Multivariate multiscale entropy (mMSE) as a tool for understanding the resting-state EEG signal dynamics: the spatial distribution and sex/gender-related differences.

BACKGROUND: The study aimed to determine how the resting-state EEG (rsEEG) complexity changes both over time and space (channels). The complexity of rsEEG and its sex/gender differences were examined using the multivariate Multiscale Entropy (mMSE) in 95 healthy adults. Following the probability maps (Giacometti et al. in J Neurosci Methods 229:84-96, 2014), channel sets have been identified that correspond to the functional networks. For each channel set the area under curve (AUC), which represents the total complexity, MaxSlope-the maximum complexity change of the EEG signal at thefine scales (1:4 timescales), and AvgEnt-to the average entropy level at coarse-grained scales (9:12 timescales), respectively, were extracted. To check dynamic changes between the entropy level at the fine and coarse-grained scales, the difference in mMSE between the #9 and #4 timescale (DiffEnt) was also calculated. RESULTS: We found the highest AUC for the channel sets corresponding to the somatomotor (SMN), dorsolateral network (DAN) and default mode (DMN) whereas the visual network (VN), limbic (LN), and frontoparietal (FPN) network showed the lowest AUC. The largest MaxSlope were in the SMN, DMN, ventral attention network (VAN), LN and FPN, and the smallest in the VN. The SMN and DAN were characterized by the highest and the LN, FPN, and VN by the lowest AvgEnt. The most stable entropy were for the DAN and VN while the LN showed the greatest drop of entropy at the coarse scales. Women, compared to men, showed higher MaxSlope and DiffEnt but lower AvgEnt in all channel sets. CONCLUSIONS: Novel results of the present study are: (1) an identification of the mMSE features that capture entropy at the fine and coarse timescales in the channel sets corresponding to the main resting-state networks; (2) the sex/gender differences in these features.

The less complex temporal patterns of resting­state EEG activity, the lower the visual temporal order threshold.

Speech understanding, watching a movie, listening to music etc., requires perception of the temporal order of at least two incoming events. A history of performing these tasks may be reflected in spontaneous brain activity. Here, we examined the relationship between the complexity (temporal dynamics) of resting­state EEG (rsEEG) signal, assessed using the multivariate MultiScale Entropy (mMSE) algorithm, and the perception of event ordering, indexed by a visual temporal order threshold (TOT), i.e., the minimum duration necessary to correctly identify the before­after relation between two stimuli. Healthy adolescents and young adults performed a psychophysical task measuring the TOT and underwent an eyes­closed rsEEG study. The features of mMSE vectors, namely the area under curve (AUC) that represents total signal complexity, as well as the MaxSlope and the AvgEnt, corresponding to the entropy at fine­ and coarse­grained timescales, respectively, were obtained for the central (midline), anterior, middle and posterior channel sets. The greater the AUC and AvgEnt values in the central, left and right posterior areas, and the higher AUC in the right middle region, the higher the TOT. The most significant relationships were found for the midline electrodes (Fz, Cz, Pz, Oz). There were no significant correlations between the MaxSlope values and the TOT. To the best of our knowledge, this is the first study demonstrating that spontaneous EEG signal complexity is associated with the temporal order perception of two stimuli presented in rapid succession. Our findings may indicate that low total and coarse entropy levels of rsEEG signal are beneficial for visual temporal order judgments.

Co-Delivery of 8-Hydroxyquinoline Glycoconjugates and Doxorubicin by Supramolecular Hydrogel Based on α-Cyclodextrin and pH-Responsive Micelles for Enhanced Tumor Treatment.

The sustained release of multiple anti-cancer drugs using a single delivery carrier to achieve a synergistic antitumor effect remains challenging in biomaterials and pharmaceutics science. In this study, a supramolecular hydrogel based on the host-guest complexes between pH-responsive micelle derived poly(ethylene glycol) chains and α-cyclodextrin was designed for codelivery of two kinds of anti-cancer agents, hydrophilic 8-hydroxyquinoline glycoconjugate and hydrophobic doxorubicin. The host-guest interactions were characterized using X-ray diffraction and differential scanning calorimetry techniques. The resultant supramolecular hydrogel showed thixotropic properties, which are advantageous to drug delivery systems. In vitro release studies revealed that the supramolecular hydrogel exhibited faster drug release profiles in acidic conditions. The MTT assay demonstrated a synergistic cancer cell proliferation inhibition of DOX/8HQ-Glu mixture. In vitro cytotoxicity studies indicated excellent biocompatibility of the supramolecular hydrogel matrix, whereas the DOX/8HQ-Glu-loaded supramolecular hydrogel showed a sustained inhibition efficacy against cancer cells. The codelivery of hydrophobic anti-cancer drugs and hydrophilic anti-cancer drug glycoconjugates via a pH-responsive supramolecular hydrogel opens up new possibilities for the development of an effective cancer treatment based on the tumor-specific Warburg effect.

Treatment-integrated imaging, radiomics, and personalised radiotherapy: the future is at hand.

Since the introduction of computed tomography for planning purposes in the 1970s, we have been observing a continuous development of different imaging methods in radiotherapy. The current achievements of imaging technologies in radiotherapy enable more than just improvement of accuracy on the planning stage. Through integrating imaging with treatment machines, they allow advanced control methods of dose delivery during the treatment. This article reviews how the integration of existing and novel forms of imaging changes radiotherapy and how these advances can allow a more individualised approach to cancer therapy. We believe that the significant challenge for the next decade is the continued integration of a range of different imaging devices into linear accelerators. These imaging modalities should show intra-fraction changes in body morphology and inter-fraction metabolic changes. As the use of these more advanced, integrated machines grows, radiotherapy delivery will become more accurate, thus resulting in better clinical outcomes: higher cure rates with fewer side effects.

The utility of 18F-FDG PET/CT in brain tumours diagnosis.

Background: The purpose of the study was to discuss whether 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) study protocol should include brain imaging. Materials and methods: Analysis of international societies recommendations compared with the original data obtained in over 1000 consecutive torso and brain 18F-FDG PET/CT studies collected in 2010. Results: According to the international societies recommendations, the 18F-FDG should not be the radiotracer of choice considering the brain region PET/CT study. However, it can be performed as an additional brain imaging tool. Based on at least a 3-year follow-up, we detected 8 cases of suspicious brain findings and no primary lesion among over 1000 consecutive torso and brain 18F-FDG PET/CT scans performed in 2010. However, in 5 out of 8 patients, the brain lesion was the only metastasis detected, affecting further therapy. Conclusions: The 18F-FDG PET/CT study may help detect malignant brain lesions and, therefore, including brain region imaging into the study protocol should be considered.

Resting-state fMRI functional connectivity of the left temporal parietal junction is associated with visual temporal order threshold.

The study aimed to determine the relationship between the millisecond timing, measured by visual temporal order threshold (TOT), i.e. a minimum gap between two successive stimuli necessary to judge a before-after relation, and resting-state fMRI functional connectivity (rsFC). We assume that the TOT reflects a relatively stable feature of local internal state networks and is associated with rsFC of the temporal parietal junction (TPJ). Sixty five healthy young adults underwent the visual TOT, fluid intelligence (Gf) and an eyes-open resting-state fMRI examination. After controlling for the influence of gender, the higher the TOT, the stronger was the left TPJ's rsFC with the left postcentral and the right precentral gyri, bilateral putamen and the right supplementary motor area. When the effects of Gf and TOT × Gf interaction were additionally controlled, the TOT-left TPJ's rsFC relationship survived for almost all above regions with the exception of the left and right putamen. This is the first study demonstrating that visual TOT is associated with rsFC between the areas involved both in sub-second timing and motor control. Current outcomes indicate that the local neural networks are prepared to process brief, rapidly presented, consecutive events, even in the absence of such stimulation.

Prediction of Incomplete Response of Primary Tumour Based on Clinical and Radiomics Features in Inoperable Head and Neck Cancers after Definitive Treatment.

Radical treatment of patients diagnosed with inoperable and locally advanced head and neck cancers (LAHNC) is still a challenge for clinicians. Prediction of incomplete response (IR) of primary tumour would be of value to the treatment optimization for patients with LAHNC. Aim of this study was to develop and evaluate models based on clinical and radiomics features for prediction of IR in patients diagnosed with LAHNC and treated with definitive chemoradiation or radiotherapy. Clinical and imaging data of 290 patients were included into this retrospective study. Clinical model was built based on tumour and patient related features. Radiomics features were extracted based on imaging data, consisting of contrast- and non-contrast-enhanced pre-treatment CT images, obtained in process of diagnosis and radiotherapy planning. Performance of clinical and combined models were evaluated with area under the ROC curve (AUROC). Classification performance was evaluated using 5-fold cross validation. Model based on selected clinical features including ECOG performance, tumour stage T3/4, primary site: oral cavity and tumour volume were significantly predictive for IR, with AUROC of 0.78. Combining clinical and radiomics features did not improve model's performance, achieving AUROC 0.77 and 0.68 for non-contrast enhanced and contrast-enhanced images respectively. The model based on clinical features showed good performance in IR prediction. Combined model performance suggests that real-world imaging data might not yet be ready for use in predictive models.

Plan quality assessment in clinical practice: Results of the 2020 ESTRO survey on plan complexity and robustness.

PURPOSE: Plan complexity and robustness are two essential aspects of treatment plan quality but there is a great variability in their management in clinical practice. This study reports the results of the 2020 ESTRO survey on plan complexity and robustness to identify needs and guide future discussions and consensus. METHODS: A survey was distributed online to ESTRO members. Plan complexity was defined as the modulation of machine parameters and increased uncertainty in dose calculation and delivery. Robustness was defined as a dose distribution's sensitivity towards errors stemming from treatment uncertainties, patient setup, or anatomical changes. RESULTS: A total of 126 radiotherapy centres from 33 countries participated, 95 of them (75%) from Europe and Central Asia. The majority controlled and evaluated plan complexity using monitor units (56 centres) and aperture shapes (38 centres). To control robustness, 98 (97% of question responses) photon and 5 (50%) proton centres used PTV margins for plan optimization while 75 (94%) and 5 (50%), respectively, used margins for plan evaluation. Seventeen (21%) photon and 8 (80%) proton centres used robust optimisation, while 10 (13%) and 8 (80%), respectively, used robust evaluation. Primary uncertainties considered were patient setup (photons and protons) and range calculation uncertainties (protons). Participants expressed the need for improved commercial tools to control and evaluate plan complexity and robustness. CONCLUSION: Clinical implementation of methods to control and evaluate plan complexity and robustness is very heterogeneous. Better tools are needed to manage complexity and robustness in treatment planning systems. International guidelines may promote harmonization.

Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol "Best for Adaptive Radiotherapy" in Head and Neck Cancer.

No clear criteria have yet been established to guide decision-making for patient selection and the optimal timing of adaptive radiotherapy (ART) based on image-guided radiotherapy (IGRT). We have developed a novel protocol­the Best for Adaptive Radiotherapy (B-ART) protocol­to guide patient selection for ART. The aim of the present study is to describe this protocol, to evaluate its validity in patients with head and neck (HN) cancer, and to identify the anatomical and clinical predictors of the need for replanning. We retrospectively evaluated 82 patients with HN cancer who underwent helical tomotherapy (HT) and subsequently required replanning due to soft tissue changes upon daily MVCT. Under the proposed criteria, patients with anatomical changes >3 mm on three to four consecutive scans are candidates for ART. We compared the volumes on the initial CT scan (iCT) and the replanning CT (rCT) scan for the clinical target volumes (CTV1, referring to primary tumor or tumor bed and CTV2, metastatic lymph nodes) and for the parotid glands (PG) and body contour (B-body). The patients were stratified by primary tumor localization, clinical stage, and treatment scheme. The main reasons for replanning were: (1) a planning target volume (PTV) outside the body contour (n = 70; 85.4%), (2) PG shrinkage (n = 69; 84.1%), (3) B-body deviations (n = 69; 84.1%), and (4) setup deviations (n = 40; 48.8%). The replanning decision was made, on average, during the fourth week of treatment (n = 47; 57.3%). The mean reductions in the size of the right and left PG volumes were 6.31 cc (20.9%) and 5.98 cc (20.5%), respectively (p < 0.001). The reduction in PG volume was ≥30% in 30 patients (36.6%). The volume reduction in all of the anatomical structures was statistically significant. Four variables­advanced stage disease (T3−T4), chemoradiation, increased weight loss, and oropharyngeal localization­were significantly associated with the need for ART. The B-ART protocol provides clear criteria to eliminate random errors, and to allow for an early response to relevant changes in target volumes.

Accuracy of the doses computed by the Eclipse treatment planning system near and inside metal elements.

Metal artefacts degrade clinical image quality which decreases the confidence of using computed tomography (CT) for the delineation of key structures for treatment planning and leads to dose errors in affected areas. In this work, we investigated accuracy of doses computed by the Eclipse treatment planning system near and inside metallic elements for two different computation algorithms. An impact of CT metal artefact reduction methods on the resulting calculated doses has also been assessed. A water phantom including Gafchromic film and metal inserts was irradiated (max dose 5 Gy) using a 6 MV photon beam. Three materials were tested: titanium, alloy 600, and tungsten. The phantom CT images were obtained with the pseudo-monoenergetic reconstruction (PMR) and the iterative metal artefact reduction (iMAR). Image sets were used for dose calculation using an Eclipse treatment planning station (TPS). Monte Carlo (MC) simulations were used to predict the true dose distribution in the phantom allowing for comparison with doses measured by film and calculated by TPS. Measured and simulated percentage depth doses (PDDs) were not statistically different (p > 0.618). Regional differences were observed at edges of metallic objects (max 8% difference). However, PDDs simulated with and without film were statistically different (p < 0.002). PDDs calculated by the Acuros XB algorithm based on the dose-to-medium approach best matched the MC reference regardless of the CT reconstruction methods and inserts used (p > 0.078). PDDs obtained using other algorithms significantly differ from the MC values (p < 0.011). The Acuros XB algorithm with a dose-to-medium approach provides reliable dose calculation in all metal regions when using the Varian system. The inability of the AAA algorithm to model backscatter dose significantly limits its clinical application in the presence of metal. No significant impact on the dose calculation was found for a range of metal artefact reduction strategies.

Dosimetric Comparison of Ultra-Hypofractionated and Conventionally Fractionated Radiation Therapy Boosts for Patients with High-Risk Prostate Cancer.

Recent comparison of an ultra-hypofractionated radiotherapy (UF-RT) boost to a conventionally fractionated (CF-RT) option showed similar toxicity and disease control outcomes. An analysis of the treatment plans for these patients is needed for evaluating calculated doses for different organs, treatment beam-on time, and requirements for human and financial resources. Eighty-six plans for UF-RT and 93 plans for CF-RT schemes were evaluated. The biologically equivalent dose, EQD2, summed for the first phase and the boost, was calculated for dose-volume parameters for organs at risk (OARs), as well as for the PTV1. ArcCHECK measurements for the boost plans were used for a comparison of planned and delivered doses. Monitor units and beam-on times were recorded by the Eclipse treatment planning system. Statistical analysis was performed with a significance level of 0.05. Dosimetric parameter values for OARs were well within tolerance for both groups. EQD2 for the PTV1 was on average 84 Gy for UF-RT patients and 76 Gy for CF-RT patients. Gamma passing rate for planned/delivered doses comparison was above 98% for both groups with 3 mm/3% distance to agreement/dose difference criteria. Total monitor units per fraction were 647 ± 94 and 2034 ± 570 for CF-RT and UF-RT, respectively. The total delivery time for boost radiation for the patients in the UF-RT arm was, on average, four times less than the total time for a conventional regimen with statistically equal clinical outcomes for the two arms in this study.

The 3rd ESTRO-EFOMP core curriculum for medical physics experts in radiotherapy.

PURPOSE: To update the 2011 ESTRO-EFOMP core curriculum (CC) for education and training of medical physics experts (MPE)s working in radiotherapy (RT), in line with recent EU guidelines, and to provide a framework for European countries to develop their own curriculum. MATERIAL AND METHODS: Since September 2019, 27 European MPEs representing ESTRO, EFOMP and National Societies, with expertise covering all subfields of RT physics, have revised the CC for recent advances in RT. The ESTRO and EFOMP Education Councils, all European National Societies and international stakeholders have been involved in the revision process. RESULTS: A 4-year training period has been proposed, with a total of 240 ECTS (European Credit Transfer and Accumulation System). Training entrance levels have been defined ensuring the necessary physics and mathematics background. The concept of competency-based education has been reinforced by introducing the CanMEDS role framework. The updated CC includes (ablative) stereotactic-, MR-guided- and adaptive RT, particle therapy, advanced automation, complex quantitative data analysis (big data/artificial intelligence), use of biological images, and personalized treatments. Due to the continuously increasing RT complexity, more emphasis has been given to quality management. Clear requirements for a research project ensure a proper preparation of MPE residents for their central role in science and innovation in RT. CONCLUSION: This updated, 3rd edition of the CC provides an MPE training framework for safe and effective practice of modern RT, while acknowledging the significant efforts needed in some countries to reach this level. The CC can contribute to further harmonization of MPE training in Europe.

Evaluation of the accuracy of dose delivery in stereotactic radiotherapy using the Velocity commercial software.

PURPOSE: The purpose of this study was to evaluate the accuracy of dose delivery during stereotactic radiotherapy of the lung (SBRT) and brain (SRT) tumours by registered CT (rCT) images obtained from CT used for planning (pCT) and cone-beam CT (CBCT). METHODS: The study is based on two groups of patients (10 patients each) undergoing SBRT and SRT. To assess the correctness of the propagation of the GTV (brain group) and ITV (lung group) contours, the volumes calculated on the pCT and rCT studies were analysed. The Dice-Sørensen similarity coefficient (DSC) was used to check the variability in the position of GTV/ITV observed between pCT and rCT. The dose recalculated on rCT was compared with the dose from pCT. RESULT: GTV and ITV determined on pCT and rCT studies did not differ statistically (p = 0.770 for ITV and p = 0.086 for GTV). DSC obtained for the lung group was statistically smaller than that for the brain group (p < 0.001). Differences between doses obtained for 99% of the ITV/GTV on pCT and rCT studies were within ±10% and did not exceed the clinically acceptable tolerance. CONCLUSION: The observed changes in the volume (ITV/GTV) were within the area of the original PTV volume. The differences between the planned and delivered doses in the ITV/GTV were not clinically significant.

Utility of deformable image registration for adaptive prostate cancer treatment. Analysis and comparison of two commercially available algorithms.

INTRODUCTION: This study aimed to assess and compare the capabilities of two commercially available deformable image registration algorithms implemented in Raystation 9A (A1) and Velocity AI (A2) for possible usage in adaptive prostate radiotherapy based on the propagation of anatomical contours from computed tomography (CT) images to cone-beam CT (CBCT) images. MATERIAL AND METHODS: Ten patients were retrospectively selected from a group treated for localized prostate cancer. The propagation of rectum contours was analyzed in a set of CT-CBCT pairs. Two independent observers carried out qualitative analysis using the two-level descriptive scale (meet/fail). Quantitative analysis was done using landmark points distances based on implanted markers as navigation points and differently obtained contours (manually and automatically using DIR algorithms). Quantitative analysis was taken on sets preselected by qualitative analysis. RESULTS: Qualitative analysis shows that 83.7% of the rectum contours were scored identically (meet or fail) for both algorithms, from which 53.5% and 55.8% are failed results for A1 and A2, respectively. For the rectum size (RWD parameter), differences between referenced and deformation-based values were 5.5 and 5.8mm, and for the rectum wall, the prostate marker distance (WMD parameter) was 4.5 and 5.5mm for A1 and A2, respectively. The differences between the WMD parameters were statistically significant (p=0.007). CONCLUSIONS: In both tested algorithms, neither effectiveness nor measured uncertainties in the propagation of rectum contour process in prostate patient cases were satisfactory. Careful selection of input images followed by case/set-based verification of every deformable registration is a substantial step to avoid inappropriate results.

The impact of different optimization strategies on the agreement between planned and delivered doses during volumetric modulated arc therapy for total marrow irradiation.

AIM OF THE STUDY: To evaluate the agreement between planned and delivered doses and its potential correlation with the plans' complexity subjected to dosimetric verification. MATERIAL AND METHODS: Four isocentre volumetric modulated arc therapy for total marrow irradiation plans optimized simultaneously with (P1) and without (P2) MU reduction were evaluated dosimetrically by γ method performed in a global mode for 4 combinations of γ-index criteria (2%/2 mm, 2%/3 mm, 3%/2 mm, and 3%/3 mm). The evaluation was conducted for 4 regions (head and neck, chest, abdomen and upper pelvis, and lower pelvis and thighs) that were determined geometrically by the isocentres. The Wilcoxon test was used to detect significant differences between γ passing rate (GPR) analysis results for the P1 and P2 plans. The Pearson correlation was used to check the relationship between GPR and the plans' complexity. RESULTS: Except for the head and neck region, the P2 plans had better GPRs than the P1 plans. Only for hard combinations of γ-index criteria (i.e. 2%/3 mm, 2%/2 mm) were the GPRs differences between P1 and P2 clinically meaningful, and they were detected in the chest, abdomen and upper pelvis, and lower pelvis and thighs regions. The highest correlations between GPR and the indices describing the plans' complexity were found for the chest region. No correlation was found for the head and neck region. CONCLUSIONS: The P2 plans showed better agreement between planned and delivered doses compared to the P1 plans. The GPR and the plans' complexity depend on the anatomy region and are most important for the chest region.

Detection of clinically silent brain lesions in [18F]FDG PET/CT study in oncological patients: analysis of over 10,000 studies.

The study aimed to show that including the brain region into the standard 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) study protocol may result in detecting clinically silent brain tumours. We retrospectively analyzed the group of 10,378 from the total of 12,011 consecutive patients who underwent the torso and brain [18F]FDG PET/CT scanning, considering an ability of the method to evaluate undetected before brain tumours in patients diagnosed and treated in our institution. While collecting the database, we followed the inclusion criteria: at least 1-year of follow-up, a full medical history collected in our institution, histopathologic examination or other studies available to confirm the type of observed lesion, and the most importantly-no brain lesions reported in the patients' medical data. In this study, performing the torso and brain [18F]FDG PET/CT imaging helped to detect clinically silent primary and metastatic brain tumours in 129 patients, and the benign lesions in 24 studied cases, in whom no suspicious brain findings were reported prior to the examination. In conclusion, including the brain region into the standard [18F]FDG PET/CT protocol can be considered helpful in detecting clinically silent malignant and benign brain tumours.

Primary and Metastatic Brain Tumours Assessed with the Brain and Torso [18F]FDG PET/CT Study Protocol-10 Years of Single-Institutional Experiences.

According to the international societies' recommendations, the 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) technique should not be used as the method of choice in brain tumour diagnosis. Therefore, the brain region can be omitted during standard [18F]FDG PET/CT scanning. We performed comprehensive literature research and analysed results from 14,222 brain and torso [18F]FDG PET/CT studies collected in 2010-2020. We found 131 clinically silent primary and metastatic brain tumours and 24 benign lesions. We concluded that the brain and torso [18F]FDG PET/CT study provides valuable data that may support therapeutic management by detecting clinically silent primary and metastatic brain tumours.

Differences between TNM classification and 2-[18F]FDG PET parameters of primary tumor in NSCLC patients.

BACKGROUND: The aim of the study was to compare the TNM classification with 2-[18F]FDG PE T biological parameters of primary tumor in patients with NSCLC. MATERIALS AND METHODS: Retrospective analysis was performed on a group of 79 newly diagnosed NSCLC patients. PET scans were acquired on Gemini TF PET/CT scanner 60-70 min after injection of 2-[18F]FDG with the mean activity of 364 ± 75 MBq, with the area being examined from the vertex to mid-thigh. The reconstructed PET images were evaluated using MIM 7.0 Software for SUVmax, MTV and TLG values. RESULTS: The analysis of the cancer stage according to TNM 8th edition showed stage IA2 in 8 patients, stage IA3 - 6 patients, stage IB - 4 patients, IIA - 3 patients, 15 patients with stage IIB, stage IIIA - 17 patients, IIIB - 5, IIIC - 5, IVA in 7 patients and stage IVB in 9 patients. The lowest TLG values of primary tumor were observed in stage IA2 (11.31 ± 15.27) and the highest in stage IIIC (1003.20 ± 953.59). The lowest value of primary tumor in SUVmax and MTV were found in stage IA2 (6.8 ± 3.8 and 1.37 ± 0.42, respectively), while the highest SUVmax of primary tumor was found in stage IIA (13.4 ± 11.4) and MTV in stage IIIC (108.15 ± 127.24). CONCLUSION: TNM stages are characterized by different primary tumor 2-[18F]FDG PET parameters, which might complement patient outcome.

Forecasting of the composite dose for organs at risk and solid targets with random movements during different image-guided scenarios of the photon radiation therapy. Solution for the Varian therapeutic line.

BACKGROUND: This study aims to develop a useful tool for robust plan analysis which includes the effects of soft tissue deformations on simulated dose distributions. The solution was benchmarked in the light of the commercial method implemented in EclipseTM treatment planning system (TPS). MATERIALS AND METHODS: Study was carried out on data of one patient with prostate-restricted cancer. The workflow of the procedure developed focused on three executive elements: in-house script to create a set of artificial CT images and for movement simulation of the CT V; the VelocityTM software for the calculations of the deformation matrixes and, then, to generate deformed CT sets; the EclipseTM TPS for dose re-calculations and analysis. Two scenarios were examined - first when the recalculation was done for the original geometry and second, when the isocentre from the original plan geometry was moved according to the movement of the CT V. The dose distributions were analysed on dose volume histograms (DVHs) in the light of the results obtained from the method implemented in the EclipseTM TPS. RESULTS: The DVHs from our methods are more informative than the DVH from commercially implemented tools. For the first scenario, the highest impact on dose uncertainty has boundary positions of the CT V to the CT V-PTV margin. Using the second scenario, it is the relation of the CT V position to the whole body that has the highest effect on dose uncertainty. CONCLUSION: Our method enables a more accurate analysis of the treatment plan robustness than the method currently implemented in EclipseTM TPS.

First case of acrometastases to the wrist reported from penile cancer.

Penile cancer is a rarely diagnosed cancer that affects 0.4%-0.6% of all male population. Metastases to the bones from various human cancers are common; however, acrometastases are extremely rare with the most common primary tumor from lung, kidney, and breast. We report the first case of a patient with acrometastases to the left wrist reported from penile cancer.