OPTIMUM TREATMENT MODE APPLIED TO POST-OPERATIVE CERVICAL CANCER FOR 5F-IMRT PLAN BASED ON FOUR VARIABLES IN VARIAN ECLIPSE TPS

2016 ◽  
Vol 16 (07) ◽  
pp. 1650095
Author(s):  
JUN LI ◽  
XIAO-BIN TANG ◽  
XI-ZHI ZHANG ◽  
LONG-GANG GUI ◽  
YUN GE ◽  
...  

Purpose: This study aimed to determine the dosimetric effect on the target volume, organs at risk (OARs) and normal tissues based on the different choice for four types of mechanical variables, i.e., treatment position, dose calculation algorithm, mulitleaf collimator (MLC) motion mode and X-ray energy; and to investigate the optimum treatment mode applied to post-operative cervical cancer for 5-field intensity-modulated radiation therapy (5F-IMRT) technique. Methods: The dosimetric difference on the target volume and OARs under the influence of four types of variables were initially compared by changing one variable at a time. Then, based on the above compared results, we compared the dosimetric difference on planning target volume (PTV) and OARs between group A composed of the superior four variables and group B composed of the relatively inferior four variables. The dosimetric parameters included dose distribution of the target volume, OARs and normal tissues, conformal index (CI), homogeneity index (HI), monitor units (MU) and beam-on time ([Formula: see text]. The independent and paired t-tests were used for statistical analysis, and the threshold for statistical significance was [Formula: see text]. Results: Compared with the supine position, the maximum dose of PTV ([Formula: see text]), the maximum dose of small intestine ([Formula: see text]) and [Formula: see text] of bladder ([Formula: see text] were all lower in prone position. In contrast with the pencil beam convolution (PBC), CI of PTV (CI[Formula: see text]) was larger while HI of PTV (HI[Formula: see text]) was lower, both [Formula: see text] and the maximum dose of rectum ([Formula: see text]) were lower using anisotropic analytical algorithm (AAA). Moreover, the same results were obtained using sliding window (SW) compared with multiple static segments (MSS). The mean dose of PTV ([Formula: see text] and CI[Formula: see text] was larger while the maximum dose of the spinal cord ([Formula: see text]), [Formula: see text] and the maximum dose of femoral heads were lower with 15 MV X-rays compared with 6 MV X-rays. In comparison with group B comprising the supine position, PBC, MSS and 6 MV X-rays, [Formula: see text] and HI[Formula: see text] decreased 1.4% and 53.4% respectively, CI[Formula: see text] increased 5.8% medially, while [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] all decreased in group A comprising of prone position, AAA, SW and 15 MV X-rays. Conclusion: The treatment mode composed of prone position, AAA algorithm, SW and 15 MV X-rays is chosen for the post-operative cervical cancer of 5F-IMRT technique, which is more capable of meeting the target volume constraints and maximal protection of OARs.

2020 ◽  
Author(s):  
Yiwei Zhao ◽  
Wubo Liu ◽  
Suomao Yuan ◽  
Yonghao Tian ◽  
Xinyu Liu

Abstract Background In the present study, we reported the clinical use of uniplanar cannulated pedicle screws for the correction of Lenke type 1 adolescent Idiopathic scoliosis (AIS), and its safety and clinical outcomes were also evaluated. Methods 68 patients with Lenke type 1 AIS were included, among which 38 patients were treated with uniplanar cannulated screws at the concave side of periapical levels and multiaxial screws at the other levels (group A). Moreover, the remaining 30 patients were treated with all multiaxial screws (group B). The preoperative and postoperative radiographic parameters of the Lenke type 1 AIS, axial vertebral rotation, and the safety of the pedicle screws were evaluated by X-rays and computed tomography (CT). Results Preoperative data was comparable between two groups. The postoperative proximal thoracic (PT) curve, main thoracic (MT) curve, thoracolumbar/lumbar (TL/L) curve, and apical vertebral rotation were significantly improved compared with the preoperative data. The coronal correction rates in group A and B were 83% and 81.9%, respectively (P > 0.05). The derotation rates in group A and B were 60.8% and 43.2%, respectively (P < 0.05). The rotation classification in the group A was also better compared with the group B. The misplacement rate in group A and B was 7.9% and 11.8%, respectively (P < 0.05), and the total misplacement rate on the concave side (11.4%) was higher than that of convex side (8.4%). The lateral perforation was found at the concave side, while the medial perforation was found at the convex side. On the concave side, the misplacement rate in group A and B was 9.7% and 12.3%, respectively (P < 0.05). The grades 2 and 3 perforations were three (3.5%) in the group A and eight (8.2%) in the group B (P < 0.05). On the convex side, the misplacement rate in group A and B was 5.9% and 11.1%, respectively (P < 0.05). The grades 2 and 3 perforations were one (0.9%) in the group A and four (4.4%) in the group B (P < 0.05). Conclusion Collectively, uniplanar cannulated pedicle screws could effectively increase the accuracy of pedicle screws and facilitate the derotation of the apical vertebra compared with the multiaxial pedicle screws. Trial registration retrospectively registered


1993 ◽  
Vol 2 (6) ◽  
pp. 474-477 ◽  
Author(s):  
PA Shinners ◽  
MO Pease

OBJECTIVE: To compare hemodynamic measurements made before turning and at 5 and 30 minutes after turning, and to determine whether the stabilization period affects the difference between supine and side-lying pulmonary artery pressures. METHODS: This study was performed in the cardiothoracic surgical intensive care unit of a midwestern university hospital. The 31 postoperative open-heart surgical patients, 26 men and 5 women aged 41 to 76 years (64 +/- 9.3, mean +/- SD) with pulmonary artery catheters in place, were divided into two groups to compare supine to side-lying pressures and the time intervals between the position changes. The supine-first subjects (Group A) were placed in the supine position for baseline measurements and turned to either the right or left side-lying position for the 5- and 30-minute pulmonary artery pressure measurements. The side-first subjects (Group B) were placed in either the right or left side-lying position for baseline measurements and then in the supine position for the 5- and 30-minute pulmonary artery pressure measurements. RESULTS: Pulmonary artery pressures, heart rate and arterial pressure were not significantly different at 5 and 30 minutes. Supine pulmonary artery pressures in Group A were not significantly different from supine pressures in Group B. Side-lying pulmonary artery pressures in Group A were not significantly different from side-lying pressures in Group B. Side-lying vs supine pulmonary artery pressures were significantly different in both Group A and Group B. CONCLUSION: The current practice of turning and settling the patient, zeroing the transducer and proceeding to make the pulmonary artery pressure readings appears to be valid. The stabilization period after turning does not explain the differences found between side-lying and supine pulmonary artery pressures.


2020 ◽  
pp. 1-6
Author(s):  
Esam Desoky ◽  
Khaled M. Abd Elwahab ◽  
Islam M. El-Babouly ◽  
Mohammed M. Seleem

<b><i>Objective:</i></b> To evaluate the impact of body mass index (BMI) on the outcomes of percutaneous nephrolithotomy (PCNL) in the flank-free modified supine position. <b><i>Patients and Methods:</i></b> A prospective study was carried out in the urology department during the period from May 2015 to October 2019 on 464 patients admitted for PCNL. The patients were divided into 4 matched groups according to their BMI: group A, normal weight with 18.5 ≤ BMI &#x3c;25 kg/m<sup>2</sup>; group B, overweight with 25 ≤ BMI &#x3c;30 kg/m<sup>2</sup>; group C, obese with 30 ≤ BMI &#x3c;40 kg/m<sup>2</sup>; and group D, morbid obesity with BMI ≥40 kg/m<sup>2</sup>. All operative data as well as postoperative outcomes are recorded and compared to each other. <b><i>Results:</i></b> The 4 studied groups were matched regarding age. The comorbidities were slightly higher in groups C and D. The operative time and fluoroscopy time were slightly high in obese and morbid obese groups but with no significant difference. The rate of complications either major or minor was comparable in all groups. No significant difference was seen among all groups regarding hemoglobin loss, stone-free rate, hospital stay, and need for auxiliary procedures. <b><i>Conclusions:</i></b> The outcome of PCNL in flank-free modified supine position is not affected by changes in BMI. The procedure can be performed in obese and morbid obese patients safely with results similar to and comparable to nonobese patients.


2000 ◽  
Vol 56 (3) ◽  
pp. 29-32 ◽  
Author(s):  
M. W. Krause ◽  
H. Van Aswegen ◽  
E. H. De Wet ◽  
G. Joubert

Objectives: The movement and mobilisation of an intubated patient in the intensive care unit is restricted by the presence of various drains and intravenous lines. Difficulty to position the patient in the correct postural drainage positions, often leads physiotherapists to using modified postural drainage positions to mobilise secretions. A comparison of effectiveness between the correct postural drainage positions and the modified postural drainage positions during the treatment of acute lobar atelectasis in the intubated patient was conducted. Subjects: Intubated men and women between the ages of 13 and 85 years in the intensive care units of Pelonomi and Universitas Hospitals in Bloemfontein diagnosed with acute lobar atelectasis of the lower lobes were considered for inclusion in this pilot study.Intervention: A controlled randomised clinical experiment was conducted. Group A received inhalation therapywhilst placed in a postural drainage position for 15 minutes. Thereafter percussion was done for five minutes followed by a sterile suction procedure. Group B received the same treatment but modified postural drainage positions were used. Both groups received treatment twice daily.Results: On average, group A required three treatments and nil follow-up chest X-rays before the collapse was resolved, as opposed to the average of 4.5 treatments and one follow-up chest X-ray required by group B before the same result was obtained. In group A the oxygenation compared to Group B was improved. The findings were not statistically significant.Conclusion: The use of postural drainage positions in intensive care suggests quicker resolution of acute lobar atelectasis and improves oxygenation.


Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1447 ◽  
Author(s):  
Yoshiki Kubota ◽  
Masahiko Okamoto ◽  
Yang Li ◽  
Shintaro Shiba ◽  
Shohei Okazaki ◽  
...  

We aimed to clarify the accuracy of rigid image registration and deformable image registration (DIR) in carbon-ion radiotherapy (CIRT) for pancreatic cancer. Six patients with pancreatic cancer who were treated with passive irradiation CIRT were enrolled. Three registration patterns were evaluated: treatment planning computed tomography images (TPCT) to CT images acquired in the treatment room (IRCT) in the supine position, TPCT to IRCT in the prone position, and TPCT in the supine position to the prone position. After warping the contours of the original CT images to the destination CT images using deformation matrices from the registration, the warped delineated contours on the destination CT images were compared with the original ones using mean displacement to agreement (MDA). Four contours (clinical target volume (CTV), gross tumor volume (GTV), stomach, duodenum) and four registration algorithms (rigid image registration [RIR], intensity-based DIR [iDIR], contour-based DIR [cDIR], and a hybrid iDIR-cDIR ([hDIR]) were evaluated. The means ± standard deviation of the MDAs of all contours for RIR, iDIR, cDIR, and hDIR were 3.40 ± 3.30, 2.2 1± 2.48, 1.46 ± 1.49, and 1.46 ± 1.37 mm, respectively. There were significant differences between RIR and iDIR, and between RIR/iDIR and cDIR/hDIR. For the pancreatic cancer patient images, cDIR and hDIR had better accuracy than RIR and iDIR.


Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 254-254
Author(s):  
Chengmin Zhang ◽  
Paul M Arnold ◽  
Qiang Zhou

Abstract INTRODUCTION horacolumbar fractures are common spinal injuries. Posterior fixation and fusion is the primary treatment, although this may sacrifice range of motion (ROM) to achieve stability, rather than treating the fracture itself. Two issues addressed when treating thoracolumbar fractures include: 1) replacing the fractured vertebrae, especially the upper endplate of the injured vertebrae, and 2) provide strong fixation with biomechanical stability and flexibility. METHODS This retrospective study included 75 consecutive patients with thoracic or lumbar fractures treated from October 2010 to May 2014. A total of 61 patients met inclusion criteria. Patients were divided into one of two groups: group A, intra-vertebral bone graft with balloon kyphoplasty (non-fusion surgery); and group B, traditional posterior fixation and fusion surgery. The Visual Analog Scale (VAS) was done preoperatively as well as at three months, one year, and two years. X-ray, CT, and MRI were done preoperatively. X-rays were done postoperatively at three months and two years. Postoperatively at 3 months, CT was used to confirm healing of the vertebral fracture. RESULTS >Patient demographics and baseline characteristics were similar in the two groups. All fractures in both groups were reduced successfully, deformity was improved, and the anterior vertebral height restoration (AHR) was 98.76% ± 3.78% of PDS group and 95.38% ± 5.07% of Fusion group. After removal of hardware in group A, ROM at the injury level recovered (mean ROM 8.57°), and at 2 years, there was no loss of vertebral height or recurrence of deformity. There was no hardware failure in group A, but there was evidence of screw loosening three screws in group B. CONCLUSION Non-fusion treatment of intra-vertebral bone graft assisted with balloon kyphoplasty demonstrated good fracture reduction, deformity correction, fracture healing, and ROM maintenance. There were no complications associated with the implant. With the continued development of surgical techniques and materials, we believe that an increasing number of spinal fracture patients can avoid spinal fusion.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4645-4645
Author(s):  
K. Kang ◽  
B. Choi ◽  
H. Jang ◽  
S. Bae ◽  
M. Ryu ◽  
...  

4645 Background: Conventional radiotherapy has historically played a limited role in the primary treatment of hepatocellular carcinoma (HCC). This study evaluated the effect of Cyberknife stereotactic radiosurgery (SRS) with for both for small primary non-resectable HCC, and for advanced HCC with portal vein tumor thrombosis (PVTT). Methods: From March 2004 to March 2005, thirty one patients with HCC were treated Cyberknife SRS was used for 32 lesions in patients with SRS for primary HCC. There was performed in 22 patients (23 lesions) with targeting to the primary HCC was treated (Group A), and in 9 patients with targeting to the PVTT was treated (Group B). The total SRS doses treated were 30–39 Gy (median, 36 Gy) to the 70–85%, 3 fractions and the target volume was of 3.6–57.3 cc (median, 25.2 cc). Results: The median follow up was 10.5 months. A complete response (CR) was achieved in 10 lesions, a partial response (PR) in 13 lesions, stable disease was noted in 6 lesions, and disease progression in 3 lesions. The response rate (CR+PR) was 71.9% (group A: 82.6%, group B: 44.4%). The level of serum alpha-fetoprotein after the treatment was decreased significantly in 17 patients (54.8%) (group A: 54.5%, group B: 55.5%). Complications were observed in 15 patients, among them, greater than grade 3 complication was observed in two patients of group A (gastric ulcer bleeding (1), liver necrosis (1)). Conclusions: These results suggest that Cyberknife SRS could be considered as an effective and safe treatment for primary HCC. For PVTT, Cyberknife SRS as the only curative tool, and produced acceptable local control in this study. No significant financial relationships to disclose.


2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 818-818
Author(s):  
Shinya Kajiura ◽  
Shingo Chikaoka ◽  
Ayaka Kadota ◽  
Sakie Fukai ◽  
Takako Matsushita ◽  
...  

818 Background: Opioid-induced constipation (OIC) is the most common side effect of opioid therapy. Laxatives are usually used as a first-line treatment for OIC. Treatment options for OIC are switching to other opioids associated with less frequent OIC, such as Fentanyl. Naldemedine is an orally active peripherally acting µ-opioid receptor antagonists that was approved in Japan from 2017 for management of cancer-related OIC. The aim of this study is to investigate the relationship between Naldemedine administration and the maximum dose of oral Oxycodone which is the most frequently used oral opioids at our hospital. Methods: During June 2017 and December 2018, a total of 217 patients with cancer-related pain received Oxycodone at our institution. The first group of the patients concurrently received Naldemedine 0.2 mg daily (group A, n = 101), and the second group didn’t receive it (group B, n = 116) for cancer-related OIC reduction. We compared the maximum Oxycodone dose between two groups by medical record retrospectively. Results: The median age of group A was 69 y.o. (range 20-87 y.o.), and the median age of group B was 67 y.o. (range 27-88y.o.). There was no significant difference in common patient background between group A and B. The median dose of maximum Oxycodone dose of group A was 40 mg/day (range 10-480 mg/day), and that of group B was 20 mg/day (range 10-320 mg/day). There was a significant difference in the median dose of maximum Oxycodone between group A and B (Mann-Whitney U test, P < 0.0001). In Group A, the administration was started in 31 patient Naldemedine and Oxycodone at the same time. As for 70 remaining patients, the administration was started when they had constipation after oxycodone was administrated. In those patients, the median days was 19 days from the Oxycodone administration starting date to the Naldemedine administration starting date. Conclusions: Naldemedine administration in patients with cancer-related OIC may increase the maximum dose of oral Oxycodone.


2008 ◽  
Vol 93 (4) ◽  
pp. 1203-1210 ◽  
Author(s):  
Ursula Plöckinger ◽  
Susann Albrecht ◽  
Christian Mawrin ◽  
Wolfgang Saeger ◽  
Michael Buchfelder ◽  
...  

Abstract Objective: The somatostatin analog octreotide preferentially binds to somatostatin receptor (sst) 2A and to a lesser extent to sst5. Although sst2A and sst5 mRNAs are consistently expressed in GH-secreting adenomas, octreotide controls GH secretion only in 65% of acromegalic patients. Hence, we investigated the immunocytochemical expression of sst in a large group of somatotroph tumors. Methods: Acromegalic patients, cared for in a university referral center, were either operated on without pretreatment (group A, n = 14) or pretreated with octreotide [median (minimum-maximum): dose 1250 (300–1500) μg/d for 5.6 (3–9) months] before surgery (group B, n = 20). In group B octreotide reduced GH secretion by more than 50% in 14 patients (70%) (GH responders). Six patients with less than 50% GH suppression were considered GH nonresponders. We used a panel of extensively characterized antibodies to determine the immunocytochemical sst status in somatotroph adenomas and compared their expression between the groups. Results: All group A tumors demonstrated immunoreactive sst2A, and all but one had sst5. A similar pattern was found in the GH responders of group B. In contrast, none of the GH nonresponders exhibited detectable sst2A (sst2A: GH responders vs. GH nonresponders, P &lt; 0.0001), whereas sst5 was found in 70%. sst1 and sst3 were detected in 85 and 24% of all cases, independent of previous octreotide treatment. Conclusions: Our findings suggest that octreotide resistance in GH-secreting adenomas occurs due to a selective loss of sst2A. The persistent expression of sst1 and sst5 receptors suggests that these tumors are potential targets for pan-somatostatin analogs.


2020 ◽  
Vol 9 (8) ◽  
pp. 2475
Author(s):  
Frangiskos Frangopoulos ◽  
Ivi Nicolaou ◽  
Savvas Zannetos ◽  
Nicholas-Tiberio Economou ◽  
Tonia Adamide ◽  
...  

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO2 (p < 0.001). Arrhythmias correlated with mean SaO2 (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO2. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO2. Arrhythmias correlated only with hypoxemia (mean SaO2), whereas heart failure correlated only with REI, especially in the supine position.


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