3D Conformal Radiotherapy Research Articles

Dose Verification with diode versus TLD as in-vivo dosimeters for external radiotherapy

Background: Conformal radiotherapy was the first step toward patient-specific treatment, this is, in turn, arise the need to perform quality dose verification (DV) with in-vivo (IV) dosimetry. Aim: two common IV dosimeters were compared separately, diode and thermoluminescent dosimeters (TLD), the dose was compared with calculated dose and the isocenter dose measured with ion chamber (IC). Materials and Methods: First The absolute dose was measured in PTW Farmer IC (0.6 cc) on Varian machine model Unique for twenty cancer patients planned in 3D conformal radiotherapy, they were randomly selected to cover different clinical sites, the dose was calculated in Eclipse treatment planning system (TPS). Then in the treatment position, the in-vivo DV dosimetry was performed using: Sun nuclear Semiconductor diode and TLD. Results: the dose measured with Diode had less variance (-1.94±2.05) with TPS than dose measured with TLD/TPS (4.08 ±6.51), when comparing the dose measures with IC this discrepancy is not the case with IC/TPS as they were measured in the isocentre point and compared with prescribed doses Conclusion: patient specific DV performed with IC is the most accurate as a double check with prescribed dose. For IV dosimetry diode was closer to calculated dose, however, both diode and TLD characterized by uniform difference versus calculated dose within different clinical sites which keep each of them an accepted device especially when seeking their additive values either of small field dosimetry with TLD or skin dose measurement with diode. Those outcomes highlight the limitation of each device for IV dosimetry.

Radiotherapy and Radiosurgery for Treatment of Residual or Recurrent Endolymphatic Sac Tumor Following Previous Microsurgical Resection

To report and discuss the effectiveness of stereotactic radiosurgery (SRS) or fractionated radiotherapy (FRT) for tumor control following surgical resection of endolymphatic sac tumors (ELST). Retrospective case series. Multi-institutional academic referral centers. Patients undergoing surgical resection for ELST followed by SRS or FRT. Surgical resection followed by radiotherapy. Local tumor control. Two of the five patients experienced tumor recurrence after gross total microsurgical at 78 and 11 months, respectively. The former patient received salvage 3D conformal radiotherapy (3D-CRT) and while the latter patient underwent three courses of salvage SRS for recurrence, two of which were in-field and was disease-free at last follow up. Two additional patients underwent subtotal tumor resection (STR) followed by intensity-modulated radiation therapy (IMRT) and are currently without disease. One patient underwent STR followed by proton-beam therapy (PBT) and was free of disease at most recent follow-up. SRS/FRT remains a useful adjuvant for treatment of residual or recurrent ELSTs, where the risk of revision microsurgical resection is high.

Hypofractionated Whole Breast Radiotherapy with Simultaneous Integrated Boost Following Breast Conservative Surgery for Early Breast Cancer

Background: Hypofractionated whole breast radiotherapy (HFWBRT) showed comparable efficacy and safety to conventional fractionated radiotherapy. Dose and fractionation of the tumor bed boost to be integrated during HF-WBRT schedules is still to be determined. Aim: to investigate the clinical feasibility of HF-WBRT with simultaneous integrated boost (SIB), in early breast cancer patients who underwent breast conserving surgery (BCS). Methods: This single arm prospective study included 40 female patients with pathologically proven stage I-II breast cancer following BCS with high risk factors. Patients received 3D conformal radiotherapy (3DCRT) with field in field (FIF) technique. The whole breast received a dose of 40 gray (Gy) over 15 fractions for 3 weeks with an additional SIB dose of 8 Gy over 15 fractions to be give daily during WBRT. Radiation toxicities were graded using the common terminology criteria for adverse events (NCI-CTCAE) scale version 4.03. Cosmetic outcome was assessed using Harvard cosmetic score. Kaplan Meier method was used to estimate the 3- year disease free (DFS) and overall survival (OS). Results: The median age at presentation was 48 years (range 33-68). No reported grade 3 or 4 toxicities. Grade 1 and 2 radiation dermatitis affected 80% of the patients, breast pain was observed in 62.5% of the patients while 25% had radiation pneumonitis. Most of the patients (95%) had excellent and good cosmetic outcomes. At 3 years the estimated DFS was 95% and OS was 97.5 %. Conclusion: WBRT-SIB using 3DCRT with FIF technique is clinically feasible for early stage breast cancer patients.

Tibialis Anterior Tendon Transfer for Correction of Residual Dynamic Supination of Clubfoot Treated with Ponseti Technique

Background: Hypofractionated whole breast radiotherapy (HF-WBRT) showed comparable efficacy and safety to conventional fractionated radiotherapy. Dose and fractionation of the tumor bed boost to be integrated during HF-WBRT schedules is still to be determined. Aim: to investigate the clinical feasibility of HF-WBRT with simultaneous integrated boost (SIB), in early breast cancer patients who underwent breast conserving surgery (BCS). Methods: This single arm prospective study included 40 female patients with pathologically proven stage I-II breast cancer following BCS with high risk factors. Patients received 3D conformal radiotherapy (3DCRT) with field in field (FIF) technique. The whole breast received a dose of 40 gray (Gy) over 15 fractions for 3 weeks with an additional SIB dose of 8 Gy over 15 fractions to be give daily during WBRT. Radiation toxicities were graded using the common terminology criteria for adverse events (NCI-CTCAE) scale version 4.03. Cosmetic outcome was assessed using Harvard cosmetic score. Kaplan Meier method was used to estimate the 3- year disease free (DFS) and overall survival (OS). Results: The median age at presentation was 48 years (range 33-68). No reported grade 3 or 4 toxicities. Grade 1 and 2 radiation dermatitis affected 80% of the patients, breast pain was observed in 62.5% of the patients while 25% had radiation pneumonitis. Most of the patients (95%) had excellent and good cosmetic outcomes. At 3 years the estimated DFS was 95% and OS was 97.5 %. Conclusion: WBRT-SIB using 3DCRT with FIF technique is clinically feasible for early stage breast cancer patients.

Trends in Intensity Modulated Radiation Therapy for Early Stage Glottic Larynx Cancer and Impact on Outcome

Definitive radiation remains a treatment option for early stage glottic larynx cancer. Intensity modulated radiation therapy (IMRT) has been the standard treatment for more advanced head and neck cancers, while 3D conformal radiotherapy (3D CRT) has remained standard for early glottic cancers. We used the National Cancer Database (NCDB) to identify predictors of IMRT use and effect on outcome in these patients.

3D-Conformal Radiation Therapy and IntensityModulated Radiation Therapy Techniques for Laryngeal Cancer Taking Parotid Glands as Organ at Risk

Background: Three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques are used for the treatment of patients with laryngeal cancer. Objective: This study aimed to investigate the effects of these 2 treatment techniques on the planning target volume (PTV) (laryngeal cancer), dose homogeneity, dose of organs at risk (OARs) (parotid glands), and conformity index. Methods: This study compared 2 treatment techniques and was conducted from October 2018 to April 2019 at the Zhianawa Cancer Center (ZCC), Sulaimaniyah, Iraq. Eight patients with laryngeal cancer were selected for this study. 3D-CRT and IMRT were used to produce the maximum dose of target volume coverage and minimum dose to the parotid glands. Elekta synergy with a photon beam of 6 MV was used for all measurements. Data analysis was performed using the available statistical package of SPSS 25. Results: The comparison of 3D-CRT with IMRT showed that the mean conformity index value for IMRT was more conformal than the 3D-CRT plan (0.956, 0.945, respectively), but the homogeneity index was better with 3D-CRT than with IMRT (0.175, 0.202, respectively). The mean dose for Rt. parotid glands was higher with IMRT than with 3D-CRT (232.71, 23.26, respectively), and in both plans the mean dose was less than 26 Gy (the standard tolerance value). While in the Lt. parotid gland the mean dose was higher with 3D-CRT than with IMRT (26.95, 23.71, respectively), the mean dose with 3D-CRT was greater than 26 Gy. The amount of PTV was significantly greater with the IMRT technique than with 3D-CRT (52.15±1.61, 51.09.4±0.74 Gy, respectively). Conclusion: This study further supports that IMRT has improved the long-term quality of life of patients with laryngeal cancer.

Abstract P4-12-27: Dosimetric impact of axillary irradiation: Comparison between 3D-conformal radiotherapy and two types of intensity-modulated radiotherapy

Abstract The challenge with early breast cancer (EBC) management is finding balance between the most effective curative treatments with minimal long-term toxicity. De-escalade treatment modalities are emerging: sentinel lymph node biopsy instead of systematic axillary dissection, chemotherapy indications reduced with molecular signature, reduction of adjuvant trastuzumab duration, partial breast irradiation. Several trials, such as ACOSOG Z011 and AMAROS trials, demonstrated safety and tolerability of axillary RT instead of surgical approach. In this context, we aim to evaluate the dosimetric impact of axillary irradiation during adjuvant breast/chest wall radiotherapy (RT) for EBC and comparison between 3 techniques: three-dimensional conformal RT (3D), rotational intensity-modulated RT (IMRT) (VMAT) and helical IMRT with Tomotherapy® (HT). We selected all consecutive patients treated with RT including lymph node in our institution between February 2017 and November 2018. All patients received either 50Gy in 25 fractions or 40Gy in 15 fractions on the breast/chest wall and lymph node regions (IV, III, II, interpectoral, internal mammary chain+/- I, according to ESTRO Guidelines). In case of conservative surgery, patients received tumor bed boost (16Gy in 8 fractions in both arm); simultaneous integrated boost (SIB) was allowed (51.52Gy on breast and 63Gy on boost in 28 fractions and 42.3Gy on breast and 52.2Gy on boost in 18 fractions respectively). Dosimetric plan were performed on Eclipse TPS (3D and VMAT) or Tomotherapy® TPS (HT). We compared patients with axilla level I irradiation (group A) with patient without (group B); in group B, axilla level I (CTV) was retrospectively delineated. 68 patients, all female, were included in our dosimetric analysis. All patients received 95% of the prescribed dose on breast/chest wall and lymph node regions PTV (except 2 patients with 3D in group A, on the axilla level I). In B group, the axilla level I mean dose was superior with VMAT (44.7 and 36Gy) and HT (44.6 and 33.3Gy) compared with 3D (27.2 and 13.1Gy) with both treatment schedules respectively. This non-intentional axillary irradiation was heterogenous (table 1). Differences to organs at risk (OAR) doses between groups according treatment schedule are presented in table 2 (no comparison was calculated in 3D because only one patient in each schedules). HT was associated with additional doses to lungs and heart when the axilla level I was treated. This difference was not seen using VMAT. Our dosimetric work shows in group B that axilla level I receive a non-intentional dose, especially with IMRT. Although this irradiation is heterogenous, it is a non-negligible dose which could potentially have deleterious effect considering the morbidity of axillary treatment(s) already received by the patients. Willingly axillary irradiation (group A) is associated with increased doses to OAR with HT whereas it is not observed with VMAT. This suggest to wisely choose the IMRT technics according to patient medical history, especially cardiac and pulmonary morbidity. Table 1: Axilla level I dose according radiotherapy technics, with normo- (left column) and hypo-fractionated (right column) schedule, in group B.3DTomotherapy®VMATV953.11.433.723.431.121.4V8011.14.440.029.440.230.4V5028.516.445.43446.538.3Dmean27.213.144.633.344.736V95: volume of axilla level I that receive at least 95% of prescribed dose.V80: volume of axilla level I that receive at least 80% of prescribed dose.V50: volume of axilla level I that receive at least 50% of prescribed dose.Dmean: mean dose in Gy received by axilla level I region.3D: three-dimensional conformal radiotherapy.VMAT: rotational intensity-modulated radiotherapy Table 2: Additional dose to organs at risk according to radiotherapy technics, with normo- (left column) and hypo-fractionated (right column) schedules, in group A compared with group B.Tomotherapy®VMATHeart Dmean+2.1Gy+0.4Gy-2.2Gy-0.3GyHeart Dmax+11.7Gy+6.6Gy-10.6Gy-1GyIpsilateral lung V20-1.7%+3.2Gy-2.2%-3.5%Ipsilateral lung V30-1.1%+0.5%-1.7%-0.3%Controlateral lung V5+17.2%+1.1%-17.2%+4.2%Dmean: mean dose.Dmax: maximal dose.V20: lung volume receiving at least 20Gy.V30: lung volume receiving at least 30Gy.V5: lung volume receiving at least 5Gy. Citation Format: Louisa Marie Abbassi, Alexandre Arsène-Henry, Youlia M Kirova. Dosimetric impact of axillary irradiation: Comparison between 3D-conformal radiotherapy and two types of intensity-modulated radiotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-27.

A Cost-Effectiveness and Quality of Life Analysis of Different Approaches to the Management and Treatment of Localized Prostate Cancer.

The aim of this study was to compare the cost-effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50–69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Monte Carlo simulations revealed that the mean cost for AM, PR, and RT were $15,654, $18,791, and $30,378, respectively, and QALYs were 6.96, 7.44, and 7.9 years, respectively. The incremental cost-effectiveness ratio (ICER) was $6,548 for PR over AM and $68,339 for RT over PR. Results were sensitive to the number of years of follow-up and procedure cost. With relaxed assumptions for AM, the ICER of PR and RT met the societal willingness to pay (WTP) threshold of $50,000 per QALY. Compared with AM, PR was highly cost-effective. RT and PR for localized prostate cancer can be cost-effective, but RT must offer increased QALYs or decreased procedural costs to be cost-effective compared to PR. Newer and cheaper radiotherapy strategies like stereotactic body radiotherapy may play a crucial role in future early prostate cancer management.

Assessment of DNA damage by 53PB1 and pKu70 detection in peripheral blood lymphocytes by immunofluorescence and high-resolution transmission electron microscopy

Purpose53BP1 foci detection in peripheral blood lymphocytes (PBLs) by immunofluorescence microscopy (IFM) is a sensitive and quantifiable DNA double-strand break (DSB) marker. In addition, high-resolution transmission electron microscopy (TEM) with immunogold labeling of 53BP1 and DSB-bound phosphorylated Ku70 (pKu70) can be used to determine the progression of the DNA repair process. To establish this TEM method in the PBLs of patients with cancer, we analyzed and characterized whether different modes of irradiation influence the formation of DSBs, and whether accompanying chemotherapy influences DSB formation.MethodsWe obtained 86 blood samples before and 0.1, 0.5, and 24 h after irradiation from patients (n = 9) with head and neck or rectal cancers receiving radiotherapy (RT; n = 4) or radiochemotherapy (RCT; n = 5). 53BP1 foci were quantified by IFM. In addition, TEM was used to quantify gold-labelled pKu70 dimers and 53BP1 clusters within euchromatin and heterochromatin of PBLs.ResultsIFM analyses showed that during radiation therapy, persistent 53BP1 foci in PBLs accumulated with increasing numbers of administered RT fractions. This 53BP1 foci accumulation was not influenced by the irradiation technique applied (3D conformal radiotherapy versus intensity-modulated radiotherapy), dose intensity per fraction, number of irradiation fields, or isodose volume. However, more 53BP1 foci were detected in PBLs of patients treated with accompanying chemotherapy. TEM analyses showed that DSBs, indicated by pKu70, were present for longer periods in PBLs of RCT patients than in PBLs of RT only patients. Moreover, not every residual 53BP1 focus was equivalent to a remaining DSB, since pKu70 was not present at every damage site. Persistent 53BP1 clusters, visualized by TEM, without colocalizing pKu70 likely indicate chromatin alterations after repair completion or, possibly, defective repair.ConclusionIFM 53BP1 foci analyses alone are not adequate to determine individual repair capacity after irradiation of PBLs, as a DSB may be indicated by a 53BP1 focus but not every 53BP1 focus represents a DSB.

Interaction between CIEDs and modern radiotherapy techniques: Flattening filter free-VMAT, dose-rate effects, scatter radiation, and neutron-generating energies

Background and purposeProviding evidence for radiotherapy (RT)-induced effects on cardiac implantable electric devices (CIEDs) with focus on flattening filter free-volumetric modulated arc therapy (FFF-VMAT) at 6 and 10 MV as well as 3D-conformal radiotherapy (3D-CRT) at 18 MV. Materials and methods68 CIEDs (64 implantable cardioverter-defibrillators (ICDs) and 4 cardiac pacemakers (PMs)) were located on the left chest position on a slab phantom and irradiated under telemetrical surveillance either directly, or distant to 3D-CRT or FFF-VMAT, dose-rate 2500 cGy/min, and target dose of 150 Gy. Devices were placed within, close by (2.5 cm and 5 cm), and distant (35 cm) to the radiation field. Scatter radiation (SR) and photon neutrons (PN) were recorded. CIEDs were investigated in following groups: 1a) 18 MV 3D-CRT − 4 ICDs/4 PMs out of radiation field, 1b) 18 MV open field − 4 ICDs/4 PMs within radiation field, 2) 6 MV FFF-VMAT, 15 ICDs in 35 cm distance to VMAT, 3) 10 MV-FFF VMAT, 15 ICDs in 35 cm distance to VMAT, 4) 6 MV FFF-VMAT, 15 ICDs in 2.5 cm distance to VMAT, 5) 10 MV FFF-VMAT, 15 ICDs in 2.5 cm distance to VMAT. ResultsNo incidents occurred at 6 MV FFF. 10 MV FFF-VMAT and 18 MV 3D-CRT resulted in data loss, reset, and erroneous sensing with inhibition of pacing (leading to inadequate defibrillation) in 8/34 ICDs and 2/4 PMs which were not located within radiation. Direct radiation triggered instantaneous defibrillation in 3/4 ICDs. Conclusions6 MV FFF-VMAT is safe even at high dose-rates of 2500 cGy/min, regardless whether CIEDs are located close (2.5 cm) or distant (35 cm) to the radiation beam. CIEDs should never be placed within radiation and energy should always be limited to 6 MV. At 6 MV, VMAT at high dose-rates can be used to treat tumors, which are located close to CIEDs.

Stereotactic radiotherapy for small and very small tumours (≤1 to ≤3 cc): evaluation of the influence of volumetric-modulated arc therapy in comparison to dynamic conformal arc therapy and 3D conformal radiotherapy as a function of flattened and unflattened beam models

AbstractPurpose:The objective of this article is to evaluate the dosimetric efficacy of volumetric modulated arc therapy (VMAT) in comparison to dynamic conformal arc therapy (DCAT) and 3D conformal radiotherapy (3DCRT) for very small volume (≤1 cc) and small volume (≤3 cc) tumours for flattened (FF) and unflattened (FFF) 6 MV beams.Materials and methods:A total of 21 patients who were treated with single-fraction stereotactic radiosurgery, using either VMAT, DCAT or 3DCRT, were included in this study. The volume categorisation was seven patients each in <1, 1–2 and 2–3 cc volume. The treatment was planned with 6 MV FF and FFF beams using three different techniques: VMAT/Rapid Arc (RA) (RA_FF and RA_FFF), dynamic conformal arc therapy (DCA_FF and DCA_FFF) and 3DCRT (Static_FF and Static_FFF). Plans were evaluated for target coverage (V100%), conformity index, homogeneity index, dose gradient for 50% dose fall-off, total MU and MU/dose ratio [intensity-modulated radiotherapy (IMRT) factor], normal brain receiving >12 Gy dose, dose to the organ at risk (OAR), beam ON time and dose received by 12 cc of the brain.Result:The average target coverage for all plans, all tumour volumes (TVs) and delivery techniques is 96·4 ± 4·5 (range 95·7 ± 6·1–97·5 ± 2·9%). The conformity index averaged over all volume ranges <1, 2, 3 cc> varies between 0·55 ± 0·08 and 0·68 ± 0·04 with minimum and maximum being exhibited by DCA_FFF for 1 cc and Static_FFF/RA_FFF for 3 cc tumours, respectively. Mean IMRT factor averaged over all volume ranges for RA_FF, DCA_FF and Static_FF are 3·5 ± 0·8, 2·0 ± 0·2 and 2·0 ± 0·2, respectively; 50% dose fall-off gradient varies in the range of 0·33–0·42, 0·35–0·40 and 0·38–0·45 for 1, 2 and 3 cc tumours, respectively.Conclusion:This study establishes the equivalence between the FF and FFF beam models and different delivery techniques for stereotactic radiosurgery in small TVs in the range of ≤1 to ≤3 cc. Dose conformity, heterogeneity, dose fall-off characteristics and OAR doses show no or very little variation. FFF could offer only limited time advantage due to excess dose rate over an FF beam.

Dosimetry evaluation of salivary glands in 3D conformal radiotherapy and intensity modulated radiotherapy in oral tongue cancer

Dosimetry evaluation of salivary glands in 3D conformal radiotherapy and intensity modulated radiotherapy in oral tongue cancer

Impact of radiotherapy on mandibular bone: A retrospective study of digital panoramic radiographs.

PurposeThe purpose of this study was to investigate the impact of radiotherapy on mandibular bone tissue in head and neck cancer patients through an analysis of pixel intensity and fractal dimension values on digital panoramic radiographs.Materials and MethodsThirty patients with radiographic records from before and after 3-dimensional (3D) conformational radiotherapy were selected. A single examiner carried out digital analyses of pixel intensity values and fractal dimensions, with the areas of interest unilaterally located in the right angle medullary region of the mandible below the mandibular canal and posterior to the molar region.ResultsStatistically significant decreases were observed in the mean pixel intensity (P=0.0368) and fractal dimension (P=0.0495) values after radiotherapy.ConclusionThe results suggest that 3D conformational radiotherapy for head and neck cancer negatively affected the trabecular microarchitecture and mandibular bone mass.

P1355 Short-term cardiac side-effects from radiotherapy in women with breast cancer

Abstract Introduction Breast cancer radiotherapy provides an apparent benefit for long-term survival and local recurrence rate. However, there is still much concern about the early and late radiation-induced cardiac toxicity. Therefore, various radiotherapy techniques have been developed to reduce the cardiopulmonary radiation doses in patients with left-sided breast cancer, who are at particular risk of developing post-radiation cardiac injury. Aim We sought to investigate the early effect of radiotherapy on left (LV) and right ventricular (RV) function in females subjected to this treatment. Methods Fifty left-sided breast cancer patients , who underwent adjuvant radiotherapy between May 2017 and May 2018 were included in the study. Forty-nine enrollees were initially treated with breast conserving surgery, and 1 - with mastectomy and axillary lymph node resection. Adjuvant radiotherapy was carefully planned to minimize the radiation side effects and 37 patient received radiotherapy with deep inspiration breath hold technique and 13 patients with free breathing technique. In most cases (n = 33), 3D conformal tangential field radiation therapy was applied, 13 patients received radiotherapy with dynamic-Rapid-Arc technique with additional 3D fields, and 4 patients underwent radiotherapy only with Rapid-Arc technique. Before surgery and 3 months after radiotherapy, echocardiography with measurement of conventional cardiac function parameters, as well as LV and RV longitudinal deformation analysis by speckle tracking technique was performed, and venous blood for biomarkers - galectin-3 reflecting myocardial fibrosis and NT-proBNP was sampled. Results At a mean follow-up of 97 ± 19 days , there were no significant changes in any of the studied cardiac systolic or diastolic function parameters (Table). There were no relationships between the change in LV longitudinal strain at follow-up and type of radiotherapy, as well as type of radiotherapy gating (both R = 0.02, p = 0.90). Similarly, no analogous associations were demonstrated for RV longitudinal strain (R = 0.02, p = 0.88, and R = 0.04, p = 0.77, respectively). No significant changes were found post radiotherapy in serum galectin-3 (7.2 ± 2.6 ng/ml vs. 6.8 ± 2.5 ng/ml; p = 0.58) and NT-proBNP (83 ± 68 pg/ml vs. 84 ± 54 pg/ml; p = 0.90). Conclusions Breast cancer radiotherapy with the use of contemporary planning techniques shows an excellent early cardiac safety. Abstract P1355 Figure.

Ectopic breast tissue carcinoma—a case report

Background: Ectopic breast cancer is a rare entity and an important diagnostic and treatment challenge. Case Presentation: 46-year-old female with previous history of resection of ectopic axillary breast tissue who was referred to our Institution after a second resection following an increase in left axillary volume. Histology reported a ductal ectopic breast tissue carcinoma that invaded the deep layer of the dermis and was positive for estrogen and progesterone receptors and Human Epidermal growth factor Receptor-type 2. After being referred to our Institution, surgical margin re-excision and sentinel node biopsy were performed. The patient initiated hormone therapy and underwent adjuvant radiotherapy to the breast and axilla (50 Gy/25 fractions, in daily 2 Gy fractions with a 3D conformal radiation therapy technique) and boost with bolus to the axilla (to complete 60 Gy). She remains in follow-up, with no recurrence to date. Conclusion: A high index of suspicion is required for the timely diagnosis of this rare condition. Since there are no specific guidelines, treatment remains a challenge.

Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients.

The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.

ABO blood groups as a new potential predictive factor in radiotherapy hematological changes.

Cancer treatments specially with new high Tec radiotherapy equipment's calling daily progression in method and predictive factors affecting treatment goals. Due to important effect of oxygen on cells radio sensitivity, tumor blood circulation and it's antigens like ABO blood groups maybe an important predictive factor for radiotherapy response and it is adverse events. The aim of this study was the assessment of the hematological manifestations of local radiotherapy and association with ABO blood groups. In this observational study, 2 ml of peripheral blood were taken from 152 patients with routine 3D conformal radiotherapy treatment course and the blood parameters achieve and documented at four stage during treatment courses. The data were analyzed by repeated measurement andone-way ANOVA. Statistically significant reductions of the platelets, white blood cells (WBC), and lymphocytes counts were demonstrated. Also an increased percentage of polymorphonuclear cells during local radiotherapy exposure was found. The changes in WBC counts were observed to be in association with ABO blood groups. The other evaluated factors were not significantly associated with ABO blood groups. Our results showed an association between radiotherapy patients ABO blood groups and some hematological changes in their blood circulation (Fig. 7, Ref. 23).

Dose Volume Relationship in Estimating Cardiac Doses in Breast Cancer Radiotherapy

Introduction: Radiation therapy is an integral part of adjuvant treatment for breast cancer which reduces local recurrence and significantly increases survival. But, radiation therapy also has the propensity to increase cardiac morbidity and mortality due to dose received by the heart which is more in left-sided breast cancer. Mean Heart dose and Maximum Heart Distance (MHD) are two parameters to study dose received by the heart. Aim: The purpose of this study was to determine individual doses received by the heart and to correlate MHD with the mean heart dose received by heart in carcinoma breast patients receiving radiotherapy. Materials and Methods: Ninety patients of histologically proven carcinoma breast who attended the Department of Radiotherapy, Acharya Harihar Regional Cancer, Cuttack from January 2017 to January 2019 were selected for a prospective observational study. All patients were treated with 3D Conformal Radiotherapy technique using free breathing multi slice Computed Tomography (CT) scans to contour target and vital organs. Parallel opposed tangential treatment plans were generated for each patient. Individual dose received by the heart and MHD was assessed for each case. SPSS version 21 used for statistical analysis. The Spearman’s Rho test was used for correlation of MHD with Mean heart dose. The Mann-Whitney U test was used for comparing mean of MHD in left-sided and right-sided breast cancer. The Independent t-test was used for comparing means of Mean heart dose in left-sided and right-sided breast cancer. A p-value &lt;0.05 was considered as statistically significant. Results: The Mean Heart Dose was 4.63 Gy for left-sided breast carcinoma patients and 0.846 Gy for right-sided breast cancer and there was a significant difference (p&lt;0.001). Mean MHD for left-sided breast cancer was 2.974 cm while for right-sided it was 0.017 cm, the difference was statistically significant (p-value &lt;0.001). MHD also correlated positively with Mean Heart Dose with correlation coefficient of 0.849 and p-value &lt;0.001. Conclusion: MHD and Mean Heart dose were significantly higher in left-sided breast cancer receiving radiotherapy. MHD was also found to be positively related to Mean Heart dose and therefore found to be an important predictor of cardiac dose. For right-sided breast carcinoma receiving radiotherapy, free breathing technique using 3-Dimensional Conformal Radiotherapy (3DCRT) will suffice in terms of cardiac dose.

Comparison of dosimetric accuracy of acuros XB and analytical anisotropic algorithm against Monte Carlo technique

This study reports the comparison between two dose calculation algorithms, Acuros XB 13.5 (AXB) and Analytical Anisotropic Algorithm (AAA) against Monte Carlo (MC) simulations for 3D-Conformal Radiation Therapy (3D-CRT) using a female pelvic rando phantom. 3D-CRT treatment plans were generated on the CT images of rando phantom using AXB and AAA with Source to Axis Distance (SAD) technique. Doses obtained using two algorithms and MC results were compared using MATLAB based software CERR. In house MATLAB code was developed to calculate the gamma dose distribution comparison in terms of dose difference (DD) and distance to agreement distribution (DTA). The results showed that the Dmean in the PTV TOTAL (PTV) volume for AXB and AAA was equal to the mean dose calculated by MC simulations. The gamma passing rates for AXB were more accurate in comparison to AAA with reference to MC for PTV, Bladder and Femoral Heads region. After analysing the dose comparison specially for the PTV, femoral heads, also the analysis of dose volume histogram (DVH) and gamma dose distribution comparison for PTV, femoral heads and bladder, it can be concluded that AXB is more accurate in comparison to AAA. It can be said that AXB is well suited for dose calculation in clinical setup when compared to MC calculations.

Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy: a randomized clinical trial

Background One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. Material and Methods 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. Results No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. Conclusions L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients. Key words:Radiotherapy, osteoradionecrosis, tooth extraction, head and neck cancer.