[Dosimetric impact of hydrogel spacer use for stereotactic body radiotherapy of localised prostate cancer]. / Impact dosimétrique de la pose d'un espaceur rectal dans le traitement de cancer de la prostate localisé par irradiation en conditions stéréotaxiques.

PURPOSE: Stereotactic body radiotherapy (SBRT) of prostate cancer is associated with rectal toxicities, which can be reduced by using a hydrogel spacer. The object of this retrospective study was to show the feasibility of spacer placement under local anesthesia and utility of hydrogel spacer to reduce the dose to the rectal wall. MATERIAL AND METHODS: We collected data from all patients with localised prostate cancer treated with SBRT (40Gy in 5 fractions) between 2018 and 2020. A hydrogel spacer (SpaceOAR®) was placed depending on the availability of the product. We collected dosimetric data for target volumes and organs at risk. We calculated mean values, which were compared using non-parametric tests. RESULTS: Among 35 patients, mean age was 75 years. Seventeen had a spacer placed, with a mean space created of 10mm. No complication was reported during the intervention. High doses to the rectal wall were significantly lower in spacer group (V38: 0.39 cm3 vs. 0.72 cm3; P=0.02). PTV were better covered in spacer group (P=0.07). Doses to the bladder wall were similar in both groups. CONCLUSION: Spacer procedure under local anesthesia was well tolerated. Hydrogel spacer allowed to reduce doses to the rectum while improving PTV coverage.

Bolus-tracking MRI with a simultaneous T1- and T2*-measurement.

The aim of this study was to propose and evaluate a methodology to analyze simultaneously acquired T2*-weighted dynamic susceptibility contrast (DSC) MRI and T(1)-weighted dynamic contrast enhanced (DCE) MRI data. Two generalized models of T2*-relaxation are proposed to account for tracer leakage, and a two-compartment exchange model is used to separate tracer in intra- and extravascular spaces. The methods are evaluated using data extracted from ROIs in three mice with subcutaneously implanted human colorectal tumors. Comparing plasma flow values obtained from DCE-MRI and DSC-MRI data defines a practical experimental paradigm to measure T2*-relaxivities, and reveals a factor of 15 between values in tissue and blood. Comparing mean transit time values obtained from DCE-MRI and DSC-MRI without leakage correction, indicates a significant reduction of susceptibility weighting in DSC-MRI during tracer leakage. A one-parameter gradient correction model provides a good approximation for this susceptibility loss, but redundancy of the parameter limits the practical potential of this model for DSC-MRI. Susceptibility loss is modeled more accurately with a variable T2*-relaxivity, which allows to extract new parameters that cannot be derived from DSC-MRI or DCE-MRI alone. They reflect the cellular and vessel geometry, and thus may lead to a more complete characterization of tissue structure.

Ratings of perceived exertion (RPE) during cycling exercises at constant power output.

The purpose of the present investigation was to study the overall rating of perceived exertion (RPEov) according to the 6-20 scale proposed by Borg (1970) and muscular RPE (RPEmu) in exercises at constant load. The relationship between RPE and heart rate for three different loads was studied during exhausting exercises in 10 participants. Whether the drift of RPE during a 20 min exercise at constant load could be an index of the endurance time during long-lasting exercises at constant load was also investigated. At 1-week intervals, the participants performed cycling exercises up to exhaustion at 60, 73, and 86% maximal aerobic power (MAP) measured during an incremental test. Heart rate, RPEov, RPEmu and exhaustion time (tlim) were measured. The upward shift of the HRmax-RPE regressions was significant between 86, 73 and 60% MAP (p < 0.001) for RPEov and RPEmu. This result suggests that the equation HR = 10 x RPE proposed by Borg (1973) for incremental exercise is not valid for long-lasting exercise at constant load until exhaustion because the heart rate corresponding to a given RPE depends on load and time. Mean RPE increased linearly with time up to exhaustion. Unexpectedly, the relationships between RPEmu or RPEov and percentage of exhaustion time were similar for exercises at 60 and 73% MAP although the exhaustion times were very different (79.40 +/- 30.64 min versus 36.19 +/- 15.99 min, respectively) (p < 0.001). Consequently, it is likely that RPE was a subjective estimation of the hardness of exercise rather than the intensity of exercise. The RPE pattern at the beginning of long-lasting exercises at constant load (60 and 73% MAP) cannot be considered as a sensitive predictor of the point of self-imposed exhaustion for individuals. Indeed, the errors in the estimation of exhaustion time from extrapolation of RPE at the beginning of exercise were very large. Moreover, at 60% MAP, a steady-state in RPE was observed during 20 min in five subjects whose tlim were not longer than tlim of the other subjects. In addition, the data of the present study indicate that RPEmu could be more useful than RPEov in cycling.

Ratings of perceived exertion (RPE) as an index of aerobic endurance during local and general exercises.

The main purpose of this study was to assess the correlations of RPE with indicators of endurance (critical power), exhaustion time and the electromyographic activity of a relevant muscle during general and local exercises. Eight healthy subjects participated in the study. During the first session, Maximal Aerobic Power (MAP) was measured by means of an incremental cycling exercise on a Monark ergometer. At 1-week intervals the participants performed a general or local exhausting exercise, which consisted of a cycle exercise (60, 73, 86 or 100% MAP) and a knee extension exercise (lifting a load between 17.5 and 32.5 kg every 3 s), respectively. The critical powers corresponding to cycling (CPcycling) and knee extension (CPknee) were calculated from the slope of the linear relationship between exhaustion time (tlim) and work. Rate of perceived exertion, concerning the whole body (overall RPE [RPEov]), RPE concerning the exercising muscles (muscular RPE [RPEmu]) and exhaustion time were measured. During the last session, the integrated electromyogram of the right Vastus Lateralis (iEMG s-1) was measured during short (20 s) cycling and knee extension non-exhausting exercises, with the same electrode location, at the different power outputs used during the exhausting exercises. The relationships between RPEmu at the fifth minute and log tlim and between iEMG% (percentage of the iEMG s-1 corresponding to 100% MAP during cycling) and log tlim were similar for the cycling and knee extension exercises. The mean values of RPEmu at the fifth minute of exercise calculated for CPcycling and CPknee were almost equal (12.3 +/- 1.7 versus 12.2 +/- 0.9). Similarly, the mean values of iEMG% corresponding to CPcycling and CPknee were equal (78.44 versus 79.02%). These results suggest that RPEmu is related to aerobic endurance and that the possibility of sustaining a high percentage of maximal aerobic power during a general exercise is mainly related to local muscular factors.

Work-exhaustion time relationships and the critical power concept. A critical review.

The present review is focused on the physiological meanings of the critical power concept proposed by Scherrer in 1954 and its applications to general exercises such as running, cycling and swimming. Since the first studies on the critical power of local exercises, many studies have found that critical power is correlated with indices which are related to aerobic endurance such as maximal oxygen uptake, ventilatory threshold, OBLA or maximal lactate steady state. In fact, the relationship between exhaustion time t(lim) and the Work Wlim (or Distance Dlim) performed at exhaustion is not exactly linear and, consequently, the power-t(lim) equation is not a true hyperbola. The effect of the range of t(lim), used in the calculation of the slope of the Wlim-t(lim) relationship (called critical power) are discussed. When critical power is calculated from short supramaximal exercises, this power is higher than the power output which corresponds to a lactate steady state (or an oxygen uptake steady state) and does not correspond to a power output which can be sustained a long time. The authors present experimental data collected during local (knee extension) and general (running and cycling) exercises which suggest that critical power could correspond to a steady state provided that critical power is calculated from heavy submaximal exercises only (t(lim) ranging between 6 and 30 min). It is difficult to predict exhaustion time from critical power or critical velocity because of the hyperbolic nature of the power-t(lim) relationship. On the other hand, a large error in the measure of t(lim) should have a small effect on the calculation of critical power or velocity. In contrast, the value of Y intercept of the Wlim-t(lim) (or Dlim-(t(lim)) relationship should be sensitive to errors in t(lim).

Critical power as an endurance index.

The relationship between exhaustion time (t(lim)) and the work performed at the end of constant-power exercises can be described by a linear relationship (Wlim = a + b t(lim)) for work involving the whole body (eg cycling) or part of the body (eg knee extensions). The slope b in the equation is termed the critical power and has been proposed as an index of the capacity to perform work over a long period of time. The first objective of the present study was to compare the values of slopes b calculated from whole-body work of short duration, ie maximal and supra-maximal cycling exercises (slope b1), with the values calculated from the same work, the durations of which were between 3.5 and 35 min (slope b3), as in the protocols used by Scherrer and Monod (1960) for body-part work. Slope b1 was significantly higher than slope b3 in 10 subjects who performed 5 cycling exhausting exercises (60, 73, 86, 100 and 120% of maximal aerobic power (MAP) in watts). Exhaustion times corresponding to power outputs equivalent to b1 and b3 were equal to 29.0 +/- 19.1 min and 48.6 +/- 9.8 min respectively. Moreover, the exhaustion times at 60 and 73%,MAP were significantly correlated with slope b3 (expressed in %MAP) but not with slope b1. Consequently, slope b3 should be considered as the critical power instead of slope b1 as in some studies in the literature (Moritani et al, 1981). The second objective was to study the physiological significance of the critical power (slope b3) of whole-body work (cycling). The workload that corresponded to a lactate steady state was not significantly different from b3 (68.8 +/- 6.0 vs 68.7 +/- 6.3% MAP). Nevertheless, slope b3 represents a workload corresponding to a slight but significant drift of heart rate or oxygen uptake. These results probably explain why b3 is a power which can be maintained for a long time but not beyond about l h in an average subject.

Prediction of exhaustion time from heart rate drift.

Beaury and Eclache (1978) proposed to extrapolate the drift of the heart rate up to maximal heart rate (Hrmax measured during an incremental maximal test) as a convenient way of estimation of the exhaustion tim (tlim) of an exercise at constant power (75 or 80% of Maximal Aerobic Power (MAP)). The purpose of this study was to evaluate this method of estimation of exhaustion time for a large range of power (60, 73, 86, 100 and 120% MAP). We compared the exercise duration calculated with this method (1limtheo) and the actual exhaustion time (tlim). The results showed that the subjects did not reach their maximal heart rate (Hrmax) at tlim and consequently that tlimtheo, calculated by extrapolation of heart rate drift, overestimated tlim, for all the loads in our study. The difference between tlimtheo and tlim (delta tlim expressed as a percentage of tlim) is significantly lower at 86% MAP than delta tlim at the other loads. It is likely that delta tlim is minimal around 80% MAP, i.e. the loads used in the study by Beaury and Eclache (1978). The values of heart rate (Hrlim), oxygen uptake (VO2lim) and oxygen puls (O2pulslim) measured at exhaustion suggested that the high level of energy cost is one of the main limiting factors at 86% MAP, in contrast with other loads.