Feasibility of fast, four-dimensional computed tomography-based O-ring LINAC plans for lung stereotactic body radiotherapy in patients with poor performance status.

Purpose: We aimed to retrospectively analyzed the feasibility of fast four-dimensional computed tomography (4DCT)-based O-ring LINAC treatment for patients with an average respiratory amplitude was< 0.5 cm and who cannot endure long treatment times due to poor performance status in lung 4D-stereotactic body radiotherapy (SBRT). Methods: This study included data of 38 patients who received lung 4D-SBRT and had average respiratory amplitude< 0.5 cm in the full phase. C-arm LINAC plans were based on 4DCT data obtained at phase values ranging from 20-70% using a C-arm LINAC. O-ring LINAC plans were retrospectively established based on 4DCT data obtained at phase values of 0-90% using an O-ring LINAC. The conformity index (CI), homogeneity index (HI), and gradient measurement of the planning target volumes (PTV) were analyzed to compare dosimetric data between C-arm LINAC and O-ring LINAC plans. Organs at risk were analyzed in accordance with the Radiation Therapy Oncology Group 0915 protocol. Treatment delivery time and total monitor units were analyzed to compare the efficiency of treatment delivery. Statistical comparisons were performed using the Wilcoxon signed-rank test (P< 0.05). Results: For the PTV, there was no significant difference in the CI or HI between C-arm LINAC and O-ring LINAC plans. For organs-at-risk, all plans met the criteria for dose constraint. There was a significant difference between C-arm LINAC and O-ring LINAC plans except in the spinal cord. Treatment delivery time was 92% longer for C-arm LINAC plans than for O-ring LINAC plans. The total MU value for C-arm LINAC plans was 9.6% higher than that for O-ring LINAC plans. Conclusion: We verified the feasibility of fast 4DCT-based O-ring LINAC treatment for patients with average respiratory amplitude< 0.5 cm and who cannot endure long treatment times due to poor performance status in lung 4D-SBRT.

Retrieval of aerosol optical properties from GOCI-II observations: Continuation of long-term geostationary aerosol monitoring over East Asia.

Since the Geostationary Ocean Color Imager (GOCI) was successfully launched in 2010, the GOCI Yonsei aerosol retrieval (YAER) algorithm has been continuously updated to retrieve hourly aerosol optical properties. GOCI-II has 4 more channels including UV, finer spatial resolution (250 m), and daily full disk coverage as compared to GOCI, and was launched in February 2020, onboard the GEO-KOMPSAT-2B (GK-2B) satellite. In this study, we extended the YAER algorithm to GOCI-II data based on its improved performance in many aspects and present the first results of aerosol optical properties retrieved from GOCI-II data. Utilizing the overlapping period between the GOCI-II and GOCI in geostationary Earth orbit, we present GOCI-II aerosol retrievals for high aerosol-loading cases over East Asia and show that these have a consistent spatial distribution with those from GOCI. Furthermore, GOCI-II provides AOD at an even higher spatial resolution, revealing finer changes in aerosol concentrations. Validation results for one year data show that the GOCI-II AOD has a correlation coefficient of 0.83 and a ratio within the expected error (EE) of 59.4 % when compared with the aerosol robotic network (AERONET) data. We compared statistical metrics for the GOCI and GOCI-II AODs to assess the consistency between the two datasets. In addition, it was found that there is a strong correlation between the two datasets from the comparison of gridded GOCI and GOCI-II AOD products. It is expected that data from GOCI-II will continue long-term aerosol records with high accuracy that can be used to address air-quality issues over East Asia.

Floating Debris in the Northern Gulf of Mexico after Hurricane Katrina.

Hurricane Katrina (category 5 with maximum wind of 280 km/h when the eye is in the central Gulf of Mexico) made landfall near New Orleans on August 29, 2005, causing millions of cubic meters of disaster debris, severe flooding, and US$125 billion in damage. Yet, despite numerous reports on its environmental and economic impacts, little is known about how much debris has entered the marine environment. Here, using satellite images (MODIS, MERIS, and Landsat), airborne photographs, and imaging spectroscopy, we show the distribution, possible types, and amount of Katrina-induced debris in the northern Gulf of Mexico. Satellite images collected between August 30 and September 19 show elongated image features around the Mississippi River Delta in a region bounded by 92.5°W-87.5°W and 27.8°N-30.25°N. Image spectroscopy and color appearance of these image features indicate that they are likely dominated by driftwood (including construction lumber) and dead plants (e.g., uprooted marsh) and possibly mixed with plastics and other materials. The image sequence shows that if aggregated together to completely cover the water surface, the maximal debris area reached 21.7 km2 on August 31 to the east of the delta, which drifted to the west following the ocean currents. When measured by area in satellite images, this perhaps represents a historical record of all previously reported floating debris due to natural disasters such as hurricanes, floodings, and tsunamis.

Detecting the Great Pacific Garbage Patch floating plastic litter using WorldView-3 satellite imagery.

We present a direct and proxy-based approach to qualitatively and semi-quantitatively observe floating plastic litter in the Great Pacific Garbage Patch (GPGP) based on a survey in 2018 using very high geo-spatial resolution 8-waveband WorldView-3 imagery. A proxy for the plastics was defined as a waveband difference for anomalies in the top-of-the-atmosphere spectra. The anomalies were computed by subtracting spatially varying reflectance of the surrounding ocean water as background from the top-of-the-atmosphere reflectance. Spectral shapes and magnitude were also evaluated using a reference target of known plastics, The Ocean Cleanup System 001 Wilson. Presence of 'suspected plastics' was confirmed by the similarity in derived anomalies and spectral shapes with respect to the known plastics in the image as well as direct observations in the true color composites. The proposed proxy-based approach is a step towards future mapping techniques of suspected floating plastics with potential operational monitoring applications from the Sentinel-2 that recently started regular imaging over the GPGP that will be supported or validated by numerical solutions and net trawling survey.

Dosimetric comparison of VitalBeam® and HalcyonTM 2.0 for hypofractionated VMAT with simultaneous integrated boost treatment of early-stage left-sided breast cancer.

PURPOSE: This study compared the quality of treatment plans for early-stage, left-sided breast cancer, as planned for and delivered by the HalcyonTM and VitalBeam® . MATERIALS AND METHODS: Fifteen patients diagnosed with early-stage left-sided breast cancer, who had received VMAT with hypofractionated SIB, were recruited. All cases were planned using HalcyonTM comprising a dual-layer MLC (DL-MLC) and VitalBeam® with a Millennium 120 MLC (VB-MLC). For the PTVs, the quality of coverage (QC), conformity index (CI), and homogeneity index (HI) were calculated for each plan. The dosimetric differences between the two treatment plans were statistically compared using the Wilcoxon signed-rank test (p < 0.05). To evaluate delivery efficiency, the average delivery time for each patient's treatment plan was recorded and compared. RESULTS: For the PTVs, the two plans (DL-MLC and VB-MLC) were comparable in terms of the QC, CI, and HI. However, V30Gy and Dmean for the heart in the DL-MLC plan were significantly reduced by 0.49% and 14.6%, respectively, compared with those in the VB-MLC plan (p < 0.05). The Dmean value for the ipsilateral lung in the DL-MLC plan significantly decreased by 5.5%, compared with that in the VB-MLC plan (p < 0.05). In addition, the delivery times for the DL-MLC and VB-MLC plans were 79 ± 10 and 101 ± 11 s, respectively. CONCLUSIONS: DL-MLC plans were found to improve OAR sparing. In particular, when treating left-sided breast cancer via DL-MLC plans, the risk of heart toxicity is expected to be reduced.

Ropivacaine continuous wound infusion after mastectomy with immediate autologous breast reconstruction: A retrospective observational study.

ABSTRACT: Continuous wound infusion usually provides postoperative analgesia as a multimodal analgesia with systemic opioid use. When continuous wound infusion of local anesthetics (LA) supports successful postoperative analgesia without systemic opioid use, the side effects of opioid can be reduced. Nevertheless, continuous wound infusion after mastectomy with immediate autologous breast reconstruction leads to concerns about wound healing. This study evaluated analgesic effects and wound healing conditions of continuous wound infusion of LA compared with opioid-based, intravenous patient-controlled analgesia (IV PCA) in mastectomy with immediate autologous breast reconstruction.This retrospective observational study included females, aged between 33 and 67 years, who underwent mastectomy with immediate autologous breast reconstruction. Sixty-five patients were enrolled. The eligible patients were placed into 2 groups for managing postoperative pain, one used continuous wound infusion with 0.5% ropivacaine (ON-Q, n = 32) and the other used a fentanyl-based IV PCA (IV PCA, n = 33). Using the electronic medical record system, the postoperative recovery profiles were examined over 5 days using a visual analogue scale (VAS), incidence of postoperative nausea and vomiting (PONV), incidence of sleep disturbance, frequency of rescue analgesic use, analgesia-related adverse events, length of hospital stay, and degree of patient satisfaction. The condition of the surgical wound was observed for 1 year after surgery.The primary endpoint was the intensity of pain at 6 hours after surgery. The VAS was comparable between the groups (P > .05). Although recovery profiles and the degree of patient satisfaction were similar between the groups, the incidence of PONV was significantly lower in the ON-Q group than in the IV PCA group on the day of surgery and postoperative day 1. No patients had severe wound complications. The satisfaction score of analgesia in the ON-Q group was comparable with that of the patients in the IV PCA group.This study demonstrates that single use of continuous wound infusion showed comparable analgesia with fentanyl-based IV PCA in patients who underwent mastectomy with immediate autologous breast reconstruction. Furthermore, the continuous infusion of LA directly on the surgical site did not significantly affect wound healing.

Comparing efficacy of high-dose rate brachytherapy versus helical tomotherapy in the treatment of cervical cancer.

OBJECTIVE: Boost radiation using brachytherapy (BT) is a standard treatment for local disease control in concomitant chemoradiation therapy (CCRT) for advanced cervical cancer. However, it is associated with gastrointestinal and genitourinary complications. Hence, this study investigates the feasibility of helical tomotherapy (HT) as an alternative to BT. METHODS: Medical records of patients who underwent CCRT between 2000 and 2017 at a single institution were retrospectively reviewed. Patients with stage IIB-IVA cancers were selected based on the 2009 criteria of The International Federation of Gynaecology and Obstetrics. External beam radiation combined with chemotherapy was followed by either BT or HT. The propensity score matching of both groups was calculated using logistic regression analysis. Disease outcomes and treatment-related adverse events were compared between the 2 groups. RESULTS: The matched population included 70 BT patients and 35 HT patients. The 5-year progression-free survival rates for BT and HT were 72.6% and 72.5%, respectively (p=0.721). There was no difference in the overall survival rate between the two groups (p=0.203). The presence of acute and chronic gastrointestinal complications was also similar between the groups (p=0.460 and p=0.563, respectively). The chronic genitourinary toxicities were also comparable (p=0.105). CONCLUSIONS: HT boost treatment showed comparable disease outcomes with those observed with conventional BT in patients with advanced cervical cancer. HT could be a complementary boost protocol as a single modality or hybrid with BT in selected patients. Further studies with longer follow-up periods are warranted to confirm long-term outcomes.

Sequential simulation computed tomography allows assessment of internal rectal movements during preoperative chemoradiotherapy in rectal cancer.

PURPOSES: The purpose of this study was to assess the internal rectal movement and to determine the factors related to extensive internal rectal movement using sequential simulation computed tomography (CT) images. MATERIALS AND METHODS: From 2010 to 2015, 96 patients receiving long-course preoperative chemoradiotherapy were included in our retrospective study. The initial simulation CT (Isim-CT) and follow-up simulation CT (Fsim-CT) for a boost were registered according to the isocenters and bony structure. The rectums on Isim-CT and Fsim-CT were compared on four different axial planes as follows: (1) lower pubis symphysis (AXVERYLOW), (2) upper pubis symphysis (AXLOW), (3) superior rectum (AXHIGH), and (4) middle of AXLOW and AXHIGH (AXMID). The involved rectum in the planning target volume was evaluated. The maximal radial distances (MRD), the necessary radius from the end of Isim-CT rectum to cover entire Fsim-CT rectum, and the common area rate (CAR) of the rectum (CAR, (Isim-CT∩Fsim-CT)/(Isim-CT)) were measured. Linear regression tests for the MRDs and logistic regression tests for the CARs were conducted. RESULTS: The mean ± standard deviation (mm) of MRDs and CAR <80% for AXVERYLOW, AXLOW, AXMID, and AXHIGH were 2.3 ± 2.5 and 8.9%, 3.0 ± 3.7 and 17.4%, 4.0 ± 5.2 and 27.1%, and 4.1 ± 5.2 and 25%, respectively. For MRDs and CARs, a higher axial level (AXVERYLOW/AXMID-HIGH, P = 0.018 and P = 0.034, respectively), larger bladder volume (P = 0.054 and P = 0.017, respectively), smaller bowel gas extent (small/marked, P = 0.014 and P = 0.001, respectively), and increased bowel gas change (decrease/increase, both P < 0.001) in rectum were associated with extensive internal rectal movement in multivariate analyses. CONCLUSIONS: As a result of following internal rectal movement through sequential simulation CT, the rectum above the pubis symphysis needs a larger margin, and bladder volume and bowel gas should be closely observed.

Factors predicting intolerance to definitive conventional radiotherapy in geriatric patients.

PURPOSE: Although radiotherapy can be administered with a relatively low therapeutic burden, many elderly patients do not complete radiotherapy. In order to predict intolerance during radiotherapy, this study retrospectively analyzed the frequency of and risk factors for radiotherapy interruption among geriatric patients. METHODS: From September 2009 to December 2016, 353 patients aged ≥70 years received definitive radiotherapy with a conventionally fractionated schedule. "Total interruption" included completion of ≤90% of a planned radiotherapy, temporary discontinuation, and treatment-related mortality within 2 months. "Early-phase incompletion" and "mid-phase incompletion" represented completion of ≤50 and ≤80% of a planned radiotherapy, respectively. RESULTS: The median age of patients was 74 years. Early- and mid-phase incompletions and total interruption occurred in 4.2, 9.3, and 19.3% of patients, respectively. Total interruption occurred frequently in cancers involving the thorax (27.4%), head and neck (23.1%), abdomen (20.0%), pelvis (17.4%), and breast/extremity (8.1%). The Eastern Cooperative Oncology Group (ECOG) performance score (P = 0.004 and 0.002), serum albumin level (P = 0.016 and 0.002), and the expected 5­year survival (P = 0.033 and 0.034) were significant factors for mid-phase incompletion and total interruption. Age ≥ 75 years (P = 0.008), concurrent chemotherapy (P = 0.017), and the extent of radiation field (P = 0.027) were factors associated with total interruption. CONCLUSION: Overall, 19.3% of the elderly patients showed treatment intolerance during conventional radiotherapy. Serum albumin level and ECOG performance score should be considered as surrogate markers for radiotherapy interruption prior to the decision regarding definite conventional radiotherapy.

Remote quantification of Cochlodinium polykrikoides blooms occurring in the East Sea using geostationary ocean color imager (GOCI).

Accurate and timely quantification of widespread harmful algal bloom (HAB) distribution is crucial to respond to the natural disaster, minimize the damage, and assess the environmental impact of the event. Although various remote sensing-based quantification approaches have been proposed for HAB since the advent of the ocean color satellite sensor, there have been no algorithms that were validated with in-situ quantitative measurements for the red tide occurring in the Korean seas. Furthermore, since the geostationary ocean color imager (GOCI) became available in June 2010, an algorithm that exploits its unprecedented observation frequency (every hour during the daytime) has been highly demanded to better track the changes in spatial distribution of red tide. This study developed a novel red tide quantification algorithm for GOCI that can estimate hourly chlorophyll-a (Chl a) concentration of Cochlodinium (Margalefidinium) polykrikoides, one of the major red tide species around Korean seas. The developed algorithm has been validated using in-situ Chl a measurements collected from a cruise campaign conducted in August 2013, when a massive C. polykrikoides bloom devastated Korean coasts. The proposed algorithm produced a high correlation (R2=0.92) with in-situ Chl a measurements with robust performance also for high Chl a concentration (300mg/m3) in East Sea areas that typically have a relatively low total suspended particle concentration (<0.5mg/m3).

Validation of Nomograms for Survival and Metastases after Hysterectomy and Adjuvant Therapy in Uterine Cervical Cancer with Risk Factors.

Background. Three nomogram models for early stage uterine cervical cancer have been developed (KROG 13-03 for overall survival [OS], SNUH/AMC for disease-free survival [DFS], and KROG 12-08 for distant metastases-free survival [DMFS]) after radical hysterectomy (RH) and pelvic lymph node dissection (PLND). This study aimed to validate these models using our cohort with adjuvant radiotherapy. Methods. According to the eligibility criteria of nomogram studies, patients were enrolled in Group A (N = 109) for the two KROG models (RH with PLND and whole pelvic irradiation) and Group B (N = 101) for the SNUH/AMC model (RH with PLND and squamous histology). Using Cox-regression hazard models, the prognostic factors of our cohorts were evaluated. The risk probabilities induced from published nomogram scores were calculated and the concordance indices were evaluated. Results. Group A had 88.1% 5-year OS and 86.0% 5-year DMFS. Group B had 83.0% 5-year DFS. In multivariate analyses, large tumor size for OS (HR 8.62, P < 0.001) and DMFS (HR 5.13, P = 0.003), young age (≤40 versus 41-64 years) for OS (HR 4.63, P = 0.097) and DFS (HR 3.44, P = 0.051), and multiple lymph node metastases (0 versus ≥3) for DMFS (HR 4.03, P = 0.031) and DFS (HR 3.90, P = 0.038) were significantly correlated. The concordance indices for OS, DMFS, and DFS were 0.612 (P = 0.002), 0.597 (P = 0.014), and 0.587 (P = 0.020), respectively. Conclusion. The developed nomogram models after RH and PLND are clinically useful in predicting various types of survival with significance.

Comprehensive Evaluation of Personal, Clinical, and Radiation Dosimetric Parameters for Acute Skin Reaction during Whole Breast Radiotherapy.

Skin reaction is major problem during whole breast radiotherapy. To identify factors related to skin reactions during whole breast radiotherapy, various personal, clinical, and radiation dosimetric parameters were evaluated. From January 2012 to December 2013, a total of 125 patients who underwent breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients had both whole breast irradiation and boost to the tumour bed. Skin reaction was measured on the first day of boost therapy based on photography of the radiation field and medical records. For each area of axilla and inferior fold, the intensity score of erythema (score 1 to 5) and extent (score 0 to 1) were summed. The relationship of various parameters to skin reaction was evaluated using chi-square and linear regression tests. The V 100 (volume receiving 100% of prescribed radiation dose, p < 0.001, both axilla and inferior fold) and age (p = 0.039 for axilla and 0.026 for inferior fold) were significant parameters in multivariate analyses. The calculated axilla dose (p = 0.003) and breast separation (p = 0.036) were also risk factors for axilla and inferior fold, respectively. Young age and large V 100 are significant factors for acute skin reaction that can be simply and cost-effectively measured.

Novel ray tracing method for stray light suppression from ocean remote sensing measurements.

We developed a new integrated ray tracing (IRT) technique to analyze the stray light effect in remotely sensed images. Images acquired with the Geostationary Ocean Color Imager show a radiance level discrepancy at the slot boundary, which is suspected to be a stray light effect. To determine its cause, we developed and adjusted a novel in-orbit stray light analysis method, which consists of three simulated phases (source, target, and instrument). Each phase simulation was performed in a way that used ray information generated from the Sun and reaching the instrument detector plane efficiently. This simulation scheme enabled the construction of the real environment from the remote sensing data, with a focus on realistic phenomena. In the results, even in a cloud-free environment, a background stray light pattern was identified at the bottom of each slot. Variations in the stray light effect and its pattern according to bright target movement were simulated, with a maximum stray light ratio of 8.5841% in band 2 images. To verify the proposed method and simulation results, we compared the results with the real acquired remotely sensed image. In addition, after correcting for abnormal phenomena in specific cases, we confirmed that the stray light ratio decreased from 2.38% to 1.02% in a band 6 case, and from 1.09% to 0.35% in a band 8 case. IRT-based stray light analysis enabled clear determination of the stray light path and candidates in in-orbit circumstances, and the correction process aided recovery of the radiometric discrepancy.

Simple aerosol correction technique based on the spectral relationships of the aerosol multiple-scattering reflectances for atmospheric correction over the oceans.

An estimation of the aerosol multiple-scattering reflectance is an important part of the atmospheric correction procedure in satellite ocean color data processing. Most commonly, the utilization of two near-infrared (NIR) bands to estimate the aerosol optical properties has been adopted for the estimation of the effects of aerosols. Previously, the operational Geostationary Color Ocean Imager (GOCI) atmospheric correction scheme relies on a single-scattering reflectance ratio (SSE), which was developed for the processing of the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) data to determine the appropriate aerosol models and their aerosol optical thicknesses. The scheme computes reflectance contributions (weighting factor) of candidate aerosol models in a single scattering domain then spectrally extrapolates the single-scattering aerosol reflectance from NIR to visible (VIS) bands using the SSE. However, it directly applies the weight value to all wavelengths in a multiple-scattering domain although the multiple-scattering aerosol reflectance has a non-linear relationship with the single-scattering reflectance and inter-band relationship of multiple scattering aerosol reflectances is non-linear. To avoid these issues, we propose an alternative scheme for estimating the aerosol reflectance that uses the spectral relationships in the aerosol multiple-scattering reflectance between different wavelengths (called SRAMS). The process directly calculates the multiple-scattering reflectance contributions in NIR with no residual errors for selected aerosol models. Then it spectrally extrapolates the reflectance contribution from NIR to visible bands for each selected model using the SRAMS. To assess the performance of the algorithm regarding the errors in the water reflectance at the surface or remote-sensing reflectance retrieval, we compared the SRAMS atmospheric correction results with the SSE atmospheric correction using both simulations and in situ match-ups with the GOCI data. From simulations, the mean errors for bands from 412 to 555 nm were 5.2% for the SRAMS scheme and 11.5% for SSE scheme in case-I waters. From in situ match-ups, 16.5% for the SRAMS scheme and 17.6% scheme for the SSE scheme in both case-I and case-II waters. Although we applied the SRAMS algorithm to the GOCI, it can be applied to other ocean color sensors which have two NIR wavelengths.

Vicarious calibration of the Geostationary Ocean Color Imager.

Measurements of ocean color from Geostationary Ocean Color Imager (GOCI) with a moderate spatial resolution and a high temporal frequency demonstrate high value for a number of oceanographic applications. This study aims to propose and evaluate the calibration of GOCI as needed to achieve the level of radiometric accuracy desired for ocean color studies. Previous studies reported that the GOCI retrievals of normalized water-leaving radiances (nLw) are biased high for all visible bands due to the lack of vicarious calibration. The vicarious calibration approach described here relies on the assumed constant aerosol characteristics over the open-ocean sites to accurately estimate atmospheric radiances for the two near-infrared (NIR) bands. The vicarious calibration of visible bands is performed using in situ nLw measurements and the satellite-estimated atmospheric radiance using two NIR bands over the case-1 waters. Prior to this analysis, the in situ nLw spectra in the NIR are corrected by the spectrum optimization technique based on the NIR similarity spectrum assumption. The vicarious calibration gain factors derived for all GOCI bands (except 865nm) significantly improve agreement in retrieved remote-sensing reflectance (Rrs) relative to in situ measurements. These gain factors are independent of angular geometry and possible temporal variability. To further increase the confidence in the calibration gain factors, a large data set from shipboard measurements and AERONET-OC is used in the validation process. It is shown that the absolute percentage difference of the atmospheric correction results from the vicariously calibrated GOCI system is reduced by ~6.8%.

Development of a 3D optical scanner for evaluating patient-specific dose distributions.

PURPOSE: This paper describes the hardware and software characteristics of a 3D optical scanner (P3DS) developed in-house. The P3DS consists of an LED light source, diffuse screen, step motor, CCD camera, and scanner management software with 3D reconstructed software. MATERIALS AND METHOD: We performed optical simulation, 2D and 3D reconstruction image testing, and pre-clinical testing for the P3DS. We developed the optical scanner with three key characteristics in mind. First, we developed a continuous scanning method to expand possible clinical applications. Second, we manufactured a collimator to improve image quality by reducing scattering from the light source. Third, we developed an optical scanner with changeable camera positioning to enable acquisition of optimal images according to the size of the gel dosimeter. RESULTS: We confirmed ray-tracing in P3DS with optic simulation and found that 2D projection and 3D reconstructed images were qualitatively similar to the phantom images. For pre-clinical tests, the dose distribution and profile showed good agreement among RTP, optical CT, and external beam radiotherapy film data for the axial and coronal views. The P3DS has shown that it can scan and reconstruct for evaluation of the gel dosimeter within 1 min. We confirmed that the P3DS system is a useful tool for the measurement of 3D dose distributions for 3D radiation therapy QA. Further experiments are needed to investigate quantitative analysis for 3D dose distribution.

Patient performance-based plan parameter optimization for prostate cancer in tomotherapy.

The purpose of this study is to evaluate the influence of treatment-planning parameters on the quality of treatment plans in tomotherapy and to find the optimized planning parameter combinations when treating patients with prostate cancer under different performances. A total of 3 patients with prostate cancer with Eastern Cooperative Oncology Group (ECOG) performance status of 2 or 3 were included in this study. For each patient, 27 treatment plans were created using a combination of planning parameters (field width of 1, 2.5, and 5cm; pitch of 0.172, 0.287, and 0.43; and modulation factor of 1.8, 3, and 3.5). Then, plans were analyzed using several dosimetrical indices: the prescription isodose to target volume (PITV) ratio, homogeneity index (HI), conformity index (CI), target coverage index (TCI), modified dose HI (MHI), conformity number (CN), and quality factor (QF). Furthermore, dose-volume histogram of critical structures and critical organ scoring index (COSI) were used to analyze organs at risk (OAR) sparing. Interestingly, treatment plans with a field width of 1cm showed more favorable results than others in the planning target volume (PTV) and OAR indices. However, the treatment time of the 1-cm field width was 3 times longer than that of plans with a field width of 5cm. There was no substantial decrease in treatment time when the pitch was increased from 0.172 to 0.43, but the PTV indices were slightly compromised. As expected, field width had the most significant influence on all of the indices including PTV, OAR, and treatment time. For the patients with good performance who can tolerate a longer treatment time, we suggest a field width of 1cm, pitch of 0.172, and modulation factor of 1.8; for the patients with poor performance status, field width of 5cm, pitch of 0.287, and a modulation factor of 3.5 should be considered.

Four-dimensional computed tomography based respiratory-gated radiotherapy with respiratory guidance system: analysis of respiratory signals and dosimetric comparison.

PURPOSE: To investigate the effectiveness of respiratory guidance system in 4-dimensional computed tomography (4 DCT) based respiratory-gated radiation therapy (RGRT) by comparing respiratory signals and dosimetric analysis of treatment plans. METHODS: The respiratory amplitude and period of the free, the audio device-guided, and the complex system-guided breathing were evaluated in eleven patients with lung or liver cancers. The dosimetric parameters were assessed by comparing free breathing CT plan and 4 DCT-based 30-70% maximal intensity projection (MIP) plan. RESULTS: The use of complex system-guided breathing showed significantly less variation in respiratory amplitude and period compared to the free or audio-guided breathing regarding the root mean square errors (RMSE) of full inspiration (P = 0.031), full expiration (P = 0.007), and period (P = 0.007). The dosimetric parameters including V(5 Gy), V(10 Gy), V(20 Gy), V(30 Gy), V(40 Gy), and V(50 Gy) of normal liver or lung in 4 DCT MIP plan were superior over free breathing CT plan. CONCLUSIONS: The reproducibility and regularity of respiratory amplitude and period were significantly improved with the complex system-guided breathing compared to the free or the audio-guided breathing. In addition, the treatment plan based on the 4D CT-based MIP images acquired with the complex system guided breathing showed better normal tissue sparing than that on the free breathing CT.

Tumor volume reduction assessed by planning computed tomography in patients with rectal cancer during preoperative chemoradiation: impact of residual tumor volume on the prediction of pathologic tumor regression.

AIMS AND BACKGROUND: To determine whether the residual tumor volume measured using the Eclipse treatment planning system correlates with pathologic tumor regression grade after preoperative chemoradiotherpy for rectal cancer. MATERIALS AND METHODS: The study included 30 patients with rectal cancer who had undergone preoperative chemoradiotherpy followed by surgery from June 2008 to April 2011 at the Korea University Guro Hospital. The tumor volume was measured using the Eclipse treatment planning system in the initial simulation computed tomography and boost planning computed tomography. The correlation between the residual tumor volume in boost planning computed tomography and the pathologic tumor regression grade was analyzed. Tumor regression grade defined in the American Joint Committee on Cancer 7th edition was used. RESULTS: The mean and median residual tumor volume was 57.34% ± 20.37% and 52.35% (range, 18.42%-95.79%), respectively. After surgery, pathologic complete response (tumor regression grade 0) occurred in 4 patients (13.33%), moderate response (tumor regression grade 1) in 18 patients (60%), minimal response (tumor regression grade 2) in 4 patients (13.33%), and poor response (tumor regression grade 3) in 4 patients (13.33%). When residual tumor volume was categorized into two groups (<50% and ≥50%), complete or moderate regression (tumor regression grade 0 or 1) was significantly greater for patients with a residual tumor volume <50% ( P <0.05). The mean residual tumor volume of tumor regression grade 0 or 1 was 49.07% ± 18.39% and that of tumor regression grade 2 or 3 was 76.31% ± 16.94% (P <0.05). CONCLUSIONS: Residual tumor volume measured using routine boost planning computed tomography during preoperative chemoradiotherpy correlated significantly with pathologic tumor regression grade after surgery.

Modified MVAC as a Second-Line Treatment for Patients with Metastatic Urothelial Carcinoma after Failure of Gemcitabine and Cisplatin Treatment.

PURPOSE: There is no established standard second-line chemotherapy for patients with advanced or metastatic urothelial carcinoma (UC) who failed gemcitabine and cisplatin (GC) chemotherapy. This study was conducted in order to investigate the efficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with metastatic UC previously treated with GC. MATERIALS AND METHODS: We retrospectively analyzed 28 patients who received modified MVAC between November 2004 and November 2012. All patients failed prior, first-line GC chemotherapy. RESULTS: The median age of patients was 64.0 years (range, 33.0 to 77.0 years), and 23 (82.1%) patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. The overall response rate and the disease control rate were 36.0% and 64.0%, respectively. After a median follow-up period of 38 weeks (range, 5 to 182 weeks), median progression free survival was 21.0 weeks (95% confidence interval [CI], 6.3 to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3 weeks). Grade 3 or 4 hematological toxicities included neutropenia (n=21, 75.0%) and anemia (n=9, 32.1%). Grade 3 or 4 non-hematological toxicities did not occur and there was no treatment-related death. CONCLUSION: Modified MVAC appears to be a safe and active chemotherapy regimen in patients with stable physical status and adequate renal function after GC treatment.