Image-guided radiation therapy for post-operative gynaecologic cancer: patient set up verification with and without implanted fiducial markers

<p><b>Background:</b> Intensity modulated radiotherapy (IMRT) is increasingly being used to treat gynaecological malignancies in the postoperative setting. The purpose of this study was to evaluate the use of image-guided radiotherapy (IGRT) using cone-beam computed tomography (CBCT) with fiducial markers for daily localization.</p> <p><b>Material and methods:</b> A single institution study was performed of consecutive cervical or endometrial cancer patients receiving adjuvant external beam radiotherapy (<i>n</i> = 15). Patients were set up at treatment using daily CBCT and alignment of implanted fiducial markers. Image registration was retrospectively completed based on soft tissue matching and the resulting couch shifts from each IGRT method were compared (<i>n</i> = 122).</p> <p><b>Results:</b> The median shift between IGRT methods was 2 mm, 1 mm and 1 mm in the anterior-posterior (A-P), superior-inferior (S-I), and lateral directions, respectively. The largest deviations were observed in the A-P direction; however, more than 90% were within 5 mm and 63.9% were within 2.5 mm.</p> <p><b>Conclusions:</b> IGRT based on soft tissue match provides a noninvasive convenient method for daily localization and is accurate within treatment uncertainty for the majority of cases.</p

Additional file 3: of Online advertising and marketing claims by providers of proton beam therapy: are they guideline-based?

Appendix C: Proportion of All Disease Sites Mentioned on Proton Therapy Centre Websites. (DOCX 21 kb

Additional file 1: of Online advertising and marketing claims by providers of proton beam therapy: are they guideline-based?

Appendix A: Data collection form. (DOCX 17 kb

Additional file 3: of A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma

Table S1. Target Dose and Volume Data by Individual Patient. CTV- clinical target volume; PTV-I – initial planning target volume; PTF-F – final planning target volume; NR – not reported. Table S2. Organ at Risk (OAR) Constraints and Doses (cGy). D1–99% of the contoured volume receives this dose or less; D33–67% of the contoured volume receives this dose or less; *Small bowel dose constraints were exceeded in Patients 2 & 6. Patient 2 reported no toxicity whatsoever and Patient 6 reported only grade 1 emesis. Table S3. Summary of Quality of Life (QoL) Data at Baseline and Last Available Follow-Up (N = 12*). (DOCX 28 kb

Additional file 1: of A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma

Figure S1. Example of treatment planning volumes. To facilitate treatment of large PTVs, the initial PTV (teal outline) was trimmed in areas of overlap (green colorwash) with organs at risk - particularly small bowel (purple colorwash) – trimmed to generate a final PTV (red colorwash). (JPEG 127 kb

Radiation-induced lung injury after concurrent neoadjuvant chemoradiotherapy for locally advanced breast cancer

Radiation-induced lung injury after concurrent neoadjuvant chemoradiotherapy for locally advanced breast cance

Optimizing SABR delivery for synchronous multiple lung tumors using volumetric-modulated arc therapy

<p><b>Background:</b> Volumetric-modulated arc therapy (VMAT) delivery for stereotactic ablative radiotherapy (SABR) of multiple lung tumors allows for faster treatments. We report on clinical outcomes and describe a general approach for treatment planning.</p> <p><b>Material and methods:</b> Patients undergoing multi iso-center VMAT-based SABR for ≥2 lung lesions between 2009 and 2014 were identified from the VU University Medical Center and London Health Sciences Centre. Patients were eligible if the start date of the SABR treatment for the different lesions was within a time range of 30 days. SABR was delivered using separate iso-centers for lesions at a substantial distance from each other. Tumors were either treated with a single fraction of 34 Gy, or using three risk-adapted dose-fractionation schemes, namely three fractions of 18 Gy, five fractions of 11 Gy, or eight fractions of 7.5 Gy, depending on the tumor size and the location. Multivariable analysis was performed to assess factors predictive of clinical outcomes.</p> <p><b>Results:</b> Of 84 patients (188 lesions) identified, 46% were treated for multiple metastases and 54% for multiple primary NSCLC. About 97% were treated for two or three lesions, and 56% had bilateral disease. After a median follow-up of 28 months, median overall survival (OS) for primary tumors was 27.6 months, and not reached for metastatic lesions (<i>p</i> = .028). Grade ≥3 toxicity was observed in 2% of patients. Multivariable analysis showed that grade 2 or higher radiation pneumonitis (<i>n</i> = 9) was best predicted by a total lung V35_Gy of ≥6.5% (in 2Gy/fraction equivalent) (<i>p</i> = .007).</p> <p><b>Conclusion:</b> Severe toxicity was uncommon following SABR using VMAT for up to three lung tumors. Further investigations of planning parameters are needed in patients presenting with more lesions.</p

Gammaherpesvirus infection and malignant disease in rhesus macaques experimentally infected with SIV or SHIV

<div><p>Human gammaherpesviruses are associated with malignancies in HIV infected individuals; in macaques used in non-human primate models of HIV infection, gammaherpesvirus infections also occur. Limited data on prevalence and tumorigenicity of macaque gammaherpesviruses, mostly cross-sectional analyses of small series, are available. We comprehensively examine all three-rhesus macaque gammaherpesviruses -Rhesus rhadinovirus (RRV), Rhesus Lymphocryptovirus (RLCV) and Retroperitoneal Fibromatosis Herpesvirus (RFHV) in macaques experimentally infected with Simian Immunodeficiency Virus or Simian Human Immunodeficiency Virus (SIV/SHIV) in studies spanning 15 years at the AIDS and Cancer Virus Program of the Frederick National Laboratory for Cancer Research. We evaluated 18 animals with malignancies (16 lymphomas, one fibrosarcoma and one carcinoma) and 32 controls. We developed real time quantitative PCR assays for each gammaherpesvirus DNA viral load (VL) in malignant and non-tumor tissues; we also characterized the tumors using immunohistochemistry and <i>in situ</i> hybridization. Furthermore, we retrospectively quantified gammaherpesvirus DNA VL and SIV/SHIV RNA VL in longitudinally-collected PBMCs and plasma, respectively. One or more gammaherpesviruses were detected in 17 tumors; generally, one was predominant, and the relevant DNA VL in the tumor was very high compared to surrounding tissues. RLCV was predominant in tumors resembling diffuse large B cell lymphomas; in a Burkitt-like lymphoma, RRV was predominant; and in the fibrosarcoma, RFHV was predominant. Median RRV and RLCV PBMC DNA VL were significantly higher in cases than controls; SIV/SHIV VL and RLCV VL were independently associated with cancer. Local regressions showed that longitudinal VL patterns in cases and controls, from SIV infection to necropsy, differed for each gammaherpesvirus: while RFHV VL increased only slightly in all animals, RLCV and RRV VL increased significantly and continued to increase steeply in cases; in controls, VL flattened. In conclusion, the data suggest that gammaherpesviruses may play a significant role in tumorogenesis in macaques infected with immunodeficiency viruses.</p></div

Representative pictures showing histopathology, immunohistochemistry and RNAscope staining representative of DLBCL cases.

<p>(A) H&E image showing diffusely distributed round or ovoid large lymphoid cells cells with vesicular nuclear chromatin, distinct central nucleoli, and scattered mitotic figures. Immunophenotyping showed (B) highly proliferative cells with strong Ki-67 expression, (C) CD20 expression, with admixed CD20-negative T-cells, (D) High expression of Bcl-2, (E) low expression of Bcl-6, (F) high expression of c-Myc, and (G) Pax5, but (H) low expression of the ORF73 protein from RFHV and (I) rare expression of RRV capside protein (clone 3D1.2). RNAscope showed (K) robust RhLCV viral RNA expression but (J)low RRV viral RNA expression in DLBCL cases.</p

Representative pictures showing histopathology, immunohistochemistry and RNAscope staining of the BL-like lymphoma case.

<p>(A) H&E images showing atypical medium-sized lymphoid cells with clumped chromatin, with admixed small lymphocytes. Immunophenotyping showed (B) strong CD20 B cell expression and rare CD3+ T cells at the periphery of the tumor, (C) highly proliferative activity with strong Ki-67 expression, (D) c-Myc, (E) Pax- 5 and (F) Bcl-6 are found highly expressed, but with (G) lower Bcl-2 expression. RNAscope demonstrated (H) robust RRV viral RNA expression, but (I) rare RhLCV viral RNA expression in this case of BL-like lymphoma.</p