[Dosimetric analysis of LINAC based stereotactic irradiation of brain tumours in CIRS SHANE phantom]. / Lineáris gyorsítóval végzett agyi sztereotaxiás besugárzások terveinek dozimetriai elemzése CIRS SHANE fantomban.

The aim of the study was to compare the different stereotactic treatment plans and dose calculation algorithms for small targets with film dosimetry in anthropomorphic phantom. Treatment plans were prepared for multiple targets with single setup isocenter. Plans for three different irradiation techniques were generated using conformal arc with four non-coplanar arcs, RapidArc with two coplanar full arcs and RapidArc with four non-coplanar arcs in the Varian Eclipse v13.7.16 TPS. Conformal arc and RapidArc plans were calculated using AAA, Acuros XBDm and XBDw algorithms. Conformity index, gradient index and dose maximum were calculated for all PTVs. All measurements were made on the Varian TrueBeam linear accelerator. Comparison between computed and measured dose distributions was performed with gamma evaluation criteria of 3%, 3 mm; 3%, 1 mm and 2%, 2 mm. According to our results, the Eclipse AAA and AXB algorithms provide accurate dose distributions for homogeneous cranial irradiation.

[Early experience with CyberKnife treatment in case of intra-, suprasellar hypernephroma metastasis]. / Korai tapasztalataink CyberKnife-kezeléssel suprasellarisan is terjedo hypernephroma-áttét esetén.

Among tumours found in the suprasellar region metastases are very rare and the most frequent primary tumours are lung and breast cancer. Data of a patient with clear cell renal carcinoma with intra-suprasellar metastasis will be discussed. As in most of the tumours in the sellar region, the first symptom was visual deterioration with visual field defect. A transsphenoidal debulking of the tumour was performed and the residual tumor was treated by CyberKnife hypofractionated stereotactic radiotherapy. Both our patient's visual acuity and visual field impairment improved after the surgery and CyberKnife treatment. At 6-month after irradiation, MR of the sella showed a complete remission of the tumour. This was the first treatment with CyberKnife in our country in case of a tumour close to the optic chiasm. According to our best knowledge, there are 21 cases in the literature with renal cell carcinoma metastasis in the suprasellar region.

[Stereotactic body radiation therapy with CyberKnife accelerator for low- and intermediate risk prostate cancer]. / Kis és közepes kockázatú prosztatarákos betegek sztereotaxiás sugárkezelése CyberKnife gyorsítóval: korai radiogén mellékhatások.

We report implementation of stereotactic body radiotherapy (SBRT) for the treatment of early, localized prostate cancer patients, and acute side effects caused by radiation therapy. Between February 2018 and July 2018, 36 prostate cancer patients were treated with SBRT. Treatments were performed with "CyberKnife M6" linear accelerator. In low-risk patients 8 Gy was delivered to the prostate in each fraction. For intermediate risk, 8 Gy to the prostate and 6.5 Gy to the seminal vesicles were delivered by each fraction with a simultaneous integrated boost technique. A total of 5 fractions (total dose 40 Gy) were given every second working days. Acute radiogenic genitourinary (GU) and gastrointestinal (GI) side effects were assessed using the Radiation Therapy Oncology Group (RTOG) score. The duration of radiotherapy was 1 week and 3 days. The frequency of acute radiogenic side effects was as follows: GU grade 0: 13.9%, grade I: 30.6%, grade II: 52.8%, grade III: 2.7%. GI grade 0: 55.5%, grade I: 30.6%, grade II: 13.9%, grade III: 0%. Grade IV-V side effects were not observed. SBRT appears to be a safe and well tolerated treatment in patients with early stage, localized prostate cancer.

[Measurement of peak correction factor of Farmer chamber for calibration of flattening filter free (FFF) clinical photon beams]. / Kiegyenlítõ szûrõ nélküli mezõk Farmer-kamrával történõ kalibrációjánál alkalmazandó csúcshatás-korrekció mérése.

Farmer-type ionization chambers are considered the most reliable detectors and for this reason they are most frequently used for the calibration of photon beams of medical linear accelerators. Flattening filter free (FFF) photon beams of linear accelerators have recently started to be used in radiotherapy. The dose profile of FFF beams is peaked in the center of the field and the dose distribution will be inhomogeneous along the axis of the 2.3 cm long measuring volume of the Farmer chamber. The peaked radiation field will result in volume averaging effects in the large Farmer chamber, therefore this chamber will underestimate the true central axis dose. Our objective was to determine the value of the peak correction factor (Kp) of Farmer-type chamber with measurements to avoid the underestimation of the central axis dose during the calibration of FFF radiation fields. Measurements were made with 6 MV and 10 MV flattened (6X and 10X) and FFF beams (6XFFF and 10XFFF) of a Varian TrueBeam medical linear accelerator in a solid water phantom at 10 cm depth. The source surface distance (SSD) was 100 cm, the field size was 10×10 cm and the dose rate was always 400 MU/min during the measurements. We delivered 100 MU in each measurement and the absorbed dose to water was calculated according to the IAEA TRS-398 dosimetry protocol. The measured signals of the ionization chambers were always corrected for the ion recombination loss. The ion recombination correction factors (Kr) were determined with the two-voltage method separately for the used ion chambers and for flattened and unflattened beams. First, we measured the dose to water with PTW TM30012 Farmer chamber in 6XFFF and 6X beams, then calculated the ratio of doses of 6XFFF and 6X beams (R6,Farmer). Immediately after this we repeated the above measurements with PTW TM31010 Semiflex chamber and determined the ratio of doses of 6XFFF and 6X beams again (R6,Semiflex). The length of the sensitive volume of the Semiflex chamber is only 6.5 mm. According to our dose profile measurements the peak correction factor of this chamber equals to unity for both photon energies. As a consequence R6,Semiflex is larger than R6,Farmer and Kp6XFFF = R6,Semiflex / R6,Farmer, where Kp6XFFF is the peak correction factor of the Farmer chamber in 6XFFF beam. The advantage of this method is that we have to calculate ratio of doses, so it is not necessary to know the calibration factors of the chambers. Repeating the above measurements with 10X and 10XFFF beams we determined the peak correction factor of Farmer chamber for 10XFFF beam, too (Kp10XFFF). According to our measurements Kp6XFFF = 1.0025 and Kp10XFFF = 1.009. The bigger peak correction factor for 10XFFF beam is in accordance with the fact that the peak of dose profile is steeper for higher photon energy. The above described method for the determination of Kp can be used for other photon energies and other large volume ionization chambers.

[Lens-sparing external beam radiotherapy of periocular lymphomas]. / Szemészeti lokalizációjú lymphomák külso sugárkezelése szemlencsekímélo eljárásokkal.

PURPOSE: The presentation of techniques and results of lens-sparing external beam radiotherapy of patients with ophthalmologic lymphomas. MATERIAL AND METHODS: From 1991 to 2001, at the Department of Radiotherapy of the National Institute of Oncology, Budapest, 92 patients with periocular lymphomas were treated by photon and/or electron beam irradiation depending on the localization. Mean age was 63 years (range: 26-89 years) and the male/female ratio was 1.3. According to the Ann Arbor classification, 72% were in stage I.E. Histologically 85 patients (92.4%) were Grade I while 7 patients (7.6%) presented with higher grade disease. In case of low-grade lymphoma, a dose of 24-32 Gy was delivered, and for higher grade of malignancy we applied 34-40 Gy total dose, using 1.8-2 Gy daily fractions. RESULTS: The local remission rate was 94.4% (CR: 78.8% and PR: 15.6%). There was no change in 2.3%, and 3.3% showed progression. Mild and intermediate acute side effects occurred in 28%, and the incidence of chronic late complications was 3%. CONCLUSION: External beam radiotherapy applying lens-sparing methods is safe and effective in the treatment of periocular lymphomas.

[Improvement of the first cerebral stereotactic radiosurgery system of Hungary]. / Az elso hazai sztereotaxiás agyi sugársebészeti rendszer továbbfejlesztése.

OBJECTIVE: The first cerebral stereotactic radiosurgery system in Hungary was built in 1991. This system was based on a Leksell stereotactic head frame and a Neptun 10p linear accelerator. We performed 624 radiosurgery treatments with this system between 1991 and 2000. Our objective was to increase the reliability of operation and to extend the applicability of our radiosurgery system. METHODS AND MATERIALS: We modified our stereotactic floor stand with specially designed adapter plates to make it compatible with the Mevatron KD and Neptun 10p linear accelerators and other stereotactic head frames (Riechert-Mundiger, CRW and BrainLab). We made a new tertiary collimator holder attachable to the Mevatron KD linac. The range of treatable cerebral lesion was increased from 10-30 mm to 5-42.5 mm with additional collimator inserts. With the above modifications our radiosurgery system is compatible simultaneously with the Neptun 10p and the Mevatron KD linear accelerators. This way we were able to increase the reliability of operation of the system, as the treatment can be performed with the Neptun 10p linac in case of breakdown of the Mevatron KD linac after fixation of the head frame to a patient's skull. RESULTS: The measured diameter of the radiation isocenter defined by the new radiosurgery collimator was less than 1 mm with the Mevatron KD linac. According to the Lutz-test the distance between the radiosurgery isocenter and the rotation axis of ZIV treatment table was less than 0.5 mm. Results of phantom test showed that the overall spatial precision of our modified radiosurgery system was better than 1.3 mm with Leksell head frame. CONCLUSIONS: On the basis of experiences with 662 patients' radiosurgery treatments, the extension of our first cerebral radiosurgery system to Mevatron KD linear accelerator resulted in a more reliable operation. In accordance with our phantom tests the extension of the original system did not worsen its overall spatial precision.

[Dosimetry of total skin electron irradiation] / Teljes bôr elektronbesugárzás dozimetriája.

Elaboration of such a simple technique for total skin electron irradiation which ensures good dose homogeneity and minimal x-ray background dose. MATERIALS AND METHODS: We started large electron field irradiations with the Neptun 10p linear accelerator in the National Institute of Oncology -Budapest in 1986. After the installation of the Siemens Mevatron KD linear accelerator it was possible to introduce the modified Stanford technique. This technique satisfies better the requirements given in the objective. The required field size of 200x75 cm is produced as a result of two fields with 30 degrees angular separation (dual field) at a source skin distance of 465 cm. The patient's body is exposed to six dual electron fields. The electron energy is 6 MeV. Despite the long source skin distance the treatment time is relatively short due to the high dose rate (940 mu/min) capability of our Mevatron KD. The in air dose profiles were measured in miniphantom with semiconductor detector. Depth dose curves were measured in water and in polystyrene phantom with semiconductor detector and with films. RESULTS: The measured dose homogeneity of the 6 MeV energy dual field with 30 degrees angular separation is within +/- 5%in a 200x75cm plane field. The depth of dose maximum of the resulting dose distribution of six dual field irradiation is between 2 mm and 5 mm, while the depth of 80% isodose curve is about 8 mm. The total body x-ray background dose is less than 1% of the skin dose. CONCLUSION: The modified Stanford technique adapted to our Mevatron KD linear accelerator is suitable for total skin electron beam therapy.