International Journal of Cancer Therapy and Oncology
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Microdosimetric characterisation of radiation fields for modelling tissue response in radiotherapy
Get PDFPurpose: Our overall goal is the development of an approach to model tissue response to radiotherapy in which a tissue is viewed as a statistical ensemble of interacting cells. This involves characterisation of radiation fields on the spatial scale of subcellular structures. On this scale, the spatial distribution of radiation energy imparted to tissue is highly non-uniform and should be characterised in statistical terms. Microdosimetry provides a formalism developed for that purpose. This study addresses limitations of the standard microdosimetric approach to modelling tissue response by introducing two new characteristics that include additional information in a form convenient for this application.Methods: The standard microdosimetric approach is based on the concept of a sensitive volume (SV) representing a target volume in the cell. It is considered in isolation from other SVs, implying that energy depositions in different SVs are statistically independent and that individual cells respond to radiation independent of each other. In this study, we examined the latter approximation through analysis of correlation functions. All calculations were performed with Geant4-DNA Monte Carlo code. Results: We found that for some realistic scenarios, spatial correlations of deposited energy can be significant. Two new characteristics of radiation fields are proposed. The first is the specific energy-volume histogram (zVH), which is a microscopic analogue of the dose-volume histogram. The second describes the probability distribution of deposited energies in two SVs without assuming statistical independence between the SVs. Numerical examples for protons and carbon ions of therapeutic energies are presented and discussed.Conclusion: We extended the microdosimetric approach to modelling tissue response by including additional important characteristics and presented them in a more conventional radiotherapy format.---------------------------------------------Cite this article as: Wang H, Vassiliev ON. Microdosimetric characterisation of radiation fields for modelling tissue response in radiotherapy. Int J Cancer Ther Oncol 2014; 2(1):020116.DOI: http://dx.doi.org/10.14319/ijcto.0201.1
Primary cerebello-pontine angle melanoma: a case report
Get PDFIntra-cranial melanomas are commonly metastatic from primary melanoma elsewhere in the body. The primary occurrence of a melanoma in the brain parenchyma is rare. We report a case of 38 year aged woman who presented with deviation of left eye and headache. On imaging, a space occupying lesion was found in the left Cerebello-pontine angle and a preoperative diagnosis of meningioma was made. She underwent left retro-mastoid sub-occipital craniectomy and excision of a black vascular tumor. Histopathological examination revealed a melanoma which was confirmed with Immunohistochemical assay. Search for dermal, mucous and ocular lesions were negative. She received adjuvant radiation to the post- operative tumor bed to 5400cGy in 30 fractions using Intensity Modulated Radiation Therapy technique along with concurrent Temozolomide. She tolerated the treatment well and is symptom free 12 months after treatment. Primary Melanomas are rare lesions of the Cerebello-pontine angle and its radiological features, evaluation and management have been discussed.-------------------Cite this article as: Ponni A, Jagannatha A, Gururajachar J, Harjani R, Koushik K, Subramanian N, Sowmya R, Varma R. Primary cerebello-pontine angle melanoma: a case report. Int J Cancer Ther Oncol 2014; 2(3):020315. DOI: 10.14319/ijcto.0203.1
Derivation of equations to define inflection point and its analysis in flattening filter free photon beams based on the principle of polynomial function
Get PDFPurpose: The objective of this work is to (1) present a mechanism for calculating inflection points on profiles at various depths and field sizes, and (2) study the doses at the inflection points for various field sizes at depth of maximum dose (Dmax) for flattening filter free (FFF) photon beam profiles. Methods: Graphical representation was done on percentage of dose versus inflection points. Also, using the polynomial function, the author formulated equations for calculating spot-on inflection point on the profiles for both the 6MV and 10 MV energies for different field sizes at various depths. Results: In a 10 MV FFF radiation beam, the dose at inflection point of the profile decreases as the field size increases. However, in 6MV FFF radiation beam, the dose at the inflection point initially increases with an increase in the field size up to 10 ×10 cm2 and decreases after 10 ×10 cm2. The polynomial function was fitted for both the 6 MV and 10 MV FFF beams for all field sizes and depths. Conclusion: Polynomial function is one of the easiest ways of identifying the inflection point in FFF beam for various field sizes and depths. Graphical representation of dose versus inflection point for both FFF energies was derived
Impact of different IMRT techniques to improve conformity and normal tissue sparing in upper esophageal cancer
Get PDFPurpose: Intensity modulated radiotherapy (IMRT) for cervical esophageal cancer is challenging. Although IMRT techniques using inverse planning algorithms are facilitating the treatment planning process, the irradiation dose to the normal tissues can be a critical issue. This study was performed to investigate the effect of beam numbers and their directions and local optimization on: (1) dose conformity and homogeneity to the planning target volume (PTV) and (2) dose to the organ at risks (OARs).Methods: Four upper esophageal cancer cases were randomly selected for this treatment planning study. Eight IMRT plans were generated for each case with the same dose-volume constraints but with different beam numbers and arrangements. Local optimization using regular structures drawn automatically around the PTV with margins from 0.5-1.5 cm was performed. IMRT plans were evaluated with respect to isodose distributions, dose-volume histograms (DVHs) parameters, homogeneity index (HI), and conformity index (CI). The statistical comparison between the types of plans was done using the One Way ANOVA test.Results: The results showed that IMRT using three or five beams was not sufficient to obtain good dose optimization. The seven field plans showed the best coverage for the PTV with tolerable doses for the OARs, and the beam orientation was very critical. Increasing beams (Bs) number from 7 to 13 did not show significant differences in the PTV coverage, while the mean lung dose was increased. The PTV coverage were 95.1, 95.1, 98.1, 97.3, 97.3, 97.3, 97.0, and 97.0% for 3Bs, 5Bs, 7Bs, 9Bs, 13Bs, 7Bs(30), 7Bs(60) (beam angles were changed from 0o to 30o and 60o), and 7Bs(R) (seven IMRT plans with ring), respectively. The mean heart dose did not exceed 0.36 Gy with p < 0.05. For lung doses, the best plan was the one with 9Bs which reduced lung volume doses V20Gy (%) and V30Gy (%), and reduced mean lung dose from 5.4 to 4.5 Gy with p < 0.05 for 7Bs(R) plans. IMRT improved the homogeneity indices (p > 0.05), yet conformity was better with 9Bs and 7Bs(R) IMRT plans with p < 0.05.Conclusion: Seven equispaced coplanar intensity-modulated beams with an addition of a ring structure can produce desirable dose distributions to the PTV. Moreover, dose-volume of exposed normal lung can be reduced with 9Bs and 7Bs(R) IMRT plans
Thoracic spinal cord compression due to xtramedullary haemopoiesis in a patient with beta-thalassemia: complete clinical regression with radiation therapy alone
Get PDFSpinal cord compression due to Extramedullary Haemopoesis in beta-thalassemia is extremely rare. Controversies are there between the two modalities of treatment surgery vs radiation therapy. We present here a case of beta thalassemia major in a twenty one years female patient who presented with features of spinal cord compression due to extramedullary haemopoesis.. She was then treated with 3000 cGy of radiation therapy targeted to the T5-T8 region, as 200 cGy/fraction daily, 5 fractions/week , over 6 weeks .The patient’s haemoglobin was elevated from 6.1g/dl to 10.1g/dl, with her haematocrit rising from 26.3 % to 32.8%.Steroid dose was tapered on hospital day number 7.She achieved near full neurological recovery after medical treatment with steroids, blood transfusion and radiation therapy.
Energy dependence of polymer gels in the orthovoltage energy range
Get PDFPurpose: Ortho-voltage energies are often used for treatment of patients’ superficial lesions, and also for small- animal irradiations. Polymer-Gel dosimeters such as MAGAT (Methacrylic acid Gel and THPC) are finding increasing use for 3-dimensional verification of radiation doses in a given treatment geometry. For mega-voltage beams, energy dependence of MAGAT has been quoted as nearly energy-independent. In the kilo-voltage range, there is hardly any literature to shade light on its energy dependence.Methods: MAGAT was used to measure depth-dose for 250 kVp beam. Comparison with ion-chamber data showed a discrepancy increasing significantly with depth. An over-response as much as 25% was observed at a depth of 6 cm.Results and Conclusion: Investigation concluded that 6 cm water in the beam resulted in a half-value-layer (HVL) change from 1.05 to 1.32 mm Cu. This amounts to an effective-energy change from 81.3 to 89.5 keV. Response measurements of MAGAT at these two energies explained the observed discrepancy in depth-dose measurements. Dose-calibration curves of MAGAT for (i) 250 kVp beam, and (ii) 250 kVp beam through 6 cm of water column are presented showing significant energy dependence.-------------------Cite this article as: Roed Y, Tailor R, Pinksy L, Ibbott G. Energy dependence of polymer gels in the orthovoltage energy range. Int J Cancer Ther Oncol 2014; 2(2):020232. DOI: 10.14319/ijcto.0202.32
Atypical presentation of primary renal squamous cell cancer: a case report
Get PDFRenal squamous cell cancer is one of the rare primary urothelial tumors with only a handful of cases reported in literature. Because of high grade, advanced and late presentation, they herald a grave prognosis. They are frequently associated with calculus disease, smoking, phenacetin consumption and foci of squamous metaplasia due to chronic irritation. Nephroureterectomy is the treatment of choice for such tumors. We hereby present a case of 59 year old female who presented with squamous cell cancer of renal pelvis. The case presented here is different from what has already been reported in literature, as the patient had no antecedent risk factors for renal squamous cell carcinoma.-------------------------------------------------Cite this article as: Pahwa M, Pahwa AR, Girotra M, Chawla A. Atypical presentation of primary renal squamous cell cancer: a case report. Int J Cancer Ther Oncol 2014; 2(1):02015.DOI: http://dx.doi.org/10.14319/ijcto.0201.
Effect of interfractional shoulder motion on low neck nodal targets for patients treated using volume modulated arc therapy (VMAT)
Get PDFPurpose: To quantify the dosimetric impact of interfractional shoulder motion on targets in the low neck for head and neck patients treated with volume modulated arc therapy (VMAT).Methods: Three patients with head and neck cancer were selected. All three required treatment to nodal regions in the low neck in addition to the primary tumor site. The patients were immobilized during simulation and treatment with a custom thermoplastic mask covering the head and shoulders. One VMAT plan was created for each patient utilizing two full 360° arcs and a second plan was created consisting of two superior VMAT arcs matched to an inferior static AP supraclavicular field. A CT-on-rails alignment verification was performed weekly during each patient’s treatment course. The weekly CT images were registered to the simulation CT and the target contours were deformed and applied to the weekly CT. The two VMAT plans were copied to the weekly CT datasets and recalculated to obtain the dose to the deformed low neck contours.Results: The average observed shoulder position shift in any single dimension relative to simulation was 2.5 mm. The maximum shoulder shift observed in a single dimension was 25.7 mm. Low neck target mean doses, normalized to simulation and averaged across all weekly recalculations were 0.996, 0.991, and 1.033 (Full VMAT plan) and 0.986, 0.995, and 0.990 (Half-Beam VMAT plan) for the three patients, respectively. The maximum observed deviation in target mean dose for any individual weekly recalculation was 6.5%, occurring with the Full VMAT plan for Patient 3.Conclusion: Interfractional variation in dose to low neck nodal regions was quantified for three head and neck patients treated with VMAT. Mean dose was 3.3% higher than planned for one patient using a Full VMAT plan. A Half-Beam technique is likely a safer choice when treating the supraclavicular region with VMAT.-------------------------------------------Cite this article as: Casey K, Wang P, Tung S, Rosenthal D. Effect of interfractional shoulder motion on low neck nodal targets for patients treated using volume modulated arc therapy (VMAT). Int J Cancer Ther Oncol 2014; 2(2):020218. DOI: 10.14319/ijcto.0202.1
Comparison of low contrast sensitivity among multi-slice CT units using various mAs setting for the potential benefit of non-MRI compatible, stereotactic radiosurgery (SRS) patients
Get PDFPurpose: To evaluate the low contrast detectability sensitivity among 4-slice, 8-slice and 16-slice CT units using various mAs settings. Findings of the study may elucidate the most optimal imaging parameter for stereotactic radiosurgery (SRS) patients who are not MRI compatible.Methods and Materials: Low contrast targets in the CATPHAN phantom (model: CTP 504, The Phantom Laboratory) were imaged on a 4-slice LightSpeed Advantage™ GE CT scanner (GE Healthcare, WI) and a 16- slice LightSpeed Advantage™ GE CT scanner (GE Healthcare, WI) in 8-slice and 16-slice mode. The CATPHAN CTP515 low contrast targets of size 15, 9, 8, 7, 6, 5, 4, 3 and 2 mm for each contrast difference of 1%, 0.5% and 0.3% from the water-equivalent background was imaged using a SRS protocol. Two image sets per setting were acquired for mAs parameters of 300, 350 and 440. Images were evaluated in a blind study by three independent reviewers.Results: Using 300,350 and 440mAs settings on the 4-slice scanner, the average smallest diameters recorded at 1% contrast were 5 ± 1 mm, 5 ± 1 mm and 5 ± 0 mm and at 0.5% were 7 ± 2 mm, 7 ± 1 mm and 6 ± 1 mm. For the 8 - slice scanner, the average smallest diameters recorded at 1% contrast were 7 ± 0 mm, 6 ± 0 mm and 5 ± 0 mm, and at 0.5% were 12 ± 3 mm, 9 ± 1 mm and 6 ± 1 mm. For the 16 - slice scanner, the average smallest diameters recorded at 1% contrast were 7 ± 1 mm, 7 ± 1 mm and 6 ± 1 mm, and at 0.5% were 11 ± 3 mm, 8 ± 1 mm and 8 ± 1 mm. A difference was observed between the 4 and 8 - slice scanners at 300mAs (p < 0.01) for each contrast level as well as the 4 and 16 slice at 440 (p < 0.01) and 350 (p < 0.01) mAs. Additionally, a difference was observed between each mAs for the 8 slice at 1% (p < 0.01) and 0.5% (p < 0.01) contrast.Conclusion: Results demonstrate consistently improved low contrast detectability as mAs was increased. CT simulation imaging parameters can be optimized to improve low contrast sensitivity for non MRI compatible SRS patients.----------------Cite this article as: Stanley D, Narayanasamy G, Breton C, Papanikolaou N, Gutierrez AN. Comparison of low contrast sensitivity among multi-slice CT units using various mAs setting for the potential benefit of non-MRI compatible, stereotactic radiosurgery (SRS) patients. Int J Cancer Ther Oncol 2014; 2(2):020237. DOI: 10.14319/ijcto.0202.3
A method to quantify and assess the dosimetric and clinical impact resulting from the heterogeneity correction in radiotherapy for lung cancer
Get PDFPurpose: The aim of this study was to propose a method to quantify and assess the differences in dose computations using heterogeneity correction algorithms for the planning target volumes and organs at risk.Methods: Six patients with lung cancer treated with 3-dimensional conformal radiation therapy were included and analysed. Dose calculations were performed using the pencil beam convolution (PBC) algorithm without heterogeneity correction and the Modified Batho method (PBC-MB) with heterogeneity correction. For each patient, 3 treatment plans were generated using exactly the same beam configuration. In plan 1, the dose was calculated using the PBC algorithm. In plan 2, the dose was calculated using the PBC-MB. In plan 3, the dose was calculated using the PBC-MB method but with the same number of monitor units obtained from plan 1. To evaluate the treatment plans computed by the PBC and PBC-MB, the monitor units, dose at the isocenter, spatial isodose distribution, dose volume histograms, conformity index, homogeneity index, planning target volumes conformity index, and geometrical index were compared. A statistical analysis was carried out using Wilcoxon signed rank test. Results: The PBC-MB method in plan 2 produced a lower number of monitor units than in plan 1 using PBC algorithm (p < 0.001). Dosimetric parameters derived from the dose volume histograms were higher for the planning target volumes and organs at risks using PBC-MB method for plans 2 and 3 when compared to plan 1. There was no significant difference for all the quality indices between plan 1 and plan 2, (p > 0.05), but a significant difference for the geometric index between plans 2 and 3 (p = 0.002) was observed.Conclusion: The risks related to the modification from the homogeneity plan to the heterogeneity plan were the reduction of delivered dose in monitor units for the planning target volumes and the increment of the dose to the organs at risk. We suggest the adaption in the dose prescriptions when switching the dose calculation algorithm from the PBC to PBC-MB.------------------------------------------------------Cite this article as: Chaikh A, Giraud J, Balosso J. A method to quantify and assess the dosimetric and clinical impact resulting from the heterogeneity correction in radiotherapy for lung cancer. Int J Cancer Ther Oncol 2014; 2(1):020110.DOI: http://dx.doi.org/10.14319/ijcto.0201.1