The Efficacy of Multi-Leaf Collimator in the Reduction of Cardiac and Coronary Artery Dose in Left-Sided Breast Cancer Radiotherapy

Background

Multi-leaf collimator (MLC) is one of the efficient and cost-effective methods for protecting sensitive tissues around the target. This study aimed to evaluate the protective effect of MLC on the protection of sensitive organs in patients with left breast cancer.

Materials and Methods

This study was performed on computed tomography (CT) scans of 45 patients with left breast cancer. Two treatment plans were completed for each patient. Only the heart and left lung were considered organs at risk in the first treatment plan, and in the second treatment plan, the left anterior descending artery (LAD) was also considered the organ at risk. It was covered as much as possible by the MLC. Dosimetric results of tumor and organ at risk (OARs) were extracted from the dose-volume histogram and compared.

Results

The results showed that more LAD coverage by MLC leads to a significant reduction in the mean dose of OARs (P-value <0.05). The mean dose for heart, LAD, and left lung decreased by 11%, 7.4%, and 4.9%, respectively. The values of V₅ (volume received the dose of 5 Gy) and V₂₀ for the lung, V₁₀, V₂₅, and V30 for LAD, and V₅, V₂₀, V₂₅, and V₃₀ for the heart also decreased significantly (P-value <0.05).

Conclusions

In general, better protection of LAD, heart, and lungs can be achieved by maximal shielding organs at risk by MLC in radiation therapy for patients with left breast cancer.

Dosimetric impact of different multileaf collimators on cardiac and left anterior descending coronary artery dose reduction

Introduction

Radiotherapy (RT) may increase the dose of heart structure like left anterior descending coronary artery (LAD). The purpose of this paper was to evaluate the impact of various multileaf collimators (MLCs) in shielding organ at risks (OARs), especially LAD, of patients with left breast cancer.

Materials and Methods

Forty-five patients with left breast cancer were selected. The treatment plans were created applying three techniques for all patients. In the first plan (uncovered LAD), the treatment plan was made without considering LAD as OARs. In the two other plans, two MLCs with different leaf widths (6.8 mm and 5 mm) were used to shield the LAD. For all plans, MLC was shielded as much of OAR as possible without compromising planning target volume (PTV) coverage. Dosimetric parameters of the heart, LAD, and ipsilateral lung were assessed.

Results

Compared to other plans, the covered LAD plan 1(CL1) obtained lower lung, cardiac, and LAD doses with the same PTV coverage. On average, the mean heart dose decreased from 6.2 Gy to 5.4 Gy by CL1, and the average mean dose to the LAD was reduced from 36.4 Gy to 33.7 Gy, which was statistically significant. The average lung volume receiving >20 Gy was significantly reduced from 24.6% to 23.4%. Moreover, the results show that covered LAD plan 2(CL2) is less useful for shielding OARs compared to CL1.

Conclusion

CL1 plans may reduce OAR dose for patients without compromising the target coverage. Hence, the proper implementation of MLC can decrease the side effects of RT.

Ultrasound-guided chemoradiotherapy of breast cancer using smart methotrexate-loaded perfluorohexane nanodroplets

Chemoradiotherapy with controlled-release nanocarriers such as sono-sensitive nanodroplets (NDs) can enhance the anticancer activity of chemotherapy medicines and reduces normal tissue side effects. In this study, folic acid-functionalized methotrexate-loaded perfluorohexane NDs with alginate shell (FA-MTX/PFH@alginate NDs) were synthesized, characterized, and their potential for ultrasound-guided chemoradiotherapy of breast cancer was investigated in vitro and in vivo. The cancer cell (4T1) viabilities and surviving fractions after NDs and ultrasound treatments were significantly decreased. However, this reduction was much more significant for ultrasound in combination with X-ray irradiation. The in vitro and in vivo results confirmed that MTX-loaded NDs are highly biocompatible and they have no significant hemolytic activity and organ toxicity. Furthermore, the in vivo results indicated that the FA-MTX/PFH@alginate NDs were accumulated selectively in the tumor region. In conclusion, FA-functionalized MTX/PFH@alginate NDs have a great theranostic performance for ultrasound-controlled drug delivery in combination with radiotherapy of breast cancer.

Evaluation of Targeted Image-Guided Radiation Therapy Treatment Planning System by Use of American Association of Physicists in Medicine Task Group-119 Test Cases

BACKGROUND

This study aimed to evaluate the overall accuracy of the beam commissioning criteria of targeted image-guided radiation therapy (TiGRT) treatment planning system (TPS) based on the American Association of Physicists in Medicine (AAPM) Task Group Report 119 (TG-119).

METHODS

The work was performed using 6 MV energy LINAC with a variable dose rate of 200 MU/min which equipped with the high-quality external TiGRT dynamic multileaf collimator model H. The AAPM TG-119 intensity-modulated radiation therapy (IMRT) commissioning tests are composed of two preliminary tests and four clinical test cases. The clinical tests consisted of mock prostate, mock head and neck, C-shaped target, and multitarget. EDR2 film was used for evaluating the IMRT plans and point dose measured by a Pinpoint chamber positioned in slab phantom. The film analysis was done with the Sun Nuclear Corporation patient software. The dose prescription for each fraction was 200 cGy in mock prostate, mock head and neck, C-shaped target, and multitarget. Dose distributions were analyzed using gamma criteria of 3% and 2% dose difference (DD) and 3 and 2 mm distance to agreement.

RESULTS

In all test cases, the gamma criteria for 2%/2 and 3%/3 were found to be 94% and 98%, respectively. Results showed that the average gamma criteria result was in the range of 99.1% to 93% (3%/3, 2%/2) overall test cases.

CONCLUSIONS

Findings were favorable and in some tests were comparable with the other studies. The dose point values were within the mean values of the range reported by TG-119. Overall, the TiGRT TPS is needed to apply IMRT technique in radiation therapy centers.

Clinical Implications of TiGRT Algorithm for External Audit in Radiation Oncology

Background:

Performing audits play an important role in quality assurance program in radiation oncology. Among different algorithms, TiGRT is one of the common application software for dose calculation. This study aimed to clinical implications of TiGRT algorithm to measure dose and compared to calculated dose delivered to the patients for a variety of cases, with and without the presence of inhomogeneities and beam modifiers.

Materials and Methods:

Nonhomogeneous phantom as quality dose verification phantom, Farmer ionization chambers, and PC-electrometer (Sun Nuclear, USA) as a reference class electrometer was employed throughout the audit in linear accelerators 6 and 18 MV energies (Siemens ONCOR Impression Plus, Germany). Seven test cases were performed using semi CIRS phantom.

Results:

In homogeneous regions and simple plans for both energies, there was a good agreement between measured and treatment planning system calculated dose. Their relative error was found to be between 0.8% and 3% which is acceptable for audit, but in nonhomogeneous organs, such as lung, a few errors were observed. In complex treatment plans, when wedge or shield in the way of energy is used, the error was in the accepted criteria. In complex beam plans, the difference between measured and calculated dose was found to be 2%–3%. All differences were obtained between 0.4% and 1%.

Conclusions:

A good consistency was observed for the same type of energy in the homogeneous and nonhomogeneous phantom for the three-dimensional conformal field with a wedge, shield, asymmetric using the TiGRT treatment planning software in studied center. The results revealed that the national status of TPS calculations and dose delivery for 3D conformal radiotherapy was globally within acceptable standards with no major causes for concern.

Zinc, copper, iron, and chromium concentrations in young patients with type 2 diabetes mellitus

Homeostasis of trace elements can be disrupted by diabetes mellitus. On the other hand, disturbance in trace element status in diabetes mellitus may contribute to the insulin resistance and development of diabetic complications. The aim of present study was to compare the concentration of essential trace elements, zinc, copper, iron, and chromium in serum of patients who have type 2 diabetes mellitus (n = 20) with those of nondiabetic control subjects (n = 20). The serum concentrations of zinc, copper, iron, and chromium were measured by means of an atomic absorption spectrophotometer (Shimadzu AA 670, Kyoto, Japan) after acid digestion. The results of this study showed that the mean values of zinc, copper, and chromium were significantly lower in the serum of patients with diabetes as compared to the control subjects (P < 0.05). Our results show that deficiency of some essential trace elements may play a role in the development of diabetes mellitus.

Adenoid cystic carcinoma of base of tongue

Adenoid cystic carcinoma (ACC) is a rare malignant tumour arising from salivary glands. ACC of the head and neck shows a long natural course, high recurrence rates, late metastasis and a tendency for perineural invasion. The authors present a woman with ACC at base of tongue with good response to radiotherapy.

Gene expression pattern of adiponectin and adiponectin receptors in dominant and atretic follicles and oocytes screened based on brilliant cresyl blue staining

Adiponectin and its receptors (AdipoR1 and AdipoR2) are novel endocrine systems that act at various levels to control male and female fertility. The aim of this study was to determine whether adiponectin and its receptors gene expression levels differ between dominant follicle (DF) and atretic follicle (AF) and also between oocytes which were stained positively and negatively with brilliant cresyl blue (BCB(+) and BCB(-)). Based on estradiol/progesterone ratio, follicles from ovaries were classified as AFs and DFs. The stages of estrous cycle (follicular or luteal phases) were defined by macroscopic observation of the ovaries and the uterus. Oocytes were stained with BCB for 90 min. The relative expression of adiponectin, AdipoR1 and AdipoR2 mRNA in theca and cumulus cells and oocytes of different follicles were determined by quantitative real time PCR. Adiponectin and its receptors genes were clearly expressed higher (P<0.05) in theca and cumulus cells and oocytes of DFs than those of AFs during the follicular and luteal phases. BCB(+) oocytes showed a higher (P<0.05) expression of adiponectin and its receptors compared with their BCB(-) counterparts. Positive correlation (r>0.725, P<0.001) was observed between adiponectin mRNA level in ovarian cells of DFs and follicular fluid E2 concentration in follicular phase. Adiponectin mRNA abundance in ovarian cells of AFs showed a significant negative correlation with follicular fluid progesterone concentration in follicular and luteal phases (r<-0.731, P<0.001). This work has revealed the novel association of adiponectin and its receptors genes with follicular dominance and oocyte competence, thereby opening several new avenues of research into the mechanisms of dominance and competence in animal and human.

Changes in the gene expression of adiponectin and adiponectin receptors (AdipoR1 and AdipoR2) in ovarian follicular cells of dairy cow at different stages of development

Adiponectin is one of the most important, recently discovered adipocytokines that acts at various levels to control male and female fertility through central effects on the hypothalamus-pituitary axis or through peripheral effects on the ovary, uterus, and embryo. We studied simultaneous changes in the gene expression pattern of adiponectin and adiponectin receptors 1 and 2 (AdipoR1 and AdipoR2) in granulosa and theca cells, cumulus-oocyte complex, and in corpus luteum in healthy bovine (Bos tarus) follicles at different stages of development. The expression levels of adiponectin, AdipoR1, and AdipoR2 mRNA were lower (P<0.05) in granulosa and cumulus cells in comparison with that in theca cells and oocyte. In contrast with the oocyte, AdipoR1 in granulosa, theca, and luteal cells was expressed (P<0.05) more than AdipoR2. Adiponectin expression increased (P<0.05) in granulosa cells and in cumulus-oocyte complex during follicular development from small to large follicles. Opposite results were observed in theca cells. Expression of adiponectin was highest in the late stages of corpus luteum (CL) regression, whereas lower expression was recorded in active CL (P<0.05). AdipoR1 and AdipoR2 expression increased during the terminal follicular growth in granulosa and theca cells (P<0.05) and during the luteal phase progress in CL. There was positive correlation between adiponectin mRNA level in granulosa cells from large follicles and follicular fluid estradiol concentration (r=0.48, P<0.05) and negative correlation between adiponectin mRNA abundance in theca cells and follicular fluid progesterone concentration (r=-0.44, P<0.05). In conclusion, we found that the physiologic status of the ovary has significant effects on the natural expression patterns of adiponectin and its receptors in follicular and luteal cells of bovine ovary.

Physiological response of dromedary camels to road transportation in relation to circulating levels of cortisol, thyroid hormones and some serum biochemical parameters

Transportation is often considered as one of the main causes of stress raising considerable interest, both in economic and animal welfare terms. The objective of the current study was to determine physiological response of dromedary camels to road transportation in relation to circulating levels of cortisol, thyroid hormones and some serum biochemical factors during summer conditions. Ten Iranian dromedary camels, five males and five females, were selected for the study. The study was conducted on three consecutive days in August 2008. At first day, blood samples were collected at 08:30 A.M., 09:30 A.M. and 01:30 P.M. to determine any possible variation in individual measurements due to diurnal changes or as a result of food and water deprivation for 5 h. Travel commenced on day 2 at 08:30 A.M. for 5 h, with a total of about 300 km traveled. At second day, blood samples were collected immediately before loading, at 08:30 a.m., after 1 h transport, at 09:30 A.M., and on the end of transportation, after unloading, at 01:30 P.M. Final blood sample was taken 24 h after arrival. In the current study no significant difference was observed in any parameter between sexes at each sampling time. The data related to day before transport had no significant differences between different times except for values obtained for cortisol that at 01:30 P.M. showed a significant decrease in comparison with data at 08:30 and 09:30. Circulating cortisol, T(4), T(3) and fT(4) levels was significantly higher after transportation compared with pre-transport values and returned to basal values within 24 h after transport. Transportation had effects on metabolism as demonstrated by increase in serum concentrations of glucose, NEFA, and urea nitrogen. Serum concentrations of glucose, NEFA, and urea nitrogen returned to basal values in final bleeding at 24 h after transport termination. In the current study transportation had no significant effects on serum concentrations of fT(3), triglycerides, cholesterol, beta-hydroxybutyrate, albumin and total protein. Taken together, the results obtained for short road transportation of dromedary camels showed a strong physiological response and provide some biomarkers for stress detection in this species. Further research to validate these potential biomarkers is necessary.

Serum lipid profile in Iranian fat-tailed sheep in late pregnancy, at parturition and during the post-parturition period

Blood samples were obtained from 12 Iranian fat-tailed sheep during 7 weeks pre-partum, at parturition and 7 weeks post-partum. The lipids measured were cholesterol, triglyceride, total lipid, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, and very low-density lipoprotein (VLDL)-cholesterol. The concentrations of cholesterol, triglyceride, HDL-cholesterol and VLDL-cholesterol during the 7 weeks pre-partum, at parturition and the 7 weeks post-partum were significantly different (P < 0.05). One week before parturition, the concentrations of cholesterol, triglyceride, HDL-cholesterol and VLDL-cholesterol were higher (P < 0.05) than at other periods. The lowest concentrations of these parameters were observed 2-3 weeks after parturition. In this study, significant positive correlations were observed between the time of sampling (pre-partum, parturition and post-partum) and serum cholesterol (r = 0.22; P < 0.01) and HDL-cholesterol (r = 0.25; P < 0.01).