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Tyler M, Duncan M, McNamara J. kV reference dosimetry in Australia and New Zealand: Survey results and trends. J Appl Clin Med Phys 2024:e14458. [PMID: 39023212 DOI: 10.1002/acm2.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/22/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE To assess the number of radiotherapy kilovoltage (kV) units in service, their clinical utilization, and methodology and equipment used for absorbed dose determination across Australia and New Zealand. METHODS A survey was sent to 61 Australian and New Zealand radiotherapy providers in the second half of 2023. RESULTS Fifty-seven responses were received, with 43 departments having kV units and providing beam quality data for 185 therapeutic kV beams 20-300 kVp. Percentage depth dose curves were compared between five clinical beams with 100 kVp and 2.13-6.28 mm Aluminum half value layers (HVLs), demonstrating large differences that can occur between beams with the same kVp. Eighteen departments provided clinical utilization data for their kV units, with a total of 4458 treatment courses and their corresponding kVp reported. All departments complied with national and international recommendations with respect to the equipment used for reference dosimetry of kV beams; 77% of ionization chambers used for absorbed dose determination were of Farmer-type, with the remaining 23% being plane parallel soft x-ray chambers. Methods of derivation of air-kerma calibration factors varied, with 73% of respondents using a draft document disseminated by the Australian Primary Standards laboratory, 23% using HVL alone, and 6% using other methods. CONCLUSIONS The results of this survey provide a snapshot of kilovoltage radiation therapy use and the number of kV units across Australia and New Zealand. This data can be used as a point of reference for future investigations into clinical utilization and reference dosimetry methods across Australia and New Zealand or for comparisons with other countries, facilitating standardization of reference dosimetry practice for kilovoltage units.
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Affiliation(s)
- Madelaine Tyler
- Shoalhaven Cancer Care Centre, Nowra, New South Wales, Australia
| | | | - Joanne McNamara
- Shoalhaven Cancer Care Centre, Nowra, New South Wales, Australia
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Mäntylä VM, Lehtonen AJ, Korhonen V, Srbova L, Pokki J. Quantifying the Influence of X-Ray Irradiation on Cell-Size-Scale Viscoelasticity of Collagen Type 1. J Biomech Eng 2024; 146:044501. [PMID: 38183220 DOI: 10.1115/1.4064404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
X-rays are widely used in mammography and radiotherapy of breast cancer. The research has focused on the effects of X-rays on cells in breast tissues, instead of the tissues' nonliving material, extracellular matrix. It is unclear what the influence of X-ray irradiation is on the matrix's mechanical cues, known to regulate malignant cancer-cell behaviors. Here, we developed a technique based on magnetic microrheology that can quantify the influence of X-ray irradiation on matrix viscoelasticity--or (solid-like) elastic and (liquid-like) viscous characteristics--at cell-size scales. To model breast-tissue extracellular matrix, we used the primary component of the tissue matrix, collagen type 1, as it is for control, and as irradiated by X-rays (tube voltage 50 kV). We used a magnetic microrheometer to measure collagen matrices using 10-μm-diameter magnetic probes. In each matrix, the probes were nanomanipulated using controlled magnetic forces by the microrheometer while the probes' displacements were detected to measure the viscoelasticity. The collagen-matrix data involve with a typical spatial variation in viscoelasticity. We find that higher irradiation doses (320 Gy) locally reduce stiffness (soften) collagen matrices and increase their loss tangent, indicating an elevated liquid-like nature. For lower, clinically relevant irradiation doses (54 Gy), we find insignificant matrix-viscoelasticity changes. We provide this irradiation-related technique for detection, and modification, of matrix viscoelastic cues at cell-size scales. The technique enables enhanced characterization of irradiated tissue constituents in a variety of breast-cancer radiotherapy types.
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Affiliation(s)
- Väinö Mikael Mäntylä
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Arttu Juhani Lehtonen
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Vesa Korhonen
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Linda Srbova
- Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
| | - Juho Pokki
- ASME Professional Mem. Department of Electrical Engineering and Automation, Aalto University, Espoo FI-02150, Finland
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Peters I, Nelson V, Deshpande S, Walker A, Hiatt J, Roach D, Erven T, Rajapakse S, Gray A. The assessment of the clinical impact of using a single set of radiotherapy planning data for two kilovoltage therapy units. Phys Eng Sci Med 2024; 47:49-59. [PMID: 37843767 DOI: 10.1007/s13246-023-01339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/14/2023] [Indexed: 10/17/2023]
Abstract
Kilovoltage therapy units are used for superficial radiotherapy treatment delivery. Peer reviewed studies for MV linear accelerators describe tolerances to dosimetrically match multiple linear accelerators enabling patient treatment on any matched machine. There is an absence of literature on using a single planning data set for multiple kilovoltage units which have limited ability for beam adjustment. This study reviewed kilovoltage dosimetry and treatment planning scenarios to evaluate the feasibility of using ACPSEM annual QA tolerances to determine whether two units (of the same make and model) were dosimetrically matched. The dosimetric characteristics, such as measured half value layer (HVL), percentage depth dose (PDD), applicator factor and output variation with stand-off distance for each kV unit were compared to assess the agreement. Independent planning data based on the measured HVL for each beam energy from each kV unit was prepared. Monitor unit (MU) calculations were performed using both sets of planning data for approximately 200 clinical scenarios and compared with an overall agreement between units of < 2%. Additionally, a dosimetry measurement comparison was completed at each site for a subset of nine scenarios. All machine characterisation measurements were within the ACPSEM Annual QA tolerances, and dosimetric testing was within 2.5%. This work demonstrates that using a single set of planning data for two kilovoltage units is feasible, resulting in a clinical impact within published uncertainty.
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Affiliation(s)
- Iliana Peters
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia.
| | - Vinod Nelson
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Shrikant Deshpande
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- South West Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amy Walker
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- South West Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Joshua Hiatt
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Dale Roach
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Tania Erven
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Satya Rajapakse
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Alison Gray
- South Western Sydney Local Health District, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- South West Sydney Clinical School, School of Medicine, University of New South Wales, Sydney, NSW, Australia
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Miles D, Sforza D, Wong J, Rezaee M. Dosimetric characterization of a rotating anode x-ray tube for FLASH radiotherapy research. Med Phys 2024; 51:1474-1483. [PMID: 37458068 PMCID: PMC10792113 DOI: 10.1002/mp.16609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/16/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE Most current research toward ultra-high dose rate (FLASH) radiation is conducted with advanced proton and electron accelerators, which are of limited accessibility to basic laboratory research. An economical alternative to charged particle accelerators is to employ high-capacity rotating anode x-ray tubes to produce kilovoltage x-rays at FLASH dose rates at short source-to-surface distances (SSD). This work describes a comprehensive dosimetric evaluation of a rotating anode x-ray tube for potential application in laboratory FLASH study. METHODS AND MATERIALS A commercially available high-capacity fluoroscopy x-ray tube with 75 kW input power was implemented as a potential FLASH irradiator. Radiochromic EBT3 film and thermoluminescent dosimeters (TLDs) were used to investigate the effects of SSD and field size on dose rates and depth-dose characteristics in kV-compatible solid water phantoms. Custom 3D printed accessories were developed to enable reproducible phantom setup at very short SSD. Open and collimated radiation fields were assessed. RESULTS Despite the lower x-ray energy and short SSD used, FLASH dose rates above 40 Gy/s were achieved for targets up to 10-mm depth in solid water. Maximum surface dose rates of 96 Gy/s were measured in the open field at 47 mm SSD. A non-uniform high-to-low dose gradient was observed in the planar dose distribution, characteristic of anode heel effects. With added collimation, beams up to 10-mm diameter with reasonable uniformity can be produced. Typical 80%-20% penumbra in the collimated x-ray FLASH beams were less than 1 mm at 5-mm depth in phantom. Ramp-up times at the maximum input current were less than 1 ms. CONCLUSION Our dosimetric characterization demonstrates that rotating anode x-ray tube technology is capable of producing radiation beams in support of preclinical FLASH radiobiology research.
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Affiliation(s)
- Devin Miles
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, 21231 MD, USA
| | - Daniel Sforza
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, 21231 MD, USA
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, 21231 MD, USA
| | - Mohammad Rezaee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, 21231 MD, USA
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Xiong Z, Zhong Y, Banks TI, Reynolds R, Chiu T, Tan J, Zhang Y, Parsons D, Yan Y, Godley A, Stojadinovic S. Machine characterization and central axis depth dose data of a superficial x-ray radiotherapy unit. Biomed Phys Eng Express 2022; 9. [PMID: 36541531 DOI: 10.1088/2057-1976/aca611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Objectives. The purpose of this study is to present data from the clinical commissioning of an Xstrahl 150 x-ray unit used for superficial radiotherapy,Methods. Commissioning tasks included vendor acceptance tests, timer reproducibility, linearity and end-effect measurements, half-value layer (HVL) measurements, inverse square law verification, head-leakage measurements, and beam output calibration. In addition, percent depth dose (PDD) curves were determined for different combinations of filter/kV settings and applicators. Automated PDD water phantom scans were performed utilizing four contemporary detectors: a microDiamond detector, a microSilicon detector, an EDGE detector, and a PinPoint ionization chamber. The measured PDD data were compared to the published values in BJR Supplement 25,Results. The x-ray unit's mechanical, safety, and radiation characteristics were within vendor-stated specifications. Across sixty commissioned x-ray beams, the PDDs determined in water using solid state detectors were in excellent agreement with the BJR 25 data. For the lower (<100 kVp) and medium-energy (≥100 kVp) superficial beams the average agreement was within [-3.6,+0.4]% and [-3.7,+1.4]% range, respectively. For the high-energy superficial (low-energy orthovoltage) x-rays at 150 kVp, the average difference for the largest 20 × 20 cm2collimator was (-0.7 ± 1.0)%,Conclusions. This study presents machine characterization data collected for clinical use of a superficial x-ray unit. Special focus was placed on utilizing contemporary detectors and techniques for the relative PDD measurements using a motorized water phantom. The results in this study confirm that the aggregate values published in the BJR 25 report still serve as a valid benchmark when comparing data from site-specific measurements, or the reference data for clinical utilization without such measurements,Advances in knowledge. This paper presents comprehensive data from the acceptance and commissioning of a modern kilovoltage superficial x-ray radiotherapy machine. Comparisons between the PDD data measured in this study using different detectors and BJR 25 data are highlighted.
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Affiliation(s)
- Zhenyu Xiong
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.,Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America
| | - Yuncheng Zhong
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Thomas I Banks
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Robert Reynolds
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Tsuicheng Chiu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jun Tan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - You Zhang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Yulong Yan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Andrew Godley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Strahinja Stojadinovic
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
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Kilovoltage therapy is well and truly alive and needed in a modern radiotherapy centre. Phys Eng Sci Med 2021; 44:341-345. [PMID: 33899157 DOI: 10.1007/s13246-021-00998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Sumini M, Isolan L, Cremonesi M, Garibaldi C. A Plasma Focus device as ultra-high dose rate pulsed radiation source. Part II: X-ray pulses characterization. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2019.108360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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An evaluation of techniques used in superficial radiotherapy for non-melanoma skin cancer to replicate the planned treatment area: A prospective study. Radiography (Lond) 2019; 25:280-287. [PMID: 31582233 DOI: 10.1016/j.radi.2019.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/30/2019] [Accepted: 04/23/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Accuracy of superficial radiotherapy for non-melanoma skin cancer is dependent on replicating the original clinical mark-up. Responses from 18 UK Radiotherapy centres identified the four most common replication techniques; the accuracy and time-efficiency of each was evaluated, as well as participant preference and confidence. METHODS A 2.0 cm × 2.5 cm ellipse field was drawn around the nasal ala of a surrogate patient. Templates for each replication method (1-4) were created, and skin marks removed. Twenty-five therapeutic radiographers used each method to replicate the mark-up. Measurements were recorded for lateral and longitudinal displacement, ellipse diameter and time taken. A post-study questionnaire recorded participant preference and perceived confidence. RESULTS Comparison of the mean ellipse areas for methods 1-4 identified no statistically significant differences (ANOVA test; p = 0.579 to p = 0.999). Lateral and longitudinal displacements for method 1-4 showed a statistically significant difference between method 3 and each of methods 1, 2, 4 for lateral and longitudinal respectively (ANOVA; lateral: p = 0.008, p = 0.002, p = 0.05; longitudinal: p = 0.036, p = 0.000, and p = 0.000). Mean time taken was longest for method 3, and was compared using a Friedman test (p = 0.000) identifying a statistically significant difference. Twenty-two participants completed the questionnaire. 48% favoured method 2, 41% method 4. Method 3 was least favourite. A Likert scale (1-10) measured confidence. Participants had most confidence in methods 2 and 4. CONCLUSION In this study, method 3 was least accurate, most time consuming, and was least favoured by users. The clinical significance of these results will depend on the margins used in local practise.
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Hill R, Healy B, Butler D, Odgers D, Gill S, Lye J, Gorjiara T, Pope D, Hill B. Australasian recommendations for quality assurance in kilovoltage radiation therapy from the Kilovoltage Dosimetry Working Group of the Australasian College of Physical Scientists and Engineers in Medicine. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:781-808. [DOI: 10.1007/s13246-018-0692-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kisling KD, Ger RB, Netherton TJ, Cardenas CE, Owens CA, Anderson BM, Lee J, Rhee DJ, Edward SS, Gay SS, He Y, David SD, Yang J, Nitsch PL, Balter PA, Urbauer DL, Peterson CB, Court LE, Dube S. A snapshot of medical physics practice patterns. J Appl Clin Med Phys 2018; 19:306-315. [PMID: 30272385 PMCID: PMC6236839 DOI: 10.1002/acm2.12464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/16/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022] Open
Abstract
A large number of surveys have been sent to the medical physics community addressing many clinical topics for which the medical physicist is, or may be, responsible. Each survey provides an insight into clinical practice relevant to the medical physics community. The goal of this study was to create a summary of these surveys giving a snapshot of clinical practice patterns. Surveys used in this study were created using SurveyMonkey and distributed between February 6, 2013 and January 2, 2018 via the MEDPHYS and MEDDOS listserv groups. The format of the surveys included questions that were multiple choice and free response. Surveys were included in this analysis if they met the following criteria: more than 20 responses, relevant to radiation therapy physics practice, not single‐vendor specific, and formatted as multiple‐choice questions (i.e., not exclusively free‐text responses). Although the results of free response questions were not explicitly reported, they were carefully reviewed, and the responses were considered in the discussion of each topic. Two‐hundred and fifty‐two surveys were available, of which 139 passed the inclusion criteria. The mean number of questions per survey was 4. The mean number of respondents per survey was 63. Summaries were made for the following topics: simulation, treatment planning, electron treatments, linac commissioning and quality assurance, setup and treatment verification, IMRT and VMAT treatments, SRS/SBRT, breast treatments, prostate treatments, brachytherapy, TBI, facial lesion treatments, clinical workflow, and after‐hours/emergent treatments. We have provided a coherent overview of medical physics practice according to surveys conducted over the last 5 yr, which will be instructive for medical physicists.
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Affiliation(s)
- Kelly D Kisling
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel B Ger
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tucker J Netherton
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Cardenas
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Constance A Owens
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian M Anderson
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joonsang Lee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dong Joo Rhee
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharbacha S Edward
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Skylar S Gay
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yulun He
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shaquan D David
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paige L Nitsch
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter A Balter
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana L Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine B Peterson
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence E Court
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Scott Dube
- Morton Plant Mease Health System, Clearwater, FL, USA
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Sarria GR, Sarria GJ, Rivera PF, Zaharia M, Serpa S, Buitrago M. Phase I/II study on kilovoltage surface brachytherapy in conjunctival cancer: preliminary results. Ecancermedicalscience 2018; 12:835. [PMID: 29910832 PMCID: PMC5985750 DOI: 10.3332/ecancer.2018.835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In ocular conjunctival carcinoma after surgery, adjuvant treatment has a role and kilovoltage surface brachytherapy opens a new door for the range of therapeutic options. MATERIALS AND METHODS Between October 2014 and June 2017, at the National Institute of Neoplastic Diseases (INEN) from Peru, 39 patients with squamous cell carcinoma of ocular conjunctiva, T1-T3, resected, were selected to receive adjuvant treatment. The portable accelerator of 50-kV INTRABEAM (Carl Zeiss Meditec) was used, after local anaesthesia and blocking of ocular muscles movement. The doses used were 18 Gy for patients with free margins and 22 Gy for positive edges, according to calculation of equivalent dose of 2Gy per fraction of 46 and 66 Gy, respectively, assuming a tumoural α/β ratio of 8 Gy. The prescription was done to 2 mm depth. RESULTS The median age was 69 years, distributed evenly between both genders, with a median follow-up of 12 months. The surgical margins were 59% free and 41% committed, with no difference between the institutions where the surgery was performed (P = 0.069). The median tumour size was 7 mm with 2 mm of invasion, 61.5% was T2 and 35.9% T1. The mean time between surgery and irradiation was 1.5 months, 23.1% of patients developed grade I toxicity of spontaneous resolution, without evidence of greater degree in any case. The dose had no statistical relationship with toxicity (P = 0.533). One-year disease-free survival was 96.7%. CONCLUSIONS Kilovoltage surface brachytherapy is an applicable and reproducible tool in the treatment of squamous cell carcinoma of ocular conjunctiva. The administered doses are well tolerated by patients with low levels of acute toxicity. Longer follow-up is needed to establish disease control rates and late toxicities.
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Affiliation(s)
- Gustavo R Sarria
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Gustavo J Sarria
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Paola Fuentes Rivera
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Mayer Zaharia
- Radiotherapy Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Solón Serpa
- Ophthalmic Oncology Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
| | - Mario Buitrago
- Ophthalmic Oncology Department, National Institute of Neoplastic Diseases (INEN), Lima 15038, Peru
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Palmer AL, Jafari SM, Mone I, Muscat S. Evaluation and clinical implementation of in vivo dosimetry for kV radiotherapy using radiochromic film and micro-silica bead thermoluminescent detectors. Phys Med 2017; 42:47-54. [PMID: 29173920 DOI: 10.1016/j.ejmp.2017.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/09/2017] [Accepted: 08/23/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Antony L Palmer
- Portsmouth Hospitals NHS Trust, Portsmouth, UK; University of Surrey, Guildford, UK.
| | - Shakardokht M Jafari
- Portsmouth Hospitals NHS Trust, Portsmouth, UK; University of Surrey, Guildford, UK
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