Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity

Soft-tissue sarcoma (STS) is a histopathologically diverse group of tumors accounting for approximately 10,000 new malignancies in the US each year. The proximal lower extremity is the most common site for STS, accounting for approximately one-third of all cases. Coordinated multimodality management in the form of surgery and radiation is often critical to local control, limb preservation, and functional outcome. Based on a review of currently available Medline literature and professional experience, this paper provides an overview of the treatment of STS of the lower extremity with a particular focus on the modern role of radiotherapy

Implementation of a double scattering nozzle for Monte Carlo recalculation of proton plans with variable relative biological effectiveness

A constant relative biological effectiveness (RBE) of 1.1 is currently used in clinical proton therapy. However, the RBE varies with factors such as dose level, linear energy transfer (LET) and tissue type. Multiple RBE models have been developed to account for this biological variation. To enable recalculation of patients treated with double scattering (DS) proton therapy, including LET and variable RBE, we implemented and commissioned a Monte Carlo (MC) model of a DS treatment nozzle. The main components from the IBA nozzle were implemented in the FLUKA MC code. We calibrated and verified the following entities to experimental measurements: range of pristine Bragg peaks (PBPs) and spread-out Bragg peaks (SOBPs), energy spread, lateral profiles, compensator range degradation, and absolute dose. We recalculated two patients with different field setups, comparing FLUKA vs. treatment planning system (TPS) dose, also obtaining LET and variable RBE doses. We achieved good agreement between FLUKA and measurements. The range differences between FLUKA and measurements were for the PBPs within ±0.9 mm (83% ≤ 0.5 mm), and for SOBPs ±1.6 mm (82% ≤ 0.5 mm). The differences in modulation widths were below 5 mm (79% ≤ 2 mm). The differences in the distal dose fall off (D80%–D20%) were below 0.5 mm for all PBPs and the lateral penumbras diverged from measurements by less than 1 mm. The mean dose difference (RBE = 1.1) in the target between the TPS and FLUKA were below 0.4% in a three-field plan and below 1.4% in a four-field plan. A dose increase of 9.9% and 7.2% occurred when using variable RBE for the two patients, respectively. We presented a method to recalculate DS proton plans in the FLUKA MC code. The implementation was used to obtain LET and variable RBE dose and can be used for investigating variable RBE for previously treated patients.publishedVersio

High Resolution He-like Argon And Sulfur Spectra From The PSI ECRIT

We present new results on the X-ray spectroscopy of multicharged argon, sulfur and chlorine obtained with the Electron Cyclotron Resonance Ion Trap (ECRIT) in operation at the Paul Scherrer Institut (Villigen, Switzerland). We used a Johann-type Bragg spectrometer with a spherically-bent crystal, with an energy resolution of about 0.4 eV. The ECRIT itself is of a hybrid type, with a superconducting split coil magnet, special iron inserts which provides the mirror field, and a permanent magnetic hexapole. The high frequency was provided by a 6.4 GHz microwave emitter. We obtained high intensity X-ray spectra of multicharged F-like to He-like argon, sulfur and chlorine with one 1s hole. In particular, we observed the 1s2s^{3}S_1 \to 1s^2^{1}S_0 M1 and 1s2p^{3}P_2 \to 1s^2^{1}S_0 M2 transitions in He-like argon, sulfur and chlorine with unprecedented statistics and resolution. The energies of the observed lines are being determined with good accuracy using the He-like M1 line as a reference

A case-control study of linear energy transfer and relative biological effectiveness related to symptomatic brainstem toxicity following pediatric proton therapy

Background and purpose A fixed relative biological effectiveness (RBE) of 1.1 (RBE1.1) is used clinically in proton therapy even though the RBE varies with properties such as dose level and linear energy transfer (LET). We therefore investigated if symptomatic brainstem toxicity in pediatric brain tumor patients treated with proton therapy could be associated with a variable LET and RBE. Materials and methods 36 patients treated with passive scattering proton therapy were selected for a case-control study from a cohort of 954 pediatric brain tumor patients. Nine children with symptomatic brainstem toxicity were each matched to three controls based on age, diagnosis, adjuvant therapy, and brainstem RBE1.1 dose characteristics. Differences across cases and controls related to the dose-averaged LET (LETd) and variable RBE-weighted dose from two RBE models were analyzed in the high-dose region. Results LETd metrics were marginally higher for cases vs. controls for the majority of dose levels and brainstem substructures. Considering areas with doses above 54 Gy(RBE1.1), we found a moderate trend of 13% higher median LETd in the brainstem for cases compared to controls (P =.08), while the difference in the median variable RBE-weighted dose for the same structure was only 2% (P =.6). Conclusion Trends towards higher LETd for cases compared to controls were noticeable across structures and LETd metrics for this patient cohort. While case-control differences were minor, an association with the observed symptomatic brainstem toxicity cannot be ruled out.publishedVersio

The Peak of the Fallback Rate from Tidal Disruption Events: Dependence on Stellar Type

A star completely destroyed in a tidal disruption event (TDE) ignites a luminous flare that is powered by the fallback of tidally stripped debris to a supermassive black hole (SMBH) of mass $M_{\bullet}$. We analyze two estimates for the peak fallback rate in a TDE, one being the "frozen-in" model, which predicts a strong dependence of the time to peak fallback rate, $t_{\rm peak}$, on both stellar mass and age, with $15\textrm{ days} \lesssim t_{\rm peak} \lesssim 10$ yr for main sequence stars with masses $0.2\le M_{\star}/M_{\odot} \le 5$ and $M_{\bullet} = 10^6M_{\odot}$. The second estimate, which postulates that the star is completely destroyed when tides dominate the maximum stellar self-gravity, predicts that $t_{\rm peak}$ is very weakly dependent on stellar type, with $t_{\rm peak} = \left(23.2\pm4.0\textrm{ days}\right)\left(M_{\bullet}/10^6M_{\odot}\right)^{1/2}$ for $0.2\le M_{\star}/M_{\odot} \le 5$, while $t_{\rm peak} = \left(29.8\pm3.6\textrm{ days}\right)\left(M_{\bullet}/10^6M_{\odot}\right)^{1/2}$ for a Kroupa initial mass function truncated at $1.5 M_{\odot}$. This second estimate also agrees closely with hydrodynamical simulations, while the frozen-in model is discrepant by orders of magnitude. We conclude that (1) the time to peak luminosity in complete TDEs is almost exclusively determined by SMBH mass, and (2) massive-star TDEs power the largest accretion luminosities. Consequently, (a) decades-long extra-galactic outbursts cannot be powered by complete TDEs, including massive-star disruptions, and (b) the most highly super-Eddington TDEs are powered by the complete disruption of massive stars, which -- if responsible for producing jetted TDEs -- would explain the rarity of jetted TDEs and their preference for young and star-forming host galaxies.Comment: 10 pages, 4 figures, ApJL accepte

Fundamental parameters related to selenium kα and kβ emission x-ray spectra

This research was funded in part by FCT (Portugal) under research center grants UID/FIS/04559/2020 (LIBPhys) and UID/MULTI/04046/2020 (BioISI). This work was also funded through the project PTDC/FIS-AQM/31969/2017, "Ultra-high-accuracy x-ray spectroscopy of transition metal oxides and rare earths." J.M. and J.P.S acknowledge the support of EMPIR, under Contract No. 17FUN02MetroMMC. The EMPIR initiative is co-funded by the European Union's Horizon 2020 research and innovation programme and the EMPIR participating States.We present relativistic ab initio calculations of fundamental parameters for atomic selenium, based on the Multiconfiguration Dirac-Fock method. In detail, fluorescence yields and subshell linewidths, both of K shell, as well as Kβ to Kα intensity ratio are provided, showing overall agreement with previous theoretical calculations and experimental values. Relative intensities were evaluated assuming the same ionization cross-section for the K-shell hole states, leading to a statistical distribution of these initial states. A method for estimating theoretical linewidths of X-ray lines, where the lines are composed by a multiplet of fine-structure levels that are spread in energy, is proposed. This method provides results that are closer to Kα1,2 experimental width values than the usual method, although slightly higher discrepancies occur for the Kβ1,3 lines. This indicates some inaccuracies in the calculation of Auger rates that have a higher contribution for partial linewidths of the subshells involved in the Kβ1,3 profile. Apart from this, the calculated value of Kβ to Kα intensity ratio, which is less sensitive to Auger rates issues, is in excellent agreement with recommended values.publishersversionpublishe

Observation of a low-lying metastable electronic state in highly charged lead by Penning-trap mass spectrometry

Highly charged ions (HCIs) offer many opportunities for next-generation clock research due to the vast landscape of available electronic transitions in different charge states. The development of XUV frequency combs has enabled the search for clock transitions based on shorter wavelengths in HCIs. However, without initial knowledge of the energy of the clock states, these narrow transitions are difficult to be probed by lasers. In this Letter, we provide experimental observation and theoretical calculation of a long-lived electronic state in Nb-like Pb$^{41+}$ which could be used as a clock state. With the mass spectrometer Pentatrap, the excitation energy of this metastable state is directly determined as a mass difference at an energy of 31.2(8) eV, corresponding to one of the most precise relative mass determinations to date with a fractional uncertainty of $4\times10^{-12}$. This experimental result agrees within 1 $\sigma$ with two partially different \textit{ab initio} multi-configuration Dirac-Hartree-Fock calculations of 31.68(13) eV and 31.76(35) eV, respectively. With a calculated lifetime of 26.5(5.3) days, the transition from this metastable state to the ground state bears a quality factor of $1.1\times10^{23}$ and allows for the construction of a HCI clock with a fractional frequency instability of $<10^{-19}/\sqrt{\tau}$

Towards Precision Muonic X-ray Measurements of Charge Radii of Light Nuclei

Funding Information: B.O. is thankful for the support of the Council for Higher Education Program for Hiring Outstanding Faculty Members in Quantum Science and Technology. The Kirchhoff Institute for Physics group at Heidelberg University is supported by Field Of Focus II initiative at Heidelberg University. D.U. acknowledges the support by the Research Training Group HighRR (GRK 2058) funded through the Deutsche Forschungsgemeinschaft, DFG. The work of the KU Leuven group is supported by FWO-Vlaanderen (Belgium), KU Leuven BOF C14/22/104, and European Research Council, grant no. 101088504 (NSHAPE). P.N. acknowledges support from the NSERC Grant No. SAPIN-2022-00019. TRIUMF receives federal funding via a contribution agreement with the National Research Council of Canada. The Lisboa group is supported in part by Fundação para a Ciência e Tecnologia (FCT; Portugal) through research center Grant No. UID/FIS/04559/2020 to LIBPhys-UNL. The work of the ETH group was supported by the ETH Research Grant 22-2 ETH-023, Switzerland. Publisher Copyright: © 2024 by the authors.We, the QUARTET Collaboration, propose an experiment to measure the nuclear charge radii of light elements with up to 20 times higher accuracy. These are essential both for understanding nuclear physics at low energies, and for experimental and theoretical applications in simple atomic systems. Such comparisons advance the understanding of bound-state quantum electrodynamics and are useful for searching for new physics beyond the Standard Model. The energy levels of muonic atoms are highly susceptible to nuclear structure, especially to the mean square charge radius. The radii of the lightest nuclei (with the atomic number, (Formula presented.)) have been determined with high accuracy using laser spectroscopy in muonic atoms, while those of medium mass and above were determined using X-ray spectroscopy with semiconductor detectors. In this communication, we present a new experiment, aiming to obtain precision measurements of the radii of light nuclei (Formula presented.) using single-photon energy measurements with cryogenic microcalorimeters; a quantum-sensing technology capable of high efficiency with outstanding resolution for low-energy X-rays.publishersversionpublishe

Investigating the Role of Hypothalamic Tumor Involvement in Sleep and Cognitive Outcomes Among Children Treated for Craniopharyngioma

Objective: Despite excellent survival prognosis, children treated for craniopharyngioma experience significant morbidity. We examined the role of hypothalamic involvement (HI) in excessive daytime sleepiness (EDS) and attention regulation in children enrolled on a Phase II trial of limited surgery and proton therapy. Methods: Participants completed a sleep evaluation (N = 62) and a continuous performance test (CPT) during functional magnetic resonance imaging (fMRI; n = 29) prior to proton therapy. Results: EDS was identified in 76% of the patients and was significantly related to increased HI extent (p = .04). There was no relationship between CPT performance during fMRI and HI or EDS. Visual examination of group composite fMRI images revealed greater spatial extent of activation in frontal cortical regions in patients with EDS, consistent with a compensatory activation hypothesis. Conclusion: Routine screening for sleep problems during therapy is indicated for children with craniopharyngioma, to optimize the timing of interventions and reduce long-term morbidity

Towards Precision Muonic X-Ray Measurements of Charge Radii of Light Nuclei

Precision studies of the properties of nuclei are essential both for understanding nuclear physics at low energy, and for confronting experiment and theory in simple atomic systems. Such comparisons advance our understanding of bound-state quantum electrodynamics and are useful for searching for new physics beyond the Standard Model. The energy levels of muonic atoms are highly susceptible to nuclear structure, especially to the RMS charge radius. The radii of the lightest nuclei ($Z=1,2$) have been determined with high accuracy via laser spectroscopy in muonic atoms, while those of medium mass and above, from X-ray spectroscopy with semiconductor detectors. In this communication we present a new experiment aiming at precision measurements of the radii of light nuclei $3 \leq Z \leq 10$ via single-photon energy measurements with cryogenic microcalorimeters; a quantum sensing technology capable of high efficiency and outstanding resolution for low-energy X-rays