Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases

<p>Abstract</p> <p>Background</p> <p>Recent developments enable to deliver rotational IMRT with standard C-arm gantry based linear accelerators. This upcoming treatment technique was benchmarked in a multi-center treatment planning study against static gantry IMRT and rotational IMRT based on a ring gantry for a complex parotid gland sparing head-and-neck technique.</p> <p>Methods</p> <p>Treatment plans were created for 10 patients with head-and-neck tumours (oropharynx, hypopharynx, larynx) using the following treatment planning systems (TPS) for rotational IMRT: Monaco (ELEKTA VMAT solution), Eclipse (Varian RapidArc solution) and HiArt for the helical tomotherapy (Tomotherapy). Planning of static gantry IMRT was performed with KonRad, Pinnacle and Panther DAO based on step&shoot IMRT delivery and Eclipse for sliding window IMRT. The prescribed doses for the high dose PTVs were 65.1Gy or 60.9Gy and for the low dose PTVs 55.8Gy or 52.5Gy dependend on resection status. Plan evaluation was based on target coverage, conformity and homogeneity, DVHs of OARs and the volume of normal tissue receiving more than 5Gy (V_5Gy). Additionally, the cumulative monitor units (MUs) and treatment times of the different technologies were compared. All evaluation parameters were averaged over all 10 patients for each technique and planning modality.</p> <p>Results</p> <p>Depending on IMRT technique and TPS, the mean CI values of all patients ranged from 1.17 to 2.82; and mean HI values varied from 0.05 to 0.10. The mean values of the median doses of the spared parotid were 26.5Gy for RapidArc and 23Gy for VMAT, 14.1Gy for Tomo. For fixed gantry techniques 21Gy was achieved for step&shoot+KonRad, 17.0Gy for step&shoot+Panther DAO, 23.3Gy for step&shoot+Pinnacle and 18.6Gy for sliding window.</p> <p>V_5Gyvalues were lowest for the sliding window IMRT technique (3499 ccm) and largest for RapidArc (5480 ccm). The lowest mean MU value of 408 was achieved by Panther DAO, compared to 1140 for sliding window IMRT.</p> <p>Conclusions</p> <p>All IMRT delivery technologies with their associated TPS provide plans with satisfying target coverage while at the same time respecting the defined OAR criteria. Sliding window IMRT, RapidArc and Tomo techniques resulted in better target dose homogeneity compared to VMAT and step&shoot IMRT. Rotational IMRT based on C-arm linacs and Tomotherapy seem to be advantageous with respect to OAR sparing and treatment delivery efficiency, at the cost of higher dose delivered to normal tissues. The overall treatment plan quality using Tomo seems to be better than the other TPS technology combinations.</p

Robust signatures of solar neutrino oscillation solutions

With the goal of identifying signatures that select specific neutrino oscillation parameters, we test the robustness of global oscillation solutions that fit all the available solar and reactor experimental data. We use three global analysis strategies previously applied by different authors and also determine the sensitivity of the oscillation solutions to the critical nuclear fusion cross section, S_{17}(0), for the production of 8B. The favored solutions are LMA, LOW, and VAC in order of g.o.f. The neutral current to charged current ratio for SNO is predicted to be 3.5 +- 0.6 (1 sigma), which is separated from the no-oscillation value of 1.0 by much more than the expected experimental error. The predicted range of the day-night difference in charged current rates is (8.2 +- 5.2)% and is strongly correlated with the day-night effect for neutrino-electron scattering. A measurement by SNO of either a NC to CC ratio > 3.3 or a day-night difference > 10%, would favor a small region of the currently allowed LMA neutrino parameter space. The global oscillation solutions predict a 7Be neutrino-electron scattering rate in BOREXINO and KamLAND in the range 0.66 +- 0.04 of the BP00 standard solar model rate, a prediction which can be used to test both the solar model and the neutrino oscillation theory. Only the LOW solution predicts a large day-night effect(< 42%) in BOREXINO and KamLAND. For the KamLAND reactor experiment, the LMA solution predicts 0.44 of the standard model rate; we evaluate 1 sigma and 3 sigma uncertainties and the first and second moments of the energy spectrum.Comment: Included predictions for KamLAND reactor experiment and updated to include 1496 days of Super-Kamiokande observation

Low-lying continuum structures in B8 and Li8 in a microscopic model

We search for low-lying resonances in the B8 and Li8 nuclei using a microscopic cluster model and a variational scattering method, which is analytically continued to complex energies. After fine-tuning the nucleon-nucleon interaction to get the known 1+ state of B8 at the right energy, we reproduce the known spectra of the studied nuclei. In addition, our model predicts a 1+ state at 1.3 MeV in B8, relative to the Be7+p threshold, whose corresponding pair is situated right at the Li7+n threshold in Li8. Lacking any experimental evidence for the existence of such states, it is presently uncertain whether these structures really exist or they are spurious resonances in our model. We demonstrate that the predicted state in B8, if it exists, would have important consequences for the understanding of the astrophysically important Be7(p,gamma)B8 reaction.Comment: 6 pages with 1 figure. The postscript file and more information are available at http://nova.elte.hu/~csot

Extrapolation of the astrophysical S factor for ^7Be(p,gamma)^8B to solar energies

We investigate the energy dependence of the astrophysical $S$ factor for the reaction $^7$Be$(p,\gamma)^8$B, the primary source of high-energy solar neutrinos in the solar $pp$ chain. Using simple models we explore the model dependence in the extrapolation of the experimental data to the region of astrophysical interest near 20 keV. We find that below approximately 400 keV the energy dependence is very well understood and constrained by the data for the elastic scattering of low energy neutrons from $^7$Li. Above 400 keV nuclear distortion of the wave function of the incident proton introduces a significant model dependence. This is particularly important for the s-wave contribution to the $S$ factor. The extracted value of S(0) is $19.0 \pm 1.0 \pm 0.2$~eVb. The first error is experimental while the second is an estimate of the theoretical error in the extrapolation.Comment: 30 pages, 12 figures, 6 table

Analysis of Death Receptor 5 and Caspase-8 Expression in Primary and Metastatic Head and Neck Squamous Cell Carcinoma and Their Prognostic Impact

Death receptor 5 (DR5) and caspase-8 are major components in the extrinsic apoptotic pathway. The alterations of the expression of these proteins during the metastasis of head and neck squamous cell carcinoma (HNSCC) and their prognostic impact have not been reported. The present study analyzes the expression of DR5 and caspase-8 by immunohistochemistry (IHC) in primary and metastatic HNSCCs and their impact on patient survival. Tumor samples in this study included 100 primary HNSCC with no evidence of metastasis, 100 primary HNSCC with lymph node metastasis (LNM) and 100 matching LNM. IHC analysis revealed a significant loss or downregulation of DR5 expression in primary tumors with metastasis and their matching LNM compared to primary tumors with no evidence of metastasis. A similar trend was observed in caspase-8 expression although it was not statistically significant. Downregulation of caspase-8 and DR5 expression was significantly correlated with poorly differentiated tumors compared to moderately and well differentiated tumors. Univariate analysis indicates that, in HNSCC with no metastasis, higher expression of caspase-8 significantly correlated with better disease-free survival and overall survival. However, in HNSCC with LNM, higher caspase-8 expression significantly correlated with poorer disease-free survival and overall survival. Similar results were also generated when we combined both DR5 and caspase-8. Taken together, we suggest that both DR5 and caspase-8 are involved in regulation of HNSCC metastasis. Our findings warrant further investigation on the dual role of caspase-8 in cancer development