High spatial resolution inorganic scintillator detector for high energy X-ray beam at small field irradiation

International audiencePurpose: Small fielddosimetry for radiotherapy is one of the major challenges due to the size of most dosimeters,e.g. sufficient spatial resolution, accurate dose distribution and energy dependency of the detector. In this context, the purpose of this research is to develop a small size scintillating detector targeting small field dosimetry and compare its performance with other commercial detectors. Method: An inorganic scintillator detector (ISD) of about 200 μm outer diameter was developed and tested through different small fields dosimetric characterization under high energy photons (6 MV and 15 MV) delivered by an Elekta Linear Accelerator (LINAC). PDD and beam profile measurements were compared using dosimeters from PTW namely, microdiamond and PinPoint 3D detector. A background fiber method has been considered to quantifyand eliminate the minimal Cerenkov effect from the total optical signal magnitude. Measurements were performed inside a water phantom under IAEA Technical reports series recommendations (IAEA TRS 381 and TRS 483). Results:Small fields ranging from 3 x 3 cm2, down to 0.5 x 0.5 cm2 were sequentiallymeasured using the ISD and commercial dosimeters, and a good agreement was obtained among all measurements. The result also shows that, scintillating detector has good repeatabilityand reproducibility of the output signal with maximum deviation of 0.26% and 0.5% respectively. The Full Width Half Maximum (FWHM) was measured 0.55 cm for the smallest available square size field of 0.5 x 0.5 cm2, where the discrepancy of 0.05 cm is dueto the scattering effects inside the water and convolution effect between field and detector geometries. Percentage Depth Dose (PDD) factor dependence variation with water depth exhibits nearly the same behavior for all tested detectors. The ISD allows to perform dose measurements at a very high accuracy from low (50 cGy/min) to high dose rates (800 cGy/min) and found to be independent of dose rate variation. The detection system also showed an excellent linearity with dose; hence calibration was easily achieved. Conclusions: The developed detector can be used to accurately measure the delivered dose at small field during the treatment of small volume tumors. The author’s measurement shows that despite using a non-water equivalent detector, the detector can be a powerful candidate for beam characterization and quality assurance in e.g., radiosurgery, Intensity Modulated Radiotherapy (IMRT), and brachytherapy. Our detector can provide real-time dose measurement and good spatial resolution with immediate readout, simplicity, flexibility, and robustness

Rationale for the Use of Upfront Whole Brain Irradiation in Patients with Brain Metastases from Breast Cancer

Breast cancer is the second most common cause of brain metastases and deserves particular attention in relation to current prolonged survival of patients with metastatic disease. Advances in both systemic therapies and brain local treatments (surgery and stereotactic radiosurgery) have led to a reappraisal of brain metastases management. With respect to this, the literature review presented here was conducted in an attempt to collect medical evidence-based data on the use of whole-brain radiotherapy for the treatment of brain metastases from breast cancer. In addition, this study discusses here the potential differences in outcomes between patients with brain metastases from breast cancer and those with brain metastases from other primary malignancies and the potential implications within a treatment strategy

Dosimetric characterization of a small-scale (Zn,Cd)S:Ag inorganic scintillating detector to be used in radiotherapy

International audienc

High resolution small‐scale inorganic scintillator detector: HDR brachytherapy application

International audiencePurpose: Brachytherapy (BT) deals with high gradient internal dose irradiation made up of a complex system where the source is placed nearby the tumor to destroy cancerous cells. A primary concern of clinical safety in BT is quality assurance to ensure the best matches between the delivered and prescribed doses targeting small volume tumors and sparing surrounding healthy tissues. Hence, the purpose of this study is to evaluate the performance of a point size inorganic scintillator detector (ISD) in terms of high dose rate brachytherapy (HDR-BT) treatment. total signal in all the irradiations. Excellent symmetrical behavior of the dose rate regarding source position was observed at different radiation planes. Finally, a comparison with TG-43 reference dataset shows that corrected measurements agreed with simulation data within 1.2% and 1.3%, and valid for the source-to-detector distance greater than 0.25 cm. Conclusion: The proposed ISD in this study anticipated that the system could be promoted to validate with further clinical investigations. It allows an appropriate dose verification with dwelltime estimation during source tracking and suitable dose measurement with a high spatial resolution both nearby (high dose gradient) and far (low dose gradient) from the source position

Contribution of intraoperative radiotherapy (IORT) for therapeutic de-escalation in early breast cancer: Report of a single institution's experience

The spread of systematic screening and the emergence of oncoplastic techniques allow more breast conservative treatment associating lumpectomy and external beam radiation therapy. In order to furthermore facilitate the patient's treatment, intraoperative radiation therapy (IORT) has been developed. The oncological safety of this technique has been studied, and is considered acceptable. Many questions remain unsolved in regard of the toxicity of this procedure as well as the patient's selection criteria. In this study, we present the first results and complications rate of patients treated by IORT in a single French institution. Between 2012 and 2015, all patients with breast cancer treated in a one-step procedure associating lumpectomy and IORT were retrospectively included in a monocentric cohort. Acute and long-term toxicities were evaluated using CTCAE v4.0 classification. 280 breast cancers were treated using IORT procedure. Additional external beam radiation therapy was requested for 45.7% patients. The acute complications rate was 14.6%, with 5 surgical revisions needed (1.78%). With a median follow up of 911 days, the long-term grade-3 toxicity rate was 1.1%. The only risk factor for local fibrosis was external beam radiation therapy (EBRT) (OR = 1.99; IC95 [1.05-3.81], P = 0.036). Three patients (1.07%) were diagnosed with local recurrence. The results from this cohort confirm the low complication and recurrence rate of IORT procedure. A good selection of patients is necessary in order to lower the EBRT rate and allow therapeutic de-escalation. The classification of tumors into IHC subsets seems a good selection gate. Intraoperative radiation therapy appears to have a low toxicity rate with an acceptable local recurrence risk, and should therefore be considered as an option in the treatment of early breast cancer

Is post mastectomy radiotherapy contributive in pN0-1mi breast cancers patients? Results of a French multi-centric cohort

San Antonio Breast Cancer Symposium, San Antonio, TX, DEC 05-09, 201

Is post mastectomy radiotherapy contributive in pN0-1mi breast cancers patients? Results of a French multi-centric cohort

San Antonio Breast Cancer Symposium, San Antonio, TX, DEC 05-09, 201

Corrigendum to “Immunohistochemical subtypes predict survival in metastatic breast cancer receiving high-dose chemotherapy with autologous haematopoietic stem cell transplantation” [Eur J Cancer 57 (April 2016) 118–126]

International audienc

Prognostic impact of hormone receptor- and HER2-defined subtypes in inflammatory breast cancer treated with high-dose chemotherapy: a retrospective study

International audiencePurpose: Studies examining high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDC-AHSCT) strategies in inflammatory breast cancer (IBC), showed encouraging results in terms of disease-free survival (DFS), and overall survival (OS). The lack of data regarding HER2 status in all of these studies prevented any prognostic analysis involving breast cancer subtypes. Methods: All consecutive female patients treated for IBC with HDC and AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. Since 2005, trastuzumab was included in initial treatment. Patient, tumor and treatment characteristics were collected. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: Luminal, (HR+/HER2-), HER2 (HER2+, any HR), and triple negative (TN) (HER2-and HR-). The main objective was the analysis of OS according to the IHC subtypes. Results: Sixty-seven patients were included. Eleven patients received trastuzumab. Median follow up was 80.04 months (95% CI 73.2-88.08). Five-year OS and DFS for the whole population patients were 74% (95% CI 61-83) and 65 % (95% CI 52-75), respectively. OS differed across subtypes (p=0.057) : HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89% (95% CI 64-97) compared to 57% (95% CI 33-76) for the TN subgroup (HR 5.38, 95% CI 1.14-25.44; p=0.034). Conclusions: In IBC patients receiving HDC-AHSCT, OS favorably compares with data available in the literature on similar groups of patients. TN patients carried the least favourable OS and HER2 patients, half of them also receiving trastuzumab, had the best outcome. These findings provide additional information and options for patients with IBC and who could potentially benefit of HDC-AHSCT