WorldWideScience

Sample records for rate intracavitary therapy

  1. Intracavitary therapy of craniopharyngiomas

    International Nuclear Information System (INIS)

    Shapiro, B.; Fig, L. M.; Gross, M.D.; Ann Arbor Nuclear Medicine Service, Ann Arbor, MI

    1999-01-01

    Craniopharyngiomas are benign cystic para-hypophyseal tumors often associated with hypopituitarism and visual-field abnormalities. Their therapy by surgery and external beam radiotherapy is imperfect. The intracavitary instillation of beta-emitting colloid radiopharmaceuticals into the cysts permits the delivery of far higher radiation doses to the cyst lining than is possible by external beam radiotherapy. This technique permits destruction of the lining epithelium with resultant elimination of cyst fluid formation and cyst shrinkage in up to 80% of cases

  2. Mis-dose rate intracavitary therapy for cervical cancer with a Selectron; A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Teshima, Teruki; Inoue, Takehiro; Inoue, Toshihiko; Ikeda, Hiroshi; Yamazaki, Hideya; Ohtani, Masatoshi; Sasaki, Shigeru; Murayama, Shigeyuki; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    Our early experience with Selectron MDR in treating cervical cancer patients at Osaka University Hospital is presented. From May 1991 through December 1992, a total of 22 patients (stage Ia, 1; stage Ib, 3; stage IIa, 1; stage IIb, 2; stage IIIb, 13 and stage IVa, 2) with previously untreated uterine cervical cancer and intact uterus were treated with mid-dose rate intracavitary therapy administered with a Selectron. A rigid applicator made of stainless steel for the Selectron was used for the treatment. The [sup 137]Cs source had an activity of 1.48 GBq as of reference time. Source loading corresponded to the Manchester System. Early tumor responses for all patients were complete. No acute radiation injury has been observed. There have been two local recurrences in stage IIIb patients. One of them developed para-aortic lymph node metastasis and died from distant metastasis. Another patient in stage IIIb had para-aortic and left supraclavicular lymph node metastasis and died from distant metastasis. Four patients developed rectal bleeding (grade 1, 3; grade 3, 1) . One of them had been treated for aplastic anemia with steroid. The cause of grade 3 rectal bleeding was considered to be technical failure in intracavitary application. The remaining two patients recovered without treatment. From our early experience, it is concluded that Selectron MDR can be used for cervical cancer patients as safely and effectively as our previously used high-dose rate machine. (author).

  3. Mid-dose rate intracavitary therapy for uterine cervix cancer with a Selectron; An early experience of Osaka University

    Energy Technology Data Exchange (ETDEWEB)

    Teshima, Teruki; Inoue, Takehiro; Sasaki, Shigeru; Ohtani, Masatoshi; Kozuka, Takahiro; Inoue, Toshihiko; Ikeda, Hiroshi; Yamazaki, Hideya (Osaka Univ. (Japan). Faculty of Medicine); Murayama, Shigeyuki

    1993-05-01

    From May 1991 through September 1992, a total of 17 previously untreated patients with invasive uterine cervix cancer and with intact uterus were treated with mid-dose rate intracavitary therapy administered with a Selectron. Early primary tumor responses for all patients were complete. No acute or subacute radiation injury was observed except one patient with aplastic anemia who developed rectal ulcer. Two patients of Stage IIIb died from tumor because of local, paraaortic lymph node and distant metastases. Our early experience concluded that Selectron MDR can be used for cervix cancer patients as safely and effectively as our previously used high-dose rate machine. (author).

  4. A consideration of distributions and treatment schedules in high dose rate intracavitary therapy of carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Sakata, Suoh; Sato, Sigehiro; Nakano, Masao; Iida, Koyo; Yui, Nobuharu

    1979-01-01

    A remotely controlled afterloading device for high dose rate intracavitary radiation, the remote afterloader Shimadzu Ralstron MTSW-20, was installed at Chiba Cancer Center Hospital in 1973 and put into clinical use for the treatment of carcinoma of the uterine cervix. Before the clinical use, isodose distributions and treatment schedules were investigated, compared with the low dose rate intracavitary radiation by linear sources of 137 Cs used hitherto. The isodose distributions, calculated by using an electronic computer, for various combinations of the length of uterine canal and the separation of vaginal applicators, were the same as those obtained with linear sources. As for the treatment schedules, by using PT (partial tolerance) which was derived from NSD concept of Ellis, a number of fractional radiation regimes with high dose rate, equivalent to continuous low dose rate radiation, was calculated. From these, a dose of 600 rad per fraction to point A every week has been chosen as the standard radiation schedule. The number of fractions has been varied with the clinical stages. Furthermore, some changes of total dose or small modification of dose distribution have been made for individual lesions. According to the preliminary results, three-year cumulative survival rate was 68.7% and complication rate was 15.2%. Comparing these results with those of the treatment at low dose rate, the former is nearly equal, while the latter is lower. The reduction of complication rate is probably due to the improvement of therapeutic techniques such as continuous observation by fractionated intracavitary radiation, variety of isodose distributions and accuracy of source placement by a short treatment time. (author)

  5. Intracavitary ultrasound phased arrays for thermal therapies

    Science.gov (United States)

    Hutchinson, Erin

    Currently, the success of hyperthermia and thermal surgery treatments is limited by the technology used in the design and fabrication of clinical heating devices and the completeness of the thermometry systems used for guidance. For both hyperthermia and thermal surgery, electrically focused ultrasound generated by phased arrays provides a means of controlling localized energy deposition in body tissues. Intracavitary applicators can be used to bring the energy source close to a target volume, such as the prostate, thereby minimizing normal tissue damage. The work performed in this study was aimed at improving noninvasive prostate thermal therapies and utilized three research approaches: (1) Acoustic, thermal and optimization simulations, (2) Design and fabrication of multiple phased arrays, (3) Ex vivo and in vivo experimental testing of the heating capabilities of the phased arrays. As part of this study, a novel aperiodic phased array design was developed which resulted in a 30- 45% reduction in grating lobe levels when compared to conventional phased arrays. Measured acoustic fields generated by the constructed aperiodic arrays agreed closely with the fields predicted by the theoretical simulations and covered anatomically appropriate ranges. The power capabilities of these arrays were demonstrated to be sufficient for the purposes of hyperthermia and thermal surgery. The advantage of using phased arrays in place of fixed focus transducers was shown by demonstrating the ability of electronic scanning to increase the size of the necrosed tissue volume while providing a more uniform thermal dose, which can ultimately reduce patient treatment times. A theoretical study on the feasibility of MRI (magnetic resonance imaging) thermometry for noninvasive temperature feedback control was investigated as a means to improve transient and steady state temperature distributions achieved in hyperthermia treatments. MRI guided ex vivo and in vivo experiments demonstrated

  6. Value and importance of intracavitary therapy in uterine cervix carcinoma

    International Nuclear Information System (INIS)

    Frischkorn, R.

    1986-01-01

    The guiding topic of this report was 'the value and importance of intracavitary therapy in uterine cervix carcinoma'. This implies first of all the task to assess the importance of contact therapy within the scope of all therapeutic measures taken in case of uterine cervix carcinoma. Furthermore it was necessary to compare the importance of the different methods of contact therapy: conventional radium therapy as well as low dose rate and high dose rate afterloading techniques. As to surgical intervention, it is clear that only favorable stages can be taken into consideration for this treatment. It is shown by means of data taken from the Annual Report, Vol. 18, that a considerable number of patients with uterine cervix carcinoma I are irradiated even in hospitals whose field of activity lies preponderantly in surgery, and that by far most of the patients cured from uterine cervix cancer owe their recovery to contact therapy. The consideration of contact therapy methods show clearly that radium should no longer be used in clinical practice. Psychological doubts often hinder the decision if long-term or short-term afterloading therapy is to be applied. It is therefore shown that the very different forms of radium therapy with their chronological and spatial dose distribution were due to the characteristics of radium (e.g. little specific activity) or to other compelling features and that they were not based on radiobiological aspects. The radium dose values obtained by empirical research and the resulting spatial and chronological dose distribution are therefore not imperative. So it is not inevitable to choose the low dose rate afterloading method. On the contrary, the high dose rate technique with an adequate fractionation is very probably the method of choice. To sum up it can be said that contact therapy is still the most important therapeutic method in uterine cervix cancer. (orig.) [de

  7. Medium-dose-rate intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Tanaka, Eiichi; Isohashi, Fumiaki; Oh, Ryoong-Jin

    2003-01-01

    The purpose of this study was to evaluate the results of medium-dose-rate (MDR) intracavitary brachytherapy (ICRT) for cervical cancer. Between May 1991 and March 2001, 80 patients with cervical cancer were treated with external radiotherapy combined with MDR-ICRT. Two patients were excluded from this study. The median age of patients was 61 years (range: 30-87 years). Seventy-five patients had pathologically proved squamous cell carcinoma, and 3 had adenocarcinoma. The patients were staged by Union Internationale Contre le Cancer (UICC) classification as follows: Stage IA (2), Stage IB (4), Stage IIA (5), Stage IIB (22), Stage IIIA (1), Stage IIIB (32), Stage IVA (5), Stage IVB (7). Median follow-up for survivor was 68 months (range: 12-131 months). The radiation therapy was based on a combination of ICRT and external pelvic irradiation. Patients with stages II, III and IVA were treated with whole-pelvic irradiation with respective total doses of 20, 30, and 40 Gy. Doses of 40, 30, 20, and 20 Gy parametrial irradiation were added with central shield pelvic irradiation for stages IB, II, III and IVA lesions respectively. For MDR-ICRT, from May 1991 to December 1995, point A dose were 40 Gy/4 fractions for stages I and II, 38 Gy/4 fractions for stage III, and 28.5 Gy/3 fractions for stage IVA. And from January 1996 to March 2001, point A dose of 36 Gy/4 fractions for stages I and II, 34 Gy/4 fractions for stage III, and 25.5 Gy/3 fractions for stage IVA. The median dose rate at point A was 1.7 Gy/hour (range: 1.3-2.2 Gy/hour). The 5-year cause-specific survival rates were 100%, 76%, 51% and 40% for stages I, II, III and IVA respectively. All patients with stage IVB died from the tumor with a median survival time of 12 months. The 5-year pelvic control rates were 100%, 88%, 69% and 40% for stages I, II, III and IVA respectively. Major late complications occurred in 2 patients (3%). One patient developed vesico- and recto-vaginal fistulae, and died of pelvic infection

  8. Occupational monitoring in intracavitary radium therapy

    International Nuclear Information System (INIS)

    Araujo, A.M.C. de

    1985-01-01

    In Brazil, the highest incidence of cancer in females is in the uterine cervix, in which Bracytherapy treatment plays a very important role. The majority of our Clinics use 226 Ra or 137 Cs tubes to perform this therapy. As many of these Clinics do not use the afterloading technique, we investigated the occupational exposure for the staffs belonging to two big Hospitals in Rio de Janeiro, where the working conditions are very different. For this, besides the normal film badge, placed in the upper part of the trunk, each person has been provided with seven additional thermoluminescent dosimeters (chips - 7 LiF) placed at: left ring finger, right ring finger, forehead (between the eyes), over the thyroid, in the midle of the back and the front of the trunk, and over the gonadal region. In Hospital A, where the staff is composed of 1 medical doctor and 1 nurse, they treat about 13 patients per month. In Hospital B, the staff was composed of 12 medical doctors, 2 technicians and 7 murses, and about 20 patients are treated monthly. The occupational exposures have been investigated separately for each step of the 226 Ra routine. From these results we could easily identify that: the nurses working in the infermary do not use the lateral lead protection of beds to clean the patients; in Hospital B, where there are perfect conditions for storage and manipulation of the radioactive sources, the technician in charge of these tasks, together with the transport of the applicator, except in his hands, suffers no exposure at all. Besides that, we could also see that in Hospital A, where the nurse plays also the role of that technician, and the local protection conditions are not correct, the estimated annual exposures are still below the annual limits according to ICRP N 0 . 26/1977. This analysis has been completed with measures of occupational exposures in Clinics using the after loading technique. (author) [pt

  9. Holmium-166-chico intracavitary radiation therapy for cystic brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Rhee, C. H.; Lee, S. H.; Jang, J. S.; Kim, E. H.; Choi, C. W.; Hong, S. W.; Lim, S. M. [Korea Cancer Center, Seoul (Korea, Republic of)

    1997-07-01

    Holmium-166-chitosan complex (Ho-166-chico) is injected into the unresectable seven cystic brain tumors (2 cases of metastatic brain tumors from lung cancer, 1 case of recurrent trigeminal neurinoma, 3 cases of recurrent low grade cystic astrocytomas, and 1 case of craniopharyngioma). The Ommaya reservoir was installed stereotactically. The cyst volume and wall thickness were measured by MRI before Ho-166-chico injection. The thickness of the cyst wall is up to 4 mm. Ho-166-chico (555-740 MBq) injected into the cyst to result in 25 Gy of dose to a cyst wall at a depth of 4 mm. Dose to the cyst wall was estimated by Monte Carlo simulation using the EGS4 code. All Ho-166-chico injected was assumed to be uniformly distributed in the spherical cyst. After Ho-166-chico injection, the distribution of isotopes was monitored by gamma camera. Two injections were administrated in two cases, and one injection in all the others. The response was evaluated with MRI. Four of 7 cases were shrunk in size with thinning of the cyst wall, 2 of 7 cases showed growth arrest, and one case showed progression. Estimated surface dose of cyst wall was between 78 and 2566 Gy. No one showed systemic absorption of Ho-166-chico, and specific complication associated with isotope injection. Ho-166-chico intracavitary radiation therapy for cystic brain tumor may be safe, and reliable method and deserves further evaluation.

  10. A prospective randomized study concerning the point a dose in high-dose rate intracavitary therapy for carcinoma of the uterine cervix. The final results

    International Nuclear Information System (INIS)

    Chatani, M.; Matayoshi, Y.; Masaki, N.; Teshima, T.; Inoue, T.

    1994-01-01

    Between January 1983 and February 1989, a total of 165 patients with carcinoma of the unterine cervix was entered in a prospective randomized study concerning the point A dose of HDR therapy (6 Gy/fraktion vs 7.5 Gy/fraction) and external irradiation dose at Department of Radiation Therapy, The Center for Adult Diseases, Osaka. UICC stage distribution of patients was as follows: Stage IA=4, stage IB=33, stage IIA=18, stage IIB=38, stage III=57, stage IV=15. Overall 5-year cause specific survivals were as follows: Stage IA=100%, stage IB=96%, stage IIA=92%, stage IIB=79%, stage III=57%, stage IV=27%. In each stage, 5-year survival rates in groups A and B were 100%, 93% in stage I, 82% and 85% in stage II, 62% and 52% in stage II and 22% and 31% in stage IV, respectively. There were no statistically significant differences among these survival curves in each stage. Five-year local failure rates were 16% in group A and 16% in group B (p=0.9096), and corresponding distant failure rates were 23% in group A and 19% in group B (p=0.2955). Moderate-to-severe complications requiring treatment (Kottmeier's grade 2 or more) were noted in 6 patients (7%) in group A and 6 patients (7%) in group B. All of the bladder and rectal complications needed medical treatment (Kottmeier's grade 2). Severe complications receiving surgery were noted in 4 patients (A: 1; B: 3), i.e., small intestine 3 and sigmoid colon 1 patient. Another 1 patient (A) was dead of ileus. There were no statistically significant differences between 2 treatment schedules in survival rates, failure patterns and complications rates. This fact suggests that small number of fractions (7.5 Gy/fraction) may be advantageous because of short duration and a low load of treatment. (orig.) [de

  11. Packing effects on the intracavitary radiation therapy of the uterine cervix cancer

    International Nuclear Information System (INIS)

    Cho, Jung Kun; Lee, Du Hyun; Si, Chang Kun; Choi, Yoon Kyung; Kim, Tae Yoon

    2004-01-01

    Purpose of the radio-therapy is maximize the radiation dose to the tumor while minimizing the dose to the critical organ. Carcinoma of the uterine cervix treatment are external irradiation or an interstitial brachytherapy make use of isotope. Brachytherapy is a method of radiotherapy in advantage to achieve better local control with minimum radiation toxicity in comparison with external irradiation because radiation dose is distributed according to the inverse square low of gamma-ray emitted from the implanted sources. Authors make use of the patients data which 192 Ir gives medical treatment intracavity. Intracavitary radiation of the uterine cervix cancer, critical organ take 20% below than exposure dose of A point in the ICRU report. None the less of the advice, Radiation proctitis and radiation cystitis are frequent and problematic early complications in patients treated with radiation for the uterine cervix cancer. In brachytherapy of uterine cervical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. Use of packing to reduce late complications intracavitary radiation of the uterine cervix cancer. Bladder and rectum changes exposure dose rate by radiotherapy make use of packing.

  12. High dose rate intracavitary afterloading irradiation in malignant inoperable obturation of bile ducts

    Energy Technology Data Exchange (ETDEWEB)

    Itami, J.; Saegusa, K.; Mamiya, T.; Miyoshi, T.; Arimizu, N.; Tsuchiya, Y.; Ohto, M.

    1986-02-01

    After decompression of the bile duct with PTCD, seven patients with carcinomas of the bile ducts were submitted to an intracavitary Ir-afterloading irradiation performed according to the high-dose-rate method with a Buchler device. Most of the patients were irradiated with 30 Gy in two fractions. Five patients were also exposed to percutaneous radiation with 40 to 50 Gy. Local control was achieved in six patients. One patient developed a locoregional recurrence which was possibly due to a so-called 'geographic miss'. In one patient a benign fibrotic stenosis of the bile duct was found at the site of most intensive irradiation. Intracavitary irradiation is very important in the treatment of malignant of bile ducts. However, there is an urgent need of research with regard to the combined method with percutaneous irradiation and to the optimum fractionation of intracavitary high dose rate irradiation.

  13. High versus low dose rate intracavitary irradiation for adenocarcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Kim, Woo-Chul; Loh, John J.K.; Kim, Gwi-Eon; Suh, Chang-Ok

    2001-01-01

    Traditionally, low dose rate (LDR) brachytherapy has been used as a standard modality in the treatment of patients with carcinoma of the uterine cervix. The purpose of this work was to evaluate the effects of high dose rate (HDR) brachytherapy on patients with adenocarcinoma of the uterine cervix and to compare them with the effects of LDR brachytherapy. From January 1971 to December 1992, 104 patients suffering from adenocarcinoma of the uterine cervix were treated with radiation therapy in the Department of Radiation Oncology, Yonsei University. LDR brachytherapy was carried out on 34 patients and HDR brachytherapy on 70 patients. In the LDR group, eight patients were in stage IB, six in IIA, 12 in IIB, three in IIIA and five in IIIB. External radiation therapy was delivered with 10 MV X-rays, 2 Gy fraction per day, total dose of whole pelvis 36-52 Gy (median 46 Gy). LDR radium intracavitary irradiation was performed with a Henschke applicator, 37-59 Gy targeted at point A (median 43 Gy). In the HDR group, there were 16 patients in stage IB, six in IIA, 32 in IIB and 16 in IIIB. The total whole pelvis dose of external radiation was 40-50 Gy (median 44 Gy), daily 1.8-2.0 Gy. HDR Co-60 intracavitary irradiation was performed with a remotely controlled after-loading system (RALS), 30-48 Gy (median 39 Gy) targeted at point A, three times per week, 3 Gy per fraction. The 5-year overall survival rate in the LDR group was 72.9, 61.9 and 35.7% in stage I, II and III, respectively and the corresponding figures for HDR were 87.1, 58.3 and 43.8% (p 0.05). No prognostic factors were evident in the comparison between the two groups. There was no difference in terms of 5-year survival rate in the patients with adenocarcinoma of the uterine cervix between those treated with HDR and those treated with LDR brachytherapy. Even though late complication rates were higher in the HDR group, most of them were classified as grade I. This retrospective study suggests that HDR

  14. Intracavitary after loading techniques, advantages and disadvantages with high and low dose-rate methods

    International Nuclear Information System (INIS)

    Walstam, Rune

    1980-01-01

    Even though suggested as early as 1903, it is only when suitable sealed gamma sources became available, afterloading methods could be developed for interstitial as well as intracavitary work. Manual afterloading technique can be used only for low dose rate irradiation, while remote controlled afterloading technique can be used for both low and high dose-rate irradiation. Afterloading units used at the Karolinska Institute, Stockholm, are described, and experience of their use is narrated briefly. (M.G.B.)

  15. Treatment of carcinoma of uterine cervix with high-dose-rate intracavitary irradiation using Ralstron

    International Nuclear Information System (INIS)

    Suh, C.O.; Kim, G.E.; Loh, J.J.K.

    1988-01-01

    From May 1979 through December 1981, a total of 530 patients with carcinoma of the uterine cervix were treated with radiation therapy with curative intent. Of the 530 patients, 365 were treated with a high-dose-rate remote-controlled afterloading system (RALS) using a cobalt source, and 165 patients received a low dose rate using a radium source. External pelvic irradiation with a total of 40-50 Gy to the whole pelvis followed by intracavitary radiation (ICR) with a total dose of 30-39 Gy in ten to 13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rate with high-dose-rate ICR by stage was as follows: stage I:82.7% (N = 19) stage II:69.6% (N = 184), and stage III:52.2% (N = 156). The above results were comparable with those with conventional low-dose-rate ICR treatment, and late complications were far less. The application of high-dose-rate ICR was technically simple and easily performed on an outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually none as compared with that of low-dose-rate ICR. Within a given period of time, more patients can be treated with high-dose-rate ICR because of the short treatment time. The authors therefore conclude that high-dose-rate ICR is suitable for a cancer center where a large number of patients are to be treated

  16. Local vaginal anesthesia during high-dose-rate intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Chen, H.-C.; Wan Leung, Stephen; Wang, C.-J.; Sun, L.-M.; Fang, F.-M.; Huang, E.-Y.; Wang, S.-J.; Yang, C.-W.

    1998-01-01

    Purpose: To evaluate the clinical efficacy of local vaginal lidocaine application for pain relief during high-dose-rate (HDR) intracavitary brachytherapy for patients with cervical cancer, and to investigate sequential changes in serum levels of lidocaine during the procedures. Methods and Materials: This prospective study was designed to examine the analgesic effect, physical response, and side effects of local anesthesia during HDR intracavitary brachytherapy. Forty patients were enrolled. All patients received 10-15 MV X-rays to the pelvis with a total dose of 45-59.4 Gy 5-6 weeks before undergoing HDR intracavitary brachytherapy. All patients underwent first intracavitary brachytherapy under general anesthesia. These patients were randomly allocated to receive one of two different treatment protocols as follows: (1) treatment session - control session - treatment session - control session; or (2) control session - treatment session- control session - treatment session. In the treatment sessions, topical anesthesia was administered using 4 ml of 10% lidocaine solution sprayed liberally on the cervix and vagina during intracavitary brachytherapy. In the control sessions, a placebo was administered in the same manner during brachytherapy. The Hensche's applicators for brachytherapy were inserted into the cervix and vagina 5 min after lidocaine application. The visual analogue scale (VAS) was used to assess pain and discomfort during brachytherapy. Blood pressure and heart rates were measured to evaluate the physiological response. Another prospective study was then performed to investigate the sequential changes of serum lidocaine levels during the anesthetic procedure. Eleven additional patients with similar disease state and demographic characteristics were enrolled and blood samples were obtained before, and 5, 15, 30, and 45 min after the initiation of lidocaine application. Results: The mean VAS values recorded during the treatment sessions and control

  17. High versus low dose-rate intracavitary irradiation for adenocarcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Kim, Woo Chul; Kim, Gwi Eon; Chung, Eun Ji; Suh, Chang Ok; Hong, Soon Won; Cho, Young Kap; Loh, John Jk

    1999-01-01

    The incidence of adenocarcinoma of the uterine cervix is low. Traditionally, Low Dose Rate (LDR) brachytherapy has been used as a standard modality in the treatment for patients with carcinoma of the uterine cervix. The purpose of this report is to evaluate the effects of the High Dose Rate (HDR) brachytherapy in the patients with adenocarcinoma of the uterine cervix compared with the LDR. From January 1971 to December 1992, 106 patients of adenocarcinoma of uterine cervix were treated with radiation therapy in the Department of Radiation Oncology, Yonsei University with curative intent. LDR brachytherapy was carried out on 35 patients and 71 patients were treated with HDR brachytherapy. In LDR Group, 8 patients were in stage I, 18 in stage II and 9 in stage III. external radiation therapy was delivered with 10 MV X-ray, daily 2 Gy fractionation, total dose 40-46 Gy (median 48 Gy). And LDR Radium intracavitary irradiation was performed with Henschke applicator, 22-56 Gy to point A (median 43 Gy). In HDR Group, there were 16 patients in stage I, 38 in stage II and 17 in stage III. The total dose of external radiation was 40-61 Gy (median 45 Gy), daily 1.8-2.0 Gy. HDR Co-60 intracavitary irradiation was performed with RALS(Remote Afterloading System), 30-57 Gy (median 39 Gy) to point A, 3 times a week, 3 Gy per fraction. The 5-year overall survival rate in LDR Group was 72.9%, 61.9%, 45.0% in stage I, II, III, respectively and corresponding figures for HDR were 87.1%, 58.3%, 41.2%, respectively (p>0.05). There was no statistical difference in terms of the 5-year overall survival rate between HDR Group and LDR Group in adenocarcinoma of the uterine cervix. There was 11% of late complication rates in LDR Group and 27% in HDR Group. There were no prognostic factors compared HDR with LDR group. The incidence of the late complication rate in HDR Group stage II, III was higher than that in LDR Group (16.7% vs. 31.6% in stage II, 11.1% vs. 35.3% in stage III, p>0

  18. A quality indicator to evaluate high-dose-rate intracavitary brachytherapy for cancer of the cervix

    International Nuclear Information System (INIS)

    Morales, Francisco Contreras; Soboll, Daniel Scheidegger

    2000-01-01

    The aim of this report is to prevent a simple quality indicator (QI) that can be promptly used to evaluate the high-dose-rate (HDR) intracavitary brachytherapy for the treatment of cancer of the cervix, and if necessary, to correct applicators' geometry before starting the treatment. We selected 51 HDR intracavitary applications of brachytherapy of patients with carcinoma of the cervix treated with 60 mm uterine tandem and small Fletcher colpostat, according to the Manchester method (dose prescription on point A). A QI was defined as the ratio between the volume of 100% isodose curve of the study insertion and the volume of the 100% isodose curve of an insertion considered to be ideal. The data obtained were distributed in three groups: the group with tandem placement slippage (67,5%), a group with colpostat placement slippage (21,9%), and a third group, considered normal (10,6%). Each group showed particular characteristics (p < 0.0001). QI can be the best auxiliary method to establish the error tolerance (%) allowed for HDR intracavitary brachytherapy. (author)

  19. Carcinoma of Uterine Cervix Treated with High Dose Rate Intracavitary Irradiation : 1. Patterns of Failure

    International Nuclear Information System (INIS)

    Kim, Ok Bae; Choi, Tae Jin; Kim, Jin Hee

    1993-01-01

    226 patients with carcinoma of the uterine cervix treated with curative radiation therapy at the Department of Therapeutic Radiology, Dongsan hospital, Keimyung university, School of medicine, from July, 1988 to May, 1991 were evaluated. The patients with all stages of the disease were included in this study. The maximum and mean follow up durations were 60 and 43 months. The radiation therapy consisted of external irradiation to the whole pelvis (2700 - 4500 cGy) and boost parametrial doses(for a total of 4500 - 6300 cGy) with midline shill(4x10 cm), and combined with intracavitary irradiation irradiation(5700 - 7500 cGy to point A). The distribution of patients according to the stage was as follows: stage IB 37(16.4%), stage IIA 91 (40.3%), Stage IIB 58(25.7%), stage III 32(13.8%), stage IV 8 (3.5%). The overall failure rate was 23.9%(54 patients). The failure rate increased as a function of stage from 13.5% in stage 1B to 15.4% in stage IIA, 25.9% in stage IIB, 46.9% in stage III, and 62.5% in stage IV. The pelvic failure alone were 32 patients and 11 patients were as a components of other failure, and remaining 11 patients had distant metastasis only. Among the 43 patients of locoregional failure, 28 patients were not controlled initially and in other words nearly half of total failures were due to residual tumor. The mean medial paracervical(point A) doses were 6700 cGy in stage IIB, 7200 cGy in stage IIA, 7450 cGy in stage IIB, 7600 cGy in stage III and 8100 cGy in stage IV. The medial paracevical doses showed some correlation with tumor control rate in early stage of disease (stage Ib, IIA), but there were higher central failure rate in advanced stage in spite of higher paracervical doses. In advanced stage, failure were not reduced by simple Increment of paracervical doses. To improve a locoregional control rate in advanced stages, it is necessary to give additional treatment such as concomitant chemoradiation

  20. High-dose-rate intracavitary brachytherapy in the management of cervical and vaginal intraepithelial neoplasia

    International Nuclear Information System (INIS)

    Ogino, Ichiro; Kitamura, Tatsuo; Okajima, Hiroyuki; Matsubara, Sho

    1998-01-01

    Purpose: To assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with grade 3 cervical intraepithelial neoplasia (CIN-3) and grade 3 vaginal intraepithelial neoplasia (VAIN-3). Methods and Materials: This was a retrospective analysis in 20 patients with CIN-3 (n = 14) or VAIN-3 (n = 6), average age 61.9 years, managed with HDR-ICR at Kanagawa Cancer Center. Two patients with CIN-3 with microinvasive foci and 11 other patients with CIN-3 were treated with HDR-ICR for cervical lesions. Six patients with CIN-3 after hysterectomy received HDR-ICR for recurrent or residual VAIN-3 lesions. One patient received radiation therapy for both CIN-3 and VAIN-3 lesions. All these patients but one were postmenopausal. Results: Seventeen patients were treated with HDR-ICR alone, and three with combined external radiation therapy. The dose was calculated at Point A located 2 cm superior to the external os and 2 cm lateral to the axis of the intrauterine tube for intact uterus. For lesions of the vaginal stump, the dose was calculated at a point 1 cm superior to the vaginal apex or 1 cm beyond vaginal mucosa. In the 14 patients treated for CIN-3 lesions, the mean total dose of HDR-ICR was 26.1 Gy (range 20-30). Six patients received HDR-ICR for VAIN-3 lesions with mean dose of 23.3 Gy (range 15-30). At follow-up (mean 90.5 months; range 13-153), 14 patients were alive and 6 had died owing to nonmalignant intercurrent disease. No patient developed recurrent disease. Rectal bleeding occurred in three patients, but this symptom subsided spontaneously. Moderate and severe vaginal reactions were noted in two patients, in whom the treatment had included the entire vagina. Conclusions: HDR-ICR can be employed as the primary management strategy for postmenopausal women with CIN-3. In intraepithelial neoplasia involving the vaginal wall after hysterectomy, HDR-ICR should be considered as an alternative to total vaginectomy

  1. Treatment Outcome of Medium-Dose-Rate Intracavitary Brachytherapy for Carcinoma of the Uterine Cervix: Comparison With Low-Dose-Rate Intracavitary Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kaneyasu, Yuko, E-mail: kaneyasu@hiroshima-u.ac.jp [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Kita, Midori [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Department of Clinical Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo (Japan); Okawa, Tomohiko [Evaluation and Promotion Center, Utsunomiya Memorial Hospital, Tochigi (Japan); Maebayashi, Katsuya [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Kohno, Mari [Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women' s Medical University Hospital, Tokyo (Japan); Sonoda, Tatsuo; Hirabayashi, Hisae [Department of Radiology, Tokyo Women' s Medical University Hospital, Tokyo (Japan); Nagata, Yasushi [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-09-01

    Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women's Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.

  2. Treatment Outcome of Medium-Dose-Rate Intracavitary Brachytherapy for Carcinoma of the Uterine Cervix: Comparison With Low-Dose-Rate Intracavitary Brachytherapy

    International Nuclear Information System (INIS)

    Kaneyasu, Yuko; Kita, Midori; Okawa, Tomohiko; Maebayashi, Katsuya; Kohno, Mari; Sonoda, Tatsuo; Hirabayashi, Hisae; Nagata, Yasushi; Mitsuhashi, Norio

    2012-01-01

    Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women’s Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.

  3. Case of severe intestinal complications caused by high dose-rate intracavitary irradiation for cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Koga, Kenji; Nishikawa, Kiyoshi; Matsuki, Kazuhiko; Watanabe, Katsushi

    1987-02-01

    A 46-year-old woman with severe intestinal complication caused by high dose-rate intracavitary irradiation is reported. She received radiation treatment of stage IIb cervical cancer between July 24 and September 26, 1984: a dose of 2400 rad to a point A concurrently with 2000 rad to the parametrium following 4000 rad to the whole pelvis. Eight months later she developed diarrhea and bloody stool. Barium enema study revealed a stenosis at 20 to 25 cm from the anal ring and romanoscopy oozing coagula at the same site. On November 29, 1985 transverse colostomy was performed because of continuing bloody stool and abdominal pain. On January 30, 1986 resection of the ileum and ileostomy were done because of the ileum perforation located 26 cm apart from the ileum end. Some discussion on the causes of this complication are made, suggesting that short length of a tandem and deep location of ovoids influence its cause.

  4. Clinical significance of shape of isodosecurves in intracavitary radiation therapy in carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Higuchi, Tatsuo

    1985-01-01

    In intracavitary radiation therapy of carcinoma of the uterine cervix, deviated position of microsources in the uterine and vaginal cavities from standard position was classified as follows: (1) Slipped position of a whole system of microsources. (2) Slipped position of the uterine tandem. (3) Slipped position of the colpostat. (4) Anteversion-flexion position of the uterine tandem. (a) Anterior displacement of the vaginal colpostat. (b) Posterior displacement of the vaginal colpostat. (5) Retroversion-flexion position of the uterine tandem. (a) Posterior displacement of the vaginal colpostat. (b) Retroposed position of the uterine tandem. (6) Side inclination of the uterine tandem. In every position, dose distribution around microsources was calculated by computers and isodosecurves in the vicinity of the cervix were constructed in three dimensions. Advantage and disadvantage of shape of these isodosecurves were discussed clinically with special reference to dosage of the lesions, rectum and bladder which was delivered from microsources. Besides these studies we clarified the reason why adequate cancerocidal dosage of carcinoma of the uterine cervix in the aged was much less than in the younger on the basis of anatomical and tumor size difference between two groups. The similar difference could be found between Japanese and Westerns in radiation therapy of carcinoma of the uterine cervix. (author)

  5. Low dose rate and high dose rate intracavitary treatment for cervical cancer

    International Nuclear Information System (INIS)

    Hareyama, Masato; Oouchi, Atsushi; Shidou, Mitsuo

    1997-01-01

    From 1984 through 1993, 144 previous untreated patients with carcinoma of uterine cervix were treated with either low dose rate 137 Cs therapy (LDR) or high dose rate 60 Co therapy (HDR). The local failure rates for more than 2-years for the primary lesions were 11.8% (8 of 63 patients) for LDR and 18.0% (11 of 61 patients). Rectal complication rates were significantly lower for HDR versus LDR (14.3% VS. 32.8%. p<0.01). Also, bladder complication rates were significantly lower for HDR versus LDR (0% VS. 10.4%, p<0.005). Treatment results in term of local control were equivalent for HDR and LDR treatment. However, the incidence of complications was higher for the LDR group than for the HDR group. (author)

  6. Impact of catheter reconstruction error on dose distribution in high dose rate intracavitary brachytherapy and evaluation of OAR doses

    International Nuclear Information System (INIS)

    Thaper, Deepak; Shukla, Arvind; Rathore, Narendra; Oinam, Arun S.

    2016-01-01

    In high dose rate brachytherapy (HDR-B), current catheter reconstruction protocols are relatively slow and error prone. The purpose of this study is to evaluate the impact of catheter reconstruction error on dose distribution in CT based intracavitary brachytherapy planning and evaluation of its effect on organ at risk (OAR) like bladder, rectum and sigmoid and target volume High risk clinical target volume (HR-CTV)

  7. 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

  8. External Beam Boost for Cancer of the Cervix Uteri When Intracavitary Therapy Cannot Be Performed

    International Nuclear Information System (INIS)

    Barraclough, Lisa Helen; Swindell, Ric; Livsey, Jacqueline E.; Hunter, Robin D.; Davidson, Susan E.

    2008-01-01

    Purpose: To assess the outcome of patients treated with radical radiotherapy for cervical cancer who received an external beam boost, in place of intracavitary brachytherapy (ICT), after irradiation to the whole pelvis. Methods and Materials: Case notes were reviewed for all patients treated in this way in a single center between 1996 and 2004. Patient and tumor details, the reasons why ICT was not possible, and treatment outcome were documented. Results: Forty-four patients were identified. The mean age was 56.4 years (range, 26-88 years). Clinical International Federation of Gynecology and Obstetrics or radiologic stage for Stages I, II, III, and IV, respectively, was 16%, 48%, 27%, and 7%. A total radiation dose of 54-70 Gy was given (75% received ≥60 Gy). Reasons for ICT not being performed were technical limitations in 73%, comorbidity or isolation limitations in 23%, and patient choice in 4%. The median follow-up was 2.3 years. Recurrent disease was seen in 48%, with a median time to recurrence of 2.3 years. Central recurrence was seen in 16 of the 21 patients with recurrent disease. The 5-year overall survival rate was 49.3%. The 3-year cancer-specific survival rate by stage was 100%, 70%, and 42% for Stages I, II, and III, respectively. Late Grades 1 and 2 bowel, bladder, and vaginal toxicity were seen in 41%. Late Grade 3 toxicity was seen in 2%. Conclusion: An external beam boost is a reasonable option after external beam radiotherapy to the pelvis when it is not possible to perform ICT

  9. Positional variation of applicators during low dose rate intracavitary brachytherapy for cervical cancer: a prospective study

    Directory of Open Access Journals (Sweden)

    Arul Ponni

    2010-10-01

    Full Text Available Purpose: In order to know the effect of variation in position of applicators to the dose received by the tumor volume, critical organs such as rectum and bladder and the correlation of variation on the clinical outcome.Material and methods: 36 patients with histologically proven cervical cancer, undergoing intracavitary brachythe - rapy (ICBT from October 2005 to December 2006 were the subjects of the study. Two pairs of orthogonal X-ray films were taken: one prior to loading of sources and the other after removal of sources. These patients were followed up as per the RTOG criteria.Results: The median duration of insertion was 25 hours with a median follow up period of 6.7 months. The translational variation of the applicator position for all patients was 3 mm and 1 mm (2 SD, respectively, in the patient’s lateral and antero-posterior direction. The rotational variation was 3 and 4 degrees (2 SD in the patient’s transverse and sagittal planes. Detailed analysis of source movement showed following changes in median dose: point A: 14%, point B: 2%, point P: 1%, Rectum 1: 3.5%, Rectum 2: 4% and Bladder: 9.1%. The incidence of rectal toxicity was 6/36(16.7% and that of bladder was 1/36 (2.8%. When the variables were grouped to evaluate the relationship, our study showed statistically significant relationship between: R2 and rectal toxicity (p value: 0.002, point A and rectal toxicity (Pearson: 0.792, lateral displacement/anteroposterior displacement and rectal toxicity (p value: 0.012/0.003, beta angle and R2 (p value: 0.002.Conclusions: The geometric relationships between the ICBT applicators and the critical structures vary during the course of low dose rate brachytherapy. Source movement does result in significant dose alterations in terms of increased rate of complications, but its impact on cure rates needs to be studied in the future.

  10. MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience

    Energy Technology Data Exchange (ETDEWEB)

    Gill, Beant S.; Kim, Hayeon; Houser, Christopher J. [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Kelley, Joseph L.; Sukumvanich, Paniti; Edwards, Robert P.; Comerci, John T.; Olawaiye, Alexander B.; Huang, Marilyn; Courtney-Brooks, Madeleine [Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Beriwal, Sushil, E-mail: beriwals@upmc.edu [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials: Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high–dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD{sub 2}) with planned HRCTV doses of 75 to 85 Gy. Results: From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P<.01) and clinical response at 3 months (P<.01). Among the adenocarcinoma subset, receiving HRCTV D{sub 90} EQD{sub 2} ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. Conclusions: This study constitutes one of the largest reported series of MRI

  11. Optimal bladder filling during high-dose-rate intracavitary brachytherapy for cervical cancer: a dosimetric study

    Directory of Open Access Journals (Sweden)

    Umesh Mahantshetty

    2017-04-01

    Full Text Available Purpose: The aim of this study is to compare 3D dose volume histogram (DVH parameters of bladder and other organs at risk with different bladder filling protocol during high-dose-rate intracavitary brachytherapy (HDR-ICBT in cervical cancer, and to find optimized bladder volume. Material and methods : This dosimetric study was completed with 21 patients who underwent HDR-ICBT with computed tomography/magnetic resonance compatible applicator as a routine treatment. Computed tomography planning was done for each patient with bladder emptied (series 1, after 50 ml (series 2, and 100 ml (series 3 bladder filling with a saline infusion through the bladder catheter. Contouring was done on the Eclipse Planning System. 7 Gy to point A was prescribed with the standard loading patterns. Various 3D DVH parameters including 0.1 cc, 1 cc, 2 cc doses and mean doses to the OAR’s were noted. Paired t-test was performed. Results : The mean (± SD bladder volume was 64.5 (± 25 cc, 116.2 (± 28 cc, and 172.9 (± 29 cc, for series 1, 2, and 3, respectively. The 0.1 cm 3 ,1 cm 3 , 2 cm 3 mean bladder doses for series 1, series 2, and series 3 were 9.28 ± 2.27 Gy, 7.38 ± 1.72 Gy, 6.58 ± 1.58 Gy; 9.39 ± 2.28 Gy, 7.85 ± 1.85 Gy, 7.05 ± 1.59 Gy, and 10.09 ± 2.46 Gy, 8.33 ± 1.75 Gy, 7.6 ± 1.55 Gy, respectively. However, there was a trend towards higher bladder doses in series 3. Similarly, for small bowel dose 0.1 cm 3 , 1 cm 3 , and 2 cm 3 in series 1, 2, and 3 were 5.44 ± 2.2 Gy, 4.41 ± 1.84 Gy, 4 ± 1.69 Gy; 4.57 ± 2.89 Gy, 3.78 ± 2.21 Gy, 3.35 ± 2.02 Gy, and 4.09 ± 2.38 Gy, 3.26 ± 1.8 Gy, 3.05 ± 1.58 Gy. Significant increase in small bowel dose in empty bladder (series 1 compared to full bladder (series 3 (p = 0.03 was noted. However, the rectal and sigmoid doses were not significantly affected with either series. Conclusions : Bladder filling protocol with 50 ml and 100 ml was well tolerated and achieved a reasonably reproducible bladder volume

  12. High-dose-rate afterloading intracavitary irradiation and expandable metallic biliary endoprosthesis for malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Yoshimura, Hitoshi; Ohishi, Hajime; Yoshioka, Tetsuya [Nara Medical Univ., Kashihara (Japan); and others

    1989-04-01

    A double lumen catheter was developed as an applicator for the remote afterloading system (RALS) of {sup 60}Co for the intracavitary irradiation of an obstructed common bile duct due to gallbladder cancer in 1 case and by cholangiocarcinoma in 7 cases. This was followed by the biliary endoprosthesis with expandable metallic stents to maintain patency. The mean survival period after treatment was not long (14 weeks). However, removal of the external drainage tube was possible in 7 of the 8 cases, and none of the 8 cases showed dislodgement or deformity of the stent, or obstruction of the bile duct in the stent-inserted area. This combination effectively provided palliation, and has considerable potential for malignant biliary obstruction. (author).

  13. Evaluation of conditions of radiation protection of medical personnel in intracavitary neutron therapy of cervical cancer

    International Nuclear Information System (INIS)

    Kostromina, K.N.; Korenkov, I.P.; Bocharov, A.L.; Gladkikh, N.N.

    1991-01-01

    Combined radiation therapy was provided to cervical cancer patients. Working conditions of personnel were examined, the rate of exposure doses and flows of neutrons at working places were measured, dose exposures of the personnel were evaluated. It has been concluded that occupational conditions for the medical personnel are considered to be relatively safe

  14. Intracavitary irradiation of prostatic carcinoma by a high dose-rate afterloading technique

    Energy Technology Data Exchange (ETDEWEB)

    Odelberg-Johnson, O.; Underskog, I.; Johansson, J.E.; Bernshaw, D.; Sorbe, B.; Persson, J.E. (Oerebro Medical Center Hospital (Sweden). Dept. of Oncology Oerebro Medical Center Hospital (Sweden). Dept. of Urology Oerebro Medical Center Hospital (Sweden). Dept. of Gynecologic Oncology Oerebro Medical Center Hospital (Sweden). Dept. of Radiation Physics)

    1991-01-01

    A high dose-rate ({sup 60}Co) afterloading technique was evaluated in a series of 73 patients with prostatic carcinoma stages I-IV. The intraurethral irradiation was combined with external pelvic radiotherapy. A minimum total dose of 78 Gy was delivered to the target volume. In a subgroup of patients extramustine (Estracyt) was given as adjuvant chemohormonal therapy during irradiation. The median follow-up for the whole group was 63 months. The crude 5-year survival rate was 60% and the corrected survival rate 90%. Survival was related to the tumor grade. Local pelvic recurrences were recorded in 17.8%. 'Viable cells' in posttherapy aspiration biopsy were not associated with tumor recurrences or survival. Four patients (5%) had grade 3 late radiation reactions with urethral structure or bladder fibrosis. Urinary tract infections and prior transurethral resections were not associated with a higher frequency of reactions. Concurrent estramustine therapy seemed to increase the frequency of both acute and chronic radiation reactions. Local control, recurrence, and survival were not affected by chemohormonal therapy. The use of tomography, magnetic resonance, and ultrasound as aids to computerized dosimetry may improve local dose distribution and reduce the irradiated volume. (orig.).

  15. Retrospective Dosimetric Comparison of Low-Dose-Rate and Pulsed-Dose-Rate Intracavitary Brachytherapy Using a Tandem and Mini-Ovoids

    International Nuclear Information System (INIS)

    Mourtada, Firas; Gifford, Kent A.; Berner, Paula A.; Horton, John L.; Price, Michael J.; Lawyer, Ann A.; Eifel, Patricia J.

    2007-01-01

    The purpose of this study was to compare the dose distribution of Iridium-192 ( 192 Ir) pulsed-dose-rate (PDR) brachytherapy to that of Cesium-137 ( 137 Cs) low-dose-rate (LDR) brachytherapy around mini-ovoids and an intrauterine tandem. Ten patient treatment plans were selected from our clinical database, all of which used mini-ovoids and an intrauterine tandem. A commercial treatment planning system using AAPM TG43 formalism was used to calculate the dose in water for both the 137 Cs and 192 Ir sources. For equivalent system loadings, we compared the dose distributions in relevant clinical planes, points A and B, and to the ICRU bladder and rectal reference points. The mean PDR doses to points A and B were 3% ± 1% and 6% ± 1% higher than the LDR doses, respectively. For the rectum point, the PDR dose was 4% ± 3% lower than the LDR dose, mainly because of the 192 Ir PDR source anisotropy. For the bladder point, the PDR dose was 1% ± 4% higher than the LDR dose. We conclude that the PDR and LDR dose distributions are equivalent for intracavitary brachytherapy with a tandem and mini-ovoids. These findings will aid in the transfer from the current practice of LDR intracavitary brachytherapy to PDR for the treatment of gynecologic cancers

  16. High-dose-rate intracavitary brachytherapy combined with external beam radiotherapy for stage IIIb adenocarcinoma of the uterine cervix in Japan. A multi-institutional study of Japanese Society of Therapeutic Radiology and Oncology 2006-2007 (Study of JASTRO 2006-2007)

    International Nuclear Information System (INIS)

    Niibe, Yuzuru; Kenjo, Masahiro; Onishi, Hiroshi

    2010-01-01

    The current study was a retrospective questionnaire survey of stage IIIb adenocarcinoma of the uterine cervix treated with high-dose-rate intracavitary brachytherapy combined with external beam radiation therapy in Japan aimed to investigate the optimal dose on the basis of the biological effective dose and prognostic factors. Between 1990 and 2000, 61 patients with stage IIIb adenocarcinoma of the uterine cervix underwent high-dose-rate intracavitary brachytherapy combined with external beam radiation therapy in 19 major hospitals in Japan. This retrospective questionnaire survey was performed by mail including survey charts to be fulfilled by radiation oncologists in these 19 major hospital. Fifty had only adenocarcinoma components and 11 had adenosquamous cell carcinoma components. All patients were treated with high-dose-rate intracavitary brachytherapy combined with external beam radiation therapy. Total biological effective dose (T-BED 10 ) was calculated from the sum of the biological effective doses of the external beam radiation therapy and the intracavitary brachytherapy. Thirty-two patients underwent chemotherapy. The 5-year overall survival rate of all patients was 20.2%. Stratified by total biological effective dose, the 5-year overall survival rate was 0% for T-BED 10 10 between 75 and 100 Gy and 0% for T-BED 10 >110 Gy (P=0.15). Stratified by histopathology, the 5-year overall survival rate was 22.1% for adenocarcinoma and 13.6% for adenosquamous cell carcinoma (P=0.43). Stratified by chemotherapy, the 5-year overall survival rate was 20.3% in patients who received chemotherapy and 20.4% in patients who did not receive chemotherapy (P=0.96). The 5-year overall survival rate of stage IIIb adenocarcinoma of the uterine cervix in this retrospective questionnaire survey was 20.2%. The optimal T-BED 10 and evident prognostic factors were not clear from this questionnaire survey. (author)

  17. Early esophageal carcinoma treated with intracavitary irradiation

    International Nuclear Information System (INIS)

    Hishikawa, Y.; Tanaka, S.; Miura, T.

    1985-01-01

    Five patients with early esophageal carcinoma were treated by 6-12 Gy of intracavitary irradiation following 50-60 Gy of external irradiation as a boost therapy. Surgery was not performed in these cases. None of the patients had local recurrence after radiation therapy, as demonstrated by esophagography and endoscopy. Three patients have been alive for 1-3 years 10 months. Esophageal ulceration induced by intracavitary irradiation has occurred in three of the five patients; however, intracavitary irradiation is still a beneficial treatment because of its efficacy in controlling local lesions and because radiation ulceration can eventually be cured. Intracavitary irradiation is recommended to follow external irradiation as a boost therapy for the treatment of early esophageal carcinoma

  18. A real-time in vivo dosimetric verification method for high-dose rate intracavitary brachytherapy of nasopharyngeal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Qi Zhenyu; Deng Xiaowu; Cao Xinping; Huang Shaomin; Lerch, Michael; Rosenfeld, Anatoly [State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060 (China) and Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou 510060 (China); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia)

    2012-11-15

    Purpose: A real-time in vivo dosimetric verification method using metal-oxide-semiconductor field effect transistor (MOSFET) dosimeters has been developed for patient dosimetry in high-dose rate (HDR) intracavitary brachytherapy of nasopharyngeal carcinoma (NPC). Methods: The necessary calibration and correction factors for MOSFET measurements in {sup 192}Iridium source were determined in a water phantom. With the detector placed inside a custom-made nasopharyngeal applicator, the actual dose delivered to the tumor was measured in vivo and compared to the calculated values using a commercial brachytherapy planning system. Results: Five MOSFETs were independently calibrated with the HDR source, yielding calibration factors of 0.48 {+-} 0.007 cGy/mV. The maximum sensitivity variation was no more than 7% in the clinically relevant distance range of 1-5 cm from the source. A total of 70 in vivo measurements in 11 NPC patients demonstrated good agreement with the treatment planning. The mean differences between the planned and the actually delivered dose within a single treatment fraction were -0.1%{+-} 3.8% and -0.1%{+-} 3.7%, respectively, for right and left side assessments. The maximum dose deviation was less than 8.5%. Conclusions: In vivo measurement using the real-time MOSFET dosimetry system is possible to evaluate the actual dose to the tumor received by the patient during a treatment fraction and thus can offer another line of security to detect and prevent large errors.

  19. Treatment of cystic craniopharyngioma with phosphorus-32 intracavitary irradiation

    Science.gov (United States)

    Zhao, Rong; Deng, Jinglan; Liang, Xiaoyan; Zeng, Jin; Chen, Xiaoyuan

    2013-01-01

    Purpose The aim of the study was to evaluate the effect of phosphorus-32 colloid ([32P]) intracavitary irradiation on the treatment of patients with cystic craniopharyngiomas. Methods Twenty patients with predominantly cystic craniopharyngiomas were admitted from 1981 to 2006. Eleven patients had [32P] intracavitary irradiation by stereotactic injection or Ommaya cyst instillation as the primary treatment, and the remaining nine had the same internal irradiation as an adjuvant treatment after tumor resection. A calculated irradiation dose of 400~500 Gy per once was delivered to the cyst wall. Conclusion The patients were followed up ranging from 36 to 336 months; no operative morbidity or mortality was found from [32P] intracavitary irradiation. Fourteen patients (70%) had tumor progression and required further two to four times intracavitary irradiation. All 20 cases achieved tumor shrinkage or stabilization with effective outcome 3–6 months after the last [32P] therapy. For patients with cystic craniopharyngioma, [32P] administration by stereo-tactic injection or Ommaya cyst instillation is a safe and helpful option, which could improve the life quality, prolong the life span, and enhance the survival rate of cystic craniopharyngioma patients. PMID:19904543

  20. Effect of bedside shielding on air-kerma rates around gynecologic intracavitary brachytherapy patients containing 226Ra or 137Cs

    International Nuclear Information System (INIS)

    Papin, P.J.; Ramsey, M.J.; LaFontaine, R.L.; LePage, R.P.

    1990-01-01

    An anthropomorphic phantom was implanted with 226Ra or 137Cs gynecologic intracavitary brachytherapy sources. Air-kerma rate measurements were taken at 10-cm increments along a horizontal plane from the side of the bed at 50 cm, 87 cm, and 136 cm heights above the floor. Five portable lead shields were placed at the head, at the foot and along one side of the bed and readings were taken again at the corresponding heights above, below and behind the shields. The readings were normalized to 100-mg Ra equivalence, and air-kerma rate curves were drawn allowing for the comparison of 226Ra and 137Cs with and without lead shields. The data demonstrated that the air-kerma rates for 137Cs were reduced more than those for 226Ra with the use of the portable lead shields. There was four times the transmission with 226Ra than with 137Cs. The optimal placement was with the lateral bedside shields proximal to the head and foot closest to the bed, with the middle shield overlapping in back. The shields at the head and foot should extend out and overlap the bedside shields. The level of the sources should be positioned near the bottom of the shields. This information will provide the medical health physicist with an estimate of air-kerma rates for both 226Ra and 137Cs with and without shielding for evaluating personnel exposures as well as the effectiveness of current shielding in relation to radiation protection requirements in adjacent rooms or hallways

  1. Biological effective doses in the intracavitary high dose rate brachytherapy of cervical cancer

    Directory of Open Access Journals (Sweden)

    Y. Sobita Devi

    2011-12-01

    Full Text Available Purpose: The aim of this study is to evaluate the decrease of biological equivalent dose and its correlation withlocal/loco-regional control of tumour in the treatment of cervical cancer when the strength of the Ir-192 high dose rate(HDR brachytherapy (BT source is reduced to single, double and triple half life in relation to original strength of10 Ci (~ 4.081 cGy x m2 x h–1. Material and methods: A retrospective study was carried out on 52 cervical cancer patients with stage II and IIItreated with fractionated HDR-BT following external beam radiation therapy (EBRT. International Commission onRadiation Units and Measurement (ICRU points were defined according to ICRU Report 38, using two orthogonal radiographimages taken by Simulator (Simulix HQ. Biologically effective dose (BED was calculated at point A for diffe -rent Ir-192 source strength and its possible correlation with local/loco-regional tumour control was discussed. Result: The increase of treatment time per fraction of dose due to the fall of dose rate especially in HDR-BT of cervicalcancer results in reduction in BED of 2.59%, 7.02% and 13.68% with single, double and triple half life reduction ofsource strength, respectively. The probabilities of disease recurrence (local/loco-regional within 26 months are expectedas 0.12, 0.12, 0.16, 0.39 and 0.80 for source strength of 4.081, 2.041, 1.020, 0.510 and 0.347 cGy x m2 x h–1, respectively.The percentages of dose increase required to maintain the same BED with respect to initial BED were estimated as1.71, 5.00, 11.00 and 15.86 for the dose rate of 24.7, 12.4, 6.2 and 4.2 Gy/hr at point A, respectively. Conclusions: This retrospective study of cervical cancer patients treated with HDR-BT at different Ir-192 sourcestrength shows reduction in disease free survival according to the increase in treatment time duration per fraction.The probable result could be associated with the decrease of biological equivalent dose to point A. Clinical

  2. Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Kemmerer, Eric [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Hernandez, Enrique; Ferriss, James S. [Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Valakh, Vladimir; Miyamoto, Curtis; Li, Shidong [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Micaily, Bizhan, E-mail: bizhan.micaily@tuhs.temple.edu [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: Retrospective analysis of patients with invasive endometrial neoplasia who were treated with external beam radiation therapy followed by stereotactic body radiation therapy (SBRT) boost because of the inability to undergo surgery or brachytherapy. Methods and Materials: We identified 11 women with stage I-III endometrial cancer with a median age of 78 years that were not candidates for hysterectomy or intracavitary brachytherapy secondary to comorbidities (91%) or refusal (9%). Eight patients were American Joint Committee on Cancer (AJCC) stage I (3 stage IA, 5 stage IB), and 3 patients were AJCC stage III. Patients were treated to a median of 4500 cGy at 180 cGy per fraction followed by SBRT boost (600 cGy per fraction Multiplication-Sign 5). Results: The most common side effect was acute grade 1 gastrointestinal toxicity in 73% of patients, with no late toxicities observed. With a median follow-up of 10 months since SBRT, 5 patients (45%) experienced locoregional disease progression, with 3 patients (27%) succumbing to their malignancy. At 12 and 18 months from SBRT, the overall freedom from progression was 68% and 41%, respectively. Overall freedom from progression (FFP) was 100% for all patients with AJCC stage IA endometrial carcinoma, whereas it was 33% for stage IB at 18 months. The overall FFP was 100% for International Federation of Obstetrics and Gynecology grade 1 disease. The estimated overall survival was 57% at 18 months from diagnosis. Conclusion: In this study, SBRT boost to the intact uterus was feasible, with encouragingly low rates of acute and late toxicity, and favorable disease control in patients with early-stage disease. Additional studies are needed to provide better insight into the best management of these clinically challenging cases.

  3. Use of Laminaria Japonica in intracavitary radiation therapy when anesthesia is contraindicated

    International Nuclear Information System (INIS)

    Peeples, W.J.; Given, F.T. Jr.; Bakri, Y.N.

    1983-01-01

    Laminaria tents have been used to dilate the cervix for interruption of pregnancy and other intrauterine procedures. Their use is presented in 5 patients with cervical and endometrial carcinoma where general anesthesia was contraindicated. Cervical dilation was sufficient with a single Laminaria to carry out intrauterine and intravaginal instrumentation for radiation therapy with no local or general anesthesia

  4. Clinical evaluation of high dose rate intra-cavitary irradiation for treatment of uterine cervical cancer, combined with pepleomycin suppository in uterine cavity

    International Nuclear Information System (INIS)

    Yamanashi, Shunji; Abe, Tatsuyuki; Mochizuki, Sachio; Murakami, Yoshitaka; Iida, Nobuhisa.

    1990-01-01

    By means of re-irradiation using pepleomycin suppository in uterine cavity, we attained local control for one patient who had local recurrence in uterine cavity and suffered from uterine fluor in which viable cancer cells were confirmed. We were enlightened by this therapeutic experience, so we attempted combination therapy using pepleomycin suppositories to supplement intra-cavitary irradiation, for the 11 selected patients who were suffering from uterine fluor. We investigated the treatment results in 7 patients of stage III out of 11 patients (of all stages), in comparison with 13 patients of stage III who were treated by irradiation alone. Consequently, these treatment results were approximately equivalent, and the incidence of sigmoid complications could be decreased. Side effects which were followed by the combination therapy were not serious, and so we believe that pepleomycin suppository is a simple method and valuable to supplement radiation therapy of uterine cervical cancer. (author)

  5. Clinical evaluation of high dose rate intra-cavitary irradiation for treatment of uterine cervical cancer, combined with pepleomycin suppository in uterine cavity

    Energy Technology Data Exchange (ETDEWEB)

    Yamanashi, Shunji; Abe, Tatsuyuki; Mochizuki, Sachio (Jikei Univ., Tokyo (Japan). School of Medicine); Murakami, Yoshitaka; Iida, Nobuhisa

    1990-02-01

    By means of re-irradiation using pepleomycin suppository in uterine cavity, we attained local control for one patient who had local recurrence in uterine cavity and suffered from uterine fluor in which viable cancer cells were confirmed. We were enlightened by this therapeutic experience, so we attempted combination therapy using pepleomycin suppositories to supplement intra-cavitary irradiation, for the 11 selected patients who were suffering from uterine fluor. We investigated the treatment results in 7 patients of stage III out of 11 patients (of all stages), in comparison with 13 patients of stage III who were treated by irradiation alone. Consequently, these treatment results were approximately equivalent, and the incidence of sigmoid complications could be decreased. Side effects which were followed by the combination therapy were not serious, and so we believe that pepleomycin suppository is a simple method and valuable to supplement radiation therapy of uterine cervical cancer. (author).

  6. Prediction of late rectal complication following high-dose-rate intracavitary brachytherapy in cancer of the uterine cervix

    International Nuclear Information System (INIS)

    Lee, Jeung Eun; Huh, Seung Jae; Park, Won; Lim, Do Hoon; Ahn, Yong Chan

    2003-01-01

    Although high-dose-rate intracavitary radiotherapy (HDR ICR) has been used in the treatment of cervical cancer, the potential for increased risk of late complication, most commonly in the rectum, is a major concern. We have previously reported on 136 patients treated with HDR brachytherapy between 1995 and 1999. The purpose of this study is to upgrade the previous data and confirm the correlation between late rectal complication and rectal dose in cervix cancer patients treated with HDR ICR. A retrospective analysis was performed for 222 patients with cervix cancer who were treated for curative intent with extemal beam radiotherapy (EBRT) and HDR ICR from July 1995 to December 2001. The median dose of EBRT was 50.4 (30.6-56.4) Gy with a daily fraction size 1.8 Gy. A total of six fractions of HDR ICR were given twice weekly with fraction size of 4 (3-5.5) Gy to A point by Iridium-192 source. The rectal dose was calculated at the rectal reference point using the barium contrast criteria in vivo measurement of the rectal dose was performed with thermoluminescent dosimeter (TLD) during HDR ICR. The median follow-up period was 39 months, ranging from 6 to 90 months. Twenty-one patients (9.5%) experienced late rectal bleeding, from 3 to 44 months (median, 13 months) after the completion of RT. The calculated rectal doses were not different between the patients with rectal bleeding and those without, but the measured rectal doses were higher in the complicated patients. The differences of the measured ICR rectal fractional dose, ICR total rectal dose, and total rectal biologically equivalent dose (BED) were statistically significant. When the measured ICR total rectal dose was beyond 16 Gy, when the ratio of the measured rectal dose to A point dose was beyond 70%, or when the measured rectal BED was over 110 GY 3 , a high possibility of late rectal complication was found. Late rectal complication was closely correlated with measured rectal dose by in vivo dosimetry using

  7. Intracavitary ultrasound phased arrays for prostate thermal therapies: MRI compatibility and in vivo testing.

    Science.gov (United States)

    Hutchinson, E B; Hynynen, K

    1998-12-01

    A 62 element MRI-compatible linear phased array was designed and constructed to investigate the feasibility of using transrectal ultrasound for the thermal therapeutic treatment of prostate cancer and benign prostatic hyperplasia. An aperiodic design technique developed in a previous study was used in the design of this array, which resulted in reduced grating lobe levels by using an optimized random distribution of unequally sized elements. The element sizes used in this array were selected to be favorable for both grating lobe levels as determined by array aperiodicity and array efficiency as determined by width to thickness ratios. The heating capabilities and MRI compatibility of the array were tested with in vivo rabbit thigh muscle heating experiments using MRI temperature monitoring. The array produced therapeutic temperature elevations in vivo at depths of 3-6 cm and axial locations up to 3 cm off the central axis and increased the size of the heated volume with electronic scanning of a single focus. The ability of this array to be used for ultrasound surgery was demonstrated by creating necrosed tissue lesions in vivo using short high-power sonications. The ability of the array to be used for hyperthermia was demonstrated by inducing therapeutic temperature elevations for longer exposures. Based on the acoustic and heating performance of this array, it has the potential to be clinically useful for delivering thermal therapies to the prostate and other target volumes close to body cavities.

  8. FIGO IIIB squamous cell carcinoma of the cervix: an analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy

    International Nuclear Information System (INIS)

    Logsdon, Mark D.; Eifel, Patricia J.

    1999-01-01

    Purpose: To define patient, tumor, and treatment factors that influence the outcome of patients with FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix. Methods and Materials: The records of 1,096 patients treated with radiation therapy between 1960 and 1993 for FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix were reviewed retrospectively. Of these, 983 (90%) were treated with curative intent and 113 were treated only to achieve palliation of symptoms. Of 907 patients who completed the intended curative treatment, 641 (71%) were treated with a combination of external beam irradiation (EBRT) and intracavitary irradiation (ICRT) and 266 (29%) were treated with EBRT only. The median duration of treatment for these 907 patients was 51 days. Between 1966 and 1980, only 52% of patients who completed treatment with curative intent received ICRT, compared with 92% of patients treated during 1981-1993, an increase that reflects an evolution in the philosophy of treatment for advanced tumors. In general, the intensity of ICRT correlated inversely with the dose of EBRT to the central pelvis. Median follow-up of surviving patients was 134 months. Results: For 983 patients treated with initial curative intent, disease-specific survival (DSS) was significantly worse for those who were 52 Gy of EBRT to the central pelvis had DSS rates of 27-34%, compared with 53% for patients treated with lower doses of EBRT to the central pelvis and more intensive ICRT (p 52 Gy of EBRT to the central pelvis (57-68%), compared with those who had 48-52 Gy (28%) and those who had ≤ 47 Gy of EBRT to the central pelvis (15%) (p < 0.0001). Outcome was also compared for four time periods during which different treatment policies were in place for patients with Stage IIIB disease. The highest DSS (51%) and lowest actuarial complication rate (17%) were achieved during the most recent period (1981-1993) when modest doses of EBRT were combined with relatively

  9. Method for dose calculation in intracavitary irradiation of endometrical carcinoma

    International Nuclear Information System (INIS)

    Zevrieva, I.F.; Ivashchenko, N.T.; Musapirova, N.A.; Fel'dman, S.Z.; Sajbekov, T.S.

    1979-01-01

    A method for dose calculation for the conditions of intracavitary gamma therapy of endometrial carcinoma using spherical and linear 60 Co sources was elaborated. Calculations of dose rates for different amount and orientation of spherical radiation sources and for different planes were made with the aid of BEhSM-4M computer. Dosimet were made with the aid of BEhSM-4M computer. Dosimetric study of dose fields was made using a phantom imitating the real conditions of irradiation. Discrepancies between experimental and calculated values are within the limits of the experiment accuracy

  10. Intracavitary radiation for rectal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Basrur, V.R. (Ontario Cancer Treatment and Research Foundation, Hamilton (Canada). Hamilton Clinic); Knight, P.R. (McMaster Univ., Hamilton, Ontario (Canada))

    1983-03-01

    Thirty-five patients with low-lying rectal adenocarcinoma have been treated with intra-cavitary radiation (Papillon's technique). Twenty-three were treated for cure and 12 for palliation. The indications for curative intracavity radiation were mobile polypoid tumors, less than 3 cm in diameter, with Broder's Grades 1 and 2 differentiation lying less than 11 cm from the anal verge. Doses between 2000 and 4000 cGy were delivered to a total of 7000 to 20000 cGy with complete resolution of the tumors. Eighty-seven per cent in the curative group are alive and well up to 42 months after treatment with a minimum follow-up of six months. Of the 23 patients treated for cure, three patients had recurrences within 18 months of therapy. Two of the three patients are alive following surgery. The third patient died in the postoperative period. The results of intracavitary radiation are comparable to ablative surgery and avoid a permanent colostomy. Age, frailty, or other medical conditions do not preclude this treatment. Anesthesia and hospitalization are not required. This method can also be used for palliation of recurrent tumors and in patients who are unsuitable for surgery.

  11. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Isoyama-Shirakawa, Yuko; Abe, Madoka; Nakamura, Katsumasa

    2015-01-01

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  12. Intracavitary radiation treatment planning and dose evaluation

    International Nuclear Information System (INIS)

    Anderson, L.L.; Masterson, M.E.; Nori, D.

    1987-01-01

    Intracavitary radiation therapy with encapsulated radionuclide sources has generally involved, since the advent of afterloading techniques, inserting the sources in tubing previously positioned within a body cavity near the region to be treated. Because of the constraints on source locations relative to the target region, the functions of treatment planning and dose evaluation, usually clearly separable in interstitial brachytherapy, tend to merge in intracavitary therapy. Dose evaluation is typically performed for multiple source-strength configurations in the process of planning and thus may be regarded as complete when a particular configuration has been selected. The input data for each dose evaluation, of course, must include reliable dose distribution information for the source-applicator combinations used. Ultimately, the goal is to discover the source-strength configuration that results in the closest possible approach to the dose distribution desired

  13. Cervical cancer: intracavitary dose specification and prescription

    International Nuclear Information System (INIS)

    Potish, R.A.; Gerbi, B.J.

    1987-01-01

    Dose and volume specifications for reporting intracavitary therapy were analyzed according to criteria recommended by the International Commission on Radiation Units and Measurements (ICRU). Ninety Fletcher-Suit radium applications were studied to examine the validity of the assumptions of the ICRU and the merit of their routine reporting. It was demonstrated that the reporting recommendations were inconsistent with clinical prescription systems and added little to dose specification. The distinction between dose specification and dose prescription was stressed

  14. High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: A study from rural centre of Maharashatra, India

    Directory of Open Access Journals (Sweden)

    Jain Vandana

    2007-01-01

    Full Text Available Aim : To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR intracavitary brachytherapy (ICBT. Materials and Methods : Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C. The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups- less then 80% (< 80%, 80-100% and above 100% (>100%. A total of 180 applications for 60 patients were calculated for the above analyses. Results : There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by ′A′ radiotherapist were within the limits in the self as well as in the shared groups more number of times, by ′B′ radiotherapist was more times exceeding the limit and by ′C′ radiotherapist doses were in between the A and B. Discussion and Conclusion : For the rectal and bladder doses most important factors are patient′s age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

  15. High-dose-rate intracavitary brachytherapy (HDR-IC) in treatment of cervical carcinoma: 5-year results and implication of increased low-grade rectal complication on initiation of an HDR-IC fractionation scheme

    International Nuclear Information System (INIS)

    Wang Chongjong; Wan Leung, Stephen; Chen Huichun; Sun Limin; Fang Fumin; Changchien Chanchao; Huang Engyen; Wu Jiaming; Chen Chuhnchih

    1997-01-01

    Purpose: To report the treatment results and rectal/bladder complications of cervical carcinoma radically treated with high-dose-rate intracavitary brachytherapy (HDR-IC). The current policy of using three-fraction scheme was examined. Methods and Materials: Between November 1987 and August 1990, 173 patients with cervical carcinoma were treated with curative-intent radiation therapy. Whole pelvic irradiation was administered with 10-MV X ray. Dose to the central cervix was 40-44 Gy in 20-22 fractions, following by pelvic wall boost 6-14 Gy in three to seven fractions with central shielding. 60 Co sources were used for HDR-IC, and 7.2 Gy was given to Point A for three applications, 1-2 weeks apart. Duration of follow-up was 5-7.8 years. Results: Twenty-eight patients (16%) developed central-regional recurrences. Overall 5-year actuarial pelvic control rate was 83%. By stage, 5-year actuarial pelvic control rates were 94%, 87%, and 72% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Thirty-one patients (18%) developed distant metastasis. Overall 5-year actuarial survival rate was 58%. By stage, 5-year actuarial survival rates were 79%, 59%, and 41% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Sixty-six (38%) and 19 patients (11%) developed rectal and bladder complications, respectively. For rectal complication, the overall actuarial rate was 38% at 5 years. By grade, 5-year actuarial rectal complication rates were 24%, 15%, 4%, and 3% for Grades 1-4, respectively. Overall prevalence of rectal complications was 37% and 14% at 2 and 5 years, respectively. Prevalence of low-grade rectal complication (Grades 1 and 2) was dominant at 2 years (30%), but declined to 8% at 5 years. Prevalence of high-grade, severe rectal complication (Grades 3 and 4) remained steady at 2 and 5 years (7% and 6%, respectively). Five-year actuarial bladder complication was 9%. Five-year prevalence of bladder complication was 2%. Conclusion: Using a three

  16. Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue

    International Nuclear Information System (INIS)

    Lu, Sharon M.; Scanderbeg, Daniel J.; Barna, Patrick; Yashar, William; Yashar, Catheryn

    2012-01-01

    The SAVI and Contura breast brachytherapy applicators represent 2 recent advancements in brachytherapy technology that have expanded the number of women eligible for accelerated partial breast irradiation in the treatment of early-stage breast cancer. Early clinical experience with these 2 single-entry, multichannel high-dose-rate brachytherapy devices confirms their ease of use and dosimetric versatility. However, current clinical guidelines for SAVI and Contura brachytherapy may result in a smaller or less optimal volume of treated tissue compared with traditional interstitial brachytherapy. This study evaluates the feasibility of using the SAVI and Contura to irradiate larger and irregularly shaped target volumes, approaching what is treatable with the interstitial technique. To investigate whether additional tissue can be treated, 17 patients treated with the SAVI and 3 with the Contura were selected. For each patient, the planning target volume (PTV) was modified to extend 1.1 cm, 1.3 cm, and 1.5 cm beyond the tumor bed cavity. To evaluate dose conformance to an irregularly shaped target volume, 9 patients treated with the SAVI and 3 with the Contura were selected from the original 20 patients. The following asymmetric PTV margin combinations were assessed for each patient: 1.5/0.3, 1.3/0.3, and 1.1/0.3 cm. For all patients, treatment planning was performed, adopting the National Surgical Adjuvant Breast and Bowel Project guidelines, and dosimetric comparisons were made. The 6–1 and 8–1 SAVI devices can theoretically treat a maximal tissue margin of 1.5 cm and an asymmetric PTV with margins ranging from 0.3 to 1.5 cm. The 10–1 SAVI and Contura can treat a maximal margin of 1.3 cm and 1.1 cm, respectively, and asymmetric PTV with margins ranging from 0.3–1.3 cm. Compared with the Contura, the SAVI demonstrated greater dosimetric flexibility. Risk of developing excessive hot spots increased with the size of the SAVI device. Both the SAVI and Contura

  17. Dose rate effect from the relationship between ICRU rectal dose and local control rate in intracavitary radiotherapy for carcinoma of the uterine cervix. Six fraction HDR and three-fraction LDR in three weeks

    International Nuclear Information System (INIS)

    Jingu, Kenichi; Akita, Yuzou; Ohmagari, Jyunichi

    2001-01-01

    The dose rate effect, low dose rate radiotherapy (LDR)/high dose rate radiotherapy (HDR), was calculated using the isoeffect ICRU rectal dose by intracavitary radiotherapy (ICRT) for uterine cervix cancer. The subjects analyzed consisted of 78 LDR and 74 HDR patients whose ICRU rectal dose could be calculated and whose local control as stage II/III cases could be evaluated. The point A dose in ICRT was 45-55 Gy/3 fractions/3 weeks for LDR and 30 Gy/6 fractions/3 weeks for HDR. The dose effect relationships associated with local control at each whole pelvis external radiation dose were calculated using the double integration method and Probit analysis, and the 50% and 90% local control ICRU rectal doses were calculated from this relationship. Finally, the dose rate effect LDR/HDR was determined from 50% and 90% local control doses. The dose rate effect calculated from the 50% local control dose was 1.24 and that from the 90% local control dose was 1.14. (author)

  18. Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

    Energy Technology Data Exchange (ETDEWEB)

    Toita, Takafumi, E-mail: b983255@med.u-ryukyu.ac.jp [Department of Radiology, Graduate School of Medical Science, University of Ryukyus, Okinawa (Japan); Kato, Shingo [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Ehime (Japan); Shikama, Naoto [Department of Radiation Oncology, Saku Central Hospital, Saku (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Tokumaru, Sunao [Department of Radiology, Saga University, Saga (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tsukuba (Japan); Numasaki, Hodaka; Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital, Tokyo (Japan); Kagami, Yoshikazu [Radiation Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-01-01

    Purpose: To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials: Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size <40 mm in diameter (assessed by T2-weighted magnetic resonance imaging), and no pelvic/para-aortic lymphadenopathy. The treatment protocol consisted of whole-pelvis external beam radiotherapy (EBRT) of 20 Gy/10 fractions, pelvic EBRT with midline block of 30 Gy/15 fractions, and HDR-ICBT of 24 Gy/4 fractions (at point A). The cumulative biologically effective dose (BED) was 62 Gy{sub 10} ({alpha}/{beta} = 10) at point A. The primary endpoint was the 2-year pelvic disease progression-free (PDPF) rate. All patients received a radiotherapy quality assurance review. Results: Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6-39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7-72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%-100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%-98%) and 95% (95% CI, 89%-100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade {>=}1) were 18% (95% CI, 8%-28%) for large intestine/rectum, 4% (95% CI, 0%-8%) for small intestine, and 0% for bladder. No Grade {>=}3 cases were

  19. Miniature sources of irradiation for intracavitary thermo radiotherapy

    Science.gov (United States)

    Taubin, M.; Chesnokov, D.; Simonov, A.

    2018-02-01

    This report presents the development of a miniature ionizing and thermal radiation source for oncological diseases treatment namely the inward parts of the body. This source can be placed next to the tumor inside of the body. This report is only about methods and devices for the intracavitary therapy. Irradiation by external sources wasn’t considered in our investigation.

  20. Occupational monitoring intracavitary radium therapy

    International Nuclear Information System (INIS)

    Araujo, A.M.C. de

    1987-01-01

    The working exposure conditions in two big hospital in Rio de Janeiro, Brazil, that use 226 Ra tubes in preloaded applicators were evaluated. The effective dose equivalents were obtained and the results of the investigation lead to the conclusion that it can be reduced to lower and reasonably achievable Le vels with good professional training, correct working conditions and afterloading techniques. (M.C.K.)

  1. Combined teletherapy and intracavitary brachytherapy boost for the treatment of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Kouvaris, J.; Plataniotis, G.A.; Sandilos, P.; Dardoufas, C.; Damatopoulou, A.; Vlahos, L.; Papavasiliou, C.

    1996-01-01

    For the non-metastatic nasopharyngeal carcinoma, external beam radiation therapy (median dose 64 Gy) and a boost of intracavitary irradiation (ICRT) has been given. Caesium-137 pellets of 40 mCi were used at a dose rate of 3-3.5 Gy/h, 1 cm from the sources. The median dose was 8.5 Gy. Overall 5-year actuarial survival for the 48 studied patients was 60.4% and LRFS was 64%. The procedure was well tolerated by our patients

  2. Stereotaxic intracavitary irradiation for cystic craniopharyngiomas

    International Nuclear Information System (INIS)

    Pollack, I.F.; Lunsford, L.D.; Slamovits, T.L.; Gumerman, L.W.; Levine, G.; Robinson, A.G.

    1988-01-01

    Stereotaxic intracavitary irradiation with instillation of phosphorus-32 ( 32 P) colloidal chromic phosphate was performed in nine patients with cystic craniopharyngiomas. Serial neurological, ophthalmological, neuroendocrinological, and radiological examinations were performed before and after treatment. Dosimetry was determined based on a computerized tomography (CT) estimation of tumor volume, and was calculated to provide a tumoricidal dose (200 to 300 Gy) to the cyst wall. The follow-up period ranged from 14 to 45 months (mean 27 months). After treatment, all nine patients showed improvement of symptoms and radiological evidence of cyst regression. Because of an expanding solid component producing recurrent symptoms, one patient required a craniotomy 14 months after isotope instillation. Three of five patients with impaired visual acuity before surgery had significant improvement in acuity after treatment. Preoperative visual field defects in eight patients improved in four after 32 P therapy. Of seven patients with preoperative endocrine abnormalities, one individual showed almost complete normalization and another had improvement in endocrine function. Patients who exhibited residual neuroendocrine function before isotope instillation developed no significant deterioration in endocrine status during the follow-up period. The findings suggest that stereotaxic intracavitary irradiation is a safe and effective treatment which should be considered as the initial surgery for cystic craniopharyngiomas

  3. 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.

  4. Perioperative and postoperative complications of intracavitary radiation for FIGO stage I-III carcinoma of the cervix

    International Nuclear Information System (INIS)

    Jhingran, Anuja; Eifel, Patricia J.

    2000-01-01

    Purpose: To evaluate perioperative and postoperative complications of low-dose-rate (LDR) intracavitary radiation therapy in patients with FIGO Stage I-III carcinoma of the uterine cervix. Methods and Materials: We retrospectively reviewed the medical and radiotherapy records of all patients treated with radiation between 1960 and 1992 at The University of Texas M. D. Anderson Cancer Center for FIGO I-III carcinomas of the cervix. Patients who had had initial hysterectomy or whose treatment did not include intracavitary irradiation were excluded. The final study included 4043 patients who had undergone 7662 intracavitary procedures. Results: Eleven (0.3%) patients had documented or suspected cases of thromboembolism resulting in 4 deaths. Of these 11 patients, 8 had clinical or radiographic evidence of tumor involving pelvic nodes or fixed pelvic wall. The risk of postoperative thromboembolism did not decrease significantly with the routine use of mini-dose heparin prophylaxis (p = 0.3). Other life-threatening perioperative complications included myocardial infarction (1 death in 5 patients), cerebrovascular accident (2 patients), congestive heart failure or atrial fibrillation (3 patients), and halothane liver toxicity (2 deaths in 2 patients). Intraoperative complications included uterine perforation (2.8%) and vaginal laceration (0.3%), which occurred more frequently in patients ≥ 60 years old (p < 0.01). Fourteen percent of patients had a temperature ≥ 101 deg. F during at least one hospital stay. The only correlation between minor intraoperative complications and disease-specific survival was found in patients who had Stage III disease and uterine perforation; survival was significantly (p = 0.01) decreased in these patients. Conclusions: Fatal or life-threatening complications of intracavitary treatment were very rare. Deep venous thrombosis (DVT) and pulmonary embolism (PE) did not occur in otherwise healthy patients with early disease and were rare even

  5. Intracavitary irradiation of early rectal cancer for cure. A series of 186 cases

    International Nuclear Information System (INIS)

    Papillon, J.

    1975-01-01

    If radical surgery is the only rational policy for most cases of rectal cancer, the problem of local treatment in poor surgical risk patients should be discussed in selected cases. Only limited, fairly-well-differentiated tumors, still confined to the rectal wall may have a sufficiently low probability of lymphatic spread to be amenable to local treatment. Rectal cancer, usually regarded as being slightly radiosensitive when treated by external irradiation, proves to be highly radiosensitive in the case of early cancer treated by intracavitary irradiation. This method is able to control a large amount of limited polypoid and ulcerative adenocarcinomas. In a series of 133 cases followed more than 5 years, the rate of death from cancer is only 9 percent, and the 5-year survival rate is 78 percent. As compared with local excision or electrocoagulation, intracavitary irradiation has several advantages. It does not require colostomy nor anesthesia. Contact x-ray therapy is an ambulatory treatment applicable even to elderly and fragile patients. There is no danger of fistula in the case of tumor of the anterior wall in female patients. It preserves all the chances of cure by subsequent surgery in case of failure. (auth)

  6. 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

  7. The dose distribution of low dose rate Cs-137 in intracavitary brachytherapy: comparison of Monte Carlo simulation, treatment planning calculation and polymer gel measurement

    International Nuclear Information System (INIS)

    Fragoso, M; Love, P A; Verhaegen, F; Nalder, C; Bidmead, A M; Leach, M; Webb, S

    2004-01-01

    In this study, the dose distribution delivered by low dose rate Cs-137 brachytherapy sources was investigated using Monte Carlo (MC) techniques and polymer gel dosimetry. The results obtained were compared with a commercial treatment planning system (TPS). The 20 mm and the 30 mm diameter Selectron vaginal applicator set (Nucletron) were used for this study. A homogeneous and a heterogeneous-with an air cavity-polymer gel phantom was used to measure the dose distribution from these sources. The same geometrical set-up was used for the MC calculations. Beyond the applicator tip, differences in dose as large as 20% were found between the MC and TPS. This is attributed to the presence of stainless steel in the applicator and source set, which are not considered by the TPS calculations. Beyond the air cavity, differences in dose of around 5% were noted, due to the TPS assuming a homogeneous water medium. The polymer gel results were in good agreement with the MC calculations for all the cases investigated

  8. Thermometric analysis of intra-cavitary hyperthermia for esophageal cancer.

    Science.gov (United States)

    Qi, C; Li, D J

    1999-01-01

    Thermometric analysis was carried out in 51 patients with esophageal cancer treated with intra-cavitary hyperthermia combined with radio chemotherapy, to test whether temperature index (T20, T50) and T90) could be used as an indicator for tumour control. Hyperthermia was administered by intra-cavitary microwave applicator. The T20, T50 and T90 were deducted from the temperature sensors T0 and T3 situated at the center of the tumour surface and 3cm from it. Eighteen patients with local control > or =36 months were named long term control patients (LC), 24 patients with local recurrence within 24 months (LR) (there were no events occurring between 24 and 36 months) and nine patients died of metastasis without local recurrence (DM). The overall survival rates were 80.4 +/- 5.6% at 1 year, 38.3 +/- 6.9% at 3 years and 31 +/- 6.7% at 5 years, respectively. Chi-square test showed no influence of the number of hyperthermia sessions on the local control (p > 0.25). The 5-year local control rate was 18.8% for the patients with T90 or = 43 degrees C (p < 0.01). The average T90 was 43.76 +/- 0.74 degrees C for the LC patients and 43.17 +/- 0.57 degrees C for those LR (p = 0.024). The mean T90 was higher than 43 degrees C in 94.4% of LC, whereas in 58.8% of LR. The study suggested that T90 was a good parameter for thermal dose in the intracavitary hyperthermia for the treatment of esophageal cancer.

  9. Occupational monitoring in intracavitary radium therapy. Monitoracao de pessoas ocupacionalmente expostas no tratamento de cancer de colo uterino com Ra-226

    Energy Technology Data Exchange (ETDEWEB)

    Araujo, A M.C. de [Instituto de Radioprotecao e Dosimetria (IRD), Rio de Janeiro, RJ (Brazil)

    1985-07-01

    In Brazil, the highest incidence of cancer in females is in the uterine cervix, in which Bracytherapy treatment plays a very important role. The majority of our Clinics use {sup 226}Ra or {sup 137}Cs tubes to perform this therapy. As many of these Clinics do not use the afterloading technique, we investigated the occupational exposure for the staffs belonging to two big Hospitals in Rio de Janeiro, where the working conditions are very different. Besides the normal film badge, placed in the upper part of the trunk, each person has been provided with seven additional thermoluminescent dosimeters (chips - {sup 7}LiF) placed at: left ring finger, right ring finger, forehead (between the eyes), over the thyroid, in the midle of the back and the front of the trunk, and over the gonadal region. In Hospital A, where the staff is composed of 1 medical doctor and 1 nurse, they treat about 13 patients per month. In Hospital B, the staff was composed of 12 medical doctors, 2 technicians and 7 murses, and about 20 patients are treated monthly. The occupational exposures have been investigated separately for each step of the {sup 226}Ra routine. From these results we could easily identify that: the nurses working in the infermary do not use the lateral lead protection of beds to clean the patients; in Hospital B, where there are perfect conditions for storage and manipulation of the radioactive sources, the technician in charge of these tasks, together with the transport of the applicator, except in his hands, suffers no exposure at all. Besides that, we could also see that in Hospital A, where the nurse plays also the role of that technician, and the local protection conditions are not correct, the estimated annual exposures are still below the annual limits according to ICRP N{sup 0}. 26/1977. This analysis has been completed with measures of occupational exposures in Clinics using the after loading technique. (author).

  10. Results of radiation therapy for uterine cervical cancer using high dose rate remote after loading system

    International Nuclear Information System (INIS)

    Ogawa, Yoshihiro; Nemoto, Kenji

    2003-01-01

    In Japan, radiotherapy with high dose rate remote after loading system (HDR-RALS) for intracavitary brachytherapy is the standard treatment for more than 30 years. This report showed the usefulness of HDR-RALS for uterine cervical cancer. From 1980 through 1999, 442 patients with uterine cervical cancers (stage I: 66, stage II: 161, stage III: 165, stage IV: 50) were treated. Radiotherapy was performed both external teletherapy and HDR-RALS. Overall survival rate at 5 years was 60.2%. The 5-year actuarial incidence of all complications was 16.4%. The 5-year actuarial incidence of all complications in cases treated with the sum doses of whole pelvic irradiation (without central shield) and RALS up to 49 Gy, 50 to 59 Gy or larger doses were 7.5%, 11.0% and 25.2%, respectively. Radiation therapy using HDR-RALS was very effective. While the dose of whole pelvic irradiation was increased, the actuarial incidence of all complications was increased. (author)

  11. Survival and Complication Rate of Radiation Therapy in Stage I and II Carcinoma of uterine Cervix

    International Nuclear Information System (INIS)

    Ma, Sun Young; Cho, Heung Lea; Sohn, Seung Chang

    1995-01-01

    Purpose : To analyze survival rate and late rectal and bladder complication for patients with stage with stage I and II carcinoma of uterine cervix treated by radiation alone or combined with chemotherapy. Materials and Methods : Between November 1984 and December 1993, 127 patients with stage I and II carcinoma of uterine cervix treated by radiation alone or combined therapy of radiation and chemotherapy. Retrospective analysis for survival rate was carried out on eligible 107 patients and review for complication was possible in 91 patients. The median follow-up was 47 months (range 3-118) and the median age of patients was 56 years (range 31-76). 26 patients were stage IB by FIGO classification. 40 were stage IIA and 41 were stage IIB. 86 cases were treated by radiation alone and 21 were treated by radiation and chemotherapy. 101 patients were treated with intracavitary radiation therapy (ICRT), of these, 80 were received low dose rate (LDR) ICRT and 21 were received high dose rate (HDR) ICRT. Of the patients who received LDR ICRT, 63 were treated by 1 intracavitary insertion and 17 were underwent 2 insertions. And we evaluated the external radiation dose and midline shield. Results : Acturial survival rate at 5 years was 92% for stage IB, 75% for stage IIA, 53% for stage IIB and 69% in all patients. Grade 1 rectal complications were developed in 20 cases(22%), grade 2 were in 22 cases (24%), 22 cases (24%) of grade 1 urinary complications and 17 cases (19%) of grade 2 urinary complications were observed But no patients had severe complications that needed surgical management or admission care. Maximum bladder dose for the group of patients with urinary complications was higher than that for the patients without urinary complications(7608cGy v 6960cGy, p<0.01). Maximum rectal dose for the group of patients with rectal complications was higher than that for the patients without urinary complications (7041cGy v 6269cGy, p<0.01). While there was no significant

  12. [A new applicator with regulatable air bag designed for intracavitary brachytherapy of nasopharyngeal carcinoma].

    Science.gov (United States)

    Zhang, Ning; Wei, Guang-Yu; Tan, Yi-Chang; Huang, Ze-Li; Li, Shao-En; Lu, Zhi-Qian

    2004-10-01

    Nasopharynx applicator used in intracavitary brachytherapy plays an important role in the radiotherapy of nasopharyngeal carcinoma (NPC), its quality affects the efficiency of treatment. This study was to design a new applicator for clinical use. An inexpensive, reusable, and flexible latex nasopharynx applicator was designed. An air bag was placed at 15 mm from the foreside of the applicator, clung to the tube. The edge of air bag is tangent to the axis of tube. When the bag was full of air, the tube would hunch reversely,close to nasopharyngeal vault. After introduced into nasopharynx through middle nasal meatus, the applicator could be fixed in suitable position by its rotation, and air bag regulation, and confirmed its position by simulation. A total of 221 patients with NPC were treated with external beam radiation therapy in our hospital, and boosted HDR brachytherapy using this new applicator. The response rate was 92.6% in the primary tumor group (200/216), and 100% in the recurrent tumor group (5/5). Mucosal necrosis in the posterior or anterior wall of nasopharynx occurred in 5 patients, 8 patients experienced nasal congestion and nasal synechia. This new nasopharynx applicator is easy to operate, painless, and well dosage-distributed. Mucosal necrosis is likely due to higher fractional dose.

  13. Radiotherapy in head and neck area using intracavitary irradiation

    International Nuclear Information System (INIS)

    Iwata, Takeo; Mamiya, Hajime; Tsutsumi, Masami; Nara, Yuichi

    1986-01-01

    It has been very popular that Intracavitary irradiation is used for Otolaryngology area but which is limited regions like the upper jaw cavity which can be easy to be fixed and looked into the face. Nowadays, the thrapy combined between external and intracavitary irradiation in the cancer of esophagus and we have a great expectation for the effects. As we could have chances to do radiotherapy for Uvular Carcinoma, we tried the Intracavitary irradiation for the Anterior aspect of the Soft Palate through the nose with external rotation irradiation. Of couse when we inserted tandem, we inserted and fixed it by using Otolaryngology fiberscope from another nose cavity and getting the advices from Otolaryngology specialists. From our studies, we publish that we could reconsider the limits of Intracavitary irradiation in Head and Neck area if we used our experiments. (author)

  14. Design and thermometry of an intracavitary microwave applicator suitable for treatment of some vaginal and rectal cancers

    International Nuclear Information System (INIS)

    Li, D.J.; Luk, K.H.; Jiang, H.B.; Chou, C.K.; Hwang, G.Z.

    1984-01-01

    The construction of a modified coaxial cable as an intracavitary microwave applicator suitable for use in some vaginal and rectal cancers is presented. Thermometry is performed for microwave frequencies of 300, 400, 650, and 915 MHz. Temperature profiles in tissue phantoms were obtained with Vitek 101 temperature probes and thermography, and the data were compared with those obtained in dogs. The temperature profiles are dependent on the frequency of the microwaves and the insertion depth of the applicator. In addition, a lucite cylindrical spacer external to the applicator also altered the heating pattern. Therefore, with proper combinations of frequency, insertion depth, and spacer, the applicator can be used for heating tumors in some clinical situations. Two patients were treated with this intracavitary microwave applicator in conjunction with interstitial radiation therapy. Tolerance to such combined therapy was satisfactory in these preliminary trial treatments

  15. Retention Rate in Methadone Maintenance Therapy

    Directory of Open Access Journals (Sweden)

    G Dastjerdi

    2010-08-01

    Full Text Available Introduction: Methadone maintenance therapy is a well-known approach to the treatment of drug use disorders and harm reduction. But the main challenge is retention rate in MMT Methods: Through simple random sampling, 155 addicts aged between 18-60 years who referred to drug addiction center of university and underwent MMT were followed for at least one year and up to two and half years. Results: Of the total, 3.9% female, 62% married, 37.4% workers and 27.1% were jobless. 80% had education level of less than diploma, 43.2% abused marijuana, 54.2% abused alcohol and 49.7% were living in rented houses. 60% referred to this center because of economical problems, 15.5% because of legal issues and 67.7% because of family pressure. 31.6% were opium and opium resin addicts, 60% were heroin addicts, 8.4% were crack addicts and 21.9% were IV abusers. 76.8% had at least one high risk behavior. Average dose of methadone was 86.5+35 mg/day. Mean survival time was 80 weeks. Relapse rate was 3.3% in the first month, 13.9% in three months, 23.2% in six months, 31.7% in first year and 41. 7% was a total relapse rate. Survival rate had a direct significant statistical relationship with the age, type of drug and method of use. Conclusion: According to the results of the present study that indicate a survival rate of 68.2% in a year and 58.3% after a year and also considering the results of other studies, we can conclude that MMP could be an effective method in the treatment of opiate drug disorders.

  16. Problems of treatment planning of intracavitary brachytherapy for advanced esophageal cancer

    International Nuclear Information System (INIS)

    Fukui, Akira; Yamamoto, Koji; Yoshioka, Shinji; Kawamura, Masashi; Kataoka, Masaaki; Fujii, Takashi; Ikezoe, Junpei

    1999-01-01

    In high dose rate intracavitary irradiation for esophageal cancer, the most acceptable dose point is at 5 mm deep from the mucosal surface currently. However, the balloon applicator has a tendency to distort due to irregularity of the tumor, especially advanced cancer. Therefore we studied the difference of the dose distribution when the definition of the mucosal surface was changed in five cases. We concluded that the difference of the distance between the source and the mucosal surface is significant, and the definition of the mucosal surface and mucosal surface dose should also be designated. (author)

  17. Radiation treatment of esophageal carcinoma using a high-dose-rate remote afterloader

    International Nuclear Information System (INIS)

    Hishikawa, Yoshio

    1984-01-01

    Between May 1980 and March 1983, 31 patients with esophageal carcinoma were treated with a high-dose-rate remote controlled afterloading unit, as a boost therapy of the intracavitary irradiation following the external irradiation. The data of these patients were analyzed by the regression analysis which is one of the multivariate analyses, and following results were obtained. 1) Factors which affect local control achieved by intracavitary irradiation were the existence of deep ulcer or stenosis after external irradiation, age of the patient, dosage of intracavitary irradiation and tumor length. 2) The local control estimation index was determined by these five factors. Local control estimation index=1.38950-0.01571 x age+0.04517 x tumor length+0.62167 x stenosis* + 0.94811 x deep ulcer*-0.02969 x dosage of intracavitary irradiation. * Existence of stenosis/ulcer was represented by 1, and absence was represented by 0. 3) The local control estimation indices obtained in the above formula were then approved by applying internal samples, and also external samples. Indices of 0.5 or more mean local failure, and those of less than 0.5 mean possible local control. Examination was then made as to the local control estimation indices of another group of 30 patients who had been treated by external irradiation alone between November 1974 and April 1980. Comparison of the indices of the two groups showed the following results. 1) Rate of possible local control by external irradiation alone was 23%. 2) Rate of possible local control was increased up to 62% by using intracavitary irradiation following external irradiation. (author)

  18. Remote-controlled afterloading for intracavitary brachytherapy in gynecological carcinomas

    International Nuclear Information System (INIS)

    Rotte, K.

    1983-01-01

    Classical radiotherapy is gradually being replaced by remote-controlled afterloading procedures in the intracavitary treatment of tumors found during gynecological examination. These new procedures practically eliminate the exposure of the clinic staff to radiation. The possibilities of this new method are discussed with regard to the physics and biology of radiation. Our own results with this new method are reported. (orig.)

  19. Afterloading intracavitary irradiation and expanding stent for malignant biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Yoshimura, Hitoshi; Sakaguchi, Hiroshi; Yoshioka, Tetsuya and others

    1989-02-01

    A double lumen catheter was developed as an apllicator for the remote afterloading (RALS) of /sup 60/Co source for the intracavitary irradiation of an obstructed common bile duct caused by carcinoma of the gallbladder. This was followed by the placement of nylon-covered expandable metallic stents to maintain patency. This combination effectively provided palliation. (author).

  20. Piroxicam and intracavitary platinum-based chemotherapy for the treatment of advanced mesothelioma in pets: preliminary observations

    Directory of Open Access Journals (Sweden)

    Citro Gennaro

    2008-05-01

    Full Text Available Abstract Malignant Mesothelioma is an uncommon and very aggressive tumor that accounts for 1% of all the deaths secondary to malignancy in humans. Interestingly, this neoplasm has been occasionally described in companion animals as well. Aim of this study was the preclinical evaluation of the combination of piroxicam with platinum-based intracavitary chemotherapy in pets. Three companion animals have been treated in a three years period with this combination. Diagnosis was obtained by ultrasonographic exam of the body cavities that evidenced thickening of the mesothelium. A surgical biopsy further substantiated the diagnosis. After drainage of the malignant effusion from the affected cavity, the patients received four cycles of intracavitary CDDP at the dose of 50 mg/m2 every three weeks if dogs or four cycles of intracavitary carboplatin at the dose of 180 mg/m2 (every 3 weeks if cats, coupled with daily administration of piroxicam at the dose of 0.3 mg/kg. The therapy was able to arrest the effusion in all patients for variable remission times: one dog is still in remission after 3 years, one dog died of progressive disease after 8 months and one cat died due to progressive neoplastic growth after six months, when the patient developed a mesothelial cuirass. The combination showed remarkable efficacy at controlling the malignant effusion secondary to MM in our patients and warrants further investigations.

  1. Piroxicam and intracavitary platinum-based chemotherapy for the treatment of advanced mesothelioma in pets: preliminary observations

    Science.gov (United States)

    Spugnini, Enrico P; Crispi, Stefania; Scarabello, Alessandra; Caruso, Giovanni; Citro, Gennaro; Baldi, Alfonso

    2008-01-01

    Malignant Mesothelioma is an uncommon and very aggressive tumor that accounts for 1% of all the deaths secondary to malignancy in humans. Interestingly, this neoplasm has been occasionally described in companion animals as well. Aim of this study was the preclinical evaluation of the combination of piroxicam with platinum-based intracavitary chemotherapy in pets. Three companion animals have been treated in a three years period with this combination. Diagnosis was obtained by ultrasonographic exam of the body cavities that evidenced thickening of the mesothelium. A surgical biopsy further substantiated the diagnosis. After drainage of the malignant effusion from the affected cavity, the patients received four cycles of intracavitary CDDP at the dose of 50 mg/m2 every three weeks if dogs or four cycles of intracavitary carboplatin at the dose of 180 mg/m2 (every 3 weeks) if cats, coupled with daily administration of piroxicam at the dose of 0.3 mg/kg. The therapy was able to arrest the effusion in all patients for variable remission times: one dog is still in remission after 3 years, one dog died of progressive disease after 8 months and one cat died due to progressive neoplastic growth after six months, when the patient developed a mesothelial cuirass. The combination showed remarkable efficacy at controlling the malignant effusion secondary to MM in our patients and warrants further investigations. PMID:18577247

  2. Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Brandao, Samia de Freitas, E-mail: samiabrandao@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear; Campos, Tarcisio Passos Ribeiro de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

    2013-06-15

    Objective: comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and methods: simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results: intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h{sup -1}.p{sup -1}.s, respectively, on the healthy tissue, on the balloon periphery and on the /{sub 1} and /{sub 2} tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h{sup -1}.p{sup -1}.s, respectively on the healthy tissue, on the target tumor and on the /{sub 1} and /{sub 2} infiltration zones. Conclusion: Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones. (author)

  3. Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

    Directory of Open Access Journals (Sweden)

    Samia de Freitas Brandao

    2013-07-01

    Full Text Available Objective Comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and Methods Simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results Intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h-1.p-1.s, respectively, on the healthy tissue, on the balloon periphery and on the I 1 and I 2 tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h-1.p-1.s, respectively on the healthy tissue, on the target tumor and on the I 1 and I 2 infiltration zones. Conclusion Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones.

  4. A theoretical study of cylindrical ultrasound transducers for intracavitary hyperthermia

    International Nuclear Information System (INIS)

    Lin, W.-L.; Fan, W.-C.; Yen, J.-Y.; Chen, Y.-Y.; Shieh, M.-J.

    2000-01-01

    Purpose: The purpose of this paper was to examine the heating patterns and penetration depth when a cylindrical ultrasound transducer is employed for intracavitary hyperthermia treatments. Methods and Materials: The present study employs a simulation program based on a simplified power deposition model for infinitely long cylindrical ultrasound transducers. The ultrasound power in the tissue is assumed to be exponentially attenuated according to the penetration depth of the ultrasound beam, and a uniform attenuation for the entire treatment region is also assumed. The distribution of specific absorption rate (SAR) ratio (the ratio of SAR for a point within the tissue to that for a specific point on the cavity surface) is used to determine the heating pattern for a set of given parameters. The parameters considered are the ultrasound attenuation in the tissue, the cavity size, and the transducer eccentricity. Results: Simulation results show that the ultrasound attenuation in the tissue, the cavity size, and the transducer eccentricity are the most influential parameters for the distribution of SAR ratio. A low frequency transducer located in a large cavity can produce a much better penetration. The cavity size is the major parameter affecting the penetration depth for a small cavity size, such as interstitial hyperthermia. The heating pattern can also be dramatically changed by the transducer eccentricity and radiating sector. In addition, for a finite length of cylindrical transducer, lower SAR ratio appears in the regions near the applicator's edges. Conclusion: The distribution of SAR ratio indicates the relationship between the treatable region and the parameters if an appropriate threshold of SAR ratio is taken. The findings of the present study comprehend whether or not a tumor is treatable, as well as select the optimal driving frequency, the appropriate cavity size, and the eccentricity of a cylindrical transducer for a specific treatment

  5. Reirradiation of nasopharyngeal carcinoma with intracavitary mold brachytherapy: an effective means of local salvage

    International Nuclear Information System (INIS)

    Law, Stephen C.K.; Lam, W.-K.; Ng, M.-F.; Au, S.-K.; Mak, W.-T.; Lau, W.-H.

    2002-01-01

    Purpose: To assess the role of intracavitary mold brachytherapy in salvaging local failure of nasopharyngeal carcinoma (NPC). Methods and Materials: The outcomes of 118 consecutive NPC patients with local failure treated with mold brachytherapy between 1989 and 1996 were retrospectively reviewed. Eleven patients received additional external radiotherapy. Results: All molds were tailor-made, and the whole procedure was performed under local anesthesia. Pharyngeal recess dissection was routinely performed to allow direct contact of the radioactive source with the pharyngeal recess, a common site of local failure. Initially, the molds were preloaded with 192 Ir wires, but since 1992, the sources have been manually afterloaded; the mold has also been redesigned for better conformity, ease of insertion, and radiation safety. Using brachytherapy alone, 50-55 Gy was given for recurrence in 4-7 days; for persistence, 40 Gy was administered. The overall complete remission rate was 97%. The rates of 5-year local control, relapse-free survival, disease-specific survival, overall survival, and major complication were 85%, 68.3%, 74.8%, 61.3%, and 46.9%, respectively. Major complications included nasopharyngeal necrosis with headache, necrosis of cervical vertebrae with atlantoaxial instability, temporal lobe necrosis, and palsy of the cranial nerves. The afterloaded mold was as effective as the preloaded version, but with fewer complications. Conclusions: Intracavitary mold brachytherapy was effective in salvaging NPC with early-stage local persistence or first recurrence

  6. dose in cervical cancer intracavitary brachytherapy

    Directory of Open Access Journals (Sweden)

    Zahra Siavashpour

    2016-04-01

    Full Text Available Purpose: To analyze the optimum organ filling point for organs at risk (OARs dose in cervical cancer high-dose-rate (HDR brachytherapy. Material and methods : In a retrospective study, 32 locally advanced cervical cancer patients (97 insertions who were treated with 3D conformal external beam radiation therapy (EBRT and concurrent chemotherapy during 2010-2013 were included. Rotterdam HDR tandem-ovoid applicators were used and computed tomography (CT scanning was performed after each insertion. The OARs delineation and GEC-ESTRO-based clinical target volumes (CTVs contouring was followed by 3D forward planning. Then, dose volume histogram (DVH parameters of organs were recorded and patients were classified based on their OARs volumes, as well as their inserted tandem length. Results : The absorbed dose to point A ranged between 6.5-7.5 Gy. D 0.1cm ³ and D 2cm ³ of the bladder significantly increased with the bladder volume enlargement (p value < 0.05. By increasing the bladder volume up to about 140 cm3, the rectum dose was also increased. For the cases with bladder volumes higher than 140 cm3, the rectum dose decreased. For bladder volumes lower than 75 cm3, the sigmoid dose decreased; however, for bladder volumes higher than 75 cm3, the sigmoid dose increased. The D 2cm ³ of the bladder and rectum were higher for longer tandems than for shorter ones, respectively. The divergence of the obtained results for different tandem lengths became wider by the extension of the bladder volume. The rectum and sigmoid volume had a direct impact on increasing their D 0.1cm ³ and D 2cm ³, as well as decreasing their D 10 , D 30 , and D 50 . Conclusions : There is a relationship between the volumes of OARs and their received doses. Selecting a bladder with a volume of about 70 cm3 or less proved to be better with regards to the dose to the bladder, rectum, and sigmoid.

  7. Radiation therapy for carcinoma of the endometrium

    International Nuclear Information System (INIS)

    Potish, R.A.

    1987-01-01

    Carcinoma of the endometrium is the most common malignant tumor in the female genital tract. Radiation therapy continues to play a major role in the management of endometrial carcinoma, both as primary therapy and as adjuvant treatment. The utility of pelvic external beam therapy and intracavitary therapy is long established. However, the modern era of surgical staging has lead to an appreciation of the role of radiation therapy beyond the pelvis. Radiation therapy has been shown to be of particular benefit in peritoneal and nodal spread. The classic management of endometrial cancer is reviewed and relatively new and somewhat controversial topics, such as preoperative intracavitary therapy followed by external beam therapy are discussed

  8. Microfluidic thrombosis under multiple shear rates and antiplatelet therapy doses.

    Directory of Open Access Journals (Sweden)

    Melissa Li

    Full Text Available The mainstay of treatment for thrombosis, the formation of occlusive platelet aggregates that often lead to heart attack and stroke, is antiplatelet therapy. Antiplatelet therapy dosing and resistance are poorly understood, leading to potential incorrect and ineffective dosing. Shear rate is also suspected to play a major role in thrombosis, but instrumentation to measure its influence has been limited by flow conditions, agonist use, and non-systematic and/or non-quantitative studies. In this work we measured occlusion times and thrombus detachment for a range of initial shear rates (500, 1500, 4000, and 10000 s(-1 and therapy concentrations (0-2.4 µM for eptifibatide, 0-2 mM for acetyl-salicylic acid (ASA, 3.5-40 Units/L for heparin using a microfluidic device. We also measured complete blood counts (CBC and platelet activity using whole blood impedance aggregometry. Effects of shear rate and dose were analyzed using general linear models, logistic regressions, and Cox proportional hazards models. Shear rates have significant effects on thrombosis/dose-response curves for all tested therapies. ASA has little effect on high shear occlusion times, even at very high doses (up to 20 times the recommended dose. Under ASA therapy, thrombi formed at high shear rates were 4 times more prone to detachment compared to those formed under control conditions. Eptifibatide reduced occlusion when controlling for shear rate and its efficacy increased with dose concentration. In contrast, the hazard of occlusion from ASA was several orders of magnitude higher than that of eptifibatide. Our results show similar dose efficacy to our low shear measurements using whole blood aggregometry. This quantitative and statistically validated study of the effects of a wide range of shear rate and antiplatelet therapy doses on occlusive thrombosis contributes to more accurate understanding of thrombosis and to models for optimizing patient treatment.

  9. Geometrical considerations in dose volume analysis in intracavitary treatment

    International Nuclear Information System (INIS)

    Deshpande, D.D.; Shrivastava, S.K.; Pradhan, A.S.; Viswanathan, P.S.; Dinshaw, K.A.

    1996-01-01

    The present work was aimed at to study the relationship between the volume enclosed by reference iodose surface and various geometrical parameters of the intracavitary applicator in treatment of carcinoma of cervix. Pearshape volume of the reference isodose derived from the Total Reference Air Kerma (TRAK) and the product of its dimensions, height H, width W and thickness T which is dependent on the applicator geometry, were estimated for 100 intracavitary applications treated by Selectron LDR machine. Orthogonal radiographs taken for each patient were used for measurement of actual geometric dimensions of the applicator and carrying out the dosimetry on TP-11 treatment planning system. The dimensions H, W and T of reference isodose surface (60 Gy) were also noted. Ratio of the product HWT and the pearshape volume was found mainly to be a function of colpostat separation and not of other geometrical parameters like maximum vertical and anterio-posterior dimension of the applicator. The ratio remained almost constant for a particular combination of uterine tandem and colpostat. Variation in the ratios were attributed to the non-standard geometry. The ratio of the volume of reference isodose surface to the product of its dimensions in the applicator depends upon the colpostat separation. (orig./MG) [de

  10. Mapping {sup 15}O Production Rate for Proton Therapy Verification

    Energy Technology Data Exchange (ETDEWEB)

    Grogg, Kira; Alpert, Nathaniel M.; Zhu, Xuping [Center for Advanced Radiological Sciences, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Boston, Massachusetts (United States); Min, Chul Hee [Department of Radiological Science, College of Health Science, Yonsei University, Wonju, Kangwon (Korea, Republic of); Testa, Mauro; Winey, Brian [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Normandin, Marc D. [Center for Advanced Radiological Sciences, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Boston, Massachusetts (United States); Shih, Helen A.; Paganetti, Harald; Bortfeld, Thomas [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); El Fakhri, Georges, E-mail: elfakhri@pet.mgh.harvard.edu [Center for Advanced Radiological Sciences, Nuclear Medicine and Molecular Imaging, Radiology Department, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-06-01

    Purpose: This work was a proof-of-principle study for the evaluation of oxygen-15 ({sup 15}O) production as an imaging target through the use of positron emission tomography (PET), to improve verification of proton treatment plans and to study the effects of perfusion. Methods and Materials: Dynamic PET measurements of irradiation-produced isotopes were made for a phantom and rabbit thigh muscles. The rabbit muscle was irradiated and imaged under both live and dead conditions. A differential equation was fitted to phantom and in vivo data, yielding estimates of {sup 15}O production and clearance rates, which were compared to live versus dead rates for the rabbit and to Monte Carlo predictions. Results: PET clearance rates agreed with decay constants of the dominant radionuclide species in 3 different phantom materials. In 2 oxygen-rich materials, the ratio of {sup 15}O production rates agreed with the expected ratio. In the dead rabbit thighs, the dynamic PET concentration histories were accurately described using {sup 15}O decay constant, whereas the live thigh activity decayed faster. Most importantly, the {sup 15}O production rates agreed within 2% (P>.5) between conditions. Conclusions: We developed a new method for quantitative measurement of {sup 15}O production and clearance rates in the period immediately following proton therapy. Measurements in the phantom and rabbits were well described in terms of {sup 15}O production and clearance rates, plus a correction for other isotopes. These proof-of-principle results support the feasibility of detailed verification of proton therapy treatment delivery. In addition, {sup 15}O clearance rates may be useful in monitoring permeability changes due to therapy.

  11. Accurate and economical intracavitary endocurietherapy in the treatment of uterine cervix cancer

    International Nuclear Information System (INIS)

    Kumar, P.P.; Good, R.R.

    1986-01-01

    A modified afterloading cervical applicator and intracavitary endocurietherapy application technique eliminates several problems associated with the Henschke cervical applicator, and conventional preloading technique. The Kumar cervical applicator minimizes patient discomfort, and improves patient mobility while reducing the tendency of the applicator to rotate during the 40 to 50 hours of uterine intracavitary endocurietherapy. The use of hygroscopic laminaria tent for gradual cervical dilatation in plate of manual cervical dilatation, and the use of inflatable Foley balloon threaded onto the tandem instead of vaginal packing, to separate the 137 Cesium sources away from the rectum and bladder, eliminate the need of general anesthesia for the majority of patients undergoing intracavitary endocurietherapy. (orig.) [de

  12. The effect of combined external beam and high-dose intracavitary brachytherapy on dysphagia and survival in patients with advanced esophageal cancer

    International Nuclear Information System (INIS)

    Yorozu, Atsunori; Dokiya, Takushi; Ogita, Mikio; Kutsuki, Shoji

    1996-01-01

    During an 11-year period, a group of 130 patients with esophageal cancer of stages 2 to 4 were treated with external beam irradiation (40 to 60 Gy) followed by boost dose of 10 to 20 Gy of high-dose intracavitary brachytherapy. The overall 2-year survival rate was 15.4%. The significant prognostic factors were tumor size, response to external beam irradiation, pretreatment dysphagia score, and presence of distant metastases. The palliative effect was excellent; the dysphagia scores of 122 of 130 patients (93.8%) improved. The significant palliative factors were response to external beam irradiation and pretreatment dysphagia score. Tracheoesophageal fistulas developed after treatment in 13 of 130 patients (10%); 3 of the fistulas were probably related to radiotherapy. We conclude that intracavitary brachytherapy is useful in the treatment of cases of advanced cancer which show a good response to external beam irradiation and may be curative in patients with mild dysphagia. (author)

  13. Hemostatic Agents for Control of Intracavitary Non-Compressible Hemorrhage: An Overview of Current Results

    National Research Council Canada - National Science Library

    Kheirabadi, Bijan; Klemcke, Harold G

    2004-01-01

    The majority (̃80%) of hemorrhagic deaths on the battlefield are due to intracavitary hemorrhage that is not accessible for direct compression and cannot be treated with externally applied hemostatic agents...

  14. Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results

    International Nuclear Information System (INIS)

    Pollock, Bruce E.; Lunsford, L. Dade; Kondziolka, Douglas; Levine, Geoffrey; Flickinger, John C.

    1995-01-01

    Purpose: The management of patients with craniopharyngiomas is often multifaceted and multidisciplinary. The purpose of this study was to examine the results of phosphorus-32 intracavitary irradiation in the treatment of patients with predominately cystic craniopharyngiomas. Methods and Materials: Thirty patients with cystic craniopharyngiomas underwent phosphorus-32 intracavitary irradiation at our center between 1981 and 1993. The median patient age was 26 years (range, 3-70 years). Thirteen patients had intracavitary irradiation as the primary surgery for their cystic tumors, whereas 17 patients had adjuvant intracavitary irradiation after microsurgical resection, fractionated radiotherapy, or both. Patients in the adjuvant treatment group were more likely to have preoperative anterior pituitary insufficiency (p = 0.008 Fischer exact test) and diabetes insipidus (p = 0.003 Fischer exact test). The median follow-up was 37 months (mean, 46 months, range, 7-116 months). Results: Phosphorus-32 intracavitary irradiation resulted in cyst regression in 28 of 32 treated cysts (88%). Ten patients (33%) have had tumor progression requiring further surgical intervention. Three patients (10%) died: two of tumor progression, and one of unrelated causes. Visual acuity and fields improved or remained stable in 63% of the patients. Fifteen patients had residual anterior pituitary function before intracavitary irradiation and 10 (67%) retained their preoperative endocrine status. New-onset diabetes insipidus occurred in 3 of 17 patients (18%) who had normal posterior pituitary function preoperatively. Fourteen of 20 adult patients (70%) continued to perform at their preoperative functional level; 3 of 5 pediatric patients who were age appropriate at the time of treatment continued to develop normally. No difference was noted between primary and adjuvant treatment patients with respect to cyst control, visual deterioration, or endocrine preservation after phosphorus-32

  15. Radiation therapy alone for adenocarcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Nakano, Takashi; Arai, Tatsuo; Morita, Shinroku; Oka, Kuniyuki

    1995-01-01

    Purpose: Radiation therapy alone for adenocarcinoma of the cervix is currently evaluated by the accumulation of long-term results because of the low incidence of this disease. Materials and Methods: Fifty-eight patients with adenocarcinoma of the cervix treated with radiation therapy alone between 1961 and 1988 were studied. The radiation therapy consisted of a combination of intracavitary and external pelvis irradiation. Intracavitary treatment was performed with low dose rate and/or high dose rate sources. Results: The 5-year survival rates for Stages I, II, III, and IV were 85.7%, 66.7%, 32.3%, and 9.1%, respectively, and the 10-year survival rates were 85.7%, 60.0%, 27.6%, and 9.1%, respectively. The local control rate with high dose rate treatment was 45.5%, significantly lower than 85.7% and 72.7% with low and mixed dose rate treatments, respectively. Five-year survival and local control rates by tumor volume were 68.6% and 80.0% for small tumors, 63.6% and 66.0% for medium tumors, and 14.4% and 18.2% for large tumors, respectively. The survival rate and local control rate for large tumors were significantly lower than those for small and medium tumors. Multiple regression analysis indicated that stage and tumor volume were independent variables for survival and local control, respectively. Isoeffective dose expressed by time dose fractionation (TDF) was not associated with local control. Radiation complications developed in 10 patients (17.2%), most of which were of moderate degree. Conclusion: Radiation therapy alone for adenocarcinoma of the cervix was regarded to be an effective treatment, comparable to combination therapy of surgery and radiation therapy

  16. VASCULAR REMODELING AND HEART RATE VARIABILITY IN DIFFERENT ANTIHYPERTENSIVE THERAPIES

    Directory of Open Access Journals (Sweden)

    E. D. Golovanova

    2008-01-01

    Full Text Available Aim. To study the effect of the long-term antihypertensive monotherapy with indapamide (Arifon Retard, 1,5 mg/d, metoprolol tartrate (Egilok Retard, 50 mg/d and combined therapy with indapamide and perindopril (Noliprel Forte, 1 tab/d: perindopril 4 mg and indapamide 1,25 mg on pulse wave velocity (PWV, cardio-ankle vascular index (CAVI and the sympathetic system activity.Material and methods. 88 patients, aged 30-59 y.o. (32 normotensive patients, 56 with arterial hypertension [HT] of 1-2 grades were examined. Biological age (BA was determined by the linear regression and the vascular wall age (VWA was estimated with the use of volume sphygmography (“VaSera-1000”, “Fucuda Denshi”, Japan. 39 patients with HT were randomized into 3 parallel groups with studied therapies lasted for 6 months. PWV, CAVI of the vessels of elastic, muscular and mixed types, blood pressure, measured in upper and lower extremities and heart rate variability (HRV were determined before and at the end of the therapies.Results. BA and VWA were elevated in all of patients with HT as compared with normotensive patients. The reduction in PWV and CAVI of the vessels of elastic and mixed types, HRV increase were found in patients with Arifon Retard monotherapy. Monotherapy with metoprolol significantly improved HVR without any influence on the vascular remodeling. Noliprel Forte significantly decreased in blood pressure in the upper and lower extremities, PWV and CAVI of the vessels of all types, decreased in VWA and increased in parasympathetic drive.Conclusion. Long-term therapy with Arifon Retard and Noliprel Forte resulted in decrease in vascular remodeling and increase in HRV simultaneously with significant antihypertensive effect in patients with HT. Metoprolol low doses therapy resulted in normalization of autonomic drive independently on antihypertensive action.

  17. Radiopharmaceuticals for therapy

    International Nuclear Information System (INIS)

    Lazarus, C.R.; Maisey, M.N.

    1985-01-01

    Several factors influencing the choice of radiopharmaceutical used in the treatment of benign and malignant disease are discussed. A brief review is given of the routine clinical uses of radiopharmaceuticals including treatments for hyperthyroidism, thyroid cancer, polycythaemia rubra vera and intracavitary therapy. Finally clinical situations using radionuclides under evaluation including the treatment of bone disease, adrenal tumours and monoclonal antibodies are discussed. (UK)

  18. Intracavitary mould brachytherapy in malignant tumors of the maxilla

    International Nuclear Information System (INIS)

    Rosenblatt, Edward; Blumenfeld, Israel; Cederbaum, Martin; Kuten, Abraham

    1996-01-01

    Purpose: To integrate brachytherapy in the combined modality management of malignant tumors of the maxilla, as a means of increasing the radiotherapy dose to the tumor bed while avoiding high doses to the orbital contents. Materials and methods: Following a partial or total maxillectomy, a duplication of the interim surgical obturator was created using a wash of vinyl polysiloxane. This mould was used as a carrier for afterloading nylon catheters through which 192-Iridium seed-ribbons were inserted. Following brachytherapy, selected patients also received external beam irradiation. Results and discussion: After a median follow-up of 36 months, 9 out of 11 patients are alive and disease-free; 1 developed a local recurrence and another relapsed at another site in the oral cavity. Transient grade 1 - 2 mucositis at the implant site was observed in all patients. The review of computer isodose distributions showed that the average dose received by the homolateral eyeball was 10% (range 9,2 - 10.0) of the prescribed surface dose to the surgical cavity. Conclusions: Brachytherapy can be integrated in the management of patients with malignant tumors of the maxilla in the form of a custom-made intracavitary mould carrying 192-Iridium sources. We found this technique particularly useful in cases with close or positive surgical margins

  19. Intracavitary drainage procedure for giant bullae in compromised patients.

    Science.gov (United States)

    Verma, R K; Nishiki, M; Mukai, M; Fujii, T; Kuranishi, F; Yoshioka, S; Ohtani, M; Dohi, K

    1991-09-01

    Two cases of giant bullae were treated by intracavitary suction and drainage procedure under local anesthesia because of the poor pulmonary function. After staged bullectomy, the patients returned to normal life. The first case was admitted to our intensive care unit (ICU). Tube drainage was performed in the giant bulla of the left lung immediately after admission. One month after recovery from right heart failure and mediastinal shift to the right side, bullectomy was performed using linear stapler. The patient was discharged 20 days later. The second case was admitted with severe dyspnea and bilateral giant bullae were noticed. We performed tube drainage for larger bulla of the left lung under local anesthesia. Two months later, bullectomy was performed on the right side, because the bulla on the left side became smaller and the general condition of the patient improved. The patient was discharged three months later on foot and has since been asymptomatic. Giant bulla is a well-established clinical entity which includes abnormal dilatation of various parts of the tracheo-bronchial tree and other discrete sacs originating from the interstitial portion of the lung. Giant bullae are frequently associated with marked dyspnea and emphysematous symptoms. However, these symptoms depend upon various factors: size, location, valvular mechanism, condition of the contiguous lung parenchyma and the changes that may take place in the intrathoracic pressure.

  20. A newly developed MR simulation system for intracavitary brachytherapy for cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ebe, Kazuyu; Matsunaga, Naofumi [Yamaguchi Univ., Ube (Japan). School of Medicine

    1997-03-01

    We have developed a prototype system for a magnetic resonance (MR) simulation to accurately estimate radiation doses to the tumor and surrounding normal tissues during brachytherapy for cervical cancer. Six patients with cervical cancer underwent MR simulation prior to intracavitary high-dose-rate brachytherapy using Co-60 sources. Tandem and ovoid applicators filled with tap-water were placed in the uterine cavity and vaginal fornix, then MR imaging examinations were performed. Frontal and lateral images of maximum intensity projection (MIP) of applicators generated from a data set of half-Fourier single shot turbo spin-echo (HASTE) images were chosen for processing by the treatment planning computer system. Then, isodose curves on the coronal or sagittal plane of the tandem section were superimposed on corresponding T2-weighted images derived from a turbo spin-echo technique. Doses to the tumor, the posterior wall of the urinary bladder, the anterior wall of the rectum, and the urethra were read from isodose curves superimposed on the T2-weighted sagittal image. Phantom experiments were done to evaluate geometrical errors. The possible distortion of the lattice image on the phantom was small. This system promises to be useful in customizing the dose distribution corresponding to the tumor and surrounding normal tissues. (author)

  1. A newly developed MR simulation system for intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Ebe, Kazuyu; Matsunaga, Naofumi

    1997-01-01

    We have developed a prototype system for a magnetic resonance (MR) simulation to accurately estimate radiation doses to the tumor and surrounding normal tissues during brachytherapy for cervical cancer. Six patients with cervical cancer underwent MR simulation prior to intracavitary high-dose-rate brachytherapy using Co-60 sources. Tandem and ovoid applicators filled with tap-water were placed in the uterine cavity and vaginal fornix, then MR imaging examinations were performed. Frontal and lateral images of maximum intensity projection (MIP) of applicators generated from a data set of half-Fourier single shot turbo spin-echo (HASTE) images were chosen for processing by the treatment planning computer system. Then, isodose curves on the coronal or sagittal plane of the tandem section were superimposed on corresponding T2-weighted images derived from a turbo spin-echo technique. Doses to the tumor, the posterior wall of the urinary bladder, the anterior wall of the rectum, and the urethra were read from isodose curves superimposed on the T2-weighted sagittal image. Phantom experiments were done to evaluate geometrical errors. The possible distortion of the lattice image on the phantom was small. This system promises to be useful in customizing the dose distribution corresponding to the tumor and surrounding normal tissues. (author)

  2. Patient-based dosimetric comparison of interstitial and intracavitary brachytherapy in cases of cancer cervix

    International Nuclear Information System (INIS)

    Bansal, Anil K.; Julka, P.K.; Sharma, D.N.; Rustogi, Ashish; Subramani, V.; Prabhakar, R.; Rath, G.K.; Semwal, Manoj K.; Thulkar, S.

    2008-01-01

    Brachytherapy in the form of High Dose Rate (HDR) intracavitary radiotherapy (ICRT) along with external beam radiotherapy(EBRT) is the main treatment in cancer cervix. Of late, some large centres have started practicing template based transperineal interstitial brachytherapy (TIB) for advanced/ bulky cancer cervix. Usually, TIB is given for patients with advanced disease/ distorted anatomy or recurrent disease for better lateral target coverage. CT/MRI/USG based planning has made volumetric dosimetry possible for the target and the organs at risk (OARs). This has resulted in better correlation between dose received and treatment outcome in terms of tumour control and late toxicities as against the point dosimetry system. It has been shown by many studies that ICRU based point dose reporting may not represent the actual doses received by the OARs. Though it is expected that TIB gives better target coverage and OAR sparing in advanced/ bulky cancer cervix cases as compared to ICRT, detailed patient studies on the subject have not been reported. We have carried out dosimetric comparison between ICRT and TIB for cancer cervix patients undergoing treatment at our centre in terms of treated volume and doses to OARs

  3. [Historical overview and the current practice of intracavitary treatment of cervical and endometrial cancer in the Oncoradiology Center of Budapest].

    Science.gov (United States)

    Sinkó, Dániel; Nemeskéri, Csaba; Pallinger, Ágnes; Weisz, Csaba; Naszály, Attila; Landherr, László

    2015-06-01

    .002-0.06). During treatments no severe side effects were found. During gynecological intracavitary HDR therapies the calculated dose of the target volume can be given safely using the EclipseTM 11.0.47. brachytherapy planning system and CT-based planning. CT-based treatment planning provides optimal safety for organs at risk, acceptable doses for rectum and urinary bladder while the target volume receives the proper prescribed dose.

  4. Technological Advancements and Error Rates in Radiation Therapy Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Margalit, Danielle N., E-mail: dmargalit@partners.org [Harvard Radiation Oncology Program, Boston, MA (United States); Harvard Cancer Consortium and Brigham and Women' s Hospital/Dana Farber Cancer Institute, Boston, MA (United States); Chen, Yu-Hui; Catalano, Paul J.; Heckman, Kenneth; Vivenzio, Todd; Nissen, Kristopher; Wolfsberger, Luciant D.; Cormack, Robert A.; Mauch, Peter; Ng, Andrea K. [Harvard Cancer Consortium and Brigham and Women' s Hospital/Dana Farber Cancer Institute, Boston, MA (United States)

    2011-11-15

    Purpose: Technological advances in radiation therapy (RT) delivery have the potential to reduce errors via increased automation and built-in quality assurance (QA) safeguards, yet may also introduce new types of errors. Intensity-modulated RT (IMRT) is an increasingly used technology that is more technically complex than three-dimensional (3D)-conformal RT and conventional RT. We determined the rate of reported errors in RT delivery among IMRT and 3D/conventional RT treatments and characterized the errors associated with the respective techniques to improve existing QA processes. Methods and Materials: All errors in external beam RT delivery were prospectively recorded via a nonpunitive error-reporting system at Brigham and Women's Hospital/Dana Farber Cancer Institute. Errors are defined as any unplanned deviation from the intended RT treatment and are reviewed during monthly departmental quality improvement meetings. We analyzed all reported errors since the routine use of IMRT in our department, from January 2004 to July 2009. Fisher's exact test was used to determine the association between treatment technique (IMRT vs. 3D/conventional) and specific error types. Effect estimates were computed using logistic regression. Results: There were 155 errors in RT delivery among 241,546 fractions (0.06%), and none were clinically significant. IMRT was commonly associated with errors in machine parameters (nine of 19 errors) and data entry and interpretation (six of 19 errors). IMRT was associated with a lower rate of reported errors compared with 3D/conventional RT (0.03% vs. 0.07%, p = 0.001) and specifically fewer accessory errors (odds ratio, 0.11; 95% confidence interval, 0.01-0.78) and setup errors (odds ratio, 0.24; 95% confidence interval, 0.08-0.79). Conclusions: The rate of errors in RT delivery is low. The types of errors differ significantly between IMRT and 3D/conventional RT, suggesting that QA processes must be uniquely adapted for each technique

  5. Technological Advancements and Error Rates in Radiation Therapy Delivery

    International Nuclear Information System (INIS)

    Margalit, Danielle N.; Chen, Yu-Hui; Catalano, Paul J.; Heckman, Kenneth; Vivenzio, Todd; Nissen, Kristopher; Wolfsberger, Luciant D.; Cormack, Robert A.; Mauch, Peter; Ng, Andrea K.

    2011-01-01

    Purpose: Technological advances in radiation therapy (RT) delivery have the potential to reduce errors via increased automation and built-in quality assurance (QA) safeguards, yet may also introduce new types of errors. Intensity-modulated RT (IMRT) is an increasingly used technology that is more technically complex than three-dimensional (3D)–conformal RT and conventional RT. We determined the rate of reported errors in RT delivery among IMRT and 3D/conventional RT treatments and characterized the errors associated with the respective techniques to improve existing QA processes. Methods and Materials: All errors in external beam RT delivery were prospectively recorded via a nonpunitive error-reporting system at Brigham and Women’s Hospital/Dana Farber Cancer Institute. Errors are defined as any unplanned deviation from the intended RT treatment and are reviewed during monthly departmental quality improvement meetings. We analyzed all reported errors since the routine use of IMRT in our department, from January 2004 to July 2009. Fisher’s exact test was used to determine the association between treatment technique (IMRT vs. 3D/conventional) and specific error types. Effect estimates were computed using logistic regression. Results: There were 155 errors in RT delivery among 241,546 fractions (0.06%), and none were clinically significant. IMRT was commonly associated with errors in machine parameters (nine of 19 errors) and data entry and interpretation (six of 19 errors). IMRT was associated with a lower rate of reported errors compared with 3D/conventional RT (0.03% vs. 0.07%, p = 0.001) and specifically fewer accessory errors (odds ratio, 0.11; 95% confidence interval, 0.01–0.78) and setup errors (odds ratio, 0.24; 95% confidence interval, 0.08–0.79). Conclusions: The rate of errors in RT delivery is low. The types of errors differ significantly between IMRT and 3D/conventional RT, suggesting that QA processes must be uniquely adapted for each technique

  6. Low morbidity following 9,000-rad intracavitary endocurietherapy (ECT) using the Kumar cervical applicator and external-beam radiotherapy (EXRT) in the management of carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Kumar, P.P.; Good, R.R.; Scott, J.C.; Jones, E.O.; Lynch, G.; McCaul, G.F.

    1988-01-01

    The Kumar Cervical Applicator minimizes patient discomfort and improves patient mobility while reducing the tendency of the applicator to rotate during the 40 to 50 hours of uterine intracavitary endocurietherapy. Patients with previously untreated invasive carcinoma of the uterine cervix, F.I.G.O. stages IB-IVA, were treated with two Kumar intracavitary endocurietherapy (ECT) applications of 2,500 rad each to point ''A,'' and 4,000 rad external-beam radiotherapy (EXRT) to midplane, for a total dose of 9,000 rad. The major complication rate was 2.7 %, and the local control rate was 85 % (22/26 patients) for stage I and II, and 91 % (10/11 patients) for stage III and IVA. (author)

  7. Radiation therapy alone in the treatment of cervix cancer stages IIB and IIB. Results from Hospital Mario Gatti, Pontificia Universidade Catolica de Campinas

    International Nuclear Information System (INIS)

    Ferrigno, Robson; Oliveira Faria, Sergio Luis Campos de

    1995-01-01

    From September 1989 to December 1992, 178 patients with cervix cancer were treated with radiation therapy alone, being 81 stage IIIB patients were randomized according to the number of intracavitary brachytherapy insertion realized after external irradiation. Of these, 34 were treated with two intracavitary insertion (group A) and 47 with one insertion (group B). Among stage IIIB patients, 54 were treated with one intracavitary insertion after external irradiation (group C) and 47 with external irradiation alone as they had no geometrical condition for intracavitary insertion (group D). There were no statistical difference in 50 months disease free survival among patients stage IIB treated with one or two intracavitary insertion, 72,3% and 70.6% respectively (P=0,711). The 50 months disease free survival were better in patients stage IIIB treated with external irradiation followed by one intracavitary insertion, compared with those treated with external irradiation alone, 51,8% and 30,2% respectively (P=0,007). This series suggests that there is no difference in the treatment of stage IIB cervix cancer with one or two intracavitary insertion. Among stage IIIB patients, the worse result of those treated with external irradiation alone was probably due to the unfavorable prognostic factors, as they were excluded for brachytherapy because they showed no geometrical condition for intracavitary insertion and larger tumor volume. (author)

  8. Effects of major geometric variations between intracavitary applications on pear-shaped isodose dimension in cancer of the cervix

    International Nuclear Information System (INIS)

    Kim, R. Y.

    1996-01-01

    PURPOSE: The basic principal of intracavitary brachytherapy for cancer of the cervix is based on specific loading rules to achieve a pear-shaped isodose distribution centered around the cervix. Recently, ICRU Report 38 recommends a dose reference volume for reporting. Our previous studies have confirmed that there is considerable variations of geometry between applications. This study is to evaluate the effect of major geometric variations on pear-shaped isodose dimension in manual afterloading low-dose-rate system. MATERIAL AND METHODS: One hundred orthogonal films of 50 patients with cancer of the cervix (2 applications/patient) were reviewed for comparative measurements of geometric variations between applications. Major geometric variations were found for 13 patients in lengths of tandem, 7 patients in colpostats separation and 16 patients in vaginal packing. The direct measurement of these geometric variations were compared with the three-dimensional measurement of the pear-shaped isodose enclosed by the point A between the two applications. RESULTS: The geometric variations in the width of colpostats separation and length of tandem were directly related to the width and height of the pear-shaped isodose dimension. The geometric relationship between the colpostats and distal tandem had an important effect on the thickness of the pear-shape. In optimization of poor geometry for rectum or bladder wall, high dose volume centered around the cervix is reduced without changing the overall pear-shaped volume due to changing configuration of the pear-shaped isodose. In our selected patients with two applications, variations in vaginal packing had no direct effect on the width and thickness of the pear-shape due to other variables. CONCLUSION: Major geometric variations between applications greatly affect the dimension of the pear-shaped isodose distribution. Optimization of poor geometry is quite limited without compromising the high-dose volume centered around the

  9. Applying the Collaborative Study Psychotherapy Rating Scale to Rate Therapist Adherence in Cognitive-Behavior Therapy, Interpersonal Therapy, and Clinical Management.

    Science.gov (United States)

    Hill, Clara E.; And Others

    1992-01-01

    Studied adherence of therapists to behaviors specified in cognitive-behavior therapy, interpersonal therapy, and clinical management manuals. Rated therapist adherence in each of 4 sessions from 180 patients in treatment phase of National Institute of Mental Health Treatment of Depression Collaborative Research Program. Therapists exhibited more…

  10. Intracavitary deposits on Essure® hysteroscopic sterilization devices : A case report

    NARCIS (Netherlands)

    Maassen, L. W.; van Gastel, Maatje D A; Lentjes, E. G.W.M.; Bongers, M. Y.; Veersema, S.

    2017-01-01

    Objective To study the composition of intracavitary deposits on Essure® hysteroscopic sterilization devices. Design Case report. Setting Reproductive Medicine and Gynecology department of a University Hospital. Patient(s) A 39 years old patient presenting with a request for surgical removal of

  11. Volumetric modulated arc therapy for lung stereotactic radiation therapy can achieve high local control rates.

    Science.gov (United States)

    Yamashita, Hideomi; Haga, Akihiro; Takahashi, Wataru; Takenaka, Ryousuke; Imae, Toshikazu; Takenaka, Shigeharu; Nakagawa, Keiichi

    2014-11-11

    The aim of this study was to report the outcome of primary or metastatic lung cancer patients undergoing volumetric modulated arc therapy for stereotactic body radiation therapy (VMAT-SBRT). From October 2010 to December 2013, consecutive 67 lung cancer patients received single-arc VMAT-SBRT using an Elekta-synergy system. All patients were treated with an abdominal compressor. The gross tumor volumes were contoured on 10 respiratory phases computed tomography (CT) datasets from 4-dimensional (4D) CT and merged into internal target volumes (ITVs). The planning target volume (PTV) margin was isotropically taken as 5 mm. Treatment was performed with a D95 prescription of 50 Gy (43 cases) or 55 Gy (12 cases) in 4 fractions for peripheral tumor or 56 Gy in 7 fractions (12 cases) for central tumor. Among the 67 patients, the median age was 73 years (range, 59-95 years). Of the patients, male was 72% and female 28%. The median Karnofsky performance status was 90-100% in 39 cases (58%) and 80-90% in 20 cases (30%). The median follow-up was 267 days (range, 40-1162 days). Tissue diagnosis was performed in 41 patients (61%). There were T1 primary lung tumor in 42 patients (T1a in 28 patients, T1b in 14 patients), T2 in 6 patients, three T3 in 3 patients, and metastatic lung tumor in 16 patients. The median mean lung dose was 6.87 Gy (range, 2.5-15 Gy). Six patients (9%) developed radiation pneumonitis required by steroid administration. Actuarial local control rate were 100% and 100% at 1 year, 92% and 75% at 2 years, and 92% and 75% at 3 years in primary and metastatic lung cancer, respectively (p =0.59). Overall survival rate was 83% and 84% at 1 year, 76% and 53% at 2 years, and 46% and 20% at 3 years in primary and metastatic lung cancer, respectively (p =0.12). Use of VMAT-based delivery of SBRT in primary in metastatic lung tumors demonstrates high local control rates and low risk of normal tissue complications.

  12. Volumetric modulated arc therapy for lung stereotactic radiation therapy can achieve high local control rates

    International Nuclear Information System (INIS)

    Yamashita, Hideomi; Haga, Akihiro; Takahashi, Wataru; Takenaka, Ryousuke; Imae, Toshikazu; Takenaka, Shigeharu; Nakagawa, Keiichi

    2014-01-01

    The aim of this study was to report the outcome of primary or metastatic lung cancer patients undergoing volumetric modulated arc therapy for stereotactic body radiation therapy (VMAT-SBRT). From October 2010 to December 2013, consecutive 67 lung cancer patients received single-arc VMAT-SBRT using an Elekta-synergy system. All patients were treated with an abdominal compressor. The gross tumor volumes were contoured on 10 respiratory phases computed tomography (CT) datasets from 4-dimensional (4D) CT and merged into internal target volumes (ITVs). The planning target volume (PTV) margin was isotropically taken as 5 mm. Treatment was performed with a D95 prescription of 50 Gy (43 cases) or 55 Gy (12 cases) in 4 fractions for peripheral tumor or 56 Gy in 7 fractions (12 cases) for central tumor. Among the 67 patients, the median age was 73 years (range, 59–95 years). Of the patients, male was 72% and female 28%. The median Karnofsky performance status was 90-100% in 39 cases (58%) and 80-90% in 20 cases (30%). The median follow-up was 267 days (range, 40–1162 days). Tissue diagnosis was performed in 41 patients (61%). There were T1 primary lung tumor in 42 patients (T1a in 28 patients, T1b in 14 patients), T2 in 6 patients, three T3 in 3 patients, and metastatic lung tumor in 16 patients. The median mean lung dose was 6.87 Gy (range, 2.5-15 Gy). Six patients (9%) developed radiation pneumonitis required by steroid administration. Actuarial local control rate were 100% and 100% at 1 year, 92% and 75% at 2 years, and 92% and 75% at 3 years in primary and metastatic lung cancer, respectively (p = 0.59). Overall survival rate was 83% and 84% at 1 year, 76% and 53% at 2 years, and 46% and 20% at 3 years in primary and metastatic lung cancer, respectively (p = 0.12). Use of VMAT-based delivery of SBRT in primary in metastatic lung tumors demonstrates high local control rates and low risk of normal tissue complications

  13. Preliminary estimation of minimum target dose in intracavitary radiotherapy for cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ohara, Kiyoshi; Oishi-Tanaka, Yumiko; Sugahara, Shinji; Itai, Yuji [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    2001-08-01

    In intracavitary radiotherapy (ICRT) for cervical cancer, minimum target dose (D{sub min}) will pertain to local disease control more directly than will reference point A dose (D{sub A}). However, ICRT has been performed traditionally without specifying D{sub min} since the target volume was not identified. We have estimated D{sub min} retrospectively by identifying tumors using magnetic resonance (MR) images. Pre- and posttreatment MR images of 31 patients treated with high-dose-rate ICRT were used. ICRT was performed once weekly at 6.0 Gy D{sub A}, and involved 2-5 insertions for each patient, 119 insertions in total. D{sub min} was calculated arbitrarily simply at the point A level using the tumor width (W{sub A}) to compare with D{sub A}. W{sub A} at each insertion was estimated by regression analysis with pre- and posttreatment W{sub A}. D{sub min} for each insertion varied from 3.0 to 46.0 Gy, a 16-fold difference. The ratio of total D{sub min} to total D{sub A} for each patient varied from 0.5 to 6.5. Intrapatient D{sub min} difference between the initial insertion and final insertion varied from 1.1 to 3.4. Preliminary estimation revealed that D{sub min} varies widely under generic dose prescription. Thorough D{sub min} specification will be realized when ICRT-applicator insertion is performed under MR imaging. (author)

  14. Results of irradiation therapy for advanced uterine cervical cancer

    International Nuclear Information System (INIS)

    Saito, Haruo; Asakawa, Hiroshi; Otawa, Hirokazu; Nemoto, Kenji; Saito, Hiroyuki

    1983-01-01

    152 patients with advanced uterine cervical cancer (76 in stage III, 47 in stage IV and 29 in recurrence) were treated at Miyagi Seijinbyo Center in fifteen years (1967-1981). Our standard treatment was a combined therapy of 6 MVX ray whole pelvis irradiation and intracavitary radium irradiation (or simple total hysterectomy) The actuarial 5-year-survival rate was 46.0% in stage III, 9.4% in stage IV and 10.3% in recurrence. In stage III, the actuarial 5-year-survival rate in nine cases with external irradiation alone was (22.2%), in 44 cases with intracavitary irradiation and external irradiation 48.7%; in 14 cases with operation and external irradiation 57.1%. No five year survival was found in nine interrupted-irradation cases. Moderate complications in the rectum and/or the urinary bladder were found in eight of 67 (12%) irradiation-completed patients in stage III. Five 5-year-survival cases (two in stage IV and three in recurrence) were reported. (author)

  15. Reproducibility of saline contrast sonohysterography for the detection of intracavitary abnormalities in women with abnormal uterine bleeding

    NARCIS (Netherlands)

    Beemsterboer, S. N.; Thurkow, A. L.; Verstraeten, R.; Brölmann, H. A. M.

    2008-01-01

    Saline contrast sonohysterography (SCSH) is a diagnostic test for the examination of intracavitary abnormalities. The objective of this study was to calculate interobserver and intraobserver agreement for the interpretation of video recordings of SCSH procedures according to different levels of

  16. Present status of radiation therapy in the conservative management of cancer

    International Nuclear Information System (INIS)

    Papillon, J.

    1990-01-01

    Conservative treatment of rectal cancer may be a valid alternative to radical surgery in cases selected with regard to their very low probability of lymphatic spread. Beside the surgical modalities of local treatment, radiation therapy has gained a substantial place thaks to the use of intracavitary irradiation. In series of 310 cases of T 1 -T 2 tumors followed more than 5 years, the rate of death of cancer is 7.7% and the rate of local failures is 5%. The protocol is based on a short but intensive course of external beam irradiation (30 Gy over 12 days) followed 2 months later by intracavitary irradiation directed to the tumor bed. In a series of 71 patients (mean age 74 years) with selected T 2 or T 3 tumors larger than 4 cm, followed more than 3 years, the rate of death of cancer is 11% and the rate of death of intercurrent disease is 22%. At 5 years the rate of death of cancer is 16%. It is emphasized the necessity of a strict selection of cases by clinical means and endorectal sonography. This strategy must only be conceived as a teamwork of radiation therapists and sureons. (author). 36 refs.; 6 tabs

  17. The American Brachytherapy Society recommendations for low-dose-rate brachytherapy for carcinoma of the cervix

    International Nuclear Information System (INIS)

    Nag, Subir; Chao, Clifford; Erickson, Beth; Fowler, Jeffery; Gupta, Nilendu; Martinez, Alvaro; Thomadsen, Bruce

    2002-01-01

    Purpose: This report presents guidelines for using low-dose-rate (LDR) brachytherapy in the management of patients with cervical cancer. Methods: Members of the American Brachytherapy Society (ABS) with expertise in LDR brachytherapy for cervical cancer performed a literature review, supplemented by their clinical experience, to formulate guidelines for LDR brachytherapy of cervical cancer. Results: The ABS strongly recommends that radiation treatment for cervical carcinoma (with or without chemotherapy) should include brachytherapy as a component. Precise applicator placement is essential for improved local control and reduced morbidity. The outcome of brachytherapy depends, in part, on the skill of the brachytherapist. Doses given by external beam radiotherapy and brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tumor regression during pelvic irradiation, and institutional practice. The ABS recognizes that intracavitary brachytherapy is the standard technique for brachytherapy for cervical carcinoma. Interstitial brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary brachytherapy. The ABS recommends completion of treatment within 8 weeks, when possible. Prolonging total treatment duration can adversely affect local control and survival. Recommendations are made for definitive and postoperative therapy after hysterectomy. Although recognizing that many efficacious LDR dose schedules exist, the ABS presents suggested dose and fractionation schemes for combining external beam radiotherapy with LDR brachytherapy for each stage of disease. The dose prescription point (point A) is defined for intracavitary insertions. Dose rates of 0.50 to 0.65 Gy/h are suggested for intracavitary brachytherapy. Dose rates of 0.50 to 0.70 Gy/h to the periphery of the implant are suggested for interstitial implant. Use of differential source activity or

  18. Electron dose rate and photon contamination in electron arc therapy

    International Nuclear Information System (INIS)

    Pla, M.; Podgorsak, E.B.; Pla, C.

    1989-01-01

    The electron dose rate at the depth of dose maximum dmax and the photon contamination are discussed as a function of several parameters of the rotational electron beam. A pseudoarc technique with an angular increment of 10 degrees and a constant number of monitor units per each stationary electron field was used in our experiments. The electron dose rate is defined as the electron dose at a given point in phantom divided by the number of monitor units given for any one stationary electron beam. For a given depth of isocenter di the electron dose rates at dmax are linearly dependent on the nominal field width w, while for a given w the dose rates are inversely proportional to di. The dose rates for rotational electron beams with different di are related through the inverse square law provided that the two beams have (di,w) combinations which give the same characteristic angle beta. The photon dose at the isocenter depends on the arc angle alpha, field width w, and isocenter depth di. For constant w and di the photon dose at isocenter is proportional to alpha, for constant alpha and w it is proportional to di, and for constant alpha and di it is inversely proportional to w. The w and di dependence implies that for the same alpha the photon dose at the isocenter is inversely proportional to the electron dose rate at dmax

  19. Intracavitary Irradiation as a Safe Alternative for Cystic Craniopharyngiomas: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Alejandro Enriquez-Marulanda

    2016-01-01

    Full Text Available Craniopharyngioma treatment remains a challenge for clinicians and patients. There are many treatment alternatives; however one of them (intracavitary irradiation seeks to control this type of benign brain tumor using minimally invasive techniques, with the specific aim of avoiding causing significant damage to important structures surrounding the sellar/suprasellar region. We present the case of a 3-year-old patient with a predominantly cystic craniopharyngioma who underwent intracavitary irradiation by stereotactic placement. Using this approach, the patient showed a successful response with remission of headaches and hydrocephalus. A reduction in the size of the cyst was achieved, without deterioration of visual fields, with no hormonal supplementation being needed, and with no evidence of focal neurological signs.

  20. Radiological safety problems in intracavitary brachytherapy using the manual afterloading in Venezuela

    International Nuclear Information System (INIS)

    Lea, D.; Gonzales, E.; Gallardo, J.; Diaz, M.

    1996-01-01

    In three venezuelan public hospitals it was detected radioactive contamination for Cs-137 during inspection with the wipe test technique in areas where is applied intracavitary brachytherapy using manual afterloading. This caused a condition of great stress in the personal engaged the treatments. In each Cs-137 source in these hospitals was tested leakage. The source plastic holder was analysed. The authors were able to demonstrate: a) The radioactive contamination found in the treatment area had its origin in the Cs-137 capsule corrosion and b) The corrosion in the source capsule was produced by the radiolytic degradation of the PVC tube used as source-holder in the intracavitary treatments. (authors). 3 refs., 1 tab

  1. Intracavitary deposits on Essure® hysteroscopic sterilization devices : A case report

    OpenAIRE

    Maassen, L. W.; van Gastel, Maatje D A; Lentjes, E. G.W.M.; Bongers, M. Y.; Veersema, S.

    2017-01-01

    Objective: To study the composition of intracavitary deposits on Essure® hysteroscopic sterilization devices. Design: Case report. Setting: Reproductive Medicine and Gynecology department of a University Hospital. Patient(s): A 39 years old patient presenting with a request for surgical removal of Essure® sterilization devices. Diagnostic hysteroscopy showed a crystal like white deposit attached to one of the devices. Intervention: Diagnostic hysteroscopy and surgical removal of E...

  2. Design and construction of a holder to the safety handling of Cs-137 to be used in cervix cancer treatments using intracavitary brachytherapy by afterloading

    International Nuclear Information System (INIS)

    Gonzales, E.; Lea, D.

    1996-01-01

    In venezuelan public hospitals where cervix cancer treatments are performed by means of Cs-137 manual afterloading systems, the handling of the sources is done with two type of holders, metallic and plastic, the plastic holders are pieces of induced serious radio-sanitary problem such as loser of the Cs-137 source and radioactive contamination in the treatment area, this has caused the interruption of the treatments in many hospitals. This interruption had a high social cost because of the thousands women waiting for intracavitary therapy. To start again with the treatments, the metallic holders were required but there were not enough funds in the budget, because of this problem in a short time IVIS'S health physics drew and made a low price source holder. (authors). 2 figs., 2 tabs

  3. Gastric emptying rate in the elderly: implications for drug therapy

    International Nuclear Information System (INIS)

    Evans, M.A.; Triggs, E.J.; Cheung, M.; Broe, G.A.; Creasey, H.

    1981-01-01

    The effect of the aging process on gastric emptying was studied in 11 elderly subjects (mean age, 77) and in 7 young healthy volunteers (mean age, 26). Gastric emptying rates were assessed by a modified sequential scinti-scanning technique after administration of the nonabsorbable chelated radiopharmaceutical 99mTc-DTPA. The rate of emptying, expressed as half-time (T 1/2e) in minutes, was significantly longer (p less than 0.001) in the elderly subjects (mean apparent T 1/2e . 123.23 min) compared to the young healthy volunteers (mean apparent T 1/2e . 49.69 min). Clinical implications of these findings are discussed, particularly with respect to the rate and extent of drug absorption in elderly persons

  4. Phosphorus-32 therapy for cystic craniopharyngiomas

    International Nuclear Information System (INIS)

    Barriger, Robert Bryan; Chang, Andrew; Lo, Simon S.; Timmerman, Robert D.; DesRosiers, Colleen; Boaz, Joel C.; Fakiris, Achilles J.

    2011-01-01

    Background and purpose: To examine control rates for predominantly cystic craniopharyngiomas treated with intracavitary phosphorus-32 (P-32). Material and methods: 22 patients with predominantly cystic craniopharyngiomas were treated at Indiana University between October 1997 and December 2006. Nineteen patients with follow-up of at least 6 months were evaluated. The median patient age was 11 years, median cyst volume was 9 ml, a median dose of 300 Gy was prescribed to the cyst wall, and median follow-up was 62 months. Results: Overall cyst control rate after the initial P-32 treatment was 67%. Complete tumor control after P-32 was 42%. Kaplan-Meier 1-, 3-, and 5-year initial freedom-from-progression rates were 68%, 49%, and 31%, respectively. Following salvage therapy, the Kaplan-Meier 1-, 3-, and 5-year ultimate freedom-from-progression rates were 95%, 95%, and 86%, respectively. All patients were alive at the last follow-up. Visual function was stable or improved in 81% when compared prior to P-32 therapy. Pituitary function remained stable in 74% of patients following P-32 therapy. Conclusions: Intracystic P-32 can be an effective and tolerable treatment for controlling cystic components of craniopharyngiomas as a primary treatment or after prior therapies, but frequently allows for progression of solid tumor components. Disease progression in the form of solid tumor progression, re-accumulation of cystic fluid, or development of new cysts may require further radiotherapy or surgical intervention for optimal long-term disease control.

  5. Transperineal high-dose-rate interstitial radiation therapy in the management of gynecologic malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Itami, Jun; Hara, Ryuseke; Kozuka, Takuyou; Yamashita, Hideomi; Nakajima, Kaori; Shibata, Kouji; Abe, Yoshihisa; Fuse, Masashi; Ito, Masashi [International Medical Center of Japan, Tokyo (Japan). Dept. of Radiation Therapy and Oncology

    2003-11-01

    Background: High-dose-rate interstitial radiation therapy is a newly introduced modality, and its role in the management of gynecologic malignancies remains to be studied. Clinical experience in high-dose-rate interstitial radiation therapy was retrospectively investigated. Patients and Methods: Eight patients with primary and nine with recurrent gynecologic malignancies underwent high-dose-rate interstitial radiation therapy with/without external-beam irradiation. Fractional dose of the high-dose-rate interstitial radiation therapy ranged between 4 and 6 Gy with total doses of 15-54 Gy. Interstitial irradiation was performed twice daily with an interval of > 6 h. Results: 2-year local control rate was 75% for primary treatment and 47% for treatment of recurrence (p = 0.46). Maximum tumor size had a statistically significant impact on local control (p < 0.002). Grade 2 and 4 late complications were seen in five patients, and the incidence was significantly higher in patients with a larger volume enclosed by the prescribed fractional dose of high-dose-rate interstitial radiation therapy. The incidence of grade 2 and 4 complications at 18 months was 78% and 0% with a volume > 100 cm{sup 3} and {<=} 100 cm{sup 3}, respectively (p < 0.04). Conclusion: Although high-dose-rate interstitial radiation therapy is a promising modality, it must be applied cautiously to patients with bulky tumors because of the high incidence of serious complications. (orig.)

  6. Preoperative radiation therapy in endometrial carcinoma: preliminary report of a clinical trial

    International Nuclear Information System (INIS)

    Weigensberg, I.J.

    1976-01-01

    A total of 91 patients with stage 1 endometrial adenocarcinoma who were referred for radiation prior to hysterectomy were randomly allocated to receive either intracavitary or external beam irradiation. Total abdominal hysterectomy was done 4--8 weeks later. The 53 patients who received intracavitary irradiation had an actuarial 5 year disease-free survival rate of 75 percent; the survival rate of the 38 patients in the external beam group was 48 percent. Nine patients in the external beam group had recurrence or metastases compared to two in the intracavitary group. These recurrences were predominantly pelvic. Complications were also more frequent in the external beam group. These results demonstrate that intracavitary radiation is superior to external beam radiation using the regimens described

  7. Classical tandem-source dwelling covering the entire uterus. Essential in modern intracavitary radiotherapy for cervical cancer?

    International Nuclear Information System (INIS)

    Ohara, Kiyoshi; Nemoto, Keiko; Ohnishi, Kayoko; Hashimoto, Takayuki; Fukumitsu, Nobuyoshi; Hata, Masaharu; Sugahara, Shinji; Tokuuye, Koichi; Akine, Yasuyuki

    2007-01-01

    We investigated whether conventional tandem-source dwelling to cover the entire uterus, classically regarded as the target volume, is necessary in modem intracavitary radiotherapy (ICRT) for cervical cancer. The study included 95 cervical squamous cell carcinoma patients treated by high-dose-rate ICRT (point A dose was 6.0 Gy, with three to five insertions per patient) after external beam radiotherapy (EBRT), with central pelvic doses of 12-50 Gy. The tandem-source dwell length was adjusted to the target volume specified by magnetic resonance (MR) imaging. A tandem applicator was inserted as far as the uterine fundus in accordance with the post-EBRT MR-assessed cavity length. The pre-EBRT MR-specified target volume was used for the dwell-length adjustment. The safety of the dwell-length adjustment was assessed in terms of treatment failure. The dwell-length adjustment was made in 248 of 366 total insertions with a dwell-length reduction of 5-55 mm (median 15 mm) at the corpus. Pelvic failure was identified in 22 patients with a 2-year pelvic disease-free survival rate of 75.6% but without evidence of failure at dwelling-skipped corpuses. Given after pelvic EBRT and ICRT of full-length dwelling in part, which may have eradicated possible subclinical extension, adjustment of the tandem-source dwell length to the MR-specified target volume appeared to be safe. (author)

  8. Comparison of one and two low dose rate brachytherapy insertions in the treatment of stage IIB cervix cancer with radiation therapy alone

    International Nuclear Information System (INIS)

    Ferrigno, Robson; Faria, S.L.C.O.

    1996-01-01

    Purpose/Objective: To compare one and two intracavitary brachytherapy with low dose rate in the management of stage IIB cervix cancer through a prospective and randomized trial. Materials and Methods: From September 1989 to December 1992, 81 patients with stage IIB cervix cancer were randomized in two arms according to the number of intracavitary brachytherapy insertion to be realized. Of these, 34 were treated by two intracavitary insertions (group A) and 47 by one insertion (group B). The external beam radiotherapy (EBRT) was realized through a Cobalt unit at whole pelvis with total dose of 40Gy in 20 fractions of 2,0Gy, in box arrangement, followed by parametrial complementation of 10Gy. The brachytherapy was realized right after the end of EBRT. The patients from group A were underwent to two insertions of 25Gy, calculated at point A, defined by the Manchester system. The interval between each insertions was 2 weeks. The patients from group B were underwent to one insertion of 40 Gy at point A. The average dose rate was 60cGy per hour at point A. Results: With the follow up ranging from 36 to 75 months and medium of 55 months, the disease free survival of the patients from group A was not statistically different of those from group B, 70,6% and 72,3% respectively (p=0,711). Local recurrence occurred in four patients from group A (11,7%) and in eight from group B (17%). Distant metastasis occurred in one patient from group A (2,9%) and in two from group B (4,2%). Three patients from group A (8,8%) and three from group B (6,4%) were lost to follow up and considered as dead. The causes of death among patients from group A were progression of local disease in four, distant metastasis in one, complicated diabetes mellitus in one and actinic intestinal complications in other one. The cause of deaths among patients from group B were progression of local disease in eight and distant metastasis in two. The grade I and II rectal complications rate was 5,9% and 6,3% at

  9. Clinical Use of the Utrecht Applicator for Combined Intracavitary/Interstitial Brachytherapy Treatment in Locally Advanced Cervical Cancer

    International Nuclear Information System (INIS)

    Nomden, Christel N.; Leeuw, Astrid A.C. de; Moerland, Marinus A.; Roesink, Judith M.; Tersteeg, Robbert J.H.A.; Jürgenliemk-Schulz, Ina Maria

    2012-01-01

    Purpose: The aims of this study were to investigate the benefit of the Utrecht interstitial CT/MR applicator for combined intracavitary/interstitial (IC/IS) approach, using magnetic resonance imaging—guided brachytherapy, over the intracavitary approach alone in patients with locally advanced cervical cancer and to analyze the clinical use of needles. Methods and Materials: This study includes the first 20 patients treated with the new applicator. Brachytherapy consisted of two pulsed dose rate applications, and the second application was performed with the IC/IS approach. The number of needles, chosen guiding holes through the ovoids, and insertion depths were based on the dose distribution and dosimetric shortcomings of the first application (IC alone). We investigated the dosimetric gain by comparing the clinical interstitial optimized plan (IC/IS clinical ) with an additionally generated optimized plan without needle use (IC study ). Furthermore, we studied the relation of the inserted needles and their source loading patterns with the high-risk clinical target volume (HR-CTV). Results: A total of 54 needles (range, 1–6 per application) were applied with an average depth of 25 mm. The chosen needle positions corresponded with the location of the HR-CTV extensions. The total and individual needle treatment times per application were on average 19% (range, 4–35%) and 7% (range, 2–14%) of the implant treatment time, respectively. The total (external-beam radiotherapy + brachytherapy) D90 HR-CTV for the IC study and the IC/IS clinical were on average 79.5 (SD 7.4) Gy α/β10 and 83.9 (SD 6.7) Gy α/β10 , respectively, with an average gain of 4.4 (SD 2.3) Gy α/β10 for the second application. Conclusions: Needle placement was feasible in all patients and resulted in a gain in dose and better coverage of HR-CTV. Defining the location of HR-CTV protrusions and analyzing the associated needles has given us deeper understanding of the possibilities in magnetic

  10. The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence.

    Science.gov (United States)

    Ebersole, Barbara; Soni, Resha S; Moran, Kathleen; Lango, Miriam; Devarajan, Karthik; Jamal, Nausheen

    2018-05-01

    Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P 40 is a significant cutoff point for predicting therapy nonadherence (P demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  11. Radiation therapy for primary carcinoma of the female urethra: a survey over 25 years

    Energy Technology Data Exchange (ETDEWEB)

    Weghaupt, K.; Gerstner, G.J.; Kucera, H.

    1984-01-01

    Sixty-two patients with primary carcinoma of the female urethra were treated with a combined radiation therapy (high-dose intracavitary vaginal radium and external beam). Treatment was strictly individualized, but an administered tumor dose of 5500-7000 rad (55-70 Gy) was always attempted. Forty-two patients (67.7%) had tumors of the anterior urethra, and in 20 women (32.3%) the posterior urethra was involved. In 19 patients (30.6%) the clinical diagnosis of lymph node involvement was made. The overall 5-year-survival rate was 64.5%. Patients with anterior urethral carcinoma had a higher 5-year-survival rate (71.4%) than patients with posterior carcinoma (50.0%). The favorable results underline the substantial role of radiation therapy for this malignancy.

  12. Radiation therapy for primary carcinoma of the female urethra: a survey over 25 years

    International Nuclear Information System (INIS)

    Weghaupt, K.; Gerstner, G.J.; Kucera, H.

    1984-01-01

    Sixty-two patients with primary carcinoma of the female urethra were treated with a combined radiation therapy (high-dose intracavitary vaginal radium and external beam). Treatment was strictly individualized, but an administered tumor dose of 5500-7000 rad (55-70 Gy) was always attempted. Forty-two patients (67.7%) had tumors of the anterior urethra, and in 20 women (32.3%) the posterior urethra was involved. In 19 patients (30.6%) the clinical diagnosis of lymph node involvement was made. The overall 5-year-survival rate was 64.5%. Patients with anterior urethral carcinoma had a higher 5-year-survival rate (71.4%) than patients with posterior carcinoma (50.0%). The favorable results underline the substantial role of radiation therapy for this malignancy

  13. Clinical Outcomes of Intensity-Modulated Pelvic Radiation Therapy for Carcinoma of the Cervix

    International Nuclear Information System (INIS)

    Hasselle, Michael D.; Rose, Brent S.; Kochanski, Joel D.; Nath, Sameer K.; Bafana, Rounak; Yashar, Catheryn M.; Hasan, Yasmin; Roeske, John C.; Mundt, Arno J.; Mell, Loren K.

    2011-01-01

    Purpose: To evaluate disease outcomes and toxicity in cervical cancer patients treated with pelvic intensity-modulated radiation therapy (IMRT). Methods and Materials: We included all patients with Stage I-IVA cervical carcinoma treated with IMRT at three different institutions from 2000-2007. Patients treated with extended field or conventional techniques were excluded. Intensity-modulated radiation therapy plans were designed to deliver 45 Gy in 1.8-Gy daily fractions to the planning target volume while minimizing dose to the bowel, bladder, and rectum. Toxicity was graded according to the Radiation Therapy Oncology Group system. Overall survival and disease-free survival were estimated by use of the Kaplan-Meier method. Pelvic failure, distant failure, and late toxicity were estimated by use of cumulative incidence functions. Results: The study included 111 patients. Of these, 22 were treated with postoperative IMRT, 8 with IMRT followed by intracavitary brachytherapy and adjuvant hysterectomy, and 81 with IMRT followed by planned intracavitary brachytherapy. Of the patients, 63 had Stage I-IIA disease and 48 had Stage IIB-IVA disease. The median follow-up time was 27 months. The 3-year overall survival rate and the disease-free survival rate were 78% (95% confidence interval [CI], 68-88%) and 69% (95% CI, 59-81%), respectively. The 3-year pelvic failure rate and the distant failure rate were 14% (95% CI, 6-22%) and 17% (95% CI, 8-25%), respectively. Estimates of acute and late Grade 3 toxicity or higher were 2% (95% CI, 0-7%) and 7% (95% CI, 2-13%), respectively. Conclusions: Intensity-modulated radiation therapy is associated with low toxicity and favorable outcomes, supporting its safety and efficacy for cervical cancer. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT vs. conventional techniques.

  14. Radical radiation therapy for adenocarcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Toita, T.; Takizawa, Y.; Nakano, M.; Sueyama, H.; Kushi, A.; Kakihana, Y.; Ogawa, K.; Hara, R.; Higashi, M.; Sakumoto, K.; Moromizato, H.; Kanazawa, K.

    1994-01-01

    20 patients with uterine cervical adenocarcinoma were treated with a combination of external beam and intracavitary irradiation (four patients stage IB, one stage IIA, three stage IIB and twelve patients stage IIIB). Seven patients were treated with high dose-rate (HDR) intracavitary irradiation, eleven with low dose-rate (LDR) intracavitary irradiation and two with HDR and LDR. Six out of the 20 patients experienced pelvic recurrence (all stage IIIB patients). Analysis of the relation between pelvic recurrence and dose rate of intracavitary irradiation revealed that LDR showed a higher pelvic disease control rate than HDR (6/7 vs. 0/4) in stage IIIB patients. Intracavitary irradiation doses of LDR were 1.2 to 1.5 times higher than those of HDR. Three out of the 20 patients developed rectal complication grade 2 (two patients treated with HDR, one with LDR). The five-year cumulative survival rate was 67.2% for all, 100% for stage I and II, and 43.3% for stage IIIB patients. (orig./MG) [de

  15. Radioiodine therapy in toxic multinodular goiter- the influence of carbimazole therapy and dietary iodine on relapse rates

    International Nuclear Information System (INIS)

    Mitra, S.; Muthu, G.S.

    2007-01-01

    Full text: The relapse rate of radioiodine therapy in toxic multinodular goiter (TMNG) is reported to be around 34% at one year. The effect of antithyroid drugs on the response rate is controversial with studies reporting a higher relapse rate in patients pretreated with antithyroid drugs. Other studies report no influence of pretreatment with antithyroid drugs. The thyroid clinic at Tata Main Hospital is a referral center for thyroid disorders in Jamshedpur. 63 patients of TMNG (Group A) were treated with Radioiodine between 1995-2003. The demographic profile of these patients was as follows: M/F- 38%: 62%, 76% of patients were above 40 years, 85% had been on anti-thyroid drugs for more than 18 months. Fixed dose radioiodine in an oral dose varying from 5-10 mCi was given in all patients of Group A. 32.4 % of patients continued to be toxic or relapsed after a period of euthyroid status within 1 year of Radioiodine therapy. A change in protocol for radioiodine therapy was introduced in 2003. This included withdrawal of antithyroid drugs for one month before radioiodine therapy and the use of noniodized salt and abstinence from seafood in diet during this period. 33 TMN Goiter patients (Group B) followed this protocol before receiving Radioiodine. The dose of Radioiodine remained 5-10 mCi. The age and sex profile of Group A and B were comparable. However, Group B patients had been on antithyroid drugs for a shorter period (p< 0.001). The dose of Radioiodine in 94% of Group B patients was between 7-10mCi, whereas this was 63.4% in Group A. The rest of the patients had received a dose between 5-7 mCi. The relapse rate in Group B was 9.1% compared to 32.4% in Group A. Improvement in response rates with increase in Radioiodine dose remains controversial.P PThe better response rate in Group B patients may be attributed to the withdrawal of antithyroid drugs for one month before therapy and the reduction in dietary intake of Iodine for a month before therapy. However, a

  16. Dose Distribution of Rectum and Bladder in Intracavitary Irradiation

    International Nuclear Information System (INIS)

    Chu, S. S.; Oh, W. Y.; Suh, C. O.; Kim, G. E.

    1984-01-01

    The intrauterine irradiation is essential to achieve adequate tumor dose to central tumor mass of uterine malignancy in radiotherapy. The complications of pelvic organ are known to be directly related to radiation dose and physical parameters. The simulation radiogram and medical records of 206 patients, who were treated with intrauterine irradiation from Feb. 1983 to Oct. 1983, were critically analyzed. The physical parameters to include distances between lateral walls of vaginal fornices, longitudinal and lateral cervix to the central axis of ovoid were measured for low dose rate irradiation system and high dose rate remote control after loading system. The radiation doses and dose distributions within cervical area including interesting points and bladder, rectum, according to sources arrangement and location of applicator, were estimated with personal computer. Followings were summary of study results; 1. In distances between lateral walls of vaginal fornices, the low dose rate system showed as 4-7cm width and high dose rate system showed as 5-6cm. 2. In Horizontal angulation of tandem to body axis, the low dose rate system revealed mid position 64.6%, left deviation 19.2% and right deviation 16.2%. 3. In longitudinal angulation of tandem to body axis, the mid position was 11.8% and anterior angulation 88.2% in low dose rate system but in high dose rate system, anterior angulation was 98.5%. 4. Down ward displacement of ovoid below external os was only 3% in low dose rate system and 66.6% in high dose rate system. 5. In radiation source arrangement, the most activities of tandem and ovoid were 35 by 30 in low dose rate system but 50 by 40 in high dose rate system. 6. In low and high dose rate system, the total doses and TDF were 80, 70 Gy and 131, 123 including 40 Gy external irradiation. 7. The doses and TDF in interesting points Co, B, were 98, 47 Gy and 230, 73 in high dose rate system but in low dose rate system 125, 52 Gy and 262, 75 respectively. 8. Doses

  17. Seasonal Admission Rates of Geriatric Patients with Musculoskeletal Problems to Physical Therapy and Rehabilitation Clinics

    OpenAIRE

    Sari, Zubeyir; Yurdalan, Saadet Ufuk; Polat, Mine Gulden; Ozgul, Bahar; Kanberoglu, Ayfer; Onel, Selma

    2013-01-01

    Seasonal variations in the admission rates of geriatric patients with musculoskeletal problems to physical therapy and rehabilitation clinics were examined in this study. Totally 2257 patients (1802, 79.84% female; 455, 20.16% male) over the age of 65 years (mean age 72.32±5.67years) who were admitted to Duygu Private Hospital and Burcu Private Physical Therapy Branch Center in Istanbul were included. Monthly admissions and seasonal distribution were retrospectively calculated for 2 years. Ad...

  18. Long-term follow-up of patients after intracavitary irradiation of cystic craniopharyngiomas with Y-90 colloid

    International Nuclear Information System (INIS)

    Vizda, J.; Urbanova, E.

    2007-01-01

    therapy, 14 patients live, nine without recurrence of cyst volume. Four patients died, one due to pulmonary embolism and three from complications related to a solid or cystic recurrence. Conclusion: Intracavitary irradiation of craniopharyngioma cysts by means 90Y colloid is effective and a non-invasive method with minimum adverse side effects. Positive influence on the health condition was seen in nearly 80% of patients one year after therapy and persisted five years in one half of patients. (author)

  19. Novel Use of the Contura for High Dose Rate Cranial Brachytherapy

    International Nuclear Information System (INIS)

    Scanderbeg, Daniel J.; Alksne, John F.; Lawson, Joshua D.; Murphy, Kevin T.

    2011-01-01

    A popular choice for treatment of recurrent gliomas was cranial brachytherapy using the GliaSite Radiation Therapy System. However, this device was taken off the market in late 2008, thus leaving a treatment void. This case study presents our experience treating a cranial lesion for the first time using a Contura multilumen, high-dose-rate (HDR) brachytherapy balloon applicator. The patient was a 47-year-old male who was diagnosed with a recurrent right frontal anaplastic oligodendroglioma. Previous radiosurgery made him a good candidate for brachytherapy. An intracavitary HDR balloon brachytherapy device (Contura) was placed in the resection cavity and treated with a single fraction of 20 Gy. The implant, treatment, and removal of the device were all completed without incident. Dosimetry of the device was excellent because the dose conformed very well to the target. V90, V100, V150, and V200 were 98.9%, 95.7%, 27.2, and 8.8 cc, respectively. This patient was treated successfully using the Contura multilumen balloon. Contura was originally designed for deployment in a postlumpectomy breast for treatment by accelerated partial breast irradiation. Being an intracavitary balloon device, its similarity to the GliaSite system makes it a viable replacement candidate. Multiple lumens in the device also make it possible to shape the dose delivered to the target, something not possible before with the GliaSite applicator.

  20. Novel use of the Contura for high dose rate cranial brachytherapy.

    Science.gov (United States)

    Scanderbeg, Daniel J; Alksne, John F; Lawson, Joshua D; Murphy, Kevin T

    2011-01-01

    A popular choice for treatment of recurrent gliomas was cranial brachytherapy using the GliaSite Radiation Therapy System. However, this device was taken off the market in late 2008, thus leaving a treatment void. This case study presents our experience treating a cranial lesion for the first time using a Contura multilumen, high-dose-rate (HDR) brachytherapy balloon applicator. The patient was a 47-year-old male who was diagnosed with a recurrent right frontal anaplastic oligodendroglioma. Previous radiosurgery made him a good candidate for brachytherapy. An intracavitary HDR balloon brachytherapy device (Contura) was placed in the resection cavity and treated with a single fraction of 20 Gy. The implant, treatment, and removal of the device were all completed without incident. Dosimetry of the device was excellent because the dose conformed very well to the target. V90, V100, V150, and V200 were 98.9%, 95.7%, 27.2, and 8.8 cc, respectively. This patient was treated successfully using the Contura multilumen balloon. Contura was originally designed for deployment in a postlumpectomy breast for treatment by accelerated partial breast irradiation. Being an intracavitary balloon device, its similarity to the GliaSite system makes it a viable replacement candidate. Multiple lumens in the device also make it possible to shape the dose delivered to the target, something not possible before with the GliaSite applicator. Copyright © 2011 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  1. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children

    International Nuclear Information System (INIS)

    Maarouf, Mohammad; El Majdoub, Faycal; Fuetsch, Manuel; Hoevels, Mauritius; Lehrke, Ralph; Berthold, Frank; Voges, Juergen; Sturm, Volker

    2016-01-01

    Although microsurgery remains the first-line treatment, gross total resection of cystic craniopharyngeomas (CP) is associated with significant morbidity and mortality and the addition of external irradiation to subtotal resection proves to achieve similar tumor control. However, concern regarding long-term morbidity associated with external irradiation in children still remains. With this retrospective analysis, the authors emphasize intracavitary brachytherapy using phosphorus-32 (P-32) as a treatment option for children with cystic CP. Between 1992 and 2009, 17 children (median age 15.4 years; range 7-18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid-cystic lesions (median tumor volume 11.1 ml; range 0.5-78.9 ml). The median follow-up time was 61.9 months (range 16.9-196.6 months). Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3-10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively. Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations. (orig.) [de

  2. Visual outcome in cystic craniopharyngiomas treated with intracavitary phosphorus-32

    International Nuclear Information System (INIS)

    Anderson, D.R.; Trobe, J.D.; Taren, J.A.; Gebarski, S.S.

    1989-01-01

    Seven patients with cystic craniopharyngiomas were treated with stereotactic instillation of radioactive phosphorus-32 (32P). Five patients had been previously treated with various combinations of surgery and external beam irradiation, whereas two had the 32 P instillation as a primary therapy. Visual acuity improved in 13 eyes and remained stable in 1. Visual fields normalized in three patients, improved in two, and remained stable in two. Two patients received single treatments with 32 P, whereas five required multiple instillations for recurrent cyst expansion

  3. Current Status and Perspectives of Hyperthermia in Cancer Therapy

    Science.gov (United States)

    Hiraoka, Masahiro; Nagata, Yasushi; Mitsumori, Michihide; Sakamoto, Masashi; Masunaga, Shin-ichiro

    2004-08-01

    Clinical trials of hyperthermia in combination with radiation therapy or chemotherapy undertaken over the past decades in Japan have been reviewed. Originally developed heating devices were mostly used for these trials, which include RF (radiofrequency) capacitive heating devices, a microwave heating device with a lens applicator, an RF intracavitary heating device, an RF current interstitial heating device, and ferromagnetic implant heating device. Non-randomized trials for various cancers, demonstrated higher response rate in thermoradiotherapy than in radiotherapy alone. Randomized trials undertaken for esophageal cancers also demonstrated improved local response with the combined use of hyperthermia. Furthermore, the complications associated with treatment were not generally serious. These clinical results indicate the benefit of combined treatment of hyperthermia and radiotherapy for various malignancies. On the other hand, the presently available heating devices are not satisfactory from the clinical viewpoints. With the advancement of heating and thermometry technologies, hyperthermia will be more widely and safely used in the treatment of cancers.

  4. High-resolution MR imaging of urethra for incontinence by means of intracavitary surface coils

    International Nuclear Information System (INIS)

    Yang, A.; Mostwin, J.L.; Genadry, R.; Yang, S.S.

    1991-01-01

    Urinary incontinence is a major medical problem affecting millions of older women. This paper demonstrates the use of dynamic MR imaging in noninvasive quantification of prolapse in all three pelvic compartments. In this exhibit we use high-resolution MR imaging with intracavity (intravaginal, intrarectal) and surface/intracavitary coils to diagnose intrinsic urethral pathology that prevents opening (dysuria) or coaptation (incontinence). Normal anatomy, congenital anatomy (pelvic floor defects, hypoplasia), acquired anatomy (periurethral cyst/divertivulum, tumor, hypertrophy), and operative failure as causes of incontinence (postoperative scarring, misplacement/dehiscence of sutures and flaps) are shown. We demonstrate a novel method for MR cine voiding cystourethrography. Technical factors and applications are discussed

  5. Short-distance tumour irradiation system for interstitial and intracavitary use, with preselectable isodose programme

    International Nuclear Information System (INIS)

    Sauerwein, K.

    1976-01-01

    The report describes a new development of the short distance irradiation system for interstitial and intracavitary use, GammaMedsup((R)). First, the main data of GammaMed I are summarized. Next, the development in cooperation with M. Busch of the Essen University Radiation Clinic of GammaMed II is outlined. The new unit includes an Ir-192 point source emitter which scans the applicator probe in accordance with a computer program which can be preselected at random. In this way, all isodose distributions can be achieved which are needed in practice. (orig./HP) [de

  6. A phase I/II clinical trial for the hybrid of intracavitary and interstitial brachytherapy for locally advanced cervical cancer.

    Science.gov (United States)

    Murakami, Naoya; Kato, Shingo; Nakano, Takashi; Uno, Takashi; Yamanaka, Takeharu; Sakurai, Hideyuki; Yoshimura, Ryoichi; Hiratsuka, Junichi; Kuroda, Yuki; Yoshio, Kotaro; Itami, Jun

    2016-08-17

    This paper describes about a study protocol of phase I/II multicenter prospective clinical trial evaluating the feasibility and efficacy of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced uterine cervical cancer patients. Patients with histologically confirmed FIGO stage IB2, IIA2, IIB, and IIIB uterine cervical carcinoma width of which is larger than 5 cm assessed by MRI will be entered to this clinical trial. Protocol therapy is 30-30.6 Gy in 15-17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP (40 mg/m(2)), followed by 24 Gy in 4 fractions of HBT and central shield EBRT up to 50-50.4 Gy in 25-28 fractions. Tumor width is assessed again within one week before the first HBT and if the tumor width is larger than 4 cm, patients proceed to the secondary registration. In phase I section, feasibility of this will be investigated. If less than 10 % out of 20 patients experienced greater than grade 3 acute non-hematologic adverse effects, the study proceeds to phase II part. In phase II part a total of 55 patients will be accrued and the efficacy of the HBT will be investigated comparing with historical control data. If the lower margin of 90 % confidence interval of the 2-year pelvic progression-free survival of the HBT trial is higher than 64 %, the HBT is considered to be more effective than conventional ICBT. The aim of this study is to demonstrate the feasibility and efficacy of the HBT for locally advanced cervical cancer. This trial will clarify the indication, feasibility, and efficacy of this new technique. UMIN000019081 ; Registration date: 2015/9/30.

  7. A three-dimensional computed tomography-assisted Monte Carlo evaluation of ovoid shielding on the dose to the bladder and rectum in intracavitary radiotherapy for cervical cancer

    International Nuclear Information System (INIS)

    Gifford, Kent A.; Horton, John L.; Pelloski, Christopher E.; Jhingran, Anuja; Court, Laurence E.; Mourtada, Firas; Eifel, Patricia J.

    2005-01-01

    Purpose: To determine the effects of Fletcher Suit Delclos ovoid shielding on dose to the bladder and rectum during intracavitary radiotherapy for cervical cancer. Methods and Materials: The Monte Carlo method was used to calculate the dose in 12 patients receiving low-dose-rate intracavitary radiotherapy with both shielded and unshielded ovoids. Cumulative dose-difference surface histograms were computed for the bladder and rectum. Doses to the 2-cm 3 and 5-cm 3 volumes of highest dose were computed for the bladder and rectum with and without shielding. Results: Shielding affected dose to the 2-cm 3 and 5-cm 3 volumes of highest dose for the rectum (10.1% and 11.1% differences, respectively). Shielding did not have a major impact on the dose to the 2-cm 3 and 5-cm 3 volumes of highest dose for the bladder. The average dose reduction to 5% of the surface area of the bladder was 53 cGy. Reductions as large as 150 cGy were observed to 5% of the surface area of the bladder. The average dose reduction to 5% of the surface area of the rectum was 195 cGy. Reductions as large as 405 cGy were observed to 5% of the surface area of the rectum. Conclusions: Our data suggest that the ovoid shields can greatly reduce the radiation dose delivered to the rectum. We did not find the same degree of effect on the dose to the bladder. To calculate the dose accurately, however, the ovoid shields must be included in the dose model

  8. Different Approaches in Radiation Therapy

    Directory of Open Access Journals (Sweden)

    Rolf-Dieter eKortmann

    2011-12-01

    Full Text Available Radiation therapy is a cornerstone in the therapeutic management of craniopharyngioma. The close proximity to neighbouring eloquent structures pose a particular challenge to radiation therapy. Modern treatment technologies including fractionated 3-d conformal radiotherapy, intensity modulated radiation therapy and recently proton therapy are able to precisely cover the target while preserving surrounding tissue,Tumour controls between 80 and in access of 90 % can be achieved. Alternative treatments consisting of radiosurgery, intracavitary application of isotopes and brachytherapy also offer an acceptable tumour control and might be given in selected cases. More research is needed to establish the role of each treatment modality.

  9. Short- and long-term effectiveness of intracavitary urokinase in loculated thoracic empyema

    International Nuclear Information System (INIS)

    Jeong, Tae Gon; Han, Young Min; Chang, Suk Kyeong; Chung, Gyung Ho; Sohn, Myung Hee; Kim, Chong Soo; Choi, Ki Chul

    1995-01-01

    The purpose of this study was to evaluate the short-and long-term effectiveness of intracavitary urokinase with percutaneous catheter drainage in loculated thoracic empyemas. 15 patients were identified as second stage of loculated thoracic empyema by estimating nature of pleural fluid, chest PA, lateral decubitus view and CT scan. Under the guidance of fluoroscopy or ultrasound, catheter was inserted percutaneously. Instillation of urokinase was started when amount of drained fluid became less than 30 ml per day with 100,000U of urokinase mixed with 100 ml of normal saline. Trial of urokinase was repeated until complete drainage of empyema was demonstrated on plain chest film obtained after 48 hours. Successful complete drainage was achieved in 14 of 15 patients. In long-term study, complete resorption was demonstrated in 11 of 12 patients. Average dosage of used urokinase was 330,000U and mean duration of catheter insertion was 35 days. Intracavitary urokinase with percutaneous catheter drainage is a safe and effective method to facilitate drainage of loculated empyema and to prevent recurrence

  10. Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life

    International Nuclear Information System (INIS)

    Vordermark, D.; Flentje, M.; Koelbl, O.; Sailer, M.

    2001-01-01

    Background: First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported. Patients and Methods: 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean ±SD follow-up for living patients of 4.4±2.1 years. Quality of life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors. Results: Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumorrelated. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers. Conclusion: the described regimen is highly effective but associated with increased toxicity. (orig.) [de

  11. Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

    Energy Technology Data Exchange (ETDEWEB)

    Tinga, D.J.; Bouma, J.; Aalders, J.G. (Dept. of Obstetrics and Gynaecology, State Univ. Hospital, Groningen (Netherlands)); Hollema, H. (Dept. of Pathology, State Univ. Hospital, Groningen (Netherlands))

    1990-01-01

    Forty-nine patients aged {le} 45 years, with cervical carcinoma stage IB ({le} 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors).

  12. Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

    International Nuclear Information System (INIS)

    Tinga, D.J.; Bouma, J.; Aalders, J.G.; Hollema, H.

    1990-01-01

    Forty-nine patients aged ≤ 45 years, with cervical carcinoma stage IB (≤ 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors)

  13. Regional changes over time in initial virologic response rates to combination antiretroviral therapy across Europe

    DEFF Research Database (Denmark)

    Bannister, Wendy P; Kirk, Ole; Gatell, Jose M

    2006-01-01

    BACKGROUND: Changes in virologic response to initial combination antiretroviral therapy (cART) over calendar time may indicate improvements in cART or emergence of primary resistance. Regional variations may identify differences in available antiretroviral drugs or patient management. METHODS: Vi...... rates Udgivelsesdato: 2006/6...

  14. Longitudinal Changes in Tear Evaporation Rates After Eyelid Warming Therapies in Meibomian Gland Dysfunction.

    Science.gov (United States)

    Yeo, Sharon; Tan, Jen Hong; Acharya, U Rajendra; Sudarshan, Vidya K; Tong, Louis

    2016-04-01

    Lid warming is the major treatment for meibomian gland dysfunction (MGD). The purpose of the study was to determine the longitudinal changes of tear evaporation after lid warming in patients with MGD. Ninety patients with MGD were enrolled from a dry eye clinic at Singapore National Eye Center in an interventional trial. Participants were treated with hot towel (n = 22), EyeGiene (n = 22), or Blephasteam (n = 22) twice daily or a single 12-minute session of Lipiflow (n = 24). Ocular surface infrared thermography was performed at baseline and 4 and 12 weeks after the treatment, and image features were extracted from the captured images. The baseline of conjunctival tear evaporation (TE) rate (n = 90) was 66.1 ± 21.1 W/min. The rates were not significantly different between sexes, ages, symptom severities, tear breakup times, Schirmer test, corneal fluorescein staining, or treatment groups. Using a general linear model (repeat measures), the conjunctival TE rate was reduced with time after treatment. A higher baseline evaporation rate (≥ 66 W/min) was associated with greater reduction of evaporation rate after treatment. Seven of 10 thermography features at baseline were predictive of reduction in irritative symptoms after treatment. Conjunctival TE rates can be effectively reduced by lid warming treatment in some MGD patients. Individual baseline thermography image features can be predictive of the response to lid warming therapy. For patients that do not have excessive TE, additional therapy, for example, anti-inflammatory therapy, may be required.

  15. 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.)

  16. Impact of systematic errors on DVH parameters of different OAR and target volumes in Intracavitary Brachytherapy (ICBT)

    International Nuclear Information System (INIS)

    Mourya, Ankur; Singh, Gaganpreet; Kumar, Vivek; Oinam, Arun S.

    2016-01-01

    Aim of this study is to analyze the impact of systematic errors on DVH parameters of different OAR and Target volumes in intracavitary brachytherapy (ICBT). To quantify the changes in dose-volume histogram parameters due to systematic errors in applicator reconstruction of brachytherapy planning, known errors in catheter reconstructions have to be introduced in applicator coordinate system

  17. Advanced gastric adenocarcinoma. Influence of preoperative radiation therapy on toxicity and long-term survival rates

    International Nuclear Information System (INIS)

    Malzoni, Carlos Eduardo

    1996-01-01

    The surgical treatment of gastric cancer has better long-term survival rates when performed in patients with early gastric cancer. Worse results are obtained in treatment of advanced gastric cancer. Most patients in west centers are treated in advanced stages. A great number of them go through a surgical treatment unable by itself to cure them. the frequent local recurrence caused by failure of the surgical treatment has been keeping poor survival rates in patients with advanced gastric cancer for decades. The desire of improving survival is the reason of the use of adjuvant therapies. This paper achieved the retrospective study of the influence of preoperative radiation therapy (2000 cGy) in long-term survival rates (120 months) of patients with advanced gastric cancer on stages IIIa, IIIb and IV. The possible injuries caused in the liver and kidney were observed also as well as first group was treated by surgical and radiation therapies and the second received surgical treatment only. There was no statistical difference between the two groups when sex, age, race, occurrence of other diseases, nutritional assessment, TNM stage, occurrence of obstruction or bleeding caused by tumor, surgical procedure and hepatic and renal function were considered. Survival rates and changes on hepatic and renal function were statistically compared. The results showed a statistic improvement on the long-term survival rates of stage IIIa patients treated by preoperative radiation therapy. No statistic difference was observed on hepatic or renal function between the groups. No adverse influence of radiation therapy method was detected by the used parameters. There was no statistical difference between the two groups when immediate surgical complications were considered. (author)

  18. Occurrence of chronic esophageal ulcer after high dose rate intraluminal radiation therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Soejima, Toshinori; Hirota, Saeko; Okamoto, Yoshiaki; Obayashi, Kayoko; Takada, Yoshiki

    1995-01-01

    Ninety-eight patients with esophageal cancer were treated by high dose rate intraluminal radiation therapy at the Department of Radiology of the Hyogo Medical Center for Adults between January 1982 and December 1993. Twenty patients with complete response after intraluminal radiation therapy, who were followed up with esophageal fiberscopy in our institute, were reviewed. The one-year cumulative rate of occurrence of esophageal ulcers was 81%, and in 69% of the cases the ulcers occurred from 4 to 8 months after completion of intraluminal radiation therapy. We graded esophageal ulcer by fiberscopic findings. Grade 0 was defined as no ulcer, grade 1 as superficial ulcer, grade 2 as deep ulcer, grade 3 as circumferencial ulcer, and severe stenosis. Factors related to grade were studied, and shorter distances from the source to the surface of the mucosa and lower surface doses of intraluminal radiation therapy appear to reduce the severity as graded on the above scale, of the esophageal ulcer. Four of the five 2-year recurrence-free patients suffered esophageal ulcers, which were cured from 15 to 22 months after intraluminal radiation therapy. However ulcers recurred in two patients, ong term care was thought to be necessary. (author)

  19. Impact of pulmonary arterial hypertension and its therapy on indices of heart rate variability.

    Science.gov (United States)

    Can, Mehmet Mustafa; Kaymaz, Cihangir; Pochi, Nartilla; Aktimur, Tugba

    2013-08-01

    To compare heart rate variability (HRV) indices between pulmonary arterial hypertension (PAH) patients and controls, and to investigate whether therapy improves heart rhythm. Thirty-eight patients and 20 controls underwent Holter monitoring. HRV was analyzed before and after PAH therapy. Various time, and frequency domain indices of HRV analysis including standard deviation of all normal-to-normal intervals, standard deviation of mean values for all normal-to-normal intervals over 5 min, and square root of the mean square differences of successive RR intervals were recorded and analyzed before and after 1 year of PAH therapy. Significant differences with regard to diminished physical capacity, impared cardiac output, increased BNP in PAH cohort; HRV indices were diminished compared to controls and no differences between before and after PAH therapy with respect to analysis of HRV. Patients exhibited depressed HRV and therapy failed to improve HRV indices suggesting urgent unmet need for better therapeutic options. Patients with PAH exhibit severely depressed HRV. Surprisingly, PAH specific therapy for 1 year with phosphodiesterase- 5 inhibitor, prostacyclin analogue, endhotelin receptor antagonist, or their combination failed to improve HRV indices suggesting urgent unmet need for better therapeutic options.

  20. Radiation therapy in recurrence of carcinoma of the uterine cervix after primary surgery

    International Nuclear Information System (INIS)

    Kim, Jin Hee; Kim, Ok Bae

    2003-01-01

    The purpose of this study was to evaluate treatment results in terms of the survival and failure patterns subsequent to radiation therapy in recurrent cervical cancer, following primary surgery. Between January 1990 and December 1999, 27 patients, with recurrent cervical cancer following primary surgery, were subsequently treated with radiation in the Department of Radiation Oncology, at the Keimyung University Dongsan Medical Center. Their median age was 48, ranging from 31 to 70 years old. With regard to the initial FIGO stage on presentation, 20 and 7 patients were stages I and II, respectively. Twenty three patients had squamous ceH carcinomas and 4 had adenocarcinomas. The time interval from the primary surgery to the recurrence ranged from 2 to 90 months with a median of 29 months. The recurrent sites were the vaginal cuff alone, the pelvic cavity and combined recurrence in 14, 9 and 4 patients, respectively. Radiation was performed, with external and vaginal intracavitary radiation in 13 patients, external radiation alone in 13 and vaginal intracavitary radiation alone in another one. The median follow-up period was 55 months, ranging from 6 to 128 months. The five year disease free survival (5y DFS) and five year overall survival (5y OS) rates were 68.2 and 71.9%, respectively. There was a marginal statistically significant difference in the 5y DFS in relation to the recurrent site (5y DFS, 85.7% in vaginal cuff recurrence alone, 53.3% in pelvic cavity recurrence, p=0.09). There was no difference in the survival according to the time interval between the primary surgery and a recurrence. There was only a 7% local failure rate in the patients with a vaginal cuff recurrence. The major failure patterns were local failure in the patients with pelvic cavity recurrence, and distant failure in the patients with a combined recurrence. There were no complications above grade 3 after the radiation therapy. Radiation therapy was safe and effective treatment for a

  1. Continuation rate of hormone replacement therapy in Hong Kong public health sector.

    Science.gov (United States)

    Leung, K Y; Ling, M; Tang, G W K

    2004-12-10

    To assess the 1-year continuation rate of HRT prescribed in Hong Kong public health sector and to identify factors affecting this continuation rate. All women who received at least one dispensed prescription of estrogens between January 1998 and December 2000 from 36 specialist outpatient clinics of the Hospital Authority were selected, and observed for at least 2 years and at most 3 years. The duration of use and variables including age, types of hormones, routes of delivery, dose of estrogen, and prescribing specialty were retrieved from the central prescription database of the Hospital Authority. Of 12,711 incident users of HRT, more than half were aged 50-59. Most (78.5%) of the users took conjugated equine estrogens (CEE) 0.625 mg or related products. Only a small proportion (3.0%) of women used CEE 0.3 mg. Initial estrogen prescriptions were written by gynaecologists in 86.7%. The overall 1-year continuation rate was 68.3%. The highest and lowest continuation rates were observed in women aged 40-49 and the two extreme age groups (35-39 and 70-79), respectively. Better continuation rate was observed in women taking estrogen-only therapy such as CEE or estradiol (overall 76.3%) than in women using continuous combined therapy (58.6%), sequential combined therapy (64.8%), or transdermal estrogen (60.6%). In the age group 60-69, the use of CEE 0.3 mg was associated with better continuation rate than CEE 0.625 mg. Better continuation rate at 1 year was associated with age younger than 60, oral route of HRT and hysterectomy.

  2. Image-based dose planning of intracavitary brachytherapy: registration of serial-imaging studies using deformable anatomic templates

    International Nuclear Information System (INIS)

    Christensen, Gary E.; Carlson, Blake; Chao, K.S. Clifford; Yin Pen; Grigsby, Perry W.; Nguyen, Kim; Dempsey, James F; Lerma, Fritz A.; Bae, Kyongtae T.; Vannier, Michael W.; Williamson, Jeffrey F.

    2001-01-01

    Purpose: To demonstrate that high-dimensional voxel-to-voxel transformations, derived from continuum mechanics models of the underlying pelvic tissues, can be used to register computed tomography (CT) serial examinations into a single anatomic frame of reference for cumulative dose calculations. Methods and Materials: Three patients with locally advanced cervix cancer were treated with CT-compatible intracavitary (ICT) applicators. Each patient underwent five volumetric CT examinations: before initiating treatment, and immediately before and after the first and second ICT insertions, respectively. Each serial examination was rigidly registered to the patient's first ICT examination by aligning the bony anatomy. Detailed nonrigid alignment for organs (or targets) of interest was subsequently achieved by deforming the CT exams as a viscous-fluid, described by the Navier-Stokes equation, until the coincidence with the corresponding targets on CT image was maximized. In cases where ICT insertion induced very large and topologically complex rearrangements of pelvic organs, e.g., extreme uterine canal reorientation following tandem insertion, a viscous-fluid-landmark transformation was used to produce an initial registration. Results: For all three patients, reasonable registrations for organs (or targets) of interest were achieved. Fluid-landmark initialization was required in 4 of the 11 registrations. Relative to the best rigid bony landmark alignment, the viscous-fluid registration resulted in average soft-tissue displacements from 2.8 to 28.1 mm, and improved organ coincidence from the range of 5.2% to 72.2% to the range of 90.6% to 100%. Compared to the viscous-fluid transformation, global registration of bony anatomy mismatched 5% or more of the contoured organ volumes by 15-25 mm. Conclusion: Pelvic soft-tissue structures undergo large deformations and displacements during the external-beam and multiple-ICT course of radiation therapy for locally advanced cervix

  3. Music therapy can lower the heart rates of severely sick children.

    Science.gov (United States)

    Uggla, L; Bonde, L O; Svahn, B M; Remberger, M; Wrangsjö, B; Gustafsson, B

    2016-10-01

    Paediatric recipients of haematopoietic stem cell transplants (HSCT) are at increased risk of developing post-traumatic stress disorder (PTSD), and there is a need to identify interventions that can alleviate stress in this group. The aim of this study was to examine the previously unexplored effect of music therapy on children undergoing HSCT, by analysing physiological parameters and comparing them with a control group. We performed a randomised clinical pilot study of 24 patients up to the age of 16 undergoing HSCT at Karolinska University Hospital, Huddinge, Sweden. Music therapy, including expressive and receptive elements, was performed twice a week in the treatment group and compared to standard care in the control group. Physiological parameters were evaluated according to the hospital's protocols. The music therapy group had significantly reduced evening heart rates compared to the control group (p Music therapy significantly lowered the heart rate of children undergoing HSCT for at least four to eight hours, indicating reduced stress levels and potentially lowering the risk of developing PTSD. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  4. Alteration of left ventricular endocardial function by intracavitary high-power ultrasound interacts with volume, inotropic state, and alpha 1-adrenergic stimulation

    NARCIS (Netherlands)

    de Hert, S. G.; Gillebert, T. C.; Brutsaert, D. L.

    1993-01-01

    BACKGROUND: High-power intracavitary ultrasound abbreviates left ventricular (LV) ejection duration, thereby decreasing mechanical LV performance, presumably by selective impairment of endocardial endothelial function. METHODS AND RESULTS: Effects of ultrasound were evaluated in the ejecting LV of

  5. Intracavitary deposits on Essure® hysteroscopic sterilization devices: A case report.

    Science.gov (United States)

    Maassen, L W; van Gastel, D M; Lentjes, E G W M; Bongers, M Y; Veersema, S

    2017-07-01

    To study the composition of intracavitary deposits on Essure® hysteroscopic sterilization devices. Case report. Reproductive Medicine and Gynecology department of a University Hospital. A 39 years old patient presenting with a request for surgical removal of Essure® sterilization devices. Diagnostic hysteroscopy showed a crystal like white deposit attached to one of the devices. Diagnostic hysteroscopy and surgical removal of Essure® devices was performed. The deposits were collected and infrared spectroscopy analysis was performed. Chemical composition of the deposits attached to the device. Infrared spectroscopy of the material showed patterns conclusive with calcite (calcium carbonate, CaCO 3 ). Until now, it is not clear if there is a relationship between reported complaints and formation of calcite deposits on Essure®. Infrared spectroscopy of deposits on Essure® devices showed a pattern conclusive with calcite. The relationship between reported complaints and the formation of calcite deposits on Essure® remains unclear.

  6. 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)

  7. The effects of sustained manual pressure stimulation according to Vojta Therapy on heart rate variability.

    Science.gov (United States)

    Opavsky, Jaroslav; Slachtova, Martina; Kutin, Miroslav; Hok, Pavel; Uhlir, Petr; Opavska, Hana; Hlustik, Petr

    2018-05-23

    The physiotherapeutic technique of Vojta reflex locomotion is often accompanied by various autonomic activity changes and unpleasant sensations. It is unknown whether these effects are specific to Vojta Therapy. Therefore, the aim of this study was to compare changes in cardiac autonomic control after Vojta reflex locomotion stimulation and after an appropriate sham stimulation. A total of 28 young healthy adults (20.4 - 25.7 years) were enrolled in this single-blind randomized cross-over study. Participants underwent two modes of 20-minute sustained manual pressure stimulation on the surface of the foot on two separate visits. One mode used manual pressure on the lateral heel, i.e., in a zone employed in the Vojta Therapy (active stimulation). The other mode used pressure on the lateral ankle (control), in an area not included among the active zones used by Vojta Therapy and whose activation does not evoke manifestations of reflex locomotion. Autonomic nervous system activity was evaluated using spectral analysis of heart rate variability before and after the intervention. The active stimulation was perceived as more unpleasant than the control stimulation. Heart rate variability parameters demonstrated almost identical autonomic responses after both stimulation types, showing either modest increase in parasympathetic activity, or increased heart rate variability with similar contribution of parasympathetic and sympathetic activity. The results demonstrate changes of cardiac autonomic control in both active and control stimulation, without evidence for a significant difference between the two.

  8. Accurate localization of intracavitary brachytherapy applicators from 3D CT imaging studies

    International Nuclear Information System (INIS)

    Lerma, F.A.; Williamson, J.F.

    2002-01-01

    Purpose: To present an accurate method to identify the positions and orientations of intracavitary (ICT) brachytherapy applicators imaged in 3D CT scans, in support of Monte Carlo photon-transport simulations, enabling accurate dose modeling in the presence of applicator shielding and interapplicator attenuation. Materials and methods: The method consists of finding the transformation that maximizes the coincidence between the known 3D shapes of each applicator component (colpostats and tandem) with the volume defined by contours of the corresponding surface on each CT slice. We use this technique to localize Fletcher-Suit CT-compatible applicators for three cervix cancer patients using post-implant CT examinations (3 mm slice thickness and separation). Dose distributions in 1-to-1 registration with the underlying CT anatomy are derived from 3D Monte Carlo photon-transport simulations incorporating each applicator's internal geometry (source encapsulation, high-density shields, and applicator body) oriented in relation to the dose matrix according to the measured localization transformations. The precision and accuracy of our localization method are assessed using CT scans, in which the positions and orientations of dense rods and spheres (in a precision-machined phantom) were measured at various orientations relative to the gantry. Results: Using this method, we register 3D Monte Carlo dose calculations directly onto post insertion patient CT studies. Using CT studies of a precisely machined phantom, the absolute accuracy of the method was found to be ±0.2 mm in plane, and ±0.3 mm in the axial direction while its precision was ±0.2 mm in plane, and ±0.2 mm axially. Conclusion: We have developed a novel, and accurate technique to localize intracavitary brachytherapy applicators in 3D CT imaging studies, which supports 3D dose planning involving detailed 3D Monte Carlo dose calculations, modeling source positions, shielding and interapplicator shielding

  9. Importance of heart rate during exercise for response to cardiac resynchronization therapy.

    Science.gov (United States)

    Maass, Alexander H; Buck, Sandra; Nieuwland, Wybe; Brügemann, Johan; van Veldhuisen, Dirk J; Van Gelder, Isabelle C

    2009-07-01

    Cardiac resynchronization therapy (CRT) is an established therapy for patients with severe heart failure and mechanical dyssynchrony. Response is only achieved in 60-70% of patients. To study exercise-related factors predicting response to CRT. We retrospectively examined consecutive patients in whom a CRT device was implanted. All underwent cardiopulmonary exercise testing prior to implantation and after 6 months. The occurrence of chronotropic incompetence and heart rates exceeding the upper rate of the device, thereby compromising biventricular stimulation, was studied. Response was defined as a decrease in LVESV of 10% or more after 6 months. We included 144 patients. After 6 months 86 (60%) patients were responders. Peak VO2 significantly increased in responders. Chronotropic incompetence was more frequently seen in nonresponders (21 [36%] vs 9 [10%], P = 0.03), mostly in patients in SR. At moderate exercise, defined as 25% of the maximal exercise tolerance, that is, comparable to daily life exercise, nonresponders more frequently went above the upper rate of the device (13 [22%] vs 2 [3%], P exercise (OR 15.8 [3.3-76.5], P = 0.001) and nonischemic cardiomyopathy (OR 2.4 [1.0-5.7], P = 0.04) as predictive for response. Heart rate exceeding the upper rate during moderate exercise is an independent predictor for nonresponse to CRT in patients with AF, whereas chronotropic incompetence is a predictor for patients in SR.

  10. A meta-analysis of dropout rates in acceptance and commitment therapy.

    Science.gov (United States)

    Ong, Clarissa W; Lee, Eric B; Twohig, Michael P

    2018-05-01

    Many psychotherapies, including cognitive behavioral therapy and acceptance and commitment therapy (ACT), have been found to be effective interventions for a range of psychological and behavioral health concerns. Another aspect of treatment utility to consider is dropout, as interventions only work if clients are engaged in them. To date, no research has used meta-analytic methods to examine dropout in ACT. Thus, the objectives of the present meta-analysis were to (1) determine the aggregate dropout rate for ACT in randomized controlled trials, (2) compare dropout rates in ACT to those in other psychotherapies, and (3) identify potential moderators of dropout in ACT. Our literature search yielded 68 studies, representing 4,729 participants. The weighted mean dropout rates in ACT exclusive conditions and ACT inclusive conditions (i.e., those that included an ACT intervention) were 15.8% (95% CI: 11.9%, 20.1%) and 16.0% (95% CI: 12.5%, 19.8%), respectively. ACT dropout rates were not significantly different from those of established psychological treatments. In addition, dropout rates did not vary by client characteristics or study methodological quality. However, master's-level clinicians/therapists (weighted mean = 29.9%, CI: 17.6%, 43.8%) were associated with higher dropout than psychologists (weighted mean = 12.4%, 95% CI: 6.7%, 19.4%). More research on manipulable, process variables that influence dropout is needed. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography

    International Nuclear Information System (INIS)

    Park, Y.; Kim, T.S.; Yi, C.A.; Cho, E.Y.; Kim, H.; Choi, Y.S.

    2007-01-01

    Aim: The objective of this study was to identify whether there were any significant differences in the computed tomography (CT) findings of an intracavitary aspergilloma and a cavitating lung cancer containing a mural nodule. Materials and methods: The CT and histopathological findings of 12 patients (male:female ratio 3:9; aged 51-76 years) with cavitating lung cancer containing a mural nodule and 26 patients (male:female ratio 14:12; aged 29-72 years) with intracavitary aspergilloma were retrospectively reviewed. Results: The mural nodules within cavitating lung cancer were more enhanced (p < 0.001) and showed a nondependent location more frequently (p = 0.012) than those of intracavitary aspergillomas. The cavitary walls were thicker in cavitating lung cancer (mean 5.8 mm thick) than those in intracavitary aspergillomas (mean 2.6 mm thick; p = 0.035). Adjacent bronchiectasis and volume decrease of the involved lobe were observed more frequently in intracavitary aspergillomas than in cavitating lung cancers (p < 0.001 and p = 0.008, respectively). Conclusion: Whether a mural nodule within a cavitary lesion is contrast-enhanced or not is one of the most important features in making a differential diagnosis between an intracavitary aspergilloma and a cavitating lung cancer. Assessment of dependent location of a mural nodule within the cavity and wall thickness of the cavity itself can also be helpful for differentiation

  12. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Park, Y. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, T.S. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)]. E-mail: tskim.kim@samsung.com; Yi, C.A. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Cho, E.Y. [Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Kim, H. [Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of); Choi, Y.S. [Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710 (Korea, Republic of)

    2007-03-15

    Aim: The objective of this study was to identify whether there were any significant differences in the computed tomography (CT) findings of an intracavitary aspergilloma and a cavitating lung cancer containing a mural nodule. Materials and methods: The CT and histopathological findings of 12 patients (male:female ratio 3:9; aged 51-76 years) with cavitating lung cancer containing a mural nodule and 26 patients (male:female ratio 14:12; aged 29-72 years) with intracavitary aspergilloma were retrospectively reviewed. Results: The mural nodules within cavitating lung cancer were more enhanced (p < 0.001) and showed a nondependent location more frequently (p = 0.012) than those of intracavitary aspergillomas. The cavitary walls were thicker in cavitating lung cancer (mean 5.8 mm thick) than those in intracavitary aspergillomas (mean 2.6 mm thick; p = 0.035). Adjacent bronchiectasis and volume decrease of the involved lobe were observed more frequently in intracavitary aspergillomas than in cavitating lung cancers (p < 0.001 and p = 0.008, respectively). Conclusion: Whether a mural nodule within a cavitary lesion is contrast-enhanced or not is one of the most important features in making a differential diagnosis between an intracavitary aspergilloma and a cavitating lung cancer. Assessment of dependent location of a mural nodule within the cavity and wall thickness of the cavity itself can also be helpful for differentiation.

  13. Recurrence rates following I-131 therapy of differentiated thyroid carcinoma: results of meta-analysis

    International Nuclear Information System (INIS)

    Obaldo, J.M.

    1990-01-01

    To examine the efficacy of I-131 therapy in decreasing recurrence rates after surgery for differentiated thyroid carcinoma, a research tool called meta-analysis was used. Data were pooled from five published studies which evaluated recurrences following at least sub-total thyroidectomy with or without I-131 ablation of remnants. Of 1332 patients managed surgically only 202 (15%) developed recurrences compared to 36 of 339 (11%) treated with radioiodine. This difference was statistically significant at p<.05. When a separate analysis of only those studies which directly compared the two modes of management was conducted, recurrence rates for patients treated by surgery alone was higher at 18% (185 of 1034) compared with those who had subsequent I-131 therapy with a rate of 9% (27 of 297). This difference was again significant at p <.001. This meta-analysis strongly suggests that the use of I-131 for ablation of post-surgical thyroid remnants significantly reduces recurrence rates in patients with differentiated thyroid carcinoma. (Auth.). 34 refs., 1 tab.; 1 fig

  14. Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children.

    Science.gov (United States)

    Kotilea, Kallirroi; Mekhael, Joyce; Salame, Assaad; Mahler, Tania; Miendje-Deyi, Veronique Yvette; Cadranel, Samy; Bontems, Patrick

    2017-08-01

    Current commonly accepted strategies to eradicate Helicobacter pylori in children are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended. Adherence to therapy is also a risk factor for treatment failure but that has been poorly studied. The purpose of this study was to evaluate the influence of adherence to therapy on the elimination rates obtained with different treatment regimens. Cohort study analysis of children, aged 2-17 years, treated for Helicobacter pylori infection between October 2011 and December 2013. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while children infected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility. The eradication rate was assessed by a negative 13 C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary. One hundred forty-five children (67 girls/78 boys, median age 9.7 years) fulfilled the inclusion criteria, 118 being infected with a strain susceptible to both clarithromycin and metronidazole, 10 with a clarithromycin resistant, and 17 with a metronidazole resistant strain. A sequential regimen was prescribed in 44, a triple therapy containing clarithromycin in 84 and containing metronidazole in 17. Follow-up data were available for 130/145 and clearance of the infection observed in 105 of them. A concordance of more than

  15. Loading pattern calculated by inverse optimization vs traditional dosimetry systems of intracavitary brachytherapy of cervical cancer: a dosimetric study

    International Nuclear Information System (INIS)

    Jamema, S.V.; Deshpande, D.D.; Kirisits, C.; Trnkova, P.; Poetter, R.; Mahantshetty, U.; Shrivastava, S.K.; Dinshaw, K.A.

    2008-01-01

    In the recent past, inverse planning algorithms were introduced for intracavitary brachytherapy planning (ICBT) for cervical cancer. The loading pattern of these algorithms in comparison with traditional systems may not be similar. The purpose of this study was to objectively compare the loading patterns of traditional systems with the inverse optimization. Based on the outcome of the comparison, an attempt was made to obtain a loading pattern that takes into account the experience made with the inverse optimization

  16. Total skin high-dose-rate electron therapy dosimetry using TG-51

    International Nuclear Information System (INIS)

    Gossman, Michael S.; Sharma, Subhash C.

    2004-01-01

    An approach to dosimetry for total skin electron therapy (TSET) is discussed using the currently accepted TG-51 high-energy calibration protocol. The methodology incorporates water phantom data for absolute calibration and plastic phantom data for efficient reference dosimetry. The scheme is simplified to include the high-dose-rate mode conversion and provides support for its use, as it becomes more available on newer linear accelerators. Using a 6-field, modified Stanford technique, one may follow the process for accurate determination of absorbed dose

  17. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: A quality improvement project

    OpenAIRE

    Mitra, Sujata; Muthu, Sonai G

    2012-01-01

    Introduction: Radioiodine (I-131) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after I-131 therapy. The present study was undertaken to reduce treatment failure rate of I-131 therapy in TMNG patients. Materials and Methods: Multiple causes may have lead to treatment failure of I-131 in TMNG patients making it difficult to establish a direct cause?effect relationship and take corrective action. Therefore, the JURAN methodology...

  18. Predicted Rates of Secondary Malignancies From Proton Versus Photon Radiation Therapy for Stage I Seminoma

    Energy Technology Data Exchange (ETDEWEB)

    Simone, Charles B., E-mail: csimone@alumni.upenn.edu [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania (United States); Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Kramer, Kevin [Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland (United States); O' Meara, William P. [Division of Radiation Oncology, National Naval Medical Center, Bethesda, Maryland (United States); Bekelman, Justin E. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania (United States); Belard, Arnaud [Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland (United States); McDonough, James [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania (United States); O' Connell, John [Radiation Oncology Service, Walter Reed Army Medical Center, Washington, DC (United States)

    2012-01-01

    Purpose: Photon radiotherapy has been the standard adjuvant treatment for stage I seminoma. Single-dose carboplatin therapy and observation have emerged as alternative options due to concerns for acute toxicities and secondary malignancies from radiation. In this institutional review board-approved study, we compared photon and proton radiotherapy for stage I seminoma and the predicted rates of excess secondary malignancies for both treatment modalities. Methods and Material: Computed tomography images from 10 consecutive patients with stage I seminoma were used to quantify dosimetric differences between photon and proton therapies. Structures reported to be at increased risk for secondary malignancies and in-field critical structures were contoured. Reported models of organ-specific radiation-induced cancer incidence rates based on organ equivalent dose were used to determine the excess absolute risk of secondary malignancies. Calculated values were compared with tumor registry reports of excess secondary malignancies among testicular cancer survivors. Results: Photon and proton plans provided comparable target volume coverage. Proton plans delivered significantly lower mean doses to all examined normal tissues, except for the kidneys. The greatest absolute reduction in mean dose was observed for the stomach (119 cGy for proton plans vs. 768 cGy for photon plans; p < 0.0001). Significantly more excess secondary cancers per 10,000 patients/year were predicted for photon radiation than for proton radiation to the stomach (4.11; 95% confidence interval [CI], 3.22-5.01), large bowel (0.81; 95% CI, 0.39-1.01), and bladder (0.03; 95% CI, 0.01-0.58), while no difference was demonstrated for radiation to the pancreas (0.02; 95% CI, -0.01-0.06). Conclusions: For patients with stage I seminoma, proton radiation therapy reduced the predicted secondary cancer risk compared with photon therapy. We predict a reduction of one additional secondary cancer for every 50 patients

  19. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children

    Energy Technology Data Exchange (ETDEWEB)

    Maarouf, Mohammad; El Majdoub, Faycal [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); University of Witten/Herdecke, Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne (Germany); Fuetsch, Manuel [University Hospital of Munich, Department of Neurosurgery, Munich (Germany); Hoevels, Mauritius [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); Lehrke, Ralph [St. Barbara-Klinik Hamm-Heessen, Department of Stereotaxy and Functional Neurosurgery, Hamm (Germany); Berthold, Frank [University Hospital of Cologne, Department Pediatric Oncology, Cologne (Germany); Voges, Juergen [University Hospital of Magdeburg, Department of Stereotaxy and Functional Neurosurgery, Magdeburg (Germany); Sturm, Volker [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); University Hospital of Wurzburg, Department of Neurosurgery, Wuerzburg (Germany)

    2016-03-15

    Although microsurgery remains the first-line treatment, gross total resection of cystic craniopharyngeomas (CP) is associated with significant morbidity and mortality and the addition of external irradiation to subtotal resection proves to achieve similar tumor control. However, concern regarding long-term morbidity associated with external irradiation in children still remains. With this retrospective analysis, the authors emphasize intracavitary brachytherapy using phosphorus-32 (P-32) as a treatment option for children with cystic CP. Between 1992 and 2009, 17 children (median age 15.4 years; range 7-18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid-cystic lesions (median tumor volume 11.1 ml; range 0.5-78.9 ml). The median follow-up time was 61.9 months (range 16.9-196.6 months). Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3-10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively. Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations. (orig.) [German] Obwohl die Mikrochirurgie die Methode der Wahl darstellt, ist die komplette Resektion zystischer Kraniopharyngeome haeufig mit einer

  20. The rate of 99m Tc-MDP uptake in metastatic bone lesions before and after 89m Sr therapy

    International Nuclear Information System (INIS)

    Souza, Joseane Fonseca; Braga, Francisco J.H.N.

    1996-01-01

    The rate of 99m Tc-MDP uptake is studied in metastatic bone lesions, before and after 89m Sr therapy. Eight hopeless patients (age between 56 and 74) presenting disseminated carcinoma of the prostate are evaluated. No hormonal therapy and a limited radiotherapy were considered. It is concluded that therapeutical doses of 89m Sr reduces MDP uptake

  1. The effect of educational group therapy plan on self–esteem rate in adolescent girls

    Directory of Open Access Journals (Sweden)

    Roya Turkashvand

    2011-07-01

    Full Text Available Background: Adolescence is a period of major changes in various aspects of physical, mental and social caracters they may get. There are new requirements for the changes have been occurred. Attention to these needs, in turn, are faster and better compatibility and increase self-esteem. Self-esteem is the basic factor of personality development in adolescents. Therefore, the aim of this study was to evaluate the effect of educational group therapy on self-esteem of adolescent girls.Materials and Method: This is a quasi- experimental study. Seventy-one adolescent girls of 13-15 years old were selected cluster-randomly from guidance school and divided in two groups of experimental and control (35 cases, 36 controls. Self-esteem of adolescents in two groups measured using Pop test. Then the educational group therapy plan was utilized based on promotion of adolescent’s self- esteem at 10 sessions for case group. Self-esteem rate was measured just after the performance of planned session and were analyzed with SPSS-14 software.Results: The results of the study indicated that performing educational group therapy session can increase the mean self-esteem score for case group (84.74 comparing to control group (74.05. Independent t-test shows significant difference between self-esteem score in case and control groups.Conclusion: According to our results the authors suggest that using educational group therapy plan is an effective approach in increasing self-esteem in adolescent girls and may improve mental health. Therefore, we suggest this plan for increasing self-esteem of adolescents in the schools

  2. Virulence factor genotypes of Helicobacter pylori affect cure rates of eradication therapy.

    Science.gov (United States)

    Sugimoto, Mitsushige; Yamaoka, Yoshio

    2009-01-01

    The cure rates of Helicobacter pylori infection by using a combination of a proton pump inhibitor (PPI) and antimicrobial agents are mainly influenced by bacterial susceptibility to antimicrobial agents and the magnitude of acid inhibition during the treatment. Currently used empirical triple therapies do not reliably produce a > or =80% cure rate on an intention-to-treat basis. Therefore, tailored regimens based on relevant microbiological findings and pharmacogenomics are recommended for attaining an acceptable > or =95% cure rate. Recently, virulence factors of H. pylori, such as cagA and vacA, are reported to be major factors determining the cure rates. Individuals infected with strains with cagA-negative and vacA s2 genotypes have significantly increased risk of eradication failure of H. pylori infection. These virulence factors enhance gastric mucosal inflammation and are associated with the development of peptic ulcer and gastric cancer. H. pylori virulence factors induce proinflammatory cytokines, such as interleukin (IL)-1, IL-8, and tumor necrosis factor (TNF)- which influence mucosal inflammation and/or gastric acid secretion. When physicians select an H. pylori eradication regimen with an acceptable cure rate, they might need to consider H. pylori virulence factors, especially cagA and vacA.

  3. Therapy with radionuclides. Radionuklid-Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Biersack, H.J.; Hotze, A.L. (Bonn Univ. (Germany). Klinik fuer Nuklearmedizin)

    1992-12-01

    Radioiodine therapy of benign and malignant thyroid diseases is a well-established procedure in Nuclear Medicine. However, the therapeutic use of radioisotopes in other diseases is relatively unknown among our refering physicians. The therapeutic effects of intraarticular (rheumatoid arthritis) and intracavitary (pleural and peritoneal carcinosis) applications yields good results. The radiophosphorus therapy in polycythemia vera rubra has always to be considered as an alternative to chemotherapy. The use of analgetics may be reduced by pain therapy of bone metastasis by injection of bone-seeking beta emitters like Rh-186 HEDP. Other procedures like therapeutic application of meta-iodo-benzylguanidine in neuroblastoma and malignant pheochromocytoma resulted in at least remissions of the disease. Radioimmunotherapy needs further evaluation before it can be recommended as a routine procedure. (orig.).

  4. Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life

    Energy Technology Data Exchange (ETDEWEB)

    Vordermark, D.; Flentje, M.; Koelbl, O. [Wuerzburg Univ. (Germany). Klinik und Poliklinik fuer Strahlentherapie; Sailer, M. [Wuerzburg Univ. (Germany). Klinik fuer Chirurgie

    2001-05-01

    Background: First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported. Patients and Methods: 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean {+-}SD follow-up for living patients of 4.4{+-}2.1 years. Quality of life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors. Results: Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumorrelated. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers. Conclusion: the described regimen is highly effective but associated with increased toxicity. (orig.) [German] Hintergrund: Erste klinische Ergebnisse einer neuen Methode zur intrakavitaeren Afterloading-Boost-Bestrahlung des Analkanalkarzinoms werden vorgestellt. Patienten und Methoden: 20 in Folge behandelte Patienten (T1 5%, T2 70%, T3 20%, T4 5%, N0 75%, N1 10%, N2 15 %; alle M0) erhielten eine perkutane Bestrahlung (mediane Dosis 56 Gy, 46-64 Gy), simultan 5-FU und Mitomycin (75%) und einen intrakavitaeren Afterloading-Boost (eine oder zwei Fraktionen mit je 5 Gy in 5 mm Tiefe). Der mittlere Nachbeobachtungszeitraum lebender Patienten betrug 4,4{+-}2,1 Jahre. Zehn kolostomiefrei Ueberlebende wurden bezueglich Lebensqualitaet und anorektaler Manometriewerte untersucht. Ergebnisse: Gesamtueberleben, rezidivfreies und kolostomiefreies Ueberleben nach 5 Jahren betrugen 84%, 79% und 69%. Kein Todesfall war

  5. Intracavitary in vivo dosimetry based on multichannel fiber-coupled optically stimulated luminescence (OSL) of Al2O3:C for Curietherapy

    International Nuclear Information System (INIS)

    Spasic, Estelle

    2012-01-01

    The brachytherapy is an old technique using sealed radioactive sources of low or average energy. This technique is still therapeutically and economically relevant today and always evolving (e.g. High Dose Rate (HDR) brachytherapy). This treatment enables to deliver a high dose of irradiation in a limited tumoral volume and enables to minimize the risk of radiation-induced cancer as preserving the Organs at Risks (OAR). However, this technique generates high dose gradients, which makes in vivo dosimetry difficult to implement. Hence, the deviations observed between doses delivered and prescribed are often up to the maximal deviation tolerated by the nuclear safety regulations (± 5%) in conformational radiotherapy. Those regulations have been made mandatory in France since 2011. This thesis has been done within the framework of the ANR-TECSAN INTRADOSE project and is based on the past technological benefits demonstrated during the MAESTRO European project and the ANR-TECSAN CODOFER project, in particular a RL/OSL multichannel instrumentation (Radioluminescence - Optically Stimulated Luminescence) made and validated in preclinical evaluation during the MAESTRO project. The purpose of the INTRADOSE project is to demonstrate the feasibility of the intracavitary In Vivo Dosimetry (IVD) by dosimetric catheter using optical fibers and alumina crystals Al 2 O 3 :C with the aim of improving the safety of patients treated by HDR brachytherapy. This new probe enables to measure a dose distribution (several points) close to the OAR, it offers a little diameter (≤ 3 mm) designed for an intracavitary use (e.g. to insert in the urethra), it is transparent, radiation stable and reusable after dose reading and sterilization. During this study, we have first developed this new dosimetric sensor based on the OSL using the properties of the alumina crystal. Several tests have been done in order to evaluate the feasibility and the compatibility with a medical application. Then

  6. Modifiable variables in physical therapy education programs associated with first-time and three-year National Physical Therapy Examination pass rates in the United States

    Directory of Open Access Journals (Sweden)

    Chad Cook

    2015-09-01

    Full Text Available Purpose: This study aimed to examine the modifiable programmatic characteristics reflected in the Commission on Accreditation in Physical Therapy Education (CAPTE Annual Accreditation Report for all accredited programs that reported pass rates on the National Physical Therapist Examination, and to build a predictive model for first-time and three-year ultimate pass rates. Methods: This observational study analyzed programmatic information from the 185 CAPTE-accredited physical therapy programs in the United States and Puerto Rico out of a total of 193 programs that provided the first-time and three-year ultimate pass rates in 2011. Fourteen predictive variables representing student selection and composition, clinical education length and design, and general program length and design were analyzed against first-time pass rates and ultimate pass rates on the NPTE. Univariate and multivariate multinomial regression analysis for first-time pass rates and logistic regression analysis for three-year ultimate pass rates were performed. Results: The variables associated with the first-time pass rate in the multivariate analysis were the mean undergraduate grade point average (GPA and the average age of the cohort. Multivariate analysis showed that mean undergraduate GPA was associated with the three-year ultimate pass rate. Conclusions: Mean undergraduate GPA was found to be the only modifiable predictor for both first-time and three-year pass rates among CAPTE-accredited physical therapy programs.

  7. The effect of patients’ time of arrival at the hospital on the rate of Thrombolytic therapy

    Directory of Open Access Journals (Sweden)

    Toba Kazemi

    2013-01-01

    Full Text Available The honorable editor-in-chief of the Journal of ARYA We read with interest the article of Dr. Maleki that has recently been published.1 We conducted a similar study in Birjand Vali-e-Asr Hospital in 2009-2010. This study was done on 125 patients with STEMI with a mean age of 59.2 ± 11.9 years. In this study, 65.6% of patients underwent thrombolytic therapy. This showed a crucial increase compared to the previous study in Birjand in 2003 that showed 17.3% of patients underwent thrombolytic therapy.2 Mean door to needle time was 74.8 ± 42.7 minutes (median 60 minutes. Thrombolytic therapy showed no difference for difference in sex (69.4% in males, and 51.9% in females, P = 0.08. However, in working staff (86.7% in employees, and 51.2% in farmers/workers, P = 0.003, in highly educated individuals (92.3% at university level, and 45.5% illiterate, P < 0.001, and in citizens (73.2% in urban, and 51.2% in rural citizens, P = 0.01 there was a higher percentage of thrombolytic therapy. The main reason for this difference between them is earlier arrival to the hospital since the onset of symptoms. The arrival time in the city's residents was 166.7 ± 179.6 minutes, but for villagers it was 221.6 ± 112 minutes (P = 0.001. Furthermore, the rate of thrombolytic therapy during the night was not significantly different compared to the rest of the day (73% during morning, 62.9% during afternoon, and 62.3% during night, P = 0.52. The patient's arrival time to the hospital at night was not different compared to the rest of the day (166.9 ± 174.7 minutes in the morning shift, and 148.2 ± 85.2 minutes during the night shift, P = 0.63. Visiting patients during the night shift was similar to other shifts; visit by intern was 12.3 ± 9.1 minutes during the morning shift, and 14.1 ± 9.3 minutes during the night shift (P = 0.73. The rate of thrombolytic therapy in our study was similar to the study by Dr. Maleki;1 however, door to needle time was longer. In our

  8. Smoking cessation in workplace settings: quit rates and determinants in a group behaviour therapy programme.

    Science.gov (United States)

    Hausherr, Yann; Quinto, Carlos; Grize, Leticia; Schindler, Christian; Probst-Hensch, Nicole

    2017-09-25

    To capitalise on the opportunities that the smoking ban legislation in Switzerland offers for the prevention of tobacco-related diseases, a smoking cessation programme in a workplace setting was developed and implemented in companies across the language and cultural regions of Switzerland. Our goal was to identify factors associated with relapse into smoking that may be overcome during training sessions or that should be considered for the optimisation of future interventions. Between 2006 and 2012, 1287 smokers aged 16 to 68 years voluntarily attended smoking cessation training at their workplace. The intervention was based on a cognitive behavioural group therapy combined with individual proactive telephone counselling. The evaluation consisted of three anonymised questionnaires (pre- and postintervention, and 12-month follow-up). In this prospective cohort study, we investigated the association of smoking quit rates with training and participant characteristics, including withdrawal symptoms, by use of multilevel logistic regression analysis with a random intercept for training courses. The self-reported abstinence rate was 72.4% at the end of the training, and 18.6% 1 year later. The risk of relapse during the training was positively associated with the number of years and daily cigarettes smoked, and negatively with increased appetite, sleeping troubles and satisfaction with learned techniques. Failed abstinence within the first year was associated with younger age, higher numbers of daily smoked cigarettes and unsuccessful recent quit attempts. Our evaluation suggests that younger and more addicted smokers attending smoking cessation trainings may need additional support to achieve long lasting abstinence rates. Offering smoking cessation training in a workplace setting can achieve reasonable long-term quit rates, but a subset of employees needs additional support at the group or personal level. Group behaviour therapy could be an effective method to achieve

  9. The heart field effect: Synchronization of healer-subject heart rates in energy therapy.

    Science.gov (United States)

    Bair, Christine Caldwell

    2008-01-01

    Recent health research has focused on subtle energy and vibrational frequency as key components of health and healing. In particular, intentional direction of bioenergy is receiving increasing scientific attention. This study investigates the effect of the healer's electromagnetic (EM) heart field upon subjects during energy healing as measured by synchronization of heart rates and scores on a Subjective Units of Distress (SUD) scale and a Profile of Mood States (POMS) inventory. A nonequivalent pretest-posttest design was used based on heart rate comparisons between healer and subject and correlated with pre-and posttest SUD and POMS scores. Subjects included those who sat within the 3- to 4-foot "strong" range of the independent variable, the healer's heart field, while performing self-application of WHEE (the wholistic hybrid derived from EMDR [eye movement desensitization and reprocessing], and EFT [emotional freedom technique]), a meridian-based tapping technique (n=50); and those who performed the same process beyond the 15- to 18-foot range of the healer's EM heart field (n=41). The dependent variables were heart rate, SUD, and POMS inventory. All subjects completed these measures within 1 hour. Study results showed statistically significant heart-rate synchronization with the intervention population. In addition, SUD and POMS scores demonstrated considerably more improvement than in the control population, indicating additional benefit beyond the meridian-based therapies, such as WHEE, alone. Additional findings and future research recommendations are presented in this article.

  10. Impact of Drug Therapy, Radiation Dose, and Dose Rate on Renal Toxicity Following Bone Marrow Transplantation

    International Nuclear Information System (INIS)

    Cheng, Jonathan C.; Schultheiss, Timothy E.; Wong, Jeffrey Y.C.

    2008-01-01

    Purpose: To demonstrate a radiation dose response and to determine the dosimetric and chemotherapeutic factors that influence the incidence of late renal toxicity following total body irradiation (TBI). Methods and Materials: A comprehensive retrospective review was performed of articles reporting late renal toxicity, along with renal dose, fractionation, dose rate, chemotherapy regimens, and potential nephrotoxic agents. In the final analysis, 12 articles (n = 1,108 patients), consisting of 24 distinct TBI/chemotherapy conditioning regimens were included. Regimens were divided into three subgroups: adults (age ≥18 years), children (age <18 years), and mixed population (both adults and children). Multivariate logistic regression was performed to identify dosimetric and chemotherapeutic factors significantly associated with late renal complications. Results: Individual analysis was performed on each population subgroup. For the purely adult population, the only significant variable was total dose. For the mixed population, the significant variables included total dose, dose rate, and the use of fludarabine. For the pediatric population, only the use of cyclosporin or teniposide was significant; no dose response was noted. A logistic model was generated with the exclusion of the pediatric population because of its lack of dose response. This model yielded the following significant variables: total dose, dose rate, and number of fractions. Conclusion: A dose response for renal damage after TBI was identified. Fractionation and low dose rates are factors to consider when delivering TBI to patients undergoing bone marrow transplantation. Drug therapy also has a major impact on kidney function and can modify the dose-response function

  11. Comparison of circuit patency and exchange rates between 2 different continuous renal replacement therapy machines.

    Science.gov (United States)

    Razavi, Seyed Amirhossein; Still, Mary D; White, Sharon J; Buchman, Timothy G; Connor, Michael J

    2014-04-01

    Continuous renal replacement therapy (CRRT) is an important tool in the care of critically ill patients. However, the impact of a specific CRRT machine type on the successful delivery of CRRT is unclear. The purpose of this study was to evaluate the effectiveness of CRRT delivery with an intensive care unit (ICU) bedside nurse delivery model for CRRT while comparing circuit patency and circuit exchange rates in 2 Food and Drug Administration-approved CRRT devices. This article presents the data comparing circuit exchange rates for 2 different CRRT machines. A group of ICU nurses were selected to undergo expanded training in CRRT operation and empowered to deliver all aspects of CRRT. The ICU nurses then provided all aspects of CRRT on 2 Food and Drug Administration-approved CRRT devices for 6 months. Each device was used exclusively in the designated ICU for a 2-week run-in period followed by 3-month data collection period. The primary end point for the study was the differences in average number of filter exchanges per day during each CRRT event. A total of 45 unique patients who underwent 64 separate CRRT treatment periods were included. Four CRRT events were excluded (see text for details). Twenty-eight CRRT events occurred in the NxStage System One arm (NxStage Medical, Lawrence, Mass) and 32 events in the Gambro Prismaflex arm (Gambro Renal Products, Boulder, Colo). Average (SD) filter exchanges per day was 0.443 (0.60) for the NxStage System One machine and 0.553 (0.65) for Gambro Prismaflex machine (P = .09). There was no demonstrable difference in circuit patency as defined by the rate of filter exchanges per day of CRRT therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Low rate of infectious complications following immunoadsorption therapy without regular substitution of intravenous immunoglobulins.

    Science.gov (United States)

    Tselmin, Sergey; Julius, Ulrich; Bornstein, Stefan R; Hohenstein, Bernd

    2017-11-01

    Immunoadsorption (IA) is increasingly used instead of plasma exchange due to lower risk of side effects and a higher selectivity. As a consequence of the reduction of immunoglobulins (Ig), the rate of infectious complications might increase in those patients. We therefore aimed to investigate the infection rate following IA without intravenous IG (IVIG) substitution in our apheresis center, where patients do not receive IVIG on a regular basis. We conducted a retrospective analysis of the IA treatments performed between 2010 and 2015 without IVIG substitution and collected data on patient age, diagnosis, number of IA treatments, serum levels of Ig, total protein, albumin, C-reactive protein (CRP) and infectious complications that occurred within 2 months after the IA treatment cycle. A total number of 52 patients (27 females) received at least 5 IA sessions using the following adsorbers: TheraSorb™-Ig (n = 3), TheraSorb™-Ig flex (n = 44), TheraSorb™ Ig pro (n = 1) and TheraSorb™-IgE (n = 5). The median number of treatment sessions was 8.8 [range 5-16], the median IgG reduction was 82 [11-99] %. Serum albumin was decreased by 8%. The median CRP levels remained normal until the end of therapy and within 2 months after that (3.10 and 4.30 mg/L respectively). Only 4 patients had infections (7.7%). Three of them received additional immunosuppressive therapy. Immunoadsorption leads to a significant reduction of IgG. CRP as inflammatory marker is not affected. Even without substitution of IVIG the complication rate directly linked with IA is low and questionable. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Intracavitary irradiation with deferred radioactive load Technique, remote control high activity sources

    International Nuclear Information System (INIS)

    Badell, M.; Lejarceguir, J.A.; Guix, B.; Rubio, A.; Pons, A.; Farrus, B.

    1988-01-01

    From december 1981 to septembre 1986, 149 patients were treated at the Radiotherapy Department of the Hospital Clinico y Provincial of Barcelona by means of intracavitary irradiation with 137 cesium high 1 sources and 2. To 112 of the total number of patients external radiotherapy to the whole of the pelvis using photons of 6 MeV was also administered. A total of 46 (30.7%) patients presented rectal complications. The rectitis observed was mild in 16 cases (10.7%). moderate in 15 (10%) and severe in 15 15(10%) and severe in 15(10%). The 15 patients with severe rectitis had to be treated by unloading colostomy. In patients with severe complications, the maximum total rectal dose administered was between 5,855 and 9,490 cGy, and the maximum rectal dose administered via curietherapy was 1.055 to 7.320 cGy. Maximum total rectal dose administration greater than 4, cGy and maximum rectal dose administered via curietherapy greater than 5,800 cGy were statistically significant prognostic factors (p0.001) of severe rectal complications. (Author)

  14. Nutritional prognostic scores in patients with hilar cholangiocarcinoma treated by percutaneous transhepatic biliary stenting combined with 125I seed intracavitary irradiation: A retrospective observational study.

    Science.gov (United States)

    Cui, Peiyuan; Pang, Qing; Wang, Yong; Qian, Zhen; Hu, Xiaosi; Wang, Wei; Li, Zongkuang; Zhou, Lei; Man, Zhongran; Yang, Song; Jin, Hao; Liu, Huichun

    2018-06-01

    We mainly aimed to preliminarily explore the prognostic values of nutrition-based prognostic scores in patients with advanced hilar cholangiocarcinoma (HCCA).We retrospectively analyzed 73 cases of HCCA, who underwent percutaneous transhepatic biliary stenting (PTBS) combined with I seed intracavitary irradiation from November 2012 to April 2017 in our department. The postoperative changes of total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and albumin (ALB) were observed. The preoperative clinical data were collected to calculate the nutrition-based scores, including controlling nutritional status (CONUT), C-reactive protein/albumin ratio (CAR), and prognostic nutritional index (PNI). Kaplan-Meier curve and Cox regression model were used for overall survival (OS) analyses.The serum levels of TBIL, DBIL, ALT, AST, and ALP significantly reduced, and ALB significantly increased at 1 month and 3 months postoperatively. The median survival time of the cohort was 12 months and the 1-year survival rate was 53.1%. Univariate analysis revealed that the statistically significant factors related to OS were CA19-9, TBIL, ALB, CONUT, and PNI. Multivariate analysis further identified CA19-9, CONUT, and PNI as independent prognostic factors.Nutrition-based prognostic scores, CONUT and PNI in particular, can be used as predictors of survival in unresectable HCCA.

  15. Nocturnal heart rate variability in patients treated with cognitive-behavioral therapy for insomnia.

    Science.gov (United States)

    Jarrin, Denise C; Chen, Ivy Y; Ivers, Hans; Lamy, Manon; Vallières, Annie; Morin, Charles M

    2016-06-01

    Insomnia and reduced heart rate variability (HRV) increase the risk of cardiovascular disease and its precursors; thus, it is important to evaluate whether treatment for insomnia provides cardiovascular safeguards. The present study aimed to evaluate potential cardiovascular benefits of cognitive behavioral therapy for insomnia (CBT-I). The present study included 65 patients treated for chronic insomnia (M = 51.8 years, SD = 10.0; 66.2% female) at a university hospital. Patients received CBT-I over a 6-week period, and change scores from pre- to posttreatment derived from the Insomnia Severity Index, sleep diary, and polysomnography (PSG) were used as indices of sleep improvement. HRV variables (i.e., low frequency [LF], high frequency [HF], and the ratio of low to high frequency [LF:HF ratio]) were derived for Stage 2 (S2) and rapid-eye movement (REM) sleep at pre- and posttreatment. High HF (i.e., parasympathetic activity) and/or low LF:HF ratio (i.e., sympathovagal balance) were used as indices of HRV improvement. Following therapy, sleep improvements, particularly for sleep onset latency, were related with reduced HF in S2 (r = .30, p insomnia symptoms and increased HF in REM (r = -.21, p insomnia treatment might play a role in physiological changes associated with cardiovascular anomalies. Future research is needed to examine the long-term impact of treatment as a preventative tool against insomnia-related morbidity. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Measuring Supportive Music and Imagery Interventions: The Development of the Music Therapy Self-Rating Scale.

    Science.gov (United States)

    Meadows, Anthony; Burns, Debra S; Perkins, Susan M

    2015-01-01

    Previous research has demonstrated modest benefits from music-based interventions, specifically music and imagery interventions, during cancer care. However, little attention has been paid to measuring the benefits of music-based interventions using measurement instruments specifically designed to account for the multidimensional nature of music-imagery experiences. The purpose of this study was to describe the development of, and psychometrically evaluate, the Music Therapy Self-Rating Scale (MTSRS) as a measure for cancer patients engaged in supportive music and imagery interventions. An exploratory factor analysis using baseline data from 76 patients who consented to participate in a music-based intervention study during chemotherapy. Factor analysis of 14 items revealed four domains: Awareness of Body, Emotionally Focused, Personal Resources, and Treatment Specific. Internal reliability was excellent (Cronbach alphas ranging from 0.75 to 0.88) and construct and divergent-discriminant validity supported. The MTSRS is a psychometrically sound, brief instrument that captures essential elements of patient experience during music and imagery interventions. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Interferon alpha 2 maintenance therapy may enable high rates of treatment discontinuation in chronic myeloid leukemia.

    Science.gov (United States)

    Burchert, A; Saussele, S; Eigendorff, E; Müller, M C; Sohlbach, K; Inselmann, S; Schütz, C; Metzelder, S K; Ziermann, J; Kostrewa, P; Hoffmann, J; Hehlmann, R; Neubauer, A; Hochhaus, A

    2015-06-01

    A minority of chronic myeloid leukemia (CML) patients is capable of successfully discontinuing imatinib. Treatment modalities to increase this proportion are currently unknown. Here, we assessed the role of interferon alpha 2a (IFN) on therapy discontinuation in a previously reported cohort of 20 chronic phase CML patients who were treated upfront with IFN alpha plus imatinib followed by IFN monotherapy to maintain cytogenetic or molecular remission (MR) after imatinib discontinuation. After a median follow-up of 7.9 years (range, 5.2-12.2), relapse-free survival was 73% (8/11 patients) and 84% (5/6 patients) for patients who discontinued imatinib in major MR (MMR) and MR4/MR4.5, respectively. Ten patients discontinued IFN after a median of 4.5 years (range, 0.24-9.3). After a median of 2.8 years (range, 0.7-5.1), nine of them remain in ongoing treatment-free remission with MR5 (n=6) and MR4.5 (n=3). The four patients who still administer IFN are in stable MR5, MR4.5, MR4, and MMR, respectively. In conclusion, an IFN/imatinib induction treatment followed by a temporary IFN maintenance therapy may enable a high rate of treatment discontinuation in CML patients in at least MMR when stopping imatinib.

  18. High-dose-rate intraoperative radiation therapy: the nuts and bolts of starting a program

    Science.gov (United States)

    Moningi, Shalini; Armour, Elwood P.; Terezakis, Stephanie A.; Efron, Jonathan E.; Gearhart, Susan L.; Bivalacqua, Trinity J.; Kumar, Rachit; Le, Yi; Kien Ng, Sook; Wolfgang, Christopher L.; Zellars, Richard C.; Ellsworth, Susannah G.; Ahuja, Nita

    2014-01-01

    High-dose-rate intraoperative radiation therapy (HDR-IORT) has historically provided effective local control (LC) for patients with unresectable and recurrent tumors. However, IORT is limited to only a few specialized institutions and it can be difficult to initiate an HDR-IORT program. Herein, we provide a brief overview on how to initiate and implement an HDR-IORT program for a selected group of patients with gastrointestinal and pelvic solid tumors using a multidisciplinary approach. Proper administration of HDR-IORT requires institutional support and a joint effort among physics staff, oncologists, surgeons, anesthesiologists, and nurses. In order to determine the true efficacy of IORT for various malignancies, collaboration among institutions with established IORT programs is needed. PMID:24790628

  19. High-dose rate intra-operative radiation therapy for local advanced and recurrent colorectal cancer

    International Nuclear Information System (INIS)

    Harrison, L.B.; Mychalczak, B.; Enker, W.; Anderson, L.; Cohen, A.E.; Minsky, B.

    1996-01-01

    In an effort to improve the local control for advanced and recurrent cancers of the rectum, we have integrated high-dose rate intra-operative radiation therapy (HDR-IORT) into the treatment program. Between 11/92 and 10/95, 47 patients (pts) were treated. There were 26 males and 21 females whose ages ranged from 30-80 (median = 62) years. There were 19 pts with primary unresectable rectal cancer, and 28 pts who were treated for recurrent rectal cancer. Histology was adenocarcinoma - 45 pts, squamous cancer - 2 pts. The range of follow-up is 1-34 months (median = 14 months). The majority of primary unresectable pts received pre-operative radiation therapy (4500-5040 cGy) with chemotherapy (5-FU with Leucovorin) 4-6 weeks later, they underwent resection + HDR-IORT (1200 cGy). For the 28 pts with recurrent cancer, the majority received surgery and HDR-IORT alone because they had received prior RT. For the pts with primary unresectable disease, actuarial 2-year local control was 77%, actuarial distant metastasis-free survival was 71%, disease free survival was 66%, and overall survival was 84%. For those pts with recurrent disease, actuarial 2-year local control rate was 65%, distant metastasis-free survival was 65%, disease free survival was 47%, and overall survival was 61%. Complications occurred in 36%. There were no cases where the anatomical distribution of disease, or technical limitations prevented the adequate delivery of HDR-IORT. We conclude that this technique was most versatile, and enabled all appropriate pts to receive IORT. The preliminary data in terms of local control are encouraging, even for the poor prognostic sub-group of pts with recurrent cancer

  20. Hydroxyurea with Radiation Therapy of the Carcinoma of the Cervix IIA, IIB

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Youn, Seon Min; Kim, Ok Bae [Keimyung University College of Medicine, Taegu (Korea, Republic of)

    1995-12-15

    Purpose : To evaluate the efficacy of hydroxyurea with radiation in carcinoma of the cervix, huge exophytic or endophytic stage IIa and Iib. Materials and Methods : Sixty four patients with carcinoma of the cervix stage IIA(29 patients) with exophytic({>=}3cm in diameter) or huge endophytic mass and IIB(35 patients) treated with radiation and hydroxyurea at the Department of Radiation Oncology, Dongsan Hospital, Keimyung University, School of Medicine from Aug, 1989 to May, 1991. The maximum and mean follow up durations were 68 and 57 months respectively. The radiation therapy consisted of external irradiation to the whole pelvis(3600-5400cGy) shield (4X10 cm), and combined with intracavitary irradiation (3000-3500cGy to point A). Hydroxyurea was to be taken in a single oral dose of 1.0gm/day during radiation therapy. Results : The control rate was 89.1%. The actuarial overall five year survival rate was 78.8% for stage IIA and 72.8% for stage IIB. The overall recurrence rate was 25%(16/64). Twenty-three percent of the patients developed or greater thrombocytopenia. Grade 3 or greater GI, GU complication and anemia were not noted. There was no treatment related death noted. Conclusion : We considered that hydroxyurea and radiation therapy may improve survival rate in huge exophytic and endophytic stage IIa cervical carcinoma with acceptible morbidity.

  1. Hydroxyurea with Radiation Therapy of the Carcinoma of the Cervix IIA, IIB

    International Nuclear Information System (INIS)

    Kim, Jin Hee; Youn, Seon Min; Kim, Ok Bae

    1995-01-01

    Purpose : To evaluate the efficacy of hydroxyurea with radiation in carcinoma of the cervix, huge exophytic or endophytic stage IIa and Iib. Materials and Methods : Sixty four patients with carcinoma of the cervix stage IIA(29 patients) with exophytic(≥3cm in diameter) or huge endophytic mass and IIB(35 patients) treated with radiation and hydroxyurea at the Department of Radiation Oncology, Dongsan Hospital, Keimyung University, School of Medicine from Aug, 1989 to May, 1991. The maximum and mean follow up durations were 68 and 57 months respectively. The radiation therapy consisted of external irradiation to the whole pelvis(3600-5400cGy) shield (4X10 cm), and combined with intracavitary irradiation (3000-3500cGy to point A). Hydroxyurea was to be taken in a single oral dose of 1.0gm/day during radiation therapy. Results : The control rate was 89.1%. The actuarial overall five year survival rate was 78.8% for stage IIA and 72.8% for stage IIB. The overall recurrence rate was 25%(16/64). Twenty-three percent of the patients developed or greater thrombocytopenia. Grade 3 or greater GI, GU complication and anemia were not noted. There was no treatment related death noted. Conclusion : We considered that hydroxyurea and radiation therapy may improve survival rate in huge exophytic and endophytic stage IIa cervical carcinoma with acceptible morbidity

  2. Assessment of volumetric-modulated arc therapy for constant and variable dose rates

    Directory of Open Access Journals (Sweden)

    Mariluz De Ornelas-Couto

    2017-01-01

    Full Text Available Purpose: The aim of this study is to compare the effects of dose rate on volumetric-modulated arc therapy plans to determine optimal dose rates for prostate and head and neck (HN cases. Materials and Methods: Ten prostate and ten HN cases were retrospectively studied. For each case, seven plans were generated: one variable dose rate (VDR and six constant dose rate (CDR (100–600 monitor units [MUs]/min plans. Prescription doses were: 80 Gy to planning target volume (PTV for the prostate cases, and 70, 60, and 54 Gy to PTV1, PTV2, and PTV3, respectively, for HN cases. Plans were normalized to 95% of the PTV and PTV1, respectively, with the prescription dose. Plans were assessed using Dose-Volume-Histogram metrics, homogeneity index, conformity index, MUs, and delivery time. Results: For the prostate cases, significant differences were found for rectum D35 between VDR and all CDR plans, except CDR500. Furthermore, VDR was significantly different than CDR100 and 200 for bladder D50. Delivery time for all CDR plans and MUs for CDR400–600 were significantly higher when compared to VDR. HN cases showed significant differences between VDR and CDR100, 500 and 600 for D2 to the cord and brainstem. Significant differences were found for delivery time and MUs for all CDR plans, except CDR100 for number of MUs. Conclusion: The most significant differences were observed in delivery time and number of MUs. All-in-all, the best CDR for prostate cases was found to be 300 MUs/min and 200 or 300 MUs/min for HN cases. However, VDR plans are still the choice in terms of MU efficiency and plan quality.

  3. Dose and volume specification for reporting interstitial therapy

    International Nuclear Information System (INIS)

    1997-01-01

    The ICRU has previously published reports dealing with Dose Specification for Reporting External Beam Therapy with Photons and Electrons (ICRU Report 29, ICRU, 1978), Dose Specification for Reporting External Beam Therapy (ICRU Report 50, ICRU, 1993) and Dose and Volume Specification for Reporting Intracavitary Therapy in Gynecology (ICRU Report 38, ICRU, 1985). The present report addresses the problem of absorbed dose specification for report interstitial therapy. Although specific to interstitial therapy, many of the concepts developed in this report are also applicable to certain other kinds of brachytherapy applications. In particular, special cases of intraluminal brachytherapy and plesio-brachytherapy via surface molds employing x or gamma emitters are addressed in this report

  4. Therapy with radionuclides

    International Nuclear Information System (INIS)

    Biersack, H.J.; Hotze, A.L.

    1992-01-01

    Radioiodine therapy of benign and malignant thyroid diseases is a well-established procedure in Nuclear Medicine. However, the therapeutic use of radioisotopes in other diseases is relatively unknown among our refering physicians. The therapeutic effects of intraarticular (rheumatoid arthritis) and intracavitary (pleural and peritoneal carcinosis) applications yields good results. The radiophosphorus therapy in polycythemia vera rubra has always to be considered as an alternative to chemotherapy. The use of analgetics may be reduced by pain therapy of bone metastasis by injection of bone-seeking beta emitters like Rh-186 HEDP. Other procedures like therapeutic application of meta-iodo-benzylguanidine in neuroblastoma and malignant pheochromocytoma resulted in at least remissions of the disease. Radioimmunotherapy needs further evaluation before it can be recommended as a routine procedure. (orig.) [de

  5. Cytogenetic biodosimetry and dose-rate effect after radioiodine therapy for thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Khvostunov, Igor K. [Russian Ministry of Health Care, A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Obninsk, Kaluga Region (Russian Federation); Nagasaki University, Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki (Japan); Saenko, Vladimir A.; Yamashita, Shunichi [Nagasaki University, Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki (Japan); Krylov, Valeri; Rodichev, Andrei [Russian Ministry of Health Care, A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Obninsk, Kaluga Region (Russian Federation)

    2017-08-15

    This study set out to investigate chromosomal damage in peripheral blood lymphocytes of thyroid cancer patients receiving {sup 131}I for thyroid remnant ablation or treatment of metastatic disease. The observed chromosomal damage was further converted to the estimates of whole-body dose to project the adverse side effects. Chromosomal aberration analysis was performed in 24 patients treated for the first time or after multiple courses. Blood samples were collected before treatment and 3 or 4 days after administration of 2-4 GBq of {sup 131}I. Both conventional cytogenetic and chromosome 2, 4 and 12 painting assays were used. To account for dose-rate effect, a dose-protraction factor was applied to calculate the whole-body dose. The mean dose was 0.62 Gy (95% CI: 0.44-0.77 Gy) in the subgroup of patients treated one time and 0.67 Gy (95% CI: 0.03-1.00 Gy) in re-treated patients. These dose estimates are about 1.7-fold higher than those disregarding the effect of exposure duration. In re-treated patients, the neglected dose-rate effect can result in underestimation of the cumulative whole-body dose by the factor ranging from 2.6 to 6.8. Elevated frequency of chromosomal aberrations observed in re-treated patients before radioiodine therapy allows estimation of a cumulative dose received from all previous treatments. (orig.)

  6. Self-rated health by HIV-infected individuals undergoing antiretroviral therapy in Brazil

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Borges de Souza Junior

    2011-01-01

    Full Text Available In 2008, a survey was applied to a probabilistically selected sample of 1,245 HIV-infected patients on antiretroviral therapy in Brazil. In this work, the analysis was focused on self-rated health. The analysis was conducted according to sex, age, socioeconomic variables, and clinical and treatment-related patient characteristics. Through stepwise logistic regression procedures, the main predictors of good perception of health status were established. Results showed that 65% self-rated health state as good or excellent, 81% do have no or slight difficulty in following treatment, but 34% men and 47% women reported intense or extreme degree of anxiety/worry feelings. Educational level, work situation, presence of side effects and AIDS-related symptoms were the main predictors of good self-perception of health. Problems related to animus status, involving worry and anxiety about the future are still barriers that must be overcome to improve quality of life of people living with HIV/AIDS.

  7. Dosimetric comparison of different dose prescription systems with CT based intracavitary brachytherapy and manual back projection technique to reconstruct the applicator

    International Nuclear Information System (INIS)

    Oinam, A.S.; Dubey, S.; Kehwar, T.S.; Rout, Sanjaya K.; Patel, F.D.; Sharma, S.C.; Goyal, D.R.; Narayan, P.

    2002-01-01

    Intracavitary brachytherapy is one of the well-established techniques for the treatment of carcinoma of cervix. The prediction of late effect of normal tissue like rectum and bladder needs the defining of the volume of the bladder and rectum in situ. In the normal planning of intracavitary and interstitial implants, simulated radiograph films are used to reconstruct the applicator geometry and dose points to represent the dose to critical organs. CT based brachytherapy can define such volume instead of defining dose points, which represent the dose to these critical organs

  8. SU-F-T-62: Three-Dimensional Dosimetric Gamma Analysis for Impacts of Tissue Inhomogeneity Using Monte Carlo Simulation in Intracavitary Brachytheray for Cervix Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Tran Thi Thao; Nakamoto, Takahiro; Shibayama, Yusuke [Graduate School of Medical Sciences, Kyushu University (Japan); Arimura, Hidetaka [Faculty of Medical Sciences, Kyushu University (Japan); Oku, Yoshifumi [Kagoshima University Hospital (Japan); Yoshiura, Takashi [Graduate School of Diagnostic Radiotherapy, Kagoshima University (Japan)

    2016-06-15

    Purpose: The aim of this study was to investigate the impacts of tissue inhomogeneity on dose distributions using a three-dimensional (3D) gamma analysis in cervical intracavitary brachytherapy using Monte Carlo (MC) simulations. Methods: MC simulations for comparison of dose calculations were performed in a water phantom and a series of CT images of a cervical cancer patient (stage: Ib; age: 27) by employing a MC code, Particle and Heavy Ion Transport Code System (PHIT) version 2.73. The {sup 192}Ir source was set at fifteen dwell positions, according to clinical practice, in an applicator consisting of a tandem and two ovoids. Dosimetric comparisons were performed for the dose distributions in the water phantom and CT images by using gamma index image and gamma pass rate (%). The gamma index is the minimum Euclidean distance between two 3D spatial dose distributions of the water phantom and CT images in a same space. The gamma pass rates (%) indicate the percentage of agreement points, which mean that two dose distributions are similar, within an acceptance criteria (3 mm/3%). The volumes of physical and clinical interests for the gamma analysis were a whole calculated volume and a region larger than t% of a dose (close to a target), respectively. Results: The gamma pass rates were 77.1% for a whole calculated volume and 92.1% for a region within 1% dose region. The differences of 7.7% to 22.9 % between two dose distributions in the water phantom and CT images were found around the applicator region and near the target. Conclusion: This work revealed the large difference on the dose distributions near the target in the presence of the tissue inhomogeneity. Therefore, the tissue inhomogeneity should be corrected in the dose calculation for clinical treatment.

  9. Effects of Swedish Massage Therapy on Blood Pressure, Heart Rate, and Inflammatory Markers in Hypertensive Women

    Directory of Open Access Journals (Sweden)

    Izreen Supa’at

    2013-01-01

    Full Text Available Swedish Massage Therapy (SMT is known for its therapeutic relaxation effects. Hypertension is associated with stress and elevated endothelial inflammatory markers. This randomized control trial measured the effects of whole body SMT (massage group or resting (control group an hour weekly for four weeks on hypertensive women. Blood pressure (BP and heart rate (HR were measured before and after each intervention and endothelial inflammatory markers: vascular endothelial adhesion molecules 1 (VCAM-1 and intracellular adhesion molecules 1 (ICAM-1 were measured at baseline and after the last intervention. Massage group (n=8 showed significant systolic BP (SBP reduction of 12 mmHg (P=0.01 and diastolic BP (DBP reduction of 5 mmHg (P=0.01 after four sessions with no significant difference between groups. Reductions in HR were also seen in massage group after sessions 1, 3, and 4 with significant difference between groups. VCAM-1 showed significant reduction after four sessions: the massage group showed reduction of 998.05 ng/mL (P=0.03 and the control group of 375.70 ng/mL (P=0.01 with no significant differences between groups. There were no changes in ICAM-1. In conclusion, SMT or resting an hour weekly has effects on reducing BP, HR, and VCAM-1 in hypertensive women.

  10. Storage container of radium source newly manufactured for trial for intracavitary irradiation of cancer of the uterine cervix, 2

    International Nuclear Information System (INIS)

    Yamamoto, Chiaki; Sasaki, Tsuneo; Tanaka, Yoshiaki

    1977-01-01

    To decrease exposure dose from radium source to operators during the treatment of cancer of the uterine cervix, new-type storage container was manufactured and its usefullness was discussed. The new-type container manufactured for trial houses radium source, for intracavitary irradiation of cancer of the cervix, connecting with TAO-type applicator for afterloading. TLD 1200 Type was used for measurement of radiation dose, and radium 50 mCi was used per one case. The obtained results were as follows: Using the new-type container, 45-60% decrease of exposure dose in the hands and fingers and 44% decrease in the body were obtained. The exposure dose of persons engaged in work of radiotherapy for one week was only 2.2% of the maximum permissible exposure dose, The time treating radium source was shortened to 50% by using the new-type container, and the shortening of that time was a great factor of countermeasures for decreasing exposure dose to operators. From above-mentioned results, the new-type storage container can be put sufficiently to practical use as a storage container of radium source for intracavitary irradiation of cancer of the cervix (when using TAO type afterloading method). (Tsunoda, M.)

  11. Intracavitary dosimetry: a comparison of MGHR prescription to doses at points A and B in cervical cancer

    International Nuclear Information System (INIS)

    Cunningham, D.E.; Stryker, J.A.; Velkley, D.E.; Chung, C.K.

    1981-01-01

    This study, involving 77 patients with carcinoma of the cervix, compares the doses at points A and B with the milligram-hour (mg-h) prescription for the intracavitary use of the Fletcher-Suit after loading applicators. The doses at points A and B were computer calculated. A linear least-square regression analysis was used to compare the two sets of data. Correlation coefficients between doses at points A and B and the mg-h prescription are 0.84 (p < 0.001) and 0.88 (p < 0.001) respectively. The slope of the point A line is 0.78 and the slope of the point B line is 0.24. Therefore, for purposes of a nominal comparison, the dose at point A is approximately 3/4 the mg-h prescription; the dose at point B is approximately 1/4 the mg-h prescription. The limitations and significance of the comparison of the two approaches to intracavitary dosimetry is discussed

  12. Progress in the Full-Text Publication Rate of Orthopaedic and Sport Physical Therapy Abstracts Presented at the American Physical Therapy Association's Combined Sections Meeting.

    Science.gov (United States)

    Warden, Stuart J; Fletcher, Jacquelyn M; Barker, Rick G; Guildenbecher, Elizabeth A; Gorkis, Colleen E; Thompson, William R

    2017-10-07

    Study Design Descriptive study. Background Professional meetings, such as the American Physical Therapy Association's (APTA's) Combined Sections Meeting (CSM), provide forums for sharing information. However, it was reported that only one-quarter of orthopaedic and sports physical therapy abstracts presented at the CSM between 2000 and 2004 went on to full-text publication. This low conversion rate raises a number of concerns regarding the full dissemination of work within the profession. Objectives The purpose of this study was to determine the full-text publication rate of work presented in abstract form at subsequent CSMs and investigate factors influencing the rate. Methods A systematic search was undertaken to locate full-text publications of orthopaedic and sports physical therapy abstracts presented at CSMs between 2005 and 2011. Eligible publications were published within 5 years following abstract presentation. The influences of year of abstract presentation, APTA section, presentation type, institution of origin, study design, and study significance were assessed. Results Over one-third (38.6%) of presented abstracts progressed to full-text publication. Odds of full-text publication increased if the abstract was presented as a platform presentation, originated from a doctorate-granting institution, reported findings of an experimental study, or reported a statistically significant finding. Conclusion The full-text publication rate for orthopaedic and sports physical therapy abstracts presented at recent CSMs has increased by over 50% compared to that reported for the preceding period. The rate is now in the range of that reported in comparable clinical disciplines, demonstrating important progress in the full dissemination of work within the profession. J Orthop Sports Phys Ther, Epub 7 Oct 2017. doi:10.2519/jospt.2018.7581.

  13. Long-term Follow-up Results of a Multi-institutional Phase 2 Study of Concurrent Chemoradiation Therapy for Locally Advanced Cervical Cancer in East and Southeast Asia

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Shingo, E-mail: s_kato@saitama-med.ac.jp [Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama (Japan); National Institute of Radiological Sciences of Japan, Chiba (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Gunma University, Gunma (Japan); Thephamongkhol, Kullathorn; Chansilpa, Yaowalak [Division of Radiation Oncology, Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok (Thailand); Cao, Jianping [School of Radiation Medicine and Public Health, Soochow University, Soochow (China); Xu, Xiaoting [Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow (China); Devi, C. R. Beena; Swee, Tang Tieng [Department of Radiotherapy and Oncology, Hospital Umum Sarawak, Kuching (Malaysia); Calaguas, Miriam J.C. [Department of Radiation Oncology, St. Luke' s Medical Center, Quezon City, the Philippines (Philippines); Reyes, Rey H. de los [Department of Obstetrics and Gynecology, Dr Jose R. Reyes Memorial Medical Center, Manila, the Philippines (Philippines); Cho, Chul-Koo [Department of Radiation Oncology, Korea Cancer Center Hospital, Seoul (Korea, Republic of); Dung, To Anh [Department of Breast and Gynecology Radiotherapy, National Cancer Institute, Hanoi (Viet Nam); Supriana, Nana [Department of Radiation Therapy, Faculty of Medicine, University of Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta (Indonesia); Erawati, Dyah [Division of Radiotherapy, Dr Soetomo General Hospital, Surabaya (Indonesia); Mizuno, Hideyuki [National Institute of Radiological Sciences of Japan, Chiba (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma (Japan); Tsujii, Hirohiko [National Institute of Radiological Sciences of Japan, Chiba (Japan)

    2013-09-01

    Purpose: To report the long-term survival and toxicity of a multi-institutional phase 2 study of concurrent chemoradiation therapy (CCRT) for locally advanced cervical cancer in east and southeast Asia. Methods and Materials: Ten institutions from 8 Asian countries participated in the study. Between April 2003 and March 2006, 120 patients (60 with bulky stage IIB and 60 with stage IIIB) were treated with CCRT. Radiation therapy consisted of pelvic external beam radiation therapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m{sup 2}) were administered during the course of radiation therapy. Treatment results were evaluated by the rates of local control, overall survival, and late toxicities. Results: Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year local control and overall survival rates for all patients were 76.8% and 55.1%, respectively. The 5-year rates of major late toxicities of the rectum and bladder were 7.9% and 0%, respectively. Conclusions: The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in east and southeast Asia. However, further efforts are needed to improve overall survival.

  14. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study

    DEFF Research Database (Denmark)

    LU, Fokdal; Sturdza, Alina; Mazeron, Renaud

    2016-01-01

    Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicat...... IC/IS brachytherapy improves the therapeutic ratio in LACC by enabling a tumour specific dose escalation resulting in significantly higher local control in large tumours without adding treatment related late morbidity.......Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC....../IS) applicators. The aim of this analysis was to evaluate the impact on local control and late morbidity of application of combined IS/IC brachytherapy in a large multicentre population. Material/methods 610 patients with LACC from the retroEMBRACE study were included. Patients were divided into an IC group (N...

  15. Importance of Heart Rate During Exercise for Response to Cardiac Resynchronization Therapy

    NARCIS (Netherlands)

    Maass, Alexander H.; Buck, Sandra; Nieuwland, Wybe; Bruegemann, Johan; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.

    Background: Cardiac resynchronization therapy (CRT) is an established therapy for patients with severe heart failure and mechanical dyssynchrony. Response is only achieved in 60-70% of patients. Objectives: To study exercise-related factors predicting response to CRT. Methods: We retrospectively

  16. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

    International Nuclear Information System (INIS)

    Mitra, Sujata; Muthu, Sonai G.

    2012-01-01

    Radioiodine ( 131 I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after 131 I therapy. The present study was undertaken to reduce treatment failure rate of 131 I therapy in TMNG patients. Multiple causes may have lead to treatment failure of 131 I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with 131 I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with 131 I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to 131 I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post- 131 I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of 131 I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)

  17. Reduction in relapse rate of radioiodine therapy in patients of toxic multinodular goiter: a quality improvement project

    Energy Technology Data Exchange (ETDEWEB)

    Mitra, Sujata; Muthu, Sonai G., E-mail: sujatamitra@tatasteel.com [Department of Nuclear Medicine, Tata Main Hospital, Jamshedpur (India)

    2012-01-15

    Radioiodine ({sup 131}I) therapy is the definitive treatment of toxic multinodular goiter (TMNG). Treatment failure may result in relapse after {sup 131}I therapy. The present study was undertaken to reduce treatment failure rate of {sup 131}I therapy in TMNG patients. Multiple causes may have lead to treatment failure of {sup 131}I in TMNG patients making it difficult to establish a direct cause-effect relationship and take corrective action. Therefore, the JURAN methodology of quality improvement was applied. The treatment failure rate in 80 TMNG patients treated with {sup 131}I in the period 2003-06 was 29%. The root cause analysis identified delay in decision to radioablate and concomitant antithyroid drugs (ATD) with {sup 131}I therapy as factors leading to relapse. In 2007, a change in management was introduced with decision to radioablate all TMNG patients not remitting at 1 year of ATD and to withdraw ATD for 2 weeks prior to {sup 131}I therapy. A total of 63 patients of TMNG followed the changed protocol between 2007 and 2009. Further analysis showed that one of the factors identified in the initial brainstorming (high iodide pool in the patient) had not been addressed in the protocol currently followed. The protocol was modified to include patient preparation and implemented after standardization. The post-{sup 131}I relapse rate in patients treated after implementation of the new protocol from 2007 to 2009 was 18% which further reduced to 16% in 2011 after modification of the protocol. The failure rate of {sup 131}I therapy in TMNG reduced from 29% to 16% through standardization of the treatment procedure achieved by the use of Juran Methodology that helped to identify process-related defects. (author)

  18. Clinical experience with the MammoSite[reg] radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial

    International Nuclear Information System (INIS)

    Niehoff, Peter; Polgar, Csaba; Ostertag, Horst; Major, Tibor; Sulyok, Zoltan; Kimmig, Bernhard; Kovacs, Gyoergy

    2006-01-01

    Background and purpose: In a prospective multi-center phase II trial, we investigated the MammoSite[reg] Radiation Therapy System, a new device for delivering intracavitary brachytherapy following breast conserving surgery. The MammoSite[reg] is a dual lumen, closed ended catheter with a small, spherical inflatable balloon and a port for connecting a remote afterloader to the central lumen. We analyzed the surgical procedure and placement of the MammoSite[reg], treatment planning and radiation delivery complications and cosmesis, as well the comfort for the patients. Patients and methods: Between 2002 and 2004 a total of 32 patients (pts) were implanted using the MammoSite[reg]. The reference isodose was defined 1 cm from the balloon surface. We analyzed the post-implant anatomic position of the applicator and the geometric form of the balloon via ultrasound, CT and X-ray, related side effects, cosmetic outcome and patient quality of life. Results: Twenty-three out of 32 patients (72%) were eligible for MammoSite[reg] intracavitary brachytherapy. Twenty-eight percentage had to be excluded because of different reasons. Eleven patients were treated with primary brachytherapy with a total dose of 34 Gy (2x3.4 Gy) and 12 had a boost with a mean dose of 13.3 Gy (range: 7.5-15 Gy; 2x2.5 Gy) combined with EBRT and doses ranged between 46 and 50 Gy. In three cases a balloon rupture occurred. We observed two abscesses within 3 months of implantation and serious seroma development in 10 patients (39%). Skin related side effects were erythema in 21 patients (91%), hyperpigmentation in 13 patients (56%) and teleangiectasia in six patients (26%) after mean follow-up 20 months. Conclusions: The MammoSite[reg] Radiation Therapy System is a feasible treatment modality for intracavitary brachytherapy of breast cancer after breast conserving surgery. The advantage of the system is only one applicator is necessary for the delivery of a fractionated radiotherapy. In addition, patient

  19. Impact of 'optimized' treatment planning for tandem and ring, and tandem and ovoids, using high dose rate brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Noyes, William R.; Peters, Nancy E.; Thomadsen, Bruce R.; Fowler, Jack F.; Buchler, Dolores A.; Stitt, Judith A.; Kinsella, Timothy J.

    1995-01-01

    Purpose: Different treatment techniques are used in high dose rate (HDR) remote afterloading intracavitary brachytherapy for uterine cervical cancer. We have investigated the differences between 'optimized' and 'nonoptimized' therapy using both a tandem and ring (T/R) applicator, and a tandem and ovoids (T/O), applicator. Methods and Materials: HDR afterloading brachytherapy using the Madison System for Stage IB cervical cancer was simulated for 10 different patients using both a T/R applicator and a T/O applicator. A treatment course consists of external beam irradiation and five insertions of HDR afterloading brachytherapy. Full dosimetry calculations were performed at the initial insertion for both applicators and used as a reference for the following four insertions of the appropriate applicator. Forty dosimetry calculations were performed to determine the dose delivered to Point M (similar to Point A), Point E (obturator lymph nodes), vaginal surface, bladder, and rectum. 'Optimized' doses were specified to Point M and to the vaginal surface. 'Nonoptimized' doses were specified to Point M only. Using the linear-quadratic equation, calculations have been performed to convert the delivered dose using HDR to the biologically equivalent doses at the conventional low dose rate (LDR) at 0.60 Gy/h. Results: Major differences between 'optimized' and 'nonoptimized' LDR equivalent doses were found at the vaginal surface, bladder, and rectum. Overdoses at the vaginal surface, bladder, and rectum were calculated to be 208%, nil, and 42%, respectively, for the T/R applicator with 'nonoptimization'. However, for the T/O applicator, the overdoses were smaller, being nil, 32%, and 27%, respectively, with 'nonoptimization'. Conclusion: Doses given in high dose rate intracavitary brachytherapy border on tissue tolerance. 'Optimization' of either applicator decreases the risk of a dose that may have potential for complications. Optimization of a tandem and ovoids best ensures

  20. A method of quality audit for treatment planning system for intracavitary HDR brachytherapy

    International Nuclear Information System (INIS)

    Sharma, S.D.; Vandana, S.; Philomina, A.; Kannan, S.; Rituraj, U.

    2007-01-01

    High dose rate brachytherapy is a multipurpose modality. Quality audit (QAu) is an independent examination and evaluation of quality assurance activities and results of an institution. Both clinical and physical aspects of patient treatments must be subjected to careful control and planning to achieve a high degree of accuracy in radiation therapy treatments. Comprehensive quality assurance (QA) programmes should be established to cover all steps from dose prescription to dose delivery. These programmes should include detailed internal checks performed by the radiotherapy centres and external audits made by independent bodies. A systematic and independent examination and evaluation to determine whether quality activities and results comply with planned arrangements and whether the arrangements are implemented effectively and are suitable to achieve objectives is called quality audit. One purpose of a quality audit (QAu) is to evaluate the need for improvement or corrective action

  1. Interferon alpha therapy for hepatitis C: treatment completion and response rates among patients with substance use disorders

    Directory of Open Access Journals (Sweden)

    Loftis Jennifer M

    2007-01-01

    Full Text Available Abstract Background Individuals with substance use disorders (SUDs are at increased risk for hepatitis C viral infection (HCV, and few studies have explored their treatment responses empirically. The objective of this study was to assess interferon alpha therapy (IFN completion and response rates among patients with HCV who had a history of comorbid SUDs. More data is needed to inform treatment strategies and guidelines for these patients. Using a medical record database, information was retrospectively collected on 307,437 veterans seen in the Veterans Integrated Service Network 20 (VISN 20 of the Veterans Healthcare Administration (VHA between 1998 and 2003. For patients treated with any type of IFN (including regular or pegylated IFN or combination therapy (IFN and ribavirin who had a known HCV genotype, IFN completion and response rates were compared among patients with a history of SUD (SUD+ Group and patients without a history of SUD (SUD- Group. Results Odds ratio analyses revealed that compared with the SUD- Group, the SUD+ Group was equally likely to complete IFN therapy if they had genotypes 2 and 3 (73.1% vs. 68.0%, and if they had genotypes 1 and 4 (39.5% vs. 39.9%. Within the sample of all patients who began IFN therapy, the SUD- and SUD+ groups were similarly likely to achieve an end of treatment response (genotypes 2 and 3, 52.8% vs. 54.3%; genotypes 1 and 4, 24.5% vs. 24.8% and a sustained viral response (genotypes 2 and 3, 42.6% vs. 41.1%; genotypes 1 and 4: 16.0% vs. 22.3%. Conclusion Individuals with and without a history of SUD responded to antiviral therapy for HCV at similar rates. Collectively, these findings suggest that patients who have co-morbid SUD and HCV diagnoses can successfully complete a course of antiviral therapy.

  2. Variations of intracavitary applicator geometry during multiple HDR brachytherapy insertions in carcinoma cervix and its influence on reporting as per ICRU report 38

    International Nuclear Information System (INIS)

    Datta, Niloy Ranjan; Kumar, Shaleen; Das, Koilpillai Joseph Maria; Pandey, Chandra Mani; Halder, Shikha; Ayyagari, Sunder

    2001-01-01

    Purpose: This paper examines the extent of variation in the applicator geometry during multiple high dose rate (HDR) intracavitary brachytherapy (ICBT) applications and its impact on reporting as per ICRU report 38. Materials and methods: Eighty orthogonal radiographs from 20 consecutive patients of carcinoma cervix (FIGO stages, IIA-IIIB) having four HDR ICBT applications of 6 Gy each at weekly intervals following teletherapy were evaluated. The applicator consisted of a flexible intrauterine tandem (IUT) independent of the ovoid assembly. The applicator geometry was evaluated in terms of: α angle, β angle, intrauterine length (IUTL), interovoid (IOV), os to right ovoid (ORT) and os to left ovoid (OLT) distances along with vertical (VDL) and anteroposterior displacements (ADL) of the os with respect to the ovoids. The Cartesian co-ordinates (X, Y, and Z) of the IUT tip, centre of both ovoids and os were also measured. Doses to right point A (ARD), left point A (ALD), along with a reference volume of 6 Gy for ICRU height (IRH), width (IRW), thickness (IRT) and volume (IRV) were estimated for each application. Results: Highly significant differences (P<0.001) between four insertions in any given patient across 20 patients for α angle, β angle, IUTL, IOV, ORT, VDL, co-ordinates of the IUT, ovoids and os were observed, except for ADL (P=0.041) and OLT (P=0.247). As a consequence, variations were observed in ARD (P=0.027), ALD (P=0.017); IRH, IRW, IRT and IRV (all P<0.001). Applicator factors which influenced the various dose specification parameters were: β angle and ORT for both ARD and ALD; UTLN, VDL and ORT for IRH; UTLN and IOV for IRW; UTLN for IRT and VDL for the 6 Gy IRV. Conclusions: A significant variation of the applicator geometry and its movement was observed in patients undergoing multiple HDR ICBT. This could have implications for reporting dose and volume specifications as required by ICRU report 38

  3. Dosimetric evaluation of rectum and bladder using image-based CT planning and orthogonal radiographs with ICRU 38 recommendations in intracavitary brachytherapy

    Directory of Open Access Journals (Sweden)

    Jamema Swamidas

    2008-01-01

    Full Text Available The purpose is to compare CT-based dosimetry with International Commission on Radiation Units and Measurements (ICRU 38 bladder and rectum reference points in patients of carcinoma of uterine cervix treated with intracavitary brachytherapy (ICA. Twenty-two consecutive patients were evaluated. Orthogonal radiographs and CT images were acquired and transferred to PLATO planning system. Bladder and rectal reference points were identified according to ICRU 38 recommendations. Dosimetry was carried out based on Manchester system. Patient treatment was done using 192 Iridium high dose rate (HDR remote after-loading machine based on the conventional radiograph-based dosimetry. ICRU rectal and bladder point doses from the radiograph plans were compared with D 2 , dose received by 2 cm 3 of the organ receiving maximum dose from CT plan. V 2 , volume of organ receiving dose more than the ICRU reference point, was evaluated. The mean (±standard deviation volume of rectum and bladder was 60 (±28 cm 3 and 138 (±41 cm 3 respectively. The mean reference volume in radiograph and CT plan was 105 (±7 cm 3 and 107 (±7 cm 3 respectively. It was found that 6 (±4 cm3 of rectum and 16 (±10 cm 3 of bladder received dose more than the prescription dose. V2 of rectum and bladder was 7 (±1.7 cm 3 and 20.8 (±6 cm 3 respectively. Mean D 2 of rectum and bladder was found to be 1.11 (±0.2 and 1.56 (±0.6 times the mean ICRU reference points respectively. This dosimteric study suggests that comparison of orthogonal X-ray-based and CT-based HDR ICA planning is feasible. ICRU rectal point dose correlates well with maximum rectal dose, while ICRU bladder point underestimates the maximum bladder dose.

  4. A study on the variation of bladder and rectal doses with respiration in intracavitary brachytherapy for cervix cancer

    Directory of Open Access Journals (Sweden)

    Singh Karuna

    2010-04-01

    Full Text Available Purpose: In cervical intracavitary brachytherapy, it is mandatory to evaluate if the doses to bladder and rectum are within tolerance limits. In this study, an effort has been made to evaluate the effect of respiration on the doses to bladder and rectum in patients undergoing brachytherapy.Material and methods: Fifteen patients with cervix cancer treated with concurrent chemoradiation followed by intracavitary brachytherapy were included in this study. At the time of brachytherapy, all patients underwent 4D computed tomography (CT imaging. Five out of fifteen patients were scanned with empty bladder while the rest had full bladder during sectional imaging. Four sets of pelvic CT image datasets with applicators in place were acquired at equal interval in a complete respiratory cycle. Treatment plans were generated for all the CT datasets on a PlatoTM Sunrise planning system. A dose of 7 Gy was prescribed to Point A. Doses to ICRU (Report No.38 bladder (IBRP and rectal (IRRP reference points were calculated in all the CT datasets.Results: The mean of maximum dose to IBRP at four different respiratory phases for full and empty bladder were 53.38 ± 19.20%, 55.75 ± 16.71%, 56.13 ± 17.70%, 57.50 ± 17.48% and 60.93 ± 15.18%, 60.29 ± 16.28%, 60.86 ± 15.90%, 60.82 ± 15.42% of the prescribed dose respectively. Similarly, maximum dose to IRRP for full and empty bladder were 55.50 ± 18.66%, 57.38 ± 14.81%, 58.00 ± 14.97%, 58.38 ± 17.28% and 71.96 ± 6.90%, 71.58 ± 7.52%, 68.92 ± 6.21%, 71.45 ± 7.16% respectively.Conclusions: Our study shows that respiration affects the dose distribution to the bladder and rectum in intracavitary brachytherapy of cervix cancer. It is advisable to reduce the critical organ dose to account for the dose variation introduced by respiratory motion.

  5. Cytomorphological monitoring in multimodality therapy of endometral cancer patients

    International Nuclear Information System (INIS)

    Galil-Ogly, G.A.; Titova, V.A.; Yarovaya, N.Yu.; Ingberman, Ya.Kh.; Bershchanskaya, A.M.; Pukhlikov, A.V.

    1990-01-01

    The paper is devoted to analysis of clinicomorphological data on the status of a primary endometrial tumor in 209 endometrial cancer patients, treated by radical and palliative radiation therapy (112 patients) and the combined method (88 patients) including preoperative intensive concentrated intracavitary irradiation and hormonotherapy. Dynamic cytological monitoring was performed during radiation therapy and in a period up to 12 mos. after the discontinuation of antitumor therapy. Dynamic cytomorphological monitoring is an important stage in patients who cannot be operated upon as a result of tumor spreading or somatic contraindications

  6. Vaginal bacterial flora of patients with operated endometrial carcinoma prior to and following intracavitary vaginal irradiation (Ir-192, afterloading)

    International Nuclear Information System (INIS)

    Gerstner, G.; Kucera, H.; Weghaupt, K.; Rotter, M.; Vienna Univ.; Vienna Univ.

    1982-01-01

    In a prospective bacteriological and clinical study the vaginal bacterial flora of 35 patients with endometrial carcinoma, who underwent surgery 4 to 6 weeks earlier, was investigated prior to and following intracavitary vaginal irradiation with 10 Gy in 0,75 cm (Ir-192, afterloading device, Buchler). Bacteriological swabs were taken prior to and following the insertion of a tube applicator. Anaerobic transport-media were used and cultures were performed aerobically and anaerobically. The mean number of aerobic species per patient increased slightly from 3.26 to 3.60 (n.s.), anaerobic species remained constant (1.36 before and 1.30 after irradiation). Also the frequency of isolation of most aerobic and of all anaerobic species was statistically not altered following irradiation. Staphylococcus epidermidis decreased from 51.4% to 22.8% significantly (2p [de

  7. A comparison of mghr prescription to doses at points A and B in intracavitary radiotherapy of cervix cancer

    International Nuclear Information System (INIS)

    Park, C.I.; Ha, S.W.; Kang, W.S.

    1981-01-01

    The 42 patients with carcinoma of the cervix, performed intracavitary radiotherapy, were analysed the doses at points A and B comparing to the mghr prescription. The doses at points A and B were calculated by PC-12 computer planning system. Correlation coefficiency between doses at points A and B and the mghr prescription are 0.82 (p<0.001) and 0.90 (p<0.001) respectively. The slope of the point A line is 0.70 and the slope of the point B is 0.21. Therefore, the dose at point A is approximately 3/4 the mghr prescription and the dose at point B is approximately 1/4 the mghr prescription. (author)

  8. Can we improve partner notification rates through expedited partner therapy in the UK? Findings from an exploratory trial of Accelerated Partner Therapy (APT).

    Science.gov (United States)

    Estcourt, Claudia; Sutcliffe, Lorna; Cassell, Jackie; Mercer, Catherine H; Copas, Andrew; James, Laura; Low, Nicola; Horner, Patrick; Clarke, Michael; Symonds, Merle; Roberts, Tracy; Tsourapas, Angelos; Johnson, Anne M

    2012-02-01

    To develop two new models of expedited partner therapy for the UK, and evaluate them for feasibility, acceptability and preliminary outcome estimates to inform the design of a randomised controlled trial (RCT). Two models of expedited partner therapy (APTHotline and APTPharmacy), known as 'Accelerated Partner Therapy' (APT) were developed. A non-randomised comparative study was conducted of the two APT models and routine partner notification (PN), in which the index patient chose the PN option for his/her partner(s) in two contrasting clinics. The proportion of contactable partners treated when routine PN was chosen was 42/117 (36%) and was significantly higher if either APT option was chosen: APTHotline 80/135 (59%), p=0.003; APTPharmacy 29/44 (66%) p=0.001. However, partner treatment was often achieved through other routes. Although 40-60% of partners in APT groups returned urine samples for sexually transmitted infection (STI) testing, almost none accessed HIV and syphilis testing. APT options appear to facilitate faster treatment of sex partners than routine PN. Preferences and recruitment rates varied between sites, related to staff satisfaction with existing routine PN; approach to consent; and possibly, characteristics of local populations. Both methods of APT were feasible and acceptable to many patients and led to higher rates of partner treatment than routine PN. Preferences and recruitment rates varied greatly between settings, suggesting that organisational and cultural factors may have an important impact on the feasibility of an RCT and on outcomes. Mindful of these factors, it is proposed that APT should now be evaluated in a cluster RCT.

  9. The effects of short-term relaxation therapy on indices of heart rate variability and blood pressure in young adults.

    Science.gov (United States)

    Pal, Gopal Krushna; Ganesh, Venkata; Karthik, Shanmugavel; Nanda, Nivedita; Pal, Pravati

    2014-01-01

    Assessment of short-term practice of relaxation therapy on autonomic and cardiovascular functions in first-year medical students. Case-control, interventional study. Medical college laboratory. Sixty-seven medical students, divided into two groups: study group (n = 35) and control group (n = 32). Study group subjects practiced relaxation therapy (shavasana with a soothing background music) daily 1 hour for 6 weeks. Control group did not practice relaxation techniques. Cardiovascular parameters and spectral indices of heart rate variability (HRV) were recorded before and after the 6-week practice of relaxation therapy. The data between the groups and the data before and after practice of relaxation techniques were analyzed by one-way analysis of variance and Student t-test. In the study group, prediction of low-frequency to high-frequency ratio (LF-HF) of HRV, the marker of sympathovagal balance, to blood pressure (BP) status was assessed by logistic regression. In the study group, there was significant reduction in heart rate (p = .0001), systolic (p = .0010) and diastolic (p = .0021) pressure, and rate pressure product (p linked to BP status in these individuals.

  10. Placebo response and remission rates in randomised trials of induction andmaintenance therapy for ulcerative colitis

    NARCIS (Netherlands)

    Jairath, Vipul; Zou, G. Y.; Parker, Claire E.; Macdonald, John K.; AlAmeel, Turki; Al Beshir, Mohammad; Almadi, Majid A.; Al-Taweel, Talal; Atkinson, Nathan S. S.; Biswas, Sujata; Chapman, Thomas; Dulai, Parambir S.; Glaire, Mark A.; Hoekman, Daniel R.; Koutsoumpas, Andreas; Minas, Elizabeth; Mosli, Mahmoud H.; Samaan, Mark; Khanna, Reena; Travis, Simon; D'Haens, Geert; Sandborn, William J.; Feagan, Brian G.

    2017-01-01

    Background It is important to minimize placebo rates in randomised controlled trials (RCTs) to efficiently detect treatment differences between interventions. Historically, high placebo rates have been observed in clinical trials of ulcerative colitis (UC). A better understanding of factors

  11. Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial.

    Science.gov (United States)

    Fealy, Nigel; Aitken, Leanne; du Toit, Eugene; Lo, Serigne; Baldwin, Ian

    2017-10-01

    To determine whether blood flow rate influences circuit life in continuous renal replacement therapy. Prospective randomized controlled trial. Single center tertiary level ICU. Critically ill adults requiring continuous renal replacement therapy. Patients were randomized to receive one of two blood flow rates: 150 or 250 mL/min. The primary outcome was circuit life measured in hours. Circuit and patient data were collected until each circuit clotted or was ceased electively for nonclotting reasons. Data for clotted circuits are presented as median (interquartile range) and compared using the Mann-Whitney U test. Survival probability for clotted circuits was compared using log-rank test. Circuit clotting data were analyzed for repeated events using hazards ratio. One hundred patients were randomized with 96 completing the study (150 mL/min, n = 49; 250 mL/min, n = 47) using 462 circuits (245 run at 150 mL/min and 217 run at 250 mL/min). Median circuit life for first circuit (clotted) was similar for both groups (150 mL/min: 9.1 hr [5.5-26 hr] vs 10 hr [4.2-17 hr]; p = 0.37). Continuous renal replacement therapy using blood flow rate set at 250 mL/min was not more likely to cause clotting compared with 150 mL/min (hazards ratio, 1.00 [0.60-1.69]; p = 0.68). Gender, body mass index, weight, vascular access type, length, site, and mode of continuous renal replacement therapy or international normalized ratio had no effect on clotting risk. Continuous renal replacement therapy without anticoagulation was more likely to cause clotting compared with use of heparin strategies (hazards ratio, 1.62; p = 0.003). Longer activated partial thromboplastin time (hazards ratio, 0.98; p = 0.002) and decreased platelet count (hazards ratio, 1.19; p = 0.03) were associated with a reduced likelihood of circuit clotting. There was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy.

  12. Stadium IB - IIA cervical cancer patient’s survival rate after receiving definitive radiation and radical operation therapy followed by adjuvant radiation therapy along with analysis of factors affecting the patient’s survival rate

    Science.gov (United States)

    Ruslim, S. K.; Purwoto, G.; Widyahening, I. S.; Ramli, I.

    2017-08-01

    To evaluate the characteristics and overall survival rates of early stage cervical cancer (FIGO IB-IIA) patients who receive definitive radiation therapy and those who are prescribed adjuvant postoperative radiation and to conduct a factors analysis of the variables that affect the overall survival rates in both groups of therapy. The medical records of 85 patients with cervical cancer FIGO stages IB-IIA who were treated at the Department of Radiotherapy of Cipto Mangunkusumo Hospital were reviewed and analyzed to determine their overall survival and the factors that affected it between a definitive radiation group and an adjuvant postoperative radiation group. There were 25 patients in the definitive radiation and 60 patients in the adjuvant radiation group. The overall survival rates in the adjuvant radiation group at years one, two, and three were 96.7%, 95%, and 93.3%, respectively. Negative lymph node metastasis had an average association with overall survival (p 12 g/dl was a factor with an average association with the overall survival (p cervical cancer FIGO stage IB-IIA patients who received definitive radiation or adjuvant postoperative radiation. Negative lymph node metastasis had an effect on the overall survival rate in the adjuvant postoperative radiation group, while a preradiation Hb level >12 g/dl tended to affect the overall survival in the definitive radiation group patients.

  13. Endoscope-guided interstitial intensity-modulated brachytherapy and intracavitary brachytherapy as boost radiation for primary early T stage nasopharyngeal carcinoma.

    Directory of Open Access Journals (Sweden)

    Xiang-Bo Wan

    Full Text Available BACKGROUND: Intracavitary brachytherapy (ICBT is usually applied as boost radiotherapy for superficial residual of nasopharyngeal carcinoma (NPC after primary extern-beam radiptherapy (ERT. Here, we evaluated the outcome of endoscope-guided interstitial intensity-modulated brachytherapy (IMBT boost radiation for deep-seated residual NPC. METHODOLOGY/PRINCIPAL FINDINGS: Two hundred and thirteen patients with residual NPC who were salvaged with brachytherapy boost radiation during 2005-2009 were analyzed retrospectively. Among these patients, 171 patients had superficial residual NPC (≤1 cm below the nasopharyngeal epithelium were treated with ICBT boost radiation, and interstitial IMBT boost radiation was delivered to 42 patients with deep-seated residual NPC (>1 cm below the nasopharyngeal epithelium. We found that IMBT boost subgroup had a higher ratio of T2b (81.0% VS 34.5%, P<0.001 and stage II (90.5% VS 61.4%, P = 0.001 than that of ICBT boost subgroup. The dosage of external-beam radiotherapy in the nasopharyngeal (63.0±3.8 VS 62.6±4.3 Gray (Gy, P = 0.67 and regional lymph nodes (55.8±5.0 VS 57.5±5.7 Gy, P = 0.11 was comparable in both groups. For brachytherapy, IMBT subgroup had a lower boost radiation dosage than ICBT subgroup (11.0±2.9 VS 14.8±3.2 Gy, P<0.01. Though the IMBT group had deeper residual tumors and received lower boost radiation dosages, both subgroups had the similar 5-year actuarial overall survival rate (IMBT VS ICBT group: 96.8% VS 93.6%, P = 0.87, progression-free survival rate (92.4% VS 86.5%, P = 0.41 and distant metastasis-free survival rate (94.9% VS 92.7%, P = 0.64. Moreover, IMBT boost radiation subgroup had a similar local (97.4% VS 94.4%, P = 0.57 and regional (95.0% VS 97.2%, P = 0.34 control to ICBT subgroup. The acute and late toxicities rates were comparable between the both subgroups. CONCLUSIONS/SIGNIFICANCE: IMBT boost radiation may be a promising therapeutic

  14. External beam and HDR intracavitary irradiation: an effective tool in the primary treatment of cervical cancer - excellent 10 year results and low side effects

    International Nuclear Information System (INIS)

    Hammer, J.; Zoidl, J.P.; Track, C.; Seewald, D.H.; Labeck, W.

    1996-01-01

    Introduction: The purpose of this paper is to present our 15 years experience in the primary treatment of cervical cancer with a combination of external beam irradiation and high dose rate brachytherapy. Survival data will be presented and the safe use of intrauterine HDR applications will be demonstrated. Material and Methods: From August 1980 to December 1990, 303 patients with cancer of the uterine cervix underwent primary irradiation in a combination of external beam and HDR intracavitary treatment at the Department of Radiation Oncology at the Sisters of Mercy Hospital in Linz, Austria. All patients were classified according to the FIGO rules: Stage I 54 patients, stage II 171, stage III 75 and stage IV 3 patients. 8 patients were lost to follow up. The mean follow up time of survivors is 110 months. Results and Discussion: A complete remission could be achieved in 282 patients, which is 93%; persistent tumour was found in 21 patients at the first follow up check 3 to 5 months after completion of irradiation. The actuarial overall survival probability for all patients at 5 and 10 years is 62 % and 42 % respectively, the disease specific survival probability is 68 % and 64 %. The local control rate at 5 and 10 years is 73 % and 72 % respectively. According to stage, disease specific survival lies at 90 % for stage I, 69 % for stage II, and 48 % for stage III and IV at 5 years, and at 10 years 87 %, 66 % and 41 % respectively. The actuarial local control probability for stages I, II, and III/IV is 90 %, 74 %, and 60 % respectively at 5 yr, and 88 %, 74 %, and 56 % at 10 yr. (Kaplan-Meier calculations). From all 303 patients 34 suffered from 40 severe and moderate side effects (glossary of Chassagne and Sismondi). The rate for grade II complications is 10 % and for grade III 3 %. Conclusion: Intrauterine HDR brachycurietherapy in addition to external beam irradiation for primary treatment of invasive carcinoma of the uterine cervix provides the same treatment

  15. External beam and HDR intracavitary irradiation: an effective tool in the primary treatment of cancer of the uterine cervix - excellent 10 year results and low side effects

    International Nuclear Information System (INIS)

    Hammer, Josef; Zoidl, Johann P.; Track, Christine; Seewald, Dietmar H.; Labeck, Werner

    1996-01-01

    Purpose/Objective: The purpose of this paper is to present our 15 years experience in the primary treatment of cervical cancer with a combination of external beam irradiation and high dose rate brachytherapy. Survival data will be presented and the safe use of intrauterine HDR applications will be demonstrated. Material and Methods: From August 1980 to December 1990, 303 patients with cancer of the uterine cervix underwent primary irradiation in a combination of external beam and HDR intracavitary treatment at the Department of Radiation Oncology at the Sisters of Mercy Hospital in Linz, Austria. All patients were classified according to the FIGO rules: Stage I 54 patients, stage II 171, stage III 75 and stage IV 3 patients. 8 patients were lost to follow up. The mean follow up time of survivors is 110 months. Results: A complete remission could be achieved in 282 patients (93%); persistent tumour was found in 21 patients at the first follow up check 3 to 5 months after completion of irradiation. The actuarial overall survival probability for all patients at 5 and 10 years is 62 % and 49 % respectively, the disease specific survival probability is 68 % and 64 %. The local control rate at 5 and 10 years is 73 % and 72 % respectively. According to stage, disease specific survival lies at 90 % for stage I, 69 % for stage II, and 49 % for stage III and IV at 5 years, and at 10 years 87 %, 66 % and 41 % respectively. The actuarial local control probability for stages I, II, and III/IV is 90 %, 74 %, and 60 % respectively at 5 years, and 88 %, 74 %, and 57 % at 10 years (Kaplan-Meier calculations). From all 303 patients 34 suffered from 40 severe and moderate side effects (glossary of Chassagne and Sismondi). The rate for grade II complications is 10 % and for grade III 3 %. Conclusion: Intrauterine HDR brachycurietherapy in addition to external beam irradiation for primary treatment of invasive carcinoma of the uterine cervix provides the same treatment results as LDR

  16. Binocular Rivalry Measured 2 Hours After Occlusion Therapy Predicts the Recovery Rate of the Amblyopic Eye in Anisometropic Children.

    Science.gov (United States)

    Lunghi, Claudia; Morrone, Maria Concetta; Secci, Jacopo; Caputo, Roberto

    2016-04-01

    Recent studies on adults have shown that short-term monocular deprivation boosts the deprived eye signal in binocular rivalry, reflecting homeostatic plasticity. Here we investigate whether homeostatic plasticity is present also during occlusion therapy for moderate amblyopia. Binocular rivalry and visual acuity (using Snellen charts for children) were measured in 10 children (mean age 6.2 ± 1 years) with moderate anisometropic amblyopia before the beginning of treatment and at four intervals during occlusion therapy (2 hours, 1, 2, and 5 months). Visual stimuli were orthogonal gratings presented dichoptically through ferromagnetic goggles and children reported verbally visual rivalrous perception. Bangerter filters were applied on the spectacle lens over the best eye for occlusion therapy. Two hours of occlusion therapy increased the nonamblyopic eye predominance over the amblyopic eye compared with pretreatment measurements, consistent with the results in adults. The boost of the nonamblyopic eye was still present after 1 month of treatment, steadily decreasing afterward to reach pretreatment levels after 2 months of continuous occlusion. Across subjects, the increase in nonamblyopic eye predominance observed after 2 hours of occlusion correlated (rho = -0.65, P = 0.04) with the visual acuity improvement of the amblyopic eye measured after 2 months of treatment. Homeostatic plasticity operates during occlusion therapy for moderate amblyopia and the increase in nonamblyopic eye dominance observed at the beginning of treatment correlates with the amblyopic eye recovery rate. These results suggest that binocular rivalry might be used to monitor visual cortical plasticity during occlusion therapy, although further investigations on larger clinical populations are needed to validate the predictive power of the technique.

  17. High-dose-rate afterloading brachytherapy in carcinoma of the cervix: an experience of 1992 patients

    International Nuclear Information System (INIS)

    Lorvidhaya, Vicharn; Tonusin, Anun; Changwiwit, Witit; Chitapanarux, Imjai; Srisomboon, Jatupol; Wanwilairat, Somsak; Chawapun, Nisa; Sukthomya, Vimol

    2000-01-01

    Purpose: To report the results of radiation therapy in carcinoma of the cervix treated by external irradiation and high-dose-rate (HDR) intracavitary brachytherapy. Methods and Materials: This is a retrospective analysis of 2063 patients with histologically proven carcinoma of the cervix treated by external irradiation and HDR intracavitary brachytherapy between March 1985-December 1991. The Kaplan-Meier method was used for survival and disease-free survival analysis. Late complications in the bowel and bladder were calculated actuarially. Results: There were 71 patients who did not complete the course of irradiation so only 1992 patients were retrospectively analyzed for survival. There were 2 patients (0.1%) in Stage IA, 211 (10.2%) Stage IB, 225 (10.9%) in Stage IIA, 902 (43.7%) in Stage IIB, 14 (0.7%) in Stage IIIA, 675 (32.7%) in Stage IIIB, 16 (0.8%) in Stage IVA, and 16 (0.8%) in Stage IVB. The median follow-up time was 96 months. The actuarial 5-year disease-free survival rate was 79.5%, 70.0%, 59.4%, 46.1%, 32.3%, 7.8%, and 23.1% for Stage IB, IIA, IIB, IIIA, IIIB, IVA, and IVB respectively. The actuarial 5-year disease-free survival rate for Stage IB 1 and IB 2 squamous cell carcinoma was 88.7% and 67.0%. The actuarial 5-year overall survival rate was 86.3%, 81.1%, 73.0%, 50.3%, 47.8%, 7.8%, and 30.8% for Stage IB, IIA, IIB, IIIA, IIIB, IVA, and IVB respectively. Pattern of failure revealed 20.8% local recurrence, 18.7% distant metastases, and 4% in both. The late complication rate Grade 3 and 4 (RTOG) for bowel and bladder combined was 7.0% with 1.9% Grade 4. Conclusion: HDR brachytherapy used in this series produced pelvic control and survival rates comparable to other LDR series

  18. An optimized clarithromycin-free 14-day triple therapy for Helicobacter pylori eradication achieves high cure rates in Uruguay.

    Science.gov (United States)

    Dacoll, Cristina; Sánchez-Delgado, Jordi; Balter, Henia; Pazos, Ximena; Di Pace, María; Sandoya, Gabriela; Cohen, Henry; Calvet, Xavier

    Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme. The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole. Patients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40mg twice a day plus amoxicillin 1g and metronidazole 500mg, both three times a day. H. pylori cure was assessed by UBT. Forty-one patients were enrolled. Mean age was 53.3±13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4-92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2-99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache). Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT. Copyright © 2017 Elsevier España, S

  19. Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients?

    Science.gov (United States)

    Didona, Annamaria; Lancellotta, Valentina; Zucchetti, Claudio; Panizza, Bianca Moira; Frattegiani, Alessandro; Iacco, Martina; Di Pilato, Anna Concetta; Saldi, Simonetta; Aristei, Cynthia

    2018-01-01

    Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle 3 TPS (v 9.8) using 6 MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66 Gy, 60 Gy and 54 Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs ( D mean , D 2% , D 50% , D 95% , D 98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times. Compared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D 98% and D 95% . It significantly spared parotid and submandibular glands and was associated with a lower D mean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better D mean , to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the D mean to the larynx was also worse

  20. Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence

    DEFF Research Database (Denmark)

    Roerholt, C; Eiken, P; Abrahamsen, Bo

    2009-01-01

    initiation within 1 year was highest after spine fracture: 39.6% of women began therapy in 2004 compared with 19.5% in 1997. In men, 16.5% began therapy in 2004 vs. 8.0% in 1997. Following hip fracture, 9.2% of women and 4.1% of men began therapy in 2004 vs. 3.4% and 0.7% in 1997, respectively. Median...... or weekly alendronate obtaining treatment durations equalling those of the licensing trials. INTRODUCTION: Reducing the societal fracture burden remains challenging due to failure to treat fragility fractures and non-compliance with treatment. METHODS: We used national registers to identify patients born...... persistence (years) was 2.8 for daily alendronate, 3.8 for weekly alendronate, 2.5 for etidronate and 4.7 for raloxifene. The risk of discontinuing or changing therapy increased with age. CONCLUSIONS: Prescription rates for anti-osteoporotic medication are very low, especially in hip fracture and in men...

  1. Influence of Parotid from Various Dose Rate in Intensity Modulated Radiation Therapy Planning for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Hong, Joo Wan; Jeong, Yun Ju; Won, Hui Su; Chang, Nam Jun; Choi, Ji Hun; Seok, Jin Yong

    2010-01-01

    There are various beam parameter in intensity modulated radiation therapy (IMRT). The aim of this study is to investigate how various dose rate affect the parotid in treatment plan of IMRT. Materials and Methods: The study was performed on 10 nasopharyngeal carcinoma patients who have undergone IMRT. CT images were scanned 3 mm of thickness in the same condition and the treatment plan was performed by Eclipse (Ver.7.1, Varian, Palo Alto, USA). The parameters for planning used 6 MV energy and 8 beams under the same dose volume constraint. The variation of dose rates were used 300, 400, 500 MU/min. The mean dose of both parotid was accessed from the calculated planning among the 10 patients. The mean dose of parotid was verificated by 2D diode array (Mapcheck from Sun Nuclear Corporation, Melbourne, Florida). Also, Total monitor unit (MU) and beam-on time was analysed. Results: According to the dose rate, the mean dose of parotid was increased by 0.8%, 2.0% each, when dose rate was changed from 300 MU/min to 400, 500 MU/min, moreover Total MU was increased by 5.4% and 10.6% each. There was also a dose upward trend in the dose measurement of parotid by 2D diode array. However, beam - on time difference of 1-2 minutes was no significant in the dose rate increases. From this study, when the dose rates increase, there was a significant increase of Total MU and the parotid dose accordingly, however the shortened treatment time was not significant. Hence, it is considered that there is a significant decrease of late side effect in parotid radiation therapy, if the precise dose rate in IMRT is used.

  2. A new thermoplastic resin shell for immobilization of patients receiving high-dose-rate intracavitary irradiation for rectal cancer

    International Nuclear Information System (INIS)

    Kamikonya, Norihiko; Hishikawa, Yoshio; Kurisu, Koichi; Taniguchi, Midori; Miura, Takashi

    1990-01-01

    An adjustable immobilizing shell, made of thermoplastic resin (Kurare Shell Filter, KSL) was developed for stabilizing the source during radiotherapy. A piece of KSF was cut to about 15 x 30 cm in size. The KSF was heated at 70-80deg C to soften up. It was kept at room temperature until it cooled to 40deg C. A colonoscope was used to determine the source position in patients being in a left lateral position on the table of the simulator. A piece of KSF was then molded around the patient to fit it over the gluteofemoral region in conformity with the body curvature. The position of the anus was confirmed and marked on the KSF. A cold towel was applied to the shell to harden it rapidly. When the KSF became transparent and hard, it was detached from the patient. A hole was made to insert the outer tube of the radiation source. A cylinder for immobilizing the outer tube was attached. The outer tube of the radiation source was inserted into the patient lying in a left lateral position on the radiotherapy couch. The shell was placed over the outer tube and hold in position on the patient using an elastic tape. The inner tube with its dummy source was introduced into the outer tube, and the source position was fluoroscopically determined. The shell and the inner tube were immobilized with a tape and irradiation was commenced. The newly developed shell was clinically used in 5 patients. The movement of the source during radiotherapy was compared with that in 5 other patients not using the shell. There were no significant differences in irradiation time between the groups, The movement of the source per unit time varied between 0 and 0.13 with a mean of 0.05 in the shell group and 0.09 and 0.60 with a mean of 0.48 in the non-shell group, with statistically significant difference. (N.K.)

  3. Locally advanced cervix carcinoma - innovation in combined modality therapy

    International Nuclear Information System (INIS)

    Swift, Patrick S.

    1996-01-01

    Locally advanced cervical carcinoma continues to be a challenge to the clinician due to local failure as well as systemic metastases. Standard intracavitary and external beam techniques result in local control rates of only 35-65%, with long term survival rates of 25-60% in patients with state IIIA-IVA disease, indicating the need to identify new treatment strategies. Optimization programs for remote-afterloading interstitial brachytherapy allow the delivery of higher local doses of radiation to volumes that more closely approximate tumor target volumes as identified on MR scans, leading to improved therapeutic ratios. Identification of subsets of patients more likely to fail standard therapy, either locally or systemically, may be possible through such techniques as in vivo measurements of hypoxia with Eppendorf oxygen electrodes, interstitial fluid pressure measurements, the Comet assay, and nitroimidazole binding methods. Traditional chemotherapies, administered in either a neoadjuvant role or concomitantly with radiation have been disappointing in prospective trials. A variety of new agents are being investigated to determine if they can increase the frequency or duration of complete response. The taxanes, with response rates of 17-23% by themselves, are being assessed as potential radiosensitizers. The camptotheicin CRT-11 (Irinotecan) has demonstrated activity in platinum resistant cervix cancer, with response rates of 24%. Bioradiotherapeutic approaches, using 13-cis-retinoic acid and interferon-2a, are undergoing phase II studies. Neoangiogenesis inhibitors and vaccines against HPV are also being examined. The aggressive pursuit of techniques that help identify those patients most likely to fail, that allow the delivery of higher radiation doses more safely to the target volume, and that incorporate the use of more effective systemic therapies is necessary to improve the outcome for this disease

  4. Conventional external beam radiation therapy and high dose rate afterloading brachytherapy as a boost for patients older than 70 years

    International Nuclear Information System (INIS)

    Pellizzon, Antonio Cassio Assis; Salvajoli, Joao Vitor; Fogaroli, Ricardo Cesar; Novaes, Paulo Eduardo R.S.; Maia, Maria Aparecida Conte; Ferrigno, Robson

    2005-01-01

    The treatment options for patients with non metastatic prostate cancer range from observation, radical prostatectomy, radiation therapy, hormonal therapy to various combination of some to all of them. Objective: we evaluated the impact on biochemical control of disease (bNED), acute and late intestinal (GI) and urological (GU) morbidity for a group of patients older than 70 years presenting initial or locally advanced prostate cancer treated with fractionated high dose rate brachytherapy (HDRB) as a boost to conventional external beam radiation therapy (RT) at the Department of Radiation Oncology from Hospital do Cancer A. C. Camargo, Sao Paulo, Brazil. Methods: a total of 56 patients older than 70 were treated from March, 1997 to June, 2002. All patients had prior to HDRB a course of RT to a median dose of 45 Gy. HDRB doses ranged from 16 Gy to 20 Gy, given in 4 fractions. Results: the median age of the patients was 74.4 years (range 70-83) and the median follow-up 33 months (range 24 to 60). The 5-year actuarial bNED rate was 77%. Acute GU and GI morbidity G1-2 were seen in 17.8% and 7.1% of patients, respectively. Late G1 or G2 GU morbidity was seen in 10.7% of the patients, while late G3 morbidity was observed in 7.1% of the patients, represented by urethral strictures. Conclusion: this group of patients had similar bNED rates when compared to literature, with acceptable morbidity rates. (author)

  5. Restriction of therapy mainly explains lower thrombolysis rates in reduced stroke service levels.

    Science.gov (United States)

    Gumbinger, Christoph; Reuter, Björn; Hacke, Werner; Sauer, Tamara; Bruder, Ingo; Diehm, Curt; Wiethölter, Horst; Schoser, Karin; Daffertshofer, Michael; Neumaier, Stephan; Drewitz, Elke; Rode, Susanne; Kern, Rolf; Hennerici, Michael G; Stock, Christian; Ringleb, Peter

    2016-05-24

    To assess the influence of preexisting disabilities, age, and stroke service level on standardized IV thrombolysis (IVT) rates in acute ischemic stroke (AIS). We investigated standardized IVT rates in a retrospective registry-based study in 36,901 patients with AIS from the federal German state Baden-Wuerttemberg over a 5-year period. Patients admitted within 4.5 hours after stroke onset were selected. Factors associated with IVT rates (patient-level factors and stroke service level) were assessed using robust Poisson regression modeling. Interactions between factors were considered to estimate risk-adjusted mortality rates and potential IVT rates by service level (with stroke centers as benchmark). Overall, 10,499 patients (28.5%) received IVT. The IVT rate declined with service level from 44.0% (stroke center) to 13.1% (hospitals without stroke unit [SU]). Especially patients >80 years of age and with preexisting disabilities had a lower chance of being treated with IVT at lower stroke service levels. Interactions between stroke service level and age group, preexisting disabilities, and stroke severity (all p < 0.0001) were observed. High IVT rates seemed not to increase mortality. Estimated potential IVT rates ranged between 41.9% and 44.6% depending on stroke service level. Differences in IVT rates among stroke service levels were mainly explained by differences administering IVT to older patients and patients with preexisting disabilities. This indicates considerable further potential to increase IVT rates. Our findings support guideline recommendations to admit acute stroke patients to SUs. © 2016 American Academy of Neurology.

  6. Regional changes over time in initial virological response rates to combination antiretroviral therapy across Europe

    DEFF Research Database (Denmark)

    Bannister, W; Kirk, O; Gatell, J

    2006-01-01

    BACKGROUND: Changes in virologic response to initial combination antiretroviral therapy (cART) over calendar time may indicate improvements in cART or emergence of primary resistance. Regional variations may identify differences in available antiretroviral drugs or patient management. METHODS.......026) and time (P changes were observed (south, P = 0.061; central west, P ....001; north: P = 0.070; east, P = 0.001). CONCLUSIONS: There was some evidence of regional differences in initial virologic response to cART. Improvements over time were observed, suggesting that so far, the effect of primary resistance has not been of sufficient magnitude to prevent increasing suppression...

  7. Preliminary results of concurrent chemotherapy and radiation therapy using high-dose-rate brachytherapy for cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Ja; Lee, Ji Hye; Lee, Re Na; Suh, Hyun Suk [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2006-09-15

    To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range 34 {approx} 74) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follow: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of 45 {approx} 50.4 Gy (median: 50.4 Gy) over 5 {approx} 5.5 weeks. Ir-192 HDR intracavity brachytherapy (ICBT) was given after a total dose of 41.1 Gy. HDR-ICBT was performed twice a week, with a fraction point. A dose of 4 Gy and median dose to point A was 28 Gy (range: 16 {approx} 32 Gy) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 88 Gy{sub 10} (range:77 {approx} 94 Gy{sub 10}). The median cumulative BED at ICRU 38 reference point (EBRT + ICBT) was 131 Gy{sub 3} (range: 122 {approx} 140 Gy{sub 3}) at point A, 109 Gy{sub 3} (range:88{approx} 125 Gy{sub 3}) at the rectum and 111 Gy{sub 3} (range: 91 {approx} 123 Gy{sub 3}) at the urinary bladder. Cisplatin (60 mg/m{sup 2}) and 5-FU (1,000 mg/m{sup 2}) was administered intravenously at 2 weeks interval from the first day of radiation for median 5 (range:2 {approx} 6) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range:8{approx} 50 months). The complete response rate after concurrent chemo radiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure

  8. Preliminary results of concurrent chemotherapy and radiation therapy using high-dose-rate brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Lee, Ji Hye; Lee, Re Na; Suh, Hyun Suk

    2006-01-01

    To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range 34 ∼ 74) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follow: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of 45 ∼ 50.4 Gy (median: 50.4 Gy) over 5 ∼ 5.5 weeks. Ir-192 HDR intracavity brachytherapy (ICBT) was given after a total dose of 41.1 Gy. HDR-ICBT was performed twice a week, with a fraction point. A dose of 4 Gy and median dose to point A was 28 Gy (range: 16 ∼ 32 Gy) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 88 Gy 10 (range:77 ∼ 94 Gy 10 ). The median cumulative BED at ICRU 38 reference point (EBRT + ICBT) was 131 Gy 3 (range: 122 ∼ 140 Gy 3 ) at point A, 109 Gy 3 (range:88∼ 125 Gy 3 ) at the rectum and 111 Gy 3 (range: 91 ∼ 123 Gy 3 ) at the urinary bladder. Cisplatin (60 mg/m 2 ) and 5-FU (1,000 mg/m 2 ) was administered intravenously at 2 weeks interval from the first day of radiation for median 5 (range:2 ∼ 6) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range:8∼ 50 months). The complete response rate after concurrent chemo radiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure rate was 13% and distant metastatic rate was 3.3%. The crude rate of minor hematologic

  9. Development of computerized dose planning system and applicator for high dose rate remote afterloading irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, T. J. [Keimyung Univ., Taegu (Korea); Kim, S. W. [Fatima Hospital, Taegu (Korea); Kim, O. B.; Lee, H. J.; Won, C. H. [Keimyung Univ., Taegu (Korea); Yoon, S. M. [Dong-a Univ., Pusan (Korea)

    2000-04-01

    To design and fabricate of the high dose rate source and applicators which are tandem, ovoids and colpostat for OB/Gyn brachytherapy includes the computerized dose planning system. Designed the high dose rate Ir-192 source with nuclide atomic power irradiation and investigated the dose characteristics of fabricated brachysource. We performed the effect of self-absorption and determining the gamma constant and output factor and determined the apparent activity of designed source. he automated computer planning system provided the 2D distribution and 3D includes analysis programs. Created the high dose rate source Ir-192, 10 Ci(370GBq). The effective attenuation factor from the self-absorption and source wall was examined to 0.55 of the activity of bare source and this factor is useful for determination of the apparent activity and gamma constant 4.69 Rcm{sup 2}/mCi-hr. Fabricated the colpostat was investigated the dose distributions of frontal, axial and sagittal plane in intra-cavitary radiation therapy for cervical cancer. The reduce dose at bladder and rectum area was found about 20 % of original dose. The computerized brachytherapy planning system provides the 2-dimensional isodose and 3-D include the dose-volume histogram(DVH) with graphic-user-interface mode. emoted afterloading device was built for experiment of created Ir-192 source with film dosimetry within {+-}1 mm discrepancy. 34 refs., 25 figs., 11 tabs. (Author)

  10. High-dose-rate brachytherapy using molds for oral cavity cancer. The technique and its limitations

    International Nuclear Information System (INIS)

    Nishimura, Yasumasa; Yokoe, Yoshihiko; Nagata, Yasushi; Okajima, Kaoru; Nishida, Mitsuo; Hiraoka, Masahiro

    1998-01-01

    With the availability of a high-dose-rate (HDR) remote afterloading device, a Phase I/II protocol was initiated at our institution to assess the toxicity and efficacy of HDR intracavitary brachytherapy, using molds, in the treatment of squamous cell carcinomas of the oral cavity. Eight patients with squamous cell carcinoma of the oral cavity were treated by the technique. The primary sites of the tumors were the buccal mucosa, oral floor, and gingiva. Two of the buccal mucosal cancers were located in the retromolar trigon. For each patient, a customized mold was fabricated, in which two to four afterloading catheters were placed for an 192 Ir HDR source. Four to seven fractions of 3-4 Gy, 5 mm below the mold surface, were given following external radiation therapy of 40-60 Gy/ 2 Gy. The total dose of HDR brachytherapy ranged from 16 to 28Gy. Although a good initial complete response rate of 7/8 (88%) was achieved, there was local recurrence in four of these seven patients. Both of the retromolar trigon tumors showed marginal recurrence. No serious (e.g., ulcer or bone exposure) late radiation damage has been observed thus far in the follow up period of 15-57 months. High-dose-rate brachytherapy using the mold technique seems a safe and useful method for selected early and superficial oral cavity cancer. However, it is not indicated for thick tumors and/or tumors located in the retromolar trigon. (author)

  11. A model for inverse dose-rate effects - low dose-rate hyper-sensibility in response to targeted radionuclide therapy

    International Nuclear Information System (INIS)

    Murray, I.; Mather, S.J.

    2015-01-01

    Full text of publication follows. The aim of this work was to test the hypothesis that the Linear-Quadratic (LQ) model of cell survival, developed for external beam radiotherapy (EBRT), could be extended to targeted radionuclide therapy (TRT) in order to predict dose-response relationships in a cell line exhibiting low dose hypersensitivity (LDH). Methods: aliquots of the PC-3 cancer cell line were treated with either EBRT or an in-vitro model of TRT (Irradiation of cell culture with Y-90 EDTA over 24, 48, 72 or 96 hours). Dosimetry for the TRT was calculated using radiation transport simulations with the Monte Carlo PENELOPE code. Clonogenic as well as functional biological assays were used to assess cell response. An extension of the LQ model was developed which incorporated a dose-rate threshold for activation of repair mechanisms. Results: accurate dosimetry for in-vitro exposures of cell cultures to radioactivity was established. LQ parameters of cell survival were established for the PC-3 cell line in response to EBRT. The standard LQ model did not predict survival in PC-3 cells exposed to Y 90 irradiation over periods of up to 96 hours. In fact cells were more sensitive to the same dose when irradiation was carried out over 96 hours than 24 hours. I.e. at a lower dose-rate. Deviations from the LQ predictions were most pronounced below a threshold dose-rate of 0.5 Gy/hr. These results led to an extension of the LQ model based upon a dose-rate dependent sigmoid model of single strand DNA repair. This extension to the model resulted in predicted cell survival curves that closely matched the experimental data. Conclusion: the LQ model of cell survival to radiation has been shown to be largely predictive of response to low dose-rate irradiation. However, in cells displaying LDH, further adaptation of the model was required. (authors)

  12. Posttreatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanomas: dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Murray, Kevin; Gillin, Michael; Albano, Katherine; Erickson, Beth

    2002-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1994, 63 patients underwent 125 I episcleral plaque (Collaborative Ocular Melanoma Study [COMS] design) application for the treatment of choroidal melanoma. The mean tumor height was 4.5 mm (range 1.7-8.3). Doses and dose rates at the tumor apex, macula, and optic disc were calculated. Forty-three records were scored to assess whether a decrease in visual acuity of >2 lines on a standard Snellen eye chart had occurred. Patient age and the presence of hypertension or diabetes were noted. Statistical analysis was performed to assess both the rate at which visual decline had occurred and the presence of significant factors that had contributed to this decline. Results: With a median follow-up of 36 months, the 3-year actuarial survival rate was 93.6%. The 3-year actuarial local control rate was 86.9%. The median time to visual loss after therapy was 18.7 months. The 3-year actuarial rate of visual preservation was 40.5%. Multivariate analysis demonstrated higher macula dose rates (p=0.003) to forecast visual decline. Macula dose rates of 111±11.1 cGy/h were associated with a 50% risk of significant visual loss. Conclusion: Patients in our series treated with 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of visual decline. Higher dose rates to the macula correlated strongly with poorer posttreatment visual outcome. This information may be valuable in selecting the optimal dose rates to treat choroidal melanomas and to predict the risk of visual decline

  13. Successful maintenance on sulphonylurea therapy and low diabetes complication rates in a HNF1A-MODY cohort.

    Science.gov (United States)

    Bacon, S; Kyithar, M P; Rizvi, S R; Donnelly, E; McCarthy, A; Burke, M; Colclough, K; Ellard, S; Byrne, M M

    2016-07-01

    HNF1A gene mutations are the most common cause of maturity-onset diabetes of the young (MODY) in the UK. Persons with HNF1A-MODY display sensitivity to sulphonylurea therapy; however, the long-term efficacy is not established. There is limited literature as to the prevalence of micro- and macrovascular complications in this unique cohort. The aim of this study was to determine the natural progression and clinical management of HNF1A-MODY diabetes in a dedicated MODY clinic. Sixty patients with HNF1A-MODY and a cohort of 60 BMI-, age-, ethnicity- and diabetes duration-matched patients with Type 1 diabetes mellitus participated in the study. All patients were phenotyped in detail. Clinical follow-up of the HNF1A-MODY cohort occurred on a bi-annual basis. Following a genetic diagnosis of MODY, the majority of the cohort treated with sulphonylurea therapy remained insulin independent at 84-month follow-up (80%). The HbA1c in the HNF1A-MODY group treated with sulphonylurea therapy alone improved significantly over the study period [from 49 (44-63) mmol/mol, 6.6 (6.2-7.9)% to 41 (31-50) mmol/mol, 5.9 (5-6.7)%; P = 0.003]. The rate of retinopathy was significantly lower than that noted in the Type 1 diabetes mellitus group (13.6 vs. 50%; P = 0.0001).There was also a lower rate of microalbuminuria and cardiovascular disease in the HNF1A-MODY group compared with the Type 1 diabetes mellitus group. This study demonstrates that the majority of patients with HNF1A-MODY can be maintained successfully on sulphonylurea therapy with good glycaemic control. We note a significantly lower rate of micro- and macrovascular complications than reported previously. The use of appropriate therapy at early stages of the disorder may decrease the incidence of complications. © 2015 Diabetes UK.

  14. Relapse rate following antithyroid drug therapy of immunogenic and non-immunogenic hyperthyroidism

    International Nuclear Information System (INIS)

    Voth, E.; Dickmann, N.; Schicha, H.; Emrich, D.

    1990-01-01

    Data of 196 patients treated for hyperthyroidism exclusively with anthyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogenic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p [de

  15. Dose distribution and risk factors in tele cobalt therapy and intracavitary treatment with sealed sources of Cesium-137

    International Nuclear Information System (INIS)

    Briquet, C.

    1984-01-01

    The purpose of this work is to evaluate dose to organs, outside the treatment volume. The experimental measurements were done using TLD dosemeters, placed in various regions of a Rando Alderson Phantom. The theoretical absorbed doses were calculated using the Monte Carlo method applied to a mathematical phantom. (author)

  16. The use of Selectron afterloading equipment to simulate and extend the Manchester system for intracavitary therapy of the cervix uteri

    International Nuclear Information System (INIS)

    Wilkinson, J.M.; Moore, C.J.; Notley, H.M.; Hunter, R.D.

    1983-01-01

    When Selectron afterloading machines were introduced in the Christie Hospital the first aim was to reproduce, as closely as possible, the isodose distributions achieved with the traditional Manchester Radium System. This resulted in the establishment of standard pellet loading patterns, and standard treatment times, for programming the Selectron channels. However, the availability of whole-body CT scanning facilities provides a method of accurately locating the source positions with respect to the local anatomy and hence the possibility of dosage control based on doses to specific pelvic structures. Various computer programs have been written to extract source position data from the CT images, to allow the operator to propose pellet loading patterns and treatment times, and ultimately to display the resultant isodose distribution superposed on the cross-sectional scans. The effects on the dose distribution arising from changing the number of pellets, the pellet positions within the applicators, and the treatment times, are briefly discussed. (author)

  17. External beam radiation therapy and a low-dose-rate brachytherapy boost without or with androgen deprivation therapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Strom, Tobin J.; Hutchinson, Sean Z.; Shrinath, Kushagra; Cruz, Alex A.; Figura, Nicholas B.; Nethers, Kevin; Biagioli, Matthew C.; Fernandez, Daniel C.; Heysek, Randy V.; Wilder, Richard B., E-mail: richard.wilder@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (United States)

    2014-07-15

    Purpose: To assess outcomes with external beam radiation therapy (EBRT) and a low-dose-rate (LDR) brachytherapy boost without or with androgen deprivation therapy (ADT) for prostate cancer. Materials and Methods: From January 2001 through August 2011, 120 intermediate-risk or high-risk prostate cancer patients were treated with EBRT to a total dose of 4,500 cGy in 25 daily fractions and a palladium-103 LDR brachytherapy boost of 10,000 cGy (n = 90) or an iodine-125 LDR brachytherapy boost of 11,000 cGy (n = 30). ADT, consisting of a gonadotropin-releasing hormone agonist ± an anti-androgen, was administered to 29/92 (32%) intermediate-risk patients for a median duration of 4 months and 26/28 (93%) high-risk patients for a median duration of 28 months. Results: Median follow-up was 5.2 years (range, 1.1-12.8 years). There was no statistically-significant difference in biochemical disease-free survival (bDFS), distant metastasis-free survival (DMFS), or overall survival (OS) without or with ADT. Also, there was no statistically-significant difference in bDFS, DMFS, or OS with a palladium-103 vs. an iodine-125 LDR brachytherapy boost. Conclusions: There was no statistically-significant difference in outcomes with the addition of ADT, though the power of the current study was limited. The Radiation Therapy Oncology Group 0815 and 0924 phase III trials, which have accrual targets of more than 1,500 men, will help to clarify the role ADT in locally-advanced prostate cancer patients treated with EBRT and a brachytherapy boost. Palladium-103 and iodine-125 provide similar bDFS, DMFS, and OS. (author)

  18. Antipsychotic adjunctive therapy to mood stabilizers and 1-year rehospitalization rates in bipolar disorder: A cohort study.

    Science.gov (United States)

    Hochman, Eldar; Krivoy, Amir; Schaffer, Ayal; Weizman, Abraham; Valevski, Avi

    2016-12-01

    Antipsychotic adjunctive therapy to mood stabilizers (MSs) may improve relapse prevention; however, only a few naturalistic studies, reflecting more generalizable bipolar disorder (BD) samples, support this notion. We compared the 1-year rehospitalization rates of manic patients with bipolar I disorder (BD-I) who were discharged with MS (lithium or valproate) monotherapy or with adjunctive atypical or typical antipsychotic therapy. A total of 201 patients with BD-I who were hospitalized with manic episodes between 2005 and 2013 were retrospectively followed for 1-year rehospitalization rates according to treatment at discharge: MS monotherapy, MS with atypical antipsychotics, and MS with typical antipsychotics. Additionally, time to rehospitalization during the 1-year period after discharge was compared between treatment groups. Multivariable survival analyses adjusted for covariates known to influence rehospitalization were conducted. Rehospitalization rates within 1 year were significantly lower in the MS with atypical antipsychotics group (6.3%) compared to the MS monotherapy group (24.3%, P=.008) and to the MS with typical antipsychotics group (20.6%, P=.02). Time to rehospitalization was significantly longer for the MS with atypical antipsychotics group (345.5 days) compared to the MS monotherapy group (315.1 days, P=.006) and to the MS with typical antipsychotics group (334.1 days, P=.02). The MS with atypical antipsychotics group had a significantly reduced adjusted risk of rehospitalization (hazard ratio=0.17, 95% confidence interval: 0.05-0.61, P=.007) compared to the MS monotherapy group. Atypical antipsychotic adjunctive therapy to MSs may be more effective than MS monotherapy in preventing rehospitalization during the 1-year period after a BD manic episode. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Variability of Basal Rate Profiles in Insulin Pump Therapy and Association with Complications in Type 1 Diabetes Mellitus.

    Science.gov (United States)

    Laimer, Markus; Melmer, Andreas; Mader, Julia K; Schütz-Fuhrmann, Ingrid; Engels, Heide-Rose; Götz, Gabriele; Pfeifer, Martin; Hermann, Julia M; Stettler, Christoph; Holl, Reinhard W

    2016-01-01

    Traditionally, basal rate profiles in continuous subcutaneous insulin infusion therapy are individually adapted to cover expected insulin requirements. However, whether this approach is indeed superior to a more constant BR profile has not been assessed so far. This study analysed the associations between variability of BR profiles and acute and chronic complications in adult type 1 diabetes mellitus. BR profiles of 3118 female and 2427 male patients from the "Diabetes-Patienten-Verlaufsdokumentation" registry from Germany and Austria were analysed. Acute and chronic complications were recorded 6 months prior and after the most recently documented basal rate. The "variability index" was calculated as variation of basal rate intervals in percent and describes the excursions of the basal rate intervals from the median basal rate. The variability Index correlated positively with severe hypoglycemia (r = .06; p1), hypoglycemic coma (r = .05; p = 0.002), and microalbuminuria (r = 0.05; p = 0.006). In addition, a higher variability index was associated with higher frequency of diabetic ketoacidosis (r = .04; p = 0.029) in male adult patients. Logistic regression analysis adjusted for age, gender, duration of disease and total basal insulin confirmed significant correlations of the variability index with severe hypoglycemia (β = 0.013; p1) and diabetic ketoacidosis (β = 0.012; p = 0.017). Basal rate profiles with higher variability are associated with an increased frequency of acute complications in adults with type 1 diabetes.

  20. Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders - a population based study

    Directory of Open Access Journals (Sweden)

    Nordenskjöld Axel

    2012-08-01

    Full Text Available Abstract Background The aim of the present study is to investigate the responder rate of Electroconvulsive therapy, ECT, in clinical routine work and to define clinical characteristics predictive of response to ECT. The main hypothesis is that the responder rate of ECT might be lower in clinical routine than in controlled trials. Methods This is a population-based study of all patients (N = 990 treated with ECT for depressive disorders, between 2008–2010 in eight hospitals in Sweden. Patients with Clinical Global Impression-Improvement scores of 1 or 2 (much improved within one week after ECT were considered responders to ECT. The predictive values of single clinical variables were tested by means of chi-squared tests and the relative importance was tested in a logistic regression analysis. Results The responder rate was 80.1%. A higher proportion of older patients (>50 years responded (84.3% vs. 74.2%, p  Conclusions This study focuses exclusively on the short term responder rate with ECT in clinical practice. Similarly to results from controlled trials a high responder rate is reported. Older patients, more severely ill patients, psychotically ill patients and patients without personality disorders had the highest responder rates. Inpatients may have better outcome with ECT than outpatients.

  1. Exposure rate measurements and radiation control in post therapy with I131

    International Nuclear Information System (INIS)

    Vazquez A, M.; Castillo D, C.; Flores U, H.; Cespedes C, L.; Morgan N, C.; Sifuentes D, Y.; Marin R, K.

    2015-10-01

    During hyperthyroidism treatment, 131 I activities from 111 MBq up to 296 MBq are used. In the aim to determine if the 131 I uptake by the patient is a radiological risk to family members and public around the patient exposure rate measurements were carried out, using a limit 1.8 m R/h. Measurements were carried out in the Nuclear Medicine department of Almenara hospital in Lima, Peru. The exposure rate was measured to 0.3, 0.6, and 1.0 m from the patient from 0 to 11 days after post-administrated dose (Pda). In this study measurements were carried out in 21 hyperthyroid patients. Measurements to 1 meter, along 2-4 (16/16), 5-7 (15/15), and 8-11 (14/14) days after Pda, indicate the dose rate around 100% of patients is ≤ 1.8 m R /h. Measurements to 0.6 meters along 2-4 (16/16), 5 -7 (15/15), and 8-11 (14/14) days after Pda, indicate that the dose rate around 44% (7/16), 93% (14/15), and 100% (14/14) of patients is ≤ 1.8 m R h. On the other hand, dose rate measurements to 0.3 meters, along 2-4 (16/16), 5-7 (15/15), and 8 -11 (14/14) days after Pda, indicate that de dose rate is 13% (2/16), 6% (1/15), and 43% (6/14) of patients is ≤ 1.8 m R/h. Measured exposure rates are alike to values reported in the literature, and were used to define radiation control recommendations. (Author)

  2. Effectiveness of music therapy in state-trait anxiety rate of addicts in drug-free rehabilitation stage

    Directory of Open Access Journals (Sweden)

    E Soleimani

    2016-02-01

    Full Text Available Objective: This study was an attempt to investigate the effect of music therapy on addicts’ state-trait anxiety rate in the stage of drug-free rehabilitation. Method: A quasi-experimental research design, along with pretest-posttest and control group was employed for the conduct of this study. The statistical population of the study included the addicts in the rehabilitation stage who had referred to the clean collaborators rehabilitation camp in Ardebil province in November 2014. From this population, the number of 32 addicts in 16-50-year-old age range was selected as the participants of the study by convenience sampling method. State-Trait Anxiety Inventory was used for data collection. Results: The results of multivariate covariant analysis showed that there is a significant difference between control and experimental groups in state and trait anxiety. In other words, the state and trait anxiety of addicts in the experimental group had been reduced after music therapy. Conclusion: Considering the obtained results, it can be concluded that music therapy alone or along other psychological interventions can be an effective method for reducing addicts’ anxiety in drug-free rehabilitation stage.

  3. Autonomic dysfunction in HIV patients on antiretroviral therapy: studies of heart rate variability

    DEFF Research Database (Denmark)

    Lebech, Anne-Mette; Kristoffersen, Ulrik Sloth; Mehlsen, Jesper

    2007-01-01

    of healthy volunteers (n = 12) were included. All were non-smokers, non-diabetic and had never received medication for dyslipidaemia or hypertension. Following a 10 min resting period a 5 min ECG recording was performed. Heart rate variability (HRV) analysis was performed in accordance with current...

  4. Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment

    International Nuclear Information System (INIS)

    Bedard, Gillian; Hoskin, Peter; Chow, Edward

    2014-01-01

    Introduction: Radiation therapy has been shown to successfully palliate bone metastases. A number of systematic reviews and large clinical trials have reported response rates for initial treatment and retreatment. Objective: To determine overall response rates of patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment. Methods: Intent-to-treat and evaluable patient statistics from a systematic review of palliative radiotherapy trials for initial treatment of bone metastases and a randomized clinical trial of retreatment were pooled and analyzed to determine the overall response rates for patients receiving initial treatment and retreatment. Results: In the intent-to-treat calculation, 71–73% of patients had an overall response to radiation treatment and in the evaluable patient population; 85–87% of patients did so. Response rates varied slightly whether patients underwent single or multiple fractions in initial treatment or retreatment. Conclusions: Single and multiple fraction radiation treatment yielded very similar overall response rates. Patients treated with a single fraction for both initial and repeat radiation experience almost identical overall response to those patients treated with multiple fraction treatment. It is therefore recommended that patients with uncomplicated painful bone metastases be treated with a single 8 Gy fraction of radiation at both the initial treatment and retreatment

  5. SU-F-T-36: Dosimetric Comparison of Point Based Vs. Target Based Prescription for Intracavitary Brachytherapy in Cancer of the Cervix

    Energy Technology Data Exchange (ETDEWEB)

    Ashenafi, M; McDonald, D; Peng, J; Mart, C; Koch, N; Cooper, L; Vanek, K [Medical University of South Carolina, Charleston, SC (United States)

    2016-06-15

    Purpose: Improved patient imaging used for planning the treatment of cervical cancer with Tandem and Ovoid (T&O) Intracavitary high-dose-rate brachytherapy (HDR) now allows for 3D delineation of target volumes and organs-at-risk. However, historical data relies on the conventional point A-based planning technique. A comparative dosimetric study was performed by generating both target-based (TBP) and point-based (PBP) plans for ten clinical patients. Methods: Treatment plans created using Elekta Oncentra v. 4.3 for ten consecutive cervical cancer patients were analyzed. All patients were treated with HDR using the Utrecht T&O applicator. Both CT and MRI imaging modalities were utilized to delineate clinical target volume (CTV) and organs-at-risk (rectum, sigmoid, bladder, and small bowel). Point A (left and right), vaginal mucosa, and ICRU rectum and bladder points were defined on CT. Two plans were generated for each patient using two prescription methods (PBP and TBP). 7Gy was prescribed to each point A for each PBP plan and to the target D90% for each TBP plan. Target V90%, V100%, and V200% were evaluated. In addition, D0.1cc and D2cc were analyzed for each organ-at-risk. Differences were assessed for statistical significance (p<0.05) by use of Student’s t-test. Results: Target coverage was comparable for both planning methods, with each method providing adequate target coverage. TBP showed lower absolute dose to the target volume than PBP (D90% = 7.0Gy vs. 7.4Gy, p=0.028), (V200% = 10.9cc vs. 12.8cc, p=0.014), (ALeft = 6.4Gy vs. 7Gy, p=0.009), and (ARight = 6.4Gy vs. 7Gy, p=0.013). TBP also showed a statistically significant reduction in bladder, rectum, small bowel, and sigmoid doses compared to PBP. There was no statistically significant difference in vaginal mucosa or ICRU-defined rectum and bladder dose. Conclusion: Target based prescription resulted in substantially lower dose to delineated organs-at-risk compared to point based prescription, while

  6. State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses.

    Science.gov (United States)

    Owusu-Edusei, K; Cramer, R; Chesson, H W; Gift, T L; Leichliter, J S

    2017-06-01

    In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. Longitudinal study. We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners. Published by Elsevier Ltd.

  7. Analysis of autonomic modulation of heart rate in patients with Parkinson's disease and elderly individuals submitted to game therapy training.

    Science.gov (United States)

    Rocha, Rodrigo Santiago Barbosa; De Oliveira Rocha, Larissa Salgado; Pena, Elza Sara Maués; Caldas, Laiz Cristinna Ponce; Moreno, Marlene Aparecida

    2018-01-01

    Elderly patients and individuals with Parkinson's disease have a reduction in autonomic heart rate modulation, which may influence the survival of these patients, and rehabilitation can minimize this event. We tested the hypothesis that rehabilitation protocol with game console would influence the cardiac autonomic modulation of patients with Parkinson's Disease. Eight-seven volunteers were divided into two groups, control (n = 45) and Parkinson's (n = 42), they completed the study 40 volunteers in the control group (CG) and 31 patients in the Parkinson group (PG), and subjected to 24 sessions of game therapy physiotherapy, thrice a week. Analysis of autonomic HR modulation was conducted before and after the rehabilitation program using a Polar RS800CX HR sensor. For the analysis of heart rate variability the data were transferred to the Kubios HRV 2.2 program. Statistical analysis was performed in the Biostat 5.2 program, the comparison of the data by ANOVA followed by Tukey test, and the general characteristics by the chi-square test. The critical value for rejecting the null hypothesis was set at P modulation of HR values. Subjects with PD exhibit less autonomic modulation of HR and the rehabilitation protocol with game therapy improved autonomic modulation of HR. Geriatr Gerontol Int 2018; 18: 20-25. © 2017 Japan Geriatrics Society.

  8. Is intensive multimodality therapy the best treatment for fournier gangrene? Evaluation of clinical outcome and survival rate of 41 patients.

    Science.gov (United States)

    Wagner, Sigrid; Greco, Francesco; Hoda, M Raschid; Kawan, Felix; Heynemann, Hans; Fornara, Paolo

    2011-10-01

    To evaluate the effect of surgical wound debridement, antibiotics, and hyperbaric oxygen (HBO) in the treatment of Fournier gangrene (FG). Forty-one patients with a mean age of 54.3±14.6 years were referred to our department with a diagnosis of FG. To calculate a Fourier Gangrene Severity Index (FGSI), nine factors were assessed (temperature; heart rate; ventilatory rate; serum sodium, potassium, creatinine, and bicarbonate concentrations; hematocrit; and leukocyte count). After clinical stabilization, extensive debridement of the necrotic tissue was performed, and a surgical vacuum-assisted closure (V.A.C.®) device was applied. Hyperbaric oxygen was administered; medical therapy consisted of intravenous antibiotics, electrolyte replacement, and parenteral nutrition. Intraoperative cultures revealed Escherichia coli in 27 patients (66%), Pseudomonas aeruginosa in 28 (68%), gram-positive cocci in 24 (59%), and mixed flora (aerobic and anaerobic bacteria) in 39 (95%). One month after primary debridement, wound granulation was sufficient for plastic surgical reconstruction in all patients. Because of the rapid worsening of FG, early diagnosis and immediate, aggressive multi-modality therapy with surgical debridement and broad-spectrum empiric antibiotics is crucial. The utility of HBO remains unproved.

  9. Magnetic nanoparticles with high specific absorption rate of electromagnetic energy at low field strength for hyperthermia therapy

    Science.gov (United States)

    Shubitidze, Fridon; Kekalo, Katsiaryna; Stigliano, Robert; Baker, Ian

    2015-03-01

    Magnetic nanoparticles (MNPs), referred to as the Dartmouth MNPs, which exhibit high specific absorption rate at low applied field strength have been developed for hyperthermia therapy applications. The MNPs consist of small (2-5 nm) single crystals of gamma-Fe2O3 with saccharide chains implanted in their crystalline structure, forming 20-40 nm flower-like aggregates with a hydrodynamic diameter of 110-120 nm. The MNPs form stable (>12 months) colloidal solutions in water and exhibit no hysteresis under an applied quasistatic magnetic field, and produce a significant amount of heat at field strengths as low as 100 Oe at 99-164 kHz. The MNP heating mechanisms under an alternating magnetic field (AMF) are discussed and analyzed quantitatively based on (a) the calculated multi-scale MNP interactions obtained using a three dimensional numerical model called the method of auxiliary sources, (b) measured MNP frequency spectra, and (c) quantified MNP friction losses based on magneto-viscous theory. The frequency responses and hysteresis curves of the Dartmouth MNPs are measured and compared to the modeled data. The specific absorption rate of the particles is measured at various AMF strengths and frequencies, and compared to commercially available MNPs. The comparisons demonstrate the superior heating properties of the Dartmouth MNPs at low field strengths (therapy to deeper tumors that were previously non-viable targets, potentially enabling the treatment of some of the most difficult cancers, such as pancreatic and rectal cancers, without damaging normal tissue.

  10. Pain during photodynamic therapy is associated with protoporphyrin IX fluorescence and fluence rate

    DEFF Research Database (Denmark)

    Wiegell, S.R.; Skiveren, J.; Philipsen, P.A.

    2008-01-01

    and protoporphyrin IX (PpIX) fluorescence, lesion type, lesion preparation and lesion localization. Methods Twenty-six patients with actinic keratoses (AKs) in different localizations and 34 patients with facial acne vulgaris were treated with methyl aminolaevulinate-PDT. Patients with acne were illuminated using......) patients with acne had a pain score of 6 [interquartile range (IQR) 5-7] compared with 8 (IQR 6-10) when using a fluence rate of 68 mW cm(-2) (P = 0.018). After correcting the pain score for PpIX fluorescence no differences in pain scores were found between first and second acne treatment, locations of AK...... lesions or between the two types of lesions. Conclusions Pain during PDT was correlated with the PpIX fluorescence in the treatment area prior to illumination. Pain was reduced using a lower fluence rate during PDT of acne Udgivelsesdato: 2008/4...

  11. Combined use of autogenic therapy and biofeedback in training effective control of heart rate by humans

    Science.gov (United States)

    Cowings, P. S.

    1977-01-01

    Experiments were performed on 24 men and women (aged 20-27 yr) in three equal groups who were taught to control their own heart rates by autogenic training and biofeedback under dark and sound-isolated conditions. Group I was parasympathetic dominant, group II was sympathetic dominant, and group III consisted of parasympathetic-dominant subjects and controls who received only biofeedback of their own heart rates. The results corroborate three hypotheses: (1) subjects with para-sympathetic-dominant autonomic profiles perform in a way that is both qualitatively and quantitatively different from subjects with sympathetic-dominant autonomic profiles; (2) tests of interindividual variability yield data relevant to individual performance in visceral learning tasks; and (3) the combined use of autogenic training, biofeedback, and verbal feedback is suitable for conditioning large stable autonomic responses in humans.

  12. Intracavitary brachytherapy significantly enhances local control of early T-stage nasopharyngeal carcinoma: the existence of a dose-tumor-control relationship above conventional tumoricidal dose

    International Nuclear Information System (INIS)

    Teo, Peter Man Lung; Leung, Sing Fai; Lee, Wai Yee; Zee, Benny

    2000-01-01

    Purpose: To study the efficacy of intracavitary brachytherapy (ICT) in early T-stage nasopharyngeal carcinoma (NPC). Methods and Materials: All T1 and T2 (nasal infiltration) NPC treated with a curative intent from 1984 to 1996 were analyzed (n = 509). One hundred sixty-three patients were given ICT after radical external radiotherapy (ERT) (Group A). They were compared with 346 patients treated by ERT alone (Group B). The ERT delivered the tumoricidal dose (uncorrected BED-10 ≥75 Gy) to the primary tumor and did not differ between the two groups in technique or dosage. The ICT delivered a dose of 18-24 Gy in 3 fractions over 15 days to a point 1 cm perpendicular to the midpoint of the plane of the sources. ICT was used to treat local persistence diagnosed at 4-6 weeks after ERT (n = 101) or as an adjuvant for the complete responders to ERT (n = 62). Results: The two groups did not differ in patients' age or sex, rate of distant metastasis, rate of regional failure, overall survival, or the follow-up duration. However, Group A had significantly more T2 lesions and Group B had significantly more advanced N-stages. Local failure was significantly less (crude rates 6.75% vs. 13.0%; 5-year actuarial rates 5.40% vs. 10.3%) and the disease-specific mortality was significantly lower (crude rates 14.1 % vs. 21.7%; 5-year actuarial rates 11.9% vs. 16.4%) in Group A compared to Group B. Multivariate analysis showed that the ICT was the only significant prognostic factor predictive for fewer local failures (Cox regression p = 0.0328, risk ratio = 0.49, 95% confidence interval (95% CI) = 0.256-0.957). However, when ICT was excluded from the Cox regression model, the total physical dose or the total BED-10 uncorrected for tumor repopulation during the period of radiotherapy became significant in predicting ultimate local failure rate. The two groups were comparable in the incidence rates of each individual chronic radiation complication and the actuarial cumulative rate of

  13. A Case of a Cardiac Resynchronization Therapy-Defibrillator Exhibiting a Lower and Alternately Variable Basic Rate.

    Science.gov (United States)

    Iwazaki, Keigo; Kojima, Toshiya; Murasawa, Takahide; Yokota, Jun; Tanimoto, Hikaru; Matsuda, Jun; Fukuma, Nobuaki; Matsubara, Takumi; Shimizu, Yu; Oguri, Gaku; Hasumi, Eriko; Kubo, Hitoshi; Chang, Kyungho; Fujiu, Katsuhito; Komuro, Issei

    2018-04-06

    A cardiac resynchronization therapy defibrillator (CRT-D) (Medtronic Inc. Protecta XT) was implanted in a 67-year-old man who had cardiac sarcoidosis with extremely low cardiac function. He had ventricular tachycardia which was controlled by catheter ablation, medication and pacing. The programmed mode was DDI, lower rate was 90 beats/minute, paced AV delay was 150 ms, and the noncompetitive atrial pacing (NCAP) function was programmed as 300 ms.After his admission for pneumonia and heart failure, we changed his DDI mode to a DDD mode because he had atrial tachycardia, which led to inadequate bi-ventricular pacing. After a while, there were cycle lengths which were longer than his device setting and alternately varied. We were able to avoid this phenomenon with AV delay of 120 ms and NCAP of 200 ms.NCAP is an algorithm which creates a gap above a certain period after the detection of an atrial signal during the postventricular atrial refractory period of the pacemaker. This is to prevent atrial tachycardia and repetitive non-reentrant ventriculoatrial (VA) synchrony in the presence of retrograde VA conduction. But in this case, NCAP algorithm induced much lower rate than the programmed basic lower rate. This situation produced some arrhythmias and exacerbated symptoms of heart failure. This had to be paid attention to, especially when the device was programmed at high basic heart rate.

  14. Optimization of dose designs in intracavitary radiotherapy of patients with uterine body carcinoma

    International Nuclear Information System (INIS)

    Ushakova, G.A.; Afanas'ev, B.P.

    1991-01-01

    The potentialities of mathematical optimization were investigated with respect to dosimetric design of radiation therapy of endometral cancer patients using Agat-B and Agat-apparatus. The effectiveness of linear programming for creating in a pathological focus and in normal tissues of a dose distribution, meeting clinical requirements to the maximum, was shown

  15. Rates and Durability of Response to Salvage Radiation Therapy Among Patients With Refractory or Relapsed Aggressive Non-Hodgkin Lymphoma

    International Nuclear Information System (INIS)

    Tseng, Yolanda D.; Chen, Yu-Hui; Catalano, Paul J.; Ng, Andrea

    2015-01-01

    Purpose: To evaluate the response rate (RR) and time to local recurrence (TTLR) among patients who received salvage radiation therapy for relapsed or refractory aggressive non-Hodgkin lymphoma (NHL) and investigate whether RR and TTLR differed according to disease characteristics. Methods and Materials: A retrospective review was performed for all patients who completed a course of salvage radiation therapy between January 2001 and May 2011 at Brigham and Women's Hospital/Dana-Farber Cancer Institute. Separate analyses were conducted for patients treated with palliative and curative intent. Predictors of RR for each subgroup were assessed using a generalized estimating equation model. For patients treated with curative intent, local control (LC) and progression-free survival were estimated with the Kaplan-Meier method; predictors for TTLR were evaluated using a Cox proportional hazards regression model. Results: Salvage radiation therapy was used to treat 110 patients to 121 sites (76 curative, 45 palliative). Salvage radiation therapy was given as part of consolidation in 18% of patients treated with curative intent. Median dose was 37.8 Gy, with 58% and 36% of curative and palliative patients, respectively, receiving 39.6 Gy or higher. The RR was high (86% curative, 84% palliative). With a median follow-up of 4.8 years among living patients, 5-year LC and progression-free survival for curative patients were 66% and 34%, respectively. Refractory disease (hazard ratio 3.3; P=.024) and lack of response to initial chemotherapy (hazard ratio 4.3; P=.007) but not dose (P=.93) were associated with shorter TTLR. Despite doses of 39.6 Gy or higher, 2-year LC was only 61% for definitive patients with refractory disease or disease that did not respond to initial chemotherapy. Conclusions: Relapsed or refractory aggressive NHL is responsive to salvage radiation therapy, and durable LC can be achieved in some cases. However, refractory disease is associated with a

  16. Severe hypoglycemia rates and associated costs among type 2 diabetics starting basal insulin therapy in the United States.

    Science.gov (United States)

    Ganz, Michael L; Wintfeld, Neil S; Li, Qian; Lee, Yuan-Chi; Gatt, Elyse; Huang, Joanna C

    2014-10-01

    To derive current real-world data on the rates and costs of severe hypoglycemia (SH) for people with type 2 diabetes mellitus (T2D) who have initiated basal insulin therapy and to examine differences in SH rates and costs stratified by history of prior SH events. We used a nation-wide electronic health records database that included encounter and laboratory data, as well as clinical notes, to estimate the rates and costs of SH events among adults with T2D who initiated basal insulin between 2008 and 2011. Unadjusted and regression-adjusted rates and quarterly costs were calculated for all patients as well as stratified by history of a SH event before starting basal insulin and history of a SH event during the basal insulin titration period. We identified 7235 incident cases of basal insulin use among patients with T2D who did not use insulin during the previous 12 months. Regression-adjusted incidence and total event rates were 10.36 and 11.21 per 100 patient-years, respectively. A history of SH events during the pre-index baseline and post-index titration periods were statistically significantly associated with both the incidence and total event rates (p history of previous SH or SH events during the titration period were not statistically significantly associated with costs. These results suggest that the real-world burden of SH is high among people with T2D who start using basal insulin and that history of previous SH events, both before starting insulin and during the insulin titration period, influences future SH. These results can also provide insights into interventions that can prevent or delay SH. These results should, however, be interpreted in light of the key limitations of our study: not all SH events may have been captured or coded in the database, data on filled prescriptions were not available, and the post-titration follow-up period could have been divided into time units other than quarters (3 month blocks) resulting in potentially different

  17. Long-term results of exclusive low-dose rate curie-therapy for a high-grade vaginal intraepithelial neoplasia

    International Nuclear Information System (INIS)

    Blanchard, P.; Monnier, L.; Dumas, I.; Azoury, F.; Mazeron, R.; Haie-Meder, C.

    2010-01-01

    The authors report the results of an exclusive low dose rate curie therapy for female patients treated for a grade 3 vaginal intraepithelial neoplasia. They reviewed the medical files of patients treated since 1983, i.e. 28 women. They analysed demographic characteristics, the clinic description of lesions, possible treatments which occurred before this high-grade vaginal intraepithelial neoplasia, possible previous history of cervical or endometrial cancer, curie therapy detailed data, presence of tumorous relapse. According to that, they conclude that a 60 Gy exclusive low- vaginal dose-rate curie-therapy is an efficient and well tolerated treatment for high-grade vaginal intraepithelial neoplasia. Short communication

  18. Comparison of efficacy of meperidine and fentanyl in terms of pain management and quality of life in patients with cervical cancer receiving intracavitary brachytherapy: a double-blind, randomized controlled trial.

    Science.gov (United States)

    Thanthong, Saengrawee; Rojthamarat, Sirikorn; Worasawate, Wipra; Vichitvejpaisal, Phongthara; Nantajit, Danupon; Ieumwananontachai, Nantakarn

    2017-08-01

    The aim of this study was to compare the effectiveness of two sedative regimens, a benzodiazepine with either meperidine or fentanyl, in relieving pain in patients with cervical cancer undergoing intracavitary brachytherapy in terms of pain score and quality of life. Forty unselected outpatients undergoing brachytherapy (160 fractions) were enrolled with informed consent and randomized to receive a benzodiazepine with either meperidine or fentanyl. The perceived pain score according to a standard 10-item numeric rating scale was collected every 15 min during the procedure, and the perceived quality of life was determined at the end of each procedure using the EuroQol five-dimension questionnaire. The patients and medical staff members directly involved with the procedure were blinded to the medication used. The patients' pain levels were mild in both analgesic groups. Meperidine appeared to be slightly more effective than fentanyl, although the differences in the average pain score and quality of life were not statistically significant. Both meperidine and fentanyl in combination with benzodiazepine were effective in relieving pain and discomfort in patients undergoing brachytherapy. NCT02684942, ClinicalTrials.gov.

  19. Results of combined therapy of irradiation and bleomycin suppository for advanced uterine cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Haruo; Asakawa, Hiroshi; Otawa, Hirokazu; Nemoto, Kenji; Saito, Hiroyuki (Miyagi Prefectural Adult Disease Center, Natori (Japan))

    1984-09-01

    Efficacy, survival rates and adverse effects of the combined therapy of irradiation with intravaginal bleomycin suppositories were analyzed and discussed in 49 patients with uterine cervical cancer. The results were as follows: 1. Histological examination of biopsy specimens from the uterine cervix taken just after the completion of this treatment showed favorable control over the primary lesions. However, the efficacy of the bleomycin suppositories was too mild to form a basis for treatment without intracavitary irradiation. Because of the low concentration of bleomycin in serum after suppository administration, it is thought that bleomycin would have little effect on distant metastases. 2. Survival rates in stage III patients were 83% at 12 months, 77% at 24 months and 70% at 36 months. These were superior to those for irradiation alone. 3. The major adverse effect of bleomycin suppositories was fever, reduction of the bleomycin dose in each suppository but controlled this to some extent Lung fibrosis or severe damage to the liver, kidney and bone marrow were not found.

  20. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer

    International Nuclear Information System (INIS)

    Yang, Ruijie; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-01-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5 mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78 Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D 90 of 34 Gy in 8.5 Gy per fraction, and 145 Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2 Gy per fraction, EQD 2 ) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The D mean (EQD 2 ) of rectum decreased 22.36 Gy in HDR and 17.01 Gy in LDR from 30.24 Gy in VMAT, respectively. The D mean (EQD 2 ) of bladder decreased 6.91 Gy in HDR and 2.53 Gy in LDR from 13.46 Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD 2 ) was 80.26, 70.23, and 104.91 Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR.

  1. HIGH-DOSE RATE BRACHYTHERAPY IN CARCINOMA CERVIX STAGE IIIB

    Directory of Open Access Journals (Sweden)

    Sathya Maruthavanan

    2016-07-01

    Full Text Available INTRODUCTION Radiotherapy is the standard treatment in locally advanced (IIB-IVA and early inoperable cases. The current standard of practice with curable intent is concurrent chemoradiation in which intracavitary brachytherapy is an integral component of radiotherapy. This study aims at assessing the efficacy of HDR ICBT (High-dose rate intracavitary brachytherapy in terms local response, normal tissue reactions, and feasibility. METHODS AND MATERIALS A total of 20 patients of stage IIIB cancer of the uterine cervix were enrolled in the study and were planned to receive concurrent chemotherapy weekly along with EBRT (external beam radiotherapy to a dose of 50 Gy/25 Fr. Suitability for ICBT was assessed at 40 Gy/20 Fr. 6/20 patients were suitable at 40 Gy and received HDR ICBT with a dose of 5.5 Gy to point A in 4 sessions (5.5 Gy/4 Fr. The remaining 14/20 patients completed 50 Gy and received HDR ICBT with a dose of 6 Gy to point A in 3 sessions (6 Gy/3 Fr. RESULTS A total of 66 intracavitary applications were done and only one application required dose modification due to high bladder dose, the pelvic control rate was 85% (17/20. 10% (2/20 had stable disease and 5% (1/20 had progressive disease at one year of follow up. When toxicity was considered only 15% developed grade I and grade II rectal complications. Patient compliance and acceptability was 100%. Patients were very comfortable with the short treatment time as compared with patients on LDR ICBT (low-dose rate intracavitary brachytherapy treatment interviewed during the same period. CONCLUSION This study proves that HDR brachytherapy is efficacious and feasible in carcinoma of cervix stage IIIB. It also proves that good dose distribution can be achieved with HDR intracavitary facility by the use of dose optimization. The short treatment time in HDR ICBT makes it possible to maintain this optimised dose distribution throughout the treatment providing a gain in the therapeutic ratio and

  2. Significance of cytology in the evaluation of radiation therapy for cancer of the uterine cervix

    International Nuclear Information System (INIS)

    Tsukahara, Yoshiharu; Kato, Junzo; Nakayama, Akiko; Fukamatsu, Yoshito; Shiozawa, Isao; Tomita, Kazuhiko; Noguchi, Hiroshi; Fukuta, Toru.

    1986-01-01

    Cytologic and histologic diagnoses were made on 184 patients with cancer of the uterine cervix treated with radiation therapy. In 125 patients examined at the 8th day after completion of external irradiation, 73 and 52 patients were cytologically positive and negative, respectively, for persistent cancer. Histologically, 74 and 51 patients were positive and negative, respectively. Fifty-eight and 36 patients showed an agreement between the two procedures for positive and negative findings, respectively. In 159 patients examined at the 8th day after both external and intracavitary irradiation, 17 were cytologically diagnosed as positive and 142 as negative: histologically, 53 were positive and 106 were negative. Thirteen and 102 patients showed an agreement between the procedures for positive and negative findings, respectively. Using histological findings as the standard, false negative cases of cytology increased after doing intracavitary irradiation than after external irradiation (25 % vs 13 %). (Namekawa, K.)

  3. Tyrosine positron emission tomography and protein synthesis rate in pituitary adenoma: Different effects of surgery and radiation therapy

    International Nuclear Information System (INIS)

    Bergh, Alfons C.M. van den; Pruim, Jan; Links, Thera P.; Vliet, Anton M. van der; Sluiter, Wim; Wolffenbuttel, Bruce H.R.; Langendijk, Johannes A.; Hoving, Eelco W.; Dullaart, Robin P.F.

    2011-01-01

    Introduction: Positron emission tomography (PET) using amino acid tracers is able to establish biochemical tumour characterization in vivo. The use of PET in the follow-up of non-functioning pituitary adenomas (NFA) and growth hormone producing pituitary adenomas (GHA) after surgery and radiation treatment is not yet clear. Methods: To determine the value of PET before and after transsphenoidal neurosurgery in NFA and GHA, we investigated 12 patients with pituitary adenoma (9 NFA and 3 GHA) before and 4 months after surgery with magnetic resonance imaging (MRI) and tyrosine PET (TYR-PET). Three years after radiation therapy TYR-PET was used to document residual activity in 6 of these patients (4 NFA- and 2 GHA). Tumour size was quantified by computerized MRI measurements. In TYR-PET, tumour activity was assessed by computerized measurements of the hot spot and by determination of protein synthesis rate (PSR). Results: In response to surgery, MRI showed a median tumour volume reduction of 58% (P 0.30). After radiation therapy the MRI-volumes of the residual pituitary adenomas did not change but the volume of the hot spot on TYR-PET-imaging was reduced by 58% (P = 0.02), and PSR decreased in 5 of 6 patients (P = 0.12). Conclusion: Amino acid PET tumour activity is reduced parallel with MRI volume changes after surgery. The decrease in TYR-PET activity after radiation therapy, despite unaltered MRI tumour volume, supports the concept that it is possible to follow biological tumour activity with this technique. The diagnostic merit of this tracer technique, predicting pituitary adenoma re-growth, needs to be validated in a large prospective study.

  4. Radiation dose rates from adult patients receiving 131I therapy for thyrotoxicosis

    International Nuclear Information System (INIS)

    O'Doherty, M.J.; Kettle, A.G.; Eustance, C.N.P.; Mountford, P.J.; Coakley, A.J.

    1993-01-01

    Recommendations for restricting the exposure to radiation of members of the public coming into contact with thyrotoxic patients treated with 131 I are currently based on the activity retained by the patient, and not on the doses likely to be received by such individuals. In order to examine whether these current recommendations restrict these doses to less than the current annual limit of 5 mSv, and to identify the implications of a reduction in this limit to 1 mSv, measurements were made of the dose rates at distances of 0.1, 0.5 and 1.0 m from 60 patients just before they left the nuclear medicine department. These measurements were repeated 1, 3, 6, 8 and 10 days after administration for 30 patients, and the radioactivity in samples of saliva taken on each of these days and secreted in sweat over the first 24 h were also measured. Doses were estimated for administered activities of approximately 200-600 MBq, assuming appropriate values for the times and distances spent near other individuals while travelling, at work, at home and near to young children considered in three age groups. Periods of restriction were derived which would reduce these doses to 5 or 1 mSv. (Author)

  5. Hemostasis in acquired hemophilia--role of intracavitary instillation of EACA.

    Directory of Open Access Journals (Sweden)

    Sahu S

    1996-07-01

    Full Text Available An 82 year old man developed antibodies against coagulation factor VIII:C without any apparent cause. Bleeding from the soft tissue cavity could not be controlled by factor VIII:C concentrates, immunosuppression with steroids and intravenous immunoglobulin therapy in the standard dosages. However, a single injection of Epsilon Aminocaproic Acid (EACA instilled into the cavity under aseptic precautions achieved lasting hemostasis with resultant wound healing.

  6. Results of Radiation Therapy in Stage III Uterine Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Chang Woo; Shin, Byung Chul; Yum, Ha Yong; Jeung, Tae Sig; Yoo, Myung Jin [Kosin University College of Medicine, Seoul (Korea, Republic of)

    1995-09-15

    Purpose : The aim of this study is to analyze the survival rate, treatment failure and complication of radiation therapy alone in stage III uterine cervical cancer. Materials and Methods : From January 1980 through December 1985, 227 patients with stage II uterine cervical cancer treated with radiation therapy at Kosin Medical Center were retrospectively studied. Among 227 patients, 72 patients(31.7%) were stage IIIa, and 155 patients(68.3%) were stage IIIb according to FIGO classification. Age distribution was 32-71 years(median: 62 years). Sixty nine patients(95.8%) in stage IIIa and 150 patients(96.8%) in stage IIIb were squamous cell carcinoma. Pelvic lymph node metastasis at initial diagnosis was 8 patients (11.1%) in stage IIIa and 29 patients(18.7%) in stage IIIb. Among 72 patients with stage IIIa, 36 patients(50%) were treated with external radiation therapy alone by conventional technique (180-200 cGy/fr). And 36 patients(50%) were treated with external radiation therapy with intracavitary radiotherapy(ICR) with Cs137 sources, and among 155 patients with stage IIIb, 80 patients(51.6%) were treated with external radiation therapy alone and 75 patients(48.4%) were treated with external radiation therapy with ICR. Total radiation doses of stage IIIa and IIIb were 65-105 Gy(median : 78.5 Gy) and 65-125.5 Gy (median :83.5 Gy). Survival rate was calculated by life-table method. Results : Complete response rates were 58.3% (42 patients) in state IIIa and 56.1%(87 patients) in stage Iiib. Overall 5 year survival rates were 57% in stage IIIa and 40% in stage IIIb. Five year survival rates by radiation technique in stage IIIa and IIIb were 64%, 40% in group treated in combination of external radiation and ICR, and 50%, 40% in the group of external radiation therapy alone(P=NS). Five year survival rates by response of radiation therapy in stage IIIa and IIIb were 90%, 66% in responder group, and 10%, 7% in non-responder group (P<0.01). There were statistically no

  7. Results of Radiation Therapy in Stage III Uterine Cervical Cancer

    International Nuclear Information System (INIS)

    Moon, Chang Woo; Shin, Byung Chul; Yum, Ha Yong; Jeung, Tae Sig; Yoo, Myung Jin

    1995-01-01

    Purpose : The aim of this study is to analyze the survival rate, treatment failure and complication of radiation therapy alone in stage III uterine cervical cancer. Materials and Methods : From January 1980 through December 1985, 227 patients with stage II uterine cervical cancer treated with radiation therapy at Kosin Medical Center were retrospectively studied. Among 227 patients, 72 patients(31.7%) were stage IIIa, and 155 patients(68.3%) were stage IIIb according to FIGO classification. Age distribution was 32-71 years(median: 62 years). Sixty nine patients(95.8%) in stage IIIa and 150 patients(96.8%) in stage IIIb were squamous cell carcinoma. Pelvic lymph node metastasis at initial diagnosis was 8 patients (11.1%) in stage IIIa and 29 patients(18.7%) in stage IIIb. Among 72 patients with stage IIIa, 36 patients(50%) were treated with external radiation therapy alone by conventional technique (180-200 cGy/fr). And 36 patients(50%) were treated with external radiation therapy with intracavitary radiotherapy(ICR) with Cs137 sources, and among 155 patients with stage IIIb, 80 patients(51.6%) were treated with external radiation therapy alone and 75 patients(48.4%) were treated with external radiation therapy with ICR. Total radiation doses of stage IIIa and IIIb were 65-105 Gy(median : 78.5 Gy) and 65-125.5 Gy (median :83.5 Gy). Survival rate was calculated by life-table method. Results : Complete response rates were 58.3% (42 patients) in state IIIa and 56.1%(87 patients) in stage Iiib. Overall 5 year survival rates were 57% in stage IIIa and 40% in stage IIIb. Five year survival rates by radiation technique in stage IIIa and IIIb were 64%, 40% in group treated in combination of external radiation and ICR, and 50%, 40% in the group of external radiation therapy alone(P=NS). Five year survival rates by response of radiation therapy in stage IIIa and IIIb were 90%, 66% in responder group, and 10%, 7% in non-responder group (P<0.01). There were statistically no

  8. Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM

    DEFF Research Database (Denmark)

    Phillips, Andrew N; Cambiano, Valentina; Miners, Alec

    2015-01-01

    count 350/μl. We investigated what would be required to reduce HIV incidence in MSM to below 1 per 1000 person-years (i.e. cost-effective. METHODS: A dynamic, individual-based simulation model was calibrated to multiple data sources...... with viral suppression to 80%, and it would be 90%, if ART is initiated at diagnosis. The scenarios required for such a policy to be cost-effective are presented. CONCLUSION: This analysis provides targets for the proportion of all HIV-positive MSM with viral suppression required to achieve substantial......BACKGROUND: Increased rates of testing, with early antiretroviral therapy (ART) initiation, represent a key potential HIV-prevention approach. Currently, in MSM in the United Kingdom, it is estimated that 36% are diagnosed by 1 year from infection, and the ART initiation threshold is at CD4 cell...

  9. Predictors and rate of adjuvant radiation therapy following radical prostatectomy: A report from the Prostate Cancer Registry

    International Nuclear Information System (INIS)

    Daniels, Christopher P.; Millar, Jeremy L.; Spelman, Tim; Sengupta, Shomik; Evans, Sue M.

    2016-01-01

    Long-term data from three randomized trials have demonstrated that adjuvant radiation therapy (ART) reduces the rate of biochemical failure in high-risk men following radical prostatectomy (RP). One of these trials has shown a survival advantage. We investigated the rate of ART in Victoria and the predictors for this treatment. We analysed data from eligible patients who were notified to the Victorian Prostate Cancer Registry (PCR) by 37 Victorian hospitals between 1 August 2008 and 31 October 2011. We defined ART as radiation therapy (RT) delivered within 6 months of RP. Predictors of ART receipt were modelled using adjusted and unadjusted logistic regression. There were 4626 eligible cases from which 2018 underwent RP with recorded date of surgery. Of these eligible prostatectomy cases, a total of 89 received ART. A subgroup of 833 men had an adverse pathologic feature, of whom 78 received ART. In a multivariate model, pathologic tumour stage pT3a (odds ratio (OR) 2.64; 95% confidence interval (CI) 1.4–5.00; P = 0.003), pT3b (OR 4.58; 95% CI 2.12–9.89; P = 0.000), a positive surgical margin (OR 8.91; 95% CI 4.61–17.2; P = 0.000) and pathologic Gleason grade >7 (OR 7.18; 95% CI 1.54–33.6; P = 0.012) predicted receipt of ART. Adverse pathologic features and high pathologic Gleason score predict for receiving ART in Victorian men after RP, but overall, ART is not commonly prescribed. This finding is consistent with other published series and may reflect clinician scepticism regarding the benefit of ART over salvage RT and concern about toxicity and the risk of over treatment.

  10. Prostate-specific antigen bounce after high-dose rate brachytherapy with external beam radiation therapy for prostate cancer patients

    International Nuclear Information System (INIS)

    Sakamoto, Naotaka; Kakinoki, Hiroaki; Tsutsui, Akio; Yoshikawa, Masahiro; Iguchi, Atsushi; Matsunobu, Toru; Uehara, Satoru

    2008-01-01

    Prostate-specific antigen (PSA) bounce after high-dose rate (HDR) brachytherapy with external beam radiation therapy (EBRT) for prostate cancer patients was evaluated. Sixty-one patients treated with HDR-brachytherapy followed by EBRT had a minimum follow-up of 12 months (median, 24 months) in our institute. A PSA bounce was defined as a rise of at least 0.1 ng/ml greater than a previous PSA level, with a subsequent decline equal to, or less than, the initial nadir. A PSA bounce was noted in 16 (26.2%) of 61 patients (one patient had a PSA bounce twice). Median time to develop a PSA bounce was 18 months, but 23.5% developed a PSA bounce after 24 months. Median duration of PSA bounce was 6 months and 11.8% had increased PSA within a period of 12 months. Median bounce height was 0.2 ng/ml (range, 0.1 to 3.39 ng/ml). A bounce height of gerater than 2 ng/ml was seen in 11.8%. Clinical characteristics (age, prostate volume, neoadjuvant endocrine therapy, risk classification, stage, pretreatment PSA, Gleason score) do not predict whether or not there will be a PSA bounce. In patients treated with HDR-brachytherapy followed by EBRT, the incidence and characteristics of PSA bounce were similar to those in patients treated with low-dose rate brachytherapy. Physicians should be aware of the possibility of PSA bounce following HDR-brachytherapy with EBRT. (author)

  11. Effect of music therapy on the anxiety levels and pregnancy rate of women undergoing in vitro fertilization-embryo transfer: A randomized controlled trial.

    Science.gov (United States)

    Aba, Yilda Arzu; Avci, Dilek; Guzel, Yilmaz; Ozcelik, Semanur Kumral; Gurtekin, Basak

    2017-08-01

    The aim of this study was to determine the effect of music therapy on the anxiety levels and pregnancy rates of women who underwent in vitro fertilization-embryo transfer. This prospective randomized controlled trial was conducted with 186 infertile women who presented to the In Vitro Fertilization Unit at the American Hospital in Turkey between April 2015 and April 2016. The infertile women who met the inclusion criteria were assigned to the music therapy group or the standard therapy group through block randomization. The study data were collected using the Personal Information Form, and State-Trait Anxiety Inventory. Early treatment success was determined by serum beta human chorionic gonadotrophin levels seven or ten days after the luteal day zero. For the analysis, descriptive statistics, chi-square test, Fisher's exact test, independent sample t-test were used. After the embryo transfer, the mean state anxiety scores decreased in both groups, and the mean trait anxiety score decreased in the music therapy group; however, the difference was not statistically significant (p>0.05). Clinical pregnancy rates did not differ between the music (48.3%) and standard (46.4%) therapy groups. After the two sessions of music therapy, state and trait anxiety levels decreased and pregnancy rates increased, but the difference was not significant. Therefore, larger sample sizes and more sessions are needed to evaluate whether music therapy has an effect on clinical outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Radiation therapy alone in stage III-B cancer of the uterine cervix - a 17-year experience in Southern Brazil

    International Nuclear Information System (INIS)

    Ferreira, Paulo R.F.; Braga-Filho, Aroldo; Barletta, Antonio; Ilha, Ligia A.

    1999-01-01

    Purpose: External irradiation followed by intracavitary therapy (EBIC) has been considered the standard treatment for stage III-B cancer of the uterine cervix. For different reasons, some patients are not suited for intracavitary therapy (ICT), and the treatment may be given entirely by external beam irradiation alone (EBRTA). The purpose of our study is to discuss treatment results and complications for patients undergoing EBIC or EBRTA. Methods and Materials: A retrospective study was carried out on 202 eligible patients with stage III-B cancer of the uterine cervix admitted for radiotherapy from 1980-1997. Ninety-three patients were able to receive EBIC (50 Gy, 8 MV RX whole pelvis followed by one session of 38-45 Gy ICT to point A). The remaining received EBRTA (50-70 Gy for 5-9 or more weeks). Median follow-up procedure was 18.5 months (range: 4-182) for all patients and 26 months (range 4-147) for the patients at risk. Results: The most frequent reason for precluding ICT was large residual tumor volume (32.1%). Ten-year overall survival rates, relapse free survival, and pelvic failure rate for the EBIC and EBRTA patients were, respectively, 22.5% x 15.6% (p = 0.0087), 23.5% x 14.8% (p = 0.005), and 51.6% x 68.8% (p = 0.005). However, when the same comparisons were performed with EBIC patients x EBRTA patients receiving a high dose schedule (60 Gy/6-8 wk to 70 Gy/7-9 wk), the results of the EBIC group remained higher, but the differences became insignificant: respectively, 22.5% x 18.9% (p = 0.17), 23.5% x 15.3% (p = 0.052), and 51.6% x 60.0% (p = 0.10). The distribution of complications was similar in both groups. Conclusions: We found that EBIC was the best treatment modality in our patients with stage III-B cancer of the uterine cervix, whereas for patients who were not candidates for ICT, EBRTA with a high dose schedule appears to be an efficient and safe alternative

  13. Impact of Anti-Helicobacter Therapy of H.pylori-Infected Parents on H.pylori Reinfection Rate in Children after Successful Eradication

    Directory of Open Access Journals (Sweden)

    O.P. Volosovets

    2012-02-01

    Full Text Available The article presents the data about the rate of H.pylori reinfection during 12 months after anti-helicobacter therapy among the children after successful eradication. It was shown that H.pylori reinfection rate was lower in children after successful eradication who were living after the treatment with parents non-infectead with H.pylori than among children who were living with H.pylori-infected parents. It was demonstrated that simultaneous anti-helicobacter therapy in H.pylori-infected parents of children with with chronic gastroduodenal diseases associated with H.pylori decreased H.pylori reinfection rate in children with successful eradication.

  14. SU-F-J-45: Sparing Normal Tissue with Ultra-High Dose Rate in Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Y [DCH Reg. Medical Center, Tuscaloosa, AL (United States)

    2016-06-15

    Purpose: To spare normal tissue by reducing the location uncertainty of a moving target, we proposed an ultra-high dose rate system and evaluated. Methods: High energy electrons generated with a linear accelerator were injected into a storage ring to be accumulated. The number of the electrons in the ring was determined based on the prescribed radiation dose. The dose was delivered within a millisecond, when an online imaging system found that the target was in the position that was consistent with that in a treatment plan. In such a short time period, the displacement of the target was negligible. The margin added to the clinical target volume (CTV) could be reduced that was evaluated by comparing of volumes between CTV and ITV in 14 cases of lung stereotactic body radiation therapy (SBRT) treatments. A design of the ultra-high dose rate system was evaluated based clinical needs and the recent developments of low energy (a few MeV) electron storage ring. Results: This design of ultra-high dose rate system was feasible based on the techniques currently available. The reduction of a target volume was significant by reducing the margin that accounted the motion of the target. ∼50% volume reduction of the internal target volume (ITV) could be achieved in lung SBRT treatments. Conclusion: With this innovation of ultra-high dose rate system, the margin of target is able to be significantly reduced. It will reduce treatment time of gating and allow precisely specified gating window to improve the accuracy of dose delivering.

  15. Variations in living donor graft rates by dialysis clinic: effect on outcome and cost of chronic renal failure therapy.

    Science.gov (United States)

    Baltzan, M A; Ahmed, S; Baltzan, R B; Marshall, R P; Thoma, E L; Nicol, M F

    1997-06-01

    Examination of nephrology practice variations in living donor renal grafts to determine their influence on organ supply, quality, and cost of chronic renal failure therapy. Saskatchewan chronic dialysis, cadaveric, and living donor renal grafts in 1983-1994 inclusive. Saskatchewan has three dialysis (I, II, III) and one transplant clinic. In the period the renal graft incidences/million population by these dialysis clinics by organ source were; Cadaveric: 23.1, 23.2, 21.1 (p = ns). Living: 5.4, 21.7, 8.3 (I or III vs II p actuarial patient survival is 92% and B 44%. Series A ten-year actuarial graft survival (including regrafts) is 77% and B 39%. Rehabilitation rate in patients with functioning grafts is 88.5%. Province-wide extension of the Clinic II living-donor graft rate in 1983-1994 would have produced 160 more renal grafts or 59% of those receiving chronic dialysis in 1994. The annual maintenance for a graft with the initial grafting cost taken over five years was $10,825 and the dialysis cost $40,100. (1) nephrology practice variations caused a 2.5-4.0-fold difference in living donor renal graft rates, indicating patient education by the attending nephrologist influences the living donor transplantation rate, (2) with such education the combined living donor and the cadaveric organ supply virtually meets graft demand, (3) living donor renal grafts yield a better quantity and quality of life and better cost control than dialysis with their annual cost being one-quarter that for dialysis.

  16. High-dose-rate stereotactic body radiation therapy for postradiation therapy locally recurrent prostatic carcinoma: Preliminary prostate-specific antigen response, disease-free survival, and toxicity assessment.

    Science.gov (United States)

    Fuller, Donald B; Wurzer, James; Shirazi, Reza; Bridge, Stephen S; Law, Jonathan; Mardirossian, George

    2015-01-01

    Patients with locally recurrent adenocarcinoma of the prostate following radiation therapy (RT) present a challenging problem. We prospectively evaluated the use of "high-dose-rate-like" prostate stereotactic body RT (SBRT) salvage for this circumstance, evaluating prostate-specific antigen response, disease-free survival, and toxicity. Between February 2009 and March 2014, 29 patients with biopsy-proven recurrent locally prostate cancer >2 years post-RT were treated. Median prior RT dose was 73.8 Gy and median interval to SBRT salvage was 88 months. Median recurrence Gleason score was 7 (79% was ≥7). Pre-existing RT toxicity >grade 1 was a reason for exclusion. Magnetic resonance imaging-defined prostate volume including any suspected extraprostatic extension, comprising the planning target volume. A total of 34 Gy/5 fractions was given, delivering a heterogeneous, high-dose-rate-like dose-escalation pattern. Toxicities were assessed using Common Terminology Criteria for Adverse Events, version 3.0, criteria. Twenty-nine treated patients had a median 24-month follow-up (range, 3-60 months). A median pre-SBRT salvage baseline prostate-specific antigen level of 3.1 ng/mL decreased to 0.65 ng/mL and 0.16 ng/mL at 1 and 2 years, respectively. Actuarial 2-year biochemical disease-free survival measured 82%, with no local failures. Toxicity >grade 1 was limited to the genitourinary domain, with 18% grade 2 or higher and 7% grade 3 or higher. No gastrointestinal toxicity >grade 1 occurred. Two-year disease-free survival is encouraging, and the prostate-specific antigen response kinetic appears comparable with that seen in de novo patients treated with SBRT, albeit still a preliminary finding. Grade ≥2 genitourinary toxicity was occasionally seen with no obvious predictive factor. Noting that our only brachytherapy case was 1 of the 2 cases with ≥grade 3 genitourinary toxicity, caution is recommended treating these patients. SBRT salvage of post-RT local recurrence

  17. Comparison of high dose rate (HDR) and low dose rate (LDR) brachytherapy in the treatment of stage IIIB cervix cancer with radiation therapy alone. The preliminary results

    International Nuclear Information System (INIS)

    Trippe, Nivaldo; Novaes, P.E.; Ferrigno, R.; Pellizzon, A.C.; Salvajoli, J.V.; Fogaroli, R.C.; Maia, M.A.C.; Baraldi, H.E.

    1996-01-01

    Purpose/Objective: To compare the results between HDR and LDR brachytherapy in the treatment of stage IIIB cervix cancer with radiation therapy alone through a prospective and randomized trial. Materials and Methods: From September 1992 to December 1993, 65 patients with stage IIIB cervical cancer were randomized to one of the following treatment schedule according to the brachytherapy used to complement the dose of external beam radiotherapy (EBRT): 1 - High dose rate (HDR) - 36 patients - 4 weekly insertions of 6,0 Gy at point A 2 - Low dose rate (LDR) - 29 patients - 2 insertions two weeks apart of 17,5 Gy at point A The External Beam radiotherapy was performed through a Linac 4MV, in box arrangement for whole pelvis and in AP-PA fields for parametrial complementation of dose. The dose at the whole pelvis was 45 Gy in 25 fractions of 1,8 Gy and the parametrial dose was 16 Gy. The brachytherapy was realized with Fletcher colpostats and intrauterine tandem, in both arms. The HDR brachytherapy was realized through a Micro-Selectron device, working with Iridium-192 with initial activity of 10 Ci and started ten days after the beginning of EBRT. The total treatment time was shortened in two weeks for this group. The LDR brachytherapy started only after the end of EBRT. Results: With the minimum follow up of 24 months and medium of 31 months, the disease free survival was 50% among the 36 patients in HDR group and 47,8% among the 29 patients in LDR group. Local failures occurred in 50% and 52,8% respectively. Grade I and II complications were restricted to rectites and cistites and the incidence of them was 8,3% for HDR group and 13% for LDR group. Until the time of evaluation there were no grade III complications in any group. Conclusions: Although the number of patients is small and the time of follow up still short, these preliminary results suggest that the HDR brachytherapy has an equivalent efficiency in local control as the LDR in the treatment of stage IIIB

  18. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ruijie, E-mail: ruijyang@yahoo.com; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-10-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5 mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78 Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D{sub 90} of 34 Gy in 8.5 Gy per fraction, and 145 Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2 Gy per fraction, EQD{sub 2}) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The D{sub mean} (EQD{sub 2}) of rectum decreased 22.36 Gy in HDR and 17.01 Gy in LDR from 30.24 Gy in VMAT, respectively. The D{sub mean} (EQD{sub 2}) of bladder decreased 6.91 Gy in HDR and 2.53 Gy in LDR from 13.46 Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD{sub 2}) was 80.26, 70.23, and 104.91 Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR.

  19. Factors Related to Significant Improvement of Estimated Glomerular Filtration Rates in Chronic Hepatitis B Patients Receiving Telbivudine Therapy

    Directory of Open Access Journals (Sweden)

    Te-Fu Lin

    2017-01-01

    Full Text Available Background and Aim. The improvement of estimated glomerular filtration rates (eGFRs in chronic hepatitis B (CHB patients receiving telbivudine therapy is well known. The aim of this study was to clarify the kinetics of eGFRs and to identify the significant factors related to the improvement of eGFRs in telbivudine-treated CHB patients in a real-world setting. Methods. Serial eGFRs were calculated every 3 months using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI equation. The patients were classified as CKD-1, -2, or -3 according to a baseline eGFR of ≥90, 60–89, or <60 mL/min/1.73 m2, respectively. A significant improvement of eGFR was defined as a more than 10% increase from the baseline. Results. A total of 129 patients were enrolled, of whom 36% had significantly improved eGFRs. According to a multivariate analysis, diabetes mellitus (DM (p=0.028 and CKD-3 (p=0.043 were both significantly related to such improvement. The rates of significant improvement of eGFR were about 73% and 77% in patients with DM and CKD-3, respectively. Conclusions. Telbivudine is an alternative drug of choice for the treatment of hepatitis B patients for whom renal safety is a concern, especially patients with DM and CKD-3.

  20. Controversies in external beam and high dose rate brachytherapy of oesophageal cancer

    International Nuclear Information System (INIS)

    Sur, R.K.; Levin, V.C.; Malas, Simon; Donde, Bernard

    1994-01-01

    Various controversies in the treatment of oesophageal carcinoma with external beam radiotherapy and high dose rate intracavitary irradiation have been reviewed. Conflicting results from different parts of the world has made it difficult to optimize the radiation dose that may give the best results. More studies and longer follow-up are needed before a definite conclusion can be made on the optimization of dose. (author). 18 refs., 2 tabs

  1. Impact of Pretreatment Tumor Growth Rate on Outcome of Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Atallah, Soha; Cho, B.C. John; Allibhai, Zishan; Taremi, Mojgan; Giuliani, Meredith [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Le, Lisa W. [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Brade, Anthony; Sun, Alexander; Bezjak, Andrea [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Hope, Andrew J., E-mail: andrew.hope@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2014-07-01

    Purpose: To determine the influence of pretreatment tumor growth rate on outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Methods and Materials: A review was conducted on 160 patients with T1-T2N0M0 NSCLC treated with SBRT at single institution. The patient's demographic and clinical data, time interval (t) between diagnostic and planning computed tomography (CT), vital status, disease status, and cause of death were extracted from a prospectively kept database. Differences in gross tumor volume between diagnostic CT (GTV1) and planning CT (GTV2) were recorded, and growth rate was calculated by use of specific growth rate (SGR). Kaplan-Meier curves were constructed for overall survival (OS). Differences between groups were compared with a log-rank test. Multivariate analyses were performed by use of the Cox proportional hazard model with SGR and other relevant clinical factors. Cumulative incidence was calculated for local, regional, and distant failures by use of the competing risk approach and was compared with Gray's test. Results: The median time interval between diagnostic and planning CT was 82 days. The patients were divided into 2 groups, and the median SGR was used as a cut-off. The median survival times were 38.6 and 27.7 months for the low and high SGR groups, respectively (P=.03). Eastern Cooperative Oncology Group performance status (P=.01), sex (P=.04), SGR (P=.03), and GTV2 (P=.002) were predictive for OS in multivariable Cox regression analysis and, except sex, were similarly predictive for failure-free survival (FFS). The 3-year cumulative incidences of regional failure were 19.2% and 6.0% for the high and low SGR groups, respectively (P=.047). Conclusion: High SGR was correlated with both poorer OS and FFS in patients with early-stage NSCLC treated with SBRT. If validated, this measurement may be useful in identifying patients most likely to benefit from

  2. On the impact of dose rate variation upon RapidArc implementation of volumetric modulated arc therapy

    International Nuclear Information System (INIS)

    Nicolini, Giorgia; Clivio, Alessandro; Cozzi, Luca; Fogliata, Antonella; Vanetti, Eugenio

    2011-01-01

    Purpose: A study was carried out to evaluate the robustness and mutual interplay of two variables concurring to generate modulation patterns of the RapidArc (RapidArc) implementation of volumetric modulated arc therapy. Dose rate (DR) and gantry speed (GS) are free parameters optimized alongside field aperture shape by the RapidArc engine; however, they are limited by machine constraints and mutually compensate in order to deliver the proper MU/deg during the gantry rotation. Methods: Four test cases (one geometrical and three clinical) were selected and RapidArc plans were optimized using maximum allowed dose rates from 100 to 600 MU/min. The maximum gantry speed was fixed at 4.8 deg/s. Qualitative analysis of DR and GS patterns from these cases was summarized together with quantitative assessment of delivery parameters. Pretreatment quality assurance measurements and scoring of plan quality aimed to determine whether preferable initial conditions might be identified or the optimization engine might be invariant to those variables and capable of providing adequate plans independently from the limits applied. Results: The results of the study were: (i) High dynamic range in MU/deg is achievable across all dose rates by means of gantry speed modulation; (ii) there is a robust compensation mechanism between the two variables; (iii) from a machine delivery point-of-view, slightly improved accuracy is achieved when lower DRs are applied; however, this does not have practical consequences since measurements and plan evaluation showed a lack of clinically relevant deviation; and (iv) reduced total treatment time is a major advantage of high DR. Conclusions: A trend toward improved plan quality for clinical cases was observed with high DR but cannot be generalized, due to the limited amount of cases investigated and the consequent limited significance of the observed differences. As a minimum benefit, the reduced total treatment time should be considered as well.

  3. SU-E-T-421: Feasibility Study of Volumetric Modulated Arc Therapy with Constant Dose Rate for Endometrial Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, R; Wang, J [Peking University Third Hospital, Beijing, Beijing (China)

    2014-06-01

    Purpose: To investigate the feasibility, efficiency, and delivery accuracy of volumetric modulated arc therapy with constant dose rate (VMAT-CDR) for whole-pelvic radiotherapy (WPRT) of endometrial cancer. Methods: The nine-Field intensity-modulated radiotherapy (IMRT), VMAT with variable dose-rate (VMAT-VDR), and VMAT-CDR plans were created for 9 patients with endometrial cancer undergoing WPRT. The dose distribution of planning target volume (PTV), organs at risk (OARs), and normal tissue (NT) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. For each VMAT-CDR plan, a dry Run was performed to assess the dosimetric accuracy with MatriXX from IBA. Results: Compared with IMRT, the VMAT-CDR plans delivered a slightly greater V20 of the bowel, bladder, pelvis bone, and NT, but significantly decreased the dose to the high-dose region of the rectum and pelvis bone. The MUs Decreased from 1105 with IMRT to 628 with VMAT-CDR. The delivery time also decreased from 9.5 to 3.2 minutes. The average gamma pass rate was 95.6% at the 3%/3 mm criteria with MatriXX pretreatment verification for 9 patients. Conclusion: VMAT-CDR can achieve comparable plan quality with significant shorter delivery time and smaller number of MUs compared with IMRT for patients with endometrial cancer undergoing WPRT. It can be accurately delivered and be an alternative to IMRT on the linear accelerator without VDR capability. This work is supported by the grant project, National Natural; Science Foundation of China (No. 81071237)

  4. Dose-related difference in progression rates of cytomegalovirus retinopathy during foscarnet maintenance therapy. AIDS Clinical Trials Group Protocol 915 Team.

    Science.gov (United States)

    Holland, G N; Levinson, R D; Jacobson, M A

    1995-05-01

    A previous dose-ranging study of foscarnet maintenance therapy for cytomegalovirus retinopathy showed a positive relationship between dose and survival but could not confirm a relationship between dose and time to first progression. This retrospective analysis of data from that study was undertaken to determine whether there was a relationship between dose and progression rates, which reflects the amount of retina destroyed when progression occurs. Patients were randomly given one of two foscarnet maintenance therapy doses (90 mg/kg of body weight/day [FOS-90 group] or 120 mg/kg of body weight/day [FOS-120 group] after induction therapy. Using baseline and follow-up photographs and pre-established definitions and methodology in a masked analysis, posterior progression rates and foveal proximity rates for individual lesions, selected by prospectively defined criteria, were calculated in each patient. Rates were compared between groups. The following median rates were greater for the FOS-90 group (N = 8) than for the FOS-120 group (N = 10): greatest maximum rate at which lesions enlarged in a posterior direction (43.5 vs 12.5 microns/day; P = .002); posterior progression rate for lesions closest to the fovea (42.8 vs 5.5 microns/day; P = .010); and maximum foveal proximity rate for either eye (32.3 vs 3.4 microns/day; P = .031). Patients receiving higher doses of foscarnet have slower rates of progression and therefore less retinal tissue damage during maintenance therapy. A foscarnet maintenance therapy dose of 120 mg/kg of body weight/day instead of 90 mg/kg of body weight/day may help to preserve vision in patients with cytomegalovirus retinopathy.

  5. Primary percutaneous and intracavitary radiotherapy of carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Hammer, J.; Zoidl, J.P.; Seewald, D.H.; Track, C.; Ledermair, O.; Altendorfer, C.

    1991-01-01

    At the Krankenhaus der Barmherzigen Schwestern in Linz 153 patients with cancer of the uterine cervix in the stages 1 to 3 have been treated from August 1980 to December 1985. In 146 patients (95.4 %) complete remission could be achieved. The 5-years overall survival probability (Kaplan-Mayer) in the stages 1 to 3 is 79.3 %, 62.6 % and 40.8 % respectively. The 5-year recurrence free survival rate is 91.5 %, 59.6 % and 52.9 % respectively. These results are equivalent to the data achieved by treatments with Radium application. Using the high-dose-rate afterloading method the complication rate is lower. (Authors)

  6. Conservative management of anal and rectal cancer. The role of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Gerard, J.P.; Romestaing, P.; Montbarbon, X. (Centre Hospitalier Lyon Sud, 69 - Pierre-Benite (France). Dept. of Radiotherapy)

    1989-01-01

    The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.).

  7. Results of combined therapy of irradiation and bleomycin suppository for advanced uterine cervical cancer

    International Nuclear Information System (INIS)

    Saito, Haruo; Asakawa, Hiroshi; Otawa, Hirokazu; Nemoto, Kenji; Saito, Hiroyuki

    1984-01-01

    Efficacy, survival rats and adverse effects of the combined therapy of irradiation with intravaginal bleomycin suppositories were analyzed and discussed in 49 patients with uterine cervical cancer. The results were as follows: 1. Histological examination of biopsy specimens from the uterine cervix taken just after the completion of this treatment showed favorable control over the primary lesions. However, the efficacy of the bleomycin suppositories was too mild to form a basis for treatment without intracavitary irradiation. Because of the low concentration of bleomycin in serum after suppository administration, it is thought that bleomycin would have little effect on distant metastases. 2. Survival rates in stage III patients were 83% at 12 months, 77% at 24 months and 70% at 36 months. These were superior to those for irradiation alone. 3. The major adverse effect of bleomycin suppositories was fever, reduction of the bleomycin dose in each suppository but controlled this to some extent Lung fibrosis or severe damage to the liver, kidney and bone marrow were not found. (author)

  8. A Rare Case of Intracavitary Fungus Ball (Aspergilloma in the Old Pulmonary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Majzoobi MM

    2017-06-01

    Full Text Available Introduction: Pulmonary fungus ball is a rare complication in pre-existing pulmonary cavitary lesions, due to some chronic pulmonary diseases including tuberculosis, lung abscess and sarcoidosis. Fungus ball is mostly caused by aspergillus. In many patients, fungus ball is asymptomatic, but in a significant number of them it can develop cough and hemoptysis, which may be massive and fatal. The cornerstone of assessment is chest imaging, along with sputum culture or aspergillus antibody in patient's serum. The purpose of this report is increment in attention to this complication in patients with previous pulmonary tuberculosis (TB. Case Presentation: The patient was a 23-year-old woman with chief complaint of fever, cough and hemoptysis, who was hospitalized in the Infectious Diseases Ward of Farshchian Sina hospital in March 2016. She had a history of anti-TB therapy from two years before. Sputum and bronchoalveolar lavage (BAL were negative for cytology and Mycobacterium tuberculosis, but cultures of both samples were positive for Aspergillus niger. Her lung contrast-enhanced computerized tomography (CECT scan revealed the presence of a fungus ball inside the upper lobe cavity of right lung. After lobectomy, fungal mass was confirmed by histopathology. Conclusions: In patients with pulmonary complaints (especially hemoptysis and history of cavitary pulmonary tuberculosis, the differential diagnosis of community-acquired pneumonia, lung abscess, reactivation of tuberculosis and lung cancer as well as fungal infections should be considered.

  9. The Rate and Shape of Change in Binge Eating Episodes and Weight: An Effectiveness Trial of Emotionally Focused Group Therapy for Binge-Eating Disorder.

    Science.gov (United States)

    Compare, Angelo; Tasca, Giorgio A

    2016-01-01

    This study investigated the phases of change and the relationship between binge eating (BE) episodes and weight across 20 weeks of emotionally focused group therapy (EFGT) and combined therapy (CT) of EFGT plus dietary counselling for BE disorder. We used a non-randomized observational study design that included 118 obese adult patients with BE disorder who were treated by manualized therapy protocols. Participants were assigned to treatment condition (EFGT or CT) based on consensus among clinicians. Participants were assessed weekly during the 20 weeks of therapy for weight and BE episodes and at pre-treatment and 6 months post-treatment. Binge eating episodes and weight significantly declined during EFGT and CT. Compared with EFGT, CT resulted in more rapid weight loss across weeks of therapy. BE episodes and weight significantly covaried, and their positive association increased as sessions progressed. Change in BE episodes and weight during treatment was best modelled by a cubic growth curve showing a slow rate of change in early sessions, a faster rate of change in middle sessions and a slower rate of change in late sessions. This cubic modelling of change was associated with better outcomes 6 months post-treatment. Cubic modelling of change supported a three-stage model of EFGT and CT, and the cubic trajectory was associated with better outcomes at follow-up. The addition of dietary counselling to EFGT resulted in earlier response to treatment in terms of BE episodes and weight among those in the CT condition. Decline in binge eating (BE) episodes is related to decline in weight, and this relationship was greater towards the end of treatment. Emotionally focused group therapy plus dietary counselling that targets both affect regulation and nutritional problems resulted in faster rate of response early in treatment both in terms of BE episodes and weight. Combined emotionally focused group therapy and dietary counselling may provide clinicians with an

  10. Monte Carlo model for a prototype CT-compatible, anatomically adaptive, shielded intracavitary brachytherapy applicator for the treatment of cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Price, Michael J.; Gifford, Kent A.; Horton, John L. Jr.; Eifel, Patricia J.; Gillin, Michael T.; Lawyer, Ann A.; Mourtada, Firas [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1220 Holcombe Boulevard, Houston, Texas 77030 and Graduate School of Biomedical Sciences, University of Texas-Houston, 6767 Bertner Avenue, Houston, Texas 77030 (United States); Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1220 Holcombe Boulevard, Houston, Texas 77030 (United States); Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1220 Holcombe Boulevard, Houston, Texas 77030 and Graduate School of Biomedical Sciences, University of Texas-Houston, 6767 Bertner Avenue, Houston, Texas 77030 (United States); Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1220 Holcombe Boulevard, Houston, Texas 77030 and Graduate School of Biomedical Sciences, University of Texas-Houston, 6767 Bertner Avenue, Houston, Texas 77030 (United States); Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1220 Holcombe Boulevard, Houston, Texas 77030 (United States); Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1220 Holcombe Boulevard, Houston, Texas 77030 and Graduate School of Biomedical Sciences, University of Texas-Houston, 6767 Bertner Avenue, Houston, Texas 77030 (United States)

    2009-09-15

    Purpose: Current, clinically applicable intracavitary brachytherapy applicators that utilize shielded ovoids contain a pair of tungsten-alloy shields which serve to reduce dose delivered to the rectum and bladder during source afterloading. After applicator insertion, these fixed shields are not necessarily positioned to provide optimal shielding of these critical structures due to variations in patient anatomies. The authors present a dosimetric evaluation of a novel prototype intracavitary brachytherapy ovoid [anatomically adaptive applicator (A{sup 3})], featuring a single shield whose position can be adjusted with two degrees of freedom: Rotation about and translation along the long axis of the ovoid. Methods: The dosimetry of the device for a HDR {sup 192}Ir was characterized using radiochromic film measurements for various shield orientations. A MCNPX Monte Carlo model was developed of the prototype ovoid and integrated with a previously validated model of a v2 mHDR {sup 192}Ir source (Nucletron Co.). The model was validated for three distinct shield orientations using film measurements. Results: For the most complex case, 91% of the absolute simulated and measured dose points agreed within 2% or 2 mm and 96% agreed within 10% or 2 mm. Conclusions: Validation of the Monte Carlo model facilitates future investigations into any dosimetric advantages the use of the A{sup 3} may have over the current state of art with respect to optimization and customization of dose delivery as a function of patient anatomical geometries.

  11. Monte Carlo model for a prototype CT-compatible, anatomically adaptive, shielded intracavitary brachytherapy applicator for the treatment of cervical cancer

    International Nuclear Information System (INIS)

    Price, Michael J.; Gifford, Kent A.; Horton, John L. Jr.; Eifel, Patricia J.; Gillin, Michael T.; Lawyer, Ann A.; Mourtada, Firas

    2009-01-01

    Purpose: Current, clinically applicable intracavitary brachytherapy applicators that utilize shielded ovoids contain a pair of tungsten-alloy shields which serve to reduce dose delivered to the rectum and bladder during source afterloading. After applicator insertion, these fixed shields are not necessarily positioned to provide optimal shielding of these critical structures due to variations in patient anatomies. The authors present a dosimetric evaluation of a novel prototype intracavitary brachytherapy ovoid [anatomically adaptive applicator (A 3 )], featuring a single shield whose position can be adjusted with two degrees of freedom: Rotation about and translation along the long axis of the ovoid. Methods: The dosimetry of the device for a HDR 192 Ir was characterized using radiochromic film measurements for various shield orientations. A MCNPX Monte Carlo model was developed of the prototype ovoid and integrated with a previously validated model of a v2 mHDR 192 Ir source (Nucletron Co.). The model was validated for three distinct shield orientations using film measurements. Results: For the most complex case, 91% of the absolute simulated and measured dose points agreed within 2% or 2 mm and 96% agreed within 10% or 2 mm. Conclusions: Validation of the Monte Carlo model facilitates future investigations into any dosimetric advantages the use of the A 3 may have over the current state of art with respect to optimization and customization of dose delivery as a function of patient anatomical geometries.

  12. The Creteil method of intracavitary brachytherapy for cancer of the cervix

    International Nuclear Information System (INIS)

    Pierquin, B.; Marinello, G.

    1981-01-01

    This system is based on a principle of direct proportionality between the dimensions of the uterine cervix and the length of the vaginal sources. The system defines a reference isodose of fixed value encompassing a target volume of constant anatomic structures. The target volume always contains the same anatomic structures, independent of the tumor extent. The technique for doing the application is based upon certain practical principles: - the use of a cervical-vaginal plastic mould with a semi-rigid uterine tandem; - the use of 192 Ir wires; - the same uniform linear exposure rate for each source used in the application; - a single application for each patient; - the source in the uterus and the sources in the vagina are left in place for the same time. The maximum total dose is 60 Gy, calculated at the reference isodose of 4 Gy/day, assuming a linear nominal exposure rate of 1 mR x h -1 x m 2 x cm -1 . This corresponds to an effective dose rate which varies between 8 and 16 Gy/day, when the actual linear exposure rate of the 192 Ir wires is taken into account. The cervical dose, calculated at the level of the mucosa, is approximately twice the reference dose. It depends upon the size of the cervix, being 2.1 times the reference dose when the cervix is greater than 4 cm in diameter and 2.6 times when the cervix is less than 2.5 cm in diameter. The vaginal dose, calculated at the ''Cap Sassal point'', on the anterior part of the rectum, is always less than the reference dose [fr

  13. Microbubbles in macrocysts - Contrast-enhanced ultrasound assisted sclerosant therapy of a congenital macrocystic lymphangioma: a case report.

    Science.gov (United States)

    Menendez-Castro, Carlos; Zapke, Maren; Fahlbusch, Fabian; von Goessel, Heiko; Rascher, Wolfgang; Jüngert, Jörg

    2017-07-06

    Congenital cystic lymphangiomas are benign malformations due to a developmental disorder of lymphatic vessels. Besides surgical excision, sclerosant therapy of these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option. For an appropriate application of OK-432, a detailed knowledge about the structure and composition of the congenital cystic lymphangioma is essential. SonoVue® is a commercially available contrast agent commonly used in sonography by intravenous and intracavitary application. Here we report the case of 2 month old male patient with a large thoracic congenital cystic lymphangioma. Preinterventional imaging of the malformation was performed by contrast-enhanced ultrasound after intracavitary application of SonoVue® immediately followed by a successful sclerotherapy with OK-432. Contrast agent-enhanced ultrasound imaging offers a valuable option to preinterventionally clarify the anatomic specifications of a congenital cystic lymphangioma in more detail than by single conventional sonography. By the exact knowledge about the composition and especially about the intercystic communications of the lymphangioma sclerosant therapy becomes safer and more efficient.

  14. Treatment outcome and prognostic factors of Stage IIIb squamous cell carcinoma of the uterine cervix treated with radiation therapy. Establish of historical controls

    International Nuclear Information System (INIS)

    Yokoyama, Takashi; Kataoka, Masaaki; Mogami, Hiroshi; Nogawa, Takayoshi; Chiba, Take; Hiura, Masamichi

    2001-01-01

    Neoadjuvant chemotherapy (NAC) and concurrent chemoradiotherapy (CCR) have been used to treat advanced squamous cell carcinoma of the uterine cervix. While the effectiveness of these therapies should be evaluated by a prospective randomized control study, no such study had ever been performed at the National Shikoku Cancer Center Hospital. For this reason, the authors assessed the results of radiotherapy after introduction of RALS (remote-controlled afterloading system) for patients with Stage IIIb squamous cell carcinoma of the uterine cervix and establish historical controls. The subjects were 95 patients (median age: 68 years) who had been treated at this hospital between 1983 and 1993. Twelve patients with PS4, severe complications, and active double cancer, received palliative external irradiation alone to the pelvis and 1 received palliative intracavitary received irradiation alone. The other 82 patients had external irradiation to the pelvis and intracavitary irradiation as curative irradiation. Thus, palliative irradiation and curative irradiation were performed in 13 cases and 82 cases, respectively. The overall survival rate (OAS), disease-specific survival rate (DDS), and disease-free survival rate (DFS) at 5 years in the palliative irradiation group were 7.7%, 16.8%, and 0%, respectively. In the curative irradiation group, OAS, DDS, and DFS were 56.1%, 65.9%, and 61.9%, respectively. Comparisons between the two groups showed significant differences each of the survival rates, and the outcome in the palliative irradiation group was very poor. Risk factors for recurrence were investigated, by comparing DFS among the 82 curatively irradiated cases, but no independent risk factors were identified by multivariate analysis. Exclusive of the patients with PS4, severe complications, active double cancer, and palliative irradiation, 62 patients were defined as historical controls. The survival rates of 62 patients were significantly better than those of the

  15. Intracavitary radiotherapy of cervix carcinoma with flexible applicators after vesicovaginal interposition operation of the uterus

    International Nuclear Information System (INIS)

    Busch, M. II; Burmester, U.; Matthaei, D.; Duehmke, E.; Meden, H.; Kuhn, K.

    1991-01-01

    Advantages of new flexible intracervical applicators treating cervical cancer with high dose rate afterloading brachytherapy are reported: The insertion of the flexible applicator is usually possible without anesthesia and dilatation of the cervix. Therefore the treatment can be performed on an outpatient basis. The risks of perforation and infection are minimal. Dosimetry and documentation of the applicator geometry are possible, if the planning system allows the definition of individual curves of an individual applicator. We now prefer flexible applicators instead of rigid steel applicators treating cervix carcinoma. (orig.) [de

  16. Intracavitary dosimetry of a high-activity remote loading device with oscillating source

    International Nuclear Information System (INIS)

    Arcovito, G.; Piermattei, A.; D'Abramo, G.; Bassi, F.A.

    1984-01-01

    Dosimetric experiments have been carried out in water around a Fletcher applicator loaded by a Buchler system containing two 137 Cs 148 GBq (4 Ci) sources and one 192 Ir 740 GBq (20 Ci) source. The mechanical system which controls the movement of the 192 Ir source and the resulting motion of the source are described. The dose distribution around the sources was measured photographically and by a PWT Normal 0.22 cm 3 ionisation chamber. The absolute dose rate was measured along the lateral axes of the sources. The measurements of exposure in water near the sources were corrected for the effect due to the finite volume of the chamber. The ''quantisation method'' described by Cassell (1983) was utilised to calculate the variation of the dose rate along the lateral axes of the sources. The dose distribution around both 192 Ir and 137 Cs sources was found to be spherical for angles greater than 40 0 from the longitudinal axes of the sources. A simple algorithm fitting the data for the moving 192 Ir source is proposed. A program written in FORTRAN IV and run on a Univac 1100/80 computer has been used to plot dose distributions on anatomical data obtained from CT images. (author)

  17. Direction Modulated Brachytherapy for Treatment of Cervical Cancer. II: Comparative Planning Study With Intracavitary and Intracavitary–Interstitial Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Han, Dae Yup [Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California (United States); Safigholi, Habib; Soliman, Abraam [Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario (Canada); Ravi, Ananth [Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Leung, Eric [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Scanderbeg, Daniel J. [Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California (United States); Liu, Zhaowei [Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California (United States); Owrangi, Amir [Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Song, William Y., E-mail: william.song@sunnybrook.ca [Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2016-10-01

    Purpose: To perform a comprehensive comparative planning study evaluating the utility of the proposed direction modulated brachytherapy (DMBT) tandem applicator against standard applicators, in the setting of image guided adaptive brachytherapy of cervical cancer. Methods and Materials: A detailed conceptual article was published in 2014. The proposed DMBT tandem applicator has 6 peripheral grooves of 1.3-mm width, along a 5.4-mm-thick nonmagnetic tungsten alloy rod of density 18.0 g/cm{sup 3}, capable of generating directional dose profiles. We performed a comparative planning study with 45 cervical cancer patients enrolled consecutively in the prospective observational EMBRACE study. In all patients, MRI-based planning was performed while utilizing various tandem-ring (27 patients) and tandem-ring-needles (18 patients) applicators, in accordance with the Groupe Européen de Curiethérapie–European Society for Radiotherapy and Oncology recommendations. For unbiased comparisons, all cases were replanned with an in-house–developed inverse optimization code while enforcing a uniform set of constraints that are reflective of the clinical practice. All plans were normalized to the same high-risk clinical target volume D90 values achieved in the original clinical plans. Results: In general, if the standard tandem was replaced with the DMBT tandem while maintaining all other planning conditions the same, there was consistent improvement in the plan quality. For example, among the 18 tandem-ring-needles cases, the average D2cm{sup 3} reductions achieved were −2.48% ± 11.03%, −4.45% ± 5.24%, and −5.66% ± 6.43% for the bladder, rectum, and sigmoid, respectively. An opportunity may also exist in avoiding use of needles altogether for when the total number of needles required is small (approximately 2 to 3 needles or less), if DMBT tandem is used. Conclusions: Integrating the novel DMBT tandem onto both intracavitary and intracavitary

  18. Treatment results by uneven fractionated irradiation, low-dose rate telecobalt therapy as a boost, and intraoperative irradiation for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Shogo; Takai, Yoshihiro; Nemoto, Kenji; Ogawa, Yoshihiro; Kakuto, Yoshihisa; Hoshi, Akihiko; Sakamoto, Kiyohiko; Kayama, Takamasa; Yoshimoto, Takashi (Tohoku Univ., Sendai (Japan). School of Medicine)

    1992-08-01

    The prognosis of malignant glioma is extremely poor. We applied conventionally fractionated irradiation combined with 1-(4-aminio-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU), uneven fractionated irradiation with ACNU, low dose rate telecobalt therapy as a boost, and intraoperative irradiation against 110 malignant gliomas to investigate the efficacy of these methods as alternative treatments for malignant glioma. Although local tumor control by uneven fractionated irradiation was better than that by the other methods, no significant improvement was obtained in survival rates. As a result of multiple regression analysis, age and histology were major factors for survival rates, and the difference of treatment methods was not important. Both low-dose rate telecobalt therapy as a boost and intraoperative irradiation showed little advantage because of the high risk of brain necrosis associated with them. (author).

  19. Client Perceptions of Helpfulness in Therapy: a Novel Video-Rating Methodology for Examining Process Variables at Brief Intervals During a Single Session.

    Science.gov (United States)

    Cocklin, Alexandra A; Mansell, Warren; Emsley, Richard; McEvoy, Phil; Preston, Chloe; Comiskey, Jody; Tai, Sara

    2017-11-01

    The value of clients' reports of their experiences in therapy is widely recognized, yet quantitative methodology has rarely been used to measure clients' self-reported perceptions of what is helpful over a single session. A video-rating method using was developed to gather data at brief intervals using process measures of client perceived experience and standardized measures of working alliance (Session Rating Scale; SRS). Data were collected over the course of a single video-recorded session of cognitive therapy (Method of Levels Therapy; Carey, 2006; Mansell et al., 2012). We examined the acceptability and feasibility of the methodology and tested the concurrent validity of the measure by utilizing theory-led constructs. Eighteen therapy sessions were video-recorded and clients each rated a 20-minute session of therapy at two-minute intervals using repeated measures. A multi-level analysis was used to test for correlations between perceived levels of helpfulness and client process variables. The design proved to be feasible. Concurrent validity was borne out through high correlations between constructs. A multi-level regression examined the independent contributions of client process variables to client perceived helpfulness. Client perceived control (b = 0.39, 95% CI .05 to 0.73), the ability to talk freely (b = 0.30, SE = 0.11, 95% CI .09 to 0.51) and therapist approach (b = 0.31, SE = 0.14, 95% CI .04 to 0.57) predicted client-rated helpfulness. We identify a feasible and acceptable method for studying continuous measures of helpfulness and their psychological correlates during a single therapy session.

  20. Treatment of 29 patients with bulky squamous cell carcinoma of the cervix with simultaneous cisplatin, 5-fluorouracil, and split-course hyperfractionated radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Heaton, D.; Yordan, E.; Reddy, S.; Bonomi, P.; Lee, M.S.; Lincoln, S.; Graham, J.; Dolan, T.; Miller, A.; Phillips, A. (Rush Presbyterian-St. Lukes Hospital, Chicago, IL (USA))

    1990-09-01

    Attempting to improve local disease control in bulky primary or recurrent pelvic tumors, 29 patients with squamous cell carcinoma of the cervix were treated with concomitant chemotherapy and split-course hyperfractionated radiation therapy between April 1983 and August 1988. Cisplatin (CDDP) and 5-fluorouracil (5-FU) have been shown to be radiation enhancers; furthermore, CDDP, radiation therapy, and continuous-infusion 5-FU have elicited high local response rates in head and neck squamous cell carcinoma. A pilot study of cyclical week on/week off CDDP, continuous-infusion 5-FU, and hyperfractionated radiation therapy was developed. Radiation was administered at 116 cGy twice daily, Days 1-5, every other week for a median dose of 4600 cGy to a pelvic field, with paraaortic extension if indicated. Concomitant chemotherapy included CDDP 60 mg/m2 IV Day 1 and 5-FU 600 mg/m2 IV continuous infusion for 96 hr following CDDP infusion. Patients received a median of four cycles of combined treatment, and intracavitary or interstitial brachytherapy followed in 21 patients. Local pelvic response was achieved in 29 of 29 (100%): complete response (CR) in 19 of 29 (66%), partial response (PR) in 10 of 29 (34%). Among CR patients 10 of 19 (53%) were without evidence of disease at a mean follow-up of 29 (range 12-76) months. Five-year actuarial disease-free survival among complete responders was 65%. Of the 10 CR patients 2 failed in the pelvis, for a local control rate of 17/19 (89%). Chemotherapy-related and acute radiation morbidity was minimal but 2 patients required surgical correction of radiation injury. Aggressive combination of split-course hyperfractionated radiation therapy with radiation enhancers resulted in promising local control of bulky pelvic tumor, with an acceptable complication rate, in this otherwise very poor prognostic group of patients.

  1. Rate of improvement during and across three treatments for panic disorder with or without agoraphobia : Cognitive behavioral therapy, selective serotonin reuptake inhibitor or both combined

    NARCIS (Netherlands)

    Van Apeldoorn, Franske J.; Van Hout, Wiljo J. P. J.; Timmerman, Marieke E.; Mersch, Peter Paul A.; den Boer, Johan A.

    2013-01-01

    Background: Existing literature on panic disorder (PD) yields no data regarding the differential rates of improvement during Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitor (SSRI) or both combined (CBT+SSRI). Method: Patients were randomized to CBT, SSRI or CBT+SSRI which

  2. Adjuvant postoperative radiation therapy for carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Moon, Hye Seong; Kim, Seung Cheol; Kim, Chong Il; Ahn, Jung Ja

    2003-01-01

    This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study, The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, Iymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was 45 - 50 Gy. Vagina cuff irradiation was performed, after completion of the external beam irradiation, al a low-dose rate of CS-137, with the total dose of 4488-4932 chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months (15-108 months), The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95% and 94%, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Our results indicate that postoperative radiation therapy can

  3. Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program.

    Science.gov (United States)

    Wichrowski, Matthew; Whiteson, Jonathan; Haas, François; Mola, Ana; Rey, Mariano J

    2005-01-01

    To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) in patients participating in an inpatient cardiac rehabilitation program. Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT group consisted of 59 subjects (34 males, 25 females). The control group, which participated in patient education classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC are components of the inpatient rehabilitation program. Each group was evaluated before and after a class in their respective modality. Evaluation consisted of the completion of a Profile of Mood States (POMS) inventory, and an HR obtained by pulse oximetry. Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and postintervention were compared between groups. There was no presession difference in either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79 +/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD was significantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantly changed (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but was unchanged in PEC. These findings indicate that HT improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation.

  4. Limited Margin Radiation Therapy for Children and Young Adults With Ewing Sarcoma Achieves High Rates of Local Tumor Control

    Energy Technology Data Exchange (ETDEWEB)

    Talleur, Aimee C.; Navid, Fariba [Department of Oncology, St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Spunt, Sheri L. [Department of Pediatrics, Stanford University School of Medicine, Stanford, California (United States); McCarville, M. Beth [Department of Diagnostic Imaging, St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Wu, John; Mao, Shenghua [Department of Biostatistics, St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Davidoff, Andrew M. [Department of Surgery, St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee (United States); Neel, Michael D. [Department of Surgery, St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Krasin, Matthew J., E-mail: matthew.krasin@stjude.org [Department of Radiation Oncology, St. Jude Children' s Research Hospital, Memphis, Tennessee (United States)

    2016-09-01

    Purpose: To determine the rate of local failure using focal conformal, limited margin radiation therapy (RT) and dose escalation for tumors ≥8 cm (greatest dimension at diagnosis) in children and young adults with Ewing sarcoma (EWS). Methods and Materials: Eligible patients with EWS were treated on a phase 2 institutional trial of focal conformal, limited margin RT using conformal or intensity modulated techniques. The treatment volume incorporated a 1-cm constrained margin around the gross tumor. Unresected tumors, <8 cm at diagnosis, received a standard dose of 55.8 Gy and tumors ≥8 cm, an escalated dose to 64.8 Gy. Patients with microscopic residual disease after resection received adjuvant RT to 50.4 Gy. Adjuvant brachytherapy was permitted in selected patients. Results: Forty-five patients were enrolled: 26 with localized and 19 with metastatic disease. Median (range) age, tumor size, and follow-up were 13.0 years (2.9-24.7 years), 9.0 cm (2.4-17.0 cm), and 54.5 months (1.9-122.2 months), respectively. All patients received systemic chemotherapy. The median (range) RT dose for all patients was 56.1 Gy (45-65.5 Gy). Seventeen patients received adjuvant, 16 standard-dose, and 12 escalated-dose RT. Failures included 1 local, 10 distant, and 1 local/distant. The estimated 10-year cumulative incidence of local failure was 4.4% ± 3.1%, with no statistical difference seen between RT treatment groups and no local failures in the escalated-dose RT treatment group. Conclusions: Treatment with focal conformal, limited margin RT, including dose escalation for larger tumors, provides favorable local tumor control in EWS.

  5. Limited Margin Radiation Therapy for Children and Young Adults With Ewing Sarcoma Achieves High Rates of Local Tumor Control

    International Nuclear Information System (INIS)

    Talleur, Aimee C.; Navid, Fariba; Spunt, Sheri L.; McCarville, M. Beth; Wu, John; Mao, Shenghua; Davidoff, Andrew M.; Neel, Michael D.; Krasin, Matthew J.

    2016-01-01

    Purpose: To determine the rate of local failure using focal conformal, limited margin radiation therapy (RT) and dose escalation for tumors ≥8 cm (greatest dimension at diagnosis) in children and young adults with Ewing sarcoma (EWS). Methods and Materials: Eligible patients with EWS were treated on a phase 2 institutional trial of focal conformal, limited margin RT using conformal or intensity modulated techniques. The treatment volume incorporated a 1-cm constrained margin around the gross tumor. Unresected tumors, <8 cm at diagnosis, received a standard dose of 55.8 Gy and tumors ≥8 cm, an escalated dose to 64.8 Gy. Patients with microscopic residual disease after resection received adjuvant RT to 50.4 Gy. Adjuvant brachytherapy was permitted in selected patients. Results: Forty-five patients were enrolled: 26 with localized and 19 with metastatic disease. Median (range) age, tumor size, and follow-up were 13.0 years (2.9-24.7 years), 9.0 cm (2.4-17.0 cm), and 54.5 months (1.9-122.2 months), respectively. All patients received systemic chemotherapy. The median (range) RT dose for all patients was 56.1 Gy (45-65.5 Gy). Seventeen patients received adjuvant, 16 standard-dose, and 12 escalated-dose RT. Failures included 1 local, 10 distant, and 1 local/distant. The estimated 10-year cumulative incidence of local failure was 4.4% ± 3.1%, with no statistical difference seen between RT treatment groups and no local failures in the escalated-dose RT treatment group. Conclusions: Treatment with focal conformal, limited margin RT, including dose escalation for larger tumors, provides favorable local tumor control in EWS.

  6. Magnetic Resonance Imaging-Guided Intracavitary Brachytherapy for Cancer of the Cervix

    International Nuclear Information System (INIS)

    Zwahlen, Daniel; Jezioranski, John; Chan, Philip; Haider, Masoom A.; Cho, Young-Bin; Yeung, Ivan; Levin, Wilfred; Manchul, Lee; Fyles, Anthony; Milosevic, Michael

    2009-01-01

    Purpose: To determine the feasibility and benefits of optimized magnetic resonance imaging (MRI)-guided brachytherapy (BT) for cancer of the cervix. Methods and Materials: A total of 20 patients with International Federation of Gynecology and Obstetrics Stage IB-IV cervical cancer had an MRI-compatible intrauterine BT applicator inserted after external beam radiotherapy. MRI scans were acquired, and the gross tumor volume at diagnosis and at BT, the high-risk (HR) and intermediate-risk clinical target volume (CTV), and rectal, sigmoid, and bladder walls were delineated. Pulsed-dose-rate BT was planned and delivered in a conventional manner. Optimized MRI-based plans were developed and compared with the conventional plans. Results: The HR CTV and intermediate-risk CTV were adequately treated (the percentage of volume treated to ≥100% of the intended dose was >95%) in 70% and 85% of the patients with the conventional plans, respectively, and in 75% and 95% of the patients with the optimized plans, respectively. The minimal dose to the contiguous 2 cm 3 of the rectal, sigmoid, and bladder wall volume was 16 ± 6.2, 25 ± 8.7, and 31 ± 9.2 Gy, respectively. With MRI-guided BT optimization, it was possible to maintain coverage of the HR-CTV and reduce the dose to the normal tissues, especially in patients with small tumors at BT. In these patients, the HR percentage of volume treated to ≥100% of the intended dose approached 100% in all cases, and the minimal dose to the contiguous 2-cm 3 of the rectum, sigmoid, and bladder was 12-32% less than with conventional BT planning. Conclusion: MRI-based BT for cervical cancer has the potential to optimize primary tumor dosimetry and reduce the dose to critical normal tissues, particularly in patients with small tumors.

  7. Relationship of long-term highly active antiretroviral therapy on salivary flow rate and CD4 Count among HIV-infected patients.

    Science.gov (United States)

    Kumar, J Vijay; Baghirath, P Venkat; Naishadham, P Parameswar; Suneetha, Sujai; Suneetha, Lavanya; Sreedevi, P

    2015-01-01

    To determine if long-term highly active antiretroviral therapy (HAART) therapy alters salivary flow rate and also to compare its relation of CD4 count with unstimulated and stimulated whole saliva. A cross-sectional study was performed on 150 individuals divided into three groups. Group I (50 human immunodeficiency virus (HIV) seropositive patients, but not on HAART therapy), Group II (50 HIV-infected subjects and on HAART for less than 3 years called short-term HAART), Group III (50 HIV-infected subjects and on HAART for more than or equal to 3 years called long-term HAART). Spitting method proposed by Navazesh and Kumar was used for the measurement of unstimulated and stimulated salivary flow rate. Chi-square test and analysis of variance (ANOVA) were used for statistical analysis. The mean CD4 count was 424.78 ± 187.03, 497.82 ± 206.11 and 537.6 ± 264.00 in the respective groups. Majority of the patients in all the groups had a CD4 count between 401 and 600. Both unstimulated and stimulated whole salivary (UWS and SWS) flow rates in Group I was found to be significantly higher than in Group II (P flow rate between Group II and III subjects were also found to be statistically significant (P relationship in Group II (P flow rates of HIV-infected individuals who are on long-term HAART.

  8. Analysis of prognostic factors in stage IIB-IVA cervical carcinoma treated with radiation therapy: value of computed tomography

    International Nuclear Information System (INIS)

    Ogino, Ichiro; Okamoto, Naoyuki; Andoh, Kazuo; Kitamura, Tatsuo; Okajima, Hiroyuki; Matsubara, Sho

    1997-01-01

    Purpose: To define the influence of the tumor size measured by computed tomography (CT) and lymph node involvement detected by CT in patients treated with radiation therapy for Stage IIB-IVA carcinoma of intact uterine cervix. Methods and Materials: This was a retrospective analysis of 233 patients with uterine cervical cancer managed with both external irradiation and high-dose-rate intracavitary brachytherapy (HDR-ICR) at Kanagawa Cancer Center. The results were analyzed for the end points of absolute survival (AS), disease-free survival (DFS), pelvic control (PC), and central control (CC). The parameters of stage, CT-measured anterior-posterior (AP) cervix size, and CT-detected lymph node metastases were evaluated using univariate and multivariate analysis. Results: The stage, AP cervix size, and lymph node involvement were significant pretreatment factors in univariate analysis with respect to AS, DFS, PC, and CC. Multivariate analysis confirmed that significant risk was associated with certain prognostic parameters. Those in terms of AS, in order of decreasing significance, were lymph node involvement, AP cervix size, age, and total HDR-ICR dose. When DFS was studied, lymph node involvement and AP cervix size were demonstrated to have a significant effect. Stage and lymph node involvement significantly affected PC. Conclusion: Because the International Federation of Gynecological Obstetrics staging system fails to incorporate important prognostic information about tumor volume and lymph node involvement, CT-detected lymph node metastases as well as CT-measured cervix size should be determined as complementary additional prognostic measures

  9. Effects of age, replicative lifespan and growth rate of human nucleus pulposus cells on selecting age range for cell-based biological therapies for degenerative disc diseases.

    Science.gov (United States)

    Lee, J S; Lee, S M; Jeong, S W; Sung, Y G; Lee, J H; Kim, K W

    2016-07-01

    Autologous disc cell implantation, growth factors and gene therapy appear to be promising therapies for disc regeneration. Unfortunately, the replicative lifespan and growth kinetics of human nucleus pulposus (NP) cells related to host age are unclear. We investigated the potential relations among age, replicative lifespan and growth rate of NP cells, and determined the age range that is suitable for cell-based biological therapies for degenerative disc diseases. We used NP tissues classified by decade into five age groups: 30s, 40s, 50s, 60s and 70s. The mean cumulative population doubling level (PDL) and population doubling rate (PDR) of NP cells were assessed by decade. We also investigated correlations between cumulative PDL and age, and between PDR and age. The mean cumulative PDL and PDR decreased significantly in patients in their 60s. The mean cumulative PDL and PDR in the younger groups (30s, 40s and 50s) were significantly higher than those in the older groups (60s and 70s). There also were significant negative correlations between cumulative PDL and age, and between PDR and age. We found that the replicative lifespan and growth rate of human NP cells decreased with age. The replicative potential of NP cells decreased significantly in patients 60 years old and older. Young individuals less than 60 years old may be suitable candidates for NP cell-based biological therapies for treating degenerative disc diseases.

  10. Clinical and dosimetric results of three-dimensional image-guided and pulsed dose rate curie-therapy in locally advanced cervical cancers

    International Nuclear Information System (INIS)

    Mazeron, R.; Gilmore, J.; Dumas, I.; Abrous-Anane, S.; Haberer, S.; Verstraet, R.; Champoudry, J.; Martinetti, F.; Morice, P.; Haie-Meller, C.

    2011-01-01

    The authors report a review of data obtained between 2004 and 2009 on 130 women who had been treated by optimized pulsed-rate curie-therapy for a locally advanced cervical cancer. Results are discussed in terms of cancer stage, treatment (with or without concomitant chemotherapy), planning method (MRI, scanography), delivered doses in the clinical target volumes, surgery, relapse occurrence and localizations, global survival probability, local control, undesirable side effects, occurrence of intestine or urinary toxicity. It appears that the association of a concomitant chemo-radiotherapy and optimized curie-therapy results in a good local-regional control and a low toxicity level. Short communication

  11. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies

    International Nuclear Information System (INIS)

    Sarkaria, Jann N.; Petereit, Daniel G.; Kinsella, Timothy J.; Buchler, Dolores A.

    1995-01-01

    Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR 192 Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p 2) experienced greater morbidity and mortality, while the best predictor of complications in the cervix patients was age greater than 70 years. For the entire cohort of patients, no correlation was found between the 30 day morbidity and mortality and the doses of fentanyl and midazolam used or the length of the procedure. Conclusions: The acute complication rate from HDR brachytherapy performed on an outpatient basis with heavy intravenous sedation is acceptable for the great majority of patients who present for treatment. However, the high morbidity and mortality experienced by certain patient cohorts suggests that careful assessment of the risk/benefit ratio for treatment

  12. Enhancement of viability of radiosensitive (PBMC and resistant (MDA-MB-231 clones in low-dose-rate cobalt-60 radiation therapy

    Directory of Open Access Journals (Sweden)

    Patrícia Lima Falcão

    2015-06-01

    Full Text Available Abstract Objective: In the present study, the authors investigated the in vitro behavior of radio-resistant breast adenocarcinoma (MDA-MB-231 cells line and radiosensitive peripheral blood mononuclear cells (PBMC, as a function of different radiation doses, dose rates and postirradiation time kinetics, with a view to the interest of clinical radiotherapy. Materials and Methods: The cells were irradiated with Co-60, at 2 and 10 Gy and two different exposure rates, 339.56 cGy.min–1 and the other corresponding to one fourth of the standard dose rates, present over a 10-year period of cobalt therapy. Post-irradiation sampling was performed at pre-established kinetics of 24, 48 and 72 hours. The optical density response in viability assay was evaluated and a morphological analysis was performed. Results: Radiosensitive PBMC showed decrease in viability at 2 Gy, and a more significant decrease at 10 Gy for both dose rates. MDAMB- 231 cells presented viability decrease only at higher dose and dose rate. The results showed MDA-MB-231 clone expansion at low dose rate after 48–72 hours post-radiation. Conclusion: Low dose rate shows a possible potential clinical impact involving decrease in management of radio-resistant and radiosensitive tumor cell lines in cobalt therapy for breast cancer.

  13. Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Mahantshetty, Umesh; Khanna, Nehal; Swamidas, Jamema; Engineer, Reena; Thakur, Meenakshi H.; Merchant, Nikhil H.; Deshpande, Deepak D.; Shrivastava, Shyamkishore

    2012-01-01

    Purpose: Trans-abdominal ultrasonography (US) is capable of determining size, shape, thickness, and diameter of uterus, cervix and disease at cervix or parametria. To assess the potential value of US for image-guided cervical cancer brachytherapy, we compared US-findings relevant for brachytherapy to the corresponding findings obtained from MR imaging. Materials and methods: Twenty patients with biopsy proven cervical cancer undergoing definitive radiotherapy with/without concomitant Cisplatin chemotherapy and suitable for brachytherapy were invited to participate in this study. US and MR were performed in a similar reproducible patient positioning after intracavitary application. US mid-sagittal and axial image at the level of external cervical os was acquired. Reference points D1 to D9 and distances were identified with respect to central tandem and flange, to delineate cervix, central disease, and external surface of the uterus. Results: Thirty-two applications using CT/MR compatible applicators were evaluable. The D1 and D3 reference distances which represent anterior surface had a strong correlation with R = 0.92 and 0.94 (p < 0.01). The D2 and D4 reference distances in contrast, which represent the posterior surface had a moderate (D2) and a strong (D4) correlation with R = 0.63 and 0.82 (p < 0.01). Of all, D2 reference distance showed the least correlation of MR and US. The D5 reference distance representing the fundal thickness from tandem tip had a correlation of 0.98. The reference distances for D6, D7, D8, and D9 had a correlation of 0.94, 0.82, 0.96, and 0.93, respectively. Conclusions: Our study evaluating the use of US, suggests a reasonably strong correlation with MR in delineating uterus, cervix, and central disease for 3D conformal intracavitary brachytherapy planning.

  14. Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings

    NARCIS (Netherlands)

    H. Rigter (Henk); C.E. Henderson (Craig); I. Pelc (Isidore); P. Tossmann (Peter); O. Phan (Olivier); V. Hendriks (Vincent); M. Schaub (Michael); C. Rowe (Cindy)

    2013-01-01

    textabstractBackground: Noticing a lack of evidence-based programmes for treating adolescents heavily using cannabis in Europe, government representatives from Belgium, France, Germany, The Netherlands, and Switzerland decided to have U.S.-developed multidimensional family therapy (MDFT) tested in

  15. Is the detection rate of 18F-choline PET/CT influenced by androgen-deprivation therapy?

    Energy Technology Data Exchange (ETDEWEB)

    Chondrogiannis, Sotirios; Marzola, Maria Cristina; Grassetto, Gaia; Maffione, Anna Margherita; Rampin, Lucia; Rubello, Domenico [' ' Santa Maria della Misericordia' ' Hospital, Rovigo (Italy). PET/CT Centre; Ferretti, Alice [' ' San Giacomo Apostolo' ' Hospital, Castelfranco Veneto, Treviso (Italy). Service of Medical Physics; Fanti, Stefano [Azienda Ospedaliero-Univ. Policlinico S. Orsola-Malpighi, Bologna (Italy). Dept. of Nuclear Medicine; Giammarile, Francesco [Lyon 1 Univ. Centre Hospitalier Lyon Sud Biophysique, Villeurbanne (Italy). Dept. of Nuclear Medicine

    2014-07-15

    To evaluate if the detection rate (DR) of {sup 18}F-choline (18F-CH) PET/CT is influenced by androgen-deprivation therapy (ADT) in patients with prostate cancer (PC) already treated with radical intent and presenting biochemical relapse. We have retrospectively evaluated {sup 18}F-CH PET/CT scans of 325 consecutive PC patients enrolled in the period November 2009 to December 2012 previously treated with radical intent and referred to our centre to perform {sup 18}F-CH PET/CT for biochemical relapse. Two different groups of patients were evaluated. group A included the whole sample of 325 patients (mean age 70 years, range: 49-86) who presented trigger PSA between 0.1 and 80 ng/ml (mean 5.5 ng/ml), and group B included 187 patients (mean age 70 years, range 49-86) with medium-low levels of trigger PSA ranging between 0.5 and 5 ng/ml (mean PSA 2.1 ng/ml); group B was chosen in order to obtain a more homogeneous group of patients in terms of PSA values also excluding both very low and very high PSA levels avoiding the ''a priori'' higher probability of negative or positive PET scan, respectively. At the time of examination, 139 patients from group A and 72 patients from group B were under ADT: these patients were considered to be hormone-resistant PC patients because from their oncologic history (>18 months) an increase of PSA levels emerged despite the ongoing ADT. The relationship between {sup 18}F-CH PET/CT findings and possible clinical predictors was investigated using both univariate and multivariate binary logistic regression analyses, including trigger PSA and ADT. Considering the whole population, overall DR of {sup 18}F-CH PET was 58.2 % (189/325 patients). In the whole sample of patients (group A), both at the univariate and multivariate logistic regression analysis, trigger PSA and ADT were significantly correlated with the DR of {sup 18}F-CH PET (p < 0.05). Moreover, the DR in patients under ADT (mean PSA 7.8 ng/ml) was higher than in

  16. Is the detection rate of 18F-choline PET/CT influenced by androgen-deprivation therapy?

    International Nuclear Information System (INIS)

    Chondrogiannis, Sotirios; Marzola, Maria Cristina; Grassetto, Gaia; Maffione, Anna Margherita; Rampin, Lucia; Rubello, Domenico; Ferretti, Alice; Fanti, Stefano; Giammarile, Francesco

    2014-01-01

    To evaluate if the detection rate (DR) of 18 F-choline (18F-CH) PET/CT is influenced by androgen-deprivation therapy (ADT) in patients with prostate cancer (PC) already treated with radical intent and presenting biochemical relapse. We have retrospectively evaluated 18 F-CH PET/CT scans of 325 consecutive PC patients enrolled in the period November 2009 to December 2012 previously treated with radical intent and referred to our centre to perform 18 F-CH PET/CT for biochemical relapse. Two different groups of patients were evaluated. group A included the whole sample of 325 patients (mean age 70 years, range: 49-86) who presented trigger PSA between 0.1 and 80 ng/ml (mean 5.5 ng/ml), and group B included 187 patients (mean age 70 years, range 49-86) with medium-low levels of trigger PSA ranging between 0.5 and 5 ng/ml (mean PSA 2.1 ng/ml); group B was chosen in order to obtain a more homogeneous group of patients in terms of PSA values also excluding both very low and very high PSA levels avoiding the ''a priori'' higher probability of negative or positive PET scan, respectively. At the time of examination, 139 patients from group A and 72 patients from group B were under ADT: these patients were considered to be hormone-resistant PC patients because from their oncologic history (>18 months) an increase of PSA levels emerged despite the ongoing ADT. The relationship between 18 F-CH PET/CT findings and possible clinical predictors was investigated using both univariate and multivariate binary logistic regression analyses, including trigger PSA and ADT. Considering the whole population, overall DR of 18 F-CH PET was 58.2 % (189/325 patients). In the whole sample of patients (group A), both at the univariate and multivariate logistic regression analysis, trigger PSA and ADT were significantly correlated with the DR of 18 F-CH PET (p 18 F-CH PET and ADT. In group B patients only trigger PSA resulted a reliable predictor of the 18 F-CH positivity, since ADT was not

  17. Decreasing rate of multiple treatment modifications among individuals who initiated antiretroviral therapy in 1997-2009 in the Danish HIV Cohort Study

    DEFF Research Database (Denmark)

    Helleberg, Marie; Kronborg, Gitte; Larsen, Carsten S

    2012-01-01

    BACKGROUND: We hypothesized that rates and reasons for treatment modifications have changed since the implementation of combination antiretroviral therapy (cART) due to improvements in therapy. METHODS: From a nationwide population-based cohort study we identified all HIV-1 infected adults who...... initiated cART in Denmark 1997-2009 and were followed (3)1 year. Incidence rate ratios (IRR) and reasons for treatment modifications were estimated and compared between patients, who initiated treatment in 1997-1999, 2000-2004 and 2005-2009. Rates of discontinuation of individual antiretroviral drugs (ARVs......) were evaluated. RESULTS: 3,107 patients were followed median 7.3 years (IQR 3.8-10.8). Rates of first treatment modification ≤1 year after cART initiation did not change (IRR 0.88 (95% CI 0.78-1.01) and 1.03 (95% CI 0.90-1.18) in 2000-2004 and 2005-2009 compared to 1997-1999). Rates of multiple...

  18. Investigation of rectal complication after RALS-therapy for uterine cervix cancer using multivariate analysis

    International Nuclear Information System (INIS)

    Inoue, Takehiro; Inoue, Toshihiko; Suzuki, Takaichiro

    1983-01-01

    Rectal injury is one of the major side effects after radiation therapy for carcinoma of the uterine cervix. According to our previous reports, the cases of rectal complication were mainly related to the measured rectal dose in half of patients, and the other causes were related to the following factors; such as diabetes mellitus, hemorrhagic tendency, syphilis and so on. Concerning to rectal complication, these factors were investigated by means of the discriminant analysis, one of the multivariate analyses, in this paper. Twenty-eight factors as to radiation dose, laboratory tests and physical condition of patients were analyzed. From August 1978 through January 1980, 52 cases of previously untreated carcinoma of the uterine cervix were treated using RALS, remotely controlled high dose rate intracavitary radiotherapy, at our department. The data from 49 out of 52 cases were available for the discriminant analysis. By m eans of this analysis, it was found that these factors, such as the dose of whole pelvic irradiation, Point A dose of RALS, measured rectal dose by RALS, WGC-Z and TPHA were important factors for occurence of rectal complication. According to the discriminant score, 46 out of 49 cases (94 %) could be correctly discriminated. There were two cases of false positive and one false negative. Form February 1980 through July 1980, 27 cases of previously untreated carcinoma of the uterine cervix were treated at our department. The obtained discriminant function was applied to these 27 cases, and 24 out of 27 cases (89 %) were correctly predicted. There were two cases of false positive, and one of false negative. Discriminant analysis is useful for the prediction of rectal complication after radiation therapy for carcinoma of the uterine cervix. (J.P.N.)

  19. Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer

    International Nuclear Information System (INIS)

    Gonnelli, Fernanda Aurora Stabile; Palma, Luiz Felipe; Giordani, Adelmo Jose; Dias, Rodrigo Souza; Segreto, Roberto Araujo; Segreto, Helena Regina Comodo; Deboni, Aline Lima Silva

    2016-01-01

    Objective: to determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and methods: ee evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm 2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm 2 , three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (NO) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment induced salivary hypofunction in patients with head and neck cancer. (author)

  20. Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gonnelli, Fernanda Aurora Stabile [Faculdades Metropolitanas Unidas (FMU), Sao Paulo, SP (Brazil); Palma, Luiz Felipe; Giordani, Adelmo Jose; Dias, Rodrigo Souza; Segreto, Roberto Araujo; Segreto, Helena Regina Comodo [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina; Deboni, Aline Lima Silva

    2016-03-15

    Objective: to determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and methods: ee evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm{sup 2} and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm{sup 2} , three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (NO) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment induced salivary hypofunction in patients with head and neck cancer. (author)

  1. Effect of radiation therapy on the mitogenic response of in vitro irradiated human lymphocytes to phytohaemagglutinin

    International Nuclear Information System (INIS)

    Baral, E.; Blomgren, H.; Einhorn, N.; Lax, I.; Juhlin, I.

    1977-01-01

    Irradiation of human peripheral lymphocytes in vitro reduces their capacity to be triggered to DNA-synthesis by PHA in a two-dose shaped fashion suggesting the presence of one relatively radiationsensitive and one relatively resistant cell population. Intracavitary and external radiation therapy for carcinoma of the uterus and vagina, which reduced the lymphocyte counts by approximately 66 per cent, did not significantly change the ratio of these subpopulations, indicating that PHA-reactive cells cannot be grouped into radiation sensitive and resistant subpopulations

  2. Radiation therapy of cancer of the cervix, corpus uteri and vagina at the 1st University Clinic of Gynaecology in Vienna from 1950 to 1979

    International Nuclear Information System (INIS)

    Kucera, H.

    1980-01-01

    On the occasion of the 30th anniversary of the department of radiotherapy of th 1st University-Clinic of Gynaecology and Obstetrics in Vienna, the results obtained in the treatment of gynaecologic malignancy are presented. During this period, more than 10 000 malignant tumors of the female genital tract were treated, including 3605 cases of cancer of the cervix, 1412 endometrial carcinomas and 397 cases of cancer of the vagina. The principal method of irradiation was local application of radium. Dosage was established empirically after measurements on a model. In addition conventional percutaneous roentgen therapy was used until 1972, when telecobalt irradiation equipment was put into use. Five-year survival rates for cervical, endometrial and vaginal cancer are presented for the years from 1950 through 1972. These results are attributed primarily to intracavitary radium application. Of 2687 cases with cervical cancer 1222 (45.5%) were alive after five years, in stage III cervical cancer 535 out of 1321 (40.5%). The latest international tables published in the Annual Report give a five-year survival rate of 31.7% for stage-III cancer of the cervix. Of 994 cases of endometrial cancer 473 were alive after five years (49.8%), while the Annual Report gives a five-year survival rate of 39.0% for primary irradiation in endometrial cancer. For cancer of the vagina, our five-year survival rate was 42.8% (127 patients out of a total of 297), while the Annual Report gives 37.3%. This demonstrates, that the results obtained at the department of radiotherapy of the 1st University Clinic of Gynaecology and Obstetrics in Vienna are better than the international average. Apart from the different methods of treatment the importance of primary radiation therapy in gynaecologic oncology is pointed out, and the side effects and complications are discussed. (orig.) [de

  3. Dosimetric Considerations to Determine the Optimal Technique for Localized Prostate Cancer Among External Photon, Proton, or Carbon-Ion Therapy and High-Dose-Rate or Low-Dose-Rate Brachytherapy

    International Nuclear Information System (INIS)

    Georg, Dietmar; Hopfgartner, Johannes; Gòra, Joanna; Kuess, Peter; Kragl, Gabriele; Berger, Daniel; Hegazy, Neamat; Goldner, Gregor; Georg, Petra

    2014-01-01

    Purpose: To assess the dosimetric differences among volumetric modulated arc therapy (VMAT), scanned proton therapy (intensity-modulated proton therapy, IMPT), scanned carbon-ion therapy (intensity-modulated carbon-ion therapy, IMIT), and low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy (BT) treatment of localized prostate cancer. Methods and Materials: Ten patients were considered for this planning study. For external beam radiation therapy (EBRT), planning target volume was created by adding a margin of 5 mm (lateral/anterior–posterior) and 8 mm (superior–inferior) to the clinical target volume. Bladder wall (BW), rectal wall (RW), femoral heads, urethra, and pelvic tissue were considered as organs at risk. For VMAT and IMPT, 78 Gy(relative biological effectiveness, RBE)/2 Gy were prescribed. The IMIT was based on 66 Gy(RBE)/20 fractions. The clinical target volume planning aims for HDR-BT ( 192 Ir) and LDR-BT ( 125 I) were D 90% ≥34 Gy in 8.5 Gy per fraction and D 90% ≥145 Gy. Both physical and RBE-weighted dose distributions for protons and carbon-ions were converted to dose distributions based on 2-Gy(IsoE) fractions. From these dose distributions various dose and dose–volume parameters were extracted. Results: Rectal wall exposure 30-70 Gy(IsoE) was reduced for IMIT, LDR-BT, and HDR-BT when compared with VMAT and IMPT. The high-dose region of the BW dose–volume histogram above 50 Gy(IsoE) of IMPT resembled the VMAT shape, whereas all other techniques showed a significantly lower high-dose region. For all 3 EBRT techniques similar urethra D mean around 74 Gy(IsoE) were obtained. The LDR-BT results were approximately 30 Gy(IsoE) higher, HDR-BT 10 Gy(IsoE) lower. Normal tissue and femoral head sparing was best with BT. Conclusion: Despite the different EBRT prescription and fractionation schemes, the high-dose regions of BW and RW expressed in Gy(IsoE) were on the same order of magnitude. Brachytherapy techniques were clearly superior in

  4. Dosimetric Considerations to Determine the Optimal Technique for Localized Prostate Cancer Among External Photon, Proton, or Carbon-Ion Therapy and High-Dose-Rate or Low-Dose-Rate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Georg, Dietmar, E-mail: Dietmar.Georg@akhwien.at [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Hopfgartner, Johannes [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Gòra, Joanna [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Kuess, Peter [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Kragl, Gabriele [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Berger, Daniel [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Hegazy, Neamat [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Goldner, Gregor; Georg, Petra [Department of Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna/Allgemeines Krankenhaus der Stadt Wien, Vienna (Austria)

    2014-03-01

    Purpose: To assess the dosimetric differences among volumetric modulated arc therapy (VMAT), scanned proton therapy (intensity-modulated proton therapy, IMPT), scanned carbon-ion therapy (intensity-modulated carbon-ion therapy, IMIT), and low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy (BT) treatment of localized prostate cancer. Methods and Materials: Ten patients were considered for this planning study. For external beam radiation therapy (EBRT), planning target volume was created by adding a margin of 5 mm (lateral/anterior–posterior) and 8 mm (superior–inferior) to the clinical target volume. Bladder wall (BW), rectal wall (RW), femoral heads, urethra, and pelvic tissue were considered as organs at risk. For VMAT and IMPT, 78 Gy(relative biological effectiveness, RBE)/2 Gy were prescribed. The IMIT was based on 66 Gy(RBE)/20 fractions. The clinical target volume planning aims for HDR-BT ({sup 192}Ir) and LDR-BT ({sup 125}I) were D{sub 90%} ≥34 Gy in 8.5 Gy per fraction and D{sub 90%} ≥145 Gy. Both physical and RBE-weighted dose distributions for protons and carbon-ions were converted to dose distributions based on 2-Gy(IsoE) fractions. From these dose distributions various dose and dose–volume parameters were extracted. Results: Rectal wall exposure 30-70 Gy(IsoE) was reduced for IMIT, LDR-BT, and HDR-BT when compared with VMAT and IMPT. The high-dose region of the BW dose–volume histogram above 50 Gy(IsoE) of IMPT resembled the VMAT shape, whereas all other techniques showed a significantly lower high-dose region. For all 3 EBRT techniques similar urethra D{sub mean} around 74 Gy(IsoE) were obtained. The LDR-BT results were approximately 30 Gy(IsoE) higher, HDR-BT 10 Gy(IsoE) lower. Normal tissue and femoral head sparing was best with BT. Conclusion: Despite the different EBRT prescription and fractionation schemes, the high-dose regions of BW and RW expressed in Gy(IsoE) were on the same order of magnitude. Brachytherapy techniques

  5. Acute electroconvulsive therapy followed by maintenance electroconvulsive therapy decreases hospital re-admission rates of older patients with severe mental illness.

    Science.gov (United States)

    Shelef, Assaf; Mazeh, Doron; Berger, Uri; Baruch, Yehuda; Barak, Yoram

    2015-06-01

    Electroconvulsive therapy (ECT) is a highly effective treatment for patients with severe mental illness (SMI). Maintenance ECT (M-ECT) is required for many elderly patients experiencing severe recurrent forms of mood disorders, whereas M-ECT for schizophrenia patients is a poorly studied treatment. We report on the outcomes in aged patients with SMI: schizophrenia and severe affective disorders treated by M-ECT of varying duration to prevent relapse after a successful course of acute ECT. The study measured the effectiveness of M-ECT in preventing hospital readmissions and reducing admission days. A retrospective chart review of 42 consecutive patients comparing the number and length of psychiatric admissions before and after the start of M-ECT was used. We analyzed diagnoses, previous ECT treatments, number of ECT treatments, and number and length of psychiatric admissions before and after M-ECT. Mean age in our sample was 71.5 (6.9) years. Twenty-two (52%) patients experienced severe affective disorders and 20 (48%) experienced schizophrenia. Patients were administered 92.8 (85.9) M-ECT treatments. Average duration of the M-ECT course was 34 (29.8) months. There were on average 1.88 admissions before M-ECT and only 0.38 admissions in the M-ECT period (P < 0.001). Duration of mean hospitalization stay decreased from 215.9 to 12.4 days during the M-ECT (P < 0.01). Our findings suggest that acute ECT followed by M-ECT is highly effective in selected elderly patients with SMIs.

  6. Learning how to rate video-recorded therapy sessions: a practical guide for trainees and advanced clinicians.

    Science.gov (United States)

    McCullough, Leigh; Bhatia, Maneet; Ulvenes, Pal; Berggraf, Lene; Osborn, Kristin

    2011-06-01

    Watching and rating psychotherapy sessions is an important yet often overlooked component of psychotherapy training. This article provides a simple and straightforward guide for using one Website (www.ATOStrainer.com) that provides an automated training protocol for rating of psychotherapy sessions. By the end of the article, readers will be able to have the knowledge to go to the Website and begin using this training method as soon as they have a recorded session to view. This article presents, (a) an overview of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough et al., 2003a), a research tool used to rate psychotherapy sessions; (b) a description of APA training tapes, available for purchase from APA Books, that have been rated and scored by ATOS trained clinicians and posted on the Website; (c) step-by-step procedures on how ratings can be done; (d) an introduction to www.ATOStrainer.com where ratings can be entered and compared with expert ratings; and (e) first-hand personal experiences of the authors using this training method and the benefits it affords both trainees and experienced therapists. This psychotherapy training Website has the potential to be a key resource tool for graduate students, researchers, and clinicians. Our long-range goal is to promote the growth of our understanding of psychotherapy and to improve the quality of psychotherapy provided for patients.

  7. Benign paroxysmal positional vertigo (BPPV): influence of pharmacotherapy and rehabilitation therapy on patients' recovery rate and life quality.

    Science.gov (United States)

    Maslovara, Sinisa; Soldo, Silva Butkovic; Puksec, Mirjana; Balaban, Branka; Penavic, Ivana Pajic

    2012-01-01

    This prospective clinical study includes 96 BPPV patients with the results of DHI testing ≥ 40 points. They were segregated to be taken into this study and randomly divided into two therapy groups: 48 patients in Group I were treated pharmacotherapeutically with Betahistine Chloride (BC) and 48 patients in Group II underwent a rehabilitation treatment by performing an Epley maneuver. Total study duration was eight weeks, during which the patients were first examined upon arrival, checked after one, and rechecked after eight weeks. The tests included otoneurological examination and VNG, as well as completing three questionnaires: DHI, SF-36®, and HADS®. During the first checkup after one week, 86.96% of patients in Group I and 93.33% in Group II had negative results at the Dix-Hallpike test. During the second checkup after an eight weeks' treatment, 95.65% in Group I and 97.78% patients in Group II had a negative result. At the beginning of the study, the values of patients' physical, emotional, and functional health (QoL) were equally distributed in both therapy groups, compared to standardized values of healthy population. During the first checkup, the values were significantly higher and by the second checkup, reached the statistic average, which corresponds with the healthy population. There was an obviously faster and more complete recovery of the patients in Group II, who underwent a rehabilitation treatment.

  8. A Comparison of Evidence-Based Estimates and Empirical Benchmarks of the Appropriate Rate of Use of Radiation Therapy in Ontario

    International Nuclear Information System (INIS)

    Mackillop, William J.; Kong, Weidong; Brundage, Michael; Hanna, Timothy P.; Zhang-Salomons, Jina; McLaughlin, Pierre-Yves; Tyldesley, Scott

    2015-01-01

    Purpose: Estimates of the appropriate rate of use of radiation therapy (RT) are required for planning and monitoring access to RT. Our objective was to compare estimates of the appropriate rate of use of RT derived from mathematical models, with the rate observed in a population of patients with optimal access to RT. Methods and Materials: The rate of use of RT within 1 year of diagnosis (RT 1Y ) was measured in the 134,541 cases diagnosed in Ontario between November 2009 and October 2011. The lifetime rate of use of RT (RT LIFETIME ) was estimated by the multicohort utilization table method. Poisson regression was used to evaluate potential barriers to access to RT and to identify a benchmark subpopulation with unimpeded access to RT. Rates of use of RT were measured in the benchmark subpopulation and compared with published evidence-based estimates of the appropriate rates. Results: The benchmark rate for RT 1Y , observed under conditions of optimal access, was 33.6% (95% confidence interval [CI], 33.0%-34.1%), and the benchmark for RT LIFETIME was 41.5% (95% CI, 41.2%-42.0%). Benchmarks for RT LIFETIME for 4 of 5 selected sites and for all cancers combined were significantly lower than the corresponding evidence-based estimates. Australian and Canadian evidence-based estimates of RT LIFETIME for 5 selected sites differed widely. RT LIFETIME in the overall population of Ontario was just 7.9% short of the benchmark but 20.9% short of the Australian evidence-based estimate of the appropriate rate. Conclusions: Evidence-based estimates of the appropriate lifetime rate of use of RT may overestimate the need for RT in Ontario

  9. Nodal Clearance Rate and Long-Term Efficacy of Individualized Sentinel Node–Based Pelvic Intensity Modulated Radiation Therapy for High-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Müller, Arndt-Christian, E-mail: arndt-christian.mueller@med.uni-tuebingen.de [Department of Radiation Oncology, Eberhard Karls University, Tübingen (Germany); Eckert, Franziska; Paulsen, Frank; Zips, Daniel [Department of Radiation Oncology, Eberhard Karls University, Tübingen (Germany); Stenzl, Arnulf; Schilling, David [Department of Urology, Eberhard Karls University, Tübingen (Germany); Alber, Markus [Department of Oncology, Aarhus University, Aarhus (Denmark); Bares, Roland [Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tübingen (Germany); Martus, Peter [Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Tübingen (Germany); Weckermann, Dorothea [Department of Urology, Klinikum Augsburg, Augsburg (Germany); Belka, Claus; Ganswindt, Ute [Department of Radiation Oncology, Ludwig-Maximilians-University, Munich (Germany)

    2016-02-01

    Purpose: To assess the efficacy of individual sentinel node (SN)-guided pelvic intensity modulated radiation therapy (IMRT) by determining nodal clearance rate [(n expected nodal involvement − n observed regional recurrences)/n expected nodal involvement] in comparison with surgically staged patients. Methods and Materials: Data on 475 high-risk prostate cancer patients were examined. Sixty-one consecutive patients received pelvic SN-based IMRT (5 × 1.8 Gy/wk to 50.4 Gy [pelvic nodes + individual SN] and an integrated boost with 5 × 2.0 Gy/wk to 70.0 Gy to prostate + [base of] seminal vesicles) and neo-/adjuvant long-term androgen deprivation therapy; 414 patients after SN–pelvic lymph node dissection were used to calculate the expected nodal involvement rate for the radiation therapy sample. Biochemical control and overall survival were estimated for the SN-IMRT patients using the Kaplan-Meier method. The expected frequency of nodal involvement in the radiation therapy group was estimated by imputing frequencies of node-positive patients in the surgical sample to the pattern of Gleason, prostate-specific antigen, and T category in the radiation therapy sample. Results: After a median follow-up of 61 months, 5-year OS after SN-guided IMRT reached 84.4%. Biochemical control according to the Phoenix definition was 73.8%. The nodal clearance rate of SN-IMRT reached 94%. Retrospective follow-up evaluation is the main limitation. Conclusions: Radiation treatment of pelvic nodes individualized by inclusion of SNs is an effective regional treatment modality in high-risk prostate cancer patients. The pattern of relapse indicates that the SN-based target volume concept correctly covers individual pelvic nodes. Thus, this SN-based approach justifies further evaluation, including current dose-escalation strategies to the prostate in a larger prospective series.

  10. High-dose rate brachytherapy (HDRB) for primary or recurrent cancer in the vagina

    International Nuclear Information System (INIS)

    Beriwal, Sushil; Heron, Dwight E; Mogus, Robert; Edwards, Robert P; Kelley, Joseph L; Sukumvanich, Paniti

    2008-01-01

    The purpose of this study was to evaluate the efficacy of HDR brachytherapy for primary or recurrent vaginal cancer. Between the years 2000 to 2006, 18 patients with primary or recurrent vaginal cancer were treated with brachytherapy (HDRB). Six patients had primary vaginal cancer (stage II to IVA) while 12 were treated for isolated vaginal recurrence (primary cervix = 4, vulva = 1 and endometrium = 7). Five patients had previous pelvic radiation therapy. All except one patient received external beam radiation therapy to a median dose of 45 Gy (range 31.2–55.8 Gy). The HDRB was intracavitary using a vaginal cylinder in 5 patients and interstitial using a modified Syed-Nesblett template in 13 patients. The dose of interstitial brachytherapy was 18.75 Gy in 5 fractions delivered twice daily. The median follow-up was 18 months (range 6–66 months). Complete response (CR) was achieved in all but one patient (94%). Of these 17 patients achieving a CR, 1 had local recurrence and 3 had systemic recurrence at a median time of 6 months (range 6–22 months). The 2-year actuarial local control and cause-specific survival for the entire group were 88% and 82.5%, respectively. In subset analysis, the crude local control was 100% for primary vaginal cancer, 100% for the group with recurrence without any prior radiation and 67% for group with recurrence and prior radiation therapy. Two patients had late grade 3 or higher morbidity (rectovaginal fistula in one patient and chronic vaginal ulcer resulting in bleeding in one patient). Both these patients had prior radiation therapy. Our small series suggests that HDRB is efficacious for primary or recurrent vaginal cancer. Patients treated with primary disease and those with recurrent disease without prior irradiation have the greatest benefit from HDRB in this setting. The salvage rate for patients with prior radiation therapy is lower with a higher risk of significant complications. Additional patients and follow-up are ongoing

  11. Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales

    DEFF Research Database (Denmark)

    Hawley, Samuel; Cordtz, René; Dreyer, Lene

    2018-01-01

    OBJECTIVE: To estimate the impact of NICE approval of tumor necrosis factor inhibitor (TNFi) therapies on the incidence of total hip replacement (THR) and total knee replacement (TKR) among rheumatoid arthritis (RA) patients in England and Wales. METHODS: Primary care data [Clinical Practice.......92 PYs, respectively. NICE guidance was associated with a significant average decrease in TKR incidence of -4.41/1000 PYs (95% C.I. -6.88 to -1.94), equating to a relative 34% reduction. Overall, no effect was seen on THR rates. CONCLUSIONS: Among incident RA patients in England and Wales, NICE guidance...

  12. Evaluation of therapy for dilated cardiomyopathy with heart failure by iodine-123 metaiodobenzyl-guanidine imaging. Comparison with heart rate variability power spectral analysis

    Energy Technology Data Exchange (ETDEWEB)

    Li, Shou-lin; Ikeda, Jun; Takita, Tamotsu; Sekiguchi, Yohei; Demachi, Jun; Chikama, Hisao; Goto, Atsushi; Shirato, Kunio [Tohoku Univ., Sendai (Japan). School of Medicine

    1998-11-01

    The relationship between the myocardial uptake of iodine-123 metaiodobenzylguanidine ({sup 123}I-MIBG) and heart rate variability parameters has not been determined. This study determined the relationship between the change in myocardial uptake of {sup 123}I-MIBG and improvement in left ventricular function after treatment, to determine the usefulness of {sup 123}I-MIBG imaging to assess the effect of therapy on heart failure due to dilated cardiomyopathy (DCM). {sup 123}I-MIBG imaging and power spectral analysis of heart rate variability were performed before and after treatment in 17 patients with heart failure due to DCM. The following parameters were compared before and after treatment: New York Heart Association (NYHA) functional class, radiographic cardiothoracic ratio (CTR), blood pressure, echocardiographic data (left ventricular end-systolic (LVDs) and end-diastolic (LVDd) diameters, left ventricular ejection fraction (LVEF)), plasma concentrations of norepinephrine and epinephrine, heart rate variability power spectral analysis data (mean low frequency (MLF) and high frequency power (MHF)) and the myocardium to mediastinum activity ratio (MYO/M) obtained in early and late images, and washout rate calculated by anterior planar imaging of {sup 123}I-MIBG. The NYHA functional class, LVEF, LVDs, CTR, MLF and MHF improved after treatment. Early MYO/M and late MYO/M improved after treatment. The rate of increase in late MYO/M was positively correlated with the rate of improvement of LVEF after treatment. Furthermore, the late MYO/M was negatively correlated with MLF. Washout rate revealed no correlation with hemodynamic parameters. These findings suggest that late MYO/M is more useful than washout rate to assess the effect of treatment on heart failure due to DCM. Furthermore, the {sup 123}I-MIBG imaging and heart rate variability parameters are useful to assess the autonomic tone in DCM with heart failure. (author)

  13. Evaluation of therapy for dilated cardiomyopathy with heart failure by iodine-123 metaiodobenzyl-guanidine imaging. Comparison with heart rate variability power spectral analysis

    International Nuclear Information System (INIS)

    Li, Shou-lin; Ikeda, Jun; Takita, Tamotsu; Sekiguchi, Yohei; Demachi, Jun; Chikama, Hisao; Goto, Atsushi; Shirato, Kunio

    1998-01-01

    The relationship between the myocardial uptake of iodine-123 metaiodobenzylguanidine ( 123 I-MIBG) and heart rate variability parameters has not been determined. This study determined the relationship between the change in myocardial uptake of 123 I-MIBG and improvement in left ventricular function after treatment, to determine the usefulness of 123 I-MIBG imaging to assess the effect of therapy on heart failure due to dilated cardiomyopathy (DCM). 123 I-MIBG imaging and power spectral analysis of heart rate variability were performed before and after treatment in 17 patients with heart failure due to DCM. The following parameters were compared before and after treatment: New York Heart Association (NYHA) functional class, radiographic cardiothoracic ratio (CTR), blood pressure, echocardiographic data (left ventricular end-systolic (LVDs) and end-diastolic (LVDd) diameters, left ventricular ejection fraction (LVEF)), plasma concentrations of norepinephrine and epinephrine, heart rate variability power spectral analysis data (mean low frequency (MLF) and high frequency power (MHF)) and the myocardium to mediastinum activity ratio (MYO/M) obtained in early and late images, and washout rate calculated by anterior planar imaging of 123 I-MIBG. The NYHA functional class, LVEF, LVDs, CTR, MLF and MHF improved after treatment. Early MYO/M and late MYO/M improved after treatment. The rate of increase in late MYO/M was positively correlated with the rate of improvement of LVEF after treatment. Furthermore, the late MYO/M was negatively correlated with MLF. Washout rate revealed no correlation with hemodynamic parameters. These findings suggest that late MYO/M is more useful than washout rate to assess the effect of treatment on heart failure due to DCM. Furthermore, the 123 I-MIBG imaging and heart rate variability parameters are useful to assess the autonomic tone in DCM with heart failure. (author)

  14. Variations of high frequency parameter of heart rate variability following osteopathic manipulative treatment in healthy subjects compared to control group and sham therapy: randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Nuria eRuffini

    2015-08-01

    Full Text Available Context: Heart Rate Variability (HRV indicates how heart rate changes in response to inner and external stimuli. HRV is linked to health status and it is an indirect marker of the autonomic nervous system (ANS function. Objective: To investigate the influence of osteopathic manipulative treatment (OMT on ANS activity through changes of High Frequency, a heart rate variability index indicating the parasympathetic activity, in healthy subjects, compared with sham therapy and control group.Methods: Sixty-six healthy subjects, both male and female, were included in the present 3-armed randomized placebo controlled within subject cross-over single blinded study. Participants were asymptomatic adults, both smokers and non-smokers and not on medications. At enrollment subjects were randomized in 3 groups: A, B, C. Standardized structural evaluation followed by a patient need-based osteopathic treatment was performed in the first session of group A and in the second session of group B. Standardized evaluation followed by a protocoled sham treatment was provided in the second session of group A and in the first session of group B. No intervention was performed in the two sessions of group C, acting as a time-control. The trial was registered on clinicaltrials.gov identifier: NCT01908920.Main Outcomes Measures: HRV was calculated from electrocardiography before, during and after the intervention, for a total amount time of 25 minutes.Results: OMT engendered a statistically significant increase of parasympathetic activity, as shown by High Frequency rate (p<0.001, and decrease of sympathetic activity, as revealed by Low Frequency rate (p<0.01; results also showed a reduction of Low Frequency/High Frequency ratio (p<0.001 and Detrended fluctuation scaling exponent (p<0.05. Conclusions: Findings suggested that OMT can influence ANS activity increasing parasympathetic function and decreasing sympathetic activity, compared to sham therapy and control group.

  15. A Calibrated Method of Massage Therapy Decreases Systolic Blood Pressure Concomitant With Changes in Heart Rate Variability in Male Rats.

    Science.gov (United States)

    Spurgin, Kurt A; Kaprelian, Anthony; Gutierrez, Roberto; Jha, Vidyasagar; Wilson, Christopher G; Dobyns, Abigail; Xu, Karen H; Curras-Collazo, Margarita C

    2017-02-01

    The purpose of this study was to develop a method for applying calibrated manual massage pressures by using commonly available, inexpensive sphygmomanometer parts and validate the use of this approach as a quantitative method of applying massage therapy to rodents. Massage pressures were monitored by using a modified neonatal blood pressure (BP) cuff attached to an aneroid gauge. Lightly anesthetized rats were stroked on the ventral abdomen for 5 minutes at pressures of 20 mm Hg and 40 mm Hg. Blood pressure was monitored noninvasively for 20 minutes following massage therapy at 5-minute intervals. Interexaminer reliability was assessed by applying 20 mm Hg and 40 mm Hg pressures to a digital scale in the presence or absence of the pressure gauge. With the use of this method, we observed good interexaminer reliability, with intraclass coefficients of 0.989 versus 0.624 in blinded controls. In Long-Evans rats, systolic BP dropped by an average of 9.86% ± 0.27% following application of 40 mm Hg massage pressure. Similar effects were seen following 20 mm Hg pressure (6.52% ± 1.7%), although latency to effect was greater than at 40 mm Hg. Sprague-Dawley rats behaved similarly to Long-Evans rats. Low-frequency/high-frequency ratio, a widely-used index of autonomic tone in cardiovascular regulation, showed a significant increase within 5 minutes after 40 mm Hg massage pressure was applied. The calibrated massage method was shown to be a reproducible method for applying massage pressures in rodents and lowering BP. Copyright © 2016. Published by Elsevier Inc.

  16. 腔内探头经腹探查诊断剖宫产瘢痕妊娠的应用价值%Value and Application of Intracavitary Probe Transabdominal Ultrasound in Diagnosis of Cesarean Scar Pregnancy

    Institute of Scientific and Technical Information of China (English)

    刘波; 王芙霞; 刘雪皎

    2013-01-01

    目的 探讨腔内探头经腹探查诊断子宫瘢痕妊娠的临床应用价值.方法 收集我院已确诊的剖宫产瘢痕妊娠患者46例,行经腹、经阴道超声及腔内探头经腹3种不同超声检查方式进行对比分析.结果 常规经阴道超声及腔内探头经腹超声与常规经腹超声检查确诊率比较有统计学意义(P <0.05);用常规经阴道及腔内探头经腹超声探查子宫瘢痕处肌层厚度比用常规经腹超声图像更加清晰,用腔内探头经腹超声探查瘢痕处滋养层血流阻力指数比较常规经腹及经阴道超声更加敏感.结论 腔内探头经腹超声是对常规经腹及经阴道超声的重要补充,对临床的诊断及治疗有重要指导价值.%Objective To evaluate the clinical effectiveness of ITAS(Intracavitary Probe Transabdominal Ultrasound) in diagnosis of CSP(Cesarean Scar Pregnancy). Methods Conventional TAS(Transabdominal Ultrasound), conventional TVS(Transvaginal Ultrasound) and ITAS were performed respectively in 46 patients who were confirmed as sufferers from cesarean scar pregnancy in our hospital, based on which comparative analysis was made. Results Comparisons of the definite diagnosis rate were drawn among TAS, TVS and ITAS, which was of great statistical significance(P<0.05). Ultrasound images obtained through conventional TVS and ITAS were sharper than that through conventional TAS in displaying the thickness of the muscular layer in the uterine scar. As for exploration of blood flow RI(Resistance Index) in the trophoblast of the scar, ITAS was more sensitive than TAS and TVS. Conclusion As a supplemental diagnostic technique to conventional TAS and conventional TVS, ITAS is of great value in guiding the clinical diagnosis and treatment of CSP.

  17. Clinical feasibility of combined intracavitary/interstitial brachytherapy in locally advanced cervical cancer employing MRI with a tandem/ring applicator in situ and virtual preplanning of the interstitial component

    International Nuclear Information System (INIS)

    Fokdal, Lars; Tanderup, Kari; Hokland, Steffen Bjerre; Røhl, Lisbeth; Pedersen, Erik Morre; Nielsen, Søren Kynde; Paludan, Merete; Lindegaard, Jacob Christian

    2013-01-01

    Purpose: To investigate the reproducibility of virtually planned needles, changes in DVH parameters and clinical feasibility of combined intracavitary/interstitial (IC/IS) pulsed dose rate brachytherapy (PDR-BT) for locally advanced cervical cancer based on 3D MRI preplanning. Material and methods: Fifty-eight consecutively patients accrued in the EMBRACE study were included. Treatment was initiated with external beam radiotherapy and cisplatin. Three BT implants and MRI with the applicator in situ were performed in all patients, i.e. week 5 (BT0), week 6 (BT1) and week 7 (BT2) of the treatment. BT0 was only used for preplanning of subsequent implantations, whereas BT1 and BT2 comprised 2 equal sized fractions of PDR BT. Results: Based on BT0, 24 patients (41%) were selected for a combined IC/IS implant at BT1 and BT2. Patients treated with IC/IS BT had significantly larger tumours compared with patients treated with IC BT only (p < 0.03). Additional time in general anaesthesia for the IC/IS component was on average 16 min. The number of preplanned virtual needles was 5.3 ± 2.7 compared to 5.3 ± 2.9 and 5.4 ± 3.0 needles implanted at BT1 and BT2, respectively (p = 0.72). Planned needle implantation depth was 33 ± 15 mm compared to 30 ± 10 mm at BT1 and 29 ± 11 mm at BT2 (p = 0.04). In the 24 patients selected for IC/IS BT both the virtual IC/IS plan (BT0) and the actually delivered plan (BT1 + BT2) significantly increased D90 and D100 for HR CTV (p < 0.01) and reduced D2cc for sigmoid (p < 0.01) and bowel (p = 0.04) compared to the optimised IC preplan (BT0). IC/IS BT was only associated with minor morbidity, which was resolved at a 3-month follow up. Conclusion: Combined IC/IS BT based on full 3D MRI preplanning is clinically feasible. The virtual preplanned needle positions are reproducible at subsequent BT applications leading to significantly improved DVH parameters and a clinically feasible and fast implant procedure

  18. Evaluation of the contribution of contamination of radiotherapy room surfaces in the measure of exposure rate of radioiodine therapy patients

    International Nuclear Information System (INIS)

    Campos, Rafael Ferreira

    2015-01-01

    The contamination of radiotherapy room surfaces is significant and the measures of patient exposure rate are held on the fourth dependencies, relevant questions are raised: the background radiation of the room stay high due to surface contamination, may interfere with the rate of patient exposure at the time of its release? The monitoring site is important to determine whether the patient will be released? The value of the deal activity and the clinical condition of the patient may increase the contamination, influencing the monitoring results? This paper aims to conduct a quantitative analysis of surface contamination of the contribution of therapeutic room at the time is monitored exposure rate from inpatient. Measurements were made regarding the hospitalization of 32 patients with different doses administered activity, age and of both genders. The measurements were performed in the therapeutic rooms at the hospital Brotherhood Santa Casa de Misericordia de Sao Paulo. Exposure rate measurements were performed at the center of the room at 1 meter of the patient on the day of its release. After his release and prior to decontamination, measurements were performed at predetermined landmarks within the therapeutic room. The results revealed that on average background radiation, high due to surface contamination contributes only 2% of the patient dose rate. It can be considered that even with influence of contamination of surfaces, this is insignificant to determine if the patient may or may not be released. This study suggests that the site in which monitoring occurs exposure rate of the patient should not be decisive for liberation thereof. (author)

  19. Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

    Energy Technology Data Exchange (ETDEWEB)

    Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna (Austria); Nout, Remi A. [Department of Clinical Oncology, Leiden University Medical Center (Netherlands); Tanderup, Kari; Lindegaard, Jacob C. [Department of Oncology, Aarhus University Hospital (Denmark); Westerveld, Henrike [Department of Radiotherapy, Academic Medical Centre, University of Amsterdam (Netherlands); Haie-Meder, Christine [Department of Radiotherapy, Gustave-Roussy, Villejuif (France); Petrič, Primož [Department of Radiotherapy, Institute of Oncology Ljubljana (Slovenia); Department of Radiotherapy, National Center for Cancer Care and Research, Doha (Qatar); Mahantshetty, Umesh [Department of Radiation Oncology, Tata Memorial Hospital, Mumbai (India); Dörr, Wolfgang; Pötter, Richard [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna (Austria)

    2014-05-01

    Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity

  20. Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

    International Nuclear Information System (INIS)

    Kirchheiner, Kathrin; Nout, Remi A.; Tanderup, Kari; Lindegaard, Jacob C.; Westerveld, Henrike; Haie-Meder, Christine; Petrič, Primož; Mahantshetty, Umesh; Dörr, Wolfgang; Pötter, Richard

    2014-01-01

    Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity

  1. The rate and factors associated with non-adherence to surgery, chemotherapy, radiotherapy and hormonal therapy among breast cancer patients attending public hospitals in Malaysia

    Directory of Open Access Journals (Sweden)

    Nur Aishah Taib

    2017-12-01

    Full Text Available Background: The role of breast cancer treatments in reducing recurrence and death has been established. However, the treatments side effects greatly impact on quality of life and little is known about the non-adherence rates. The purpose of this study was to determine the non-adherence rates to surgery, chemotherapy, radiotherapy and hormonal therapy, and factors that affect it in public hospitals in Malaysia. Methods: A multicentre cross-sectional study was conducted in six public hospitals involving all newly diagnosed breast cancer patients in 2012. Data were collected through medical record reviews and interview by using structured questionnaire. Non-adherence was categorized as any breast cancer patients refusing or discontinuing any treatment due to non-medical reasons. Univariable logistic regression and multiple logistic regressions were used for analysis. Results: A total of 340 breast cancer patients were included in the study. The proportion for non-adherence to surgery, chemotherapy, radiotherapy and hormonal therapy were 14%, 30.1%, 33.3% and 36.3% respectively. Factors associated with non-adherence to surgery were localities involving Kuala Lumpur (2 (OR: 3.41, Johor (OR: 8.38 and Kelantan (OR: 6.32, and those required mastectomy (OR: 5.66. No factors were found to be associated with non-adherence to chemotherapy, radiotherapy and hormonal therapy. These three treatment modalities were then combined as oncology therapy and the only independent factor associated with non-adherence to oncology therapy was Perak locality (OR: 1.42. Conclusion: Non-adherence to breast cancer treatments was high among breast cancer patients at public hospitals in Malaysia. Factors influencing non-adherence were locations and mastectomy implicating of socio-culture, body image issues, psychological disturbance and treatment navigation. Community educational programs focusing on correcting misconceptions, treatment outcomes and treatments’ side effects

  2. Post-treatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanoma: Dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Gillin, Michael; Albano, Katherine; Erickson, Beth

    1996-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1993, 63 patients underwent 125 I episcleral plaque application for the treatment of choroidal melanoma. Mean tumor height was 4.6 mm (range 1.7-8.3 mm). Plaques utilized were of COMS design. Doses and dose rates at the tumor apex, macula, and optic disc were obtained. Visual acuity data prior to and after plaque application was available for 52 patients. 9 patients were excluded from analysis secondary to co-morbidities or disease progression. 43 records were scored to assess if a decrease in visual acuity of ≥ 2 lines on a standard Snellen eye chart had occurred. Statistical analysis was performed using chi-square tests of significance. Results: Of the 63 total patients, 59 (93.7%) were alive at a median follow-up of 36 months. Local progression occurred in (7(63)) (11.1%). Median dose and dose rate to the tumor apex were 90 Gy and 97.2 cGy/hr, respectively. Of the 43 patients with post-treatment visual acuity analysis, 28 (65.1%) experienced visual loss of ≥ 2 lines on a standard eye chart. Median time to altered visual acuity was 20 months. Median dose and dose rates to the macula in patients with a significant visual loss were 123.3 Gy and 122.5 cGy/hr, respectively, compared with 38 Gy and 51.9 cGy/hr in those without notable visual change. These differences reached statistical significance at a dose and dose rate to the macula of 82.0 Gy (p 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of decreased visual acuity. Both total dose and dose rates to the macula and optic disc correlated strongly with post-treatment visual outcome. This information may be valuable in decisions about the dose and dose rates used to treat

  3. Post-treatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanoma: dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Murray, Kevin; Gillin, Michael; Albano, Katherine; Erickson, Beth

    1996-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1994, 63 patients underwent 125 I episcleral plaque application for the treatment of choroidal melanoma. Mean tumor height was 4.6 mm (range 1.7-8.3 mm). Plaques utilized were of COMS design. Doses and dose rates at the tumor apex, macula, and optic disc were obtained. Visual acuity data prior to and after plaque application was available for 52 patients. Nine patients were excluded from analysis secondary to co-morbidities or disease progression. Forty-three records were scored to assess if a decrease in visual acuity of ≥ 2 lines on a standard Snellen eye chart had occurred. Statistical analysis was performed using chi-square tests of significance. Results: Of the 63 total patients, 59 (93.7%) were alive at a median follow-up of 36 months. Local progression occurred in 7/63 (11.1%). Median dose and dose rate to the tumor apex were 90 Gy and 97.2 cGy/hr, respectively. Of the 43 patients with post-treatment visual acuity analysis, 28 (65.1%) experienced visual loss of ≥ 2 lines on a standard eye chart. Median time to altered visual acuity was 20 months. Median dose and dose rates to the macula in patients with a significant visual loss were 123.3 Gy and 122.5 cGy/hr, respectively, compared with 38 Gy and 51.9 cGy/hr in those without notable visual change. These differences reached statistical significance at a dose and dose rate to the macula of 82.0 Gy (p 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of decreased visual acuity. Both total dose and dose rates to the macula and optic disc correlated strongly with post-treatment visual outcome. This information may be valuable in decisions about the dose and dose rates used to

  4. Comparison of the measured radiation dose-rate by the ionization chamber and G (Geiger-Mueller) counter after radioactive lodine therapy in differentiated thyroid cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Hun [Dept. of Nuclear Medicine, Kyungbuk National University Hospital, Daegu (Korea, Republic of); Kim, Kgu Hwan [Dept. of Radiological Technology, Daegu Health College, Daegu (Korea, Republic of)

    2016-12-15

    Radioactive iodine(131I) treatment reduces recurrence and increases survival in patients with differentiated thyroid cancer. However, it is important in terms of radiation safety management to measure the radiation dose rate generated from the patient because the radiation emitted from the patient may cause the exposure. Research methods, it measured radiation dose-rate according to the elapsed time from 1 m from the upper abdomen of the patient by intake of radioactive iodine. Directly comparing the changes over time, high dose rate sensitivity and efficiency is statistically significant, and higher chamber than GM counter(p<0.05). Low dose rate sensitivity and efficiency in the chamber had lower levels than gm counter, but not statistically significant(p>0.05). In this study confirmed the characteristics of calibrated ionization chamber and GM counter according to the radiation intensity during high-dose radioactive iodine therapy by measuring the accurate and rapid radiation dose rate to the patient explains, discharged patients will be reduced to worry about radiation hazard of family and others person.

  5. The validity and internal structure of the Bipolar Depression Rating Scale: data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder.

    Science.gov (United States)

    Berk, Michael; Dodd, Seetal; Dean, Olivia M; Kohlmann, Kristy; Berk, Lesley; Malhi, Gin S

    2010-10-01

    Berk M, Dodd S, Dean OM, Kohlmann K, Berk L, Malhi GS. The validity and internal structure of the Bipolar Depression Rating Scale: data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder. The phenomenology of unipolar and bipolar disorders differ in a number of ways, such as the presence of mixed states and atypical features. Conventional depression rating instruments are designed to capture the characteristics of unipolar depression and have limitations in capturing the breadth of bipolar disorder. The Bipolar Depression Rating Scale (BDRS) was administered together with the Montgomery Asberg Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) in a double-blind randomised placebo-controlled clinical trial of N-acetyl cysteine for bipolar disorder (N = 75). A factor analysis showed a two-factor solution: depression and mixed symptom clusters. The BDRS has strong internal consistency (Cronbach's alpha = 0.917), the depression cluster showed robust correlation with the MADRS (r = 0.865) and the mixed subscale correlated with the YMRS (r = 0.750). The BDRS has good internal validity and inter-rater reliability and is sensitive to change in the context of a clinical trial.

  6. An opioid-based pain control program for head and neck cancer patients undergoing chemoradiation therapy achieves a high completion rate of radiation

    International Nuclear Information System (INIS)

    Kato, Kengo; Matsuura, Kazuto; Zenda, Sadamoto

    2011-01-01

    Appropriate supportive care is essential for intensive chemoradiation therapy (CRT), and pain management is an important supportive care for CRT for head and neck cancer. We developed an opioid-based pain control program for head and neck cancer patients undergoing CRT, and assessed its efficacy and safety. 110 head and neck cancer patients undergoing platinum-based concomitant CRT were enrolled from 10 cancer centers or university hospitals. Their pain caused by CRT was managed with a four-step opioid-based pain control program, and adverse events and usage of opioid were analyzed. 101 suitable cases of 110 patients were analyzed. 53% of cases suffered grade 3-4 mucositis. The rate of completion of radiotherapy was 99% and the rate of unplanned breaks in radiotherapy was 13%. The usage rate of opioid was 83% and the rate of compliance with the pain control program was 92%. The median maximum quantity of morphine used per day was 35 mg. No patient had to stop the opioid program or radiotherapy due to adverse effects of opioids. An opioid-based pain control program for head and neck cancer patients undergoing CRT achieves a high completion rate of radiation. (author)

  7. A randomized controlled trial to compare cure and relapse rate of paucibacillary multidrug therapy with monthly rifampicin, ofloxacin, and minocycline among paucibacillary leprosy patients in Agra District, India

    Directory of Open Access Journals (Sweden)

    Anil Kumar

    2015-01-01

    Full Text Available Objectives: To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT with monthly rifampicin, ofloxacin, and minocycline for six months (ROM-6 among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001-2004, who had paucibacillary (PB leprosy having 1-5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the first day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for first 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Cηi σθuαρε test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not significant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053 ; statistically not significant. Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6, 4 during 5-8 years (3 in PB-MDT and 1 in ROM-6, and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional difficulties in the field

  8. The Cure Rate after Placebo or No Therapy in American Cutaneous Leishmaniasis: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Gláucia Fernandes Cota

    Full Text Available There are few drugs with proven efficacy in cutaneous leishmaniasis (CL, and pentavalent antimonial derivatives are still the main first-line therapeutic agents worldwide, despite their recognized high toxicities. Randomized controlled clinical trials assessing the efficacy and safety of new therapeutic modalities are of high priority, and the definition of the design of such trials raises debate about the use of placebo as a comparator. To support the use of placebo as a comparator, two main points need to be addressed: 1--the cure rate without any therapeutic intervention and 2--the damage caused by CL and its impact on patients.The aim of this study was to systematically assess the spontaneous cure rate for American CL and to broaden the discussion about placebo use in CL trials.The PRISMA guidelines for systematic reviews and the Cochrane manual were followed. The sources used were the PubMed and LILACS databases. Studies were included if they reported cure rates using placebo or no treatment in American CL.Thirteen studies of a total of 352 patients were ultimately included in this review. The summarized global cure rates for all Leishmania species according to the intention-to-treat analyses performed at approximately three ("initial cure" and nine ("definitive cure" months after "no treatment" or placebo use were 26% (CI95%: 16 to 40% and 26% (CI95%:16 to 38%, respectively. Notably, a significantly lower cure rate was observed for L. braziliensis infection (6.4%, CI95%:0.2 to 20% than for L. mexicana infection (44%, CI95%:19 to 72%, p = 0.002. Of note, relapse occurred in 20% of patients with initial healing (CI95%:9.2 to 38.9%.These results clearly demonstrate a low spontaneous cure rate following no-treatment or placebo use, confirming that this strategy for the control group in CL studies expose patients to greater morbidity, especially for CL caused by L. braziliensis. Therefore, from this point, the crucial question to consider

  9. Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Phillips, Andrew N; Ledergerber, Bruno

    2010-01-01

    BACKGROUND: Patients receiving combination antiretroviral therapy (cART) might continue treatment with a virologically failing regimen. We sought to identify annual change in CD4(+) T-cell count according to levels of viraemia in patients on cART. METHODS: A total of 111,371 CD4(+) T-cell counts...... and viral load measurements in 8,227 patients were analysed. Annual change in CD4(+) T-cell numbers was estimated using mixed models. RESULTS: After adjustment, the estimated average annual change in CD4(+) T-cell count significantly increased when viral load was cells/mm(3), 95......% confidence interval [CI] 26.6-34.3), was stable when viral load was 500-9,999 copies/ml (3.1 cells/mm(3), 95% CI -5.3-11.5) and decreased when viral load was >/=10,000 copies/ml (-14.8 cells/mm(3), 95% CI -4.5--25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4(+) T-cell...

  10. Considering baseline factors and early response rates to optimize therapy for chronic myeloid leukemia in chronic phase.

    Science.gov (United States)

    Akard, Luke P; Bixby, Dale

    2016-05-01

    Multiple BCR-ABL tyrosine kinase inhibitors (TKIs) are available for the treatment of chronic myeloid leukemia in chronic phase (CML-CP), and several baseline and on-treatment predictive factors have been identified that can be used to help guide TKI selection for individual patients. In particular, early molecular response (EMR; BCR-ABL ≤10% on the International Scale at 3 months) has become an accepted benchmark for evaluating whether patients with CML-CP are responding optimally to frontline TKI therapy. Failure to achieve EMR is considered an inadequate initial response according to the National Comprehensive Cancer Network guidelines and a warning response according to the European LeukemiaNet recommendations. Here we review data supporting the importance of achieving EMR for improving patients' long-term outcomes and discuss key considerations for selecting a frontline TKI in light of these data. Because a higher proportion of patients achieve EMR with second-generation TKIs such as nilotinib and dasatinib than with imatinib, these TKIs may be preferable for many patients, particularly those with known negative prognostic factors at baseline. We also discuss other considerations for frontline TKI choice, including toxicities, cost-effectiveness, and the emerging goals of deep molecular response and treatment-free remission.

  11. Chromosome Damage and Cell Proliferation Rates in In Vitro Irradiated Whole Blood as Markers of Late Radiation Toxicity After Radiation Therapy to the Prostate

    Energy Technology Data Exchange (ETDEWEB)

    Beaton, Lindsay A., E-mail: Lindsay.Beaton@hc-sc.gc.ca [Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, ON (Canada); Ferrarotto, Catherine; Marro, Leonora [Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, ON (Canada); Samiee, Sara; Malone, Shawn; Grimes, Scott; Malone, Kyle [The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Rd, Ottawa, ON (Canada); Wilkins, Ruth C. [Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, ON (Canada)

    2013-04-01

    Purpose: In vitro irradiated blood samples from prostate cancer patients showing late normal tissue damage were examined for lymphocyte response by measuring chromosomal aberrations and proliferation rate. Methods and Materials: Patients were selected from a randomized trial evaluating the optimal timing of dose-escalated radiation and short-course androgen deprivation therapy. Of 438 patients, 3% experienced grade 3 late radiation proctitis and were considered to be radiosensitive. Blood samples were taken from 10 of these patients along with 20 matched samples from patients with grade 0 proctitis. The samples were irradiated at 6 Gy and, along with control samples, were analyzed for dicentric chromosomes and excess fragments per cell. Cells in first and second metaphase were also enumerated to determine the lymphocyte proliferation rate. Results: At 6 Gy, there were statistically significant differences between the radiosensitive and control cohorts for 3 endpoints: the mean number of dicentric chromosomes per cell (3.26 ± 0.31, 2.91 ± 0.32; P=.0258), the mean number of excess fragments per cell (2.27 ± 0.23, 1.43 ± 0.37; P<.0001), and the proportion of cells in second metaphase (0.27 ± 0.10, 0.46 ± 0.09; P=.0007). Conclusions: These results may be a valuable indicator for identifying radiosensitive patients and for tailoring radiation therapy.

  12. 500 kHZ intracavitary hyperthermia in the treatment of patients with cervical and endometrial cancer - preliminary results and treatment description

    International Nuclear Information System (INIS)

    Piotrowicz, N.; Lyczek, J.; Zielinski, J.; Debicki, P.

    2002-01-01

    The effectiveness of elevated temperature (hyperthermia) in cancer treatment is a well-known issue. However, due to technical problems with generating hyperthermia within the tumour and, at the same time, sparing the healthy tissues, in practice this modality is not widely used. Local hyperthermia was induced by a computer-controlled generator (500 kHz) with three amplifiers transmitting energy to the lesion via a modified uterine brachytherapy applicator. Temperature was measured with 3 thermocouples.Total treatment time was 60-90 minutes. 10 patients with cervical and endometrial cancer were enrolled into this study and 11 procedures were performed. Prior to hyperthermia all patients were treated with external field irradiation to the pelvis to the dose of 45-46 Gy. Intracavitary LDR/HDR brachytherapy (dose of 45 Gy/point Ai n two fractions) with colpostat used for the hyperthermia procedure was than performed. In all cases, except one, caused by equipment failure, biologically stable temperature was observed. No severe side effects of treatment were observed. There was no need to terminate treatment due to high temperature intolerance. (author)

  13. Intracavitary application of contrast medium in the follow-up of complicated tube-drained pleural empyema: Conventional radiography vs CT

    International Nuclear Information System (INIS)

    Duex, M.; Bischoff, H.; Schmaehl, A.; Tuengerthal, S.

    1997-01-01

    Purpose: To define the value of conventional radiography compared with CT in the follow-up of complicated, long-term tube drained pleural empyema after intracavitary application of contrast medium. Methods: 28 patients with complicated pleural empyema (stage III) and longterm tube drainage were submitted to fluoroscopy of the pleural cavity and a CT of the thorax after contrast medium had been instilled into the pleural space. Both examinations were judged by the following criteria: Number and morphology of pleural cavities, quality of drainage and accompanying thoracic disease. Results: 49 pleural cavities were diagnosed. Judgement of drainage corresponded in 79% of cases and differed 21% with proof of further not drained cavities only on CT. 4 bronchopleural fistulas were diagnosed by fluoroscopy, of which only 2 were evident on CT. Accompanying thoracic disease was reliably detected by CT only. Conclusions: Diagnosis of bronchopleural fistulas and judgement of the pleural drainage is best possible using fluoroscopy after application of contrast medium into the pleural space. CT is most accurate to detect further cavities that have not been drained, to look for concomitant thoracic disease, and to judge the morphology of the pleural cavity. Conventional radiography of the pleural space is effective and recommended to be used as a first line investigation for the follow-up of stage III empyemas. Patients in poor general condition (fever, elevated blood markers indicating inflammation) should be examined by both fluoroscopy and CT. (orig.) [de

  14. Revascularização da artéria coronária direita intra-atrial Revascularization of intracavitary right coronary artery

    Directory of Open Access Journals (Sweden)

    Artur Lourenção Júnior

    1990-12-01

    Full Text Available A artéria coronária direita, em seu trajeto no sulco atrioventricular direito, pode, em raras ocasiões, penetrar na cavidade atrial direita. Esta variação anatômica poderá modificar a tática cirúrgica em operações de revascularização miocárdica. No presente trabalho, relatamos o caso em que a ponte de veia safena para a artéria coronária direita foi realizada em posição intra-atrial direita.The right coronary artery, during your course in the right atrioventricular sulcus, can sometimes penetrate the right atrial cavity. This anatomical variety can modify the surgical tactics in aortocoronary by-pass surgery. In this paper we present a patient in whom the by-pass with saphenous vein graft to the right coronary artery was made in right intracavitary position.

  15. A retrospective study of the role of intracavitary brachytherapy and prognotic factors determining local tumour control after primary radical radiotherapy in 903 non-disseminated nasopharyngeal carcinoma patients

    International Nuclear Information System (INIS)

    Teo, P.M.L.; Kwan, W.H.; Yu, P.; Lee, W.Y.; Leung, S.F.; Choi, P.

    1996-01-01

    The aims of this retrospective study were to determine the role of intracavitary brachytherapy given shortly after external beam radiotherapy in the primary radical treatment of non-metastatic nasopharyngeal (NPC) cancer patients, and the prognostic factors governing local tumour control. From 1984 to 1989, 903 patients with non-disseminated NPC who had no previous treatment were managed at the Prince of Wales Hospital, Hong Kong, where investigation and treatment methods had been standardized according to a departmental protocol. In the 903 non-disseminated NPCs, the patient's age and tumour involvement of the skull base and cranial nerves were significant independent prognostic factors governing local tumour control. In the 358 patients with Ho T 3 disease, tumour involvement of the orbits and the laryngopharynx significantly worsened local tumour control. The presence of local persistence at 4 weeks after external radiotherapy, for which therapeutic brachytherapy was given, was marginally significant as a prognostic factor in addition to the presence of cranial nerve palsy. (author)

  16. Direct-acting antiviral therapy decreases hepatocellular carcinoma recurrence rate in cirrhotic patients with chronic hepatitis C.

    Science.gov (United States)

    Virlogeux, Victor; Pradat, Pierre; Hartig-Lavie, Kerstin; Bailly, François; Maynard, Marianne; Ouziel, Guillaume; Poinsot, Domitille; Lebossé, Fanny; Ecochard, Marie; Radenne, Sylvie; Benmakhlouf, Samir; Koffi, Joseph; Lack, Philippe; Scholtes, Caroline; Uhres, Anne-Claire; Ducerf, Christian; Mabrut, Jean-Yves; Rode, Agnès; Levrero, Massimo; Combet, Christophe; Merle, Philippe; Zoulim, Fabien

    2017-08-01

    Arrival of direct-acting antiviral agents against hepatitis C virus with high-sustained virological response rates and very few side effects has drastically changed the management of hepatitis C virus infection. The impact of direct-acting antiviral exposure on hepatocellular carcinoma recurrence after a first remission in patients with advanced fibrosis remains to be clarified. 68 consecutive hepatitis C virus patients with a first hepatocellular carcinoma diagnosis and under remission, subsequently treated or not with a direct-acting antiviral combination, were included. Clinical, biological and virological data were collected at first hepatocellular carcinoma diagnosis, at remission and during the surveillance period. All patients were cirrhotic. Median age was 62 years and 76% of patients were male. Twenty-three patients (34%) were treated with direct-acting antivirals and 96% of them achieved sustained virological response. Median time between hepatocellular carcinoma remission and direct-acting antivirals initiation was 7.2 months (IQR: 3.6-13.5; range: 0.3-71.4) and median time between direct-acting antivirals start and hepatocellular carcinoma recurrence was 13.0 months (IQR: 9.2-19.6; range: 3.0-24.7). Recurrence rate was 1.7/100 person-months among treated patients vs 4.2/100 person-months among untreated patients (P=.008). In multivariate survival analysis, the hazard ratio for hepatocellular carcinoma recurrence after direct-acting antivirals exposure was 0.24 (95% confidence interval: 0.10-0.55; PHepatocellular carcinoma recurrence rate was significantly lower among patients treated with direct-acting antivirals compared with untreated patients. Given the potential impact of our observation, large-scale prospective cohort studies are needed to confirm these results. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. The rate and extent of improvement with therapy from the different types of aphasia in the first year after stroke.

    Science.gov (United States)

    Bakheit, A M O; Shaw, S; Carrington, S; Griffiths, S

    2007-10-01

    To examine the rate and extent of improvement from the different types of aphasia in the first year after stroke. A prospective longitudinal study. A specialist stroke unit. Seventy-five aphasic patients with first-ever stroke. The type of aphasia was classified according to the criteria of the Western Aphasia Battery. The Western Aphasia Battery aphasia quotient was used to measure the initial severity and the rate and extent of improvement from aphasia. Assessments were made at baseline and 4, 8, 12 and 24 weeks later. The median percentage increase in the Western Aphasia Battery aphasia quotient was statistically higher in patients with Broca's aphasia than in the other groups at all weeks. Patients with Wernicke's aphasia had a significantly greater median percentage increase in their aphasia quotient than those with conduction and anomic aphasia at weeks 12 and 24, but less than patients with global aphasia at week 24. Patients with Broca's aphasia appear to have the best prognosis for improvement of language function in the first year of stroke. The extent of improvement in patients with global aphasia is better than that of patients with Wernicke's aphasia.

  18. Pregnancy rate of gonadotrophin therapy and laparoscopic ovarian electrocautery in polycystic ovary syndrome resistant to clomiphene citrate: a comparative study

    Directory of Open Access Journals (Sweden)

    Ghafarnegad M

    2010-01-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Polycystic ovary syndrome (PCOS is a common cause of ovulation insufficiency and then infertility. Therapeutic options to induce ovulation in anovulatory PCOS patients are clomiphene citrate, metformin, tamoxifen, dopamine agonists (bromocriptin, Gonadotrophin and laparoscopic ovarian electrocautery (LOE. Gonadotrophin and LOE are important options in anovulatory clomiphene citrate-resistant patients with PCOS. Literature data regarding compare of the efficacy of these two treatments are few. Therefore we aimed to study the pregnancy rates of these treatments in infertile clomiphene citrate-resistant patients with PCOS."n"nMethods: A randomized clinical trial study was carried out in infertile clomiphene citrate-resistant patients with PCOS, referred to infertility clinic of Mirza Koochackhan Hospital of Tehran University of Medical Science in Tehran, Iran, between 2003 and 2008."n"nResults: A total of 100 patients women were randomly allocated in two groups. There were no differences in age and pimary and secondary infertility duration. In LOE treatment group, eight cases (16% were pregnant and all delivered at term. in gonadotrophin treatment 14 cases (28% were pregnant, 10 cases (20% delivered at term

  19. Verification of the calculation program for brachytherapy planning system of high dose rate (PLATO)

    International Nuclear Information System (INIS)

    Almansa, J.; Alaman, C.; Perez-Alija, J.; Herrero, C.; Real, R. del; Ososrio, J. L.

    2011-01-01

    In our treatments are performed brachytherapy high dose rate since 2007. The procedures performed include gynecological intracavitary treatment and interstitial. The treatments are performed with a source of Ir-192 activity between 5 and 10 Ci such that small variations in treatment times can cause damage to the patient. In addition the Royal Decree 1566/1998 on Quality Criteria in radiotherapy establishes the need to verify the monitor units or treatment time in radiotherapy and brachytherapy. All this justifies the existence of a redundant system for brachytherapy dose calculation that can reveal any abnormality is present.

  20. Radio-Tympano-Sinu-Orthesis - a new therapy of recurrent otitis media and chronic sinusitis

    International Nuclear Information System (INIS)

    Czech, N.; Godbersen, G.S.

    2006-01-01

    The practicability, safety and clinical efficacy of intracavitary therapy with Re-186-colloid in patients with recurrent otitis media and paranasal sinusitis, resistant to pharmacotherapy and surgical treatment is demonstrated based on a preliminary treatment trial. Methods: the authors report on a total of 39 applications of 5-35 MBq 186 Re-colloid into the tympanon and the paranasal sinuses in six patients. Biodistribution and biokinetics were studied by gamma camera imaging. Clinical success was documented 6-20 months after therapy both by patients self-evaluation and by objective rhinootological follow-up, using a four-step score from -1 to+2. Results: no serious side effects were seen. There was good to excellent clinical improvement with a mean score of +1.44 ± 0.5 by patients self-evaluation and by physicians scoring of +0.81 ± 0.9 with only negligible extracranial tracer deposition. Conclusion: this novel treatment option using intracavitary application of Re-186-colloid in chronic otitis media and sinusitis is safe and effective. The term Radio-Tympano-Sinu-Orthesis (RTSO) might be proposed analogously to the well-known radiosynoviorthesis (RSO). (orig.)

  1. Microwave hyperthermia as an adjuvant to radiation therapy. Summary experience of 256 multifraction treatment cases

    International Nuclear Information System (INIS)

    Bicher, H.I.

    1985-01-01

    Analysis is presented of a series of 256 human tumors treated under multifraction protocol regimes with standard controlled hyperthermia parameters and increasing doses of radiation therapy. Air cooled microwave applicators intracavitary and interstitial antennae operating at 915 or 300 MHz were used in various sites. Temperatures were measured by micro-thermocouples. Minimum tumor temperatures of 42 0 C were maintained at 1 hour, twice weekly. Treatment included a radiation dose of 1600-1700 rads. Tumor response was 94% with 60% or more total response. Frequency and duration of total responses depended mainly on the radiation dose. Skin tumors, melanomas, chest wall recurrences responded better than head and neck or intrapelvic recurrences. Side effects observed were minor burns; proctitis or oesophagitis with intracavitary devices; ulcerations or fistulae due to rapid tumor regression; 4 cases of pleuritis treating chest wall. Overall toxicity was less than 5%. In conclusion: 1) Combination heat-low dose radiation offers good palliation. 2) Response depends on radiation dose. 3) Combination of full dose radiation therapy plus hyperthermia proves to be well tolerated

  2. Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost

    International Nuclear Information System (INIS)

    Singh, Anurag K; Godette, Denise J; Stall, Bronwyn R; Coleman, C Norman; Camphausen, Kevin; Ménard, Cynthia; Guion, Peter; Susil, Robert C; Citrin, Deborah E; Ning, Holly; Miller, Robert W; Ullman, Karen; Smith, Sharon; Crouse, Nancy Sears

    2006-01-01

    To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise >35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. Median follow-up was 24 months (range 18–36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive

  3. Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV-tuberculosis co-infected patients on combination antiretroviral therapy.

    Science.gov (United States)

    Ezeamama, Amara E; Mupere, Ezekiel; Oloya, James; Martinez, Leonardo; Kakaire, Robert; Yin, Xiaoping; Sekandi, Juliet N; Whalen, Christopher C

    2015-06-01

    Baseline age and combination antiretroviral therapy (cART) were examined as determinants of CD4+ T-cell recovery during 6 months of tuberculosis (TB) therapy with/without cART. It was determined whether this association was modified by patient sex and nutritional status. This longitudinal analysis included 208 immune-competent, non-pregnant, ART-naive HIV-positive patients from Uganda with a first episode of pulmonary TB. CD4+ T-cell counts were measured using flow cytometry. Age was defined as ≤24, 25-29, 30-34, and 35-39 vs. ≥40 years. Nutritional status was defined as normal (>18.5kg/m(2)) vs. underweight (≤18.5kg/m(2)) using the body mass index (BMI). Multivariate random effects linear mixed models were fitted to estimate differences in CD4+ T-cell recovery in relation to specified determinants. cART was associated with a monthly rise of 15.7 cells/μl (precovery during TB therapy (p = 0.655). However, among patients on cART, the age-associated CD4+ T-cell recovery rate varied by sex and nutritional status, such that age recovery among females (p=0.006) and among patients with a BMI ≥18.5kg/m(2) (p18.5kg/m(2) or they are female. These patients may benefit from increased monitoring and nutritional support during cART. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Prostate Specific Antigen (PSA) as Predicting Marker for Clinical Outcome and Evaluation of Early Toxicity Rate after High-Dose Rate Brachytherapy (HDR-BT) in Combination with Additional External Beam Radiation Therapy (EBRT) for High Risk Prostate Cancer.

    Science.gov (United States)

    Ecke, Thorsten H; Huang-Tiel, Hui-Juan; Golka, Klaus; Selinski, Silvia; Geis, Berit Christine; Koswig, Stephan; Bathe, Katrin; Hallmann, Steffen; Gerullis, Holger

    2016-11-10

    High-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT) is a common treatment option for locally advanced prostate cancer (PCa). Seventy-nine male patients (median age 71 years, range 50 to 79) with high-risk PCa underwent HDR-BT following EBRT between December 2009 and January 2016 with a median follow-up of 21 months. HDR-BT was administered in two treatment sessions (one week interval) with 9 Gy per fraction using a planning system and the Ir192 treatment unit GammaMed Plus iX. EBRT was performed with CT-based 3D-conformal treatment planning with a total dose administration of 50.4 Gy with 1.8 Gy per fraction and five fractions per week. Follow-up for all patients was organized one, three, and five years after radiation therapy to evaluate early and late toxicity side effects, metastases, local recurrence, and prostate-specific antigen (PSA) value measured in ng/mL. The evaluated data included age, PSA at time of diagnosis, PSA density, BMI (body mass index), Gleason score, D'Amico risk classification for PCa, digital rectal examination (DRE), PSA value after one/three/five year(s) follow-up (FU), time of follow-up, TNM classification, prostate volume, and early toxicity rates. Early toxicity rates were 8.86% for gastrointestinal, and 6.33% for genitourinary side effects. Of all treated patients, 84.81% had no side effects. All reported complications in early toxicity were grade 1. PSA density at time of diagnosis ( p = 0.009), PSA on date of first HDR-BT ( p = 0.033), and PSA on date of first follow-up after one year ( p = 0.025) have statistical significance on a higher risk to get a local recurrence during follow-up. HDR-BT in combination with additional EBRT in the presented design for high-risk PCa results in high biochemical control rates with minimal side-effects. PSA is a negative predictive biomarker for local recurrence during follow-up. A longer follow-up is needed to assess long-term outcome and toxicities.

  5. Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region.

    Directory of Open Access Journals (Sweden)

    Stephen Wright

    Full Text Available In the Asia-Pacific region many countries have adopted the WHO's public health approach to HIV care and treatment. We performed exploratory analyses of the factors associated with first major modification to first-line combination antiretroviral therapy (ART in resource-rich and resource-limited countries in the region.We selected treatment naive HIV-positive adults from the Australian HIV Observational Database (AHOD and the TREAT Asia HIV Observational Database (TAHOD. We dichotomised each country's per capita income into high/upper-middle (T-H and lower-middle/low (T-L. Survival methods stratified by income were used to explore time to first major modification of first-line ART and associated factors. We defined a treatment modification as either initiation of a new class of antiretroviral (ARV or a substitution of two or more ARV agents from within the same ARV class.A total of 4250 patients had 961 major modifications to first-line ART in the first five years of therapy. The cumulative incidence (95% CI of treatment modification was 0.48 (0.44-0.52, 0.33 (0.30-0.36 and 0.21 (0.18-0.23 for AHOD, T-H and T-L respectively. We found no strong associations between typical patient characteristic factors and rates of treatment modification. In AHOD, relative to sites that monitor twice-yearly (both CD4 and HIV RNA-VL, quarterly monitoring corresponded with a doubling of the rate of treatment modifications. In T-H, relative to sites that monitor once-yearly (both CD4 and HIV RNA-VL, monitoring twice-yearly corresponded to a 1.8 factor increase in treatment modifications. In T-L, no sites on average monitored both CD4 & HIV RNA-VL concurrently once-yearly. We found no differences in rates of modifications for once- or twice-yearly CD4 count monitoring.Low-income countries tended to have lower rates of major modifications made to first-line ART compared to higher-income countries. In higher-income countries, an increased rate of RNA-VL monitoring was

  6. Effect of Immunoglobulin Therapy on the Rate of Infections in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation and or Treated with Immunomodulatory Agents

    Directory of Open Access Journals (Sweden)

    Alhossain A. Khalafallah

    2010-04-01

    Full Text Available There are few data available regarding the prevalence of infection in multiple myeloma (MM patients in conjunction with newer generations of immunomodulatory drugs (thalidomide, bortezomib, lenalidomide or post autologous stem cell transplantation.  We retrospectively analyzed 47 patients with MM from March 2006 to June 2009 at our institution. All patients received thalidomide and steroid therapy for at least 6 months. Nine patients received bortezomib and 11 lenalidomide subsequently to thalidomide, because of disease progression and 22 patients underwent autologous stem cell transplantation.   The median age was 64 years (range 37-86, with a female–to-male ratio of 18:29. The median residual-serum IgG-level at time of infection was 3.2 g/L, IgA 0.3 g/L and IgM 0.2 g/L. Most patients suffered from recurrent moderate to severe infections. All patients except 3 received intravenous immunoglobulin (IVIG therapy with a significant decline of the rate of infection thereafter. Our analysis shows that IVIG appears to be an effective strategy to prevent infection in MM patients. Further studies to confirm these findings are warranted.

  7. BiRD (Biaxin [clarithromycin]/Revlimid [lenalidomide]/dexamethasone) combination therapy results in high complete- and overall-response rates in treatment-naive symptomatic multiple myeloma.

    Science.gov (United States)

    Niesvizky, Ruben; Jayabalan, David S; Christos, Paul J; Furst, Jessica R; Naib, Tara; Ely, Scott; Jalbrzikowski, Jessica; Pearse, Roger N; Zafar, Faiza; Pekle, Karen; Larow, April; Lent, Richard; Mark, Tomer; Cho, Hearn J; Shore, Tsiporah; Tepler, Jeffrey; Harpel, John; Schuster, Michael W; Mathew, Susan; Leonard, John P; Mazumdar, Madhu; Chen-Kiang, Selina; Coleman, Morton

    2008-02-01

    This trial determined the safety and efficacy of the combination regimen clarithromycin (Biaxin), lenalidomide (Revlimid), and dexamethasone (BiRD) as first-line therapy for multiple myeloma. Patients received BiRD in 28-day cycles. Dexamethasone (40 mg) was given orally once weekly, clarithromycin (500 mg) was given orally twice daily, and lenalidomide (25 mg) was given orally daily on days 1 to 21. Objective response was defined by standard criteria (ie, decrease in serum monoclonal protein [M-protein] by at least 50%, and a decrease in urine M-protein by at least 90%). Of the 72 patients enrolled, 65 had an objective response (90.3%). A combined stringent and conventional complete response rate of 38.9% was achieved, and 73.6% of the patients achieved at least a 90% decrease in M-protein levels. This regimen did not interfere with hematopoietic stem-cell harvest. Fifty-two patients who did not go on to receive transplants received continued therapy (complete response, 37%; very good partial response, 33%). The major adverse events were thromboembolic events, corticosteroid-related morbidity, and cytopenias. BiRD is an effective regimen with manageable side effects in the treatment of symptomatic, newly diagnosed multiple myeloma. This trial was registered at www.clinicaltrials.gov as #NCT00151203.

  8. Improved Helicobacter pylori Eradication Rate of Tailored Triple Therapy by Adding Lactobacillus delbrueckii and Streptococcus thermophilus in Northeast Region of Thailand: A Prospective Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Taweesak Tongtawee

    2015-01-01

    Full Text Available Background and Aim. To evaluate the effect of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus to Helicobacter pylori eradication in different periods of therapeutic protocol. Methods. Infected patients were randomized to one-week tailored triple therapy (esomeprazole 20 mg bid, clarithromycin 500 mg bid/metronidazole 400 mg tid if clarithromycin resistant, and amoxicillin 1000 mg bid with placebo (group 1, n=100; one week of pretreatment with probiotics (group 2, n=100; and one week of pretreatment with probiotic followed by one week of the same probiotics after treatment (group 3, n=100. Result. PP analysis involved 292 patients, 98 in group 1, 97 in group 2, and 97 in group 3. Successful eradication was observed in 229 patients; by PP analysis, the eradication rates were significantly higher (P<0.01, 95% CI; 0.71–0.97 in group 2 and group 3 than group 1. ITT analysis eradication rates were significantly higher in group 2 and group 3 than group 1 (P<0.01 95% CI; 0.72–0.87, and there is no significant difference between the three groups (P=0.32 in terms of adverse events. Conclusion. Adding probiotics before or before and after tailored treatment can improve Helicobacter pylori eradication rates. This trial is registered with Thai Clinical Trials Registry number: TCTR20141209001.

  9. Improved Helicobacter pylori Eradication Rate of Tailored Triple Therapy by Adding Lactobacillus delbrueckii and Streptococcus thermophilus in Northeast Region of Thailand: A Prospective Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Tongtawee, Taweesak; Dechsukhum, Chavaboon; Leeanansaksiri, Wilairat; Kaewpitoon, Soraya; Kaewpitoon, Natthawut; Loyd, Ryan A; Matrakool, Likit; Panpimanmas, Sukij

    2015-01-01

    Background and Aim. To evaluate the effect of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus to Helicobacter pylori eradication in different periods of therapeutic protocol. Methods. Infected patients were randomized to one-week tailored triple therapy (esomeprazole 20 mg bid, clarithromycin 500 mg bid/metronidazole 400 mg tid if clarithromycin resistant, and amoxicillin 1000 mg bid) with placebo (group 1, n=100); one week of pretreatment with probiotics (group 2, n=100); and one week of pretreatment with probiotic followed by one week of the same probiotics after treatment (group 3, n=100). Result. PP analysis involved 292 patients, 98 in group 1, 97 in group 2, and 97 in group 3. Successful eradication was observed in 229 patients; by PP analysis, the eradication rates were significantly higher (P<0.01, 95% CI; 0.71-0.97) in group 2 and group 3 than group 1. ITT analysis eradication rates were significantly higher in group 2 and group 3 than group 1 (P<0.01 95% CI; 0.72-0.87), and there is no significant difference between the three groups (P=0.32) in terms of adverse events. Conclusion. Adding probiotics before or before and after tailored treatment can improve Helicobacter pylori eradication rates. This trial is registered with Thai Clinical Trials Registry number: TCTR20141209001.

  10. Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiation Therapy in the Treatment of Intermediate-Risk Prostate Cancer - Long Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Cury, Fabio L., E-mail: fabio.cury@muhc.mcgill.ca [Department of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada); Duclos, Marie [Department of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada); Aprikian, Armen [Department of Urology, McGill University Health Centre, Montreal, QC (Canada); Patrocinio, Horacio [Department of Medical Physics, McGill University Health Centre, Montreal, QC (Canada); Kassouf, Wassim [Department of Urology, McGill University Health Centre, Montreal, QC (Canada); Shenouda, George; Faria, Sergio; David, Marc; Souhami, Luis [Department of Radiation Oncology, McGill University Health Centre, Montreal, QC (Canada)

    2012-03-15

    Purpose: We present the long-term results of a cohort of patients with intermediate-risk prostate cancer (PC) treated with single-fraction high-dose-rate brachytherapy (HDRB) combined with hypofractionated external beam radiation therapy (HypoRT). Methods and Materials: Patients were treated exclusively with HDRB and HypoRT. HDRB delivered a dose of 10 Gy to the prostate surface and HypoRT consisted of 50 Gy delivered in 20 daily fractions. The first 121 consecutive patients with a minimum of 2 years posttreatment follow-up were assessed for toxicity and disease control. Results: The median follow-up was 65.2 months. No acute Grade III or higher toxicity was seen. Late Grade II gastrointestinal toxicity was seen in 9 patients (7.4%) and Grade III in 2 (1.6%). Late Grade III genitourinary toxicity was seen in 2 patients (1.6%). After a 24-month follow-up, a rebiopsy was offered to the first 58 consecutively treated patients, and 44 patients agreed with the procedure. Negative biopsies were found in 40 patients (91%). The 5-year biochemical relapse-free survival rate was 90.7% (95% CI, 84.5-96.9%), with 13 patients presenting biochemical failure. Among them, 9 were diagnosed with distant metastasis. Prostate cancer-specific and overall survival rates at 5 years were 100% and 98.8% (95% CI, 96.4-100%), respectively. Conclusion: The combination of HDRB and HypoRT is well tolerated, with acceptable toxicity rates. Furthermore, results from rebiopsies revealed an encouraging rate of local control. These results confirm that the use of conformal RT techniques, adapted to specific biological tumor characteristics, have the potential to improve the therapeutic ratio in intermediate-risk PC patients.

  11. Rate of candidiasis among HIV-infected children in Spain in the era of highly active antiretroviral therapy (1997-2008).

    Science.gov (United States)

    Álvaro-Meca, Alejandro; Jensen, Julia; Micheloud, Dariela; Díaz, Asunción; Gurbindo, Dolores; Resino, Salvador

    2013-03-04

    Candidiasis is the most common opportunistic infection seen in human immunodeficiency virus (HIV)-infected individuals. The aim of our study was to estimate the candidiasis rate and evaluate its trend in HIV-infected children in Spain during the era of highly active antiretroviral therapy (HAART) compared to HIV-uninfected children. We carried out a retrospective study. Data were obtained from the records of the Minimum Basic Data Set from hospitals in Spain. All HIV-infected children were under 17 years of age, and a group of HIV-uninfected children with hospital admissions matching the study group by gender and age were randomly selected. The follow-up period (1997-2008) was divided into three calendar periods: a) From 1997 to 1999 for early-period HAART; b) from 2000 to 2002 for mid-period HAART; and c) from 2003 to 2008 for late-period HAART. Among children with hospital admissions, HIV-infected children had much higher values than HIV-uninfected children during each of the three calendar periods for overall candidiasis rates (150.0 versus 6.1 events per 1,000 child hospital admissions/year (p candidiasis rate (events per 1,000 HIV-infected children/year) decreased from 1997-1999 to 2000-2002 (18.8 to 10.6; p candidiasis, both non-ICM and ICM rates experienced significant decreases from 1997-1999 to 2003-2008 (15.9 to 5.7 (p candidiasis rate still remains higher than in the general population (from 1997 to 2008), candidiasis diagnoses have decreased among HIV-infected children throughout the HAART era, and it has ceased to be a major health problem among children with HIV infection.

  12. Rate of candidiasis among HIV-infected children in Spain in the era of highly active antiretroviral therapy (1997–2008)

    Science.gov (United States)

    2013-01-01

    Background Candidiasis is the most common opportunistic infection seen in human immunodeficiency virus (HIV)-infected individuals. The aim of our study was to estimate the candidiasis rate and evaluate its trend in HIV-infected children in Spain during the era of highly active antiretroviral therapy (HAART) compared to HIV-uninfected children. Methods We carried out a retrospective study. Data were obtained from the records of the Minimum Basic Data Set from hospitals in Spain. All HIV-infected children were under 17 years of age, and a group of HIV-uninfected children with hospital admissions matching the study group by gender and age were randomly selected. The follow-up period (1997–2008) was divided into three calendar periods: a) From 1997 to 1999 for early-period HAART; b) from 2000 to 2002 for mid-period HAART; and c) from 2003 to 2008 for late-period HAART. Results Among children with hospital admissions, HIV-infected children had much higher values than HIV-uninfected children during each of the three calendar periods for overall candidiasis rates (150.0 versus 6.1 events per 1,000 child hospital admissions/year (p candidiasis rate (events per 1,000 HIV-infected children/year) decreased from 1997–1999 to 2000–2002 (18.8 to 10.6; p candidiasis, both non-ICM and ICM rates experienced significant decreases from 1997–1999 to 2003–2008 (15.9 to 5.7 (p candidiasis rate still remains higher than in the general population (from 1997 to 2008), candidiasis diagnoses have decreased among HIV-infected children throughout the HAART era, and it has ceased to be a major health problem among children with HIV infection. PMID:23510319

  13. A reviewed technique for total body electron therapy using a Varian Clinac 2100C/D high dose rate treatment beam facility

    International Nuclear Information System (INIS)

    Oliver, L.D.; Xuereb, E.M.A.; Last, V.; Hunt, P.B.; Wilfert, A.

    1996-01-01

    Our (Royal North Shore Hospital) most recent linear accelerator acquisition is a Varian Clinac 2100C/D which has a high dose rate (approximately 25Gy per minute at 1 metre) total body electron option. We investigated the physical characteristics of the electron beam to develop a suitable method of treatment for total body electron therapy. The useful electron beam width is defined as 80cm above and below the reference height. Measurements of the electron dose received from the two angled electron beams showed a critical dependence on the gantry angles. The treatment protocol uses ten different patient angles, fractionated into directly opposing fields and treated seuqentially each day. A full cycle of treatment is completed in five days. (author)

  14. Do Differences in Programmatic Resource Investments Result in Different 3-Year Pass Rates on the U.S. National Physical Therapy Examination?

    Science.gov (United States)

    Covington, Kyle; McCallum, Christine; Engelhard, Chalee; Landry, Michel D; Cook, Chad

    2016-01-01

    The rising cost of health professions education is well documented and a growing concern among educators; however, little is known about the implications of resource investment on student success. The objective of this study was to determine whether programs with higher National Physical Therapist Exam (NPTE) pass rates invested significantly more on programmatic resources. This observational study used data from the Commission on Accreditation in Physical Therapy Education's (CAPTE) Annual Accreditation Report including all accredited physical therapist programs from the United States who graduated physical therapist students in 2011. Resource expenditures were recorded as both raw and as an index variable (resources per student). Descriptive statistics and comparisons (using chi-square and t-tests) among programs with invested significantly more per student for selected resources.

  15. Aspirin plus dipyridamole has the highest surface under the cumulative ranking curves (SUCRA) values in terms of mortality, intracranial hemorrhage, and adverse event rate among 7 drug therapies in the treatment of cerebral infarction.

    Science.gov (United States)

    Zhang, Jian-Jun; Liu, Xin

    2018-03-01

    The standardization for the clinical use of drug therapy for cerebral infarction (CI) has not yet determined in some aspects. In this paper, we discussed the efficacies of different drug therapies (aspirin, aspirin plus dipyridamole, aspirin plus clopidogrel, aspirin plus warfarin, cilostazol, warfarin, and ticlopidine) for CI. We searched databases of PubMed and Cochrane Library from the inception to April, 2017, randomized controlled trials (RCTs) met the inclusion and exclusion criteria were enrolled in this study. The network meta-analysis integrated evidences of direct and indirect comparisons to assess odd ratios (OR) and surface under the cumulative ranking curves (SUCRA) value. Thirteen eligible RCTs including 7 drug therapies were included into this network meta-analysis. The network meta-analysis results showed that CI patients who received aspirin plus dipyridamole presented lower mortality when compared with those received aspirin plus clopidogrel (OR = 0.46, 95% CI = 0.18-0.99), indicating aspirin plus dipyridamole therapy had better efficacy for CI. As for intracranial hemorrhage (ICH), stroke recurrence, and adverse event (AE) rate, there were no significant differences of efficacy among 7 drug therapies. Besides, SUCRA values demonstrated that in the 7 drug therapies, aspirin plus dipyridamole therapy was more effective than others (mortality: 80.67%; ICH: 76.6%; AE rate: 90.2%). Our findings revealed that aspirin plus dipyridamole therapy might be the optimum one for patients with CI, which could help to improve the survival of CI patients.

  16. Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Damast, Shari, E-mail: shari.damast@yale.edu [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Alektiar, Kaled M. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Goldfarb, Shari [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Eaton, Anne; Patil, Sujata [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Mosenkis, Jeffrey [Department of Comparative Human Development, University of Chicago, Chicago, Illinois (United States); Bennett, Antonia [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Atkinson, Thomas [Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Jewell, Elizabeth; Leitao, Mario; Barakat, Richard; Carter, Jeanne [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Basch, Ethan [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-10-01

    Purpose: We used the Female Sexual Function Index (FSFI) to investigate the prevalence of sexual dysfunction (SD) and factors associated with diminished sexual functioning in early stage endometrial cancer (EC) patients treated with simple hysterectomy and adjuvant brachytherapy. Methods and Materials: A cohort of 104 patients followed in a radiation oncology clinic completed questionnaires to quantify current levels of sexual functioning. The time interval between hysterectomy and questionnaire completion ranged from <6 months to >5 years. Multivariate regression was performed using the FSFI as a continuous variable (score range, 1.2-35.4). SD was defined as an FSFI score of <26, based on the published validation study. Results: SD was reported by 81% of respondents. The mean ({+-} standard deviation) domain scores in order of highest-to-lowest functioning were: satisfaction, 2.9 ({+-}2.0); orgasm, 2.5 ({+-}2.4); desire, 2.4 ({+-}1.3); arousal, 2.2 ({+-}2.0); dryness, 2.1 ({+-}2.1); and pain, 1.9 ({+-}2.3). Compared to the index population in which the FSFI cut-score was validated (healthy women ages 18-74), all scores were low. Compared to published scores of a postmenopausal population, scores were not statistically different. Multivariate analysis isolated factors associated with lower FSFI scores, including having laparotomy as opposed to minimally invasive surgery (effect size, -7.1 points; 95% CI, -11.2 to -3.1; P<.001), lack of vaginal lubricant use (effect size, -4.4 points; 95% CI, -8.7 to -0.2, P=.040), and short time interval (<6 months) from hysterectomy to questionnaire completion (effect size, -4.6 points; 95% CI, -9.3-0.2; P=.059). Conclusions: The rate of SD, as defined by an FSFI score <26, was prevalent. The postmenopausal status of EC patients alone is a known risk factor for SD. Additional factors associated with poor sexual functioning following treatment for EC included receipt of laparotomy and lack of vaginal lubricant use.

  17. Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

    International Nuclear Information System (INIS)

    Damast, Shari; Alektiar, Kaled M.; Goldfarb, Shari; Eaton, Anne; Patil, Sujata; Mosenkis, Jeffrey; Bennett, Antonia; Atkinson, Thomas; Jewell, Elizabeth; Leitao, Mario; Barakat, Richard; Carter, Jeanne; Basch, Ethan

    2012-01-01

    Purpose: We used the Female Sexual Function Index (FSFI) to investigate the prevalence of sexual dysfunction (SD) and factors associated with diminished sexual functioning in early stage endometrial cancer (EC) patients treated with simple hysterectomy and adjuvant brachytherapy. Methods and Materials: A cohort of 104 patients followed in a radiation oncology clinic completed questionnaires to quantify current levels of sexual functioning. The time interval between hysterectomy and questionnaire completion ranged from 5 years. Multivariate regression was performed using the FSFI as a continuous variable (score range, 1.2-35.4). SD was defined as an FSFI score of <26, based on the published validation study. Results: SD was reported by 81% of respondents. The mean (± standard deviation) domain scores in order of highest-to-lowest functioning were: satisfaction, 2.9 (±2.0); orgasm, 2.5 (±2.4); desire, 2.4 (±1.3); arousal, 2.2 (±2.0); dryness, 2.1 (±2.1); and pain, 1.9 (±2.3). Compared to the index population in which the FSFI cut-score was validated (healthy women ages 18-74), all scores were low. Compared to published scores of a postmenopausal population, scores were not statistically different. Multivariate analysis isolated factors associated with lower FSFI scores, including having laparotomy as opposed to minimally invasive surgery (effect size, −7.1 points; 95% CI, −11.2 to −3.1; P<.001), lack of vaginal lubricant use (effect size, −4.4 points; 95% CI, −8.7 to −0.2, P=.040), and short time interval (<6 months) from hysterectomy to questionnaire completion (effect size, −4.6 points; 95% CI, −9.3-0.2; P=.059). Conclusions: The rate of SD, as defined by an FSFI score <26, was prevalent. The postmenopausal status of EC patients alone is a known risk factor for SD. Additional factors associated with poor sexual functioning following treatment for EC included receipt of laparotomy and lack of vaginal lubricant use.

  18. Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fowble, Barbara, E-mail: BFowble@radonc.ucsf.edu [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Park, Catherine [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Wang, Frederick; Peled, Anne [Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States); Alvarado, Michael; Ewing, Cheryl; Esserman, Laura [Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California (United States); Foster, Robert; Sbitany, Hani [Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States); Hanlon, Alex [University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (United States)

    2015-07-01

    Objectives: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Methods and Materials: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Results: Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. Conclusions: RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and

  19. Time Course and Accumulated Risk of Severe Urinary Adverse Events After High- Versus Low-Dose-Rate Prostate Brachytherapy With or Without External Beam Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Tward, Jonathan D., E-mail: Jonathan.Tward@hci.utah.edu [Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (United States); Jarosek, Stephanie; Chu, Haitao [University of Minnesota, Minneapolis, Minnesota (United States); Thorpe, Cameron; Shrieve, Dennis C. [Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (United States); Elliott, Sean [University of Minnesota, Minneapolis, Minnesota (United States)

    2016-08-01

    Purpose: Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence, and radiation cystitis. We compared the incidence of grade 3 UAEs, according to the Common Terminology Criteria for Adverse Events, after low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy, as well as after LDR plus external beam radiation therapy (EBRT) and HDR plus EBRT. Methods and Materials: Men aged >65 years with nonmetastatic prostate cancer were identified from the Surveillance, Epidemiology, and End Results–Medicare database who were treated with LDR (n=12,801), HDR (n=685), LDR plus EBRT (n=8518), or HDR plus EBRT (n=2392). The populations were balanced by propensity weighting, and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared with those in a cohort of men not treated for prostate cancer. Results: Median follow-up was 4.3 years. At 8 years, the propensity-weighted cumulative UAE incidence was highest after HDR plus EBRT (26.6% [95% confidence interval, 23.8%-29.7%]) and lowest after LDR (15.7% [95% confidence interval, 14.8%-16.6%]). The absolute excess risk over nontreated controls at 8 years was 1.9%, 3.8%, 8.4%, and 12.9% for LDR, HDR, LDR plus EBRT, and HDR plus EBRT, respectively. These represent numbers needed to harm of 53, 26, 12, and 8 persons, respectively. The additional risk of development of a UAE related to treatment for LDR, LDR plus EBRT, and HDR plus EBRT was greatest within the 2 years after treatment and then continued to decline over time. Beyond 4 years, the risk of development of a new severe UAE matched the baseline risk of the control population for all treatments. Conclusions: Toxicity differences were observed between LDR and HDR, but the differences did not meet statistical significance. However, combination radiation therapy (either HDR plus EBRT or LDR plus

  20. Time Course and Accumulated Risk of Severe Urinary Adverse Events After High- Versus Low-Dose-Rate Prostate Brachytherapy With or Without External Beam Radiation Therapy

    International Nuclear Information System (INIS)

    Tward, Jonathan D.; Jarosek, Stephanie; Chu, Haitao; Thorpe, Cameron; Shrieve, Dennis C.; Elliott, Sean

    2016-01-01

    Purpose: Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence, and radiation cystitis. We compared the incidence of grade 3 UAEs, according to the Common Terminology Criteria for Adverse Events, after low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy, as well as after LDR plus external beam radiation therapy (EBRT) and HDR plus EBRT. Methods and Materials: Men aged >65 years with nonmetastatic prostate cancer were identified from the Surveillance, Epidemiology, and End Results–Medicare database who were treated with LDR (n=12,801), HDR (n=685), LDR plus EBRT (n=8518), or HDR plus EBRT (n=2392). The populations were balanced by propensity weighting, and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared with those in a cohort of men not treated for prostate cancer. Results: Median follow-up was 4.3 years. At 8 years, the propensity-weighted cumulative UAE incidence was highest after HDR plus EBRT (26.6% [95% confidence interval, 23.8%-29.7%]) and lowest after LDR (15.7% [95% confidence interval, 14.8%-16.6%]). The absolute excess risk over nontreated controls at 8 years was 1.9%, 3.8%, 8.4%, and 12.9% for LDR, HDR, LDR plus EBRT, and HDR plus EBRT, respectively. These represent numbers needed to harm of 53, 26, 12, and 8 persons, respectively. The additional risk of development of a UAE related to treatment for LDR, LDR plus EBRT, and HDR plus EBRT was greatest within the 2 years after treatment and then continued to decline over time. Beyond 4 years, the risk of development of a new severe UAE matched the baseline risk of the control population for all treatments. Conclusions: Toxicity differences were observed between LDR and HDR, but the differences did not meet statistical significance. However, combination radiation therapy (either HDR plus EBRT or LDR plus

  1. Time Course and Accumulated Risk of Severe Urinary Adverse Events After High- Versus Low-Dose-Rate Prostate Brachytherapy With or Without External Beam Radiation Therapy.

    Science.gov (United States)

    Tward, Jonathan D; Jarosek, Stephanie; Chu, Haitao; Thorpe, Cameron; Shrieve, Dennis C; Elliott, Sean

    2016-08-01

    Severe urinary adverse events (UAEs) include surgical treatment of urethral stricture, urinary incontinence, and radiation cystitis. We compared the incidence of grade 3 UAEs, according to the Common Terminology Criteria for Adverse Events, after low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy, as well as after LDR plus external beam radiation therapy (EBRT) and HDR plus EBRT. Men aged >65 years with nonmetastatic prostate cancer were identified from the Surveillance, Epidemiology, and End Results-Medicare database who were treated with LDR (n=12,801), HDR (n=685), LDR plus EBRT (n=8518), or HDR plus EBRT (n=2392). The populations were balanced by propensity weighting, and the Kaplan-Meier incidence of severe UAEs was compared. Propensity-weighted Cox proportional hazards models were used to compare the adjusted hazard of UAEs. These UAEs were compared with those in a cohort of men not treated for prostate cancer. Median follow-up was 4.3 years. At 8 years, the propensity-weighted cumulative UAE incidence was highest after HDR plus EBRT (26.6% [95% confidence interval, 23.8%-29.7%]) and lowest after LDR (15.7% [95% confidence interval, 14.8%-16.6%]). The absolute excess risk over nontreated controls at 8 years was 1.9%, 3.8%, 8.4%, and 12.9% for LDR, HDR, LDR plus EBRT, and HDR plus EBRT, respectively. These represent numbers needed to harm of 53, 26, 12, and 8 persons, respectively. The additional risk of development of a UAE related to treatment for LDR, LDR plus EBRT, and HDR plus EBRT was greatest within the 2 years after treatment and then continued to decline over time. Beyond 4 years, the risk of development of a new severe UAE matched the baseline risk of the control population for all treatments. Toxicity differences were observed between LDR and HDR, but the differences did not meet statistical significance. However, combination radiation therapy (either HDR plus EBRT or LDR plus EBRT) increases the risk of severe UAEs compared with HDR

  2. Multiple Genetic Analysis System-Based Antibiotic Susceptibility Testing in Helicobacter pylori and High Eradication Rate With Phenotypic Resistance-Guided Quadruple Therapy.

    Science.gov (United States)

    Dong, Fangyuan; Ji, Danian; Huang, Renxiang; Zhang, Fan; Huang, Yiqin; Xiang, Ping; Kong, Mimi; Nan, Li; Zeng, Xianping; Wu, Yong; Bao, Zhijun

    2015-11-01

    Antibiotics resistance in Helicobacter pylori (H. pylori) is the major factor for eradication failure. Molecular tests including fluorescence in situ hybridization, PCR-restriction fragment length polymorphism, and dual priming oligonucleotide-PCR (DPO-PCR) play critical roles in the detection of antibiotic susceptibility; however, limited knowledge is known about application of multiple genetic analysis system (MGAS) in the area of H. pylori identification and antibiotics resistance detection.The aim of this study is to determine the antibiotics resistance using different molecular tests and evaluate the treatment outcomes of E-test-based genotypic resistance.A total of 297 patients with dyspepsia complaint were recruited for gastroscopies. Ninety patients with H. pylori culture positive were randomly divided into 2 groups (test group and control group). E-test, general PCR, and MGAS assay were performed in test group. Patients in control group were treated with empirical therapy (rabeprazole + bismuth potassium citrate + amoxicillin [AMX] + clarithromycin [CLR]), whereas patients in test group received quadruple therapy based on E-test results twice daily for 14 consecutive days. The eradication effect of H. pylori was confirmed by C-urea breath test after at least 4 weeks when treatment was finished.Rapid urease test showed 46.5% (128/297) patients with H. pylori infection, whereas 30.3% (90/297) patients were H. pylori culture positive. E-test showed that H. pylori primary resistance rate to CLR, AMX, metronidazole, tetracycline, and levofloxacin (LVX) was 40.0% (18/45), 4.4% (2/45), 53.3% (24/45), 0% (0/45), and 55.6% (25/45), respectively. In addition, there are many multidrug resistant (MDR) phenotypes, and the MDR strains have higher minimum inhibitory concentration than their single-drug resistant counterparts. Considering E-test as the reference test, the sensitivities of general PCR and MGAS in detecting CLR resistance were 83.3% (15/18) and 94.4% (17

  3. The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study.

    Science.gov (United States)

    Rossetti, Francesca; Pittiruti, Mauro; Lamperti, Massimo; Graziano, Ugo; Celentano, Davide; Capozzoli, Giuseppe

    2015-01-01

    The Italian Group for Venous Access Devices (GAVeCeLT) has carried out a multicenter study investigating the safety and accuracy of intracavitary electrocardiography (IC-ECG) in pediatric patients. We enrolled 309 patients (age 1 month-18 years) candidate to different central venous access devices (VAD) - 56 peripherally inserted central catheters (PICC), 178 short term centrally inserted central catheters (CICC), 65 long term VADs, 10 VADs for dialysis - in five Italian Hospitals. Three age groups were considered: A (ECG was applicable in 307 cases. The increase of the P wave on IC-ECG was detected in all cases but two. The tip of the catheter was positioned at the cavo-atrial junction (CAJ) (i.e., at the maximal height of the P wave on IC-ECG) and the position was checked during the procedure by fluoroscopy or chest x-ray, considering the CAJ at 1-2 cm (group A), 1.5-3 cm (group B), or 2-4 cm (group C) below the carina. There were no complications related to IC-ECG. The overall match between IC-ECG and x-ray was 95.8% (96.2% in group A, 95% in group B, and 96.8% in group C). In 95 cases, the IC-ECG was performed with a dedicated ECG monitor, specifically designed for IC-ECG (Nautilus, Romedex): in this group, the match between IC-ECG and x-ray was 98.8%. We conclude that the IC-ECG method is safe and accurate in the pediatric patients. The applicability of the method is 99.4% and its feasibility is 99.4%. The accuracy is 95.8% and even higher (98.8%) when using a dedicated ECG monitor.

  4. A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya

    Science.gov (United States)

    PATEL, Rena C.; ONONO, Maricianah; GANDHI, Monica; BLAT, Cinthia; HAGEY, Jill; SHADE, Starley B.; VITTINGHOFF, Eric; BUKUSI, Elizabeth A.; NEWMANN, Sara J.; COHEN, Craig R.

    2015-01-01

    SUMMARY Background Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. Methods We conducted a retrospective cohort analysis of HIV-positive women aged 15–45 years enrolled in HIV care facilities in western Kenya from January 2011 to December 2013. Pregnancy was diagnosed clinically and the primary exposure was a combination of contraceptive method and ART regimen. We used Poisson models, adjusting for repeated measures, as well as demographic, behavioral and clinical factors, to compare pregnancy rates among women on different contraceptive/ART combinations. Findings 24,560 women contributed 37,635 years of follow-up with 3,337 incident pregnancies. Among women using implants, adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 1·1 (95% CI 0·72–1·5) and 3·3 (95% CI 1·8–4·8) per 100 women-years (w-y), respectively (adjusted incidence rate ratio (aIRR) 3·0, 95% CI 1·3–4·6). Among women using depomedroxyprogesterone acetate (DMPA), adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 4·5 (95% CI 3·7–5·2) and 5·4 (95% CI 4·0–6·8) per 100 w-y, respectively (aIRR 1·2, 95% CI 0·91–1·5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, experienced 3·1–4·1 higher rates of pregnancy than women using implants, with 1·6–2·8 higher rates specifically among women using efavirenz-based ART. Interpretation While HIV-positive women using implants on efavirenz-based ART faced three times higher risk of contraceptive failure than those on nevirapine-based ART, these women still experienced lower contraceptive failure rates than women on all other contraceptive methods, except for intrauterine devices and permanent methods

  5. Pregnancy rates in HIV-positive women using contraceptives and efavirenz-based or nevirapine-based antiretroviral therapy in Kenya: a retrospective cohort study.

    Science.gov (United States)

    Patel, Rena C; Onono, Maricianah; Gandhi, Monica; Blat, Cinthia; Hagey, Jill; Shade, Starley B; Vittinghoff, Eric; Bukusi, Elizabeth A; Newmann, Sara J; Cohen, Craig R

    2015-11-01

    Concerns have been raised about efavirenz reducing the effectiveness of contraceptive implants. We aimed to establish whether pregnancy rates differ between HIV-positive women who use various contraceptive methods and either efavirenz-based or nevirapine-based antiretroviral therapy (ART) regimens. We did this retrospective cohort study of HIV-positive women aged 15-45 years enrolled in 19 HIV care facilities supported by Family AIDS Care and Education Services in western Kenya between Jan 1, 2011, and Dec 31, 2013. Our primary outcome was incident pregnancy diagnosed clinically. The primary exposure was a combination of contraceptive method and efavirenz-based or nevirapine-based ART regimen. We used Poisson models, adjusting for repeated measures, and demographic, behavioural, and clinical factors, to compare pregnancy rates among women receiving different contraceptive and ART combinations. 24,560 women contributed 37,635 years of follow-up with 3337 incident pregnancies. In women using implants, adjusted pregnancy incidence was 1.1 per 100 person-years (95% CI 0.72-1.5) for nevirapine-based ART users and 3.3 per 100 person-years (1.8-4.8) for efavirenz-based ART users (adjusted incidence rate ratio [IRR] 3.0, 95% CI 1.3-4.6). In women using depot medroxyprogesterone acetate, adjusted pregnancy incidence was 4.5 per 100 person-years (95% CI 3.7-5.2) for nevirapine-based ART users and 5.4 per 100 person-years (4.0-6.8) for efavirenz-based ART users (adjusted IRR 1.2, 95% CI 0.91-1.5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, had 3.1-4.1 higher rates of pregnancy than did those using implants, with 1.6-2.8 higher rates in women using efavirenz-based ART. Although HIV-positive women using implants and efavirenz-based ART had a three-times higher risk of contraceptive failure than did those using nevirapine-based ART, these women still had lower contraceptive failure rates than did those receiving all other

  6. Moderate Sustained Virologic Response Rates With 6-Week Combination Directly Acting Anti-Hepatitis C Virus Therapy in Patients With Advanced Liver Disease.

    Science.gov (United States)

    Kattakuzhy, Sarah; Wilson, Eleanor; Sidharthan, Sreetha; Sims, Zayani; McLaughlin, Mary; Price, Angie; Silk, Rachel; Gross, Chloe; Akoth, Elizabeth; McManus, Maryellen; Emmanuel, Benjamin; Shrivastava, Shikha; Tang, Lydia; Nelson, Amy; Teferi, Gebeyehu; Chavez, Jose; Lam, Brian; Mo, Hongmei; Osinusi, Anuoluwapo; Polis, Michael A; Masur, Henry; Kohli, Anita; Kottilil, Shyamasundaran

    2016-02-15

    Treatment of genotype 1 hepatitis C virus (HCV) infection with combination directly acting antivirals (DAA) for 8-24 weeks is associated with high rates of sustained virologic response (SVR). We previously demonstrated that adding a third DAA to ledipasvir and sofosbuvir (LDV/SOF) can result in high SVR rates in patients without cirrhosis. In this study, we investigated whether a similar regimen would yield equivalent rates of cure in patients with advanced liver fibrosis. Fifty patients were enrolled at the Clinical Research Center of the National Institutes of Health and associated healthcare centers. Enrollment and follow-up data from April 2014 to June 2015 are reported here. Eligible participants were aged ≥18 years, had chronic HCV genotype 1 infection (serum HCV RNA ≥2000 IU/mL), and stage 3-4 liver fibrosis. HCV RNA was measured using a reverse-transcription polymerase chain reaction assay. Of patients treated with LDV, SOF, and the NS3/4A protease inhibitor GS-9451 for 6 weeks, 76% (38 of 50; 95% confidence interval, 60%-85%) had SVR achieved 12 weeks after the end of treatment. There was no statistically significant difference in treatment efficacy between treatment-naive patients (72%, 18 of 25) and those with treatment experience (80%; 20 of 25) (P = .51). Overall, 11 patients (22%) experienced virologic relapse, and 1 (2%) was lost to follow-up at 4 weeks after treatment. No serious adverse events, discontinuations, or deaths were associated with this regimen. Adding a third DAA to LDV/SOF may result in a moderate SVR rate, lower than that observed in patients without cirrhosis. Significant liver fibrosis remains an impediment to achieving SVR with short-duration DAA therapy. CT01805882. Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  7. Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study.

    Science.gov (United States)

    Walter, Daniel; Dachs, Lydia; Faber, Martin; Goletz, Hildegard; Goertz-Dorten, Anja; Hautmann, Christopher; Kinnen, Claudia; Rademacher, Christiane; Schuermann, Stephanie; Metternich-Kaizman, Tanja Wolff; Doepfner, Manfred

    2018-01-01

    Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21 years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen's d) were small-to-medium for the total sample (d = 0.23 to d = 0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d = 0.65 to d = 1.48). We obtained medium net effect sizes (d = 0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.

  8. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Sarkaria, Jann N; Petereit, Daniel G; Kinsella, Timothy J; Buchler, Dolores A

    1995-07-01

    Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR {sup 192}Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p<0.001). Four of these uterine patients (10%) died of medical complications related to therapy or disease progression within 30 days, while 2 of the cervix patients (1.5%) died: one from disease progression and the other due to radiation enteritis (p=0.05). Preliminary analysis suggests that uterine patients with a high anesthesia risk score (ASA>2) experienced greater morbidity and mortality, while the best predictor of complications in the cervix patients was age greater than 70 years. For the entire cohort of patients, no correlation was found between the 30 day morbidity and mortality and the doses of fentanyl and midazolam used or the length of the procedure

  9. Comparison of acute and subacute genitourinary and gastrointestinal adverse events of radiotherapy for prostate cancer using intensity-modulated radiation therapy, three-dimensional conformal radiation therapy, permanent implant brachytherapy and high-dose-rate brachytherapy

    NARCIS (Netherlands)

    Morimoto, Masahiro; Yoshioka, Yasuo; Konishi, Koji; Isohashi, Fumiaki; Takahashi, Yutaka; Ogata, Toshiyuki; Koizumi, Masahiko; Teshima, Teruki; Bijl, Henk P; van der Schaaf, Arjen; Langendijk, Johannes A; Ogawa, Kazuhiko

    2014-01-01

    AIMS AND BACKGROUND: To examine acute and subacute urinary and rectal toxicity in patients with localized prostate cancer monotherapeutically treated with the following four radiotherapeutic techniques: intensity-modulated radiation therapy, three-dimensional conformal radiation therapy,

  10. The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Baglan, Kathy L.; Martinez, Alvaro A.; Frazier, Robert C.; Kini, Vijay R.; Kestin, Larry L.; Chen, Peter Y.; Edmundson, Greg; Mele, Elizabeth; Jaffray, David; Vicini, Frank A.

    2001-01-01

    Purpose: We present the preliminary results of our in-house protocol using outpatient high-dose-rate (HDR) brachytherapy as the sole radiation modality following lumpectomy in patients with early-stage breast cancer. Methods and Materials: Thirty-seven patients with 38 Stage I-II breast cancers received radiation to the lumpectomy cavity alone using an HDR interstitial implant with 192 Ir. A minimum dose of 32 Gy was delivered on an outpatient basis in 8 fractions of 4 Gy to the lumpectomy cavity plus a 1- to 2-cm margin over consecutive 4 days. Results: Median follow-up is 31 months. There has been one ipsilateral breast recurrence for a crude failure rate of 2.6% and no regional or distant failures. Wound healing was not impaired in patients undergoing an open-cavity implant. Three minor breast infections occurred, and all resolved with oral antibiotics. The cosmetic outcome was good to excellent in all patients. Conclusion: In selected patients with early-stage breast cancer, treatment of the lumpectomy cavity alone with outpatient HDR brachytherapy is both technically feasible and well tolerated. Early results are encouraging, however, longer follow-up is necessary before equivalence to standard whole-breast irradiation can be established and to determine the most optimal radiation therapy technique to be employed

  11. Modeling tumor growth in the presence of a therapy with an effect on rate growth and variability by means of a modified Gompertz diffusion process.

    Science.gov (United States)

    Román-Román, Patricia; Román-Román, Sergio; Serrano-Pérez, Juan José; Torres-Ruiz, Francisco

    2016-10-21

    In experimental studies on tumor growth, whenever the time evolution of the relative volume of a tumor in an untreated (control) group can be fitted by a Gompertz diffusion process there is a possibility that an antiproliferative therapy, which modifies the growth rate of the process that fits the treated group, may also affect its variability. The present paper proposes several procedures for the estimation of the time function included in the infinitesimal variance of the new process, as well as the time function affecting the growth rate (which is included in the infinitesimal mean). Also, a hypothesis testing is designed to confirm or refute the need for including such a time-dependent function in the infinitesimal variance. In order to validate and compare the proposed procedures a simulation study has been carried out. In addition, a proposal is made for a strategy aimed at finding the optimal combination of procedures for each case. A real data application concerning the effects of cisplatin on a patient-derived xenograft (PDX) tumor model showcases the advantages of this model over others that have been used in the past. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. The rate of adherence to urate-lowering therapy and associated factors in Chinese gout patients: a cross-sectional study.

    Science.gov (United States)

    Yin, Rulan; Cao, Haixia; Fu, Ting; Zhang, Qiuxiang; Zhang, Lijuan; Li, Liren; Gu, Zhifeng

    2017-07-01

    The aim of this study was to assess adherence rate and predictors of non-adherence with urate-lowering therapy (ULT) in Chinese gout patients. A cross-sectional study was administered to 125 gout patients using the Compliance Questionnaire on Rheumatology (CQR) for adherence to ULT. Patients were asked to complete the Treatment Satisfaction Questionnaire for Medication version II, Health Assessment Questionnaire, Confidence in Gout Treatment Questionnaire, Gout Knowledge Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and 36-Item Short Form Health Survey. Data were analyzed by independent sample t test, rank sum test, Chi-square analysis as well as binary stepwise logistic regression modeling. The data showed that the rate of adherence (CQR ≥80%) to ULT was 9.6% in our investigated gout patients. Adherence was associated with functional capacity, gout-related knowledge, satisfaction with medication, confidence in gout treatment and mental components summary. Multivariable analysis of binary stepwise logistic regression identified gout-related knowledge and satisfaction of effectiveness with medication was the independent risk factors of medication non-adherence. Patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication, were more likely not to adhere to ULT. Non-adherence to ULT among gout patients is exceedingly common, particularly in patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication. These findings could help medical personnel develop useful interventions to improve gout patients' medication adherence.

  13. Comparison of PSA value at last follow-up of patients who underwent low-dose rate brachytherapy and intensity-modulated radiation therapy for prostate cancer.

    Science.gov (United States)

    Tanaka, Nobumichi; Asakawa, Isao; Nakai, Yasushi; Miyake, Makito; Anai, Satoshi; Fujii, Tomomi; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2017-08-25

    To compare the PSA value at the last follow-up of patients who underwent prostate low-dose rate brachytherapy (LDR-BT) with that of patients who underwent intensity-modulated radiation therapy (IMRT). A total of 610 prostate cancer patients (cT1c-3bN0M0) were enrolled, and 445 of them underwent LDR-BT, while 165 received IMRT (74-76 Gy). The median follow-up period of these two groups was 75 months (LDR-BT) and 78 months (IMRT), respectively. We also evaluated the biochemical recurrence (BCR)-free rate using two definitions (Phoenix definition and PSA ≥ 0.2 ng/mL). The percentage of patients who achieved PSA LDR-BT group and 49.7% in the IMRT group (p LDR-BT group and 32.1% in the IMRT group (p LDR-BT groups was 89.5 and 95.0% (p LDR-BT groups, respectively (p LDR-BT was significantly lower than that of IMRT, and this result was particularly marked in patients with a normal testosterone level at the last follow-up.

  14. Stereotactic body radiation therapy versus conventional radiation therapy in patients with early stage non-small cell lung cancer - An updated retrospective study on local failure and survival rates

    International Nuclear Information System (INIS)

    Jeppesen, Stefan S.; Schytte, Tine; Hansen, Olfred; Jensen, Henrik R.; Brink, Carsten

    2013-01-01

    Introduction: Stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) is now an accepted and patient friendly treatment, but still controversy exists about its comparability to conventional radiation therapy (RT). The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT. Material and methods: From August 2005 to June 2012, 100 medically inoperable patients were treated with SBRT at Odense Univ. Hospital. The thoracic RT consisted of 3 fractions (F) of 15-22 Gy delivered in nine days. For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35-40 F (5 F/week) in the period of July 1998 to August 2011 were analyzed. All tumors had histological or cytological proven NSCLC T1-2N0M0. Results: The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT, respectively (p = 0.015). Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 %, SBRT and conventional RT respectively (p = 0.99). On multivariate analysis, female gender and performance status of 0-1 and SBRT predicted improved prognosis. Conclusion: In a cohort of patients with NSCLC there was a significant difference in overall survival favoring SBRT. Performance status of 0-1, female gender and SBRT predicted improved prognosis. However, staging procedure, confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes. However, SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients

  15. JUVENILE MYOCLONIC EPILEPSY: A FOCUS ON THE EFFICACY OF THERAPY AND THE RATE OF RELAPSES ACCORDING TO LONG-TERM FOLLOW-UP DATA

    Directory of Open Access Journals (Sweden)

    K. Yu. Mukhin

    2015-01-01

    Full Text Available Juvenile myoclonic epilepsy (JME is a type of adolescent-onset idiopathic generalized epilepsy with the appearance of massive myoclonic seizures and, in most cases, generalized convulsions occurring chiefly in the period after awakening. It is assumed that there is a two-locus (dominant and recessive model of inheritance of JME; moreover, the dominant gene is located on the short arm of chromosome 6. JME is one of the most common types of epilepsy and most frequent among idiopathic generalized epilepsies. Its rate is 5 to 11 % of all types of epilepsy with some female predominance. The diagnosis of JME creates no problems in typical cases. The disease is generally manifested by a concurrence of myoclonic (usually in the hands and generalized clonic-tonic-clonic seizures occurring during waking. Typical absences and epileptic myoclonus of the eyelid are rarer. Seizures are clearly provoked by sleep deprivation. As in other types of idiopathic epilepsy, the patients’ neurological status is normal; no intellectual disabilities are observed. This type of epilepsy is well treatable and, when initial monotherapy is correctly used, sustainable remission occurs immediately in the vast majority (75–85 % of the patients with JME. However, the problem of these patients, unlike that of patients with many forms of idiopathic epilepsy, is that sleep pattern disturbance, missing a dose of antiepileptic drugs (AED, or therapy refusal give rise to relapse of seizures in the vast majority of patients even in long-term remission.Due to the fact that the data available in the literature on the efficacy of therapy in patients with JME and particularly on the results of its discontinuation are contradictory, the authors of the paper conducted an investigation to determine therapeutic effectiveness and the frequency of relapse of seizures in patients with JME during a long-term follow-up.The study enrolled 106 JME patients who had been regularly followed up at

  16. Physics and quality assurance for brachytherapy - Part II: Low dose rate and pulsed dose rate

    International Nuclear Information System (INIS)

    Williamson, Jeffrey F.

    1997-01-01

    Purpose: A number of recent developments have revitalized brachytherapy including remote afterloading, implant optimization, increasing use of 3D imaging, and advances in dose specification and basic dosimetry. However, the core physical principles underlying the classical methods of dose calculation and arrangement of multiple sources remain unchanged. The purpose of this course is to review these principles and their applications to low dose-rate interstitial and intracavitary brachytherapy. Emphasis will be placed upon the classical implant systems along with classical and modern methods of dose specification. The level of presentation is designed for radiation oncology residents and beginning clinical physicists. A. Basic Principles (1) Radium-substitute vs. low-energy sealed sources (2) Dose calculation principles (3) The mysteries of source strength specification revealed: mgRaEq, mCi and air-kerma strength B. Interstitial Brachytherapy (1) Target volume, implanted volume, dose specification in implants and implant optimization criteria (2) Classical implant systems: Manchester Quimby and Paris a) Application of the Manchester system to modern brachytherapy b) Comparison of classical systems (3) Permanent interstitial implants a) Photon energy and half life b) Dose specification and pre-operative planning (4) The alphabet soup of dose specification: MCD (mean central dose), minimum dose, MPD (matched peripheral dose), MPD' (minimum peripheral dose) and DVH (dose-volume histogram) quality indices C. Intracavitary Brachytherapy for Carcinoma of the Cervix (1) Basic principles a) Manchester System: historical foundation of U.S. practice patterns b) Principles of applicator design (2) Dose specification and treatment prescription a) mg-hrs, reference points, ICRU Report 38 reference volume -- Point A dose vs mg-hrs and IRAK (Integrated Reference Air Kerma) -- Tissue volume treated vs mg-hrs and IRAK b) Practical methods of treatment specification and prescription

  17. Physics and quality assurance for brachytherapy - Part II: Low dose rate and pulsed dose rate

    International Nuclear Information System (INIS)

    Williamson, Jeffrey F.

    1996-01-01

    Purpose: A number of recent developments have revitalized brachytherapy including remote afterloading, implant optimization, increasing use of 3D imaging, and advances in dose specification and basic dosimetry. However, the core physical principles underlying the classical methods of dose calculation and arrangement of multiple sources remain unchanged. The purpose of this course is to review these principles and their applications to low dose-rate interstitial and intracavitary brachytherapy. Emphasis will be placed upon the classical implant systems along with classical and modern methods of dose specification. The level of presentation is designed for radiation oncology residents and beginning clinical physicists. A. Basic Principles (1) Radium-substitute vs. low-energy sealed sources (2) Dose calculation principles (3) The mysteries of source strength specification revealed: mgRaEq, mCi and air-kerma strength B. Interstitial Brachytherapy (1) Target volume, implanted volume, dose specification in implants and implant optimization criteria (2) Classical implant systems: Manchester Quimby and Paris a) Application of the Manchester system to modern brachytherapy b) Comparison of classical systems (3) Permanent interstitial implants a) Photon energy and half life b) Dose specification and pre-operative planning (4) The alphabet soup of dose specification: MCD (mean central dose), minimum dose, MPD (matched peripheral dose), MPD' (minimum peripheral dose) and DVH (dose-volume histogram) quality indices C. Intracavitary Brachytherapy for Carcinoma of the Cervix (1) Basic principles a) Manchester System: historical foundation of U.S. practice patterns b) Principles of applicator design (2) Dose specification and treatment prescription a) mg-hrs, reference points, ICRU Report 38 reference volume --Point A dose vs mg-hrs and IRAK (Integrated Reference Air Kerma) --Tissue volume treated vs mg-hrs and IRAK b) Practical methods of treatment specification and prescription

  18. Results of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) in treatment of obstructive endobronchial non-small cell lung cancer

    Science.gov (United States)

    Weinberg, Benjamin D.; Allison, Ron R.; Sibata, Claudio; Parent, Teresa; Downie, Gordon

    2009-06-01

    We reviewed the outcome of combined photodynamic therapy (PDT) and high dose rate brachytherapy (HDR) for patients with symptomatic obstruction from endobronchial non-small cell lung cancer. Methods: Nine patients who received combined PDT and HDR for endobronchial cancers were identified and their charts reviewed. The patients were eight males and one female aged 52-73 at diagnosis, initially presenting with various stages of disease: stage IA (N=1), stage IIA (N=1), stage III (N=6), and stage IV (N=1). Intervention was with HDR (500 cGy to 5 mm once weekly for 3 weeks) and PDT (2 mg/kg Photofrin, followed by 200 J/cm2 illumination 48 hours post infusion). Treatment group 1 (TG-1, N=7) received HDR first; Treatment group 2 (TG-2, N=2) received PDT first. Patients were followed by regular bronchoscopies. Results: Treatments were well tolerated, all patients completed therapy, and none were lost to follow-up. In TG-1, local tumor control was achieved in six of seven patients for: 3 months (until death), 15 months, 2+ years (until death), 2+ years (ongoing), and 5+ years (ongoing, N=2). In TG-2, local control was achieved in only one patient, for 84 days. Morbidities included: stenosis and/or other reversible benign local tissue reactions (N=8); photosensitivity reaction (N=2), and self-limited pleural effusion (N=2). Conclusions: Combined HDR/PDT treatment for endobronchial tumors is well tolerated and can achieve prolonged local control with acceptable morbidity when PDT follows HDR and when the spacing between treatments is one month or less. This treatment regimen should be studied in a larger patient population.

  19. Reminiscence therapy using odor in alcohol-dependent patients--psychophysiological evaluation and psychological evaluation; power spectral analysis of heart rate variability.

    Science.gov (United States)

    Arizono, H; Morita, N; Iizuka, S; Satoh, S; Nakatani, Y

    2000-12-01

    This research was based on the hypothesis that when alcohol-dependent patients describe themselves, awakening of emotion by affirmative odor stimulation may facilitate memory reframing focusing on more affirmative emotion and memories. To prove the hypothesis, physiological changes accompanied by emotional awakening were evaluated by measuring the autonomic activity. In addition, subjective evaluation by a self-report manner was examined to investigate the effectiveness of Reminiscence Therapy (RT) using odor in alcohol-dependent patients. Thirty-four patients who met the DSM-IV criteria of alcohol-related disorders and were hospitalized in a ward specialized to alcohol dependence therapy. Each patient underwent a one-to-one interview twice. For counterbalance, one interview was performed with odor stimulation using an odor with a relaxing effect that recall pleasant emotion, and the other was without odor stimulation. As the evaluation indices of physiological changes accompanied by emotional awakening, index of autonomic function (HRV; Heart rate variability) for objective evaluation and psychological indices (STAI; State-Trait Anxiety Inventory VAS; Visual Analog Scale) for subjective evaluation were measured. 1) Objective evaluation: Regarding the evaluation index of the autonomic function, the sympathetic nervous system activity (LF/HF; low frequency component/high frequency component ratio) was significantly inhibited by odor stimulation (p Subjective evaluation: Compared to the state prior to interview, state anxiety judged by STAI was significantly decreased after interview (p subjective evaluation, but the objective evaluation suggested that the odor inhibited the sympathetic nervous system. Thus, it was suggested that odor can be used in RT, that is, emotional changes due to stimulation of odor may be applicable in RT.

  20. [Effect of combined therapy with bailing capsule and benazepril on urinary albumin excretion rate and C-reactive protein in patients with early diabetic nephropathy].

    Science.gov (United States)

    Song, Jian; Li, Yan-Hua; Yang, Xiang-Dong

    2009-09-01

    To observe the effect of combined therapy with Bailing Capsule (BC) and benazepril on the levels of urinary albumin excretion rate (UAER) and C-reactive protein (CRP) for exploring its protective effect on early diabetic nephropathy. Sixty patients with early diabetic nephropathy were randomly assigned to the control group treated by benazepril alone, and the treated group treated by BC and benazepril, and the treatment lasted for 16 weeks. The changes of UAER and CRP levels were measured to estimate the protective effect of the combined therapy. Levels of 24h urinary protein, UAER, CRP were (0.85 +/- 0.32) g/24 h, (83.34 +/- 38.27) microg/min, (2.67 +/- 1.72) mg/L before treatment in the control group, and (0.43 +/- 0.17) g/24 h, (71.22 +/- 31.12) microg/min, (1.05 +/- 0.78) mg/L after treatment and they were (0.87 +/- 0.31) g/24 h, (81.59 +/- 35.69) microg/min, (2.55 +/- 1.66) mg/L before treatment in treated group, and (0.25 +/- 0.29) g/24 h, (57.32 +/- 31.11) microg/min, (0.49 +/- 0.38) mg/L after treatment respectively, all of them decreased after treatment in both groups, showing significant differences as compared with those before treatment (P0.05). Combined use of BC and benazepril could significantly lower the UAER and CRP levels in patients with early diabetic nephropathy to alleviate the renal impairment, showing an effect better than that of using benazepril alone.

  1. Intraoperative Radiation Therapy Reduces Local Recurrence Rates in Patients With Microscopically Involved Circumferential Resection Margins After Resection of Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Alberda, Wijnand J.; Verhoef, Cornelis [Department of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Nuyttens, Joost J. [Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Meerten, Esther van [Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Rothbarth, Joost [Department of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Wilt, Johannes H.W. de [Department of Surgery, Division of Surgical Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Burger, Jacobus W.A., E-mail: j.burger@erasmusmc.nl [Department of Surgery, Division of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)

    2014-04-01

    Purpose: Intraoperative radiation therapy (IORT) is advocated by some for patients with locally advanced rectal cancer (LARC) who have involved or narrow circumferential resection margins (CRM) after rectal surgery. This study evaluates the potentially beneficial effect of IORT on local control. Methods and Materials: All surgically treated patients with LARC treated in a tertiary referral center between 1996 and 2012 were analyzed retrospectively. The outcome in patients treated with IORT with a clear but narrow CRM (≤2 mm) or a microscopically involved CRM was compared with the outcome in patients who were not treated with IORT. Results: A total of 409 patients underwent resection of LARC, and 95 patients (23%) had a CRM ≤ 2 mm. Four patients were excluded from further analysis because of a macroscopically involved resection margin. In 43 patients with clear but narrow CRMs, there was no difference in the cumulative 5-year local recurrence-free survival of patients treated with (n=21) or without (n=22) IORT (70% vs 79%, P=.63). In 48 patients with a microscopically involved CRM, there was a significant difference in the cumulative 5-year local recurrence-free survival in favor of the patients treated with IORT (n=31) compared with patients treated without IORT (n=17) (84 vs 41%, P=.01). Multivariable analysis confirmed that IORT was independently associated with a decreased local recurrence rate (hazard ratio 0.24, 95% confidence interval 0.07-0.86). There was no significant difference in complication rate of patients treated with or without IORT (65% vs 52%, P=.18) Conclusion: The current study suggests that IORT reduces local recurrence rates in patients with LARC with a microscopically involved CRM.

  2. G2 arrest and apoptosis of cultured Raji cells by continuous low dose rate beta irradiation therapy with 188Re-perrhenate

    International Nuclear Information System (INIS)

    Yim, S. J.; Kim, E. H.; Lee, T. S.; Woo, K. S.; Jeong, W. S.; Choi, C. W.; Yim, S. M.

    2001-01-01

    Beta emitting radionuclide therapy gives exponentially decreasing radiation dose rate and results in cell death presumably by apoptosis. We observed changes in DNA content and apoptosis in relatively low dose rate beta irradiation. Raji cells were cultured and incubated with 188Re-perrhenate (3.7MBq, or 370MBq/ml) for 4 hours to give irradiation dose of 0.4, 4, or 40 Gy. After changing the culture media, cells were cultured for 2,4,8,16, and 24 hours. The cells were stained with Trypan blue, Annexin-V and Propidium Iodide (PI) to observe cell viability, cell membrane alternation by apoptosis and changes in DNA content respectively. Flowcytometry was done for Annexin-V and PI to quantitate apoptosis and necrosis in the irradiated cells. DAPI(4,6-diamidino-2-phenylindole) stain was also done to observe the damage in the nucleus. Cell viability decreased with an increasing radiation dose. Cells irradiated in 40 Gy showed early uptake of both Annexin-V and PI suggesting cell death by necrosis. Cells irradiated in 0.4 Gy showed delayed uptake of Annexin-V only, and later on PI uptake suggesting cell death mainly by apoptosis. The cells irradiated in 0.4 Gy showed G2 arrest in 16 hours after irradiation, but the cells irradiated in 40 Gy showed early DNA fragmentation within 2 hours after irradiation. In DAPI stain, early nucleus damage was observed in the cells irradiated in 40 Gy. On the other hand, slowly increasing apoptotic bodies were observed in the cells irradiated in 0.4 Gy. These results suggest that continuous low-dose irradiation induces G2 arrest and progressive apoptosis in cells while continuous high-dose irradiation induces rapid necrosis. Therefore, we expect therapeutic effect by continuous low-dose rate irradiation with beta emitting radiopharmaceuticals