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Vlachaki M.T.,Cancer Agency Vancouver Island Center
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2010

Radiation therapy for advanced Hodgkin's disease often requires large fields and may result in significant exposure of normal tissues to ionizing radiation. In long-term survivors, this may increase the risk for late toxicity including secondary malignancies. 3DCRT has been successfully used to treat this disease but treatment delivery is often complex requiring matching of photon with electron beams, utilization of field-in-field techniques and of partial transmission blocks. HT is an arc-rotational intensity modulated radiation therapy technique proven to achieve superior target dose conformality and sharp dose gradients around critical normal tissues. HT however, has also been associated with higher volumes of low dose regions in normal tissues and therefore, higher integral dose. The present study was undertaken to compare the dosimetry of 3DCRT to HT in a pediatric patient with advanced HD. Clinical target volume (CTV) included bilateral lower cervical and supraclavicular areas, mediastinum, bilateral hili, left axilla and bilateral diaphragmatic lymph nodes. The planning target volume (PTV) was derived by circumferentially expanding the CTV by 1 cm. Whole lung and heart irradiation was also planned due to bilateral pleural and pericardial effusions. The prescribed radiation dose was 21 Gy to the PTV and 10.5 Gy to the whole lung and heart. Target coverage was comparable for both plans. The minimum, maximum and mean PTV doses were 18.61 Gy, 22.45 Gy and 21.52 Gy with 3DCRT and 19.85 Gy, 22.36 Gy and 21.39 Gy with HT, respectively. HT decreased mean normal tissue dose by 21.6% and 20.07% for right and left breast, 20.40% for lung, 30.78% for heart and 22.74% for the thyroid gland. Integral dose also decreased with HT by 46.50%. HT results in significant dosimetric gain related to normal tissue sparing compared to 3DCRT. Further studies are warranted to evaluate clinical applications of HT in patients with HD. Source


Jirasek A.,University of Victoria | Hilts M.,Cancer Agency Vancouver Island Center | McAuley K.B.,Queens University
Physics in Medicine and Biology | Year: 2010

A primary limitation of current x-ray CT polymer gel dosimetry is the low contrast, and hence poor dose resolution, of dose images produced by the system. The low contrast is largely due to the low-dose sensitivity of current formulations of polymer gel for x-ray CT imaging. This study reports on the investigation of new dosimeter formulations with improved dose sensitivity for x-ray CT polymer gel dosimetry. We incorporate an isopropanol co-solvent into an N-isopropylacrylamide-based gel formulation in order to increase the total monomer/crosslinker concentration %T) within the formulation. It is shown that gels of high %T exhibit enhanced dose sensitivity and dose resolutions over traditional formulations. The gels are shown to be temporally stable and reproducible. A single formulation 16%T) is used to demonstrate the capabilities of the x-ray CT polymer gel dosimetry system in measuring known dose distributions. A 1 L gel volume is exposed to three separate irradiations: a single-field percent depth dose, a two-field 'cross' and a three-field 'test case'. The first two irradiations are used to generate a dose calibration curve by which images are calibrated. The calibrated images are compared with treatment planning predictions and it is shown that the x-ray CT polymer gel dosimetry system is capable of capturing spatial and dose information accurately. The proposed new gel formulation is shown to be sensitive, stable and to improve the dose resolution over current formulations so as to provide a feasible gel for clinical applications of x-ray CT polymer gel dosimetry. © 2010 Institute of Physics and Engineering in Medicine. Source


Johnston H.,University of Victoria | Hilts M.,University of Victoria | Hilts M.,Cancer Agency Vancouver Island Center | Carrick J.,University of Victoria | Jirasek A.,University of Victoria
Physics in Medicine and Biology | Year: 2012

This article reports on the dosimetric properties of a new N-isopropylacrylamide, high %T, polymer gel formulation (19.5%T, 23%C), optimized for x-ray computed tomography (CT) polymer gel dosimetry (PGD). In addition, a new gel calibration technique is introduced together with an intensity-modulated radiation therapy (IMRT) treatment validation as an example of a clinical application of the new gel dosimeter. The dosimetric properties investigated include the temporal stability, spatial stability, batch reproducibility and dose rate dependence. The polymerization reaction is found to stabilize after 15 h post-irradiation. Spatial stability investigations reveal a small overshoot in response for gels imaged later than 36 h post-irradiation. Based on these findings, it is recommended that the new gel formulation be imaged between 1536 h after irradiation. Intra- and inter-batch reproducibility are found to be excellent over the entire range of doses studied (028 Gy). A significant dose rate dependence is found for gels irradiated between 100600 MUmin 1. Overall, the new gel is shown to have promising characteristics for CT PGD, however the implication of the observed dose rate dependence for some clinical applications remains to be determined. The new gel calibration method, based on pixel-by-pixel matching of dose and measured CT numbers, is found to be robust and to agree with the previously used region of interest technique. Pixel-by-pixel calibration is the new recommended standard for CT PGD. The dose resolution for the system was excellent, ranging from 0.20.5 Gy for doses between 020 Gy and 0.30.6 Gy for doses beyond 20 Gy. Comparison of the IMRT irradiation with planned doses yields excellent results: gamma pass rate (3%, 3 mm) of 99.3% at the isocentre slice and 93.4% over the entire treated volume. © 2012 Institute of Physics and Engineering in Medicine. Source


Nesslinger N.J.,Cancer Agency Vancouver Island Center | Ng A.,Cancer Agency Vancouver Island Center | Tsang K.-Y.,U.S. National Cancer Institute | Ferrara T.,U.S. National Cancer Institute | And 5 more authors.
Clinical Cancer Research | Year: 2010

Purpose: We previously reported a randomized phase II clinical trial combining a poxvirus-based vaccine encoding prostate-specific antigen (PSA) with radiotherapy in patients with localized prostate cancer. Here, we investigate whether vaccination against PSA induced immune responses to additional tumor-associated antigens and how this influenced clinical outcome. Experimental Design: Pretreatment and posttreatment serum samples from patients treated with vaccine + external beam radiation therapy (EBRT) versus EBRT alone were evaluated by Western blot and serologic screening of a prostate cancer cDNA expression library (SEREX) to assess the development of treatment-associated autoantibody responses. Results: Western blotting revealed treatment-associated autoantibody responses in 15 of 33 (45.5%) patients treated with vaccine + EBRT versus 1 of 8 (12.5%) treated with EBRT alone. SEREX screening identified 18 antigens, which were assembled on an antigen array with 16 previously identified antigens. Antigen array screening revealed that 7 of 33 patients (21.2%) treated with vaccine + EBRT showed a vaccine-associated autoantibody response to four ubiquitously expressed self-antigens: DIRC2, NDUFS1, MRFAP1, and MATN2. These responses were not seen in patients treated with EBRT alone, or other control groups. Patients with autoantibody responses to this panel of antigens had a trend toward decreased biochemical-free survival. Conclusions: Vaccine + EBRT induced antigen spreading in a large proportion of patients. A subset of patients developed autoantibodies to a panel of four self-antigens and showed a trend toward inferior outcomes. Thus, cancer vaccines directed against tumor-specific antigens can trigger autoantibody responses to self-proteins, which may influence the efficacy of vaccination. ©2010 AACR. Source


Han K.,Odette Cancer Center | Cheung P.,Odette Cancer Center | Basran P.S.,Cancer Agency Vancouver Island Center | Poon I.,Odette Cancer Center | And 2 more authors.
Radiotherapy and Oncology | Year: 2010

Purpose: This study aims to compare the efficacy, efficiency and comfort level of two immobilization systems commonly used in lung stereotactic body radiation therapy (SBRT): the Bodyfix and the abdominal compression plate (ACP). Materials and methods: Twenty-four patients undergoing SBRT for medically inoperable stage I lung cancer or pulmonary metastases were entered on this prospective randomized study. All underwent 4DCT simulation with free breathing, the Bodyfix, and the ACP to assess respiratory tumor motion. After CT simulation, patients were randomly assigned to immobilization with either the Bodyfix or the ACP for the actual SBRT treatment. Cone beam CTs (CBCTs) were acquired before and after each treatment to assess intrafraction tumor motion. Setup time and patient comfort were recorded. Results: There were 16 upper lobe, two middle lobe and seven lower-lobe lesions. Both the Bodyfix and the ACP significantly reduced the superior-inferior (SI) and overall respiratory tumor motion compared to free breathing (4.6 and 4.0 vs 5.3 mm; 5.3 and 4.7 vs 6.1 mm, respectively, p < 0.05). The ACP further reduced the SI and overall respiratory tumor motion compared to the Bodyfix (p < 0.05). The mean overall intrafraction tumor motion was 2.3 mm with the Bodyfix and 2.0 mm with the ACP (p > 0.05). The ACP was faster to set up and rated more comfortable by patients than the Bodyfix (p < 0.05). Conclusions: While there is no significant difference between the Bodyfix and ACP in reducing intrafraction tumor motion, the ACP is more comfortable, faster to set up, and superior to the Bodyfix in reducing SI and overall respiratory tumor motion. © 2010 Elsevier Ireland Ltd. All rights reserved. Source

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