...with the emergence of novel cancer therapies such as targeted therapy, immunotherapy, and chimeric antigen receptor T-cell therapy 2-4, it is crucial to understand how these modalities could ...potentially impact the occurrence of FN and subsequent visits to the ED. Surprisingly, despite the implementation of obligatory face masks and social distancing measures during the pandemic, there was no significant change in FN rates. ...it was interesting to note that more patients received G-CSF prophylaxis during this period, and one-year survival rates were higher compared to the pre-pandemic era 14. ...by investigating the interplay between various treatment modalities and ED revisits, these studies have the potential to facilitate the development of personalized treatment strategies for cancer patients, ultimately shaping the landscape of emergency medicine and ambulatory oncology.Funding None.CRediT authorship contribution statement Wei-Jen Lai: Data curation, Writing – original draft, Writing – review & editing.
...it is essential to promptly diagnose and treat the bleeding site, whether it is from the primary cancer site, vessels, as this can significantly impact patient outcomes 2. ...the occurrence of ...acute bleeding from the carotid artery, known as carotid blowout syndrome (CBS), remains a rare but devastating side effect of salvage re-irradiation in patients with HNC 3. While life-saving interventions such as supportive care and endovascular and surgical procedures can achieve rapid hemostasis and offer high short-term survival rates, patients at risk of developing CBS should be informed about the various treatment options available for hemorrhage control and the anticipated long-term outcomes, which may be influenced by the underlying recurrent and metastatic disease.
Radiotherapy treatment planning (RTP) is time-consuming and labor-intensive since medical physicists must devise treatment plans carefully to reduce damage to tissues and organs for patients. ...Previously, we proposed the volume-based algorithm (VBA) method, providing optimal partial arcs (OPA) angle to achieve the low-dose volume of lungs in dynamic arc radiotherapy. This study aimed to implement the VBA for esophageal cancer (EC) patients and compare the lung dose and delivery time between full arcs (FA) without using VBA and OPA angle using VBA in volumetric modulated arc therapy (VMAT) plans. We retrospectively included 30 patients diagnosed with EC. RTP of each patient was replanned to 4 VMAT plans, including FA plans without (FA-C) and with (FA + C) dose constraints of OARs and OPA plans without (OPA-C) and with (OPA + C) dose constraints of OARs. The prescribed dose was 45 Gy. The OARs included the lungs, heart, and spinal cord. The dose distribution, dose-volume histogram, monitor units (MUs), delivery time, and gamma passing rates were analyzed. The results showed that the lung V
and V
in OPA + C plans were significantly lower than in FA + C plans (p < 0.05). No significant differences were noted in planning target volume (PTV) coverage, lung V
, lung V
, mean lung dose, heart V
, heart V
, mean heart dose, and maximal spinal cord dose between FA + C and OPA + C plans. The delivery time was significantly longer in FA + C plans than in OPA + C plans (237 vs. 192 s, p < 0.05). There were no significant differences between FA + C and OPA + C plans in gamma passing rates. We successfully applied the OPA angle based on the VBA to clinical EC patients and simplified the arc angle selection in RTP. The VBA could provide a personalized OPA angle for each patient and effectively reduce lung V
, V
and delivery time in VMAT.
This study aims to develop a volume-based algorithm (VBA) that can rapidly optimize rotating gantry arc angles and predict the lung V
preceding the treatment planning. This phantom study was ...performed in the dynamic arc therapy planning systems for an esophageal cancer model. The angle of rotation of the gantry around the isocenter as defined as arc angle (θ
), ranging from 360° to 80° with an interval of 20°, resulting in 15 different θ
of treatment plans. The corresponding predicted lung V
was calculated by the VBA, the mean lung dose, lung V
, lung V
, mean heart dose, heart V
, the spinal cord maximum dose and conformity index were assessed from dose-volume histogram in the treatment plan. Correlations between the predicted lung V
and the dosimetric indices were evaluated using Pearson's correlation coefficient. The results showed that the predicted lung V
and the lung V
in the treatment plan were positively correlated (r = 0.996, p < 0.001). As the θ
decreased, lung V
, lung V
, and the mean lung dose decreased while the mean heart dose, V
and the spinal cord maximum dose increased. The V
and the mean lung dose also showed high correlations with the predicted lung V
(r = 0.974, 0.999, p < 0.001). This study successfully developed an efficient VBA to rapidly calculate the θ
to predict the lung V
and reduce the lung dose, with potentials to improve the current clinical practice of dynamic arc radiotherapy.
Adjuvant breast radiotherapy could reduce the risk of local recurrence. However, the radiation dose received by the heart also increases the risk of cardiotoxicity and causes consequential heart ...diseases. This prospective study aimed to evaluate more precisely cardiac subvolume doses and corresponding myocardial perfusion defects according to the American Heart Association (AHA)'s 20-segment model for single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) interpretation for breast cancer after radiotherapy. The 61 female patients who underwent adjuvant radiotherapy following breast cancer surgery for left breast cancer were enrolled. SPECT MPI were performed before radiotherapy for baseline study, and 12 months after for follow-up. Enrolled patients were divided into two groups, new perfusion defect (NPD) and non new perfusion defect found (non-NPD) according to myocardial perfusion scale score. CT simulation data, radiation treatment planning, and SPECT MPI images were fused and registered. The left ventricle was divided into four rings, three territories, and 20 segments according to the AHA's 20-segment model of the LV. The doses between NPD and non-NPD groups were compared by the Mann-Whitney test. The patients were divided into two groups: NPD group (n = 28) and non-NPD group (n = 33). The mean heart dose was 3.14 Gy in the NPD group and 3.08 Gy in the non-NPD group. Mean LV doses were 4.84 Gy and 4.71 Gy, respectively. The radiation dose of the NPD group was higher than the non-NPD group in the 20 segments of LV. There was significant difference in segment 3 (p = 0.03). The study indicated that the radiation doses to 20 segments of LV in NPD were higher than those in non-NPD significantly at segment 3, and higher in other segments in general. In the bull's eye plot combining radiation dose and NPD area, we found that the new cardiac perfusion decline may exist even in the low radiation dose region.Trial registration: FEMH-IRB-101085-F. Registered 01/01/2013, https://clinicaltrials.gov/ct2/show/NCT01758419?cond=NCT01758419&draw=2&rank=1 .
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