Purpose: Radiosurgery is a high-precision technique that delivers a single highly conformed dose to a stereotactically localized target in most cases. This study proposes a simple and reliable postal quality assurance (QA) phantom for use in an independent evaluation. Methods: Two important parameters were verified, including the dosimetric precision of the treatment planning system, by comparing the absorbed dose measured in the target volume using different dosimeters (i.e., radiochromic film and thermoluminescence dosimeters) calibrated against a small volume ion chamber. The head phantom and the instruction sheets were extensively tested and sent by mail to selected institutions. The institutions were chosen according to the type of linear accelerator they had. The three institutions chosen had different radiosurgery systems for the delivery of treatment and the planning system. The objective was to understand whether our system would be applicable to different radiosurgery delivery systems. Results: A comparison between the TPS plan and the measurement plan using the radiochromic film showed that the gamma pass rate was more than 90% for a gamma criteria of 2 mm/2%. In the worst case scenario, the disagreement with TLD measurements at position 1 arose because the highest dose gradient occurred in that region. The other positions measured with thermoluminescence dosimeters (TLDs) varied by less than 3% from the calculated dose. Conclusion: The overall results were very encouraging and suggest that the proposed phantom may be used as a postal system as part of an independent QA tool for radiosurgery.

Purpose: Elevated b III -tubulin levels are associated with resistance to a broad spectrum of drugs in different carcinomas and are associated with poor prognosis of different epithelial cancers. 5-Fluorouracil (5-FU) is a widely used standard drug in chemotherapeutic regimens for colorectal cancer treatment, although the resistance to 5-FU is a major obstacle to successful therapy. The aim of the study was to compare the invasive and adhesion properties and the expression levels of b III -tubulin in a 5-Fluorouracil (5-FU)-resistant colorectal cancer (CRC) cell line HCT116 and parental cells. Methods: The 5-FU-resistant cell line was established by continuous stepwise selection with increasing concentrations of 5-FU. Cell viability and properties were evaluated using MTT, adhesion and transwell invasion assays respectively. The expression of b III -tubulin was revealed by immunoblot and immunofluorescence. Results: The derivative line is 25-fold resistant to 5-FU and characterized by altered cell morphology, twice as many cells of the 5-FU-resistant line fail to adhere than is the case for the parental cell line and were characterized by enhanced invasiveness, accompanied by increased b III -tubulin expression. In addition, we found that loss of b III -tubulin expression was correlated with loss of 5-FU resistance. Conclusion: Our results indicate that even though 5-FU does not target microtubules, there appears to be a correlation between b III -tubulin expression and resistance to 5-FU and that this is particularly important with regard to invasiveness. These findings indicate a possible contribution of b III -tubulin to 5-FU resistance in vivo.

Breast cancer accounts for approximately 16% of all newly diagnosed cancer cases in the Philippines. Among these, 5% are metastatic at presentation. The eye is an atypical location for metastatic spread from breast cancer. A 53-year-old Filipino female presented with a breast mass with concomitant blurring of vision. Further work-up showed invasive ductal carcinoma with bone metastasis. Ophthalmologic examination showed an intraocular mass with associated exudation and retinal detachment, which explained the blurring of vision. Chemotherapy for the breast cancer subsequently reduced tumor mass of both breast and eye, with progression of both after first line chemotherapy. Clinicians should be wary of patients presenting with a known primary mass lesion with associated ophthalmologic complaints. The possibility of metastatic disease in these patients should warrant ophthalmologic screening to possibly prevent the deterioration of the quality of life of these patients.

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.

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).

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.

Purpose: The primary aim in cancer treatment is to provide excellent tumor response while maintaining the most acceptable quality of life. The relationship of QoL to tumor response has not yet been well discussed. This study determines the association between the change in the QoL from baseline to one (1) year follow-up and tumor response among patients enrolled in the ASEAN Cost in Oncology (ACTION) study. Methods: Pooled data from the ACTION study was reviewed. Associations between demographics, cancer type, and tumor response were analyzed. Results: Of the qualified profiles (412 / 742), breast cancer (42.2%), colorectal (21.8%), and head neck (10%) are still most common. Of these cases, 126 (30.6%) were metastatic on presentation. Demographic data showed female sex having better tumor response. More importantly, tumor response was significantly associated with improvement in QoL: complete or partial response was associated with improvement in QoL (p = .000) while progressive disease related to worse situations. The general pattern seen above was reflected in female breast cancer cases, colon and rectal cancer, and other malignant neoplasms. Conclusion: Improvement in QoL was significantly associated with better tumor response. This trend was similar for breast cancer, colorectal cancer and other malignancies. The use of universal measures of health like the EQ5D 3L may be used to quantify improvements in QoL with several limitations: 1) cultural differences should be established and 2) limitations in quantifying precise changes in QoL. The utilization of more culturally adept QoL measures may address this problem. Similarly, the use of secondary data may limit the results in this study. Prospective studies specifically addressing the objectives may improve results.

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.

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.

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.