Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study

Abstract

Background

The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer.

Methods

An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05.

Results

Significantly best target coverage and homogeneity was achieved using VMAT FFF with V_95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V_95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a D_mean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min.

Conclusion

Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.

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Actualités en phytothérapie

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How receptive are patients with late stage cancer to rehabilitation services and what are the sources of their resistance?

Publication date: Available online 31 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Andrea L. Cheville, Lori Rhudy, Jeffrey R. Basford, Joan M. Griffin, Ann Marie Flores
ObjectiveTo describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, as well as the rationale for their level of interest.SettingA comprehensive cancer center in a Northcentral US quaternary medical centerDesignA prospective mixed methods studyParticipants311 adults with Stage IIIC or IV non-small cell or extensive stage small cell lung cancer.InterventionsNot applicableMain Outcome MeasuresTelephone acquired responses to the administration of: 1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); 2) Numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; 3) a query regarding receptivity to receipt of rehabilitation services, and 4) a query about rationale for non-receptivity.ResultsOverall 99 (31.8%) of the study's 311 participants expressed interest in receiving rehabilitation services; 38 at the time of enrollment and an additional 61 during at least one subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs. 9.91%, p = 0.04) and a musculoskeletal comorbidity (42.4% vs. 31.6%, p = 0.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns.ConclusionsOne-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.



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Effet d’une association de Porphyra umbilicalis , de Polypodium leucotomos et de vitamines C et E sur la dose érythémateuse minimale chez des volontaires sains

Résumé

Les produits de protection solaire topiques protègent efficacement contre les ultraviolets mais présentent une efficacité de courte durée souvent limitée par une utilisation inadéquate. Des produits systémiques ont donc été développés en complément des méthodes de photoprotection externe. Nous avons évalué l'effet d'une association de Porphyra umbilicalis, de Polypodium leucotomos et de vitamines C et E sur la dose érythémateuse minimale (DEM). Cette étude en ouvert, avec comparaisons intra-individuelles, a été réalisée chez des volontaires sains de phototypes II et III ayant pris cette association pendant 14 jours. La DEM a été évaluée à j0, j3, j7 et j14. À j14, une augmentation statistiquement significative de la DEM de 19 % (p < 0,001) a été observée chez 82 % (18/22) des volontaires. Cette augmentation a été significative dès j7 (+10 % ; p = 0,002). L'analyse par phototype a montré que l'augmentation de la DEM était significative dès j3 chez les volontaires de phototype II (n = 13 ; +7 % ; p = 0,009), et à partir de j14 chez les volontaires de phototype III (n = 9 ; +17 % ; p = 0,011). Ces résultats suggèrent que l'association de Porphyra umbilicalis, de Polypodium leucotomos et de vitamines C et E pourrait renforcer les capacités de photoprotection chez un individu se protégeant déjà par voie externe.

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Safe landing strategies during a fall: Systemic review and meta-analysis

Publication date: Available online 31 August 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yaejin Moon, Jacob J. Sosnoff
ObjectiveTo systematically synthesize information on safe landing strategies for a fall and quantitatively examine the effects of the strategies to reduce risk of injury from a fall.Data SourcesPubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane LibraryStudy SelectionDatabases were searched using the combinations of keywords of "falls", "strategy", "impact" and "load". Randomized control trials, cohort studies, pre-post studies, or cross-sectional studies were included.Data ExtractionThe fall strategies were extracted and categorized by falling direction. Measurements of impact loads that reflect the risk of injuries were extracted (e.g. impact velocity, impact force, fall duration, and impact angle). Hedges g was used as effect size to quantify effect of a protective landing strategy to reduce the impact load.Data SynthesisA total of seven landing strategies (squatting, elbow flexion, forward rotation, martial arts rolling, martial arts slapping, relaxed muscle, and stepping) in 13 studies were examined. In general, all strategies, except for the martial arts slapping technique, significantly reduced impact load (g's=0.73 to 2.70). Squatting was an efficient strategy to reduce impact in backward falling (g=1.77) while elbow flexion with outstretched arms was effective in forward falling (g=0.82). Also, in sideways falling strategies, martial arts rolling (g=2.70) and forward rotation (g=0.82) were the most efficient strategies to reduce impact load.ConclusionsThe result showed that landing strategies have significant effect on reducing impact load during a fall and might be effective to reduce impact load of falling. The current study also highlighted limitations of the previous studies which focused on a young population and self-initiated falls. Further investigation with elderly individuals and unexpected falls is necessary to verify effectiveness and suitableness of the strategies to at-risk population in real-life falls.



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Affiliate faculty members honored

Dr. Bill McHugh and Dr. Franco Audia are the newest recipients of the Hungate Awards for Teaching Excellence, which recognize outstanding work by affiliate faculty.

The post Affiliate faculty members honored appeared first on UW School of Dentistry.

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Can fascia’s characteristics be influenced by manual therapy?

Publication date: Available online 31 August 2016
Source:Journal of Bodywork and Movement Therapies
Author(s): Serge Gracovetsky




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