Comparison of dose volume histograms for supine and prone position in patients irradiated for prostate cancer—A preliminary study

AbstractAimTo compare DVHs for OARs in two different positions – prone and supine – for prostate cancer patients irradiated with a Tomotherapy unit.BackgroundIn the era of dose escalation, the choice of optimal patient immobilization plays an essential role in radiotherapy of prostate cancer.Materials and methodsThe study included 24 patients who were allocated to 3 risk groups based on D’Amico criteria; 12 patients represented a low or intermediate and 12 a high risk group.For each patient two treatment plans were performed: one in the supine and one in the prone position. PTV included the prostate, seminal vesicles and lymph nodes for the high risk group and the prostate and seminal vesicles for the intermediate or low risk groups. DVHs for the two positions were compared according to parameters: Dmean, D70, D50 and D20 for the bladder and rectum and Dmean, D10 for the intestine. The position accuracy was verified using daily MVCT.ResultsProne position was associated with lower doses in OARs, especially in the rectum. Despite the fact that in the entire group the differences between tested parameters were not large, the Dmean and D10 for the intestine were statistically significant. In the case of irradiation only to the prostate and seminal vesicles, the prone position allowed for substantial reduction of all tested DVH parameters in the bladder and rectum, except D20 for bladder. Moreover, the Dmean and D50 parameter differences for the bladder were statistically significant.No significant differences between positions reproducibility were demonstrated.ConclusionIn patients irradiated to prostate and seminal vesicles, the prone position may support sparing of the rectum and bladder.The reproducibility of position arrangement in both positions is comparable

Wismodegib — szansa na istotną poprawę jakości życia u chorych na miejscowo zaawansowanego raka podstawnokomórkowego skóry — opis przypadku

Rak podstawnokomórkowy jest najczęstszym nowotworem skóry. Obecnie dostępne strategie terapeutyczne obejmują leczenie chirurgiczne i radioterapię oraz — u chorych z niskim ryzykiem nawrotu — powierzchowne stosowanie preparatów fluorouracylu i imikwimodu. Rak podstawnokomórkowy jest często umiejscowiony na skórze okolicy gałki ocznej i nierzadko penetruje w głąb tkanek, a zastosowanie standardowych metod leczenia może prowadzić do ślepoty. Doustne małocząsteczkowe leki hamujące kluczowy dla rozwoju raka podstawno­komórkowego szlak Hedgehog stanowią nową opcję terapeutyczną u chorych w stadium zaawansowanym, którzy nie kwalifikują się do leczenia chirurgicznego lub radioterapii. Prezentowany przypadek dotyczy chorego na miejscowo zaawansowanego raka podstawnokomórkowego okolicy skóry twarzy oraz zatok i oczodołu, który był poddany rozległemu zabiegowi operacyjnemu z ewentracją prawej gałki ocznej. Po 8 miesiącach od zabiegu stwierdzono miejscowy nawrót choroby. Ze względu na rozległość zmian odstąpiono od zabiegu chirurgicznego. Zastosowanie radioterapii wiązałoby się z dużym ryzykiem ślepoty pozostałej gałki ocznej. U chorego wdrożono leczenie wismodegibem, które doprowadziło do uzyskania całkowitej odpowiedzi w wyniku zastosowanego leczenia. Ponadto uniknięto utraty wzroku, który zostałby uszkodzony w przebiegu radioterapii. Ustąpiły również objawy związane z miejscowym szerzeniem się nowotworu. Chory od 20 miesięcy przyjmuje inhibitor szlaku Hedgehog bez cech progresji w badaniach obrazowych

Significance of neutrophil to lymphocyte ratio as a predictor of outcome in head and neck cancer treated with definitive chemoradiation

Background: The role of host immune system in carcinogenesis and response to treatment is increasingly studied, including predictive potential of circulating neutrophils and lymphocytes. The objective of the study was to evaluate the prognostic value of pre- and post-treatment neutrophil-to-lymphocyte (NLR) for treatment outcome in patients diagnosed with squamous cell carcinoma of head and neck (HNSCC) treated with definitive chemoradiation. Materials and methods: Electronic medical records of patients were evaluated and NLR was calculated. Cox regression was used to assess the impact of selected variables on overall survival (OS), disease specific survival (DSS), progression free survival (PFS) and distant failure free survival (DFFS). Logistic regression was used to estimate odds ratios of complete response with NLR. Results: 317 patients' records were included in the study. Increases in both pre-and post-NLR were associated with decreased OS in univariable analysis [hazard ratio (HR): 2.26 (1.25–4.07), p = 0.0068 and HR: 1.57 (1.03–2.37), p = 0.035 respectively). Post-NLR remained significant for OS in multivariable analysis [HR: 1.93 (1.22–3.1), p = 0.005] as well as for unfavorable DSS [HR: 2.31 (1.22–4.4), p = 0.01]. Pre-treatment NLR and nodal status correlated with shorter DFFS in multivariable analysis [HR 4.1 (1.14–14), p = 0.03 and HR 5.3: (1.62–18), p = 0.0062, respectively]. Strong correlation of increased both pre- and post-NLR with probability of clinical tumor response (CR) was found [odds ratio (OR): 0.23 (0.08–0.6), p = 0.003, and OR: 0.39 (0.2–0.8), p = 0.01 respectively]. Conclusion: NLR evaluated before and post treatment was a strong predictor of unfavorable treatment outcome and can be used for risk evaluation and clinical decision about treatment and post-treatment surveillance

Poglądy wybranych autorów odnośnie do koncepcji gry

As many people around the world, as many games does it exist. Asking few people what the term ‘game’ does mean, what kind of games do they know, we would become the same amount of answers. This suggests, that the term “game” is either well known, either good defined. However the field of science in games is evolving, new types of games come into existence, there is a lack of one game definition. To investigate this issue, I researched the evolution of primary game definition in math, through manager simulating games, strategy games up to the interactive games. This paper presents the overview of many games types that were created during the time.Tyle ile ludzi jest na świecie, tyle istnieje gier. Gdyby zapytać, co oznacza sam termin „gra”, jakie są jej rodzaje, otrzymałoby się taką samą liczbę odpowiedzi jak liczba pytanych. To sugeruje, że samo sformułowanie „gry” nie jest ani dobrze znane, ani dobrze zdefiniowane. Pomimo tego iż na polu naukowym gry są rozwijane, powstają nowe ich typy, brakuje jednej konkretnej definicji gry. Aby zbadać tę kwestię, prześledziłem ewolucję terminu „gra” od podstawowej definicji matematycznej aż po gry menedżerskie, strategiczne i symulacyjne. W artykule zaprezentowano przegląd wielu typów gier, które powstały w ciągu lat

Vismodegib — a chance for improvement of quality of life in patients with locally advanced basal cell carcinoma — a case report

Basal cell carcinoma (BCC) is the most common non-melanocytic skin cancer. Therapeutic strategies available so far include: surgical resection, radiotherapy, or — in the case of low risk of recurrence — superficial application of drugs like 5-fluorouracil or imiquimod. The frequent localisation of BCC is eye bulb area, often with deep penetration into the tissues. Standard therapies in this area may lead to blindness. The Hedgehog (HH) pathway is a key point in BCC development. For patients with advanced BCC, not suitable for surgical resection or radiotherapy, oral small-molecule drug inhibitors of this pathway are the new therapeutic option. Here we present a case of a patient with locally advanced skin BCC localised on the face, sinuses, and eye-socket region. Wide excision with the right eye bulb resection was performed. Eight months after the treatment the patient developed regional recurrence. Due to the advanced stage of the disease the patient was disqualified from further surgical resection. Use of radiotherapy was associated with high risk of blindness of the left eye. The patient was treated with vismodegib and developed a complete response. Moreover, we avoided blindness after radiotherapy. Also, the patient’s symptoms due to locally spreading cancer resolved. The patient has been receiving HH inhibitor without any progression in imaging tests for 20 months

"Czy Napoleon musiał przegrać Bitwę pod Waterloo?" - analiza wrażliwości i optymalizacja z użyciem vensima

Problem analizy wrażliwości i optymalizacji nieliniowych, dynamicznych i wielopoziomowych systemów jest bardzo interesujący zarówno z punktu widzenia metodologii, jak i zastosowań praktycznych. Celem tego artykułu jest zaprezentowanie nowych wyników autorów w dziedzinie symulacji i optymalizacji z użyciem modelu typu SD (Dynamiki Systemowej). Modelowany system jest interesujący i prezentowany w prostszej wersji jako "Bitwa pod Waterloo" autorstwa profesora Coyla. Wykorzystywane przez autorów oprogramowanie Vensim umożliwia analizę wrażliwości (metodą Monte Carlo) i optymalizację z różnymi typami funkcji celu. Z kolei graficzna wizualizacja wyników zwana "confidence bounds" jest pomocna przy szacowaniu "wrażliwych parametrów" modelu i w ten sposób przy odpowiedzi na pytanie zawarte w tytule artykułu "Czy Napoleon musiał przegrać bitwę pod Waterloo?"

Prediction of Incomplete Response of Primary Tumour Based on Clinical and Radiomics Features in Inoperable Head and Neck Cancers after Definitive Treatment

Radical treatment of patients diagnosed with inoperable and locally advanced head and neck cancers (LAHNC) is still a challenge for clinicians. Prediction of incomplete response (IR) of primary tumour would be of value to the treatment optimization for patients with LAHNC. Aim of this study was to develop and evaluate models based on clinical and radiomics features for prediction of IR in patients diagnosed with LAHNC and treated with definitive chemoradiation or radiotherapy. Clinical and imaging data of 290 patients were included into this retrospective study. Clinical model was built based on tumour and patient related features. Radiomics features were extracted based on imaging data, consisting of contrast- and non-contrast-enhanced pre-treatment CT images, obtained in process of diagnosis and radiotherapy planning. Performance of clinical and combined models were evaluated with area under the ROC curve (AUROC). Classification performance was evaluated using 5-fold cross validation. Model based on selected clinical features including ECOG performance, tumour stage T3/4, primary site: oral cavity and tumour volume were significantly predictive for IR, with AUROC of 0.78. Combining clinical and radiomics features did not improve model’s performance, achieving AUROC 0.77 and 0.68 for non-contrast enhanced and contrast-enhanced images respectively. The model based on clinical features showed good performance in IR prediction. Combined model performance suggests that real-world imaging data might not yet be ready for use in predictive models