Does Thermoplastic Mask Alleivates Skin Sparing Effect of Photons in Head and Neck Cancer Patients: A Pilot study

Introduction: Head and Neck tumors are mainly treated with concurrent chemoradiation. Treatment delivery with Megavoltage beam has the advantage of skin sparing effect but still skin reactions have been a major side effect since 2D era. Initially these reactions were due to the delivery with bilateral opposed portals but with advent of IMRT/ VMAT, it has been possible to escalate the tumor dose with the need of strict immobilization with thermoplastic mask. This thermoplastic mask may have a bolus effect and can result in increase in surface dose resulting in skin reactions. The aim of this study was to evaluate if any bolus effect of thermoplastic mask exists. Materials and Methods: A total of 15 patients of histologically proven carcinoma oropharynx and hypopharynx were taken. Patients were scanned for planning CT with thermoplastic mask. Another scan was taken in the same position but without thermoplastic mask. Same contouring and planning were done on both the scans. Plans were made and ascertained that all OAR’s and target volumes should get similar doses. Skin contoured on both the scans was evaluated for the dose received. Results: Mean dose received by skin in patients with thermoplastic mask was 48.15 GY while Mean dose received by skin in patients without thermoplastic mask was 43.18 GY. A paired t-test was applied on the dataset which revealed a statistically significant difference between the skin doses with and without mask with a p value of < 0.05. Conclusion: Increase in skin dose can be attributed of the bolus effect of thermoplastic mask. This bolus effect should be considered once high dose to skin is observed during planning or patient develops skin reaction.

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Skin dose assessment with treatment planning system (TPS) and skin reaction evaluation of early breast cancer patients treated via an intraoperative radiation therapy (IORT) device

Journal of Radiotherapy in Practice ◽

10.1017/s1460396918000237 ◽

2018 ◽

Vol 17 (4) ◽

pp. 417-421

Author(s):

Omid Baziar ◽

Hamid Gholamhosseinian ◽

Mohammad Naser Forghani

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Planning System ◽

Treatment Planning System ◽

Intraoperative Radiation Therapy ◽

Skin Dose ◽

Breast Cancer Patients ◽

Skin Reactions ◽

Intraoperative Radiation ◽

Skin Doses

AbstractPurposeTo assess skin dose and incidence of skin reactions in early breast cancer patients treated via Intrabeam™ intraoperative radiation therapy (IORT) device.Materials and methodsIn total, 250 breast cancer patients treated with a single fraction of 20 Gy using 50 kV photon were recruited. The applicator to skin distance (ASD) was measured before the initiation of the radiation and the skin dose in each patient was accordingly calculated based on the treatment planning system (TPS).ResultsThe average skin doses calculated were equal to 7·91, 5·83, 3·96 and 2·14 Gy for 6–10, 10–15, 15–20 and 20–30 mm ASD values, respectively. It is noticeable that the skin doses could be lower than the TPS measurements up to 45%, mostly due to lack of backscatter radiation in breast tissue compared with the full scatter condition in the Zeiss water phantom. Finally, only three patients showed low-grade skin reactions 1 week after IORT. A review of the related literature also revealed the incidence of lower skin complications among patients treated via Intrabeam™ compared with MammoSite™ machine.ConclusionsThe Intrabeam™ TPS did not seem to be very reliable for accurate skin dosimetry. However, breast cancer treatment using Intrabeam™ could result in fewer incidences of skin reactions than MammoSite™ machine.

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Impact of brachial plexus movement during radical radiotherapy for head and neck cancers: the case for a larger planning organ at risk volume margin

Journal of Radiotherapy in Practice ◽

10.1017/s1460396919000499 ◽

2019 ◽

Vol 19 (2) ◽

pp. 103-107

Author(s):

Asma Sarwar ◽

Shelly English ◽

Yanni Papastavrou ◽

Anna Thompson

Keyword(s):

At Risk ◽

Brachial Plexus ◽

Head And Neck ◽

Head And Neck Cancers ◽

Conformity Index ◽

High Dose ◽

Radical Radiotherapy ◽

Number Of Patients ◽

Significant Difference ◽

The Mean

AbstractIntroduction:Treatment volumes for radical radiotherapy to head and neck cancers commonly extend into the lower neck, the territory of the brachial plexus (BP). There is a risk of radiation-induced brachial plexopathy, a non-reversible late toxicity experienced by a small number of patients. The BP was anatomically divided into superior and inferior divisions and analysed to establish if segmental inter-fractional BP movement should be considered when planning radiotherapy in this high-dose region.Methods:A retrospective single-centre analysis of 15 patients with head and neck cancers treated with radical bilateral neck irradiation was conducted. The extent of BP movement relative to the planning scan was assessed using weekly cone beam computed tomography (CBCT) scans. The BP was contoured on the planning scan and the subsequent six weekly CBCTs; this was used to calculate the Jaccard Conformity Index (JCI) for the left, right, superior and inferior divisions of the BP.Results:The mean (±SD) JCI for right and left superior BP was 44·4±15·5%, whereas the mean (±SD) JCI for right and left inferior BP was 38·3±15·5%. There was a statistically significant difference between superior and inferior JCI, p=0·0002, 95% CI (−9·26 to −2·88). Bilateral superior BP JCI was higher, with better conformity than the corresponding inferior divisions.Conclusions:Inter-fractional BP movement occurs; the greatest movement is seen at the inferior division. This data suggest the need for re-evaluation of current BP margins and consideration of a larger inferior BP planning at risk volume (PRV) margin.

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TO COMPARE THE TOXICITY PROFILE OF ACCELERATED RADIOTHERAPY (SIX FRACTIONS PER WEEK) WITH CONCOMITANT CHEMO-RADIOTHERAPY IN LOCALLY ADVANCED HEAD AND NECK CANCER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.725 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Vikrant Kaushal ◽

Amit Rana ◽

Manoj Gupta ◽

Rajeev Seam ◽

Manish Gupta

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Randomized Study ◽

Locally Advanced ◽

Medical Science ◽

Hematological Toxicity ◽

P Value ◽

Significant Difference ◽

The Difference

Background: Head and neck malignancies are common among males in India. The age adjusted incidence rate of head and neck cancer in India in males is 16.4/100,000 and in females it is 8.8/100,000.In All India Institute of Medical Science head and neck cancer represents 25% of all malignancies registered Methods: This prospective randomized study was conducted in the Department of Radiation Therapy & Oncology, Regional Cancer Centre, IGMC, Shimla and patients were enrolled for a period of one year, from July 2012 to July 2013.It included all the eligible, previously untreated patients of squamous cell carcinoma of Head and Neck with histologically confirmed diagnosis and no evidence of distant metastasis. The sites included were oro-pharynx, hypo-pharynx and larynx with stages III, IV A and IV B. Results: Grade 3 and grade 4 skin toxicities were higher in CRT arm but without statistically significant difference from that in ART arm. G3 & G4 mucositis was higher in the Concomitant CRT arm however the difference was not statistically significant. G2 and G3 Laryngeal Toxicities were higher in Concomitant CRT arm as compared to Accelerated arm but the difference was not statistically significant. G2 & G3 haematological toxicities were significantly (combined p value = 0.002) higher in the concomitant CRT arm (32.4%) as compared to Accelerated RT arm (2.9%). Only one patient in accelerated arm had any hematological toxicity. Conclusion: Higher peak incidence of toxicities was seen in concomitant CRT arm as compared to accelerated arm. Keywords: Toxocity, six fraction, chemoradiation, Local control

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Vascular Rehabilitation Benefits of Tribulus Terrestris (TT), Taurine and High Dose Alpha Lipoic Acid (ALA) Supplementation with Interval Walking Training Program after Surgical Vascular Bypass Treatment (Pilot Study)

International Journal of Kinesiology and Sports Science ◽

10.7575/aiac.ijkss.v.7n.3p.22 ◽

2019 ◽

Vol 7 (3) ◽

pp. 22

Author(s):

Sid Solakovic Solakovic ◽

Ratko Pavlovic ◽

Mensur Vrcic ◽

Emir Solakovic

Keyword(s):

Physical Activity ◽

Training Program ◽

P Value ◽

High Dose ◽

Tribulus Terrestris ◽

Graft Occlusion ◽

Amputation Level ◽

Below The Knee ◽

Significant Difference ◽

Vein Bypass

Background: Some of main raisons for the elderly graft occlusion after successful aortal-iliac, aortal Femoral and Femoral Distal Vein Bypass, progression of main disease, continuing bad life Habits and uncontrolled risk factors such are mostly: poor nutrition traditional or fast food, Smocking and Lacks of Walking and Physical Activity Habits. Objective: The primary objective of the study was to estimate influence of Interval Walking Training Program combine with Tribulus Terrestris, 3-5 gram of Taurine and high dose of 1800mg supplementation of ALA on primary potency and vascular treatment. Secondary goals of this study is determinate by establishing better understanding connection between ordinary vascular walking therapy 30-45 min and interval walking program combine with Tribulus Terrestris, Taurine and high dose of and ALA as secondary supplementation after surgical and endovascular treatment. Methodology: The study included 112 patients, at the Clinic of cardiovascular surgery, Clinical Center University of Sarajevo, age between 50 and 75 (50 patients surgical treated with aortic-iliac, aortic-femoral and femoral distal vein bypass with and without Linton-patch/Taylor patch-first group) and (62 endovascular Iliac treated patients (indication TASC II A and B) with and without support Tribulus Terrestris, high dose of ALA and Taurine - second group). Results: Final analysis has reveal the rehabilitation outcome in 83% patients with bypass above the knee was fully rehabilitated compared to 46,6% patients with bypass below the knee was statistically considered significant by using p value less than (p<0,05) In anamnestic history in 83% patient with amputation above the knee was documented the presence of hypertension, hyperlipidemia, nicotinismus and diabetes compared to 66,7% of patients with amputation level below the knee but there was no statistically significant difference (p>0,05). Conclusion: Interval Walking Training Program on Tribulus Terrestris, Taurine and high dose of ALA had a significantly and successfully higher bypass potency and rehabilitation prognosis compare to patients without supplementation and postsurgical physical therapy concept. It is obviously the is certain link between physical activity, life style modification and serum testosterone on primary bypass potency.

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The Feasibility of a Novel Dose Painting Procedure to Treat Prostate Cancer Based on mpMR Images and Hierarchical Clustering

10.21203/rs.3.rs-605561/v1 ◽

2021 ◽

Author(s):

Seyed Masoud Rezaeijo ◽

Bijan Hashemi ◽

Bahram Mofid ◽

Mohsen Bakhshandeh ◽

Arash Mahdavi ◽

...

Keyword(s):

Prostate Cancer ◽

Hierarchical Clustering ◽

Post Treatment ◽

P Value ◽

Agglomerative Clustering ◽

Dose Painting ◽

Significant Difference ◽

Target Volumes ◽

Adc Values

Abstract BackgroundWe aimed to assess the feasibility of a novel dose painting (DP) procedure for treating prostate cancer with dominant intraprostatic lesions (DILs) based on mpMR images and hierarchical clustering with a machine learning technique. MethodsThe mpMR images of 120 patients were used to create hierarchical clustering and draw a dendrogram. Three clusters were selected for performing agglomerative clustering. Then, the DIL acquired from the mpMR images of 20 patients were categorized into three groups to have them treated with a novel DP procedure being composed of three planning target volumes (PTVs) determined as PTV1, PTV2, and PTV3 in treatment plans. The DP procedure was carried out on the patients wherein a total dose of 80, 85, and 91 Gy were delivered to the PTV1, PTV2, and PTV3, respectively. Dosimetric and radiobiologic parameters (TCP & NTCP) of the DP procedure were compared with those of the conventional IMRT and 3DCRT procedures carried out on another group of 20 patients. A post-treatment follow-up was also made four months after the radiotherapy procedures.ResultsAll the dosimetric variables and the NTCPs of the organs at risks revealed no significant difference between the DP and IMRT procedures. Regarding the TCP of three investigated PTVs, significant differences were observed between the DP vs. IMRT and also DP vs. 3DCRT procedures. At post-treatment follow-up, the DIL volumes and ADC values in the DP group differed significantly (p-value<0.001) from those of the IMRT. However, the whole prostate ADC and PSA indicated no significant difference (p-value>0.05) between the DP vs. IMRT. ConclusionsThe results of this comprehensive clinical trial illustrated the feasibility of our novel DP procedure for treating prostate cancer based on mpMR images validated with acquired patients’ dosimetric and radiobiologic assessment and their follow-ups. This study confirms significant potential of the proposed DP procedure as a promising treatment planning to achieve effective dose escalation and treatment for prostate cancer.Trial registrationIRCT20181006041257N1; Iranian Registry of Clinical Trials, Registered: 23 Oct. 2019, https://en.irct.ir/trial/34305

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Evaluation of the changes in Tei-index (myocardial performance index) in Doppler echocardiography before and after treating with anthracycline combinations in children with malignancy

Iranian Journal of Pediatric Hematology & Oncology ◽

10.18502/ijpho.v11i4.7166 ◽

2021 ◽

Author(s):

Majid Naderi ◽

Maryam Judi ◽

Maryam Yazdanparast ◽

Sima SavadKuhi ◽

Saeedeh Yaghoubi

Keyword(s):

Performance Index ◽

Myocardial Performance Index ◽

P Value ◽

High Dose ◽

Healthy Children ◽

Myocardial Performance ◽

Tei Index ◽

Significant Difference ◽

Group A ◽

Group B

Background: Cardiomyopathy usually causes a cardiac dysfunction resistant to treatment due to anthracycline. This study aimed to evaluate the changes in Tei-Index (myocardial performance index) in patients with malignancies treated with anthracycline. Material and Methods: This case-control study was done on 15 children who were treated with low-dose anthracycline (1-199mg/kg) called group A and 15 children who were treated with high dose (>200mg/kg) anthracycline called group B after acquiring consent from their parents. Children with no abnormality in Echo-Doppler results were included in this study. The patients’ age range between 1- 17 years with a mean age of 6.57 years. Another group of healthy children were assigned to group C as a control group who had not received chemotherapy. The first echo was performed right before the treatment and the second one, two weeks after completing chemotherapy. Data were analyzed by the SPSS statistical software. Results: Changes in mean Tei-index in group A were 0.36 ± 0.04 before treatment and 0.43 ± 0.11 after treatment. Changes in mean Tei-index in group B were 0.37 ± 0.04 before treatment and 0.45 ± 0.06 after treatment. There was no significant difference between the two groups using the independent T-test. (p-value= 0.57). No significant correlation between the changes in mean ejection fraction (EF) and treatment was found in the three groups (p-value=0.45). Conclusion: This study showed a change in the Tei-index (MPI) in patients receiving anthracycline; regardless of the dosage, they got in their regimen. Given the use of anthracycline, any abnormal cardiac finding can alert the physicians to the possibility of cardiomyopathy, hence scheduling routine follow-ups are necessary.

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Evaluation of thermoplastic Klarity mask use during intensity-modulated radiation therapy for head and neck carcinoma

Journal of Radiotherapy in Practice ◽

10.1017/s1460396917000632 ◽

2018 ◽

Vol 17 (2) ◽

pp. 171-178 ◽

Cited By ~ 3

Author(s):

Khaldoon Radaideh

Keyword(s):

Radiation Therapy ◽

Head And Neck ◽

Intensity Modulated Radiation Therapy ◽

Planning System ◽

Skin Dose ◽

Surface Dose ◽

Thermoluminescent Dosimeters ◽

Intensity Modulated ◽

Skin Doses ◽

Dose Measurements

AbstractAimTo evaluate the Klarity® Mask with respect to skin doses and toxicity secondary to head and neck cancer radiation treatment.Materials and methodsThis prospective study included five nasopharyngeal cancer patients who underwent intensity-modulated radiation therapy and monitored for skin toxicity. An anatomical Perspex head and neck phantom was designed and used. All patients’ treatment plans were separately transferred to the phantom. Dosimetric measurements were performed using chip-shaped thermoluminescent dosimeters (LiF:Mg,Ti TLDs) which were distributed at certain target points on the phantom. Phantom was irradiated twicely with and without a Klarity® Mask. Three fractions for each patient plan were obtained and compared with treatment planning system (TPS) doses as guided by computed tomography.ResultsThe Klarity mask used for patient immobilisation increased the surface dose by 10·83% more than that without the mask. The average variations between skin dose measurements with and without the Klarity mask for all patients’ plans ranged from 10·26 to 11·83%. TPS overestimated the surface dose by 19·13% when compared with thermoluminescent dosimeters that measured the direct skin dose.ConclusionsKlarity immobilisation mask increases skin doses, as a consequence, surface dose measurements should be monitored and must be taken into account.

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Association of MTR A2756G Gene Polymorphism with Risk of Head and Neck Cancer

Life and Science ◽

10.37185/lns.1.1.82 ◽

2020 ◽

Vol 1 (3) ◽

pp. 6

Author(s):

Muhammad Tahir ◽

Aamer Ali Khattak ◽

Erum Monis ◽

Sana Gul

Keyword(s):

Head And Neck ◽

Age Groups ◽

P Value ◽

Chi Square ◽

Normal Individuals ◽

Increased Risk ◽

Significant Difference ◽

Pcr Rflp ◽

Chi Square Test ◽

History Of

Objective: To perform genotyping for MTR A2756G polymorphism and identification of risk factors associated with head and neck squamous cell carcinoma (HNSCC). Study Design: Cross section, comparative study. Place and Duration of Study: The study was carried out at the Department of Biochemistry of Quaid-i- Azam University, Islamabad from October 2014 to August 2015. Materials and Methods: In this study, 292 diagnosed patients HNSCC and 324 normal individuals without any history of cancer were enrolled. Blood samples of patients and controls were collected in ethylenediamine tetra acetic acid (EDTA) and DNA was extracted using conventional method. All samples were genotyped for the MTR A2756G polymorphism using PCR-RFLP. Frequency of polymorphism was compared between HNSCC patients andcontrols. MultipleLogisticRegression(MLR)andchi-squaretestwasperformedtoexaminetheassociation of MTR A2756G polymorphism with risk factor. Results: Chi-square test of independence showed statistically significant difference among the variables of age, smoking and MTR A2756G genotype (p-value<0.05). Multivariate analysis showed that smoking (adjusted OR, 3.7; 95% CI, 2.3 – 6.0), age groups 41 – 50 years (adjusted OR, 3.6; 95% CI, .9 – 6.7) and > 60 years (adjusted OR, 3.5; 95% CI, 1.7 – 7.3), MTR 2756 AG genotype (adjusted OR, 2.1; 95% CI, 1.3 – 3.5) is associated with increased risk of HNSCC. Conclusion: The results suggest that the genetic polymorphism MTR A2756G is associated with the occurrence of HNSCC in the Pakistani population while the individuals between 40 to 50 years of age and those who are smokers are at a greater risk of developing HNSCC.

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Toxicity evaluation of Dolichandrone serrulata flower extract on vital and reproductive organs in adult male rats

Brazilian Journal of Biology ◽

10.1590/1519-6984.251224 ◽

2024 ◽

Vol 84 ◽

Author(s):

C. Chaimontri ◽

S. Iamsaard

Keyword(s):

Adult Male ◽

Chronic Toxicity ◽

Vas Deferens ◽

Reproductive Organs ◽

Male Rats ◽

P Value ◽

High Dose ◽

Flower Extract ◽

Normal Ranges ◽

Significant Difference

Abstract Although Dolichandrone serrulata flower (DSF) aqueous extract has been shown to possess pharmacological properties, its systemic toxicity has still to be evaluated. The present study aimed to investigate the sub-chronic toxicity effect of DSF extract on biochemical parameters and histological structures of liver, kidney, testis, and epididymis plus vas deferens. Adult male rats were administered DSF at 100, 300, and 600 mg/kgBW via oral gavage for 48 consecutive days while control rats received distilled water. At the end of the experiment, blood, liver, kidney, testis, and epididymis plus vas deferens samples were collected to determine any changes to serum biochemical components including ALT, ALP, and creatinine levels and histological structures. The results revealed no significant difference in body weight and food or water consumption between control and the DSF-treated groups. It was found that DSF significantly increases the weight of epididymis plus vas deferens, while the kidney and liver showed a decrease in the high dose group (P value < 0.05). Histological changes in these vital and reproductive tissues including fibrosis were not observed after administration but ALT, ALP, and creatinine levels were significantly altered in the treated groups (P value < 0.05). These altered levels, however, were still within normal ranges. In conclusion, these findings demonstrated that D. serrulata flower extract had no sub-chronic toxicity on vital and reproductive structures but slightly altered some liver and kidney functions.

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Predictive Performance of Gargle Test in Prediction of Successful Extubation in Patients Undergoing Head and Neck Surgery in ICU

10.21203/rs.3.rs-490228/v1 ◽

2021 ◽

Author(s):

Mohammad Taghi Beigmohammadi ◽

Laya Amoozadeh ◽

Abbas Alipour

Keyword(s):

Head And Neck ◽

Predictive Performance ◽

Neck Surgery ◽

Extubation Failure ◽

Categorical Variables ◽

P Value ◽

Predictive Values ◽

Airway Edema ◽

Significant Difference ◽

Successful Extubation

Abstract Background Improvement of predictive tools for recognition of airway edema is crucial for safe extubation and patient safety. This study aims to evaluate the efficacy of gargle test for assessment of airway edema and prediction of successful extubation in patients undergoing head and neck surgeries. Methods This is a prospective observational study on 118 patients that were undergone head and neck surgeries and been admitted to intensive care units. All the patients were weaned based on the same protocol. Initially, quantitative, and qualitative Cuff Leak Test were done and, the decision for extubation was made by employing them. Subsequently, gargling with purified water was implemented. Exclusion criteria were consisted of the impossibility of extubation due to reasons other than airway edema such as pneumonia. Independent sample t-test was applied to study the difference between quantitative variables between two groups, and Fisher’s exact test was used for categorical variables. P-value < 0.05 was determined as a significant difference between the variables. To investigate the relationship between these two tests, sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Result One hundred eighteen were enrolled in this study. Sixty-seven patients (56.78%) male and 51 patients (43.22%) were female with a mean age of 54.7 ± 12.2 year. Due to surgical manipulations, and anatomical problems in the hypopharynx and larynx, 5 patients (4.2%) were not able to perform the gargle test. Six patients (5.1%) were facing extubation failure since they experienced respiratory distress and stridor. A measure of agreement (kappa) of gargle test with qualitative and quantitative CLT was low (K = 0.21, k = 0.07, respectively). The gargle test had higher specificity, negative predictive value (NPV), and accuracy compared to quantitative and qualitative CLT. Extubation failure in patients with positive gargle test was significantly lower than patients with negative gargle test (3.7% vs. 33.4 % respectively, P = 0.032). Conclusion The gargle test is simple, cheap, and does not require any equipment, and groups of nerves and muscles which control larynx function are being assessed in the gargle test. It provides better patients safety in difficult extubations.

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