•The average emission per treatment and fraction delivered was 489 kg CO₂eq and 27 kg CO₂eq, respectively.•Patient transportation (43 %) and the construction and maintenance of linear accelerators ...(LINACs) and scanners (17 %) represented the most significant components.•Electricity, the only energy used, accounted for only 2 % of emissions.•A significant reduction in the carbon footprint of a radiotherapy unit can be achieved without compromising the quality of care.
Data on the carbon footprint of external beam radiotherapy (EBRT) are scarce. Reliable and exhaustive data, including a detailed carbon inventory, are needed to determine effective mitigation strategies.
This study proposes a methodology for calculating the carbon footprint of EBRT and applies it to a single center. Mitigation strategies are derived from the carbon inventory, and their potential reductions are quantified whenever possible.
The average emission per treatment and fraction delivered was 489 kg CO₂eq and 27 kg CO₂eq, respectively. Patient transportation (43 %) and the construction and maintenance of linear accelerators (LINACs) and scanners (17 %) represented the most significant components. Electricity, the only energy source used, accounted for only 2 % of emissions.
Derived mitigation strategies include a data deletion policy (reducing emissions in 30 years by 12.5 %), geographical appropriateness (−12.2 %), transportation mode appropriateness (−9.3 %), hypofractionation (−5.9 %), decrease in manufacturers’ carbon footprint (−5.2 %), and an increase in machine durability (−3.5 %).
Our findings indicate that a significant reduction in the carbon footprint of a radiotherapy unit can be achieved without compromising the quality of care.
This study provides a methodology and a starting point for comparison and proposes and quantifies mitigation strategies, paving the way for others to follow.
Several studies suggest that surgical excision of the primary tumor improves survival among patients with stage IV breast cancer at diagnosis. Exclusive locoregional radiotherapy (LRR) is an ...alternative form of locoregional treatment (LRT) in this setting. We retrospectively studied the impact of LRT on the survival of breast cancer patients with synchronous metastases.
Among 18,753 breast cancer patients treated in our institution between 1980 and 2004, 598 patients (3.2%) had synchronous metastasis at diagnosis. Demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The impact of LRT on overall survival (OS) was evaluated by multivariate analysis including known prognostic factors.
Among 581 eligible patients, 320 received LRT (group A), and 261 received no LRT (group B). LRT consisted of exclusive LRR in 249 patients (78%), surgery of the primary tumor with adjuvant LRR in 41 patients (13%), and surgery alone in 30 patients (9%). With a median follow-up time of 39 months, the 3-year OS rates were 43.4% and 26.7% in group A and group B (P =.00002), respectively. The association between LRT and improved survival was particularly marked in women with visceral metastases. LRT was an independent prognostic factor in multivariate analysis (hazard ratio HR = 0.70; 95% CI, 0.58 to 0.85; P = .0002). The adjusted HR for late death (>or= 1 year) was 0.76 (95% CI, 0.61 to 0.96; P = .02).
In our experience, LRT, consisting mainly of exclusive LRR, was associated with improved survival in breast cancer patients with synchronous metastases. Exclusive LRR may thus represent an active alternative to surgery.
•A typical radiotherapy treatment emits from 185 to 2066 kgCO2eq in France.•CO2eq emissions are mostly driven by accelerator acquisition and maintenance as well as patients and workers ...rides.•Hypofractionation has a strong impact on mitigating carbon footprint.•Hypofractionation related toxicities are usually lower than damages avoided to future people thanks to CO2eq mitigation.
The major drivers of carbon dioxide (CO2eq) emissions of external beam radiation therapy (EBRT) are not well known and limit our ability to initiate mitigation strategies.
We describe the carbon footprint of four typical centers. We explore direct EBRT associated factors such as the impact of fractionation and use of MRI-LINAC, as well as indirect factors (e.g. patient rides). Treatment strategy related CO2eq emissions are included in a health technology assessment analysis that takes into account CO2eq emissions.
A typical EBRT treatment emits from 185 kgCO2eq to 2066 kgCO2eq. CO2eq emissions are mostly driven by (i) accelerator acquisition and maintenance (37.8 %), (ii) patients and workers rides (32.7 %), (iii) drugs and medical devices (7.3 %), (iv) direct energy consumption (6.1 %), and (v) building and bunker construction (5.6 %) with a substantial heterogeneity among centers. Hypofractionation has a strong impact to mitigate emissions. MRI-LINAC is associated with a substantial increase in CO2eq emissions per fraction and requires ultra hypofractionation in 5 fractions to achieve a similar carbon footprint compared to 20 fractions treatment schemes. The expected limited small increase in toxicities due to hypofractionation (when existing) are in the same range as avoided detrimental effects to future people’s health thanks to CO2eq mitigation.
Carbon footprint of EBRT is not neglectable and could be mitigated. When safely feasible, hypofractionation is one of the main factors to decrease this impact. Taking into account CO2eq emissions has a substantial impact on the health technology assessment of EBRT, favoring hypofractionated regimens.
Cystadenoma of the tunica of the adult male testis has rarely been reported in the literature. We report a case of an adult serous cystadenoma along with the radiological and pathological findings. ...The patient was a 40-year-old male with a slowly growing mass on the left testis. An ultrasound scan of left testis showed features highly suspicious for malignancy. Lactate dehydrogenase (LDH) was mildly elevated. Alpha feta-protein (AFP) and beta-human chorionic gonadotropin (beta hCG) were negative. We performed left radical orchiectomy. The pathological findings showed serous cystadenoma of the tunica of the testis. The patient remains asymptomatic.
First and foremost, the present study seeks to traverse the informal sector characterized by a shadow economy in the presence of financial development, economic growth, and stock market performance ...on environmental pollution in Nigeria from 1981 to 2019. The dynamic autoregressive distributed lag (DARDL) approach was used to measure the short- and long-run elasticities, while spectral causality is applied to categorize the causal directions. Findings from the study revealed that the structural break unit root test revealed that all variables are stationary at first difference. The ARDL bound test confirmed the existence of long-run association among the used variables. The ARDL long-run results reveal that economic growth, financial development, and stock market performance are significantly responsible for carbon emission in Nigeria, while the shadow economy significantly improves environmental quality in Nigeria. Findings from the spectral causality results show a unidirectional causal relationship between financial development, economic growth, trade, stock market performance, and shadow economy to carbon emission in Nigeria. The empirical findings of this study provide some perceptive policy recommendations to overcome the adverse effect of carbon emissions in the environment.
Data from the Surveillance, Epidemiology, and End Results program and the European Concerted Action on survival and Care of Cancer Patients (EUROCARE) project indicate that about 6% of women newly ...diagnosed with breast cancer have stage IV disease, representing about 12 600 new cases per year in the United States in 2005. Historically, local therapy of the primary tumor in this setting has been aimed solely at symptom palliation. However, several studies suggest that surgical excision of the primary tumor can prolong these patients' survival.
Exclusive locoregional radiotherapy is an alternative form of locoregional treatment in this setting and may represent an effective alternative to surgery in this setting. Here we discuss current issues regarding exclusive and adjuvant locoregional radiotherapy in breast cancer patients with synchronous metastases.
Several studies suggest that surgery or exclusive irradiation of the primary tumor is associated with better survival in breast cancer patients with synchronous metastases and that exclusive locoregional radiotherapy may represent an effective alternative to surgery in this setting. Results of well-designed prospective studies are needed to re-evaluate treatment of the primary breast tumor in patients with metastases at diagnosis, and to identify those patients who are most likely to benefit.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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