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Experimental determination of breast skin dose using volumetric modulated arc therapy and field-in-field treatment techniques 体积调制电弧疗法和场中治疗技术测定乳腺皮肤剂量的实验研究
IF 0.4 Q4 Medicine Pub Date : 2022-10-03 DOI: 10.1017/S1460396922000292
Ana María Cardona-Maya, J. A. Rojas-López, A. Germanier, P. Murina, D. Venencia
Abstract Introduction: The use of volumetric modulated arc therapy (VMAT) on the breast has several dosimetric advantages but its impact on skin dose should be evaluated and compared to well-established treatment techniques using tangential fields. The aim of this work is to contrast the skin dose for VMAT and field-in-field (FIF) and to estimate the magnitude of the skin dose involved. Method: The skin dose was measured, without build-up, using thermoluminescent dosimeter (TLD) and optically stimulated luminescence dosimeter (OSLD) in breast radiotherapy by an in-house anthropomorphic phantom. Two different treatment techniques were used: FIF and VMAT, based on the planning strategy proposed by Nicolini et al. The dose levels were 4300 cGy, 4600 cGy and 5600 cGy in 20 fractions. In vivo dosimetry with TLD for VMAT was performed for different breast sizes in the same locations as phantom measurements. Results: The ipsilateral phantom breast skin dose using both treatment techniques was equivalent. TLD measured doses by the VMAT technique were up to 5% higher than OSLD, although they agree if we consider the geometry uncertainty of the TLD. In accordance with in vivo dosimetry, the mean dose of the ipsilateral breast skin was 62 ± 6% (51%, 75%) relative to the prescribed dose, regardless of the breast size for the volumes considered with this small population (n = 9) as shown by Mann–Whitney U-test (Z = 1·9, 95% confidence). The uncertainty expected in this region due to geometry (volume) changes is up to 9% higher for volumes from 225·9 cc to 968·8 cc. According to the treatment techniques and in vivo dosimetry, the contralateral breast skin dose was 1·0% in FIF and 2·5% in VMAT concerning the prescribed dose. Conclusion: There is no difference in skin dosimetry between VMAT and FIF techniques on the ipsilateral breast. It provides useful support for the use of VMAT as a planning technique for breast irradiation. The work describes the importance of quantifying potential differences in skin dosimetry.
摘要简介:在乳腺上使用体积调制电弧疗法(VMAT)有几个剂量测量优势,但应评估其对皮肤剂量的影响,并将其与使用切向场的成熟治疗技术进行比较。这项工作的目的是对比VMAT和场中(FIF)的皮肤剂量,并估计所涉及的皮肤剂量的大小。方法:使用热致发光剂量计(TLD)和光刺激发光剂量计(OSLD),通过内部拟人体模测量乳腺放射治疗中的皮肤剂量,不产生累积。根据Nicolini等人提出的计划策略,使用了两种不同的治疗技术:FIF和VMAT。20个部分的剂量水平分别为4300 cGy、4600 cGy和5600 cGy。在与体模测量相同的位置,对不同乳房尺寸的VMAT进行TLD体内剂量测定。结果:使用两种治疗技术的同侧体模乳腺皮肤剂量相等。VMAT技术测得的TLD剂量比OSLD高出5%,尽管如果我们考虑TLD的几何不确定性,它们是一致的。根据体内剂量测定,同侧乳腺皮肤的平均剂量相对于规定剂量为62±6%(51%,75%),而不考虑这个小群体(n=9)体积的乳房大小,如Mann–Whitney U型检验(Z=1.9,95%置信度)所示。对于225.9立方厘米至968.8立方厘米的体积,由于几何形状(体积)变化,该区域的预期不确定性高达9%。根据治疗技术和体内剂量测定,FIF中对侧乳腺皮肤剂量为1.0%,VMAT中规定剂量的对侧乳腺皮肤剂量为2.5%。结论:VMAT和FIF技术在同侧乳腺的皮肤剂量测定上没有差异。它为VMAT作为乳腺照射计划技术的使用提供了有用的支持。这项工作描述了量化皮肤剂量测定中潜在差异的重要性。
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引用次数: 0
Effect of tumour involvement on activity determination of resin Yttrium-90 in selective internal radiation therapy of metastatic liver cancer 肿瘤受累对转移性肝癌选择性内放射治疗中树脂钇-90活性测定的影响
IF 0.4 Q4 Medicine Pub Date : 2022-09-29 DOI: 10.1017/S1460396922000280
Jun Yu Li, Yan Yu, R. Anne
Abstract Introduction: The study was aimed to evaluate the effect of tumour involvement on resin Yttrium-90 (Y90) activity determination for metastatic liver cancer treatment. Methods: One hundred and two cases of resin Y90 microsphere treatment were retrospectively studied. Body surface area (BSA) method was used in the calculation of resin Y90 activity. The total activity (TA) was calculated as a summation of activities obtained from BSA-based calculation and tumour involvement (TI). TI and TA of each case were evaluated. The contributions of TI to TA were calculated with the ratio of TI/TA. Results: The average contribution of TI to TA was 4·1%. The contributions were < 5·8% in 75% of the cases, < 2·2% in 50% of the cases and < 1·0% in 25% of the cases. Conclusions: Overall the effect of tumour involvement on the activity determination was small. The activity calculation could be simplified by neglecting TI in 25% of the cases where the activity contribution from TI was less than 1%. Contouring tumour and liver structures for TI calculation could be avoided in these cases, and the efficiency of the workflow for resin Y90 procedures could be improved.
摘要简介:本研究旨在评估肿瘤累及对树脂钇-90 (Y90)活性测定在转移性肝癌治疗中的影响。方法:对102例Y90树脂微球治疗的临床资料进行回顾性分析。采用体表面积法(BSA)计算树脂Y90活性。总活性(TA)是由基于bsa的计算和肿瘤累及(TI)计算得到的活性的总和。评估每个病例的TI和TA。用TI/TA的比值计算TI对TA的贡献。结果:TI对TA的平均贡献为4.1%。75%的病例贡献< 5.8%,50%的病例贡献< 2.2%,25%的病例贡献< 1.0%。结论:总体而言,肿瘤累及对活性测定的影响很小。当TI对活性的贡献小于1%时,在25%的情况下忽略TI可以简化活性计算。在这些情况下,可以避免对肿瘤和肝脏结构进行TI计算,并且可以提高树脂Y90程序的工作流程效率。
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引用次数: 0
Association of survival with stereotactic body radiation therapy following induction chemotherapy for unresected locally advanced pancreatic cancer. 未切除的局部晚期胰腺癌诱导化疗后立体定向放射治疗与生存率的关系。
IF 0.4 Q4 Medicine Pub Date : 2022-09-01 Epub Date: 2021-04-14 DOI: 10.1017/s1460396921000212
Sung Jun Ma, Lucas M Serra, Austin J Bartl, Hye Ri Han, Fatemeh Fekrmandi, Austin J Iovoli, Kavitha M Prezzano, Gregory M Hermann, Han Yu, Anurag K Singh

Background: Induction chemotherapy (iC) followed by concurrent chemoradiation has been shown to improve overall survival (OS) for locally advanced pancreatic cancer (LAPC). However, the survival benefit of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy (CFRT) following iC remains unclear.

Methods: The National Cancer Database (NCDB) was queried for primary stage III, cT4N0-1M0 LAPC (2004-2015). Kaplan-Meier analysis, Cox proportional hazards method, and propensity score matching were used.

Results: Among 872 patients, 738 patients underwent CFRT and 134 patients received SBRT. Median follow-up was 24.3 months and 22.9 months for the CFRT and SBRT cohorts, respectively. The use of SBRT showed improved survival in both the multivariate analysis (HR 0.78, p=0.025) and 120 propensity-matched pairs (median OS 18.1 vs 15.9 months, p=0.004) compared to the CFRT.

Conclusion: This NCDB analysis suggests survival benefit with the use of SBRT versus CFRT following iC for the LAPC.

背景:诱导化疗(iC)后同步放化疗已被证明可提高局部晚期胰腺癌(LAPC)的总生存期(OS)。然而,立体定向放射治疗(SBRT)与传统分次放射治疗(CFRT)在iC后的生存益处尚不清楚。方法:查询国家癌症数据库(NCDB)的原发性III期cT4N0-1M0 LAPC(2004-2015)。采用Kaplan-Meier分析、Cox比例风险法和倾向评分匹配。结果:872例患者中,738例接受了CFRT, 134例接受了SBRT。CFRT和SBRT组的中位随访时间分别为24.3个月和22.9个月。与CFRT相比,SBRT的使用在多变量分析(HR 0.78, p=0.025)和120对倾向匹配对(中位OS 18.1 vs 15.9个月,p=0.004)中均显示生存率提高。结论:这项NCDB分析表明,与CFRT相比,使用SBRT治疗LAPC的生存率更高。
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引用次数: 2
Adjuvant chemotherapy versus observation following neoadjuvant therapy and surgery for resectable stage I-II pancreatic cancer. 可切除的 I-II 期胰腺癌新辅助治疗和手术后的辅助化疗与观察。
IF 0.3 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2022-09-01 Epub Date: 2021-04-14 DOI: 10.1017/s1460396921000194
Sung Jun Ma, Lucas M Serra, Austin J Bartl, Hye Ri Han, Fatemeh Fekrmandi, Austin J Iovoli, Gregory M Hermann, Han Yu, Anurag K Singh

Background: Neoadjuvant therapy (NT), either with systemic treatment alone or in combination with radiation, is often utilized in the management of pancreatic adenocarcinoma to increase the likelihood of margin-negative resection. Following NT and resection, additional adjuvant chemotherapy (AC) can be considered for select patients and has been shown to improve overall survival (OS). This National Cancer Data Base (NCDB) analysis was performed to evaluate the outcomes of AC versus observation for resected pancreatic adenocarcinoma treated with NT.

Methods: The NCDB was queried for primary stage I-II cT1-3N0-1M0 resected pancreatic adenocarcinoma treated with NT (2004-2015). Baseline patient, tumor, and treatment characteristics were extracted. The primary endpoint was OS. With a 6-month conditional landmark, Kaplan-Meier analysis, multivariable Cox proportional hazards method, 1:1 propensity score matching were used to analyze the data.

Results: A total of 1737 eligible patients were identified, of which 1247 underwent postoperative observation compared to 490 with AC. The overall median follow-up was 34.7 months. The addition of AC showed improved survival on the multivariate analysis (HR 0.78, p<0.001). Of 490 propensity-matched pairs, all variables were well balanced, including age (p=0.61), Charlson-Deyo comorbidity score (p=0.80), ypT stage (p=0.93), ypN stage (p=0.83), surgical margin (p=0.83), duration of postoperative inpatient admission (p=0.96), and 30-day unplanned readmission after resection (p=0.34). AC remained statistically significant for improved OS, with median OS of 26.3 months vs 22.3 months and 2-year OS of 63.9% vs 52.9% for the observation cohort (p<0.001). Treatment interaction analysis showed OS benefit of AC for patients with smaller tumors (HR 0.67, p<0.001 for <3.1 cm vs HR 0.93, p=0.48 for ≥3.1 cm).

Conclusion: Using propensity score matched analysis, our findings suggest a survival benefit for adjuvant chemotherapy compared to observation following NT and surgery for resectable pancreatic adenocarcinoma, especially in patients with smaller tumors. Prospective studies are needed to identify subset of patients that would benefit from adjuvant chemotherapy.

背景:在胰腺腺癌的治疗中,通常会采用新辅助治疗(NT),无论是单独的全身治疗还是与放疗相结合,以增加边缘阴性切除的可能性。在NT和切除术后,可考虑对部分患者进行额外的辅助化疗(AC),并已证明可提高总生存率(OS)。本研究对美国国家癌症数据库(NCDB)进行了分析,以评估对接受NT治疗的胰腺腺癌患者进行AC治疗与观察治疗的结果:对NCDB中接受NT治疗的原发性I-II期cT1-3N0-1M0切除胰腺腺癌进行了查询(2004-2015年)。提取了患者、肿瘤和治疗的基线特征。主要终点是OS。以6个月为条件地标,采用Kaplan-Meier分析法、多变量Cox比例危险法、1:1倾向得分匹配法对数据进行分析:共确定了1737名符合条件的患者,其中1247人接受了术后观察,而490人接受了AC治疗。总体中位随访时间为 34.7 个月。在多变量分析中,加用 AC 可提高生存率(HR 0.78,pConclusion):通过倾向评分匹配分析,我们的研究结果表明,对于可切除的胰腺腺癌,尤其是肿瘤较小的患者,NT和手术后辅助化疗比观察化疗更有利于患者生存。需要进行前瞻性研究,以确定哪些患者可从辅助化疗中获益。
{"title":"Adjuvant chemotherapy versus observation following neoadjuvant therapy and surgery for resectable stage I-II pancreatic cancer.","authors":"Sung Jun Ma, Lucas M Serra, Austin J Bartl, Hye Ri Han, Fatemeh Fekrmandi, Austin J Iovoli, Gregory M Hermann, Han Yu, Anurag K Singh","doi":"10.1017/s1460396921000194","DOIUrl":"10.1017/s1460396921000194","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant therapy (NT), either with systemic treatment alone or in combination with radiation, is often utilized in the management of pancreatic adenocarcinoma to increase the likelihood of margin-negative resection. Following NT and resection, additional adjuvant chemotherapy (AC) can be considered for select patients and has been shown to improve overall survival (OS). This National Cancer Data Base (NCDB) analysis was performed to evaluate the outcomes of AC versus observation for resected pancreatic adenocarcinoma treated with NT.</p><p><strong>Methods: </strong>The NCDB was queried for primary stage I-II cT1-3N0-1M0 resected pancreatic adenocarcinoma treated with NT (2004-2015). Baseline patient, tumor, and treatment characteristics were extracted. The primary endpoint was OS. With a 6-month conditional landmark, Kaplan-Meier analysis, multivariable Cox proportional hazards method, 1:1 propensity score matching were used to analyze the data.</p><p><strong>Results: </strong>A total of 1737 eligible patients were identified, of which 1247 underwent postoperative observation compared to 490 with AC. The overall median follow-up was 34.7 months. The addition of AC showed improved survival on the multivariate analysis (HR 0.78, p<0.001). Of 490 propensity-matched pairs, all variables were well balanced, including age (p=0.61), Charlson-Deyo comorbidity score (p=0.80), ypT stage (p=0.93), ypN stage (p=0.83), surgical margin (p=0.83), duration of postoperative inpatient admission (p=0.96), and 30-day unplanned readmission after resection (p=0.34). AC remained statistically significant for improved OS, with median OS of 26.3 months vs 22.3 months and 2-year OS of 63.9% vs 52.9% for the observation cohort (p<0.001). Treatment interaction analysis showed OS benefit of AC for patients with smaller tumors (HR 0.67, p<0.001 for <3.1 cm vs HR 0.93, p=0.48 for ≥3.1 cm).</p><p><strong>Conclusion: </strong>Using propensity score matched analysis, our findings suggest a survival benefit for adjuvant chemotherapy compared to observation following NT and surgery for resectable pancreatic adenocarcinoma, especially in patients with smaller tumors. Prospective studies are needed to identify subset of patients that would benefit from adjuvant chemotherapy.</p>","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9398187/pdf/nihms-1698775.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33438069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic self-reporting of patients’ symptoms: improving oncologic care and patients’ satisfaction 患者症状的系统自我报告:改善肿瘤护理和患者满意度
IF 0.4 Q4 Medicine Pub Date : 2022-08-09 DOI: 10.1017/S1460396922000255
E. Osei, Catherine B. McKenna, J. Darko, Kathy McKnight, Christine Y Peters
Abstract Background: In recent years, there has been a growing interest to enhance patients’ symptom management during routine cancer care using patient-reported outcome measures. The goal of this study is to analyse patients’ responses to the Edmonton Symptom Assessment System (ESAS) to determine whether patient-reported outcomes could help characterise those patients with the highest supportive care needs and symptom burden in order to help provide targeted support for patients. Methods: In this study, we analysed ESAS questionnaire responses completed by patients as part of their routine care and considered part of patients’ standard of care. Statistical analyses were performed using the IBM SPSS Statistics version 26.0. Descriptive statistics are used to summarise patient demographics, disease characteristics and patient-reported symptom severity and prevalence. Results: The overall mean age is 65.2 ± 12.8 years comprising 43.8% male and 56.2% female patients. The five common primary disease sites are breast (26.2%), haematology (21.1%), gastrointestinal (15.3%), genitourinary (12.7%) and lung (12.0%) cancers. The mean severity for each symptom is all mild (score: 1–3). The three most common reported symptoms causing distress are tiredness, poor overall wellbeing and anxiety, and the least reported symptom is nausea. Conclusions: Systematic self-reporting of patients’ symptoms is important to improve symptom management, timely facilitation of appropriate intervention, patient experience, and patient and family satisfaction. The awareness of disease site, gender and age-related symptom variations should help in the design and provision of appropriate symptom-directed, tumour-specific and patient-focused interventions to meet patients’ immediate needs.
背景:近年来,人们越来越关注在常规癌症护理中使用患者报告的结果测量来加强患者的症状管理。本研究的目的是分析患者对埃德蒙顿症状评估系统(ESAS)的反应,以确定患者报告的结果是否可以帮助表征那些最高支持性护理需求和症状负担的患者,以便帮助为患者提供有针对性的支持。方法:在本研究中,我们分析了ESAS问卷的回答,这些问卷是患者日常护理的一部分,并被认为是患者标准护理的一部分。采用IBM SPSS Statistics 26.0版本进行统计分析。描述性统计用于总结患者人口统计、疾病特征和患者报告的症状严重程度和患病率。结果:患者总体平均年龄为65.2±12.8岁,男性占43.8%,女性占56.2%。五种常见的原发部位是乳腺癌(26.2%)、血液病(21.1%)、胃肠道(15.3%)、泌尿生殖系统(12.7%)和肺癌(12.0%)。每个症状的平均严重程度均为轻度(得分:1-3)。最常见的三种引起痛苦的症状是疲劳、整体健康状况不佳和焦虑,而最不常见的症状是恶心。结论:系统的患者症状自我报告对改善症状管理、及时促进适当干预、患者体验以及患者和家属满意度具有重要意义。对疾病部位、性别和年龄相关症状变化的认识应有助于设计和提供适当的症状导向、肿瘤特异性和以患者为中心的干预措施,以满足患者的直接需求。
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引用次数: 1
Dosimetric effects of oral contrast in the planning of conventional radiotherapy and IMRT, for rectal cancer treatment 口服造影剂在直肠癌常规放疗和IMRT计划中的剂量学效应
IF 0.4 Q4 Medicine Pub Date : 2022-08-02 DOI: 10.1017/S1460396922000243
Nadia Montero-Oleas, Andrés Imbaquingo-Cabrera, Alejandro Coloma-Espin, Vladimir Collantes-Cruz, Carlos Molineros, Cristina Núñez-Silva
Abstract Introduction: Contrast media are frequently used during radiation therapy simulation. However, there are concerns about dosimetric variations when dose calculation is done on contrast-enhanced computed tomography (CT). This study evaluates the dosimetric effect of oral contrast during three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc radiotherapy (VMAT) planning. Methods: Rectal cancer patients were consecutively enrolled. For each patient, one unenhanced CT and one contrast-enhanced CT were taken using oral and intravenous contrast. Then, a 3D-CRT plan and an Intensity-modulated radiation therapy (IMRT)/VMAT plan were generated in the enhanced CT, and the dose distribution was recalculated in the respective unenhanced CT. The beam intensities were kept the same as for the enhanced CT plans. Finally, the unenhanced and enhanced plans were compared by calculating the gamma index. Results: For 3D-CRT plans, there were statistically significant differences in second phase planning target volume (PTV) D2% (Mean difference (MD) between unenhanced and enhanced CT 0·01 Gy, 95% CI [0·003 to 0·02 Gy]) and in maximum doses to the bladder (MD 0·26 Gy, 95% CI [0·05 to 0·47 Gy]). For IMRT/VMAT plans, there were statistically significant differences in small intestine V45 Gy (MD 3·1 cc, 95% CI [0·81 to 5·4 cc]), bladder V45 Gy (MD 2·9%, 95% CI [1·4 to 4·3%]) and maximum dose to the bladder (MD 0·65 Gy, 95% CI [0·46 Gy to 0·85 Gy]). In addition, for PTV D98% the MD between unenhanced and enhanced CT was 0·22 Gy 95% CI [0·05 to 0·39]. Conclusions: For most of the dose metrics, the differences were not clinically meaningful. The greatest differences were found in VMAT plans, especially in V45 Gy of the small intestine. This difference could lead to an underestimation of dose–volume metrics when the plan is based on an enhanced CT. The use of small bowel oral contrast does not significantly influence dose calculations and may not affect the acceptability of plans when adhering to constraints.
摘要简介:造影剂是放射治疗模拟中常用的造影剂。然而,当在对比增强计算机断层扫描(CT)上进行剂量计算时,存在对剂量测量变化的担忧。本研究评估了口腔造影剂在三维适形放射治疗(3D-CRT)和体积调制电弧放射治疗(VMAT)计划中的剂量测定效果。方法:连续入组癌症直肠肿瘤患者。对于每位患者,使用口服和静脉造影剂进行一次未增强CT和一次增强CT。然后,在增强CT中生成3D-CRT计划和强度调制放射治疗(IMRT)/VMAT计划,并在各自的未增强CT中重新计算剂量分布。光束强度与增强CT计划保持相同。最后,通过计算gamma指数对未增强和增强方案进行比较。结果:对于3D-CRT计划,第二阶段计划目标体积(PTV)D2%(未增强和增强CT之间的平均差异(MD)0.01Gy,95%CI[0.003~0.02Gy])和膀胱最大剂量(MD0.26Gy,95%CI[0.05-0.47Gy])存在统计学显著差异。对于IMRT/VMAT方案,小肠V45Gy(MD 3.1 cc,95%CI[0.81至5.4 cc])、膀胱V45Gy、膀胱最大剂量(MD 0.65 Gy、95%CI[0.46 Gy至0.85 Gy])存在统计学显著差异。此外,对于PTV D98%,未增强和增强CT之间的MD为0.22Gy 95%CI[0.05至0.39]。结论:对于大多数剂量指标,这些差异没有临床意义。VMAT方案的差异最大,尤其是小肠的V45Gy。当计划基于增强CT时,这种差异可能会导致低估剂量-体积指标。使用小肠口腔造影剂不会显著影响剂量计算,并且在遵守限制条件时可能不会影响计划的可接受性。
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引用次数: 0
Total body irradiation using volumetric modulated arc therapy, experience of a cancer hospital in Pakistan 使用体积调制弧线治疗的全身照射,巴基斯坦一家癌症医院的经验
IF 0.4 Q4 Medicine Pub Date : 2022-08-01 DOI: 10.1017/S1460396922000097
Tabinda Sadaf, A. Rashid, Waqas Imam Bokhari, E. Samuel, A. Shahid, Raheel Mukhtar, Umair Zafar, K. Iqbal
Abstract Introduction: To report the planning parameters, efficacy and toxicity of total body irradiation using volumetric modulated arc therapy (VMAT). Methods: From July 2019 till May 2021, nine patients treated with VMAT-based total body irradiation as a part of the myeloablative regimen for homologous stem cell transplant were evaluated. The CT acquisition, planning parameters, doses to target volume and critical structures were evaluated retrospectively. Results: Median age was 24 with median height 172 cm. Average Mean Lung dose was 9·5 Gy, mean dose to kidney was kidney dose 8·4 Gy, planning target volume (PTV) 95% was 98 % and mean heterogeneity index of PTV was 1·2 all patients. Total fraction delivery time including setup was 3·1 h while beam on time was 23 min. Main toxicity observed was mucositis and fatigue, while no Grade 3 or more acute radiation toxicity was observed. Conclusion: At our institution, high dose TBI performed with multi-isocentric VMAT is now a standard procedure. Though it is cumbersome and time-consuming process but VMAT offers an advantage of increased dose homogeneity in the target volume with reduction in doses to critical organs especially lungs and kidneys in comparison to standard source to skin distance technique, longer follow-up time is necessary to evaluate our method and long-term toxicity.
摘要简介:报道体积调制电弧治疗(VMAT)全身照射的计划参数、疗效和毒性。方法:从2019年7月到2021年5月,对9例患者进行基于vmat的全身照射治疗,作为骨髓清除方案的一部分,用于同源干细胞移植。回顾性评价CT采集、规划参数、靶体积剂量及关键结构。结果:中位年龄24岁,中位身高172 cm。肺平均剂量为9.5 Gy,肾平均剂量为8.4 Gy,计划靶体积(PTV) 95%为98%,PTV平均异质性指数为1.2。包括设置在内的总剂量递送时间为3.1 h,光束到达时间为23 min。观察到的主要毒性是粘膜炎和疲劳,未观察到3级或以上的急性辐射毒性。结论:在我们的机构,采用多等中心VMAT进行高剂量TBI现在是一种标准程序。虽然这是一个繁琐和耗时的过程,但VMAT的优势在于,与标准源到皮肤距离技术相比,它增加了靶体积的剂量均匀性,减少了对关键器官(尤其是肺和肾脏)的剂量,需要更长的随访时间来评估我们的方法和长期毒性。
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引用次数: 0
Expanding access to rectal spacers in the United Kingdom: an examination of current evidence and an early review of data from a single institution 在英国扩大直肠垫片的使用范围:对现有证据的审查和对单一机构数据的早期审查
IF 0.4 Q4 Medicine Pub Date : 2022-07-25 DOI: 10.1017/S146039692200022X
I. Watts, A. Clifford, S. Needleman, Ashoke Roy, C. Hartill, Alexandra Gore, M. Prentice
Abstract Background: Prostate cancer is a common malignancy with rising incidence in Western countries such as the United Kingdom. In localised disease there are a variety of curative treatment modalities. Patients can be referred for surgery, or for a combination of hormonal therapies and radiotherapy (external beam radiotherapy or brachytherapy). Each treatment option comes with side effects and in the case of radiotherapy one potential complication is bowel toxicity from radiation exposure. New technologies are being developed to try and mitigate the side effects and long term morbidity of this treatment, and to expand access to radiotherapy for patients who may previously have been excluded (i.e those with inflammatory bowel disease). Rectal Spacers are absorbable polyethylene glycol hydrogels injected into the perirectal space. These position the anterior rectal wall away from the prostate, subsequently minimising radiation dose to the rectum. Rectal Spacers have been introduced to National Healthcare Service (NHS) practice as part of the Innovation and Technology Payment (ITP) programme, however, their use is now under review. Methodology and Results: In this editorial we conduct a narrative review of some of the available evidence for Rectal Spacers, discuss their utilization within the NHS and the barriers to their wider use. We also explore preliminary dosimetry and quality of life data for use of Rectal Spacers in our centre where we have been part of the NHS ITP programme. Dosimetry data and Quality of life questionnaires were gathered from 22 treated patients and 11 matched controls. This indicated lower radiation doses to the prostate in those treated with Rectal Spacers. Conclusion: Rectal Spacers are an effective method to reduce radiation dose to the prostate in men treated for localised prostate cancer, however, their use remains under review in the NHS and there are a variety of barriers to upscaling their use.
摘要背景:癌症是一种常见的恶性肿瘤,在英国等西方国家发病率不断上升。在局部疾病中,有多种治疗方式。患者可以接受手术治疗,也可以接受激素治疗和放射治疗(外照射放射治疗或近距离放射治疗)的组合治疗。每种治疗方案都有副作用,在放射治疗的情况下,一个潜在的并发症是辐射暴露引起的肠道毒性。正在开发新技术,试图减轻这种治疗的副作用和长期发病率,并扩大以前可能被排除在外的患者(即炎症性肠病患者)获得放射治疗的机会。直肠间隔器是一种可吸收的聚乙二醇水凝胶,注入直肠周围空间。这些措施使直肠前壁远离前列腺,从而最大限度地减少对直肠的辐射剂量。直肠间隔器已被引入国家医疗服务体系(NHS),作为创新和技术支付(ITP)计划的一部分,但其使用目前正在审查中。方法和结果:在这篇社论中,我们对直肠间隔器的一些可用证据进行了叙述性审查,讨论了它们在英国国家医疗服务体系中的使用以及更广泛使用的障碍。我们还探索了在我们的中心使用直肠间隔器的初步剂量测定和生活质量数据,我们是NHS ITP计划的一部分。从22名接受治疗的患者和11名匹配的对照组中收集剂量测定数据和生活质量问卷。这表明接受直肠间隔器治疗的患者前列腺的辐射剂量较低。结论:直肠间隔器是一种有效的方法,可以减少接受局部前列腺癌症治疗的男性前列腺的辐射剂量,然而,在英国国家医疗服务体系中,直肠间隔器的使用仍在审查中,扩大其使用存在各种障碍。
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引用次数: 0
Radiographers’ perception on the provision of psychosocial support for cancer patients 放射技师对癌症患者提供心理社会支持的看法
IF 0.4 Q4 Medicine Pub Date : 2022-07-22 DOI: 10.1017/S1460396922000218
Jade Azzopardi, S. Mercieca, J. L. Portelli
Abstract Introduction: Therapeutic radiographers are the first point of contact for cancer patients undergoing radiotherapy treatment and therefore have an important role in providing both physical and psychosocial support to these patients. This study aimed to evaluate therapeutic radiographers’ perception about their role in identifying and providing psychosocial support for patients receiving RT treatment. Method: The study used a cross-sectional, prospective research design. A self-designed questionnaire was distributed to all therapeutic radiographers (n = 26) working at a radiotherapy department in Malta. Results: A total of 21 therapeutic radiographers completed the questionnaire. All participants felt that the provision of psychological care was an important part of their role as therapeutic radiographers. The majority of the participants reported having the most confidence in giving treatment-related symptoms advice rather than psychological support. The most common barrier to providing psychological support was lack of training (95·2%), followed by the lack of an appropriate screening tool (85·7%), availability of private space to talk to patients (76·2%) and a lack of knowledge (61·9%). Conclusion: While most therapeutic radiographers believed that providing psychosocial support was an important aspect of their role, several barriers prevented them from fulfilling this role. Training, the introduction of a psychosocial screening tool and clear referral processes are recommended to improve radiotherapy service.
摘要简介:放射技师是接受放射治疗的癌症患者的第一联络点,因此在为这些患者提供身体和心理支持方面发挥着重要作用。本研究旨在评估放射治疗技师对其在识别接受放射治疗的患者并为其提供心理社会支持方面的作用的看法。方法:本研究采用横断面前瞻性研究设计。一份自行设计的问卷被分发给马耳他放射治疗部门的所有放射治疗技师(n=26)。结果:共有21名放射治疗技师完成了问卷调查。所有参与者都认为,提供心理护理是他们作为放射治疗技师的重要组成部分。大多数参与者报告说,他们最有信心给出与治疗相关的症状建议,而不是心理支持。提供心理支持最常见的障碍是缺乏培训(95.2%),其次是缺乏适当的筛查工具(85.7%)、缺乏与患者交谈的私人空间(76.2%)和缺乏知识(61.9%)。结论:虽然大多数放射治疗技师认为提供心理社会支持是他们角色的一个重要方面,但有几个障碍阻碍了他们履行这一角色。建议进行培训,引入心理社会筛查工具和明确的转诊流程,以改善放射治疗服务。
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引用次数: 0
Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey 比较两种Elekta系统中mr引导放疗与传统CBCT的患者可接受性:一项基于问卷的调查
IF 0.4 Q4 Medicine Pub Date : 2022-07-21 DOI: 10.1017/S1460396922000206
L. Whiteside, C. Nelder, E. Pitt, C. Hodgson, A. Choudhury, C. Eccles
Abstract Background and Purpose: The magnetic resonance linear accelerator system (MR Linac) is a novel piece of radiotherapy (RT) equipment allowing the routine application of daily MR-guided treatment adaptation. The hardware design required for such technical capabilities and the increased complexity of the treatment workflow entails a notable departure from cone beam computed tomography (CBCT)-based RT. Patient tolerability of treatment is paramount to RT practice where high compliance is required. Presented is a comparative analysis of how such modality specific characteristics may ultimately impact the patient experience of treatment. Materials and Methods: Forty patients undergoing RT for prostate cancer (PCa) on either the MR Linac (n = 20) or a CBCT-based linac (n = 20) were provided with a validated patient reported outcomes measures (PROM’s) questionnaire at fraction 1 and fraction 20. The 18-item questionnaire provided patient responses recorded using a 4-point Likert scale, 0 denoting a response of ‘Not at all’, 1 ‘Slightly’, 2 ‘Moderately’ and 3 signifying ‘Very’. The analysis provided insight into both comparisons between modalities at singular time points (fractions 1 and 20), as well as a temporal analysis within a single modality, denoting changing patient experience. Results: Patients generally found the MR Linac treatment couch more comfortable, however, found the increase in treatment duration harder to tolerate. Responses for all items remained stable between first and last fraction across both cohorts, indicating minimal temporal variation within a single modality. None of the responses were statistically significant at the 0·01 level. Conclusion: Whether radiotherapy for PCa is delivered on a CBCT linac or the MR Linac, there is little difference in patient experience with minimal experiential variation within a single modality.
摘要背景和目的:磁共振直线加速器系统(MR-Linac)是一种新型的放射治疗设备,可用于日常磁共振引导下的治疗适应。这种技术能力所需的硬件设计和治疗工作流程的复杂性增加,与基于锥束计算机断层扫描(CBCT)的RT有着显著的不同。患者对治疗的耐受性对于要求高依从性的RT实践至关重要。本文对这种特定模式的特征如何最终影响患者的治疗体验进行了比较分析。材料和方法:对40名在MR-Linac(n=20)或基于CBCT的Linac(n=2 0)上接受前列腺癌症(PCa)RT的患者在第1部分和第20部分提供经验证的患者报告结果测量(PROM)问卷。18项问卷提供了使用4点Likert量表记录的患者反应,0表示“完全没有”,1表示“轻微”,2表示“中等”,3表示“非常”。该分析提供了对单个时间点(分数1和20)模态之间的比较以及单个模态内的时间分析的见解,表示患者体验的变化。结果:患者通常发现MR Linac治疗沙发更舒适,但发现治疗时间的增加更难忍受。在两个队列中,所有项目的反应在第一部分和最后一部分之间保持稳定,表明单一模式内的时间变化最小。在0.01水平上,没有任何反应具有统计学意义。结论:无论PCa的放射治疗是在CBCT直线加速器上还是在MR直线加速器上进行,患者体验差异不大,单一模式下的体验变化最小。
{"title":"Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey","authors":"L. Whiteside, C. Nelder, E. Pitt, C. Hodgson, A. Choudhury, C. Eccles","doi":"10.1017/S1460396922000206","DOIUrl":"https://doi.org/10.1017/S1460396922000206","url":null,"abstract":"Abstract Background and Purpose: The magnetic resonance linear accelerator system (MR Linac) is a novel piece of radiotherapy (RT) equipment allowing the routine application of daily MR-guided treatment adaptation. The hardware design required for such technical capabilities and the increased complexity of the treatment workflow entails a notable departure from cone beam computed tomography (CBCT)-based RT. Patient tolerability of treatment is paramount to RT practice where high compliance is required. Presented is a comparative analysis of how such modality specific characteristics may ultimately impact the patient experience of treatment. Materials and Methods: Forty patients undergoing RT for prostate cancer (PCa) on either the MR Linac (n = 20) or a CBCT-based linac (n = 20) were provided with a validated patient reported outcomes measures (PROM’s) questionnaire at fraction 1 and fraction 20. The 18-item questionnaire provided patient responses recorded using a 4-point Likert scale, 0 denoting a response of ‘Not at all’, 1 ‘Slightly’, 2 ‘Moderately’ and 3 signifying ‘Very’. The analysis provided insight into both comparisons between modalities at singular time points (fractions 1 and 20), as well as a temporal analysis within a single modality, denoting changing patient experience. Results: Patients generally found the MR Linac treatment couch more comfortable, however, found the increase in treatment duration harder to tolerate. Responses for all items remained stable between first and last fraction across both cohorts, indicating minimal temporal variation within a single modality. None of the responses were statistically significant at the 0·01 level. Conclusion: Whether radiotherapy for PCa is delivered on a CBCT linac or the MR Linac, there is little difference in patient experience with minimal experiential variation within a single modality.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44351740","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}
引用次数: 0
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Journal of Radiotherapy in Practice
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