International Journal of Cancer Therapy and Oncology
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Pretreatment quality assurance of volumetric modulated arc therapy on patient CT scan using indirect 3D dosimetry system
Get PDFPurpose: Aim of this study is to clinically implement the COMPASS 3D dosimetry system for pretreatment quality assurance of volumetric modulated arc therapy (VMAT-RapidArc) treatment plans. Methods: For this study, 10 head and neck (H&N) and 10 pelvis VMAT plans dose response from Linac was measured using COMPASS system along with MatriXXEvolution and 3D dose was reconstructed in the patient computed tomography (CT) scan. Dose volume histograms and 3D gamma were used to evaluate the difference between the measured and calculated values. In order to validate the COMPASS system, dose response for open fields were acquired for both homogeneous and inhomogeneous phantoms. Results: The average dose difference between Eclipse treatment planning system (TPS) calculated and COMPASS measured (homogenous medium) in normalization region, inner region, penumbra region and buildup region was less than ±2%. In inhomogeneous phantom, there was a maximum difference of -3.17% in lung, whereas the difference other densities was within ±2%. The systematic increase in the average 3D gamma between the TPS calculated and COMPASS measured for VMAT plans with known dose errors and multi-leaf collimator (MLC) offset errors shows that COMPASS system was sensitive enough to find clinical significant errors. The 3D dose parameters (D95, D1, and average dose) of all H&N and pelvis patients were well within the clinically acceptable tolerance level of ±5%. The average 3D gammas for planning target volumes (PTV) and organ at risks (OAR) of the patients were less than 0.6. Conclusion: The results from this study show that COMPASS along with MatriXXEvolution can be effectively used for pretreatment verification of VMAT plans in the patient anatomy
Hepatoblastoma survival and the prognostic role of cancer stem cell markers
Get PDFPurpose: Hepatoblastoma (HB) is an embryonal tumor of the liver that occurs in infants and young children. Complete surgical resection and cisplatin-containing chemotherapy are crucial for cure in HB. Cancer stem cells (CSCs) constitute a newly identified subpopulation, which may differentiate into heterogeneous progenies of malignant cells. The aim of this study was to assess the survival outcome and the prognostic value of CSCs markers (CD133, CD90 and CD44) in a cohort of HB patients from Egypt.Methods: Disease status of 43 HB patients was evaluated at the main checkpoints of therapy and during follow-up. Treatment included surgical tumor resection and systemic chemotherapy (cisplatin, 5-fluorouracil, doxorubicin, and vincristine). Protein and RNA expressions of CD44, CD 90 and CD 133 were assessed by immunohistochemistry and quantitative PCR. Results: The OS for all patients was 58.2 at 4 years. Patients with localized disease stages (I&II) had a better OS than those with advanced stages (III&IV) (81.9% versus 30%, p<0.001). Total surgical resection was superior to incomplete/no resection (83.8% versus 25.2 %; p<0.001). The OS was significantly correlated with tumor response (p<0.001) and each of CD44, CD 90, CD 133 expression (p<0.001) whereas reduced DFS was associated with CD44 and CD133 expression (p<0.001).Conclusion: Localized disease is associated with higher OS than more advanced stages III and IV. Complete surgical resection facilitated with systemic preoperative chemotherapy in initially irresectable cases can improve survival in HB while CSC markers (CD133, 44, and 90) can predict survival and response to treatment in HB patients.-------------------------------------------------------------Cite this article as:Fawzy M, Bahnassy A, El-Wakil M, Abdel-Sayed A. Hepatoblastoma survival and the prognostic role of cancer stem cell markers. Int J Cancer Ther Oncol 2014; 2(1):02011.DOI: http://dx.doi.org/10.14319/ijcto.0201.
Evaluation of planned dosimetry when beam energies are substituted for a fraction of the treatment course
Get PDFPurpose: The purpose of this technical study was to evaluate how the effect of changing beam energies for one to multiple fractions of a patient’s plan affected the overall dose delivered to the planning target volume (PTV) and surrounding organs at risk (OAR’s). Method: In this study, twenty-eight patient plans from treatment sites including the oesophagus, prostate, lung, spine, rectum, bladder, chest, scapula, and breast were evaluated in the Philips Pinnacle treatment planning system (TPS), of these 14 were originally planned with 15MV and 14 with 10MV. Each of these plans were substituted with a single to multiple fractions with 10MV and 15MV respectively while keeping the original monitor units the same.Results: It was determined that when the number of fractions of the substituted beam energy remained at one fifth or less of the overall fractions a change of dose of less than 2% to the PTV could be maintained. The OAR’s dose, when the plan had 20% of its fractions substituted with a different energy, were found to change by on average up to 3.5% and 2.3% for original plan energies of 15MV and 10MV respectively. The dose change calculated in the TPS was then verified using ion chamber measurements for bladder and oesophagus treatment plans. Conclusion: Results appear to indicate that the site of treatment was not an important factor when changing energy but the overall number of fractions versus the number of fractions substituted with an alternative energy was fundamental. These results may be clinically useful when a radiotherapy department have machines with different photon energies. In the event of a break down, when a patient needs to be urgently treated, it may be possible to treat them on another machine with a different energy, without an immediate recalculation in the TPS. This decision would depend upon the percentage of fractions of their overall treatment needing to be treated before the machine was repaired-------------------------------Cite this article as:Hawke S, Torrance A, Tremethick L. Evaluation of planned dosimetry when beam energies are substituted for a fraction of the treatment course. Int J Cancer Ther Oncol 2013; 1(2):01014.DOI: http://dx.doi.org/10.14319/ijcto.0102.
Laser photobiomodulation: A new promising player for the multi-hallmark treatment of advanced cancer
Get PDFThis article does not include an abstract. Full text of this article is available in PDF.Cite this article as:Santana-Blank L, Rodríguez-Santana E, Reyes H, Santana-Rodríguez J, Santana-Rodríguez K. Laser photobiomodulation: A new promising player for the multi-hallmark treatment of advanced cancer. Int J Cancer Ther Oncol 2013;1(1):01012. DOI: 10.14319/ijcto.0101.2-------------------------------------
Water-light interaction: A novel pathway for multi hallmark therapy in cancer
Get PDFLaser photobiomodulation (LPBM) has been proposed as a multi-target (multi-hallmark) therapy for cancer and other complex diseases based on an approach that aims to substitute and/or complement metabolic energy pathways through oxygen-dependent (e.g., cytochrome c oxidase (CcO)) and/or oxygen-independent (e.g., light-water interactions (e.g., F0-F1 motors)) mechanisms with critical signaling pathways in primarily aqueous media. Cellular and molecular bases for water-mediated, long-range, energy supplementation aimed at inducing and modulating physiologically reparative processes, including apoptosis, have been previously presented through a mechanism termed Photo Infrared Pulsed Biomodulation (PIPBM). Water’s role as an oscillator in LPBM has also been documented. These ideas were recently complemented by integrating the role of the quasi-crystalline exclusion zone (EZ) described by Pollack as the fourth phase of water. This is retrospective analysis of experimental and clinical data using an infrared pulsed laser device (IPLD). It found photo-induced effects over the water dynamics of burned rat tissue monitored by 1H-NMR transverse relaxation times (1/T2), indicating significantly greater structuring of water. In addition, a microdensitometry study of T2 weighted tumor heterogeneities from a phase I clinical trial of the IPLD in patients with advanced neoplasias and an algorithm for tumor characterization indicated significantly increased structuring of water, possibly proving a photobiomodulation effect over the EZ associated with histologically-confirmed selective photo-induced tumor cell death. To the best of our knowledge, this is the first clinical demonstration of light-induced effects over the EZ. It supports our premise that LPBM can increase potential energy in the EZ, which then acts as a rechargeable electrolytic bio-battery for the external selective supplementation of the energy demand required for cellular work, signaling pathways and gene expression in the presence of injury-induced redox potentials. It further suggests that EZ structuring may be used as a predicator of anticancer response before measurable tumor volume reduction.------------------------------------------------Cite this article as: Santana-Blank L, Rodriguez-Santana E, Reyes H, Santana- Rodriguez J, Santana- Rodriguez K. Water-light interaction: A novel pathway for multi hallmark therapy in cancer. Int J Cancer Ther Oncol 2014; 2(1):02012.DOI: http://dx.doi.org/10.14319/ijcto.0201.
Dosimetric impact of mixed-energy volumetric modulated arc therapy plans for high-risk prostate cancer
Get PDFPurpose: This study investigated the dosimetric impact of mixing low and high energy treatment plans for prostate cancer treated with volumetric modulated arc therapy (VMAT) technique in the form of RapidArc.Methods: A cohort of 12 prostate cases involving proximal seminal vesicles and lymph nodes was selected for this retrospective study. For each prostate case, the single-energy plans (SEPs) and mixed-energy plans (MEPs) were generated. First, the SEPs were created using 6 mega-voltage (MV) energy for both the primary and boost plans. Second, the MEPs were created using 16 MV energy for the primary plan and 6 MV energy for the boost plan. The primary and boost MEPs used identical beam parameters and same dose optimization values as in the primary and boost SEPs for the corresponding case. The dosimetric parameters from the composite plans (SEPs and MEPs) were evaluated. Results: The dose to the target volume was slightly higher (on average <1%) in the SEPs than in the MEPs. The conformity index (CI) and homogeneity index (HI) values between the SEPs and MEPs were comparable. The dose to rectum and bladder was always higher in the SEPs (average difference up to 3.7% for the rectum and up to 8.4% for the bladder) than in the MEPs. The mean dose to femoral heads was higher by about 0.8% (on average) in the MEPs than in the SEPs. The number of monitor units and integral dose were higher in the SEPs compared to the MEPs by average differences of 9.1% and 5.5%, respectively.Conclusion: The preliminary results from this study suggest that use of mixed-energy VMAT plan for high-risk prostate cancer could potentially reduce the integral dose and minimize the dose to rectum and bladder, but for the higher femoral head dose.-----------------------------------------------Cite this article as:Pokharel S. Dosimetric impact of mixed-energy volumetric modulated arc therapy plans for high-risk prostate cancer. Int J Cancer Ther Oncol 2013;1(1):01011.DOI: http://dx.doi.org/10.14319/ijcto.0101.1 //
Urological management (medical and surgical) of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation
Get PDFAim: Haemorrhagic cystitis (HC) is uncommon and in its severe form potentially life threatening complication of Haematopoietic stem cell transplantation (HSCT) in children. We present our single centre experience in the urological management of this clinically challenging condition. Patients and Methods: Fourteen patients were diagnosed with BK-Virus HC in our centre. The mean age at diagnosis was 8.8 years (range, 3.2-18.4 years). The mean number of days post-BMT until onset of HC was 20.8 (range, 1 – 51). While all patients tested urine positive for BKV at the clinical onset of HC, only four patients had viral quantification, with viral loads ranging from 97,000 to >1 billion/ml. 8 patients had clinical HC. Ten patients experienced acute GVHD (grade I: 6 patients, grade II: 3 patients, grade 4: 1 patient).Results: Four patients received medical management for their HC. Treatments included hyperhydration, MESNA, blood and platelet transfusion, premarin and oxybutynin (Table 6). Two patients received both medical and surgical management which included cystoscopy with clot evacuation, bladder irrigation and supra-pubic catheter insertion. One patient received exclusive surgical management. Seven patients were treated conservatively. Conclusion: There is limited available evidence for other potential therapeutic strategies highlighting the need for more research into the pathophysiology of HSCT-associated HC. Commonly used interventions with possible clinical benefit (e.g. cidofovir, ciprofloxacin) still require to be evaluated in multi-centre, high-quality studies. Potential future preventative and therapeutic options, such as modulation of conditioning, immunosuppression and engraftment, new antiviral and anti-inflammatory and less nephrotoxic agents need to be assessed.---------------------------Cite this article as:Vasdev N, Davidson A, Harkensee C, Slatter M, Gennery A, Willetts I, Thorpe A.Urological management (medical and surgical) of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation. Int J Cancer Ther Oncol 2013;1(1):01013. DOI:http://dx.doi.org/10.14319/ijcto.0101.
Assessment of pulmonary toxicities in breast cancer patients undergoing treatment with anthracycline and taxane based chemotherapy and radiotherapy- a prospective study
Get PDFBackground: Anthracycline based regiments and/or taxanes and adjuvant radiotherapy; the main modalities of treatment for breast cancers are associated with deterioration of pulmonary functions and progressive pulmonary toxicities. Aim: Assessment of pulmonary toxicities and impact on pulmonary functions mainly in terms of decline of forced vital capacity (FVC) and the ratio of forced expiratory volume (FEV) in 1 Second and FEV1/FVC ratio with different treatment times and follow ups in carcinoma breast patients receiving anthracycline and/or taxane based chemotherapy and radiotherapy. Materials and methods: A prospective single institutional cohort study was performed with 58 breast cancer patients between January 2011 to July 2012 who received either anthracycline based (37 patients received 6 cycles FAC= 5 FU, Adriamycin, Cyclophosphamide regime) and radiotherapy or anthracycline and taxane based chemotherapy (21 patients received 4cycles AC= Adriamycin, Cyclophosphamide; followed by 4 cycles of T=Taxane) and radiotherapy. Assessment of pulmonary symptoms and signs, chest x-ray and pulmonary function tests were performed at baseline, midcycle, at end of chemotherapy, at end radiotherapy, at 1 and 6 months follow ups and compared. By means of a two-way analysis of variance (ANOVA) model, the course of lung parameters across the time points was compared. Results and Conclusion: Analysis of mean forced vital capacities at different points of study times showed definitive declining pattern, which is at statistically significant level at the end of 6th month of follow up (p=0.032) .The FEV1/FVC ratio (in percentage) also revealed a definite decreasing pattern over different treatment times and at statistically significant level at 6th month follow up with p value 0.003. Separate analysis of mean FEV1/FVC ratios over time in anthracycline based chemotherapy and radiotherapy group as well as anthracycline and taxane based chemotherapy and radiotherapy group showed a similar declining pattern.-------------------------Cite this article as:Saha A, Chattopadhyay S. Assessment of pulmonary toxicities in breast cancer patients undergoing treatment with anthracycline and taxane based chemotherapy and radiotherapy- a prospective study. Int J Cancer Ther Oncol 2013; 1(2):01021.DOI: http://dx.doi.org/10.14319/ijcto.0102.
MicroRNAs as molecular markers in lung cancer
Get PDFLung cancer is the most common cause of cancer death in the western world for both men and women. Lung cancer appears to be a perfect candidate for a screening program, since it is the number one cancer killer, it has a long preclinical phase, curative treatment for the minority of patients who are diagnosed early and a target population at risk (smokers) and it is also a major economic burden. The earliest approaches to identifying cancer markers were based on preliminary clinical or pathological observations, although molecular biology is a strong candidate for occupying a place among the set of methods. In search of markers, several alterations, such as mutations, loss of heterozygosity, microsatellite instability, DNA methylation, mitochondrial DNA mutations, viral DNA, modified expression of mRNA, miRNA and proteins, and structurally altered proteins have all been analysed. MicroRNAs (miRNA) are small RNA molecules, about 19-25 nucleotides long and encoded in genomes of plants, animals, fungi and viruses. It has been reported that miRNAs may have multiple functions in lung development and that aberrant expression of miRNAs could induce lung tumorigenesis. We review here the role of miRNAs in lung tumorigenesis and also as a novel type of biomarker.-----------------------------------Cite this article as:Silva J, Garcia V, Lopez-Gonzalez A, Provencio M. MicroRNAs as molecular markers in lung cancer. Int J Cancer Ther Oncol 2013;1(1):010111. DOI: http://dx.doi.org/10.14319/ijcto.0101.1