International Journal of Cancer Therapy and Oncology
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Evaluation of Eclipse 3D plans using an independent treatment planning system
Get PDFPurpose: The goal of the current investigation was to compare complex 3D conformal plans generated on Eclipse™ treatment planning system (TPS) with independent dose calculations from radiation oncology planning system (ROPS™) TPS used as a secondary quality assurance check.Methods: Fifteen cancer patients that were treated with complex conformal treatment plans with cobalt and linac beams, using Eclipse TPS, were selected for this study. The structure sets, treatment beam data and prescription information were exported from the Eclipse TPS using DICOM-RT export. Using custom software, these data were imported into ROPS TPS. Independent dose calculation on the ROPS planning system using Clarkson summation algorithm was done. The dose volume histograms (DVH) from both planning systems were extracted and analyzed using custom software. Dose assessment was accomplished by defining criteria based on gross tumor volume (GTV) dose coverage, dose homogeneity and mean dose. For organs at risk (OAR) other than GTV, the main dose parameters were, mean dose and percentage of volume receiving 95% of prescription dose.Results: For the GTV, all 15 cases met the criteria set for the mean dose and dose homogeneity index. However, breast cases were found to have deviation in the percentage volume receiving the 95% of prescription dose.Conclusion: Using the criteria set for plan acceptance, all the 15 clinical cases were evaluated. Except for breast tangent plans, all plans passed all the criteria set. The large deviation for breast tangent plans was attributed to differences in dose calculation algorithms
A preliminary investigation on long-term consistency of MPC as a quick daily QA application
Get PDFPurpose: The purpose of this study was to establish Machine performance check (MPC) application as a comprehensive daily QA program in a clinical setting for a True Beam 2.0 system and investigate the first ten months (195 days) daily QA data generated by the MPC.Methods: An automated daily quality assurance (QA) application named machine performance check (MPC) was recently launched by Varian Medical Systems with their TrueBeam 2.0 linear accelerator (linac) system. MPC performs all the essential machine tests such as Beam Constancy Check, and Geometry Check with the use of an IsoCal phantom. There is no systematic published study on long-term consistency and validation of MPC in a clinical set-up for its acceptance as an alternative QA application. In the present study, we collected data with the MPC for over ten months (195 days) on a TrueBeam 2.0 system. The data was analysed for reproducibility and also compared with the data collected with other statndard QA devices at the time of commissioning of the TrueBeam system for validation.Results: The results showed that the reproducibility of MPC was at least an order of magnitude less than the tolerance values for the respective parameters and also the average measured values for all QA parameters studied. The MPC measured isocenter accuracy, and output values were close to the Winston-Lutz test (within 0.1 mm) and the ion-chamber measurements (within 0.1%), respectively.Conclusion: With our long term result, it is evident that the MPC could be an alternative daily QA tool. A comprehensive and long-term validation of the MPC measured values with the other standard QA methods over the ten month period will be needed before accepting MPC as a reliable QA tool
Area-level factors associated with spatial variation of prostate cancer incidence for black men
Get PDFPurpose: Black men are disproportionately affected by prostate cancer (CaP) compared to any other racial/ethnic groups within the United States. Identifying CaP hotspots along with associated local area-level risk factors is crucial to tackling the significant burden of CaP and the disparity seen in Black men. The objective of this study was to determine the scope of geographical variation in CaP incidences and to assess the degree to which this variation is associated with county-level risk and protective factors.Methods: The study population was Black men diagnosed with prostate cancer between 2006-2010 in Florida. County-level CaP incidence rates were computed as the ratios of the numbers of new CaP cases diagnosed between 2006 and 2010 to the corresponding 2000 US census population of Black men 20 and over years old data (US Census 2000). Other county-level environmental and health care factors were also obtained. A random effects Poisson model and Geographical Information System (GIS) were used to map and assess the spatial patterns of CaP incidences in 67 Florida counties. These statistical techniques involved a Bayesian approach for estimating the underlying county-specific CaP risk since the data are very sparse.Results: The findings showed that an increasing CaP incidence of Black Men in Florida was significantly associated with an increasing unemployment rate ( 2 with 95% CI: (.0025, .2703), does not include zero suggesting significance) and with increasing number of physicians per capita after controlling for other county characteristics. There was a negative association between poverty and CaP incidence. Regarding spatial distribution of CaP incidence, we observed that there are clustering and hotspots of high CaP incidence rates in Palm Beach county in South Florida, and Alachua and Marion counties in north Florida.Conclusion: Our findings showed that indicators of socioeconomic status and accessibility of health care services such as poverty, unemployment and health care providers are important variables that explain spatial variation of prostate cancer incidence rates of Black Men. Better understanding of such risk factors and identifying specific counties with a disproportionate burden of CaP disease may help formulate targeted interventions and resource allocation by state and local public official
Clinical characteristics of aggressive Non-Hodgkin lymphoma with emphasis on the role of positron emission tomography/computed tomography in assessment of treatment response: a retrospective study
Get PDFPurpose: The purpose of this study was to evaluate the role of post-treatment Positron Emission Tomography/Computed Tomography (PET/CT) in aggressive non-Hodgkin’s lymphoma (NHL) with regard to the clinical and treatment characteristics and disease-free survival (DFS).Methods: We retrospectively studied charts of 30 patients with aggressive NHL who had PET/CT only after completion of treatment.Results: Thirty patients received CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or Rituximab (R)-CHOP (22 and 8 patients respectively), followed by radiotherapy in 19/30 patients (63.3%). Following 3-4 cycles of chemotherapy, interim CT showed regressive, stationary and progressive disease in 18, 10, 2 (60%, 33.3%, 2%) patients respectively. PET/CT was performed 4-6 weeks after end of treatment. 22/30 (73.3%) patients had negative scan, of whom 13 (59.1%) patients remained in remission till the end of the study while 9 patients relapsed after a median DFS of 12 months. PET/CT was positive in 8/30 (26.7%) patients who had refractory disease. PET/ CT scan had sensitivity of 75%, specificity of 72.7%, negative predictive value (NPV) of 88.9%, and positive predictive value (PPV) of 50%.Conclusion: PET/CT has an important role in end- of- therapy response evaluation in fluorodeoxyglucose (FDG)-avid aggressive NHL. It proves high sensitivity and specificity in detection of residual disease and provides an accurate indication of overall survival and disease-free survival. CT continues to have an important role in post-treatment response assessment whether as a single modality or in combination with PET scan
Cloning and expression of the V-domain of the CD166 in prokaryotic host cell
Get PDFPurpose: CD166/ALCAM (Activated leukocyte cell adhesion molecule) as an immunoglobulin is implicated in cell migration. It is also involved in tumorigenesis of CRC (colorectal cancer) and known as a cancer stem cell marker. CD166, as a membrane protein, potentially represents either diagnostic or therapeutic capacities for CRC.Methods: In this study, the sequence of V domain was optimized for expression in prokaryotic host using online tools and cloned into pET-28a plasmid. The recombinant pET28a was transformed into the E. coli BL21DE3 using heat shock method and expression of recombinant V domain was examined using SDS-PAGE (sodium dodecyl sulfate polyacrylamide gel electrophoresis).Results: The results confirmed protein expression of recombinant 22.77 kDa V domains in bacterial expression system.Conclusion: V domain of the CD166 was expressed successfully in E. coli bacteria. This recombinant fragment can be introduced as a suitable diagnostic and therapeutic candidate for screening and cancer-therapy of CRC patients, respectively.
The comparison between TP53 gene polymorphisms (c.[215G>C]) homozygotes and heterozygotes in Breast Cancer Patients: A clinicopathological analysis
Get PDFPurpose: TP53 is a tumor suppressor gene which participates in regulation of cell cycle check points, DNA repair, and apoptosis. The aim of this study was to compare TP53 germ line gene polymorphisms (c.[215G>C]) wild – type homozygotes GG with heterozygotes GC according to clinicopathological factors.Methods: We reviewed the medical records of 87 (22% TP53 gene homozygotes and 78% heterozygotes) breast cancer patients who were diagnosed and treated in COI in Gliwice. Polymorphism profile was assessed by RFLP-PCR technique.Results: The presence of lobular invasive carcinoma was observed insignificantly more often in homozygotes, especially in the group of patients at the age below 50 years (29% vs. 4%, p = 0.095). Patients being TP53 gene heterozygotes had larger tumor size (T > 2) than homozygotes (16% vs. 5%, p = 0.450). There was observed a tendency to the presence of lymph node metastases (53% vs. 34%, p = 0.182) and higher Ki67 (> 20%) (69% vs. 46%, p = 0.209) in TP53 gene homozygotes. HER2 overexpression was associated with TP53 heterozygotes, especially in the group of patients at the age above 50 years (33% vs. 8%, p = 0.144). A negative receptor status was reported more frequently in homozygotes (43% vs.21%, p = 0.340) in patients with age below 50 years. Similarly higher histological grade G3 was detected more often in homozygotes in patients at the age below 50 years (80% vs. 33%, p = 0.130).Conclusion: TP53 gene homozygotes and heterozygotes differ from each other in respect of clinicopathological factors such as: histological type, lymph node metastases, higher Ki67 (> 20%), histological grade G3, ER/PR status, tumor size (T > 2), HER2 overexpression, cancer in family history and diabetes. Patient’s age was associated with the pathological characteristics of tumor
Exploring the role of “Glycerine plus Honey” in delaying chemoradiation induced oral mucositis in head and neck cancers
Get PDFPurpose: The purpose of this study was to assess the efficacy of adding “Glycerine plus Honey” to standard management protocol, in terms of time to delay in oral mucositis ≥ grade 2.Methods: Hundred patients of oral cavity and oropharangeal cancers, planned for concurrent chemoradiation (Dose: 60–66 Gy/30-33 fractions) were randomized 1:1 to receive either home-made remedy made of “Glycerine plus Honey” added to the standard management protocol to prevent mucositis versus standard treatment alone. CTCAE v 4 (Common toxicity criteria for adverse events) was used for assessing oral mucositis scores weekly. Chi square test was used to compare mucositis scores, weight loss, opioid use, ryles tube feeding, and unplanned treatment breaks in each cohort. Independent T-test was used to compare means to assess the effect of treatment in delaying mucositis ≥ grade 2.Results: Significantly higher number of patients developed grade ≥ 2 mucositis in control arm [n = 43 (86%)] compared to study arm [n = 30 (60%)] (p = 0.003). CTCAE scores favored Glycerine plus honey at week 4, and on last day of radiotherapy. Whereas, time to first occurrence of oral mucositis grade ≥ 2 was 23.17 (± 1.01) days for study arm [radiation dose 31.67 Gy (± 1.44)], it was 20.65 (± 0.8) days for control arm [radiation dose 28.14 Gy (± 1.16)] (p = 0.05). Study patients had lesser weight loss (2.76 kg) than control subjects (3.9 kg) with p = 0.008. There were significantly higher number of patients in control arm who required opioid analgesia, ryles tube insertion and had unplanned treatment breaks, compared to study arm.Conclusion: Glycerine plus honey demonstrated superiority in delaying oral mucositis, and the combination is safe and well tolerable.
Clinical implementation of IMRT step and shoot with simultaneous integrated boost for breast cancer: A dosimetric comparison of planning techniques
Get PDFPurpose: Radiotherapy post-lumpectomy with two coplanar tangent beams is the standard treatment for women with early stage breast cancer. Despite the use of wedges as tissue compensators, the resultant plans often contains a significant dose gradient and 'hot spots' in excess of 15% or more of prescribed dose. In recent years a field-in-field (FIF) dose-compensation technique, which use two standard tangent fields and one or two (rarely three) small beams within these, was developed. It allows to obtain a more uniform dose throughout the target volume in the majority of cases but not in all. This study presents our experience to develop optimal intensity modulated radiation therapy (IMRT) techniques to be applied clinically in those cases where the traditional technique with two tangent fields or its variant field in field (FIF) are unable to achieve a satisfactory planning target volumes (PTVs) coverage and dose objectives to the organs at risk (OARs). Methods: We investigated two pure IMRT plans (named 3F-IMRT and 4F-IMRT) and a hybrid one (H-IMRT). Treatment plans were performed for 7 left-sided and 4 right-sided breasts using simultaneously integrated boost (SIB) planned technique with inverse optimization. Results were compared with those obtained with FIF technique. Dose prescribed was 45 Gy/20 fractions to the breast and 50 Gy /20 fractions to the lumpectomy cavity delivered in 5 fr/week. Dose–volume histograms were generated and parameters as target dose coverage, conformity and homogeneity as well as OARs dose distribution were analyzed. Finally the secondary cancer risk to contralateral breast due to radiation was evaluated as a further parameter for the choice of the optimal plan. Results: Compared to the FIF, the three IMRT plans provided the same target coverage and a better dose conformation, but a worst dose homogeneity of the boost target. The volume of the OARs, receiving higher doses than 15 Gy was reduced but was increased the volume receiving low doses. This causes the increase of the risk of radiation induced cancer, especially for the contralateral breast. For this organ, the highest value of the excess absolute risk (EAR) was associated to the 4F-IMRT, while the lower, to the FIF. Conclusion: The intensity-modulated radiation therapy techniques 5F-IMRT and 4F-IMRT were the best to be applied clinically in those cases, where the traditional technique of irradiation of the breast is unable to achieve the PTVs coverage and dose objectives to the OARs. However, all the IMRT techniques showed an increased volume of healthy tissues receiving low doses, so they should not be used in extensive manner and in particular should be avoided in the cases of young women due to the excess of risk to develop a secondary cancer
Chronic adult T-cell Leukemia in a young male after blood transfusion as a newborn
Get PDFHuman T-cell Lymphotropic virus type 1 (HTLV-1) is the etiological agent of Adult T-cell Leukemia/Lymphoma (ATLL) and HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis (HTM/TSP). Areas of extremely high HTLV-1 prevalence are surrounded by areas of middle or very low prevalence. ATLL is an aggressive lymphoproliferative malignancy of peripheral T cells, with an incidence of less than 5% in HTLV-1-infected individuals. ATLL developed in the majority of cases in individuals who were infected with HTLV-1 by their mothers due to prolonged breastfeeding. In non-endemic areas, ATLL is usually limited to immigrants, their sexual partners and descendants from endemic regions. Very few cases of ATLL have been diagnosed in recipient patients few years after an organ transplantation or blood transfusion worldwide. Achieving an accurate and fast diagnosis of ATLL can be challenging due to the lack of professional experience, delayed consultation and difficulty in its sub-classification. We present a case of a delayed onset of a chronic ATLL in an 18-years-old male who was transfused with blood components as a premature newborn in Buenos Aires, a non-endemic city of South America
Involved-site radiation therapy by volumetric modulated arc therapy versus 3D- conformal radiotherapy for treatment of stages I and II supra-diaphragmatic Hodgkin’s lymphoma
Get PDFPurpose: Based on the observation that recurrences of Hodgkin's lymphoma (HL) typically occur in sites of initial nodal involvement the need to concise radiotherapy to only involved nodes that was termed as involved nodal radiotherapy (INRT) or of involved site lymph nodes, involved-site radiation therapy (ISRT) is starting to be widely accepted to use in early stage HL. We aimed in our study to compare between volumetric modulated arc therapy (VMAT) and 3D-conformal radiotherapy (3D-CRT) in radiation of early stage supra-diaphragmatic HL.Methods: The clinical and dosimetric data of 34 patients affected with stages I and II supra-diaphragmatic HL, treated between January 2011 and September 2015 with combined modalities therapy in a single institution were analyzed. Patients received 2-8 cycles of combination chemotherapy ABVD (Adriamycin, Bleomycin, Vinblastine & Dacarbazine) on days 1 and 15 repeated every 28 days. The clinical target volume (CTV) was contoured based on the pre-chemotherapy CT and PET-CT scans. Modification of the CTV was done according to post-chemotherapy anatomical changes. The radiation dose given was 30 Gy/15 fractions.Results: After a median follow up period of 30 months, the progression free survival (PFS) and overall survival (OS) in both groups were 100%. Oropharengeal mucositis was the commonest toxicity in both groups. There was no statistically significant deference between the acute radiation toxicities in both groups. The Dmean valuefor lung was higher in 3D-CRT than VMAT (12.0 ± 6.1 Gy vs. 9.9 Gy ± 8.6 Gy). For the breasts volume, the V5Gy was slightly higher for 3D-CRT compared with VMAT at, 7.6% and 6.5% respectively. For the heart, V5Gy and V10Gy valueswere higher for the RA than for 3D-CRT accounting for (51.9 ± 28.9%) and (41.0 ± 24.6%) versus (40.0 ± 25.9% and 30.7 ± 22.5%) respectively. Thyroid gland mean dose was lower for VMAT (21.8 ± 7.7 Gy) than for 3D-CRT (26.8 Gy ± 4.1 Gy) but did not reach statistically significant value (P = 0.06).Conclusion: Involved-site VMAT technique is safe and effective in term of providing excellent local control and survival following ABVD-based chemotherapy