International journal of radiation oncology, biology, physics
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Int. J. Radiat. Oncol. Biol. Phys. · Jul 2004
Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignancies.
Development and implementation of a strategy to use a stereotactic ultrasound (US)-based image-guided targeting device (BAT) to align intensity-modulated radiotherapy (IMRT) target volumes accurately in the upper abdomen. Because the outlines of such targets may be poorly visualized by US, we present a method that uses adjacent vascular guidance structures as surrogates for the target position. We assessed the potential for improvement of daily repositioning and the feasibility of daily application. ⋯ Daily US-guided BAT targeting for patients with upper abdominal tumors was feasible in the vast majority of attempted setups. This method of US-based image-guided tumor targeting has been successfully implemented in clinical routine. The observed improved daily repositioning accuracy might allow for individualized reduction of safety margins and optional dose escalation. Compared with the established application of the BAT device for prostate radiotherapy, in which the target can be directly visualized, the TV in the present study was predominantly positioned relative to guidance vascular structures in close anatomic relation. We perceived an enormous potential in improved and individualized patient positioning for fractionated radiotherapy and also for stereotactic extracranial radiotherapy and radiosurgery, especially for tumors of the liver and pancreas.
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Int. J. Radiat. Oncol. Biol. Phys. · Jul 2004
Randomized Controlled Trial Multicenter Study Clinical TrialLong-term results of a phase III trial comparing once-daily radiotherapy with twice-daily radiotherapy in limited-stage small-cell lung cancer.
This Phase III study was performed to determine whether twice-daily (b.i.d.) radiotherapy (RT) resulted in better survival than once-daily (q.d.) RT for patients with limited-stage small-cell lung cancer (LD-SCLC). ⋯ Although this study did not demonstrate an advantage to split-course b.i.d. RT, the long-term survival was favorable, likely reflecting the positive influences of concurrent combined modality therapy and prophylactic cranial RT.
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Int. J. Radiat. Oncol. Biol. Phys. · Jul 2004
Randomized Controlled Trial Clinical TrialPerirectal seeds as a risk factor for prostate brachytherapy-related rectal bleeding.
To correlate rectal wall doses and perirectal seed numbers with late rectal bleeding after prostate brachytherapy. ⋯ A limited number of errant perirectal sources in itself does not appear to place patients at increased risk of rectal bleeding, providing that the overall rectal wall doses are within acceptable values.
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Int. J. Radiat. Oncol. Biol. Phys. · Jul 2004
Low complication rates are achievable after postmastectomy breast reconstruction and radiation therapy.
To report our institution's experience of complications and cosmetic results among patients who underwent modified radical mastectomy followed by reconstruction and radiation therapy (RT). ⋯ Patients treated with breast reconstruction and RT can experience a very low rate of major complications. We demonstrate no significant difference in the overall rate of major complications between TRAM and TE/I patients. Bolus can be safely used during postmastectomy RT with reconstruction, and we advocate the use of a custom wax bolus in the treatment of these patients. Postmastectomy RT should be considered in all eligible patients, even in the setting of reconstruction.
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Int. J. Radiat. Oncol. Biol. Phys. · Jul 2004
3D CT-based high-dose-rate breast brachytherapy implants: treatment planning and quality assurance.
Although accelerated partial breast irradiation (APBI) as the sole radiation modality after lumpectomy has shown promising results for select breast cancer patients, published experiences thus far have provided limited information on treatment planning methodology and quality assurance measures. A novel three-dimensional computed tomography (CT)-based treatment planning method for accurate delineation and geometric coverage of the target volume is presented. A correlation between treatment volume and irradiation time has also been studied for quality assurance purposes. ⋯ CT-based treatment planning allowed excellent visualization of the lumpectomy cavity and normal structures, thereby improving target volume delineation and optimal coverage, relative to conventional orthogonal film dosimetry. Using the Manchester volume implant table calculated irradiation time can be used as quality assurance for the HDR computed time. Thus dosimetric quality assurance and adequate target volume coverage can be concurrently confirmed, allowing prospective evaluation and optimization of implants.