Radiation Treatment Of Cancer Patients Research Articles

Technologies of modern radiotherapy and development prospects. Quality assurance concept

At the clinic of the N.N. Blokhin National Medical Research Center of Oncology has been using the following conformal irradiation technologies for cancer patients that meet international standards for more than 13 years: 3D conformal radio therapy (3DCRT); intensity modulated radiotherapy (IMRT); volume modulated arc therapy (VMAT); stereotactic radiation technique (SRT); radiotherapy technique with breathing control, total therapeutic irradiation (TRT) technique followed by bone marrow transplantation. The technological complex with which these technologies are implemented has demonstrated an increase in the quality of radiation treatment for cancer patients. However, despite the “advancement” of technology, there are limitations in the ability to reduce dose loads on critical organs for a number of nosologies. Therefore, the prospects for the development of radiotherapy in Russia lie in the creation of several clinical centers for the use of heavy charged particles that have different physical and dosimetric characteristics and, from this point of view, carry other opportunities and prospects. There is great interest in flash therapy.

Nutritional support is an effective tool in the hands of an oncologist

As part of the XXVII Russian Oncology Congress, a section “Nutritional support — an underestimated tool in the hands of an oncologist. How to ensure successful continuous antitumor therapy?” was held. The presented message outlines the abstracts of the reports of the section participants. Report by A.R. Gevorkov concerned the relevance of nutritional support in oncology, the negative impact of nutritional deficiency on the results of surgical, drug and radiation treatment of cancer patients at all stages. Report by O.A. Obukhova was devoted to the effectiveness of nutritional support during surgical treatment of cancer patients, based on the results of well-planned and executed clinical studies, including the first domestic prospective multicenter randomized trial of perioperative high-protein enteral nutrition NUTRILUNC. Report by M.Yu. Kukosh reflected the role of rehabilitation in the continuity of antitumor treatment and the place of nutritional support in the corresponding rehabilitation program. The authors concluded that nutritional support at all stages of antitumor treatment is relevant, effective and safe, and called on oncologists to widely introduce artificial nutrition into clinical practice.

Dosiomics in the analysis of medical images and prospects for its use in clinical practice

BACKGROUND: In recent years, there has been a notable increase in the number of articles using the term dosiomics. However, there are no literature reviews on this topic in the Russian language.
 AIM: This study aims to describe the basic principles of dosiomics as a derivative of radiomics and to analyze studies devoted to assessing the possibilities of its application in clinical practice.
 MATERIALS AND METHODS: A systematic literature search was performed in the PubMed database using the search query dosiomics OR dosiomic, and in the eLibrary database using the search query dosiomics. By April 2023, 43 foreign articles and 1 Russian article had been published.
 RESULTS: The analysis encompassed 43 foreign studies investigating the use of dosiomics in clinical practice, alongside one Russian article that provided a definition of the term dosiomics. The analyzed papers were divided into three groups according to their subject matter, and two tables describing the results of 27 studies on the prediction of clinical outcomes were created.
 CONCLUSION: Currently, dosiomics is a new and promising derivative of radiomics used in the textural analysis of medical images associated with radiation treatment of cancer patients. Dosiomics can contribute to the development of a more personalized approach to the planning of radiotherapy, the prediction of radiation damage of normal tissues, and the diagnosis of recurrence.

The influence of artificial intelligence on the work of the medical physicist in radiotherapy practice: a short review.

There have been many applications and influences of Artificial intelligence (AI) in many sectors and its professionals, that of radiotherapy and the medical physicist is no different. AI and technological advances have necessitated changing roles of medical physicists due to the development of modernized technology with image-guided accessories for the radiotherapy treatment of cancer patients. Given the changing role of medical physicists in ensuring patient safety and optimal care, AI can reshape radiotherapy practice now and in some years to come. Medical physicists' roles in radiotherapy practice have evolved to meet technology for the management of better patient care in the age of modern radiotherapy. This short review provides an insight into the influence of AI on the changing role of medical physicists in each specific chain of the workflow in radiotherapy in which they are involved.

Single-arm Cohort Study on the Effects of the COVID-19 Pandemic on the Radiation Treatment of Cancer Patients Referred to the Radiation Oncology Division of a Tertiary Hospital

Single-arm Cohort Study on the Effects of the COVID-19 Pandemic on the Radiation Treatment of Cancer Patients Referred to the Radiation Oncology Division of a Tertiary Hospital

Curcumin supplementation in the treatment of patients with cancer: a systematic review

Feeding with high levels of phytochemicals, including curcumin, may be a therapeutic option for diseases such as cancer which is a public health problem. The aim of this study was to systematically review the results of clinical trials investigating the effect of oral curcumin supplementation on anti-inflammatory and antioxidant profiles, reduction of PSA levels and degree of dermatitis in radiotherapy treatment in cancer patients. The review was carried out based on the items of the PRISMA Statement. A bias risk assessment was performed according to Cochrane Collaboration criteria. Six studies met the eligibility criteria and were included in the systematic review. The results of this study are based on those obtained in the literature on the effect of curcumin on the anti-inflammatory profile, on reducing dermatitis, on PSA alteration and on anti-oxidant profile for a total of 450 individuals, comprising 259 in the intervention group and 191 in the control group. Some studies have reported improvement in biochemical and clinical indicators, with limited adverse effects and good tolerance. It was not possible to determine, with the desired degree of evidence, the effect of curcumin supplementation in the treatment of cancer patients. It is important to consider the great heterogeneity and methodological weaknesses of the studies, and that it was not possible to perform a meta-analysis of the data available in the literature.

Reações adversas em pacientes oncológicos após tratamento radioterápico

Objetivo: Descrever reações adversas após tratamento radioterápico em pessoas com cânceratendidas em um ambulatório de radioterapia. Metodologia: Trata-se de um estudo documental pormeio da coleta de dados em prontuários clínicos. Foram avaliados 436 pacientes que realizaramtratamento radioterápico em busca de episódios de reações adversas registrados nos prontuários.Foram elegíveis os pacientes maiores de 18 anos com diagnóstico de neoplasia (confirmado porlaudos citopatológicos e/ou histopatológico) que realizaram cinco ou mais sessões de radioterapiaentre 2015 e 2016. Resultados: 353 prontuários clínicos foram incluídos (83,6%) e 1.390 reaçõesassociadas ao tratamento radioterápico foram descritas nestes pacientes, sendo 53,2% mulheres. Asreações adversas mais frequentes relacionadas à radioterapia foram dor (14%), radiodermite (9%) efalta de apetite (8%). 69% dos pacientes não apresentavam sinais ou sintomas antes do diagnóstico,sendo 25% diagnosticados com adenocarcinoma. A técnica de radioterapia mais utilizada foi a 3D(67%), com cerca de 30 frações (14%) e 5000 Gy como dose total planejada (17%). 70% dospacientes que apresentaram reações adversas possuíam ao menos uma comorbidade. Conclusão: Aradioterapia pode estar associada à diversas reações adversas, variando os sinais e sintomas nospacientes acometidos. A prevenção e o manejo destas condições podem potencializar o tratamento,reduzindo a morbidade e a mortalidade, além de proporcionar qualidade de vida aos pacientes comcâncer.

Software Method of Determining Tumor Parameters from CT Images

A clinically available software method has been developed and tested for evaluating tumor dynamics according to size and physical density in adaptive radiation treatment of cancer patients for any cases of imaging of tumor borders, including fuzzy imaging of the tumor borders. The quantitative informativeness of the method is shown.

Evaluation of conformal radiotherapy treatment planning of breast cancer patients: Preliminary case study patients from Persahabatan Central Hospital

Persahabatan Central Hospital has served radiotherapy treatment for cancer patients using linac, Elekta Precise and XiO treatment planning system (TPS) since May 2017. This study collected 91 breast cancer patients treated from May 2017 until January 2019. Most patients were preceded by surgery either mammae radical mastectomy (MRM) (83.5%) or breast conservative surgery (BCS) (16.5%). Conformal treatment planning generally performed with 2 tangential fields and most included oblique fields for treating axillary lymph nodes. Percentage of patients with clinical tumor volumes >400 cm3 was 29%, in the range of 200-400 cm3 was 36%, and the rest was <200 cm3. The lung volume irradiated with dose ≥20 Gy was used as one of parameters for treatment optimization. The mrm patient number with lung volume irradiated >30% was 9 persons (11.8%), in the range of 20-30% was 65 persons (85.5%), and <20% was 2 persons (2.6%). For the bcs patients, the number followed these criteria with lung volume of 20-30% was 13 persons (86.7%), and <20% was 2 persons (13.3%). Most breast cancer patients treated with radiotherapy were advanced stage preceded by mrm, treatment planning was difficult for achieving lung volume <30% that irradiated with the dose ≥20 Gy.

OC-0600 Assessment of non-adherence to external radiotherapy treatment in cancer patients in Catalonia,Spain

OC-0600 Assessment of non-adherence to external radiotherapy treatment in cancer patients in Catalonia,Spain

Diagnosis of pre-sarcopenia from a single selectional crosscut at C3 region, using CT scans before radiotherapy.

Purpose: the main purpose of this study was to diagnose pre-sarcopenia in cancer patients who had lack of computed tomography (CT) abdominal images, with a newly discovered method based on cervical images. Material and methods: a sample of 37 patients with either lung cancer or a cancer that affected the upper digestive system underwent radiotherapy computed simulation which included measurements at C3 and L3 regions. Skeletal muscle mass (SMM) and skeletal muscle index (SMI) were determined by Hounsfield units and compared in both regions. Pre-sarcopenia was identified according to the cut-points currently established: ≤ 41 cm2/m2 in females, ≤ 43 cm2/m2 in males with a BMI ≤ 25 kg/m2, and ≤ 53 cm2/m2 in males with a BMI > 25 kg/m2. Results: the correlation of SMM and SMI between the C3 and L3 regions was R2 = 0.876 and R2 = 0.805, respectively. Moreover, there was a positive association (86.49%) in terms of the diagnosis of pre-sarcopenia according to both regions. In total, eleven pre-sarcopenic patients (29.37%) were identified; three of them being overweight (27.27%) and two of them being obese (18.18%). Conclusion: a single sectional cross at the level of C3 can be used for the diagnosis of pre-sarcopenia. This new method avoids unnecessary irradiation, saves hospital costs and detects malnutrition before starting radiotherapy treatment in cancer patients who have lack of CT abdominal imaging.

PLUNC 3D Radiation Treatment Planning System (TPS): An Educational Platform for Medical Physics Students

Technological innovations with modern planning and treatment techniques have transformed the way of radiation treatment for cancer patients. A tremendous evolution in radiation treatment process occurred in recent years. This allowed the delivery of the desired radiation dose distribution to target tissue, while delivering an acceptable radia­tion dose to the surrounding normal tissues with greater dose gradients and tighter margins. Evolution of the computers and computerized systems enabled the possibility to improve the basic two-dimensional (2D) radiotherapy treatment planning to a more accurate and more visualised three-dimensional (3D) treatment planning systems. Today there is now several commercialized planning system competitors used for external beam radiation therapy. PLUNC was one of the first operating 3D radiation treatment planning (RTP) systems’. This RTP system has been developed in the Department of Radiation Oncology at the University of North Carolina (UNC) since 1985 for research and educational purposes. PLUNC is freely distributed to the field of radiation oncology for research and educational use under special license agreement. In this study, PLUNC 3D treatment planning system has been installed and implemented for research and educational purpose in the field of medical physics. A 3D treatment plan has been created and analyzed in a typical patient CT image for educational demonstration purpose. Based on this analysis, it is concluded that the PLUNC 3D TPS could be successfully used for research and education purposes in M Sc/PhD thesis works of students from medical physics discipline.&#x0D; Bangladesh J. Nuclear Med. 21(1): 35-42, January 2018

A method for evaluating treatment quality using in vivo EPID dosimetry and statistical process control in radiation therapy

PurposeDue to increasing complexity, modern radiotherapy techniques require comprehensive quality assurance (QA) programmes, that to date generally focus on the pre-treatment stage. The purpose of this paper is to provide a method for an individual patient treatment QA evaluation and identification of a “quality gap” for continuous quality improvement.Design/methodology/approachA statistical process control (SPC) was applied to evaluate treatment delivery using in vivo electronic portal imaging device (EPID) dosimetry. A moving range control chart was constructed to monitor the individual patient treatment performance based on a control limit generated from initial data of 90 intensity-modulated radiotherapy (IMRT) and ten volumetric-modulated arc therapy (VMAT) patient deliveries. A process capability index was used to evaluate the continuing treatment quality based on three quality classes: treatment type-specific, treatment linac-specific, and body site-specific.FindingsThe determined control limits were 62.5 and 70.0 per cent of the χ pass-rate for IMRT and VMAT deliveries, respectively. In total, 14 patients were selected for a pilot study the results of which showed that about 1 per cent of all treatments contained errors relating to unexpected anatomical changes between treatment fractions. Both rectum and pelvis cancer treatments demonstrated process capability indices were less than 1, indicating the potential for quality improvement and hence may benefit from further assessment.Research limitations/implicationsThe study relied on the application of in vivo EPID dosimetry for patients treated at the specific centre. Sampling patients for generating the control limits were limited to 100 patients. Whilst the quantitative results are specific to the clinical techniques and equipment used, the described method is generally applicable to IMRT and VMAT treatment QA. Whilst more work is required to determine the level of clinical significance, the authors have demonstrated the capability of the method for both treatment specific QA and continuing quality improvement.Practical implicationsThe proposed method is a valuable tool for assessing the accuracy of treatment delivery whilst also improving treatment quality and patient safety.Originality/valueAssessing in vivo EPID dosimetry with SPC can be used to improve the quality of radiation treatment for cancer patients.

A 360-degree Holographic Display System for Radiotherapy Treatment Planning

ABSTRACTBeam's Eye View is a commercial software system that is used by radiologists to plan radiotherapy treatment for cancer patients. It utilizes an algorithm that reconstructs a three-dimensional (3D) image from a serial of composite images of both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). While it is effective, the display of 3D images on a 2D flat screen often creates confusion and limits its efficiency. In this paper, the use of holographic display is proposed. Two different holographic display systems are discussed, including the 4-side pseudo 3D holographic display system and 360-degree spinning holographic display system. The unambiguous holographic display helps the doctor to plan the radiotherapy treatment in a straightforward manner. With further development, it is expected that the proposed technology will soon find practical applications in the hospital.

Interpretation of a heterogeneous radiological response as tumor heterogeneity or a non-tumor diagnosis: A case report.

Heterogeneous radiological responses (HRRs) among tumor lesions are usually observed following chemotherapy or radiation treatment in cancer patients. When HRR is observed after chemotherapy or radiation treatment, a change in anticancer treatment is recommended due to the clinically high suspicion of resistance in the majority of cases. The present study reports the case report of a patient with limited-stage small cell lung cancer, diagnosed by bronchoscopy, who received concurrent chemoradiation therapy. Upon response evaluation, the majority of lesions irradiated had nearly completely disappeared following treatment, but one lesion had apparently increased in size. For histological confirmation, a percutaneous needle biopsy for the lesion was performed, however, non-specific necrosis was found and the results were inconclusive for the differentiation of other causes from tumor necrosis. Several acid-fast bacilli were identified on Ziehl-Neelsen staining for the differential diagnosis. This case suggests that a non-tumor diagnosis should be considered when HRR presents after treatment that is expected to result in a higher response rate, particularly in tuberculosis endemic areas.

A new approach to cancer treatment

AbstractA new approach is applied to correlate different phases of the HeLa cell S-3 with mean lethal ionising radiation dose (Do) along with nuclear magnetic resonance water-proton spin-lattice relaxation time (T1). This information can be used to pin-point the mitotic phase of the cells in vivo. This enables us to apply ionising radiation treatment at that particular time. This will increase the efficacy of radiation treatment in cancer patients.

Monte Carlo simulation based study of a proposed multileaf collimator for a telecobalt machine

The objective of the present work was to propose a design of a secondary multileaf collimator (MLC) for a telecobalt machine and optimize its design features through Monte Carlo simulation. The proposed MLC design consists of 72 leaves (36 leaf pairs) with additional jaws perpendicular to leaf motion having the capability of shaping a maximum square field size of 35 × 35 cm(2). The projected widths at isocenter of each of the central 34 leaf pairs and 2 peripheral leaf pairs are 10 and 5 mm, respectively. The ends of the leaves and the x-jaws were optimized to obtain acceptable values of dosimetric and leakage parameters. Monte Carlo N-Particle code was used for generating beam profiles and depth dose curves and estimating the leakage radiation through the MLC. A water phantom of dimension 50 × 50 × 40 cm(3) with an array of voxels (4 × 0.3 × 0.6 cm(3) = 0.72 cm(3)) was used for the study of dosimetric and leakage characteristics of the MLC. Output files generated for beam profiles were exported to the PTW radiation field analyzer software through locally developed software for analysis of beam profiles in order to evaluate radiation field width, beam flatness, symmetry, and beam penumbra. The optimized version of the MLC can define radiation fields of up to 35 × 35 cm(2) within the prescribed tolerance values of 2 mm. The flatness and symmetry were found to be well within the acceptable tolerance value of 3%. The penumbra for a 10 × 10 cm(2) field size is 10.7 mm which is less than the generally acceptable value of 12 mm for a telecobalt machine. The maximum and average radiation leakage through the MLC were found to be 0.74% and 0.41% which are well below the International Electrotechnical Commission recommended tolerance values of 2% and 0.75%, respectively. The maximum leakage through the leaf ends in closed condition was observed to be 8.6% which is less than the values reported for other MLCs designed for medical linear accelerators. It is concluded that dosimetric parameters and the leakage radiation of the optimized secondary MLC design are well below their recommended tolerance values. The optimized design of the proposed MLC can be integrated into a telecobalt machine by replacing the existing adjustable secondary collimator for conformal radiotherapy treatment of cancer patients.

Output factor determination for dose measurements in axial and perpendicular planes using a silicon strip detector

In this work we present the output factor measurements of a clinical linear accelerator using a silicon strip detector coupled to a new system for complex radiation therapy treatment verification. The objective of these measurements is to validate the system we built for treatment verification. The measurements were performed at the Virgin Macarena University Hospital in Seville. Irradiations were carried out with a Siemens ONCOR™ linac used to deliver radiotherapy treatment for cancer patients. The linac was operating in 6 MV photon mode; the different sizes of the fields were defined with the collimation system provided within the accelerator head. The output factor was measured with the silicon strip detector in two different layouts using two phantoms. In the first, the active area of the detector was placed perpendicular to the beam axis. In the second, the innovation consisted of a cylindrical phantom where the detector was placed in an axial plane with respect to the beam. The measured data were compared with data given by a commercial treatment planning system. Results were shown to be in a very good agreement between the compared set of data.

Association between Normal Tissue Complications after Radiotherapy and Polymorphic Variations inTGFB1andXRCC1Genes

Genetic predictive biomarkers of radiosensitivity are being sought to individualize radiation treatment of cancer patients. In this pilot case-control study, we tested the association between TGFB1 T869C codon 10 Leu/Pro (rs1982073), XRCC1 G28152A codon 399 Arg/Gln (rs25487), and XRCC3 C18067T codon 241 Thr/Met (rs861539) single-nucleotide polymorphisms (SNPs) and late reaction to radiotherapy in 60 nasopharyngeal cancer patients. Subcutaneous and deep tissue fibrosis was scored using the RTOG/EORTC grading system. Patients with moderate to severe fibrosis (radiosensitive cases, G2-3, n = 30) were matched and compared to those with little or no reaction (controls, G0-1, n = 30). The three nonsynonymous SNPs were genotyped by direct DNA sequencing. Significant association was observed for TGFB1 T869C and XRCC1 G28152A genotypes (P < or = 0.05). Both variant alleles, TGFB1 869C and XRCC1 28152A, were associated with a lower grade of fibrosis (odds ratios were 0.41, 95% CI: 0.20-0.86, P = 0.02 and 0.30, 95% CI: 0.10-0.89, P = 0.02, respectively), and therefore the wild-types were the risk alleles. Interestingly, there was a significant difference in the median number of risk alleles between the radiosensitive and the control groups (P = 0.006). We conclude that radiotherapy complications are associated with genetic variations in our nasopharynx cancer patients. Our findings support the assumption of the combined effects of multiple SNPs. Large-scale studies are required to confirm these findings before polymorphisms can be used as predictive markers to individualize radiation therapy on genetic bases.

TH‐C‐AUD C‐03: Patient Setup Using 2D Projected Images and Setup Error Estimation

Purpose: Fiducial markers or bone structure are widely used in patient setup for image guided therapies and is also important in interventional radiology. A general approach (“2D‐2D”) for patient setup is based on 2D projected images on the anterior‐posterior (AP) and lateral (LAT) directions. However, it is still an open question to decide the number of fiducial markers required for patient setup, the optimal locations for marker plantation, the selection of fiducial markers versus bone structure, and the error estimations of different setup methods. Our work will address some of these issues and provide quantified information. Method and Materials: Clinical patient setup procedure (“2D‐2D”) is simulated using rigid registration. Least square metric is applied to minimize the alignment error of markers. Registration under different degree of freedom (DOF) are performed, including 3DOF (translation only), 4DOF (translation and AP couch rotation) and 5DOF (translation and rotation on AP and LAT). Registration errors are calculated based on absolute or percentage of missed volume between estimation tumor location and real tumor location. Results: Patient setup errors were investigated using different registration methods under various tumor motion conditions. The results showed that back and forth shifts using alternating projection planes can worsen the true registration of the target center with each “correction” step given target rotation. Second, for off center rotations of five degrees, no alignment can result in smaller errors than 2D‐2D registrations, despite a true translation of the target center. In addition, a 3DOF alignment process performs better against rotational shifts than both 4DOF and 5DOF that allow rotations within the projection planes. Conclusion: The quantitative analysis and setup error estimation using “2D‐2D” registration will provide better guidance for patient setup, which is important for effective radiation treatment of cancer patients.