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Sample records for external pelvic radiotherapy

  1. Internal hemipelvectomy with intraoperative and external beam radiotherapy in the limb-sparing treatment of a pelvic girdle chondrosarcoma

    NARCIS (Netherlands)

    Hoekstra, HJ; Szabo, BG

    The case of a patient with an extensive pelvic girdle chondrosarcoma treated with internal hemipelvectomy and intraoperative radiotherapy, followed by adjuvant high-dose external beam radiotherapy, with a successful attempt in achieving long-term local tumor control and limb-sparing treatment is

  2. Bladder extension variability during pelvic external beam radiotherapy with a full or empty bladder

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Asadpour, Branka; Siluschek, Jaroslav; Gagel, Bernd; Piroth, Marc D.; Demirel, Cengiz; Eble, Michael J.

    2007-01-01

    Background and purpose: Varying bladder fillings during radiotherapy lead to a changing dose-volume load to the bladder and adjacent structures. The aim of the study was to compare the extent of bladder wall movements during parallel series with full bladder (FB) and empty bladder (EB). Materials and methods: Three hundred and forty serial computed tomography (CT) scans were performed in 50 patients scheduled for primary and postoperative radiotherapy for prostate cancer. Each patient underwent two CT scans (with FB and EB) before and 2-3 times during radiotherapy. Displacements of the bladder wall were compared and correlated with changing bladder fillings. Results: The variability of FB was larger compared to EB volume (standard deviation of 124cc and 56cc; p < 0.01), but significant bladder wall displacement variabilities were only found at the anterior and superior borders. Within a bladder volume range between -100 and +200 ml relative to the FB planning scan, the mean bladder wall displacement remained <5 mm at the inferior, lateral, and posterior borders - as opposed to 15 and 21 mm at the anterior and superior borders. Conclusions: Treating the pelvis with EB compared to FB, bladder wall displacement can be only reduced at the superior and anterior borders. FB wall displacements are comparable with EB displacements at all other borders

  3. Bone Health and Pelvic Radiotherapy.

    Science.gov (United States)

    Higham, C E; Faithfull, S

    2015-11-01

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

  4. Post Pelvic Radiotherapy Bony Changes

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-03-15

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

  5. A consensus-based guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer

    International Nuclear Information System (INIS)

    Toita, Takafumi; Ohno, Tatsuya; Kaneyasu, Yuko

    2010-01-01

    The objective of this study was to develop a consensus-based guideline as well as an atlas defining pelvic nodal clinical target volumes in external beam radiotherapy for uterine cervical cancer. A working subgroup to establish the consensus-based guideline on clinical target volumes for uterine cervical cancer was formulated by the Radiation Therapy Study Group of the Japan Clinical Oncology Group in July 2008. The working subgroup consisted of seven radiation oncologists. The process resulting in the consensus included a comparison of contouring on CT images among the members, reviewing of published textbooks and the relevant literature and a distribution analysis of metastatic nodes on computed tomography/magnetic resonance imaging of actual patients. The working subgroup defined the pelvic nodal clinical target volumes for cervical cancer and developed an associated atlas. As a basic criterion, the lymph node clinical target volume was defined as the area encompassed by a 7 mm margin around the applicable pelvic vessels. Modifications were made in each nodal area to cover adjacent adipose tissues at risk of microscopic nodal metastases. Although the bones and muscles were excluded, the bowel was not routinely excluded in the definition. Each of the following pelvic node regions was defined: common iliac, external iliac, internal iliac, obturator and presacral. Anatomical structures bordering each lymph node region were defined for six directions; anterior, posterior, lateral, medial, cranial and caudal. Drafts of the definition and the atlas were reviewed by members of the JCOG Gynecologic Cancer Study Group (GCSG). We developed a consensus-based guideline defining the pelvic node clinical target volumes that included an atlas. The guideline will be continuously updated to reflect the ongoing changes in the field. (author)

  6. Quality of Life After Whole Pelvic Versus Prostate-Only External Beam Radiotherapy for Prostate Cancer: A Matched-Pair Comparison

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Piroth, Marc D.; Holy, Richard; Fischedick, Karin; Klotz, Jens; Szekely-Orban, Dalma; Eble, Michael J.

    2011-01-01

    Purpose: Comparison of health-related quality of life after whole pelvic (WPRT) and prostate-only (PORT) external beam radiotherapy for prostate cancer. Methods and Materials: A group of 120 patients (60 in each group) was surveyed prospectively before radiation therapy (RT) (time A), at the last day of RT (time B), at a median time of 2 months (time C) and >1 year after RT (time D) using a validated questionnaire (Expanded Prostate Cancer Index Composite). All patients were treated with 1.8- to 2.0-Gy fractions up to 70.2 to 72.0 Gy with or without WPRT up to 45 to 46 Gy. Pairs were matched according to the following criteria: age ± 5years, planning target volume ± 10 cc (considering planning target volume without pelvic nodes for WPRT patients), urinary/bowel/sexual function score before RT ± 10, and use of antiandrogens. Results: With the exception of prognostic risk factors, both groups were well balanced with respect to baseline characteristics. No significant differences were found with regard to urinary and sexual score changes. Mean bladder function scores reached baseline levels in both patient subgroups after RT. However, bowel function scores decreased significantly more for patients after WPRT than in those receiving PORT at all times (p once a day in 15% vs. 3%; p = 0.03), bloody stools (≥half the time in 7% vs. 0%; p = 0.04) and frequent bowel movements (>two on a typical day in 32% vs. 7%; p < 0.01) more often than did patients after PORT. Conclusion: In comparison to PORT, WPRT (larger bladder and rectum volumes in medium dose levels, but similar volumes in high dose levels) was associated with decreased bowel quality of life in the acute and chronic phases after treatment but remained without adverse long-term urinary effects.

  7. External beam radiotherapy for rectal adenocarcinoma

    International Nuclear Information System (INIS)

    Taylor, R.E.; Kerr, G.R.; Arnott, S.J.

    1987-01-01

    A series of 243 patients with adenocarcinoma of the rectum treated with radiotherapy is presented. Radiotherapy was combined with 5-fluorouracil, or given alone. Seventy-four patients were treated with radical external beam radiotherapy for recurrent or inoperable rectal adenocarcinoma. One hundred and forty-five patients with advanced pelvic tumours or metastases were treated with palliative pelvic radiotherapy. Twenty-four patients with small-volume residual pelvic tumour or who were felt to be at high risk of pelvic recurrence following radical resection received postoperative radiotherapy. Complete tumour regression was seen in 38% of radically treated patients, and 24% of palliatively treated patients. Partial regression was observed in 56% of radically treated patients, and 58% of palliatively treated patients. Long-term local tumour control was more commonly observed for small tumours (< 5 cm diameter). Fifty-eight % of patients treated with postoperative radiotherapy remained free of local recurrence. Survival was significantly better with small tumours. The addition of 5FU did not appear to improve survival or tumour control. (author)

  8. Effect of pelvic radiotherapy for prostrate cancer on bowel, bladder and sexual functions

    International Nuclear Information System (INIS)

    Saif-ur-Rahman; Ali, N.

    2002-01-01

    Objective: To study the effects of pelvic radiotherapy for prostate cancer on sexual, bowel and urinary functions. Study Design: a prospective cohort study. Place and duration of study: The study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore from July 1998 to January 2000. Patients and Method: This study included 52 patients with diagnosis of prostate cancer who were given external beam pelvic radiotherapy. The effects of pelvic radiotherapy on their sexual, bowel and bladder functions were calculated at 6, 12 and 18 months and mean composite scores for each entity were examined. Results: Decrease in sexual function (up to 35%) was most significant observation followed by bowel dysfunction (10-12%). Bladder function deranged early during radiotherapy but there was no remarkable bladder dysfunction, overall a good proportion of patients (70 - 72%) felt satisfied with their treatment by external beam radiotherapy. By lapse of time there was gradual worsening of erectile function especially after a couple of months of pelvic radiotherapy, while bowel and bladder functions improved 8-12 months post radiotherapy. Conclusion: Proper counselling of patients regarding potential side effects of pelvic radiotherapy can make them understand the outcome of treatment. (author)

  9. Pelvic radiotherapy and sexual dysfunction in women

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine; Froeding, Ligita Paskeviciute

    2015-01-01

    focus on late effects and an increasing awareness that patient reported outcomes (PROs) i.e., patient assessment of physical, social, psychological, and sexual functioning provides the most valid information on the effects of cancer treatment. Following cure of cancer allow survivors focus on quality...... of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors. METHODS: An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological...... and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities. RESULTS...

  10. Less gastrointestinal toxicity after adjuvant radiotherapy on a small pelvic field compared to a standard pelvic field in patients with endometrial carcinoma

    NARCIS (Netherlands)

    de Jong, Renske A.; Pras, Elisabeth; Boezen, H. Marike; van der Zee, Ate G. J.; Mourits, Marian J. E.; Arts, Henriette J. G.; Aalders, Jan G.; Slot, Annerie; Timmer, Paul R.; Hollema, Harry; Nijman, Hans W.

    Objective: Radiotherapy is associated with short-term and long-term morbidity. This study compared toxicity rates among patients with endometrial carcinoma (EC) treated with adjuvant external beam radiation therapy (EBRT) on a small pelvic field (SmPF) in comparison with a standard pelvic field

  11. A prospective study of urinary tract infection during pelvic radiotherapy

    International Nuclear Information System (INIS)

    Bialas, I.; Bessell, E.M.; Sokal, M.

    1989-01-01

    The frequency of urinary tract infection before and during pelvic radiotherapy was studied prospectively in 172 patients who were not catherised and had not had instrumentation for at least 4 weeks prior to radiotherapy. The incidence of urinary tract infection prior to radiotherapy was 17% and a further 17% of patients develped a urinary tract infection during radiotherapy. Mid-stream specimens of urine (MSU) should be examined for infection on a weekly basis during pelvic radiotherapy not only to identify this additional 17% of patients but also to detect those patients who have persistent urinary tract infection in spite of treatment with appropriate antibiotics. (author). 6 refs.; 1 fig.; 4 tabs

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

    LENUS (Irish Health Repository)

    Joyce, M

    2012-02-01

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

  13. Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

    International Nuclear Information System (INIS)

    Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

    2010-01-01

    Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

  14. External radiotherapy in thyroid cancer

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  15. Postoperative radiotherapy for prostate cancer. Morbidity of local-only or local-plus-pelvic radiotherapy

    International Nuclear Information System (INIS)

    Waldstein, Cora; Poetter, Richard; Widder, Joachim; Goldner, Gregor; Doerr, Wolfgang

    2018-01-01

    The aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer. Based on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups. For local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7 Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3 Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5-year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5-year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%. Despite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4-field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects. (orig.) [de

  16. External audit in radiotherapy dosimetry

    International Nuclear Information System (INIS)

    Thwaites, D.I.; Western General Hospital, Edinburgh

    1996-01-01

    Quality audit forms an essential part of any comprehensive quality assurance programme. This is true in radiotherapy generally and in specific areas such as radiotherapy dosimetry. Quality audit can independently test the effectiveness of the quality system and in so doing can identify problem areas and minimize their possible consequences. Some general points concerning quality audit applied to radiotherapy are followed by specific discussion of its practical role in radiotherapy dosimetry, following its evolution from dosimetric intercomparison exercises to routine measurement-based on-going audit in the various developing audit networks both in the UK and internationally. Specific examples of methods and results are given from some of these, including the Scottish+ audit group. Quality audit in radiotherapy dosimetry is now well proven and participation by individual centres is strongly recommended. Similar audit approaches are to be encouraged in other areas of the radiotherapy process. (author)

  17. Vaginal dilator therapy for women receiving pelvic radiotherapy.

    Science.gov (United States)

    Miles, Tracie; Johnson, Nick

    2014-09-08

    Vaginal dilation therapy is advocated after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina), but can be uncomfortable and psychologically distressing. To assess the benefits and harms of different types of vaginal dilation methods offered to women treated by pelvic radiotherapy for cancer. Searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 5), MEDLINE (1950 to June week 2, 2013), EMBASE (1980 to 2013 week 24) and CINAHL (1982 to 2013). Comparative data of any type, which evaluated dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer. Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We found no trials and therefore analysed no data. We identified no studies for inclusion in the original review or for this update. However, we felt that some studies that were excluded warranted discussion. These included one randomised trial (RCT), which showed no improvement in sexual scores associated with encouraging women to practise dilation therapy; a recent small RCT that did not show any advantage to dilation over vibration therapy during radiotherapy; two non-randomised comparative studies; and five correlation studies. One of these showed that objective measurements of vaginal elasticity and length were not linked to dilation during radiotherapy, but the study lacked power. One study showed that women who dilated tolerated a larger dilator, but the risk of objectivity and bias with historical controls was high. Another study showed that the vaginal measurements increased in length by a mean of 3 cm after dilation was introduced 6 to 10 weeks after radiotherapy, but there was no control group; another case series showed the opposite. Three recent studies showed less stenosis associated with prophylactic dilation after radiotherapy. One small case series suggested that dilation years after radiotherapy might restore the

  18. Verification of the Patient Positioning in the Bellyboard Pelvic Radiotherapy

    International Nuclear Information System (INIS)

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

    2008-01-01

    The size and shape of the treatment fields applied in radiotherapy account for uncertainties in the daily set-up of the patients during the treatment. We investigated the accuracy of daily patient positioning in the bellyboard pelvic radiotherapy in order to find out the magnitude of the patients movement during the treatment. Translational as well as rotational movements of the patients are explored. Film portal imaging is used in order to find patient positioning error during the treatment of the pelvic region. Patients are treated in the prone position using the bellyboard positioning device. Thirty six patients are included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisition was completed in 85 percent and systematic and random positioning errors in 453 images are analyzed. (author)

  19. Guide of external radiotherapy procedures 2007

    International Nuclear Information System (INIS)

    Anon.

    2008-01-01

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

  20. Shielding for Scattered Radiation to the Testis During Pelvic Radiotherapy: Is it worth?

    International Nuclear Information System (INIS)

    NAZMY, M.S.; El-Taher, M.M.; Attalla, E.M.; El-Hosiny, H.A.; Lotayef, M.M.

    2007-01-01

    To assess the value of external shielding of the testis during pelvic radiotherapy. Material and Methods: Nineteen patients, receiving radiotherapy to the pelvis with the lower border of the field at the obturator foramen, were randomly selected. A 5 half value layer cerro bent shield was positioned at the inferior border of the field. The dose to the testis was measured with and without the shield. Observations were made regarding the reflex cre master contraction and phantom measurements were done at different distances from the perineum. Results: The mean radiation dose to the testis for patients receiving treatment with no shield was 7.4 cGy (±) and it was 5.7c Gy (±) for patients with external shield, this difference was statistically significant by the paired t test p<0.0001. This accounted for a 22% decrease in the dose received by the testis. The position of the testis with the contraction of the cre master muscle and the dartos fascia after manipulation of the testis during diodes placement changed up to 3.5 cm (mean 1.5). Phantom measurements showed 37% increase in the dose with 2 cm change in the position of the testis to the pelvic direction. Conclusion: External shield at the inferior border of the pelvic field is a simple, easy reproducible, convenient shielding method. Clam-shell scrotal shield is not free of drawbacks, but still its benefits overweigh its harms and should be used with caution

  1. Prostatic cancer: intolerance and morbidity of external radiotherapy

    International Nuclear Information System (INIS)

    Douchez, J.; Fregevu, Y.; Allain, Y.M.; Cellier, P.; Fenton, J.; Hay, M.; Le Bourgeois, J.P.; Vincent, F.

    1985-01-01

    The pertherapeutic intolerance and morbidity are analyzed in a groupe of 597 patients with localized prostatic carcinoma treated by definitive radiotherapy between 1975 and 1982. Minimum follow-up is 2 years, median is 46 months. The results are compared to following parameters: associated diseases, associated surgical treatments, doses and irradiated target volumes. Pertherapeutic intolerance manifestations were found in 73% of patients and lead to complications. Urinary incontinence and chronic cystitis were more frequent after transurethral resection or prostatic target volume and by split course irradiation. Chronic diarrhea was more frequent when using large target volume. Leg edema was closely associated with pelvic lymphadenectomy. The control of pertherapeutic manifestations and the prevention of complications should improve survival in patients treated by external radiotherapy [fr

  2. External radiotherapy of pituitary adenomas

    International Nuclear Information System (INIS)

    Zierhut, Dietmar; Flentje, Michael; Adolph, Juergen; Erdmann, Johannes; Raue, Friedhelm; Wannenmacher, Michael

    1995-01-01

    Purpose: To evaluate therapeutic outcome and side effects of radiotherapy in pituitary adenomas as sole or combined treatment. Methods and Materials: Retrospective analysis of 138 patients (74 male, 64 female) irradiated for pituitary adenoma from 1972 to 1991 was performed. Mean age was 49.7 years (15-80 years). Regular follow-up (in the mean 6.53 ± 3.99 years) included radiodiagnostical [computed tomography (CT), magnetic resonance imaging (MRI), x-ray], endocrinological, and ophthalmological examinations. Seventy patients suffered from nonfunctional pituitary adenoma, 50 patients suffered from growth-hormone producing adenomas, 11 had prolactinomas, and 7 patients had adrenocorticotropic hormone (ACTH) producing pituitary adenomas. In 99 patients surgery was followed by radiotherapy in case of suspected remaining tumor (invasive growth of the adenoma, assessment of the surgeon, pathologic CT after surgery, persisting hormonal overproduction). Twenty-three patients were treated for recurrence of disease after surgery and 16 patients received radiation as primary treatment. Total doses from 40-60 Gy (mean: 45.5 Gy) were given with single doses of 2 Gy 4 to five times a week. Results: Tumor control was achieved in 131 patients (94.9%). In seven patients, recurrence of disease was diagnosed in the mean 2.9 years (9-98 months) after radiotherapy and salvaged by surgery. A statistically significant dose-response relationship was found in favor of doses ≥ 45 Gy. Ninety percent of the patients with hormonally active pituitary adenomas had a benefit from radiotherapy in means of complete termination (38%) or at least reduction (52%) of hormonal overproduction. Partial or complete hypopituitarism after radiotherapy developed, depending on hormonal axis, in 12 (prolactin) to 27% (follicle-stimulating hormone FSH) of patients who had not already had hypopituitarism prior to radiation. Two out of 138 patients suffered reduction of visual acuity, which was, in part

  3. Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

    International Nuclear Information System (INIS)

    Oh, Dongryul; Huh, Seung Jae; Nam, Heerim; Park, Won; Han, Youngyih; Lim, Do Hoon; Ahn, Yong Chan; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho

    2008-01-01

    Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer. Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed. Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age ≥55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose ≥50.4 Gy (p = 0.005) were the predisposing factors for development of PIF. Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age ≥55 years (p < 0.001), body weight <55 kg (p = 0.02), curative treatment (p = 0.03), and radiation dose ≥50.4 Gy (p = 0.04) were significant predisposing factors for development of PIF. Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight

  4. External radiotherapy in a pleural mesothelioma tumor

    International Nuclear Information System (INIS)

    Fernandez, M.C.; Garcia, J.L.; Gomez, A.; Simon, J.L.; Maillo, M.; Jimenez Torres, M. J.

    1994-01-01

    Pleural mesothelioma is an uncommon tumor compared with other thoracic malignancies and a 80% of the cases have asbestos exposure. From 1983 to 1992 we have examined patients suffering from malignant pleural mesothelioma treated with external radiotherapy. We treated 11 patients of which 9 were males and 2 were females. The most frequent symptom was the chest pain and all these patients underwent a torascoscopy followed by a pleasured. Of the 11 cases: 10 were malignant epithelial mesothelioma and 1 was a mixed pleural case. Afterwards, they were treated with external radiotherapy between 30 and 55 Gy, with few complications. At the moment, 5 patients are still alive and there is a survival rate of 50% at 24 and 60 months and of 25% at 120 months. We think that external radiotherapy is a good palliative treatment with few complications. (Author) 28 refs

  5. Spontaneous occurrence of synergistic bacterial gangrene following external pelvic irradiation

    International Nuclear Information System (INIS)

    Husseinzadeh, N.; Nahhas, W.A.; Manders, E.K.; Whitney, C.W.; Mortel, R.

    1984-01-01

    A case of spontaneous synergistic bacterial gangrene occurring after external pelvic irradiation is presented in a 25-year-old woman with invasive cervical cancer. Treatment consisted of aggressive antibiotic therapy and extensive excision and debridement followed by split-thickness skin grafting. Both recovery and cosmetic results were satisfactory. The pathophysiology, predisposing factors, and treatment modalities are presented

  6. Bone marrow changes adjacent to the sacroiliac joints after pelvic radiotherapy mimicking metastases on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kanberoglu, K.; Mihmanli, I.; Kurugoglu, S.; Ogut, G.; Kantarci, F. [Dept. of Radiology, Istanbul Univ. (Turkey)

    2001-09-01

    Radiation-induced changes in the sacroiliac joints mimicking metastases on MR images were evaluated. Twelve patients who received radiotherapy to the pelvic region due to pelvic malignancy were included in the study. All patients had undergone external beam radiation therapy to the pelvic region, and 2 patients received supplementary internal radiation. The changes in the sacroiliac joints were evaluated. Computed-tomography-guided core bone biopsy from the bone marrow was taken from their corresponding MR sections in 5 of the patients. T1 hypointense and T2 hyperintense areas with ill-defined margins in the bone marrow adjacent to the sacroiliac joints were observed in all patients. On bone scintigraphy all the lesions demonstrated increased activity. Other radiological modalities excluded fracture, soft tissue mass, and osseous destruction. Bone biopsies demonstrated peritrabecular fibrosis and inflammatory cell infiltration. Patients receiving radiotherapy to the pelvis may demonstrate T1 hypointense/T2 hyperintense, ill-defined postradiotherapeutic benign changes in the sacroiliac joints. In the absence of any other signs of disease progression and when the imaging pattern is typical, close radiological follow-up should be sufficient to rule out metastases. (orig.)

  7. Feasibility and early results of interstitial intensity-modulated HDR/PDR brachytherapy (IMBT) with/without complementary external-beam radiotherapy and extended surgery in recurrent pelvic colorectal cancer

    International Nuclear Information System (INIS)

    Tepel, J.; Bokelmann, F.; Faendrich, F.; Kremer, B.; Schmid, A.; Kovacs, G.; University Hospital of Schleswig-Holstein, Kiel

    2005-01-01

    Background: A new multimodality treatment concept consisting of extended resection and postoperative fractionated intensity-modulated interstitial brachytherapy (IMBT) was introduced for pelvic recurrence of colorectal carcinoma. Patients and Methods: 46 patients received extended resection and single plastic tubes were sutured directly onto the tumor bed. IMBT was started within 2 weeks postoperatively with a median dose of 24.5 Gy (5-35 Gy). Patients were treated either with high-dose-rate brachytherapy (HDR; n=23) or with pulsed-dose-rate brachytherapy (PDR; n=23). 25 patients received complementary 45-Gy external-beam irradiation (EBRT) to the pelvic region after explanting the plastic tubes. Results: Median follow-up was 20.6 months (7-107 months) and mean patient survival 25.7±25.8 months (median 17, range 1-107 months). After 5 years overall survival, disease-free survival and local control rate were 23%, 20% and 33%, significantly influenced by the resectional state. There was a trend in favor of PDR compared to HDR, which reached statistical significance in patients who had not received additional EBRT. Conclusion: The combination of extended surgery and postoperative interstitial IMBT is feasible and offers effective interdisciplinary treatment of recurrent colorectal cancer. In this small and inhomogeneous cohort of patients PDR seems to be more effective than HDR, particularly when application of complementary EBRT is not possible. None of the patients who required resection of distant metastasis survived >2 years in this study. (orig.)

  8. Post-external radiotherapy hypothyroidism: 15 cases

    International Nuclear Information System (INIS)

    Kaffel, N.; Mnif, M.; Abid, M.; Daoud, J.

    2001-01-01

    Post-external radiotherapy hypothyroidism: 15 cases. Hypothyroidism frequency is estimated to be between 10 and 45% after radiotherapy alone, and 40 to 67% after radiotherapy associated with thyroidectomy. This hypothyroidism is infra-clinical in 60% of the cases. Our study concerned 15 cases of hypothyroidism after external radiotherapy delivered between and 1991 and 1999. An irradiation of the cervical, cerebral and thorax regions was indicated for different types of cancers. Larynx carcinoma epidermoid was the most frequent cancer (seven cases); the radiation treatment used cobalt 60 with conventional fractionation, i.e., 2 Gy per treatment, five treatments a week. In nine cases, the hypothyroidism was discovered during a systematic examination; it was clinically evident in the six remaining cases. Hypothyroidism appeared after an irradiation dose average of 50 Gy (extremes 30-65 Gy). The average duration of the irradiation was about 7 weeks and the hypothyroidism appeared in a mean 22 months. In all cases, the substituting treatment was initiated with a favorable progression. Faced with the risk of hypothyroidism, it is necessary to check patients who have undergone external irradiation of the neck. (authors)

  9. Guide for External Beam Radiotherapy. Procedures 2007

    International Nuclear Information System (INIS)

    Ardiet, Jean-Michel; Bourhis, Jean; Eschwege, Francois; Gerard, Jean-Pierre; Martin, Philippe; Mazeron, Jean-Jacques; Barillot, Isabelle; Bey, Pierre; Cosset, Jean-Marc; Thomas, Olivier; Bolla, Michel; Bourguignon, Michel; Godet, Jean-Luc; Krembel, David; Valero, Marc; Bara, Christine; Beauvais-March, Helene; Derreumaux, Sylvie; Vidal, Jean-Pierre; Drouard, Jean; Sarrazin, Thierry; Lindecker-Cournil, Valerie; Robin, Sun Hee Lee; Thevenet, Nicolas; Depenweiller, Christian; Le Tallec, Philippe; Ortholan, Cecile; Aimone, Nicole; Baldeschi, Carine; Cantelli, Andree; Estivalet, Stephane; Le Prince, Cyrille; QUERO, Laurent; Costa, Andre; Gerard, Jean-Pierre; Ardiet, Jean-Michel; Bensadoun, Rene-Jean; Bourhis, Jean; Calais, Gilles; Lartigau, Eric; Ginot, Aurelie; Girard, Nicolas; Mornex, Francoise; Bolla, Michel; Chauvet, Bruno; Maingon, Philippe; Martin, Etienne; Azria, David; Gerard, Jean-Pierre; Grehange, Gilles; Hennequin, Christophe; Peiffert, Didier; Toledano, Alain; Belkacemi, Yazid; Courdi, Adel; Belliere, Aurelie; Peignaux, Karine; Mahe, Marc; Bondiau, Pierre-Yves; Kantor, Guy; Lepechoux, Cecile; Carrie, Christian; Claude, Line

    2007-01-01

    In order to optimize quality and security in the delivery of radiation treatment, the French SFRO (Societe francaise de radiotherapie oncologique) is publishing a Guide for Radiotherapy. This guide is realized according to the HAS (Haute Autorite de sante) methodology of 'structured experts consensus'. This document is made of two parts: a general description of external beam radiation therapy and chapters describing the technical procedures of the main tumors to be irradiated (24). For each procedure, a special attention is given to dose constraints in the organs at risk. This guide will be regularly updated

  10. Conformal radiotherapy for prostate cancer: contribution of pelvic immobilization and new fiducial markers

    International Nuclear Information System (INIS)

    Garcia, R.; Oozeer, R.; Le Thanh, H.; Chauvet, B.; Toy, B.J.; Reboul, F.

    1997-01-01

    To reduce errors in the positioning of patients treated with external conformal radiotherapy for prostate cancer, we evaluated both the use of an immobilization device and new fiducial markers. The immobilization device consisted of an individual mold made of polyurethane foam. Two sets of skin markers located on the anterior tibial surfaces were used to identify the pelvic isocenter. The patient's position was evaluated by orthogonal port film which were then compared with the original simulation film. Results are presented with respect to orthogonal axes. Comparison with classic procedures without immobilization showed that use of the mold and new fiducial markers led to a decrease in set-up errors which were less than 5 mm. With the use of an immobilization device and optimized techniques for patients' positioning, conformal radiotherapy of prostate cancer is more accurate. (authors)

  11. Postoperative radiotherapy for prostate cancer. Morbidity of local-only or local-plus-pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Waldstein, Cora; Poetter, Richard; Widder, Joachim; Goldner, Gregor [Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, General Hospital of Vienna, Vienna (Austria); Doerr, Wolfgang [Medical University of Vienna, Department of Radiation Oncology, Comprehensive Cancer Center, General Hospital of Vienna, Vienna (Austria); Medical University of Vienna, Christian-Doppler Laboratory for Medical Radiation Research for Radiooncology, Vienna (Austria)

    2018-01-15

    The aim of this work was to characterise actuarial incidence and prevalence of early and late side effects of local versus pelvic three-dimensional conformal postoperative radiotherapy for prostate cancer. Based on a risk-adapted protocol, 575 patients received either local (n = 447) or local-plus-pelvic (n = 128) radiotherapy. Gastrointestinal (GI) and genitourinary (GU) side effects (≥grade 2 RTOG/EORTC criteria) were prospectively assessed. Maximum morbidity, actuarial incidence rate, and prevalence rates were compared between the two groups. For local radiotherapy, median follow-up was 68 months, and the mean dose was 66.7 Gy. In pelvic radiotherapy, the median follow-up was 49 months, and the mean local and pelvic doses were 66.9 and 48.3 Gy respectively. Early GI side effects ≥ G2 were detected in 26% and 42% of patients respectively (p < 0.001). Late GI adverse events were detected in 14% in both groups (p = 0.77). The 5-year actuarial incidence rates were 14% and 14%, while the prevalence rates were 2% and 0% respectively. Early GU ≥ G2 side effects were detected in 15% and 16% (p = 0.96), while late GU morbidity was detected in 18% and 24% (p = 0.001). The 5-year actuarial incidence rates were 16% and 35% (p = 0.001), while the respective prevalence rates were 6% and 8%. Despite the low prevalence of side effects, postoperative pelvic radiotherapy results in significant increases in the actuarial incidence of early GI and late GU morbidity using a conventional 4-field box radiotherapy technique. Advanced treatment techniques like intensity-modulated radiotherapy (IMRT) or volumetric modulated arc radiotherapy (VMAT) should therefore be considered in pelvic radiotherapy to potentially reduce these side effects. (orig.) [German] Ziel der vorgestellten Arbeit ist es, die Haeufigkeit frueher und spaeter Nebenwirkungen nach postoperativer Bestrahlung von Prostatakarzinompatienten zu analysieren. Verglichen wurden dabei die Nebenwirkungen von lokaler

  12. Colestipol hydrochloride prophylaxis of diarrhea during pelvic radiotherapy

    International Nuclear Information System (INIS)

    Stryker, J.A.; Chung, C.K.; Layser, J.D.

    1983-01-01

    Thirty-three patients were randomized prior to pelvic radiotherapy to receive the bile acid-sequestering resin colestipol hydrochloride, 5 grams qid, during the entire time of their therapy or diphenoxylate hydrochloride and atropine sulfate 2.5-20 mg per day (control) if they experienced diarrhea. The colestipol patients also took diphenoxylate if they had diarrhea. The patients in the colestipol group often experienced nausea, vomiting, and abdominal cramps and 8 were forced to discontinue the drug. There was no difference in the weekly stool frequency between the colestipol and the control patients but the colestipol patients who took at least 50% of the prescribed dose required fewer diphenoxylate tablets than the controls. The data suggest that colestipol hydrochloride is not of value in preventing radiation-induced diarrhea because of the side effects associated with the drug, but the theory on which the use of bile acid-sequestering agents is based may be correct

  13. Dose-Effect Relationships for Individual Pelvic Floor Muscles and Anorectal Complaints After Prostate Radiotherapy

    International Nuclear Information System (INIS)

    Smeenk, Robert Jan; Hoffmann, Aswin L.; Hopman, Wim P.M.; Lin, Emile N.J. Th. van; Kaanders, Johannes H.A.M.

    2012-01-01

    Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). Methods and Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. Results: The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: ≤30 Gy to the IAS; ≤10 Gy to the EAS; ≤50 Gy to the PRM; and ≤40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Conclusions: Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are

  14. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy.

    Science.gov (United States)

    Smeenk, Robert Jan; Hoffmann, Aswin L; Hopman, Wim P M; van Lin, Emile N J Th; Kaanders, Johannes H A M

    2012-06-01

    To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: ≤ 30 Gy to the IAS; ≤ 10 Gy to the EAS; ≤ 50 Gy to the PRM; and ≤ 40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are excluded. Copyright © 2012 Elsevier Inc. All rights

  15. Minimal requirements for quality controls in radiotherapy with external beams

    International Nuclear Information System (INIS)

    1999-01-01

    Physical dosimetric guidelines have been developed by the Italian National Institute of Health study group on quality assurance in radiotherapy to define protocols for quality controls in external beam radiotherapy. While the document does not determine strict rules or firm recommendations, it suggests minimal requirements for quality controls necessary to guarantee an adequate degree of accuracy in external beam radiotherapy [it

  16. Bilateral Avascular Necrosis and Pelvic Insufficiency Fractures Developing after Pelvic Radiotherapy in a Patient with Prostate Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    Hidayet Sarı

    2016-12-01

    Full Text Available Prostate cancer is one of the most common malignancies in men. Pelvic radiotherapy is commonly used in both radical and palliative treatment for prostate cancer. Radiation-induced adverse effects might be seen on adjacent healthy tissues (such as vessels, bones and soft tissues with the exception of targeted area. Particularly several years after radiotherapy, low back and hip pain may occur due to bone edema, necrosis or fractures. In these cases, whether complaints due to the degenerative, metastatic or radiotherapy complications must be examined and appropriate treatment should be arranged. For this purpose, we present our elderly patient who received radiotherapy for prostate cancer, and thereafter, developed bilateral avascular hip necrosis and pelvic insufficiency fractures.

  17. External quality audits in radiotherapy in Poland

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  18. Improving TL dosimetry for external radiotherapy

    International Nuclear Information System (INIS)

    Bustos, S.R.; Velez, G.; Rubio, M.

    1998-01-01

    Full text: In vivo thermoluminescence dosimetry (TLD) has always been one of the most accurate dosimetry method for external radiotherapy control, but the delay in the response is a well know drawback when it is applied. In this work we show some improvements and demonstrate that keeping the precision and accuracy of this technique, it is possible to obtain a response in few hours. Harshaw 4000 TL reader and LiF TLD-100 dosimeters, chips (3,1 x 3,1 x 0,9 mm 3 ) and rods (1 x 1 x 6 mm 3 ) have been used. The thermal treatment necessary to reuse the TLD is only 1h at 400 degree C, by using a glow curve analyser developed at the Ciemat (Spain), that allows a complete, prompt and precise identification of the individuals peaks. The dosimeters are periodically and individually calibrated. We also have study the factors contributing to the relation TL-dose like linearity, energy correction, directional response and fading. All those results are included into an Excel worksheet which automatically give us the dose resulting from the TL reading (peaks areas 4 and 5). The obtained uncertainty is better than 5%. The TLD already irradiated in radiotherapy institutions distant 30-40 Km from our centre can be read and analysed in about 3-4 hours. These facts render our methods rapid and allow a better control of radiotherapy treatment even if it is bi-fractionated. (author) [es

  19. Simulation and radiation treatment in external radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Singer, E [Mevaterapia Medical Center, Buenos Aires (Argentina)

    1996-08-01

    It is well known that in order to obtain a uniform dose in the treated volume as defined in ICRU 50, there should be a 10% maximum difference between maximum and minimum dose values in treatment planning. Clinical target volume (CTV) should be related to external areas of body sections where tumour is located. These areas are important because different radiation beams enter through them. Therefore, verification of the planning target volume (PTV) through the external areas is highly significant. In this work we point out the importance of controlling that PTV is irradiated as planned considering some error sources usually found in radiotherapy practice with equipment that has been intensively used for a long time. Moreover, I think this experience will be helpful for those centers around the world where radiation treatment is carried out with reconditioned units. (author).

  20. Simulation and radiation treatment in external radiotherapy

    International Nuclear Information System (INIS)

    Singer, E.

    1996-01-01

    It is well known that in order to obtain a uniform dose in the treated volume as defined in ICRU 50, there should be a 10% maximum difference between maximum and minimum dose values in treatment planning. Clinical target volume (CTV) should be related to external areas of body sections where tumour is located. These areas are important because different radiation beams enter through them. Therefore, verification of the planning target volume (PTV) through the external areas is highly significant. In this work we point out the importance of controlling that PTV is irradiated as planned considering some error sources usually found in radiotherapy practice with equipment that has been intensively used for a long time. Moreover, I think this experience will be helpful for those centers around the world where radiation treatment is carried out with reconditioned units. (author)

  1. External beam radiotherapy for unresectable pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kagami, Yoshikazu; Nishio, Masamichi; Narimatsu, Naoto; Ogawa, Hajime; Betsuyaku, Takashi; Hirata, Kouji; Ikeda, Shigeyuki (Sapporo National Hospital (Japan). Hokkaido Cancer Center)

    1992-04-01

    Between 1980 to 1989, 24 patients with unresectable pancreatic cancer (10 with localized tumor alone and 14 with distant metastases) have been treated with external beam radiation at Sapporo National Hospital, Hokkaido Cancer Center. Response rate of pancreatic tumor treated with external beam radiation was 33.3% (7/21) with no complete response. Median survival time of the patients with localized tumor was 10 months and that of the patients with distant metastases was 3 months. Relief of pain occurred in 92.9% (12/13) of patients having pain due to pancreatic tumor and in 75% (3/4) of patients having pain due to bone metastases. Major complication was gastric ulcer which developed in 5 patients of 21 patients given stomach irradiation. We concluded that unresectable pancreatic cancer would be frequently indicated for radiotherapy. (author).

  2. Post-external radiotherapy hypothyroidism: 15 cases; Hypothyroidie apres radiotherapie externe. A propos de 15 cas

    Energy Technology Data Exchange (ETDEWEB)

    Kaffel, N.; Mnif, M.; Abid, M. [Centre Hospitalier Universitaire Hedi Chaker, Sfax (Tunisia); Daoud, J. [Centre Hospitalier Universitaire Habib Bourguiba, Sfax (Tunisia)

    2001-06-01

    Post-external radiotherapy hypothyroidism: 15 cases. Hypothyroidism frequency is estimated to be between 10 and 45% after radiotherapy alone, and 40 to 67% after radiotherapy associated with thyroidectomy. This hypothyroidism is infra-clinical in 60% of the cases. Our study concerned 15 cases of hypothyroidism after external radiotherapy delivered between and 1991 and 1999. An irradiation of the cervical, cerebral and thorax regions was indicated for different types of cancers. Larynx carcinoma epidermoid was the most frequent cancer (seven cases); the radiation treatment used cobalt 60 with conventional fractionation, i.e., 2 Gy per treatment, five treatments a week. In nine cases, the hypothyroidism was discovered during a systematic examination; it was clinically evident in the six remaining cases. Hypothyroidism appeared after an irradiation dose average of 50 Gy (extremes 30-65 Gy). The average duration of the irradiation was about 7 weeks and the hypothyroidism appeared in a mean 22 months. In all cases, the substituting treatment was initiated with a favorable progression. Faced with the risk of hypothyroidism, it is necessary to check patients who have undergone external irradiation of the neck. (authors)

  3. In vivo dosimetry in external beam radiotherapy

    International Nuclear Information System (INIS)

    Mijnheer, Ben; Beddar, Sam; Izewska, Joanna; Reft, Chester

    2013-01-01

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

  4. In vivo dosimetry in external beam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-07-15

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

  5. Conventional external beam radiotherapy for central nervous system malignancies

    International Nuclear Information System (INIS)

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

    1985-01-01

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

  6. A common language in external radiotherapy

    International Nuclear Information System (INIS)

    Gerard, J.P.; Sentenac, I.; Carrie, C.; Barbet, N.

    1990-01-01

    In June 1989, an International meeting with the joint participation of Radiation Oncologists and Radiophysicists took place in Lyon. The aim of the meeting was to reach a common language in external radiotherapy. The ICRU report no 29 is the gold standard in that field. However it appears that it is not always used in practice. Some ambiguous points require further clarification. A consensus can be reached for the definition of concepts like, tumour volume, target volume, safety margin. A clear distinction must be made between prescribed dose (dose that the radiation oncologist wants to deliver in the target volume) and the reported or specified dose (dose used to describe the treatment after completion). With the modern techniques of irradiation, a rather homogeneous dose can be delivered in the target volume. It seems possible that a variation of -5% and +7-10% can be accepted in relation to a mean dose in the center of the target volume. A very important question remains unsolved. What is the dose which governs the likelihood of local control in the target volume. Is it a minimal dose at the periphery of the target volume or a mean dose in the center. The last hypothesis would have the advantage to simplify the relation between the prescribed and the reported dose. The reported or specified dose should always be mentioned according to the recommendation of the future revised ICRU report 29 [fr

  7. Shenlingbaishusan, a chines herbal medicine, in the prevention and treatment of colo-rectal radiation reactions during pelvic tumor radiotherapy

    International Nuclear Information System (INIS)

    Hu Yueran; Liu Yajie; Wu Chaoquan; Chen Chuping; Wang Yaobang; Li Xianming; Zhong Heli; Wu Dong

    2005-01-01

    Objective: To study the effect of traditional Chinese herbal medicine-Shenlingbaishusan in preventing and treating colon and rectum radiation reactions. Methods: Ninty-six patients with female pelvic tumor (cervical and endometrial cancer) were randomly divided into two groups: radiotherapy (RT) alone group (47 patients) and RT+ Shenlingbaishusan group(49 patients). RT in both groups, being similar, 1.8-2.0 Gy/per fraction, five fractions/per week, to a total dose of 48-50 Gy/5-6 weeks to the whole pelvis by external irradiation plus brachytherapy: to a total dose of 42-49 Gy/6-7 weeks for cervix carcinoma, and 10-15 Gy/1-2 weeks for endometrial cancer. Results: All patients have been were followed for more than one year after radiotherapy. The incidence of acute and late colon and rectum radiation reactions. was:15 patients in the RT + Shenlingbaishusan group: grade I10 patients, Grade II3 patients, grade III2 patients incontrast to the 47 patients in the RT group: grade I 24 patients, grade II 14 patients and grade III 9 patients (P<0.01). Conclusions: The traditional Chinese medicine-Shenlingbaishusan is effective in preventing and treating colon and rectum radiation reactions during pelvic tumor radiotherapy.(authors)

  8. External Beam Radiotherapy in Metastatic Bone Pain from Solid ...

    African Journals Online (AJOL)

    Key Words: Bone, metastasis, radiotherapy, pain, control randomized ... described the efficacy of external beam radiotherapy in pain .... life of patients with multiple myeloma. Eur. J. ... Rades D, Jeremic B, Hoskin PJ: The Role of ... randomised multicenter trial on single fraction ... "The subjective experience of acute pain. An.

  9. Design, manufacture, and evaluation of an anthropomorphic pelvic phantom purpose-built for radiotherapy dosimetric intercomparison

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, K. M.; Ebert, M. A.; Kron, T.; Howlett, S. J.; Cornes, D.; Hamilton, C. S.; Denham, J. W. [Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales 2298, Australia and School of Physics, University of Newcastle, New South Wales 2308 (Australia); Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia, Australia and School of Physics, University of Western Australia, Western Australia 6009 (Australia); Department of Physical Sciences, Peter MacCallum Cancer Centre, Victoria 8006 (Australia); Australiasian College of Physical Scientists and Engineers in Medicine, Sydney, New South Wales 2020 (Australia); Trans-Tasman Radiation Oncology Group, Calvary Mater Newcastle, New South Wales 2298 (Australia); Heidelberg Repatriation Hospital, Victoria 3081 (Australia); Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales 2298, Australia and School of Medicine and Population Health, University of Newcastle, New South Wales 2308 (Australia)

    2011-10-15

    Purpose: An anthropomorphic pelvic phantom was designed and constructed to meet specific criteria for multicenter radiotherapy dosimetric intercomparison. Methods: Three dimensional external and organ outlines were generated from a computed tomography image set of a male pelvis, forming the basis of design for an anatomically realistic phantom. Clinically relevant points of interest were selected throughout the dataset where point-dose values could be measured with thermoluminescence dosimeters and a small-volume ionization chamber. Following testing, three materials were selected and the phantom was manufactured using modern prototyping techniques into five separate coronal slices. Time lines and resource requirements for the phantom design and manufacture were recorded. The ability of the phantom to mimic the entire treatment chain was tested. Results: The phantom CT images indicated that organ densities and geometries were comparable to those of the original patient. The phantom proved simple to load for dosimetry and rapid to assemble. Due to heat release during manufacture, small air gaps and density heterogeneities were present throughout the phantom. The overall cost for production of the prototype phantom was comparable to other commercial anthropomorphic phantoms. The phantom was shown to be suitable for use as a ''patient'' to mimic the entire treatment chain for typical external beam radiotherapy for prostate and rectal cancer. Conclusions: The phantom constructed for the present study incorporates all characteristics necessary for accurate Level III intercomparison studies. Following use in an extensive Level III dosimetric comparison over a large time scale and geographic area, the phantom retained mechanical stability and did not show signs of radiation-induced degradation.

  10. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy.

    NARCIS (Netherlands)

    Smeenk, R.J.; Hoffmann, A.L.; Hopman, W.P.M.; Lin, E.N.J.T. van; Kaanders, J.H.A.M.

    2012-01-01

    PURPOSE: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). METHODS AND MATERIALS: In 48 patients treated for localized prostate

  11. Acute and late side-effects of conventional and conformal pelvic radiotherapy for cervical and endometrial cancer

    International Nuclear Information System (INIS)

    Izmajlowicz, B.; Komafel, J.

    2010-01-01

    Aim of the study. The purpose of this prospective study was to analyze and compare acute and late side-effects observed in patients with cervical and endometrial cancer treated with conventional 2-dimensional (2D) and conformal 3-dimensional (3D) pelvic radiotherapy. Patients and method. 50 patients treated with conventional pelvic radiotherapy and 50 patients treated with conformal pelvic radiotherapy at the Clinical Department of Gynecological Radiotherapy of the Lower Silesian Oncology Center between November 2004 and October 2005 were entered into a prospective study. We assessed Radiotherapy side-effects according to EORTCIRTOG, performance status according to the WHO, Body Mass Index and hematologic parameters during radiotherapy and one year after treatment. Results. Performance status acc. to the WHO was significantly better in the conformal arm. Anemia and nausea were more frequent in the conventional arm. In both the study groups acute gastrointestinal and genitourinary morbidity was more frequent than late morbidity and performance status was better after than before radiotherapy. Mean BMI was lower after radiotherapy than before treatment. Conclusions. Conformal pelvic radiotherapy in patients with cervical and endometrial cancer is less toxic than conventional pelvic radiotherapy which is also confirmed by the performance status. (authors)

  12. Care of patients undergoing external radiotherapy

    International Nuclear Information System (INIS)

    Lang, C.

    1977-01-01

    The anxiety and associated depression suffered by most patients undergoing radiotherapy is discussed and the possibilities open to the nurse to encourage and reassure patients thus facilitating physical care are considered. The general symptoms of anorexia, nausea, tiredness, skin problems, alopecia, bonemarrow depresssion and rapid tumour destruction are described and nursing care prescribed. The side-effects which may occur following radiation of the brain, head and neck region, eyes, oesophagus, lung, abdomen, pelvis, bones, skin, spine, and spinal cord are considered from the nursing standpoint. The specialised subject of radiotherapy in children is discussed briefly. (U.K.)

  13. Vaginal delivery after hemipelvectomy and pelvic radiotherapy for chondrosarcoma

    NARCIS (Netherlands)

    Browne, J. L.; Oudijk, M. A.; Holtslag, H. R.; Schreuder, H. W. R.

    2014-01-01

    Chondosarcoma of the proximal femur is a rare malignant disorder in women of (pre-) childbearing age, for which a radical resection through a hemipelvectomy could be indicated. We describe a case of a 36-year-old primigravida with a hemipelvectomy (2004) who had a history of radiotherapy of the

  14. Biomechanical comparison of supraacetabular external fixation and anterior pelvic bridge plating.

    Science.gov (United States)

    Çavuşoğlu, Ali Turgay; Erbay, Fatma Kübra; Özsoy, Mehmet Hakan; Demir, Teyfik

    2017-10-01

    Unstable pelvic ring injuries are complex and risky injuries due to high morbidity and mortality. Although anterior pelvic external fixator is a suitable method for rapid stabilization of an injured pelvic ring, due to some disadvantages such as high complication rate, nerve damage, and difficulties of patient's mobility and comfort, there has recently been increased searching for alternative methods for stabilization of the pelvic ring. Pubic symphysis zone freely moves in pelvic models. This study aims to evaluate the biomechanical stability of anterior pelvic bridge plating and compare it with supraacetabular external fixators in an untreated unstable pelvic fracture model. Samples were loaded statically with 2-mm/min loading rate in single leg standing position. Maximum load was 2.3 kN. When loading the samples, photographs were taken continuously. Stiffness values were calculated from the load displacement curves. Some reference parameters were described and were measured from unloaded and 2.3-kN-loaded photographs of the test. The mean stiffness values were 491.14 ± 52.22, 478.55 ± 41.44, and 470.25 ± 44.51 N/mm for anterior pelvic bridge plating group, supraacetabular external fixator group, and Control group, respectively. According to the measured parameters from photographs, the mean displacement at the pubic symphysis was 4.7 ± 0.32, 15.8 ± 2.01, and 18.2 ± 0.47 mm for anterior pelvic bridge plating, supraacetabular external fixator, and Control group, respectively. The highest displacement in the pubic symphysis was found in Control group, and minimum displacement was observed in anterior pelvic bridge plating group. When the perpendicular distance between the right and left lower end of ischium was examined, it was observed that displacement was minimum in anterior pelvic bridge plating group compared to other two groups, regarding to the high stability of pubic symphysis. In conclusion, this study revealed

  15. Fatal outcome of pelvic radiotherapy for carcinoma of the cervix in a patient with systemic lupus erythematosis

    International Nuclear Information System (INIS)

    Olivotto, I.A.; Fairey, R.N.; British Columbia Univ., Vancouver; Gillies, J.H.; Stein, H.; British Columbia Univ., Vancouver

    1989-01-01

    Although there is an impression that patients with connective tissue disorders tolerate radiotherapy less well than other patients, this is not well documented. The authors present the case of a patient with a 7-year history of systemic lupus erythematosis who developed fatal pelvic necrosis as an unexpectedly severe complication after radiotherapy for carcinoma of the cervix. (author)

  16. Fatal outcome of pelvic radiotherapy for carcinoma of the cervix in a patient with systemic lupus erythematosis

    Energy Technology Data Exchange (ETDEWEB)

    Olivotto, I A; Fairey, R N; Gillies, J H; Stein, H

    1989-01-01

    Although there is an impression that patients with connective tissue disorders tolerate radiotherapy less well than other patients, this is not well documented. The authors present the case of a patient with a 7-year history of systemic lupus erythematosis who developed fatal pelvic necrosis as an unexpectedly severe complication after radiotherapy for carcinoma of the cervix.

  17. DISTRACTION EXTERNAL FIXATIONS OF PELVIC FRACTURES CAUSED BY A LATERAL COMPRESSION.

    Directory of Open Access Journals (Sweden)

    Pavlin Apostolov

    2011-11-01

    Full Text Available The authors represent a distraction external pelvic fixation technique, which they use in pelvic fractures caused by a lateral compression. They consider the indications and mounting techniques. The authors recommend the early movement activities (on the 3rd - 5th day after the external fixator placement. This method had been used in 8 patients and 3 cases are analyzed in details. The priority of this technique over open reduction and internal fixation (ORIF mainly are: (1 the implementation of good reduction of the fracture preventing the risk of ORIF; (2 the possibility for early movement activities for the patient.

  18. Radical external radiotherapy for prostatic carcinoma

    International Nuclear Information System (INIS)

    Beiler, D.D.; Wright, D.J.; Reddy, G.N.

    1981-01-01

    From 1965 through 1974, 88 patients with Stage B or C prostatic carcinoma were treated with radical megavoltage therapy. Treatment technique was small field arc alone for Stage B and 4 field box whole pelvis irradiation to 4400 or 5000 rad with small field rotational boost for Stage C. All were at risk for 5 years and 30 for 10 years or more. None of the 14 Stage B patients have died of cancer. In Stage C (74 patients) uncorrected acturial survival was 55% (5 year) and 28% (10 year). Thirty-one percent of local failures appeared after 5 years. Whole pelvis dose of 5000 rad was associated with a higher 5 and 10 year survival than 4400 rad but the difference was not statistically significant. Comparison between groups treated with radiation alone, versus radiation plus a simultaneous hormonal therapy showed no significant differences in survival, local control or complications. Complications were generally mild, but early in the series 2 patients receiving 7500 rad developed ano-rectal necrosis; one of these patients died. More common problems were urethral stricture (12%) and ano-rectal stenosis (10%). Changes in technique in 1971 drastically reduced the subsequent complications. The failure of whole pelvic irradiation to improve on the 10 year results of local treatment is discussed

  19. Bilateral Rhegmatogenous Retinal Detachment during External Beam Radiotherapy

    Directory of Open Access Journals (Sweden)

    Takako Hidaka

    2016-06-01

    Full Text Available Herein, we report a case of nontraumatic bilateral rhegmatogenous retinal detachment (RRD during external beam radiotherapy for nonocular tumor, presented as an observational case study in conjunction with a review of the relevant literature. A 65-year-old male was referred to our hospital due to bilateral RRD. He underwent a biopsy for a tumor of the left frontal lobe 4 months prior to presentation, and the tumor had been diagnosed as primary central nerve system B-cell type lymphoma. He received chemotherapy and external beam radiotherapy for 1 month. There were no traumatic episodes. Bilateral retinal detachment occurred during a series of radiotherapies. Simultaneous nontraumatic bilateral retinal detachment is rare. The effects of radiotherapy on ocular functionality, particularly in cases involving retinal adhesion and vitreous contraction, may include RRD. Thus, it is necessary to closely monitor the eyes of patients undergoing radiotherapy, particularly those undergoing surgery for retinal detachment and those with a history of photocoagulation for retinal tears, a relevant family history, or risk factors known to be associated with RRD.

  20. QA programme in external radiotherapy in Romania - status and perspective

    International Nuclear Information System (INIS)

    Dumitrescu, A.; Milu, C.

    2008-01-01

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

  1. Preoperative external beam radiotherapy and reduced dose brachytherapy for carcinoma of the cervix: survival and pathological response

    International Nuclear Information System (INIS)

    Jacinto, Alexandre A; Maia, Maria AC; Fogaroli, Ricardo C; Castilho, Marcus S; Novaes, Paulo ERS; Novick, Pablo R; Viani, Gustavo A; Salvajoli, João V; Ferrigno, Robson; Pellizzon, Antonio Cássio A; Lima, Stella SS

    2007-01-01

    To evaluate the pathologic response of cervical carcinoma to external beam radiotherapy (EBRT) and high dose rate brachytherapy (HDRB) and outcome. Between 1992 and 2001, 67 patients with cervical carcinoma were submitted to preoperative radiotherapy. Sixty-five patients were stage IIb. Preoperative treatment included 45 Gy EBRT and 12 Gy HDRB. Patients were submitted to surgery after a mean time of 82 days. Lymphadenectomy was performed in 81% of patients. Eleven patients with residual cervix residual disease on pathological specimen were submitted to 2 additional insertions of HDRB. median follow up was 72 months. Five-year cause specific survival was 75%, overall survival 65%, local control 95%. Complete pelvic pathological response was seen in 40%. Surgery performed later than 80 days was associated with pathological response. Pelvic nodal involvement was found in 12%. Complete pelvic pathological response and negative lymphnodes were associated with better outcome (p = .03 and p = .005). Late grade 3 and 4 urinary and intestinal adverse effects were seen in 12 and 2% of patients. Time allowed between RT and surgery correlated with pathological response. Pelvic pathological response was associated with improved outcome. Postoperative additional HDRB did not improve therapeutic results. Treatment was well tolerated

  2. Impact of hip prosthesis on dose distribution of pelvic radiotherapy

    International Nuclear Information System (INIS)

    Ren Jiangping; Zhang Songfang; Zhu Qibao; Guo Jianxin; Zha Yuanzi

    2011-01-01

    Objective: To study the scattering effect of Co-Cr-Mo hip prosthesis which was high Z material for patients undergoing pelvic irradiation. Methods: The hip prosthesis was set in water phantom (30 cm x 30 cm x 30 cm), determining points were chosen on the entrance side of both 6 MV and 10 MV beams at the distance of 0.5 cm, 1.0 cm, 2.0 cm to the hip prosthesis, and also on the exit side of both 6 MV and 10 MV beams at the distance of 3.0 cm, 5.0 cm, 7.0 cm to the hip prostheses. Dose behind the hip prosthesis at depths of 5.0 cm and 10.0 cm for 6 MV and 10 MV beams are also measured. Results: The dose deviation on the beams' entrance side is between 0 to 5.0%, the backscatter effect was more obviously with the higher energy beam. The dose deviation on the beams' exit side was between 21.6%-30.8%. With the same field size and depth, dose deviation becomes smaller when the beam energy was higher; while with the same energy and depth, dose deviation becomes smaller when the field size was bigger. Dose profiles behind the head of the hip prosthesis indicate obvious attenuation of the beam. Conclusions: Beam arrangements that avoid the prosthesis should be considered first or we should at least reduce the weight of the beam that pass through the prosthesis. (authors)

  3. Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review.

    Science.gov (United States)

    Pahwa, Avita K; Siegelman, Evan S; Arya, Lily A

    2015-04-01

    Pelvic organ prolapse, a herniation of pelvic organs through the vagina, is a common condition in older women. Pelvic organ prolapse distorts vaginal anatomy making pelvic examination difficult. A clinician must accurately identify anatomic landmarks both in women presenting with symptoms of prolapse and in women noted to have coincidental prolapse during routine gynecologic examination. We present a systematic approach to the female pelvic examination including anatomic landmarks of the external genitalia, vagina, and uterus in women with normal support as well as changes that occur with pelvic organ prolapse. Knowledge and awareness of normal anatomic landmarks will improve a clinician's ability to identify defects in pelvic support and allow for better diagnosis and treatment of pelvic organ prolapse. © 2014 Wiley Periodicals, Inc.

  4. External and internal hemipelvectomy for sarcomas of the pelvic girdle : consequences of limb-salvage treatment

    NARCIS (Netherlands)

    Ham, SJ; Veth, RPH; van Horn, [No Value; Eisma, WH; Hoekstra, HJ; Schraffordt Koops, H.

    1997-01-01

    The outcome of different Limb-saving treatment modalities for pelvic girdle sarcoma is controversial. The oncological and functional results after 11 external and 10 internal hemipelvectomies and the consequences of limb-salvage treatment were studied in 21 consecutive patients with primary bone (19

  5. Pharmacological interventions for the prevention of insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults.

    Science.gov (United States)

    van den Blink, Qurrat U; Garcez, Kate; Henson, Caroline C; Davidson, Susan E; Higham, Claire E

    2018-04-23

    Pelvic radiotherapy is a treatment delivered to an estimated 150,000 to 300,000 people annually across high-income countries. Fractures due to normal stresses on weakened bone due to radiotherapy are termed insufficiency fractures. Pelvic radiotherapy-related interruption of the blood supply to the hip is termed avascular necrosis and is another recognised complication. The reported incidences of insufficiency fractures are 2.7% to 89% and risk of developing avascular necrosis is 0.5%. These complications lead to significant morbidity in terms of pain, immobility and consequently risk of infections, pressure sores and mortality. To assess the effects of pharmacological interventions for preventing insufficiency fractures and avascular necrosis in adults over 18 years of age undergoing pelvic radiotherapy. We performed electronic literature searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and DARE to 19 April 2017. We also searched trial registries. Further relevant studies were identified through handsearching of citation lists of included studies. Randomised controlled trials (RCTs) or non RCTs with concurrent comparison groups including quasi-RCTs, cluster RCTs, prospective cohort studies and case series of 30 or more participants were screened. We included studies assessing the effect of pharmacological interventions in adults over 18 years of age undergoing radical pelvic radiotherapy as part of anticancer treatment for a primary pelvic malignancy. We excluded studies involving radiotherapy for bone metastases. We assessed use of pharmacological interventions at any stage before or during pelvic radiotherapy. Interventions included calcium or vitamin D (or both) supplementation, bisphosphonates, selective oestrogen receptor modulators, hormone replacement therapy (oestrogen or testosterone), denosumab and calcitonin. Two review authors independently assessed trial quality and extracted data. We contacted study authors to

  6. Olfactory neural tumours - the role of external beam radiotherapy

    International Nuclear Information System (INIS)

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

    1996-01-01

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

  7. Rotation of the Sacrum During Bellyboard Pelvic Radiotherapy

    International Nuclear Information System (INIS)

    Kasabasic, Mladen; Faj, Dario; Ivkovic, Ana; Jurkovic, Slaven; Belaj, Nenad

    2010-01-01

    Patients with cervical, uterine, and rectal carcinomas are usually treated in the prone position using the bellyboard positioning device. Specific and uncomfortable prone position gives rise to uncertainties in the daily set-up of patients during the treatment. During investigation of translational movements, rotational movements of the pelvis are observed and investigated. The film portal imaging is used to discover patient positioning errors during treatment. We defined the rotational set-up errors by angle deviations of the sacrum. Thirty-six patients were included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisitions were completed in 84%. Systematic and random positioning errors were analyzed in 725 images. Approximately half of the patients had adjusted to the bellyboard in the first few fractions, with sacrum angles remaining the same for the rest of the treatment. The other half had drifts of the sacrum angle during the whole treatment. The rotation of the sacrum during treatment ranged up to 14 deg., causing the usual set-up verification and correction procedure to result in errors up to 15 mm. Rotational movements of the patient pelvis during bellyboard pelvis radiotherapy can introduce considerable patient position error.

  8. In-vivo (entrance) dose measurements in external beam radiotherapy with aqueous FBX dosimetry system

    International Nuclear Information System (INIS)

    Semwal, M.K.; Thakur, P.K.; Bansal, A.K.; Vidyasagar, P.B.

    2005-01-01

    FBX aqueous chemical dosimetry system has been found useful in radiotherapy owing to its low dose measuring capability. In the present work, entrance dose measurements in external beam radiotherapy on a telecobalt machine were carried out with the system on 100 patients. Treatments involving simple beam arrangement of open parallel-opposed beams in cranial and pelvic irradiations were selected for this study. In place of a spectrophotometer, a simple and inexpensive colorimeter was used for absorbance measurements. The purpose was to assess the efficacy of the FBX system for in-vivo dose measurements. The results obtained show that the average discrepancy between the measured and expected dose for both categories of patients was 0.2% (standard deviation 3.2%) with a maximum of +1 0.3%. There were 5.5% cases showing more than ± 5% discrepancy. Comparison of the results obtained with published work on entrance dose measurements, with diode detectors, shows that the inexpensive FBX system can be used for in-vivo (entrance) dose measurements for simple beam arrangements in radiotherapy and can thus serve as a useful QA tool. (author)

  9. Age is not a limiting factor for radical radiotherapy in pelvic malignancies

    International Nuclear Information System (INIS)

    Pignon, T.; Horiot, J.C.; Bolla, M.; Poppel, H. van; Bartelink, H.; Roelofsen, F.; Pene, F.; Gerard, A.; Einhorn, N.; Nguyen, T.D.; Vanglabbeke, M.; Scalliet, P.

    1997-01-01

    Background and purpose: Pelvic radiotherapy (RT) toxicity in the elderly is poorly documented. We developed a study aiming to evaluate whether or not a limit of age could be identified beyond which toxicities in patients receiving pelvic RT were more frequent or more severe. Material and methods: 1619 patients with pelvic cancers enrolled in nine EORTC trials, RT arms, were retrospectively studied. Patients were split into six age ranges from 50 years to 70 years and over. Survivals and late toxicity occurrence were calculated with the Kaplan-Meier method and comparison between age groups with the logrank test. A trend test was done to examine if chronological age had an impact on acute toxicity occurrence. Results: Survival was comparable in each age group for prostate (P=0.18), uterus (0.41), anal canal cancer (P=0.6) and slightly better for the younger group of rectum cancer (P=0.04). A total of 1722 acute and 514 late grade ≥1 were recorded. Acute nausea/vomiting, skin complications and performance status deterioration were significantly more frequent in younger patients. There was no trend toward more aged patients to experience diarrhea (P=0.149) and after adjustment on RT dose, acute urinary complications were observed equally in each age range (P=0.32). Eighty percent of patients were free of late complication at 5 years in each age range (P=0.79). For the grade >2 late side-effects, a plateau was observed after 1 year at near 9% without any difference (P=0.06) nor trend (P=0.13) between age-groups. Conclusion: Age per se is not a limiting factor for radical radiotherapy in pelvic malignancies

  10. External beam radiotherapy in the management of ovarian carcinoma

    International Nuclear Information System (INIS)

    Reinfuss, Marian; Zbigniew, Kojs; Skolyszewski, Jan

    1993-01-01

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

  11. Dose-volume effects for pelvic bone marrow in predicting hematological toxicity in prostate cancer radiotherapy with pelvic node irradiation.

    Science.gov (United States)

    Sini, Carla; Fiorino, Claudio; Perna, Lucia; Noris Chiorda, Barbara; Deantoni, Chiara Lucrezia; Bianchi, Marco; Sacco, Vincenzo; Briganti, Alberto; Montorsi, Francesco; Calandrino, Riccardo; Di Muzio, Nadia; Cozzarini, Cesare

    2016-01-01

    To prospectively identify clinical/dosimetric predictors of acute/late hematologic toxicity (HT) in chemo-naÏve patients treated with whole-pelvis radiotherapy (WPRT) for prostate cancer. Data of 121 patients treated with adjuvant/salvage WPRT were analyzed (static-field IMRT n=19; VMAT/Rapidarc n=57; Tomotherapy n=45). Pelvic bone marrow (BM) was delineated as ilium (IL), lumbosacral, lower and whole pelvis (WP), and the relative DVHs were calculated. HT was graded both according to CTCAE v4.03 and as variation in percentage relative to baseline. Logistic regression was used to analyze association between HT and clinical/DVHs factors. Significant differences (p<0.005) in the DVH of BM volumes between different techniques were found: Tomotherapy was associated with larger volumes receiving low doses (3-20 Gy) and smaller receiving 40-50 Gy. Lower baseline absolute values of WBC, neutrophils and lymphocytes (ALC) predicted acute/late HT (p ⩽ 0.001). Higher BM V40 was associated with higher risk of acute Grade3 (OR=1.018) or late Grade2 lymphopenia (OR=1.005). Two models predicting lymphopenia were developed, both including baseline ALC, and BM WP-V40 (AUC=0.73) and IL-V40+smoking (AUC=0.904) for acute/late respectively. Specific regions of pelvic BM predicting acute/late lymphopenia, a risk factor for viral infections, were identified. The 2-variable models including specific constraints to BM may help reduce HT. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Intestinal lesions induced by radiotherapy of malignant pelvic tumors. 2 cases

    Energy Technology Data Exchange (ETDEWEB)

    Manigand, G; Pointud, P; Foulon, D; Montely, J M; Testas, P; Paillas, J; Deparis, M [Hopital de Bicetre, 94 - le Kremlin-Bicetre (France)

    1976-11-16

    Intestinal lesions after radiotherapy for pelvic malignant tumors are of two types: ulcerative colitis with stenosis and hemorrhage sometimes severe and repeated, and ileal involvement with focal ischemic lesions and malabsorption responsible for nutritional disorders. It is difficult to distinguish them from a recurrence of the tumor in spite of endoscopy, arteriography and biopsy. The course in 3 stages is of great value in diagnosis. A reduction in the frequency of such complications may be hoped for by assessment and exclusion of predisposing factors, by strict observance of therapeutic rules. They are serious owing to the marked irreversible conjunctivo-vascular changes and the fragility of the irradiated tissues during operation.

  13. Impact of pelvic nodal irradiation with intensity-modulated radiotherapy on treatment of prostate cancer

    International Nuclear Information System (INIS)

    Price, Robert A.; Hannoun-Levi, Jean-Michel; Horwitz, Eric; Buyyounouski, Mark; Ruth, Karen J.; Ma, C.-M.; Pollack, Alan

    2006-01-01

    Purpose: The aim of this study was to evaluate the feasibility of treating the pelvic lymphatic regions during prostate intensity-modulated radiotherapy (IMRT) with respect to our routine acceptance criteria. Methods and Materials: A series of 10 previously treated prostate patients were randomly selected and the pelvic lymphatic regions delineated on the fused magnetic resonance/computed tomography data sets. A targeting progression was formed from the prostate and proximal seminal vesicles only to the inclusion of all pelvic lymphatic regions and presacral region resulting in 5 planning scenarios of increasing geometric difficulty. IMRT plans were generated for each stage for two accelerator manufacturers. Dose volume histogram data were analyzed with respect to dose to the planning target volumes, rectum, bladder, bowel, and normal tissue. Analysis was performed for the number of segments required, monitor units, 'hot spots,' and treatment time. Results: Both rectal endpoints were met for all targets. Bladder endpoints were not met and the bowel endpoint was met in 40% of cases with the inclusion of the extended and presacral lymphatics. A significant difference was found in the number of segments and monitor units with targeting progression and between accelerators, with the smaller beamlets yielding poorer results. Treatment times between the 2 linacs did not exhibit a clinically significant difference when compared. Conclusions: Many issues should be considered with pelvic lymphatic irradiation during IMRT delivery for prostate cancer including dose per fraction, normal structure dose/volume limits, planning target volumes generation, localization, treatment time, and increased radiation leakage. We would suggest that, at a minimum, the endpoints used in this work be evaluated before beginning IMRT pelvic nodal irradiation

  14. A comparative study of external radiotherapy alone versus external radiotherapy + brachytherapy in carcinoma cervix stage III B

    International Nuclear Information System (INIS)

    Bardia, M.R.; Bhargava, S.C.; Chaudhary, R.K.; Agrawal, V.K.; Singh, K.; Vyas, R.

    1987-01-01

    Carcinoma of the cervix is the commonest cancer seen in women at Sardar Patel Medical College, Bikaner (Rajasthan). In the present study external radio-therapy and brachytherapy are used in carcinoma cervix stage III B. After 4000 to 4500 rads to pelvis by external radio-therapy, patient was assessed for intra cavitary application. Total given dose to point A was 7500 rads, to point B was 5000 rads. If patient was not suitable a split course was given where patient was asked to come after 3 weeks for intracavitary application. A comparative study of both methods was done. There was significant improvement in the control of central disease by applying intracavitary source. Radiation reactions were comparable. (author). 4 tables, 10 refs

  15. Pelvic control following external beam radiation for surgical Stage I endometrial adenocarcinoma

    International Nuclear Information System (INIS)

    Rush, Stephen; Gal, David; Potters, Louis; Bosworth, Jay; Lovecchio, John

    1995-01-01

    Purpose: To determine if postoperative external pelvic radiation (EBRT), without vaginal brachytherapy, is sufficient to prevent vaginal cuff and pelvic recurrences in patients with surgical Stage I endometrial adenocarcinoma (ACA). Methods and Materials: The records of 122 patients with surgical Stage I endometrial cancer were reviewed. There were 87 patients with ACA who received EBRT alone and are the subject of this study. Their radiation records were reviewed. All patients underwent exploration, total abdominal hysterectomy, and bilateral salpingo-oophorectomy (TAH BSO), and pelvic and paraaortic lymph node sampling. They were staged according to the FIGO 1988 surgical staging system recommendations. Postoperatively, pelvic EBRT was administered by megavoltage equipment using four fields, to a total dose of 45 to 50.4 Gy. Actuarial survival and disease free survival were calculated according to Kaplan-Meier Method. Results: Twenty-seven patients with Stage IA Grade 1 or 2 ACA with less than one-third myometrial invasion, who did not receive EBRT, and eight patients with histology other than adenocarcinoma (i.e., serous papillary, mucinous, etc.) were not included in the study. For the remaining 87 patients who are in the study group, the median follow-up was 52 months (range: 12-82 months). The 5-year overall survival for these 87 patients was 92%, with a disease-free survival of 83%. There were no tumor recurrences in the upper vagina or in the pelvis. Two patients developed small bowel obstruction (no surgery required), and one patient developed chronic enteritis. Conclusion: Adjuvant external pelvic radiation, without vaginal brachytherapy, prevents pelvic and vaginal cuff recurrences in surgical Stage I endometrial ACA

  16. External Beam Radiotherapy for Carcinoma of the Extrahepatic Biliary System

    International Nuclear Information System (INIS)

    Chun, Ha Chung; Lee, Myung Za

    1996-01-01

    Purpose : To evaluate the effectiveness and tolerance of patients of external beam radiotherapy of carcinoma of the extrahepatic biliary system (EHBS) including gall bladder (GB) and extrahepatic bile ducts (EHBD) and to define the role of radiotherapy for these tumors. Methods and Materials : We retrospectively analyzed the records of 43 patients with carcinoma of the EHBS treated with external beam radiotherapy at our institution between April, 1986 and July, 1994. Twenty three patients had GB cancers and remaining 20 patients did EHBD cancers. Of those 23 GB cancers, 2 had Stage II, 12 did Stage III and 9 did Stage IV disease, respectively. Male to female ratio was 11 to 12. Fifteen patients underwent radical surgery with curative intent and 8 patients did biopsy and bypass surgery alone. Postoperatively 16 patients were irradiated with 4500 cGy or higher doses and 4 patients with 3180 to 4140 cGy. Follow up periods ranged from 8 to 34 months. Results : overall median survival time of patients with GB cancer was 11 months. Median survival time for patients with Stage III and IV disease were 14 months and 5 months, respectively. Corresponding two year survival rates were 36%(4/11) and 13%(1/8), respectively. Those who underwent surgery with curative intent showed significantly better survival at 12 months than those who underwent bypass surgery alone(67% vs 13%). None of the patients died of treatment related complications. Median survival time for entire group of 20 EHBD patients was 10 months. Median survivals of 10 Stage III and 7 Stage IV disease were 10 and 8 months, respectively. Two patients who underwent Whipple's procedure had 11 and 14 month survival and those treated with resection and drainage showed median survival of 10 month. Conclusion : Postoperative external beam radiotherapy for carcinoma of the extrahepatic billary system is well tolerated and might improve survival of patients. especially those with respectable lesions with microscopic or

  17. External quality audit programmes for radiotherapy dosimetry and equipment

    International Nuclear Information System (INIS)

    Thwaites, D.I.

    1997-01-01

    It is widely accepted that individual radiotherapy centres should have in place a comprehensive quality assurance programme on all the necessary steps for the delivery of safe accurate treatment. As regards the performance of radiotherapy equipment and dosimetry, the most widely used process of external checking has been dosimetry intercomparison, comparing independently measured doses to locally stated doses in a variety of conditions. These have been at a number of different levels: from basic beam calibration; up to and including exercises employing anatomic or pseudo-anatomic phantoms and incorporating tests of treatment planning equipment and procedures. Some of these have been one-off exercises, whilst others are continuing, or have given rise to on-going quality audit programmes on a national (or wider) basis. A number of these have evolved, or are evolving, into audits which include external checking of the achievement of standards in performance of treatment equipment, as well as in the dosimetry in each institution involved. The principles and methodologies of the various types of external checking programmes for treatment equipment and dosimetry are reviewed, covering the experimental approaches and the tolerances applied. What is included in a given programme will, of necessity, depend on the resources available and the purpose of the exercise. Methods and tolerances must be matched to endpoint. Tolerance levels must take into account the experimental uncertainties of the measurement methods employed. Finally, external audit can only be used to complement, and in conjunction with, institutional quality assurance programmes and not as a substitute for them

  18. Improving external beam radiotherapy by combination with internal irradiation.

    Science.gov (United States)

    Dietrich, A; Koi, L; Zöphel, K; Sihver, W; Kotzerke, J; Baumann, M; Krause, M

    2015-07-01

    The efficacy of external beam radiotherapy (EBRT) is dose dependent, but the dose that can be applied to solid tumour lesions is limited by the sensitivity of the surrounding tissue. The combination of EBRT with systemically applied radioimmunotherapy (RIT) is a promising approach to increase efficacy of radiotherapy. Toxicities of both treatment modalities of this combination of internal and external radiotherapy (CIERT) are not additive, as different organs at risk are in target. However, advantages of both single treatments are combined, for example, precise high dose delivery to the bulk tumour via standard EBRT, which can be increased by addition of RIT, and potential targeting of micrometastases by RIT. Eventually, theragnostic radionuclide pairs can be used to predict uptake of the radiotherapeutic drug prior to and during therapy and find individual patients who may benefit from this treatment. This review aims to highlight the outcome of pre-clinical studies on CIERT and resultant questions for translation into the clinic. Few clinical data are available until now and reasons as well as challenges for clinical implementation are discussed.

  19. Radiotherapy in Prostate Cancer Patients With Pelvic Lymphocele After Surgery: Clinical and Dosimetric Data of 30 Patients.

    Science.gov (United States)

    Jereczek-Fossa, Barbara Alicja; Colangione, Sarah Pia; Fodor, Cristiana; Russo, Stefania; Cambria, Raffaella; Zerini, Dario; Bonora, Maria; Cecconi, Agnese; Vischioni, Barbara; Vavassori, Andrea; Matei, Deliu Victor; Bottero, Danilo; Brescia, Antonio; Musi, Gennaro; Mazzoleni, Federica; Orsi, Franco; Bonomo, Guido; De Cobelli, Ottavio; Orecchia, Roberto

    2015-08-01

    The purpose of the study was to evaluate the feasibility of irradiation after prostatectomy in the presence of asymptomatic pelvic lymphocele. The inclusion criteria for this study were: (1) patients referred for postoperative (adjuvant or salvage) intensity modulated radiotherapy (IMRT; 66-69 Gy in 30 fractions); (2) detection of postoperative pelvic lymphocele at the simulation computed tomography [CT] scan; (3) no clinical symptoms; and (4) written informed consent. Radiotherapy toxicity and occurrence of symptoms or complications of lymphocele were analyzed. Dosimetric data (IMRT plans) and the modification of lymphocele volume during radiotherapy (cone beam CT [CBCT] scan) were evaluated. Between January 2011 and July 2013, in 30 of 308 patients (10%) treated with radiotherapy after prostatectomy, pelvic lymphocele was detected on the simulation CT. The median lymphocele volume was 47 cm(3) (range, 6-467.3 cm(3)). Lymphocele was not included in planning target volume (PTV) in 8 cases (27%). Maximum dose to lymphocele was 57 Gy (range, 5.7-73.3 Gy). Radiotherapy was well tolerated. In all but 2 patients, lymphoceles remained asymptomatic. Lymphocele drainage-because of symptom occurrence-had to be performed in 2 patients during IMRT and in one patient, 7 weeks after IMRT. CBCT at the end of IMRT showed reduction in lymphocele volume and position compared with the initial data (median reduction of 37%), more pronounced in lymphoceles included in PTV. Radiotherapy after prostatectomy in the presence of pelvic asymptomatic lymphocele is feasible with acceptable acute and late toxicity. The volume of lymphoceles decreased during radiotherapy and this phenomenon might require intermediate radiotherapy plan evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Neuro-urological consequences of gynaecological surgery (endometriosis, simple hysterectomy, radical colpohysterectomy), colorectal surgery and pelvic radiotherapy

    International Nuclear Information System (INIS)

    Vidait, A.; Mozer, P.; Chartier-Kastler, E.; Ruffion, A.

    2007-01-01

    Apart from damage to bladder innervation, a number of local diseases and treatments such as radiotherapy can induce lower urinary tract functional disorders. Some of these disorders can be treated according to the principles used in the management of neurogenic bladder. The purpose of this review is to report the functional consequences of pelvic endometriosis, radiotherapy, colorectal surgery and urinary incontinence surgery with particular emphasis on situations in which a neurogenic mechanism is suspected. (authors)

  1. The anal canal as a risk organ in cervical cancer patients with hemorrhoids undergoing whole pelvic radiotherapy.

    Science.gov (United States)

    Jang, Hyunsoo; Baek, Jong Geun; Jo, Sunmi

    2015-01-01

    Tolerance of the anal canal tends to be ignored in patients with cervical cancer undergoing whole pelvic radiotherapy. However, patients with hemorrhoids may be troubled with low radiation dose. We tried to analyze the dose-volume statistics of the anal canal in patients undergoing whole pelvic radiotherapy. The records of 31 patients with cervical cancer who received definite or postoperative radiotherapy at one institution were reviewed. Acute anal symptoms, such as anal pain and bleeding, were evaluated from radiotherapy start to 1 month after radiotherapy completion. Various clinical and dosimetric factors were analyzed to characterize relations with acute anal complications. The anal verge was located an average of 1.2 cm (range -0.6~3.9) below the lower border of the ischial tuberosity and an average of 2.7 cm (range -0.6~5.7) behind the sacral promontory level. The presence of hemorrhoids before radiotherapy was found to be significantly associated with acute radiation-induced anal symptoms (p = 0.001), and the mean induction dose for anal symptoms was 36.9 Gy. No patient without hemorrhoids developed an anal symptom during radiotherapy. Dosimetric analyses of V30 and V40 showed marginal correlations with anal symptoms (p = 0.07). The present study suggests a relation between acute anal symptoms following radiotherapy and acute hemorrhoid aggravation. Furthermore, the location of the anal verge was found to be variable, and consequently doses administered to the anal canal also varied substantially. Our results caution careful radiation treatment planning for whole pelvic radiotherapy, and that proper clinical management be afforded patients with hemorrhoids during radiotherapy.

  2. Intracavitary curietherapy of nasopharyngeal cancer after external radiotherapy

    International Nuclear Information System (INIS)

    Latini, P.; Panizza, B.M.; Checcaglini, F.; Maranzano, E.; Aristei, C.; Perucci, E.

    1991-01-01

    The authors report their experience in the treatment of nasopharyngeal carcinoma with intracavitary curietherapy to cure small recurring carcinomas or residual local disease 2-6 weeks after completing external radiotherapy. Since 1984 , 10 patients have received intracavitary radiotherapy with customized molds charged with Ir 192. Six of them received a boost dose because of residual disease and for local recurrence. The technique we employed to shape the molds is described, together with the mode of use and the doses to target volume. Due to both the small number of treated cases and the short follow-up, no significant conclusions could be drawn relative to survival time. However, it must be stressed that this therapeutic approach gives a high local control rate with no severe side-effects or sequelae

  3. Palliative radiotherapy in patients with a symptomatic pelvic mass of metastatic colorectal cancer

    International Nuclear Information System (INIS)

    Bae, Sun Hyun; Yun, Seong Hyeon; Kim, Hee Cheol; Park, Won; Choi, Doo Ho; Nam, Heerim; Kang, Won Ki; Park, Young Suk; Park, Joon Oh; Chun, Ho Kyung; Lee, Woo Yong

    2011-01-01

    To evaluate the palliative role of radiotherapy (RT) and define the effectiveness of chemotherapy combined with palliative RT (CCRT) in patients with a symptomatic pelvic mass of metastatic colorectal cancer. From August 1995 to December 2007, 80 patients with a symptomatic pelvic mass of metastatic colorectal cancer were treated with palliative RT at Samsung Medical Center. Initial presenting symptoms were pain (68 cases), bleeding (18 cases), and obstruction (nine cases). The pelvic mass originated from rectal cancer in 58 patients (73%) and from colon cancer in 22 patients (27%). Initially 72 patients (90%) were treated with surgery, including 64 complete local excisions; 77% in colon cancer and 81% in rectal cancer. The total RT dose ranged 8-60 Gy (median: 36 Gy) with 1.8-8 Gy per fraction. When the α/β for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the median RT dose was 46.8 Gy 10 (14.4-78). Twenty one patients (26%) were treated with CCRT. Symptom palliation was assessed one month after the completion of RT. Symptom palliation was achieved in 80% of the cases. During the median follow-up period of five months (1-44 months), 45% of the cases experienced reappearance of symptoms; the median symptom control duration was five months. Median survival after RT was six months. On univariate analysis, the only significant prognostic factor for symptom control duration was BED ≥40 Gy 10 (p < 0.05), and CCRT was a marginally significant factor (p = 0.0644). On multivariate analysis, BED and CCRT were significant prognostic factors for symptom control duration (p < 0.05). RT was an effective palliation method in patients with a symptomatic pelvic mass of metastatic colorectal cancer. For improvement of symptom control rate and duration, a BED ≥ 40 Gy 10 is recommended when possible. Considering the low morbidity and improved symptom palliation, CCRT might be considered in patients with good performance status

  4. Palliative radiotherapy in patients with a symptomatic pelvic mass of metastatic colorectal cancer

    Directory of Open Access Journals (Sweden)

    Chun Ho Kyung

    2011-05-01

    Full Text Available Abstract Background To evaluate the palliative role of radiotherapy (RT and define the effectiveness of chemotherapy combined with palliative RT (CCRT in patients with a symptomatic pelvic mass of metastatic colorectal cancer. Methods From August 1995 to December 2007, 80 patients with a symptomatic pelvic mass of metastatic colorectal cancer were treated with palliative RT at Samsung Medical Center. Initial presenting symptoms were pain (68 cases, bleeding (18 cases, and obstruction (nine cases. The pelvic mass originated from rectal cancer in 58 patients (73% and from colon cancer in 22 patients (27%. Initially 72 patients (90% were treated with surgery, including 64 complete local excisions; 77% in colon cancer and 81% in rectal cancer. The total RT dose ranged 8-60 Gy (median: 36 Gy with 1.8-8 Gy per fraction. When the α/β for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED, the median RT dose was 46.8 Gy10 (14.4-78. Twenty one patients (26% were treated with CCRT. Symptom palliation was assessed one month after the completion of RT. Results Symptom palliation was achieved in 80% of the cases. During the median follow-up period of five months (1-44 months, 45% of the cases experienced reappearance of symptoms; the median symptom control duration was five months. Median survival after RT was six months. On univariate analysis, the only significant prognostic factor for symptom control duration was BED ≥40 Gy10 (p Conclusions RT was an effective palliation method in patients with a symptomatic pelvic mass of metastatic colorectal cancer. For improvement of symptom control rate and duration, a BED ≥ 40 Gy10 is recommended when possible. Considering the low morbidity and improved symptom palliation, CCRT might be considered in patients with good performance status.

  5. Pelvic Radiotherapy for Cancer of the Cervix: Is What You Plan Actually What You Deliver?

    International Nuclear Information System (INIS)

    Lim, Karen; Kelly, Valerie; Stewart, James; Xie, Jason; Cho, Young-Bin; Moseley, Joanne B.; Brock, Kristy; Fyles, Anthony; Lundin, Anna; Rehbinder, Henrik; Milosevic, Michael

    2009-01-01

    Purpose: Whole pelvic intensity-modulated radiotherapy (IMRT) is increasingly being used to treat cervix cancer and other gynecologic tumors. However, tumor and normal organ movement during treatment can substantially detract from the benefits of this approach. This study explored the effect of internal anatomic changes on the dose delivered to the tumor and organs at risk using a strategy integrating deformable soft-tissue modeling with simulated dose accumulation. Methods and Materials: Twenty patients with cervix cancer underwent baseline and weekly pelvic magnetic resonance imaging during treatment. Interfraction organ motion and delivered (accumulated) dose was modeled for three treatment scenarios: four-field box, large-margin whole pelvic IMRT (20-mm planning target volume, but 10 mm inferiorly) and small-margin IMRT (5-mm planning target volume). Results: Individually, the planned dose was not the same as the simulated delivered dose; however, when taken as a group, this was not statistically significant for the four-field box and large-margin IMRT plans. The small-margin IMRT plans yielded adequate target coverage in most patients; however, significant target underdosing occurred in 1 patient who displayed excessive, unpredictable internal target movement. The delivered doses to the organs at risk were significantly reduced with the small-margin plan, although substantial variability was present among the patients. Conclusion: Simulated dose accumulation might provide a more accurate depiction of the target and organ at risk coverage during fractionated whole pelvic IMRT for cervical cancer. The adequacy of primary tumor coverage using 5-mm planning target volume margins is contingent on the use of daily image-guided setup.

  6. Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass.

    Science.gov (United States)

    Mansukhani, Neel A; Havelka, George E; Helenowski, Irene B; Rodriguez, Heron E; Hoel, Andrew W; Eskandari, Mark K

    2017-07-01

    Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging

  7. External beam radiotherapy alone in advanced esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sung Ja; Chung, Woong Ki; Nah, Byung Sik; Nam, Taek Keun [College of Medicine, Chonnam National Univ., Kwangju (Korea, Republic of)

    1999-09-01

    We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (94%) and ranged from 1 month to 92 months (median; 6 months). The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration of the radiation therapy was days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rate was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except for 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 months and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less tumor length and those with more than 5 cm tumor length was marginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor, length, and

  8. Biochemical failure after radical external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Nomoto, Satoshi; Imada, Hajime; Kato, Fumio; Yahara, Katsuya; Morioka, Tomoaki; Ohguri, Takayuki; Nakano, Keita; Korogi, Yukunori

    2005-01-01

    The purpose of this study was to evaluate biochemical failures after radical external beam radiotherapy for prostate cancer. A total of 143 patients with prostate cancer (5 cases in stage A2, 95 in stage B and 43 in stage C; 18 in low risk group, 37 in intermediate risk group, 67 in high risk group and 21 in unknown group) were included in this study. Patients of stage A2 and B underwent external irradiation of 46 Gy to the prostate gland and seminal vesicle and additional 20 Gy to the prostate gland, while patients of stage C underwent external irradiation of 66 Gy to the prostate gland and seminal vesicle including 46 Gy to the pelvis. Neoadjuvant hormonal therapy was done in 66 cases, and long-term hormonal therapy in 75 cases; two cases were treated with radiation therapy alone. The 3-year relapse free survival rates by stage A2, B and C were 100%, 96.7% and 88.1%, respectively. The 3-year relapse free survival rates by low, intermediate and high risk groups were 100%, 92.3% and 89.7%, respectively. Biochemical failure was noted in nine cases during the average observation term of 32.2 months; in this group the median of prostate specific antigen (PSA) value was 2.6 ng/ml, the doubling time was 8.6 months, and the term of biochemical failure was 33.2 months. Six of eight cases with biochemical failure were the neoadjuvant hormonal therapy group, but biochemical no evidence of disease (bNED) curve showed no significant difference between neoadjuvant and long-term hormonal groups. It is supposed that unnecessary hormonal therapies were performed based on the nonspecific diagnosis of biochemical failure after radical radiotherapy in our group of patients. A precise criterion of biochemical failure after radical radiotherapy for prostate cancer is necessary. (author)

  9. External Pelvic and Vaginal Irradiation Versus Vaginal Irradiation Alone as Postoperative Therapy in Medium-Risk Endometrial Carcinoma—A Prospective Randomized Study

    International Nuclear Information System (INIS)

    Sorbe, Bengt; Horvath, György; Andersson, Håkan; Boman, Karin; Lundgren, Caroline; Pettersson, Birgitta

    2012-01-01

    Purpose: To evaluate the value of adjuvant external beam pelvic radiotherapy as adjunct to vaginal brachytherapy (VBT) in medium-risk endometrial carcinoma, with regard to locoregional tumor control, recurrences, survival, and toxicity. Methods and Materials: Consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study endpoints were locoregional recurrences and overall survival. Secondary endpoints were recurrence-free survival, recurrence-free interval, cancer-specific survival, and toxicity. Results: Five-year locoregional relapse rates were 1.5% after external beam radiotherapy (EBRT) plus VBT and 5% after vaginal irradiation alone (p = 0.013), and 5-year overall survival rates were 89% and 90%, respectively (p = 0.548). Endometrial cancer-related death rates were 3.8% after EBRT plus VBT and 6.8% after VBT (p = 0.118). Pelvic recurrences (exclusively vaginal recurrence) were reduced by 93% by the addition of EBRT to VBT. Deep myometrial infiltration was a significant prognostic factor in this medium-risk group of endometrioid carcinomas but not International Federation of Gynecology and Obstetrics grade or DNA ploidy. Combined radiotherapy was well tolerated, with serious (Grade 3) late side effects of less than 2%. However, there was a significant difference in favor of VBT alone. Conclusions: Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded, but increased late toxicity was noted in the intestine, bladder, and vagina. Combined RT should probably be reserved for high-risk cases with two or more high-risk factors. VBT alone should be the adjuvant treatment option for purely medium-risk cases.

  10. Combined external beam and intraluminal radiotherapy for irresectable Klatskin tumors

    Energy Technology Data Exchange (ETDEWEB)

    Schleicher, U.M. [Klinik fuer Strahlentherapie, Technische Hochschule Aachen (Germany); Staatz, G. [Klinik fuer Radiologische Diagnostik, Technische Hochschule Aachen (Germany); Alzen, G. [Klinik fuer Radiologische Diagnostik, Technische Hochschule Aachen (Germany); Abt. Kinderradiologie, Giessen Univ. (Germany); Andreopoulos, D. [Klinik fuer Strahlentherapie, Technische Hochschule Aachen (Germany); BOC Oncology Centre, Nikosia (Cyprus)

    2002-12-01

    Background: In most cases of proximal cholangiocarcinoma, curative surgery is not possible. Radiotherapy can be used for palliative treatment. We report our experience with combined external beam and intraluminal radiotherapy of advanced Klatskin's tumors. Patients and Methods: 30 patients were treated for extrahepatic proximal bile duct cancer. Our schedule consisted for external beam radiotherapy (median dose 30 Gy) and a high-dose-rate brachytherapy boost (median dose 40 Gy) delivered in four or five fractions, which could be applied completely in twelve of our patients. 15 patients in the brachytherapy and nine patients in the non-brachytherapy group received additional low-dose chemotherapy with 5-fluorouracil. Results: The brachytherapy boost dose improved the effect of external beam radiotherapy by increasing survival from a median of 3.9 months in the non-brachytherapy group to 9.1 months in the brachytherapy group. The effect was obvious in patients receiving a brachytherapy dose above 30 Gy, and in those without jaundice at the beginning of radiotherapy (p<0.05). Conclusions: The poor prognosis in patients with advanced Klatskin's tumors may be improved by combination therapy, with the role of brachytherapy and chemotherapy still to be defined. Our results suggest that patients without jaundice should be offered brachytherapy, and that a full dose of more than 30 Gy should be applied. (orig.) [German] Hintergrund: Bei den meisten Patienten mit proximalen Cholangiokarzinomen ist eine kurative Operation nicht mehr moeglich. Im Rahmen der Palliativbehandlung kann die Strahlentherapie eingesetzt werden. Wir berichten ueber unsere Erfahrungen mit der Kombination aus perkutaner und intraluminaler Strahlentherapie fortgeschrittener Klatskin-Tumoren. Patienten und Methode: 30 Patienten wurden wegen extrahepatischer proximaler Gallengangskarzinome behandelt. Unser Therapieschema umfasste eine perkutane Strahlentherapie (mediane Dosis: 30 Gy) sowie einen

  11. Complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels.

    Science.gov (United States)

    Nishikimi, Kyoko; Tate, Shinichi; Matsuoka, Ayumu; Shozu, Makio

    2017-08-01

    Locally advanced ovarian carcinomas may be fixed to the pelvic sidewall, and although these often involve the internal iliac vessels, they rarely involve the external iliac vessels. Such tumors are mostly considered inoperable. We present a surgical technique for complete resection of locally advanced ovarian carcinoma fixed to the pelvic sidewall and involving external and internal iliac vessels. A 69-year-old woman presented with ovarian carcinoma fixed to the right pelvic sidewall, which involved the right external and internal iliac arteries and veins and the right lower ureter, rectum, and vagina. We cut the external iliac artery and vein at the bifurcation and at the inguinal ligament to resect the external artery and vein. Then, we reconstructed the arterial and venous supplies of the right external artery and vein with grafts. After creating a wide space immediately inside of the sacral plexus to allow the tumor fixed to pelvic sidewall with the internal iliac vessels to move medially, we performed total internal iliac vessel resection. We achieved complete en bloc tumor resection with the right external and internal artery and vein, right ureter, vagina, and rectum adhering to the tumor. There were no intra- or postoperative complications, such as bleeding, graft occlusion, infection, or limb edema. Exfoliation from the sacral plexus and total resection with external and internal iliac vessels enables complete resection of the tumor fixed to the pelvic sidewall. Copyright © 2017 Elsevier Inc. All rights reserved.

  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. Dose-rate effects in external beam radiotherapy redux

    International Nuclear Information System (INIS)

    Ling, C. Clifton; Gerweck, Leo E.; Zaider, Marco; Yorke, Ellen

    2010-01-01

    Recent developments in external beam radiotherapy, both in technical advances and in clinical approaches, have prompted renewed discussions on the potential influence of dose-rate on radio-response in certain treatment scenarios. We consider the multiple factors that influence the dose-rate effect, e.g. radical recombination, the kinetics of sublethal damage repair for tumors and normal tissues, the difference in α/β ratio for early and late reacting tissues, and perform a comprehensive literature review. Based on radiobiological considerations and the linear-quadratic (LQ) model we estimate the influence of overall treatment time on radio-response for specific clinical situations. As the influence of dose-rate applies to both the tumor and normal tissues, in oligo-fractionated treatment using large doses per fraction, the influence of delivery prolongation is likely important, with late reacting normal tissues being generally more sensitive to the dose-rate effect than tumors and early reacting tissues. In conventional fractionated treatment using 1.8-2 Gy per fraction and treatment times of 2-10 min, the influence of dose-rate is relatively small. Lastly, the dose-rate effect in external beam radiotherapy is governed by the overall beam-on-time, not by the average linac dose-rate, nor by the instantaneous dose-rate within individual linac pulses which could be as high as 3 x 10 6 MU/min.

  14. Factors associated with changes in vaginal length and diameter during pelvic radiotherapy for cervical cancer.

    Science.gov (United States)

    Martins, Jumara; Vaz, Ana Francisca; Grion, Regina Celia; Esteves, Sérgio Carlos Barros; Costa-Paiva, Lúcia; Baccaro, Luiz Francisco

    2017-12-01

    This study reports the incidence and factors associated with vaginal stenosis and changes in vaginal dimensions after pelvic radiotherapy for cervical cancer. A descriptive longitudinal study with 139 women with cervical cancer was conducted from January 2013 to November 2015. The outcome variables were vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE v3.0) and changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using χ 2 , Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model. Most women (50.4%) had stage IIIB tumors. According to CTCAE v3.0 scale, 30.2% had no stenosis, 69.1% had grade 1 and 0.7% had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures, the mean variation in diameter was - 0.6 (± 1.7) mm and the mean variation in length was - 0.6 (± 1.3) cm. In the final statistical model, having tumoral invasion of the vaginal walls (coefficient + 0.73, p vaginal stenosis and lower reduction of vaginal dimensions. Advanced clinical stage (coefficient + 1.44; p = 0.02) and receiving brachytherapy/teletherapy (coefficient - 1.17, p vaginal dimensions. Most women had mild vaginal stenosis with slight reductions in both diameter and length of the vaginal canal. Women with tumoral invasion of the vagina have an increase in vaginal length soon after radiotherapy due to a reduction in tumoral volume.

  15. Pelvic Ewing sarcomas. Three-dimensional conformal vs. intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mounessi, F.S.; Lehrich, P.; Haverkamp, U.; Eich, H.T. [Muenster Univ. (Germany). Dept. of Radiation Oncology; Willich, N. [Muenster Univ. (Germany). Dept. of Radiation Oncology; Universitaetsklinikum Muenster (Germany). RiSK - Registry for the Evaluation of Late Side Effects after Radiotherapy in Childhood and Adolescence; Boelling, T. [Center for Radiation Oncology, Osnabrueck (Germany)

    2013-04-15

    The goal of the present work was to assess the potential advantage of intensity-modulated radiotherapy (IMRT) over three-dimensional conformal radiotherapy (3D-CRT) planning in pelvic Ewing's sarcoma. A total of 8 patients with Ewing sarcoma of the pelvis undergoing radiotherapy were analyzed. Plans for 3D-CRT and IMRT were calculated for each patient. Dose coverage of the planning target volume (PTV), conformity and homogeneity indices, as well as further parameters were evaluated. Results The average dose coverage values for PTV were comparable in 3D-CRT and IMRT plans. Both techniques had a PTV coverage of V{sub 95} > 98 % in all patients. Whereas the IMRT plans achieved a higher conformity index compared to the 3D-CRT plans (conformity index 0.79 {+-} 0.12 vs. 0.54 {+-} 0.19, p = 0.012), the dose distribution across the target volumes was less homogeneous with IMRT planning than with 3D-CRT planning. This difference was statistically significant (homogeneity index 0.11 {+-} 0.03 vs. 0.07 {+-} 0.0, p = 0.035). For the bowel, D{sub mean} and D{sub 1%}, as well as V{sub 2} to V{sub 60} were reduced in IMRT plans. For the bladder and the rectum, there was no significant difference in D{sub mean}. However, the percentages of volumes receiving at least doses of 30, 40, 45, and 50 Gy (V{sub 30} to V{sub 50}) were lower for the rectum in IMRT plans. The volume of normal tissue receiving at least 2 Gy (V{sub 2}) was significantly higher in IMRT plans compared with 3D-CRT, whereas at high dose levels (V{sub 30}) it was significantly lower. Compared to 3D-CRT, IMRT showed significantly better results regarding dose conformity (p = 0.012) and bowel sparing at dose levels above 30 Gy (p = 0.012). Thus, dose escalation in the radiotherapy of pelvic Ewing's sarcoma can be more easily achieved using IMRT. (orig.)

  16. Interfractional variability in intensity-modulated radiotherapy of prostate cancer with or without thermoplastic pelvic immobilization

    International Nuclear Information System (INIS)

    Lee, J.A.; Kim, C.Y.; Park, Y.J.; Yoon, W.S.; Lee, N.K.; Yang, D.S.

    2014-01-01

    To determine the variability of patient positioning errors associated with intensity-modulated radiotherapy (IMRT) for prostate cancer and to assess the impact of thermoplastic pelvic immobilization on these errors using kilovoltage (kV) cone-beam computed tomography (CBCT). From February 2012 to June 2012, the records of 314 IMRT sessions in 19 patients with prostate cancer, performed with or without immobilization at two different facilities in the Korea University Hospital were analyzed. The kV CBCT images were matched to simulation computed tomography (CT) images to determine the simulation-to-treatment variability. The shifts along the x (lateral)-, y (longitudinal)- and z (vertical)-axes were measured, as was the shift in the three dimensional (3D) vector. The measured systematic errors in the immobilized group during treatment were 0.46 ± 1.75 mm along the x-axis, - 0.35 ± 3.83 mm along the y-axis, 0.20 ± 2.75 mm along the z-axis and 4.05 ± 3.02 mm in the 3D vector. Those of nonimmobilized group were - 1.45 ± 7.50 mm along the x-axis, 1.89 ± 5.07 mm along the y-axis, 0.28 ± 3.81 mm along the z-axis and 8.90 ± 4.79 mm in the 3D vector. The group immobilized with pelvic thermoplastics showed reduced interfractional variability along the x- and y-axes and in the 3D vector compared to the nonimmobilized group (p < 0.05). IMRT with thermoplastic pelvic immobilization in patients with prostate cancer appears to be useful in stabilizing interfractional variability during the planned treatment course. (orig.)

  17. Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review.

    Science.gov (United States)

    Murray, Louise Janet; Lilley, John; Hawkins, Maria A; Henry, Ann M; Dickinson, Peter; Sebag-Montefiore, David

    2017-11-01

    To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Dosimetric Study of Pelvic Proton Radiotherapy for High-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Chera, Bhishamjit S.; Vargas, Carlos; Morris, Christopher G.; Louis, Debbie; Flampouri, Stella; Yeung, Daniel; Duvvuri, Srividya; Li Zuofeng; Mendenhall, Nancy Price

    2009-01-01

    Purpose: To compare dose distributions in targeted tissues (prostate, seminal vesicles, pelvic regional nodes) and nontargeted tissues in the pelvis with intensity-modulated radiotherapy (IMRT) and forward-planned, double-scattered, three-dimensional proton radiotherapy (3D-PRT). Methods and Materials: IMRT, IMRT followed by a prostate 3D-PRT boost (IMRT/3D-PRT), and 3D-PRT plans were created for 5 high-risk prostate cancer patients (n = 15 plans). A 78-CGE/Gy dose was prescribed to the prostate and proximal seminal vesicles and a 46-CGE/Gy was prescribed to the pelvic nodes. Various dosimetric endpoints were compared. Results: Target coverage of the prostate and nodal planning target volumes was adequate for all three plans. Compared with the IMRT and IMRT/3D-PRT plans, the 3D-PRT plans reduced the mean dose to the rectum, rectal wall, bladder, bladder wall, small bowel, and pelvis. The relative benefit of 3D-PRT (vs IMRT) at reducing the rectum and rectal wall V5-V40 was 53% to 71% (p < 0.05). For the bladder and bladder wall, the relative benefit for V5 to V40 CGE/Gy was 40% to 63% (p < 0.05). The relative benefit for reducing the volume of small bowel irradiated from 5 to 30 CGE/Gy in the 3D-PRT ranged from 62% to 69% (p < 0.05). Use of 3D-PRT did not produce the typical low-dose 'bath' of radiation to the pelvis seen with IMRT. Femoral head doses were higher for the 3D-PRT. Conclusions: Use of 3D-PRT significantly reduced the dose to normal tissues in the pelvis while maintaining adequate target coverage compared with IMRT or IMRT/3D-PRT. When treating the prostate, seminal vesicles, and pelvic lymph nodes in prostate cancer, proton therapy may improve the therapeutic ratio beyond what is possible with IMRT.

  19. Intraoperative and external beam radiotherapy for pancreatic carcinoma; Intraoperative und perkutane Radiotherapie des Pankreaskarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Eble, M.J. [Abt. Klinische Radiologie, Radiologische Universitaetsklinik Heidelberg (Germany); Maurer, U. [Klinikum der Stadt Mannheim (Germany). Inst. fuer Radiologie

    1996-05-01

    Therapeutic strategies in the treatment of pancreatic carcinoma are based on the high number of non-resectable cancers, the high relative radioresistance and the high distant metastases rate. Even in curatively resected carcinomas, a locally effective treatment modality is needed because of the risk of microscopical residual disease in the peripancreatic tissue. The efficacy of radiotherapy is dose dependent. Based on an analysis of published data a dose of more than 50 Gy is recommended, resulting in a high morbidity rate with external beam radiotherapy alone. The use of intraoperative radiotherapy allows locally restricted dose escalation without increased perioperative morbidity. In adjuvant and in primary treatment, local tumor control was improved (70-90%). With palliative intent, pain relief was obtained rapidly in over 60% of patients and led to improved patient performance. As a result of the high distant metastases rate, even in curatively resected carcinomas, the overall prognosis could not be significantly improved. Further dose escalation is limited by the increasing incidence of upper gastrointestinal bleeding (20-30%). (orig.) [Deutsch] Therapiestrategien beim Pankreaskarzinom werden bestimmt durch den hohen Anteil primaer nicht resektabler Karzinome, der hohen relativen Strahlenresistenz und der hohen Fernmetastasierungsrate. Selbst kurativ resezierte Karzinome erfordern durch ihre hohe lokale Tumorzellpersistenz eine lokal effektive adjuvante Behandlungsmassnahme. Die Effektivitaet einer Radiotherapie ist dosisabhaengig. Aus der Analyse publizierter Daten wird eine Dosis von >50 Gy, welche bei der alleinigen perkutanen Bestrahlung mit einer hohen Morbiditaet verbunden ist, empfohlen. Mit der intraoperativen Radiotherapie ist eine lokal begrenzte Dosiseskalation ohne erhoehte perioperative Morbiditaet moeglich. Sowohl in der adjuvanten als auch in der primaeren Behandlung kann die lokale Tumorkontrolle deutlich verbessert werden (70-90%). Unter

  20. Radiotherapy in poor risk patients with stage I cancer of the endometrium: results of not giving external beam radiotherapy.

    Science.gov (United States)

    DeCruze, B; Guthrie, D

    1999-01-01

    Poor prognosis (poorly differentiated and/or deep myometrial invasion) Stage I endometrial cancer can have a relapse rate as high as 50%. Traditionally, most clinical oncologists treat these patients with external beam radiotherapy after surgery but there is no evidence to show that this improves survival. The retrospective study looks at the results of not giving external beam radiotherapy in 25 consecutive patients and compares the results with a group of 13 consecutive patients who did have such treatment. The two groups were comparable with regard to age, degree of differentiation and degree of invasion. Survival was comparable in the two groups. There is no evidence of any obvious decrease in survival from withholding external beam radiotherapy, but this was not a prospective randomized controlled trial. This study illustrates that it is essential that the Medical Research Council ASTEC trial should be supported because this will determine the true place of external beam radiotherapy in such patients.

  1. Leukemia in patients following radiotherapy for malignant neoplasms in the pelvic region

    Energy Technology Data Exchange (ETDEWEB)

    Murohashi, Ikuo

    1985-01-01

    A prospective study of 1572 women treated with radiotherapy for cervical (1478 women) and ovarian cancer (95 women) was done. Patients had been followed clinically and especially by blood tests between 1961 and 1981, comprising 8990 women-years (WY). Following radiotherapy, 5 patients developed non-lymphocytic leukemia (2 acute myeloblastic leukemia (AML), 1 acute monocytic leukemia (AMoL), and 2 chronic myeloid leukemia (CML)). Based on rates for the general population, 0.45 case would be expected, and, therefore, the relative risk was 11.2. The average mean marrow dose for all our subjects was calculated to be 11.77 rad, the risk of radiation-induced leukemia was 0.43 excess case per year per one million women exposed to 1 rad of radiation to the bone marrow. Four patients with cervical cancer who developed leukemia were in a high-dose-rate group treated with both a linear accelerator (Linac) and remote afterloading system (RALS), and 1 patient with ovarian cancer who developed leukemia was treated with a Linac alone. This is the first report of a statistically significant increased risk of leukemia for patients treated with large doses of radiation for malignant neoplasms in the pelvic region. (author).

  2. Leukemia in patients following radiotherapy for malignant neoplasms in the pelvic region

    International Nuclear Information System (INIS)

    Murohashi, Ikuo

    1985-01-01

    A prospective study of 1572 women treated with radiotherapy for cervical (1478 women) and ovarian cancer (95 women) was done. Patients had been followed clinically and especially by blood tests between 1961 and 1981, comprising 8990 women-years (WY). Following radiotherapy, 5 patients developed non-lymphocytic leukemia [2 acute myeloblastic leukemia (AML), 1 acute monocytic leukemia (AMoL), and 2 chronic myeloid leukemia (CML)]. Based on rates for the general population, 0.45 case would be expected, and, therefore, the relative risk was 11.2. The average mean marrow dose for all our subjects was calculated to be 11.77 rad, the risk of radiation-induced leukemia was 0.43 excess case per year per one million women exposed to 1 rad of radiation to the bone marrow. Four patients with cervical cancer who developed leukemia were in a high-dose-rate group treated with both a linear accelerator (Linac) and remote afterloading system (RALS), and 1 patient with ovarian cancer who developed leukemia was treated with a Linac alone. This is the first report of a statistically significant increased risk of leukemia for patients treated with large doses of radiation for malignant neoplasms in the pelvic region. (author)

  3. The brachytherapy vaginal cuff boost in patients with cervix cancer IB1-IB2 that have been treated with surgery plus pelvic radiotherapy in ION SOLCA, Guayaquil Ecuador from November 1 to October 2002

    International Nuclear Information System (INIS)

    Gamboa, Eugenia; Falquez, Roberto

    2003-01-01

    To determine if the additional vaginal cuff irradiation is necessary or not in patients with cervix cancer, stages IB 1- IB 2, that has been treated previously with radical hysterectomies and pelvic radiotherapy, to get better local control and global survival versus presence of complications. We studied 54 patients from Radiation Oncology Department of ION SOLCA Guayaquil Ecuador, with cervix cancer stages IB1 - IB2, that have been treated with surgery plus pelvic radiotherapy plus or not brachytherapy. They have been divides into two arms, group one included surgery plus Rx T (radiotherapy) plus BxT (Brachytherapy), and group two included those patients with surgery plus external RxT alone. We studied, aged, histologic type, surgery type, doses and techniques of teletherapy and brachytherapy and we analyzed the presence of complications. Conclusions: The brachytherapy vaginal cuff boost in patients with cervix cancer IB1-IB2 that have been treated with surgery plus pelvic radiotherapy is not useful to get better local control and global survival in some patients carefully chosen without desfavorable factors, because this therapy represent and increase in the complication. (The author)

  4. Evaluating efficiency of split VMAT plan for prostate cancer radiotherapy involving pelvic lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Mun, Jun Ki; Son, Sang Jun; Kim, Dae Ho; Seo, Seok Jin [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2015-12-15

    The purpose of this study is to evaluate the efficiency of Split VMAT planning(Contouring rectum divided into an upper and a lower for reduce rectum dose) compare to Conventional VMAT planning(Contouring whole rectum) for prostate cancer radiotherapy involving pelvic lymph nodes. A total of 9 cases were enrolled. Each case received radiotherapy with Split VMAT planning to the prostate involving pelvic lymph nodes. Treatment was delivered using TrueBeam STX(Varian Medical Systems, USA) and planned on Eclipse(Ver. 10.0.42, Varian, USA), PRO3(Progressive Resolution Optimizer 10.0.28), AAA(Anisotropic Analytic Algorithm Ver. 10.0.28). Lower rectum contour was defined as starting 1 cm superior and ending 1 cm inferior to the prostate PTV, upper rectum is a part, except lower rectum from the whole rectum. Split VMAT plan parameters consisted of 10 MV coplanar 360° arcs. Each arc had 30° and 30° collimator angle, respectively. An SIB(Simultaneous Integrated Boost) treatment prescription was employed delivering 50.4 Gy to pelvic lymph nodes and 63- 70 Gy to the prostate in 28 fractions. D{sub mean} of whole rectum on Split VMAT plan was applied for DVC(Dose Volume Constraint) of the whole rectum for Conventional VMAT plan. In addition, all parameters were set to be the same of existing treatment plans. To minimize the dose difference that shows up randomly on optimizing, all plans were optimized and calculated twice respectively using a 0.2 cm grid. All plans were normalized to the prostate PTV{sub 100%} = 90% or 95%. A comparison of D{sub mean} of whole rectum, upperr ectum, lower rectum, and bladder, V{sub 50%} of upper rectum, total MU and H.I.(Homogeneity Index) and C.I.(Conformity Index) of the PTV was used for technique evaluation. All Split VMAT plans were verified by gamma test with portal dosimetry using EPID. Using DVH analysis, a difference between the Conventional and the Split VMAT plans was demonstrated. The Split VMAT plan demonstrated better in the D

  5. Late effects of external radiotherapy on the thyroid gland

    International Nuclear Information System (INIS)

    Monnier, A.

    1997-01-01

    The thyroid is the purest endocrine gland in the body and is likely to produce clinically significant abnormalities after external radiotherapy. Functional clinical modifications after direct irradiation exceeding 30 Gy are essentially related to hypothyroidism which may be clinically overt or subclinical with normal serum free thyroxine levels and high thyrotropin concentrations; the risk of hyperthyroidism, silent thyroiditis and Hashimoto's disease is also increased. secondary hypothyroidism related to irradiation of the hypothalamus and the pituitary gland may arise with doses over 40-50 Gy following treatment for brain and nasopharyngeal tumors - Morphological glandular modifications induced by radiotherapy are responsible for the appearance of benign adenomas, more rarely cystic degenerations and specially well differentiated papillary or follicular carcinomas among children and adults. After irradiation during childhood for benign or malignant tumors, thyroid cancers are more frequent, higher for younger children, and the relative excess risk is increased from 15.6-to 53-fold; tumors can belatedly occur, more than 35 years after initial therapy. Thereby, in order to limit excess morbidity, it is evident that long term supervision with careful clinical and biological evaluations is necessary for patients who previously received neck, upper mediastinum and pituitary radiation therapy. (author)

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

    International Nuclear Information System (INIS)

    2007-06-01

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

  7. Uterine cervix cancer treatment in IIB, IIIA and IIIB stages with external radiotherapy versus external radiotherapy and scintiscanning of low dose. ION SOLCA. Years 1998-2000

    International Nuclear Information System (INIS)

    Sanchez, Doris; Falquez, Roberto

    2002-01-01

    We realized study of retrospective accomplished in course of years 1998-2000, reviewing clinical charts of statistical department of ION SOLCA. We reviewed 544 cases in 1998, 603 patients in 1999, and 630 cases in 2000. In the radiotherapy service, 133 patients received treatment with external radiotherapy between February 1998 to February 1999 in IIB, IIIA, IIIB stages and only 80 patients were treated with external radiotherapy and scintiscanning of low dose rate in the same stages between March 1999 to March 2000. (The author)

  8. Late effects of external radiotherapy on the thyroid gland; Effets tardifs de la radiotherapie externe sur la glande thyroide

    Energy Technology Data Exchange (ETDEWEB)

    Monnier, A. [Centre Hospitalier general A-Boulloche, 25 - Montbeliard (France)

    1997-12-01

    The thyroid is the purest endocrine gland in the body and is likely to produce clinically significant abnormalities after external radiotherapy. Functional clinical modifications after direct irradiation exceeding 30 Gy are essentially related to hypothyroidism which may be clinically overt or subclinical with normal serum free thyroxine levels and high thyrotropin concentrations; the risk of hyperthyroidism, silent thyroiditis and Hashimoto`s disease is also increased. secondary hypothyroidism related to irradiation of the hypothalamus and the pituitary gland may arise with doses over 40-50 Gy following treatment for brain and nasopharyngeal tumors - Morphological glandular modifications induced by radiotherapy are responsible for the appearance of benign adenomas, more rarely cystic degenerations and specially well differentiated papillary or follicular carcinomas among children and adults. After irradiation during childhood for benign or malignant tumors, thyroid cancers are more frequent, higher for younger children, and the relative excess risk is increased from 15.6-to 53-fold; tumors can belatedly occur, more than 35 years after initial therapy. Thereby, in order to limit excess morbidity, it is evident that long term supervision with careful clinical and biological evaluations is necessary for patients who previously received neck, upper mediastinum and pituitary radiation therapy. (author)

  9. 14C-lactose breath tests during pelvic radiotherapy: the effect of the amount of small bowel irradiated

    International Nuclear Information System (INIS)

    Weiss, R.G.; Stryker, J.A.

    1982-01-01

    Thirty patients who were undergoing pelvic radiotherapy had 14 C-lactose breath tests performed in the first and fifth weeks of treatment. In Group I (21 patients), a significant portion of the small intestine was irradiated, and in Group II (9 patients), only a small portion of the small intestine was irradiated. In Group I, the average reductions in the excretion of ingested 14 C between the first- and fifth-week tests were 41.5% at 1/2 hour postingestion (p 0.05). The data suggest that lactose malabsorption is a factor in the etiology of the nausea, vomiting, and diarrhea experienced by patients who are undergoing pelvic radiotherapy, and that the amount of bowel included in the treatment volume significantly influences the degree of malabsorption

  10. Bony landmarks are not an adequate substitute for lymphangiography in defining pelvic lymph node location for the treatment of cervical cancer with radiotherapy

    International Nuclear Information System (INIS)

    Bonin, Steven R.; Lanciano, Rachelle M.; Corn, Benjamin W.; Hogan, W. Michael; Hartz, William H.; Hanks, Gerald E.

    1996-01-01

    Purpose: Curative radiotherapy (RT) for carcinoma of the cervix requires adequate irradiation of regional lymph node groups. The best nonsurgical method of defining lymph node anatomy in the pelvis remains the lymphangiogram (LAG). This study was designed to determine if bony landmarks could accurately substitute for LAG as a means of determining lymph node position for the purpose of pelvic RT treatment planning. Methods and Materials: The post-LAG simulation films of 22 patients treated at the Fox Chase Cancer Center for cervical cancer were examined. On anterior/posterior (A/P) simulation films, the distance of lymph nodes was determined from the top, middle, and bottom of the sacroiliac joint, and at the pelvic rim, 1 and 2 cm above the acetabulum. On lateral (LAT) simulation films, lymph node position was measured at points 0, 4, and 8 cm along a line from the bottom of L5 to the anterior aspect of the pubic symphysis. Positive values represent lateral and anterior distances relative to the reference point on A/P and LAT films, respectively. Negative values represent distances in the opposite direction. The adequacy of standard pelvic fields as defined by the Gynecologic Oncology Group (GOG) (A/P: 1.5 cm margin on the pelvic rim; LAT field edge is a vertical line anterior to the pubic symphysis) was also examined. Data are expressed as the mean ± two standard deviations, (i.e. 95% confidence level). Results: On A/P simulation films, the distance of visualized lymph nodes had mean values of -1.6 ± 1.7 cm (range -4.1 to -0.4 cm), -1.3 ± 1.5 cm (range -3.4 to 0.0 cm), and 1.2 ± 1.8 cm (range -1.0 to 2.6 cm) from the sacro-iliac (SI) joint at the superior, middle, and inferior points, respectively. The mean distance of the nodes from the pelvic rim at points 1 and 2 cm above the acetabulum was 0.3 ± 1.2 cm (range -0.6 to 1.8 cm) and 0.2 ± 1.8 cm (range -1.6 to 2.1 cm), respectively. On LAT simulation films, the distance of lymph nodes from points 0, 4, and 8

  11. Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    OpenAIRE

    Castilho, Marcus S; Jacinto, Alexandre A; Viani, Gustavo A; Campana, Andre; Carvalho, Juliana; Ferrigno, Robson; Novaes, Paulo ERS; Fogaroli, Ricardo C; Salvajoli, Joao V

    2006-01-01

    Abstract Background Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case We report on a 50 year-old patient with a serous-papilif...

  12. Plasma citrulline levels predict intestinal toxicity in patients treated with pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Onal, Cem; Kotek, Ayse; Arslan, Gungor; Topkan, Erkan (Dept. of Radiation Oncology, Baskent Univ. Faculty of Medicine, Adana (Turkey)), E-mail: hcemonal@hotmail.com; Unal, Birsel (Dept. of Biochemistry, Baskent Univ. Faculty of Medicine, Ankara (Turkey)); Yavuz, Aydin; Yavuz, Melek (Dept. of Radiation Oncology, Akdeniz Univ. Faculty of Medicine, Antalya (Turkey))

    2011-11-15

    Background. Radiotherapy (RT) for abdominal and pelvic malignancies often causes severe small bowel toxicity. Citrulline concentrations are known to decrease with intestinal failure. We thus evaluated the feasibility of plasma citrulline levels in predicting radiation-induced intestinal toxicity. Material and methods. Fifty-three patients (36 prostate cancer, 17 endometrial cancer) who received 45 Gy pelvic RT using conventional fractionation were prospectively evaluated. Patients with prostate cancer received an additional 25-30.6 Gy conformal boost. Plasma citrulline levels were assessed on day 0, mid- (week 3) and post-RT (week 8), and four months post-RT. Dose-volume histogram, citrulline concentration changes, and weekly intestinal toxicity scores were analyzed. Results. Mean age was 63 years (range: 43-81 years) and mean baseline citrulline concentration was 38.0 +- 10.1 mumol/l. Citrulline concentrations were significantly reduced at week 3 (27.4 +- 5.9 mumol/l; p < 0.0001), treatment end (29.9 +- 8.8 mumol/l; p < 0.0001), and four months post-treatment (34.3 +- 12.1; p 0.01). The following factor pairs were significantly positively correlated: Citrulline concentration/mean bowel dose during, end of treatment, and four months post-RT; dose-volume parameters/citrulline change groups; cumulative mean radiation dose/intestinal toxicity at end and four months post-RT; citrulline changes/intestinal toxicity during and end of RT. Citrulline concentration changes significantly differed during treatment according to RTOG intestinal toxicity grades (p < 0.0001). Although the citrulline changes differed significantly within RTOG intestinal toxicity grades (p = 0.003), the difference between Grade 0 and Grade 1 did not differ significantly at the end of the treatment. At four months after RT, no significant differences were apparent. Conclusion. Citrulline-based assessment scores are objective and should be considered in measuring radiation-induced intestinal toxicity

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-08-01

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

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  15. Dosimetric comparison of intensity-modulated, conformal, and four-field pelvic radiotherapy boost plans for gynecologic cancer: a retrospective planning study

    International Nuclear Information System (INIS)

    Chan, Philip; Yeo, Inhwan; Perkins, Gregory; Fyles, Anthony; Milosevic, Michael

    2006-01-01

    To evaluate intensity-modulated radiation therapy (IMRT) as an alternative to conformal radiotherapy (CRT) or 4-field box boost (4FB) in women with gynecologic malignancies who are unsuitable for brachytherapy for technical or medical reasons. Dosimetric and toxicity information was analyzed for 12 patients with cervical (8), endometrial (2) or vaginal (2) cancer previously treated with external beam pelvic radiotherapy and a CRT boost. Optimized IMRT boost treatment plans were then developed for each of the 12 patients and compared to CRT and 4FB plans. The plans were compared in terms of dose conformality and critical normal tissue avoidance. The median planning target volume (PTV) was 151 cm 3 (range 58–512 cm 3 ). The median overlap of the contoured rectum with the PTV was 15 (1–56) %, and 11 (4–35) % for the bladder. Two of the 12 patients, both with large PTVs and large overlap of the contoured rectum and PTV, developed grade 3 rectal bleeding. The dose conformity was significantly improved with IMRT over CRT and 4FB (p ≤ 0.001 for both). IMRT also yielded an overall improvement in the rectal and bladder dose-volume distributions relative to CRT and 4FB. The volume of rectum that received the highest doses (>66% of the prescription) was reduced by 22% (p < 0.001) with IMRT relative to 4FB, and the bladder volume was reduced by 19% (p < 0.001). This was at the expense of an increase in the volume of these organs receiving doses in the lowest range (<33%). These results indicate that IMRT can improve target coverage and reduce dose to critical structures in gynecologic patients receiving an external beam radiotherapy boost. This dosimetric advantage will be integrated with other patient and treatment-specific factors, particularly internal tumor movement during fractionated radiotherapy, in the context of a future image-guided radiation therapy study

  16. Impact of Scattered Radiation onTestosterone Deficiency and MaleHypogonadism in Rectal Cancer Treatedwith External Beam Pelvic Irradiation

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    Halimeh Khatoon Ahmadi

    2010-07-01

    Full Text Available Background: We performed a prospective study to evaluate the effects of pelvic irradiation on FSH, LH and testosterone levels in male patients with rectal adenocarcinoma. Our aim was to compare the level of male sex hormones in peripheral blood serum before and after pelvic irradiation.Methods:The eligible participants were 40 men with rectal adenocarcinoma who underwent pelvic radiotherapy as part of their treatment for primary tumor, either beforeor after surgery. All patients received a 50-Gy radiation dose to the pelvis, 2 Gy perfraction, five days per week. Blood was sampled three times during the study: once before radiation, at the end of the radiation course and 4 to 6 weeks after radiotherapy.Results:Median age of the patients was 58 years (range 18-82. The mean testis dose of radiation per fraction in all 40 patients was 16.3 cGy with a standard deviation of 15.22 (range 5.5-64.8. Serum levels of FSH revealed a significant increase from 7.5 ± 1.7 IU/L(before treatment to 20.9 ± 17.8 IU/L[end of radiotherapy (P<0.001]and 24.1 ± 20.5 IU/L[4 to 6 weeks after radiotherapy (P<0.001]. Serum LH levelswere significantly elevated from 8.04 ± 1.2 IU/L before radiation to 11.6 ± 11.5 IU/Lat the end of radiotherapy (P<0.001 and 12.5 ± 9.9 IU/L4 to 6 weeks after the final course of radiotherapy (P<0.001. There was a decrease in serum testosterone from5.3±2.1 ng/mL before radiation to 4.2 ± 1.9 ng/mLat the end of radiotherapy (P=0.004and 4.5 ± 2 ng/mL4 to 6 weeks after radiotherapy (P=0.035. No significant correlation was seen between age and differences in sex hormones (LH, P=0.605; FSH, P=0.380;testosterone,P=0.161.Conclusion:There was a significant change in serum levels of male sex hormones after pelvic irradiation for rectal cancer (total dose, 50 Gy that indicates considerable testicular damage under these circumstances. Thus, it seems logical to use techniques that reduce the radiation dose to the testicles and to consider the

  17. Pelvic symptoms after radiotherapy in prostate cancer: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Aline Moreira Ribeiro

    Full Text Available Abstract Introduction: Despite the technical and scientific progress that improved therapeutic resources available in Oncology, adverse effects of treatment can be prominent, impacting the quality of life (QoL. Objective: This research aims to determine the prevalence of post-radiotherapy pelvic symptoms in prostate cancer (PC and its impact on QoL. Methods: We assessed three groups of patients at different stages during radiotherapy (RT: Pre-RT, evaluated before of RT; Post-RT#1, evaluated between six months and one year post-RT; Post-RT#2, evaluated between two and a half and four years post-RT. The presence of urinary incontinence (UI, its characteristics and impact on daily living activities (DLA were evaluated by ICIQ-SF questionnaire. WHOQOL-BREF questionnaire was used to assess QoL. Student t test was used, considering significant p < 0.05. Results: Thirty-three men were assessed (pre-RT, n = 12; Post-RT#1, n = 10; Post-RT#2, n = 11. The prevalence of lower urinary tract symptoms (LUTS was highest in Post-RT#1 group. Post-RT#2 group had the highest prevalence of post-RT UI. In QoL, Pre-RT and Post-RT#2 groups experiencing the greatest impact on physical, environmental and overall QoL. Conclusion: Acute effect of RT is characterized by a high prevalence of LUTS. Post-RT#2 group experienced the most adverse effects on DLA due to a higher prevalence of post-RT UI.

  18. Factors influencing bowel sparing in intensity modulated whole pelvic radiotherapy for gynaecological malignancies

    International Nuclear Information System (INIS)

    Georg, Petra; Georg, Dietmar; Hillbrand, Martin; Kirisits, Christian; Poetter, Richard

    2006-01-01

    Background and purpose: To evaluate the influence of uterus and bladder size on large and small bowel sparing with intensity modulated whole pelvic radiotherapy (IM-WPRT) in gynecologic patients. Patients and methods: Twenty patients were selected; 10 women with cervical cancer treated with definitive radiotherapy (group 'DEF') and 10 endometrial cancer patients treated postoperatively (group 'POST'). Bladder, rectal wall, small (SB) and large bowel (LB) were delineated as organs at risk. A conformal four field technique and a seven field IMRT plan (prescription dose 50.4 Gy) were compared in terms of DVH and various target parameters. Results: At doses between 40 and 50.4 Gy statistically significant improvements (P<0.05) were observed for IM-WPRT for irradiated volume of rectal wall and bladder. In both patient groups, with IMRT the average irradiated volume of SB was reduced by a factor of 6 at 50.4 Gy. This ratio was 2 for LB. In the DEF group the effect of SB-sparing with IMRT correlated with bladder size (correlation coefficient 0.70) while it did not correlate in the postoperative group. The effect of LB-sparing decreased with increasing bladder size in both groups but the impact of IMRT was larger for postoperative patients. Conclusions: IMRT significantly reduced the absolute volume of rectal wall, bladder and bowel irradiated at the prescribed dose level in gynaecologic patients. Main differences between POST and DEF patients receiving IM-WPRT were absolute volumes of LB irradiated to doses between 35 and 50 Gy, suggesting an impact of intact uterus on LB volume in the pelvis. POST patients seem to benefit most from elective nodal IMRT. Bladder filling is an important co-factor influencing the benefit of IMRT with respect to OAR sparing

  19. Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy

    International Nuclear Information System (INIS)

    Ogino, Ichiro; Okamoto, Naoyuki; Ono, Yoshimi; Kitamura, Tatsuo; Nakayama, Hiroki

    2003-01-01

    Purpose: To assess the predisposing factors and clinical characteristics of pelvic insufficiency fractures (PIF) in postmenopausal women with pelvic irradiation. Material and methods: A total 335 postmenopausal patients with cervical cancer of the intact uterus treated with radiation therapy between 1983 and 1998 were reviewed. Total external dose was delivered between 45 and 50.4 Gy with parallel opposed anteroposterior portals. Total brachytherapy dose at point A was delivered between 10 and 36 Gy. PIF were diagnosed by bone scintigraphy and confirmed by computed tomography. The cumulative incidence of symptomatic PIF was estimated by actuarial methods. Potential risk factors (age, weight, type II diabetes, delivery, menopause, total external dose, total brachytherapy dose) were assessed. Results: Fifty-seven (17.0%) of 335 patients were diagnosed as having PIF. Forty-seven patients were symptomatic and ten were asymptomatic. Parameters carrying a significant association with PIF were body weight 49 kg or below (P=0.044) in stepwise logistic regression analysis. The cumulative incidence of symptomatic PIF at 5 years was 17.9% calculated by the Kaplan-Meier method. A body weight of 49 kg or below and more than three deliveries were identified as having a significant effect on symptomatic PIF in univariate analysis (P=0.021, P=0.003, log-rank test) and Cox life table regression analysis (P=0.038, P=0.013). Five patients required narcotic agents and eight patients required hospital admission. Conclusions: We should consider reducing the dose contribution to the sacrum and sacroilac joints, without underdosing the tumor, especially in postmenopausal women with many deliveries or low body weight

  20. Comparison of clinical and functional outcome between surgical treatment and carbon ion radiotherapy for pelvic chondrosarcoma.

    Science.gov (United States)

    Outani, Hidetatsu; Hamada, Kenichiro; Imura, Yoshinori; Oshima, Kazuya; Sotobori, Tsukasa; Demizu, Yusuke; Kakunaga, Shigeki; Joyama, Susumu; Imai, Reiko; Okimoto, Tomoaki; Naka, Norifumi; Kudawara, Ikuo; Ueda, Takafumi; Araki, Nobuhito; Kamada, Tadashi; Yoshikawa, Hideki

    2016-02-01

    As there are no reports of studies in patients with pelvic chondrosarcoma treated with carbon ion radiotherapy (CIRT), the aim of this study was to evaluate the applicability of CIRT for patients with chondrosarcoma of the pelvis. The medical records of 31 patients with chondrosarcoma of the pelvis treated either by surgical resection or by CIRT between 1983 and 2014 were reviewed. There were 22 males and 9 females with a median age of 43 years (range 16-77 years). The median duration of follow-up was 66 months (range 5-289 months). Twenty-four patients underwent surgery, and 7 patients received CIRT (70.4 GyE in 16 fractions over 4 weeks). The overall local recurrence rate was 32 %, and the estimated overall 5- and 10-year survival rates were 72 and 57 %, respectively. The mean Musculoskeletal Tumor Society functional score was 59 %. The treatment procedures (surgery or CIRT) did not affect overall survival (P = 0.347). However, the patients who underwent surgery had impaired function compared with those who received CIRT (P = 0.03). Although more patients need to be monitored to assess the clinical and functional outcomes of CIRT for patients with chondrosarcoma of the pelvis, this treatment might offer an acceptable alternative.

  1. Influence of Routine MV CBCT Usage on Dose Distribution in Pelvic Radiotherapy

    International Nuclear Information System (INIS)

    Faj, D.; Kasabasic, M.; Ivkovic, A.; Tomas, I.; Jurkovic, S.

    2013-01-01

    The pelvic radiotherapy is a standard treatment for patients with cervical, uterine and rectal carcinomas. During radiation treatment open tabletop device or bellyboard is used to reduce the side effects of healthy surrounding tissue. Patients are continually adjusting to the bellyboard during the treatment which causes geometrical and dosage uncertainties and influences the results of the treatment. Therefore, to reduce these uncertainties, megavoltage cone-beam computed tomography (MV CBCT) system is used. The objective of this research was to evaluate the image acquisition dose delivered to patients from MV CBCT. MV CBCT imaging was simulated on 15 patients using 3D treatment planning software XiO (CMS Inc., St. Louis, MO). The influence of the routine MV CBCT usage on treatment plan was investigated by analyzing the changes in dose volume histograms, mean values and maximum doses in the planning volumes. Simulations have shown that daily usage of MV CBCT causes differences in the dose volume histograms. Moreover, for every patient mean value exceeded prescribed tolerance (±1% of the prescribed dose) and maximum value exceeded recommended maximum of 107% of the prescribed dose. The results have shown that MV CBCT dose to the patient should be a part of the RT plan.(author)

  2. Tumor motion and deformation during external radiotherapy of bladder cancer

    International Nuclear Information System (INIS)

    Lotz, Heidi T.; Pos, Floris J.; Hulshof, Maarten C.C.M.; Herk, Marcel van; Lebesque, Joos V.; Duppen, Joop C.; Remeijer, Peter

    2006-01-01

    Purpose: First, to quantify bladder-tumor motion in 3 dimensions during a 4-week to 5-week course of external radiotherapy. Second, to relate the motion to the tumor location on the bladder wall. Third, to extensively evaluate gross tumor volume (GTV) shape and volume changes during the course of the treatment. Methods and Materials: Multiple repeat computed tomography (CT) images were obtained for 21 bladder cancer patients. These scans were matched to the rigid bony anatomy. For each patient, the main direction and magnitude of the tumor movement was determined by use of principle-component analysis. To study GTV shape changes, all GTVs were registered to the GTV in the planning CT scan, and the residual shape errors were determined by measurement of edge variations perpendicular to the median surface. Results: Gross tumor volume translations were largest in cranial-caudal and anterior-posterior direction (SD, 0.1 to ∼0.9 cm). The translations were strongly correlated with the tumor location on the bladder wall. The average value of the local standard deviations of the GTV shape ranged from 0.1 to approximately 0.35 cm. Conclusions: Despite large differences in bladder filling, variations in GTV shape were small compared with variations in GTV position. Geometric uncertainties in the GTV position depended strongly on the tumor location on the bladder wall

  3. Tumor motion and deformation during external radiotherapy of bladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lotz, Heidi T [Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam (Netherlands); Pos, Floris J [Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Hulshof, Maarten C.C.M. [Department of Radiation Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam (Netherlands); Herk, Marcel van [Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Lebesque, Joos V [Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Duppen, Joop C [Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Remeijer, Peter [Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)

    2006-04-01

    Purpose: First, to quantify bladder-tumor motion in 3 dimensions during a 4-week to 5-week course of external radiotherapy. Second, to relate the motion to the tumor location on the bladder wall. Third, to extensively evaluate gross tumor volume (GTV) shape and volume changes during the course of the treatment. Methods and Materials: Multiple repeat computed tomography (CT) images were obtained for 21 bladder cancer patients. These scans were matched to the rigid bony anatomy. For each patient, the main direction and magnitude of the tumor movement was determined by use of principle-component analysis. To study GTV shape changes, all GTVs were registered to the GTV in the planning CT scan, and the residual shape errors were determined by measurement of edge variations perpendicular to the median surface. Results: Gross tumor volume translations were largest in cranial-caudal and anterior-posterior direction (SD, 0.1 to {approx}0.9 cm). The translations were strongly correlated with the tumor location on the bladder wall. The average value of the local standard deviations of the GTV shape ranged from 0.1 to approximately 0.35 cm. Conclusions: Despite large differences in bladder filling, variations in GTV shape were small compared with variations in GTV position. Geometric uncertainties in the GTV position depended strongly on the tumor location on the bladder wall.

  4. Measurement of weekly prostate specific antigen levels in patients receiving pelvic radiotherapy for nonprostatic malignancies

    International Nuclear Information System (INIS)

    Vijayakumar, Srinivasan; Quadri, S. Farhat; Sen, Saunak; Vaida, Florin; Ignacio, Lani; Weichselbaum, R. R.

    1995-01-01

    Purpose: To study the response of nonmalignant prostatic tissue to ionizing irradiation in terms of the resultant changes in serum prostate specific antigen (PSA) levels. Methods and Materials: Weekly serum PSA values were determined during radiotherapy (RT) in nine patients ('treatment group') without clinical evidence of prostate cancer (PC), and who received pelvic RT for other indications. Slopes for the rate of change in PSA was determined using model: log PSA = β0 + β1 * week + β2 * week 2 + error. These results are compared with 17 normal volunteers ('control group') who were not exposed to ionizing irradiation. An attempt is made to compare any similarities and differences in subsets of 64 T1-T4N0M0 PC patients who received pelvic RT. Results: An elevation in the serum PSA levels were noted in eight of nine patients in the 'treatment group' with a median time of 4.2 weeks to reach the maximum serum PSA values. After an initial increase, PSA values declined. In some patients, manifold increase in PSA was noted, for example, from 1.8 to 13.5 ng/ml and 3.3 to 9.8 ng/ml in two patients. The PSA increase ranged from 50-650%. The median slope was 0.601 week -1 (range 0.192-3.045 week -1 ). No such increases were seen in the 'control group' (median slope = 0.03 week -1 ; range, 0.18-0.13 week -1 ). When differences between the mean increase/decrease for each week compared to pretreatment values were analyzed, the irradiated group had statistically significant elevations in the PSA for weeks 3 (p = 0.034), 4 (p = 0.035), and 5 (p 0.024). A similar trend of increasing PSA levels during radiotherapy was noted in prostate cancer patients whose initial PSA values were ≤ 20 ng/ml: whereas positive slopes (i.e., increasing PSA levels during radiotherapy course) was seen in 7.1% of those with > 20 ng/ml preradiotherapy PSA values, such trends were seen in 52.7% of those with ≤ 20 ng/ml preradiotherapy PSA values. Conclusions: (a) Incidental exposure of noncancerous

  5. Measurement of weekly prostate specific antigen levels in patients receiving pelvic radiotherapy for nonprostatic malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Vijayakumar, Srinivasan; Quadri, S Farhat; Sen, Saunak; Vaida, Florin; Ignacio, Lani; Weichselbaum, R R

    1995-04-30

    Purpose: To study the response of nonmalignant prostatic tissue to ionizing irradiation in terms of the resultant changes in serum prostate specific antigen (PSA) levels. Methods and Materials: Weekly serum PSA values were determined during radiotherapy (RT) in nine patients ('treatment group') without clinical evidence of prostate cancer (PC), and who received pelvic RT for other indications. Slopes for the rate of change in PSA was determined using model: log PSA = {beta}0 + {beta}1{sup *}week + {beta}2{sup *}week{sup 2} + error. These results are compared with 17 normal volunteers ('control group') who were not exposed to ionizing irradiation. An attempt is made to compare any similarities and differences in subsets of 64 T1-T4N0M0 PC patients who received pelvic RT. Results: An elevation in the serum PSA levels were noted in eight of nine patients in the 'treatment group' with a median time of 4.2 weeks to reach the maximum serum PSA values. After an initial increase, PSA values declined. In some patients, manifold increase in PSA was noted, for example, from 1.8 to 13.5 ng/ml and 3.3 to 9.8 ng/ml in two patients. The PSA increase ranged from 50-650%. The median slope was 0.601 week{sup -1} (range 0.192-3.045 week{sup -1}). No such increases were seen in the 'control group' (median slope = 0.03 week{sup -1}; range, 0.18-0.13 week{sup -1}). When differences between the mean increase/decrease for each week compared to pretreatment values were analyzed, the irradiated group had statistically significant elevations in the PSA for weeks 3 (p = 0.034), 4 (p = 0.035), and 5 (p 0.024). A similar trend of increasing PSA levels during radiotherapy was noted in prostate cancer patients whose initial PSA values were {<=} 20 ng/ml: whereas positive slopes (i.e., increasing PSA levels during radiotherapy course) was seen in 7.1% of those with > 20 ng/ml preradiotherapy PSA values, such trends were seen in 52.7% of those with {<=} 20 ng/ml preradiotherapy PSA values

  6. Plasma citrulline levels predict intestinal toxicity in patients treated with pelvic radiotherapy

    International Nuclear Information System (INIS)

    Onal, Cem; Kotek, Ayse; Arslan, Gungor; Topkan, Erkan; Unal, Birsel; Yavuz, Aydin; Yavuz, Melek

    2011-01-01

    Background. Radiotherapy (RT) for abdominal and pelvic malignancies often causes severe small bowel toxicity. Citrulline concentrations are known to decrease with intestinal failure. We thus evaluated the feasibility of plasma citrulline levels in predicting radiation-induced intestinal toxicity. Material and methods. Fifty-three patients (36 prostate cancer, 17 endometrial cancer) who received 45 Gy pelvic RT using conventional fractionation were prospectively evaluated. Patients with prostate cancer received an additional 25-30.6 Gy conformal boost. Plasma citrulline levels were assessed on day 0, mid- (week 3) and post-RT (week 8), and four months post-RT. Dose-volume histogram, citrulline concentration changes, and weekly intestinal toxicity scores were analyzed. Results. Mean age was 63 years (range: 43-81 years) and mean baseline citrulline concentration was 38.0 ± 10.1 μmol/l. Citrulline concentrations were significantly reduced at week 3 (27.4 ± 5.9 μmol/l; p < 0.0001), treatment end (29.9 ± 8.8 μmol/l; p < 0.0001), and four months post-treatment (34.3 ± 12.1; p 0.01). The following factor pairs were significantly positively correlated: Citrulline concentration/mean bowel dose during, end of treatment, and four months post-RT; dose-volume parameters/citrulline change groups; cumulative mean radiation dose/intestinal toxicity at end and four months post-RT; citrulline changes/intestinal toxicity during and end of RT. Citrulline concentration changes significantly differed during treatment according to RTOG intestinal toxicity grades (p < 0.0001). Although the citrulline changes differed significantly within RTOG intestinal toxicity grades (p = 0.003), the difference between Grade 0 and Grade 1 did not differ significantly at the end of the treatment. At four months after RT, no significant differences were apparent. Conclusion. Citrulline-based assessment scores are objective and should be considered in measuring radiation-induced intestinal toxicity

  7. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies

    International Nuclear Information System (INIS)

    Mundt, Arno J.; Lujan, Anthony E.; Rotmensch, Jacob; Waggoner, Steven E.; Yamada, S. Diane; Fleming, Gini; Roeske, John C.

    2002-01-01

    Purpose: To describe our initial clinical experience with intensity-modulated whole pelvic radiotherapy (IM-WPRT) in women with gynecologic malignancies. Methods and Materials: Between February 2000 and August 2001, 40 gynecology patients underwent IM-WPRT. After fabrication of customized immobilization, all patients underwent contrast-enhanced CT, and a clinical target volume was contoured consisting of the upper vagina, parametria, uterus (if present), and presacral and pelvic lymph node regions. The clinical target volume was expanded by 1 cm to create a planning target volume (PTV). Using commercially available software, 7- or 9-field, 6-MV, coplanar IM-WPRT plans were generated for all patients. The worst acute gastrointestinal and genitourinary toxicity during treatment was scored on a 4-point scale: 0, none; 1, mild, no medications required; 2, moderate, medications required; and 3, severe, treatment breaks or cessation, hospitalization. As a comparison, acute toxicities in 35 previously treated conventional WPRT patients were analyzed. No significant differences were noted in the clinicopathologic and treatment factors between the two groups. Results: IM-WPRT plans provided excellent PTV coverage, with considerable sparing of the surrounding normal tissues. On average, 98.1% of the PTV received the prescription dose. The average percentage of the PTV receiving 110% and 115% of the prescription dose was 9.8% and 0.2%, respectively. IM-WPRT was well tolerated, with no patient developing Grade 3 toxicity. Grade 2 acute gastrointestinal toxicity was less common in the IM-WPRT group (60 vs. 91%, p=0.002) than in the conventional WPRT group. Moreover, the percentage of IM-WPRT and WPRT patients requiring no or only infrequent antidiarrheal medications was 75% and 34%, respectively (p=0.001). Although less Grade 2 genitourinary toxicity was seen in the IM-WPRT group (10% vs. 20%), this difference was not statistically significant (p=0.22). Conclusion: IM-WPRT is a

  8. Clinical outcome of extended-field irradiation vs. pelvic irradiation using intensity-modulated radiotherapy for cervical cancer.

    Science.gov (United States)

    Ouyang, Yi; Wang, Yanhong; Chen, Kai; Cao, Xinping; Zeng, Yiming

    2017-12-01

    The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para-aortic node involvement, who were treated with extended-field intensity-modulated radiotherapy (EF-IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF-IMRT and 52 patients treated with pelvic IMRT at the Sun Yat-Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF-IMRT had the highest level of lymph node involvement to the para-aortic or common iliac nodes, while patients treated with pelvic IMRT had no para-aortic or common iliac nodes involved (Pirradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF-IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF-IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para-aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.

  9. Californium-252 Brachytherapy Combined With External-Beam Radiotherapy for Cervical Cancer: Long-Term Treatment Results

    International Nuclear Information System (INIS)

    Lei Xin; Qian Chengyuan; Qing Yi; Zhao Kewei; Yang Zhengzhou; Dai Nan; Zhong Zhaoyang; Tang Cheng; Li Zheng; Gu Xianqing; Zhou Qian; Feng Yan; Xiong Yanli; Shan Jinlu; Wang Dong

    2011-01-01

    Purpose: To observe, by retrospective analysis, the curative effects and complications due to californium-252 ( 252 Cf) neutron intracavitary brachytherapy (ICBT) combined with external-beam radiotherapy (EBRT) in the treatment of cervical cancer. Methods and Materials: From February 1999 to December 2007, 696 patients with cervical cancer (Stages IB to IIIB) were treated with 252 Cf-ICBT in combination of EBRT. Of all, 31 patients were at Stage IB, 104 at IIA, 363 at IIB, 64 at IIIA, and 134 at IIIB. Californium-252 ICBT was delivered at 7–12 Gy per insertion per week, with a total dose of 29–45 Gy to reference point A in three to five insertions. The whole pelvic cavity was treated with 8-MV X-ray external irradiation at 2 Gy per fraction, four times per week. After 16–38 Gy of external irradiation, the center of the whole pelvic field was blocked with a 4-cm-wide lead shield, with a total external irradiation dose of 44–56 Gy. The total treatment course was 5 to 6 weeks. Results: Overall survival rate at 3 and 5 years for all patients was 76.0% and 64.9%, respectively. Disease-free 3- and 5-year survival rates of patients were 71.2% and 58.4%, respectively. Late complications included vaginal contracture and adhesion, radiation proctitis, radiation cystitis, and inflammatory bowel, which accounted for 5.8%, 7.1%, 6.2%, and 4.9%, respectively. Univariate analysis results showed significant correlation of stage, age, histopathologic grade, and lymph node status with overall survival. Cox multiple regression analysis showed that the independent variables were stage, histopathologic grade, tumor size, and lymphatic metastasis in all patients. Conclusion: Results of this series suggest that the combined use of 252 Cf-ICBT with EBRT is an effective method for treatment of cervical cancer.

  10. Gastrointestinal toxicity of vorinostat: reanalysis of phase 1 study results with emphasis on dose-volume effects of pelvic radiotherapy

    International Nuclear Information System (INIS)

    Bratland, Åse; Dueland, Svein; Hollywood, Donal; Flatmark, Kjersti; Ree, Anne H

    2011-01-01

    In early-phase studies with targeted therapeutics and radiotherapy, it may be difficult to decide whether an adverse event should be considered a dose-limiting toxicity (DLT) of the investigational systemic agent, as acute normal tissue toxicity is frequently encountered with radiation alone. We have reanalyzed the toxicity data from a recently conducted phase 1 study on vorinostat, a histone deacetylase inhibitor, in combination with pelvic palliative radiotherapy, with emphasis on the dose distribution within the irradiated bowel volume to the development of DLT. Of 14 eligible patients, three individuals experienced Common Terminology Criteria of Adverse Events grade 3 gastrointestinal and related toxicities, representing a toxicity profile vorinostat has in common with radiotherapy to pelvic target volumes. For each study patient, the relative volumes of small bowel receiving radiation doses between 6 Gy and 30 Gy at 6-Gy intervals (V6-V30) were determined from the treatment-planning computed tomography scans. The single patient that experienced a DLT at the second highest dose level of vorinostat, which was determined as the maximum-tolerated dose, had V6-V30 dose-volume estimates that were considerably higher than any other study patient. This patient may have experienced an adverse radiation dose-volume effect rather than a toxic effect of the investigational drug. When reporting early-phase trial results on the tolerability of a systemic targeted therapeutic used as potential radiosensitizing agent, radiation dose-volume effects should be quantified to enable full interpretation of the study toxicity profile.

  11. Safe and successful birth following pelvic radiotherapy for rectal mucosa-associated lymphoid tissue lymphoma: a case report.

    Science.gov (United States)

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

    2017-02-01

    Mucosa-associated lymphoid tissue lymphomas can occur in various parts of the body, and half of mucosa-associated lymphoid tissue lymphomas occur in the gastrointestinal tract. Gastric mucosa-associated lymphoid tissue lymphoma is the most common lymphoma of the gastrointestinal tract and primary rectal mucosa-associated lymphoid tissue lymphoma is very rare. Because of the high radiosensitivity of mucosa-associated lymphoid tissue lymphomas, this condition can be controlled with radiotherapy of approximately 30 Gy alone. However, ovarian dysfunction as an adverse event of radiotherapy for pelvic lesions can become a problem in girls and women. We report a case of a 28-year-old woman with rectal mucosa-associated lymphoid tissue lymphoma who safely gave birth to a baby following 30.6 Gy radiotherapy to her whole rectum. A 28-year-old Japanese woman became aware of bloody stools and was diagnosed as having Lugano I rectal mucosa-associated lymphoid tissue lymphoma. She was referred to our institute and initiated on radiotherapy. However, she expressed a desire to bear children. We used horizontally opposed pair fields for radiotherapy to minimize the irradiation to her endometrium and ovary. A total dose of 30.6 Gy was given in 17 fractions of 1.8 Gy by 10-Megavolt X-ray linear accelerator. As a result, one-third of her uterus and half of her ovary were outside the irradiation field. After approximately 1 year of treatment, positive pregnancy was confirmed and finally she safely gave birth to a baby girl without congenital abnormalities. This report provides hope for girls and women who have undergone irradiation for pelvic mucosa-associated lymphoid tissue lymphomas and who desire to bear children.

  12. External Beam Radiotherapy for Colon Cancer: Patterns of Care

    International Nuclear Information System (INIS)

    Dunn, Emily F.; Kozak, Kevin R.; Moody, John S.

    2010-01-01

    Purpose: Despite its common and well characterized use in other gastrointestinal malignancies, little is known about radiotherapy (RT) use in nonmetastatic colon cancer in the United States. To address the paucity of data regarding RT use in colon cancer management, we examined the RT patterns of care in this patient population. Methods and Materials: Patients with nonmetastatic colon cancer, diagnosed between 1988 and 2005, were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate methods were used to identify factors associated with RT use. Results: On univariate analysis, tumor location, age, sex, race, T stage, N stage, and geographic location were each associated with differences in RT use (all p < 0.01). In general, younger patients, male patients, and patients with more advanced disease were more likely to receive RT. On multivariate analysis, tumor location, age, gender, T and N stage, time of diagnosis and geographic location were significantly associated with RT use (all p < 0.001). Race, however, was not associated with RT use. On multivariate analysis, patients diagnosed in 1988 were 2.5 times more likely to receive RT than those diagnosed in 2005 (p = 0.001). Temporal changes in RT use reflect a responsiveness to evolving evidence related to the therapeutic benefits of adjuvant RT. Conclusions: External beam RT is infrequently used for colon cancer, and its use varies according to patient and tumor characteristics. RT use has declined markedly since the late 1980s; however, it continues to be used for nonmetastatic disease in a highly individualized manner.

  13. Invasive bladder cancer treated by radical external radiotherapy

    International Nuclear Information System (INIS)

    Corcoran, M.O.; Thomas, D.M.; Lim, A.; Berry, R.J.; Milroy, E.J.G.

    1985-01-01

    Fifty-three consecutive unselected patients with invasive bladder cancer, Stage T2 to T3, treated by radical radiotherapy have been reviewed. Cystectomy was reserved for patients with significant worsening of disease during treatment, histologically confirmed persistent or recurrent invasive tumour after treatment, or patients with intolerable symptoms due to radiation cystitis. In 64% of our patients a favourable tumour response to radiotherapy was seen, while a further 31% showed disease progression either during or on completion of radiotherapy. Cystectomy was performed on 22% of patients, mainly for radiation cystitis, and was not associated with a significant operative mortality rate. The crude 5-year survival rate was 42%. We conclude that radical radiotherapy is as effective as other forms of treatment for invasive bladder cancer, but that there remains a need to identify those bladder tumours destined to respond poorly to radiotherapy at an earlier stage. (author)

  14. Intensity Modulated Radiotherapy (IMRT in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    Directory of Open Access Journals (Sweden)

    Novaes Paulo ERS

    2006-11-01

    Full Text Available Abstract Background Pelvic Radiotherapy (RT as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. Conclusion IMRT is a valid technique to prevent the kidney from radiation damage.

  15. Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    International Nuclear Information System (INIS)

    Castilho, Marcus S; Jacinto, Alexandre A; Viani, Gustavo A; Campana, Andre; Carvalho, Juliana; Ferrigno, Robson; Novaes, Paulo ERS; Fogaroli, Ricardo C; Salvajoli, Joao V

    2006-01-01

    Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. IMRT is a valid technique to prevent the kidney from radiation damage

  16. Proposed Rectal Dose Constraints for Patients Undergoing Definitive Whole Pelvic Radiotherapy for Clinically Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Chan, Linda W.; Xia Ping; Gottschalk, Alexander R.; Akazawa, Michelle; Scala, Matthew; Pickett, Barby M.S.; Hsu, I-C.; Speight, Joycelyn; Roach, Mack

    2008-01-01

    Purpose: Although several institutions have reported rectal dose constraints according to threshold toxicity, the plethora of trials has resulted in multiple, confusing dose-volume histogram recommendations. A set of standardized, literature-based constraints for patients undergoing whole pelvic radiotherapy (RT) for prostate cancer would help guide the practice of prostate RT. The purpose of this study was to develop these constraints, demonstrate that they are achievable, and assess the corresponding rectal toxicity. Methods and Materials: An extensive literature search identified eight key studies relating dose-volume histogram data to rectal toxicity. A correction factor was developed to address differences in the anatomic definition of the rectum across studies. The dose-volume histogram constraints recommended by each study were combined to generate the constraints. The data from all patients treated with definitive intensity-modulated RT were then compared against these constraints. Acute rectal toxicity was assessed. Results: A continuous, proposed rectal dose-constraint curve was generated. Intensity-modulated RT not only met this constraint curve, but also was able to achieve at least 30-40% lower dose to the rectum. The preliminary clinical results were also positive: 50% of patients reported no acute bowel toxicity, 33% reported Grade 1 toxicity, and 17% reported Grade 2 toxicity. No patients reported Grade 3-4 acute rectal toxicity. Conclusions: In this study, we developed a set of proposed rectal dose constraints. This allowed for volumetric assessment of the dose-volume relationship compared with single dose-volume histogram points. Additional research will be performed to validate this threshold as a class solution for rectal dose constraints

  17. Development of immobilization devices for patients with pelvic malignancies and a feasibility evaluation during radiotherapy

    International Nuclear Information System (INIS)

    Park, Jong Min; Park, Yang Kyun; Cho, Woong; Park, Charn Il; Ha, Sung Whan

    2007-01-01

    Immobilization devices that improve the setup reproducibility of pelvic cancer patients and that provide comfort to patients during radiotherapy were designed and the feasibility of the devices was evaluated. A customized device was designed to immobilize a knee, thigh, and foot of a patient. Sixty-one patients with prostate cancer were selected and were divided into two groups-with or without devices. The setup errors were measured with respect to bony landmarks. The difference between digitally reconstructed radiographs (DRR) and simulation films, and the differences between DRR and portal films were measured. The left-right (LR), anterior-posterior (AP) and craniocaudal (CC) errors between the DRR and simulation films were 1.5 ± 0.9 mm, 3.0 ± 3.6 mm, and 1.6 ± 0.9 mm, respectively without devices. The errors were reduced to 1.3 ± 1.9 mm, 1.8 ± 1.5 mm and 1.1 ± 1.1 mm, respectively with the devices. The errors between DRR and portal films were 1.6 ± 1.2 mm, 4.0 ± 4.1 mm, and 4.2 ± 5.5 mm, respectively without the devices and were reduced to 1.0 ± 1.8 mm, 1.2 ± 0.9 mm, and 1.2 ± 0.8 mm, respectively, with the devices. The standard deviations among the portal films were 1.1 mm, 2.1 mm, and 1.0 mm at each axis without the devices and 0.9 mm, 1.6 mm and 0.8 mm with the devices. The percentage of setup errors larger than 3 mm and 5 mm were significantly reduced by use of the immobilization devices. The designed devices improved the setup reproducibility for all three directions and significantly reduced critical setup errors

  18. DOSE-ESCALATED EXTERNAL BEAM RADIOTHERAPY DURING HORMONO-RADIOTHERAPY FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    Yu. V. Gumenetskaya

    2016-01-01

    Full Text Available Introduction. The introduction of modern technologies of conformal external beam radiotherapy (EBRT into clinical practice for the treatment of prostate cancer requires proper quality assurance measures as well as a careful analysis of both the efficacy and toxicity data of treatments. The purpose of this study was to inves- tigate tolerance and the immediate efficacy of conformal dose-escalated EBRT during hormono-radiotherapy for prostate cancer. material and methods. The study involved 156 prostate cancer patients treated with EBRT. Among them, 30 patients received a total dose of 70 Gy, and in 126 patients the total dose was esca- lated to 72-76 Gy (median total dose - 74.0 Gy. Fifty-nine patients received intensity modulated radiation therapy. Results. The prescribed course of treatment was completed in all the patients with prostate cancer. Acute radiation-induced bladder reactions (RTOG were observed in 50 (32.1 % patients, of whom 48 (30.8 % experienced grade I reactions, and 2 (1.3 % experienced grade II reactions. Eighteen (11.5 % patients had radiation-induced rectum reactions, not above grade I. The development of grade II dysuric phenomena necessitated treatment interruption only in two patients. Of 9 (5.8 % patients who had late bladder complica- tions (RTOG/EORTC, 8 (5.1 % patients developed grade I complications, and one (0.6 % patient developed grade II complications. Of 11 (7.1 % patients who had rectum complications, 8 (5.1 % patients developed grade I complications, and 3 (1.9 % patients developed grade II complications. No patients experienced the increase in toxicity of treatment during dose escalation up to a total dose exceeding 70 Gy. During the follow-up period, only one patient developed recurrent disease. Conclusion. The results of our study suggest acceptable levels of toxicity following a continuous course of dose-escalated EBRT given in conjunction with hormono-radiotherapy to prostate cancer patients. Further

  19. The potential impact of the tension of the pelvic muscles on set-up errors in radiotherapy for pelvic malignancies

    International Nuclear Information System (INIS)

    Bujko, Krzysztof; Czuchraniuk, Piotr; Zolciak, Agnieszka; Kukolowicz, Pawel; Kepka, Lucyna; Bielik, Agnieszka

    2004-01-01

    The purpose of the study reported here was to evaluate the potential impact of the tension of pelvic muscles on set-up errors. Twenty-nine consecutive patients with rectal cancer were included. The treatment simulation of the lateral beam in prone position was performed twice-with relaxed and next with maximally tense pelvic muscles. During the second simulation, the couch was moved so as to align the centre of the beam with the actual position of the skin mark tattooed during the first simulation. The bony landmarks on both images of corresponding lateral fields were matched. The beam's centre displacement and the rotation were measured using the beam image taken in relaxed position as a reference. The absolute values were used in calculation of the mean. For the anterior-posterior direction, the mean value of displacements was 15.3 mm, standard deviation (SD) 6.9 mm and the maximal value 37 mm. For the cranial-caudal direction, the mean value was 4.4 mm, SD 4 mm and the maximal value 17 mm. The mean rotation of the pelvis was 5.3 degrees, SD 2.4 degrees and maximal rotation 11 degrees. The majority of displacements were in the posterior (86%) and caudal (55%) directions. The majority of rotations were clockwise (76%). It was shown that pelvic muscle tension was the reason for anal verge displacements and mispositionings of the shielding block. This results in set-up inaccuracy, especially in the anterior-posterior direction, shielding block mispositioning and anal verge displacement

  20. Whole-pelvic radiotherapy with spot-scanning proton beams for uterine cervical cancer: a planning study

    International Nuclear Information System (INIS)

    Hashimoto, Shingo; Shibamoto, Yuta; Iwata, Hiromitsu; Ogino, Hiroyuki; Shibata, Hiroki; Toshito, Toshiyuki; Sugie, Chikao; Mizoe, Jun-etsu

    2016-01-01

    The aim of this study was to compare the dosimetric parameters of whole-pelvic radiotherapy (WPRT) for cervical cancer among plans involving 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), or spot-scanning proton therapy (SSPT). The dose distributions of 3D-CRT-, IMRT-, and SSPT-based WPRT plans were compared in 10 patients with cervical cancer. All of the patients were treated with a prescribed dose of 50.4 Gy in 1.8-Gy daily fractions, and all of the plans involved the same planning target volume (PTV) constrictions. A 3D-CRT plan involving a four-field box, an IMRT plan involving seven coplanar fields, and an SSPT plan involving four fields were created. The median PTV D95% did not differ between the 3D-CRT, IMRT and SSPT plans. The median conformity index 95% and homogeneity index of the IMRT and SSPT were better than those of the 3D-CRT. The homogeneity index of the SSPT was better than that of the IMRT. SSPT resulted in lower median V20 values for the bladder wall, small intestine, colon, bilateral femoral heads, skin, and pelvic bone than IMRT. Comparing the Dmean values, SSPT spared the small intestine, colon, bilateral femoral heads, skin and pelvic bone to a greater extent than the other modalities. SSPT can reduce the irradiated volume of the organs at risk compared with 3D-CRT and IMRT, while maintaining excellent PTV coverage. Further investigations of SSPT are warranted to assess its role in the treatment of cervical cancer.

  1. Prospective survey of erectile dysfunction after external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Kikuchi, Eiji; Ando, Toshiyuki; Nagata, Hirohiko; Miyajima, Akira; Nakagawa, Ken; Oya, Mototsugu; Nakashima, Jun; Marumo, Ken

    2011-01-01

    We prospectively evaluated the effect of external beam radiotherapy on erectile function in patients with localized or locally advanced prostate cancer using the Japanese version of the International Index of Erectile Function (IIEF) survey. From 2000 to 2007, we identified 55 patients who underwent external beam radiotherapy at our institution for localized or locally advanced prostate cancer and could respond to the IIEF survey. The patients did not receive neo- and/or adjuvant hormone therapy and they were followed-up for at least 12 months after radiotherapy. Mean patient age was 69 years and the mean prostate specific antigen (PSA) level before radiotherapy was 24.9 ng/ml. First we evaluated the change of the erectile function domain score over time before and after radiotherapy. The population of severe erectile dysfunction (ED) increased while those with no or mild ED decreased after radiotherapy. The erectile function and intercourse satisfaction domain score of the IIEF declined significantly after radiotherapy, however, the orgasmic function, sexual desire, and overall satisfaction domain scores did not change after external beam radiation. Of the 34 patients who had erectile function at baseline, 10 patients could maintain erectile function 12 months after radiotherapy. Though there were no significant differences in clinical features between patients who could maintain erectile function and those who had worsening erectile function 12 months after radiotherapy, the sexual desire domain score before radiotherapy was significantly higher in patients who could maintain erectile function than their counterparts. Using the IIEF survey, external beam radiation was found to affect erectile function in patients with localized or locally advanced prostate cancer. (author)

  2. Volumes and doses for external radiotherapy - Definitions and recommendations; Volum og doser i ekstern straaleterapi - Definisjoner og anbefalinger

    Energy Technology Data Exchange (ETDEWEB)

    Levernes, Sverre (ed.)

    2012-07-01

    The report contains definitions of volume and dose parameters for external radiotherapy. In addition the report contains recommendations for use, documentation and minimum reporting for radiotherapy of the individual patient.(Author)

  3. Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Park, Shin Hyung; Kim, Jae Chul; Lee, Jeong Eun; Park, In Kyu [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2011-12-15

    To determine the incidence, risk factors, and clinical characteristics of pelvic insufficiency fracture (PIF) in patients with cervical cancer. Between July 2004 and August 2009, 235 patients with non-metastatic cervical cancer were treated with definitive chemoradiation or postoperative radiotherapy. Among 235 patients, 117 (49.8%) underwent the first positron emission tomography/computed tomography (PET/CT) within 1 year after radiotherapy. The median radiation dose was 55 Gy (range, 45 to 60 Gy). Medical charts and imaging studies, including PET/CT, magnetic resonance imaging (MRI), CT, bone scintigraphy were reviewed to evaluate the patients with PIF. Among 235 patients, 16 developed PIF. The 5-year detection rate of PIF was 9.5%. The 5-year detection rate of PIF in patients who underwent the first PET/CT within a year was 15.6%. The median time to development of PIF was 12.5 months (range, 5 to 30 months). The sites of fracture included 12 sacroiliac joints, 3 pubic rami, 3 iliac bones, and 1 femoral neck. Eleven of 16 patients having PIF complained of hip pain requiring medications. One patient required hospitalization for pain control. The significant risk factors of PIF were old age, body mass index less than 23, bone mineral density less than -3.5 SD, and the first PET/CT within a year after radiotherapy. Radiation dose and concurrent chemotherapy had no impact on PIF rate. PIFs were not rare after pelvic radiotherapy in cervical cancer patients in the era of PET/CT. Timely diagnosis and management of PIF can improve quality of life in patients with cervical cancer, in addition to reducing unnecessary medical expenses.

  4. Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT

    International Nuclear Information System (INIS)

    Park, Shin Hyung; Kim, Jae Chul; Lee, Jeong Eun; Park, In Kyu

    2011-01-01

    To determine the incidence, risk factors, and clinical characteristics of pelvic insufficiency fracture (PIF) in patients with cervical cancer. Between July 2004 and August 2009, 235 patients with non-metastatic cervical cancer were treated with definitive chemoradiation or postoperative radiotherapy. Among 235 patients, 117 (49.8%) underwent the first positron emission tomography/computed tomography (PET/CT) within 1 year after radiotherapy. The median radiation dose was 55 Gy (range, 45 to 60 Gy). Medical charts and imaging studies, including PET/CT, magnetic resonance imaging (MRI), CT, bone scintigraphy were reviewed to evaluate the patients with PIF. Among 235 patients, 16 developed PIF. The 5-year detection rate of PIF was 9.5%. The 5-year detection rate of PIF in patients who underwent the first PET/CT within a year was 15.6%. The median time to development of PIF was 12.5 months (range, 5 to 30 months). The sites of fracture included 12 sacroiliac joints, 3 pubic rami, 3 iliac bones, and 1 femoral neck. Eleven of 16 patients having PIF complained of hip pain requiring medications. One patient required hospitalization for pain control. The significant risk factors of PIF were old age, body mass index less than 23, bone mineral density less than -3.5 SD, and the first PET/CT within a year after radiotherapy. Radiation dose and concurrent chemotherapy had no impact on PIF rate. PIFs were not rare after pelvic radiotherapy in cervical cancer patients in the era of PET/CT. Timely diagnosis and management of PIF can improve quality of life in patients with cervical cancer, in addition to reducing unnecessary medical expenses.

  5. Comparison of radioimmunotherapy and external beam radiotherapy in colon cancer xenografts

    International Nuclear Information System (INIS)

    Buras, R.R.; Wong, J.F.C.; Kuhn, J.A.; Beatty, B.G.; Williams, L.E.; Beatty, J.D.; Wanek, P.M.

    1993-01-01

    Radioimmunotherapy and external beam radiotherapy were compared in a nude mouse human colon cancer model. Radioimmunotherapy was delivered by intraperitoneal injection of 90 Y-labeled anticarcinoembryonic antigen monoclonal antibody (anti-CEA MAB). Single fraction external beam radiotherapy was delivered using a 60 Co teletherapy unit. Control groups received saline, unlabeled anit-CEA monoclonal antibody and labeled nonspecific monoclonal antibody. Tumor growth suppression was expressed as delay to reach 2g compared to saline controls. Unlabeled anti-CEA monoclonal antibody and labeled nonspecific monoclonal antibody had no effect. External beam radiotherapy of 300, 600, 1000 and 2000 cGy produced growth delays of 3, 12, 17, and 22 days, respectively. Radioimmunotherapy with 120 μCi, 175 μCi, and 225 μCi resulted in growth delays of 20, 34, and 36 days. Estimated absorbed tumor dose was 1750 cGy in the 120 μCi group. Similar comparisons were done with the more radioresistant WiDr human colon carcinoma cell line. External beam radiotherapy doses of 400, 800, 1200, and 1600 cGy resulted in growth delays of 6, 21, 36 and 48 days, respectively. Radioimmunotherapy of 120 μCi and 175 μCi resulted in growth delays of 9 and 19 days, respectively. The 120 μCi dose delivered an estimated absorbed tumor dose of 1080 cGy to WiDr tumors. In summary, for the radiosensitive LS174T line, radioimmunotherapy produced biologic effects that were comparable to a similar dose of single fraction external beam radiotherapy. For the more radioresistant WiDr tumor, radioimmunotherapy produced a biologic effect which was less than a similar dose of single fraction external beam radiotherapy. These studies suggest that a tumor's response to radioimmunotherapy relative to that of external beam radiotherapy is, in part, dependent on tumor radiosensitivity and repair capacity. 23 refs., 5 figs. 4 tabs

  6. Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

    Science.gov (United States)

    Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J; Hoffmann, Matthew; McKay, Michael J; Shakespeare, Thomas P

    2014-02-01

    Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Is “pelvic radiation disease” always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

    International Nuclear Information System (INIS)

    Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J.; Hoffmann, Matthew; McKay, Michael J.; Shakespeare, Thomas P.

    2014-01-01

    Background: Pelvic radiation disease (PRD) also widely known as “radiation proctopathy” is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. Methods and materials: A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Results: Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Conclusions: Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines

  8. Role of external radiotherapy when taking into care hepatic metastases; Place de la radiotherapie externe dans la prise en charge des metastases hepatiques

    Energy Technology Data Exchange (ETDEWEB)

    Dietmann, A.S.; Taste-Geroge, H.; Peiffert, D. [Centre Alexis-Vautrin, 54 - Nancy (France)

    2010-10-15

    After having indicated the various origins of hepatic metastases, the authors outline that surgery and local treatment are applicable for 20 per cent of patients. But some of these local treatments may have contra-indications or may entail complications. Radiotherapy techniques used to have possible severe late effects on the liver, but new external radiotherapy apparatus, like the Cyberknife, can now be used. With its ballistic technique and its tracking system, it allows healthy tissues to be protected. It is also well tolerated by the patients. A comparative study with other local treatment techniques (radio-frequency, alcoolization, chemoembolisation) is still to be done. Short communication

  9. 14C-lactose breath tests during pelvic radiotherapy: the effect of the amount of small bowel irradiated

    International Nuclear Information System (INIS)

    Weiss, R.G.; Stryker, J.A.

    1982-01-01

    Thirty patients who were undergoing pelvic radiotherapy had 14 C-lactose breath tests performed in the first and fifth weeks of treatment. In Group I (21 patients), a significant portion of the small intestine was irradiated, and in Group II (9 patients), only a small portion of the small intestine was irradiated. In Group I, the average reductions in the excretion of ingested 14 C between the first- and fifth-week tests were 41.5% at 1/2 hour postingestion (p less than 0.05), and 21.8% at 1 hour postingestion (p less than 0.05). In Group II, the percentage reductions were 11.8% and 3.7% at 1/2 and 1 hour, respectively (p greater than 0.05). The data suggest that lactose malabsorption is a factor in the etiology of the nausea, vomiting, and diarrhea experienced by patients who are undergoing pelvic radiotherapy, and that the amount of bowel included in the treatment volume significantly influences the degree of malabsorption

  10. Acute toxicity in pelvic radiotherapy; a randomised trial of conformal versus conventional treatment

    International Nuclear Information System (INIS)

    Tait, Diana M.; Nahum, Alan E.; Meyer, Lesley C.; Law, Matthew; Dearnaley, David P.; Horwich, Alan; Mayles, W. Philip; Yarnold, John R.

    1997-01-01

    Background: A prospective, randomized clinical trial to assess the effect of reducing the volume of irradiated normal tissue on acute reactions in pelvic radiotherapy accrued 266 evaluable patients between 1988 and 1993. Purpose: This is the definitive analysis to assess the differences between the conformal and conventional arms of the trial. Materials and methods: In both arms, patients were treated with 6 MV X-rays using a 3-field technique (in all but 5 cases) consisting of an anterior and two wedged lateral or posterior oblique fields; in the conventional arm, rectangular fields were employed, whereas in the conformal arm, the fields were shaped with customized blocks drawn according to the beam's-eye-view of the target volume. The most common dosage was 65 Gy in 2-Gy fractions 5 times a week, although a subgroup (of ca. bladder patients) were treated with 30-36 Gy in once-a-week 6 Gy fractions. Each patient completed a comprehensive acute toxicity scoring questionnaire concentrating on bowel and bladder problems, tiredness and nausea, before the start of treatment, weekly during and for 3 weeks after the end of treatment and then monthly for a further 2 months. Compliance was excellent. Results: There were no differences between the patients in the two arms with respect to age, gender, tumour type (52% prostate, 41% bladder, 5% rectum, 2% other) fractionation/dosage, anterior field size, weight, or baseline symptoms. Substantial differences in normal-tissue volumes (rectum, bladder, etc.) were achieved: median high-dose volume (HDV) of 689 cm 3 for the conformal technique versus 792 cm 3 for the conventional. A clear pattern of an increase in symptoms during RT, followed by a decrease after RT, was observed for the patient group as a whole. However, a very extensive analysis has not revealed any (statistically) significant differences between the two arms in level of symptoms, nor in medication prescribed. The disparity between our findings and those of other

  11. Split-Course, High-Dose Palliative Pelvic Radiotherapy for Locally Progressive Hormone-Refractory Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gogna, Nirdosh Kumar, E-mail: kumar_gogna@health.qld.gov.au [Radiation Oncology Services, Mater Centre, Brisbane, Queensland (Australia); Baxi, Siddhartha; Hickey, Brigid; Baumann, Kathryn [Radiation Oncology Services, Mater Centre, Brisbane, Queensland (Australia); Burmeister, Elizabeth [Princess Alexandra Hospital, Brisbane, Queensland (Australia); Holt, Tanya [Radiation Oncology Services, Mater Centre, Brisbane, Queensland (Australia)

    2012-06-01

    Purpose: Local progression, in patients with hormone-refractory prostate cancer, often causes significant morbidity. Pelvic radiotherapy (RT) provides effective palliation in this setting, with most published studies supporting the use of high-dose regimens. The aim of the present study was to examine the role of split-course hypofractionated RT used at our institution in treating this group of patients. Methods and Materials: A total of 34 men with locoregionally progressive hormone-refractory prostate cancer, treated with a split course of pelvic RT (45-60 Gy in 18-24 fractions) between 2000 and 2008 were analyzed. The primary endpoints were the response rate and actuarial locoregional progression-free survival. Secondary endpoints included overall survival, compliance, and acute and late toxicity. Results: The median age was 71 years (range, 53-88). Treatment resulted in an overall initial response rate of 91%, a median locoregional progression-free survival of 43 months, and median overall survival of 28 months. Compliance was excellent and no significant late toxicity was reported. Conclusions: The split course pelvic RT described has an acceptable toxicity profile, is effective, and compares well with other high-dose palliative regimens that have been previously reported.

  12. Locally advanced prostatic cancer: experience with combined pelvic external beam irradiation and interstitial thermobrachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hancock, Steven L; Kapp, Daniel S; Goffinet, Don R; Prionas, Stavros; Cox, Richard S; Bagshaw, Malcolm A

    1995-07-01

    Purpose: Recurrence of prostatic carcinoma within the prostate gland remains a significant problem for patients who present with locally advanced disease. In an attempt to improve the local control of such tumors, an iridium-192 transperineal, template-guided prostatic implant was combined wit radiofrequency-induced hyperthermia after external beam irradiation of the pelvic lymph nodes and prostate gland. This study evaluates the influence of pre-treatment patient characteristics and treatment parameters upon outcome. Materials and Methods: Between July 1987 and April 1992 33 patients with adenocarcinoma of the prostate were selected for treatment: 28 of these patients had extensive local disease on clinical examination (AJCC-4 stages T2b or c: 9 patients; T3: 19 patients); two patients with T2a tumors had Gleason grade 5 + 4 disease or disproportionately high prostate specific antigen (PSA) values and a mass encroaching upon the bladder on computerized tomographic scan. Three patients with more clinically limited T2a or T2b involvement elected implantation in lieu of an external beam irradiation boost. The mean pre-treatment serum PSA value was 25.6 ng/ml (Hybritech scale), with values of above 19 ng/ml for 17 of the patients. Treatment consisted of 50 Gy of external beam irradiation to the prostate and pelvic lymph nodes followed by a transperineal needle implant of the prostate gland. Thirty-two patients had no evidence of pelvic nodal involvement during exploration at laparotomy performed after external irradiation, and 25 of these had lymph node samplings that were histologically negative for metastasis. Perineal template oriented needles were placed by inspection and palpation at laparotomy; 2 were performed closed under ultrasound guidance. Needles were afterloaded with {sup 192}Ir to provide a dose of 30 Gy to the periphery of the prostate gland. Interstitial radiofrequency-induced hyperthermia treatments were given in conjunction with the implant, one just

  13. External beam radiotherapy facilities in Ukraine. Trends and challenges

    International Nuclear Information System (INIS)

    Starenkiy, V.P.; Petrichenko, O.O.; Averyanova, L.O.

    2017-01-01

    The most important aspects of technological support of the radiation therapy of Ukraine are considered in accordance with the requirements of the IAEA. The reasons that influence the availability of radiotherapy for cancer patients in Ukraine are analyzed taking into account the experience of Grigoriev Institute for Medical Radiology of the National Academy of Medical Sciences of Ukraine.

  14. Can dosimetric parameters predict acute hematologic toxicity in rectal cancer patients treated with intensity-modulated pelvic radiotherapy?

    International Nuclear Information System (INIS)

    Wan, Juefeng; Liu, Kaitai; Li, Kaixuan; Li, Guichao; Zhang, Zhen

    2015-01-01

    To identify dosimetric parameters associated with acute hematologic toxicity (HT) in rectal cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. Ninety-three rectal cancer patients receiving concurrent capecitabine and pelvic intensity-modulated radiation therapy (IMRT) were analyzed. Pelvic bone marrow (PBM) was contoured for each patient and divided into three subsites: lumbosacral spine (LSS), ilium, and lower pelvis (LP). The volume of each site receiving 5–40 Gy (V 5, V10, V15, V20, V30, and V40, respectively) as well as patient baseline clinical characteristics was calculated. The endpoint for hematologic toxicity was grade ≥ 2 (HT2+) leukopenia, neutropenia, anemia or thrombocytopenia. Logistic regression was used to analyze correlation between dosimetric parameters and grade ≥ 2 hematologic toxicity. Twenty-four in ninety-three patients experienced grade ≥ 2 hematologic toxicity. Only the dosimetric parameter V40 of lumbosacral spine was correlated with grade ≥ 2 hematologic toxicity. Increased pelvic lumbosacral spine V40 (LSS-V40) was associated with an increased grade ≥ 2 hematologic toxicity (p = 0.041). Patients with LSS-V40 ≥ 60 % had higher rates of grade ≥ 2 hematologic toxicity than did patients with lumbosacral spine V40 < 60 % (38.3 %, 18/47 vs.13 %, 6/46, p =0.005). On univariate and multivariate logistic regression analysis, lumbosacral spine V40 and gender was also the variable associated with grade ≥ 2 hematologic toxicity. Female patients were observed more likely to have grade ≥ 2 hematologic toxicity than male ones (46.9 %, 15/32 vs 14.8 %, 9/61, p =0.001). Lumbosacral spine -V40 was associated with clinically significant grade ≥ 2 hematologic toxicity. Keeping the lumbosacral spine -V40 < 60 % was associated with a 13 % risk of grade ≥ 2 hematologic toxicity in rectal cancer patients undergoing concurrent chemoradiotherapy

  15. Clinical Outcome in Posthysterectomy Cervical Cancer Patients Treated With Concurrent Cisplatin and Intensity-Modulated Pelvic Radiotherapy: Comparison With Conventional Radiotherapy

    International Nuclear Information System (INIS)

    Chen, M.-F.; Tseng, C.-J.; Tseng, C.-C.; Kuo, Y.-C.; Yu, C.-Y.; Chen, W.-C.

    2007-01-01

    Purpose: To assess local control and acute and chronic toxicity with intensity-modulated radiation therapy (IMRT) as adjuvant treatment of cervical cancer. Methods and Materials: Between April 2002 and February 2006, 68 patients at high risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy. Adjuvant chemotherapy consisted of cisplatin (50 mg/m 2 ) for six cycles every week. Thirty-three patients received adjuvant radiotherapy by IMRT. Before the IMRT series was initiated, 35 other patients underwent conventional four-field radiotherapy (Box-RT). The two groups did not differ significantly in respect of clinicopathologic and treatment factors. Results: IMRT provided compatible local tumor control compared with Box-RT. The actuarial 1-year locoregional control for patients in the IMRT and Box-RT groups was 93% and 94%, respectively. IMRT was well tolerated, with significant reduction in acute gastrointestinal (GI) and genitourinary (GU) toxicities compared with the Box-RT group (GI 36 vs. 80%, p = 0.00012; GU 30 vs. 60%, p = 0.022). Furthermore, the IMRT group had lower rates of chronic GI and GU toxicities than the Box-RT patients (GI 6 vs. 34%, p = 0.002; GU 9 vs. 23%, p = 0.231). Conclusion: Our results suggest that IMRT significantly improved the tolerance to adjuvant chemoradiotherapy with compatible locoregional control compared with conventional Box-RT. However, longer follow-up and more patients are needed to confirm the benefits of IMRT

  16. Gastrointestinal toxicity of vorinostat: reanalysis of phase 1 study results with emphasis on dose-volume effects of pelvic radiotherapy

    LENUS (Irish Health Repository)

    Bratland, Ase

    2011-04-08

    Abstract Background In early-phase studies with targeted therapeutics and radiotherapy, it may be difficult to decide whether an adverse event should be considered a dose-limiting toxicity (DLT) of the investigational systemic agent, as acute normal tissue toxicity is frequently encountered with radiation alone. We have reanalyzed the toxicity data from a recently conducted phase 1 study on vorinostat, a histone deacetylase inhibitor, in combination with pelvic palliative radiotherapy, with emphasis on the dose distribution within the irradiated bowel volume to the development of DLT. Findings Of 14 eligible patients, three individuals experienced Common Terminology Criteria of Adverse Events grade 3 gastrointestinal and related toxicities, representing a toxicity profile vorinostat has in common with radiotherapy to pelvic target volumes. For each study patient, the relative volumes of small bowel receiving radiation doses between 6 Gy and 30 Gy at 6-Gy intervals (V6-V30) were determined from the treatment-planning computed tomography scans. The single patient that experienced a DLT at the second highest dose level of vorinostat, which was determined as the maximum-tolerated dose, had V6-V30 dose-volume estimates that were considerably higher than any other study patient. This patient may have experienced an adverse radiation dose-volume effect rather than a toxic effect of the investigational drug. Conclusions When reporting early-phase trial results on the tolerability of a systemic targeted therapeutic used as potential radiosensitizing agent, radiation dose-volume effects should be quantified to enable full interpretation of the study toxicity profile. Trial registration ClinicalTrials.gov: NCT00455351

  17. Radiotherapy, cancer and some anatomical structures related with the pelvic floor: an evaluation of the scientific literature

    Energy Technology Data Exchange (ETDEWEB)

    Santos-Filho, Sebastiao David; Fonseca, Adenilson de Souza da; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria; Presta, Giuseppe Antonio [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Inst. Biomedico. Dept. de Fisiologia Humana; Paoli, Severo de [Centro Universitario Serra dos Orgaos, Teresopolis, RJ (Brazil). Centro de Ciencias da Saude; Missailids, Sotiris [The Open University, Milton Keynes (United Kingdom). Dept. of Chemistry and Analytical Sciences

    2008-12-15

    Radiotherapy is a cancer treatment that uses high-energy X-rays or other types of ionizing radiation to try to kill the cancer cells in various organs/tissues. PubMed is a database used as a tool in various publications. The aim of this work was to evaluate, in the PubMed, the number of publications (NP) in radiotherapy and cancer in various organs related to the pelvic floor as well as brachytherapy. The searches were performed (August 2008) in the PubMed (http://www.pubmed.com) using the words: radiotherapy (RT) or cancer (CA), RT and CA, RT and CA and prostate, RT and CA and testis, RT and CA and breast, RT and CA and kidneys, RT and CA and vulva, RT and CA and vagina, RT and CA and penis, RT and CA and uterus, RT and CA and ovary, RT and CA and bladder, and RT and CA and urethra. A search using brachytherapy was also performed. The NP in each subject was determined and was 2178635 to CA and about 9% of them are related with RT. The NP in RT and CA and breast or prostate is bigger than for the other organs, whereas brachytherapy is mainly cited in the studies about CA of prostate, bladder and breast. In conclusion, our findings demonstrate the importance of radiation therapy studies in the cancer of several organs. This information is crucial in understanding the field and demonstrates areas of significant progress or existing gaps of research in radiotherapy treatment of various cancers of the pelvis. Furthermore, it could significantly aid the interprofessional team in the determination of actions related to the treatment of patients that are undertaking radiotherapy, due to the possible complications of this modality of treatment. (author)

  18. Radiotherapy, cancer and some anatomical structures related with the pelvic floor: an evaluation of the scientific literature

    International Nuclear Information System (INIS)

    Santos-Filho, Sebastiao David; Fonseca, Adenilson de Souza da; Bernardo-Filho, Mario; Presta, Giuseppe Antonio; Paoli, Severo de; Missailids, Sotiris

    2008-01-01

    Radiotherapy is a cancer treatment that uses high-energy X-rays or other types of ionizing radiation to try to kill the cancer cells in various organs/tissues. PubMed is a database used as a tool in various publications. The aim of this work was to evaluate, in the PubMed, the number of publications (NP) in radiotherapy and cancer in various organs related to the pelvic floor as well as brachytherapy. The searches were performed (August 2008) in the PubMed (http://www.pubmed.com) using the words: radiotherapy (RT) or cancer (CA), RT and CA, RT and CA and prostate, RT and CA and testis, RT and CA and breast, RT and CA and kidneys, RT and CA and vulva, RT and CA and vagina, RT and CA and penis, RT and CA and uterus, RT and CA and ovary, RT and CA and bladder, and RT and CA and urethra. A search using brachytherapy was also performed. The NP in each subject was determined and was 2178635 to CA and about 9% of them are related with RT. The NP in RT and CA and breast or prostate is bigger than for the other organs, whereas brachytherapy is mainly cited in the studies about CA of prostate, bladder and breast. In conclusion, our findings demonstrate the importance of radiation therapy studies in the cancer of several organs. This information is crucial in understanding the field and demonstrates areas of significant progress or existing gaps of research in radiotherapy treatment of various cancers of the pelvis. Furthermore, it could significantly aid the interprofessional team in the determination of actions related to the treatment of patients that are undertaking radiotherapy, due to the possible complications of this modality of treatment. (author)

  19. The Detection of Patients at Risk of Gastrointestinal Toxicity during Pelvic Radiotherapy by Electronic Nose and FAIMS: A Pilot Study

    Science.gov (United States)

    Covington, James A.; Wedlake, Linda; Andreyev, Jervoise; Ouaret, Nathalie; Thomas, Matthew G.; Nwokolo, Chuka U.; Bardhan, Karna D.; Arasaradnam, Ramesh P.

    2012-01-01

    It is well known that the electronic nose can be used to identify differences between human health and disease for a range of disorders. We present a pilot study to investigate if the electronic nose and a newer technology, FAIMS (Field Asymmetric Ion Mobility Spectrometry), can be used to identify and help inform the treatment pathway for patients receiving pelvic radiotherapy, which frequently causes gastrointestinal side-effects, severe in some. From a larger group, 23 radiotherapy patients were selected where half had the highest levels of toxicity and the others the lowest. Stool samples were obtained before and four weeks after radiotherapy and the volatiles and gases emitted analysed by both methods; these chemicals are products of fermentation caused by gut microflora. Principal component analysis of the electronic nose data and wavelet transform followed by Fisher discriminant analysis of FAIMS data indicated that it was possible to separate patients after treatment by their toxicity levels. More interestingly, differences were also identified in their pre-treatment samples. We believe these patterns arise from differences in gut microflora where some combinations of bacteria result to give this olfactory signature. In the future our approach may result in a technique that will help identify patients at “high risk” even before radiation treatment is started. PMID:23201982

  20. The Detection of Patients at Risk of Gastrointestinal Toxicity during Pelvic Radiotherapy by Electronic Nose and FAIMS: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ramesh P. Arasaradnam

    2012-09-01

    Full Text Available It is well known that the electronic nose can be used to identify differences between human health and disease for a range of disorders. We present a pilot study to investigate if the electronic nose and a newer technology, FAIMS (Field Asymmetric Ion Mobility Spectrometry, can be used to identify and help inform the treatment pathway for patients receiving pelvic radiotherapy, which frequently causes gastrointestinal side-effects, severe in some. From a larger group, 23 radiotherapy patients were selected where half had the highest levels of toxicity and the others the lowest. Stool samples were obtained before and four weeks after radiotherapy and the volatiles and gases emitted analysed by both methods; these chemicals are products of fermentation caused by gut microflora. Principal component analysis of the electronic nose data and wavelet transform followed by Fisher discriminant analysis of FAIMS data indicated that it was possible to separate patients after treatment by their toxicity levels. More interestingly, differences were also identified in their pre-treatment samples. We believe these patterns arise from differences in gut microflora where some combinations of bacteria result to give this olfactory signature. In the future our approach may result in a technique that will help identify patients at “high risk” even before radiation treatment is started.

  1. Clinical picture and treatment of complications of lower part of large intestine resulting from radiotherapy for intra-pelvic cancer

    International Nuclear Information System (INIS)

    Ikeda, Yoshihito; Sunagawa, Keishin; Matsumura, Shigejiro; Watanabe, Kenji; Masaoka, Yoshio

    1976-01-01

    The authors described clinical pictures and those treatments of 40 patients with complications of the lower part of the large intestine resulting from radiotherapy for cancer of the uterus, ovarium or the penis. As the radiotherapy, 60 Co-telecobalt (6,000-16,000R) and 60 Co-needle (1,000-8,568 mch) intracavitary irradiation were used alone or in combination. Findings in the complications of the lower part of the large intestine were classified into Grade I (13 cases), II (14), III (14), and IV (4) according to Sherman. The prodromal symptoms of the complications appeared in 2-6 months following the irradiation in more than a half of the patients, and it appeared within a year in most of the patients. Most of the patients complained about melena, anemia, proctagra, tenesmus and diarrhea. In the cases of Grade III, the symptoms of ileus such as constipation, abdominal distention, and abdominal pain appeared. Internal treatment was given principally, and preternal anus was made when frequent blood transfusion was required. Fourteen cases of those in Grade I and II recovered within 1-3 years. The cases which received proctostomy, including those who had bleeding, stricture and fistulation, had favorable prognosis. This result suggested that the radiotherapy for intra-pelvic cancer should be controlled to prevent further development of the complications in the rectum beyond Grade I. (Serizawa, K.)

  2. Assessment of patient radiation protection in external radiotherapy departments after inspections performed by the ASN 2008

    International Nuclear Information System (INIS)

    Franchi, Vincent; Marchal, Carole

    2009-10-01

    This report proposes an assessment of patient radiation protection in external radiotherapy. It is based on inter-regional syntheses of inspections performed by the ASN in external radiotherapy departments during 2008. It addresses 6 main themes related to patient radiation protection: human and material resources, organisation of medical physics, training in patient radiation protection, mastering of equipment (maintenance, internal quality controls of medical devices), safety and care quality management (formalization of the patient care process and definition of responsibilities, patient identity control, treatment preparation, and treatment execution), and risk management (a priori risk analysis, declaration, recording and internal processing of dysfunctions, improvements of care quality and safety management system)

  3. External Beam Radiotherapy for Prostate Cancer Patients on Anticoagulation Therapy: How Significant is the Bleeding Toxicity?

    International Nuclear Information System (INIS)

    Choe, Kevin S.; Jani, Ashesh B.; Liauw, Stanley L.

    2010-01-01

    Purpose: To characterize the bleeding toxicity associated with external beam radiotherapy for prostate cancer patients receiving anticoagulation (AC) therapy. Methods and Materials: The study cohort consisted of 568 patients with adenocarcinoma of the prostate who were treated with definitive external beam radiotherapy. Of these men, 79 were receiving AC therapy with either warfarin or clopidogrel. All patients were treated with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Bleeding complications were recorded during treatment and subsequent follow-up visits. Results: With a median follow-up of 48 months, the 4-year actuarial risk of Grade 3 or worse bleeding toxicity was 15.5% for those receiving AC therapy compared with 3.6% among those not receiving AC (p < .0001). On multivariate analysis, AC therapy was the only significant factor associated with Grade 3 or worse bleeding (p < .0001). For patients taking AC therapy, the crude rate of bleeding was 39.2%. Multivariate analysis within the AC group demonstrated that a higher radiotherapy dose (p = .0408), intensity-modulated radiotherapy (p = 0.0136), and previous transurethral resection of the prostate (p = .0001) were associated with Grade 2 or worse bleeding toxicity. Androgen deprivation therapy was protective against bleeding, with borderline significance (p = 0.0599). Dose-volume histogram analysis revealed that Grade 3 or worse bleeding was minimized if the percentage of the rectum receiving ≥70 Gy was <10% or the rectum receiving ≥50 Gy was <50%. Conclusion: Patients taking AC therapy have a substantial risk of bleeding toxicity from external beam radiotherapy. In this setting, dose escalation or intensity-modulated radiotherapy should be used judiciously. With adherence to strict dose-volume histogram criteria and minimizing hotspots, the risk of severe bleeding might be reduced.

  4. Movement of the cervix in after-loading brachytherapy: implications for designing external-beam radiotherapy boost fields.

    Science.gov (United States)

    Hombaiah, U; Blake, P; Bidmead, M

    2006-05-01

    Women with invasive carcinoma of the cervix treated by chemo-radiotherapy and brachytherapy may also receive a pelvic sidewall boost using a midline shield (MLS). The purpose of this study was to assess the usefulness of implanted gold grains in detecting the movement of the cervix caused by the insertion of low-dose-rate brachytherapy applicators, and its implications in designing the MLS. The medical records of 42 women with various stages of cervical carcinoma, who were treated by radical chemo-radiotherapy, were reviewed. All of these women underwent examination under anaesthesia (EUA) and a gold-grain insertion to demarcate the vaginal tumour extent, in the antero-posterior and lateral planes, before starting external-beam radiotherapy. The isocentric orthogonal films (simulator films) of external radiotherapy and brachytherapy were compared to assess the change in position of the gold grains and the consequences for the design of the MLS for parametrial and pelvic sidewall boosts. A significant shift in the position of the gold grains was noted in both the x (lateral) and the y (cranial/caudal) axes. The median shift of the midline, right and left lateral gold grains was 4.5, 5 and 7 mm in the x axis, whereas it was 10, 8 and 9.5 mm in the y axis, respectively. The median shift in the x and y axes was 5.5 and 9 mm, ranging from 1 to 40 mm and 1 to 45 mm, respectively. The gold grains were shifted cranially in 34 (80%) and laterally in 29 (69%) women. Thirty-two women (76.2%) received parametrial boost radiotherapy, of which 25 (59.5%) women had a customised, pear-shaped shield, and the remaining seven (16.7%) had a straight-sided, rectangular MLS. Four women (9.5%) relapsed locally, and three of them had been treated using a customised shield. In two of these four women, there was an absolute under-dosage of the central pelvis at the tip of the intra-uterine tube by 50% of the parametrial boost dose (5.4 Gy/3 fractions/3 days). Insertion of the gold grains

  5. Cardiovascular dosimetry using hybrid computational phantoms after external radiotherapy

    International Nuclear Information System (INIS)

    Moignier, Alexandra

    2014-01-01

    Cardiovascular diseases following radiotherapy are major secondary late effects raising questions among the scientific community, especially regarding the dose-effect relationship and confounding risk factors (chemotherapy, cholesterolemia, age at treatment, blood pressure,..). Post-radiation coronary diseases are one of the main causes of cardiac morbidity. Some approximations are made when coronary doses due to radiotherapy are estimated, especially regarding the morphology. For retrospective studies with old medical records, only radiographs are usually available with sometimes some contours made with a simulator. For recent medical records, CT scans displaying the anatomy in 3D are used for radiotherapy simulation but do not allow the coronary artery visualization due to low resolution and contrast. Currently, coronary doses are barely assessed in clinical practice, and when it is done, anatomical prior knowledge is generally used. This thesis proposes an original approach based on hybrid computational phantoms to study coronary artery doses following radiotherapy for left-side breast cancer and Hodgkin lymphoma. During the thesis, a method inserting hybrid computational phantoms in a DICOM format into the treatment planning system has been developed and validated. It has been adapted and tested in conditions where only radiographs provide anatomical information, as with old medical records for left side breast radiotherapy. The method has also been adapted to perform precise dose reconstructions to the coronary artery for patients treated for a mediastinal Hodgkin lymphoma and diagnosed with coronary stenosis through a coro-scanner. A case-control study was carried out and the risk of coronary stenosis on a coronary artery segment was assessed to be multiplied by 1.049 at each additional gray on the median dose to the coronary artery segment. For recent medical records, coronary doses uncertainties related to an approach by anatomical prior knowledge

  6. Adverse effect after external radiotherapy for brain tumors

    International Nuclear Information System (INIS)

    Yoshii, Yoshihiko; Takano, Shingo; Yanaka, Kiyoyuki

    1989-01-01

    This report discusses the effects on normal brain tissue of radiotherapy in relation to age and irradiation dose as determined from whole-brain sections of the autopsied brains with tumors. Twenty four patients (7 glioblastomas, 2 benign gliomas, 12 brain metastases, 2 malignant lymphomas, and 1 pituitary adenoma) older than 65 years (aged), and 17 younger than 65 years (non-aged) were treated by cobalt- or linear accelerator radiotherapy. Nine patients without brain disease (4 aged and 5 non-aged) were used as a control group. The histological findings were evaluated by grading the small and capillary vessels, fibrinoid necrosis, and myelination in the white matter in whole-brain sections. Those findings were compared to the irradiation doses within all radiation fields in whole-brain sections corresponding to CT scans. Hyalinization of the small vessels was observed within the postradiation 12 months in fields exposed to total doses of less than 800 neuret. Hyalinization of the capillary vessels was greater in the irradiated group than in the control group. Demyelination was observed within the postradiation 12 months in fields irradiated by more than 800 neuret in aged patients and in fields irradiated by less than 800 neuret in non-aged patients. Fibrinoid necrosis was observed after the post-radiation 12 months in fields irradiated by less than 800 neuret in aged patients and in fields irradiated by more than 800 neuret in non-aged patients. It is worth noting that in non-aged patients with brain tumors, adverse effects of radiotherapy on vessels and parenchyma were very high even in low-dose radiation areas; and in aged patients fibrinoid necrosis, which indicates irreversible damage of vessels, was observed in low-dose radiation areas. (author)

  7. Injectable silver nanosensors: in vivo dosimetry for external beam radiotherapy using positron emission tomography

    DEFF Research Database (Denmark)

    Christensen, Anders Nymark; Rydhög, J. S.; Søndergaard, Rikke Vicki

    2016-01-01

    Development of safe and efficient radiotherapy routines requires quantification of the delivered absorbed dose to the cancer tissue in individual patients. In vivo dosimetry can provide accurate information about the absorbed dose delivered during treatment. In the current study, a novel silver......-nanosensor formulation based on poly(vinylpyrrolidinone)-coated silver nanoparticles formulated in a gelation matrix composed of sucrose acetate isobutyrate has been developed for use as an in vivo dosimeter for external beam radiotherapy. In situ photonuclear reactions trigger the formation of radioactive (106)Ag......, which enables post treatment verification of the delivered dose using positron emission tomography imaging. The silver-nanosensor was investigated in a tissue equivalent thorax phantom using clinical settings and workflow for both standard fractionated radiotherapy (2 Gy) and stereotactic radiotherapy...

  8. Review of common accidents in external beam radiotherapy

    International Nuclear Information System (INIS)

    Ombogo, C.M

    2015-02-01

    This work covers patients protection in Radiotherapy which is a multi step procedure that is complex. Any error in any step has an effect on the patient and therefore the entire process requires attention to details in order to achieve patients protection. This project reviews eight case studies involving accidents that occurred during the process of therapy delivery. Professionalism in case one and two was not practiced in that in case one medical physicist failed to calculate decay data instead relied on incorrect decay graph thus giving wrong dose. While in case two a wrong TPS was approved following a formal written procedure due to new technology. In case three and seven there was a software malfunction due to uniformed choice of TPS and in case four a computer file was not updated in the TPS while in eight the failure is inter look system led to patients recieving high dose than was prescribed. Calibration in case five and six was due to wrong actions in both repairs and interpretation of treatment time than the overdose to patient. The lessen learnt seeks to act as a checklist for ensuring patient protection in radiotherapy and prevention of future accidents. (au)

  9. Salvage radiotherapy with or without concurrent chemotherapy for pelvic recurrence after hysterectomy alone for early-stage uterine cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang-Won [Ajou University School of Medicine, Department of Radiation Oncology, Yeongtong-gu, Suwon, Gyeonggi-do (Korea, Republic of); Konyang University School of Medicine, Department of Radiation Oncology, Daejeon (Korea, Republic of); Chun, Mison; Oh, Young-Taek [Ajou University School of Medicine, Department of Radiation Oncology, Yeongtong-gu, Suwon, Gyeonggi-do (Korea, Republic of); Ryu, Hee-Sug; Chang, Suk-Joon; Kong, Tae Wook [Ajou University School of Medicine, Department of Obstetrics and Gynecology, Yeongtong-gu, Suwon, Gyeonggi-do (Korea, Republic of); Lee, Eun Ju [Ajou University School of Medicine, Department of Radiology, Yeongtong-gu, Suwon, Gyeonggi-do (Korea, Republic of); Lee, Yong Hee [Ajou University School of Medicine, Department of Pathology, Yeongtong-gu, Suwon, Gyeonggi-do (Korea, Republic of)

    2017-07-15

    Treatment outcomes of patients with pelvic recurrence after hysterectomy alone for uterine cervical cancer who received salvage radiotherapy (RT) with or without concurrent chemotherapy were investigated. Salvage RT for recurrent cervical cancer confined to the pelvic cavity after hysterectomy alone was received by 33 patients. The median interval between initial hysterectomy and recurrence was 26 months. Whole-pelvic irradiation was delivered to median dose of 45 Gy, followed by a boost with a median dose of 16 Gy to the gross tumor volume. Cisplatin-based concurrent chemotherapy was administered to 29 patients. The median follow-up period was 53 months for surviving patients. Most patients (97.0%) completed salvage RT of ≥45 Gy. Complete response (CR) was achieved in 23 patients (69.7%). Pelvic sidewall involvement and evaluation with positron-emission tomography-computed tomography were significantly associated with CR. The 5-year progression-free survival (PFS), local control (LC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 62.7, 79.5, 72.5, and 60.1%, respectively. Initial International Federation of Gynecology and Obstetrics stage, pelvic sidewall involvement, and CR status were significant factors for PFS and OS rates in multivariate analysis. The incidence of severe acute and late toxicities (≥grade 3) was 12.1 and 3.0%, respectively. Aggressive salvage RT with or without concurrent chemotherapy for recurrent cervical cancer confined to the pelvic cavity was feasible, with promising treatment outcomes and acceptable toxicities. However, even more intensive novel treatment strategies should be investigated for patients with unfavorable prognostic factors. (orig.) [German] Untersuchung der Behandlungsergebnisse von Patientinnen mit Beckenrezidiv nach alleiniger Hysterektomie bei Zervixkarzinom, die eine Salvage-Radiotherapie (RT) mit oder ohne begleitende Chemotherapie erhalten hatten. Insgesamt 33 Patientinnen erhielten

  10. Patterns of Pelvic Radiotherapy in Patients with Stage II/III Rectal Cancer

    International Nuclear Information System (INIS)

    Fitzgerald, T. L.; Zervos, E.; Wong, J. H.; Fitzgerald, T. L.; Zervos, E.; Wong, J. H.; Fitzgerald, T. L.; Zervos, E.; Wong, J. H.

    2013-01-01

    High-level evidence supports adjuvant radiotherapy for rectal cancer. We examined the influence of socio demographic factors on patterns of adjuvant radiotherapy for resected Stage II/III rectal cancer. Methods. Patients undergoing surgical resection for stage II/III rectal cancer were identified in SEER registry. Results. A total of 21,683 patients were identified. Majority of patients were male (58.8%), white (83%), and with stage III (54.9%) and received radiotherapy (66%). On univariate analysis, male gender, stage III, younger age, year of diagnosis, and higher socioeconomic status (SES) were associated with radiotherapy. Radiotherapy was delivered in 84.4% of patients <50; however, only 32.8% of those are >80 years. Logistic regression demonstrated a significant increase in the use of radiotherapy in younger patients who are 50 (OR, 10.3), with stage III (OR, 1.21), males (OR, 1.18), and with higher SES. Conclusions. There is a failure to conform to standard adjuvant radiotherapy in one-third of patients, and this is associated with older age, stage II, area-level of socioeconomic deprivation, and female sex.

  11. An assessment of effective dose to staff in external beam radiotherapy

    International Nuclear Information System (INIS)

    Rawlings, D.J.; Nicholson, L.

    1997-01-01

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

  12. The role and strategy of IMRT in radiotherapy of pelvic tumors: Dose escalation and critical organ sparing in prostate cancer

    International Nuclear Information System (INIS)

    Liu, Y.-M.; Shiau, C.-Y.; Lee, M.-L.; Huang, P.-I.; Hsieh, C.-M.; Chen, P.-H.; Lin, Y.-H.; Wang, L.-W.; Yen, S.-H.

    2007-01-01

    Purpose: To investigate the intensity-modulated radiotherapy (IMRT) strategy in dose escalation of prostate and pelvic lymph nodes. Methods and Materials: Plan dosimetric data of 10 prostate cancer patients were compared with two-dimensional (2D) or IMRT techniques for pelvis (two-dimensional whole pelvic radiation therapy [2D-WPRT] or IM-WPRT) to receive 50 Gy or 54 Gy and additional prostate boost by three-dimensional conformal radiation therapy or IMRT (3D-PBRT or IM-PBRT) techniques up to 72 Gy or 78 Gy. Dose-volume histograms (DVHs), normal tissue complication probabilities (NTCP) of critical organ, and conformity of target volume in various combinations were calculated. Results: In DVH analysis, the plans with IM-WPRT (54 Gy) and additional boost up to 78 Gy had lower rectal and bladder volume percentage at 50 Gy and 60 Gy, compared with those with 2D-WPRT (50 Gy) and additional boost up to 72 Gy or 78 Gy. Those with IM-WPRT (54 Gy) also had better small bowel sparing at 30 Gy and 50 Gy, compared with those with 2D-WPRT (50 Gy). In NTCP, those with IM-WPRT and total dose of 78 Gy achieved lower complication rates in rectum and small bowel, compared with those of 2D-WPRT with total dose of 72 Gy. In conformity, those with IM-WPRT had better conformity compared with those with 2D-WPRT with significance (p < 0.005). No significant difference in DVHs, NTCP, or conformity was found between IM-PBRT and 3D-PBRT after IM-WPRT. Conclusions: Initial pelvic IMRT is the most important strategy in dose escalation and critical organ sparing. IM-WPRT is recommended for patients requiring WPRT. There is not much benefit for critical organ sparing by IMRT after 2D-WPRT

  13. Suggested recommendations for a minimal programme of quality assurance in external radiotherapy

    International Nuclear Information System (INIS)

    Aletti, P.; Bey, P.; Brossens, M.; Chauvel, P.; Chavaudra, J.; Cohen-Solal, C.; Costa, A.; Desprez, P.; Donnarieix, D.; Gaboriaud, G.; Kinany, R.; Lagrange, J.L.; Manny, C.; Pontvert, D.; Rozan, R.; Valinta, D.; Van Dam, J.

    1991-01-01

    This article gives the suggested recommendations for a minimal programme of quality assurance in external radiotherapy made by a study group of the French Society of hospital physicists and the French Society of oncological radiation therapy with belgian physicists and radiotherapists [fr

  14. HEMIPELVECTOMY AND INTRAOPERATIVE RADIOTHERAPY FOR BONE AND SOFT-TISSUE SARCOMAS OF THE PELVIC GIRDLE

    NARCIS (Netherlands)

    HOEKSTRA, HJ; SINDELAR, WF; SZABO, BG; KINSELLA, TJ

    1995-01-01

    Current treatment of locally advanced bone and soft tissue sarcomas of the pelvic girdle are associated with a high local and distant failure rate, and local tumor control after hemipelvectomy can be a significant problem. IORT has been used in conjunction with hemipelvectomy, both conventional

  15. Uterine carcinosarcoma associated with pelvic radiotherapy for sacral chordoma: A case report

    Directory of Open Access Journals (Sweden)

    Korhan Kahraman

    2012-03-01

    Conclusion: In uterine masses seen in patients with history of irradiation to the pelvic field, the probability of uterine sarcomas should always be kept in mind. These tumors may occur simultaneously with recurrence of primary tumor previously treated by adjuvant radiation therapy.

  16. The patient radiation protection in external radiotherapy: specificity and methods; La radioprotection du patient en radiotherapie externe: specificites et methodes

    Energy Technology Data Exchange (ETDEWEB)

    Beauvais March, H. [Hopital Val de Grace, 75 - Paris (France)

    1999-07-01

    The daily use of high level radiation doses to fight against carcinomas has often led to consider radiation protection as a marginal problem, in this area. But the therapeutic advances, by increasing the life time and life quality have made the side effects unacceptable and revealed the appearance of radioinduced carcinomas. So, it is necessary to practice a patient radiation protection. The general principles of radiation protection are applicable to radiotherapy. (justification, optimization and dose limit, planning of the treatment, quality control of installations). (N.C.)

  17. External radiotherapy in the management of malignant pericardial effusion

    Energy Technology Data Exchange (ETDEWEB)

    Fairlamb, D.J. (The Royal Hospital, Wolverhampton (UK))

    1989-05-01

    Malignant pericardial effusions that are not causing tamponade can be effectively treated by external beam irradiation - a readily available non-invasive treatment. In a consecutive series six out of eight patients achieved good palliation of their effusions as a result of this treatment. (author).

  18. The relationship between external beam radiotherapy dose and chronic urinary dysfunction - A methodological critique

    International Nuclear Information System (INIS)

    Rosewall, Tara; Catton, Charles; Currie, Geoffrey; Bayley, Andrew; Chung, Peter; Wheat, Janelle; Milosevic, Michael

    2010-01-01

    Purpose: To perform a methodological critique of the literature evaluating the relationship between external beam radiotherapy dose/volume parameters and chronic urinary dysfunction to determine why consistent associations between dose and dysfunction have not been found. Methods and materials: The radiotherapy literature was reviewed using various electronic medical search engines with appropriate keywords and MeSH headings. Inclusion criteria comprised of; English language articles, published between 1999 and June 2009, incorporating megavoltage external beam photons in standard-sized daily fraction. A methodological critique was then performed, evaluating the factors affected in the quantification of radiotherapy dose and chronic urinary dysfunction. Results: Nine of 22 eligible studies successfully identified a clinically and statistically significant relationship between dose and dysfunction. Accurate estimations of external beam radiotherapy dose were compromised by the frequent use of dosimetric variables which are poor surrogates for the dose received by the lower urinary tract tissue and do not incorporate the effect of daily variations in isocentre and bladder position. The precise categorization of chronic urinary dysfunction was obscured by reliance on subjective and aggregated toxicity metrics which vary over time. Conclusions: A high-level evidence-base for the relationship between external beam radiotherapy dose and chronic urinary dysfunction does not currently exist. The quantification of the actual external beam dose delivered to the functionally important tissues using dose accumulation strategies and the use of objective measures of individual manifestations of urinary dysfunction will assist in the identification of robust relationships between dose and urinary dysfunction for application in widespread clinical practice.

  19. Metastatic tumor of thoracic and lumbar spine: prospective study comparing the surgery and radiotherapy vs external immobilization with radiotherapy

    International Nuclear Information System (INIS)

    Falavigna, Asdrubal; Ioppi, Ana Elisa Empinotti; Grasselli, Juliana

    2007-01-01

    Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patient's decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation longer and significant reduction of pain.(author)

  20. When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study.

    Science.gov (United States)

    Mcdonald, E; Theologis, A A; Horst, P; Kandemir, U; Pekmezci, M

    2015-12-01

    This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C). An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated. The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18-7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (p < 0.05). Rotation of the pubis and sacrum was not different between In-Fix constructs combined with single-level IS and TS fixation. In this model of an unstable pelvic fracture (OTA 61-C), anterior fixation with an In-Fix was biomechanically superior to an anterior Ex-Fix in the setting of single-level posterior fixation. There was no biomechanical difference between the In-Fix and Ex-Fix when each was combined with two levels of posterior sacral fixation.

  1. Outcome after salvage radiotherapy (brachytherapy +/- external) in patients with a vaginal recurrence from endometrial carcinomas

    International Nuclear Information System (INIS)

    Hasbini, Ali; Haie-Meder, Christine; Morice, Philippe; Chirat, Eric; Duvillard, Pierre; Lhomme, Catherine; Delapierre, Monique; Gerbaulet, Alain

    2002-01-01

    Background and purpose: The vagina is the site most commonly affected by loco-regional failure in endometrial carcinoma (EC). The aim of this study was to evaluate the efficacy of vaginal brachytherapy (BT) combined or not with whole pelvic external radiotherapy (RT) for the treatment of patients with vaginal recurrences from endometrial cancer. Patients and methods: Between 1986 and 1999 25 women were treated at the Institut Gustave Roussy (IGR) for a vaginal relapse (VR) from EC. Patient characteristics were as follows: median age 65 years (range 43-84), histologic type: adenocarcinoma (21 patients); endometrioid carcinoma (three patients); adenoacanthoma (one patient); FIGO staging for initial disease: Ia, three; Ib, eight; Ic, four; II, seven; IIIa, two; IVa, one. The initial tumor was treated by surgery alone in 18 patients, or surgery combined with RT and/or BT in seven patients. A VR occurred in a median interval of 21 months (range 2-89); 10/25 (40%) occurred within the first year following initial treatment. The recurrence was exclusively in the vagina in 18 patients and was associated with parametrial and or nodal involvement in seven patients; it was localized in the upper 1/3 of the vagina in nine patients, in the upper 2/3 or the entire vagina in 11 patients or in the lower 1/3 in five patients. The largest tumor diameter ranged from 10 to 70 mm (median: 25 mm). The treatment of the VR included low-dose rate endocavitary BT in all cases: three patients received endocavitary BT alone, or it was associated with external RT in 22 patients or delivered after surgical removal of the lesion in nine patients. Seven patients were submitted to further irradiation combining endocavitary and interstitial BT. Results: Local control was achieved in 23 patients (92%). With a follow-up ranging from 4 to 154 months, 13 patients have died (ten due to metastasis, two of intercurrent disease and two due to local tumor progression) and ten patients are alive and disease

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

    Science.gov (United States)

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

    2012-04-01

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

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  4. External beam radiotherapy for carcinoma of the prostate

    International Nuclear Information System (INIS)

    Sagerman, R.H.; Chun, H.C.; King, G.A.; Chung, C.T.; Dalal, P.S.

    1989-01-01

    Five hundred nineteen patients with prostate cancer were seen in the Radiation Oncology Division of the State University of New York (SUNY) Health Science Center, Syracuse, New York, between 1969 and 1981. The results for the 239 patients treated with radical intent are reported here. All patients received 60 to 70 Gy to the prostate with megavoltage beam irradiation; 142 with a small field (10 X 10 cm) 360 degrees rotational technique for Stage A, B, or C disease and 69 with a four-field pelvic brick technique (followed by a boost to the prostate) for Stage A through C and D1 disease. Twenty-eight patients were treated postoperatively for residual disease after radical prostatectomy or for recurrent tumor. The minimum follow-up time was 5 years. Actuarial 5-year and 7-year survival rates for Stage A (n = 34), B (n = 100), C (n = 63), and D1 (n = 14) were 91% and 76%, 86% and 75%, 67% and 40%, and 46% and 36%, respectively. The corresponding 5-year and 7-year relapse-free survival rates were 72% and 65%, 77% and 60%, 46% and 28%, and 38% and 25%. The local tumor control rates at 5 years were 91%, 85%, 77%, and 62% for Stage A, B, C, and D1, respectively. In our experience, there was no significant difference in relapse-free survival rates for patients who underwent transurethral resection (TURP) versus those who did not (67% versus 78% for Stage B [P greater than 0.25] and 38% versus 47% for Stage C [P greater than 0.25], respectively). Also there was no significant difference in relapse-free survival rates between large and small field techniques (64% versus 77% for Stage B [P greater than 0.25] and 56% versus 41% for Stage C [P greater than 0.25], respectively). The 5-year and 7-year actuarial survival rates were 90% and 71%, respectively, for the 15 patients with residual tumor and 58% and 33%, respectively, for the 13 patients treated for postprostatectomy recurrence

  5. Adjuvant radiotherapy for uterine papillary serous carcinoma: Whole abdominopelvic or pelvic irradiation?

    International Nuclear Information System (INIS)

    Casey, W.; Chen, Y.; DuBeshter, B.; Angel, C.; Dawson, A.; Smudzin, T.; Rubin, P.

    1996-01-01

    Objective: The optimum adjuvant therapy for uterine papillary serous carcinoma (UPSC), a rare but clinically aggressive histologic variant of endometrial carcinoma, is a controversial issue. UPSC behaves in a pattern that resembles the papillary serous carcinoma of the ovary with a tendency to spread to the peritoneal surfaces. Whole abdominopelvic irradiation (WAI) has been advocated but it remains unclear if adjuvant pelvic irradiation alone is sufficient for early stage UPSC. We reviewed our experience in the adjuvant radiation treatment for UPSC treated at our institution. Materials and Methods: Between 1985 and 1995, a series of 351 cases of endometrial carcinoma were referred to the department of Radiation Oncology. There were a total of 26 UPSC cases with 25 medical records available for review. Except for one case which received irradiation alone, the remaining 24 cases were all surgically staged with TAH/BSO. These patients were treated with WAI or pelvic irradiation with or without a vaginal cuff boost using brachytherapy. The irradiation treatment fields, dose, the local/regional and distant disease status at last follow-up were recorded. The medium follow-up interval was four years with a range of one to eight years. Kaplan-Meier plots for disease specific survival and local/regional disease free survival were obtained. Results: Of the 25 surgically staged UPSC patients, the stage distribution was as follows: 9 stage I, 4 stage II, 10 stage III, and 2 stage IVB. Twelve patients received WAI (4 stage I disease, and 8 stage III disease), while the remaining patients were treated with pelvic irradiation (XRT). 1.) 13 patients were alive without disease and 3 were alive with disease. Seven patients died of either distant metastasis or abdominal recurrence and two died of intercurrent disease (5 year disease specific survival for the whole group was 43%). Two of 17 patients with stages IIIA and below vs. five of 8 patients with stages IIIB and above died of

  6. A Bile Duct Cancer Patient Whose Stent Shifted Significantly Over the Course of External Beam Radiotherapy

    International Nuclear Information System (INIS)

    Yun, Hyong Geun

    2011-01-01

    The author reports a bile duct cancer patient whose stent shifted significantly from right to left over the course of radiotherapy. The 80-year-old female patient had a short stature with thoracic kyphosis and mutiple spinal compression fractures. She was also emaciated and very lean. By comparing the weekly scanned computed tomography images, the author found her stent to have shifted by more than 4 cm from right to left over the course of external beam radiotherapy. The results of this case study suggest that for a very lean and emaciated kyphotic bile duct cancer patient, the possibility of large interfractional movement of the bile duct or stent during radiotherapy should be considered.

  7. Prognosis of external radiotherapy for unresected bile duct carcinoma

    International Nuclear Information System (INIS)

    Hirokawa, Yutaka; Kashiwado, Kozo; Kashimoto, Kazuki

    1991-01-01

    Thirty two patients with unresectable bile duct carcinoma were treated with external irradiation. The outcome of these patients was retrospectively analyzed in terms of survival time and prognostic variables. Nine prognostic variables were examined as follows: sex, performance status, age, radiation doses; irradiation fields, the presence or absence of chemotherapy, values of lactic dehydrogenase before the beginning of treatment, total bilirubin values, and hemoglobin values. In all patients, median survival was 7.3 months, and one-year survival time was 34.4%. The most significant prognostic variable was total radiation doses, followed by performance status, total bilirubin values, and irradiation fields. Higher survival rate was associated with 60 Gy or more doses, the combination of UFT chemotherapy, and 4 mg/dl or less of total bilirubin values. (N.K.)

  8. A comparison of protocols for external beam radiotherapy beam calibrations

    International Nuclear Information System (INIS)

    Saeed Al-Ahbabi, Salma; Bradley, D.A.; Beyomi, M.; Alkatib, Z.; Adhaheri, S.; Darmaki, M.; Nisbet, A.

    2012-01-01

    A number of codes of practice (CoP) for electron and photon radiotherapy beam dosimetry are currently in use. Comparison is made of the more widely used of these, specifically those of the International Atomic Energy Agency (IAEA TRS-398), the American Association of Physicists in Medicine (AAPM TG-51) and the Institute of Physics and Engineering in Medicine (IPEM 2003). All are based on calibration of ionization chambers in terms of absorbed dose to water, each seeking to reduce uncertainty in delivered dose, providing an even stronger system of primary standards than previous air-kerma based approaches. They also provide a firm, traceable and straight-forward formalism. Included in making dose assessments for the three CoP are calibration coefficients for a range of beam quality indices. Measurements have been performed using clinical photon and electron beams, the absorbed dose to water being obtained following the recommendations given by each code. Electron beam comparisons have been carried out using measurements for electron beams of nominal energies 6, 9, 12, 16 and 20 MeV. Comparisons were also carried out for photon beams of nominal energies 6 and 18 MV. For photon beams use was made of NE2571 cylindrical graphite walled ionization chambers, cross-calibrated against an NE2611 Secondary Standard; for electron beams, PTW Markus and NACP-02 plane-parallel chambers were used. Irradiations were made using Varian 600C/2100C linacs, supported by water tanks and Virtual Water™ phantoms. The absorbed doses for photon and electron beams obtained following these CoP are all in good agreement, with deviations of less than 2%. A number of studies have been carried out by different groups in different countries to examine the consistency of dosimetry codes of practice or protocols. The aim of these studies is to confirm that the goal of those codes is met, namely uniformity in establishment of dosimetry of all radiation beam types used in cancer therapy in the world

  9. Clinical and anatomical guidelines in pelvic cancer contouring for radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Portaluri, M.; Bambace, S.; Giuliano, G.; Pili, G.; Didonna, V.; Perez, C.; Angone, G.; Alloro, E.; Scialpi, M.

    2004-01-01

    Background and purpose. Many observations on potential inadequate coverage of tumour volume at risk in advanced cervical cancer (CC) when conventional radiation fields are used, have further substantiated by investigators using MRI, CT or lymph-angiographic imaging. This work tries to obtain three dimensional margins by observing enlarged nodes in CT scans in order to improve pelvic nodal chains clinical target volumes (CTVs) drawing, and by looking for corroborative evidence in the literature for a better delineation of tumour CTV. Method. Eleven consecutive patients (seven males, four females, mean age 62 years, range 43 8) with CT diagnosis of nodal involvement caused by pathologically proved carcinoma of the cervix (n = 2), carcinoma of the rectum (n = 2), carcinoma of the prostate (n = 2), non-Hodgkin lymphoma (n 2), Hodgkin lymphoma (n = 1), carcinoma of the penis (n = 1) and carcinoma of the corpus uteri (n = 1) were retrospectively reviewed. Sixty CT scans with 67 enlarged pelvic nodes were reviewed in order to record the more proximal structures (muscle, bone, vessels, cutis or sub-cutis and other organs) to each enlarged node or group of nodes according to the four surfaces (anterior, lateral, posterior and medial) in a clockwise direction. Results. summary of the observations of each nodal chain and the number of occurrences of every marginal structure on axial CT slices is presented. Finally, simple guidelines are proposed. Conclusions. Tumour CTV should be based on individual tumour anatomy mainly for lateral beams as it results from sagittal T2 weighted MRI images. Boundaries of pelvic nodes CTVs can be derived from observations of enlarged lymph nodes in CT scans. (author)

  10. The three-item ALERT-B questionnaire provides a validated screening tool to detect chronic gastrointestinal symptoms after pelvic radiotherapy in cancer survivors

    OpenAIRE

    Taylor, Sophia; Byrne, Anthony; Adams, R.; Turner, J.; Hanna, L.; Staffurth, John Nicholas; Farnell, Damian; Sivell, Stephanie; Nelson, Annmarie; Green, J.

    2016-01-01

    Aims: Although pelvic radiotherapy is an effective treatment for various malignancies, around half of patients develop significant gastrointestinal problems. These symptoms often remain undetected, despite the existence of effective treatments. This study developed and refined a simple screening tool to detect common gastrointestinal symptoms in outpatient clinics. These symptoms have a significant effect on quality of life. This tool will increase detection rates and so enable access to spec...

  11. Effect of supplements: Probiotics and probiotic plus honey on blood cell counts and serum IgA in patients receiving pelvic radiotherapy

    Directory of Open Access Journals (Sweden)

    Hajar-Alsadat Mansouri-Tehrani

    2015-01-01

    Full Text Available Background: Radiotherapy is frequently used in treatment approaches of pelvic malignancies. Nevertheless, it has some known systemic effects on blood cells and the immune system that possibly results in their susceptibility to infection. Probiotics are live microbial food ingredients that provide a health advantage to the consumer. Honey has prebiotic properties. The aim of this clinical trial was to investigate probable effects of probiotic or probiotics plus honey on blood cell counts and serum IgA levels in patients receiving pelvic radiotherapy. Materials and Methods: Sixty-seven adult patients with pelvic cancer were enrolled. Patients were randomized to receive either: (1 Probiotic capsules (including: Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium longum, and Streptococcus thermophiles (n = 22, (2 probiotic capsules plus honey (n = 21 or (3 placebo capsules (n = 24 all for 6 weeks. Blood and serum samples were collected for one week before radiotherapy and 24-72 h after the end of radiotherapy. Results: White blood cells (WBC, red blood cells (RBC, platelet counts, and serum IgA level were not significantly changed in patients taking probiotic (alone or plus honey during pelvic radiotherapy. The mean decrease in RBC count was 0.52, 0.18, and 0.23 × 10 6 cells/μL, WBC count was 2.3, 1.21, and 1.34 × 10 3 cells/μL and platelet count was, 57.6, 53.3, and 66.35 × 10 3 cells/μL for the probiotic, probiotic plus honey, and placebo groups, respectively. The mean decrease of serum IgA was 22.53, 29.94, and 40.73 mg/dL for the probiotic, probiotic plus honey, and placebo groups, respectively. Conclusion: The observed nonsignificant effect of probiotics may be in favor of local effects of this product in the gut rather than systemic effects, however, as a trend toward a benefit was indicated, further studies are necessary in order to extract effects of

  12. Effect of supplements: Probiotics and probiotic plus honey on blood cell counts and serum IgA in patients receiving pelvic radiotherapy.

    Science.gov (United States)

    Mansouri-Tehrani, Hajar-Alsadat; Rabbani-Khorasgani, Mohammad; Hosseini, Sayyed Mohsen; Mokarian, Fariborz; Mahdavi, Hoda; Roayaei, Mahnaz

    2015-07-01

    Radiotherapy is frequently used in treatment approaches of pelvic malignancies. Nevertheless, it has some known systemic effects on blood cells and the immune system that possibly results in their susceptibility to infection. Probiotics are live microbial food ingredients that provide a health advantage to the consumer. Honey has prebiotic properties. The aim of this clinical trial was to investigate probable effects of probiotic or probiotics plus honey on blood cell counts and serum IgA levels in patients receiving pelvic radiotherapy. Sixty-seven adult patients with pelvic cancer were enrolled. Patients were randomized to receive either: (1) Probiotic capsules (including: Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium longum, and Streptococcus thermophiles) (n = 22), (2) probiotic capsules plus honey (n = 21) or (3) placebo capsules (n = 24) all for 6 weeks. Blood and serum samples were collected for one week before radiotherapy and 24-72 h after the end of radiotherapy. White blood cells (WBC), red blood cells (RBC), platelet counts, and serum IgA level were not significantly changed in patients taking probiotic (alone or plus honey) during pelvic radiotherapy. The mean decrease in RBC count was 0.52, 0.18, and 0.23 × 10(6) cells/μL, WBC count was 2.3, 1.21, and 1.34 × 10(3) cells/μL and platelet count was, 57.6, 53.3, and 66.35 × 10(3) cells/μL for the probiotic, probiotic plus honey, and placebo groups, respectively. The mean decrease of serum IgA was 22.53, 29.94, and 40.73 mg/dL for the probiotic, probiotic plus honey, and placebo groups, respectively. The observed nonsignificant effect of probiotics may be in favor of local effects of this product in the gut rather than systemic effects, however, as a trend toward a benefit was indicated, further studies are necessary in order to extract effects of probiotics or probiotic plus honey on hematologic and

  13. Phase II study of vitamin E and pentoxifylline in patients with late side effects of pelvic radiotherapy

    International Nuclear Information System (INIS)

    Gothard, Lone; Cornes, Paul; Brooker, Sonja; Earl, Judith; Glees, John; Hall, Emma; Peckitt, Clare; Tait, Diana; Yarnold, John

    2005-01-01

    Background and purpose: Radiation-induced tissue fibrosis is a common adverse effect of curative treatment for pelvic cancer. Pilot studies testing alpha-tocopherol and pentoxifylline provide evidence of clinical regression of superficial radiation fibrosis after radiotherapy. Patients and methods: Twenty-seven eligible research volunteers with a minimum of one grade 3 or 4 disability (LENT SOMA) due to previous radiotherapy were entered into the study. Volunteers were given dl-alpha tocopheryl acetate 500 mg twice a day orally plus pentoxifylline 400 mg twice a day orally over a period of 6 months. Clinical assessment of late side effects recorded using LENT SOMA scales was selected as the primary endpoint, taken at baseline and at 6 and 12 months post-registration. Patient self-assessment of function and quality of life was assessed as a secondary endpoint using the EORTC QLQ-C30 core questionnaire and the EORTC QLQ-CR38 pelvic module. Magnetic resonance imaging was undertaken in 13/23 evaluable volunteers before and after 6 months of therapy. Results: At 12 months post-registration there were 4 out of 23 responders. At 6 months post-registration there was a statistically significant improvement (i.e. reduction) in the median of the LENT SOMA summed scores in all areas assessed apart from 'male sexual dysfunction', 'vulva' and 'vagina' which were unchanged at 6 months. The median total LENT SOMA score at baseline and 6 months was 49 and 34, respectively, with a median change in total LENT SOMA score between baseline and 6 months of 9 (IQR 7-18) (P<0.001). The maximum LENT SOMA scores improved over the study period, with a total number of 82 maximum grade 3 or 4 normal tissue scores at baseline (median of four complications per person) reduced to a total number of 67 maximum grade 3 or 4 scores at 6 months post-registration (median of 3 complications per person), i.e. a median reduction in severe complications of one per person. LENT SOMA scores at 12 months were

  14. Effect of Whole Pelvic Radiotherapy for Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy and Long-Term Androgen Deprivation Therapy

    International Nuclear Information System (INIS)

    Mantini, Giovanna; Tagliaferri, Luca; Mattiucci, Gian Carlo; Balducci, Mario; Frascino, Vincenzo; Dinapoli, Nicola; Di Gesù, Cinzia; Ippolito, Edy; Morganti, Alessio G.; Cellini, Numa

    2011-01-01

    Purpose: To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT). Methods and materials: Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score ≥7 and/or prostate-specific antigen level ≥20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT). Results: A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12–38). With a median follow-up of 52 months (range, 20–150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p = NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p = .03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p = NS). Conclusions: Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.

  15. Quality assurance for external radiotherapy equipment in Japan

    International Nuclear Information System (INIS)

    Tomaru, Teizo

    1993-01-01

    In Japan, quality assurance (QA) for external beam teletherapy equipment is carried out according to QA protocols issued by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO), which are modified from the IEC recommendations. The QA program in Japan is introduced in this paper. It is advisable to do several tests daily, including the accuracy of the optical distance indicator, alignment of the sidelight, check of 10 x 10 cm light field, and constancy of the dose monitor. Pencil marks on the wall and floor can be used to check light alignment. Dose monitor calibration and flatness/symmetry should be checked weekly. Monthly tests should include 8 items: depth dose characteristics of electron beam, radiation-light field congruence, indication of x-ray beam axis (patient entry and exit), indication of isocenter, distance indicator, and vertical movement of table. Film is used to test the flatness/symmetry, and congruence of the radiation and light field. The alignment of the intersection of the cross hair is useful to check the x-ray beam axis indication and vertical movement of table. Checks of stability of each dose monitor system and mechanical alignment should be performed every 6 months or annually. Mechanical alignment is fundamentally important for the performance of a teletherapy unit. As a constancy check of the overall system, a split-field test is recommended due to its rapid and simple execution. (author)

  16. Unilateral solitary choroid metastasis from breast cancer: Rewarding results of external radiotherapy

    Directory of Open Access Journals (Sweden)

    Nirmala S

    2008-01-01

    Full Text Available Intraocular metastatic tumor is the commonest intraocular malignancy in adults, with uveal tract the commonest site. In nearly 85% of cases the choroid is the afflicted site due to its vascularity. Breast and lung are the common primaries. In breast primaries, this could be the first metastatic disease. This condition should always be kept in mind in patients with visual symptoms. Fundus examination, ultrasonography and CT/MRI of the orbit help in diagnosis. Early recognition and timely treatment can save the visual function thus imparting good quality of life to the patient. External beam radiotherapy is a good local form of treatment. Hormone therapy in hormone receptor positive tumors can have additional benefits. Here we report a case of unilateral solitary choroid metastasis in a case of breast cancer treated with external beam radiotherapy.

  17. Comparison of two methods for anterior-posterior isocenter localization in pelvic radiotherapy using electronic portal imaging

    International Nuclear Information System (INIS)

    Greer, Peter B.; Mortensen, Trina M.; Jose, C.C.

    1998-01-01

    Purpose: The two setup methods commonly used to determine the anterior-posterior isocenter location in pelvic radiotherapy are to align lateral localization lasers with lateral skin tattoos on the patient, or to set the couch height so that the isocenter is at a fixed height (determined during simulation or treatment planning) above the couch top. This study was implemented to determine which technique gives more accurate patient treatment by comparison of the anterior-posterior setup variation measured with electronic portal imaging. Methods and Materials: Eleven supine prostate patients were treated with tattoo localization and 159 left-lateral portal images were taken during the treatments. The field displacements were then determined by template matching. These patients were compared to nine patients (205 images) set up to a fixed isocenter height. Similarly, eight prone rectal patients (136 right-lateral images) set up to tattoos were compared to six patients (108 images) set up to a fixed height. The patients were not immobilized and were all treated with three field techniques on a hard couch top. The overall mean treatment position deviation and the standard deviation of the displacements (total setup variation) were calculated for each patient group along with the systematic (simulator-to-treatment) and the random (treatment-to-treatment) setup variation. Results: The mean treatment position deviations were 3.3 mm anterior and 5.2 mm posterior with the tattoo method for the prostate and rectal patients, respectively. These mean position deviations were 0.4/0.1 mm anterior with the fixed height technique. The total setup variations were 4.6/5.2 mm (1 SD) with tattoo localization and 1.7/1.5 mm (1 SD) with the fixed height method. Similarly, random variation was 2.3/3.3 mm (1 SD) with the tattoo method compared to 1.3/1.2 mm (1 SD) with the fixed height method. Systematic variation was 3.7/4.5 mm (1 SD) compared to 1.2/1.1 mm (1 SD). Conclusion: The fixed

  18. A three-dimensional definition of nodal spaces on the basis of CT images showing enlarged nodes for pelvic radiotherapy

    International Nuclear Information System (INIS)

    Portaluri, Maurizio; Bambace, Santa; Perez, Celeste; Angone, Grazia

    2005-01-01

    Purpose: To demonstrate that margins of each pelvic chain may be derived by verifying the bony and soft tissue structures around abnormal nodes on computed tomography (CT) slices. Methods and Materials: Twenty consecutive patients (16 males, 4 females; mean age, 66 years; range, 43-80 years) with radiologic diagnosis of nodal involvement by histologically proved cervix carcinoma (two), rectum carcinoma (three), prostate carcinoma (four), lymphoma (five), penis carcinoma (one), corpus uteri carcinoma (one), bladder carcinoma (two), cutis tumor (one), and soft-tissue sarcoma (one) were retrospectively reviewed. One hundred CT scans showing 85 enlarged pelvic nodes were reviewed by two radiation oncologists (M.P., S.B.), and two radiologists (C.P., G.A.). Results: The more proximal structures to each enlarged node or group of nodes were thus recorded in a clockwise direction. Conclusion: According to their frequency and visibility, craniocaudal, anterior, lateral, posterior and medial margins of common iliac, external and internal iliac nodal chains, obturator and pudendal nodes, and deep and superficial inguinal nodes were derived from CT observations

  19. The Early Result of Whole Pelvic Radiotherapy and Stereotactic Body Radiotherapy Boost for High Risk Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Yu-Wei eLin

    2014-10-01

    Full Text Available PurposeThe rationale for hypofractionated radiotherapy in the treatment of prostate cancer is based on the modern understanding of radiobiology and advances in stereotactic body radiotherapy (SBRT techniques. Whole-pelvis irradiation combined with SBRT boost for high-risk prostate cancer might escalate biologically effective dose without increasing toxicity. Here, we report our 4-year results of SBRT boost for high-risk localized prostate cancer.Methods and MaterialsFrom October 2009 to August 2012, 41 patients of newly diagnosed, high-risk or very high-risk (NCCN definition localized prostate cancer patients were treated with whole-pelvis irradiation and SBRT boost. The whole pelvis dose was 45Gy (25 fractions of 1.8Gy. The SBRT boost dose was 21 Gy (three fractions of 7 Gy. Ninety percent of these patients received hormone therapy. The toxicities of gastrointestinal (GI and genitourinary (GU tracts were scored by Common Toxicity Criteria Adverse Effect (CTCAE v3.0. Biochemical failure was defined by Phoenix definition.ResultsMedian follow-up was 42 months. Mean PSA before treatment was 44.18 ng/ml. Mean PSA level at 3, 6, 12, 18, and 24 months was 0.94, 0.44, 0.13, 0.12, and 0.05 ng/ml, respectively. The estimated 4-year biochemical failure-free survival was 91.9%. Three biochemical failures were observed. GI and GU tract toxicities were minimal. No grade 3 acute GU or GI toxicity was noted. During radiation therapy, 27% of the patient had grade 2 acute GU toxicity and 12% had grade 2 acute GI toxicity. At 3 months, most toxicity scores had returned to baseline. At the last follow up, there was no grade 3 late GU or GI toxicity.ConclusionsWhole-pelvis irradiation combined with SBRT boost for high-risk localized prostate cancer is feasible with minimal toxicity and encouraging biochemical failure-free survival. Continued accrual and follow-up would be necessary to confirm the biochemical control rate and the toxicity profiles.

  20. External radiotherapy in macular degeneration: technique and preliminary subjective response

    International Nuclear Information System (INIS)

    Freire, Jorge; Longton, Wallace A.; Miyamoto, Curtis T.; Brady, Luther W.; Augsburger, James; Brown, Gary; Micaily, Bizhan; Unda, Ricardo

    1996-01-01

    Purpose: This study attempted to assess the toxicity and possible preliminary benefits from the administration of low-dose external beam irradiation for age-related macular degeneration (ARMD). The premise of the treatment is that radiation induces regression and/or promotes inactivation of the subretinal neovasculature which would result in reabsorption of fluid and blood. This would reduce the risk for further leakage or bleeding, as well as subretinal fibrosis. Consequently, the beneficial effect could be translated into stabilization of visual acuity and prevention of progression of the wet ARMD with the possibility for slight improvement. Methods and Materials: Allegheny University Department of Radiation Oncology treated 41 patients prospectively from January through October 1995 with low-dose irradiation for wet-type macular degeneration. A total of 39 patients were treated with a total dose of 14.4 Gy in eight fractions of 1.8 Gy/fraction over 10-13 elapsed days. The first two patients were treated with a total dose of 10 Gy in fivefractions of 2 Gy. Patients were evaluated at 2-3 weeks and 2-3 months. Some of the patients (36.7%) had laser treatments in the study eye: 21.9% (9) once, 5% (2) twice, 9.7% (4) thrice or more. Subjective visual acuity and toxicity data were collected on all patients. Results: At 2-3 weeks after treatment 29 patients (70%) retained their visual acuity without change, 10 (24.5%) stated they had improved vision, and 2 (4.8%) stated their vision continued to decrease. At 2-3 months after treatment, 27 patients (65.8%) had no change in their vision, 11 (27%) had an improvement in their vision, and 3 (7.2%) had a decrease in visual acuity. Six patients of 41 in the treated group had acute transient side effects. Conclusion: Our observations in this group of 41 patients support the conclusion that many patients will have improved or stable vision after treatment with low-dose irradiation for age-related wet-type macular degeneration

  1. The normal tissue sparing obtained with simultaneous treatment of pelvic lymph nodes and bladder using intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Soendergaard, Jimmi; Hoeyer, Morten; Wright, Pauliina; Grau, Cai; Muren, Ludvig Paul; Petersen, Joergen B.

    2009-01-01

    We have implemented an intensity-modulated radiotherapy (IMRT) protocol for simultaneous irradiation of bladder and lymph nodes. In this report, doses to normal tissue from IMRT and our previous conformal sequential boost technique are compared. Material and methods. Sixteen patients with urinary bladder cancer were treated using a six-field dynamic IMRT beam arrangement delivering 60 Gy to the bladder and 48 Gy to the pelvic lymph nodes. Dose-volume histogram (DVH) parameters for relevant normal tissues (bowel, bowel cavity, rectum and femoral heads) for the IMRT plans were compared with corresponding DVHs from our previous conformal sequential boost technique. Calculations of the generalized Equivalent Uniform Dose (gEUD) were performed for the bowel, with a reference volume of 200 cm 3 and a volume effect parameter k = 4, as well as for the rectum, using k = 12. Acute gastrointestinal (GI) and genitourinary (GU) RTOG toxicity was recorded. Results. Statistical significant normal tissue sparing was obtained by IMRT. For the bowel, a significant reduction was obtained at all dose levels between 20 and 50 Gy (p 3 at 50 Gy, while the gEUD was reduced from 58 to 53 Gy (p 3 at 50 Gy. The rectum gEUD was reduced from 55 to 53 Gy (p < 0.05). For the femoral heads, IMRT reduced the maximum dose as well as the volumes above all dose levels. The rate of acute peak Grade 2 GI RTOG complications was 38% after IMRT. Conclusion. IMRT to the urinary bladder and elective lymph nodes result in considerable normal tissue sparing compared to conformal sequential boost technique. This has paved the way for further studies combining IMRT with image-guided radiotherapy (IGRT) in bladder cancer

  2. Dose perturbation due to the presence of a prostatic urethral stent in patients receiving pelvic radiotherapy: an in vitro study.

    Science.gov (United States)

    Gez, E; Cederbaum, M; Yachia, D; Bar-Deroma, R; Kuten, A

    1997-01-01

    Temporary metallic intraprostatic stent is a new alternative treatment for patients with urinary obstructive syndrome caused by prostate cancer. Definitive radiotherapy is a treatment of choice for localized prostate cancer. This study evaluates in vitro the effect of a urethral intraprostatic metallic stent on the dose absorbed by the surrounding tissue. The study was designed to mimic the conditions under which the prostatic stent is placed in the body during pelvic irradiation. A urethral stent composed of a 50% nickel-50% titanium alloy (Uracoil-InStent) was imbedded in material mimicking normal tissue (bolus) at a simulated body depth of 10 cm. The distribution of the absorbed dose of irradiation was determined by film dosimetry using Kodak X-Omat V film. Irradiation was done in a single field at the isocenter of a 6 MV linear accelerator with a field size of 7 x 7 cm. The degree of film blackening was in direct proportion to the absorbed dose. The measurements showed an increase in dose of up to 20% immediately before the stent and a decrease of up to 18% immediately after the stent. These changes occurred within a range of 1-3 mm from both sides of the stent. In practice, irradiation in prostate cancer is given by two pairs of opposed co-axial fields; a total of four fields (Box Technique). The dose perturbations are partly cancelled in a pair of opposed beams resulting in a net variation of +/- 4%; therefore, the presence of the intraprostatic stent should not influence radiotherapy planning for prostate cancer.

  3. Dosimetric comparison between intensity modulated brachytherapy versus external beam intensity modulated radiotherapy for cervix cancer: a treatment planning study

    International Nuclear Information System (INIS)

    Subramani, V.; Sharma, D.N.; Jothy Basu, K.S.; Rath, G.K.; Gopishankar, N.

    2008-01-01

    To evaluate the dosimetric superiority of intensity modulated brachytherapy (IMBT) based on inverse planning optimization technique with classical brachytherapy optimization and also with external beam intensity modulated radiotherapy planning technique in patients of cervical carcinoma

  4. Neural Stem Cell-Preserving External-Beam Radiotherapy of Central Nervous System Malignancies

    International Nuclear Information System (INIS)

    Barani, Igor J.; Cuttino, Laurie W.; Benedict, Stanley H.; Todor, Dorin; Bump, Edward A.; Wu Yan; Chung, Theodore D.; Broaddus, William C.; Lin, Peck-Sun

    2007-01-01

    Purpose: Recent discoveries have implicated neural stem cells (NSC) as the source of plasticity and repair in the mature mammalian brain. Treatment-induced NSC dysfunction may lead to observed toxicity. This study evaluates the feasibility of NSC-preserving external beam radiotherapy. Methods and Materials: A single computed tomography (CT) dataset depicting a right periventricular lesion was used in this study as this location reflects the most problematic geometric arrangement with respect to NSC preservation. Conventional and NSC preserving radiotherapy (RT) plans were generated for the same lesion using two clinical scenarios: cerebral metastatic disease and primary high-grade glioma. Disease-specific target volumes were used. Metastatic disease was conventionally treated with whole-brain radiotherapy (WBRT) to 3,750 cGy (15 fractions) followed by a single stereotactic radiosurgery (SRS) boost of 1,800 cGy to gross disease only. High-grade glioma was treated with conventional opposed lateral and anterior superior oblique beams to 4,600 cGy (23 fractions) followed by a 1,400 cGy (7 fractions) boost. NSC preservation was achieved in both scenarios with inverse-planned intensity modulated radiotherapy (IMRT). Results: Cumulative dose reductions of 65% (metastatic disease) and 25% (high-grade glioma) to the total volume of the intracranial NSC compartments were achieved with NSC-preserving IMRT plans. The reduction of entry and exit dose to NSC niches located contralateral to the target contributed most to NSC preservation. Conclusions: Neural stem cells preservation with current external beam radiotherapy techniques is achievable in context of both metastatic brain disease and high-grade glioma, even when the target is located adjacent to a stem cell compartment. Further investigation with clinical trials is warranted to evaluate whether NSC preservation will result in reduced toxicity

  5. Guidelines for the preparation of a quality manual for external audit groups on dosimetry in radiotherapy

    International Nuclear Information System (INIS)

    Izewska, Joanna; Arib, M.; Saravi, M.

    2002-01-01

    This document has been prepared within the framework of a Co-ordinated Research Programme (CRP) on Development of Quality Assurance Programme for Radiation Therapy Dosimetry in Developing Countries, during two Meetings at the IAEA Headquarters in Vienna (11-14 November 1996 and 6-10 October 1997). It is based on the recommendations of ISO 9000 series and ISO/IEC guide No. 25. The document can be used as a guide on how to prepare a quality manual for national External Audit Groups (EAG), i.e., a nationally recognised group in charge of operating external quality audits for radiotherapy dosimetry. The EAG of a given country includes the SSDL, a Measuring Group and a Medical Physics Group, who work in close co-operation at all steps of the audit. The content herein should be considered as a suggestion and additions or deletions can be made in accordance with the specific conditions in each country. It is preferable that the manual itself be as concise as possible, limiting it to the core scope. Detailed working sheets describing the procedures should be included in Appendices together with data sheets, questionnaires and reporting forms. The quality manual of each country should be carefully reviewed by all members of the EAG and, as far as possible, should be approved by relevant professional bodies and supported by health authorities. It has long been recognised that accurate knowledge of the dose in radiotherapy is vital to ensure safe and effective radiation treatments. To achieve this goal, comprehensive quality assurance programmes should be established to cover all steps from dose prescription to dose delivery. These programmes should include internal checks performed by the radiotherapy centres and external audits made by independent external bodies. It is estimated that not more than 50% of radiotherapy facilities world-wide have participated in some level of dose quality audit by an independent expert. Genuine concern exists that some, or even many

  6. Finite element simulation of interactions between pelvic organs: predictive model of the prostate motion in the context of radiotherapy.

    Science.gov (United States)

    Boubaker, Mohamed Bader; Haboussi, Mohamed; Ganghoffer, Jean-François; Aletti, Pierre

    2009-08-25

    The setting up of predictive models of the pelvic organ motion and deformation may prove an efficient tool in the framework of prostate cancer radiotherapy, in order to deliver doses more accurately and efficiently to the clinical target volume (CTV). A finite element (FE) model of the prostate, rectum and bladder motion has been developed, investigating more specifically the influence of the rectum and bladder repletions on the gland motion. The required organ geometries are obtained after processing the computed tomography (CT) images, using specific softwares. Due to their structural characteristics, a 3D shell discretization is adopted for the rectum and the bladder, whereas a volume discretization is adopted for the prostate. As for the mechanical behavior modelling, first order Ogden hyperelastic constitutive laws for both the rectum and bladder are identified. The prostate is comparatively considered as more rigid and is accordingly modelled as an elastic tissue undergoing small strains. A FE model is then created, accounting for boundary and contact conditions, internal and applied loadings being selected as close as possible to available anatomic data. The order of magnitude of the prostate motion predicted by the FE simulations is similar to the measurements done on a deceased person, accounting for the delineation errors, with a relative error around 8%. Differences are essentially due to uncertainties in the constitutive parameters, pointing towards the need for the setting up of direct measurement of the organs mechanical behavior.

  7. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures.

    Science.gov (United States)

    Vigdorchik, Jonathan M; Esquivel, Amanda O; Jin, Xin; Yang, King H; Onwudiwe, Ndidi A; Vaidya, Rahul

    2012-09-27

    We have recently developed a subcutaneous anterior pelvic fixation technique (INFIX). This internal fixator permits patients to sit, roll over in bed and lie on their sides without the cumbersome external appliances or their complications. The purpose of this study was to evaluate the biomechanical stability of this novel supraacetabular pedicle screw internal fixation construct (INFIX) and compare it to standard internal fixation and external fixation techniques in a single stance pelvic fracture model. Nine synthetic pelves with a simulated anterior posterior compression type III injury were placed into three groups (External Fixator, INFIX and Internal Fixation). Displacement, total axial stiffness, and the stiffness at the pubic symphysis and SI joint were calculated. Displacement and stiffness were compared by ANOVA with a Bonferroni adjustment for multiple comparisons The mean displacement at the pubic symphysis was 20, 9 and 0.8 mm for external fixation, INFIX and internal fixation, respectively. Plate fixation was significantly stiffer than the INFIX and external Fixator (P = 0.01) at the symphysis pubis. The INFIX device was significantly stiffer than external fixation (P = 0.017) at the symphysis pubis. There was no significant difference in SI joint displacement between any of the groups. Anterior plate fixation is stiffer than both the INFIX and external fixation in single stance pelvic fracture model. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis. Combined with the presumed benefit of minimizing the complications associated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used.

  8. A comparative dosimetric study of conventional, conformal and intensity-modulated radiotherapy in postoperative pelvic irradiation of cervical cancer

    International Nuclear Information System (INIS)

    Li Bin; An Jusheng; Wu Lingying; Huang Manni; Gao Juzhen; Xu Yingjie; Dai Jianrong

    2008-01-01

    Objective: To evaluate target-volume coverage and organ at risk (OAR) protection achieved with conventional radiotherapy (CRT), three dimensional conformal radiotherapy (3DCRT), and intensity-modulated radiotherapy(IMRT) through dosimetric comparison in patients with cervical cancer after hysterectomy. Methods: The planning CT scans of 10 patients treated with pelvic radiation after hysterectomy for cervical cancer were used to generate CRT, 3DCRT and IMRT plans for this study. Clinical target volume(CTV) was contoured on the individual axial CT slices of every patient. The CTV was then uniformly expanded by 1.0 cm to create the planning target volume (PTV). The small bowel, rectum, bladder, bone marrow, ovaries, and femoral heads were outlined for the organ at risk (OAR) evaluation. The CRT, 3DCRT and IMRT plans were generated using commercial planning software. CRT plan was prescribed to deliver 45 Gy to the reference point, while IMRT and 3DCRT plans were 45 Gy to 95% of the PTV. Isodose line and dose volume histograms(DVH) were used to evaluate the dose distribution in CTV and OAR. Results: For 10 patients, the average volume of CTV receiving the prescribed dose of CRT was significantly lower than 3DCRT(Q=8.27, P<0.01) and IMRT(Q=8.37, P<0.01), respectively. Comparing with the CRT plan, the 3DCRT and IMRT plans notably reduced the volume of bowel at 30 and 45 Gy levels. The IMRT plan significantly spared rectum and bladder at 30 and 45 Gy levels comparing with the CRT (P<0.01) and 3DCRT(P<0.05) plans, while the 3DCRT plan significantly spared rectum and bladder at 45 Gy level comparing with the CRT(P<0.01) plans. For 4 patients with ovarian transposition, the average doses of ovary over 3 Gy were 2 patients with the 3 DCRT and IMRT plans, and 2 with all three plans. Conclusions: IMRT and 3DCRT are superior to CRT in improving dose coverage of target volume and sparing of OAR, while IMRT being the best. The superiority of IMRT and 3DCRT is obvious in sparing

  9. Conventional four-field pelvic radiotherapy technique without computed tomography-treatment planning in cancer of the cervix: potential geographic miss and its impact on pelvic control

    International Nuclear Information System (INIS)

    Kim, Robert Y.; McGinnis, L. Scott; Spencer, Sharon A.; Meredith, Ruby F.; Jennelle, Richard L.S.; Salter, Merle M.

    1995-01-01

    Purpose: To evaluate the impact of inadequate margins on pelvic control using the conventional four-field pelvic portals without computed tomography (CT)-treatment planning. Methods and Materials: Between 1986 and 1991, 34 patients with invasive cancer of the cervix were eligible for outcome study of conventional four-field radiation therapy (10 Stage I, 16 Stage II, 8 Stage III). The eligibility for this study includes four-field pelvic technique, definitive radiation therapy, and diagnostic CT scan of the pelvis. For this study, an inadequate margin is arbitrarily defined as ≤ 1.0 cm of normal tissue around the CT-defined tumor volume. Results: All 34 patients had adequate margins for anterio-posterior/posterio-anterior portals. However, 19 patients had an inadequate margin at the posterior border (S2-S3 interspace) and/or custom-shaped rectal block for lateral pelvic portals. Two patients had inadequate margins at the anterior border (level of symphysis pubis) due to an enlarged uterus. With a median follow-up of 36 months, pelvic control for adequate margins and inadequate margins was 100% and 71% for Stage IB disease and 88% and 50% for Stage IIB disease, respectively. However, pelvic control for Stage IIIB disease was 50% for both groups. There was no difference in total dose to point A or point B between the two groups. Conclusion: Our preliminary data show higher local failure in patients with an inadequate margin. For four-field pelvic radiation therapy, we strongly recommend CT-treatment planning. Otherwise, anterio-posterior/posterio-anterior pelvic therapy is the most reliable treatment for cancer of the uterine cervix

  10. 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

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

    International Nuclear Information System (INIS)

    Jang, Ji Young

    2008-01-01

    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 ∼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∼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 patients (6

  12. Ultrasound-guided supra-acetabular pin placement in pelvic external fixation: description of a surgical technique and results.

    Science.gov (United States)

    Chana-Rodríguez, Francisco; Cuervas-Mons, Manuel; Rojo-Manaute, José; Mora, Félix; Arnal, Juan; Vaquero-Martín, Javier

    2017-11-01

    Pelvic fracture in trauma patients can lead to hemodynamic instability. External fixation is a treatment capable of stabilizing these injuries in the context of damage control surgery. Supra-acetabular pin offers the greater biomechanical stability but requires the use of intraoperative fluoroscopy. The aim of this study was to analyze our results for an ultrasound-guided supra-acetabular pinning. Cross-sectional study with cadaveric specimens. Ultrasound-guided pin placement assessed by fluoroscopy and dissection. Fourteen ultrasound-guided supra-acetabular pins were placed in seven cadaveric specimens. Excellent placement in all cases, evaluated with radiological control. Good qualitative bone fixation after dissection. One femoral cutaneous nerve was not found during anatomic dissection and was assumed injured. Ultrasound-guided supra-acetabular pin placement is a feasible and effective technique. Our study indicates that pin placement without intraoperative fluoroscopy is feasible without compromising the reliability of its placement. © 2017 Elsevier Ltd. All rights reserved.

  13. Persistent pain after targeted intraoperative radiotherapy (TARGIT) or external breast radiotherapy for breast cancer: A randomized trial

    DEFF Research Database (Denmark)

    Andersen, Kenneth Geving; Gärtner, Rune; Kroman, Niels

    2012-01-01

    for participation, and a total of 244 patients were included and received a detailed questionnaire. The response rate was 98%, leaving 238 patients for the final analysis. Pain prevalence were 33.9% in the EBRT group and 24.6% in the IORT group (p = 0.11). Treatment with IORT may not alter the risk of PPBCT.......Persistent pain after breast cancer treatment (PPBCT) affects between 25 and 60% of patients depending on surgical and adjuvant treatment. External breast radiotherapy (EBRT) has been shown to be a riskfactor for PPBCT, raising the question whether intraoperative radiation therapy (IORT), with its...... smaller radiation field may reduce the development of PPBCT. Using data from the TARGIT-A trial, the aim of this study was to compare these two treatments with regard to development of PPBCT. A total of 281 patients enrolled in the TARGIT-A trial from the Copenhagen University Hospitals was screened...

  14. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

    Energy Technology Data Exchange (ETDEWEB)

    Droege, L.H.; Hinsche, T.; Hess, C.F.; Wolff, H.A. [University Hospital of Goettingen, Department of Radiotherapy and Radiation Oncology, Goettingen (Germany); Canis, M. [University of Goettingen, Department of Otorhinolaryngology, Head and Neck Surgery, Goettingen (Germany); Alt-Epping, B. [University of Goettingen, Department of Palliative Medicine, Goettingen (Germany)

    2014-02-15

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. (orig.)

  15. A Preliminary Design Of Application Of Wireless Identification And Sensing Platform On External Beam Radiotherapy

    Science.gov (United States)

    Heranudin; Bakhri, S.

    2018-02-01

    A linear accelerator (linac) is widely used as a means of radiotherapy by focusing high-energy photons in the targeted tumor of patient. Incorrectness of the shooting can lead normal tissue surrounding the tumor received unnecessary radiation and become damaged cells. A method is required to minimize the incorrectness that mostly caused by movement of the patient during radiotherapy process. In this paper, the Wireless Identification and Sensing Platform (WISP) architecture was employed to monitor in real time the movement of the patient’s body during radiotherapy process. In general, the WISP is a wearable sensors device that can transmit measurement data wirelessly. In this design, the measurement devices consist of an accelerometer, a barometer and an ionizing radiation sensor. If any changes in the body position which resulted in incorrectness of the shooting, the accelerometer and the barometer will trigger a warning to the linac operator. In addition, the radiation sensor in the WISP will detect unwanted radiation and that can endanger the patient. A wireless feature in this device can ease in implementation. Initial analyses have been performed and showed that the WISP is feasible to be applied on external beam radiotherapy.

  16. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

    International Nuclear Information System (INIS)

    Droege, L.H.; Hinsche, T.; Hess, C.F.; Wolff, H.A.; Canis, M.; Alt-Epping, B.

    2014-01-01

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting. (orig.)

  17. External beam radiotherapy dose response characteristics of 1127 men with prostate cancer treated in the PSA era

    International Nuclear Information System (INIS)

    Pollack, Alan; Smith, Lewis G.; Eschenbach, Andrew C. von

    2000-01-01

    Purpose: To characterize the relationship of radiotherapy dose to prostate cancer patient outcome, with an emphasis on the influence of pretreatment prognostic variables. Methods and Materials: The 1127 Stage T1-T4 prostate cancer patients examined were treated consecutively with definitive external beam radiotherapy at the University of Texas-M.D. Anderson Cancer Center from 1987 to 1997. All had a pretreatment prostate-specific antigen (PSA) level. Treatment failure was defined as two consecutive PSA elevations on follow-up. There were 994 patients treated with a four-field box throughout to 60-70 Gy after a small reduction at 46 Gy and 161 treated with a six-field conformal boost after 46 Gy to 74-78 Gy. No patient received neoadjuvant or adjuvant androgen ablation. Median follow-up was 51.8 months. Results: Patients were divided into three radiotherapy dose groups consisting of ≤67 Gy (n = 500), >67-77 Gy (n = 495), and >77 Gy (n = 132). Relative to other prognostic factors, there were fewer patients treated to the highest dose level with a pretreatment PSA (PSAB) ≤4 or >20 ng/ml, Stage T3/T4 disease, or a Gleason score of 2-6. Actuarial 4-year freedom from biochemical failure (bNED) rates for the entire cohort were 54%, 71%, and 77% (p 67-77 Gy was associated with improved bNED rates for all PSAB (≤10 and >10), stage (T1/T2 and T3/T4), and Gleason score (2-6 and 7-10) subgroups tested. In contrast, the only prognostic group that benefited from raising dose from >67-77 Gy to >77 Gy was patients with a PSAB >10 ng/ml; although trends were noted for Stage T1/T2 and Gleason 2-6 patients. Patients with the combined features of a PSAB >10 ng/ml and Stage T1/T2 disease had 4-year bNED rates of 61% and 93% at the intermediate- and high-dose levels. A strongly significant linear association between dose (60-78 Gy) and 4-year actuarial bNED was demonstrated for patients with these intermediate-risk features. Conclusion: Prostate cancer dose response to external

  18. Treatment of bulky stage IB and IIB cervical cancers with outpatient neutron brachytherapy, external pelvic radiation and extrafascial hysterectomy

    International Nuclear Information System (INIS)

    Van Nagell, J.R.; Maruyama, Y.; Yoneda, J.; Donaldson, E.S.; Hanson, M.B.; Gallion, H.H.; Powell, D.E.; Kryscio, R.J.

    1986-01-01

    From January, 1977, to December, 1982, twenty-nine patients with bulky (>4 cms diameter) Stage IB or IIB cervical cancer were treated at the University of Kentucky Medical Center by a combination of out-patient neutron brachytherapy (Cf-252) and external pelvic radiation followed by extrafascial hysterectomy. Residual tumor was present in the hysterectomy specimens of 25 per cent. Complications during and following radiation therapy and surgery were minimal and included vaginal stenosis, proctitis, and hemorrhagic cystitis. The mean duration of hospitalization for surgery in these patients was 6.6 days (range 5-15 days) and postoperative morbidity was low. No patient required blood transfusion. Four patients developed urinary tract infections and two had superficial wound separations. Following treatment, patients were seen at monthly intervals for one year, every three months for two years, and every six months thereafter. No patient has been lost to follow-up. Two patients (7 per cent) developed tumor recurrence and have died of disease (1 of distant metastases; 1 local). The remaining 27 patients (93 per cent) are alive and well with no evidence of disease 24-89 months (mean 48 months) after therapy. No radiogenic fistulae or bowel obstruction were observed. These preliminary results suggest that the combination of outpatient neutron brachytherapy, external pelvic radiation, and extrafascial hysterectomy for patients with Stage IB and IIB cervical cancer is well tolerated. Complications associated with this treatment regimen have been minimal, and the recurrence rate is low. The duration of intracavitary neutron brachytherapy was short, and outpatient therapy was well received by patients

  19. External beam radiotherapy of localized prostatic adenocarcinoma. Evaluation of conformal therapy, field number and target margins

    International Nuclear Information System (INIS)

    Lennernaes, B.; Rikner, G.; Letocha, H.; Nilsson, S.

    1995-01-01

    The purpose of the present study was to identify factors of importance in the planning of external beam radiotherapy of prostatic adenocarcinoma. Seven patients with urogenital cancers were planned for external radiotherapy of the prostate. Four different techniques were used, viz. a 4-field box technique and four-, five- or six-field conformal therapy set-ups combined with three different margins (1-3 cm). The evaluations were based on the doses delivered to the rectum and the urinary bladder. A normal tissue complication probability (NTCP) was calculated for each plan using Lyman's dose volume reduction method. The most important factors that resulted in a decrease of the dose delivered to the rectum and the bladder were the use of conformal therapy and smaller margins. Conformal therapy seemed more important for the dose distribution in the urinary bladder. Five- and six-field set-ups were not significantly better than those with four fields. NTCP calculations were in accordance with the evaluation of the dose volume histograms. To conclude, four-field conformal therapy utilizing reduced margins improves the dose distribution to the rectum and the urinary bladder in the radiotherapy of prostatic adenocarcinoma. (orig.)

  20. External radiotherapy prior to thyroid cancer: A case-control study

    International Nuclear Information System (INIS)

    Hallquist, A.; Loefroth, P.O.; Hardell, L.

    1993-01-01

    The aim of this investigation was to study previous radiotherapy of malignant diseases as a risk factor for thyroid cancer. By using the Swedish Cancer Registry all cases of thyroid cancer with another malignant disease at least one year previously and living within the catchment area of the hospital were traced. During 1959-1989 a total of 1056 cases of thyroid cancer were identified. Of these, 37 had had another previous malignant disease and they constituted the cases in this study. As controls four persons with at least two malignant diseases, thyroid cancer excluded, were selected for each case from the same cancer registry. Ten (27.0%) of the 37 patients with thyroid cancer as a second tumor had earlier been irradiated with the treatment dose including the thyroid gland as compared with 34 (24.5%) of the 139 control patients. Eight of the ten cases with previous irradiation of the thyroid gland had papillary cancer. The median latency was 13 years. The estimated radiation dose in the thyroid varied between 3 and 40 Gy. External radiotherapy gave a crude odds ratio of 1.1 with 95% confidence interval = 0.5-2.8 for thyroid cancer. The weighted odds ratio was calculated to 2.3 with confidence interval = 0.5-8.9. This case-control study gave a nonsignificantly increased odds ratio for thyroid cancer in patients with external radiotherapy including the thyroid gland. 26 refs., 4 tabs

  1. Prospective analysis of patient-reported late toxicity following pelvic radiotherapy for gynaecological cancer

    International Nuclear Information System (INIS)

    Barraclough, Lisa H.; Routledge, Jacqueline A.; Farnell, Damian J.J.; Burns, Meriel P.; Swindell, Ric; Livsey, Jacqueline E.; Davidson, Susan E.

    2012-01-01

    Background and purpose: As late radiotherapy toxicity impacts negatively on the quality-of-life of cancer survivors and is often under reported, a study was set up to prospectively collect patient-reported data in an unselected series of patients with gynaecological malignancy. Aim 1 – To provide 3 year results for the longitudinal study. Aim 2 – To improve the questionnaire used to collect data by identifying redundant items and modifying for use to collect Common Terminology Criteria for Adverse Events (CTCAE) data. Material and methods: Aim 1 – Patient reported outcome data were collected prospectively by 226 patients before and up to 3 years following radiotherapy for gynaecological cancer using a questionnaire developed to collect LENT subjective data. Aim 2 – A factor analysis was performed to identify which questions gave the most and least information. Results: Aim 1 – Faecal urgency and incontinence (all grades) peaked at 79% and 24%, respectively at 1 year then settled to 69% and 18% at 3 years, respectively. Urinary urgency (all grades) increased with time and was described in 75% at 3 years. Other symptoms reported at 3 years include diarrhoea in 12%, urinary incontinence in 27% and vaginal dryness in 29%. A third of patients did not feel their sex life had changed following treatment, while a quarter felt that it had. Aim 2 – some questions overlapped and others were non-specific. The questionnaire has subsequently been altered. Conclusions: The extent of late toxicity is substantial. This detailed information is important for both patients and clinicians in terms of treatment decisions and follow-up care. The LENT questionnaire provides a feasible tool for capture of this information in the clinic.

  2. Six fractions per week of external beam radiotherapy and high-dose-rate brachytherapy for carcinoma of the uterine cervix: A phase I/II study

    International Nuclear Information System (INIS)

    Yoon, Sang Min; Huh, Seung Jae; Park, Won; Lee, Jeung Eun; Park, Young Je; Nam, Hee Rim; Lim, Do Hoon; Ahn, Yong Chan

    2006-01-01

    Purpose: This study evaluated the treatment results of external beam radiotherapy administered in six fractions per week and high-dose-rate (HDR) brachytherapy for the treatment of cervical cancer. Methods and Materials: From July 2000 to July 2003, 43 patients were enrolled in this study. The patients received 45 Gy from a 10-MV photon beam using four-field box or anterior-posterior beams. Parametrial regions and the pelvic side walls were boosted with up to 50.4 Gy using a midline block. The daily fraction dose was 1.8 Gy administered in six-weekly fractions, from Monday to Saturday. HDR brachytherapy was also delivered at doses of 24 Gy to point A in six fractions twice a week. The median follow-up time was 37 months (range, 9-60 months). Results: The median overall treatment time was 51 days for all patients (range, 44-62 days). Thirty-four patients (79.1%) achieved complete remission and 8 (18.6%) achieved partial remission after radiotherapy. Locoregional recurrence occurred in 5 patients (11.6%), and a distant metastasis was encountered in 6 patients (13.9%). The 3-year overall survival, locoregional, and distant metastasis-free survival rates were 74.7%, 87.8%, and 84.7%, respectively. Grade 2 and 3 late rectal complications were encountered in 3 (6.5%) and 1 (2.2%), respectively. There were no Grade 3 late bladder complications. Conclusions: Six fractions per week of external beam radiotherapy and HDR brachytherapy is an effective treatment for patients with a carcinoma of the uterine cervix and can be used as a possible alternative to concomitant chemoradiotherapy in elderly patients or in patients with co-morbidity

  3. Differentiated Thyroid Cancer with Extrathyroidal Extension: Prognosis and the Role of External Beam Radiotherapy

    Directory of Open Access Journals (Sweden)

    Michael A. Sia

    2010-01-01

    Full Text Available A study was performed to identify variables that affected cause-specific survival (CSS and local relapse-free rate (LRFR in patients with differentiated thyroid cancer (DTC and extrathyroid extension (ETE and to examine the role of external beam radiotherapy (XRT. Prognostic factors were similar to those found in studies of all patients with DTC. In patients with postoperative gross residual disease treated with radiotherapy, 10-year CSS and LRFR were 48% and 90%. For patients with no residual or microscopic disease, 10-year CSS and LRFR were 92% and 93%. In patients older than 60 years with T3 ETE but no gross residual disease postoperatively there was an improved LRFR at 5 years of 96%, compared to 87.5% without XRT (P=.02. Patients with gross ETE benefit from XRT and there may be a potential benefit in reducing locoregional failure in patients over 60 years with minimal extrathyroidal extension (T3.

  4. Radiation safety assessment of cobalt 60 external beam radiotherapy using the risk-matrix method

    International Nuclear Information System (INIS)

    Dumenigo, C; Vilaragut, J.J.; Ferro, R.; Guillen, A.; Ramirez, M.L.; Ortiz Lopez, P.; Rodriguez, M.; McDonnell, J.D.; Papadopulos, S.; Pereira, P.P.; Goncalvez, M.; Morales, J.; Larrinaga, E.; Lopez Morones, R.; Sanchez, R.; Delgado, J.M.; Sanchez, C.; Somoano, F.

    2008-01-01

    External beam radiotherapy is the only practice in which humans are placed directly in a radiation beam with the intention to deliver a very high dose. This is why safety in radiotherapy is very critical, and is a matter of interest to both radiotherapy departments and regulatory bodies. Accidental exposures have occurred throughout the world, thus showing the need for systematic safety assessments, capable to identify preventive measures and to minimize consequences of accidental exposure. Risk-matrix is a systematic approach which combines the relevant event features to assess the overall risk of each particular event. Once an event sequence is identified, questions such as how frequent the event, how severe the potential consequences and how reliable the existing safety measures are answered in a risk-matrix table. The ultimate goal is to achieve that the overall risk for events with severe consequences should always be low o very low. In the present study, the risk-matrix method has been applied to an hypothetical radiotherapy department, which could be equivalent to an upper level hospital of the Ibero American region, in terms of safety checks and preventive measures. The application of the method has identified 76 event sequences and revealed that the hypothetical radiotherapy department is sufficiently protected (low risk) against them, including 23 event sequences with severe consequences. The method has revealed that the risk of these sequences could grow to high level if certain specific preventive measures were degraded with time. This study has identified these preventive measures, thus facilitating a rational allocation of resources in regular controls to detect any loss of reliability. The method has proven to have an important practical value and is affordable at hospital level. The elaborated risk-matrix can be easily adapted to local circumstances, in terms of existing controls and safety measures. This approach can help hospitals to identify

  5. Defining patient-based minimal clinically important effect sizes: a study in palliative radiotherapy for painful unresectable pelvic recurrences from rectal cancer

    International Nuclear Information System (INIS)

    Wong, Rebecca K.S.; Gafni, Amiram; Whelan, Tim; Franssen, Edmee; Fung, Karen

    2002-01-01

    Purpose: To measure patient-based minimal clinically important effect sizes (minimal incremental benefit that an individual would require to accept one treatment option over another) for pain relief between two contrasting palliative radiotherapy regimens for painful pelvic recurrences from rectal cancer. Methods and Materials: Forty-three patients with a history of cancer pain without prior pelvic radiotherapy participated in decision aid-facilitated trade-off exercises. The clinical scenario and treatment options of a 5-day vs. a 20-day course of radiotherapy were described. The duration of pain relief for the 20-day regimen was increased until the respondents' preferences switched to the 20-day regimen. The exercises were repeated for different probabilities of benefit and pain intensity at the time of decision making. Results: When the probability of pain relief was unchanged, the median switch point for the duration of pain relief was 6.7 and 7.2 months for severe and mild pain, respectively. The cumulative percentage frequency curve for the switch points approximated a sigmoid distribution. Conclusion: Determining the minimal clinically important effect sizes for symptom relief for palliative therapies is feasible. This type of information can be used to incorporate patient values into clinical trial designs. Modification of this method can be used to improve our understanding of shared (physician and patient) decision making

  6. Internal Motion Estimation by Internal-external Motion Modeling for Lung Cancer Radiotherapy.

    Science.gov (United States)

    Chen, Haibin; Zhong, Zichun; Yang, Yiwei; Chen, Jiawei; Zhou, Linghong; Zhen, Xin; Gu, Xuejun

    2018-02-27

    The aim of this study is to develop an internal-external correlation model for internal motion estimation for lung cancer radiotherapy. Deformation vector fields that characterize the internal-external motion are obtained by respectively registering the internal organ meshes and external surface meshes from the 4DCT images via a recently developed local topology preserved non-rigid point matching algorithm. A composite matrix is constructed by combing the estimated internal phasic DVFs with external phasic and directional DVFs. Principle component analysis is then applied to the composite matrix to extract principal motion characteristics, and generate model parameters to correlate the internal-external motion. The proposed model is evaluated on a 4D NURBS-based cardiac-torso (NCAT) synthetic phantom and 4DCT images from five lung cancer patients. For tumor tracking, the center of mass errors of the tracked tumor are 0.8(±0.5)mm/0.8(±0.4)mm for synthetic data, and 1.3(±1.0)mm/1.2(±1.2)mm for patient data in the intra-fraction/inter-fraction tracking, respectively. For lung tracking, the percent errors of the tracked contours are 0.06(±0.02)/0.07(±0.03) for synthetic data, and 0.06(±0.02)/0.06(±0.02) for patient data in the intra-fraction/inter-fraction tracking, respectively. The extensive validations have demonstrated the effectiveness and reliability of the proposed model in motion tracking for both the tumor and the lung in lung cancer radiotherapy.

  7. Closed External End Double J Catheter as a Nephrostent in Pyeloplasty for Infants with Uretero-Pelvic Junction Obstruction

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Reza Rabani

    2010-12-01

    Full Text Available Uretero-Pelvic Junction Obstruction (UPJO is a common congenitalanomaly that may need pyeloplasty to prevent renalfunction deterioration. The purpose of this study was to describea modified use of jj stent catheter in pyeloplasty for infantwith UPJO. A series of 12 children, between 3 and 10months, underwent stenting open pyeloplasty. In each patient a6 French Foley catheter was placed within the bladder. One mlsterile methylene blue was instilled into the catheter, which wasclamped during the operation time. During a dismembered pyeloplasty,a small (3F double j stent was placed through theflank into renal pelvis, passing the flank skin, muscles and enteringvia lower pole posteriorly to pass the anastomosis andentering the ureter and urinary bladder, confirmed by observingmethylene blue within the wound. The external end of the jjcatheter was doubled up and sutured to the flank skin and thenremoved 4 weeks later. No procedure related complication(ssuch as extravasation, infection, and stent displacement wasseen. The duration of follow up was 6 months to 3 years. Thismethod of stenting pyeloplasty is easily tolerated and causes noneed for endoscopic removal of the catheter. It is an invaluabletechnique of pyeloplasty with stenting in very small children,and needs no external appliance.Iran J Med Sci 2010; 35(4: 319-322.Keywords ● Hydronephrosis ● newborn infant

  8. Observer variability when evaluating patient movement from electronic portal images of pelvic radiotherapy fields

    International Nuclear Information System (INIS)

    Geraint Lewis, D.; Ryan, Karen R.; Smith, Cyril W.

    2005-01-01

    Background and purpose: A study has been performed to evaluate inter-observer variability when assessing pelvic patient movement using an electronic portal imaging device (EPID). Materials and methods: Four patient image sets were used with 3-6 portal images per set. The observer group consisted of nine radiographers with 3-18 months clinical EPID experience. The observers outlined bony landmarks on a digital simulator image and used matching software to evaluate field placement errors (FPEs) on each portal image relative to the reference simulator image. Data were evaluated statistically, using a two-component analysis of variance technique, to quantify both the inter-observer variability in evaluating FPEs and inter-fraction variability in patient position relative to the residuals of the analysis. Intra-observer variability was also estimated using four of the observers carrying out three sets of repeat readings. Results: Eight sets of variance data were analysed, based on FPEs in two orthogonal directions for each of the four patient image sets studied. Initial analysis showed that both inter-observer variation and inter-fraction-patient position variation were statistically significant (P<0.05) in seven of the eight cases evaluated. The averaged root-mean-square (RMS) deviation of the observers from the group mean was 1.1 mm, with a maximum deviation of 5.0 mm recorded for an individual observer. After additional training and re-testing of two of the observers who recorded the largest deviations from the group mean, a subsequent analysis showed the inter-observer variability for the group to be significant in only three of the eight cases, with averaged RMS deviation reduced to 0.5 mm, with a maximum deviation of 2.7 mm. The intra-observer variability was 0.5 mm, averaged over the four observers tested. Conclusions: We have developed a quantitative approach to evaluate inter-observer variability in terms of its statistical significance compared to inter

  9. Adaptive radiotherapy strategies for pelvic tumors - a systematic review of clinical implementations

    DEFF Research Database (Denmark)

    Thörnqvist, Sara; Hysing, Liv B; Tuomikoski, Laura

    2016-01-01

    Med. For each tumor site, the identified papers were screened independently by two researches for selection of studies describing all processes of an ART workflow: treatment monitoring and evaluation, decision and execution of adaptations. Both brachytherapy and external beam studies were eligible for review...... patients were treated with offline re-planning, all to account for tumor regression detected by magnetic resonance imaging (MRI)/computed tomography (CT). For bladder and gyne, 161 and 64 patients, respectively, were treated with library-based online plan selection to account for target volume and shape...

  10. Poster - 32: Atlas Selection for Automated Segmentation of Pelvic CT for Prostate Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mallawi, Abrar; Farrell, TomTom; Diamond, Kevin-Ross; Wierzbicki, Marcin [McMaster University / National Guard Health Affairs, Radiation Oncology Department, Riyadh, Saudi Arabia, McMaster University / Juravinski Cancer Centre, McMaster University / Juravinski Cancer Centre, McMaster University / Juravinski Cancer Centre (Saudi Arabia)

    2016-08-15

    Atlas based-segmentation has recently been evaluated for use in prostate radiotherapy. In a typical approach, the essential step is the selection of an atlas from a database that the best matches of the target image. This work proposes an atlas selection strategy and evaluate it impacts on final segmentation accuracy. Several anatomical parameters were measured to indicate the overall prostate and body shape, all of these measurements obtained on CT images. A brute force procedure was first performed for a training dataset of 20 patients using image registration to pair subject with similar contours; each subject was served as a target image to which all reaming 19 images were affinity registered. The overlap between the prostate and femoral heads was quantified for each pair using the Dice Similarity Coefficient (DSC). Finally, an atlas selection procedure was designed; relying on the computation of a similarity score defined as a weighted sum of differences between the target and atlas subject anatomical measurement. The algorithm ability to predict the most similar atlas was excellent, achieving mean DSCs of 0.78 ± 0.07 and 0.90 ± 0.02 for the CTV and either femoral head. The proposed atlas selection yielded 0.72 ± 0.11 and 0.87 ± 0.03 for CTV and either femoral head. The DSC obtained with the proposed selection method were slightly lower than the maximum established using brute force, but this does not include potential improvements expected with deformable registration. The proposed atlas selection method provides reasonable segmentation accuracy.

  11. Poster - 32: Atlas Selection for Automated Segmentation of Pelvic CT for Prostate Radiotherapy

    International Nuclear Information System (INIS)

    Mallawi, Abrar; Farrell, TomTom; Diamond, Kevin-Ross; Wierzbicki, Marcin

    2016-01-01

    Atlas based-segmentation has recently been evaluated for use in prostate radiotherapy. In a typical approach, the essential step is the selection of an atlas from a database that the best matches of the target image. This work proposes an atlas selection strategy and evaluate it impacts on final segmentation accuracy. Several anatomical parameters were measured to indicate the overall prostate and body shape, all of these measurements obtained on CT images. A brute force procedure was first performed for a training dataset of 20 patients using image registration to pair subject with similar contours; each subject was served as a target image to which all reaming 19 images were affinity registered. The overlap between the prostate and femoral heads was quantified for each pair using the Dice Similarity Coefficient (DSC). Finally, an atlas selection procedure was designed; relying on the computation of a similarity score defined as a weighted sum of differences between the target and atlas subject anatomical measurement. The algorithm ability to predict the most similar atlas was excellent, achieving mean DSCs of 0.78 ± 0.07 and 0.90 ± 0.02 for the CTV and either femoral head. The proposed atlas selection yielded 0.72 ± 0.11 and 0.87 ± 0.03 for CTV and either femoral head. The DSC obtained with the proposed selection method were slightly lower than the maximum established using brute force, but this does not include potential improvements expected with deformable registration. The proposed atlas selection method provides reasonable segmentation accuracy.

  12. Time patterns of changes in biomarkers, symptoms and histopathology during pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Larsen, Annette; Dahl, Olav [Section of Oncology, Institute of Medicine, Univ. of Bergen, and Dept. of Oncology, Haukeland Univ. Hospital, Bergen (Norway); Bjoerge, Benedikte; Klementsen, Beate [National Institute of Nutrition and Seafood Research, Bergen (Norway); Helgeland, Lars [Dept. of Pathology, Haukeland Univ. Hospital, Bergen (Norway); Wentzel-Larsen, Tore [Centre for Clinical Research, Haukeland Univ. Hospital, Bergen (Norway); Fagerhol, Magne K. [Dept. of Immunology and Transfusion Medicine, Ullevaal Univ. Hospital, Oslo (Norway); Hovdenak, Nils [Dept. of Medicine, Haukeland Univ. Hospital, Bergen (Norway)

    2007-07-15

    Acute radiation proctitis was evaluated before, during and after radiotherapy (RT) for prostate cancer. The main aims of the study were to examine changes related to the increasing radiation dose, and identify surrogate markers of gastrointestinal (GI) reaction to radiation. Twenty consecutive prostate cancer patients scheduled for 7 weeks of conformal RT were prospectively included in a longitudinal study assessing symptoms, inflammation in rectal mucosa biopsies, and blood and stool samples at four time points (before RT and 2, 6 and 11 weeks after start of RT). Blood samples were examined for acute phase response-related markers, fatty acids (FAs), vitamin E and leukotriene B4 (LTB4). Lactoferrin, calprotectin and S100A12 were measured in stool samples and FAs in biopsies from rectal mucosa. The increase in histopathological inflammation reached a maximum 2 weeks after start of RT. Symptoms of GI toxicity increased with higher radiation dose and had not returned to pre-treatment level 4 weeks after RT. Lactoferrin concentrations in stool increased significantly at week 6. Significant decreases of vitamin E, leukocyte count, hemoglobin and some groups of FAs were discovered, while a few FAs increased significantly during the study period. Time courses vary between the selected indicators of acute radiation proctitis. The biopsy grading of inflammatory changes were most intense 2 weeks into the treatment period while symptoms continued to increase until week 6. Lactoferrin in stool samples could be a non-invasive marker of GI inflammation during RT. A transient decrease in vitamin E and some FAs during RT warrants further studies.

  13. Gas in the rectum tends to reduce during radical external beam radiotherapy for localised prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Naoki; Mizuno, Norifumo; Endo, Haruna; Ogita, Mami; Kawamori, Jiro; Sekigucho, Kenji; Hatanaka, Shogo; Takahashi, Osamu; Tamaki, Seiichi; Shikama, Naoto

    2014-01-01

    This study aims to clarify the time-course of gas accumulation in the rectum during treatment as guidance for the management of rectal volumes. We reviewed 2042 sets (35.2 sets per patient) of anteroposterior and right–left mega voltage (MV) images obtained for daily set-up from 58 patients who underwent radical external beam radiotherapy for localised prostate cancer. The patients were instructed to take magnesium oxide tablets during radiotherapy. They were also encouraged to avoid foods that might cause intestinal gas during radiotherapy. Gas accumulation in the rectum was graded into three classes by the same radiation oncologist. If no gas was seen in the rectum, it was classified as grade 0. A small amount of gas was classified as grade 1, whereas a marked amount of gas that required removal was classified as grade 2. Of the 2042 sets of MV images, grades 1 and 2 gas accumulation were seen in 332 (16%) and 156 (8%), respectively. By the trend test, gas accumulation significantly decreased towards the end of treatment (P=0.02 for grade 1 or 2 and P=0.02 for grade 2). On multivariate analysis, we did not identify any significant independent predictors for either baseline gas accumulation or gas reduction. Gas accumulation tended to decrease until the end of treatment. This tendency should be reconfirmed by other institutions.

  14. Assessment of internal and external exposure to ionizing radiation in laboratories of nuclear medicine and radiotherapy

    International Nuclear Information System (INIS)

    Adamiak-Ziemba, J.; Doniec, J.; Kocznow, W.; Hawrynski, M.

    1985-01-01

    The investigations with determination of radioisotopes in urine led to detection of contamination with 99m Tc and radioactive iodine. The measurements and dosimetry of external radiation demonstrated that workers in laboratories of radioisotope diagnosis received a mean annual equivalent doses amounted less than 5% of the permissible dose for persons with occupational exposure. It was also established that external exposure was mainly responsible for this. The data about the levels of internal exposure in laboratories of nuclear medicine and radiotherapy demonstrated that introduction of a permanent central system of control of internal contamination of workers would be useless since the observation of the already accepted principles of radiological protection is sufficient for avoiding contamination. (author)

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

    Science.gov (United States)

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

    2017-02-01

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

  16. Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement.

    Science.gov (United States)

    Dröge, L H; Hinsche, T; Canis, M; Alt-Epping, B; Hess, C F; Wolff, H A

    2014-02-01

    Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting.

  17. Preparation Of Thermoluminescence Dosimeters For External Radiotherapy Beam Audit In Malaysia

    International Nuclear Information System (INIS)

    Norhayati Abdullah; Siti Sara Deraman; Taiman Kadni; Mohd Taufik Dollah; Norhayati Salleh

    2014-01-01

    The external beam audit is a part of the Quality Assurance Programme (QAP) in radiotherapy that should be carried out to check the accuracy of dose delivered by the radiotherapy treatment units are within the tolerance limit of A ± 5 % as recommended by the International Commission of Radiation Units and Measurements (ICRU) Report No. 24. In this work, thermoluminescence dosimeters (TLD) in powder form were chosen to be used in the dose quality audit for the radiotherapy treatment units in Malaysia. As a preparation, the characterizations of a new batch of TLD-100 powders were studied. The studies include checks for the response of TLD-100 before and after pre-annealing process, reproducibility and linearity of TL signal. Results show that the response of TLD-100 powder after pre-annealing increases by 65 % compared with before pre-annealing process. These TLD-100 powders also provide reliable and consistent readings for the absorbed dose to water within the range of 150 cGy to 250 cGy with the maximum standard uncertainty of 0.554 μC. Finally, the calibration curves for 6 MV and 10 MV photon beams were established. These curves will be used in determining the absorbed dose to water (Dw) from user's irradiated TLDs. The expanded uncertainty (coverage factor k=2) of Dw determination was estimated to be 4.1 %. As a conclusion, these TLD-100 powders are ready to be used as a transfer detector for evaluating the accuracy of user's delivery dose in the radiotherapy beam audit program in Malaysia. (author)

  18. Personalizes lung motion simulation fore external radiotherapy using an artificial neural network

    International Nuclear Information System (INIS)

    Laurent, R.

    2011-01-01

    The development of new techniques in the field of external radiotherapy opens new ways of gaining accuracy in dose distribution, in particular through the knowledge of individual lung motion. The numeric simulation NEMOSIS (Neural Network Motion Simulation System) we describe is based on artificial neural networks (ANN) and allows, in addition to determining motion in a personalized way, to reduce the necessary initial doses to determine it. In the first part, we will present current treatment options, lung motion as well as existing simulation or estimation methods. The second part describes the artificial neural network used and the steps for defining its parameters. An accurate evaluation of our approach was carried out on original patient data. The obtained results are compared with an existing motion estimated method. The extremely short computing time, in the range of milliseconds for the generation of one respiratory phase, would allow its use in clinical routine. Modifications to NEMOSIS in order to meet the requirements for its use in external radiotherapy are described, and a study of the motion of tumor outlines is carried out. This work lays the basis for lung motion simulation with ANNs and validates our approach. Its real time implementation coupled to its predication accuracy makes NEMOSIS promising tool for the simulation of motion synchronized with breathing. (author)

  19. External beam radiotherapy for subretinal neovascularization in age-related macular degeneration: is this treatment efficient?

    International Nuclear Information System (INIS)

    Staar, Susanne; Krott, Ralf; Mueller, Rolf-Peter; Bartz-Schmidt, Karl U.; Heimann, Klaus

    1999-01-01

    Purpose: Control of the natural course of sub retinal neovascularization (SRNV) in age-related macular degeneration (AMD) is difficult. Only a subset of patients is suitable for laser coagulation. This prospective study aimed to determine the efficacy and individual benefit of external beam radiotherapy (EBRT). Methods and Materials: The prospective trial included 287 patients with subfoveal neovascularization due to AMD which was verified by fluorescein angiography. Patients have been treated between January 1996 and October 1997. All patients received a total dose of 16 Gy in 2-Gy daily fractions with 5-6 MeV photons based on computerized treatment planning in individual head mask fixation. This first analysis is based on 73 patients (50 women, 23 men, median age 74.3 years), with a median follow-up of 13.3 months and a minimum follow-up of 11 months. Results: All patients completed therapy and tolerability was good. First clinical control with second angiography was performed 6 weeks after irradiation, then in 3-month intervals. Eighteen patients with SRNV refusing radiotherapy served as a control group and were matched with 18 irradiated patients. After 7 months median visual acuity (VA) was 20/160 for the irradiated and 20/400 for the untreated patients. One year after radiotherapy final median VA was 20/400 in both groups. Conclusion: These results suggest that 16 Gy of conventionally fractionated external beam irradiation slows down the visual loss in exudative AMD for only a few months. Patients' reading vision could not be saved for a long-term run

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

    International Nuclear Information System (INIS)

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

    1996-01-01

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

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

    International Nuclear Information System (INIS)

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

    1996-01-01

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

  2. Preliminary experience with external hemipelvectomy for locally advanced and recurrent pelvic carcinoma

    DEFF Research Database (Denmark)

    Nielsen, Mette Bak; Rasmussen, Peter Chr.; Keller, Johnny Østergaard

    2012-01-01

    Aim Eight highly selected patients are reported, under- going external hemipelvectomy (EHP) for malignant infiltration of the lumbosacral neural plexus. 3 Method All patients were evaluated by PET ⁄ computed tomography (CT), CT and magnetic resonance imaging. No evidence of disseminated disease...... have died, one from postoperative complications at 5 months and two from recurrence at 5 and 52.8 months. Phantom-limb was experienced in six patients. Four patients received a prosthesis, one is considering this and one does not want a prosthesis. Conclusion Hemipelvectomy may be considered...

  3. External respiratory motion for abdominal radiotherapy patients: implications for patient alignment

    International Nuclear Information System (INIS)

    Kearvell, Rachel; Ebert, Martin A.

    2003-01-01

    Conformal external beam radiotherapy relies on accurate spatial positioning of the tumor and normal tissues during treatment. For abdominal patients, this is complicated by the motion of internal organs and the external patient contour due to respiration. As external motion influences the degree of accuracy achievable in patient setup, this motion was studied to provide indication of motions occurring during treatment, as well as to assess the technique of breath-holding at exhale (B-HEX). The motion of external abdominal points (anterior and right lateral) of a series of volunteers was tracked in real-time using an infrared tracking system, with the volunteers in treatment position. The resulting motion data was assessed to evaluate (1) the change in position of each point per breath/breath-hold, (2) the change in position between breaths/breath-holds, and (3) the change in position across the whole recording time. Analysis shows that, for the anterior abdominal point, there is little difference in the variation of position with time for free-breathing as opposed to the B-HEX technique. For the lateral point however, the B-HEX technique reduces the motion during each treatment cycle (i.e., during the breath-hold) and over an extended period (i.e., during a series of breath-holds). The B-HEX technique thus provides greater accuracy for setup to lateral markers and provides the opportunity to reduce systematic and random localization errors

  4. Interstitial and external radiotherapy in carcinoma of the soft palate and uvula

    International Nuclear Information System (INIS)

    Esche, B.A.; Haie, C.M.; Gerbaulet, A.P.; Eschwege, F.; Richard, J.M.; Chassagne, D.

    1988-01-01

    Forty-three patients, all male, with limited epidermoid carcinoma of the soft palate and uvula were treated by interstitial implant usually associated with external radiotherapy. Most patients received 50 Gy external irradiation to the oropharynx and neck followed by 20-35 Gy by interstitial iridium-192 wires using either guide gutters or a plastic tube technique. Twelve primary tumors and two recurrences after external irradiation alone had implant only for 65-75 Gy. Total actuarial local control is 92% with no local failures in 34 T1 primary tumors. Only one serious complication was seen. Overall actuarial survival was 60% at 3 years and 37% at 5 years but cause-specific survivals were 81% and 64%. The leading cause of death was other aerodigestive cancer, with an actuarial rate of occurrence of 10% per year after treatment of a soft palate cancer. Interstitital brachytherapy alone or combined with external irradiation is safe, effective management for early carcinoma of the soft palate and uvula but second malignancy is a serious problem

  5. External Auditing on Absorbed Dose Using a Solid Water Phantom for Domestic Radiotherapy Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Chang Heon; Kim, Jung In; Park, Jong Min; Park, Yang Kyun; Ye, Sung Joon [Medical Research Center, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cho, Kun Woo; Cho, Woon Kap [Radiation Research, Korean Institute of Nuclear Safety, Daejeon (Korea, Republic of); Lim, Chun Il [Korea Food and Drug Administration, Seoul (Korea, Republic of)

    2010-11-15

    We report the results of an external audit on the absorbed dose of radiotherapy beams independently performed by third parties. For this effort, we developed a method to measure the absorbed dose to water in an easy and convenient setup of solid water phantom. In 2008, 12 radiotherapy centers voluntarily participated in the external auditing program and 47 beams of X-ray and electron were independently calibrated by the third party's American Association of Physicists in Medicine (AAPM) task group (TG)-51 protocol. Even though the AAPM TG-51 protocol recommended the use of water, water as a phantom has a few disadvantages, especially in a busy clinic. Instead, we used solid water phantom due to its reproducibility and convenience in terms of setup and transport. Dose conversion factors between solid water and water were determined for photon and electron beams of various energies by using a scaling method and experimental measurements. Most of the beams (74%) were within {+-}2% of the deviation from the third party's protocol. However, two of 20 X-ray beams and three of 27 electron beams were out of the tolerance ({+-}3%), including two beams with a >10% deviation. X-ray beams of higher than 6 MV had no conversion factors, while a 6 MV absorbed dose to a solid water phantom was 0.4% less than the dose to water. The electron dose conversion factors between the solid water phantom and water were determined: The higher the electron energy, the less is the conversion factor. The total uncertainty of the TG-51 protocol measurement using a solid water phantom was determined to be {+-}1.5%. The developed method was successfully applied for the external auditing program, which could be evolved into a credential program of multi-institutional clinical trials. This dosimetry saved time for measuring doses as well as decreased the uncertainty of measurement possibly resulting from the reference setup in water.

  6. Field displacement during external radiotherapy in prostatic adenocarcinoma treated with radioactive 198Au implants and external irradiation

    International Nuclear Information System (INIS)

    Lennernaes, B.; Letocha, H.; Rikner, G.; Magnusson, A.; Nilsson, S.

    1995-01-01

    The purpose of this work was to study displacement error and internal movements of the prostate during external beam radiotherapy. Verification films in the frontal (n=194) and lateral (n=64) portals were investigated in 14 patients treated with radioactive 198 Au implants. Displacement errors of two implants were investigated. In seven patients, filling of the rectum and the bladder with contrast medium or isotonic saline was performed during CT investigation for planning purposes to detect movements of the prostate. Most (95%) of the displacement errors were less than 10 mm in the frontal portal and less than 15 mm in the lateral portals. No correlation to the patient's weight was found. The displacement errors were randomly distributed. The spatial relations between the implants were not altered during the treatments. Small movements of the prostate were observed. To conclude, the positioning system employed at present (laser) can be sufficient for the margins used (2 cm). In lateral portals, however, the system did not have the ability to detect a possible systematic displacement error from simulator to accelerator. The intention is to decrease the margins to 1 cm, which will necessitate a better positioning system. (orig.)

  7. The feasibility and safety of high-intensity focused ultrasound combined with low-dose external beam radiotherapy as supplemental therapy for advanced prostate cancer following hormonal therapy.

    Science.gov (United States)

    Wu, Rui-Yi; Wang, Guo-Min; Xu, Lei; Zhang, Bo-Heng; Xu, Ye-Qing; Zeng, Zhao-Chong; Chen, Bing

    2011-05-01

    The aim of this study was to investigate the feasibility and safety of high-intensity focused ultrasound (HIFU) combined with (+) low-dose external beam radiotherapy (LRT) as supplemental therapy for advanced prostate cancer (PCa) following hormonal therapy (HT). Our definition of HIFU+LRT refers to treating primary tumour lesions with HIFU in place of reduced field boost irradiation to the prostate, while retaining four-field box irradiation to the pelvis in conventional-dose external beam radiotherapy (CRT). We performed a prospective, controlled and non-randomized study on 120 patients with advanced PCa after HT who received HIFU, CRT, HIFU+LRT and HT alone, respectively. CT/MR imaging showed the primary tumours and pelvic lymph node metastases visibly shrank or even disappeared after HIFU+LRT treatment. There were significant differences among four groups with regard to overall survival (OS) and disease-specific survival (DSS) curves (P = 0.018 and 0.015). Further comparison between each pair of groups suggested that the long-term DSS of the HIFU+LRT group was higher than those of the other three groups, but there was no significant difference between the HIFU+LRT group and the CRT group. Multivariable Cox's proportional hazard model showed that both HIFU+LRT and CRT were independently associated with DSS (P = 0.001 and 0.035) and had protective effects with regard to the risk of death. Compared with CRT, HIFU+LRT significantly decreased incidences of radiation-related late gastrointestinal (GI) and genitourinary (GU) toxicity grade ≥ II. In conclusion, long-term survival of patients with advanced PCa benefited from strengthening local control of primary tumour and regional lymph node metastases after HT. As an alternative to CRT, HIFU+LRT showed good efficacy and better safety.

  8. Feasibility of retroperitoneal pelvic lymph node exploration in cervix-carcinoma treated by radio-surgery association or a definitive radiotherapy

    International Nuclear Information System (INIS)

    Bolla, M.; Sarrazin, R.; Berland, E.; Schmidt, M.H.; Rolachon, I.; Salvat, J.

    1995-01-01

    From June 1980 to May 1993, 52 patients with a mean age of 49, underwent a retroperitoneal pelvic lymph node laparoscopy procedure for cervix carcinoma classified as stage IA (14), IB (12), IIA (6), IIB (14), IIIB(3), IVA (3). Two techniques were used: a retroperitoneoscopy in 16 cases and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases. The aim was to define, with a better accuracy, the pelvic lymph node status, to adapt the target volume, and to estimate the morbidity.More nodes were biopsied with PRPP than with retroperitoneoscopy (p<0.05). There was a disagreement between the conventional radiologic assessment and the histological results in 28.6%. Specificity is 100%. Intra-operative and post-surgical morbidity was equivalent in the two procedures. One grade 3 urinary late morbidity (3%) was observed among the 33 patients who underwent a pelvic external irradiation. There was no morbidity of the gastro-intestinal tract. Discussion deals with the support offered by the two laparoscopic procedures to define the pelvic lymph node status, to choose the planning target volume, and to precise the lymph node boost. (authors) 24 refs., 3 tabs

  9. Certification of health care organisations, assessment of professional practices and external radiotherapy;Certification des etablissements de sante, evaluation des pratiques professionnelles et radiotherapie externe

    Energy Technology Data Exchange (ETDEWEB)

    Abdelmoumene, N.; Le Moign, R. [Haute Autorite de Sante (HAS), 75 - Paris (France)

    2009-12-15

    In France, accreditation of health care organisations (HCOs) is mandatory every 4 years. It is based on a systemic approach and, since 2004, includes professional practice appraisal (EPP) against good practice guidelines. However, following an incident in Epinal, a new quality assurance criterion was introduced in 2007 for external radiotherapy (ERT) on top of the annual inspection of patient radiation protection by the Nuclear Safety Authority. In the accreditation procedure starting January 2010, ERT work organisation will come under 'high-risk activity' (criterion 26b) and radio-vigilance will be included in the adverse events reporting system (8i). In addition, ERT will have to comply with many generic criteria on quality and safety improvement. For example, practice appraisal of all clinical activities will become routine. Thus, besides self-assessment against criteria 26b and 8i, ERT professionals will have report the impact of their quality improvement actions on patient care. They will be able to freely choose the area for improvement, as long as it is in line with the HCO's overall quality and safety plan. In oncology, multidisciplinary team meetings for deciding on the treatment plan, as well as mortality and morbidity meetings providing feedback, are compulsory (28a). Appraisal of appropriateness of care (28b) and indicator-based practice appraisal (28c) complete the process. In conclusion, the generic practice appraisal approach that is part of the French HCO accreditation procedure can contribute toward improving health care and education, but it has not been designed for in-depth assessment of complex, multidisciplinary clinical practice such as ERT. Such assessment requires a specific clinical audit and specialized auditors. (authors)

  10. Parallelization of learning problems by artificial neural networks. Application in external radiotherapy; Parallelisation de problemes d'apprentissage par des reseaux neuronaux artificiels. Application en radiotherapie externe

    Energy Technology Data Exchange (ETDEWEB)

    Sauget, M

    2007-12-15

    This research is about the application of neural networks used in the external radiotherapy domain. The goal is to elaborate a new evaluating system for the radiation dose distributions in heterogeneous environments. The al objective of this work is to build a complete tool kit to evaluate the optimal treatment planning. My st research point is about the conception of an incremental learning algorithm. The interest of my work is to combine different optimizations specialized in the function interpolation and to propose a new algorithm allowing to change the neural network architecture during the learning phase. This algorithm allows to minimise the al size of the neural network while keeping a good accuracy. The second part of my research is to parallelize the previous incremental learning algorithm. The goal of that work is to increase the speed of the learning step as well as the size of the learned dataset needed in a clinical case. For that, our incremental learning algorithm presents an original data decomposition with overlapping, together with a fault tolerance mechanism. My last research point is about a fast and accurate algorithm computing the radiation dose deposit in any heterogeneous environment. At the present time, the existing solutions used are not optimal. The fast solution are not accurate and do not give an optimal treatment planning. On the other hand, the accurate solutions are far too slow to be used in a clinical context. Our algorithm answers to this problem by bringing rapidity and accuracy. The concept is to use a neural network adequately learned together with a mechanism taking into account the environment changes. The advantages of this algorithm is to avoid the use of a complex physical code while keeping a good accuracy and reasonable computation times. (author)

  11. Multiobjective optimization with a modified simulated annealing algorithm for external beam radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Aubry, Jean-Francois; Beaulieu, Frederic; Sevigny, Caroline; Beaulieu, Luc; Tremblay, Daniel

    2006-01-01

    Inverse planning in external beam radiotherapy often requires a scalar objective function that incorporates importance factors to mimic the planner's preferences between conflicting objectives. Defining those importance factors is not straightforward, and frequently leads to an iterative process in which the importance factors become variables of the optimization problem. In order to avoid this drawback of inverse planning, optimization using algorithms more suited to multiobjective optimization, such as evolutionary algorithms, has been suggested. However, much inverse planning software, including one based on simulated annealing developed at our institution, does not include multiobjective-oriented algorithms. This work investigates the performance of a modified simulated annealing algorithm used to drive aperture-based intensity-modulated radiotherapy inverse planning software in a multiobjective optimization framework. For a few test cases involving gastric cancer patients, the use of this new algorithm leads to an increase in optimization speed of a little more than a factor of 2 over a conventional simulated annealing algorithm, while giving a close approximation of the solutions produced by a standard simulated annealing. A simple graphical user interface designed to facilitate the decision-making process that follows an optimization is also presented

  12. Treatment of locally advanced breast carcinoma with high-dose external beam supervoltage radiotherapy

    International Nuclear Information System (INIS)

    Brufman, G.; Weshler, Z.; Prosnitz, L.R.; Fuks, Z.

    1981-01-01

    Between 1960 and 1978, 87 patients with locally advanced Tsub(3-4)Nsub(0-3)M 0 carcinoma of the breast were treated with 5,000 to 8,000 rad of external beam supervoltage radiotherapy. Initial clinical eradication of the tumour was observed in 76 of 87 cases (87%), but the actuarial probability of local control at 5 yr was only 53%. Furthermore, the actuarial probability of disease-free survival was 25% at 5 yr and 13% at 10 yr. Most of the patients eventually succumbed to metastatic breast carcinoma and the actuarial survival at 5 yr was 43% and at 10 yr, 16%. The addition of adjuvant low-dose chemotherapy, given to 13 patients, did not affect the rates of local control, survival or disease-free survival. The most common long-term complication was extensive and deforming radiation-induced fibrosis of the treated breast. The actuarial probability of 10-yr survival without a local recurrence and without severe fibrosis of the treated breast was only 17.5%. The role of adjuvant high-dose chemotherapy in the treatment of locally advanced breast carcinoma and the possible use of improved radiotherapy techniques to achieve a more effective long-term local control and a more desirable cosmetic end result are discussed. (author)

  13. Automatic analysis of image quality control for Image Guided Radiation Therapy (IGRT) devices in external radiotherapy

    International Nuclear Information System (INIS)

    Torfeh, Tarraf

    2009-01-01

    On-board imagers mounted on a radiotherapy treatment machine are very effective devices that improve the geometric accuracy of radiation delivery. However, a precise and regular quality control program is required in order to achieve this objective. Our purpose consisted of developing software tools dedicated to an automatic image quality control of IGRT devices used in external radiotherapy: 2D-MV mode for measuring patient position during the treatment using high energy images, 2D-kV mode (low energy images) and 3D Cone Beam Computed Tomography (CBCT) MV or kV mode, used for patient positioning before treatment. Automated analysis of the Winston and Lutz test was also proposed. This test is used for the evaluation of the mechanical aspects of treatment machines on which additional constraints are carried out due to the on-board imagers additional weights. Finally, a technique of generating digital phantoms in order to assess the performance of the proposed software tools is described. Software tools dedicated to an automatic quality control of IGRT devices allow reducing by a factor of 100 the time spent by the medical physics team to analyze the results of controls while improving their accuracy by using objective and reproducible analysis and offering traceability through generating automatic monitoring reports and statistical studies. (author) [fr

  14. External radiotherapy in macular degeneration: Our technique, dosimetric calculation, and preliminary results

    International Nuclear Information System (INIS)

    Akmansu, M.; Dirican, Bahar; Oeztuerk, Berrin; Egehan, Ibrahim; Subasi, Mahmut; Or, Meral

    1998-01-01

    Purpose: This study was performed to determine the toxicity and efficacy of external-beam radiotherapy in patients with age-related subfoveal neovascularization. Methods and Materials: Between January 1996 and September 1996, 25 patients with a mean age of 70.5 (60-84) years were enrolled. All patients underwent fluorescein angiographic evaluation and documentation of their neovascular disease prior to irradiation. A total of 25 patients were treated with a total dose of 12 Gy in 6 fractions over 8 days. We used a lens-sparing technique and patients were treated with a single lateral 6-MV photon beam. To assess the risk of radiation carcinogenesis after treatment of age-related subfoveal neovascularization, we estimated the effective dose for a standard patient on the basis of tissue-weighting factors as defined by the International Commission on Radiological Protection (ICRP). The calculations were made with TLD on a male randophantom. The lens dose was found to be 0.217 Gy per fraction. Results: No significant acute morbidity was noted. Visual acuity was maintained or improved in 76% and 80% of treated patients at their 1- and 3-month follow-up examinations, respectively. On angiographic imaging, there was stabilization of subfoveal neovascular membranes in 23 patients (92%) at 3 months after irradiation. Conclusion: Our observations on these 25 patients in this study indicate that many patients will have improved or stable vision after radiotherapy treatment with low-dose irradiation

  15. Diode In-vivo Dosimetry for External Beam Radiotherapy: Patient Data Analysis

    International Nuclear Information System (INIS)

    Mrcela, I.; Bokulic, T.; Budanec, M; Froebe, A.; Soldic, Z.; Kusic, Z.

    2008-01-01

    In-vivo dosimetry is known as simple and reliable method for checking the final accuracy of the dose delivered in external radiotherapy making a supplement to the regular quality control. Entrance dose measurements in the beginning of the treatment assure detection of major errors that can affect the therapy outcome. Silicon diodes are often the detectors of choice for their ability of real time dose measurements and the simplicity of use. There are many publications describing the procedures for the implementation of in-vivo dosimetry. Routine in-vivo dosimetry has been introduced in our department after initial procedures including physical characterization, calibration and determination of correction factors for the detectors in use. This work presents patient data analysis with more than 700 field measurements taken in last 2 years period

  16. Radiation dose to laterally transposed ovaries during external beam radiotherapy for cervical cancer

    International Nuclear Information System (INIS)

    Mazonakis, Michael; Damilakis, John; Varveris, Haris; Gourtsoyiannis, Nicholas

    2006-01-01

    The purpose of this study was to estimate the radiation dose to laterally transposed ovaries from external beam radiotherapy for cervical cancer. Dose measurements were performed in a modified humanoid phantom using a 6 MV photon beam. The dependence of the ovarian dose upon the field size, the distance from the primary irradiation field and the presence of wedges or gonadal shielding was determined. For a tumor dose of 45 Gy, ovarian dose was 0.88-8.51 Gy depending on the field size employed and the location of the transposed ovary in respect to the treatment field. Positioning of 7 cm thick shielding reduced the dose to ovary by less than 19%. The use of wedges increased the ovarian dose by a factor up to 1.5. Accurate radiographic localization of the ovaries allows the use of the presented dosimetric results to obtain a reasonable prediction of the ovarian dose

  17. Treatment of primary tracheal carcinoma. The role of external and endoluminal radiotherapy

    International Nuclear Information System (INIS)

    Harms, W.; Wannenmacher, M.; Becker, H.; Herth, F.; Gagel, B.

    2000-01-01

    Background and Purpose: In a retrospective study the role of radiation therapy for the treatment of primary tracheal carcinoma was investigated. Patients and Methods: Between 1984 and 1997, 25 patients with primary tracheal carcinoma were treated with external beam radiotherapy (17 squamous-cell carcinoma [SCC], 8 adenoid cystic carcinoma [ACC], median dose SCC 60 Gy, ACC 55 Gy). An additional brachytherapy boost was carried out in 10/25 patients (median dose SCC 18 Gy, ACC 15 Gy). Ten patients underwent operative treatment. Results: The median survival (Kaplan-Meier) for patients with SCC was 33 months (ACC 94.2). The 1-, 2- and 5-year survival rates (Kaplan-Meier) for patients with SCC were 64.7% (ACC 85.7%), 64.7% (ACC 85.7%), and 26% (ACC 85.7%). Patients with ACC and patients with a complete remission after treatment had a significantly better survival probability (log rank test, p [de

  18. A digital fluoroscopic imaging system for verification during external beam radiotherapy

    International Nuclear Information System (INIS)

    Takai, Michikatsu

    1990-01-01

    A digital fluoroscopic (DF) imaging system has been constructed to obtain portal images for verification during external beam radiotherapy. The imaging device consists of a fluorescent screen viewed by a highly sensitive video camera through a mirror. The video signal is digitized and processed by an image processor which is linked on-line with a host microcomputer. The image quality of the DF system was compared with that of film for portal images of the Burger phantom and the Alderson anthropomorphic phantom using 10 MV X-rays. Contrast resolution of the DF image integrated for 8.5 sec. was superior to the film resolution, while spatial resolution was slightly inferior. The DF image of the Alderson phantom processed by the adaptive histogram equalization was better in showing anatomical landmarks than the film portal image. The DF image integrated for 1 sec. which is used for movie mode can show patient movement during treatment. (author)

  19. Different rectal toxicity tolerance with and without simultaneous conventionally-fractionated pelvic lymph node treatment in patients receiving hypofractionated prostate radiotherapy

    International Nuclear Information System (INIS)

    McDonald, Andrew M; Baker, Christopher B; Popple, Richard A; Shekar, Kiran; Yang, Eddy S; Jacob, Rojymon; Cardan, Rex; Kim, Robert Y; Fiveash, John B

    2014-01-01

    To investigate added morbidity associated with the addition of pelvic elective nodal irradiation (ENI) to hypofractionated radiotherapy to the prostate. Two-hundred twelve patients, treated with hypofractionated radiotherapy to the prostate between 2004 and 2011, met the inclusion criteria for the analysis. All patients received 70 Gy to the prostate delivered over 28 fractions and 103 (49%) received ENI consisting of 50.4 Gy to the pelvic lymphatics delivered simultaneously in 1.8 Gy fractions. The mean dose-volume histograms were compared between the two subgroups defined by use of ENI, and various dose-volume parameters were analyzed for effect on late lower gastrointestinal (GI) and genitourinary (GU) toxicity. Acute grade 2 lower GI toxicity occurred in 38 (37%) patients receiving ENI versus 19 (17%) in those who did not (p = 0.001). The Kaplan-Meier estimate of grade ≥ 2 lower GI toxicity at 3 years was 15.3% for patients receiving ENI versus 5.3% for those who did not (p = 0.026). Each rectal isodose volume was increased for patients receiving ENI up to 50 Gy (p ≤ 0.021 for each 5 Gy increment). Across all patients, the absolute V 70 of the rectum was the only predictor of late GI toxicity. When subgroups, defined by the use of ENI, were analyzed separately, rectal V 70 was only predictive of late GI toxicity for patients who received ENI. For patients receiving ENI, V 70 > 3 cc was associated with an increased risk of late GI events. Elective nodal irradiation increases the rates of acute and late GI toxicity when delivered simultaneously with hypofractioanted prostate radiotherapy. The use of ENI appears to sensitize the rectum to hot spots, therefore we recommend added caution to minimize the volume of rectum receiving 100% of the prescription dose in these patients

  20. Different rectal toxicity tolerance with and without simultaneous conventionally-fractionated pelvic lymph node treatment in patients receiving hypofractionated prostate radiotherapy.

    Science.gov (United States)

    McDonald, Andrew M; Baker, Christopher B; Popple, Richard A; Shekar, Kiran; Yang, Eddy S; Jacob, Rojymon; Cardan, Rex; Kim, Robert Y; Fiveash, John B

    2014-06-03

    To investigate added morbidity associated with the addition of pelvic elective nodal irradiation (ENI) to hypofractionated radiotherapy to the prostate. Two-hundred twelve patients, treated with hypofractionated radiotherapy to the prostate between 2004 and 2011, met the inclusion criteria for the analysis. All patients received 70 Gy to the prostate delivered over 28 fractions and 103 (49%) received ENI consisting of 50.4 Gy to the pelvic lymphatics delivered simultaneously in 1.8 Gy fractions. The mean dose-volume histograms were compared between the two subgroups defined by use of ENI, and various dose-volume parameters were analyzed for effect on late lower gastrointestinal (GI) and genitourinary (GU) toxicity. Acute grade 2 lower GI toxicity occurred in 38 (37%) patients receiving ENI versus 19 (17%) in those who did not (p = 0.001). The Kaplan-Meier estimate of grade ≥ 2 lower GI toxicity at 3 years was 15.3% for patients receiving ENI versus 5.3% for those who did not (p = 0.026). Each rectal isodose volume was increased for patients receiving ENI up to 50 Gy (p ≤ 0.021 for each 5 Gy increment). Across all patients, the absolute V70 of the rectum was the only predictor of late GI toxicity. When subgroups, defined by the use of ENI, were analyzed separately, rectal V70 was only predictive of late GI toxicity for patients who received ENI. For patients receiving ENI, V70 > 3 cc was associated with an increased risk of late GI events. Elective nodal irradiation increases the rates of acute and late GI toxicity when delivered simultaneously with hypofractioanted prostate radiotherapy. The use of ENI appears to sensitize the rectum to hot spots, therefore we recommend added caution to minimize the volume of rectum receiving 100% of the prescription dose in these patients.

  1. Minimal requirements for quality controls in radiotherapy with external beams; Controlli di qualita' essenziali in radioterapia con fasci esterni

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    Physical dosimetric guidelines have been developed by the Italian National Institute of Health study group on quality assurance in radiotherapy to define protocols for quality controls in external beam radiotherapy. While the document does not determine strict rules or firm recommendations, it suggests minimal requirements for quality controls necessary to guarantee an adequate degree of accuracy in external beam radiotherapy. [Italian] Il gruppo di studio Assicurazione di qualita' in radioterapia dell'Istituto Superiore di Sanita' presenta le linee guida per la stesura dei protocolli di controllo di qualita' essenziali necessari a garantire un adeguato livello di accuratezza del trattamento radiante e rappresenta pertanto una parte essenziale del contributo fisico-dosimetrico globale di assicurazione di qualita' in radioterapia con fasci esterni.

  2. Adjuvant radiotherapy for stage I endometrial cancer.

    Science.gov (United States)

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

    2007-04-18

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

  3. Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial

    NARCIS (Netherlands)

    Nout, Remi A.; van de Poll-Franse, Lonneke V.; Lybeert, Marnix L. M.; Warlam-Rodenhuis, Carla C.; Jobsen, Jan J.; Mens, Jan Willem M.; Lutgens, Ludy C. H. W.; Pras, Betty; van Putten, Wim L. J.; Creutzberg, Carien L.

    2011-01-01

    Purpose To determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial. Patients and Methods Between 1990 and

  4. External radiotherapy for bone and lymph-node metastases from thyroid cancer

    International Nuclear Information System (INIS)

    Niunoya, Koichiro; Kusakabe, Kiyoko; Obara, Takao; Ito, Yukio; Fujimoto, Yoshihide

    2002-01-01

    The therapeutic effects of external beam radiation to bone or lymph-node metastatic lesions of thyroid cancer were evaluated in 11 patients. These 11 cases included four male and seven female patients ranging in age from 44 to 69 years (mean age 54 years), were treated by 4MV-Xray irradiation. Thyroid surgery had been performed in all patients. The thyroid tumors were classified histologically as papillary carcinoma in 3 patients and follicular carcinoma in 8. Following surgical total thyroidectomy, thyroid ablation and/or therapy with I-131 was performed in 8 patients with follicular carcinoma. Using a 4MV-Xray external beam, a total dose of 54 to 68 Gy (mean dose 62 Gy) was delivered to 28 metastatic lesions including 2 lymph nodes and 26 bones, although an 82-Gy total dose was used for one lymph node. All patients underwent follow-up for more than 8 years. Ten of the 11 patients died, 6 of thyroid cancer and 4 of other diseases. Two of them suffered anaplastic transformation of differentiated thyroid carcinoma and died. The survival term was 0.2 to 8.6 years (mean 4.9 years) after initial external radiotherapy. Local irradiation with a curative dose was able to control most of the lesions in the 11 patients (29 lesions with the exception of 2 cases showing anaplastic transformation). In some patients, pain relief was obtained although tumor size measured by CT did not reveal marked regression. External beam radiation therapy with a curative dose was thought to be beneficial for patients with metastatic lesions of thyroid cancer as slow-growing and having relatively long survival period of patients. (author)

  5. A modified inflammatory bowel disease questionnaire and the Vaizey Incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading

    International Nuclear Information System (INIS)

    Khalid, Usman; McGough, Camilla; Hackett, Claire; Blake, Peter; Harrington, Kevin J.; Khoo, Vincent S.; Tait, Diana; Norman, Andrew R.; Andreyev, H. Jervoise N.

    2006-01-01

    Purpose: Simple scales with greater sensitivity than Radiation Therapy Oncology Group (RTOG) grading to detect acute gastrointestinal toxicity during pelvic radiotherapy, could be clinically useful. Methods and Materials: Do questionnaires used in benign gastrointestinal diseases detect toxicity in patients undergoing radiotherapy? The patient-completed Inflammatory Bowel Disease (IBDQ) and Vaizey Incontinence questionnaires were compared prospectively at baseline and at Week 5 to physician-completed RTOG grading. Results: A total of 107 patients, median age 63 years, were recruited. After 5 weeks of treatment, patients with gynecologic and gastrointestinal cancer were more symptomatic than urologic patients (p 0.012; p = 0.014). Overall, 94% had altered bowel habits, 80% loose stool, 74% frequency, 65% difficult gas, 60% pain, >48% distress, 44% tenesmus, >40% restrictions in daily activity, 39% urgency, 37% fecal incontinence, and 40% required antidiarrheal medication. The median RTOG score was 1 (range, 0-2), median IBDQ score 204.5 (range, 74-224), and median Vaizey score 5 (range, 0-20). Chemotherapy preceding radiotherapy increased fecal incontinence (p 0.002). RTOG scores stabilized after 3 weeks, IBDQ scores peaked at Week 4, and Vaizey scores worsened throughout treatment. IBDQ and Vaizey scores distinguished between groups with different RTOG scores. Conclusion: The IBDQ and Vaizey questionnaires are reliable and sensitive, offering greater insight into the severity and range of symptoms compared with RTOG grading

  6. Baseline demographic profile and general health influencing the post-radiotherapy health related quality-of-life in women with gynaecological malignancy treated with pelvic irradiation

    Directory of Open Access Journals (Sweden)

    Sourav Sau

    2013-01-01

    Full Text Available Background: Cancer specific survival and quality-of-life (QOL assessment are important in evaluating cancer treatment outcomes. Baseline demographic profiles have significant effects on follow-up health related QOL (HRQOL and affect the outcome of treatments. Materials and Methods: Post-operative gynaecological cancer patients required adjuvant pelvic radiation enrolled longitudinal assessment study. Patients had completed the short form-36 (SF-36 questionnaire before the adjuvant radiotherapy and functional assessments of cancer therapy-general module at 6 th month′s follow-up period to assess the HRQOL. Baseline variables were race, age, body mass index (BMI, education, marital status, type of surgery, physical composite scores (PCS and mental composite scores (MCS summary scores of the SF-36. Univariate and multivariate regression analysis used to determine the influence of these variables on post-radiotherapy HRQOL domains. Results: Baseline PCS, MCS, age, education and marital status had positively correlation with post-radiotherapy HRQOL while higher BMI had a negative impact in univariate analysis. In multivariate regression analysis, education and MCS had a positive correlation while higher BMI had a negative correlation with HRQOL domains. Conclusion: Enhance our ability to detect demographic variables and modify those factors and develops new treatment aimed at improving all aspect of gynaecological cancer including good QOL.

  7. Internal versus external fixation of the anterior component in unstable fractures of the pelvic ring: pooled results from a systematic review.

    Science.gov (United States)

    Wardle, B; Eslick, G D; Sunner, P

    2016-10-01

    Improving reduction of the pelvic ring improves long-term functional outcomes for patients. It has been demonstrated that posterior internal fixation is necessary to adequately control fractures to the posterior ring and there is evidence that supplementing this with fixation of the anterior ring improves stability. It is accepted that internal fixation provides greater stability than external fixation of the anterior ring but long-term differences in radiographic and functional outcomes have not yet been quantified. A search of electronic databases, reference lists and review articles from 1989 to 2015 yielded 18 studies (n = 884) that met our inclusion criteria. We included studies that discussed pelvic ring injuries in adults, reported functional or radiological outcomes or complications by anterior ring intervention and exceeded 14 patients. We excluded biomechanical and cadaver studies. Internal fixation of the anterior pelvic ring had better functional and radiographic outcomes. Residual displacement of >10 mm was less common with internal fixation (ER 0.12, 95 % CI 0.06-0.24) than external fixation (ER 0.31, 95 % CI 0.11-0.62). Unsatisfactory outcomes also occurred at a lower rate (ER 0.09, 95 % CI 0.03-0.22) compared to external fixation (ER 0.32, 95 % CI 0.18-0.50). Losses of reduction (ER 0.02, 95 % CI 0.01-0.04 versus ER 0.07, 95 % CI 0.02-0.21), malunions (ER 0.03, 95 % CI 0.01-0.08 versus ER 0.07, 95 % CI 0.02-0.21) and delayed/non-unions (ER 0.02, 95 % CI 0.01-0.05 versus ER 0.04, 95 % CI 0.02-0.07). Internal fixation of the anterior pelvic ring as supplementary fixation for unstable injuries to the pelvic ring appears to result in better radiographic and functional outcomes as well as fewer complications. However, data that separated outcomes and complications in relation to interventions of the anterior pelvic ring were limited. More studies looking specifically at outcomes in relation to the type of anterior ring intervention are

  8. Radiotherapy

    International Nuclear Information System (INIS)

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

    1983-01-01

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

  9. The target volume concept at the recording of external beam radiotherapy

    International Nuclear Information System (INIS)

    Quast, U.; Glaeser, L.

    1981-01-01

    With the aim of complete, exact and reproducible manual recording and documentation of external beam radiotherapy a concept is proposed providing treatment planning and recording related to space and time for target volumes of different order corresponding to Ist, IInd or IIIrd part of treatment course, regarding all dose limiting organs at risk. The record consists of the dosage plan for medical treatment planning, the treatment plan for physical dose distribution planning and the treatment record of absorbed doses delivered as well as a checklist for patient and machine set-up, and labels for intended actions during treatment development. A clear arrangement of the record form in logical order was found, demanding exact specification of target(s) and beam(s) and their relation in space and time; asking for verbal and graphical description of target volumes, organs at risk, patient positioning, beam portals and dose reference points in terms of patients' anatomy; emphasizing the most important medical data by marked areas and leaving enough empty space for additional data, remarks or comments. During several years of clinical use these record forms proved to be suitable for all cases of external beam therapy, for complex situations of target volumes and treatment-scheduling, for all treatment techniques and radiation qualities and for all ways of physical treatment planning. They can be extended to automatic treatment verification, monitoring and recording as well as to the application of in-vivo-measurements of absorbed doses. (orig.) [de

  10. Skin markings in external radiotherapy by temporary tattooing with henna: Improvement of accuracy and increased patient comfort

    International Nuclear Information System (INIS)

    Wurstbauer, Karl; Sedlmayer, Felix; Kogelnik, H. Dieter

    2001-01-01

    Purpose: To guarantee invariable skin markings in patients undergoing a course of external radiotherapy, especially using conformal techniques. Cutaneous markings with henna also increase patient comfort, because washing and showering are allowed. Methods and Materials: Henna, a completely natural product, is a skin colorant with a history of 5,000 years. It is applied to the skin in the form of a paste. While drying, henna stains the superficial skin layers for several weeks, and the marked area can be exposed to water arbitrarily. In case of fading of the stain before the end of radiotherapy, the marking procedure can be repeated. From November 1998 until March 2000, we performed skin markings with henna in 158 patients with different tumor sites. The majority of patients received conformal radiotherapy techniques. All patients have been evaluated concerning durability of the markings, the required number of marking procedures per treatment course, and possible related side effects. Results: The median durability of henna staining is 23 days (range 12-48 days). On average, two marking procedures (range 1-4) are necessary for a patient treated with curative intent. Although washing and showering are freely permitted, no adverse cutaneous side effects (e.g., erythema, allergic reactions) have been observed. Conclusions: Skin marking by temporary tattooing with henna increases the accuracy of external radiotherapy. It yields stable and invariable markings for the entire course of radiotherapy and also increases the comfort of patients

  11. Long-term results after external radiotherapy in age-related macular degeneration. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Prettenhofer, U.; Mayer, R.; Stranzl, H.; Oechs, A.; Hackl, A. [Dept. of Radiotherapy, Univ. Medical School, Graz (Austria); Haas, A. [Dept. of Opthalmology, Univ. Medical School, Graz (Austria)

    2004-02-01

    Purpose: to prospectively evaluate the short- and long-term efficacy of external radiotherapy (RT) in patients with age-related macular degeneration (AMD) by comparing two different dose schedules. Patients and methods: in this prospective, nonrandomized, comparative study including 80 patients, the efficacy of external RT with a total dose of 14.4 Gy (group A, n = 40) and 25.2 Gy (group B, n = 40) was compared. Patients of group a were irradiated between September 1995 and July 1996, patients of group b between August 1996 and November 1997. 67 patients presented with occult choroidal neovascularization (CNV), 13 with classic subfoveal lesions. Complete ophthalmologic investigation was performed before RT, at intervals of 3 months during the 1st year after RT, and of 6 months thereafter. Results: 12 months after RT, vision deteriorated in 85% (14.4 Gy) and 65% (25.2 Gy) of patients. Central visual field decreased with both dose schedules. There was no morphological benefit in neovascular changes. After 48 months, complete follow-up was possible in 46 patients who showed a significant loss of vision similar to the natural course of AMD. Conclusion: external RT of AMD with 14.4 Gy as well as with the escalated dose of 25.2 Gy showed a poor beneficial outcome after 6 and 12 months, respectively. After a follow-up of 4 years, visual outcome in irradiated patients was similar to the natural course of the disease. A conspicuous efficacy of RT in prevention of blindness could not be demonstrated. (orig.)

  12. Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience.

    Science.gov (United States)

    Tharavichitkul, Ekkasit; Chakrabandhu, Somvilai; Wanwilairat, Somsak; Tippanya, Damrongsak; Nobnop, Wannapha; Pukanhaphan, Nantaka; Galalae, Razvan M; Chitapanarux, Imjai

    2013-07-01

    To evaluate the outcomes of image-guided brachytherapy combined with 3D conformal or intensity modulated external beam radiotherapy (3D CRT/IMRT) in cervical cancer at Chiang Mai University. From 2008 to 2011, forty-seven patients with locally advanced cervical cancer were enrolled in this study. All patients received high-technology (3D CRT/IMRT) whole pelvic radiotherapy with a total dose of 45-46 Gy plus image-guided High-Dose-Rate intracavitary brachytherapy 6.5-7 Gy × 4 fractions to a High-Risk Clinical Target Volume (HR-CTV) according to GEC-ESTRO recommendations. The dose parameters of the HR-CTV for bladder, rectum and sigmoid colon were recorded, as well as toxicity profiles. In addition, the endpoints for local control, disease-free, metastasis-free survival and overall survival were calculated. At the median follow-up time of 26 months, the local control, disease-free survival, and overall survival rates were 97.9%, 85.1%, and 93.6%, respectively. The mean dose of HR-CTV, bladder, rectum and sigmoid were 93.1, 88.2, 69.6, and 72 Gy, respectively. In terms of late toxicity, the incidence of grade 3-4 bladder and rectum morbidity was 2.1% and 2.1%, respectively. A combination of image-guided brachytherapy and IMRT/3D CRT showed very promising results of local control, disease-free survival, metastasis-free survival and overall survival rates. It also caused a low incidence of grade 3-4 toxicity in treated study patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Safety and Efficacy of Thoracic External Beam Radiotherapy After Airway Stenting in Malignant Airway Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Rochet, Nathalie, E-mail: nrochet@partners.org [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Hauswald, Henrik; Schmaus, Martina; Hensley, Frank [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Huber, Peter [Department of Radiotherapy, German Cancer Research Center, Heidelberg (Germany); Eberhardt, Ralf; Herth, Felix J. [Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg (Germany); Debus, Juergen; Neuhof, Dirk [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany)

    2012-05-01

    Purpose: We retrospectively evaluated the outcome and toxicity of external beam radiotherapy (EBRT) after airway stents were placed in patients treated for malignant airway obstruction. Methods and Materials: Between 2004 and 2009, we performed airway stenting followed by EBRT in 43 patients for symptomatic primary lung cancer (n = 31) or other thoracic malignancies (n = 12). The median time interval between stent placement and first irradiation was 14 days. A median total dose of 50 Gy was delivered. Sixty-seven percent of the patients had reduced performance status (Karnofsky performance score, {<=}70). Results: EBRT had to be stopped prematurely in 16 patients (37%), at a median total dose of 17 Gy, for various reasons. In this group of patients, the survival was poor, with a median overall survival (OS) of only 21 days. Twenty-seven patients (63%) completed radiotherapy as planned, with a median OS of 8.4 months. Fourteen of 43 patients (33%) developed at least one Common Terminology Criteria for Adverse Event of grade 3 to 5. The most common event was a malignant restenosis of the stent leading to asphyxia (n = 7), followed by fistula formation (n = 4), necrosis (n = 3), mediastinitis with abscess (n = 1), secondary nonmalignant airway stenosis (n = 1), and hemoptysis (n = 1). With the exception of one event, all events were associated with a local progression of the tumor. Conclusions: Although the long-term prognosis for patients with malignant airway obstruction is poor, airway stenting combined with EBRT offers a possible therapeutic option, achieving fast relief of acute respiratory distress with an associated antitumor effect, resulting in a potential survival benefit. However, due to local advanced tumor growth, increased rates of adverse events are to be expected, necessitating careful monitoring.

  14. Safety and Efficacy of Thoracic External Beam Radiotherapy After Airway Stenting in Malignant Airway Obstruction

    International Nuclear Information System (INIS)

    Rochet, Nathalie; Hauswald, Henrik; Schmaus, Martina; Hensley, Frank; Huber, Peter; Eberhardt, Ralf; Herth, Felix J.; Debus, Juergen; Neuhof, Dirk

    2012-01-01

    Purpose: We retrospectively evaluated the outcome and toxicity of external beam radiotherapy (EBRT) after airway stents were placed in patients treated for malignant airway obstruction. Methods and Materials: Between 2004 and 2009, we performed airway stenting followed by EBRT in 43 patients for symptomatic primary lung cancer (n = 31) or other thoracic malignancies (n = 12). The median time interval between stent placement and first irradiation was 14 days. A median total dose of 50 Gy was delivered. Sixty-seven percent of the patients had reduced performance status (Karnofsky performance score, ≤70). Results: EBRT had to be stopped prematurely in 16 patients (37%), at a median total dose of 17 Gy, for various reasons. In this group of patients, the survival was poor, with a median overall survival (OS) of only 21 days. Twenty-seven patients (63%) completed radiotherapy as planned, with a median OS of 8.4 months. Fourteen of 43 patients (33%) developed at least one Common Terminology Criteria for Adverse Event of grade 3 to 5. The most common event was a malignant restenosis of the stent leading to asphyxia (n = 7), followed by fistula formation (n = 4), necrosis (n = 3), mediastinitis with abscess (n = 1), secondary nonmalignant airway stenosis (n = 1), and hemoptysis (n = 1). With the exception of one event, all events were associated with a local progression of the tumor. Conclusions: Although the long-term prognosis for patients with malignant airway obstruction is poor, airway stenting combined with EBRT offers a possible therapeutic option, achieving fast relief of acute respiratory distress with an associated antitumor effect, resulting in a potential survival benefit. However, due to local advanced tumor growth, increased rates of adverse events are to be expected, necessitating careful monitoring.

  15. Salvage external beam radiotherapy for clinical failure after cryosurgery for prostate cancer

    International Nuclear Information System (INIS)

    McDonough, Michael J.; Feldmeier, John J.; Parsai, Ishmael; Dobelbower, Ralph R.; Selman, Steven H.

    2001-01-01

    Purpose: To investigate the role of external beam radiotherapy (EBRT) as salvage treatment of prostate cancer after cryosurgery failure. Methods and Materials: Between 1993 and 1998, 6 patients underwent EBRT with curative intent for local recurrence of prostate cancer after cryosurgery. All 6 patients had biopsy-proven recurrence and palpable disease on digital rectal examination at the time of EBRT. The median follow-up was 34 months (range 8-46). The median prostate-specific antigen level was 2.3 ng/mL (range 0.8-4.1). No patient had evidence of metastatic disease. Two patients received hormonal therapy before beginning EBRT. No patient received hormonal therapy after EBRT completion. The median elapsed time between cryosurgery and EBRT was 3 years (range 1.5-4). The median delivered dose was 66 Gy (range 62-70.2) using a 10-MeV photon beam. An in-house-developed three-dimensional treatment planning system was used to plan delivery of the prescribed dose with conformal radiotherapy techniques. Results: After EBRT, all patients had complete resolution of palpable disease. Four patients (66%) were disease free at the time of the last follow-up. Two patients developed biochemical failure as defined by the American Society for Therapeutic Radiology and Oncology consensus definition. One of these patients had a prostate-specific antigen level of 97 ng/mL before cryosurgery. No patient developed distant metastasis during follow-up. Two patients (33%) developed proctitis; 1 case resolved with Rowasa suppositories and 1 required blood transfusion. Conclusions: Our preliminary results suggest that EBRT can render a significant number of patients biochemically free of disease and can cause complete resolution of clinically palpable disease after initial cryosurgery. The results also showed that EBRT can be given without excessive morbidity. EBRT should be considered as a treatment option in these potentially curable cases

  16. Targeted Intraoperative Radiotherapy for Breast Cancer in Patients in Whom External Beam Radiation Is Not Possible

    International Nuclear Information System (INIS)

    Keshtgar, Mohammed R.S.; Vaidya, Jayant S.; Tobias, Jeffrey S.; Wenz, Frederik; Joseph, David; Stacey, Chris; Metaxas, Marinos G.; Keller, Anke; Corica, Tammy; Williams, Norman R.; Baum, Michael

    2011-01-01

    Purpose: External beam radiation therapy (EBRT) following wide local excision of the primary tumor is the standard treatment in early breast cancer. In some circumstances this procedure is not possible or is contraindicated or difficult. The purpose of this study was to determine the safety and efficacy of targeted intraoperative radiotherapy (TARGIT) when EBRT is not feasible. Methods and Materials: We report our experience with TARGIT in three centers (Australia, Germany, and the United Kingdom) between 1999 and 2008. Patients at these centers received a single radiation dose of 20 Gy to the breast tissue in contact with the applicator (or 6 Gy at 1-cm distance), as they could not be given EBRT and were keen to avoid mastectomy. Results: Eighty patients were treated with TARGIT. Reasons for using TARGIT were 21 patients had previously received EBRT, and 31 patients had clinical reasons such as systemic lupus erythematosus, motor neuron disease, Parkinson's disease, ankylosing spondylitis, morbid obesity, and cardiovascular or severe respiratory disease. Three of these patients received percutaneous radiotherapy without surgery; 28 patients were included for compelling personal reasons, usually on compassionate grounds. After a median follow-up of 38 months, only two local recurrences were observed, an annual local recurrence rate of 0.75% (95% confidence interval, 0.09%-2.70%). Conclusions: While we await the results of the randomized trial (over 2,000 patients have already been recruited), TARGIT is an acceptable option but only in highly selected cases that cannot be recruited in the trial and in whom EBRT is not feasible/possible.

  17. Knowledge-based prediction of three-dimensional dose distributions for external beam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shiraishi, Satomi; Moore, Kevin L., E-mail: kevinmoore@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California 92093 (United States)

    2016-01-15

    Purpose: To demonstrate knowledge-based 3D dose prediction for external beam radiotherapy. Methods: Using previously treated plans as training data, an artificial neural network (ANN) was trained to predict a dose matrix based on patient-specific geometric and planning parameters, such as the closest distance (r) to planning target volume (PTV) and organ-at-risks (OARs). Twenty-three prostate and 43 stereotactic radiosurgery/radiotherapy (SRS/SRT) cases with at least one nearby OAR were studied. All were planned with volumetric-modulated arc therapy to prescription doses of 81 Gy for prostate and 12–30 Gy for SRS. Using these clinically approved plans, ANNs were trained to predict dose matrix and the predictive accuracy was evaluated using the dose difference between the clinical plan and prediction, δD = D{sub clin} − D{sub pred}. The mean (〈δD{sub r}〉), standard deviation (σ{sub δD{sub r}}), and their interquartile range (IQR) for the training plans were evaluated at a 2–3 mm interval from the PTV boundary (r{sub PTV}) to assess prediction bias and precision. Initially, unfiltered models which were trained using all plans in the cohorts were created for each treatment site. The models predict approximately the average quality of OAR sparing. Emphasizing a subset of plans that exhibited superior to the average OAR sparing during training, refined models were created to predict high-quality rectum sparing for prostate and brainstem sparing for SRS. Using the refined model, potentially suboptimal plans were identified where the model predicted further sparing of the OARs was achievable. Replans were performed to test if the OAR sparing could be improved as predicted by the model. Results: The refined models demonstrated highly accurate dose distribution prediction. For prostate cases, the average prediction bias for all voxels irrespective of organ delineation ranged from −1% to 0% with maximum IQR of 3% over r{sub PTV} ∈ [ − 6, 30] mm. The

  18. Knowledge-based prediction of three-dimensional dose distributions for external beam radiotherapy

    International Nuclear Information System (INIS)

    Shiraishi, Satomi; Moore, Kevin L.

    2016-01-01

    Purpose: To demonstrate knowledge-based 3D dose prediction for external beam radiotherapy. Methods: Using previously treated plans as training data, an artificial neural network (ANN) was trained to predict a dose matrix based on patient-specific geometric and planning parameters, such as the closest distance (r) to planning target volume (PTV) and organ-at-risks (OARs). Twenty-three prostate and 43 stereotactic radiosurgery/radiotherapy (SRS/SRT) cases with at least one nearby OAR were studied. All were planned with volumetric-modulated arc therapy to prescription doses of 81 Gy for prostate and 12–30 Gy for SRS. Using these clinically approved plans, ANNs were trained to predict dose matrix and the predictive accuracy was evaluated using the dose difference between the clinical plan and prediction, δD = D clin − D pred . The mean (〈δD r 〉), standard deviation (σ δD r ), and their interquartile range (IQR) for the training plans were evaluated at a 2–3 mm interval from the PTV boundary (r PTV ) to assess prediction bias and precision. Initially, unfiltered models which were trained using all plans in the cohorts were created for each treatment site. The models predict approximately the average quality of OAR sparing. Emphasizing a subset of plans that exhibited superior to the average OAR sparing during training, refined models were created to predict high-quality rectum sparing for prostate and brainstem sparing for SRS. Using the refined model, potentially suboptimal plans were identified where the model predicted further sparing of the OARs was achievable. Replans were performed to test if the OAR sparing could be improved as predicted by the model. Results: The refined models demonstrated highly accurate dose distribution prediction. For prostate cases, the average prediction bias for all voxels irrespective of organ delineation ranged from −1% to 0% with maximum IQR of 3% over r PTV ∈ [ − 6, 30] mm. The average prediction error was less

  19. Study of a bio-mechanical model of the movements and deformations of the pelvic organs and integration in the process of radiotherapy treatment for prostate cancer

    International Nuclear Information System (INIS)

    Azad, M.

    2011-01-01

    One of the goals of optimizing treatment planning of prostate cancer radiation therapy is to maintain the margins added to the clinical target volume (CTV) as small as possible to reduce the volumes of normal tissue irradiated. Several methods have been proposed to define these margins: 1) Methods based on the observation of movements obtained by different imaging systems, 2) The predictive methods of the movement of organs, from a model representing the motions of pelvis organs, a calculation of a margin can be made. We have developed and optimized a finite element bio-mechanical model of the prostate, bladder and rectum. This model describes the movement and deformation of the pelvic organs during the filling of certain organs such as the bladder and rectum. An evaluation of this model to predict the movement of the prostate during the various sessions of radiotherapy is shown using a series of CBCT images (Cone Beam Computerized Tomography). (author)

  20. Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy.

    Science.gov (United States)

    Hwang, Jong Ha; Yoo, Heon Jong; Park, Sae Hyun; Lim, Myong Cheol; Seo, Sang-Soo; Kang, Sokbom; Kim, Joo-Young; Park, Sang-Yoon

    2012-06-01

    To evaluate the effectiveness of ovarian transposition procedures in preserving ovarian function in relation to the location of the transposed ovaries in patients who underwent surgery with or without pelvic radiotherapy. Retrospective. Uterine cancer center. A total of 53 patients with cervical cancer who underwent ovarian transposition between November 2002 and November 2010. Ovarian transposition to the paracolic gutters with or without radical hysterectomy and lymph node dissection. Preservation of ovarian function, which was assessed by patient's symptoms and serum FSH level. Lateral ovarian transposition was performed in 53 patients. Based on receiver operator characteristic curve analysis, optimum cutoff value of location more than 1.5 cm above the iliac crest was significantly associated with preservation of ovarian function after treatment (area under receiver operator characteristic curve: 0.757, 95% confidence interval [CI]: 0.572-0.943). In univariate analysis, higher location of transposed ovary more than 1.5 cm from the iliac crest was the only independent factor for intact ovarian function (odds ratio 9.91, 95% CI: 1.75-56.3). Multivariate analysis confirmed that the location of transposed ovary (odds ratio 11.72, 95% CI 1.64-83.39) was the most important factor for intact ovarian function. Location of transposed ovary higher than 1.5 cm above the iliac crest is recommended to avoid ovarian failure after lateral ovarian transposition after primary or adjuvant pelvic radiotherapy in cervical cancer. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Evaluation of overall setup accuracy and adequate setup margins in pelvic image-guided radiotherapy: Comparison of the male and female patients

    International Nuclear Information System (INIS)

    Laaksomaa, Marko; Kapanen, Mika; Tulijoki, Tapio; Peltola, Seppo; Hyödynmaa, Simo; Kellokumpu-Lehtinen, Pirkko-Liisa

    2014-01-01

    We evaluated adequate setup margins for the radiotherapy (RT) of pelvic tumors based on overall position errors of bony landmarks. We also estimated the difference in setup accuracy between the male and female patients. Finally, we compared the patient rotation for 2 immobilization devices. The study cohort included consecutive 64 male and 64 female patients. Altogether, 1794 orthogonal setup images were analyzed. Observer-related deviation in image matching and the effect of patient rotation were explicitly determined. Overall systematic and random errors were calculated in 3 orthogonal directions. Anisotropic setup margins were evaluated based on residual errors after weekly image guidance. The van Herk formula was used to calculate the margins. Overall, 100 patients were immobilized with a house-made device. The patient rotation was compared against 28 patients immobilized with CIVCO's Kneefix and Feetfix. We found that the usually applied isotropic setup margin of 8 mm covered all the uncertainties related to patient setup for most RT treatments of the pelvis. However, margins of even 10.3 mm were needed for the female patients with very large pelvic target volumes centered either in the symphysis or in the sacrum containing both of these structures. This was because the effect of rotation (p ≤ 0.02) and the observer variation in image matching (p ≤ 0.04) were significantly larger for the female patients than for the male patients. Even with daily image guidance, the required margins remained larger for the women. Patient rotations were largest about the lateral axes. The difference between the required margins was only 1 mm for the 2 immobilization devices. The largest component of overall systematic position error came from patient rotation. This emphasizes the need for rotation correction. Overall, larger position errors and setup margins were observed for the female patients with pelvic cancer than for the male patients

  2. A criterion-based audit of the technical quality of external beam radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Brundage, Michael; Danielson, Brita; Pearcey, Robert; Bass, Brenda; Pickles, Tom; Bahary, Jean-Paul; Peng, Yingwei; Wallace, David; Mackillop, William

    2013-01-01

    Purpose: To evaluate the technical quality of external beam radiotherapy for prostate cancer in Canada. Methods: This was a multi-institution, retrospective study of a random sample of patients undergoing radiotherapy (RT) for prostate cancer in Canada. Patterns of care were determined by abstracting details of the patients’ management from original records. The quality of patient’s technical care was measured against a previously published, comprehensive suite of quality indicators. Results: 32 of the 37 RT centres participated. The total study population of 810 patients included 25% low-risk, 44% intermediate-risk, and 28% high-risk cases. 649 received external beam RT (EBRT) only, for whom compliance with 12 indicators of the quality of pre-treatment assessment ranged from 56% (sexual function documented) to 96% (staging bone scan obtained in high-risk patients). Compliance with treatment-related indicators ranged from 78% (dose to prostate ⩾74 Gy in intermediate risk patients not receiving hormone therapy) to 100% (3DCRT or IMRT plan). Compliance varied among centres; no centre demonstrated 100% compliance on all indicators and every centre was 100% compliant on at least some indicators. The number of assessment-related indicators (n = 13) with which a given centre was 100% compliant ranged from 4 to 11 (median 7) and the number of the treatment-specific indicators (n = 8) with which a given centre was 100% compliant ranged from 6 to 8 (median 8). ADT therapy was utilised in most high-risk cases (191, 92.3%). Conclusions: While patterns of prostate cancer care in Canada vary somewhat, compliance on the majority of quality indicators is very high. However, all centres showed room for improvement on several indicators and few individual patients received care that met target benchmarks on all quality measures. This variation is particularly important for indicators such as delivered dose where impact on disease outcome is known to exist, and suggests that

  3. Urinary incontinence in prostate cancer patients treated with external beam radiotherapy

    International Nuclear Information System (INIS)

    Liu, Mitchell; Pickles, Tom; Berthelet, Eric; Agranovich, Alexander; Kwan, Winkle; Tyldesley, Scott; McKenzie, Michael; Keyes, Mira; Morris, James; Pai, Howard

    2005-01-01

    Background and purpose: To describe the incidence of urinary incontinence among prostate cancer patients treated with external beam radiotherapy (RT) and to investigate associated risk factors. Patients and methods: One thousand and hundred ninety-two patients with ≥24 months follow-up were the subjects of this series. All patients received between 50 and 72 Gy in 20-37 fractions (median 66 Gy/33). Post-RT urinary incontinence was scored by direct patient interviewing according to the modified RTOG/SOMA scale: Grade 1-occasional use of incontinence pads, Grade 2-intermittent use of incontinence pads, Grade 3-persistent use of incontinence pads, and Grade 4-permanent catheter. Risk-factors investigated were: age, diabetes, TURP prior to RT, elapsed time from TURP to RT, clinical stage, RT dose and presence of Grade ≥2 acute GU and GI toxicity. Non-parametric, actuarial univariate (Kaplan-Meier) and multivariate tests (MVA, Cox regression) were performed. Results: Median follow-up for the group is 52 months (24-109). Thirty-four patients (2.9%) had incontinence prior to RT, which was more common in TURP patients (7.8% vs 1.6% P<0.001). These are excluded from further analysis. Fifty-seven patients (4.9%) developed Grade 1 incontinence, 7 (0.6%) Grade 2, and 7 (0.6%) Grade 3. There was no Grade 4 incontinence. Actuarial rates for Grade ≥1 and ≥2 incontinence at 5 years are 7 and 1.7%, respectively. Risk factors on MVA associated with the development of Grade 1 or worse incontinence are pre-RT TURP (5-year rates 10% vs 6%, P=0.026), presence of Grade ≥2 acute GU toxicity (5-year rates 11% vs 5%, P=0.002). Age, diabetes, clinical stage, elapsed time from TURP to RT, RT dose or fraction size, acute GI toxicity were not significant. Patients who underwent post-RT TURP or dilatation for obstructive symptoms (4.3%), were more likely to develop Grade 2-3 incontinence (5-year rate 8 vs 1.5%, P=0.0015). Conclusions: Grade 2 or greater urinary incontinence is rare

  4. 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.

  5. Phase I clinical trial of parenteral hydroxyurea in combination with pelvic and para-aortic external radiation and brachytherapy for patients with advanced squamous cell cancer of the uterine cervix

    International Nuclear Information System (INIS)

    Beitler, Jonathan J.; Anderson, Patrick; Haynes, Hilda; Sood, Brij; Fields, Abbi; Goldberg, Gary; Vikram, Bhadrasain; Runowicz, Carolyn D.; Wadler, Scott

    2002-01-01

    Purpose: Oral hydroxyurea (HU) is a potent radiation sensitizer, but in vitro studies have suggested that prolonged exposure to HU by way of continuous parenteral infusion would enhance clinical efficacy. The objective of this study was to determine the maximal tolerated dose and identify the toxicities of continuous infusion HU in combination with pelvic and para-aortic external beam radiotherapy (RT) and intrauterine brachytherapy in patients with locally advanced carcinoma of the uterine cervix. Methods: This Phase I study of concomitant RT was designed with an escalating dose schedule of HU administered by continuous infusion. HU was administered parenterally as a continuous infusion, 5 d/wk, during the first 21 days of external radiation, during the final 5 days of external beam RT, followed by another 5-day infusion schedule bracketing the single fraction of brachytherapy. The maximal tolerated dose was defined as the highest dose level at which 3 of 3 or 5 of 6 patients could be treated without dose-limiting toxicity. Results: At dose level 1 (0.25 mg/m 2 /min), 0 of 4 patients experienced Grade 4 toxicities and 2 patients experienced Grade 3 hematologic toxicities that were not considered dose-limiting. One of the first 4 patients at level 2 (0.375 mg/m 2 /min) had Grade 3 diarrhea, but the 3 subsequent patients tolerated the dose. At level 3 (0.5 mg/m 2 /min), 4 of 5 patients failed to complete therapy without a >7-day interruption in HU. Conclusions: The maximal tolerated dose of parenteral HU was 0.375 mg/m 2 /min when administered with concomitant RT. The most common toxicities were hematologic. A new trial, incorporating concurrent cisplatin, HU, and RT is planned

  6. Multicenter study differentiated thyroid carcinoma (MSDS). Diminished acceptance of adjuvant external beam radiotherapy

    International Nuclear Information System (INIS)

    Biermann, M.; Pixberg, M.K.; Schober, O.; Schuck, A.; Willich, N.; Heinecke, A.; Koepke, W.; Schmid, K.W.; Dralle, H.

    2003-01-01

    Aim: The Multicenter Study Differentiated Thyroid Carcinoma (MSDS) is an ongoing study in Germany, Austria, and Switzerland on the clinical benefit of adjuvant external beam radiotherapy (RTx) for locally invasive differentiated thyroid carcinoma (DTC) in TNM stages pT4 pNO/1/xMO/x (5th ed. 1997). Methods: MSDS was designed as a prospective randomized trial. Patients receive thyroidectomy, radioiodine therapy (RIT) to ablate the thyroid remnant, and TSH-suppressive L-thyroxine therapy with or without RTx after documented elimination of cervical iodine-131 uptake (http://msds-studie.uni-muenster.de). Results: 311 patients were enrolled between January 2000 and March 2003. 279 patients met the trial's inclusion criteria. 45 consented to randomization, of whom 17 were randomized into treatment arm A (RTx) and 18 into arm B (no RTx). Advised by the trial's independent Data Monitoring and Safety Committee, the MSDS steering committee decided to terminate randomization in April 2003 and continue MSDS as a prospective cohort study. 23 of the 234 patients in the observation arm of the trial were prescribed RTx by their physicians. Thus, 14% of the trial cohort were randomized or assigned to receive RTx (intention-to-treat analysis). In contrast, at least 44% of all patients with pT4 papillary DTC in Germany in the nationwide PCES study underwent RTx in 1996 (p 2 -test). Conclusions: Acceptance of external beam RTx as a treatment modality for DTC has receded to a degree that accrual of a sufficient number of patients for a randomized trial has been impossible. Observation of the trial cohort is continued in order to assess clinical event rates with and without RTx and chronic RTx toxicity. (orig.) [de

  7. A simple method to prolong the service life of radioactive sources for external radiotherapy.

    Science.gov (United States)

    Xu, Yingjie; Tian, Yuan; Dai, Jianrong

    2014-07-08

    A radioactive source is usually replaced and disposed after being used for a certain amount of time (usually a half-life). In this study, a simple method is proposed to prolong its service life. Instead of replacing the used source with a new source of full activity, a new source of less activity is added in the source holder in front of the used one, so that the total activity of two sources is equal to the initial activity of the used source or even higher. Similarly, more sources can be added to the previous ones. Attenuation of front source(s) to the back source(s) was evaluated with exponential attenuation equation, and variation of source-focus distance (SFD) with inverse square law for Leksell 4C Gamma Knife, which served as an example of external radiotherapy units. When the number of front sources increased from 1 to 3, the relative air kerma decreased from 36.5% to 5.0%. Both the attenuation effect and SFD variation contributed to the decrease in air kerma, with the former being the major factor. If the height of the source can be decreased in some way, such as increasing the specific activity of sources, the sources can be used more efficiently. The method prolongs the service life of sources by several factors, and reduces the expense of source exchange and reclamation.

  8. Perspectives in absorbed dose metrology with regard to the technical evolutions of external beam radiotherapy

    International Nuclear Information System (INIS)

    Chauvenet, B.; Bordy, J.M.; Barthe, J.

    2009-01-01

    This paper presents several R and D axes in absorbed close metrology to meet the needs resulting from the technical evolutions of external beam radiotherapy. The facilities in operation in France have considerably evolved under the impulse of the plan Cancer launched in 2003: replacements and increase of the number of accelerators, substitution of accelerators for telecobalt almost completed and acquisition of innovative facilities for tomo-therapy and stereotaxy. The increasing versatility of facilities makes possible the rapid evolution of treatment modalities, allowing to better delimit irradiation to tumoral tissues and spare surrounding healthy tissues and organs at risk. This leads to a better treatment efficacy through dose escalation. National metrology laboratories must offer responses adapted to the new need, i.e. not restrict themselves to the establishment of references under conventional conditions defined at international level, contribute to the improvement of uncertainties at all levels of reference transfer to practitioners: primary measurements under conditions as close as possible to those of treatment, characterization of transfer and treatment control dosimeters., metrological validation of treatment planning tools... Those axes have been identified as priorities for the next years in ionizing radiation metrology at the European level and included in the European. Metrology Research Programme. A project dealing with some of those topics has been selected in the frame of the Eranet+ Call EMRP 2007 and is now starting. The LNE-LAM is strongly engaged in it. (authors)

  9. Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients

    International Nuclear Information System (INIS)

    Putora, P.M.; Buchauer, K.; Plasswilm, L.; Engeler, D.; Schmid, H.P.; Haile, S.R.; Graf, N.

    2016-01-01

    For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry. Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter. Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF). In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP. (orig.) [de

  10. Reducing the risk of radiocarcinogenesis in paediatric patients treated with external beam radiotherapy

    International Nuclear Information System (INIS)

    Taylor, M.L.; Franich, R.D.; Kron, Tomas

    2010-01-01

    Full text: The aim of this study was to determine readily-implementable means of out-of-field dose reduction in paediatric patients undergoing external beam radiotherapy for intracranial lesions. [n this way, the risk of secondary cancer induction may be reduced. Dose measurements were taken using LiF:Mg, Cu, P TLD 1 00 H chips in a 5 year old paediatric phantom. Multiple TLDs were placed at: the right and left lenses of the eye, optic nerve, brain, thyroid, lungs, heart, kidneys, abdomen and gonads. Varian 600 C and Varian Trilogy linear accelerators, both at 6 MV, were investigated, using different delivery parameters. Most of the out-of-field dose at large distances is attributable to leakage. The difference between stereotactic and larger field sizes is less significant far from the primary field. Out-of-field dose from the Trilogy was 40% higher than the 600 e . Aligning the craniocaudal axis of the patient with the x-plane of the collimator results in a dose reduction of 40%, for both machines. - A simple shielding arrangement may halve out-of-field dose. (author)

  11. Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Silvia Johansson

    2012-01-01

    Full Text Available Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT. The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU and gastrointestinal (GI toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity.

  12. Sexual function after external-beam radiotherapy for prostate cancer: what do we know?

    Science.gov (United States)

    Incrocci, Luca

    2006-02-01

    Quality of life in general and sexual functioning in particular have become very important in cancer patients. Due to modern surgical techniques, improved quality of drugs for chemotherapy and very modern radiation techniques, more patients can be successfully treated without largely compromising sexual functioning. One can assume that because of the life-threatening nature of cancer, sexual activity is not important to patients and their partners, but this is not true. Prostate cancer has become the most common non-skin malignant neoplasm in older men in Western countries. In this paper, we discuss the various methods used to evaluate erectile and sexual dysfunction and the definition of potency. Data on the etiology of erectile dysfunction after external-beam radiotherapy for prostate cancer is reviewed, and the literature is been summarized. Patients should be offered sexual counseling and informed about the availability of effective treatments for erectile dysfunction, such as sildenafil, intracavernosal injection, and vacuum devices. Cancer affects quality of life and sexual function. The challenge for oncologists is to address this with compassion.

  13. Hypofractionated Proton Boost Combined with External Beam Radiotherapy for Treatment of Localized Prostate Cancer

    Science.gov (United States)

    Johansson, Silvia; Åström, Lennart; Sandin, Fredrik; Isacsson, Ulf; Montelius, Anders; Turesson, Ingela

    2012-01-01

    Proton boost of 20 Gy in daily 5 Gy fractions followed by external beam radiotherapy (EBRT) of 50 Gy in daily 2 Gy fractions were given to 278 patients with prostate cancer with T1b to T4N0M0 disease. Fifty-three percent of the patients received neoadjuvant androgen deprivation therapy (N-ADT). The medium followup was 57 months. The 5-year PSA progression-free survival was 100%, 95%, and 74% for low-, intermediate-, and high-risk patients, respectively. The toxicity evaluation was supported by a patient-reported questionnaire before every consultant visit. Cumulative probability and actuarial prevalence of genitourinary (GU) and gastrointestinal (GI) toxicities are presented according to the RTOG classification. N-ADT did not influence curability. Mild pretreatment GU-symptoms were found to be a strong predictive factor for GU-toxicity attributable to treatment. The actuarial prevalence declined over 3 to 5 years for both GU and GI toxicities, indicating slow resolution of epithelial damage to the genitourinary and gastrointestinal tract. Bladder toxicities rather than gastrointestinal toxicities seem to be dose limiting. More than 5-year followup is necessary to reveal any sign of true progressive late side effects of the given treatment. Hypofractionated proton-boost combined with EBRT is associated with excellent curability of localized PC and acceptable frequencies of treatment toxicity. PMID:22848840

  14. Optimising measles virus-guided radiovirotherapy with external beam radiotherapy and specific checkpoint kinase 1 inhibition

    International Nuclear Information System (INIS)

    Touchefeu, Yann; Khan, Aadil A.; Borst, Gerben; Zaidi, Shane H.; McLaughlin, Martin; Roulstone, Victoria; Mansfield, David; Kyula, Joan; Pencavel, Tim; Karapanagiotou, Eleni M.; Clayton, Jamie; Federspiel, Mark J.; Russell, Steve J.; Garrett, Michelle; Collins, Ian; Harrington, Kevin J.

    2013-01-01

    Background and purpose: We previously reported a therapeutic strategy comprising replication-defective NIS-expressing adenovirus combined with radioiodide, external beam radiotherapy (EBRT) and DNA repair inhibition. We have now evaluated NIS-expressing oncolytic measles virus (MV-NIS) combined with NIS-guided radioiodide, EBRT and specific checkpoint kinase 1 (Chk1) inhibition in head and neck and colorectal models. Materials and methods: Anti-proliferative/cytotoxic effects of individual agents and their combinations were measured by MTS, clonogenic and Western analysis. Viral gene expression was measured by radioisotope uptake and replication by one-step growth curves. Potential synergistic interactions were tested in vitro by Bliss independence analysis and in in vivo therapeutic studies. Results: EBRT and MV-NIS were synergistic in vitro. Furthermore, EBRT increased NIS expression in infected cells. SAR-020106 was synergistic with EBRT, but also with MV-NIS in HN5 cells. MV-NIS mediated 131 I-induced cytotoxicity in HN5 and HCT116 cells and, in the latter, this was enhanced by SAR-020106. In vivo studies confirmed that MV-NIS, EBRT and Chk1 inhibition were effective in HCT116 xenografts. The quadruplet regimen of MV-NIS, virally-directed 131 I, EBRT and SAR-020106 had significant anti-tumour activity in HCT116 xenografts. Conclusion: This study strongly supports translational and clinical research on MV-NIS combined with radiation therapy and radiosensitising agents

  15. Time of Decline in Sexual Function After External Beam Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Siglin, Joshua; Kubicek, Gregory J.; Leiby, Benjamin; Valicenti, Richard K.

    2010-01-01

    Purpose: Erectile dysfunction is one of the most concerning toxicities for patients in the treatment of prostate cancer. The inconsistent evaluation of sexual function (SF) and limited follow-up data have necessitated additional study to clarify the rate and timing of erectile dysfunction after external beam radiotherapy (EBRT) for prostate cancer. Methods and Materials: A total of 143 men completed baseline data on SF before treatment and at the subsequent follow-up visits. A total of 1187 validated SF inventories were analyzed from the study participants. Multiple domains of SF (sex drive, erectile function, ejaculatory function, and overall satisfaction) were analyzed for ≤8 years of follow-up. Results: The median follow-up was 4.03 years. The strongest predictor of SF after EBRT was SF before treatment. For all domains of SF, the only statistically significant decrease in function occurred in the first 24 months after EBRT. SF stabilized 2 years after treatment completion, with no statistically significant change in any area of SF >2 years after the end of EBRT. Conclusion: These data suggest that SF does not have a continuous decline after EBRT. Instead, SF decreases maximally within the first 24 months after EBRT, with no significant changes thereafter.

  16. Palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shinya; Hayashi; Hidekazu; Tanaka; Hiroaki; Hoshi

    2014-01-01

    The incidence of bone metastases(BMs)from hepatocellular carcinoma(HCC)is relatively low compared to those of other cancers,but it has increased recently,especially in Asian countries.Typically,BMs from HCC appear radiologically as osteolytic,destructive,and expansive components with large,bulky soft-tissue masses.These soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive growth.They often compress the peripheral nerves,spinal cord,or cranial nerves,causing not only bone pain but also neuropathic pain and neurological symptoms.In patients with spinal BMs,the consequent metastatic spinal cord compression(MSCC)causes paralysis.Skull base metastases(SBMs)with cranial nerve involvement can cause neurological symptoms.Therefore,patients with bony lesions often suffer from pain or neurological symptoms that have a severe,adverse effect on the quality of life.External-beam radiotherapy(EBRT)can effectively relieve bone pain and neurological symptoms caused by BMs.However,EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant studies.Furthermore,the optimal dosing schedule remains unclear,despite clinical evidence to support single-fraction ra-diation schedules for primary cancers.In this review,we outline data describing palliative EBRT for BMs from HCC in the context of(1)bone pain;(2)MSCC;and(3)SBMs.

  17. Evaluation of surface and shallow depth dose reductions using a Superflab bolus during conventional and advanced external beam radiotherapy.

    Science.gov (United States)

    Yoon, Jihyung; Xie, Yibo; Zhang, Rui

    2018-03-01

    The purpose of this study was to evaluate a methodology to reduce scatter and leakage radiations to patients' surface and shallow depths during conventional and advanced external beam radiotherapy. Superflab boluses of different thicknesses were placed on top of a stack of solid water phantoms, and the bolus effect on surface and shallow depth doses for both open and intensity-modulated radiotherapy (IMRT) beams was evaluated using thermoluminescent dosimeters and ion chamber measurements. Contralateral breast dose reduction caused by the bolus was evaluated by delivering clinical postmastectomy radiotherapy (PMRT) plans to an anthropomorphic phantom. For the solid water phantom measurements, surface dose reduction caused by the Superflab bolus was achieved only in out-of-field area and on the incident side of the beam, and the dose reduction increased with bolus thickness. The dose reduction caused by the bolus was more significant at closer distances from the beam. Most of the dose reductions occurred in the first 2-cm depth and stopped at 4-cm depth. For clinical PMRT treatment plans, surface dose reductions using a 1-cm Superflab bolus were up to 31% and 62% for volumetric-modulated arc therapy and 4-field IMRT, respectively, but there was no dose reduction for Tomotherapy. A Superflab bolus can be used to reduce surface and shallow depth doses during external beam radiotherapy when it is placed out of the beam and on the incident side of the beam. Although we only validated this dose reduction strategy for PMRT treatments, it is applicable to any external beam radiotherapy and can potentially reduce patients' risk of developing radiation-induced side effects. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  18. Carcinoma of the prostate treated by pelvic node dissection, iodine-125 seed implant and external irradiation; a study of rectal complications

    Energy Technology Data Exchange (ETDEWEB)

    Abadir, R.; Ross, G. Jr.; Weinstein, S.H. (Missouri Univ., Columbia (USA). Hospital and Clinics)

    1984-09-01

    The University of Missouri-Columbia protocol for localised cancer of the prostate calls for pelvic node dissection, 10 000 cGy at the periphery of the prostate from /sup 125/I and 4000 cGy in 20 fractions to the whole pelvis using supervoltage X-ray therapy. Rectal complications were studied in 104 patients; acute and chronic reactions were defined. During external irradiation 54% did not develop diarrhoea, 43% had mild diarrhoea and 3% had severe diarrhoea. In the chronic stage 77% did not have diarrhoea, 12% had delayed, non-distressing rectal bleeding which did not need specific treatment or needed only simple treatment, 7% had prolonged distressing proctitis and 4% had rectal ulceration or recto-urethral fistula necessitating colostomy. Each of the four patients who had colostomy had an additional aetiological factor (arterial disease, pelvic inflammation, additional radiation, pelvic malignancy or second operation). None of the patients entered in the combined brachytherapy and teletherapy programme, and in whom 0.5 cm space was maintained between the closest seed and the rectal mucosa, developed prolonged proctitis.

  19. Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy - evaluation of long-term effects of diagnosis and treatment

    International Nuclear Information System (INIS)

    Bye, A.; Trope, C.; Loge, J.H.; Hjermstad, M.; Kaasa, S.

    2000-01-01

    Health-related quality of life (HRQOL) and occurrence of late intestinal side effects were assessed 3-4 years after pelvic radiotherapy for carcinoma of the endometrium and cervix. During 1988-1990, 143 women were included in a clinical trial to evaluate the effect of a low fat, low lactose diet on radiation-induced diarrhoea. Of 94 survivors, 79 (84%) answered the request. HRQOL was assessed by the EORTC QLQ-C36 and compared with population-based norms. The women scored lower than the general population on role functioning (81.5 versus 90.6 (p < 0.01)) and higher on diarrhoea (23.8 versus 9.5 (p < 0.01)). Compared with pre-treatment conditions, an increase in cases with pain in the lower back, hips and thighs was seen. Substantial pain and diarrhoea were associated with deterioration in HRQOL. In conclusion, few treatment and/or disease-related effects were detected 3-4 years after radiotherapy, with the exception of increased bowel frequency and pain in the lower back, hips and thighs

  20. Estimating internal pelvic sizes using external body measurements in the double-muscled Belgian Bleu beef breed

    NARCIS (Netherlands)

    Coopman, F.; Smet, S.; Gengler, N.; Haegeman, A.; Jacobs, K.; Poucke, van M.; Laevens, H.; Zeveren, van A.; Groen, A.F.

    2003-01-01

    In the double-muscled (DM) Belgian Blue beef (BBB) breed, caesarean section (CS) is being applied systematically as a management tool to prevent dystocia. As a matter of fact, CS is the only possible way of calving in the breed. High birth weight and a relatively small pelvic area are the main

  1. A survey of techniques to reduce and manage external beam radiation-induced xerostomia in British oncology and radiotherapy departments

    International Nuclear Information System (INIS)

    Macknelly, Andrew; Day, Jane

    2009-01-01

    Xerostomia is the most common side effect of external beam radiotherapy to the head and neck [Anand A, Jain J, Negi P, Chaudhoory A, Sinha S, Choudhury P, et-al. Can dose reduction to one parotid gland prevent xerostomia? - A feasibility study for locally advanced head and neck cancer patients treated with intensity-modulated radiotherapy. Clinical Oncology 2006;18(6):497-504.]. A survey was carried out in British oncology departments to determine what treatment regimes, to minimise xerostomia, are used for patients with head-and-neck cancers treated with external beam radiotherapy. A semi-structured questionnaire consisting of both quantitative and qualitative questions was designed that asked departments which of the identified methods they used, why a method might not be currently employed, and whether its use had ever been considered. The study found that there are wide disparities between the techniques employed by oncology departments to avoid and reduce xerostomia in patients with cancers of the head and neck. The National Institute of Clinical Health and Excellence, [National Institute for Clinical Health and Excellence (NICE). Improving outcomes in head and neck cancers: the manual. London: Office of Public Sector Information; 2004.] for example, recommends that patients are given dental care and dietary advice but some departments did not appear to be doing this. Less than half of departments stated that they offer complementary therapies and less than 40% prescribed pilocarpine, a saliva-stimulant. Only two respondents stated that they use amifostine, a radioprotector, during radiotherapy treatment to the head and neck. The results also suggested a move toward using Intensity Modulated Radiotherapy (IMRT) for treating head-and-neck cancers which offers better normal tissue sparing than three-dimensional conformal radiotherapy. [Anand A, Jain J, Negi P, Chaudhoory A, Sinha S, Choudhury P, et al. Can dose reduction to one parotid gland prevent xerostomia

  2. External and intraoperative radiotherapy for resectable and unresectable pancreatic cancer: analysis of survival rates and complications

    International Nuclear Information System (INIS)

    Nishimura, Yasumasa; Hosotani, Ryo; Shibamoto, Yuta; Kokubo, Masaki; Kanamori, Shuichi; Sasai, Keisuke; Hiraoka, Masahiro; Ohshio, Gakuji; Imamura, Masayuki; Takahashi, Masaji; Abe, Mitsuyuki

    1997-01-01

    Purpose: Clinical results of intraoperative radiotherapy (IORT) and/or external beam radiotherapy (EBRT) for both resectable and unresectable pancreatic cancer were analyzed. Methods and Materials: Between 1980 and 1995, 332 patients with pancreatic cancer were treated with surgery and/or radiation therapy (RT). Of the 332 patients, 157 patients were treated with surgical resection of pancreatic tumor, and the remaining 175 patients had unresectable pancreatic tumors. Among the 157 patients with resected pancreatic cancer, 62 patients were not treated with RT, while 40 patients were treated with EBRT alone (mean RT dose; 46.3 Gy) and 55 patients with IORT (25.2 Gy) ± EBRT (44.0 Gy). On the other hand, among the 175 patients with unresectable pancreatic cancer, 58 patients were not treated with RT, 46 patients were treated with EBRT alone (39.2 Gy), and the remaining 71 patients with IORT (29.3 Gy) ± EBRT (41.2 Gy). Results: For 87 patients with curative resection, the median survival times (MSTs) of the no-RT, the EBRT, and the IORT ± EBRT groups were 10.4, 13.0, and 15.5 months, respectively, without significant difference. For 70 patients with non curative resection, the MSTs of the no-RT, the EBRT, and the IORT ± EBRT groups were 5.3, 8.7, and 6.5 months, respectively. When the EBRT and the IORT ± EBRT groups were combined, the survival rate was significantly higher than that of the no RT group for non curatively resected pancreatic cancers (log rank test; p = 0.028). The 2-year survival probability of the IORT ± EBRT group (16%) was higher than that of the EBRT group (0%). For unresectable pancreatic cancer, the MSTs of 52 patients without distant metastases were 6.7 months for palliative surgery alone, 7.6 months for EBRT alone, and 8.2 months for IORT ± EBRT. The survival curve of the IORT ± EBRT group was significantly better than that of the no-RT group (p 2 years) were obtained by IORT ± EBRT for non curatively resected and unresectable pancreatic

  3. Optical eye tracking system for real-time noninvasive tumor localization in external beam radiotherapy.

    Science.gov (United States)

    Via, Riccardo; Fassi, Aurora; Fattori, Giovanni; Fontana, Giulia; Pella, Andrea; Tagaste, Barbara; Riboldi, Marco; Ciocca, Mario; Orecchia, Roberto; Baroni, Guido

    2015-05-01

    External beam radiotherapy currently represents an important therapeutic strategy for the treatment of intraocular tumors. Accurate target localization and efficient compensation of involuntary eye movements are crucial to avoid deviations in dose distribution with respect to the treatment plan. This paper describes an eye tracking system (ETS) based on noninvasive infrared video imaging. The system was designed for capturing the tridimensional (3D) ocular motion and provides an on-line estimation of intraocular lesions position based on a priori knowledge coming from volumetric imaging. Eye tracking is performed by localizing cornea and pupil centers on stereo images captured by two calibrated video cameras, exploiting eye reflections produced by infrared illumination. Additionally, torsional eye movements are detected by template matching in the iris region of eye images. This information allows estimating the 3D position and orientation of the eye by means of an eye local reference system. By combining ETS measurements with volumetric imaging for treatment planning [computed tomography (CT) and magnetic resonance (MR)], one is able to map the position of the lesion to be treated in local eye coordinates, thus enabling real-time tumor referencing during treatment setup and irradiation. Experimental tests on an eye phantom and seven healthy subjects were performed to assess ETS tracking accuracy. Measurements on phantom showed an overall median accuracy within 0.16 mm and 0.40° for translations and rotations, respectively. Torsional movements were affected by 0.28° median uncertainty. On healthy subjects, the gaze direction error ranged between 0.19° and 0.82° at a median working distance of 29 cm. The median processing time of the eye tracking algorithm was 18.60 ms, thus allowing eye monitoring up to 50 Hz. A noninvasive ETS prototype was designed to perform real-time target localization and eye movement monitoring during ocular radiotherapy treatments. The

  4. Optical eye tracking system for real-time noninvasive tumor localization in external beam radiotherapy

    International Nuclear Information System (INIS)

    Via, Riccardo; Fassi, Aurora; Fattori, Giovanni; Fontana, Giulia; Pella, Andrea; Tagaste, Barbara; Ciocca, Mario; Riboldi, Marco; Baroni, Guido; Orecchia, Roberto

    2015-01-01

    Purpose: External beam radiotherapy currently represents an important therapeutic strategy for the treatment of intraocular tumors. Accurate target localization and efficient compensation of involuntary eye movements are crucial to avoid deviations in dose distribution with respect to the treatment plan. This paper describes an eye tracking system (ETS) based on noninvasive infrared video imaging. The system was designed for capturing the tridimensional (3D) ocular motion and provides an on-line estimation of intraocular lesions position based on a priori knowledge coming from volumetric imaging. Methods: Eye tracking is performed by localizing cornea and pupil centers on stereo images captured by two calibrated video cameras, exploiting eye reflections produced by infrared illumination. Additionally, torsional eye movements are detected by template matching in the iris region of eye images. This information allows estimating the 3D position and orientation of the eye by means of an eye local reference system. By combining ETS measurements with volumetric imaging for treatment planning [computed tomography (CT) and magnetic resonance (MR)], one is able to map the position of the lesion to be treated in local eye coordinates, thus enabling real-time tumor referencing during treatment setup and irradiation. Experimental tests on an eye phantom and seven healthy subjects were performed to assess ETS tracking accuracy. Results: Measurements on phantom showed an overall median accuracy within 0.16 mm and 0.40° for translations and rotations, respectively. Torsional movements were affected by 0.28° median uncertainty. On healthy subjects, the gaze direction error ranged between 0.19° and 0.82° at a median working distance of 29 cm. The median processing time of the eye tracking algorithm was 18.60 ms, thus allowing eye monitoring up to 50 Hz. Conclusions: A noninvasive ETS prototype was designed to perform real-time target localization and eye movement monitoring

  5. A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer. Results at median follow-up of 102 months

    International Nuclear Information System (INIS)

    Akakura, Koichiro; Suzuki, Hiroyoshi; Ichikawa, Tomohiko

    2006-01-01

    The background of this study was to investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy. One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissection and 49 were treated with external beam radiation by linear accelerator with 40-50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined. Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2% versus 71.1% for biochemical progression-free rates; P=0.25, 83.5% versus 66.1% for clinical progression-free rates; P=0.14, 85.7% versus 77.1% for cause-specific survival rates; P=0.06, and 67.9% versus 60.9% for overall survival rates; P=0.30), although none of them reached statistical significance. Erectile dysfunction was recognized in almost all patients as a result of continuous endocrine therapy. Incontinence requiring more than one pad per day was observed more frequently in the surgery group than the radiation group (P<0.01). For the treatment of patients with locally advanced prostate cancer, when combined with endocrine therapy, either radical prostatectomy or external beam radiotherapy demonstrated favorable long-term outcomes. The radiation dose of 60-70 Gy might not be enough for the local treatment of locally advanced prostate cancer. (author)

  6. Radiotherapy

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  7. High biologically effective dose radiation therapy using brachytherapy in combination with external beam radiotherapy for high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Keisei Okamoto

    2017-02-01

    Full Text Available Purpose : To evaluate the outcomes of high-risk prostate cancer patients treated with biologically effective dose (BED ≥ 220 Gy of high-dose radiotherapy, using low-dose-rate (LDR brachytherapy in combination with external beam radiotherapy (EBRT and short-term androgen deprivation therapy (ADT. Material and methods : From 2005 to 2013, a total of 143 patients with high-risk prostate cancer were treated by radiotherapy of BED ≥ 220 Gy with a combination of LDR brachytherapy, EBRT, and androgen deprivation therapy (ADT. The high-risk patients in the present study included both high-risk and very high-risk prostate cancer. The number of high-risk features were: 60 patients with 1 high-risk factor (42%, 61 patients with 2 high-risk factors (43%, and 22 patients with 3 high-risk factors (15% including five N1 disease. External beam radiotherapy fields included prostate and seminal vesicles only or whole pelvis depending on the extension of the disease. Biochemical failure was defined by the Phoenix definition. Results : Six patients developed biochemical failure, thus providing a 5-year actual biochemical failure-free survival (BFFS rate of 95.2%. Biochemical failure was observed exclusively in cases with distant metastasis in the present study. All six patients with biochemical relapse had clinical failure due to bone metastasis, thus yielding a 5-year freedom from clinical failure (FFCF rate of 93.0%. None of the cases with N1 disease experienced biochemical failure. We observed four deaths, including one death from prostate cancer, therefore yielding a cause-specific survival (CSS rate of 97.2%, and an overall survival (OS rate of 95.5%. Conclusions : High-dose (BED ≥ 220 Gy radiotherapy by LDR in combination with EBRT has shown an excellent outcome on BFFS in high-risk and very high-risk cancer, although causal relationship between BED and BFFS remain to be explained further.

  8. Influence of boost technique (external beam radiotherapy or brachytherapy) on the outcome of patients with carcinoma of the base of the tongue

    International Nuclear Information System (INIS)

    Regueiro, C.A.; Millan, I.; Torre, A. de la; Valcarcel, F.J.; Magallon, R.; Fernandez, E.; Aragon, G.

    1995-01-01

    We reviewed 90 patients with squamous cell carcinoma of the base of the tongue. Fifty-three patients were treated with external beam radiotherapy alone (3 T1, 11 T2, 21 T3, and 18 T4 tumors) and thirty-seven patients were treated with external beam radiotherapy plus brachytherapy boost (4 T1, 15 T2, 11 T3, and 7 T4 tumors). For patients with T1, T2 and T3 primaries, the actuarial 3-year local relapse-free survival was 42% following external beam radiotherapy alone and 67% following external beam radiotherapy plus brachytherapy (p<0.05). The actuarial 3-year cause specific survival for these T-stages was 37% for patients treated with external beam radiotherapy alone and 53% for patients treated with external beam radiotherapy plus brachytherapy (p=0.1). In the Cox multivariate analyses restricted patients with T1, T2 and T3 staged tumors, treatment modality was the only predictor for local control but no influence on specific survival was found. The trend towards significant differences in specific survival found in the univariate comparison of both treatment modalities was probably due to the significantly higher number of N-positive patients treated with external beam radiotherapy alone. When all stages were included in the Cox analysis, low hemoglobin level, invasion of deep muscle, number of palpable nodes, and history of weight loss significantly influenced the outcome. Soft tissue necrosis occurred more frequently in patients treated with external beam radiotherapy plus brachytherapy (33% vs. 10%, p=0.52). (orig.)

  9. Assessment by the patient of the acute toxicity of the pelvic radiotherapy according to the Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE v3.0): dream or reality

    International Nuclear Information System (INIS)

    Champeaux-Orange, E.; Reynaud-Bougnoux, A.; Barillot, I.

    2010-01-01

    The Common Terminology Criteria for Adverse Events which contains a classification of radiotherapy side effects has been simplified and adapted into a notebook in order to make it clearer and easier to understand for the patient. The patients are given this notebook to fill it in on a daily basis. The authors report a survey which aimed at assessing the feasibility of using such a notebook to report the acute toxicity of pelvic radiotherapy. All the concerned patients filled in the notebook. A great majority of them filled it completely and every day. The rest of them filled in the notebook only on the days they had symptoms. Short communication

  10. Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Putora, P.M.; Buchauer, K.; Plasswilm, L. [Kantonsspital St. Gallen, Department of Radiation Oncology, St. Gallen (Switzerland); Engeler, D.; Schmid, H.P. [Kantonsspital St. Gallen, Department of Urology, St. Gallen (Switzerland); Haile, S.R.; Graf, N. [Kantonsspital St. Gallen, Clinical Trials Unit, St. Gallen (Switzerland)

    2016-03-15

    For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry. Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter. Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF). In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP. (orig.) [German] Die externe Radiotherapie (EBRT), die radikale Prostatektomie (RP) sowie die Brachytherapie (BT) stellen Behandlungsoptionen fuer das lokalisierte Prostatakarzinom dar. Die erektile Dysfunktion (ED) ist eine haeufige Nebenwirkung dieser Therapien. Unser Ziel war es, die penile erektile Funktion (EF) vor und nach BT, EBRT und RP mit Hilfe eines validierten, vom Patienten ausgefuellten Lebensqualitaetsfragebogens aus einer prospektiven Datenbank zu beurteilen. Mit einer minimalen Nachbeobachtungszeit von einem Jahr wurden 478 Patienten analysiert, die eine RP (n = 252), EBRT (n = 91) oder BT (n = 135) erhalten hatten und deren EF mit

  11. Prostate cancer: variables to keep in mind at the moment to decide the external radiotherapy dose

    International Nuclear Information System (INIS)

    Donato, H.; Barros, J.M.; Fernandez Bibiloni, C.; Barrios, E.; Martinez, A.; Broda, E.; Cardiello, C.; Alva, R.; Chiozza, J.; Filomia, M.L.; Rafailovici, L.; Dosoretz, B.

    2007-01-01

    The objective of this work is to evaluate forecast factors and other variables in the decision of the final dose for prostate cancer treatment with 3D conformal radiotherapy techniques of modulated intensity. To determine the optimal dose, direct and indirect variables related to the disease should be considered. Also the equipment and the radiotherapy technique will impact on this decision [es

  12. Re-irradiation: Outcome, cumulative dose and toxicity in patients retreated with stereotactic radiotherapy in the abdominal or pelvic region

    NARCIS (Netherlands)

    H. Abusaris (Huda); M.S. Hoogeman (Mischa); J.J.M.E. Nuyttens (Joost)

    2012-01-01

    textabstractThe purpose of the present study was to explore the outcome, cumulative dose in tumor and organs at risk and toxicity after extra-cranial stereotactic re-irradiation. Twenty-seven patients were evaluated who had been re-irradiated with stereotactic body radiotherapy (SBRT) after

  13. Variation in Adherence to External Beam Radiotherapy Quality Measures Among Elderly Men With Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Bekelman, Justin E.; Zelefsky, Michael J.; Jang, Thomas L.; Basch, Ethan M.; Schrag, Deborah

    2007-01-01

    Purpose: To characterize the variation in adherence to quality measures of external beam radiotherapy (EBRT) for localized prostate cancer and its relation to patient and provider characteristics in a population-based, representative sample of U.S. men. Methods and Materials: We evaluated EBRT quality measures proposed by a RAND expert panel of physicians among men aged ≥65 years diagnosed between 2000 and 2002 with localized prostate cancer and treated with primary EBRT using data from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare program. We assessed the adherence to five EBRT quality measures that were amenable to analysis using SEER-Medicare data: (1) use of conformal RT planning; (2) use of high-energy (>10-MV) photons; (3) use of custom immobilization; (4) completion of two follow-up visits with a radiation oncologist in the year after therapy; and (5) radiation oncologist board certification. Results: Of the 11,674 patients, 85% had received conformal RT planning, 75% had received high-energy photons, and 97% had received custom immobilization. One-third of patients had completed two follow-up visits with a radiation oncologist, although 91% had at least one visit with a urologist or radiation oncologist. Most patients (85%) had been treated by a board-certified radiation oncologist. Conclusions: The overall high adherence to EBRT quality measures masked substantial variation in geography, socioeconomic status in the area of residence, and teaching affiliation of the RT facility. Future research should examine the reasons for the variations in these measures and whether the variation is associated with important clinical outcomes

  14. Parallelization of learning problems by artificial neural networks. Application in external radiotherapy

    International Nuclear Information System (INIS)

    Sauget, M.

    2007-12-01

    This research is about the application of neural networks used in the external radiotherapy domain. The goal is to elaborate a new evaluating system for the radiation dose distributions in heterogeneous environments. The al objective of this work is to build a complete tool kit to evaluate the optimal treatment planning. My st research point is about the conception of an incremental learning algorithm. The interest of my work is to combine different optimizations specialized in the function interpolation and to propose a new algorithm allowing to change the neural network architecture during the learning phase. This algorithm allows to minimise the al size of the neural network while keeping a good accuracy. The second part of my research is to parallelize the previous incremental learning algorithm. The goal of that work is to increase the speed of the learning step as well as the size of the learned dataset needed in a clinical case. For that, our incremental learning algorithm presents an original data decomposition with overlapping, together with a fault tolerance mechanism. My last research point is about a fast and accurate algorithm computing the radiation dose deposit in any heterogeneous environment. At the present time, the existing solutions used are not optimal. The fast solution are not accurate and do not give an optimal treatment planning. On the other hand, the accurate solutions are far too slow to be used in a clinical context. Our algorithm answers to this problem by bringing rapidity and accuracy. The concept is to use a neural network adequately learned together with a mechanism taking into account the environment changes. The advantages of this algorithm is to avoid the use of a complex physical code while keeping a good accuracy and reasonable computation times. (author)

  15. Comparative Study of Inguinal Hernia Repair Rates After Radical Prostatectomy or External Beam Radiotherapy

    International Nuclear Information System (INIS)

    Lughezzani, Giovanni; Sun, Maxine; Perrotte, Paul; Alasker, Ahmed; Jeldres, Claudio; Isbarn, Hendrik; Budaeus, Lars; Lattouf, Jean-Baptiste; Valiquette, Luc; Benard, Francois; Saad, Fred; Graefen, Markus; Montorsi, Francesco; Karakiewicz, Pierre I.

    2010-01-01

    Purpose: We tested the hypothesis that patients treated for localized prostate cancer with radical prostatectomy (RP) have a higher risk of requiring an inguinal hernia (IH) repair than their counterparts treated with external beam radiotherapy (EBRT). Methods and Materials: Within the Quebec Health Plan database, we identified 6,422 men treated with RP and 4,685 men treated with EBRT for localized prostate cancer between 1990 and 2000, in addition to 6,933 control patients who underwent a prostate biopsy. From among that population, we identified patients who underwent a unilateral or bilateral hernia repair after either RP or EBRT. Kaplan-Meier plots showed IH repair-free survival rates. Univariable and multivariable Cox regression models tested the predictors of IH repair after RP or EBRT. Covariates consisted of age, year of surgery, and Charlson Comorbidity Index. Results: IH repair-free survival rates at 1, 2, 5, and 10 years were 96.8, 94.3, 90.5, and 86.2% vs. 98.9, 98.0, 95.4, and 92.2%, respectively, in RP vs. EBRT patients (log-rank test, p < 0.001). IH repair-free survival rates in the biopsy population were 98.3, 97.1, 94.9, and 90.2% at the same four time points. In multivariable Cox regression models, RP predisposed to a 2.3-fold higher risk of IH repair than EBRT (p < 0.001). Besides therapy type, patient age (p < 0.001) represented the only other independent predictor of IH repair. Conclusions: RP predisposes to a higher rate of IH repair relative to EBRT. This observation should be considered at informed consent.

  16. Non-rigid CT/CBCT to CBCT registration for online external beam radiotherapy guidance

    Science.gov (United States)

    Zachiu, Cornel; de Senneville, Baudouin Denis; Tijssen, Rob H. N.; Kotte, Alexis N. T. J.; Houweling, Antonetta C.; Kerkmeijer, Linda G. W.; Lagendijk, Jan J. W.; Moonen, Chrit T. W.; Ries, Mario

    2018-01-01

    Image-guided external beam radiotherapy (EBRT) allows radiation dose deposition with a high degree of accuracy and precision. Guidance is usually achieved by estimating the displacements, via image registration, between cone beam computed tomography (CBCT) and computed tomography (CT) images acquired at different stages of the therapy. The resulting displacements are then used to reposition the patient such that the location of the tumor at the time of treatment matches its position during planning. Moreover, ongoing research aims to use CBCT-CT image registration for online plan adaptation. However, CBCT images are usually acquired using a small number of x-ray projections and/or low beam intensities. This often leads to the images being subject to low contrast, low signal-to-noise ratio and artifacts, which ends-up hampering the image registration process. Previous studies addressed this by integrating additional image processing steps into the registration procedure. However, these steps are usually designed for particular image acquisition schemes, therefore limiting their use on a case-by-case basis. In the current study we address CT to CBCT and CBCT to CBCT registration by the means of the recently proposed EVolution registration algorithm. Contrary to previous approaches, EVolution does not require the integration of additional image processing steps in the registration scheme. Moreover, the algorithm requires a low number of input parameters, is easily parallelizable and provides an elastic deformation on a point-by-point basis. Results have shown that relative to a pure CT-based registration, the intrinsic artifacts present in typical CBCT images only have a sub-millimeter impact on the accuracy and precision of the estimated deformation. In addition, the algorithm has low computational requirements, which are compatible with online image-based guidance of EBRT treatments.

  17. An analysis of patient positioning during stereotactic lung radiotherapy performed without rigid external immobilization.

    Science.gov (United States)

    Dahele, Max; Verbakel, Wilko; Cuijpers, Johan; Slotman, Ben; Senan, Suresh

    2012-07-01

    Intra-fraction patient motion is incompletely understood and the optimum amount of support or immobilization during stereotactic body radiotherapy (SBRT) is unclear. Rigid immobilization is often advocated, but motion still occurs. In contrast, we deliver the vast majority of SBRT using simple supporting devices, simultaneously emphasizing comfort, frequent position checks and progressive reduction in treatment times. We report spine stability during lung SBRT. Patients lie on a thin mattress with arms supported above their head and below-knee support. Stereoscopic spine X-rays before and after fraction delivery identified motion in three translational and three rotational directions. Images from 109 fractions in 30 patients resulted in 327 translational and 327 rotational pre- and post-fraction comparisons. Mean RapidArc® delivery time for variable fraction dose was 4.2 min (SD=1.4). 92% and 97% of translational and rotational differences were ≤1 mm and ≤1° in any direction and 98% of translational differences were ≤1.5mm. Mean vertical, longitudinal and lateral motion was 0mm (SD=0.4), 0mm (0.6) and 0mm (0.6). 84% and 94% of the 109 fractions were delivered with ≤1 and ≤1.5mm translation in all three directions and 93% with ≤1° of rotation. Two patients accounted for 10/17 fractions with >1mm translational motion. Based on pre and post-fraction X-ray imaging during fast lung SBRT, simple support devices can result in spine stability that is comparable to that reported with rigid external immobilization. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Certification of health care organisations, assessment of professional practices and external radiotherapy

    International Nuclear Information System (INIS)

    Abdelmoumene, N.; Le Moign, R.

    2009-01-01

    In France, accreditation of health care organisations (HCOs) is mandatory every 4 years. It is based on a systemic approach and, since 2004, includes professional practice appraisal (EPP) against good practice guidelines. However, following an incident in Epinal, a new quality assurance criterion was introduced in 2007 for external radiotherapy (ERT) on top of the annual inspection of patient radiation protection by the Nuclear Safety Authority. In the accreditation procedure starting January 2010, ERT work organisation will come under 'high-risk activity' (criterion 26b) and radio-vigilance will be included in the adverse events reporting system (8i). In addition, ERT will have to comply with many generic criteria on quality and safety improvement. For example, practice appraisal of all clinical activities will become routine. Thus, besides self-assessment against criteria 26b and 8i, ERT professionals will have report the impact of their quality improvement actions on patient care. They will be able to freely choose the area for improvement, as long as it is in line with the HCO's overall quality and safety plan. In oncology, multidisciplinary team meetings for deciding on the treatment plan, as well as mortality and morbidity meetings providing feedback, are compulsory (28a). Appraisal of appropriateness of care (28b) and indicator-based practice appraisal (28c) complete the process. In conclusion, the generic practice appraisal approach that is part of the French HCO accreditation procedure can contribute toward improving health care and education, but it has not been designed for in-depth assessment of complex, multidisciplinary clinical practice such as ERT. Such assessment requires a specific clinical audit and specialized auditors. (authors)

  19. Role of adjuvant postoperative external beam radiotherapy for well differentiated thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jeanny; Wu, Hong Gyun; Youn, Yeo Kyu; Lee, Kyu Eun; Kim, Kwang Hyun; Park, Do Joon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2013-09-15

    To analyze the outcome of adjuvant postoperative external beam radiotherapy (EBRT) in well-differentiated thyroid cancer (WDTC). We identified 84 patients treated with EBRT for WDTC from February 1981 to December 2010. Among them, we analyzed 39 patients who received EBRT after initial radical surgery. Twenty-four females and 15 males were included. The median age was 49 years (range, 16 to 72 years). There were 34 papillary thyroid carcinomas and 5 follicular thyroid carcinomas. Most patients showed pathologic T3/T4 stage (54%/26%). Ten patients (25.6%) had gross residual tumors. Five patients (12.8%) had tumor cells at the margin. The median EBRT dose and fraction size were 62.6 Gy and 1.8 to 2.0 Gy, respectively. The median follow-up was 73 months (range, 21 to 372 months). The five-year overall survival (OS) and locoregional recurrence free survival (LRFS) were 97.4% and 86.9%, respectively. Locoregional failures occurred in 5 and all failure sites were the neck node area. In univariate analysis, OS was significantly influenced by invasion of the trachea (p = 0.016) or esophagus (p = 0.006). LRFS was significantly decreased by male (p = 0.020), gross residuum after resection (p = 0.002), close or positive tumor at surgical margin involvement (p = 0.044), and tracheal invasion (p = 0.040). No significant prognostic factor was identified in the multivariate analysis. No patient experienced the Radiation Therapy Oncology Group grade 3 or more toxicity. Our locoregional control rate of 87.2% is comparable to historical controls with surgery alone, even though our study had a large proportion of advanced stage. Adjuvant EBRT may an effective and safe treatment option in patients with WDTC.

  20. External beam radiotherapy (EBRT) techniques used in breast cancer treatment to reduce cardiac exposure

    International Nuclear Information System (INIS)

    Fung, Esther; Hendry, Julie

    2013-01-01

    Radiotherapy in breast cancer treatment has been shown to reduce local recurrence and improve survival rates. However, there is a concern that breast radiotherapy can cause an increase in cardiac mortality, particularly in patients being treated for left-sided breast cancer. This review aims to investigate how cardiac exposure is minimised in breast radiotherapy and determine an optimal method for reducing cardiac dose, using literature from ScienceDirect, Medline and CINAHL. IMRT and breathing-adapted radiotherapy both reduce cardiac exposure but IMRT also increases the irradiated volume at low dose. Several issues were reported with regards to the clinical implementation of these techniques. It is suggested that inspiration breath-hold radiotherapy, is the preferred solution to minimising cardiac exposure but more research is warranted to confirm this. Long-term follow-up is required to determine dose–response relationships. Research needs to focus on breast cancer treatment as a whole in order to effectively reduce cardiac mortality.

  1. Optimum location of external markers using feature selection algorithms for real-time tumor tracking in external-beam radiotherapy: a virtual phantom study.

    Science.gov (United States)

    Nankali, Saber; Torshabi, Ahmad Esmaili; Miandoab, Payam Samadi; Baghizadeh, Amin

    2016-01-08

    In external-beam radiotherapy, using external markers is one of the most reliable tools to predict tumor position, in clinical applications. The main challenge in this approach is tumor motion tracking with highest accuracy that depends heavily on external markers location, and this issue is the objective of this study. Four commercially available feature selection algorithms entitled 1) Correlation-based Feature Selection, 2) Classifier, 3) Principal Components, and 4) Relief were proposed to find optimum location of external markers in combination with two "Genetic" and "Ranker" searching procedures. The performance of these algorithms has been evaluated using four-dimensional extended cardiac-torso anthropomorphic phantom. Six tumors in lung, three tumors in liver, and 49 points on the thorax surface were taken into account to simulate internal and external motions, respectively. The root mean square error of an adaptive neuro-fuzzy inference system (ANFIS) as prediction model was considered as metric for quantitatively evaluating the performance of proposed feature selection algorithms. To do this, the thorax surface region was divided into nine smaller segments and predefined tumors motion was predicted by ANFIS using external motion data of given markers at each small segment, separately. Our comparative results showed that all feature selection algorithms can reasonably select specific external markers from those segments where the root mean square error of the ANFIS model is minimum. Moreover, the performance accuracy of proposed feature selection algorithms was compared, separately. For this, each tumor motion was predicted using motion data of those external markers selected by each feature selection algorithm. Duncan statistical test, followed by F-test, on final results reflected that all proposed feature selection algorithms have the same performance accuracy for lung tumors. But for liver tumors, a correlation-based feature selection algorithm, in

  2. Accelerated partial breast irradiation with external beam radiotherapy. First results of the German phase 2 trial

    Energy Technology Data Exchange (ETDEWEB)

    Ott, Oliver J.; Strnad, Vratislav; Stillkrieg, Wilhelm; Fietkau, Rainer [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Uter, Wolfgang [University Erlangen-Nuremberg, Dept. of Medical Informatics, Biometry and Epidemiology, Erlangen (Germany); Beckmann, Matthias W. [University Hospital Erlangen, Dept. of Gynecology, Erlangen (Germany)

    2017-01-15

    To evaluate the feasibility and efficacy of external beam three-dimensional (3D) conformal accelerated partial breast irradiation (APBI) for selected patients with early breast cancer. Between 2011 and 2016, 72 patients were recruited for this prospective phase 2 trial. Patients were eligible for APBI if they had histologically confirmed breast cancer or pure ductal carcinoma in situ (DCIS), a tumor diameter ≤3 cm, clear resection margins ≥2 mm, no axillary lymph node involvement, no distant metastases, tumor bed clips, and were aged ≥50 years. Patients were excluded if mammography showed a multicentric invasive growth pattern, or if they had residual diffuse microcalcifications postoperatively, an extensive intraductal component, or vessel invasion. Patients received 3D conformal external beam APBI with a total dose of 38 Gy in 10 fractions in 1-2 weeks. The trial had been registered at the German Clinical Trials Register, DRKS-ID: DRKS00004417. Median follow-up was 25.5 months (range 1-61 months). Local control was maintained in 71 of 72 patients. The 3-year local recurrence rate was 2.1% (95% confidence interval, CI: 0-6.1%). Early toxicity (grade 1 radiodermatitis) was seen in 34.7% (25/72). Late side effects ≥ grade 3 did not occur. Cosmetic results were rated as excellent/good in 96.7% (59/61). APBI with external beam radiotherapy techniques is feasible with low toxicity and, according to the results of the present and other studies, on the way to becoming a standard treatment option for a selected subgroup of patients. (orig.) [German] Untersuchung der Vertraeglichkeit und Sicherheit der externen, 3-D-konformalen akzelerierten Teilbrustbestrahlung (APBI) fuer ausgewaehlte Patientinnen mit einem fruehen Mammakarzinom. Von 2011 bis 2016 wurden 72 Patientinnen in diese prospektive Phase-2-Studie eingebracht. Einschlusskriterien waren ein histologisch gesichertes Mammakarzinom oder DCIS, ein Tumordurchmesser ≤ 3 cm, tumorfreie Resektionsraender ≥ 2

  3. Prostate specific antigen levels during and after external beam radiotherapy for localized carcinoma of the prostate: Predictor of therapeutic efficancy

    International Nuclear Information System (INIS)

    Rodrigus, P.; Landeghem, A.A.J. van

    1992-01-01

    For 105 patients with locoregional carcinoma of the prostate, prostate specific antigen (PSA) levels were evaluated before, during and after external beam radiotherapy. The median follow-up is 17 months. In 51 patients (48.5%) initial PSA levels exceeded the maximum normal value of 20 ng/ml. Nine patients kept non-declining high levels just after radiotherapy. Only one of these is free of disease. Assuming PSA levels decrease exponentially during radiotherapy, a mean half-life of 62 days (median 54, SD 26 days) was calculated. Three out of five patients with a PSA half-life of more than 88 days relapsed as compared to a 8% (3/37) relapse rate in patients with a 'normal' half-life. Prolonged PSA half-life suggests residual disease. PSA levels are expected to further decrease after radiation. Six months after irradiation persistent high PSA levels were found in 14/51 (27.5%) patients. Only four of them had no evidence of manifest disease. Important negative prognostic factors for disease control in our series were non-declining high levels of PSA, a PSA serum half-life exceeding 88 days and persistence of elevated PSA values longer than six months after treatment. In our opinion, PSA is a valuable marker in the follow-up of prostate cancer patients during and after radiotherapy. (orig.) [de

  4. Carcinomas of endometrium and cervix: magnetic resonance assessment of changes following radiotherapy

    International Nuclear Information System (INIS)

    Olega, L.; Cura, J.L. del; Grande, D.; Martinez, B.; Fernandez, A.; Martinez, S.; Martin, J.C.

    1998-01-01

    To present the changes induced at the tissue level in patients subjected to external radiotherapy and brachytherapy to treat carcinomas of endometrium and cervix, as disclosed by magnetic resonance (MR). The MR study dealt with 26 patients 14 with endometrial carcinoma and 12 with cervical carcinoma who were treated with external radiotherapy and brachytherapy. The features assessed retrospectively were bone marrow of the lumbar and sacral spine, pelvic fat, abdominal wall, uterine, junction and size, rectal and bladder wall and pelvic musculature. The most common changes observed after radiotherapy according to our study were changes in signal intensity in the bone marrow of the pelvic bones (88%), followed by changes in the pelvic fat (65.3%). Other radiotherapy-related findings in order of frequency were cervical fibrosis, colitis and cystitis. Radiotherapy induces changes in the tissue of the pelvic structures, and the knowledge of these changes is important in the evaluation of the follow-up studies of these patients. (Author) 12 refs

  5. Effect of fractionated regional external beam radiotherapy on peripheral blood cell count

    International Nuclear Information System (INIS)

    Zachariah, B.; Jacob, S.S.; Gwede, C.; Cantor, A.; Patil, J.; Casey, L.; Zachariah, A.B.

    2001-01-01

    Purpose: The purpose of this study was to assess the need for obtaining weekly complete blood count (CBC) values and to identify the pattern of changes in CBC during regional conventional fractionated radiotherapy. Methods and Materials: A retrospective analysis of CBC data on 299 adult cancer patients who received definitive conventional radiotherapy to head and neck (n=95), chest (n=96), and pelvis (n=108) was performed. Temporal patterns and magnitude of change in white blood cells, neutrophils, lymphocytes, and platelets during radiotherapy were examined. Results: There were statistically significant declines in all counts, albeit not clinically significant. Notable differences between disease sites were found. The greatest weekly interval change in counts occurred during the first week of radiotherapy for all groups of patients. The mean WBC nadir values during treatment were 5.8 for head and neck, 6.8 for chest, and 5.4 for pelvis. The nadirs for all counts occurred toward the middle-to-end of radiotherapy. Lymphocytes were found to be more sensitive to radiotherapy than other leukocyte subcomponents. Conclusion: Our study suggests that weekly CBC monitoring is not necessary for all patients undergoing standard fractionated radiotherapy. Baseline blood counts may be used to determine an optimal schedule for monitoring CBCs in patients receiving conventional radiation alone. Reduced monitoring of CBC may result in significant financial savings

  6. Sexual dysfunction after curietherapy and external radiotherapy of the prostate for localized prostate cancer

    International Nuclear Information System (INIS)

    Huyghe, E.; Bachaud, J.-M.; Achard, J.-L.; Bossi, A.; Droupy, S.

    2009-01-01

    Knowing the importance of sexuality items in the choice by the patient of the modality of treatment of localized prostate cancer, we aimed at reviewing and updating the effects of prostate radiotherapy and brachytherapy on sexual functions. A PubMed search was done using the keywords: prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, ejaculation and orgasm. After both radiotherapy and brachytherapy, sexual troubles occur progressively, the onset of occurrence of erectile dysfunction being 12-18 months after both treatments. Even though the pathophysiological pathways by which radiotherapy and brachytherapy result in erectile dysfunction have not yet been fully clarified, arterial damage and exposure of neurovascular bundle to high levels of radiation seem to be two main causes of erectile dysfunction after radiotherapy and brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of erectile dysfunction. Another important factor following radiotherapy is the treatment modality. Not many data about ejaculation and orgasm after radiation treatments have been published yet. Recent data show that most of the population treated by brachytherapy conserves ejaculation and orgasm after treatment, even if a majority describe reduction of volume and deterioration of orgasm. Patients need to be correctly informed on the possible sequela of radiotherapy and brachytherapy on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for erectile dysfunction. (authors)

  7. Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

    International Nuclear Information System (INIS)

    Chow, Edward; Ling, Alison; Davis, Lori; Panzarella, Tony; Danjoux, Cyril

    2005-01-01

    Background and purpose: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials

  8. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna.

    Science.gov (United States)

    Esik, O; Seitz, W; Lövey, J; Knocke, T H; Gaudi, I; Németh, G; Pötter, R

    1999-04-01

    To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care. Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E. Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993,29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects between those of cases

  9. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna

    International Nuclear Information System (INIS)

    Esik, O.; Seitz, W.; Loevey, J.; Knocke, T.H.; Gaudi, I.; Nemeth, G.; Poetter, R.

    1999-01-01

    Purpose: To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care.Methods: Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E, Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993;29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects

  10. Dosimetric planning study for the prevention of anal complications after post-operative whole pelvic radiotherapy in cervical cancer patients with hemorrhoids.

    Science.gov (United States)

    Baek, J G; Kim, E C; Kim, S K; Jang, H

    2015-01-01

    Radiation-induced anal toxicity can be induced by low radiation doses in patients with haemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in post-operative patients with cervical cancer. The planning CT images of 10 patients with cervical cancer undergoing postoperative radiotherapy were used for comparison of three different plans. All patients had been treated using the conventional box technique WPRT (CV-WPRT), and we tried low-margin-modified WPRT (LM-WPRT), three-dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of the anal canal, retrospectively. Mean anal canal doses of the IM-WPRT were significantly lower (p 99%, and the proportion that received ≥108% of the prescribed dose for IM-WPRT was <2%. Volumes of bladders and rectums that received ≥30 or ≥40 Gy were significantly lower for IM-WPRT than for three of the four-field WPRT plans (p = 0.000). IM-WPRT can significantly reduce radiation dose delivered to the anal canal and does not compromise PTV coverage. In patients with haemorrhoids, IM-WPRT may be of value for the prevention of anal complications. Although tolerance of the anal canal tends to be ignored in patients undergoing post-operative WPRT, patients with haemorrhoids may suffer complications at low radiation doses. The present study shows IM-WPRT can be meaningful in these patients.

  11. Radiotherapy

    International Nuclear Information System (INIS)

    Wannenmacher, M.; Debus, J.; Wenz, F.

    2006-01-01

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

  12. The effectiveness of external beam radiotherapy for acromegaly is not affected by previous pituitary ablative treatments

    International Nuclear Information System (INIS)

    Reed, P.I.; Joplin, G.F.; Speirs, C.J.; Morrison, R.; Aber, V.

    1990-01-01

    Thirty-three acromegalic patients were treated with radiotherapy and followed up for at least 3 years (mean 6 years, range 3 to 12). Seventeen had not had previous pituitary ablative therapy and 16 had. The mean GH level for these two groups before radiotherapy was comparable at 98 and 119 mlU/l. The observed frequency of reaching <10 mlU/L was 53% and 75% of patients in the two groups, respectively, the mean observed falls in growth hormone level were 81 and 85% of the initial level, and the calculated exponential decline rate of GH level was 72 and 52% per fyear. Considering all 35 patients, requirement for pituitary hormone replacement therapy increased from 15 patients before radiotherapy to 20 after radiotherapy, being mostly those who had had prior ablative therapies. There were no complications attributable to the radiotherapy treatment. It appears that radiotherapy is equally efficacious whether a prior unsuccessful ablative procedure had been used or not. (author)

  13. The effectiveness of external beam radiotherapy for acromegaly is not affected by previous pituitary ablative treatments

    Energy Technology Data Exchange (ETDEWEB)

    Reed, P.I.; Joplin, G.F. (Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London (UK)); Speirs, C.J. (Department of Clinical Pharmacology, Royal Postgraduate Medical School, Hammersmith Hospital, London (UK)); Morrison, R. (Department of Radiotherapy, Royal Postgraduate Medical School, Hammersmith Hospital, London (UK)); Aber, V. (Department of Medical Physics, Royal Postgraduate Medical School, Hammersmith Hospital, London (UK))

    1990-01-01

    Thirty-three acromegalic patients were treated with radiotherapy and followed up for at least 3 years (mean 6 years, range 3 to 12). Seventeen had not had previous pituitary ablative therapy and 16 had. The mean GH level for these two groups before radiotherapy was comparable at 98 and 119 mlU/l. The observed frequency of reaching <10 mlU/L was 53% and 75% of patients in the two groups, respectively, the mean observed falls in growth hormone level were 81 and 85% of the initial level, and the calculated exponential decline rate of GH level was 72 and 52% per fyear. Considering all 35 patients, requirement for pituitary hormone replacement therapy increased from 15 patients before radiotherapy to 20 after radiotherapy, being mostly those who had had prior ablative therapies. There were no complications attributable to the radiotherapy treatment. It appears that radiotherapy is equally efficacious whether a prior unsuccessful ablative procedure had been used or not. (author).

  14. Radiotherapy.

    Science.gov (United States)

    Krause, Sonja; Debus, Jürgen; Neuhof, Dirk

    2011-01-01

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

  15. Postoperative high-dose pelvic radiotherapy for N+ prostate cancer: Toxicity and matched case comparison with postoperative prostate bed-only radiotherapy

    International Nuclear Information System (INIS)

    Van Praet, Charles; Ost, Piet; Lumen, Nicolaas; De Meerleer, Gert; Vandecasteele, Katrien; Villeirs, Geert; Decaestecker, Karel; Fonteyne, Valérie

    2013-01-01

    Purpose: To report on toxicity of postoperative high-dose whole-pelvis radiotherapy (WPRT) with androgen deprivation therapy for lymph node metastasized (N1) prostate cancer (PC). To perform a matched-case analysis to compare this toxicity profile to postoperative prostate bed-only radiotherapy (PBRT). Materials and methods: Forty-eight N1-PC patients were referred for WPRT and 239 node-negative patients for PBRT. Patients were matched 1:1 according to pre-treatment demographics, symptoms, treatment and tumor characteristics. Mean dose to the prostate bed was 75 Gy (WPRT–PBRT) and 54 Gy to the elective nodes (WPRT) in 36 or 37 fractions. End points are genito-urinary (GU) and gastro-intestinal (GI) toxicity. Results: After WPRT, 35% developed grade 2 (G2) and 4% G3 acute GU toxicity. Acute GI toxicity developed in 42% (G2). Late GU toxicity developed in 36% (G2) and 7% (G3). One patient had G4 incontinence. Recuperation occurred in 59%. Late GI toxicity developed in 25% (G2) with 100% recuperation. Incidence of acute and late GI toxicity was higher following WPRT compared to PBRT (p ⩽ 0.041). GU toxicity was similar. With WPRT mean dose to bladder and rectosigmoid were higher. Conclusions: Postoperative high-dose WPRT comes at the cost of a temporary increase in G2. GI toxicity compared to PBRT because larger volumes of rectosigmoid are irradiated

  16. Measurement and properties of the dose-area product ratio in external small-beam radiotherapy.

    Science.gov (United States)

    Niemelä, Jarkko; Partanen, Mari; Ojala, Jarkko; Sipilä, Petri; Björkqvist, Mikko; Kapanen, Mika; Keyriläinen, Jani

    2017-06-21

    In small-beam radiation therapy (RT) the measurement of the beam quality parameter, i.e. the tissue-phantom ratio or TPR 20,10 , using a conventional point detector is a challenge. To obtain reliable results, one has to consider potential sources of error, including volume averaging and adjustment of the point detector into the narrow beam. To overcome these challenges, a different type of beam quality parameter in small beams was studied, namely the dose-area product ratio, or DAPR 20,10 . With this method, the measurement of a dose-area product (DAP) using a large-area plane-parallel chamber (LAC) eliminates the uncertainties in detector positioning and volume averaging that are present when using a point detector. In this study, the properties of the DAPR 20,10 of a cone-collimated 6 MV photon beam were investigated using Monte Carlo (MC) calculations and the obtained values were compared to measurements obtained using two LAC detectors, PTW Type 34073 and PTW Type 34070. In addition, the possibility of determining the DAP using EBT3 film and a Razor diode detector was studied. The determination of the DAPR 20,10 value was found to be feasible in external small-beam radiotherapy using cone-collimated beams with diameters from 4-40 mm, based on the results of the two LACs, the MC calculations and the Razor diode. The measurements indicated a constant DAPR 20,10 value for fields 20-40 mm in diameter, with a maximum relative change of 0.6%, but an increase of 7.0% for fields from 20-4 mm in diameter for the PTW Type 34070 chamber. Simulations and measurements showed an increase of DAPR 20,10 with increasing LAC size or dose integral area for the studied 4-40 mm cone-collimated 6 MV photon beams. This has the consequence that there should be a reference to the size of the used LAC active area or the DAP integration area with the reported DAPR 20,10 value.

  17. Probability dynamics of a repopulating tumor in case of fractionated external radiotherapy.

    Science.gov (United States)

    Stavreva, Nadia; Stavrev, Pavel; Fallone, B Gino

    2009-12-01

    In this work two analytical methods are developed for computing the probability distribution of the number of surviving cells of a repopulating tumor during a fractionated external radio-treatment. Both methods are developed for the case of pure birth processes. They both allow the description of the tumor dynamics in case of cell radiosensitivity changing in time and for treatment schedules with variable dose per fraction and variable time intervals between fractions. The first method is based on a direct solution of the set of differential equations describing the tumor dynamics. The second method is based on the works of Hanin et al. [Hanin LG, Zaider M, Yakovlev AY. Distribution of the number of clonogens surviving fractionated radiotherapy: a long-standing problem revisited. Int J Radiat Biol 2001;77:205-13; Hanin LG. Iterated birth and death process as a model of radiation cell survival. Math Biosci 2001;169:89-107; Hanin LG. A stochastic model of tumor response to fractionated radiation: limit theorems and rate of convergence. Math Biosci 2004;191:1-17], where probability generating functions are used. In addition a Monte Carlo algorithm for simulating the probability distributions is developed for the same treatment conditions as for the analytical methods. The probability distributions predicted by the three methods are compared graphically for a certain set of values of the model parameters and an excellent agreement is found to exist between all three results, thus proving the correct implementation of the methods. However, numerical difficulties have been encountered with both analytical methods depending on the values of the model parameters. Therefore, the Poisson approximation is also studied and it is compared to the exact methods for several different combinations of the model parameter values. It is concluded that the Poisson approximation works sufficiently well only for slowly repopulating tumors and a low cell survival probability and that it

  18. A simple technique for treating age-related macular degeneration with external beam radiotherapy

    International Nuclear Information System (INIS)

    Roos, Daniel E.; Francis, J. Winston; Newnham, W. John

    1999-01-01

    Purpose: To develop a simple external beam photon radiotherapy technique to treat age-related macular degeneration without the need for simulation, planning computed tomography (CT) or computer dosimetry. Methods and Materials: The goal was to enable the treatment to be set up reliably on the treatment machine on Day 1 with the patient supine in a head cast without any prior planning. Using measurements of ocular globe topography from Karlsson et al. (Int J Radiat Oncol Biol Phys 1996; 33: 705-712), we chose a point 1.5 cm behind the anterior surface of the upper eyelid (ASUE) as the isocentre of a half-beam, blocked, 5.0 x 3.0-cm, angled lateral field to treat the involved eye. This would position the isocentre about 0.5 cm behind the posterior surface of the lens, and a little over 1 cm in front of the macula, according to Karlsson et al. The setup requires initial adjustment of the gantry from horizontal (to account for any asymmetry of position of the eyes), then angling 15 deg. posteriorly to avoid the contralateral eye. Finally, the couch is raised to position the isocentre 1.5 cm behind the ASUE. Results: To verify the applicability of the technique, we performed CT and computer dosimetry on the first 11 eyes so treated. Our CT measurements were in good agreement with Karlsson et al. The lens dose was < 5% and the macula was within the 95% isodose curve in each case (6-MV linac). Treatment setup time is approximately 10 min each day. The 11 patients were treated with 5 x 2.00 Gy (2 patients) or 5 x 3.00 Gy (9 patients), and subjective response on follow-up over 1 to 12 months (median 4 months) was comparable to previously reported results, with no significant acute side effects. Conclusion: Our technique is easy to set up and reliably treats the macula, with sparing of the lens and contralateral eye. It enables treatment to commence rapidly and cost-effectively without the need for simulation or CT computer planning

  19. Measurement and properties of the dose-area product ratio in external small-beam radiotherapy

    Science.gov (United States)

    Niemelä, Jarkko; Partanen, Mari; Ojala, Jarkko; Sipilä, Petri; Björkqvist, Mikko; Kapanen, Mika; Keyriläinen, Jani

    2017-06-01

    In small-beam radiation therapy (RT) the measurement of the beam quality parameter, i.e. the tissue-phantom ratio or TPR20,10, using a conventional point detector is a challenge. To obtain reliable results, one has to consider potential sources of error, including volume averaging and adjustment of the point detector into the narrow beam. To overcome these challenges, a different type of beam quality parameter in small beams was studied, namely the dose-area product ratio, or DAPR20,10. With this method, the measurement of a dose-area product (DAP) using a large-area plane-parallel chamber (LAC) eliminates the uncertainties in detector positioning and volume averaging that are present when using a point detector. In this study, the properties of the DAPR20,10 of a cone-collimated 6 MV photon beam were investigated using Monte Carlo (MC) calculations and the obtained values were compared to measurements obtained using two LAC detectors, PTW Type 34073 and PTW Type 34070. In addition, the possibility of determining the DAP using EBT3 film and a Razor diode detector was studied. The determination of the DAPR20,10 value was found to be feasible in external small-beam radiotherapy using cone-collimated beams with diameters from 4-40 mm, based on the results of the two LACs, the MC calculations and the Razor diode. The measurements indicated a constant DAPR20,10 value for fields 20-40 mm in diameter, with a maximum relative change of 0.6%, but an increase of 7.0% for fields from 20-4 mm in diameter for the PTW Type 34070 chamber. Simulations and measurements showed an increase of DAPR20,10 with increasing LAC size or dose integral area for the studied 4-40 mm cone-collimated 6 MV photon beams. This has the consequence that there should be a reference to the size of the used LAC active area or the DAP integration area with the reported DAPR20,10 value.

  20. Moderate hypofractionated radiotherapy with volumetric modulated arc therapy and simultaneous integrated boost for pelvic irradiation in prostate cancer.

    Science.gov (United States)

    Franzese, C; Fogliata, A; D'Agostino, G R; Di Brina, L; Comito, T; Navarria, P; Cozzi, L; Scorsetti, M

    2017-07-01

    The optimal treatment for unfavourable intermediate/high-risk prostate cancer is still debated. In the present study, the pattern of toxicity and early clinical outcome of patients with localized prostate cancer was analyzed. A cohort of 90 patients treated on pelvic lymph nodes from 2010 to 2015 was selected. All patients were treated with Volumetric Modulated Arc Therapy (VMAT), and Simultaneous integrated boost (SIB) in 28 fractions; the prostate, the seminal vesicle and the pelvic lymph node received total doses of 74.2, 65.5, and 51.8 Gy, respectively. End points were the detection of acute and late toxicities graded according to the Common Toxicity Criteria CTCAE version 3, evaluating the rectal, genito-urinary and gastro-intestinal toxicity. Correlation of OARs dose parameters and related toxicities was explored. Preliminary overall survival and Progression-free survival (PFS) were evaluated. With a median follow-up of 25 months, no interruptions for treatment-related toxicity were recorded. Univariate analysis among dosimetric data and acute toxicities showed no correlations. Regarding late toxicity: the dose received by a rectal volume of 90 cm 3 was found to be significant for toxicity prediction (p = 0.024). PFS was 90.6% and 60.2% at 2 and 4 years, respectively. PFS correlates with age (p = 0.011) and Gleason score (p = 0.011). Stratifying the PSA nadir in quartiles, its value was significant (p = 0.016) in predicting PFS, showing a reduction of PFS of 2 months for each PSA-nadir increase of 0.1 ng/ml. HRT with VMAT and SIB on the whole pelvis in unfavourable prostate cancer patients is effective with a mild pattern of toxicity.

  1. Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Donovan, E. M.; James, H.; Bonora, M.; Yarnold, J. R.; Evans, P. M. [Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton SM2 5PT (United Kingdom); Physics Department, Ipswich Hospital NHS Foundation Trust, Ipswich IP4 5PD (United Kingdom); Department of Academic Radiotherapy, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom and School of Radiotherapy, University of Milan, Milan 20122 (Italy); Department of Academic Radiotherapy, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton SM2 5PT (United Kingdom); Centre for Vision Speech and Signal Processing, University of Surrey, Guildford GU2 7XH (United Kingdom)

    2012-10-15

    Purpose: To compare organ specific cancer incidence risks for standard and complex external beam radiotherapy (including cone beam CT verification) following breast conservation surgery for early breast cancer.Method: Doses from breast radiotherapy and kilovoltage cone beam CT (CBCT) exposures were obtained from thermoluminescent dosimeter measurements in an anthropomorphic phantom in which the positions of radiosensitive organs were delineated. Five treatment deliveries were investigated: (i) conventional tangential field whole breast radiotherapy (WBRT), (ii) noncoplanar conformal delivery applicable to accelerated partial beast irradiation (APBI), (iii) two-volume simultaneous integrated boost (SIB) treatment, (iv) forward planned three-volume SIB, and (v) inverse-planned three volume SIB. Conformal and intensity modulated radiotherapy methods were used to plan the complex treatments. Techniques spanned the range from simple methods appropriate for patient cohorts with a low cancer recurrence risk to complex plans relevant to cohorts with high recurrence risk. Delineated organs at risk included brain, salivary glands, thyroid, contralateral breast, left and right lung, esophagus, stomach, liver, colon, and bladder. Biological Effects of Ionizing Radiation (BEIR) VII cancer incidence models were applied to the measured mean organ doses to determine lifetime attributable risk (LAR) for ages at exposure from 35 to 80 yr according to radiotherapy techniques, and included dose from the CBCT imaging. Results: All LAR decreased with age at exposure and were lowest for brain, thyroid, liver, and bladder (<0.1%). There was little dependence of LAR on radiotherapy technique for these organs and for colon and stomach. LAR values for the lungs for the three SIB techniques were two to three times those from WBRT and APBI. Uncertainties in the LAR models outweigh any differences in lung LAR between the SIB methods. Constraints in the planning of the SIB methods ensured that

  2. Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer

    International Nuclear Information System (INIS)

    Donovan, E. M.; James, H.; Bonora, M.; Yarnold, J. R.; Evans, P. M.

    2012-01-01

    Purpose: To compare organ specific cancer incidence risks for standard and complex external beam radiotherapy (including cone beam CT verification) following breast conservation surgery for early breast cancer.Method: Doses from breast radiotherapy and kilovoltage cone beam CT (CBCT) exposures were obtained from thermoluminescent dosimeter measurements in an anthropomorphic phantom in which the positions of radiosensitive organs were delineated. Five treatment deliveries were investigated: (i) conventional tangential field whole breast radiotherapy (WBRT), (ii) noncoplanar conformal delivery applicable to accelerated partial beast irradiation (APBI), (iii) two-volume simultaneous integrated boost (SIB) treatment, (iv) forward planned three-volume SIB, and (v) inverse-planned three volume SIB. Conformal and intensity modulated radiotherapy methods were used to plan the complex treatments. Techniques spanned the range from simple methods appropriate for patient cohorts with a low cancer recurrence risk to complex plans relevant to cohorts with high recurrence risk. Delineated organs at risk included brain, salivary glands, thyroid, contralateral breast, left and right lung, esophagus, stomach, liver, colon, and bladder. Biological Effects of Ionizing Radiation (BEIR) VII cancer incidence models were applied to the measured mean organ doses to determine lifetime attributable risk (LAR) for ages at exposure from 35 to 80 yr according to radiotherapy techniques, and included dose from the CBCT imaging. Results: All LAR decreased with age at exposure and were lowest for brain, thyroid, liver, and bladder (<0.1%). There was little dependence of LAR on radiotherapy technique for these organs and for colon and stomach. LAR values for the lungs for the three SIB techniques were two to three times those from WBRT and APBI. Uncertainties in the LAR models outweigh any differences in lung LAR between the SIB methods. Constraints in the planning of the SIB methods ensured that

  3. Dosimetric comparison of vaginal vault ovoid brachytherapy versus intensity-modulated radiation therapy plans in postoperative patients of cervical carcinoma following whole pelvic radiotherapy

    Directory of Open Access Journals (Sweden)

    Divya Khosla

    2014-01-01

    Full Text Available Introduction: Dosimetric study to compare high dose rate (HDR vaginal vault ovoid brachytherapy plan versus intensity-modulated radiation therapy (IMRT boost plan for doses delivered to target volume and organs at risk (OAR in postoperative patients of cervical carcinoma following whole pelvic radiotherapy (WPRT. Materials and Methods: Fifteen postoperative patients of cervical carcinoma suitable for vaginal ovoid brachytherapy following WPRT of 46 Gy/23 fractions/4.5 weeks were included. All were treated with brachytherapy (two sessions of 8.5 Gy each. The equivalent dose for IMRT was calculated by computing biologically effective dose of brachytherapy by linear quadratic model. Dose of brachytherapy (two sessions of 8.5 Gy was equivalent to IMRT dose of 26 Gy/13 fractions. Doses to target volume and OAR were compared between HDR and IMRT plans. Results: Target volume was well covered with both HDR and IMRT plans, but dose with brachytherapy was much higher (P < 0.05. Mean doses, doses to 0.1, 1, 2, and 5cc, 1/3 rd , 1/2, and 2/3 rd volume of bladder and rectum were significantly lower with HDR plans. Conclusion: In postoperative patients of cervical carcinoma, HDR brachytherapy following WPRT appears to be better than IMRT for tumor coverage and reducing dose to critical organs.

  4. Reduction and temporary stabilization of Tile C pelvic ring injuries using a posteriorly based external fixation system.

    Science.gov (United States)

    Martin, Murphy P; Rojas, David; Mauffrey, Cyril

    2017-12-05

    Tile C pelvic ring injuries are challenging to manage even in the most experienced hands. The majority of such injuries can be managed using percutaneous reduction techniques, and the posterior ring can be stabilized using percutaneous transiliac-transsacral screw fixation. However, a subgroup of patients present with inadequate bony corridors, significant sacral zone 2 comminution or significant lateral/vertical displacement of the hemipelvis through a complete sacral fracture. Percutaneous strategies in such circumstances can be dangerous. Those patients may benefit from prone positioning and open reduction of the sacral fracture with fixation through tension band plating or lumbo-pelvic fixation. Soft tissue handling is critical, and direct reduction techniques around the sacrum can be difficult due to the complex anatomy and the fragile nature of the sacrum making clamp placement and tightening a challenge. In this paper, we propose a mini-invasive technique of indirect reduction and temporary stabilization, which is soft tissue friendly and permits maintenance of reduction during definitive fixation surgical.

  5. Combined modality treatment including intraoperative radiotherapy in locally advanced and recurrent rectal cancer

    International Nuclear Information System (INIS)

    Tveit, Kjell Maque; Wiig, Johan N.; Olsen, Dag Rune; Storaas, Andreas; Poulsen, Jan Peter; Giercksky, Karl-Erik

    1997-01-01

    Background: Treatment of locally advanced and recurrent rectal cancer usually has a high local recurrence rate and poor survival. Promising results have been reported by combined external radiotherapy, extensive surgery and intraoperative radiotherapy (IORT). Methods: One hundred fifteen patients with locally advanced rectal cancers fixed to the pelvic wall or locally recurrent rectal cancers underwent preoperative external radiotherapy with 46-50 Gy. Six to 8 weeks later radical pelvic surgery was attempted, and was combined with intraoperative electron beam radiotherapy (15-20 Gy) in 66 patients. The patients were followed closely to evaluate complication rate, local and distant recurrence rate and survival. Results: Surgery with no macroscopic tumour remaining was obtained in 65% of the patients with no postoperative deaths. Pelvic infection was the major complication (21%). Although the observation time is short (3-60 months), the local recurrence rate seems low (22%) and survival seems promising (about 60% at 4 years) in patients with complete tumour resection, in contrast to patients with residual tumour (none living at 4 years). Conclusions: The combined modality treatment with preoperative external radiotherapy and extensive pelvic surgery with IORT is sufficiently promising to start a randomized trial on the clinical value of IORT as a boost treatment in the multidisciplinary approach to this disease

  6. External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Beetz, Ivo; Schilstra, Cornelis; Luijk, Peter van; Christianen, Miranda E.M.C.; Doornaert, Patricia; Bijl, Henk P.; Chouvalova, Olga; Heuvel, Edwin R. van den; Steenbakkers, Roel J.H.M.; Langendijk, Johannes A.

    2012-01-01

    Purpose: The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER 6M ) and sticky saliva (STIC 6M ) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). Methods and materials: Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER 6M consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC 6M consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R 2 Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer–Lemeshow “goodness-of-fit” test. Results: Overall model performance of the 3D-CRT based predictive models for XER 6M and STIC 6M was significantly worse in terms of the Brier score and R 2 Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer–Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. Conclusion: 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or

  7. A retrospective comparison of outcome and toxicity of preoperative image-guided intensity-modulated radiotherapy versus conventional pelvic radiotherapy for locally advanced rectal carcinoma

    International Nuclear Information System (INIS)

    Huang, Chun-Ming; Huang, Ming-Yii; Tsai, Hsiang-Lin; Huang, Ching-Wen; Ma, Cheng-Jen; Lin, Chih-Hung; Huang, Chih-Jen; Wang, Jaw-Yuan

    2017-01-01

    The aim of the study was to compare clinical outcomes and toxicity between 3D conformal radiotherapy (3DCRT) and image-guided intensity-modulated radiotherapy (IG-IMRT) administered through helical tomotherapy in locally advanced rectal cancer (LARC) patients receiving preoperative chemoradiotherapy. We reviewed 144 patients with Stage II–III rectal cancer receiving preoperative fluoropyrimidine-based chemoradiotherapy followed by radical resection. Tumor responses following chemoradiotherapy were evaluated using the Dworak tumor regression grade (TRG). Of the 144 patients, 45 received IG-IMRT and 99 received 3DCRT. A significant reduction in Grade 3 or 4 acute gastrointestinal toxicity (IG-IMRT, 6.7%; 3DCRT, 15.1%; P = 0.039) was observed by IG-IMRT. The pathologic complete response (pCR) rate did not differ between the IG-IMRT and the 3DCRT group (17.8% vs 15.1%, P = 0.52). Patients in the IG-IMRT group had the trend of favorable tumor regressions (TRG 3 or 4) compared with those in the 3DCRT group (66.7% vs 43.5%, P = 0.071). The median follow-up was 53 months (range, 18–95 months) in the 3DCRT group and 43 months (range, 17–69 months) in the IG-IMRT group. Four-year overall, disease-free, and local failure–free survival rates of the IG-IMRT and 3DCRT groups were 81.6% and 67.9% (P = 0.12), 53.8% and 51.8% (P = 0.51), and 88% and 75.1% (P = 0.031), respectively. LARC patients treated with preoperative IG-IMRT achieved lower acute gastrointestinal adverse effects and a higher local control rate than those treated with 3DCRT, but there was no prominent difference in distant metastasis rate and overall survival between two treatment modalities.

  8. External beam abdominal radiotherapy in patients with seminoma stage I: field type, testicular dose, and spermatogenesis

    International Nuclear Information System (INIS)

    Jacobsen, Kari Dolven; Olsen, Dag Rune; Fossaa, Kristian; Fossaa, Sophie Dorothea

    1997-01-01

    Purpose: To establish a predictive model for the estimation of the gonadal dose during adjuvant para-aortic (PA) or dog leg (DL: PA plus ipsilateral iliac) field radiotherapy in patients with testicular seminoma. Methods and Materials: The surface gonadal dose was measured in patients with seminoma Stage I receiving PA or DL radiotherapy. Sperm cell analysis was performed before and 1 year after irradiation. PA and DL radiotherapy were simulated in the Alderson phantom while we measured the dose to the surface and middle of an artificial testicle, varying its position within realistic anatomical constraints. The symphysis-to-testicle distance (STD), field length, and thickness of the patient were experimental variables. The developed mathematical model was validated in subsequent patients. Results: The mean gonadal dose in patients was 0.09 and 0.32 Gy after PA and DL irradiation, respectively (p < 0.001). DL radiotherapy, but not PA irradiation led to significant reduction of the sperm count 1 year after irradiation. The gonadal dose-reducing effect of PA irradiation was confirmed in the Alderson phantom. A significant correlation was found between the STD and the gonadal dose during DL irradiation. A mathematical model was established for calculation of the gonadal dose and confirmed by measurements in patients. Conclusions: During radiotherapy of seminoma, the gonadal dose decreases with increasing STD. It is possible to predict the individual gonadal dose based on delivered midplane dose and STD

  9. Capillary haemangioma involving the middle and external ear: radiotherapy as a treatment method

    International Nuclear Information System (INIS)

    Pavamani, S.P.; Ram, T.S.; Viswanathan, P.N.; Viswanathan, F.R.; Surendrababu, N.R.S.; Thomas, M.

    2007-01-01

    Capillary haemangiomas rarely occur in the auditory canal and have mainly been managed with surgical excision or kept on close follow up for development of symptoms. Radiotherapy, as a treatment method, has not been reported previously in the published work. We describe a study of a capillary haemangioma in the auditory canal of a 26-year-old woman who presented with bleeding. She was treated with radiotherapy, after the lesion was found to be unsuitable for surgery and embolization. The patient remains well 5 years after completion of treatment

  10. Evaluation of cost functions for gray value matching of two-dimensional images in radiotherapy

    NARCIS (Netherlands)

    Dekker, Niels; Ploeger, Lennert S.; van Herk, Marcel

    2003-01-01

    In external beam radiotherapy, portal imaging is applied for verification of the patient setup. Current automatic methods for portal image registration, which are often based on segmentation of anatomical structures, are especially successful for images of the pelvic region. For portal images of

  11. Relations of image quality in on-line portal images and individual patient parameters for pelvic field radiotherapy

    International Nuclear Information System (INIS)

    Heuvel, F. van den; Neve, W. de; Coghe, M.; Verellen, D.; Storme, G.

    1992-01-01

    The aims of the present study involving 566 pelvic fields on 13 patients were: 1. To study the machine- and patient-related factors influencing image quality. 2. To study the factors related to machine, patient and patient set-up, influencing the errors of field set-up. 3. To develop a method for predicting the camera settings. The OPI device consisted of a fluorescent screen scanned by a video camera. An image quality score on a scale 0-5 was given for 546/566 fields. In a univariate analysis, open field subtraction adversely affected the score. The image score of anterior fields was significantly better than that of posterior fields. Multivariate stepwise logistic regression showed that, in addition to anterior or posterior field and subtraction, gender was also a significant predictor of image score. Errors requiring field adjustments were detected on 289/530 (54.5%) evaluable fields or 229/278 (82.4%) evaluable patient set-ups. Multivariate logistic regression showed that the probability of performing an adjustment was significantly related to gender, image quality and AP-PA diameter. The magnitude of adjustments made in the lateral direction correlated significantly with patient bulk. The camera kV level with gain held constant showed an exponential dependency on dose rate at the image detector plate and can thus be predicted by treatment planning. (orig.)

  12. Radiotherapy

    International Nuclear Information System (INIS)

    Pistenma, D.A.

    1980-01-01

    The need for radiotherapy research is exemplified by the 100,000 cancer patients who will fail treatment locally and/or regionally annually for the next several years but who would benefit from better local treatment modalities. Theoretically, all of the areas of investigation discussed in this projection paper have the potential to significantly improve local-regional treatment of cancer by radiotherapy alone or in combination with other modalities. In many of the areas of investigation discussed in this paper encouraging results have been obtained in cellular and animal tumor studies and in limited studies in humans as well. In the not too distant future the number of patients who would benefit from better local control may increase by tens of thousands if developments in chemotherapy and/or immunotherapy provide a means to eradicate disseminated microscopic foci of cancer. Thus the efforts to improve local-regional control take on even greater significance

  13. WE-E-213AB-01: Medical Physics Challenges for Implementation of New Technologies in External Beam Radiotherapy.

    Science.gov (United States)

    Boiras, C; Bourland, J; Gonzalez, L Brualla; Bulychkin, P; Ford, E; Kazantsev, P; Krylova, T; Medina, A Lopez; Prusova, M; Romanov, D; Ferrando, J Rosello; Willoughby, T; Yan, D; Yu, C; Zvereva, A

    2012-06-01

    The AAPM has signed two formal Educational Exchange Agreements with the Spanish (SEFM) and the Russian (AMPR) medical physics societies. While the primary purpose of the Agreements is to provide educational opportunities for young medical physicists, the Agreements also contemplate holding joint sessions at scientific congresses. The purpose of this professional AAPM/SEFM/AMPR Joint Symposium is to explore the challenges that medical physicists in the three countries face when new external beam radiotherapy technologies are introduced in their facilities and to suggest potential solutions to limitations in testing equipment and lack of familiarity with protocols. Speakers from the three societies will present reviews of the technical aspects of IMRT, Arc EVIRT (IMAT/VMAT/Rapid Arc), SRS/SRBT, and IGRT/Adaptive radiotherapy, and will describe the status of these technologies in their countries, including the challenges found in tasks such as developing anatomical and biological dose optimization techniques and implementing QA management, risk assessment and patient safety programs. The SEFM will offer AAPM and AMPR members the possibility to participate in collaborative proposals for future research bids in UE and USA based on an ongoing Spanish project for adaptive radiotherapy using functional imaging. A targeted discussion will debate three propositions: the cost/benefit ratio of IGRT, whether IMRT requires IGRT, and the use of non-ionizing radiation technologies for realtime monitoring of prostate IGRT. For these debates, each society has designated one speaker to present and defend either "For" or "Against" the proposition, followed by discussion by all participants. The Symposium presentations and the country-tailored recommendations drawn will be made available to each society for inclusion in their websites. The WGNIMP, the AAPM Work Group charged with executing the AAPM/SEFM and AAPM/AMPR Agreements, will follow up on the commitments made by the AAPM.Di Yan

  14. External beam radiotherapy for head and neck carcinomas with preservation of parotid function: indications, techniques and long term results

    International Nuclear Information System (INIS)

    Ding-Jen, Lee; Fairbanks, Robert; Lee, Frank C.

    1995-01-01

    Purpose/Objective: To reduce the incidence of radiotherapy induced xerostomia, we developed techniques of external beam irradiation with preservation of parotid function for patients with early to intermediate stage carcinomas of the head and neck. This analysis reports the efficacy of our methods. Materials and Methods: From 1985 to 1993, 42 patients with early to intermediate stage (T 1-3 N 0-2 M 0 ) head and neck carcinomas received a course of external beam radiotherapy. There were 13 patients with carcinoma of the oropharynx, 26 with carcinomas of the oral cavity and 3 with carcinomas of the hypopharynx (lateral wall). 7 patients received a course of definitive radiotherapy (66 to 72 Gy), while 35 patients received a course of postoperative radiotherapy (60-66 Gy). The fraction size was 2 Gy per day. In terms of treatment planning, the primary site (plus a margin) and the ipsilateral neck were covered by the irradiation volume. The ipsilateral parotid gland was within the treatment volume while the contralateral parotid gland was not. The most frequently used field arrangement was a paired wedge fields with an AP (medially just across the mid-line) and an ipsilateral posterior oblique field (usually 30 deg. off vertical axis with a spinal cord block). Multiple level of contours were taken and transmission blocks were used to improve dose homogeneity. In all patients, the ipsilateral parotid gland (and the neck) was irradiated while the contralateral parotid gland (and the neck) was not. Results: With a median follow up of 4 years (ranged from 1.5 to 9 years), only one patient developed symptomatic xerostomia. None had radiation induced dental caries. No patient developed recurrent disease in the contralateral neck. The local control rate was (38(42)) (90%) in the primary site and(41(42)) (98%) in the ipsilateral neck. Conclusion: With appropriate treatment planning, external beam irradiation with parotid function preservation can be achieved. Our results

  15. The international protocol for the dosimetry of external radiotherapy beams based on standards of absorbed dose to water

    International Nuclear Information System (INIS)

    Andreo, P.

    2001-01-01

    An International Code of Practice (CoP, or dosimetry protocol) for external beam radiotherapy dosimetry based on standards of absorbed dose to water has been published by the IAEA on behalf of IAEA, WHO, PAHO and ESTRO. The CoP provides a systematic and internationally unified approach for the determination of the absorbed dose to water in reference conditions with radiotherapy beams. The development of absorbed-dose-to-water standards for high-energy photons and electrons offers the possibility of reducing the uncertainty in the dosimetry of radiotherapy beams. Many laboratories already provide calibrations at the radiation quality of 60Co gamma-rays and some have extended calibrations to high-energy photon and electron beams. The dosimetry of kilovoltage x-rays, as well as that of proton and ion beams can also be based on these standards. Thus, a coherent dosimetry system based on the same formalism is achieved for practically all radiotherapy beams. The practical use of the CoP as simple. The document is formed by a set of different CoPs for each radiation type, which include detailed procedures and worksheets. All CoPs are based on ND,w chamber calibrations at a reference beam quality Qo, together with radiation beam quality correction factors kQ preferably measured directly for the user's chamber in a standards laboratory. Calculated values of kQ are provided together with their uncertainty estimates. Beam quality specifiers are 60Co, TPR20,10 (high-energy photons), R50 (electrons), HVL and kV (x-rays) and Rres (protons and ions) [es

  16. SU-E-T-66: A Prototype for Couch Based Real-Time Dosimetry in External Beam Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ramachandran, P [Peter MacCallum Cancer Centre, Bendigo (Australia)

    2015-06-15

    Purpose: The main purpose of this study is to design a prototype for couch-based based real time dosimetry system in external beam radiotherapy Methods: A prototype of 100 ionization chambers was designed on a printed circuit board by etching the copper layer and each ionization chamber was wired to a 50 pin connector. The signals from the two 50 pin connectors collected from the ionization chambers were then transferred to a PXI module from National Instruments. The PXI module houses a current amplifier that amplifies the charge collected from the ionization chamber. The amplified signal is then sent to a digital multimeter module for converting the analog signal to digital signal. A software was designed in labview to read and display the signals obtained from the PXI module. A couch attachment frame was designed to house the 100 ionization chamber module. The frame was fixed underneath the treatment couch for measuring the dose during treatment. Resutls: The ionization chamber based prototype dosimetry was tested for simple radiotherapy treatment fields and found to be a useful device for measuring real time dosimetry at the treatment couch plane. This information could be used to assess the delivered dose to a patient during radiotherapy. It could be used as an invivo dosimeter during radiotherapy. Conclusion: In this study, a prototype for couch based real time dosimetry system was designed and tested. The prototype forms a basis for the development of large scale couch based real time dosimetry system that could be used to perform morning QA prior to treatment, assess real time doses delivered to patient and as a device to monitor the output of the treatment beam. Peter MacCallum Cancer Foundation.

  17. SU-E-T-66: A Prototype for Couch Based Real-Time Dosimetry in External Beam Radiotherapy

    International Nuclear Information System (INIS)

    Ramachandran, P

    2015-01-01

    Purpose: The main purpose of this study is to design a prototype for couch-based based real time dosimetry system in external beam radiotherapy Methods: A prototype of 100 ionization chambers was designed on a printed circuit board by etching the copper layer and each ionization chamber was wired to a 50 pin connector. The signals from the two 50 pin connectors collected from the ionization chambers were then transferred to a PXI module from National Instruments. The PXI module houses a current amplifier that amplifies the charge collected from the ionization chamber. The amplified signal is then sent to a digital multimeter module for converting the analog signal to digital signal. A software was designed in labview to read and display the signals obtained from the PXI module. A couch attachment frame was designed to house the 100 ionization chamber module. The frame was fixed underneath the treatment couch for measuring the dose during treatment. Resutls: The ionization chamber based prototype dosimetry was tested for simple radiotherapy treatment fields and found to be a useful device for measuring real time dosimetry at the treatment couch plane. This information could be used to assess the delivered dose to a patient during radiotherapy. It could be used as an invivo dosimeter during radiotherapy. Conclusion: In this study, a prototype for couch based real time dosimetry system was designed and tested. The prototype forms a basis for the development of large scale couch based real time dosimetry system that could be used to perform morning QA prior to treatment, assess real time doses delivered to patient and as a device to monitor the output of the treatment beam. Peter MacCallum Cancer Foundation

  18. SU-G-TeP3-06: Nanoparticle-Aided External Beam Radiotherapy Leveraging the Cerenkov Effect

    Energy Technology Data Exchange (ETDEWEB)

    Ouyang, Z; Ngwa, W [University of Massachusetts Lowell, Lowell, MA (United States); Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School (United States); Liu, B; Sajo, E [University of Massachusetts Lowell, Lowell, MA (United States); Yasmin-Karim, S [Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School (United States)

    2016-06-15

    Purpose: This study investigates the feasibility of exploiting the Cerenkov radiation (CR) present during external beam radiotherapy (EBRT) for significant therapeutic gain, using titanium dioxide nanoparticles (titania) delivered via a new design of radiotherapy biomaterials. Methods: Recently published work has shown that CR generated by radionuclides during PET imaging could substantially enhance damage to cancer cells in the presence of 0.625 µg/g titania. We hypothesize that equal or greater damage can be achieved during EBRT. To test this hypothesis, Monte Carlo simulation was done using GEANT4 in order to get the total CR yield inside a tumor volume during EBRT compared to that of the radionuclides. We considered a novel approach where a sufficiently potent concentration of the titania was delivered directly into the tumor using radiotherapy biomaterials (e.g. fiducials) loaded with the titania. The intra-tumor distribution/diffusion of titania released from the fiducials was calculated. An in-vitro MTS assay experiment was also carried out to establish the relative non-toxicity of titania for concentrations of up to 1 µg/g. Results: For a radiotherapy biomaterial loaded with 15 µg/g of 2-nm titania, at least 0.625 µg/g could be delivered through out a tumor sub-volume of 2-cm diameter after 14 days. This concentration level could inflict substantial damage to tumor cells during EBRT. The Monte Carlo results showed the CR yield in tumor by 6 MV radiation was higher than the radionuclides and hence potentially greater damage may be obtained during EBRT. No significant cell viability change was observed for 1 µg/g titania. Conclusion: Altogether, these preliminary findings demonstrate a potential new approach that can be used to take advantage of the CR present during megavoltage EBRT to boost damage to tumor cells. The results provide significant impetus for further experimental studies towards development of nanoparticle-aided EBRT powered by the

  19. External beam radiotherapy alone or combined with high-dose-rate intracavitary irradiation in the treatment of cancer of the esophagus

    International Nuclear Information System (INIS)

    Hishikawa, Y.; Taniguchi, M.; Kamikonya, N.; Tanaka, S.; Miura, T.

    1988-01-01

    Autopsy findings of 35 patients, treated with radiotherapy for an esophageal carcinoma, were reviewed. A residual tumor was seen at autopsy in 7 of 16 patients treated with high-dose-rate intracavitary irradiation following external irradiation, in 13 of 14 patients treated with external irradiation of 50 Gy or more, and in all 5 patients treated with external irradiation of less than 50 Gy. Incidence on lymph node metastasis, at autopsy, did not diifer between the combined radiotherapy group and the external irradiation groups. However, it correlated with disease stage. It was observed in 11 of 17 patients with Stage 1 and Stage 2 disease, compared to 17 of 18 patients with Stage 3 and Stage 4 disease. Distant organ metastasis, at autopsy, also did not differ between the combined radiotherapy group and the external irradiation groups, and was also correlated with disease stage. It was found in 8 of 17 patients with Stage 1 and Stage 2 disease, compared to all 18 patients with Stage 3 and Stage 4 disease. Mean survival was different between the patients treated by high-dose-rate intracavitary irradiation following external irradiation and those treated by external irradiation alone; 11.3 months in the 16 patients treated with combined therapy, as compared to 6.9 months in the 14 patients who received external irradiation of 50 Gy or more, and 3.6 months in the 5 patients who received external irradiation of less than 50 Gy. 6 refs.; 5 tabs

  20. Adjuvant high-dose-rate brachytherapy after external beam radiotherapy in nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Oezyar, Enis; Yildz, Ferah; Akyol, Fadil H.; Atahan, I. Lale

    2002-01-01

    Purpose: To compare the local control and survival rates obtained with either external beam radiation therapy (ERT) and adjuvant high-dose-rate (HDR) brachytherapy (BRT) or ERT alone in patients with nasopharyngeal cancer. Methods and Materials: Between December 1993 and December 1999, 144 patients (106 male, 38 female) with the diagnosis of nasopharyngeal cancer were treated with either ERT and adjuvant HDR BRT (Group A) or ERT alone (Group B) at our department. BRT was not applied in 38 patients for the following reasons: (1) Unit was unavailable (n=13), (2) Patient was younger than 18 years (n=17), (3) Patient received accelerated hyperfractionated ERT (n=6), and (4) Patient refused BRT (n=2). The median age for whole group was 43 (range: 9-82 years). According to the AJCC-1997 staging system, there were 11 (7.6%), 35 (24.3%), 38 (26.4%), and 60 (41.7%) patients in Stage I, II, III, and IV, respectively. There were 57 (39.6%) patients with T1, 41 (28.5%) with T2, 20 (13.9%) with T3, and 26 (18.1%) with T4 tumors. Histopathologic diagnosis was WHO 2-3 in 137 (95.2%) patients. ERT doses ranged between 58.8 and 74 Gy (median: 66 Gy). There were significantly more patients with young age, N2 status, and Stage III disease in Group B and with Stage II disease in Group A. Significantly more patients received chemotherapy in Group B. BRT with an HDR 192 Ir microSelectron afterloading unit was delivered in 106 patients at the conclusion of ERT using a single-channel nasal applicator. Dose was prescribed at 1 cm from the source, and total dose of 12 Gy in 3 fractions on 3 consecutive days was given immediately after ERT. Besides radiotherapy, 82 (56.9%) patients received cisplatin-based chemotherapy, as well. Follow-up time ranged between 12 and 80 months (median: 32 months). Results: The two groups were comparable in terms of local recurrence, locoregional failure, regional failure, and rate of distant metastasis. Local failure was observed in 11 (10.3%) out of 106

  1. Organ localization in fractionated external beam radiotherapy for early stage prostatic adenocarcinoma

    International Nuclear Information System (INIS)

    Jaffray, D.A.; Horwitz, E.M.; Wong, J.W.; Martinez, A.A.; Brabbins, D.S.

    1996-01-01

    Purpose: Trends toward higher target doses and more conformal radiation field shaping place strict requirements on geometric localisation of the target and surrounding normal structures. Daily localization of these structures is not possible on a conventional treatment machine. For this reason, margins must be incorporated in the field shaping to accommodate any target or normal structure displacement. There are few studies which examine the magnitude of these displacements. We hypothesize that these uncertainties can be reduced by daily radiographic imaging of bony anatomy as an alternative to skin tattoos. This hypothesis is tested using multiple (15-19) CT scans on five patients receiving external beam radiotherapy of the prostate. Materials and Methods: Five patients were CT scanned in treatment position (with immobilization device) on every second day of their initial XRT course (non-boost). Radiopaque markers were placed on the skin tattoos to make them visible in the CT datasets. The scans were collected on a helical CT scanner (SR-7000, 3mm and 5mm slice thickness, 120kVp) and transferred to a workstation for analysis. The structures (prostate, rectum, bladder, and seminal vesicles) on all 80 CT datasets were contoured (manually) by two physicians. A reference dataset was chosen for each patient. The 3D transformations between the study datasets and the reference set were determined using an automated technique. A separate transformation was determined for the alignment of (i) bone (excluding femora) and (ii) skin marks. The contours from each dataset were then transformed back to the reference dataset. The resulting contours show the position of organ relative to either the skin marks (tattoos) or the bony anatomy. The displacement and distortion of the organs were parameterized by the displacement of the volume edge (AP, LAT, SUP-INF), volume, and center-of-mass (COM). Each calculation was performed for an individual patient. Population averages were also

  2. Pinnacle Scripts: Clearing automated treatment in external radiotherapy after unscheduled interruptions

    International Nuclear Information System (INIS)

    Jover Perez, C. I.; Alaman Sanchez, C.; Osorio Ceballos, J. L.; Real Nunez, R. del; Almansa Lopez, J.

    2013-01-01

    The stops not foreseen during the usual course of radiotherapy treatment affect the quality of the same. The calculation of dosage compensation is the tool that have physicists and radiation therapists in order to mitigate the effect of these disruptions and achieve an effective treatment. (Author)

  3. A Phase II study of external-beam radiotherapy and endovascular brachytherapy with PTA and stenting for femoropopliteal artery restenosis

    International Nuclear Information System (INIS)

    Narayan, Kailash; Denton, Michael; Das, Ram; Bernshaw, David; Rolfo, Aldo; Dyk, Sylvia van; Mirakian, Alex

    2006-01-01

    Purpose: To assess the safety and seek evidence of efficacy of combined external-beam radiotherapy (EBRT) and endovascular brachytherapy in the treatment of stenotic vascular lesions. Methods and Materials: Seventeen patients with high risk for restenosis of femoropopliteal arteries were enrolled in this study from February 2000 to August 2002. The external beam radiotherapy regimen consisted of 10 Gy in 5 fractions of 2 Gy, starting on Day 0. This was followed on Day 6 by angiography, stent placement, and intraluminal brachytherapy to a dose of 10 Gy at 1.2 mm from stent surface. The EBRT was continued from the same day to another 10 Gy in 2 Gy daily fractions for 5 days. Results: The follow up ranged from 33 months to 60 months. At the time of analysis 15 of 17 patients were alive with patent stents. Of these, 10 were symptom-free. Two patients died of unrelated causes. Conclusions: The combination of EBRT and endovascular brachytherapy provided adequate dose distribution without any geographical miss or 'candy wrapper' restenosis. No incidence of aneurysmal dilation of radiated vascular segment was observed. The treatment was feasible, well tolerated, and achieved 88% stenosis free survival

  4. Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report.

    Science.gov (United States)

    Giannelli, Flavio; Chiola, Ilaria; Belgioia, Liliana; Garelli, Stefania; Pastorino, Alice; Marcenaro, Michela; Mammoliti, Serafina; Costantini, Sergio; Bizzarri, Nicolò; Vellone, Valerio; Barra, Salvina; Corvò, Renzo

    2017-12-01

    Hidradenocarcinoma (HC) is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB), followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 - PTV1), 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node), and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes). Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1), and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2). D 90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

  5. Complete response in a patient with gynecological hidradenocarcinoma treated with exclusive external beam radiotherapy and brachytherapy: a case report

    Directory of Open Access Journals (Sweden)

    Flavio Giannelli

    2017-12-01

    Full Text Available Hidradenocarcinoma (HC is a very rare disease. This case report illustrates a successful treatment of a 60-year-old woman with vulvo-vaginal localization of hidradenocarcinoma treated with external beam radiotherapy delivered by helical tomotherapy with a simultaneous integrated boost (SIB, followed by brachytherapy. External beam radiotherapy dose prescription was 50.4 Gy in 28 fractions, five fractions per week to whole pelvis (planning target volume 1 – PTV1, 60.2 Gy in 28 fractions to SIB1 (fundus of uterus and right inguinal node, and 58.8 Gy in 28 fractions to SIB2 (lower/middle third of vagina, paraurethral region and right inguinal lymph nodes. Brachytherapy dose prescription was 28 Gy in 4 fractions for cervix, fundus of uterus and upper third of vagina (HR-CTV1, and 22 Gy in 4 fractions to middle third of vagina and paraurethral region (HR-CTV2. D90 for whole treatment was 91.9 Gy and 86.0 Gy for HR-CTV1 and HR-CTV2, respectively. Patient remained 12-months disease-free without treatment related side effects.

  6. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis.

    Science.gov (United States)

    Blake, P; Swart, Ann Marie; Orton, J; Kitchener, H; Whelan, T; Lukka, H; Eisenhauer, E; Bacon, M; Tu, D; Parmar, M K B; Amos, C; Murray, C; Qian, W

    2009-01-10

    Early endometrial cancer with low-risk pathological features can be successfully treated by surgery alone. External beam radiotherapy added to surgery has been investigated in several small trials, which have mainly included women at intermediate risk of recurrence. In these trials, postoperative radiotherapy has been shown to reduce the risk of isolated local recurrence but there is no evidence that it improves recurrence-free or overall survival. We report the findings from the ASTEC and EN.5 trials, which investigated adjuvant external beam radiotherapy in women with early-stage disease and pathological features suggestive of intermediate or high risk of recurrence and death from endometrial cancer. Between July, 1996, and March, 2005, 905 (789 ASTEC, 116 EN.5) women with intermediate-risk or high-risk early-stage disease from 112 centres in seven countries (UK, Canada, Poland, Norway, New Zealand, Australia, USA) were randomly assigned after surgery to observation (453) or to external beam radiotherapy (452). A target dose of 40-46 Gy in 20-25 daily fractions to the pelvis, treating five times a week, was specified. Primary outcome measure was overall survival, and all analyses were by intention to treat. These trials were registered ISRCTN 16571884 (ASTEC) and NCT 00002807 (EN.5). After a median follow-up of 58 months, 135 women (68 observation, 67 external beam radiotherapy) had died. There was no evidence that overall survival with external beam radiotherapy was better than observation, hazard ratio 1.05 (95% CI 0.75-1.48; p=0.77). 5-year overall survival was 84% in both groups. Combining data from ASTEC and EN.5 in a meta-analysis of trials confirmed that there was no benefit in terms of overall survival (hazard ratio 1.04; 95% CI 0.84-1.29) and can reliably exclude an absolute benefit of external beam radiotherapy at 5 years of more than 3%. With brachytherapy used in 53% of women in ASTEC/EN.5, the local recurrence rate in the observation group at 5 years

  7. Technical Note: Radiological properties of tissue surrogates used in a multimodality deformable pelvic phantom for MR-guided radiotherapy

    International Nuclear Information System (INIS)

    Niebuhr, Nina I.; Johnen, Wibke; Güldaglar, Timur; Runz, Armin; Echner, Gernot; Mann, Philipp; Möhler, Christian; Pfaffenberger, Asja; Greilich, Steffen; Jäkel, Oliver

    2016-01-01

    Purpose: Phantom surrogates were developed to allow multimodal [computed tomography (CT), magnetic resonance imaging (MRI), and teletherapy] and anthropomorphic tissue simulation as well as materials and methods to construct deformable organ shapes and anthropomorphic bone models. Methods: Agarose gels of variable concentrations and loadings were investigated to simulate various soft tissue types. Oils, fats, and Vaseline were investigated as surrogates for adipose tissue and bone marrow. Anthropomorphic shapes of bone and organs were realized using 3D-printing techniques based on segmentations of patient CT-scans. All materials were characterized in dual energy CT and MRI to adapt CT numbers, electron density, effective atomic number, as well as T1- and T2-relaxation times to patient and literature values. Results: Soft tissue simulation could be achieved with agarose gels in combination with a gadolinium-based contrast agent and NaF to simulate muscle, prostate, and tumor tissues. Vegetable oils were shown to be a good representation for adipose tissue in all modalities. Inner bone was realized using a mixture of Vaseline and K_2HPO_4, resulting in both a fatty bone marrow signal in MRI and inhomogeneous areas of low and high attenuation in CT. The high attenuation of outer bone was additionally adapted by applying gypsum bandages to the 3D-printed hollow bone case with values up to 1200 HU. Deformable hollow organs were manufactured using silicone. Signal loss in the MR images based on the conductivity of the gels needs to be further investigated. Conclusions: The presented surrogates and techniques allow the customized construction of multimodality, anthropomorphic, and deformable phantoms as exemplarily shown for a pelvic phantom, which is intended to study adaptive treatment scenarios in MR-guided radiation therapy

  8. Technical Note: Radiological properties of tissue surrogates used in a multimodality deformable pelvic phantom for MR-guided radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Niebuhr, Nina I., E-mail: n.niebuhr@dkfz.de; Johnen, Wibke; Güldaglar, Timur; Runz, Armin; Echner, Gernot; Mann, Philipp; Möhler, Christian; Pfaffenberger, Asja; Greilich, Steffen [Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany and Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology, Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Jäkel, Oliver [Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology, Im Neuenheimer Feld 280, Heidelberg 69120 (Germany); Department of Medical Physics, Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, Heidelberg 69120 (Germany)

    2016-02-15

    Purpose: Phantom surrogates were developed to allow multimodal [computed tomography (CT), magnetic resonance imaging (MRI), and teletherapy] and anthropomorphic tissue simulation as well as materials and methods to construct deformable organ shapes and anthropomorphic bone models. Methods: Agarose gels of variable concentrations and loadings were investigated to simulate various soft tissue types. Oils, fats, and Vaseline were investigated as surrogates for adipose tissue and bone marrow. Anthropomorphic shapes of bone and organs were realized using 3D-printing techniques based on segmentations of patient CT-scans. All materials were characterized in dual energy CT and MRI to adapt CT numbers, electron density, effective atomic number, as well as T1- and T2-relaxation times to patient and literature values. Results: Soft tissue simulation could be achieved with agarose gels in combination with a gadolinium-based contrast agent and NaF to simulate muscle, prostate, and tumor tissues. Vegetable oils were shown to be a good representation for adipose tissue in all modalities. Inner bone was realized using a mixture of Vaseline and K{sub 2}HPO{sub 4}, resulting in both a fatty bone marrow signal in MRI and inhomogeneous areas of low and high attenuation in CT. The high attenuation of outer bone was additionally adapted by applying gypsum bandages to the 3D-printed hollow bone case with values up to 1200 HU. Deformable hollow organs were manufactured using silicone. Signal loss in the MR images based on the conductivity of the gels needs to be further investigated. Conclusions: The presented surrogates and techniques allow the customized construction of multimodality, anthropomorphic, and deformable phantoms as exemplarily shown for a pelvic phantom, which is intended to study adaptive treatment scenarios in MR-guided radiation therapy.

  9. Bladder filling variations during concurrent chemotherapy and pelvic radiotherapy in rectal cancer patients: early experience of bladder volume assessment using ultrasound scanner

    International Nuclear Information System (INIS)

    Chang, Jee Suk; Yoon, Hong In; Cha, Hye Jung; Chang, Yoon Sun; Cho, Yeo Na; Keum, Ki Chang; Koom, Woong Sub

    2013-01-01

    To describe the early experience of analyzing variations and time trends in bladder volume of the rectal cancer patients who received bladder ultrasound scan. We identified 20 consecutive rectal cancer patients who received whole pelvic radiotherapy (RT) and bladder ultrasound scan between February and April 2012. Before simulation and during the entire course of treatment, patients were scanned with portable automated ultrasonic bladder scanner, 5 times consecutively, and the median value was reported. Then a radiation oncologist contoured the bladder inner wall shown on simulation computed tomography (CT) and calculated its volume. Before simulation, the median bladder volume measured using simulation CT and bladder ultrasound scan was 427 mL (range, 74 to 1,172 mL) and 417 mL (range, 147 to 1,245 mL), respectively. There was strong linear correlation (R = 0.93, p < 0.001) between the two results. During the course of treatment, there were wide variations in the bladder volume and every time, measurements were below the baseline with statistical significance (12/16). At 6 weeks after RT, the median volume was reduced by 59.3% to 175 mL. Compared to the baseline, bladder volume was reduced by 38% or 161 mL on average every week for 6 weeks. To our knowledge, this study is the first to prove that there are bladder volume variations and a reduction in bladder volume in rectal cancer patients. Moreover, our results will serve as the basis for implementation of bladder training to patients receiving RT with full bladder.

  10. Comparison of setup accuracy between exactrac X-ray 6 dimensions and cone-beam computed tomography for intracranial and pelvic image-guided radiotherapy

    International Nuclear Information System (INIS)

    Kudo, Tsuyoshi; Ono, Kaoru; Furukawa, Kengo; Fujimoto, Sachie; Akagi, Yukio; Koyama, Tadashi; Hirokawa, Yutaka

    2012-01-01

    The aim of this study was to compare the setup difference measured with ExacTrac X-ray 6D (ETX6D) and cone-beam computed tomography (CBCT) for non-invasive fractionated radiotherapy. Setup data were collected on a Novalis Tx treatment unit for both a head phantom and patients with intracranial tumors and a pelvic phantom and patients with prostate cancer. Initially, setup was done for a phantom using ETX6D. Secondly, a treatment couch was shifted or rotated by each already known value. Thirdly, ETX6D and CBCT scans were obtained. Finally, setup difference was determined: the registrations of ETX6D images with the corresponding digitally reconstructed radiographs using ETX6D fusion, and registrations of CBCT images with the planning CT using online 6D fusion. The setup difference between ETX6D and CBCT was compared. The impact of shifts and rotations on the difference was evaluated. Patients' setup data was similarly analyzed. In phantom experiments, the root mean square (RMS) of difference of the shift and rotation was less than 0.45 mm for translations, and 0.17 degrees for rotations. In intracranial patients' data, the RMS of that was 0.55 mm and 0.44 degree, respectively. In prostate cancer patients' data, the RMS of that was 0.77 mm and 0.79 degree, respectively. In this study, we observed modest setup differences between ETX6D and CBCT. These differences were generally less than 1.00 mm for translations, and 1.00 degrees for rotations, respectively. (author)

  11. Effect of beam arrangement on oral cavity dose in external beam radiotherapy of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Wu, Vincent W.C.; Yang Zhining; Zhang Wuzhe; Wu Lili; Lin Zhixiong

    2012-01-01

    This study compared the oral cavity dose between the routine 7-beam intensity-modulated radiotherapy (IMRT) beam arrangement and 2 other 7-beam IMRT with the conventional radiotherapy beam arrangements in the treatment of nasopharyngeal carcinoma (NPC). Ten NPC patients treated by the 7-beam routine IMRT technique (IMRT-7R) between April 2009 and June 2009 were recruited. Using the same computed tomography data, target information, and dose constraints for all the contoured structures, 2 IMRT plans with alternative beam arrangements (IMRT-7M and IMRT-7P) by avoiding the anterior facial beam and 1 conventional radiotherapy plan (CONRT) were computed using the Pinnacle treatment planning system. Dose-volume histograms were generated for the planning target volumes (PTVs) and oral cavity from which the dose parameters and the conformity index of the PTV were recorded for dosimetric comparisons among the plans with different beam arrangements. The dose distributions to the PTVs were similar among the 3 IMRT beam arrangements, whereas the differences were significant between IMRT-7R and CONRT plans. For the oral cavity dose, the 3 IMRT beam arrangements did not show significant difference. Compared with IMRT-7R, CONRT plan showed a significantly lower mean dose, V30 and V-40, whereas the V-60 was significantly higher. The 2 suggested alternative beam arrangements did not significantly reduce the oral cavity dose. The impact of varying the beam angles in IMRT of NPC did not give noticeable effect on the target and oral cavity. Compared with IMRT, the 2-D conventional radiotherapy irradiated a greater high-dose volume in the oral cavity.

  12. Commissioning and quality assurances of the CMS XIO radiotherapy treatment planning system for external beam photons

    International Nuclear Information System (INIS)

    Muralidhar, K.R.; Anurupa; Soubhagya; Sudhakar; Shiva; Krishnam Raju, A.; Narayana Murthy, P.

    2008-01-01

    The commissioning of XIO treatment planning system (TPS) was carried out by Computerized Medical Devices, USA for Siemens and Elekta linear accelerators. The Commissioning and quality assurance of the CMS XIO radiotherapy treatment planning system involves many steps, beginning from beam data acquisition and entry into the computerized TPS, through patient data acquisition, to treatment plan generation and the final transfer of data to the treatment machine and quality assurance of TPS

  13. Defining a dose-response relationship for prostate external beam radiotherapy

    International Nuclear Information System (INIS)

    Trada, Yuvnik; Plank, Ash; Martin, Jarad

    2013-01-01

    We aimed to quantify a relationship between radiotherapy dose and freedom from biochemical failure (FFBF) in low- and intermediate-risk prostate cancer. To reduce confounding we used data with a standardised end–point, mature follow-up, low competing risk of metastatic failure, conventional fractionation and separate reporting for outcomes with hormonal therapy (HT). A systematic review of the literature was carried out. Studies that reported the use of radiotherapy alone in 1.8–2Gy fractions in low- and intermediate-risk prostate cancer were included. The primary end–point was Phoenix definition 5-year FFBF. A logistic regression was used to quantify the dose–response relationship. Data from eight studies with 3037 patients met the inclusion criteria. The data from 810 low-risk patients and 2245 intermediate-risk patients were analysed. A strong association between radiotherapy dose and FFBF was found in low- and intermediate-risk patients managed with radiotherapy alone. In low-risk patients not treated with HT the dose required to achieve 50% biochemical tumour control (TCD 50 ) is 52.0 Gy and the slope of the dose–response curve at TCD 50 (γ 50 ) is 2.1%/Gy. At 78Gy this represented a FFBF of 90.3%. In intermediate-risk patients not treated with HT the TCD 50 is 64.7Gy and γ 50 is 3.2%/Gy. At 78 Gy this translated into a FFBF of 84.3%. HT had a small effect for low-risk patients and an inconsistent effect for intermediate-risk men. A strong association was found between radiation dose and biochemical outcome in both low- and intermediate-risk patients. Standardised reporting of results from future studies will make future analyses more robust.

  14. Potential for enhancing external beam radiotherapy for lung cancer using high-Z nanoparticles administered via inhalation

    Science.gov (United States)

    Hao, Yao; Altundal, Yucel; Moreau, Michele; Sajo, Erno; Kumar, Rajiv; Ngwa, Wilfred

    2015-09-01

    Nanoparticle-aided radiation therapy is emerging as a promising modality to enhance radiotherapy via the radiosensitizing action of high atomic number (Z) nanoparticles. However, the delivery of sufficiently potent concentrations of such nanoparticles to the tumor remain a challenge. This study investigates the dose enhancement to lung tumors due to high-Z nanoparticles (NPs) administered via inhalation during external beam radiotherapy. Here NPs investigated include: cisplatin nanoparticles (CNPs), carboplatin nanoparticles (CBNPs), and gold nanoparticles (GNPs). Using Monte Carlo-generated megavoltage energy spectra, a previously employed analytic method was used to estimate dose enhancement to lung tumors due to radiation-induced photoelectrons from the NPs administered via inhalation route (IR) in comparison to intravenous (IV) administration. Previous studies have indicated about 5% of FDA-approved cisplatin concentrations reach the lung via IV. Meanwhile recent experimental studies indicate that 3.5-14.6 times higher concentrations of NPs can reach the lung by IR compared to IV. Taking these into account, the dose enhancement factor (DEF) defined as the ratio of the radiotherapy dose with and without nanoparticles was calculated for a range of NPs concentrations and tumor sizes. The DEF for IR was then compared with that for IV. For IR with 3.5 times higher concentrations than IV, and 2 cm diameter tumor, clinically significant DEF values of up to 1.19, 1.26, and 1.51 were obtained for CNPs, CBNPs and GNPs. In comparison values of 1.06, 1.08, and 1.15 were obtained via IV administration. For IR with 14.6 times higher concentrations, even higher DEF values were obtained e.g. 1.81 for CNPs. Results also showed that the DEF increased with increasing field size or decreasing tumor volume, as expected. The results of this work indicate that IR administration of targeted high-Z CNPs/CBNPs/GNPs could enable clinically significant DEF to lung tumors compared to IV

  15. Toxicity Profile With a Large Prostate Volume After External Beam Radiotherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Pinkawa, Michael; Fischedick, Karin; Asadpour, Branka; Gagel, Bernd; Piroth, Marc D.; Nussen, Sandra; Eble, Michael J.

    2008-01-01

    Purpose: To assess the impact of prostate volume on health-related quality of life (HRQOL) before and at different intervals after radiotherapy for prostate cancer. Methods and Materials: A group of 204 patients was surveyed prospectively before (Time A), at the last day (Time B), 2 months after (Time C), and 16 months (median) after (Time D) radiotherapy, with a validated questionnaire (Expanded Prostate Cancer Index Composite). The group was divided into subgroups with a small (11-43 cm 3 ) and a large (44-151 cm 3 ) prostate volume. Results: Patients with large prostates presented with lower urinary bother scores (median 79 vs. 89; p = 0.01) before treatment. Urinary function/bother scores for patients with large prostates decreased significantly compared to patients with small prostates due to irritative/obstructive symptoms only at Time B (pain with urination more than once daily in 48% vs. 18%; p 3 vs. 47 cm 3 ; p < 0.01). Conclusions: Patients with a large prostate volume have a great risk of irritative/obstructive symptoms (particularly dysuria) in the acute radiotherapy phase. These symptoms recover rapidly and do not influence long-term HRQOL

  16. Standard operating procedures for quality audits of 60Co external beam radiotherapy facilities

    International Nuclear Information System (INIS)

    Larrinaga Cortina, E.F.; Dominguez Hung, L.; Campa Menendez, R.

    2001-01-01

    The use of radiotherapy implies the necessity of rigorous quality standards in its different components, aimed to provide the best possible treatment and avoid potential patients' risks, that could even cause him death. Projects of technical cooperation developed in Cuba and supported by the International Atomic Energy Agency address the implementation of Programs of Quality Assurance (PGC) in radiotherapy services. The establishment of the National Quality Audit Program (PNAC) is a superior stage. The National Control Center for Medical Devices, as the national regulator entity for the control and supervision of medical devices in the National Health System, is responsible for the making and execution of the PNAC. The audit modality selected was the inspection visit in situ due to its intrinsic advantages, our geographical extension and the number of radiotherapy services. This paper presents the methodology for the execution of the PNAC, in form of a Normalized Procedure of Operation (PNO) that defines the objectives, scope, terms and definitions, responsibilities, composition and selection of the auditor team, security's conditions, materials and equipment, steps of the audit execution, results calculation and interpretation, records, etc. (author)

  17. Can the prostate brachytherapy by permanent implants represent an alternative to external radiotherapy for the localised prostate cancers with intermediary risk?

    International Nuclear Information System (INIS)

    Farnault, B.; Duberge, T.; Salem, N.; Boher, J.M.; Gravis, G.; Bladou, F.; Jochen, W.; Resbeut, M.

    2009-01-01

    Purpose: the prostate brachytherapy stands out as treatment of low risk prostate cancers, but the data concerning its use as exclusive treatment of intermediary risk prostate cancer are rare. We present a retrospective analysis of intermediary risk prostate cancers which treatment was either an external conformal radiotherapy or an exclusive brachytherapy. conclusion: In this mono centric series, the brachytherapy brings excellent results in comparison with external conformal radiotherapy with dose escalation and could be proposed as alternative to patients suffering of intermediary risk prostate cancer. (N.C.)

  18. External Beam Radiotherapy for Clinically Localized Hormone-Refractory Prostate Cancer: Clinical Significance of Nadir Prostate-Specific Antigen Value Within 12 Months

    International Nuclear Information System (INIS)

    Ogawa, Kazuhiko; Nakamura, Katsumasa; Sasaki, Tomonari; Onishi, Hiroshi; Koizumi, Masahiko; Shioyama, Yoshiyuki; Araya, Masayuki; Mukumoto, Nobutaka M.S.; Mitsumori, Michihide; Teshima, Teruki

    2009-01-01

    Purpose: To analyze retrospectively the results of external beam radiotherapy for clinically localized hormone-refractory prostate cancer and investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcomes after radiotherapy. Methods and Materials: Eighty-four patients with localized hormone-refractory prostate cancer treated with external beam radiotherapy were retrospectively reviewed. The total radiation doses ranged from 30 to 76 Gy (median, 66 Gy), and the median follow-up period for all 84 patients was 26.9 months (range, 2.7-77.3 months). Results: The 3-year actuarial overall survival, progression-free survival (PFS), and local control rates in all 84 patients after radiotherapy were 67%, 61%, and 93%, respectively. Although distant metastases and/or regional lymph node metastases developed in 34 patients (40%) after radiotherapy, local progression was observed in only 5 patients (6%). Of all 84 patients, the median nPSA12 in patients with clinical failure and in patients without clinical failure was 3.1 ng/mL and 0.5 ng/mL, respectively. When dividing patients according to low (<0.5 ng/mL) and high (≥0.5 ng/mL) nPSA12 levels, the 3-year PFS rate in patients with low nPSA12 and in those with high nPSA12 was 96% and 44%, respectively (p < 0.0001). In univariate analysis, nPSA12 and pretreatment PSA value had a significant impact on PFS, and in multivariate analysis nPSA12 alone was an independent prognostic factor for PFS after radiotherapy. Conclusions: External beam radiotherapy had an excellent local control rate for clinically localized hormone-refractory prostate cancer, and nPSA12 was predictive of clinical outcomes after radiotherapy.

  19. Poster — Thur Eve — 59: Atlas Selection for Automated Segmentation of Pelvic CT for Prostate Radiotherapy

    International Nuclear Information System (INIS)

    Mallawi, A; Farrell, T; Diamond, K; Wierzbicki, M

    2014-01-01

    Automated atlas-based segmentation has recently been evaluated for use in planning prostate cancer radiotherapy. In the typical approach, the essential step is the selection of an atlas from a database that best matches the target image. This work proposes an atlas selection strategy and evaluates its impact on the final segmentation accuracy. Prostate length (PL), right femoral head diameter (RFHD), and left femoral head diameter (LFHD) were measured in CT images of 20 patients. Each subject was then taken as the target image to which all remaining 19 images were affinely registered. For each pair of registered images, the overlap between prostate and femoral head contours was quantified using the Dice Similarity Coefficient (DSC). Finally, we designed an atlas selection strategy that computed the ratio of PL (prostate segmentation), RFHD (right femur segmentation), and LFHD (left femur segmentation) between the target subject and each subject in the atlas database. Five atlas subjects yielding ratios nearest to one were then selected for further analysis. RFHD and LFHD were excellent parameters for atlas selection, achieving a mean femoral head DSC of 0.82 ± 0.06. PL had a moderate ability to select the most similar prostate, with a mean DSC of 0.63 ± 0.18. The DSC obtained with the proposed selection method were slightly lower than the maximums established using brute force, but this does not include potential improvements expected with deformable registration. Atlas selection based on PL for prostate and femoral diameter for femoral heads provides reasonable segmentation accuracy

  20. Poster — Thur Eve — 59: Atlas Selection for Automated Segmentation of Pelvic CT for Prostate Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mallawi, A [McMaster University, Medical Physics and Applied Radiation Sciences Department, Hamilton, Ontario (Canada); Farrell, T; Diamond, K; Wierzbicki, M [McMaster University, Medical Physics and Applied Radiation Sciences Department, Hamilton, Ontario (Canada); Juravinski Cancer Centre, Medical Physics Department, Hamilton, Ontario (Canada)

    2014-08-15

    Automated atlas-based segmentation has recently been evaluated for use in planning prostate cancer radiotherapy. In the typical approach, the essential step is the selection of an atlas from a database that best matches the target image. This work proposes an atlas selection strategy and evaluates its impact on the final segmentation accuracy. Prostate length (PL), right femoral head diameter (RFHD), and left femoral head diameter (LFHD) were measured in CT images of 20 patients. Each subject was then taken as the target image to which all remaining 19 images were affinely registered. For each pair of registered images, the overlap between prostate and femoral head contours was quantified using the Dice Similarity Coefficient (DSC). Finally, we designed an atlas selection strategy that computed the ratio of PL (prostate segmentation), RFHD (right femur segmentation), and LFHD (left femur segmentation) between the target subject and each subject in the atlas database. Five atlas subjects yielding ratios nearest to one were then selected for further analysis. RFHD and LFHD were excellent parameters for atlas selection, achieving a mean femoral head DSC of 0.82 ± 0.06. PL had a moderate ability to select the most similar prostate, with a mean DSC of 0.63 ± 0.18. The DSC obtained with the proposed selection method were slightly lower than the maximums established using brute force, but this does not include potential improvements expected with deformable registration. Atlas selection based on PL for prostate and femoral diameter for femoral heads provides reasonable segmentation accuracy.

  1. Effect of Gold Nanoparticles on Prostate Dose Distribution under Ir-192 Internal and 18 MV External Radiotherapy Procedures Using Gel Dosimetry and Monte Carlo Method

    Directory of Open Access Journals (Sweden)

    Khosravi H.

    2015-03-01

    Full Text Available Background: Gel polymers are considered as new dosimeters for determining radiotherapy dose distribution in three dimensions. Objective: The ability of a new formulation of MAGIC-f polymer gel was assessed by experimental measurement and Monte Carlo (MC method for studying the effect of gold nanoparticles (GNPs in prostate dose distributions under the internal Ir-192 and external 18MV radiotherapy practices. Method: A Plexiglas phantom was made representing human pelvis. The GNP shaving 15 nm in diameter and 0.1 mM concentration were synthesized using chemical reduction method. Then, a new formulation of MAGIC-f gel was synthesized. The fabricated gel was poured in the tubes located at the prostate (with and without the GNPs and bladder locations of the phantom. The phantom was irradiated to an Ir-192 source and 18 MV beam of a Varian linac separately based on common radiotherapy procedures used for prostate cancer. After 24 hours, the irradiated gels were read using a Siemens 1.5 Tesla MRI scanner. The absolute doses at the reference points and isodose curves resulted from the experimental measurement of the gels and MC simulations following the internal and external radiotherapy practices were compared. Results: The mean absorbed doses measured with the gel in the presence of the GNPs in prostate were 15% and 8 % higher than the corresponding values without the GNPs under the internal and external radiation therapies, respectively. MC simulations also indicated a dose increase of 14 % and 7 % due to presence of the GNPs, for the same experimental internal and external radiotherapy practices, respectively. Conclusion: There was a good agreement between the dose enhancement factors (DEFs estimated with MC simulations and experiment gel measurements due to the GNPs. The results indicated that the polymer gel dosimetry method as developed and used in this study, can be recommended as a reliable method for investigating the DEF of GNPs in internal

  2. Effect of Gold Nanoparticles on Prostate Dose Distribution under Ir-192 Internal and 18 MV External Radiotherapy Procedures Using Gel Dosimetry and Monte Carlo Method.

    Science.gov (United States)

    Khosravi, H; Hashemi, B; Mahdavi, S R; Hejazi, P

    2015-03-01

    Gel polymers are considered as new dosimeters for determining radiotherapy dose distribution in three dimensions. The ability of a new formulation of MAGIC-f polymer gel was assessed by experimental measurement and Monte Carlo (MC) method for studying the effect of gold nanoparticles (GNPs) in prostate dose distributions under the internal Ir-192 and external 18MV radiotherapy practices. A Plexiglas phantom was made representing human pelvis. The GNP shaving 15 nm in diameter and 0.1 mM concentration were synthesized using chemical reduction method. Then, a new formulation of MAGIC-f gel was synthesized. The fabricated gel was poured in the tubes located at the prostate (with and without the GNPs) and bladder locations of the phantom. The phantom was irradiated to an Ir-192 source and 18 MV beam of a Varian linac separately based on common radiotherapy procedures used for prostate cancer. After 24 hours, the irradiated gels were read using a Siemens 1.5 Tesla MRI scanner. The absolute doses at the reference points and isodose curves resulted from the experimental measurement of the gels and MC simulations following the internal and external radiotherapy practices were compared. The mean absorbed doses measured with the gel in the presence of the GNPs in prostate were 15% and 8 % higher than the corresponding values without the GNPs under the internal and external radiation therapies, respectively. MC simulations also indicated a dose increase of 14 % and 7 % due to presence of the GNPs, for the same experimental internal and external radiotherapy practices, respectively. There was a good agreement between the dose enhancement factors (DEFs) estimated with MC simulations and experiment gel measurements due to the GNPs. The results indicated that the polymer gel dosimetry method as developed and used in this study, can be recommended as a reliable method for investigating the DEF of GNPs in internal and external radiotherapy practices.

  3. Evaluation of off-axis wedge correction factor using diode dosimeters for estimation of delivered dose in external radiotherapy

    International Nuclear Information System (INIS)

    Allahverdi, Mahmoud; Shirazi, Alireza; Geraily, Ghazale; Mohammadkarim, Alireza; Esfehani, Mahbod; Nedaie, Hasanali

    2012-01-01

    An in vivo dosimetry system, using p-type diode dosimeters, was characterized for clinical applications of treatment machines ranging in megavoltage energies. This paper investigates two different models of diodes for externally wedged beams and explains a new algorithm for the calculation of the target dose at various tissue depths in external radiotherapy. The values of off-axis wedge correction factors were determined at two different positions in the wedged (toward the thick and thin edges) and in the non-wedged directions on entrance and exit surfaces of a polystyrene phantom in 60 Co and 6 MV photon beams. Depth transmission was defined on the entrance and exit surfaces to obtain the off-axis wedge correction factor at any depth. As the sensitivity of the diodes depends on physical characteristics (field size, source-skin distance (SSD), thickness, backscatter), correction factors were applied to the diode reading when measuring conditions different from calibration situations. The results indicate that needful correction factors for 60 Co wedged photons are usually larger than those for 6 MV wedged photon beams. In vivo dosimetry performed with the proposed algorithms at externally wedged beams has negligible probable errors (less than 0.5%) and is a reliable method for patient dose control. (author)

  4. Evaluation of off-axis wedge correction factor using diode dosimeters for estimation of delivered dose in external radiotherapy

    Directory of Open Access Journals (Sweden)

    Mahmoud Allahverdi

    2012-01-01

    Full Text Available An in vivo dosimetry system, using p-type diode dosimeters, was characterized for clinical applications of treatment machines ranging in megavoltage energies. This paper investigates two different models of diodes for externally wedged beams and explains a new algorithm for the calculation of the target dose at various tissue depths in external radiotherapy. The values of off-axis wedge correction factors were determined at two different positions in the wedged (toward the thick and thin edges and in the non-wedged directions on entrance and exit surfaces of a polystyrene phantom in 60 Co and 6 MV photon beams. Depth transmission was defined on the entrance and exit surfaces to obtain the off-axis wedge correction factor at any depth. As the sensitivity of the diodes depends on physical characteristics [field size, source-skin distance (SSD, thickness, backscatter], correction factors were applied to the diode reading when measuring conditions different from calibration situations . The results indicate that needful correction factors for 60 Co wedged photons are usually larger than those for 6 MV wedged photon beams. In vivo dosimetry performed with the proposed algorithms at externally wedged beams has negligible probable errors (less than 0.5% and is a reliable method for patient dose control.

  5. Successful delivery of adjuvant external beam radiotherapy for ependymoma in a patient with Ondine's curse

    International Nuclear Information System (INIS)

    Choi, Mehee; Thoma, Miranda; Tolekidis, George; Byrne, Richard W.; Diaz, Aidnag Z.

    2015-01-01

    Ondine's curse is a rare, potentially life-threatening disorder characterized by loss of automatic breathing during sleep and preserved voluntary breathing. It is seldom encountered in the radiotherapy clinic but can pose significant technical challenges and safety concerns in the delivery of a prescribed radiation course. We report a unique case of successful delivery of radiotherapy for ependymoma in a patient with Ondine's curse. A 53-year-old gentleman presented with vertigo when lying down. Brain magnetic resonance imaging revealed an enhancing mass in the floor of the fourth ventricle. He underwent maximal safe resection. Pathology revealed ependymoma. The patient was referred for radiotherapy. Computed tomography simulation was performed in supine position with 3-point thermoplastic mask immobilization. Sequential TomoTherapy plans were developed. At first scheduled treatment, shortly after mask placement, his arms went limp and he was unresponsive. Vitals showed oxygen saturation 83%, pulse 127, and blood pressure 172/97 mm Hg. He was diagnosed with Ondine's curse thought secondary to previous brainstem damage; the combination of lying flat and pressure from the mask was causing him to go into respiratory arrest. As supine positioning did not seem clinically advisable, he was simulated in prone position. A RapidArc plan and a back-up conformal plan were developed. Prescriptions were modified to meet conservative organs-at-risk constraints. Several strategies were used to minimize uncertainties in set-up reproducibility associated with prone positioning. He tolerated prone RapidArc treatments well. The report highlights the importance of applying practical patient safety and treatment planning/delivery strategies in the management of this challenging case.

  6. From Passive to Active in the Design of External Radiotherapy Database at Oncology Institute

    Directory of Open Access Journals (Sweden)

    Valentin Ioan CERNEA

    2009-12-01

    Full Text Available Implementation during 1997 of a computer network at Oncology Institute “Prof. Dr. Ion Chiricuţă" from Cluj-Napoca (OICN opens the era of patient electronic file where the presented database is included. The database developed before 2000, used till December 2006 in all reports of OICN has collected data from primary documents as radiotherapy files. Present level of the computer network permits to change the sense of data from computer to primary document. Now the primary document is built firstly electronically inside the computer, and secondly, after validation is printed as a known document. The paper discusses the issues concerning safety, functionality and access derived.

  7. Photochemical Internalization of Bleomycin Before External-Beam Radiotherapy Improves Locoregional Control in a Human Sarcoma Model

    International Nuclear Information System (INIS)

    Norum, Ole-Jacob; Bruland, Oyvind Sverre; Gorunova, Ludmila; Berg, Kristian

    2009-01-01

    Purpose: The aim of this study was to explore the tumor growth response of the combination photochemical internalization and external-beam radiotherapy. Photochemical internalization is a technology to improve the utilization of therapeutic macromolecules in cancer therapy by photochemical release of endocytosed macromolecules into the cytosol. Methods and Materials: A human sarcoma xenograft TAX-1 was inoculated subcutaneously into nude mice. The photosensitizer AlPcS 2a and bleomycin were intraperitoneally administrated 48 h and 30 min, respectively, before diode laser light exposure at 670 nm (20 J/cm 2 ). Thirty minutes or 7 days after photochemical treatment, the animals were subjected to 4 Gy of ionizing radiation. Results: Using photochemical internalization of bleomycin as an adjunct to ionizing radiation increased the time to progression for the tumors from 17 to 33 days as compared with that observed with photodynamic therapy combined with ionizing radiation as well as for radiochemotherapy with bleomycin. The side effects observed when photochemical internalization of bleomycin was given shortly before ionizing radiation were eliminated by separating the treatment modalities in time. Conclusion: Photochemical internalization of bleomycin combined with ionizing radiation increased the time to progression and showed minimal toxicity and may therefore reduce the total radiation dose necessary to obtain local tumor control while avoiding long-term sequelae from radiotherapy.

  8. Salvage radical prostatectomy after external radiotherapy for prostate cancer: Indications, morbidity and results. Review from CCAFU prostate section

    International Nuclear Information System (INIS)

    Paparel, P.; Soulie, M.; Mongiat-Artus, P.; Cornud, F.; Borgogno, C.; Les membres du sous-comite prostate du CCAFU

    2010-01-01

    Local recurrence after external radiotherapy for prostate cancer occurs in 30 to 50 % and is often diagnosed by a rising PSA. The absence of local control after radiotherapy is a risk factor of metastases and specific mortality. There are several therapeutic options to treat these patients: surveillance, hormonotherapy and salvage therapies (radical prostatectomy, cysto-prostatectomy, brachytherapy, high intensity focused ultrasound [HIFU] and cryotherapy). Hormonotherapy is not a curative treatment and after a couple of years, the disease will progress again. Local salvage therapies are the only treatment to have the potential to cure these patients with the condition of very strict inclusion criteria. Among these therapies, only radical prostatectomy demonstrated his efficacy with a follow-up of 10 years on specific survival and survival without biological progression respectively from 70 to 77 % and from 30 to 43 %. During last decade, morbidity of RP has strongly decreased with a percentage of rectal and ureteral injury at 3 %. Nevertheless, percentage of urinary incontinence remains high from 29 to 50 %. Salvage mini-invasive therapies (cryotherapy, HIFU and cryotherapy) are under constant evolution due to progress of technology. Functional and oncological results are better with last generation devices but need to be evaluated and compared with radical prostatectomy. (authors)

  9. Pattern of failures in gastric cancer patients with lymph node involvement treated by surgery, intraoperative and external beam radiotherapy

    International Nuclear Information System (INIS)

    Glehen, O.; Peyrat, P.; Beaujard, A.C.; Chapet, O.; Romestaing, P.; Sentenac, I.; Francois, Y.; Vignal, J.; Gerard, J.P.; Gilly, F.N.

    2003-01-01

    Aims: High local failure rates in gastric cancer have been reported, up to 67%. To achieve a better local control, we evaluated intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) in association with surgery for gastric cancer patients with lymph node involvement. We report here the analysis of the patterns of failure for patients involved in this IORT protocol. Material and methods: Forty-two positive lymph node (N+) gastric cancer patients were operated on (31 total, three subtotal and eight extended gastrectomies) with IORT procedure between 1985 and 1997 (33 males, nine females, mean age 61.3 years). IORT was focused on coeliac area (mean dose 15 Gy), followed by EBRT (46 Gy) in 36 patients. Ten patients were pN1 and 32 were pN2. A concurrent systemic chemotherapy (five Fluoro-Uracil and Cisplatinum) was performed in 14 patients. Results: One patient died postoperatively. Actuarial pN+ 10 year survival rate was 44.8%. The 5 year actuarial local control and disease-free survival rates were 78.8 and 47.5%, respectively. As far as patterns of failure were explored, 5 patients have a local coeliac recurrence (12%) and 12 have distant metastases with no evidence of coeliac recurrence. Conclusion: This retrospective analysis suggests a potential effect of IORT and/or EBRT in promoting local control and long-term survival in gastric cancer patients with lymph node involvement

  10. Combination of peptide receptor radionuclide therapy with fractionated external beam radiotherapy for treatment of advanced symptomatic meningioma

    International Nuclear Information System (INIS)

    Kreissl, Michael C; Flentje, Michael; Sweeney, Reinhart A; Hänscheid, Heribert; Löhr, Mario; Verburg, Frederik A; Schiller, Markus; Lassmann, Michael; Reiners, Christoph; Samnick, Samuel S; Buck, Andreas K

    2012-01-01

    External beam radiotherapy (EBRT) is the treatment of choice for irresectable meningioma. Due to the strong expression of somatostatin receptors, peptide receptor radionuclide therapy (PRRT) has been used in advanced cases. We assessed the feasibility and tolerability of a combination of both treatment modalities in advanced symptomatic meningioma. 10 patients with irresectable meningioma were treated with PRRT ( 177 Lu-DOTA0,Tyr3 octreotate or - DOTA0,Tyr3 octreotide) followed by external beam radiotherapy (EBRT). EBRT performed after PRRT was continued over 5–6 weeks in IMRT technique (median dose: 53.0 Gy). All patients were assessed morphologically and by positron emission tomography (PET) before therapy and were restaged after 3–6 months. Side effects were evaluated according to CTCAE 4.0. Median tumor dose achieved by PRRT was 7.2 Gy. During PRRT and EBRT, no side effects > CTCAE grade 2 were noted. All patients reported stabilization or improvement of tumor-associated symptoms, no morphologic tumor progression was observed in MR-imaging (median follow-up: 13.4 months). The median pre-therapeutic SUV max in the meningiomas was 14.2 (range: 4.3–68.7). All patients with a second PET after combined PRRT + EBRT showed an increase in SUV max (median: 37%; range: 15%–46%) to a median value of 23.7 (range: 8.0–119.0; 7 patients) while PET-estimated volume generally decreased to 81 ± 21% of the initial volume. The combination of PRRT and EBRT is feasible and well tolerated. This approach represents an attractive strategy for the treatment of recurring or progressive symptomatic meningioma, which should be further evaluated

  11. External Beam Radiotherapy for Focal Lymphoepithelioma-Like Carcinoma in the Urinary Bladder: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Nobuhiro Kushida

    2015-01-01

    Full Text Available Lymphoepithelioma is a malignant epithelial tumor in the nasopharynx characterized by prominent lymphoid infiltration. Carcinomas that resemble lymphoepitheliomas have been called lymphoepithelioma-like carcinomas and have been reported in other organs. A tumor in the bladder is categorized by the percentage of the total area occupied by the lymphoepithelioma-like carcinoma pattern, with the prognosis dependent on the percentage. We present an 81-year-old man with stage 3 chronic obstructive pulmonary disease and a history of aortic aneurysm repair. The computed tomography scans indicated thickening and irregularity of the bladder wall, with left external iliac lymph node metastasis. His diagnosis was bladder cancer, and the clinical stage was evaluated as T3N1M0. Transurethral resection of the bladder tumor was performed, and the pathological specimen showed that the tumor was composed of undifferentiated malignant cells with sheets and nests arranged in a syncytial pattern, as well as an urothelial carcinoma lesion. A prominent lymphoid reaction accompanied the tumor. The pathological diagnosis was focal-type lymphoepithelioma-like carcinoma containing a component of urothelial carcinoma G3>G2. His general condition was such that he could not tolerate radical cystectomy or systemic chemotherapy. External beam radiotherapy (total 60 Gy was given to the bladder, including the lymph node metastatic lesion. No cancer recurrence was detected by regular follow-up computed tomography and cystoscopy. He eventually died of other causes 48 months later. Although treatment for focal lymphoepithelioma-like carcinoma generally requires multifocal therapies, in the present case, the bladder became tumor free. We also summarize previously reported lymphoepithelioma-like carcinoma cases treated with radiotherapy.

  12. External beam radiotherapy for carcinoma of the prostate: a retrospective study

    International Nuclear Information System (INIS)

    Mithal, N.P.; Hoskin, P.J.

    1993-01-01

    Two hundred and thirty-seven consecutive patients receiving radiotherapy for primary prostatic carcinoma have been reviewed. The presenting symptoms included acute retention, chronic outflow obstruction and haematuria. The diagnosis was confirmed at trans-urethral resection of the prostate (TURP) in 95%; all but seven patients had adenocarcinoma. The clinical stage at presentation was T 0 (3%), T 1 (9%), T 2 (49%), T 3 (21%) and T 4 (17%). Two hundred and six patients received primary radiotherapy, 38 had concurrent endocrine therapy. Local relapse alone occurred in 38 patients (16%), distant relapse alone occurred in 30 (13%), and both local and distant relapse occurred in 30 (13%). Median time to local relapse alone was 25 months, distant relapse alone 14 months, and local and distant relapse 22 months. Overall survival was related to stage and grade at presentation. No influence of endocrine therapy, dose or planning technique was seen, but a significant advantage for those patients treated using a planned volume compared with parallel opposed fields was observed. Acute radiation toxicity affecting the bladder occurred in 42% and the bowel in 45%. Late toxicity affecting the bladder occurred in 7% and the bowel in 2%. (author)

  13. Beam related response of in vivo diode detectors for external radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Baci, Syrja, E-mail: sbarci2013@gmail.com [Department of Physics, Faculty of Natural Sciences, University of Gjirokastra, “Eqrem Çabej” (Albania); Telhaj, Ervis [Department of Medical Physics, Hygeia Hospital Tirana (Albania); Malkaj, Partizan [Department of Physical Engineering, Polytechnic University, Tirana (Albania)

    2016-03-25

    In Vivo Dosimetry (IVD) is a set of methods used in cancer treatment clinics to determine the real dose of radiation absorbed by target volume in a patient’s body. IVD has been widely implemented in radiotherapy treatment centers and is now recommended part of Quality Assurance program by many International health and radiation organizations. Because of cost and lack of specialized personnel, IVD has not been practiced as yet, in Albanian radiotherapy clinics. At Hygeia Hospital Tirana, patients are irradiated with high energy photons generated by Elekta Synergy Accelerators. We have recently started experimenting with the purpose of establishing an IVD practice at this hospital. The first set of experiments was aimed at calibration of diodes that are going to be used for IVD. PMMA, phantoms by PTW were used to calibrate p – type Si, semiconductor diode dosimeters, made by PTW Freiburg for entrance dose. Response of the detectors is affected by energy of the beam, accumulated radiation dose, dose rate, temperature, angle against the beam axis, etc. Here we present the work done for calculating calibration factor and correction factors of source to surface distance, field size, and beam incidence for the entrance dose for both 6 MV photon beam and 18 MV photon beam. Dependence of dosimeter response was found to be more pronounced with source to surface distance as compared to other variables investigated.

  14. Beam related response of in vivo diode detectors for external radiotherapy

    International Nuclear Information System (INIS)

    Baci, Syrja; Telhaj, Ervis; Malkaj, Partizan

    2016-01-01

    In Vivo Dosimetry (IVD) is a set of methods used in cancer treatment clinics to determine the real dose of radiation absorbed by target volume in a patient’s body. IVD has been widely implemented in radiotherapy treatment centers and is now recommended part of Quality Assurance program by many International health and radiation organizations. Because of cost and lack of specialized personnel, IVD has not been practiced as yet, in Albanian radiotherapy clinics. At Hygeia Hospital Tirana, patients are irradiated with high energy photons generated by Elekta Synergy Accelerators. We have recently started experimenting with the purpose of establishing an IVD practice at this hospital. The first set of experiments was aimed at calibration of diodes that are going to be used for IVD. PMMA, phantoms by PTW were used to calibrate p – type Si, semiconductor diode dosimeters, made by PTW Freiburg for entrance dose. Response of the detectors is affected by energy of the beam, accumulated radiation dose, dose rate, temperature, angle against the beam axis, etc. Here we present the work done for calculating calibration factor and correction factors of source to surface distance, field size, and beam incidence for the entrance dose for both 6 MV photon beam and 18 MV photon beam. Dependence of dosimeter response was found to be more pronounced with source to surface distance as compared to other variables investigated.

  15. External Beam Radiotherapy of Recurrent Glioma: Radiation Tolerance of the Human Brain

    Energy Technology Data Exchange (ETDEWEB)

    Sminia, Peter, E-mail: p.sminia@vumc.nl [Department of Radiation Oncology, Radiobiology Section, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, Amsterdam (Netherlands); Mayer, Ramona [EBG MedAustron GmbH., Viktor Kaplan-Strasse 2, A-2700, Wiener Neustadt (Austria)

    2012-04-05

    Malignant gliomas relapse in close proximity to the resection site, which is the postoperatively irradiated volume. Studies on re-irradiation of glioma were examined regarding radiation-induced late adverse effects (i.e., brain tissue necrosis), to obtain information on the tolerance dose and treatment volume of normal human brain tissue. The studies were analyzed using the linear-quadratic model to express the re-irradiation tolerance in cumulative equivalent total doses when applied in 2 Gy fractions (EQD2{sub cumulative}). Analysis shows that the EQD2{sub cumulative} increases from conventional re-irradiation series to fractionated stereotactic radiotherapy (FSRT) to LINAC-based stereotactic radiosurgery (SRS). The mean time interval between primary radiotherapy and the re-irradiation course was shortened from 30 months for conventional re-irradiation to 17 and 10 months for FSRT and SRS, respectively. Following conventional re-irradiation, radiation-induced normal brain tissue necrosis occurred beyond an EQD2{sub cumulative} around 100 Gy. With increasing conformality of therapy, the smaller the treatment volume is, the higher the radiation dose that can be tolerated. Despite the dose escalation, no increase in late normal tissue toxicity was reported. On basis of our analysis, the use of particle therapy in the treatment of recurrent gliomas, because of the optimized physical dose distribution in the tumour and surrounding healthy brain tissue, should be considered for future clinical trials.

  16. The use of Monte-Carlo codes for treatment planning in external-beam radiotherapy

    International Nuclear Information System (INIS)

    Alan, E.; Nahum, PhD.

    2003-01-01

    Monte Carlo simulation of radiation transport is a very powerful technique. There are basically no exact solutions to the Boltzmann transport equation. Even, the 'straightforward' situation (in radiotherapy) of an electron beam depth-dose distribution in water proves to be too difficult for analytical methods without making gross approximations such as ignoring energy-loss straggling, large-angle single scattering and Bremsstrahlung production. monte Carlo is essential when radiation is transport from one medium into another. As the particle (be it a neutron, photon, electron, proton) crosses the boundary then a new set of interaction cross-sections is simply read in and the simulation continues as though the new medium were infinite until the next boundary is encountered. Radiotherapy involves directing a beam of megavoltage x rays or electrons (occasionally protons) at a very complex object, the human body. Monte Carlo simulation has proved in valuable at many stages of the process of accurately determining the distribution of absorbed dose in the patient. Some of these applications will be reviewed here. (Rogers and al 1990; Andreo 1991; Mackie 1990). (N.C.)

  17. External Beam Radiotherapy of Recurrent Glioma: Radiation Tolerance of the Human Brain

    Directory of Open Access Journals (Sweden)

    Peter Sminia

    2012-04-01

    Full Text Available Malignant gliomas relapse in close proximity to the resection site, which is the postoperatively irradiated volume. Studies on re-irradiation of glioma were examined regarding radiation-induced late adverse effects (i.e., brain tissue necrosis, to obtain information on the tolerance dose and treatment volume of normal human brain tissue. The studies were analyzed using the linear-quadratic model to express the re-irradiation tolerance in cumulative equivalent total doses when applied in 2 Gy fractions (EQD2cumulative. Analysis shows that the EQD2cumulative increases from conventional re-irradiation series to fractionated stereotactic radiotherapy (FSRT to LINAC-based stereotactic radiosurgery (SRS. The mean time interval between primary radiotherapy and the re-irradiation course was shortened from 30 months for conventional re-irradiation to 17 and 10 months for FSRT and SRS, respectively. Following conventional re-irradiation, radiation-induced normal brain tissue necrosis occurred beyond an EQD2cumulative around 100 Gy. With increasing conformality of therapy, the smaller the treatment volume is, the higher the radiation dose that can be tolerated. Despite the dose escalation, no increase in late normal tissue toxicity was reported. On basis of our analysis, the use of particle therapy in the treatment of recurrent gliomas, because of the optimized physical dose distribution in the tumour and surrounding healthy brain tissue, should be considered for future clinical trials.

  18. What is the value of Image guidance in external beam radiotherapy?

    International Nuclear Information System (INIS)

    Kron, Tomas

    2010-01-01

    Full text: Image guided radiation therapy (lGRT) has become available in many radiotherapy centres in Australia. It is intuitive that frequent imaging of the patient with a modality that identifies the target directly at the time of treatment delivery should benefit patients. However, TGRT is also associated with increased cost for equipment, associated training, quality assurance and imaging time. The Trans Tasman Radiation Oncology Group (TROG) has been contracted by the Australian Commonwealth Department of Health and Ageing (DoHA) to investigate a framework that could be applied to establish a cost/utility assessment of IGRT. The present work aims to develop a study that can test this for daily image guidance of prostate cancer patients. Approach Thirty intermediate risk prostate cancer patients treated at ten or more radiotherapy centres in Australia will be invited to participate. Their treatment as per local practice will not be modified; however two additional treatment plans will be created with margins that would reflect a typical margin appropriate for a treatment delivery with and without daily image guidance. Patients will be stratified for volumetric versus planar orthogonal imaging and for IMRT or conformal approaches. The outcome will be a comparison of dose volume histograms for critical structures based on equal target coverage in all plans.

  19. Minimal requirements for quality controls in radiotherapy with external beams; Controlli di qualita' essenziali in radioterapia con fasci esterni

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-07-01

    Physical dosimetric guidelines have been developed by the Italian National Institute of Health study group on quality assurance in radiotherapy to define protocols for quality controls in external beam radiotherapy. While the document does not determine strict rules or firm recommendations, it suggests minimal requirements for quality controls necessary to guarantee an adequate degree of accuracy in external beam radiotherapy. [Italian] Il gruppo di studio Assicurazione di qualita' in radioterapia dell'Istituto Superiore di Sanita' presenta le linee guida per la stesura dei protocolli di controllo di qualita' essenziali necessari a garantire un adeguato livello di accuratezza del trattamento radiante e rappresenta pertanto una parte essenziale del contributo fisico-dosimetrico globale di assicurazione di qualita' in radioterapia con fasci esterni.

  20. Successful treatment of a 67-year-old woman with urethral adenocarcinoma with the use of external beam radiotherapy and image guided adaptive interstitial brachytherapy

    DEFF Research Database (Denmark)

    Mujkanovic, Jasmin; Tanderup, Kari; Agerbæk, Mads

    2016-01-01

    Primary urethral cancer (PUC) is a very rare disease. This case report illustrates a successful treatment approach of a 67-year-old woman with a urethral adenocarcinoma selected for an organ preserving treatment with external beam radiotherapy (EBRT) and interstitial brachytherapy (BT) boost, using...

  1. External Beam Radiotherapy in the Management of Low Grade Astrocytoma of the Brain

    International Nuclear Information System (INIS)

    Jeon, Ha Jung

    2009-01-01

    This study was designed to evaluate the effectiveness of postoperative radiotherapy for patients with low-grade astrocytomas and to define an optimal radiotherapeutic regimen and prognostic factors. A total of 69 patients with low-grade astrocytomas underwent surgery and postoperative radiotherapy immediately following surgery at our institution between October 1989 and September 2006. The median patient age was 36 years. Forty-one patients were 40 years or younger and 28 patients were 41 years or older. Fourteen patients underwent a biopsy alone and the remaining 55 patients underwent a subtotal resection. Thirty-nine patients had a Karnofsky performance status of less than 80% and 30 patients had a Karnofsky performance status greater than 80%. Two patients were treated with whole brain irradiation followed by a coned down boost field to the localized area. The remaining 67 patients were treated with a localized field with an appropriate margin. Most of the patients received a dose of 50∼55 Gy and majority of the patients were treated with a dose of 54 Gy. The overall 5-year and 7-year survival rates for all of the 69 patients were 49% and 44%, respectively. Corresponding disease free survival rates were 45% and 40%, respectively. Patients who underwent a subtotal resection showed better survival than patients who underwent a biopsy alone. The overall 5-year survival rates for patients who underwent a subtotal resection and patients who underwent a biopsy alone were 57% and 38%, respectively (p<0.05). Forty-one patients who were 40 years or younger showed a better overall 5-year survival rate as compared with 28 patients who were 41 years or older (56% versus 40%, p<0.05). The overall 5-year survival rates for 30 patients with a Karnofsky performance status greater than 80% and 39 patients with a Karnofsky performance status less than 80% were 51% and 47%, respectively. This finding was not statistically significant. Although one patient was not able to

  2. External radiotherapy for circumscribed choroidal haemangiomas using a modified retinoblastoma technique

    International Nuclear Information System (INIS)

    Eide, N.; Syrdalen, P.; Tausjoe, J.; Tveraa, K.

    1995-01-01

    This report describes two cases of circumscribed choroidal haemangiomas involving the fovea, complicated by serous retinal detachment. Laser photocoagulation, generally accepted as the treatment of choice for choroidal haemangioma, was considered either to be of no visual benefit or a risk for jeopardizing vision further due to the subfoveolar lesions. Fractionated radiotherapy using a lens-sparing, modified retinoblastoma technique, was given, using circular fields of 15 mm diameter. The dose was 24 Gy in 8 fractions. In both eyes the retina reattached completely. The visual acuity improved markedly in the first, and was restored to the prior level in the second. Normalization of a high intraocular pressure was also achieved in the second case. We believe this method to be a reasonable and effective therapy for some choroidal haemangiomas after careful individual consideration. (au) 17 refs

  3. Nasopharyngeal carcinoma. Clinical diagnosis, external radiotherapy and brachytherapy. Status of the art in 2001

    International Nuclear Information System (INIS)

    Eschwege, F.; Bourkhis, J.; El Gueddari, B.

    2001-01-01

    Nasopharynx carcinomas (NPC) are a very special head and neck cancer, in term of epidemiology, clinic and pathology. Endemic disease in South East Asia, undifferentiated nasopharynx carcinoma are very frequent CT scan and NMR allow a better knowledge of the modalities of the clinical presentation. Prognostic factors include local and regional extension. NPC is a well known radiosensitive disease with a dose-response curve well established. Modern imaging modalities and modification of the ballistic explain the amelioration of the local control and the diminution of therapeutic sequelae. Brachytherapy is an interesting modalities for the boost and the treatment of recurrent disease. The exact place of 3 D CRT and IMRT is not yet known as modifications of fractionation. Local control for T1 T2 tumor is excellent but is related to clinical extension (cranial and neurologic involvement) and nodal extension (supra clavicular N3) and show the interest of combined chemo-radiotherapy protocols. (authors)

  4. Impact of Image Guidance on Outcomes After External Beam Radiotherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Kupelian, Patrick A.; Willoughby, Twyla R.; Reddy, Chandana A.; Klein, Eric A.; Mahadevan, Arul

    2008-01-01

    Purpose: To verify whether rectal distention at the time of planning impacts outcomes in patients with localized prostate cancer treated with daily image guidance. Methods and Materials: Between 1998 and 2002, a total of 488 prostate cancer patients were treated with intensity-modulated radiotherapy. The radiation dose was 70 Gy delivered at 2.5 Gy per fraction in all cases. All cases were treated with a 4-mm margin posteriorly. In all cases the total rectal volume documented on the CT scan was used for treatment planning. No special bowel preparation instructions were given, either for the simulation or the daily treatments. Before each daily treatment, alignment of the prostate was performed with the B-mode acquisition and targeting (BAT) transabdominal ultrasound system. The median follow-up for all 488 patients was 60 months (range, 24-96 months). Results: For all patients the biochemical relapse-free survival (bRFS) rate at 5 years was 86%. The 5-year bRFS rate for the rectal distention 3 , 50 to 3 , and ≥100 cm 3 groups was 90%, 83%, and 85%, respectively (p = 0.18). To adjust for other potential variables affecting bRFS rates, a multivariate time-to-failure analysis using the Cox proportional hazards model was performed. Rectal distention was not an independent predictor of biochemical failure on multivariate analysis (p = 0.80). Rectal distention was not a predictor of rectal or urinary toxicity. Conclusion: The use of daily image guidance eliminates errors such as rectal distention at the initial planning stage that can affect outcomes after radiotherapy for localized prostate cancer

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

    Science.gov (United States)

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

    2017-05-18

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

  6. Neoadjuvant hormonal therapy and external-beam radiotherapy versus external-beam irradiation alone for prostate cancer. A quality-of-life analysis

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, Michael; Piroth, Marc D.; Asadpour, Branka; Gagel, Bernd; Fischedick, Karin; Siluschek, Jaroslav; Kehl, Mareike; Krenkel, Barbara; Eble, Michael J. [RWTH Aachen (Germany). Dept. of Radiotherapy

    2009-02-15

    To evaluate the impact of neoadjuvant hormonal therapy (NHT) on quality of life after external-beam radiotherapy (EBRT) for prostate cancer. A group of 170 patients (85 with and 85 without NHT) has been surveyed prospectively before EBRT (70.2-72 Gy), at the last day of EBRT, a median time of 2 months and 15 months after EBRT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Pairs with and without NHT (median treatment time of 3.5 months before EBRT) were matched according to the respective planning target volume and prostate volume. Before EBRT, significantly lower urinary function/bother, sexual function and hormonal function/bother scores were found for patients with NHT. More than 1 year after EBRT, only sexual function scores remained lower. In a multivariate analysis, NHT and adjuvant hormonal therapy (HT) versus NHT only (hazard ratio 14; 95% confidence interval 2.7-183; p = 0.02) and luteinizing hormone-releasing hormone (LHRH) agonists versus antiandrogens (hazard ratio 3.6; 95% confidence interval 1.1-12; p = 0.04) proved to be independent risk factors for long-term erectile dysfunction (no or very poor ability to have an erection). With the exception of sexual function (additional adjuvant HT and application of LHRH analog independently adverse), short-term NHT was not found to decrease quality of life after EBRT for prostate cancer. (orig.)

  7. Real-Time Study of Prostate Intrafraction Motion During External Beam Radiotherapy With Daily Endorectal Balloon

    Energy Technology Data Exchange (ETDEWEB)

    Both, Stefan, E-mail: Stefan.Both@uphs.upenn.edu [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States); Wang, Ken Kang-Hsin; Plastaras, John P.; Deville, Curtiland; Bar Ad, Voika; Tochner, Zelig; Vapiwala, Neha [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)

    2011-12-01

    Purpose: To prospectively investigate intrafraction prostate motion during radiofrequency-guided prostate radiotherapy with implanted electromagnetic transponders when daily endorectal balloon (ERB) is used. Methods and Materials: Intrafraction prostate motion from 24 patients in 787 treatment sessions was evaluated based on three-dimensional (3D), lateral, cranial-caudal (CC), and anterior-posterior (AP) displacements. The mean percentage of time with 3D, lateral, CC, and AP prostate displacements >2, 3, 4, 5, 6, 7, 8, 9, and 10 mm in 1 minute intervals was calculated for up to 6 minutes of treatment time. Correlation between the mean percentage time with 3D prostate displacement >3 mm vs. treatment week was investigated. Results: The percentage of time with 3D prostate movement >2, 3, and 4 mm increased with elapsed treatment time (p < 0.05). Prostate movement >5 mm was independent of elapsed treatment time (p = 0.11). The overall mean time with prostate excursions >3 mm was 5%. Directional analysis showed negligible lateral prostate motion; AP and CC motion were comparable. The fraction of time with 3D prostate movement >3 mm did not depend on treatment week of (p > 0.05) over a 4-minute mean treatment time. Conclusions: Daily endorectal balloon consistently stabilizes the prostate, preventing clinically significant displacement (>5 mm). A 3-mm internal margin may sufficiently account for 95% of intrafraction prostate movement for up to 6 minutes of treatment time. Directional analysis suggests that the lateral internal margin could be further reduced to 2 mm.

  8. Survey of Stereotactic Body Radiation Therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group

    International Nuclear Information System (INIS)

    Nagata, Yasushi; Hiraoka, Masahiro; Mizowaki, Takashi; Narita, Yuichiro; Matsuo, Yukinori; Norihisa, Yoshiki; Onishi, Hiroshi; Shirato, Hiroki

    2009-01-01

    Purpose: To recognize the current status of stereotactic body radiotherapy (SBRT) in Japan, using a nationwide survey conducted by the Japan 3-D Conformal External Beam Radiotherapy Group. Methods and Materials: The questionnaire was sent by mail to 117 institutions. Ninety-four institutions (80%) responded by the end of November 2005. Fifty-three institutions indicated that they have already started SBRT, and 38 institutions had been reimbursed by insurance. Results: A total of 1111 patients with histologically confirmed lung cancer were treated. Among these patients, 637 had T1N0M0 and 272 had T2N0M0 lung cancer. Metastatic lung cancer was found in 702 and histologically unconfirmed lung tumor in 291 patients. Primary liver cancer was found in 207 and metastatic liver cancer in 76 patients. The most frequent schedule used for primary lung cancer was 48Gy in 4 fractions at 22 institutions (52%), followed by 50Gy in 5 fractions at 11 institutions (26%) and 60Gy in 8 fractions at 4 institutions (10%). The tendency was the same for metastatic lung cancer. The average number of personnel involved in SBRT was 1.8 radiation oncologists, including 1.1 certified radiation oncologists, 2.8 technologists, 0.7 nurses, and 0.6 certified quality assurance personnel and 0.3 physicists. The most frequent amount of time for treatment planning was 61-120min, for quality assurance was 50-60min, and for treatment was 30min. There were 14 (0.6% of all cases) reported Grade 5 complications: 11 cases of radiation pneumonitis, 2 cases of hemoptysis, and 1 case of radiation esophagitis. Conclusion: The current status of SBRT in Japan was surveyed.

  9. Technique of Injection of Hyaluronic Acid as a Prostatic Spacer and Fiducials Before Hypofractionated External Beam Radiotherapy for Prostate Cancer.

    Science.gov (United States)

    Boissier, Romain; Udrescu, Corina; Rebillard, Xavier; Terrier, Jean-Etienne; Faix, Antoine; Chapet, Olivier; Azria, David; Devonec, Marian; Paparel, Philippe; Ruffion, Alain

    2017-01-01

    To describe a technique combining the implantation of fiducials and a prostatic spacer (hyaluronic acid [HA]) to decrease the rectal toxicity after an image-guided external beam radiotherapy (EBRT) with hypofractionation for prostate cancer and to assess the tolerance and the learning curve of the procedure. Thirty patients with prostate cancer at low or intermediate risk were included in a phase II trial: image-guided EBRT of 62 Gy in 20 fractions of 3.1 Gy with intensity-modulated radiotherapy. A transrectal implantation of 3 fiducials and transperineal injection of 10 cc of HA (NASHA gel spacer, Q-Med AB, Uppsala, Sweden) between the rectum and the prostate was performed by 1 operator. The thickness of HA was measured at 10 points on magnetic resonance imaging to establish a quality score of the injection (maximum score = 10) and determine the learning curve of the procedure. The quality score increased from patients 1-10, 11-20, to 21-30 with respective median scores: 7 [2-10], 5 [4-7], and 8 [3-10]. The average thicknesses of HA between the base, middle part, and apex of the prostate and the rectum were the following: 15.1 mm [6.4-29], 9.8 mm [5-21.2], and 9.9 mm [3.2-21.5]. The injection of the HA induced a median pain score of 4 [1-8] and no residual pain at mid-long term. Creating an interface between the rectum and the prostate and the implantation of fiducials were feasible under local anesthesia with a short learning curve and could become a standard procedure before a hypofractionated EBRT for prostate cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Radical External Beam Radiotherapy for Clinically Localized Prostate Cancer in Japan: Changing Trends in the Patterns of Care Process Survey

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Kazuhiko, E-mail: kogawa@med.u-ryukyu.ac.jp [Department of Radiology, University of the Ryukyus, Okinawa (Japan); Nakamura, Katsumasa [Department of Clinical Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Sasaki, Tomonari [Department of Radiation Oncology, National Kyushu Center, Fukuoka (Japan); Onishi, Hiroshi [Department of Radiology, Yamanashi University, Yamanashi (Japan); Koizumi, Masahiko [Department of Radiation Oncology, Osaka University, Osaka (Japan); Araya, Masayuki [Department of Radiology, Yamanashi University, Yamanashi (Japan); Mukumoto, Nobutaka; Teshima, Teruki [Department of Medical Physics and Engineering, Osaka University, Osaka (Japan); Mitsumori, Michihide [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto (Japan)

    2011-12-01

    Purpose: To delineate changing trends in radical external beam radiotherapy (EBRT) for prostate cancer in Japan. Methods and Materials: Data from 841 patients with clinically localized prostate cancer treated with EBRT in the Japanese Patterns of Care Study (PCS) from 1996 to 2005 were analyzed. Results: Significant increases in the proportions of patients with stage T1 to T2 disease and decrease in prostate-specific antigen values were observed. Also, there were significant increases in the percentages of patients treated with radiotherapy by their own choice. Median radiation doses were 65.0 Gy and 68.4 Gy from 1996 to 1998 and from 1999 to 2001, respectively, increasing to 70 Gy from 2003 to 2005. Moreover, conformal therapy was more frequently used from 2003 to 2005 (84.9%) than from 1996 to 1998 (49.1%) and from 1999 to 2001 (50.2%). On the other hand, the percentage of patients receiving hormone therapy from 2003 to 2005 (81.1%) was almost the same as that from 1996 to 1998 (86.3%) and from 1999 to 2001 (89.7%). Compared with the PCS in the United States, patient characteristics and patterns of treatments from 2003 to 2005 have become more similar to those in the United States than those from 1996 to 1998 and those from 1999 to 2001. Conclusions: This study indicates a trend toward increasing numbers of patients with early-stage disease and increasing proportions of patients treated with higher radiation doses with advanced equipment among Japanese prostate cancer patients treated with EBRT during 1996 to 2005 survey periods. Patterns of care for prostate cancer in Japan are becoming more similar to those in the United States.

  11. Continuous or split-course combined external and intracavitary radiotherapy of locally advanced carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Pedersen, D.; Bentzen, S.M.; Overgaard, J.

    1994-01-01

    From 1974 to 1984, 442 consecutive patients with carcinoma of the uterine cervix (FIGO IIB: 139, IIIA: 10, IIIB: 221, IVA: 72) were referred for combined intracavitary (IRT) and external radiotherapy (ERT). To improve local control and reduce late rectosigmoid morbidity the treatment strategy was changed from continuous (CRT) to split-course radiotherapy (SCRT) in 1978. Stage by stage the 5-year actuarial estimates of survival, local control, and late morbidity did not differ in relation to strategy. In the patients with tumours larger than 8 cm, the SCRT involved an increased dose in point B, a reduced dose in point A from the IRT, a lower total dose in point A, and a 34 day's prolongation of the total treatment time (TTT). The resulting 5-year actuarial local control rates were significantly lower compared with those after CRT. No difference of late severe morbidity was found except in IVA patients. In the patients with tumours between 4 and 8 cm, the SCRT involved a reduced dose in point A from the IRT, an increased total dose in point A and B, and a 50 day's prolongation of the TTT. In patients with stage IIB, the 5-year actuarial central local control rate was lower (p=0.06), and the 5-year estimate of late severe morbidity significantly higher after SCRT compared with CRT. It is concluded that the increase of the dose in point B in the SCRT was insufficient to prevent the deleterious effect on local tumour control of either the lower dose from IRT in point A, or the prolonged TTT. The increase of the total dose in the SCRT may explain why the late morbidity was not reduced, and may suggest that the TTT is of no significant importance for the risk of late normal tissue damage. (orig.)

  12. Breast conserving surgery in combination with intraoperative radiotherapy after previous external beam therapy: an option to avoid mastectomy.

    Science.gov (United States)

    Thangarajah, F; Heilmann, J; Malter, W; Kunze, S; Marnitz, S; Mallmann, P; Wenz, F; Sperk, E

    2018-04-01

    Mastectomy is the standard procedure in patients with in-breast tumor recurrence (IBTR) or breast cancer after irradiation of the chest due to Hodgkin's disease. In certain cases a second breast conserving surgery (BCS) in combination with intraoperative radiotherapy (IORT) is possible. To date, data concerning BCS in combination with IORT in pre-irradiated patients are limited. This is the first pooled analysis of this special indication with a mature follow-up of 5 years. Patients with IBTR after external beam radiotherapy (EBRT; treated in two centers) for breast cancer were included. Patients with previous EBRT including the breast tissue due to other diseases were also included. IORT was performed with the Intrabeam™-device using low kV X-rays. Clinical data including outcome for all patients and toxicity for a representative cohort (LENT-SOMA scales) were obtained. Statistical analyses were done including Kaplan-Meier estimates for local recurrence, distant metastasis and overall survival. A total of 41 patients were identified (39 patients with IBTR, 2 with Hodgkin`s disease in previous medical history). Median follow-up was 58 months (range 4-170). No grade 3/4 acute toxicity occurred within 9 weeks. Local recurrence-free survival rate was 89.9% and overall survival was 82.7% at 5 years. Seven patients developed metastasis within the whole follow-up. BCS in combination with IORT in IBTR in pre-irradiated patients is a feasible method to avoid mastectomy with a low risk of side effects and an excellent local control and good overall survival.

  13. Endometrial cancers occurring 10 or more years after pelvic irradiation for carcinoma

    International Nuclear Information System (INIS)

    Rodriguez, J.; Hart, W.R.

    1982-01-01

    Fifteen patients who developed cancer of the endometrium 10 or more years after pelvic irradiation for carcinoma were selected for study from a group of 64 cases of postirradiation malignant pelvic tumors diagnosed during a 48-year span. The average interval between radiotherapy and diagnosis of the subsequent endometrial cancer was 17.2 years. Irradiation initially had been done for squamous cell carcinoma of the cervix in 13 cases (87%) and for ovarian tumors in two instances. Almost all patients had received megavoltage external radiation combined with radium implants. Two-thirds of the tumors were adenocarcinomas and one-third were carcinosarcomas (either homologous or heterologous). Although the risk of second primary malignant tumors following therapeutic irradiation for pelvic tumors probably is very low, the emergence of new genital tract cancers in long-term survivors must be anticipated, regardless of whether the postirradiation cancers are spontaneous or radiation-induced

  14. Perspectives in absorbed dose metrology with regard to the technical evolutions of external beam radiotherapy; Perspectives en metrologie de la dose face aux evolutions techniques de la radiotherapie externe

    Energy Technology Data Exchange (ETDEWEB)

    Chauvenet, B.; Bordy, J.M. [CEA Saclay, Lab. National Henri Becquerel (LNE-LNHB), 91 - Gif-sur-Yvette (France); Barthe, J. [CEA Saclay (LIST), 91 - Gif-sur-Yvette (France)

    2009-07-01

    This paper presents several R and D axes in absorbed close metrology to meet the needs resulting from the technical evolutions of external beam radiotherapy. The facilities in operation in France have considerably evolved under the impulse of the plan Cancer launched in 2003: replacements and increase of the number of accelerators, substitution of accelerators for telecobalt almost completed and acquisition of innovative facilities for tomo-therapy and stereotaxy. The increasing versatility of facilities makes possible the rapid evolution of treatment modalities, allowing to better delimit irradiation to tumoral tissues and spare surrounding healthy tissues and organs at risk. This leads to a better treatment efficacy through dose escalation. National metrology laboratories must offer responses adapted to the new need, i.e. not restrict themselves to the establishment of references under conventional conditions defined at international level, contribute to the improvement of uncertainties at all levels of reference transfer to practitioners: primary measurements under conditions as close as possible to those of treatment, characterization of transfer and treatment control dosimeters., metrological validation of treatment planning tools... Those axes have been identified as priorities for the next years in ionizing radiation metrology at the European level and included in the European. Metrology Research Programme. A project dealing with some of those topics has been selected in the frame of the Eranet+ Call EMRP 2007 and is now starting. The LNE-LAM is strongly engaged in it. (authors)

  15. Residual motion of lung tumors in end-of-inhale respiratory gated radiotherapy based on external surrogates

    International Nuclear Information System (INIS)

    Berbeco, Ross I.; Nishioka, Seiko; Shirato, Hiroki; Jiang, Steve B.

    2006-01-01

    It has been noted that some lung tumors exhibit large periodic motion due to respiration. To limit the amount of dose to healthy lung tissues, many clinics have begun gating radiotherapy treatment using externally placed surrogates. It has been observed by several institutions that the end-of-exhale (EOE) tumor position is more reproducible than other phases of the breathing cycle, so the gating window is often set there. From a treatment planning perspective, end-of-inhale (EOI) phase might be preferred for gating because the expanded lungs will further decrease the healthy tissue within the treatment field. We simulate gated treatment at the EOI phase, using a set of recently measured internal/external anatomy patient data. This paper attempts to answer three questions: (1) How much is the tumor residual motion when we use an external surrogate gating window at EOI? (2) How could we reduce the residual motion in the EOI gating window? (3) Is there a preference for amplitude- versus phase-based gating at EOI? We found that under free breathing conditions the residual motion of the tumors is much larger for EOI phase than for EOE phase. The mean values of residual motion at EOI were found to be 2.2 and 2.7 mm for amplitude- and phase-based gating, respectively, and, at EOE, 1.0 and 1.2 mm for amplitude- and phase-based gating, respectively. However, we note that the residual motion in the EOI gating window is correlated well with the reproducibility of the external surface position in the EOI phase. Using the results of a published breath-coaching study, we deduce that the residual motion of a lung tumor at EOI would approach that at EOE, with the same duty cycle (30%), under breath-coaching conditions. Additionally, we found that under these same conditions, phase-based gating approaches the same residual motion as amplitude-based gating, going from a 28% difference to 11%, for the patient with the largest difference between the two gating modalities. We conclude

  16. Phantom study of radiation doses outside the target volume brachytherapy versus external radiotherapy of early breast cancer

    International Nuclear Information System (INIS)

    Johansson, Bengt; Persson, Essie; Westman, Gunnar; Persliden, Jan

    2003-01-01

    Background and purpose: Brachytherapy is sometimes suggested as an adjuvant treatment after surgery of some tumours. When introducing this, it would be useful to have an estimate of the dose distribution to different body sites, both near and distant to target, comparing conventional external irradiation to brachytherapy. The aim of the present study was to determine radiation doses with both methods at different body sites, near and distant to target, in an experimental situation on an operated left sided breast cancer on a female Alderson phantom. Methods: Five external beam treatments with isocentric tangential fields were given by a linear accelerator. A specified dose of 1.0 Gy was given to the whole left sided breast volume. Five interstitial brachytherapy treatments were given to the upper, lateral quadrant of the left breast by a two plane, 10 needles implant. A dose of 1.0 Gy specified according to the Paris system was administered by a pulsed dose rate afterloading machine. Absorbed dose in different fixed dose points were measured by thermoluminescence dosimeters. Results: Both methods yielded an absorbed dose of the same size to the bone marrow and internal organs distant to target, 1.0-1.4% of the prescribed dose. There was a trend of lower doses to the lower half of the trunk and higher doses to the upper half of the trunk, respectively, by brachytherapy. A 90% reduction of absorbed dose with brachytherapy compared to external irradiation was found in the near-target region within 5 cm from target boundary where parts of the left lung and the heart are situated. If an adjuvant dose of 50 Gy is given with the external radiotherapy and brachytherapy, the absorbed dose in a part of the myocardium could be reduced from 31.8 to 2.1 Gy. Conclusions: Near target, brachytherapy yielded a considerably lower absorbed dose which is of special importance when considering radiation effects on the myocard and lungs. We could not demonstrate any difference of

  17. Infrastructure of radiation oncology in France: A large survey of evolution of external beam radiotherapy practice

    International Nuclear Information System (INIS)

    Ruggieri-Pignon, Sophie; Pignon, Thierry; Marty, Michel; Rodde-Dunet, Marie-Helene; Destembert, Brigitte; Fritsch, Beatrice

    2005-01-01

    Purpose: To study the structural characteristics of radiation oncology facilities for France and to examine how technological evolutions had to be taken into account in terms of accessibility and costs. This study was initiated by the three health care financing administrations that cover health care costs for the French population. The needs of the population in terms of the geographic distribution of the facilities were also investigated. The endpoint was to make proposals to enable an evolution of the practice of radiotherapy (RT) in France. Methods and materials: A survey designed by a multidisciplinary committee was distributed in all RT facilities to collect data on treatment machines, other equipment, personnel, new patients, and new treatments. Medical advisors ensured site visits in each facility. The data were validated at the regional level and aggregated at the national level for analysis. Results: A total of 357 machines had been installed in 179 facilities: 270 linear accelerators and 87 cobalt units. The distribution of facilities and megavoltage units per million inhabitants over the country was good, although some disparities existed between areas. It appeared that most megavoltage units had not benefited from technological innovation, because 25% of the cobalt units and 57% of the linear accelerators were between 6 and 15 years old. Computed tomography access for treatment preparation was not sufficient, and complete data management systems were scarce (15% of facilities). Seven centers had no treatment planning system. Electronic portal imaging devices were available in 44.7% of RT centers and in vivo dosimetry in 35%. A lack of physicians and medical physicists was observed; consequently, the workload exceeded the normal standard recommended by the French White Book. Discrepancies were found between the number of patients treated per machine per year in each area (range, 244.5-604). Most treatments were delivered in smaller facilities (61

  18. External beam radiotherapy boosted with high dose rate brachytherapy in completely resected uterine sarcomas. Is this a treatment option?

    Energy Technology Data Exchange (ETDEWEB)

    Pellizzon, Antonio Cassio Assis; Novaes, Paulo Eduardo Ribeiro dos Santos; Maia, Maria Aparecida Conte; Ferrigno, Robson; Fogarolli, Ricardo; Salvajoli, Joao Vitor [Hospital de Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Oncologia de Radiacao]. E-mail: pellizzon@aol.com

    2005-04-15

    Uterine sarcoma (US) is a relative rare tumor, which accounts for only about 3-5% of all uterine cancers. Aggressive cytoreductive surgery at the time of the initial diagnosis with maximum tumor debulking may lead to a prolonged survival or cure. Objective: to identify and review the role of adjuvant external beam radiation therapy (EBRT) associated with high dose rate brachytherapy (HDRB) in the management of patients presenting US with complete resection. Material and methods: this study is a retrospective analysis of 23 patients with US treated from 10/92 to 03/03, with surgery, external beam radiation therapy (EBRT) and high dose rate brachytherapy (HDRB). The inclusion criteria for study participation included: histologically proven and graded US, completely resection of tumor, Karnofsky status 60-100, absence of significant infection, and recovery from recent surgery. Results: The median age of patients was 62 years (range 39-84); ten-year actuarial disease-free and overall survivals were 42.2% and 63.4%, respectively. On univariate analysis, predictive factors for disease-free survival (DFS) were age at initial presentation (p=0.0268), parity (p=0.0441), tumor grade (p= 0.0095), cervical or vaginal invasion (p=0.0014) and node dissection at time of surgery (p= 0.0471). On multivariate analysis, the only predictive factor was cervical or vaginal invasion (p= 0.048), hazard ratio of 4.7. Conclusion: it is quite likely that neither radiotherapy nor chemotherapy alone will appreciably improve survival in US. If radiation therapy provides better locoregional tumor control, hematogenous metastases will assume an even greater proportion of treatment failures. Unfortunately, our small and heterogeneous group analyzed precludes any definitive conclusions about the impact of HDRB associated to EBRT radiation therapy on recurrence or survival. (author)

  19. External beam radiotherapy boosted with high dose rate brachytherapy in completely resected uterine sarcomas. Is this a treatment option?

    International Nuclear Information System (INIS)

    Pellizzon, Antonio Cassio Assis; Novaes, Paulo Eduardo Ribeiro dos Santos; Maia, Maria Aparecida Conte; Ferrigno, Robson; Fogarolli, Ricardo; Salvajoli, Joao Vitor

    2005-01-01

    Uterine sarcoma (US) is a relative rare tumor, which accounts for only about 3-5% of all uterine cancers. Aggressive cytoreductive surgery at the time of the initial diagnosis with maximum tumor debulking may lead to a prolonged survival or cure. Objective: to identify and review the role of adjuvant external beam radiation therapy (EBRT) associated with high dose rate brachytherapy (HDRB) in the management of patients presenting US with complete resection. Material and methods: this study is a retrospective analysis of 23 patients with US treated from 10/92 to 03/03, with surgery, external beam radiation therapy (EBRT) and high dose rate brachytherapy (HDRB). The inclusion criteria for study participation included: histologically proven and graded US, completely resection of tumor, Karnofsky status 60-100, absence of significant infection, and recovery from recent surgery. Results: The median age of patients was 62 years (range 39-84); ten-year actuarial disease-free and overall survivals were 42.2% and 63.4%, respectively. On univariate analysis, predictive factors for disease-free survival (DFS) were age at initial presentation (p=0.0268), parity (p=0.0441), tumor grade (p= 0.0095), cervical or vaginal invasion (p=0.0014) and node dissection at time of surgery (p= 0.0471). On multivariate analysis, the only predictive factor was cervical or vaginal invasion (p= 0.048), hazard ratio of 4.7. Conclusion: it is quite likely that neither radiotherapy nor chemotherapy alone will appreciably improve survival in US. If radiation therapy provides better locoregional tumor control, hematogenous metastases will assume an even greater proportion of treatment failures. Unfortunately, our small and heterogeneous group analyzed precludes any definitive conclusions about the impact of HDRB associated to EBRT radiation therapy on recurrence or survival. (author)

  20. Digital test objects (D.T.O.) for treatment planning systems quality control in external beam radiotherapy

    International Nuclear Information System (INIS)

    Denis, E.

    2008-04-01

    This work presents the conception and implementation of new automatic and quantitative quality assessment methods for geometric treatment planning in external radiotherapy. Treatment planning Systems (T.P.S.) quality control is mandatory in France and in the world because of encountered risks but the physical tools recommended to lead this quality control are not adapted to the situation. We present a new methodology for control quality based on the definition of Digital Test Objects (D.T.O.) that are directly introduced in the T.P.S. without acquisition device. These D.T.O. are consistently defined in a continuous and discrete modes. The T.P.S. responses to input D.T.O. are compared to theoretical results thanks to figures of merit specifically designed for each elementary control. The tests we carried out during this study allow to validate our solutions for the quality assessment of the auto-contouring, auto-margining, isocenter computation, collimator conformation and digitally reconstructed radiograph generation tools, as well as our solutions for marker positioning, collimator and displayed bean rotation, incidence, divergence and dimensions. Quality assessment solutions we propose are then fast and effective (no acquisition by the device, reduced manipulations), and more precise thanks to the continuous-discrete equivalence realized at the beginning of the modelling

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

    Science.gov (United States)

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

    2017-07-01

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

  2. The effect of external beam radiotherapy volume on locoregional control in patients with locoregionally advanced or recurrent nonanaplastic thyroid cancer

    International Nuclear Information System (INIS)

    Kim, Tae Hyun; Kim, Sang Soo; Cho, Kwan Ho; Shin, Kyung Hwan; Chung, Ki-Wook; Lee, You Jin; Park, Chan Sung; Lee, Eun Kyung; Kim, Tae Sung; Kim, Seok Ki; Jung, Yoo Seok; Ryu, Jun Sun

    2010-01-01

    We evaluated outcomes of patients treated with external beam radiotherapy (EBRT) for locoregionally advanced or recurrent nonanaplastic thyroid cancer and analyzed the effect of EBRT volume on locoregional control. This study included 23 patients with locoregionally advanced or recurrent nonanaplastic thyroid cancer who were treated with EBRT. Two different EBRT target volumes were executed as follows: 1) limited field (LF, n = 11) included the primary (involved lobe) or recurrent tumor bed and the positive nodal area; 2) elective field (EF, n = 12) included the primary (involved lobe) or recurrent tumor bed and the regional nodal areas in the cervical neck and upper mediastinum. Clinical parameters, such as gender, age, histologic type, recurrence, stage, thyroglobulin level, postoperative residuum, radioiodine treatment, and EBRT volume were analyzed to identify prognostic factors associated with locoregional control. There were no significant differences in the clinical parameter distributions between the LF and EF groups. In the LF group, six (55%) patients developed locoregional recurrence and three (27%) developed distant metastasis. In the EF group, one (8%) patient developed locoregional recurrence and one (8%) developed a distant metastasis. There was a significant difference in locoregional control rate at 5 years in the LF and EF groups (40% vs. 89%, p = 0.041). There were no significant differences in incidences of acute and late toxicities between two groups (p >0.05). EBRT with EF provided significantly better locoregional control than that of LF; however, further larger scaled studies are warranted

  3. The management of carcinoma of the anal canal by external beam radiotherapy, experience in Vancouver 1971-1988

    International Nuclear Information System (INIS)

    Newman, G.; Calverley, D.C.; Acker, B.D.; Manji, M.; Hay, J.; Flores, A.D.

    1992-01-01

    From 1971 to 1988 72 cases of carcinoma of the anal canal were treated by external beam radiotherapy, most commonly by 5000 cGy in 20 fractions given over 4 weeks. The actuarial survival at 5 years was 66% and the disease specific survival 78%. Nine patients had inguinal node metastases at diagnosis; their 5-year disease specific survival was 75%. 63 Patients were inguinal node negative at presentation; their 5-year specific survival was 78%, by UICC 1987 staging: T 1 71%, T 2 88%, T 3 41%, T 4 42%. 17 Patients developed local recurrence; 10 were suitable for abdominoperineal resection which was successful in 7. The probability of local control was related to T stage. 13 patients were left with a colostomy because of recurrence, 2 had a colostomy for radiation damage and 4 had their local recurrence managed palliatively, without a colostomy. As a result, 53 of the 72 patients (74%) were left with a functional anus. Severe late complications occurred in 6 (8%). (author). 13 refs., 3 figs., 7 tabs

  4. The management of carcinoma of the anal canal by external beam radiotherapy, experience in Vancouver 1971-1988

    Energy Technology Data Exchange (ETDEWEB)

    Newman, G. (Bristol Oncology Centre (United Kingdom)); Calverley, D.C.; Acker, B.D.; Manji, M.; Hay, J.; Flores, A.D. (British Columbia Cancer Inst., Vancouver, BC (Canada))

    1992-11-01

    From 1971 to 1988 72 cases of carcinoma of the anal canal were treated by external beam radiotherapy, most commonly by 5000 cGy in 20 fractions given over 4 weeks. The actuarial survival at 5 years was 66% and the disease specific survival 78%. Nine patients had inguinal node metastases at diagnosis; their 5-year disease specific survival was 75%. 63 Patients were inguinal node negative at presentation; their 5-year specific survival was 78%, by UICC 1987 staging: T[sub 1] 71%, T[sub 2] 88%, T[sub 3] 41%, T[sub 4] 42%. 17 Patients developed local recurrence; 10 were suitable for abdominoperineal resection which was successful in 7. The probability of local control was related to T stage. 13 patients were left with a colostomy because of recurrence, 2 had a colostomy for radiation damage and 4 had their local recurrence managed palliatively, without a colostomy. As a result, 53 of the 72 patients (74%) were left with a functional anus. Severe late complications occurred in 6 (8%). (author). 13 refs., 3 figs., 7 tabs.

  5. Comparison between external beam radiotherapy (70 Gy/74 Gy) and permanent interstitial brachytherapy in 890 intermediate risk prostate cancer patients

    International Nuclear Information System (INIS)

    Goldner, Gregor; Pötter, Richard; Battermann, Jan J.; Kirisits, Christian; Schmid, Maximilian P.; Sljivic, Samir; Vulpen, Marco van

    2012-01-01

    <