Dosimetric verification of vmat dose distribution with DELTA4 Phantom

Radiation Oncology, has changed a great deal, undergoing an innovation and technical development; there has been an evolution from conformal radiotherapy techniques (3D-CRT), through advanced modalities like intensity-modulated radiation therapy (IMRT) and next volumetric modulated arc therapy (VMAT). VMAT technique requires a dedicated QA (Quality Assurance) procedure for dosimetric verification of a planned dose distribution to check for the agreement between a dose distribution calculated by the Treatment Planning System (TPS) and the corresponding measured dose distribution. Since November 2010, in Radiation Therapy Department of “V. Fazzi” hospital in Lecce (Italy), 257 patients were treated with VMAT and the corresponding dose distribution were verified with the Delta4 diode array phantom. Parameters used in the comparison between calculated e measured dose are the dose agreement (DA), the distance to agreement (DTA) and the -index. The phantom measurements closely match the planned dose distributions in high and low dose-gradient region

L’evoluzione tecnologica in Radioterapia: modulazione volumetrica del fascio ed Adaptavtive Radiation Therapy

Le innovazioni in radioterapia sono volte all’aumento del gradiente di dose tra neoplasia e tessuto sano attraverso un miglioramento sia dell’erogazione del fascio sia del controllo dell’errore. La più importante novità nel delivering è la modulazione volumetrica della intensità del fascio. La novità nel controllo dell’errore è rappresentata dalla Adaptative Radiation Therapy (ART), che prevede l’adattamento della distribuzione di dose ad un target mobile o deformabile, seguendo il movimento d’organo (IGRT) e la deformazione e cambio di volume di tumore e degli organi a rischio. La posizione iniziale del target viene riprodotta attraverso il movimento del lettino, il movimento elettronico del fascio, il movimento del braccio dell’acceleratore e la modifica dell’apertura del collimatore. La ART off line individua e corregge errori sistematici che possono avere origine in diverse fasi del processo e si propagano fino alla fine dello stesso, presentandosi in modo identico e ricorrente in ciascuna frazione attraverso il monitoraggio (IGRT) del posizionamento del paziente durante le prime frazioni, allo scopo di adattare i margini di trattamento e/o i piani di trattamento per le restanti sedutesu base individuale. La ART on line corregge errori random (di “esecuzione”), che possono variare di giorno in giorno, poiché si possono presentare in modo diverso per ciascuna frazione del trattamento, attraverso il monitoraggio (IGRT) del posizionamento del paziente durante tutte le frazioni per la misura e la correzione giornaliera degli errori di setup del paziente

The observational clinical registry (cohort design) of the European Reference Network on Rare Adult Solid Cancers: The protocol for the rare head and neck cancers

Care for head and neck cancers is complex in particular for the rare ones. Knowledge is limited and histological heterogeneity adds complexity to the rarity. There is a wide consensus that to support clinical research on rare cancer, clinical registries should be developed within networks specializing in rare cancers. In the EU, a unique opportunity is provided by the European Reference Networks (ERN). The ERN EURACAN is dedicated to rare adults solid cancers, here we present the protocol of the EURACAN registry on rare head and neck cancers (ClinicalTrials.gov Identifier: NCT05483374). Study design Registry-based cohort study including only people with rare head and neck cancers. Objectives 1.To help describe the natural history of rare head and neck cancers; 2.To evaluate factors that influence prognosis; 3.To assess treatment effectiveness; 4.To measure indicators of quality of care. Methods Settings and participants It is an hospital based registry established in hospitals with expertise in head and neck cancers. Only adult patients with epithelial tumours of nasopharynx; nasal cavity and paranasal sinuses; salivary gland cancer in large and small salivary glands; and middle ear will be included in the registry. This registry won t select a sample of patients. Each patient in the facility who meets the above mentioned inclusion criteria will be followed prospectively and longitudinally with follow-up at cancer progression and / or cancer relapse or patient death. It is a secondary use of data which will be collected from the clinical records. The data collected for the registry will not entail further examinations or admissions to the facility and/or additional appointments to those normally provided for the patient follow-up. Variables Data will be collected on patient characteristics (eg. patient demographics, lifestyle, medical history, health status); exposure data (eg. disease, procedures, treatments of interest) and outcomes (e.g. survival, progression, progression-free survival, etc.). In addition, data on potential confounders (e.g. comorbidity; functional status etc.) will be also collected. Statistical methods The data analyses will include descriptive statistics showing patterns of patients and cancers variables and indicators describing the quality of care. Multivariable Cox s proportional hazards model and Hazard ratios (HR) for all-cause or cause specific mortality will be used to determine independent predictors of overall survival, recurrence etc. Variables to include in the multivariable regression model will be selected based on the results of univariable analysis. The role of confounding or effect modifiers will be evaluated using stratified analysis or sensitivity analysis. To assess treatment effectiveness, multivariable models with propensity score adjustment and progression-free survival will be performed. Adequate statistical (eg. marginal structural model) methods will be used if time-varying treatments/ confounders and confounding by indication (selective prescribing) will be present. Results The registry initiated recruiting in May 2022. The estimated completion date is December 2030 upon agreement on the achievement of all the registry objectives. As of October 2022, the registry is recruiting. There will be a risk of limited representativeness due to the hospital-based nature of the registry and to the fact that hospital contributing to the registry are expert centres for these rare cancers. Clinical Follow-up could also be an issue but active search of the life status of the patients will be guaranteed

Lungworms and gastrointestinal parasites of domestic cats: a European perspective

With the exception of Aelurostrongylus abstrusus, feline lungworms have been poorly studied. Information on their distribution is patchy and mostly limited to case reports. In this study, the occurrence of feline lungworms and co-infecting gastrointestinal parasites has been investigated in 12 European countries (i.e. Austria, Belgium, Bulgaria, France, Greece, Hungary, Italy, Portugal, Romania, Spain, Switzerland and the United Kingdom). An average of 10 domestic cats, with regular outdoor access, was sampled each month for 12 months, and freshly passed faeces were collected. Stools were processed using a McMaster assay and a quantitative Baermann-Wetzel method. Animals positive for lungworms and/or gastrointestinal parasites were treated with a formulation containing fipronil, (S)-methoprene, eprinomectin, and praziquantel (Broadline®, Merial), and re-sampled 28 days post-treatment. The association between lungworm infection and risk factors was analysed using statistical medians/means and the efficacy of the treatment against each lungworm species was assessed. Of 1990 cats sampled, 613 (30.8%) were positive for at least one parasite, while 210 (10.6%) were infected by lungworms. The prevalence of lungworm infection varied between the sampled sites, with the highest recorded in Bulgaria (35.8%) and the lowest in Switzerland (0.8%). None of the cats from Austria or the United Kingdom were infected by lungworms. Aelurostrongylus abstrusus was the species most frequently detected (78.1%), followed by Troglostrongylus brevior (19.5%), Eucoleus aerophilus (14.8%) and Oslerus rostratus (3.8%). The overall efficacy of the treatment was 99% for A. abstrusus and 100% for T. brevior, O. rostratus and E. aerophilus. Data presented provide a comprehensive account of the diagnosis, epidemiology and treatment of feline lungworms in Europe, as well as of the occurrence of co-infections by gastrointestinal parasites.This work was funded by Merial SAS (Europe)

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian Consensus Conference on Pain in Neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

What Performance Analysts Need to Know About Research Trends in Association Football (2012–2016): A Systematic Review

Evolving patterns of match analysis research need to be systematically reviewed regularly since this area of work is burgeoning rapidly and studies can offer new insights to performance analysts if theoretically and coherently organized