Radiotherapy Sessions Research Articles

Skin Dosimetric Comparison of 3DCRT and IMRT Planning for Post-Mastectomy Breast Radiotherapy

Breast cancer is the most common cancer for incidence and mortality among females globally and in Indonesia. Mastectomy is still the most common surgery for female breast cancer in Indonesia. After the mastectomy, several patients will receive a whole breast radiotherapy session. About 68.75 % of breast cancer patients in the radiotherapy department at Lavalette Hospital during 2019 had undergone the mastectomy. Radiotherapy treatment for breast cancer can be delivered using Intensity Modulated Radiotherapy (IMRT) or 3D-Conformal Radiotherapy (3DCRT) technique. This study is aimed to compare the skin dosimetric between IMRT and 3DCRT for post-mastectomy breast radiotherapy. Left-sided breast cancer patients who underwent radiotherapy at Lavalette Hospital during 2019 were included in this study, and 15 patients were selected. All patients received 50 Gy in 25 fractions over 5 weeks using 6 MV photons. The planning target volume (PTV) and organ at risk (OAR) were delineated. Skin with 3 mm thickness along PTV was also contoured for evaluating the dose delivered to the skin. The treatment planning was conducted using 3DCRT and 5 fields IMRT planning. The plans were optimized for at least 95 % of the prescribed dose to cover 95 % volume of the PTV. The mean dose and maximum dose were used for evaluating and comparing each plan. The skin’s mean dose from 3DCRT planning was 24.65 ± 4.12 Gy and 22.85 ± 3.68 Gy ( p = 0.002) for IMRT planning. Meanwhile, skin maximum doses were 54.15 ± 0.68 Gy and 53.89 ± 1.05 Gy ( p = 0.001) respectively for 3DCRT and IMRT planning. These results showed that IMRT offered a lower dose to the skin and a better skin-sparing effect than 3DCRT. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";}

Cardiac implantable electronic device dysfunctions in patients undergoing radiotherapy: A prospective cohort study.

Increasing numbers of patients with cardiac implantable electronic devices (CIEDs) are undergoing radiotherapy (RT) for cancer. The aim of the study was to prospectively evaluate the incidence, characteristics, and associated factors of CIED dysfunctions related to RT. Between April 2013 and March 2020, all patients with a CIED who underwent ≥1 RT session were enrolled. Patients were monitored according to a systematic protocol, including device interrogation before the first and after each RT session. The primary endpoint was CIED dysfunction, defined as oversensing, total or partial deprogramming, and/or unrecoverable reset. We included a total of 92 CIED RT courses: 77 (83.7%) in patients with a pacemaker and 15 (16.3%) in those with an implantable cardioverter-defibrillator. Overall, 13 dysfunctions (14.1%) were observed during 92 courses (1509 sessions), giving an incidence of 0.9 per 100 sessions. These included nine deprogramming (three total resets to back-up pacing mode and six partial deprogramming that were all successfully reprogrammed), three transient oversensing, and one unrecoverable oversensing requiring CIED and leads replacement. There were no adverse clinical events related to device dysfunction. In multivariable analysis, neutron-producing irradiation (odds ratio [OR], 5.59; 95% confidence interval [CI], 1.09-28.65; p = .039) and cumulative tumor dose (OR, 1.05; 95% CI, 1.01-1.10; p = .007) remained significantly associated with CIED dysfunction. In this prospective study, transient or permanent subclinical CIED dysfunction occurred in 14.1% of RT courses. Our findings emphasize the importance of high-energy beams and neutron-producing irradiation in risk assessment.

Local recurrence and cerebral progression-free survival after multiple sessions of stereotactic radiotherapy of brain metastases: aretrospective study of 184patients : Statistical analysis.

Forty to sixty percent of patients treated with focal therapy for brain metastasis (BM) will have distant brain recurrence (C-LR), while 10-25% of patients will have local recurrence (LR) within 1year after stereotactic radiotherapy (SRT). The purpose of this study was to analyze cerebral progression-free survival (C-PFS) and LR of BM among patients treated with repeated courses of radiotherapy in stereotactic conditions. We retrospectively reviewed data from 184 patients treated for 915 BMs with at least two courses of SRT without previous WBRT. Initial patient characteristics, patient characteristics at each SRT, brain metastasis velocity (BMV), delay between SRT, MRI response, LR and C‑LR were analyzed. In all, 123(66.9%), 39 (21.2%), and 22 (12%) patients received 2, 3, or4 or more SRT sessions, respectively. Ninety percent of BMs were irradiated without prior surgery, and 10% were irradiated after neurosurgery. The MRI response at 3, 6, 12 and 24months after SRT was stable regardless of the SRT session. At 6, 12 and 24months, the rates of local control were 96.3, 90.1, and 85.8%, respectively. In multivariate analysis, P‑LR was statistically associated with kidney (HR = 0.08) and lung cancer (HR = 0.3), ECOG1 (HR = 0.5), and high BMV grade (HR = 5.6). The median C‑PFS after SRT1, SRT2, SRT3 and SRT4 and more were 6.6, 5.1, 6.7, and 7.7months, respectively. C‑PFS after SRT2 was significantly longer among patients in good general condition (HR = 0.39), patients with high KPS (HR = 0.91), patients with no extracerebral progression (HR = 1.8), and patients with alow BMV grade (low vs. high: HR = 3.8). Objective MRI response rate after repeated SRT is stable from session to session. Patients who survive longer, such as patients with breast cancer or with low BMV grade, are at risk of local reirradiation. C‑PFS after SRT2 is better in patients in good general condition, without extracerebral progression and with low BMV grade.

Generation of ozone during irradiation using medical linear accelerators: an experimental study

BackgroundSome patients have noted a foul odor during radiation therapy sessions, but the cause of the odor remains unknown. Since we suspected that this phenomenon is due to ozone generated by ionizing radiation, this experimental study measured ozone concentrations in the treatment room and in a coiled polyvinyl chloride (PVC) tube placed within the radiation field.MethodsWe measured ozone concentrations using an ultraviolet absorption method and an ozone monitor. A PVC tube (inner diameter 7 mm, outer diameter 10 mm) was used to mimic the environment of the nasal cavity. The tube (790 cm) was coiled and set between two 4-cm-thick (for X-rays) or 2-cm-thick (for electron beams) water-equivalent solid phantoms. The sampling tube of the ozone monitor was inserted into the PVC tube, and the joint was sealed to prevent environmental air contamination. To measure ozone concentrations in the atmosphere, the sampling tube supplied with the unit was used. A linac was used on a full-sized treatment field (40 cm × 40 cm at a source-to-axis distance of 100 cm). The effect of an electron beam on ozone concentrations was also evaluated with a full-sized treatment field (40 cm × 40 cm at a source-to-surface distance of 100 cm).ResultsOzone levels in the treatment room were undetectable before the start of daily treatment but reached 0.008 parts per million (ppm) or more at 1 h after the start of treatment. Concentrations then remained nearly constant at 0.010–0.015 ppm throughout the day. The maximum ozone concentration in the PVC tube was only 0.006 ppm, even when it was irradiated at 2400 monitor units/min. Depending on the X-ray dose rate, the concentration increased to a maximum of 0.010 ppm with oxygen flowing into the other end of the tube at 1.5 L/min. Ozone concentrations in the PVC tube did not differ significantly between X-ray and electron-beam irradiation.ConclusionsOnly traces of ozone were found in the PVC tube that was used to mimic the nasal passages during radiation, these concentrations were too low for human perception. However, ozone concentrations did reach potentially detectable levels in the treatment room.

Impact of photobiomodulation for oral mucositis on body weight and BMI of patients with head and neck cancer.

To evaluate the impact of photobiomodulation for oral mucositis on body weight and body mass index (BMI) in head and neck cancer patients. Patients were separated into two groups: photobiomodulation (PBM) (n = 17) and SHAM (n = 19). Participants assigned to the PBM group received the photobiomodulation therapy on alternate days at 33 different sites of the oral mucosa (1J for 10s per application point) using a low-power aluminum gallium arsenide (AsGaAl) laser device with a maximum output power of 86.7 mW and a wavelength of 660nm (red). The same protocol was performed in patients allocated in the SHAM group but with the device turned off. At the first and twenty-fourth radiotherapy sessions, participants from both groups underwent an intraoral examination to assess the presence or absence of mucositis using the WHO scale, and measurements of weight and height for BMI calculation were undertaken. All patients had significant differences in weight and BMI throughout the study period. Patients in the PBM group lost less weight (p < 0.01) and had a reduced BMI loss (p < 0.01) in comparison to patients in the SHAM group. Although PBM did not prevent oral mucositis, it decreased its severity (p < 0.01). Photobiomodulation for oral mucositis reduced weight loss and prevented a reduction in BMI in patients who underwent chemoradiotherapy for head and neck cancer. Retrospectively registered at https://data.mendeley.com//datasets/4kd7s49wk4/1 .

Impact d’un test de diagnostic du coronavirus positif sur le parcours du patient en radiothérapie à l’institut Gustave-Roussy

PurposeThe coronavirus disease 2019 (COVID-19) epidemic continues to spread exponentially around the world. Cancer patients have a higher risk of commorbidity than the rest of the population. Radiotherapy departments are actively involved in the management of these patients, whether they have COVID or not, and it is recognized that the time taken to take charge and the continuity of treatment have a prognostic impact. The main objective was to assess the impact of the coronavirus on the treatment times of patients undergoing radiotherapy. Material and methodsThis retrospective study was conducted in the radiotherapy department of Gustave-Roussy institute (France) during the period from March 3, 2020 to January 12, 2021. Organizational changes, patient care times between the day of the scan and the last radiotherapy session as well as the time taken to take charge of patients between the first session and the last radiotherapy session has been studied. ResultsA total of 1183 patients were included, among which 60 had COVID-19. Patients were divided into four categories. Treatment times of patients who did not have COVID-19 and those of patients who did were not statistically significantly different. ConclusionThe organization of the radiotherapy department at the Gustave-Roussy institute is based on several points: carrying out preventive screening tests, protecting staff and patients and reorganizing the patient circuit. Thanks to the performance of diagnostic tests and the implementation of a specific workflow for patients with COVID, we ensure the continuity of patient treatment in complete safety without impacting treatment times.

Pleomorphic Rhabdomyosarcoma on the Lumbal in Adult Patient: A Case Report

BACKGROUND: The incidence of Rhabdomyosarcoma in children found at the top of age 5-15 years, with median age about 10 years. In adult, the tumor occurs about 10 % of all cases. PRMS is a very rare subtype of RMS and almost exclusively in male patient older than 45 years. Approximately 40% of RMS occurs in the head and neck region, RMS in the trunk is rare. RMS arising from the paraspinal area only comprises 3.3% of all cases.&#x0D; &#x0D; CASE REPORTS: This case report described a 38 years-old male with lump on his back, since 1 year ago and enlarge slowly until bigger than a tennis ball, with no neurological deficit. Based on MRI with contrast there’s a solid mass on the subcutis on the level L4-5 with size 7,5 x 3 x 7,2 cm. Patient was underwent wide excision and the histopathology examination was referred to Pleomorphic Rhabdomyosarcoma. Patient underwent radiotherapy procedure for 1 month in outpatient clinic, with maximum dose radiotherapy 60 Gy, and patient underwent 30 times session of radiotherapy with dose 2 Gy for each session. After 1,5 years of control there’s no sign of recurrences. &#x0D; &#x0D; RESULTS: Based on clinical, radiologic, and histological examination, the diagnosis of pleomorphic rhabdomyosarcoma confirmed by an expert pathology consultant. Immunohistochemical examination was performed, and patient underwent wide excision and definitive radiotherapy.&#x0D; &#x0D; DISCUSSION: Pleomorphic Rhabdomyosarcoma on the back is extremely rare and difficult to distinguish histologically. This is a very valuable case, which highlights the need for orthopedic surgeons to re-evaluate clinical and histologic finding carefully when diagnosing patients with soft tissue tumor on the lumbal region.

Therapeutic Potential of Naturally Occurring Small Molecules to Target the Wnt/β-Catenin Signaling Pathway in Colorectal Cancer.

Simple SummaryColorectal cancer (CRC) is an emerging public health problem and the second leading cause of death worldwide, with a significant socioeconomic impact in several countries. The 5-year survival rate is only 12% due to the lack of early diagnosis and resistance to available treatments, and the canonical Wnt signaling pathway is involved in this process. This review underlines the importance of understanding the fundamental roles of this pathway in physiological and pathological contexts and analyzes the use of naturally occurring small molecules that inhibits the Wnt/β-catenin pathway in experimental models of CRC. We also discuss the progress and challenges of moving these small molecules off the laboratory bench into the clinical platform.Colorectal cancer (CRC) ranks second in the number of cancer deaths worldwide, mainly due to late diagnoses, which restrict treatment in the potentially curable stages and decrease patient survival. The treatment of CRC involves surgery to remove the tumor tissue, in addition to radiotherapy and systemic chemotherapy sessions. However, almost half of patients are resistant to these treatments, especially in metastatic cases, where the 5-year survival rate is only 12%. This factor may be related to the intratumoral heterogeneity, tumor microenvironment (TME), and the presence of cancer stem cells (CSCs), which is impossible to resolve with the standard approaches currently available in clinical practice. CSCs are APC-deficient, and the search for alternative therapeutic agents such as small molecules from natural sources is a promising strategy, as these substances have several antitumor properties. Many of those interfere with the regulation of signaling pathways at the central core of CRC development, such as the Wnt/β-catenin, which plays a crucial role in the cell proliferation and stemness in the tumor. This review will discuss the use of naturally occurring small molecules inhibiting the Wnt/β-catenin pathway in experimental CRC models over the past decade, highlighting the molecular targets in the Wnt/β-catenin pathway and the mechanisms through which these molecules perform their antitumor activities.

The Preventive Effects of Boron-Based Gel on Radiation Dermatitis in Patients Being Treated for Breast Cancer: A Phase III Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Introduction: Radiation dermatitis (RD) is a side effect of radiation therapy (RT) which is experienced by over 90% of patients being treated for breast cancer. The current clinical trial was conducted to measure the preventative effects of a boron-based gel on several different clinical outcomes (dermatitis, erythema, dry desquamation, and moist desquamation) after 25 radiotherapy sessions. Methods: This research used a double-blind parallel-group design with a placebo control (n = 76) and randomized group (n = 181), with all participants being between 18 and 75 years old. Fifteen minutes before each radiotherapy, participants in the intervention group were given a gel containing 3% sodium pentaborate pentahydrate, while those in the placebo group received a gel with no chemical substance. Dermatitis, erythema, dry desquamation, and moist desquamation were compared between the 2 groups. Results: At baseline, there were no significant differences between the groups (p > 0.05), except for body mass index. After 14 days of treatment, dermatitis (98.7% vs. 9.9%; p < 0.001), erythema (96.1% vs. 12.2%; p < 0.001), dry desquamation (50% vs. 3.9%; p < 0.001), and moist desquamation (18.4% vs. 0.6%; p < 0.001) were much more common in the placebo group than the intervention group. To prevent dermatitis, erythema, dry desquamation, and moist desquamation in 1 patient, on average, 1.1 (95% confidence interval [CI]: 1.1–1.2), 1.2 (95% CI: 1.1–1.3), 2.2 (95% CI: 1.7–2.9), and 5.6 (95% CI: 3.8–11.0) patients need to be treated, respectively. Conclusion: The boron-based gel has a significant preventive effect on several categories of RD which might be used by clinicians in breast cancer.

Biopsychosocial impact on caregivers of head and neck cancer patients undergoing radiotherapy at a tertiary care hospital.

IntroductionPatients diagnosed with head and neck cancer are often subjected to an array of unprecedented challenges, which have seldom been scrutinized in other cancers, such as prolonged restrictions in their capaci-ty to breathe, speak, and swallow, considerable deformity, and an alleviated risk of death. These predicaments have consequential repercussions on the psychological well-being of patients, and they debilitate the mental, social, and financial facet of not only the patient’s but also of the caregiver’s lives, placing them in a state of constant uncertainty while also deteriorating their physical and mental health. Aim of the study was to assess the burden on the caregiver and their quality of life (QOL) using the Caregiver Quality of Life Index-Cancer (CQOLC) scale by comparing the sali-vary cortisol levels of caregivers at different intervals of the radiotherapy session.Materials and methodsThe current study was a prospective cohort study conducted on 28 caregivers of patients undergoing radiotherapy, aged 15 years and more. The entire collection of saliva samples of each of the caregivers was collected on day 1, day 14, and day 21 of the radiotherapy session while simultaneously handing out the CQOLC for them to fill out. The samples were later analysed using an ELISA kit to measure the cortisol levels.ResultsOn day 1 the QOL score was 1.97 ±0.28, on day 14 the QOL score was 2.53 ±0.31, and on day 21 the QOL score was 3.15 ±0.26, with a p-value of 0.0001 over the entire session. There was no statistically significant change in the salivary cortisol level. P < 0.05 is considered statistically significant.ConclusionsThe assessed quality of life portrayed a progressive decline over the calculated period, concluding that the radiotherapy sessions of the patients subjected the caregivers to distress. It was also found that the males had a noteworthy diminution in QOL compared to the females; however, there was no signifi-cant change in the cortisol level over the calculated period.

Monte Carlo-based software for 3D personalized dose calculations in image-guided radiotherapy.

Image-guided radiotherapy (IGRT) involves frequent in-room imaging sessions contributing to additional patient irradiation. The present work provided patient-specific dosimetric data related to different imaging protocols and anatomical sites. We developed a Monte Carlo based software able to calculate 3D personalized dose distributions for five imaging devices delivering kV-CBCT (Elekta and Varian linacs), MV-CT (Tomotherapy machines) and 2D-kV stereoscopic images from BrainLab and Accuray. Our study reported the dose distributions calculated for pelvis, head and neck and breast cases based on dose volume histograms for several organs at risk. 2D-kV imaging provided the minimum dose with less than 1mGy per image pair. For a single kV-CBCT and MV-CT, median dose to organs were respectively around 30mGy and 15mGy for the pelvis, around 7mGy and 10mGy for the head and neck and around 5mGy and 15mGy for the breast. While MV-CT dose varied sparsely with tissues, dose from kV imaging was around 1.7 times higher in bones than in soft tissue. Daily kV-CBCT along 40 sessions of prostate radiotherapy delivered up to 3.5Gy to the femoral heads. The dose level for head and neck and breast appeared to be lower than 0.4Gy for every organ in case of a daily imaging session. This study showed the dosimetric impact of IGRT procedures. Acquisition parameters should therefore be chosen wisely depending on the clinical purposes and tailored to morphology. Indeed, imaging dose could be reduced up to a factor 10 with optimized protocols.

Ultrasound-guided multiple injection costotransverse block in a patient with postradiation therapy recurrent dermatofibrosarcoma protuberans: A technical glitch

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft-tissue tumor with a high recurrence rate, often requiring multiple surgeries with multiple sessions of radiotherapy that alters the anatomy and makes regional anesthesia challenging in these patients. The multiple injection costotransverse block (MICB) is a type of “paravertebral by proxy” block in which the drug is injected within the thoracic intertransverse tissue complex with spread to the paravertebral space without any epidural spread. Unlike the traditional approach to paravertebral block, which involves piercing the superior costotransverse ligament, the MICB has a shallower needle trajectory making needle visualization easier and the more superficial needle tip location reduces the chances of a pleural puncture and subcostal vessel injury. We present the case of a 51-year-old male with recurrent DFSP in the anterior axillary fold who was posted for tumor debulking. As the sonoanatomy was altered due to multiple previous surgeries and radiotherapy, we chose to perform an ultrasound-guided MICB.

Recove® burn ointment for managing acute radiodermatitis in patients with breast cancer: A double blind randomized controlled trial

Background:Radiodermatitis is the most common complication of radiotherapy. There is no gold standard for managing the radiodermatitis. This study aimed to evaluate the effect of topical Recove® burn ointment; basically compounded of sesame oil, camphor, and zinc oxide; in preventing acute radiodermatitis.Methods:This double blind RCT (IRCT No.: 201204047136N2) was performed on 71 patients that referred for radiotherapy after mastectomy to Shahid Rajaee Hospital (Babolsar-Iran) during 2013-2017. Patients were allocated into 2 groups; 34 in control group and 37 in Recove® group. Patients applied the ointment 2 times a day, before every radiation therapy session for 5 weeks. The radiation oncologist assessed the severity of dermatitis weekly for 5 weeks and graded it from 0 to 4 according to the RTOG criteria.Results:Baseline characteristics including age, and BMI had no significant difference between groups. The Recover group patients experienced significantly less severe dermatitis compared to the controls (p<0.001). None of the patients in Recove® group encountered more than grade 2 of RTOG criteria, however, in the control group, 4 (12.9%) patients experienced grade 3 of RTOG and 3 (9.7%) patients developed grade 4 of RTOG at the end of the 5th week.Conclusion:Our results indicate that Recove® ointment significantly reduces the severity of acute radiodermatitis.

Recove® burn ointment for managing acute radiodermatitis in patients with breast cancer: A double blind randomized controlled trial.

Radiodermatitis is the most common complication of radiotherapy. There is no gold standard for managing the radiodermatitis. This study aimed to evaluate the effect of topical Recove® burn ointment; basically compounded of sesame oil, camphor, and zinc oxide; in preventing acute radiodermatitis.This double blind RCT (IRCT No.: 201204047136N2) was performed on 71 patients that referred for radiotherapy after mastectomy to Shahid Rajaee Hospital (Babolsar-Iran) during 2013-2017. Patients were allocated into 2 groups; 34 in control group and 37 in Recove® group. Patients applied the ointment 2 times a day, before every radiation therapy session for 5 weeks. The radiation oncologist assessed the severity of dermatitis weekly for 5 weeks and graded it from 0 to 4 according to the RTOG criteria.Baseline characteristics including age, and BMI had no significant difference between groups. The Recover group patients experienced significantly less severe dermatitis compared to the controls (p<0.001). None of the patients in Recove® group encountered more than grade 2 of RTOG criteria, however, in the control group, 4 (12.9%) patients experienced grade 3 of RTOG and 3 (9.7%) patients developed grade 4 of RTOG at the end of the 5th week.Our results indicate that Recove® ointment significantly reduces the severity of acute radiodermatitis.

A Model for Nano-Scale Spherical Surface Coverage and Protein Corona Formation By Amyloidogenic Peptides

The conformation of three amyloidogenic peptides; amyloid beta 1–40 (Aβ1−40), alpha synuclein (α-syn), and beta-2-microglobulin (β2m) are closely associated with the process of causing neurodegenerative diseases. Use of a peptide adsorbed gold nano-particle system allowed us to investigate the interactive segment of each peptide responsible for peptide-peptide networking, which is crucial to initiate the formation of an oligomer and leads to fibrillogenesis. The adsorption orientationof theamyloidogenic peptides onthe nano-goldcolloid spherical surface wasexplainedbysimulatinghowmuchareaofthemetalsurfacewascoveredbythepeptides,i.e.,coverageratio,Θ. The empirically extracted Θ was explained by the summation of the 1st layer and the 2nd layer with a spikingout orientation of the prolate. Of note, the involvement of the 2nd layer was peptide type dependent. The nanosize dependence of Θ was linearly correlated with available spacing between adjacent peptides, Sd, which were approximated as prolates, For Aβ1−40 and α-syn, the 2nd layer was more included as Sd increased. In contrast, β2m was found to gyrate over the gold surface as Sd increased, creating a partially positive (δ+) region and repelling the extra β2m from the surface. Thus, as Sd decreased, it prohibited the gyration of β2m resulting in less δ+ region, and more β2m monomers were adsorbed with δ+ segment as the 2nd layer than the case where β2m gyrates more under relatively larger Sd. Based on the trend found in an experimentally extracted Θ as a function of Sd, optimized charge distribution of Aβ1−40 and α-syn were concluded to be negative partial charge (δ−) region that was covered by the positive partial charge (δ+) region. However, β2m may have a relatively large and/or distributed δ+ region with a small portion of δ− at the one end of a prolate. The characterization made in this work confirmed current understandings on the formation of the protein corona over nano-particles.

Use of Chamomile Infusion to Mitigate Radiotherapy-Induced Dry Desquamation in Head and Neck Cancer Patients.

Purpose:To evaluate the effect of using a compress with Chamomilla recutita infusion in the regression of dry desquamation and in the prevention of moist desquamation in head and neck cancer patients undergoing radiotherapy.Methods:A prospective intervention study was carried out from May 2019 to May 2021. In total, 43 participants were included, who were instructed to apply the compress with the infusion 3 times a day, after occurrence of dry desquamation. Skin evaluation took place daily from initiation of the intervention up to the end of radiotherapy.Results:All the participants presented dry desquamation regression, where 65.1% (95% CI 50.1-78.1) had total regression until the end of radiotherapy, with a mean of 9 days of regression. Only 34.9% (95% CI 21.8-49.9) of the participants developed moist desquamation by the end of the radiotherapy sessions, with a mean accumulated dose of ionizing radiation of 50.9 Gy.Conclusion:This study highlighted the potential clinical benefits of using Chamomilla recutita in the regression of dry desquamation and in the prevention of moist desquamation.

FAILURE MODE AND EFFECT ANALYSIS FOR THREE DIMENSIONAL RADIOTHERAPY AT AIN SHAMS UNIVERSITY HOSPITAL

Introduction: Three-dimensional radiotherapy (3D) is an important modality in management of cancer. This complex process is liable to many types of errors. Risk management approaches are mandatory to decrease the risk of these errors. Failure mode &amp; effect analysis(FMEA) is a proactive risk assessment strategy used to in identify and anticipate potential errors and to take action before a radiation incident occurs. Aim: The aim of this study is to apply a proactive risk analysis of the 3D radiotherapy process,to quantify the most significant sources of failures using FMEA &amp; to recommend risk reduction measures. Methods: A FMEA was conducted over 12-months period at Clinical Oncology and Nuclear Medicine Department at Ain-Shams University Hospital. A detailed process map for 3-D radiotherapy technique was created starting from the decision taken for radiotherapy till the end of radiotherapy sessions. The Delphi method was used in this study to achieve consensus among participants about the level of risk associated with failure modes.Semi-structured interviews wereconducted with twenty radiation personnel to identify potential failure modes in each step of 3-D radiotherapy process. Scoring of the failure modes was identified in round 1, according to Severity, Occurrence and lack of detectability scores. Round 2 confirmed the results of round 1.In Round 3:Risk mitigation strategies were suggested. Results: The 3-D radiotherapy process map consisted of 69 process steps of the 10stages of the3-D radiotherapy process.One hundred –fifty-two failure modes were identified. Thirty-two top ranked failure modes were prioritized according to RPN and severity scoring. An affinity diagram for these preventive measures was constructed. Conclusion: FMEA is an effective proactive risk assessmentapproach in 3-D radiotherapy as elaborated by identification of potential failure modes,focusing on the top ranked ones and also suggesting risk reduction measures.

Usual acinar adenocarcinoma and osteoblastic lesion in the distal middle third of the femur, an unusual finding: a case report / Adenocarcinoma acinar usual e lesão osteoblástica no terço médio distal do fêmur, um achado incomum: relato de caso

A patient with prostate cancer may initially be asymptomatic, compromising early diagnosis and treatment. A 42-year-old male patient on a routine examination had a PSA of 4.18 ng / ml. Prostate biopsy revealed usual Gleason 7 stage T2a acinar adenocarcinoma. Magnetic resonance imaging revealed a nodule in the prostate. Bone scintigraphy showed osteoblastic lesion of the left femur, considered a possibility of a secondary lesion to adenocarcinoma, but his biopsy showed tissue without significant histological changes, ruling out malignancy. The patient was submitted to a radical prostatectomy and bilateral lymphadenectomy, evolving without complications. Follow-up tests showed reactive Protein C negative, alkaline phosphatase, lactate dehydrogenase and total testosterone without changes, total PSA 0.011; Free PSA less than 0.01. The total PSA 0.3 indicated a possible recurrence after 3 years. Magnetic resonance imaging showed no suspicious lesions, PET / CT was performed, which showed molecular hyperexpression of specific membrane antigen for the prostate, confirming local recurrence. Therefore, he was submitted to 36 radiotherapy sessions in the prostate bed from July to August. In October, the total PSA was performed, which decreased sharply. The early stage of prostate cancer may show only benign prostate growth, while the advanced stage may reveal bone pain. Bone tissue often develops a metastatic lesion, resulting in a worse prognosis. In this patient, a link between prostate carcinoma and bone lesion was ruled out by biopsy, which demonstrated the absence of spread of the disease.

Whole-body thermal therapy as adjuvant therapy to radiation in a dog with metastasized anal sac adenocarcinoma

An eleven-year-old Galgo Espagnol was diagnosed with metastasized anal sac adenocarcinoma. The patient was enrolled into a clinical trial and underwent three “whole-body thermal therapy” (WBTT) sessions combined with four hypofractionated radiotherapy sessions during a ten-weeks’ time period. The medical device and corresponding treatment protocol were designed by ElmediX (ElmediX NV, Belgium). Air was injected at high speed in a treatment chamber and automatically regulated to reach and maintain a body temperature of 41.5°C for eight hours. Thermometry was ensured by temperature sensors placed in and on the patient. During four radiotherapy sessions, an external beam delivered hypofractionated doses of 6Gy on both the primary tumor and the metastatic lymph nodes. Clinical monitoring and assessment of quality of life confirmed that the WBTT sessions were well tolerated. Although burn wounds at pressure points occurred, prolonged severe adverse effects were not observed. Furthermore, the disease progression was deemed slower than the expected progression based on the literature.

Shortening the preparation time of the single prolonged breath-hold for radiotherapy sessions.

Objective:Single prolonged breath-holds of >5 min can be obtained in cancer patients. Currently, however, the preparation time in each radiotherapy session is a practical limitation for clinical adoption of this new technique. Here, we show by how much our original preparation time can be shortened without unduly compromising breath-hold duration.Methods:44 healthy subjects performed single prolonged breath-holds from 60% O2 and mechanically induced hypocapnia. We tested the effect on breath-hold duration of shortening preparation time (the durations of acclimatization, hyperventilation and hypocapnia) by changing these durations and or ventilator settings.Results:Mean original breath-hold duration was 6.5 ± 0.2 (standard error) min. The total original preparation time (from connecting the facemask to the start of the breath-hold) was 26 ± 1 min. After shortening the hypocapnia duration from 16 to 5 min, mean breath-hold duration was still 6.1 ± 0.2 min (ns vs the original). After abolishing the acclimatization and shortening the hypocapnia to 1 min (a total preparation time now of 9 ± 1 min), a mean breath-hold duration of >5 min was still possible (now significantly shortened to 5.2 ± 0.6 min, p < 0.001). After shorter and more vigorous hyperventilation (lasting 2.7 ± 0.3 min) and shorter hypocapnia (lasting 43 ± 4 s), a mean breath-hold duration of >5 min (5.3 ± 0.2 min, p < 0.05) was still possible. Here, the final total preparation time was 3.5 ± 0.3 min.Conclusions:These improvements may facilitate adoption of the single prolonged breath-hold for a range of thoracic and abdominal radiotherapies especially involving hypofractionation.Advances in knowledge:Multiple short breath-holds improve radiotherapy for thoracic and abdominal cancers. Further improvement may occur by adopting the single prolonged breath-hold of >5 min. One limitation to clinical adoption is its long preparation time. We show here how to reduce the mean preparation time from 26 to 3.5 min without compromising breath-hold duration