Radiotherapy in prostate cancer after kidney transplant: review of the literature and report of 6 cases

Background: Patients who received a kidney transplant (KT) are described in literature as a group with a higher incidence of malignant neoplasms compared to the general population. Cancer development after KT has become a major issue, as a remarkable percentage of patients are diagnosed with cancer. Treatment of prostate cancer (PCa) in renal transplant recipients (RTRs) is a challenging issue that has been discussed by many authors over the years, but evidence is sparse and often includes conflicting reports. Among the therapeutic options for PCa in these patients, prostate irradiation represents a valuable alternative to surgery or other systemic therapies, as RTRs are often ineligible for these treatments. Objective: To report six cases treated at our institution between 1998 and 2017 and discuss the available literature. Methods: Patients’ characteristics were reported along with biochemical status at diagnosis, type of immunosuppressive treatment, radiation therapy technique, and dose to transplanted kidney. Results: Overall, prostate irradiation was delivered respecting the dose constraints and patients showed good tolerance with no reports of acute or late transplanted kidney injury. Conclusions: Our experience confirms that prostate radiotherapy for RTRs is feasible and effective and represents a valid option that should be considered by the multidisciplinary team

Toxicity after moderately hypofractionated versus conventionally fractionated prostate radiotherapy: A systematic review and meta-analysis of the current literature

Background: Moderately hypofractionated radiotherapy (RT) currently represents the standard RT approach for all prostate cancer (PCa) risk categories. We performed a systematic review and meta-analysis of available literature, focusing on acute and late genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) of moderate hypofractionation for localized PCa. Materials and methods: Literature search was performed and two independent reviewers selected the records according to the following Population (P) Intervention (I) Comparator (C) and Outcomes (O) (PICO) question: “In patients affected by localized PCa (P), moderately hypofractionated RT (defined as a treatment schedule providing a single dose per fraction of 3–4.5 Gy) (I) can be considered equivalent to conventionally fractionated RT (C) in terms of G > 2 GI and GU acute and late adverse events (O)?”. Bias assessment was performed using Cochrane Cochrane Collaboration's Tool for Assessing Risk of Bias. Results: Thirteen records were identified and a meta-analysis was performed. Risk of acute GI and GU > 2 adverse events in the moderately hypofractionated arm was increased by 9.8 % (95 %CI 4.8 %–14.7 %; I2 = 57 %) and 1.5 % (95 % CI -1.5 %-4.4 %; I2 = 0%), respectively. Discussion: Overall, majority of trials included in our meta-analysis suggested that moderately hypofractionated RT is equivalent, in terms of GI and GU adverse events, to conventional fractionation. Pooled analysis showed a trend to increased GI toxicity after hypofractionated treatment, but this might be related to dose escalation rather than hypofractionation

CaloCube: a novel calorimeter for high-energy cosmic rays in space

In order to extend the direct observation of high-energy cosmic rays up to the PeV region, highly performing calorimeters with large geometrical acceptance and high energy resolution are required. Within the constraint of the total mass of the apparatus, crucial for a space mission, the calorimeters must be optimized with respect to their geometrical acceptance, granularity and absorption depth. CaloCube is a homogeneous calorimeter with cubic geometry, to maximise the acceptance being sensitive to particles from every direction in space; granularity is obtained by relying on small cubic scintillating crystals as active elements. Different scintillating materials have been studied. The crystal sizes and spacing among them have been optimized with respect to the energy resolution. A prototype, based on CsI(Tl) cubic crystals, has been constructed and tested with particle beams. Some results of tests with different beams at CERN are presented.Comment: Seven pages, seven pictures. Proceedings of INSTR17 Novosibirs

Radiotherapy is effective in the management of rare penile metastases: Two case reports

Penile metastasization is an uncommon condition, mostly derived from primitive advanced abdominal cancers, with disabling symptoms. Palliative treatment, in reason of poor prognosis patients, is frequently surgical with destructive management. We report two cases of penile metastasis, from primitive prostatic adenocarcinoma and primitive urothelial carcinoma, effectively managed with radiation treatment at our institution. A three-dimensional conformal radiation therapy with 42 Gy to the planning target volume in 14 fractions was delivered. Radiation treatment was safely delivered, with low toxicity profile and achieved adequate symptoms control without compromising genitourinary functions. Radiation therapy should be considered in management of rare penile metastases

Direct cooling of the catheter tip increases safety for CMR-guided electrophysiological procedures

<p>Abstract</p> <p>Background</p> <p>One of the safety concerns when performing electrophysiological (EP) procedures under magnetic resonance (MR) guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF) field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating.</p> <p>Methods</p> <p>A two-step approach was chosen. Firstly, tests on passive catheter heating were performed in a 1.5 T Avanto system (Siemens Healthcare Sector, Erlangen, Germany) using a ASTM Phantom in order to determine a possible maximum temperature rise. Secondly, a phantom was designed for simulation of the interface between blood and the vascular wall. The MR-RF induced temperature rise was simulated by catheter tip heating via a standard ablation generator. Power levels from 1 to 6 W were selected. Ablation duration was 120 s with no tip irrigation during the first 60 s and irrigation at rates from 2 ml/min to 35 ml/min for the remaining 60 s (Biotronik Qiona Pump, Berlin, Germany). The temperature was measured with fluoroscopic sensors (Luxtron, Santa Barbara, CA, USA) at a distance of 0 mm, 2 mm, 4 mm, and 6 mm from the catheter tip.</p> <p>Results</p> <p>A maximum temperature rise of 22.4°C at the catheter tip was documented in the MR scanner. This temperature rise is equivalent to the heating effect of an ablator's power output of 6 W at a contact force of the weight of 90 g (0.883 N). The catheter tip irrigation was able to limit the temperature rise to less than 2°C for the majority of examined power levels, and for all examined power levels the residual temperature rise was less than 8°C.</p> <p>Conclusion</p> <p>Up to a maximum of 22.4°C, the temperature rise at the tissue surface can be entirely suppressed by using the catheter's own irrigation system. The irrigated tip system can be used to increase MR safety of EP catheters by suppressing the effects of unwanted passive catheter heating due to RF exposure from the MR scanner.</p

CaloCube: an innovative homogeneous calorimeter for the next-generation space experiments

The direct measurement of the cosmic-ray spectrum, up to the knee region, is one of the instrumental challenges for next generation space experiments. The main issue for these measurements is a steeply falling spectrum with increasing energy, so the physics performance of the space calorimeters are primarily determined by their geometrical acceptance and energy resolution. CaloCube is a three-year R&D project, approved and financed by INFN in 2014, aiming to optimize the design of a space-born calorimeter. The peculiarity of the design of CaloCube is its capability of detecting particles coming from any direction, and not only those on its upper surface. To ensure that the quality of the measurement does not depend on the arrival direction of the particles, the calorimeter will be designed as homogeneous and isotropic as possible. In addition, to achieve a high discrimination power for hadrons and nuclei with respect to electrons, the sensitive elements of the calorimeter need to have a fine 3-D sampling capability. In order to optimize the detector performances with respect to the total mass of the apparatus, which is the most important constraint for a space launch, a comparative study of different scintillating materials has been performed using detailed Monte Carlo simulation based on the FLUKA package. In parallel to simulation studies, a prototype consisting in 14 layers of 3 x 3 CsI(Tl) crystals per layer has been assembled and tested with particle beams. An overview of the obtained results during the first two years of the project will be presented and the future of the detector will be discussed too