Heterologous prime-boost immunization with CoronaVac and Convidecia

Background The safety and immunogenicity of heterologous prime-boost COVID-19 vaccine regimens with one shot of a recombinant adenovirus type-5-vectored COVID-19 vaccine Convidecia has not been reported. Methods We conducted a randomized, controlled, observer-blinded trial of heterologous prime-boost immunization with CoronaVac and Convidecia in healthy adults 18-59 years of age. Eligible participants who were primed with one or two doses of CoronaVac were randomly assigned at a 1:1 ratio to receive a booster dose of Convidecia or CoronaVac. Participants were masked to the vaccine received but not to the three-dose or two-dose regimen. The occurrences of adverse reactions within 28 days after the vaccination were documented. The geometric mean titers of neutralizing antibodies against live SARS-CoV-2 virus were measured at 14 and 28 days after the booster vaccination. Results Between May 25 and 26, 2021, a total of 300 participants were enrolled. Participants who received a booster shot with a heterologous dose of Convidecia reported increased frequencies of solicited injection-site reactions than did those received a homogeneous dose of CoronaVac, but frequencies of systemic reactions. The adverse reactions were generally mild to moderate. The heterologous immunization with Convidecia induced higher live viral neutralizing antibodies than did the homogeneous immunization with CoronaVac (197.4[167.7, 232.4] vs. 33.6[28.3, 39.8] and 54.4[37. 9, 78.0] vs. 12.8[9.3, 17.5]) at day 14 in the three- and two-dose regimen cohort, respectively. Conclusions The heterologous prime-boost regimen with Convidecia after the priming with CoronaVac was safe and significantly immunogenic than a homogeneous boost with CoronaVac (ClinicalTrials.gov, number NCT04892459).

Intensity-Modulated Proton Therapy (IMPT) Treatment of Angiosarcoma of the Face and Scalp

Purpose To successfully plan and treat a patient with diffuse angiosarcoma involving the face and scalp with intensity-modulated proton therapy (IMPT) before surgical resection. Materials and Methods A patient presented to the radiation oncology department for preoperative treatment of an angiosarcoma diffusely involving the face and scalp. A 4-field IMPT technique was used to create a homogeneous dose distribution to the entire target volume while sparing underlying critical structures from toxicity and low-dose spread. A custom Monte Carlo optimizer was necessary to achieve treatment goals. Biological dose was evaluated with a linear energy transfer–based biological enhancement model. Robustness criteria were evaluated per department standard. The patient was successfully planned and treated according to clinical goals. Results The patient successfully completed the course of IMPT and was able to undergo surgical resection. Pathology indicated no presence of angiosarcoma. Conclusion IMPT using a custom Monte Carlo optimizer is a suitable radiation therapy treatment option for patients with diffuse angiosarcoma of the scalp and face.

Dosimetric and radiobiological comparison of treatment plan between CyberKnife and EDGE in stereotactic body radiotherapy for pancreatic cancer

To perform a comparison of the different stereotactic body radiotherapy (SBRT) plans between the Varian EDGE and CyberKnife (CK) systems for locally advanced unresectable pancreatic cancer. Fifteen patients with pancreatic cancer were selected in this study. The median planning target volume (PTV) was 28.688 cm3 (5.736–49.246 cm3). The SBRT plans for the EDGE and CK were generated in the Eclipse and Multiplan systems respectively with the same contouring and dose constrains for PTV and organs at risk (OARs). Dose distributions in PTV were evaluated in terms of coverage, conformity index (CI), new conformity index (nCI), homogeneity index (HI), and gradient index (GI). OARs, including spinal cord, bowel, stomach, duodenum and kidneys were statistically evaluated by different dose-volume metrics and equivalent uniform dose (EUD). The volume covered by the different isodose lines (ISDL) ranging from 10 to 100% for normal tissue were also analyzed. All SBRT plans for EDGE and CK met the dose constraints for PTV and OARs. For the PTV, the dosimetric metrics in EDGE plans were lower than that in CK, except that D99 and GI were slightly higher. The EDGE plans with lower CI, nCI and HI were superior to generate more conformal and homogeneous dose distribution for PTV. For the normal tissue, the CK plans were better at OARs sparing. The radiobiological indices EUD of spinal cord, duodenum, stomach, and kidneys were lower for CK plans, except that liver were higher. The volumes of normal tissue covered by medium ISDLs (with range of 20–70%) were lower for CK plans while that covered by high and low ISDLs were lower for EDGE plans. This study indicated that both EDGE and CK generated equivalent plan quality, and both systems can be considered as beneficial techniques for SBRT of pancreatic cancer. EDGE plans offered more conformal and homogeneous dose distribution for PTV, while the CK plans could minimize the exposure of OARs.

Evaluation Treatment Planning for Breast Cancer Based on Dose-Response Model

The delivery of radiation therapy to patients requires prior planning made by medical physicists to achieve radiotherapy goals. Radiotherapy has a plan to eradicate the growth of cancer cells by giving high doses and minimizing the radiation dose to normal tissue. Evaluation of planning is generally done based on dosimetric parameters, such as minimum dose, maximum dose, and means dose obtained from the DVHs data. Based on the same DVHs, data were evaluate dinterms of biological effects to determine the highest possible toxicity in normal tissue after the tumor had been treated with radiation using the NTCP model. The evaluation was conducted by selecting three DICOM-RT data of post-mastectomy right breast cancer patients who had been prescribed a dose of 50 Gy obtained from the Hospital MRCCC Siloam Semanggi database. All data were processed using open-source software DICOManTX to get the DVH and isodose information. Matlab-based CERR software was used to calculate the NTCP model. The results show that the three patients' DVH and isodose treatment planning result in a homogeneous dose distribution result because the PTV area obtains adose limit of ≥ 95%. Moreover, normalt issue still gets adose below the tolerance limit based on the standard from RTOG 1005 and ICRU 83. Analysis of NTCP shows a complication probability below 1% for each organ, suggesting that any organ which has been irradiated has a low likelihood of complications. Therefore, it can be concluded that the treatment planning which has been made in the three patients using the IMRT technique has achieved the objectives of radiotherapy, which is to minimize toxicity to healthy organs. |Keywords: DVH, isodose, NTCP, radiotherapy.

Teknik 3D Conformal Radioterapi (3DCRT) Pada Keganasan Sinus Paranasal Dengan Modalitas Linac

Background: Radiotherapy is a radiation therapy action using ionizing radiation. To obtain the maximum dose of radiation in the tumour and the lowest possible dose on critical organs required a technique of radiation technique 3 Dimensional Conformal Radiotherapy (3DCRT). Radiotherapy Unit Radiology Installation Dr Sardjito Hospital Yogyakarta using 3DCRT technique. This research aims to know the radiotherapy procedure on paranasal sinus cancer using 3DCRT technique, to know the implementation of bolus beam modifier and dose optimization with the addition of electron radiation.Methods: The type of research in this thesis is qualitative research with case study approach. The research was conducted at Radiotherapy Unit Radiology Installation Dr Sardjito Hospital Yogyakarta after published Ethical Clearance. Methods of data collection in this study are observation, interviews, and documentation.Result: The results of this study indicate that the radiotherapy procedure in paranasal sinus cancer using 3DCRT technique can produce a homogeneous dose distribution, the implementation of bolus beam modifier is capable of generating dosage homogeneity on uneven target surfaces, and the distribution of doses with electron radiation on the target in the surface area can be optimal.Conclusion: With these techniques, the goal of radiotherapy can be achieved is to give the maximum dose in the tumour and the minimum dose possible in healthy tissue located in the vicinity.

Dosimetric evaluation employing TL and OSL techniques with different luminescent materials for clinical evaluation of extremity doses using electron beams applied to Total-Irradiation-of-Skin treatments

Total-skin electron beam (TSEB) irradiation is used to deliver a homogeneous dose distribution over the entire skin surface of a patient. TSEB dosimetry is quite complex as to the evaluation and measurement of absorbed dosage in the cutaneous region. This paper evaluates the performance of different dosimetric materials, using TL and OSL dosimetry, in the extremity-dose assessment of TSEB treatments using the six-dual-field technique and an anthropomorphic phantom. Dosimeters were selected with repeatability better than [Formula: see text] and calibrated to 6-MeV electron-beam dosimetry. Measurements were conducted in the abdominal region as a reference point and on the extremities. Results show expected deviations ranging up to [Formula: see text] in the dose received in the extremities and good results in dose assessment using all dosimetric materials tested.

A supine cranio-spinal irradiation technique using moving field junctions

Aim: To demonstrate a simple technique of cranio-spinal irradiation (CSI) in supine position using inter fraction moving field junctions to feather out any potential hot and cold spots. Materials and Methods: Fifteen patients diagnosed with medulloblastoma were treated during the period February 2011 to June 2015 were included in this study. Out of fifteen patients in the study nine were male and 6 were female with a median age of 13.4 years (range 5-27 years). All the patients were positioned supine on CT simulation, immobilized using thermoplastic mask and aligned using room based laser system. Two parallel opposed lateral fields for the whole brain using an asymmetrical jaw with isocenter at C2 vertebral body. A posterior field also placed to cover the cervical and dorsal field using the same isocenter at C2. The second isocenter was placed at lumbar vertebral region to cover the remaining dorsal, lumbar and sacral region using an inter-fraction moving junction. Field-in-field and enhanced dynamic wedge used to homogeneous dose distribution when required. Results and Discussion: In this study, we found that only two patients failed in the primary site, no radiation myelitis or recurrences in the filed junctions were reported in these fifteen patients with a median follow-up of 36.4 months. The automated sequence of treatment plans with moving junctions in the comfortable supine position negating the need for manual junction matching or junction shifts avoiding potential treatment errors and also facilitating delivery of anesthesia where necessary.