Seema Sharma, S. Chander, Subramani Velliyan, S. Bhaskar, S. Pathy, Pratik Kumar, G. Natanasabapathi, S. Thulkar
Purpose: The aim of this study is to evaluate influence of statistical uncertainty on Monte-Carlo dose calculation of Monaco 5.11 treatment planning system (TPS). Methods: Phantom with contoured C-Shape structure set was downloaded from AAPM website provided with TG119 report. VMAT plan was created for C-Shape test case using Monaco TPS for 6 MV Elekta Versa-HD linear-accelerator. Dose prescription and constraints were as per TG119. After optimizations, C-Shape plan was calculated with different statistical-uncertainty (i) 0.5%, 1.0%, 3.0% and 5.0% per control point and (ii) 0.5%, 1.0%, 3.0% and 5.0% per calculation. Base plan was calculated with 0.5% per control point. Results: Variations in PTV doses for different statistical-uncertainties with respect to 0.5% per control point were within PTV-D95: 82 cGy(1.64%); PTV-D10: 14.8 cGy(0.28%); Core-D10: 3.7 cGy(0.15%). MU required to deliver a plan (920 MU) were observed same with different statistical-uncertainty. Calculation time increases with decrease in statistical-uncertainty due to more number of histories. 2D-Gamma pass rate was ranging from 98.1% to 98.9% for analyzed statistical-uncertainties. Statistical-uncertainty 0.5% per control point showed higher Gamma pass-rate (98.9%). Conclusion: Minor variation (<1.64%) in dose volume parameters was observed with different statistical-uncertainties, whereas Monitor unit remain same. 3.0% per control point and 0.5% per calculation resulted in almost similar results and found optimal with reasonable calculation time in terms of plan quality and delivery accuracy (gamma pass-rate).
{"title":"Effect of statistical uncertainty on Monaco Monte-Carlo dose calculation","authors":"Seema Sharma, S. Chander, Subramani Velliyan, S. Bhaskar, S. Pathy, Pratik Kumar, G. Natanasabapathi, S. Thulkar","doi":"10.14319/IJCTO.61.11","DOIUrl":"https://doi.org/10.14319/IJCTO.61.11","url":null,"abstract":"Purpose: The aim of this study is to evaluate influence of statistical uncertainty on Monte-Carlo dose calculation of Monaco 5.11 treatment planning system (TPS). Methods: Phantom with contoured C-Shape structure set was downloaded from AAPM website provided with TG119 report. VMAT plan was created for C-Shape test case using Monaco TPS for 6 MV Elekta Versa-HD linear-accelerator. Dose prescription and constraints were as per TG119. After optimizations, C-Shape plan was calculated with different statistical-uncertainty (i) 0.5%, 1.0%, 3.0% and 5.0% per control point and (ii) 0.5%, 1.0%, 3.0% and 5.0% per calculation. Base plan was calculated with 0.5% per control point. Results: Variations in PTV doses for different statistical-uncertainties with respect to 0.5% per control point were within PTV-D95: 82 cGy(1.64%); PTV-D10: 14.8 cGy(0.28%); Core-D10: 3.7 cGy(0.15%). MU required to deliver a plan (920 MU) were observed same with different statistical-uncertainty. Calculation time increases with decrease in statistical-uncertainty due to more number of histories. 2D-Gamma pass rate was ranging from 98.1% to 98.9% for analyzed statistical-uncertainties. Statistical-uncertainty 0.5% per control point showed higher Gamma pass-rate (98.9%). Conclusion: Minor variation (<1.64%) in dose volume parameters was observed with different statistical-uncertainties, whereas Monitor unit remain same. 3.0% per control point and 0.5% per calculation resulted in almost similar results and found optimal with reasonable calculation time in terms of plan quality and delivery accuracy (gamma pass-rate).","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73435641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. R. Rani, K. Ayyangar, A. R. Reddy, A. Kumar, P. Y. Reddy
Purpose: The purpose of the paper is to present the design, development and dosimetric characteristics of an automated Multi-leaf collimator (MLC) integrated along with an inexpensive Treatment Planning System (ROPS), developed for existing telecobalt units as an add-on without making any modifications to the treatment machine. Method: The prototype MLC design consists of 28 tungsten alloy leaves (14 leaf pairs) having a mass density of 18 g cm -3 . Each of the leaves projects 10 mm width at the isocenter, which is at 80 cm from the source. The automation has been achieved with a dedicated linear actuator for each leaf. Radiochromic films and IC PROFILER™ (Sun Nuclear Corporation, Melbourne, FL) were used for the measurement of beam profiles and the profiles were analyzed to arrive at radiation field width, beam flatness, symmetry and beam penumbra. Results: The prototype MLC can define radiation fields of up to 14 × 14 cm² within the prescribed tolerance values of 2 mm. The flatness and symmetry were found to be within the prescribed tolerance value of 3%. The penumbra for a 10 × 10 cm² field size is 9.5 mm which is less than the generally acceptable value of 12 mm for a telecobalt machine. The maximum leakage through the leaf ends in closed condition was observed to be 7.3% which is less than the values reported for other MLCs designed for medical linear accelerators. Conclusion: It is concluded that dosimetric parameters and the leakage radiation of the prototype MLC are well below their recommended tolerance values. The MLC can be used for carrying out conformal radiotherapy with existing telecobalt machines.
目的:本文的目的是介绍一种自动化多叶准直仪(MLC)的设计、开发和剂量学特性，该准直仪集成了一种廉价的治疗计划系统(ROPS)，该系统是为现有的远程钴单元开发的，作为附加组件，无需对治疗机进行任何修改。方法:采用质量密度为18 g cm -3的28片钨合金叶片(14对叶片)组成MLC原型设计。每片叶子在离源80厘米的等心处投射出10毫米的宽度。自动化已经实现了一个专用的线性执行器为每个叶片。使用放射致色膜和IC PROFILER™(Sun Nuclear Corporation, Melbourne, FL)测量光束轮廓，并对这些轮廓进行分析，以获得辐射场宽度、光束平坦度、对称性和光束半影。结果:原型MLC可以在2mm的规定公差范围内定义最大14 × 14 cm²的辐射场。平整度和对称性均在3%的公差范围内。10 × 10 cm²场尺寸的半影为9.5 mm，小于远程钴机通常可接受的12 mm值。在封闭条件下，通过叶片末端的最大泄漏量为7.3%，低于为医用线性加速器设计的其他MLCs的报告值。结论:样品MLC的剂量学参数和泄漏辐射均低于推荐容限值。MLC可用于与现有的远程钴机进行适形放疗。
{"title":"Design and development of an add-on automated multi-leaf collimator for telecobalt therapy machine and study of its characteristics","authors":"A. R. Rani, K. Ayyangar, A. R. Reddy, A. Kumar, P. Y. Reddy","doi":"10.14319/IJCTO.61.4","DOIUrl":"https://doi.org/10.14319/IJCTO.61.4","url":null,"abstract":"Purpose: The purpose of the paper is to present the design, development and dosimetric characteristics of an automated Multi-leaf collimator (MLC) integrated along with an inexpensive Treatment Planning System (ROPS), developed for existing telecobalt units as an add-on without making any modifications to the treatment machine. Method: The prototype MLC design consists of 28 tungsten alloy leaves (14 leaf pairs) having a mass density of 18 g cm -3 . Each of the leaves projects 10 mm width at the isocenter, which is at 80 cm from the source. The automation has been achieved with a dedicated linear actuator for each leaf. Radiochromic films and IC PROFILER™ (Sun Nuclear Corporation, Melbourne, FL) were used for the measurement of beam profiles and the profiles were analyzed to arrive at radiation field width, beam flatness, symmetry and beam penumbra. Results: The prototype MLC can define radiation fields of up to 14 × 14 cm² within the prescribed tolerance values of 2 mm. The flatness and symmetry were found to be within the prescribed tolerance value of 3%. The penumbra for a 10 × 10 cm² field size is 9.5 mm which is less than the generally acceptable value of 12 mm for a telecobalt machine. The maximum leakage through the leaf ends in closed condition was observed to be 7.3% which is less than the values reported for other MLCs designed for medical linear accelerators. Conclusion: It is concluded that dosimetric parameters and the leakage radiation of the prototype MLC are well below their recommended tolerance values. The MLC can be used for carrying out conformal radiotherapy with existing telecobalt machines.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85439729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Kobawala, K. Gajjar, T. Trivedi, G. Patel, N. Ghosh
Purpose: The roles of IL-2 and IL-12, in different malignancies have been looked for since years. But very few studies have elucidated their role in thyroid tumorigenesis. Hence, present study sought to explore their utility in thyroid cancer, mainly the papillary thyroid cancer (PTC). Methods: A total of 67 patients with benign thyroid diseases, 106 with thyroid cancer and 67 healthy individuals were included in the study. Circulating levels of IL-2 and IL-12 were estimated by ELISA from all patients and controls. Protein expression of both interleukins was determined using immunohistochemistry. The results were statistically analysed using SPSS software. Results: Serum IL-12 exhibited good discriminatory efficacy between patients with benign thyroid diseases and healthy individuals. IL-2 and IL-12 levels could efficiently differentiate PTC and anaplastic thyroid cancer (ATC) patients from healthy individuals. Additionally, IL-12 showed good discriminating efficacy between PTC and benign thyroid disease patients and IL-2 well discriminated ATC patients from benign thyroid diseases. IL-2 was significantly higher in patients having unilateral tumors (P=0.006) while, IL-12 was significantly higher in patients with smaller tumor size (P=0.036) and early stage disease (P=0.008). The cytokine protein expressions in benign thyroid tissues and carcinoma did not differ significantly. IL-12 expression was significantly higher in male patients (P=0.042) and unilateral tumors (P=0.031).Kaplan-Meier survival analysis revealed that nuclear IL-2 expression was able to predict disease free survival and overall survival (OS) in subgroup of PTC patients having multifocal tumors and only OS in patients having bilateral tumors. Moreover, higher IL-12 immunoreactivity was a significant predictor of shorter OS in PTC patients treated with surgery alone. Conclusion: Serologic determination of IL-2 and IL-12 may help in validating indeterminate FNAC results and disclose diagnostic difference between benign and malignant thyroid diseases. However, a large cohort study is mandatory to establish a defined cut off for such discrimination.
{"title":"IL-2 and IL-12 in thyroid cancer: Clinical implication","authors":"T. Kobawala, K. Gajjar, T. Trivedi, G. Patel, N. Ghosh","doi":"10.14319/ijcto.61.7","DOIUrl":"https://doi.org/10.14319/ijcto.61.7","url":null,"abstract":"Purpose: The roles of IL-2 and IL-12, in different malignancies have been looked for since years. But very few studies have elucidated their role in thyroid tumorigenesis. Hence, present study sought to explore their utility in thyroid cancer, mainly the papillary thyroid cancer (PTC). Methods: A total of 67 patients with benign thyroid diseases, 106 with thyroid cancer and 67 healthy individuals were included in the study. Circulating levels of IL-2 and IL-12 were estimated by ELISA from all patients and controls. Protein expression of both interleukins was determined using immunohistochemistry. The results were statistically analysed using SPSS software. Results: Serum IL-12 exhibited good discriminatory efficacy between patients with benign thyroid diseases and healthy individuals. IL-2 and IL-12 levels could efficiently differentiate PTC and anaplastic thyroid cancer (ATC) patients from healthy individuals. Additionally, IL-12 showed good discriminating efficacy between PTC and benign thyroid disease patients and IL-2 well discriminated ATC patients from benign thyroid diseases. IL-2 was significantly higher in patients having unilateral tumors (P=0.006) while, IL-12 was significantly higher in patients with smaller tumor size (P=0.036) and early stage disease (P=0.008). The cytokine protein expressions in benign thyroid tissues and carcinoma did not differ significantly. IL-12 expression was significantly higher in male patients (P=0.042) and unilateral tumors (P=0.031).Kaplan-Meier survival analysis revealed that nuclear IL-2 expression was able to predict disease free survival and overall survival (OS) in subgroup of PTC patients having multifocal tumors and only OS in patients having bilateral tumors. Moreover, higher IL-12 immunoreactivity was a significant predictor of shorter OS in PTC patients treated with surgery alone. Conclusion: Serologic determination of IL-2 and IL-12 may help in validating indeterminate FNAC results and disclose diagnostic difference between benign and malignant thyroid diseases. However, a large cohort study is mandatory to establish a defined cut off for such discrimination.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86352480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mirza, S. Mushtaq, R. Reddy, Mina S Mousa, Kullatham Kongpakpaisarn, C. Bohra, S. Verma, R. Mhaskar, R. Baz, C. Bassil
Purpose: It is clinically understood that chronic kidney disease (CKD) and cancer are interrelated. Yet, few studies measure how renal outcomes vary according to common malignancies and common therapeutic agents. We report the incidence and the nature of CKD among cancer patients from a single institution. Methods: A retrospective chart review of cancer patients managed in the onconephrology clinic at the Moffitt Cancer Center from 05/01/2015 to 07/31/2016 was conducted. Patients with kidney injury were included in this study. Renal function was recorded at three-month follow-up intervals for 15-month duration. Results: Out of the total 88 patients with median age of 68 years, 63 patients (~ 72%) were diagnosed with chronic kidney disease (CKD), whereas the remaining had acute kidney injury. Kidney cancer and multiple myeloma represented the single malignancies with the largest proportion of CKD with 12 patients each (~14% each). Patients with kidney cancer had a mean creatinine of (2.35, 1.74 SD) mg/dl compared to patients without kidney cancer with creatinine (1.97, 1.07 SD) mg/dl. Abdominal cancers represented the highest frequency category of malignancies in this sample (n = 38), and about 32 (84%) of these patients had CKD. About 80% of patients with genitourinary cancers (n = 27) had CKD. In terms of prescribed chemotherapeutic agents, patients treated with tyrosine kinase inhibitors had a lower average estimated glomerular filtration rate (28.37, 9.86 SD) mL/min/1.73 m 2 compared to other chemotherapeutic agents, though this was weakly significant (p-value = 0.07). Similar renal outcomes per malignancy and chemotherapy are reported. Conclusion: This group of patients demonstrated the frequency of chronic kidney disease differs depending on the type of malignancy or chemotherapy. A multidisciplinary approach involving oncologists and nephrologists should be adopted to prevent further renal damage from cancer and its therapies.
{"title":"A single center study of cancer patients with chronic kidney disease","authors":"A. Mirza, S. Mushtaq, R. Reddy, Mina S Mousa, Kullatham Kongpakpaisarn, C. Bohra, S. Verma, R. Mhaskar, R. Baz, C. Bassil","doi":"10.14319/IJCTO.61.1","DOIUrl":"https://doi.org/10.14319/IJCTO.61.1","url":null,"abstract":"Purpose: It is clinically understood that chronic kidney disease (CKD) and cancer are interrelated. Yet, few studies measure how renal outcomes vary according to common malignancies and common therapeutic agents. We report the incidence and the nature of CKD among cancer patients from a single institution. Methods: A retrospective chart review of cancer patients managed in the onconephrology clinic at the Moffitt Cancer Center from 05/01/2015 to 07/31/2016 was conducted. Patients with kidney injury were included in this study. Renal function was recorded at three-month follow-up intervals for 15-month duration. Results: Out of the total 88 patients with median age of 68 years, 63 patients (~ 72%) were diagnosed with chronic kidney disease (CKD), whereas the remaining had acute kidney injury. Kidney cancer and multiple myeloma represented the single malignancies with the largest proportion of CKD with 12 patients each (~14% each). Patients with kidney cancer had a mean creatinine of (2.35, 1.74 SD) mg/dl compared to patients without kidney cancer with creatinine (1.97, 1.07 SD) mg/dl. Abdominal cancers represented the highest frequency category of malignancies in this sample (n = 38), and about 32 (84%) of these patients had CKD. About 80% of patients with genitourinary cancers (n = 27) had CKD. In terms of prescribed chemotherapeutic agents, patients treated with tyrosine kinase inhibitors had a lower average estimated glomerular filtration rate (28.37, 9.86 SD) mL/min/1.73 m 2 compared to other chemotherapeutic agents, though this was weakly significant (p-value = 0.07). Similar renal outcomes per malignancy and chemotherapy are reported. Conclusion: This group of patients demonstrated the frequency of chronic kidney disease differs depending on the type of malignancy or chemotherapy. A multidisciplinary approach involving oncologists and nephrologists should be adopted to prevent further renal damage from cancer and its therapies.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86541632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sakda Kingkaew, S. Asavaphatiboon, Lukkana Apipunyasopon
Purpose: Choosing an appropriate parameter on the computerized treatment planning systems (TPSs) influences on the accuracy of dose calculation. Several dosimetric parameters have been studied to achieve a more accurate dose and qualitative plan. The purpose of this study was to determine the impact of maximum control point on the dose calculation on Eclipse TPSs for lung Stereotactic Body Radiation Therapy (SBRT) considering the plan quality, the computation time and the treatment file size. Methods: Dose distributions for the 8 lung SBRT plans with varying maximum control point of 64, 166, and 320 were calculated by Eclipse TPSs with flattening filter free (FFF) beam. The treatment dose was prescribed at 85% isodose level of 54 Gy to the planning target volume (PTV). The dosimetric impact can be evaluated from target coverage, conformity index (CI), homogeneity index (HI), and organ at risk (OAR) doses, while the computation time and the file storage space were compared with the recommended number of control point. Results: The use of 64 control points per subfields tended to increase the dose at PTV and OARs comparing with the 166 and 320 control point plans, while the HI and CI values were similar. The average increases of OARs doses including the spinal cord, heart, esophagus and total lung depended on the photon beam energy. The higher average control point (AVG) number leaded to increase the computation time and the file size for both 6X-FFF and 10X-FFF photon beams. The correlations between AVG and plan storaage space were observed in the same ratio as the computation time. Conclusion: Using the minimal number of control point, the quantitative analysis in the PTV and OARs showed no clinically significant variation in dose, therefore choosing an optimal number of fixed control points leaded to balance the plan quality, the computation time and the file size.
{"title":"Investigation the impact of maximum control point on dose calculation in Eclipse treatment planning system for lung SBRT","authors":"Sakda Kingkaew, S. Asavaphatiboon, Lukkana Apipunyasopon","doi":"10.14319/IJCTO.51.20","DOIUrl":"https://doi.org/10.14319/IJCTO.51.20","url":null,"abstract":"Purpose: Choosing an appropriate parameter on the computerized treatment planning systems (TPSs) influences on the accuracy of dose calculation. Several dosimetric parameters have been studied to achieve a more accurate dose and qualitative plan. The purpose of this study was to determine the impact of maximum control point on the dose calculation on Eclipse TPSs for lung Stereotactic Body Radiation Therapy (SBRT) considering the plan quality, the computation time and the treatment file size. Methods: Dose distributions for the 8 lung SBRT plans with varying maximum control point of 64, 166, and 320 were calculated by Eclipse TPSs with flattening filter free (FFF) beam. The treatment dose was prescribed at 85% isodose level of 54 Gy to the planning target volume (PTV). The dosimetric impact can be evaluated from target coverage, conformity index (CI), homogeneity index (HI), and organ at risk (OAR) doses, while the computation time and the file storage space were compared with the recommended number of control point. Results: The use of 64 control points per subfields tended to increase the dose at PTV and OARs comparing with the 166 and 320 control point plans, while the HI and CI values were similar. The average increases of OARs doses including the spinal cord, heart, esophagus and total lung depended on the photon beam energy. The higher average control point (AVG) number leaded to increase the computation time and the file size for both 6X-FFF and 10X-FFF photon beams. The correlations between AVG and plan storaage space were observed in the same ratio as the computation time. Conclusion: Using the minimal number of control point, the quantitative analysis in the PTV and OARs showed no clinically significant variation in dose, therefore choosing an optimal number of fixed control points leaded to balance the plan quality, the computation time and the file size.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"208 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77470049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
X. Dong, S. Barasch, D. Rohan, Michael Cho, L. Thomas, L. Koutcher
Multiple primary cancers are known entity due to the propensity of cancer survivors to develop additional malignancies both from genetic predisposition and exogenous influences. However, the development of triple or quadruple primary cancers, especially presenting simultaneously, presents challenging diagnostic and treatment dilemmas. We report here a patient who presented initially with neurological symptoms. Extensive evaluation and pathologic workup revealed that the patient actually has an intra-medullary vascular neoplasm at the level of upper thoracic spine, mucinous adenocarcinoma of the right lower lobe, poorly differentiated adenocarcinoma of the stomach near the gastro-esophageal (GE) junction, and conventional type adenocarcinoma of the hepatic flexure of the colon. The patient underwent neoadjuvant chemo-radiation for the GE junction carcinoma followed by surgical resection of the three different adenocarcinomas simultaneously as definitive management. This case illustrates the utility of immuno-histochemistry in delineating the site of origin for primary tumors, and the challenges posed when dealing with multiple primary neoplasms concurrently.
{"title":"Management of Multiple Primary Cancers: What is the Priority?","authors":"X. Dong, S. Barasch, D. Rohan, Michael Cho, L. Thomas, L. Koutcher","doi":"10.14319/IJCTO.51.19","DOIUrl":"https://doi.org/10.14319/IJCTO.51.19","url":null,"abstract":"Multiple primary cancers are known entity due to the propensity of cancer survivors to develop additional malignancies both from genetic predisposition and exogenous influences. However, the development of triple or quadruple primary cancers, especially presenting simultaneously, presents challenging diagnostic and treatment dilemmas. We report here a patient who presented initially with neurological symptoms. Extensive evaluation and pathologic workup revealed that the patient actually has an intra-medullary vascular neoplasm at the level of upper thoracic spine, mucinous adenocarcinoma of the right lower lobe, poorly differentiated adenocarcinoma of the stomach near the gastro-esophageal (GE) junction, and conventional type adenocarcinoma of the hepatic flexure of the colon. The patient underwent neoadjuvant chemo-radiation for the GE junction carcinoma followed by surgical resection of the three different adenocarcinomas simultaneously as definitive management. This case illustrates the utility of immuno-histochemistry in delineating the site of origin for primary tumors, and the challenges posed when dealing with multiple primary neoplasms concurrently.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"630 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77514737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: 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 officials
{"title":"Area-level factors associated with spatial variation of prostate cancer incidence for black men","authors":"G. Dagne, F. Odedina, Nickyjeanna Aime, M. Young","doi":"10.14319/IJCTO.51.23","DOIUrl":"https://doi.org/10.14319/IJCTO.51.23","url":null,"abstract":"Purpose: 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 officials","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86289275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Chaikh, C. Khamphan, A. Delbaere, J. Ojala, Robin García, J. Balosso
Purpose: To track the dosimetric changes for similar dose prescriptions, when dose calculation algorithms are upgraded in the treatment planning system (TPS). Clinically significant representations of the treatment outcomes are used to provide interpretable data for radiation oncologists, as the equivalent uniform dose (EUD), the tumor control probability (TCP), the late toxicity as normal tissue complication probability (NTCP) and the uncomplicated tumor control probability (UTCP) scores. Results are presented and discussed in a clinical perspective. Methods: Ten lung cancer patients were included in this study. For each patient, five treatment plans were generated. The doses were calculated using Anisotropic Analytical Algorithm (AAA) and both Acuros XB (AXB) dose reporting modes: dose-to-medium AXB D(m,m) and dose-to-water AXB D(w,m). In plans 1, 2 and 3, the doses were calculated respectively with AAA, AXB D(m,m) and AXB D(w,m) using exactly the same prescription dose and beam set-up. The doses in plans 4 and 5 were calculated using both AXB dose reporting modes using, as input, the same number of monitor units (MUs) as yielded by AAA, with the same beam set-up. The EUD, TCP and NTCP were computed using the assumed radiobiological parameters from literature. The Wilcoxon paired test was used to calculate p-values. Results: Using the same prescription dose, TCP values were higher with AXB than with AAA, and corresponding UTCP scores were 1-2% better with p < 0.05. In addition, absolute NTCP values were slightly increased with AXB. Both AXB dose reporting modes yielded comparable lower TCP and NTCP values (again in the order of 1-2%) than with AAA, when using same MU numbers as with AAA. Conclusion: Compared to AAA, taken as reference, both AXB dose reporting modes yielded better results. AAA showed very close values to AXB D(w,m), but it is difficult to give recommendation between D(w,m) and D(m,m) yet, due to the lack of recommended radiobiological parameters associated with these dose reporting modes. We suggest doing experimental and modelling studies to determine the real radiobiological effects in both targets and organs at risks. Should the differences be substantial in some conditions and relevant to clinical practice, discussions regarding dose prescription and optimization of the tolerance doses to OAR should be undertaken between medical physicists and radiation oncologists.
{"title":"Radiobiological assessment of dose-to-medium or dose-to-water with Acuros XB algorithm compared with Anisotropic Analytical Algorithm for lung cancer radiotherapy- What should we know to manage the transition?","authors":"A. Chaikh, C. Khamphan, A. Delbaere, J. Ojala, Robin García, J. Balosso","doi":"10.14319/IJCTO.51.18","DOIUrl":"https://doi.org/10.14319/IJCTO.51.18","url":null,"abstract":"Purpose: To track the dosimetric changes for similar dose prescriptions, when dose calculation algorithms are upgraded in the treatment planning system (TPS). Clinically significant representations of the treatment outcomes are used to provide interpretable data for radiation oncologists, as the equivalent uniform dose (EUD), the tumor control probability (TCP), the late toxicity as normal tissue complication probability (NTCP) and the uncomplicated tumor control probability (UTCP) scores. Results are presented and discussed in a clinical perspective. Methods: Ten lung cancer patients were included in this study. For each patient, five treatment plans were generated. The doses were calculated using Anisotropic Analytical Algorithm (AAA) and both Acuros XB (AXB) dose reporting modes: dose-to-medium AXB D(m,m) and dose-to-water AXB D(w,m). In plans 1, 2 and 3, the doses were calculated respectively with AAA, AXB D(m,m) and AXB D(w,m) using exactly the same prescription dose and beam set-up. The doses in plans 4 and 5 were calculated using both AXB dose reporting modes using, as input, the same number of monitor units (MUs) as yielded by AAA, with the same beam set-up. The EUD, TCP and NTCP were computed using the assumed radiobiological parameters from literature. The Wilcoxon paired test was used to calculate p-values. Results: Using the same prescription dose, TCP values were higher with AXB than with AAA, and corresponding UTCP scores were 1-2% better with p < 0.05. In addition, absolute NTCP values were slightly increased with AXB. Both AXB dose reporting modes yielded comparable lower TCP and NTCP values (again in the order of 1-2%) than with AAA, when using same MU numbers as with AAA. Conclusion: Compared to AAA, taken as reference, both AXB dose reporting modes yielded better results. AAA showed very close values to AXB D(w,m), but it is difficult to give recommendation between D(w,m) and D(m,m) yet, due to the lack of recommended radiobiological parameters associated with these dose reporting modes. We suggest doing experimental and modelling studies to determine the real radiobiological effects in both targets and organs at risks. Should the differences be substantial in some conditions and relevant to clinical practice, discussions regarding dose prescription and optimization of the tolerance doses to OAR should be undertaken between medical physicists and radiation oncologists.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77980464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: 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.
{"title":"Exploring the role of “Glycerine plus Honey” in delaying chemoradiation induced oral mucositis in head and neck cancers","authors":"A. Bansal, S. Ghoshal, B. Yadav, A. Bahl","doi":"10.14319/IJCTO.51.3","DOIUrl":"https://doi.org/10.14319/IJCTO.51.3","url":null,"abstract":"Purpose: 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.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81450773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Bhatt, M. Semwal, Sukhvir Singh, K. Chufal, K. Sharma
Purpose: 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.
{"title":"A preliminary investigation on long-term consistency of MPC as a quick daily QA application","authors":"C. Bhatt, M. Semwal, Sukhvir Singh, K. Chufal, K. Sharma","doi":"10.14319/IJCTO.51.17","DOIUrl":"https://doi.org/10.14319/IJCTO.51.17","url":null,"abstract":"Purpose: 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.","PeriodicalId":13931,"journal":{"name":"International Journal of Cancer Therapy and Oncology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73820997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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