Off-isocentric VMAT technique for breast cancer: Effective dose reduction to organs at risk and its applicability based on patient anatomy.

PURPOSE: This study aims to explore the off-isocentric volumetric modulated arc therapy (offVMAT) technique for breast cancer and determine its applicability based on patient anatomical parameters. METHODS: We retrospectively analyzed 44 breast cancer patients with varied lymph node involvement using different arc designs. Off-isocentric techniques were benchmarked against previously published arc techniques: classic arcs (clVMAT), tangential arcs (tVMAT), and split arcs (spVMAT). During optimization, target coverage was made for all plans as close as possible to the criteria D99% > 95% and Dmax < 110% of the prescribed dose. A novel patient categorization, based on anatomical parameters (auxiliary structures) rather than lymph node involvement, is introduced. This categorization considers the volume of ipsilateral organs at risk (OARs) adjacent to the target. A binary regression model was developed on these anatomical parameters. It predicts the likelihood of offVMAT (P[offVMAT]) achieving better criteria. RESULTS: Using the regression model, patients were divided into two groups: P(offVMAT) > 0.5 and P(offVMAT) < 0.5. For the P(offVMAT) > 0.5 group, most tVMAT plans are unable to achieve the clinical objectives. Comparing offVMAT with spVMAT, offVMAT exhibited better dose parameters for the heart (V20, V10, and D2 are 7.1, 2.4, and 1.5 times lower respectively), ipsilateral lung (V20, V10, V5 and the mean dose are 1.4, 1.3, 1.2, and 1.2 times lower respectively). The average doses to the contralateral side are consistent. In the P(offVMAT) < 0.5 group, the tVMAT technique showed increased doses at medium and high levels, yet reduced doses in contralateral OARs compared to spVMAT and offVMAT. spVMAT showed lower doses in the contralateral lung relative to the offVMAT technique, while clVMAT trailed in both groups. Validation of the model yielded a 90% accuracy rate. CONCLUSIONS: The new off-isocentric breast planning technique effectively reduces doses to ipsilateral OARs, maintaining acceptable contralateral mean doses. This technique has an advantage over other techniques for patients with intricate anatomies. It is evaluated using anatomical parameters, which are also used to build binary regression model, which shows the dependence of anatomical parameters on whether offVMAT is preferred for individual patients. Also, such anatomical parameters provide a more objective and precise comparison between different planning techniques.

Stereotactic radiotherapy for uveal melanoma: A case report.

Uveal melanoma (UM) is the most common primary intraocular malignancy worldwide. Surgical intervention and radiation therapy (RT) are the primary treatment options. Given the complexity and cosmetic discomfort associated with eye enucleation, this method is less frequently used. As a result, RT, including photon therapy, proton therapy and brachytherapy, has become the treatment of choice. Traditionally, plaque brachytherapy has been the most commonly used in clinical practice. However, the question of which type of radiation therapy is the most effective, safe, commonly available and cost-effective remains open. The present study provided a follow-up analysis of a patient with UM who was treated using the image-guided volumetric modulated arc therapy (IG-VMAT) technique. A complete response without complications and symptom relief were noted one and a half years after treatment. The present findings suggest that photon external beam radiotherapy using the IG-VMAT technique may offer a viable and safe alternative for the management of UM. This approach potentially sidesteps the complex and morbid aspects of surgical intervention and plaque brachytherapy. Owing to the limited sample size, a more robust understanding of the efficacy and safety of this treatment will require the analysis of additional cases. Further research with a larger cohort is essential to validate these preliminary observations.

Expression, purification, crystallization and preliminary X-ray structure analysis of Vibrio cholerae uridine phosphorylase in complex with thymidine.

A high-resolution structure of the complex of Vibrio cholerae uridine phosphorylase (VchUPh) with its physiological ligand thymidine is important in order to determine the mechanism of the substrate specificity of the enzyme and for the rational design of pharmacological modulators. Here, the expression and purification of VchUPh and the crystallization of its complex with thymidine are reported. Conditions for crystallization were determined with an automated Cartesian Dispensing System using The Classics, MbClass and MbClass II Suites crystallization kits. Crystals of the VchUPh-thymidine complex (of dimensions ∼200-350 µm) were grown by the sitting-drop vapour-diffusion method in ∼7 d at 291 K. The crystallization solution consisted of 1.5 µl VchUPh (15 mg ml(-1)), 1 µl 0.1 M thymidine and 1.5 µl reservoir solution [15%(w/v) PEG 4000, 0.2 M MgCl(2).6H2O in 0.1 M Tris-HCl pH 8.5]. The crystals diffracted to 2.12 Šresolution and belonged to space group P2(1) (No. 4), with unit-cell parameters a=91.80, b=95.91, c=91.89 Å, ß=119.96°. The Matthews coefficient was calculated as 2.18 Å3 Da(-1); the corresponding solvent content was 43.74%.

Crystallization and preliminary X-ray study of Vibrio cholerae uridine phosphorylase in complex with 6-methyluracil.

Uridine phosphorylase catalyzes the phosphorolysis of ribonucleosides, with the nitrogenous base and ribose 1-phosphate as products. Additionally, it catalyzes the reverse reaction of the synthesis of ribonucleosides from ribose 1-phosphate and a nitrogenous base. However, the enzyme does not catalyze the synthesis of nucleosides when the substrate is a nitrogenous base substituted at the 6-position, such as 6-methyluracil (6-MU). In order to explain this fact, it is essential to investigate the three-dimensional structure of the complex of 6-MU with uridine phosphorylase. 6-MU is a pharmaceutical agent that improves tissue nutrition and enhances cell regeneration by normalization of nucleotide exchange in humans. 6-MU is used for the treatment of diseases of the gastrointestinal tract, including infectious diseases. Here, procedures to obtain the uridine phosphorylase from the pathogenic bacterium Vibrio cholerae (VchUPh), purification of this enzyme, crystallization of the complex of VchUPh with 6-MU, and X-ray data collection and preliminary X-ray analysis of the VchUPh-6-MU complex at atomic resolution are reported.