Chondrosarcomas are malignant bone tumors which develop as a cartilaginous differentiation of primary mesenchymal cells and the second most frequently seen malignant tumor of the bone after osteosarcoma. These maligna...Chondrosarcomas are malignant bone tumors which develop as a cartilaginous differentiation of primary mesenchymal cells and the second most frequently seen malignant tumor of the bone after osteosarcoma. These malignancies are slowly growing non-epithelial tumors with unknown etiology and most frequently seen during the 4 decades of life. They are frequently localized on pelvis, ribs and long bones. Nasal septum CSs are very rarely seen malignancies. They originate from septal mucosa or cartilage and it is difficult to make a diagnosis unless they reach a certain size. A few cases of CSs with nasal septum have been reported in the literature. In cases of CSs, surgery is the gold standard treatment modality;however in surgically unresectable cases or close to margins, radiotherapy plays a significant role in primary and adjuvant treatment. Based on the position of the tumor in head and neck and extremely closeness of the tumor to vital organs as optic nerve, chiasm and brain, image guided-intensity modulated radiation therapy (IG-IMRT) becomes very effective and reliable modalities and may be a favorable treatment alternative.展开更多
Background: For image-guided radiotherapy(IGRT) of prostate cancer, the current standard is online image guidance which can effectively correct setup errors and inter-fraction rigid organ motion. However, planning mar...Background: For image-guided radiotherapy(IGRT) of prostate cancer, the current standard is online image guidance which can effectively correct setup errors and inter-fraction rigid organ motion. However, planning margins are still necessary for deformation and intra-fraction motion. Objective: This paper aims to investigate an adaptive planning technique incorporating offline dose feedback to manage interfraction motion and residuals from online corrections. Methods:Repeated CT scans from 28 patients were studied. Online IG was simulated by matching center-of-mass of prostate. A seven-beam IMRT plan with zero margins was designed for each patient. Dose distribution at each fraction was evaluated based on actual target and OARs from that fraction. Cumulative dose was calculated using deformable registration and compared to initial plan. If deviation exceeded pre-defined 2% threshold in prostate D99 an adaptive planning technique called dose compensation was invoked, in which cumulative dose was fed back to the planning system and dose deficit was made up through boost radiation in future fractions through IMRT. Results: If 2% under-dose was allowed at the end of course, then 11 patients failed. If the same criteria was assessed at the end of each week(every 5 fractions), then 14 patients failed. The average dose deficit for these 14 patients was4.4%. They improved to 2% after weekly compensation. 10(out of 14) patients passed criterion after weekly dose compensation; 3 failed marginally; 1 failed significantly(10% deficit). A more aggressive compensation frequency(every 3 fractions) could reduce the dose deficit to the acceptable level for this patient. The doses to OARs were not significantly different from online IG only without dose compensation.Conclusion: We demonstrated an offline dose compensation technique in prostate IGRT which can effectively account for residual uncertainties uncorrectable in online IG. Dose compensation allows further margin reduction and critical organs sparing.展开更多
文摘Chondrosarcomas are malignant bone tumors which develop as a cartilaginous differentiation of primary mesenchymal cells and the second most frequently seen malignant tumor of the bone after osteosarcoma. These malignancies are slowly growing non-epithelial tumors with unknown etiology and most frequently seen during the 4 decades of life. They are frequently localized on pelvis, ribs and long bones. Nasal septum CSs are very rarely seen malignancies. They originate from septal mucosa or cartilage and it is difficult to make a diagnosis unless they reach a certain size. A few cases of CSs with nasal septum have been reported in the literature. In cases of CSs, surgery is the gold standard treatment modality;however in surgically unresectable cases or close to margins, radiotherapy plays a significant role in primary and adjuvant treatment. Based on the position of the tumor in head and neck and extremely closeness of the tumor to vital organs as optic nerve, chiasm and brain, image guided-intensity modulated radiation therapy (IG-IMRT) becomes very effective and reliable modalities and may be a favorable treatment alternative.
文摘Background: For image-guided radiotherapy(IGRT) of prostate cancer, the current standard is online image guidance which can effectively correct setup errors and inter-fraction rigid organ motion. However, planning margins are still necessary for deformation and intra-fraction motion. Objective: This paper aims to investigate an adaptive planning technique incorporating offline dose feedback to manage interfraction motion and residuals from online corrections. Methods:Repeated CT scans from 28 patients were studied. Online IG was simulated by matching center-of-mass of prostate. A seven-beam IMRT plan with zero margins was designed for each patient. Dose distribution at each fraction was evaluated based on actual target and OARs from that fraction. Cumulative dose was calculated using deformable registration and compared to initial plan. If deviation exceeded pre-defined 2% threshold in prostate D99 an adaptive planning technique called dose compensation was invoked, in which cumulative dose was fed back to the planning system and dose deficit was made up through boost radiation in future fractions through IMRT. Results: If 2% under-dose was allowed at the end of course, then 11 patients failed. If the same criteria was assessed at the end of each week(every 5 fractions), then 14 patients failed. The average dose deficit for these 14 patients was4.4%. They improved to 2% after weekly compensation. 10(out of 14) patients passed criterion after weekly dose compensation; 3 failed marginally; 1 failed significantly(10% deficit). A more aggressive compensation frequency(every 3 fractions) could reduce the dose deficit to the acceptable level for this patient. The doses to OARs were not significantly different from online IG only without dose compensation.Conclusion: We demonstrated an offline dose compensation technique in prostate IGRT which can effectively account for residual uncertainties uncorrectable in online IG. Dose compensation allows further margin reduction and critical organs sparing.
