| 1. |
- Brodin, N. Patrik, et al.
(författare)
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Life years lost-comparing potentially fatal late complications after radiotherapy for pediatric medulloblastoma on a common scale
- 2012
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Ingår i: Cancer. - : Wiley. - 1097-0142 .- 0008-543X. ; 118:21, s. 5432-5440
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The authors developed a framework for estimating and comparing the risks of various long-term complications on a common scale and applied it to 3 different techniques for craniospinal irradiation in patients with pediatric medulloblastoma. METHODS: Radiation dose-response parameters related to excess hazard ratios for secondary breast, lung, stomach, and thyroid cancer; heart failure, and myocardial infarction were derived from large published clinical series. Combined with age-specific and sex-specific hazards in the US general population, the dose-response analysis yielded excess hazards of complications for a cancer survivor as a function of attained age. After adjusting for competing risks of death, life years lost (LYL) were estimated based on excess hazard and prognosis of a complication for 3-dimensional conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT). RESULTS: Lung cancer contributed most to the estimated LYL, followed by myocardial infarction, and stomach cancer. The estimates of breast or thyroid cancer incidence were higher than those for lung and stomach cancer incidence, but LYL were lower because of the relatively good prognosis. Estimated LYL ranged between 1.90 years for 3D CRT to 0.28 years for IMPT. In a paired comparison, IMPT was associated with significantly fewer LYL than both photon techniques. CONCLUSIONS: Estimating the risk of late complications is associated with considerable uncertainty, but including prognosis and attained age at an event to obtain the more informative LYL estimate added relatively little to this uncertainty. Cancer 2012. (c) 2012 American Cancer Society.
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| 2. |
- Colvill, Emma, et al.
(författare)
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A dosimetric comparison of real-time adaptive and non-adaptive radiotherapy : A multi-institutional study encompassing robotic, gimbaled, multileaf collimator and couch tracking
- 2016
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140. ; 119:1, s. 159-165
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Tidskriftsartikel (refereegranskat)abstract
- Purpose A study of real-time adaptive radiotherapy systems was performed to test the hypothesis that, across delivery systems and institutions, the dosimetric accuracy is improved with adaptive treatments over non-adaptive radiotherapy in the presence of patient-measured tumor motion. Methods and materials Ten institutions with robotic(2), gimbaled(2), MLC(4) or couch tracking(2) used common materials including CT and structure sets, motion traces and planning protocols to create a lung and a prostate plan. For each motion trace, the plan was delivered twice to a moving dosimeter; with and without real-time adaptation. Each measurement was compared to a static measurement and the percentage of failed points for γ-tests recorded. Results For all lung traces all measurement sets show improved dose accuracy with a mean 2%/2 mm γ-fail rate of 1.6% with adaptation and 15.2% without adaptation (p < 0.001). For all prostate the mean 2%/2 mm γ-fail rate was 1.4% with adaptation and 17.3% without adaptation (p < 0.001). The difference between the four systems was small with an average 2%/2 mm γ-fail rate of <3% for all systems with adaptation for lung and prostate. Conclusions The investigated systems all accounted for realistic tumor motion accurately and performed to a similar high standard, with real-time adaptation significantly outperforming non-adaptive delivery methods.
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| 3. |
- Carlsson Tedgren, Åsa, et al.
(författare)
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Experience from long-term monitoring of RAKR ratios in Ir-192 brachytherapy
- 2008
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Ingår i: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 89:2, s. 217-221
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ratios of values of brachytherapy source strengths, as measured by hospitals and vendors, comprise constant differences as, e.g., systematic errors in ion chamber calibration factors and measurement setup. Such ratios therefore have the potential to reveal the systematic changes in routines or calibration services at either the hospital or the vendor laboratory, which could otherwise be hidden by the uncertainty in the source strength values. Methods: The RAKR of each new source in 13 afterloading units at five hospitals were measured by well-type ion chambers and compared to values for the same source stated on vendor certificates. Results: Differences from unity in the ratios of RAKR values determined by hospitals and vendors are most often small and stable around their mean values to within +/- 11.5%. Larger deviations are rare but occur. A decreasing ratio, seen at two hospitals for the same source, was useful in detecting an erroneous pressure gauge at the vendors site. Conclusions: Establishing a mean ratio of RAKR values, as measured at the hospital and supplied on the vendor certificate, and monitoring this as a function of time are an easy way for the early detection of problems with equipment or routines at either the hospital or the vendor site.
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| 4. |
- Nenoff, Lena, et al.
(författare)
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Daily Adaptive Proton Therapy : Is it Appropriate to Use Analytical Dose Calculations for Plan Adaption?
- 2020
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Ingår i: International Journal of Radiation Oncology Biology Physics. - : Elsevier BV. - 0360-3016. ; 107:4, s. 747-755
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The accuracy of analytical dose calculations (ADC) and dose uncertainties resulting from anatomical changes are both limiting factors in proton therapy. For the latter, rapid plan adaption is necessary; for the former, Monte Carlo (MC) approaches are increasingly recommended. These, however, are inherently slower than analytical approaches, potentially limiting the ability to rapidly adapt plans. Here, we compare the clinical relevance of uncertainties resulting from both. Methods and Materials: Five patients with non-small cell lung cancer with up to 9 computed tomography (CT) scans acquired during treatment and five paranasal (head and neck) patients with 10 simulated anatomical changes (sinus filling) were analyzed. On the initial planning CT scans, treatment plans were optimized and calculated using an ADC and then recalculated with MC. Additionally, all plans were recalculated (non-adapted) and reoptimized (adapted) on each repeated CT using the same ADC as for the initial plan, and the resulting dose distributions were compared. Results: When comparing analytical and MC calculations in the initial treatment plan and averaged over all patients, 94.2% (non-small cell lung cancer) and 98.5% (head and neck) of voxels had differences <±5%, and only minor differences in clinical target volume (CTV) V95 (average <2%) were observed. In contrast, when recalculating nominal plans on the repeat (anatomically changed) CT scans, CTV V95 degraded by up to 34%. Plan adaption, however, restored CTV V95 differences between adapted and nominal plans to <0.5%. Adapted organ-at-risk doses remained the same or improved. Conclusions: Dose degradations caused by anatomic changes are substantially larger than uncertainties introduced by the use of analytical instead of MC dose calculations. Thus, if the use of analytical calculations can enable more rapid and efficient plan adaption than MC approaches, they can and should be used for plan adaption for these patient groups.
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