Retrospective feasibility study of simultaneous integrated boost in cervical cancer using Tomotherapy: the impact of organ motion and tumor regression.

BACKGROUND: Whole pelvis intensity modulated radiotherapy (IMRT) is increasingly being used to treat cervical cancer aiming to reduce side effects. Encouraged by this, some groups have proposed the use of simultaneous integrated boost (SIB) to target the tumor, either to get a higher tumoricidal effect or to replace brachytherapy. Nevertheless, physiological organ movement and rapid tumor regression throughout treatment might substantially reduce any benefit of this approach. PURPOSE: To evaluate the clinical target volume - simultaneous integrated boost (CTV-SIB) regression and motion during chemo-radiotherapy (CRT) for cervical cancer, and to monitor treatment progress dosimetrically and volumetrically to ensure treatment goals are met. METHODS AND MATERIALS: Ten patients treated with standard doses of CRT and brachytherapy were retrospectively re-planned using a helical Tomotherapy - SIB technique for the hypothetical scenario of this feasibility study. Target and organs at risk (OAR) were contoured on deformable fused planning-computed tomography and megavoltage computed tomography images. The CTV-SIB volume regression was determined. The center of mass (CM) was used to evaluate the degree of motion. The Dice's similarity coefficient (DSC) was used to assess the spatial overlap of CTV-SIBs between scans. A cumulative dose-volume histogram modeled estimated delivered doses. RESULTS: The CTV-SIB relative reduction was between 31 and 70%. The mean maximum CM change was 12.5, 9, and 3 mm in the superior-inferior, antero-posterior, and right-left dimensions, respectively. The CTV-SIB-DSC approached 1 in the first week of treatment, indicating almost perfect overlap. CTV-SIB-DSC regressed linearly during therapy, and by the end of treatment was 0.5, indicating 50% discordance. Two patients received less than 95% of the prescribed dose. Much higher doses to the OAR were observed. A multiple regression analysis showed a significant interaction between CTV-SIB reduction and OAR dose increase. CONCLUSIONS: The CTV-SIB had important regression and motion during CRT, receiving lower therapeutic doses than expected. The OAR had unpredictable shifts and received higher doses. The use of SIB without frequent adaptation of the treatment plan exposes cervical cancer patients to an unpredictable risk of under-dosing the target and/or overdosing adjacent critical structures. In that scenario, brachytherapy continues to be the gold standard approach

Radioiodine releases in nuclear emergency scenarios.

This document provides a comprehensive overview study on the physico-chemical speciation of radioiodine observed in the atmosphere after various emissions related to nuclear activities: nuclear weapon tests, accident and incident releases, and routine discharges. The study covers different types of nuclear facilities including medical isotope production facilities (MIPFs), reprocessing plants (RPs), and nuclear power plants (NPPs). Most attention is paid to 131I which has a major human health impact in the early stages of a nuclear emergency situation with regard to inhalation. Iodine-131 combines a high yield by neutron-induced nuclear fission of 235U (2.87%) or 239Pu (3.8%), high dose coefficients, and a radioactive half-life long enough to allow for spreading at global scales and entering the food chain but sufficiently short to produce a significant dose commitment when inhaled or ingested. Reliable dose assessment requires both detailed and valid information on the physico-chemical composition of 131I present in the air. Apart from reactor explosions and fires, which produce large amounts of particles and may therefore favor the presence of iodine in particulate form at short distance, other nuclear accident scenarios will lead fairly rapidly to a dominant gaseous radioiodine proportion in the atmosphere