The National Working Group on Prostate Radiotherapy of AIRO (Associazione Italiana Radioterapia O... more The National Working Group on Prostate Radiotherapy of AIRO (Associazione Italiana Radioterapia Oncologica, Italian Association of Radiotherapeutic Oncology) was established in March 2001. A retrospective multi-center survey was performed to analyze the patterns of care for prostate cancer patients treated with postoperative radiotherapy following radical prostatectomy in Italy with regard to the year 2000. A structured questionnaire was mailed to 47 Italian radiotherapy centers to assess patient accrual in the postoperative setting in the interval comprised between period January-December 2000. Numbers of patients treated for different stages, specific prognostic factors indicating the need for adjuvant radiotherapy, fractionation schedules and prescription doses were acquired as well as other clinically important factors such as radiotherapy timing and the use of hormone therapy. More technical features of the treatment, such as patient positioning, mode of simulation, typical fie...
PurDose: The aim of the present study is to develop a cheap and reliable tool to provide informat... more PurDose: The aim of the present study is to develop a cheap and reliable tool to provide information on exit and midline dose variations in patients. Material and Methods: Optical densities measured on routinely taken portal films are converted to relative doses. The influence of scattered and primary radiation distribution between the patient exit surface and the film is assessed by comparing dose profiles obtained on films taken at very low patient-to-film distance (PFD) and films taken at a routine focus-film-distance (FFD 135-145 cm). From transmission doses, exit doses are determined from which midline doses can be estimated. Results: When doses obtained from films taken close to and far from the exit sudace are compared, it is demonstrated that dose variations are overestimated on films taken at a routine (large) FFD. This phenomenon is predominantly found in regions where the distance from the patient to the film is varying and the overestimation (5-15%) is shown to be dependent upon variations in PFD which result from (1) the distance between the 2 planes (far and close) and variations in patient diameter. The application of an empirically determined correction factor substantially reduces this overestimation in dose variation. This correction factor is counterbalanced by the correction (inverse square law) applied to calculate exit doses from transmission doses (differences between transmission doses at a FFD of 135 cm and exit doses < 5%). Other variables such as patient thickness and inhomogeneities in tissue density appear to have no major influence on the radiation distribution between the 2 planes (close and far), Conclusion: Portal films taken in routine practice can be used to have quick and cheap information on exit dose variations in the patient, but in regions with varying PFD an overestimation of dose variations has to be taken into account.
International Journal of Radiation Oncology*Biology*Physics, 2002
was not significantly different to the manual separated post planning (pϭ 0,29). The values for t... more was not significantly different to the manual separated post planning (pϭ 0,29). The values for the V100 between CT vs. manual separated TRUS showed no significance (91,6% (ϩ4,9) vs. 92,9% (ϩ5,0); pϭ0,229).
... 8, Milano S.Pio X. ... 1034 POSTER INCIDENCE OF LYMPHOEDEMA AND IMPAIRED SHOULDER FUNCTION AF... more ... 8, Milano S.Pio X. ... 1034 POSTER INCIDENCE OF LYMPHOEDEMA AND IMPAIRED SHOULDER FUNCTION AFTER AXILLARY DISSECTION AM Cady, C. Pertzsch, T. Jurgensen Surgical Department K, Bispebjerg Hospiral, University of Copenhagen, Denmark Aim: To assess ...
The optimal treatment of ductal carcinoma in situ (DCIS) of the breast has not yet been establish... more The optimal treatment of ductal carcinoma in situ (DCIS) of the breast has not yet been established. The effectiveness of adjuvant postoperative radiotherapy after conservative surgery is debated. Few data are available in Italy on the combined treatment. A collaborative multi-institutional study on this issue in 10 radiation oncology departments of the north-east of Italy was conducted. One hundred and thirty nine women with DCIS of the breast were treated between 1980 and 1990. Age ranged between 28 and 88 years (median 50 years). Surgical procedures were: quadrantectomy in 108, lumpectomy in 22 and wide excision in 9 cases. The axilla was surgically staged in 97 cases: all the patients were node-negative. Radiation therapy was delivered with 60Co units (78%) or 6 MV linear accelerators (22%) for a median total dose to the entire breast of 50 Gy (mean 49.48 Gy; range 45-60 Gy). The tumour bed was boosted in 109 cases (78%) at a dose of 4-30 Gy (median 10 Gy) for a minimum tumour dose of 58 Gy. Median follow-up was 81 months. Thirteen local recurrences were recorded, 7 intraductal and 6 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease. Actuarial overall, cause-specific and recurrence-free survival at 10 years are of 93%, 100% and 86%, respectively. The results of this retrospective multicentric study substantiate the favourable data reported in the literature and confirm the efficacy of the breast-conserving treatment of DCIS employing conservative surgery and adjuvant radiation therapy.
To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast trea... more To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. Material and methods: A self-completed questionnaire covering many disease-, symptom-, and treatmentspecific issues was administered to 106 conservatively treated patients affected by non-infiltrating breast cancer. The questionnaire was based on a series of 34 items assessing five main fields of post-treatment adjustment: physical well being, sexual adaptation, aesthetic outcome, emotional/psychological well being, relational behaviour. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning surgical procedures and radiation therapy, and to evaluate the effects of the treatment on their social and overall life.
The article reports a feasibility study about the potentiality of an in vivo dosimetry method for... more The article reports a feasibility study about the potentiality of an in vivo dosimetry method for the adaptive radiotherapy of the lung tumors treated by 3D conformal radiotherapy techniques (3D CRTs). At the moment image guided radiotherapy (IGRT) has been used for this aim, but it requires taking many periodic radiological images during the treatment that increase workload and patient dose. In vivo dosimetry reported here can reduce the above efforts, alerting the medical staff for the commissioning of new radiological images for an eventual adaptive plan. The in vivo dosimetry method applied on 20 patients makes use of the transit signal St on the beam central axis measured by a small ion chamber positioned on an electronic portal imaging device (EPID) or by the EPID itself. The reconstructed in vivo dosimetry at the isocenter point Diso requires a convolution between the transit signal St and a dose reconstruction factor C that essentially depends on (i) tissue inhomogeneities along the beam central axis and (ii) the in-patient isocenter depth. The C factors, one for every gantry angle, are obtained by processing the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s computed tomography scan. The method has been recently applied in some Italian centers to check the radiotherapy of pelvis, breast, head, and thorax treatments. In this work the dose reconstruction was carried out in five centers to check the Diso in the lung tumor during the 3D CRT, and the results have been used to detect the interfraction tumor anatomy variations that can require new CT imaging and an adaptive plan. In particular, in three centers a small ion chamber was positioned below the patient and used for the St measurement. In two centers, the St signal was obtained directly by 25 central pixels of an a-Si EPID, equipped with commercial software that enabled its use as a stable detector. A tolerance action level of +/- 6% for every checked beam was assumed. This means that when a difference greater than 6% between the predicted dose by the treatment planning system, Diso,TPS, and the Diso was observed, the clinical action started to detect possible errors. 60% of the patients examined presented morphological changes during the treatment that were checked by the in vivo dosimetry and successively confirmed by the new CT scans. In this work, a patient that showed for all beams Diso values outside the tolerance level, new CT scans were commissioned for an adaptive plan. The lung dose volume histograms (DVHs) for a Diso,TPs=2 Gy for fraction suggested the adaptive plan to reduce the dose in lung tissue. The results of this research show that the dose guided radiotherapy (DGRT) by the Diso reconstruction was feasible for daily or periodic investigation on morphological lung tumor changes. In other words, since during 3D CRT treatments the anatomical lung tumor changes occur frequently, the DGRT can be well integrated with the IGRT.
The National Working Group on Prostate Radiotherapy of AIRO (Associazione Italiana Radioterapia O... more The National Working Group on Prostate Radiotherapy of AIRO (Associazione Italiana Radioterapia Oncologica, Italian Association of Radiotherapeutic Oncology) was established in March 2001. A retrospective multi-center survey was performed to analyze the patterns of care for prostate cancer patients treated with postoperative radiotherapy following radical prostatectomy in Italy with regard to the year 2000. A structured questionnaire was mailed to 47 Italian radiotherapy centers to assess patient accrual in the postoperative setting in the interval comprised between period January-December 2000. Numbers of patients treated for different stages, specific prognostic factors indicating the need for adjuvant radiotherapy, fractionation schedules and prescription doses were acquired as well as other clinically important factors such as radiotherapy timing and the use of hormone therapy. More technical features of the treatment, such as patient positioning, mode of simulation, typical fie...
PurDose: The aim of the present study is to develop a cheap and reliable tool to provide informat... more PurDose: The aim of the present study is to develop a cheap and reliable tool to provide information on exit and midline dose variations in patients. Material and Methods: Optical densities measured on routinely taken portal films are converted to relative doses. The influence of scattered and primary radiation distribution between the patient exit surface and the film is assessed by comparing dose profiles obtained on films taken at very low patient-to-film distance (PFD) and films taken at a routine focus-film-distance (FFD 135-145 cm). From transmission doses, exit doses are determined from which midline doses can be estimated. Results: When doses obtained from films taken close to and far from the exit sudace are compared, it is demonstrated that dose variations are overestimated on films taken at a routine (large) FFD. This phenomenon is predominantly found in regions where the distance from the patient to the film is varying and the overestimation (5-15%) is shown to be dependent upon variations in PFD which result from (1) the distance between the 2 planes (far and close) and variations in patient diameter. The application of an empirically determined correction factor substantially reduces this overestimation in dose variation. This correction factor is counterbalanced by the correction (inverse square law) applied to calculate exit doses from transmission doses (differences between transmission doses at a FFD of 135 cm and exit doses < 5%). Other variables such as patient thickness and inhomogeneities in tissue density appear to have no major influence on the radiation distribution between the 2 planes (close and far), Conclusion: Portal films taken in routine practice can be used to have quick and cheap information on exit dose variations in the patient, but in regions with varying PFD an overestimation of dose variations has to be taken into account.
International Journal of Radiation Oncology*Biology*Physics, 2002
was not significantly different to the manual separated post planning (pϭ 0,29). The values for t... more was not significantly different to the manual separated post planning (pϭ 0,29). The values for the V100 between CT vs. manual separated TRUS showed no significance (91,6% (ϩ4,9) vs. 92,9% (ϩ5,0); pϭ0,229).
... 8, Milano S.Pio X. ... 1034 POSTER INCIDENCE OF LYMPHOEDEMA AND IMPAIRED SHOULDER FUNCTION AF... more ... 8, Milano S.Pio X. ... 1034 POSTER INCIDENCE OF LYMPHOEDEMA AND IMPAIRED SHOULDER FUNCTION AFTER AXILLARY DISSECTION AM Cady, C. Pertzsch, T. Jurgensen Surgical Department K, Bispebjerg Hospiral, University of Copenhagen, Denmark Aim: To assess ...
The optimal treatment of ductal carcinoma in situ (DCIS) of the breast has not yet been establish... more The optimal treatment of ductal carcinoma in situ (DCIS) of the breast has not yet been established. The effectiveness of adjuvant postoperative radiotherapy after conservative surgery is debated. Few data are available in Italy on the combined treatment. A collaborative multi-institutional study on this issue in 10 radiation oncology departments of the north-east of Italy was conducted. One hundred and thirty nine women with DCIS of the breast were treated between 1980 and 1990. Age ranged between 28 and 88 years (median 50 years). Surgical procedures were: quadrantectomy in 108, lumpectomy in 22 and wide excision in 9 cases. The axilla was surgically staged in 97 cases: all the patients were node-negative. Radiation therapy was delivered with 60Co units (78%) or 6 MV linear accelerators (22%) for a median total dose to the entire breast of 50 Gy (mean 49.48 Gy; range 45-60 Gy). The tumour bed was boosted in 109 cases (78%) at a dose of 4-30 Gy (median 10 Gy) for a minimum tumour dose of 58 Gy. Median follow-up was 81 months. Thirteen local recurrences were recorded, 7 intraductal and 6 invasive. All recurrent patients had a salvage mastectomy and are alive and free of disease. Actuarial overall, cause-specific and recurrence-free survival at 10 years are of 93%, 100% and 86%, respectively. The results of this retrospective multicentric study substantiate the favourable data reported in the literature and confirm the efficacy of the breast-conserving treatment of DCIS employing conservative surgery and adjuvant radiation therapy.
To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast trea... more To evaluate the quality of life (QL) in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiation. Material and methods: A self-completed questionnaire covering many disease-, symptom-, and treatmentspecific issues was administered to 106 conservatively treated patients affected by non-infiltrating breast cancer. The questionnaire was based on a series of 34 items assessing five main fields of post-treatment adjustment: physical well being, sexual adaptation, aesthetic outcome, emotional/psychological well being, relational behaviour. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning surgical procedures and radiation therapy, and to evaluate the effects of the treatment on their social and overall life.
The article reports a feasibility study about the potentiality of an in vivo dosimetry method for... more The article reports a feasibility study about the potentiality of an in vivo dosimetry method for the adaptive radiotherapy of the lung tumors treated by 3D conformal radiotherapy techniques (3D CRTs). At the moment image guided radiotherapy (IGRT) has been used for this aim, but it requires taking many periodic radiological images during the treatment that increase workload and patient dose. In vivo dosimetry reported here can reduce the above efforts, alerting the medical staff for the commissioning of new radiological images for an eventual adaptive plan. The in vivo dosimetry method applied on 20 patients makes use of the transit signal St on the beam central axis measured by a small ion chamber positioned on an electronic portal imaging device (EPID) or by the EPID itself. The reconstructed in vivo dosimetry at the isocenter point Diso requires a convolution between the transit signal St and a dose reconstruction factor C that essentially depends on (i) tissue inhomogeneities along the beam central axis and (ii) the in-patient isocenter depth. The C factors, one for every gantry angle, are obtained by processing the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s computed tomography scan. The method has been recently applied in some Italian centers to check the radiotherapy of pelvis, breast, head, and thorax treatments. In this work the dose reconstruction was carried out in five centers to check the Diso in the lung tumor during the 3D CRT, and the results have been used to detect the interfraction tumor anatomy variations that can require new CT imaging and an adaptive plan. In particular, in three centers a small ion chamber was positioned below the patient and used for the St measurement. In two centers, the St signal was obtained directly by 25 central pixels of an a-Si EPID, equipped with commercial software that enabled its use as a stable detector. A tolerance action level of +/- 6% for every checked beam was assumed. This means that when a difference greater than 6% between the predicted dose by the treatment planning system, Diso,TPS, and the Diso was observed, the clinical action started to detect possible errors. 60% of the patients examined presented morphological changes during the treatment that were checked by the in vivo dosimetry and successively confirmed by the new CT scans. In this work, a patient that showed for all beams Diso values outside the tolerance level, new CT scans were commissioned for an adaptive plan. The lung dose volume histograms (DVHs) for a Diso,TPs=2 Gy for fraction suggested the adaptive plan to reduce the dose in lung tissue. The results of this research show that the dose guided radiotherapy (DGRT) by the Diso reconstruction was feasible for daily or periodic investigation on morphological lung tumor changes. In other words, since during 3D CRT treatments the anatomical lung tumor changes occur frequently, the DGRT can be well integrated with the IGRT.
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