scholarly journals Treatment outcome and compliance to dose-intensified linac-based SBRT for unfavorable prostate tumors using a novel real-time organ-motion tracking

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Raffaella Lucchini ◽  
Denis Panizza ◽  
Riccardo Ray Colciago ◽  
Veronica Vernier ◽  
Martina Camilla Daniotti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Outcome ◽  
Real Time ◽  
Tracking System ◽  
Organ Motion ◽  
Prostate Tumors ◽  
Reliable Technique ◽  
Prostate Motion ◽  
Beam Delivery

Abstract Purpose/objectives To report preliminary data on treatment outcome and compliance to dose-intensified organ sparing SBRT for prostate cancer using a novel electromagnetic transmitter-based tracking system (RayPilot® System) to account for intra-fractional organ motion. Material/methods Thirteen patients with intermediate unfavorable (9) and selected high-risk (4) prostate cancer underwent dose-escalated SBRT in 4 or 5 fractions (BED1.5 = 279 Gy and 253 Gy, respectively). The VMAT treatment consisted in two 6FFF or 10FFF full arcs optimized to have the 95% isodose covering at least 95% of the PTV (2 mm isotropic expansion of the CTV). Whenever the real-time tracking registered a displacement that exceeded 2 mm during the setup and/or the beam delivery, the treatment was interrupted and the prostate motion was promptly corrected. The incidence of treatment-related genitourinary (GU) and gastrointestinal (GI) toxicity, patient QoL and PSA outcomes were computed from the start of treatment to the last follow-up date. Results All patients completed the treatment in the expected time (10.2 +/− 4.2 minutes) and their compliance to the procedure was excellent. No clinically significant acute Grade 2 or higher GI (rectal) and GU side effects were observed within 90 days from the treatment completion. The median IPSS increased from 8 at baseline to 12 one-month after treatment and settled to 6 at 3 months. EPIC-26 scores in the urinary domain decreased from a median baseline of 86 pre-treatment to 79 at one-month and returned to baseline at a later timepoint (median score of 85 at 3 months). EPIC-26 scores in the bowel domains did not show significant changes within 3 months following RT. The prostate was found within 1 mm from its initial position in 78% of the beam-on time, between 1 and 2 mm in 20%, and exceeded 2 mm only in 2%, after correction for motion which was performed in 45% of the fractions, either during setup or beam delivery. Conclusions Our preliminary findings show that dose intensified SBRT for unfavorable prostate tumors does not come at the cost of an increased toxicity, provided that a reliable technique for real time prostate monitoring is ensured. Fast FFF beams contributed to reduce intra-fractional motion. These observations need to be confirmed on a larger scale and a longer follow up.

Development of a PSA tracking system for patients wtih prostate cancer following definitive radiotherapy to enhance rural health.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 39-39 ◽  
Author(s):  
Michael G. Chang ◽  
Kristine DeSotto ◽  
Paul Taibi ◽  
Sandra Troeschel
Keyword(s):  
Prostate Cancer ◽  
Detection System ◽  
Tracking System ◽  
Failure Detection ◽  
Phone Call ◽  
Therapeutic Window ◽  
Definitive Radiotherapy ◽  
Psa Testing ◽  
Query Tool

39 Background: Patients with prostate cancer (PC) may benefit from early intervention when they experience relapse/recur. About 50% of our PC patients are rural and experience barriers to care due to distance, cost, and convenience. We sought to create a PSA tracking system with the Veterans Administration’s (VA) Electronic Medical Record (EMR) that would provide a remote way to monitor disease progression after definitive radiotherapy (XRT) by annual PSA testing alone. Methods: Using VA’s EMR, we developed a query tool to identify all patients ever treated at our center with XRT for prostate cancer who were alive, had not been seen in our clinic in more than a year, did not have metastatic disease, and had a rising PSA of at least 0.5 ng/ml above nadir, or who had no PSA drawn within 15 months. Results: Among roughly 50,000 unique patients in the McGuire VAMC EMR, we found 1,858 patients treated with XRT for PC more than 5 years ago between 1997 and 2015. Of these 1,190 were still alive and 455 had not been seen by our clinic in 400 days or more. Of these 455 patients, 159 patients had not had a PSA drawn within 15 months and/or their most recent PSA was more than 0.5 ng/ml above nadir, triggering a chart review followed by either a phone call, repeat testing, in person follow up visit, or removal from follow up monitoring if clinically indicated. 296 patients were receiving appropriate care outside of our clinic and had no sign of significant rise in PSA. An analysis by the VA showed annual savings of $60,360 per year in fuel costs by avoiding unnecessary visits. Conclusions: The VA’s robust EMR and a new query tool can identify patients with prostate cancer who are lost to follow up or who needed intervention from among thousands of patients in the EMR, improving quality while reducing cost and unnecessary time and travel for rural and all patients. More importantly, our tool could be modified to improve survival for all VA patients with prostate cancer by creating a VA-wide PSA failure detection system. The system would alert providers to any patient who may benefit from early salvage radiotherapy or hormonal therapy before their disease progresses beyond the therapeutic window of benefit.

Tumor protein expression of BRCA1 and development of lethal prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 65-65
Author(s):  
Carl Ceraolo ◽  
Travis A. Gerke ◽  
Piotr Zareba ◽  
Andreas Pettersson ◽  
Konrad H. Stopsack ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dna Repair ◽  
Protein Expression ◽  
Positive Association ◽  
Proliferation Index ◽  
Proliferative Index ◽  
Prostate Tumors ◽  
Brca1 Protein ◽  
Lethal Prostate Cancer

65 Background: DNA repair genes including BRCA1 are commonly altered in metastatic prostate tumors. However, mutations and copy number aberrations in these genes are rare in primary tumors. Instead, preliminary studies suggest that higher tumor expression of the BRCA1 protein may be associated with worse prognosis. Methods: We undertook a prospective study of tumor BRCA1 protein expression and lethal prostate cancer among men with clinically localized prostate cancer in the Health Professionals Follow-up Study. We performed immunohistochemical staining for BRCA1 on tumor tissue microarrays using a validated antibody and scored expression as positive or negative. We also assessed tumor proliferation by immunostaining for Ki67, angiogenesis by immunostaining for CD34, and apoptosis using a TUNEL assay. Proportional hazards regression was used to evaluate the association between BRCA1 protein expression and development of lethal prostate cancer (metastasis or cancer-specific death). Results: Ten percent of tumors (60 of 589) stained positive for the BRCA1 protein. BRCA1-positive tumors were characterized by higher Gleason scores, a higher proliferative index, and a higher apoptotic index. During a median follow-up of 14.3 years, 18 men (34%) in the BRCA1-positive group and 74 men (14%) in the BRCA1-negative group developed lethal prostate cancer. There was a strong positive association between BRCA1 protein expression and lethal prostate cancer in both unadjusted analyses (HR 2.71, 95% CI 1.73–4.26) and after adjusting for clinical factors (HR 2.00, 95% CI 1.26–3.18). The positive association with BRCA1 protein expression was also independent of proliferation index. Conclusions: Primary prostate tumors expressing the BRCA1 protein have a highly proliferative phenotype and are more likely to progress to lethal disease, independent of its higher proliferative index. Assessing tumor protein expression of BRCA1 may help elucidate the Janus-faced role of DNA repair pathways in prostate cancer progression.[Table: see text]

scholarly journals Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

2019 ◽  
Author(s):  
Peter Okpeh Amede ◽  
Elizabeth Adedire ◽  
Aishat Usman ◽  
Celestine A. Ameh ◽  
Faruk S. Umar ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Tracking System ◽  
Treatment Success ◽  
Incidence Rates ◽  
Prison Inmates ◽  
Successful Treatment Outcome ◽  
Tb Treatment ◽  
Hiv Negative

Abstract Background: Tuberculosis (TB) is a contagious disease and its transmissibility potential is increased in congregate settings like the prisons. TB incidence rates are five to fifty times higher among prison inmates than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its predictors in Nigerian prisons. We therefore assessed TB treatment outcomes among prison inmates in Bauchi State, Nigeria. Method: We conducted a retrospective data analysis of inmates with TB in the five main prisons in Bauchi State. We extracted sociodemographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a standardized checklist. We estimated the TB treatment success rate (TSR) and explored the relationship between the TSR and sociodemographic and clinical characteristics. Related variables were modelled in multivariate logistic regression to identify predictors of TSR at 5% level of significance. Results: All 216 inmates were male with mean age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 48 (22.2%) were lost to follow-up, 17 (7.9%) were transferred out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Odds of successful treatment outcome were age; 20-29 years (AOR=10.5; 95% CI: 3.2-35.1), 30-39 years (AOR=4.2; 95% CI: 1.3-13.1), pretreatment weight; 50-59 kg (AOR= 9.6; 95% CI: 1.4-65.6), ≥60 kg (AOR= 18.6; 95% CI: 2.5-140.1) and being HIV negative (AOR=3.3; 95% CI:1.4-7.8). Conclusion: The predictors of successful TB treatment outcome were being less than 40 years of age, having a pretreatment body weight of or greater than 50 kg, imprisonment for less than 2 years, and being HIV negative. We recommended that to improve TB TSR among prison inmates; age, duration of imprisonment, weight and TB/HIV coinfection should be the major consideration during drugs adherence, psychological and nutritional counselling and a tracking system be developed by the prisons authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated. Key words: Tuberculosis, Treatment outcomes, Prison inmates, Predictors, Bauchi State, Nigeria

scholarly journals Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

2020 ◽  
Author(s):  
Peter Okpeh Amede ◽  
Elizabeth Adedire ◽  
Aishat Usman ◽  
Celestine A. Ameh ◽  
Faruk S. Umar ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Tracking System ◽  
Treatment Success ◽  
Incidence Rates ◽  
Prison Inmates ◽  
Successful Treatment Outcome ◽  
Tb Treatment ◽  
Hiv Negative

Abstract Background : Tuberculosis (TB) is a contagious disease and its transmissibility potential is increased in congregate settings like the prisons. TB incidence rates are five to fifty times higher among prison inmates than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its predictors in Nigerian prisons. We therefore assessed TB treatment outcomes among prison inmates in Bauchi State, Nigeria. Method: We conducted a retrospective data analysis of inmates with TB in the five main prisons in Bauchi State. We extracted sociodemographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a standardized checklist. We estimated the TB treatment success rate (TSR) and explored the relationship between the TSR and sociodemographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify predictors of TSR at 5% level of significance. Results: All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 48 (22.2%) were lost to follow-up, 17 (7.9%) were transferred out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Predictors of successful treatment outcome were age; 20-29 years (AOR=10.5; 95% CI: 3.2-35.1), 30-39 years (AOR=4.2; 95% CI: 1.3-13.1), pretreatment weight; ≥ 55kg (AOR= 13.3; 95% CI: 6.0-29.6), imprisonment for ≤ 2 years (AOR= 2.6; 95% CI: 1.3-5.4) and being HIV negative (AOR=3.3; 95% CI:1.4-7.8). Conclusion: The predictors of successful TB treatment outcome were being less than 40 years of age, having a pretreatment body weight of or greater than 55 kg, imprisonment for less than 2 years, and being HIV negative. We recommended that to improve TB TSR among prison inmates; age, duration of imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking system be developed by the prisons authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated.

scholarly journals Dementia People Tracking System

2021 ◽  
Author(s):  
S. Deepa ◽  
Lavanya Dhanesh ◽  
Danusha V ◽  
Divya Dath K ◽  
Pavadhaarini G K ◽  
...  
Keyword(s):  
Real Time ◽  
Elderly People ◽  
Tracking System ◽  
The Elderly ◽  
Long Distance ◽  
People With Dementia ◽  
History Of ◽  
Real Time Information ◽  
Abnormal Behaviors

The number of elderly people worldwide is rigidly increasing due to decrease in birth rates and innovations implemented in medical field. Due to the increase in elderly people population diseases like dementia are also being increased year by year. Having done many kinds of research it is found that there is no permanent treatment for diseases like dementia, even if those patients come in public they look similar to normal people, however, people with dementia have abnormal behaviors like loss of patience, aggression, lack of thinking which in turn causes burden to family members and caretakers. In order to address this issues, this paper demonstrates a follow-up and rescue program for the elderly. The system includes a GPS receiver, a GSM module and a long-distance RF transmitter and receiver, real-time location. Families and care takers can obtain real-time information and history of patient location through GPS to avoid loss of elderly patients. With the help of this system, the number of losing patients will be decreased and the pressure on the caretakers and family people will be cut down to some extent.

scholarly journals A simulation study on the dosimetric benefit of real-time motion compensation in spot-scanning proton therapy for prostate

2017 ◽  
Vol 58 (4) ◽  
pp. 591-597 ◽  
Author(s):  
Yusuke Fujii ◽  
Taeko Matsuura ◽  
Seishin Takao ◽  
Yuka Matsuzaki ◽  
Takaaki Fujii ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Real Time ◽  
Patient Positioning ◽  
Time Motion ◽  
Spot Scanning ◽  
Real Time Image ◽  
Treatment Plans ◽  
Beam Delivery ◽  
Single Field ◽  
Time Image

Abstract For proton spot scanning, use of a real-time-image gating technique incorporating an implanted marker and dual fluoroscopy facilitates mitigation of the dose distribution deterioration caused by interplay effects. This study explored the advantages of using a real-time-image gating technique, with a focus on prostate cancer. Two patient-positioning methods using fiducial markers were compared: (i) patient positioning only before beam delivery, and (ii) patient positioning both before and during beam delivery using a real-time-gating technique. For each scenario, dose distributions were simulated using the CT images of nine prostate cancer patients. Treatment plans were generated using a single-field proton beam with 3-mm and 6-mm lateral margins. During beam delivery, the prostate was assumed to move by 5 mm in four directions that were perpendicular to the beam direction at one of three separate timings (i.e. after the completion of the first, second and third quartiles of the total delivery of spot irradiation). Using a 3-mm margin and second quartile motion timing, the averaged values for ΔD99, ΔD95, ΔD5 and D5–95 were 5.1%, 3.3%, 3.6% and 9.0%, respectively, for Scenario (i) and 2.1%, 1.5%, 0.5% and 4.1%, respectively, for Scenario (ii). The margin expansion from 3 mm to 6 mm reduced the size of ΔD99, ΔD95, ΔD5 and D5–95 only with Scenario (i). These results indicate that patient positioning during beam delivery is an effective way to obtain better target coverage and uniformity while reducing the target margin when the prostate moves during irradiation.

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