Chemobrachyradiotherapy and consolidation chemotherapy in treatment of locally advanced cervical cancer : A retrospective single institution study.

BACKGROUND: Given the lack of primary and secondary prevention programs and cancer awareness in general, cervical cancer remains one of the main causes of cancer-related death in developing countries, such as Bosnia and Herzegovina. Optimization of combinations of external radiation therapy (ERT), brachytherapy and chemotherapy is still needed to improve outcomes in the treatment of advanced cervical cancer. PATIENTS AND METHODS: We retrospectively analyzed 48 consecutive patients with Fédération Internationale de Gynecologie et d'Obstetrique (FIGO) 2009 stage IB2-IVA, who were treated with primary concomitant chemobrachyradiotherapy (CCBRT) and consolidation chemotherapy at the Department of Oncology, University Hospital Mostar, Bosnia and Herzegovina between December 2012 and June 2020. Patients were treated with ERT plus two cycles of concomitant chemobrachytherapy with ifosfamide and cisplatin and low-dose rate (LDR) brachytherapy followed by four cycles of consolidation chemotherapy at 3­week intervals. We evaluated local control rate (LCR), disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS) and toxicity. RESULTS: After 45.5 months (interquartile range, IQR = 47 months) of median follow-up, 5­year DFS was 72.8% (95% confidence interval. CI 59-78%), OS was 76.6% (95% CI 60-79%), and DSS was 88% (95% CI 71-86%) with acceptable toxicity. LCR was 94%. CONCLUSION: Primary CCBRT and consolidation chemotherapy applied in standard clinical practice in the treatment of locally advanced cervical cancer (LACC) produce respectable outcomes.

Lead Exposure Influences Serum Biomarkers, Hepatocyte Survival, Bone Marrow Hematopoiesis, and the Reproductive Cycle in Japanese Quails.

Lead toxicity has been a hallmark issue of toxicology over the last decades. However, predictive and non-robust models did not provide complete data on low-dose lead interaction with the organism at different functional levels (e.g., blood-serum-liver-bone marrow-bursa fabricii-reproductive system axis). Japanese quails are an animal model with a strong immune system, making them suitable for the thorough assessment of in vivo chronic lead toxicity. In this study, we have exposed Japanese quails via water ingestion to 0.25 and 0.5 µg/mL lead(II) chloride (PbCl2) for 20 days and assessed blood cells, serum biomarkers, hepatocyte survival, bone marrow hematopoiesis, bursa fabricii, and lead accumulation in eggs. Blood cells passed through morphological alterations (loss and inversion of the erythrocyte nucleus, multiple erythrocyte and thrombocyte aggregation, lymphocyte degradation, and blast cell infiltration). In the serum, PbCl2 increased the activity of creatine kinase (CK) and lactate dehydrogenase (LDH); increased the level of cholesterol, sodium, creatinine, and urea; and reduced the level of proteins, triglycerides, chloride, potassium, calcium, and alkaline phosphatase (ALP) activity (P < 0.05). Liver tissue of the exposed animals exhibited apparent death of hepatocytes. In the bone marrow, macrophages and heterophils contained a vast number of the infiltrated/uptaken granules upon PbCl2 exposure. Ultimately, PbCl2 exposure elicited a series of events observed first in the blood and serum parameters and later translated to the hematopoietic centers.

A Method of High-Resolution Radiotherapy Delivery Fluences with a Pair of Fields with Orthogonal Collimator Settings: A Study on Ten Head-and-Neck Cancer Patients.

CONTEXT: Introduction of dual-layer multileaf collimator (MLC) radiotherapy linear accelerators into clinical practice is an important development in advanced external beam radiotherapy. A method of delivering comparable high-resolution fluences with a single-layer MLC is presented. AIMS: The aims of this study are to present new algorithms and approaches to define high-resolution hypermodulated fluences, obtain orthogonal decomposition of fluences, and deliver them on a linear accelerator with single MLC from two perpendicular collimator settings. MATERIALS AND METHODS: High-resolution fluences were defined using Monte Carlo (MC) calculation. A novel use of a limited-memory, bounded, Broyden-Fletcher-Goldfarb-Shanno algorithm was used to decompose such fluences to ones deliverable with a pair of fields with mutually orthogonal collimator settings. Such a technique, here named cross motion leaf calculator (XMLC), is compared against single sliding window (SSW) technique typically used in intensity-modulated radiation therapy (IMRT). An electronic portal imaging device (EPID) is used, and the results were compared with gamma analysis. Furthermore, MC was used to determine dose distributions for computed tomography images of ten head-and-neck cancer patients. RESULTS: Gamma analysis (3%, 3 mm) against ideal fluence is considerably more favorable to XMLC (94% ± 4%) versus SSW (76% ± 5%). Furthermore, the dose-volume histogram (DVH) analysis showed that XMLC enables delivery of fluences superior to that of IMRT and these results in clinically relevant enhancements in DVH results. CONCLUSIONS: At the time of writing of this study, there were more than 12,000 medical linear accelerators in clinical use, and XMLC can prove itself useful wherever linac is equipped with MLC but cannot delivery latest techniques, such as volumetric modulated arc therapy.

CT protocols and radiation doses for hematuria and urinary stones: Comparing practices in 20 countries.

PURPOSE: Patients with hematuria and renal colic often undergo CT scanning. The purpose of our study was to assess variations in CT protocols and radiation doses for evaluation of hematuria and urinary stones in 20 countries. METHOD: The International Atomic Energy Agency (IAEA) surveyed practices in 51 hospitals from 20 countries in the European region according to the IAEA Technical cooperation classification and obtained following information for three CT protocols (urography, urinary stones, and routine abdomen-pelvis CT) for 1276 patients: patient information (weight, clinical indication), scanner information (scan vendor, scanner name, number of detector rows), scan parameters (such as number of phases, scan start and end locations, mA, kV), and radiation dose descriptors (CTDIvol, DLP). Two radiologists assessed the appropriateness of clinical indications and number of scan phases using the ESR Referral Guidelines and ACR Appropriateness Criteria. Descriptive statistics and Student's t tests were performed. RESULTS: Most institutions use 3-6 phase CT urography protocols (80 %, median DLP 1793-3618 mGy.cm) which were associated with 2.4-4.9-fold higher dose compared to 2-phase protocol (20 %, 740 mGy.cm) (p < 0.0001). Likewise, 52 % patients underwent 3-5 phase routine abdomen- pelvis CT (1574-2945 mGy.cm) as opposed to 37 % scanned with a single-phase routine CT (676 mGy.cm). The median DLP for urinary stones CT (516 mGy.cm) were significantly lower than the median DLP for the other two CT protocols (p < 0.0001). CONCLUSIONS: Few institutions (4/13) use low dose CT for urinary stones. There are substantial variations in CT urography and routine abdomen-pelvis CT protocols result in massive radiation doses (up to 2945-3618 mGy.cm).