ABSTRACT
PURPOSE: Brachytherapy (BRT) is a cornerstone in cervical cancer treatment, with the ultimate goal to maximize the tumor dose while sparing organs at risk (OARs), such as rectum. Several studies evaluated the effect of rectal volume on rectal doses, but the results are inconsistent. This study aimed to evaluate the rectal volume and dose-volume histogram (DVH) relationship in high-dose-rate (HDR) brachytherapy in locally advanced cervical cancer. MATERIAL AND METHODS: Planning computed tomography of 65 patients who underwent HDR brachytherapy boost as a component of definitive radiotherapy from March 2016 to February 2018 were reviewed. OARs and target volume were re-delineated by a single physician to decrease interobserver variation. Two sets of plan were generated; in the first set, the dose was prescribed to point A with Manchester system loading pattern, while in the second set, the dose was prescribed to high-risk clinical target volume (HR-CTV) D90 with inverse planning optimization. The DVH values for rectum, sigmoid, and HR-CTV were generated and correlated with rectal or sigmoidal volume variation. RESULTS: Dose to 2cc (D2cc), 1cc (D1cc), and 0.1cc (D0.1cc) of rectum and sigmoid showed a significant decrease in optimization vs. point A planning (p < 0.0001). HR-CTV D90 coverage was significantly higher in optimization vs. point A planning (p = 0.041). Rectal volume showed a significant correlation with D2cc (rs, 0.302, p = 0.014), D1cc (rs, 0.310, p = 0.012), and D0.1cc (rs, 0.283, p = 0.02) of rectum in optimization planning. CONCLUSIONS: Larger rectal volumes are associated with higher rectal dose parameters during HDR brachytherapy using inverse planning optimization. This method spares OAR, while producing reasonable HR-CTV D90. Prospective studies are needed to find appropriate technique of rectal volume reduction.
ABSTRACT
OBJECTIVES: To assess and compare demographic and diagnostic characteristics of inpatients with mood disorders in Iran. MATERIALS AND METHODS: We collected the demographic, clinical, and treatment characteristics of patients, who were hospitalized during five years from April 2006 to March 2010, in Iran hospital of psychiatry, a residency training center to evaluate the general clinical picture of the disorder. RESULTS: Overall, 95.3% of subjects had a diagnosis of bipolar I disorder (BID), 2.5% were diagnosed as bipolar II disorder (BIID) and 1.3% and 0.9% met the criteria for major depressive disorder (MDD) and bipolar not otherwise specified (NOS), respectively. Compared to patients with MDD and BIID, the onset of BID was at an earlier age (32.2 ± 1, 34.8 ± 1.5 and 29.9 ± 1.9 years old, respectively, P < 0.001). In addition, a number of admissions, mean duration of each admission and number of treatments with electro-convulsive therapy (ECT) were significantly higher in patients with BID. CONCLUSIONS: Bipolar I disorder was the most common diagnosis for inpatients with mood disorders and a more severe course in BID may indicate more severe impairments that would result in more severe disabilities.
ABSTRACT
BACKGROUND: Patients' characteristics influence the disorders outcome, so it is valuable to compare mood disorders and inpatients' attributes in different large samples. OBJECTIVES: This study was designed to assess demographic and diagnostic characteristics of 3000 Iranian inpatient with bipolar disorders. PATIENTS AND METHODS: We collected the information of demographic, clinical, and therapeutic characteristics of the patients who were hospitalized in Iran Hospital of Psychiatry, a university affiliated hospital in Tehran, during the 5 years from 2006 to 2011. RESULTS: About 66.1% of the subjects were males and 33.9% were females. Iranian patients are characterized by a higher rate of unemployment, being more single, having health insurance and lower rate of divorce and education compared to the other clinical samples. In the majority of the patients, the disorder had begun with manic phase. CONCLUSIONS: Clinical and therapeutic features of Iranian patients are different from patients in western countries.
