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Westley R, Dunlop A, Alexander S, Mitchell A, Diamantopoulos S, Chick J, Hall E, Mohajer J, Tree A. Is the Motion Causing a Commotion? Two-Fraction Prostate SBRT on the MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e449-e450. [PMID: 37785446 DOI: 10.1016/j.ijrobp.2023.06.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In HERMES (NCT04595019) men with localized prostate cancer are treated on the Unity MR-Linac platform (MRL, Elekta AB, Stockholm) and randomized between stereotactic body radiotherapy (SBRT) with 36.25 Gy in 5 fractions and 24 Gy in 2 fractions. Patients randomized to two fractions receive 24 Gy to the high risk PTV, 20 Gy to the low risk PTV and a boost of 27 Gy to the dominant intraprostatic lesion. This study explores dose received by the target and organs at risk (OARs) when considering intrafraction motion in two fraction SBRT. MATERIALS/METHODS Targets and OARs were delineated and a reference plan generated on Monaco v5.40.01 (Elekta). An Adapt-to-Shape (ATS) workflow was used. Contours were propagated to the session MRI (MRIsession) and edited accordingly. Prior to delivery, a verification MRI (MRIverif) was acquired with baseline shifts corrected for using the Adapt-to-Position (ATP-of-ATS) workflow. A post treatment MRI (MRIpost) was acquired after delivery. Men in the 2-fraction arm received each fraction in 2 sub-fractions sequentially on the same day, to mitigate intrafraction motion. The plans of 5 men receiving 2 fraction SBRT were analyzed. The targets, urethra, bladder and rectum were recontoured on the MRIverif and MRIpost. Delivered plans were recalculated on the corresponding MRIverif and MRIpost. The percentage of optimal and mandatory target dose constraints met were calculated. Accumulated OAR doses were calculated by averaging their respective dose statistics across all sub-fractions, conservatively assuming that the same area of the OAR receives the maximum dose each fraction. Analysis was carried out separately for MRIverif and MRIpost as the true 'delivered dose' most likely lies between these two estimates. RESULTS There was good coverage across all fractions. The mandatory constraints of CTVpsv V24.0 Gy > 95% and CTVsv V20.0 Gy > 95% were met in 100% of fractions and V2700cGy > 95% in 90% on the MRIpost. Table 3 shows OAR dose. CONCLUSION This work demonstrates that target coverage is good, even for the GTV where no margin is applied. With our conservative dose calculation approach, we found dose constraints are exceeded for some patients. However, treatment has been well tolerated, suggesting that that our current dose constraints may be cautious. Once Elekta's True Tracking and automated gating software is implemented at our center we will be able to further improve OAR clinical goal compliance.
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Affiliation(s)
- R Westley
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - S Alexander
- Institute of Cancer Research, Sutton, United Kingdom
| | - A Mitchell
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - J Chick
- The Royal Marsden, Sutton, United Kingdom
| | - E Hall
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, United Kingdom
| | - J Mohajer
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A Tree
- Radiotherapy and Imaging Division, Institute of Cancer Research, London, United Kingdom
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Mitchell A, Ingle M, Smith G, Chick J, Diamantopoulos S, Goodwin E, Herbert T, Huddart R, McNair H, Oelfke U, Nill S, Dunlop A, Hafeez S. Feasibility of tumour-focused adaptive radiotherapy for bladder cancer on the MR-linac. Clin Transl Radiat Oncol 2022; 35:27-32. [PMID: 35571274 PMCID: PMC9092067 DOI: 10.1016/j.ctro.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Abstract
Bladder tumour-focused magnetic resonance image-guided adaptive radiotherapy using a 1.5 Tesla MR-linac is feasible. A full online workflow adapting to anatomy at each fraction is achievable in approximately 30 min. Intra-fraction bladder filling did not compromise target coverage with the class solution employed.
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Affiliation(s)
- A. Mitchell
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - M. Ingle
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Diamantopoulos
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - E. Goodwin
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Herbert
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Huddart
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Hafeez
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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Diamantopoulos S, Platoni K, Karaiskos P, Kouloulias V, Efstathopoulos E. A novel isodose surface-based method for patient specific QA analysis. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Diamantopoulos S, Kagkiouzis I, Patatoukas G, Kypraiou E, Kouloulias V, Efstathopoulos E, Platoni K. Three dimensional printed electron beam modifier for total skin electron treatments. Med Dosim 2018; 44:173-178. [PMID: 31079619 DOI: 10.1016/j.meddos.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/06/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
Total Skin Electron Beam (TSEB) treatment, despite its proven effectiveness in skin malignancies, is a rather exhausting irradiation method, especially for feeble patients. In an effort to reduce treatment time by creating a clinically acceptable single TSEB field, various beam modifiers of different materials and shapes were tested. Using the TSEB immobilization device of our department and 3D printing technology, aluminum and thermoplastic modifiers were designed and constructed, according to the resulting profiles at treatment distance. Electron beam characteristics were measured and calculated both at SSD = 100 cm and at treatment level. Aluminum scatterers of the same thickness caused different modification according to the area of blocking. Aluminum modifiers reduced significantly central dose deposition for the same amount of MUs and therefore they expanded treatment time in undesirable levels. Plastic modifiers offer a good combination of field dimensions and treatment time. The final 3D printed modifier shaped the electron beam as desired resulting to a clinically acceptable 6 MeV field of 176 × 70 cm field with 10% inhomogeneity in vertical and 3% in the lateral dimension with adequate skin coverage at SSD = 400 cm. This modification offered approximately a two-minute treatment time reduction compared to the current technique. Underdosed areas appear near the edge of the field, but in regions that are far from the torso of the patient. Bremsstrahlung radiation was kept at clinically accepted levels (< 5%). This modification of the original six dual-field technique of our hospital could probably benefit fragile patients who could not easily tolerate a twenty-minute standing position without compromising the quality of their treatment.
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Affiliation(s)
- S Diamantopoulos
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece.
| | - I Kagkiouzis
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - G Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - E Kypraiou
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - V Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - E Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - K Platoni
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
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Vendrame F, Hopfner Y, Diamantopoulos S, Virdi SK, Allende G, Snowhite IV, Reijonen HK, Chen L, Ruiz P, Ciancio G, Hutton JC, Messinger S, Burke GW, Pugliese A. Risk Factors for Type 1 Diabetes Recurrence in Immunosuppressed Recipients of Simultaneous Pancreas-Kidney Transplants. Am J Transplant 2016; 16:235-45. [PMID: 26317167 PMCID: PMC5053280 DOI: 10.1111/ajt.13426] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/29/2015] [Accepted: 06/15/2015] [Indexed: 01/25/2023]
Abstract
Patients with type 1 diabetes (T1D) who are recipients of pancreas transplants are believed to rarely develop T1D recurrence in the allograft if effectively immunosuppressed. We evaluated a cohort of 223 recipients of simultaneous pancreas-kidney allografts for T1D recurrence and its risk factors. With long-term follow-up, recurrence was observed in approximately 7% of patients. Comparing the therapeutic regimens employed in this cohort over time, lack of induction therapy was associated with recurrence, but this occurs even with the current regimen, which includes induction; there was no influence of maintenance regimens. Longitudinal testing for T1D-associated autoantibodies identified autoantibody positivity, number of autoantibodies, and autoantibody conversion after transplantation as critical risk factors. Autoantibodies to the zinc transporter 8 had the strongest and closest temporal association with recurrence, which was not explained by genetically encoded amino acid sequence donor-recipient mismatches for this autoantigen. Genetic risk factors included the presence of the T1D-predisposing HLA-DR3/DR4 genotype in the recipient and donor-recipient sharing of HLA-DR alleles, especially HLA-DR3. Thus, T1D recurrence is not uncommon and is developing in patients treated with current immunosuppression. The risk factors identified in this study can be assessed in the transplant clinic to identify recurrent T1D and may lead to therapeutic advances.
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Affiliation(s)
- F. Vendrame
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - Y‐Y. Hopfner
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - S. Diamantopoulos
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL,Department of Pediatrics, Leonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - S. K. Virdi
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - G. Allende
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - I. V. Snowhite
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL
| | | | - L. Chen
- Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - P. Ruiz
- Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - G. Ciancio
- Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - J. C. Hutton
- Barbara Davis Center for Childhood DiabetesUniversity of Colorado DenverAuroraCO
| | - S. Messinger
- Department of Epidemiology and Public Health Sciences, Division of Biostatistics, Leonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - G. W. Burke
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL,Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of MiamiMiamiFL
| | - A. Pugliese
- Diabetes Research InstituteLeonard Miller School of MedicineUniversity of MiamiMiamiFL,Department of Medicine, Division of Endocrinology and Metabolism, Leonard Miller School of MedicineUniversity of MiamiMiamiFL,Department of Microbiology and ImmunologyLeonard Miller School of MedicineUniversity of MiamiMiamiFL
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Maritsi D, Vartzelis G, Spyridis N, Garoufi A, Diamantopoulos S. SAT0500 The Immune Response to Hepatitis a Vaccine in Children with Pfapa Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maritsi D, Vartzelis G, Metaxa Z, Vougiouka O, Spyridis N, Diamantopoulos S. THU0505 The Immune Response to Hepatitis a Vaccine in Children with Autoinflammatory Disorders. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lyra M, Charalambatou P, Sotiropoulos M, Diamantopoulos S. Radiation protection of staff in 111In radionuclide therapy--is the lead apron shielding effective? Radiat Prot Dosimetry 2011; 147:272-276. [PMID: 21816731 DOI: 10.1093/rpd/ncr330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
(111)In (Eγ = 171-245 keV, t1/2 = 2.83 d) is used for targeted therapies of endocrine tumours. An average activity of 6.3 GBq is injected into the liver by catheterisation of the hepatic artery. This procedure is time-consuming (4-5 min) and as a result, both the physicians and the technical staff involved are subjected to radiation exposure. In this research, the efficiency of the use of lead apron has been studied as far as the radiation protection of the working staff is concerned. A solution of (111)In in a cylindrical scattering phantom was used as a source. Close to the scattering phantom, an anthropomorphic male Alderson RANDO phantom was positioned. Thermoluminescent dosemeters were located in triplets on the front surface, in the exit and in various depths in the 26th slice of the RANDO phantom. The experiment was repeated by covering the RANDO phantom by a lead apron 0.25 mm Pb equivalent. The unshielded dose rates and the shielded photon dose rates were measured. Calculations of dose rates by Monte Carlo N-particle transport code were compared with this study's measurements. A significant reduction of 65 % on surface dose was observed when using lead apron. A decrease of 30 % in the mean absorbed dose among the different depths of the 26th slice of the RANDO phantom has also been noticed. An accurate correlation of the experimental results with Monte Carlo simulation has been achieved.
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Affiliation(s)
- M Lyra
- Medical Physics Unit, A' Radiology Department, University of Athens, Aretaieion Hospital, Athens 11528, Greece
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Diamantopoulos S, Butt S, Milickovic N, Katsilieri Z, Kefala V, Zogal P, Sakas G, Baltas D. 687 poster EFFECT OF USING DIFFERENT U/S PROBE STANDOFF MATERIALS IN IMAGE GEOMETRY FOR BRACHYTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Diamantopoulos S, Platoni K, Dilvoi M, Nazos I, Geropantas K, Maravelis G, Tolia M, Beli I, Efstathopoulos E, Pantelakos P, Panayiotakis G, Kouloulias V. Clinical implementation of total skin electron beam (TSEB) therapy: A review of the relevant literature. Phys Med 2011; 27:62-8. [DOI: 10.1016/j.ejmp.2010.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 07/15/2010] [Accepted: 09/01/2010] [Indexed: 10/18/2022] Open
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