International journal of radiation oncology, biology, physics
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Int. J. Radiat. Oncol. Biol. Phys. · Jun 1998
The use of adaptive radiation therapy to reduce setup error: a prospective clinical study.
Adaptive Radiation Therapy (ART) is a feedback treatment process that optimizes a patient's treatment according to the patient specific information measured during the course of treatment. Utilizing an electronic portal imaging device (EPID) and a computer-controlled multileaf collimator (MLC), the ART process is currently being implemented in our clinic to improve the treatment accuracy by compensating for the treatment setup error. A prospective study was conducted to evaluate the feasibility and efficacy of the ART process for clinical use. ⋯ The prospective study demonstrates that the ART process can be effectively implemented in routine clinical practice to improve treatment accuracy. This process is also ready to be further extended to reoptimize the treatment plan by incorporating the predicted patient specific setup variation.
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Int. J. Radiat. Oncol. Biol. Phys. · Jun 1998
High dose-rate afterloading 192Iridium prostate brachytherapy: feasibility report.
RESULTS from localized prostate cancer series using seed implants have been most encouraging. However, with current techniques, inadequate dosimetry sometimes occurs. Remote afterloading high dose rate 192Iridium brachytherapy (HDR-Ir192) theoretically remedies some potential inadequacies of seed implantation by performing the dosimetry after the needles are in place. This study was undertaken to determine the feasibility of incorporating multifractionated HDR-Ir192 in the brachytherapy management of prostate carcinoma. ⋯ We found the use of transperineal ultrasonography, postimplant CT-based dosimetry, coupled with adjustable dose delivery inherent to remote afterloading technology, to give unparalleled control in performing this complex brachytherapy task. Thus, it may be advantageous in certain clinical situations where the resultant MPD is needed to reliably cover the target volume, such as in patients with carcinomas at base locales, when the possibility of moderate to extensive intraprostatic tumor exists, and in patients with large glands. Early PSA data suggest that it may be effective as a definitive treatment with rates of adverse late tissue effects that are acceptable using current technique and doses described herein. Longer follow-up is needed to ascertain its position among the various treatment regimens for prostate carcinoma.
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Int. J. Radiat. Oncol. Biol. Phys. · Jun 1998
Dose escalation with 3D conformal treatment: five year outcomes, treatment optimization, and future directions.
To report the 5-year outcomes of dose escalation with 3D conformal treatment (3DCRT) of prostate cancer. ⋯ A dose response was observed for patients with pretreatment PSA >10 ng/ml based on 5-year bNED results. No dose response was observed for patients with pretreatment PSA < 10 ng/ml. Dose response was observed for FC-LENT grade 2 and grade 3,4 GI sequelae and for LENT grade 2 GU sequelae. Optimization of treatment was made possible by the results in this report. The improvement in 5-year bNED rates for patients with PSA levels > 10 ng/ml strongly suggests that clinical trials employing radiation should investigate the use of 3DCRT and prostate doses of 76-80 Gy.
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Int. J. Radiat. Oncol. Biol. Phys. · Jun 1998
The treatment of nonpalpable PSA-detected adenocarcinoma of the prostate with 3-dimensional conformal radiation therapy.
We reviewed our institution's experience treating patients with nonpalpable PSA-detected prostate cancer with three-dimensional conformal radiation therapy (3DCRT) to determine prognostic factors that predict for biochemical-free survival (bNED) control and present the bNED control rates. ⋯ Patients with nonpalpable PSA-detected prostate cancer can be effectively treated with 3DCRT with minimal morbidity and high rates of bNED control at 5 years. Pretreatment PSA level is an independent predictor of bNED control.
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Int. J. Radiat. Oncol. Biol. Phys. · Jun 1998
Cataracts after total body irradiation and bone marrow transplantation in patients with acute leukemia in complete remission: a study of the European Group for Blood and Marrow Transplantation.
Advances in bone marrow transplantation (BMT) have consistently improved long-term survival. Therefore, evaluation of late complications such as cataracts is of paramount importance. ⋯ High dose rate and STBI are the main risk factors for cataract development and the need for surgery, and the administration of heparin has a protective role in cataractogenesis.