RESUMEN
Ion-beam-sputtering (IBS) single-layer and multilayer coating designs for UV applications were examined after the deposition process as well as after a defined postdeposition treatment. High internal compressive film stress as well as moderate absorption losses in the UV spectral range were measured at the as-deposited thin films. Due to a controlled postdeposition treatment process, the absorption losses and the high compressive stress can be reduced significantly. We show that the remaining thin-film stress of SiO2 and HfO2 multilayer designs can be specifically manipulated by the parameters of the postdeposition treatment. Even zero and tensile stress can be achieved for complex multilayer coatings.
RESUMEN
PURPOSE: Craniopharyngiomas (CPs) are rare tumors of the sellar region often leading to significant comorbidities due to their close proximity to critical structures. The aim of this study was to analyze survival outcome and late toxicities after surgery and proton beam therapy (PBT) in childhood CPs. METHODS AND MATERIALS: Within the prospective registry study "KiProReg" (DRKS0000536), data of 74 childhood patients with CP, receiving PBT between August 2013 to June 2022 were eligible. Late toxicities were analyzed according to the grading system of the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: Median follow-up since first diagnosis was 4.3 years (range, 0.8-14.7). In addition, 75.7% of patients received PBT at time of disease progression or recurrence, whereas 24.3% as part of their primary therapy (definitive or adjuvant). Predominantly (85.1%), pencil beam scanning technique was used. The median total dose and initial tumor volume were 5400 cGy relative biologic effectiveness (RBE) and 17.64 cm³ (range, 3.07-300.59), respectively. The estimated (±SE) 3-year overall survival, progression-free, and cystic failure-free survival rate after PBT were 98.2% (±1.7), 94.7% (±3.0), and 76.8% (±5.4), respectively. All local failures (n = 3) were in-field relapses necessitating intervention and occurred exclusively in patients receiving PBT at progression or recurrence. Early cystic enlargements after PBT were typically asymptomatic and self-limiting. Fatigue, headaches, vision disorders, obesity, and endocrinopathies were the predominant late toxicities. No high-grade (≥3) new-onset visual impairment or cognitive deterioration occurred compared with baseline. The presence of cognitive impairments at the end of follow-up correlated with size of the planning target volume (P = .034), Dmean dose to the temporal lobes (P = .032, P = .045) and the number of surgical interventions before PBT (P = .029). CONCLUSIONS: Our findings demonstrate favorable local control rates using modern PBT with acceptable late toxicities. Cyst growth within 12 months after radiation therapy is typically not associated with tumor progression. Longer follow-up must be awaited to confirm results.
Asunto(s)
Craneofaringioma , Neoplasias Hipofisarias , Terapia de Protones , Sistema de Registros , Humanos , Craneofaringioma/radioterapia , Craneofaringioma/mortalidad , Terapia de Protones/efectos adversos , Niño , Masculino , Femenino , Estudios Prospectivos , Preescolar , Adolescente , Neoplasias Hipofisarias/radioterapia , Neoplasias Hipofisarias/mortalidad , Resultado del Tratamiento , Carga Tumoral , Recurrencia Local de Neoplasia , Dosificación Radioterapéutica , Lactante , Efectividad Biológica RelativaRESUMEN
Background: Proton beam therapy (PBT) is being increas16ingly used to treat residual craniopharyngioma (CP) after hypothalamus-sparing surgery. Compared to photon-based radiation therapy (XRT) with PBT, less irradiation in the penumbra reduces the scattered dose to critical organs neighboring but outside the area of treatment, minimizing the risk of sequelae. Patients and methods: Between 2007 and 2019, 99 of 290 (34%) childhood-onset CP patients recruited in KRANIOPHARYNGEOM 2007 received external radiation therapy (RT) (65% PBT, 35% XRT). Outcome was analyzed in terms of survival, endocrinological and anthropometric parameters (BMI and height SDS), quality of life (QoL using PEDQOL), and functional capacity (FMH) with special regard to irradiation technique. Results: PBT became predominant (used in 43% and 72% of all irradiated patients registered within the first and second halves of the recruitment period, between 2008 and 2013 and 2013 and 2018, respectively). Five-year event-free survival rates after PBT or XRT were comparable (92% ± 4% vs. 91% ± 4%, p = 0.42) and higher than for the whole cohort since diagnosis, including non-RT patients (37% ± 4%). Radiation doses to the hypothalamus and pituitary did not differ between PBT and XRT. Endocrine deficits due to disturbances of the hypothalamic-pituitary axis (HPA) were already common before irradiation. During the first 5 years after CP diagnosis/RT, no differences between PBT, XRT, and non-RT CP patients concerning functional capacity and anthropometric parameters have been obtained. Only for the PEDQOL domain "physical function", parental-assessed QoL was lower 12 months after PBT versus XRT or non-RT patients. Conclusion: QoL, functional capacity, degree of obesity, and endocrinopathy varied over time from diagnosis, but by 5 years, there was no significant difference between PBT and XRT upfront or delayed, nor was there any compromise in historic survival rates, which remained high >90%. RT of any type is extremely effective at stabilizing disease after hypothalamic-sparing surgery. The purported specific benefits of PBT-reducing sequelae are not proven in this study where the organ of critical interest is itself diseased, increasing an urgent need to better address and treat the tumor-induced endocrine harm from diagnosis in dedicated pituitary services. Other hypothesized benefits of PBT versus XRT on vascular events and secondary cancers await longer comparison. Clinical trial registration number: https://clinicaltrials.gov/study/, identifier NCT01272622.
RESUMEN
PURPOSE: To examine the dosimetric feasibility of hypofractionated/dose escalated radiation therapy in patients with localized prostate carcinoma using simultaneous integrated boost intensity-modulated proton beam therapy (SIB-IMPT) in absence or presence of prostate-rectum spacer. METHODS: IMPT technique was implemented in 23 patients with intermediate- and high-risk prostate cancer treated at West German Proton Therapy Centre from March 2016 till June 2018, using SIB technique prescribing 60 GyRBE and 72â¯GyRBE in 30 fractions to PTV1 (prostate and seminal vesicle) and PTV2 boost (prostate and proximal seminal vesicle), respectively. In 15 patients, a transperineal injection of hydrogel was applied prior to radiotherapy to increase the distance between prostate and rectum. Planning and all treatments were performed with a 120 ml fluid-filled endorectal balloon customised daily for each patient. For each patient, 2 lateral IMPT beams were implemented taking a field-specific range uncertainty (RU) into account. Dose volume histograms (DVH) were analyzed for PTV2, PTV2 with range uncertainty margin (PTV2RU), rectum, bladder, right/left femoral heads, and penile bulb. For late rectal toxicities, the normal tissue complication probabilities (NTCP) were calculated using different biological models. A DVH- and NTCP-based dosimetric comparison was carried out between non-spacer and spacer groups. RESULTS: For the 23 patients, high-quality plans could be achieved for target volume and for other organs at risk (OARs). For PTV2, the V107% was 0% and the Dmax did not exceed 106.2% of the prescribed dose. The volume PTV2RU covered by 95% of the dose ranged from 96.16 to 99.95%. The conformality index for PTV2RU was 1.12 ± 0.057 and the homogeneity index (HI) was 1.04 ± 0.014. Rectum Dmax and rectal volume receiving 73-50 Gy could be further reduced for the spacer-group. Significant reductions in mean and median rectal NTCPs (stenosis/necrosis, late rectal bleeding ≥ 2, and late rectal toxicities ≥ 3) were predicted for the spacer group in comparison to the non-spacer group. CONCLUSION: Hypofractionated/dose escalated radiotherapy with SIB-IMPT is dosimetrically feasible. Further reduction of the rectal volumes receiving high and medium dose levels (73-50 Gy) and rectal NTCP could be achieved through injection of spacers between rectum and prostate.
Asunto(s)
Neoplasias de la Próstata , Terapia de Protones , Estudios de Factibilidad , Humanos , Hidrogeles , Masculino , Próstata/patología , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/radioterapia , Planificación de la Radioterapia Asistida por Computador/métodos , Recto/patologíaRESUMEN
The combination of in situ spectrophotometry during film deposition and ex situ spectrophotometry allows insight into the depth distribution of optical losses in plasma ion assisted deposition coatings. An adapted optical characterization strategy for absorbing coatings using only in situ transmittance data has been developed and is exemplified in application to magnesium fluoride coatings. Measurements and simulation results strongly indicate an increased absorption caused by local understoichiometry of the fluoride material close to the fused silica substrate.
RESUMEN
We realized metal fluoride coatings with a high packing density and a low extinction coefficient by plasma (ion)-assisted deposition. The densification can be performed by different types of plasma sources, e.g., by a Leybold LION source and a Leybold APSpro, respectively. But the as-deposited coatings show a characteristic absorption behavior, whereas the absorption losses can be reduced in a postdeposition UV treatment step. We show experimental results of the plasma-assisted metal fluorides before and after the UV treatment and present a new model that allows us to describe and calculate the characteristic absorption losses of LaF3, MgF2, and AlF3.
RESUMEN
Material mixtures offer new possibilities for synthesizing coating materials with tailored optical and mechanical properties. We present experimental results on mixtures of HfO2, ZrO2, and Al2O3, pursuing applications in UV coating technology, while the mixtures are prepared by magnetron sputtering, ion beam sputtering, plasma ion-assisted deposition (PIAD), and electron beam evaporation without assistance. The properties investigated include the refractive index, optical gap, thermal shift, and mechanical stress. The first high reflectors for UV applications have been deposited by PIAD.