International Journal of Cancer Therapy and Oncology
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2D vs 3D gamma analysis: Establishment of comparable clinical action limits
Get PDFPurpose: As clinics begin to use 3D metrics for intensity-modulated radiation therapy (IMRT) quality assurance; these metrics will often produce results different from those produced by their 2D counterparts. 3D and 2D gamma analyses would be expected to produce different values, because of the different search space available. We compared the results of 2D and 3D gamma analysis (where both datasets were generated the same way) for clinical treatment plans. Methods: 50 IMRT plans were selected from our database and recalculated using Monte Carlo. Treatment planning system-calculated (“evaluated”) and Monte Carlo-recalculated (“reference”) dose distributions were compared using 2D and 3D gamma analysis. This analysis was performed using a variety of dose-difference (5%, 3%, 2%, and 1%) and distance-to-agreement (5, 3, 2, and 1 mm) acceptance criteria, low-dose thresholds (5%, 10%, and 15% of the prescription dose), and data grid sizes (1.0, 1.5, and 3.0 mm). Each comparison was evaluated to determine the average 2D and 3D gamma and percentage of pixels passing gamma.Results: Average gamma and percentage of passing pixels for each acceptance criterion demonstrated better agreement for 3D than for 2D analysis for every plan comparison. Average difference in the percentage of passing pixels between the 2D and 3D analyses with no low-dose threshold ranged from 0.9% to 2.1%. Similarly, using a low-dose threshold resulted in a differences ranging from 0.8% to 1.5%. No appreciable differences in gamma with changes in the data density (constant difference: 0.8% for 2D vs. 3D) were observed.Conclusion: We found that 3D gamma analysis resulted in up to 2.9% more pixels passing than 2D analysis. Factors such as inherent dosimeter differences may be an important additional consideration to the extra dimension of available data that was evaluated in this study.------------------------------------Cite this article as: Pulliam KB, Huang JY, Bosca R, Followill D, Kry SF. 2D vs. 3D gamma analysis: Establishment of comparable clinical action limits. Int J Cancer Ther Oncol 2014; 2(2):020231. DOI: 10.14319/ijcto.0202.3
A 3D quantitative evaluation for assessing the changes of treatment planning system and irradiation techniques in radiotherapy
Get PDFPurpose: This work proposes and compares two 3D global evaluation methods for assessing the alteration of calculated dose distributions when treatment planning system algorithms or irradiation techniques is modified in radiation therapy. Methods: The global analysis is based on gamma index (γ) proposed by Low et al.1 and Chi (χ) index proposed by Bakai et al.2. The γ and χ values are signed in order to identify the over and under estimating dosage. The 3D maps, the cumulative Gamma Voxels Histograms (GVHs) and Chi Voxels Histograms (CVHs) were generated using two software. The γ and χ criteria were set to 3 mm for the distance to agreement and 3% for dose. Pearson's Chi-squared test was applied to assess the statistically significance between GVHs and CVHs. We illustrated this method for the change of dose calculation algorithms for lung cancer, and the change of irradiation techniques for breast cancer. For each patient, 2 treatment plans were generated. For the example of change of dose calculation algorithms, a plan 1 was calculated using Pencil Beam Convolution (PBC) algorithm and a plan 2 was calculated using Modified Batho method (PBC-MB). For the example of change of irradiation technique, a plan 1 was calculated using Source Skin Distance SSD technique and a plan 2 was calculated using a single isocenter technique. Results: The 3D analysis based on γ and χ indexes showed a significant effect on the dosimetric representation in the lung cancer when we change the PBC algorithm to PBC-MB method. The comparison between the two irradiation techniques showed that the single isocenter technique produces a better dose distribution for the treatment of breast cancer. Pearson's Chi-squared test showed that there was no statistically significance between GVHs and CVHs generated by γ and χ indexes, (p > 0.05). The global analysis using 3D for γ and χ indexes confirmed the results obtained from dosimetric analysis. Conclusion: The methods proposed in this study provide useful tools for radiotherapy to compare two dose distributions obtained using different algorithms or different irradiation techniques. The χ-index was (~190) times faster than γ-index. The χ-index is thus a valuable and more convenient method for 3D global analysis compared with γ-index.------------------------Cite this article as: Chaikh A, Giraud JY, Balosso J. A 3D quantitative evaluation for assessing the changes of treatment planning system and irradiation techniques in radiotherapy. Int J Cancer Ther Oncol 2014; 2(3):02033. DOI: 10.14319/ijcto.0203.
Clinical use of electronic portal imaging to analyse tumor motion variation during a 3D-conformal prostate cancer radiotherapy using online target verification and implanted markers
Get PDFPurpose: To evaluate the daily treatment setup variation and the interfraction and intrafraction prostate motion with portal imaging and implanted fiducial markers during irradiation with a 3D conformal radiotherapy for localized prostate cancer patients.Methods: By remote verification, shifts from isocenteric positioning and inter/intra-fraction prostate motion were investigated for 34 patients treated supine with escalated dose conformal radiotherapy. To limit the effect of inter-fraction prostate motion, patients were planned and treated with an empty rectum and a comfortably full bladder. Daily pre-therapy and treatment electronic portal images were obtained for anterior and lateral treatment fields according to an on-line target localization protocol using three gold markers. From these images, random and systematic set-up errors were measured by matching corresponding patients’ gold markers on reference digitally reconstructed radiographs (DRR). Superior-inferior, anterior-posterior and lateral motions were measured from the displacement of the gold markers implanted into the prostate before planning. A planning target volume (PTV) was derived to account for the measured prostate motion and field placement deviations.Results: Analysis of 1,278 portal images to determine changes in the radiation field during the course of treatment. From the data, random isocenter positioning deviations were 2.66 mm, 2.78 mm and 2.59 mm for vertical, lateral and longitudinal movements respectively. The systematic deviations were 3.15 mm, 3.09 mm and 2.52 mm for vertical, lateral and longitudinal movements respectively. From the verification process, it was realized that 44.7%, 42.8% and 31.4% of the vertical, lateral and longitudinal prostate migrations respectively needed correction/shift.Conclusion: Random set-up errors were small using real-time isocenter placement corrections. Inter-fraction prostate motion remained the largest source of treatment error, and observed motion was greatest at the laterals. In the absence of real-time pre-treatment imaging of the prostate position, using sequential portal films of implanted gold markers, portions of the PTV is missed and surrounding tissues not spared. This research improves quality assurance by confirming the prostate position within the treatment field over the course of therapy.-----------------------------Cite this article as: Acquah GF, Gustavsson M, Doudoo CO, Agbeve RK, Schiestl B. Clinical use of electronic portal imaging to analyze tumor motion variation during a 3D-conformal prostate cancer radiotherapy using online target verification and implanted markers. Int J Cancer Ther Oncol 2014; 2(4):02044. DOI: 10.14319/ijcto.0204.
Splenic artery infusion of IL-2 might allow treatment of melanoma and renal cell cancer with less side effects and greater efficacy
Get PDFTreatment of stave IV renal cell cancer and melanoma with intravenous interleukin-2 (IL-2) is often limited by side effects, and only a minority of patients obtain sustained remissions. This editorial proposes that infusing IL-2 into the splenic artery will allow much stronger immune activation without systemic side effects, achieving a superior clinical response and enabling treatment of patients currently excluded from IL-2 by medical comorbidities.----------------------------------Cite this article as: Alisky JM. Splenic artery infusion of IL-2 might allow treatment of melanoma and renal cell cancer with less side effects and greater efficacy. Int J Cancer Ther Oncol 2014; 2(1):020115.DOI: http://dx.doi.org/10.14319/ijcto.0201.15
Efficacy and safety of transarterial chemoembolization combined to conformal radiotherapy for uninodular hepatocellular carcinoma
Get PDFPurpose: A proportion of patients with uninodular hepatocellular carcinoma (HCC) cannot benefit from potential curative therapies such as liver transplantation, surgical resection or radiofrequency ablation. Thus, they are prone to receive transarterial chemoembolization (TACE) that is a palliative option with low probability of both complete response and prolonged local control. Herein, we assessed the combination of TACE and 3D-high dose conformal radiotherapy (3D-HDCRT) for efficacy and safety in HCC. Methods: We retrospectively analyzed the outcome of 35 consecutive patients with uninodular HCC ≤ 100 mm, treated by one course of TACE combined to 3D-HDCRT. The follow-up consisted on clinics, biology, hepatic CT-scan or MRI at month-1 and -3, and thereafter every 3 months. Results: Complete response was obtained in 80% of patients following mRECIST criteria (95% in HCC ≤ 50 mm, and 60% in HCC > 50 mm) with uncommon local recurrence (11%), overall survival rates of 79%, 59% and 44% at respectively 1, 2 and 3 years (median, 37.3 months), and 11.4% grade-3/4 toxicities. Pre-therapeutic α-fetoprotein level ≥ 200 ng/mL was found as a strong predictor of poorer outcome. Conclusion: We showed that TACE combined to 3D-HDCRT can be highly efficient to reach local control and interesting overall survival rates for uninodular HCC, with limited severe toxicities for Child-Pugh A patients. Subsequent prospective controlled trials are warranted for comparison with therapeutic standards
Acknowledgement to Reviewers
No full textAcknowledgement to ReviewersThe editorial board of International Journal of Cancer Therapy and Oncology (IJCTO) wishes to acknowledge the help of reviewers who have generously contributed their valuable time and efforts during the period September 2013–October 2014 in the appraisal of manuscripts submitted to the IJCTO. Abdulhamid Chaikh (France)Alok Singh (USA)Anamika Basu (USA)Anish Banerjee (India)Antonella Fogliata (Switzerland)Arun Oinam (India)Birendra Kumar Rout (India)Brindha Subramanian (Australia)Charles Bloch (USA)Charles Shang (USA)Chee-Wai Cheng (USA)Chih-Yao Cheng (USA)Daniel Bailey (USA)Danijela Scepanovic (Slovakia)Ersalan Hernandez (USA)Esmaeel Ghasroddashti (Canada)H Sudahar (India)He Wang (USA)Kanan Jassal (India)Lanchun Lu (USA)Lei Guo (USA)Leonardo da Silva Boia (USA)Luiz Antonio Ribeiro da Rosa (Brasil)Maria Chan (USA)Ming Yan (USA)Mohamed Fawzy (Egypt)Mohammad Rafiqul Islam (USA)Nilseia Aparecida Barbosa (Brasil)Nita Nair (India)Panayiotis Mavroidis (USA)Paul Sijens (Netherlands)Paulo Roberto Fonseca (Brasil)Pei-Hsin Cheng (USA)Prabhakar Ramachandran (Australia)Pradip Maiti (India)Pratik Kumar (India)Qinghui Zhang (USA)Qiyong Fan (USA)Radu Alin Vasilache (Romania)Rajesh Thiyagarajan (India)Ranjita Shegokar (Germany)Rick Sims (New Zeland)Sara Bresciani (Italy)Saurabh Varshney (India)Shyam Pokhrel (USA)Sunder Goyal (India)Supriya Chopra (India)Suresh Rana (USA)Toks Yerokun (USA)Tulika Seth (USA)V. Kannan (India)Waldemar Ulmer (Germany)Waqas Shuaib (USA)Xiang-Ming Ding (USA)Yida Hu (USA)Yong Chen (USA)Yu Wang (USA)Yuanming Feng (USA)Yulin Song (USA
The MIQE Revolution: implementation of standards for the reporting of quantitative PCR studies
Get PDFThe discovery of the polymerase chain reaction (PCR) a few decades ago initiated a global impact on the entirety of the medical and life sciences research spheres. Nowadays, essentially all laboratories focusing on such vital research employ in-house PCR techniques on a near-daily basis, due to the wide spectrum of applications which PCR technology can adopt itself to. Unfortunately, ubiquitously available and affordable technologies, such as RT-qPCR, do have a major passive drawback: inter-laboratory reproducibility. Variations in the routine methodologies implemented by individual laboratories can inevitably lead to severe lapse of data robustness and reliability for publication in peer-reviewed journals. In order to address this pressing issue, a consortium of eminent research group leaders in the field of RT-qPCR technology decided to propose a distinct set of standardized guidelines for the reporting of RT-qPCR study results, known as the Minimum Information for Publication of Quantitative Real Time PCR Experiments (MIQE), which were published in early 2009.2 This concept is very much similar to the one leading to the development of the Minimum Information for Microarray Experimets (MIAME) guidelines for reporting of microarray-based studies. In order to address this pressing issue, a consortium of eminent research group leaders in the field of RT-qPCR technology decided to propose a distinct set of standardized guidelines for the reporting of RT-qPCR study results, known as the Minimum Information for Publication of Quantitative Real Time PCR Experiments (MIQE), which were published in early 2009. This concept is very much similar to the one leading to the development of the Minimum Information for Microarray Experimets (MIAME) guidelines for reporting of microarray-based studies.-------------------Cite this article as: Ayers D. The MIQE Revolution: Implementation of standards for the reporting of quantitative PCR studies. Int J Cancer Ther Oncol 2014; 2(2):02026. DOI: 10.14319/ijcto.0202.
Are output measurements always necessary after CT tube replacement?
Get PDFPurpose: TX regulations and the ACR require that CT radiation output be measured within 30 days of major service. The most common major service is tube replacement. We hypothesized that historical QC data could be used instead to determine if output measurements are necessary, reducing the need for costly output measurements.Methods: We reviewed 66 records of tube replacements to determine with what frequency output falls outside specifications. We also conducted an experiment to verify that clinically significant output changes could be identified by comparing image noise in historical QC data with the same data after tube replacement. We used 30 days of historical QC data to establish a baseline noise level and 95% confidence interval (CI) for individual noise measurements. To simulate output changes, we acquired phantom images with our QC protocol while manually changing output (mA). We acquired 10 images using the baseline output and 10 images at each different “output”. We evaluated individual images and subsets of images at each “output” to determine if the system was within the manufacturer’s specifications.Results: None of the 66 tube replacements resulted in an output change that exceeded specifications. Analysis of 30 days of historic QC data for our experimental system indicated a mean noise of 5.4 HU with 95% CI of 5.1 ‒ 5.7 HU. When using the mean noise of 10 images acquired at each of the varying outputs, we were able to identify, with 100% accuracy, images acquired at outputs outside manufacturer’s specifications.Conclusion: The results of our review of historical tube replacement data indicated the likelihood of output falling outside manufacturer’s specifications is low. Considering this, it is likely that by using QC data from programs required by regulation and the ACR physicists can reliably verify radiation output stability remotely instead of making physical measurements.--------------------Cite this article as: P Stauduhar, A Jones. Are output measurements always necessary after CT tube replacement? Int J Cancer Ther Oncol 2014; 2(2):020238. DOI: 10.14319/ijcto.0202.3
Clinical trends and outcomes of male breast cancer: Experience of a tertiary oncology centre in India
Get PDFPurpose: Because of its rarity in any oncology centre, the clinical trends of male breast cancer specific to its geographical distribution have remained relatively unexplored. This study was done to analyze the clinico-pathological data, treatment given and survival patterns of male breast cancer patients visiting our tertiary medical centre and compare our results with available literature. Methods: All male breast cancer patients registered at our clinic from 2003 to 2009 were included. Frequency distribution analysis of the demographic and clinico-pathological data and treatment variables was done. Treatment outcome was examined from Kaplan-Meir survival estimates. Results: Thirty-three male breast cancer patients were encountered. The median age of presentation was sixty years. Mostly (87.9%) they presented with lump in breast or axilla and were clinically staged to be ‘3’ (57.6%).Obesity and alcohol were the commonest risk factors identified. Modified radical mastectomy was the commonest (69.6%) definitive therapy rendered with (only for clinically staged 3 patients) or without neo-adjuvant chemotherapy. Infiltrating ductal carcinoma was identified in most cases. Twenty-two patients received adjuvant chemotherapy and twenty-four received adjuvant radiotherapy. Eighteen (54.5%) patients were hormone-receptor positive and received tamoxifen. The median Overall survival (OS) and Progression-free survival (PFS) came out to be 14.3 months (standard error, SE of 1.185; 95% confidence interval, CI 12-16.6) and 15.7 (SE 5.35, 95% CI 5.2-26.19) months respectively.Conclusion: Male breast cancers usually carry a poor prognosis due to presentation at later stages. Most of our results correlate with previous literature. Multi-centric prospective studies are required to validate the etiological factors and prognostic determinants of survival.-----------------------------Cite this article as: Mukherjee A, Saha A, Chattopadhyay S, Sur P. Clinical trends and outcomes of Male Breast Cancer: experience of a tertiary oncology centre in India. Int J Cancer Ther Oncol 2014; 2(3):02035. DOI: 10.14319/ijcto.0203.
Gall stones size, number, biochemical analysis and lipidogram- an association with gall bladder cancer: a study of 200 cases
Get PDFPurpose: Objective of the study was to find out if there is any relation of number, size and type of gall stones and patient’s lipid profile with the occurrence of gall bladder carcinoma (GBC) as presence of gall stones is considered to be the most important risk factor for gall bladder cancer.Methods: 200 specimens of post-cholecystectomy gallbladder were studied. The number, size and type of stones and lipid profile were compared in all these cases. Gross as well as histopathological examination of gall bladders specimens was done.Results: 185 (92.5%) gall bladders were associated with gall stones. On histopathological examination, malignancy was found in 6 cases (3%) only and rest 194 cases (97%) revealed inflammatory/ non-neoplastic pathology. A statistically significant difference was observed in the number of stones in gall bladders with malignancy than those with benign lesions (P < 0.001). Similarly, a statistically significant difference was seen in terms of stone size between gallbladder cancer (GBC) cases and those with benign pathology (P < 0.005). Benign lesions of gall bladders were mostly associated with mixed type of stones whereas malignant cases were associated with pure cholesterol type of stones. No significant relation was found between the patient’s lipid profile and occurrence of gallbladder carcinoma (GBC) (p > 0.005). Conclusion: Thus we concluded that as the number, size and cholesterol gall stone increase the risk of gall bladder cancer also increases without any relation with lipid profile................................................Cite this article as:Narang S, Goyal P, Bal MS, Bandlish U, Goyal S. Gall stones size, number, biochemical analysis and lipidogram- an association with gall bladder cancer: a study of 200 cases. Int J Cancer Ther Oncol 2014; 2(3):020310. DOI: 10.14319/ijcto.0203.1