Erratum to: Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran.

[This corrects the article DOI: 10.5603/RPOR.a2022.0103.].

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran.

Background: The aim of the study is to evaluate the overall accuracy of the surface-guided radiotherapy (SGRT) workflow through a comprehensive commissioning and quality assurance procedures and assess the potential benefits of deep-inspiration breath-hold (DIBH) radiotherapy as a cardiac and lung dose reduction approach for left-sided breast cancer irradiation. Materials and methods: Accuracy and reproducibility of the optical surface scanner used for DIBH treatment were evaluated using different phantoms. Patient positioning accuracy and reproducibility of DIBH treatment were evaluated. Twenty patients were studied for treatment plan quality in target dose coverage and healthy organ sparing for the two different treatment techniques. Results: Reproducibility tests for the surface scanner showed good stability within 1 mm in all directions. The maximum position variation between applied shifts on the couch and the scanner measured offsets is 1 mm in all directions. The clinical study of 200 fractions showed good agreement between the surface scanner and portal imaging with the isocenter position deviation of less than 3 mm in each lateral, longitudinal, and vertical direction. The standard deviation of the DIBH level showed a value of < 2 mm during all evaluated DIBHs. Compared to the free breathing (FB) technique, DIBH showed significant reduction of 48% for heart mean dose, 43% for heart V25, and 20% for ipsilateral lung V20. Conclusion: Surface-guided radiotherapy can be regarded as an accurate tool for patient positioning and monitoring in breast radiotherapy. DIBH treatment are considered to be effective techniques in heart and ipsilateral lung dose reductions for left breast radiotherapy.

Dynamic anthropomorphic thorax phantom for quality assurance of motion management in radiotherapy.

Background and purpose: Motion management techniques are important to spare the healthy tissue adequately. However, they are complex and need dedicated quality assurance. The aim of this study was to create a dynamic phantom designed for quality assurance and to replicate a patient's size, anatomy, and tissue density. Materials and methods: A computed tomography (CT) scan of a cancer patient was used to create molds for the lungs, heart, ribs, and vertebral column via additive manufacturing. A pump system and software were developed to simulate respiratory dynamics. The extent of respiratory motion was quantified using a 4DCT scan. End-to-end tests were conducted to evaluate two motion management techniques for lung stereotactic body radiotherapy (SBRT). Results: The chest wall moved between 4 mm and 13 mm anteriorly and 2 mm to 7 mm laterally during the breathing. The diaphragm exhibited superior-inferior movement ranging from 5 mm to 16 mm in the left lung and 10 mm to 36 mm in the right lung. The left lung tumor displaced ± 7 mm superior-inferiorly and anterior-posteriorly. The CT numbers were for lung: -716 ± 108 HU (phantom) and -713 ± 70 HU (patient); bone: 460 ± 20 HU (phantom) and 458 ± 206 HU (patient); soft tissue: 92 ± 9 HU (phantom) and 60 ± 25 HU (patient). The end-to-end testing showed an excellent agreement between the measured and the calculated dose for ion chamber and film dosimetry. Conclusions: The phantom is recommended for quality assurance, evaluating the institution's specific planning and motion management strategies either through end-to-end testing or as an external audit phantom.

A dose planning study for cardiac and lung dose sparing techniques in left breast cancer radiotherapy: Can free breathing helical tomotherapy be considered as an alternative for deep inspiration breath hold?

Purpose: To investigate the possibility to be able to offer left sided breast cancer patients, not suitable for DIBH, an organ at risk saving treatment. Materials and Methods: Twenty patients receiving radiotherapy for left breast cancer in DIBH were enrolled in the study. Planning CT scans were acquired in the same supine treatment position in FB and DIBH. 3DCRT_DIBH plans were designed and optimized using two parallel opposed tangent beams (with some additional segments) for the breast and chest wall and anterior-posterior fields for regional lymph nodes irradiation. Additionally, FB helical tomotherapy plans were optimized to minimize heart and lung dose. All forty plans were optimized with at least 95% of the total CTV covered by the 95% of prescribed dose of 50 Gy in 25 fractions. Results: HT_FB plans showed significantly better dose homogeneity and conformity compared to the 3DCRT_DIBH specially for regional nodal irradiation. The heart mean dose was almost comparable in 3DCRT_DIBH and HT_FB while the volume (%) of the heart receiving 25 Gy had a statistically significant reduction from 7.90 ± 3.33 in 3DCRT_DIBH to 0.88 ± 0.66 in HT_FB. HT_FB was also more effective in left descending artery (LAD) mean dose reduction about 100% from 30.83 ± 9.2 Gy to 9.7 ± 3.1. The ipsilateral lung volume receiving 20 Gy has a further reduction of 43 % in HT_FB compared with 3DCRT_DIBH. For low dose comparison, 3DCRT_DIBH was superior for contralateral organ sparing compared to the HT_FB due to the limited angle for dose delivery. Conclusion: For patients who cannot be a candidate for DIBH for any reason, HT in free breathing may be a good alternative and provides heart and ipsilateral lung dose sparing, however with the cost of increased dose to contralateral breast and lung.

Chemoradiotherapy alone as the standard treatment of epidermoid esophageal carcinoma.

OBJECTIVES: Surgery has traditionally been the treatment of choice for patients with potentially resectable esophageal carcinoma. Recently, however, definitive chemoradiotherapy (CRT) has been suggested as a preferred treatment modality. In this study, CRT results with or without surgery are compared. METHODS: A total of 986 patients of esophageal carcinoma were categorized into two groups depending on the treatment: surgery (675 patients) or CRT (311 patients). These two groups were compared based on age, sex, weight loss, tumor location and length, tumor shape, grade, stage, delay in receiving treatment, event-free survival (EFS) and overall survival (OS). RESULTS: Patients in the CRT arm were significantly older (p = 0.01), had a more significant adenocarcinoma histology (p = 0.015), upper esophageal carcinoma (p = 0.0001) and more advanced stages of the disease (p = 0.0001). The median EFS for the surgery group was 24.5 months [95% confidence interval (CI), 17-32] versus 22.5 months (95% CI, 16.7-28.2) for the CRT arm (p = 0.56). The mean OS was 59.25 months (95% CI, 53.8-64.7) for the surgery group compared to 58.77 months (95% CI, 50.9-66.6) for the CRT group (p = 0.78). CONCLUSION: Definitive CRT is effective enough so as to consider omitting surgery and could be used as a standard treatment for patients with esophageal carcinoma.

miRNA-Related Polymorphisms in miR-423 (rs6505162) and PEX6 (rs1129186) and Risk of Esophageal Squamous Cell Carcinoma in an Iranian Cohort.

AIMS: Iran is located in the Asian esophageal cancer belt. It is a high-risk region for esophageal squamous cell carcinoma (ESCC). The extent to which genetic components, especially variants within miRNAs or their binding sites, contribute to risk of ESCC in the region is not yet fully understood. Herein, tests were done on an Iranian cohort to evaluate the association of miRNA-related polymorphisms in miR-423 (rs6505162) and peroxisomal biogenesis factor 6 (PEX6) (rs1129186 within a miR-149-5p-binding site) with the risk of ESCC risk. METHODS: This study recruited 200 ESCC patients and 300 healthy individuals. Genotyping was performed using the polymerase chain reaction-restriction fragment length polymorphism method. Target genes and biological processes that are regulated by miR-423 and may be affected by a change in miR-423 expression were identified by in silico analysis. RESULTS: Logistic regression analyses revealed an association between rs6505162 and ESCC, assuming codominant (AA vs. CC, odds ratios, OR [95% confidence interval, CI]: 0.32 [0.15-0.69], p-value: 0.0076), recessive (AA vs. CC+CA, OR [95% CI]: 0.35 [0.16-0.73], p-value: 0.0027), and log-additive models (OR [95% CI]: 0.69 [0.52-0.91], p-value: 0.0084). No significant association was observed for PEX6 rs1129186. In silico analyses revealed several genes and biological processes that are regulated by miR-423 in ESCC. CONCLUSION: This study identified the first evidence of an association of a miRNA-related variant with risk of ESCC in an Iranian cohort. PEX6 rs1129186 may not modulate the risk of ESCC in the cohort.

p63 is more sensitive and specific than 34ßE12 to differentiate adenocarcinoma of prostate from cancer mimickers.

OBJECTIVES: Prostate cancer is the world's leading cause of cancer and the second cause of cancer-related death in men after lung cancer. Differentiation of prostate adenocarcinoma from benign prostate lesions and hyperplasia sometimes cannot be done on the basis of morphologic findings. Considering the fact that in the prostate adenocarcinoma there is no basal cell layer, basal cell markers can help to differentiate prostate adenocarcinoma from cancer mimickers. MATERIALS AND METHODS: We studied 98 prostate biopsy blocks (40 adenocarcinoma and 58 benign lesions) for basal cell marker expression. RESULTS: p63 and 34ßE12 were negative in all prostate adenocarcinoma specimens, but all benign prostate hyperplasia and high grade intraepithelial neoplasia cases expressed them. CONCLUSION: Basal cell markers can help to distinguish prostate adenocarcinoma from cancer mimickers.

Assessment of skin dose modification caused by application of immobilizing cast in head and neck radiotherapy.

Skin dose assessment for radiotherapy patients is important to ensure that the dose received by skin is not excessive and does not cause skin reactions. Immobilizing casts may have a buildup effect, and can enhance the skin dose. This study has quantified changes to the surface dose as a result of head and neck immobilizing casts. Medtech and Renfu casts were stretched on the head of an Alderson Rando-Phantom. Irradiation was performed using 6 and 15 MV X-rays, and surface dose was measured by thermoluminescence dosimeters. In the case of 15MV photons, immobilizing casts had no effect on the surface dose. However, the mean surface dose increase reached up to 20 % when 6MV X-rays were applied. Radiation incidence angle, thickness, and meshed pattern of the casts affected the quantity of dose enhancement. For vertical beams, the surface dose increase was more than tangential beams, and when doses of the points under different areas of the casts were analysed separately, results showed that only doses of the points under the thick area had been changed. Doses of the points under the thin area and those within the holes were identical to the same points without immobilizing casts. Higher dose which was incurred due to application of immobilizing casts (20 %) would not affect the quality of life and treatment of patients whose head and neck are treated. Therefore, the benefits of head and neck thermoplastic casts are more than their detriments. However, producing thinner casts with larger holes may reduce the dose enhancement effect.