a Solution for Dosimetry and Quality Assurance in Imrt and Hadrontherapy:. the Pixel Ionization Chamber

The new radiotherapy techniques require new detectors to monitor and measure the clinical field. The Intensity Modulated Radiation Therapy (IMRT) techniques like step and shoot, sliding window, dynamic wedge or scanning beam add the time variable to the treatment field. In this case the water phantom with a single ionization chamber moving inside the field needs very long measurement time. Linear arrays of ionization chambers or diodes measure the field only along a line. 2D detectors like radiographic or gafchromic film are not suitable to be used as on line detectors. We have developed, built and tested an ionization chamber segmented in pixels that measure the dose in a plane at several points. Every channel has a dedicated electronic chain that digitizes the collected charge and data from all the channels are sent to the computer that performs the data acquisition. One read out cycle is very fast allowing to measure in real time the fluency and the shape of the field. The chamber can be used in two different ways, as monitor chamber and as relative dosemeter. A description of the detector, the electronics, and test results with both photon and hadron beams will be reported

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

OBJECTIVE: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome

Brachiterapia con impianto permanente nel trattamento del carcinoma prostatico

Scopo del presente studio è analizzare caratteristiche ed andamento biochimico dopo impianto permanete (LDRBT) di una vasta popolazione consecutiva di pazienti con carcinoma della prostata localizzato. Undici istituti italiani hanno raccolto i loro dati per generare una coorte di 3497 pazienti trattati dal maggio 1998 al maggio 2014. Sono stati valutati i pazienti con un followup superiore a 2 anni (2326/3497)