Third whole-brain radiation therapy for multiple brain metastases. Should it be considered in selected patients?

Whole brain reirradiation for the treatment of multiple brain metastases has shown promising results. However, concerns remain over the possible neurotoxic effects of the cumulative dose as well as the questionable radiosensitivity of recurrent metastases. A second reirradiation of the whole brain is ordinarily performed in our department for palliative purposes in patients presenting with multiple metastatic brain progression. For this study, an investigational third whole brain reirradiation has been administered to highly selected patients to obtain disease control and delay progression. Clinical outcomes and neurological toxicity were also evaluated.

Absorbed dose evaluation of a blood irradiator with alanine, TLD-100 and ionization chamber.

Irradiation of blood bags using X-ray irradiators and dosimetry services are required to ensure uniform dose levels in the range 25-50 Gy to prevent Transfusion Associated Graft versus Host Disease (TA-GvHD). An absorbed dose characterization of a Raycell MK2 X-Irradiator was performed using three different dosimetric systems. Results showed a dosimetric accuracy of the ionization chamber together with the Alanine dosimeter. TLDs measurements exhibited a small overestimation by 4% of the absorbed dose. The Dose Uniformity Ratio (DUR), between maximum and minimum dose levels in the canister, was in good agreement with the manufacturer specifications (≤1.5).

IGF-1 concentrations after weaning in young sows fed different pre-mating diets are positively associated with piglet mean birth weight at subsequent farrowing.

Pre-mating diets can influence piglet birth weight and within-litter birth weight variation and thereby piglet survival and development. The major objective of this study was to evaluate the litter characteristics of young sows whose pre-mating diets received different supplementation. The supplements included a top-dressing of 200 g, consisting of either wheat (CON) or wheat plus microfibrillated cellulose, L-carnitine or L-arginine at one of two supplementation levels (low and high) in late lactation and during the weaning-to-oestrus interval (WEI). The second objective was to investigate the role of body condition loss and IGF-1 concentration during the WEI for subsequent litter characteristics. In total, sows after their first (N =41) and second (N =15) lactation were used. One week before weaning, the sows were allocated to the seven treatments based on the number of piglets and BW loss from farrowing until 1 week before weaning. Pre-mating diets did not affect litter characteristics at subsequent farrowing. However, at subsequent farrowing, sows after their first lactation had a lower total number of piglets born per litter (18.3 v. 20.3), higher mean piglet birth weight (1365 v. 1253 g), lower CV of birth weight (20.0 v. 26.1%) and lower percentage of piglets <1000 g (11.5 v. 24.4%) than sows after their second lactation. Litter weight at second parturition was positively related to IGF-1 during the WEI after first lactation (P <0.04). Within parity, piglet mean birth weight was positively related to IGF-1 at oestrus (P <0.02). Surprisingly, within parity, a higher relative loin muscle depth loss during previous lactation was related to lower CV and SD of birth weight (P <0.05, for both). In conclusion, pre-mating diets did not affect litter characteristics at subsequent birth. However, a higher IGF-1 concentration during the WEI was positively associated with subsequent litter weight and piglet mean birth weight. Further studies should elucidate the role of IGF-1 during the WEI for subsequent litter characteristics and dietary interventions to stimulate IGF-1.

Personalized treatment planning in eye brachytherapy for ocular melanoma: Dosimetric analysis on ophthalmic structure at risk.

PURPOSE: To evaluate the impact on dose distribution to eye organs-at-risk (eOARs) of a computed tomography (CT)-based treatment planning in eye plaque brachytherapy (EPB) treatment. METHODS: We analyzed 19 ocular melanoma patients treated with ruthenium-106 plaques to a total dose of 100 Gy to tumor apex using conventional central-axis-point dose calculation. Treatments were re-planned using the Plaque Simulator (PS) software implementing two different strategies: a personalized CT-eye-model (CT-PS) and a standard-eye-model (SEM-PS) defined by Collaborative Ocular Melanoma Study. Dice coefficient and Hausdorff distance evaluated the concordance between eye-bulb-models. Mean doses (Dmean) to tumor and eOARs were extracted from Dose-Volume-Histograms and Retinal-Dose-Area-Histogram. Differences between planning approaches were tested by Wilcoxon signed-rank test. RESULTS: In the analyzed cohort, 8 patients (42%) had posterior tumor location, 8 (42%) anterior, and 3 (16%) equatorial. The SEM did not accurately described the real CT eye-bulb geometry (median Hausdorff distance 0.8 mm, range: (0.4-1.3) mm). Significant differences in fovea and macula Dmean values were found (p = 0.04) between CT-PS and SEM-PS schemes. No significant dosimetric differences were found for tumor and other eOARs. The planning scheme particularly affects the OARs closest to the tumor with a general tendency of SEM-PS to overestimate the doses to the OARs closest to the tumor. CONCLUSION: The dosimetric accuracy achievable with CT-PS EPB treatment planning may help to identify ocular melanoma patients who could benefit the most from a personalized eye dosimetry for an optimal outcome in terms of tumor coverage and eOARs sparing. Further research and larger studies are underway.

IGF-1 concentration patterns and their relationship with follicle development after weaning in young sows fed different pre-mating diets.

Piglet birth weight and within-litter birth weight variation are important for piglet survival and growth. Pre-mating diets may improve IGF-1 and follicle development during the weaning-to-oestrus interval (WEI) and subsequent piglet birth weight. The objective of this study was to modulate IGF-1 concentration during late lactation and the WEI of young sows by using specific pre-mating diets supplemented with microfibrillated cellulose (MF), l-carnitine (LC) or l-arginine (AR). A further objective was to investigate the relationship between IGF-1 and subsequent follicle development and oestrus and ovulation characteristics. In total, 56 first-parity and 20 second-parity sows in three consecutive batches were used for this experiment. Sows received daily either wheat (CON) or wheat plus MF, LC or AR at one of two supplementation levels (low and high) during last week of lactation and WEI. From weaning onwards, follicle and corpus luteum (CL) diameters were repeatedly measured with ultrasound. Blood samples were collected during the WEI for IGF-1 and on day 21 of pregnancy for progesterone analyses, respectively. Insulin-like growth factor-1 concentration, follicle diameter, oestrus and ovulation characteristics and CL diameter were not affected by pre-mating diets. Low IGF-1 class (≤156 ng/ml, N = 22) sows had smaller follicles at weaning (3.5 v. 3.8 mm, P < 0.05) and a longer weaning-to-ovulation interval (147.2 v. 129.8 h, P < 0.05) than high IGF-1 class sows. In first-parity sows, high loin muscle depth (LM) loss sows (≥8%, N = 28) had lower IGF-1 concentrations at weaning (167 v. 214 ng/ml, P < 0.05) compared to low LM loss sows (<8%, N = 28). However, after weaning, IGF-1 concentrations increased and did not differ between high LM loss and low LM loss sows. In conclusion, the different supplemented compounds in pre-mating diets did not improve IGF-1 concentrations around weaning in young sows. Furthermore, high body condition loss caused lower IGF-1 concentrations at weaning, but these levels rapidly recovered after weaning and were related to follicle development and the interval from weaning to ovulation.

Factors affecting piglet mortality during the first 24 h after the onset of parturition in large litters: effects of farrowing housing on behaviour of postpartum sows.

The present study aimed to identify the factors that affect immediate (within 24 h after farrowing onset) postnatal piglet mortality in litters with hyperprolific sows, and investigate their associations with behaviour of postpartum sows in two different farrowing housing systems. A total of 30 sows were housed in: (1) CRATE (n=15): the farrowing crate closed (0.80×2.20 m) within a pen (2.50×1.70 m), and (2) OPEN (n=15): the farrowing crate open (0.80×2.20×1.80 m) within a pen (2.50×2.40 m) with a provision of 20 ls of hay in a rack. A total of 518 live born piglets, produced from the 30 sows, were used for data analyses during the first 24 h after the onset of parturition (T24). Behavioural observations of the sows were assessed via video analyses during T24. Total and crushed piglet mortality rates were higher in OPEN compared with CRATE (P<0.01, for both). During T24, the OPEN sows tended to show higher frequency of postural changes (P=0.07) and duration of standing (P=0.10), and showed higher frequencies of bar-biting (P<0.05) and piglet trapping (P<0.01), when compared with the CRATE sows. During T24, the mortality rates caused by crushing were correlated with the piglet trapping event (r=0.93, P<0.0001), postural changes (r=0.37, P<0.01), duration of standing (r=0.32, P<0.01) and frequency of bar-biting behaviour (r=0.51, P<0.01) of the sows (n=30). In conclusion, immediate postnatal piglet mortality, mainly due to crushing, may be associated with potential increases in frequency of postural changes, duration of standing and incidence of piglet trapping in postpartum sows in the open crate system with large litters.

Late gestation diet supplementation of resin acid-enriched composition increases sow colostrum immunoglobulin G content, piglet colostrum intake and improve sow gut microbiota.

Resin acid-enriched composition (RAC) mainly containing tall oil fatty acid with an active component of resin acid (RA) can improve the microbial population in the digestive system, change the microbial fermentation, and improve the feed conversion ratio. We investigated the effects of dietary supplementation of RAC on sow colostrum yield (CY), colostrum composition and gut microbiota. Tall oil fatty acid and RA are commonly termed RAC and CLA, pinolenic, abietic, dehydrobiotic acids are characteristic components of RAC. The experiment was conducted in three trials in three respective herds. Sows were fed with a control diet and the same diet supplemented with 5 g RAC/day per sow during the last week of gestation. The 16S ribosomal RNA gene sequencing technique was used to assess sows' faecal microbiota populations at farrowing. Colostrum nutritional composition, acute phase proteins (APPs) and immunoglobulin (Ig) content were also assessed. Individual piglets were weighed at birth and 24 h after the birth of first piglets in order to calculate CY and later at 3 to 4 weeks to calculate average daily gain. The RAC-fed sows had significantly higher IgG levels (P0.05), but those fed RAC had higher levels of colostrum serum amyloid A. Colostrum yield was significantly higher in RAC-fed sows in herds 2 and 3 with heavier piglets between 3 and 4 weeks of age (P0.05). Resin acid-enriched composition supplementation significantly increased some beneficial and fermentative bacteria (Romboutsia and Clostridium sensu stricto) than the control diet (P<0.01) while some opportunistic pathogens (Barnesiella, Sporobacter, Intestinimonas and Campylobacter), including Proteobacteria, were suppressed. Therefore, RAC added to the sow diet at late pregnancy increases colostrum IgG, colostrum availability for neonate piglets, and seems to promote better maternal intestinal microbial sources.

The effect of farrowing duration and parity on preovulatory follicular size and oxytocin release of sows at subsequent oestrus.

This study examined the extent to which prolonged farrowing and parity are associated with plasma oxytocin concentrations and follicular development of oestrous sows during subsequent insemination. A total of 30 sows were allocated to two groups based on farrowing duration: (i) SHORT (n = 14): 159 ± 29 min, (ii) LONG (n = 16): 533 ± 190 min. The sows were also divided into two parity classes: (i) YOUNG (n = 14): parity 2.5 ± 0.8, (ii) OLD (n = 16): parity 6.4 ± 2.3. After weaning, the ovaries were examined daily with transrectal ultrasound. On the second day of oestrus, blood samples were collected for oxytocin (OT) assay at -15, -10, -5, 0, +1, +2, +3, +4, +6, +8, +10, +15, +20, +25, +30, +40, +50 and +60 min with a boar contact between 0 and +10 min. Boar presence stimulated an increase in OT concentrations (p < .05). During boar presence, OT in the LONG group was higher than in the SHORT group (p < .01). The sows in the OLD group had a longer farrowing duration than in the YOUNG group (p < .05). OT levels and diameters of follicles were more relevant for parity than was the duration of farrowing. We therefore conclude that the OT levels and follicular development of oestrous sows are associated due to parity but difficult to be predicted from the duration of previous farrowing.

Prolonged parturition and impaired placenta expulsion increase the risk of postpartum metritis and delay uterine involution in sows.

It was hypothesized that prolonged parturition and impaired placenta expulsion increase the risk of postpartum metritis and delay uterine involution. At parturition, for 99 Yorkshire x Large White sows (parity 2-5), we determined the number of liveborn (NLP; 14.8 ± 3.4) and stillborn piglets (NSP; 1.1 ± 1.1), farrowing duration (FAR, time between first and last piglet; 333 ± 249 min), placenta expulsion duration (PLA, time between first and last placental part; 292 ± 241 min) and number of expelled placental parts (PART; 3.0 ± 1.0). FAR was categorized as 'normal' (<300 min; n = 44/99) or 'prolonged' (>300 min; n = 55/99). The relative PLA (rPLA; (PLA * 100)/FAR; 76 ± 101%) and the relative PART (rPART; (PART * 100)/(NLP + NSP); 22 ± 8%) were calculated and placenta expulsion was categorized as 'normal' (rPLA and rPART > 10%; n = 93/99) or 'impaired' (relPLA and relPART < 10%; n = 6/99). We also recorded whether manual palpation occurred (Yes/No) and/or oxytocin was used (Yes/No). After parturition, an ultrasound examination of the uterus was performed once for each sow between the 2nd and 7th day postpartum and the uterine size (mean sectional area of three to five uterine cross-sections) and intrauterine fluid accumulation (Yes/No) were recorded. Uterine size was categorized as 'normal' (n = 55/99) or 'enlarged' (n = 44/99) and used as an indicator of delayed uterine involution. Intrauterine fluid was used as an indicator of metritis. Prolonged FAR (35/54, 2.0 ± 0.5, 13.1, 7.6; n/N, ß ± SE, Wald χ2, Odds; P = 0.001), manual palpation (12/17, 1.5 ± 0.7, 4.4, 4.3; P = 0.036), oxytocin administration (18/31, - 1.5 ± 0.7, 4.7, 0.2, P = 0.040) and NSP ≥ 2 (15/21, 1.4 ± 0.7, 3.8, 3.9; P = 0.052) were associated with increased uterine size (n = 44/99) and NSP ≥ 2 (7/21, 2.6 ± 0.9, 8.7, 13.7; P = 0.003), manual palpation (10/17, 1.8 ± 0.8, 5.0, 6.0; P = 0.025), prolonged FAR (13/15, 1.7 ± 0.8, 4.3, 5.7; P = 0.039) and impaired PLA (4/6, 3.3 ± 1.7, 4.0, 26.9; P = 0.044) with intrauterine fluid accumulation (n = 15/99). The results confirm the hypothesis, indicating that prolonged parturition and impaired placenta expulsion increased the risk for postpartum metritis. Stillborn piglets and manual palpation were also identified as risk factors. Postpartum metritis delays uterine involution whereas the use of exogenous oxytocin supports it.

Serial transvaginal ultrasound-guided biopsy of the porcine corpus luteum in vivo.

The aims of the present study was to develop and describe a transvaginal ultrasound-guided biopsy method for luteal tissue in the porcine and to evaluate the effects of the method on the reproductive tract, ovarian status and pregnancy status. Biopsies were performed in four multiparous sows on Days 9 and 15 of three consecutive oestrous cycles; the size and histological composition of the samples obtained were evaluated and the reproductive tract of the sows was monitored. Furthermore, biopsies were performed in 26 multiparous sows on Days 10 and 13 after insemination, and the pregnancy rate, gestation length and subsequent litter size were evaluated. RNA was extracted from the samples obtained and the quality and quantity were determined. Altogether, 76 biopsies were performed and 38 samples were obtained. Compared with sows from which no samples were obtained (n=6), sows from which one or more samples were obtained (n=24) were older (parity 5.0±2.8 vs 2.2±0.4, mean±s.d.), heavier (290±26 vs 244±27kg) and had higher back fat (11.4±2.7 vs 6.4±2.5mm; P<0.05 for all). No effect of the biopsies (P>0.05) was observed on the cyclicity and reproductive organs of the sows, or on corpus luteum diameter on Day 13 (8.9±1.0 vs 9.2±1.1mm), pregnancy rate (95% vs 96%), gestation length (115±1 vs 115±1 days) and subsequent litter size (12.7±2.5 vs 13.3±2.8) between sows from which samples were obtained and those from which no samples were obtained. The samples obtained had a diameter of 1mm and contained heterogeneous tissue with various cell types. The RNA quantity was 520±160µg per sample and the RNA integrity number was 8.5±1.0. In conclusion, an ultrasound-guided biopsy method for ovarian tissue, which can be used for gene expression studies, was established in the porcine. No effect on corpus luteum function was found.

The effect of litter size, parity and farrowing duration on placenta expulsion and retention in sows.

The hypothesis was that a prolonged parturition impairs placenta expulsion and can lead to retained placentas in sows. Furthermore, we hypothesized that application of oxytocin around the time of expulsion of the first placental part improves placenta expulsion. We recorded 142 parturitions of 101 Yorkshire x Large White sows. We determined parity, gestation length, number of liveborn and stillborn piglets, farrowing duration (time between first and last piglet) and the outcome variables: number of expelled placental parts, placenta expulsion duration (time between first and last placental part), first placental part expulsion (time between last piglet and first placental part) and last placental part expulsion (time between last piglet and last placental part). The relationship between farrowing duration and each of the outcome variables was investigated using four distinct multivariable models. Use of oxytocin (used in 44 out of 142 parturitions) increased number of expelled placental parts (3.8 ± 0.2 vs. 2.9 ± 0.3; P = 0.035), decreased the placenta expulsion duration (172 ± 44 vs. 328 ± 26 min; P = 0.011) and time of last placental part expulsion (148 ± 48 vs. 300 ± 24 min; P = 0.025). If oxytocin was not used, farrowing duration obeyed a quadratic relationship with the number of expelled placental parts (P = 0.001), placenta expulsion duration (P = 0.002) and time of last placental part expulsion (P = 0.024). If oxytocin was used, number of expelled placental parts was positively associated with number of liveborn piglets (ß = 0.2 ± 0.1; P = 0.002) and affected by parity. 5th parity sows expelled more placental parts (4.3 ± 0.4) than 4th (3.2 ± 0.3; P = 0.024) and 3rd parity sows (2.7 ± 0.4; P = 0.008). Furthermore, placenta expulsion duration was positively associated with number of liveborn piglets (ß = 18 ± 8 min; P = 0.025). First placental part expulsion was negatively correlated with farrowing duration (ß = 0.3 ± 0.1; P = 0.001). Sows that experienced total (no expulsion of placental parts; n = 4) and partial retained placentas (no expulsion of placental parts after birth of the last piglet; n = 4) had longer farrowing durations (1009 ± 275 and 734 ± 136 min) than sows with no retained placentas (369 ± 202 min; P = 0.021 and P = 0.004). The results show that a prolonged parturition impaired and oxytocin improved placenta expulsion in sows. Furthermore, retained placentas occurred in 3-6% of the sows and was correlated with a prolonged parturition.

Parturition effects on reproductive health in the gilt and sow.

In this review, we address significant characteristics of parturition in the pig and their connection to post-partum reproductive health and fertility. We discuss the normal physiology and behaviour around parturition and the effect of the second phase (expulsion of foetuses) on the third phase of parturition (expulsion of foetal membranes). In addition, we intend to cover retained placenta, and the connection to post-partum uterine health and fertility in the contemporary prolific sow. We also explore factors that support successful parturition or can cause potential problems. Successful parturition in the pig includes the possibility to express adequate maternal behaviour, rapid expulsion of the piglets, complete expulsion of the placenta, neonatal activity and colostrum intake. Abnormal incidents during any phase of parturition can cause subsequent problems. Duration of the expulsion phase of foetuses can be used as a simple measure of whether parturition is considered successful. Prolonged parturition can impair health of the sow and piglet and fertility after weaning. New insights, such as adding more fibre to sow diets during pregnancy, and especially during the period prior to farrowing, may prevent constipation, increase water intake of the sow around parturition and increase milk intake and performance of piglets. Maternal characteristics, including maternal behaviour, ease of parturition, colostrum production and piglet quality parameters, may be utilized to improve success rate of reproductive management during farrowing and early lactation. Additionally, we share some of the recent developments in methods, including ultrasonography in evaluation of post-partum uterine health. In conclusion, successful farrowing is of the greatest importance for reproductive health of the sow and survival of the piglets. We suggest connections exist among prolonged farrowing and yield of colostrum, retained placenta, development of PDS, and impaired involution of the uterus and reduced subsequent fertility.

Validation of Brix refractometer to estimate colostrum immunoglobulin G content and composition in the sow.

Colostrum is an essential source of immunoglobulin G (IgG) for neonate piglets. However, colostrum IgG content and nutritional composition can vary considerably among sows due to age, parity, feeding regime and immunological background. Currently, there is no practical way to obtain information about colostrum IgG concentration at herd level. We evaluated sows' colostrum IgG content on-farm using a Brix refractometer and its performance was compared with that of an IgG ELISA. In addition, nutritional compositions of the colostrum samples were analyzed using Fourier transform IR spectroscopy. Colostrum samples (5 to 6 ml) (n=153) were obtained within 0 to 3 h of farrowing. However, to obtain a 24 h IgG profile for 11 sows, colostrum samples were collected at 0, 2, 4, 6, 8, 10, 16 and 24 h after farrowing. A 0.3 ml of freshly drawn colostrum sample was used for the on-farm measurement of Brix percentages using a digital refractometer shortly after collection. The remaining fractions of the samples were frozen and submitted to laboratory analysis for total IgG, using a commercially available pig IgG ELISA kit. For nutritional composition analysis, a 35 ml colostrum sample (n=34) was obtained immediately after birth of first piglet from the first three pairs of frontal teats. Colostrum concentrations of IgG averaged 52.03±30.70 mg/ml (mean±SEM) at 0 to 3 h after farrowing. Concentration of IgG decreased on average by 50% during the 1st day of lactation (P30%. Colostrum IgG concentration is highly variable among sows, Brix measurement of a sows' fresh colostrum is an inexpensive, rapid and satisfactorily accurate method of estimating IgG concentration, providing indication of differentiation between good and poor IgG content of colostrum.

Clinically relevant quality assurance for intensity modulated radiotherapy plans: gamma maps and DVH-based evaluation.

PURPOSE: To explore a novel patient-dose DVH-based method for pretreatment dose quality assurance tests. METHODS: 20 IMRT plans for head-and-neck cancer patients were used. A comparison was performed between the planned dose distributions, the computed, and the reconstructed ones using the gamma-index (GI) method. The GI analysis was performed using both the 3%/3 mm and the 2%/2 mm criteria. RESULTS: No significant DVH-deviation was observed. Considering the 3%/3 mm criteria the mean GI% < 1 for the body and structures was significantly higher compared to 2%/2 mm criteria. CONCLUSIONS: Our results underline the importance of QA-methods based on DVH-metrics to predict the impact of delivered dose.

Clinically relevant quality assurance (QA) for prostate RapidArc plans: gamma maps and DVH-based evaluation.

The aim of this paper is to evaluate clinically relevant quality assurance (QA) tests for RapidArc prostate patients. 26 plans were verified by the COMPASS system that provides an independent angle response and a reconstruction of dose distribution in patient CT model. Plan data were imported from treatment planning system via DICOM. The fluencies, measured by a 2D detector, were used by COMPASS to forward calculate dose in CT patients and reconstruct dose-volume-histogram (DVH). The gamma analysis was performed, using both the criteria 3%-3-mm and 2%-2 mm, for the whole grid patient and the per-structure volume. A DVH-based analysis was accomplished for target and organs-at-risk (OAR). The correlation between gamma passing rates and DVH discrepancies was performed using Pearson's test. Sensitivity, specificity and accuracy of whole and per-structure gamma method were calculated. No significant DVH deviation was observed for target and OAR. Weak correlation between gamma passing rates and dosimetric deviations was observed, all significant r-values were negative. The whole gamma method shows lack of sensitivity to detect dosimetric deviations >5%. Instead, a better balance between sensitivity and specificity was obtained employing per structure gamma both with 3%-3 mm and 2%-2 mm criteria. Because of the poor correlation between DVH goals and gamma passing rates, we encourage the DVH-based gamma passing rates, when it is possible. At least, a gamma method specific for structure was strongly suggested.

Impact pf machines on plan quality: volumetric modulated arc therapy and intensity modulated radiation therapy

PURPOSE: To evaluate the impact of different machines on plan quality using both intensity modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques. MATERIALS AND METHODS: Eight patients with squamous cell carcinoma of the oropharynx were selected at random. Plans were computed for IMRT and VMAT Smart Arc, using Pinnacle TPS for an Elekta (IMRT-E, VMAT-E) and Varian linac (IMRT-V, VMAT-V). A three-dose level prescription was used to deliver 70, 63 and 58.1 Gy to regions of macroscopic, microscopic high- and low-risk disease, respectively. All doses were given in 35 fractions. Comparisons were performed on dose-volume histogram data, monitor units (MU), and delivery time. RESULTS: VMAT-E plans resulted slightly MU efficient (-24 % p < 0.05) compared to VMAT-V while IMRT-V shortened delivery time (-19 % p < 0.05) compared to IMRT-E. All the delivery techniques resulted in equivalent target coverage in terms of D(98) % and D(2) %. For VMAT technique, a significant improvement of 7 % in homogeneity index (HI) for PTV58.1 was observed for Varian machine. A slight improvement in OARs sparing was observed with Elekta machine both for IMRT and VMAT techniques. CONCLUSION: Similar plan quality was observed for Elekta and Varian linacs, significant differences were observed in delivery efficiency, as MU number and delivery times, in favor of Elekta and Varian, respectively (AU)

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Impact of machines on plan quality: volumetric modulated arc therapy and intensity modulated radiation therapy.

PURPOSE: To evaluate the impact of different machines on plan quality using both intensity modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques. MATERIALS AND METHODS: Eight patients with squamous cell carcinoma of the oropharynx were selected at random. Plans were computed for IMRT and VMAT Smart Arc, using Pinnacle TPS for an Elekta (IMRT-E, VMAT-E) and Varian linac (IMRT-V, VMAT-V). A three-dose level prescription was used to deliver 70, 63 and 58.1 Gy to regions of macroscopic, microscopic high- and low-risk disease, respectively. All doses were given in 35 fractions. Comparisons were performed on dose-volume histogram data, monitor units (MU), and delivery time. RESULTS: VMAT-E plans resulted slightly MU efficient (-24 % p < 0.05) compared to VMAT-V while IMRT-V shortened delivery time (-19 % p < 0.05) compared to IMRT-E. All the delivery techniques resulted in equivalent target coverage in terms of D(98) % and D(2) %. For VMAT technique, a significant improvement of 7 % in homogeneity index (HI) for PTV58.1 was observed for Varian machine. A slight improvement in OARs sparing was observed with Elekta machine both for IMRT and VMAT techniques. CONCLUSION: Similar plan quality was observed for Elekta and Varian linacs, significant differences were observed in delivery efficiency, as MU number and delivery times, in favor of Elekta and Varian, respectively.

Volumetric and dosimetric assessment by cone-beam computed tomography scans in head and neck radiation therapy: a monitoring in four phases of treatment.

Due to the anatomical changes frequently occurring during the course of head and neck (H&N) cancer radiotherapy, the dose distribution, which was actually delivered to the patient, might significantly differ from that planned. The aim of this paper is to investigate these volumetric changes and the resulting dosimetric implications on organs at risk (OARs) and clinical target volumes (CTVs) by cone beam computed tomography (CBCT) scans throughout the treatment. Ten H&N patients, treated by Intensity Modulated Radiotherapy, were analyzed. CTVs and OARs were delineated on four CBCT, acquired at the 10(th), 15(th), 20(th) and 25(th) treatment session, and then compared with the ones at planning CT. The planned beams were applied to each CBCT to recalculate the dose distribution and the corresponding dose volume histograms were compared with those generated on planning CT. To evaluate the HU discrepancies between the conventional CT and CBCT images we used a Catphan(r) 504, observing a maximum discrepancy of about 30 HU. We evaluated the impact of this HU difference in dose calculation and a not clinically relevant error, within 2.8%, was estimated. No inhomogeneity correction was used. The results showed an increased CTV mean dose (Dmean) of about 3% was found, without significant reduction in volume. Due to the parotids' shrinkage (up to 42%), significant dosimetric increases were observed: ipsilateral gland at 15th CBCT (Dmean by 18%; V30 by 31%); controlateral gland at the 10(th) CBCT (Dmean by 12.2%; V30 by 18.7%). For the larynx, a significant increase of volume was found at the 20th (15.7%) and 25th CBCT (13.3%) but it complied with dose constraint. The differences observed for the spinal cord and mandible maximum doses were not clinically relevant. In conclusion, the dosimetric analysis on CBCT can help clinicians to monitor treatment progress and to evaluate whether and when a new plan is necessary. The main benefit of replanning could be to preserve the parotids and our data support the hypothesis that the 3rd week of radiotherapy should be a check point for parotids.

Cone-beam computed tomography dose monitoring during intensity-modulated radiotherapy in head and neck cancer: parotid glands

PURPOSE: To evaluate the dosimetric changes of parotid glands (PG) during a course of intensity-modulated radiotherapy (IMRT) in head and neck (H&N) cancer patients. METHODS: Ten patients with H&N cancer treated by IMRT were analyzed. The original treatment plan (CT(plan)) was transferred to cone-beam computed tomography (CBCT) acquired at the 15th and 20th treatment day (CBCT(plan) I and II, respectively). The PG mean dose (D(mean)), the dose to 50 % of the volume, and the percent of volume receiving 30 and 50 Gy were measured by the dose volume histogram. RESULTS: 30 IMRT plans were evaluated (3 plans/patient). All dosimetric end points increased significantly for both PG only when CT(plan) was compared to CBCT(plan) I. The D(mean) increased significantly only for ipsilateral PG (p = 0.02) at week 3. CONCLUSION: During a course of IMRT, CBCT is a feasible method to heck the PG dosimetric variations. Perhaps, the 3rd week of radiotherapy could be considered as the time-check-point (AU)

Cone-beam computed tomography dose monitoring during intensity-modulated radiotherapy in head and neck cancer: parotid glands.

PURPOSE: To evaluate the dosimetric changes of parotid glands (PG) during a course of intensity-modulated radiotherapy (IMRT) in head and neck (H&N) cancer patients. METHODS: Ten patients with H&N cancer treated by IMRT were analyzed. The original treatment plan (CT(plan)) was transferred to cone-beam computed tomography (CBCT) acquired at the 15th and 20th treatment day (CBCT(plan) I and II, respectively). The PG mean dose (D(mean)), the dose to 50 % of the volume, and the percent of volume receiving 30 and 50 Gy were measured by the dose volume histogram. RESULTS: 30 IMRT plans were evaluated (3 plans/patient). All dosimetric end points increased significantly for both PG only when CT(plan) was compared to CBCT(plan) I. The D(mean) increased significantly only for ipsilateral PG (p = 0.02) at week 3. CONCLUSION: During a course of IMRT, CBCT is a feasible method to check the PG dosimetric variations. Perhaps, the 3rd week of radiotherapy could be considered as the time-check-point.