performance assessment of a new optimization system for robotic sbrt mlc based plans

Abstract Purpose To assess the performance of a new optimization system, VOLO, for CyberKnife MLC-based SBRT plans in comparison with the existing Sequential optimizer. Methods MLC-plans were created for 25 SBRT cases (liver, prostate, pancreas and spine) using both VOLO and Sequential. Monitor units (MU), delivery time (DT), PTV coverage, conformity (nCI), dose gradient (R50%) and OAR doses were used for comparison and combined to obtain a mathematical score (MS) of plan quality for each solution. MS strength was validated by changing parameter weights and by a blinded clinical plan evaluation. The optimization times (OT) and the average segment areas (SA) were also compared. Results VOLO solutions offered significantly lower mean DT (−19%) and MU (−13%). OT were below 15 min for VOLO, whereas for Sequential, values spanned from 8 to 160 min. SAs were significantly larger for VOLO: on average 10 cm2 versus 7 cm2. VOLO optimized plans achieved a higher MS than Sequential for all tested parameter combinations. PTV coverage and OAR sparing were comparable for both groups of solutions. Although slight differences in R50% and nCI were found, the parameters most affecting MS were MU and DT. VOLO solutions were selected in 80% of cases by both physicians with 88% inter-observer agreement. Conclusions The good performance of the VOLO optimization system, together with the large reduction in OT, make it a useful tool to improve the efficiency of CK SBRT planning and delivery. The proposed methodology for comparing different planning solutions can be applied in other contexts

Dose-escalated pelvic radiotherapy for prostate cancer in definitive or postoperative setting

Purpose Given the absence of standardized planning approach for clinically node-positive (cN1) prostate cancer (PCa), we collected data about the use of prophylactic pelvic irradiation and nodal boost. The aim of the present series is to retrospectively assess clinical outcomes after this approach to compare different multimodal treatment strategies in this scenario. Methods Data from clinical records of patients affected by cN1 PCa and treated in six different Italian institutes with prophylactic pelvic irradiation and boost on pathologic pelvic lymph nodes detected with CT, MRI or choline PET/CT were retrospectively reviewed and collected. Clinical outcomes in terms of overall survival (OS) and biochemical relapse-free survival (b-RFS) were explored. The correlation between outcomes and baseline features (International Society of Urological Pathology-ISUP pattern, total dose to positive pelvic nodes 60 Gy, sequential or simultaneous integrated boost (SIB) administration and definitive vs postoperative treatment) was explored. Results ISUP pattern < 2 was a significant predictor of improved b-RFS (HR = 0.3, 95% CI 0.1220-0.7647, P = 0.0113), while total dose < 60 Gy to positive pelvic nodes was associated with worse b-RFS (HR = 3.59, 95% CI 1.3245-9.741, P = 0.01). Conversely, treatment setting (postoperative vs definitive) and treatment delivery technique (SIB vs sequential boost) were not associated with significant differences in terms of b-RFS (HR = 0.85, 95% CI 0.338-2.169, P = 0.743, and HR = 2.39, 95% CI 0.93-6.111, P = 0.067, respectively). Conclusion Results from the current analysis are in keeping with data from literature showing that pelvic irradiation and boost on positive nodes are effective approaches. Upfront surgical approach was not associated with better clinical outcomes

Choline PET/CT in recurrent prostate cancer

PurposeBiochemical recurrence (BR) occurs in up to 40% of patients with prostate cancer (PCa) treated with primary radical prostatectomy (RP). Choline PET/CT may show, in a single-step examination, the site of tumor recurrence earlier than traditional imaging methods, particularly at low prostate-specific antigen (PSA) levels, thus influencing subsequent treatment. Methods/patientsPatients with recurrent and non-metastatic prostate cancer (nmPCa), who were assessed with choline PET/CT, were included in the analysis. Based on imaging results, the following therapeutic strategies were chosen: radiotherapy to the prostatic bed, androgen deprivation therapy (ADT), and chemotherapy or stereotactic body radiotherapy (SBRT) to either the pelvic lymph nodes or distant metastases. We assessed the impact of age, PSA levels, Gleason score (GS), and adjuvant therapy on oncological outcomes.ResultsData from 410 consecutive nmPCa patients with BR who underwent RP as primary treatment were analyzed. One hundred seventy-six (42.9%) patients had a negative choline PET/CT, and 234 (57.1%) patients resulted positive. In the multivariate analysis, only chemotherapy and PSA at recurrence were significant independent prognostic factors on overall survival (OS). In the PET-positive subgroup, the number of relapses, PSA post-prostatectomy, and chemotherapy impacted on OS. PSA (post-surgery and at recurrence) affected progression-free survival (PFS) in the univariate analysis. In the multivariate analysis, GS, the number of relapse sites, and PSA (post-surgery and at recurrence) were significant prognostic factors for disease-free survival (DFS).ConclusionCholine PET/CT provides better accuracy than conventional imaging for the assessment of nmPCa with BR after prostatectomy, thereby enabling salvage strategies and improving quality of life

Étude du maintien de l’intégrité cérébrovasculaire et de l’inflammation dans des modèles animaux d’athérosclérose

Stroke is the leading cause of disabilities worldwide and is mainly caused by atherosclerosis. But this is not the only risk for patients. Indeed, as this pathology is due to a lack of circulating cholesterol management and could lead to more pernicious outcomes such as cerebrovascular units disorganization whom, when combined with systemic and local inflammation can result in serious brain aftermath.Aged murine and non-human primate (NHP) animal models under high cholesterol diet were used to be closest to the human pathology. A translational approach with longitudinal follow-up of circulating and imaging biomarkers combined with a tissular characterization of inflammation was performed in order to elucidate the specificities of the inflammatory response in vascular wall of large vessels and brain tissue.We showed that in old ApoE-/- mice exercise can counterbalance deleterious effects of high fat diet when caloric intake is controlled but no longer when food is given ad libitum. The leakage of blood-brain barrier might explain the neuroinflammation observed in vivo and confirmed by tissular analysis. The study on NHP showed the interest of combine multimodal imaging with blood dosage for cardiovascular risk stratification and the importance of associating metabolic, inflammatory but also anti-inflammatory markers.We highlighted the importance of controlling calories intake in order to benefit of protective effects of exercise on atherosclerosis and the relevance of having an overview of the patient’s status for an accurate individual stratification of cardio and cerebrovascular riskLes accidents vasculaires cérébraux sont la première cause mondiale d'handicap et l'athérosclérose en est le principal facteur. Cette pathologie, liée à une mauvaise prise en charge du cholestérol pourra avoir des conséquences plus pernicieuses comme la fragilisation des unités cérébrovasculaires qui, combinée à une inflammation systémique et locale, peut entraîner d'importantes répercussions cérébrales.Pour être au plus proche de l'humain nous avons utilisé des modèles animaux murins et primate non-humain (PNH) âgés sous régime gras. Une approche translationnelle avec suivi longitudinal de biomarqueurs sanguins et d'imagerie combinée à la caractérisation tissulaire de l'inflammation a été effectuée pour tenter d'élucider les spécificités de la réponse inflammatoire dans la paroi vasculaire des grosses artères et le tissu cérébral.Nous avons montré que chez des souris ApoE-/- âgées l'exercice physique peut contrecarrer les effets délétères d'un régime gras lorsque l'apport calorique est contrôlé mais plus lorsqu'il ne l'est pas. La dégradation de la barrière hémato-encéphalique pourrait expliquer l'inflammation observée in vivo et confirmée par l'analyse tissulaire. L'étude des PNH a montré l'intérêt d'associer imagerie multimodale et dosages sanguins dans la stratification du risque cardiovasculaire ainsi que l'importance d'associer des marqueurs métaboliques, inflammatoires et anti-inflammatoires.Nous avons montré l'intérêt de contrôler les apports caloriques pour bénéficier des effets protecteurs de l'exercice sur l'athérosclérose et l'importance d'avoir une vue globale du patient pour une stratification individuelle précise du risque cardio et cérébrovasculair

Safety evaluation and imaging properties of gadolinium-based nanoparticles in nonhuman primates

In this article, we report the safety evaluation of gadolinium-based nanoparticles in nonhuman primates (NHP) in the context of magnetic resonance imaging (MRI) studies in atherosclerosis bearing animals and healthy controls. In healthy NHP, the pharmacokinetics and toxicity profiles demonstrated the absence of dose, time, and sex-effects, as well as a suitable tolerance of intravenous administration of the nanoparticles. We investigated their imaging properties for arterial plaque imaging in a standard diet or a high cholesterol diet NHP, and compared their characteristics with clinically applied Gd-chelate. This preliminary investigation reports the efficient and safe imaging of atherosclerotic plaques

Suprarenal Masses in Very Young Infants: Is It Safe to Watch and Wait? Report of a SIOPEN Observational Study Results

Suprarenal Masses in Very Young Infants: Is It Safe to Watch and Wait? Report of a SIOPEN Observational Study Result

Safety Evaluation and Imaging Properties of Gadolinium-Based Nanoparticles in nonhuman primates

International audienceIn this article, we report the safety evaluation of gadolinium-based nanoparticles in nonhuman primates (NHP) in the context of magnetic resonance imaging (MRI) studies in atherosclerosis bearing animals and healthy controls. In healthy NHP, the pharmacokinetics and toxicity profiles demonstrated the absence of dose, time, and sex-effects, as well as a suitable tolerance of intravenous administration of the nanoparticles. We investigated their imaging properties for arterial plaque imaging in a standard diet or a high cholesterol diet NHP, and compared their characteristics with clinically applied Gd-chelate. This preliminary investigation reports the efficient and safe imaging of atherosclerotic plaques

Application of helical tomotherapy for the treatment of a right atrium angiosarcoma: A case report

We report the case of a 48-year-old woman affected by inoperable primary angiosarcoma of the right atrium who was treated with 4 cycles of induction chemotherapy and radical radiotherapy. We present the application and the result of helical tomotherapy for this patient. We also describe the technical aspects of the simulation, planning, setup and delivery of radiotherapy. At 16 months after the diagnosis the patient is still in good condition without any symptoms and with a partial response of the lesion. This case shows the feasibility of treatment with high doses of radiation for a primary unresectable cardiac sarcoma