FDG-PET/CT imaging for staging and radiotherapy treatment planning of head and neck carcinoma

<p>Abstract</p> <p>Background</p> <p>Positron emission tomography (PET) has a potential improvement for staging and radiation treatment planning of various tumor sites. We analyzed the use of ¹⁸F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) images for staging and target volume delineation of patients with head and neck carcinoma candidates for radiotherapy.</p> <p>Methods</p> <p>Twenty-two patients candidates for primary radiotherapy, who did not receive any curative surgery, underwent both CT and PET/CT simulation. Gross Tumor Volume (GTV) was contoured on CT (CT-GTV), PET (PET-GTV), and PET/CT images (PET/CT-GTV). The resulting volumes were analyzed and compared.</p> <p>Results</p> <p>Based on PET/CT, changes in TNM categories and clinical stage occurred in 5/22 cases (22%). The difference between CT-GTV and PET-GTV was not statistically significant (p = 0.2) whereas the difference between the composite volume (PET/CT-GTV) and CT-GTV was statistically significant (p < 0.0001).</p> <p>Conclusion</p> <p>PET/CT fusion images could have a potential impact on both tumor staging and treatment planning.</p

Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

<p>Abstract</p> <p>Background</p> <p>A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series.</p> <p>Methods</p> <p>Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected.</p> <p>Results</p> <p>Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85%) patients treated with hypofractionation and in 67/70 (96%) patients treated with conventional fractionation (p = 0.01). Late toxicity was observed in 8 patients (10%) in the hypofractionation group and in 10 patients (15%) in the conventional fractionation group, respectively (p = 0.4).</p> <p>Conclusions</p> <p>The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.</p

Stereotactic ablative radiotherapy for oligometastatic prostate cancer

Background: The present study assessed clinical outcomes of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer patients. Materials and methods: Between 2017 and 2020, 37 lesions (12 osseous and 25 nodal targets) detected with conventional and/or functional imaging, were treated in 29 patients (pts), in different clinical settings: de novo oligometastatic (2 pts), oligorecurrent castration-sensitive (19 pts), castration-resistant (6 pts) prostate cancers and oligoprogressive disease during systemic therapy (2 pts). SBRT was delivered with volumetric modulated arc therapy up to a total dose of 21 Gy given in 3 fractions for bone and 30 Gy in 5 fractions for nodal metastases. A total of 34% of pts received hormonal therapy. We evaluated biochemical control [prostate serum antigen (PSA) increase grade 2 was reported. Conclusions: SBRT for oligometastatic prostate cancer offers a good biochemical/local control and tangible delay of hormone/systemic therapy without major toxicities

Stereotactic ablative radiotherapy for oligometastatic prostate cancer

Background: The present study assessed clinical outcomes of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer patients. Materials and methods: Between 2017 and 2020, 37 lesions (12 osseous and 25 nodal targets) detected with conventional and/or functional imaging, were treated in 29 patients (pts), in different clinical settings: de novo oligometastatic (2 pts), oligorecurrent castration-sensitive (19 pts), castration-resistant (6 pts) prostate cancers and oligoprogressive disease during systemic therapy (2 pts). SBRT was delivered with volumetric modulated arc therapy up to a total dose of 21 Gy given in 3 fractions for bone and 30 Gy in 5 fractions for nodal metastases. A total of 34% of pts received hormonal therapy. We evaluated biochemical control [prostate serum antigen (PSA) increase &lt; 10%)], progression free-survival (PFS) (time from SBRT to biochemical progression), local control (LC) (time from SBRT to in-field radiologic progression), hormone/systemic therapy-free survival, acute and late toxicities. Results: At 3 months, biochemical response was observed in 20/29 pts (69%). At a median follow-up of 17 months (range 6-33), 8/20 (40%) of the 3-month responders remained free from progression. Two-year PFS and LC were 37% and 70%, respectively. In-field progression occurred in 3/37 (8%) lesions. Hormone/systemic therapy was delayed by an average of 11.6 months (range 3–28). No significant difference in PFS based on the type of lesion or concomitant endocrine therapy was observed and no toxicity &gt; grade 2 was reported. Conclusions: SBRT for oligometastatic prostate cancer offers a good biochemical/local control and tangible delay of hormone/systemic therapy without major toxicities

Reproducibility of patient setup by surface image registration system in conformal radiotherapy of prostate cancer

<p>Abstract</p> <p>Background</p> <p>The reproducibility of patient setup for radiotherapy is based on various methods including external markers, X-rays with planar or computerized image acquisition, and, more recently, surface matching imaging. We analyzed the setup reproducibility of 16 patients affected by prostate cancer who underwent conformal radiotherapy with curative intent by using a surface image registration system.</p> <p>Methods</p> <p>We analyzed the setup reproducibility of 16 patients affected by prostate cancer candidates for conformal radiotherapy by using a surface image registration system. At the initial setup, EPID images were compared with DRRs and a reference 3D surface image was obtained by the AlignRT system (Vision RT, London, UK). Surface images were acquired prior to every subsequent setup procedure. EPID acquisition was repeated when errors > 5 mm were reported.</p> <p>Results</p> <p>The mean random and systematic errors were 1.2 ± 2.3 mm and 0.3 ± 3.0 mm along the X axis, 0.0 ± 1.4 mm and 0.5 ± 2.0 mm along the Y axis, and 2.0 ± 1.8 mm and -0.7 ± 2.4 mm along the Z axis respectively. The positioning error detected by AlignRT along the 3 axes X, Y, and Z exceeded the value of 5 mm in 14.1%, 2.0%, and 5.1% measurements and the value of 3 mm in 36.9%, 13.6% and 27.8% measurements, respectively. Correlation factors calculated by linear regression between the errors measured by AlignRT and EPID ranged from 0.77 to 0.92 with a mean of 0.85 and SD of 0.13. The setup measurements by surface imaging are highly reproducible and correlate with the setup errors detected by EPID.</p> <p>Conclusion</p> <p>Surface image registration system appears to be a simple, fast, non-invasive, and reproducible method to analyze the set-up alignment in 3DCRT of prostate cancer patients.</p

Lead pollution of coastal sediments by ceramic waste

© 2018 Ceramic fragments and fractionated (<2 mm) sediment have been sampled from two beaches in southwest England, along with sediment from a control beach where ceramic waste was lacking. Analysis of the glazed ceramic surfaces by X-ray fluorescence (XRF) spectrometry returned concentrations of Pb up to 729,000 mg kg−1, while XRF analysis of sediment samples revealed high but heterogeneous concentrations of Pb at the two sites impacted by ceramic waste (median = 292 and 737 mg kg−1) compared with the control beach (median ~ 20 mg kg−1). These observations are attributed to the disposal of contemporary and historical ceramic products, and the subsequent attrition of material and contamination of local sediment. Extraction of a milled ceramic composite (Pb = 2780 mg kg−1) by 1 M HCl, revealed a high (34%) environmental mobility and availability of Pb; extraction in a solution of protein, however, suggested a low (0.1%) bioaccessibility to sediment-ingesting invertebrates

IROCA-TES: Improving Quality in Radiation Oncology through Clinical Audits — Training and Education for Standardization

Background: Clinical audits are an important tool to objectively assess clinical protocols, procedures, and processes and to detect deviations from good clinical practice. The main aim of this project is to determine adherence to a core set of consensus-based quality indicators and then to compare the institutions in order to identify best practices. Materials and methods: We conduct a multicentre, international clinical audit of six comprehensive cancer centres in Poland, Spain, Italy, Portugal, France, and Romania as a part of the project, known as IROCATES (Improving Quality in Radiation Oncology through Clinical Audits — Training and Education for Standardization). Results: Radiotherapy practice varies from country to country, in part due to historical, economic, linguistic, and cultural differences. The institutions developed their own processes to suit their existing clinical practice. Conclusions: We believe that this study will contribute to establishing the value of routinely performing multi-institutional clinical audits and will lead to improvement of radiotherapy practice at the participating centres

Cadmium pigments in consumer products and their health risks

© 2018 Elsevier B.V. Cadmium is a toxic heavy metal that has been increasingly regulated over the past few decades. The main exposure routes for the general public are the consumption of certain foods and the inhalation of cigarette smoke. However, additional exposure may occur through the current and historical use of the metal in consumer products. In this paper, the uses of Cd in consumer goods are reviewed, with the focus on brightly-coloured Cd sulphide and sulphoselenide pigments, and measurements of Cd in historical and contemporary products ascertained by XRF are reported. Cadmium is encountered across a wide range of contemporary plastic products, mainly because of the unregulated recycling of electronic waste and polyvinyl chloride. However, concentrations are generally low (<100 μg g−1), conforming with current limits and posing minimal risk to consumers. Of greater concern is high concentrations of pigmented Cd (up to 2% by weight) in old products, and in particular children's toys that remain in circulation. Here, tests conducted suggest that Cd migration in some products exceeds the Toy Safety Directive limit of 17 μg g−1 by an order of magnitude. The principal current use of Cd pigments is in ceramic products where the metal is encapsulated and overglazed. Leaching tests on new and secondhand items of hollowware indicate compliance with respect to the current Cd limit of 300 μg L−1, but that non-compliance could occur for items of earthenware or damaged articles should a proposed limit of 5 μg L−1 be introduced. The greatest consumer risk identified is the use of Cd pigments in the enamels of decorated drinking glasses. Thus, while décor is restricted to the exterior, any enamel within the lip area is subject to ready attack from acidic beverages because the pigments are neither encapsulated nor overglazed. Glass bottles decorated with Cd-based enamel do not appear to represent a direct health hazard but have the propensity to contaminate recycled glass products. It is recommended that decorated glassware is better regulated and that old, brightly-coloured toys are treated cautiously