External beam radiotherapy alone in advanced esophageal cancer

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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

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)

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.

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

Prostatic cancer: intolerance and morbidity of external radiotherapy

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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

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

External beam radiotherapy for unresectable pancreatic cancer

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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).

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

Combined external beam and intraluminal radiotherapy for irresectable Klatskin tumors

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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

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

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

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)

Simulation and radiation treatment in external radiotherapy

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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).

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

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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.)

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.

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)

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.

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

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

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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.

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)

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)

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

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

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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)

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

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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)

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

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...

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.

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)

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

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

Postoperative radiotherapy of uterine sarcoma: A multicentric retrospective study; Radiotherapie postoperatoire dans les sarcomes uterins: etude retrospective multicentrique

Energy Technology Data Exchange (ETDEWEB)

Champetier, C.; Cowen, D. [Service de radiotherapie, hopital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05 (France); Hannoun-Levi, J.M. [Centre Antoine-Lacassagne, 33, avenue Valombrose, 06100 Nice (France); Resbeut, M. [Centre de radiotherapie Saint-Louis, rue Andre-Blondel, 83100 Toulon (France); Azria, D. [Centre Val-d' Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5 (France); Salem, N. [Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille (France); Tessier, E. [Centre azureen de radiotherapie, 1, place du Docteur-Jean-Luc-Broquerie, 06250 Mougins (France); Ellis, S. [Centre catalan de radiotherapie, 80, rue Pascal-Marie-Agasse, 66000 Perpignan (France)

2011-04-15

Purpose. - Surgery is the treatment of choice for localized uterine sarcomas. We conducted a retrospective study to define prognostic factors. Patients and methods. - We studied 111 cases of patients treated by adjuvant radiotherapy for uterine sarcoma in seven French centers. The median decline was 31 months. We conducted a univariate analysis to identify factors correlated with local recurrence. The statistically significant factors were studied in multivariate analysis by Cox model. Results. - The median dose of external beam radiotherapy was 45 Gy. Forty-three percent of patients had vaginal vault brachytherapy and 21 % chemotherapy. Only 6.3 % of patients had complications of acute grade III and 8.1 % of long-term sequelae of radiotherapy. The survival rate at 5 years was 74.6 %. They noted 12.6 % of isolated locoregional recurrences, against 29.7 % for distant recurrences, 80 % were pulmonary. Factors correlated with the risk of locoregional relapse were menopausal status (P = 0.045) and surgical margins suspicious or not healthy (P = 0.0095). The chemotherapy did not improve overall survival or disease free survival but the numbers were low. Conclusion. - The postoperative radiotherapy provides good local control in this disease. Brachytherapy is sometimes done, but it does not improve local control. Chemotherapy is not a standard localized stage but the rate of metastatic recurrence calls for the development of strategies involving systemic treatment with radiotherapy. (authors)

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

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)

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

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.

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

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

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

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

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.

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)

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)

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.

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.

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.

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

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)

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.)

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

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.)

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

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.)

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.)

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)

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.

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.

A consensus-based guideline defining clinical target volume for primary disease in external beam radiotherapy for intact uterine cervical cancer

International Nuclear Information System (INIS)

Toita, Takafumi; Ohno, Tatsuya; Kaneyasu, Yuko

2011-01-01

The objective of this study was to develop a consensus-based guideline to define clinical target volume for primary disease (clinical target volume primary) in external beam radiotherapy for intact uterine cervical cancer. The working subgroup of the Japan Clinical Oncology Group (JCOG) Radiation Therapy Study Group began developing a guideline for primary clinical target volume in November 2009. The group consisted of 10 radiation oncologists and 2 gynecologic oncologists. The process started with comparing the contouring on computed tomographic images of actual cervical cancer cases among the members. This was followed by a comprehensive literature review that included primary research articles and textbooks as well as information on surgical procedures. Extensive discussion occurred in face-to-face meetings (three occasions) and frequent e-mail communications until a consensus was reached. The working subgroup reached a consensus on the definition for the clinical target volume primary. The clinical target volume primary consists of the gross tumor volume, uterine cervix, uterine corpus, parametrium, vagina and ovaries. Definitions for these component structures were determined. Anatomical boundaries in all directions were defined for the parametrium. Examples delineating these boundaries were prepared for the posterior border of the parametrium for various clinical situations (id est (i.e.) central tumor bulk, degree of parametrial involvement). A consensus-based guideline defining the clinical target volume primary was developed for external beam radiotherapy for intact uterine cervical cancer. This guideline will serve as a template for radiotherapy protocols in future clinical trials. It may also be used in actual clinical practice in the setting of highly precise external beam radiotherapy, including intensity-modulated radiotherapy. (author)

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.

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)

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.

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

DEFF Research Database (Denmark)

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

2014-01-01

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

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

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

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)

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

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

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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

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.

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

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

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

Radiotherapy in bladder cancer

International Nuclear Information System (INIS)

Rozan, R.

1992-01-01

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

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.)

Historical review of radiotherapy

International Nuclear Information System (INIS)

Onai, Yoshio

1993-01-01

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

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

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

High-dose rate fractionated interstitial radiotherapy for oropharyngeal carcinoma

Energy Technology Data Exchange (ETDEWEB)

Nose, Takayuki; Inoue, Toshihiko; Inoue, Takehiro; Teshima, Teruki; Murayama, Shigeyuki [Osaka Univ. (Japan). Faculty of Medicine

1995-03-01

The limitations of treating oropharyngeal cancer patients with definitive external radiotherapy are the complications of salivary glands, taste buds, mandible and temporomandibular joints. To avoid these complications we started interstitial radiotherapy as boost after 46 Gy of external radiotherapy. Ten cases (retromolar trigone; 1, soft palate; 1, base of tongue; 3, lateral wall; 5) were treated with this method and seven cases were controlled locally. With short follow-up period, xerostomia and dysgeusia are less than definitive external radiotherapy as clinical impression and no in-field recurrences have been experienced. With markedly increased tumor dose, the local control rate can be improved. This treatment method will be an alternative to definitive external radiotherapy to gain better QOL and higher control rate. (author).

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

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

Evaluation of radiotherapy and chemotherapy treatment in patients of oral squamous cell carcinoma

International Nuclear Information System (INIS)

Sannomiya, Eduardo Kazuo; Medici Filho, Edmundo; Moraes, Luiz Cesar de; Castilho, Julio Cezar de Melo; Furukawa, Souhei

2003-01-01

We evaluated the effectiveness of radiotherapy combined with chemotherapy in patients with oral squamous cell carcinoma. Therefore, 1042 cases where reviewed in School Dentistry - Osaka Univ. Seven hundred and fifteen were male and three hundred and twenty-seven were female. Ora cancer was affected more male than female patients, with mean age of 582 years old. The tongue was the most common anatomic localization of oral cancer. In tongue, the use of external radiotherapy y combined with brachytherapy and brachytherapy isolated presented better results than chemotherapy combined with external radiotherapy. In buccal mucosa, there was not differences in the treatment's results using external radiotherapy and combined chemotherapy and external radiotherapy. In tongue's floor and upper and jaw gingiva the combined treatment with chemotherapy and external radiotherapy presented better results than isolated external radiotherapy. (author)

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

Intraoperative radiotherapy in breast cancer: literature review

International Nuclear Information System (INIS)

Alfaro Hidalgo, Sabrina A.

2013-01-01

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

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

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.

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)

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

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-12-15

conference concluded with a roundtable discussion on patient information. All the available presentations, documents and posters are compiled in this document which starts with a report summarising the presentations and the main findings from the conference. 40 presentations (slides) are compiled in this document: 1 - Advances in external radiotherapy (M. Brada, Institute of Cancer Research, Royal Marsden Hospital UK); 2 - Advances in brachytherapy (D. Peiffert, Alexis Vautrin center, Nancy); 3 - The impact of new technologies on the risk of accident (R. Almaberti, HAS); 4 - What is a side effect, a complication or an accident in radiotherapy? (P. Scalliet, University hospital St Luc, Belgium); 5 - The range of radiosensitivity in the human population: hyper- and hypo- sensitivity (S. Bouffler, HPA UK) 6 - Radiation-induced sequelae: toward an individual profile (D. Azria, CRLC Val d'Aurelle, France); 7 - Evaluation and management of secondary cancer risk in modern Radiation Therapy: elaboration of an ICRP/ICRU publication (J.M. Cosset, Curie Institute - ICRP); 8 - Cardiovascular risks in radiotherapy (K. Trott, University College London Institute UK); 9 - Risk acceptability in radiotherapy; 10 - Lessons learned from accidents in conventional external radiotherapy; 11 - Lessons learned from accidental exposures in modern external radiotherapy (P. Ortiz Lopez, ICRP); 12 - Lessons learned from accidents in brachytherapy; 13 - Lessons learned from French accidents; 14-15 - WHO Radiotherapy risk profile; 16 - Methods of risk analysis applied to radiotherapy; 17 - Radiation safety issues linked to the omnipresence of computers; 18 - From Airline Safety Management System to Security in Radiotherapy:a French experience; 19 - Accident reporting system; the Rosis experience; 20 - Side effects of radiotherapy: general management; 21 - Cell therapy treatment for radiation induced cutaneous damage; 22 - The Equipment: safety, commissioning, re-commissioning - calibration, A medical

Perawatan Kandidiasis Pseuodomembran Akut dan Mukositis Oral pada Penderita Kanker Nasofaring yang Menerima Khemoterapi dan Radioterapi

Directory of Open Access Journals (Sweden)

S. Supriatno

2016-10-01

Full Text Available Latar belakang: Terapi radiasi merupakan metode primer perawatan pasien kanker leher dan kepala. Perubahan funsional dan kerusakan jaringan oral menyebabkan timbulnya mukositia oral yang diikuti dengan kandidiasis oral. Tujuan: Melaporkan efek samping perawatan khemoterapi dan radioterapi pada pasien kanker nasofaring yang terjadi di rongga mulut berupa kandidiasis pseudomembran akut dan mukositis oral serta penatalaksanaannya. Kasus: Seorang laki-laki, 69 tahun, datang ke Bagian Gigi dan Mulut RSUP Dr. Sardjito, atas rujukan dari instalasi Penyakit Dalam., RSUP Dr. Sardjito, dengan keluhan sakit untuk menelan makanan dan mulutnya banyak bercak-bercak putih. Keluhan dirasakan satu minggu setelah dilakukan khemoterapi ke-3 dan radioterapi ke-9. Pasien didiagnosa kanker nasofaring (NPC dengan klasifikasi T2N3M0. Pemeriksaan klinik menunjukkan adanya lapisan putih pada mukosa lidah, pipi, palatum, dan mukosa bibir. Seluruh mukosa mulut berwarna merah tua dan terdapat anguler cheilitis di kedua sudut bibir. Pasien diklasifikasikan menderita mukositis oral derajat 1. Penatalaksanaan: Menghilangkan jaringan nekrotik dan debris dengan berkumur larutan perhidrol 3% dan pemberian medikasi termasuk tablet nistatin 500.000 IU, betadin kumur, dan larutan perhidrol 3% selama 1 minggu. Saat reevaluasi, pasien sudah dapat menelan dan makan yang sedikit keras tanpa ada rasa sakit lagi. Pemeriksaan klinis didapatkan bercak putih di lidah, palatum, pipi dan bibir sudah tidak ada. Warna mukosa oral telah normal, OHI dan kondisi umum baik dalam 1 minggu pasca perawatan. Kesimpulan: Perawatan kandidiasis dan mukositis oral akibat kemoradioterapi pada pasien kanker nasofaring telah berhasil dan kondisi oral membaik. Pasien dapat mengunyah dan menelan makanan tanpa ada rasa sakit, dan hasil pengobatan yang diberikan pada pasien sesuai dengan harapan operator.   Background: Radiation therapy remains the primary method of treatment for patients with head and neck

Can All Centers Plan Intensity-Modulated Radiotherapy (IMRT) Effectively? An External Audit of Dosimetric Comparisons Between Three-Dimensional Conformal Radiotherapy and IMRT for Adjuvant Chemoradiation for Gastric Cancer

International Nuclear Information System (INIS)

Chung, Hans T.; Lee, Brian; Park, Eileen; Lu, Jiade J.; Xia Ping

2008-01-01

Purpose: To compare dosimetric endpoints between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) at our center with limited IMRT experience, and to perform an external audit of the IMRT plans. Methods and Materials: Ten patients, who received adjuvant chemoradiation for gastric cancer, formed the study cohort. For standardization, the planning target volume (PTV) and organs at risk were recontoured with the assistance of a study protocol radiologic atlas. The cohort was replanned with CMS Xio to generate coplanar 3D-CRT and IMRT plans. All 10 datasets, including volumes but without the plans (i.e., blinded), were transmitted to an experienced center where IMRT plans were designed using Nomos Corvus (IMRT-C) and ADAC Pinnacle (IMRT-P). All IMRT plans were normalized to D95% receiving 45 Gy. Results: Intensity-modulated radiotherapy yielded higher PTV V45 (volume that receives ≥45 Gy) (p < 0.001) than 3D-CRT. No difference in V20 was seen in the right (p = 0.9) and left (p 0.3) kidneys, but the liver mean dose (p < 0.001) was superior with IMRT. For the external audit, IMRT-C (p = 0.002) and IMRT-P (p < 0.001) achieved significantly lower left kidney V20 than IMRT, and IMRT-P (p < 0.001) achieved lower right kidney V20 than IMRT. The IMRT-C (p = 0.003) but not IMRT-P (p = 0.6) had lower liver mean doses than IMRT. Conclusions: At our institution with early IMRT experience, IMRT improved PTV dose coverage and liver doses but not kidney doses. An external audit of IMRT plans showed that an experienced center can yield superior IMRT plans

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)

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

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

To understand radiotherapy

International Nuclear Information System (INIS)

2009-01-01

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

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.

Radiotherapy in digestive tumours in elderly patients; Radiotherapie dans les tumeurs digestives chez le patient age

Energy Technology Data Exchange (ETDEWEB)

Guillerme, F.; Clavier, J.B.; Nehme-Schuster, H.; Schumacher, C.; Noel, G. [Centre de lutte contre le cancer Paul-Strauss, Strasbourg (France)

2011-10-15

The authors comment the taking into care of a digestive cancer in the case of elderly patient. These patients are treated by radiotherapy, operative radiotherapy with concomitant chemotherapy, or pre-operative radiotherapy, depending on the age, on the cancer type, with an adaptation of the total dose or with a hypo-fractionation of the treatment. Short communication

The Role of Radiotherapy in the Treatment of Extrahepatic Bile Duct Carcinoma

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Shin, Hyun Soo; Kim, Gwi Eon; Lee, Hyung Sik; Suh, Chang Ok; Loh, John Ku; Lee, Jong Tae [Yonsei National University College of Medicine, Seoul (Korea, Republic of)

1991-12-15

Twenty-seven patients with unresectable extrahepatic bile duct carcinoma (n=21) or with microscopic evidence of tumor rest after aggressive surgery for extrahepatic bile duct carcinoma(n=6) between 1985 and 1990 were given radiotherapy consisting intentionally external radiotherapy and /or intraluminal therapy using Gamma-Med 12i (192-lr) high dose rate (HDR) remote control afterloading system following bile drainage procedures and Gianturco stent insertion. The objectives of this study has been to assess the feasibility and effects on survival of a combination of external radiotherapy and brachytherapy with which we hope to achieve optimal loco-regional control for patients with unresectable extrahepatic bile duct tumors. Sixteen patients were men and eleven were women, and the mean age was 58 years (34-70 ). 10MV X-ray was used for radiation therapy, with the total dose ranging from 45 Gy to 55 Gy, and intraluminal brachytherapy performed after external radiotherapy, with the dose of total 15 Gy. The minimum follow up was 12 months. Failure were predominantly local-regional, without distant failure. Median survival was 10 months; 2-year actuarial survival rates was 21%. Median survival for common hepatic duct(CHD) cancer was 9 months; for common bile duct (CBD) cancer, was 16 months. And median survival for incomplete surgery/external radiotherapy group and external/intraluminal radiotherapy group was 10 months; for external radiotherapy alone group, was 6 months. Use of chemotherapy and/or hyperthermia were not affected in survival. Therefore, our result is that the survival rates in the group of external/intraluminal radiotherapy were comparable with ones in the group of incomplete resection/external radiotherapy, and so we believe that the aggressive local and regional radiotherapy can improve the quality of life and the survival length.

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

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.

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.

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

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

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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.

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

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

Non small cells stage I bronchial cancers: three-dimensional radiotherapy and radiotherapy in stereotactic conditions; Cancers bronchiques non a petites cellules de stade I: radiotherapie tridimensionnelle et radiotherapie en conditions stereotaxiques

Energy Technology Data Exchange (ETDEWEB)

Schipman, B.; Bosset, J.F. [CHU, 25 - Besancon (France); Marchesi, V.; Beckendorf, V.; Desandes, E.; Peiffert, D. [CRLCC Alexis-Vautrin, 54 - Vandaeuvre-les-Nancy (France); Bosset, M. [CHU, 26 - Valence (France)

2010-10-15

The authors report a comparison between three-dimensional conformation radiotherapy and robotic irradiation in stereotactic conditions (with CyberKnife) for patients suffering from a bronchial cancer with no small cells of stage I. Acute and late toxicity have been recorded, and the monitoring comprised a clinic examination and a thoracic scanography. The external radiotherapy results in an important local control rate and an acceptable toxicity. Some prospective studies are still needed to compare three-dimensional conformation respiratory-gated radiotherapy and radiotherapy in stereotactic conditions. Short communication

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

Nanoparticle-guided radiotherapy

DEFF Research Database (Denmark)

2012-01-01

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

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...

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)

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.

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

PERGESERAN KARIR TRADISIONAL MENJADI KARIR PROTEAN: DAMPAK DAN IMPLIKASINYA PADA INDIVIDU DAN PERUSAHAAN

Directory of Open Access Journals (Sweden)

Christofera Marliana Junaedi

2003-01-01

Full Text Available It was started by The Great Depression in America that so many changes happened on the organization internally and externally, and the change of career development from career job to protean career as well. Some researchers prove it and state that the job esspecially for career nowadays is different from it was few decades ago. The effect of this changes occur on the system and value that employees have and career development management conducted by the company. This article will discuss the change factor of company internally and externally, its effects,the subtitution of the new paradigm from the old one, and also its implications on the individu and the company. Abstract in Bahasa Indonesia : Berawal dari terjadinya depresi yang besar (The Great Depression di Amerika yang menyebabkan perubahan organisasi secara internal dan eksternal, perubahan pengembangan karir pun bergeser dari karir tradisional menjadi karir protean. Banyak peneliti yang membuktikannya dan menyatakan bahwa karir saat ini berbeda dengan beberapa decade sebelumnya. Dampak dari perubahan ini tentu saja menimbulkan sistem dan nilai yang dimiliki karyawan dan juga manajemen pengembangan karir perusahaan. Artikel ini akan membahas tentang perubahan factor internal dan eksternal organisasi, dampaknya pada perubahan paradigma dari paradigma lama menjadi baru, dan juga implikasinya pada individu dan perusahaan. Kata kunci: karir tradisional, karir protean, paradigma lama, paradigma baru, manajemen karir.

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

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)

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

Radiotherapy and skin tumors; Radiotherapie et tumeurs curanees

Energy Technology Data Exchange (ETDEWEB)

Calitchi, E.; KIrova, Y.; Le bourgeois, J.P. [Hopital Henri-Mondor, 94 - Creteil (France)

1998-09-01

Radiotherapy plays an important role in treatment of skin tumours. For skin carcinomas, external irradiation (kilo-voltage X-rays or electrons according to clinical characteristics) is more valuable than interstitial brachytherapy, which is recommended for tumours of the lip and of the nasal vestibule. In mycosis fungoides, total cutaneous electron beam radiation therapy is efficient for patients with limited superficial plaques. In the classical form of Kaposi`s sarcoma, radiotherapy can achieve local control-whereas it obtains good palliative results in the epidemic form. (author)

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.

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

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

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

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

The effect of aerobic exercise on treatment-related acute toxicity in men receiving radical external beam radiotherapy for localised prostate cancer.

Science.gov (United States)

Kapur, G; Windsor, P M; McCowan, C

2010-09-01

We retrospectively analysed acute radiation toxicity data for patients who had participated in a randomised controlled study in our centre in order to assess the impact of aerobic exercise on acute rectal and bladder morbidity during treatment. Data from 65 of 66 patients were analysed: 33 allocated into a control group (standard advice) and 33 into an exercise group (aerobic walking for 30 min at least three times per week) during 4 weeks of external beam radiotherapy; one patient in the exercise group withdrew after randomisation before starting radiotherapy. There was a trend towards less severe acute rectal toxicity in the exercise group with a statistically significant difference in mean toxicity scores over the 4 weeks of radiotherapy (P=0.004), with no significant difference in bladder toxicity scores between the two groups (P=0.123). The lack of an association for severity of bladder toxicity could be attributed to the confounding effect of lower urinary tract symptoms from their prostate cancer. Keeping active and being asked to adhere to a well-defined exercise schedule appears to reduce the severity of rectal toxicity during radiotherapy to the prostate.

Phase I study of twice-weekly gemcitabine and concomitant external-beam radiotherapy in patients with adenocarcinoma of the pancreas

International Nuclear Information System (INIS)

Pipas, J. Marc; Mitchell, Sandra E.; Barth, Richard J.; Vera-Gimon, Raul; Rathmann, Joerg; Meyer, Louise P.; Wagman, Richard S.; Lewis, Lionel D.; McDonnell, Carol; Colacchio, Thomas A.; Perez, Raymond P.

2001-01-01

Purpose: To determine the maximum tolerated dose and dose-limiting toxicity associated with twice-weekly gemcitabine and concomitant external-beam radiotherapy in patients with adenocarcinoma of the pancreas. Methods and Materials: Twenty-one patients with biopsy-proven adenocarcinoma of the pancreas were treated with external-beam radiotherapy to a dose of 50.4 Gy in 28 fractions, concurrent with gemcitabine, infused over 30 min before irradiation on a Monday and Thursday schedule. The dose of gemcitabine was escalated in 5 cohorts of 3-6 patients each. Initial gemcitabine dose was 10 mg/m 2 , with dose escalation until dose-limiting toxicity was observed. Results: The maximum tolerated dose of gemcitabine was 50 mg/m 2 , when given in a twice-weekly schedule with radiation. Dose-limiting toxicity was seen in 2 patients at 60 mg/m 2 , and consisted of severe upper gastrointestinal bleeding approximately 1 month after completion of treatment. Six patients had radiographic evidence of response to treatment, and 5 of these underwent complete surgical resection. Three patients who underwent complete resection had been deemed to have unresectable tumors before enrollment on trial. Four patients are alive, including 2 without evidence of disease more than 1 year after resection. Conclusion: The combination of external-beam radiation and twice-weekly gemcitabine at a dose of 50 mg/m 2 is well tolerated and shows promising activity for the treatment of pancreatic cancer. Our data suggest a higher maximum tolerated dose and different dose-limiting toxicity than previously reported. Further investigation of this regimen is warranted

Procedures for the definitive calibration of radiotherapy equipment

International Nuclear Information System (INIS)

1993-01-01

Recommendations from the Institute of Physical Sciences in Medicine are given for the definition calibration of external beam radiotherapy treatment machines and radiation dose measuring equipment used in radiotherapy. (UK)

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.

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

Adaptive Motion Compensation in Radiotherapy

CERN Document Server

Murphy, Martin J

2011-01-01

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

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

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...

LIFE CYCLE COSTING DAN EKSTERNALITAS BIODIESEL DARI MINYAK SAWIT DAN MINYAK ALGA DI INDONESIA (Life Cycle Costing and Externities of Palm and Algal Biodiesel in Indonesia

Directory of Open Access Journals (Sweden)

Arif Dwi Santoso

2014-10-01

Full Text Available ABSTRAK Biaya produksi biodiesel menjadi salah satu hambatan program konversi bahan bakar minyak ke biodiesel negara-negara termasuk Indonesia dalam upaya mengantipasi terjadinya krisis energi. Salah satu penyebab biaya produksi yang tinggi adalah karena variabel biaya produksi yang diperbandingkan selama ini belum sepenuhnya mencerminkan keseluruhan potensi yang terkandung dalam biodiesel. Potensi biodiesel yang tergolong ke dalam komoditas lingkungan seperti sifat terbarukan, rendah dalam penggunaan lahan, dan ramah lingkungan perlu dimasukkan dalam perhitungan agar mendapatkan perbandingan perhitungan yang obyektif. Penelitian ini bertujuan untuk mengevaluasi pengaruh penambahan komoditas lingkungan pada stuktur biaya produksi biodiesel dari minyak sawit dan minyak alga. Nilai komoditas lingkungan diperkirakan dengan metode metode benefit transfer dan untuk memperlihatkan nilai keuntungan digunakan pendekatan willing to pay (WTP. Nilai-nilai komoditas lingkungan diacu dari hasil perhitungan perangkat lunak Environmental Priority Strategy (EPS versi 2000. Untuk kasus Indonesia, nilai komoditas lingkungan EPS diinferensi dengan elastisitas berdasarkan dari perbandingan nilai pendapatan per kapita negara Swedia dan Indonesia. Hasil penelitian menyatakan bahwa analisis life cycle costing (LCC yang diaplikasikan dengan menambahkan variabel eksternalitas dapat memberikan informasi yang detil tentang komposisi biaya produksi biodiesel dan dapat digunakan sebagai metode untuk mendapatkan gambaran total biaya produksi yang paling kompetitif dari beberapa sumber.  Analisis juga menyimpulkan bahwa variabel eksternalitas turut mempengaruhi kenaikan total biaya produksi biodiesel hingga 14%. Hasil analisis profitabilitas menyatakan bahwa pasokan biomasa alga untuk produksi biodiesel lebih terjamin dan berkelanjutan dibandingkan biomasa sawit karena kendala teknis dan non teknis pada produksi biomasa alga lebih mudah diatasi selain itu juga keunggulan

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

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

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

Elevation of PSA after prostate radiotherapy: Rebound or biochemical recurrence?

International Nuclear Information System (INIS)

Toledano, A.; Kanoui, A.; Chiche, R.; Lamallem, H.; Beley, S.; Thibault, F.; Sebe, P.

2008-01-01

The fact that external beam radiotherapy and brachytherapy are now considered to be curative techniques has led to major review of the modalities of follow-up after radiotherapy for prostate cancer. The problem concerns both the diagnosis of recurrence, rapidly announced by elevation of prostatic-specific antigen (PSA), usually at a subclinical stage, and the validity of criteria of biochemical recurrence to allow comparison of various study. Physicians involved in follow-up should be aware of the potential of bounce in PSA follow-up after external beam radiotherapy or brachytherapy. The PSA bounce phenomenon was defined by a rise of PSA values (+ 0.1 -0.8 ng/ml) with a subsequent fall. Biochemical failure after external beam radiotherapy or brachytherapy (with or without hormonotherapy) was defined by Phoenix criteria by a rise of 2 ng/ml above an initial PSA nadir. This definition was more correlated to PSA bounce phenomenon. (authors)

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.)

Development of targeted radiotherapy systems

International Nuclear Information System (INIS)

Ferro, Guillermina; Villarreal, Jose E.; Garcia, Laura; Tendilla, Jose I.; Paredes, Lydia; Murphy, Consuelo A.; Pedraza, Martha

2001-01-01

Conventional or external beam radiotherapy, has been a viable alternative for cancer treatment. Although this technique is effective, its use is limited if the patient has multiple malignant lesions (metastases). An alternative approach is based on the design of radiopharmaceuticals that, to be administered in the patient, are directed specifically toward the target cell producing a selective radiation delivery. This treatment is known as targeted radiotherapy. We have summarized and discussed some results related to our investigations on the development of targeted radiotherapy systems, including aspects of internal dosimetry

Quality assurance protocol for linear accelerators used in radiotherapy

International Nuclear Information System (INIS)

Petkovska, Sonja

2012-01-01

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

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

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

CERN Document Server

Lemoigne, Yves

2009-01-01

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

Biochemical failure as single abnormality in patients with prostate cancer following radical treatment with external radiotherapy: follow-up without immediate treatment

Directory of Open Access Journals (Sweden)

Sergio L. Faria

2004-08-01

Full Text Available INTRODUCTION: Biochemical failure has been defined as 3 consecutive increases in PSA following curative treatment of prostate cancer. The appropriate management in such cases is controversial. The most usual treatment has been early introduction of hormones. Such patients will live for many years and hormone therapy causes important secondary effects and increases costs. The guideline in our Department of Radiotherapy has been to follow up, with no initial therapy, cases with low PSA and short PSA doubling time. The present study reports this experience. MATERIALS AND METHODS: 528 patients with localized prostate cancer were treated by radical approach between 1992 and 1999, with external radiotherapy, with or without adjuvant hormone therapy. After a median follow-up of 77 months, there were 207 (39% cases with biochemical failure, 78 of which were followed without therapy after the identification of biochemical failure. All of them were asymptomatic patients and had negative radiographic examinations or did not have imaging exams requested since they presented a favorable outcome. The follow-up included at least 2 annual visits with physical examination and PSA. RESULTS: Of the 78 patients with biochemical failure followed without initial therapy, 7 died from other causes than prostate cancer and the remaining 71 cases were alive and asymptomatic in the last follow-up. Prognostic factors previous to radiotherapy such as stage and Gleason score were not considered when deciding for follow-up without initial therapy in these cases. The most significant aspects considered for this decision were low PSA value (median PSA on the last visit for the 78 cases was only 3.9 ng/mL and a slow PSA doubling time (in the present experience the median PSA doubling time was 22.5 months. CONCLUSION: There seems to be space for expectant management, without initial hormone therapy, in patients with prostate cancer who present biochemical failure and are

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

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

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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.)

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

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

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

2012-03-15

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

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

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

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

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

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

Intraoperative radiotherapy for cancer of the pancreas

International Nuclear Information System (INIS)

Manabe, Tadao; Nagai, Toshihiro; Tobe, Takayoshi; Shibamoto, Yuta; Takahashi, Masaharu; Abe, Mitsuyuki

1985-01-01

Seven patients treated by intraoperative radiotherapy for cancer of the pancreas were evaluated. Three patients undergoing pancreaticoduodenectomy for cancer of the head of the pancreas received a dose of 2,500--3,000 rad (6--10 MeV Betatron) intraoperatively with or without external beam irradiation at a dose of 2,520 rad (10 MeV lineac X-ray). One patient developed radiation pancreatitis and died 0.8 month after surgery. Autopsy revealed the degeneration of cancer cells in the involved superior mesenteric artery. One died of hepatic metastasis 8.5 months after surgery, however, recurrence was not found in the irradiation field. The other patient who had external beam irradiation combined with intraoperative radiotherapy is alive 7.5 months after surgery. Four patients with unresectable cancer of the body of the pancreas received a dose of 2,500--3,000 rad (13--18 MeV Betatron) intraoperatively with or without external beam irradiation at a dose of 1,500--5,520 rad (10 MeV lineac X-ray). One patient died of peritonitis carcinomatosa 3.0 months after surgery. One patient died of DIC 0.6 month after surgery. Two patients are alive 1.0 and 6.5 months after surgery. In these patients with intraoperative radiotherapy for unresectable cancer of the pancreas, remarkable effects on relief of pain and shrinkage of tumor were obtained. Further pursuit of intraoperative and external beam radiotherapies in combination with pancreatectomy should be indicated in an attempt to prolong survival of patient with cancer of the pancreas. (author)

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

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.

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.

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

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.

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)

Estimating the demand for radiotherapy from the evidence: A review of changes from 2003 to 2012

International Nuclear Information System (INIS)

Barton, Michael B.; Jacob, Susannah; Shafiq, Jesmin; Wong, Karen; Thompson, Stephen R.; Hanna, Timothy P.; Delaney, Geoff P.

2014-01-01

Background and Purpose: In 2003 we estimated that 52.3% of new cases of cancer in Australia had an indication for external beam radiotherapy at least once at some time during the course of their illness. This update reviews the contemporary evidence to define the optimal proportion of new cancers that would benefit from radiotherapy as part of their treatment and estimates the changes to the optimal radiotherapy utilisation rate from 2003 to 2012. Materials and Methods: National and international guidelines were reviewed for external beam radiotherapy indications in the management of cancers. Epidemiological data on the proportion of new cases of cancer with each indication for radiotherapy were identified. Indications and epidemiological data were merged to develop an optimal radiotherapy utilisation tree. Univariate and Monte Carlo simulations were used in sensitivity analysis. Results: The overall optimal radiotherapy utilisation rate (external beam radiotherapy) for all registered cancers in Australia changed from 52.3% in 2003 to 48.3% in 2012. Overall 8.9% of all cancer patients in Australia have at least one indication for concurrent chemo-radiotherapy during the course of their illness. Conclusions: The reduction in the radiotherapy utilisation rate was due to changes in epidemiological data, changes to radiotherapy indications and refinements of the model structure

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.

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

TRANSFORMASI ORGANISASIONAL DAN MSDM: HAMBATAN DAN IMPLIKASINYA PADA REKRUTMEN DAN SELEKSI

Directory of Open Access Journals (Sweden)

Licen Indahwati Darsono

2002-01-01

Full Text Available Rapid change of environment is an external force that causes the organization to transform. Fundamentally, the main purpose of the transformation is to change the organizational structure to be more flexible and competitive with fewer hierarchial levels, managers, and employees. The transformation needs to be radical, causing resistance from the organization's members. Their resistance can cause the transformation to fail, therefore organization must find ways to lessen this resistance. First, organization must learn about the diversity of its members' cultures and values. Second, organization must build its own organizational culture which can support the success of the transformation, by communicating it with the members of the organization. To support organizational culture building efforts, it needs changes in human resources practices, especially recruitment and selection. Abstract in Bahasa Indonesia : Perubahan yang cepat dalam lingkungan merupakan kekuatan eksternal yang mengakibatkan transformasi dalam sebuah organisasi. Pada dasarnya, tujuan utama dari transformasi tersebut adalah merubah struktur organisasi agar menjadi lebih fleksibel dan mampu bersaing, dengan tingkat structural yang sedikit, serta jumlah manajer dan karyawan yang lebih kecil. Transformasi tersebut harus menyeluruh, dan hal ini dapat menyebabkan resistensi dari para anggota organisasi yang memperhambat perubahan tersebut. Resistensi itu bisa menyebabkan perubahan tersebut batal, oleh karena itu organisasi harus mencari jalan untuk mengurangi hambatan-hambatan tersebut. Pertama, organisasi harus belajar keanekaragaman dari budaya dan nilai anggotanya. Kedua, organisasi harus mengembangkan budaya organisasi sendiri melalui komunikasi yang baik dengan anggotanya. Untuk mendukung usaha mengembangkan budaya organisasi, harus ada perubaban pada kebijakan sumber daya manusia, terutama dalam rekrutmen dan seleksi karyawan. Kata kunci: transformasi, resistensi, budaya

Otologic disorders following radiotherapy for nasopharyngeal carcinoma

International Nuclear Information System (INIS)

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

2007-01-01

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

External Beam Radiotherapy for Focal Lymphoepithelioma-Like Carcinoma in the Urinary Bladder: A Case Report and Literature Review

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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.

Neoadjuvant androgen deprivation and long-term results for patients with intermediate- and high-risk prostate cancer treated with high-dose rate brachytherapy and external beam radiotherapy

International Nuclear Information System (INIS)

Pellizzon, Antonio Cassio Assis; Fogaroli, Ricardo Cesar; Silva, Maria Leticia Gobo; Castro, Douglas Guedes; Maia, Maria Conte

2010-01-01

Purpose: to evaluate the influence of neoadjuvant androgen deprivation (NAAD) and report the long term biochemical control rates according to the Phoenix Consensus Conference, and prognostic factors of intermediate- (IR) and high-risk (HR) prostate cancer treated with external beam radiotherapy and high-dose-rate brachytherapy (HDR-BT). Methods and materials: between March, 1997 and June, 2005, 184 patients considered IR or HR were treated with localized radiotherapy and HDR-BT at the Department of Radiation Oncology, Hospital A.C. Camargo, Sao Paulo, Brazil. Patient's age, Gleason score, clinical stage, initial PSA value, risk group for biochemical failure, presence of NAAD, doses of radiotherapy and HDR-BT were evaluated. Results: median age and follow-up were 70 years old (range, 47-83) and 74.5 months (range, 24-123 months), respectively. Patients considered IR were 91 (49.4%) and HR 93 (50.6%). Ninety-nine (53.8%) patients had no NAAD. The overall survival at 5 years was 93.6%. The 5-year actuarial biochemical control rates for all patients, IR and HR were 83.4%, 86.2% and 78.8%, respectively, p0.076. On univariate analysis the prognostic factors related to better biochemical control were Gleason score 45 Gy (p= 0.011) and HDR-BT dose > 20 Gy (p< 0.001). On multivariate analysis no statistical significant predictive factor related to biochemical control was found. Conclusions: the role of NAAD for IR and HR prostate cancer is still to be defined. HDR-BT combined to external radiotherapy is a successful form of treatment for these patients, with our results comparable to published data. (author)

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

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)

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.

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.

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)

Customized mold radiotherapy with prosthetic apparatus for oral cancers

International Nuclear Information System (INIS)

Noguchi, Tadahide; Tsuchiya, Yoshiyuki; Hayasaka, Junichi; Itoh, Hiroto; Jinbu, Yoshinori; Kusama, Mikio; Takahashi, Satoru; Nakazawa, Masanori

2014-01-01

Eight patients (6 males, 2 females; median age, 78 years; age range, 31-94 years) were treated by mold radiotherapy with a prosthetic apparatus for oral cancers between October 2006 and March 2013. The primary sites were the tongue in 3 cases, hard palate and buccal mucosa in 2 cases each, and oral floor in 1 case. The type of treatment consisted of radical radiotherapy and palliative radiotherapy in 2 cases each, and preoperative radiotherapy, postoperative radiotherapy, additional radiotherapy after external beam radiotherapy and systemic chemotherapy in 1 case each. Patients received 40-50 Gy in 8-10 fractions with mold radiotherapy. Two patients who received radical radiotherapy showed no signs of recurrence or metastasis. The present therapy contributed to patients' palliative, postoperative, and preoperative therapy. Mold radiotherapy with a prosthetic appliance was performed safely and was a useful treatment for several types of oral cancer. (author)

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.

Radiotherapy for the treatment of primary vaginal cancer

International Nuclear Information System (INIS)

Samant, Rajiv; Tam, Tiffany; Dahrouge, Simon; E, Choan

2005-01-01

Disease control rates and toxicity were evaluated among 28 primary vaginal cancer patients treated with curative intent using radiotherapy. At 5 years, the majority (60%) of patients were disease-free and local control was 73% when a combination of external beam radiotherapy and brachytherapy were used. Serious late toxicity was seen in 11% of patients

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)

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.

Interstitial radiotherapy

International Nuclear Information System (INIS)

Scardino, P.T.; Bretas, F.

1987-01-01

The authors now have 20 years of experience with modern techniques of brachytherapy. The large number of patients treated in medical centers around the world and the widespread use of this type of radiotherapy have provided us with substantial information about the indications and contraindications, advantages and disadvantages, pitfalls and complications, as well as the results of these techniques. Although the focus of this review is the experience at Baylor using the combined technique of gold seed implantation plus external beam irradiation, the alternative forms of brachytherapy will be described and compared. The authors' intention is to provide the busy clinician with a succinct and informative review indicating the status of modern interstitial radiotherapy and describing day-to-day approach and results

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

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

Comparative sensitivities of functional MRI sequences in detection of local recurrence of prostate carcinoma after radical prostatectomy or external-beam radiotherapy.

Science.gov (United States)

Roy, Catherine; Foudi, Fatah; Charton, Jeanne; Jung, Michel; Lang, Hervé; Saussine, Christian; Jacqmin, Didier

2013-04-01

The aim of this retrospective study was to determine the respective accuracies of three types of functional MRI sequences-diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) MRI, and 3D (1)H-MR spectroscopy (MRS)-in the depiction of local prostate cancer recurrence after two different initial therapy options. From a cohort of 83 patients with suspicion of local recurrence based on prostate-specific antigen (PSA) kinetics who were imaged on a 3-T MRI unit using an identical protocol including the three functional sequences with an endorectal coil, we selected 60 patients (group A, 28 patients who underwent radical prostatectomy; group B, 32 patients who underwent external-beam radiation) who had local recurrence ascertained on the basis of a transrectal ultrasound-guided biopsy results and a reduction in PSA level after salvage therapy. All patients presented with a local relapse. Sensitivity with T2-weighted MRI and 3D (1)H-MRS sequences was 57% and 53%, respectively, for group A and 71% and 78%, respectively, for group B. DCE-MRI alone showed a sensitivity of 100% and 96%, respectively, for groups A and B. DWI alone had a higher sensitivity for group B (96%) than for group A (71%). The combination of T2-weighted imaging plus DWI plus DCE-MRI provided a sensitivity as high as 100% in group B. The performance of functional imaging sequences for detecting recurrence is different after radical prostatectomy and external-beam radiotherapy. DCE-MRI is a valid and efficient tool to detect prostate cancer recurrence in radical prostatectomy as well as in external-beam radiotherapy. The combination of DCE-MRI and DWI is highly efficient after radiation therapy. Three-dimensional (1)H-MRS needs to be improved. Even though it is not accurate enough, T2-weighted imaging remains essential for the morphologic analysis of the area.

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

Musik Internal dan Eksternal dalam Kesenian Randai

Directory of Open Access Journals (Sweden)

Sri Rustiyanti

2015-03-01

Full Text Available Kehidupan musik pada masyarakat Minangkabau tidak terlepas adanya peranan serta fungsi yang melekat pada kesenian Randai. Melalui pendekatan etnomusikologi, tulisan ini menelaah peranan musik internal dan eksternal dalam kesenian Randai. Kesenian ini menggunakan medium seni ganda atau kolektif karena didukung oleh beberapa cabang seni antara lain tari, musik, teater, sastra, dan rupa. Hasil penelitian menunjukkan bahwa musik iringan dalam Randai terbagi menjadi dua, yaitu musik internal dan musik eksternal. Musik internal adalah musik atau bunyi-bunyian yang berasal dari anggota tubuh manusia (penari, misalnya tepukan tangan, petik jari, tepuk dada, siulan, hentakan kaki ke tanah dan sebagainya, sedangkan musik eksternal adalah bunyi-bunyian atau suara yang berasal dari alat musik atau instrumen seperti talempong, gandang, saluang, dan rabab.   The Role of Internal and External Music in the Arts of Randai. The musical life in Minangkabau society is inseparable from its roles and functions which attach to the arts of Randai. Through the ethnomusicology approach, this paper examines the role of internal and external music in the art of Randai. Considering its sustainability and amendment, the musicality is the identity of Minangkabau society so that the sustainability of the music can be run in accordance with the dynamics of society today. Among the types of arts in Minangkabau, Randai is an art form that uses multiple or collective art medium for it is supported by several branches of the arts, including dance, music, theater arts, literary arts, and fine arts. The results of this study is more focused on the art of music. Musical accompaniment in Randai is divided into two, namely internal and external music. The internal music is the music or the sounds that come from the human body (a dancer, for example, clapping, finger picking, patting the chest, whistling, stomping on the ground, and so on, while the external music is the sounds

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)

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.

Experimental radiotherapy and clinical radiobiology. Vol. 20. Proceedings

International Nuclear Information System (INIS)

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

2011-01-01

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

Evaluation of radiotherapy and chemotherapy treatment in patients of oral squamous cell carcinoma; Avaliacao dos resultados dos tratamentos radioterapico e quimioterapico em pacientes portadores de carcinoma espinocelular na cavidade bucal

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Sannomiya, Eduardo Kazuo [Universidade de Santo Amaro (UNISA), SP (Brazil). Faculdade de Odontologia. Dept. de Diagnostico e Cirurgia; Medici Filho, Edmundo; Moraes, Luiz Cesar de; Castilho, Julio Cezar de Melo [UNESP, Sao Jose dos Campos, SP (Brazil). Faculdade de Odontologia. Dept. de Cirurgia, Periodontia e Radiologia; Furukawa, Souhei [Osaka Univ. (Japan). Faculdade de Odontologia. Dept. de Radiologia e Radioterapia Buco-Maxilo-Facial

2003-12-01

We evaluated the effectiveness of radiotherapy combined with chemotherapy in patients with oral squamous cell carcinoma. Therefore, 1042 cases where reviewed in School Dentistry - Osaka Univ. Seven hundred and fifteen were male and three hundred and twenty-seven were female. Ora cancer was affected more male than female patients, with mean age of 582 years old. The tongue was the most common anatomic localization of oral cancer. In tongue, the use of external radiotherapy y combined with brachytherapy and brachytherapy isolated presented better results than chemotherapy combined with external radiotherapy. In buccal mucosa, there was not differences in the treatment's results using external radiotherapy and combined chemotherapy and external radiotherapy. In tongue's floor and upper and jaw gingiva the combined treatment with chemotherapy and external radiotherapy presented better results than isolated external radiotherapy. (author)

Secondary effects of radiotherapy on the orofacial sphere

International Nuclear Information System (INIS)

Guillaume, Nicolas

2012-01-01

The objective of this research is to determine the role of the dental surgeon in the taking into care of patients treated by head and neck radiotherapy. It also aims at giving information to the patient on secondary effects which radiotherapy may induce, and at determining which therapeutic behaviour to adopt to prevent or at least mitigate the appearance of complications. The author first presents some generalities on radiotherapy: presentation of upper aero-digestive tract cancers (surgery, radiotherapy, and chemotherapy), description of the different radiotherapy techniques (external radiotherapy, brachytherapy), discussion of factors influencing local secondary effects of radiotherapy. The second part addresses the specific case of early orofacial secondary effects, discusses their origin, clinic signs and prevention means: cutaneous effect, mucositis, xerostomia, candidiasis, taste disorders, relationship between early local reactions and anti-tumour treatment efficiency. The third part addresses late orofacial secondary effects: cervix sclerosis, limitation of mouth opening, dental effects, periodontal diseases, osteoradionecrosis. The last part discusses the evolution of radiotherapy: intensity modulated conformational radiotherapy, targeted therapeutics [fr

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)

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

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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.)

Advice concerning radiotherapy

International Nuclear Information System (INIS)

1984-01-01

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

Effectiveness and problems of radiotherapy for the advanced biliary tract cancer

International Nuclear Information System (INIS)

Ueda, Nobuhiko; Konishi, Ichiro; Izumi, Ryohei

1999-01-01

To elucidate the effectiveness and problems of radiotherapy for the advanced biliary tract cancer, 19 cases with the biliary tract cancer adding radiotherapy (7 cases with bile duct cancer and 12 cases with gallbladder cancer) were stratified into two groups: 3 cases with microscopically non-curative resection adding radiotherapy (group I) and 16 cases with macroscopically non-curative resection or non-resection adding radiotherapy (group II). In the group I, one case of bile duct cancer has been alive for 8 years and 9 months, and the other case had survived for 1 year and 8 months, and one case of gallbladder cancer has been alive for 2 years and 2 months. Survival periods in 12 of 16 cases of group II were within 1 year. But recanalization of bile duct was recognized in 2 of 4 cases of bile duct cancer with external radiotherapy and 7 of 8 cases of gallbladder cancer with external and/or intraoperative radiotherapy. Moreover, in 5 of 6 cases with biliary stent, patency of billary stent had been kept until death. From the above results, radiotherapy is suggested to be effective on the prognosis in group I, and recanalization of bile duct and patency of biliary stent in group II. (author)

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

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

Intensity modulated radiotherapy (IMRT) in bilateral retinoblastoma

International Nuclear Information System (INIS)

Atalar, Banu; Ozyar, Enis; Gunduz, Kaan; Gungor, Gorkem

2010-01-01

External beam radiotherapy (EBRT) for retinoblastoma has traditionally been done with conventional radiotherapy techniques which resulted high doses to the surrounding normal tissues. A 20 month-old girl with group D bilateral retinoblastoma underwent intensity modulated radiotherapy (IMRT) to both eyes after failing chemoreduction and focal therapies including cryotherapy and transpupillary thermotherapy. In this report, we discuss the use of IMRT as a method for reducing doses to adjacent normal tissues while delivering therapeutic doses to the tumour tissues compared with 3-dimensional conformal radiotherapy (3DCRT). At one year follow-up, the patient remained free of any obvious radiation complications. Image guided IMRT provides better dose distribution than 3DCRT in retinoblastoma eyes, delivering the therapeutic dose to the tumours and minimizing adjacent tissue damage

Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy

International Nuclear Information System (INIS)

Riaz, Nadeem; Afaq, Asim; Akin, Oguz; Pei Xin; Kollmeier, Marisa A.; Cox, Brett; Hricak, Hedvig; Zelefsky, Michael J.

2012-01-01

Purpose: To investigate the utility of endorectal coil magenetic resonance imaging (eMRI) in predicting biochemical relapse in prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Methods and Materials: Between 2000 and 2008, 279 men with intermediate- or high-risk prostate cancer underwent eMRI of their prostate before receiving brachytherapy and supplemental intensity-modulated radiotherapy. Endorectal coil MRI was performed before treatment and retrospectively reviewed by two radiologists experienced in genitourinary MRI. Image-based variables, including tumor diameter, location, number of sextants involved, and the presence of extracapsular extension (ECE), were incorporated with other established clinical variables to predict biochemical control outcomes. The median follow-up was 49 months (range, 1–13 years). Results: The 5-year biochemical relapse-free survival for the cohort was 92%. Clinical findings predicting recurrence on univariate analysis included Gleason score (hazard ratio [HR] 3.6, p = 0.001), PSA (HR 1.04, p = 0.005), and National Comprehensive Cancer Network risk group (HR 4.1, p = 0.002). Clinical T stage and the use of androgen deprivation therapy were not correlated with biochemical failure. Imaging findings on univariate analysis associated with relapse included ECE on MRI (HR 3.79, p = 0.003), tumor size (HR 2.58, p = 0.04), and T stage (HR 1.71, p = 0.004). On multivariate analysis incorporating both clinical and imaging findings, only ECE on MRI and Gleason score were independent predictors of recurrence. Conclusions: Pretreatment eMRI findings predict for biochemical recurrence in intermediate- and high-risk prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Gleason score and the presence of ECE on MRI were the only significant predictors of biochemical relapse in this group of patients.

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)

Nonrandomized study comparing the effects of preoperative radiotherapy and daily administration of low-dose cisplatin with those radiotherapy alone for oral cancer

International Nuclear Information System (INIS)

Kurita, Hiroshi; Azegami, Takuya; Kobayashi, Hirokazu; Kurashina, Kenji; Tanaka, Kouichi; Kotani, Akira; Oguchi, Masahiko; Tamura, Minoru.

1997-01-01

The purpose of this study was to compare the effect of preoperative radiotherapy and daily administration of low-dose cisplatin with those of radiotherapy alone for oral cancer. Ten patients underwent preoperative radiotherapy of 30 to 40 Gy with concomitant daily administration of low-dose cisplatin (5 mg/body or 5 mg/m 2 ). Ten patients received external radiotherapy alone. The locoregional response rates (complete response and partial response) did not differ significantly between the two groups (80% for combined therapy and 60% for radiotherapy alone). On histopathologic evaluation of surgical specimens, however, the combined-therapy group (80%) had a higher response rate than did the radiotherapy-alone group (10%; p<0.01). We conclude that daily administration of low-dose cisplatin enhances the efficacy of radiotherapy against primary tumors. We also suggested that combined therapy may be beneficial as an initial treatment for oral cancer before a planned operation. (author)

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

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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)

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.

External Volume Expansion in Irradiated Tissue: Effects on the Recipient Site.

Science.gov (United States)

Chin, Michael S; Lujan-Hernandez, Jorge; Babchenko, Oksana; Bannon, Elizabeth; Perry, Dylan J; Chappell, Ava G; Lo, Yuan-Chyuan; Fitzgerald, Thomas J; Lalikos, Janice F

2016-05-01

External volume expansion prepares recipient sites to improve outcomes of fat grafting. For patients receiving radiotherapy after mastectomy, results with external volume expansion vary, and the relationship between radiotherapy and expansion remains unexplored. Thus, the authors developed a new translational model to investigate the effects in chronic skin fibrosis after radiation exposure. Twenty-four SKH1-E mice received 50 Gy of β-radiation to each flank and were monitored until fibrosis developed (8 weeks). External volume expansion was then applied at -25 mmHg to one side for 6 hours for 5 days. The opposite side served as the control. Perfusion changes were assessed with hyperspectral imaging. Mice were euthanized at 5 (n = 12) and 15 days (n = 12) after the last expansion application. Tissue samples were analyzed with immunohistochemistry for CD31 and Ki67, Masson trichrome for skin thickness, and picrosirius red to analyze collagen composition. All animals developed skin fibrosis 8 weeks after radiotherapy and became hypoperfused based on hyperspectral imaging. Expansion induced edema on treated sides after stimulation. Perfusion was decreased by 13 percent on the expansion side (p External volume expansion temporarily reduces perfusion, likely because of transient ischemia or edema. Together with mechanotransduction, these effects encourage a proangiogenic and proliferative environment in fibrotic tissue after radiotherapy in the authors' mouse model. Further studies are needed to assess these changes in fat graft retention.

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

Science.gov (United States)

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

2013-01-01

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

Situation of radiotherapy in 2010 - context and methods, data for 2003/2010, synthesis

International Nuclear Information System (INIS)

2011-03-01

Illustrated by data tables and figures, this report first gives an overview of the status and situation of European and French radiotherapy centres, and of care activity authorizations regarding external radiotherapy. It gives an overview of equipment used for treatments and for treatment preparation and delivery, and of the different treatment techniques (three dimensional conformational, intensity-modulated conformational, stereotactic, whole body radiotherapy, proton-therapy). It comments the activity of radiotherapy centres: patients (age, sessions, and treated pathologies), comments data regarding medical and paramedical personnel involved in radiotherapy, and financial data regarding radiotherapy in 2009

ANALISIS FAKTOR-FAKTOR YANG MEMENGARUHI TRANSFORMASI KAPABILITAS ORGANISASI DAN PERAN BADAN PEMERIKSA KEUANGAN RI

Directory of Open Access Journals (Sweden)

Agus Joko Pramono

2017-01-01

Full Text Available ABSTRACT This study is aimed to study the influencing factors of the Audit Board of Republic Indonesia’s roles and capabilities transformation to meet the national development goals. This study use a qualitative approach with Analytic Network Process (ANP method, to map out the interrelated factors of nodes within 3 clusters, which are the external, internal, and supporting factors. Focus Group Discussion (FGD was conducted to design a Framework Analysis. The participants of the FGD were BPK RI officials and its stakeholders including relevant external experts. The FGD has made a quantification framework as an ideal approach to use for data processing on software superdecisions. This process has brought about the priorities as follows: external stakeholder engagement, leadership and governance system, communication and the management of information system. The research has found out that the most significant and urgent factor is the concern of, and support from, the external stakeholders for BPK RI. Therefore, BPK RI has to design a strategy and communication program that can effectively improve the external support and concern. Keywords: Transformation, organizational capability, organizational roles, The Audit  Board of Indonesia, Analytic Network Process. ABSTRAK Kajian ini bertujuan untuk mengkaji faktor-faktor yang berpengaruh terhadap transformasi kapabilitas dan peran Badan Pemeriksa Keuangan Republik Indonesia. Kajian ini menggunakan pendekatan kualitatif dengan metode Analytic Network Process (ANP untuk mendapatkan hubungan antar node dalam 3 cluster (faktor eksternal, internal dan penunjang yang bersifat network. Framework analysis disusun melalui FGD para pakar dari eksternal dan internal BPK RI. Kuantifikasi framework dihasilkan dari FGD para pakar internal BPK RI. Olah data pada software superdecisions menghasilkan prioritas-prioritas sebagai berikut: faktor eksternal prioritasnya Stakeholders Engagement; faktor internal

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

The development of radiotherapy in Slovenia

International Nuclear Information System (INIS)

Kuhelj, Janez; Ravnihar, Bozena

1996-01-01

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

Who risk profile in radiotherapy

International Nuclear Information System (INIS)

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

2009-01-01

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

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

Role of radiotherapy in the treatment of meningiomas; Role de la radiotherapie dans le traitement des meningiomes cerebraux

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Noel, G. [Centre de protontherapie, 91 - Orsay (France); Renard, A.; Mazeron, J.J. [Groupe Hospitalier la Pitie-Salpetriere, Service de Radiotherapie, AP-HP, 75 - Paris (France); Valery, C. [Groupe Hospitalier la Pitie-Salpetriere, Service de Neurochirurgie, AP-HP, 75 - Paris (France); Mokhtari, K. [Groupe Hospitalier la Pitie-Salpetriere, Lab. de Neuropathologie Raymond-Escourolle, AP-HP, 75 - Paris (France)

2001-06-01

Role of radiotherapy in the treatment of meningiomas. Cerebral meningiomas account for 15-20% of all cerebral tumours. Although seldom malignant, they frequently recur in spite of complete surgery, which remains the cornerstone of the treatment. In order to decrease the probability of local recurrence, radiotherapy has often been recommended in atypical or malignant meningioma as well as in benign meningioma which was incompletely resected. However, this treatment never was the subject of prospective studies, randomized or not. The purpose of this review of the literature was to give a progress report on the results of different published series in the field of methodology as well as in the techniques of radiotherapy. Proposals for a therapeutic choice are made according to this analysis. For grade I or grade II-III meningiomas, limits of gross tumor volume (GTV) include the tumour in place or the residual tumour after surgery; clinical target volume (CTV) limits include gross tumour volume before surgery with a GTV-CTV distance of 1 and 2 cm respectively. Delivered doses are 55 Gy into CTV and 55-60 Gy and 70 Gy into GTV for grade I and grade II-III meningiomas respectively. (authors)

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

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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.

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

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

2013-01-01

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

The effectiveness of external beam radiotherapy for acromegaly is not affected by previous pituitary ablative treatments

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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)

The effectiveness of external beam radiotherapy for acromegaly is not affected by previous pituitary ablative treatments

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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).

A comparison of the palliative effects of strontium-89 and external beam radiotherapy in metastatic prostate cancer

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Quilty, P.M.; Kirk, D.; Bolger, J.J.; Dearnaley, D.P.; Mason, M.D.; Lewington, V.J.; Reed, N.S.E.; Russell, J.M.; Yardley, J.

1994-01-01

From 1988 to 1991, 284 patients with prostatic cancer and painful bone metastases were treated with either radiotherapy or strontium-89 (200 MBq). Patients were first stratified according to suitability for local or hemibody radiotherapy, then randomly allocated that form of treatment or strontium-89 (i.v. injection). After 4,8 and 12 weeks pain sites were mapped, toxicity monitored, and all additional palliative treatments recorded. There was no significant difference in median survival (after >80% had died); 33 weeks following strontium 8 9 and 28 weeks following radiotherapy (p=0.1). All treatments provided effective pain relief; improvement was sustained to 3 months in 63.6% after hemibody radiotherapy compared with 66.1% after strontium-89, and in 61% after local radiotherapy compared with 65.9% in the comparable strontium 8 9 group. Fewer patients reported new pain sites after strontium-89 than after local or hemibody radiotherapy (p < 0.05). Radiotherapy to a new site was required by 12 patients in the local radiotherapy group compared with 2 after strontium-89 (p < 0.01), although there was no significant difference between hemibody radiotherapy (6 patients) and strontium-89 (9 patients) in this respect. Platelets and leukocytes fell by an average 30-40% after strontium-89 but sequelae were uncommon, and other symptoms rare

Success Stories in Radiotherapy Development Projects: Lessons Learned from Radiotherapy Development Projects. Chapter 29

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Zubizarreta, E.; Van Der Merwe, D.

2017-01-01

This chapter examines some problems found to be common in the process of setting up, running or expanding radiotherapy facilities. The establishment of radiotherapy services is essential to consolidate any national cancer control plan. In other words, such a plan cannot exist without radiotherapy. The IAEA guidance on setting up a radiotherapy programme covering the clinical, medical physics, radiation protection and safety aspects gives an estimate of one teletherapy machine needed per million population]. The IAEA’s Directory of Radiotherapy Centres (DIRAC) shows that the number of megavoltage (MV) machines per million population varies from 8.2 in the United States of America to 5.5 in western Europe. There are still many countries without a single radiotherapy department, especially in Africa, and many others have very low coverage, e.g. up to one external beam radiotherapy machine to cover a population of 35 million, which is close to having no coverage. There are many possible reasons for this situation. In many low income countries, the combination of lower life expectancy, low income taxes, a small budget for public health, and unmet basic needs such as housing, prevention and/or treatment of infectious diseases (malaria, tuberculosis, human immunodeficiency virus (HIV), diarrhoea), drinkable water and sewerage makes the cancer control problem a lower priority. The indicators shown illustrate these points. Establishing a radiotherapy programme requires careful planning, including the requirement for successive phases. Resources should be available for designing, building, purchasing, maintaining and replacing equipment, and for providing training in its use. In the case of a first radiotherapy facility with basic staffing levels, there is not likely to be enough expertise to guide and oversee the process in many or all of these areas.

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

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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)

Oxygenation of cervical cancers during radiotherapy and radiotherapy + cis-retinoic acid/interferon

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Dunst, Jeurgen; Heansgen, Gabriele; Lautenschleager, Christine; Feuchsel, Glenn; Becker, Axel

1999-01-01

Purpose: We have evaluated the tumor tissue pO 2 in cervical cancers during radiotherapy with special emphasis on the course of the pO 2 in primarily hypoxic tumors and in patients treated with radiotherapy plus 13-cis-retinoic acid/interferon-α-2a. Methods and Materials: From June 1995 through April 1997, 49 patients with squamous cell carcinoma FIGO IIB-IVA of the cervix who were treated with definitve radiotherapy with curative intent underwent polarographic measurement of tumor tissue pO 2 with an Eppendorf pO 2 -histograph prior to and during radiation treatment. Radiotherapy consisted of external irradiation with 50.4 Gy in 28 fractions of 1.8 Gy plus high dose rate (HDR) brachytherapy. Twenty-two patients had additional treatment with 13-cis-retinoic acid (cRA, isotretinoin) and interferon-α-2a (IFN-α-2a). Therapy with cRA/IFN in these patients started 2 weeks before radiotherapy; during this induction period, cRA was administered in a dosage of 1 mg per kilogram body weight orally daily and IFN-α-2a in a dosage of 6 x 10 6 I.U. subcutaneously daily. After start of external radiotherapy (XRT), cRA/IFN was continued concomitantly with radiotherapy in reduced doses (0.5 mg cRA per kg body weight orally daily plus 3 x 10 6 I.U. IFN-α-2a subcutaneously three times weekly until the end of the radiation treatment). pO 2 measurements were performed prior to radiotherapy, at 20 Gy, and at the end of radiotherapy. Results: A poor oxygenation defined as a median pO 2 of 10 mm Hg or less was present in 15/38 tumors (39%) in which measurements prior to any treatment were done. Low pO 2 readings below 5 mm Hg were present in 70% of all tumors prior to treatment. In 13 of 15 hypoxic tumors, pO 2 measurements at 19.8 Gy were performed. In these tumors, a significant increase of the median pO 2 from 6.0 ± 3.1 mm Hg to 20.7 ± 21.2 mm Hg was found, p 2 was more pronounced in patients with radiotherapy plus additional cRA/IFN treatment as compared to patients treated

Absorbed dose determination in external beam radiotherapy. An international code of practice for dosimetry based on standards of absorbed dose to water

International Nuclear Information System (INIS)

2000-01-01

The International Atomic Energy Agency published in 1987 an International Code of Practice entitled 'Absorbed Dose Determination in Photon and Electron Beams' (IAEA Technical Reports Series No. 277 (TRS-277)), recommending procedures to obtain the absorbed dose in water from measurements made with an ionization chamber in external beam radiotherapy. A second edition of TRS-277 was published in 1997 updating the dosimetry of photon beams, mainly kilovoltage X rays. Another International Code of Practice for radiotherapy dosimetry entitled 'The Use of Plane-Parallel Ionization Chambers in High Energy Electron and Photon Beams' (IAEA Technical Reports Series No. 381 (TRS-381)) was published in 1997 to further update TRS-277 and complement it with respect to the area of parallel-plate ionization chambers. Both codes have proven extremely valuable for users involved in the dosimetry of the radiation beams used in radiotherapy. In TRS-277 the calibration of the ionization chambers was based on primary standards of air kerma; this procedure was also used in TRS-381, but the new trend of calibrating ionization chambers directly in a water phantom in terms of absorbed dose to water was introduced. The development of primary standards of absorbed dose to water for high energy photon and electron beams, and improvements in radiation dosimetry concepts, offer the possibility of reducing the uncertainty in the dosimetry of radiotherapy beams. The dosimetry of kilovoltage X rays, as well as that of proton and heavy ion beams, interest in which has grown considerably in recent years, can also be based on these standards. Thus a coherent dosimetry system based on standards of absorbed dose to water is possible for practically all radiotherapy beams. Many Primary Standard Dosimetry Laboratories (PSDLs) already provide calibrations in terms of absorbed dose to water at the radiation quality of 60 Co gamma rays. Some laboratories have extended calibrations to high energy photon and

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

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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.

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

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

2007-06-15

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

Biological-effective versus conventional dose volume histograms correlated with late genitourinary and gastrointestinal toxicity after external beam radiotherapy for prostate cancer: a matched pair analysis

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Roeske John C

2003-05-01

Full Text Available Abstract Background To determine whether the dose-volume histograms (DVH's for the rectum and bladder constructed using biological-effective dose (BED-DVH's better correlate with late gastrointestinal (GI and genitourinary (GU toxicity after treatment with external beam radiotherapy for prostate cancer than conventional DVH's (C-DVH's. Methods The charts of 190 patients treated with external beam radiotherapy with a minimum follow-up of 2 years were reviewed. Six patients (3.2% were found to have RTOG grade 3 GI toxicity, and similarly 6 patients (3.2% were found to have RTOG grade 3 GU toxicity. Average late C-DVH's and BED-DVH's of the bladder and rectum were computed for these patients as well as for matched-pair control patients. For each matched pair the following measures of normalized difference in the DVH's were computed: (a δAUC = (Area Under Curve [AUC] in grade 3 patient – AUC in grade 0 patient/(AUC in grade 0 patient and (b δV60 = (Percent volume receiving = 60 Gy [V60] in grade 3 patient – V60 in grade 0 patient/(V60 in grade 0 patient. Results As expected, the grade 3 curve is to the right of and above the grade 0 curve for all four sets of average DVH's – suggesting that both the C-DVH and the BED-DVH can be used for predicting late toxicity. δAUC was higher for the BED-DVH's than for the C-DVH's – 0.27 vs 0.23 (p = 0.036 for the rectum and 0.24 vs 0.20 (p = 0.065 for the bladder. δV60 was also higher for the BED-DVH's than for the C-DVH's – 2.73 vs 1.49 for the rectum (p = 0.021 and 1.64 vs 0.71 (p = 0.021 for the bladder. Conclusions When considering well-established dosimetric endpoints used in evaluating treatment plans, BED-DVH's for the rectum and bladder correlate better with late toxicity than C-DVH's and should be considered when attempting to minimize late GI and GU toxicity after external beam radiotherapy for prostate cancer.

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

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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.

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.

Adjuvant radiotherapy in high-grade extremity sarcomas

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Franca, Carlos Antonio da Silva; Penna, Antonio Belmiro Rodrigues Campbell; Carvalho, Antonio Carlos Pires; Vieira, Sergio Lannes

2010-01-01

Objective: to evaluate the therapies utilized in the authors' institution for management of high-grade extremity sarcomas, analyzing the overall survival rates following multidisciplinary treatment. Materials and methods: retrospective study developed in the period from 1993 to 2007 with 36 patients diagnosed with stages IIb/III, submitted to postoperative external beam radiotherapy, with or without boost dose, utilizing high-dose brachytherapy. Results: thirty-six patients underwent surgery followed by adjuvant external beam radiation therapy. Four patients (11%) received boost dose with brachytherapy, and seven (19%) received chemotherapy. The average dose for radiotherapy was 50 Gy (CI 95%: 47-53 Gy), and the four patients with brachytherapy boost received doses ranging from 16.2 to 35 Gy. Chemotherapy was indicated for seven patients (19%) with positive margins. Fifteen patients (42%) presented local or distant recurrence, and all of them progressed to death. Twenty-one patients (58%) remain with no clinical/radiological evidence of local/distant recurrence. The mean follow-up time was 88 months (IC 95%: 74-102). The overall seven years survival rate was 80%. Conclusion: combined surgery and radiotherapy is an effective treatment with excellent outcomes in cases where brachytherapy is associated, with improved overall survival rates. (author)

Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

International Nuclear Information System (INIS)

Ferrer, Montserrat; Suarez, Jose Francisco; Guedea, Ferran; Fernandez, Pablo; Macias, Victor; Marino, Alfonso; Hervas, Asuncion; Herruzo, Ismael; Ortiz, Maria Jose; Villavicencio, Humberto; Craven-Bratle, Jordi; Garin, Olatz; Aguilo, Ferran

2008-01-01

Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel

Gamma apparatuses for radiotherapy

International Nuclear Information System (INIS)

Sul'kin, A.G.

1986-01-01

Scientific and technical achievements in development and application of gamma therapeutic apparatuses for external and intracavity irradiations are generalized. Radiation-physical parameters of apparatuses providing usability of progressive methods in radiotherapy of onclogical patients are given. Optimization of main apparatus elements, ensurance of its operation reliability, reduction of errors of irradiation plan reproduction are considered. Attention is paid to radiation safety

Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy.

Science.gov (United States)

Yeh, Jekwon; Lehrich, Brandon; Tran, Carolyn; Mesa, Albert; Baghdassarian, Ruben; Yoshida, Jeffrey; Torrey, Robert; Gazzaniga, Michael; Weinberg, Alan; Chalfin, Stuart; Ravera, John; Tokita, Kenneth

2016-01-01

To present rectal toxicity rates in patients administered a polyethylene glycol (PEG) hydrogel rectal spacer in conjunction with combination high-dose-rate brachytherapy and external beam radiotherapy. Between February 2010 and April 2015, 326 prostate carcinoma patients underwent combination high-dose-rate brachytherapy of 16 Gy (average dose 15.5 Gy; standard deviation [SD] = 1.6 Gy) and external beam radiotherapy of 59.4 Gy (average dose 60.2 Gy; SD = 2.9 Gy). In conjunction with the radiation therapy regimen, each patient was injected with 10 mL of a PEG hydrogel in the anterior perirectal fat space. The injectable spacer (rectal spacer) creates a gap between the prostate and the rectum. The rectum is displaced from the radiation field, and rectal dose is substantially reduced. The goal is a reduction in rectal radiation toxicity. Clinical efficacy was determined by measuring acute and chronic rectal toxicity using the National Cancer Center Institute Common Terminology Criteria for Adverse Events v4.0 grading scheme. Median followup was 16 months. The mean anterior-posterior separation achieved was 1.6 cm (SD = 0.4 cm). Rates of acute Grade 1 and 2 rectal toxicity were 37.4% and 2.8%, respectively. There were no acute Grade 3/4 toxicities. Rates of late Grade 1, 2, and 3 rectal toxicity were 12.7%, 1.4%, and 0.7%, respectively. There were no late Grade 4 toxicities. PEG rectal spacer implantation is safe and well tolerated. Acute and chronic rectal toxicities are low despite aggressive dose escalation. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Radiotherapy and brachytherapy

International Nuclear Information System (INIS)

2007-02-01

This presentation first defines the radiotherapy and brachytherapy techniques, indicates the used ionizing radiations (electromagnetic and particles), describes the mechanisms and processes of action of ionizing radiations: they can be physical by photon-matter interactions (Compton effect and photoelectric effect) or due to electron-matter interactions (excitation, ionization), physical-chemical by direct or indirect action (DNA damage), cellular (mitotic or apoptotic death), tissue (sane and tumorous tissues and differential effect). It discusses the biological efficiency of these treatments which depends on different parameters: intrinsic radio-sensitivity, time (session fractioning and organisation in time), oxygen, radiation quality, cellular cycle, dose rate, temperature. It presents the different types of radiotherapy: external radiotherapy (general sequence, delineation, dosimetry, protection of critical organs, treatment session, quality control, monitoring consultation) and briefly presents some specific techniques (total body irradiation, total cutaneous electron therapy, pre-operation radiotherapy, radio-surgery, hadron-therapy). It proposes an overview of the main indications for this treatment: brain tumours, upper aero digestive tract tumours, bronchial tumours, oesophagus, stomach and pancreas tumours, breast tumours, cervix cancer, rectum tumour, and so on, and indicates the possible associated treatments. The next part addresses brachytherapy. It presents the principles and comments the differences with radiotherapy. It indicates the used radio-elements (Caesium 137, Iridium 192, Iodine 125), describes the implementation techniques (plastic tubes, use of iodine 125, intracavitary and endo-luminal radiation therapy). It proposes an overview of the different treated tumours (skin, breast, prostates, bronchial, oesophagus, ENT) and indicates possible early and late secondary effects for different organs

Radioiodine and radiotherapy in the management of thyroid cancers

International Nuclear Information System (INIS)

Simpson, W.J.

1990-01-01

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

Traumatismes externes du larynx | Ghorbal | Journal Tunisien d'ORL ...

African Journals Online (AJOL)

Le but de ce travail est de rappeler la présentation clinique des traumatismes externes du larynx et d'étayer notre attitude dans la prise en charge de ces ... Introduction: External laryngeal trauma is rare but acutely life-threatening. ... The main presenting symptoms were hoarseness, cervical pain, dyspnea and bleeding.

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

Science.gov (United States)

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

2018-02-01

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

Environmental dose level survey of radiotherapy center in large cancer hospital

International Nuclear Information System (INIS)

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

2009-01-01

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

Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

Energy Technology Data Exchange (ETDEWEB)

Watson, Linda C., E-mail: Linda.watson@albertahealthservices.ca [Department of Interdisciplinary Practice, Community Oncology, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Gies, Donna [Department of Radiation Oncology Nursing, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Thompson, Emmanuel [Department of Mathematics and Statistics, University of Calgary Faculty of Science, Calgary, AB (Canada); Thomas, Bejoy [Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care, Calgary, AB (Canada); Department of Psychosocial Oncology, University of Calgary Faculty of Medicine, Calgary, AB (Canada)

2012-05-01

Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy's questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from

Randomized Control Trial: Evaluating Aluminum-Based Antiperspirant Use, Axilla Skin Toxicity, and Reported Quality of Life in Women Receiving External Beam Radiotherapy for Treatment of Stage 0, I, and II Breast Cancer

International Nuclear Information System (INIS)

Watson, Linda C.; Gies, Donna; Thompson, Emmanuel; Thomas, Bejoy

2012-01-01

Purpose: Standard skin care instructions regarding the use of antiperspirants during radiotherapy to the breast varies across North America. Women have articulated that when instructed to not use antiperspirant, the potential for body odor is distressing. Historical practices and individual opinions have often guided practice in this field. The present study had 2 purposes. To evaluate whether the use of aluminum-based antiperspirant while receiving external beam radiotherapy for stage 0, I, or II breast cancer will increase axilla skin toxicity and to evaluate whether the use of antiperspirant during external beam radiotherapy improves quality of life. Methods: A total of 198 participants were randomized to either the experimental group (antiperspirant) or control group (standard care-wash only). The skin reactions in both groups were measured weekly and 2 weeks after treatment using the National Cancer Institute Common Toxicity Criteria Adverse Events, version 3, toxicity grading criteria. Both groups completed the Functional Assessment for Chronic Illness Therapy’s questionnaire for the breast population quality of life assessment tool, with additional questions evaluating the effect of underarm antiperspirant use on quality of life before treatment, immediately after treatment, and 2 weeks after treatment during the study. Results: The skin reaction data were analyzed using the generalized estimating equation. No statistically significant difference was seen in the skin reaction between the 2 groups over time. The quality of life data also revealed no statistically significant difference between the 2 groups over time. Conclusions: Data analysis indicates that using antiperspirant routinely during external beam radiotherapy for Stage 0, I, or II breast cancer does not affect the intensity of the skin reaction or the self-reported quality of life. This evidence supports that in this particular population, there is no purpose to restrict these women from using

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

Three dimensional conformal radiation therapy (3d-crt) in prostate carcinoma: for whom and how?; La radiotherapie conformationnelle dans le cancer de la prostate: pour qui et comment?

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Bey, P.; Beckendorf, V.; Aletti, P.; Marchesi, V. [Centre Alexis-Vautrin, Dept. de Radiotherapie, 54 - Vandoeuvre-les-Nancy (France)

2002-05-01

External radiotherapy is one of the modalities use o cure localized prostate carcinoma. Most of localized prostate carcinomas, specially those of the intermediate prognostic group, may benefit from escalated dose above 70 Gy at least as regard biochemical and clinical relapse free survival. 3D-CRT allows a reduction of the dose received by organs at risk and an increase of prostate dose over 70 Gy. It is on the way to become a standard. Intensity modulated radiation therapy increases dose homogeneity and reduces rectal dose. These methods necessitate rigorous procedures in reproducibility, delineation of volumes, dosimetry, daily treatment. They need also technological and human means. It is clear that localized prostate cancer is a good example for evaluation of these new radiotherapy modalities. (author)

Radiation for skull base meningiomas: review of the literature on the approach to radiotherapy.

Science.gov (United States)

Moraes, Fabio Y; Chung, Caroline

2017-07-01

Skull base meningiomas (SBM) pose unique challenges for radiotherapy as these tumors are often in close proximity to a number of critical structures and may not be surgically addressed in many cases, leaving the question about the tumor grade and expected biological behaviour. External beam radiotherapy and radiosurgery are longstanding treatments for meningioma that are typically used as upfront primary therapy, for recurrent tumors and as adjuvant therapy following surgical resection. There is controversy regarding the optimal timing and approach for radiation therapy in various clinical settings such as the role of adjuvant radiotherapy for completely resected grade 2 tumours. Despite the use of radiotherapy for many decades, the evidence to guide optimal radiation treatment is limited largely to single institution series of EBRT, SRS and particle therapy. In this article, we review the published data to clarify the role of external beam radiotherapy, proton radiotherapy and single and multi-fraction radiosurgery for SBM. We also highlight the areas of potential research and need for clinical improvement, including the growing awareness and effort to improve cognitive function in this patient population, who typically have long life expectancy following their meningioma diagnosis.

Neoadjuvant hormonal therapy and external-beam radiotherapy versus external-beam irradiation alone for prostate cancer. A quality-of-life analysis

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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.)

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

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

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)

A Simulation Study of a Radiofrequency Localization System for Tracking Patient Motion in Radiotherapy.

Science.gov (United States)

Ostyn, Mark; Kim, Siyong; Yeo, Woon-Hong

2016-04-13

One of the most widely used tools in cancer treatment is external beam radiotherapy. However, the major risk involved in radiotherapy is excess radiation dose to healthy tissue, exacerbated by patient motion. Here, we present a simulation study of a potential radiofrequency (RF) localization system designed to track intrafraction motion (target motion during the radiation treatment). This system includes skin-wearable RF beacons and an external tracking system. We develop an analytical model for direction of arrival measurement with radio frequencies (GHz range) for use in a localization estimate. We use a Monte Carlo simulation to investigate the relationship between a localization estimate and angular resolution of sensors (signal receivers) in a simulated room. The results indicate that the external sensor needs an angular resolution of about 0.03 degrees to achieve millimeter-level localization accuracy in a treatment room. This fundamental study of a novel RF localization system offers the groundwork to design a radiotherapy-compatible patient positioning system for active motion compensation.

A Simulation Study of a Radiofrequency Localization System for Tracking Patient Motion in Radiotherapy

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Mark Ostyn

2016-04-01

Full Text Available One of the most widely used tools in cancer treatment is external beam radiotherapy. However, the major risk involved in radiotherapy is excess radiation dose to healthy tissue, exacerbated by patient motion. Here, we present a simulation study of a potential radiofrequency (RF localization system designed to track intrafraction motion (target motion during the radiation treatment. This system includes skin-wearable RF beacons and an external tracking system. We develop an analytical model for direction of arrival measurement with radio frequencies (GHz range for use in a localization estimate. We use a Monte Carlo simulation to investigate the relationship between a localization estimate and angular resolution of sensors (signal receivers in a simulated room. The results indicate that the external sensor needs an angular resolution of about 0.03 degrees to achieve millimeter-level localization accuracy in a treatment room. This fundamental study of a novel RF localization system offers the groundwork to design a radiotherapy-compatible patient positioning system for active motion compensation.

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

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

KEPUASAN KLIEN DAN KEGUNAAN LAPORAN AUDIT EKSTERNAL STAKE HOLDER (PERSPEKTIF KLIEN AUDIT

Directory of Open Access Journals (Sweden)

Tubagus Ismail

2015-05-01

Full Text Available The purpose of the paper is to test a structural equation model (SEM of client satisfaction with the audit, and of client perception of the usefulness of the audit to external stakeholders. A questionnaire was mailed to audit clients, i.e. of manufacturing go public companies in the province of Banten; 57 useable questionnaires were returned. Data were processed using the SEM software Partial Least Square (PLS. The data suggest that auditors face difficulties in handling divided loyalties, as audit clients perceive a strong relationship between client satisfaction and usefulness to external stakeholders. The higher auditors competence is perceived to be by the clients, the more satisfied they are with the audit and the more useful they believe the audit is to external stakeholders. The more skeptical the auditor is perceived to be by the clients, the less satisfied they are with the audit and the moreuseful they believe the audit is to external stakeholders. The findings extend previous results, the better the relationship with the auditor is perceived to be by the clients, the more satisfied they are with the audit and the less useful they believe the audit is to external stakeholders. The study addresses an issue most auditing research has not explicitly considered: the distinction between client satisfaction with the audit and client perceptions of the usefulness of the audit to external stakeholders. Tujuan dari artikel ini adalah untuk menguji model persamaan struktural (SEM atas kepuasan klien, audit, dan persepsi klien tentang kegunaan audit kepada pemangku kepentingan eksternal. Responden penelititan ini adalah 57 klien audit, yang bekerja di perusahaan manufaktur go public di Provinsi Banten. Data diolah dengan menggunakan software SEM Partial Least Square (PLS. Hasil penelitian menunjukkan bahwa auditor menghadapi kesulitan dalam menangani kesetiaan yang terbagi bagi, antara harus berada pada posisi kepuasan klien dan kegunaan kepada

Development study of a quality control for clinical dosimeters of radiotherapy

International Nuclear Information System (INIS)

Damatto, Willian B.; Potiens, Maria P.A.; Santos, Gelson P.; Vivolo, Vitor

2011-01-01

This paper presents the partial results of a scientific initiation which the main objective is the enhancement of the quality system of the dosimeter calibration laboratory (LCI-IPEN) on 60 Co gamma radiation to the International Atomic Energy Agency (IAEA), being this the new protocol denominated Calibration of Reference Dosimeters for External Beam Radiotherapy (Technical Reports Series 469). This paper is an actualization of the protocol Absorbed Dose Determination for External Beam Radiotherapy (Technical Reports Series 398). Therefore, in this paper it will presented the study on the clinical dosimeters composed of electrometer, wires, triaxial connectors, and thimble type ionization chamber - 0.60 cm 3 . (author)

Practical recommendations for breathing-adapted radiotherapy

International Nuclear Information System (INIS)

Simon, L.; Giraud, P.; Rosenwald, J.C.; Dumas, J.L.; Lorchel, F.; Marre, D.; Dupont, S.; Varmenot, N.; Ginestet, C.; Caron, J.; Marchesi, V.; Ferreira, I.; Garcia, R.

2007-01-01

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

Validation of an amino-acid-based radionuclide therapy plus external beam radiotherapy in heterotopic glioblastoma models

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Israel, Ina [Department of Nuclear Medicine, University of Wuerzburg, D-97080 Wuerzburg (Germany); Blass, Georg [Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg (Germany); Reiners, Christoph [Department of Nuclear Medicine, University of Wuerzburg, D-97080 Wuerzburg (Germany); Samnick, Samuel, E-mail: samnick_s@klinik.uni-wuerzburg.d [Department of Nuclear Medicine, University of Wuerzburg, D-97080 Wuerzburg (Germany)

2011-05-15

Background and purpose: Malignant gliomas represent a major therapeutic challenge because no efficient treatment is currently available. p-[{sup 131}I]iodo-L-phenylalanine ([{sup 131}I]IPA) is a glioma avid radiopharmaceutical that demonstrated antiproliferative and tumoricidal effects in gliomas. The present study validated the therapeutic efficiency of [{sup 131}I]IPA combined with external beam radiotherapy in experimental gliomas. Materials and methods: Glioma cells derived from the primary human A1207, T5135, Tx3868 and M059K glioblastoma cell lines or rat F98 glioma cell line were treated with various doses of [{sup 131}I]IPA, external photon irradiation (RT) or combined [{sup 131}I]IPA/RT treatment. Responsiveness of glioma cells to the different therapy modalities was investigated at 24, 48 and 72 h after treatments by trypan blue, WST-1 assay, propidium iodide and bisbenzimide staining as well as by clonogenic assay. In addition, the therapy-induced DNA damage and repair were evaluated using phosphorylated histone H2AX ({gamma}-H2AX). In vivo, the effectiveness of the combination treatment was validated in human Tx3868 and A1207 glioblastoma xenografts in CD1 nu/nu mice and RNU rats. Results: In vitro, the combination treatment resulted in a greater than additive increase in cytotoxic effect in glioma cell lines. Cell survival rate following a treatment with 1.0 {mu}Ci (37 kBq) of [{sup 131}I]IPA amounted to 70%{+-}15% and 60%{+-}10% after 48 and 72 h, respectively, and decreased under 20% after additional RT with 5 Gy. At higher RT doses, cell survival rate decreased below 5%. As a measure of DNA double-strand break, nuclear {gamma}-H2AX foci were determined as a function of time. Within 24 h, the number of {gamma}-H2AX foci per cell was significantly greater after combined modality compared with the individual treatments. In vivo, when combined with RT, the radionuclide therapy with [{sup 131}I]IPA resulted in an extended tumor growth delay, a reduction

Changes in performance status of elderly patients after radiotherapy

International Nuclear Information System (INIS)

Yamazaki, Hideya; Inoue, Takehiro; Yoshida, Ken

2001-01-01

The purpose of this study was to examine the feasibility of external radiation therapy for patients 80 years old and older. We analyzed changes in the performance status (PS) of 1353 patients by external radiotherapy at Osaka Teishin Hospital. In addition, factors influencing PS change and interruption of treatment were assessed in patients undergoing radical and palliative radiotherapy. Among elderly patients aged 80 years or more (n=67), two patients showed deterioration in PS (3%), whereas 128 (10%) did so among those 79 years old or younger. The rate of treatment completion was 90% (60/67) for patients aged 80 years and over compared with 89% (1146/1286) for younger patients. Changes in PS were more frequent for palliative treatment (improvement 83/683, 12%; deterioration 77/683, 11%) than for radical treatment (improvement 12/305, 4%:, deterioration 21/305, 7%) because patients with better performance status and early disease stages underwent radical treatment. For radical radiotherapy, patients with advanced disease (stages III and IV) showed more changes (improvement 4/108, 4%; deterioration 17/108, 16%) than those with early ones (stages I and II) (improvement 7/132, 5%; deterioration 3/132, 2%) (p<0.01). Better treatment results showed a higher treatment completion rate (CR 99%, PR 86%) than poor treatment results (NC 75%, PD 50%) (p<0.01). For palliative therapy, better performance status (PS 0-2) showed a better correlation with completion of treatment (403/451 or 89%) than did poor performance status (PS 3-4) (174/232, 75%) (p<0.01). Age is not a limiting factor for external radiation therapy. Poor performance status is a significant predisposing factor for interruption of palliative radiotherapy. (author)

Long-term follow-up after modern radical prostate cancer radiotherapy

DEFF Research Database (Denmark)

Sander, Lotte

that clinical target volumes are up to 30% smaller on MRI delineation compared to computer tomography delineation. The overall aim of the thesis was to explore the use of MRI target planning and a Nicle-Titanium prostate stent as fiducial marker for both MR-CT co-registration and image guided radiotherapy....... radiotherapy is a well established treatment modality for prostate cancer. Accuracy and precision are key words with regard to optimal survival and minimal toxicity in modern radiotherapy and are fundamentals in modern radiotherapy. Modern imaging has improved the ability to define radiotherapy target volumes......A significant increase in the prostate cancer incidence has made prostate cancer a major health problem in recent years. Because of the often but unfortunately not always indolent nature of the disease, over-diagnosis and over-treatment are relevant clinical and ethic dilemmas. External beam...

Quality of life assessment with different radiotherapy schedules in palliative management of advanced carcinoma esophagus: A prospective randomized study

Directory of Open Access Journals (Sweden)

Shaveta Mehta

2008-01-01

Full Text Available Aim: To investigate the quality of life (QOL of patients with advanced carcinoma esophagus treated with different palliative radiation schedules. Methods: Sixty-two consecutive patients with inoperable, non-metastatic carcinoma of the esophagus were randomly allocated to Arm-A (external radiotherapy 30 Gy/10 fractions + brachytherapy 12 Gy/two sessions, Arm-B (external radiotherapy 30 Gy /10 fractions and Arm-C (external radiotherapy 20Gy /five fractions. The QOL was assessed using the European Organization for Research and Treatment of Cancer questionnaire at presentation, after treatment and at 3 months follow-up. Results: The mean QOL score improved, in arm-A from 38 to 52 after treatment and 56 at 3 months, in arm-B from 30 to 44 after treatment and 55 at 3 months and in arm-C from 24 to 40 after treatment but decreased to 37 at 3 months. Improvement in dysphagia scores at the first follow-up was 46.1% in arm-A, 25.0% in arm-B and 22.6% in arm-C. The difference was maintained at 3 months, with maximum improvement in arm-A (57.6%. No significant differences were found between the three arms with regard to complications and additional procedures needed for relief of dysphagia. Conclusion: In comparison with external radiotherapy alone, external radiotherapy with intraluminal brachytherapy has shown a trend toward better QOL and consistent dysphagia relief without significant difference in adverse effects.

Radiotherapy for pituitary adenoma: long-term outcome and sequelae

International Nuclear Information System (INIS)

McCord, Mark W.; Buatti, John M.; Fennell, Eileen M.; Mendenhall, William M.; Marcus, Robert B.; Rhoton, Albert L.; Grant, Maria B.; Friedman, William A.

1997-01-01

Purpose: To review outcome and treatment sequelae in patients treated with external beam radiotherapy for pituitary adenomas. Methods and Materials: One hundred forty-one patients with pituitary adenomas received radiotherapy at the University of Florida and had 2-year minimum potential follow-up. One hundred twenty-one had newly diagnosed adenomas, and 20 had recurrent tumors. Newly diagnosed tumors were treated with surgery and radiotherapy (n = 98) or radiotherapy alone (n = 23). Patients with recurrent tumors received salvage treatment with surgery and radiotherapy (n = 10) or radiotherapy alone (n = 10). The impact of age, sex, presenting symptoms, tumor extent, surgery type, degree of resection, hormonal activity, primary or salvage therapy, and radiotherapy dose on tumor control was analyzed. Tumor control is defined by the absence of radiographic progression and stable or decreased hormone level (in hormonally active tumors) after treatment. Effect of therapy on vision, hormonal function, neurocognitive function, life satisfaction, and affective symptoms were examined. A Likert categorical scale survey was used for assessment of neurocognitive, life satisfaction, and affective symptom status. Survey results from the radiotherapy patients were compared with a control group treated with transsphenoidal surgery alone. Multivariate analysis used the forward step-wise sequence of chi squares for the log rank test. Results: At 10 years, tumor control for the surgery and radiotherapy group (S + RT) was 95% and not statistically different (p = 0.58) than for patients treated with radiotherapy alone (RT) (90%). Patients with prolactin- and ACTH-secreting tumors had significantly worse tumor control, as did patients treated for recurrent tumors. Multivariate analysis for tumor control revealed that only young age was predictive of worse outcome (p = 0.0354). Visual function was either unaffected or improved in most patients, although four patients developed visual

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)

Use of 'sham' radiotherapy in randomized clinical trials

International Nuclear Information System (INIS)

Schwarz, F.; Christie, D.

2008-01-01

The objective of this systematic review was to identify quality trials that use sham radiotherapy in their design and review them to determine its potential value. The Cochrane Library, Pubmed and a Reference Search served as data sources. Trials were included if they met a minimum quality score of 3 on a validated assessment instrument (which assesses randomization, control and blinding) and if they compared sham radiotherapy to active treatment. External beam therapy and brachytherapy trials were considered. Twenty-six trials were identified, collectively including 2663 participants in the period of 1970-2004. All the trials studied the value of radiotherapy for treatment or prevention of benign diseases, including multiple sclerosis, coronary artery restenosis, age-related macular degeneration and Graves' ophthalmopathy. There were no trials relating to the use of radiotherapy in the treatment of malignancy. This review showed that it is possible to carry out sham radiotherapy with due regard for ethical concerns, with effective blinding and high levels of patient acceptance. Large sample sizes with multicentre trial designs were achievable. Although the statistical philosophy for using sham radiotherapy in trials is legitimate, it is no longer routinely used.

Implementation of a system for external audits beam radiation therapy in terms of reference no

International Nuclear Information System (INIS)

Alonso Samper, Jose Luis; Dominguez, Lourdes; Alert Silva, Jose; Alfonso Laguardia, Rodolfo; Larrinaga Cortina, Eduardo; Garcia Yip, Fernando; Rodriguez Machado, Jorge; Morales Lopez, Jorge Luis; Silvestre Patallo, Ileana

2009-01-01

This paper presents our experience in implementing a external audit system for radiotherapy beam in no reference conditions with the use of CIRS and a summary of the measurements with him made.This paper presents our experience in implementing a external audit system for radiotherapy beam in no reference conditions with the use of CIRS and a summary of the measurements with him made. Centers were audited with external beam high-energy Co-60, 6 MV and 15 MV and were considered 4 treatment planning systems (TPS): AMEPLAN, Theraplan Plus, Precise Plan and MIRS to calculate doses prescribed in each test case. All measurements were acquired by the audit team using the anthropomorphic phantom CIRS, Semiflex chamber PTW 31010 and PTW electrometer STATES. The implementation and development of the external audits of beams radiotherapy in terms of 'no reference' has brought an improvement in both clinical aspects of treatment and the radiation safety and the quality control, has given us greater confidence and for this reason we believe has become essential. (Author)

Comparative Analysis between preoperative Radiotherapy and postoperative Radiotherapy in Clinical Stage I and II Endometrial Carcinoma

International Nuclear Information System (INIS)

Keum, Ki Chang; Lee, Chang Geol; Chung, Eun Ji; Lee, Sang Wook; Kim, Woo Cheol; Chang, Sei Kyung; Oh, Young Taek; Suh, Chang Ok; Kim, Gwi Eon

1995-01-01

Purpose : To obtain the optical treatment method in patients with endometrial carcinoma(clinical stage FIGO I, II) by comparative analysis between preoperative radiotherapy(pre-op R) and postoperative radiotherapy(post-op RT). Materials and Methods : A retrospective review of 62 endometrial carcinoma patients referred to the Yonsei Cancer Center for radiotherapy between 1985 and 1991 was undertaken. Of 62 patients, 19 patients(Stage I; 12 patients, Stage II; 7 patients) received pre-op RT before TAH(Total Abdominal Hysterectomy) and BSO(Bilateral Salphingoophorectomy) (Group 1) and 43 patients( Stage 1; 32 patients, Stage 2; 11 patients) received post-op RT after TAH and BSO (Group 2). Pre-op irradiation was given 4-6 weeks prior to surgery and post-op RT was administered on 4-5 weeks following surgery. All patients exept 1 patient(Group2; ICR alone) received external irradiation. Seventy percent(13/19) of pre-op RT group and 54 percent(23/42) of post-op RT group received external pelvic irradiation and intracavitary radiation therapy(ICR). External radiation dose was 39.6-55Gy(median 45Gy) in 5-6 week through opposed AP/PA fields or 4-field box technique treating daily, five days per week, 180cGy per fraction. ICR doses were prescribed to point A(20-39.6 Gy, median 39Gy) in Group 1 and 0.5cm depth from vaginal surface (18-30 Gy, median 21Gy) in Group2. Results : The overall 5 year survival rate was 95%. No survival difference between pre-op and post-op RT group.(89.3% vs 97.7%, p>0.1) There was no survival difference by stage, grade and histology between two groups. The survival rate was not affected by presence of residual tumor of surgical specimen after pre-op RT in Group 1(p>0.1), but affected by presence of lymph node metastasis in post-op RT group(p<0.5). The complication rate of pre-op RT group was higher than post-op RT.(16% vs 5%) Conclusion : Post-op radiotherapy offers the advantages of accurate surgical-pathological staging and low complication rate

Guidelines for primary radiotherapy of patients with prostate cancer

International Nuclear Information System (INIS)

Boehmer, Dirk; Maingon, Philippe; Poortmans, Philip; Baron, Marie-Helene; Miralbell, Raymond; Remouchamps, Vincent; Scrase, Christopher; Bossi, Alberto; Bolla, Michel

2006-01-01

Background and purposes: The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. Patients and methods: Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information. Results: Target volume definitions for different risk groups of prostate cancer patients based on pathological and imaging studies are provided. Available imaging modalities, patient positioning and treatment preparation studies as well as verification procedures are collected from literature studies. These studies are summarised and recommendations are given where appropriate. Conclusions: On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group this article presents a common set of recommendations for external beam radiotherapy of patients with prostate cancer

Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline

International Nuclear Information System (INIS)

Lutz, Stephen; Berk, Lawrence; Chang, Eric; Chow, Edward; Hahn, Carol; Hoskin, Peter; Howell, David; Konski, Andre; Kachnic, Lisa; Lo, Simon; Sahgal, Arjun; Silverman, Larry; Gunten, Charles von; Mendel, Ehud; Vassil, Andrew; Bruner, Deborah Watkins; Hartsell, William

2011-01-01

Purpose: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. Conclusions: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use

Metastatic tumor of thoracic and lumbar spine: prospective study comparing the surgery and radiotherapy vs external immobilization with radiotherapy; Metastases do segmento toracico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirurgico e radioterapico com a imobilizacao externa e radioterapia

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Falavigna, Asdrubal; Ioppi, Ana Elisa Empinotti; Grasselli, Juliana [Universidade de Caxias do Sul, RS (Brazil). Faculdade de Medicina]. E-mail: asdrubal@doctor.com; Righesso Neto, Orlando [Faculdade Federal de Ciencias Medicas da Santa Casa de Sao Paulo, SP (Brazil)

2007-09-15

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)

Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer. Changing focus from rectal bleeding to detailed quality of life analysis

International Nuclear Information System (INIS)

Yamazaki, Hideya; Nakamura, Satoaki; Nishimura, Takuya; Yoshida, Ken; Yoshioka, Yasuo; Koizumi, Masahiko; Ogawa, Kazuhiko

2014-01-01

With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (1) because of the increasing number of patients aged >80 years, and (2) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment. (author)

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.

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

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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

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)

Evidence-based optimal number of radiotherapy fractions for cancer: A useful tool to estimate radiotherapy demand.

Science.gov (United States)

Wong, Karen; Delaney, Geoff P; Barton, Michael B

2016-04-01

The recently updated optimal radiotherapy utilisation model estimated that 48.3% of all cancer patients should receive external beam radiotherapy at least once during their disease course. Adapting this model, we constructed an evidence-based model to estimate the optimal number of fractions for notifiable cancers in Australia to determine equipment and workload implications. The optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the evidence-based recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of variables on the model. Of the 27 cancer sites, the optimal number of fractions for the first course of radiotherapy ranged from 0 to 23.3 per cancer patient, and 1.5 to 29.1 per treatment course. Brain, prostate and head and neck cancers had the highest average number of fractions per course. Overall, the optimal number of fractions was 9.4 per cancer patient (range 8.7-10.0) and 19.4 per course (range 18.0-20.7). These results provide valuable data for radiotherapy services planning and comparison with actual practice. The model can be easily adapted by inserting population-specific epidemiological data thus making it applicable to other jurisdictions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

Analysis of oral cancer treated by preoperative radiotherapy

International Nuclear Information System (INIS)

Hosokawa, Yoichiro; Kaneko, Masayuki; Yasuda, Motoaki

1997-01-01

Fifty-eight patients with squamous cell carcinoma of the oral region, treated by preoperative radiotherapy between January 1988 and December 1993, were reviewed to evaluate the relation between prognosis and pathological findings after preoperative radiotherapy. All patients underwent external radiotherapy of up to 40 Gy in 16 fractions (2.5 Gy a day, 4 fractions a week) before surgery, and the average term from the end of preoperative radiotherapy to surgery were 27.3 days. According to pathological findings during surgery, the patients were divided into a radiation effective group and a radiation noneffective group. There was a significant difference in the survival rates of the two groups, but there was no difference in local control rates. After surgery, regional lymph node metastasis and distant metastasis were more common in the radiation noneffective group than in the radiation effective group. It was considered that regional lymph node metastasis after treatment in the noneffective group is the determining factor in the progress. (author)

A Case of Post-Radiotherapy Gastritis: Radiation Does Not Explain Everything

Directory of Open Access Journals (Sweden)

André Abrunhosa-Branquinho

2014-01-01

Full Text Available Hemorrhagic gastritis is a possible late toxicity outcome after radical radiotherapy but it is nowadays a very rare condition and most likely depends on other clinical factors. We report the case of a 77-year-old woman with a symptomatic solitary extramedullary intra-abdominal plasmacytoma and multiple gastric comorbidities, treated with external beam radiotherapy. Despite the good response to radiotherapy, the patient experienced multiple gastric bleeding a few months later, with the need of multiple treatments for its control. In this paper we will discuss in detail all aspects related to the different causes of hemorrhagic gastritis.

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

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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)

STRATEGI PENINGKATAN KETAHANAN PANGAN DINAS PERTANIAN DAN KETAHANAN PANGAN KOTA TANGERANG SELATAN

Directory of Open Access Journals (Sweden)

Dini Maharani Arum Rimadianti

2016-09-01

Full Text Available ABSTRACTThe objectives of this study were to analyze the food security condition, to analyze the external and internal factors that affect food security and to formulate strategies for improving food security in Tangerang Selatan. The primary data was collected by conducting a focus group discussion and questionnaire filling with purposive sampling technique. Descriptive method on secondary data such as food availability was used to analyze the food security condition. Internal Factor Evaluation (IFE matrix and External Factor Evaluation (EFE matrix were used to formulate strategies. Strengths, Weakness, Opportunities, and Threats (SWOT matrix was used to determine the alternative strategies and Quantitative Strategic Planning Matrix (QSPM was used to determine among feasible alternative strategies. The results showed that the most important internal factor is commitment of the regional leader and the most important external factor is geographical location of Tangerang Selatan. The total weighted score IFE matrix of 2.86 is average and EFE matrix of 2.81 is above the average. The SWOT matrix showed that the government of Tangerang Selatan may need to “improve food availability” because of “food price volatility”. The QSPM sum total attractiveness scores of 3.76 indicate that the government of Tangerang Selatan should “improve triple helix relations among university, industry, and government” as the strategy to improve food security in South Tangerang.Keywords: EFE matrix, food security, IFE matrix, QSPM, SWOTABSTRAKTujuan dari penelitian ini adalah untuk menganalisis kondisi ketahanan pangan, menganalisis faktor eksternal dan internal yang memengaruhi ketahanan pangan serta merumuskan strategi guna meningkatkan kondisi ketahanan pangan di Kota Tangerang Selatan. Data primer diperoleh berdasarkan hasil focus group discussion dan pengisian kuesioner oleh subjek terpilih. Analisis deskriptif pada data sekunder antara lain ketersediaan

On the implementation of new versions of the algorithms of calculation of dose absorbed in radiotherapy external; Sobre la implementacion de nuevas versiones de los algoritmos de calculo de dosis absorbida en radioterapia externa

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Latorre-Musoll, A.; Carrasco de Fez, P.; Lizondo Gisbert, M.; Jordi-Ollero, O.; Jornet Sala, N.; Eudaldo Puell, T.; Ruiz Martinez, A.; Ribas Morales, M.

2015-07-01

The changes of version of the algorithms of calculation of dose absorbed in radiotherapy external should implement in a time reduced due to the pressure care. A set reduced of checks could pass by high discrepancies significant between the stones and the measures experimental, as illustrate in this work. (Author)

[Head and neck adaptive radiotherapy].

Science.gov (United States)

Graff, P; Huger, S; Kirby, N; Pouliot, J

2013-10-01

Onboard volumetric imaging systems can provide accurate data of the patient's anatomy during a course of head and neck radiotherapy making it possible to assess the actual delivered dose and to evaluate the dosimetric impact of complex daily positioning variations and gradual anatomic changes such as geometric variations of tumors and normal tissues or shrinkage of external contours. Adaptive radiotherapy is defined as the correction of a patient's treatment planning to adapt for individual variations observed during treatment. Strategies are developed to selectively identify patients that require replanning because of an intolerable dosimetric drift. Automated tools are designed to limit time consumption. Deformable image registration algorithms are the cornerstones of these strategies, but a better understanding of their limits of validity is required before adaptive radiotherapy can be safely introduced to daily practice. Moreover, strict evaluation of the clinical benefits is yet to be proven. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Beam monitoring in radiotherapy and hadron-therapy

International Nuclear Information System (INIS)

Fontbonne, J.M.

2012-01-01

Radiotherapy techniques have evolved over the past twenty years. For photon beams, the development of tools such as multi leaf collimators, machines such as Cyberknife or tomo-therapy, have improved the conformation of treatments to the tumor volume and lowered maximum dose to healthy tissue. In another register, the use of proton-therapy is expanding in all countries and the development of carbon ions beams for hadron-therapy is also increasing. If techniques improve, the control requirements for the monitoring of the dose administered to patients are always the same. This document presents, first, the ins and outs of the different techniques of external beam radiotherapy: photon treatments, protons and hadrons. Starting from the basis of clinical requirements, it sets the variables to be measured in order to ensure the quality of treatment for the different considered modalities. It then describes some implementations, based on precise and rigorous specifications, for the monitoring and measurement of beams delivered by external beam radiotherapy equipments. Two instrumental techniques are particularly highlighted, plastic scintillators dosimetry for the control of megavoltage photon beams and ionization chamber dosimetry applied to proton-therapy or radiobiology experiments conducted at the GANIL facility. Analyzes and perspectives, based on the recent developments of treatment techniques, are delivered in conclusion and can serve as guide for future instrumental developments. (author)

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; Miandoab, Payam Samadi; Baghizadeh, Amin

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Harriet B. Eldredge-Hindy

2014-01-01

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

Item 141 Radiotherapy. Radiobiological notions; main secondary effects

International Nuclear Information System (INIS)

Azria, David; Dubois, Jean-Bernard

2006-11-01

This document first gives definitions of ionizing radiations, photons, electrons and Gray (as a dose unit). It describes the mechanisms of action of ionizing radiations: physical, chemical, cellular actions, actions on tissues. It analyses and discusses the factors influencing the effects of radiations: intrinsic radio-sensitivity, cellular cycle, oxygen, time (session fractioning and organisation in time), and dose. The different types of radiotherapy are then presented: external radiotherapy, brachytherapy, radio-immunotherapy of internal radiotherapy. It discusses tissues tolerance doses and doses required to sterilize tumours, and discusses the various and main secondary effects: stochastic secondary effects and deterministic secondary effects. A table indicates possible early and late reactions for different organs (skin, lung, brain, medulla, nerves, oesophagus, heart, pancreas, stomach, liver, intestine, kidney, bladder, rectum, ENT, or eye's lens)

Radiotherapy for local progression in patients with hormone-refractory prostate cancer

International Nuclear Information System (INIS)

Furuya, Yuzo; Akakura, Koichiro; Akimoto, Susumu; Ichikawa, Tomohiko; Ito, Haruo

1999-01-01

The aim of the present study was to investigate the effect of radiotherapy on the local progression of hormone-refractory prostate cancer. From 1986 to 1995, 38 patients were diagnosed with local progression without distant progression after hormonal therapy at Chiba University Hospital. Eleven cases were treated with irradiation for local progression. External beam irradiation was delivered to the prostate at a dose of 50-66.6 Gy. In patients treated with radiotherapy, the duration from initial treatment to local recurrence was 6-80 months (mean±SD: 33.9±22.9 months). The follow-up period after irradiation was 7-64 months (mean±SD: 25.4±18.8 months). Three and 5 year cause-specific survival rates from radiotherapy were 46.2 and 23.1%, respectively. Radiotherapy had a marked effect on symptoms associated with local progression and no patients suffered from the symptoms after the radiotherapy. Complications of radiotherapy were limited. In patients with hormone refractory local progression without distant progression, low morbidity, low mortality radiotherapy offers a variable therapy to other palliative treatments because radiotherapy is able to control local symptoms for a long period of time. (author)

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

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

1987-07-01

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

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

International Nuclear Information System (INIS)

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

1987-01-01

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

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.

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

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

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.

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.)

Hormone levels in radiotherapy treatment related fatigue

International Nuclear Information System (INIS)

Biswal, B.M.; Mallik, G.S.

2003-01-01

Radiotherapy is known to cause debilitating treatment related fatigue. Fatigue in general is a conglomeration of psychological, physical, hematological and unknown factors influencing the internal milieu of the cancer patient. Radiotherapy can add stress at the cellular and somatic level to aggravate further fatigue in cancer patients undergoing radiotherapy. Stress related hormones might be mediating in the development of fatigue. This is an ongoing prospective study to evaluate if the hormonal profile related to stress is influenced by radiotherapy treatment related fatigue. The study was conducted from September 2002 onwards in the division of Radiotherapy and Oncology of our Medical School. Previously untreated patients with histopathology proof of malignancy requiring external beam radiotherapy were considered for this study. Selection criteria were applied to exclude other causes of fatigue. Initial fatigue score was obtained using Pipers Fatigue Score questionnaire containing 23 questions, subsequently final fatigue score was obtained at the end of radiotherapy. Blood samples were obtained to estimate the levels of ACTH, TSH, HGH, and cortisol on the final assessment. The hormone levels were compared with resultant post radiotherapy fatigue score. At the time of reporting 50 patients were evaluable for the study. The total significant fatigue score was observed among 12 (24%) patients. The individual debilitating fatigue score were behavioral severity 14 (28%), affective meaning 14(28%), Sensory 13 (26%) and cognitive mood 10 (20%) respectively. From the analysis of hormonal profile, growth hormone level > 1 ng/mL and TSH <0.03 appears to be associated with high fatigue score (though statistically not significant); whereas there was no correlation with ACTH and serum cortisol level. In our prospective study severe radiotherapy treatment related fatigue was found among our patient population. Low levels of TSH and high levels of GH appear to be associated

Radiotherapy for prostatic cancer in patients aged 75 or older

International Nuclear Information System (INIS)

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

2000-01-01

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

Thyroid dysfunction following radiotherapy for head and neck cancer

International Nuclear Information System (INIS)

Turner, S.L.; Tiver, K.W.; Boyages, S.C.

1995-01-01

Purpose: To determine the frequency of hypothyroidism (both subclinical and clinical) following external beam radiotherapy to the whole of the thyroid gland in the treatment of squamous cell cancers of the head and neck. Methods and Materials: One hundred and four patients who had completed radiotherapy 30 days to 5 years earlier (84 patients) or who were scheduled for radiotherapy (20 patients) had a single measurement of serum-free thyroxine and thyroid stimulating hormone levels between August 1991 and May 1992. Results: None of the 20 patients assessed prior to treatment showed thyroid dysfunction. Twenty of 84 (23.8%) previously treated patients had subclinical (9.5%) or clinical (14.3%) hypothyroidism. By 5 years, up to 40% of patients may become hypothyroid. Thyroid underactivity was significantly more common in patients having both laryngectomy (including hemi-thyroidectomy) and radiotherapy compared to radiotherapy alone (p < 0.001). Hypothyroidism had not been suspected clinically in any patient tested. Conclusion: In view of the frequency and potential morbidity of this complication, thyroid function testing should become a routine part of posttreatment follow-up for these patients

Radiotherapy in Cancer Management at Ahmadu Bello University ...

African Journals Online (AJOL)

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

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

The management of carcinoma of the anal canal by external beam radiotherapy, experience in Vancouver 1971-1988

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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.

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)

PENGARUH PERSEPSI DUKUNGAN ORGANISASI EKSTERNAL DAN INTERNAL MELALUI KOMITMEN KARYAWAN TERHADAP KEBERHASILAN PERUSAHAAN PERBANKAN DI JAWA TIMUR

Directory of Open Access Journals (Sweden)

J.F.X Susanto Soekiman

2007-01-01

Full Text Available The objectives of this research is to find out these following maters: the influence of perception external organizational support toward perception internal organizational support, the influence of perception external organizational support toward employee commitments, the influence of perception internal organizational support toward employee commitments, the influence of employee commitments toward companies success, the influence of perception external organizational support toward companies success, and the influence of perception internal organizational support toward companies success. This research uses survey and questioners as the tools in collecting data. The data were obtained from 156 consumer of 39 bank in East Java. Data analyzed using the Structural Equation Modeling (SEM with AMOS 4.0 program. The results of the research showed the following results: perception external organizational support has positive and significant effect on perception internal organizational support, perception external organizational support has positive and significant effect on employee commitments, perception internal organizational support has positive and significant effect on employee commitments, employee commitments has positive and significant effect on companies success, perception external organizational support has no significant effect on companies success, and perception internal organizational support has no significant effect on companies success of Banking business especially in East Java. Abstract in Bahasa Indonesia : Tujuan penelitian ini adalah untuk mengetahui pengaruh persepsi dukungan organisasi eksternal terhadap persepsi dukungan organisasi internal, pengaruh persepsi dukungan organisasi eksternal terhadap komitmen karyawan, pengaruh persepsi dukungan organisasi internal terhadap komitmen karyawan, pengaruh komitmen karyawan terhadap keberhasilan perusahaan, pengaruh persepsi dukungan organisasi eksternal terhadap keberhasilan

Combined intraoperative and external irradiation of the celiac artery in the rabbit: Effects on gastric mucosal blood flow; Kombinierte intraoperative und externe Bestrahlung der Arteria coeliaca beim Kaninchen: Auswirkungen auf die Durchblutung der Magenschleimhaut

Energy Technology Data Exchange (ETDEWEB)

Doerr, W. [Universitaetsklinikum Carl Gustav Carus, Dresden (Germany). Klinik und Poliklinik fuer Strahlentherapie]|[GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Kallfass, E. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Berg, D. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Kummermehr, J. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany)

1996-12-01

Aim: To demonstrate changes in gastric mucosal blood flow caused by intraoperative radiotherapy of the celiac artery combined with external radiotherapy of the upper abdomen in a rabbit model. The study was designed to identify a possible correlation between a radiation-induced reduction in mucosal blood flow and the induction of gastric ulcer. Material and Method: Intraoperative radiation doses of 0 or 30 Gy were given to the celiac artery in rabbits. After a delay of 14 days external radiotherapy of the upper abdomen with 3x4 Gy/week to a maximum total dose of 40 Gy was initiated. Gastric mucosal blood flow was assessed by intraventricular injection of radioactively-labelled microspheres (15 {mu}m) followed by measurement of radioactivity in the mucosa. The injections were performed at various time intervals between 2 and 63 days after intraoperative radiation. Results: Intraoperative radiotherapy, including sham-intraoperative radiation, resulted in a transitory reduction of mucosal blood flow by about 50% of the control value on day 7. After a temporary recovery by day 14, a marked and permanent reduction in blood flow was assessed after week 6. This time corresponds to the time of development of gastric ulcer. Conclusions: A relationship between the time of ulcer development and of reduced gastric mucosal blood flow was observed after combined intraoperative and external radiotherapy. The mechanical component of intraoperative treatment has to be emphasized. Reduced blood flow was also seen after intraoperative radiotherapy alone, without an induction of ulcer by this treatment. Hence additional mucosal damage by external radiation must be present for the induction of gastric ulcer. (orig.) [Deutsch] Ziel: Untersuchung der Veraenderungen der Magenschleimhautdurchblutung am Kaninchen als Folge einer kombinierten intraoperativen Bestrahlung der Arteria coeliaca und externen Bestrahlung des Oberbauchs. Durch diesen Ansatz sollte ein moeglicher Zusammenhang

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

International Nuclear Information System (INIS)

Schiochet, Luc

2010-01-01

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

Treatment of acromegaly by external irradiation

Energy Technology Data Exchange (ETDEWEB)

Macleod, A.F.; Clarke, D.G.; Pambakian, H.; Lowy, C.; Sonksen, P.H.; Collins, C.D. (Saint Thomas' Hospital, London (UK))

1989-03-01

Despite hypophysectomy as the primary treatment in acromegaly, external radiotherapy maintains a role as a relatively slow but effective therapy for inadequately treated patients or those unsuitable for operation. Over the last 25 years the authors' regimen has differed from published series in that they give a larger dose per fraction, with fewer treatments. They have analysed the efficacy and side-effects of this regimen in 27 subjects with acromegaly. Growth hormone levels have fallen by, on average, 27% per year in the first five years, 83% of subjects achieving a basal growth hormone of <10mU/1. The acute and chronic side-effects of irradiation are discussed, including the relevance of estimates of biological potency, for example Time Dose Fraction (TDF). One patient suffered visual loss that was most likely to be secondary to the radiotherapy. Histological appearances of the pituitary fossa in five subjects previously treated with radiotherapy are reported. (author).

Treatment of acromegaly by external irradiation

International Nuclear Information System (INIS)

Macleod, A.F.; Clarke, D.G.; Pambakian, H.; Lowy, C.; Sonksen, P.H.; Collins, C.D.

1989-01-01

Despite hypophysectomy as the primary treatment in acromegaly, external radiotherapy maintains a role as a relatively slow but effective therapy for inadequately treated patients or those unsuitable for operation. Over the last 25 years the authors' regimen has differed from published series in that they give a larger dose per fraction, with fewer treatments. They have analysed the efficacy and side-effects of this regimen in 27 subjects with acromegaly. Growth hormone levels have fallen by, on average, 27% per year in the first five years, 83% of subjects achieving a basal growth hormone of <10mU/1. The acute and chronic side-effects of irradiation are discussed, including the relevance of estimates of biological potency, for example Time Dose Fraction (TDF). One patient suffered visual loss that was most likely to be secondary to the radiotherapy. Histological appearances of the pituitary fossa in five subjects previously treated with radiotherapy are reported. (author)

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)

Pengaruh Struktur Kepemilikan Saham Leverage Faktor Intern Dan Faktor Ekstern Terhadap Nilai Perusahaan (Studi empirik pada perusahaan manufaktur dan non manufaktur di Bursa Efek Jakarta

Directory of Open Access Journals (Sweden)

Sujoko

2007-01-01

Full Text Available The main objective of the study is to examine the impact of ownership structure%2C leverage%2C external factor%2C internal factor on the value of the firms in Jakarta Stock Exchange. It is argued that unlike the agency problem advanced stock market%2C the agency problem in the Jakarta Stock Exchange is the divergence of interest between the minority holders and majority holders. This is because the Jakarta Stock Exchange is characterized%2C among other things%2C by the domination of large shareholders. It is hypotheses that :(1 there are the impact ownership structure %2C external factor%2C internal factor%2C on leverage%2C (2 there are the impact of ownership structure %2C external factor%2C internal factor%2C leverage on value of the firm . This study is to examine Agency Theory%2C Jensen and Meckling (1976%2C Pecking Order Theory%2C Myers (1984%2C Trade Off Model and Signaling Theory (1979. Population in this study are public company listed in Jakarta Stock Exchange during 2000 – 2004. As much as 134 firms listed in Jakarta Stock Exchange were taken as a sample using a purposive sampling method.The data were then analyzed by the structural equation modeling ( SEM analysis%2C using the AMOS Program version 4.01.The results of this study show that (1 there are the impact of ownership structure %2C external factor%2C internal factor on leverage%2C(2there are the impact of ownership structure%2C external factor%2C internal factor%2C leverage%2C on valueof the firm . The result of the study is not support the Agency Theory%2C Jensen and Meckling (1976%2C but the result of the study is support Pecking Order Theory%2C Myers (1984%2C Trade off model and Signaling Theory%2C Battacharya (1979. Abstract in Bahasa Indonesia : Tujuan utama dari studi ini adalah untuk menguji pengaruh struktur kepemilikan%2C leverage%2C faktor ekstern%2C dan faktor intern terhadap nilai perusahaan di Bursa Efek Jakarta. Tidak seperti pada permasalahan keagenan di pasar

Quality of life outcomes after primary radiotherapy for squamous cell carcinoma of the base of tongue

International Nuclear Information System (INIS)

Moore, Giselle J.; Parsons, James T.; Mendenhall, William M.

1996-01-01

Purpose: To determine quality of life functional outcome after primary radiotherapy for carcinoma of the base of tongue. Methods and Materials: At the University of Florida, essentially all patients with squamous cell carcinoma of the base of tongue are treated with primary continuous-course, external-beam radiotherapy alone or followed by a neck dissection. Fifty-three patients who remained continuously free of disease at 2 to 23 years were eligible to participate in an assessment of the posttreatment quality of their lives. Three patients could not be located for quality of life assessment, and one patient refused to participate, leaving 49 evaluable patients. Radiotherapy doses were 60 to 75 Gy in once daily fractions, or 74 to 79 Gy in twice daily fractions. The subjective Performance Status Scale for Head and Neck Cancer, which assigns a functional score ranging from 0 to 100, was completed by each of the patients during routine follow-up appointments. The scale measures ability to eat in public, understandability of speech, and normalcy of diet. Results: Patients treated with external-beam radiotherapy alone had excellent results with regard to eating in public, though scores showed a decline as T stage increased (average scores were T1: 90.6%; T2: 88.1%; T3: 82.8%; T4: 75.0%). Results for understandability of speech were T1: 93.75%; T2: 100%; T3: 82.8%; and T4: 87.5%. Fixation of the tongue at diagnosis was not a predictor of poor function. Normalcy of diet scores likewise decreased with increasing T stage: T1: 93.8%; T2: 89.5%; T3: 71.3%; T4: 60.0%. The addition of a neck dissection had no impact on the functional outcomes that were evaluated. Functional results did not deteriorate with prolonged follow-up of more than 5 years. Results were compared with those from the literature for patients treated by surgery plus postoperative radiotherapy or external-beam irradiation plus interstitial 192 Ir implant. The functional results of high-dose external

Worldwide QA networks for radiotherapy dosimetry

International Nuclear Information System (INIS)

Izewska, J.; Svensson, H.; Ibbott, G.

2002-01-01

A number of national or international organizations have developed various types and levels of external audits for radiotherapy dosimetry. There are three major programmes who make available external audits, based on mailed TLD (thermoluminescent dosimetry), to local radiotherapy centres on a regular basis. These are the IAEA/WHO TLD postal dose audit service operating worldwide, the European Society for Therapeutic Radiology and Oncology (ESTRO) system, EQUAL, in European Union (EU) and the Radiological Physics Center (RPC) in North America. The IAEA, in collaboration with WHO, was the first organization to initiate TLD audits on an international scale in 1969, using mailed system, and has a well-established programme for providing dose verification in reference conditions. Over 32 years, the IAEA/WHO TLD audit service has checked the calibration of more than 4300 radiotherapy beams in about 1200 hospitals world-wide. Only 74% of those hospitals who receive TLDs for the first time have results with deviation between measured and stated dose within acceptance limits of ±5%, while approximately 88% of the users that have benefited from a previous TLD audit are successful. EQUAL, an audit programme set up in 1998 by ESTRO, involves the verification of output for high energy photon and electron beams, and the audit of beam parameters in non-reference conditions. More than 300 beams are checked each year, mainly in the countries of EU, covering approximately 500 hospitals. The results show that although 98% of the beam calibrations are within the tolerance level of ±5%, a second check was required in 10% of the participating centres, because a deviation larger than ±5% was observed in at least one of the beam parameters in non-reference conditions. EQUAL has been linked to another European network (EC network) which tested the audit methodology prior to its application. The RPC has been funded continuously since 1968 to monitor radiation therapy dose delivery at

Experience of the Casablanca radiotherapy-oncology centre on radiotherapy in the treatment of the adult Hodgkin lymphoma; Experience du centre de radiotherapie-oncologie de Casablanca sur la radiotherapie dans le traitement du lymphome de Hodgkin de l'adulte

Energy Technology Data Exchange (ETDEWEB)

Bouchbika, Z.; Benchakroun, N.; Sellai, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Benider, A. [Service radiotherapie-oncologie, CHU Ibn-Rochd, Casablanca (Morocco)

2011-10-15

The authors report the assessment of the local control, global survival and survival without recurrence, and also late complications, based on retrospective study over 8 years of 169 cases Hodgkin lymphoma in patients older than 18 (average age of 34) and who had been submitted to radiotherapy. Survival has been computed according to the Kaplan-Meier method. The authors notice that the recurrence rate is slightly higher than in the literature. During the considered period, radiotherapy was two-dimensional with higher doses than those corresponding to current standards. The improvement of radiotherapy techniques and the decrease of doses within the standards should improve the therapeutic results. Short communication

Radiotherapy enhances laser palliation of malignant dysphagia: a randomised study

Energy Technology Data Exchange (ETDEWEB)

Sargeant, I.R.; Thorpe, S.; Glover, J.R.; Bown, S.G. [National Medical Laser Centre, London (United Kingdom); Tobias, J.S.; Blackman, G. [University Coll., London (United Kingdom). Meyerstein Inst. of Oncology

1997-03-01

A major drawback of laser endoscopy in the palliation of malignant dysphagia is the need for repeated treatments. This study was designed to test whether external beam radiotherapy would reduce the necessity for repeated laser therapy. (author).

Radiotherapy enhances laser palliation of malignant dysphagia: a randomised study

International Nuclear Information System (INIS)

Sargeant, I.R.; Thorpe, S.; Glover, J.R.; Bown, S.G.; Tobias, J.S.; Blackman, G.

1997-01-01

A major drawback of laser endoscopy in the palliation of malignant dysphagia is the need for repeated treatments. This study was designed to test whether external beam radiotherapy would reduce the necessity for repeated laser therapy. (author)

Nasopharyngeal carcinoma treated by radical radiotherapy alone: Ten-year experience of a single institution

International Nuclear Information System (INIS)

Yi Junlin; Gao Li; Huang Xiaodong; Li Suyan; Luo Jinwei; Cai Weiming; Xiao Jianping; Xu Guozhen

2006-01-01

Purpose: To report on our experience in the treatment of nasopharyngeal carcinoma (NPC) by radical radiotherapy alone in our institution during the last decade. Methods and Materials: From January 1990 to May 1999, 905 NPC patients were treated and were studied retrospectively. Radical radiotherapy was given to this cohort by conventional technique in a routine dose of 70-72 Gy to the primary tumor and metastatic lymph nodes. In case of residual primary lesion, a boost dose of 8-24 Gy was delivered by either 192 Ir afterloading brachytherapy, fractionated stereotactic radiotherapy, conformal radiotherapy, or small external-beam fields. Results: The 5-year and 10-year local-regional control, overall survival, and disease-free survival rates were 81.7% and 76.7%, 76.1% and 66.5%, 58.4% and 52.1%, respectively. In case of residual primary lesions after a dose of 70-72 Gy of conventional external-beam radiotherapy (EBRT), an additional boost was able to achieve a local control of 80.8%, similar to that obtained with primary lesions that completely disappeared at 70-72 Gy (82.6%, p = 0.892). Conclusions: The treatment results of radical EBRT followed by a boost dose to the residual primary tumor for nasopharyngeal carcinoma in our institution are promising

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

Long-term effects of radiotherapy for acromegaly on circulating prolactin

International Nuclear Information System (INIS)

Ciccarelli, E.; Corsello, S.M.; Besser, G.M.; Wass, J.A.H.; Plowman, P.N.; Jones, A.E.; Touzel, R.; Rees, L.H.

1989-01-01

In 61 acromegalic patients, serum PRL was assessed (off medical treatment) before and 2 to 12 (mean 6 p years after external beam radiotherapy. Before radiotherapy elevated PRL levels were present in 22 of 35 males (63%) and 12 of 26 females (46%) and were above 1000 mU/l in 11 males and 5 females. When studied for up to 5 years after radiotherapy, 22 or 23 (96%) patients who had not had surgery and who had normal PRL preradiotherapy showed an increased PRL level and this was also seen in 17 or 27 (63%) who had hyperprolactinaemic initially. In contrast, 10 of 27 patients (37%) who had elevated pre-radiotherapy levels (all greater than 1000 mU/l) had a reduction in PRL values after radiotherapy. In all 11 patients who underwent surgery before radiotherapy, an increase in PRL was seen after radiotherapy. In the 21 patients followed for 10-12 years, the peak PRL value occurred 1-6 years after radiotherapy. After this, a progressive reduction of PRL to normal was seen. Normal levels were reached 4 to 10 years after radiotherapy. No correlation was found between pretreatment PRL values and final GH values in the whole group, nor between changes in PRL and the development of Impaired ACTH or TSH secretion. Thus, different patterns of PRL behaviour suggest that radiotherapy treatment may either produce hyperprolactinemia from mild hypothalamic damage or ablate PRL secreting cells if they were present in the tumour before treatment. These changes do not predict final GH results or the development of hypopituitarism after radiotherapy. (author)

Long-term effects of radiotherapy for acromegaly on circulating prolactin

Energy Technology Data Exchange (ETDEWEB)

Ciccarelli, E.; Corsello, S.M.; Besser, G.M.; Wass, J.A.H. (Department of Endocrinology, St. Bartholomew' s Hospital, West Smithfield, London (UK)); Plowman, P.N.; Jones, A.E. (Department of Radiotherapy, St. Bartholomew' s Hospital, West Smithfield, London (UK)); Touzel, R.; Rees, L.H. (Department of Chemical Endocrinology, St. Bartholomew' s Hospital, West Smithfield, London (UK))

1989-01-01

In 61 acromegalic patients, serum PRL was assessed (off medical treatment) before and 2 to 12 (mean 6 p) years after external beam radiotherapy. Before radiotherapy elevated PRL levels were present in 22 of 35 males (63%) and 12 of 26 females (46%) and were above 1000 mU/l in 11 males and 5 females. When studied for up to 5 years after radiotherapy, 22 or 23 (96%) patients who had not had surgery and who had normal PRL preradiotherapy showed an increased PRL level and this was also seen in 17 or 27 (63%) who had hyperprolactinaemic initially. In contrast, 10 of 27 patients (37%) who had elevated pre-radiotherapy levels (all greater than 1000 mU/l) had a reduction in PRL values after radiotherapy. In all 11 patients who underwent surgery before radiotherapy, an increase in PRL was seen after radiotherapy. In the 21 patients followed for 10--12 years, the peak PRL value occurred 1--6 years after radiotherapy. After this, a progressive reduction of PRL to normal was seen. Normal levels were reached 4 to 10 years after radiotherapy. No correlation was found between pretreatment PRL values and final GH values in the whole group, nor between changes in PRL and the development of Impaired ACTH or TSH secretion. Thus, different patterns of PRL behaviour suggest that radiotherapy treatment may either produce hyperprolactinemia from mild hypothalamic damage or ablate PRL secreting cells if they were present in the tumour before treatment. These changes do not predict final GH results or the development of hypopituitarism after radiotherapy. (author).

PENGARUH MEKANISME CORPORATE GOVERNANCE, KUALITAS AUDITOR EKSTERNAL, DAN LIKUIDITAS TERHADAP KUALITAS LABA

Directory of Open Access Journals (Sweden)

Amanita Novi Yushita

2013-10-01

Full Text Available Abstrak: Pengaruh Mekanisme Corporate Governance, Kualitas Auditor Eksternal, dan Likuiditas Terhadap Kualitas Laba. Tujuan penelitian ini adalah memberikan bukti empiris pengaruh penerapan mekanisme corporate governance yang terdiri dari struktur dewan direksi, kepemilikan manajerial, kepemilikan institusional, komite audit, dan komisaris independen terhadap kualitas laba. Penelitian ini menggunakan sampel sebanyak 22 perusahaan manufaktur yang listing di BEI pada periode 2007-2011. Analisis GLS digunakan sebagai teknik analisis data dalam penelitian ini. Hasil penelitian menunjukkan bahwa struktur dewan direksi, komisaris independen berpengaruh positif dan signifikan terhadap Discretionary Accrual (DTAC atau berpengaruh negatif terhadap kualitas laba. Kemudian kualitas auditor eksternal berpengaruh negatif dan signifikan terhadap Discretionary Accrual (DTAC atau berpengaruh positif terhadap kualitas laba. Sedangkan kepemilikan manajerial, kepemilikan institusional, komite audit, dan likuiditas tidak berpengaruh signifikan terhadap kualitas laba.   Kata kunci: corporate governance, kualitas auditor eksternal, likuiditas, kualitas laba. Abstract: The influence of Corporate Governance Mechanism, External Auditor Quality, and Liquidity on the Quality of Earnings. The purpose of this study is to provide empirical evidence of the effect of the application of corporate governance mechanisms consisting of board structure, managerial ownership, institutional ownership, audit committees and independent commissioners on the quality of earnings. This study used a sample of 22 manufacturing companies listed on the Stock Exchange in the period 2007-2011. GLS analysis is used as a data analysis technique in this study. The results showed that the board structure and the proportions of independent commissioner have a positive and significant effect to discretionary accrual (DTAC or have a negative effect to the earnings quality. The quality of external

(18) F-FDG PET/CT for planning external beam radiotherapy alters therapy in 11% of 581 patients

DEFF Research Database (Denmark)

Birk Christensen, Charlotte; Loft-Jakobsen, Annika; Munck Af Rosenschöld, Per

2018-01-01

BACKGROUND: (18) F-FDG PET/CT (FDG PET/CT) used in radiotherapy planning for extra-cerebral malignancy may reveal metastases to distant sites that may affect the choice of therapy. AIM: To investigate the role of FDG PET/CT on treatment strategy changes induced by the use of PET/CT as part...... planning in our institution in the year 2008. All PET/CT scans were performed with the patient in treatment position with the use of immobilization devices according to the intended radiotherapy treatment. All scans were evaluated by a nuclear medicine physician together with a radiologist to delineate PET......% of the patients for whom the PET/CT simulation scan revealed unexpected dissemination, radiotherapy was given - changed (n = 38) or unchanged (n = 13) according to the findings on the FDG PET/CT. CONCLUSION: Unexpected dissemination on the FDG PET/CT scanning performed for radiotherapy planning caused a change...

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

Australian survey on current practices for breast radiotherapy.

Science.gov (United States)

Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois

2015-12-01

Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

How effective is external pituitary irradiation for growth hormone-secreting pituitary tumours

International Nuclear Information System (INIS)

Feek, C.M.; McLelland, J.; Seth, J.; Toft, A.D.; Irvine, W.J.; Padfield, P.L.; Edwards, C.R.W.

1984-01-01

Forty-six patients with GH-secreting pituitary tumours were treated with external pituitary irradiation through two opposed fields to a total dose of 3750 cGy over 15 fractions. Thirty-patients received external radiotherapy as primary treatment; 16 received radiotherapy combined with pituitary surgery. The mean (+- SD) serum GH in the former group was 74.3 +- 74.8 mU/l before treatment, falling by 28% per year over 0-5 years and by 16% per year over 0-20 years. The mean (+- SD) serum GH in the latter group was 265.4 +- 209.3 mU/l before treatment, falling by 76% in the first year-a direct result of surgery-then by 30% per year over 1-5 years and 16% per year over 1-20 years. Progressive failure of normal anterior pituitary function developed by 10 years, with variable loss of gonadotrophin, corticotrophin and thyrotrophin function. The respective figures for patients treated with radiotherapy alone were 47.4, 29.6 and 16.0% and for the combined group 70.2, 53.9 and 38.1%. Whilst external pituitary irradiation appears to reduce serum GH concentrations in patients with GH-secreting pituitary tumours the major disadvantages are the time taken to achieve a cure and the high incidence of hypopituitarism. (author)

Bone damage of mandibles after radiotherapy for carcinoma of the tongue

Energy Technology Data Exchange (ETDEWEB)

Nakamura, Motoyasu; Kubo, Kazuko; Furukawa, Sohei; Fuchihata, Hajime; Shimizutani, Kiminari; Inoue, Takehiro; Nishiyama, Kinji; Ikeda, Hiroshi; Masaki, Norie

1987-10-01

At Osaka University Hospital, the 5-year survival rate for carcinoma of the tongue, treated by radiotherapy, is almost 60 % and in early cases, around 80 %. However, with this improvement in the survival rate, an increase in the incidence of various complications (xerostomia, soft tissue ulcer, bone damage, etc.) has been observed. Because of these circumstances, a radiographic analysis on the bone damage of the mandibles after radiotherapy was made. Only those patients whose progress had been followed for more than one year and whose disease was well controlled were selected for this study. Early radiographic signs of bone damages showed an enlargement of the periodontal space and a loss of lamina dura. From the results of the study it has been found that bone damage is less common in patients treated by interstitial radiotherapy alone. Bone damage seems to develope more frequently in patients who receive about 30 Gy by external radiotherapy, followed by more than 2,000 mgh. Ra. eq. of interstitial radiotherapy.

Acute skin toxicity-related, out-of-pocket expenses in patients with breast cancer treated with external beam radiotherapy: a descriptive, exploratory study.

Science.gov (United States)

Schnur, Julie B; Graff Zivin, Joshua; Mattson, David M K; Green, Sheryl; Jandorf, Lina H; Wernicke, A Gabriella; Montgomery, Guy H

2012-12-01

Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The secondary aims were to: (1) estimate nonmedical out-of-pocket costs, (2) examine the nature of the costs, (3) explore potential background predictors of costs, and (4) explore the relationship between patient-reported dermatologic quality of life and expenditures. A total of 50 patients (mean age = 54.88, Stage 0-III) undergoing external beam radiotherapy completed a demographics/medical history questionnaire as well as a seven-item Skin Toxicity Costs (STC) questionnaire and the Skindex-16 in week 5 of treatment. Mean skin toxicity costs were $131.64 (standard error [SE] = $23.68). Most frequently incurred expenditures were new undergarments and products to manage toxicity. Education was a significant unique predictor of spending, with more educated women spending more money. Greater functioning impairment was associated with greater costs. The STC proved to be a practical, brief measure which successfully indicated specific areas of patient expenditures and need. Results reveal the nonmedical, out-of-pocket costs associated with acute skin toxicity in the context of breast cancer radiotherapy. To our knowledge, this study is the first to quantify individual costs associated with this treatment side effect, as well as the first to present a scale specifically designed to assess such costs. In future research, the STC could be used as an outcome variable in skin toxicity prevention and control research, as a behavioral indicator of symptom burden, or as part of a needs assessment.

Carcinoma of the external auditory canal and middle ear

International Nuclear Information System (INIS)

Pfreundner, Leo; Schwager, Konrad; Willner, Jochen; Baier, Kurt; Bratengeier, Klaus; Brunner, Franz Xaver; Flentje, Michael

1999-01-01

Purpose: To evaluate therapeutic modalities used at our institutions regarding local control, disease-free survival and actuarial survival in carcinoma of the external auditory canal and middle ear, in an attempt to provide guidelines for therapy. Methods and Materials: A series of 27 patients with carcinoma of the external auditory canal and middle ear treated between 1978 and 1997 in our institutions were analyzed with particular reference to tumor size and its relation to surrounding tissues, patterns of neck node involvement, surgical procedures, and radiation techniques employed. Clinical endpoints were freedom from local failure, overall survival, and disease-free survival. The median follow-up was 2.7 years (range 0.1-17.9 years). Results: Treatment by surgery and radiotherapy resulted in an overall 5-year survival rate of 61%. According to the Pittsburgh classification, the actuarial 5-year survival rate for early disease (T1 and T2 tumors) was 86%, for T3 tumors 50%, and T4 stages 41%. Patients with tumors limited to the external auditory canal had a 5-year survival rate of 100%, patients with tumor invasion of the temporal bone 63%, and patients with tumor infiltration beyond the temporal bone 38%. The rate of freedom from local recurrence was 50% at 5 years. Unresectability by dural and cerebral infiltration, and treatment factors such as complete resection or resection with tumor beyond surgical margins are of prognostic relevance. All patients with dural invasion died within 2.2 years. The actuarial 5-year survival rate of patients with complete tumor resection was 100%, but 66% in patients with tumor beyond surgical margins. 192 Iridium high-dose-rate (HDR) afterloading brachytherapy based on three-dimensional computed tomography (3D CT)-treatment planning was an effective tool in management of local recurrences following surgery and a full course of external beam radiotherapy. Conclusion: Surgical resection followed by radiotherapy adapted to stage

Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

Energy Technology Data Exchange (ETDEWEB)

Vaidya, Jayant S., E-mail: jayant.vaidya@ucl.ac.uk [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Baum, Michael [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Tobias, Jeffrey S. [Department of Radiation Oncology, University College London Hospitals, London (United Kingdom); Wenz, Frederik [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Massarut, Samuele [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Keshtgar, Mohammed [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Hilaris, Basil [Radiation Oncology, Our Lady of Mercy, New York Medical College, New York (United States); Saunders, Christobel [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Williams, Norman R.; Brew-Graves, Chris [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Corica, Tammy [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Roncadin, Mario [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Kraus-Tiefenbacher, Uta; Suetterlin, Marc [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Bulsara, Max [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Joseph, David [Radiation Oncology, Sir Charles Gairdner Hospital and School of Surgery, University of Western Australia, Perth (Australia)

2011-11-15

Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

Evaluation of inter-fraction error during prostate radiotherapy

International Nuclear Information System (INIS)

Komiyama, Takafumi; Nakamura, Koji; Motoyama, Tsuyoshi; Onishi, Hiroshi; Sano, Naoki

2008-01-01

The purpose of this study was to evaluate inter-fraction error (inter-fraction set-up error+inter-fraction internal organ motion) between treatment planning and delivery during radiotherapy for localized prostate cancer. Twenty three prostate cancer patients underwent image-guided radical irradiation with the CT-linac system. All patients were treated in the supine position. After set-up with external skin markers, using CT-linac system, pretherapy CT images were obtained and isocenter displacement was measured. The mean displacement of the isocenter was 1.8 mm, 3.3 mm, and 1.7 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. The maximum displacement of the isocenter was 7 mm, 12 mm, and 9 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. The mean interquartile range of displacement of the isocenter was 1.8 mm, 3.7 mm, and 2.0 mm in the left-right, ventral-dorsal, and cranial-caudal directions, respectively. In radiotherapy for localized prostate cancer, inter-fraction error was largest in the ventral-dorsal directions. Errors in the ventral-dorsal directions influence both local control and late adverse effects. Our study suggested the set-up with external skin markers was not enough for radical radiotherapy for localized prostate cancer, thereby those such as a CT-linac system for correction of inter-fraction error being required. (author)

Evaluation of the response of concurrent high dose rate intracavitary brachytherapy with external beam radiotherapy in management of early stage carcinoma cervix.

Science.gov (United States)

Patidar, Arvind Kumar; Kumar, H S; Walke, Rahul V; Hirapara, Pushpendra H; Jakhar, Shankar Lal; Bardia, M R

2012-10-01

To evaluate local disease control and early complications of concomitant brachytherapy with external beam-radiotherapy in early stage carcinoma cervix. Fifty patients of early stage carcinoma cervix (FIGO-IB/IIA) were randomly divided into study group concomitant external beam irradiation (EBRT) and HDR-ICBT (intra-cavitary brachytherapy, xrt = 50 Gy/25 Fr, HDR 5.2 Gy*5 Fr) and the control group EBRT followed by HDR-ICBT (xrt = 50 Gy/25 Fr, HDR 7.5 Gy*3 Fr). Acute reactions and local disease response were compared between treatment and at 6-month follow up. Median overall treatment times were 38 and 61 days in the study and the control groups, respectively. Acute skin reactions and diarrhea were more in the study but manageable. At the completion of the study, there were 80 and 68 % complete responses, 16 and 20 % partial responses, 0 and 8 % stable diseases in the study group and the control group, respectively. Response was better in the study group but statistically insignificant. Larger number of patients and longer follow up are required to arrive at concrete conclusion.

Quality audit for dose determination in the field of radiotherapy using TLD

International Nuclear Information System (INIS)

Kharita, M. H.; Anjak, O.

2010-08-01

Quality audit is one of the important procedures in radiotherapy centers in order to verify the accuracy of the delivered radiation doses. The aim of this work is to establish a procedure for dose audit using TL dosimeters and to apply this procedure in radiotherapy centers. TL Dosimeters were distributed to several radiotherapy centers in Syria and Lebanon (4 with Co-60 and 14 with high energy photon beam radiotherapy units). They were exposed to 2 Gy in order to make an intercomparison study of the absorbed dose in water determined under reference conditions. The results show that only two beams were outside the accepted range, which is ±3.5%. and the were within the accepted range. External Quality audit is one of the important procedures in field of radiotherapy dosimeter in order to verify the accuracy of the radiation doses delivered to patients. (Author)

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

Energy Technology Data Exchange (ETDEWEB)

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

2005-03-01

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

Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

International Nuclear Information System (INIS)

Morton, Gerard C.; Loblaw, D. Andrew; Chung, Hans; Tsang, Gail; Sankreacha, Raxa; Deabreu, Andrea; Zhang Liying; Mamedov, Alexandre; Cheung, Patrick; Batchelar, Deidre; Danjoux, Cyril; Szumacher, Ewa

2011-01-01

Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose

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)

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.

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.

18 F-FDG PET/CT for planning external beam radiotherapy alters therapy in 11% of 581 patients.

Science.gov (United States)

Birk Christensen, Charlotte; Loft-Jakobsen, Annika; Munck Af Rosenschöld, Per; Højgaard, Liselotte; Roed, Henrik; Berthelsen, Anne K

2018-03-01

18 F-FDG PET/CT (FDG PET/CT) used in radiotherapy planning for extra-cerebral malignancy may reveal metastases to distant sites that may affect the choice of therapy. To investigate the role of FDG PET/CT on treatment strategy changes induced by the use of PET/CT as part of the radiotherapy planning. 'A major change of treatment strategy' was defined as either including more lesions in the gross tumour volume (GTV) distant from the primary tumour or a change in treatment modalities. The study includes 581 consecutive patients who underwent an FDG PET/CT scan for radiotherapy planning in our institution in the year 2008. All PET/CT scans were performed with the patient in treatment position with the use of immobilization devices according to the intended radiotherapy treatment. All scans were evaluated by a nuclear medicine physician together with a radiologist to delineate PET-positive GTV (GTV-PET). For 63 of the patients (11%), the PET/CT simulation scans resulted in a major change in treatment strategy because of the additional diagnostic information. Changes were most frequently observed in patients with lung cancer (20%) or upper gastrointestinal cancer (12%). In 65% of the patients for whom the PET/CT simulation scan revealed unexpected dissemination, radiotherapy was given - changed (n = 38) or unchanged (n = 13) according to the findings on the FDG PET/CT. Unexpected dissemination on the FDG PET/CT scanning performed for radiotherapy planning caused a change in treatment strategy in 11% of 581 patients. © 2017 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Respiratory gated radiotherapy: current techniques and potential benefits

International Nuclear Information System (INIS)

Giraud, P.; Campana, F.; Rosenwald, J.C.; Cosset, J.M.; Reboul, F.; Garcia, R.; Clippe, S.; Carrie, C.; Dubray, B.

2003-01-01

Respiration-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast and liver tumors. An increased conformality of irradiation fields leading to decreased complications rates of organs at risk (lung, heart...) is expected. Respiratory gating is in line with the need for improved precision required by radiotherapy techniques such as 3D conformal radiotherapy or intensity modulated radiotherapy. Reduction of respiratory motion can be achieved by using either breath hold techniques or respiration synchronized gating techniques. Breath-hold techniques can be achieved with active, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily breath-hold. Synchronized gating techniques use external devices to predict the phase of the respiration cycle while the patient breaths freely. These techniques presently investigated in several medical centers worldwide. Although promising, the first results obtained in lung and liver cancer patients require confirmation. Physical, technical and physiological questions still remain to be answered. This paper describes the most frequently used gated techniques and the main published clinical reports on the use of respiration-gated radiotherapy in order to evaluate the impact of these techniques. (author)

Conservative treatment of anal canal carcinoma with external radiotherapy and interstitial brachytherapy, with or without chemotherapy: long-term results; Traitement conservateur des cancers du canal anal par irradiation suivie de curietherapie interstitielle, avec ou sans chimiotherapie: resultats a long terme

Energy Technology Data Exchange (ETDEWEB)

Berger, C.; Felix-Faure, C.; Chauvet, B.; Vincent, P.; Alfonsi, M.; Coudurier, P.; Plat, F.; Reboul, F. [Clinique Sainte-Catherine, 84 - Avignon (France)

1999-12-01

Purpose: a retrospective analysis of conservative treatment of anal canal cancers with external radiation therapy and interstitial brachytherapy with or without chemotherapy. Patients and methods: from 1986 to 1996, 69 patients were treated with external radiotherapy (40 Gy/20 fractions) and interstitial brachytherapy (20 Gy) after a mean interval of six weeks for a localized epidermoid carcinoma of the anal canal. Patients who did not complete the whole therapeutic sequence were not included. Forty-five patients received additional 5-fluorouracil- and/or mitomycin C-based chemotherapy regimen. Results: acute toxicity was acceptable. Complete response rate was 81%. Actuarial local control rate was at two and five years, 65% and 59% respectively (median follow-up: eight years). At two, five and ten years, actuarial colostomy rate was 26%, 33% and 33% respectively, and colostomy-free survival rates 61%, 47% and 37%. Overall survival at two, five and ten years was 81%, 65% and 53% respectively. Distant metastases occurred in 11 patients (16%). Prognostic factors for overall survival were performance status (PS) (79% survival at five years for patients with PS 0 versus 50% for patients with PS 1-3, P = 0.04) and tumor stage (80% at five years for T1-T2 versus 53% for T3-T4, P = 0.03). Overall treatment time less than 12 weeks and time interval between external radiotherapy and brachytherapy inferior than six weeks were associated with a better local control (P = 0.05). In multivariate analysis, these prognostic factors were not significant. Conclusion: these results confirm the efficacy of external radiotherapy and brachytherapy in the treatment of small anal canal cancers, and point out the need for improving treatment outcome of larger tumors. (author)

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.

Audit on dose delivery by using TLD in Radiotherapy Centers in Malaysia

International Nuclear Information System (INIS)

Md Saion Salikin; Taiman Kadni; Husaini Salleh; Asmaliza Hashim; Hasrul Husham Hussain

2004-01-01

The External Audit Group (EAQ) is established and supported by IAEA. Its main objective is to audit the accuracy of dose delivery to patients in radiotherapy centres or hospitals in developing countries in IAEA member states. At MINT the operation of EAG is managed by Medical Physics Group and supported by Secondary Standard Dosimetry Laboratory (SSDL), MINT. The selected radiotherapy centers are supplied with TLD powder in capsule form, to be irradiated with the required radiation doses, by their physicists. The irradiated TLD is analysed at SSDL. The result of the audit for a few radiotherapy centres in Malaysia, is presented in brief in this paper. (Author)

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

International Nuclear Information System (INIS)

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

2014-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2014-07-15

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

Intraoperative radiotherapy for pancreatic carcinoma

International Nuclear Information System (INIS)

Nishimura, Akira; Iida, Koyo; Sato, Shigehiro; Sakata, Suo

1986-01-01

Twenty-eight patients with pancreatic carcinoma, 23 (82 %) of whom had Stage III or IV, received intraoperative radiotherapy (IOR) with curative or non-curative surgery. Electron beams (10 to 18 MeV) with doses of 20 to 40 Gy were delivered to the tumor. Eight of 26 patients with unresectable tumor had postoperative external irradiation of 10.5 to 50 Gy. Abdominal and back pain relief was achieved after IOR in 12 (71 %) and in 6 (60 %) of the 26 patients, respectively. Appetite was promoted in 11 patients. In the case of unresectable carcinoma, survival time tended to prolong in the 8 patients receiving both IOR and postoperative external irradiation. One patient developed perforation of the colon probably caused by IOR. (Namekawa, K.)

Quality assurance of radiotherapy and its clinical assessment

International Nuclear Information System (INIS)

Inoue, Toshihiko

2002-01-01

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

Radiotherapy for Locoregional Recurrent Cervix Cancer after Surgery

International Nuclear Information System (INIS)

Yang, Mi Gyoung

1994-01-01

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

[Guidelines for external radiotherapy and brachytherapy: introduction to the 2nd edition. Société française de radiothérapie oncologique (SFRO)].

Science.gov (United States)

Mahé, M-A; Barillot, I; Chauvet, B

2014-10-01

In 2007, a first edition was published with the objective to produce guidelines for optimization, harmonization and homogenization of practices in external radiation therapy in France. The second edition, including brachytherapy, has the same objective and takes into account recent technologic improvements (intensity modulation radiation therapy, stereotactic radiotherapy, and 3-dimension brachytherapy) and recent results of the literature. The first part is about daily use of general principles (quality, security, image-guided radiation therapy) and the second is to describe each step of treatment of main cancers. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

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

Energy Technology Data Exchange (ETDEWEB)

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

2011-10-15

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

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

Study on change of multi-modally evoked potentials in nasopharyngeal carcinoma patients after radiotherapy

International Nuclear Information System (INIS)

Qin Ling; Chen Jiaxin; Zhang Lixiang; Wang Tiejian; Han Min; Lu Xiaoling

2001-01-01

Objective: To investigate possible changes of multi-modally evoked potentials in nasopharyngeal carcinoma patients after radiotherapy. Methods: Altogether 48 nasopharyngeal carcinoma patients receiving primary conventional external beam irradiation were examined before and after radiotherapy to determine their brainstem auditory-evoked potential (BAEP), short-latency somatosensory-evoked potential (SLSEP) and pattern reversal visual-evoked potential (PRVEP). Results: In comparison with the conditions before radiotherapy, in different periods after radiotherapy abnormal peak latency and interval latency difference were found in BAEP, SLSEP and PRVEP. Conclusion: Nasopharyngeal carcinoma after radiotherapy may cause abnormal function of nerve conduction in early periods, which can be showed by BAEP, SLSEP, PRVEP, and injury can be timely detected if the three evoked potentials are used together. Thus authors suggest BAEP, SLSEP, PRVEP should be examined in nasopharyngeal carcinoma patients during and after the radiotherapy so as to find early damage in auditory somatosensory and visual conduction pathways

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.

Pain and Mean Absorbed Dose to the Pubic Bone After Radiotherapy Among Gynecological Cancer Survivors

International Nuclear Information System (INIS)

Waldenstroem, Ann-Charlotte; Olsson, Caroline; Wilderaeng, Ulrica; Dunberger, Gail; Lind, Helena; Al-Abany, Massoud; Palm, Asa; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

2011-01-01

Purpose: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors. Methods and Materials: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire. Results: We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses ≥52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence. Conclusions: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.

The place of radiotherapy in muco-epidermoid carcinomas of salivary glands in child; Place de la radiotherapie dans les carcinomes mucoepidermoides des glandes salivaires de l'enfant

Energy Technology Data Exchange (ETDEWEB)

Thariat, J. [Centre Antoine-Lacassagne, Nice (France); Temam, S. [Institut Gustave-Roussy, Villejuif (France); Orbach, D. [Institut Curie, Paris (France); Nicollas, R.; Penicaud, M. [Hopital La Timone, Marseille (France); Toussaint, B. [CHU, Nancy (France); Makeieff, M. [CHU, Montpellier (France); Laprie, A. [Institut Claudius-Regaud, Toulouse (France); Castillo, L. [CHU, Nice (France); Vedrin, P. [CHC de Cannes, Cannes (France)

2011-10-15

As muco-epidermoid carcinomas are the most frequent tumours of salivary glands for child, the authors report the study of the role of radiotherapy. This study is based on a survey performed in 34 paediatric departments. The authors analyse the age and gender, the use of irradiation, the tumour location, the tumour grade and size, the use of surgery and of radiotherapy, and survival. Radiotherapy is beneficial for high grade tumours, but cannot be recommended for low and intermediate grades. Short communication

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

Quality of life after radiotherapy for prostate cancer; Qualite de vie apres radiotherapie pour un cancer localise de la prostate

Energy Technology Data Exchange (ETDEWEB)

Joly, F. [Service d' oncologie medicale, CLCC Francois-Baclesse, 14 - Caen (France); CHU Cote-de-Nacre, 14 - Caen (France); Degrendel, A.C. [Service de radiotherapie, CLCC Francois-Baclesse, 14 - Caen (France); Guizard, A.V. [Registre general des tumeurs du Calvados, CLCC Francois-Baclesse, 14 - Caen (France)

2010-10-15

The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormono-therapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormono-therapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormono-therapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormono-therapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up. (authors)

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

Energy Technology Data Exchange (ETDEWEB)

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

2009-12-15

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

Occult carcinoma discovered after simple hysterectomy treated with postoperative radiotherapy

International Nuclear Information System (INIS)

Crane, Christopher H.; Schneider, Bernard F.

1999-01-01

Purpose: Treatment of patients with occult carcinoma of the cervix discovered after simple hysterectomy is controversial. The purpose of this review is to examine our results with postoperative radiotherapy and to compare them to similar reports and to reports of treatment with radical parametrectomy. Methods and Materials: Between November 1979 and April:, 18 patients were treated with radiotherapy at the University of Virginia for invasive carcinoma of the cervix discovered after simple hysterectomy. Simple hysterectomy was performed in all 18 patients for a variety of indications. After surgery gross residual carcinoma remained in four patients; and microscopic disease was present at the surgical margins in two patients. The remaining patients had no evidence of residual disease. All 18 patients had postoperative radiotherapy with or without brachytherapy. The endpoints for this study were local control, survival, and treatment-related toxicity. Actuarial rates were calculated using the Life method. Results: Median follow-up for all 18 patients was 42 months (range 2-202 months). Both the 5 and the 10-year actuarial local control rates were 88%. Five and 10-year actuarial overall survival rates were both 93%. Two patients had both local and distant cancer recurrences. There were no recurrences among the six patients treated with external beam alone. The remaining patients are all alive without evidence of disease, including two patients who had gross residual disease after surgery, and one patient with both microscopic positive margin and a positive lymph node (the only patient to undergo lymph node sampling). There was no severe acute morbidity and only one patient had severe late morbidity. Conclusions: Invasive carcinoma found after simple hysterectomy may be treated safely and effectively with postoperative radiotherapy. Patients with known residual disease following surgery do poorly with either radiotherapy or reoperation, but treatment with radiotherapy

The influence of radiotherapy on cosmetic outcome after breast conservative surgery

International Nuclear Information System (INIS)

McCormick, Beryl; Sacchini, Virgilio; Luini, Alberto; Agresti, Roberto; Greco, Marco; Manzari, Antonella; Mariani, Luigi; Zucali, Roberto

1995-01-01

Purpose: The influence of radiotherapy in the cosmetic outcome after conservative surgery for breast cancer was evaluated using an objective method of calculating the asymmetry between the two breasts. Methods and Materials: One hundred and one patients treated with the same conservative surgery were evaluated for cosmetic outcome. Sixty-one of them received external radiotherapy (50 + 10 Gy) to the residual breast; the remaining 40 underwent surgery only. The aspect of the patients' breasts was objectively assessed for symmetry by means of a computerized technique. A subjective assessment of the cosmetic outcome was performed both by physician and patient. These objective and subjective assessments were compared in the two groups treated with or without radiotherapy. Results: The results obtained did not show significant differences in terms of cosmetic outcome in the two groups. Skin telangectasia was noted in two radiotherapy patients, while hypertrophic breast scars were only noted in six nonirradiated patients. Conclusions: We found that standard radiotherapy does not seem to influence the symmetry and the cosmetic results in breast conservative treatment when compared to a similar group of patients with the same quadrantectomy procedure and no radiotherapy

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.

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.

The role of primary radiotherapy in acromegaly (abstract)

International Nuclear Information System (INIS)

Ali, M.; Knob, G.

1998-01-01

The aim of the study was to evaluate the role of primary radiotherapy in acromegaly. Fifteen cases were randomly included in this study from 1989 to 1998. The patients were given external radiotherapy using Co/sup 60/ source and 200 cGy/F, 5F/week up to 5000 cGy, Tumor dose (TD). The target volume was irradiated by opposite parallel lateral field. The field size ranged from 4.5 to 6.5 cm. depending upon the tumor size and its extensions. These patients were continuously followed up for variable period depending upon the history of the patient and compliance by serial Growth Hormone (GH) assay and Clinical and Radiological evaluation. Out of these fifteen patients one died of cardiac sequelae. In the remaining treated patients majority has normal or continuously decreasing GH levels. The treatment of Acromegaly includes surgery, radiotherapy, medical treatment or the combination of these with variable success and non is perfect. We used radiotherapy as the primary modality, due to medical contraindication or refusal of patient for surgery and found that this is an effective modality in the treatment of acromegaly even in patients with extra sellar extension of the tumor. (author)

ANALISIS KEPUASAN PENGHUNI DAN PERANAN ENVIRONMENTAL INFLUENCES INDIVIDUAL CONSUMERS DAN MARKETER STIMULI PADA KONDOMINIUM MEWAH DI SURABAYA

Directory of Open Access Journals (Sweden)

Timoticin Kwanda

2002-01-01

Full Text Available The occupancy rate of luxurious condominiums in Surabaya keep on decreasing. There are many reasons for these problems, among others economic crisis that weakened market-buying capability (external and decreased preferences to reside (internal. The internal factor comprises of occupant’s satisfaction, environmental influences, individual consumers and marketer stimuli. The purpose of the research is to know according to the assessment of the occupants which of these four factors, is higher and more dominant. The occupants surveyed are the occupants of the luxurious condominiums in Surabaya, such as Paragon, Beverly, Puri Matahari, Regency, Graha Famili, and Puri Darmo. Samples were taken with Purposive Sampling method and collected through questioners. Anova is used to analyse the data with SPS 2000 program. The result showed that there are no significant differences of occupant’s satisfaction, environmental influences, individual consumers and marketer stimuli on the six observed condominiums. Meanwhile according to the mean, occupant’s satisfaction, individual consumers and marketer stimuli are dominant at Puri Matahari, and environmental influences are dominant at Puri Darmo. Abstract in Bahasa Indonesia : Tingkat hunian kondominium mewah di Surabaya terus menurun tajam. Hal yang menjadi penyebabnya antara lain krisis ekonomi yang memperlemah daya beli pasar (eksternal dan menurunnya minat menempati (internal. Faktor internal adalah kepuasan penghuni, environmental influences, individual consumers dan marketer stimuli. Penelitian ini bertujuan untuk mengetahui penilaian penghuni kondominium mewah di Surabaya, yaitu Paragon, Beverly, Puri Matahari, Regency, Graha Famili, dan Puri Darmo terhadap keempat faktor ini. Ingin diketahui faktor mana yang lebih tinggi dan lebih dominan peranannya. Pengambilan sampel menggunakan metode Purposive Sampling dengan pengumpulan data melalui kuesioner. Analisis data menggunakan Anova dengan program SPS

Radiotherapy Results of Early Uterine Cervix Cancer

International Nuclear Information System (INIS)

Choi, Doo Ho; Huh, Seung Jae

1996-01-01

Purpose : This study was done to analyze survivals, patterns of failure, and complications of early uterine cervix cancer after curative radiotherapy. Methods and Materials : Eighty patients with uterine cervix cancer FIGO Stage IB (48 cases) and Stage IIA (32 cases) treated with radiotherapy were analyzed retrospectively. Patients were treated from November 1985 to May 1993, and minimum follow up period was 24 months. and 6 cases were lost to follow up. All of them were treated with external radiotherapy and different fractions of high dose rate intracavitary radiotherapy. Survival rates, failure patterns, complication rates and degrees of severity were analyzed according to several factors. Results : Overall 5 year survival rate and relapse free survival rate were 72.3%, and 72.8% respectively. Prognostic factors were stage, size, pathology, RT response and there was no significant survival difference among the reasons of radiotherapy choice. There were 19 cases of treatment failure, another 3 cases were not tumor related death, and most of treatment related failure occurred within 24 months. Late complication rate of bladder and rectum were 8.8%, 15% respectively, frequency and severity of complication were correlated with ICR fractionation dose and total dose. Conclusion : These results showed that survival rates of early stage radiation treated cervix cancer patients were comparable to surgical series, but more aggressive treatment methods needed for stage IIA poor prognostic patients, To decrease late complication, choice of proper ICR dose and meticulous vaginal packing is needed

Quality of life after radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Joly, F.; Degrendel, A.C.; Guizard, A.V.

2010-01-01

The goal of localized prostate cancer radiotherapy is to cure patients. The decision-making must integrate the survival but also the quality of life of patients. Some French validated self-reported questionnaires are available to evaluate quality of life. Whatever the treatments (radical prostatectomy, brachytherapy, external beam radiation, with or without hormono-therapy), even if patients report more sequelae, their long-term quality of life is similar to that of the general population, except for patients treated with hormono-therapy who complain more decline of physical quality of life. In comparison with prostatectomy, patients treated with external beam radiation report less long-lasting urinary symptoms, but more bowel side effects, with no difference in global quality of life. Sexual disorders are initially less important with external beam radiation but increase over time. Brachytherapy shows no sexual function preservation benefit relative to radiation and may be less favourable with more urinary sequelae. The association of hormono-therapy and external beam radiation decreases the quality of life of the patients, with a negative impact on vitality, sexuality and increase urinary disorders. Intensity-modulated radiotherapy (IMRT) seems to better preserve the long-term digestive quality of life in comparison with conformal radiation therapy. Post-prostatectomy could induce more digestive toxicity, such as rectal irritation. The adjunction of hormono-therapy to radiation, the previous medical history of abdominal surgery, the field of radiation and the acute reactions to radiation are the main predictive factors to late toxicity and should be considered in the choice of initial treatment and for the follow-up. (authors)

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2011-07-01

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

A TCP model for external beam treatment of intermediate-risk prostate cancer.

LENUS (Irish Health Repository)

Walsh, Seán

2013-03-01

Biological models offer the ability to predict clinical outcomes. The authors describe a model to predict the clinical response of intermediate-risk prostate cancer to external beam radiotherapy for a variety of fractionation regimes.

Fractionated stereotaxic radiotherapy in the treatment of the retinoblastoma: preliminary results; Radiotherapie stereotaxique fractionnee dans le traitement du retinoblastome: resultats preliminaires

Energy Technology Data Exchange (ETDEWEB)

Pica, A. [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Radiotherapie, Lausanne (Switzerland); Moeckli, R.; Do, H. [Institut de Radiophysique Appliquee, Lausanne (Switzerland); Balmer, A.; Munier, F. [Hopital ophtalmique Jules-Gonin, Lausanne (Switzerland); Chollet Rivier, M. [Centre Hospitalier Universitaire Vaudois (CHUV), Service d' Anesthesie, Lausanne (Switzerland)

2006-11-15

The objective of this study is to evaluate the impact in term of morbidity at short and long term and the response to the fractionated stereotaxic radiotherapy with a micro multi slides collimator in the treatment of the retinoblastoma. (N.C.)

A Dosimetric Evaluation of Conventional Helmet Field Irradiation Versus Two-Field Intensity-Modulated Radiotherapy Technique

International Nuclear Information System (INIS)

Yu, James B.; Shiao, Stephen L.; Knisely, Jonathan

2007-01-01

Purpose: To compare dosimetric differences between conventional two-beam helmet field irradiation (external beam radiotherapy, EBRT) of the brain and a two-field intensity-modulated radiotherapy (IMRT) technique. Methods and Materials: Ten patients who received helmet field irradiation at our institution were selected for study. External beam radiotherapy portals were planned per usual practice. Intensity-modulated radiotherapy fields were created using the identical field angles as the EBRT portals. Each brain was fully contoured along with the spinal cord to the bottom of the C2 vertebral body. This volume was then expanded symmetrically by 0.5 cm to construct the planning target volume. An IMRT plan was constructed using uniform optimization constraints. For both techniques, the nominal prescribed dose was 3,000 cGy in 10 fractions of 300 cGy using 6-MV photons. Comparative dose-volume histograms were generated for each patient and analyzed. Results: Intensity-modulated radiotherapy improved dose uniformity over EBRT for whole brain radiotherapy. The mean percentage of brain receiving >105% of dose was reduced from 29.3% with EBRT to 0.03% with IMRT. The mean maximum dose was reduced from 3,378 cGy (113%) for EBRT to 3,162 cGy (105%) with IMRT. The mean percent volume receiving at least 98% of the prescribed dose was 99.5% for the conventional technique and 100% for IMRT. Conclusions: Intensity-modulated radiotherapy reduces dose inhomogeneity, particularly for the midline frontal lobe structures where hot spots occur with conventional two-field EBRT. More study needs to be done addressing the clinical implications of optimizing dose uniformity and its effect on long-term cognitive function in selected long-lived patients

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.

Local control and image diagnosis of cases of esophageal carcinoma treated by external and intracavitary irradiation

International Nuclear Information System (INIS)

Hishikawa, Yoshio; Miura, Takashi

1984-01-01

Discussions are made on local control of 31 cases of esophageal carcinoma which were treated by external and intracavitary irradiation between May 1980 and March 1983. X-ray and endoscopic findings have been used for the image diagnosis. Before the begining of radiotherapy, types of esophageal carcinoma were determined from X-ray findings according to Borrmann's classification. There were 10 cases of types 1 and 2, and 21 cases of types 3 and 4. After completion of external and intracvitary irradiation, all 10 cases of types 1 and 2 were locally controlled. Of the 21 cases of types 3 and 4, 8 cases which developed stenosis or deep ulcer after external irradiation all failed in local control. The remaining 13 cases of types 3 and 4 were locally controlled except 2 by radiotherapy. (author)

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

TRS 398 dosimetry protocol for radiotherapy

International Nuclear Information System (INIS)

Palmans, H.; Smyth, V.

2004-01-01

Full text: In recent years, international codes of practice based on absorbed dose to water standards have been published for the clinical reference dosimetry of external beams. It has become widely accepted that dosimetry of radiotherapeutic beams should be based on these standards. These codes of practice are a major improvement over earlier ones that used air kerma calibration factors as they are based on a calibration directly in a phantom in terms of the quantity of interest. The previous codes begin with calibration in air in terms of air kerma, then use theoretical and generic conversion factors to obtain dose to water that do not take account of chamber-to-chamber variation. Other good reasons for implementing the new codes are that they are conceptually simpler, include improved physical data and improve the consistency for various ionisation chamber types as well as between different beam types. TRS-3982,3 is a new Code of Practice (CoP) for reference dosimetry of external radiotherapy beams based on absorbed dose to, water calibrations and was published by the IAEA in a joint effort with the WHO, PAHO and ESTRO. It is the first CoP of its kind comprehensively covering all external radiotherapy beams except neutrons. The Radiotherapy Interest Group (RJG) of the ACPSEM has recommended that radiotherapy centres in Australia and New Zealand implement this CoP by the end of 2004. In this workshop, the general philosophy of the CoP will be outlined which will provide a framework for each of the individual subcodes. Although it represents just one of the potential implementations of the CoP, this workshop will deal only with dosimetry based on a cylindrical ionisation chamber with an absorbed dose calibration factor in 60Co from the standards laboratory. With the framework of the code in mind, it is straightforward to identify the basic steps that are required for measuring absorbed dose under reference conditions in a high-energy photon beam. The same is true

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

Predicted allowable doses to normal organs for biologically targeted radiotherapy

International Nuclear Information System (INIS)

O'Donoghue, J.A.; Wheldon, T.E.; Western Regional Hospital Board, Glasgow

1988-01-01

The authors have used Dale's extension to the ''linear quadratic'' (LQ) model (Dale, 1985) to evaluate ''equivalent doses'' in cases involving exponentially decaying dose rates. This analysis indicates that the dose-rate effect will be a significant determinant of allowable doses to organs such as liver, kidney and lung. These organ tolerance doses constitute independent constraints on the therapeutic intensity of biologically targeted radiotherapy in exactly the same way as for conventional external beam radiotherapy. In the context of marrow rescue they will in all likelihood constitute the dose-limiting side-effects and thus be especially important. (author)

Clinical experience with intraoperative radiotherapy for locally advanced colorectal cancer

International Nuclear Information System (INIS)

Shibamoto, Yuta; Takahashi, Masaharu; Abe, Mitsuyuki

1988-01-01

Intraoperative radiotherapy (IORT) was performed on 20 patients with colorectal cancer. IORT with a single dose of 20 to 40 Gy was delivered to the residual tumor, tumor bed, and/or lymphnode regions. Although most of the patients had advanced lesions, local control was achieved in 67 % of the patients when IORT was combined with tumor resection, and 4 patients survived more than 5 years. There were no serious complications, except for contracture or atrophy of the psoas muscle seen in 2 patients. IORT combined with external beam radiotherapy should be a useful adjuvant therapy to surgery for locally advanced colorectal cancer. (author)

Thyroid adenomas and carcinomas following radiotherapy for a hemangioma during infancy

International Nuclear Information System (INIS)

Haddy, Nadia; Andriamboavonjy, Tianarimanana; Paoletti, Catherine; Dondon, Marie-Gabrielle; Mousannif, Abdeddahir; Shamsaldin, Akhtar; Doyon, Francoise; Labbe, Martine; Robert, Caroline; Avril, Marie-Francoise; Fragu, Philippe; Eschwege, Francois; Chavaudra, Jean; Schvartz, Claire; Lefkopoulos, Dimitri; Schlumberger, Martin; Diallo, Ibrahima; Vathaire, Florent de

2009-01-01

Background and purpose: A cohort study was performed to investigate the carcinogenic effect of treating skin hemangioma with ionizing radiation during early childhood. This paper presents the incidence of differentiated thyroid adenomas and carcinomas after radiotherapy in this cohort. Methods and materials: Of a total of 8307 patients treated for a skin hemangioma between 1940 and 1973 at the Institut Gustave-Roussy, 4767 were included in an incidence study, among whom 3795 had received radiotherapy. Seventy-three percent were less than 1-year-old at the time of treatment. External radiotherapy, Radium 226, Strontium 90, Yttrium 90, and Phosphorus 32 were used. The radiation dose received by the thyroid during radiotherapy, estimated in 3497 of the 3795 patients using specific software, was 41 mGy on average. Thyroid tumor cases were obtained by sending out a questionnaire, and were verified in pathological reports. Estimates of thyroid cancer specific incidence rates in the French population were obtained from the French cancer registry network. External and internal analyses were performed. Results: During an average follow-up of 35 years, 11 patients developed a differentiated thyroid carcinoma and 44 a thyroid adenoma. The incidence of thyroid adenoma was found to be higher among taller and heavier individuals. The incidence of both thyroid carcinoma and adenoma was higher among non-smoker patients. A significant dose-response relationship was found between the radiation dose received by thyroid and the risk of thyroid cancer (Excess Relative Risk per GY, ERR/Gy: 14.7, 95%CI: 1.6-62.9) and of adenoma (ERR/Gy: 5.7, 95%CI: 0.7-19.4). Conclusion: This study confirms that radiation treatment performed in the past for hemangioma during infancy increased the risk of thyroid carcinoma and adenoma. Patients treated with external radiotherapy or with Radium 226 applicators for hemangiomas have to be more specifically followed up because this is the subgroup in whom the

Comparative study of reference points by dosimetric analyses for late complications after uniform external radiotherapy and high-dose-rate brachytherapy for cervical cancer

International Nuclear Information System (INIS)

Chen, S.-W.; Liang, J.-A.; Yeh, L.-S.; Yang, S.-N.; Shiau, A.-C.; Lin, F.-J.

2004-01-01

Purpose: This study aimed to correlate and compare the predictive values of rectal and bladder reference doses of uniform external beam radiotherapy without shielding and high-dose-rate intracavitary brachytherapy (HDRICB) with late sequelae in patients with uterine cervical cancer. Methods and materials: Between September 1992 and December 1998, 154 patients who survived more than 12 months after treatment were studied. Initially, they were treated with 10-MV X-rays (44 to 45 Gy/22 to 25 fractions over 4 to 5 weeks) to the whole pelvis, after which HDRICB was performed using 192 Ir remote afterloading at 1-week intervals for 4 weeks. The standard prescribed dose for each HDRICB was 6.0 Gy to point A. Patient- and treatment-related-factors were evaluated for late rectal complications using logistic regression modeling. Results: The probability of rectal complications showed better correlation of dose-response with increasing total ICRU (International Committee on Radiotherapy Units and Measurements) rectal dose. Multivariate logistic regression demonstrated a high risk of late rectal sequelae in patients who developed rectal complications (p 0.0001;relative risk, 15.06;95% CI, 2.89∼43.7) and total ICRU rectal dose greater than 16 Gy (p = 0.02;relative risk, 2.07;95% CI, 1.13∼4.55). The high risk factors for bladder complications were seen in patients who developed rectal complications (p = 0.0001;relative risk, 15.2;95% CI, 2.81∼44.9) and total ICRU bladder dose greater than 24 Gy (p = 0.02;relative risk, 8.93;95% CI, 1.79∼33.1). Conclusion: This study demonstrated the predictive value of ICRU rectal and bladder reference dosing in HDRICB for patients receiving uniform external beam radiation therapy without central shielding. Patients who had a total ICRU rectal dose greater than 16 Gy, or a total ICRU bladder dose over 24 Gy, were at risk of late sequelae

Brushed permanent magnet DC MLC motor operation in an external magnetic field.

Science.gov (United States)

Yun, J; St Aubin, J; Rathee, S; Fallone, B G

2010-05-01

Linac-MR systems for real-time image-guided radiotherapy will utilize the multileaf collimators (MLCs) to perform conformal radiotherapy and tumor tracking. The MLCs would be exposed to the external fringe magnetic fields of the linac-MR hybrid systems. Therefore, an experimental investigation of the effect of an external magnetic field on the brushed permanent magnet DC motors used in some MLC systems was performed. The changes in motor speed and current were measured for varying external magnetic field strengths up to 2000 G generated by an EEV electromagnet. These changes in motor characteristics were measured for three orientations of the motor in the external magnetic field, mimicking changes in motor orientations due to installation and/or collimator rotations. In addition, the functionality of the associated magnetic motor encoder was tested. The tested motors are used with the Varian 120 leaf Millennium MLC (Maxon Motor half leaf and full leaf motors) and the Varian 52 leaf MKII MLC (MicroMo Electronics leaf motor) including a carriage motor (MicroMo Electronics). In most cases, the magnetic encoder of the motors failed prior to any damage to the gearbox or the permanent magnet motor itself. This sets an upper limit of the external magnetic field strength on the motor function. The measured limits of the external magnetic fields were found to vary by the motor type. The leaf motor used with a Varian 52 leaf MKII MLC system tolerated up to 450 +/- 10 G. The carriage motor tolerated up to 2000 +/- 10 G field. The motors used with the Varian 120 leaf Millennium MLC system were found to tolerate a maximum of 600 +/- 10 G. The current Varian MLC system motors can be used for real-time image-guided radiotherapy coupled to a linac-MR system, provided the fringe magnetic fields at their locations are below the determined tolerance levels. With the fringe magnetic fields of linac-MR systems expected to be larger than the tolerance levels determined, some form of

Brushed permanent magnet DC MLC motor operation in an external magnetic field

Energy Technology Data Exchange (ETDEWEB)

Yun, J.; St Aubin, J.; Rathee, S.; Fallone, B. G. [Department of Physics, University of Alberta, 11322-89 Avenue, Edmonton, Alberta T6G 2G7 (Canada) and Department of Oncology, Medical Physics Division, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada) and Department of Oncology, Medical Physics Division, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Department of Physics, University of Alberta, 11322-89 Avenue, Edmonton, Alberta T6G 2G7 (Canada); Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada) and Department of Oncology, Medical Physics Division, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada)

2010-05-15

Purpose: Linac-MR systems for real-time image-guided radiotherapy will utilize the multileaf collimators (MLCs) to perform conformal radiotherapy and tumor tracking. The MLCs would be exposed to the external fringe magnetic fields of the linac-MR hybrid systems. Therefore, an experimental investigation of the effect of an external magnetic field on the brushed permanent magnet DC motors used in some MLC systems was performed. Methods: The changes in motor speed and current were measured for varying external magnetic field strengths up to 2000 G generated by an EEV electromagnet. These changes in motor characteristics were measured for three orientations of the motor in the external magnetic field, mimicking changes in motor orientations due to installation and/or collimator rotations. In addition, the functionality of the associated magnetic motor encoder was tested. The tested motors are used with the Varian 120 leaf Millennium MLC (Maxon Motor half leaf and full leaf motors) and the Varian 52 leaf MKII MLC (MicroMo Electronics leaf motor) including a carriage motor (MicroMo Electronics). Results: In most cases, the magnetic encoder of the motors failed prior to any damage to the gearbox or the permanent magnet motor itself. This sets an upper limit of the external magnetic field strength on the motor function. The measured limits of the external magnetic fields were found to vary by the motor type. The leaf motor used with a Varian 52 leaf MKII MLC system tolerated up to 450{+-}10 G. The carriage motor tolerated up to 2000{+-}10 G field. The motors used with the Varian 120 leaf Millennium MLC system were found to tolerate a maximum of 600{+-}10 G. Conclusions: The current Varian MLC system motors can be used for real-time image-guided radiotherapy coupled to a linac-MR system, provided the fringe magnetic fields at their locations are below the determined tolerance levels. With the fringe magnetic fields of linac-MR systems expected to be larger than the

Brushed permanent magnet DC MLC motor operation in an external magnetic field

International Nuclear Information System (INIS)

Yun, J.; St Aubin, J.; Rathee, S.; Fallone, B. G.

2010-01-01

Purpose: Linac-MR systems for real-time image-guided radiotherapy will utilize the multileaf collimators (MLCs) to perform conformal radiotherapy and tumor tracking. The MLCs would be exposed to the external fringe magnetic fields of the linac-MR hybrid systems. Therefore, an experimental investigation of the effect of an external magnetic field on the brushed permanent magnet DC motors used in some MLC systems was performed. Methods: The changes in motor speed and current were measured for varying external magnetic field strengths up to 2000 G generated by an EEV electromagnet. These changes in motor characteristics were measured for three orientations of the motor in the external magnetic field, mimicking changes in motor orientations due to installation and/or collimator rotations. In addition, the functionality of the associated magnetic motor encoder was tested. The tested motors are used with the Varian 120 leaf Millennium MLC (Maxon Motor half leaf and full leaf motors) and the Varian 52 leaf MKII MLC (MicroMo Electronics leaf motor) including a carriage motor (MicroMo Electronics). Results: In most cases, the magnetic encoder of the motors failed prior to any damage to the gearbox or the permanent magnet motor itself. This sets an upper limit of the external magnetic field strength on the motor function. The measured limits of the external magnetic fields were found to vary by the motor type. The leaf motor used with a Varian 52 leaf MKII MLC system tolerated up to 450±10 G. The carriage motor tolerated up to 2000±10 G field. The motors used with the Varian 120 leaf Millennium MLC system were found to tolerate a maximum of 600±10 G. Conclusions: The current Varian MLC system motors can be used for real-time image-guided radiotherapy coupled to a linac-MR system, provided the fringe magnetic fields at their locations are below the determined tolerance levels. With the fringe magnetic fields of linac-MR systems expected to be larger than the tolerance

STRATEGI PENGEMBANGAN AGROINDUSTRI DAN PENINGKATAN NILAI TAMBAH GAMBIR DI KABUPATEN LIMA PULUH KOTA SUMATERA BARAT

Directory of Open Access Journals (Sweden)

Nur Afni Evalia

2012-11-01

dan memahami nilai tambah yang diterima dari mengembangkan produk gambir, (2 menyusun faktor internal dan eksternal yang efek pengembangan industri gambir dan implikasinya terhadap kekuatan, kelemahan, peluang, dan ancaman pengembangan agroindustri gambir, dan 3 menyusun strategi untuk mengembangkan industri pengolahan gambir  kuat berorientasi ekspor studi markets. Analisis yang  digunakan adalah matriks internal factor evaluation-external factors evaluation yang digunakan untuk sum-up dan untuk mengevaluasi kekuatan dan kelemahan utama dalam fungsi tertentu dan juga digunakan sebagai dasar untuk mengidentifikasi kekuatan dan kelemahan kondisi, analisis SWOT, dan quantitative strategic planning matrix. Metode Hayami juga digunakan dalam penelitian ini untuk menggambarkan nilai tambah pengelolahan gambir. Penelitian menghasilkan peningkatan nilai tambah diperoleh dari pengolahan gambir ke catechine dan Tannin. Tiga kilogram gambir dapat menghasilkan 91,67% nilai tambah rasio catechine dan 83,81% ditambahkan nilai rasio Tannin. Strategi yang diperoleh dari matriks SWOT, empat set alternatif strategi yang dibuat, meliputi: (1 reenvigorating ATP (agrotechnopark dalam upaya untuk membangun inovasi teknologi pengolahan gambir menjadi berbagai produk olahan yang telah meyakinkan kualitas dan addequate ammounts, (2 menciptakan kebijakan nyaman untuk mengatur izin bagi investor untuk masuk yang mencakup investasi domestik dan asing, (3 meningkatkan peran pemerintah daerah, instansi perkebunan, akademisi, Lembaga Keuangan, dan instansi terkait lainnya dalam upaya untuk mengembangkan agroindustri dan untuk meningkatkan nilai tambah dari gambir di Kabupaten Lima Puluh Kota, dan (4 membentuk gambir Marketing Support Organisation (BPPG.Kata kunci:  gambir, matriks IFE dan EFE, metode hayami, analisis SWOT, analisis QSPM

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.

Sexual dysfunction after radiotherapy for cancer of the cervix uteri

Energy Technology Data Exchange (ETDEWEB)

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

1981-03-01

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

Sexual dysfunction after radiotherapy for cancer of the cervix uteri

International Nuclear Information System (INIS)

Ohkawa, Reiko; Takamizawa, Hiroyoshi; Arai, Tatsuo; Morita, Shinroku.

1981-01-01

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

Postoperative radiotherapy for intracranial meningioma

International Nuclear Information System (INIS)

Chun, Ha Chung; Lee, Myung Za

2001-01-01

To evaluate the effectiveness and tolerance of postoperative external radiotherapy for patients with intracranial meningiomas. The records of thirty three patients with intracranial meningiomas who were treated with postoperative external irradiation at our institution between Feb, 1988 and Nov, 1999 were retrospectively analyzed. Median age of patients at diagnosis was 53 years with range of 17 to 68 years. Sites of involvement were parasagital, cerebral convexity, sphenoid ridge, parasellar and tentorium cerebella. Of 33 evaluated patients, 15 transitional, 10 meningotheliomatous, 4 hemangiopericytic, 3 atypical and 1 malignant meningioma were identified. Four patients underwent biopsy alone and remaining 29 patients underwent total tumor resection. A dose of 50 to 60 Gy was delivered in 28-35 daily fractions over a period of 5 to 7 weeks. Follow-up period ranged from 12 months to 8 years. The actuarial survival rates at 5 and 7 years for entire group of patients were 78% and 67%, respectively. The corresponding disease free survival rates were 73% and 61 %, respectively. The overall local control rate at 5 years was 83%. One out of 25 patients in benign group developed local failure, while 4 out of 8 patients in malignant group did local failure (p <0.05), Of 4 patients who underwent biopsy alone, 2 developed local failure. There was no significant difference in 5 year actuarial survival between patients who underwent total tumor resection and those who did biopsy alone. Patients whose age is under 60 showed slightly better survival than those whose age is 60 or older, although this was not statistically significant. There was no documented late complications in any patients. Based on our study, we might conclude that postoperative external beam radiotherapy tends to improve survival of patients with intracranial meningiomas comparing with surgery alone

Treatment results of radical radiotherapy in uterine cervix cancer

Energy Technology Data Exchange (ETDEWEB)

Huh, Seung Jae; Kim, Bo Kyong; Lim, Do Hoon; Shin, Seong Soo; Lee, Jeong Eun; Kang, Min Kyu; Ahn, Yong Chan [Samsung Medical center, sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2002-09-15

This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radiotherapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range 30.6 {approx} 50.4 Gy to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of 24 {approx} 28 Gy with 6 {approx} 7 fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Early response of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was 82%, and 73%, and the disease free survival (DFS) rate was 72%, and 69%, at 3, and 5 years, respectively. The pelvic control rate (PCR) was 79% at both 3 and 5 years. According to the FIGO stage, 3 and 5 year OS were 100% and 50% in CIS/IA, 100% in 100% in IB, 83% and 69% in IIA, 87% and 80% in IIB, and 62% and 62% in III, respectively. The 3 year OS in 4 patients with stage IVA was 100%. Three-year DFS were 80% in CIS/IA, 88% in IB, 100% in IIA, 64% in IIB, 58% in III, and 75% in IVA. Three-year PCR were 100% in CIS/IA, 94% in IB, 100% in IIA, 84% in IIB, 69% in III, and 50% in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate

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)

Definitive radiotherapy for primary vaginal cancer. Correlation between treatment patterns and recurrence rate

International Nuclear Information System (INIS)

Kanayama, Naoyuki; Isohashi, Fumiaki; Yoshioka, Yasuo

2015-01-01

The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1–169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III–IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge. (author)

Validation of the D'amico risk groups classification, valuation of high-risk patients with or without hormonal therapy and complications of patients with adenocarcinoma of the prostate, after treatment with external radiotherapy, Hospital Calderon Guardia, 2003-2004

International Nuclear Information System (INIS)

Lopez Arias, Ever Roy

2008-01-01

D'amico risk groups have been classified to estimate the probability of biochemical recurrence after treatment for localized prostate cancer. The evolution of patients that have received external radiotherapy were analyzed according to the risk group. The medical records of 50 patients between 2003 and 2004 have been assessed and has observed the evolution of Prostatic Specific Antigen after treatment ends, at Hospital Calderon Guardia. Adverse reactions resulting from radiotherapy treatment and the organs most affected by the same have been documented nith the possibility to compare the results of similar studies in the literature. The best performance is given by receiving concomitant hormonal therapy that high risk patients of D'amico without receiving. (author) [es

Radiotherapy access in Belgium: How far are we from evidence-based utilisation?

Science.gov (United States)

Lievens, Y; De Schutter, H; Stellamans, K; Rosskamp, M; Van Eycken, L

2017-10-01

Underutilisation of radiotherapy has been observed worldwide. To evaluate the current situation in Belgium, optimal utilisation proportions (OUPs) adopted from the European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project were compared to actual utilisation proportions (AUPs) and with radiotherapy advised during the multidisciplinary cancer team (MDT) meetings. In addition, the impact of independent variables was analysed. AUPs and advised radiotherapy were calculated overall and by cancer type for 110,810 unique cancer diagnoses in 2009-2010. Radiotherapy utilisation was derived from reimbursement data and distinguished between palliative and curative intent external beam radiotherapy (EBRT) and/or brachytherapy (BT). Sensitivity analyses regarding the influence of the follow-up period, the survival length and patient's age were performed. Advised radiotherapy was calculated based on broad treatment categories as reported at MDT meetings. The overall AUP of 37% (39% including BT) was lower than the OUP of 53%, but in line with advised radiotherapy (35%). Large variations by tumour type were observed: in some tumours (e.g. lung and prostate cancer) AUP was considerably lower than OUP, whereas in others there was reasonable concordance (e.g. breast and rectal cancer). Overall, 84% of treatments started within 9 months following diagnosis. Survival time influenced AUP in a cancer type-dependent way. Elderly patients received less radiotherapy. Although the actually delivered radiotherapy in Belgium aligns well to MDT advices, it is lower than the evidence-based optimum. Further analysis of potential barriers is needed for radiotherapy forecasting and planning, and in order to promote adequate access to radiotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

Labelling techniques of biomolecules for targeted radiotherapy final report of a co-ordinated research project 1998-2002

CERN Document Server

International Atomic Energ Agency. Vienna

2003-01-01

Malignant tumour disease accounts for approximately one third of deaths worldwide. Gastrointestinal adenocarcinomas, prostate and breast cancers are among the most frequently appearing tumours. Radiotherapy is an essential mode of treatment of all cancer patients either alone or in conjunction with other modalities like surgery and chemotherapy. In most cases radiotherapy is given using external radiation sources. It is also possible to administer radiotherapy by specifically localizing radioisotopes emitting particulate radiation in the tumour tissue. This targeted therapy has proved to have several advantages over external beam therapy, notably the possibility of selectively delivering higher radiation doses to the targeted tumour cells and treating multiple metastases. Procedures for therapy of thyroid carcinoma and hyper-thyroidism using radioiodine (131I) introduced about five decades ago, have stood the test of time and are still widely used the world over. In addition to the therapeutic nuclides of the...

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.)

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.

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).

Salvage HIFU after radiotherapy and salvage radiotherapy after HIFU in locally recurrent prostate cancer: Retrospective analysis of morbidity

International Nuclear Information System (INIS)

Lee, J.-W.; Hannoun-Leviac, J.-M.; Chevallier, D.; Rouscoff, Y.; Durand, M.; Amiel, J.; Gal, J.; Natale, R.; Chand, M.-E.; Raffaelli, C.; Ambrosetti, D.

2012-01-01

To evaluate the toxicity of therapeutic sequences High Intensity Focused Ultrasound (HIFU)-salvage radiotherapy (HIFU-RT) or radiotherapy-salvage HIFU (RT-HIFU) in case of locally recurrent prostate cancer. Nineteen patients had a local recurrence of prostate cancer. Among them, 10 patients were treated by HIFU-RT and 9 patients by RT- HIFU (4 by external beam radiotherapy [EBR] and 5 by brachytherapy [BRACHY]). Urinary side effects were assessed using CTCAE v4. At the time of the initial management, the median age was 66.5 years (53 72), the median PSA was 10.8 ng/mL (3.4 50) and the median initial Gleason score was 6.3 (5 8). Median follow-up after salvage treatment was 46.3 months (2 108). Thirty percent of the patients in the HIFU-RT group and 33.3 % of the patients in the RT-HIFU group, all belonging to the sub-group BRACHY-HIFU, had urinary complication greater than or equal to grade 2. Among all the patients, only 1 had grade 1 gastrointestinal toxicity. BRACHY-HIFU sequence seems to be purveyor of many significant urinary side effects. A larger database is needed to confirm this conclusion. (authors)

Analysis of the testicular dose in patients undergoing radiotherapy for carcinoma of the prostate

International Nuclear Information System (INIS)

Bejar Navarro, M. J.; Ordonez Marquez, J.; Hervas Moron, A.; Alvarez Rodriguez, S.; Garcia-Galloway, E.; Sanchez Casanueva, R.; Polo Rubio, A.; Rodriguez-Patron, R.; Yanowsky, K.; Gomez Dos Santos, V.

2013-01-01

The objectives of this work are: -Studying comparatively the doses received in testes in patients undergoing radiotherapy of prostate carcinoma with external beam radiation and brachytherapy of low rate using I-125 seeds. -Compare doses due to images of verification using Cone Beam CT (CBCT), with doses of radiotherapy treatment itself. -Determine the seminal alterations and cytogenetic after treatment with ionizing radiation (RTE or BQT) in patients diagnosed with prostate cancer and its relation with testicular dose. (Author)

Dosimetric quality control in radiotherapy using TLD methodology

International Nuclear Information System (INIS)

Saravi, M.C.; Kessler, C.; Alvarez, P.E.; Feld, D.B.

2002-01-01

In the frame of the IAEA Co-ordinated Research Project 'Development of a Quality Assurance Program for Radiation Therapy Dosimetry in Developing Countries' a Dosimetric Quality Control Group was set up in Argentina in 1996, to develop a program in order to improve radiotherapy in the country. Nowadays, this Group, briefly called External Audit Group (EAG), is composed by the national Secondary Standard Dosimetry Laboratory (SSDL), which has the responsibility for dose determinations, traceability to international dosimetry chain and TLD measurements, and two Medical Physicists from CNEA who are working at the Oncology Hospital 'Marie Curie' in Buenos Aires. The present paper reports the activities performed by the EAG with external high energy photon beams in reference conditions and the results of two pilot studies on cobalt 60 beams in non-reference conditions. The first step of the program was to update the existing data base about the radiotherapy centres operating in the country. A form was sent to each of them in order to obtain basic information about their staff, number and type of treatment machines, brachytherapy sources, measuring devices, beam calibration, treatment planning system, simulator and other relevant data. 90 radiotherapy centres were registered in the EAG data base. Forms were completed by 75/90 centres. There are nowadays 69 cobalt 60 units and 42 LINACs operating in the country (18/42 LINACs producing high energy X ray and electron beams). EAG deals with measurements performed with mailed TLD irradiated at radiotherapy centres. Internal quality control on our TLD system is made during each audit by means of reference capsules irradiated by IAEA; external controls consist in blind tests performed by IAEA once a year. The correction factor, K en , determined at our SSDL for high energy X-rays was checked with the collaboration of IAEA and Prague National Radiation Protection Institute (PNRPI) by means of a blind test. Results for 4 MV, 6 MV

Constitution of a centralised data base for the internal quality control in radiotherapy; Constitution d'une base de donnees centralisee pour le controle de qualite interne en radiotherapie

Energy Technology Data Exchange (ETDEWEB)

Fau, P.; Rodrigues, C.; Ruchaud, R.; Bravetti, J. [Centre Prive de Radiotherapie de Metz, 57 - Metz (France)

2009-10-15

The objective of this project was to implement a centralised data base of internal quality control in radiotherapy according to the criteria of the decree of A.f.s.s.a.p.s. (French agency of sanitary safety of health products on 27 july 2007, about the internal quality control of external radiotherapy facilities. The software on one year meets the objectives: compliance by comparison with A.f.s.s.a.p.s. criteria but particularly optimization of the centralisation and analysis of the internal quality controls. (N.C.)

Outcome analysis of salvage radiotherapy for occult cervical cancer found after simple hysterectomy

International Nuclear Information System (INIS)

Koh, Hyeon-Kang; Jeon, Wan; Kim, Hak-Jae; Wu, Hong-Gyun; Kim, Kyubo; Chie, Eui-Kyu; Ha, Sung-W.

2013-01-01

The objective was to analyze the outcomes of the patients, who received salvage radiotherapy for incidentally discovered cervical cancer following simple hysterectomy, and to identify the influence of intracavitary radiotherapy on treatment outcomes. Data from 117 patients with occult cervical cancer who underwent simple hysterectomy followed by salvage radiotherapy from September 1979 to November 2010 were collected. All the patients received external beam radiotherapy with (n=45) or without (n=72) intracavitary radiotherapy. Local control, disease-free survival, overall survival and treatment-related toxicity were investigated. The median follow-up time was 75 months. The 5- and 10-year local control/disease-free survival/overall survival rates were 93/87/87% and 90/84/83%, respectively. Among 98 patients who had no residual disease and negative resection margin on surgical specimens, 32 (33%) received intracavitary radiotherapy and 66 (67%) did not. There were no differences in patient and tumor characteristics between patients treated with and without intracavitary radiotherapy. The 5-year local control rate for the non-intracavitary radiotherapy group was 93 versus 94% for the intracavitary radiotherapy group (P=0.564); the disease-free survival rate was 88 versus 94% (P=0.894); the overall survival rate was 95 versus 85% (P=0.106), respectively. Among all patients, there were 5% of Grade 3 or higher late toxicities. Patients with occult invasive cervical cancer discovered following simple hysterectomy could be treated safely and effectively with salvage radiotherapy. For patients with no residual disease and negative resection margin, intracavitary radiotherapy could be omitted. (author)

Postoperative radiotherapy of uterine sarcoma: A multicentric retrospective study

International Nuclear Information System (INIS)

Champetier, C.; Cowen, D.; Hannoun-Levi, J.M.; Resbeut, M.; Azria, D.; Salem, N.; Tessier, E.; Ellis, S.

2011-01-01

Purpose. - Surgery is the treatment of choice for localized uterine sarcomas. We conducted a retrospective study to define prognostic factors. Patients and methods. - We studied 111 cases of patients treated by adjuvant radiotherapy for uterine sarcoma in seven French centers. The median decline was 31 months. We conducted a univariate analysis to identify factors correlated with local recurrence. The statistically significant factors were studied in multivariate analysis by Cox model. Results. - The median dose of external beam radiotherapy was 45 Gy. Forty-three percent of patients had vaginal vault brachytherapy and 21 % chemotherapy. Only 6.3 % of patients had complications of acute grade III and 8.1 % of long-term sequelae of radiotherapy. The survival rate at 5 years was 74.6 %. They noted 12.6 % of isolated locoregional recurrences, against 29.7 % for distant recurrences, 80 % were pulmonary. Factors correlated with the risk of locoregional relapse were menopausal status (P = 0.045) and surgical margins suspicious or not healthy (P = 0.0095). The chemotherapy did not improve overall survival or disease free survival but the numbers were low. Conclusion. - The postoperative radiotherapy provides good local control in this disease. Brachytherapy is sometimes done, but it does not improve local control. Chemotherapy is not a standard localized stage but the rate of metastatic recurrence calls for the development of strategies involving systemic treatment with radiotherapy. (authors)

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.

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.

Tumors in dogs exposed to experimental intraoperative radiotherapy

International Nuclear Information System (INIS)

Johnstone, Peter A.S.; Laskin, William B.; De Luca, Anne Marie; Barnes, Margaret; Kinsella, Timothy J.; Sindelar, William F.

1996-01-01

Purpose: The frequency of radiation-induced neoplasms was determined in dogs enrolled in the National Cancer Institute canine trials of intraoperative radiotherapy (IORT). Methods and Materials: Twelve protocols assessing normal tissue response to IORT involved 238 dogs in a 15-year trial. Eighty-one dogs were followed for > 24 months postoperatively and were assessed for tumor development; 59 of these animals received IORT. Results: Twelve tumors occurred in the 59 dogs receiving IORT. Nine were in the IORT portals and were considered to be radiation induced. No tumors occurred in 13 sham animals or in 9 animals treated with external beam radiotherapy alone. The frequency of radiation-induced malignancies in dogs receiving IORT was 15%, and was 25% in animals receiving ≥ 25 Gy IORT. Frequency of all tumors, including spontaneous lesions, was 20%. Conclusions: Intraoperative radiotherapy contributed to a high frequency of sarcoma induction in these dogs. Unknown to date in humans involved in clinical trials of IORT, this potential complication should be looked for as long-term survivors are followed

Intraoperative radiotherapy (IORT) for locally advanced or recurrent renal cell carcinoma; Intraoperative Radiotherapie (IORT) lokal ausgedehnter und rezidivierter Nierenzellkarzinome

Energy Technology Data Exchange (ETDEWEB)

Eble, M.J.; Wannenmacher, M. [Radiologische Klinik, Ruprecht-Karls-Univ. Heidelberg (Germany); Staehler, G. [Urologische Klinik, Ruprecht-Karls-Univ. Heidelberg (Germany)

1998-01-01

In a pilot study the role of intraoperative radiotherapy in the treatment of locally advanced or recurrent renal cell cacinomas was analysed. From January 1992 to July 1994 11 patients with a primary (n=3) or recurrent renal cell carcinoma had IORT. One patient had complete resection and in 3 respectively 7 patients microscopically or macroscopically residual disease was left. Using 6 to 10 MeV, a single dose of 15 to 20 Gy was delivered to the fossa renalis and the corresponding paraaortic area. Based on three-dimensional treatment planning, additional external beam radiotherapy was given 3 to 4 weeks later (40 Gy, 2 Gy SD, 23 mV). After a mean follow-up of 24.3 months 5 patients had died of distant metastases (lung, liver, bone, mediastinum) with a mean survival time of 11.5 months. Mean disease-free interval was 6.4 months. One patient suffered from a second malignancy. Two patients are alive with distant metastases. Local tumor control in the entire group was 100%. The calculated 4-year overall and disease-free survival was 47% and 34%. The postoperative course was affected in 3 patients (abscess n=1, short dehiscence of the abdominal wound n=2). The gastrointestinal toxicity during external beam radiotherapy was low. No IORT-specific late adverse effects were observed. (orig./MG) [Deutsch] In einer Pilotstudie wurde die Wertigkeit der intraoperativen Radiotherapie bei lokal ausgedehnten primaeren oder rezidivierten Nierenzellkarzinomen ueberprueft. Von Januar 1992 bis Juli 1994 konnten bei elf Patienten mit einem primaeren (n=3) oder rezidivierten Nierenzellkarzinom intraoperativ mit 15 bis 20 Gy das Nierenlager und der Paraaortalraum bestrahlt werden. Ein Patient war vollstaendig reseziert, und bei drei bzw. sieben Patienten verblieben mikroskopische bzw. makroskopische Reste. Nach dreidimensionaler Planung wurde perkutan die Dosis mit 40 Gy aufgesaettigt (23 MV, 2 Gy ED). Nach einer mittleren Nachbeobachtung von 24,3 Monaten waren fuenf Patienten nach im

Commissioning of radiotherapy treatment planning systems: Testing for typical external beam treatment techniques. Report of the Coordinated Research Project (CRP) on Development of Procedures for Quality Assurance of Dosimetry Calculations in Radiotherapy

International Nuclear Information System (INIS)

2008-01-01

Quality Assurance (QA) in the radiation therapy treatment planning process is essential to ensure accurate dose delivery to the patient and to minimize the possibility of accidental exposure. Computerized radiotherapy treatment planning systems (RTPSs) are now widely available in both industrialised and developing countries so, it is of special importance to support hospitals in the IAEA Member States in developing procedures for acceptance testing, commissioning and ongoing QA of their RTPSs. Responding to these needs, a group of experts developed a comprehensive report, the IAEA Technical Reports Series No 430 'Commissioning and quality assurance of computerized planning systems for radiation treatment of cancer', that provides the general framework and describes a large number of tests and procedures to be considered by the RTPS users. To provide practical guidance for implementation of IAEA Technical Reports Series No. 430 in radiotherapy hospitals and particularly in those with limited resources, a coordinated research project (CRP E2.40.13) 'Development of procedures for dosimetry calculation in radiotherapy' was established. The main goal of the project was to create a set of practical acceptance and commissioning tests for dosimetry calculations in radiotherapy, defined in a dedicated protocol. Two specific guidance publications that were developed in the framework of the Coordinated Research Project E2.40.13 are based on guidelines described in the IAEA Technical Report Series No. 430 and provide a step-by-step description for users at hospitals or cancer centres how to implement acceptance and commissioning procedures for their RTPSs. The first publication, 'Specification and acceptance testing of radiotherapy treatment planning systems' IAEA-TECDOC-1540 uses the International Electrotechnical Commission (IEC) standard IEC 62083 as its basis and addresses the procedures for specification and acceptance testing of RTPSs to be used by both manufacturers and

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

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

External Beam Radiotherapy of Recurrent Glioma: Radiation Tolerance of the Human Brain

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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.

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.

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

International Nuclear Information System (INIS)

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

2009-01-01

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

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.

Evaluation of the treatment planning system of three-dimensional conformal external radiotherapy in Hospital Mexico of San Jose, Costa Rica

International Nuclear Information System (INIS)

Venegas Rojas, Deybith

2014-01-01

An evaluation and analysis are realized of dosimetry of the treatment planning system (TPS) of three-dimensional conformal external radiotherapy in the Servicio de Radioterapia of the Hospital Mexico of Costa Rica. An evaluation procedure is proposed based on IAEA-TECDOC-1540 document, and may continue to be applied periodically in this or other radiotherapy services. Tests realized have checked the representation of distances and electronics densities transferred to the TPS, match with those of real objects. The 16 tests applied have represented situations of real treatments with different configurations and beam modifiers in the equipment used daily. The tests have measured the absorbed dose to water in different significant points at different depths, using photon beams of 6 MeV and 18 MeV. The physical parameters of the tests were simulated. The absorbed dose has been calculated at specified points. The XiO and Eclipse TPS have been used with the calculation algorithms: Superposition, Convolution and AAA. The results of the calculations are evaluated with statistical methods and comparing them with the measurements of absorbed dose. A generalized tendency has been detected toward negative relative errors, implying an underestimation of the dose by the TPS; due to a difference found in the accelerator output factor respect to its commissioning. The AAA algorithm has determined a better performance, although with greater difficulties of calculus in the region of build-up. Convolution and Superposition algorithms have had similar performances and both have presented problems in high depths and out of edges of the fields. The result of the dosimetric evaluation has been satisfactory in real conditions of equipment; but several particularities have been found that should be reviewed and adjusted. The precision of the TPS has been adequate in the majority of situations important for treatment planning. [author] [es

Spatial aspects of combined modality radiotherapy

International Nuclear Information System (INIS)

Bodey, Rachel K.; Evans, Phil M.; Flux, Glenn D.

2005-01-01

Background and purpose: A combined modality radiotherapy (CMRT) incorporates both external beam radiotherapy (EBT) and targeted radionuclide therapy (TRT) components. The spatial aspects of this combination were explored by utilising intensity modulated radiotherapy (IMRT) to provide a non-uniform EBT dose distribution. Patients and methods: Three methods of prescribing the required non-uniform distribution of EBT dose are described, based on both physical and biological criteria according to the distribution of TRT uptake. The results and consequences of these prescriptions are explored by application to three examples of patient data. Results: The planning procedure adopted allowed IMRT plans to be produced that met the prescription requirements. However, when the treatment was planned as a CMRT, compared with the use of EBT alone, more satisfactory target doses could be achieved with lower doses to normal tissues. The effects of errors in EBT delivery and in the functional data were found to cause a non-uniform prescription to tend towards the uniform case. Conclusions: The methods and results are relevant for more general biological treatment planning, in which IMRT may be used to produce dose distributions prescribed according to tumour function. The effects of delivery and dose calculation errors can have a significant impact on how such treatments should be planned

Dose-response characteristics of low- and intermediate-risk prostate cancer treated with external beam radiotherapy

International Nuclear Information System (INIS)

Cheung, Rex; Tucker, Susan L.; Lee, Andrew K.; Crevoisier, Renaud de; Dong Lei; Kamat, Ashish; Pisters, Louis; Kuban, Deborah

2005-01-01

Purpose: In this era of dose escalation, the benefit of higher radiation doses for low-risk prostate cancer remains controversial. For intermediate-risk patients, the data suggest a benefit from higher doses. However, the quantitative characterization of the benefit for these patients is scarce. We investigated the radiation dose-response relation of tumor control probability in low-risk and intermediate-risk prostate cancer patients treated with radiotherapy alone. We also investigated the differences in the dose-response characteristics using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition vs. an alternative biochemical failure definition. Methods and materials: This study included 235 low-risk and 387 intermediate-risk prostate cancer patients treated with external beam radiotherapy without hormonal treatment between 1987 and 1998. The low-risk patients had 1992 American Joint Committee on Cancer Stage T2a or less disease as determined by digital rectal examination, prostate-specific antigen (PSA) levels of ≤10 ng/mL, and biopsy Gleason scores of ≤6. The intermediate-risk patients had one or more of the following: Stage T2b-c, PSA level of ≤20 ng/mL but >10 ng/mL, and/or Gleason score of 7, without any of the following high-risk features: Stage T3 or greater, PSA >20 ng/mL, or Gleason score ≥8. The logistic models were fitted to the data at varying points after treatment, and the dose-response parameters were estimated. We used two biochemical failure definitions. The ASTRO PSA failure was defined as three consecutive PSA rises, with the time to failure backdated to the mid-point between the nadir and the first rise. The second biochemical failure definition used was a PSA rise of ≥2 ng/mL above the current PSA nadir (CN + 2). The failure date was defined as the time at which the event occurred. Local, nodal, and distant relapses and the use of salvage hormonal therapy were also failures. Results: On the basis of the

[Principles of radiotherapy of non-small cell lung cancer].

Science.gov (United States)

Esik, Olga; Horváth, Akos; Bajcsay, András; Hideghéty, Katalin; Agócs, László; Pikó, Béla; Lengyel, Zsolt; Petrányi, Agota; Pisch, Julianna

2002-01-01

The long-term survival probability for Hungarian lung cancer patients is 10% worse than the best results published in the most highly developed countries (the mean 5-year survival probability in Hungary is 5%, in contrast with the 15% survival probability in the USA). On the basis of the international recommendations and personal experience, an attempt was made to formulate the guidelines for radiotherapy as one of the fundamental non-small cell lung cancer (NSCLC) treatment modalities for national use. An expert panel was set up comprising physicians from 6 radiotherapeutic centers (the National Institute of Oncology / Semmelweis University, Budapest; the Beth Israel Medical Center, New York; the University of Kaposvár; the University of Essen; the University of Debrecen; and the County Hospital of Gyula). Experts in two important medical fields closely related to radiotherapy (surgery and diagnostic imaging) were also engaged in the elaboration of the manuscript. Discussion of the most important principles of the radiotherapy and an overview of the prognostic factors was followed by a critical analysis of the protocols applied in the radiotherapy of Hungarian NSCLC patients during recent decades. The new guidelines suggested for the radiotherapy of NSCLC are presented separately for the postoperative period, marginally resectable tumors, and the aggressive or non-aggressive radiotherapy of inoperable tumors. Detailed accounts are given of the techniques of external irradiation and brachytherapy, and of the acute and late radiation-induced damage of normal tissues. The authors believe that this document may be instrumental in improving the survival index of Hungarian NSCLC patients in the near future.

Development of dose audits for complex treatment techniques in radiotherapy

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Stefanic, A. M.; Molina, L.; Vallejos, M.; Montano, G.; Zaretzky, A.; Saravi, M., E-mail: stefanic@cae.cnea.gov.ar [Centro Regional de Referencia con Patrones Secundarios para Dosimetria - CNEA, Presbitero Juan Gonzalez y Aragon 15, B1802AYA Ezeiza (Argentina)

2014-08-15

This work was performed in the frame of a Coordinated Research Project (CRP) with IAEA whose objective was to extend the scope of activities carried out by national TLD-based networks from dosimetry audit for rectangular radiation fields to irregular and small fields relevant to modern radiotherapy. External audit is a crucial element in QA programmes for clinical dosimetry in radiotherapy, therefore a methodology and procedures were developed and were made available for dose measurement of complex radiotherapy parameters used for cancer treatment. There were three audit steps involved in this CRP: TLD based dosimetry for irregular MLC fields for conformal radiotherapy, dosimetry in the presence of heterogeneities and 2D MLC shaped fields relevant to stereotactic radiotherapy and applicable to dosimetry for IMRT. In addition, a new development of film-based 2D dosimetry for testing dose distributions in small field geometry was included. The plan for each audit step involved a pilot study and a trial audit run with a few local hospitals. The pilot study focused on conducting and evaluation of the audit procedures with all participants. The trial audit run was the running of the audit procedures by the participants to test them with a few local radiotherapy hospitals. This work intends to provide audits which are much nearer clinical practice than previous audits as they involve significant testing of Tps methods, as well as verifications to determinate whether hospitals can correctly calculate dose delivery in radiation treatments. (author)

Development of dose audits for complex treatment techniques in radiotherapy

International Nuclear Information System (INIS)

Stefanic, A. M.; Molina, L.; Vallejos, M.; Montano, G.; Zaretzky, A.; Saravi, M.

2014-08-01

This work was performed in the frame of a Coordinated Research Project (CRP) with IAEA whose objective was to extend the scope of activities carried out by national TLD-based networks from dosimetry audit for rectangular radiation fields to irregular and small fields relevant to modern radiotherapy. External audit is a crucial element in QA programmes for clinical dosimetry in radiotherapy, therefore a methodology and procedures were developed and were made available for dose measurement of complex radiotherapy parameters used for cancer treatment. There were three audit steps involved in this CRP: TLD based dosimetry for irregular MLC fields for conformal radiotherapy, dosimetry in the presence of heterogeneities and 2D MLC shaped fields relevant to stereotactic radiotherapy and applicable to dosimetry for IMRT. In addition, a new development of film-based 2D dosimetry for testing dose distributions in small field geometry was included. The plan for each audit step involved a pilot study and a trial audit run with a few local hospitals. The pilot study focused on conducting and evaluation of the audit procedures with all participants. The trial audit run was the running of the audit procedures by the participants to test them with a few local radiotherapy hospitals. This work intends to provide audits which are much nearer clinical practice than previous audits as they involve significant testing of Tps methods, as well as verifications to determinate whether hospitals can correctly calculate dose delivery in radiation treatments. (author)

Results of radiotherapy in craniopharyngiomas analysed by the linear quadratic model

Energy Technology Data Exchange (ETDEWEB)

Guerkaynak, M. [Dept. of Radiation Oncology, Hacettepe Univ., Ankara (Turkey); Oezyar, E. [Dept. of Radiation Oncology, Hacettepe Univ., Ankara (Turkey); Zorlu, F. [Dept. of Radiation Oncology, Hacettepe Univ., Ankara (Turkey); Akyol, F.H. [Dept. of Radiation Oncology, Hacettepe Univ., Ankara (Turkey); Lale Atahan, I. [Dept. of Radiation Oncology, Hacettepe Univ., Ankara (Turkey)

1994-12-31

In 23 craniopharyngioma patients treated by limited surgery and external radiotherapy, the results concerning local control were analysed by linear quadratic formula. A biologically effective dose (BED) of 55 Gy, calculated with time factor and an {alpha}/{beta} value of 10 Gy, seemed to be adequate for local control. (orig.).

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

Constitution of a centralised data base for the internal quality control in radiotherapy

International Nuclear Information System (INIS)

Fau, P.; Rodrigues, C.; Ruchaud, R.; Bravetti, J.

2009-01-01

The objective of this project was to implement a centralised data base of internal quality control in radiotherapy according to the criteria of the decree of A.f.s.s.a.p.s. (French agency of sanitary safety of health products on 27 july 2007, about the internal quality control of external radiotherapy facilities. The software on one year meets the objectives: compliance by comparison with A.f.s.s.a.p.s. criteria but particularly optimization of the centralisation and analysis of the internal quality controls. (N.C.)

Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review

International Nuclear Information System (INIS)

Pieters, Bradley R.; Back, Djuna Z. de; Koning, Caro C.E.; Zwinderman, Aeilko H.

2009-01-01

Background and Purpose: For the radiation treatment of prostate cancer high dose should be delivered for optimal biochemical control. Treatment can be given by dose-escalated external beam radiotherapy (EBRT) or external beam radiotherapy combined with a radioactive seed implantation (EBSeeds) or high-dose rate (HDR) brachytherapy (EBTI). Differences in outcome between the modalities were assessed by a systematic review. Materials and methods: A systematic search was performed resulting in 40 articles to be used. Data were extracted on biochemical control and overall survival at 3, 5, and 8 years and other time points mentioned in the articles. Also known prognostic parameters were noted. Comparison of the modalities was done by a Weibull survival analysis and estimation of Hazard Ratio's (HR) was done with 95% confidence intervals (95% CIs). Results: The HR for biochemical recurrence was 1.40 (95% CI 1.31-1.51) for EBRT relative to EBTI, and was 1.37 (95% CI 1.26-1.49) for EBSeeds relative to EBTI. The HR for overall survival was 1.50 (95% CI 1.29-1.73) for EBRT relative to EBTI, and was 2.33 (95% CI 2.04-2.66) for EBSeeds relative to EBTI. Conclusion: The combination of external beam radiotherapy and HDR brachytherapy results in a superior biochemical control and overall survival found in a systematic review on radiotherapy for prostate cancer.

Efficacy of external fractionated radiation therapy in the treatment of meningiomas: a 20-year experience

International Nuclear Information System (INIS)

Pourel, Nicolas; Auque, Jean; Bracard, Serge; Hoffstetter, Sylvette; Luporsi, Elisabeth; Vignaud, Jean-Michek; Bey, Pierre

2001-01-01

Background: This is a retrospective analysis of a series of meningiomas treated by radiotherapy. Materials and methods: From 1978 to 1997, 45 patients with intracranial meningiomas were referred for external fractionated radiotherapy at Centre Alexis Vautrin. All patients were given 50-70 Gy to the tumor bed (median: 56 Gy), 1.8-2 Gy per fraction. Results: Evaluation was performed in June 1999 using the Kaplan-Meyer actuarial method with a median follow-up of 30 months (range: 1-166), relapse-free survivals (RFSs) were 75% at 5 years and 67% at 8 years; overall survival (OS) was 74% at 5 and 8 years. For the 26 benign histologically documented lesions, RFSs were 95% at 5 years and 81% at 8 years; OS was 85% at 5 and 8 years. One major radiation-induced complication occurred in this series (decline of cognitive function). According to the indication of radiotherapy, we divided the series into four groups: postoperative irradiation after a first subtotal resection (11 patients), 5-year RFS was 90%; after first recurrence (±salvage surgery, 14 patients), 73%; after further recurrence (±salvage surgery, 11 patients), 67%; as exclusive treatment (nine patients), 80%. Atypical and malignant lesions (n=7) all relapsed before 24 months of follow-up, all patients but one died before 42 months. Age at the time of irradiation (≥60 vs. <60 years) and radiotherapy dose (≥60 vs. <60 Gy) did not influence local control or OS. Atypical and malignant lesions (WHO grades II and III) meningiomas had a worse outcome than benign lesions (WHO grade I, P<0.01). Conclusions: These results compare favorably with previously published data. External fractionated radiotherapy is well tolerated and effective. There is still a debate about the place of radiotherapy in the treatment of meningiomas: after subtotal resection, should radiotherapy be given postoperatively or at the time of progression? Should radiotherapy replace surgery when the risk of postoperative sequellae is high

Cost of quality assurance in radiotherapy: human and material requirements

International Nuclear Information System (INIS)

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

2005-01-01

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

MRI before and after external beam intensity-modulated radiotherapy of patients with prostate cancer: The feasibility of monitoring of radiation-induced tissue changes using a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence

International Nuclear Information System (INIS)

Franiel, Tobias; Luedemann, Lutz; Taupitz, Matthias; Boehmer, Dirk; Beyersdorff, Dirk

2009-01-01

Purpose: To identify and quantify suitable pharmacokinetic MRI parameters for monitoring tissue changes after external beam intensity-modulated radiotherapy of prostate cancer. Material and methods: Six patients with biopsy-proven prostate cancer (initial PSA, 6.0-81.4 ng/ml) underwent MRI at 1.5 T using a combined endorectal/body phased-array coil and a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence (T1/T2*w; 1.65 s temporal resolution). MRI was performed before and immediately after radiotherapy, at 3 months and at 1 year. Perfusion, blood volume, mean transit time, delay, dispersion, interstitial volume, and extraction coefficient were calculated in prostate cancer and normal prostate for all four time points using a sequential 3-compartment model. Results: Prostate cancer and normal prostate tissue showed a statistically significant decrease in perfusion (p = 0.006, p = 0.001) and increase in extraction coefficient (p = 0.004, p 3 min, p = 0.028) and a smaller extraction coefficient (0.42 vs. 0.64, p = 0.028). Conclusions: Two pharmacokinetic parameters, perfusion and extraction coefficient, appear to be suitable candidates for monitoring the response to percutaneous intensity-modulated radiotherapy of prostate cancer.

Anaplastic thyroid carcinoma: 91 patients treated by surgery and radiotherapy

International Nuclear Information System (INIS)

Junor, E.J.; Paul, J.; Reed, N.S.

1992-01-01

Ninety-one patients with histologically proven anaplastic carcinoma of the thyroid were referred to the Beatson Oncology Centre between 1961 and 1986. The female:male ratio was 2.4:1 and the median age at presentation was 70 (range 38-92) years. All patients had a thyroid mass at presentation and the most common symptoms were dyspnoea, dyspnagia and dysphonia. Five patients had a total thyroidectomy and 28 partial thyroidectomy. Ninety five per cent of patients received external beam radiotherapy. Results show dyspnoea to be the only symptom strongly influencing survival. Total or partial thyroidectomy is associated with increased survival. This association is most marked for patients presenting without dyspnoea. Eighty per cent of patients responded to radiotherapy. (Author)

Anaplastic thyroid carcinoma: 91 patients treated by surgery and radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Junor, E.J.; Paul, J.; Reed, N.S. (Beatson Oncology Centre, Glasgow (United Kingdom))

1992-04-01

Ninety-one patients with histologically proven anaplastic carcinoma of the thyroid were referred to the Beatson Oncology Centre between 1961 and 1986. The female:male ratio was 2.4:1 and the median age at presentation was 70 (range 38-92) years. All patients had a thyroid mass at presentation and the most common symptoms were dyspnoea, dyspnagia and dysphonia. Five patients had a total thyroidectomy and 28 partial thyroidectomy. Ninety five per cent of patients received external beam radiotherapy. Results show dyspnoea to be the only symptom strongly influencing survival. Total or partial thyroidectomy is associated with increased survival. This association is most marked for patients presenting without dyspnoea. Eighty per cent of patients responded to radiotherapy. (Author).

Adaptive-Predictive Organ Localization Using Cone-Beam Computed Tomography for Improved Accuracy in External Beam Radiotherapy for Bladder Cancer

International Nuclear Information System (INIS)

Lalondrelle, Susan; Huddart, Robert; Warren-Oseni, Karole; Hansen, Vibeke Nordmark; McNair, Helen; Thomas, Karen; Dearnaley, David; Horwich, Alan; Khoo, Vincent

2011-01-01

Purpose: To examine patterns of bladder wall motion during high-dose hypofractionated bladder radiotherapy and to validate a novel adaptive planning method, A-POLO, to prevent subsequent geographic miss. Methods and Materials: Patterns of individual bladder filling were obtained with repeat computed tomography planning scans at 0, 15, and 30 minutes after voiding. A series of patient-specific plans corresponding to these time-displacement points was created. Pretreatment cone-beam computed tomography was performed before each fraction and assessed retrospectively for adaptive intervention. In fractions that would have required intervention, the most appropriate plan was chosen from the patient's 'library,' and the resulting target coverage was reassessed with repeat cone-beam computed tomography. Results: A large variation in patterns of bladder filling and interfraction displacement was seen. During radiotherapy, predominant translations occurred cranially (maximum 2.5 cm) and anteriorly (maximum 1.75 cm). No apparent explanation was found for this variation using pretreatment patient factors. A need for adaptive planning was demonstrated by 51% of fractions, and 73% of fractions would have been delivered correctly using A-POLO. The adaptive strategy improved target coverage and was able to account for intrafraction motion also. Conclusions: Bladder volume variation will result in geographic miss in a high proportion of delivered bladder radiotherapy treatments. The A-POLO strategy can be used to correct for this and can be implemented from the first fraction of radiotherapy; thus, it is particularly suited to hypofractionated bladder radiotherapy regimens.

Accelerated partial breast irradiation with external beam three-dimensional conformal radiotherapy. Five-year results of a prospective phase II clinical study

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Mozsa, Emoeke [National Institute of Oncology, Centre of Radiotherapy, Budapest (Hungary); Landesklinikum Wiener Neustadt, Department of Radiooncology and Radiotherapy, Wiener Neustadt (Austria); Meszaros, Norbert; Major, Tibor; Froehlich, Georgina; Stelczer, Gabor; Fodor, Janos; Polgar, Csaba [National Institute of Oncology, Centre of Radiotherapy, Budapest (Hungary); Sulyok, Zoltan [National Institute of Oncology, Centre of Surgery, Budapest (Hungary)

2014-05-15

The aim of this study was to report the 5-year results of accelerated partial breast irradiation (APBI) using external beam three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2011, 44 patients with low-risk, stage I-II breast cancer underwent breast-conserving surgery. Postoperative APBI was given by means of 3D-CRT using three to five non-coplanar fields. The total dose of APBI was 36.9 Gy (nine fractions of 4.1 Gy b.i.d.). The mean follow-up time was 58.2 months for surviving patients. Survival results, side effects, and cosmetic results were assessed. One (2.3 %) local recurrence was observed, for a 5-year actuarial rate of 3.7 %. Neither regional nor distant failure was observed. Two patients died of internal disease. The 5-year disease-free, cancer-specific, and overall survival rates were 96.3, 100, and 95.1 %, respectively. Acute side effects included grade 1 (G1) erythema in 75 %, G1 parenchymal induration in 46 %, and G1 pain in 46 % of patients. No G2 or higher acute side effect occurred. Late side effects included G1, G2, and G3 fibrosis in 44, 7, and 2 % of patients, respectively, G1 skin pigmentation in 12 %, and G1 pain in 2 %. Asymptomatic fat necrosis occurred in 14 %. Cosmetic results were rated excellent or good in 86 % of cases by the patients themselves and 84 % by the physicians. The 5-year local tumor control, toxicity profile, and cosmetic results of APBI delivered with external beam 3D-CRT are encouraging and comparable to other APBI series. (orig.) [German] Evaluation der 5-Jahres-Ergebnisse bezueglich Ueberleben, Tumorkontrolle, Nebenwirkungen und Kosmetik nach Teilbrustbestrahlung (APBI) mittels 3-D-konformaler, akzelerierter Radiotherapie (3D-CRT). Zwischen 2006 und 2011 wurden 44 Patienten mit Brustkrebs im Stadium I-II und niedrigem Risikoprofil brusterhaltend operiert. Die adjuvante, 3-D-konformale APBI wurde mittels 3-5 nonkoplanarer Feldern durchgefuehrt. Die Gesamtdosis betrug 36,9 Gy bei 9 -mal 4,1 Gy b.i.d.. Nach

Combinatie van uit- en inwendige radiotherapie voor het oesofaguscarcinoom: een nieuw perspectief

NARCIS (Netherlands)

Caspers, R. J.; Zwinderman, A. H.; Griffioen, G.; Welvaart, K.; Leer, J. W.

1993-01-01

Thirty-five patients with an inoperable or non-resectable oesophageal carcinoma were treated with external radiotherapy to a maximum dose of 60 Gy followed by a booster irradiation by means of intraluminal brachytherapy at a low dose rate (40-112 cGy/h). For this extra irradiation, which lasted

Dose calculation system for remotely supporting radiotherapy

International Nuclear Information System (INIS)

Saito, K.; Kunieda, E.; Narita, Y.; Kimura, H.; Hirai, M.; Deloar, H. M.; Kaneko, K.; Ozaki, M.; Fujisaki, T.; Myojoyama, A.; Saitoh, H.

2005-01-01

The dose calculation system IMAGINE is being developed keeping in mind remotely supporting external radiation therapy using photon beams. The system is expected to provide an accurate picture of the dose distribution in a patient body, using a Monte Carlo calculation that employs precise models of the patient body and irradiation head. The dose calculation will be performed utilising super-parallel computing at the dose calculation centre, which is equipped with the ITBL computer, and the calculated results will be transferred through a network. The system is intended to support the quality assurance of current, widely carried out radiotherapy and, further, to promote the prevalence of advanced radiotherapy. Prototypes of the modules constituting the system have already been constructed and used to obtain basic data that are necessary in order to decide on the concrete design of the system. The final system will be completed in 2007. (authors)

New method in radiotherapy of bronchial carcinoma

International Nuclear Information System (INIS)

Macha, H.N.; Mai, J.; Stadler, M.; Koch, K.; Loddenkemper, R.; Krumhaar, D.; Schumacher, W.; Lungenklinik Heckeshorn, Berlin; Staedtisches Rudolf-Virchow-Krankenhaus, Berlin

1986-01-01

106 patients with inoperable malignant tumours constricting the central bronchial tree underwent endobronchial small-field radiotherapy with iridium-192 at high dose between June 1983 and September 1985. Treatment was performed using the computer-guided after-loading technique and a flexible bronchoscope under local anaesthesia. In complete occlusion of a bronchus by the tumour, a neodymium YAG-laser was applied (57 patients) to allow insertion of the afterloading probe. Endoscopy showed tumour regression in 75% of the patients, accompanied by clinical improvement. Pulmonary function tests, arterial blood gas analyses and pulmonary perfusion scans yielded a highly significant improvement of data after treatment. The procedure also proved effective upon exhaustion of external radiation. Apart from its positive palliation, endobronchial small-field radiotherapy using high doses of iridium-192 also has a curative effect, thus opening up a new approach to the therapy of advanced bronchial carcinoma. (orig.) [de

Irradiation of low rectal cancers; Radiotherapie des carcinomes du bas rectum

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Ardiet, J.M.; Coquard, R.; Romestaing, P.; Fric, D.; Baron, M.H.; Rocher, F.P.; Sentenac, I.; Gerard, J.P. [Centre Hospitalier Lyon-Sud, 69 -Pierre-Benite (France)

1994-12-31

The low rectal cancers are treated by anorectal amputation and pose the problem of the sphincter conservation. Some authors extend the clinical definition to developed injuries until 12 cm from the anal margin. The rectal cancer is a frequent tumour which remains serious. When the tumour is low, the treatment consists in an anorectal amputation with a permanent colostomy. The radical non preserving surgery is the usual treatment of these injuries. Until 1960 the rectal adenocarcinoma was considered as a radioresistant tumour because of the impossibility to deliver an enough dose to the tumour by external radiotherapy. But other studies showed that those lesions were radiosensitive and often radiocurable. The medical treatments haven`t yet demonstrated their efficiency in the treatment of the rectal cancer. We`ll study the radiotherapy in the treatment of the low rectal cancer, solely radiotherapy, radiosurgical associations. 32 refs., 5 tabs.

Radiotherapy of tonsillar and base of the tongue carcinoma. Prediction of local control

NARCIS (Netherlands)

Mak-Kregar, S.; Baris, G.; Lebesque, J. V.; Balm, A. J.; Hart, A. A.; Hilgers, F. J.

1993-01-01

119 patients with squamous cell carcinoma of the tonsillar region (68) and the base of the tongue (51), who received external radiotherapy with curative intent between 1966 and 1984, are analysed with respect to overall treatment results, local tumour control and prognostic factors. Radiation doses

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

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.

A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma.

Science.gov (United States)

Windsor, Phyllis M; Nicol, Kathleen F; Potter, Joan

2004-08-01

Advice to rest and take things easy if patients become fatigued during radiotherapy may be detrimental. Aerobic walking improves physical functioning and has been an intervention for chemotherapy-related fatigue. A prospective, randomized, controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma. Sixty-six men were randomized before they received radical radiotherapy for localized prostate carcinoma, with 33 men randomized to an exercise group and 33 men randomized to a control group. Outcome measures were fatigue and distance walked in a modified shuttle test before and after radiotherapy. There were no significant between group differences noted with regard to fatigue scores at baseline (P = 0.55) or after 4 weeks of radiotherapy (P = 0.18). Men in the control group had significant increases in fatigue scores from baseline to the end of radiotherapy (P = 0.013), with no significant increases observed in the exercise group (P = 0.203). A nonsignificant reduction (2.4%) in shuttle test distance at the end of radiotherapy was observed in the control group; however, in the exercise group, there was a significant increase (13.2%) in distance walked (P = 0.0003). Men who followed advice to rest and take things easy if they became fatigued demonstrated a slight deterioration in physical functioning and a significant increase in fatigue at the end of radiotherapy. Home-based, moderate-intensity walking produced a significant improvement in physical functioning with no significant increase in fatigue. Improved physical functioning may be necessary to combat radiation fatigue.

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)

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)

PERANCANGAN DAN IMPLEMENTASI SISTEM PENGUKURAN KINERJA DENGAN METODE INTEGRATED PERFORMANCE MEASUREMENT SYSTEMS (Studi Kasus: Jurusan Teknik Mesin Universitas Mataram

Directory of Open Access Journals (Sweden)

Bambang Syairuddin

2007-01-01

Full Text Available To assure the quality of education in the Department of Mechanical Engineering, we need to design an integrated performance measurement system. For that purpose, we used the IPMS (Integrated Performance Measurement Systems method. Using the IPMS method, Key Performance Indicators (KPIs of the Department of Mechanical Engineering were determined by pursuant to stakeholder requirement through four steps. Those are identifying the stakeholder requirement, external monitor, stipulating objectives, and identification of KPIs. Performance measurement system with the IPMS method in the Department of Mechanical Engineering of Mataram University can be identified into 38 KPIs grouped in 9 criterias of performance of the Department of Mechanical Engineering, that are curriculum, student, financial, human resources, administration academic, teaching and learning, alumnus, evaluation and operation, and external party. Abstract in Bahasa Indonesia : Untuk menjamin kualitas pendidikan di Jurusan Teknik Mesin, diperlukan sebuah rancangan sistem pengukuran kinerja (SPK yang terintegrasi dengan metode IPMS (Integrated Performance Measurement Systems. Dengan metode IPMS, Key Performance Indicators (KPI Jurusan Teknik Mesin ditentukan berdasarkan stakeholder requirement melalui empat tahapan yaitu; identifikasi stakeholder requirement, external monitor, penetapan objectives, dan identifikasi KPIs. Hasil perancangan SPK di Jurusan Teknik Mesin Universitas Mataram, dapat mengidentifikasi 38 KPIs yang dikelompokkan dalam 9 kriteria kinerja Jurusan Teknik Mesin, yaitu; kurikulum, mahasiswa, finansial, SDM, administrasi akademik, proses pembelajaran, alumni, evaluasi dan pengendalian, dan external party. Kata Kunci : Sistem Pengukuran Kinerja, IPMS, Teknik Mesin Unram.

Radical external beam radiotherapy for prostate cancer in Japan. Differences in the patterns of care between Japan and the United States

International Nuclear Information System (INIS)