DEFF Research Database (Denmark)

    Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max


    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....

  1. DEGRO practical guidelines: radiotherapy of breast cancer III - radiotherapy of the lymphatic pathways

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Staedtisches Klinikum Karlsruhe, Klinik fuer Radioonkologie und Strahlentherapie, Karlsruhe (Germany); Sedlmayer, F.; Fussl, C. [LKH Salzburg, Paracelsus Medical University Hospital, Department of Radiotherapy and Radiation Oncology, Salzburg (Austria); Budach, W. [University Hospital Duesseldorf, Duesseldorf (Germany); Dunst, J. [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Fietkau, R.; Sauer, R. [University Hospital Erlangen, Erlangen (Germany); Harms, W. [St. Clara Hospital, Basel, Basel (Switzerland); Piroth, M.D. [Helios-Klinikum Wuppertal, Klinik fuer Strahlentherapie und Radioonkologie, Wuppertal (Germany); Souchon, R. [University Hospital Tuebingen, Tuebingen (Germany); Wenz, F. [University Hospital Mannheim, Mannheim (Germany); Haase, W.


    The purpose of this work is to update the practical guidelines for adjuvant radiotherapy of the regional lymphatics of breast cancer published in 2008 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). A comprehensive survey of the literature concerning regional nodal irradiation (RNI) was performed using the following search terms: ''breast cancer'', ''radiotherapy'', ''regional node irradiation''. Recent randomized trials were analyzed for outcome as well as for differences in target definition. Field arrangements in the different studies were reproduced and superimposed on CT slices with individually contoured node areas. Moreover, data from recently published meta-analyses and guidelines of international breast cancer societies, yielding new aspects compared to 2008, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the German interdisciplinary S3 guidelines updated in 2012, this paper addresses indications, targeting, and techniques of radiotherapy of the lymphatic pathways after surgery for breast cancer. International guidelines reveal substantial differences regarding indications for RNI. Patients with 1-3 positive nodes seem to profit from RNI compared to whole breast (WBI) or chest wall irradiation alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular, and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and one meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection (ALND), while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel node (SN) or microscopic metastases on prognosis are conflicting. Recent data

  2. Role of radiotherapy in hospice care

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.


    The aim of palliative radiotherapy for the terminally ill is to improve the quality of the remaining span of life. From November 1982 to September 1987, 69 patients in the Seirei Hospice have been treated with such radiotherapy, and symptomatic relief was obtained in 64% of these patients. Radiotherapy also proved useful in achieving an improvement in their performance status. While the aim of hospice care is not directed towards treatment of the underlying disease, the use of radiotherapy is considered to have an important role in hospice care.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  4. Technical note: DIRART--A software suite for deformable image registration and adaptive radiotherapy research. (United States)

    Yang, Deshan; Brame, Scott; El Naqa, Issam; Aditya, Apte; Wu, Yu; Goddu, S Murty; Mutic, Sasa; Deasy, Joseph O; Low, Daniel A


    Recent years have witnessed tremendous progress in image guide radiotherapy technology and a growing interest in the possibilities for adapting treatment planning and delivery over the course of treatment. One obstacle faced by the research community has been the lack of a comprehensive open-source software toolkit dedicated for adaptive radiotherapy (ART). To address this need, the authors have developed a software suite called the Deformable Image Registration and Adaptive Radiotherapy Toolkit (DIRART). DIRART is an open-source toolkit developed in MATLAB. It is designed in an object-oriented style with focus on user-friendliness, features, and flexibility. It contains four classes of DIR algorithms, including the newer inverse consistency algorithms to provide consistent displacement vector field in both directions. It also contains common ART functions, an integrated graphical user interface, a variety of visualization and image-processing features, dose metric analysis functions, and interface routines. These interface routines make DIRART a powerful complement to the Computational Environment for Radiotherapy Research (CERR) and popular image-processing toolkits such as ITK. DIRART provides a set of image processing/registration algorithms and postprocessing functions to facilitate the development and testing of DIR algorithms. It also offers a good amount of options for DIR results visualization, evaluation, and validation. By exchanging data with treatment planning systems via DICOM-RT files and CERR, and by bringing image registration algorithms closer to radiotherapy applications, DIRART is potentially a convenient and flexible platform that may facilitate ART and DIR research. 0 2011 Ameri-

  5. Radiotherapy and local control in rectal cancer. (United States)

    Valentini, V; Rosetto, M E; Fares, C; Mantini, G; Salvi, G; Turriziani, A


    Recurrence is a stage in the natural history of rectal cancer. Preoperative radiotherapy or postoperative radiochemotherapy lower the rate of recurrence, improving local control. From 1980 to 1997, at the "Divisione di Radioterapia" of the "Università Cattolica del S. Cuore" of Rome 380 patients with rectal cancer of early clinical stage T2-3, candidates for surgery for cure, underwent radiation therapy. 119 patients underwent postoperative radiotherapy (45-50 Gy); 45 patients underwent "sandwich" radiotherapy (45 Gy:27 Gy before and 28 Gy after surgery), of whom 7 were treated with preoperative radiotherapy alone; 145 patients underwent preoperative concomitant radiochemotherapy according to 3 different protocols, radiotherapy (38 Gy) combined with mitomycin C and 5-FU; radiotherapy (50.4 Gy) combined with cisplatin and 5-FU; radiotherapy (45 Gy) combined with 5-FU and folinic acid. 71 patients were treated with preoperative radiotherapy (38 Gy) combined with IORT (10 Gy). Median follow-up was 6 years. Overall local control was 85% at 3 years, 83% at 5 years, 81% at 10 years. The rate of local control at 5 years was: 76% for postoperative radiotherapy, 83% for "sandwich" radiotherapy, 84% for preoperative radiochemotherapy and 93% for preoperative radiotherapy combined with IORT. Local control was shown to be significantly better with preoperative treatment as compared to postoperative treatment (p = 0.02). The incidence of metastases was 35% in the patients with local recurrence and 16% in those with local control. The difference in survival was highly significant in patients with local control as compared to those with local recurrence: at 5 years 87% and 32% respectively. Patients with local control showed a lower incidence of metastasis and a better survival.

  6. Special radiobiological features of second cancer risk after particle radiotherapy. (United States)

    Trott, Klaus-Rüdiger


    In absolute terms: second cancer risks from radiotherapy of first cancers in adults are small compared to the benefits from radiotherapy but this is not so for radiotherapy of childhood cancers. Moreover, the radiation dose dependence of cancer induction differs between organs and tissues. The organ-specific dose dependence of second cancer risks may indicate the existence of different radiobiological mechanisms. As an inevitable consequence of the age dependence of organ sensitivity to second cancer induction, the organ/tissue weighting factors which have been proposed by ICRP for calculating effective dose (the dose unit Sv) and for risk estimation in the general population should not be used in medical radiation exposures. In adult cancer radiotherapy, the most common unwanted effect is local tumour recurrence whereas both, severe late normal tissue damage and radiation-induced second cancers are rare, around 1% of locally controlled cancer patients. In childhood cancers, local failures are rare (particle radiotherapy for childhood cancers is the possibility to exploit their physical characteristics to reduce the radiation exposure to organs and tissues close to and distant from the primary cancer which is to be targeted. However, the relative biological effectiveness of the radiation doses within the proton beam is not a constant and the relative biological effectiveness of the neutrons is not known as far as the mechanisms of late normal tissue damage and second cancer risk are concerned. In view of the highly charged discussions of the potential risks of treatment-induced seecond cancers from the neutron contamination of exposure doses in out-of-PTV critical organs a comprehensive European project called ANDANTE was performed which integrated the disciplines of radiation physics, molecular biology, systems biology modelling and epidemiology in order to investigate the RBE of induction of cancer from exposure to neutrons compared to photons. Since out

  7. 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)


    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.

  8. Use of primary radiotherapy for rectal cancer in the Netherlands between 1997 and 2008: a population-based study

    NARCIS (Netherlands)

    Jobsen, J. J.; Aarts, M. J.; Siesling, S.; Klaase, J.; Louwman, W. J.; Poortmans, P. M. P.; Lybeert, M. L. M.; Koning, C. C. E.; Struikmans, H.; Coebergh, J. W. W.


    To describe variation in the utilisation rates of primary radiotherapy for patients with rectal cancer in the Netherlands, focusing on time trends and age effects. Data on primary non-metastatic rectal cancer were derived from the population-based cancer registries of four comprehensive cancer

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

    CERN Document Server

    Lemoigne, Yves


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

  10. Post-mastectomy radiotherapy in Denmark

    DEFF Research Database (Denmark)

    Thomsen, Mette S; Berg, Martin; Nielsen, Hanne M


    This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially, i...

  11. Three dimensional conformal postoperative radiotherapy for ...

    African Journals Online (AJOL)

    Introduction: Postoperative radiotherapy of the parotid gland could be achieved with various radiotherapy techniques. However they irradiate differently the surrounding organs at risk (OARs) in particular the cochlea, oral cavity & contralateral parotid causing significant increase in the risk of oral mucositis, xerostomia, and ...

  12. Radiotherapy for Oligometastatic Lung Cancer

    Directory of Open Access Journals (Sweden)

    Derek P. Bergsma


    Full Text Available Non-small cell lung cancer (NSCLC typically presents at an advanced stage, which is often felt to be incurable, and such patients are usually treated with a palliative approach. Accumulating retrospective and prospective clinical evidence, including a recently completed randomized trial, support the existence of an oligometastatic disease state wherein select individuals with advanced NSCLC may experience historically unprecedented prolonged survival with aggressive local treatments, consisting of radiotherapy and/or surgery, to limited sites of metastatic disease. This is reflected in the most recent AJCC staging subcategorizing metastatic disease into intra-thoracic (M1a, a single extra thoracic site (M1b, and more diffuse metastases (M1c. In the field of radiation oncology, recent technological advances have allowed for the delivery of very high, potentially ablative, doses of radiotherapy to both intra- and extra-cranial disease sites, referred to as stereotactic radiosurgery and stereotactic body radiotherapy (or SABR, in much shorter time periods compared to conventional radiation and with minimal associated toxicity. At the same time, significant improvements in systemic therapy, including platinum-based doublet chemotherapy, molecular agents targeting oncogene-addicted NSCLC, and immunotherapy in the form of checkpoint inhibitors, have led to improved control of micro-metastatic disease and extended survival sparking newfound interest in combining these agents with ablative local therapies to provide additive, and in the case of radiation and immunotherapy, potentially synergistic, effects in order to further improve progression-free and overall survival. Currently, despite the tantalizing potential associated with aggressive local therapy in the setting of oligometastatic NSCLC, well-designed prospective randomized controlled trials sufficiently powered to detect and measure the possible added benefit afforded by this approach are

  13. Postoperative radiotherapy for endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Eun Cheol; Kim, Jin Hee; Kim, Ok Bae; Byun, Sang Jun; Park, Seung Gyu; Kwon, Sang Hoon [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)


    To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. Sixty four patients with stage I?III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended fi eld. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.

  14. Basic radiotherapy physics and biology

    CERN Document Server

    Chang, David S; Das, Indra J; Mendonca, Marc S; Dynlacht, Joseph R


    This book is a concise and well-illustrated review of the physics and biology of radiation therapy intended for radiation oncology residents, radiation therapists, dosimetrists, and physicists. It presents topics that are included on the Radiation Therapy Physics and Biology examinations and is designed with the intent of presenting information in an easily digestible format with maximum retention in mind. The inclusion of mnemonics, rules of thumb, and reader-friendly illustrations throughout the book help to make difficult concepts easier to grasp. Basic Radiotherapy Physics and Biology is a

  15. Quality and safety in radiotherapy

    CERN Document Server

    Pawlicki, Todd


    The first text to focus solely on quality and safety in radiotherapy, this work encompasses not only traditional, more technically oriented, quality assurance activities, but also general approaches of quality and safety. It includes contributions from experts both inside and outside the field to present a global view. The task of assuring quality is no longer viewed solely as a technical, equipment-dependent endeavor. Instead, it is now recognized as depending on both the processes and the people delivering the service. Divided into seven broad categories, the text covers: Quality Management

  16. Management of radiotherapy-induced skin reactions. (United States)

    Trueman, Ellen


    Radiotherapy is a highly effective cancer treatment that not only offers cure but also excellent palliation of disease related symptoms and complications. Although radiotherapy is primarily an outpatient treatment, delivered within specialist centres, a diverse range of health professionals may be involved in the treatment pathway before, during and after treatment. Radiotherapy can, and does, make a significant contribution to improving a patient's wellbeing through effective symptom management. However, treatment-related side-effects do occur, with an acute skin reaction being one of the most common. It is imperative that radiotherapy-induced skin reactions are correctly assessed and appropriately managed in promoting patient comfort, treatment compliance and enhanced quality of life. This article describes how the use of a recognised assessment tool and evidence-based guidelines can facilitate consistent, high-quality care in the management of radiotherapy-induced skin reactions.

  17. Radiotherapy in patients with connective tissue diseases. (United States)

    Giaj-Levra, Niccolò; Sciascia, Savino; Fiorentino, Alba; Fersino, Sergio; Mazzola, Rosario; Ricchetti, Francesco; Roccatello, Dario; Alongi, Filippo


    The decision to offer radiotherapy in patients with connective tissue diseases continues to be challenging. Radiotherapy might trigger the onset of connective tissue diseases by increasing the expression of self-antigens, diminishing regulatory T-cell activity, and activating effectors of innate immunity (dendritic cells) through Toll-like receptor-dependent mechanisms, all of which could potentially lead to breaks of immune tolerance. This potential risk has raised some debate among radiation oncologists about whether patients with connective tissue diseases can tolerate radiation as well as people without connective tissue diseases. Because the number of patients with cancer and connective tissue diseases needing radiotherapy will probably increase due to improvements in medical treatment and longer life expectancy, the issue of interactions between radiotherapy and connective tissue diseases needs to be clearer. In this Review, we discuss available data and evidence for patients with connective tissue diseases treated with radiotherapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Optimization of human cancer radiotherapy

    CERN Document Server

    Swan, George W


    The mathematical models in this book are concerned with a variety of approaches to the manner in which the clinical radiologic treatment of human neoplasms can be improved. These improvements comprise ways of delivering radiation to the malignan­ cies so as to create considerable damage to tumor cells while sparing neighboring normal tissues. There is no unique way of dealing with these improvements. Accord­ ingly, in this book a number of different presentations are given. Each presentation has as its goal some aspect of the improvement, or optimization, of radiotherapy. This book is a collection of current ideas concerned with the optimization of human cancer radiotherapy. It is hoped that readers will build on this collection and develop superior approaches for the understanding of the ways to improve therapy. The author owes a special debt of thanks to Kathy Prindle who breezed through the typing of this book with considerable dexterity. TABLE OF CONTENTS Chapter GENERAL INTRODUCTION 1. 1 Introduction 1...

  19. Craniospinal radiotherapy in adult medulloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Selek, U.; Zorlu, F.; Hurmuz, P.; Cengiz, M.; Gurkaynak, M. [Hacettepe Univ., Ankara (Turkey). Dept. of Radiation Oncology; Turker, A. [Hacettepe Univ., Ankara (Turkey). Dept. of Internal Medicine; Soylemezoglu, F. [Hacettepe Univ., Ankara (Turkey). Dept. of Pathology


    Purpose: To evaluate the outcome and prognostic factors of adult patients with medulloblastoma. Patients and Methods: 26 adult medulloblastoma patients with a median age of 27 were subjected to craniospinal radiotherapy. A dose of 30.6 Gy with 1.8 Gy/fraction/day was prescribed to M0 patients, while 36 Gy were to be applied in patients with positive cerebrospinal liquor findings. The posterior fossa was boosted to 54 Gy. While 20 patients underwent external-beam radiotherapy alone, only six received sequential adjuvant chemotherapy. Results: Male/female ratio was 1.2. Preradiotherapy Karnofsky performance status was recorded as median 100%. 50% were classified as poor risk (n = 10, subtotal resection; n = 3, M+). The median follow-up time was 46.5 months. The 5-year actuarial survival rates for recurrence-free, distant metastasis-free, disease-free, and overall survival were 82.5%, 90.8%, 73.5%, and 89.7%, respectively. Patient characteristics, treatment factors and tumor characteristics failed to show any significance in univariate analysis. Grade 3 or 4 late morbidities were not observed. Conclusion: Yet, the current standard of care seems to remain craniospinal irradiation after maximal surgical resection of the primary neoplasm without clear indications for adjuvant chemotherapy. (orig.)

  20. [Percutaneous radiotherapy of bone metastases]. (United States)

    Schüller, H; Wisser, L; Pauleit, D


    Bone metastases causing pain syndromes and imminent pathologic fractures are among the main reasons for radiotherapy in patients suffering from malignant tumors. The indication is much influenced by the radiologic findings. Surgical methods are to be chosen in the first place in cases of pathologic fractures or patients with a high risk of such fractures. Different authors recommend various therapeutic regimens. Effective pain control can be achieved with one single dose of radiation. Doses of 6 to 40 Gy applied in one to 19 days are also efficient. Side effects, especially nausea and vomiting occur in 25% of cases; this number rises to 50% in cases of half body irradiation. Visible changes of bone mineral density may be noticed about 6 weeks after termination of radiotherapy. About 70% of osteolytic metastases show progressive sclerosis whereas osteosclerotic lesions may show both increase or decline of bone mass. In spite many years of experience the optimal strategy for radiation therapy of bone metastasis has not been defined; further studies are needed.

  1. Psychological and physical distress of cancer patients during radiotherapy

    CERN Document Server

    König, A


    Purpose: patients undergoing radiotherapy have physical and psychological symptoms related to the underlying disease and the treatment. In order to give the best possible support to the patients, more knowledge about the amount and the changing of distress in the course of radiotherapy is of essentially importance. Methods: The distress was measured in a consecutive sample of cancer patients (n=82) undergoing radiotherapy. Each patient was given the EORTC-QLQ-C30, the HADS and a special questionnaire which ascertain radiotherapy-specific items before starting the radiotherapy, at the onset of radiotherapy, in the third week of radiotherapy and 3 weeks after the end of radiotherapy. Results: within the first week of treatment the psychological distress of the patients is increasing; 98.8 % of the patients are 'moderate distressed', 46 % 'severe distressed'. General physical symptoms seem not to be affected by the radiotherapy, there is no changing. The distress caused by the organization of the radiotherapy is...

  2. Systematic Review of Hearing Preservation After Radiotherapy for Vestibular Schwannoma. (United States)

    Coughlin, Adam R; Willman, Tyler J; Gubbels, Samuel P


    To determine the long-term hearing preservation rate for spontaneous vestibular schwannoma treated by primary radiotherapy. The MEDLINE/PubMed, Web of Science, Cochrane Reviews, and EMBASE databases were searched using a comprehensive Boolean keyword search developed in conjunction with a scientific librarian. English language papers published from 2000 to 2016 were evaluated. Inclusion criteria: full articles, pretreatment and posttreatment audiograms or audiogram based scoring system, vestibular schwannoma only tumor type, reported time to follow-up, published after 1999, use of either Gamma Knife or linear accelerator radiotherapy. case report or series with fewer than five cases, inadequate audiometric data, inadequate time to follow-up, neurofibromatosis type 2 exceeding 10% of study population, previous treatment exceeding 10% of study population, repeat datasets, use of proton beam therapy, and non-English language. Two reviewers independently analyzed papers for inclusion. Class A/B, 1/2 hearing was defined as either pure tone average less than or equal to 50 db with speech discrimination score more than or equal to 50%, American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) Hearing Class A or B, or Gardner-Robertson Grade I or II. Aggregate data were used when individual data were not specified. Means were compared with student t test. Forty seven articles containing a total of 2,195 patients with preserved Class A/B, 1/2 hearing were identified for analysis. The aggregate crude hearing preservation rate was 58% at an average reporting time of 46.6 months after radiotherapy treatment. Analysis of time-based reporting shows a clear trend of decreased hearing preservation extending to 10-year follow-up. This data encourages a future long-term controlled trial.

  3. Concurrent chemotherapy and radiotherapy for cervical cancer. (United States)

    Martín-Martínez, A; Molano, F; Lloret, M; Falcón-Vizcaino, O; García-Hernández, J A


    To compare the results obtained following treatment, from a group of patients with locally advanced cervical cancer (Stage IB or higher) treated with concurrent chemotherapy and radiotherapy in relation to a group of patients treated exclusively with radiotherapy. All patients treated with concurrent chemotherapy and radiotherapy at the Gynaecologic Oncology Unit of the University Hospital Materno Infantil of the Canaries between 1999 and 2000, both inclusive, were included. The first group to be considered was formed by patients who received combined treatment. The second group of patients received radiotherapy exclusively, having been treated in previous years (1997-1998 period). The results were compared in relation to survival in the two following years from treatment (2000-2001) in the group of combined treatment and years 1999-2000 in the group that received only radiotherapy. To compare the survival of both groups the chi-square test and Odds Ratio were utilised. The groups compared are homogeneous when looking at the stage of the disease when diagnosed, the histological type of tumour and its degree of cellular differentiation, the CAT results and tumoral markers. Survival of more than two years was observed in the group treated with concurrent chemotherapy and radiotherapy in relation to the group treated exclusively with radiotherapy; chi-square 9.92, p < 0.01, OR: 0.1 (0.01-0.6).

  4. Predictors for trismus in patients receiving radiotherapy. (United States)

    van der Geer, S Joyce; Kamstra, Jolanda I; Roodenburg, Jan L N; van Leeuwen, Marianne; Reintsema, Harry; Langendijk, Johannes A; Dijkstra, Pieter U


    Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of trismus after radiotherapy in head and neck cancer patients using a large database (n = 641). Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for trismus using a multivariable logistic regression analysis. At six months after radiotherapy, 28.1% of the patients without trismus prior to radiotherapy developed trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points. Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.


    Directory of Open Access Journals (Sweden)

    G. V. Afonin


    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

  6. Carotid artery stenosis after neck radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shimamura, Munehisa; Hashimoto, Yoichiro; Kasuya, Junji; Terasaki, Tadashi [Kumamoto City Hospital (Japan); Uchino, Makoto


    Carotid artery stenosis sometimes occurs after cervical radiotherapy. We report a 70-year-old woman with a history of radiotherapy for thyroid cancer at the age of 28 years. She had no signs and symptoms except the skin lesion at the irradiation site. Duplex ultrasonography revealed heterogeneous plaques showing 50% stenosis of bilateral common carotid arteries. Those lesions were observed within segment of irradiation, where atheromatous plaque usually seldom occurs. These indicated that the carotid stenosis was induced by radiotherapy. Although the efficacy of antiplatelet therapy for radiation-induced plaque is not clear, the plaques remained unchanged for 4 years in spite of aspirin administration. (author)

  7. 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...

  8. Radiotherapy versus combined modality in early stages

    DEFF Research Database (Denmark)

    Specht, L; Carde, P; Mauch, P


    In early stage Hodgkin's disease the optimal choice of treatment for the individual patient is still an unresolved issue. So far, twenty-two randomized trials of radiotherapy alone versus radiotherapy plus combination chemotherapy have been carried out worldwide. The preliminary results of a global...... be reduced, and that the stress of experiencing a relapse is avoided in many patients. The major argument against the use of chemotherapy up front is: that by careful staging and selection of patients and by careful radiotherapy techniques the number of patients exposed to potentially toxic chemotherapy may...

  9. Treatise on intuitionistic type theory

    CERN Document Server

    Granström, Johan Georg


    Intuitionistic type theory can be described, somewhat boldly, as a fulfillment of the dream of a universal language for science.  In particular, intuitionistic type theory is a foundation for mathematics and a programming language.

  10. An elementary treatise on electricity

    CERN Document Server

    Maxwell, James Clerk


    Albert Einstein characterized the work of James Clerk Maxwell as the ""most profound and the most fruitful that physics has experienced since the time of Newton."" Max Planck went even further, declaring that ""he achieved greatness unequalled,"" and Richard Feynman asserted that ""From a long view of the history of mankind - seen from, say, ten thousand years from now - there can be little doubt that the most significant event of the nineteenth century will be judged as Maxwell's discovery of the laws of electrodynamics."" Maxwell made numerous other contributions to the advancement of scien

  11. Introduction to Radiotherapy with Photon and Electron Beams and Treatment Planning from Conformal Radiotherapy to IMRT (United States)

    Wilkens, Jan J.


    Besides surgery and chemotherapy, radiation therapy is one of the three main treatment options for cancer patients. This paper provides an introduction to the basic principles of radiotherapy with photons and electrons. It includes a brief summary of the physical properties for photon and electron beams as well as a description of treatment machines used to create these beams. The second part introduces the treatment planning process as it is commonly employed in radiotherapy. It covers dose calculation algorithms, conventional planning strategies for three-dimensional conformal radiotherapy, and optimization techniques for intensity modulated radiotherapy (IMRT).

  12. A comprehensive intervention program on the long-term placement of peripherally inserted central venous catheters


    Wenfeng Chen; Haoyu Deng; Liangfang Shen; Man Qin; Lianxian He


    Background: Peripherally inserted central venous catheters (PICCs) have been increasingly utilized in treating patients in intensive care. The purpose of this study is to analyze the related complications and to evaluate effect of a comprehensive intervention on long-term PICCs. Materials and Methods: We selected 217 and 243 cases before and after comprehensive intervention respectively from the department of radiotherapy in our hospital. Various possible factors affecting PICCs insertions...

  13. Dermatologic radiotherapy and breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goldschmidt, H.; Gorson, R.O.; Lassen, M.


    This study was set up to provide quantitative data to evaluate unsubstantiated claims that improper dermatologic radiation techniques may cause breast cancer. A thin mylar window ionization rate meter placed at the location of the right breast of an Alderson-RANDO anthropomorphic phantom was used to measure direct and scatter radiation reaching the female breast during radiotherapy of the facial region (as given for acne). The results indicate that scatter doses are very small; they are influenced by radiation quality and the use or nonuse of a treatment cone. Quantitative risk estimates show that the very small risk of breast cancer induction can be reduced even further by the use of proper radiation protection measures.

  14. Tomodensitometry images: integration in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dessy, F.; Hoornaert, M.T. [Jolimont Hospital, Haine Saint Paul (France). Cancer and Nuclear Medicine Dept.; Malchair, F. [Biomed Engineering, Boncelles (France)


    With a view to utilization of CT scan images in radiotherapy, the effective energy and the linearity of four different scanners (Siemens somatom CR, HiQS, Plus and Picker PQ 2000) and two non standard scanners, simulators with CT option (Webb 1990) (Varian Ximatron and Oldelft Simulx CT) has been measured using the method described by White and Speller in 1980. When the linearity relation in presented using the density or the electron density as the abscissa, a blurred area where two different components of equal density or electron density can have two different Hounsfield`s numbers. Using the linearity relation, the density of Rando`s lung heterogeneity is determined. We calculated a treatment planning (TP) using this value and made a comparison between the TP and the real absorbed dose with was measured using diodes. The comparison between the TP and the relative Absorbed doses showed a difference of up to 4.5%.

  15. Radiogenomics and radiotherapy response modeling (United States)

    El Naqa, Issam; Kerns, Sarah L.; Coates, James; Luo, Yi; Speers, Corey; West, Catharine M. L.; Rosenstein, Barry S.; Ten Haken, Randall K.


    Advances in patient-specific information and biotechnology have contributed to a new era of computational medicine. Radiogenomics has emerged as a new field that investigates the role of genetics in treatment response to radiation therapy. Radiation oncology is currently attempting to embrace these recent advances and add to its rich history by maintaining its prominent role as a quantitative leader in oncologic response modeling. Here, we provide an overview of radiogenomics starting with genotyping, data aggregation, and application of different modeling approaches based on modifying traditional radiobiological methods or application of advanced machine learning techniques. We highlight the current status and potential for this new field to reshape the landscape of outcome modeling in radiotherapy and drive future advances in computational oncology.

  16. Comprehensive metabolic panel (United States)

    Metabolic panel - comprehensive; Chem-20; SMA20; Sequential multi-channel analysis with computer-20; SMAC20; Metabolic panel 20 ... Chernecky CC, Berger BJ. Comprehensive metabolic panel (CMP) - ... Diagnostic Procedures . 6th ed. St Louis, MO: Elsevier Saunders; ...

  17. The role of perioperative radiotherapy in gastric cancer (United States)

    Batista, Thales Paulo; de Mendonça, Lucas Marques; Fassizoli-Fonte, Ana Luiza


    Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment. PMID:25992221

  18. Hippocampal-Sparing Whole-Brain Radiotherapy for Lung Cancer. (United States)

    Zhao, Ren; Kong, Wei; Shang, Jun; Zhe, Hong; Wang, Yan-Yang


    Brain metastases occur in 20% to 40% of lung cancer patients. Whole-brain radiotherapy (WBRT) has long been considered the treatment of choice for many patients with lung cancer, because of its wide availability, ease of delivery, and effectiveness in prolonging survival. However, WBRT is also associated with several side effects, such as decline in memory and other cognitive functions. There exists significant preclinical and clinical evidence that radiation-induced injury to the hippocampus correlates with neurocognitive decline of patients who receive WBRT. Technological advances in treatment planning and delivery facilitate the use of hippocampal-sparing (HS) WBRT as prophylactic cranial irradiation or the primary treatment modality for lung cancer patients with brain metastases. In this review, we provide a detailed and comprehensive discussion of the safety profile, techniques for hippocampus-sparing, and the clinical evidence of HS-WBRT for lung cancer patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Stereotactic body radiotherapy a practical guide

    CERN Document Server

    Gaya, Andrew


    Collecting the key information in this burgeoning field into a single volume, this handbook for clinical oncology trainees and consultants covers all of the basic aspects of stereotactic radiotherapy systems and treatment and includes plenty of case studies.

  20. Glioblastoma after radiotherapy for pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Young; Park, Kyung Ran; KIm, Jun Joo; Lee, Chong In; Kim, Myung Soon; Jung, Soon Hee [Wonju College of Medicine, Yonsei Univ., Wonju (Korea, Republic of)


    A 39-year-old woman developed a glioblastoma about 7 years and 10 months after local radiotherapy (45 Gy) for pituitary adenoma. Clinical and histopathological details are presented, and previously reported cases of radiation-induced glioma are reviewed.

  1. Estimating the Risks of Breast Cancer Radiotherapy

    DEFF Research Database (Denmark)

    Taylor, Carolyn; Correa, Candace; Duane, Frances K


    Purpose Radiotherapy reduces the absolute risk of breast cancer mortality by a few percentage points in suitable women but can cause a second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy. Methods First, a systematic literature...... review was performed of lung and heart doses in breast cancer regimens published during 2010 to 2015. Second, individual patient data meta-analyses of 40,781 women randomly assigned to breast cancer radiotherapy versus no radiotherapy in 75 trials yielded rate ratios (RRs) for second primary cancers...... and cause-specific mortality and excess RRs (ERRs) per Gy for incident lung cancer and cardiac mortality. Smoking status was unavailable. Third, the lung or heart ERRs per Gy in the trials and the 2010 to 2015 doses were combined and applied to current smoker and nonsmoker lung cancer and cardiac mortality...

  2. MRI-guided radiotherapy for renal tumours

    NARCIS (Netherlands)

    Stam, M.K.


    The current surgical treatment for renal cell carcinoma (RCC) experiences complications due to the invasiveness of the treatment. Minimally invasive alternative treatments, such as radiofrequency and cryogen ablation, have fewer complications but a lower local control. Radiotherapy is an established

  3. The result of radiotherapy for pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, H. J.; Yang, K. M.; Suh, S. H. [Inje Univ., Seoul (Korea, Republic of). Coll. of Medicine; Cho, H. L.; Shon, S. C. [Pusan Paik Hospital, Pusan (Korea, Republic of)


    To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median: 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy(median: 5040cGy) were delivered over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. For radiation therapy alone, the 5 YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy , the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P>0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achieved normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes. (author).

  4. Immediate side effects of large fraction radiotherapy. (United States)

    Devereux, S; Hatton, M Q; Macbeth, F R


    The use of hypofractionated radiotherapy regimens is becoming more widely recognized in the palliation of non-small cell lung carcinoma (NSCLC). Anecdotal reports of chest pain, rigors and fevers in the hours that follow radiotherapy led us to perform a survey estimating the frequency and severity of these symptoms following treatment to the thorax. One hundred and eighteen patients completed questionnaires 24 hours after palliative radiotherapy treatment; 84 were male. The median age was 67 years. One hundred and seven had histologically confirmed NSCLC. A parallel opposed technique was used in 113 patients. Doses ranged from 8 Gy in a single fraction to 60 Gy in 30 fractions. Chest pain was reported by 54 (45.8%) patients after the first radiotherapy fraction; in 42 it commenced within 12 hours of treatment. The pain varied in site, nature and duration; on 23 occasions, it lasted under 2 hours. Systemic symptoms (rigors, sweating, fevers) were documented on 43 questionnaires, starting within 12 hours of treatment in 33 patients and on 30 occasions lasting less than 2 hours. Chest pain and systemic symptoms occurred together in 28 patients. Only 49 (41.5%) patients reported no immediate side effects. We conclude that patients receiving palliative radiotherapy for bronchial carcinoma often develop significant symptoms in the hours following treatment. The timing and duration suggest a relationship with the radiotherapy, and we feel that patients should be warned of the possible occurrence of these symptoms.

  5. Role of radiotherapy fractionation in head and neck cancers (MARCH) : an updated meta-analysis

    NARCIS (Netherlands)

    Lacas, Benjamin; Bourhis, Jean; Overgaard, Jens; Zhang, Qiang; Grégoire, Vincent; Nankivell, Matthew; Zackrisson, Björn; Szutkowski, Zbigniew; Suwiński, Rafał; Poulsen, Michael; O'Sullivan, Brian; Corvò, Renzo; Laskar, Sarbani Ghosh; Fallai, Carlo; Yamazaki, Hideya; Dobrowsky, Werner; Cho, Kwan Ho; Garden, Adam S; Langendijk, Johannes A; Viegas, Celia Maria Pais; Hay, John; Lotayef, Mohamed; Parmar, Mahesh K B; Aupérin, Anne; van Herpen, Carla; Maingon, Philippe; Trotti, Andy M; Grau, Cai; Pignon, Jean-Pierre; Blanchard, Pierre

    BACKGROUND: The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival compared with conventional radiotherapy, with hyperfractionated radiotherapy showing the

  6. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis

    NARCIS (Netherlands)

    Lacas, B.; Bourhis, J.; Overgaard, J.; Zhang, Q; Gregoire, V.; Nankivell, M.; Zackrisson, B.; Szutkowski, Z.; Suwinski, R.; Poulsen, M.; O'Sullivan, B.; Corvo, R.; Laskar, S.G.; Fallai, C.; Yamazaki, H.; Dobrowsky, W.; Cho, K.H.; Garden, A.S.; Langendijk, J.A.; Viegas, C.M.P.; Hay, J.; Lotayef, M.; Parmar, M.K.; Auperin, A.; Herpen, C.M. van; Maingon, P.; Trotti, A.M.; Grau, C.; Pignon, J.P.; Blanchard, P.


    BACKGROUND: The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival compared with conventional radiotherapy, with hyperfractionated radiotherapy showing the

  7. Radiotherapy for pain management of bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano, E-mail: [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)


    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  8. Intraoperative Radiotherapy for Breast Cancer

    Directory of Open Access Journals (Sweden)

    Eleanor E. R. Harris


    Full Text Available Intraoperative radiotherapy (IORT for early stage breast cancer is a technique for partial breast irradiation. There are several technologies in clinical use to perform breast IORT. Regardless of technique, IORT generally refers to the delivery of a single dose of radiation to the periphery of the tumor bed in the immediate intraoperative time frame, although some protocols have performed IORT as a second procedure. There are two large prospective randomized trials establishing the safety and efficacy of breast IORT in early stage breast cancer patients with sufficient follow-up time on thousands of women. The advantages of IORT for partial breast irradiation include: direct visualization of the target tissue ensuring treatment of the high-risk tissue and eliminating the risk of marginal miss; the use of a single dose coordinated with the necessary surgical excision thereby reducing omission of radiation and the selection of mastectomy for women without access to a radiotherapy facility or unable to undergo several weeks of daily radiation; favorable toxicity profiles; patient convenience and cost savings; radiobiological and tumor microenvironment conditions which lead to enhanced tumor control. The main disadvantage of IORT is the lack of final pathologic information on the tumor size, histology, margins, and nodal status. When unexpected findings on final pathology such as positive margins or positive sentinel nodes predict a higher risk of local or regional recurrence, additional whole breast radiation may be indicated, thereby reducing some of the convenience and low-toxicity advantages of sole IORT. However, IORT as a tumor bed boost has also been studied and appears to be safe with acceptable toxicity. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses. It may also be very useful in specific situations, such as prior to oncoplastic reconstruction to improve accuracy of

  9. Comparison of Plutarch’s Defence of Animals in the Treatise On the Eating of Flesh and Shelley’s A Vindication of Natural Diet

    Directory of Open Access Journals (Sweden)

    Branislava Vičar


    equality of human and animal sentient experience and rejects the view that animals’ fundamental interest is not to suffer as inadequate. The essay A Vindication of Natural Diet by Percy B. Shelley, while primarily based on Plutarch’s treatise, comes to conclusions supporting the lifestyle argument with emerging elements of liberal individualism. Shelley’s argumentation is not built on the conception of justice like Plutarch’s, but on the conceptions of happiness, satisfaction and enjoyment of the individual. Plutarch’s ethical argument is replaced by the so-called ‘lifestyle’ argument, which is completely in accordance with the self-centred and self-oriented Romantic as a self-sufficient subject in the early 19th century. In terms of consideration of animals and their moral status, it is particularly important that Shelley in this essay does not actually argue for animals, but rather for spe- ciesism, that is, he builds his argumentation on the hierarchisation in which humans hold the top position.

  10. Radiotherapy Treatment Planning for Testicular Seminoma

    Energy Technology Data Exchange (ETDEWEB)

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


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

  11. Post Pelvic Radiotherapy Bony Changes

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Seung Jae [Samsung Medical Center, Seoul (Korea, Republic of)


    There has been recent interest in radiation-induced bone injury in clinical conditions, especially for pelvic insufficiency fracture (PIF). A PIF is caused by the effect of normal or physiological stress on bone with demineralization and decreased elastic resistance. Pelvic radiotherapy (RT) can also contribute to the development of a PIF. A PIF has been regarded as a rare complication with the use of megavoltage equipment. However, recent studies have reported the incidence of PIFs as 8.2{approx}20% after pelvic RT in gynecological patients, an incidence that was higher than previously believed. The importance of understanding a PIF lies in the potential for misdiagnosis as a bony metastasis. If patients complain of pelvic pain after whole-pelvis radiation therapy, the presence of a PIF must be considered in the differential diagnosis. The use of multibeam arrangements and conformal RT to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture. In addition to a PIF, osteonecrosis and avascular necrosis of the femoral head can develop after radiation therapy. Osteoradionecrosis of the pelvic bone is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. A post-radiation bone sarcoma can result as a long-term sequela of pelvic irradiation for uterine cervical cancer.

  12. Radiotherapy for the vulvar cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hirota, Saeko; Soejima, Toshinori; Motohara, Tomofumi (Hyogo Medical Center for Adults, Akashi (Japan)) (and others)


    Fifteen patients who had primary vulvar cancer treated with radiotherapy as an initial treatment at Hyogo Medical Center for Adults and Hyogo Cancer Center from January 1971 to December 1990 are presented. Two patients were stage 0, one stage I, three stage II and nine stage III. Nine patients received electron irradiation with or without interstitial irradiation and intracavitary vaginal irradiation. Five patients received megavoltage X-ray irradiation using AP/PA parallel opposed fields including the pelvic nodes and perineum followed by boost irradiation of electrons, interstitial irradiation and intracavitary vaginal irradiation. The total dose delivered to the primary tumor ranged from 50 to 100 Gy (73 Gy on average). The actuarial 5-year survival rate of the patients was 43.6%. Complete regression (CR) was achieved in 60% of the patients. However, CR was not achieved in any of five patients with palpable inguinal nodes. In contrast, all the patients who had tumors of less than 2 cm in diameter achieved CR. Five of nine CR cases relapsed. First sites of failure were vagina, groin and vulvar region. Recurrence occurred more than four years after treatment in three cases. Necrosis occurred in five of nine CR cases. (author).

  13. Collision prediction software for radiotherapy treatments

    Energy Technology Data Exchange (ETDEWEB)

    Padilla, Laura [Virginia Commonwealth University Medical Center, Richmond, Virginia 23298 (United States); Pearson, Erik A. [Techna Institute and the Princess Margaret Cancer Center, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Pelizzari, Charles A., E-mail: [Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637 (United States)


    Purpose: This work presents a method of collision predictions for external beam radiotherapy using surface imaging. The present methodology focuses on collision prediction during treatment simulation to evaluate the clearance of a patient’s treatment position and allow for its modification if necessary. Methods: A Kinect camera (Microsoft, Redmond, WA) is used to scan the patient and immobilization devices in the treatment position at the simulator. The surface is reconstructed using the SKANECT software (Occipital, Inc., San Francisco, CA). The treatment isocenter is marked using simulated orthogonal lasers projected on the surface scan. The point cloud of this surface is then shifted to isocenter and converted from Cartesian to cylindrical coordinates. A slab models the treatment couch. A cylinder with a radius equal to the normal distance from isocenter to the collimator plate, and a height defined by the collimator diameter is used to estimate collisions. Points within the cylinder clear through a full gantry rotation with the treatment couch at 0° , while points outside of it collide. The angles of collision are reported. This methodology was experimentally verified using a mannequin positioned in an alpha cradle with both arms up. A planning CT scan of the mannequin was performed, two isocenters were marked in PINNACLE, and this information was exported to AlignRT (VisionRT, London, UK)—a surface imaging system for patient positioning. This was used to ensure accurate positioning of the mannequin in the treatment room, when available. Collision calculations were performed for the two treatment isocenters and the results compared to the collisions detected the room. The accuracy of the Kinect-Skanect surface was evaluated by comparing it to the external surface of the planning CT scan. Results: Experimental verification results showed that the predicted angles of collision matched those recorded in the room within 0.5°, in most cases (largest deviation

  14. Review of the curative role of radiotherapy in the treatment of non-small cell lung cancer. (United States)

    Damstrup, L; Poulsen, H S


    The present paper is a comprehensive review of available data concerning the role of radiotherapy as an intended curative treatment in patients with non-small cell lung cancer (NSCL). The following issues are reviewed (1) optimal dose, (2) optimal fractionation, (3) optimal treatment planning, (4) clinical results in terms of single treatment and combined treatment with either surgery or chemotherapy. In resectable NSCLC high dose radiotherapy to small localized tumours gives a 5-year survival rate of 7-38%. It is concluded that this treatment modality is appropriate for certain selected patients who refuse to have surgery, who have medical contradications for surgery, or who are of old age. It is discussed whether the treatment should be split course, continuous, hypo-og hyperfraction. A total dose of 55 Gy must be given. CT scanning should be mandatory for optimal planning and therapy. The literature does not give a conclusive answer to whether preoperative or postoperative radiotherapy is indicated. The data indicate that patients with Stage III NSCLC will benefit from a combined treatment modality in terms of chemotherapy based on high dose cisplatinum and radiotherapy. The main conclusion of the review is that many areas with randomized controlled trials are needed in order to answer the critical issue of the role of radiotherapy in the treatment of NSCLS.

  15. Cardiovascular effects after low-dose exposure and radiotherapy: what research is needed?

    Energy Technology Data Exchange (ETDEWEB)

    Wondergem, Jan [International Atomic Energy Agency, Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences and Applications, Vienna (Austria); Boerma, Marjan [University of Arkansas for Medical Sciences, Division of Radiation Health, Department of Pharmaceutical Sciences, Little Rock, AR (United States); Kodama, Kazunori [Radiation Effects Research Foundation, Hiroshima (Japan); Stewart, Fiona A. [Netherlands Cancer Institute, Biological Stress Response (H3), Amsterdam (Netherlands); Trott, Klaus R.


    The authors of this report met at the Head Quarter of the International Atomic Energy Agency (IAEA) in Vienna, Austria, on 2-4 July 2012, for intensive discussions of an abundance of original publications on new epidemiological studies on cardiovascular effects after low-dose exposure and radiotherapy and radiobiological experiments as well as several comprehensive reviews that were published since the previous meeting by experts sponsored by the IAEA in June 2006. The data necessitated a re-evaluation of the situation with special emphasis on the consequences current experimental and clinical data may have for clinical oncology/radiotherapy and radiobiological research. The authors jointly arrived at the conclusions and recommendations presented here. (orig.)

  16. Technical Note: DIRART – A software suite for deformable image registration and adaptive radiotherapy research (United States)

    Yang, Deshan; Brame, Scott; El Naqa, Issam; Aditya, Apte; Wu, Yu; Murty Goddu, S.; Mutic, Sasa; Deasy, Joseph O.; Low, Daniel A.


    Purpose: Recent years have witnessed tremendous progress in image guide radiotherapy technology and a growing interest in the possibilities for adapting treatment planning and delivery over the course of treatment. One obstacle faced by the research community has been the lack of a comprehensive open-source software toolkit dedicated for adaptive radiotherapy (ART). To address this need, the authors have developed a software suite called the Deformable Image Registration and Adaptive Radiotherapy Toolkit (DIRART). Methods:DIRART is an open-source toolkit developed in MATLAB. It is designed in an object-oriented style with focus on user-friendliness, features, and flexibility. It contains four classes of DIR algorithms, including the newer inverse consistency algorithms to provide consistent displacement vector field in both directions. It also contains common ART functions, an integrated graphical user interface, a variety of visualization and image-processing features, dose metric analysis functions, and interface routines. These interface routines make DIRART a powerful complement to the Computational Environment for Radiotherapy Research (CERR) and popular image-processing toolkits such as ITK. Results: DIRART provides a set of image processing∕registration algorithms and postprocessing functions to facilitate the development and testing of DIR algorithms. It also offers a good amount of options for DIR results visualization, evaluation, and validation. Conclusions: By exchanging data with treatment planning systems via DICOM-RT files and CERR, and by bringing image registration algorithms closer to radiotherapy applications, DIRART is potentially a convenient and flexible platform that may facilitate ART and DIR research. PMID:21361176

  17. DEGRO practical guidelines for radiotherapy of breast cancer I. Breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Municipal Hospital Karlsruhe (Germany); Budach, W. [Univ. Hospital Duesseldorf (Germany); Dunst, J. [Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Haase, W. [St.-Vincentius-Kliniken, Karlsruhe (Germany); Harms, W. [Univ. Hospital Heidelberg (Germany); Sedlmayer, F. [Univ. Hospital, Salzburger Landeskliniken, Salzburg (Austria); Souchon, R. [Allgemeines Krankenhaus Hagen (Germany); Wenz, F. [Univ. Hospital Mannheim (Germany); Sauer, R. [Univ. Hospital Erlangen-Nuremberg, Erlangen (Germany)


    Background: The present paper is an update of the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). These recommendations have been elaborated on the basis of the S3 guidelines of the German Cancer Society that were revised in March 2007 by an interdisciplinary panel. Methods: The DEGRO expert panel performed a comprehensive survey of the literature, comprising lately published meta-analyses, data from recent randomized trials and guidelines of international breast cancer societies, referring to the criteria of evidence-based medicine. In addition to the more general statements of the German Cancer Society, this paper emphasizes specific radiotherapeutic aspects. It is focused on radiotherapy after breast-conserving surgery. Technique, targeting, and dose are described in detail. Results: Postoperative radiotherapy significantly reduces rates of local recurrence. The more pronounced the achieved reduction is, the more substantially it translates into improved survival. Four prevented local recurrences result in one avoided breast cancer death. This effect is independent of age. An additional boost provides a further absolute risk reduction for local recurrence irrespective of age. Women > 50 years have a hazard ratio of 0.59 in favor of the boost. For DCIS, local recurrence was 2.4% per patient year even in a subgroup with favorable prognostic factors leading to premature closure of the respective study due to ethical reasons. For partial-breast irradiation as a sole method of radiotherapy, results are not yet mature enough to allow definite conclusions. Conclusion: After breast-conserving surgery, whole-breast irradiation remains the gold standard of treatment. The indication for boost irradiation should no longer be restricted to women {<=} 50 years. Partial-breast irradiation is still an experimental treatment and therefore discouraged outside controlled

  18. Value of intraoperative radiotherapy in locally advanced rectal cancer

    NARCIS (Netherlands)

    Ferenschild, Floris T. J.; Vermaas, Maarten; Nuyttens, Joost J. M. E.; Graveland, Wilfried J.; Marinelli, Andreas W. K. S.; van der Sijp, Joost R.; Wiggers, Theo; Verhoef, Cornelis; Eggermont, Alexander M. M.; de Wilt, Johannes H. W.

    PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable

  19. Needs and financing of radiotherapy in France and Europe


    Defourny, Noémie; Lievens, Yolande


    Access to high-quality and safe radiotherapy is a prerequisite to assure optimal oncology care in a multi-disciplinary environment. In view of supporting long-term radiotherapy planning, actual and predicted radiotherapy needs should be put in context of the nowadays' available resources. The present article reviews the existing data on radiotherapy resources and needs, along with the prevailing reimbursement systems in the different European countries, with a specific emphasis on France. It ...

  20. Clinical development of new drug–radiotherapy combinations


    Sharma, Ricky A.; Plummer, Ruth; Stock, Julie K.; Greenhalgh, Tessa A.; Ataman, Ozlem; Kelly, Stephen; Clay, Robert; Adams, Richard Alexander; Baird, Richard D; Billingham, Lucinda; Brown, Sarah R; Buckland, Sean; Bulbeck, Helen; Chalmers, Anthony J.; Clack, Glen


    In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiother...

  1. Assessment of post-radiotherapy salivary glands (United States)

    Cheng, S C H; Wu, V W C; Kwong, D L W; Ying, M T C


    Salivary glands are usually irradiated during radiotherapy for head and neck cancers, which can lead to radiation-induced damage. Radiation-induced xerostomia (oral dryness) is the most common post-radiotherapy complication for head and neck cancer patients and can reduce the patient’s quality of life. Accurate and efficient salivary gland assessment methods provide a better understanding of the cause and degree of xerostomia, and may help in patient management. At present, there are different methods for the assessment of salivary gland hypofunction; however, none of them are considered to be standard procedure. This article reviews the value of common methods in the assessment of post-radiotherapy salivary glands. PMID:21511748

  2. Track structure modelling for ion radiotherapy

    CERN Document Server

    Korcyl, Marta


    In its broadest terms, doctoral dissertation entitled "Track structure modelling for ion radiotherapy" is part of the supporting research background in the development of the ambitious proton radiotherapy project currently under way at the Institute of Nuclear Physics PAN in Krak\\'ow. Another broad motivation was the desire to become directly involved in research on a topical and challenging subject of possibly developing a therapy planning system for carbon beam radiotherapy, based in its radiobiological part on the Track Structure model developed by prof. Robert Katz over 50 years ago. Thus, the general aim of this work was, firstly, to recapitulate the Track Structure model and to propose an updated and complete formulation of this model by incorporating advances made by several authors who had contributed to its development in the past. Secondly, the updated and amended (if necessary) formulation of the model was presented in a form applicable for use in computer codes which would constitute the "radiobio...

  3. Pelvic radiotherapy and sexual dysfunction in women

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine; Froeding, Ligita Paskeviciute


    BACKGROUND: During the past decade there has been considerable progress in developing new radiation methods for cancer treatment. Pelvic radiotherapy constitutes the primary or (neo) adjuvant treatment of many pelvic cancers e.g., locally advanced cervical and rectal cancer. There is an increasing...... of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors. METHODS: An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological...... and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities. RESULTS...

  4. Experience with carbon ion radiotherapy at GSI

    Energy Technology Data Exchange (ETDEWEB)

    Jaekel, O. [Division of Medical Physics in Radiation Therapy (E040), German Cancer Research Center, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany)]. E-mail:; Schulz-Ertner, D. [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Karger, C.P. [Division of Medical Physics in Radiation Therapy (E040), German Cancer Research Center, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Heeg, P. [Division of Medical Physics in Radiation Therapy (E040), German Cancer Research Center, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Debus, J. [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany)


    At GSI, a radiotherapy facility was established using beam scanning and active energy variation. Between December 1997 and April 2004, 220 patients have been treated at this facility with carbon ions. Most patients are treated for chordoma and chondrosarcoma of the base of skull, using a dose of 60 Gye (Gray equivalent) in 20 fractions. Carbon ion therapy is also offered in a combination with conventional radiotherapy for a number of other tumors (adenoidcystic carcinoma, chordoma of the cervical spine and sacrum, atypical menningeoma). The patients treated for skull base tumors showed an overall local control rate after two years of 90%. The overall treatment toxicity was mild. This shows that carbon ion radiotherapy can safely be applied using a scanned beam and encouraged the Heidelberg university hospital to build a hospital based facility for ion therapy.

  5. Experience with carbon ion radiotherapy at GSI (United States)

    Jäkel, O.; Schulz-Ertner, D.; Karger, C. P.; Heeg, P.; Debus, J.


    At GSI, a radiotherapy facility was established using beam scanning and active energy variation. Between December 1997 and April 2004, 220 patients have been treated at this facility with carbon ions. Most patients are treated for chordoma and chondrosarcoma of the base of skull, using a dose of 60 Gye (Gray equivalent) in 20 fractions. Carbon ion therapy is also offered in a combination with conventional radiotherapy for a number of other tumors (adenoidcystic carcinoma, chordoma of the cervical spine and sacrum, atypical menningeoma). The patients treated for skull base tumors showed an overall local control rate after two years of 90%. The overall treatment toxicity was mild. This shows that carbon ion radiotherapy can safely be applied using a scanned beam and encouraged the Heidelberg university hospital to build a hospital based facility for ion therapy.

  6. Growth laws in cancer: implications for radiotherapy. (United States)

    Castorina, P; Deisboeck, T S; Gabriele, P; Guiot, C


    Comparing the conventional Gompertz tumor growth law (GL) with the "Universal" law (UL), which has recently been proposed and applied to cancer, we have investigated the implications of the growth laws for various radiotherapy regimens. According to the GL, the surviving tumor cell fraction could be reduced ad libitum, independent of the initial tumor mass, simply by increasing the number of treatments. In contrast, if tumor growth dynamics follows the Universal scaling law, there is a lower limit of the surviving fraction that cannot be reduced further regardless of the total number of treatments. This finding can explain the so-called tumor size effect and re-emphasizes the importance of early diagnosis because it implies that radiotherapy may be successful provided that the tumor mass at treatment onset is rather small. Taken together with our previous work, the implications of these findings include revisiting standard radiotherapy regimens and treatment protocols overall.

  7. Radiotherapy versus combined modality in early stages

    DEFF Research Database (Denmark)

    Specht, L.; Carde, P.; Mauch, P.


    metaanalysis of these trials indicate that we still do not definitively know whether or not the addition of prophylactic chemotherapy up front improves survival. Arguments in favour of the addition of chemotherapy up front are: that laparotomy may be avoided, that radiation fields and doses may perhaps......In early stage Hodgkin's disease the optimal choice of treatment for the individual patient is still an unresolved issue. So far, twenty-two randomized trials of radiotherapy alone versus radiotherapy plus combination chemotherapy have been carried out worldwide. The preliminary results of a global...... be reduced, and that the stress of experiencing a relapse is avoided in many patients. The major argument against the use of chemotherapy up front is: that by careful staging and selection of patients and by careful radiotherapy techniques the number of patients exposed to potentially toxic chemotherapy may...

  8. Recommendation: Comprehensive Programming. (United States)

    Kelly, Judith


    This article summarizes recommendations of the Richardson Study regarding a comprehensive approach to programing for gifted students. Basic components of comprehensive programing are outlined, and seven steps deemed essential to program development and implementation are described, as implemented by the Pyramid Project in four school districts in…

  9. Spectrum of Physics Comprehension (United States)

    Blasiak, W.; Godlewska, M.; Rosiek, R.; Wcislo, D.


    The paper presents the results of research on the relationship between self-assessed comprehension of physics lectures and final grades of junior high school students (aged 13-15), high school students (aged 16-18) and physics students at the Pedagogical University of Cracow, Poland (aged 21). Students' declared level of comprehension was measured…

  10. Scaffolding Reading Comprehension Skills (United States)

    Salem, Ashraf Atta Mohamed Safein


    The current study investigates whether English language teachers use scaffolding strategies for developing their students' reading comprehension skills or just for assessing their comprehension. It also tries to demonstrate whether teachers are aware of these strategies or they use them as a matter of habit. A questionnaire as well as structured…

  11. Disentangling Accent from Comprehensibility (United States)

    Trofimovich, Pavel; Isaacs, Talia


    The goal of this study was to determine which linguistic aspects of second language speech are related to accent and which to comprehensibility. To address this goal, 19 different speech measures in the oral productions of 40 native French speakers of English were examined in relation to accent and comprehensibility, as rated by 60 novice raters…

  12. Case in Language Comprehension

    NARCIS (Netherlands)

    Bader, Markus; Lamers, Monique


    Research on human language comprehension has been heavily influenced by properties of the English language. Since case plays only a minor role in English, its role for language comprehension has only recently become a topic for extensive research on psycholinguistics. In the psycholinguistic

  13. Comprehensive geriatric assessment

    African Journals Online (AJOL)


    Sep 14, 2007 ... i.e. difficulty performing simple physical and mental tasks necessary for daily ... elderly person's medical, psychological and functional capability in ... care. Components of comprehensive geriatric assessment. Comprehensive geriatric assessment. The increasing morbidity related to old age requires careful.

  14. [Radiotherapy in node-positive prostate cancer]. (United States)

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


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

  15. Radiotherapy in the treatment of solitary plasmacytoma. (United States)

    Jyothirmayi, R; Gangadharan, V P; Nair, M K; Rajan, B


    Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMP) are rare. High local control rates are reported with radiotherapy, although the optimal dose and extent of radiotherapy portals remains controversial. Between 1983 and 1993, 30 patients with solitary plasmacytoma were seen at the Regional Cancer Centre, Trivandrum, India. 23 patients had SPB and seven EMP. The mean age was 52 years and the male to female ratio 3.2:1. Diagnosis of SPB was confirmed by biopsy in 16 patients and tumour excision in seven. 20 patients received megavoltage radiotherapy to the bone lesion with limited margins, and one received chemotherapy. Two patients who underwent complete tumour excision received no further treatment. All seven patients with EMP received megavoltage radiotherapy, four following biopsy and three after tumour excision. Local control was achieved in all patients with SPB. Nine progressed to multiple myeloma and one developed a solitary plasmacytoma in another bone. Six patients with EMP achieved local control. Three later progressed to multiple myeloma and one had local relapse. Median time to relapse was 28 months in SPB and 30 months in EMP. 5-year overall survival rates were 82% and 57% for patients with SPB and EMP, respectively. The corresponding progression free survival rates were 55% and 50%, respectively. Age, sex, site of tumour, serum M protein and haemoglobin levels did not significantly influence progression free survival. The extent of surgery, radiotherapy dose or time to relapse were not significant prognostic factors. Radiotherapy appears to be an effective modality of treatment of solitary plasmacytoma. No dose-response relationship is observed, and high local control rates are achieved with limited portals. Progression to multiple myeloma is the commonest pattern of failure, although no prognostic factors for progression are identified. The role of chemotherapy in preventing disease progression needs further evaluation.

  16. Usefulness of a guide book for patients to self-help during radiotherapy for anxiety before radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hoshino, Naoko; Yamada, Nami [Aichi Cancer Center, Nagoya (Japan). Hospital; Morita, Kozo


    From May through August 1993, `a guide book for patients to self-help during radiotherapy` prepared at our department was given 80 patients before radiotherapy and the usefulness of this book for understanding of radiotherapy and reduction of anxiety for radiotherapy was investigated. In 83% of patients could read it through, and in 67% of these patients anxiety for treatment reduced. It is necessary that medical staffs make it clear more often, to let them understand this book more correctly. (author).

  17. Radiotherapy QA of the DAHANCA 19 protocol

    DEFF Research Database (Denmark)

    Samsøe, E.; Andersen, E.; Hansen, C. R.


    Purpose/Objective: It has been demonstrated that nonadherence to protocol-specified radiotherapy (RT) requirements is associated with reduced survival, local control and potentially increased toxicity [1]. Thus, quality assurance (QA) of RT is important when evaluating the results of clinical...... the Danish Head and Neck Cancer Group (DAHANCA). Materials and Methods: The clinical results of the DAHANCA 19 randomized phase III trial evaluated the effect of concurrent EGFR-inhibition during primary curative (chemo) radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC). A total...

  18. The Use of Creams in Radiotherapy

    DEFF Research Database (Denmark)

    Martinsen, May-Lin; Frost, Else; Bergmansen, Nina


    Purpose/Objective: At the Danish wards for radiotherapy there are different rules regarding the intervals that have to pass from the moment the patients applies moisturizer until they can be treated. This is due to the fact that it is unclear whether the cream can cause bolus effect, thereby...... causing the dose to move towards the skin. This would increase the damages to the patient’s skin during the radiotherapy. There is no evidence on the use of moisturizers. Materials and Methods: We have carried out an experimental trial testing whether creams cause bolus effect. We used two pieces of pork...

  19. Radical radiotherapy for urinary bladder cancer

    DEFF Research Database (Denmark)

    Fokdal, Lars; Høyer, Morten; von der Maase, Hans


    The exact value of radiotherapy in the treatment of muscle-invasive       bladder cancer is difficult to establish, as most studies exploring this       issue are retrospective with different procedures for selecting patients       for treatment, as well as varying treatment strategies. An estimate...... of the       5-year overall survival rate following radiotherapy is approximately 35%       in consecutive-selected patients and approximately 25% in       negative-selected patients...

  20. Second Study of Hyper-Fractionated Radiotherapy

    Directory of Open Access Journals (Sweden)

    R. Jacob


    Full Text Available Purpose and Method. Hyper-fractionated radiotherapy for treatment of soft tissue sarcomas is designed to deliver a higher total dose of radiation without an increase in late normal tissue damage. In a previous study at the Royal Marsden Hospital, a total dose of 75 Gy using twice daily 1.25 Gy fractions resulted in a higher incidence of late damage than conventional radiotherapy using 2 Gy daily fractions treating to a total of 60 Gy. The current trial therefore used a lower dose per fraction of 1.2 Gy and lower total dose of 72 Gy, with 60 fractions given over a period of 6 weeks.

  1. Subacute Cutaneous Lupus Erythematosus Triggered by Radiotherapy

    Directory of Open Access Journals (Sweden)

    I. Kolm


    Full Text Available Background: The origin of collagen autoimmune diseases is not fully understood. Some studies postulate a mechanism of molecular mimicry or heterologous immunity following viral infections triggering autoimmunity. Apart from infections, other exogenous factors such as visible light or X-rays have been reported to incite autoimmunity. Case Report: We report a case of histologically and serologically confirmed subacute lupus erythematosus (SCLE following radiotherapy for breast cancer. Discussion: The close temporal and spatial correlation between radiotherapy and onset of SCLE in this patient suggests that an autoimmune reaction may have been triggered locally by functionally altering the immune system and breaking self-tolerance.

  2. ["El Informe Médico-Moral de la Penosissima y Rigorosa Enfermedad de la Epilepsi" (1763) by the Spaniard Pedro de Horta, the 1st American treatise on epilepsy]. (United States)

    García-Albea, E


    In 1763 Pedro de Horta was requested by the prioress of the convent of San Gerónimo in Puebla de los Angeles to draw up a report to establish whether the epidemic of queer turns, violent shaking or epilepsy which affected the novices was caused by the Devil or was due to natural causes. Pedro de Horta, a doctor qualified in Mexico, methodically and thoroughly prepared an extensive monographic treatise on the illness which included all that was known at the time. The report showed the fierce debates provoked by the subject of epilepsy in the eighteenth century regarding whether it was of natural or supernatural origin. It also contained detailed accounts of the episodes, their causes and treatment. The Spaniard Pedro de Horta should be justly recognized as the first American epileptologist.

  3. [Osseointegration of dental implants after radiotherapy for oral cancer]. (United States)

    Nagy, Judit; Seres, László; Novák, Péter; Nagy, Katalin


    The goal of rehabilitation following radical surgery and radiotherapy for oral cancer is the restoration of oral functions and aesthetics. Osseointegrated implants improve prosthesis stability. Previous radiotherapy was originally considered a contraindication for implant placement. The aim of this study was to evaluate the survival of dental implants following radiotherapy. Nine oral cancer patients who had undergone radical surgery and radiotherapy were selected. A total of 23 implants were inserted. Twenty-one implants (91.3%) have been functioning without discomfort or infection. This study shows that osseointegrated implants should be considered part of the treatment plan for the rehabilitation of oral cancer patients after radiotherapy.

  4. The radiotherapy affects the cognitive processes; La radiotherapie affecte la cognition

    Energy Technology Data Exchange (ETDEWEB)



    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.)

  5. Interruptions disrupt reading comprehension. (United States)

    Foroughi, Cyrus K; Werner, Nicole E; Barragán, Daniela; Boehm-Davis, Deborah A


    Previous research suggests that being interrupted while reading a text does not disrupt the later recognition or recall of information from that text. This research is used as support for Ericsson and Kintsch's (1995) long-term working memory (LT-WM) theory, which posits that disruptions while reading (e.g., interruptions) do not impair subsequent text comprehension. However, to fully comprehend a text, individuals may need to do more than recognize or recall information that has been presented in the text at a later time. Reading comprehension often requires individuals to connect and synthesize information across a text (e.g., successfully identifying complex topics such as themes and tones) and not just make a familiarity-based decision (i.e., recognition). The goal for this study was to determine whether interruptions while reading disrupt reading comprehension when the questions assessing comprehension require participants to connect and synthesize information across the passage. In Experiment 1, interruptions disrupted reading comprehension. In Experiment 2, interruptions disrupted reading comprehension but not recognition of information from the text. In Experiment 3, the addition of a 15-s time-out prior to the interruption successfully removed these negative effects. These data suggest that the time it takes to process the information needed to successfully comprehend text when reading is greater than that required for recognition. Any interference (e.g., an interruption) that occurs during the comprehension process may disrupt reading comprehension. This evidence supports the need for transient activation of information in working memory for successful text comprehension and does not support LT-WM theory. (c) 2015 APA, all rights reserved).

  6. A Bayesian network and heuristic approach for systematic characterization of radiotherapy receipt after breast-conservation surgery. (United States)

    Soto-Ferrari, Milton; Prieto, Diana; Munene, Gitonga


    Breast-conservation surgery with radiotherapy is a treatment highly recommended by the guidelines from the National Comprehensive Cancer Network. However, several variables influence the final receipt of radiotherapy and it might not be administered to breast cancer patients. Our objective is to propose a systematic framework to identify the clinical and non-clinical variables that influence the receipt of unexpected radiotherapy treatment by means of Bayesian networks and a proposed heuristic approach. We used cancer registry data of Detroit, San Francisco-Oakland, and Atlanta from years 2007-2012 downloaded from the Surveillance, Epidemiology, and End Results Program. The samples had patients diagnosed with in situ and early invasive cancer with 14 clinical and non-clinical variables. Bayesian networks were fitted to the data of each region and systematically analyzed through the proposed Zoom-in heuristic. A comparative analysis with logistic regressions is also presented. For Detroit, patients under stage 0, grade undetermined, histology lobular carcinoma in situ, and age between 26-50 were found more likely to receive breast-conservation surgery without radiotherapy. For stages I, IIA, and IIB patients with age between 51-75, and grade II were found to be more likely to receive breast-conservation surgery with radiotherapy. For San Francisco-Oakland, patients under stage 0, grade undetermined, and age >75 are more likely to receive BCS. For stages I, IIA, and IIB patients with age >75 are more likely to receive breast-conservation surgery without radiotherapy. For Atlanta, patients under stage 0, grade undetermined, year 2011, and primary site C509 are more likely to receive breast-conservation surgery without radiotherapy. For stages I, IIA, and IIB patients in year 2011, and grade III are more likely to receive breast-conservation surgery without radiotherapy. For in situ breast cancer and early invasive breast cancer, the results are in accordance with the

  7. Film dosimetry in conformal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Danciu, C.; Proimos, B.S. [Patras Univ. (Greece). Dept. of Medical Physics


    Dosimetry, through a film sandwiched in a transverse cross-section of a solid phantom, is a method of choice in Conformal Radiotherapy because: (a) the blackness (density) of the film at each point offers a measure of the total dose received at that point, and (b) the film is easily calibrated by exposing a film strip in the same cross-section, through a stationary field. The film must therefore have the following properties: (a) it must be slow, in order not to be overexposed, even at a therapeutic dose of 200 cGy, and (b) the response of the film (density versus dose curve) must be independent of the photon energy spectrum. A few slow films were compared. It was found that the Kodak X-Omat V for therapy verification was the best choice. To investigate whether the film response was independent of the photon energy, response curves for six depths, starting from the depth of maximum dose to the depth of 25 cm, in solid phantom were derived. The vertical beam was perpendicular to the anterior surface of the phantom, which was at the distance of 100 cm from the source and the field was 15x15 cm at that distance. This procedure was repeated for photon beams emitted by a Cobalt-60 unit, two 6 MV and 15 MV Linear Accelerators, as well as a 45 MV Betatron. For each of those four different beams the film response was the same for all six depths. The results, as shown in the diagrams, are very satisfactory. The response curve under a geometry similar to that actually applied, when the film is irradiated in a transverse cross-section of the phantom, was derived. The horizontal beam was almost parallel (angle of 85) to the plane of the film. The same was repeated with the central ray parallel to the film (angle 90) and at a distance of 1.5 cm from the horizontal film. The field size was again 15x15 at the lateral entrance surface of the beam. The response curves remained the same, as when the beam was perpendicular to the films.

  8. Quotient-Comprehension Chains

    Directory of Open Access Journals (Sweden)

    Kenta Cho


    Full Text Available Quotients and comprehension are fundamental mathematical constructions that can be described via adjunctions in categorical logic. This paper reveals that quotients and comprehension are related to measurement, not only in quantum logic, but also in probabilistic and classical logic. This relation is presented by a long series of examples, some of them easy, and some also highly non-trivial (esp. for von Neumann algebras. We have not yet identified a unifying theory. Nevertheless, the paper contributes towards such a theory by introducing the new quotient-and-comprehension perspective on measurement instruments, and by describing the examples on which such a theory should be built.

  9. Clinical development of new drug-radiotherapy combinations. (United States)

    Sharma, Ricky A; Plummer, Ruth; Stock, Julie K; Greenhalgh, Tessa A; Ataman, Ozlem; Kelly, Stephen; Clay, Robert; Adams, Richard A; Baird, Richard D; Billingham, Lucinda; Brown, Sarah R; Buckland, Sean; Bulbeck, Helen; Chalmers, Anthony J; Clack, Glen; Cranston, Aaron N; Damstrup, Lars; Ferraldeschi, Roberta; Forster, Martin D; Golec, Julian; Hagan, Russell M; Hall, Emma; Hanauske, Axel-R; Harrington, Kevin J; Haswell, Tom; Hawkins, Maria A; Illidge, Tim; Jones, Hazel; Kennedy, Andrew S; McDonald, Fiona; Melcher, Thorsten; O'Connor, James P B; Pollard, John R; Saunders, Mark P; Sebag-Montefiore, David; Smitt, Melanie; Staffurth, John; Stratford, Ian J; Wedge, Stephen R


    In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.

  10. Barriers to palliative radiotherapy referral: A Canadian perspective

    Energy Technology Data Exchange (ETDEWEB)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D. [Univ. of Ottawa. Ottawa, ON (Canada)


    Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral.

  11. Post-radiotherapy hypothyroidism in dogs treated for thyroid carcinomas. (United States)

    Amores-Fuster, I; Cripps, P; Blackwood, L


    Hypothyroidism is a common adverse event after head and neck radiotherapy in human medicine, but uncommonly reported in canine patients. Records of 21 dogs with histologically or cytologically confirmed thyroid carcinoma receiving definitive or hypofractionated radiotherapy were reviewed. Nine cases received 48 Gy in 12 fractions, 10 received 36 Gy in 4 fractions and 2 received 32 Gy in 4 fractions. Seventeen cases had radiotherapy in a post-operative setting. Ten cases developed hypothyroidism (47.6%) after radiotherapy. The development of hypothyroidism was not associated with the radiotherapy protocol used. Median time to diagnosis of hypothyroidism was 6 months (range, 1-13 months). Hypothyroidism is a common side effect following radiotherapy for thyroid carcinomas. Monitoring of thyroid function following radiotherapy is recommended. No specific risk factors have been identified. © 2015 John Wiley & Sons Ltd.

  12. Hypnotherapy in radiotherapy patients: A randomized trial

    NARCIS (Netherlands)

    Stalpers, Lukas J. A.; da Costa, Hanna C.; Merbis, Merijn A. E.; Fortuin, Andries A.; Muller, Martin J.; van Dam, Frits S. A. M.


    Purpose: To determine whether hypnotherapy reduces anxiety and improves the quality of life in cancer patients undergoing curative radiotherapy (RT). Methods and Materials: After providing written informed consent, 69 patients were randomized between standard curative RT alone (36 controls) and RT

  13. Magnetic resonance imaging in radiotherapy treatment planning

    NARCIS (Netherlands)

    Moerland, Marinus Adriaan


    From its inception in the early 1970's up to the present, magnetic resonance imaging (MRI) has evolved into a sophisticated technique, which has aroused considerable interest in var- ious subelds of medicine including radiotherapy. MRI is capable of imaging in any plane and does not use ionizing

  14. Internet-based computer technology on radiotherapy. (United States)

    Chow, James C L


    Recent rapid development of Internet-based computer technologies has made possible many novel applications in radiation dose delivery. However, translational speed of applying these new technologies in radiotherapy could hardly catch up due to the complex commissioning process and quality assurance protocol. Implementing novel Internet-based technology in radiotherapy requires corresponding design of algorithm and infrastructure of the application, set up of related clinical policies, purchase and development of software and hardware, computer programming and debugging, and national to international collaboration. Although such implementation processes are time consuming, some recent computer advancements in the radiation dose delivery are still noticeable. In this review, we will present the background and concept of some recent Internet-based computer technologies such as cloud computing, big data processing and machine learning, followed by their potential applications in radiotherapy, such as treatment planning and dose delivery. We will also discuss the current progress of these applications and their impacts on radiotherapy. We will explore and evaluate the expected benefits and challenges in implementation as well.

  15. Symptomatic vertebral hemangioma: Treatment with radiotherapy

    Directory of Open Access Journals (Sweden)

    Aich Ranen


    Full Text Available Background: Vertebrae are the second commonest site among skeletal locations affected by hemangioma, but only about one per cent becomes symptomatic throughout the life. Though surgery, intra vertebral injection of various sclerosing agents have been tried in treating this benign process, no general consensus regarding management has been reached. Radiotherapy is emerging as a low cost, simple, non-invasive but very effective modality of treatment of symptomatic vertebral hemangioma. Aim: This study aims to find out the role of external beam radiotherapy in alleviating the symptoms of symptomatic vertebral hemangiomas without compromising the quality of life. Materials and Methods: Seven consecutive patients with symptomatic vertebral hemangioma were treated with a fixed dose of external beam radiotherapy; and muscle power was assessed before, after treatment and during follow-up. Results: All patients showed improvement of muscle power, which increased with the passage of time. Pain relief with improvement of quality of life was obtained in all the patients. Conclusion: Effect of radiotherapy on vertebral hemangioma is dose-dependent and the dose limiting factor is the spinal cord tolerance. In the present era of IMRT, greater dose can be delivered to the parts of vertebra affected by the hemangioma without compromising the spinal cord tolerance and expected to give better results.

  16. Improving postoperative radiotherapy following radical prostatectomy

    NARCIS (Netherlands)

    Lipman, D.; Pieters, B. R.; de Reijke, Theo M.


    Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized

  17. Breast Cancer Radiotherapy Associated Diabetes Mellitus Case ...

    African Journals Online (AJOL)

    Primary breast cancer when detected early can be treated by radical mastectomy alone. However, 20-30% of women treated as such later on, develop local or regional recurrence. This leads to an additional treatment with radiotherapy by the oncologist for the sake of the 20-30% of patients that may need it postoperatively.

  18. A cardiac contouring atlas for radiotherapy

    DEFF Research Database (Denmark)

    Duane, Frances; Aznar, Marianne C; Bartlett, Freddie


    BACKGROUND AND PURPOSE: The heart is a complex anatomical organ and contouring the cardiac substructures is challenging. This study presents a reproducible method for contouring left ventricular and coronary arterial segments on radiotherapy CT-planning scans. MATERIAL AND METHODS: Segments were...


    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 ...

  20. Impaired anastomotic healing after preoperative radiotherapy ...

    African Journals Online (AJOL)

    Background. Patients with rectal carcinoma undergoing total mesorectal excision (TME) have a lower recurrence rate with preoperative radiotherapy (RT). The aim of this study was to assess the side-effects in patients who had preoperative RT compared with those who did not receive it (because of palliative resections, ...

  1. Three dimensional conformal postoperative radiotherapy for ...

    African Journals Online (AJOL)

    Azza Helal


    Jun 17, 2013 ... Abbreviations: 3DCRT, three dimensional conformal radiotherapy;. OARs, organs at risk; DVPs, dose volume parameters; PTV, planning target volume; RT, radiation therapy; ACOD, Alexandria Clinical. Oncology Department; CT, computed tomography; ICRU, Interna- tional Commission on Radiation Units; ...

  2. Motion compensation for MRI-guided radiotherapy

    NARCIS (Netherlands)

    Glitzner, M.


    Radiotherapy aims to deliver a lethal radiation dose to cancer cells immersed in the body using a high energetic photon beam. Due to physiologic motion of the human anatomy (e.g. caused by filling of internal organs or breathing), the target volume is under permanent motion during irradiation,

  3. On-line MRI guidance for Radiotherapy

    NARCIS (Netherlands)

    Crijns, S.P.M.


    Image-guided radiotherapy has the potential to increase success of treatment by decreasing uncertainties concerning tumour position and shape. MRI is the modality of choice when it comes to imaging for tumour delineation and characterisation, set-up correction, treatment plan adaptation, response

  4. Radiotherapy reduces sialorrhea in amyotrophic lateral sclerosis. (United States)

    Neppelberg, E; Haugen, D F; Thorsen, L; Tysnes, O-B


    Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. Sialorrhea is a frequent problem in ALS patients with bulbar symptoms, because of progressive weakness of oral, lingual and pharyngeal muscles. This prospective study aimed to investigate the putative effect of palliative single-dose radiotherapy on problematic sialorrhea in patients with ALS. Twenty patients with ALS and problematic drooling were included; 14 were given radiotherapy with a single fraction of 7.5 Grey (Gy). Five patients were treated with botulinum toxin A (BTX-A) injections (20 U) into the parotid glands; two of these were later given radiotherapy. Symptom assessment, clinical examination and measurements of salivary flow (ml/min) were performed before and after treatment (1-2 weeks, 3 months). Salivary secretion was significantly reduced after radiation treatment, with a mean reduction of 60% (1 week) and 51% (2 weeks). Three months post-treatment, 21% reduction of the salivary secretion was observed compared with salivation before treatment. Mean salivary flow was not reduced after BTX-A treatment in five patients. No serious side-effects were observed with either of the two treatment modalities. Single-dose radiotherapy (7.5 Gy) significantly reduces sialorrhea and is an effective and safe palliative treatment in patients with ALS.

  5. Oral sequelae of head and neck radiotherapy

    NARCIS (Netherlands)

    Vissink, A; Jansma, J; Spijkervet, FKL; Burlage, FR; Coppes, RP

    In addition to anti-tumor effects, ionizing radiation causes damage in normal tissues located in the radiation portals. Oral complications of radiotherapy in the head and neck region are the result of the deleterious effects of radiation on, e. g., salivary glands, oral mucosa, bone, dentition,


    NARCIS (Netherlands)

    Strojan, Primoz; Ferlito, Alfio; Langendijk, Johannes A.; Silver, Carl E.

    Up-front surgery and postoperative radiotherapy constitute a well-recognized treatment concept for locally or regionally advanced squamous cell carcinoma of the head and neck. This "treatment package" is further intensified with the concomitant application of chemotherapy during irradiation when

  7. A Comprehensive Advising Effort. (United States)

    Seeger, Brian A.; McLean, Daniel D.


    The Iowa State Department of Physical Education and Leisure Studies model for comprehensive advising system is explained, including how it evolved, its limitations, and what has been learned. (Author/MLW)

  8. Efficacy of compound Kushen injection plus radiotherapy on nonsmall-cell lungcancer: A systematic review and meta-analysis. (United States)

    Wang, Shanshan; Lian, Xiaobo; Sun, Miaomiao; Luo, Lei; Guo, Lizhong


    To evaluate the benefits of compound Kushen injection (CKI) combined with radiotherapy for nonsmall cell lung cancer. We searched nine electronic databases and six gray literature databases comprehensively until June 2015. Two reviewers independently selected and assessed the included trials according to the inclusion and exclusion criteria. The risk of bias tool from the Cochrane Handbook version 5.1.0, the Review Manager 5.3 software was employed for data analysis. Funnel plot and Egger's test were applied to evaluate the publication bias. Thirteen studies including 1558 participants met the inclusion criteria, most of which were low quality. Compared with radiotherapy alone, CKI plus the same radiotherapy significantly improved the effective rate (odds ratio [OR] =1.92, 95% confidence interval [95% CI]: [1.42, 2.60] P < 0.0001) and quality of life (OR = 4.61, 95% CI: [3.28, 6.48], P < 0.00001). There was a significant decrement in the incidences of acute radiation pneumonia (OR = 0.48, 95% CI: [0.37, 0.61], P < 0.00001), radiation pneumonia 3 months after radiotherapy (OR = 0.29, 95% CI: [0.20, 0.41], P < 0.00001), radiation pneumonia 6 months after radiotherapy (OR = 0.24, 95% CI: [0.08, 0.69], P < 0.009), radiation esophagitis (OR = 0.29, 95% CI: [0.19, 0.45], P < 0.00001), and bone marrow suppression (OR = 0.35, 95% CI: [0.24, 0.51], P < 0.00001). CKI combined with radiotherapy significantly improved the clinical effect and reduced the incidence of adverse events. Use of the CONSORT statement for randomized controlled trials is recommended for rigorous reporting.

  9. Progress of clinical research on targeted therapy combined with thoracic radiotherapy for non-small-cell lung cancer

    Directory of Open Access Journals (Sweden)

    Zhuang HQ


    Full Text Available Hongqing Zhuang,1,* Xianzhi Zhao,1,* Lujun Zhao,1 Joe Y Chang,2 Ping Wang1 1Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, People's Republic of China; 2Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA *These authors contributed equally to this paper Abstract: The combination of radiotherapy and targeted therapy is an important approach in the application of targeted therapy in clinical practice, and represents an important opportunity for the development of radiotherapy itself. Numerous agents, including epidermal growth factor receptor, monoclonal antibodies, tyrosine kinase inhibitors, and antiangiogenic therapies, have been used for targeted therapy. A number of studies of radiotherapy combined with targeted therapy in non-small-cell lung carcinoma have been completed or are ongoing. This paper briefly summarizes the drugs involved and the important related clinical research, and indicates that considerable progress has been made with the joint efforts of the two disciplines. Many issues, including drug selection, identification of populations most likely to benefit, timing of administration of medication, and side effects of treatment require further investigation. However, further fundamental research and accumulation of clinical data will provide a more comprehensive understanding of these therapies. Targeted therapy in combination with radiotherapy has a bright future. Keywords: non-small-cell lung carcinoma, radiotherapy, epidermal growth factor receptor, monoclonal antibody, tyrosine kinase inhibitors, antiangiogenic therapies

  10. Experimental and clinical studies with intraoperative radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Sindelar, W.F.; Kinsella, T.; Tepper, J.; Travis, E.L.; Rosenberg, S.A.; Glatstein, E.


    Studies of normal tissue tolerance to intraoperative radiotherapy were done upon 65 dogs subjected to laparotomy and 11 million electron volt electron irradiation in doses ranging from zero to 5,000 rads. Results of studies indicated that intact aorta and vena cava tolerate up to 5,000 rads without loss of structural integrity. Ureteral fibrosis and stenosis develop at doses of 3,000 rads or more. Arterial anastomoses heal after doses of 4,500 rads, but fibrosis can lead to occlusion. Intestinal suture lines heal after doses of 4,500 rads. Bile duct fibrosis and stenosis develop at doses of 2,000 rads or more. Biliary-enteric anastomoses fail to heal at any dose level. A clinical trial of intraoperative radiotherapy combined with radical surgery was performed upon 20 patients with advanced malignant tumors which were considered unlikely to be cured by conventional therapies and which included carcinomas of the stomach, carcinomas of the pancreas, carcinomas involving the hilus of the liver, retroperitoneal sarcomas and osteosarcomas of the pelvis. All patients underwent resection of gross tumor, followed by intraoperative irradiation of the tumor bed and regional nodal basins. Some patients received additional postoperative external beam radiotherapy. Treatment mortality for combined operation and radiotherapy occurred in four of 20 patients. Postoperative complications occurred in four of the 16 surviving patients. Local tumor control was achieved in 11 of the 16 surviving patients, with an over-all median follow-up period of 18 months. The clinical trial suggested that intraoperative radiotherapy is a feasible adjunct to resection in locally advanced tumors, that the resulting mortality and morbidity is similar to that expected from operation alone and that local tumor control may be improved.

  11. Adjuvant and salvage radiotherapy after prostatectomy: a systematic review and meta-analysis. (United States)

    Chen, Changhao; Lin, Tianxin; Zhou, Yu; Li, Doudou; Xu, Kewei; Li, Zhihua; Fan, Xinxiang; Zhong, Guangzheng; He, Wang; Chen, Xu; He, Xianyin; Huang, Jian


    In men with adverse prognostic factors (APFs) after radical prostatectomy (RP), the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). We comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs) and retrospective comparative studies assessing the prognostic factors of ART and SRT. Between May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT). 5-year biochemical failure free survival (BFFS) for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30-0.46; pAPFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.

  12. Delivering sensitive health care information: challenging the taboo of women's sexual health after pelvic radiotherapy. (United States)

    Faithfull, Sara; White, Isabel


    The aim of this study was to elicit current practice with regard to the content and delivery of patient education for women undergoing pelvic radiotherapy. A 38-item questionnaire was sent to all radiotherapy departments (n=65) and a convenience sample of specialist gynaecological oncology nurses (n=166), with response rates of 62% (n=40) and 42% (n=52), respectively. Data analysis of 32 different patient education leaflets from individual cancer units, cancer networks and vaginal dilator manufacturers was conducted. Content was evaluated on the inclusion and accuracy of the key knowledge women should receive before completing pelvic radiotherapy. Patient education focused on the technical aspects of vaginal dilation with minimal content on psychosocial 6% (n=2) or sexual health components 44% (n=14). It was evident from the information leaflets reviewed and questionnaire responses that there was duplication of verbal and written information provision in the clinical setting as opposed to using different information strategies to provide more comprehensive coverage of knowledge gaps in post-treatment sexual rehabilitation. Results suggest the provision of vaginal dilation advice and sexual health information may benefit from being placed in the wider context of assessing treatment impact on women's health. It is important to analyse the management of sensitive content, within both written information materials and verbal consultations, to determine the most effective information provision strategies that support sexual health interventions in cancer practice.

  13. The Erlangen Dose Optimization Trial for radiotherapy of benign painful shoulder syndrome. Long-term results

    Energy Technology Data Exchange (ETDEWEB)

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


    To evaluate the long-term efficacy of pain reduction by two dose-fractionation schedules for radiotherapy of painful shoulder syndrome. Between February 2006 and February 2010, 312 evaluable patients were recruited for this prospective trial. All patients received low-dose orthovoltage radiotherapy. One course consisted of 6 fractions in 3 weeks. In the case of insufficient pain remission after 6 weeks, a second course was administered. Patients were randomly assigned to one of two groups to receive single doses of either 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before radiotherapy, as well as immediately after (early response), 6 weeks after (delayed response) and approximately 3 years after (long-term response) completion of radiotherapy using a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). Median follow-up was 35 months (range 11-57). The overall early, delayed and long-term response rates for all patients were 83, 85 and 82%, respectively. The mean VAS scores before treatment and those for early, delayed and long-term response in the 0.5- and 1.0-Gy groups were 56.8±23.7 and 53.2±21.8 (p=0.16); 38.2±36.1 and 34.0±24.5 (p=0.19); 33.0±27.2 and 23.7±22.7 (p=0.04) and 27.9±25.8 and 32.1±26.9 (p=0.25), respectively. The mean CPS values before treatment and those for early, delayed and long-term response were 9.7±3.0 and 9.5±2.7 (p=0.31); 6.1±3.6 and 5.4±3.6 (p=0.10); 5.3±3.7 and 4.1±3.7 (p=0.05) and 4.0±3.9 and 5.3±4.4 (p=0.05), respectively. No significant differences in the quality of the long-term response were found between the 0.5- and 1.0-Gy arms (p=0.28). Radiotherapy is an effective treatment for the management of benign painful shoulder syndrome. For radiation protection reasons, the dose for a radiotherapy series should not exceed 3.0 Gy. (orig.)

  14. The choice of statistical methods for comparisons of dosimetric data in radiotherapy. (United States)

    Chaikh, Abdulhamid; Giraud, Jean-Yves; Perrin, Emmanuel; Bresciani, Jean-Pierre; Balosso, Jacques


    Novel irradiation techniques are continuously introduced in radiotherapy to optimize the accuracy, the security and the clinical outcome of treatments. These changes could raise the question of discontinuity in dosimetric presentation and the subsequent need for practice adjustments in case of significant modifications. This study proposes a comprehensive approach to compare different techniques and tests whether their respective dose calculation algorithms give rise to statistically significant differences in the treatment doses for the patient. Statistical investigation principles are presented in the framework of a clinical example based on 62 fields of radiotherapy for lung cancer. The delivered doses in monitor units were calculated using three different dose calculation methods: the reference method accounts the dose without tissues density corrections using Pencil Beam Convolution (PBC) algorithm, whereas new methods calculate the dose with tissues density correction for 1D and 3D using Modified Batho (MB) method and Equivalent Tissue air ratio (ETAR) method, respectively. The normality of the data and the homogeneity of variance between groups were tested using Shapiro-Wilks and Levene test, respectively, then non-parametric statistical tests were performed. Specifically, the dose means estimated by the different calculation methods were compared using Friedman's test and Wilcoxon signed-rank test. In addition, the correlation between the doses calculated by the three methods was assessed using Spearman's rank and Kendall's rank tests. The Friedman's test showed a significant effect on the calculation method for the delivered dose of lung cancer patients (p test of paired comparisons indicated that the delivered dose was significantly reduced using density-corrected methods as compared to the reference method. Spearman's and Kendall's rank tests indicated a positive correlation between the doses calculated with the different methods. This paper illustrates

  15. From Kitāb al-ḥadā’iq to Kitāb al-dawā’ir: Reconsidering Ibn al-Sīd al-Batalyawsī’s Philosophical Treatise

    Directory of Open Access Journals (Sweden)

    Eliyahu, Ayala


    Full Text Available The philosophical treatise known as Kitāb al-ḥadā’iq is generally ascribed to the 12th century Andalusian author Ibn al-Sīd al-Batalyawsī, although this attribution is sometimes contested. This paper offers a new interpretation of the title, textual history, authorship, sources, and literary genre of this treatise, on the basis of new textual evidence, a reexamination of known evidence, and a comparison between the treatise and Batalyawsī’s works. The conclusions of this study are first, that Kitāb al-ḥadā’iq was not the treatise’s original title, and therefore it should be renamed Kitāb al-dawā’ir; second, that Kitāb al-dawā’ir was originally part of (one of the versions of Batalyawsī’s Kitāb al-masā’il; and third, that the textual and stylistic similarities between this treatise and Batalyawsī’s other works prove the authenticity of the treatise’s attribution to Batalyawsī. In addition, new findings regarding Batalyawsī’s use of formulas from the Rasā’il Ikhwān al-Safā, in Kitāb al-dawā’ir and Kitāb al-masā’il provide further evidence for the deep impact of the Ikhwān on Batalyawsī’s thought, as well as for the close connection between Kitāb al-dawā’ir and Kitāb al-masā’il. This connection is further highlighted according to the attribution of both treatises to the genre of questions and answers in Arabic literature. The evidence gathered in this paper supports the claim that Batalyawsī’s Kitāb al-dawā’ir should be seen as an integral part of his literary oeuvre, as well as of Andalusian philosophical literature in general.Generalmente el tratado filosófico conocido como Kitāb al-ḥadā’iq se asocia al autor andalusí del siglo XII Ibn al-Sid al-Batalyawsī, aunque esta atribución ha sido discutida en ocasiones. Este artículo ofrece una nueva interpretación del título, la historia del texto, la autoría, las fuentes e incluso del género literario al que se

  16. Comprehensive cardiac rehabilitation

    DEFF Research Database (Denmark)

    Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O


    OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... for the situation at hand. Due to challenging circumstances, the cost assessment turned out to be ex-post and top-down. RESULTS: Cost per treatment sequence is estimated to be approximately euro 976, whereas the incremental cost (compared with usual care) is approximately euro 682. The cost estimate is uncertain...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

  17. Postoperative stereotactic body radiotherapy for spinal metastases. (United States)

    Alghamdi, Majed; Tseng, Chia-Lin; Myrehaug, Sten; Maralani, Pejman; Heyn, Chris; Soliman, Hany; Lee, Young; Ruschin, Mark; Da Costa, Leodante; Yang, Victor; Campbell, Mikki; Sahgal, Arjun


    Spine is a common site of metastases in cancer patients. Spine surgery is indicated for select patients, typically those with mechanical instability and/or malignant epidural spinal cord (or cauda equina) compression. Although post-operative conventional palliative external beam radiation therapy has been the standard of care, technical improvements in radiation planning and image-guided radiotherapy have allowed for the application of stereotactic body radiotherapy (SBRT) to the spine. Spine SBRT is intended to ablate residual tumor and optimize local control by delivering several fold greater biologically effective doses. Early clinical experience of postoperative spinal SBRT report encouraging results in terms of safety and efficacy. In this review, we summarize the clinical and technical aspects pertinent to a safe and effective practice of postoperative SBRT for spinal metastases.

  18. Chondrosarcoma of the larynx: treatment with radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dailiana, T.; Thanos, L.; Papathanasiou, M.; Alexopoulou, E.; Papaioannou, G.; Kelekis, D.A. [2. Department of Radiology, Evgenidion Hospital, Medical School, University of Athens, 20, Papadiamantopoulou St., Athens 15452 (Greece); Nomikos, P. [Department of ENT, Ippokrateion Hospital, Medical School, University of Athens, Athens (Greece); Kapranos, N. [Department of Pathology, Division of Molecular Pathology, Amalia Fleming Hospital, Athens (Greece)


    The case of a 50-year-old man with chondrosarcoma of the larynx treated with radiotherapy is reported. The patient presented with hoarseness and dyspnea. He underwent computed tomography (CT), which demonstrated a soft tissue mass of the larynx. Direct laryngoscopy with biopsy established the diagnosis of chondrosarcoma. Although experience with radiotherapy in these cases has been lacking in the literature, it was considered and eventually used, as radical surgery would result in severe cosmetic and functional impairment. Radiation therapy alone resulted in long-term remission of the tumour for more than 3 years. The patient has been followed up using CT and direct laryngoscopy for early detection of recurrence or metastases. (orig.)

  19. Proton Radiotherapy for Solid Tumors of Childhood (United States)

    Cotter, Shane E.; McBride, Sean M.; Yock, Torunn I.


    The increasing efficacy of pediatric cancer therapy over the past four decades has produced many long-term survivors that now struggle with serious treatment related morbidities affecting their quality of life. Radiation therapy is responsible for a significant proportion of these late effects, but a relatively new and emerging modality, proton radiotherapy hold great promise to drastically reduce these treatment related late effects in long term survivors by sparing dose to normal tissues. Dosimetric studies of proton radiotherapy compared with best available photon based treatment show significant dose sparing to developing normal tissues. Furthermore, clinical data are now emerging that begin to quantify the benefit in decreased late treatment effects while maintaining excellent cancer control rates. PMID:22417062

  20. Radiotherapy and breast reconstruction: a meta-analysis.

    LENUS (Irish Health Repository)

    Barry, M


    The optimum sequencing of breast reconstruction (BR) in patients receiving postmastectomy radiation therapy (PMRT) is controversial. A comprehensive search of published studies that examined postoperative morbidity following immediate or delayed BR with combined radiotherapy was performed. Medical (MEDLINE & EMBASE) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured. A total of 1,105 patients were identified from 11 appropriately selected studies. Patients undergoing PMRT and BR are more likely to suffer morbidity compared with patients not receiving PMRT (OR = 4.2; 95% CI, 2.4-7.2 [no PMRT vs. PMRT]). Reconstruction technique was also examined with outcome when PMRT was delivered after BR, and this demonstrated that autologous reconstruction is associated with less morbidity in this setting (OR = 0.21; 95% CI, 0.1-0.4 [autologous vs. implant-based]). Delaying BR until after PMRT had no significant effect on outcome (OR = 0.87; 95% CI, 0.47-1.62 [delayed vs. immediate]). PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared with implant-based reconstruction.

  1. Radiotherapy equipment--purchase or lease? (United States)

    Nisbet, A; Ward, A


    Against a background of increasing demand for radiotherapy equipment, this study was undertaken to investigate options for equipment procurement, in particular to compare purchase with lease. The perceived advantages of lease are that equipment can be acquired within budget and cashflow constraints, with relatively low amounts of cash leaving the NHS in the first year, avoiding the necessity of capitalizing the equipment and providing protection against the risk of obsolescence associated with high technology equipment. The perceived disadvantages of leasing are that the Trust does not own the equipment, leasing can be more expensive in revenue terms, the tender process is extended and there may be lease conditions to be met, which may be costly and/or restrictive. There are also a number of technical considerations involved in the leasing of radiotherapy equipment that influence the financial analysis and practical operation of the radiotherapy service. The technical considerations include servicing and planned preventative maintenance, upgrades, spare parts, subsequent purchase of "add ons", modification of equipment, research and development work, commencement of the lease period, return of equipment at the end of the lease period and negotiations at the end of the lease period. A study from Raigmore Hospital, Inverness is described, which involves the procurement of new, state-of-the-art radiotherapy equipment. This provides an overview of the procurement process, including a summary of the advantages and disadvantages of leasing, with the figures from the financial analysis presented and explained. In addition, a detailed description is given of the technical considerations to be taken into account in the financial analysis and negotiation of any lease contract.

  2. Solid Mesh Registration for Radiotherapy Treatment Planning

    DEFF Research Database (Denmark)

    Noe, Karsten Østergaard; Sørensen, Thomas Sangild


    We present an algorithm for solid organ registration of pre-segmented data represented as tetrahedral meshes. Registration of the organ surface is driven by force terms based on a distance field representation of the source and reference shapes. Registration of internal morphology is achieved usi...... to complete. The proposed method has many potential uses in image guided radiotherapy (IGRT) which relies on registration to account for organ deformation between treatment sessions....

  3. On-line MRI guidance for Radiotherapy


    Crijns, S.P.M.


    Image-guided radiotherapy has the potential to increase success of treatment by decreasing uncertainties concerning tumour position and shape. MRI is the modality of choice when it comes to imaging for tumour delineation and characterisation, set-up correction, treatment plan adaptation, response monitoring and intra-fraction motion compensation. To boost the possibilities of image guidance by providing images with superior soft-tissue contrast during treatment, integrated diagnostic quality ...

  4. Motion compensation for MRI-guided radiotherapy


    Glitzner, M


    Radiotherapy aims to deliver a lethal radiation dose to cancer cells immersed in the body using a high energetic photon beam. Due to physiologic motion of the human anatomy (e.g. caused by filling of internal organs or breathing), the target volume is under permanent motion during irradiation, diluting the applied dose into regions around the target volume. Traditionally, the target volume is expanded about margins encompassing the geometric uncertainty in order to retain the target dose. As ...

  5. Impact of pelvic radiotherapy on female sexuality. (United States)

    Rodrigues, Ana Cláudia; Teixeira, Rubina; Teixeira, Tânia; Conde, Sofia; Soares, Paula; Torgal, Isabel


    To assess physical and psychological morbidity, sexual functioning and social and relationship satisfaction among women treated with pelvic radiotherapy. Observational (case-control) study of 199 women: 98 submitted to pelvic radiotherapy for the treatment of uterine, rectal or anal cancers and 101 without a personal history of cancer and similar socio-demographic variables. These completed a socio-demographic and clinical questionnaire, and validated measures of psychological health (DASS: Lovibond and Lovibond in Behav Res Ther 33:353-343, 1995), sexual function (FSFI: Rosen et al. in J Sex Marital Ther 26:191-208, 2007), social support (ESSS: Ribeiro in Analise Psicologica 3:547-558, 1999) and relationship satisfaction (IMS: Hudson in The WALMYR assessment scales scoring manual 1992). Women submitted to pelvic irradiation reported a higher rate of adverse physical symptoms in the last month: fatigue 59 versus 25% (p radiotherapy patients, but only reach statistical significance for the stress parameter (6.1 vs. 4.0, p = 0.012). Also these women reported lower scores of satisfaction with social support (57.2 vs. 62.2, p = 0.005) and sexual function (8.5 vs. 13.5, p = 0.049). No statistically significant differences occurred between the two groups regarding scores of relationship satisfaction (20.8 vs. 19.9, p = n.s.). Our results suggested that pelvic radiotherapy had a negative impact on female sexuality. Thus, interventions that would help to reduce this impact need to be designed and integrated into routine clinical practice.


    Luna, Javier; Amaya, Enrique; de Torres, M Victoria; Peña, M Carmen; Prieto, Isabel


    nutrition is an important influence on treatments and quality of life of cancer patients. The relationship between different nutritional components and radiotherapy is today a topic of growing interest. to evaluate the influence of macro and micronutrients on tolerance and effectiveness of radiotherapy and their role in modulating chronic toxicity. we performed a research of the published literature by consulting the MEDLINE database and Cochrane Library online between 1995 and 2015, relevant publications based on impact factor were selected. Data from the analyzed studies were exposed in sections by type of nutrient. most of the studies showed common features: small sample sizes, high heterogeneity, underpowered results and few prospective randomized studies. In the section of fiber, its use in prophylaxis and treatment of radiation enteritis has been successfully evaluated in some studies, although evidence of its recommendation is still weak. Omega 3 and omega 6 fatty acids have a high metabolic potential, however the evidence regarding this benefit is limited to observational studies in certain tumors. Among the amino acids, glutamine is the most studied, and controversial results of its effect on mucositis, esophagitis and radiation enteritis were found. Vitamins and minerals are a heterogeneous group of substances that showed potential benefit due to their antioxidant activity and their supposed protector effect against toxicity secondary to radiotherapy. Ketogenic diets are beginning to be clinically studied after promising preclinical results. the analyzed studies show controversial or inconclusive results regarding the influence of nutrients in the radiotherapy. It has been not found Sorong evidence about their role in patients receiving ionizing radiation. Well-designed, prospective and randomized studies are needed to establish recommendations. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  7. Role of palliative radiotherapy in brain metastases

    Directory of Open Access Journals (Sweden)

    Ramesh S Bilimagga


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

  8. Radiotherapy treatment planning linear-quadratic radiobiology

    CERN Document Server

    Chapman, J Donald


    Understand Quantitative Radiobiology from a Radiation Biophysics PerspectiveIn the field of radiobiology, the linear-quadratic (LQ) equation has become the standard for defining radiation-induced cell killing. Radiotherapy Treatment Planning: Linear-Quadratic Radiobiology describes tumor cell inactivation from a radiation physics perspective and offers appropriate LQ parameters for modeling tumor and normal tissue responses.Explore the Latest Cell Killing Numbers for Defining Iso-Effective Cancer TreatmentsThe book compil

  9. The role of image guidance in respiratory gated radiotherapy

    DEFF Research Database (Denmark)

    Korreman, Stine Sofia; Juhler-Nøttrup, Trine; Fredberg Persson, Gitte


    Respiratory gating for radiotherapy beam delivery is a widely available technique, manufactured and sold by most of the major radiotherapy machine vendors. Respiratory gated beam delivery is intended to limit the irradiation of tumours moving with respiration to selected parts of the respiratory...... is therefore of utmost importance for the safe introduction of respiratory gating. In this short overview, suitable image guidance strategies for respiratory gated radiotherapy are reviewed for two cancer sites; breast cancer and lung tumours....

  10. A rare case of unusual gingival enlargement post radiotherapy


    Vishal Singh; G Subraya Bhat; K Mahalinga Bhat


    Oral changes following radiotherapy are not uncommon. Oral mucositis, alteration in salivary gland function, radiation caries, and gingival changes have all been reported following radiotherapy and chemotherapy. The gingival changes seen after radiotherapy may be unusual and often cause diagnostic dilemma. Metastasis to the gingiva has also to be ruled out in these cases. A 30-year-old female patient presented with enlargement of the gingiva of 6 months? duration and lower lip swelling of 7 m...

  11. Cardiovascular complications following thoracic radiotherapy in patients with cancer

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Borchsenius, Julie I Helene; Offersen, Birgitte Vrou


    Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects...... of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients....

  12. Updates on clinical studies of selenium supplementation in radiotherapy


    Puspitasari, Irma M.; Abdulah, Rizky; Yamazaki, Chiho; KAMEO, Satomi; Nakano, Takashi; Koyama, Hiroshi


    To establish guidelines for the selenium supplementation in radiotherapy we assessed the benefits and risks of selenium supplementation in radiotherapy. Clinical studies on the use of selenium in radiotherapy were searched in the PubMed electronic database in January 2013. Sixteen clinical studies were identified among the 167 articles selected in the initial search. Ten articles were observational studies, and the other 6 articles reported studies on the effects of selenium supplementation i...

  13. Contemporary Breast Radiotherapy and Cardiac Toxicity. (United States)

    Yeboa, Debra Nana; Evans, Suzanne Buckley


    Long-term cardiac effects are an important component of survivorship after breast radiotherapy. The pathophysiology of cardiotoxicity, history of breast radiotherapy, current methods of cardiac avoidance, modern outcomes, context of historical outcomes, quantifying cardiac effects, and future directions are reviewed in this article. Radiation-induced oxidative stress induces proinflammatory cytokines and is a process that potentiates late effects of fibrosis and intimal proliferation in endothelial vasculature. Breast radiation therapy has changed substantially in recent decades. Several modern technologies exist to improve cardiac avoidance such as deep inspiration breath hold, gating, accelerated partial breast irradiation, and use of modern 3-dimensional planning. Modern outcomes may vary notably from historical long-term cardiac outcomes given the differences in cardiac dose with modern techniques. Methods of quantifying radiation-related cardiotoxicity that correlate with future cardiac risks are needed with current data exploring techniques such as measuring computed tomography coronary artery calcium score, single-photon emission computed tomography imaging, and biomarkers. Placing historical data, dosimetric correlations, and relative cardiac risk in context are key when weighing the benefits of radiotherapy in breast cancer control and survival. Estimating present day cardiac risk in the modern treatment era includes challenges in length of follow-up and the use of confounding cardiotoxic agents such as evolving systemic chemotherapy and targeted therapies. Future directions in both multidisciplinary management and advancing technology in radiation oncology may provide further improvements in patient risk reduction and breast cancer survivorship. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Clinico-statistical study on radiotherapy prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Takaaki; Taniguchi, Hisashi; Sunahara, Yuichi; Shinozuka, Osamu; Suzuki, Ruri; Ohyama, Takashi; Takeda, Masamune [Tokyo Medical and Dental Univ. (Japan). School of Dentistry


    Various radiotherapy prostheses, including spacer, protector, carrier and mold, are frequently used for oral and maxillofacial cancer patients because they enhance the treatment efficacy of radiotherapy and protect adjacent normal tissue from irradiation. Therefore a clinical investigation was carried out on 310 cases of radiotherapy prostheses applied in our clinic from 1981 to 1995. The results were as follows: Sex ratio (male: female) of patients was 1.67: 1 and the number of the patients at the age of 60-69 was the largest. Spacer accounted for 81.0% of prostheses, followed by mold (10.6%), protector (5.5%) and carrier (2.9%). As for the site of malignant tumor, the tongue was 77.1% of all cases. External irradiation was already performed on 23.3% of all cases. Abutment teeth remained in 85.9% of 304 cases in which the prostheses were applied intraorally. The average time to make the prostheses was 12.4 days. As for the retention of the prosthesis to the mouth, a ball clasp was used most frequently in spacer and carrier, and overlay type was applied most frequently in mold and protector. As for the retention of shield to carrier in mold cases, mechanical interlocking of the resin parts of carrier and shield was 75.8% of the cases. (author)

  15. Big Data Analytics for Prostate Radiotherapy. (United States)

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


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

  16. Radiotherapy in the treatment of ameloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Gardner, D.G.


    There is a lack of well-documented evidence in the literature concerning the relative radioresponsiveness or radioresistance of ameloblastomas, although they are generally considered radioresistant. Most of the previous papers reffering to this subject lack acceptable histopathologic proof of the diagnosis, adequate radiotherapeutic data, and/or follow-up information; many predate the use of megavoltage irradiation. The present article reports 5 cases of ameloblastoma that were treated by radiotherapy, 3 by megavoltage irradiation. All have been confirmed histologically by an oral pathologist, all have adequate radiotherapeutic data and, with one exception, adequate follow-up information. In addition, the reasons for our present lack of knowledge of this subject are discussed; objective criteria are presented for evaluating the results of radiotherapy on ameloblastomas; the only other series of ameloblastomas treated by megavoltage irradition is analyzed. Although radiotherapy can reduce the size of an ameloblastoma, primarily that part of the tumor which has expanded the jaw or broken into the soft tissues, it does not appear to be an appropriate treatment for an operable ameloblastoma. Its main use is in inoperable cases, primarily in the posterior maxilla.

  17. Painless reading comprehension

    CERN Document Server

    Jones, EdD, Darolyn "Lyn"


    Reading comprehension gets easier as students learn what kind of reader they are, discover how to keep facts in their head, and much more. Bonus Online Component: includes additional games, including Beat the Clock, a line match game, and a word scramble.

  18. Enhancing Comprehension with Videodiscs. (United States)

    Howson, Betty Ann; Davis, Hilarie


    Discusses the use of videodiscs to increase students' comprehension. Benefits of adding visual images to learning activities are discussed, videodiscs as sources of data for students to analyze are considered, and an example is given of using videodiscs to illustrate concepts in a chemistry class. (LRW)




  20. The Comprehensive Examination. (United States)

    Gothberg, Helen M.; Aleamoni, Lawrence M.


    Describes an objective test used as the comprehensive examination in a graduate library school and discusses its advantages over essay tests. The topics covered include test construction, the use of item analysis for scoring and test revision, and student reactions to the objective test. (1 reference) (CLB)

  1. [Development of an educational program starting from a process approach in a department of radiotherapy]. (United States)

    Lenaerts, E; Delgaudine, M; Coucke, P


    In order to be able to implement technological evolution and organizational changes on a regular and continuous manner, the radiotherapy department initiated in 2007 a comprehensive policy of operational risk management and overall quality program. The leadership in the department is convinced that the management of professional skills is mandatory to implement rapidly new treatment techniques while simultaneously assuring a high level of quality for patient care. The "process approach" is based on a comprehensive description of all the processes building up the organization in order to check how every single process contributes to patient satisfaction. This kind of approach allows an enhanced visibility on the functioning of the department, a better control on the inter-individual relations, both between different professional groups among caregivers and between those latter and the patients. This approach yields a view on the gain obtained with each single process and leads to identification of failures in safety barriers. The process approach identifies the required professional skills in order to guarantee a high quality of care. This has resulted in the development of a training program tailored to the needs of a radiotherapy department. This training program has recently been submitted and validated by the university authorities and is nowadays registered as a certificate at the university of Liège.

  2. The effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review

    NARCIS (Netherlands)

    Groenen, K.H.; Pouw, M.H.; Hannink, G.J.; Hosman, A.J.; Linden, Y.M. van der; Verdonschot, N.J.; Tanck, E.J.


    PURPOSE: The role of radiotherapy in stabilizing metastatic bones is unclear. This systematic review assessed the effects of (1) radiotherapy, (2) radiotherapy combined with bisphosphonates, and (3) radiotherapy combined with RANK ligand (RANKL) inhibitors on bone quality and bone strength in bone

  3. The effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review

    NARCIS (Netherlands)

    Groenen, K.H.J.; Pouw, M.H.; Hannink, G.; Hosman, A.J.; van der Linden, Y.M.; Verdonschot, Nicolaas Jacobus Joseph; Tanck, E.


    Purpose The role of radiotherapy in stabilizing metastatic bones is unclear. This systematic review assessed the effects of (1) radiotherapy, (2) radiotherapy combined with bisphosphonates, and (3) radiotherapy combined with RANK ligand (RANKL) inhibitors on bone quality and bone strength in bone

  4. Genome-wide transcription responses to synchrotron microbeam radiotherapy. (United States)

    Sprung, Carl N; Yang, Yuqing; Forrester, Helen B; Li, Jason; Zaitseva, Marina; Cann, Leonie; Restall, Tina; Anderson, Robin L; Crosbie, Jeffrey C; Rogers, Peter A W


    The majority of cancer patients achieve benefit from radiotherapy. A significant limitation of radiotherapy is its relatively low therapeutic index, defined as the maximum radiation dose that causes acceptable normal tissue damage to the minimum dose required to achieve tumor control. Recently, a new radiotherapy modality using synchrotron-generated X-ray microbeam radiotherapy has been demonstrated in animal models to ablate tumors with concurrent sparing of normal tissue. Very little work has been undertaken into the cellular and molecular mechanisms that differentiate microbeam radiotherapy from broad beam. The purpose of this study was to investigate and compare the whole genome transcriptional response of in vivo microbeam radiotherapy versus broad beam irradiated tumors. We hypothesized that gene expression changes after microbeam radiotherapy are different from those seen after broad beam. We found that in EMT6.5 tumors at 4-48 h postirradiation, microbeam radiotherapy differentially regulates a number of genes, including major histocompatibility complex (MHC) class II antigen gene family members, and other immunity-related genes including Ciita, Ifng, Cxcl1, Cxcl9, Indo and Ubd when compared to broad beam. Our findings demonstrate molecular differences in the tumor response to microbeam versus broad beam irradiation and these differences provide insight into the underlying mechanisms of microbeam radiotherapy and broad beam.

  5. 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)


    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

  6. Fatigue and radiotherapy. A literature review; Fatigue et radiotherapie. Revue de la litterature

    Energy Technology Data Exchange (ETDEWEB)

    Dilhuydy, J.M.; Ouhtatou, F.; Laporte, C.; Nguyen, T.V.F.; Vendrely, V. [Institut Bergonie Centre Regional de Lutte Contre le Cancer, 33 - Bordeaux (France); Dilhuydy, J.M. [Federation Nationale des Centres de Lutte Contre le Cancer, FNCLCC, Groupe Rehabilitation, 75 - Paris (France); Dilhuydy, M.S. [Hopital Saint-Andre, Service de Medecine Interne, 33 - Bordeaux (France)


    Fatigue is a common complaint for the cancer patient during and after radiotherapy, according to the published studies. Fatigue is a subjective symptom mostly underestimated by oncologists and other care givers. Etiology is complex, poorly understood in spite of obvious causes like insomnia, nausea, pain, depression, psychological distress, anemia, hypothyroidism, menopause disturbances, treatment adverse effects. Fatigue presents multi-factorial and multidimensional aspects. To evaluate it, many tools can be used as single-item, unidimensional and multidimensional instruments. Practically, the open discussion with the patient throughout radiotherapy is essential to define it. Taking charge fatigue requires its acknowledgement by radiotherapist, treatment of associated symptoms with a multidisciplinary approach. (authors)

  7. Automatic image segmentation for treatment planning in radiotherapy; Segmentation automatique des images pour la planifi cation dosimetrique en radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Pasquiera, D. [Centre Galilee, polyclinique de la Louviere, 59 - Lille (France); Peyrodie, L. [Ecole des hautes etudes d' ingenieur, 59 - Lille (France); Laboratoire d' automatique, genie informatique et signal (LAGIS), Cite scientifi que, 59 - Villeneuve d' Ascq (France); Denis, F. [Centre Jean-Bernard, 72 - Le Mans (France); Pointreau, Y.; Bera, G. [Clinique d' oncologie radiotherapie, Centre Henry-S.-Kaplan, CHU Bretonneau, 37 - Tours (France); Lartigau, E. [Departement universitaire de radiotherapie, Centre O. Lambret, Universite Lille 2, 59 - Lille (France)


    One drawback of the growth in conformal radiotherapy and image-guided radiotherapy is the increased time needed to define the volumes of interest. This also results in inter- and intra-observer variability. However, developments in computing and image processing have enabled these tasks to be partially or totally automated. This article will provide a detailed description of the main principles of image segmentation in radiotherapy, its applications and the most recent results in a clinical context. (authors)

  8. DEGRO practical guidelines: radiotherapy of breast cancer II. Radiotherapy of non-invasive neoplasia of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Souchon, R. [University Hospital Tuebingen, Klinik fuer Radioonkologie, Tuebingen (Germany); Sautter-Bihl, M.L. [Municipal Hospital Karlsruhe, Karlsruhe (Germany); Sedlmayer, F. [LKH Salzburg, Paracelsus Medical University Hospital, Salzburg (Austria); Budach, W. [University Hospital Duesseldorf, Duesseldorf (Germany); Dunst, J. [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Fietkau, R.; Sauer, R. [University Hospital Erlangen, Erlangen (Germany); Harms, W. [St. Clara Hospital, Basel (Switzerland); Wenz, F. [University Hospital Mannheim, Mannheim (Germany); Haase, W.


    To complement and update the 2007 practice guidelines of the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO) for radiotherapy (RT) of breast cancer. Owing to its growing clinical relevance, in the current version, a separate paper is dedicated to non-invasive proliferating epithelial neoplasia of the breast. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indication and technique of RT in addition to breast conserving surgery. The DEGRO expert panel performed a comprehensive survey of the literature comprising recently published data from clinical controlled trials, systematic reviews as well as meta-analyses, referring to the criteria of evidence-based medicine yielding new aspects compared to 2005 and 2007. The literature search encompassed the period 2008 to September 2012 using databases of PubMed and Guidelines International Network (G-I-N). Search terms were ''non invasive breast cancer'', ''ductal carcinoma in situ, ''dcis'', ''borderline breast lesions'', ''lobular neoplasia'', ''radiotherapy'' and ''radiation therapy''. In addition to the more general statements of the German interdisciplinary S3 guidelines, this paper is especially focused on indications of RT and decision making of non-invasive neoplasia of the breast after surgery, especially ductal carcinoma in situ. Among different non-invasive neoplasia of the breast only the subgroup of pure ductal carcinoma in situ (DCIS; synonym ductal intraepithelial neoplasia, DIN) is considered for further recurrence risk reduction treatment modalities after complete excision of DCIS, particularly RT following breast conserving surgery (BCS), in order to avoid a mastectomy. About half of recurrences are invasive cancers. Up to 50?% of all recurrences require salvage mastectomy

  9. Comprehensive hard materials

    CERN Document Server


    Comprehensive Hard Materials deals with the production, uses and properties of the carbides, nitrides and borides of these metals and those of titanium, as well as tools of ceramics, the superhard boron nitrides and diamond and related compounds. Articles include the technologies of powder production (including their precursor materials), milling, granulation, cold and hot compaction, sintering, hot isostatic pressing, hot-pressing, injection moulding, as well as on the coating technologies for refractory metals, hard metals and hard materials. The characterization, testing, quality assurance and applications are also covered. Comprehensive Hard Materials provides meaningful insights on materials at the leading edge of technology. It aids continued research and development of these materials and as such it is a critical information resource to academics and industry professionals facing the technological challenges of the future. Hard materials operate at the leading edge of technology, and continued res...

  10. 501 reading comprehension questions

    CERN Document Server


    This updated edition offers the most extensive and varied practice for all types of questions students might face on standardized and in-class tests. With this guide, students will learn to develop expert reading strategies, understand how to read faster and with greater comprehension, overcome reading anxiety, and increase appreciation of reading for pleasure. This book's step-by-step approach provides graduated coverage that moves from the basics to more advanced reading.

  11. Brazilian medicinal plants used by the Dr. João Ferreyra da Rosa according to his “Treatise on Pestilence in Pernambuco” at the end of the 17th century

    Directory of Open Access Journals (Sweden)

    Érika Alves Tavares Marques


    Full Text Available João Ferreyra da Rosa’s “Treatise on Pestilence in Pernambuco”, published in 1694 was the first document on yellow fever, its symptoms and treatment, and it described the phytomedicines used at the time. Rosa described a hundred medicinal plants used to treat the epidemic; most of them came already prepared from Europe, since the majority of Portuguese physicians rejected the indigenous therapeutic knowledge. However, later, due to the lenght and adverse conditions of maritime trevel, leading to losses in the effectiveness of the active ingredients of such phytotherapeutic products, doctors were obliged to employ native medicinal plants in their treatments. The Brazilian medicinal plants used in the treatment of the first epidemic of yellow fever in Brazil (17th century had been brought up to date from the taxonomic point of view, and were comparable with those used in popular medicine today. As part of the phytotherapeutic treatment of yellow fever at the end of the 17th century, Rose made use of the following medicinal plants: copaíba, macela, maracujá-mirim, red aroeira, angélico and almécega.

  12. Practical recommendations for breathing-adapted radiotherapy; Bonnes pratiques pour la radiotherapie asservie a la respiration

    Energy Technology Data Exchange (ETDEWEB)

    Simon, L.; Giraud, P.; Rosenwald, J.C. [Institut Curie, Dept. d' Oncologie-radiotherapie, 75 - Paris (France); Dumas, J.L.; Lorchel, F. [CHU de Besancon, Hopital Jean-Minjoz, Service Radiotherapie, 25 - Besancon (France); Marre, D. [Institut Claudius-Regaud, Dept. des Radiations, 31 - Toulouse (France); Dupont, S. [Hopital Europeen Georges-Pompidou, Service d' Oncoradiotherapie, 75 - Paris (France); Varmenot, N. [Centre Henri-Becquerel, UnitE de Physique Medicale, 76 - Rouen (France); Ginestet, C. [Centre Leon-Berard, Dept. de Radiotherapie, 69 - Lyon (France); Caron, J. [Institut Bergonie, Dept. de Radiotherapie, 33 - Bordeaux (France); Marchesi, V. [Centre Alexis-Vautrin, Dept. de Radiotherapie, 54 - Vandoeuvre-les-Nancy (France); Ferreira, I. [Institut Gustave-Roussy, Dept. d' Oncologie Radiotherapie, 94 - Villejuif (France); Garcia, R. [Institut Sainte-Catherine, Service de Radiotherapie, 84 - Avignon (France)


    Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath-hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily holds his/her breath. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. This work summarizes the different experiences of the centers of the STIC 2003 project. It describes the different techniques, gives an overview of the literature and proposes a practice based on our experience. (authors)

  13. Characterization of spatial distortion in a 0.35 T MRI-guided radiotherapy system (United States)

    Ginn, John S.; Agazaryan, Nzhde; Cao, Minsong; Baharom, Umar; Low, Daniel A.; Yang, Yingli; Gao, Yu; Hu, Peng; Lee, Percy; Lamb, James M.


    Spatial distortion results in image deformation that can degrade accurate targeting and dose calculations in MRI-guided adaptive radiotherapy. The authors present a comprehensive assessment of a 0.35 T MRI-guided radiotherapy system’s spatial distortion using two commercially-available phantoms with regularly spaced markers. Images of the spatial integrity phantoms were acquired using five clinical protocols on the MRI-guided radiotherapy machine with the radiotherapy gantry positioned at various angles. Software was developed to identify and localize all phantom markers using a template matching approach. Rotational and translational corrections were implemented to account for imperfect phantom alignment. Measurements were made to assess uncertainties arising from susceptibility artifacts, image noise, and phantom construction accuracy. For a clinical 3D imaging protocol with a 1.5 mm reconstructed slice thickness, 100% of spheres within a 50 mm radius of isocenter had a 3D deviation of 1 mm or less. Of the spheres within 100 mm of isocenter, 99.9% had a 3D deviation less than 1 mm. 94.8% and 100% of the spheres within 175 mm were found to be within 1 mm and 2 mm of the expected positions in 3D respectively. Maximum 3D distortions within 50 mm, 100 mm and 175 mm of isocenter were 0.76 mm, 1.15 mm and 1.88 mm respectively. Distortions present in images acquired using the real-time imaging sequence were less than 1 mm for 98.1% and 95.0% of the cylinders within 50 mm and 100 mm of isocenter. The corresponding maximum distortion in these regions was 1.10 mm and 1.67 mm. These results may be used to inform appropriate planning target volume (PTV) margins for 0.35 T MRI-guided radiotherapy. Observed levels of spatial distortion should be explicitly considered when using PTV margins of 3 mm or less or in the case of targets displaced from isocenter by more than 50 mm.

  14. Radiotherapy for renal cell carcinoma: renaissance of an overlooked approach. (United States)

    Siva, Shankar; Kothari, Gargi; Muacevic, Alexander; Louie, Alexander V; Slotman, Ben J; Teh, Bin S; Lo, Simon S


    Conventional radiotherapy previously had a limited role in the definitive treatment of renal cell carcinoma (RCC), owing to the disappointing outcomes of several trials and the perceived radioresistance of this type of cancer. In this context, radiotherapy has been relegated largely to the palliation of symptoms in patients with metastatic disease, with variable rates of response. Following the availability of newer technologies that enable safe delivery of high-dose radiotherapy, stereotactic ablative radiotherapy (SABR) has become increasingly used in patients with RCC. Preclinical evidence demonstrates that RCC cells are sensitive to ablative doses of radiotherapy (≥8-10 Gy). Trials in the setting of intracranial and extracranial oligometastases, as well as primary RCC, have demonstrated excellent tumour control using this approach. Additionally, an awareness of the capacity of high-dose radiation to stimulate antitumour immunity has resulted in novel combinations of SABR with immunotherapies. Here we describe the historical application of conventional radiotherapy, the current biological understanding of the effects of radiation, and the clinical evidence supporting the use of ablative radiotherapy in RCC. We also explore emerging opportunities to combine systemic targeted agents or immunotherapies with radiation. Radiotherapy, although once an overlooked approach, is moving towards the forefront of RCC treatment.

  15. Rotational radiotherapy for prostate cancer in clinical practice

    DEFF Research Database (Denmark)

    Aznar, Marianne C; Petersen, Peter Meidahl; Logadottir, Ashildur


    Radiotherapy is the standard treatment in locally advanced prostate cancer. The latest technological improvement is modulated rotational radiotherapy, where one single rotation of the treatment machine is used to conform the dose delivery to the target and spare organs at risk, requiring less than...

  16. Rotational radiotherapy for prostate cancer in clinical practice

    DEFF Research Database (Denmark)

    Aznar, Marianne; Munck af Rosenschöld, Per; Logadottir, Ashildur


    Background and purpose Radiotherapy is the standard treatment in locally advanced prostate cancer. The latest technological improvement is modulated rotational radiotherapy, where one single rotation of the treatment machine is used to conform the dose delivery to the target and spare organs...

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

    African Journals Online (AJOL)

    Management Of Carcinoma Of The Bronchus By Radiotherapy In Lagos, Nigeria. ... Journal of Medicine and Medical Sciences ... The use of radiotherapy in the management of bronchial carcinoma was evaluated in 106 patients (mean age: 56.6 yrs, s. d. 9.10) with male:female ratio of 2:2.1 who presented at the Lagos ...

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

    African Journals Online (AJOL)

    The Management of Keloids by Radiotherapy in Nigeria. ... Nigerian Quarterly Journal of Hospital Medicine ... technique in five hundred and twenty eight Nigerian patients with 617 keloid lesions seen at the Department of Radiation Biology and Radiotherapy, Lagos University Teaching Hospital, between 1969 and 1981.

  19. Children Undergoing Radiotherapy: Swedish Parents’ Experiences and Suggestions for Improvement (United States)

    Mullaney, Tara; Nilsson, Kristina; Wickart-Johansson, Gun; Svärd, Anna-Maja; Nyholm, Tufve; Lindh, Jack; Lindh, Viveca


    Approximately 300 children, from 0 to 18 years old, are diagnosed with cancer in Sweden every year. Of these children, 80–90 of them undergo radiotherapy treatment for their cancer. Although radiotherapy is an encounter with advanced technology, few studies have investigated the child’s and the parent’s view of the procedure. As part of an ongoing multicenter study aimed to improve patient preparation and the care environment in pediatric radiotherapy, this article reports the findings from interviews with parents at baseline. The aim of the present study was twofold: to describe parents’ experience when their child undergoes radiotherapy treatment, and to report parents’ suggestions for improvements during radiotherapy for their children. Sixteen mothers and sixteen fathers of children between 2–16 years old with various cancer diagnoses were interviewed. Data were analyzed using content analysis. The findings showed that cancer and treatment turns people’s lives upside down, affecting the entire family. Further, the parents experience the child’s suffering and must cope with intense feelings. Radiotherapy treatment includes preparation by skilled and empathetic staff. The parents gradually find that they can deal with the process; and lastly, parents have suggestions for improvements during the radiotherapy treatment. An overarching theme emerged: that despair gradually turns to a sense of security, with a sustained focus on and close interaction with the child. In conclusion, an extreme burden was experienced around the start of radiotherapy, though parents gradually coped with the process. PMID:26509449

  20. Biomarkers of Tumour Radiosensitivity and Predicting Benefit from Radiotherapy. (United States)

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


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

  1. PET/CT and radiotherapy in prostate cancer

    NARCIS (Netherlands)

    De Jong, I. J.; De Haan, T. D.; Wiegman, E. M.; Van den Bergh, A. C. M.; Pruim, J.; Breeuwsma, J.


    Radiotherapy is one of the corner stone treatments for patients with prostate cancer. Especially for locally advanced tumors radiotherapy +/- adjuvant androgen deprivation treatment is standard of care. This brings up the need for accurate assessment of extra prostatic tumor growth and/or the

  2. Updates on clinical studies of selenium supplementation in radiotherapy. (United States)

    Puspitasari, Irma M; Abdulah, Rizky; Yamazaki, Chiho; Kameo, Satomi; Nakano, Takashi; Koyama, Hiroshi


    To establish guidelines for the selenium supplementation in radiotherapy we assessed the benefits and risks of selenium supplementation in radiotherapy. Clinical studies on the use of selenium in radiotherapy were searched in the PubMed electronic database in January 2013. Sixteen clinical studies were identified among the 167 articles selected in the initial search. Ten articles were observational studies, and the other 6 articles reported studies on the effects of selenium supplementation in patients with cancer who underwent radiotherapy. The studies were conducted worldwide including European, American and Asian countries between 1987 and 2012. Plasma, serum or whole blood selenium levels were common parameters used to assess the effects of radiotherapy and the selenium supplementation status. Selenium supplementation improved the general conditions of the patients, improved their quality of life and reduced the side effects of radiotherapy. At the dose of selenium used in these studies (200-500 μg/day), selenium supplementation did not reduce the effectiveness of radiotherapy, and no toxicities were reported. Selenium supplementation may offer specific benefits for several types of cancer patients who undergo radiotherapy. Because high-dose selenium and long-term supplementation may be unsafe due to selenium toxicity, more evidence-based information and additional research are needed to ensure the therapeutic benefits of selenium supplementation.

  3. Updates on clinical studies of selenium supplementation in radiotherapy (United States)


    To establish guidelines for the selenium supplementation in radiotherapy we assessed the benefits and risks of selenium supplementation in radiotherapy. Clinical studies on the use of selenium in radiotherapy were searched in the PubMed electronic database in January 2013. Sixteen clinical studies were identified among the 167 articles selected in the initial search. Ten articles were observational studies, and the other 6 articles reported studies on the effects of selenium supplementation in patients with cancer who underwent radiotherapy. The studies were conducted worldwide including European, American and Asian countries between 1987 and 2012. Plasma, serum or whole blood selenium levels were common parameters used to assess the effects of radiotherapy and the selenium supplementation status. Selenium supplementation improved the general conditions of the patients, improved their quality of life and reduced the side effects of radiotherapy. At the dose of selenium used in these studies (200–500 μg/day), selenium supplementation did not reduce the effectiveness of radiotherapy, and no toxicities were reported. Selenium supplementation may offer specific benefits for several types of cancer patients who undergo radiotherapy. Because high-dose selenium and long-term supplementation may be unsafe due to selenium toxicity, more evidence-based information and additional research are needed to ensure the therapeutic benefits of selenium supplementation. PMID:24885670

  4. Client perception of radiotherapy services at the Lagos University ...

    African Journals Online (AJOL)

    Assessment of quality from the patient's perspective could be a method of aiding improvement of services to achieve total quality management. This study set out to determine the level of knowledge of radiotherapy among patients and assess their attitude to the radiotherapy services provided at the Oncology clinic of the ...

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  6. Benign painful shoulder syndrome: initial results of a single-center prospective randomized radiotherapy dose-optimization trial. (United States)

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


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

  7. From image-guided radiotherapy to dose-guided radiotherapy; De la radiotherapie guidee par l'image a la radiotherapie guidee par la dose

    Energy Technology Data Exchange (ETDEWEB)

    Cazoulat, G.; Lesaunier, M.; Simon, A.; Haigron, P.; Acosta, O. [Inserm, U642, 35000 Rennes (France); LTSI, universite de Rennes-1, 35000 Rennes (France); Louvel, G.; Chajon, E.; Leseur, J. [Centre Eugene-Marquis, rue de La-Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex (France); Lafond, C.; De Crevoisier, R. [Inserm, U642, 35000 Rennes (France); LTSI, universite de Rennes-1, 35000 Rennes (France); Centre Eugene-Marquis, rue de La-Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex (France)


    Purpose. - In case of tumour displacement, image-guided radiotherapy (IGRT) based on the use of cone beam CT (tomographie conique) allows replacing the tumour under the accelerator by rigid registration. Anatomical deformations require however re-planning, involving an estimation of the cumulative dose, session after session. This is the objective of this study. Patients and methods. - Two examples of arc-intensity modulated radiotherapy are presented: a case of prostate cancer (total dose = 80 Gy) with tomographie conique (daily prostate registration) and one head and neck cancer (70 Gy). For the head and neck cancer, the patient had a weekly scanner allowing a dose distribution calculation. The cumulative dose was calculated per voxel on the planning CT after deformation of the dose distribution (with trilinear interpolation) following the transformation given by a non-rigid registration step (Demons registration method) from: either the tomographie conique (prostate), or the weekly CT. The cumulative dose was eventually compared with the planned dose. Results. - In cases of prostate irradiation, the 'cumulative' dose corresponded to the planned dose to the prostate. At the last week of irradiation, it was above the planned dose for the rectum and bladder. The volume of rectal wall receiving more than 50 Gy (V50) was 20% at the planning and 26% at the end of treatment, increasing the risk of rectal toxicity (NTCP) of 14%. For the bladder wall, V50 were 73% and 82%, respectively. In head and neck, the 'cumulative' dose to the parotid exceeded the planned dose (mean dose increasing from 46 Gy to 54 Gy) from the 5. week of irradiation on, suggesting the need for re-planning within the first 5 weeks of radiotherapy. Conclusion. - The deformable registration estimates the cumulative dose delivered in the different anatomical structures. Validation on digital and physical phantoms is however required before clinical evaluation. (authors)

  8. Radiotherapy for cutaneous cancers with xeroderma pigmentosum; Radiotherapie des cancers cutanes au cours du xeroderma pigmentosum

    Energy Technology Data Exchange (ETDEWEB)

    Ben Salah, H.; Bahri, M.; Turki, H.; Abdelmoula, M.; Frikha, M.; Daoud, J. [Service de radiotherapie, CHU Habib-Bourguiba, route Majida-Bouleila, 3029 Sfax (Tunisia)


    Purpose. - To analyze the therapeutic results of cutaneous cancers on xeroderma pigmentosum through a series of 15 patients treated by radiotherapy. Patients and methods. - Between 1993 and 2006, 15 patients with xeroderma pigmentosum and having cutaneous cancers were treated in the Radiotherapy Department of university hospital Habib-Bourguiba of Sfax in Tunisia. Seventy-three percent of the cases occurred in male patients and the mean age of appearance of the first tumour was 18.2 years. Tumour histology was squamous cell carcinoma in 74% of the cases. The total number of cutaneous tumours was 84. Ten patients had a surgical resection. Four patients did not respond to chemotherapy. The modality of irradiation was decided according to the size, thickness and localization of the tumour. The dose of radiotherapy was 60 Gy or equivalent with classic irradiation. Results. - The total number of lesions treated with radiotherapy was 64. Forty-three lesions were treated with contact-therapy, ten with brachytherapy and 11 with cobalt-therapy. The following acute complications were observed: cutaneous infection (53.3% of patients), radio-epithelitis (80% of patients) and necroses (33.3% of patients). Evaluation after treatment showed a clinical complete remission in 73% of the cases. Late effects were noted in seven cases: telangiectasia and cutaneous atrophy. A recurrence in the irradiated zone was observed in one case. A nodal metastasis was observed in two cases. Another patient presented lung metastases. After a median follow up of 37.2 months, four patients died, seven are alive with cutaneous cancer and four are alive with complete remission. Conclusion. - Radiotherapy is a possible and effective therapeutic alternative. Dose and methods are not defined for xeroderma pigmentosum. (authors)

  9. Surgery Followed by Radiotherapy Versus Radiotherapy Alone for Metastatic Spinal Cord Compression From Unfavorable Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Rades, Dirk, E-mail: [Department of Radiation Oncology, University of Lubeck (Germany); Huttenlocher, Stefan [Department of Radiation Oncology, University of Lubeck (Germany); Bajrovic, Amira [Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf (Germany); Karstens, Johann H. [Department of Radiation Oncology, Medical University Hannover (Germany); Adamietz, Irenaeus A. [Department of Radiation Oncology, Ruhr University Bochum (Germany); Kazic, Nadja [Department of Radiation Oncology, University of Sarajevo (Bosnia and Herzegowina); Rudat, Volker [Department of Radiation Oncology, Saad Specialist Hospital Al Khobar (Saudi Arabia); Schild, Steven E. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)


    Purpose: Despite a previously published randomized trial, controversy exists regarding the benefit of adding surgery to radiotherapy for metastatic spinal cord compression (MSCC). It is thought that patients with MSCC from relatively radioresistant tumors or tumors associated with poor functional outcome after radiotherapy alone may benefit from surgery. This study focuses on these tumors. Methods and Materials: Data from 67 patients receiving surgery plus radiotherapy (S+RT) were matched to 134 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for 10 factors and compared for motor function, ambulatory status, local control, and survival. Additional separate matched-pair analyses were performed for patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS) and patients receiving laminectomy (LE). Results: Improvement of motor function occurred in 22% of patients after S+RT and 16% after RT (p = 0.25). Posttreatment ambulatory rates were 67% and 61%, respectively (p = 0.68). Of nonambulatory patients, 29% and 19% (p = 0.53) regained ambulatory status. One-year local control rates were 85% and 89% (p = 0.87). One-year survival rates were 38% and 24% (p = 0.20). The matched-pair analysis of patients receiving LE showed no significant differences between both therapies. In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred more often after DDSS+RT than RT (28% vs. 19%, p = 0.024). Posttreatment ambulatory rates were 86% and 67% (p = 0.30); 45% and 18% of patients regained ambulatory status (p = 0.29). Conclusions: Patients with MSCC from an unfavorable primary tumor appeared to benefit from DDSS but not LE when added to radiotherapy in terms of improved functional outcome.

  10. DEGRO practical guidelines for radiotherapy of breast cancer II. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Municipal Hospital Karlsruhe (Germany); Souchon, R. [Allgemeines Krankenhaus Hagen (Germany); Budach, W. [Univ. Hospital Duesseldorf (Germany); Sedlmayer, F. [Univ. Hospital, Salzburger Landeskliniken, Salzburg (Austria); Feyer, P. [Klinikum Neukoelln, Berlin (Germany); Harms, W. [St. Clara Hospital, Basel (Switzerland); Haase, W. [St.-Vincentius-Kliniken, Karlsruhe (Germany); Dunst, J. [Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Wenz, F. [Univ. Hospital Mannheim (Germany); Sauer, R. [Univ. Hospital Erlangen (Germany)


    Background and purpose: the aim of the present paper is to update the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society for Radiooncology (DEGRO). These recommendations were complementing the S3 guidelines of the German Cancer Society (DKG) elaborated in 2004. The present DEGRO recommendations are based on a revision of the DKG guidelines provided by an interdisciplinary panel and published in February 2008. Methods: the DEGRO expert panel (authors of the present manuscript) performed a comprehensive survey of the literature. Data from lately published meta-analyses, recent randomized trials and guidelines of international breast cancer societies, yielding new aspects compared to 2006, provided the basis for defining recommendations referring to the criteria of evidence-based medicine. In addition to the more general statements of the DKG, this paper emphasizes specific radiooncologic issues relating to radiotherapy after mastectomy (PMRT), locally advanced disease, irradiation of the lymphatic pathways, and sequencing of local and systemic treatment. Technique, targeting, and dose are described in detail. Results: PMRT significantly reduces local recurrence rates in patients with T3/T4 tumors and/or positive axillary lymph nodes (12.9% with and 40.6% without PMRT in patients with four or more positive nodes). The more local control is improved, the more substantially it translates into increased survival. In node-positive women the absolute reduction in 15-year breast cancer mortality is 5.4%. Data referring to the benefit of lymphatic irradiation are conflicting. However, radiotherapy of the supraclavicular area is recommended when four or more nodes are positive and otherwise considered individually. Evidence concerning timing and sequencing of local and systemic treatment is sparse; therefore, treatment decisions should depend on the dominating risk of recurrence. Conclusion: there

  11. Ichthyosiform scaling secondary to megavoltage radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ross, E.V. (National Naval Medical Center, Bethesda, MD (USA))


    Acquired ichthyosis is a rare dermatosis associated with a number of malignancies. Side effects seen on the skin secondary to megavoltage radiotherapy are uncommon but may include fine dry desquamation and tanning. The authors present a case of ichthyosiform scaling limited to the radiation fields in a patient treated for brain metastases of a primary small cell lung carcinoma. The reader is reminded that side effects of megavoltage treatment do occur on the skin. A brief review of these effects is included. 5 references.

  12. [Quality and safety management for radiotherapy]. (United States)

    Pourel, N; Meyrieux, C; Perrin, B


    Quality and safety management have been implemented for many years in healthcare structures (hospitals treating cancer, private radiotherapy centres). Their structure and formalization have improved progressively over time. These recommendations aim at describing the link between quality and safety management through its organization scheme based on quality-safety policy, process approach, document management and quality measurement. Dedicated tools, such as experience feedback, a priori risk mapping, to-do-lists and check-lists are shown as examples and recommended as routine practice. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  13. Stevens-Johnson syndrome after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Howell, W.R.; Knight, A.L.; Scruggs, H.J. (Roanoke Memorial Hospitals, VA (USA))


    We have reported a case of classic Stevens-Johnson syndrome in association with treatment using a cobalt radiation therapy unit. Previous reports of such an association have been extremely rare. At the time of the reaction, the patient's only medications were methyldopa and trichlormethiazide. Other drugs in the thiazide class have been associated with such a reaction. We feel this is an unlikely association in our patient, however, because she had been on trichlormethiazide for a number of years. This report suggests the role of radiotherapy as a rare cause of Stevens-Johnson syndrome. 14 references.

  14. PET/CT Based Dose Planning in Radiotherapy

    DEFF Research Database (Denmark)

    Berthelsen, Anne Kiil; Jakobsen, Annika Loft; Sapru, Wendy


    This mini-review describes how to perform PET/CT based radiotherapy dose planning and the advantages and possibilities obtained with the technique for radiation therapy. Our own experience since 2002 is briefly summarized from more than 2,500 patients with various malignant diseases undergoing...... radiotherapy planning with PET/CT prior to the treatment. The PET/CT, including the radiotherapy planning process as well as the radiotherapy process, is outlined in detail. The demanding collaboration between mould technicians, nuclear medicine physicians and technologists, radiologists and radiology...... technologists, radiation oncologists, physicists, and dosimetrists is emphasized. We strongly believe that PET/CT based radiotherapy planning will improve the therapeutic output in terms of target definition and non-target avoidance and will play an important role in future therapeutic interventions in many...

  15. Application of individual lead shield in radiotherapy of eyelid tumor

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, Tadashi; Taniguchi, Hisashi; Inoue, Takaaki; Ohyama, Takashi [Tokyo Medical and Dental Univ. (Japan). Hospital; Oki, Meiko; Takeda, Masamune; Shibuya, Hitoshi


    In the treatment of the maxillofacial tumors, radiotherapy plays an important role in the achievement of good local control and to keep the normal shape and function. For the tumors occurring in or adjacent to the orbit, especially the tumors of eyelids, radiotherapy combined with/without surgery also yields better results than surgery alone, but the lens of the eye is a radiosensitive organ. Loss of vision could occur when radiation beam is directed at the eye, so radiotherapy prostheses must be used in the radiotherapy of eyelid tumor. An individual lead shield for the lens of eye was made for each of the 10 eyelid tumor patients and it was carefully placed in the conjunctival sac after anaesthesia with a few drops of oxybuprocaine (Benoxil) to avoid irradiation of the globe. The lead shield was applied to protect the normal surrounding structures. Excellent cosmetic and functional results were achieved during and after radiotherapy. (author)

  16. Comparison and Prognostic Analysis of Adjuvant Radiotherapy versus Salvage Radiotherapy for Treatment of Radically Resected Locally Advanced Esophageal Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Xin Xu


    Full Text Available Objective. To compare adjuvant radiotherapy and salvage radiotherapy after radical resection for treatment of esophageal squamous cell carcinoma (ESCC. Methods. Data from 155 patients with locally advanced ESCC who underwent radical resection and received postoperative radiotherapy from 2005 to 2011 were reviewed. Seventy-nine patients received adjuvant radiotherapy and 76 received salvage radiotherapy after locoregional recurrence. Results. The median disease-free survival (DFS and overall survival (OS were significantly higher in the adjuvant radiotherapy group than the salvage radiotherapy group (DFS 25.73 months versus 10.73 months, P 65 years or with PS ≥ 2. Conclusion. Compared to salvage radiotherapy, postoperative adjuvant radiotherapy can prolong DFS and OS for patients with radically resected local advanced ESCC but cannot improve survival for patients aged > 65 years or with PS ≥ 2.

  17. Sexual dysfunction after radiotherapy for cancer of the cervix uteri

    Energy Technology Data Exchange (ETDEWEB)

    Ohkawa, R.; Takamizawa, H. (Chiba Univ. (Japan). School of Medicine); Arai, T.; Morita, S.


    Investigations of sexual consciousness and sexual dysfunction after radiotherapy for cancer of the cervix uteri were performed on patients of middle and old ages by questionnaires and questioning by doctors, and the following results were obtained. 1. Before radiotherapy, sexual activity was most prominent in their twenties and thirties. However, patients who were in fifties when this study was performed had most active sexual lives during the ages from 35 to 50 years. 2. Frequencies of sexual intercourse decreased markedly just before radiotherapy, and many patients received radiotherapy when sexual activity fell. 3. 32% of the patients have not experienced sexual intercourse after radiotherapy. 4. Decreases in the sex urge, sexuality, vaginal discharge, and frequency of sexual intercourse after radiotherapy were recognized in 77%, 77%, 70%, and 93% respectively. 5. Patients who became unwilling to maintain sexual lives after radiotherapy because of fear about recurrence or aggravation of cancer were 38% by questionaires and 49% by questioning by doctors. 6. Pains on sexual intercourse were found in 69% by questionaires and 49% by questionning by doctors. Most pains occurred at penis insertion and was thought to be due to atrophy and inflammation of vagina and external genitalia in most cases. 7. Both vaginal damage and sexual dysfunction in patients with radiotherapy following surgery for cancer of the cervix uteri, in patients with radiotherapy alone for cancer of the cervix uteri, and in patients with radiotherapy following surgery for cancer of the ovary and corpus uteri were marked, modest and mild, respectively. 8. Vaginal damage score was higher in patients treated more than 5 years before than those less than 2 years ago, but there were no differences in sexual dysfunction score between both groups.

  18. Contribution of FDOPA PET to radiotherapy planning for advanced glioma (United States)

    Dowson, Nicholas; Fay, Michael; Thomas, Paul; Jeffree, Rosalind; McDowall, Robert; Winter, Craig; Coulthard, Alan; Smith, Jye; Gal, Yaniv; Bourgeat, Pierrick; Salvado, Olivier; Crozier, Stuart; Rose, Stephen


    Despite radical treatment with surgery, radiotherapy and chemotherapy, advanced gliomas recur within months. Geographic misses in radiotherapy planning may play a role in this seemingly ineluctable recurrence. Planning is typically performed on post-contrast MRIs, which are known to underreport tumour volume relative to FDOPA PET scans. FDOPA PET fused with contrast enhanced MRI has demonstrated greater sensitivity and specificity than MRI alone. One sign of potential misses would be differences between gross target volumes (GTVs) defined using MRI alone and when fused with PET. This work examined whether such a discrepancy may occur. Materials and Methods: For six patients, a 75 minute PET scan using 3,4-dihydroxy-6-18F-fluoro-L-phynel-alanine (18F-FDOPA) was taken within 2 days of gadolinium enhanced MRI scans. In addition to standard radiotherapy planning by an experienced radiotherapy oncologist, a second gross target volume (GTV) was defined by an experienced nuclear medicine specialist for fused PET and MRI, while blinded to the radiotherapy plans. The volumes from standard radiotherapy planning were compared to the PET defined GTV. Results: The comparison indicated radiotherapy planning would change in several cases if FDOPA PET data was available. PET-defined contours were external to 95% prescribed dose for several patients. However, due to the radiotherapy margins, the discrepancies were relatively small in size and all received a dose of 50 Gray or more. Conclusions: Given the limited size of the discrepancies it is uncertain that geographic misses played a major role in patient outcome. Even so, the existence of discrepancies indicates that FDOPA PET could assist in better defining margins when planning radiotherapy for advanced glioma, which could be important for highly conformal radiotherapy plans.

  19. Cardiac Side-effects From Breast Cancer Radiotherapy. (United States)

    Taylor, C W; Kirby, A M


    Breast cancer radiotherapy reduces the risk of cancer recurrence and death. However, it usually involves some radiation exposure of the heart and analyses of randomised trials have shown that it can increase the risk of heart disease. Estimates of the absolute risks of radiation-related heart disease are needed to help oncologists plan each individual woman's treatment. The risk for an individual woman varies according to her estimated cardiac radiation dose and her background risk of ischaemic heart disease in the absence of radiotherapy. When it is known, this risk can then be compared with the absolute benefit of the radiotherapy. At present, many UK cancer centres are already giving radiotherapy with mean heart doses of less than 3 Gy and for most women the benefits of the radiotherapy will probably far outweigh the risks. Technical approaches to minimising heart dose in breast cancer radiotherapy include optimisation of beam angles, use of multileaf collimator shielding, intensity-modulated radiotherapy, treatment in a prone position, treatment in deep inspiration (including the use of breath-hold and gating techniques), proton therapy and partial breast irradiation. The multileaf collimator is suitable for many women with upper pole left breast cancers, but for women with central or lower pole cancers, breath-holding techniques are now recommended in national UK guidelines. Ongoing work aims to identify ways of irradiating pan-regional lymph nodes that are effective, involve minimal exposure of organs at risk and are feasible to plan, deliver and verify. These will probably include wide tangent-based field-in-field intensity-modulated radiotherapy or arc radiotherapy techniques in combination with deep inspiratory breath-hold, and proton beam irradiation for women who have a high predicted heart dose from intensity-modulated radiotherapy. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  20. DEGRO practical guidelines for radiotherapy of breast cancer IV. Radiotherapy following mastectomy for invasive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wenz, Frederik; Sperk, Elena [Universitaetsmedizin Mannheim, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Budach, Wilfried [Heinrich-Heine-University, Duesseldorf (Germany); Dunst, Juergen [University Hospital Schleswig-Holstein, Luebeck (Germany); Feyer, Petra [Vivantes Hospital Neukoelln, Berlin (Germany); Fietkau, Rainer; Sauer, Rolf [University Hospital Erlangen, Erlangen (Germany); Haase, Wulf [Formerly St.-Vincentius-Hospital, Karlsruhe (Germany); Harms, Wolfgang [St. Clara Hospital, Basel (Switzerland); Piroth, Marc D. [Helios Hospital, Wuppertal (Germany); Sautter-Bihl, Marie-Luise [Municipal Hospital, Karlsruhe (Germany); Sedlmayer, Felix; Fussl, Christoph [Paracelsus Medical University Hospital, Salzburg (Germany); Souchon, Rainer; Collaboration: Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)


    Since the last recommendations from the Breast Cancer Expert Panel of the German Society for Radiation Oncology (DEGRO) in 2008, evidence for the effectiveness of postmastectomy radiotherapy (PMRT) has grown. This growth is based on updates of the national S3 and international guidelines, as well as on new data and meta-analyses. New aspects were considered when updating the DEGRO recommendations. The authors performed a comprehensive survey of the literature. Data from recently published (meta-)analyses, randomized clinical trials and international cancer societies' guidelines yielding new aspects compared to 2008 were reviewed and discussed. New aspects were included in the current guidelines. Specific issues relating to particular PMRT constellations, such as the presence of risk factors (lymphovascular invasion, blood vessel invasion, positive lymph node ratio > 20 %, resection margins < 3 mm, G3 grading, young age/premenopausal status, extracapsular invasion, negative hormone receptor status, invasive lobular cancer, size > 2 cm or a combination of ≥ 2 risk factors) and 1-3 positive lymph nodes are emphasized. The evidence for improved overall survival and local control following PMRT for T4 tumors, positive resection margins, > 3 positive lymph nodes and in T3 N0 patients with risk factors such as lymphovascular invasion, G3 grading, close margins, and young age has increased. Recently identified risk factors such as invasive lobular subtype and negative hormone receptor status were included. For patients with 1-3 positive lymph nodes, the recommendation for PMRT has reached the 1a level of evidence. PMRT is mandatory in patients with T4 tumors and/or positive lymph nodes and/or positive resection margins. PMRT should be strongly considered in patients with T3 N0 tumors and risk factors, particularly when two or more risk factors are present. (orig.) [German] Seit der letzten Aktualisierung der 2008 publizierten Leitlinie der &apos

  1. A comprehensive French grammar

    CERN Document Server

    Price, Glanville


    Characterized by clear and accessible explanations, numerous examples and sample sentences, a new section on register and tone, and useful appendices covering topics including age and time, A Comprehensive French Grammar, Sixth Edition is an indispensable tool for advanced students of French language and literature.A revised edition of this established, bestselling French grammarIncludes a new section on register and medium and offers expanded treatment of French punctuationFeatures numerous examples and sample sentences, and useful appendices covering topics including age, time, and dimension

  2. A comprehensive psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G


    A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service......, and an outpatient service. The number of chronic patients has not decreased, due to an influx of unruly senile patients. The close proximity of the service to the community has increased the pressure with regard to the care of such patients. Other services, such as outpatient treatment of alcoholics and neurotics...

  3. A comprehensive psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G


    , and an outpatient service. The number of chronic patients has not decreased, due to an influx of unruly senile patients. The close proximity of the service to the community has increased the pressure with regard to the care of such patients. Other services, such as outpatient treatment of alcoholics and neurotics......A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service...

  4. Comprehensive national energy strategy

    Energy Technology Data Exchange (ETDEWEB)



    This Comprehensive National Energy Strategy sets forth a set of five common sense goals for national energy policy: (1) improve the efficiency of the energy system, (2) ensure against energy disruptions, (3) promote energy production and use in ways that respect health and environmental values, (4) expand future energy choices, and (5) cooperate internationally on global issues. These goals are further elaborated by a series of objectives and strategies to illustrate how the goals will be achieved. Taken together, the goals, objectives, and strategies form a blueprint for the specific programs, projects, initiatives, investments, and other actions that will be developed and undertaken by the Federal Government, with significant emphasis on the importance of the scientific and technological advancements that will allow implementation of this Comprehensive National Energy Strategy. Moreover, the statutory requirement of regular submissions of national energy policy plans ensures that this framework can be modified to reflect evolving conditions, such as better knowledge of our surroundings, changes in energy markets, and advances in technology. This Strategy, then, should be thought of as a living document. Finally, this plan benefited from the comments and suggestions of numerous individuals and organizations, both inside and outside of government. The Summary of Public Comments, located at the end of this document, describes the public participation process and summarizes the comments that were received. 8 figs.

  5. In vivo dosimetry in external beam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mijnheer, Ben [Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam 1066 CX (Netherlands); Beddar, Sam [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Izewska, Joanna [Division of Human Health, International Atomic Energy Agency, Vienna 1400 (Austria); Reft, Chester [Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois 60637 (United States)


    In vivo dosimetry (IVD) is in use in external beam radiotherapy (EBRT) to detect major errors, to assess clinically relevant differences between planned and delivered dose, to record dose received by individual patients, and to fulfill legal requirements. After discussing briefly the main characteristics of the most commonly applied IVD systems, the clinical experience of IVD during EBRT will be summarized. Advancement of the traditional aspects of in vivo dosimetry as well as the development of currently available and newly emerging noninterventional technologies are required for large-scale implementation of IVD in EBRT. These new technologies include the development of electronic portal imaging devices for 2D and 3D patient dosimetry during advanced treatment techniques, such as IMRT and VMAT, and the use of IVD in proton and ion radiotherapy by measuring the decay of radiation-induced radionuclides. In the final analysis, we will show in this Vision 20/20 paper that in addition to regulatory compliance and reimbursement issues, the rationale for in vivo measurements is to provide an accurate and independent verification of the overall treatment procedure. It will enable the identification of potential errors in dose calculation, data transfer, dose delivery, patient setup, and changes in patient anatomy. It is the authors' opinion that all treatments with curative intent should be verified through in vivo dose measurements in combination with pretreatment checks.

  6. Adaptive management of cervical cancer radiotherapy. (United States)

    Tanderup, Kari; Georg, Dietmar; Pötter, Richard; Kirisits, Christian; Grau, Cai; Lindegaard, Jacob C


    Since the breakthrough 10 years ago with concomitant radio-chemotherapy, substantial progress in the treatment of locally advanced cervical cancer has been lacking. Radiotherapy continues to be the cornerstone in the treatment of this disease and now shows much potential for progress, as image guidance of both external beam radiation therapy and brachytherapy, linked with strong tools for treatment planning and dose delivery, is becoming available. With these new techniques, it again seems possible to improve the therapeutic ratio as we begin to understand how the treatment for each patient can be individualized, not only in terms of volume (3-dimensional), but also during treatment (4-dimensional), as the tumor regresses and the topography of the target and organs at risk change significantly. New promising data with increased loco-regional control and decreased morbidity compared with the past are appearing. At the dawn of this new era, it is the aim of the present article to give an overview of the use of image-guided adaptive radiotherapy in the multimodal management of locally advanced cervical cancer. Copyright 2010 Elsevier Inc. All rights reserved.

  7. Accelerated radiotherapy for advanced laryngeal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Haugen, Hedda; Mercke, Claes [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Oncology; Johansson, Karl-Axel [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Radiophysics; Ejnell, Hasse; Edstroem, Staffan [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Oto-Rhino-Laryngology


    The purpose of this study was to evaluate a single institution's outcome for patients with advanced laryngeal cancer treated with accelerated radiotherapy (RT). Fifty-eight patients with advanced laryngeal cancer were treated with curative intent with accelerated RT during the period 1990-1998. Patients received radiotherapy alone or with induction chemotherapy. The 5-year local control (LC) and loco-regional control (LRC) probabilities were both 49% for T3 and 75% for T4 tumors. The 5-year disease-free survival probability was 46% and 68% and overall survival probability was 30% and 39% for T3 and T4 tumors respectively. No significant statistical difference in outcome was found, either between T3 and T4 tumors, or between patients who received induction chemotherapy and those who did not. The treatment results for advanced laryngeal cancer at this institution were comparable to those reported in the literature. The results for T3 and T4 were similar. T4 classification alone should not be an exclusion criterion for larynx preservation. Overall survival was poor, partly because of a high incidence of deaths from intercurrent diseases.

  8. [Current requirements for image management in radiotherapy]. (United States)

    Steil, V; Röhner, F; Schneider, F; Wenz, F; Lohr, F; Weisser, G


    Treatment techniques of increasing complexity such as dynamic/rotational techniques mandate digital management and increasingly image guidance. This constantly increases requirements for image management and archiving. This article discusses the current status of these requirements and will present potential image administration strategies. Fundamentals of image administration and storage/archiving are presented (DICOM Standard, radiotherapy-specific issues) along the typical patient pathway (demographic data, radiotherapy treatment planning, signatures/approval of plan and image data, archiving of plan and image data). Different strategies for image management are presented (archiving centered on individual application vs. integral approach with central archiving in a DICOM-RT-PACS governed by a radiation oncology information system (ROCIS)). Infrastructural requirements depending on the amount of image data generated in the department are discussed. Application-centered image management provides access to image data including all relevant RT-specific elements. This approach, however, is not migration-safe, requires significant administrative work to ensure a redundancy level that protects against data loss and does not provide datasets that are linked to respective therapeutic interventions. Therefore, centralized image management and archiving that links images to patients and individual steps in the treatment pathway within a standardized DICOM(-RT) environment is preferable despite occasional problems with visualization of specific data elements.

  9. A scintillating fiber dosimeter for radiotherapy (United States)

    Bartesaghi, G.; Conti, V.; Bolognini, D.; Grigioni, S.; Mascagna, V.; Prest, M.; Scazzi, S.; Mozzanica, A.; Cappelletti, P.; Frigerio, M.; Gelosa, S.; Monti, A.; Ostinelli, A.; Giannini, G.; Vallazza, E.


    Radiotherapy, together with chemotherapy and surgery, is one of the main methods applied in the fight against cancer; in order to increase the chances of a successful radiotherapy treatment the dose delivery to the tumor and the surrounding normal tissues has to be computed with high accuracy. Traditional dosimeters are accurate but single channel (ionization chambers and diodes) or non real-time (radiographic films) devices. At present there is no device water equivalent that can perform real-time and bidimensional measurements of a dose distribution. This article describes the development of a real-time dosimeter based on scintillating fibers for photon and electron beams; the fibers are made of polystyrene, that is water equivalent and thus tissue equivalent, allowing a direct dose calculation. Three prototypes (single and multichannel) have been assembled, consisting in small scintillators coupled to white fibers that carry the light to photomultiplier tubes. In this article the prototypes and the readout electronics are described, together with the results of the measurements with electron and photon beams with energy up to 20 MeV (produced by linear accelerators Varian Clinac 1800 and 2100CD).

  10. Dose masking feature for BNCT radiotherapy planning (United States)

    Cook, Jeremy L.; Wessol, Daniel E.; Wheeler, Floyd J.


    A system for displaying an accurate model of isodoses to be used in radiotherapy so that appropriate planning can be performed prior to actual treatment on a patient. The nature of the simulation of the radiotherapy planning for BNCT and Fast Neutron Therapy, etc., requires that the doses be computed in the entire volume. The "entire volume" includes the patient and beam geometries as well as the air spaces in between. Isodoses derived from the computed doses will therefore extend into the air regions between the patient and beam geometries and thus depict the unrealistic possibility that radiation deposition occurs in regions containing no physical media. This problem is solved by computing the doses for the entire geometry and then masking the physical and air regions along with the isodose contours superimposed over the patient image at the corresponding plane. The user is thus able to mask out (remove) the contour lines from the unwanted areas of the image by selecting the appropriate contour masking region from the raster image.

  11. Results of radiotherapy for esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Matsuki, Kazuhiko; Koga, Kenji; Nishikawa, Kiyoshi; Ebihara, Hiroaki; Futami, Shigemi; Watanabe, Katsushi


    The results of radiotherapy for esophageal cancer are described in 80 patients treated between January 1978 and December 1985. Five-year survival rates were 3 % in all the patients and 5 % in 42 patients without distant metastasis, who were irradiated a dose of 50 Gy or more. There were 4 survivors more than 3 years, who showed tumorous type and length of less than 5 cm in all. Median survival months correlated with length and radiological types of tumor (p < 0.05), but no with sex and age. Combined radiotherapy and chemotherapy did not give any impact on survival times. Optimal tumor dose was estimated to be 50 to 70 Gy. Esophageal bypass prolonged survival times and provided real palliation (p < 0.1). Four patients with advanced stage were treated by intracavitary irradiation following external irradiation. Radiation myelopathy and radiation pericarditis were observed in one patient, respectively. The problem of the intracavitary irradiation and the treatment method of esophageal cancer with respiratory tract fistula are discussed in this paper.

  12. Development of evaluation and performance verification technology for radiotherapy radiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, J. Y.; Jang, S. Y.; Kim, B. H. and others


    No matter how much the importance is emphasized, the exact assessment of the absorbed doses administered to the patients to treat the various diseases such as lately soaring malignant tumors with the radiotherapy practices is the most important factor. In reality, several over-exposed patients from the radiotherapy practice become very serious social issues. Especially, the development of a technology to exactly assess the high doses and high energies (In general, dose administered to the patients with the radiotherapy practices are very huge doses, and they are about three times higher than the lethal doses) generated by the radiation generators and irradiation equipment is a competing issue to be promptly conducted. Over fifty medical centers in Korea operate the radiation generators and irradiation equipment for the radiotherapy practices. However, neither the legal and regulatory systems to implement a quality assurance program are sufficiently stipulated nor qualified personnel who could run a program to maintain the quality assurance and control of those generators and equipment for the radiotherapy practices in the medical facilities are sufficiently employed. To overcome the above deficiencies, a quality assurance program such as those developed in the technically advanced countries should be developed to exactly assess the doses administered to patients with the radiotherapy practices and develop the necessary procedures to maintain the continuing performance of the machine or equipment for the radiotherapy. The QA program and procedures should induce the fluent calibration of the machine or equipment with quality, and definitely establish the safety of patients in the radiotherapy practices. In this study, a methodology for the verification and evaluation of the radiotherapy doses is developed, and several accurate measurements, evaluations of the doses delivered to patients and verification of the performance of the therapy machine and equipment are

  13. Phase Measurement of Cognitive Impairment Specific to Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Armstrong, Carol L., E-mail: [Children' s Hospital of Philadelphia, Philadelphia, Pennsylvania (United States); Department of Pediatrics, Division of Neuro-Oncology, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania (United States); Shera, David M. [Children' s Hospital of Philadelphia, Philadelphia, Pennsylvania (United States); Department of Pediatrics, Division of Biostatistics and Epidemiology, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania (United States); Lustig, Robert A. [Department of Radiation Oncology, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania (United States); Phillips, Peter C. [Children' s Hospital of Philadelphia, Philadelphia, Pennsylvania (United States); Department of Pediatrics, Division of Neurology and Oncology, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania (United States)


    Purpose: Memory impairment is an early-delayed effect of radiotherapy (RT). The prospective longitudinal measurement of the cognitive phase effects from RT was conducted on treated and untreated brain tumor patients. The study design investigated semantic vs. perceptual and visual vs. verbal memory to determine the most disease-specific measure of RT-related changes and understanding of the neurotoxicity from RT to the brain. Methods and Materials: Tests of memory that had previously shown RT-related phasic changes were compared with experimental tests of memory to test hypotheses about cognition targeted to the neural toxicity of RT. The results from 41 irradiated and 29 nonirradiated patients with low-grade, supratentorial tumors were analyzed. The methods controlled for comorbid white matter risk, recurrence, interval after treatment, and age (18-69 years). The effects were examined before RT and at three points after RT to 1 year using a mixed effects model that included interval, group, surgical status, medication use, practice, and individual random effects. Four new tests of memory and other candidate cognitive tests were investigated, and a post hoc analysis of a comprehensive battery of tests was performed to identify the cognitive processes most specific to RT. Results: The RT effects on memory were identified in the treated group only; among the new tests of memory and the complete neurocognitive battery, the RT effects were significant only for delayed recall (p < 0.009) and interval to recognize (p < 0.002). Tumor location was not related to the treatment effect. Memory decline was specific to retrieval of semantic memories; a double dissociation of semantic from perceptual visual memory was demonstrated in the RT group. Conclusions: These results implicate memory dependent on the semantic cortex and the hippocampal memory system. A cognitive measurement that is brief but specific to neural mechanisms is effective and feasible for studies of RT damage.

  14. Total laryngectomy for a dysfunctional larynx after (chemo)radiotherapy. (United States)

    Theunissen, Eleonoor A R; Timmermans, Adriana J; Zuur, Charlotte L; Hamming-Vrieze, Olga; Paul de Boer, Jan; Hilgers, Frans J M; van den Brekel, Michiel W M


    To evaluate the functional outcomes after total laryngectomy (TLE) for a dysfunctional larynx in patients with head and neck cancer that is in complete remission after (chemo)radiotherapy. Retrospective cohort study. Tertiary comprehensive cancer center. The study included 25 patients from a cohort of 217 consecutive patients with TLE who were treated between January 2000 and July 2010. The inclusion criteria for this subgroup analysis were complete remission and functional problems for which TLE was considered to be the only resolution. Quality of life assessment was carried out using the European Organization for Research and Treatment of Cancer Quality of Life C30 and Head and Neck Module 35 questionnaires and an additional study-specific questionnaire covering functional aspects, such as swallowing and dyspnea, in more detail. Total laryngectomy. Morbidity, mortality, and functional outcomes. RESULTS The indication for TLE was chronic aspiration with or without recurrent pneumonia (n = 15 [60%]), debilitating dyspnea (n = 8 [32%]), and persistent profuse hemorrhage (radiation ulcer) (n = 2 [8%]). After TLE, 14 of the 25 patients (56%) had 20 major postoperative complications, including 11 pharyngocutaneous fistulas, requiring additional treatment. Tube feeding and recurrent pneumonia incidence had decreased from 80% and 28% to 29% and 0%, respectively, 2 years after surgery. Prosthetic voice rehabilitation was possible in 19 patients (76%). Two years after surgery, 10 of 14 patients (71%) still reported TLE-related pulmonary problems despite the consistent use of a heat and moisture exchanger. The 5-year overall survival rate was 35%. Total laryngectomy for a dysfunctional larynx tends to have a high complication rate. However, in this study, the initial functional problems (aspiration, recurrent pneumonia, and dyspnea) did not recur. Tube feeding was significantly reduced, and the quality of life of the surviving patients appeared to be reasonable.

  15. Spine Stereotactic Body Radiotherapy: Indications, Outcomes, and Points of Caution (United States)

    Eppinga, Wietse; Charest-Morin, Raphaele; Soliman, Hany; Myrehaug, Sten; Maralani, Pejman Jabehdar; Campbell, Mikki; Lee, Young K.; Fisher, Charles; Fehlings, Michael G.; Chang, Eric L.; Lo, Simon S.; Sahgal, Arjun


    Study Design: A broad narrative review. Objectives: The objective of this article is to provide a technical review of spine stereotactic body radiotherapy (SBRT) planning and delivery, indications for treatment, outcomes, complications, and the challenges of response assessment. The surgical approach to spinal metastases is discussed with an overview of emerging minimally invasive techniques. Methods: A comprehensive review of the literature was conducted on the techniques, outcomes, and developments in SBRT and surgery for spinal metastases. Results: The optimal management of patients with spinal metastases is complex and requires multidisciplinary assessment from an oncologic team that is familiar with the shifting paradigm as a consequence of evolving techniques in surgery and stereotactic radiation, as well as new developments in systemic agents. The Spinal Instability Neoplastic Score and the epidural spinal cord compression (Bilsky) grading system are useful tools that facilitate communication among oncologic team members and can direct management by providing a baseline assessment of risks prior to therapy. The combined multimodality approach with “separation surgery” followed by postoperative spine SBRT achieves thecal sac decompression, improves tumor control, and avoids complications that may be associated with more extensive surgery. Conclusion: Spine SBRT is a highly effective treatment that is capable of delivering ablative doses to the target while sparing the critical organs-at-risk, chiefly the critical neural tissues, within a short and manageable schedule. At the same time, surgery occupies an important role in select patients, particularly with the expanding availability and expertise in minimally invasive techniques. With rapid adoption of spine SBRT in centers outside of the academic setting, it is imperative for the practicing oncologist to understand the relevance and application of these evolving concepts. PMID:28507888

  16. The Validity of Reading Comprehension Rate: Reading Speed, Comprehension, and Comprehension Rates (United States)

    Skinner, Christopher H.; Williams, Jacqueline L.; Morrow, Jennifer Ann; Hale, Andre D.; Neddenriep, Christine E.; Hawkins, Renee O.


    This article describes a secondary analysis of a brief reading comprehension rate measure, percent comprehension questions correct per minute spent reading (%C/M). This measure includes reading speed (seconds to read) in the denominator and percentage of comprehension questions answered correctly in the numerator. Participants were 22 4th-, 29…

  17. Heavy-ion transport codes for radiotherapy and radioprotection in space

    Energy Technology Data Exchange (ETDEWEB)

    Mancusi, Davide


    Simulation of the transport of heavy ions in matter is a field of nuclear science that has recently received attention in view of its importance for some relevant applications. Accelerated heavy ions can, for example, be used to treat cancers (heavy-ion radiotherapy) and show some superior qualities with respect to more conventional treatment systems, like photons (x-rays) or protons. Furthermore, long-term manned space missions (like a possible future mission to Mars) pose the challenge to protect astronauts and equipment on board against the harmful space radiation environment, where heavy ions can be responsible for a significant share of the exposure risk. The high accuracy expected from a transport algorithm (especially in the case of radiotherapy) and the large amount of semi-empirical knowledge necessary to even state the transport problem properly rule out any analytical approach; the alternative is to resort to numerical simulations in order to build treatment-planning systems for cancer or to aid space engineers in shielding design. This thesis is focused on the description of HIBRAC, a one-dimensional deterministic code optimised for radiotherapy, and PHITS (Particle and Heavy- Ion Transport System), a general-purpose three-dimensional Monte-Carlo code. The structure of both codes is outlined and some relevant results are presented. In the case of PHITS, we also report the first results of an ongoing comprehensive benchmarking program for the main components of the code; we present the comparison of partial charge-changing cross sections for a 400 MeV/n {sup 40}Ar beam impinging on carbon, polyethylene, aluminium, copper, tin and lead targets.

  18. Adjuvant and salvage radiotherapy after prostatectomy: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Changhao Chen

    Full Text Available In men with adverse prognostic factors (APFs after radical prostatectomy (RP, the most appropriate timing to administer radiotherapy remains a subject for debate. We conducted a systemic review and meta-analysis to evaluate the therapeutic strategies: adjuvant radiotherapy (ART and salvage radiotherapy (SRT.We comprehensively searched PubMed, EMBASE, Web of Science and the Cochrane Library and performed the meta-analysis of all randomized controlled trials (RCTs and retrospective comparative studies assessing the prognostic factors of ART and SRT.Between May 1998 and July 2012, 2 matched control studies and 16 retrospective studies including a total of 2629 cases were identified (1404 cases for ART and 1185 cases for SRT. 5-year biochemical failure free survival (BFFS for ART was longer than that for SRT (Hazard Ratio [HR]: 0.37; 95% CI, 0.30-0.46; p<0.00001, I(2 = 0%. 3-year BFFS was significantly longer in the ART (HR: 0.38; 95% CI, 0.28-0.52; p<0.00001, I(2 = 0%. Overall survival (OS was also better in the ART (RR: 0.53; 95% CI, 0.41-0.68; p<0.00001, I(2 = 0%, as did disease free survival (DFS (RR: 0.53; 95% CI, 0.43-0.66; p<0.00001, I(2  = 0%. Exploratory subgroup analysis and sensitivity analysis revealed the similar results with original analysis.ART therapy offers a safe and efficient alternative to SRT with longer 3-year and 5-year BFFS, better OS and DFS. Our recommendation is to suggest ART for patients with APFs and may reduce the need for SRT. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update this analysis.

  19. Stereotactic body radiotherapy (SBRT): Technological innovation and application in gynecologic oncology. (United States)

    Higginson, Daniel S; Morris, David E; Jones, Ellen L; Clarke-Pearson, Daniel; Varia, Mahesh A


    Stereotactic body radiotherapy (SBRT) is a novel form of noninvasive, highly conformal radiation treatment that delivers a high dose to tumor. The advantage of the technique resides in its ability to provide a high dose to tumor but spare normal tissues to an extent not previously possible. In this paper we will provide an introduction and review of this technology with regard to its use in gynecologic malignancies. Preliminary results from our experience are presented for the purpose of illustrating the range of SBRT applications in gynecologic oncology. A comprehensive literature review was conducted and our experience from the past three years was reviewed. Six case series are published that report results of SBRT for gynecologic malignancies. Sixteen gynecologic patients have been treated with SBRT at our institution. Treatment sites include pelvic and periaortic nodes (9 patients), oligometastatic disease (2), and cervical or endometrial primary tumors when other conventional external radiation or brachytherapy techniques were unsuitable (5). Preliminary follow-up at a median of 11 months (range, 0.3-33 months) demonstrates 79% locoregional control, 43% distant failure, and 50% overall survival. SBRT boosts to macroscopic periaortic node recurrences and other sites seem to provide local control and a possibility of long-term disease-free survival in carefully selected patients. Previously this had been difficult to achieve with conventional radiotherapy because of the proximity of periaortic nodes to small bowel. SBRT also offers a novel approach for minimally invasive treatment in the management of gynecological cancer where current surgical and radiotherapy techniques are unsuitable. Copyright © 2010 Elsevier Inc. All rights reserved.

  20. Commissioning and quality control of a dedicated wide bore 3T MRI simulator for radiotherapy planning

    Directory of Open Access Journals (Sweden)

    Aitang Xing


    Full Text Available Purpose: The purpose of this paper is to describe a practical approach to commissioning and quality assurance (QA of a dedicated wide-bore 3 Tesla (3T magnetic resonance imaging (MRI scanner for radiotherapy planning.Methods: A comprehensive commissioning protocol focusing on radiotherapy (RT specific requirements was developed and performed. RT specific tests included: uniformity characteristics of radio-frequency (RF coil, couch top attenuation, geometric distortion, laser and couch movement and an end-to-end radiotherapy treatment planning test. General tests for overall system performance and safety measurements were also performed.Results: The use of pre-scan based intensity correction increased the uniformity from 61.7% to 97% (body flexible coil, from 50% to 90% (large flexible coil and from 51% to 98% (small flexible coil. RT flat top couch decreased signal-to-noise ratio (SNR by an average of 42%. The mean and maximum geometric distortion was found to be 1.25 mm and 4.08 mm for three dimensional (3D corrected image acquisition, 2.07 mm and 7.88 mm for two dimensional (2D corrected image acquisition over 500 mm × 375 mm × 252 mm field of view (FOV. The accuracy of the laser and couch movement was less than ±1 mm. The standard deviation of registration parameters for the end-to-end test was less than 0.41 mm. An on-going QA program was developed to monitor the system’s performance.Conclusion: A number of RT specific tests have been described for commissioning and subsequent performance monitoring of a dedicated MRI simulator (MRI-Sim. These tests have been important in establishing and maintaining its operation for RT planning.

  1. Bladder filling variation during conformal radiotherapy for rectal cancer (United States)

    Sithamparam, S.; Ahmad, R.; Sabarudin, A.; Othman, Z.; Ismail, M.


    Conformal radiotherapy for rectal cancer is associated with small bowel toxicity mainly diarrhea. Treating patients with a full bladder is one of the practical solutions to reduce small bowel toxicity. Previous studies on prostate and cervix cancer patients revealed that maintaining consistent bladder volume throughout radiotherapy treatment is challenging. The aim of this study was to measure bladder volume variation throughout radiotherapy treatment. This study also measured the association between bladder volume changes and diarrhea. Twenty two rectal cancer patients were recruited prospectively. Patients were planned for treatment with full bladder following departmental bladder filling protocol and the planning bladder volume was measured during CT-simulation. During radiotherapy, the bladder volume was measured weekly using cone-beam computed tomography (CBCT) and compared to planning bladder volume. Incidence and severity of diarrhea were recorded during the weekly patient review. There was a negative time trend for bladder volume throughout five weeks treatment. The mean bladder volume decreased 18 % from 123 mL (SD 54 mL) during CT-simulation to 101 mL (SD 71 mL) on the 5th week of radiotherapy, but the decrease is not statistically significant. However, there was a large variation of bladder volume within each patient during treatment. This study showed an association between changes of bladder volume and diarrhea (P = 0.045). In conclusion bladder volume reduced throughout radiotherapy treatment for conformal radiotherapy for rectal cancer and there was a large variation of bladder volume within patients.

  2. Quality assurance of radiotherapy and its clinical assessment

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Toshihiko [Osaka Univ., Suita (Japan). Graduate School of Medicine


    We investigated the clinical quality assurance (QA) of radiotherapy in Japan since 1981. The aim of this study was to establish the QA of a radiotherapy system and its clinical assessment in Japan. We introduced the Patterns of Care Study (PCS) into Japan to perform this study in 1996. The PCS is a retrospective study designed to establish the national practice for cancer patients during a specific period and should be a complementary study to a prospective randomized controlled study. We collected precise data for 4399 patients with carcinomas of the breast, cervix, esophagus, lung and prostate by means of external audits for 96 institutes from 1998 through 2001. Patients were randomly sampled with two-stage cluster sampling. We stratified 556 institutes into four categories according to the academic condition and annual number of radiotherapy patients. National and regional averages of various factors of radiotherapy could be calculated and were used to measure QA of radiotherapy. Using a standard score, we could compare the process of individual institutions with national averages and feed back the evaluation score to each institution. With a PCS process survey, we could observe the dissemination of the treatment method under evidence-based medicine from the prospective randomized controlled study. We proposed future prediction of the number of radiotherapy patients and a counter plan for equipment and personnel. The first US-Japan PCS Workshop was held at San Francisco in 2001. We could establish QA of a radiotherapy system using PCS 1995-97 in Japan. (author)

  3. Fast neutron radiotherapy in the treatment of malignant pleural mesothelioma. (United States)

    Patel, Shilpen A; Kusano, Aaron S; Truong, Anh; Stelzer, Keith J; Laramore, George E


    Malignant pleural mesothelioma (MPM) is a fatal disease lacking standardized treatment. We describe the use of fast neutron radiation therapy in MPM patients referred to the Department of Radiation Oncology at the University of Washington Medical Center. Retrospective chart review of MPM patients receiving neutron radiotherapy treatment from 1980 to 2012. A total of 30 MPM patients received fast neutron radiotherapy as part of their treatment regimen. Median age at diagnosis was 59.6 years (range, 46.6 to 72.3 y). Eighteen patients received fast neutron radiotherapy as a component of trimodality treatment. Median overall survival was 20.3 months (range, 5.5 to 73.3 mo) with 1 patient censored at 34.8 months and all other patients with confirmed dates of death. One patient receiving radiotherapy alone as a palliative measure died during radiation treatment. One patient was unable to tolerate radiotherapy and stopped before completing prescribed treatment. On univariate analysis, Brigham Stage at presentation was a significant predictor of survival (Ptreatment compared to those who did not. Fast neutron radiotherapy may be utilized in the management of MPM patients. However, treatment with fast neutron radiotherapy did not significantly improvement outcome, even when used in a trimodality regimen.

  4. The role of radiotherapy in the management of POEMS syndrome. (United States)

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


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

  5. Long-term results of radiotherapy for pituitary adenomas. Evaluation of tumor control and hypopituitarism after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchida, Emiko; Sakai, Kunio; Matsumoto, Yasuo; Sugita, Tadashi; Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine


    To evaluate the results of conventional radiotherapy for pituitary adenomas assessed with computed tomography (CT) or magnetic resonance imaging (MRI). Endpoints include tumor control, normalization of hormone levels in functioning adenomas, and hypopituitarism after radiotherapy as an adverse effect. Forty-two patients were treated with radiotherapy from 1982 to 1995 at Niigata University Hospital. Forty patients were irradiated after surgery because of residual adenomas in 33 patients and tumor regrowth in 7 patients. One patient was treated with radiotherapy alone, and the remaining 1 patient was treated with preoperative radiotherapy. Tumor size and extension were evaluated using CT or MRI, and all tumors were macroadenomas. They consisted of 18 non-functioning and 24 functioning adenomas (growth hormone (GH)-secreting: 11, prolactinomas: 7, concomitant GH and prolactin (PRL)-secreting: 5, gonadotropin-secreting: 1). Treatment was given in 200 cGy daily fraction size and a total dose of 50 Gy was given to most patients. Sixteen patients with GH- and/or PRL-secreting adenomas received bromocriptine. Tumor progression was determined by increase in tumor size as shown by CT or MRI. Hypopituitarism after radiotherapy was evaluated using the functions of corticotropin (ACTH), thyrotropin (TSH), and gonadotropin. Median follow-up time from the end of radiotherapy was 103 months. Tumor progression occurred in 2 out of 42 patients and 10-year progression-free rate for all patients was 93.7%. Normalization of GH levels was obtained in 12 of 16 GH-secreting adenomas with a mean time of 27 months after radiotherapy, and 9 of 12 PRL-secreting adenomas achieved normalization of PRL levels with a mean time of 34 months. One gonadotropin-secreting adenoma achieved normalization of gonadotropin level at 21 months after radiotherapy. The incidence of hypopituitarism after radiotherapy increased with time, and cumulative risk of deficiencies of ACTH, TSH, and gonadotropin at 10

  6. Comprehensive nuclear materials

    CERN Document Server

    Allen, Todd; Stoller, Roger; Yamanaka, Shinsuke


    Comprehensive Nuclear Materials encapsulates a panorama of fundamental information on the vast variety of materials employed in the broad field of nuclear technology. The work addresses, in five volumes, 3,400 pages and over 120 chapter-length articles, the full panorama of historical and contemporary international research in nuclear materials, from Actinides to Zirconium alloys, from the worlds' leading scientists and engineers. It synthesizes the most pertinent research to support the selection, assessment, validation and engineering of materials in extreme nuclear environments. The work discusses the major classes of materials suitable for usage in nuclear fission, fusion reactors and high power accelerators, and for diverse functions in fuels, cladding, moderator and control materials, structural, functional, and waste materials.

  7. Prognostic implications of immediate PSA response to early salvage radiotherapy. (United States)

    Turner I I, Robert M; Yabes, Jonathan G; Woldemichael, Elen; Deutsch, Melvin M; Smith, Ryan P; Werner, Robert S; Jacobs, Bruce L; Nelson, Joel B


    Up to 25% of men with prostate cancer who undergo radical prostatectomy will recur. In this setting, salvage radiotherapy may cure patients with local recurrence, but is unable to cure those with occult metastatic disease. The objective of this study is to examine how prostate-specific antigen (PSA) response to radiotherapy predicts subsequent disease progression and survival. Using a prospectively populated database of 3089 men who underwent open radical prostatectomy, 212 patients (7%) were identified who received early salvage radiotherapy for biochemical recurrence. The main outcome was time to disease progression after salvage radiotherapy. Patients were stratified by PSA response after radiotherapy: 1) PSA radiotherapy at a median PSA of 0.20 ng/mL (IQR 0.10-0.30 ng/mL). At a median follow up of 47.3 months, a total of 52 (25%) patients experienced disease progression. On multivariable analysis, both persistent PSA (HR 5.12; 95% CI 1.98-13.23) and rising PSA (HR 16.55; 95% CI 6.61-41.48) were associated with increased risk of disease progression compared to those with PSA radiotherapy PSA, Gleason score, margin status, stage, and time to radiotherapy. Only rising PSA was associated with an increased risk of cancer-specific and all-cause mortality. PSA response is associated with the risk of disease progression following salvage radiotherapy. This information can be used to counsel patients on the potential need for additional therapy and identify those at greatest risk for progression and cancer-related mortality.

  8. 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)


    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

  9. Testis cancer: role of radiotherapy in 2003; Cancer du testicule: place de la radiotherapie en 2003

    Energy Technology Data Exchange (ETDEWEB)

    Clippe, S. [Centre de Lutte Contre le Cancer Leon-Berard, Dept. de Radiotherapie, 69 - Lyon (France); Flechon, A.; Droz, J.P. [Centre de Lutte Contre le Cancer Leon-Berard, Dept. de Cancerologie Medicale, 69 - Lyon (France)


    Germ-cell minors of the testis are rare tumors of the young adult. Half of them are seminoma. The majority of patients have disease limited to the testis. Radiotherapy still remains the standard treatment of these patients. Almost all patients are cured by orchidectomy and radiotherapy on the lomboaortic area extended to homolateral iliac area. The dose is 24 to 30 Gy in a standard fractionation. Different studies are ongoing to reduce the irradiation field (omission of the pelvic irradiation), to decrease irradiation dose (to 20 Gy). Other treatment options are strict surveillance and adjuvant carbo-platin based chemotherapy. None of these options are standard treatments. A strict attention must be directed on controlateral germ-cell tumors and second cancers. (author)

  10. [Comprehensive geriatric medicine]. (United States)

    Endo, Hidetoshi


    This paper is written to make clear the new medical system in the elderly and to standardize of Geriatrics and care. There are two major important components in geriatrics and geriatric care which are comprehensive geriatric assessment and team approach. But this is sometimes difficulut to do geriatric medicine. This goal is to make clear the usefulness of comprehensive geriatric assessment (CGA) and team approach. And the research purpose is to make standardization of geriatric medicine and care of elderly patients and organization of professionals. I have studied QOL of elderly people in the community. The scale, SF36, was used in this study. I compared with QOL between elderly with dementia and healthy elderly. QOL was studied with statistical analysis of SPSS. Physical function and symptomatic vitality in lower items of QOL were much better in health people than demented elderly. But global subjective health was much better in demented elderly than healthy people in the community. And I made clinical path of dementia for examination in the hospital. The results were clinical path made clear the importance of team approaches and standard of medical course in the hospital. It was helpful in medicine and care and its bindings. Dr. Murashima and her group have developed a new check list of screening risk factor of long stay of elderly inpatient. And they studied about the effects of supportive group for discharge using assessment and team approaches. This unit has a good function which support home care of the elderly patients. Finally narrative based medicine is very important to take care for the elderly patients. It has been lacked to do the present medicine for the elderly patient by evidence based medicine. In conclusion, for the standardization of geriatrics, CGA is useful for support for the frail elderly and team approach is good for staff communication through team conference.

  11. Late effects of radiotherapy on rectum; Les complications rectales de la radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Bosset, J.F.; Bontemps, P.; Courvoisier, P. [Centre Hospitalier Universitaire, 25 - Besancon (France)


    Late rectal morbidity has been observed in 2 % - 25 % of patients treated with radiotherapy using curative doses for prostate, cervix and rectal cancers. The major encountered clinical pictures are rectal proctitis, rectal/anal strictures, rectal bleeding, ulcers and fistula. Some may alter the patient`s lifestyle while other may induce death. Recommendations concerning the clinical practice are described. The treatment of these late rectal effects include nutritional recommendations, laser, formalin application, and surgery. (author)

  12. Out-of-field dose measurements in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kaderka, Robert


    This thesis describes the results from measurements of the out-of-field dose in radiotherapy. The dose outside the treatment volume has been determined in a water phantom and an anthropomorphic phantom. Measurements were performed with linac photons, passively delivered protons, scanned protons, passively delivered carbon ions as well as scanned carbon ions. It was found that the use of charged particles for radiotherapy reduces the out-of-field dose by up to three orders of magnitude compared to conventional radiotherapy with photons.

  13. Acquired lymphangiectasis following surgery and radiotherapy of breast cancer

    Directory of Open Access Journals (Sweden)

    Angoori Gnaneshwar Rao


    Full Text Available Acquired lymphangiectasia (AL is a significant and rare complication of surgery and radiotherapy. We report lymphangiectasia in a 40-year-old woman who had undergone radical mastectomy and radiotherapy. After 4 years of combined therapy, she developed multiple vesicles and bullae. Skin biopsy confirmed the diagnosis of lymphangiectasia. The case is unique as it is not associated with lymphedema, which is a usual accompaniment of lymphangiectasia following surgery and radiotherapy. AL is usually asymptomatic, but trauma may cause recurrent cellulitis. Treatment modalities include electrodessication, surgical excision, sclerotherapy and carbon dioxide laser ablation.

  14. Cardiac Toxicity after definitive Radiotherapy of locally advanced NSCLC

    DEFF Research Database (Denmark)

    Schytte, Tine; Hansen, Olfred; Stohlberg-Rohr, Thomine


        Cardiac Toxicity after definitive Radiotherapy of locally advanced NSCLC Tine Schytte, Olfred Hansen, Thomine Stolberg-Rohr* and Carsten Brink*. Dept. Oncology and Radiophysic Lab.* Odense University Hospital, Denmark   Keyword: Radiotherapy, Locally advanced NSCLC, Cardiac toxicity......   Background: Lung and oesophageal toxicity have been regarded as main toxicity in definitive radiotherapy (RT) of non-small cell lung cancer (NSCLC), whereas cardiac toxicity has not been offered much concern. This is probably due to the poor prognosis for patients with unresectable NSCLC. In this study we...

  15. Antitumor efficacy of extracellular complexes with gadolinium in Binary Radiotherapy. (United States)

    Lipengolts, A A; Cherepanov, A A; Kulakov, V N; Grigorieva, E Yu; Sheino, I N; Klimanov, V A


    In this report the efficacy of extracellular pharmaceutical Gd-DTPA in Binary Radiotherapy was studied. The study was carried out in mice bearing transplantable adenocarcinoma Ca755 using X-ray based contrast enhanced radiotherapy as a practical implementation of Binary Radiotherapy. It was shown that intravenous administration of 0.3 ml of 0.5 M water solution of Gd-DTPA followed by X-irradiation at a dose of 10 Gy provides T/C%=10±3% and leads to complete tumor regression in 25% of mice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Motion management for MRI-guided abdominal radiotherapy


    Stemkens, Bjorn


    The recent introduction of hybrid MRI-linac (MRL) systems will drive a paradigm shift in radiotherapy. For the first time in history we have the ability to visualize both the tumor and surrounding healthy tissue before and during treatment in real time. The first high-field MRL, which was developed within the department of radiotherapy at the UMC Utrecht, in cooperation with Philips and Elekta, successfully treated the first patients in May 2017 at the UMC Utrecht. MR-guided radiotherapy has ...

  17. Conformal Radiotherapy: Physics, Treatment Planning and Verification. Proceedings book

    Energy Technology Data Exchange (ETDEWEB)

    De Wagter, C. [ed.


    The goal of conformal radiotherapy is to establish radiation dose distributions that conform tightly to the target volume in view of limiting radiation to normal tissues. Conformal radiotherapy significantly improves both local control and palliation and thus contributes to increase survival and to improve the quality of life. The subjects covered by the symposium include : (1) conformal radiotherapy and multi-leaf collimation; (2) three dimensional imaging; (3) treatment simulation, planning and optimization; (4) quality assurance; and (5) dosimetry. The book of proceedings contains the abstracts of the invited lectures, papers and poster presentations as well as the full papers of these contributions.

  18. Dosimetry comparison of irradiation with conformal radiotherapy, intensity modulated radiotherapy, conformal radiotherapy in stereotactic conditions and robotic stereotactic radiotherapy for benign brain tumours; Comparaison dosimetrique de la radiotherapie conformationnelle, la radiotherapie conformationnelle avec modulation d'intensite, la radiotherapie conformationnelle en conditions stereotaxiques et la radiotherapie en conditions stereotaxiques robotisee des tumeurs cerebrales benignes

    Energy Technology Data Exchange (ETDEWEB)

    Spasic, E.; Noel, A. [Departement de radiophysique, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy cedex (France); UMR 7039 CNRS, centre de recherche en automatique de Nancy (Cran), BP 239, 54506 Vandoeuvre-les-Nancy cedex (France); Cran UMR 7039, faculte des sciences et techniques, universite Henri-Poincare Nancy 1, BP 239, 54506 Vandoeuvre-les-Nancy cedex (France); Cran UMR 7039, institut national polytechnique de Lorraine, BP 239, 54506 Vandoeuvre-les-Nancy cedex (France); Buchheit, I.; Bernier, V. [Departement de radiophysique, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy cedex (France)


    Purpose. - To compare several techniques in order to determine the best treatment for benign brain tumours. Methods and patients. - A retrospective study was performed for five patients who received 3D-conformal radiotherapy, intensity modulated radiotherapy or CyberKnife{sup R}. These patients had a meningioma, a pituitary tumour, a cranio-pharyngioma or a neurinoma. In each case, these treatment plans were optimised and compared with the three other dosimetries. Radiobiological or positioning parameters were evaluated, as well as dosimetric parameters, in order to compare treatments with different characteristics. Results. - The dosimetric parameters showed that the choice of treatment seemed to be determined mostly by tumour size, shape and proximity with organs at risk (not tumour localisation). Whereas the results showed no significant deviations with regards to the radiobiological parameters. Therefore, with these parameters, it was difficult to give priority to a treatment. Conclusions. - With regards to benign brain tumours of medium or large size, intensity modulated radiotherapy seemed the recommended treatment. It enabled to obtain a good ratio between efficacy and toxicity for tumours that are really close to organs at risk. Concerning small benign brain tumours, the CyberKnife{sup R} was probably the best treatment. (authors)

  19. Peptides for radiotherapy of neuroendocrine cancers

    Energy Technology Data Exchange (ETDEWEB)

    Melendez A, L. [Facultad de Medicina, Universidad Autonoma del Estado de Mexico, Paseo Tollocan s/n esquina con Jesus Carranza, Colonia Moderna de la Cruz, Toluca, C.P. 50180 (Mexico)]. E-mail:


    During the last decade there has been a resurgence of interest in therapeutic nuclear medicine, due to the limitation of conventional or external beam radiotherapy in the treatment of secondary or metastatic cancer sites outside of the primary treatment area. Some of the human tumours that produce metastases express high levels of somatostatin receptors. In order to make possible the diagnostic and radiotherapeutic treatment of these kind of tumours, various somatostatin analogue peptides have been developed in recent years. Peptides have become an important class of radiopharmaceuticals,due to its unique ability to detect specific sites as receptors or enzymes. This paper describes the work with {sup 99m} Tc to establish the labelling and analytical conditions for a somatostatin analogue as a precursor, to undertake a therapeutic radiopharmaceutical labelled with {sup 188} Re for treatment of somatostatin receptor positive tumours. (Author)

  20. Nanoscale radiotherapy with hafnium oxide nanoparticles. (United States)

    Maggiorella, Laurence; Barouch, Gilles; Devaux, Corinne; Pottier, Agnès; Deutsch, Eric; Bourhis, Jean; Borghi, Elsa; Levy, Laurent


    There is considerable interest in approaches that could improve the therapeutic window of radiotherapy. In this study, hafnium oxide nanoparticles were designed that concentrate in tumor cells to achieve intracellular high-energy dose deposit. Conventional methods were used, implemented in different ways, to explore interactions of these high-atomic-number nanoparticles and ionizing radiation with biological systems. Using the Monte Carlo simulation, these nanoparticles, when exposed to high-energy photons, were shown to demonstrate an approximately ninefold radiation dose enhancement compared with water. Importantly, the nanoparticles show satisfactory dispersion and persistence within the tumor and they form clusters in the cytoplasm of cancer cells. Marked antitumor activity is demonstrated in human cancer models. Safety is similar in treated and control animals as demonstrated by a broad program of toxicology evaluation. These findings, supported by good tolerance, provide the basis for developing this new type of nanoparticle as a promising anticancer approach in human patients.

  1. Mammary Malignant Ulcer after Radiotherapy: Unpleasant Surprise. (United States)

    Vindigni, Vincenzo; Kohlscheen, Eva; Kraljic, Tajna; Bassetto, Franco; Pavan, Chiara


    We present a case of a woman, 79 years old, followed by Psychiatry for depressive episodes after breast cancer removal. She was operated on for ductal breast carcinoma in 1983. Afterward she was submitted to adjuvant radiotherapy. She came to our attention for a chronic skin ulcer that developed into the radio-treated area about 4 years ago. We performed a skin biopsy and programed adipose tissue grafts to promote wound healing. The result of the biopsy was unexpected: dermal localization of not differentiated breast carcinoma. She is currently under systemic chemotherapy treatment. The key message is to always perform a skin biopsy of a chronic skin ulcer developed after breast cancer removal before planning surgical reconstruction.

  2. [Radiotherapy phase I trials' methodology: Features]. (United States)

    Rivoirard, R; Vallard, A; Langrand-Escure, J; Guy, J-B; Ben Mrad, M; Yaoxiong, X; Diao, P; Méry, B; Pigne, G; Rancoule, C; Magné, N


    In clinical research, biostatistical methods allow the rigorous analysis of data collection and should be defined from the trial design to obtain the appropriate experimental approach. Thus, if the main purpose of phase I is to determine the dose to use during phase II, methodology should be finely adjusted to experimental treatment(s). Today, the methodology for chemotherapy and targeted therapy is well known. For radiotherapy and chemoradiotherapy phase I trials, the primary endpoint must reflect both effectiveness and potential treatment toxicities. Methodology should probably be complex to limit failures in the following phases. However, there are very few data about methodology design in the literature. The present study focuses on these particular trials and their characteristics. It should help to raise existing methodological patterns shortcomings in order to propose new and better-suited designs. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  3. TOPICAL REVIEW: Anatomical imaging for radiotherapy (United States)

    Evans, Philip M.


    The goal of radiation therapy is to achieve maximal therapeutic benefit expressed in terms of a high probability of local control of disease with minimal side effects. Physically this often equates to the delivery of a high dose of radiation to the tumour or target region whilst maintaining an acceptably low dose to other tissues, particularly those adjacent to the target. Techniques such as intensity modulated radiotherapy (IMRT), stereotactic radiosurgery and computer planned brachytherapy provide the means to calculate the radiation dose delivery to achieve the desired dose distribution. Imaging is an essential tool in all state of the art planning and delivery techniques: (i) to enable planning of the desired treatment, (ii) to verify the treatment is delivered as planned and (iii) to follow-up treatment outcome to monitor that the treatment has had the desired effect. Clinical imaging techniques can be loosely classified into anatomic methods which measure the basic physical characteristics of tissue such as their density and biological imaging techniques which measure functional characteristics such as metabolism. In this review we consider anatomical imaging techniques. Biological imaging is considered in another article. Anatomical imaging is generally used for goals (i) and (ii) above. Computed tomography (CT) has been the mainstay of anatomical treatment planning for many years, enabling some delineation of soft tissue as well as radiation attenuation estimation for dose prediction. Magnetic resonance imaging is fast becoming widespread alongside CT, enabling superior soft-tissue visualization. Traditionally scanning for treatment planning has relied on the use of a single snapshot scan. Recent years have seen the development of techniques such as 4D CT and adaptive radiotherapy (ART). In 4D CT raw data are encoded with phase information and reconstructed to yield a set of scans detailing motion through the breathing, or cardiac, cycle. In ART a set of

  4. Radiotherapy for metastatic fibrolamellar hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Justin G. Peacock


    Full Text Available Fibrolamellar hepatocellular carcinoma (FLHCC is a rare variant of hepatocellular carcinoma (HCC that commonly affects young individuals without a prior history of liver disease. FLHCC commonly results in a better prognosis than HCC; however, the risk of recurrence and metastatic disease is high. FLHCC is typically treated by primary resection of the tumor with 50-75% cure rates. The use of radiation therapy in FLHCC has not been assessed on its own, and may show some success in a very few reported combination therapy cases. We report on the successful use of radiation therapy in a case of metastatic FLHCC to the lung following primary and secondary resections. Our treatment of the large, metastatic, pulmonary FLHCC tumor with 40 Gy in 10 fractions resulted in an 85.9% tumor volume decrease over six months. This suggests FLHCC may be a radiosensitive tumor and radiotherapy may be valuable in unresectable or metastatic tumors.

  5. Retinal angiomatous proliferation occurring after radiotherapy. (United States)

    De Salvo, G; Hannan, S R; James, N; Lotery, A J


    To describe two cases of retinal angiomatous proliferation (RAP)-like lesion following radiation therapy for primary tumor. Retrospective evaluation of two patients with previous irradiation treatment for a pleomorphic adenoma of the lacrimal gland and a vocal cord carcinoma, respectively. Visual acuity (VA), fluorescein angiography and optical coherence tomography were performed and demonstrated a RAP-like lesion in both cases. Treatment with intravitreal injections of Ranibizumab was performed with a follow-up of 19 and 10 months, respectively. Both the patients had a positive response to the treatment with improvement in VA and reduction of intraretinal fluid. RAP-like lesions can develop following radiation treatment for a primary tumor. In patients presenting with idiopathic RAP, a history of prior radiotherapy should be considered.

  6. Radiotherapy in the Era of Precision Medicine. (United States)

    Yard, Brian; Chie, Eui Kyu; Adams, Drew J; Peacock, Craig; Abazeed, Mohamed E


    Current predictors of radiation response are largely limited to clinical and histopathologic parameters, and extensive systematic analyses of the correlation between radiation sensitivity and genomic parameters remain lacking. In the era of precision medicine, the lack of -omic determinants of radiation response has hindered the personalization of radiation delivery to the unique characteristics of each patient׳s cancer and impeded the discovery of new therapies that can be administered concurrently with radiation therapy. The cataloging of the -omic determinants of radiation sensitivity of cancer has great potential in enhancing efficacy and limiting toxicity in the context of a new approach to precision radiotherapy. Herein, we review concepts and data that contribute to the delineation of the radiogenomic landscape of cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. The future of heavy ion radiotherapy. (United States)

    Jäkel, Oliver; Karger, Christian P; Debus, Jürgen


    Currently, there is an increasing interest in heavy ion radiotherapy (RT) and a number of new facilities are being installed in Europe and Japan. This development is accompanied by intensive technical, physical, and clinical research. The authors identify six research fields where progress is likely and propose a thesis on the expected achievements for each of the fields: (1) Synchrotrons with active energy variation and three-dimensional beam scanning will be the standard in ion beam RT. (2) Common standards for precise measurement, prescription, and reporting of dose will be available. (3) Intensity-modulated particle therapy will be state-of-the-art. (4) Time-adaptive treatments of moving targets will be feasible. (5) Therapeutic effectiveness of heavy ions will be known for the most important indications while cost effectiveness will remain to be shown. (6) The potential of high-linear energy transfer radiation will be known. The rationale for each of these theses is described.

  8. High-LET charged particle radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Castro, J.R. (Lawrence Berkeley Lab., CA (United States). Research Medicine and Radiation Biophysics Div. California Univ., San Francisco, CA (United States). Dept. of Radiation Oncology)


    The Department of Radiation Oncology at UCSF Medical Center and the Radiation Oncology Department at UC Lawrence Berkeley Laboratory have been evaluating the use of high LET charged particle radiotherapy in a Phase 1--2 research trial ongoing since 1979. In this clinical trail, 239 patients have received at least 10 Gy (physical) minimum tumor dose with neon ions, meaning that at least one-half of their total treatment was given with high-LET charged particle therapy. Ninety-one patients received all of their therapy with neon ions. Of the 239 patients irradiated, target sites included lesions in the skin, subcutaneous tissues, head and neck such as paranasal sinuses, nasopharynx and salivary glands (major and minor), skull base and juxtaspinal area, GI tract including esophagus, pancreas and biliary tract, prostate, lung, soft tissue and bone. Analysis of these patients has been carried out with a minimum followup period of 2 years.

  9. Magnetic Resonance Imaging in Postprostatectomy Radiotherapy Planning

    Energy Technology Data Exchange (ETDEWEB)

    Sefrova, Jana, E-mail: [Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Odrazka, Karel [Department of Clinical and Radiation Oncology, Multiscan and Pardubice Regional Hospital, Pardubice (Czech Republic); First and Third Faculty of Medicine, Charles University in Prague, Prague (Czech Republic); Paluska, Petr [Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Belobradek, Zdenek [Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Brodak, Milos [Department of Urology, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Dolezel, Martin [Department of Clinical and Radiation Oncology, Multiscan and Pardubice Regional Hospital, Pardubice (Czech Republic); First and Third Faculty of Medicine, Charles University in Prague, Prague (Czech Republic); Prosvic, Petr [Department of Urology, Regional Hospital Nachod, Nachod (Czech Republic); Macingova, Zuzana; Vosmik, Milan [Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Hoffmann, Petr [Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Louda, Miroslav [Department of Urology, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic); Nejedla, Anna [Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove (Czech Republic)


    Purpose: To investigate whether the use of magnetic resonance imaging (MRI) in prostate bed treatment planning could influence definition of the clinical target volume (CTV) and organs at risk. Methods and Materials: A total of 21 consecutive patients referred for prostate bed radiotherapy were included in the present retrospective study. The CTV was delineated according to the European Organization for Research and Treatment of Cancer recommendations on computed tomography (CT) and T{sub 1}-weighted (T{sub 1}w) and T{sub 2}-weighted (T{sub 2}w) MRI. The CTV magnitude, agreement, and spatial differences were evaluated on the planning CT scan after registration with the MRI scans. Results: The CTV was significantly reduced on the T{sub 1}w and T{sub 2}w MRI scans (13% and 9%, respectively) compared with the CT scans. The urinary bladder was drawn smaller on the CT scans and the rectum was smaller on the MRI scans. On T{sub 1}w MRI, the rectum and urinary bladder were delineated larger than on T{sub 2}w MRI. Minimal agreement was observed between the CT and T{sub 2}w images. The main spatial differences were measured in the superior and superolateral directions in which the CTV on the MRI scans was 1.8-2.9 mm smaller. In the posterior and inferior border, no difference was seen between the CT and T{sub 1}w MRI scans. On the T{sub 2}w MRI scans, the CTV was larger in these directions (by 1.3 and 1.7 mm, respectively). Conclusions: The use of MRI in postprostatectomy radiotherapy planning resulted in a reduction of the CTV. The main differences were found in the superior part of the prostate bed. We believe T{sub 2}w MRI enables more precise definition of prostate bed CTV than conventional planning CT.

  10. Targeted Radiotherapy of Estrogen Receptor Positive Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Raghavan Rajagopalan


    The overall objectives of the proposal were to develop estrogen receptor (ER) binding small molecule radiopharmaceuticals for targeted radiotherapy of ER positive (ER+) tumors. In particular, this proposal focused on embedding a {sup 186,188}Re or a {sup 32}P radionuclide into an estrogen steroidal framework by isosteric substitution such that the resulting structure is topologically similar to the estrogen (estrogen mimic). The estrogen mimic molecules expected to bind to the ER and exhibit biodistribution akin to that of native estrogen due to structural mimicry. It is anticipated that the {sup 186,188}Re- or a {sup 32}P-containing estrogen mimics will be useful for targeted molecular radiotherapy of ER+ tumors. It is well established that the in vivo target tissue uptake of estrogen like steroidal molecules is related to the binding of the steroids to sex hormone binding globulin (SHBG). SHBG is important in the uptake of estrogens and testosterone in target tissues by SHBG receptors on the cell surface. However, hitherto the design of estrogen like small molecule radiopharmaceuticals was focused on optimizing ER binding characteristics without emphasis on SHBG binding properties. Consequently, even the molecules with good ER affinity in vitro, performed poorly in biodistribution studies. Based on molecular modeling studies the proposal focused on developing estrogen mimics 1-3 which were topologically similar to native estrogens, and form hydrogen bonds in ER and SHBG in the same manner as those of native estrogens. To this end the technical objectives of the proposal focused on synthesizing the rhenium-estrone and estradiol mimics 1 and 2 respectively, and phosphorous estradiol mimic 3 and to assess their stability and in vitro binding characteristics to ER and SHBG.

  11. Trajectory optimization in radiotherapy using sectioning (TORUS). (United States)

    Locke, Christopher Barry; Bush, Karl Kenneth


    A challenging problem in trajectory optimization for radiotherapy is properly handling the synchronization of the medical accelerators dynamic delivery. The initial coarse sampling of control points implemented in a Progressive Resolution Optimization type approach (VMAT) routinely results in MLC aperture forming contention issues as the sampling resolution increases. This work presents an approach to optimize continuous, beam-on radiation trajectories through exploration of the anatomical topology present in the patient and formation of a novel dual-metric graph optimization problem. This work presents a new perspective on trajectory optimization in radiotherapy using the concept of sectioning (TORUS). TORUS avoids degradation of 3D dose optimization quality by mapping the connectedness of target regions from the BEV perspective throughout the space of deliverable coordinates. This connectedness information is then incorporated into a graph optimization problem to define ideal trajectories. The unique usage of two distance functions in this graph optimization permits the TORUS algorithm to generate efficient dynamic trajectories for delivery while maximizing the angular flux through all PTV voxels. 3D dose optimization is performed for trajectories using a commercial TPS progressive resolution optimizer. The TORUS algorithm is applied to three example treatments: chest wall, scalp, and the TG-119 C-shape phantom. When static collimator coplanar trajectories are generated for the chest wall and scalp cases, the TORUS trajectories are found to outperform both 7 field IMRT and 2 arc VMAT plans in delivery time, organ at risk sparing, conformality, and homogeneity. For the TG-119 phantom, when static couch and collimator non-coplanar trajectories are optimized, TORUS trajectories have superior sparing of the central core avoidance with shorter delivery times, with similar dose conformality and homogeneity. The TORUS algorithm is able to automatically generate

  12. Superselective arterial infusion and concomitant radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Homma, Akihiro; Suzuki, Fumiyuki; Inuyama, Yukio; Fukuda, Satoshi [Hokkaido Univ., Sapporo (Japan). School of Medicine


    Superselective arterial infusion for patients with advanced head and neck cancer has been increasingly applied in Japan. We analyzed our experiences and evaluated the efficacy and safety of this treatment. Through October 1999 to March 2002, 29 patients, ranging in age between 33 and 71 years (median 52 years), received superselective intra-arterial infusion therapy of cisplatin (100-120 mg/m{sup 2}/week) with simultaneous intravenous infusion of thiosulfate for neutralizing cisplatin toxicity, and conventional concomitant extrabeam radiotherapy (65 Gy/26 f/6.5 weeks). Four patients were diagnosed with stage III and 25 with stage IV. Thirteen patients were considered contraindicated for surgery, and the other 16 patients rejected radical surgery. Primary tumor sites included paranasal sinus (11 patients), hypopharynx (7), oropharynx (6), oral cavity (4), and parotid gland (1). During the median follow-up period of 20 months, there was no apparent recurrence in 14 (48.3%) of 29 patients. Eleven (37.9%) patients died of disease, and three (10.3%) were alive with disease. In twenty-one patients (72.4%) the primary lesions were well-controlled. Acute toxic effects were moderate, and severe toxic events occurred in four cases, namely, methicillin-resistant staphylococcus aureus (MRSA) pneumonia, sepsis, tetraplasia, and osteoradionecrosis. We confirmed the effectiveness and safety of superselective arterial infusion and concomitant radiotherapy. Furthermore, we must establish the optimal procedures and schedule, as well as the indications for this treatment. This treatment protocol may improve the prognosis of patients with unresectable disease and patients rejecting surgical treatment. Further study in this particular area is needed. (author)

  13. Can automation in radiotherapy reduce costs? (United States)

    Massaccesi, Mariangela; Corti, Michele; Azario, Luigi; Balducci, Mario; Ferro, Milena; Mantini, Giovanna; Mattiucci, Gian Carlo; Valentini, Vincenzo


    Computerized automation is likely to play an increasingly important role in radiotherapy. The objective of this study was to report the results of the first part of a program to implement a model for economical evaluation based on micro-costing method. To test the efficacy of the model, the financial impact of the introduction of an automation tool was estimated. A single- and multi-center validation of the model by a prospective collection of data is planned as the second step of the program. The model was implemented by using an interactive spreadsheet (Microsoft Excel, 2010). The variables to be included were identified across three components: productivity, staff, and equipment. To calculate staff requirements, the workflow of Gemelli ART center was mapped out and relevant workload measures were defined. Profit and loss, productivity and staffing were identified as significant outcomes. Results were presented in terms of earnings before interest and taxes (EBIT). Three different scenarios were hypothesized: baseline situation at Gemelli ART (scenario 1); reduction by 2 minutes of the average duration of treatment fractions (scenario 2); and increased incidence of advanced treatment modalities (scenario 3). By using the model, predicted EBIT values for each scenario were calculated across a period of eight years (from 2015 to 2022). For both scenarios 2 and 3 costs are expected to slightly increase as compared to baseline situation that is particularly due to a little increase in clinical personnel costs. However, in both cases EBIT values are more favorable than baseline situation (EBIT values: scenario 1, 27%, scenario 2, 30%, scenario 3, 28% of revenues). A model based on a micro-costing method was able to estimate the financial consequences of the introduction of an automation tool in our radiotherapy department. A prospective collection of data at Gemelli ART and in a consortium of centers is currently under way to prospectively validate the model.

  14. Surveillance after prostate cancer radiotherapy; Suivi apres la radiotherapie des cancers de la prostate: bases scientifiques, rapport cout-benefice

    Energy Technology Data Exchange (ETDEWEB)

    Supiot, S.; Rio, E.; Clement-Colmou, K. [Service de radiotherapie, institut de cancerologie de l' Ouest Rene-Gauducheau, boulevard Jacques-Monod, 44805 Nantes-Saint-Herblain (France); Bouchot, O.; Rigaud, J. [Service d' urologie, CHU Hotel-Dieu, place Alexis-Ricordeau, 44000 Nantes (France)


    Follow-up after prostate cancer radiotherapy aims at detecting local or metastatic relapse, as well as long-term toxicity, requiring adapted treatments. Several scientific societies have published guidelines including clinical, biological and imaging recommendations. More data suggest a role for aggressive salvage therapy in case of local failure following radiotherapy. An adequate follow-up is required for the sake of patients' safety, i.e. to a posteriori validate dose constraints and radiation technique in each radiotherapy department. (authors)

  15. Fractionated stereotactically guided radiotherapy for pharmacoresistant epilepsy; Fraktionierte, stereotaktisch gefuehrte Radiotherapie der pharmakoresistenten Epilepsie

    Energy Technology Data Exchange (ETDEWEB)

    Grabenbauer, G.G.; Reinhold, C.; Lambrecht, U.; Sauer, R. [Klinik und Poliklinik fuer Strahlentherapie, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Kerling, F.; Pauli, E.; Stefan, H. [Neurologische Klinik, Abt. Epileptologie, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Mueller, R.G. [Inst. fuer Medizinische Physik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany); Ganslandt, O. [Neurochirurgische Klinik, Friedrich-Alexander-Univ. Erlangen-Nuernberg, Erlangen (Germany)


    Aim: This prospective study evaluated the efficiency of fractionated stereotactically guided radiotherapy as a treatment of pharmacoresistant temporal lobe epilepsy. Patients and Methods: Inclusion criteria were patients aged between 17 and 65 years with one-sided temporally located focus, without sufficient epilepsy control by, antiepileptic drugs or neurosurgery. Between 1997 and 1999, two groups of six patients each were treated with 21 Gy (7 times 3 Gy) and 30 Gy (15 times 2 Gy). Study end points were seizure frequency, intensity, seizure length and neuropsychological parameters. Results: All patients experienced a marked reduction in seizure frequency. The mean reduction of seizures was 37% (range 9-77%, i.e. seizures reduced from a monthly mean number of 11.75 to 7.52) at 18 months following radiation treatment and 46% (23-94%, i.e. 0.2-23 seizures per month) during the whole follow-up time. Seizure length was reduced in five out of eleven patients and intensity of seizures in seven out of eleven patients. Conclusion: Radiotherapy was identified as safe and effective for pharmacoresistant epilepsy since a very good reduction of seizure frequency was observed. It is no substitute for regular use of antiepileptic drugs, but means an appropriate alternative for patients with contraindication against neurosurgery or insufficient seizure reduction after neurosurgery. (orig.) [German] Ziel: Diese prospektive Studie untersuchte die Effizienz einer fraktionierten stereotaktischen Radiotherapie (RT) bei therapieresistenter Temporallappenepilepsie. Patienten und Methoden: Einschlusskriterien waren Patienten im Alter von 17 bis 65 Jahren, die weder medikamentoes noch epilepsiechirurgisch anfallsfrei wurden und einen einseitigen Fokus aufwiesen. Zwei Patientenkohorten zu je sechs Patienten wurden zwischen 1997 und 1999 einer fraktionierten, stereotaktisch gefuehrten Radiotherapie mit 21 Gy (7 x 3 Gy) bzw. 30 Gy (15 x 2 Gy) unterzogen. Endpunkte der Untersuchung waren

  16. Role of interim {sup 18}F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Cremonesi, Marta; Garibaldi, Cristina [European Institute of Oncology, Radiation Research Unit, Milano (Italy); Gilardi, Laura; Travaini, Laura Lavinia; Grana, Chiara Maria [European Institute of Oncology, Division of Nuclear Medicine, Milano (Italy); Ferrari, Mahila Esmeralda; Botta, Francesca [Medical Physics Unit, European Institute of Oncology, Milano (Italy); Piperno, Gaia; Ronchi, Sara; Ciardo, Delia [European Institute of Oncology, Division of Radiation Oncology, Milano (Italy); Timmerman, Robert [University of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX (United States); Baroni, Guido [Politecnico di Milano University, Department of Electronics, Information and Bioengineering, Milano (Italy); Jereczek-Fossa, Barbara Alicja [European Institute of Oncology, Division of Radiation Oncology, Milano (Italy); University of Milan, Department of Oncology and Hemato-Oncology, Milano (Italy); Orecchia, Roberto [University of Milan, Department of Oncology and Hemato-Oncology, Milano (Italy); European Institute of Oncology, Department of Medical Imaging and Radiation Sciences, Milano (Italy)


    Non-Small Cell Lung Cancer (NSCLC) is characterized by aggressiveness and includes the majority of thorax malignancies. The possibility of early stratification of patients as responsive and non-responsive to radiotherapy with a non-invasive method is extremely appealing. The distribution of the Fluorodeoxyglucose ({sup 18}F-FDG) in tumours, provided by Positron-Emission-Tomography (PET) images, has been proved to be useful to assess the initial staging of the disease, recurrence, and response to chemotherapy and chemo-radiotherapy (CRT). In the last years, particular efforts have been focused on the possibility of using ad interim {sup 18}F-FDG PET (FDG{sub int}) to evaluate response already in the course of radiotherapy. However, controversial findings have been reported for various malignancies, although several results would support the use of FDG{sub int} for individual therapeutic decisions, at least in some pathologies. The objective of the present review is to assemble comprehensively the literature concerning NSCLC, to evaluate where and whether FDG{sub int} may offer predictive potential. Several searches were completed on Medline and the Embase database, combining different keywords. Original papers published in the English language from 2005 to 2016 with studies involving FDG{sub int} in patients affected by NSCLC and treated with radiation therapy or chemo-radiotherapy only were chosen. Twenty-one studies out of 970 in Pubmed and 1256 in Embase were selected, reporting on 627 patients. Certainly, the lack of univocal PET parameters was identified as a major drawback, while standardization would be required for best practice. In any case, all these papers denoted FDG{sub int} as promising and a challenging examination for early assessment of outcomes during CRT, sustaining its predictivity in lung cancer. (orig.)

  17. Language Comprehension as Structure Building (United States)


    G CO O MP R EHEO N N A SC N ESTR ANCTU RE LD I G G - A F S - - 5 Dr ~ ~ ~ ~ ~ ~ ~ P Alre R2rg313NY EOT UU AFOAS-/A4 Brorting AB DC 20332/644 7...language comprehension, and in particular, the general, cognitive processes and mechanisms that underlie language comprehension. These general...views language comprehension and production as drawing on general, cognitive processes and mechanisms. Such processes and mechanisms also underlie

  18. Doses to organs at cerebral risks: optimization by robotized stereotaxic radiotherapy and automatic segmentation atlas versus three dimensional conformal radiotherapy; Doses aux organes a risque cerebraux: optimisation par radiotherapie stereotaxique robotisee et atlas de segmentation automatique versus radiotherapie conformationnelle tridimensionnelle

    Energy Technology Data Exchange (ETDEWEB)

    Bondiau, P.Y.; Thariat, J.; Benezery, K.; Herault, J.; Dalmasso, C.; Marcie, S. [Centre Antoine-Lacassagne, 06 - Nice (France); Malandain, G. [Institut National de Recherche en Informatique et en Automatique (INRIA), Sophia-Antipolis, 06 - Nice (France)


    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.)

  19. Monitoring and blunting in palliative and curative radiotherapy consultations.

    NARCIS (Netherlands)

    Timmermans, L.; Zuuren, F.J. van; Maazen, R.W.M. van der; Leer, J.W.H.; Kraaimaat, F.W.


    OBJECTIVE: The present research paper investigates how cancer patients' monitoring and blunting coping styles are reflected in their communications during their initial radiotherapy consultations and in their evaluations of the consultation. Additionally, it is explored how a patient's disease

  20. Automated Image-Based Procedures for Adaptive Radiotherapy

    DEFF Research Database (Denmark)

    Bjerre, Troels

    Fractionated radiotherapy for cancer treatment is a field of constant innovation. Developments in dose delivery techniques have made it possible to precisely direct ionizing radiation at complicated targets. In order to further increase tumour control probability (TCP) and decrease normal...... to encourage bone rigidity and local tissue volume change only in the gross tumour volume and the lungs. This is highly relevant in adaptive radiotherapy when modelling significant tumour volume changes. - It is described how cone beam CT reconstruction can be modelled as a deformation of a planning CT scan...... be employed for contour propagation in adaptive radiotherapy. - MRI-radiotherapy devices have the potential to offer near real-time intrafraction imaging without any additional ionising radiation. It is detailed how the use of multiple, orthogonal slices can form the basis for reliable 3D soft tissue tracking....

  1. Chamomile Mouth Rinse Effects on Mucositis Reduction After Radiotherapy

    Directory of Open Access Journals (Sweden)

    Talaipour AR


    Full Text Available In recent years many patients have been received radiotherapy for head and neck tumors and"na large number of them have been survived for some years."nThe side effects of radiotherapy in oral region are mucositis, ulcers, fungal and viral infections and"nsalivary glands dysfunction. Among these, mucositis is the most important one."nA randomized double blind clinical trial was performed in radiotherapy department of Tehran Imam"nKhomeini Hospital to determine chamomile mouth rinse effects on mucositis after radiotherapy."nThe patients are selected randomly from those with oral oropharyngeal or nasopharyngeal cancers."nData showed that chamomile administration could decrease mucositis rate significantly,

  2. Saliva in relation to dental erosion before and after radiotherapy

    DEFF Research Database (Denmark)

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


    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...... rates ∼ 17-fold before as well as after radiotherapy (p radiotherapy. Also, saliva became more under-saturated with respect to HAp during (p

  3. Effects of Yifukang Oral Liquid on Chemotherapy- and Radiotherapy ...

    African Journals Online (AJOL)

    Purpose: To investigate the effects of Yifukang oral liquid (YFKOL) on chemotherapy- and radiotherapy-induced myelosuppression, leucopenia and gastrointestinal tract disturbances. Methods: The effects of YFKOL on myelosuppression, leucopenia and gastrointestinal tract disturbances were assessed by ...

  4. Molecular Imaging and Radiotherapy: Theranostics for Personalized Patient Management


    Irina Velikyan


    This theme issue presents current achievements in the development of radioactive agents, pre-clinical and clinical molecular imaging, and radiotherapy in the context of theranostics in the field of oncology.

  5. Nuclear medicine imaging to predict response to radiotherapy: a review.

    NARCIS (Netherlands)

    Wiele, C. van de; Lahorte, C.; Oyen, W.J.G.; Boerman, O.C.; Goethals, I.; Slegers, G.; Dierckx, R.A.


    PURPOSE: To review available literature on positron emission tomography (PET) and single photon emission computerized tomography (SPECT) for the measurement of tumor metabolism, hypoxia, growth factor receptor expression, and apoptosis as predictors of response to radiotherapy. METHODS AND

  6. History of the development of radiotherapy in Latin America. (United States)

    Pinillos, Luis; Pinto, Joseph A; Sarria, Gustavo


    Radiotherapy was the first nonsurgical treatment for malignant tumours and represents one of the oldest disciplines of oncology. In Latin America, as in many parts of the world, the history of modern oncology begins with the implementation of radiation therapy facilities. The development of radiotherapy in Latin America was possible thanks to the seminal work of radiation oncologists in different countries. As a large territory, there is a need to implement modern facilities and equipment, but unfortunately there are disparities in the access and quality of radiotherapy services across Latin America and even within individual countries. In this review, we describe the history, challenges and success in the implementation of radiotherapy and the frustration caused by the lack of facilities in several Latin American countries.

  7. Histopathological changes in dental pulp of rats following radiotherapy

    Directory of Open Access Journals (Sweden)

    Zahra Sadat Madani


    Conclusion: Radiotherapy with doses of 12 and 18 Gy had no significant effect on inflammation, necrosis, and hyalinization in all groups; however, the difference was significant for vascular congestion.

  8. Prosody and language comprehension. (United States)

    Dahan, Delphine


    This review provides a summary of the most recent advances on the study of how prosody is used during language comprehension. Prosody is characterized as an abstract structure composed of discrete tonal elements aligned with the segmental composition of the sentence organized in constituents of increasing size, and this structure is influenced by the phonological, syntactic, and informational structures of the sentence. Here, we discuss evidence that listeners are affected by prosody when establishing those linguistic structures. Prosody has been shown to influence the segmentation of the utterance into syllables and words, and, in some cases, whether a syllable or word is judged to be present or not. The literature on how prosody informs the structural relationship between words and phrases is also discussed, contrasting views that assume a direct (albeit probabilistic) link between syntax and prosody with those that posit a complex interface between syntax and prosodic structure. Finally, the role of prosody in conveying important aspects pertaining to the sentence's information structure (i.e., which parts of the sentence's meaning are highlighted and brought forward to the discourse, which ones are presupposed and left in the background, which attitudes are being conveyed about the concepts or propositional content) has long been recognized. Current research focuses on which prosodic elements contribute to marking the dimensions (or semantic primitives) of the information structure. © 2015 Wiley Periodicals, Inc.

  9. Comprehensive facilities plan

    Energy Technology Data Exchange (ETDEWEB)



    The Ernest Orlando Lawrence Berkeley National Laboratory`s Comprehensive Facilities Plan (CFP) document provides analysis and policy guidance for the effective use and orderly future development of land and capital assets at the Berkeley Lab site. The CFP directly supports Berkeley Lab`s role as a multiprogram national laboratory operated by the University of California (UC) for the Department of Energy (DOE). The CFP is revised annually on Berkeley Lab`s Facilities Planning Website. Major revisions are consistent with DOE policy and review guidance. Facilities planing is motivated by the need to develop facilities for DOE programmatic needs; to maintain, replace and rehabilitate existing obsolete facilities; to identify sites for anticipated programmatic growth; and to establish a planning framework in recognition of site amenities and the surrounding community. The CFP presents a concise expression of the policy for the future physical development of the Laboratory, based upon anticipated operational needs of research programs and the environmental setting. It is a product of the ongoing planning processes and is a dynamic information source.

  10. The 2001 Comprehensive Review

    CERN Multimedia

    Åkesson, T

    A new approach for CERN to monitor the LHC-experiments' technical and scientific progress was introduced last year: The Comprehensive Reviews. A significant fraction of the full LHCC committee is mobilized during two days to review the complete project status. This event took place for ATLAS during 2-3 of July this year. With a rather exhaustive program we presented our status in 39 talks. It was a demanding and close to impossible task for the referees to comprehend the ATLAS status by listening to this massive amount of information, but from the ATLAS point-of-view we judged it important that the referees were exposed to both the progress and the remaining problem areas. The referees were satisfied with our status; probably more so this year than last year. They judged the main critical issues to be: The schedules of the barrel toroid, the end-cap TRT, the LAr barrel and end-cap A, and the MDTs. The procurement of radiation hard electronics was also thought to be a critical issue. They were informed of ...

  11. Comprehensive test ban negotiations (United States)

    Grab, G. Allen; Heckrotte, Warren


    Although it has been a stated policy goal of American and Soviet leaders since 1958 (with the exception of Ronald Reagan), the world today is still without a Comprehensive Test Ban Treaty. Throughout their history, test an negotiatins have been plagued by a number of persistent problems. Chief among these is East-West differences on the verification question, with the United States concerned about the problem of possible Soviet cheating and the USSR concerned about the protection of its national sovereignty. In addition, internal bureaucratic politics have played a major role in preventing the successful conclusion of an agreement. Despite these problems, the superpowers have concluded several significant partial meausres: a brief (1958-1961) total moratorium on nuclear weapons tests; the Limited Test Ban Treaty of 1963, banning tests in the air, water and outer space; the Threshold Test Ban Treaty of 1974 (150 KT limit on underground explosions); and the Peaceful Nuclear Explosions Treaty of 1976 (150 KT limit on individal PNEs). Today, the main U.S. objections to a CTBT center is the nuclear weapons laboratories, the Department of Energy, and the Pentagon, who all stress the issues of stockpile reliability and verification. Those who remain committed to a CTBT emphasize and the potential political leverage it offers in checking both horizontal and vertical proliferation.

  12. Comprehensive eye evaluation algorithm (United States)

    Agurto, C.; Nemeth, S.; Zamora, G.; Vahtel, M.; Soliz, P.; Barriga, S.


    In recent years, several research groups have developed automatic algorithms to detect diabetic retinopathy (DR) in individuals with diabetes (DM), using digital retinal images. Studies have indicated that diabetics have 1.5 times the annual risk of developing primary open angle glaucoma (POAG) as do people without DM. Moreover, DM patients have 1.8 times the risk for age-related macular degeneration (AMD). Although numerous investigators are developing automatic DR detection algorithms, there have been few successful efforts to create an automatic algorithm that can detect other ocular diseases, such as POAG and AMD. Consequently, our aim in the current study was to develop a comprehensive eye evaluation algorithm that not only detects DR in retinal images, but also automatically identifies glaucoma suspects and AMD by integrating other personal medical information with the retinal features. The proposed system is fully automatic and provides the likelihood of each of the three eye disease. The system was evaluated in two datasets of 104 and 88 diabetic cases. For each eye, we used two non-mydriatic digital color fundus photographs (macula and optic disc centered) and, when available, information about age, duration of diabetes, cataracts, hypertension, gender, and laboratory data. Our results show that the combination of multimodal features can increase the AUC by up to 5%, 7%, and 8% in the detection of AMD, DR, and glaucoma respectively. Marked improvement was achieved when laboratory results were combined with retinal image features.

  13. Postoperative (Chemo)Radiotherapy for Oral Cavity Squamous Cell Carcinomas: Outcomes and Patterns of Failure. (United States)

    Metcalfe, E; Aspin, L; Speight, R; Ermiş, E; Ramasamy, S; Cardale, K; Dyker, K E; Sen, M; Prestwich, R J D


    To determine outcomes after adjuvant radiotherapy for squamous cell carcinoma of the oral cavity and to correlate locoregional recurrence patterns with radiotherapy target volumes. All patients receiving adjuvant radiotherapy±chemotherapy after surgery with curative intent for oral cavity squamous cell carcinoma between 2007 and 2012 were retrospectively analysed. Locoregional recurrences were reconstructed on the planning computed tomography scan by both deformable image co-registration and by visual assessment. Recurrences were categorised as in-field, marginal or out-of-field if >95%, 20-95%, and Oral cavity subsites included oral tongue (54%) and floor of mouth (32%). Thirty (28%) patients received concurrent chemotherapy. Fifty-five (52%) patients received bilateral neck radiotherapy. Two year overall, disease-free, local disease-free, regional disease-free and distant metastases-free survival were 72, 83, 92, 89, 94%, respectively. On multivariate analysis, extracapsular nodal spread was the only factor significantly associated with inferior overall survival. Fourteen (13%) patients have experienced locoregional failure. Of the eight local recurrences at the primary tumour site, four, three and one were classified as in-field, marginal and out-of-field, respectively. Of 10 regional recurrences, one, one and eight were in-field, marginal and out-of-field. There were 7/21 (33%) contralateral regional recurrences in patients with pN2a/b disease who did not receive contralateral neck irradiation; there were 0/21 (0%) and 0/9 (0%) contralateral regional recurrences in patients with pN0 or pN1 disease, respectively, who did not receive contralateral neck irradiation. Marginal recurrences highlight the need for generous target volume delineation. Based upon rates of contralateral regional recurrences, a comprehensive approach to target volume selection should be advised for tumour subsites with bilateral lymphatic drainage in the presence of pN2a/b disease

  14. SITE COMPREHENSIVE LISTING (CERCLIS) (Superfund) (United States)

    U.S. Environmental Protection Agency — The Comprehensive Environmental Response, Compensation and Liability Information System (CERCLIS) (Superfund) Public Access Database contains a selected set of...

  15. Blood Test: Comprehensive Metabolic Panel (CMP) (United States)

    ... Voice in Health Care Decisions Blood Test: Comprehensive Metabolic Panel (CMP) KidsHealth > For Parents > Blood Test: Comprehensive Metabolic Panel ( ... or kidneys) is working. What Is a Comprehensive Metabolic Panel (CMP)? The comprehensive metabolic panel (CMP) is a ...

  16. Factors associated with refusal of radiotherapy among oral cancer patients

    Directory of Open Access Journals (Sweden)

    Agaku IT


    Full Text Available Background: Surgery is commonly favored in the management of oral cancer but radiotherapy may be essential because of the size or location of the tumor. Refusal of radiotherapy by patients is an important issue, which must be taken into consideration during treatment planning. This study assessed prevalence and correlates of radiotherapy refusal among oral cancer patients. Methods: Data was analyzed for 47, 174 oral cancer cases in the Surveillance, Epidemiology and End Results (SEER database during 1988–2008. Point estimates were calculated overall and by selected socio-demographic and clinical characteristics. A multivariate logistic regression model was fitted to determine predictors of radiotherapy refusal. Results: The overall prevalence of refusal of radiotherapy was 2.31%. Factors associated with increased likelihood of refusal of radiotherapy included age ± 45 years (adjusted odds ratio, aOR=2.48; P=0.031; gingival/floor of mouth tumors (aOR=1.32; P=0.010; receipt of surgery (aOR=1.21; P=0.04. Conversely, protective factors included being married (aOR=0.59; P<0.001; non-Hispanic blacks (aOR=0.53; P=0.001; involvement of paired structures (aOR=0.61; P<0.001 as well as multiple tumors (aOR=0.75; P=0.021. Sex was not a significant predictor on multivariate analysis. Conclusion: Prevalence of refusal of radiotherapy among oral cancer patients is relatively low and is significantly associated with age, marital status, as well as location, extent and severity of disease. Clinicians may anticipate patients likely to refuse radiotherapy and develop patient-tailored counseling considering the benefits and risks of proposed treatment. Final treatment decision must however take into consideration the wishes of the fully informed patient.

  17. Atypical acute reaction associated with radiotherapy. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Akamansu, M.; Erel, A. [Gazi Univ., Ankara (Turkey). Faculty of Medicine


    Radiation therapy may cause acute and/or chronic skin reactions. In this paper a patient with contact urticaria associated with irradiation is described. We could not determine the agent behind the contact urticaria in our patient in light of the current literature. We are reporting this case because the literature neither mentioned radiotherapy as being among the agents that lead to contact urticaria nor reported contact urticaria as being among the acute reactions to radiotherapy. (author)

  18. Stereotactic body radiotherapy in lung cancer: an update

    Energy Technology Data Exchange (ETDEWEB)

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


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

  19. Fractionated stereotactic radiotherapy of vestibular schwannomas accelerates hearing loss

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Claesson, Magnus; Stangerup, Sven-Eric


    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 hear......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...

  20. Functional experiential hallucinosis after radiotherapy for nasopharyngeal carcinoma


    Lam, L; Leung, S; L. Chow


    OBJECTIVE—To consider the relation between functional experiential hallucinosis and brain injury induced by radiotherapy.
METHODS—Single case report.
RESULTS—A female patient presented with a four year history of functional experiential hallucinosis after two courses of radiotherapy for nasopharyngeal carcinoma. Brain MRI showed hyperintense changes over the left temporal lobe.
CONCLUSION— It is proposed that the hallucinosis was causally related to temporal lobe injury, a docu...

  1. Bcl-2 expression predicts radiotherapy failure in laryngeal cancer


    Nix, P; Cawkwell, L; Patmore, H.; Greenman, J.; Stafford, N


    Early stage laryngeal cancer can be effectively cured by radiotherapy or conservative laryngeal surgery. In the UK, radiotherapy is the preferred first line treatment. However, up to 25% of patients with T2 tumours will demonstrate locally persistent or recurrent disease at the original site, requiring salvage surgery to achieve a definitive cure. Patients experiencing treatment failure have a relatively poor prognosis. A retrospective analysis was conducted consisting of 124 patients with ea...

  2. Surgery and radiotherapy in the treatment of cutaneous melanoma

    DEFF Research Database (Denmark)

    Testori, A; Rutkowski, P; Marsden, J


    Adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis, is the only established curative treatment. Surgical management of primary melanomas consists of excisions with 1-2 cm margins and primary closure. The recommended method of biopsy...... on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases....

  3. Sensori-neural hearing loss following radiotherapy to the nasopharynx

    Energy Technology Data Exchange (ETDEWEB)

    Moretti, J.A.


    A retrospective study was done to ascertain the risks of cochlear damage from radiotherapy of the nasopharynx. Audiometric evaluation, pre- and post-radiotherapy, revealed that 7 out of 13 patients had sustained sensori-neural deafness. Contrary to what is generally believed of the resistance of the cochlea to radiotherapeutic damage, eventual loss of hearing can occasionally be expected in patients undergoing radiation therapy for head and neck tumors.

  4. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. (United States)

    Thompson, Ian M; Valicenti, Richard K; Albertsen, Peter; Davis, Brian J; Goldenberg, S Larry; Hahn, Carol; Klein, Eric; Michalski, Jeff; Roach, Mack; Sartor, Oliver; Wolf, J Stuart; Faraday, Martha M


    The purpose of this guideline is to provide a clinical framework for the use of radiotherapy after radical prostatectomy as adjuvant or salvage therapy. A systematic literature review using the PubMed®, Embase, and Cochrane databases was conducted to identify peer-reviewed publications relevant to the use of radiotherapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. Guideline statements are provided for patient counseling, the use of radiotherapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a re-staging evaluation. Physicians should offer adjuvant radiotherapy to patients with adverse pathologic findings at prostatectomy (i.e., seminal vesicle invasion, positive surgical margins, extraprostatic extension) and should offer salvage radiotherapy to patients with prostatic specific antigen or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiotherapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiotherapy as well as the potential benefits of preventing recurrence. The decision to administer radiotherapy should be made by the patient and the multi-disciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. Please visit the ASTRO and AUA websites ( and to view this guideline in its entirety, including the full literature review. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Stereotactic body radiotherapy in lung cancer: an update * (United States)

    Abreu, Carlos Eduardo Cintra Vita; Ferreira, Paula Pratti Rodrigues; de Moraes, Fabio Ynoe; Neves, Wellington Furtado Pimenta; Gadia, Rafael; Carvalho, Heloisa de Andrade


    Abstract For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique. PMID:26398758

  6. An instrument dedicated for modelling of pulmonary radiotherapy. (United States)

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


    Radiotherapy plays a pivotal role in lung cancer treatment. Selection of patients for new (radio)therapeutic options aiming at improving outcomes requires reliable and validated prediction models. We present the implementation of a prospective platform for evaluation and development of lung radiotherapy (proPED-LUNG) as an instrument enabling multidimensional predictive modelling. ProPED-LUNG was designed to comprise relevant baseline and follow up data of patients receiving pulmonary radiotherapy with curative intent. Patient characteristics, diagnostic and staging information, treatment parameters including full dose-volume-histograms, tumour control, survival, and toxicity are scored. Besides physician-rated data, a range of patient-rated data regarding symptoms and health-related quality-of-life are collected. After 18 months of accrual, 315 patients have been included (accrual rate, 18 per month). Of the first hundred patients included, 70 received conformal (chemo)radiotherapy and 30 underwent stereotactic radiotherapy. Compliance at 3 and 6 months follow-up was 96-100% for patient-rated, and 81-94% for physician-rated assessments. For data collection, 0.4 FTE were allocated in a 183 FTE department (0.2%). ProPED-LUNG is feasible with high compliance rates and yields a large amount of high quality prospective disease-related, treatment-related, patient- and physician-rated data which can be used to evaluate new developments in pulmonary radiotherapy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Australian survey on current practices for breast radiotherapy. (United States)

    Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois


    Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

  8. Development of dose audits for complex treatment techniques in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Stefanic, A. M.; Molina, L.; Vallejos, M.; Montano, G.; Zaretzky, A.; Saravi, M., E-mail: [Centro Regional de Referencia con Patrones Secundarios para Dosimetria - CNEA, Presbitero Juan Gonzalez y Aragon 15, B1802AYA Ezeiza (Argentina)


    This work was performed in the frame of a Coordinated Research Project (CRP) with IAEA whose objective was to extend the scope of activities carried out by national TLD-based networks from dosimetry audit for rectangular radiation fields to irregular and small fields relevant to modern radiotherapy. External audit is a crucial element in QA programmes for clinical dosimetry in radiotherapy, therefore a methodology and procedures were developed and were made available for dose measurement of complex radiotherapy parameters used for cancer treatment. There were three audit steps involved in this CRP: TLD based dosimetry for irregular MLC fields for conformal radiotherapy, dosimetry in the presence of heterogeneities and 2D MLC shaped fields relevant to stereotactic radiotherapy and applicable to dosimetry for IMRT. In addition, a new development of film-based 2D dosimetry for testing dose distributions in small field geometry was included. The plan for each audit step involved a pilot study and a trial audit run with a few local hospitals. The pilot study focused on conducting and evaluation of the audit procedures with all participants. The trial audit run was the running of the audit procedures by the participants to test them with a few local radiotherapy hospitals. This work intends to provide audits which are much nearer clinical practice than previous audits as they involve significant testing of Tps methods, as well as verifications to determinate whether hospitals can correctly calculate dose delivery in radiation treatments. (author)

  9. Radiation-induced heart disease in lung cancer radiotherapy (United States)

    Ming, Xin; Feng, Yuanming; Yang, Chengwen; Wang, Wei; Wang, Ping; Deng, Jun


    Abstract Background: Radiation-induced heart disease (RIHD), which affects the patients’ prognosis with both acute and late side effects, has been published extensively in the radiotherapy of breast cancer, lymphoma and other benign diseases. Studies on RIHD in lung cancer radiotherapy, however, are less extensive and clear even though the patients with lung cancer are delivered with higher doses to the heart during radiation treatment. Methods: In this article, after extensive literature search and analysis, we reviewed the current evidence on RIHD in lung cancer patients after their radiation treatments and investigated the potential risk factors for RIHD as compared to other types of cancers. Result: Cardiac toxicity has been found highly relevant in lung cancer radiotherapy. So far, the crude incidence of cardiac complications in the lung cancer patients after radiotherapy has been up to 33%. Conclusion: The dose to the heart, the lobar location of tumor, the treatment modality, the history of heart and pulmonary disease and smoking were considered as potential risk factors for RIHD in lung cancer radiotherapy. As treatment techniques improve over the time with better prognosis for lung cancer survivors, an improved prediction model can be established to further reduce the cardiac toxicity in lung cancer radiotherapy. PMID:27741117

  10. Unintended cardiac irradiation during left-sided breast cancer radiotherapy. (United States)

    Goody, R B; O'Hare, J; McKenna, K; Dearey, L; Robinson, J; Bell, P; Clarke, J; McAleer, J J A; O'Sullivan, J M; Hanna, G G


    Cardiac irradiation during left-sided breast radiotherapy may lead to deleterious cardiac side effects. Using image guided radiotherapy, it is possible to exclude the heart from treatment fields and monitor reproducibility of virtual simulation (VS) fields at treatment delivery using electronic portal imaging (EPI). Retrospectively, we evaluate the incidence of cardiac irradiation at VS and subsequent unintended cardiac irradiation during treatment. Patients receiving left-sided radiotherapy to the breast or chest wall, treated with a glancing photon field technique during a four-month period, were included. VS images and EPIs during radiotherapy delivery were visually assessed. The presence of any portion of the heart within the treatment field at VS or during treatment was recorded. Central lung distance and maximum heart distance were recorded. Of 128 patients, 45 (35.1%) had any portion of the heart within the planned treatment field. Of these, inclusion of the heart was clinically unavoidable in 25 (55.6%). Of those with no heart included in the treatment fields at VS, 41 (49.4%) had presence of the heart as assessed on EPI during treatment. Unintended cardiac irradiation during left-sided breast radiotherapy treatment occurs in a sizeable proportion of patients. Despite the use of three-dimensional computed tomography simulation and cardiac shielding, sizeable proportions of patients receiving left-sided breast cancer radiotherapy have unintended cardiac irradiation.

  11. Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma

    Energy Technology Data Exchange (ETDEWEB)

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


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

  12. Time, space and technology in radiotherapy departments: how do these factors impact on patients' experiences of radiotherapy? (United States)

    Merchant, S; O'Connor, M; Halkett, G


    Radiation therapists (RTs) plan and deliver radiotherapy treatment for patients diagnosed with cancer. They need to communicate regularly with their patients and may have a role to play in reducing patient anxiety and distress. The objectives were to explore how the environment of radiotherapy departments supports or inhibits communication generally and information giving and supportive care provision in particular. An ethnographic approach was used to gather rich descriptive data through observations and interviews conducted in two Australian radiotherapy centres. Time, space and a technology driven culture was found to negatively affect the quality of interaction that occurred between RTs and their patients. This research has shown design/modification of spaces is needed in the radiotherapy environment to reflect a patient care centred culture and to enhance opportunities for RTs to provide supportive care for their patients. © 2015 John Wiley & Sons Ltd.

  13. Stereotactic radiotherapy by cyberknife of sub-diaphragm digestive tumors; Radiotherapie stereotaxique par Cyberknife des tumeurs digestives sous diaphragmatiques

    Energy Technology Data Exchange (ETDEWEB)

    Taste, H.; Peiffert, D.; Beckendorf, V.; Marchesi, V.; Noel, A. [Centre Alexis-Vautrin, 54 - Vandoeuvre-les-Nancy (France)


    The stereotactic radiotherapy is a low toxic, efficient therapy offering a supplementary curative alternative, with promising first results, confirmed by literature. ts indications, its place in the therapy strategy stay to determine in the clinical research program. (N.C.)

  14. The Erlangen Dose Optimization Trial for radiotherapy of benign painful shoulder syndrome. Long-term results. (United States)

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


    To evaluate the long-term efficacy of pain reduction by two dose-fractionation schedules for radiotherapy of painful shoulder syndrome. Between February 2006 and February 2010, 312 evaluable patients were recruited for this prospective trial. All patients received low-dose orthovoltage radiotherapy. One course consisted of 6 fractions in 3 weeks. In the case of insufficient pain remission after 6 weeks, a second course was administered. Patients were randomly assigned to one of two groups to receive single doses of either 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before radiotherapy, as well as immediately after (early response), 6 weeks after (delayed response) and approximately 3 years after (long-term response) completion of radiotherapy using a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). Median follow-up was 35 months (range 11-57). The overall early, delayed and long-term response rates for all patients were 83, 85 and 82 %, respectively. The mean VAS scores before treatment and those for early, delayed and long-term response in the 0.5- and 1.0-Gy groups were 56.8 ± 23.7 and 53.2 ± 21.8 (p = 0.16); 38.2 ± 36.1 and 34.0 ± 24.5 (p = 0.19); 33.0 ± 27.2 and 23.7 ± 22.7 (p = 0.04) and 27.9 ± 25.8 and 32.1 ± 26.9 (p = 0.25), respectively. The mean CPS values before treatment and those for early, delayed and long-term response were 9.7 ± 3.0 and 9.5 ± 2.7 (p = 0.31); 6.1 ± 3.6 and 5.4 ± 3.6 (p = 0.10); 5.3 ± 3.7 and 4.1 ± 3.7 (p = 0.05) and 4.0 ± 3.9 and 5.3 ± 4.4 (p = 0.05), respectively. No significant differences in the quality of the long-term response were found between the 0.5- and 1.0-Gy arms (p = 0.28). Radiotherapy is an effective treatment for the management of benign painful shoulder syndrome. For radiation protection reasons, the dose for a radiotherapy series should

  15. Adjuvant radiotherapy for stage I endometrial cancer (United States)

    Kong, Anthony; Johnson, Nick; Kitchener, Henry C; Lawrie, Theresa A


    Background This is an updated version of the original Cochrane review published in Issue 2, 2007. The role of radiotherapy (both pelvic external beam radiotherapy (EBRT) and vaginal intracavity brachytherapy (VBT)) in stage I endometrial cancer following hysterectomy remains controversial. Objectives To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. Search methods We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Specialised Register to end-2005 for the original review, and extended the search to January 2012 for the update. Selection criteria We included randomised controlled trials (RCTs) that compared post-operative adjuvant radiotherapy (either EBRTor VBT, or both) versus no radiotherapy or VBT in women with stage I endometrial cancer. Data collection and analysis Two review authors independently assessed trials and extracted data to a specifically designed data collection form. The primary outcome was overall survival. Secondary outcomes were endometrial cancer-related deaths, locoregional recurrence and distant recurrence. Meta-analyses were performed using Cochrane Review Manager Software 5.1. Main results We included eight trials. Seven trials (3628 women) compared EBRT with no EBRT (or VBT), and one trial (645 women) compared VBTwith no additional treatment. We considered six of the eight trials to be of a high quality. Time-to-event data were not available for all trials and all outcomes. EBRT (with or without VBT) compared with no EBRT (or VBT alone) for stage I endometrial carcinoma significantly reduced locoregional recurrence (time-to-event data: five trials, 2965 women; Hazard Ratio (HR) 0.36, 95% Confidence Interval (CI) 0.25 to 0.52; and dichotomous data: seven trials, 3628 women; Risk Ratio (RR) 0.33, 95% CI 0.23 to 0.47). This reduced risk of locoregional recurrence did not translate into improved overall survival (time-to-event data: five trials, 2

  16. Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing. (United States)

    Vrána, David; Študentová, Hana; Matzenauer, Marcel; Vlachová, Zuzana; Cwiertka, Karel; Gremlica, David; Kalita, Ondřej


    Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm3, with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience.

  17. Estimating radiotherapy demands in South East Asia countries in 2025 and 2035 using evidence-based optimal radiotherapy fractions. (United States)

    Yahya, Noorazrul; Roslan, Nurhaziqah


    As about 50% of cancer patients may require radiotherapy, the demand of radiotherapy as the main treatment to treat cancer is likely to rise due to rising cancer incidence. This study aims to quantify the radiotherapy demand in countries in Southeast Asia (SEA) in 2025 and 2035 using evidence-based optimal radiotherapy fractions. SEA country-specific cancer incidence by tumor site for 2015, 2025 and 2035 was extracted from the GLOBOCAN database. We utilized the optimal radiotherapy utilization rate model by Wong et al. (2016) to calculate the optimal number of fractions for all tumor sites in each SEA country. The available machines (LINAC & Co-60) were extracted from the IAEA's Directory of Radiotherapy Centres (DIRAC) from which the number of available fractions was calculated. The incidence of cancers in SEA countries are expected to be 1.1 mil cases (2025) and 1.4 mil (2035) compared to 0.9 mil (2015). The number of radiotherapy fractions needed in 2025 and 2035 are 11.1 and 14.1 mil, respectively, compared to 7.6 mil in 2015. In 2015, the radiotherapy fulfillment rate (RFR; required fractions/available fractions) varied between countries with Brunei, Singapore and Malaysia are highest (RFR > 1.0 - available fractions > required fractions), whereas Cambodia, Indonesia, Laos, Myanmar, Philippines, Timor-Leste and Vietnam have RFR fractions, estimation for number of machines required can be obtained which will guide acquisition of machines in SEA countries. RFR is low with access varied based on the economic status. © 2018 John Wiley & Sons Australia, Ltd.

  18. A Treatise on Acoustic Radiation. Volume 1. (United States)


    saddle point is located at B a Since a 0 - arcos (I ix’) it is easily found that da dx The integral then becomes 2i e l- 2 e- eAR ’rrR sin B J, (kr...T to vanish one finally obtains the sim- pie formula, T I I(yo) 12 To 1o(y) (11.2.25) aye y - -+ logy 1 0(y) - exp (units: none) 2 -C V By choosing... pie of virtual work. 12.5b DAMPING MATRIX The equation of motion (12.2.19) is a statement that internal mass and elastic forces (left hand side) balance

  19. Guidelines for target volume definition in post-operative radiotherapy for prostate cancer, on behalf of the EORTC Radiation Oncology Group

    NARCIS (Netherlands)

    Poortmans, Philip; Bossi, Alberto; Vandeputte, Katia; Bosset, Mathieu; Miralbell, Raymond; Maingon, Philippe; Boehmer, Dirk; Budiharto, Tom; Symon, Zvi; van den Bergh, Alfons C. M.; Scrase, Christopher; Van Poppel, Hendrik; Bolla, Michel

    The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing post-operative radiotherapy for prostate cancer requires a standardisation of the target volume definition and delineation as well as stanclardisation of

  20. Reading comprehension in Parkinson's disease. (United States)

    Murray, Laura L; Rutledge, Stefanie


    Although individuals with Parkinson's disease (PD) self-report reading problems and experience difficulties in cognitive-linguistic functions that support discourse-level reading, prior research has primarily focused on sentence-level processing and auditory comprehension. Accordingly, the authors investigated the presence and nature of reading comprehension in PD, hypothesizing that (a) individuals with PD would display impaired accuracy and/or speed on reading comprehension tests and (b) reading performances would be correlated with cognitive test results. Eleven adults with PD and 9 age- and education-matched control participants completed tests that evaluated reading comprehension; general language and cognitive abilities; and aspects of attention, memory, and executive functioning. The PD group obtained significantly lower scores on several, but not all, reading comprehension, language, and cognitive measures. Memory, language, and disease severity were significantly correlated with reading comprehension for the PD group. Individuals in the early stages of PD without dementia or broad cognitive deficits can display reading comprehension difficulties, particularly for high- versus basic-level reading tasks. These reading difficulties are most closely related to memory, high-level language, and PD symptom severity status. The findings warrant additional research to delineate further the types and nature of reading comprehension impairments experienced by individuals with PD.

  1. Comprehensive mathematics for computer scientists

    CERN Document Server

    Mazzola, Guerino; Weissmann, Jody


    This two-volume textbook Comprehensive Mathematics for the Working Computer Scientist is a self-contained comprehensive presentation of mathematics including sets, numbers, graphs, algebra, logic, grammars, machines, linear geometry, calculus, ODEs, and special themes such as neural networks, Fourier theory, wavelets, numerical.

  2. Pragmatic Comprehension Development through Telecollaboration (United States)

    Rafieyan, Vahid; Sharafi-Nejad, Maryam; Khavari, Zahra; Eng, Lin Siew; Mohamed, Abdul Rashid


    Pragmatic comprehension can be ideally developed through contact with target language speakers. This contact can be provided in English as Foreign Language contexts through telecollaboration. To test the actual effect of telecollaboration on the development of pragmatic comprehension, 30 Iranian undergraduates of English as a Foreign Language…

  3. Postoperative radiotherapy in N0 laryngeal cancer; Radiotherapie postoperatoire des cancers larynges classes N0

    Energy Technology Data Exchange (ETDEWEB)

    Maillard, S.; Cauchois, A.; Froissart, D.; Nguyen, T.D. [Institut Jean-Godinot, Service de radiotherapie, 51 - Reims (France); Jovenin, N. [Centre Hospitalier Universitaire, DIM, 51 - Reims (France); Merol, J.C.; Chays, A. [Centre Hospitalier Universitaire, Service d' otorhinolaryngologie, 51 - Reims (France)


    Purpose. - A retrospective study to re-assess the indications for postoperative radiation therapy in squamous cell carcinoma of the larynx staged N0 after gross resection. Patients and methods. - Between January 1975 and December 2000, 166 patients with squamous cell carcinoma of the larynx were treated by total laryngectomy with or without neck dissection. Surgery was completed by external radiotherapy delivering 45 to 65 Gy to the tumour bed and 45 to 50 Gy to cervical lymphatic chains. Minimal follow-up was 36 months and median follow-up was 98 months. Results. - The rate of nodal recurrence was 6% (median time for relapse was 9 months). The survival rates at 1. 2, 3 and 5 years were 93.5, 84, 80 and 69% respectively, with a 8 year 3 month median survival. The univariate analysis showed 4 parameters, which significantly increased the risk of local recurrence: the medical necessity for immediate tracheotomy, the sub-glottic involvement, the involvement of the whole larynx and the presence of lymphatic emboli in the neck dissection. There was no statistically significant difference between the patients with or without a neck dissection. Fifty-nine secondary cancers were observed, 15 of them occurring in the head and neck area. The Late complications consisted of cervical subcutaneous fibrosis (7%), oesophageal stricture (4%), oeso-tracheal fistula (1%). hypothyroidism (3%), bone necrosis (1%). Conclusion. - Prophylactic cervical radiotherapy in laryngeal cancers resulted in 6% cervical node recurrence rate. This value may resent the maximal rate to accept if one would favour new therapeutic strategies based on restricted indications for radiotherapy. (authors)

  4. Hypofractionated radiotherapy for localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hoecht, Stefan [Xcare Gruppe, Radiologie, Nuklearmedizin und Strahlentherapie, Saarlouis (Germany); Aebersold, Daniel M. [University of Bern, Universitaetsklinik fuer Radio-Onkologie, Inselspital, Bern (Switzerland); Albrecht, Clemens [Universitaetsklinikum der Paracelsus Medizinischen Privatuniversitaet, Klinik fuer Radioonkologie und Gemeinschaftspraxis fuer Strahlentherapie, Klinikum Nuernberg Nord, Nuremberg (Germany); Boehmer, Dirk [Charite Universitaetsmedizin, Klinik fuer Radioonkologie und Strahlentherapie, Berlin (Germany); Flentje, Michael [Universitaetsklinikum Wuerzburg, Klinik und Poliklinik fuer Strahlentherapie, Wuerzburg (Germany); Ganswindt, Ute [Ludwig-Maximilians-Universitaet Muenchen, Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie, Munich (Germany); Hoelscher, Tobias [Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Klinik und Poliklinik fuer Strahlentherapie und Radioonkologie, Dresden (Germany); Martin, Thomas [Klinikum Bremen-Mitte, Klinik fuer Strahlentherapie und Radioonkologie, Bremen (Germany); Sedlmayer, Felix [Universitaetsklinikum der Paracelsus Medizinischen Privatuniversitaet, Universitaetsklinik fuer Radiotherapie und Radio-Onkologie, Landeskrankenhaus, Salzburg (Austria); Wenz, Frederik [Universitaetsmedizin Mannheim, Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Zips, Daniel [Universitaetsklinikum Tuebingen, Universitaetsklinik fuer Radioonkologie, Tuebingen (Germany); Wiegel, Thomas [Universitaetsklinikum Ulm, Abteilung Strahlentherapie, Ulm (Germany)


    This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use. Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control. Several large-scale trials on moderate hypofractionation with single doses from 2.4-3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2-3 years. Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials. (orig.) [German] Diese Uebersichtsarbeit soll den aktuellen Status der hypofraktionierten Radiotherapie des Prostatakarzinoms mit dem Fokus auf die Anwendung in der Routinetherapie darstellen. Basierend auf einem kuerzlich erschienen systematischen Review zur Hypofraktionierung sind durch das DEGRO Expertengremium zusaetzliche, in der Zwischenzeit verfuegbar gewordene Informationen mit beruecksichtigt worden. Die Validitaet der Aussagen zu Ergebnissen wurde speziell im Hinblick auf die Langzeittoxizitaet und -erkrankungskontrolle bewertet. Mehrere grosse Phase-3-Studien zur moderaten Hypofraktionierung mit Dosen von 2,4-3,4 Gy pro Fraktion

  5. New Methods for Targeted Alpha Radiotherapy (United States)

    Robertson, J. David


    Targeted radiotherapies based on alpha emitters are a promising alternative to beta emitting radionuclides. Because of their much shorter range, targeted α-radiotherapy (TAT) agents have great potential for application to small, disseminated tumors and micro metastases and treatment of hematological malignancies consisting of individual, circulating neoplastic cells. A promising approach to TAT is the use of the in vivo α-generator radionuclides 223 = 11.4 d) and 225Ac 1/2 = 10.0 d). In addition to their longer half-lives, these two isotopes have the potential of dramatically increasing the therapeutic efficacy of TAT as they each emit four α particles in their decay chain. This principle has recently been exploited in the development of Xofigo®, the first TAT agent approved for clinical use by the U.S. FDA. Xofigo, formulated as 223RaCl2, is used for treatment of metastatic bone cancer in men with castration-resistant prostate cancer. TAT with 223Ra works, however, only in the case of bone cancer because radium, as a chemical analogue of calcium, efficiently targets bone. In order to bring the benefits of TAT with 223Ra or 225Ac to other tumor types, a new delivery method must be devised. Retaining the in vivo α generator radionuclides at the target site through the decay process is one of the major challenges associated with the development of TAT. Because the recoil energy of the daughter radionuclides from the α-emission is ~ 100 keV - a value which is four orders of magnitude greater than the energy of a covalent bond - the daughters will not remain bound to the bioconjugate at the targeting site. Various approaches have been attempted to achieve retention of the α-generator daughter radionuclides at the target site, including incorporation of the in vivo generator into liposomes and fullerenes. Unfortunately, to date single wall liposomes and fullerenes are able to retain less than 10% of the daughter radionuclides. We have recently demonstrated that a

  6. Radiotherapy physics research in the UK: challenges and proposed solutions. (United States)

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


    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.

  7. Radiotherapy physics research in the UK: challenges and proposed solutions (United States)

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


    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

  8. Long-term results of ipsilateral radiotherapy for tonsil cancer

    Energy Technology Data Exchange (ETDEWEB)

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


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

  9. Postoperative radiotherapy in salivary ductal carcinoma: a single institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hyung; Kim, Mi Sun; Choi, Seo Hee; Suh, Yang Gun; Koh, Yoon Woo; Kim, Se Hun; Choi, Eun Chang; Keum, Ki Chang [Yonsei University College of Medicine, Seoul (Korea, Republic of)


    We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.

  10. Hypnotherapy in radiotherapy patients: a randomized trial. (United States)

    Stalpers, Lukas J A; da Costa, Hanna C; Merbis, Merijn A E; Fortuin, Andries A; Muller, Martin J; van Dam, Frits S A M


    To determine whether hypnotherapy reduces anxiety and improves the quality of life in cancer patients undergoing curative radiotherapy (RT). After providing written informed consent, 69 patients were randomized between standard curative RT alone (36 controls) and RT plus hypnotherapy (33 patients). Patients in the hypnotherapy group received hypnotherapy at the intake, before RT simulation, before the first RT session, and halfway between the RT course. Anxiety was evaluated by the State-Trait Anxiety Inventory DY-1 form at six points. Quality of life was measured by the Rand Medical Outcomes Study 36-item Health Survey (SF-36) at five points. Additionally, patients answered a questionnaire to evaluate their experience and the possible benefits of this research project. No statistically significant difference was found in anxiety or quality of life between the hypnotherapy and control groups. However, significantly more patients in the hypnotherapy group indicated an improvement in mental (p Hypnotherapy did not reduce anxiety or improve the quality of life in cancer patients undergoing curative RT. The absence of statistically significant differences between the two groups contrasts with the hypnotherapy patients' own sense of mental and overall well-being, which was significantly greater after hypnotherapy. It cannot be excluded that the extra attention by the hypnotherapist was responsible for this beneficial effect in the hypnotherapy group. An attention-only control group would be necessary to control for this effect.

  11. Craniospinal radiotherapy in an advanced technique

    Energy Technology Data Exchange (ETDEWEB)

    Christ, G.; Denninger, D.; Weigel, B.; Hoenes, A. [Medical Physics, Dept. of Radiooncology, Univ. of Tuebingen (Germany); Dohm, O.S. [Section Biomedical Physics, Dept. of Radiooncology, Univ. of Tuebingen (Germany); Paulsen, F. [Radiotherapy, Dept. of Radiooncology, Univ. of Tuebingen (Germany)


    Background and purpose: whole craniospinal irradiation cannot be achieved in one field at a normal treatment distance for adults. The aim of this newly developed technique is to minimize problems of matching fields and to maximize precision of craniospinal radiotherapy. Patients and methods: twelve patients (3-59 years) had craniospinal irradiation in supine position. The head was treated with lateral opposed isocentric fields with collimator rotation and isocentric table rotation. Using an extended source-skin distance of 160 cm only one dorsal field is necessary to cover the whole spinal axis. To avoid systematic under- or overdosage, junction field edges were moved twice by 1.5 cm. Treatment planning was performed based on CT scans. For visual verification of field matching an additional line laser was first adjusted to the caudal edge of one lateral light field and then checked against the light field of the spinal field under the table. Results: control films show good homogeneity in the junction between lateral and vertical fields. Reproducibility of table movements is acceptable. Total time needed for one fraction is about 15-20 min. Conclusion: the described technique is now well established, feasible and leads to less risk of dose uncertainties. (orig.)

  12. Vestibular schwannoma: an unusual post radiotherapy response. (United States)

    Uddin, Najam; Iqbal, Muhammad; Memon, Muhammad Ali; Farrukh, Salman


    Vestibular schwannoma is a relatively uncommon tumor. Although, it is benign but locally expansile and spreads to damage the adjacent structures. Treatment strategy includes surgery, Stereotactic Radiosurgery (SRS) either by standard or hypofractionated protocols. Due to its benign nature, radiation therapy cannot remove the tumor completely, instead radiation therapy halts the growth of vestibular schwannoma and inactivates this benign tumor. Response of radiation in the form of tumor shrinkage is seen 2 - 2.5 years after the radiations. We report a case of vestibular Schwannoma in which residual tumor of 3.1 cm size following subtotal resection was irradiated of the dose of 54 Gy in 30 equal fractions on 3-Dimensional Conformal Radiation Therapy (3-DCRT). A follow-up CT scan brain after 2 months of radiotherapy showed complete disappearance of the disease categorized as complete response. This is an unusual phenomenon and is likely due to the very rarely seen malignant transformation or presence of malignant component in this benign tumor.

  13. [Systematic approach for dysfunctional analysis in radiotherapy]. (United States)

    Reitz, A; Levrat, E; Pétin, J-F; Noël, A; Aigle, D; Peiffert, D; Graff, P


    We previously presented a systematic and structured approach to acquire an accurate functional model of the patient's process in radiotherapy. This approach relied on new functional structuring patterns, derived from system engineering and knowledge engineering. Additionally, we propose a complementary methodical process for the dysfunctional analysis of the obtained functional model. The procedure is based on joint implementation of two qualitative methods named "Failure modes and effects analysis" (FMEA) and "Hazard and operability" (HazOp). All the technical, the human and the organizational dimensions of the patient's process are pooled in a unique, exhaustive and detailed dysfunctional analysis. The application of this systematic approach within a particular institution can precisely identify the risks incurred by patients in care, but also highlight the logical sequence between precursor events and incidents. The dysfunctional analysis presented in this document will be used for the development still in process of quantified risk models. Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  14. Present Status of Radiotherapy in Clinical Practice (United States)

    Duehmke, Eckhart

    Aims of radiation oncology are cure from malignant diseases and - at the same time preservation of anatomy (e.g. female breast, uterus, prostate) and organ functions (e.g. brain, eye, voice, sphincter ani). At present, methods and results of clinical radiotherapy (RT) are based on experiences with natural history and radiobiology of malignant tumors in properly defined situations as well as on technical developments since World War II in geometrical and biological treatment planning in teletherapy and brachytherapy. Radiobiological research revealed tolerance limits of healthy tissues to be respected, effective total treatment doses of high cure probability depending on histology and tumor volume, and - more recently - altered fractionation schemes to be adapted to specific growth fractions and intrinsic radiosensitivities of clonogenic tumor cells. In addition, Biological Response Modifiers (BRM), such as cis-platinum, oxygen and hyperthermia may steepen cell survival curves of hypoxic tumor cells, others - such as tetrachiordekaoxid (TCDO) - may enhance repair of normal tissues. Computer assisted techniques in geometrical RT-planning based on individual healthy and pathologic anatomy (CT, MRT) provide high precision RT for well defined brain lesions by using dedicated linear accelerators (Stereotaxy). CT-based individual tissue compensators help with homogenization of distorted dose distributions in magna field irradiation for malignant lymphomas and with total body irradiation (TBI) before allogeneic bone marrow transplantation, e.g. for leukemia. RT with fast neutrons, Boron Neutron Capture Therapy (BNCT), RT with protons and heavy ions need to be tested in randomized trials before implementation into clinical routine.

  15. Radiotherapy for Pertussis: An Historical Assessment

    Directory of Open Access Journals (Sweden)

    Edward J. Calabrese PhD


    Full Text Available X-ray therapy was used to treat pertussis/whooping cough during a 13-year period from 1923 to 1936 in North America and Europe. Twenty studies from clinicians in the United States reported that approximately 1500 cases of pertussis were treated by X-ray therapy usually with less than 0.5 erythema dose. Young children (<3 years comprised about 70% to 80% of the cases, with the age of cases ranging from as young as 1 month to 50 years. In general, symptoms of severe coughing, vomiting episodes, and spasms were significantly relieved in about 85% of cases following up to 3 treatments, while about 15% of the cases showed nearly full relief after only 1 treatment. The X-ray therapy was also associated with a marked reduction in mortality of young (<3 years children by over 90%. Despite such reported clinical success from a wide range of experienced researchers, the use of X-rays for the treatment of pertussis in young children was controversial, principally due to concerns of exposure to the thymus and thyroid even with the availability of lead shielding. By the mid-1930s, the treatment of pertussis cases via vaccine therapy came to dominate the therapeutic arena, and the brief era of a radiotherapy option for the treatment of pertussis ended.

  16. Quality assurance in radiotherapy of mammary cancer

    CERN Document Server

    Mangold, C A


    characteristics and correction factors necessary for the clinical application are investigated. For the brachytherapy treatment the dose distributions calculated with the TPS are in good agreement with both TLD and radiochromic film measurements (average deviations of point doses < +- 6 %). However, close to the interface tissue-air the dose is overestimated by the TPS since it neglects the finite size of a breast and hence the associated lack of backscatter (average deviations of point doses up to -13 %). The average deviation for the in vivo measurements performed on the body surface is -9.5 (+-5.3) %. Doses delivered by external radiotherapy are significantly overestimated by the TPS in the dose points located close to the surface (up to -16 %). The deviations are due to the insufficient ability of the TPS to account for the absence of tissue in the beam. In the wedged fields negative deviations are also observed for inner dose points (up to -8 %). These disagreements are either due to a wrong determina...

  17. Technological advances in radiotherapy for cervical cancer. (United States)

    Walsh, Lorraine; Morgia, Marita; Fyles, Anthony; Milosevic, Michael


    To discuss the important technological advances that have taken place in the planning and delivery of both external beam radiotherapy and brachytherapy for patients with locally advanced cervical cancer, and the implications for improved clinical outcomes. Technological advances in external beam radiation treatment and brachytherapy for patients with cervical cancer allow more precise targeting of tumour and relative sparing of surrounding normal organs and tissues. Early evidence is emerging to indicate that these advances will translate into improvements in tumour control and reduced side effects. However, there are patient, tumour and treatment-related factors that can detract from these benefits. Foremost among these is complex, unpredictable and sometimes dramatic internal tumour and normal organ motion during treatment. The focus of current research and clinical development is on tracking internal anatomic change in individual patients and adapting treatment plans as required to assure that optimal tumour coverage and normal tissue sparing is maintained at all times. The success of this approach will depend on clear definitions of target volumes, high resolution daily soft tissue imaging, and new software tools for rapid contouring, treatment planning and quality assurance. Radiation treatment of locally advanced cervical cancer is evolving rapidly, driven by advances in technology, towards more individualized patient care that has the potential to substantially improve clinical outcomes.

  18. Systemic Targeted Alpha Radiotherapy for Cancer

    Directory of Open Access Journals (Sweden)

    Allan B. J.


    Full Text Available Background: The fundamental principles of internal targeted alpha therapy for cancer were established many decades ago.The high linear energy transfer (LET of alpha radiation to the targeted cancer cellscauses double strand breaks in DNA. At the same time, the short range radiation spares adjacent normal tissues. This targeted approach complements conventional external beam radiotherapy and chemotherapy. Such therapies fail on several fronts, such as lack of control of some primary cancers (e.g.glioblastoma multiformeand to inhibit the development of lethal metastatic cancer after successful treatment of the primary cancer. Objective: This review charts the developing role of systemic high LET, internal radiation therapy. Method: Targeted alpha therapy is a rapidly advancing experimental therapy that holds promise to deliver high cytotoxicity to targeted cancer cells. Initially thought to be indicated for leukemia and micrometastases, there is now evidence that solid tumors can also be regressed. Results: Alpha therapy may be molecular or physiological in its targeting. Alpha emitting radioisotopes such as Bi-212, Bi-213, At-211 and Ac-225 are used to label monoclonal antibodies or proteins that target specifc cancer cells. Alternatively, Radium-233 is used for palliative therapy of breast and prostate cancers because of its bone seeking properties. Conclusion: Preclinical studies and clinical trials of alpha therapy are discussed for leukemia, lymphoma, melanoma, glioblastoma multiforme, bone metastases, ovarian cancer, pancreatic cancer and other cancers.

  19. Clinical advantages of carbon-ion radiotherapy (United States)

    Tsujii, Hirohiko; Kamada, Tadashi; Baba, Masayuki; Tsuji, Hiroshi; Kato, Hirotoshi; Kato, Shingo; Yamada, Shigeru; Yasuda, Shigeo; Yanagi, Takeshi; Kato, Hiroyuki; Hara, Ryusuke; Yamamoto, Naotaka; Mizoe, Junetsu


    Carbon-ion radiotherapy (C-ion RT) possesses physical and biological advantages. It was started at NIRS in 1994 using the Heavy Ion Medical Accelerator in Chiba (HIMAC); since then more than 50 protocol studies have been conducted on almost 4000 patients with a variety of tumors. Clinical experiences have demonstrated that C-ion RT is effective in such regions as the head and neck, skull base, lung, liver, prostate, bone and soft tissues, and pelvic recurrence of rectal cancer, as well as for histological types including adenocarcinoma, adenoid cystic carcinoma, malignant melanoma and various types of sarcomas, against which photon therapy could be less effective. Furthermore, when compared with photon and proton RT, a significant reduction of overall treatment time and fractions has been accomplished without enhancing toxicities. Currently, the number of irradiation sessions per patient averages 13 fractions spread over approximately three weeks. This means that in a carbon therapy facility a larger number of patients than is possible with other modalities can be treated over the same period of time.

  20. Radiotherapy in the treatment of multiple myeloma. (United States)

    Bosch, A; Frias, Z


    Fifty-nine patients with multiple myeloma referred for treatment of painful bony lesions received irradiation to 95 local areas, and 16 of the 59 were irradiated using hemibody techniques. Pain relief was obtained in practically all of the irradiated regions. Most local areas were treated to doses of 3000 cGy in 10 to 15 fractions. Patients with generalized pain due to multiple site involvement were treated with single dose hemibody irradiation, to doses of 600 cGy to the upper hemibody, and of 800 cGy to the lower hemibody. This treatment was well tolerated and side effects minimal. Median survival from diagnosis was 30 months and the survival at 1, 3, and 5 years was 80%, 42%, and 12% respectively. Key articles on radiation therapy of multiple myeloma are reviewed and discussed. Since all patients eventually relapse after chemotherapy, the role of radiotherapy using present techniques should be fully evaluated and considered as an alternative in the primary treatment of multiple myeloma.

  1. Peculiarities of radiotherapy in the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Michael Jenwei, E-mail: [Hospital Israelita Albert Einstein, Sao Paulo SP, (Brazil); Nadalin, Wladimir [Universidade de Sao Paulo (InRad/HC/FM/USP), Ribeirao Preto, SP (Brazil). Unit of Radiotherapy


    It is known that the aging of the world population during the twentieth century and the beginning of this new century is a first-order challenge for nations, especially in the socio-economic field. An important aspect of the aging of global population is that, for older age groups, the prevalence of degenerative diseases is also higher, including malignancies. On the other hand, among the population of patients with cancer, half of these patients will receive radiation therapy at some point in their illness and their individual characteristics can somehow influence the prognosis, the indication and daily doses of treatment prescriptions. In this context, the health assistance for the elderly patient with cancer should be seen as an important challenge, mainly due to two factors: an increased demand for treatments, in quantitative terms, and physiological characteristics unique to this population, which can influence the therapeutic decision-making. This review proposes a discussion of some relevant aspects of both the physiology of the elderly, which may influence the course of radiation therapy, as well as of some technical advances in radiotherapy, which can in turn benefit these patients by offering, for example, lower toxicity, greater effectiveness and speed. (author)

  2. Porphyria and radiotherapy: yet a constellation of risk?; Porphyrie und Radiotherapie: doch eine Risikokonstellation?

    Energy Technology Data Exchange (ETDEWEB)

    Rhomberg, W. [Abt. fuer Radioonkologie, Landeskrankenhaus, Feldkirch (Austria); Offner, F.A. [Abt. fuer Pathologie, Landeskrankenhaus, Feldkirch (Austria)


    Background: little is known concerning the relation of porphyrias to radiation treatment for cancer. The recent literature does not report negative outcomes at least in single cases of breast cancer, bladder cancer or in a patient with lymphoma. Theoretically, there is a risk for radiation treatment in cases of porphyrias. Case report: two patients with porphyria are described who underwent radiotherapy for glioblastoma multiforme. Case histories, radiation treatment data and the proof of porphyria are given in detail. The patients received a concomitant radiochemotherapy with infusions of ACNU [1-(4-amino-2-methyl-5-pyrimidinyl)-methyl-(2-chloroethyl)-3-nitrosourea] every 6 weeks. The total radiation doses at the ICRU point were 60 and 38 Gy, respectively, given in single daily fractions of 2 Gy. Results: both patients responded well as far as objective tumor regression is concerned but died early after 7 and 1.5 months following diagnosis. The first patient experienced a large brain necrosis and deterioration of her porphyria. The second patient died of cardiopulmonary insufficiency still during radiotherapy with persistent or even increased signs of porphyria. The tumor showed extensive necrosis already after 38 Gy. Conclusion: in view of annotations in the literature and this case report, caution is advised as for irradiation of brain or nervous tissues in case of porphyrias. Molecular biology data seems to support this warning to some extent. (orig.)

  3. PET/CT and radiotherapy : data transfer, radiotherapy workflow and quality assurance. (United States)

    Fioroni, F; Iotti, C; Paiusco, M; Versari, A; Grassi, E; Salvo, D; Iori, M


    The development of new technologies in radiation therapy has made it possible to introduce more sophisticated techniques that can deliver the prescribed dose with more conformation and accuracy and to apply dose escalation protocols without increasing the risk of healthy tissue damage. This has consented the simultaneous delivery of different dose levels to different parts of the target, making it possible to boost those tumour sub-volumes that are considered more radio resistant. The use of PET for radiotherapy planning purposes has become increasingly important in the last few years, because of its ability to provide valuable biologic and functional data. PET imaging can affect the treatment strategy definition and improve the target delineation and the assessment of therapy response. The most attractive aspect is the perspective to deliver differential doses inside target volumes for areas of different biologic behaviour based on functional imaging, moving closer to the goals of biologically conformal radiation therapy. Each single step of PET/CT-guided radiotherapy workflow, needs to be performed following high standard procedures, within a rigorous and appropriate quality assurance protocol to minimize the sources of errors and to maximize the efficacy of PET imaging in radiation therapy, ensuring safe and effective use of the technology. The present paper focuses on aspects concerning the use of PET/CT in radiation treatment process, with the aim to delineate different possible approaches to its clinical application and to highlight the critical aspects of the various subprocesses.

  4. A prospective and randomized study of radiotherapy, sequential chemotherapy radiotherapy and concomitant chemo therapy-radiotherapy in unresectable non small cell carcinoma of the lung

    Directory of Open Access Journals (Sweden)

    Dasgupta Anirban


    Full Text Available Purpose: Treatment of advanced Non small cell lung cancer (NSCLC often produces dismal results. Combination of available treatment modalities has reportedly improved the outcome. A prospectively randomized trial was conducted, comparing combined treatment modalities versus radiotherapy alone, in treatment of unresectable NSCLC. Materials and Methods: A total of 103 patients were randomized to three groups. In group ′A′, 32 patients received radiotherapy alone (6500 cGy/30 fraction. In group ′B′, 35 patients received neoadjuvant chemotherapy (Cisplatin 80 mg/m2 on day 1 and Etoposide 100 mg/m day 1-3 intravenously q3 weeks for 3 cycles, followed by radiotherapy (6000 cGy/30 fractions and 3 more cycles of Chemotherapy, with the same regimen. In group ′C′, 36 patients received radiotherapy (5000 cGy/25 fractions with concurrent chemotherapy (ciplatin 20 mg/m2 + Etoposide 75 mg/m2 intravenously on day 1-5 and day 22-26, followed by 2 more cycles of chemotherapy,q3 weeks with the same regimen. Results: Initial treatment responses were significantly higher in group ′B′ ( P P Conclusion: Addition of chemotherapy with radiation in unresectable NSCLC improves response rates, time to tumour progression and disease free survival, though the same effect is not translated in overall survival.

  5. Radiotherapy demand and activity in England 2006-2020. (United States)

    Round, C E; Williams, M V; Mee, T; Kirkby, N F; Cooper, T; Hoskin, P; Jena, R


    This paper compares the predictions of radiotherapy demand for England from the Malthus model with those from the earlier National Radiotherapy Advisory Group (NRAG) model, from the international literature and also with observed radiotherapy usage in England as a whole as recorded in the English radiotherapy dataset (RTDS). We reviewed the evidence base for radiotherapy for each type and stage of cancer using national and international guidelines, meta-analyses, systematic reviews and key clinical trials. Twenty-two decision trees were constructed and radiotherapy demand was calculated using English cancer incidence data for 2007, 2008 and 2009, accurate to the Primary Care Trust (PCT) level (population 91,500-1,282,384). The stage at presentation was obtained from English cancer registry data. In predictive mode, the model can take account of changes in cancer incidence as the population grows and ages. The Malthus model indicates reduced indications for radiotherapy, principally for lung cancer and rarer tumours. Our estimate of the proportion of patients who should receive radiotherapy at some stage of their illness is 40.6%. This is lower than previous estimates of about 50%. Nevertheless, the overall estimate of demand in terms of attendances is similar for the NRAG and Malthus models. The latter models that 48,827 attendances should have been delivered per million population in 2011. National data from RTDS show 32,071 attendances per million in 2011. A 50% increase in activity would be required to match estimated demand. This underprovision extends across all cancers and represents reduced access and the use of dose fractionation at odds with international norms of evidence-based practice. By 2016, demand is predicted to grow to about 55,206 attendances per million and by 2020 to 60,057. Services have increased their activity by 14% between 2006 and 2011, but estimated demand has increased by 11%. Access remains low and English radiotherapy dose

  6. Effects of radiotherapy on the sense of taste

    Energy Technology Data Exchange (ETDEWEB)

    Umeyama, Masayoshi; Suzaki, Harumi [Showa Univ., Tokyo (Japan). School of Medicine


    The adverse effects of radiotherapy for cancer in the head and neck region include impairment of the sense of taste and smell and dry mouth. The present study was conducted to examine the effects of such radiotherapy on the sense of taste, in view of its influence on the quality of life of patients with malignant tumors of the head and neck following treatment. In 18 patients with malignant tumors of the head and neck (mean age, 59.9 years) the sense of taste was tested using the filter-paper disc method, serially before and after radiotherapy with {sup 60}Co {gamma} rays, in order to analyze the changes in gustatory threshold after radiotherapy. The patients were also observed for subjective symptoms, including dry mouth and impairment of the sense of taste, and changes in the lingual surface over the course of radiotherapy. No increase in the gustatory threshold or subjective impairment of the sense of taste was noted after radiotherapy when the field of irradiation did not include the tongue (4 cases of laryngeal cancer). When the field of irradiation included a part of the tongue (3 cases of maxillary cancer, 3 cases of hypopharyngeal cancer, 1 case of epipharyngeal cancer) or the entire tongue (2 cases of lingual cancer, 2 cases of cancer of the floor of the mouth, 3 cases of mesopharyngeal cancer), dry mouth was noted after irradiation at 7.2-39.6 Gy, and the gustatory threshold increased after irradiation at 12-40 Gy. Subjective impairment of the sense of taste was also reported after irradiation at 10-25.2 Gy, which was restored to normal within 2-3 months after the end of radiotherapy. In relation to the quality of taste, the gustatory threshold for sweet tastes increased the slowest, and was restored rapidly. In contrast, the gustatory threshold for sour tastes increased most rapidly, and was restored slowly. The relationship between the serum zinc level and the increase in gustatory threshold was unclear. There was a tendency for the lingual surface to

  7. Modeling the Risk of Secondary Malignancies after Radiotherapy

    Directory of Open Access Journals (Sweden)

    Uwe Schneider


    Full Text Available In developed countries, more than half of all cancer patients receive radiotherapy at some stage in the management of their disease. However, a radiation-induced secondary malignancy can be the price of success if the primary cancer is cured or at least controlled. Therefore, there is increasing concern regarding radiation-related second cancer risks in long-term radiotherapy survivors and a corresponding need to be able to predict cancer risks at high radiation doses. Of particular interest are second cancer risk estimates for new radiation treatment modalities such as intensity modulated radiotherapy, intensity modulated arc-therapy, proton and heavy ion radiotherapy. The long term risks from such modern radiotherapy treatment techniques have not yet been determined and are unlikely to become apparent for many years, due to the long latency time for solid tumor induction. Most information on the dose-response of radiation-induced cancer is derived from data on the A-bomb survivors who were exposed to γ-rays and neutrons. Since, for radiation protection purposes, the dose span of main interest is between zero and one Gy, the analysis of the A-bomb survivors is usually focused on this range. With increasing cure rates, estimates of cancer risk for doses larger than one Gy are becoming more important for radiotherapy patients. Therefore in this review, emphasis was placed on doses relevant for radiotherapy with respect to radiation induced solid cancer. Simple radiation protection models should be used only with extreme care for risk estimates in radiotherapy, since they are developed exclusively for low dose. When applied to scatter radiation, such models can predict only a fraction of observed second malignancies. Better semi-empirical models include the effect of dose fractionation and represent the dose-response relationships more accurately. The involved uncertainties are still huge for most of the organs and tissues. A major reason for

  8. The relationship between ovarian function and ovarian limited dose in radiotherapy postoperation of ovarian transposition in young patients with cervical cancer. (United States)

    Du, Zhenhua; Qu, Hui


    In this study, the relationship between ovarian function and ovarian limited dose in radiotherapy was evaluated in young patients with cervical cancer who underwent ovarian transposition (Fig1B). Moreover, the novel ovarian dose limit for a better preservation of ovarian function in intensity-modulated radiation therapy (IMRT) was determined. We retrospectively analyzed data from 86 patients with cervical cancer who received radical hysterectomy and ovarian transposition from January 2013 to June 2015. In agreement with the National Comprehensive Cancer Network Guidelines (NCCN) for Cervical Cancer Version 2.2015, 65 patients with pathological high-risk factors were administered adjuvant radiotherapy-20 of them received three-dimensional conformal radiotherapy (Observation Group A), 24 patients received IMRT with no limitation on radiation dose to ovaries (Observation Group B), and 21 patients underwent IMRT with limited radiation dose(V10  0.05). Within each observation group, there was a statistically significant difference in the sex hormone levels in patients before the radiation and after the radiation (P function (area under ROC curve was 0.740, confidence interval [CI] = 0.606-0.874). In young patients with cervical cancer who underwent radical hysterectomy and ovarian transposition without receiving adjuvant radiotherapy, ovarian endocrine function was well preserved. In patients who received any type of postoperative radiotherapy, ovarian function was affected, suggesting that the standard ovarian limited dose used in IMRT disrupted ovarian function. The results of the ROC curve analysis suggested that the new optimal dose limit of V7.5  function (P = 0.003). © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  9. Chemotherapy, radiotherapy and combined modality for Hodgkin's disease, with emphasis on second cancer risk

    DEFF Research Database (Denmark)

    Franklin, J.G.; Paus, M.D.; Pluetschow, A.


    BACKGROUND: Second malignancies (SM) are a major late effect of treatment for Hodgkin's disease (HD). Reliable comparisons of SM risk between alternative treatment strategies are lacking. OBJECTIVES: Radiotherapy (RT), chemotherapy (CT) and combined chemo-radiotherapy (CRT) for newly...

  10. Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy

    DEFF Research Database (Denmark)

    Wirth, A; Gospodarowicz, M; Aleman, B M P


    We evaluated the long-term results of radiotherapy for patients with gastric marginal zone lymphoma (GMZL).......We evaluated the long-term results of radiotherapy for patients with gastric marginal zone lymphoma (GMZL)....

  11. Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

    DEFF Research Database (Denmark)

    Roug, Anne Stidsholt; Rasmussen, Åse Krogh; Juhler, M


    To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis.......To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis....

  12. Efficacy of Radiotherapy for Painful Bone Metastases During the Last 12 Weeks of Life

    NARCIS (Netherlands)

    Meeuse, Jan J.; van der Linden, Yvette M.; van Tienhoven, Geertjan; Gans, Rijk O. B.; Leer, Jan Willem H.; Reyners, An K. L.


    BACKGROUND: Radiotherapy is an effective treatment for painful bone metastases. Whether this applies also in patients with limited survival remains to be investigated. This study analyzed the effect of radiotherapy for painful bone metastases in patients with a survival

  13. Early changes of auditory brain stem evoked response after radiotherapy for nasopharyngeal carcinoma - a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Lau, S.K.; Wei, W.I.; Sham, J.S.T.; Choy, D.T.K.; Hui, Y. (Queen Mary Hospital, Hong Kong (Hong Kong))


    A prospective study of the effect of radiotherapy for nasopharyngeal carcinoma on hearing was carried out on 49 patients who had pure tone, impedance audiometry and auditory brain stem evoked response (ABR) recordings before, immediately, three, six and 12 months after radiotherapy. Fourteen patients complained of intermittent tinnitus after radiotherapy. We found that 11 initially normal ears of nine patients developed a middle ear effusion, three to six months after radiotherapy. There was mixed sensorineural and conductive hearing impairment after radiotherapy. Persistent impairment of ABR was detected immediately after completion of radiotherapy. The waves I-III and I-V interpeak latency intervals were significantly prolonged one year after radiotherapy. The study shows that radiotherapy for nasopharyngeal carcinoma impairs hearing by acting on the middle ear, the cochlea and the brain stem auditory pathway. (Author).

  14. Late urologic morbidity in 177 consecutive patients after radiotherapy for cervical carcinoma: a longitudinal study

    DEFF Research Database (Denmark)

    Lajer, Henrik; Thranow, Ingrid R.; Skovgaard, Lene Theil


    Radiotherapy; carcinoma of the uterine cervix; Urologic morbidity; Franco-Italian glossary; Actuarial estimate......Radiotherapy; carcinoma of the uterine cervix; Urologic morbidity; Franco-Italian glossary; Actuarial estimate...

  15. Clinical trial of thalidomide combined with radiotherapy in patients with esophageal cancer. (United States)

    Yu, Jing-Ping; Sun, Su-Ping; Sun, Zhi-Qiang; Ni, Xin-Chu; Wang, Jian; Li, Yi; Hu, Li-Jun; Li, Dong-Qing


    To investigate the short-term efficacy and tolerability of radiotherapy plus thalidomide in patients with esophageal cancer (EC). Serum samples from 86 EC patients were collected before, during, and after radiotherapy, and the vascular endothelial growth factor (VEGF) level was examined by ELISA. According to the change in serum VEGF level during radiotherapy, the patients were divided into two groups: in the drug group, VEGF level was increased or remained unchanged, and thalidomide was administered up to the end of radiotherapy; in the non-drug group, VEGF level was decreased and radiotherapy was given alone. Thirty healthy volunteers served as controls. The efficacy and safety of radiotherapy plus thalidomide therapy were investigated. The 86 EC patients had a significantly higher level of VEGF compared with the 30 healthy controls before radiotherapy (P Thalidomide can down-regulate serum VEGF level in EC patients, and combined with radiotherapy may improve treatment outcome. Thalidomide was well tolerated by EC patients.

  16. Bilateral Rhegmatogenous Retinal Detachment during External Beam Radiotherapy

    Directory of Open Access Journals (Sweden)

    Takako Hidaka


    Full Text Available Herein, we report a case of nontraumatic bilateral rhegmatogenous retinal detachment (RRD during external beam radiotherapy for nonocular tumor, presented as an observational case study in conjunction with a review of the relevant literature. A 65-year-old male was referred to our hospital due to bilateral RRD. He underwent a biopsy for a tumor of the left frontal lobe 4 months prior to presentation, and the tumor had been diagnosed as primary central nerve system B-cell type lymphoma. He received chemotherapy and external beam radiotherapy for 1 month. There were no traumatic episodes. Bilateral retinal detachment occurred during a series of radiotherapies. Simultaneous nontraumatic bilateral retinal detachment is rare. The effects of radiotherapy on ocular functionality, particularly in cases involving retinal adhesion and vitreous contraction, may include RRD. Thus, it is necessary to closely monitor the eyes of patients undergoing radiotherapy, particularly those undergoing surgery for retinal detachment and those with a history of photocoagulation for retinal tears, a relevant family history, or risk factors known to be associated with RRD.

  17. Postoperative radiotherapy of pterygium with Strontium-90 plaque

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Michinori; Hada, Yoshihiro; Akagi, Yasushi [National Hospital of Kure, Hiroshima (Japan)


    Between 1979 and 1998, radiotherapy with a Strontium (Sr)-90 plaque after pterygium excision was administered in 36 patients (40 eyes). All lesions were nasal (rt. eyes 21, lt. eyes 19). Thirty-eight were primary pterygia and 2 were recurrent ones. The study included 18 males and 18 females, 43 to 80 years of age (median: 64). The interval between pterygium excision and postoperative radiotherapy was less than 24 hours in 17 cases, 2 days in 1, 4 days in 3, 9 days in 5 and 10 days and more in 14. Although total radiation dose in all patients was 40 Gy in the Sr-90 plaque surface, the daily dose fraction was 8 Gy in 20 cases until 1985 and 10 Gy in 20 cases after 1985. All courses of radiotherapy were delivered using once-daily fractionation, 1 day per week. The median follow-up period was 43 months (range, 12-180 months). Of 40 lesions, 5 recurred. Of the 5 recurrent cases, 4 recurred within 5 months after treatment. The remaining 1 case recurred in 30 months. The local control rate at 2 years was 90% in all cases. No significant difference in local control rates was seen for the subgroups classified by age, gender, primary or recurrent, interval between pterygium excision and radiotherapy or treatment time. No patients had severe radiation-induced complications. Postoperative radiotherapy with a Sr-90 plaque was safe and effective in preventing local recurrence after pterygium excision. (author)

  18. Definitive radiotherapy for extramedullary plasmacytomas of the head and neck. (United States)

    Michalaki, V J; Hall, J; Henk, J M; Nutting, C M; Harrington, K J


    Extramedullary plasmacytoma of the head and neck region (EMPHN) is an uncommon malignant plasma cell neoplasm. In this study we conducted a retrospective analysis of our experience of EMPHN with particular emphasis on the role of definitive radiotherapy. From 1982 to 2001, 10 patients (6 males, 4 females) with EMPHN were treated in our institution. Of nine patients treated at initial diagnosis, all received definitive radiotherapy. One patient treated at relapse underwent surgical resection followed by post-operative radiotherapy. The median age at diagnosis was 55 years (range 35-84 years). The disease was most frequently localized in the paranasal sinuses (50%). All nine patients who received definitive radiotherapy at a dose of 40-50 Gy achieved a complete response. The median follow up period was 29 months (range 7-67 months). Four patients (40%) relapsed, three have died of their disease. Two patients (20%) with paranasal sinus disease subsequently relapsed with multiple myeloma at 10 months and 24 months, respectively. Our results indicate that treatment of EMPHN with radiotherapy achieves excellent rates of local control. The relapse rate in neck nodes of 10% does not justify elective irradiation of the uninvolved neck.


    African Journals Online (AJOL)

    READING COMPREHENSION RFSEARCH AND LINGUISTIC PRAGMATICS: MAPPING OUT SOME UNRECOGNIZED INTERDISCIPLINARY. COMMON GROUND. 1. Introduction. Melinda Sinclair. Department of General Linguistics. University of SteUenbosch. 83. On the whole, research into the various aspects of natural ...

  20. Comprehensive Error Rate Testing (CERT) (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare...



    Maria Novary Ngabut


    In this article several reading theories in their relations to reading comprehension teachers and lecturers of English need to know are reviewed. At the theory level, three other Models of Reading, namely Bottom-Up, Top-Down, and Interactive are previously discussed to the Schema Theory. In reviewing the reading comprehension, the history of reading instruction, types and purposes of reading, and cognitive reading skills are discussed. Finally, it reviews six variables involved in the compreh...

  2. Accelerated Deformable Registration of Repetitive MRI during Radiotherapy in Cervical Cancer

    DEFF Research Database (Denmark)

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


    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.    ...

  3. Predicting radiotherapy outcomes using statistical learning techniques

    Energy Technology Data Exchange (ETDEWEB)

    El Naqa, Issam; Bradley, Jeffrey D; Deasy, Joseph O [Washington University, Saint Louis, MO (United States); Lindsay, Patricia E; Hope, Andrew J [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada)


    Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for 'generalizabilty' validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among

  4. Predicting radiotherapy outcomes using statistical learning techniques (United States)

    El Naqa, Issam; Bradley, Jeffrey D.; Lindsay, Patricia E.; Hope, Andrew J.; Deasy, Joseph O.


    Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for 'generalizabilty' validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among model

  5. Radiotherapy-induced concomitant coronary artery stenosis and mitral valve disease. (United States)

    Akboga, Mehmet Kadri; Akyel, Ahmet; Sahinarslan, Asife; Cengel, Atiye


    Radiotherapy is extensively used in the treatment of Hodgkin's disease. One of its untoward effects is on heart. Coronary arteries and heart valves can be adversely affected from radiotherapy. However, co-existence of both conditions is very rare. In this report, we present a patient with Hodgkin's disease who developed both coronary artery stenosis and severe mitral valve regurgitation after radiotherapy.

  6. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast

    NARCIS (Netherlands)

    Correa, C.; McGale, P.; Taylor, C.; Wang, Y.; Clarke, M.; Davies, C.; Peto, R.; Bijker, N.; Solin, L.; Darby, S.; Abe, O.; Abe, R.; Enomoto, K.; Kikuchi, K.; Koyama, H.; Masuda, H.; Nomura, Y.; Ohashi, Y.; Sakai, K.; Sugimachi, K.; Toi, M.; Tominaga, T.; Uchino, J.; Yoshida, M.; Haybittle, J. L.; Leonard, C. F.; Calais, G.; Geraud, P.; Collett, V.; Delmestri, A.; Sayer, J.; Harvey, V. J.; Holdaway, T. M.; Kay, R. G.; Mason, B. H.; Forbes, J. F.; Wilcken, N.; Bauernhofer, T.; Dubsky, P.; Fesl, C.; Fohler, H.; Filipcic, L.; Filipits, M.; Fridrik, M.; Gnant, M.; Greil, R.; Hegenbarth, K.; Jakesz, R.; Kwasny, W.; Lang, A.; Luschin-Ebengreuth, G.; Marth, C.; Menzel, C.; Mlineritsch, B.; Samonigg, H.; Seifert, M.; Sevelda, P.; Singer, C.; Steger, G. G.; Stöger, H.; Thaler, J.; Tschmelitsch, J.; Zielinski, C.; Canney, P.; Yosef, H. M. A.; Focan, C.; Peek, U.; Oates, G. D.; Powell, J.; Durand, M.; Mauriac, L.; Di Leo, A.; Dolci, S.; Piccart, M. J.; Masood, M. B.; Parker, D.; Price, J. J.; Lindsay, M. A.; Mackey, J.; Martin, M.; Hupperets, P. S. G. J.; Bates, T.; Blamey, R. W.; Chetty, U.; Ellis, I. O.; Mallon, E.; Morgan, D. A. L.; Patnick, J.; Pinder, S.; Jackson, S.; Ragaz, J.; Berry, D.; Broadwater, G.; Cirrincione, C.; Muss, H.; Norto, L.; Weiss, R. B.; Abu-Zahra, H. T.; Portnoj, S. M.; Baum, M.; Cuzick, J.; Dowsett, M.; Houghton, J.; Ledermann, J.; Riley, D.; Bowdon, S.; Brookes, C.; Fernando, I.; Rea, D.; Spooner, D.; Mansel, R. E.; Gordon, N. H.; Davis, H. L.; Lehingue, Y.; Romestaing, P.; Dubois, J. B.; Delozier, T.; Griffon, B.; Mace Lesec'h, J.; Rambert, P.; Mustacchi, G.; Petruzelka, L.; Pribylova, O.; Owen, J. R.; Harbeck, N.; Jänicke, F.; Meisner, C.; Schmitt, M.; Thomssen, C.; Meier, P.; Howell, A.; Swindell, R.; Burrett, J.; Collins, R.; Cutter, D.; Davies, K.; Elphinstone, P.; Evans, V.; Gettins, L.; GodwinF, J.; Gray, R.; Gregory, C.; Hermans, D.; Hicks, C.; James, S.; Kerr, A.; MacKinnon, E.; Lay, M.; McHugh, T.; Albano, J.; de Oliveira, C. F.; Gervásio, H.; Gordilho, J.; Johansen, H.; Mouridsen, H. T.; Gelman, R. S.; Harris, J. R.; Hayes, D.; Henderson, I. C.; Shapiro, C. L.; Winer, E.; Christiansen, P.; Ejlertsen, B.; Ewertz, M.; Møller, S.; Overgaard, M.; Carstensen, B.; Palshof, T.; Trampisch, H. J.; Dalesio, O.; de Vries, E. G. E.; Rodenhuis, S.; van Tinteren, H.; ComisF, R. L.; DavidsonF, N. E.; Robert, N.; SledgeF, G.; Solin, F. J.; Tormey, D. C.; Wood, W.; Cameron, D.; Forrest, P.; Jack, W.; Rossbach, J.; Klijn, J. G. M.; Treurniet-Donker, A. D.; van Putten, W. L. J.; Costa, A.; Veronesi, U.; Viale, G.; Bartelink, H.; Bogaerts, J.; Julien, J. P.; Legrand, C.; Rutgers, E.; Sylvester, R.; van de Velde, C. J. H.; van Nes, J. G. H.; Cunningham, M. P.; Huovinen, R.; Joensuu, H.; Tinterri, C.; Valagussa, P.; Goldstein, L. J.; Bonneterre, J.; Fargeot, P.; Fumoleau, P.; Kerbrat, P.; Luporsi, E.; Namer, M.; Eiermann, W.; Hilfrich, J.; Jonat, W.; Kaufmann, M.; KreienbergF, R.; Schumacher, M.; Bastert, G.; Rauschecker, H.; Sauer, R.; Sauerbrei, W.; Schauer, A.; Blohmer, J. U.; Costa, S. D.; Eidtmann, H.; Gerber, B.; Jackisch, C.; Loibl, S.; von Minckwitz, G.; de Schryver, A.; Vakaet, L.; Belfiglio, M.; Nicolucci, A.; Pellegrini, F.; Sacco, M.; Valentini, M.; McArdle, C. S.; Smith, D. C.; Stallard, S.; Galligioni, E.; Lopez, M.; Boccardo, F.; Rubagotti, A.; Dent, D. M.; Gudgeon, C. A.; Hacking, A.; Murray, E.; Panieri, E.; Briones, L.; Carrasco, E.; Erazo, A.; Medina, J. Y.; Horiguchi, J.; Takei, H.; Fentiman, I. S.; Hayward, J. L.; Rubens, R. D.; Skilton, D.; Scheurlen, H.; Sohn, H. C.; Untch, M.; Dafni, U.; Markopoulos, C.; Fountzilas, G.; Mavroudis, D.; Klefstrom, P.; Blomqvist, C.; Saarto, C.; Gallen, M.; Margreiter, R.; de Lafontan, B.; Mihura, J.; RochéF, H.; Asselain, B.; Salmon, R. J.; Vilcoq, J. R.; Arriagada, R.; Hill, C.; Laplanche, A.; Lê, M. G.; Spielmann, M.; A'Hern, R.; Barrett-Lee, P.; Bliss, J.; Ellis, P.; Kilburn, L.; Yarnold, J. R.; Bruzzi, P.; del Mastro, L.; Pronzato, P.; Sertoli, M. R.; Venturini, M.; Amadori, D.; Benraadt, J.; Kooi, M.; van de Velde, A. O.; van Dongen, J. A.; Vermorken, J. B.; Castiglione, M.; Cavalli, F.; Coates, A.; Collins, J.; Forbes, J.; Gelber, R. D.; Goldhirsch, A.; Lindtner, J.; Price, K. N.; Raina, V.; Rudenstam, C. M.; Senn, H. J.; Bliss, J. M.; Chilvers, C. E. D.; Coombes, R. C.; Hall, E.; Marty, M.; Buyse, M.; Possinger, K.; Schmid, P.; Wallwiener, D.; Borovik, R.; Brufman, G.; Hayat, H.; Robinson, E.; Yaal-Hahoshen, N.; Bonadonna, G.; Camerini, T.; de Palo, G.; Di MauroF, M. G.; Formelli, F.; Martoni, A.; Pannuti, F.; Cocconi, G.; Colozza, A.; Camisa, R.; Gori, S.; Aogi, K.; Takashima, S.; Ikeda, T.; Inokuchi, K.; Sawa, K.; Sonoo, H.; Korzeniowski, S.; Skolyszewski, J.; Ogawa, M.; Yamashita, J.; Christiaens, R.; Neven, P.; Paridaens, R.; van den Bogaert, W.; Braun, S.; Janni, W.; Martin, P.; Romain, S.; Hakes, T.; Hudis, C. A.; Norton, L.; Wittes, R.; Giokas, G.; Kondylis, D.; Lissaios, B.; de la Huerta, R.; Sainz, M. G.; Altemus, R.; Camphausen, K.; Cowan, K.; Danforth, D.; Lichter, A.; Lippman, M.; O'Shaughnessy, J.; PierceF, L. J.; Steinberg, S.; Venzon, D.; Zujewski, J. A.; D'Amico, C.; Lioce, M.; Paradiso, A.; Chapman, J. W.; Goss, P. E.; Levine, M. N.; Myles, J. D.; Pater, J. L.; Pritchard, K. I.; Shepherd, L. E.; Tu, D.; Whelan, D.; Zee, B.; Anderson, S.; Bass, G.; Brown, A.; Bryant, J.; Costantino, J.; Fisher, B.; Geyer, C.; Paik, S.; Redmond, C.; Wickerham, L.; Wolmark, N.; Jackson, I. M.; Palmer, M. K.; Perez, E.; Ingle, J. N.; Suman, V. J.; Bengtsson, N. O.; Emdin, S.; Granstrand, B.; Jonsson, H.; Lythgoe, J. P.; Kissin, M.; Erikstein, B.; Hannisdal, E.; Jacobsen, A. B.; Varhaug, J. E.; Gundersen, S.; Hauer-Jensen, M.; Høst, H.; Nissen-Meyer, R.; Mitchell, A. K.; Robertson, J. F. R.; Di Palma, M.; Mathé, G.; Misset, J. L.; Clark, R. M.; LevineF, M.; Whelan, T.; Morimoto, K.; Takatsuka, Y.; Crossley, E.; Harris, A.; Talbot, D.; Taylor, M.; Martin, A. L.; Roché, H.; di Blasio, B.; Ivanov, V.; Semiglazov, V.; Brockschmidt, J.; Cooper, M. R.; Ueo, H.; Falkson, C. I.; Ashley, S.; Makris, A.; Powles, T. J.; Smith, I. E.; Gazet, J. C.; Browne, L.; Graham, P.; Corcoran, N.; Deshpande, N.; di Martino, L.; Douglas, P.; Lindtner, A.; Notter, G.; Bryant, A. J. S.; Ewing, G. H.; Firth, L. A.; Krushen-Kosloski, J. L.; Foster, L.; George, W. D.; Stewart, H. J.; Stroner, P.; Anderson, H.; Malmström, P.; Möller, T. R.; Ringberg, A.; Rydén, L.; Tengrup, I.; Tennvall-Nittby, L.; Arnesson, L.-G.; Carstensen, J.; Dufmats, M.; Nordenskjöld, B.; Söderberg, M.; Carpenter, J. T.; AlbainF, K.; Barlow, W.; CrowleyF, J.; Gralow, J.; Green, S.; Hortobagyi, G.; Livingston, R.; Martino, S.; Osborne, C. K.; Ravdin, P. M.; Murray, N.; Royle, G. T.; Simmonds, P. D.; Askergren, J.; Bäckdahl, M.; Bergh, J.; Fernstad, R.; Fornander, T.; Frisell, J.; Glas, U.; Hatschek, T.; Ideström, K.; Johansson, U.; Perbeck, L.; Rotstein, S.; Rutqvist, L. E.; Sandelin, K.; Singnomklao, T.; Skoog, L.; Somell, A.; Wallgren, A.; Wilking, N.; Maibach, R.; Thürlimann, B.; Holli, K.; Rouhento, K.; Brenner, H.; Hercbergs, A.; Yoshimoto, M.; DeBoer, G.; Paterson, A. H. G.; Fyles, A.; Meakin, J. W.; Panzarella, T.; Shan, Y.; Shao, Y. F.; Wang, X.; Zhao, D. B.; Bahi, J.; Reid, M.; Spittle, M.; Bishop, H.; Bundred, N. J.; Forsyth, S.; Pai, V. R.; Pinder, S. E.; Sestak, I.; Deutsch, G. P.; KwongF, D. L. W.; Senanayake, F.; Bianco, A. R.; Carlomagno, C.; de Laurentiis, M.; de Placido, S.; Broglio, K.; Buzdar, A. U.; Love, R. R.; Garmo, H.; Holmberg, L.; Liljegren, G.; NilssonF, J.; Jones, S. E.; Loesch, D. M.; Janauer, M.; Zielinski, C. C.; Gluz, O.; Nitz, U.; Dunn, J. A.; Hills, R. K.; Lee, M.; Morrison, J. M.; Poole, C.; Litton, A.; Karlsson, P.; Chlebowski, R. T.; Caffier, H.


    Individual patient data were available for all four of the randomized trials that began before 1995, and that compared adjuvant radiotherapy vs no radiotherapy following breast-conserving surgery for ductal carcinoma in situ (DCIS). A total of 3729 women were eligible for analysis. Radiotherapy

  7. The physics of radiotherapy X-rays and electrons

    CERN Document Server

    Metcalfe, Peter; Hoban, Peter


    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...

  8. An electromechanical, patient positioning system for head and neck radiotherapy (United States)

    Ostyn, Mark; Dwyer, Thomas; Miller, Matthew; King, Paden; Sacks, Rachel; Cruikshank, Ross; Rosario, Melvin; Martinez, Daniel; Kim, Siyong; Yeo, Woon-Hong


    In cancer treatment with radiation, accurate patient setup is critical for proper dose delivery. Improper arrangement can lead to disease recurrence, permanent organ damage, or lack of disease control. While current immobilization equipment often helps for patient positioning, manual adjustment is required, involving iterative, time-consuming steps. Here, we present an electromechanical robotic system for improving patient setup in radiotherapy, specifically targeting head and neck cancer. This positioning system offers six degrees of freedom for a variety of applications in radiation oncology. An analytical calculation of inverse kinematics serves as fundamental criteria to design the system. Computational mechanical modeling and experimental study of radiotherapy compatibility and x-ray-based imaging demonstrates the device feasibility and reliability to be used in radiotherapy. An absolute positioning accuracy test in a clinical treatment room supports the clinical feasibility of the system.

  9. Late bilateral temporal lobe necrosis after conventional radiotherapy. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Hoshi, Michio; Hayashi, Toshiyuki; Kagami, Hiroshi; Murase, Ikurou; Nakatsukasa, Masashi [Saiseikai Utsunomiya Hospital (Japan)


    A 63-year-old woman presented with radionecrosis in the bilateral temporal lobes manifesting as dementia about 30 years after undergoing conventional radiotherapy for pituitary adenoma. Computed tomography and magnetic resonance (MR) imaging showed edema and cystic lesions in both temporal lobes. The mass in the left temporal lobe was excised. MR imaging 12 days after surgery showed reduced edema. Her dementia had improved. Radionecrosis usually occurs between several months and a few years after radiotherapy. The incidence of radionecrosis is estimated as 5%, but may be higher with longer follow-up periods. Clinical reports have suggested that larger total doses of radiation are associated with earlier onset of delayed necrosis and the fractional dose is the most significant factor causing cerebral radionecrosis. Radionecrosis can occur long after conventional radiotherapy or stereotactic radiosurgery using a linac-based system or a gamma knife unit. (author)

  10. Organization and visualization of medical images in radiotherapy

    CERN Document Server

    Lorang, T


    In modern radiotherapy, various imaging equipment is used to acquire views from inside human bodies. Tomographic imaging equipment is acquiring stacks of cross-sectional images, software implementations derive three-dimensional volumes from planar images to allow for visualization of reconstructed cross-sections at any orientation and location and higher-level visualization systems allow for transparent views and surface rendering. Of upcoming interest in radiotherapy is mutual information, the integration of information from multiple imaging equipment res. from the same imaging equipment at different time stamps and varying acquisition parameters. Huge amounts of images are acquired nowadays at radiotherapy centers, requiring organization of images with respect to patient, acquisition and equipment to allow for visualization of images in a comparative and integrative manner. Especially for integration of image information from different equipment, geometrical information is required to allow for registration...

  11. EGFR-inhibitors, radiotherapy and normal tissue toxicity

    DEFF Research Database (Denmark)

    Eriksen, J. G.


    EGFR-inhibitors have been used in several clinical settings during the last decade and side-effects related to normal tissues like the skin, mucosa and kidney has been well described. However, when EGFR-inhibitors are combined with radiotherapy, then different skin and mucosa toxicity profiles can...... will be explained with references to the current knowledge of the biology of skin toxicity. Treatment options for acute side-effects in skin and mucosa after bio-radiotherapy is rarely causal. A few attempts have been done; some of them aiming to rephosphorylate the EGFreceptor in the skin with vitamin K3. The talk...... single nucleotide polymorphisms in the EGF-gene that alter the ligand-receptor binding might be responsible for the observed clinical correlation. These data will be discussed in the light of EGFR-inhibition in combination with chemotherapy and/or radiotherapy....

  12. Measuring side effects after radiotherapy for pharynx cancer

    DEFF Research Database (Denmark)

    Jensen, Kenneth


    measure is obtainable, and the case of a patient-relevant measure is even rarer. Radiotherapy is often followed by complex symptoms not easily quantifiable by the observer. Quantitative patient reported side effects can be retrieved using validated questionnaires, but this kind of data is often difficult......Data on side effects after radiotherapy is needed to establish the benefits and drawbacks of new treatments, but side effects are not quantified as easily as survival or local control. Side effects may be quantified using physical measures. Unfortunately, only few endpoints exist where a physical...... effects. Using pharynx cancer as an example, the purpose of this article is to summarize the possibilities and limitations of different methods for measurement of radiotherapy-induced side effects. Udgivelsesdato: 2007-Sep-17...

  13. Data for TROTS – The Radiotherapy Optimisation Test Set

    Directory of Open Access Journals (Sweden)

    Sebastiaan Breedveld


    Full Text Available The Radiotherapy Optimisation Test Set (TROTS is an extensive set of problems originating from radiotherapy (radiation therapy treatment planning. This dataset is created for 2 purposes: (1 to supply a large-scale dense dataset to measure performance and quality of mathematical solvers, and (2 to supply a dataset to investigate the multi-criteria optimisation and decision-making nature of the radiotherapy problem. The dataset contains 120 problems (patients, divided over 6 different treatment protocols/tumour types. Each problem contains numerical data, a configuration for the optimisation problem, and data required to visualise and interpret the results. The data is stored as HDF5 compatible Matlab files, and includes scripts to work with the dataset.

  14. Data for TROTS - The Radiotherapy Optimisation Test Set. (United States)

    Breedveld, Sebastiaan; Heijmen, Ben


    The Radiotherapy Optimisation Test Set (TROTS) is an extensive set of problems originating from radiotherapy (radiation therapy) treatment planning. This dataset is created for 2 purposes: (1) to supply a large-scale dense dataset to measure performance and quality of mathematical solvers, and (2) to supply a dataset to investigate the multi-criteria optimisation and decision-making nature of the radiotherapy problem. The dataset contains 120 problems (patients), divided over 6 different treatment protocols/tumour types. Each problem contains numerical data, a configuration for the optimisation problem, and data required to visualise and interpret the results. The data is stored as HDF5 compatible Matlab files, and includes scripts to work with the dataset.

  15. The role of radiotherapy in multimodal treatment of pancreatic carcinoma

    Directory of Open Access Journals (Sweden)

    Scott-Brown Martin


    Full Text Available Abstract Pancreatic ductal carcinoma is one of the most lethal malignancies, but in recent years a number of positive developments have occurred in the management of pancreatic carcinoma. This article aims to give an overview of the current knowledge regarding the role of radiotherapy in the treatment of pancreatic ductal adenocarcinoma (PDAC. The results of meta-analyses, phase III-studies, and phase II-studies using chemoradiotherapy and chemotherapy for resectable and non-resectable PDAC were reviewed. The use of radiotherapy is discussed in the neoadjuvant and adjuvant settings as well as in the locally advanced situation. Whenever possible, radiotherapy should be performed as simultaneous chemoradiotherapy. Patients with PDAC should be offered entry into clinical trials to identify optimal treatment results.

  16. Could Radiotherapy Effectiveness Be Enhanced by Electromagnetic Field Treatment?

    Directory of Open Access Journals (Sweden)

    Núñez María Isabel


    Full Text Available One of the main goals in radiobiology research is to enhance radiotherapy effectiveness without provoking any increase in toxicity. In this context, it has been proposed that electromagnetic fields (EMFs, known to be modulators of proliferation rate, enhancers of apoptosis and inductors of genotoxicity, might control tumor recruitment and, thus, provide therapeutic benefits. Scientific evidence shows that the effects of ionizing radiation on cellular compartments and functions are strengthened by EMF. Although little is known about the potential role of EMFs in radiotherapy (RT, the radiosensitizing effect of EMFs described in the literature could support their use to improve radiation effectiveness. Thus, we hypothesized that EMF exposure might enhance the ionizing radiation effect on tumor cells, improving the effects of RT. The aim of this paper is to review reports of the effects of EMFs in biological systems and their potential therapeutic benefits in radiotherapy.

  17. Regression of posterior uveal melanomas following cobalt-60 plaque radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cruess, A.F.; Augsburger, J.J.; Shields, J.A.; Brady, L.W.; Markoe, A.M.; Day, J.L.


    A method has been devised for evaluating the rate and extent of regression of the first 100 consecutive patients with a posterior uveal melanoma that had been managed by Cobalt-60 plaque radiotherapy at Wills Eye Hospital. It was found that the average posterior uveal melanoma in the series did not regress rapidly to a flat, depigmented scar but shrank slowly and persisted as a residual mass approximately 50% of the thickness of the original tumor at 54 months following Cobalt-60 plaque radiotherapy. The authors also found that the rate and extent of regression of the tumors in patients who subsequently developed metastatic melanoma were not appreciably different from the rate and extent of regression of the tumors in patients who remained well systemically. These observations indicate that the rate and extent of regression of posterior uveal melanomas following Cobalt-60 plaque radiotherapy are poor indicators of the prognosis of the affected patients for subsequent development of clinical metastatic disease.

  18. Increased pancreatic cancer risk following radiotherapy for testicular cancer. (United States)

    Hauptmann, Michael; Børge Johannesen, Tom; Gilbert, Ethel S; Stovall, Marilyn; van Leeuwen, Flora E; Rajaraman, Preetha; Smith, Susan A; Weathers, Rita E; Aleman, Berthe M P; Andersson, Michael; Curtis, Rochelle E; Dores, Graça M; Fraumeni, Joseph F; Hall, Per; Holowaty, Eric J; Joensuu, Heikki; Kaijser, Magnus; Kleinerman, Ruth A; Langmark, Frøydis; Lynch, Charles F; Pukkala, Eero; Storm, Hans H; Vaalavirta, Leila; van den Belt-Dusebout, Alexandra W; Morton, Lindsay M; Fossa, Sophie D; Travis, Lois B


    Pancreatic cancer risk is elevated among testicular cancer (TC) survivors. However, the roles of specific treatments are unclear. Among 23 982 5-year TC survivors diagnosed during 1947-1991, doses from radiotherapy to the pancreas were estimated for 80 pancreatic cancer patients and 145 matched controls. Chemotherapy details were recorded. Logistic regression was used to estimate odds ratios (ORs). Cumulative incidence of second primary pancreatic cancer was 1.1% at 30 years after TC diagnosis. Radiotherapy (72 (90%) cases and 115 (80%) controls) was associated with a 2.9-fold (95% confidence interval (CI) 1.0-7.8) increased risk. The OR increased linearly by 0.12 per Gy to the pancreas (P-trendcancer risk, and persists for over 20 years. These excesses, although small, should be considered when radiotherapy with exposure to the pancreas is considered for newly diagnosed patients. Additional data are needed on the role of chemotherapy.

  19. Could Radiotherapy Effectiveness Be Enhanced by Electromagnetic Field Treatment? (United States)

    Francisco, Artacho-Cordón; del Mar, Salinas-Asensio María; Irene, Calvente; Sandra, Ríos-Arrabal; Josefa, León; Elisa, Román-Marinetto; Nicolás, Olea; Isabel, Núñez María


    One of the main goals in radiobiology research is to enhance radiotherapy effectiveness without provoking any increase in toxicity. In this context, it has been proposed that electromagnetic fields (EMFs), known to be modulators of proliferation rate, enhancers of apoptosis and inductors of genotoxicity, might control tumor recruitment and, thus, provide therapeutic benefits. Scientific evidence shows that the effects of ionizing radiation on cellular compartments and functions are strengthened by EMF. Although little is known about the potential role of EMFs in radiotherapy (RT), the radiosensitizing effect of EMFs described in the literature could support their use to improve radiation effectiveness. Thus, we hypothesized that EMF exposure might enhance the ionizing radiation effect on tumor cells, improving the effects of RT. The aim of this paper is to review reports of the effects of EMFs in biological systems and their potential therapeutic benefits in radiotherapy. PMID:23867611

  20. Faecal incontinence following radiotherapy for prostate cancer: A systematic review

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Høyer, Morten; Lundby, Lilli


    for this review. The incidence of faecal incontinence following radiotherapy for prostate cancer varied from 1.6% to 58%. The mechanism of faecal incontinence was not entirely clear but it is most likely due to injury to the nerve plexus of the rectal muscular layer. Correlation between rectal dose......BACKGROUND: Faecal incontinence (FI) after radiotherapy is a known phenomenon, but has received little attention to date. This article aimed to review current knowledge on faecal incontinence related to radiotherapy for prostate cancer. METHODS: PubMed was searched for English-language articles...... screened permissively and evaluated as to whether they satisfied the predefined inclusion and exclusion criteria. RESULTS: Nine hundred and ninety four articles were identified from the search. After step-wise review, 213 papers were selected for full article review of which 40 were selected...

  1. Dose factor entry and display tool for BNCT radiotherapy (United States)

    Wessol, Daniel E.; Wheeler, Floyd J.; Cook, Jeremy L.


    A system for use in Boron Neutron Capture Therapy (BNCT) radiotherapy planning where a biological distribution is calculated using a combination of conversion factors and a previously calculated physical distribution. Conversion factors are presented in a graphical spreadsheet so that a planner can easily view and modify the conversion factors. For radiotherapy in multi-component modalities, such as Fast-Neutron and BNCT, it is necessary to combine each conversion factor component to form an effective dose which is used in radiotherapy planning and evaluation. The Dose Factor Entry and Display System is designed to facilitate planner entry of appropriate conversion factors in a straightforward manner for each component. The effective isodose is then immediately computed and displayed over the appropriate background (e.g. digitized image).

  2. Rapidly Growing Esophageal Carcinosarcoma Reduced by Neoadjuvant Radiotherapy Alone

    Directory of Open Access Journals (Sweden)

    Naotaka Ogasawara


    Full Text Available Esophageal carcinosarcoma is a rare malignant neoplasm consisting of both carcinomatous and sarcomatous components. It is generally treated by surgery, radiotherapy and chemotherapy according to the protocols used for other esophageal cancers. However, the treatment of esophageal carcinosarcoma by radiotherapy alone before surgery has not been previously described. We report a patient with a rapidly growing esophageal carcinosarcoma that was efficiently reduced by neoadjuvant radiotherapy alone. A previously healthy 69-year-old man was admitted with dysphagia. Initial esophagogastroduodenoscopy (EGD revealed a small nodular polypoid lesion of about 10 mm in the middle esophagus. A second EGD 1 month later showed that the tumor had expanded into a huge mass. A biopsy specimen revealed that the tumor comprised squamous cell carcinoma with spindle cell components, and the tumor was diagnosed as carcinosarcoma which was diagnosed as stage I (T1bN0M0. Due to renal dysfunction, the patient was treated with neoadjuvant radiotherapy (40 Gy without chemotherapy. A third EGD 1 month later revealed remarkable tumor reduction. He then underwent total esophagectomy with regional lymph node dissection (pStage 0, pT1aN0M0. After surgical operation, the patient was followed up without adjuvant therapy. Whole body computed tomography revealed lung metastasis 14 months after surgery, and the patient died 2 months later. The neoadjuvant radiotherapy for esophageal carcinosarcoma was considered to have contributed to the subsequent surgery and his prolonged survival time. Thus, radiotherapy alone might be a suitable neoadjuvant therapy for esophageal carcinosarcomas.

  3. Recommendations for safer radiotherapy: what’s the message?

    Directory of Open Access Journals (Sweden)

    Peter eDunscombe


    Full Text Available Radiotherapy, with close to a million courses delivered per year in North America, is a very safe and effective intervention for a devastating disease. However, although rare, several deeply regrettable incidents have occurred in radiotherapy and have rightly been the subject of considerable public interest. Partly in response to reports of these incidents a variety of authoritative organizations across the globe has harnessed the expertise amongst their members in attempts to identify the measures that will make radiotherapy safer. While the intentions of all these organizations are clearly good it is challenging for the health care providers in the clinic to know where to start with so much advice coming from so many directions. Through a mapping exercise we have identified commonalities between recommendations made in seven authoritative documents and identified those issues most frequently cited. The documents reviewed contain a total of 117 recommendations. Using the 37 recommendations in Towards Safer Radiotherapy as the initial base layer, recommendations in the other documents were mapped, adding to the base layer to accommodate all the recommendations from the additional six documents as necessary. This mapping exercise resulted in the distillation of the original 117 recommendations down to 61 unique recommendations. Twelve topics were identified in three or more of the documents as being pertinent to the improvement of patient safety in radiotherapy. They are, in order of most to least cited: training, staffing, documentation, incident learning, communication, check lists, quality control and preventive maintenance, dosimetric audit, accreditation, minimizing interruptions, prospective risk assessment and safety culture. This analysis provides guidance for the selection of those activities most likely to enhance safety and quality in radiotherapy based on the frequency of citation in selected recent authoritative literature.

  4. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    Energy Technology Data Exchange (ETDEWEB)

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


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

  5. Unilateral Radiotherapy for the Treatment of Tonsil Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chronowski, Gregory M., E-mail: [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S.; Morrison, William H.; Frank, Steven J. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Schwartz, David L. [Department of Radiation Medicine, Long Island Jewish Hospital (United States); Shah, Shalin J.; Beadle, Beth M.; Gunn, G. Brandon [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Kupferman, Michael E. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Ang, Kian K.; Rosenthal, David I. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)


    Purpose: To assess, through a retrospective review, clinical outcomes of patients with squamous cell carcinoma of the tonsil treated at the M. D. Anderson Cancer Center with unilateral radiotherapy techniques that irradiate the involved tonsil region and ipsilateral neck only. Methods and Materials: Of 901 patients with newly diagnosed squamous cell carcinoma of the tonsil treated with radiotherapy at our institution, we identified 102 that were treated using unilateral radiotherapy techniques. All patients had their primary site of disease restricted to the tonsillar fossa or anterior pillar, with <1 cm involvement of the soft palate. Patients had TX (n = 17 patients), T1 (n = 52), or T2 (n = 33) disease, with Nx (n = 3), N0 (n = 33), N1 (n = 23), N2a (n = 21), or N2b (n = 22) neck disease. Results: Sixty-one patients (60%) underwent diagnostic tonsillectomy before radiotherapy. Twenty-seven patients (26%) underwent excision of a cervical lymph node or neck dissection before radiotherapy. Median follow-up for surviving patients was 38 months. Locoregional control at the primary site and ipsilateral neck was 100%. Two patients experienced contralateral nodal recurrence (2%). The 5-year overall survival and disease-free survival rates were 95% and 96%, respectively. The 5-year freedom from contralateral nodal recurrence rate was 96%. Nine patients required feeding tubes during therapy. Of the 2 patients with contralateral recurrence, 1 experienced an isolated neck recurrence and was salvaged with contralateral neck dissection only and remains alive and free of disease. The other patient presented with a contralateral base of tongue tumor and involved cervical lymph node, which may have represented a second primary tumor, and died of disease. Conclusions: Unilateral radiotherapy for patients with TX-T2, N0-N2b primary tonsil carcinoma results in high rates of disease control, with low rates of contralateral nodal failure and a low incidence of acute toxicity

  6. Oral cancer: Current role of radiotherapy and chemotherapy. (United States)

    Huang, Shao-Hui; O'Sullivan, Brian


    The term oral cavity cancer (OSCC) constitutes cancers of the mucosal surfaces of the lips, floor of mouth, oral tongue, buccal mucosa, lower and upper gingiva, hard palate and retromolar trigone. Treatment approaches for OSCC include single management with surgery, radiotherapy [external beam radiotherapy (EBRT) and/or brachytherapy], as well as adjuvant systemic therapy (chemotherapy and/or target agents); various combinations of these modalities may also be used depending on the disease presentation and pathological findings. The selection of sole or combined modality is based on various considerations that include disease control probability, the anticipated functional and cosmetic outcomes, tumor resectability, patient general condition, and availability of resources and expertise. For resectable OSCC, the mainstay of treatment is surgery, though same practitioners may advocate for the use of radiotherapy alone in selected "early" disease presentations or combined with chemotherapy in more locally advanced stage disease. In general, the latter is more commonly reserved for cases where surgery may be problematic. Thus, primary radiotherapy ± chemotherapy is usually reserved for patients unable to tolerate or who are otherwise unsuited for surgery. On the other hand, brachytherapy may be considered as a sole modality for early small primary tumor. It also has a role as an adjuvant to surgery in the setting of inadequate pathologically assessed resection margins, as does postoperative external beam radiotherapy ± chemotherapy, which is usually reserved for those with unfavorable pathological features. Brachytherapy can also be especially useful in the re-irradiation setting for persistent or recurrent disease or for a second primary arising within a previous radiation field. Biological agents targeting the epithelial growth factor receptor (EGFR) have emerged as a potential modality in combination with radiotherapy or chemoradiotherapy and are currently under

  7. Stereotactic radiotherapy as an alternative to plaque brachytherapy in retinoblastoma. (United States)

    Eldebawy, Eman; Patrocinio, Horacio; Evans, Michael; Hashem, Rania; Nelson, Sylvie; Sidi, Rubina; Freeman, Carolyn


    Radioactive plaque brachytherapy has an established role for selected patients with retinoblastoma. Newer non-invasive radiotherapy techniques such as stereotactic conformal radiotherapy (SCR) that uses highly accurate positioning to deliver treatment with small beams may be an interesting alternative to brachytherapy. We report a case treated with SCR and compare the dosimetry with that achievable with brachytherapy. With advantages and disadvantages to both, SCR should more often be considered in the management of RB because of the more homogeneous dose within the target volume and similar or lower doses to surrounding normal tissues.

  8. [Radiotherapy of chloroma or granulocytic sarcoma: A literature review]. (United States)

    Yossi, S; de Talhouet, S; Ducastelle-Leprêtre, S; Hassouni, A; Pigné, G; Selmaji, I; Samlali, H; Ginoux, M; Caraivan, I; d'Hombres, A


    Granulocytic sarcoma, or chloroma, is a rare clinical entity, usually associated with a blood disease, including acute myeloid leukemia. Management strategies are based on the combination of systemic therapy and local therapy (surgery or radiation). Data for radiotherapy dose are derived from retrospective studies and case reports. We conducted a literature review using the Pubmed search engine to clarify the terms and indications for radiotherapy of chloromas. Copyright © 2015 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  9. Interobserver delineation variation in lung tumour stereotacticbody radiotherapy

    DEFF Research Database (Denmark)

    Persson, G. F.; Nygaard, D. E.; Hollensen, Christian


    Objectives In radiotherapy, delineation uncertainties are important as they contribute to systematic errors and can lead to geographical miss of the target. For margin computation, standard deviations (SDs) of all uncertainties must be included as SDs. The aim of this study was to quantify...... the interobserver delineation variation for stereotactic body radiotherapy (SBRT) of peripheral lung tumours using a cross-sectional study design. Methods 22 consecutive patients with 26 tumours were included. Positron emission tomography/CT scans were acquired for planning of SBRT. Three oncologists and three...

  10. [Radiotherapy and implantable medical device: example of infusion pumps]. (United States)

    Abrous-Anane, S; Benhassine, S; Lopez, S; Cristina, K; Mazeron, J-J


    Indication for radiotherapy is often questioned for patients equipped with implantable medical devices like infusion pumps as the radiation tolerance is poor or not known. We report here on the case of a patient who we treated with pelvic radiotherapy for cervical cancer and who had an infusion pump in iliac fossa. We conducted a series of tests on five identical pumps that insured that the treatment protocol is harmless to the implanted device. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  11. The use of antioxidants in radiotherapy-induced skin toxicity. (United States)

    Amber, Kyle T; Shiman, Michael I; Badiavas, Evangelos V


    Radiation-induced skin damage is one of the most common complications of radiotherapy. In order to combat these side effects, patients often turn to alternative therapies, which often include antioxidants. Antioxidants such as those in the polyphenol chemical class, xanthine derivatives, tocepherol, sucralfate, and ascorbate have been studied for their use in either preventing or treating radiotherapy-induced skin damage. Apart from their known role as free radical scavengers, some of these antioxidants appear to alter cytokine release affecting cutaneous and systemic changes. We review the role of antioxidants in treating and preventing radiation-induced skin damage as well as the possible complications of using such therapy.

  12. Bronchiolitis obliterans organising pneumonia: a consequence of breast radiotherapy. (United States)

    Fahim, Ahmed; Campbell, Anne P; Hart, Simon Paul


    The authors describe a case of 51-year-old woman who presented with breathlessness following radiotherapy for breast carcinoma. A chest radiograph and thoracic CT scan revealed extensive airspace consolidation affecting right upper and lower lobes. A trans-bronchial biopsy revealed evidence of foamy macrophages and fibroblastic plugs within alveoli, consistent with organising pneumonia. Indirect immunofluorescence microscopy revealed evidence of antiepithelial antibodies. Gradual but complete resolution occurred without any specific treatment. This case highlights the importance of considering radiation induced bronchiolitis obliterans organising pneumonia in the context of parenchymal shadowing following radiotherapy. Although corticosteroids are widely recommended for treatment, this case illustrates that organising pneumonia may resolve spontaneously.

  13. Radiation therapy in elderly patients; Radiotherapie et sujet age

    Energy Technology Data Exchange (ETDEWEB)

    Durdux, C.; Boisserie, T. [Hopital Europeen Georges-Pompidou, Service de Radiotherapie, 75 - Paris (France); Gisselbrecht, M. [Hopital Europeen Georges-Pompidou, Service de Geriatrie, 75 - Paris (France)


    Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatment against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation, as dose, irradiated volume and fractionation. (authors)

  14. [Biochemical recurrence criteria after radiotherapy (external beam, brachytherapy). Natural history of the disease after radiotherapy]. (United States)

    Villoslada, Carmen Ibáñez; Olombrada, Maria Victoria de Torres; San Segundo, Carmen González


    Prostate specific antigen (PSA) is the main tool in the follow-up of prostate cancer patients after definitive therapy. It's widely used as an early marker to value treatment success. Biochemical recurrence predicts metastatic disease progression and prostate cancer-specific mortality. In 1996, the American Society for Therapeutic Radiology and Oncology (ASTRO) provided a definition of biochemical failure after radiotherapy, based on three consecutive increases in PSA after nadir. As more experience was gained using the proposed definition and follow up duration in the PSA era matured, deficiencies and controversial issues emerged, so more recently proposed candidate definitions have provided consistent outcome. In view of the criticisms, a second consensus conference was held on 2005, with "nadir + 2 ng/ml" accepted as standard definition. The natural history and evidence of PSA kinetic parameters and different definitions of biochemical failure after external beam radiation therapy and/or brachytherapy are reviewed in the following article.

  15. Metabolic radiotherapy: which place in 2001?; Radiotherapie metabolique: quel role en 2001?

    Energy Technology Data Exchange (ETDEWEB)

    Georges, B.; Douard, M.C. [Hopital Saint-Louis, Unite Douleur, Dept. d' Anesthesie-Reanimation, 75 - Paris (France); Rain, J.D. [Hopital Saint-Louis, Service de Medecine Nucleaire, 75 - Paris (France)


    Metabolic radiotherapy is a new therapy for management of bone pain in patients with bone metastatic prostate carcinoma. Strontium-89 and Samarium-153 concentrate in bone metastases and radiate them. A pain decrease is obtained in 60-70% of cases. Side effects are a significant hematological depression without great clinical consequences if good therapeutic indications are respected. Our multidisciplinary experience of these radionuclides in 54 performed treatments shows a rate of good responders of 66 % with a rate of excellent results (total decrease of pain) in 47%. The therapeutic effectiveness is correlated with pain intensity measured by Visual Analogic Scale (VAS) and equivalent dose of morphine. Radionuclide therapy should be applied to patients as early as possible alter establishment of bone metastases. (author)

  16. Intraoperative radiotherapy: back to the future?; Quel avenir pour la radiotherapie peroperatoire?

    Energy Technology Data Exchange (ETDEWEB)

    Dubois, J.B. [CRLC Val-d' Aurelle - Paul-Lamarque, Dept. d' Oncologie Radiotherapie, 34 - Montpellier (France)


    Since the first Japanese publications, intraoperative radiotherapy (I.O.R.T.) has been used with electrons delivered with homogeneous techniques in miscellaneous indications. The main goal was to increase the total dose in a limited volume leading to an optimized therapeutic ratio between the tumor and the healthy tissue. The main indications are not only recurrences of digestive and gynecological tumors but also retroperitoneal sarcomas. Recently, the development of the concept of partial breast irradiation reinforces the use of such a technique in the strategy of breast-conserving surgery for small tumors in the elderly. I.O.R.T. was evaluated either as boost or as an exclusive treatment delivering one fraction during the surgical procedure. (author)

  17. Epicondylopathia humeri. Indication, technique and clinical results of radiotherapy; Epicondylopathia humeri. Indikation, Technik, klinische Ergebnisse der Radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H. [Strahlentherapeutische Klinik und Poliklinik, Waldkrankenhaus St. Marien, Erlangen-Nuernberg Univ., Erlangen (Germany)]|[Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfred-Krupp von Bohlen und Halbach-Krankenhaus, Essen (Germany); Keilholz, L. [Strahlentherapeutische Klinik und Poliklinik, Waldkrankenhaus St. Marien, Erlangen-Nuernberg Univ., Erlangen (Germany); Martus, P. [Inst. fuer Medizinische Statistik und Dokumentation, Waldkrankenhaus St. Marien, Erlangen-Nuernberg Univ., Erlangen (Germany); Kuhr, M. [Orthopaedische Klinik, Waldkrankenhaus St. Marien, Erlangen-Nuernberg Univ., Erlangen (Germany); Wichmann, G. [Strahlentherapeutische Klinik und Poliklinik, Waldkrankenhaus St. Marien, Erlangen-Nuernberg Univ., Erlangen (Germany); Sauer, R. [Strahlentherapeutische Klinik und Poliklinik, Waldkrankenhaus St. Marien, Erlangen-Nuernberg Univ., Erlangen (Germany)


    Background: The efficacy of radiotherapy for degenerative-inflammatory disorders is well known, but so far long-term observations and reliable assessment of symptoms according to objective criteria and scores for validation are still missing. Results: Forty-three patients (ot totally 85)(50 elbows of totally 93) achieved `complete pain relief (CR)` in all pain categories: 59% elbows with pain at strain had `complete pain relief`, 79% with pain at night, 84% with permanent pain, 80% with pain at rest and 81% with pain at initiation or morning stiffness. Nineteen elbows gained `major pain relief (PR)`, i.e. had minor symptoms (maximum grade 1) in all categories. Thus, a total of 69 (74%) elbows responded to radiotherapy. Seventeen patients (19 elbows) were operated because of persistent symptoms or dissatisfaction in long-term follow-up; 7 of those became completely free of symptoms. The Morrey-Score improved by a mean of 18 points from 78 prior to radiotherapy to 96 points at last follow-up. According to the Morrey-Score only 2 patients became worse in long-term follow-up. Two parameters indicated a negative prognosis in multivariate analysis: Long symptom duration prior to radiotherapy and immobilisation with plaster (p<0.05). Conclusions: Radiotherapy for refractory epicondylopathia humeri is highly effective. Long symptom duration and long-term immobilisation by plaster are negative prognostic factors for treatment outcome. Due to the low side effects and treatment costs, radiotherapy is a good therapeutic option in comparison to conventional treatment methods and surgery in the chronic stage of epicondylopathia humeri. (orig./VHE) [Deutsch] Hintergrund: Die Wirksamkeit der Radiotherapie bei degenerativ-entzuendlichen Erkrankungen ist klinisch zwar gut belegt, doch fehlen ausreichende Langzeitbeobachtungen und eine Bewertung nach objektivierbaren Kriterien zur Validierung. Ergebnis: 43 Patienten (von insgesamt 85)(50 Ellenbogen von insgesamt 93) wurden in allen

  18. The radiological protection in the radiotherapy; La proteccion radiologica en la radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Castaneda M, A.; Gonzalez N, A. G. [Comision Nacional de Seguridad Nuclear y Salvaguardias, Dr. Barragan No. 779, Col. Narvarte, 03020 Mexico D. F. (Mexico)


    The cancer incidence in the world has been increased with the course of the time. Fifty percent of the patients receive radiotherapy, as much in the initial treatment, as in the recurrence cases or palliatives. At the moment is considered that in 1998 there were 2,500 teletherapy machines in operation in the countries in development and for the year 2015 will be necessary 10,000. In Mexico the use of these teletherapy units goes back to the year of 1956, when the effort of the Dr. Noriega Limon was consolidated with the installation of the first teletherapy unit with a cobalt 60 source in the National Medical Center of the IMSS. In the same decade the operation began of the Calibration Secondary Center located in the facilities of the General Hospital of Assistance and Health Secretary where a group of seven physicists began in the metrology techniques. Also the national authority in matter of the ionizing radiations use appears and promulgates the first Law in Nuclear Matter. The application has extended in the country, as well as other techniques that have gone incorporating for the cancer treatment. Such as: the brachytherapy, the stereo ataxia and the ophthalmic applicators. In the current application of the radiotherapy several factors are interrelated that have for objective that the dose to the workers and the public is as low as reasonably it can be achieved and that the patient receives the dose prescribed by the medical treatable in the organ or tissue and in the orderly quantity with the minor damage for the healthy tissues. To reach all this, it is necessary to have equipment s, systems, procedures, personal and standards that improve their quality in a gradual but firm way, also the good communication and comprehension among authorities are fundamental for this noble task. (Author)

  19. Measuring the Quality of Personal Care in Patients Undergoing Radiotherapy for Prostate Cancer. (United States)

    Foley, K A; Groome, P A; Feldman-Stewart, D; Brundage, M D; Foley, J H; McArdle, S; Mackillop, W J


    To describe the quality of the non-technical component of the care (personal care) of patients receiving radical radiotherapy for prostate cancer and to identify elements of personal care that should be priorities for quality improvement. One hundred and eight patients undergoing radiotherapy for localised prostate cancer completed a self-administered questionnaire that asked them to rate the importance of 143 non-technical elements of care and to rate the quality of their own care with respect to each element. The elements that a patient rated as both 'very important' and less than 'very good' were deemed to be his priorities for improvement. The priorities of the population were established by ranking the elements based on the percentage of patients who identified them as a priority (importance/quality analysis). The response rate was 65%. The percentage of elements rated 'very good' varied from patient to patient: median 79% (interquartile range 69-92%). The percentage of elements rated either 'very good' or 'good' was higher: median 96% (interquartile range 86-98%). Nonetheless, almost every patient rated at least some elements of his care as less than optimal, regardless of the cut-off point used to define optimal quality. Patients assigned their lowest quality ratings to elements relating to the quality of the treatment environment and comprehensiveness of additional services available to them. However, patients rated most of these elements as relatively unimportant, and importance/quality analysis identified elements of care relating to communication of information about the disease and its treatment as the highest priorities for quality improvement. Most patients rated most elements of their personal care as very good, but almost all were able to identify some elements that were less than optimal. When ratings of quality were integrated with ratings of importance, elements relating to communication emerged as the patients' highest priorities for quality

  20. Exploring Genetic Attributions Underlying Radiotherapy-Induced Fatigue in Prostate Cancer Patients. (United States)

    Hashemi, Sepehr; Fernandez Martinez, Juan Luis; Saligan, Leorey; Sonis, Stephen


    Despite numerous proposed mechanisms, no definitive pathophysiology underlying radiotherapy-induced fatigue (RIF) has been established. However, the dysregulation of a set of 35 genes was recently validated to predict development of fatigue in prostate cancer patients receiving radiotherapy. To hypothesize novel pathways, and provide genetic targets for currently proposed pathways implicated in RIF development through analysis of the previously validated gene set. The gene set was analyzed for all phenotypic attributions implicated in the phenotype of fatigue. Initially, a "directed" approach was used by querying specific fatigue-related sub-phenotypes against all known phenotypic attributions of the gene set. Then, an "undirected" approach, reviewing the entirety of the literature referencing the 35 genes, was used to increase analysis sensitivity. The dysregulated genes attribute to neural, immunological, mitochondrial, muscular, and metabolic pathways. In addition, certain genes suggest phenotypes not previously emphasized in the context of RIF, such as ionizing radiation sensitivity, DNA damage, and altered DNA repair frequency. Several genes also associated with prostate cancer depression, possibly emphasizing variable radiosensitivity by RIF-prone patients, which may have palliative care implications. Despite the relevant findings, many of the 35 RIF-predictive genes are poorly characterized, warranting their investigation. The implications of herein presented RIF pathways are purely theoretical until specific end-point driven experiments are conducted in more congruent contexts. Nevertheless, the presented attributions are informative, directing future investigation to definitively elucidate RIF's pathoetiology. This study demonstrates an arguably comprehensive method of approaching known differential expression underlying a complex phenotype, to correlate feasible pathophysiology. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All