Journal articles on the topic 'Generative organs, Female – Cancer – Radiotherapy'
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Kiyohara, H., S. Kato, T. Ohno, Y. Ohkubo, T. Tamaki, and T. Kamada. "Carbon ion radiotherapy for malignant melanoma of female genital organs." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16548-e16548. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16548.
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e16548 Background: Malignant melanoma of the female genital organs is a very rare tumor and resistant to conventional photon radiotherapy. We report six cases of female genital malignant melanoma those were well controlled locally by carbon ion radiotherapy (CIRT). Methods: Between November 2004 and October 2008, six patients with unresectable female genital malignant melanoma were treated with CIRT. Age of the patients ranged from 55 to 80 years (median; 69 years). Four patients had previously untreated locally invasive tumors and other two had locally recurrent tumors after surgery and adjuvant chemotherapy. The tumor located in the vagina (4 patients), both the cervix and the vagina (1 patient), or both the vagina and the vulva (1 patient). Two patients had inguinal lymph node metastasis and two had distant metastases at CIRT. All patients received a total dose of 57.6 gray equivalent (GyE) in 16 fractions over 4 weeks of CIRT. Three patients received chemotherapy using dacarbazine, ACNU, and vincristine after CIRT. Results: The follow-up durations after CIRT were from 9 to 20 months (median; 13 months). No patient developed severe acute toxicity during CIRT. No late toxicity of greater Grade 2 was experienced, while Grade 1 proctitis was observed in a patient. All tumors completely responded to CIRT. No patient developed in-field recurrence. The four patients without distant metastasis were alive with no evidence of disease for 9–20 months after CIRT. The two patients with distant metastases died from metastatic disease 13 and 18 months after CIRT, respectively. Conclusions: CIRT achieved favorable local tumor control without developing severe acute and late toxicity in the treatment of unresectable malignant melanoma of the female genital organs. No significant financial relationships to disclose.
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Kiyohara, H., S. Kato, T. Ohno, Y. Ohkubo, T. Tamaki, and T. Kamada. "Carbon Ion Radiotherapy for Malignant Melanoma of Female Genital Organs." International Journal of Radiation Oncology*Biology*Physics 75, no. 3 (November 2009): S369. http://dx.doi.org/10.1016/j.ijrobp.2009.07.847.
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Apriantoro, Nursama Heru, Bambang Sutrisno Wibowo, Muhammad Irsal, and Prima Chintya Delsi Kasih. "Result Analysis Of Treatment Planning System Between 3-Dimensional Conformal Radiation Therapy Technique And Intensity Modulated Radiation Therapy Technique In Nasopharyngeal Cancer Cases." SANITAS : Jurnal Teknologi dan Seni Kesehatan 8, no. 1 (June 1, 2017): 29–34. http://dx.doi.org/10.36525/sanitas.2017.5.
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This study aims to analyze the difference in results between TPS 3D-CRT radiotherapy irradiation technique and IMRT radiotherapy irradiation technique in nasopharyngeal cancer cases based on the doses received by the target volume and organs at risk and results of isodosis curve which include the value of the index conformity and homogeneity index value. Type of this research is quantitative experimental method. As for the population was taken in 10 patients consisting of 5 male and 5 female patients with nasopharyngeal cancer who received radiation therapy with 3D-CRT irradiation technique and IMRT radiation technique. Meaningfully, the results shows that are no difference in the dose received by the target volume, the dose received by organs at risk, and the curve isodose on these two techniques, including index values of conformity and homogeneity index. In conclusion, IMRT radiotherapy irradiation technique for nasopharyngeal cancer is more prioritized than 3DCRT radiotherapy irradiation technique, as the radiotherapy principle can be achieved by using IMRT radiotherapy irradiation technique.
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Geraily, Ghazale, Soheil Elmtalab, Najmeh Mohammadi, Zahra Alirezaei, S. A. Martinez-Ovalle, Iraj Jabbari, Hector Rene Vega-Carrillo, and Amir Hossein Karimi. "Monte Carlo evaluation of out-of-field dose in 18 MV pelvic radiotherapy using a simplified female MIRD phantom." Biomedical Physics & Engineering Express 8, no. 1 (November 11, 2021): 015004. http://dx.doi.org/10.1088/2057-1976/ac35a1.
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Abstract This study was devoted to determining the unwanted dose due to scattered photons to the out-of-field organs and subsequently estimate the risk of secondary cancers in the patients undergoing pelvic radiotherapy. A typical 18 MV Medical Linear Accelerator (Varian Clinac 2100 C/D) was modeled using MCNPX® code to simulate pelvic radiotherapy with four treatment fields: anterior-posterior, posterior-anterior, right lateral, left lateral. Dose evaluation was performed inside Medical Internal Radiation Dose (MIRD) revised female phantom. The average photon equivalent dose in out-of-field organs is 8.53 mSv Gy−1, ranging from 0.17 to 72.11 mSv Gy−1, respectively, for the organs far from the Planning Treatment Volume (Brain) and those close to the treatment field (Colon). Evidence showed that colon with 4.3049% and thyroid with 0.0020% have the highest and lowest risk of secondary cancer, respectively. Accordingly, this study introduced the colon as an organ with a high risk of secondary cancer which should be paid more attention in the follow-up of patients undergoing pelvic radiotherapy. The authors believe that this simple Monte Carlo (MC) model can be also used in other radiotherapy plans and mathematical phantoms with different ages (from childhood to adults) to estimate the out-of-field dose. The extractable information by this simple MC model can be also employed for providing libraries for user-friendly applications (e.g. ‘.apk’) which in turn increase the public knowledge about fatal cancer risk after radiotherapy and subsequently decrease the concerns in this regard among the public.
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Achard, Vérane, Frederic Ris, Michel Rouzaud, Giacomo Puppa, Nicolas C. Buchs, Thomas De Perrot, Thibaud Koessler, Cristina Picardi, and Thomas Zilli. "Sexual organ-sparing with hydrogel spacer injections for rectal cancer radiotherapy: a feasibility pilot study." British Journal of Radiology 94, no. 1120 (April 1, 2021): 20200931. http://dx.doi.org/10.1259/bjr.20200931.
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Objectives: The aim of this pilot study was to investigate in two rectal cancer patients undergoing neoadjuvant chemo-radiotherapy (nCRT) the implant feasibility and dosimetric benefit in sexual organ-sparing of an injectable, absorbable, radiopaque hydrogel spacer. Methods: Two rectal cancer patients (one male and one female) underwent hydrogel implant between rectum and vagina/prostate before nCRT and curative surgery. A CT scan was performed before and after injection and a comparative dosimetric study was performed testing a standard (45/50 Gy) and a dose escalated (46/55.2 Gy) schedule. Results: In both patients, the spacer implant in the recto-prostatic or recto-vaginal space was feasible and well tolerated. For the male, the dosimetric benefit with spacer was minimal for sexual organs. For the female however, doses delivered to the vagina were significantly reduced with spacer with a mean reduction of more than 5 Gy for both regimens. Conclusions: For organ preservation protocols and selected sexually active female patients, use of hydrogel spacers can be considered to spare sexual organs from the high radiotherapy dose levels. Advances in knowledge: For females with advanced rectal tumor, a spacer implant between the rectum and the vagina before nCRT is feasible and reduces doses delivered to the vagina.
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Sukhina, O., K. Nemaltsova, and O. Panov. "LATE RADIATION TOXICITY AFTER RADICAL RADIOTHERAPY FOR GENITAL CANCER." Проблеми радіаційної медицини та радіобіології = Problems of Radiation Medicine and Radiobiology 25 (2020): 130–47. http://dx.doi.org/10.33145/2304-8336-2020-25-130-147.
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Radiation therapy for malignant tumors of the female genital area, even with the use of modern radiotherapy equipment and dosimetric planning, causes the development of local radiation changes. An approach involving methods of general and local exposure is used in their treatment. One of the most promising directions is the creation of optimal combinations of medicines (in the form of ointments, gels, aerosols, suppositories, etc.), which have a therapeutic effect on the inflammatory process. The article reflects the clinical course and stage of occurrence of late radiation reactions of the skin, vaginal/cervix mucosa, bladder, and intestines, as well as the features of their treatment. Literary data and own practical experience in the treatment of radiation complications are presented. When reviewing the topic under study, it could be concluded that the leading cause of the development of local radiation damage is the errors in the planning and implementation of radiation therapy, when high absorbed doses that exceed the tolerance of healthy tissues are used. Another reason for this is the poor accounting for dose distribution of ionizing radiation in tissues, the presence of concomitant diseases in patients, and the underestimation of the long-term effects of radiation. Key words: female genital organs, radiation damage, radiodermatitis, radioepitheliitis, radiation rectitis, radiation cystitis.
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Mazonakis, Michalis, Eleftherios Tzanis, Efrossyni Lyraraki, and John Damilakis. "Automatic Radiobiological Comparison of Radiation Therapy Plans: An Application to Gastric Cancer." Cancers 14, no. 24 (December 11, 2022): 6098. http://dx.doi.org/10.3390/cancers14246098.
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(1) Aim: This study was conducted to radiobiologically compare radiotherapy plans for gastric cancer with a newly developed software tool. (2) Methods: Treatment planning was performed on two computational phantoms simulating adult male and female patients. Three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans for gastric cancer were generated with three-photon beam energies. The equivalent uniform dose (EUD), tumor control probability (TCP) of the target and normal tissue control probability (NTCP) of eight different critical organs were calculated. A new software was employed for these calculations using the EUD-based model and dose-volume-histogram data. (3) Results: The IMRT and VMAT plan led to TCPs of 51.3–51.5%, whereas 3D-CRT gave values up to 50.2%. The intensity-modulated techniques resulted in NTCPs of (5.3 × 10−6–3.3 × 10−1)%. The corresponding NTCPs from 3D-CRT were (3.4 × 10−7–7.4 × 10−1)%. The above biological indices were automatically calculated in less than 40 s with the software. (4) Conclusions: The direct and quick radiobiological evaluation of radiotherapy plans is feasible using the new software tool. The IMRT and VMAT reduced the probability of the appearance of late effects in most of the surrounding critical organs and slightly increased the TCP compared to 3D-CRT.
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Bourbonne, Vincent, Vincent Jaouen, Clément Hognon, Nicolas Boussion, François Lucia, Olivier Pradier, Julien Bert, Dimitris Visvikis, and Ulrike Schick. "Dosimetric Validation of a GAN-Based Pseudo-CT Generation for MRI-Only Stereotactic Brain Radiotherapy." Cancers 13, no. 5 (March 3, 2021): 1082. http://dx.doi.org/10.3390/cancers13051082.
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Purpose: Stereotactic radiotherapy (SRT) has become widely accepted as a treatment of choice for patients with a small number of brain metastases that are of an acceptable size, allowing for better target dose conformity, resulting in high local control rates and better sparing of organs at risk. An MRI-only workflow could reduce the risk of misalignment between magnetic resonance imaging (MRI) brain studies and computed tomography (CT) scanning for SRT planning, while shortening delays in planning. Given the absence of a calibrated electronic density in MRI, we aimed to assess the equivalence of synthetic CTs generated by a generative adversarial network (GAN) for planning in the brain SRT setting. Methods: All patients with available MRIs and treated with intra-cranial SRT for brain metastases from 2014 to 2018 in our institution were included. After co-registration between the diagnostic MRI and the planning CT, a synthetic CT was generated using a 2D-GAN (2D U-Net). Using the initial treatment plan (Pinnacle v9.10, Philips Healthcare), dosimetric comparison was performed using main dose-volume histogram (DVH) endpoints in respect to ICRU 91 guidelines (Dmax, Dmean, D2%, D50%, D98%) as well as local and global gamma analysis with 1%/1 mm, 2%/1 mm and 2%/2 mm criteria and a 10% threshold to the maximum dose. t-test analysis was used for comparison between the two cohorts (initial and synthetic dose maps). Results: 184 patients were included, with 290 treated brain metastases. The mean number of treated lesions per patient was 1 (range 1–6) and the median planning target volume (PTV) was 6.44 cc (range 0.12–45.41). Local and global gamma passing rates (2%/2 mm) were 99.1 CI95% (98.1–99.4) and 99.7 CI95% (99.6–99.7) respectively (CI: confidence interval). DVHs were comparable, with no significant statistical differences regarding ICRU 91′s endpoints. Conclusions: Our study is the first to compare GAN-generated CT scans from diagnostic brain MRIs with initial CT scans for the planning of brain stereotactic radiotherapy. We found high similarity between the planning CT and the synthetic CT for both the organs at risk and the target volumes. Prospective validation is under investigation at our institution.
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Sarker, MK, and SS Rahman. "Magnitude of cancer patients in a teaching hospital." Bangladesh Medical Journal Khulna 44, no. 1-2 (April 23, 2012): 18–20. http://dx.doi.org/10.3329/bmjk.v44i1-2.10471.
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This was an observational study carried out among all cancer patients attended at radiotherapy department of Khulna medical college hospital between January 2010 and December 2010. The study aimed to develop a primary data source for further research and improvement of patient care. Data were collected by a questionnaire. Total study population was 321 and out of them 158 was male and 163 were female. Top five organs involved with malignancies of both sexes are breast (14.64%), non-Hodgkins Lymphoma (1 0.59%), lung (7.79%), mouth and oral cavity (7.48%), and stomach (7.48%). This hospital-based cancer registry should be maintained to improve the treatment facilities and follow-up system.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10471Bang Med J (Khulna) 2011: 44(1&2) 18-24
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Jalbout, Wassim, Rania Jbara, Chadia Rizk, and Bassem Youssef. "On the risk of secondary cancer from thymoma radiotherapy." Physics in Medicine & Biology 67, no. 15 (July 25, 2022): 155015. http://dx.doi.org/10.1088/1361-6560/ac7c50.
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Abstract Objective. This study aims at quantifying the lifetime attributable risk of secondary fatal cancer (LARFAC) to patients receiving adjuvant radiotherapy treatment for thymoma, a neoplasm where cure rates and life expectancy are relatively high, patient age at presentation relatively low and indications for radiotherapy controversial depending on the disease stage. Approach. An anthropomorphic phantom was scanned, organs were contoured and a standard 6 MV 3DCRT treatment plan was produced for thymoma treatment. The phantom was loaded with thermoluminescent dosimeters (TLDs) and treated by linear accelerator per plan. The TLDs were subsequently read for out-of-field dose distribution while in-field dose distribution was obtained from the planning system. Sex and age-specific lifetime radiogenic cancer risk was calculated as the sum of in-field risk and out-of-field risk. The latter risk was estimated using hybrid ICRP 2007 103-BEIR VII tables of organ-specific risks based on the linear-no threshold (LNT) model and applicable at low doses, while the former using mathematical risk models applicable at high doses. Main results. The LARFAC associated with a prescribed dose of 50 Gy to target volume in 25 fractions was in the approximate range of 1%–3%. The risk was higher for young and female patients. The largest contributing organ to this risk were the lungs by far. Using the LNT model inappropriately to calculate risk at therapeutic doses (in-field) would overestimate the risk up to tenfold. Significance. The LARFAC to patient from thymoma radiotherapy was quantified taking into consideration the inapplicability of the LNT model at therapeutic doses. The risk is not negligible; the information may be relevant to patients and clinicians.
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Jeong, Seonghoon, Myonggeun Yoon, Weon Kuu Chung, Mijoo Chung, and Dong Wook Kim. "Estimation of the risk of secondary malignancies following intraoral electron radiotherapy for tongue cancer patients." Journal of Radiotherapy in Practice 16, no. 1 (November 28, 2016): 46–52. http://dx.doi.org/10.1017/s1460396916000480.
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AbstractPurposeTo measure dosimetric characteristics for linear accelerator-based electron beams, which are applied through locally manufactured acrylic tubes for intraoral radiotherapy and to calculate the secondary cancer risk for organs at risk.Materials and methodsSix different acrylic tubes were exposed to a 6-MeV electron beam; they had tips with three angles (0°, 15° and 30°) and two diameters (2·5 and 3·0 cm). Gafchromic EBT2 film was horizontally and vertically inserted in a solid water phantom to measure the dose profiles and percentage depth doses (PDDs). The measured data from radio-photoluminescence glass dosimeters placed on the neck and both eyes were used to estimate the lifetime attributable risk of secondary cancer resulting from intraoral radiotherapy for tongue cancer.ResultsA total of 12 dose profiles were obtained from six different acrylic applicators at 0·5 and 1·28 cm depths. Circular shapes were obtained from 0° applicators, and oval shapes were obtained from 15° and 30° applicators. Absorbed doses at a 0·5 cm depth were higher than those at a 1·28 cm depth. PDD shapes for the six acrylic applicators were similar to those of a normal 6 MeV electron beam. Larger-diameter applicators showed higher PDD than smaller-diameter applicators with the same tip angle. According to our secondary cancer risk estimation, if 100,000 patients received intraoral radiotherapy at 30 years and lived until 80 years, 122 female and 22 male patients would develop secondary thyroid cancer, while 13 female and 18 male patients would develop secondary ocular melanoma or retinoblastoma.ConclusionsDosimetric characteristics for linear accelerator-based intraoperative radiotherapy treatment beam were confirmed. In addition, we found that 0·1% of tongue cancer patients would get secondary malignancies for both eyes and thyroid from this treatment.
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Wierzbicka, Adrianna, Dorota Mańkowska-Wierzbicka, Stanisław Cieślewicz, Marta Stelmach-Mardas, and Marcin Mardas. "Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 8 (April 8, 2021): 3932. http://dx.doi.org/10.3390/ijerph18083932.
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Background: Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies. Materials and methods: A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS). Results: The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding. Conclusions: Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy.
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König, Laila, Juliane Hörner-Rieber, Matthew Forsthoefel, Peter Haering, Eva Meixner, Tanja Eichkorn, Anna Krämer, et al. "Secondary Malignancy Risk Following Proton vs. X-ray Radiotherapy of Thymic Epithelial Tumors: A Comparative Modeling Study of Thoracic Organ-Specific Cancer Risk." Cancers 14, no. 10 (May 13, 2022): 2409. http://dx.doi.org/10.3390/cancers14102409.
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Background: Proton beam radiotherapy (PBT) offers physical dose advantages that might reduce the risk for secondary malignancies (SM). The aim of the current study is to calculate the risk for SM after X-ray-based 3D conformal (3DCRT) radiotherapy, intensity-modulated radiotherapy (IMRT), and active pencil beam scanned proton therapy (PBS) in patients treated for thymic malignancies. Methods: Comparative treatment plans for each of the different treatment modalities were generated for 17 patients. The risk for radiation-induced SM was estimated using two distinct prediction models—the Dasu and the Schneider model. Results: The total and fatal SM risks estimated using the Dasu model demonstrated significant reductions with the use of PBS relative to both 3DCRT and IMRT for all independent thoracic organs analyzed with the exception of the thyroid gland (p ≤ 0.001). SM rates per 10,000 patients per year per Gy evaluated using the Schneider model also resulted in significant reductions with the use of PBS relative to 3DCRT and IMRT for the lungs, breasts, and esophagus (p ≤ 0.001). Conclusions: PBS achieved superior sparing of relevant OARs compared to 3DCRT and IMRT, leading to a lower risk for radiation-induced SM. PBS should therefore be considered in patients diagnosed with thymic malignancies, particularly young female patients.
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Marshall, Deborah C., Zahra Ghiassi-Nejad, Allison Powers, Joy S. Reidenberg, Pamela Argiriadi, Meng Ru, Vishruta Dumane, et al. "A first radiotherapy application of functional bulboclitoris anatomy, a novel female sexual organ-at-risk, and organ-sparing feasibility study." British Journal of Radiology 94, no. 1124 (August 1, 2021): 20201139. http://dx.doi.org/10.1259/bjr.20201139.
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Objective: The bulboclitoris (clitoris and vestibular bulbs) is the primary organ responsible for female sexual arousal and orgasm. Effects of radiotherapy on the bulboclitoris are unknown, as its structure/function has yet to be described in radiotherapy, and it overlaps only partially with the external genitalia structure. Our aim was to: describe bulboclitoris structure, function and delineation; compare volume of and dose delivered to the bulboclitoris vs external genitalia; and, compare bulboclitoris-sparing IMRT (BCS-IMRT) to standard IMRT (S-IMRT) to determine reoptimization feasibility. Methods: Our expert team (anatomist, pelvic radiologist, radiation oncologist) reviewed bulboclitoris anatomy and developed contouring guidance for radiotherapy. 20 female patients with anal cancer treated with chemoradiation were analyzed. Sexual organs at risk (OARs) included the external genitalia and the bulboclitoris. Volumes, dice similarity coefficients (DSCs) and dose received using S-IMRT were compared. Plans were reoptimized using BCS-IMRT. Dose–volume histograms (DVHs) for PTVs and all OARs were compared for BCS-IMRT vs S-IMRT. Results: Bulboclitoris structure, function and delineation are described herein. The bulboclitoris occupies 20cc (IQR:12–24), largely distinct from the external genitalia (DSC <0.05). BCS-IMRT was superior to S-IMRT in reducing the dose to the bulboclitoris, with the greatest reductions in V30 and V40, with no significant changes in dose to other OARs or PTV 1/V95. Conclusion: The bulboclitoris can be contoured on planning imaging, largely distinct from the external genitalia. Compared with S-IMRT, BCS-IMRT dramatically reduced dose to the bulboclitoris in anal cancer planning. BCS-IMRT might safely reduce sexual toxicity compared with standard approaches. Advances in knowledge: The structure and function of the bulboclitoris, the critical primary organ responsible for female sexual arousal and orgasm, has yet to be described in the radiotherapy literature. Structure, function and delineation of the bulboclitoris are detailed, delineation and bulboclitoris-sparing IMRT were feasible, and sparing reduces the dose to the bulboclitoris nearly in half in female patients receiving IMRT for anal cancer, warranting further clinical study.
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Cozzi, Salvatore, Matteo Augugliaro, Patrizia Ciammella, Andrea Botti, Valeria Trojani, Masoumeh Najafi, Gladys Blandino, et al. "The Role of Interstitial Brachytherapy for Breast Cancer Treatment: An Overview of Indications, Applications, and Technical Notes." Cancers 14, no. 10 (May 23, 2022): 2564. http://dx.doi.org/10.3390/cancers14102564.
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Breast cancer represents the second leading cause of cancer-related death in the female population, despite continuing advances in treatment options that have significantly accelerated in recent years. Conservative treatments have radically changed the concept of healing, also focusing on the psychological aspect of oncological treatments. In this scenario, radiotherapy plays a key role. Brachytherapy is an extremely versatile radiation technique that can be used in various settings for breast cancer treatment. Although it is invasive, technically complex, and requires a long learning curve, the dosimetric advantages and sparing of organs at risk are unequivocal. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy, with longer follow-up than new, emerging radiation techniques, whose effectiveness is proven by over 20 years of experience. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy to perform breast lumpectomy boost, breast-conserving accelerated partial breast irradiation, and salvage reirradiation for ipsilateral breast recurrence, with particular focus on the implant description, limits, and advantages of the technique.
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Chiu, Hsiao-Wen, Lu-Han Lai, and Chien-Yi Ting. "A Dosimetric Analysis of Reduction Cardiac Dose with Lead Shielding in Breast Cancer Radiotherapy." Applied Sciences 11, no. 20 (October 17, 2021): 9686. http://dx.doi.org/10.3390/app11209686.
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Adjuvant radiotherapy is an important treatment modality after breast-conserving surgery. Due to its proximity, radiation therapy for the left breast can often lead to an escalated heart dose that can result in heart diseases. The purpose of this study was to evaluate the heart dose reduction by using lead shields surrounding the left breast. The doses of a 3D conformal radiotherapy (3D-CRT) plan, an intensity-modulated radiotherapy (IMRT) plan, and volumetric-modulated arc therapy (VMAT) to the left breast tumor in a CIRS ATOM anthropomorphic female adult phantom were measured by optically stimulated luminescence dosimeters (OSLDs). To protect critical organs, the skin around the target area was covered by lead shields of two different thicknesses (0.125 mm and 0.25 mm). The results showed that compared to IMRT and 3D-CRT, VMAT provided better planning target volume (PTV) coverage, a better conformity index (CI), and homogeneity index (HI). With the use of lead shields, the thyroid dose was reduced by 5.12–27.5% and 20.51–30%, respectively; the heart dose was reduced by 49.41–50.12% and 56.38–57.42%, respectively; and the lung dose was reduced by 1.23–45.22% and 0.98–57.83%, respectively. Although the clinical application of lead shields was rare, this study verified that it could effectively decrease the heart dose from 4.31 ± 0.09 Gy to 1.88–2.18 Gy, thereby potentially reducing the risk of associated heart diseases by 14.8%. Further works to implement this method into clinical practice are needed.
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Lushnikova, P. A., and E. S. Sukhikh. "Radiation Treatment of Synchronous Gynaecologic Cancer: a Clinical Case." Creative surgery and oncology 10, no. 3 (November 30, 2020): 221–27. http://dx.doi.org/10.24060/20763093-2020-10-3-221-227.
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Introduction. Recent years have witnessed an increased incidence of multiple neoplasms. In multiple combined cancer, the choice of treatment strategy remains challenging, as two or more tumours require treatment in the shortest perspective. However, an intense treatment may induce many and severe complications with co-located organs and systems. No universal protocol or treatment standard for managing multiple primary cancers is accepted in Russia or worldwide.Materials and methods. The clinical case describes radiation treatment of a female patient with synchronous gynaecologic cancer of vagina and endometrium at the “TOOD” medical facility’s radiotherapy unit. Our treatment was designed to maximise the dosage targeting at a minimal off-coverage of healthy tissues. The treatment was conducted in two steps on an Elekta Synergy Platform S instrument, with the total duration of 62 days.Results and discussion. After radiotherapy, the patient had an oncologic and gynaecologic observation for one year. A complete tumour regression in two localities was confirmed visually, cytologically and instrumentally.Conclusion. A treatment strategy in multiple primary cancers should be personalised. With unfeasible “standard therapy”, alternative approaches for the patient’s treatment are to be explored. We report a successful therapy in a woman with synchronous gynaecologic cancer by applying remote conformal radiation in regional uterine cancers with simultaneous integrated boost to the vaginal tumour during the first radiation step. Brachytherapy at the second step was replaced with stereotactic radiation due to vaginal constriction, pain syndrome and unfeasible applicator installation.
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Dasgupta, Sujoy. "An Unusual Association of Lung and Ovarian Malignancy in a Young Nonsmoker Female." International Journal of User-Driven Healthcare 2, no. 4 (October 2012): 20–28. http://dx.doi.org/10.4018/ijudh.2012100104.
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Lung cancer in a 25-year-old nonsmoker female is extremely rare. Ovarian malignancy in this age group is also infrequent and if occurs, is usually of germ cell type. If a patient presents with both lung and ovarian mass, the initial impression is the metastasis from one organ to the other. Chest X-ray, ultrasonogram, whole abdomen, CT scan of thorax and abdomen, bronchoscopic biopsy of lung mass and excision biopsy of ovarian mass are all needed to accurately diagnose condition. Therapy is also challenging for such patients. After accurate diagnosis for both the organs, surgery, chemotherapy, or radiotherapy should be considered after individualization of the case. Squamous cell carcinoma lung in advanced stage associated with early stage ovarian serous cystadenocarcinoma has not been described in literature. The rarity of the case, absence of cigarette smoking or radiation exposure, negative family history, unusual association and fatality of the cases prompted us to report this case.
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Hadžismailović, Ademir, and Alen Pilav. "Evaluation of the Preoperative Stage and Operative Findings in Patients With Non-Small Cell Lung Cancer." Bosnian Journal of Basic Medical Sciences 7, no. 3 (August 20, 2007): 239–44. http://dx.doi.org/10.17305/bjbms.2007.3052.
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Lung cancer is responsible for 40% mortalities from malignant diseases in man and exhibits an extremely infiltrating way of growing. It does not respect the lobes’ or the organs’ borders and spreads by blood system, lymph system and per continuitatem. According to its biological characteristics and response to treatments it may be divided in to small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC), which also includes other histological types. Lung cancer treatment includes surgical treatment, chemotherapy, radiotherapy, the combination of the former three as well as symptomatic treatment.In this study, we analyzed 125 patients with lung cancer, that were hospitalized at the Clinic for Thoracic Surgery in KCU Sarajevo. The difference according to gender is statistically significant because we had 111 (88,8%) male patients in comparison with 14 (11,2%) female patients. The average age of male patients was 60,3 years while female patients were 61,9 years old on average. Thus, the difference in average age is not statistically significant.In diagnostic procedures: chest radiography was the most significant in peripheral lesions (60, 8%). CT of the thoracic organs has a statistical significance because the tumor changes were confirmed in 123 patients (98,4%). In bronchoscopy, we had 120 patients (96,0%). The number of patients with preformed lobectomy (63) is statistically significantly greater in the observed group (125) then the number of patients with other operative procedures preformed. From the postoperative complications we had exitus letalis 2 (1,6%), wound infection 19 (15,2%), and 104 without complications (83,2%). The results of testing the significance of differences according to the cancer types in non small cell lung cancer were planocellular, adenocarcinoma, and macrocellular. Comparing the preoperative staging and operative findings through stages we obtained to the following results: in stage ST0 the deviation was 16,7%, STIA the deviation was 40,1%, STIB the deviation was 16,1%, STIIA the deviation was 11,1%, STIIB the deviation was 12,5%, STIIIA the deviation was 33,33%, STIIIB the deviation was 33, 3%.From the overall number of patients, who were in preoperativly graded stage STIA, operative findings confirmed STIA, which makes the most important statistically significant difference. In 36 patients or 28,8% the status was changed in operative finding. In 89 patients preoperative status or 72,2% remained unchanged following the operation.
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Heinrich, Bernhard, Richard F. Schlenk, Olaf Lothar Brudler, Simone Edenhofer, Angelika Scheuerle, Ralph Naumann, Regine Mayer-Steinacker, Markus Bangerter, and Lars Bullinger. "Activity of cabazitaxel in temozolomide refractory glioblastoma: Final results of a phase 2 study (C-GBM study; EudraCT 2013-001550-98 NCT 01866449)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 2056. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.2056.
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2056 Background: Following progression on Temozolomide (TMZ) glioblastoma (GBM) is a therapeutic challenge with a 6 month survival rate of only ~20-30% and no well-established 2nd line treatments. Methods: We designed a phase II study to assess the efficacy of cabazitaxel, a second generation taxoid, in TMZ-refractory GBM pts (pts). Primary enpoint was response at 12 weeks of treatment. Secondary endpoints were overall survival (OS), quality of life, and pharmacokinetics. The study population were pts with progressive GBM during or within 6 months after TMZ treatment, in whom radiotherapy and surgery was no treatment options. Exclusion criteria were signs of inflammation, an ECOG performance score (PS) > 2, as well as impaired organ function. Patient characteristics: In total, between 2014 and 2016 8 female and 16 male pts were included with a median age of 55 years (range 32-76 years) and a median of 3 previous therapies (range 1-9). Treatment: Cabazitaxel was given at 25mg/m² q3w with G-CSF prophylaxis. Every two cycles response assessment was performed (MRI). Treatment was discontinued in case of i) progressive disease (RANO criteria), ii) PS≥3, or iii) persistent toxicity. Results: Five pts went off study prior to the first MRI assessment due to progressive disease, while 19 of 24 of pts could be evaluated for response after 2 cycles. We did not observe any objective response (i.e. complete or partial remission). In 7 pts a stable disease (SD) was obtained; 12 pts had progressive disease. Of the 7 SD pts, 4 progressed after 4 cycles of treatment and the remaining pts remained in SD for 6, 10 and 12 cycles, respectively. The median OS was 155 days. Toxicity was manageable by G-CSF application in pts with CTC grade 3/4 neutropenia/leukopenia in 12 pts. Non-hematological toxicity CTC grade 3/4 comprised infection (n = 2), diarrhea (n = 2), vaginal bleeding (n = 1) and hypokalemia (n = 1). Conclusions: Cabazitaxel shows only marginal activity in TMZ refractory GBM with a disease stabilization rate following 4 cycles of only 12.5% in heavily pretreated GBM pts and median OS of 155 days. Clinical trial information: NCT 01866449.
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Saeed, Mirza Farad, Isam Mazin Juma, Roshan George Varkey, Keith Pappachen Mathew, and Maryam Abdollah Kamali. "Rare presentation of metastasized primary neuroendocrine breast carcinoma to the right colon and literature review of primary neuroendocrine breast carcinoma metastasized to other organs of the body: case report." International Surgery Journal 7, no. 12 (November 27, 2020): 4188. http://dx.doi.org/10.18203/2349-2902.isj20205381.
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Primary neuroendocrine breast tumors account for less than 0.1% of all breast cancers, hence, unique in nature. This paper aims to report a 56 years old female, known case of primary neuroendocrine breast cancer with a metastatic right colonic neuro-endocrine tumor. The article also aims to review and acclaim the literature regarding primary breast neuroendocrine tumors metastasized to other parts of the body. The patient presented complaining of a breast mass, ulceration, and discharge, which was rapidly progressing. Examination revealed a right breast mass with skin erythema and impending ulceration and right axillary lymph nodes fixed with palpable supra-clavicular lymph nodes. Ultrasound-guided biopsy of right breast mass and axilla disclosed a large cell neuroendocrine carcinoma. CT abdomen and chest revealed metastases to the ascending colon. The patient was treated with palliative radiotherapy along with multiple cycles of chemotherapy for the primary breast cancer. She also underwent a laparoscopic-assisted right hemicolectomy with complete mesocolic excision and primary anastomosis for the metastatic colon cancer. The paper compares the reported case to other similar cases using the framework of an analysis based on age of the patient, primary breast cancer location, method of detection, presence of neuroendocrine markers, primary cancer presentation, metastases symptoms, and location and treatment approach. In conclusion, metastasized primary neuroendocrine breast cancer is a very rare presentation. Incidence and prevalence maybe influenced by age, primary breast cancer location, and presence of neuroendocrine markers. Prognosis may also be a product of metastatic location, associated symptoms and treatment approaches.
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Baumann, Brian C., Walter Bosch, Amit Bahl, Alison J. Birtle, Rodney H. Breau, Amarnath Challapalli, Albert Chang, et al. "Development and validation of contouring guidelines for post-cystectomy adjuvant radiation of bladder cancer." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 409. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.409.
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409 Background: Several organizations are developing clinical trials to evaluate adjuvant radiotherapy (RT) for bladder cancer patients at elevated risk of locoregional failure (LF). However, the clinical target volumes (CTVs) & organs at risk (OARs) for this treatment have not been defined in detail. Our purpose was to define multi-institutional consensus CTVs & OARs for male & female bladder cancer patients undergoing adjuvant RT in clinical trials. Methods: We convened a multi-disciplinary group of bladder cancer specialists from 9 centers in 3 countries. 5 radiation oncologists (ROs) & 7 urologists participated in the development of the proposed contours. The group proposed initial language for the CTVs & OARs and contoured them on CT scans of a male & female cystectomy patient with input from ≥ 1 urologist at each center. Using the binomial maximum-likelihood estimates method, we generated 95% level initial contours. We evaluated the contours for level of agreement using the Landis & Koch interpretation of the K statistic. Based on the initial contouring, the group updated its descriptions of the CTVs & OARs. To determine if the revised language produced consistent contours, the cystectomy bed (CB) contour was redrawn on the CT sets by an additional 5 ROs. Results: The group proposed that patients at elevated risk for LF with R0 resections should be treated to the pelvic nodes alone (internal/external iliac, distal common iliac & presacral) whereas patients with ≥ R1 resections should be treated to the pelvic nodes & CB. The group proposed the rectum, bowel space, bone marrow & urinary diversion as OARs. The level of agreement for the initial CTVs & OARs from the group varied substantially (Table). Consensus language to describe CTV & OAR structures where the initial contours varied was successfully developed. Contours & feedback from the validation group are being analyzed. Conclusions: Initial descriptions of CTVs & OARs have been successfully developed. External validation & feedback are pending. The results will be applicable to clinical trials of adjuvant RT in bladder cancer. [Table: see text]
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Hussain, S. A., D. Ward, D. H. Palmer, D. Barton, V. Veeranna, E. Porfiri, A. Martin, M. Wallace, and N. D. James. "The role of neoadjuvant chemotherapy in muscle invasive bladder cancer and correlation of clinical outcome with translational studies." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 15551. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.15551.
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15551 Background The aim of this study was to investigate the outcome in patients with muscle-invasive bladder cancer (MIBC) receiving neo-adjuvant chemotherapy (neo-CT) prior to organ-preservation (chemo-radiation) or cystectomy. Additional translational studies were performed. Methods Patients with stage T2-T4, N0, M0 TCC bladder with calculated GFR =40ml/min were eligible. Neo-CT comprised gemcitabine (1,000 mg/m2 d1, d8, q21) plus cisplatin (35 mg/m2 d1, d8, q21) for 4 cycles . Following chemotherapy (CT) patients underwent surgery or radiotherapy (RT) with or without chemotherapy (CRT) treatment based on response to neo-CT and clinician and patient preference. Serial blood samples were collected for proteomic analysis. Results 20 patients have been recruited : 18 males 2 females; median age 70 years (range 47–86); stage T2; 9, T3A; 7, T3B; 4, all G3. 1 patient progressed before CT. 61 cycles of CT have been administered. Treatment has been well tolerated with only 1 neutropenic sepsis episode. 3 of 20 patients developed early progression and did not receive radical treatment. For the remaining 17 patients, choice of definitive treatment (surgery vs. RT/CRT) was based on response to neo-CT. 6 patients with residual disease at post-neo CT cystoscopy underwent surgery. 11/19 (58%) patients had a complete response (CR) to neo-CT, 9 of whom were treated by RT/CRT and 2 patients with pCR declined radical treatment (both alive at 10 and 19 months follow-up (FU)). At median FU of 12 months, 3/6 patients treated surgically and 2/9 patients treated by RT/CRT have died. 1-year survival by intention to treat analysis was 70%. We have used SELDI using the IMAC protein chip array to generate proteomic profiles of the patient sera collected to date. Although the number of samples is limited, the data suggest that there are changes in the pre- chemotherapy serum proteome of 3 patients that developed early progression (relative to 8 patients with CR to neo-CT ). Conclusions Neo-CT is active and well tolerated in MIBC. Proteomic profiling may further improve patient selection. Early data show serum proteome analysis can detect markers of early progression, and may therefore help select patients for different modalities more appropriately. Recruitment is ongoing. No significant financial relationships to disclose.
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Aydogan, Gonul, E. Bilgic, F. Akici, Z. Salcioglu, P. Turhan, and D. Tugcu. "Long-Term Effect of Bleomycin on Respiratory Function Tests in Pediatric Cancer Patients." Blood 106, no. 11 (November 16, 2005): 4812. http://dx.doi.org/10.1182/blood.v106.11.4812.4812.
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Abstract Chemotherapy and radiotherapy which are used in the management of cancer have acute and chronic adverse effects on various organs. Patients develop pulmonary damage due to mantle zone irradiation and bleomycin in the short or long-term. In this study, after the completion of treatment long-term pulmonary complications of the teatment were investigated in 30 pediatric patients (19 male, 11 female) with cancer aged between 72–229 months. Twelve of the patients used also chemotherapy in addition to 1020–3570 rad. of mantle zone irradiation (median 2177 rad.), whereas the remaining 18 had chemotherapy alone. All of the patients had completed their treatment approximately 3,8 years ago, and the total dose of bleomycin they used was 12–180 mg. (median 69,83). All of the patients underwent physical examination, and complete blood count, chest radiograph and spirometric tests to measure lung volumes were also performed. Additionally, in 20 patients single breath technique to measure the diffusing capacity for carbon monoxide was carried out. Physical examination of cardiopulmonary system revealed normal findings and none of our patients had a cardiopulmonary symptom. Chest radiograph was normal in 25 (83,3%) but it was abnormal in 5 patients. Lung volume measurements were normal in 21 (71%), but were abnormal in 9 (29%) patients. Of these 9 patients 23% had restrictive, 3% had combined and 3% had obstructive disorders. In our study, no correlation could be shown between the impaired respiratory function tests and irradiation and bleomycin doses used. In 3 (10%) out of 20 patients in whom the diffusing capacity test for carbon monoxide was performed, decreases in diffusing capacity for carbon monoxide were found. One of these patients had both high dose bleomycin (156 mg.) and mantle zone irradiation (2160 rad.), whereas the remaining 2 had low dose bleomycin (30–63 mg.) alone and received no radiotherapy. The diffusing capacity test for carbon monoxide which returns to normal values in short -term is less valuable than the measurement of lung volumes for the long-term follow-up evaluation of respiratory functions in these patients. Generally, in our late phase study (3,8 years after the completion of therapy), there was a low rate of impairment in diffusing capacity test for carbon monoxide, but the rate of impairment in lung volumes was much higher. This finding was compatible with most of the related literature. In conclusion, in pediatirc cancer patients respiratory function tests should be performed during the treatment and also after the completion of treatment in order to follow the course of pulmonary function impairment.
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Sharfina, Nur Afni, and Ratna Indriawati. "Sexuality of women with cervix cancer after treatment: literature review." JNKI (Jurnal Ners dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery) 9, no. 3 (December 31, 2021): 206. http://dx.doi.org/10.21927/jnki.2021.9(3).206-213.
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<p><strong><em>Background</em></strong><em>: Cervical cancer is a complex disease that requires comprehensive treatment from clinical professionals. Treatment of women with cervical cancer, such as radiation, chemotherapy and also surgery (hysterectomy). </em><em>The positive effect of treatment is that it kills cancer cells. There were also physically negative treatments offered (chemotherapy and radiation), such as vaginal dryness, redness of the vaginal area and vaginal canal. </em></p><p><strong><em>Purpose:</em></strong><em> This adjustments are linked to sexual function directly. The main objective of this literature review is to finding clinical reports on the sexuality of cervical cancer patients undergoing cervical cancer treatment. This study is a literature review. Data based used are NCBI and Google Schoolar. </em></p><p><strong><em>Methods:</em></strong><em> This research is a study of literature. NCBI and Google Schoolar are used based on results. The writer uses keywords "sexuality, cancer, after treatment, cervix". Inclusion criteria for papers were released in 2016-2020, the analysis approach was quantitative, papers were written in English, information on the subject was found in publications.</em></p><p><strong><em>Results</em></strong><em>: </em><em>12 articles that fulfilled the inclusion criteria were analyzed and the results of this literature. </em></p><p><strong><em>Conclusion</em></strong><em>:It can be suggested, after analyzing it, that cancer therapy given to cervical cancer patients can influence sexuality, especially sexual function. The treatment available (radiotherapy, chemotherapy, and the surgical process) has a significant effect on the female reproductive organs.</em></p>
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Aydiner, Adnan, Izzet Dogan, Nijat Khanmammadov, Pinar Saip, and Sezai Vatansever. "Predictors of response in EGFR-mutant metastatic non-small cell lung cancer patients treated with tyrosine kinase inhibitors." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e21149-e21149. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e21149.
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e21149 Background: EGFR mutations are detected in 15-62% of patients with non-small cell (NSCLC) lung cancer. We can use tyrosine kinase inhibitors (such as erlotinib, gefitinib, afatinib) to treat patients with EGFR-mutant lung cancer. Tyrosine kinase inhibitors improve the survival outcomes of the patients. This study aimed to assess predictors of overall response rate (complete or partial response) in EGFR-mutant non-small cell lung cancer patients treated with EGFR inhibitors. Methods: Data of the EGFR-mutant lung cancer patients were evaluated retrospectively. Clinical, pathological, radiological, and treatment features of the patients were recorded. SPSS 25 version was used for statistical analysis. Kaplan-Meier and Cox-regression methods were used for survival analysis. Also, predictors of overall response were evaluated with logistic regression analysis. Results: 105 patients were included in the study. The female/male patients ratio was 1.25, and the median age was 61 (range, 33-85) years. Adenocarcinoma (90.4%) was the most common histopathological type. The ratios of Exon 19, exon 21, and other (rare or multiple) mutations were 59%, 25%, and 16%, respectively. 89 (84.9%) patients were de-novo metastatic at diagnosis. Before EGFR inhibitor therapy, the patients had received chemotherapy (22.9%) and palliative radiotherapy (40%). The patients received erlotinib (83.8%) or other EGFR inhibitors (16.2%) for treatment. Median overall survival was 30.8 (range 20.2-41.4) months. Overall response rate (complete or partial response) was 61.9%, stable response 11.4%, and progressive disease 26.7%. In logistic regression analysis, we found that age (p = 0.008), number of metastasis sites (p = 0.037), pathological type (adenocarcinoma or other types) (p = 0.001) were statistically significant for the overall response rate. However, gender (p = 0.98), tumor localizations (left or right lung) (p = 0.39), de-novo metastasis (p = 0.81), EGFR mutations type (p = 0.13), and type of EGFR inhibitör (p = 0.30) were not statistically significant. Conclusions: In this study, we showed real-life outcomes of the patients with EGFR-mutant metastatic non-small cell lung cancer. The data of predictors of overall response for EGFR inhibitors is limited. We detected that age, the number of metastatic organs, and histopathological type of tumor were affected the response of treatment.
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Gupta, Aashish C., Constance A. Owens, Suman Shrestha, Choonsik Lee, Susan A. Smith, Rita E. Weathers, Tucker Netherton, et al. "Body region-specific 3D age-scaling functions for scaling whole-body computed tomography anatomy for pediatric late effects studies." Biomedical Physics & Engineering Express 8, no. 2 (February 1, 2022): 025010. http://dx.doi.org/10.1088/2057-1976/ac3f4e.
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Abstract Purpose. Radiation epidemiology studies of childhood cancer survivors treated in the pre-computed tomography (CT) era reconstruct the patients’ treatment fields on computational phantoms. For such studies, the phantoms are commonly scaled to age at the time of radiotherapy treatment because age is the generally available anthropometric parameter. Several reference size phantoms are used in such studies, but reference size phantoms are only available at discrete ages (e.g.: newborn, 1, 5, 10, 15, and Adult). When such phantoms are used for RT dose reconstructions, the nearest discrete-aged phantom is selected to represent a survivor of a specific age. In this work, we (1) conducted a feasibility study to scale reference size phantoms at discrete ages to various other ages, and (2) evaluated the dosimetric impact of using exact age-scaled phantoms as opposed to nearest age-matched phantoms at discrete ages. Methods. We have adopted the University of Florida/National Cancer Institute (UF/NCI) computational phantom library for our studies. For the feasibility study, eight male and female reference size UF/NCI phantoms (5, 10, 15, and 35 years) were downscaled to fourteen different ages which included next nearest available lower discrete ages (1, 5, 10 and 15 years) and the median ages at the time of RT for Wilms’ tumor (3.9 years), craniospinal (8.0 years), and all survivors (9.1 years old) in the Childhood Cancer Survivor Study (CCSS) expansion cohort treated with RT. The downscaling was performed using our in-house age scaling functions (ASFs). To geometrically validate the scaling, Dice similarity coefficient (DSC), mean distance to agreement (MDA), and Euclidean distance (ED) were calculated between the scaled and ground-truth discrete-aged phantom (unscaled UF/NCI) for whole-body, brain, heart, liver, pancreas, and kidneys. Additionally, heights of the scaled phantoms were compared with ground-truth phantoms’ height, and the Centers for Disease Control and Prevention (CDC) reported 50th percentile height. Scaled organ masses were compared with ground-truth organ masses. For the dosimetric assessment, one reference size phantom and seventeen body-size dependent 5-year-old phantoms (9 male and 8 female) of varying body mass indices (BMI) were downscaled to 3.9-year-old dimensions for two different radiation dose studies. For the first study, we simulated a 6 MV photon right-sided flank field RT plan on a reference size 5-year-old and 3.9-year-old (both of healthy BMI), keeping the field size the same in both cases. Percent of volume receiving dose ≥15 Gy (V15) and the mean dose were calculated for the pancreas, liver, and stomach. For the second study, the same treatment plan, but with patient anatomy-dependent field sizes, was simulated on seventeen body-size dependent 5- and 3.9-year-old phantoms with varying BMIs. V15, mean dose, and minimum dose received by 1% of the volume (D1), and by 95% of the volume (D95) were calculated for pancreas, liver, stomach, left kidney (contralateral), right kidney, right and left colons, gallbladder, thoracic vertebrae, and lumbar vertebrae. A non-parametric Wilcoxon rank-sum test was performed to determine if the dose to organs of exact age-scaled and nearest age-matched phantoms were significantly different (p < 0.05). Results. In the feasibility study, the best DSCs were obtained for the brain (median: 0.86) and whole-body (median: 0.91) while kidneys (median: 0.58) and pancreas (median: 0.32) showed poorer agreement. In the case of MDA and ED, whole-body, brain, and kidneys showed tighter distribution and lower median values as compared to other organs. For height comparison, the overall agreement was within 2.8% (3.9 cm) and 3.0% (3.2 cm) of ground-truth UF/NCI and CDC reported 50th percentile heights, respectively. For mass comparison, the maximum percent and absolute differences between the scaled and ground-truth organ masses were within 31.3% (29.8 g) and 211.8 g (16.4%), respectively (across all ages). In the first dosimetric study, absolute difference up to 6% and 1.3 Gy was found for V15 and mean dose, respectively. In the second dosimetric study, V15 and mean dose were significantly different (p < 0.05) for all studied organs except the fully in-beam organs. D1 and D95 were not significantly different for most organs (p > 0.05). Conclusion. We have successfully evaluated our ASFs by scaling UF/NCI computational phantoms from one age to another age, which demonstrates the feasibility of scaling any CT-based anatomy. We have found that dose to organs of exact age-scaled and nearest aged-matched phantoms are significantly different (p < 0.05) which indicates that using the exact age-scaled phantoms for retrospective dosimetric studies is a better approach.
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Liu, Weiping, Yong Yang, Shunan Qi, Ying Wang, Xia He, Gang Wu, Baolin Qu, et al. "Risk-adapted therapy for advanced-stage natural killer/T-cell lymphoma: An analysis from the China Lymphoma Collaborative Group Study." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e20041-e20041. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e20041.
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e20041 Background: Few studies focused on the risk-adapted therapy for advanced-stage natural killer/T-cell lymphoma (NKTCL) due to poor prognosis. Methods: Data of 406 patients with advanced-stage NKTCL from 20 Chinese institutions between 2000 and 2015 were retrospectively analyzed. To develop a prognosis index model for advanced-stage NKTCL, all patients were divided into the primary cohort from South China (n = 198) and the validation cohort from North China (n = 208). Clinical factors related to survival in the primary cohort were identified to construct a new prognosis index model. An external validation for the prognosis index model was performed in the validation cohort. Stratified by the prognosis index model, survival benefit for treatment models was assessed. Results: The median age was 42 years with the ratio of male/female of 2.5:1. Extra-nodal involvement was observed in 72.4% of patients. More than one third of patients received asparaginase (Asp)–containing chemotherapy. In addition, radiotherapy was administrated in 135 (33.3%) patients. The overall response rate (ORR) and complete remission (CR) rate were 59.3% and 38.3% in 337 available patients. The expected 3-year progression-free survival (PFS) and overall survival (OS) rates were 26.9% and 37.3%, respectively. Based on 3 clinical variables including ECOG-PS > 1, elevated LDH and solid organs involvement, a new prognosis index model (ASPRIN) was developed and showed superior discrimination than current models including IPI, KPI and PINK in this particular population. The expected 3-year OS rates in the primary and validation cohort were 54.8% and 52.9% in the low risk group (with 0-1 risk factor), 34.4% and 38.0% in the intermediate risk group (with 2 risk factors), 13.8% and 10.6% in the high risk group (with 3-4 risk factors), respectively. Stratified by ASPRIN model, combined radio-chemotherapy provided better survival benefit than chemotherapy alone regardless of chemotherapy regimens in the low risk group (3-year PFS 52.6% vs. 22.6%, P < 0.001; 3-year OS 72.8% vs. 35.8%, P < 0.001), while Asp–containing chemotherapy improved survival with an increase of about 10%-15% in PFS and OS compared with non–Asp–containing chemotherapy in the intermediate and high risk groups. Conclusions: The outcome of advanced-stage NKTCL is still poor and heterogeneous even in the era of Asp–containing chemotherapy, which highlighted the need of establishing more effective risk-adapted therapeutic strategies.
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Mayer, F., H. G. Kopp, J. Classen, T. Kluba, A. Koenigsrainer, M. Horger, M. Bamberg, and J. T. Hartmann. "Radiation-induced sarcoma: A single center experience with 36 cases." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 20525. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.20525.
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20525 Background: Radiation-induced sarcoma (RIS) is a rare complication of radiation therapy for any cause. With increasing numbers of patients receiving radiotherapy, data concerning the incidence and treatment outcome of RIS are urgently needed. Methods: We screened our local sarcoma registry for patients with RIS. 36 cases of RIS that had developed after radiation for malignant disease were identified and analyzed retrospectively over a 12 year period (1994–2006). Results: All patients had received radiation therapy between 1968 and 2002. The most frequent primary tumors were breast cancer (n = 19) and lymphoma (including Hodgkin`s and non-Hodgkin`s lymphoma, n = 9). The remainder received radiation therapy for tumors of the female reproductive organs (n = 2), head and neck cancer (n = 4), neuroblastoma (n = 1), and seminoma (n = 1).The median of delivered total radiation dose per patient was 50 Gy (35 to 72 Gray). Sources of irradiation were photons (n = 9), cobalt (n = 6), electrons (n = 2), and unknown in 19 cases. The median time interval from the start of irradiation the detection of the sarcoma was 11 years (1 - 35 years). The tumors arose within the radiation field in 29 cases, on the border of the field in 6 cases, and out of field in 1 case. The histology of RIS was angiosarcoma in most cases (n = 12), followed by pleomorphic sarcomas (n = 11), leiomyosarcoma (n = 4), fibrosarcoma (n = 2), osteosarcoma (n = 2), and others (n =5). Most cases were detected in a localized stage of disease (n = 33), and therefore, complete surgical removal was achieved in almost 50% (n = 17). However, this did not translate into long term survival within the overall study population. Only 11 patients remain free of disease during a mean follow-up period of 29 months (range, 0 - 51). Conclusions: Angiosarcomas within or on the border of the radiation field are the most common histological subentity of RIS. Therefore, follow-up of previously irradiated patients should include examination of irradiated regions with a high level of suspicion if cutaneous atypical vascular lesions are found. However, the clinician should be aware of the fact that RIS also occurs out of field and can be of non-angiogenic subtype as well. As far as treatment is concerned, RIS is treated the same as non-radiation induced sarcoma. No significant financial relationships to disclose.
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Damato, Angela, Giulia Besutti, Candida Bonelli, Francesco Venturelli, Paolo Giorgi Rossi, Massimo Vicentini, Pierpaolo Pattacini, and Carmine Pinto. "Liver findings and risk of recurrence in locally-advanced rectal cancer (LARC): An Italian retrospective cohort study." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e15175-e15175. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e15175.
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e15175 Background: Despite the combination of fluoropyrimidine chemotherapy and long course radiotherapy (50.4 Gy) followed by TME, LARC still results in 30% distant recurrence within 2-3 years after surgery. One of the most affected organs is the liver. We aimed to analyze if basal liver pathological alterations and drug-induced liver damages influence the liver recurrence. Methods: 50 patients (pts) with LARC treated with neoadjuvant chemoradiotherapy (NACRT) between June 2010 and June 2017 in a single center were included. Liver function tests (LFTs) including AST, ALT and GGT at baseline and after NACRT were evaluated. The first staging CT scan and, when available, post-NACRT CT scan were reviewed to assess steatosis (unenhanced liver density < 48 HU or liver-to-spleen ratio < 1.1), and liver volume. Associations of baseline LFTs and CT liver alterations and changes after NACRT with liver metastasis (LM) during follow-up were evaluated with Hazard Ratio (HR) and respective 95%CI calculated with Cox analysis. Results: The characteristics of pts were: 68% males, median age 60.4 ys (range 34-84), cTN stage II (32%) and stage III (64%). During a follow-up ranging from 1.5 to 7 ys, 17(34%) pts developed distant recurrence and 7(14%) LM. At baseline, 2 pts had GGT > 73 U/l and 11(22%) had steatosis. After NACRT, 4(9%) pts had AST > 40 U/I and/or ALT > 49 U/l with > 2-folds increase, 6 (40%) of the 15 pts with available unenhanced post-NACRT CT had steatosis development, or increase (≥10 HU density decrease), and 9 (27%) of 33 pts with available post-NACRT CT had a > 10% increase in liver volume. LM was associated with female sex (p = 0.016). Baseline steatosis, post-NACRT steatosis development or increase, > 10% liver volume and transaminase increase were associated with LM (HR = 3.36, 95%CI = 0.75-15.1; HR = 3.67, 95%CI = 0.33-40.7; HR = 2.91, 95%CI = 0.59-14.5; HR = 3.05, 95%CI = 0.33-27.72, respectively). All the reported associations almost disappeared, when considering all-sites of distant recurrence. Conclusions: Even if small numbers cannot exclude that associations are due to chance, baseline liver steatosis and post-NACRT liver damage may be involved in LM during follow-up of LARC.
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Garcia, Joana Lemos, Isadora Rosa, Joana Moleiro, João Pereira da Silva, and António Dias Pereira. "INCIDENCE AND RISK FACTORS FOR NEOPLASIA IN INFLAMMATORY BOWEL DISEASE." Inflammatory Bowel Diseases 27, Supplement_1 (January 1, 2021): S43. http://dx.doi.org/10.1093/ibd/izaa347.105.
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Abstract Introduction and goals Inflammatory Bowel Disease (IBD) patients may have an increased risk of neoplasia due to IBD itself or its therapy. The aim of this study was to evaluate the incidence of malignant neoplasia in IBD patients in a portuguese hospital, the associated risk factors and the therapy adjustments made. Methods Unicentric retrospective cohort study. All patients followed for IBD in a tertiary portuguese hospital and oncological center during 2015–2020 were included. Demographic and clinical data were registered. Results A total of 318 patients were included: female n=175(55.0%), age at diagnosis=37.24(±15,28)years-old, Crohn’s disease (CD) n=168(52.8%), Primary Sclerosing Cholangitis n=7, family history of cancer n=12, previous diagnosis of neoplasia n=23(7.2%), smokers n=49 (15.4%). A total of 42 cancers were diagnosed in 36 patients (11.3%) - median of 12.0(IQR=8.0–21.0) years after IBD diagnosis. Most affected organs: skin (n=15 in 11 patients; melanoma=1), colon and rectum (n=8 in 6 patients), prostate (n=4), breast (n=3) and anal canal (n=2). In those with non-melanoma skin cancer, 6 patients were under active treatment with azathioprine and 2 had stopped it for more than two years. In both univariate/multivariate analysis, the occurrence of neoplasia was associated with tobacco exposure (p=0.0.29/p=0.004), age (p<0.001/p=0,003) and IBD duration (p=0.001/p=0.017). There was no association with IBD therapy. In 9 cases, the cancer treatment was different because of the IBD (type of surgery n=6, drugs used n=2, radiotherapy not used n=1); IBD treatment was changed in 9 patients; clinical remission was lost in 1 patient in whom azathioprine treatment was halted after cancer. In the last follow-up, 3 patients remained with active oncological disease and 5 had died, 3 of which with active cancer. In those affected by cancer, in the univariate analysis, its cure/remission was negatively associated with tobacco exposure (p=0.003) and positively with salicylates use (p=0.016) and IBD remission before cancer diagnosis (p=0.008). In the multivariate analysis, the statistical significance was lost. Overall survival was lower in smokers with or without neoplasia (p<0.001) and in those who developped cancer (p=0.003). Conclusion In IBD patients, cancer mostly affected the skin and the lower digestive system. As in the general population, age and tobacco exposure were risk factors for the development of neoplasia. Tobacco is globally associated with lower survival rates and may be associated with a lower cure/remission rate, while salicylates and IBD remission may have a beneficial effect.
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Бойко, А. В., Н. Д. Олтаржевская, В. И. Швец, Л. В. Демидова, Е. А. Дунаева, О. Б. Дубовецкая, В. Ю. Мельникова, Е. И. Ерастова, and С. А. Кожевникова. "New opportunities of drug delivery in oncology." ZHurnal «Patologicheskaia fiziologiia i eksperimental`naia terapiia», no. 3() (September 14, 2018): 120–27. http://dx.doi.org/10.25557/0031-2991.2018.03.120-127.
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Цель исследования. Разработка методов сопроводительной терапии для защиты нормальных органов и тканей, входящих в зону облучения. Методы. В исследование включено 112 больных раком шейки и тела матки после комбинированного или самостоятельного лучевого лечения с 2012 по 2016 гг. У 71 пациентки основной группы в качестве терапии сопровождения применяли гидрогель с деринатом и у 41 больной группы контроля - традиционные методы профилактики (масло оливковое, подсолнечное, метилурациловая мазь). Для профилактики эпителиита слизистой влагалища и шейки матки в основной группе использовали гидрогель в виде аппликаций с первого дня облучения. Для профилактики лучевого ректита гидрогель вводили в прямую кишку 1 раз в день с первого дня облучения. Инстилляции гидрогеля в мочевой пузырь начинали только при развитии первых признаков клинической картины цистита. Пациенткам контрольной группы для профилактики лучевых реакций проводились масляные, мазевые аппликации во влагалище, масляные микроклизмы в прямую кишку с первого дня облучения. Лечение лучевого цистита проводили с помощью растительных диуретиков, уросептиков. Результаты. Применение гидрогеля с деринатом позволило провести курс лучевой терапии без перерыва у 84,5% (60/71) больных, в контрольной группе - лишь у 48,8% (20/41). Лучевые циститы возникали в 2,5 раза реже (25,3% ± 3,3 против 63,4% ± 2,7, р<0,01). Анализ степени выраженности лучевого цистита по RTOG в двух группах показал, что у 75% больных основной группы наблюдалась I степень, у 25% - II степень, III и IV степени не отмечено, тогда как в контрольной группе лучевой цистит I степени развился у 44% пациенток, II - 40% и III - 16% больных. Применение гидрогеля снизило частоту лучевых ректитов в 2 раза (26,7% ± 3,3 против 53,7% ± 3,2 р<0,1).При использовании ежедневных аппликаций гидрогеля с деринатом со стороны слизистой оболочки влагалища и шейки матки преобладали эпителииты I степени (53,5%), II степень наблюдалась у 29,5% и III степень лучевой реакции - лишь в 16,9% случаев, IV степень реакции не отмечена. В контрольной группе эти показатели составили 26,8%, 24,3%, 31,7% и 17,2% соответственно. Разработаны цитологические критерии оценки течения лучевых реакций слизистой влагалища. Выделены три степени изменения цитограммы, которые коррелировали с клинической картиной. В основной группе лучевые изменения I степени зафиксированы в 4,5 раза чаще (52 ± 9,9% против 11,5 ± 6,3%, р<0,002), а III степень представлена в 3,8 раза реже, чем в контрольной группе (12 ± 6,5% против 46,1 ± 9,8%, р<0,003). Заключение. Применение гидрогелевого материала с деринатом в качестве препарата сопроводительной терапии во время курса облучения позволяет уменьшить частоту и степень выраженности лучевых повреждений со стороны слизистой влагалища, мочевого пузыря и прямой кишки, провести курс лучевой терапии без перерыва и улучшить качество жизни пациенток. Objective. Development of methods for accompanying therapy to protect normal organs and tissues in the irradiation zone. Method. The study included 112 patients with cervical and endometrial cancer after combined or independent radiotherapy from 2012 to 2016. In 71 female patients of the main group, Derinat with hydrogel was applied as a supportive therapy and in 41 patients of the control group, conventional prevention methods (olive oil, sunflower oil, methyluracyl ointment) were applied. For prevention of vaginal mucosal and cervical epitheliitis in the main group, hydrogel was used as applications from the first radiation day. For prevention of radiation proctitis, hydrogel was injected into the rectum once daily from the first radiation day. Hydrogel instillations into the bladder were started only with the first clinical signs of cystitis. For prevention of radiation reactions, vaginal oil and ointment and rectal oil micro-enema were administered to patients of the control group from the first day of irradiation. Radiation cystitis was treated with vegetable diuretics and uroseptic drugs. Results. Using the hydrogel with Derinat allowed to administer a course of radiotherapy without interruption in 84.5% (60/71) of patients and only in 48.8% (20/41) in the control group. Radiation cystitis occurred 60% less frequently (25.3% ± 3.3 versus 63.4% ± 2.7, p <0.01). Analysis of radiation cystitis severity in two groups (according to RTOG) showed that 75% of patients in the main group had grade I and 25% had grade II. Grade III and grade IV did not occur. At the same time, in the control group, grade I radiation cystitis developed in 44% of patients, grade II - in 40%, and grade III - in 16% of patients. The hydrogel treatment halved the frequency of radiation proctitis (26.7% ± 3.3 vs. 53.7% ± 3.2 p <0.1). With daily application of the hydrogel with Derinat, grade I epitheliitis (53.5%) predominated in vaginal and cervical mucosa, grade II was observed in 29.5%, and grade III radiation reaction - only in 16.9% of cases; grade IV reaction was not observed. In the control group, these proportions were 26.8%, 24.3%, 31.7%, and 17.2%, respectively. Cytological criteria were developed to evaluate the course of radiation reactions in the vaginal mucosa. Three degrees of change in the cytogram were identified, which correlated with clinical picture. In the main group, incidence of grade I radiation-induced changes was increased by more than 350% (52 ± 9.9% vs. 11.5 ± 6.3%, p <0.002), and incidence of grade III was decreased by more than 70% compared to the control group (12 ± 6.5% vs. 46.1 ± 9.8%, p <0.003). Conclusion. Using the hydrogel material with Derinat as an accompanying therapy during the course of irradiation allows to reduce frequency and severity of radiation injuries of the vaginal mucosa, bladder, and rectum, administer an uninterrupted course of radiotherapy, and improve the quality of life of patients.
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Ma, Xiangyu, Xinyuan Chen, Jingwen Li, Yu Wang, Kuo Men, and Jianrong Dai. "MRI-Only Radiotherapy Planning for Nasopharyngeal Carcinoma Using Deep Learning." Frontiers in Oncology 11 (September 8, 2021). http://dx.doi.org/10.3389/fonc.2021.713617.
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BackgroundRadical radiotherapy is the main treatment modality for early and locally advanced nasopharyngeal carcinoma (NPC). Magnetic resonance imaging (MRI) has the advantages of no ionizing radiation and high soft-tissue resolution compared to computed tomography (CT), but it does not provide electron density (ED) information for radiotherapy planning. Therefore, in this study, we developed a pseudo-CT (pCT) generation method to provide necessary ED information for MRI-only planning in NPC radiotherapy.MethodsTwenty patients with early-stage NPC who received radiotherapy in our hospital were investigated. First, 1433 sets of paired T1 weighted magnetic resonance (MR) simulation images and CT simulation images were rigidly registered and preprocessed. A 16-layer U-Net was used to train the pCT generative model and a “pix2pix” generative adversarial network (GAN) was also trained to compare with the pure U-Net regrading pCT quality. Second, the contours of all target volumes and organs at risk in the original CT were transferred to the pCT for planning, and the beams were copied back to the original CT for reference dose calculation. Finally, the dose distribution calculated on the pCT was compared with the reference dose distribution through gamma analysis and dose-volume indices.ResultsThe average time for pCT generation for each patient was 7.90 ± 0.47 seconds. The average mean (absolute) error was −9.3 ± 16.9 HU (102.6 ± 11.4 HU), and the mean-root-square error was 209.8 ± 22.6 HU. There was no significant difference between the pCT quality of pix2pix GAN and that of pure U-Net (p > 0.05). The dose distribution on the pCT was highly consistent with that on the original CT. The mean gamma pass rate (2 mm/3%, 10% low dose threshold) was 99.1% ± 0.3%, and the mean absolute difference of nasopharyngeal PGTV D99% and PTV V95% were 0.4% ± 0.2% and 0.1% ± 0.1%.ConclusionThe proposed deep learning model can accurately predict CT from MRI, and the generated pCT can be employed in precise dose calculations. It is of great significance to realize MRI-only planning in NPC radiotherapy, which can improve structure delineation and considerably reduce additional imaging dose, especially when an MR-guided linear accelerator is adopted for treatment.
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Gong, Wei, Yiming Yao, Jie Ni, Hua Jiang, Lecheng Jia, Weiqi Xiong, Wei Zhang, Shumeng He, Ziquan Wei, and Juying Zhou. "Deep learning-based low-dose CT for adaptive radiotherapy of abdominal and pelvic tumors." Frontiers in Oncology 12 (August 18, 2022). http://dx.doi.org/10.3389/fonc.2022.968537.
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The shape and position of abdominal and pelvic organs change greatly during radiotherapy, so image-guided radiation therapy (IGRT) is urgently needed. The world’s first integrated CT-linac platform, equipped with fan beam CT (FBCT), can provide a diagnostic-quality FBCT for achieve adaptive radiotherapy (ART). However, CT scans will bring the risk of excessive scanning radiation dose. Reducing the tube current of the FBCT system can reduce the scanning dose, but it will lead to serious noise and artifacts in the reconstructed images. In this study, we proposed a deep learning method, Content-Noise Cycle-Consistent Generative Adversarial Network (CNCycle-GAN), to improve the image quality and CT value accuracy of low-dose FBCT images to meet the requirements of adaptive radiotherapy. We selected 76 patients with abdominal and pelvic tumors who received radiation therapy. The patients received one low-dose CT scan and one normal-dose CT scan in IGRT mode during different fractions of radiotherapy. The normal dose CT images (NDCT) and low dose CT images (LDCT) of 70 patients were used for network training, and the remaining 6 patients were used to validate the performance of the network. The quality of low-dose CT images after network restoration (RCT) were evaluated in three aspects: image quality, automatic delineation performance and dose calculation accuracy. Taking NDCT images as a reference, RCT images reduced MAE from 34.34 ± 5.91 to 20.25 ± 4.27, PSNR increased from 34.08 ± 1.49 to 37.23 ± 2.63, and SSIM increased from 0.92 ± 0.08 to 0.94 ± 0.07. The P value is less than 0.01 of the above performance indicators indicated that the difference were statistically significant. The Dice similarity coefficients (DCS) between the automatic delineation results of organs at risk such as bladder, femoral heads, and rectum on RCT and the results of manual delineation by doctors both reached 0.98. In terms of dose calculation accuracy, compared with the automatic planning based on LDCT, the difference in dose distribution between the automatic planning based on RCT and the automatic planning based on NDCT were smaller. Therefore, based on the integrated CT-linac platform, combined with deep learning technology, it provides clinical feasibility for the realization of low-dose FBCT adaptive radiotherapy for abdominal and pelvic tumors.
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Elmtalab, Soheil, Amir Hossein Karimi, Fardin Samadi Khoshe Mehr, Hamed Zamani, Iraj Abedi, and Fakhereh Pashaei. "Estimating Radiotherapy-Induced Secondary Cancer Risk Arising from Brain Irradiation at High Energy: A Monte Carlo Study." Frontiers in Biomedical Technologies, December 26, 2021. http://dx.doi.org/10.18502/fbt.v9i1.8145.
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Background: The present study aims to determine the whole-body out-of-field photon dose equivalents of high-energy conventional radiation therapy treatment. Also, it is tried to estimate the probability of fatal secondary cancer risk for the susceptible organs using a Monte Carlo (MC) code.
Materials and methods: An Monte Carlo N-Particle eXtended (MCNPX)-based model of 18-MV Medical Linear Accelerator (LINAC) was created to calculate the out-of-field photon dose equivalent at the locations of fascinating organs in the mathematical female Medical Internal Radiation Dosimetry (MIRD) phantom. Then, the secondary malignancies risk was estimated based on out-of-field doses and radiation risk coefficients according to the National Council of Radiation Protection and Measurements (NCRP).
Results: The average photon equivalent dose in out-of-field organs was about 3.25 mSv/Gy, ranging from 0.23 to 37.2 mSv/Gy, respectively, for the organs far from the Planning Target Volume (PTV) (Eyes) and those close to the treatment field (rectum). The entire secondary cancer risk for the 60 Gy prescribed dose to isocenter was obtained as 2.9987%. Here, the maximum doses among off-field organs were related to stomach (0.0805%), lung (0.0601%), and thyroid (0.0404%).
Conclusion: Regarding the estimated values for the probability of secondary cancer risk, it is suggested to perform a long-term follow-up of brain cancer patients regarding the prevalence of thyroid, stomach, and lung cancer after completing the treatment course.
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Chourak, Hilda, Anaïs Barateau, Safaa Tahri, Capucine Cadin, Caroline Lafond, Jean-Claude Nunes, Adrien Boue-Rafle, et al. "Quality assurance for MRI-only radiation therapy: A voxel-wise population-based methodology for image and dose assessment of synthetic CT generation methods." Frontiers in Oncology 12 (October 10, 2022). http://dx.doi.org/10.3389/fonc.2022.968689.
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The quality assurance of synthetic CT (sCT) is crucial for safe clinical transfer to an MRI-only radiotherapy planning workflow. The aim of this work is to propose a population-based process assessing local errors in the generation of sCTs and their impact on dose distribution. For the analysis to be anatomically meaningful, a customized interpatient registration method brought the population data to the same coordinate system. Then, the voxel-based process was applied on two sCT generation methods: a bulk-density method and a generative adversarial network. The CT and MRI pairs of 39 patients treated by radiotherapy for prostate cancer were used for sCT generation, and 26 of them with delineated structures were selected for analysis. Voxel-wise errors in sCT compared to CT were assessed for image intensities and dose calculation, and a population-based statistical test was applied to identify the regions where discrepancies were significant. The cumulative histograms of the mean absolute dose error per volume of tissue were computed to give a quantitative indication of the error for each generation method. Accurate interpatient registration was achieved, with mean Dice scores higher than 0.91 for all organs. The proposed method produces three-dimensional maps that precisely show the location of the major discrepancies for both sCT generation methods, highlighting the heterogeneity of image and dose errors for sCT generation methods from MRI across the pelvic anatomy. Hence, this method provides additional information that will assist with both sCT development and quality control for MRI-based planning radiotherapy.
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Hsu, Shu-Hui, Zhaohui Han, Jonathan E. Leeman, Yue-Houng Hu, Raymond H. Mak, and Atchar Sudhyadhom. "Synthetic CT generation for MRI-guided adaptive radiotherapy in prostate cancer." Frontiers in Oncology 12 (September 23, 2022). http://dx.doi.org/10.3389/fonc.2022.969463.
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Current MRI-guided adaptive radiotherapy (MRgART) workflows require fraction-specific electron and/or mass density maps, which are created by deformable image registration (DIR) between the simulation CT images and daily MR images. Manual density overrides may also be needed where DIR-produced results are inaccurate. This approach slows the adaptive radiotherapy workflow and introduces additional dosimetric uncertainties, especially in the presence of the magnetic field. This study investigated a method based on a conditional generative adversarial network (cGAN) with a multi-planar method to generate synthetic CT images from low-field MR images to improve efficiency in MRgART workflows for prostate cancer. Fifty-seven male patients, who received MRI-guided radiation therapy to the pelvis using the ViewRay MRIdian Linac, were selected. Forty-five cases were randomly assigned to the training cohort with the remaining twelve cases assigned to the validation/testing cohort. All patient datasets had a semi-paired DIR-deformed CT-sim image and 0.35T MR image acquired using a true fast imaging with steady-state precession (TrueFISP) sequence. Synthetic CT images were compared with deformed CT images to evaluate image quality and dosimetric accuracy. To evaluate the dosimetric accuracy of this method, clinical plans were recalculated on synthetic CT images in the MRIdian treatment planning system. Dose volume histograms for planning target volumes (PTVs) and organs-at-risk (OARs) and dose distributions using gamma analyses were evaluated. The mean-absolute-errors (MAEs) in CT numbers were 30.1 ± 4.2 HU, 19.6 ± 2.3 HU and 158.5 ± 26.0 HU for the whole pelvis, soft tissue, and bone, respectively. The peak signal-to-noise ratio was 35.2 ± 1.7 and the structural index similarity measure was 0.9758 ± 0.0035. The dosimetric difference was on average less than 1% for all PTV and OAR metrics. Plans showed good agreement with gamma pass rates of 99% and 99.9% for 1%/1 mm and 2%/2 mm, respectively. Our study demonstrates the potential of using synthetic CT images created with a multi-planar cGAN method from 0.35T MRI TrueFISP images for the MRgART treatment of prostate radiotherapy. Future work will validate the method in a large cohort of patients and investigate the limitations of the method in the adaptive workflow.
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Cui, Jiaqi, Zhengyang Jiao, Zhigong Wei, Xiaolin Hu, Yan Wang, Jianghong Xiao, and Xingchen Peng. "CT-Only Radiotherapy: An Exploratory Study for Automatic Dose Prediction on Rectal Cancer Patients Via Deep Adversarial Network." Frontiers in Oncology 12 (July 18, 2022). http://dx.doi.org/10.3389/fonc.2022.875661.
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PurposeCurrent deep learning methods for dose prediction require manual delineations of planning target volume (PTV) and organs at risk (OARs) besides the original CT images. Perceiving the time cost of manual contour delineation, we expect to explore the feasibility of accelerating the radiotherapy planning by leveraging only the CT images to produce high-quality dose distribution maps while generating the contour information automatically.Materials and MethodsWe developed a generative adversarial network (GAN) with multi-task learning (MTL) strategy to produce accurate dose distribution maps without manually delineated contours. To balance the relative importance of each task (i.e., the primary dose prediction task and the auxiliary tumor segmentation task), a multi-task loss function was employed. Our model was trained, validated and evaluated on a cohort of 130 rectal cancer patients.ResultsExperimental results manifest the feasibility and improvements of our contour-free method. Compared to other mainstream methods (i.e., U-net, DeepLabV3+, DoseNet, and GAN), the proposed method produces the leading performance with statistically significant improvements by achieving the highest HI of 1.023 (3.27E-5) and the lowest prediction error with ΔD95 of 0.125 (0.035) and ΔDmean of 0.023 (4.19E-4), respectively. The DVH differences between the predicted dose and the ideal dose are subtle and the errors in the difference maps are minimal. In addition, we conducted the ablation study to validate the effectiveness of each module. Furthermore, the results of attention maps also prove that our CT-only prediction model is capable of paying attention to both the target tumor (i.e., high dose distribution area) and the surrounding healthy tissues (i.e., low dose distribution areas).ConclusionThe proposed CT-only dose prediction framework is capable of producing acceptable dose maps and reducing the time and labor for manual delineation, thus having great clinical potential in providing accurate and accelerated radiotherapy. Code is available at https://github.com/joegit-code/DoseWithCT
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Kalantar, Reza, Christina Messiou, Jessica M. Winfield, Alexandra Renn, Arash Latifoltojar, Kate Downey, Aslam Sohaib, Susan Lalondrelle, Dow-Mu Koh, and Matthew D. Blackledge. "CT-Based Pelvic T1-Weighted MR Image Synthesis Using UNet, UNet++ and Cycle-Consistent Generative Adversarial Network (Cycle-GAN)." Frontiers in Oncology 11 (July 30, 2021). http://dx.doi.org/10.3389/fonc.2021.665807.
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BackgroundComputed tomography (CT) and magnetic resonance imaging (MRI) are the mainstay imaging modalities in radiotherapy planning. In MR-Linac treatment, manual annotation of organs-at-risk (OARs) and clinical volumes requires a significant clinician interaction and is a major challenge. Currently, there is a lack of available pre-annotated MRI data for training supervised segmentation algorithms. This study aimed to develop a deep learning (DL)-based framework to synthesize pelvic T1-weighted MRI from a pre-existing repository of clinical planning CTs.MethodsMRI synthesis was performed using UNet++ and cycle-consistent generative adversarial network (Cycle-GAN), and the predictions were compared qualitatively and quantitatively against a baseline UNet model using pixel-wise and perceptual loss functions. Additionally, the Cycle-GAN predictions were evaluated through qualitative expert testing (4 radiologists), and a pelvic bone segmentation routine based on a UNet architecture was trained on synthetic MRI using CT-propagated contours and subsequently tested on real pelvic T1 weighted MRI scans.ResultsIn our experiments, Cycle-GAN generated sharp images for all pelvic slices whilst UNet and UNet++ predictions suffered from poorer spatial resolution within deformable soft-tissues (e.g. bladder, bowel). Qualitative radiologist assessment showed inter-expert variabilities in the test scores; each of the four radiologists correctly identified images as acquired/synthetic with 67%, 100%, 86% and 94% accuracy. Unsupervised segmentation of pelvic bone on T1-weighted images was successful in a number of test casesConclusionPelvic MRI synthesis is a challenging task due to the absence of soft-tissue contrast on CT. Our study showed the potential of deep learning models for synthesizing realistic MR images from CT, and transferring cross-domain knowledge which may help to expand training datasets for 21 development of MR-only segmentation models.
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Jakšić, B., M. Prpić, J. Murgić, A. Prgomet Sečan, M. Zovak, V. Tomašić, and A. Frӧbe. "20 TREATMENT OPTIMIZATION AND PROGNOSTIC FACTORS IN ADVANCED ESOPHAGEAL CANCER." Diseases of the Esophagus 33, Supplement_1 (September 2020). http://dx.doi.org/10.1093/dote/doaa087.01.
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Abstract Esophageal cancer is a disease with high mortality due to advanced stage at the time of diagnosis in patients with poor general condition and/or multiple comorbidities which makes them unsuitable for radical treatment. The goal of this clinical trial is finding optimal treatment for this group of patients. Methods Hypothesis of this clinical trial is that sequential use of high dose rate intraluminal brachytherapy, external beam radiotherapy and chemotherapy decreases symptoms of disease, improves quality of life and prolongs overall survival in patients with esophageal cancer that are not candidates for radical treatment. We have included patients with esophageal cancer that are not candidates for radical treatment. Statistical analysis was done only for the patients that have completed planned treatment and not for the intent to treat population. Therefore, statistical analysis was done for 39 patients, 22 in control group and 17 in interventional group. Results In a survival analysis adapted for AJCC stage of the disease, addition of sequential chemotherapy improves overall survival statistically significant (P = 0.004). Sequential use of high dose rate intraluminal brachytherapy and external beam radiotherapy decreases the degree of: dysphagia (P = 0.001), odynophagia (P = 0.002) and regurgitation (P = 0.008) statistically significant. Decrease of a pain degree is statistically significant only with the use of sequential chemotherapy (P = 0.031). Sequential use of chemotherapy does not improve control over dysphagia (P = 0.872), odynophagia (P = 0.872) and regurgitation (P = 0.872) any further. Patients of female gender have greater improvement of regurgitation score (P = 0.068), pain score (P = 0.09) and quality of life (P = 0.019). Conclusion Sequential use of high dose rate intraluminal brachytherapy and external beam radiotherapy provides a safe use of high radiotherapy doses with minimal exposure of organs at risk, according to dose-volume histogram analysis. Sequential use of chemotherapy, after high dose rate intraluminal brachytherapy and external beam radiotherapy, improves overall survival in patients with esophageal cancer that are not candidates for radical treatment, in comparison to patients who do not receive chemotherapy (P = 0.09).
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Thompson, J. Spencer, Yong Chen, Imad Ali, Christina Henson, Julie Arntzen, Laura Holman, J. Nathan Cantrell, and Salahuddin Ahmad. "Novel use of a vaginal cylinder purposed dually as obturator and localiser for stereotactic ablative radiotherapy delivery." Journal of Radiotherapy in Practice, March 9, 2021, 1–4. http://dx.doi.org/10.1017/s1460396921000169.
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Abstract Background: Vaginal cancer is a rare malignancy that poses a challenge to treat and cure, as surgical excision requires life-changing procedures because of the proximity and involvement of rectum, bladder and anus. We report in this case study the successful delivery of stereotactic ablative radiotherapy (SABR) for a patient with vaginal cancer after previous radiotherapy. Methods: A 71-year-old white female who presented with dyspareunia and irritative urinary symptoms proven by biopsy was our candidate patient. Subsequent PET/CT revealed a hypermetabolic 3 cm lesion at the 12–1 o’clock position in the distal vagina involving the clitoris. The patient was initially treated with volumetric-modulated arc therapy (VMAT) with simultaneous integrated boost technique to the involved nodes, and later upon recurrence treated with SABR using 30 Gy in six fractions. Findings: To our knowledge, this is the first report of a vaginal cylinder used to physically distance organs at risk from the treatment target and also as a localising device with image guidance for the delivery of SABR using an external beam.
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Wahid, Kareem A., Jiaofeng Xu, Dina El-Habashy, Yomna Khamis, Moamen Abobakr, Brigid McDonald, Nicolette O’ Connell, et al. "Deep-learning-based generation of synthetic 6-minute MRI from 2-minute MRI for use in head and neck cancer radiotherapy." Frontiers in Oncology 12 (November 8, 2022). http://dx.doi.org/10.3389/fonc.2022.975902.
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BackgroundQuick magnetic resonance imaging (MRI) scans with low contrast-to-noise ratio are typically acquired for daily MRI-guided radiotherapy setup. However, for patients with head and neck (HN) cancer, these images are often insufficient for discriminating target volumes and organs at risk (OARs). In this study, we investigated a deep learning (DL) approach to generate high-quality synthetic images from low-quality images.MethodsWe used 108 unique HN image sets of paired 2-minute T2-weighted scans (2mMRI) and 6-minute T2-weighted scans (6mMRI). 90 image sets (~20,000 slices) were used to train a 2-dimensional generative adversarial DL model that utilized 2mMRI as input and 6mMRI as output. Eighteen image sets were used to test model performance. Similarity metrics, including the mean squared error (MSE), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR) were calculated between normalized synthetic 6mMRI and ground-truth 6mMRI for all test cases. In addition, a previously trained OAR DL auto-segmentation model was used to segment the right parotid gland, left parotid gland, and mandible on all test case images. Dice similarity coefficients (DSC) were calculated between 2mMRI and either ground-truth 6mMRI or synthetic 6mMRI for each OAR; two one-sided t-tests were applied between the ground-truth and synthetic 6mMRI to determine equivalence. Finally, a visual Turing test using paired ground-truth and synthetic 6mMRI was performed using three clinician observers; the percentage of images that were correctly identified was compared to random chance using proportion equivalence tests.ResultsThe median similarity metrics across the whole images were 0.19, 0.93, and 33.14 for MSE, SSIM, and PSNR, respectively. The median of DSCs comparing ground-truth vs. synthetic 6mMRI auto-segmented OARs were 0.86 vs. 0.85, 0.84 vs. 0.84, and 0.82 vs. 0.85 for the right parotid gland, left parotid gland, and mandible, respectively (equivalence p<0.05 for all OARs). The percent of images correctly identified was equivalent to chance (p<0.05 for all observers).ConclusionsUsing 2mMRI inputs, we demonstrate that DL-generated synthetic 6mMRI outputs have high similarity to ground-truth 6mMRI, but further improvements can be made. Our study facilitates the clinical incorporation of synthetic MRI in MRI-guided radiotherapy.
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Dai, Zhenhui, Yiwen Zhang, Lin Zhu, Junwen Tan, Geng Yang, Bailin Zhang, Chunya Cai, et al. "Geometric and Dosimetric Evaluation of Deep Learning-Based Automatic Delineation on CBCT-Synthesized CT and Planning CT for Breast Cancer Adaptive Radiotherapy: A Multi-Institutional Study." Frontiers in Oncology 11 (November 9, 2021). http://dx.doi.org/10.3389/fonc.2021.725507.
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PurposeWe developed a deep learning model to achieve automatic multitarget delineation on planning CT (pCT) and synthetic CT (sCT) images generated from cone-beam CT (CBCT) images. The geometric and dosimetric impact of the model was evaluated for breast cancer adaptive radiation therapy.MethodsWe retrospectively analyzed 1,127 patients treated with radiotherapy after breast-conserving surgery from two medical institutions. The CBCT images for patient setup acquired utilizing breath-hold guided by optical surface monitoring system were used to generate sCT with a generative adversarial network. Organs at risk (OARs), clinical target volume (CTV), and tumor bed (TB) were delineated automatically with a 3D U-Net model on pCT and sCT images. The geometric accuracy of the model was evaluated with metrics, including Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD95). Dosimetric evaluation was performed by quick dose recalculation on sCT images relying on gamma analysis and dose-volume histogram (DVH) parameters. The relationship between ΔD95, ΔV95 and DSC-CTV was assessed to quantify the clinical impact of the geometric changes of CTV.ResultsThe ranges of DSC and HD95 were 0.73–0.97 and 2.22–9.36 mm for pCT, 0.63–0.95 and 2.30–19.57 mm for sCT from institution A, 0.70–0.97 and 2.10–11.43 mm for pCT from institution B, respectively. The quality of sCT was excellent with an average mean absolute error (MAE) of 71.58 ± 8.78 HU. The mean gamma pass rate (3%/3 mm criterion) was 91.46 ± 4.63%. DSC-CTV down to 0.65 accounted for a variation of more than 6% of V95 and 3 Gy of D95. DSC-CTV up to 0.80 accounted for a variation of less than 4% of V95 and 2 Gy of D95. The mean ΔD90/ΔD95 of CTV and TB were less than 2Gy/4Gy, 4Gy/5Gy for all the patients. The cardiac dose difference in left breast cancer cases was larger than that in right breast cancer cases.ConclusionsThe accurate multitarget delineation is achievable on pCT and sCT via deep learning. The results show that dose distribution needs to be considered to evaluate the clinical impact of geometric variations during breast cancer radiotherapy.
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Gao, Yi, Li Wang, Han Bai, Xiang Pan, Lan Li, Li Chang, Yaoxiong Xia, Wenhui Li, and Yu Hou. "Comparative analysis of dosimetry and predictive somatotype parameters of prone and supine whole-breast irradiation among Chinese women after breast-conserving surgery." Frontiers in Oncology 12 (November 17, 2022). http://dx.doi.org/10.3389/fonc.2022.1011805.
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PurposeFinding a better treatment position (prone or supine) for whole-breast irradiation for Chinese female patients diagnosed with breast cancer by identify the associations between predictive somatotype parameters and dosimetric gains.Materials and methodsTwo volumetric-modulated arc therapy (VMAT) plans were deployed for whole-breast irradiation in supine and prone position with a total dose of 50 Gy in 25 fractions. Dose-volume parameters were compared and analysed both in the target volume and organs at risk, and equivalent uniform dose-based figure-of-merit (fEUD) models were further used to quantitatively evaluate the overall merits of the two plans. Body shape parameters, including body mass index (BMI), body surface area (BSA), breast shape, cup size, bust size and chest size, were collected. Anatomic features such as the central heart distance (CHD) were measured on supine CT. Spearman’s correlation analysis, receiver operating characteristic (ROC) curve analysis, and the linear regression models were conducted.ResultsDoses to the heart and left anterior descending coronary artery (LADCA) are greater in left-sided breast cancer (BC) patients in the prone position than in the supine position, and the opposite was true for right-sided BC patients (p<0.001). 19 of 63 patients (5 left-sided and 14 right-sided BC) achieved greater benefit from the prone position according to the fEUD score. Right-sided BC patients with a bust size ≥92.25 cm, drop-type breasts and cup size ≥B are very likely to benefit from prone-position radiotherapy. The CHD is significantly positively associated with △fEUD among right-sided BC patients (rho=0.506, p=0.004). Using a cut-off point of 2.215, the CHD had 71.4% sensitivity and 81.2% specificity in predicting a successful prone plan.ConclusionsRight-sided BC patients had better dosimetric gain in the prone position than left-sided BC patients. The CHD is an especially good and novel predictor that could help to select prone-benefitting right-sided BC patients.
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KETENCİ GENCER, Fatma, Bülent BABAOĞLU, Zeynep Kübra USTA KURT, Hatice YAŞAT NACAR, and Sibel BEKTAŞ. "Ovarian malignant melanoma metastasized from skin mimicking a benign cyst: a rare case report and mini-review of the literature." European Research Journal, January 14, 2023, 1–6. http://dx.doi.org/10.18621/eurj.1100943.
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Malignant melanomas, often appearing on the skin, rarely metastasize to internal organs and the ovaries are the least affected site. A 45-year-old female patient presenting with a skin lesion on the right side of the neck and diagnosed with malignant melanoma through excision biopsy also appeared to have lung metastasis and a nonspecific ovarian cystic mass of 6 cm after PET-CT scan was performed. Examination revealed a mass with the widest diameter of 9 cm and a surgical decision was made due to the rapid growth pattern. Tumor markers appeared to be within the normal range. Laparoscopic right salpingoopherectomy was performed and frozen section biopsy was obtained. The result was found to be malignant and complementary surgery was performed. Pathological examination of the cystic mass, which was detected to have only nonspecific findings on radiological exam, revealed tiny solid areas in its capsule. The patient was started on postoperative Dabrafenib + Trametinib treatment by oncology and was followed up without recurrence until the 24th postoperative month. At month 24, the brain metastasis with no response to radiotherapy occurred and the patient was lost on the 15th day after decompression surgery. It is important to send adnexal masses to the frozen even if they appear to have a benign character. In patients with a known history of primary cancer, the possibility of the metastasis from the primary tumor site to the ovary should be considered in those whose peroperative frozen section result is in favor of malignancy. Our case is the first case of ovarian malignant melanoma metastasis with a completely cystic and septa-free character in the literature.