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Sample records for conventionally fractionated radiotherapy

  1. Prostate-specific antigen kinetics following hypofractionated stereotactic body radiotherapy boost as post-external beam radiotherapy versus conventionally fractionated external beam radiotherapy for localized prostate cancer

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    Phak, Jeong Hoon; Kim, Hun Jung; Kim, Woo Chul

    2015-01-01

    Background Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment for localized prostate cancer. The purpose of this study was to compare the prostate-specific antigen (PSA) kinetics between conventionally fractionated external beam radiotherapy (CF-EBRT) and SBRT boost after whole pelvis EBRT (WP-EBRT) in localized prostate cancer. Methods A total of 77 patients with localized prostate cancer [T-stage, T1–T3; Gleason score (GS) 5–9; PSA 

  2. Tcp and NTCP radiobiological models: conventional and hypo fractionated treatments in radiotherapy

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    Astudillo V, A.; Paredes G, L. [ININ, Carretera Mexico-Toluca s/n, Ocoyoacac 52750, Estado de Mexico (Mexico); Resendiz G, G.; Posadas V, A. [Hospital Angeles Lomas, Av. Vialidad de la Barranca s/n, Col. Valle de las Palmas, 52763 Huixquilucan de Degallado, Estado de Mexico (Mexico); Mitsoura, E. [Universidad Autonoma del Estado de Mexico, Facultad de Medicina, Paseo Tollocan, Esq. Jesus Carranza s/n, Col. Moderna de la Cruz, 50180 Toluca, Estado de Mexico (Mexico); Rodriguez L, A.; Flores C, J. M., E-mail: armando.astudillo@inin.gob.mx [Hospital Medica Sur, Puente de Piedra 150, Col. Toriello Guerra, 14050 Tlalpan, Mexico D. F. (Mexico)

    2015-10-15

    The hypo and conventional fractionated schedules performance were compared in terms of the tumor control and the normal tissue complications. From the records of ten patients, treated for adenocarcinoma and without mastectomy, the dose-volume histogram was used. Using radiobiological models the probabilities for tumor control and normal tissue complications were calculated. For both schedules the tumor control was approximately the same. However, the damage in the normal tissue was larger in conventional fractionated schedule. This is important because patients assistance time to their fractions (15 fractions/25 fractions) can be optimized. Thus, the hypo fractionated schedule has suitable characteristics to be implemented. (Author)

  3. Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy. Results of a single, institutional, retrospective study

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    Rudat, Volker; Nour, Alaa; Hammoud, Mohamed; Abou Ghaida, Salam [Saad Specialist Hospital, Department of Radiation Oncology, Al Khobar (Saudi Arabia)

    2017-05-15

    The aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy. Patients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction. In all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3-4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF. HF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF. (orig.) [German] Ziel der Untersuchung war es, Faktoren zu identifizieren, die mit ungeplanten Behandlungsunterbrechungen bei der adjuvanten Strahlentherapie des Mammakarzinoms assoziiert sind. Es wurden Patienten untersucht, die eine adjuvante Strahlentherapie der Mamma oder Brustwand zwischen Maerz 2014 und August 2016 erhielten. Zur Anwendung kamen als Fraktionierungsprotokoll und strahlentherapeutische Technik eine konventionell fraktionierte (CF; 28 Fraktionen mit

  4. Conventional fractionation radiotherapy combined with 5-fluorouracil for metastatic malignant melanoma

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    Klausner, J.M.; Gutman, M.; Rozin, R.R.; Lelcuk, S.; Chaitchik, S.; Inbar, M.

    1987-10-01

    Clinical and experimental data suggest a synergistic antitumoral effect with the combined treatment of radiotherapy and 5-fluorouracil (5-FU) serving as a radiosensitizer. This combined modality was studied in 30 malignant melanoma patients with advanced locoregional or isolated, bulky, soft-tissue or visceral metastases. All patients were symptomatic, pain being the chief complaint, followed by symptoms related to large tumors. Treatment was given on an ambulatory basis, twice weekly, and consisted of 5-FU, 500 mg/m2 administered in 8-h i.v. drip infusion, followed by radiotherapy 8 h after completion of the 5-FU administration. /sup 60/Co teleunit, delivering 400 rad per dose per fraction, was given over 6 1/2 weeks to a total of 5,200 rad. The overall response rate was 70% (21 of 30 patients). Three patients (10%) achieved a complete response lasting from 3 to 11 months, and 18 (60%) achieved a partial response lasting from 3 to 13 months. The response rate was 82% for skin, 75% for lymph node, and 43% for visceral metastases. Symptomatic relief was obtained in 83% (25 of 30) of the patients. This palliative therapy was well-tolerated, and patients were able to maintain their routine lifestyles throughout. Only in one patient was 5-FU abandoned after 3 weeks, due to cardiac ischemia. Similar response rates have only been achieved with radiotherapy alone employing individual fractions of 600 rad or higher. Since the 5-FU we added is known to have a very limited effect on malignant melanoma, this study suggests its potential as a radiosensitizer in malignant melanoma.

  5. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial

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    Aluwini, S.; Pos, F.; Schimmel, E.; Lin, E.N.J.T. van; Krol, S.; Toorn, P.P. van der; Jager, H.; Dirkx, M.; Alemayehu, W.G.; Heijmen, B.; Incrocci, L.

    2015-01-01

    BACKGROUND: In 2007, we began the randomised phase 3 multicentre HYPRO trial to investigate the effect of hypofractionated radiotherapy compared with conventionally fractionated radiotherapy on relapse-free survival in patients with prostate cancer. Here, we examine whether patients experience diffe

  6. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): Acute toxicity results from a randomised non-inferiority phase 3 trial

    NARCIS (Netherlands)

    S. Aluwini (Shafak); F.J. Pos (Floris); E. Schimmel (Erik); E. van Lin (Emile); S. Krol (Stijn); P.-P. van der Toorn (Peter-Paul); H. de Jager (Hanja); M.L.P. Dirkx (Maarten); W.G. Alemayehu (Wendimagegn Ghidey); B.J.M. Heijmen (Ben); L. Incrocci (Luca)

    2015-01-01

    textabstractBackground: In 2007, we began the randomised phase 3 multicentre HYPRO trial to investigate the effect of hypofractionated radiotherapy compared with conventionally fractionated radiotherapy on relapse-free survival in patients with prostate cancer. Here, we examine whether patients expe

  7. Elective Lymph Node Irradiation With Intensity-Modulated Radiotherapy: Is Conventional Dose Fractionation Necessary?

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    Bedi, Meena; Firat, Selim; Semenenko, Vladimir A.; Schultz, Christopher; Tripp, Patrick; Byhardt, Roger [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Wang, Dian, E-mail: dwang@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States)

    2012-05-01

    Purpose: Intensity-modulated radiation therapy (IMRT) is the standard of care for head-and-neck cancer (HNC). We treated patients with HNC by delivering either a moderate hypofractionation (MHF) schedule (66 Gy at 2.2 Gy per fraction to the gross tumor [primary and nodal]) with standard dose fractionation (54-60 Gy at 1.8-2.0 Gy per fraction) to the elective neck lymphatics or a conventional dose and fractionation (CDF) schedule (70 Gy at 2.0 Gy per fraction) to the gross tumor (primary and nodal) with reduced dose to the elective neck lymphatics. We analyzed these two cohorts for treatment outcomes. Methods and Materials: Between November 2001 and February 2009, 89 patients with primary carcinomas of the oral cavity, larynx, oropharynx, hypopharynx, and nasopharynx received definitive IMRT with or without concurrent chemotherapy. Twenty patients were treated using the MHF schedule, while 69 patients were treated with the CDF schedule. Patient characteristics and dosimetry plans were reviewed. Patterns of failure including local recurrence (LR), regional recurrence (RR), distant metastasis (DM), disease-free survival (DFS), overall survival (OS), and toxicities, including rate of feeding tube placement and percentage of weight loss, were reviewed and analyzed. Results: Median follow-up was 31.2 months. Thirty-five percent of patients in the MHF cohort and 77% of patients in the CDF cohort received chemotherapy. No RR was observed in either cohort. OS, DFS, LR, and DM rates for the entire group at 2 years were 89.3%, 81.4%, 7.1%, and 9.4%, respectively. Subgroup analysis showed no significant differences in OS (p = 0.595), DFS (p = 0.863), LR (p = 0.833), or DM (p = 0.917) between these two cohorts. Similarly, no significant differences were observed in rates of feeding tube placement and percentages of weight loss. Conclusions: Similar treatment outcomes were observed for MHF and CDF cohorts. A dose of 50 Gy at 1.43 Gy per fraction may be sufficient to electively

  8. Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy

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    Lavoie, Caroline; Higgins, Jane; Bissonnette, Jean-Pierre [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, M5G 2M9 (Canada); Le, Lisa W. [Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9 (Canada); Sun, Alexander; Brade, Anthony; Hope, Andrew; Cho, John [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, M5G 2M9 (Canada); Bezjak, Andrea, E-mail: andrea.bezjak@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, M5G 2M9 (Canada)

    2012-12-01

    Purpose: To compare the relative accuracy of 2 image guided radiation therapy methods using carina vs spine as landmarks and then to identify which landmark is superior relative to tumor coverage. Methods and Materials: For 98 lung patients, 2596 daily image-guidance cone-beam computed tomography scans were analyzed. Tattoos were used for initial patient alignment; then, spine and carina registrations were performed independently. A separate analysis assessed the adequacy of gross tumor volume, internal target volume, and planning target volume coverage on cone-beam computed tomography using the initial, middle, and final fractions of radiation therapy. Coverage was recorded for primary tumor (T), nodes (N), and combined target (T+N). Three scenarios were compared: tattoos alignment, spine registration, and carina registration. Results: Spine and carina registrations identified setup errors {>=}5 mm in 35% and 46% of fractions, respectively. The mean vector difference between spine and carina matching had a magnitude of 3.3 mm. Spine and carina improved combined target coverage, compared with tattoos, in 50% and 34% (spine) to 54% and 46% (carina) of the first and final fractions, respectively. Carina matching showed greater combined target coverage in 17% and 23% of fractions for the first and final fractions, respectively; with spine matching, this was only observed in 4% (first) and 6% (final) of fractions. Carina matching provided superior nodes coverage at the end of radiation compared with spine matching (P=.0006), without compromising primary tumor coverage. Conclusion: Frequent patient setup errors occur in locally advanced lung cancer patients. Spine and carina registrations improved combined target coverage throughout the treatment course, but carina matching provided superior combined target coverage.

  9. Prospective randomized trial to compare accelerated (six fractions a week radiotherapy against concurrent chemoradiotherapy (using conventional fractionation in locally advanced head and neck cancers

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    Manoj Gupta

    2015-01-01

    Full Text Available Background: Concurrent chemoradiation (CCRT is currently considered to be the standard of care in locally advanced head and neck cancer. The optimum radiotherapy schedule for best local control and acceptable toxicity is not yet clear. We aimed at shortening of treatment time by using accelerated radiation, thereby comparing the disease response, loco-regional tumor control and tolerability of accelerated radiation (six fractions per week against CCRT in locally advanced head and neck cancer. Materials and Methods: We conducted the prospective randomized study for a period of 2 years from June 2011 to May 2013 in 133 untreated patients of histologically confirmed squamous cell carcinoma of head and neck. Study group (66 patients received accelerated radiotherapy with 6 fractions per week (66Gy/33#/5½ weeks. Control group (67 patients received CCRT with 5 fractions per week radiation (66 Gy/33#/6½ weeks along with intravenous cisplatin 30 mg/m 2 weekly. Tumor control, survival, acute and late toxicities were assessed. Results: Median overall treatment time was 38 days and 45 days in the accelerated radiotherapy and concurrent chemoradiation arm, respectively. At a median follow up of 12 months, 41 patients (62.1% in the accelerated radiotherapy arm and 47 patients (70.1% in the CCRT arm were disease free (P = 0.402. Local disease control was comparable in both the arms. Acute toxicities were significantly higher in the CCRT arm as compared with accelerated radiotherapy arm. There was no difference in late toxicities between the two arms. Conclusion: We can achieve, same or near to the same local control, with lower toxicities with accelerated six fractions per week radiation compared with CCRT especially for Indian population.

  10. Second Study of Hyper-Fractionated Radiotherapy

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    R. Jacob

    1999-01-01

    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.

  11. A retrospective study of the effectiveness of hemostatic radiotherapy with conventional fractionation in patients with advanced cancer

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    Nomoto S

    2015-12-01

    Full Text Available The aim of this study was to assess the efficacy of hemostatic radiotherapy (HRT in patients with advanced cancer. Eighteen patients with advanced cancer treated with HRT at the Fukuoka University and Kyushu Rosai Hospitals in Japan between July 2010 and February 2015 were retrospectively assessed. The hemostatic effect of tumor-related bleeding was assessed by the clinical course of bleeding, laboratory data, the endoscopic study, and the number of blood transfusion units (BTRUs for one month before and after HRT. The median follow-up time was 2.6 months (range, 0.7 to 36.2 months. The median age of the patients was 77 years (range, 51 to 93. The primary diseases with tumor-related bleeding included gastric cancer, urinary bladder cancer, gynecological cancer, prostate cancer, non-small-cell lung cancer, and breast cancer. The median overall survival time was three months, and the one year survival rate was 22.9% of all patients. The HRT regimens ranged from 30 Gy in 10 fractions to 40 Gy in 20 fractions. In all patients, the anemia grade and the number of BTRUs decreased for 1 month after RT. The percentage of patients who were diagnosed as “successful” for hemostasis was 83% (15 of 18 patients. HRT is therefore strongly suggested as effective for the control of tumor-related bleeding in patients with advanced cancer. The optimal radiation doses and fractions are controversial; however, this treatment should be offered for patients with a poor life expectancy.

  12. A randomized trial comparing hypofractionated and conventionally fractionated three-dimensional external-beam radiotherapy for localized prostate adenocarcinoma. A report on acute toxicity

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    Norkus, Darius; Miller, Albert; Kurtinaitis, Juozas; Valuckas, Konstantinas Povilas [Dept. of Radiotherapy, Inst. of Oncology, Vilnius Univ. (Lithuania); Haverkamp, Uwe [Dept. of Radiology, Clemenshospital, Muenster (Germany); Popov, Sergey [Dept. of Radiotherapy, Riga Eastern Hospital, Latvian Oncology Center, Riga (Latvia); Prott, Franz-Josef [Inst. of Radiology and Radiotherapy (RNS), St. Josefs Hospital, Wiesbaden (Germany)

    2009-11-15

    Purpose: to compare acute gastrointestinal (GI) and genitourinary (GU) toxicity between patient groups with localized prostate adenocarcinoma, treated with conventionally fractionated (CFRT) and hypofractionated (HFRT) three-dimensional conformal external-beam radiotherapy (3D-CRT). Patients and methods: 91 patients were enrolled into a randomized study with a minimum follow-up of 3 months. 44 men in the CFRT arm were irradiated with 74 Gy in 37 fractions at 2 Gy per fraction for 7.5 weeks. 47 men in the HFRT arm were treated with 57 Gy in 17 fractions for 3.5 weeks, given as 13 fractions of 3 Gy plus four fractions of 4.5 Gy. The clinical target volume (CTV) included the prostate and the base of seminal vesicles. The CTV-to-PTV (planning target volume) margin was 8-10 mm. Study patients had portal imaging and/or simulation performed on the first fractions and repeated at least weekly. Results: no acute grade 3 or 4 toxicities were observed. The grade 2 GU acute toxicity proportion was significantly lower in the HFRT arm: 19.1% versus 47.7% ({chi}{sup 2}-test, p = 0.003). The grade 2 GU acute toxicity-free survival was significantly better in the HFRT arm (log-rank test, p = 0.008). The median duration of overall GI acute toxicity was shorter with HFRT: 3 compared to 6 weeks with CFRT (median test, p = 0.017). Conclusion: in this first evaluation, the HFRT schedule is feasible and induces acceptable or even lower acute toxicity compared with the toxicities in the CFRT schedule. Extended follow-up is needed to justify this fractionation schedule's safety in the long term. (orig.)

  13. Hypofractionated Prostate Radiotherapy with or without Conventionally Fractionated Nodal Irradiation: Clinical Toxicity Observations and Retrospective Daily Dosimetry

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    Andrew M. McDonald

    2012-01-01

    Methods and Materials. Fifty-seven patients received pelvic image-guided IMRT to 50.4 Gy in 28 fractions with a hypofractionated simultaneous boost to the prostate to 70 Gy. Thirty-one patients received prostate-only treatment to 70 Gy in 28 fractions. Results. Median followup was 41.1 months. Early grade ≥2 urinary toxicity rates were 49% (28 of 57 for patients receiving ENI and 58% (18 of 31 for those not (P=0.61. Early grade ≥2 rectal toxicity rates were 40% (23 of 57 and 23% (7 of 31, respectively (P=0.09. The addition of ENI resulted in a 21% actuarial rate of late grade ≥2 rectal toxicity at 4 years, compared to 0% for patients treated to the prostate only (P=0.02. Retrospective daily dosimetry of patients experiencing late rectal toxicity revealed an average increase of 2.67% of the rectal volume receiving 70 Gy compared to the original plan. Conclusions. The addition of ENI resulted in an increased risk of late rectal toxicity. Grade ≥2 late rectal toxicity was associated with worse daily rectal dosimetry compared to the treatment plan.

  14. Value of conventionally fractionated radiotherapy for the local treatment of HIV associated Kaposi`s sarcoma; Wertigkeit konventionell fraktionierter Radiotherapie bei der lokalen Behandlung des HIV-assoziierten Kaposi-Sarkoms

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    Saran, F. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Adamietz, I.A. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Mose, S. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Thilmann, C. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany); Boettcher, H.D. [Abt. fuer Strahlentherapie und Onkologie, Zentrum der Radiologie, Frankfurt Univ. (Germany)

    1995-10-01

    From June 1991 to June 1993, 43 patients with 111 HIV-associated Kaposi`s sarcoma of the skin or oral cavity were treated. Lesions were irradiated with 5 to 12 MeV electrons or 60Co gamma-rays. The fractionation scheme was 5 times 2 Gy/week for skin and enoral lesions with a total reference dosage of up to 20 Gy. Side effects were assessed during therapy and the therapeutic result 6 weeks after end of treatment. Thirty-eight out of 111 lesions were judged as complete response (CR) (34%), 61/111 as partial response (PR) (55%) and 12/111 were judged as no change (NC) (11%). Overall response (CR + PR) was 89%. Two patients with lesions of oral cavity suffered from RTOG grade-IV mucositis after 10 and 14 Gy. In 71/106 skin lesions (67%), radiation induced RTOG grade-I reactions were observed. Conclusion: In patients with HIV associated Kaposi`s sarcoma effective palliation can be achieved by means of radiotherapy with an overall dose of 20 Gy in conventional fractionation. Yet, the fraction of patients with complete responses is with 34 to 47% lower compared with doses above 20 Gy (66 to 100%). With reference to the reported data our results point to a dose-response relationship for Kaposi`s sarcoma. Therefore higher total reference doses, e.g. 30 Gy with weekly 5 times 2 Gy or 24 Gy with 5 times 1.6 Gy for mucous lesions, respectively, are suggested as by this mean the complete response rate can be coubled. (orig./MG) [Deutsch] Von Juni 1991 bis Juni 1993 wurden 43 Patienten mit 111 HIV-assoziierten Kaposi-Sarkomen der Haut oder des Mund- und Rachenraums behandelt. Die Laesionen wurden mit 5- bis 12-MeV-Elektronen oder Co-60-Gammastrahlen bestrahlt. Das Fraktionierungsschema betrug 5mal 2 Gy/Woche bei kutanen und enoralen Laesionen bis zu einer Gesamtreferenzdosis von 20 Gy. Nebenwirkungen wurden waehrend und das Ergebnis sechs Wochen nach Abschluss der Radiotherapie beurteilt. In 38 von 111 Laesionen wurde eine komplette Remission (CR) erzielt (34%), in 61/111 eine

  15. Late bilateral temporal lobe necrosis after conventional radiotherapy. Case report

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    Hoshi, Michio; Hayashi, Toshiyuki; Kagami, Hiroshi; Murase, Ikurou; Nakatsukasa, Masashi [Saiseikai Utsunomiya Hospital (Japan)

    2003-04-01

    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)

  16. Conventionally-fractionated image-guided intensity modulated radiotherapy (IG-IMRT: a safe and effective treatment for cancer spinal metastasis

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    Jiang Xiaoqin

    2008-04-01

    Full Text Available Abstract Background Treatments for cancer spinal metastasis were always palliative. This study was conducted to investigate the safety and effectiveness of IG-IMRT for these patients. Methods 10 metastatic lesions were treated with conventionally-fractionated IG-IMRT. Daily kilovoltage cone-beam computed tomography (kV-CBCT scan was applied to ensure accurate positioning. Plans were evaluated by the dose-volume histogram (DVH analysis. Results Before set-up correction, the positioning errors in the left-right (LR, superior-inferior (SI and anterior-posterior (AP axes were 0.3 ± 3.2, 0.4 ± 4.5 and -0.2 ± 3.9 mm, respectively. After repositioning, those errors were 0.1 ± 0.7, 0 ± 0.8 and 0 ± 0.7 mm, respectively. The systematic/random uncertainties ranged 1.4–2.3/3.0–4.1 before and 0.1–0.2/0.7–0.8 mm after online set-up correction. In the original IMRT plans, the average dose of the planning target volume (PTV was 61.9 Gy, with the spinal cord dose less than 49 Gy. Compared to the simulated PTVs based on the pre-correction CBCT, the average volume reduction of PTVs was 42.3% after online correction. Also, organ at risk (OAR all benefited from CBCT-based set-up correction and had significant dose reduction with IGRT technique. Clinically, most patients had prompt pain relief within one month of treatment. There was no radiation-induced toxicity detected clinically during a median follow-up of 15.6 months. Conclusion IG-IMRT provides a new approach to treat cancer spinal metastasis. The precise positioning ensures the implementation of optimal IMRT plan, satisfying both the dose escalation of tumor targets and the radiation tolerance of spinal cord. It might benefit the cancer patient with spinal metastasis.

  17. Late Toxicities after Conventional Radiotherapy for Nasopharyngeal Carcinoma: Incidence and Risk Factors

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    Wicem Siala

    2014-01-01

    Full Text Available Background. To determine the incidence and analyze the factors affecting late toxicity for nasopharyngeal carcinoma patients treated with conventional radiotherapy. Patients and Methods. Retrospective analysis was performed on 239 NPC patients treated between 1993 and 2004 in our institution. One hundred and fifty-seven patients were treated with conventional fractionation (2 Gy per fraction, 5 fractions per week and eighty-two patients with hyperfractionated radiotherapy (1.6 Gy per fraction twice a day, 5 days per week. One hundred fifty nine patients underwent neoadjuvant cisplatin based chemotherapy. Late toxicity was evaluated according to the RTOG/EORTC score. Results. Xerostomia was the most common related complication (98.7%. Neoadjuvant chemotherapy and hyperfractionated radiotherapy did not increase late toxicities. Multivariate analyses showed that radiation dose was a significant factor for hearing impairment, younger age for trismus, initial node status for neck fibrosis, and initial dental hygiene for dental complications. Female gender was associated with significantly higher incidence of trismus and hearing impairment. Conclusion. Conventional radiotherapy was associated with a high rate of late toxicities which affect patients’ quality of life. With the development of three-dimensional conformal radiotherapy and intensity modulated radiotherapy, a reduced incidence of radiation related complications could be expected.

  18. Hypofractionated SBRT versus conventionally fractionated EBRT for prostate cancer: comparison of PSA slope and nadir

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    Anwar, Mekhail; Weinberg, Vivian; Albert J. Chang; Hsu, I-Chow; Roach, Mack; Gottschalk, Alexander

    2014-01-01

    Background Patients with early stage prostate cancer have a variety of curative radiotherapy options, including conventionally-fractionated external beam radiotherapy (CF-EBRT) and hypofractionated stereotactic body radiotherapy (SBRT). Although results of CF-EBRT are well known, the use of SBRT for prostate cancer is a more recent development, and long-term follow-up is not yet available. However, rapid post-treatment PSA decline and low PSA nadir have been linked to improved clinical outcom...

  19. Spinal radiosurgery - efficacy and safety after prior conventional radiotherapy

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    Nikolajek Katharina

    2011-12-01

    Full Text Available Abstract Background Conventional external beam radiotherapy is a standard procedure for treatment of spinal metastases. In case of progression spinal cord tolerance limits further radiotherapy in pre-irradiated areas. Spinal stereotactic radiotherapy is a non-invasive option to re-treat pre-irradiated patients. Nevertheless, spinal radiosurgery results in relevant dose deposition within the myelon with potential toxicity. Aim of the study was to retrospectively analyse the efficacy and feasibility for salvage radiosurgery of spinal metastases. Methods During a period of 4 years (2005-2009 70 lesions in 54 patients were treated in 60 radiosurgery sessions and retrospectively analysed. Clinical (pain, sensory and motor deficit and radiological (CT/MRI follow-up data were collected prospectively after radiosurgery. Pain - as main symptom - was classified by the Visual Analogue Scale (VAS score. Every patient received single session radiosurgery after having been treated first-line with conventionally fractionated radiotherapy. Kaplan-Meier method and life tables were used to analyse freedom from local failure and overall survival. Results At a median follow-up of 14.5 months the actuarial rates of freedom from local failure at 6/12/18 months were 93%, 88% and 85%, respectively. The median radiosurgery dose was 1 × 18 Gy (range 10-28 Gy to the median 70% isodose. The VAS score of patients with pain (median 6 dropped significantly (median 4, p = 0.002. In 6 out of 7 patients worse sensory or motor deficit after SRS was caused by local or distant failures (diagnosed by CT/MRI. One patient with metastatic renal cell carcinoma developed a progressive complete paraparesis one year after the last treatment at lumbar level L3. Due to multiple surgery and radiosurgery treatments at the lumbar region and further local progression, the exact reason remained unclear. Apart from that, no CTC grade III or higher toxicity has been observed. Conclusions By

  20. Fractionated stereotactic radiotherapy with vagina carotica protection technique for local residual nasopharyngeal carcinoma after primary radiotherapy

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    LIU Feng; HUAN Fu-kui; FANG Hao; WAN Bao; LI Ye-xiong; XIAO Jian-ping; XU Ying-jie; ZHANG Ye; XU Guo-zhen; GAO Li; YI Jun-lin; LUO Jing-wei; HUANG Xiao-dong

    2012-01-01

    Background Local failure of nasopharyngeal carcinoma (NPC) after radiotherapy (RT) remains one of the major treatment failures.This study aimed to evaluate the clinical efficacy and complications of fractionated stereotactic radiotherapy (FSRT) with vagina carotica protection technique for local residual of NPC patients after the primary RT.Methods From August 2006 to August 2010,FSRT with vagina carotica protection technique was applied to 36 patients in our department,the patients aged between 13 and 76 years with a median of 41.3 years,25 of them were male and 11were female.According to 2002 Union for International Cancer Control (UICC) Staging System,the stages before primary radiotherapy were:Ⅱa 2,Ⅱb 5,Ⅲ 18,Ⅳa 7,Ⅳb 4.In the first course of radiotherapy,9 patients received conventional RT,27 patients received intensity modulated radiotherapy (IMRT) and 20 out of the 36 patients received concurrent chemoradiotherapy.The total dose in the first course of RT was 69.96-76.90 Gy (median,72.58 Gy).The intervals between the primary RT and FSRT ranged from 12 to 147 days (median,39.8 days).Target volumes ranged from 1.46 to 32.98 cm3 (median,14.94 cm3).The total FSRT doses were 10.0-24.0 Gy (median,16.5 Gy) with 2.0-5.0Gy per fraction.The most common regimen was 15 Gy in 5 fractions of 3 Gy,the irradiation dose to vagina carotica was less than 2 Gy per fraction.Results The median follow-up time was 34 months (range,12-59 months).The 3-year local control rate was 100%;the 3-year overall survival rate was 94.4%;the 3-year disease-free survival rate was 77.8%.In this study,we had one case of cranial nerve injury,two cases of temporal lobe necrosis,and no nasopharyngeal massive hemorrhage was observed.Conclusion FSRT with vagina carotica protection technique is an effective and safe RT regimen for local residual of NPC with reduction of radiation-related neurovascular lesions.

  1. Spatially fractionated radiotherapy (GRID) using helical tomotherapy.

    Science.gov (United States)

    Zhang, Xin; Penagaricano, Jose; Yan, Yulong; Liang, Xiaoying; Morrill, Steven; Griffin, Robert J; Corry, Peter; Ratanatharathorn, Vaneerat

    2016-01-08

    Spatially fractionated radiotherapy (GRID) was designed to treat large tumors while sparing skin, and it is usually delivered with a linear accelerator using a commercially available block or multileaf collimator (LINAC-GRID). For deep-seated (skin to tumor distance (> 8 cm)) tumors, it is always a challenge to achieve adequate tumor dose coverage. A novel method to perform GRID treatment using helical tomotherapy (HT-GRID) was developed at our institution. Our approach allows treating patients by generating a patient-specific virtual GRID block (software-generated) and using IMRT technique to optimize the treatment plan. Here, we report our initial clinical experience using HT-GRID, and dosimetric comparison results between HT-GRID and LINAC-GRID. This study evaluates 10 previously treated patients who had deep-seated bulky tumors with complex geometries. Five of these patients were treated with HT-GRID and replanned with LINAC-GRID for comparison. Similarly, five other patients were treated with LINAC-GRID and replanned with HT-GRID for comparison. The prescription was set such that the maximum dose to the GTV is 20 Gy in a single fraction. Dosimetric parameters compared included: mean GTV dose (DGTV mean), GTV dose inhomogeneity (valley-to-peak dose ratio (VPR)), normal tissue doses (DNmean), and other organs-at-risk (OARs) doses. In addition, equivalent uniform doses (EUD) for both GTV and normal tissue were evaluated. In summary, HT-GRID technique is patient-specific, and allows adjustment of the GRID pattern to match different tumor sizes and shapes when they are deep-seated and cannot be adequately treated with LINAC-GRID. HT-GRID delivers a higher DGTV mean, EUD, and VPR compared to LINAC-GRID. HT-GRID delivers a higher DNmean and lower EUD for normal tissue compared to LINAC-GRID. HT-GRID plans also have more options for tumors with complex anatomical relationships between the GTV and the avoidance OARs (abutment or close proximity).

  2. Hypofractionated versus conventional radiotherapy with or without chemotherapy in head and neck cancer: A comparative study

    Directory of Open Access Journals (Sweden)

    Somnath Roy

    2015-01-01

    Full Text Available Background: To investigate tumor response and toxicities in head and neck squamous cell cancer (HNSCC upon hypofractionated radiotherapy compared with conventional fractionation. Settings and Design: Data from patients with squamous cell cancer of oral cavity, oropharynx, hypopharynx, and larynx (AJCC, 2010 Stage II to IVB; who received hypofractionated (n = 30 or conventionally fractionated (n = 30 radiotherapy, with or without chemotherapy, between January 2010 to June 2011 were retrieved and retrospectively analyzed. Materials and Methods: In conventional arm (Arm A, each patient received 70 Gy at 2 Gy per fraction over 7 weeks, along with concurrent cisplatin (100 mg/m 2 on days 1, 22, and 43 for locally advanced stage. In hypofractionated arm (Arm B, each patient received 55 Gy at 2.75 Gy per fraction over 4 weeks, along with concurrent cisplatin (100 mg/m 2 on days 1 and 22 for locally advanced stage. The end points were tumor response, acute and late toxicities, overall survival (OS, and diseases-free survival (DFS. Results: The tumor response distribution was comparable - 24 (80% patients in arm A and 23 (76% in arm B achieved a complete response. Significant differences in frequencies of acute grade ≥ 2 skin toxicity, mucositis were found, with higher frequencies in Arm B. Higher frequencies of late grade ≥ 2 dysphagia, laryngeal edema, xerostomia, and confluent mucositis were encountered in Arm B at 6 months from start of chemoradiation. However, OS, DFS, and loco-regional recurrence rates were comparable between the two arms. Conclusions: Hypofractionated radiotherapy can achieve similar tumor response to conventionally fractionated radiotherapy in HNSCC, although with some increase of toxicity.

  3. Research on inter-fraction and intra-fraction motion of crystalline lens in radiotherapy

    Directory of Open Access Journals (Sweden)

    Shu-ming YANG

    2013-03-01

    Full Text Available Objective  To investigate the range of inter-fraction and intra-fraction motion of crystalline lens in radiotherapy. Methods  The CT and MRI images of 17 patients were registered, and the profile of crystalline lens was delineated to determine the respective center coordinates, thus simulating and analyzing inter-fraction and intra-fraction motion of lens in radiotherapy. Results  Both left and right lens moved in different degree during both inter-or intra-fraction phase. The range of lens movement was larger in inter-fraction than in intra-fraction phase in all directions. Conclusion  When radiotherapy is given in the free state, considering the distance of lens movement alone in inter-and intra-fraction and without considering the setup error, the lens planning organs at risk should increase 1.5mm outside the lens boundary.

  4. 乳腺癌根治术后大分割放疗与常规分割放疗的急性不良反应比较%Acute adverse reactions of hypofractionated and conventional fractionated radiotherapy in patients after radical mastectomy

    Institute of Scientific and Technical Information of China (English)

    何汇朗; 刘辉明; 许森奎; 姚文燕

    2016-01-01

    Objective To observe acute adverse reactions of hypofractionated and conventional fractionated radiotherapy in patients after radical mastectomy.Methods 111 patients after radical mastectomy prepared for radiotherapy in our hospital from June 2014 to June 2015 were selected and divided into conventional fractionated radiotherapy (CRT) group and hypofractionated radiotherapy (HOFRT) group according to the dose fractionation schemes.63 cases in CRT group received 50 Gy (2.0 Gy per fraction and 5 fractions per week);while 48 cases in HOFRT group received 40.05 Gy (2.67 Gy per fraction and 5 fractions per week).Results The rate of class Ⅱ or above acute radiation skin reactions was 36.5% in CRT group and 12.5% in HOFRT group (x 2=8.14,P<0.01).The rate of radiation pneumonitis was 34.9% in CRT group and 27.1% in HOFRT group (x 2=0.78,P>0.05).Conclusion The rate of acute adverse reactions of hypofractionated radiotherapy in patients after radical mastectomy is better than that of conventional fractionated radiotherapy.%目的 观察乳腺癌根治术后大剂量分割放疗和常规分割放疗的急性不良反应.方法 随机选取我院2014年6月至2015年6月收治的乳腺癌改良根治术后放疗的111例患者,根据放疗的不同剂量分割方案分为常规分割组(CRT)和大分割组(HOFRT).常规分割组63例,总DT 50 Gy,每次剂量2Gy,每周5次;大剂量分割组48例,总DT 40.05 Gy,每次2.67 Gy,每周5次.结果 常规分割组和大分割组的Ⅱ级或以上急性放射性皮肤反应、放射性肺炎的发生率分别为36.5%与12.5%(x2=8.14,P<0.01)、34.9%与27.1%(x2=0.78,P>0.05).结论 乳腺癌根治术后大分割放疗方案的急性不良反应优于常规分割方案.

  5. Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: Results from the randomized multicenter HIT-SIOP PNET 4 trial

    NARCIS (Netherlands)

    B. Lannering (Birgitta); P. Rutkowski (Piotr); F.F. Doz (François); B. Pizer (Barry); G. Gustafsson (Göran); A. Navajas (Aurora); M. Massimino (Maura); R.E. Reddingius (Roel); M. Benesch (Martin); C. Carrie (Christian); R. Taylor; L. Gandola (Lorenza); T. Bjor̈k-Eriksson (Thomas); S. Giralt; F. Oldenburger (Foppe); T. Pietsch (Torsten); D. Figarella-Branger (Dominique); K. Robson (Kathryn); G. Forni (Gianluca); S.C. Clifford (Steven); M. Warmuth-Metz (Monica); D.D. Von Hoff; A. Faldum (Andreas); V. Mosseri (Véronique); B. Kortmann

    2012-01-01

    textabstractPurpose: To compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy. Patients

  6. Fractionated stereotactic radiotherapy of vestibular schwannomas accelerates hearing loss

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Claesson, Magnus; Stangerup, Sven-Eric

    2012-01-01

    To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea...... and hearing preservation was also investigated....

  7. Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

    DEFF Research Database (Denmark)

    Roug, Anne Stidsholt; Rasmussen, Åse Krogh; Juhler, M;

    2010-01-01

    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....

  8. Intermediate-fraction neoadjuvant radiotherapy for rectal cancer.

    Science.gov (United States)

    Zhan, Tiancheng; Gu, Jin; Li, Ming; Du, Changzheng

    2013-04-01

    In China, standard neoadjuvant chemoradiation therapy has not been well accepted, not only because of financial constraints but also because of the poorly-tolerated long duration of the regimen. The current study aimed to evaluate the impact of a modified neoadjuvant radiation regimen on the prognosis of rectal cancer patients in China. This was a nonrandomized cohort study evaluating outcomes of patients who chose to undergo preoperative radiotherapy compared with those who chose not to undergo preoperative radiotherapy (controls). The study was carried out in Peking University Cancer Hospital, a tertiary care cancer center in China. Records of patients with locally advanced, mid-to-low rectal cancer who underwent total mesorectal excision at Peking University Cancer Hospital from 2001 through 2005 were analyzed in this study. Patients who chose preoperative radiotherapy received a total dose of 30 Gy delivered in 10 once-daily fractions of 3.0 Gy each, with at least a 14-day delay of surgery after delivery of the last fraction. Tumor downstaging was evaluated. Local recurrence, distant metastases, and disease-free and overall survival were analyzed with the Kaplan-Meier method. A total of 101 patients accepted and 162 patients declined the modified preoperative radiotherapy regimen. Of the 101 patients receiving preoperative radiotherapy, 5 (5%) had a complete response, and 50 (50%) achieved TNM downstaging. The local recurrence rate was 5% with preoperative radiotherapy and 18% in the control groups (p = 0.02). Within the preoperative radiotherapy group, 5-year disease-free survival and overall survival rates were significantly higher in patients with T-, N-, or TNM-downstaging than in patients without downstaging. Evaluation of literature reports indicated that clinical safety and effectiveness of the modified protocol are comparable to results of standard neoadjuvant procedures. The allocation to study groups was not randomized, and patient self-selection may

  9. 3-Dimentional radiotherapy versus conventional treatment plans for gastric cancer

    Directory of Open Access Journals (Sweden)

    Aghili M

    2010-11-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The current standard of adjuvant management for gastric cancer after curative resection based on the results of intergroup 0116 is concurrent chemoradiation. Current guidelines for designing these challenging fields still include two-dimensional simulation with simple AP-PA parallel opposed design. However, the implementation of radiotherapy (RT remains a concern. Our objective was to compare three-dimensional (3D techniques to the more commonly used AP-PA technique."n"nMethods: A total of 24 patients with stages II-IV adenocarcinoma of the stomach were treated with adjuvant postoperative chemoradiation with simple AP-PA technique, using Cobalt-60. Total radiation dose was 50.4Gy. Landmark-based fields were simulated to assess PTV coverage. For each patient, three additional radiotherapy treatment plans were generated using three-dimensional (3D technique. The four treatment plans were then compared for target volume coverage and dose to normal tissues (liver, spinal cord, kidneys using dose volume histogram (DVH analysis."n"nResults: The three-dimensional planning techniques provided 10% superior PTV coverage compared to conventional AP-PA fields (p<0.001. Comparative DVHs for the right kidney, left kidney

  10. Stromal-epithelial dynamics in response to fractionated radiotherapy

    Science.gov (United States)

    Qayyum, Muqeem Abdul

    Radiotherapy is central to the management of a number of human cancers, either as an adjuvant or primary treatment modality. The principal objective in irradiating tumors is to permanently inhibit their proliferative ability. More than half of all malignancies are primarily treated with radiation, but the heterotypic nature of tumor cells greatly complicates their response to radiotherapy. The need for reliable parameters to predict tumor and normal tissue response to radiation is therefore a prime concern of clinical oncology. Post-operative radiotherapy has commonly been used for early stage breast cancer to treat residual disease. There is continued debate as to what might be the proper dose per fraction as well as the total dose of radiation that needs to be prescribed to prevent disease recurrence. Countries outside the US have adopted increased dose fractionation (i.e., hypofractionation) schemes for early stage breast cancer as a standard of practice; however there is a lack of confidence in these approaches in the United States. The tumor microenvironment plays a significant role in regulating the progression of carcinomas, although the mechanisms are not entirely clear. The primary objective of this work was to characterize, through mechanobiological and radiobiological modeling, a test bed for radiotherapy fractionation techniques assessment. Our goal is to understand how the tumor microenvironment responds to dose fractionation schemes for Breast Conserving Therapy (BCT). Although carcinomas are the major concern for oncology, in this project, the goal is to understand how the stromal microenvironment influences behavior of the cancer cell populations. By classifying 3-D cellular co-cultures as having a reactive or quiescent stroma using the mechanobiology profile (culture stiffness,cellular activation, differentiation, and proliferation) we aim to differentiate the effectiveness of various fractionation schemes. The benefits of understanding heterotypic

  11. Impact of dose size in single fraction spatially fractionated (grid) radiotherapy for melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Hualin, E-mail: hualin.zhang@northwestern.edu, E-mail: hualinzhang@yahoo.com [Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611 and Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States); Zhong, Hualiang [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan 48202 (United States); Barth, Rolf F. [Department of Pathology, The Ohio State University, Columbus, Ohio 43210 (United States); Cao, Minsong; Das, Indra J. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202 (United States)

    2014-02-15

    Purpose: To evaluate the impact of dose size in single fraction, spatially fractionated (grid) radiotherapy for selectively killing infiltrated melanoma cancer cells of different tumor sizes, using different radiobiological models. Methods: A Monte Carlo technique was employed to calculate the 3D dose distribution of a commercially available megavoltage grid collimator in a 6 MV beam. The linear-quadratic (LQ) and modified linear quadratic (MLQ) models were used separately to evaluate the therapeutic outcome of a series of single fraction regimens that employed grid therapy to treat both acute and late responding melanomas of varying sizes. The dose prescription point was at the center of the tumor volume. Dose sizes ranging from 1 to 30 Gy at 100% dose line were modeled. Tumors were either touching the skin surface or having their centers at a depth of 3 cm. The equivalent uniform dose (EUD) to the melanoma cells and the therapeutic ratio (TR) were defined by comparing grid therapy with the traditional open debulking field. The clinical outcomes from recent reports were used to verify the authors’ model. Results: Dose profiles at different depths and 3D dose distributions in a series of 3D melanomas treated with grid therapy were obtained. The EUDs and TRs for all sizes of 3D tumors involved at different doses were derived through the LQ and MLQ models, and a practical equation was derived. The EUD was only one fifth of the prescribed dose. The TR was dependent on the prescribed dose and on the LQ parameters of both the interspersed cancer and normal tissue cells. The results from the LQ model were consistent with those of the MLQ model. At 20 Gy, the EUD and TR by the LQ model were 2.8% higher and 1% lower than by the MLQ, while at 10 Gy, the EUD and TR as defined by the LQ model were only 1.4% higher and 0.8% lower, respectively. The dose volume histograms of grid therapy for a 10 cm tumor showed different dosimetric characteristics from those of conventional

  12. A halo-ring technique for fractionated stereotactic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Clark, B.G.; Podgorsak, E.B.; Souhami, L.; Caron, J.-L.; Sixel, K.E. (Montreal General Hospital, PQ (Canada)); Olivier, A. (Montreal Neurological Inst., PQ (Canada). Dept. of Neurosurgery)

    1993-06-01

    Stereotactic radiosurgery has become established as an effective treatment modality for certain non-malignant brain diseases such as arteriovenous malformations. This paper describes an extension of the authors' linear accelerator-based radiosurgical technique to fractionated treatment of intracranial disease. The fractionated stereotactic radiotherapy technique expands the use of the modality by sparing normal cells within the treatment volume thus improving the therapeutic ratio. The first treatment is given using a stereotactic frame both for target localization and patient immobilization. The frame is then removed and subsequent treatments use a standard neurosurgical halo-ring for patient immobilization. The halo-ring is left in place on the skull for the duration of the course of treatment. They describe a sensitive and effective technique for checking the rotational beam parameters and collimator alignment which is used immediately prior to treatment to ensure adequate accuracy of dose delivery to the target volume. (author).

  13. Quantifying intra- and inter-fractional motion in breast radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Scott, E-mail: scott.jones@health.qld.gov.au [Division of Cancer Services, Radiation Oncology Mater Centre, Princess Alexandra Hospital, Brisbane (Australia); Fitzgerald, Rhys [Division of Cancer Services, Princess Alexandra Hospital, Brisbane (Australia); Owen, Rebecca; Ramsay, Jonathan [Division of Cancer Services, Radiation Oncology Mater Centre, Princess Alexandra Hospital, Brisbane (Australia)

    2015-03-15

    The magnitude of intra- and inter-fractional variation in the set up of breast cancer patients treated with tangential megavoltage photon beams was investigated using an electronic portal imaging device (EPID). Daily cine-EPID images were captured during delivery of the tangential fields for ten breast cancer patients treated in the supine position. Measurements collected from each image included the central lung distance (CLD), central flash distance (CFD), superior axial measurement (SAM) and the inferior axial measurement (IAM). The variation of motion within a fraction (intra-fraction) and the variation between fractions (inter-fraction) was analysed to quantify set up variation and motion due to respiration. Altogether 3775 EPID images were collected from 10 patients. The effect of respiratory motion during treatment was <0.1 cm standard deviation (SD) in the anterior–posterior (AP) direction. The inter-fraction movement caused by variations in daily set up was larger at 0.28 cm SD in the AP direction. Superior–inferior (SI) variation was more difficult to summarise and proved unreliable as the measurements were taken to an ambiguous point on the images. It was difficult to discern true SI movement from that implicated by AP movement. There is minimal intra-fractional chest wall motion due to respiration during treatment. Inter-fractional variation was larger, however, on average it remained within departmental tolerance (0.5 cm) for set up variations. This review of our current breast technique provides confidence in the feasibility of utilising advanced treatment techniques (field-in-field, intensity modulated radiotherapy or volumetric modulated arc therapy) following a review of the current imaging protocol.

  14. Tissue kinetics in mouse tongue mucosa during daily fractionated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Doerr, W. [Universitaetsklinikum Carl Gustav Carus, Dresden (Germany). Klinik und Poliklinik fuer Strahlentherapie]|[Institut fuer Strahlenbiologie, Oberschleissheim (Germany); Emmendoerfer, H.; Weber-Frisch, M. [Institut fuer Strahlenbiologie, Oberschleissheim (Germany)

    1996-09-01

    The purpose of the present investigation was to quantify cell flux between the distinct layers of the epithelial lining of the ventral surface of mouse tongue during daily fractionated radiotherapy. In tongue epithelium of untreated mice, the minimum residence time of cells in the germinal layer is 2-3 days. Migration through the functional layers requires an additional 2-3 days before labelled cells are observed in the most superficial layer of nucleated cells. A plateau in LI is observed for several days post-labelling in control epithelium, indicating an equilibrium between loss and proliferation of labelled cells. During fractionated radiotherapy, the minimum time from division to occurrence of labelled cells in the stratum lucidum is less than 2 days, and hence significantly shorter than in control epithelium. In contrast to untreated epithelium, no plateau in the germinal layer LI is seen, indicating that frequently both labelled daughters from dividing labelled cells are being lost from this compartment. In conclusion, the present data support a recently described model of radiation-induced accelerated repopulation in squamous epithelia, which postulates that the majority of damaged cells undergoes abortive divisions resulting in two differentiating daughters. (Author).

  15. Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

    2012-02-01

    Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

  16. Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-08-01

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

  17. 全基因组表达谱芯片筛选非小细胞肺癌常规分割和大分割放疗差异基因的初步研究*%Identifying the genetic pattern of conventional fractionated and hypofractionated radiotherapy using whole genome expression microarray in a non-small-cell lung cancer cell line

    Institute of Scientific and Technical Information of China (English)

    孙健; 刘宁波; 曲晨慧; 王宝虎; 郭华; 王平

    2013-01-01

    目的:获得稳定的非小细胞肺癌(NSCLC)放射抗拒细胞系,明确常规分割和大分割放疗后肿瘤基因表达改变。方法:采用A549细胞系,6MV X线常规照射(2 Gy×17 f)和大分割照射(4 Gy×7 f),克隆形成实验和γ-H2AX免疫荧光染色结合共聚焦显微镜验证细胞的放射抗拒特性。提取mRNA,全基因组表达谱芯片检测差异基因表达,分析2倍以上改变的基因(P<0.05),同时对芯片结果行Pathway分析(Q<0.05)。结果:获得了2株放疗抗拒细胞系A549R2Gy-R和A549R4Gy-R。表达谱芯片显示,A549与A549R2Gy-R相比,差异表达基因为1701个(357个上调,1344个下调);A549与A549R4Gy-R相比,944个基因上调,2602个基因下调。A549R2Gy-R与A549R4Gy-R相比,318个基因上调,699个基因下调。常规分割照射与大分割照射的pathway显著性富集分析显示,PI3K和Erb B通路等多条信号通路激酶出现显著性差异。结论:多种基因和信号通路参与了NSCLC常规分割和大分割放疗抗拒过程,进一步研究能明确NSCLC放射抗拒机制和为放疗增敏药物开发提供新靶点。%Objective:To obtain stable radioresistant non-small-cell lung cancer (NSCLC) cell lines and identify the genetic pattern of conventional fractioned and hypofractionated radiotherapy. Methods:A549 NSCLC cells were treated with 6 MV of x-rays through conventional fractionated (2 Gy, 17 f) and hypofractionated irradiation (4 Gy, 7 f) to establish a radiation resistance cell model. Tumor cell radioresistance was determined using a clonogenic assay andγ-H2AX immunofluorescence staining combined with confocal microscopy. After extracting total mRNA from the cells, a whole genome expression microarray was applied to detect differential gene expression. The genes with at least a twofold increase in expression (P<0.05) were analyzed, and the pathway (Q<0.05) methods were used to further analyze the chip results

  18. 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)

    2003-01-01

    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

  19. Radiobiology of hypofractionated stereotactic radiotherapy: what are the optimal fractionation schedules?

    Science.gov (United States)

    Shibamoto, Yuta; Miyakawa, Akifumi; Otsuka, Shinya; Iwata, Hiromitsu

    2016-01-01

    In hypofractionated stereotactic radiotherapy (SRT), high doses per fraction are usually used and the dose delivery pattern is different from that of conventional radiation. The daily dose is usually given intermittently over a longer time compared with conventional radiotherapy. During prolonged radiation delivery, sublethal damage repair takes place, leading to the decreased effect of radiation. In in vivo tumors, however, this decrease in effect may be counterbalanced by rapid reoxygenation. Another issue related to hypofractionated SRT is the mathematical model for dose evaluation and conversion. The linear–quadratic (LQ) model and biologically effective dose (BED) have been suggested to be incorrect when used for hypofractionation. The LQ model overestimates the effect of high fractional doses of radiation. BED is particularly incorrect when used for tumor responses in vivo, since it does not take reoxygenation into account. Correction of the errors, estimated at 5–20%, associated with the use of BED is necessary when it is used for SRT. High fractional doses have been reported to exhibit effects against tumor vasculature and enhance host immunity, leading to increased antitumor effects. This may be an interesting topic that should be further investigated. Radioresistance of hypoxic tumor cells is more problematic in hypofractionated SRT, so trials of hypoxia-targeted agents are encouraged in the future. In this review, the radiobiological characteristics of hypofractionated SRT are summarized, and based on the considerations, we would like to recommend 60 Gy in eight fractions delivered three times a week for lung tumors larger than 2 cm in diameter. PMID:27006380

  20. SU-E-T-501: Normal Tissue Toxicities of Pulsed Low Dose Rate Radiotherapy and Conventional Radiotherapy: An in Vivo Total Body Irradiation Study

    Energy Technology Data Exchange (ETDEWEB)

    Cvetkovic, D; Zhang, P; Wang, B; Chen, L; Ma, C [Fox Chase Cancer Center, Philadelphia, PA (United States)

    2014-06-01

    Purpose: Pulsed low dose rate radiotherapy (PLDR) is a re-irradiation technique for therapy of recurrent cancers. We have previously shown a significant difference in the weight and survival time between the mice treated with conventional radiotherapy (CRT) and PLDR using total body irradiation (TBI). The purpose of this study was to investigate the in vivo effects of PLDR on normal mouse tissues.Materials and Methods: Twenty two male BALB/c nude mice, 4 months of age, were randomly assigned into a PLDR group (n=10), a CRT group (n=10), and a non-irradiated control group (n=2). The Siemens Artiste accelerator with 6 MV photon beams was used. The mice received a total of 18Gy in 3 fractions with a 20day interval. The CRT group received the 6Gy dose continuously at a dose rate of 300 MU/min. The PLDR group was irradiated with 0.2Gyx20 pulses with a 3min interval between the pulses. The mice were weighed thrice weekly and sacrificed 2 weeks after the last treatment. Brain, heart, lung, liver, spleen, gastrointestinal, urinary and reproductive organs, and sternal bone marrow were removed, formalin-fixed, paraffin-embedded and stained with H and E. Morphological changes were observed under a microscope. Results: Histopathological examination revealed atrophy in several irradiated organs. The degree of atrophy was mild to moderate in the PLDR group, but severe in the CRT group. The most pronounced morphological abnormalities were in the immune and hematopoietic systems, namely spleen and bone marrow. Brain hemorrhage was seen in the CRT group, but not in the PLDR group. Conclusions: Our results showed that PLDR induced less toxicity in the normal mouse tissues than conventional radiotherapy for the same dose and regimen. Considering that PLDR produces equivalent tumor control as conventional radiotherapy, it would be a good modality for treatment of recurrent cancers.

  1. Conventional radiotherapy of localized right side breast cancer after radical mastectomy: development of innovative “field in field” technique

    Directory of Open Access Journals (Sweden)

    Goran Marošević

    2011-12-01

    Full Text Available Introduction: The aim of this paper is to study the distribution of the therapy dosage applied by a modified conventional “field in field” technique and compare it to the distribution of the dosage applied by the standard conventional technique.Methods: The study included ten patients with right side breast cancer, after they were exposed to radical mastectomy and chemotherapy. Radiotherapy dosage of TD 50 Gy in 25 fractions was applied to the anterolateral side of the right thoracic wall, with two opposite conventional tangential fields by the linear accelerator Elekta Synergy and the energy of 6 megavolts (MV. A delineation of the target volume (CTV – Clinical Target Volume was done within conventional fields. At the XiO system for planning we included additional fields within the existing conventional fields, which was the so called “field in field” technique. On the basis of CTV the Dose Volume  Histogram (DVH was calculated for conventional and “field in field” plans. VD90%, VD95%, VD107%, VD115%, CI and HI were calculated for both techniques. Means were pared with the paired Student's t-test. The results were considered significantly different if p<0.05.Results: VD90% and VD 95% were significantly higher for the “field in field” technique. Therefore, CI also favored the “field in field” technique (p=0.02. There was no difference in VD107% and VD115% between the compared groups. Consequently, there was no statistically significant difference in HI (1.13±0.03 vs.1.13±0.03, p=0.06.Conclusion: Conventional postoperative radiotherapy of localized right side breast cancer by “field in field” technique provides excellent coverage of the target volume by radiotherapy isodose.

  2. High-dose weekly fractionation radiotherapy in advanced cancer of the uterine cervix

    Energy Technology Data Exchange (ETDEWEB)

    Browde, S.; Nissenbaum, M.; De Moor, N.G. (University of the Witwatersrand, Johannesburg (South Africa))

    1984-07-07

    A trial comparing two different radiotherapy techniques and schedules is the treatment of 83 patients with advanced cancer of the uterine cervix (stage IIIB) employing external irradiation alone is described. The one technique, used routinely in this department, employed a conventional daily fractionation schedule while the other used a high-dose weekly fractionation regimen. The techniques are described. The aim of the trial was to compare the efficacy and morbidity of these two methods of treatment. Dose distribution curves in cross-section and midsagittal planes are shown and calculations or equivalent doses at various selected points using Ellis's nominal single-dose formula are tabulated. The 2-year survival figures were 33% for the daily fractionation technique and 22% for the weekly regimen. Serious late complication rates were 6% for the daily regimen and 22% for the weekly schedule. These differences are not statistically significant. Late complication rates in the weekly fractionation regimen appeared to be lower than figures quoted by other authors. Local control within the irradiated volume was better in the group treated by the daily fractionation method.

  3. Fractionated stereotactic radiotherapy in the treatment of pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Kopp, C.; Theodorou, M.; Poullos, N.; Astner, S.T.; Geinitz, H.; Molls, M. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Stalla, G.K. [Max-Planck-Institut fuer Psychiatrie, Muenchen (Germany). Klinische Neuroendokrinologie; Meyer, B. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Neurochirurgische Klinik und Poliklinik; Nieder, C. [Nordland Hospital, Bodoe (Norway). Dept. of Oncology and Palliative Medicine; Tromsoe Univ. (Norway). Inst. of Clinical Medicine; Grosu, A.L [Freiburg Univ. (Germany). Klinik fuer Strahlenheilkunde

    2013-11-15

    Purpose: The purpose of this work was to evaluate tumor control and side effects associated with fractionated stereotactic radiotherapy (FSRT) in the management of residual or recurrent pituitary adenomas. Patients and methods: We report on 37 consecutive patients with pituitary adenomas treated with FSRT at our department. All patients had previously undergone surgery. Twenty-nine patients had nonfunctioning, 8 had hormone-producing adenoma. The mean total dose delivered by a linear accelerator was 49.4 Gy (range 45-52.2 Gy), 5 x 1.8 Gy weekly. The mean PTV was 22.8 ccm (range 2.0-78.3 ccm). Evaluation included serial imaging tests, endocrinologic and ophthalmologic examination. Results: Tumor control was 91.9 % for a median follow-up time of 57 months (range 2-111 months). Before FSRT partial hypopituitarism was present in 41 % of patients, while 35 % had anterior panhypopituitarism. After FSRT pituitary function remained normal in 22 %, 43 % had partial pituitary dysfunction, and 35 % had anterior panhypopituitarism. Visual acuity was stable in 76 % of patients, improved in 19 %, and deteriorated in 5 %. Visual fields remained stable in 35 patients (95 %), improved in one and worsened in 1 patient (2.7 %). Conclusion: FSRT is an effective and safe treatment for recurrent or residual pituitary adenoma. Good local tumor control and preservation of adjacent structures can be reached, even for large tumors. (orig.)

  4. RT-01FRACTIONATED STEREOTACTIC RADIOTHERAPY FOR PITUITARY ADENOMA WITH NOVALIS

    Science.gov (United States)

    Arakawa, Yoshiki; Mizowaki, Takashi; Ogura, Kengo; Sakanaka, Katsuyuki; Hojo, Masato; Hiraoka, Masahiro; Miyamoto, Susumu; Murata, Daiki

    2014-01-01

    BACKGROUND: Radiation therapy is an available treatment modality for pituitary adenoma. In particular, it is effective for the case unable to be removed with surgery or repeating recurrence. However, hypopituitarism and optic nerve injury associated with radiation therapy become a problem. Novalis® (Brain Lab) is an equipment of radiation to establish the detailed irradiation area, fractionated stereotactic radiotherapy (fSRT) and intensity-modulated radiation therapy (IMRT). Retrospectively, we review local control and morbidity following fSRT with Novalis in pituitary adenoma. PATIENTS AND METHODS: Between 2007 and 2012, 29 patients with pituitary adenoma (9 functioning, 20 non-functioning) received fSRT with Novalis in our institute. Total radiation dose was 50.4-54Gy (1.8 Gy per fraction) and prescribed to the gross target volume + 2 mm. The effectiveness of fSRT was evaluated by tumor volume and clinical symptoms on pre- fSRT, and every 1-year. RESULTS: The median follow-up time was 59.1 months (20 to 83 months). Tumor regrowth was observed in 2 cases. Progression free survival rate was 93%. New visual field deficit was observed in 1 case, and new pituitary dysfunction were not observed in all patients. CONCLUSION: fSRT with Novalis is safe and effective in the treatment for pituitary adenoma. Although follow-up time is short, any problematic complications were not observed. In the future, fSRT is expected to make for safe and effective treatment in pituitary adenoma impossible to cure surgically.

  5. Fractionation effects in particle radiotherapy: implications for hypo-fractionation regimes

    Energy Technology Data Exchange (ETDEWEB)

    Carabe-Fernandez, A; Paganetti, H [Department of Radiation Oncology, Harvard Medical School, Francis H Burr Proton Therapy Center, Massachusetts General Hospital, Boston, MA 02114 (United States); Dale, R G [Department of Radiation Physics and Radiobiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF (United Kingdom); Hopewell, J W; Jones, B, E-mail: acarabe@partners.or [Particle Therapy Cancer Research Institute, University of Oxford, Oxford OX1 3RH (United Kingdom)

    2010-10-07

    The aim is to demonstrate the potential impact of changes in the value of the {beta} parameter in the linear quadratic (LQ) model on the calculation of clinical relative biological effectiveness (RBE) values used for high linear energy transfer (LET) radiotherapy. The parameter RBE{sub min} is introduced into the LQ formulation to account for possible changes in the {beta} radiosensitivity coefficient with changing LET. The model is used to fit fractionated data under two conditions, where RBE{sub min} = 1 and RBE{sub min} {ne} 1. Nonlinear regression and analysis of variance are used to test the hypothesis that the inclusion of a non-unity value of RBE{sub min} better predicts the total iso-effective dose required at low number of fractions for fast neutrons, carbon ions, {pi}-meson and proton fractionation data obtained for various tissues from previous publications. For neutrons the assumption of RBE{sub min} {ne} 1 provided a better fit in 89% of the cases, whereas for carbon ions RBE{sub min} {ne} 1 provided a better fit only for normal tissue at the spread-out Bragg peak. The results provide evidence of the impact that variations in the {beta} parameter may have when calculating clinically relevant RBE values, especially when using high doses per fraction (i.e. hypofractionation) of high-LET radiations.

  6. 大分割与常规分割3DCRT原发性肝癌合并门脉癌栓的临床观察%Clinical efficacy of conventionally fractionated versus hypofractionated three-dimensional conformal radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

    Institute of Scientific and Technical Information of China (English)

    芦东徽; 费振乐; 周俊平; 胡宗涛; 郝文胜

    2014-01-01

    Objective To observe the efficacy and adverse effects of conventionally fractionated (CF) versus hypofractionated (HF) three-dimensional conformal radiotherapy (3DCRT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis.Methods A retrospective analysis was performed on the clinical data of 65 patients with HCC suitable for 3DCRT from 2008 to 2012.These patients were randomly divided into HF group (n =32) and CF group (n =32).The HF group received 3DCRT at a total dose of 45-55 Gy (3-4 Gy/fraction,3-5 fractions/week),while the CF group at a total dose of 40-56 Gy (2 Gy/fraction,5 fractions/week).Results The follow-up rate was 100%.For the HF group and CF group,the short-term response rates were 72% vs.55% (P =0.034),the 1-year local control rates were 72% vs.55% (P=0.034),the 1-year overall survival rates were 59% vs.45% (P=0.042),and the numbers of individuals with grade 1-2 acute gastrointestinal reactions,deterioration of liver function,and radiation hepatitis were 14 vs.11,8 vs.8,and 1 vs.0,respectively (P =0.237).Conclusions HF 3DCRT is superior to CF 3DCRT in the treatment of HCC.%目的 观察大分割与常规分割3DCRT原发性肝癌合并门脉癌栓的疗效和不良反应.方法 回顾分析2008-2012年间对65例适合3DCRT的原发性肝癌患者资料,其中大分割组32例,常规分割组33例.大分割组3~4 Gy/次,3~5次/周,总剂量45 ~ 55 Gy,常规分割组2 Gy/次,5次/周,总剂量40 ~ 56 Gy.结果 随访率100%.大分割、常规分割3DCRT的近期有效率分别为72%、55% (P=0.034),1年局部控制率分别为72%、55%(P=0.034),1年OS分别为59%、45%(P=0.042),1~2级急性消化道反应分别为14、11例,肝功能下降分别为8、8例,放射性肝炎分别为1、0例(P=0.237).结论 大剂量分割3DCRT原发性肝癌比常规分割更具优势.

  7. Altered fractionation schedules in radiotherapy of head and neck cancer. A review.

    Science.gov (United States)

    Fallai, C; Olmi, P

    1992-10-31

    The authors review the main contributions of international literature to show the current status in clinical trials on unconventional fractionations of the dose in radiotherapy of head and neck cancers. Several clinical (but only a few randomized) trials have been conducted over the last 15 years using hyperfractionated (HF), accelerated (AF) or mixed (HF-AF) schedules. HF schedules have obtained promising results in terms of local control in comparison with conventional fractionation (CF) of the dose. Improvement in survival was also obtained by the random trials of Pinto and Sanchiz, whereas in EORTC trial no. 22791, the improvement in survival rate was only marginal. A significant increase in local control and, less frequently, in survival has been claimed in several studies using HF-AF. Such data still need to be confirmed by a random study, since EORTC trial 22811 showed superimposable results in comparison with CF. Selection of the most suitable cases for altered fractionation schemes is also being studied in ongoing trials of the EORTC (22851) and RTOG (90-03). As regards acute reactions during and after altered fractionation, they are more severe than after CF. Only pure HF with a dose intensity approximately comparable to CF seems to produce similar acute reactions. Several factors have been found to influence the severity of acute mucosal reactions: interfraction interval, overall treatment time, total dose, and field size. As regards late damage, genuine HF schemes seem to cause roughly equivalent late damage in comparison to CF, whereas high-dose intensity schedules have a higher rate of complications. Interfraction interval, overall treatment time, total dose, fraction size and field size can influence the risk of late sequelae. Before altered fractionations can be considered standard therapy, more data are needed, which should be provided by multicentric randomized trials, some of which are already in progress.

  8. Intra-fractional bladder motion and margins in adaptive radiotherapy for urinary bladder cancer

    DEFF Research Database (Denmark)

    Grønborg, Caroline; Vestergaard, Anne; Høyer, Morten

    2015-01-01

    BACKGROUND: The bladder is a tumour site well suited for adaptive radiotherapy (ART) due to large inter-fractional changes, but it also displays considerable intra-fractional motion. The aim of this study was to assess target coverage with a clinically applied method for plan selection ART and to...

  9. Dosimetric comparison between conventional and conformal radiotherapy for carcinoma cervix: Are we treating the right volumes?

    Directory of Open Access Journals (Sweden)

    Jyotirup Goswami

    2013-01-01

    Full Text Available Background and Purpose: Conventional portals, based on bony anatomy, for external beam radiotherapy for cervical cancer have been repeatedly demonstrated as inadequate. Conversely, with image-based conformal radiotherapy, better target coverage may be offset by the greater toxicities and poorer compliance associated with treating larger volumes. This study was meant to dosimetrically compare conformal and conventional radiotherapy. Materials and Methods: Five patients of carcinoma cervix underwent planning CT scan with IV contrast and targets, and organs at risk (OAR were contoured. Two sets of plans-conventional and conformal were generated for each patient. Field sizes were recorded, and dose volume histograms of both sets of plans were generated and compared on the basis of target coverage and OAR sparing. Results: Target coverage was significantly improved with conformal plans though field sizes required were significantly larger. On the other hand, dose homogeneity was not significantly improved. Doses to the OARs (rectum, urinary bladder, and small bowel were not significantly different across the 2 arms. Conclusion: Three-dimensional conformal radiotherapy gives significantly better target coverage, which may translate into better local control and survival. On the other hand, it also requires significantly larger field sizes though doses to the OARs are not significantly increased.

  10. HIGH DOSE FRACTION RADIOTHERAPY FOR MUCOSAL MALIGNANT MELANOMA OF THE HEAD AND NECK

    Institute of Scientific and Technical Information of China (English)

    Liu Xiuying; Li Huiling; Zheng Tianrong; Lin Xiangsong

    1998-01-01

    Objective:To evatuate the results of high dose fraction radiotherapy for mucosal malignant melanoma of the head and neck (HNMM). Methods: From 1984-1994, 35 patients with HNMM were enrolled in this study. Among them, 27 cases localized to the nasal cavity or para-nasal sinus, 8 to the oral cavity. All patients received high dose fraction radiotherapy (6--8 Gy/fraction)with the total dose ranged from 40 to 60 Gy. Results: The minimum follow-up was 2 years (ranged 2-7 years). The overall 3- and 5-year survival rate was 45.7% and 24%,respectively. Conclusion: High dose fraction radiotherapy is effective for local control of HNMM.

  11. Simultaneous optimization of dose distributions and fractionation schemes in particle radiotherapy

    NARCIS (Netherlands)

    Unkelbach, J.; Zeng, C.; Engelsman, M.

    2013-01-01

    Purpose: The paper considers the fractionation problem in intensity modulated proton therapy (IMPT). Conventionally, IMPT fields are optimized independently of the fractionation scheme. In this work, we discuss the simultaneous optimization of fractionation scheme and pencil beam intensities. Meth

  12. Conventional vs accelerated fractionation in head and neck cancer.

    Science.gov (United States)

    Dobrowsky, W; Dobrowsky, E; Naudé, J; Millesi, W; Pavelka, R; Kautzky, M; Grasl, M; Köhler, W; Wilson, G D; Reichel, M

    1996-07-01

    From October 1990 to March 1994, 90 patients entered a prospectively randomised trial in head and neck cancer. All patients had verified squamous cell carcinoma and were referred for primary radiation therapy. Tumours originated in the oral cavity in 25, oropharynx in 37, larynx in 15 and hypopharynx in 13 cases. Patients' stages were predominantely T3 and T4 (71/90) and had lymph node metastases (60/90). Seventy-nine male patients and 11 female patients, with a median age of 57 years (range 37-76 years) were treated. Patients were randomised to one of three treatment options: conventional fractionation (CF) consisting of 70 Gy in 35 fractions over 7 weeks or continuous hyperfractionated accelerated radiation therapy (Vienna-CHART) or Vienna-CHART with administration of a single dose of mitomycin C on day 5 of treatment (V-CHART + MMC). By the accelerated regimen a total dose of 55.3 Gy was given in 33 fractions within 17 consecutive days. Acute mucositis was the main toxicity recorded in those patients treated by accelerated fractionation, although the overall duration of mucosal reaction did not differ in the three treatment groups. There was no influence on local toxicity if MMC was added to radiation therapy or not. Those patients treated with additional MMC experienced a grade III/IV haematological toxicity in 4/28 cases. Complete remission (CR) was recorded in 48% following CF, 79% after Vienna-CHART (P < 0.05) and 71% after Vienna-CHART + MMC. The overall local failure rates were 73%, 59% and 42% (P = NS) for patients treated by CF, Vienna-CHART and Vienna-CHART + MMC respectively.

  13. SU-E-T-460: Isoeffective Dose Display (EQD2) for Composite Plan of Radiosurgery and Conventional 3D Radiotherapy.

    Science.gov (United States)

    Zheng, Y; Yuan, J; Woods, C; Machtay, M; Wessels, B

    2012-06-01

    Direct addition of doses between plans with different fractionation fails to provide accurate dose-response information to anticipate clinical outcome. To combine different fractionation patterns, first-order biological model correction for dose-rate must be included. Moreover, 3-D isoeffect patterns of the combined doses must be displayed so that overlap area to elegant volumes can be avoided. The linear quadratic (LQ) model and biologically effective dose (BED) method were used to produce a combined plan in equivalent 2 Gy fractions (EQD2) for radiosurgery and conventional 3D radiotherapy. For patients with multiple courses of radiotherapy, dose distributions of the prior and boost treatment plans were converted to BED. The fraction size specified by the prescription was applied globally for each BED calculation, α/β ratio of 10 and 2.5 was used for early and late effect, respectively. Image registration with CT or MR was performed for initial and boost plans. The registration information was applied to dose distributions to obtain the composite EQD2. As a demonstration of this method, two patients were selected who had combined treatments from substantially different modalities. A patient with liver cancer initially received radiotherapy of 30 Gy/10 Fx and re-irradiation with CyberKnife radiosurgery (15 Gy/1 Fx). The combined plan showed that the PTV received EQD2 of 63.8 Gy. Another patient had brain metastasis treated with GammaKnife of 18 Gy (50% isodose) followed by conventional 3D whole brain radiation of 30 Gy/10 Fx. The minimal combined tumor EQD2 was 74.5 Gy. Early and late calculated responses showed that all critical organ doses were within tolerance. For patients receiving radiation with different fractionation schemes, combined isoeffective dose distributions were calculated and displayed. In both cases, crucial information regarding 3-D dose distributions assisted the physicians in determining whether tolerance limits of overlap areas of retreated

  14. Dosimetric effect of intra-fractional and inter-fractional target motion in lung cancer radiotherapy techniques

    Directory of Open Access Journals (Sweden)

    Teerthraj Verma

    2015-12-01

    Full Text Available Purpose: The purpose of present study was to experimentally evaluate the dosimetric uncertainties in 3-dimensional conformal radiotherapy (3DCRT, dynamic intensity modulated radiotherapy (D-IMRT, step-shoot (SS-IMRT, and volumetric modulated arc therapy (VMAT treatment delivery techniques due to intra- and inter-fractional target motion. Methods: A previously treated lung patient was selected for this study and was replanned for 60 Gy in 30 fractions using four techniques (3DCRT, D-IMRT, SS-IMRT, and VMAT. These plans were delivered in a clinical linear accelerator equipped with HexaPOD™ evo RT System. The target dose of static QUASAR phantom was calculated that served as reference dose to the target. The QUASAR respiratory body phantom along with patients breathing wave form and HexaPOD™ evo RT System was used to simulate the intra-fraction and inter-fraction motions. Dose measurements were done by applying the intra-fractional and inter-fractional motions in all the four treatment delivery techniques.Results: The maximum percentage deviation in a single field was -4.3%, 10.4%, and -12.2% for 3DCRT, D-IMRT and SS-IMRT deliveries, respectively. Similarly, the deviation for a single fraction was -1.51%, -1.88%, -2.22%, and -3.03% for 3DCRT, D-IMRT, SS-IMRT and VMAT deliveries, respectively. Conclusion: The impact of inter-fractional and intra-fractional uncertainties calculated as deviation between dynamic and static condition dose was large in some fractions, however average deviation calculated for thirty fractions was well within 0.5% in all the four techniques. Therefore, inter- and intra-fractional uncertainties could be concern in fewer fraction treatments such as stereotactic body radiation therapy, and should be used in conjunction with intra- and inter-fractional motion management techniques.

  15. Early manifestation of communicating hydrocephalus after fractionated stereotactic radiotherapy for aggressive giant atypical prolactinoma.

    Science.gov (United States)

    Ohtakara, Kazuhiro; Ohe, Naoyuki; Iwama, Toru; Hoshi, Hiroaki

    2014-05-01

    Aggressive giant invasive pituitary adenomas refractory to standard surgical or medical treatment remain a genuine challenge. In addition, communicating hydrocephalus (CH) attributed to malabsorption of cerebrospinal fluid (CSF) developing after radiotherapy for pituitary adenomas has not been previously reported. Herein, we describe the case of a 48-year-old male presenting with a giant atypical prolactinoma refractory to previous therapies, including pharmacotherapy and repetitive surgery. He underwent image-guided fractionated stereotactic radiotherapy in 28 fractions, resulting in early manifestation of CH associated with undisputed, both radiological and hormonal response. He recovered well after a shunt placement, with otherwise favorable consequences such as sustained tumor regression, decreasing prolactin level, and retained visual function for a 22-month follow-up. Fractionated stereotactic radiotherapy would provide a viable treatment alternative for these refractory cases, while caution should be exercised regarding the possibility of iatrogenic CH.

  16. Feasibility of tomotherapy for Graves' ophthalmopathy. Dosimetry comparison with conventional radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Nam P.; Krafft, Shane P. [Arizona Univ., Tucson, AZ (United States). Dept. of Radiation Oncology; Vos, Paul [East Carolina Univ., Greenville, NC (US). Dept. of Biostatistics] (and others)

    2011-09-15

    To compare the dosimetry of tomotherapy and the conventional half-beam technique (HBT) or non-split beam technique (NSBT) for target coverage and radiation dose to the lacrimal glands and lens. A retrospective review of 7 patients with Graves' ophthalmopathy who had radiotherapy because of disease progression on high steroid dose is reported: 3 patients were treated with tomotherapy and 4 patients with HBT. Compared to HBT, tomotherapy may provide better target coverage and significant reduction of radiation dose to the lacrimal glands and a higher dose to the lens. The NSBT improved target coverage but resulted in significantly higher doses to the lens and lacrimal glands. Tomotherapy may provide better coverage of the target volume and may be more effective in reducing severe exophthalmos compared to the conventional radiotherapy technique. (orig.)

  17. The Outcome of Conventional External Beam Radiotherapy for Patients with Squamous Cell Carcinoma of the Esophagus

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2008-03-15

    The best treatment for advanced esophageal cancer is chemoradiotherapy followed by surgery. In spite of the advance of multimodality therapy, most patients with esophageal cancer are treated with radiation therapy alone. This study reports the outcome of the use of conventional external beam radiotherapy alone for the treatment of esophageal cancer. Between January 1998 and December 2005, 30 patients with squamous cell carcinoma of the esophagus were treated with external beam radiotherapy using a total dose exceeding 40 Gy. Radiotherapy was delivered with a total dose of 44-60 Gy (median dose, 57.2 Gy) over 36 {approx}115 days (median time, 45 days). Thirteen patients (43.3%) had a history of disorders such as diabetes, hypertension, tuberculosis, lye stricture, asthma, cerebral infarct, and cancers. Four patients metachronously had double primary cancers. The most common location of a tumor was the mid-thoracic portion of the esophagus (56.7%). Tumor lengths ranged from 2 cm to 11 cm, with a median length of 6 cm. For AJCC staging, stage III was the most common (63.3%). Five patients had metastases at diagnosis. The median overall survival was 8.3 months. The survival rates at 1-year and 2-years were 33.3% and 18.7%, respectively. The complete response rate 1{approx}3 months after radiotherapy was 20% (6/30) and the partial response rate was 70% (21/30). Sixteen patients (53.3%) had an improved symptom of dysphagia. Significant prognostic factors were age, tumor length, stage, degree of dysphagia at the time of diagnosis and tumor response. Cox regression analysis revealed the aim of treatment, clinical tumor response and tumor length as independent prognostic factors for overall survival. Twenty-eight patients had local failure and another four patients had metastases. Three patients were detected with double primary cancers in this analysis. A complication of esophageal stricture was observed in three patients (10%), and radiation pneumonitis occurred in two

  18. Normal tissue dose conformality measures to guide radiotherapy fractionation decisions

    Energy Technology Data Exchange (ETDEWEB)

    Myerson, Robert J. [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110 (United States)

    2011-04-15

    Purpose: To determine conditions under which hypofractionation could be favorable for a normal tissue--even if tumor [{alpha}/{beta}] exceeds the normal tissue's [{alpha}/{beta}]. Methods: The hypofractionation sufficiency condition (HSC) for an organ is defined as a dose conformality constraint such that, if satisfied, a family of tumor control probability isoeffective fractionation schemes will show decreasing normal tissue complication probability with decreasing number of fractions. Results: In the extended equivalent uniform dose (EUD) model [obtained by replacing dose with linear quadratic (LQ) 2 Gy equivalent dose], the HSC for a normal organ is proven to be satisfied if a suitably weighted average of the relative dose [hypofractionation sufficiency index (HSI)] is less than the ratio of normal tissue to tumor [{alpha}/{beta}]. The HSI is determined solely by dose distribution and the normal tissue volume factor, ''a.'' If the HSC is satisfied for every normal tissue of concern, then there is a therapeutic gain with hypofractionation. The corresponding multifractionation sufficiency condition (therapeutic gain with increasing number of fractions) and multifractionation sufficiency index (MSI) are also derived. A sample clinical case is presented. Conclusions: Within the context of the LQ/EUD models, conformality measures (HSI and MSI) can be used to inform fractionation decisions.

  19. Volumetric modulated arc therapy is superior to conventional intensity modulated radiotherapy - a comparison among prostate cancer patients treated in an Australian centre

    Directory of Open Access Journals (Sweden)

    Haydu Lauren E

    2011-09-01

    Full Text Available Abstract Background Radiotherapy technology is expanding rapidly. Volumetric Modulated Arc Therapy (VMAT technologies such as RapidArc® (RA may be a more efficient way of delivering intensity-modulated radiotherapy-like (IM treatments. This study is an audit of the RA experience in an Australian department with a planning and economic comparison to IM. Methods 30 consecutive prostate cancer patients treated radically with RA were analyzed. Eight RA patients treated definitively were then completely re-planned with 3D conformal radiotherapy (3D; and a conventional sliding window IM technique; and a new RA plan. The acceptable plans and their treatment times were compared and analyzed for any significant difference. Differences in staff costs of treatment were computed and analyzed. Results Thirty patients had been treated to date with eight being treated definitely to at least 74 Gy, nine post high dose brachytherapy (HDR to 50.4Gy and 13 post prostatectomy to at least 64Gy. All radiotherapy courses were completed with no breaks. Acute rectal toxicity by the RTOG criteria was acceptable with 22 having no toxicity, seven with grade 1 and one had grade 2. Of the eight re-planned patients, none of the 3D (three-dimensional conformal radiotherapy plans were acceptable based on local guidelines for dose to organs at risk. There was no statistically significant difference in planning times between IM and RA (p = 0.792. IM had significantly greater MUs per fraction (1813.9 vs 590.2 p Conclusions 3D was incapable of covering a modern radiotherapy volume for the radical treatment of prostate cancer. These volumes can be treated via conventional IM and RA. RA was significantly more efficient, safe and cost effective than IM. VMAT technologies are a superior way of delivering IM-like treatments.

  20. SU-E-J-105: Stromal-Epithelial Responses to Fractionated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Qayyum, M [Little Company of Mary Hospital, Ever Green Park, IL (United States)

    2014-06-01

    Purpose: The stromal-epithelial-cell interactions that are responsible for directing normal breast-tissue development and maintenance play a central role in the progression of breast cancer. In the present study, we developed three-dimensional (3-D) cell co-cultures used to study cancerous mammary cell responses to fractionated radiotherapy. In particular, we focused on the role of the reactive stroma in determining the therapeutic ratio for postsurgical treatment. Methods: Cancerous human mammary epithelial cells were cultured in a 3-D collagen matrix with human fibroblasts stimulated by various concentrations of transforming growth factor beta 1 (TGF-β1). These culture samples were designed to model the post-lumpectomy mammary stroma in the presence of residual cancer cells. We tracked over time the changes in medium stiffness, fibroblast-cell activation (conversion to cancer activated fibroblasts (CAF)), and proliferation of both cell types under a variety of fractionated radiotherapy protocols. Samples were exposed to 6 MV X-rays from a linear accelerator in daily fraction sizes of 90, 180 and 360 cGy over five days in a manner consistent with irradiation exposure during radiotherapy. Results: We found in fractionation studies with fibroblasts and CAF that higher doses per fraction may be more effective early on in deactivating cancer-harboring cellular environments. Higher-dose fraction schemes inhibit contractility in CAF and prevent differentiation of fibroblasts, thereby metabolically uncoupling tumor cells from their surrounding stroma. Yet, over a longer time period, the higher dose fractions may slow wound healing and increase ECM stiffening that could stimulate proliferation of surviving cancer cells. Conclusion: The findings suggest that dose escalation to the region with residual disease can deactivate the reactive stroma, thus minimizing the cancer promoting features of the cellular environment. Large-fraction irradiation may be used to sterilize

  1. Single fraction versus multiple fraction radiotherapy for palliation of painful vertebral bone metastases: A prospective study

    Directory of Open Access Journals (Sweden)

    Dipanjan Majumder

    2012-01-01

    Conclusions: Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.

  2. Radiotherapy for T1a glottic cancer: the influence of smoking cessation and fractionation schedule of radiotherapy.

    Science.gov (United States)

    Al-Mamgani, Abrahim; van Rooij, Peter H; Mehilal, Robert; Verduijn, Gerda M; Tans, Lisa; Kwa, Stefan L S

    2014-01-01

    The objective of the presented study is to report on retrospectively collected data on long-term outcome and toxicity and prospective assessment of quality of life (QoL) and Voice-Handicap Index (VHI) of patients with T1a glottic cancer treated with radiotherapy. Between 1985 and 2011, 549 patients were treated. Endpoints were local control (LC), toxicity, QoL and VHI. After a median follow-up of 93 months, the actuarial rates of LC were 91, and 90 % at 5- and 10-years, respectively. Continuing smoking (p VHI improved significantly from 34 at baseline to 21 at 24 months. Patients who continued smoking had significantly worse VHI. In conclusion, excellent outcome with good QoL and VHI were reported. Patients who continued smoking after radiotherapy had significantly poor LC and worse VHI. The current study emphasizes the importance of smoking cessation and the non-inferiority of hypofractionated schemes in terms of outcome and VHI. At our institution, phase II study is going to evaluate the role of single vocal cord irradiation with high fraction dose.

  3. Biological dose representation for carbon-ion radiotherapy of unconventional fractionation

    Science.gov (United States)

    Kanematsu, Nobuyuki; Inaniwa, Taku

    2017-02-01

    In carbon-ion radiotherapy, single-beam delivery each day in alternate directions has been common practice for efficient operation, taking advantage of the Bragg peak and the relative biological effectiveness (RBE) for uniform dose conformation to a tumor. Treatments are usually fractionated and treatment plans are evaluated with the total RBE-weighted dose; however, this is of limited relevance to the biological effect. In this study, we reformulate the biologically effective dose (BED) to normalize the dose-fractionation and cell-repopulation effects as well as the RBE of treating radiation, based on inactivation of a reference cell line by a reference carbon-ion radiation. The BED distribution virtually represents the biological effect of a treatment regardless of radiation modality or fractionation scheme. We applied the BED formulation to simplistic model treatments and to a preclinical survey for hypofractionation based on an actual prostate cancer treatment with carbon ions. The proposed formulation was demonstrated to be practical and to give theoretical implications. For a prostate cancer treatment in 12 fractions, the distributions of BED and of RBE-weighted dose were very similar. With hypofractionation, while the RBE-weighted dose distribution varied significantly, the BED distribution was nearly invariant, implying that carbon-ion radiotherapy would be effectively insensitive to fractionation. However, treatment evaluation with such a simplistic biological dose is intrinsically limited and must be complemented in practice by clinical experience and biological experiments.

  4. Carbon Ion Radiotherapy in Advanced Hypofractionated Regimens for Prostate Cancer: From 20 to 16 Fractions

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tohru [National Institute of Radiological Sciences, Chiba (Japan); Tsuji, Hiroshi, E-mail: h_tsuji@nirs.go.jp [National Institute of Radiological Sciences, Chiba (Japan); Kamada, Tadashi [National Institute of Radiological Sciences, Chiba (Japan); Akakura, Koichiro; Suzuki, Hiroyoshi; Shimazaki, Jun [Department of Urology, Graduate School of Medicine, Chiba University, Chiba (Japan); Tsujii, Hirohiko [National Institute of Radiological Sciences, Chiba (Japan)

    2012-11-15

    Purpose: To assess the effects of differences in dose fractionation on late radiation toxicity and biochemical control in patients with prostate cancer treated with carbon ion radiotherapy (C-ion RT). Methods and Materials: A total of 740 prostate cancer patients who received C-ion RT between April 2000 and February 2009 were analyzed. Of those, 664 patients followed for at least 1 year were analyzed with regard to late radiation toxicity. Biochemical relapse-free (BRF) and overall survival (OS) rates in patient subgroups with each dose-fractionation were analyzed. Results: Only 1 case of grade 3 genitourinary (GU) morbidity was observed in 20 fractions, and none of the patients developed higher grade morbidities. The incidence of late GU toxicity in patients treated with 16 fractions was lower than that of patients treated with 20 fractions. The OS rate and BRF rate of the entire group at 5 years were 95.2% and 89.7%, respectively. The 5-year BRF rate of the patients treated with 16 fractions of C-ion RT (88.5%) was comparable to that of the patients treated with 20 fractions (90.2%). Conclusion: C-ion RT of 57.6 GyE (the physical C-ion dose [Gy] Multiplication-Sign RBE) in 16 fractions could offer an even lower incidence of genitourinary toxicity and comparable BRF rate than that in 20 fractions. Advancement in hypofractionation could be safely achieved with C-ion RT for prostate cancer.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-11-15

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

  6. Optimum radiotherapy schedule for uterine cervical cancer based-on the detailed information of dose fractionation and radiotherapy technique

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jae Ho; Kim, Hyun Chang; Suh, Chang Ok [Yonsei University Medical School, Seoul (Korea, Republic of)] (and others)

    2005-09-15

    The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of 23.4 {approx} 59.4 Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-ICBT) was also performed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of 14.4{approx} 43.2 Gy (Median 36.0) of EBRT in 495 patients, while in the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder and rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ({alpha} / {beta} = 10) and late-responding tissues ({alpha} /{beta} = 3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED Gy{sub 3} and the risk of complication was assessed using serial multiple logistic regressions models. The associations between R

  7. CyberKnife® enhanced conventionally fractionated chemoradiation for high grade glioma in close proximity to critical structures

    Directory of Open Access Journals (Sweden)

    Oermann Eric

    2010-06-01

    Full Text Available Abstract Introduction With conventional radiation technique alone, it is difficult to deliver radical treatment (≥ 60 Gy to gliomas that are close to critical structures without incurring the risk of late radiation induced complications. Temozolomide-related improvements in high-grade glioma survival have placed a higher premium on optimal radiation therapy delivery. We investigated the safety and efficacy of utilizing highly conformal and precise CyberKnife radiotherapy to enhance conventional radiotherapy in the treatment of high grade glioma. Methods Between January 2002 and January 2009, 24 patients with good performance status and high-grade gliomas in close proximity to critical structures (i.e. eyes, optic nerves, optic chiasm and brainstem were treated with the CyberKnife. All patients received conventional radiation therapy following tumor resection, with a median dose of 50 Gy (range: 40 - 50.4 Gy. Subsequently, an additional dose of 10 Gy was delivered in 5 successive 2 Gy daily fractions utilizing the CyberKnife® image-guided radiosurgical system. The majority of patients (88% received concurrent and/or adjuvant Temozolmide. Results During CyberKnife treatments, the mean number of radiation beams utilized was 173 and the mean number of verification images was 58. Among the 24 patients, the mean clinical treatment volume was 174 cc, the mean prescription isodose line was 73% and the mean percent target coverage was 94%. At a median follow-up of 23 months for the glioblastoma multiforme cohort, the median survival was 18 months and the two-year survival rate was 37%. At a median follow-up of 63 months for the anaplastic glioma cohort, the median survival has not been reached and the 4-year survival rate was 71%. There have been no severe late complications referable to this radiation regimen in these patients. Conclusion We utilized fractionated CyberKnife radiotherapy as an adjunct to conventional radiation to improve the targeting

  8. Radiotherapy

    Directory of Open Access Journals (Sweden)

    Rema Jyothirmayi

    1999-01-01

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

  9. A new theoretical formula for fractionated radiotherapy based on a saturable cellular repair mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez-Reyes, A. (Servicio de Radioterapia, Hospital Clinico y Provincial de Barcelona (Spain)); Farrus, B. (Servicio de Radioterapia, Hospital Clinico y Provincial de Barcelona (Spain)); Biete, A. (Servicio de Radioterapia, Hospital Clinico y Provincial de Barcelona (Spain))

    1993-01-01

    Recently we have published a new model of survival cellular response to radiation based on the existence of a saturable cellular repair mechanism. In the present paper we extend the predictions of this model of calculating the change in total dose necessary to achieve an equal response in a tissue when the dose per fraction in a radiotherapy fractionation schedule is varied. The model provides a new explanation of the difference between late and early radiation reactions. Results obtained from the model for different tissues and standard fractionation schedules are approximately equal to those obtained by the L.Q. (linear-quadratic) model. The model is compatible with in vitro survival curves that are straight at high doses. (orig.).

  10. Low or High Fractionation Dose {beta}-Radiotherapy for Pterygium? A Randomized Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Viani, Gustavo Arruda, E-mail: gusviani@gmail.com [Department of Radiation Oncology, Marilia Medicine School, Sao Paulo, SP (Brazil); De Fendi, Ligia Issa; Fonseca, Ellen Carrara [Department of Ophthalmology, Marilia Medicine School, Sao Paulo, SP (Brazil); Stefano, Eduardo Jose [Department of Radiation Oncology, Marilia Medicine School, Sao Paulo, SP (Brazil)

    2012-02-01

    Purpose: Postoperative adjuvant treatment using {beta}-radiotherapy (RT) is a proven technique for reducing the recurrence of pterygium. A randomized trial was conducted to determine whether a low fractionation dose of 2 Gy within 10 fractions would provide local control similar to that after a high fractionation dose of 5 Gy within 7 fractions for surgically resected pterygium. Methods: A randomized trial was conducted in 200 patients (216 pterygia) between February 2006 and July 2007. Only patients with fresh pterygium resected using a bare sclera method and given RT within 3 days were included. Postoperative RT was delivered using a strontium-90 eye applicator. The pterygia were randomly treated using either 5 Gy within 7 fractions (Group 1) or 2 Gy within 10 fractions (Group 2). The local control rate was calculated from the date of surgery. Results: Of the 216 pterygia included, 112 were allocated to Group 1 and 104 to Group 2. The 3-year local control rate for Groups 1 and 2 was 93.8% and 92.3%, respectively (p = .616). A statistically significant difference for cosmetic effect (p = .034), photophobia (p = .02), irritation (p = .001), and scleromalacia (p = .017) was noted in favor of Group 2. Conclusions: No better local control rate for postoperative pterygium was obtained using high-dose fractionation vs. low-dose fractionation. However, a low-dose fractionation schedule produced better cosmetic effects and resulted in fewer symptoms than high-dose fractionation. Moreover, pterygia can be safely treated in terms of local recurrence using RT schedules with a biologic effective dose of 24-52.5 Gy{sub 10.}.

  11. Halo ring supporting the Brown-Roberts-Wells stereotactic frame for fractionated radiotherapy.

    Science.gov (United States)

    Carini, S; Scielzo, G; Grillo Ruggieri, F; Bistolfi, F; Ravegnani, M; Andreussi, L

    1994-01-01

    The authors describe a new instrumentation for repositioning of the Brown-Roberts-Wells (BRW) stereotaxic system, useful for precise fractionated radiotherapy. A lucite ring is fixed to the patient's skull with four screws. Another ring, partially open, is then firmly connected co-axially to the lower part of the first one with four spacer-bars. The fixture permits an exact repositioning of the B.R.W. stereotaxic system, placing the target point in the linear accelerator isocenter. The preliminary technical results obtained in five children are reported and the fixture performance, advantages, and perspectives are discussed.

  12. Conventional and conformal technique of external beam radiotherapy in locally advanced cervical cancer: Dose distribution, tumor response, and side effects

    Science.gov (United States)

    Mutrikah, N.; Winarno, H.; Amalia, T.; Djakaria, M.

    2017-08-01

    The objective of this study was to compare conventional and conformal techniques of external beam radiotherapy (EBRT) in terms of the dose distribution, tumor response, and side effects in the treatment of locally advanced cervical cancer patients. A retrospective cohort study was conducted on cervical cancer patients who underwent EBRT before brachytherapy in the Radiotherapy Department of Cipto Mangunkusumo Hospital. The prescribed dose distribution, tumor response, and acute side effects of EBRT using conventional and conformal techniques were investigated. In total, 51 patients who underwent EBRT using conventional techniques (25 cases using Cobalt-60 and 26 cases using a linear accelerator (LINAC)) and 29 patients who underwent EBRT using conformal techniques were included in the study. The distribution of the prescribed dose in the target had an impact on the patient’s final response to EBRT. The complete response rate of patients to conformal techniques was significantly greater (58%) than that of patients to conventional techniques (42%). No severe acute local side effects were seen in any of the patients (Radiation Therapy Oncology Group (RTOG) grades 3-4). The distribution of the dose and volume to the gastrointestinal tract affected the proportion of mild acute side effects (RTOG grades 1-2). The urinary bladder was significantly greater using conventional techniques (Cobalt-60/LINAC) than using conformal techniques at 72% and 78% compared to 28% and 22%, respectively. The use of conformal techniques in pelvic radiation therapy is suggested in radiotherapy centers with CT simulators and 3D Radiotherapy Treatment Planning Systems (RTPSs) to decrease some uncertainties in radiotherapy planning. The use of AP/PA pelvic radiation techniques with Cobalt-60 should be limited in body thicknesses equal to or less than 18 cm. When using conformal techniques, delineation should be applied in the small bowel, as it is considered a critical organ according to RTOG

  13. Repositioning accuracy of cerebral fractionated stereotactic radiotherapy using CT scanning; Evaluation par tomodensitometrie du repositionnement en radiotherapie stereotaxique fractionnee cerebrale

    Energy Technology Data Exchange (ETDEWEB)

    Pasquier, D.; Dubus, F.; Castelain, B.; Delplanque, M.; Lartigau, E. [Centre O.-Lambret, Dept. Universitaire de Radiotherapie, 59 - Lille (France); Pasquier, D. [Centre Galilee, Polyclinique de la Louviere, 59 - Lille (France); Bernier, V.; Buchheit, I. [Centre Alexis-Vautrin, Dept. de Radiotherapie, 54 - Vandoeuvre-les-Nancy (France); Kerr, C.; Santoro, I. [Centre Val d' Aurelle, Dept. de Radiotherapie, 34 - Montpellier (France); Huchet, A.; Causse, N. [Hopital Saint-Andre, Dept. de Radiotherapie, 33 - Bordeaux (France); Dubus, F.; Castelain, B.; Delplanque, M.; Lartigau, E. [Lille-2 Univ., 59 (France)

    2009-09-15

    Purpose: To evaluate the accuracy of patient repositioning in fractionated cerebral stereotactic radiotherapy using a Brain Lab stereotactic cranial mask in conjunction with standard dental fixation. Patients and methods: Fifty planning and checking CT scans were performed in 25 patients. The check CT scan was performed before or after one of the three sessions of treatment. Co registration to the planning CT scan was used to assess alignment of the iso centre to the reference markers. The relative position of the P.T.V. with regard to iso centre allowed us to determine its total displacement (3-dimensional vector). Results: Mean iso centre translations ({+-} S.D.) taking into account direction were -0.01 {+-} 0.7, -0.2 {+-} 1.3 and 0.07 {+-} 0.5 mm in medio-lateral, cranio caudal and anteroposterior directions respectively. Mean rotations ({+-}S.D.) were -0.02 {+-} 0.6, -0.08 {+-} 0.3 and -0.1 {+-} 0.3 degree in medio-lateral, cranio caudal and anteroposterior axes respectively. Mean overall P.T.V. displacement was 1.8 {+-} 1.5 mm. P.T.V. displacement was smaller than 2 and 3 mm in 19/25 and 23/25 patients respectively. Conclusion: The accuracy of patient positioning using a stereotactic cranial mask system is similar to those reported in the literature and shows a satisfactory reproducibility with a standard dental fixation. (authors)

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

    Energy Technology Data Exchange (ETDEWEB)

    Stiebel-Kalish, Hadas, E-mail: kalishhadas@gmail.com [Neuro-Ophthalmology Unit, Rabin Medical Center, Petah Tikva (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Reich, Ehud [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Department of Ophthalmology, Rabin Medical Center, Petah Tikva (Israel); Gal, Lior [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Rappaport, Zvi Harry [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Department of Neurosurgery, Rabin Medical Center, Petah Tikva (Israel); Nissim, Ouzi [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan (Israel); Department of Neurosurgery, Sheba Medical Center, Ramat Gan (Israel); Pfeffer, Raphael [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan (Israel); Spiegelmann, Roberto [Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Stereotactic Radiosurgery Unit, Sheba Medical Center, Ramat Gan (Israel); Department of Neurosurgery, Sheba Medical Center, Ramat Gan (Israel)

    2012-02-01

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

  15. Fractionated brain stereotactic radiotherapy: assessment of repositioning precision using a thermoforming mask; Radiotherapie stereotaxique cerebrale fractionnee: evaluation de la precision du repositionnement en utilisant un masque thermoformable

    Energy Technology Data Exchange (ETDEWEB)

    Barret, A.; Champeaux-Orange, E.; Bouscayrol, H.; Wachter, T. [CHR La Source, Orleans (France)

    2011-10-15

    The authors report a study which aimed at assessing the patient repositioning precision obtained with a support system used during a brain fractionated stereotactic radiotherapy and comprising a thermoforming mask (Elektra head mask). The repositioning is assessed by means of scano-graphies and superimposition with the stereotactic frame. A three-dimensional vector has been computed for each patient. The average displacement corresponds to that published in literature. The high quality of the support system allows a non invasive brain stereotactic radiotherapy to be performed which is also comfortable for the patient. Short communication

  16. Endocrine and visual function after fractionated stereotactic radiotherapy of perioptic tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kocher, M.; Semrau, R.; Mueller, R.P. [Universitaetsklinikum Koeln (Germany). Klinik und Poliklinik fuer Strahlentherapie; Treuer, H.; Hoevels, M.; Sturm, V. [Koeln Univ. (Germany). Dept. of Stereotaxy and Functional Neurosurgery

    2013-02-15

    Purpose: To find out whether the use of stereotactic techniques for fractionated radiotherapy reduces toxicity to the endocrine and visual system in patients with benign perioptic tumors. Patients and methods: From 1993 to 2009, 29 patients were treated with fractionated stereotactic radiotherapy. The most frequent tumor types were grade I meningioma (n = 11) and pituitary adenoma (n = 10, 7 nonfunctioning, 3 growth hormone-producing). Patients were immobilized with the GTC frame (Radionics, USA) and the planning target volume (PTV; median 24.7, 4.6-58.6 ml) was irradiated with a total dose of 52.2 Gy (range, 45.0-55.8 Gy) in 1.8-Gy fractions using a linear accelerator (6 MeV photons) equipped with a micro-multileaf collimator. Maximum doses to the optic system and pituitary gland were 53.4 Gy (range, 11.5-57.6 Gy) and 53.6 Gy (range, 12.0-57.9 Gy). Results: Median follow-up was 45 months (range, 10-105 months). Local control was achieved in all but 1 patient (actuarial rate 92% at 5 years and 10 years). In 9 of 29 patients (31%), partial remission was observed (actuarial response rate 40% at 5 years and 10 years). In 4 of 26 patients (15%) with at least partial pituitary function, new hormonal deficits developed (actuarial rate 21% at 5 years and 10 years). This rate was significantly higher in patients treated for a larger PTV ( 25 ml: 0% vs. 42% at 5 years and 10 years, p = 0.028). Visual function improved in 4 of 15 patients (27%) who had prior impairment. None of the patients developed treatment-related optic neuropathy, but 2 patients experienced new disease-related visual deficits. Conclusion: Fractionated stereotactic radiotherapy for benign tumors of the perioptic and sellar region results in satisfactory response and local control rates and does not affect the visual system. The assumption that patients can be spared hypophyseal insufficiency only holds for small tumors. (orig.)

  17. Conventional four field radiotherapy versus computed tomography-based treatment planning in cancer cervix: A dosimetric study

    Directory of Open Access Journals (Sweden)

    Abhishek Gulia

    2013-01-01

    Full Text Available Background: With advancements in imaging, wide variations in pelvic anatomy have been observed, thus raising doubts about adequate target volume coverage by conventional external radiotherapy fields based on bony landmarks. The present study evaluates the need for integrating computed tomography (CT-based planning in the treatment of carcinoma cervix. Aims: To estimate inadequacies in target volume coverage when using conventional planning based on bony landmarks. Materials and Methods: The study consisted of 50 patients. Target volume delineation was done on planning CT scans, according to the guidelines given in literature. The volume of target receiving 95% of prescribed dose (V95 was calculated after superimposing a conventional four field box on digitally reconstructed radiograph. The geographic miss with conventional four field box technique was compared with the CT-based target volume delineation. Results: In 48 out of 50 patients, the conventional four field box failed to encompass the target volume. The areas of miss were at the superior and lateral borders of the anterior-posterior fields, and the anterior border of the lateral fields. The median V95 for conventional fields marked with bony landmarks was only 89.4% as compared to 93% for target delineation based on CT contouring. Conclusions: Our study shows inadequate target volume coverage with conventional four field box technique. We recommend routine use of CT-based planning for treatment with radiotherapy in carcinoma cervix.

  18. A comparison of anatomical and dosimetric variations in the first 15 fractions, and between fractions 16 and 25, of intensity-modulated radiotherapy for nasopharyngeal carcinoma.

    Science.gov (United States)

    Yang, Haihua; Tu, Yu; Wang, Wei; Hu, Wei; Ding, Weijun; Yu, Changhui; Zhou, Chao

    2013-11-04

    The purpose of this study was to compare anatomical and dosimetric variations in first 15 fractions, and between fractions 16 and 25, during intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Twenty-three NPC patients who received IMRT in 33 fractions were enrolled. Each patient had two repeat computed tomography (CT) scans before the 16th and 25th fraction. Hybrid IMRT plans were generated to evaluate the dosimetric changes. There was a significant decrease of the transverse diameter of nasopharyngeal and neck as well as gross tumor volume (GTV) in the primary nasopharyngeal carcinoma (GTVnx) and involved lymph nodes (GTVnd) during the first 15 fractions, and between fraction 16 and 25 (p fractions treatment compared to that between fraction 16 and 25 (p fractions (p fraction 16 and 25. While the maximum dose to the spinal cord was significantly increased both in the first 15 fractions, and between fraction 16 and 25 (p fractions compared to that between fraction 16 and 25 (p fractions, and between fractions 16 and 25, of IMRT.

  19. Comparison of dose contribution to normal pelvic tissues among conventional, conformal and intensity-modulated radiotherapy techniques in prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yungan Tao; Lefkopoulos, Dimitri; Ibrahima, Diallo; Bridier, Andre; Polizzi, Maria del Pilar; Wibault, Pierre; Crevoisier, Renaud de; Arriagada, Rodrigo; Bourhis, Jean (Dept. of Radiotherapy, Institut Gustave-Roussy, Villejuif (France))

    2008-03-15

    High-energy external radiotherapy has become one of the most common treatment in localized prostate cancer. We compared the difference of dose distribution, mainly at the 5-30 Gy dose level, in the irradiated pelvic volume among three modalities of radiotherapy for patients with prostate cancer: conventional, conformal and intensity-modulated radiotherapy (IMRT). We selected six patients with prostate cancer treated by conformal radiotherapy at the doses of 46 Gy to PTVN (prostate and seminal vesicles), and 70 Gy to PTV-T (prostate). The conventional technique: an 8-field arrangement was used; the conformal technique 4 fields with a boost through 6 fields. For IMRT, a five-beam arrangement was used. Dose-volume histograms (DVH) were analyzed and compared among the three techniques. The IMRT technique significantly increased the pelvic volume covered by the isodose surfaces below 15 Gy as compared with the conventional and conformal techniques. The mean absolute increase for the pelvic volume included between 5-30 Gy for the IMRT technique, was about 2 900 ml as compared with the conventional technique. However, IMRT significantly reduced the irradiated volume of the rectum in the dose range of 5 to 40 Gy, also significantly reduced the irradiated volume of bladder and femoral heads, and obtained a similar or improved isodose distribution in the PTVs. In addition, the use of IMRT slightly increased the relative dose delivered to the body volume outside the pelvis, as estimated by the use of specific software. A long-term follow-up will be needed to evaluate potential late treatment complications related to the use of IMRT and the low or moderate irradiation dose level obtained in the pelvis and in the whole body

  20. Twice-a-day fractionated radiotherapy with chemotherapy for locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Karasawa, Kumiko; Kojima, Nahoko; Himei, Kengo; Kaneyasu, Yuko; Kita, Midori; Okawa, Tomohiko; Ishii, Tetsuo [Tokyo Women`s Medical Coll. (Japan)

    1998-11-01

    Twenty-nine patients with locally advanced head and neck cancer were treated with twice-a-day fractionated radiotherapy (TDFR) for a total dose of 72 Gy to 82 Gy combined with Neo-adjuvant chemotherapy (NAC) of CDDP+5FU and concurrent chemotherapy of low dose CBDCA between 1994 and 1997. Twenty-one cases (72%) had complete response and sixteen cases recurred. The relapse-free rate at 2 years was 23.4% and the actual 2-year survival rate was 42.0%. No severe toxicity has been observed. Based on this investigation, it was concluded that TDFR with chemotherapy is a promising modality for locally advanced head and neck cancer and toxicity is acceptable. (author)

  1. Biological dose representation for carbon-ion radiotherapy of unconventional fractionation

    CERN Document Server

    Kanematsu, Nobuyuki

    2016-01-01

    In carbon-ion radiotherapy, single-beam delivery each day in alternate directions has been commonly practiced for operational efficiency, taking advantage of the Bragg peak and the relative biological effectiveness (RBE) for uniform dose conformation to a tumor. The treatment plans are usually evaluated with total RBE-weighted dose, which is however deficient in relevance to the biological effect in the linear-quadratic model due to its quadratic-dose term, or the dose-fractionation effect. In this study, we reformulate the extrapolated response dose (ERD), or synonymously BED, which normalizes the dose-fractionation and cell-repopulation effects as well as the RBE of treating radiation, based on inactivation of a single model cell system and a typical treating radiation in carbon-ion RT. The ERD distribution virtually represents the biological effect of the treatment regardless of radiation modality or fractionation scheme. We applied the ERD formulation to simplistic model treatments and to a preclinical su...

  2. Stereotactic radiotherapy of the prostate: fractionation and utilization in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Weiner, Josph P.; Schwartz, David; Shao, Meng; Osborn, Virginia; Schreiber, David [Dept. of Radiation Oncology, Veterans Affairs New York Harbor Healthcare System, Brooklyn (United States); Choi, Kwang [Dept. of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn (United States)

    2017-06-15

    To analyze the utilization and fractionation of extreme hypofractionation via stereotactic body radiotherapy (SBRT) in the treatment of prostate cancer. Data was analyzed on men diagnosed with localized prostate cancer between 2004–2012 and treated with definitive-intent radiation therapy, as captured in the National Cancer Database. This database is a hospital-based registry that collects an estimated 70% of all diagnosed malignancies in the United States. There were 299,186 patients identified, of which 4,962 (1.7%) were identified as receiving SBRT as primary treatment. Of those men, 2,082 had low risk disease (42.0%), 2,201 had intermediate risk disease (44.4%), and 679 had high risk disease (13.7%). The relative utilization of SBRT increased from 0.1% in 2004 to 4.0% in 2012. Initially SBRT was more commonly used in academic programs, though as time progressed there was a shift to favor an increased absolute number of men treated in the community setting. Delivery of five separate treatments was the most commonly utilized fractionation pattern, with 4,635 patients (91.3%) receiving this number of treatments. The most common dosing pattern was 725 cGy × 5 fractions (49.6%) followed by 700 cGy × 5 fractions (21.3%). Extreme hypofractionation via SBRT is slowly increasing acceptance. Currently 700-725 cGy × 5 fractions appears to be the most commonly employed scheme. As further long-term data regarding the safety and efficacy emerges, the relative utilization of this modality is expected to continue to increase.

  3. Comparison of mucous and cutaneous toxicity of IMRT and of conventional radiotherapy associated with cetuximab; Comparaison de la toxicite muqueuse et cutanee de la RCMI et de la radiotherapie classique associee au cetuximab

    Energy Technology Data Exchange (ETDEWEB)

    Kreps, S.; Tamby, E.; Dessard Diana, B.; Berges, O.; Botti, M.; Deberne, M.; Henni, M.; Durdux, C.; Housset, M.; Giraud, P. [Hopital europeen Georges-Pompidou, Paris (France)

    2011-10-15

    The authors report a retrospective assessment of acute, cutaneous and mucous toxicity resulting from an association of cetuximab and conventional conformational radiotherapy, and from an intensity-modulated conformational radiotherapy (IMRT). Seven patients presenting nasopharyngeal, oropharyngeal or hypopharyngeal tumours have been irradiated with intensity modulation, and seven without. It appears that the association of cetuximab and radiotherapy is not well tolerated and requires a close monitoring. Intensity-modulated radiotherapy allows a significant reduction of dose and of toxicity. However, mucous toxicity remains significant. Short communication

  4. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Elton Trigo Teixeira; Ugino, Rafael Tsuneki; Lopes, Mauricio Russo; Pelosi, Edilson Lopes; Silva, Joao Luis Fernandes da, E-mail: eltontt@gmail.com [Hospital Sirio-Libanes, Sao paulo, SP (Brazil). Departamento de Radiologia e Oncologia; Santana, Marco Antonio; Ferreira, Denis Vasconcelos; Carvalho, Heloisa de Andrade [Universidade de Sao Paulo (FM/USP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Departamento de Radiologia e Oncologia

    2016-05-15

    Objective: to evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods: This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results: Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion: Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique. (author)

  5. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy*

    Science.gov (United States)

    Leite, Elton Trigo Teixeira; Ugino, Rafael Tsuneki; Santana, Marco Antônio; Ferreira, Denis Vasconcelos; Lopes, Maurício Russo; Pelosi, Edilson Lopes; da Silva, João Luis Fernandes; Carvalho, Heloisa de Andrade

    2016-01-01

    Objective To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique. PMID:27403017

  6. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy

    Directory of Open Access Journals (Sweden)

    Elton Trigo Teixeira Leite

    2016-06-01

    Full Text Available Abstract Objective: To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs through opposed tangential fields with conventional two-dimensional (2D or three-dimensional (3D radiotherapy techniques and to compare the results between the two techniques. Materials and Methods: This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively. We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin, and the maximum dose (Dmax. Results: Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction, or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411. Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05. The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion: Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique.

  7. Changes in different organic matter fractions during conventional treatment and advanced treatment

    Institute of Scientific and Technical Information of China (English)

    Chao Chen; Xiaojian Zhang; Lingxia Zhu; Wenjie He; Hongda Han

    2011-01-01

    XAD-8 resin isolation of organic matter in water was used to divide organic matter into the hydrophobic and hydrophilic fractions.A pilot plant was used to investigate the change in both fractions during conventional and advanced treatment processes.The treatment of hydrophobic organics (HPO), rather than hydrophilic organicas (HPI), should carry greater emphasis due to HPO's higher trihalomethane formation potential (THMFP) and haloacetic acid formation potential (HAAFP).The removal of hydrophobic matter and its transmission into hydrophilic matter reduced ultimate DBP yield during the disinfection process.The results showed that sand filtration, ozonation, and biological activated carbon (BAC) filtration had distinct influences on the removal of both organic fractions.Additionally, the combination of processes changed the organic fraction proportions present during treatment.The use of ozonation and BAC maximized organic matter removal efficiency, especially for the hydrophobic fraction.In sum, the combination of pre-ozonation,conventional treatment, and O3-BAC removed 48% of dissolved organic carbon (DOC), 60% of HPO, 30% of HPI, 63% of THMFP,and 85% of HAAFP.The use of conventional treatment and O3-BAC without pre-ozonation had a comparable performance, removing 51% of DOC, 56% of HPO, 45% of HPI, 61% of THMFP, and 72% of HAAFP.The effectiveness of this analysis method indicated that resin isolation and fractionation should be standardized as an applicable test to help assess water treatment process efficiency.

  8. Accelerated hypofractionated radiation therapy compared to conventionally fractionated radiation therapy for the treatment of inoperable non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Amini Arya

    2012-03-01

    Full Text Available Abstract Background While conventionally fractionated radiation therapy alone is an acceptable option for poor prognostic patients with unresectable stage III NSCLC, we hypothesized that accelerated hypofractionated radiotherapy will have similar efficacy without increasing toxicity. Methods This is a retrospective analysis of 300 patients diagnosed with stage III NSCLC treated between 1993 and 2009. Patients included in the study were medically or surgically inoperable, were free of metastatic disease at initial workup and did not receive concurrent chemotherapy. Patients were categorized into three groups. Group 1 received 45 Gy in 15 fractions over 3 weeks (Accelerated Radiotherapy (ACRT while group 2 received 60-63 Gy (Standard Radiation Therapy 1 (STRT1 and group 3 received > 63 Gy (Standard Radiation Therapy (STRT2. Results There were 119 (39.7% patients in the ACRT group, 90 (30.0% in STRT1 and 91 (30.3% in STRT2. More patients in the ACRT group had KPS ≤ 60 (p 5% (p = 0.002, and had stage 3B disease (p Conclusions Despite the limitations of a retrospective analysis, our experience of accelerated hypofractionated radiation therapy with 45 Gy in 15 fractions appears to be an acceptable treatment option for poor performance status patients with stage III inoperable tumors. Such a treatment regimen (or higher doses in 15 fractions should be prospectively evaluated using modern radiation technologies with the addition of sequential high dose chemotherapy in stage III NSCLC.

  9. The radiobiology of prostate cancer including new aspects of fractionated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fowler, Jack F. [Medical School of Wisconsin Univ., Madison (United States). Dept. of Human Oncology

    2005-05-01

    Total radiation dose is not a reliable measure of biological effect when dose-per-fraction or dose-rate is changed. Large differences in biological effectiveness (per gray) are seen between the 2 Gy doses of external beam radiotherapy and the large boost doses given at high dose-rate from afterloading sources. The effects are profoundly different in rapidly or slowly proliferating tissues, that is for most tumors versus late complications. These differences work the opposite way round for prostate tumors versus late complications compared with most other types of tumor. Using the Linear-Quadratic formula it is aimed to explain these differences, especially for treatments of prostate cancer. The unusually slow growth rate of prostate cancers is associated with their high sensitivity to increased fraction size, so a large number of small fractions, such as 35 or 40 'daily' doses of 2 Gy, is not an optimum treatment. Theoretical modeling shows a stronger enhancement of tumor effect than of late complications for larger (and fewer) fractions, in prostate tumors uniquely. Biologically Effective Doses and Normalized Total Doses (in 2 Gy fraction equivalents) are given for prostate tumor, late rectal reactions, and - a new development - acute rectal mucosa. Tables showing the change of fraction-size sensitivity (the alpha/beta ratio) with proliferation rates of tissues lead to the association of slow cell doubling times in prostate tumors with small alpha/beta ratios. Clinical evidence to confirm this biological expectation is reviewed. The alpha/beta ratios of prostate tumors appear to be as low as 1.5 Gy (95% confidence interval 1.3-1.8 Gy), in contrast with the value of about 10 Gy for most other types of tumor. The important point is that alpha/beta ratio=1.5 Gy appears to be significantly less than the alpha/beta ratio=3 Gy for late complications in rectal tissues. Such differences are also emerging from recent clinical results. From this important

  10. Fractionated stereotactic radiotherapy with linear accelerator for uveal melanoma - preliminary Vienna results

    Energy Technology Data Exchange (ETDEWEB)

    Zehetmayer, M.; Ruhswurm, I.; Georgopoulos, M. [Dept. of Ophthalmology, Vienna Univ. (Austria); Dieckmann, K.; Kren, G.; Poetter, R. [Dept. of Radiotherapy and Radiobiology, Vienna Univ (Austria); Kitz, K. [Dept. of Neurosurgery, Vienna Univ. (Austria)

    1999-06-01

    Between June 1997 and February 1998, 21 patients suffering from uveal melanomas have been treated with a sterotactic 6 MeV LINAC (Saturne 43 {sup trademark}, General Electric, France) in conjunction with a stereotactic frame system (BrainLAB {sup trademark}, Germany). Immobilization of the eye was ensured with an optical fixation system which was proven reliable. During radiotherapy, movements of the irradiated eye were controlled on a monitor and documented by video recording. All patients co-operated very well with the optical fixation system. In 1164 measurements, the median value of horizontal deviation of the diseased eye during treatment was 0.3 mm (range: 0 to 1.3 mm). Median vertical deviation was 0.2 mm (range: 0 to 1.2 mm). For all patients, mean tumor prominence before treatment was 6.0{+-}2.2 mm. In 20 patients, the total dose of 70 Gy (at 80%) was delivered in 5 fractions within 10 days. In one patient with a ciliary body tumor, the total dose of 70 Gy was divided into 7 fractions for better sparing of the anterior eye segment. Results: After a follow-up of at least 6 months, local tumor control was seen in all eyes. Mean tumor thickness reduction after 3, 6 and 9 months was 7%, 13% and 31%, respectively. Up to now, only mild subacute side-effects located in the anterior eye segment have been noticed. (orig.)

  11. A feasibility study: Selection of a personalized radiotherapy fractionation schedule using spatiotemporal optimization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Minsun, E-mail: mk688@uw.edu; Stewart, Robert D. [Department of Radiation Oncology, University of Washington, Seattle, Washington 98195-6043 (United States); Phillips, Mark H. [Departments of Radiation Oncology and Neurological Surgery, University of Washington, Seattle, Washington 98195-6043 (United States)

    2015-11-15

    Purpose: To investigate the impact of using spatiotemporal optimization, i.e., intensity-modulated spatial optimization followed by fractionation schedule optimization, to select the patient-specific fractionation schedule that maximizes the tumor biologically equivalent dose (BED) under dose constraints for multiple organs-at-risk (OARs). Methods: Spatiotemporal optimization was applied to a variety of lung tumors in a phantom geometry using a range of tumor sizes and locations. The optimal fractionation schedule for a patient using the linear-quadratic cell survival model depends on the tumor and OAR sensitivity to fraction size (α/β), the effective tumor doubling time (T{sub d}), and the size and location of tumor target relative to one or more OARs (dose distribution). The authors used a spatiotemporal optimization method to identify the optimal number of fractions N that maximizes the 3D tumor BED distribution for 16 lung phantom cases. The selection of the optimal fractionation schedule used equivalent (30-fraction) OAR constraints for the heart (D{sub mean} ≤ 45 Gy), lungs (D{sub mean} ≤ 20 Gy), cord (D{sub max} ≤ 45 Gy), esophagus (D{sub max} ≤ 63 Gy), and unspecified tissues (D{sub 05} ≤ 60 Gy). To assess plan quality, the authors compared the minimum, mean, maximum, and D{sub 95} of tumor BED, as well as the equivalent uniform dose (EUD) for optimized plans to conventional intensity-modulated radiation therapy plans prescribing 60 Gy in 30 fractions. A sensitivity analysis was performed to assess the effects of T{sub d} (3–100 days), tumor lag-time (T{sub k} = 0–10 days), and the size of tumors on optimal fractionation schedule. Results: Using an α/β ratio of 10 Gy, the average values of tumor max, min, mean BED, and D{sub 95} were up to 19%, 21%, 20%, and 19% larger than those from conventional prescription, depending on T{sub d} and T{sub k} used. Tumor EUD was up to 17% larger than the conventional prescription. For fast proliferating

  12. Simultaneous optimization of dose distributions and fractionation schemes in particle radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Unkelbach, Jan; Zeng, Chuan [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114 (United States); Engelsman, Martijn [Faculty of Applied Physics, Delft University of Technology/HollandPTC, 2628 CJ Delft (Netherlands)

    2013-09-15

    Purpose: The paper considers the fractionation problem in intensity modulated proton therapy (IMPT). Conventionally, IMPT fields are optimized independently of the fractionation scheme. In this work, we discuss the simultaneous optimization of fractionation scheme and pencil beam intensities.Methods: This is performed by allowing for distinct pencil beam intensities in each fraction, which are optimized using objective and constraint functions based on biologically equivalent dose (BED). The paper presents a model that mimics an IMPT treatment with a single incident beam direction for which the optimal fractionation scheme can be determined despite the nonconvexity of the BED-based treatment planning problem.Results: For this model, it is shown that a small α/β ratio in the tumor gives rise to a hypofractionated treatment, whereas a large α/β ratio gives rise to hyperfractionation. It is further demonstrated that, for intermediate α/β ratios in the tumor, a nonuniform fractionation scheme emerges, in which it is optimal to deliver different dose distributions in subsequent fractions. The intuitive explanation for this phenomenon is as follows: By varying the dose distribution in the tumor between fractions, the same total BED can be achieved with a lower physical dose. If it is possible to achieve this dose variation in the tumor without varying the dose in the normal tissue (which would have an adverse effect), the reduction in physical dose may lead to a net reduction of the normal tissue BED. For proton therapy, this is indeed possible to some degree because the entrance dose is mostly independent of the range of the proton pencil beam.Conclusions: The paper provides conceptual insight into the interdependence of optimal fractionation schemes and the spatial optimization of dose distributions. It demonstrates the emergence of nonuniform fractionation schemes that arise from the standard BED model when IMPT fields and fractionation scheme are optimized

  13. Cyberknife fractionated radiotherapy for adrenal metastases: Preliminary report from a multispecialty Indian cancer care center

    Directory of Open Access Journals (Sweden)

    Trinanjan Basu

    2015-03-01

    Full Text Available Purpose: Metastasis to adrenal gland from lung, breast, and kidney malignancies are quite common. Historically radiotherapy was intended for pain palliation. Recent studies with stereotactic body radiotherapy (SBRT including Cyberknife robotic radiosurgery aiming at disease control brings about encouraging results. Here we represent the early clinical experience with Cyberknife stereotactic system from an Indian cancer care center. The main purpose of this retrospective review is to serve as a stepping stone for future prospective studies with non- invasive yet effective technique compared to surgery. Methods: We retrospectively reviewed four cases of adrenal metastases (three: lung and one: renal cell carcinoma treated with Cyberknife SBRT. X sight spine tracking was employed for planning and treatment delivery. Patients were evaluated for local response clinically as well as with PETCT based response criteria.Results: With a median gross tumor volume of 20.5 cc and median dose per fraction of 10 Gy, two patients had complete response (CR and two had partial response (PR when assessed 8-12 weeks post treatment as per RECIST. There was no RTOG grade 2 or more acute adverse events and organs at risk dosage were acceptable. Till last follow up all the patients were locally controlled and alive. Conclusion: Cyberknife SBRT with its unique advantages like non- invasive, short duration outpatient treatment technique culminating in similar local control rates in comparison to surgery is an attractive option. World literature of linear accelerator based SBRT and our data with Cyberknife SBRT with small sample size and early follow up are similar in terms of local control in adrenal metastases. Future prospective data would reveal more information on the management of adrenal metastases.

  14. Dose-volume histogram constrains for small intestine in postoperative transcutaneous radiotherapy of endometrial carcinoma: comparison between conventional and conformal techniques

    Directory of Open Access Journals (Sweden)

    Anela Ramić

    2013-09-01

    Full Text Available Introduction: The aim of this study was to determine the dose-volume histogram (DVH constrains of conventional and conformal transcutaneous radiotherapy for small intestine and perform their comparison.Methods: This retrospective-prospective study included patients who were treated for endometrial cancer using conventional transcutaneous radiotherapy at the Department of Radiotherapy Clinic of Oncology,Hematology and Radiotherapy, University Clinical Center Tuzla in the period from 2009 to 2011. The study was performed on patients of all ages suffering from this condition. The study involved 35 patients. DVHparameters which were analyzed are: minimum dose (Dmin, maximum dose (Dmax, medium dose (Daver of the small intestine, as well as the volume of the small intestine, which is included in 75%, 95% and 100%dose (V33,75Gy, V42,75Gy, V45Gy expressed in percentages and cubic centimeters of the affected organ. Working hypothesis was tested with paired t test. The difference between the variables at the level of p Results: DVH constrains of transcutaneous conformal radiotherapy showed signifi cantly smaller dose contribution on small intestine than DVH parameters of conventional transcutaneous radiotherapy (pConclusion: The dose contribution on small intestine was signifi cantly lower by planning three-dimensional conformal transcutaneous radiotherapy in comparison to the conventional planning.

  15. Dose-volume histogram constrains for small intestine in postoperative transcutaneous radiotherapy of endometrial carcinoma: comparison between conventional and conformal techniques

    Directory of Open Access Journals (Sweden)

    Anela Ramić

    2013-09-01

    Full Text Available Introduction: The aim of this study was to determine the dose-volume histogram (DVH constrains of conventional and conformal transcutaneous radiotherapy for small intestine and perform their comparison.Methods: This retrospective-prospective study included patients who were treated for endometrial cancer using conventional transcutaneous radiotherapy at the Department of Radiotherapy Clinic of Oncology,Hematology and Radiotherapy, University Clinical Center Tuzla in the period from 2009 to 2011. The study was performed on patients of all ages suffering from this condition. The study involved 35 patients. DVHparameters which were analyzed are: minimum dose (Dmin, maximum dose (Dmax, medium dose (Daver of the small intestine, as well as the volume of the small intestine, which is included in 75%, 95% and 100%dose (V33,75Gy, V42,75Gy, V45Gy expressed in percentages and cubic centimeters of the affected organ. Working hypothesis was tested with paired t test. The difference between the variables at the level of p <0.05 was considered statistically significant.Results: DVH constrains of transcutaneous conformal radiotherapy showed signifi cantly smaller dose contribution on small intestine than DVH parameters of conventional transcutaneous radiotherapy (p<0.0001.Conclusion: The dose contribution on small intestine was signifi cantly lower by planning three-dimensional conformal transcutaneous radiotherapy in comparison to the conventional planning.

  16. SU-E-P-58: Dosimetric Study of Conventional Intensity-Modulated Radiotherapy and Knowledge-Based Radiation Therapy for Postoperation of Cervix Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ma, C; Yin, Y [Shandong Tumor Hospital, Jinan, Shandong Provice (China)

    2015-06-15

    Purpose: To compare the dosimetric difference of the target volume and organs at risk(OARs) between conventional intensity-modulated radiotherapy(C-IMRT) and knowledge-based radiation therapy (KBRT) plans for cervix cancer. Methods: 39 patients with cervical cancer after surgery were randomly selected, 20 patient plans were used to create the model, the other 19 cases used for comparative evaluation. All plans were designed in Eclipse system. The prescription dose was 30.6Gy, 17 fractions, OARs dose satisfied to the clinical requirement. A paired t test was used to evaluate the differences of dose-volume histograms (DVH). Results: Comparaed to C-IMRT plan, the KBRT plan target can achieve the similar target dose coverage, D98,D95,D2,HI and CI had no difference (P≥0.05). The dose of rectum, bladder and femoral heads had no significant differences(P≥0.05). The time was used to design treatment plan was significant reduced. Conclusion: This study shows that postoperative radiotherapy of cervical KBRT plans can achieve the similar target and OARs dose, but the shorter designing time.

  17. Patch-based generation of a pseudo CT from conventional MRI sequences for MRI-only radiotherapy of the brain

    DEFF Research Database (Denmark)

    Andreasen, Daniel; Van Leemput, Koen; Hansen, Rasmus H.

    2015-01-01

    Purpose: In radiotherapy (RT) based on magnetic resonance imaging (MRI) as the only modality, the information on electron density must be derived from the MRI scan by creating a so-called pseudo computed tomography (pCT). This is a nontrivial task, since the voxel-intensities in an MRI scan are n...... on conventional T1-weighted MRI sequences and without deformable registrations. In our evaluations, the method performed better than existing voxel-based and atlas-based methods and showed a promising potential for RT of the brain based only on MRI....

  18. A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer.

    Science.gov (United States)

    Cartmill, Bena; Cornwell, Petrea; Ward, Elizabeth; Davidson, Wendy; Porceddu, Sandro

    2012-03-01

    Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4-6 weeks post-treatment, and at 6 months post-treatment. Deterioration from pretreatment to 4-6 weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.

  19. Palonosetron and prednisolone for the prevention of nausea and emesis during fractionated radiotherapy and 5 cycles of concomitant weekly cisplatin-a phase II study

    DEFF Research Database (Denmark)

    Ruhlmann, Christina H; Belli, Charlotte; Dahl, Tina;

    2013-01-01

    Recommendations for antiemetic prophylaxis supportive to radiotherapy and concomitant chemotherapy are not evidence-based. The purpose of this study was to evaluate the efficacy of the antiemetic regimen concurrent to fractionated radiotherapy and concomitant weekly cisplatin in two Danish depart...

  20. Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial.

    NARCIS (Netherlands)

    Hout, W.B. van den; Linden, Y.J.M. van der; Steenland, E.; Wiggenraad, R.G.; Kievit, J.; Haes, J.C.J.M. de; Leer, J.W.H.

    2003-01-01

    BACKGROUND: Radiotherapy is an effective palliative treatment for cancer patients with painful bone metastases. Although single- and multiple-fraction radiotherapy are thought to provide equal palliation, which treatment schedule provides better value for the money is unknown. We compared quality-ad

  1. Risk of Heart Failure With Preserved Ejection Fraction in Older Women After Contemporary Radiotherapy for Breast Cancer.

    Science.gov (United States)

    Saiki, Hirofumi; Petersen, Ivy A; Scott, Christopher G; Bailey, Kent R; Dunlay, Shannon M; Finley, Randi R; Ruddy, Kathryn J; Yan, Elizabeth; Redfield, Margaret M

    2017-04-11

    Cardiomyocytes are resistant to radiation. However, cardiac radiation exposure causes coronary microvascular endothelial inflammation, a perturbation implicated in the pathogenesis of heart failure (HF) and particularly HF with preserved ejection fraction (HFpEF). Radiotherapy for breast cancer results in variable cardiac radiation exposure and may increase the risk of HF. We conducted a population-based case-control study of incident HF in 170 female residents of Olmsted County, Minnesota (59 cases and 111 controls), who underwent contemporary (1998-2013) radiotherapy for breast cancer with computed tomography-assisted radiotherapy planning. Controls were matched to cases for age, tumor side, chemotherapy use, diabetes mellitus, and hypertension. Mean cardiac radiation dose (MCRD) in each patient was calculated from the patient's computed tomography images and radiotherapy plan. Mean age at radiotherapy was 69±9 years. Of HF cases, 38 (64%) had EF≥50% (HFpEF), 18 (31%) had EF<50% (HF with reduced EF), and 3 (5%) did not have EF measured. The EF was ≥40% in 50 of the 56 HF cases (89%) with an EF measurement. The mean interval from radiotherapy to HF was 5.8±3.4 years. The odds of HF was higher in patients with a history of ischemic heart disease or atrial fibrillation. The MCRD was 2.5 Gy (range, 0.2-13.1 Gy) and higher in cases (3.3±2.7 Gy) than controls (2.1±2.0 Gy; P=0.004). The odds ratio (95% confidence interval) for HF per log MCRD was 9.1 (3.4-24.4) for any HF, 16.9 (3.9-73.7) for HFpEF, and 3.17 (0.8-13.0) for HF with reduced EF. The increased odds of any HF or HFpEF with increasing MCRD remained significant after adjustment for HF risk factors and in sensitivity analyses matching by cancer stage rather than tumor side. Only 18.6% of patients experienced new or recurrent ischemic events between radiotherapy and the onset of HF. The relative risk of HFpEF increases with increasing cardiac radiation exposure during contemporary conformal breast cancer

  2. Volumetric modulation arc radiotherapy with flattening filter-free beams compared with conventional beams for nasopharyngeal carcinoma: a feasibility study

    Institute of Scientific and Technical Information of China (English)

    Mingzan Zhuang; Tuodan Zhang; Zhijian Chen; Zhixiong Lin; Derui Li; Xun Peng; Qingchun Qiu

    2013-01-01

    There is increasing interest in the clinical use of flattening filter-free (FFF) beams.In this study,we aimed to investigate the dosimetric characteristics of volumetric modulated arc radiotherapy (VMAT) with FFF beams for nasopharyngeal carcinoma (NPC).Ten NPC patients were randomly selected to undergo a RapidArc plan with either FFF beams (RA-FFF) or conventional beams (RA-C).The doses to the planning target volumes (PTVs),organs at risk (OARs),and normal tissues were compared.The technical delivery parameters for RapidArc plans were also assessed to compare the characteristics of FFF and conventional beams.Both techniques delivered adequate doses to PTVs.For PTVs,RA-C delivered lower maximum and mean doses and improved conformity and homogeneity compared with RA-FFF.Both techniques provided similar maximum doses to the optic nerves and lenses.For the brain stem,spinal cord,larynx,parotid glands,oral cavity,and skin,RA-FFF showed significant dose increases compared to RA-C.The dose to normal tissue was lower in RA-FFF.The monitor units (MUs) were (536 ± 46) MU for RA-FFF and (501 ± 25) MU for RA-C.The treatment duration did not significantly differ between plans.Although both treatment plans could meet clinical needs,RA-C is dosimetrically superior to RA-FFF for NPC radiotherapy.

  3. Prescription dose and fractionation predict improved survival after stereotactic radiotherapy for brainstem metastases

    Directory of Open Access Journals (Sweden)

    Leeman Jonathan E

    2012-07-01

    Full Text Available Abstract Background Brainstem metastases represent an uncommon clinical presentation that is associated with a poor prognosis. Treatment options are limited given the unacceptable risks associated with surgical resection in this location. However, without local control, symptoms including progressive cranial nerve dysfunction are frequently observed. The objective of this study was to determine the outcomes associated with linear accelerator-based stereotactic radiotherapy or radiosurgery (SRT/SRS of brainstem metastases. Methods We retrospectively reviewed 38 tumors in 36 patients treated with SRT/SRS between February 2003 and December 2011. Treatment was delivered with the Cyberknife™ or Trilogy™ radiosurgical systems. The median age of patients was 62 (range: 28–89. Primary pathologies included 14 lung, 7 breast, 4 colon and 11 others. Sixteen patients (44% had received whole brain radiation therapy (WBRT prior to SRT/SRS; ten had received prior SRT/SRS at a different site (28%. The median tumor volume was 0.94 cm3 (range: 0.01-4.2 with a median prescription dose of 17 Gy (range: 12–24 delivered in 1–5 fractions. Results Median follow-up for the cohort was 3.2 months (range: 0.4-20.6. Nineteen patients (52% had an MRI follow-up available for review. Of these, one patient experienced local failure corresponding to an actuarial 6-month local control of 93%. Fifteen of the patients with available follow-up imaging (79% experienced intracranial failure outside of the treatment volume. The median time to distant intracranial failure was 2.1 months. Six of the 15 patients with distant intracranial failure (40% had received previous WBRT. The actuarial overall survival rates at 6- and 12-months were 27% and 8%, respectively. Predictors of survival included Graded Prognostic Assessment (GPA score, greater number of treatment fractions, and higher prescription dose. Three patients experienced acute treatment-related toxicity consisting of

  4. Can pure accelerated radiotherapy given as six fractions weekly be an option in locally advanced carcinoma cervix: Results of a prospective randomized phase III trial

    Directory of Open Access Journals (Sweden)

    Mukesh Sharma

    2016-01-01

    Conclusions: Accelerated radiotherapy given as six fractions per week is an effective alternative to concomitant chemoradiation in locally advanced carcinoma cervix and has shown lesser toxicities in our study.

  5. Hypo-fractionated treatment in radiotherapy: radio-biological models Tcp and NTCP; Tratamiento hipofraccionado en radioterapia: modelos radiobiologicos TCP y NTCP

    Energy Technology Data Exchange (ETDEWEB)

    Astudillo V, A. J.; Mitsoura, E. [Universidad Autonoma del Estado de Mexico, Facultad de Medicina, Paseo Tollocan s/n, 50180 Toluca, Estado de Mexico (Mexico); Paredes G, L. [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico); Resendiz G, G., E-mail: lydia.paredes@inin.gob.mx [Hospital Medica Sur, Departamento de Radioterapia, Puente de Piedra 150, Col. Toriello Guerra, 14050 Mexico D. F. (Mexico)

    2014-08-15

    At the present time the breast cancer in Mexico has the first place of incidence of the malignant neoplasia s in the women, and represents 11.34% of all the cancer cases. On the other hand, the treatments for cancer by means of ionizing radiations have been dominated under the approaches of the medical radio-oncologists which have been based on test and error by many years. The radio-biological models, as the Tcp, NTCP and dosimetric variables, for their clinical application in the conventional radiotherapy with hypo-fractionation have as purpose predicting personalized treatment plans that they present most probability of tumor control and minor probability of late reactions, becoming this way support tools in the decisions taking for the patient treatments planning of Medical Physicists and Radio-oncologists. (Author)

  6. Vertebral compression fractures after spine irradiation using conventional fractionation in patients with metastatic colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ree, Woo Joong; Kim, Kyung Hwan; Chang, Jee Suk; Kim, Hyun Ju; Choi, Seo Hee; Koom, Woong Sub [Dept.of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul (Korea, Republic of)

    2014-12-15

    To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.

  7. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

    Institute of Scientific and Technical Information of China (English)

    Ming Li; Gao-Feng Li; Xiu-Yu Hou; Hong Gao; Yong-Gang Xu; Ting Zhao

    2016-01-01

    Background:Image-guided radiation therapy (IGRT) is the preferred method for curative treatment of localized prostate cancer,which could improve disease outcome and reduce normal tissue toxicity reaction.IGRT using cone-beam computed tomography (CBCT) in combination with volumetric-modulated arc therapy (VMAT) potentially allows smaller treatment margins and dose escalation to the prostate.The aim of this study was to compare the difference of dosimetric diffusion in conventional IGRT using 7-field,step-and-shoot intensity-modulated radiation therapy (IMRT) and hypofractionated IGRT using VMAT for patients with localized prostate cancer.Methods:We studied 24 patients who received 78 Gy in 39 daily fractions or 70 Gy in 28 daily fractions to their prostate with/without the seminal vesicles using IMRT (n =12) or VMAT (n =12) for prostate cancer between November 2013 and October 2015.Image guidance was performed using kilovoltage CBCT scans equipped on the linear accelerator.Offline planning was performed using the daily treatment images registered with simulation computed tomography (CT) images.A total of 212 IMRT plans in conventional cohort and 292 VMAT plans in hypofractionated cohort were enrolled in the study.Dose distributions were recalculated on CBCT images registered with the planning CT scanner.Results:Compared with 7-field,step-and-shoot IMRT,VMAT plans resulted in improved planning target volume (PTV) D95% (7663.17 ± 69.57 cGy vs.7789.17 ± 131.76 cGy,P < 0.001).VMAT reduced the rectal D25 (P < 0.001),D35 (P < 0.001),and D50 (P < 0.001),bladder V50 (P < 0.001),D25 (P =0.002),D35 (P =0.028),and D50 (P =0.029).However,VMAT did not statistically significantly reduce the rectal V50,compared with 7-field,step-and-shoot IMRT (25.02 ± 5.54% vs.27.43 ± 8.79%,P =0.087).Conclusions:To deliver the hypofractionated radiotherapy in prostate cancer,VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent

  8. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

    Science.gov (United States)

    Li, Ming; Li, Gao-Feng; Hou, Xiu-Yu; Gao, Hong; Xu, Yong-Gang; Zhao, Ting

    2016-01-01

    Background: Image-guided radiation therapy (IGRT) is the preferred method for curative treatment of localized prostate cancer, which could improve disease outcome and reduce normal tissue toxicity reaction. IGRT using cone-beam computed tomography (CBCT) in combination with volumetric-modulated arc therapy (VMAT) potentially allows smaller treatment margins and dose escalation to the prostate. The aim of this study was to compare the difference of dosimetric diffusion in conventional IGRT using 7-field, step-and-shoot intensity-modulated radiation therapy (IMRT) and hypofractionated IGRT using VMAT for patients with localized prostate cancer. Methods: We studied 24 patients who received 78 Gy in 39 daily fractions or 70 Gy in 28 daily fractions to their prostate with/without the seminal vesicles using IMRT (n = 12) or VMAT (n = 12) for prostate cancer between November 2013 and October 2015. Image guidance was performed using kilovoltage CBCT scans equipped on the linear accelerator. Offline planning was performed using the daily treatment images registered with simulation computed tomography (CT) images. A total of 212 IMRT plans in conventional cohort and 292 VMAT plans in hypofractionated cohort were enrolled in the study. Dose distributions were recalculated on CBCT images registered with the planning CT scanner. Results: Compared with 7-field, step-and-shoot IMRT, VMAT plans resulted in improved planning target volume (PTV) D95% (7663.17 ± 69.57 cGy vs. 7789.17 ± 131.76 cGy, P V50 (P statistically significantly reduce the rectal V50, compared with 7-field, step-and-shoot IMRT (25.02 ± 5.54% vs. 27.43 ± 8.79%, P = 0.087). Conclusions: To deliver the hypofractionated radiotherapy in prostate cancer, VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent normal tissues comparing to 7-field, step-and-shoot IMRT. Daily online image-guidance and better management of bladder and rectum could make a more precise

  9. Volumetric Modulated Arc Radiotherapy for Early Stage Non-Small-Cell Lung Carcinoma: Is It Better Than the Conventional Static Beam Intensity Modulated Radiotherapy?

    Directory of Open Access Journals (Sweden)

    Vincent Wing Cheung Wu

    2014-01-01

    Full Text Available This study compared the performance of volumetric modulated arc therapy (VMAT techniques: single arc volumetric modulated arc therapy (SA-VMAT and double arc volumetric modulated arc therapy (DA-VMAT with the static beam conventional intensity modulated radiotherapy (C-IMRT for non-small-cell lung carcinoma (NSCLC. Twelve stage I and II NSCLC patients were recruited and their planning CT with contoured planning target volume (PTV and organs at risk (OARs was used for planning. Using the same dose constraints and planning objectives, the C-IMRT, SA-VMAT, and DA-VMAT plans were optimized. C-IMRT consisted of 7 static beams, while SA-VMAT and DA-VMAT plans consisted of one and two full gantry rotations, respectively. No significant difference was found among the three techniques in target homogeneity and conformity. Mean lung dose in C-IMRT plan was significantly lower than that in DA-VMAT plan P=0.04. The ability of OAR sparing was similar among the three techniques, with no significant difference in V20, V10, or V5 of normal lungs, spinal cord, and heart. Less MUs were required in SA-VMAT and DA-VMAT. Besides, SA-VMAT required the shortest beam on time among the three techniques. In treatment of early stage NSCLC, no significant dosimetric superiority was shown by the VMAT techniques over C-IMRT and DA-VMAT over SA-VMAT.

  10. Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma

    Directory of Open Access Journals (Sweden)

    Weber Damien C

    2011-12-01

    Full Text Available Abstract Purpose To evaluate the efficacy and toxicity of stereotactic fractionated radiotherapy (SFRT for patients with pituitary macroadenoma (PMA. Methods and Materials Between March 2000 and March 2009, 27 patients (male to female ratio, 1.25 with PMA underwent SFRT (median dose, 50.4 Gy. Mean age of the patients was 56.5 years (range, 20.3 - 77.4. In all but one patient, SFRT was administered for salvage treatment after surgical resection (transphenoidal resection in 23, transphenoidal resection followed by craniotomy in 2 and multiple transphenoidal resections in another patient. In 10 (37% patients, the PMAs were functional (3 ACTH-secreting, 3 prolactinomas, 2 growth hormone-secreting and 2 multiple hormone-secretion. Three (11.1% and 9 (33.3% patients had PMA abutting and compressing the optic chiasm, respectively. Mean tumor volume was 2.9 ± 4.6 cm3. Eighteen (66.7% patients had hypopituitarism prior to SFRT. The mean follow-up period after SFRT was 72.4 ± 37.2 months. Results Tumor size decreased for 6 (22.2% patients and remained unchanged for 19 (70.4% other patients. Two (7.4% patients had tumor growth inside the prescribed treatment volume. The estimated 5-year tumor growth control was 95.5% after SFRT. Biochemical remission occurred in 3 (30% patients with functional PMA. Two patients with normal anterior pituitary function before SFRT developed new deficits 25 and 65 months after treatment. The 5-year survival without new anterior pituitary deficit was thus 95.8%. Five patients with visual field defect had improved visual function and 1 patient with no visual defect prior to SFRT, but an optic chiasm abutting tumor, had a decline in visual function. The estimated 5-year vision and pituitary function preservation rates were 93.2% and 95.8%, respectively. Conclusions SFRT is a safe and effective treatment for patients with PMA, although longer follow-up is needed to evaluate long-term outcomes. In this study, approximately 1

  11. Fractionated but not single dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody

    Science.gov (United States)

    Dewan, M. Zahidunnabi; Galloway, Ashley E.; Kawashima, Noriko; Dewyngaert, J. Keith; Babb, James S.; Formenti, Silvia C.; Demaria, Sandra

    2009-01-01

    Purpose This study tested the hypothesis that the type of dose-fractionation regimen determines the ability of radiotherapy to synergize with anti-CTLA-4 antibody. Experimental design TSA mouse breast carcinoma cells were injected s.c. into syngeneic mice at two separate sites, defined as a “primary” site that was irradiated, and a “secondary” site outside the radiotherapy field. When both tumors were palpable mice were randomly assigned to 8 groups receiving no radiotherapy or 3 distinct regimens of radiotherapy (20 Gy × 1, 8 Gy × 3 or 6 Gy × 5 fractions in consecutive days) in combination or not with 9H10 mAb against CTLA-4. Mice were followed for tumors growth/regression. Similar experiments were conducted in the MCA38 mouse colon carcinoma model. Results In either of the 2 models tested treatment with 9H10 alone had no detectable effect. Each of the radiotherapy regimens caused comparable growth delay of the primary tumors, but had no effect on the secondary tumors, outside the radiation field. Conversely, the combination of 9H10 and either fractionated radiotherapy regimens achieved enhanced tumor response at the primary site (p<0.0001). Moreover, an abscopal effect, defined as a significant growth inhibition of the tumor outside the field occurred only in mice treated with the combination of 9H10 and fractionated radiotherapy (p<0.01). Frequency of CD8+ T cells showing tumor-specific IFNγ production was proportional to the inhibition of the secondary tumor. Conclusions Fractionated, but not single dose radiotherapy, induces an abscopal effect when in combination with anti-CTLA-4 antibody, in two preclinical carcinoma models. PMID:19706802

  12. Determining inter-fractional motion of the uterus using 3D ultrasound imaging during radiotherapy for cervical cancer

    DEFF Research Database (Denmark)

    Baker, Mariwan; Jensen, Jørgen Arendt; Behrens, Claus F.

    2014-01-01

    Uterine positional changes can reduce the accuracy of radiotherapy for cervical cancer patients. The purpose of this study was to; 1) Quantify the inter-fractional uterine displacement using a novel 3D ultrasound (US) imaging system, and 2) Compare the result with the bone match shift determined...... to the bone structures. Since the US images were significantly better than the CBCT images in terms of soft-tissue visualization, the US system can provide an optional image-guided radiation therapy (IGRT) system. US imaging might be a better IGRT system than CBCT, despite difficulty in capturing the entire...

  13. Clinical significance of geographic miss when using conventional four field radiotherapy technique in treatment of locally advanced carcinoma cervix

    Directory of Open Access Journals (Sweden)

    A Gulia

    2016-01-01

    Full Text Available Background: Although conventional four- field radiotherapy based on bony landmarks has been traditionally used, areas of geographical miss due to individual variation in pelvic anatomy have been identified with advanced imaging techniques. AIMS: The primary aim of this study is to evaluate the geographical miss in patientswhen using the conventional four-field planningplanning and to find out the impact of 3-D conformal CT based in patients with locally advanced carcinoma cervix.Materials and Methods: In 50 patients, target volume delineation was done on planning computed tomography (CT scans, according to guidelines by Taylor et al. Patients were treated with modified four field plan, except for the superior, where field border was kept at L4-L5 interspace A dosimetric comparison was done between the conventional four-field based on bony landmarks and the target volume delineated on computed tomography. The disease free survival, pelvic and para aortic nodal free survival, distant failures free survival were calculated using Kaplan Meir Product Limit Method. Results: Patients were followed-up for a median period of 11 months. The median V95 for conventional and modified extended four field plans were 89.4% and 91.3% respectively. Patients with V95 for modified extended pelvic fields less than 91.3% had a trend toward inferior disease free survival (mean DFS 9.8 vs. 13.9 months though the difference was not statistically significant log rank test.Conclusions: Our preliminary data shows trend toward lower DFS in patients with inadequate target volume coverage. We recommend routine use of CT based planning for four field technique.

  14. Unexpected radiation laryngeal necrosis after carbon ion therapy using conventional dose fractionation for laryngeal cancer.

    Science.gov (United States)

    Demizu, Yusuke; Fujii, Osamu; Nagano, Fumiko; Terashima, Kazuki; Jin, Dongcun; Mima, Masayuki; Oda, Naoharu; Takeuchi, Kaoru; Takeda, Makiko; Ito, Kazuyuki; Fuwa, Nobukazu; Okimoto, Tomoaki

    2015-11-01

    Carbon ion therapy is a type of radiotherapy that can deliver high-dose radiation to a tumor while minimizing the dose delivered to organs at risk. Moreover, carbon ions are classified as high linear energy transfer radiation and are expected to be effective for even photon-resistant tumors. A 73-year-old man with glottic squamous cell carcinoma, T3N0M0, refused laryngectomy and received carbon ion therapy of 70 Gy (relative biological effectiveness) in 35 fractions. Three months after the therapy, the patient had an upper airway inflammation, and then laryngeal edema and pain occurred. Five months after the therapy, the airway stenosis was severe and computed tomography showed lack of the left arytenoid cartilage and exacerbation of laryngeal necrosis. Despite the treatment, 5 and a half months after the therapy, the laryngeal edema and necrosis had become even worse and the surrounding mucosa was edematous and pale. Six months after the therapy, pharyngolaryngoesophagectomy and reconstruction with free jejunal autograft were performed. The surgical specimen pathologically showed massive necrosis and no residual tumor. Three years after the carbon ion therapy, he is alive without recurrence. The first reported laryngeal squamous cell carcinoma case treated with carbon ion therapy resulted in an unexpected radiation laryngeal necrosis. Tissue damage caused by carbon ion therapy may be difficult to repair even for radioresistant cartilage; therefore, hollow organs reinforced by cartilage, such as the larynx, may be vulnerable to carbon ion therapy. Caution should be exercised when treating tumors in or adjacent to such organs with carbon ion therapy.

  15. Radiobiological rationale and clinical implications of hypo-fractionated radiation therapy; Bases radiobiologiques et applications cliniques de la radiotherapie hypofractionnee

    Energy Technology Data Exchange (ETDEWEB)

    Ko, E.C.; Forsythe, K.; Buckstein, M.; Kao, J.; Rosenstein, B.S. [Department of Radiation Oncology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1236, New York, NY (United States)

    2011-06-15

    Recent clinical trials of hypo-fractionated radiation treatment have provided critical insights into the safety and efficacy of hypo-fractionation. However, there remains much controversy in the field, both at the level of clinical practice and in our understanding of the underlying radiobiological mechanisms. In this article, we review the clinical literature on hypo-fractionated radiation treatment for breast, prostate, and other malignancies. We highlight several ongoing clinical trials that compare outcomes of a hypo-fractionated approach versus those obtained with a conventional approach. Lastly, we outline some of the preclinical and clinical evidence that argue in favor of differential radiobiological mechanisms underlying hypo-fractionated radiation treatment. Emerging data from the ongoing studies will help to better define and guide the rational use of hypo-fractionation in future years. (authors)

  16. Alpha particles versus conventional radiotherapy to the pituitary region: a comparison of risk-benefit

    Energy Technology Data Exchange (ETDEWEB)

    Linfoot, J.A.

    1980-01-01

    At the present time there are no prospective controlled studies or comparative studies on the effectiveness of the various modalities of pituitary treatment-surgery and photon and alpha particle pituitary irradiation. In this review the results of alpha particle pituitary irradiation (APPI), initiated at the Donner Laboratory and Donner Pavilion at the Lawrence Berkeley Laboratory, University of California, Berkeley, and the results of conventonal photon irradiation (gamma or x-rays) will be presented. In general it has been established that the effects of photon therapy are related to the size of radiation field, type of isodose curve, total radiation dose (rads), duration of therapy, and rads delivered per fraction. Minor complications of photon therapy included epilation of the scalp and, occasionally, mild headache. In the past few years there has been a trend to reduce the total radiation dose as well as the dose per fraction. Finally, in photon therapy, large fields are utilized, involving a large volume of tissue. In contrast, alpha particle pituitary irradiation utilizes a pencil-shaped beam which is made to fit the contour of the sella turcica. The dose to the skin and peripheral portions of the brain is minimal, and no epilation occurs.

  17. Nasopharynx carcinoma treatment: from the conventional radiotherapy to the conformal radiotherapy with intensity modulation; Traitement du carcinome du nasopharynx: de la radiotherapie conventionnelle a la radiotherapie conformationnelle avec modulation d'intensite

    Energy Technology Data Exchange (ETDEWEB)

    Mokaouim, K.; Grehange, G.; Truc, G.; Peingnaux, K.; Martin, E.; Zanetta, S.; Bruchon, Y.; Bonnetain, F.; Maingon, P. [Centre Georges-Francois Leclerc, 21 - Dijon (France)

    2009-10-15

    The objective of this study was to evaluate retrospectively the impact of factors linked to the radiotherapy realisation on the local and locoregional control, the global survival, the survival without disease of patients suffering of naso-pharynx carcinoma. Conclusion: the patients suffering of a nasopharynx carcinoma treated by irradiation associated to chemotherapy have an improved global survival and an improved survival without disease. The conformal radiotherapy with or without modulated intensity reduce the risk of serous otitis, trismus and xerostomia at long term. It seems necessary to realize multi centric studies with a longer period of follow up before asserting the advantages of the I.M.R.T. in comparison to the classical and conformal technique in the treatment of naso-pharynx carcinomas. (N.C.)

  18. Will SBRT replace conventional radiotherapy in patients with low-intermediate risk prostate cancer? A review.

    Science.gov (United States)

    Arcangeli, Stefano; Scorsetti, Marta; Alongi, Filippo

    2012-10-01

    Stereotactic body radiation therapy (SBRT) is a novel treatment modality in radiation oncology that delivers a very high dose of radiation to the tumor target with high precision using single or a small number of fractions. SBRT is the result of technological advances in patient/tumor immobilization, image guidance, and treatment planning and delivery. This modality is safe and effective in both early stage primary cancer and oligometastases. Compared to the use of stereotactic radiosurgery for other tumor sites, SBRT is slow to be adopted in the management of genitourinary malignancies. Emerging data show the safety and efficacy of this treatment modality in prostate cancer. Preclinical data, clinical experience, and challenges are reviewed and discussed.

  19. Dosimetric advantages of proton therapy over conventional radiotherapy with photons in young patients and adults with low-grade glioma

    Energy Technology Data Exchange (ETDEWEB)

    Harrabi, S.B.; Herfarth, K. [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg (Germany); University Hospital Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany); Bougatf, N. [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); University Hospital Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany); German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg (Germany); Mohr, A. [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); University Hospital Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany); Haberer, T. [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg (Germany); Combs, S.E. [Helmholtz Zentrum Muenchen, Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Oberschleissheim (Germany); Deutsches Konsortium fuer Translationale Krebsforschung (dktk), Partner Site Munich, Munich (Germany); Debus, J.; Adeberg, S. [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg (Germany); University Hospital Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany); German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Heidelberg (Germany)

    2016-11-15

    Low-grade glioma (LGG) is a very common brain tumor in pediatric patients typically associated with a very good prognosis. This prognosis makes it imperative that the risk of long-term treatment-related side effects be kept at an absolute minimum. Proton therapy (PRT) provides a radiation technique that has the potential to further reduce the genesis of radiogenic impairment. We retrospectively assessed 74 patients with LGG who underwent PRT. Conventional three-dimensional photon and PRT plans were generated after contouring structures of neurogenesis, crucial neuronal structures, and areas susceptible to secondary malignancies. Target volume coverage was evaluated using the homogeneity index (HI) and inhomogeneity coefficient (IC). Results were compared using the Wilcoxon-signed rank test, with p < 0.05 being statistically significant. Target volume coverage was comparable for the photon and proton plans. Overall, we could show an essential reduction in maximal, mean, and integral doses in critical neurologic structures, areas of neurogenesis, and structures of neurocognitive function. The study indicated specifically how contralaterally located structures could be spared with PRT. PRT is a highly conformal radiation technique offering superior dosimetric advantages over conventional radiotherapy by allowing significant dose reduction for organs at risk (OAR) that are essential for neurologic function, neurocognition, and quality of life, thus demonstrating the potential of this technique for minimizing long-term sequelae. (orig.) [German] Niedriggradige Gliome (LGG) zaehlen zu den haeufigsten Hirntumoren im Kindesalter und sind ueblicherweise mit einer sehr guten Prognose vergesellschaftet. Es gilt daher, das Risiko fuer therapieassoziierte Spaetfolgen so gering wie moeglich zu halten. Mit der Protonenbestrahlung steht eine Bestrahlungsmodalitaet zur Verfuegung, mit der das Auftreten radiogener Spaetfolgen im Vergleich zu konventionellen Bestrahlungstechniken

  20. Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

    Institute of Scientific and Technical Information of China (English)

    Jian Hu; Ximing Xu; Guangjin Yuan; Wei Ge; Liming Xu; Aihua Zhang; Junjian Deng

    2015-01-01

    Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography (kV-CBCT) and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy (IMRT) or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied. kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume (GTV) was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomogra-phy image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95%(D95) or 1% (D1) of the planning target volume (PTV), mean lung dose (MLD), and volume of lung tissue that received more than 5 (V5), 10 (V10), 20 (V20), and 30 (V30) Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radio-therapy was -25.85% (range, -13.09% --56.76%). The D95 and D1 of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of >20% in the third or fourth week of treatment during IMRT, adap-tive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of 20% in the third or fourth week of treatment.

  1. Exploiting Gene Expression Kinetics in Conventional Radiotherapy, Hyperfractionation, and Hypofractionation for Targeted Therapy.

    Science.gov (United States)

    Makinde, Adeola Y; Eke, Iris; Aryankalayil, Molykutty J; Ahmed, Mansoor M; Coleman, C Norman

    2016-10-01

    The dramatic changes in the technological delivery of radiation therapy, the repertoire of molecular targets for which pathway inhibitors are available, and the cellular and immunologic responses that can alter long-term clinical outcome provide a potentially unique role for using the radiation-inducible changes as therapeutic targets. Various mathematical models of dose and fractionation are extraordinarily useful in guiding treatment regimens. However, although the model may fit the clinical outcome, a deeper understanding of the molecular and cellular effect of the individual dose size and the adaptation to repeated exposure, called multifraction (MF) adaptation, may provide new therapeutic targets for use in combined modality treatments using radiochemotherapy and radioimmunotherapy. We discuss the potential of using different radiation doses and MF adaptation for targeting transcription factors, immune and inflammatory response, and cell "stemness." Given the complex genetic composition of tumors before treatment and their adaptation to drug treatment, innovative combinations using both the pretreatment molecular data and also the MF-adaptive response to radiation may provide an important role for focused radiation therapy as an integral part of precision medicine and immunotherapy.

  2. Late-responding normal tissue cells benefit from high-precision radiotherapy with prolonged fraction delivery times via enhanced autophagy

    Science.gov (United States)

    Yao, Qiwei; Zheng, Rong; Xie, Guozhu; Liao, Guixiang; Du, Shasha; Ren, Chen; Li, Rong; Lin, Xiaoshan; Hu, Daokun; Yuan, Yawei

    2015-01-01

    High-precision radiotherapy (HPR) has established its important role in the treatment of tumors due to its precise dose distribution. Given its more complicated delivery process, HPR commonly requires more fraction delivery time (FDT). However, it is unknown whether it has an identical response of prolonged FDT on different normal tissues. Our results showed that fractionated irradiation with prolonged FDTs (15, 36, and 50 minutes) enhanced cell surviving fractions for normal tissue cells compared with irradiation with an FDT of 2 minutes. However, the late-responding normal cell line HEI-OC1 was more responsive to prolonged FDTs and demonstrated higher surviving fractions and significantly decreased apoptosis and DNA damage compared to the acute-responding normal cell line HaCaT. Increased autophagy mediated via the ATM-AMPK pathway was observed in HEI-OC1 cells compared with HaCaT cells when irradiated with prolonged FDTs. Furthermore, treatment with the autophagy inhibitor 3-MA or ATM inhibitor KU55933 resulted in enhanced ROS accumulation and attenuation of the effect of prolonged FDT-mediated protection on irradiated HEI-OC1 cells. Our results indicated that late-responding normal tissue cells benefitted more from prolonged FDTs compared with acute-responding tissue cells, which was mainly attributed to enhanced cytoprotective autophagy mediated via the ATM/AMPK signaling pathway. PMID:25766900

  3. Patch-based generation of a pseudo CT from conventional MRI sequences for MRI-only radiotherapy of the brain

    Energy Technology Data Exchange (ETDEWEB)

    Andreasen, Daniel, E-mail: dana@dtu.dk [Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby 2800, Denmark and Department of Oncology, Radiotherapy Research Unit, Copenhagen University Hospital, Herlev 2730 (Denmark); Van Leemput, Koen [Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby 2800, Denmark and A.A. Martinos Center for Biomedical Imaging, MGH, Harvard Medical School, Charlestown, Massachusetts 02129 (United States); Hansen, Rasmus H. [Department of Radiology, Copenhagen University Hospital, Herlev 2730 (Denmark); Andersen, Jon A. L.; Edmund, Jens M. [Department of Oncology, Radiotherapy Research Unit, Copenhagen University Hospital, Herlev 2730 (Denmark)

    2015-04-15

    Purpose: In radiotherapy (RT) based on magnetic resonance imaging (MRI) as the only modality, the information on electron density must be derived from the MRI scan by creating a so-called pseudo computed tomography (pCT). This is a nontrivial task, since the voxel-intensities in an MRI scan are not uniquely related to electron density. To solve the task, voxel-based or atlas-based models have typically been used. The voxel-based models require a specialized dual ultrashort echo time MRI sequence for bone visualization and the atlas-based models require deformable registrations of conventional MRI scans. In this study, we investigate the potential of a patch-based method for creating a pCT based on conventional T{sub 1}-weighted MRI scans without using deformable registrations. We compare this method against two state-of-the-art methods within the voxel-based and atlas-based categories. Methods: The data consisted of CT and MRI scans of five cranial RT patients. To compare the performance of the different methods, a nested cross validation was done to find optimal model parameters for all the methods. Voxel-wise and geometric evaluations of the pCTs were done. Furthermore, a radiologic evaluation based on water equivalent path lengths was carried out, comparing the upper hemisphere of the head in the pCT and the real CT. Finally, the dosimetric accuracy was tested and compared for a photon treatment plan. Results: The pCTs produced with the patch-based method had the best voxel-wise, geometric, and radiologic agreement with the real CT, closely followed by the atlas-based method. In terms of the dosimetric accuracy, the patch-based method had average deviations of less than 0.5% in measures related to target coverage. Conclusions: We showed that a patch-based method could generate an accurate pCT based on conventional T{sub 1}-weighted MRI sequences and without deformable registrations. In our evaluations, the method performed better than existing voxel-based and

  4. Dosimetric comparison of preoperative single-fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT.

    Science.gov (United States)

    Yoo, Sua; Blitzblau, Rachel; Yin, Fang-Fang; Horton, Janet K

    2015-01-08

    The purpose of this study was to compare dosimetric parameters of treatment plans among four techniques for preoperative single-fraction partial breast radiotherapy in order to select an optimal treatment technique. The techniques evaluated were noncoplanar 3D conformal radiation therapy (3D CRT), noncoplanar intensity-modulated radiation therapy (IMRTNC), coplanar IMRT (IMRTCO), and volumetric-modulated arc therapy (VMAT). The planning CT scans of 16 patients in the prone position were used in this study, with the single-fraction prescription doses of 15 Gy for the first eight patients and 18 Gy for the remaining eight patients. Six (6) MV photon beams were designed to avoid the heart and contralateral breast. Optimization for IMRT and VMAT was performed to reduce the dose to the skin and normal breast. All plans were normalized such that 100% of the prescribed dose covered greater than 95% of the clinical target volume (CTV) consisting of gross tumor volume (GTV) plus 1.5 cm margin. Mean homogeneity index (HI) was the lowest (1.05 ± 0.02) for 3D CRT and the highest (1.11 ± 0.04) for VMAT. Mean conformity index (CI) was the lowest (1.42 ± 0.32) for IMRTNC and the highest (1.60 ± 0.32) for VMAT. Mean of the maximum point dose to skin was the lowest (73.7 ± 11.5%) for IMRTNC and the highest (86.5 ± 6.68%) for 3D CRT. IMRTCO showed very similar HI, CI, and maximum skin dose to IMRTNC (differences radiotherapy, we can conclude that noncoplanar or coplanar IMRT were optimal in this study as IMRT plans provided homogeneous and conformal target coverage, skin sparing, and relatively short treatment delivery time.

  5. Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma. Hearing preservation and patients' self-reported outcome based on an established questionnaire

    Energy Technology Data Exchange (ETDEWEB)

    Kessel, Kerstin A.; Fischer, Hanna; Vogel, Marco M.E.; Combs, Stephanie E. [Technical University of Munich (TUM), Department of Radiation Oncology, Munich (Germany); Helmholtz Zentrum Muenchen, Institute of Innovative Radiotherapy (iRT), Neuherberg (Germany); Oechsner, Markus [Technical University of Munich (TUM), Department of Radiation Oncology, Munich (Germany); Bier, Henning [Technical University of Munich (TUM), Department of Otorhinolaryngology, Munich (Germany); Meyer, Bernhard [Technical University of Munich (TUM), Department of Neurosurgery, Munich (Germany)

    2017-03-15

    Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL). From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016. Median follow-up after RT was 7.5 years (range 0-14.4 years). Mean overall survival (OS) after RT was 31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was 13.3 years, with 5- and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of 36.3 months (range 2.3-13.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.0-13.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preservation was not significant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient files for tinnitus and facial and trigeminal nerve toxicity. Significant differences appeared regarding hearing impairment, gait uncertainty, and imbalance. These data confirm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller lesions, while FSRT can be offered independently of tumor size. Patient self-reported outcome during follow-up is of high value. The established questionnaire could be validated in the independent cohort. (orig.) [German] Die stereotaktische Radiotherapie (RT) wurde als gueltige Behandlungsalternative bei Patienten mit Vestibularisschwannom (VS) etabliert. Diskussionen ueber die optimale Fraktionierung laufen jedoch. Der Erhalt von Hoervermoegen

  6. Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for postoperative retroperitoneal soft tissue; Etude theorique d'une radiotherapie postoperatoire avec modulation d'intensite d'un sarcome retroperitoneal

    Energy Technology Data Exchange (ETDEWEB)

    Musat, E.; Kantor, G.; Caron, J.; Lagarde, P.; Laharie, H.; Angles, J.; Gilbeau, L. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Radiotherapie, 33 - Bordeaux (France); Stoeckle, E. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Chirurgie, 33 - Bordeaux (France); Bui, B.N. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Medecine, 33 - Bordeaux (France)

    2004-08-01

    External postoperative radiation therapy for retroperitoneal sarcoma is an example of treatment using large fields for complex shaped volumes of irradiation, Prescribed dose is limited by tolerance of adjacent organs at risk (OAR). From a recent case treated by conventional conformal radiotherapy (3D-CRT), we evaluate the benefit of five theoretical IMRT plans. Criteria used are calculated from DVH related to delineated PTV and OAR, IMRT should permit to enhance the prescribed dose without increasing dose in the OAR (especially residual kidney, spinal cord and small bowel). This theoretical study show the feasibility of a dose escalation from a treatment dose of 45 Gy delivered by 3D-CRT up to a planning dose of 54 Gy calculated by IMRT with: - for the PTV: an improvement of the dose homogeneity about 5% (range 2 %) and moreover the coverage factor (CF) about 13% (range 9 6%); - for the OAR: an improvement of the protection factor (PF) about 20% (range 11-24%); - and thus an improved conformity index (CI = CF x PF) about 25% (range 15-32%). (author)

  7. MRI-guided single fraction ablative radiotherapy for early-stage breast cancer : a brachytherapy versus volumetric modulated arc therapy dosimetry study

    NARCIS (Netherlands)

    Charaghvandi, Ramona K; den Hartogh, Mariska D; van Ommen, Anne-Mar L N; de Vries, Wilfred J H; Scholten, Vincent; Moerland, Rien; Philippens, Mariëlle E P; Schokker, Rogier I; van Vulpen, Marco; van Asselen, B; van den Bongard, Desirée H J G

    2015-01-01

    BACKGROUND AND PURPOSE: A radiosurgical treatment approach for early-stage breast cancer has the potential to minimize the patient's treatment burden. The dosimetric feasibility for single fraction ablative radiotherapy was evaluated by comparing volumetric modulated arc therapy (VMAT) with an inter

  8. Modeling of body tissues for Monte Carlo simulation of radiotherapy treatments planned with conventional x-ray CT systems

    Science.gov (United States)

    Kanematsu, Nobuyuki; Inaniwa, Taku; Nakao, Minoru

    2016-07-01

    In the conventional procedure for accurate Monte Carlo simulation of radiotherapy, a CT number given to each pixel of a patient image is directly converted to mass density and elemental composition using their respective functions that have been calibrated specifically for the relevant x-ray CT system. We propose an alternative approach that is a conversion in two steps: the first from CT number to density and the second from density to composition. Based on the latest compilation of standard tissues for reference adult male and female phantoms, we sorted the standard tissues into groups by mass density and defined the representative tissues by averaging the material properties per group. With these representative tissues, we formulated polyline relations between mass density and each of the following; electron density, stopping-power ratio and elemental densities. We also revised a procedure of stoichiometric calibration for CT-number conversion and demonstrated the two-step conversion method for a theoretically emulated CT system with hypothetical 80 keV photons. For the standard tissues, high correlation was generally observed between mass density and the other densities excluding those of C and O for the light spongiosa tissues between 1.0 g cm-3 and 1.1 g cm-3 occupying 1% of the human body mass. The polylines fitted to the dominant tissues were generally consistent with similar formulations in the literature. The two-step conversion procedure was demonstrated to be practical and will potentially facilitate Monte Carlo simulation for treatment planning and for retrospective analysis of treatment plans with little impact on the management of planning CT systems.

  9. SU-E-T-90: Concrete Forward-Scatter Fractions for Radiotherapy Shielding Applications

    Energy Technology Data Exchange (ETDEWEB)

    Tanny, S; Parsai, E [University of Toledo Medical Center, Toledo, OH (United States)

    2014-06-01

    Purpose: There is little instruction within the primary shielding guidance document NCRP 151 for vault designs where the primary beam intercepts the maze. We have conducted a Monte-Carlo study to characterize forward-scattered radiation from concrete barriers with the intent of quantifying what amount of additional shielding outside the primary beam is needed in this situation. Methods: We reproduced our vault in MCNP 5 and simulated spectra obtained from the literature and from our treatment planning system for 10 and 18 MV beams. Neutron and gamma-capture contributions were not simulated. Energy deposited was scored at isocenter in a water phantom, within various cells that comprised the maze, and within cells that comprised the vault door. Tracks were flagged that scattered from within the maze to the door and their contributions were tallied separately. Three different concrete mixtures found in the literature were simulated. An empirically derived analytic equation was used for comparison, utilizing patient scatter fractions to approximate the scatter from concrete. Results: Our simulated data confirms that maze-scattered radiation is a significant contribution to total photon dose at the door. It contributes between 20-35% of the photon shielding workload. Forward-scatter fractions for concrete were somewhat dependent on concrete composition and the relative abundance of higher-Z elements. Scatter fractions were relatively insensitive to changes in the primary photon spectrum. Analytic results were of the same magnitude as simulated results. Conclusions: Forward-scattered radiation from the maze barrier needs to be included in the photon workload for shielding calculations in non-standard vault designs. Scatter fractions will vary with concrete composition, but should be insensitive to spectral changes between machine manufacturers. Further plans for investigation include refined scatter fractions for various concrete compositions, scatter fraction

  10. Fast dose algorithm for generation of dose coverage probability for robustness analysis of fractionated radiotherapy

    Science.gov (United States)

    Tilly, David; Ahnesjö, Anders

    2015-07-01

    A fast algorithm is constructed to facilitate dose calculation for a large number of randomly sampled treatment scenarios, each representing a possible realisation of a full treatment with geometric, fraction specific displacements for an arbitrary number of fractions. The algorithm is applied to construct a dose volume coverage probability map (DVCM) based on dose calculated for several hundred treatment scenarios to enable the probabilistic evaluation of a treatment plan. For each treatment scenario, the algorithm calculates the total dose by perturbing a pre-calculated dose, separately for the primary and scatter dose components, for the nominal conditions. The ratio of the scenario specific accumulated fluence, and the average fluence for an infinite number of fractions is used to perturb the pre-calculated dose. Irregularities in the accumulated fluence may cause numerical instabilities in the ratio, which is mitigated by regularisation through convolution with a dose pencil kernel. Compared to full dose calculations the algorithm demonstrates a speedup factor of ~1000. The comparisons to full calculations show a 99% gamma index (2%/2 mm) pass rate for a single highly modulated beam in a virtual water phantom subject to setup errors during five fractions. The gamma comparison shows a 100% pass rate in a moving tumour irradiated by a single beam in a lung-like virtual phantom. DVCM iso-probability lines computed with the fast algorithm, and with full dose calculation for each of the fractions, for a hypo-fractionated prostate case treated with rotational arc therapy treatment were almost indistinguishable.

  11. A comparative dosimetric study of neoadjuvant 3D conformal radiotherapy for operable rectal cancer patients versus conventional 2D radiotherapy in NCI-airo

    Institute of Scientific and Technical Information of China (English)

    Mohamed Mahmoud; Hesham A. EL-Hossiny; Nashaat A. Diab; Marwa A. EL Razek

    2012-01-01

    Objective: This study was to compare this multiple-field conformal technique to the AP-PA technique with respect to target volume coverage and dose to normal tissues.Methods: We conducted a single institutional prospective comparative dosimetric analysis of 22 patients who received neoadjuvant radiation therapy for rectal cancer presented to radiotherapy department in National Cancer Institute, Cairo in period between June 2010 to September 2011 using 3D conformal radiotherapy technique for each patient, a second radiotherapy treatment plan was done using an anteroposterior (AP-PA) fields, the two techniques were then compared using dose volume histogram (DVH) analysis.Results: Comparing different DVHs, it was found that the planning target volume (PTV) was adequately covered in both ( 3D & 2D ) plans while it was demonstrates that this multiple field conformal technique produces superior distribution compared to 2D technique, with considerable sparing of bladder, ovaries and head of both femora.Conclusion: From the present study, it shows that it is recommended to use 3D planning for preoperative cases of cancer rectum so far it produces good coverage of the target as well as good sparing of the surrounding critical organs.

  12. Quantification of intra-fraction motion in breast radiotherapy using supine magnetic resonance imaging

    NARCIS (Netherlands)

    van Heijst, Tristan C F; Philippens, Mariëlle E P; Charaghvandi, Ramona K; den Hartogh, Mariska D; Lagendijk, JJW; van den Bongard, H J G Desirée; van Asselen, B

    2016-01-01

    In early-stage breast-cancer patients, accelerated partial-breast irradiation techniques (APBI) and hypofractionation are increasingly implemented after breast-conserving surgery (BCS). For a safe and effective radiation therapy (RT), the influence of intra-fraction motion during dose delivery becom

  13. Fractionated changes in prostate cancer radiotherapy using cone-beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Tzung-Chi, E-mail: tzungchi.huang@mail.cmu.edu.tw [Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City, Taiwan (China); Department of Biomedical Informatics, Asia University, Taichung City, Taiwan (China); Chou, Kuei-Ting [Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City, Taiwan (China); Yang, Shih-Neng [Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City, Taiwan (China); Department of Biomedical Informatics, Asia University, Taichung City, Taiwan (China); Chang, Chih-Kai [Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung City, Taiwan (China); Liang, Ji-An [Department of Radiation Oncology, China Medical University Hospital, Taichung City, Taiwan (China); Zhang, Geoffrey [Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States)

    2015-10-01

    The high mobility of the bladder and the rectum causes uncertainty in radiation doses prescribed to patients with prostate cancer who undergo radiotherapy (RT) multifraction treatments. The purpose of this study was to estimate the dose received by the bladder, rectum, and prostate from multifraction treatments using daily cone-beam computed tomography (CBCT). Overall, 28 patients with prostate cancer who planned to receive radiation treatments were enrolled in the study. The acquired CBCT before the treatment delivery was registered with the planning CT to map the dose distribution used in the treatment plan for estimating the received dose during clinical treatment. For all 28 patients with 112 data sets, the mean percentage differences (± standard deviation) in the volume and radiation dose were 44% (± 41) and 18% (± 17) for the bladder, 20% (± 21) and 2% (± 2) for the prostate, and 36% (± 29) and 22% (± 15) for the rectum, respectively. Substantial differences between the volumes and radiation dose and those specified in treatment plans were observed. Besides the use of image-guided RT to improve patient setup accuracy, further consideration of large changes in bladder and rectum volumes is strongly suggested when using external beam radiation for prostate cancer.

  14. Surgical Management of Combined Intramedullary Arteriovenous Malformation and Perimedullary Arteriovenous Fistula within the Hybrid Operating Room after Five Years of Performing Focus Fractionated Radiotherapy: Case Report

    Science.gov (United States)

    GEKKA, Masayuki; SEKI, Toshitaka; HIDA, Kazutoshi; OSANAI, Toshiya; HOUKIN, Kiyohiro

    2014-01-01

    Perimedullary arteriovenous fistula (AVF) shunts occur on the spinal cord surface and can be treated surgically or by endovascular embolization. In contrast, the nidus of an intramedullary arteriovenous malformation (AVM) is located in the spinal cord and is difficult to treat surgically or by endovascular techniques. The benefits of radiotherapy for treating intramedullary AVM have been published, but are anecdotal and consist largely of case reports. We present a case of combined cervical intramedullary AVM and perimedullary AVF which received surgical treatment within a hybrid operating room (OR) after 5 years of focus fractionated radiotherapy. A 37-year-old male presented with stepwise worsening myelopathy. Magnetic resonance imaging and spinal angiography revealed intramedullary AVM and perimedullary AVF at the C3 to C5 levels. In order to reduce nidus size and blood flow, we first performed focal fractionated radiotherapy. Five years later, the lesion volume was reduced. Following this, direct surgery was performed by an anterior approach using corpectomy in the hybrid OR. The spinal cord was monitored by motor-evoked potential throughout the surgery. Complete obliteration of the fistulous connection was confirmed by intraoperative indocyanine green video-angiography and intraoperative angiography, preserving the anterior spinal artery. We conclude that surgical treatment following focal fractionated radiotherapy may become one strategy for patients who are initially deemed ineligible for endovascular embolization and surgical treatment. Furthermore, the hybrid OR enables safe and precise treatment for spinal vascular disorders in the fields of endovascular treatment and neurosurgery. PMID:25367581

  15. Surgical management of combined intramedullary arteriovenous malformation and perimedullary arteriovenous fistula within the hybrid operating room after five years of performing focus fractionated radiotherapy: case report.

    Science.gov (United States)

    Gekka, Masayuki; Seki, Toshitaka; Hida, Kazutoshi; Osanai, Toshiya; Houkin, Kiyohiro

    2014-01-01

    Perimedullary arteriovenous fistula (AVF) shunts occur on the spinal cord surface and can be treated surgically or by endovascular embolization. In contrast, the nidus of an intramedullary arteriovenous malformation (AVM) is located in the spinal cord and is difficult to treat surgically or by endovascular techniques. The benefits of radiotherapy for treating intramedullary AVM have been published, but are anecdotal and consist largely of case reports. We present a case of combined cervical intramedullary AVM and perimedullary AVF which received surgical treatment within a hybrid operating room (OR) after 5 years of focus fractionated radiotherapy. A 37-year-old male presented with stepwise worsening myelopathy. Magnetic resonance imaging and spinal angiography revealed intramedullary AVM and perimedullary AVF at the C3 to C5 levels. In order to reduce nidus size and blood flow, we first performed focal fractionated radiotherapy. Five years later, the lesion volume was reduced. Following this, direct surgery was performed by an anterior approach using corpectomy in the hybrid OR. The spinal cord was monitored by motor-evoked potential throughout the surgery. Complete obliteration of the fistulous connection was confirmed by intraoperative indocyanine green video-angiography and intraoperative angiography, preserving the anterior spinal artery. We conclude that surgical treatment following focal fractionated radiotherapy may become one strategy for patients who are initially deemed ineligible for endovascular embolization and surgical treatment. Furthermore, the hybrid OR enables safe and precise treatment for spinal vascular disorders in the fields of endovascular treatment and neurosurgery.

  16. Quantification of intra-fraction motion in breast radiotherapy using supine magnetic resonance imaging

    Science.gov (United States)

    van Heijst, Tristan C. F.; Philippens, Mariëlle E. P.; Charaghvandi, Ramona K.; den Hartogh, Mariska D.; Lagendijk, Jan J. W.; Desirée van den Bongard, H. J. G.; van Asselen, Bram

    2016-02-01

    In early-stage breast-cancer patients, accelerated partial-breast irradiation techniques (APBI) and hypofractionation are increasingly implemented after breast-conserving surgery (BCS). For a safe and effective radiation therapy (RT), the influence of intra-fraction motion during dose delivery becomes more important as associated fraction durations increase and targets become smaller. Current image-guidance techniques are insufficient to characterize local target movement in high temporal and spatial resolution for extended durations. Magnetic resonance imaging (MRI) can provide high soft-tissue contrast, allow fast imaging, and acquire images during longer periods. The goal of this study was to quantify intra-fraction motion using MRI scans from 21 breast-cancer patients, before and after BCS, in supine RT position, on two time scales. High-temporal 2-dimensional (2D) MRI scans (cine-MRI), acquired every 0.3 s during 2 min, and three 3D MRI scans, acquired over 20 min, were performed. The tumor (bed) and whole breast were delineated on 3D scans and delineations were transferred to the cine-MRI series. Consecutive scans were rigidly registered and delineations were transformed accordingly. Motion in sub-second time-scale (derived from cine-MRI) was generally regular and limited to a median of 2 mm. Infrequently, large deviations were observed, induced by deep inspiration, but these were temporary. Movement on multi-minute scale (derived from 3D MRI) varied more, although medians were restricted to 2.2 mm or lower. Large whole-body displacements (up to 14 mm over 19 min) were sparsely observed. The impact of motion on standard RT techniques is likely small. However, in novel hypofractionated APBI techniques, whole-body shifts may affect adequate RT delivery, given the increasing fraction durations and smaller targets. Motion management may thus be required. For this, on-line MRI guidance could be provided by a hybrid MRI/RT modality, such as the

  17. Stereotactic multiple are radiotherapy. IV--Haemangioblastoma.

    Science.gov (United States)

    Chakraborti, P R; Chakrabarti, K B; Doughty, D; Plowman, P N

    1997-04-01

    Our initial experience in the treatment of haemangioblastoma using conventional external beam radiotherapy and stereotactic radiotherapy (radiosurgery), by the linear accelerator method, is reported. Six haemangioblastomas in five patients were treated with a mean follow-up of 40 months (range 14-60). Five haemangioblastomas in four patients were treated with stereotactic radiotherapy, where four showed complete radiological response and the fifth was static. Neurological symptoms and signs improved in those patients. The sixth haemangioblastoma was situated close to the pituitary and optic chiasm, and was treated with conventionally fractionated external beam radiotherapy. The lesion showed partial response. No complications were noted in this patient group. This series complements and extends the relatively sparse published literature demonstrating that radiotherapy is an effective option for treating haemangioblastomas. Radiosurgery often lends itself particularly well to these discrete lesions allowing highly focused treatment. For patients with multiple and metachronous cerebellar haemangioblastomas as part of the von Hipple-Lindau syndrome, the data support a policy of conventionally fractionated external beam radiotherapy to the whole cerebellum of 50-55 Gy followed, after a period of time, by radiosurgery to persisting lesions (patients 3 and 4).

  18. Stereotactic body radiotherapy for lung cancer: how much does it really cost?

    Science.gov (United States)

    Lievens, Yolande; Obyn, Caroline; Mertens, Anne-Sophie; Van Halewyck, Dries; Hulstaert, Frank

    2015-03-01

    Despite the lack of randomized evidence, stereotactic body radiotherapy (SBRT) is being accepted as superior to conventional radiotherapy for patients with T1-2N0 non-small-cell lung cancer in the periphery of the lung and unfit or unwilling to undergo surgery. To introduce SBRT in a system of coverage with evidence development, a correct financing had to be determined. A time-driven activity-based costing model for radiotherapy was developed. Resource cost calculation of all radiotherapy treatments, standard and innovative, was conducted in 10 Belgian radiotherapy centers in the second half of 2012. The average cost of lung SBRT across the 10 centers (6221&OV0556;) is in the range of the average costs of standard fractionated 3D-conformal radiotherapy (5919&OV0556;) and intensity-modulated radiotherapy (7379&OV0556;) for lung cancer. Hypofractionated 3D-conformal radiotherapy and intensity-modulated radiotherapy schemes are less costly (3993&OV0556; respectively 4730&OV0556;). The SBRT cost increases with the number of fractions and is highly dependent of personnel and equipment use. SBRT cost varies more by centre than conventional radiotherapy cost, reflecting different technologies, stages in the learning curve and a lack of clear guidance in this field. Time-driven activity-based costing of radiotherapy is feasible in a multicentre setup, resulting in real-life resource costs that can form the basis for correct reimbursement schemes, supporting an early yet controlled introduction of innovative radiotherapy techniques in clinical practice.

  19. Hypo-fractionated radiotherapy of breast cancer: long term results of a set of 80 cases treated in the radiotherapy department of the Oran university hospital; Radiotherapie hypofractionnee dans le cancer du sein: resultats a long terme d'une serie de 80 cas traites dans le service de radiotherapie du centre hospitalier universitaire d'Oran

    Energy Technology Data Exchange (ETDEWEB)

    Boukerche, A.; Yahia, A.; Madouri, R.; Belmiloud, H.; Dali-Youcef, A.F. [Service de radiotherapie, CHU d' Oran, Oran (Algeria)

    2011-10-15

    The authors report the assessment of the local and locoregional control and of the acute and late toxicity of adjuvant hypo-fractionated radiotherapy in breast cancer treatment. During 1998, 80 women have been treated by conservative or radical surgery and hypo-fractionated tele-cobalto-therapy (36 Gy in five fractions of 3 Gy a week, and a boost of 15 Gy in five fractions in case of conservative surgery). Results are discussed in terms of local and locoregional recurrence, tolerance, late toxicity, global survival, and tumour classification. The irradiation scheme seems perfectly achievable but a greater number of patients and a longer follow-up are required to better assess the efficiency and aesthetic results. Short communication

  20. Palliative radiotherapy in locally advanced head and neck cancer after failure of induction chemotherapy: Comparison of two fractionation schemes

    Directory of Open Access Journals (Sweden)

    Kailash Chandra Pandey

    2013-01-01

    conventional fractionation in the 2 nd week, could possibly offer better response rates, QOL increments, and potential survival benefits among LAHNSCC patients even after failing to respond to IC.

  1. Critical dose and toxicity index of organs at risk in radiotherapy: Analyzing the calculated effects of modified dose fractionation in non–small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pedicini, Piernicola, E-mail: ppiern@libero.it [Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture (Italy); Strigari, Lidia [Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome (Italy); Benassi, Marcello [Service of Medical Physics, Scientific Institute of Tumours of Romagna I.R.S.T., Meldola (Italy); Caivano, Rocchina [Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture (Italy); Fiorentino, Alba [U.O. of Radiotherapy, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy); Nappi, Antonio [U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy); Salvatore, Marco [U.O. of Nuclear Medicine, I.R.C.C.S. SDN Foundation, Naples (Italy); Storto, Giovanni [U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy)

    2014-04-01

    To increase the efficacy of radiotherapy for non–small cell lung cancer (NSCLC), many schemes of dose fractionation were assessed by a new “toxicity index” (I), which allows one to choose the fractionation schedules that produce less toxic treatments. Thirty-two patients affected by non resectable NSCLC were treated by standard 3-dimensional conformal radiotherapy (3DCRT) with a strategy of limited treated volume. Computed tomography datasets were employed to re plan by simultaneous integrated boost intensity-modulated radiotherapy (IMRT). The dose distributions from plans were used to test various schemes of dose fractionation, in 3DCRT as well as in IMRT, by transforming the dose-volume histogram (DVH) into a biological equivalent DVH (BDVH) and by varying the overall treatment time. The BDVHs were obtained through the toxicity index, which was defined for each of the organs at risk (OAR) by a linear quadratic model keeping an equivalent radiobiological effect on the target volume. The less toxic fractionation consisted in a severe/moderate hyper fractionation for the volume including the primary tumor and lymph nodes, followed by a hypofractionation for the reduced volume of the primary tumor. The 3DCRT and IMRT resulted, respectively, in 4.7% and 4.3% of dose sparing for the spinal cord, without significant changes for the combined-lungs toxicity (p < 0.001). Schedules with reduced overall treatment time (accelerated fractionations) led to a 12.5% dose sparing for the spinal cord (7.5% in IMRT), 8.3% dose sparing for V{sub 20} in the combined lungs (5.5% in IMRT), and also significant dose sparing for all the other OARs (p < 0.001). The toxicity index allows to choose fractionation schedules with reduced toxicity for all the OARs and equivalent radiobiological effect for the tumor in 3DCRT, as well as in IMRT, treatments of NSCLC.

  2. [Long-term results and cause of failure analysis in larynx cancer patients irradiated conventionally and with accelerated fractionation schedules in 1995-1998].

    Science.gov (United States)

    Szutkowski, Zbigniew; Kawecki, Andrzej; Jarząbski, Andrzej

    2014-01-01

    The clinical material consists of 217 patients with squamous cell carcinoma in supraglottic and glottic larynx in clinical stage T1-3N0M0 irradiated radically in Warsaw Oncology Centre in 1995-1998. All patients were treated with Co-60, according to two schedules of fractionation, with maintenance of the consistent therapeutic protocol. The same team of doctors worked on the treatment of patients and on the follow-up as well. The clinical material is a part of a three-phased clinical trial KBN 0295. In the course of observation, the progression of cancer was not observed in 157 patients, among whom, 66% were treated conventionally and 79% with accelerated fractionation method. 60 cases of loco-regional recurrences were noted, among which 55 were regional. The majority of failure cases was observed until the 30(th) of the month after the radiotherapy ended. In conventional fractionation treatment, recurrences in T1 were 8/31 (26%), in T2 22/59 (37%) and in T3 8/20 (40%). In patients treated with AF, recurrences were T1 5/39 (13%), T2 15/55 (27%) and T3 2/13 (15%) respectively. The percentage of primary site tumour recurrences for each localization and kind of treatment was analysed. In CF 28/78 (37%) of glottic tumour recurrences and 10/34 (29%) of supraglottic tumour, recurrences were observed. In AF, 12/71 (17%) and 10/36 (28%) were observed respectively. In 48 cases salvage surgery was used, and 12 patients were not qualified because of tumour massive progression or because they refused to have a surgery. Among 34 cases (16%) of the second primary tumour or distant methastases, 25 were observed with glottic cancer, among which 23 were observed in early stages, and 9 cases with supraglottic cancer, among which, 6 showed early stage of tumour. In only 3 cases out of all the patients, distant methastases were confirmed in histopatology examination. The main cause of failure in larynx cancer patients in stage T1 is that 3N0M0 are local recurrences. Second primary or

  3. Volumetric-modulated arc therapy vs conventional fixed-field intensity-modulated radiotherapy in a whole-ventricular irradiation: A planning comparison study

    Energy Technology Data Exchange (ETDEWEB)

    Sakanaka, Katsuyuki [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Mizowaki, Takashi, E-mail: mizo@kuhp.kyoto-u.ac.jp [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Sato, Sayaka; Ogura, Kengo; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)

    2013-07-01

    This study evaluated the dosimetric difference between volumetric-modulated arc therapy (VMAT) and conventional fixed-field intensity-modulated radiotherapy (cIMRT) in whole-ventricular irradiation. Computed tomography simulation data for 13 patients were acquired to create plans for VMAT and cIMRT. In both plans, the same median dose (100% = 24 Gy) was prescribed to the planning target volume (PTV), which comprised a tumor bed and whole ventricles. During optimization, doses to the normal brain and body were reduced, provided that the dose constraints of the target coverage were satisfied. The dose-volume indices of the PTV, normal brain, and body as well as monitor units were compared between the 2 techniques by using paired t-tests. The results showed no significant difference in the homogeneity index (0.064 vs 0.065; p = 0.824) of the PTV and conformation number (0.78 vs 0.77; p = 0.065) between the 2 techniques. In the normal brain and body, the dose-volume indices showed no significant difference between the 2 techniques, except for an increase in the volume receiving a low dose in VMAT; the absolute volume of the normal brain and body receiving 1 Gy of radiation significantly increased in VMAT by 1.6% and 8.3%, respectively, compared with that in cIMRT (1044 vs 1028 mL for the normal brain and 3079.2 vs 2823.3 mL for the body; p<0.001). The number of monitor units to deliver a 2.0-Gy fraction was significantly reduced in VMAT compared with that in cIMRT (354 vs 873, respectively; p<0.001). In conclusion, VMAT delivers IMRT to complex target volumes such as whole ventricles with fewer monitor units, while maintaining target coverage and conformal isodose distribution comparable to cIMRT; however, in addition to those characteristics, the fact that the volume of the normal brain and body receiving a low dose would increase in VMAT should be considered.

  4. IsoBED: a tool for automatic calculation of biologically equivalent fractionation schedules in radiotherapy using IMRT with a simultaneous integrated boost (SIB) technique

    OpenAIRE

    2011-01-01

    Abstract Background An advantage of the Intensity Modulated Radiotherapy (IMRT) technique is the feasibility to deliver different therapeutic dose levels to PTVs in a single treatment session using the Simultaneous Integrated Boost (SIB) technique. The paper aims to describe an automated tool to calculate the dose to be delivered with the SIB-IMRT technique in different anatomical regions that have the same Biological Equivalent Dose (BED), i.e. IsoBED, compared to the standard fractionation....

  5. Preoperative Single Fraction Partial Breast Radiotherapy for Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Palta, Manisha; Yoo, Sua; Adamson, Justus D.; Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Horton, Janet K., E-mail: janet.horton@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

    2012-01-01

    Purpose: Several recent series evaluating external beam accelerated partial breast irradiation (PBI) have reported adverse cosmetic outcomes, possibly related to large volumes of normal tissue receiving near-prescription doses. We hypothesized that delivery of external beam PBI in a single fraction to the preoperative tumor volume would be feasible and result in a decreased dose to the uninvolved breast compared with institutional postoperative PBI historical controls. Methods and Materials: A total of 17 patients with unifocal Stage T1 breast cancer were identified. Contrast-enhanced subtraction magnetic resonance images were loaded into an Eclipse treatment planning system and used to define the target volumes. A 'virtual plan' was created using four photon beams in a noncoplanar beam arrangement and optimized to deliver 15 Gy to the planning target volume. Results: The median breast volume was 1,713 cm{sup 3} (range: 1,014-2,140), and the median clinical target volume was 44 cm{sup 3} (range: 26-73). In all cases, 100% of the prescription dose covered 95% of the clinical target volume. The median conformity index was 0.86 (range: 0.70-1.12). The median percentage of the ipsilateral breast volume receiving 100% and 50% of the prescribed dose was 3.8% (range: 2.2-6.9) and 13.3% (range: 7.5-20.8) compared with 18% (range: 3-42) and 53% (range: 24-65) in the institutional historical controls treated with postoperative external beam PBI (p = .002). The median maximum skin dose was 9 Gy. The median dose to 1 and 10 cm{sup 3} of skin was 6.7 and 4.9 Gy. The doses to the heart and ipsilateral lung were negligible. Conclusion: Preoperative PBI resulted in a substantial reduction in ipsilateral breast tissue dose compared with postoperative PBI. The skin dose appeared reasonable, given the small volumes. A prospective Phase I trial evaluating this technique is ongoing.

  6. A survival model for fractionated radiotherapy with an application to prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zaider, Marco [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)]. E-mail: Zaiderm@mskcc.org; Zelefsky, Michael J.; Leibel, Steven A. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hanin, Leonid G. [Department of Mathematics, Idaho State University, Pocatello, ID (United States); Tsodikov, Alexander D.; Yakovlev, Andrei Y. [Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (United States)

    2001-10-01

    This paper explores the applicability of a mechanistic survival model, based on the distribution of clonogens surviving a course of fractionated radiation therapy, to clinical data on patients with prostate cancer. The study was carried out using data on 1100 patients with clinically localized prostate cancer who were treated with three-dimensional conformal radiation therapy. The patients were stratified by radiation dose (group 1: <67.5 Gy; group 2: 67.5-72.5 Gy; group 3: 72.5-77.5 Gy; group 4: 77.5-87.5 Gy) and prognosis category (favourable, intermediate and unfavourable as defined by pre-treatment PSA and Gleason score). A relapse was recorded when tumour recurrence was diagnosed or when three successive prostate specific antigen (PSA) elevations were observed from a post-treatment nadir PSA level. PSA relapse-free survival was used as the primary end point. The model, which is based on an iterated Yule process, is specified in terms of three parameters: the mean number of tumour clonogens that survive the treatment, the mean of the progression time of post-treatment tumour development and its standard deviation. The model parameters were estimated by the maximum likelihood method. The fact that the proposed model provides an excellent description both of the survivor function and of the hazard rate is prima facie evidence of the validity of the model because closeness of the two survivor functions (empirical and model-based) does not generally imply closeness of the corresponding hazard rates. The estimated cure probabilities for the favourable group are 0.80, 0.74 and 0.87 (for dose groups 1-3, respectively); for the intermediate group: 0.25, 0.51, 0.58 and 0.78 (for dose groups 1-4, respectively) and for the unfavourable group: 0.0, 0.27, 0.33 and 0.64 (for dose groups 1-4, respectively). The distribution of progression time to tumour relapse was found to be independent of prognosis group but dependent on dose. As the dose increases the mean progression

  7. Clinical radiobiology of glioblastoma multiforme. Estimation of tumor control probability from various radiotherapy fractionation schemes

    Energy Technology Data Exchange (ETDEWEB)

    Pedicini, Piernicola [I.R.C.C.S.-Regional-Cancer-Hospital-C.R.O.B, Unit of Nuclear Medicine, Department of Radiation and Metabolic Therapies, Rionero-in-Vulture (Italy); Department of Radiation and Metabolic Therapies, I.R.C.C.S.-Regional-Cancer-Hospital-C.R.O.B, Unit of Radiotherapy, Rionero-in-Vulture (Italy); Fiorentino, Alba [Sacro Cuore - Don Calabria Hospital, Radiation Oncology Department, Negrar, Verona (Italy); Simeon, Vittorio [I.R.C.C.S.-Regional-Cancer-Hospital-C.R.O.B, Laboratory of Preclinical and Translational Research, Rionero-in-Vulture (Italy); Tini, Paolo; Pirtoli, Luigi [University of Siena and Tuscany Tumor Institute, Unit of Radiation Oncology, Department of Medicine Surgery and Neurological Sciences, Siena (Italy); Chiumento, Costanza [Department of Radiation and Metabolic Therapies, I.R.C.C.S.-Regional-Cancer-Hospital-C.R.O.B, Unit of Radiotherapy, Rionero-in-Vulture (Italy); Salvatore, Marco [I.R.C.C.S. SDN Foundation, Unit of Nuclear Medicine, Napoli (Italy); Storto, Giovanni [I.R.C.C.S.-Regional-Cancer-Hospital-C.R.O.B, Unit of Nuclear Medicine, Department of Radiation and Metabolic Therapies, Rionero-in-Vulture (Italy)

    2014-10-15

    The aim of this study was to estimate a radiobiological set of parameters from the available clinical data on glioblastoma (GB). A number of clinical trial outcomes from patients affected by GB and treated with surgery and adjuvant radiochemotherapy were analyzed to estimate a set of radiobiological parameters for a tumor control probability (TCP) model. The analytical/graphical method employed to fit the clinical data allowed us to estimate the intrinsic tumor radiosensitivity (α), repair capability (b), and repopulation doubling time (T{sub d}) in a first phase, and subsequently the number of clonogens (N) and kick-off time for accelerated proliferation (T{sub k}). The results were used to formulate a hypothesis for a scheduleexpected to significantly improve local control. The 95 % confidence intervals (CI{sub 95} {sub %}) of all parameters are also discussed. The pooled analysis employed to estimate the parameters summarizes the data of 559 patients, while the studies selected to verify the results summarize data of 104 patients. The best estimates and the CI{sub 95} {sub %} are α = 0.12 Gy{sup -1} (0.10-0.14), b = 0.015 Gy{sup -2} (0.013-0.020), α/b = 8 Gy (5.0-10.8), T{sub d} = 15.4 days (13.2-19.5), N = 1 . 10{sup 4} (1.2 . 10{sup 3} - 1 . 10{sup 5}), and T{sub k} = 37 days (29-46). The dose required to offset the repopulation occurring after 1 day (D{sub prolif}) and starting after T{sub k} was estimated as 0.30 Gy/day (0.22-0.39). The analysis confirms a high value for the α/b ratio. Moreover, a high intrinsic radiosensitivity together with a long kick-off time for accelerated repopulation and moderate repopulation kinetics were found. The results indicate a substantial independence of the duration of the overall treatment and an improvement in the treatment effectiveness by increasing the total dose without increasing the dose fraction. (orig.) [German] Schaetzung eines strahlenbiologischen Parametersatzes auf der Grundlage klinischer Daten bei

  8. Standard-Fractionated Radiotherapy for Optic Nerve Sheath Meningioma: Visual Outcome Is Predicted by Mean Eye Dose

    Energy Technology Data Exchange (ETDEWEB)

    Abouaf, Lucie [Neuro-Ophthalmology Unit, Pierre-Wertheimer Hospital, Hospices Civils de Lyon, Lyon (France); Girard, Nicolas [Radiotherapy-Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon (France); Claude Bernard University, Lyon (France); Lefort, Thibaud [Neuro-Radiology Department, Pierre-Wertheimer Hospital, Hospices Civils de Lyon, Lyon (France); D' hombres, Anne [Claude Bernard University, Lyon (France); Tilikete, Caroline; Vighetto, Alain [Neuro-Ophthalmology Unit, Pierre-Wertheimer Hospital, Hospices Civils de Lyon, Lyon (France); Claude Bernard University, Lyon (France); Mornex, Francoise, E-mail: francoise.mornex@chu-lyon.fr [Claude Bernard University, Lyon (France)

    2012-03-01

    Purpose: Radiotherapy has shown its efficacy in controlling optic nerve sheath meningiomas (ONSM) tumor growth while allowing visual acuity to improve or stabilize. However, radiation-induced toxicity may ultimately jeopardize the functional benefit. The purpose of this study was to identify predictive factors of poor visual outcome in patients receiving radiotherapy for ONSM. Methods and Materials: We conducted an extensive analysis of 10 patients with ONSM with regard to clinical, radiologic, and dosimetric aspects. All patients were treated with conformal radiotherapy and subsequently underwent biannual neuroophthalmologic and imaging assessments. Pretreatment and posttreatment values of visual acuity and visual field were compared with Wilcoxon's signed rank test. Results: Visual acuity values significantly improved after radiotherapy. After a median follow-up time of 51 months, 6 patients had improved visual acuity, 4 patients had improved visual field, 1 patient was in stable condition, and 1 patient had deteriorated visual acuity and visual field. Tumor control rate was 100% at magnetic resonance imaging assessment. Visual acuity deterioration after radiotherapy was related to radiation-induced retinopathy in 2 patients and radiation-induced mature cataract in 1 patient. Study of radiotherapy parameters showed that the mean eye dose was significantly higher in those 3 patients who had deteriorated vision. Conclusions: Our study confirms that radiotherapy is efficient in treating ONSM. Long-term visual outcome may be compromised by radiation-induced side effects. Mean eye dose has to be considered as a limiting constraint in treatment planning.

  9. Fractionated stereotactic radiotherapy for skull base tumors: analysis of treatment accuracy using a stereotactic mask fixation system

    Directory of Open Access Journals (Sweden)

    Montagnoli Roberto

    2010-01-01

    Full Text Available Abstract Background To assess the accuracy of fractionated stereotactic radiotherapy (FSRT using a stereotactic mask fixation system. Patients and Methods Sixteen patients treated with FSRT were involved in the study. A commercial stereotactic mask fixation system (BrainLAB AG was used for patient immobilization. Serial CT scans obtained before and during FSRT were used to assess the accuracy of patient immobilization by comparing the isocenter position. Daily portal imaging were acquired to establish day to day patient position variation. Displacement errors along the different directions were calculated as combination of systematic and random errors. Results The mean isocenter displacements based on localization and verification CT imaging were 0.1 mm (SD 0.3 mm in the lateral direction, 0.1 mm (SD 0.4 mm in the anteroposterior, and 0.3 mm (SD 0.4 mm in craniocaudal direction. The mean 3D displacement was 0.5 mm (SD 0.4 mm, being maximum 1.4 mm. No significant differences were found during the treatment (P = 0.4. The overall isocenter displacement as calculated by 456 anterior and lateral portal images were 0.3 mm (SD 0.9 mm in the mediolateral direction, -0.2 mm (SD 1 mm in the anteroposterior direction, and 0.2 mm (SD 1.1 mm in the craniocaudal direction. The largest displacement of 2.7 mm was seen in the cranio-caudal direction, with 95% of displacements Conclusions The results indicate that the setup error of the presented mask system evaluated by CT verification scans and portal imaging are minimal. Reproducibility of the isocenter position is in the best range of positioning reproducibility reported for other stereotactic systems.

  10. Low-dose fractionated radiotherapy and concomitant chemotherapy for recurrent or progressive glioblastoma. Final report of a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Balducci, M.; Diletto, B.; Chiesa, S.; D' Agostino, G.R.; Gambacorta, M.A.; Ferro, M.; Valentini, V. [Catholic University of the Sacred Heart, Department of Radiation Oncology, Rome (Italy); Colosimo, C. [Catholic University of the Sacred Heart, Department of Radiology, Rome (Italy); Maira, G.; Anile, C. [Catholic University of the Sacred Heart, Department of Neurosurgery, Rome (Italy)

    2014-04-15

    Evaluated in this study were the feasibility and the efficacy of concurrent low dose fractionated radiotherapy (LD-FRT) and chemotherapy as palliative treatment for recurrent/progressive glioblastoma multiforme (GBM). Eligible patients had recurrent or progressive GBM, Karnofsky performance status ≥70, prior surgery, and standard radiochemotherapy treatment. Recurrence/progression disease during temozolomide (TMZ) received cisplatin (CDDP; 30 mg/m{sup 2} on days 1, 8, 15), fotemustine (FTM; 40 mg/m{sup 2} on days 2, 9, 16), and concurrent LD-FRT (0.3 Gy twice daily); recurrence/progression after 4 months from the end of adjuvant TMZ were treated by TMZ (150/200 mg/m{sup 2} on days 1-5) concomitant with LD-FRT (0.4 Gy twice daily). Primary endpoints were safety and toxicity. A total of 32 patients were enrolled. Hematologic toxicity G1-2 was observed in 18.7% of patients and G3-4 in 9.4%. One patient (3.1%) had complete response, 3 (9.4%) had partial response, 8 (25%) had stable disease for at least 8 weeks, while 20 patients (62.5%) experienced progressive disease. The clinical benefit was 37.5%. Median progression-free survival (PFS) and overall survival (OS) were 5 and 8 months, respectively. Survival rate at 12 months was of 27.8%. LD-FRT and chemotherapy for recurrent/progressive GBM have a good toxicity profile and clinical outcomes, even though further investigation of this novel palliative treatment approach is warranted. (orig.)

  11. 3D quantitative assessment of response to fractionated stereotactic radiotherapy and single-session stereotactic radiosurgery of vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, T. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD (United States); University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg (Germany); Chapiro, J. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Interventional Radiology, Baltimore, MD (United States); Lin, M. [Philips Research North America, Ultrasound Imaging and Interventions (UII), Briarcliff Manor, NY (United States); Geschwind, J.F. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Interventional Radiology, Baltimore, MD (United States); Yale University School of Medicine, Department of Radiology and Imaging Science, New Haven, CT (United States); Kleinberg, L. [The Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (United States); Rigamonti, D.; Jusue-Torres, I.; Marciscano, A.E. [The Johns Hopkins University School of Medicine, Department of Neurological Surgery, Baltimore, MD (United States); Yousem, D.M. [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD (United States)

    2016-03-15

    To determine clinical outcome of patients with vestibular schwannoma (VS) after treatment with fractionated stereotactic radiotherapy (FSRT) and single-session stereotactic radiosurgery (SRS) by using 3D quantitative response assessment on MRI. This retrospective analysis included 162 patients who underwent radiation therapy for sporadic VS. Measurements on T1-weighted contrast-enhanced MRI (in 2-year post-therapy intervals: 0-2, 2-4, 4-6, 6-8, 8-10, 10-12 years) were taken for total tumour volume (TTV) and enhancing tumour volume (ETV) based on a semi-automated technique. Patients were considered non-responders (NRs) if they required subsequent microsurgical resection or developed radiological progression and tumour-related symptoms. Median follow-up was 4.1 years (range: 0.4-12.0). TTV and ETV decreased for both the FSRT and SRS groups. However, only the FSRT group achieved significant tumour shrinkage (p < 0.015 for TTV, p < 0.005 for ETV over time). The 11 NRs showed proportionally greater TTV (median TTV pre-treatment: 0.61 cm{sup 3}, 8-10 years after: 1.77 cm{sup 3}) and ETV despite radiation therapy compared to responders (median TTV pre-treatment: 1.06 cm{sup 3}; 10-12 years after: 0.81 cm{sup 3}; p = 0.001). 3D quantification of VS showed a significant decrease in TTV and ETV on FSRT-treated patients only. NR had significantly greater TTV and ETV over time. (orig.)

  12. A Feasibility Study of a Tilted Head Position in Helical Tomotherapy for Fractionated Stereotactic Radiotherapy of Intracranial Malignancies.

    Science.gov (United States)

    Chung, Yoonsun; Yoon, Hong In; Ha, Jin Sook; Kim, Seijoon; Lee, Ik Jae

    2015-08-01

    Herein, we evaluated the feasibility of placing patients in a tilted head position as part of routine clinical practice for fractionated stereotactic radiotherapy (FSRT) of intracranial tumors using helical tomotherapy (HT), by assessing its dosimetric benefit and setup accuracy. We reviewed treatment plans of four cases that were to receive FSRT for brain lesions in normal and head-tilted positions. These patients underwent two computed tomography (CT) scans: first in the normal supine position and then in the supine position with the head tilted at a 458 angle. Two separate HT plans for each position were generated in these four patients, using the same planning parameters. Plans were compared for target conformity and dose homogeneity. Maximum and average doses to critical organs, including normal brain, brain stem, optic chiasm, optic nerves, and the eyes, were considered. To evaluate setup accuracy, patient movement during treatment was assessed by post-treatment megavoltage CT scans. Both HT plans achieved similar conformal and homogeneous dose coverage to the target. Head-tilted HT delivered lower average and maximum doses to critical organs in the cases where the tumor was located on the same plane with critical organs, particularly when they were not directly attached. Placement in the head-tilted position without a mouthpiece allowed for increased patient movement during treatment, while use of a mouthpiece reduced patient movement to even less than that observed for normal setup in the supine position. This pilot study showed that placement in a tilted head position for FSRT of intracranial tumors using HT may be of clinical use, but depends on the tumor location.

  13. Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications

    Science.gov (United States)

    O'Shea, Tuathan; Bamber, Jeffrey; Fontanarosa, Davide; van der Meer, Skadi; Verhaegen, Frank; Harris, Emma

    2016-04-01

    Imaging has become an essential tool in modern radiotherapy (RT), being used to plan dose delivery prior to treatment and verify target position before and during treatment. Ultrasound (US) imaging is cost-effective in providing excellent contrast at high resolution for depicting soft tissue targets apart from those shielded by the lungs or cranium. As a result, it is increasingly used in RT setup verification for the measurement of inter-fraction motion, the subject of Part I of this review (Fontanarosa et al 2015 Phys. Med. Biol. 60 R77-114). The combination of rapid imaging and zero ionising radiation dose makes US highly suitable for estimating intra-fraction motion. The current paper (Part II of the review) covers this topic. The basic technology for US motion estimation, and its current clinical application to the prostate, is described here, along with recent developments in robust motion-estimation algorithms, and three dimensional (3D) imaging. Together, these are likely to drive an increase in the number of future clinical studies and the range of cancer sites in which US motion management is applied. Also reviewed are selections of existing and proposed novel applications of US imaging to RT. These are driven by exciting developments in structural, functional and molecular US imaging and analytical techniques such as backscatter tissue analysis, elastography, photoacoustography, contrast-specific imaging, dynamic contrast analysis, microvascular and super-resolution imaging, and targeted microbubbles. Such techniques show promise for predicting and measuring the outcome of RT, quantifying normal tissue toxicity, improving tumour definition and defining a biological target volume that describes radiation sensitive regions of the tumour. US offers easy, low cost and efficient integration of these techniques into the RT workflow. US contrast technology also has potential to be used actively to assist RT by manipulating the tumour cell environment and by

  14. Carbon sequestration in clay and silt fractions of Brazilian soils under conventional and no-tillage systems

    Directory of Open Access Journals (Sweden)

    Cecília Estima Sacramento dos Reis

    2014-08-01

    Full Text Available The capacity of soils to sequestrate carbon (C is mainly related to the formation of organo-mineral complexes. In this study, we investigated the influence of soil management systems on the C retention capacity of soil with an emphasis on the silt and clay fractions of two subtropical soils with different mineralogy and climate. Samples from a Humic Hapludox and a Rhodic Hapludox, clayey soils cultivated for approximately 30 years under no-tillage (NT and conventional tillage (CT were collected from six layers distributed within 100-cm soil depth from each site and from an adjacent native forest. After the removal of particulate organic matter (POM, the suspension (<53 µm was sonicated, the silt and clay fractions were separated in accordance with Stokes' law and the carbon content of whole soil and physical fractions was determined. In the Humic Hapludox, the clay and silt fractions under NT showed a higher maximum C retention (72 and 52 g kg-1, respectively in comparison to those under CT (54 and 38 g kg-1, respectively. Moreover, the C concentration increase in both fractions under NT occurred mainly in the topsoil (up to 5 cm. The C retention in physical fractions of Rhodic Hapludox varied from 25 to 32 g kg-1, and no difference was observed whether under an NT or a CT management system. The predominance of goethite and gibbsite in the Humic Hapludox, as well as its exposure to a colder climate, may have contributed to its greater C retention capacity. In addition to the organo-mineral interaction, a mechanism of organic matter self-assemblage, enhanced by longer periods of soil non-disturbance, seems to have contributed to the carbon stabilization in both soils.

  15. Comparison of Miniaturized and Conventional Asymmetrical Flow Field-Flow Fractionation (AF4 Channels for Nanoparticle Separations

    Directory of Open Access Journals (Sweden)

    Zengchao You

    2017-03-01

    Full Text Available The performance of a miniaturized channel for the separation of polymer and metal nanoparticles (NP using Asymmetrical Flow Field-Flow Fractionation (AF4 was investigated and compared with a conventional AF4 system. To develop standard separation methods, experimental parameters like cross flow, gradient profile and injection time were varied and optimized. Corresponding chromatographic parameters were calculated and compared. Our results indicate that the chromatographic resolution in the miniaturized channel is lower, whereas significantly shorter analyses time and less solvent consumption were obtained. Moreover, the limit of detection (LOD and limit of quantification (LOQ obtained from hyphenation with a UV-detector are obviously lower than in a conventional channel, which makes the miniaturized channel interesting for trace analysis.

  16. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: evaluation of the randomised DAHANCA 6&7 trial

    DEFF Research Database (Denmark)

    Lassen, Pernille; Eriksen, Jesper G; Krogdahl, Annelise

    2011-01-01

    demonstrated in the randomised DAHANCA 6&7 trial. We aimed to assess the influence of tumour HPV-status, expressed by p16, on the response to accelerated fractionated radiotherapy in HNSCC through evaluation of the DAHANCA 6&7 trial. MATERIALS AND METHODS: Immunohistochemical detection of HPV-associated p16......-expression was performed on FFPE-pre-treatment tumour-tissues from 794 patients enrolled in the DAHANCA 6&7 trial. The influence of tumour p16-status on loco-regional tumour control and survival as a function of fractionation schedule (5Fx/week vs 6Fx/week) was evaluated 5years after the completion...... of radiotherapy. RESULTS: The significant and independent prognostic value of tumour p16-positivity in HNSCC radiotherapy was confirmed, with adjusted hazard ratios (HR) of 0.58 [0.43-0.78], 0.47 [0.33-0.67] and 0.54 [0.42-0.68] for loco-regional control, disease-specific and overall survival, respectively...

  17. The influence of HPV-associated p16-expression on accelerated fractionated radiotherapy in head and neck cancer: Evaluation of the randomised DAHANCA 6&7 trial

    DEFF Research Database (Denmark)

    Lassen, Pernille; Eriksen, Jesper Grau; Krogdahl, Annelise

    2011-01-01

    demonstrated in the randomised DAHANCA 6&7 trial. We aimed to assess the influence of tumour HPV-status, expressed by p16, on the response to accelerated fractionated radiotherapy in HNSCC through evaluation of the DAHANCA 6&7 trial. MATERIALS AND METHODS: Immunohistochemical detection of HPV-associated p16......-expression was performed on FFPE-pre-treatment tumour-tissues from 794 patients enrolled in the DAHANCA 6&7 trial. The influence of tumour p16-status on loco-regional tumour control and survival as a function of fractionation schedule (5Fx/week vs 6Fx/week) was evaluated 5years after the completion...... of radiotherapy. RESULTS: The significant and independent prognostic value of tumour p16-positivity in HNSCC radiotherapy was confirmed, with adjusted hazard ratios (HR) of 0.58 [0.43-0.78], 0.47 [0.33-0.67] and 0.54 [0.42-0.68] for loco-regional control, disease-specific and overall survival, respectively...

  18. Biodosimetry Based on γ-H2AX Quantification and Cytogenetics after Partial- and Total-Body Irradiation during Fractionated Radiotherapy.

    Science.gov (United States)

    Zahnreich, Sebastian; Ebersberger, Anne; Kaina, Bernd; Schmidberger, Heinz

    2015-04-01

    The aim of this current study was to quantitatively describe radiation-induced DNA damage and its distribution in leukocytes of cancer patients after fractionated partial- or total-body radiotherapy. Specifically, the impact of exposed anatomic region and administered dose was investigated in breast and prostate cancer patients receiving partial-body radiotherapy. DNA double-strand breaks (DSBs) were quantified by γ-H2AX immunostaining. The frequency of unstable chromosomal aberrations in stimulated lymphocytes was also determined and compared with the frequency of DNA DSBs in the same samples. The frequency of radiation-induced DNA damage was converted into dose, using ex vivo generated calibration curves, and was then compared with the administered physical dose. This study showed that 0.5 h after partial-body radiotherapy the quantity of radiation-induced γ-H2AX foci increased linearly with the administered equivalent whole-body dose for both tumor entities. Foci frequencies dropped 1 day thereafter but proportionality to the equivalent whole-body dose was maintained. Conversely, the frequency of radiation-induced cytogenetic damage increased from 0.5 h to 1 day after the first partial-body exposure with a linear dependence on the administered equivalent whole-body dose, for prostate cancer patients only. Only γ-H2AX foci assessment immediately after partial-body radiotherapy was a reliable measure of the expected equivalent whole-body dose. Local tumor doses could be approximated with both assays after one day. After total-body radiotherapy satisfactory dose estimates were achieved with both assays up to 8 h after exposure. In conclusion, the quantification of radiation-induced γ-H2AX foci, but not cytogenetic damage in peripheral leukocytes was a sensitive and rapid biodosimeter after acute heterogeneous irradiation of partial body volumes that was able to primarily assess the absorbed equivalent whole-body dose.

  19. Conventional and alternative principles for stabilization of protein and polyphenol fractions in beer

    Directory of Open Access Journals (Sweden)

    Marković Romeo S.

    2003-01-01

    Full Text Available Beer haze is primarily formed through complexation of protein and polyphenolic beer ingredients. The problem of reducing susceptibility of beer haze formation can be done either by lowering protein and/or polyphenol levels, or by minimizing the molecular size of protein/polyphenols. In experimental part of this work the shelf life of unstabilized beer is being compared with beer stabilized with various standard products, such as PVPP and silica gel. Furthermore, the trials have been made to prove the functionality of a new product consisting of carrageenan and cross-linked PVPP. The method used to determine shelf life was haze forcing test (0/60°C. Extract, alcohol, bitterness, foam, haze, color and pH were also monitored. The test results showed expectedly that combined treatment of beer ensures the highest level of product stability. Through selective stripping of polyphenols and protein fractions it is possible to improve shelf life of beer to a significant extent.

  20. Clinical application of 3-D conformal radiotherapy for carcinoma of the ethmoid sinus: 1. Comparative analysis between conventional 2-D and 3-D conformal plans

    Energy Technology Data Exchange (ETDEWEB)

    Lee, S. W.; Kim, G. E.; Keum, K. C.; Park, H. C.; Cho, J. H.; Han, S. U.; Lee, K. K.; Suh, C. O.; Hong, W. P.; Park, I. Y. [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine

    1997-12-01

    This is study of whether 3-D conformal radiotherapy for carcinomas of the ethmoid sinus were better than those treated with conventional 2-D plan. The 3-D conformal treatment plans were compared with conventional 2-D plans in 4 patients with malignancy of the ethmoid sinus. Isodose distribution , dose statistics, and dose volume histogram of the planning target volume were used to evaluate differences between 2-D and 3-D plans. In addition, the risk of radiation exposure of surrounding normal critical organs are evaluated by means of point dose calculation and dose volume histogram. 3-D conformal treatment plans for each patient that the better tumor coverages by the planning target volume with improved dose homogeneity, compared to 2-D conventional treatment plans in the same patient. On the other hand, the radiation dose distributions to the surrounding normal tissue organs, such as the orbit and optic nerves are not significantly reduced with our technique, but a substantial sparing in the brain stem and optic chiasm for each patient. Our findings represented the potential advantage of 3-D treatment planning for dose homogeneity as well as sparing of the normal tissue surrounding the tumor. However, further investigational studies are required to define the clinical benefit. (author).

  1. Radiobiological modeling analysis of the optimal fraction scheme in patients with peripheral non-small cell lung cancer undergoing stereotactic body radiotherapy

    OpenAIRE

    Bao-Tian Huang; Jia-Yang Lu; Pei-Xian Lin; Jian-Zhou Chen; De-Rui Li; Chuang-Zhen Chen

    2015-01-01

    This study aimed to determine the optimal fraction scheme (FS) in patients with small peripheral non-small cell lung cancer (NSCLC) undergoing stereotactic body radiotherapy (SBRT) with the 4 × 12 Gy scheme as the reference. CT simulation data for sixteen patients diagnosed with primary NSCLC or metastatic tumor with a single peripheral lesion ≤3 cm were used in this study. Volumetric modulated arc therapy (VMAT) plans were designed based on ten different FS of 1 × 25 Gy, 1 × 30 Gy, 1 × 34 Gy...

  2. Growth Laws in Cancer: Implications for Radiotherapy

    CERN Document Server

    Castorina, P; Gabriele, P; Guiot, C

    2006-01-01

    Comparing both, the more conventional Gompertz tumor growth law (GL) and the ``Universal'' law (UL), recently proposed and applied to cancer,we have investigated the growth law's implications on various radiotherapy regimen. According to GL, the surviving tumor cell fraction could be reduced 'ad libidum', independently of the initial tumor mass,simply by increasing the number of treatments. On the contrary, if tumor growth dynamics would indeed follow the Universal scaling law, there is a lower limit of the survival fraction that cannot be reduced any 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 as it implies that radiotherapy may be successful provided the tumor mass at treatment onset is rather small. Taken together with our previous works, implications of these findings include revisiting standard radiotherapy regimen and overall treatment protocols.

  3. Comparison of the immunosuppressive effect of fractionated total lymphoid irradiation (TLI) vs conventional immunosuppression (CI) in renal cadaveric allotransplantation

    Energy Technology Data Exchange (ETDEWEB)

    Waer, M.; Vanrenterghem, Y.; Ang, K.K.; van der Schueren, E.; Michielsen, P.; Vandeputte, M.

    1984-02-01

    Beginning in November 1981, eight patients with end stage diabetic nephropathy underwent renal cadaveric transplantation after TLI. Transplantation was done between 2 to 11 days after the end of a fractionated TLI to a total dose of 20 to 30 Gy. During the same observation period, 60 nondiabetic patients with end stage renal disease of different origin also received a cadaveric kidney graft, with a conventional regimen of immunosuppression that consists of anti-lymphocyte-globulin, tapering high doses of prednisone, and azathioprine. Phytohemagglutinin (PHA)-, concanavalin A (con A)-, and pokeweed mitogen (PWM)-induced blastogenesis, as well as the mixed lymphocyte reaction (MLR) and the cell-mediated lympholysis (CML) decreased progressively during the first months after conventional immunosuppression to 50% of the pretransplantation level, and remained there for the first year after transplantation. These tests were much more impaired after TLI and again no recovery occurred during the first year. In the clinic, the more profound immunosuppression in TLI patients was more frequently associated with viral infections (cytomegalovirus and herpes zoster). The incidence of rejections, however, was somewhat less frequent in the TLI-treated group and occurred significantly later. After TLI, the mean cumulative dose of steroids needed for kidney transplantation during the first year after transplantation could be substantially reduced.

  4. 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)

    1997-12-31

    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.).

  5. Comparison of clinical outcomes and toxicity in endometrial cancer patients treated with adjuvant intensity-modulated radiation therapy or conventional radiotherapy.

    Science.gov (United States)

    Chen, Chien-Chih; Wang, Lily; Lu, Chien-Hsing; Lin, Jin-Ching; Jan, Jian-Sheng

    2014-12-01

    To evaluate the treatment outcomes and toxicity in endometrial cancer patients treated with hysterectomy and adjuvant intensity-modulated radiation therapy (IMRT) or conventional radiotherapy (CRT). There were 101 patients with stage IA-IIIC2 endometrial carcinoma treated with hysterectomy and adjuvant radiotherapy. In total, 36 patients received adjuvant CRT and 65 were treated with adjuvant IMRT. The endpoints were overall survival, local failure-free survival, and disease-free survival. Patients were assessed for acute toxicity weekly according to the Common Terminology Criteria for Adverse Events version 3.0. Late toxicity was evaluated according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. The 5-year overall survival, local failure-free survival, and disease-free survival for the CRT group and the IMRT group were 82.9% versus 93.5% (p = 0.26), 93.7% versus 89.3% (p = 0.68), and 88.0% versus 82.8% (p = 0.83), respectively. Four (11.1%) patients had Grade 3 or greater acute gastrointestinal (GI) toxicity and three (8.3%) patients had Grade 3 or greater acute genitourinary (GU) toxicity in the CRT group, whereas four (6.2%) patients had Grade 3 or greater acute GI toxicity in the IMRT group and no patient had severe GU toxicity. There was one (2.8%) patient who had Grade 3 or greater late GI toxicity and one (2.8%) patient had Grade 3 or greater late GU toxicity in the CRT group, whereas no patient had severe GI or GU toxicity in the IMRT group. Adjuvant IMRT for endometrial cancer patients had comparable clinical outcomes with CRT and had less acute and late toxicity. Copyright © 2013. Published by Elsevier B.V.

  6. Radiotherapy. Non-standard feactionated regimens improving cancer treatment. Part II. Response of normal tissues to fractioned irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Villar, A.; Hernandez, M.; Pera, J.; Cambray, M.; Villa, S.; Arnaiz, M.D.

    1988-01-01

    The phenomena participating in the response of tissues to fractionated irradiation are analized with special emphasis on the most relevant points influencing the design of non-standard fractionated regimens.

  7. Whole Brain Irradiation and Hypo-fractionation Radiotherapy for the Metastases in Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Xingting GU

    2016-04-01

    Full Text Available Up to 40% non-small cell lung cancer patients developed brain metastasis during progression. Multiple brain metastases are common in non-small cell lung cancer. The prognosis of brain metastasis is poor with median survival of less than 1 year. Radio therapy for brain metastases has gradually developed from whole brain radiotherapy (WBRT to various radiation strategies. WBRT, surgery+WBRT, stereotactic radiotherapy+WBRT or WBRT with simultaneous integrated boost (SIB, etc. have better overall survival than those untreated patients. The damage of the cognitive function from WBRT has been realized recently, however, options of radiation strategies for long expected survival patients remain controversial. This paper will discuss different WBRT strategies and treatment side effects of non-small cell lung cancer with brain metastases.

  8. IsoBED: a tool for automatic calculation of biologically equivalent fractionation schedules in radiotherapy using IMRT with a simultaneous integrated boost (SIB technique

    Directory of Open Access Journals (Sweden)

    Benassi Marcello

    2011-05-01

    Full Text Available Abstract Background An advantage of the Intensity Modulated Radiotherapy (IMRT technique is the feasibility to deliver different therapeutic dose levels to PTVs in a single treatment session using the Simultaneous Integrated Boost (SIB technique. The paper aims to describe an automated tool to calculate the dose to be delivered with the SIB-IMRT technique in different anatomical regions that have the same Biological Equivalent Dose (BED, i.e. IsoBED, compared to the standard fractionation. Methods Based on the Linear Quadratic Model (LQM, we developed software that allows treatment schedules, biologically equivalent to standard fractionations, to be calculated. The main radiobiological parameters from literature are included in a database inside the software, which can be updated according to the clinical experience of each Institute. In particular, the BED to each target volume will be computed based on the alpha/beta ratio, total dose and the dose per fraction (generally 2 Gy for a standard fractionation. Then, after selecting the reference target, i.e. the PTV that controls the fractionation, a new total dose and dose per fraction providing the same isoBED will be calculated for each target volume. Results The IsoBED Software developed allows: 1 the calculation of new IsoBED treatment schedules derived from standard prescriptions and based on LQM, 2 the conversion of the dose-volume histograms (DVHs for each Target and OAR to a nominal standard dose at 2Gy per fraction in order to be shown together with the DV-constraints from literature, based on the LQM and radiobiological parameters, and 3 the calculation of Tumor Control Probability (TCP and Normal Tissue Complication Probability (NTCP curve versus the prescribed dose to the reference target.

  9. Dosimetric benefit of DMLC tracking for conventional and sub-volume boosted prostate intensity-modulated arc radiotherapy

    DEFF Research Database (Denmark)

    Pommer, Tobias; Falk, Marianne; Poulsen, Per Rugaard

    2013-01-01

    during the first 75 s. A research DMLC tracking system was used for real-time motion compensation with optical monitoring for position input. The gamma index was used for evaluation, with measurements with a static phantom or the planned dose as reference, using 2% and 2 mm gamma criteria. The average......This study investigated the dosimetric impact of uncompensated motion and motion compensation with dynamic multileaf collimator (DMLC) tracking for prostate intensity modulated arc therapy. Two treatment approaches were investigated; a conventional approach with a uniform radiation dose...... done with and without DMLC tracking on a linear acceleration with a high-resolution MLC. A cylindrical phantom containing two orthogonal diode arrays was used for dosimetry. A motion platform reproduced six patient-derived prostate motion traces, with the average displacement ranging from 1.0 to 8.9 mm...

  10. Effect of image-guided hypofractionated stereotactic radiotherapy on peripheral non-small-cell lung cancer

    Science.gov (United States)

    Wang, Shu-wen; Ren, Juan; Yan, Yan-li; Xue, Chao-fan; Tan, Li; Ma, Xiao-wei

    2016-01-01

    The objective of this study was to compare the effects of image-guided hypofractionated radiotherapy and conventional fractionated radiotherapy on non-small-cell lung cancer (NSCLC). Fifty stage- and age-matched cases with NSCLC were randomly divided into two groups (A and B). There were 23 cases in group A and 27 cases in group B. Image-guided radiotherapy (IGRT) and stereotactic radiotherapy were conjugately applied to the patients in group A. Group A patients underwent hypofractionated radiotherapy (6–8 Gy/time) three times per week, with a total dose of 64–66 Gy; group B received conventional fractionated radiotherapy, with a total dose of 68–70 Gy five times per week. In group A, 1-year and 2-year local failure survival rate and 1-year local failure-free survival rate were significantly higher than in group B (P0.05) were lower in group A than in group B. The overall survival rate of group A was significantly higher than that of group B (P=0.03), and the survival rate at 1 year was 87% vs 63%, (P0.05). Compared with conventional fractionated radiation therapy, image-guided hypofractionated stereotactic radiotherapy in NSCLC received better treatment efficacy and showed good tolerability. PMID:27574441

  11. Dosimetric benefit of DMLC tracking for conventional and sub-volume boosted prostate intensity-modulated arc radiotherapy

    Science.gov (United States)

    Pommer, Tobias; Falk, Marianne; Poulsen, Per R.; Keall, Paul J.; O’Brien, Ricky T.; Petersen, Peter Meidahl; Rosenschöld, Per Munck af

    2013-01-01

    This study investigated the dosimetric impact of uncompensated motion and motion compensation with dynamic multileaf collimator (DMLC) tracking for prostate intensity modulated arc therapy. Two treatment approaches were investigated; a conventional approach with a uniform radiation dose to the target volume and an intraprostatic lesion (IPL) boosted approach with an increased dose to a subvolume of the prostate. The impact on plan quality of optimizations with a leaf position constraint, which limited the distance between neighbouring adjacent MLC leaves, was also investigated. Deliveries were done with and without DMLC tracking on a linear acceleration with a high-resolution MLC. A cylindrical phantom containing two orthogonal diode arrays was used for dosimetry. A motion platform reproduced six patient-derived prostate motion traces, with the average displacement ranging from 1.0 to 8.9 mm during the first 75 seconds. A research DMLC tracking system was used for real-time motion compensation with optical monitoring for position input. The gamma index was used for evaluation, with measurements with a static phantom or the planned dose as reference, using 2% and 2 mm gamma criteria. The average pass rate with DMLC tracking was 99.9% (range 98.7–100%, measurement as reference), whereas the pass rate for untracked deliveries decreased distinctly as the average displacement increased, with an average pass rate of 61.3% (range 32.7–99.3%). Dose-volume histograms showed that DMLC tracking maintained the planned dose distributions in the presence of motion whereas traces with > 3 mm average displacement caused clear plan degradation for untracked deliveries. The dose to the rectum and bladder had an evident dependence on the motion direction and amplitude for untracked deliveries, and the dose to the rectum was slightly increased for IPL boosted plans compared to conventional plans for anterior motion with large amplitude. In conclusion, optimization using a leaf

  12. Quantitative effect of combined chemotherapy and fractionated radiotherapy on the incidence of radiation-induced lung damage: A prospective clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Mah, K.; Van Dyk, J.; Braban, L.E.; Hao, Y.; Keane, T.J. (Univ. of Toronto, Ontario (Canada)); Poon, P.Y. (Univ. of British Columbia (Canada))

    1994-02-01

    The objective of this work was to assess the incidence of radiological changes compatible with radiation-induced lung damage as determined by computed tomography (CT), and subsequently calculate the dose effect factors (DEF) for specified chemotherapeutic regimens. Radiation treatments were administered once daily, 5 days-per-week. Six clinical protocols were evaluated: ABVD (adriamycin, bleomycin, vincristine, and DTIC) followed by 35 Gy in 20 fractions; MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) followed by 35 Gy in 20; MOPP/ABVD followed by 35 Gy in 20; CAV (cyclophosphamide, adriamycin, and vincristine) followed by 25 Gy in 10; and 5-FU (5-fluorouracil) concurrent with either 50-52 Gy in 20-21 or 30-36 Gy in 10-15 fractions. CT examinations were taken before and at predetermined intervals following radiotherapy. CT evidence for the development of radiation-induced damage was defined as an increase in lung density within the irradiated volume. The radiation dose to lung was calculated using a CT-based algorithm to account for tissue inhomogeneities. Different fractionation schedules were converted using two isoeffect models, the estimated single dose (ED) and the normalized total dose (NTD). The actuarial incidence of radiological pneumonitis was 71% for the ABVD, 49% for MOPP, 52% for MOPP/ABVD, 67% for CAV, 73% for 5-FU radical, and 58% for 5-FU palliative protocols. Depending on the isoeffect model selected and the method of analysis, the DEF was 1.11-1.14 for the ABVD, 0.96-0.97 for the MOPP, 0.96-1.02 for the MOPP/ABVD, 1.03-1.10 for the CAV, 0.74-0.79 for the 5-FU radical, and 0.94 for the 5-FU palliative protocols. DEF were measured by comparing the incidence of CT-observed lung damage in patients receiving chemotherapy and radiotherapy to those receiving radiotherapy alone. The addition of ABVD or CAV appeared to reduce the tolerance of lung to radiation. 40 refs., 3 figs., 3 tabs.

  13. A Dosimetric Comparison between Conventional Fractionated and Hypofractionated Image-guided Radiation Therapies for Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Ming Li

    2016-01-01

    Conclusions: To deliver the hypofractionated radiotherapy in prostate cancer, VMAT significantly increased PTV D95% dose and decreased the dose of radiation delivered to adjacent normal tissues comparing to 7-field, step-and-shoot IMRT. Daily online image-guidance and better management of bladder and rectum could make a more precise treatment delivery.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-12-15

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

  15. The Treatment of Pelvic Locoregional Recurrence of Cervical Cancer After Radical Surgery With Intensity-Modulated Radiation Therapy Compared With Conventional Radiotherapy: A Retrospective Study.

    Science.gov (United States)

    Yin, Yue-ju; Li, Hui-qin; Sheng, Xiu-gui; Du, Xue-lian; Wang, Cong; Lu, Chun-hua; Pan, Chun-xia

    2015-07-01

    The aim of this study was to investigate the therapeutic response and toxicity of intensity-modulated radiation therapy (IMRT) or conventional radiotherapy (c-RT) as adjuvant therapy in patients with pelvic locoregional recurrence of cervical cancer after radical surgery. This retrospective study included 161 patients with unresectable pelvic locoregional recurrence of cervical cancer after radical surgery between March 2003 and May 2012. All patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IB-IIA cervical cancer and received radical hysterectomy and pelvic lymphadenectomy. A total of 82 patients were treated with c-RT, whereas the remaining 79 patients underwent IMRT. Intracavitary brachytherapy and concurrent chemotherapy were performed during external irradiation. The mean dose delivered to the planning target volume was significantly higher in the IMRT group than in the c-RT group (61.8 vs 50.3 Gy, P = 0.029). Intensity-modulated radiation therapy plans yielded better dose sparing of small bowel, bladder, and rectum than did c-RT (P cervical cancer after radical surgery. The acute and chronic toxicities were acceptable, and the adjacent organs at risk were well protected.

  16. Radiation-induced rib fracture after stereotactic body radiotherapy with a total dose of 54-56 Gy given in 9-7 fractions for patients with peripheral lung tumor: impact of maximum dose and fraction size.

    Science.gov (United States)

    Aoki, Masahiko; Sato, Mariko; Hirose, Katsumi; Akimoto, Hiroyoshi; Kawaguchi, Hideo; Hatayama, Yoshiomi; Ono, Shuichi; Takai, Yoshihiro

    2015-04-22

    Radiation-induced rib fracture after stereotactic body radiotherapy (SBRT) for lung cancer has been recently reported. However, incidence of radiation-induced rib fracture after SBRT using moderate fraction sizes with a long-term follow-up time are not clarified. We examined incidence and risk factors of radiation-induced rib fracture after SBRT using moderate fraction sizes for the patients with peripherally located lung tumor. During 2003-2008, 41 patients with 42 lung tumors were treated with SBRT to 54-56 Gy in 9-7 fractions. The endpoint in the study was radiation-induced rib fracture detected by CT scan after the treatment. All ribs where the irradiated doses were more than 80% of prescribed dose were selected and contoured to build the dose-volume histograms (DVHs). Comparisons of the several factors obtained from the DVHs and the probabilities of rib fracture calculated by Kaplan-Meier method were performed in the study. Median follow-up time was 68 months. Among 75 contoured ribs, 23 rib fractures were observed in 34% of the patients during 16-48 months after SBRT, however, no patients complained of chest wall pain. The 4-year probabilities of rib fracture for maximum dose of ribs (Dmax) more than and less than 54 Gy were 47.7% and 12.9% (p = 0.0184), and for fraction size of 6, 7 and 8 Gy were 19.5%, 31.2% and 55.7% (p = 0.0458), respectively. Other factors, such as D2cc, mean dose of ribs, V10-55, age, sex, and planning target volume were not significantly different. The doses and fractionations used in this study resulted in no clinically significant rib fractures for this population, but that higher Dmax and dose per fraction treatments resulted in an increase in asymptomatic grade 1 rib fractures.

  17. SU-E-T-483: In Vivo Dosimetry of Conventional and Rotational Intensity Modulated Radiotherapy Using Integral Quality Monitor (IQM)

    Energy Technology Data Exchange (ETDEWEB)

    Lin, L; Qian, J; Gonzales, R; Keck, J; Armour, E; Wong, J [Johns Hopkins University, Baltimore, MD (United States)

    2015-06-15

    Purpose: To investigate the accuracy, sensitivity and constancy of integral quality monitor (IQM), a new system for in vivo dosimetry of conventional intensity modulated radiation therapy (IMRT) or rotational volumetric modulated arc therapy (VMAT) Methods: A beta-version IQM system was commissioned on an Elekta Infinity LINAC equipped with 160-MLCs Agility head. The stationary and rotational dosimetric constancy of IQM was evaluated, using five-field IMRT and single-or double-arc VMAT plans for prostate and head-and-neck (H&N) patients. The plans were delivered three times over three days to assess the constancy of IQM response. Picket fence (PF) fields were used to evaluate the sensitivity of detecting MLC leaf errors. A single leaf offset was intentionally introduced during delivery of various PF fields with segment apertures of 3×1, 5×1, 10×1, and 24×1cm2. Both 2mm and 5mm decrease in the field width were used. Results: Repeated IQM measurements of prostate and H&N IMRT deliveries showed 0.4 and 0.5% average standard deviation (SD) for segment-by-segment comparison and 0.1 and 0.2% for cumulative comparison. The corresponding SDs for VMAT deliveries were 6.5, 9.4% and 0.7, 1.3%, respectively. Statistical analysis indicates that the dosimetric differences detected by IQM were significant (p < 0.05) in all PF test deliveries. The largest average IQM signal response of a 2 mm leaf error was found to be 2.1% and 5.1% by a 5mm leaf error for 3×1 cm2 field size. The same error in 24×1 cm2 generates a 0.7% and 1.4% difference in the signal. Conclusion: IQM provides an effective means for real-time dosimetric verification of IMRT/ VMAT treatment delivery. For VMAT delivery, the cumulative dosimetry of IQM needs to be used in clinical practice.

  18. The DAHANCA 6 randomized trial: Effect of 6 vs 5 weekly fractions of radiotherapy in patients with glottic squamous cell carcinoma

    DEFF Research Database (Denmark)

    Lyhne, Nina M; Primdahl, Hanne; Kristensen, Claus A;

    2015-01-01

    explored. PATIENTS AND METHODS: Six hundred and ninety-four patients with non-metastatic glottic SCC were randomized between six or five weekly fractions (fx/w) of radiotherapy to the same total dose. The median treatment time was 38 and 46days, respectively. The primary endpoint was loco-regional failure....... RESULTS: Median follow-up time was 14.5years. Of the 177 failures, 167 involved T-site. The cumulative incidence of loco-regional failure (LRF) was 21.6% in the 6fx/w group and 29.3% in the 5fx/w group and the corresponding hazard rate (HR) of LRF was 0.72 (CI: 0.53-0.97, p=0.04). The effect...... significantly improved loco-regional control in patients with glottic SCC....

  19. Fractionated Radiotherapy with 3 x 8 Gy Induces Systemic Anti-Tumour Responses and Abscopal Tumour Inhibition without Modulating the Humoral Anti-Tumour Response.

    Directory of Open Access Journals (Sweden)

    Thomas H P M Habets

    Full Text Available Accumulating evidence indicates that fractionated radiotherapy (RT can result in distant non-irradiated (abscopal tumour regression. Although preclinical studies indicate the importance of T cells in this infrequent phenomenon, these studies do not preclude that other immune mechanisms exhibit an addition role in the abscopal effect. We therefore addressed the question whether in addition to T cell mediated responses also humoral anti-tumour responses are modulated after fractionated RT and whether systemic dendritic cell (DC stimulation can enhance tumour-specific antibody production. We selected the 67NR mammary carcinoma model since this tumour showed spontaneous antibody production in all tumour-bearing mice. Fractionated RT to the primary tumour was associated with a survival benefit and a delayed growth of a non-irradiated (contralateral secondary tumour. Notably, fractionated RT did not affect anti-tumour antibody titers and the composition of the immunoglobulin (Ig isotypes. Likewise, we demonstrated that treatment of tumour-bearing Balb/C mice with DC stimulating growth factor Flt3-L did neither modulate the magnitude nor the composition of the humoral immune response. Finally, we evaluated the immune infiltrate and Ig isotype content of the tumour tissue using flow cytometry and found no differences between treatment groups that were indicative for local antibody production. In conclusion, we demonstrate that the 67NR mammary carcinoma in Balb/C mice is associated with a pre-existing antibody response. And, we show that in tumour-bearing Balb/C mice with abscopal tumour regression such pre-existing antibody responses are not altered upon fractionated RT and/or DC stimulation with Flt3-L. Our research indicates that evaluating the humoral immune response in the setting of abscopal tumour regression is not invariably associated with therapeutic effects.

  20. SU-F-P-14: Oxygen Inhalation Should Be the Conventional Approach in the Treatment of Thoracic and Abdominal Cancer by Radiotherapy with Active Breathing Control (ABC)

    Energy Technology Data Exchange (ETDEWEB)

    Gong, G; Guo, Y; Yin, Y [Shandong Cancer Hospital and Institute, Jinan, Shandong (China)

    2016-06-15

    Purpose: To investigate the feasibility and potential benefit of oxygen inhalation (OI) during radiotherapy applying an active breathing control (ABC) device, by analyzing the blood oxygen saturation (SpO2) and the instantaneous heart rate (IHR) variation in breath holding with OI and oxygen non-inhalation (ONI). Methods: The 27 healthy volunteers (16 males, 11 females) who were involved in this trial were all required to hold their breath for 10 times, non-inhaling and inhaling oxygen successively. The breath-holding time (BHT), rest time (RT), SpO2 and IHR under different oxygen status were recorded and compared. Results: The volunteers were divided into two groups according to SpO2 variations in breath-holding: group A (12 cases), with less than2% decline of SpO2; group B (15 cases), with a decline that surpassed 2%, and which could reach 3–6%. The BHT of group A, without inhaling oxygen, was significantly longer than that of group B (mean 33.77s Vs 30.51s, p<0.05); and was extended by 26.6% and 27.85%, after inhaling oxygen, in groups A and B, respectively. The SpO2 decreased in all volunteers during RT with ONI, to an extent that could reach up to 6%. The IHR of all volunteers showed the fast-slow-fast variation rule, and the oxygen had little effect. More than 70% of the volunteers stated that oxygen made them feel more comfortable and were more cooperative when ABC was used. Conclusion: The SpO2 declines during breath holding and RT could not be ignored while applying ABC, oxygen inhalation should become a conventional method with lengthening BHT and shortening RT, which yielded the benefit of improving the stability and reproducibility.

  1. Accelerated partial-breast irradiation vs conventional whole-breast radiotherapy in early breast cancer: A case-control study of disease control, cosmesis, and complications

    Directory of Open Access Journals (Sweden)

    Wadasadawala Tabassum

    2009-01-01

    Full Text Available Context: Accelerated partial-breast irradiation (APBI using various approaches is being increasingly employed for selected women with early breast cancer (EBC. Aims: To conduct a case-control study comparing disease control, cosmesis, and complications in patients with EBC undergoing APBI using multicatheter interstitial brachytherapy vs those receiving conventional whole breast radiotherapy (WBRT. Settings and Design: Women with EBC fulfilling the American Brachytherapy Society (ABS criteria were selected as ′cases′ if treated with APBI or as ′controls′ if offered WBRT during the period from May 2000 to December 2004. Materials and Methods: APBI patients were treated with high-dose-rate brachytherapy (HDR to a dose of 34 Gy/10#/6-8 days. WBRT was delivered to the whole breast to a dose of 45 Gy/25# followed by tumor bed boost, either with electrons (15 Gy/6# or interstitial brachytherapy (HDR 10 Gy/1#. Results: At the median follow-up of 43.05 months in APBI and 51.08 months in WBRT there was no difference in overall survival (OS, disease-free survival (DFS, late arm edema, and symptomatic fat necrosis between the two groups. However, APBI resulted in increase in mild breast fibrosis at the tumor bed. Telangiectasias were observed in three patients of the APBI group. The cosmetic outcome was significantly better in the APBI group as compared to the WBRT group (P = 0.003. Conclusions: This study revealed equivalent locoregional and distant disease control in the two groups. APBI offered better overall cosmetic outcome, though at the cost of a slight increase in mild breast fibrosis and telangiectasias.

  2. Early Treatment Response Monitoring Using 2-Deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography Imaging during Fractionated Radiotherapy of Head Neck Cancer Xenografts

    Directory of Open Access Journals (Sweden)

    Jiayi Huang

    2014-01-01

    Full Text Available Background. To determine the optimal timing and analytic method of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (PET imaging during fractionated radiotherapy (RT to predict tumor control. Methods. Ten head neck squamous cell carcinoma xenografts derived from the UT-14-SCC cell line were irradiated with 50 Gy at 2 Gy per day over 5 weeks. Dynamic PET scans were acquired over 70 minutes at baseline (week 0 and weekly for seven weeks. PET data were analyzed using standard uptake value (SUV, retention index (RI, sensitivity factor (SF, and kinetic index (Ki. Results. Four xenografts had local failure (LF and 6 had local control. Eighty scans from week 0 to week 7 were analyzed. RI and SF after 10 Gy appeared to be the optimal predictors for LF. In contrast, SUV and Ki during RT were not significant predictors for LF. Conclusion. RI and SF of PET obtained after the first week of fractionated RT were the optimal methods and timing to predict tumor control.

  3. Minimal Inter-Fractional Fiducial Migration during Image-Guided Lung Stereotactic Body Radiotherapy Using SuperLock Nitinol Coil Fiducial Markers.

    Directory of Open Access Journals (Sweden)

    Yi Rong

    Full Text Available Stereotactic body radiotherapy (SBRT is being increasingly used for the treatment of patients with lung cancer or lung metastasis who are medically unfit to undergo resection. In order to improve accuracy and confidence in targeting tumors, many centers rely on fiducial implantation. We evaluated the migration of a novel fiducial marker specifically designed for lung tissue implanted via electromagnetic navigation bronchoscopy (ENB.We retrospectively quantified the individual and group migrations of SuperLock nitinol coil fiducials for 15 patients receiving lung stereotactic body radiotherapy (SBRT, in order to evaluate the reliability of using these fiducials as a target surrogate for cases where tumors cannot be clearly delineated on cone beam CTs (CBCTs. For each fraction, we compared the individual and group migrations of the fiducials between the planning CT and the acquired CBCT. The group migration was defined as the distance between the centroids of the fiducial group and GTV.A total of 16 lung targets were included in our study for these 15 patients (one patient with two targets. Of 55 fiducials placed, we observed a 100% retention rate. The mean individual migration was 1.87 mm (range, 0.63-5.25 mm with a standard deviation of 1.26 mm. The mean group migration was 1.94 mm (range, 0.03-6.19 mm with a standard deviation of 1.45 mm. Overall, there was minimal change in the relative locations of the markers with respect to each other, as well as to the target.We found that the SuperLock nitinol coil fiducial marker positions are stable throughout the radiation treatment, and can be used as a reliable surrogate to target, and to avoid geometric misses during gated treatments.

  4. Comparison between conventional and three-dimensional conformal treatment planning for radiotherapy of cerebral tumors; Comparaison entre dosimetries classique et conformationnelle dans l'irradiation de tumeurs cerebrales

    Energy Technology Data Exchange (ETDEWEB)

    Caudrelier, J.M.; Auliard, A.; Sarrazin, T.; Gibon, D.; Coche-Dequeant, B.; Castelain, B. [Centre de Lutte Contre le Cancer Oscar-Lambret, 59 - Lille (France)

    2001-06-01

    Comparison between conventional and three-dimensional conformal treatment planning for radiotherapy of cerebral tumors. Purpose. - We prospectively compared a conventional treatment planning (PT2D) and 3-dimensional conformal treatment planning (PT3D) for radiotherapy of cerebral tumours. Patients and methods.- Patients treated between 1/10/98 and 1/4/99 by irradiation for cerebral tumours were analysed. For each case, we planned PT2D using conventional orthogonal x-ray films, and afterward, PT3D using CT scan. Gross tumor volume, planning target volume and normal tissue volumes were defined. Dose was prescribed according to report 50 of the International Commission on Radiation Units and Measurements (ICRU). We compared surfaces of sagittal view targets defined on PT2D and PT3D and called them S2D and S3D, respectively. Irradiated volumes by 90% isodoses (VE-90%) and normal tissue volumes irradiated by 20, 50, 90% isodoses were calculated and compared using Student's paired t-test. Results. -There was a concordance of 84% of target surfaces defined on PT2D and PT3D. Percentages of target surface under- or-over defined by PT2D were 16 and 13% respectively. VE-90% was decreased by 15% (p = 0.07) with PT3D. Normal brain volume irradiated by 90% isodose was decreased by 27% with PT3D (p = 0.04). Conclusion.- For radiotherapy of cerebral tumors using only coplanar beams, PT3D leads to a reduction of normal brain tissue irradiated. We recommend PT3D for radiotherapy of cerebral tumors, particularly for low-grade or benign tumors (meningiomas, neuromas, etc.). (authors)

  5. Later Outcomes and Alpha/Beta Estimate From Hypofractionated Conformal Three-Dimensional Radiotherapy Versus Standard Fractionation for Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Leborgne, Felix [Department of Radiation Oncology, Hospital Italiano, Montevideo (Uruguay); Fowler, Jack, E-mail: jackfowlersbox@gmail.com [Department of Human Oncology, University of Wisconsin Medical School, Madison, WI (United States); Leborgne, Jose H.; Mezzera, Julieta [Department of Radiation Oncology, Hospital Italiano, Montevideo (Uruguay)

    2012-03-01

    Purpose: Now that the follow-up time has exceeded 5 years, an estimate of the {alpha}/{beta} ratio can be presented. The additional late outcomes in patients treated with three-dimensional conformal external beam radiotherapy for localized prostate cancer using a hypofractionated vs. a standard fractionation regimen are reported from this prospective nonrandomized contemporary comparison. Methods and Materials: A total of 114 nonrandomized patients chose hypofractionation delivered in 20 fractions of 3 Gy or 3.15 Gy (mean 3.06 Gy) for localized prostate cancer within a median overall time of 32 days (range, 29-49) using four fractions weekly. A total of 160 comparable patients were contemporarily treated within a median of 55 days (range 49-66). The median follow-up was 66 months (range, 24-95) for the hypofractionated arm and 63 months (range, 36-92) for the standard arm. The percentage of patients in the low-, medium-, and high-risk groups was 36%, 46%, and 18% in the hypofractionated arm and 44%, 50%, and 6% in standard arm (2 Gy), respectively. Results: The 5-year actuarial biochemical absence of disease (prostate-specific antigen nadir + 2 ng/mL) and disease-free survival rate was the same at 89% in both arms, making the {alpha}/{beta} calculation unambiguous. The point ratio of {alpha}/{beta} was 1.86 (95% confidence interval, 0.7-5.1 Gy). The 95% confidence interval was determined entirely by the binomial confidence limits in the numbers of patients. Rectal reactions of grade 3 and 4 occurred in 1 of 114 (hypofractionated) and 2 of 160 (standard) patients. Conclusions: The presented three-dimensional conformal regimen was acceptable, and the {alpha}/{beta} value was 1.8, in agreement with other very recent low meta-analyses (reviewed in the '' section).

  6. Three-dimensional treatment planning for postoperative radiotherapy in patients with node-positive cervical cancer. Comparison between a conventional and a conformal technique

    Energy Technology Data Exchange (ETDEWEB)

    Olofsen-van Acht, M.J.J.; Quint, S.; Seven, M.; Berg, H.A. van den; Levendag, P.C. [University Hospital Rotterdam (Netherlands). Dept. of Radiation Oncology; Santvoort, J.P.C. van [University Hospital Rotterdam (Netherlands). Subdivision of Clinical Physics; Logmans, A. [University Hospital Rotterdam (Netherlands). Dept. of Gynecologic Oncology

    1999-09-01

    Purpose: Reduction of irradiated small bowel volume, using a conformal three-dimensional treatment planning technique in postoperative radiotherapy of cervical cancer patients. Patients and Methods: Large gynecological treatment fields including the para-aortic nodes were analyzed in 15 patients. A conventional treatment plan with anterior and posterior (AP-PA) parallel opposed fields and a 3D 4-field conformal radiotherapy plan with a central blocking of small bowel were compared for each patient. Dose-volume histograms and dose parameters were established. Because of the tolerance constraints of the small bowel, the cumulative dose applied to the target was 48.6 Gy. Results: The mean Tumor Control Probability (TCP) values for both the conventional and the conformal technique were 0.60 and 0.61, respectively, with ranges of 0.56 to 0.67 and 0.57 to 0.66, respectively. The mean volume receiving 95% or more of the prescribed dose (V95) of the small bowel was 47.6% (32.5 to 66.3%) in the AP-PA technique and 14.9% (7.0 to 22.5%) in the conformal technique (p<0.001), indicating a significant reduction in irradiated volume of small bowel in the higher dose range. The mean Normal Tissue Complication Probability (NTCP) decreased from 0.11 to 0.03 with the conformal plan. In patients who received a pedicled omentoplasty during surgery, the mean V95 for small bowel could be reduced to 8.5% (7.0 to 9.9%). The mean median dose to the kidneys was only slightly elevated in the conformal treatment. Especially the mean dose to the right kidney in conventional vs conformal treatment was 3.3 vs 7.9 Gy. The mean near-minimum dose (D95) to the rectosigmoid decreased from 48.4 to 30.1 Gy in the conformal plan compared to the conventional plan. Conclusion: The small bowel dose can be significantly reduced with 3D treatment planning, particularly if a predicled omentoplasty is performed. This allows dose escalation to the tumor region without unacceptable toxicity for the small bowel

  7. Radical hypo-fractionated radiotherapy with volumetric modulated arc therapy in lung cancer. A retrospective study of elderly patients with stage III disease

    Energy Technology Data Exchange (ETDEWEB)

    Franceschini, D. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Istituto Clinico Humanitas Cancer Center, Rozzano (Milan) (Italy); De Rose, F.; Navarria, P.; Clerici, E.; Franzese, C.; Comito, T.; Tozzi, A.; Iftode, C.; D' Agostino, G. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Cozzi, L.; Sorsetti, M. [Humanitas Cancer Center and Research Hospital, Radiotherapy and Radiosurgery Department, Milan (Italy); Humanitas University, Department of Biomedical Sciences, Milan (Italy)

    2017-05-15

    This study aimed to analyse the feasibility and acute toxicity of radical hypo-fractionated radiotherapy (RT) for elderly patients with non-small-cell lung cancer (NSCLC). We conducted a retrospective evaluation of treatment with volumetric modulated arc therapy (VMAT) of elderly patients affected by stage III inoperable NSCLC. The dose prescription was 56 Gy in 20 fractions, 55 Gy in 22 fractions, or 50 Gy in 20 fractions. Target volume included only the primary lesion and the infiltrated lymph nodes. The primary end point was acute and late toxicity, while secondary end points were progression-free survival (PFS), and overall survival (OS). In all, 41 patients were included in this analysis. The mean age of the patients was 78.6 years, and 22 patients had staged IIIA while 19 patients had stage IIIB disease. All but one patient had pathological nodal involvement; 15 patients received chemotherapy before RT. Acute grade 1-2 toxicity was recorded in 25 (61%) patients. Late toxicity was recorded in 13 (32%) patients. No cases of G3 or G4 toxicity were recorded. Complete response was obtained in two (5%) patients, 26 (63%) showed a partial response, and two (5%) experience disease progression. At a mean follow-up of 9.9 months (range, 1.1-25.4), 17 patients had died from disease progression, one died from other causes, and 23 were alive. Median OS was 13.7 ± 1.5 months (95% CI: 10.7-16.7), OS at 12 and 18 months was 51.3 ± 9.5% and 35.1 ± 10.1%, respectively. Median PFS was 13.7 ± 2.3 months (95% CI: 9.1-18.2), and PFS at 12 and 18 months was 50.1 ± 9.9% and 38.9 ± 10.4%, respectively. Radical hypo-fractionated VMAT is a promising treatment for locally advanced NSCLC in the elderly. The use of hypo-fractionated radiotherapy for lung cancer in older patients can be considered a valuable approach, particularly for patients with poor performance status or refusing other treatment approaches. (orig.) [German] Durchfuehrbarkeit und Nebenwirkungen der radikalen

  8. Effects of beam interruption time on tumor control probability in single-fractionated carbon-ion radiotherapy for non-small cell lung cancer

    Science.gov (United States)

    Inaniwa, T.; Kanematsu, N.; Suzuki, M.; Hawkins, R. B.

    2015-05-01

    Carbon-ion radiotherapy treatment plans are designed on the assumption that the beams are delivered instantaneously, irrespective of actual dose-delivery time structure in a treatment session. As the beam lines are fixed in the vertical and horizontal directions at our facility, beam delivery is interrupted in multi-field treatment due to the necessity of patient repositioning within the fields. Single-fractionated treatment for non-small cell lung cancer (NSCLC) is such a case, in which four treatment fields in multiple directions are delivered in one session with patient repositioning during the session. The purpose of this study was to investigate the effects of the period of dose delivery, including interruptions due to patient repositioning, on tumor control probability (TCP) of NSCLC. All clinical doses were weighted by relative biological effectiveness (RBE) evaluated for instantaneous irradiation. The rate equations defined in the microdosimetric kinetic model (MKM) for primary lesions induced in DNA were applied to the single-fractionated treatment of NSCLC. Treatment plans were made for an NSCLC case for various prescribed doses ranging from 25 to 50 Gy (RBE), on the assumption of instantaneous beam delivery. These plans were recalculated by varying the interruption time τ ranging from 0 to 120 min between the second and third fields for continuous irradiations of 3 min per field based on the MKM. The curative doses that would result in a TCP of 90% were deduced for the respective interruption times. The curative dose was 34.5 Gy (RBE) for instantaneous irradiation and 36.6 Gy (RBE), 39.2 Gy (RBE), 41.2 Gy (RBE), 43.3 Gy (RBE) and 44.4 Gy (RBE) for τ = 0 min, 15 min, 30 min, 60 min and 120 min, respectively. The realistic biological effectiveness of therapeutic carbon-ion beam decreased with increasing interruption time. These data suggest that the curative dose can increase by 20% or more compared to the planned dose if the

  9. 鼻咽癌常规放疗面颈联合野照射的剂量学研究%Dose evaluation of conventional radiotherapy using facial-cervical fields in nasopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    张彦新; 李素艳; 罗京伟; 章众; 徐国镇; 高黎; 戴建荣; 易俊林; 黄晓东; 肖建平

    2009-01-01

    carcinoma were treated by conventional radiotherapy as their primary treatment. All patients were simulated by the conventional simulator and the field borders were marked with thin lead wires on the mask. Then the patients were scanned by the CT-sim with the same immobilization. The planning CT images were transferred to the TPS and the field borders were copied on the DRR, and then GTV and the cranial base were contoured on the coronal CT slices. Two isoeenters were chosen, including one in front of the 1 st cervical vertebra to measeure the depth of the nasopharynx and the other in front of the 3rd cervical vertebra to measure the depth of the upper neck. The prescription dose of 36 Gy was given in 18 fractions. Dose distributions of GTV and the cranial base were calculated with TPS. Results The actual dose of 95% volume of GTV was 33.31 -35.54 Gy (median 34.83 Gy) and 31.43 -33.36 Gy (median 32.44 Gy) when the isoeenters were set in the nasopharynx and the superior neck, respectively. The corre-sponding actual dose of 95% volume of the cranial base was 17.76 - 34.60 Gy ( median 30.28 Gy ) and 16.52 -32.60 Gy (median 28.52 Gy), respectively. Conclusions For NPC patients treated with conven-tional radiotherapy using facial-cervical fields, the actual dose of GTV and the cranial base is lower than the prescribed dose whenever the isocenter is set in the nasopharynx or the upper neck,which is more significant in the latter. The isocenter should be set in the nasopharynx when the conventional radiotherapy is applied and a boost of 4- 8 Gy should be given when the cranial base is involved.

  10. SU-E-T-596: Axillary Nodes Radiotherapy Boost Field Dosimetric Impact Study: Oblique Field and Field Optimization in 3D Conventional Breast Cancer Radiation Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Su, M [Mount Sinai School of Medicine, Elmhurst, NY (United States); Sura, S

    2014-06-01

    Purpose: To evaluate dosimetric impact of two axillary nodes (AX) boost techniques: (1) posterior-oblique optimized field boost (POB), (2) traditional posterior-anterior boost (PAB) with field optimization (O-PAB), for a postmastectomy breast patient with positive axillary lymph nodes. Methods: Five patients, 3 left and 2 right chest walls, were included in this study. All patients were simulated in 5mm CT slice thickness. Supraclavicular (SC) and level I/II/III AX were contoured based on the RTOG atlas guideline. Five treatment plans, (1) tangential chest wall, (2) oblique SC including AX, (3) PAB, O-PAB and POB, were created for each patient. Three plan sums (PS) were generated by sum one of (3) plan with plan (1) and (2). The field optimization was done through PS dose distribution, which included a field adjustment, a fractional dose, a calculation location and a gantry angle selection for POB. A dosimetric impact was evaluated by comparing a SC and AX coverage, a PS maximum dose, an irradiated area percentage volume received dose over 105% prescription dose (V105), an ipsi-laterial mean lung dose (MLD), an ipsi-laterial mean humeral head dose (MHHD), a mean heart dose (MHD) (for left case only) and their DVH amount these three technique. Results: O-PAB, POB and PAB dosimetric results showed that there was no significant different on SC and AX coverage (p>0.43) and MHD (p>0.16). The benefit of sparing lung irradiation from PAB to O-PAB to POB was significant (p<0.004). PAB showed a highest PS maximum dose (p<0.005), V105 (p<0.023) and MLD (compared with OPAB, p=0.055). MHHD showed very sensitive to the patient arm positioning and anatomy. O-PAB convinced a lower MHHD than PAB (p=0.03). Conclusion: 3D CT contouring plays main role in accuracy radiotherapy. Dosimetric advantage of POB and O-PAB was observed for a better normal tissue irradiation sparing.

  11. Dosimetric study of RapidArc plans and conventional intensity modulated radiotherapy for prostate cancer involving seminal vesicles and pelvis lymph nodes

    Directory of Open Access Journals (Sweden)

    Birendra Rout

    2016-03-01

    Full Text Available Purpose: The main purpose of this study is to (1 identify the continual diversity between conventional fixed field intensity modulation radiotherapy (IMRT and RapidArc (RA for high-risk prostate cancer; and (2 determine potential benefits and drawbacks of using for this type of treatment.Methods: A cohort of 20 prostate cases including prostate, seminal vesicles and pelvic lymph nodes was selected for this study. The primary planning target volume (PTVP and boost planning target volume (PTVB were contoured. The total prescription dose was 75.6 Gy (45 Gy to PTVP and an additional 21.6 Gy to PTVB. Two plans were generated for each PTV: multiple 7-fields for IMRT and two arcs for RA.Results: A Sigma index (IMRT: 2.75 ± 0.581; RA: 2.8 ± 0.738 for PTVP and (IMRT: 2.0 ± 0.484; RA: 2.1 ± 0.464 for PTVB indicated similar dose homogeneity inside the PTV. Conformity index (IMRT: 0.96 ± 0.047; RA: 0.95 ± 0.059 for PTVP and (IMRT: 0.97 ± 0.015; RA: 0.96 ± 0.014 for PTVB was comparable for both the techniques. IMRT offered lower mean dose to organ at risks (OARs compared to RA plans. Normal tissue integral dose in IMRT plan resulted 0.87% lower than RA plans. All the plans displayed significant increase (2.50 times for PTVP and 1.72 for PTBB in the average number of necessary monitor units (MUs with IMRT beam. Treatment delivery time of RA was 2 ‒ 6 minutes shorter than IMRT treatment.Conclusion: For PTV including pelvic lymph nodes, seminal vesicles and prostate, IMRT offered a greater degree of OARs sparing. For PTV including seminal vesicles and prostate, RA with two arcs provided comparable plan with IMRT. RA also improved the treatment efficiency due to smaller number of MUs required.

  12. Breast cancer and per-operation electron radiotherapy: a review of the first 100 patients treated at the Jules-Bordet Institute; Cancer du sein et radiotherapie peroperatoire par electrons: revue des 100 premieres patientes traitees a l'institut Jules-Bordet

    Energy Technology Data Exchange (ETDEWEB)

    Philippson, C.; Simon, S.; Vandekerkhove, C.; Veys, I.; Noterman, D.; Hertens, D.; Neubourg, F. De; Larsimont, D.; Van Houtte, P.; Nogaret, J.M. [Institutjules-Bordet, Bruxelles (Belgium)

    2011-10-15

    The authors briefly discuss the results obtained on a cohort of women treated by per-operation radiotherapy for breast cancer. This technique enables a dose equivalent to that of a conventional fractionated external radiotherapy to be delivered in a single session in the tumour bed. Moreover, a weaker dose can be delivered as a boost before a conventional irradiation. Immediate morbidity is steady. Some rare complications have been noticed. Short communication

  13. Adaptive fractionated stereotactic Gamma Knife radiotherapy of meningioma using integrated stereotactic cone-beam-CT and adaptive re-planning (a-gkFSRT)

    Energy Technology Data Exchange (ETDEWEB)

    Stieler, F.; Wenz, F.; Abo-Madyan, Y.; Schweizer, B.; Polednik, M.; Herskind, C.; Giordano, F.A.; Mai, S. [University of Heidelberg, Department of Radiation Oncology, University Medical Center Mannheim, Mannheim (Germany)

    2016-11-15

    The Gamma Knife Icon (Elekta AB, Stockholm, Sweden) allows frameless stereotactic treatment using a combination of cone beam computer tomography (CBCT), a thermoplastic mask system, and an infrared-based high-definition motion management (HDMM) camera system for patient tracking during treatment. We report on the first patient with meningioma at the left petrous bone treated with adaptive fractionated stereotactic radiotherapy (a-gkFSRT). The first patient treated with Gamma Knife Icon at our institute received MR imaging for preplanning before treatment. For each treatment fraction, a daily CBCT was performed to verify the actual scull/tumor position. The system automatically adapted the planned shot positions to the daily position and recalculated the dose distribution (online adaptive planning). During treatment, the HDMM system recorded the intrafractional patient motion. Furthermore, the required times were recorded to define a clinical treatment slot. Total treatment time was around 20 min. Patient positioning needed 0.8 min, CBCT positioning plus acquisition 1.65 min, CT data processing and adaptive planning 2.66 min, and treatment 15.6 min. The differences for the five daily CBCTs compared to the reference are for rotation: -0.59 ± 0.49 /0.18 ± 0.20 /0.05 ± 0.36 and for translation: 0.94 ± 0.52 mm/-0.08 ± 0.08 mm/-1.13 ± 0.89 mm. Over all fractions, an intrafractional movement of 0.13 ± 0.04 mm was observed. The Gamma Knife Icon allows combining the accuracy of the stereotactic Gamma Knife system with the flexibility of fractionated treatment with the mask system and CBCT. Furthermore, the Icon system introduces a new online patient tracking system to the clinical routine. The interfractional accuracy of patient positioning was controlled with a thermoplastic mask and CBCT. (orig.) [German] Das Gamma Knife Icon (Elekta AB, Stockholm, Schweden) ermoeglicht die stereotaktische Behandlung von Patienten mittels Cone-beam-Computertomographie (CBCT

  14. Adaptive fractionated stereotactic Gamma Knife radiotherapy of meningioma using integrated stereotactic cone-beam-CT and adaptive re-planning (a-gkFSRT).

    Science.gov (United States)

    Stieler, F; Wenz, F; Abo-Madyan, Y; Schweizer, B; Polednik, M; Herskind, C; Giordano, F A; Mai, S

    2016-11-01

    The Gamma Knife Icon (Elekta AB, Stockholm, Sweden) allows frameless stereotactic treatment using a combination of cone beam computer tomography (CBCT), a thermoplastic mask system, and an infrared-based high-definition motion management (HDMM) camera system for patient tracking during treatment. We report on the first patient with meningioma at the left petrous bone treated with adaptive fractionated stereotactic radiotherapy (a-gkFSRT). The first patient treated with Gamma Knife Icon at our institute received MR imaging for preplanning before treatment. For each treatment fraction, a daily CBCT was performed to verify the actual scull/tumor position. The system automatically adapted the planned shot positions to the daily position and recalculated the dose distribution (online adaptive planning). During treatment, the HDMM system recorded the intrafractional patient motion. Furthermore, the required times were recorded to define a clinical treatment slot. Total treatment time was around 20 min. Patient positioning needed 0.8 min, CBCT positioning plus acquisition 1.65 min, CT data processing and adaptive planning 2.66 min, and treatment 15.6 min. The differences for the five daily CBCTs compared to the reference are for rotation: -0.59 ± 0.49°/0.18 ± 0.20°/0.05 ± 0.36° and for translation: 0.94 ± 0.52 mm/-0.08 ± 0.08 mm/-1.13 ± 0.89 mm. Over all fractions, an intrafractional movement of 0.13 ± 0.04 mm was observed. The Gamma Knife Icon allows combining the accuracy of the stereotactic Gamma Knife system with the flexibility of fractionated treatment with the mask system and CBCT. Furthermore, the Icon system introduces a new online patient tracking system to the clinical routine. The interfractional accuracy of patient positioning was controlled with a thermoplastic mask and CBCT.

  15. Inter-fractional Target Displacement in the Prostate Image-Guided Radiotherapy using Cone Beam Computed Tomography

    Energy Technology Data Exchange (ETDEWEB)

    Dong, Kap Sang; Back, Chang Wook; Jeong, Yun Jeong; Bae, Jae Beom; Choi, Young Eun; Sung, Ki Hoon [Dept. of Radiation Oncology, Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2016-12-15

    To quantify the inter-fractional variation in prostate displacement and their dosimetric effects for prostate cancer treatment. A total of 176 daily cone-beam CT (CBCT) sets acquired for 6 prostate cancer patients treated with volumetric-modulated arc therapy (VMAT) were retrospectively reviewed. For each patient, the planning CT (pCT) was registered to each daily CBCT by aligning the bony anatomy. The prostate, rectum, and bladder were delineated on daily CBCT, and the contours of these organs in the pCT were copied to the daily CBCT. The concordance of prostate displacement, deformation, and size variation between pCT and daily CBCT was evaluated using the Dice similarity coefficient (DSC). The mean volume of prostate was 37.2 cm3 in the initial pCT, and the variation was around ±5% during the entire course of treatment for all patients. The mean DSC was 89.9%, ranging from 70% to 100% for prostate displacement. Although the volume change of bladder and rectum per treatment fraction did not show any correlation with the value of DSC (r=-0.084, p=0.268 and r=-0.162, p=0.032, respectively), a decrease in the DSC value was observed with increasing volume change of the bladder and rectum (r=-0.230,p=0.049 and r=-0.240,p=0.020, respectively). Consistency of the volume of the bladder and rectum cannot guarantee the accuracy of the treatment. Our results suggest that patient setup with the registration between the pCT and daily CBCT should be considered aligning soft tissue.

  16. Hypofractionated radiotherapy for localized prostate cancer using three-dimensional conformal radiotherapy technique: 3 years toxicity analysis

    Directory of Open Access Journals (Sweden)

    R White

    2015-01-01

    Full Text Available BACKGROUND: Hypofractionated radiotherapy in the radical treatment of localized prostate cancer has potential biological advantages relative to conventional fractionation. We report prospectively collected toxicity data from a cohort of patients treated with a 3D conformal technique (3DCRT. MATERIALS AND METHODS: 90 patients receiving curative intent hypofractionated radiotherapy with 57Gy in 19 daily fractions over 3.8 weeks were evaluated prospectively for the development of radiation related toxicity over a 3 year period. RESULTS: All patients completed treatment. Maximal acute toxicity experienced was 58.6, 10 and 1.1% for grade 1, 2 and 3 genitourinary (GU toxicity respectively and 75.6, 9 and 0% for gastrointestinal (GI toxicity. For late toxicity the three year actuarial rates of grade 1, 2 and 3 GU and GI toxicity respectively were 47.3, 2.4 and 0%; and 40, 9.3 and 4.7%. There were no grade 4 or worse acute or late toxicities. 97.6% of evaluable patients remained free of biochemical failure 36 months post radiotherapy. CONCLUSIONS: A 57Gy in 19 daily fraction radiotherapy schedule using 3D conformal radiotherapy for the definitive treatment of localized prostate cancer has acceptable early and late toxicity.

  17. 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

    1999-09-01

    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

  18. Targeted tumor radiotherapy

    Directory of Open Access Journals (Sweden)

    Unak Perihan

    2002-01-01

    Full Text Available Targeted tumor radiotherapy is selectively delivery of curative doses of radiation to malignant sites. The aim of the targeted tumor radiotherapy is to use the radionuclides which have high LET particle emissions conjugated to appropriate carrier molecules. The radionuclides are selectively collected by tumor cells, depositing lethal doses to tumor cells while no admission occur to normal cells. In theory, targeted radiotherapy has several advantages over conventional radiotherapy since it allows a high radiation dose to be administered without causing normal tissue toxicity, although there are some limitations in the availability of appropriate targeting agents and in the calculations of administered doses. Therefore, for routine clinical applications more progress is still needed. In this article, the potential use of targeted tumor radiotherapy is briefly reviewed. More general aspects and considerations, such as potential radionuclides, mechanisms of tumor targeting was also outlined.

  19. Validation of the total dysphagia risk score (TDRS) in head and neck cancer patients in a conventional and a partially accelerated radiotherapy scheme

    NARCIS (Netherlands)

    Nevens, Daan; Deschuymer, Sarah; Langendijk, Johannes A.; Daisne, Jean -Francois; Duprez, Frederic; De Neve, Wilfried; Nuyts, Sandra

    Background and purpose: A risk model, the total dysphagia risk score (TDRS), was developed to predict which patients are most at risk to develop grade >= 2 dysphagia at 6 months following radiotherapy (RT) for head and neck cancer. The purpose of this study was to validate this model at 6 months and

  20. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies.

    Science.gov (United States)

    Adebahr, Sonja; Schimek-Jasch, Tanja; Nestle, Ursula; Brunner, Thomas B

    2016-08-01

    The oesophagus as a serial organ located in the central chest is frequent subject to "incidental" dose application in radiotherapy for several thoracic malignancies including oesophageal cancer itself. Especially due to the radiosensitive mucosa severe radiotherapy induced sequelae can occur, acute oesophagitis and strictures as late toxicity being the most frequent side-effects. In this review we focus on oesophageal side effects derived from treatment of gastrointestinal cancer and secondly provide an overview on oesophageal toxicity from conventional and stereotactic fractionated radiotherapy to the thoracic area in general. Available data on pathogenesis, frequency, onset, and severity of oesophageal side effects are summarized. Whereas for conventional radiotherapy the associations of applied doses to certain volumes of the oesophagus are well described, the tolerance dose to the mediastinal structures for hypofractionated therapy is unknown. The review provides available attempts to predict the risk of oesophageal side effects from dosimetric parameters of SBRT.

  1. Tissue feature-based intra-fractional motion tracking for stereoscopic x-ray image guided radiotherapy.

    Science.gov (United States)

    Xie, Yaoqin; Xing, Lei; Gu, Jia; Liu, Wu

    2013-06-07

    Real-time knowledge of tumor position during radiation therapy is essential to overcome the adverse effect of intra-fractional organ motion. The goal of this work is to develop a tumor tracking strategy by effectively utilizing the inherent image features of stereoscopic x-ray images acquired during dose delivery. In stereoscopic x-ray image guided radiation delivery, two orthogonal x-ray images are acquired either simultaneously or sequentially. The essence of markerless tumor tracking is the reliable identification of inherent points with distinct tissue features on each projection image and their association between two images. The identification of the feature points on a planar x-ray image is realized by searching for points with high intensity gradient. The feature points are associated by using the scale invariance features transform descriptor. The performance of the proposed technique is evaluated by using images of a motion phantom and four archived clinical cases acquired using either a CyberKnife equipped with a stereoscopic x-ray imaging system, or a LINAC equipped with an onboard kV imager and an electronic portal imaging device. In the phantom study, the results obtained using the proposed method agree with the measurements to within 2 mm in all three directions. In the clinical study, the mean error is 0.48 ± 0.46 mm for four patient data with 144 sequential images. In this work, a tissue feature-based tracking method for stereoscopic x-ray image guided radiation therapy is developed. The technique avoids the invasive procedure of fiducial implantation and may greatly facilitate the clinical workflow.

  2. A new concept of radiotherapy: space fractionation in proton therapy; Un nuevo concepto en radioterapia: fraccionamiento espacial en terapia con protones

    Energy Technology Data Exchange (ETDEWEB)

    Prezado Alonso, Y.; Fois, G.

    2013-07-01

    In recent years several experiments with animals have shown that the combination of small field sizes and a spatial neighborhood of the dose of radiation therapy with synchrotron radiation techniques lead to a significant increase of the dose of tolerance of healthy tissues. The aim of this study is to evaluate the feasibility of a new form of radiotherapy: radiotherapy with proton minibeams. (Author)

  3. Modeling normal tissue complication probability from repetitive computed tomography scans during fractionated high-dose-rate brachytherapy and external beam radiotherapy of the uterine cervix.

    Science.gov (United States)

    Dale, E; Hellebust, T P; Skjønsberg, A; Høgberg, T; Olsen, D R

    2000-07-01

    To calculate the normal tissue complication probability (NTCP) of late radiation effects on the rectum and bladder from repetitive CT scans during fractionated high-dose-rate brachytherapy (HDRB) and external beam radiotherapy (EBRT) of the uterine cervix and compare the NTCP with the clinical frequency of late effects. Fourteen patients with cancer of the uterine cervix (Stage IIb-IVa) underwent 3-6 (mean, 4.9) CT scans in treatment position during their course of HDRB using a ring applicator with an Iridium stepping source. The rectal and bladder walls were delineated on the treatment-planning system, such that a constant wall volume independent of organ filling was achieved. Dose-volume histograms (DVH) of the rectal and bladder walls were acquired. A method of summing multiple DVHs accounting for variable dose per fraction were applied to the DVHs of HDRB and EBRT together with the Lyman-Kutcher NTCP model fitted to clinical dose-volume tolerance data from recent studies. The D(mean) of the DVH from EBRT was close to the D(max) for both the rectum and bladder, confirming that the DVH from EBRT corresponded with homogeneous whole-organ irradiation. The NTCP of the rectum was 19.7% (13.5%, 25. 9%) (mean and 95% confidence interval), whereas the clinical frequency of late rectal sequelae (Grade 3-4, RTOG/EORTC) was 13% based on material from 200 patients. For the bladder the NTCP was 61. 9% (46.8%, 76.9%) as compared to the clinical frequency of Grade 3-4 late effects of 14%. If only 1 CT scan from HDRB was assumed available, the relative uncertainty (standard deviation or SD) of the NTCP value for an arbitrary patient was 20-30%, whereas 4 CT scans provided an uncertainty of 12-13%. The NTCP for the rectum was almost consistent with the clinical frequency of late effects, whereas the NTCP for bladder was too high. To obtain reliable (SD of 12-13%) NTCP values, 3-4 CT scans are needed during 5-7 fractions of HDRB treatments.

  4. The reoxygenation of hypoxia and the reduction of glucose metabolism in head and neck cancer by fractionated radiotherapy with intensity-modulated radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Shozo; Shiga, Tohru; Watanabe, Shiro; Hirata, Kenji; Magota, Keiichi; Kasai, Katsuhiko; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Hokkaido (Japan); Yasuda, Koichi; Onimaru, Rikiya; Tuchiya, Kazuhiko; Shirato, Hiroki [Hokkaido University Graduate School of Medicine, Department of Radiology, Hokkaido (Japan); Nishijima, Ken-ichi; Kuge, Yuji [Hokkaido University, Central Institute of Isotope Science, Hokkaido (Japan)

    2016-11-15

    The purpose of this study was to prospectively investigate reoxygenation in the early phase of fractionated radiotherapy and serial changes of tumoricidal effects associated with intensity-modulated radiation therapy (IMRT) in patients with head and neck cancer (HNC) using F-18 fluoromisonidazole (FMISO) PET and F-18 fluorodeoxyglucose (FDG) PET. Patients with untreated HNC underwent FMISO-PET and FDG-PET studies prospectively. A PET evaluation was conducted before each IMRT (Pre-IMRT), during IMRT (at 30 Gy/15 fr) (Inter-IMRT), and after completion of IMRT (70 Gy/35 fr) (Post-IMRT). FMISO-PET images were scanned by a PET/CT scanner at 4 h after the FMISO injection. We quantitatively analyzed the FMISO-PET images of the primary lesion using the maximum standardized uptake (SUVmax) and tumor-to-muscle ratio (TMR). The hypoxic volume (HV) was calculated as an index of tumor hypoxia, and was defined as the volume when the TMR was ≥ 1.25. Each FDG-PET scan was started 1 h after injection. The SUVmax and metabolic tumor volume (MTV) values obtained by FDG-PET were analyzed. Twenty patients finished the complete PET study protocol. At Pre-IMRT, 19 patients had tumor hypoxia in the primary tumor. In ten patients, the tumor hypoxia disappeared at Inter-IMRT. Another seven patients showed the disappearance of tumor hypoxia at Post-IMRT. Two patients showed tumor hypoxia at Post-IMRT. The FMISO-PET results showed that the reduction rates of both SUVmax and TMR from Pre-IMRT to Inter-IMRT were significantly higher than the corresponding reductions from Inter-IMRT to Post-IMRT (SUVmax: 27 % vs. 10 %, p = 0.025; TMR: 26 % vs. 12 %, p = 0.048). The reduction rate of SUVmax in FDG-PET from Pre-IMRT to Inter-IMRT was similar to that from Inter-IMRT to Post-IMRT (47 % vs. 48 %, p = 0.778). The reduction rate of the HV in FMISO-PET from Pre-IMRT to Inter-IMRT tended to be larger than that from Inter-IMRT to Post-IMRT (63 % vs. 40 %, p = 0.490). Conversely, the reduction rate of

  5. Fractionated and single-dose radiotherapy for heterotopic bone formation in patients with spinal cord injury. A phase-I/II study

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L.; Hueltenschmidt, B.; Liebermeister, E. [Staedtisches Klinikum Karlsruhe (Germany). Klinik fuer Strahlentherapie und Nuklearmedizin; Nanassy, A. [Klinikum Karlsbad-Langensteinbach (Germany). Orthopaedie I

    2001-04-01

    Background: Heterotopic ossification occur in about 20% of patients with spinal cord injury and may seriously compromise the rehabilitation process. Aim of the present study was to evaluate if radiotherapy administered early in the course of the disease prevents the manifestation of heterotopic ossification and if in patients whose bone formations have been resected recurrence can be avoided. Patients and Methods: 52 patients (44 males, eight females, median age 33 years) and 75 joints were irradiated between December 1989 and March 2000. 49 patients (70 joints, 65 hips, three knees, one shoulder, one elbow) were evaluable. Median follow-up was 11 months. In 58 joints radiotherapy was performed as a primary treatment in the inflammatory phase of soft tissue swelling that precedes manifestation of heterotopic ossifications. Twelve joints were treated after resection of manifest heterotopic bone, two patients had primary and postoperative irradiation in different joints. The dose was 10 Gy in single fractions of 2-2,5 Gy in 34 joints and 7.5-20 Gy in six joints. >From July 1996 on, 30 joints received single-dose irradiation with 8 Gy. Results: 50/70 joints (71%) remained free from progression. This was the case for 47/65 (72%) hips, whereas in 18 hips (27%) the Brooker score increased for 1-2 grades and caused a moderate decrease of mobility in five joints. Out of the other five joints, two knees developed progression. No relevant side effects occurred. Conclusion: The present results suggest that radiotherapy is an effective local treatment option for spinal cord injured patients with heterotopic ossifications. (orig.) [German] Hintergrund: Heterotope Ossifikationen treten bei bis zu 20% von Patienten mit verletzungsbedingter Querschnittslaehmung auf und koennen die Rehabilitation erheblich erschweren. Ziel der vorliegenden Studie war zu evaluieren, ob durch eine primaer im Anfangsstadium der Erkrankung eingesetzte Strahlentherapie die Manifestation heterotoper

  6. Comparison of Conventional and Ultrasound-assisted Extraction Techniques on Mass Fraction of Phenolic Compounds from Sage (Salvia officinalis L.)

    OpenAIRE

    2015-01-01

    An innovative ultrasound-assisted extraction (UAE) is the rapid non-thermal extraction technique, which in comparison to conventional extraction (CE), offers high reproducibility in a short time with simplified manipulation, reduced solvent consumption and lower energy. Optimization of ultrasonic conditions was conducted for devices with nominal output power of 100 and 400 W, including the influence of geometrical parameters of probes regarding ultrasound-assisted extraction. The results show...

  7. Melanoma: Last call for radiotherapy.

    Science.gov (United States)

    Espenel, Sophie; Vallard, Alexis; Rancoule, Chloé; Garcia, Max-Adrien; Guy, Jean-Baptiste; Chargari, Cyrus; Deutsch, Eric; Magné, Nicolas

    2017-02-01

    Melanoma is traditionally considered to be a radioresistant tumor. However, radiotherapy and immunotherapy latest developments might upset this radiobiological dogma. Stereotactic radiotherapy allows high dose per fraction delivery, with high dose rate. More DNA lethal damages, less sublethal damages reparation, endothelial cell apoptosis, and finally clonogenic cell dysfunction are produced, resulting in improved local control. Radiotherapy can also enhance immune responses, inducing neoantigens formation, tumor antigen presentation, and cytokines release. A synergic effect of radiotherapy with immunotherapy is expected, and might lead to abscopal effects. If hadrontherapy biological properties seem able to suppress hypoxia-induced radioresistance and increase biological efficacy, ballistic advantages over photon radiations might also improve radiotherapy outcomes on usually poor prognosis locations. The present review addresses biological and clinical effects of high fraction dose, bystander effect, abscopal effect, and hadrontherapy features in melanoma. Clinical trials results are warranted to establish indications of innovative radiotherapy in melanoma.

  8. Proton minibeam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Girst, Stefanie

    2016-03-08

    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

  9. Risk-adapted single or fractionated stereotactic high-precision radiotherapy in a pooled series of nonfunctioning pituitary adenomas. High local control and low toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Bostroem, Jan Patrick [MediClin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn (Germany); University Hospital of Bonn, Department of Neurosurgery, Bonn (Germany); Meyer, Almuth [HELIOS Klinikum Erfurt, Department of Endocrinology, Erfurt (Germany); Pintea, Bogdan [University Hospital of Bonn, Department of Neurosurgery, Bonn (Germany); Gerlach, Ruediger [HELIOS Klinikum Erfurt, Department of Neurosurgery, Erfurt (Germany); Surber, Gunnar; Hamm, Klaus [HELIOS Klinikum Erfurt, Department of Radiosurgery, Erfurt (Germany); Lammering, Guido [MediClin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn (Germany); Heinrich-Heine-University of Duesseldorf, Department of Radiotherapy and Radiation Oncology, Duesseldorf (Germany)

    2014-12-15

    The purpose of this work was to evaluate a prospectively initiated two-center protocol of risk-adapted single-fraction (SRS) or fractionated radiotherapy (SRT) in patients with nonsecretory pituitary adenomas (NSA). A total of 73 NSA patients (39 men/34 women) with a median age of 62 years were prospectively included in a treatment protocol of SRS [planning target volume (PTV) < 4 ccm, > 2 mm to optic pathways = low risk] or SRT (PTV ≥ 4 ccm, ≤ 2 mm to optic pathways = high risk) in two Novalis registered centers. Mean tumor volume was 7.02 ccm (range 0.58-57.29 ccm). Based on the protocol guidelines, 5 patients were treated with SRS and 68 patients with SRT. Median follow-up (FU) reached 5 years with 5-year overall survival (OS) of 90.4 % (CI 80.2-95 %) and 5-year local control and progression-free survival rates of 100 % (CI 93.3-100 %) and 90.4 % (CI 80.2-95 %), respectively. A post-SRS/SRT new visual disorder occurred in 2 patients (2.7 %), a new oculomotor nerve palsy in one pre-irradiated patient, in 3 patients (4.1 %) a pre-existing visual disorder improved. New complete hypopituitarism occurred in 4 patients (13.8 %) and in 3 patients (25 %) with pre-existing partial hypopituitarism. Pituitary function in 26 % of patients retained normal. Patients with tumor shrinkage (65.75 %) had a significantly longer FU (p = 0.0093). Multivariate analysis confirmed correlation of new hypopituitarism with duration of FU (p = 0.008) and correlation of new hypopituitarism and tumor volume (p = 0.023). No significant influence factors for occurrence of visual disorders were found. Our SRS/SRT protocol proved to be safe and successful in terms of tumor control and protection of the visual system, especially for large tumors located close to optic pathways. (orig.) [German] Evaluation eines prospektiv angelegten Behandlungsprotokolls einer risikoadaptierten Radiochirurgie (SRS) oder stereotaktischen Radiotherapie (SRT) von Patienten mit hormoninaktiven Hypophysenadenomen

  10. 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

    2000-10-01

    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.)

  11. Radiotherapy for diffuse brainstem glioma in children and young adults.

    Science.gov (United States)

    Hu, Xin; Fang, Yuan; Hui, Xuhui; Jv, Yan; You, Chao

    2016-06-27

    Diffuse brainstem glioma is a devastating disease with very poor prognosis. The most commonly used radiological treatment is conventional fractionated radiation. So far, there is no meta-analysis or systematic review available that assesses the benefits or harms of radiation in people with diffuse brainstem glioma. To assess the effects of conventional fractionated radiotherapy (with or without chemotherapy) versus other therapies (including different radiotherapy techniques) for newly diagnosed diffuse brainstem gliomas in children and young adults aged 0 to 21 years. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and EMBASE to 19 August 2015. We scanned conference proceedings from the International Society for Paediatric Oncology (SIOP), International Symposium on Paediatric Neuro-Oncology (ISPNO), Society of Neuro-Oncology (SNO), and European Association of Neuro-Oncology (EANO) from 1 January 2010 to 19 August 2015. We searched trial registers including the International Standard Randomised Controlled Trial Number (ISRCTN) Register, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the register of the National Institutes of Health to 19 August 2015. We imposed no language restrictions. All randomised controlled trials (RCTs), quasi-randomised trials (QRCTs), or controlled clinical trials (CCTs) that compared conventional fractionated radiotherapy (with or without chemotherapy) versus other therapies (including different radiotherapy techniques) for newly diagnosed diffuse brainstem glioma in children and young adults aged 0 to 21 years. Two review authors independently screened studies for inclusion, extracted data, assessed the risk of bias in each eligible trial, and conducted GRADE assessment of included studies. We resolved disagreements through discussion. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of

  12. The Impact of Hypofractionated Whole Breast Radiotherapy on Local Relapse in Patients With Grade 3 Early Breast Cancer: A Population-Based Cohort Study

    Energy Technology Data Exchange (ETDEWEB)

    Herbert, Christopher, E-mail: cherbert@bccancer.bc.ca [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Nichol, Alan [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Olivotto, Ivo [Department of Radiation Oncology, BC Cancer Agency, Victoria, British Columbia (Canada); Weir, Lorna [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Woods, Ryan; Speers, Caroline [Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver, British Columbia (Canada); Truong, Pauline [Department of Radiation Oncology, BC Cancer Agency, Victoria, British Columbia (Canada); Tyldesley, Scott [Department of Radiation Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada)

    2012-04-01

    Purpose: To determine whether patients with Grade 3 early breast cancer have an inferior rate of local disease control at 10 years with hypofractionated radiotherapy compared with more conventionally fractionated schedules. Methods and Materials: Local relapse rates were compared between patients receiving hypofractionated radiotherapy or conventionally fractionated radiotherapy to the whole breast in a population-based cohort of women with early-stage (T1-T2, N0, M0) Grade 3 breast cancers diagnosed between 1990 and 2000 and referred to the British Columbia Cancer Agency. Cumulative rates of local relapse were estimated using a competing risk method, and factors significant on univariate analysis were included with fractionation group in a multivariate model. The primary end point was local control at 10 years. Results: A total of 1,335 patients with Grade 3 tumors were treated with adjuvant radiotherapy, 252 with conventional fractionation, and 1,083 with a hypofractionated schedule. The 10-year cumulative incidence of local relapse was 6.9% in the hypofractionated group and 6.2% in the conventionally fractionated group (p = 0.99). Conclusions: There is no evidence that hypofractionation is inferior to conventional fractionation for breast conserving therapy in patients with Grade 3 breast cancer in this large population-based series after 10 years of follow-up.

  13. Recent Advances in Definitive Radiotherapy for Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Michael Pinkawa

    2015-03-01

    Full Text Available Definitive radiation therapy is a well-recognised curative treatment option for localised prostate cancer. A suitable technique, dose, target volume, and the option of a combination with androgen deprivation therapy needs to be considered. An optimal standard external beam radiotherapy includes currently the intensity-modulated and image-guided radiotherapy techniques with total doses of ≥76-78 Gy in conventional fractionation. Data from several randomised studies increasingly support the rationale for hypofractionated radiotherapy. A simultaneous integrated boost with dose escalation focused on a computed tomography/positron emission tomography or magnetic resonance imaging/magnetic resonance spectroscopy detected malignant lesion is an option to increase tumour control with potentially no additional toxicity. The application of a spacer is a promising concept for optimal protection of the rectal wall.

  14. SU-E-T-810: Volumetric Modulated Arc Therapy and Conventional Intensity-Modulated Radiotherapy for Non-Small-Cell Lung Cancer with Simultaneously Integrated Boost Radiation Therapy: A Planning Comparison Study

    Energy Technology Data Exchange (ETDEWEB)

    Liu, T; Chen, J; Zhang, G; Sun, T [Shandong Tumor Hospital, Jinan, Shandong (China)

    2015-06-15

    Purpose: To compare and analyze the characteristics of intensity-modulated arc therapy(IMAT) versus fixed-gantry intensity-modulated radiotherapy(IMRT) in treatment of non-small-cell lung cancer. Methods: Twelve patients treated in our radiotherapy center were selected for this study. The patient subsequently underwent 4D-CT simulation.Margins of 5mm and 10mm were added to the ITV to generate the CTV and PTV respectively. Three treatment plans (IMRT,one single arc (RA1),double arcs (RA2))were generated with Eclipse ver.8.6 planning systems. Using a dose level of 75Gy in 15fractions to the ITV,60Gy in 15fractions to the CTV and 45Gy in 15fractions to the PTV respectively. The target and normol tissue volumes were compared,as were the dosimetry parameters. Results: There were no significant differences in CI of ITV,PTV,HI of ITV,CTV and PTV, V5,V10,V15,V20,V25,V30,V45,V50 of total-lung and mean lung dose (all p>0.05). However, the differences were significant in terms of CI of CTV,V5 of B-P (all p<0.05). On the MU, IMRT=1540MU,RA1=1006 MU and RA2=1096 MU. (F=12.00,P=0.000).On the treatment time, IMRT= 13.5min,RA1= 1.5min,and RA2=2.5 min (F= 30.11,P=0.000 ). Conclusion: IMAT is equal to IMRT in dosimetril evaluation. Due to much less Mu and delivery time,IMAT is an ideal technique in treating patients by reduceing the uncomfortable influnce which could effect the treatment.

  15. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial).

    Science.gov (United States)

    Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max; Tobias, Jeffrey S; Joseph, David J; Saunders, Christobel; Brew-Graves, Chris; Potyka, Ingrid; Morris, Stephen; Vaidya, Hrisheekesh J; Williams, Norman R; Baum, Michael

    2016-01-01

    BACKGROUND Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies. OBJECTIVE To compare TARGIT within a risk-adapted approach with whole-breast external beam radiotherapy (EBRT) over several weeks. DESIGN The TARGeted Intraoperative radioTherapy Alone (TARGIT-A) trial was a pragmatic, prospective, international, multicentre, non-inferiority, non-blinded, randomised (1 : 1 ratio) clinical trial. Originally, randomisation occurred before initial lumpectomy (prepathology) and, if allocated TARGIT, the patient received it during the lumpectomy. Subsequently, the postpathology stratum was added in which randomisation occurred after initial lumpectomy, allowing potentially easier logistics and a more stringent case selection, but which needed a reoperation to reopen the wound to give TARGIT as a delayed procedure. The risk-adapted approach meant that, in the experimental arm, if pre-specified unsuspected adverse factors were found postoperatively after receiving TARGIT, EBRT was recommended. Pragmatically, this reflected how TARGIT would be practised in the real world. SETTING Thirty-three centres in 11 countries. PARTICIPANTS Women who were aged ≥ 45 years with unifocal invasive ductal carcinoma preferably ≤ 3.5 cm in size. INTERVENTIONS TARGIT within a risk-adapted approach and whole-breast EBRT. MAIN OUTCOME MEASURES The primary outcome measure was absolute difference in local recurrence, with a non-inferiority margin of 2.5%. Secondary outcome measures included toxicity and breast cancer-specific and non

  16. Whole-brain radiotherapy with 20 Gy in 5 fractions for brain metastases in patients with cancer of unknown primary (CUP)

    Energy Technology Data Exchange (ETDEWEB)

    Rades, D. [Dept. of Radiation Oncology, Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Dept. of Radiation Oncology, Univ. Hospital Hamburg-Eppendorf, Hamburg (Germany); Bohlen, G.; Dunst, J. [Dept. of Radiation Oncology, Univ. Hospital Schleswig-Holstein, Luebeck (Germany); Lohynska, R. [Dept. of Radiation Oncology, Univ. Hospital Prague (Czech Republic); Veninga, T. [Dept. of Radiotherapy, Dr. Bernard Verbeeten Inst., Tilburg (Netherlands); Stalpers, L.J.A. [Dept. of Radiotherapy, Academic Medical Center, Amsterdam (Netherlands); Schild, S.E. [Dept. of Radiation Oncology, Mayo Clinic Scottsdale, AZ (United States)

    2007-11-15

    Background: Whole brain radiotherapy (WBRT) is the most common treatment for brain metastases. Survival of patients with cancer of unknown primary (CUP) presenting with brain metastases is extremely poor. A radiation program with a short overall treatment time (short-course RT) would be preferable to longer programs if it provides similar outcomes. This study compares short-course RT with 20 Gy in 5 fractions (5 x 4 Gy) given over 5 days to longer programs in CUP patients. Patients and Methods: Data regarding 101 CUP patients who received either short course WBRT (n = 34) with 5 x 4 Gy or long-course WBRT (n = 67) with 10 x 3 Gy given over 2 weeks or 20 x 2 Gy given over 4 weeks for brain metastases were analyzed retrospectively. Six additional potential prognostic factors were investigated: age, gender, Karnofsky performance score (KPS), number of brain metastases, extracranial metastases, RPA-(Recursive Partitioning Analysis-)class. Results: On univariate analysis, the radiation program was not associated with survival (p = 0.88) nor intracerebral control (p = 0.36). Improved survival was associated with KPS {>=} 70 (p < 0.001), absence of extracranial metastases (p < 0.001), and RPA-class 1 (p < 0.001). On multivariate analyses, KPS (risk ratio [RR]: 4.55; p < 0.001), extracranial metastases (RR: 1.70; p = 0.018), and RPA-class (RR: 2.86; p < 0.001) maintained significance. On univariate analysis, KPS (p < 0.001) and RPA-class (p < 0.001) were significantly associated with intracerebral control. On multivariate analyses, KPS (RR: 2.72; p < 0.001) and RPA-class (RR: 2.09; p < 0.001) remained significant. Conclusion: Short-course WBRT with 5 x 4 Gy provided similar intracerebral control and survival as longer programs for the treatment of brain metastases in CUP patients. 5 x 4 Gy appears preferable because it is more convenient for patients. (orig.)

  17. Radiotherapy-induced emesis. An overview

    Energy Technology Data Exchange (ETDEWEB)

    Feyer, P.; Buchali, A.; Hinkelbein, M.; Budach, V. [Department Radiotherapy, Humboldt-University Berlin (Germany); Zimmermann, J.S. [Department Radiotherapy, Christian Albrechts-University Kiel (Germany); Titlbach, O.J. [Department of Medicine I, Hospital Friedrichshain, Berlin (Germany)

    1998-11-01

    Background: A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life. Methods: International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced. Results: Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exist high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%. Conclusions: Studies with total body irradiation, fractionated treatment and high-dose single exposures have cleary demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic

  18. Radiotherapy of esthesioneuroblastoma. Radiotherapie beim Aesthesioneuroblastom

    Energy Technology Data Exchange (ETDEWEB)

    Strnad, V. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik); Grabenbauer, G.G. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik); Dunst, J. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik); Sauer, R. (Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik und Poliklinik)

    1994-02-01

    From 1985 through 1990, twelve patients with estehesioneuroblastoma have been treated at the Department of Radiotherapy at the University of Erlangen. Two had Kadish stage A, one stage B, and nine stage C. There were seven males and five females with a mean age of 43 years. Eleven patients had combined trancranial-transbasal surgery prior to radiotherapy (five R0-, four R1-, and two patients R2-resections) and one received radiotherapy only. The dose was 12 to 60 Gy (mean 54 Gy) in 1.8 Gy to 2 Gy per fraction. 8/12 patients (67%) were locally controlled. One had progressive disease during radiotherapy after partial resection and died. Three had local recurrences, one in-field and two marginal. One patient with a local recurrence developed cervical lymph node metastases, and one locally controlled patient developed bone metastases but is alive eight years after chemotherapy plus radiotherapy for metastatic disease. The five-year-overall and recurrence-free survival was 72% and 55%, respectively. (orig./MG)

  19. [Hypofractionated adjuvant radiotherapy for breast cancer: no signs of increased risk of cardiotoxicity].

    Science.gov (United States)

    Aleman, Berthe M P; van Leeuwen, Floor E

    2015-01-01

    Adjuvant radiotherapy is frequently used in women with breast cancer to improve both local control of the tumour and overall survival. Hypofractionated regimens are increasingly being used as they involve fewer treatment sessions and, in terms of tumour control, the effects of conventionally fractionated and hypofractionated radiotherapy seem to be comparable. However, there is concern regarding increased cardiotoxicity following hypofractionated radiotherapy treatment to the left side. In order to determine if cardiac mortality increases with hypofractionation relative to conventional fractionation, a Canadian research group performed a retrospective analysis in 5334 women with breast cancer treated between 1990-1998 with postoperative radiotherapy to the breast/chest wall only. At 15-year follow-up the authors concluded that cardiac mortality was not statistically different among patients with left-sided breast cancer whether treated with hypofractionated or conventionally fractionated whole breast/chest wall irradiation. This commentary discusses the data presented in the paper, puts them into perspective and describes the clinical implications.

  20. Translational and rotational intra- and inter-fractional errors in patient and target position during a short course of frameless stereotactic body radiotherapy

    DEFF Research Database (Denmark)

    Josipovic, Mirjana; Persson, Gitte Fredberg; Logadottir, Ashildur;

    2012-01-01

    Implementation of cone beam computed tomography (CBCT) in frameless stereotactic body radiotherapy (SBRT) of lung tumours enables setup correction based on tumour position. The aim of this study was to compare setup accuracy with daily soft tissue matching to bony anatomy matching and evaluate...

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    The TARGIT-A trial compared risk-adapted radiotherapy using single-dose targeted intraoperative radiotherapy (TARGIT) versus fractionated external beam radiotherapy (EBRT) for breast cancer. We report 5-year results for local recurrence and the first analysis of overall survival....

  2. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): Late toxicity results from a randomised, non-inferiority, phase 3 trial

    NARCIS (Netherlands)

    S. Aluwini (Shafak); F.J. Pos (Floris); E. Schimmel (Erik); S. Krol (Stijn); P.-P. van der Toorn (Peter-Paul); H. de Jager (Hanja); W.G. Alemayehu (Wendimagegn Ghidey); W.D. Heemsbergen (Wilma); B.J.M. Heijmen (Ben); L. Incrocci (Luca)

    2016-01-01

    textabstractBackground: Several studies have reported a low α to β ratio for prostate cancer, suggesting that hypofractionation could enhance the biological tumour dose without increasing genitourinary and gastrointestinal toxicity. We tested this theory in the phase 3 HYPRO trial for patients with

  3. Concurrent Boost with Adjuvant Breast Hypofractionated Radiotherapy and Toxicity Assessment

    Directory of Open Access Journals (Sweden)

    Mona M. Sayed

    2015-01-01

    Full Text Available Background: The use of shorter radiotherapy schedules has an economic and logistic advantage for radiotherapy departments, as well as a high degree of patient convenience. The aim of this study is to assess the acute and short-term late toxicities of a hypofractionated radiotherapy schedule with a concomitant boost. Methods: We enrolled 57 eligible patients as group A. These patients received 42.5 Gy in 16 fractions of 2.66 Gy each to the whole breast over 3.2 weeks. A concomitant electron boost of 12 Gy in 16 fractions was also administered which gave an additional 0.75 Gy daily to the lumpectomy area for a total radiation dose of 54.5 Gy. Toxicity was recorded at three weeks and at three months for this group as well as for a control group (group B. The control group comprised 76 eligible patients treated conventionally with 50 Gy to the whole breast over five weeks followed by a sequential electron boost of 12 Gy in 2 Gy per fraction. Results: There were no statistically significant differences observed in the incidence of acute skin toxicity, breast pain, and edema recorded at three weeks or pigmentation and fibrosis recorded at three months between the two groups (P0.05. Conclusion: The results of this study suggest there are no increased acute and shortterm late toxicities affiliated with the hypofractionated schedule plus a concomitant boost as prescribed compared to the conventional fractionation of adjuvant breast radiotherapy. Large randomized trials and long-term follow-up are needed to confirm these favorable findings.

  4. 无法切除局限于肝内的肝细胞肝癌HT临床疗效观察%Hypofraction radiotherapy by helical tomotherapy for unresectable but confined intrahepatic hepatocellular carcinoma is efficient and safe in comparison with conventional 3-dimension conformal radiotherapy

    Institute of Scientific and Technical Information of China (English)

    江涛; 曾昭冲; 杨平; 胡永

    2016-01-01

    Objective To evaluate the safety of helical tomotherapy (HT) for hepatocellular carcinoma confined to the liver,and to investigate the efficacy of HT by comparison with three-dimensional conformal radiotherapy (3DCRT).Methods In June 2011,hypofractionated HT was performed in 35 patients with unresectable hepatocellular carcinoma confined to the liver who had no distant metastasis or tumor thrombosis.The dose in each fraction increased from 2.4 Gy to 5.0 Gy with a median dose of 3.2 Gy.The median dose for the total treatment was 50.0 Gy.Within the same period,45 patients received conventionally fractionated 3DCRT with a median dose of 54.0 Gy.The adverse reactions,clinical outcomes,and survival time were compared between the two groups.The survival rate was calculated with Kaplan-Meier method,and log-rank test was used to estimate statistical significance of survival differences.Multivariate analysis of survival was carried out with Cox' s regression model.Results There were no significant differences in adversc reactions between the two groups.The objective response rate was significantly higher in the HT group than in the 3DCRT group (60% vs.33%,P=0.024).There was no significant difference in the disease control rate between the two groups (94% vs.89%,P=0.459).The HT group showed significantly higher 1-,2-,and 3-year overall survival rates than the 3DCRT group (97% vs.80%,P=0.025;81% vs.55%,P =0.008;67% vs.50%,P =0.048).The multivariate analysis indicated that tumor smaller than 8 cm,transarterial chemoembolization before radiotherapy,and HT were associated with improved survival (P=0.005;P =0.000;P=0.002).Conclusions HT shows an advantage in precise treatment of hepatocellular carcinoma confined to the liver.With acceptable toxicity,hypofractionated HT shortens the treatment duration and improves the survival in patients.%目的 观察HT对局限于肝内的肝细胞肝癌的安全性,并与3DCRT疗效比较.方法 2011年6月对35例未手

  5. Dose-Fractionation Sensitivity of Prostate Cancer Deduced From Radiotherapy Outcomes of 5,969 Patients in Seven International Institutional Datasets: {alpha}/{beta} = 1.4 (0.9-2.2) Gy

    Energy Technology Data Exchange (ETDEWEB)

    Miralbell, Raymond, E-mail: Raymond.Miralbell@hcuge.ch [University Hospital, Geneva (Switzerland); Institut Oncologic Teknon, Barcelona (Spain); Roberts, Stephen A. [Health Sciences-Methodology, Manchester Academic Health Sciences Centre, University of Manchester, Manchester (United Kingdom); Zubizarreta, Eduardo [International Atomic Energy Agency, Vienna (Austria); Hendry, Jolyon H. [Adlington, Macclesfield (United Kingdom)

    2012-01-01

    Purpose: There are reports of a high sensitivity of prostate cancer to radiotherapy dose fractionation, and this has prompted several trials of hypofractionation schedules. It remains unclear whether hypofractionation will provide a significant therapeutic benefit in the treatment of prostate cancer, and whether there are different fractionation sensitivities for different stages of disease. In order to address this, multiple primary datasets have been collected for analysis. Methods and Materials: Seven datasets were assembled from institutions worldwide. A total of 5969 patients were treated using external beams with or without androgen deprivation (AD). Standard fractionation (1.8-2.0 Gy per fraction) was used for 40% of the patients, and hypofractionation (2.5-6.7 Gy per fraction) for the remainder. The overall treatment time ranged from 1 to 8 weeks. Low-risk patients comprised 23% of the total, intermediate-risk 44%, and high-risk 33%. Direct analysis of the primary data for tumor control at 5 years was undertaken, using the Phoenix criterion of biochemical relapse-free survival, in order to calculate values in the linear-quadratic equation of k (natural log of the effective target cell number), {alpha} (dose-response slope using very low doses per fraction), and the ratio {alpha}/{beta} that characterizes dose-fractionation sensitivity. Results: There was no significant difference between the {alpha}/{beta} value for the three risk groups, and the value of {alpha}/{beta} for the pooled data was 1.4 (95% CI = 0.9-2.2) Gy. Androgen deprivation improved the bNED outcome index by about 5% for all risk groups, but did not affect the {alpha}/{beta} value. Conclusions: The overall {alpha}/{beta} value was consistently low, unaffected by AD deprivation, and lower than the appropriate values for late normal-tissue morbidity. Hence the fractionation sensitivity differential (tumor/normal tissue) favors the use of hypofractionated radiotherapy schedules for all risk

  6. Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

    Directory of Open Access Journals (Sweden)

    Tunesi Sara

    2010-11-01

    Full Text Available Abstract Background A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series. Methods Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected. Results Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85% patients treated with hypofractionation and in 67/70 (96% patients treated with conventional fractionation (p = 0.01. Late toxicity was observed in 8 patients (10% in the hypofractionation group and in 10 patients (15% in the conventional fractionation group, respectively (p = 0.4. Conclusions The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.

  7. 浸润性乳腺癌保乳术后常规分割放疗与大分割放疗的疗效比较%Comparison of the efficacy between conventional radiotherapy and hypofractionated radiotherapy for invasive breast cancer after breast conserving surgery

    Institute of Scientific and Technical Information of China (English)

    韩彦辉; 李向平; 贺会江; 闫俊丽; 张高高

    2014-01-01

    Objective To investigate the differences in disease free survival time ,adverse reaction between conventional radiotherapy and hypofractionated radiotherapy for early‐stage invasive breast cancer patients who have received breast conserving operation .Methods Sixty early‐stage invasive breast cancer patients who had re‐ceived breast conserving operation in our department were divided into CRT group and HOFRT group ,30 patients in each group .Group CRT received conventional radiotherapy ,accepting 2 Gy/time ,1 time/d ,5 times/week ,to‐tal 50 Gy ,25 times ,completed irradiation in 5 weeks .Group HOFRT received hypofractionated radiotherapy ,ac‐cepting 3 .4 Gy/time ,1 time/d ,5 times/week ,total 44 .2 Gy ,13 times ,completed irradiation in 2 .5 weeks .In follow‐up ,the occurrence of adverse reaction and disease free survival time were recorded .Kaplan‐Meier method was used to compare the disease free survival time between two groups .Two independent samples test method was used to compare the adverse reaction between two groups .Results The median disease free survival time of CRT group patients was 89 .9 months ,and the median disease free survival time of HOFRT group patients was 93 months .There was no significant difference between the survival time of two groups patients (P>0.05) .For ad‐verse reaction of two groups patients ,there are differences ,there are more serious reaction in the hypofractionated radiotherapy than the conventional radiotherapy in acute skin reaction and suppression of bone marrow ( P<0.05) .Conclusion Patients in the two groups had no significant difference in disease free survival time ,but has great difference in the adverse reaction after treatment .Patients in the HOFRT group had more severe toxicity re‐action .We should apply different treatments according to different financial condition and body condition of pa‐tients to improve the efficacy in treatments .For the patients who have weaker physical condition and

  8. Electronic Support for Retrospective Analysis in the Field of Radiation Oncology: Proof of Principle Using an Example of Fractionated Stereotactic Radiotherapy of 251 Meningioma Patients

    OpenAIRE

    Rutzner, Sandra; Fietkau, Rainer; Ganslandt, Thomas; Prokosch, Hans-Ulrich; Lubgan, Dorota

    2017-01-01

    Introduction The purpose of this study is to verify the possible benefit of a clinical data warehouse (DWH) for retrospective analysis in the field of radiation oncology. Material and methods We manually and electronically (using DWH) evaluated demographic, radiotherapy, and outcome data from 251 meningioma patients, who were irradiated from January 2002 to January 2015 at the Department of Radiation Oncology of the Erlangen University Hospital. Furthermore, we linked the Oncology ...

  9. Peripheral dose from neutrons and photons in the radiation treatment of pelvic tumors with conventional technique or VMAT. A review; Periphere Neutronen- und Photonendosis bei der Radiotherapie von Tumoren des Beckens mit konventioneller Technik oder VMAT. Eine Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Winkler, P. [Medizinische Univ. Graz (Austria). Comprehensive Cancer Center

    2015-07-01

    Peripheral neutron and photon doses from external beam radiation therapy are associated with the risk of carcinogenesis in organs distant to the treated volume. In the irradiation of tumors and target volumes in the pelvis with convention photon-radiotherapy beams with high nominal energies (above 15 MeV) are typically used. During the last years volumetric modulated arc therapy (VMAT) techniques have gained a wide-spread use for pelvic treatments. The beam-energies that are primarily used in VMAT are below 10 MeV. Therefore, a reduction in peripheral dose due to the absence of neutrons can be expected when VMAT is utilized. On the other hand the number of monitor units is increased in increased in VMAT, as compared to conventional unmodulated fields, by a factor of two to three. This leads to an increase in transmission dose from the machine's treatment head, such that the potential benefit might be outbalanced. The question, whether the increasing use of VMAT might lead to a reduction of peripheral dose, is the subject of several studies. Those studies use either measurements in phantom settings or Monte-Carlo simulations. A systematic review of the literature shows diverging, and sometimes even contradictory, findings. Therefore, the issue of peripheral dose and the risk for secondary malignancies requires further investigation. In our opinion, the focus should be put on measurements and simulations, but also on modelling of dose-response correlations.

  10. Quality of life after intensity-modulated radiotherapy for prostate cancer with a hydrogel spacer. Matched-pair analysis

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, M.; Piroth, M.D.; Holy, R.; Escobar-Corral, N.; Caffaro, M.; Djukic, V.; Klotz, J.; Eble, M.J. [RWTH Aachen Univ. (Germany). Dept. of Radiation Oncology

    2012-10-15

    Background: Hydrogel spacer is an innovative method to protect the rectal wall during prostate cancer radiotherapy. Clinical effects are not well known. Methods: Patients have been surveyed before, at the last day, and 2-3 months after radiotherapy using a validated questionnaire (Expanded Prostate Cancer Index Composite). Median dose to the prostate in the spacer subgroup (SP) was 78 Gy in 2 Gy fractions. The results were independently compared with two matched-pair subgroups (treated conventionally without spacer): 3D conformal 70.2 Gy in 1.8 Gy fractions (3DCRT) and intensity-modulated radiotherapy (IMRT) 76 Gy in 2 Gy fractions. There were 28 patients in each of the three groups. Results: Baseline mean bowel bother scores were 96 points in all subgroups. Similar mean changes (SP 16, 3DCRT 14, IMRT 17 points) were observed at the end of radiotherapy. The smallest difference resulted in the spacer subgroup 2-3 months after radiotherapy (SP 2, 3DCRT 8, IMRT 6 points). Bowel bother scores were only significantly different in comparison to baseline levels in the spacer subgroup. The percentage of patients reporting moderate/big bother with specific symptoms did not increase for any item (urgency, frequency, diarrhoea, incontinence, bloody stools, pain). Conclusion: Moderate bowel quality-of-life changes can be expected during radiotherapy irrespective of spacer application or total dose. Advantages with a spacer can be expected a few weeks after treatment. (orig.)

  11. Volumetric modulated arc planning for lung stereotactic body radiotherapy using conventional and unflattened photon beams: a dosimetric comparison with 3D technique

    Directory of Open Access Journals (Sweden)

    Zhang Geoffrey G

    2011-11-01

    Full Text Available Abstract Purpose Frequently, three-dimensional (3D conformal beams are used in lung cancer stereotactic body radiotherapy (SBRT. Recently, volumetric modulated arc therapy (VMAT was introduced as a new treatment modality. VMAT techniques shorten delivery time, reducing the possibility of intrafraction target motion. However dose distributions can be quite different from standard 3D therapy. This study quantifies those differences, with focus on VMAT plans using unflattened photon beams. Methods A total of 15 lung cancer patients previously treated with 3D or VMAT SBRT were randomly selected. For each patient, non-coplanar 3D, coplanar and non-coplanar VMAT and flattening filter free VMAT (FFF-VMAT plans were generated to meet the same objectives with 50 Gy covering 95% of the PTV. Two dynamic arcs were used in each VMAT plan. The couch was set at ± 5° to the 0° straight position for the two non-coplanar arcs. Pinnacle version 9.0 (Philips Radiation Oncology, Fitchburg WI treatment planning system with VMAT capabilities was used. We analyzed the conformity index (CI, which is the ratio of the total volume receiving at least the prescription dose to the target volume receiving at least the prescription dose; the conformity number (CN which is the ratio of the target coverage to CI; and the gradient index (GI which is the ratio of the volume of 50% of the prescription isodose to the volume of the prescription isodose; as well as the V20, V5, and mean lung dose (MLD. Paired non-parametric analysis of variance tests with post-tests were performed to examine the statistical significance of the differences of the dosimetric indices. Results Dosimetric indices CI, CN and MLD all show statistically significant improvement for all studied VMAT techniques compared with 3D plans (p Conclusion Besides the advantage of faster delivery times, VMAT plans demonstrated better conformity to target, sharper dose fall-off in normal tissues and lower dose to

  12. Radiotherapy for craniopharyngioma.

    Science.gov (United States)

    Aggarwal, Ajay; Fersht, Naomi; Brada, Michael

    2013-03-01

    Radiotherapy remains the mainstay of multidisciplinary management of patients with incompletely resected and recurrent craniopharyngioma. Advances in imaging and radiotherapy technology offer new alternatives with the principal aim of improving the accuracy of treatment and reducing the volume of normal brain receiving significant radiation doses. We review the available technologies, their technical advantages and disadvantages and the published clinical results. Fractionated high precision conformal radiotherapy with image guidance remains the gold standard; the results of single fraction treatment are disappointing and hypofractionation should be used with caution as long term results are not available. There is insufficient data on the use of protons to assess the comparative efficacy and toxicity. The precision of treatment delivery needs to be coupled with experienced infrastructure and more intensive quality assurance to ensure best treatment outcome and this should be carried out within multidisciplinary teams experienced in the management of craniopharyngioma. The advantages of the combined skills and expertise of the team members may outweigh the largely undefined clinical gain from novel radiotherapy technologies.

  13. Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer. A toxicity review of simultaneous integrated protection (SIP) versus conventional SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Gkika, E.; Kirste, S.; Schimek-Jasch, T. [University Medical Center Freiburg, Department of Radiation Oncology, Freiburg im Breisgau (Germany); Adebahr, S. [University Medical Center Freiburg, Department of Radiation Oncology, Freiburg im Breisgau (Germany); German Cancer Consortium (DKTK), Heidelberg (partner site Freiburg) (Germany); Wiehle, R. [University Medical Center Freiburg, Division of Medical Physics, Department of Radiation Oncology, Freiburg (Germany); Claus, R. [University Medical Center Freiburg, Department of Hematology, Oncology and Stem-Cell Transplantation, Freiburg (Germany); Wittel, U. [University Medical Center Freiburg, Department of General and Visceral Surgery, Freiburg (Germany); Nestle, U.; Grosu, A.L.; Brunner, T.B. [University Medical Center Freiburg, Department of Radiation Oncology, Freiburg im Breisgau (Germany); German Cancer Consortium (DKTK), Heidelberg (partner site Freiburg) (Germany); University of Freiburg, Faculty of Medicine, Freiburg (Germany); Baltas, D. [University Medical Center Freiburg, Division of Medical Physics, Department of Radiation Oncology, Freiburg (Germany); German Cancer Consortium (DKTK), Heidelberg (partner site Freiburg) (Germany); University of Freiburg, Faculty of Medicine, Freiburg (Germany)

    2017-06-15

    Stereotactic body radiotherapy (SBRT) in pancreatic cancer can be limited by its proximity to organs at risk (OAR). In this analysis, we evaluated the toxicity and efficacy of two different treatment approaches in patients with locally recurrent or oligometastatic pancreatic cancer. According to the prescription method, patients were divided in two cohorts (C1 and C2). The planning target volume (PTV) was created through a 4 mm expansion of the internal target volume. In C2, a subvolume was additionally created, a simultaneous integrated protection (SIP), which is the overlap of the PTV with the planning risk volume of an OAR to which we prescribed a reduced dose. In all, 18 patients were treated (7 with local recurrences, 9 for oligometastases, 2 for both). Twelve of 23 lesions were treated without SIP (C1) and 11 with SIP (C2). The median follow-up was 12.8 months. Median overall survival (OS) was 13.2 (95% confidence interval [CI] 9.8-14.6) months. The OS rates at 6 and 12 months were 87 and 58%, respectively. Freedom from local progression for combined cohorts at 6 and 12 months was 93 and 67% (95% CI 15-36), respectively. Local control was not statistically different between the two groups. One patient in C2 experienced grade ≥3 acute toxicities and 1 patient in C1 experienced a grade ≥3 late toxicity. The SIP approach is a useful prescription method for abdominal SBRT with a favorable toxicity profile which does not compromise local control and overall survival despite dose sacrifices in small subvolumes. (orig.) [German] Die stereotaktische Strahlentherapie (SBRT) ist bei Pankreaskarzinomen durch die enge Lagebeziehung der Risikoorgane (OAR) zum Zielvolumen erschwert. In dieser Analyse evaluierten wir die Toxizitaet und die Lokalkontrolle von zwei unterschiedlichen Therapiestrategien bei Patienten mit rezidivierendem oder oligometastatischem Pankreaskarzinom. Die Patienten wurden anhand der Verschreibungsmethode in zwei Kohorten geteilt (C1 und C2). Das

  14. Randomized multicenter follow-up trial on the effect of radiotherapy for plantar fasciitis (painful heels spur) depending on dose and fractionation – a study protocol

    OpenAIRE

    Holtmann, Henrik; Niewald, Marcus; Prokein, Benjamin; Graeber, Stefan; Ruebe, Christian

    2015-01-01

    Background An actual clinical trial showed the effect of low dose radiotherapy in painful heel spur (plantar fasciitis) with single doses of 1.0 Gy and total doses of 6.0 Gy applied twice weekly. Furthermore, a lot of animal experimental and in vitro data reveals the effect of lower single doses of 0.5 Gy which may be superior in order to ease pain and reduce inflammation in patients with painful heel spur. Our goal is therefore to transfer this experimentally found effect into a randomized m...

  15. Impact of the target volume (prostate alone vs. prostate with seminal vesicles) and fraction dose (1.8 Gy vs. 2.0 Gy) on quality of life changes after external-beam radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Eble, Michael J. [Dept. of Radiotherapy, RWTH Aachen (Germany); Pinkawa, Michael; Piroth, Marc D.; Fischedick, Karin; Holy, Richard; Klotz, Jens; Nussen, Sandra; Krenkel, Barbara

    2009-11-15

    Purpose: to evaluate the impact of the clinical target volume (CTV) and fraction dose on quality of life (QoL) after external-beam radiotherapy (EBRT) for prostate cancer. Patients and methods: a group of 283 patients has been surveyed prospectively before, at the last day, at a median time of 2 months and 15 months after EBRT (70.2-72 Gy) using a validated questionnaire (Expanded Prostate Cancer Index Composite). FBRT of prostate alone (P, n = 70) versus prostate with seminal vesicles (PS, n = 213) was compared. Differences of fraction doses (1.8 Gy, n = 80, vs. 2.0 Gy, n = 69) have been evaluated in the patient group receiving a total dose of 72 Gy. Results: significantly higher bladder and rectum volumes were found at all dose levels for the patients with PS versus P within the CTV (p < 0.001). Similar volumes resulted in the groups with different fraction doses. Paradoxically, bowel function scores decreased significantly less 2 and 15 months after EBRT of PS versus P. 2 months after EBRT, patients with a fraction dose of 2.0 Gy versus 1.8 Gy reported pain with urination ({>=} once a day in 12% vs. 3%; p = 0.04) and painful bowel movements ({>=} rarely in 46% vs. 29%; p = 0.05) more frequently. No long-term differences were found. Conclusion: the risk of adverse QoL changes after EBRT for prostate cancer cannot be derived from the dose-volume histogram alone. Seminal vesicles can be included in the CTV up to a moderate total dose without adverse effects on QoL. Apart from a longer recovery period, higher fraction doses were not associated with higher toxicity. (orig.)

  16. Partial breast radiotherapy with simple teletherapy techniques

    Energy Technology Data Exchange (ETDEWEB)

    Fekete, Gábor; Újhidy, Dóra; Együd, Zsófia; Kiscsatári, Laura; Marosi, Gusztáv; Kahán, Zsuzsanna; Varga, Zoltán, E-mail: varga.zoltan@med.u-szeged.hu

    2015-01-01

    A prospective pilot study of partial breast irradiation (PBI) with conventional vs hypofractionated schedules was set out. The study aimed to determine efficacy, acute and late side effects, and the preference of photon vs electron irradiation based on individual features. Patients were enrolled according to internationally accepted guidelines on PBI. Conformal radiotherapy plans were generated with both photon and electron beams, and the preferred technique based on dose homogeneity and the radiation exposure of healthy tissues was applied. For electron dose verification, a special phantom was constructed. Patients were randomized for fractionation schedules of 25 × 2 vs 13 × 3 Gy. Skin and breast changes were registered at the time of and ≥1 year after the completion of radiotherapy. Dose homogeneity was better with photons. If the tumor bed was located in the inner quadrants, electron beam gave superior results regarding conformity and sparing of organ at risk (OAR). If the tumor was situated in the lateral quadrants, conformity was better with photons. A depth of the tumor bed ≥3.0 cm predicted the superiority of photon irradiation (odds ratio [OR] = 23.6, 95% CI: 5.2 to 107.5, p < 0.001) with >90% sensitivity and specificity. After a median follow-up of 39 months, among 72 irradiated cases, 1 local relapse out of the tumor bed was detected. Acute radiodermatitis of grade I to II, hyperpigmentation, and telangiectasia developed ≥1 year after radiotherapy, exclusively after electron beam radiotherapy. The choice of electrons or photons for PBI should be based on tumor bed location; the used methods are efficient and feasible.

  17. Partial breast radiotherapy with simple teletherapy techniques.

    Science.gov (United States)

    Fekete, Gábor; Újhidy, Dóra; Együd, Zsófia; Kiscsatári, Laura; Marosi, Gusztáv; Kahán, Zsuzsanna; Varga, Zoltán

    2015-01-01

    A prospective pilot study of partial breast irradiation (PBI) with conventional vs hypofractionated schedules was set out. The study aimed to determine efficacy, acute and late side effects, and the preference of photon vs electron irradiation based on individual features. Patients were enrolled according to internationally accepted guidelines on PBI. Conformal radiotherapy plans were generated with both photon and electron beams, and the preferred technique based on dose homogeneity and the radiation exposure of healthy tissues was applied. For electron dose verification, a special phantom was constructed. Patients were randomized for fractionation schedules of 25 × 2 vs 13 × 3Gy. Skin and breast changes were registered at the time of and ≥1 year after the completion of radiotherapy. Dose homogeneity was better with photons. If the tumor bed was located in the inner quadrants, electron beam gave superior results regarding conformity and sparing of organ at risk (OAR). If the tumor was situated in the lateral quadrants, conformity was better with photons. A depth of the tumor bed ≥3.0cm predicted the superiority of photon irradiation (odds ratio [OR] = 23.6, 95% CI: 5.2 to 107.5, p 90% sensitivity and specificity. After a median follow-up of 39 months, among 72 irradiated cases, 1 local relapse out of the tumor bed was detected. Acute radiodermatitis of grade I to II, hyperpigmentation, and telangiectasia developed ≥1 year after radiotherapy, exclusively after electron beam radiotherapy. The choice of electrons or photons for PBI should be based on tumor bed location; the used methods are efficient and feasible.

  18. A comparative dosimetric study of 3-dimensional conformal radical radiotherapy for bladder cancer patients versus conventional 2-dimensional radical radiotherapy in NCI-Cairo, Egypt%埃及开罗国家癌症研究所膀胱癌患者的三维适形根治性放疗与传统的二维根治性放疗的比较剂量学研究

    Institute of Scientific and Technical Information of China (English)

    Mohamed Mahmoud; Hesham A. El-Hossiny; Nashaat A. Diab; Marwa A. El Razek

    2012-01-01

    Objective: This study was to compare this multiple-field conformal technique to the 2-dimensional (2D) conventional technique with respect to target volume coverage and dose to normal tissues. Methods: We conducted a single institutional prospective comparative dosimetric analysis of 15 patients who received radical radiation therapy for bladder cancer presented to Radiotherapy Department in National Cancer Institute, Cairo (Egypt), in period between November 2011 to July 2012 using 3-dimensional (3D) conformal radiotherapy technique for each patient, a second 2D conventional radiotherapy treatment plan was done, the two techniques were then compared using dose volume histogram (DVH) analysis. Results: Comparing different DVHs, it was found that the planning target volume (PTV) was adequately covered in both (3D & 2D) plans while it was demonstrated that this multiple field conformal technique produced superior distribution compared to 2D technique, with considerable sparing of rectum and to lesser extent for the head of both femora. Conclusion: From the present study, it is recommended to use 3D planning for cases of bladder cancer especially in elderly patients as it produces good coverage of the target volume as well as good sparing of the surrounding critical organs.

  19. Radiotherapy and "new" drugs-new side effects?

    Directory of Open Access Journals (Sweden)

    Niyazi Maximilian

    2011-12-01

    Full Text Available Abstract Background and purpose Targeted drugs have augmented the cancer treatment armamentarium. Based on the molecular specificity, it was initially believed that these drugs had significantly less side effects. However, currently it is accepted that all of these agents have their specific side effects. Based on the given multimodal approach, special emphasis has to be placed on putative interactions of conventional cytostatic drugs, targeted agents and other modalities. The interaction of targeted drugs with radiation harbours special risks, since the awareness for interactions and even synergistic toxicities is lacking. At present, only limited is data available regarding combinations of targeted drugs and radiotherapy. This review gives an overview on the current knowledge on such combined treatments. Materials and methods Using the following MESH headings and combinations of these terms pubmed database was searched: Radiotherapy AND cetuximab/trastuzumab/panitumumab/nimotuzumab, bevacizumab, sunitinib/sorafenib/lapatinib/gefitinib/erlotinib/sirolimus, thalidomide/lenalidomide as well as erythropoietin. For citation crosscheck the ISI web of science database was used employing the same search terms. Results Several classes of targeted substances may be distinguished: Small molecules including kinase inhibitors and specific inhibitors, antibodies, and anti-angiogenic agents. Combination of these agents with radiotherapy may lead to specific toxicities or negatively influence the efficacy of RT. Though there is only little information on the interaction of molecular targeted radiation and radiotherapy in clinical settings, several critical incidents are reported. Conclusions The addition of molecular targeted drugs to conventional radiotherapy outside of approved regimens or clinical trials warrants a careful consideration especially when used in conjunction in hypo-fractionated regimens. Clinical trials are urgently needed in order to

  20. Intravenous administration of the selective toll-like receptor 7 agonist DSR-29133 leads to anti-tumor efficacy in murine solid tumor models which can be potentiated by combination with fractionated radiotherapy

    Science.gov (United States)

    Dovedi, Simon J.; Adlard, Amy L.; Ota, Yosuke; Murata, Masashi; Sugaru, Eiji; Koga-Yamakawa, Erina; Eguchi, Ken; Hirose, Yuko; Yamamoto, Setsuko; Umehara, Hiroki; Honeychurch, Jamie; Cheadle, Eleanor J.; Hughes, Gareth; Jewsbury, Philip J.

    2016-01-01

    Strategies to augment anti-cancer immune responses have recently demonstrated therapeutic utility. To date clinical success has been achieved through targeting co-inhibitory checkpoints such as CTLA-4, PD-1, and PD-L1. However, approaches that target co-activatory pathways are also being actively being developed. Here we report that the novel TLR7-selective agonist DSR-29133 is well tolerated in mice and leads to acute immune activation. Administration of DSR-29133 leads to the induction of IFNα/γ, IP-10, TNFα, IL-1Ra and IL-12p70, and to a reduction in tumor burden in syngeneic models of renal cancer (Renca), metastatic osteosarcoma (LM8) and colorectal cancer (CT26). Moreover, we show that the efficacy of DSR-29133 was significantly improved when administered in combination with low-dose fractionated radiotherapy (RT). Effective combination therapy required weekly administration of DSR-29133 commencing on day 1 of a fractionated RT treatment cycle, whereas no enhancement of radiation response was observed when DSR-29133 was administered at the end of the fractionated RT cycle. Combined therapy resulted in curative responses in a high proportion of mice bearing established CT26 tumors which was dependent on the activity of CD8+ T-cells but independent of CD4+ T-cells and NK/NKT cells. Moreover, long-term surviving mice originally treated with DSR-29133 and RT were protected by a tumor-specific memory immune response which could prevent tumor growth upon rechallenge. These results demonstrate that DSR-29133 is a potent selective TLR7 agonist that when administered intravenously can induce anti-tumor immune responses that can be further enhanced through combination with low-dose fractionated RT. PMID:26959743

  1. Reducing radiation induced emesis in abdominal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, K. (Royal Marsden Hospital, Sutton (United Kingdom))

    1994-06-01

    In patients with seminoma testes, a comparison was made between radiation induced emesis suffered by patients receiving 'dogleg' radiotherapy with those suffered by patients who received para-aortic radiotherapy. The same comparisons were made between the effects suffered by those patients who received the anti-emetic, Ondansetron, and those suffered by patients who received conventional anti-emetics. (UK).

  2. Fractional randomness

    Science.gov (United States)

    Tapiero, Charles S.; Vallois, Pierre

    2016-11-01

    The premise of this paper is that a fractional probability distribution is based on fractional operators and the fractional (Hurst) index used that alters the classical setting of random variables. For example, a random variable defined by its density function might not have a fractional density function defined in its conventional sense. Practically, it implies that a distribution's granularity defined by a fractional kernel may have properties that differ due to the fractional index used and the fractional calculus applied to define it. The purpose of this paper is to consider an application of fractional calculus to define the fractional density function of a random variable. In addition, we provide and prove a number of results, defining the functional forms of these distributions as well as their existence. In particular, we define fractional probability distributions for increasing and decreasing functions that are right continuous. Examples are used to motivate the usefulness of a statistical approach to fractional calculus and its application to economic and financial problems. In conclusion, this paper is a preliminary attempt to construct statistical fractional models. Due to the breadth and the extent of such problems, this paper may be considered as an initial attempt to do so.

  3. Resistance to mycobacteria in mice treated with fractionated total lymphoid irradiation (TLI) and in mice reconstituted with allogeneic bone marrow cells following radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mor, N.; Lutsky, I.; Weiss, L.; Morecki, S.; Slavin, S.

    1985-01-01

    The increased clinical use of total lymphoid irradiation (TLI) as an immunosuppressive adjunct in transplantation suggested the need for determining the effects of TLI on the in vivo susceptibility of animals to infections controlled by cell-mediated immunity. TLI-treated, TLI-treated and splenectomized, and chimeric mice prepared with TLI were inoculated in the hind foot pad with Mycobacterium marinum or Mycobacterium leprae. Although M. marinum organisms multiplied in greater numbers in the TLI mice, ultimately they were destroyed as effectively in TLI mice as in the non-irradiated control mice. M. leprae multiplied at the same rate and to the same maximum in TLI mice as in controls. Mice previously challenged with M. marinum in one hind foot pad, and challenged subsequently with the same organism in the opposite hind foot pad, showed a solid immunity against this reinfection. It appears that upon recovery from the immediate effects of radiotherapy TLI-treated mice are able to mount an effective immune response to experimental infection with M. marinum and M. leprae.

  4. Assessment of function and quality of life in a phase II multi-institutional clinical trial of fractionated simultaneous in-field boost radiotherapy for patients with 1-3 metastases.

    Science.gov (United States)

    Bauman, Glenn; Yartsev, Slav; Roberge, David; MacRae, Robert; Roa, Wilson; Panet-Raymond, Valerie; Masucci, Laura; Yaremko, Brian; D'Souza, David; Palma, David; Sexton, Tracy; Yu, Edward; Pantarotto, Jason R; Ahmad, Belal; Fisher, Barbara; Dar, A Rashid; Lambert, Carole; Pond, Gregory; Stitt, Larry; Tay, Keng Yeow; Rodrigues, George

    2016-07-01

    We examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Eighty seven people with 1-3 brain metastases (54/87 lung primary, 42/87 single brain metastases) were enrolled on this Phase II trial of WBRT (30 Gy/10) + simultaneous FSRT, (60 Gy/10). Median overall follow-up and survival was 5.4 months, 6 month actuarial intra-lesional control was 78 %; only 1 patient exhibited grade 4 toxicity (worsened seizures); most treatment related toxicity was grade 1 or 2; 2/87 patients demonstrated asymptomatic radiation necrosis on follow-up imaging. Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to <27) ranged from 26 to 38 % for KPS, 32-59 % for FACT-Br and 0-16 % for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (≤6 months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. The effects on function and quality of life of this integrated treatment of WBRT + simultaneous FSRT were similar to other published series combining WBRT + radiosurgery.

  5. Comparison of optical localization techniques for optical coherence tomography of the hand for multi-fraction orthovoltage radiotherapy or photodynamic therapy: white light vs. optical surface imaging (Conference Presentation)

    Science.gov (United States)

    Jakubovic, Raphael; Bains, Amitpal; Ramjist, Joel; Babic, Steve; Chin, Lee; Barnes, Elizabeth; Yang, Victor X. D.

    2017-02-01

    Non-melanoma skin cancer (NMSC) is considered the most commonly diagnosed cancer in the United States and Canada. Treatment options include radiotherapy, surgical excision, radiotherapy, topical therapies, electrocautery, and cryotherapy. For patients undergoing fractionated orthovoltage radiation therapy or photodynamic therapy (PDT), the lesions are typically delineated by clinical markup prior to treatment without providing any information about the underlying tissue thus increasing the risk of geographic miss. The development of biomarkers for response in NMSC is imperative considering the current treatment paradigm is based on clinical examination and biopsy confirmation. Therefore, a non-invasive image-based evaluation of skin structure would allow for faster and potentially more comprehensive microscopic evaluation of the treated region at the point of care. To address this, our group is investigating the use of optical coherence tomography (OCT) for pre- and post- treatment evaluation of NMSC lesions during radiation therapy and PDT. Localization of the OCT probe for follow-up is complex, especially in the context of treatment response where the lesion is not present, precluding accurate delineation of the planning treatment area. Further, comparison to standard white light pre-treatment images is limited by the scale of the OCT probe (6 mm X 6 mm) relative to target region. In this study we compare the set-up accuracy of a typical OCT probe to detect a theoretical lesion on a patient's hand. White light images, optical surface imaging (OSI) and OCT will be obtained at baseline and used for probe set up on subsequent scans. Set-up error will be quantified using advanced image processing techniques.

  6. Treatment of acromegaly patients with risk-adapted single or fractionated stereotactic high-precision radiotherapy. High local control and low toxicity in a pooled series

    Energy Technology Data Exchange (ETDEWEB)

    Bostroem, Jan Patrick [Mediclin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn (Germany); University Hospital of Bonn, Department of Neurosurgery, Bonn (Germany); Kinfe, Thomas; Pintea, Bogdan [University Hospital of Bonn, Department of Neurosurgery, Bonn (Germany); Meyer, Almuth [HELIOS Klinikum Erfurt, Department of Endocrinology, Erfurt (Germany); Gerlach, Ruediger [HELIOS Klinikum Erfurt, Department of Neurosurgery, Erfurt (Germany); Surber, Gunnar; Hamm, Klaus [HELIOS Klinikum Erfurt, Department of Radiosurgery, Erfurt (Germany); Lammering, Guido [Mediclin Robert Janker Clinic and MediClin MVZ Bonn, Department of Radiosurgery and Stereotactic Radiotherapy, Bonn (Germany); Heinrich-Heine-University of Duesseldorf, Department of Radiotherapy and Radiation Oncology, Duesseldorf (Germany)

    2015-01-10

    The purpose of this work was to evaluate a prospectively initiated two-center protocol of risk-adapted stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) in patients with acromegaly. In total 35 patients (16 men/19 women, mean age 54 years) were prospectively included in a treatment protocol of SRS [planning target volume (PTV) < 4 ccm, > 2 mm to optic pathways = low risk] or SRT (PTV ≥ 4 ccm, ≤ 2 mm to optic pathways = high risk). The mean tumor volume was 3.71 ccm (range: 0.11-22.10 ccm). Based on the protocol guidelines, 21 patients were treated with SRS and 12 patients with SRT, 2 patients received both consecutively. The median follow-up (FU) reached 8 years with a 5-year overall survival (OS) of 87.3 % [confidence interval (CI): 70.8-95.6 %] and 5-year local control rate of 97.1 % (CI: 83.4-99.8 %). Almost 80 % (28/35) presented tumor shrinkage during FU. Endocrinological cure was achieved in 23 % and IGF-1 normalization with reduced medication was achieved in 40 % of all patients. An endocrinological response was generally achieved within the first 3 years, but endocrinological cure can require more than 8 years. A new adrenocorticotropic hypopituitarism occurred in 13 patients (46.4 %). A new visual field disorder and a new oculomotor palsy occurred in 1 patient, respectively. Patients with occurrence of visual/neurological impairments had a longer FU (p = 0.049). Our SRS/SRT protocol proved to be safe and successful in terms of tumor control and protection of the visual system. The timing and rate of endocrine improvements are difficult to predict. One has to accept an unavoidable rate of additional adrenocorticotropic hypopituitarism in the long term. (orig.) [German] Zielsetzung dieser Arbeit ist die Evaluation eines prospektiv angelegten Behandlungsprotokolls einer risikoadaptierten stereotaktischen Radiochirurgie (SRS) oder stereotaktischen Radiotherapie (SRT) von Patienten mit Akromegalie aus 2 Zentren. Insgesamt 35 Patienten (16

  7. Electronic Support for Retrospective Analysis in the Field of Radiation Oncology: Proof of Principle Using an Example of Fractionated Stereotactic Radiotherapy of 251 Meningioma Patients.

    Science.gov (United States)

    Rutzner, Sandra; Fietkau, Rainer; Ganslandt, Thomas; Prokosch, Hans-Ulrich; Lubgan, Dorota

    2017-01-01

    The purpose of this study is to verify the possible benefit of a clinical data warehouse (DWH) for retrospective analysis in the field of radiation oncology. We manually and electronically (using DWH) evaluated demographic, radiotherapy, and outcome data from 251 meningioma patients, who were irradiated from January 2002 to January 2015 at the Department of Radiation Oncology of the Erlangen University Hospital. Furthermore, we linked the Oncology Information System (OIS) MOSAIQ(®) to the DWH in order to gain access to irradiation data. We compared the manual and electronic data retrieval method in terms of congruence of data, corresponding time, and personal requirements (physician, physicist, scientific associate). The electronically supported data retrieval (DWH) showed an average of 93.9% correct data and significantly (p = 0.009) better result compared to manual data retrieval (91.2%). Utilizing a DWH enables the user to replace large amounts of manual activities (668 h), offers the ability to significantly reduce data collection time and labor demand (35 h), while simultaneously improving data quality. In our case, work time for manually data retrieval was 637 h for the scientific assistant, 26 h for the medical physicist, and 5 h for the physician (total 668 h). Our study shows that a DWH is particularly useful for retrospective analysis in the radiation oncology field. Routine clinical data for a large patient group can be provided ready for analysis to the scientist and data collection time can be significantly reduced. Furthermore, linking multiple data sources in a DWH offers the ability to improve data quality for retrospective analysis, and future research can be simplified.

  8. Fractionated radiosurgery for painful spinal metastases: DOSIS - a phase II trial.

    Science.gov (United States)

    Guckenberger, Matthias; Hawkins, Maria; Flentje, Michael; Sweeney, Reinhart A

    2012-11-19

    One third of all cancer patients will develop bone metastases and the vertebral column is involved in approximately 70% of these patients. Conventional radiotherapy with of 1-10 fractions and total doses of 8-30 Gy is the current standard for painful vertebral metastases; however, the median pain response is short with 3-6 months and local tumor control is limited with these rather low irradiation doses. Recent advances in radiotherapy technology - intensity modulated radiotherapy for generation of highly conformal dose distributions and image-guidance for precise treatment delivery - have made dose-escalated radiosurgery of spinal metastases possible and early results of pain and local tumor control are promising. The current study will investigate efficacy and safety of radiosurgery for painful vertebral metastases and three characteristics will distinguish this study. 1) A prognostic score for overall survival will be used for selection of patients with longer life expectancy to allow for analysis of long-term efficacy and safety. 2) Fractionated radiosurgery will be performed with the number of treatment fractions adjusted to either good (10 fractions) or intermediate (5 fractions) life expectancy. Fractionation will allow inclusion of tumors immediately abutting the spinal cord due to higher biological effective doses at the tumor - spinal cord interface compared to single fraction treatment. 3) Dose intensification will be performed in the involved parts of the vertebrae only, while uninvolved parts are treated with conventional doses using the simultaneous integrated boost concept. It is the study hypothesis that hypo-fractionated image-guided radiosurgery significantly improves pain relief compared to historic data of conventionally fractionated radiotherapy. Primary endpoint is pain response 3 months after radiosurgery, which is defined as pain reduction of ≥ 2 points at the treated vertebral site on the 0 to 10 Visual Analogue Scale. 60 patients

  9. Radiotherapy; Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Wannenmacher, M. [Heidelberg Univ., Mannheim (Germany). Abt. fuer Klinische Radiologie; Debus, J. [Univ. Heidelberg (Germany). Abt. Radioonkologie und Strahlentherapie; Wenz, F. (eds.) [Universitaetsklinikum Mannheim (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2006-07-01

    The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy.

  10. How to irradiate bone metastases?; Radiotherapie des metastases osseuses: quel est le meilleur schema de radiotherapie?

    Energy Technology Data Exchange (ETDEWEB)

    Pradier, O.; Bouchekoua, M.; Albargach, N.; Muller, M.; Malhaire, J.P. [Centre Hospitalier Universitaire, Service de Radiotherapie, Institut de Cancerologie et d' Hematologie, 29 - Brest (France)

    2008-12-15

    Radiotherapy for bone metastases represents an important part of daily practice in our departments of radiotherapy. Majority of treatments deliver either one fraction (6 to 10 Gy) or multi-fractions mainly using 30 Gy in ten fractions. In the past decade, several randomized trials aimed to determine the optimal scheme of radiotherapy in this setting. In the present review, the efficacy of radiotherapy on bone metastases will be evaluated using the following parameters: the partial or complete responses on pain, the reduction of antalgic intake, bone re-calcification, and need for reirradiation. Other parameters must also be considered, such as the primary site, number of metastasis, performance status, overall prognosis and side effects of radiotherapy. (authors)

  11. Population and patient-specific target margins for 4D adaptive radiotherapy to account for intra- and inter-fraction variation in lung tumour position

    Science.gov (United States)

    Hugo, Geoffrey D.; Yan, Di; Liang, Jian

    2007-01-01

    In this work, five 4D image-guidance strategies (two population, an offline adaptive and two online strategies) were evaluated that compensated for both inter- and intra-fraction variability such as changes to the baseline tumour position and respiratory pattern. None of the strategies required active motion compensation such as gating or tracking; all strategies simulated a free-breathing-based treatment technique. Online kilovoltage fluoroscopy was acquired for eight patients with lung tumours, and used to construct inter- and intra-fraction tumour position variability models. Planning was performed on a mid-ventilation image acquired from a respiration-correlated CT scan. The blurring effect of tumour position variability was included in the dose calculation by convolution. CTV to PTV margins were calculated for variability in the cranio-caudal direction. A population margin of 9.0 ± 0.7 mm was required to account for setup error and respiration in the study population without the use of image-guidance. The greatest mean margin reduction was introduced by the offline adaptive strategy. A daily online correction strategy produced a small reduction (1.6 mm) in the mean margin from the offline strategy. Adaptively correcting for an inter-fraction change in the respiratory pattern had little effect on margin size due to most patients having only small daily changes in the respiratory pattern. A daily online correction strategy would be useful for patients who exhibit large variations in the daily mean tumour position, while an offline adaptive strategy is more applicable to patients with less variation.

  12. 非小细胞肺癌术后三维适形放疗与常规放疗结果比较%Comparison of postoperative three-dimensional conformal radiotherapy with conventional radiotherapy for non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    戴洪海; 周宗玫; 张红星; 殷蔚伯; 姬巍; 王绿化; 欧广飞; 梁军; 冯勤付; 肖泽芬; 陈东福; 吕纪马

    2009-01-01

    目的 回顾性比较非小细胞肺癌术后三维适形放疗(3DCRT)和常规放疗的疗效、失败模式及副反应.方法 分析3年余接受术后放疗的ⅠB~ⅢB期非小细胞肺癌患者162例,其中86例采用3DCRT,76例采用常规放疗.结果 总随访率91.5%,3DCRT和常规放疗的中位随访时间分别为29.4个月和33.8个月.3DCRT和常规放疗的1、2、3年无局部进展生存率分别为97.5%、83.2%、83.2%和84.3%、76.0%、65.6%(χ2=5.46,P=0.019),总生存率、无疾病进展生存率和无远转生存率均相似;总局部区域失败率分别为14.5%和33.3%(χ2=7.70 P=0.006),远处转移率两组相似.2~3级放射性肺炎发生率3DCRT显著低于常规放疗(11.6%:23.7% χ2=4.10,P=0.043).结论 术后放疗采用3DCRT技术比常规放疗技术能提高局部控制率,降低放疗相关副反应发生率.%Objective To compare postoperative three-dimensional conformal radiotherapy (3DCRT) and conventional radiotherapy (CR) in patients with non-small-cell lung cancer (NSCLC). Methods From Nov. 2002 to Mar. 2006,162 patients with stage ⅠB~ⅢB NSCLC receiving postoperative radiotherapy in our department were restrospetcively analyzed. Among them,86 received 3DCRT and 76 re-ceived CR. The survival outcome, pattern of failure and treatment-related side effects in both groups were an-alyzed. Results The median follow-up was 29.4 months in the 3DCRT group and 24 months in the CR group. The 1-,2- and 3-year local-regional free survival was 97.5% ,83.2% and 83.2% in 3DCRT group, and 84.3% ,76.0% and 65.6% in CR group(χ2= 5.46, P = 0.019), respectively. No statistically signifi-cant difference was found in the overall survival, disease-free survival or distant metastasis-free survival be-tween the two groups. The local-regional failure rate was statistically different between the two groups (14.5% vs 33.3% ,χ2 =7.70,P =0.006). The incidence of distant metastasis in the two groups was simi-lar. Radiation pneumonitis of NCI

  13. Thalassaemic osteoarthropathy treated with radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-11-01

    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).

  14. [Radiotherapy for Graves' ophthalmopathy].

    Science.gov (United States)

    Kuhnt, T; Müller, A C; Janich, M; Gerlach, R; Hädecke, J; Duncker, G I W; Dunst, J

    2004-11-01

    Graves' ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease, an autoimmune disorder of the thyroid, whereas the precise pathogenesis still remains unclear. In Hashimoto's thyroiditis the occurrence of proptosis is an extremely rare event. The therapy for middle and severe courses of GO shows in partly disappointing results, although several therapy modalities are possible (glucocorticoid therapy, radiotherapy, antithyroid drug treatment, surgery). All these therapies lead in only 40 - 70 % to an improvement of the pathogenic symptoms. An intensive interdisciplinary cooperation is necessary to satisfy the requirements for the treatment of Graves' ophthalmopathy. As a consequence of the very different results of the few of clinical studies that were accomplished with reference to this topic, treatment by radiotherapy in the management of the disease is presently controversially discussed. In the German-speaking countries the radiotherapy is, however, firmly established as a therapy option in the treatment of the moderate disease classes (class 2-5 according to NO SPECS), especially if diplopia is present. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. Altogether, radiotherapy is assessed as an effective and sure method. The administration of glucocorticoids can take place before the beginning of or during the radiotherapy. For the success of treatment the correct selection of patients who may possibly profit from a radiotherapy is absolutely essential. By realising that GO proceeds normally over a period of 2-5 years, which is followed by a period of fibrotic alteration, the application of the radiotherapy in the early, active phase is indispensable. A precise explanation for the effects of radiotherapy in treatment of the GO does not exist at present. The determination of the most effective irradiation doses was made from retrospectively evaluated

  15. Treatment outcome in patients with vulvar cancer: comparison of concurrent radiotherapy to postoperative radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ja Young; Kim, Sung Hwan; Kim, Ki Won; Park, Dong Choon; Yoon, Joo Hee; Yoon, Sei Chul [St. Vincent' s Hospital, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of); Yu, Mina [St. Mary' s Hospital, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

  16. Radiotherapy of painful heel spur with two fractionation regimens. Results of a randomized multicenter trial after 48 weeks' follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Prokein, Benjamin; Dzierma, Yvonne; Ruebe, Christian; Fleckenstein, Jochen; Niewald, Marcus [Saarland University Hospital, Department of Radiotherapy and Radiooncology, Homburg (Germany); Holtmann, Henrik [Saarland University Hospital, Department of Radiotherapy and Radiooncology, Homburg (Germany); University Hospital of Duesseldorf, Department of Oral and Maxillofacial Surgery, Duesseldorf (Germany); Hautmann, Matthias G. [University Hospital of Regensburg, Department of Radiotherapy, Regensburg (Germany); Roesler, Hans-Peter [University Hospital of Mainz, Department of Radiooncology and Radiotherapy, Mainz (Germany); Graeber, Stefan [Saarland University Hospital, Institute of Medical Biometrics, Epidemiology and Medical Informatics, Homburg (Germany)

    2017-06-15

    In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective. A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 x 1 Gy twice a week, while the experimental group was treated with single fractions of 12 x 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks. The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded. Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 x 0.5 Gy was not superior to the current standard dose of 6 x 1 Gy. Further trials are necessary to explore the best fractionation schedule. (orig.) [German] In dieser randomisierten Multizenterstudie wurde der Effekt einer niedrigen Einzeldosis von 0,5 Gy hinsichtlich Schmerzen und Lebensqualitaet mit demjenigen einer Standarddosis von 1,0 Gy verglichen, dies bei konstanter Gesamtdosis von 6 Gy. Nach Laborergebnissen war eine Ueberlegenheit der niedrigen Einzeldosis zu erwarten. Es wurden 127 Patienten randomisiert - einerseits in

  17. SU-C-210-07: Assessment of Intra-/Inter-Fractional Internal Tumor and Organ Movement in Radiotherapy of Head and Neck Cancer Using On-Board Cine MRI

    Energy Technology Data Exchange (ETDEWEB)

    Chen, H; Dolly, S; Anastasio, M; Fischer-Valuck, B; Kashani, R; Green, O; Rodriguez, V; Mutic, S; Gay, H; Thorstad, W; Li, H [Washington University School of Medicine, Saint Louis, MO (United States); Victoria, J; Dempsey, J [ViewRay Incorporated, Oakwood Village, OH (United States); Ruan, S [University of Rouen, QuantIF - EA 4108 LITIS, Rouen (France); Low, D [University of California Los Angeles, Los Angeles, CA (United States)

    2015-06-15

    Purpose: Head and neck (H&N) internal organ motion has previously been determined with low frequency and temporary nature based on population-based pre- and post-treatment studies. Using immobilization masks and adding a 4–6 mm planning-tumor-volume margin, geometric uncertainties of patients are routinely considered clinically inconsequential in H&N radiotherapy. Using the first commercially-available MR-IGRT system, we conducted the first quantitative study on inter-patient, intra- and inter-fractional H&N internal motion patterns to evaluate the necessity of individualized asymmetric internal margins. Methods: Ninety cine sagittal MR image sequences were acquired during the entire treatment course (6–7 weeks) of three H&N cancer patients using the ViewRay™ MR-IGRT system. The images were 5 mm thick and acquired at 4 frames/per second. One of the patients had a tracheostomy tube. The cross-sectional H&N airway (nasopharynx, oropharynx, and laryngopharynx portions) movement was analyzed comprehensively using in-house developed motion detection software. Results: Large inter-patient variations of swallowing frequency (0–1 times/per fraction), swallowing duration (1–3 seconds), and pharyngeal cross-sectional area (238–2516 mm2) were observed. Extensive pharyngeal motion occurred during swallowing, while nonzero and periodic change of airway geometry was observed in resting. For patient 1 with tracheostomy tube replacement, 30.3%, 30.0%, 48.7% and 0.3% of total frames showed ≥ 4 mm displacements in the anterior, posterior, inferior, and superior airway boundaries, respectively; similarly, (5.7%, 0.0%, 0.0%, 0.3%) and (23.3%, 0.0%, 35.7%, 1.7%) occurred for patients 2 and 3. Area overlapping coefficients with respect to the first frame were 76.3+/−6.4%, 90.3+/−0.6%, and 92.3+/−1.2% for the three patients, respectively. Conclusion: Both the resting and swallowing motions varied in frequency and amplitude among the patients and across fractions of a

  18. What does large randomized trials tell us about the fractionation sensitivity of prostate cancer?

    Science.gov (United States)

    Høyer, M.

    2017-01-01

    Seven randomized clinical trials have tested the use of moderate hypofractionation (2.1-3.5 Gy per fraction) compared to conventional fractionation (1.8-2.0 Gy per fraction) in radiotherapy for localized prostate cancer. The trails find that moderate hypofractionation results in acceptable PSA-control and morbidities that are comparable to conventional fractionation schedules. Extrapolation of the results from the earliest randomized trials indicated a low α/β- values for prostate cancer, but the more recent – and large – studies suggest that the value is moderately or considerably higher. Moderate hypofractionation schedules (ie. 20 x 3 Gy) are now being implemented in routine practice. They are cost-effective and convinient, but they are not consistantly concordant with fractionation sensitivity parameters extrapolated from clinical trials on moderate hypofractionation of prostate cancer.

  19. Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy.

    Science.gov (United States)

    Rudat, Volker; Nour, Alaa; Ghaida, Salam Abou; Alaradi, Aziz

    2016-07-30

    The purpose of the study was to evaluate the impact of multiple prognostic factors on the acute skin reaction in adjuvant breast cancer radiotherapy, in particular the impact of hypofractionation (HF) compared to conventional fractionation (CF) and tangential beam (TB) IMRT compared to three-dimensional conformal radiotherapy (3DCRT). Two-hundred and sixty-six breast cancer patients with postoperative radiotherapy after breast conserving surgery or mastectomy were retrospectively evaluated. Patients were treated with HF (15 fractions of 2.67 Gy; n = 121) or CF (28 fractions of 1.8 Gy or 25 fractions of 2.0 Gy; n = 145) and TB-IMRT (n = 151) or 3DCRT (n = 115). The acute skin reactions were prospectively assessed using the CTCAE v4 grading scale. Ordinal regression analysis was used to assess the impact of possible prognostic factors on the maximal acute skin reaction. Grade 2 skin reactions were observed in 19 % of the patients treated with CF compared to 2 % treated with HF. On univariate analysis, the fractionation regimen, the PTV (breast versus chest wall), the volume of the PTV and the body mass index were significant prognostic factors for the maximum acute skin reaction. On multivariate analysis, the fractionation regimen (p skin reaction compared to CF.

  20. HIV-associated cutaneous Kaposi`s sarcoma - palliative local treatment by radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Saran, F.H. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Adamietz, I.A. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Thilmann, C. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Mose, S. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany); Boettcher, H.D. [Dept. of Radiotherapy and Oncology, Univ. Hospital, Frankfurt Univ. (Germany)

    1997-07-01

    The increasing number of HIV-infected patients makes palliative treatment of HIV-associated Kaposi`s sarcoma more common. We retrospectively evaluated a reduced fractionated radiotherapy with 20 Gy in respect to response rates and acute side-effects. From January 1992 to January 1995, 52 patients with HIV-associated Kaposi`s sarcoma were treated with 133 single portals. Six weeks after the end of radiotherapy 42 patients with 124 portals were evaluable with respect to response rates and side-effects. Of the treated portals 32% were judged as complete responses (CR), 55% as partial responses (PR) and 12% as no change (NC). Skin reactions RTOG, grade 1 were seen in 74% of the patients. Compared with literature data the reduced overall dose of 20 Gy in 10 fractions led to a reduction of CRs by approximately 50% while the overall response rate remained equal. The success of radiotherapy for the nodular component of Kaposi`s sarcoma can be improved, if a dose exceeding 20 Gy in 10 fractions is applied but at the cost of increasing side-effects in case that non-conventional fractionation schemes are used. (orig.).

  1. 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: rezende.med@terra.com.br [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)

    2011-07-01

    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

  2. Detection and characterization of silver nanoparticles in chicken meat by asymmetric flow field flow fractionation with detection by conventional or single particle ICP-MS

    DEFF Research Database (Denmark)

    Löschner, Katrin; Navratilova, Jana; Købler, Carsten;

    2013-01-01

    A method of analysis of silver nanoparticles (AgNPs) in chicken meat was developed. The homogenized chicken meat sample, which was spiked with AgNPs, was subjected to enzymolysis by Proteinase K for 40 min at 37 °C. Transmission electron microscopy and inductively coupled plasma mass spectrometry...... of the AgNPs took place during the sample preparation stage. The digestate was injected into the asymmetric flow field flow fractionation (AF(4)) -ICP-MS system, which enabled fractionation of nanoparticles from the remaining meat matrix, and resulted in one large peak in the fractograms as well as two...... (ICP-MS) in single particle mode were used to characterize the number-based size distribution of AgNPs in the meat digestate. Because similar size distributions were found in the meat digestate and in the aqueous suspension of AgNPs used for spiking the meat, it was shown that no detectable dissolution...

  3. 小细胞肺癌脑转移全脑放疗失败后挽救性分次立体定向放疗疗效分析%Fractionated stereotactic radiotherapy for recurrent small cell lung cancer brain metastases after whole brain radiotherapy

    Institute of Scientific and Technical Information of China (English)

    李祥攀; 李晔雄; 肖建平; 陈秀军; 姜雪松; 张烨; 徐英杰; 郇福奎; 方浩; 万宝

    2012-01-01

    Objective Evaluation the Fractionated Stereotactic Radiotherapy (FSRT) for the patients with small-cell lung cancer (SCLC) after the whole brain radiotherapy (WBRT) failure.Methods We retrospectively analyzed 35 patients with brain metastases from small-cell lung cancer treated with linear accelerator FSRT after the WBRT failure. Multivariate analysis was used to determine significant prognostic factor related to survival.Results The following-up rate was 100%.The median following-up time was 11 months.The median over-all survival (OS) time was 10.3( 1 -30) months after FSRT.Controlled extra cranial disease was the only identified significant predictor of increased median OS time (χ2 =4.02,P =0.045 ).The median OS time from the diagnosis of brain metastasis was 22 (6 - 134 )months.14 patients died from brain metastasis,14 from extra-cranial progression,1 from leptomeningeal metastases,and 3 from other causes. Local control at 6 months and 12 months was 91% and 76%,respectively.No significant late complications.New brain metastases outside of the treated area developed in 17% of patients at a median time of 4(2 -20) months; all patients had received previous WBRT.Conclusions Fractionated stereotactic radiotherapy was safe and effective treatment for recurrent small-cell lung carcinoma brain metastases.%目的 评价小细胞肺癌( SCLC)全脑放疗(WBRT)后颅内失败分次立体定向放疗(FSRT)挽救的价值.方法 回顾分析WBRT失败后使用FSRT挽救的35例SCLC脑转移患者的生存情况,多因素分析确定和生存相关的预后因素.结果 随访率为100%,中位随访时间11个月.全组总中位生存期为10.3个月,多因素分析显示颅外疾病控制状态和患者的生存相关(χ2=4.02,P=0.045).自诊断脑转移开始中位生存期为22.0个月,未发现严重晚期不良反应.6、12个月局部控制率分别为91%、76%.6例局部未控患者中3例行二程FSRT挽救,挽救治疗后生存时间分别为3、9

  4. Hypofractionated radiotherapy in carcinoma breast: What we have achieved?

    Directory of Open Access Journals (Sweden)

    Tapesh Bhattacharyya

    2015-01-01

    Full Text Available Healthy breast tissue is sensitive to radiation fraction size, such that small changes in fraction size can lead to larger changes in radiation effects on these tissues. Conventional breast and/or chest wall irradiation uses 2 Gy daily fractions, for 5-6 weeks. Such a long treatment schedule has major implications on both patient quality of life and burden of radiotherapy (RT departments. Some investigators have hypothesized that breast cancer is as sensitive as normal breast tissue to fraction size. According to the hypothesis, small fraction sizes of 2.0 Gy or less offer no therapeutic advantage, and a more effective strategy would be to deliver fewer, larger fractions that result in a lower total radiation dose. This short (hypofractionated RT schedule would be more convenient for patients (especially those coming from remote areas to RT facilities and for healthcare providers, as it would increase the turnover in RT departments. This thought has prompted us to write a systematic review on role of hypofractionated RT in breast cancer in a developing country like ours where patient burden is an alarming problem.

  5. Study of inter-fractional variations and adaptive radiotherapy in pancreatic cancer%胰腺癌放疗分次间解剖变化及自适应放疗研究

    Institute of Scientific and Technical Information of China (English)

    杨成梁; X.Allen Li; 王建华; 李定杰; 毛荣虎

    2012-01-01

    目的 定量描述胰腺癌放疗分次间解剖位置变化及自适应放疗剂量优势.方法 回顾分析图像引导放疗的10例胰腺癌患者的226套治疗当天CT图像,自动勾画软件勾画靶器官和危及器官轮廓后由经验丰富的医师修改.应用质心距离、最大重叠率和Dice系数定量分析分次间器官移位和变形.应用自适应放疗技术处理治疗当天CT图像,比较自适应治疗计划和校位治疗计划的剂量参数.结果 胰腺癌放疗过程中胰头分次间解剖变化显著,经骨性或软组织对齐配准后胰头质心距离、最大重叠率和Dice系数分别为(7.8±1.3)mm、(87.2±8.4)%和(77.2±7.9)%.自适应治疗计划靶体积(PTy)包绕和危及器官保护方面均优于校位治疗计划,自适应治疗计划将校位治疗计划PTV的V100从(93.32 ±2.89)%提高至(96.03±1.42)%(t=2.79,P=0.008),同时将校位治疗计划的十二指肠V50.4从(43.4±12.71)%降至(15.6±6.25)%(t =3.52,P=0.000).结论 自适应放疗能有效应对胰腺癌放疗中分次间的解剖变化,可提高胰腺癌放疗剂量,这为提高胰腺癌局部控制率带来了希望.%Objective To quantitatively characterize the inter-fractional anatomy variations and advantages of dosimetry for the adaptive radiotherapy in pancreatic cancer.Methods A total of 226 daily CT images acquired from 10 patients with pancreatic cancer treated with image-guided radiotherapy were analyzed retrospectively.Targets and organs at risk (OARs) were delineated by the atlas-based automatic segmentation and modified by the skilled physician.Various parameters,including the center of mass (COM) distance,the maximal overlap ratio (MOR) and the Dice coefficient (DC),were used to quantify the inter-fractional organ displacement and deformation.The adaptive radiation therapy (ART) was applied to handle the daily GT images.The dose distributions parameters from the ART plan were compared with those from the repositioning plan

  6. Radiotherapy in Dupuytren's contracture

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, A.H. (Bezirkskrankenhaus Cottbus (German Democratic Republic))

    1984-01-01

    In Dupuytren's contracture grade I by Iselin radiotherapy is indicated. With X-ray half-depth therapy and a total dose of 20.0 Gy the disease could be treated successfully in 82 % of the cases in a sense of inhibition of progression, whereas in 18 % radiotherapy failed. Possibly the results can be improved by increase of the radiation dose and/or modified fractionating.

  7. [Radiotherapy promises: focus on lung cancer].

    Science.gov (United States)

    Jouin, Anaïs; Durand-Labrunie, Jérôme; Leroy, Thomas; Pannier, Diane; Wagner, Antoine; Rault, Erwan; Lartigau, Eric

    2013-06-01

    Radiotherapy is a key cancer treatment, which greatly modified its practice in recent years thanks to medical imaging and technical improvements. The systematic use of computed tomography (CT) for treatment planning, the imaging fusion/co-registration between CT/magnetic resonance imaging (MRI) or CT/positron emission tomography (PET) improve target identification/selection and delineation. New irradiation techniques such as image-guided radiotherapy (IGRT), stereotactic radiotherapy or hadron therapy offer a more diverse therapeutic armamentarium to patients together with lower toxicity. Radiotherapy, as well as medical oncology, tends to offer a personalized treatment to patients thanks to the IGRT, which takes into account the inter- or intra-fraction anatomic variations. IGRT leads to adaptive radiotherapy (ART) with a new planification in the treatment course in order to decrease toxicity and improve tumor control. The use of systemic therapies with radiations needs to be studied in order to improve efficiency without increasing toxicities from these multimodal approaches. Finally, radiotherapy advances were impacted by radiotherapy accidents like Epinal. They led to an increased quality control with the intensification of identity control, the emergence of in vivo dosimetry or the experience feedback committee in radiotherapy. We will illustrate through the example of lung cancer.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-06-15

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

  9. Comparison of compostable bags and aerated bins with conventional storage systems to collect the organic fraction of municipal solid waste from homes. a Catalonia case study.

    Science.gov (United States)

    Puyuelo, Belén; Colón, Joan; Martín, Patrícia; Sánchez, Antoni

    2013-06-01

    The separation of biowaste at home is key to improving, facilitating and reducing the operational costs of the treatment of organic municipal waste. The conventional method of collecting such waste and separating it at home is usually done by using a sealed bin with a plastic bag. The use of modern compostable bags is starting to be implemented in some European countries. These compostable bags are made of biodegradable polymers, often from renewable sources. In addition to compostable bags, a new model of bin is also promoted that has a perforated surface that, together with the compostable bag, makes the so-called "aerated system". In this study, different combinations of home collection systems have been systematically studied in the laboratory and at home. The results obtained quantitatively demonstrate that the aerated bin and compostable bag system combination is effective at improving the collection of biowaste without significant gaseous emissions and preparing the organic waste for further composting as concluded from the respiration indices. In terms of weight loss, temperature, gas emissions, respiration index and organic matter reduction, the best results were achieved with the aerated system. At the same time, a qualitative study of bin and bag combinations was carried in 100 homes in which more than 80% of the families participating preferred the aerated system.

  10. Bystander effects and radiotherapy.

    Science.gov (United States)

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

    2015-01-01

    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.

  11. 应用不同热塑膜定位方式研究食管癌放疗中分次间及分次内摆位误差%Research on inter-fractional and intra-fractional setup errors of esophageal carcinoma radiotherapy with different thermoplastic film immobilization

    Institute of Scientific and Technical Information of China (English)

    郭纪慈; 黄大钡; 李珍; 余建荣; 古定标

    2015-01-01

    Objective To analyze and compare the inter-fractional and intra-fractional setup errors in radiotherapy for patients with cervical or upper thoracic esophageal carcinoma fixation between using head-neck-shoulder thermoplastic film vacuum bag or thermoplastic sheet. Methods 30 patients with cervical or upper thoracic esophageal carcinoma were divided into two groups. They were received radiotherapy fixed by head-neck-shoulder thermoplastic film vacuum bag and thermoplastic sheet respectively. Patients received CBCT scans before initial setup, after re-positioning and after radiation delivery. The CBCT images were registered to the planning CT images, then obtained and analyzed the inter-fractional and intra-fractional setup errors. Results The before initial setup error of head-neck-shoulder thermoplastic film vacuum bag was X(1.1±0.8)mm, Y(1.3±1.1)mm, Z(1.0±0.9)mm. The before initial setup error of thermoplastic sheet was X(1.7±1.4)mm, Y(4.5±3.2)mm, Z(3.9±1.5)mm. The inter-fractional setup errors of two groups were not significant in X axis (P>0.05), but there were significant difference in Y and Z axis (P0.05). Conclusion The precision of radiotherapy for cervical or upper thoracic esophageal carcinoma fixed by head-neck-shoulder thermoplastic film vacuum bag is better than the thermoplastic sheet group. The variations of intra-fractional setup error were obvious during the treatment and should be taken into account.%目的:对比分析采用头颈肩热塑膜真空袋和热塑体膜固定的颈段、胸上段食管癌患者在调强放射治疗过程中出现的分次间及分次内摆位误差,并探讨其原因。方法分别采用头颈肩热塑膜真空袋和热塑体膜对颈段、胸上段食管癌患者进行体位固定各30例,实行调强放射治疗,在每次治疗的摆位纠正前、摆位纠正后及治疗后获取锥形束断层扫描(CBCT)图像,将获取的CBCT图像与计划CT图像相匹配,得到分次间及分次内摆

  12. Breath-hold technique in conventional APPA or intensity-modulated radiotherapy for Hodgkin's lymphoma. Comparison of ILROG IS-RT and the GHSG IF-RT

    Energy Technology Data Exchange (ETDEWEB)

    Kriz, Jan; Spickermann, Max; Lehrich, Philipp; Reinartz, Gabriele; Eich, Hans; Haverkamp, Uwe [University of Muenster, Department of Radiation Oncology, Muenster (Germany); Schmidberger, Heinz [University Mainz, Department of Radiation Oncology, Mainz (Germany)

    2015-09-15

    The present study addresses the role of intensity-modulated radiotherapy (IMRT) in contrast to standard RT (APPA) for patients with Hodgkin's lymphoma (HL) with a focus on deep inspiration breath-hold (DIBH) technique and a comparison between the International Lymphoma Radiation Oncology Group (ILROG) Involved Site Radiotherapy (IS-RT) versus the German Hodgkin Study Group (GHSG) Involved Field Radiotherapy (IF-RT). APPA treatment and 2 IMRT plans were compared for 11 patients with HL. Furthermore, treatment with DIBH versus free breathing (FB) and two different treatment volumes, i.e. IF-RT versus IS-RT, were compared. IMRT was planned as a sliding-window technique with 5 and 7 beam angles. For each patient 12 different treatment plans were calculated (132 plans). Following organs at risk (OAR) were analysed: lung, heart, spinal cord, oesophagus, female breast and skin. Comparisons of the different values with regard to dose-volume histograms (DVH), conformity and homogeneity indices were made. IS-RT reduces treatment volumes. With respect to the planning target volume (PTV), IMRT achieves better conformity but the same homogeneity. Regarding the D{sub mean} for the lung, IMRT shows increased doses, while RT in DIBH reduces doses. The IMRT shows improved values for D{sub max} concerning the spinal cord, whereas the APPA shows an improved D{sub mean} of the lung and the female breast. IS-RT reduces treatment volumes. Intensity-modulated radiotherapy shows advantages in the conformity. Treatment in DIBH also reduces the dose applied to the lungs and the heart. (orig.) [German] Ziel dieser Auswertung ist es, die konventionelle APPA-Feldanordnung mit der Intensitaetsmodulierten Radiotherapie (IMRT) bei Patienten mit Hodgkin-Lymphom (HL) zu vergleichen. Ein besonderer Fokus liegt hierbei auf der Bestrahlung in tiefer Inspiration und Atemanhaltetechnik (DIBH). Des Weiteren wurde die ''Involved-site''-Radiotherapie (IS-RT) der International

  13. Postoperative radiotherapy of glioblastoma multiforme. Analysis and critical assessment of different treatment strategies and predictive factors

    Energy Technology Data Exchange (ETDEWEB)

    Piroth, M.D.; Gagel, B.; Pinkawa, M.; Asadpour, B.; Eble, M.J. [Dept. of Radiation Oncology, RWTH Aachen Univ. Hospital, Aachen (Germany); Stanzel, S. [Inst. of Medical Statistics, RWTH Aachen Univ. Hospital, Aachen (Germany)

    2007-12-15

    Background and Purpose: Different factors influence glioblastoma patients' prognosis. The aim of this retrospective, explorative analysis was to define the role of recent treatment strategies and to examine the value of different prognostic factors. Patients and Methods: A total of 110 patients was analyzed. Complete resection, partial resection, and biopsy was accomplished in 69, 22, and 19 patients, respectively. 56 patients received conventionally fractionated radiotherapy with a median total dose of 60 Gy, 2 Gy daily. 54 patients received hyperfractionated accelerated radiotherapy with a median total dose of 54 Gy, 2 x 1.8 Gy daily. 20 patients had concomitant temozolomide (50-75 mg/m{sup 2}/d), and 20 patients concomitant topotecan (0.5 mg/m{sup 2} as continuous venous infusion over 21 days). 37 patients received temozolomide as salvage therapy. Results: Median overall (OS) and disease-free survival (DFS) were 8.7 and 4.8 months. After complete resection, partial resection, and biopsy, OS was 9.5, 8.5, and 5.5 months, respectively. OS was 8.5, 13.8, and 8.2 months for radiotherapy alone, concomitant temozolomide, and concomitant topotecan, respectively. Hazard ratio was 0.29 (OS; p = 0.002) and 0.32 (DFS; p = 0.003) for concomitant temozolomide compared to radiotherapy alone. Topotecan led to an increased toxicity. With 9.7 months for conventionally fractionated radiotherapy and 8.1 months for hyperfractionated radiotherapy, OS differed significantly (p = 0.003, log-rank test). OS in patients with RPA (recursive partitioning analysis) score III, IV, V, and VI was 14.1, 10, 9.5, and 5.8 months (p = 0.003, log-rank test). In the univariate (p = 0.0001, log-rank test) and multivariate analysis (p = 0.002, Cox regression), salvage temozolomide led to a statistically significant survival benefit (10.6 vs. 7.7 months). Conclusion: Concomitant topotecan or the use of hyperfractionated radiotherapy did not show to be superior in outcome in this retrospective

  14. Streptococcal toxic shock syndrome occurred during postoperative radiotherapy in a cancer patient with preexisting lymphedema and chronic illness -case report-

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Ji Young; Oh, Yoon Kyeong; Kim, Dong Min [Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2006-12-15

    A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS.

  15. Short duration radiotherapy in Stage I seminoma of the testis: preliminary results of a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Read, G.; Johnston, R.J. (Christie Hospital and Holt Radium Inst., Manchester (United Kingdom))

    1993-01-01

    Ninety-four patients with Stage 1 seminoma of the testis, treated between November 1989 and December 1991, received short duration radiotherapy (2000 cGy in 8 fractions) to the para-aortic area only. The treatment was well tolerated and, after a median follow-up time of 34 months (minimum 15 months), no patient has relapsed in the abdomen. One patient developed an apparently solitary distant metastasis from a latent teratoma and is disease free after chemotherapy. This form of radiotherapy would appear to be well-tolerated with a low relapse rate. It offers the advantage of a simpler and shorter technique compared with conventional therapy and avoids the necessity of intensive surveillance to detect relapse. (author).

  16. Incidental Dose to Pelvic Nodal Regions in Prostate-Only Radiotherapy.

    Science.gov (United States)

    Murthy, Vedang; Lewis, Shirley; Sawant, Mayur; Paul, Siji N; Mahantshetty, Umesh; Shrivastava, Shyam Kishore

    2017-04-01

    Pelvic lymph nodal regions receive an incidental dose from conformal treatment of the prostate. This study was conducted to investigate the doses received by the different pelvic nodal regions with varying techniques used for prostate radiotherapy. Twenty patients of high-risk node-negative prostate cancer treated with intensity-modulated radiotherapy to the prostate alone were studied. Replanning was done for intensity-modulated radiotherapy, 3-dimensional conformal treatment, and 2-dimensional conventional radiotherapy with additional delineation of the pelvic nodal regions, namely, common iliac (upper and lower), presacral, internal iliac, obturator, and external iliac. Dose-volume parameters such as Dmean, D100%, D66%, D33%, V40, and V50 to each of the nodal regions were estimated for all patients. The obturator nodes received the highest dose among all nodal regions. The mean dose received by obturator nodal region was 44, 29, and 22 Gy from 2-dimensional conventional radiotherapy, 3-dimensional conformal treatment, and intensity-modulated radiotherapy, respectively. The mean dose was significantly higher when compared between 2-dimensional conventional radiotherapy and 3-dimensional conformal treatment ( P < .001), 2-dimensional conventional radiotherapy and intensity-modulated radiotherapy ( P < .001), and 3-dimensional conformal treatment and intensity-modulated radiotherapy ( P < .001). The D33% of the obturator region was 64, 39, and 37 Gy from 2-dimensional conventional radiotherapy, 3-dimensional conformal treatment, and intensity-modulated radiotherapy, respectively. The dose received by all other pelvic nodal regions was low and not clinically relevant. The incidental dose received by obturator regions is significant especially with 2-dimensional conventional radiotherapy and 3-dimensional conformal treatment techniques as used in the trials studying elective pelvic nodal irradiation. However, with intensity-modulated radiotherapy, this dose is lower

  17. Radiotherapy Treatment Planning for Testicular Seminoma

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-07-15

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

  18. Testicular dose in prostate cancer radiotherapy. Impact on impairment of fertility and hormonal function

    Energy Technology Data Exchange (ETDEWEB)

    Boehmer, D.; Badakhshi, H.; Budach, V. [Dept. of Radiation Oncology, Charite - Univ. Clinic - Campus Mitte, Berlin (Germany); Kuschke, W.; Bohsung, J. [Dept. of Medical Physics, Charite - Univ. Clinic - Campus Mitte, Berlin (Germany)

    2005-03-01

    Purpose: to determine the dose received by the unshielded testicles during a course of 20-MV conventional external-beam radiotherapy for patients with localized prostate cancer. Critical evaluation of the potential impact on fertility and hormonal impairment in these patients according to the literature. Patients and methods: the absolute dose received by the testicles of 20 randomly selected patients undergoing radiotherapy of prostate cancer was measured by on-line thermoluminescence dosimetry. Patients were treated in supine position with an immobilization cushion under their knees. A flexible tube, containing three calibrated thermoluminescence dosimeters (TLDs) was placed on top or underneath the testicle closest to the perineal region with a day-to-day alternation. The single dose to the planning target volume was 1.8 Gy. Ten subsequent testicle measurements were performed on each patient. The individual TLDs were then read out and the total absorbed dose was calculated. Results: the mean total dose ({+-} standard deviation) measured in a series of 10 subsequent treatment days in all patients was 49 cGy ({+-} 36 cGy). The calculated projected doses made on a standard series of 40 fractions of external-beam radiotherapy were 196 cGy ({+-} 145 cGy). The results of this study are appraised with the available data in the literature. Conclusion: the dose received by the unshielded testes can be assessed as a risk for permanent infertility and impairment of hormonal function in prostate cancer patients treated with external-beam radiotherapy. (orig.)

  19. Fractional smith chart theory

    KAUST Repository

    Shamim, Atif

    2011-03-01

    For the first time, a generalized Smith chart is introduced here to represent fractional order circuit elements. It is shown that the standard Smith chart is a special case of the generalized fractional order Smith chart. With illustrations drawn for both the conventional integer based lumped elements and the fractional elements, a graphical technique supported by the analytical method is presented to plot impedances on the fractional Smith chart. The concept is then applied towards impedance matching networks, where the fractional approach proves to be much more versatile and results in a single element matching network for a complex load as compared to the two elements in the conventional approach. © 2010 IEEE.

  20. 宫颈癌术后常规与旋转容积调强放疗计划剂量学研究%Dosimetric study of conventional intensity-modulated radiotherapy and volumetric intensity-modulated arc radiotherapy for postoperation of cervix cancer

    Institute of Scientific and Technical Information of China (English)

    李军; 陈雪梅; 张西志; 张先稳; 花威; 汤晓斌; 柴磊; 陈达

    2014-01-01

    目的:比较研究宫颈癌常规调强放疗(conventional intensity-modulated radiotherapy,C-IMRT)与旋转容积调强放疗(volumetric intensity-modulated arc therapy,VMAT)计划对靶区及其周围危及器官受照剂量的差异.方法:随机选择2012-08-01-2013-05-31苏北人民医院收治的12例宫颈癌术后患者,进行CT模拟定位、靶区和危及器官的勾画,在同一CT图像上用治疗计划系统进行C-IMRT和VMAT计划设计,处方剂量均为CTV 50 Gy,分25次,危及器官限量参考临床要求.在95%体积的PTV达到处方剂量的条件下,比较2种计划的剂量体积直方图,靶区、危及器官、靶区剂量适形度、剂量分布均匀性、机器跳数(monitor unit,MU)和治疗时间.对治疗计划结果采用配对t检验分析方法评价各指标的差异性.结果:VMAT计划与C-IMRT计划相比,膀胱的Dmean和V20两者差异无统计学意义,P>0.05;D50、V30和V40均明显降低(P<0.05),且直肠的D5和小肠的D1也明显降低(P<0.05),其他的危及器官的剂量学参数均没有明显降低.正常组织V10 VMAT计划明显高于C-IMRT计划(P<0.05),而V30VMAT计划明显低于C-IMRT计划,P<0.05.VMAT计划相比于C-IMRT计划MU平均减少了50.7%;出束时间T减少了47.2%.结论:在宫颈癌术后放疗中,VMAT技术较C-IMRT技术有剂量学方面的优势,患者的治疗时间和机器跳数MU显著降低,在综合条件允许的情况下可推荐使用VMAT技术.

  1. Hypofractionation in radiotherapy. An investigation of injured Swedish women, treated for cancer of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Friberg, Sten; Ruden, Bengt-Inge (Division of Medical Radiation Physics, Karolinska Institute and Stockholm University, Stockholm (Sweden))

    2009-07-15

    Background. The Swedish Insurance Company for Patient Injuries asked the two authors of this report to identify the Swedish women with cancer of the breast who had been injured by radiotherapy with a hypofractionated schedule. The purpose was to provide a basis on which the Company could decide if indemnification could be given. Material and methods. We define hypo-fractionation as any fraction dose exceeding 2.0 gray (Gy) per day. We set the lower limit for the 'late effect' at 53.0 Gy with 2 Gy/fraction. All departments of radiotherapy in Sweden were asked to identify women who had developed brachial plexus neuropathy (BPN). Their medical records were obtained. The clinical picture of their injuries was recorded, and the absorbed dose was calculated or reconstructed. All doses, no matter in what way they were expressed, were recalculated to 'late effect', presented in EQD2Gy (Equalized Total Dose in 2 Gy/fraction). The latency period from therapy to onset of symptoms was also noted. Results. A variety of treatment techniques was used, fractions ranging in size from 2.5 to 6.0 Gy. Absorbed doses up to a Biologically Equivalent Dose (BED) 146 EQD2Gy in late effects were recorded (6 Gyx13). More than 95% of the injured women had a combination of stiff shoulder, paralysis, pain, oedema and atrophy of the muscles to the arm and/or hand. Latency from end of radiotherapy to onset of symptoms could be as long as 30 years. Discussion. Hypofractionated radiotherapy has injured severely numerous patients. The lesions have become a medico-legal issue in some countries. The life of many of these women has been ruined: physically, mentally, socially and economically. Conclusion. Hypofractionated radiotherapy can cause injuries if the target volume is not exact, or the total dose is not adjusted to a tolerable level as compared to conventional treatments employing 2 Gy/day fractions

  2. Stereotactic body radiotherapy in prostate cancer: is rapidarc a better solution than cyberknife?

    Science.gov (United States)

    Macdougall, N D; Dean, C; Muirhead, R

    2014-01-01

    There is increasing interest in stereotactic body radiotherapy (SBRT) for the management of prostate adenocarcinoma, with encouraging initial biological progression-free survival results. However, the limited literature is dominated by the use of the Cyberknife platform. This led to an international phase III study comparing outcomes for Cyberknife SBRT with both surgery and conventionally fractionated intensity-modulated radiotherapy (the PACE study). We aim to compare Cyberknife delivery with Rapidarc, a more widely available treatment platform. The scans of six previous prostate radiotherapy patients with a range of prostate sizes were chosen. The clinical target volume was defined as the prostate gland, with 3 mm added for the Cyberknife planning target volume (PTV) and 5 mm for the Rapidarc PTV. Accuray multiplan v. 4.5 was used for planning with delivery on a Cyberknife VSI system v9.5; Varian Eclipse v10 was used for Rapidarc planning with delivery using a Varian 21EX linear accelerator. Both systems attempted to deliver at least 35 Gy to the PTV in five fractions with PTV heterogeneity delivery time was in favour of Rapidarc. We have shown that there is no discernible dosimetric advantage to choosing Cyberknife over Rapidarc for SBRT delivery in prostate cancer. Given the significant benefits of Rapidarc in terms of availability, planning and delivery time, the authors suggest that phase III trials of SBRT should include Rapidarc or equivalent rotational delivery platforms. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Clinicopathologic Comparison of High-Dose-Rate Endorectal Brachytherapy versus Conventional Chemoradiotherapy in the Neoadjuvant Setting for Resectable Stages II and III Low Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Jessica A. Smith

    2012-01-01

    Full Text Available Purpose. To assess for differences in clinical, radiologic, and pathologic outcomes between patients with stage II-III rectal adenocarcinoma treated neoadjuvantly with conventional external beam radiotherapy (3D conformal radiotherapy (3DRT or intensity-modulated radiotherapy (IMRT versus high-dose-rate endorectal brachytherapy (EBT. Methods. Patients undergoing neoadjuvant EBT received 4 consecutive daily 6.5 Gy fractions without chemotherapy, while those undergoing 3DRT or IMRT received 28 daily 1.8 Gy fractions with concurrent 5-fluorouracil. Data was collected prospectively for 7 EBT patients and retrospectively for 25 historical 3DRT/IMRT controls. Results. Time to surgery was less for EBT compared to 3DRT and IMRT (P<0.001. There was a trend towards higher rate of pathologic CR for EBT (P=0.06. Rates of margin and lymph node positivity at resection were similar for all groups. Acute toxicity was less for EBT compared to 3DRT and IMRT (P=0.025. Overall and progression-free survival were noninferior for EBT. On MRI, EBT achieved similar complete response rate and reduction in tumor volume as 3DRT and IMRT. Histopathologic comparison showed that EBT resulted in more localized treatment effects and fewer serosal adhesions. Conclusions. EBT offers several practical benefits over conventional radiotherapy techniques and appears to be at least as effective against low rectal cancer as measured by short-term outcomes.

  4. Genetics of non-conventional lipoprotein fractions

    Science.gov (United States)

    Lipoprotein subclass measures associate with cardiometabolic disease risk. Currently the information that lipoproteins convey on disease risk over that of traditional demographic and lipid measures is minimal, and so their use is clinics is limited. However, lipoprotein subclass perturbations repres...

  5. Observation of curative effect of hypo-fractionated conformal radiotherapy for 12 patients with non-small cell lung cancer%大分割适形放射治疗非小细胞肺癌12例疗效观察

    Institute of Scientific and Technical Information of China (English)

    罗树春; 兰海涛; 吴琦

    2013-01-01

    目的 观察大分割适形放射治疗非小细胞肺癌的疗效和毒副反应.方法 对12例非小细胞肺癌采用三维适形放疗,6GY/次,5次/周,共60GY/10次.结果 近期疗效:完全缓解(CR)3例占25.0%,部分缓解(PR)5例占41.7%,稳定(SD)和疾病进展(PD)各2例,肿瘤客观缓解率(CR+PR)为66.7%,局部控制率(CR+PR+SD)83.3%.放射性肺炎0级8例、Ⅰ级3例、Ⅱ级1例;放射性食道炎0级9例、Ⅰ级2例、Ⅲ级1例.结论 大分割适形放射治疗非小细胞肺癌近期疗效较好,副反应未明显增加.%Objective To analyze the efficacy and complications of hypo-fractionated conformal radiotherapy for non-small cell lung cancer. Methods Twelve patients with non-small cell lung cancer were treated with hypo-fraction conformal radiotherapy. A dose of 60 GY was given in 10 fractions,once a day,and 5 fractions a week. Results The short-term results showed that the complete re-sponse( CR)rate,the partial response( PR) rate, the overall response( CR+PR) rate and the local regional control rate( CR+PR+SD) were 25. 0% ,41. 7% ,66. 7% and 83. 3% Respectively. There patients suffered from radiation penumonitis of grade Ⅰ ,one patient had radiation penumonitis of gradeⅡ ,and no patient developed serious ( grade Ⅲ ) radiation penumonitis. Two cases suffered from radiation esophagitis of gradeⅠ , and one patient had radiation esophagitis of grade Ⅲ. Conclusions The hypo-fraction conformal radiotherapy may be good for non-small cell lung cancer without incensement of complications.

  6. Preliminary Study of Stereotactic Radiotherapy for Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    From March 1997 to November 1999, 45 patients with lung cancer were treated by astereotactic radiotherapy, with 15 cases treated by a stereotactic radiotherapy alone, and 30 cases by the external radiotherapy plus stereotactic radiotherapy. The clinical target volume was 1.89-187. 26 cm3 with the median being 18. 17 cm3. The doses of plan target volume (PTV) edge was 16-30 Gy/2-3 times and the doses of center was 120 % to 150 % of PTV edge doses. The overall response rate was 84.4 % (38/45), with 11 complete response (CR) and 27 partial response (PR). This study confirmed that the stereotactic radiotherapy is a safe and effective therapy for lung cancer. For those early-stage patients who can tolerate neither operation nor even conventional radiotherapy for various reasons, it can both achieve therapeutic purpose and improve quality of life.

  7. Three dimensional conformal postoperative radiotherapy for ...

    African Journals Online (AJOL)

    Azza Helal

    2013-06-17

    Jun 17, 2013 ... showed the best dose homogeneity and conformity and lowest max dose to PTV and to the ... nique, size of treatment field, total dose and dose/fraction.6,7 ..... Cooperative Group: the role of radiotherapy in the treatment of.

  8. 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

    2011-07-01

    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.)

  9. The linear-quadratic model is inappropriate to model high dose per fraction effects in radiosurgery.

    Science.gov (United States)

    Kirkpatrick, John P; Meyer, Jeffrey J; Marks, Lawrence B

    2008-10-01

    The linear-quadratic (LQ) model is widely used to model the effect of total dose and dose per fraction in conventionally fractionated radiotherapy. Much of the data used to generate the model are obtained in vitro at doses well below those used in radiosurgery. Clinically, the LQ model often underestimates tumor control observed at radiosurgical doses. The underlying mechanisms implied by the LQ model do not reflect the vascular and stromal damage produced at the high doses per fraction encountered in radiosurgery and ignore the impact of radioresistant subpopulations of cells. The appropriate modeling of both tumor control and normal tissue toxicity in radiosurgery requires the application of emerging understanding of molecular-, cellular-, and tissue-level effects of high-dose/fraction-ionizing radiation and the role of cancer stem cells.

  10. Statistical-learning strategies generate only modestly performing predictive models for urinary symptoms following external beam radiotherapy of the prostate: A comparison of conventional and machine-learning methods

    Energy Technology Data Exchange (ETDEWEB)

    Yahya, Noorazrul, E-mail: noorazrul.yahya@research.uwa.edu.au [School of Physics, University of Western Australia, Western Australia 6009, Australia and School of Health Sciences, National University of Malaysia, Bangi 43600 (Malaysia); Ebert, Martin A. [School of Physics, University of Western Australia, Western Australia 6009, Australia and Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008 (Australia); Bulsara, Max [Institute for Health Research, University of Notre Dame, Fremantle, Western Australia 6959 (Australia); House, Michael J. [School of Physics, University of Western Australia, Western Australia 6009 (Australia); Kennedy, Angel [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008 (Australia); Joseph, David J. [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008, Australia and School of Surgery, University of Western Australia, Western Australia 6009 (Australia); Denham, James W. [School of Medicine and Public Health, University of Newcastle, New South Wales 2308 (Australia)

    2016-05-15

    Purpose: Given the paucity of available data concerning radiotherapy-induced urinary toxicity, it is important to ensure derivation of the most robust models with superior predictive performance. This work explores multiple statistical-learning strategies for prediction of urinary symptoms following external beam radiotherapy of the prostate. Methods: The performance of logistic regression, elastic-net, support-vector machine, random forest, neural network, and multivariate adaptive regression splines (MARS) to predict urinary symptoms was analyzed using data from 754 participants accrued by TROG03.04-RADAR. Predictive features included dose-surface data, comorbidities, and medication-intake. Four symptoms were analyzed: dysuria, haematuria, incontinence, and frequency, each with three definitions (grade ≥ 1, grade ≥ 2 and longitudinal) with event rate between 2.3% and 76.1%. Repeated cross-validations producing matched models were implemented. A synthetic minority oversampling technique was utilized in endpoints with rare events. Parameter optimization was performed on the training data. Area under the receiver operating characteristic curve (AUROC) was used to compare performance using sample size to detect differences of ≥0.05 at the 95% confidence level. Results: Logistic regression, elastic-net, random forest, MARS, and support-vector machine were the highest-performing statistical-learning strategies in 3, 3, 3, 2, and 1 endpoints, respectively. Logistic regression, MARS, elastic-net, random forest, neural network, and support-vector machine were the best, or were not significantly worse than the best, in 7, 7, 5, 5, 3, and 1 endpoints. The best-performing statistical model was for dysuria grade ≥ 1 with AUROC ± standard deviation of 0.649 ± 0.074 using MARS. For longitudinal frequency and dysuria grade ≥ 1, all strategies produced AUROC>0.6 while all haematuria endpoints and longitudinal incontinence models produced AUROC<0.6. Conclusions

  11. Stereotactic radiotherapy and radiosurgery in pediatric patients: analysis of indications and outcome

    DEFF Research Database (Denmark)

    Mirza, Bilal; Mønsted, Anne; Jensen, Josephine Harding

    2010-01-01

    We describe indications, outcomes, and risk profiles of fractionated stereotactic radiotherapy (SRT) and single fraction "radiosurgery" (SRS) in pediatric patients compared to the adult population and evaluate the causal role of SRS and SRT in inducing new neurological complications.......We describe indications, outcomes, and risk profiles of fractionated stereotactic radiotherapy (SRT) and single fraction "radiosurgery" (SRS) in pediatric patients compared to the adult population and evaluate the causal role of SRS and SRT in inducing new neurological complications....

  12. Image Guided Hypofractionated Radiotherapy by Helical Tomotherapy for Prostate Carcinoma: Toxicity and Impact on Nadir PSA

    Directory of Open Access Journals (Sweden)

    Salvina Barra

    2014-01-01

    Full Text Available Aim. To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT of prostate cancer as well as the value of the nadir PSA (nPSA and time to nadir PSA (tnPSA as surrogate efficacy of treatment. Material and Methods. Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT. A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy. Results. Most of patients (83% did not develop acute gastrointestinal (GI toxicity and 50% did not present genitourinary (GU toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL of the conventionally treated cohort (P=0.02. Conclusions. Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.

  13. 大剂量多次分割立体定向放疗对听神经瘤的疗效分析%Clinical Efficacy of Hypofractionated Stereotactic Radiotherapy in Five Fractions for Acoustic Neuromas

    Institute of Scientific and Technical Information of China (English)

    陈志萍; 溝脇尚志; 小倉健; 宇藤惠; 平岡眞寛

    2015-01-01

    目的:评价大剂量分割立体定向放疗(hypo-FSRT)治疗听神经瘤患者在肿瘤局部控制及有效听力保存等方面的临床价值。方法回顾性分析47例单侧听神经瘤患者,中位年龄61岁,放疗前19例患者持有有效听力,肿瘤最大径中位值20 mm,处方剂量:等中心总剂量25 Gy,5次分割,每日1次,80%剂量曲线包绕计划靶区( PTV)边缘。采用实体瘤消退评价标准( RECIST)改良版1.1评估肿瘤消退情况。采用Gardner-Robertson Class 评估听力保存情况。 SPSS 18.0软件进行统计分析。结果中位随访及听力随访时间分别为61及52个月,30例(63.8%)、13例(27.67%)及4例(8.5%)患者分别出现肿瘤部分缩退(PR)、稳定(SD)、进展(PD),根据Kaplan-Meier生存分析,5年肿瘤局部控制率为90.4%,放疗前肿瘤是否合并囊变成分在肿瘤控制方面存在显著性差异(P=0.015),合并囊变的肿瘤预示放疗后出现肿瘤进展的可能性大。放疗后14例(29.8%)患者出现肿瘤暂时性增大。1、3、5年患者有效听力保存率分别为68.4%,62.1%及35.5%。有效听力保存与未保存患者在肿瘤消退情况方面存在明显差异(P=0.017)。1例(2.1%)患者行挽救性手术,2例(4.3%)患者行VP-脑室分流术,2例(4.3%)患者新出现三叉神经轻度麻痹。结论 Hypo-FSRT (25 Gy/5次)治疗单侧听神经瘤可有效控制肿瘤,放疗后并发症发生率低。影像定期随访中观察到肿瘤暂时性增大及逐渐缩退过程。放疗前肿瘤合并囊变预示患者放疗后出现肿瘤进展的机率更高。%Objective To study the clinical outcomes of hypofractionated stereotactic radiotherapy ( hypo-FSRT) for a-coustic neuromas (ANs).Methods 47 patients with unilateral acoustic neuroma were treated consecutively with hypo -FSRT. The median age was 61 years old

  14. COR, a new adaptive radiotherapy technique using conical tomography and offline re-planning; COR, une nouvelle technique de radiotherapie adaptative utilisant la tomographie conique et la replannification offline

    Energy Technology Data Exchange (ETDEWEB)

    Octave, N.; Beaulieu, L. [Departement de physique, de genie physique et d' optique, universite Laval, Quebec (Canada); Boutry, C.; Dudouet, P. [Groupe Oncorad Garonne, service de radiotherapie, clinique du Pont-de-Chaume, 82 - Montauban (France); Octave, N.; Gingras, L.; Beaulieu, L. [Departement de radio-oncologie, centre de recherche en cancerologie, CHU de Quebec (Canada); Berry, I. [Biophysique et medecine nucleaire, CHU de Toulouse Rangueil, 31 - Toulouse (France); Octave, N.; Berry, I. [Universite Paul-Sabatier, Toulouse 3, 31 - Toulouse (France)

    2010-10-15

    The authors present a new adaptive radiotherapy technique which uses daily conical (or dual-axis) tomographies. For each fraction of prostatic intensity modulated and conformational radiotherapy (RCMI), conical tomographies are acquired and used to reposition the patient and to generate a new optimized RCMI plan. Three therapeutic strategies are then elaborated and studied: a conventional strategy (the patient is totally treated with a dosimetry based of the initial scanography), an optimal strategy (the patient is treated on a daily basis with the optimized RCMI plan based on the conical tomography), and a Continuous Offline Re-planning (COR) strategy which uses the whole set of plans computed on the conical tomographies performed on the day before the treatment. The obtained results show that the COR strategy leads to a better dosimetric coverage and to less severe technical and human constraints. Short communication

  15. Radiobiology of human cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Andrews, J.R.

    1978-01-01

    The author has systematically collected and collated the scientific literature correlating the basic and clinical sciences in this field in order to produce a definitive treatise. The book thoroughly reviews the biology and biochemistry relevant to radiobiology and describes the critical locus for the extinction of cell reproductive capacity. Extensive coverage is given to oxygen effect, hyperthermia, high linear energy transfer, cell populations, and similar topics. Separate sections cover time, dose, and fractionation; radiation hematology; cancer chemotherapy; and cancer immunology. The book also contains invaluable discussions of techniques for optimizing radiotherapy alone and in combination with other therapies.

  16. Palliation of dysphagia with radiotherapy for exophytic base tongue metastases in a case of renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Tabassum Wadasadawala

    2011-01-01

    Full Text Available Base tongue involvement is a rare presentation of lingual metastases from renal cell carcinoma. A 48-year-old gentleman was treated with open radical nephrectomy and adjuvant radiotherapy for Stage II Furhman grade I clear cell carcinoma of the left kidney at an outside hospital. He presented metachronously 5 years later with progressive dysphagia and change of voice. Clinicoradiological evaluation revealed a large exophytic mass in the oropharynx with epicenter in the right base of tongue. Metastatic workup revealed widespread dissemination to multiple organs and bone. In view of predominant symptom of dysphagia, base tongue metastasis was treated with protracted course of palliative radiotherapy to a dose of 50 Gy in conventional fractionation over 5 weeks. This resulted in excellent and durable response at the base tongue lesion (till the time of last follow-up. Radiation therapy is an acceptable palliative strategy for advanced lingual metastasis as it produces prompt relief of pain, bleeding, and dysphagia.

  17. Enhanced skin toxicity with concomitant cetuximab and radiotherapy in patients with locally advanced head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Bujor, L.; Grillo, I.M.; Pimentel, N. [Hospital Santa Maria, Radioterapia, Lisboa (Portugal); Macor, C.; Catarina, M. [Hospital Santa Maria, ORL, Lisboa (Portugal); Ribeiro, L. [Hospital Santa Maria, Oncologia, Lisboa (Portugal)

    2009-10-15

    Purpose: When associated with radiotherapy the monoclonal antibodies such as cetuximab might be exacerbate skin toxicity. The aim of this study was to retrospectively analyze acute dermatological toxicity in ten consecutive patients with locally advanced head and neck squamous cell carcinoma treated from march 2008 to May 2009 according to Bonner protocol. Patients and methods: We have treated with radiotherapy and cetuximab ten patients with locally advanced head and neck squamous cell carcinoma of the oropharynx, hypopharynx, larynx or oral cavity, stage 3-4B and non metastatic. All our patients were 3D planned and scheduled for conventional fractionation 70 Gy/35 fractions over 47 days, five days weekly. Uninvolved neck received 50 Gy and gross nodal disease received 70 Gy as the primary tumor. Cetuximab was administered one week before radiotherapy at a loading dose of 400 mg per square meter of body surface area over 120 minutes, followed by weekly 60 minutes infusions at 250 mg per square meter for the duration of radiotherapy. Results: In eight patients (80%) grade 3 radiation dermatitis occurred as early as with 28 Gy at a median dose of 42 Gy (range 28-60 Gy). the median radiotherapy dose was 6 Gy with an overall treatment time of 57.7 days (range 41-70 days). were administered 78 cycles of cetuximab, one patient discontinued after five cycles due to infusion reactions. There was no correlation between toxicity and acne-like rash due to cetuximab. Conclusion: Our results albeit in disagreement with the original study are rather similar with the experience of other European centers that encounter grade 3-4 radiation dermatitis in 49% of their patients or Australian centers that reported 79% of same degree of toxicity. (authors)

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

    Energy Technology Data Exchange (ETDEWEB)

    Guckenberger, M.; Sauer, O. [University of Wuerzburg, Department of Radiation Oncology, Wuerzburg (Germany); Andratschke, N. [University of Rostock, Department of Radiotherapy and Radiation Oncology, Rostock (Germany); Alheit, H. [Distler Radiation Oncology, Bautzen/Pirna (Germany); Holy, R. [RWTH Aachen University, Department of Radiation Oncology, Aachen (Germany); Moustakis, C. [University of Muenster, Department of Radiation Oncology, Muenster (Germany); Nestle, U. [University of Freiburg, Department of Radiation Oncology, Freiburg (Germany)

    2014-01-15

    This report from the Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (Deutschen Gesellschaft fuer Radioonkologie, DEGRO) provides a definition of stereotactic body radiotherapy (SBRT) that agrees with that of other international societies. SBRT is defined as a method of external beam radiotherapy (EBRT) that accurately delivers a high irradiation dose to an extracranial target in one or few treatment fractions. Detailed recommendations concerning the principles and practice of SBRT for early stage non-small cell lung cancer (NSCLC) are given. These cover the entire treatment process; from patient selection, staging, treatment planning and delivery to follow-up. SBRT was identified as the method of choice when compared to best supportive care (BSC), conventionally fractionated radiotherapy and radiofrequency ablation. Based on current evidence, SBRT appears to be on a par with sublobar resection and is an effective treatment option in operable patients who refuse lobectomy. (orig.) [German] Die Arbeitsgruppe ''Stereotaktische Radiotherapie'' der Deutschen Gesellschaft fuer Radioonkologie (DEGRO) erarbeitete eine Definition der Koerperstereotaxie (SBRT), die sich an vorhandene internationale Definitionen anlehnt: Die SBRT ist eine Form der perkutanen Strahlentherapie, die mit hoher Praezision eine hohe Bestrahlungsdosis in einer oder wenigen Bestrahlungsfraktionen in einem extrakraniellen Zielvolumen appliziert. Zur Praxis der SBRT beim nichtkleinzelligen Bronchialkarzinom (NSCLC) im fruehen Stadium werden detaillierte Empfehlungen gegeben, die den gesamten Ablauf der Behandlung von der Indikationsstellung, Staging, Behandlungsplanung und Applikation sowie Nachsorge umfassen. Die Koerperstereotaxie wurde als Methode der Wahl im Vergleich zu Best Supportive Care, zur konventionell fraktionierten Strahlentherapie sowie zur Radiofrequenzablation identifiziert. Die Ergebnisse nach SBRT und sublobaerer Resektion

  19. Non-Conventional Fractionated Radiotherapy for Head and Neck Cancer: A Systematic Review%非常规分割放疗治疗头颈部肿瘤的系统评价

    Institute of Scientific and Technical Information of China (English)

    王辛; 艾平; 沈娅丽; 任若梅; 李平

    2007-01-01

    目的 系统评价非常规分割放疗治疗头颈部肿瘤的疗效和副反应,为临床实践提供证据.方法 计算机检索CENTRAL、MEDLINE、EMbase、CBMdisc和VIP数据库,并手工检索10种中文医学期刊,纳入非常规分割放疗与常规分割放疗比较,或非常规分割放疗+同步化疗与单纯非常规分割放疗比较治疗头颈部肿瘤的随机对照试验(RCT).由两位研究者进行资料提取和质量评价,并采用RevMan4.2.8软件进行Meta分析.结果 共检索到551篇文献,最终纳入23个RCT,包含8 411例患者.其中13个是高质量研究,其余为低质量研究.Meta分析结果显示:①非常规分割放疗与常规分割放疗比较,仅分段加速超分割放疗(S-HART)与连续加速放疗(CAIR)组的完全缓解率较高,其RR分别为1.21[95%CI(1.02,1.44)]和3.31[95%CI(1.03,1.57)];随访2年时,仅超分割放疗(HRT)可提高2年总生存率[RR=1.32,95%CI(1.13,1.54)];随访5年时,总生存率差异无统计学意义;大多数非常规分割放疗会增加急性放射性副反应的发生率,但均不会增加晚期放射性副反应的发生率;②非常规分割放疗+同步化疗与单纯非常规分割放疗比较,仅连续超分割放疗(C-HRT)组的完全缓解率较高[RR=1.58,95%CI(1.18,2.11)];随访2年时,非常规分割放疗+同步化疗组提高了2年总生存率[RR=1.35,95%CI(1.18,1.54)]随访5年时,仅C-HRT组提高5年总生存率[RR=1.57,95%CI(1.19,2.07)];两组急性和晚期放射性副反应的发生率差异均无统计学意义.结论 本系统评价由于例数偏少,尚不能证明非常规分割放疗可以提高头颈部肿瘤患者的完全缓解率和总生存率;但与同步化疗联合时,可以在不增加急性和晚期放疗并发症的同时取得更好的疗效,其中HRT和C-HRT的作用尤其值得关注.

  20. Radiotherapy in the management of aggressive fibromatosis

    Energy Technology Data Exchange (ETDEWEB)

    Atahan, I.L.; Akyol, F.; Zorlu, F.; Guerkaynak, M. (Hacettepe University Hospital, Ankara (Turkey). Dept. of Radiology)

    1989-09-01

    Four case reports are summarised concerning the management of aggressive fibromatosis in children and adolescents up to the age of 15. It was concluded that radiotherapy should be reserved for recurrences or inoperable cases. A dose of 5000-6000 cGy in 25-30 fractions depending on age of patient, site, and size of tumour is necessary, since most surgical recurrences appear in 12 months, all cases with positive surgical margins should receive doses in the range 4000-4500 cGy for microscopic disease. Radiotherapy-chemotherapy combinations can also be used. (UK).

  1. Radiotherapy for renal cell carcinoma: renaissance of an overlooked approach.

    Science.gov (United States)

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

    2017-06-20

    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.

  2. Acute toxicity of adjuvant radiotherapy in locally advanced differentiated thyroid carcinoma. First results of the Multicenter Study Differential Thyroid Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Schuck, A.; Mueller, S.B.; Willich, N. [Dept. of Radiotherapy, Univ. Hospital Muenster (Germany); Biermann, M.; Pixberg, M.K.; Schober, O. [Dept. of Nuclear Medicine, Univ. Hospital Mueunster (Germany); Heinecke, A. [Dept. of Medical Informatics and Biomathematics, Univ. Hospital Muenster (Germany)

    2003-12-01

    Background and Purpose: The indication for adjuvant postoperative radiotherapy in patients with differentiated thyroid carcinoma (DTC) extending beyond the thyroid capsule has been an issue of controversy during the past 2 decades. No randomized studies evaluating the benefit of radiotherapy have been published so far. In the Multicenter Study Differentiated Thyroid Carcinoma (MSDS), a randomization has been performed concerning external-beam radiotherapy in patients with DTC extending beyond the thyroid capsule (pT4 pN0/1/ x cM0, TNM classification, 5th edition, 1997) following surgery and radioiodine therapy. Radiation-associated toxicity has been prospectively evaluated. Patients and Methods: Radiotherapy was performed with 50.4 Gy (pN1) or 54.0 Gy (pN1/x) to the cervical, supraclavicular and upper mediastinal lymph nodes. A total dose of 59.4 Gy (R0 resection) or 66.6 Gy (R1) was used to treat the tumor bed. Conventional fractionation was used with 1.8 Gy/d. At the time of the analysis, 36 patients were randomized or allocated to treatment arm A (with external-beam radiotherapy). Of these, 22 were treated with radiotherapy, and documentation of acute toxicity was available. Toxicity was evaluated prospectively according to the RTOG/EORTC criteria. Results: The maximal acute toxicity observed during radiotherapy was grade I in four patients, grade II in 16 patients, and grade III in two patients (9.1%; 95% confidence interval [95% CI] 1.1-29.2%). Toxicity was mainly observed at the pharynx, larynx, and skin. In 19 patients, residual toxicity within 100 days following radiotherapy was evaluated. No residual toxicity was observed in two patients. Maximal residual toxicity was grade I in 13 patients and grade II in four. No further grade III toxicity could be observed. Conclusion: The majority of patients experience mild to moderate side effects from adjuvant external-beam radiotherapy. At the first follow-up examination, most side effects have subsided. Acute

  3. Biomarkers for DNA DSB inhibitors and radiotherapy clinical trials.

    Science.gov (United States)

    Liu, Stanley K; Olive, Peggy L; Bristow, Robert G

    2008-09-01

    Major technical advances in radiotherapy, including IMRT and image-guided radiotherapy, have allowed for improved physical precision and increased dose delivery to the tumor, with better sparing of surrounding normal tissue. The development of inhibitors of the sensing and repair of DNA double-strand breaks (DSBs) is exciting and could be combined with precise radiotherapy targeting to improve local control following radiotherapy. However, caution must be exercised in order that DSB inhibitors are combined with radiotherapy in such a manner as to preserve the therapeutic ratio by exploiting repair deficiencies in malignant cells over that of normal cells. In this review, we discuss the rationale and current approaches to targeting DSB sensing and repair pathways in combined modality with radiotherapy. We also describe potential biomarkers that could be useful in detecting functional inhibition of DSB repair in a patient's tissues during clinical radiotherapy trials. Finally, we examine a number of issues relating to the use of DSB-inhibiting molecular agents and radiotherapy in the context of the tumor microenvironment, effects on normal tissues and the optimal timing and duration of the agent in relation to fractionated radiotherapy.

  4. Monte Carlo techniques for the study of cancer patients fractionation in head and neck treated with radiotherapy; Tecnicas de Monte Carlo para el estudio del fraccionamiento en pacientes de cancer de cabeza y cuello tratados con radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Carrasco Herrera, M. A.; Jimenez Dominguez, M.; Perucha Ortega, M.; Herrador Cordoba, M.

    2011-07-01

    The dose fractionation than the standard head and neck cancer in some situations involve a significant increase of local control and overall survival. There is clinical evidence of these results in case of hyperfractionated treatments, although the choice of optimal fractionation generally is not obtained from the results of any model, in this study has provided the tumor control probability (TCP) for various subdivisions modified (hypo fractionated and hyperfractionated) using Monte Carlo simulation techniques.

  5. Ultrafractionation does not improve the results of radiotherapy in radioresistant murine DDL1 lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Krause, M.; Prager, J.; Hessel, F.; Dorner, D. [TU Dresden (Germany). Clinic for Radiotherapy and Radiation Oncology; Wohlfarth, J.; Baumann, M. [TU Dresden (Germany). Clinic for Radiotherapy and Radiation Oncology; TU Dresden (Germany). Experimental Center; Haase, M. [TU Dresden (Germany). Inst. of Pathology; Joiner, M.C. [Wayne State University, Detroit, MI (United States). Dept. of Radiation Oncology

    2005-08-01

    Background and purpose: Low-dose hyperradiosensitivity (HRS), i.e., a relatively higher efficacy of doses {<=}0.5 Gy compared to doses >1 Gy, has been shown in a number of tumor cell lines in vitro. Therefore ultrafractionated irradiation, i.e., application of very low doses per fraction, has been proposed to improve the effects of radiotherapy. The present study investigates ultrafractionation (UF) in radioresistant murine DDL1T-cell lymphoma in mice. Material and methods: UF was performed with 0.4 Gy per fraction, three fractions per day at 7 days per week, and conventional fractionation (CF) with 1.68 Gy per fraction, one fraction per day at 5 days per week. Tumor growth delay was evaluated for 2, 4 and 6 weeks of irradiation as time that tumors needed to reach fivefold the starting volume (GD{sub V5}). Results: GD{sub V5} was not significantly different between UF and CF. The composite median relative GD{sub V5} calculated for all tumors irradiated in the present study was 1.00 [95% confidence interval 0.99; 1.08] in the CF and 0.99 [0.92; 1.01] in the UF arm (p=0.24). Conclusion: UF was not more efficient than CF in DDL1 tumors. Taken together with previous experiments on human A7 glioblastoma, which showed a negative effect of UF on local tumor control, the preclinical data obtained in this laboratory so far do not support the use of ultrafractionated schedules in radiotherapy. (orig.)

  6. Epithelioid hemangioendothelioma of the spine treated with RapidArc volumetric-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Guy, Jean-Baptiste; Trone, Jane-Chloé [Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez (France); Chargari, Cyrus [Department of Radiation Oncology, HIA du Val de Grâce, Paris (France); Falk, Alexander Tuan [Department of Radiation Oncology, Centre Antoine Lacassagne, Nice (France); Khodri, Mustapha [Department of Physics, Institut de Cancérologie de la Loire, St Priest en Jarez (France); Magné, Nicolas, E-mail: nicolas.magne@icloire.fr [Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez (France)

    2014-10-01

    Radiotherapy for epithelioid hemangioendothelioma (EHE) using volumetric intensity-modulated arc radiotherapy (VMAT). A 48-year-old woman was referred for curative irradiation of a vertebral EHE after failure of surgery. A comparison between VMAT and conventional conformal tridimensional (3D) dosimetry was performed and potential advantage of VMAT for sparing critical organs from irradiation's side effects was discussed. The total delivered dose on the planning target volume was 54 Gy in 27 fractions. The patient was finally treated with VMAT. The tolerance was excellent. There was no acute toxicity, including no increase in pain. With a follow-up of 18 months, no delayed toxicity was reported. The clinical response consisted of a decrease in the dorsal pain. The D{sub max} for the spinal cord was reduced from 55 Gy (3D-radiotherapy [RT]) (which would be an unacceptable dose to the spine because of the risk of myelopathy) to 42.8 Gy (VMAT), which remains below the recommended dose threshold (45 Gy). The dose delivered to 20% of organ volume (D{sub 20}) was reduced from 47 Gy (3D-RT) to 3 Gy (VMAT) for the spinal cord. The study shows that VMAT allows the delivery of curative treatment for vertebral EHEs because of critical organ sparing.

  7. A Phase I trial of dose escalation of topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer

    Institute of Scientific and Technical Information of China (English)

    Xiaohui Ge; Wenyan Zhao; Xiaocang Ren; Yongqiang Wang; Zhigang Li; Yanqi Li; Yuee Liu; Qiang Lin

    2012-01-01

    Objective: The aim of this study was to define the maximum-tolerated dose (MTD) and observe the toxicity of escalating topotecan combined whole brain radiotherapy for brain metastasis in lung cancer. Methods: Patients with brain metastasis of lung cancer received conventional fractionation radiotherapy, with 5 daily fractions of 2 Gy per week, the total radiation dose was 40 Gy, while the larger lesions were boosted to 50-60 Gy. The initial dose of topotecan was 1.0 mg/m2. Escalation dose was 0.25 mg/m2. Every cohort contained at least 3 patients.If no dose-limiting toxicity (DLT) was observed,the next dose level was opened for entry. These courses were repeated until DLT appeared. MTD was declared as one dose level below which DLT appeared. Results: Eighteen patients were recruited. Two cases of grade 3 leucopenia/neutropenia was observed as DLT at the level of topotecan 2.0 mg/m2. MTD of topotecan was defined as 1.75 mg/m2.The major side effects were leucopenia/neutropenia, nausea and vomiting. Conclusion: Topotecan combined with whole brain radiotherapy for brain metastasis in lung cancer is well tolerated. Maximum-tolerated dose of topotecan is 1.75 mg/m2, once a week of a total of four.

  8. IMAGE-GUIDED RADIOTHERAPY AND -BRACHYTHERAPY FOR CERVICAL CANCER

    Directory of Open Access Journals (Sweden)

    Suresh eDutta

    2015-03-01

    Full Text Available Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT, and 2-dimensional intracavitary brachytherapy.Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron emission tomography (PET and magnetic resonance imaging (MRI has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT, allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer.

  9. [Recent developments in radiotherapy of hepatocellular carcinoma].

    Science.gov (United States)

    Seong, Jinsil

    2004-12-01

    With the accumulation of clinical experiences, the efficacy of radiotherapy has been recognized in management scheme for HCC. While hepatologists are beginning to show less reluctance for applying radiotherapy to the treatment of HCC, it is necessary that the hepatologists be informed of the rapid developments in technical strategy for radiation oncology. Recent advances in several technologies have opened a new era in radiation oncology. Modern imaging technologies can provide a 3-dimensional model of patient's anatomy, and this allows radiation oncologists to identify accurate tumor volumes as well as the tumors' relationship with the adjacent normal tissues. Moreover, the development of the computer-controlled multileaf collimator systems now enables physicians to perform precise beam shaping and to modulate the radiation dose distribution. A combination of these systems, 3-DCRT, is rapidly replacing the more conventional 2-D radiotherapy. 3-DCRT has evolved into a more sophisticated technology, intensity modulated radiotherapy (IMRT). In IMRT, with the powerful computer-aided optimization process, the radiation dose can be delivered to the target using highly complex isodose profiles. This new technology has been further developed into IGRT, which combines the CT-images scanning system and radiation equipments into one hardware package, and this system is currently ready for clinical application. In parallel with the radiation technologies described above, the strategy of stereotactic radiation has evolved from the conventional linear accelerator-based system to a gammaknife, and more recently, to a cyberknife. These systems are primarily based on the concept of radiosurgery. Currently, various radiation technologies have been adopted for the radiotherapy of HCC. In this article, each strategy will be discussed as well as the indications for radiotherapy and the radiation-related complications.

  10. Hypofractionated radiotherapy as local hemostatic agent in advanced cancer

    Directory of Open Access Journals (Sweden)

    Malik Tariq Rasool

    2011-01-01

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

  11. Modelling the interplay between hypoxia and proliferation in radiotherapy tumour response

    Science.gov (United States)

    Jeong, J.; Shoghi, K. I.; Deasy, J. O.

    2013-07-01

    A tumour control probability computational model for fractionated radiotherapy was developed, with the goal of incorporating the fundamental interplay between hypoxia and proliferation, including reoxygenation over a course of radiotherapy. The fundamental idea is that the local delivery of oxygen and glucose limits the amount of proliferation and metabolically-supported cell survival a tumour sub-volume can support. The model has three compartments: a proliferating compartment of cells receiving oxygen and glucose; an intermediate, metabolically-active compartment receiving glucose; and a highly hypoxic compartment of starving cells. Following the post-mitotic cell death of proliferating cells, intermediate cells move into the proliferative compartment and hypoxic cells move into the intermediate compartment. A key advantage of the proposed model is that the initial compartmental cell distribution is uniquely determined from the assumed local growth fraction (GF) and volume doubling time (TD) values. Varying initial cell state distributions, based on the local (voxel) GF and TD, were simulated. Tumour response was simulated for head and neck squamous cell carcinoma using relevant parameter values based on published sources. The tumour dose required to achieve a 50% local control rate (TCD50) was found for various GFs and TD’s, and the effect of fraction size on TCD50 was also evaluated. Due to the advantage of reoxygenation over a course of radiotherapy, conventional fraction sizes (2-2.4 Gy fx-1) were predicted to result in smaller TCD50's than larger fraction sizes (4-5 Gy fx-1) for a 10 cc tumour with GFs of around 0.15. The time to eliminate hypoxic cells (the reoxygenation time) was estimated for a given GF and decreased as GF increased. The extra dose required to overcome accelerated stem cell accumulation in longer treatment schedules was estimated to be 0.68 Gy/day (in EQD26.6), similar to published values derived from clinical data. The model predicts

  12. Out-of-field dose measurements in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kaderka, Robert

    2011-07-13

    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. Chest Wall Pain and Rib Fracture after Stereotactic Radiotherapy for Peripheral Non-small Cell Lung Cancer

    National Research Council Canada - National Science Library

    Voroney, Jon-Paul J; Hope, Andrew; Dahele, Max R; Purdy, Thomas; Franks, Kevin N; Pearson, Shannon; Cho, John B. C; Sun, Alex; Payne, David G; Bissonnette, Jean-Pierre; Bezjak, Andrea; Brade, Anthony M

    2009-01-01

    .... With high dose per fraction radiotherapy, late side effects are of possible concern. In our initial cohort of 42 patients treated with 54 to 60 Gy in three fractions, nine patients have rib fracture...

  14. Radiotherapy of unicentric mediastinal Castleman's disease

    Institute of Scientific and Technical Information of China (English)

    Yue-Min Li; Yong-Dong Pu; Peng-Hui Liu; Yu-Hai Zhang; Huo-Sheng Xia; Liang-Liang Li; Yi-Mei Qu; Yong Wu; Shou-Yun Han; Guo-Qing Liao

    2011-01-01

    Castleman's disease is a slowly progressive and rare lymphoproliferative disorder. Here, we report a 55-year-old woman with superior mediastinal Castleman's disease being misdiagnosed for a long term. We found a 4.3 cm mass localized in the superior mediastinum accompanied with severe clinical symptoms. The patient underwent an exploratory laparotomy, but the mass failed to be totally excised. Pathologic examination revealed a mediastinal mass of Castleman's disease. After radiotherapy of 30 Gy by 15 fractions, the patient no longer presented previous symptoms. At 3 months after radiotherapy of 60 Gy by 30 fractions, Computed tomography of the chest showed significantly smaller mass, indicating partial remission. Upon a 10-month follow-up, the patient was alive and free of symptoms.

  15. Hypofractionated whole breast radiotherapy: current perspectives

    Directory of Open Access Journals (Sweden)

    Koulis TA

    2015-10-01

    Full Text Available Theodora A Koulis, Tien Phan, Ivo A Olivotto Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada Abstract: Adjuvant radiotherapy (RT is an important part of breast cancer management but the dose and fractionation schedules used are variable. A total of 50 Gy in 25 daily fractions delivered over 5 weeks is often considered the "standard" adjuvant RT prescription. Hypofractionated regimes such as 42.5 Gy in 16 daily fractions or 40 Gy in 15 daily fractions following breast-conserving surgery have proven to be equally effective and achieve similar or better cosmetic and normal tissue outcomes for both invasive and in situ diseases and when treating the regional nodes. Hypofractionation is more convenient for patients and less costly. However, certain patients at higher risk of RT late effects may benefit from a less intense, even more extended fractionation schedule. This review describes the indications for whole breast hypofractionated adjuvant RT for patients with breast cancer following breast-conserving surgery and proposes that hypofractionation should be the new "standard" for adjuvant breast cancer RT. Keywords: fractionation, breast cancer, cosmesis, radiotherapy

  16. Adaptive Radiotherapy for an Uncommon Chloroma

    Directory of Open Access Journals (Sweden)

    Soufya Majdoul

    2016-10-01

    Full Text Available Granulocytic sarcomas, also referred to as chloromas or myeloid sarcomas, are extramedullary neoplasms that are composed of immature myeloid cells. This uncommon disease is known to be radiosensitive. However, the total dose and dose per fraction are not standardized. In addition, during the course of radiation therapy, significant reduction of the tumor is usually obtained. Thus, target volume reduction may require an intermediate radiotherapy plan evaluation for an adaptive treatment. A second plan at mid-dose is highly recommended.

  17. Effects of radiotherapy and estramustine on the microvasculature in malignant glioma

    OpenAIRE

    Johansson, M; Bergenheim, A. T.; Widmark, A; Henriksson, R.

    1999-01-01

    Tumour angiogenesis is essential for progression of solid tumours and constitutes an interesting target for therapy. However, impaired tumour blood supply may also be an important obstacle for treatment by radiotherapy and chemotherapy. Estramustine has been shown to increase tumour blood flow and potentiate the effect of radiotherapy in experimental glioma. This study investigated the effects of fractionated radiotherapy and estramustine on angiogenesis in malignant glioma. The intracerebral...

  18. Single-fraction high-dose-rate brachytherapy using real-time transrectal ultrasound based planning in combination with external beam radiotherapy for prostate cancer: dosimetrics and early clinical results

    Science.gov (United States)

    Lauche, Olivier; Delouya, Guila; Taussky, Daniel; Menard, Cynthia; Béliveau-Nadeau, Dominic; Hervieux, Yannick; Larouche, Renée

    2016-01-01

    Purpose To validate the feasibility of a single-fraction high-dose-rate brachytherapy (HDRBT) boost for prostate cancer using real-time transrectal ultrasound (TRUS) based planning. Material and methods From August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15 fractions, 44 Gy/22 fractions, or 45 Gy/25 fractions) was performed before (31%) or after (69%) HDRBT boost. Genito-urinary (GU) and gastro-intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the international prostate symptom score scale (IPSS) and the common terminology criteria for adverse events (CTCAE) v3.0. Results All dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥ 105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 < 11% in 96%, urethra D10 < 120% for 99%, urethra V125 = 0% in 100%, and rectal V75 < 1 cc in 93% of patients. Median IPSS score was 4 at baseline and did not change at 4 and 12 months after combined treatment. No patients developed ≥ grade 2 GI toxicity. With a median follow-up of 10 months, only two patients experienced biochemical failure. Among patients who didn't receive ADT, cumulative percentage of patients with PSA ≤ 1 ng/ml at 4 and 18 months was respectively 23% and 66%. Conclusions Single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality. In combination with EBRT, toxicity outcomes appear promising. A longer follow-up is needed to assess long-term outcome and toxicities. PMID:27257413

  19. Radiotherapy in the management of Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sakata, Koh-ichi; Hareyama, Masato; Oouchi, Atsushi; Shidou, Mitsuo; Nagakura, Hisayasu; Morita, Kazuo; Osanai, Hajime; Ohtsuka, Kenji; Hinoda, Yuji [Sapporo Medical Univ. (Japan). School of Medicine

    1998-06-01

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

  20. Conformal radiotherapy of prostate carcinoma: Procedure description

    Directory of Open Access Journals (Sweden)

    Erak Marko

    2011-01-01

    Full Text Available Introduction. Today, three-dimensional conformal radiotherapy is a standard way in the radical treatment of localized prostate cancer, and it is an alternative to the radical prostatectomy. This method of radiotherapy treatment is widely accepted in the treatment of prostate cancer patients, and provides irradiation of targeted volume (prostate, seminal vesicles with dose escalation sparing the surrounding healthy tissues (rectum, bladder at the same time. That is not possible with the conventional twodimension technique. Procedure description. Three-dimensional conformal radiotherapy is a volumetric, visual simulation according to the computed tomography slices; it defines the tumour and organ at risk individually in each patient. Results of several studies have shown that there is a significant decrease in the development of acute toxicity when prostate cancer patients are treated with conformal radiotherapy. High dose irradiation gives excellent results in treatment of localized prostate carcinoma and improves treatment results in the patients with locally advanced carcinoma of prostate. Discussion. Prostate carcinoma irradiation techniques have been changed dramatically during recent years. Data obtained by computed tomography are important since the size and shapes of the prostate as well as its anatomic relations towards the rectum and bladder are considerably different in individual patients. The three-dimension plan of irradiation can be designed for each patient individually by performing computed tomography technique when planning radiotherapy. Conclusion. The advanced planning systems for conformal radiotherapy can reconstruct the anatomic structures of pelvis in three-dimension technique on the basis of computed tomography scans, which provides better conformality between the irradiation beam and geometrical shape of the tumour with minimal irradiation of the surrounding healthy tissue.

  1. Planning a Radiotherapy Department.

    Science.gov (United States)

    van der Merwe, D

    2017-02-01

    The master planning of new radiotherapy facilities requires the input and engagement of a range of highly specialised professionals, both in the construction and health sector. Although radiation protection and safety aspects of radiotherapy services are universal, low and middle income countries are often presented with unique challenges that also need to be considered, e.g. competing needs within the health sector, lack of financial and human resources, environmental factors like poor provision of transport or electrical power, inadequate regulatory infrastructure, etc. Efforts to establish, upgrade or expand radiotherapy services should therefore not only focus on the technology that is appropriate and sustainable, but also be mindful of the need for quality, safety and optimal utilisation of technology. The workflow in a radiotherapy department can be facilitated by strategic placement of the main functional areas into the concept design. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  2. An Expanded Multi-scale Monte Carlo Simulation Method for Personalized Radiobiological Effect Estimation in Radiotherapy: a feasibility study

    Science.gov (United States)

    Zhang, Ying; Feng, Yuanming; Wang, Wei; Yang, Chengwen; Wang, Ping

    2017-01-01

    A novel and versatile “bottom-up” approach is developed to estimate the radiobiological effect of clinic radiotherapy. The model consists of multi-scale Monte Carlo simulations from organ to cell levels. At cellular level, accumulated damages are computed using a spectrum-based accumulation algorithm and predefined cellular damage database. The damage repair mechanism is modeled by an expanded reaction-rate two-lesion kinetic model, which were calibrated through replicating a radiobiological experiment. Multi-scale modeling is then performed on a lung cancer patient under conventional fractionated irradiation. The cell killing effects of two representative voxels (isocenter and peripheral voxel of the tumor) are computed and compared. At microscopic level, the nucleus dose and damage yields vary among all nucleuses within the voxels. Slightly larger percentage of cDSB yield is observed for the peripheral voxel (55.0%) compared to the isocenter one (52.5%). For isocenter voxel, survival fraction increase monotonically at reduced oxygen environment. Under an extreme anoxic condition (0.001%), survival fraction is calculated to be 80% and the hypoxia reduction factor reaches a maximum value of 2.24. In conclusion, with biological-related variations, the proposed multi-scale approach is more versatile than the existing approaches for evaluating personalized radiobiological effects in radiotherapy. PMID:28322329

  3. An Expanded Multi-scale Monte Carlo Simulation Method for Personalized Radiobiological Effect Estimation in Radiotherapy: a feasibility study

    Science.gov (United States)

    Zhang, Ying; Feng, Yuanming; Wang, Wei; Yang, Chengwen; Wang, Ping

    2017-03-01

    A novel and versatile “bottom-up” approach is developed to estimate the radiobiological effect of clinic radiotherapy. The model consists of multi-scale Monte Carlo simulations from organ to cell levels. At cellular level, accumulated damages are computed using a spectrum-based accumulation algorithm and predefined cellular damage database. The damage repair mechanism is modeled by an expanded reaction-rate two-lesion kinetic model, which were calibrated through replicating a radiobiological experiment. Multi-scale modeling is then performed on a lung cancer patient under conventional fractionated irradiation. The cell killing effects of two representative voxels (isocenter and peripheral voxel of the tumor) are computed and compared. At microscopic level, the nucleus dose and damage yields vary among all nucleuses within the voxels. Slightly larger percentage of cDSB yield is observed for the peripheral voxel (55.0%) compared to the isocenter one (52.5%). For isocenter voxel, survival fraction increase monotonically at reduced oxygen environment. Under an extreme anoxic condition (0.001%), survival fraction is calculated to be 80% and the hypoxia reduction factor reaches a maximum value of 2.24. In conclusion, with biological-related variations, the proposed multi-scale approach is more versatile than the existing approaches for evaluating personalized radiobiological effects in radiotherapy.

  4. Acute toxicity of adjuvant radiotherapy in locally advanced differentiated thyroid carcinoma. First results of the multicenter study differentiated thyroid carcinoma (MSDS).

    Science.gov (United States)

    Schuck, Andreas; Biermann, Martin; Pixberg, Michaela K; Müller, Stefan B; Heinecke, Achim; Schober, Otmar; Willich, Normann

    2003-12-01

    The indication for adjuvant postoperative radiotherapy in patients with differentiated thyroid carcinoma (DTC) extending beyond the thyroid capsule has been an issue of controversy during the past 2 decades. No randomized studies evaluating the benefit of radiotherapy have been published so far. In the Multicenter Study Differentiated Thyroid Carcinoma (MSDS), a randomization has been performed concerning external-beam radiotherapy in patients with DTC extending beyond the thyroid capsule (pT4 pN0/1/x cM0, TNM classification, 5th edition, 1997) following surgery and radioiodine therapy. Radiation-associated toxicity has been prospectively evaluated. Radiotherapy was performed with 50.4 Gy (pN0) or 54.0 Gy (pN1/x) to the cervical, supraclavicular and upper mediastinal lymph nodes. A total dose of 59.4 Gy (R0 resection) or 66.6 Gy (R1) was used to treat the tumor bed. Conventional fractionation was used with 1.8 Gy/d. At the time of the analysis, 36 patients were randomized or allocated to treatment arm A (with external-beam radiotherapy). Of these, 22 were treated with radiotherapy, and documentation of acute toxicity was available. Toxicity was evaluated prospectively according to the RTOG/EORTC criteria. The maximal acute toxicity observed during radiotherapy was grade I in four patients, grade II in 16 patients, and grade III in two patients (9.1%; 95% confidence interval [95% CI] 1.1-29.2%). Toxicity was mainly observed at the pharynx, larynx, and skin. In 19 patients, residual toxicity within 100 days following radiotherapy was evaluated. No residual toxicity was observed in two patients. Maximal residual toxicity was grade I in 13 patients and grade II in four. No further grade III toxicity could be observed. The majority of patients experience mild to moderate side effects from adjuvant external-beam radiotherapy. At the first follow-up examination, most side effects have subsided. Acute toxicity is tolerable in these patients.

  5. Nanoparticle-guided radiotherapy

    DEFF Research Database (Denmark)

    2012-01-01

    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...... for simultaneous or integrated external beam radiotherapy and imaging, e.g., using computed tomography (CT)....

  6. Dupuytren contracture. Radiotherapy of early stages

    Energy Technology Data Exchange (ETDEWEB)

    Herbst, M.; Regler, G.

    1985-03-01

    Conventional radiotherapy is the treatment of choice for the early stages of theDupuytren contracture. The conventional semi-deep therapy is more favorable than the soft ray technique and the moulage technique. 62 patients have been treated at Erlangen; 33 out of them (46 irradiated hands) with a minimum observation time of 18 months have been evaluated. The pathologic process was stopped in 98% of the cases. 85% of the patients showed an improvement of troubles by regression of tubercules and cords, pains and sensation of pressure. A recurrence was obseved only in one patient at the edge of the irradiated volume.

  7. Proton radiotherapy of skin carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Umebayashi, Y.; Uyeno, K.; Otsuka, F. (Tsukuba Univ. (Japan). School of Medicine); Tsujii, H. (Proton Medical Research Center, Tsukuba (Japan))

    1994-01-01

    At the Proton Medical Research Centre, University of Tsukuba, a pilot study of proton-beam radiotherapy was performed in 12 patients with the following types of carcinoma: Bowen's disease (4), oral verrucous carcinoma (5), and squamous cell carcinoma (3). They received total doses of 51-99.2 Gy in fractions of 2-12.5 Gy. All tumours responded well to the treatment. All four lesions of Bowen's disease, three of the five oral verrucous carcinomas, and the three squamous cell carcinomas completely regressed following irradiation. Two squamous cell carcinomas recurred during the follow-up period. One recurrent squamous cell carcinoma was successfully treated by a salvage surgical operation, and in the other case the patient refused further therapy. In two verrucous carcinomas there was 90% regression of tumour volume. No severe radiation-related complication occurred. (Author).

  8. Hypofractionated Adjuvant Whole Breast Radiotherapy: Progress and Prospects

    Energy Technology Data Exchange (ETDEWEB)

    Yarnold, John (Section of Radiotherapy, Inst. of Cancer Research, Royal Marsden Hospital, Sutton (United Kingdom)), E-mail: john.yarnold@icr.ac.uk; Haviland, Joanne (Clinical Trials and Statistics Unit (ICR-CTSU), Section of Clinical Trials, Inst. of Cancer Research, Sutton (United Kingdom))

    2010-11-15

    Published results of randomised trials involving >7000 women confirm the safety and efficacy of hypofractionated schedules of adjuvant radiotherapy for women with early breast cancer using fraction sizes between 2 and 3 Gy assuming appropriate downward adjustments to total dose. Unnecessary concerns relating to heart tolerance, suboptimal dose distribution and duration of follow up need not discourage the routine adoption of 15- or 16-fraction schedules in women treated by breast conservation surgery for early breast cancer. Regardless of fractionation regimen, dose escalation to the index quadrant in high risk subgroups will result in a greater relative increase in late adverse effects than tumour control, a therapeutic disadvantage that can only be overcome by exploiting a marked dose-volume effect. A 15-fraction schedule of whole breast radiotherapy is unlikely to represent the lower limits of hypofractionation, and the preliminary results of a 5-fraction regimen are encouraging

  9. Adjuvant radiotherapy for gallbladder cancer: A dosimetric comparison of conformal radiotherapy and intensity-modulated radiotherapy

    Institute of Scientific and Technical Information of China (English)

    Xiao-Nan Sun; Qi Wang; Ben-Xing Gu; Yan-Hong Zhu; Jian-Bin Hu; Guo-Zhi Shi; Shu Zheng

    2011-01-01

    AIM: To assess the efficacy and toxicity of conformal radiotherapy (CRT) and compare with intensity-modulated radiotherapy (IMRT) in the treatment of gallbladder cancer.METHODS: Between November 2003 and January 2010, 20 patients with gallbladder cancer were treated with CRT with or without chemotherapy after surgical resection. Preliminary survival data were collected and examined using both Kaplan-Meier and actuarial analysis. Demographic and treatment parameters were collected. All patients were planned to receive 46-56 Gy in 1.8 or 2.0 Gy per fraction. CRT planning was compared with IMRT.RESULTS: The most common reported acute toxicities requiring medication (Radiation Therapy Oncology Group, Radiation Therapy Oncology Group Grade2) were nausea (10/20 patients) and diarrhea (3/20).There were no treatment-related deaths. Compared with CRT planning, IMRT significantly reduced the volume of right kidney receiving > 20 Gy and the volume of liver receiving > 30 Gy. IMRT has a negligible impact on the volume of left kidney receiving > 20 Gy. The 95% of prescribed dose for a planning tumor volume using either 3D CRT or IMRT planning were 84.0% ±6.7%, 82.9% ± 6.1%, respectively (P > 0.05).CONCLUSION: IMRT achieves similar excellent target coverage as compared with CRT planning, while reducingthe mean liver dose and volume above threshold dose. IMRT offers better sparing of the right kidney compared with CRT planning, with a significantly lower mean dose and volume above threshold dose.

  10. Radiobiological evaluation of the radiation dose as used in high-precision radiotherapy: effect of prolonged delivery time and applicability of the linear-quadratic model.

    Science.gov (United States)

    Shibamoto, Yuta; Otsuka, Shinya; Iwata, Hiromitsu; Sugie, Chikao; Ogino, Hiroyuki; Tomita, Natsuo

    2012-01-01

    Since the dose delivery pattern in high-precision radiotherapy is different from that in conventional radiation, radiobiological assessment of the physical dose used in stereotactic irradiation and intensity-modulated radiotherapy has become necessary. In these treatments, the daily dose is usually given intermittently over a time longer than that used in conventional radiotherapy. During prolonged radiation delivery, sublethal damage repair takes place, leading to the decreased effect of radiation. This phenomenon is almost universarily observed in vitro. In in vivo tumors, however, this decrease in effect can be counterbalanced by rapid reoxygenation, which has been demonstrated in a laboratory study. Studies on reoxygenation in human tumors are warranted to better evaluate the influence of prolonged radiation delivery. Another issue related to radiosurgery and hypofractionated stereotactic radiotherapy is the mathematical model for dose evaluation and conversion. Many clinicians use the linear-quadratic (LQ) model and biologically effective dose (BED) to estimate the effects of various radiation schedules, but it has been suggested that the LQ model is not applicable to high doses per fraction. Recent experimental studies verified the inadequacy of the LQ model in converting hypofractionated doses into single doses. The LQ model overestimates the effect of high fractional doses of radiation. BED is particularly incorrect when it is used for tumor responses in vivo, since it does not take reoxygenation into account. For normal tissue responses, improved models have been proposed, but, for in vivo tumor responses, the currently available models are not satisfactory, and better ones should be proposed in future studies.

  11. Clinical characterization of OSL dosimeters for use in dosimetry of teletherapy beams in conventional fractionation; Caracterizacion clinica de dosimetros OSL para su uso en dosimetria de haces de teleterapia en fraccionamiento convencional

    Energy Technology Data Exchange (ETDEWEB)

    Lopez V, A.; Gutierrez M, J. G.; Rivera M, T. [IPN, Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, Av. Legaria No. 694, Col. Irrigacion, 11500 Mexico D. F. (Mexico); Velazquez T, J. J., E-mail: jggm25@yahoo.com.mx [Centro Medico Nacional Siglo XXI, Hospital de Oncologia, Departamento de Fisica Medica, Av. Cuauhtemoc No. 330, Col. Doctores, 06720 Mexico D. F. (Mexico)

    2015-10-15

    Optically stimulated materials are increasingly used for dosimetry in clinical settings; to be sure of the obtained reading their proper clinical characterization is necessary. Is important to know the homogeneity of a batch, reproducibility, be exposed to the same conditions of irradiation repeatedly and other dependences that could present such as energy, angular, the type of radiation which are exposed and the dose deposited in them. For characterization they were designed and implemented tests for each of the factors of interest, taking into account the need for them (calculations, manufacture of mannequins, conditions, practicality, etc.) It was shown that we can apply this dosimetry in clinical practice within a radiotherapy center, relying on the readings and practicality. (Author)

  12. Postoperative External Beam Radiotherapy for Retroperitoneal Soft Tissue Sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Na Yong; Kim, Il Han; Choi, Jin Hwa; Park, Charn Il [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-09-15

    To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, 8-240 months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, 3-50 cm). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (>60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (>60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. Our results were comparable to previous reports in that adjacent organ invasion and patient age (>60 years) were significant predictors of poor survival and tumor recurrence, respectively.

  13. A unique hypofractionated radiotherapy schedule with 51.3 Gy in 18 fractions three times per week for early breast cancer: outcomes including local control, acute and late skin toxicity.

    Science.gov (United States)

    Vassilis, Kouloulias; Ioannis, Gogalis; Anna, Zygogianni; Christina, Armpilia; Christos, Antypas; John, Kokakis; Porfyrios, Koromperlis; Vassiliki, Gennimata; John, Kouvaris

    2017-03-01

    Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule for breast cancer patients. Between October 2007 and October 2009, 80 women with early breast cancer were treated by 42.75 Gy in 15 fractions over 5 weeks. This treatment involved three fractions per week (Monday-Wednesday-Friday). All patients received an additional boost dose to the tumor bed of 8.55 Gy in 3 fractions using 6 MV photons. The primary endpoint included any local recurrence in the treated breast. Secondary endpoint included acute and late radiation skin toxicity. The median follow-up time was 63 months (range 60-72). Radiation toxicity was graded according the RTOG/EORTC criteria. Neither local nor distant recurrence was noted in any patient during this 3-year follow-up. Grade 0, 1, 2 acute skin toxicity was observed in 56/80 (70.0 %), in 19/80 (23.8 %) and in 5/80 (6.3 %), respectively. Three months post-RT, toxicity grades 0, 1, 2 skin toxicity were 64/80 (80 %), 14/80 (17.5 %) and 2/80 (2.5 %), respectively. Late toxicity as grade 0, 1 was observed in 72/80 (90.0 %) and in 8/80 (10.0 %), respectively, 6 months post-RT, whereas after 1 year they were 78/80 (97.5 %) and 2/80 (2.5 %), respectively. Preliminary results regarding skin reactions, cosmetic appearance and local control are consistent with published data that support the use of shorter fractionation schedules in early breast cancer patients after breast conservative surgery. Longer follow-up and a randomized prospective study stand in need for the extraction of safe conclusions.

  14. Concomitant chemo-radiotherapy for locally advanced bronchial cancer: impact of radiotherapy quality on global survival: results of a trial by the Thoracic Cancerology French-speaking Inter-group (IFCT) and Pneumo-Cancerology French Group (GFPC) 02.01; Chimioradiotherapie concomitante pour cancer bronchique localement evolue: impact de la qualite de la radiotherapie sur la survie globale: resultats de l'essai de l'Intergroupe francophone de cancerologie thoracique (IFCT) et du Groupe francais de pneumo-cancerologie (GFPC) 02.01

    Energy Technology Data Exchange (ETDEWEB)

    Martel-Lafay, I.; Montella, A.; Pommier, P. [Centre Leon-Berard, 69 - Lyon (France); Clavere, P. [CHU de Limoges, 87 - Limoges (France); Labat, J.P. [CHU de Brest, 29 - (France); Benchalal, M. [Centre Eugene-Marquis, 35 - Renne (France); Teissier, E. [Centre azureen de radiotherapie, 06 - Mougins (France); Talabard, J.N.; Fournel, P. [CHU de Saint- Etienne, 42 - Saint- Etienne (France); D' Hombres, A. [Centre hospitalier Lyon Sud, 69 - Pierre-Benite (France)

    2010-10-15

    The author report the assessment of the influence of radiotherapy quality and of its consequences on the future of 113 patients during a phase-II randomized trial of concomitant chemo-radiotherapy of bronchial cancers without stage-II non-resectable small cells. The patients have been submitted to a conformational radiotherapy and a concomitant induction of consolidation chemotherapy. Ten items are analysed: immobilisation, dose per fraction, total dose, ganglion radiotherapy, number of beams, images before and after radiotherapy, radiotherapy duration, duration without radiotherapy, dose-lung volume histogram. The study notably shows the deleterious effects of an interruption of the concomitant chemotherapy on the global survival. Short communication

  15. [HARDROCK project: parametric data collection and analysis of patients with head and neck cancer in the comprehensive cancer centre of Ostrava - role of fractionation and target volume definition in radiotherapy].

    Science.gov (United States)

    Halámka, M; Feltl, D; Cvek, J; Dušek, L

    2012-01-01

    The HARDROCK project has been designed as a retrospective data collection study in a locally run database system, which fulfils the requirements on the basic version of electronic medical records of cancer patients. The diagnostic category of head and neck tumors has been selected on purpose, as it presents a major problem in the Comprehensive Cancer Centre of Ostrava, and it is relevant given the high incidence and mortality in the Moravian-Silesian Region. The target parameters of the assessment include short-term as well as long-term treatment results in patients with head and neck tumors, evaluated with standard indicators of treatment response and survival. A special emphasis is put on major treatment modalities, i.e. surgery and radiation therapy, and on related complications. In this article, we present a sample of collected data. The data from patients has been separated into two groups based on the time of their acquisition: data from patients treated in 2004-2005 versus patients treated in 2006-2010. This division was given by the change of treatment protocols in 2006 introducing accelerated radiotherapy with concomitant boost and expanded lymph node irradiation field compared to normofractionation and hyperfractionation regimes used before 2006. Introduction of new irradiation techniques did not increase the rate of acute toxicity but slightly increased late toxicity. Further, we found a decrease of number of relapse and improved overall survival in patients with stage IV disease treated in 2006-2010. The project results will contribute methodically to the exact evaluation of diagnostics and treatment of patients with head and neck cancer and will help to optimize their medical care.

  16. Volumetric Modulated Arc Therapy, Conventional Intensity-modulated Radiotherapy and Three-Dimensional Conformal Techniques for Upper Thoracic Esophageal Cancer: A Planning Comparison Study%胸上段食管癌容积旋转调强和静态调强与三维适形放疗计划的剂量学比较

    Institute of Scientific and Technical Information of China (English)

    张瑞; 习勉; 李巧巧; 赵磊; 黄晓波; 何立儒; 胡永红; 刘孟忠

    2012-01-01

    [目的]比较容积旋转调强( VMAT)、静态调强(sIMRT)与三维适形放疗(3DCRT)技术在胸上段食管癌的剂量学差异.[方法]选取7例局部晚期胸上段食管癌患者,分别制定3DCRT、7野sIMRT和360度单弧VMAT 3套放疗计划,处方剂量统一为60 Gy/30F.比较靶区、危及器官的剂量体积参数,加速器的总机器跳数(MU)和有效治疗时间(TT)等.[结果]VMAT与IMRT的靶区剂量分布基本一致,均优于3DCRT.对于正常组织,三组计划中肺、心脏的受照剂量均无明显差异,但IMRT与VMAT可较3DCRT更好的保护脊髓.3DCRT、IMRT、VMAT的MU分别为537±92、601±122、682±139,有效治疗时间(min)分别为3.9±0.3、6.0±0.7、4.7±0.7 (P< 0.05).[结论]与3DCRT相比,VMAT与IMRT在胸上段食管癌均有一定的剂量学优势,但VMAT较IMRT可显著提高治疗效率.%[Objective] A planning study was performed to compare volumetric modulated arc therapy (VMAT), static intensity-modulated radiotherapy (sIMRT), and three-dimensional conformal radiotherapy (3DCRT) for upper thoracic esophageal cancer. [Methods] Seven patients with loco-regionally advanced upper thoracic esophageal cancer were included. Based on the identical CT and planning target volume (PTV), three plans (3DCRT, sIMRT with seven fields, VMAT with a single arc) were generated. Dose prescription was set to 60Gy in 30 fractions. Dose volume histograms, MU and delivery time were evaluated to assess plan quality. [Results] In comparison to 3DCRT, both VMAT and IMRT provided a systematic improvement in PTV coverage. For normal tissues, equivalent sparing of lung and heart were achieved with three plans. However, IMRT and VMAT showed a superior sparing compared with 3DCRT for spinal cord. The MU/fraction was as follows; 537 ± 92 for 3DCRT, 601 ± 122 for IMRT, and 682 ± 139 for VMAT. Effective treatment time for 3DCRT, IMRT and VMAT were (3.9 ± 0.3) min, (6.0 ± 0.7) min and (4.7 ± 0.7)min, respectively (P< 0

  17. Use of hypofractionated radiotherapy regimens after organ-sparing surgery for Stages I–IIA breast cancers

    Directory of Open Access Journals (Sweden)

    Yu. V. Efimkina

    2010-01-01

    Full Text Available There have been recent reports on the expediency of applying postoperative hypofractionated accelerated radiotherapy (RT regimens in patients who have undergone breast-sparing surgery. The concept of accelerated hypofractionation (AH includes daily high-dose radiation for a shorter total period of time. In most radiologists’ opinion, the AH RT regimen may be as effective as more conventional treatments that use lower daily radiation doses for a longer period. The appeal of this method is that shorter treatment provides more convenience for patients. By taking into account the fact that the α/β ratio for intact breast tissues is about 3.5 Gy, larger fraction RT regi- mens are likely to be more effective, which will reduce the frequency of recurrences as compared with conventional therapy approaches without increasing the incidence of postradiation intact tissue damage.

  18. SU-E-J-206: Adaptive Radiotherapy for Gynecological Malignancies with MRIGuided Cobolt-60 Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lamb, J; Kamrava, M; Agazaryan, N; Cao, M; Low, D; Thomas, D; Yang, Y [UCLA School of Medicine, Los Angeles, CA (United States)

    2015-06-15

    Purpose: Even in the IMRT era, bowel toxicity and bone marrow irradiation remain concerns with pelvic irradiation. We examine the potential gain from an adaptive radiotherapy workflow for post-operative gynecological patients treated to pelvic targets including lymph nodes using MRI-guided Co-60 radiation therapy. Methods: An adaptive workflow was developed with the intent of minimizing time overhead of adaptive planning. A pilot study was performed using retrospectively analyzed images from one patient’s treatment. The patient’s treated plan was created using conventional PTV margins. Adaptive treatment was simulated on the patient’s first three fractions. The daily PTV was created by removing non-target tissue, including bone, muscle and bowel, from the initial PTV based on the daily MRI. The number of beams, beam angles, and optimization parameters were kept constant, and the plan was re-optimized. Normal tissue contours were not adjusted for the re-optimization, but were adjusted for evaluation of plan quality. Plan quality was evaluated based on PTV coverage and normal tissue DVH points per treatment protocol. Bowel was contoured as the entire bowel bag per protocol at our institution. Pelvic bone marrow was contoured per RTOG protocol 1203. Results: For the clinically treated plan, the volume of bowel receiving 45 Gy was 380 cc, 53% of the rectum received 30 Gy, 35% of the bladder received 45 Gy, and 28% of the pelvic bone marrow received 40 Gy. For the adaptive plans, the volume of bowel receiving 45 Gy was 175–201 cc, 55–62% of the rectum received 30 Gy, 21– 27% of the bladder received 45 Gy, and 13–17% of the pelvic bone marrow received 40 Gy. Conclusion: Adaptive planning led to a large reduction of bowel and bone marrow dose in this pilot study. Further study of on-line adaptive techniques for the radiotherapy of pelvic lymph nodes is warranted. Dr. Low is a member of the scientific advisory board of ViewRay, Inc.

  19. Evaluation of novel radiotherapy technologies: what evidence is needed to assess their clinical and cost effectiveness, and how should we get it?

    NARCIS (Netherlands)

    Loon, J. van; Grutters, J.P.C.; Macbeth, F.

    2012-01-01

    Technical innovations in radiation oncology--eg, intensity-modulated radiotherapy, stereotactic radiotherapy, and particle therapy--can be developed rapidly and introduced into the clinic even when costs associated with their use are much higher than those for conventional radiotherapy. Although cli

  20. CIK细胞在原发性肝癌三维适形放疗联合TACE治疗中的应用研究%CIK Cells in Primary Liver Cancer Three-dimensional Conformal Radiotherapy Combined with Conventional Therapy, the Application of Research

    Institute of Scientific and Technical Information of China (English)

    杨秋敏

    2013-01-01

    目的:分析CIK细胞在原发性肝癌三维适形放疗联合TACE治疗中的应用效果。方法:选取我院于2010年1月~2013年4月收治的48例不能实施手术治疗的原发性肝癌的患者,将其均分为2组,其中对照组患者接受三维适形放疗联合TA-CE(肝动脉化疗栓塞)治疗,治疗组患者在此基础上增加使用CIK细胞免疫法对患者实施治疗,对比2组患者的治疗后患者病情发展时间( TTP),并对患者进行为期1年、2年随访,观察患者的生存率。结果:治疗组患者的所有生存指标其中包括1、3年生存率以及众位生存期显著优于对照组,对比有统计学意义(P<0.05),所有患者并发症中最为常见的病症为肝功能病症。所有患者中19例(39.9%)患者出现肝功能损伤,均对患者进行保肝等对症治疗。其中治疗组患者常见的不良反应为轻度消化道反应或发热。结论:在三维适形放疗联合TACE治疗原发性肝癌的基础上,增加使用CIK免疫法对患者实施治疗,可有效改善患者的肝脏功能,提高患者机体免疫力,有利于提高患者生命质量,值得在临床医学中应用发展。%objective:to analysis of CIK cells in primary liver cancer in 3 d conformal radiotherapy combined with conventional appli-cation effect .Methods:our hospital from January 2010 to April 2013 were 48 cases can't implement of surgical treatment of primary liver cancer patients ,which were divided into two groups ,the control group patients received 3 d conformal radiotherapy combined with conven-tional (hepatic artery embolism chemotherapy) treatment, the treatment group patients on the basis of the increased use of CIK cells im-mune method for patients with treatment , compared two groups of patients after the treatment of patients with disease progression ( TTP) , and the period of 1 year, 2 years of follow-up in patients, observe patient surial rates .Results

  1. How to Move from Conventional Radiotherapy to Hadrontherapy

    Science.gov (United States)

    Miralbell, Raymond

    2008-08-01

    In order to implement a hadrontherapy project a well defined partnership is needed. This would support both investment and research. The choice of treatment concept, site, number of gantries and financial issues should be the task to be addressed by a study group. A nodal network of medical centers should be recommended in order to assure the critical number of referrals and implement high quality clinical research trials.

  2. 大分割放射治疗联合唑来磷酸治疗晚期肺癌椎体转移疼痛患者的疗效分析%Effect of large fractionated radiotherapy combined with the treatment of patients with advanced lung cancer treated with vertebral metastasis

    Institute of Scientific and Technical Information of China (English)

    李小明; 牛德森

    2015-01-01

    目的 探讨肺癌椎体转移疼痛患者在放疗期间联合使用唑来磷酸的疗效.方法 56例肺癌椎体转移疼痛患者分为2组进行对照研究,每组28例,其中观察组患者采用大分割放射治疗联合唑来磷酸治疗,对照组患者单纯采用常规分割放射治疗,对比两组患者的临床治疗效果.结果 观察组 28例患者在使用大分割放射治疗联合唑来磷酸进行治疗后1周后疼痛缓解27例,疼痛缓解率为96.4%,3月后局部再次疼痛3例,再次疼痛率为10.7%;对照组28例1周疼痛缓解15例,疼痛缓解率为53.5%;3月后局部再次疼痛11例;再次疼痛率为39.2%.;观察组患者的1周疼痛缓解症明显高于对照组患者,观察组患者3月后局部再次疼痛率明显低于对照组患者,P<0.05,差异具有统计学意义.结论 晚期肺癌椎体转移疼痛患者在临床治疗中采用大分割放射治疗联合唑来磷酸进行治疗,能够快速长效地缓解疼痛症状.%Objective: To explore the lung cancer patients with vertebral metastasis pain during radiotherapy combined cura-tive effect of phosphate.Methods:56 patients with vertebral metastasis lung cancer pain control study is divided into two groups, control group patients only with conventional radiotherapy, compared two groups of patients with the clinical therapeutic effect. Results: 28 patients in the observation group division using large radiotherapy combined azole phosphate for pain relief after 1 week after treatment of 27 cases;Observation group 1 week pain relief in patients with disease patients is significantly higher than control group, observation group of patients with localized pain again 3 months later rate is significantly lower than the control group patients,P<0.05, the difference is statistically significant.Conclusion:The patients with advanced lung cancer pain ver-tebral metastasis in clinical treatment with large divided radiotherapy combined azole phosphate treatment, better able to

  3. Fractional Echoes

    CERN Document Server

    Karras, G; Billard, F; Lavorel, B; Siour, G; Hartmann, J -M; Faucher, O; Gershnabel, Erez; Prior, Yehiam; Averbukh, Ilya Sh

    2016-01-01

    We report the observation of fractional echoes in a double-pulse excited nonlinear system. Unlike standard echoes which appear periodically at delays which are integer multiple of the delay between the two exciting pulses, the fractional echoes appear at rational fractions of this delay. We discuss the mechanism leading to this phenomenon, and provide the first experimental demonstration of fractional echoes by measuring third harmonic generation in a thermal gas of CO2 molecules excited by a pair of femtosecond laser pulses.

  4. Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing.

    Science.gov (United States)

    Vrána, David; Študentová, Hana; Matzenauer, Marcel; Vlachová, Zuzana; Cwiertka, Karel; Gremlica, David; Kalita, Ondřej

    2016-06-01

    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.

  5. FRACTIONAL BANKING

    OpenAIRE

    Maria Klimikova

    2010-01-01

    Understanding the reasons of the present financial problems lies In understanding the substance of fractional reserve banking. The substance of fractional banking is in lending more money than the bankers have. Banking of partial reserves is an alternative form which links deposit banking and credit banking. Fractional banking is causing many unfavorable economic impacts in the worldwide system, specifically an inflation.

  6. FRACTIONAL BANKING

    OpenAIRE

    Maria Klimikova

    2010-01-01

    Understanding the reasons of the present financial problems lies In understanding the substance of fractional reserve banking. The substance of fractional banking is in lending more money than the bankers have. Banking of partial reserves is an alternative form which links deposit banking and credit banking. Fractional banking is causing many unfavorable economic impacts in the worldwide system, specifically an inflation.

  7. The efficacy of radiotherapy for vertebral hemangiomas.

    Science.gov (United States)

    Miszczyk, L; Ficek, K; Trela, K; Spindel, J

    2001-01-01

    Vertebral hemangiomas are benign, slowly growing tumors sometimes causing local pain in the spine and/or neurologic disorders. The present paper includes 14 cases of painful vertebral hemangiomas treated by radiotherapy. All patients were irradiated using standard fractionation scheme with a total dose 20-30 Gy. One month after the treatment complete pain relief was noted in 36% of cases, five months later in 67% of cases, but in the remaining cases partial pain relief was noted. No correlation between treatment outcome and different biological and technical factors was found. No dose-response relationship was noted. The results suggest that anti-inflamatory effect of radiation plays the major role in this kind of treatment and that radiotherapy for vertebral hemangiomas is easy, short and highly effective analgetic treatment modality.

  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)

    2013-10-15

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

  9. Seizure control following radiotherapy in patients with diffuse gliomas: a retrospective study

    Science.gov (United States)

    Rudà, Roberta; Magliola, Umberto; Bertero, Luca; Trevisan, Elisa; Bosa, Chiara; Mantovani, Cristina; Ricardi, Umberto; Castiglione, Anna; Monagheddu, Chiara; Soffietti, Riccardo

    2013-01-01

    Background Little information is available regarding the effect of conventional radiotherapy on glioma-related seizures. Methods In this retrospective study, we analyzed the seizure response and outcome following conventional radiotherapy in a cohort of 43 patients with glioma (33 grade II, 10 grade III) and medically intractable epilepsy. Results At 3 months after radiotherapy, seizure reduction was significant (≥50% reduction of frequency compared with baseline) in 31/43 patients (72%) of the whole series and in 25/33 patients (76%) with grade II gliomas, whereas at 12 months seizure reduction was significant in 26/34 (76%) and in 19/25 (76%) patients, respectively. Seizure reduction was observed more often among patients displaying an objective tumor response on MRI, but patients with no change on MRI also had a significant seizure reduction. Seizure freedom (Engel class I) was achieved at 12 months in 32% of all patients and in 38% of patients with grade II tumors. Timing of radiotherapy and duration of seizures prior to radiotherapy were significantly associated with seizure reduction. Conclusions This study showed that a high proportion of patients with medically intractable epilepsy from diffuse gliomas derive a significant and durable benefit from radiotherapy in terms of epilepsy control and that this positive effect is not strictly associated with tumor shrinkage as shown on MRI. Radiotherapy at tumor progression seems as effective as early radiotherapy after surgery. Prospective studies must confirm and better characterize the response to radiotherapy. PMID:23897633

  10. Hyperfractionated radiotherapy and chemotherapy for childhood ependymoma: final results of the first prospective AIEOP (Associazione Italiana di Ematologia-Oncologia Pediatrica) study.

    Science.gov (United States)

    Massimino, Maura; Gandola, Lorenza; Giangaspero, Felice; Sandri, Alessandro; Valagussa, Pinuccia; Perilongo, Giorgio; Garrè, Maria Luisa; Ricardi, Umberto; Forni, Marco; Genitori, Lorenzo; Scarzello, Giovanni; Spreafico, Filippo; Barra, Salvina; Mascarin, Maurizio; Pollo, Bianca; Gardiman, Martina; Cama, Armando; Navarria, Pierina; Brisigotti, Maurizio; Collini, Paola; Balter, Rita; Fidani, Paola; Stefanelli, Maurizio; Burnelli, Roberta; Potepan, Paolo; Podda, Marta; Sotti, Guido; Madon, Enrico

    2004-04-01

    A postsurgical "stage-based" protocol for ependymoma was designed. Children were given: (1) focal hyperfractionated radiotherapy (HFRT) if with no evidence of disease (NED), or (2) 4 courses with VEC followed by HFRT for residual disease (ED). HFRT dose was 70.4 Gy (1.1 Gy/fraction b.i.d.); VEC consisted of VCR 1.5 mg/m2 1/w, VP16 100 mg/m2/day x 3, CTX 3 g/m2 d 1. When feasible, second-look surgery was recommended. Sixty-three consecutive children were enrolled: 46 NED, 17 ED; the tumor was infratentorial in 47 and supratentorial in 16, with spinal metastasis in 1. Of NED patients, 35 of 46 have been treated with HFRT; 8 received conventionally fractionated radiotherapy, and 3 received no treatment. Of the 17 ED patients, 9 received VEC + HFRT; violations due to postsurgical morbidity were as follows: HFRT only (2), conventionally fractionated radiotherapy (3) + VEC (2), and no therapy (1). Objective responses to VEC were seen in 54%; objective responses to RT were seen in 75%. Overall survival and progression-free survival at 5 years for all 63 children were 75% and 56%, respectively; for the NED subgroup, 82% and 65%; and for the ED subgroup, 61% and 35%, respectively. All histologies were centrally reviewed. At multivariate analysis, grading, age, and site proved significant for prognosis. HFRT, despite the high total dose adopted, did not change the prognosis of childhood ependymoma as compared to historical series: New radiotherapeutic approaches are needed to improve local control. Future ependymoma strategies should consider grading when stratifying treatment indications.

  11. Radiotherapy inducing total knee prosthetic component loosening for recurrent pigmented villonodular synovitis following joint replacement

    Directory of Open Access Journals (Sweden)

    Ko-Ta Chen

    2017-01-01

    Full Text Available Pigmented villonodular synovitis (PVNS following total knee arthroplasty (TKA is a rare condition. We reported a case of PVNS following TKA; initially, arthroscopic synovectomy was performed; however, recurrence of PVNS happened. We performed second arthroscopic synovectomy and moderate dose radiotherapy (total dose 44 cGy/22 fractions to posterior fossa, 36 cGy/18 fractions to knee for the patient. Unfortunately, distal femur osteonecrosis with femoral and tibial component loosening happened 2 months after completing the radiotherapy procedure. Revision TKA with Legacy Constrained Condylar Knee was done. Radiotherapy is not recommended for recurrent PVNS after TKA.

  12. Fractional thermoelasticity

    CERN Document Server

    Povstenko, Yuriy

    2015-01-01

    This book is devoted to fractional thermoelasticity, i.e. thermoelasticity based on the heat conduction equation with differential operators of fractional order. Readers will discover how time-fractional differential operators describe memory effects and space-fractional differential operators deal with the long-range interaction. Fractional calculus, generalized Fourier law, axisymmetric and central symmetric problems and many relevant equations are featured in the book. The latest developments in the field are included and the reader is brought up to date with current research.  The book contains a large number of figures, to show the characteristic features of temperature and stress distributions and to represent the whole spectrum of order of fractional operators.  This work presents a picture of the state-of-the-art of fractional thermoelasticity and is suitable for specialists in applied mathematics, physics, geophysics, elasticity, thermoelasticity and engineering sciences. Corresponding sections of ...

  13. Hypofractionated radiotherapy has the potential for second cancer reduction

    Directory of Open Access Journals (Sweden)

    Besserer Jürgen

    2010-02-01

    Full Text Available Abstract Background and Purpose A model for carcinoma and sarcoma induction was used to study the dependence of carcinogenesis after radiotherapy on fractionation. Materials and methods A cancer induction model for radiotherapy doses including fractionation was used to model carcinoma and sarcoma induction after a radiation treatment. For different fractionation schemes the dose response relationships were obtained. Tumor induction was studied as a function of dose per fraction. Results If it is assumed that the tumor is treated up to the same biologically equivalent dose it was found that large dose fractions could decrease second cancer induction. The risk decreases approximately linear with increasing fraction size and is more pronounced for sarcoma induction. Carcinoma induction decreases by around 10% per 1 Gy increase in fraction dose. Sarcoma risk is decreased by about 15% per 1 Gy increase in fractionation. It is also found that tissue which is irradiated using large dose fractions to dose levels lower than 10% of the target dose potentially develop less sarcomas when compared to tissues irradiated to all dose levels. This is not observed for carcinoma induction. Conclusions It was found that carcinoma as well as sarcoma risk decreases with increasing fractionation dose. The reduction of sarcoma risk is even more pronounced than carcinoma risk. Hypofractionation is potentially beneficial with regard to second cancer induction.

  14. Effect of Tumor Infiltrating Lymphocyte on Local Control of Rectal Cancer after Preoperative Radiotherapy

    Institute of Scientific and Technical Information of China (English)

    XU Gang; XU Bo; ZHANG Shan-wen

    2008-01-01

    Objective:To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy.Methods:From Jan.1999 to Oct.2007,a total of 107 patients with rectal cancer were reviewed.They were treated by preoperative radiotherapy,30 Gy/10 fractions/12 days.Two weeks later,the patient underwent a surgical operation.Their pathological samples were kept in our hospital before and after radiotherapy.Lymphocyte infiltration(LI)degree,pathologic degradation and fibrosis degree after radiotherapy in paraffin section were evaluated under microscope.Results:After followed-up of 21 months(2-86 months),a total of 107 patients were reviewed.Univariate analysis showed that lymphocyte infiltration(LI),fibrosis and pathologic changes after radiotherapy were significant factors on local control.Logistic regression analysis showed that LI after radiotherapy was a significant effect factor on local control.Conclusion:LI,fibrosis and pathologic degradation after radiotherapy are significant for local control of rectal cancer after preoperative radiotherapy.LI after radiotherapy was a significantly prognostic index for local control of rectal cancer after preoperative radiotherapy.

  15. Radiotherapy for the medulloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Gose, Kyuhei; Imajo, Yoshinari; Imanaka, Kazufumi (Kobe Univ. (Japan). School of Medicine)

    1983-08-01

    Eighteen patients with medulloblastoma, treated between 1972 and 1981, at Kobe University School of Medicine, were retrospectively studied. Of those completing post operative irradiation, 50% have survived for 2 years, 15% for 5 years and mean survival periods was 22.2 months. 13 out of 18 patients developed local recurrence and spinal dissemination. The mean time from the initial radiotherapy to recurrence was 8.5 months. It was suggested that posterior fossa should recieve 5,000 rad, the spine should 2,000 rad and recurrences should be treated by the combination of radiotherapy and chemotherapy.

  16. Xerostomia induced by radiotherapy

    Directory of Open Access Journals (Sweden)

    Alimi D

    2015-08-01

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

  17. Respiratory gated radiotherapy-pretreatment patient specific quality assurance

    OpenAIRE

    Rajesh Thiyagarajan; Sujit Nath Sinha; Ramamoorthy Ravichandran; Kothandaraman Samuvel; Girigesh Yadav; Ashok Kumar Sigamani; Vikraman Subramani; N Arunai Nambi Raj

    2016-01-01

    Organ motions during inter-fraction and intra-fraction radiotherapy introduce errors in dose delivery, irradiating excess of normal tissue, and missing target volume. Lung and heart involuntary motions cause above inaccuracies and gated dose delivery try to overcome above effects. Present work attempts a novel method to verify dynamic dose delivery using a four-dimensional (4D) phantom. Three patients with mobile target are coached to maintain regular and reproducible breathing pattern. Appro...

  18. 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

    2006-01-01

    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.

  19. Radiotherapy of indolent orbital lymphomas. Two radiation concepts

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, Laila; Stade, Robert; Rieber, Juliane; Debus, Juergen; Herfarth, Klaus [Universitaetsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg (Germany)

    2016-06-15

    The aim of this work was to retrospectively analyze efficacy, toxicity, and relapse rates of conventional (CRT) and low-dose radiotherapy (LDRT) in patients with indolent orbital lymphomas. From 1987-2014, 45 patients (median age 64 years) with 52 lesions of indolent orbital lymphomas were treated with CRT (median dose 36 Gy, range 26-46 Gy) and 7 patients (median age 75 years) with 8 lesions were treated with LDRT (2 fractions of 2.0 Gy). Median follow-up was 133 months (range 2-329 months) in the CRT group and 25 months (range 10-41 months) in the LDRT group. Overall response rates were 97.7 % (CRT) and 100 % (LDRT). The 2- and 5-year local progression-free survival (PFS) rates were 93.5 and 88.6 %, distant PFS 95.0 and 89.9 %, and overall survival 100 and 85.6 % after CRT. In the LDRT group, 2-year local PFS and overall survival remained 100 %, respectively, and distant PFS 68.6 %. Acute radiotherapy-related complications (grades 1-2) were detected in virtually all eyes treated with CRT. Cataracts developed in only patients who were irradiated with more than 34 Gy. LDRT was well tolerated with only mild acute and late complications. Primary radiotherapy of indolent orbital lymphomas is an effective treatment with high response rates and excellent local control in CRT and LDRT. In combination with close follow-up, LDRT may be an attractive alternative since re-irradiation even with conventional doses is still feasible. (orig.) [German] Ziel der Arbeit war die Analyse von Effektivitaet, Nebenwirkungen und Rezidivraten nach konventioneller (CRT) und Niedrigdosisbestrahlung (LDRT) indolenter Orbitalymphome. Retrospektiv evaluiert wurden 45 zwischen 1987 und 2014 behandelte Patienten (medianes Alter 64 Jahre) mit insgesamt 52 Laesionen indolenter Orbitalymphome, die mittels CRT (mediane Dosis 36 Gy, 26-46 Gy) therapiert wurden.; 7 Patienten mit insgesamt 8 Laesionen erhielten eine LDRT (2 x 2,0 Gy). Das mediane Follow-Up betrug 133 Monate (2-239 Monate) in der CRT

  20. A new plan quality index for dose painting radiotherapy.

    Science.gov (United States)

    Park, Yang-Kyun; Park, Soyeon; Wu, Hong-Gyun; Kim, Siyong

    2014-07-08

    Dose painting radiotherapy is considered a promising radiotherapy technology that enables more targeted dose delivery to tumor rich regions while saving critical normal tissues. Obviously, dose painting planning would be more complicated and hard to be evaluated with current plan quality index systems that were developed under the paradigm of uniform dose prescription. In this study, we introduce a new plan quality index, named "index of achievement (IOA)" that assesses how close the planned dose distribution is to the prescribed one in a dose painting radiotherapy plan. By using voxel-based comparison between planned and prescribed dose distributions in its formulation, the index allows for a single-value evaluation regardless of the number of prescribed dose levels, which cannot be achieved with the conventional indices such as conventional homogeneity index. Benchmark calculations using patient data demonstrated feasibility of the index not only for contour-based dose painting plans, but also for dose painting by numbers plans. Also, it was shown that there is strong correlation between the new index and conventional indices, which indicates a potential of the new index as an alternative to conventional ones in general radiotherapy plan evaluation.

  1. Erythropoietin and radiotherapy; Erythropoietine et radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-01-15

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

  2. Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-03-01

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

  3. Innovations in Radiotherapy Technology.

    Science.gov (United States)

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

    2017-02-01

    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.

  4. Upfront Bevacizumab and Temozolomide or Fotemustine before Radiotherapy for Patients with Glioblastoma and Severe Neurological Impairment at Diagnosis

    Directory of Open Access Journals (Sweden)

    Celina Bihan

    2012-09-01

    Full Text Available Unresectable glioblastomas with severe neurological impairment at diagnosis have a poor prognosis. The conventional approach using a temozolomide-based chemoradiotherapy has limited efficiency on patients in the RTOG RPA V–VI classes. The activity of the antiangiogenic monoclonal antibody bevacizumab is well defined in recurrent glioblastoma, despite the fact that its impact on survival is not yet established. We wondered if neoadjuvant bevacizumab, used as upfront treatment in combination with a cytotoxic agent, was tolerable and active on neurological signs in patients with severe alteration of the neurological status due to the tumor being located in functional areas. Eight patients received intravenous bevacizumab, 10 mg/kg every 2 weeks, and either oral temozolomide (150–200 mg/m2/day for 5 days every 4 weeks or intravenous fotemustine (80 mg/m2 every 2 weeks. After an average of 5 cycles of bevacizumab, a clinical improvement of neurological functions was recorded in 8/8 patients who could then receive radiotherapy at a conventional dose (60 Gy in 30 fractions with continuation of bevacizumab and the cytotoxic agent. Four out of the 8 patients benefited from a durable stabilization and experienced an unusually long survival in such a bad situation at diagnosis. In conclusion, neoadjuvant bevacizumab with chemotherapy appears to be feasible and efficient in a category of patients from the RTOG RPA V–VI classes, by allowing the completion of full-dose radiotherapy. A clinical trial is planned to confirm these retrospective observations.

  5. 伽玛刀分次治疗大于3cm直径脑膜瘤疗效分析%Analysis of fractionated stereotactic radiotherapy for meningiomas larger than 3 centimeters

    Institute of Scientific and Technical Information of China (English)

    欧明亮; 庞军

    2011-01-01

    目的 探讨伽玛刀分次治疗(FSRT)大于3 cm直径脑膜瘤的疗效,评价其临床应用价值.方法 搜集2007年3月至2010年3月采用FSRT的直径>3 cm脑膜瘤患者45例,其中男25例,女20例,年龄18~84岁(中位值51岁).首次应用伽玛刀治疗23例,术后残留和/或复发22例.肿瘤直径3.1~7.3 cm(中位值4.1 cm),计划靶体6积2.7~103.5cm3(中位值17.1 cm3),FSRT总剂量21~36 Gy(中位值28 Gy),分4~10次(中位值7次).结果 所有病人随访3~12个月(中位值6个月),随访率100%.局部控制率CR4.44%,PR62.22%,SD28.89%,PD4.44%,总有效率为95.56%.结论 FSRT能有效控制大于3 cm直径脑膜瘤,并改善患者生活质量,安全,副反应小.尤其是颅底深部、手术难以全切除或术后残留、复发以及年老体弱不宜手术者,首选伽玛刀可以获得理想的疗效.%Objective To assess the feasibility and the short - term effect of fractionated stereotactic radiation therapy (FSRT) with Super-Gamma-knife for meningiomas more than 3cm in diameter. Methods From March 2007 to March 2010, 45 patients (25 male and 20 female) with meningiomas larger than 3cm were treated using FSRT with Super-Gamma-knife. The median age was 51 (range, 18~84) years old. There were 23 newly diagnosed patients and 22 recurrent patients. The largest diameter of tumors was 3. 1~7. 3 cm(median, 4. Lcm). Planning target volume were 2. 7~103. 5cm3 (median, 17. Lcm3) . The median dose of FSRT was 28 (range, 21~36) Gy in 7 (range, 4~10) fractions. Results All patients followed up clinically for 3~12 months ,In 45 patients with meningiomas , the tumor disappeared in 2( 4. 44 %),reduced in 28(62. 22%), unchanged in 13(28. 89%), and increased in 2(4. 44 %)with a response rate of 95. 56%. Conclusion FSRT is definitive and safe with mild side effect for selected patients with meningiomas larger than 3cm. It is especially fitted for skull base meningiomas, unresectable meningiomas,postoperative tumor residual and recurrent

  6. Long-Term Tumor Control despite Late Pseudoprogression on 18F-FDG-PET following Extremely Hypofractionated Stereotactic Radiotherapy for Retropharyngeal Lymph Node Metastasis from Esthesioneuroblastoma

    Directory of Open Access Journals (Sweden)

    Kazuhiro Ohtakara

    2014-08-01

    Full Text Available 18F-FDG-PET is a valuable adjunct to conventional imaging for evaluating treatment response following stereotactic body radiotherapy (SBRT for head and neck malignancies (HNM. The effect of treatment-related inflammation is generally deemed negligible after 12 weeks following conventionally fractionated radiotherapy. Herein, we describe an unusual case showing pseudoprogression on 18F-FDG-PET 2 years after SBRT for retropharyngeal lymph node metastasis (RPLNm from esthesioneuroblastoma. A 36-year-old man presented with right RPLNm 32 months after the diagnosis of esthesioneuroblastoma associated with ectopic adrenocorticotropic hormone production. The RPLNm was treated with SBRT in 2 fractions over 8 days using dynamic conformal arcs with concomitant chemotherapy with cisplatin and etoposide. Although follow-up MRI showed sustained lesion regression, the early/delayed maximum standardized uptake (SUVmax values on dual-time-point 18F-FDG-PET obtained 1 and 2 years after SBRT were 7.7/8.3 and 8.5/10.1, respectively, suggesting local progression. Despite no subsequent focal or systemic treatment, the SUVmax values gradually decreased thereafter over a period of 4 years (3.3/3.4 at 76 months. MRI obtained 7 years after SBRT revealed sustained tumor regression. No obvious relevant toxicities have occurred. Thus, caution should be exercised in the interpretation of the SUVmax change following ablative irradiation for HNM.

  7. Intra- and interfraction breathing variations during curative radiotherapy for lung cancer

    DEFF Research Database (Denmark)

    Juhler Nøttrup, Trine; Korreman, Stine Sofia; Pedersen, Anders Navrsted;

    2007-01-01

    BACKGROUND AND PURPOSE: This study aimed at quantifying the breathing variations among lung cancer patients over full courses of fractionated radiotherapy. The intention was to relate these variations to the margins assigned to lung tumours, to account for respiratory motion, in fractionated...... radiotherapy. MATERIALS AND METHODS: Eleven lung cancer patients were included in the study. The patients' chest wall motions were monitored as a surrogate measure for breathing motion during each fraction of radiotherapy by use of an external optical marker. The exhale level variations were evaluated...... with respect to exhale points and fraction-baseline, defined for intra- and interfraction variations respectively. The breathing amplitude was evaluated as breathing cycle amplitudes and fraction-max-amplitudes defined for intra- and interfraction breathing, respectively. RESULTS: The breathing variations over...

  8. Outcome of postoperative radiotherapy following radical prostatectomy: a single institutional experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sea Won; Chung, Mi Joo; Jeong, Song Mi; Kim, Sung Hwan; Lee, Jong Hoon [Dept.of Radiation Oncology, St. Vincent' s Hospital, The Catholic University of Korea College of Medicine, Suwon (Korea, Republic of); Hwang, Tae Kon; Hong, Sung Hoo; Lee, Ji Youl; Jang, Hong Seok [Seoul St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of); Yoon, Sei Chul [Dept.of Radiation Oncology, Bucheon St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Bucheon (Korea, Republic of)

    2014-09-15

    This single institutional study is aimed to observe the outcome of patients who received postoperative radiotherapy after radical prostatectomy. A total of 59 men with histologically identified prostate adenocarcinoma who had received postoperative radiation after radical prostatectomy from August 2005 to July 2011 in Seoul St. Mary's Hospital of the Catholic University of Korea, was included. They received 45-50 Gy to the pelvis and boost on the prostate bed was given up to total dose of 63-72 Gy (median, 64.8 Gy) in conventional fractionation. The proportion of patients given hormonal therapy and the pattern in which it was given were analyzed. Primary endpoint was biochemical relapse-free survival (bRFS) after radiotherapy completion. Secondary endpoint was overall survival (OS). Biochemical relapse was defined as a prostate-specific antigen level above 0.2 ng/mL. After median follow-up of 53 months (range, 0 to 104 months), the 5-year bRFS of all patients was estimated 80.4%. The 5-year OS was estimated 96.6%. Patients who were given androgen deprivation therapy had a 5-year bRFS of 95.1% while the ones who were not given any had that of 40.0% (p < 0.01). However, the statistical significance in survival difference did not persist in multivariate analysis. The 3-year actuarial grade 3 chronic toxicity was 1.7% and no grade 3 acute toxicity was observed. The biochemical and toxicity outcome of post-radical prostatectomy radiotherapy in our institution is favorable and comparable to those of other studies.

  9. Radiotherapy for bone metastases - Practice in Norway 1997 - 2007. A national registry-based study

    Energy Technology Data Exchange (ETDEWEB)

    Sande Laugsand, Tonje [European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian Univ. of Technology and Science (NTNU), Trondheim (Norway)], e-mail: tonje.laugsand@ntnu.no; Kaasa, Stein; Lund, Jo-Aasmund [European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian Univ. of Technology and Science (NTNU), Trondheim (Norway); Cancer Clinic, St. Olavs Hospital, Univ. Hospital of Trondheim, Trondheim (Norway); Romundstad, Paal [Dept. of Public Health, Faculty of Medicine, Norwegian Univ. of Technology and Science (NTNU), Trondheim (Norway); Johannesen, Tom Boerge [Cancer Registry of Norway, Oslo (Norway)

    2013-08-15

    Numerous randomised clinical trials have shown that the efficacy of single fraction radiotherapy for metastatic bone pain corresponds to that of multiple fractions of radiotherapy for the majority of patients. It is not clear to which extent single fraction radiotherapy has been implemented into clinical practice. Material and methods: A Norwegian national registry based study was conducted, including all radiotherapy schedules of 8 Gy x 1 and 3 Gy x 10 delivered to bone metastases in 1997 - 2007. Binomial regression analyses were used to study whether treatment centre, primary diagnosis, anatomical region irradiated, age, sex, and travel distance, were associated with the choice of fractionation. Results: A total of 14 380 radiotherapy episodes were identified. During the period 31% of the treatments were delivered as 8 Gy x 1. The proportion of single fraction treatments increased from 16% in 1997 to 41% in 2007. There were substantial differences in the proportion of single fraction treatments between the treatment centres (range 25 - 54%). These differences persisted after adjustment for sex, age, primary diagnosis, anatomical region, and travel distance. Conclusions: The study demonstrates an under utilisation of single fraction treatment for bone metastases in Norway during the study period.

  10. Impact of prolonged fraction dose-delivery time modeling intensity-modulated radiation therapy on hepatocellular carcinoma cell killing

    Institute of Scientific and Technical Information of China (English)

    Xiao-Kang Zheng; Long-Hua Chen; Xiao Yan; Hong-Mei Wang

    2005-01-01

    AIM: To explore the impact of prolonged fraction dosedelivery time modeling intensity-modulated radiation therapy (IMRT) on cell killing of human hepatocellular carcinoma (HCC) HepG2 and Hep3B cell lines.METHODS: The radiobiological characteristics of human HCC HepG2 and Hep3b cell lines were studied with standard clonogenic assays, using standard linear-quadratic model and incomplete repair model to fit the dose-survival curves. The identical methods were also employed to investigate the biological effectiveness of irradiation protocols modeling clinical conventional fractionated external beam radiotherapy (EBRT, fraction delivery time 3 min) and IMRT with different prolonged fraction delivery time (15, 30, and 45 min). The differences of cell surviving fraction irradiated with different fraction delivery time were tested with paired t-test. Factors determining the impact of prolonged fraction delivery time on cell killing were analyzed.RESULTS: The α/β and repair half-time (T1/2) of HepG2and Hep3b were 3.1 and 7.4 Gy, and 22 and 19 min respectively. The surviving fraction of HepG2 irradiated modeling IMRT with different fraction delivery time was significantly higher than irradiated modeling EBRT and the cell survival increased more pronouncedly with the fraction delivery time prolonged from 15 to 45 min,while no significant differences of cell survival in Hep3b were found between different fraction delivery time protocols.CONCLUSION: The prolonged fraction delivery time modeling IMRT significantly decreased the cell killing in HepG2 but not in Hep3b. The capability of sub-lethal damage repair was the predominant factor determining the cell killing decrease. These effects, if confirmed by clinical studies, should be considered in designing IMRT treatments for HCC.

  11. [Hypofractionation and radiotherapy: "the eternal return"].

    Science.gov (United States)

    Cosset, J-M; Mornex, F; Eschwège, F

    2013-10-01

    Hypofractionation is not a new idea in radiotherapy. The use of a few high-dose fractions has been proposed by some pioneers of our specialty in the early years of the 20th century. Hypofractionation then reappeared several times in the next decades, based on successive radiobiological concepts, a number of them having been shown to be wrong. The nominal single dose (NSD), for example, so fashionable in the 1970's, dramatically underestimated the late toxicity of the high-dose fractions. Consequently, the NSD was directly responsible for a significant increase of the incidence and of the severity of late complications in large cohorts of patients. The linear-quadratic model (LQ) unequivocally improved our understanding of fractionation sensitivity, but one has to keep in mind its limitations, both in the areas of low and high doses per fraction. For more than a decade, prostate cancer has been the subject of fierce discussions about its sensitivity to fractionation. A number of studies have suggested an unusually low (for a malignant tumor) alpha/beta ratio. However, the available data do not allow a precise evaluation of this ratio; "very low" (1.5 Gy), with an advantage of hypofractionation in terms of local control? Or simply "low" (3-4 Gy), only allowing a reduction of the total number of fractions (with a dose adequately reduced)? While waiting for complementary data, it is advised to remain very careful when modifying the classical schemes towards hypofractionation.

  12. A randomized double-blind phase III study of nimorazole as a hypoxic radiosensitizer of primary radiotherapy in supraglottic larynx and pharynx carcinoma. Results of the Danish Head and Neck Cancer Study (DAHANCA) Protocol 5-85

    DEFF Research Database (Denmark)

    Overgaard, J.; Hansen, H.S.; Overgaard, M.

    1998-01-01

    PURPOSE: A multicenter randomized and balanced double-blind trial with the objective of assessing the efficacy and tolerance of nimorazole given as a hypoxic radiosensitizer in conjunction with primary radiotherapy of invasive carcinoma of the supraglottic larynx and pharynx. PATIENTS AND TREATMENT......: Between January 1986 and September 1990, 422 patients (414 eligible) with pharynx and supraglottic larynx carcinoma were double-blind randomized to receive the hypoxic cell radiosensitizer nimorazole, or placebo, in association with conventional primary radiotherapy (62-68 Gy, 2 Gy per fraction, five...... for the end-points of final loco-regional control (including surgical salvage) and cancer-related deaths (52 versus 41%, P = 0.002). This trend was also found in the overall survival but to a lesser, non-significant extent (26 versus 16%, 10-year actuarial values, P = 0.32). Cox multivariate regression...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-08-01

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

  14. Particle radiotherapy with carbon ion beams.

    Science.gov (United States)

    Ohno, Tatsuya

    2013-03-04

    Carbon ion radiotherapy offers superior dose conformity in the treatment of deep-seated malignant tumours compared with conventional X-ray therapy. In addition, carbon ion beams have a higher relative biological effectiveness compared with protons or X-ray beams. The algorithm of treatment planning and beam delivery system is tailored to the individual parameters of the patient. The present article reviews the available literatures for various disease sites including the head and neck, skull base, lung, liver, prostate, bone and soft tissues and pelvic recurrence of rectal cancer as well as physical and biological properties.

  15. 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)

    2009-10-15

    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)

  16. Radiotherapy - an effective treatment for vaginal verrucous carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Reinecke, L. (Witwatersand Univ. and Garden City Clinic, Johannesburg (South Africa)); Thornley, A.L. (Witwatersrand Univ., Johannesburg (South Africa). Dept. of Zoology)

    1993-04-01

    Vaginal carcinoma makes up 1%-2% of all gynaecological tumours. Verrucous carcinoma of the vagina is even more rare -only 16 cases are reported in the scientific literature. A case of a complete regression after 60 Gy fractionated radiotherapy by a tumour 12 cm[sup 3] in size is reported. Most authors are of the opinion that radiotherapy causes anaplastic transformation of verrucous carcinoma. The minority view, that anaplastic transformation does not occur, is correct and is supported by our clinical and radiological data. The conflicting literature on vaginal verrucous carcinoma (VVC) is reviewed with reference to verrucous carcinoma at other sites. (Author).

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-07-01

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

  18. Radiotherapy of cutaneous lymphomas; Radiotherapie des lymphomes cutanes

    Energy Technology Data Exchange (ETDEWEB)

    Kirova, Y.M.; Piedbois, Y.; Pan, Q.; Guo, J.P.; Le Bourgeois, J.P. [Hopital Henri-Mondor, 94 - Creteil (France). Dept. de cancerologie

    1999-03-01

    Radiotherapy plays an important role in the treatment of cutaneous lymphomas. In the treatment of Mycosis fungoides, total skin electron beam radiation therapy is efficient for patients with limited and superficial forms of the disease. Radiotherapy is also efficient for the locally advanced forms of non-epidermo-tropic lymphomas. The palliative radiotherapy is indicated for advanced, nodular and treatment resistant forms of cutaneous lymphomas and for voluminous lymphadenopathies. (authors)

  19. Fractional motions

    Energy Technology Data Exchange (ETDEWEB)

    Eliazar, Iddo I., E-mail: eliazar@post.tau.ac.il [Holon Institute of Technology, P.O. Box 305, Holon 58102 (Israel); Shlesinger, Michael F., E-mail: mike.shlesinger@navy.mil [Office of Naval Research, Code 30, 875 N. Randolph St., Arlington, VA 22203 (United States)

    2013-06-10

    Brownian motion is the archetypal model for random transport processes in science and engineering. Brownian motion displays neither wild fluctuations (the “Noah effect”), nor long-range correlations (the “Joseph effect”). The quintessential model for processes displaying the Noah effect is Lévy motion, the quintessential model for processes displaying the Joseph effect is fractional Brownian motion, and the prototypical model for processes displaying both the Noah and Joseph effects is fractional Lévy motion. In this paper we review these four random-motion models–henceforth termed “fractional motions” –via a unified physical setting that is based on Langevin’s equation, the Einstein–Smoluchowski paradigm, and stochastic scaling limits. The unified setting explains the universal macroscopic emergence of fractional motions, and predicts–according to microscopic-level details–which of the four fractional motions will emerge on the macroscopic level. The statistical properties of fractional motions are classified and parametrized by two exponents—a “Noah exponent” governing their fluctuations, and a “Joseph exponent” governing their dispersions and correlations. This self-contained review provides a concise and cohesive introduction to fractional motions.

  20. Performance of titanium salts compared to conventional FeCl 3 for the removal of algal organic matter (AOM) in synthetic seawater: Coagulation performance, organic fraction removal and floc characteristics

    KAUST Repository

    Chekli, L.

    2017-06-20

    During algal bloom periods, operation of seawater reverse osmosis (SWRO) pretreatment processes (e.g. ultrafiltration (UF)) has been hindered due to the high concentration of algal cells and algal organic matter (AOM). The present study evaluated for the first time the performance of titanium salts (i.e. titanium tetrachloride (TiCl4) and polytitanium tetrachloride (PTC)) for the removal of AOM in seawater and results were compared with the conventional FeCl3 coagulant. Previous studies already demonstrated that titanium salts not only provide a cost-effective alternative to conventional coagulants by producing a valuable by-product but also minimise the environmental impact of sludge production. Results from this study showed that both TiCl4 and PTC achieved better performance than FeCl3 in terms of turbidity, UV254 and dissolved organic carbon (DOC) removal at similar coagulant dose. Liquid chromatography – organic carbon detection (LC-OCD) was used to determine the removal of AOM compounds based on their molecular weight (MW). This investigation revealed that both humic substances and low MW organics were preferentially removed (i.e. up to 93% removal) while all three coagulants showed poorer performance for the removal of high MW biopolymers (i.e. less than 50% removal). The detailed characterization of flocs indicated that both titanium coagulants can grow faster, reach larger size and present a more compact structure, which is highly advantageous for the design of smaller and more compact mixing and sedimentation tanks. Both titanium coagulants also presented a higher ability to withstand shear force, which was related to the higher amount of DOC adsorbed with the aggregated flocs. Finally, TiCl4 had a better recovery after breakage suggesting that charge neutralization may be the dominant mechanism for this coagulant, while the lower recovery of both PTC and FeCl3 indicated that sweep flocculation is also a contributing mechanism for the coagulation of AOM.

  1. Effective local control of vertebral metastases by simultaneous integrated boost radiotherapy. Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Lubgan, Dorota; Ziegaus, Anke; Semrau, Sabine; Lambrecht, Ulrike; Lettmaier, Sebastian; Fietkau, Rainer [Erlangen University Hospital, Department of Radiation Oncology, Erlangen (Germany)

    2014-11-14

    The primary endpoint was to improve local tumour control of patients with metastatic spinal tumours by stereotactic body radiotherapy (SBRT) and dose escalation by simultaneous, integrated boost (PTV-boost). We used a whole vertebral body (PTV-elective) contouring approach. Secondary endpoints were severity of acute and chronic adverse effects and overall survival. In all, 33 patients with metastases of the vertebral column were treated at Erlangen University Hospital. SBRT was given in 12 or 10 fractions. The metastatic lesion (PTV-boost) received 3.6 Gy (range 3.0-4.51 Gy) per fraction for a total of 42.0 Gy (24.36-48.0 Gy) and the whole vertebra (PTV-elective) received 2.85 Gy (range 1.8-3.6 Gy) per fraction for a total of 32.39 Gy (range 21.60-38.0 Gy). Patients were followed up every 3 months. Local control rate of all patients was 93 % at 12 and 24 months. The overall survival rate was 54 % at 12 months, 38 % at 24 months and 18 % at 36 months. No radiation myelopathy occurred. The most frequently observed adverse events in 3 cases was oesophagitis grade 2. SBRT with simultaneous, integrated boost was associated with excellent local control of 93 % after 24 months. This result shows the possibility of delivering escalated doses to the target while still keeping the incidence of side effects low. This study forms the basis for a future randomised controlled trial comparing conventional radiotherapy (10 fractions of 3 Gy) with hypofractionated dose intensified SBRT (12 fractions of 3 Gy + integrated boost 12 fractions of 4 Gy) for improvement of local tumour control and pain. (orig.) [German] Das primaere Ziel der Studie war die Verbesserung der lokalen Tumorkontrolle von Patienten mit Wirbelkoerpermetastasen mittels stereotaktischer Radiotherapie (SBRT) mit Dosiseskalation durch einen simultan integrierten Boost (PTV-Boost). Dabei wurde der ganze Wirbelkoerper konturiert (PTV-Elektive). Zu den sekundaeren Endpunkten der Studie gehoerten der Schweregrad von

  2. Role of palliative radiotherapy in brain metastases

    Directory of Open Access Journals (Sweden)

    Ramesh S Bilimagga

    2009-01-01

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

  3. Radiotherapy of hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Gauwerky, F.

    1982-10-11

    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.

  4. GATE: computation code for medical imagery, radiotherapy and dosimetry; GATE: code de calcul pour l'imagerie medicale, la radiotherapie et la dosimetrie

    Energy Technology Data Exchange (ETDEWEB)

    Jan, S. [CEA Direction des Sciences du Vivant, Institut d ' Imagerie Bio-Medicale, Service Hospitalier Frederic Joliot, 4 pl. du Gn. Leclerc 91401 Orsay Cedex (France)

    2010-07-01

    The author presents the GATE code, a simulation software based on the Geant4 development environment developed by the CERN (the European organization for nuclear research) which enables Monte-Carlo type simulation to be developed for tomography imagery using ionizing radiation, and radiotherapy examinations (conventional and hadron therapy) to be simulated. The authors concentrate on the use of medical imagery in carcinology. They comment some results obtained in nuclear imagery and in radiotherapy

  5. 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)

    2003-11-01

    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)

  6. Current concepts on imaging in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lecchi, Michela; Elisei, Federica; Lucignani, Giovanni [University of Milan, Institute of Radiological Sciences, Milan (Italy); San Paolo Hospital, Unit of Nuclear Medicine, Milan (Italy); Fossati, Piero [University of Milan, Institute of Radiological Sciences, Milan (Italy); CNAO Foundation, Milan (Italy); Orecchia, Roberto [University of Milan, Institute of Radiological Sciences, Milan (Italy); CNAO Foundation, Milan (Italy); European Institute of Oncology, Department of Radiation Oncology, Milan (Italy)

    2008-04-15

    New high-precision radiotherapy (RT) techniques, such as intensity-modulated radiation therapy (IMRT) or hadrontherapy, allow better dose distribution within the target and spare a larger portion of normal tissue than conventional RT. These techniques require accurate tumour volume delineation and intrinsic characterization, as well as verification of target localisation and monitoring of organ motion and response assessment during treatment. These tasks are strongly dependent on imaging technologies. Among these, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and positron emission tomography (PET) have been applied in high-precision RT. For tumour volume delineation and characterization, PET has brought an additional dimension to the management of cancer patients by allowing the incorporation of crucial functional and molecular images in RT treatment planning, i.e. direct evaluation of tumour metabolism, cell proliferation, apoptosis, hypoxia and angiogenesis. The combination of PET and CT in a single imaging system (PET/CT) to obtain a fused anatomical and functional dataset is now emerging as a promising tool in radiotherapy departments for delineation of tumour volumes and optimization of treatment plans. Another exciting new area is image-guided radiotherapy (IGRT), which focuses on the potential benefit of advanced imaging and image registration to improve precision, daily target localization and monitoring during treatment, thus reducing morbidity and potentially allowing the safe delivery of higher doses. The variety of IGRT systems is rapidly expanding, including cone beam CT and US. This article examines the increasing role of imaging techniques in the entire process of high-precision radiotherapy. (orig.)

  7. Current concepts on imaging in radiotherapy.

    Science.gov (United States)

    Lecchi, Michela; Fossati, Piero; Elisei, Federica; Orecchia, Roberto; Lucignani, Giovanni

    2008-04-01

    New high-precision radiotherapy (RT) techniques, such as intensity-modulated radiation therapy (IMRT) or hadrontherapy, allow better dose distribution within the target and spare a larger portion of normal tissue than conventional RT. These techniques require accurate tumour volume delineation and intrinsic characterization, as well as verification of target localisation and monitoring of organ motion and response assessment during treatment. These tasks are strongly dependent on imaging technologies. Among these, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and positron emission tomography (PET) have been applied in high-precision RT. For tumour volume delineation and characterization, PET has brought an additional dimension to the management of cancer patients by allowing the incorporation of crucial functional and molecular images in RT treatment planning, i.e. direct evaluation of tumour metabolism, cell proliferation, apoptosis, hypoxia and angiogenesis. The combination of PET and CT in a single imaging system (PET/CT) to obtain a fused anatomical and functional dataset is now emerging as a promising tool in radiotherapy departments for delineation of tumour volumes and optimization of treatment plans. Another exciting new area is image-guided radiotherapy (IGRT), which focuses on the potential benefit of advanced imaging and image registration to improve precision, daily target localization and monitoring during treatment, thus reducing morbidity and potentially allowing the safe delivery of higher doses. The variety of IGRT systems is rapidly expanding, including cone beam CT and US. This article examines the increasing role of imaging techniques in the entire process of high-precision radiotherapy.

  8. Dose Measurements of Parotid Glands and Spinal Cord in Conventional Treatment of Nasopharyngeal Carcinoma Using RANDO Phantom and Thermoluminescent Dosimeters

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Bahreyni Toossi

    2015-07-01

    Full Text Available Introduction Radiotherapy is regarded as the first treatment of choice for nasopharyngeal carcinoma. Despite the advantages of radiotherapy, patients may suffer from a wide range of side-effects due to the presence of many sensitive normal tissues in these regions. If the absorbed dose exceeds the tolerance level in parotid glands and the spinal cord, myelopathy, Lhermitte's sign and xerostomia cannot be avoided. Materials and Methods The head and neck of a RANDO phantom (reference man, which was regarded as a hypothetical patient with nasopharyngeal carcinoma was evaluated. The full course of treatment consisted of three phases. At the beginning of each phase, an oncologist marked conventional fields on the RANDO phantom using a simulator. For measuring the absorbed dose, Thermoluminescent Dosimeters(TLD chips (TLD-100 were utilized.The absorbed dose by TLDs was read by Harshaw 3500 TLD reader. Results The total absorbed dose was calculated by measuring the absorbed dose in each phase, multiplied by the fraction numbers of each phase; the obtained values were summed up. The results showed that the received doses by spinal cord ranged from 15.24 to 54.56 Gy. Also, the absorbed dose of parotid glands was approximately 39.23 Gy. Conclusion Considering the minimum tolerance dose the absorbed doses in the spinal cord and parotid glands were above the tolerance level. The incidence rate of xerostomia and myelopathy were higher in patients, treated by conventional methods.

  9. A comparative analysis of radiobiological models for cell surviving fractions at high doses.

    Science.gov (United States)

    Andisheh, B; Edgren, M; Belkić, Dž; Mavroidis, P; Brahme, A; Lind, B K

    2013-04-01

    For many years the linear-quadratic (LQ) model has been widely used to describe the effects of total dose and dose per fraction at low-to-intermediate doses in conventional fractionated radiotherapy. Recent advances in stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have increased the interest in finding a reliable cell survival model, which will be accurate at high doses, as well. Different models have been proposed for improving descriptions of high dose survival responses, such as the Universal Survival Curve (USC), the Kavanagh-Newman (KN) and several generalizations of the LQ model, e.g. the Linear-Quadratic-Linear (LQL) model and the Pade Linear Quadratic (PLQ) model. The purpose of the present study is to compare a number of models in order to find the best option(s) which could successfully be used as a fractionation correction method in SRT. In this work, six independent experimental data sets were used: CHOAA8 (Chinese hamster fibroblast), H460 (non-small cell lung cancer, NSLC), NCI-H841 (small cell lung cancer, SCLC), CP3 and DU145 (human prostate carcinoma cell lines) and U1690 (SCLC). By detailed comparisons with these measurements, the performance of nine different radiobiological models was examined for the entire dose range, including high doses beyond the shoulder of the survival curves. Using the computed and measured cell surviving fractions, comparison of the goodness-of-fit for all the models was performed by means of the reduced χ (2)-test with a 95% confidence interval. The obtained results indicate that models with dose-independent final slopes and extrapolation numbers generally represent better choices for SRT. This is especially important at high doses where the final slope and extrapolation numbers are presently found to play a major role. The PLQ, USC and LQL models have the least number of shortcomings at all doses. The extrapolation numbers and final slopes of these models do not depend on dose. Their asymptotes

  10. Randomized multicenter trial on the effect of radiotherapy for plantar Fasciitis (painful heel spur using very low doses – a study protocol

    Directory of Open Access Journals (Sweden)

    Micke Oliver

    2008-09-01

    Full Text Available Abstract Background A lot of retrospective data concerning the effect of radiotherapy on the painful heel spur (plantar fasciitis is available in the literature. Nevertheless, a randomized proof of this effect is still missing. Thus, the GCGBD (German cooperative group on radiotherapy for benign diseases of the DEGRO (German Society for Radiation Oncology decided to start a randomized multicenter trial in order to find out if the effect of a conventional total dose is superior compared to that of a very low dose. Methods/Design In a prospective, controlled and randomized phase III trial two radiotherapy schedules are to be compared: standard arm: total dose 6.0 Gy in single fractions of 1.0 Gy applied twice a week experimental arm: total dose 0.6 Gy in single fractions of 0.1 Gy applied twice a week (acting as a placebo Patients aged over 40 years who have been diagnosed clinically and radiologically to be suffering from a painful heel spur for at least six months can be included. Former trauma, surgery or radiotherapy to the heel are not allowed nor are patients with a severe psychiatric disease or women during pregnancy and breastfeeding. According to the statistical power calculation 100 patients have to be enrolled into each arm. After having obtaining a written informed consent a patient is randomized by the statistician to one of the arms mentioned above. After radiotherapy, the patients are seen first every six weeks, then regularly up to 48 months after therapy, they additionally receive a questionnaire every six weeks after the follow-up examinations. The effect is measured using several target variables (scores: Calcaneodynia-score according to Rowe et al., SF-12 score, and visual analogue scale of pain. The most important endpoint is the pain relief three months after therapy. Patients with an inadequate result are offered a second radiotherapy series applying the standard dose (equally in both arms. This trial protocol has been

  11. Polymer fractionation

    Energy Technology Data Exchange (ETDEWEB)

    Hadermann, A. F.

    1985-04-09

    Soluble polymers are fractionated according to molecular weight by cryogenically comminuting the polymer and introducing the polymer particles, while still in the active state induced by cryogenic grinding, into a liquid having a solvent power selected to produce a coacervate fraction containing high molecular weight polymer species and a dilute polymer solution containing lower molecular weight polymer species. The coacervate may be physically separated from the solution and finds use in the production of antimisting jet fuels and the like.

  12. Mathematical modeling of brain tumors: effects of radiotherapy and chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Powathil, G [Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, N2L 3G1 (Canada); Kohandel, M [Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, N2L 3G1 (Canada); Sivaloganathan, S [Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, N2L 3G1 (Canada); Oza, A [Center for Mathematical Medicine, Fields Institute for Research in Mathematical Sciences, Toronto, Ontario M5T 3J1 (Canada); Milosevic, M [Radiation Medicine Program, Princess Margaret Hospital, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9 (Canada)

    2007-06-07

    Gliomas, the most common primary brain tumors, are diffusive and highly invasive. The standard treatment for brain tumors consists of a combination of surgery, radiation therapy and chemotherapy. Over the past few years, mathematical models have been applied to study untreated and treated brain tumors. In an effort to improve treatment strategies, we consider a simple spatio-temporal mathematical model, based on proliferation and diffusion, that incorporates the effects of radiotherapeutic and chemotherapeutic treatments. We study the effects of different schedules of radiation therapy, including fractionated and hyperfractionated external beam radiotherapy, using a generalized linear quadratic (LQ) model. The results are compared with published clinical data. We also discuss the results for combination therapy (radiotherapy plus temozolomide, a new chemotherapy agent), as proposed in recent clinical trials. We use the model to predict optimal sequencing of the postoperative (combination of radiotherapy and adjuvant, neo-adjuvant or concurrent chemotherapy) treatments for brain tumors.

  13. Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system.

    Science.gov (United States)

    Palazzi, Mauro; Tomatis, Stefano; Orlandi, Ester; Guzzo, Marco; Sangalli, Claudia; Potepan, Paolo; Fantini, Simona; Bergamini, Cristiana; Gavazzi, Cecilia; Licitra, Lisa; Scaramellini, Gabriele; Cantu', Giulio; Olmi, Patrizia

    2008-02-01

    To quantify the incidence and severity of acute local toxicity in head and neck cancer patients treated with radiotherapy (RT), with or without chemotherapy (CHT), using the Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE v3.0), scoring system. Between 2004 and 2006, 149 patients with head and neck cancer treated with RT at our center were prospectively evaluated for local toxicity during treatment. On a weekly basis, patients were monitored and eight toxicity items were recorded according to the CTCAE v3.0 scoring system. Of the 149 patients, 48 (32%) were treated with RT alone (conventional fractionation), 82 (55%) with concomitant CHT and conventional fractionation RT, and 20 (13%) with accelerated-fractionation RT and CHT. Severe (Grade 3-4) adverse events were recorded in 28% (mucositis), 33% (dysphagia), 40% (pain), and 12% (skin) of patients. Multivariate analysis showed CHT to be the most relevant factor independently predicting for worse toxicity (mucositis, dysphagia, weight loss, salivary changes). In contrast, previous surgery, RT acceleration and older age, female gender, and younger age, respectively, predicted for a worse outcome of mucositis, weight loss, pain, and dermatitis. The T-score method confirmed that conventional RT alone is in the "low-burden" class (T-score = 0.6) and suggests that concurrent CHT and conventional fractionation RT is in the "high-burden" class (T-score = 1.15). Combined CHT and accelerated-fractionation RT had the highest T-score at 1.9. The CTCAE v3.0 proved to be a reliable tool to quantify acute toxicity in head and neck cancer patients treated with various treatment intensities. The effect of CHT and RT acceleration on the acute toxicity burden was clinically relevant.

  14. Modeling the Risk of Secondary Malignancies after Radiotherapy

    Directory of Open Access Journals (Sweden)

    Uwe Schneider

    2011-11-01

    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

  15. Avoidance of radiotherapy-related, gastrointestinal complications in a patient with systemic lupus erythematosus: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Alsaeed Eyad

    2009-01-01

    Full Text Available Systemic lupus erythematosus (SLE is associated with major gastrointestinal complications due to radiotherapy. A patient with active SLE and grade 4 nephropathy presented with inoperable advanced cancer of the cervix which proved to be contraindicated for chemotherapy. The patient was treated with intensity-modulated radiotherapy technique (IMRT. The patient, however, did not experience severe radiotherapy-related complications as expected with conventional techniques of radiotherapy. The tolerance of SLE patients to radiotherapy can thus be achieved by proper delivery of radiation and the sparing of normal tissues by IMRT although further confirmatory studies are required.

  16. A national cohort study of long-course preoperative radiotherapy in primary fixed rectal cancer in Denmark

    DEFF Research Database (Denmark)

    Bulow, S.; Jensen, L.H.; Altaf, R.

    2010-01-01

    of radiotherapy concerning technique of radiotherapy, dose and fractionation and use of concomitant chemotherapy. Outcome was determined by actuarial analysis of local control, disease-free survival and overall survival. RESULTS: A total of 258 patients with fixed rectal cancer received long-course radiotherapy......-7%), and the actuarial distant recurrence rate was 41% (95% CI: 35-47%). The cumulative 5-year disease-free survival was 27% (95% CI: 22-32%) and overall 5-year survival was 34% (95% CI: 29-39%). CONCLUSIONS: This study is the first population-based report on outcome of preoperative long-course radiotherapy in a large...

  17. Accurate tracking of tumor volume change during radiotherapy by CT-CBCT registration with intensity correction

    Science.gov (United States)

    Park, Seyoun; Robinson, Adam; Quon, Harry; Kiess, Ana P.; Shen, Colette; Wong, John; Plishker, William; Shekhar, Raj; Lee, Junghoon

    2016-03-01

    In this paper, we propose a CT-CBCT registration method to accurately predict the tumor volume change based on daily cone-beam CTs (CBCTs) during radiotherapy. CBCT is commonly used to reduce patient setup error during radiotherapy, but its poor image quality impedes accurate monitoring of anatomical changes. Although physician's contours drawn on the planning CT can be automatically propagated to daily CBCTs by deformable image registration (DIR), artifacts in CBCT often cause undesirable errors. To improve the accuracy of the registration-based segmentation, we developed a DIR method that iteratively corrects CBCT intensities by local histogram matching. Three popular DIR algorithms (B-spline, demons, and optical flow) with the intensity correction were implemented on a graphics processing unit for efficient computation. We evaluated their performances on six head and neck (HN) cancer cases. For each case, four trained scientists manually contoured the nodal gross tumor volume (GTV) on the planning CT and every other fraction CBCTs to which the propagated GTV contours by DIR were compared. The performance was also compared with commercial image registration software based on conventional mutual information (MI), VelocityAI (Varian Medical Systems Inc.). The volume differences (mean±std in cc) between the average of the manual segmentations and automatic segmentations are 3.70+/-2.30 (B-spline), 1.25+/-1.78 (demons), 0.93+/-1.14 (optical flow), and 4.39+/-3.86 (VelocityAI). The proposed method significantly reduced the estimation error by 9% (B-spline), 38% (demons), and 51% (optical flow) over the results using VelocityAI. Although demonstrated only on HN nodal GTVs, the results imply that the proposed method can produce improved segmentation of other critical structures over conventional methods.

  18. Understanding Multiplication of Fractions.

    Science.gov (United States)

    Sweetland, Robert D.

    1984-01-01

    Discussed the use of Cuisenaire rods in teaching the multiplication of fractions. Considers whole number times proper fraction, proper fraction multiplied by proper fraction, mixed number times proper fraction, and mixed fraction multiplied by mixed fractions. (JN)

  19. Acute and late toxicity in radical radiotherapy of prostate cancer

    Directory of Open Access Journals (Sweden)

    Josifovski Tatjana

    2009-01-01

    Full Text Available Introduction. Although radical radiotherapy has proved to be a successful method in prostate cancer treatment, the conventional (box technique can result in significant adverse events. Objective. The objective of our study was to estimate the frequency, type and severity of acute and late toxicity in radical radiotherapy of prostate cancer. Methods. In a clinical retrospective study, we included 283 patients with histologically confirmed prostate cancer. All our patients received radical, conventional radiotherapy using the four-field technique. The study was performed at the Radiotherapy Department of the Institute for Oncology and Radiology of Serbia between January 1991 and December 2005. During regular follow-up, we analyzed the frequency, type and severity of acute and late toxicity. Results. Two thirds (71% of our patients had acute toxicity of at least one organ within the radiation field. Most frequent complication was radiation dermatitis (10.5%, and enteritis (9%, cystitis (6% and proctitis (2.5%. Acute adverse events were mostly low grade (I and II, 28-61%. Late complications were registered in 20.5% of patients. Skin fibrosis was most frequent (12%. Chronic proctitis was detected in 4% and urethral stricture in 4.5% of our patients. All late complications were low grade. Conclusion. Treatment tolerance of radical radiotherapy is relatively good. Although most patients develop acute toxicity, it is commonly low grade and requires the interruption of radiotherapy treatment in 20% of patients only. Late toxicity is rarer than acute and, in most cases, it does not affect the quality of life.

  20. Hypofractionation regimens for stereotactic radiotherapy for large brain tumors.

    Science.gov (United States)

    Yuan, Jiankui; Wang, Jian Z; Lo, Simon; Grecula, John C; Ammirati, Mario; Montebello, Joseph F; Zhang, Hualin; Gupta, Nilendu; Yuh, William T C; Mayr, Nina A

    2008-10-01

    To investigate equivalent regimens for hypofractionated stereotactic radiotherapy (HSRT) for brain tumor treatment and to provide dose-escalation guidance to maximize the tumor control within the normal brain tolerance. The linear-quadratic model, including the effect of nonuniform dose distributions, was used to evaluate the HSRT regimens. The alpha/beta ratio was estimated using the Gammaknife stereotactic radiosurgery (GKSRS) and whole-brain radiotherapy experience for large brain tumors. The HSRT regimens were derived using two methods: (1) an equivalent tumor control approach, which matches the whole-brain radiotherapy experience for many fractions and merges it with the GKSRS data for few fractions; and (2) a normal-tissue tolerance approach, which takes advantages of the dose conformity and fractionation of HSRT to approach the maximal dose tolerance of the normal brain. A plausible alpha/beta ratio of 12 Gy for brain tumor and a volume parameter n of 0.23 for normal brain were derived from the GKSRS and whole-brain radiotherapy data. The HSRT prescription regimens for the isoeffect of tumor irradiation were calculated. The normal-brain equivalent uniform dose decreased as the number of fractions increased, because of the advantage of fractionation. The regimens for potential dose escalation of HSRT within the limits of normal-brain tolerance were derived. The designed hypofractionated regimens could be used as a preliminary guide for HSRT dose prescription for large brain tumors to mimic the GKSRS experience and for dose escalation trials. Clinical studies are necessary to further tune the model parameters and validate these regimens.

  1. Adapting conventional cancer treatment for immunotherapy.

    Science.gov (United States)

    Qiao, Jian; Liu, Zhida; Fu, Yang-Xin

    2016-05-01

    The efficacy of directly killing tumors by conventional cancer therapies, such as chemotherapy and radiotherapy, has been for several decades well established. But, a suppressed immune response might become a lethal side effect after repeated cycles of intensive treatment. Recently, achievements in immune checkpoint inhibitors and adoptive T cell-mediated immunotherapies have resulted in changes in frontline management of advanced cancer diseases. However, accumulated evidence indicates that immunotherapeutic and conventional strategies alone are often ineffective to eradicate big tumors or metastasis. To improve the outcomes of treatment for advanced cancer diseases, the combination of conventional cancer treatment with various immunotherapeutic approaches has been attempted and has shown potential synergistic effects. Recent studies have unexpectedly demonstrated that some strategies of conventional cancer treatment can regulate the immune response positively, thus the understanding of how to adapt conventional treatment for immunotherapy is crucial to the design of effective combination therapy of conventional treatment with immunotherapy. Here, we review both experimental and clinical studies on the therapeutic effect and its mechanisms of combining conventional therapy with immunotherapy in treatment of cancer.

  2. Postoperative adjuvant radiotherapy and 5-fluorouracil chemotherapy for rectal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Chao, M.W.T.; Lim-Joon, M.; Wada, M. [Peter MacCallum Cancer Institute, Melbourne, VIC (Australia). Division of Radiation Oncology; Byram, D.; Vaughan, S.; McLennan, R.; Joseph, D. [Geelong Hospital, Geelong, VIC (Australia). Department of Radiation and Medical Oncology; Bell, R.; Bond, R. [St John of God Hospital, Ballarat, VIC (Australia). Department of Medical Oncology

    1998-02-01

    Postoperative combined modality therapy with radiotherapy and 5-fluorouracil (5FU) chemotherapy is an effective adjuvant approach that reduces locoregional and distant metastatic disease in patients with high-risk rectal carcinoma. However, this approach results in a treatment regimen of at least 6 months` duration. The present prospective study investigates the integration of radiotherapy and 5FU chemotherapy in a protocol designed to minimize toxicity and reduce the overall treatment time. A total of 40 patients with TNM stage 11 or 111 disease receives postoperative radiotherapy at four fractions per week with weekly 5FU bolus injections delivered on the fifth non radiotherapy day. Patients also received systemic chemotherapy with leucovorin both before and after pelvic irradiation, with the total treatment duration extending for only 18 weeks. Patients were able to complete radiotherapy in 90% of cases, while the delivery of full-dose chemotherapy was achievable in the vast majority. The incidence of haematologic and gastrointestinal toxicities requiring the cessation of treatment was acceptable. With a median follow-up of 20.9 months among surviving patients, the estimated progression-free and overall survival at 2 years were 71% and 79%, respectively. Copyright (1998) Blackwell Science Pty Ltd 15 refs., 7 tabs., 4 figs

  3. Stromal-epithelial dynamics in response to fractionated radiotherapy

    Science.gov (United States)

    Rong, Panying

    The speech of individuals with velopharyngeal incompetency (VPI) is characterized by hypernasality, a speech quality related to excessive emission of acoustic energy through the nose, as caused by failure of velopharyngeal closure. As an attempt to reduce hypernasality and, in turn, improve the quality of VPI-related hypernasal speech, this study is dedicated to developing an approach that uses speech-dependent articulatory adjustments to reduce hypernasality caused by excessive velopharyngeal opening. A preliminary study has been done to derive such articulatory adjustments for hypernasal /i/ vowels based on the simulation of an articulatorymodel (Speech Processing and Synthesis Toolboxes, Childers (2000)). Both nasal /i/ vowels with and without articulatory adjustments were synthesized by the model. Spectral analysis found that nasal acoustic features were attenuated and oral formant structures were restored after articulatory adjustments. In addition, comparisons of perceptual ratings of nasality between the two types of nasal vowels showed the articulatory adjustments generated by the model significantly reduced the perception of nasality for nasal /i/ vowels. Such articulatory adjustments for nasal /i/ have two patterns: 1) a consistent adjustment pattern, which corresponds an expansion at the velopharynx, and 2) some speech-dependent fine-tuning adjustment patterns, including adjustments in the lip area and the upper pharynx. The long-term goal of this study is to apply this approach of articulatory adjustment as a therapeutic tool in clinical speech treatment to detect and correct the maladaptive articulatory behaviors developed spontaneously by speakers with VPI on individual bases. This study constructed a speaker-adaptive articulatory model on the basis of the framework of Childers's vocal tract model to simulate articulatory adjustments aiming at compensating for the acoustic outcome caused by velopharyngeal opening and reducing nasality. To construct such a speaker-adaptive articulatory model, (1) an articulatory-acoustic-aerodynamic database was recorded using the articulography and aerodynamic instruments to provide point-wise articulatory data to be fitted into the framework of Childers's standard vocal tract model; (2) the length and transverse dimension of the vocal tract were adjusted to fit individual speaker by minimizing the acoustic discrepancy between the model simulation and the target derived from acoustic signal in the database using the simulated annealing algorithm; (3) the articulatory space of the model was adjusted to fit individual articulatory features by adapting the movement ranges of all articulators. With the speaker-adaptive articulatory model, the articulatory configurations of the oral and nasal vowels in the database were simulated and synthesized. Given the acoustic targets derived from the oral vowels in the database, speech-dependent articulatory adjustments were simulated to compensate for the acoustic outcome caused by VPO. The resultant articulatory configurations corresponds to nasal vowels with articulatory adjustment, which were synthesized to serve as the perceptual stimuli for a listening task of nasality rating. The oral and nasal vowels synthesized based on the oral and nasal vowel targets in the database also served as the perceptual stimuli. The results suggest both acoustic and perceptual effects of the mode-generated articulatory adjustment on the nasal vowels /a/, /i/ and /u/. In terms of acoustics, the articulatory adjustment (1) restores the altered formant structures due to nasal coupling, including shifted formant frequency, attenuated formant intensity and expanded formant bandwidth and (2) attenuates the peaks and zeros caused by nasal resonances. Perceptually, the articulatory adjustment generated by the speaker-adaptive model significantly reduces the perceived nasality for all three vowels (/a/, /i/, /u/). The acoustic and perceptual effects of articulatory adjustment suggest achievement of the acoustic goal of compensating for the acoustic discrepancy caused by VPO and the auditory goal of reducing the perception of nasality. Such a finding is consistent with motor equivalence (Hughes and Abbs, 1976; Maeda, 1990), which enables inter-articulator coordination to compensate for the deviation from the acoustic/auditory goal caused by the shifted position of an articulator. The articulatory adjustment responsible for the acoustic and perceptual effects as described above was decomposed into a set of empirical orthogonal modes (Story and Titze, 1998). Both gross articulatory patterns and fine-tuning adjustments were found in the principal orthogonal modes, which lead to the acoustic compensation and reduction of nasality. For /a/ and /i/, a direct relationship was found among the acoustic features, nasality, and articulatory adjustment patterns. Specifically, the articulatory adjustments indicated by the principal orthogonal modes of the adjusted nasal /a/ and /i/ were directly correlated with the attenuation of the acoustic cues of nasality (i.e., shifting of F1 and F2 frequencies) and the reduction of nasality rating. For /u/, such a direct relationship among the acoustic features, nasality and articulatory adjustment was not as prominent, suggesting the possibility of additional acoustic correlates of nasality other than F1 and F2. The findings of this study demonstrate the possibility of using articulatory adjustment to reduce the perception of nasality through model simulation. A speaker-adaptive articulatory model is able to simulate individual-based articulatory adjustment strategies that can be applied in clinical settings to serve as the articulatory targets for correction of the maladaptive articulatory behaviors developed spontaneously by speakers with hypernasal speech. Such a speaker-adaptive articulatory model provides an intuitive way of articulatory learning and self-training for speakers with VPI to learn appropriate articulatory strategies through model-speaker interaction.

  4. Plan optimization for stereotactic radiotherapy

    NARCIS (Netherlands)

    J.A. de Pooter (Jacobus Abraham)

    2008-01-01

    textabstractCancer is one of the leading causes of death in the world. Next to surgery and chemotherapy, radiotherapy is one of the most used treatment modalities for cancer. About 50% of the patients with cancer will be treated with radiotherapy during the management of their disease. In radiothera

  5. The Confluence of Radiotherapy & Immunotherapy

    Directory of Open Access Journals (Sweden)

    Ralph Robert Weichselbaum

    2012-10-01

    Full Text Available Radiotherapy has been considered a local modality and outcomes have emphasized local and regional control of tumors. Recent data suggests that radiotherapy may activate the immune system and the combination of radiation therapy and immune therapies may have the potential to improve both local and distant control of tumor deposits. Below we review principals underlying the concepts of combining both modalities.

  6. Postoperative radiotherapy for prevention of heterotopic ossification following total hip arthroplasty; Postoperative Strahlentherapie zur Praevention heterotoper Ossifikationen nach endoprothetischem Hueftgelenkersatz

    Energy Technology Data Exchange (ETDEWEB)

    Heyd, R. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Strassmann, G. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Kirchner, J. [Abt. fuer Roentgendiagnostik, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Schopohl, B. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Boettcher, H.D. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany)

    1996-10-01

    Following total hip arthroplasty high-grade heterotopic ossification occurs with a range of 0.5 to 27%. Local postoperative hip irradiation using different dosage and fractionation schedules reduces the incidence in high-risk cases on an average of 8%. The present retrospective study compares results after conventionally fractionated and high-dose radiotherapy. A total of 50 hips (46 patients) from 2 different risk groups had complete follow-up. In group I (40 hips [80.0%]) radiotherapy was indicated after surgical excision of pre-existing high-grade heterotopic ossification, in group II (10 hips [20.0%]) for several risk factors (contralateral heterotopic ossification [n=7], hypertrophic osteoarthritis [n=2], spondylosis hyperostotica [n=1]). In 28/50 cases (56.0%) conventionally fractionated irradiation with total doses ranging from 12.0 to 20.0 Gy was given, in 22/50 hips (44.0%) a high-dose irradiation consisting of 10.0 Gy given in 2 fractions on each of the first 2 postoperative days was applied. After a minimal observation period of 6 months (median: 22 months, range: 6 to 56 months) roentgenograms were analysed using a modified Brooker-score. At follow-up, 2 hips in group I had recurrence of high-grade heterotopic ossification with the stages IIIA and IVB. In 1 case radiotherapy was interrupted after 3x2.0 Gy due to sepsis (IIIA), in the other case ectopic bone recurred from bony islands which layed outside the radiation portal (IVB). In group II, 9 patients had stage 0 and 1 patient stage IA. Statistical analysis using the Wilcoxon-test showed a highly significant reduction of the amount of pre-existing heterotopic ossification (p<0.0001) for both fractionation schedules. The comparison of both fractionation groups with the Whitney-Mann-U-test (p=0.92) showed no statistical significant difference. (orig.) [Deutsch] Nach endoprothetischem Hueftgelenkersatz treten mit einer Spannbreite von 0,5 bis 27% hoehergradige heterotope Ossifikationen auf. Deren

  7. Modelling the interplay between hypoxia and proliferation in radiotherapy tumour response

    OpenAIRE

    2013-01-01

    A tumour control probability computational model for fractionated radiotherapy was developed, with the goal of incorporating the fundamental interplay between hypoxia and proliferation, including reoxygenation over a course of radiotherapy. The fundamental idea is that the local delivery of oxygen and glucose limits the amount of proliferation and metabolically-supported cell survival a tumour sub-volume can support. The model has three compartments: a proliferating compartment of cells recei...

  8. Radiotherapy of benign diseases

    Energy Technology Data Exchange (ETDEWEB)

    Haase, W.

    1982-10-11

    Still today radiotherapy is of decisive relevance for several benign diseases. The following ones are briefly described in this introductory article: 1. Certain inflammatory and degenerative diseases as furuncles in the face, acute thrombophlebitis, recurrent pseudoriparous abscesses, degenerative skeletal diseases, cervical syndrome and others; 2. rheumatic joint diseases; 3. Bechterew's disease; 4. primary presenile osteoporosis; 5. syringomyelia; 6. endocrine ophthalmopathy; 7. hypertrophic processes of the connective tissue; 8. hemangiomas. A detailed discussion and a profit-risk analysis is provided in the individual chapters of the magazine.

  9. Chest wall pain and rib fracture after stereotactic radiotherapy for peripheral non-small cell lung cancer.

    Science.gov (United States)

    Voroney, Jon-Paul J; Hope, Andrew; Dahele, Max R; Purdie, Thomas G; Purdy, Thomas; Franks, Kevin N; Pearson, Shannon; Cho, John B C; Sun, Alex; Payne, David G; Bissonnette, Jean-Pierre; Bezjak, Andrea; Brade, Anthony M

    2009-08-01

    Stereotactic body radiotherapy is an emerging treatment option for peripheral non-small cell lung cancer in medically inoperable patients. With high dose per fraction radiotherapy, late side effects are of possible concern. In our initial cohort of 42 patients treated with 54 to 60 Gy in three fractions, nine patients have rib fracture. The median dose to rib fracture sites was 46 to 50 Gy, depending on the method of dose calculation. We describe a typical case of poststereotactic radiotherapy rib fracture and present dosimetric analysis of patients with rib fracture.

  10. Mystery Fractions

    Science.gov (United States)

    Bhattacharyya, Sonalee; Namakshi, Nama; Zunker, Christina; Warshauer, Hiroko K.; Warshauer, Max

    2016-01-01

    Making math more engaging for students is a challenge that every teacher faces on a daily basis. These authors write that they are constantly searching for rich problem-solving tasks that cover the necessary content, develop critical-thinking skills, and engage student interest. The Mystery Fraction activity provided here focuses on a key number…

  11. Mystery Fractions

    Science.gov (United States)

    Bhattacharyya, Sonalee; Namakshi, Nama; Zunker, Christina; Warshauer, Hiroko K.; Warshauer, Max

    2016-01-01

    Making math more engaging for students is a challenge that every teacher faces on a daily basis. These authors write that they are constantly searching for rich problem-solving tasks that cover the necessary content, develop critical-thinking skills, and engage student interest. The Mystery Fraction activity provided here focuses on a key number…

  12. The role of stereotactically guided conformal radiotherapy for local tumor control of esthesioneuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Zabel, A.; Thilmann, C.; Zuna, I. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Radiotherapy; Milker-Zabel, S.; Wannenmacher, M. [Heidelberg Univ. (Germany). Dept. of Radiotherapy; Schlegel, W. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Medical Physics; Debus, J. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Radiotherapy; Heidelberg Univ. (Germany). Dept. of Radiotherapy

    2002-04-01

    Background: In a retrospective analysis we compared conventional radiotherapy and stereotactically guided conformal radiotherapy (SCRT) in patients with esthesioneuroblastoma. Patients and Methods: Between 1991 and 1999 14 patients with esthesioneuroblastoma underwent radiotherapy at our institution. Median follow-up was 30 months (range 12-107 months). Treatment included adjuvant radiotherapy (9), adjuvant radiochemotherapy (3) or radiotherapy alone (2). Eight patients received SCRT with 3-D treatment planning. For comparison a standard three-field plan for these patients and dose-volume histogram analyses were performed. Median total dose was 64 Gy using SCRT and 56 Gy with standard technique. Results: Local tumor control rate was 50% with conventional radiotherapy and 75% with SCRT. Overall survival was 33.3% and 62.5%, respectively. Target coverage could be improved statistically significant (p < 0.05) and dose to critical structures was reduced using SCRT. Greatest differences were seen regarding volume above the 30%-isodose as well as mean dose of brain stem (p < 0.05). A reduction of maximum dose was seen using SCRT as consequence of a more homogeneous treatment. Conclusions: SCRT improves target coverage and sparing of organs at risk. Our clinical data although with low patient numbers suggest that the technical advantage translates into a clinical advantage. The use of SCRT appears to facilitate higher dose prescriptions without risking major acute and late side effects. Thus the risk of complications in this area is minimized. Adjuvant radiotherapy is a save and effective treatment modality for local control of esthesioneuroblastoma. (orig.)

  13. Comparative analysis of dose-volume histograms between 3D conformal and conventional non-conformal radiotherapy planning for prostate cancer; Analise comparativa dos histogramas de dose e volume entre planejamentos tridimensionais conformados e convencionais nao conformados na radioterapia do cancer de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Feitosa, Silvia Moreira; Giordani, Adelmo Jose; Dias, Rodrigo Sousa; Segreto, Helena Regina Comodo; Segreto, Roberto Araujo [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil)], e-mail: silviamfeitosa@yahoo.com.br

    2009-03-15

    Objective: The present study was aimed at comparing conformal and non-conformal radiotherapy plans designed for patients with prostate cancer, by analyzing radiation doses in target volumes and organs at risk. Materials and methods: Radiotherapy plans for 40 patients with prostate cancer were analyzed. Conformal, conformal isocentric and non-conformal plans utilizing the source-surface distance were simulated for each of the patients for comparison of radiation dose in target volumes and organs at risk. For comparison purposes, dose-volume histograms for target volumes and organs at risk were analyzed. Results: Median doses were significantly lower in the conformal planning, with 25%, 40% and 60% volumes in the rectum and 30% and 60% in the bladder. The median doses were significantly lower in the conformal planning analyzing the right and left coxofemoral joints. Maximum, mean and median doses in the clinical target volume and in the planned target volume were significantly higher in the conformal planning. Conclusion: The present study has demonstrated that the conformal radiotherapy planning for prostate cancer allows the delivery of higher doses to the target volume and lower doses to adjacent healthy tissues. (author)

  14. Sphincter Preservation After Short-term Preoperative Radiotherapy for Low Rectal Cancer - Presentation of Own Data and a Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Bujko, Krzysztof; Nowacki, Marek P.; Oldzki, Janusz; Sopyo, Rafa; Skoczylas, Jerzy; Chwaliski, Maciej [The Maria Sklodowska-Curie Memorial Cancer Centre and Inst. of Oncology, Warsaw (Poland)

    2001-07-01

    This report is based on a series of 108 patients with clinically staged T2 (9), T3 (94) and T4 (5) rectal cancer treated with preoperative irradiation with 25 Gy, 5 Gy per fraction given for one week. In 77% of patients, the tumour was located within 7 cm of the anal verge and in 15% the anal canal was involved. Surgery was usually undertaken during the week after irradiation. For low tumours, total mesorectal excision was performed, and for middle and upper cancers, the whole circumference of the mesorectum was excised at least 2 cm below the lower pole of a tumour. Tumour was resected in 103 patients, and sphincter-preserving surgery was performed in 73% of them. In the subgroup where the tumour was located higher than 4 cm from the anal verge, sphincter-preserving surgery was performed in 95%. The follow-up period ranged from 10 to 49 months, with a median of 25 months. Local recurrences were observed in 4% of patients. Anorectal dysfunction caused impairment of social life in 40% of patients and 18% admitted that their quality of life was seriously affected - however, none of them stated that they would have preferred a colostomy. These preliminary data suggest that following high dose per fraction short-term preoperative radiotherapy a high rate of sphincter-preserving surgery can be reached, with acceptable anorectal function and an acceptable rate of local failure and late complications. The results of our own data and literature review indicate the need for a randomized clinical trial comparing high dose per fraction preoperative radiotherapy with immediate surgery with conventional preoperative radiochemotherapy with delayed surgery.

  15. Osteoradionecrosis of the Ribs following Breast Radiotherapy

    Directory of Open Access Journals (Sweden)

    Luke Nicholls

    2015-08-01

    Full Text Available Introduction: Osteoradionecrosis (ORN of the chest wall is a rare complication after whole-breast radiotherapy (RT. Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. Case Report: A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU requirements. Eleven months after RT, the patient developed right lateral chest wall pain, with magnetic resonance imaging (MRI demonstrating two fractures involving the underlying right fifth and sixth ribs associated with fatty marrow changes in the second to sixth ribs, thus raising the possibility of ORN. Treatments including hyperbaric oxygen, pentoxifylline and vitamin E were used with symptomatic improvements. There was demonstrable resolution on follow-up MRI at 2.5 years. Conclusion: The incidence of ORN utilising modern RT techniques and standard fractionation is rare. Numerous treatments are available, with variable response rates. Emerging evidence of predictive gene profiling to estimate the risk of radiation sensitivity may assist in individualising preventative strategies to mitigate the risk of ORN.

  16. Adjuvant postoperative radiotherapy for gastric carcinoma with poor prognostic signs.

    Science.gov (United States)

    Slot, A; Meerwaldt, J H; van Putten, W L; Treurniet-Donker, A D

    1989-12-01

    Fifty-seven patients with poor prognostic factors following resection with curative intent for gastric adenocarcinoma (T3 or T4, positive lymph nodes, positive resection line) received adjuvant radiotherapy. A dose of 30.0-50.0 Gy was given in 10-25 fractions in one course or with a split of 2 weeks after 15 fractions. This was combined with 5-fluorouracil (5-FU) (375 mg/m2) given i.v. as a bolus during the first 4 days of radiation (n = 49). The 5-year survival was 26%; this rate is higher than the figures mentioned in the literature after surgery alone. The only way to prove the role of adjuvant radiotherapy for gastric carcinoma is a prospective randomized trial.

  17. Adjuvant postoperative radiotherapy for gastric carcinoma with poor prognostic signs

    Energy Technology Data Exchange (ETDEWEB)

    Slot, A.; Meerwaldt, J.H.; Treurniet-Donker, A.D. (Dr. Daniel Den Hoed Cancer Center, Rotteram (Netherlands). Department of Radiotherapy); Putten, W.L.J. van (Dr. Daniel Den Hoed Cancer Center, Rotterdam (Netherlands). Department of Statistics)

    1989-12-01

    Fifty-seven patients with poor prognostic factors following resection with curative intent for gastric adenocarcinoma T{sub 3} or T{sub 4}, positive lymph nodes, positive resection line received adjuvant radiotherapy. A dose of 30.0-50.0 Gy was given in 10-25 fraction in one course or with a split of 2 weeks after 15 fractions. This was combined with 5-fluorouracil (5-FU) (375 mg/m{sup 2}) given i.v. as a bolus during the first 4 days of radiation (n = 49). The 5-year survival was 26%; this rate is higher than the figures mentioned in the literature after surgery alone. The only way to prove the role of adjuvant radiotherapy for gastric carcinoma is a prospective randomized trial. (author). 11 refs., 2 figs., 6 tabs.

  18. Challenges in integrating 18FDG PET-CT into radiotherapy planning of head and neck cancer.

    Science.gov (United States)

    Dandekar, P; Partridge, M; Kazi, R; Nutting, C; Harrington, K; Newbold, K

    2010-01-01

    Radiotherapy forms one of the major treatment modalities for head and neck cancers (HNC), and precision radiotherapy techniques, such as intensity-modulated radiotherapy require accurate target delineation to ensure success of the treatment. Conventionally used imaging modalities, such as X-ray computed tomography (CT) and magnetic resonance imaging are used to delineate the tumor. Imaging, such as positron emission tomography (PET)-CT, which combines the functional and anatomic modalities, is increasingly being used in the management of HNC. Currently, 18-fluorodeoxyglucose is the most commonly used radioisotope, which is accumulated in areas of high glucose uptake, such as the tumor tissue. Because most disease recurrences are within the high-dose radiotherapy volume, defining a biological target volume for radiotherapy boost is an attractive approach to improve the results. There are many challenges in employing the PET-CT for radiotherapy planning, such as patient positioning, target edge definition, and use of new PET tracers, which represent various functional properties, such as hypoxia, protein synthesis, and proliferation. The role of PET-CT for radiotherapy planning is ever expanding and more clinical data underlining the advantages and challenges in this approach are emerging. In this article, we review the current clinical evidence for the application of functional imaging to radiotherapy planning and discuss some of the current challenges and possible solutions that have been suggested to date.

  19. Assessing small-volume spinal cord dose for repeat spinal stereotactic body radiotherapy treatments

    Science.gov (United States)

    Ma, Lijun; Kirby, Neil; Korol, Renee; Larson, David A.; Sahgal, Arjun

    2012-12-01

    Spinal cord biologically effective dose (BED) limits are critical to safe spine stereotactic body radiotherapy (SBRT) delivery. In particular, when repeating SBRT to the same site, the problem of adding non-uniform BED distributions within small volumes of spinal cord has yet to be solved. We report a probability-based generalized BED (gBED) model to guide repeat spine SBRT treatment planning. The gBED was formulated by considering the sequential damaging probabilities of repeat spine SBRT treatments. Parameters from the standard linear-quadratic model, such as α/β = 2 Gy for the spinal cord, were applied. We tested the model based on SBRT specific spinal cord tolerance using a simulated and ten clinical repeat SBRT cases. The gBED provides a consistent solution for superimposing non-uniform dose distributions from different fractionation schemes, analogous to the BED for uniform dose distributions. Based on ten clinical cases, the gBED was observed to eliminate discrepancies in the cumulative BED of approximately 5% to 20% within small volumes (e.g. 0.1-2.0 cc) of spinal cord, as compared to a conventional calculation method. When assessing spinal cord tolerance for repeat spinal SBRT treatments, caution should be exercised when applying conventional BED calculations for small volumes of spinal cord irradiated, and the gBED potentially provides more conservative and consistently derived dose surrogates to guide safe treatment planning and treatment outcome modeling.