Practical robustness evaluation in radiotherapy - A photon and proton-proof alternative to PTV-based plan evaluation

Background and purpose: A planning target volume (PTV) in photon treatments aims to ensure that the clinical target volume (CTV) receives adequate dose despite treatment uncertainties. The underlying static dose cloud approximation (the assumption that the dose distribution is invariant to errors) is problematic in intensity modulated proton treatments where range errors should be taken into account as well. The purpose of this work is to introduce a robustness evaluation method that is applicable to photon and proton treatments and is consistent with (historic) PTV-base

SAFESTEREO: phase II randomized trial to compare stereotactic radiosurgery with fractionated stereotactic radiosurgery for brain metastases

Background Stereotactic radiosurgery (SRS) is a frequently chosen treatment for patients with brain metastases and the number of long-term survivors is increasing. Brain necrosis (e.g. radionecrosis) is the most important long-term side effect of the treatment. Retrospective studies show a lower risk of radionecrosis and local tumor recurrence after fractionated stereotactic radiosurgery (fSRS, e.g. five fractions) compared with stereotactic radiosurgery in one or three fractions. This is especially true for patients with large brain metastases. As such, the 2022 ASTRO guideline of radiotherapy for brain metastases recommends more research to fSRS to reduce the risk of radionecrosis. This multicenter prospective randomized study aims to determine whether the incidence of adverse local events (either local failure or radionecrosis) can be reduced using fSRS versus SRS in one or three fractions in patients with brain metastases.Methods Patients are eligible with one or more brain metastases from a solid primary tumor, age of 18 years or older, and a Karnofsky Performance Status = 70. Exclusion criteria include patients with small cell lung cancer, germinoma or lymphoma, leptomeningeal metastases, a contraindication for MRI, prior inclusion in this study, prior surgery for brain metastases, prior radiotherapy for the same brain metastases (in-field re-irradiation). Participants will be randomized between SRS with a dose of 15-24 Gy in 1 or 3 fractions (standard arm) or fSRS 35 Gy in five fractions (experimental arm). The primary endpoint is the incidence of a local adverse event (local tumor failure or radionecrosis identified on MRI scans) at two years after treatment. Secondary endpoints are salvage treatment and the use of corticosteroids, bevacizumab, or antiepileptic drugs, survival, distant brain recurrences, toxicity, and quality of life.Discussion Currently, limiting the risk of adverse events such as radionecrosis is a major challenge in the treatment of brain metastases. fSRS potentially reduces this risk of radionecrosis and local tumor failure.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

The Effect of Vibration and Translational Energy on the Reaction Dynamics of the H+2 + H2 System

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Sources of post-orogenic calcalkaline magmas : the Arrochar and Garabal Hill-Glen Fyne complexes, Scotland

The 425 Ma Arrochar and Garabal Hill–Glen Fyne complexes of highland Scotland are examples of post-orogenic magmatism accompanying extensional collapse of an orogen, in this case the Caledonian. The rocks are dominantly high-K series, but range from medium-K to shoshonitic. Mantle upwelling, melting and the intrusion of large volumes of mafic magma into the crust are inferred to have accompanied lithospheric thinning, and to have provided the heat source for melting of young arc crust accreted during the preceding subduction epoch. Fluids evolved from the subducting slab are inferred to have caused high degrees of enrichment in the overlying mantle wedge. Deep in the crust, the mantle-derived, K-rich mafic to intermediate magmas mixed with felsic crustal melts to form the spectrum of magmas intruded in the two complexes. Microgranular enclaves in the granitic rocks represent mafic magmas derived from the enriched mantle and hybridised by reaction, diffusion and mechanical mixing with their host felsic magmas, but they do not form part of the evolutionary series that produced the host magmas. Rather than inheriting its LILE-enriched character directly from crustal melts, or from crustal assimilation by mafic magmas, the high-K series may commonly owe at least part of its potassic character to the involvement of mantle (highly metasomatised by slab-derived fluids) as a major magma source. Enclave suites, though prominent in some granitic rocks should not be assumed to represent magmas that played a significant role in the production of the chemical variations in their host magmas