Pub Date : 2021-06-21DOI: 10.15406/ijrrt.2021.08.00299
Alert J, C. I, Valdes J, Ropero R, Perez M, Garcia D D, Forteza M, Avila J
Diffuse intrinsic brainstem gliomas have a bad prognosis, and short-term survival time. Radiotherapy has been the principal treatment, and chemotherapy has not improved outcome. The anti –EGFR monoclonal antibody Nimotuzumab combined with Radiotherapy was tested in a series of 41 children and adolescents with diffuse intrinsic pontine gliomas (DIPG) included between January 2008 and December 2015 and a follow-up till January 2021.They were irradiated in the Instituto Nacional de Oncologia y Radiobiologia, Havana, Cuba with a median dose of 54 Gy. Nimotuzumab was applied at a dose of 150 mg/m2, weekly during the period of irradiation, then every 2 weeks by 8 doses, and them monthly for 1,2 or more years. A response was observed in 87.8% of patients. Prolonged use of Nimotuzumab was feasible and well tolerated. Median age at diagnosis was 7 years old, median survival was 18.8 months. There were minor toxicities, only Grade I or II. Survival rate at 5 years was 34.1%, stablished till years or more. Two relapsing patients were re-irradiated. The combination of irradiation and Nimotuzumab is an option to increase survival in DIPG.
{"title":"Very long-term of survival, 5 years and more in diffuse intrinsic pontine brainstem gliomas in children and adolescents treated with Radiotherapy and Nimotuzumab","authors":"Alert J, C. I, Valdes J, Ropero R, Perez M, Garcia D D, Forteza M, Avila J","doi":"10.15406/ijrrt.2021.08.00299","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00299","url":null,"abstract":"Diffuse intrinsic brainstem gliomas have a bad prognosis, and short-term survival time. Radiotherapy has been the principal treatment, and chemotherapy has not improved outcome. The anti –EGFR monoclonal antibody Nimotuzumab combined with Radiotherapy was tested in a series of 41 children and adolescents with diffuse intrinsic pontine gliomas (DIPG) included between January 2008 and December 2015 and a follow-up till January 2021.They were irradiated in the Instituto Nacional de Oncologia y Radiobiologia, Havana, Cuba with a median dose of 54 Gy. Nimotuzumab was applied at a dose of 150 mg/m2, weekly during the period of irradiation, then every 2 weeks by 8 doses, and them monthly for 1,2 or more years. A response was observed in 87.8% of patients. Prolonged use of Nimotuzumab was feasible and well tolerated. Median age at diagnosis was 7 years old, median survival was 18.8 months. There were minor toxicities, only Grade I or II. Survival rate at 5 years was 34.1%, stablished till years or more. Two relapsing patients were re-irradiated. The combination of irradiation and Nimotuzumab is an option to increase survival in DIPG.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116603024","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}
Pub Date : 2021-05-11DOI: 10.15406/ijrrt.2021.08.00298
N. Tunçel
increased. For the first day of the treatment, an imaging and plan related algorithm leads to construct the patient’s non-treatment geometric model. Thus, one can adaptively modify not only the PTV margin, but also the spatial dose distribution to best accommodate any change in patient’s anatomy as well as the dosimetric deviation from the prescription incurred in previous fractions. A cumulative treatment plan provides an overall estimation of the treatment. In the last few years, much of the research has been dedicated to this ART and also notably, various vendors are making significant efforts. With technical advancements, particularly in computer, networking technology and optimization algorithms, online practices are becoming increasingly feasible and may likely become a ‘‘standard practice’’ in the near future. In this approach, the role of simulation geometry and the treatment plan is different from whatever is in current practice. In conclusion, the workflow and technology features are essential factors for introducing and providing robust adaptation of the treatment plan throughout the course of treatment. Indeed, the useful measure to identify patients’ need for an adaptive treatment is the goal of strategy.
{"title":"Adaptive radiotherapy from past to future frontiers","authors":"N. Tunçel","doi":"10.15406/ijrrt.2021.08.00298","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00298","url":null,"abstract":"increased. For the first day of the treatment, an imaging and plan related algorithm leads to construct the patient’s non-treatment geometric model. Thus, one can adaptively modify not only the PTV margin, but also the spatial dose distribution to best accommodate any change in patient’s anatomy as well as the dosimetric deviation from the prescription incurred in previous fractions. A cumulative treatment plan provides an overall estimation of the treatment. In the last few years, much of the research has been dedicated to this ART and also notably, various vendors are making significant efforts. With technical advancements, particularly in computer, networking technology and optimization algorithms, online practices are becoming increasingly feasible and may likely become a ‘‘standard practice’’ in the near future. In this approach, the role of simulation geometry and the treatment plan is different from whatever is in current practice. In conclusion, the workflow and technology features are essential factors for introducing and providing robust adaptation of the treatment plan throughout the course of treatment. Indeed, the useful measure to identify patients’ need for an adaptive treatment is the goal of strategy.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134047157","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}
Pub Date : 2021-05-11DOI: 10.15406/ijrrt.2021.08.00297
L. Raspante, Laura Filgueiras Mourão Ramos, U. Tazinaffo
Case report of a 95-year-old female patient that was admitted to the emergency room with a sudden weakness on the right who underwent propaedeutic imaging with cerebral perfusion study by CT using artificial intelligence (AI) software for clinical suspicion of acute stroke. The case illustrates a frequent and specific imaging finding for stroke and its disappearance in the control exam even without optimized treatment.
{"title":"Radiological CT findings and time evolution in acute stroke: case report","authors":"L. Raspante, Laura Filgueiras Mourão Ramos, U. Tazinaffo","doi":"10.15406/ijrrt.2021.08.00297","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00297","url":null,"abstract":"Case report of a 95-year-old female patient that was admitted to the emergency room with a sudden weakness on the right who underwent propaedeutic imaging with cerebral perfusion study by CT using artificial intelligence (AI) software for clinical suspicion of acute stroke. The case illustrates a frequent and specific imaging finding for stroke and its disappearance in the control exam even without optimized treatment.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116450042","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}
Pub Date : 2021-04-07DOI: 10.15406/ijrrt.2021.08.00292
Anthony Tanous, D. Tighe, J. Bartley, G. Gottschalk, Tanya Gilmour, N. Lotz, G. Fogarty
Purpose: This study is a retrospective audit of radiotherapy (RT) for skin cancer of the ear, eyelid, and lip in Sydney, Australia. The growth of referrals to a tertiary radiation oncology service over a specific time period were also assessed. Materials and Methods: The records of patients who received RT to the external ear, eyelid or lip between January 1 2007 and April 30 2020 were reviewed. Patient, tumour, treatment and outcome factors were recorded. Results: 147 patients with a mean age of 73 years (range: 33-96) were identified as eligible for inclusion. 165 lesions were treated and 18 patients had multiple treatment events. Of all the treated lesions, 81 were basal cell carcinoma (49.2%), 65 cutaneous squamous cell carcinoma (39.4%), 7 lentigo maligna (LM) (4.2%), 2 sebaceous carcinoma (1.2%), 2 merkel cell carcinoma (1.2%), 4 Bowen’s disease (2.4%), 2 actinic change (1.2%) and 2 keloid treatments (1.2%). The mean follow-up was 42 weeks. Definitive RT, that is, RT given as primary treatment rather than post operatively, was given in 108 cases. There were five cases of BCC recurrence and three cases of cSCC recurrence within 3 - 61 months. These were successfully salvaged in six cases (75%). Late side effects were seen in 26 patients with abnormal cosmetic results being the most common late effect (6/26; 23.1%). Conclusion: Lesion-based RT for skin cancer of the ear, eyelid, and lip can be delivered safely and is effective. Definitive RT may be preferable to surgery especially when tissue loss may lead to poor functional and cosmetic outcomes.
{"title":"Lesion-based radiotherapy of the ears, lips and eyelids for skin cancer","authors":"Anthony Tanous, D. Tighe, J. Bartley, G. Gottschalk, Tanya Gilmour, N. Lotz, G. Fogarty","doi":"10.15406/ijrrt.2021.08.00292","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00292","url":null,"abstract":"Purpose: This study is a retrospective audit of radiotherapy (RT) for skin cancer of the ear, eyelid, and lip in Sydney, Australia. The growth of referrals to a tertiary radiation oncology service over a specific time period were also assessed. Materials and Methods: The records of patients who received RT to the external ear, eyelid or lip between January 1 2007 and April 30 2020 were reviewed. Patient, tumour, treatment and outcome factors were recorded. Results: 147 patients with a mean age of 73 years (range: 33-96) were identified as eligible for inclusion. 165 lesions were treated and 18 patients had multiple treatment events. Of all the treated lesions, 81 were basal cell carcinoma (49.2%), 65 cutaneous squamous cell carcinoma (39.4%), 7 lentigo maligna (LM) (4.2%), 2 sebaceous carcinoma (1.2%), 2 merkel cell carcinoma (1.2%), 4 Bowen’s disease (2.4%), 2 actinic change (1.2%) and 2 keloid treatments (1.2%). The mean follow-up was 42 weeks. Definitive RT, that is, RT given as primary treatment rather than post operatively, was given in 108 cases. There were five cases of BCC recurrence and three cases of cSCC recurrence within 3 - 61 months. These were successfully salvaged in six cases (75%). Late side effects were seen in 26 patients with abnormal cosmetic results being the most common late effect (6/26; 23.1%). Conclusion: Lesion-based RT for skin cancer of the ear, eyelid, and lip can be delivered safely and is effective. Definitive RT may be preferable to surgery especially when tissue loss may lead to poor functional and cosmetic outcomes.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128798960","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}
Pub Date : 2021-04-07DOI: 10.15406/ijrrt.2021.08.00293
D. Tighe, Anthony Tanous, J. Flood, Terence SC Poon, Nina Wines, J. Sullivan, T. Gorjiara, Jacqueline Peterson, G. Fogarty
Aim:Non-melanoma skin cancer (NMSC) of the lower legs is a challenge to treat. Surgery can be difficult given the challenged blood supply.Radiotherapy (RT) is a controversial treatment modality and some radiation oncologists (ROs) will not offer definitive treatment for lesions below the knee for fear of creating a radiation-induced ulcer. This study is a retrospective audit of a single RO’s treatment of lower leg NMSCs. The aim is to evaluate the efficacy of RT in gaining local control of these lesions. The aim is also to document the development of late side effects following RT, including radiation-induced ulcers and their treatment. Referral growth over time was also investigated. Methods:Electronic medical records were searched for patients with lower leg NMSCs treated by the RO between January 2009 and December 2019 at three locations in Sydney, Australia (St Vincent’s Hospital, Mater Hospital, and Macquarie University Hospital). Patient, tumour, treatment, and outcome factors were collected and analysed.Referrals over time were recorded. Results:111 lesions arising in 56 patients were identified. There was even distribution of sex and the mean age was 82 (range 57–95). There were 78 cutaneous squamous cell carcinomas (cSCCs) and 23 basal cell carcinomas (BCC). Median lesion size was 2 centimetres (range 1–10cm). The most common RT modality used was electrons (91 [82%]), followed by superficial RT (SXRT) (20 [18%]). Median duration of follow-up was 4 months (range 0–117 months). Of the 77 lesions treated with curative intent, cure was achieved in 74 (96%) lesions. 2 cSCCs and 1 BCC recurred, with a median time to recurrence of 24 months. 15 (14%) lesions developed a radiation-induced ulcer following RT. Median duration of therapy required for these ulcers was 5 months (range 1–55 months), with conservative treatment being the most common therapy used. Referrals increased from 8 in the 2008-2011 period to 26 in the 2016-2019 period. Conclusion: This study showed RT treatment of lower leg NMSCs achieves local control of lesions with an acceptably low rate of radiation-induced ulcers, thus supporting the use of this modality for this patient population. Referrals grew over time which may reflect growing referrer knowledge and confidence in definitive RT below the knee.
{"title":"Lesion-based radiotherapy for non-melanoma skin cancer of the lower legs with a focus on radiation induced ulcers","authors":"D. Tighe, Anthony Tanous, J. Flood, Terence SC Poon, Nina Wines, J. Sullivan, T. Gorjiara, Jacqueline Peterson, G. Fogarty","doi":"10.15406/ijrrt.2021.08.00293","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00293","url":null,"abstract":"Aim:Non-melanoma skin cancer (NMSC) of the lower legs is a challenge to treat. Surgery can be difficult given the challenged blood supply.Radiotherapy (RT) is a controversial treatment modality and some radiation oncologists (ROs) will not offer definitive treatment for lesions below the knee for fear of creating a radiation-induced ulcer. This study is a retrospective audit of a single RO’s treatment of lower leg NMSCs. The aim is to evaluate the efficacy of RT in gaining local control of these lesions. The aim is also to document the development of late side effects following RT, including radiation-induced ulcers and their treatment. Referral growth over time was also investigated. Methods:Electronic medical records were searched for patients with lower leg NMSCs treated by the RO between January 2009 and December 2019 at three locations in Sydney, Australia (St Vincent’s Hospital, Mater Hospital, and Macquarie University Hospital). Patient, tumour, treatment, and outcome factors were collected and analysed.Referrals over time were recorded. Results:111 lesions arising in 56 patients were identified. There was even distribution of sex and the mean age was 82 (range 57–95). There were 78 cutaneous squamous cell carcinomas (cSCCs) and 23 basal cell carcinomas (BCC). Median lesion size was 2 centimetres (range 1–10cm). The most common RT modality used was electrons (91 [82%]), followed by superficial RT (SXRT) (20 [18%]). Median duration of follow-up was 4 months (range 0–117 months). Of the 77 lesions treated with curative intent, cure was achieved in 74 (96%) lesions. 2 cSCCs and 1 BCC recurred, with a median time to recurrence of 24 months. 15 (14%) lesions developed a radiation-induced ulcer following RT. Median duration of therapy required for these ulcers was 5 months (range 1–55 months), with conservative treatment being the most common therapy used. Referrals increased from 8 in the 2008-2011 period to 26 in the 2016-2019 period. Conclusion: This study showed RT treatment of lower leg NMSCs achieves local control of lesions with an acceptably low rate of radiation-induced ulcers, thus supporting the use of this modality for this patient population. Referrals grew over time which may reflect growing referrer knowledge and confidence in definitive RT below the knee.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129162554","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}
Pub Date : 2021-03-29DOI: 10.15406/ijrrt.2021.08.00291
Nicole El-Turk, N. Holt, T. Gorjiara, G. Gottschalk, L. Krieger, L. Berglund, G. Fogarty
Phosphatase and tensin homolog (PTEN) gene acts as a tumour suppressor gene. Mutations of this gene are a step in the development of many cancers. Sufferers can have large fields of symptomatic hamartomatous skin change especially in sun exposed areas. RT has been reported to cause increased acute toxicity in this cohort. A 78-year-old fit male had a confirmed PTEN variant LRG_311t1 Exon 5, c353A>C. Symptomatic skin lesions of left frontal scalp and left nasal ala were confirmed on punch biopsy to be basal cell carcinoma (BCC) and he was referred for definitive radiotherapy (RT). He was treated with lesion based superficial radiotherapy to the left nasal ala to a total dose of 50 Gy in 25 fractions given at 5 fractions per week using a Xstrahl 300 machine via a 3cm circle applicator at 30cm source surface distance with a generating energy of 100 kV. The left frontal scalp was treated with a field-based volumetric modulated arc therapy technique to a planning target volume (PTV) of 74.8cm3 to 45 Gy with a simultaneous integrated boost PTV to 55 Gy of 4.1 cm3 to the BCC, all in 25 fractions. He developed the expected desquamation, erythema and mucositis within the nasal field and desquamation and erythema in the left temple. The PTEN mutation had no visible increase on the acute side effect profile compared with those without the mutation. After more than 6 months, the areas treated with RT remained clear of symptomatic hamartomatous skin change with no late toxicities. To our knowledge this is the longest benefit received of any treatment for fields of symptomatic hamartomatous skin change associated with PTEN mutation. It is also a report of not observing increased acute toxicity of RT in the definitive treatment of skin cancer in those with proven PTEN mutation. This one case adds evidence that definitive RT to skin may be delivered safely in this cohort. More studies with multiple patients with longer follow up are needed to confirm that those suffering with PTEN mutation can be safely and successfully treated with definitive RT for skin cancer and fields of symptomatic hamartomatous skin change with no increase in late effects.
{"title":"Superficial radiotherapy and volumetric modulated Arc therapy for skin cancers within hamartomatous skin in patient with PTEN mutation: A case report","authors":"Nicole El-Turk, N. Holt, T. Gorjiara, G. Gottschalk, L. Krieger, L. Berglund, G. Fogarty","doi":"10.15406/ijrrt.2021.08.00291","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00291","url":null,"abstract":"Phosphatase and tensin homolog (PTEN) gene acts as a tumour suppressor gene. Mutations of this gene are a step in the development of many cancers. Sufferers can have large fields of symptomatic hamartomatous skin change especially in sun exposed areas. RT has been reported to cause increased acute toxicity in this cohort. A 78-year-old fit male had a confirmed PTEN variant LRG_311t1 Exon 5, c353A>C. Symptomatic skin lesions of left frontal scalp and left nasal ala were confirmed on punch biopsy to be basal cell carcinoma (BCC) and he was referred for definitive radiotherapy (RT). He was treated with lesion based superficial radiotherapy to the left nasal ala to a total dose of 50 Gy in 25 fractions given at 5 fractions per week using a Xstrahl 300 machine via a 3cm circle applicator at 30cm source surface distance with a generating energy of 100 kV. The left frontal scalp was treated with a field-based volumetric modulated arc therapy technique to a planning target volume (PTV) of 74.8cm3 to 45 Gy with a simultaneous integrated boost PTV to 55 Gy of 4.1 cm3 to the BCC, all in 25 fractions. He developed the expected desquamation, erythema and mucositis within the nasal field and desquamation and erythema in the left temple. The PTEN mutation had no visible increase on the acute side effect profile compared with those without the mutation. After more than 6 months, the areas treated with RT remained clear of symptomatic hamartomatous skin change with no late toxicities. To our knowledge this is the longest benefit received of any treatment for fields of symptomatic hamartomatous skin change associated with PTEN mutation. It is also a report of not observing increased acute toxicity of RT in the definitive treatment of skin cancer in those with proven PTEN mutation. This one case adds evidence that definitive RT to skin may be delivered safely in this cohort. More studies with multiple patients with longer follow up are needed to confirm that those suffering with PTEN mutation can be safely and successfully treated with definitive RT for skin cancer and fields of symptomatic hamartomatous skin change with no increase in late effects.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130942515","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}
Pub Date : 2021-03-19DOI: 10.15406/ijrrt.2021.08.00290
G. Fogarty, S. Young, S. Lo, James O’ Toole, M. Wanklyn, David Wong, S. Sinclair, G. Gottschalk, P. Guitera, S. Shumack
Introduction: Skin field cancerisation (SFC) arises from prolonged sun exposure and increases with age, especially in fair skinned individuals. Multiple areas of the skin can be involved, resulting in poor quality of life and cosmesis. Invasive skin cancer can arise causing morbidity and even death. The long-term efficacy of traditional treatments is disappointing. Volumetric modulated arc therapy (VMAT) allows efficient definitive radiotherapy treatment of large convex skin fields. This retrospective, single-institution study presents a case series of 100 consecutive SFC fields in 74 patients. Methods: The first 100 fields treated with VMAT for SFC by the same clinician (GBF) were identified through departmental medical records. Patient, field, treatment, and outcome factors were collected for analysis. The date of the first consultation was collected to calculate the rate of referrals over time. Results: The first patient completed treatment in October 2013 and the last patient in May 2020. Seventy-four mostly male (84%) patients with a median age of 76 years were identified. At least 75% had previously undergone treatment for SFC and 11% were immunosuppressed. Twenty percent of patients had more than one field treated with VMAT. Ninety-three fields of keratinocytic lineage were found with most involving the legs (27), scalp (23) or nose (20). Average planning target volume (PTV) size was 175 (range 5 - 1282) cm3. Average prescribed dose was 50 (range 15 - 72) Gy, average delivered dose was 45 (range 4 - 72) Gy. Sixty-four (69%) of fields completed the prescribed course. There were 15 (16%) in-field recurrences. In-field control on an intention-to-treat basis was 89% at 12 months. For those who completed the prescribed treatment, in-field control at 12 months was 98% as compared with 71% for those who did not (p <.0001). PTV size did not impact treatment completion. In those who completed the prescribed treatment, recurrence was not associated with PTV size nor dose. The rate of referrals increased over time. Conclusion: VMAT for SFC is feasible and effective if the whole course is completed. These findings support our national protocol. More research is warranted to predict radiosensitivity so that treatment can be better tailored. Research to identify patients at risk of lower leg lymphoedema before they become symptomatic is also needed to ensure treatment completion thereby reducing the risk of recurrence.
{"title":"Field-based radiotherapy using volumetric modulated arc therapy (VMAT) for skin field cancerisation (SFC)–outcomes from 100 consecutive fields","authors":"G. Fogarty, S. Young, S. Lo, James O’ Toole, M. Wanklyn, David Wong, S. Sinclair, G. Gottschalk, P. Guitera, S. Shumack","doi":"10.15406/ijrrt.2021.08.00290","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00290","url":null,"abstract":"Introduction: Skin field cancerisation (SFC) arises from prolonged sun exposure and increases with age, especially in fair skinned individuals. Multiple areas of the skin can be involved, resulting in poor quality of life and cosmesis. Invasive skin cancer can arise causing morbidity and even death. The long-term efficacy of traditional treatments is disappointing. Volumetric modulated arc therapy (VMAT) allows efficient definitive radiotherapy treatment of large convex skin fields. This retrospective, single-institution study presents a case series of 100 consecutive SFC fields in 74 patients. Methods: The first 100 fields treated with VMAT for SFC by the same clinician (GBF) were identified through departmental medical records. Patient, field, treatment, and outcome factors were collected for analysis. The date of the first consultation was collected to calculate the rate of referrals over time. Results: The first patient completed treatment in October 2013 and the last patient in May 2020. Seventy-four mostly male (84%) patients with a median age of 76 years were identified. At least 75% had previously undergone treatment for SFC and 11% were immunosuppressed. Twenty percent of patients had more than one field treated with VMAT. Ninety-three fields of keratinocytic lineage were found with most involving the legs (27), scalp (23) or nose (20). Average planning target volume (PTV) size was 175 (range 5 - 1282) cm3. Average prescribed dose was 50 (range 15 - 72) Gy, average delivered dose was 45 (range 4 - 72) Gy. Sixty-four (69%) of fields completed the prescribed course. There were 15 (16%) in-field recurrences. In-field control on an intention-to-treat basis was 89% at 12 months. For those who completed the prescribed treatment, in-field control at 12 months was 98% as compared with 71% for those who did not (p <.0001). PTV size did not impact treatment completion. In those who completed the prescribed treatment, recurrence was not associated with PTV size nor dose. The rate of referrals increased over time. Conclusion: VMAT for SFC is feasible and effective if the whole course is completed. These findings support our national protocol. More research is warranted to predict radiosensitivity so that treatment can be better tailored. Research to identify patients at risk of lower leg lymphoedema before they become symptomatic is also needed to ensure treatment completion thereby reducing the risk of recurrence.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123418510","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}
Pub Date : 2021-02-12DOI: 10.15406/ijrrt.2021.08.00289
P. Bagdare, S. Dubey, Sanjay Kumar Ghosh, Shital Bhandigare
Quality assurance (QA) before patient treatment plays a major role in complex radiotherapy (RT) treatment planning. Phantoms are the standard materials that are used for the pre-treatment QA of patients. Contemporary phantoms used in RT are mainly water-based, having simple geometry and of uniform density. These phantoms dose not replicate the exact heterogeneities of the actual human body. The present work aims to evaluate the results of relative dosimetry performed on in-house developed heterogeneous thorax phantom (HTP) using an electronic portal imaging device (EPID). To perform the relative dosimetry, contours were drawn on HTP at three different locations and intensity modulated radiotherapy (IMRT), as well as Rapid ARC (RA), were generated on it to compare the fluence obtained on TPS as well as on linac machine. The gamma evaluation results indicate a strong correlation between planned and the measured fluence. We found the EPID-based QA done on HTP explore its property as a QA tool and it can further be used to perform patient-specific relative dosimetry.
{"title":"Analysis of gamma index using in-house developed heterogeneous thorax phantom","authors":"P. Bagdare, S. Dubey, Sanjay Kumar Ghosh, Shital Bhandigare","doi":"10.15406/ijrrt.2021.08.00289","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00289","url":null,"abstract":"Quality assurance (QA) before patient treatment plays a major role in complex radiotherapy (RT) treatment planning. Phantoms are the standard materials that are used for the pre-treatment QA of patients. Contemporary phantoms used in RT are mainly water-based, having simple geometry and of uniform density. These phantoms dose not replicate the exact heterogeneities of the actual human body. The present work aims to evaluate the results of relative dosimetry performed on in-house developed heterogeneous thorax phantom (HTP) using an electronic portal imaging device (EPID). To perform the relative dosimetry, contours were drawn on HTP at three different locations and intensity modulated radiotherapy (IMRT), as well as Rapid ARC (RA), were generated on it to compare the fluence obtained on TPS as well as on linac machine. The gamma evaluation results indicate a strong correlation between planned and the measured fluence. We found the EPID-based QA done on HTP explore its property as a QA tool and it can further be used to perform patient-specific relative dosimetry.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121356110","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}
Pub Date : 2021-01-12DOI: 10.15406/ijrrt.2021.08.00288
Drew H. Smith, D. L. Joon, Michal Schneider, E. Lau, K. Knight, F. Foroudi, V. Khoo
Purpose Clinician inexperience, intra–observer and inter–observer variations in tumour definition may affect staging, radiotherapy target definition, and treatment outcomes, particularly in rare cancers. The purpose of this study was to assess the correlation between semi–automated methods of primary anal cancer (AC) definition and our current clinical standard of manual clinician definition using 18F–FDG–PET imaging and to provide recommendations for clinical use. Methods All patients referred for chemoradiotherapy for AC between 2012 and 2016 were prospectively enrolled, with all 18F–FDG–PET imaging acquired within one year of chemoradiotherapy collected. Three methods of primary AC definition were performed on all PET datasets. Manual definition by an experienced radiologist was considered the clinical standard for comparison of volume and coincidence (Dice coefficient) in our study. Semi–automated techniques assessed included a gradient–based SUV (SUV–gradient) method and a SUV threshold method with a range of thresholds relative to SUVmax (40 (T40), 50 (T50) and 60% (T60)). Results Ten patients were enrolled with 33 PET study sets available for analysis. While all methods created contours on pre– and post–treatment scans, manual definition of PET–avid disease was only necessary on 11 of the 33 study sets. SUV–gradient and T40 defined contours were not statistically different in volume to the clinical standard (p = 0.83 & 0.72 respectively). The observed Dice coefficient relative to the manual clinician contours were 0.75 and 0.73 for the SUV–gradient and T40 methods respectively. Conclusions It is possible to define gross AC using SUV–based methods, with the SUV–gradient–based method followed by the T40 method most closely correlating with our current clinical standard. The SUV–gradient–based method studied is housed within a proprietary clinical system. A semi–automated approach that uses a vendor neutral T40 method and the clinician’s knowledge and skill appears optimal in defining AC. With this approach AC may be defined reliably to enhance efficiencies in radiotherapy and nuclear medicine processes, and to support clinicians in identifying and defining this rare disease. Trial registration ANZCTR, ACTRN12620000066987. Registered 28 January 2020–Retrospectively registered, https://www.anzctr.org.au/ACTRN12620000066987.aspx
目的 临床医师经验不足、观察者内部和观察者之间在肿瘤定义方面的差异可能会影响分期、放疗靶点定义和治疗效果，特别是在罕见癌症中。本研究旨在评估原发性肛门癌（AC）定义的半自动化方法与目前临床医生使用 18F-FDG-PET 成像进行人工定义的临床标准之间的相关性，并为临床使用提供建议。方法 对 2012 年至 2016 年期间转诊接受化放疗的所有原发性肛门癌患者进行前瞻性研究，收集化放疗后一年内获得的所有 18F-FDG-PET 成像。对所有 PET 数据集采用三种方法进行原发性 AC 定义。在我们的研究中，由经验丰富的放射科医生手动定义被认为是比较体积和重合度（Dice系数）的临床标准。评估的半自动技术包括基于梯度的 SUV（SUV-梯度）方法和 SUV 阈值方法，阈值范围相对于 SUVmax（40 (T40)、50 (T50) 和 60% (T60)）。结果 10 名患者入选，33 组 PET 研究数据可供分析。虽然所有方法都能在治疗前和治疗后扫描中创建轮廓，但在 33 组研究中，只有 11 组需要手动定义 PET-avid 疾病。SUV梯度和T40定义的等值线在体积上与临床标准没有统计学差异（p = 0.83 和 0.72）。相对于临床医生的人工轮廓，SUV 梯度法和 T40 法观察到的 Dice 系数分别为 0.75 和 0.73。结论 使用基于 SUV 的方法可以定义毛细血管畸形，其中基于 SUV 梯度的方法和 T40 方法与我们目前的临床标准最为接近。所研究的基于 SUV 梯度的方法安装在一个专有的临床系统中。使用供应商中立的 T40 方法以及临床医生的知识和技能的半自动方法似乎是定义 AC 的最佳方法。采用这种方法可以可靠地定义 AC，从而提高放射治疗和核医学流程的效率，并为临床医生识别和定义这种罕见疾病提供支持。试验注册号：ANZCTR，ACTRN12620000066987。2020年1月28日注册-回顾注册，https://www.anzctr.org.au/ACTRN12620000066987.aspx
{"title":"Defining primary anal cancer tumour volume on FDG–PET – an initial assessment of semi–automated methods","authors":"Drew H. Smith, D. L. Joon, Michal Schneider, E. Lau, K. Knight, F. Foroudi, V. Khoo","doi":"10.15406/ijrrt.2021.08.00288","DOIUrl":"https://doi.org/10.15406/ijrrt.2021.08.00288","url":null,"abstract":"Purpose Clinician inexperience, intra–observer and inter–observer variations in tumour definition may affect staging, radiotherapy target definition, and treatment outcomes, particularly in rare cancers. The purpose of this study was to assess the correlation between semi–automated methods of primary anal cancer (AC) definition and our current clinical standard of manual clinician definition using 18F–FDG–PET imaging and to provide recommendations for clinical use. Methods All patients referred for chemoradiotherapy for AC between 2012 and 2016 were prospectively enrolled, with all 18F–FDG–PET imaging acquired within one year of chemoradiotherapy collected. Three methods of primary AC definition were performed on all PET datasets. Manual definition by an experienced radiologist was considered the clinical standard for comparison of volume and coincidence (Dice coefficient) in our study. Semi–automated techniques assessed included a gradient–based SUV (SUV–gradient) method and a SUV threshold method with a range of thresholds relative to SUVmax (40 (T40), 50 (T50) and 60% (T60)). Results Ten patients were enrolled with 33 PET study sets available for analysis. While all methods created contours on pre– and post–treatment scans, manual definition of PET–avid disease was only necessary on 11 of the 33 study sets. SUV–gradient and T40 defined contours were not statistically different in volume to the clinical standard (p = 0.83 & 0.72 respectively). The observed Dice coefficient relative to the manual clinician contours were 0.75 and 0.73 for the SUV–gradient and T40 methods respectively. Conclusions It is possible to define gross AC using SUV–based methods, with the SUV–gradient–based method followed by the T40 method most closely correlating with our current clinical standard. The SUV–gradient–based method studied is housed within a proprietary clinical system. A semi–automated approach that uses a vendor neutral T40 method and the clinician’s knowledge and skill appears optimal in defining AC. With this approach AC may be defined reliably to enhance efficiencies in radiotherapy and nuclear medicine processes, and to support clinicians in identifying and defining this rare disease. Trial registration ANZCTR, ACTRN12620000066987. Registered 28 January 2020–Retrospectively registered, https://www.anzctr.org.au/ACTRN12620000066987.aspx","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131130336","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}
Pub Date : 2020-12-22DOI: 10.15406/ijrrt.2020.07.00287
Abear Labban, Wassim Bin Khadra
The outbreak of the Coronavirus COVID-19 pandemic originated in China Wuhan province in December 2019, China and it causes severe acute respiratory and lung infection. Up to this date, over 5 million people around the world especially in Italy, USA and Iran have been infected with the virus. The Syrian government represented in Ministry of Health and other health authorities have responded to this outbreak with lockdown of the public and private activities among many other procedures. These responses are led by public health authorities in coordination with the hospitals in the Syrian cities including Damascus Hospital which belongs to Ministry of Health. Damascus hospital and other hospitals which belong to Ministry of Health continued to receive referrals of patients during the lockdown period for their diagnosis. As Damascus hospital is considered the largest hospital, the review will focus on services that had been offered by it.
{"title":"The preparedness of the radiology department at Damascus Hospital during COVID-19 lockdown","authors":"Abear Labban, Wassim Bin Khadra","doi":"10.15406/ijrrt.2020.07.00287","DOIUrl":"https://doi.org/10.15406/ijrrt.2020.07.00287","url":null,"abstract":"The outbreak of the Coronavirus COVID-19 pandemic originated in China Wuhan province in December 2019, China and it causes severe acute respiratory and lung infection. Up to this date, over 5 million people around the world especially in Italy, USA and Iran have been infected with the virus. The Syrian government represented in Ministry of Health and other health authorities have responded to this outbreak with lockdown of the public and private activities among many other procedures. These responses are led by public health authorities in coordination with the hospitals in the Syrian cities including Damascus Hospital which belongs to Ministry of Health. Damascus hospital and other hospitals which belong to Ministry of Health continued to receive referrals of patients during the lockdown period for their diagnosis. As Damascus hospital is considered the largest hospital, the review will focus on services that had been offered by it.","PeriodicalId":214028,"journal":{"name":"International Journal of Radiology & Radiation Therapy","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115925674","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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