Hybrid planning techniques for early-stage left-sided breast cancer: dose distribution analysis and estimation of projected secondary cancer-relative risk.

PURPOSE: The purpose of this study was to evaluate three techniques of irradiation of left-sided breast cancer patients, three-dimensional conformal radiotherapy (3D-CRT), hybrid Intensity-Modulated Radiotherapy (h-IMRT), and hybrid Volumetric-Modulated Arc Therapy (h-VMAT, h-ARC), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim was to estimate the projected relative risk of radiation-induced secondary cancers for hybrid techniques. MATERIALS AND METHODS: Three treatment plans were prepared in 3D-CRT, h-IMRT, and h-VMAT techniques for each of the 40 patients, who underwent CT simulation in deep inspiration breath-hold (DIBH). For hybrid techniques, plans were created by combining 3D-CRT and dynamic fields with an 80%/20% dose ratio for 3D-CRT and IMRT or VMAT. Cumulative dose-volume histograms were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], left and right lung [LL, RL], right breast [RB]). Projected risk ratios for secondary cancers were estimated relative to 3D-CRT using the organ equivalent dose (OED) concept for the Schneider's linear exponential, plateau, and full mechanistic dose-response model. RESULTS: All plans fulfilled the PTV criterium: V95%≥95%. Compared to 3D-CRT, both hybrid techniques showed significantly better target coverage (PTV: V95%>98%, p < 0.001), and the best conformality was achieved by h-ARC plans (CI: 1.18 ± 0.09, p < 0.001). Compared to 3D-CRT and h-ARC, h-IMRT increased the average sum of monitor units (MU) over 129.9% (p < 0.001). H-ARC increased the mean dose of contralateral organs and the LL V5Gy parameter (p < 0.001). Both hybrid techniques significantly reduced the Dmax of the heart by 5 Gy. Compared to h-IMRT, h-ARC increased secondary cancer projected relative risk ratios for LL, RL, and RB by 18, 152, and 81%, respectively. CONCLUSIONS: The results confirmed that both hybrid techniques provide better target quality and OARs sparing than 3D-CRT. Hybrid VMAT delivers less MU compared to hybrid IMRT but may increase the risk of radiation-induced secondary malignancies.

Special Issues of "Materials for Luminescent Detectors and Transformers of Ionizing Radiation".

The papers published in the first and second Special Issues of "Materials for Luminescent Detectors and Transformers of Ionizing Radiation" were selected from the manuscripts related to the respective presentations at the 11th International Conference on Luminescent Detectors and Transformers of Ionizing Radiation (LUMDETR 2021), which was organized by the Institute of Physics of Kazimierz Wielki University of Bydgoszcz and Oncology Center prof [...].

Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients-comparative analysis of dose distribution and estimation of projected secondary cancer risk.

PURPOSE: The purpose of this study was to compare two techniques of irradiation of left-sided breast cancer patients who underwent breast-conserving surgery, three-dimensional conformal radiotherapy technique (3D-CRT) and volumetric modulated arc therapy (VMAT), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim of the study was estimation of the projected risk of radiation-induced secondary cancer for both radiotherapy techniques. MATERIALS AND METHODS: For 25 patients who underwent CT simulation in deep inspiration breath-hold (DIBH), three treatment plans were generated: one using a three-dimensional conformal radiotherapy technique and two using volumetric modulated arc therapy. First VMAT-DIBH geometry consisted of three partial arcs (ARC-DIBH 3A) and second consisted of four partial arcs (ARC-DIBH 4A). Cumulative dose-volume histograms (DVHs) were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], ipsilateral and contralateral lung [IL, CL], and contralateral breast [CB]). Normal tissue complication probabilities (NTCPs) and organ equivalent doses (OEDs) were calculated using the differential DVHs. Excess absolute risks (EARs) for second cancers were estimated using Schneider's full mechanistic dose-response model. RESULTS: All plans fulfilled the criterium for PTV V95% ≥ 95%. The PTV coverage, homogeneity, and conformity indices were significantly better for VMAT-DIBH. VMAT showed a significantly increased mean dose and V5Gy for all OARs, but reduced LAD Dmax by 15 Gy. For IL, CL, and CB, the 3D-CRT DIBH method achieved the lowest values of EAR: 28.38 per 10,000 PYs, 2.55 per 10,000 PYs, and 4.48 per 10,000 PYs (p < 0.001), compared to 40.29 per 10,000 PYs, 15.62 per 10,000 PYs, and 23.44 per 10,000 PYs for ARC-DIBH 3A plans and 41.12 per 10,000 PYs, 15.59 per 10,000 PYs, and 22.73 per 10,000 PYs for ARC-DIBH 4A plans. Both techniques provided negligibly low NTCPs for all OARs. CONCLUSION: The study shows that VMAT-DIBH provides better OAR sparing against high doses. However, the large low-dose-bath (≤ 5 Gy) is still a concern due to the fact that a larger volume of normal tissues exposed to lower doses may increase a radiation-induced risk of secondary cancer.

Basic Characteristics of Dose Distributions of Photons Beam for Radiotherapeutic Applications Using YAG:Ce Crystal Detectors.

Thermostimulated luminescence (TSL) dosimetry is a versatile tool for the assessment of dose from ionizing radiation. In this work, the Ce3+ doped Y3Al5O12 garnet (YAG:Ce) with a density ρ = 4.56 g/cm3 and effective atomic number Zeff = 35 emerged as a prospective TSL material in radiotherapy applications due to its excellent radiation stability, uniformity of structural and optical properties, high yield of TSL, and good position of main glow peak around 290-300 °C. Namely, the set of TSL detectors produced from the YAG:Ce single crystal is used for identification of the uniformity of dose and energy spectra of X-ray radiation generated by the clinical accelerator with 6 MV and 15 MV beams located in Radiotherapy Department at the Oncology Center in Bydgoszcz, Poland. We have found that the YAG:Ce crystal detects shows very promising results for registration of X-ray radiation generated by the accelerator with 6 MV beam. The next step in the research is connected with application of TSL detectors based on the crystals of much heavier garnets than YAG. It is estimated that the LuAG:Ce garnet crystals with high density ρ = 6.0 g/cm3 and Zeff = 62 can be used to evaluate the X-rays produced by the accelerator with the 15 MV beam.

Acute Lymphoblastic Leukemia in Children: Better Transplant Outcomes After Total Body Irradiation-based Conditioning.

BACKGROUND/AIM: Comparison of transplant outcomes in long-term follow-up of children after total body irradiation (TBI)- or chemotherapy-based conditioning allogeneic hematopoietic cell transplantation (allo-HCT). PATIENTS AND METHODS: Patients undergoing allo-HCT for Acute lymphoblastic leukemia (ALL) conditioned either with TBI (n=55) or chemotherapy (n=84) were compared. The following transplant outcomes were analyzed: overall survival (OS), event-free survival (EFS), relapse incidence (RI), and graft-versus-host-disease (GVHD)-free-relapse-free survival (GRFS). RESULTS: All analyzed long-term transplant outcomes were significantly better for patients conditioned with TBI at 2 years after transplant. OS at 2 years was 84% after TBI and 60.5% after chemotherapy-conditioning (p=0.005). Risk factor analysis showed that two factors, TBI-based conditioning and transplant in first remission of ALL, significantly improved OS, EFS, GRFS, and decreased RI. CONCLUSION: TBI-based conditioning before allogeneic HCT in children with acute lymphoblastic leukemia provides significantly better transplant outcomes, when compared to chemotherapy-based conditioning.

Comparative analysis of the absorbed dose in the heart and anterior descending branch of the left coronary artery (LAD) in patients with left-sided breast cancer who received radiotherapy using 3D-CRT, IMRT and VMAT techniques.

PURPOSE: The purpose of this study was to compare the absorbed dose distributions within the heart and lad in patients with left-sided breast cancer who underwent radiotherapy using 3D-CRT, IMRT and VMAT techniques. METHODS: The treatment plans of 11 patients with left-sided breast cancer were analyzed. All of the patients were irradiated in our facility with DIBH 3D-CRT. For all patients the plans in the IMRT (sliding window) and VMAT (Rapid Arc - Varian) techniques were prepared. Cumulative dose-volume histograms (DVH) were used to compare the dose distributions between the plans for each patient. Statistical analysis was carried out using the one-way ANOVA with repeated measurements and Tukey's post hoc test. RESULTS: The use of IMRT and VMAT techniques allowed for a better coverage of the PTV with 95% isodose and a more homogeneous dose distribution compared to the 3D-CRT technique. The use of dynamic technique (IMRT or VMAT) did not provide significant protection for OARs - only the dose absorbed in LAD was slightly lower. CONCLUSION: The use of 3D-CRT allows better protection of critical organs compared to other techniques, except for the dose in the lad artery which was the lowest in IMRT technique. exposure of large tissue volumes to so-called low radiation doses is undoubtedly a disadvantage of using dynamic techniques.

Orientation Dependence of Cathodoluminescence and Photoluminescence Spectroscopy of Defects in Chemical-Vapor-Deposited Diamond Microcrystal.

Point defects, impurities, and defect-impurity complexes in diamond microcrystals were studied with the cathodoluminescence (CL) spectroscopy in the scanning electron microscope, photoluminescence (PL), and Raman spectroscopy (RS). Such defects can influence the directions that microcrystals are grown. Micro-diamonds were obtained by a hot-filament chemical vapor deposition (HF CVD) technique from the methane-hydrogen gas mixture. The CL spectra of diamond microcrystals taken from (100) and (111) crystallographic planes were compared to the CL spectrum of a (100) oriented Element Six diamond monocrystal. The following color centers were identified: 2.52, 2.156, 2.055 eV attributed to a nitrogen-vacancy complex and a violet-emitting center (A-band) observed at 2.82 eV associated with dislocation line defects, whose atomic structure is still under discussion. The Raman studies showed that the planes (111) are more defective in comparison to (100) planes. What is reflected in the CL spectra as (111) shows a strong band in the UV region (2.815 eV) which is not observed in the case of the (100) plane.

The use of hyaluronic acid hydrogel as a tumour bed marker in breast-conserving therapy.

PURPOSE: To evaluate usefulness of hyaluronic acid (HA) hydrogel as a tumour bed marker in breast conserving therapy (BCT). To analyze inter- (Inter-OV) and intraobserver (Intra-OV) variability of contouring boost target volume (CTVboost) in external beam radiotherapy (EBRT). MATERIALS AND METHODS: Thirty-two patients in the HA group and 30 patients in the control group with an early stage breast cancer were included in the study. During the surgery 1-3 ml of HA hydrogel was injected into breast to mark the tumour bed for every patient in the HA group. Moreover, surgical clips were placed underneath the lumpectomy cavity. Patients in the control group were marked only by metal markers. Three radiation oncologists delineated CTVboost twice for every patient. Three parameters were calculated to quantify contouring variability: coefficient of variation for volumes (COVV), center of mass displacement (CoMd) and conformity index (CI). RESULTS: There were no significant differences between mean values of COVV for HA and control group, neither for Intra-OV (0.14 vs 0.13) nor Inter-OV (0.19 vs 0.18) calculations. The mean CoMd were 6.1 mm and 9.1 mm for Inter-OV calculations and 3.9 mm and 6.4 mm for Intra-OV in the HA and the control group respectively. The mean CI for Intra-OV improved from 0.61 to 0.65 and from 0.47 to 0.56 for Inter-OV in the control and HA group respectively. CONCLUSION: HA hydrogel used as a tumour bed marker improves tumour bed visibility and reduces inter- and intraobserver variability of EBRT boost target volume delineations.

The effect of radiotherapy and hormone therapy on osteopontin concentrations in prostate cancer patients.

PURPOSE: To evaluate and compare plasma osteopontin (OPN, a candidate prostate cancer biomarker) levels in prostate cancer patients receiving radiotherapy or combined radiotherapy or hormone therapy. METHODS: OPN levels were determined by ELISA in 40 prostate cancer patients eligible for radiotherapy (n=18 radiotherapy alone, n=22 combined radiotherapy and hormone therapy) before the start of irradiation, during treatment, and one month after its completion. RESULTS: OPN levels were significantly higher (p=0.02) in prostate cancer patients after receiving radiotherapy compared to baseline. In a subgroup analysis, there were no differences in OPN levels before and after treatment in patients undergoing radiotherapy alone, but OPN levels were significantly higher in patients after radiotherapy with hormone therapy compared to baseline (p=0.04) and in patients during radiotherapy compared to baseline (p=0.03). CONCLUSIONS: Radiotherapy can increase plasma OPN concentrations in patients with prostate cancer, and radiotherapy may interact with hormone therapy to increase OPN concentrations. These differences suggest that OPN is worthy of further study as a predictive biomarker.

Visualization of dose distribution in intraoperative electron beam Radiotherapy based on ultrasound images.

PURPOSE: The purpose of this study was to develop a method for dose distribution visualization in the case of Electron Beam Intraoperative Radiotherapy based on the images obtained in the operating room. This cannot be relied on CT images obtained before surgery due to significant tissue deformation. METHODS: The ultrasound scanning is the only method to obtain 3-dimensional (3D) reconstruction of a patient's tissue under operating room conditions. We decided to apply this modality as a background to visualize 3D dose distribution in terms of intraoperative radiotherapy (IORT). Dose distribution was obtained on the basis of dosimetric measurements carried out in the water phantom (PDD curves, transversal profiles). RESULTS: The method which has been developed in our department helps optimize the treatment. The amount of information depends strongly on the quality of the ultrasound image. We have verified the method (spatial correctness of dose painting) using commercially available phantom typically used for performance and quality assurance in ultrasound imaging (CIRS) and we noticed good correlation between 3D dose distribution and ultrasound image. CONCLUSIONS: Using up-to-date ultrasound tissue images allows better treatment optimization compared to the previous method that uses pre-surgery scans (CT or MRI). It helps optimize the angle of the beam axis and choose the beam with adequate range (energy) and avoid the risk of inaccurate irradiation of the area of interest.

Anatomy-corresponding method of IMRT verification.

BACKGROUND: During a proper execution of dMLC plans, there occurs an undesired but frequent effect of the dose locally accumulated by tissue being significantly different than expected. The conventional dosimetric QA procedures give only a partial picture of the quality of IMRT treatment, because their solely quantitative outcomes usually correspond more to the total area of the detector than the actually irradiated volume. AIM: The aim of this investigation was to develop a procedure of dynamic plans verification which would be able to visualize the potential anomalies of dose distribution and specify which tissue they exactly refer to. MATERIALS & METHODS: The paper presents a method discovered and clinically examined in our department. It is based on a Gamma Evaluation concept and allows accurate localization of deviations between predicted and acquired dose distributions, which were registered by portal as well as film dosimetry. All the calculations were performed on the self-made software GammaEval, the γ-images (2-dimensional distribution of γ-values) and γ-histograms were created as quantitative outcomes of verification. RESULTS: Over 150 maps of dose distribution have been analyzed and the cross-examination of the gamma images with DRRs was performed. CONCLUSIONS: It seems, that the complex monitoring of treatment would be possible owing to the images obtained as a cross-examination of γ-images and corresponding DRRs.