Association of Specific Antiphospholipid Antibodies to Platelet Count and Thrombocytopenia.

Thrombocytopenia is one of the most common manifestations of the antiphospholipid syndrome (APS). However, its causes are still poorly defined. We have shown recently that antiphospholipid antibodies (aPL) directed against β2-glycoprotein I (β2GPI) of the IgG isotype induced platelet activation and aggregation while aPL directed against cardiolipin and anti-β2GPI IgM had no effect.

Dosimetric effects of saline- versus water-filled balloon applicators for IORT using the model S700 electronic brachytherapy source.

Purpose: The Xoft Axxent Electronic Brachytherapy System (Xoft, Inc., San Jose, CA) is a viable option for intraoperative radiation therapy (IORT) treatment of early-stage breast cancer. The low-energy (50-kVp) X-ray source simplifies shielding and increases relative biological effectiveness but increases dose distribution sensitivity to medium composition.

Resident-reported brachytherapy experience in ACGME-accredited radiation oncology training programs.

Purpose: To describe resident-reported experience in brachytherapy in Accreditation Council of Graduate Medical Education-accredited radiation oncology training programs over the last 5 years.

Methods And Materials: Archived reports of Accreditation Council of Graduate Medical Education final resident case logs from the last 5 years were reviewed and summarized. Brachytherapy was categorized according to the dose rate (low dose rate vs.

Thermal effusivity: a promising imaging biomarker to predict radiation-induced skin injuries.

An effective screening technology is needed to triage individuals at the time of radiation incidents involving a large population. Three-dimensional thermal tomography is a relatively new development in active thermal imaging technology that produces cross-sectional images based on the subject's ability to transfer heat-thermal effusivity-at the voxel level. This noninvasive imaging modality has been used successfully in nondestructive examination of complex materials; also it has been shown to predict the severity of radiation-induced skin injuries several days before the manifestation of severe moist desquamations or blister formation symptoms in mice at 40 Gy.

Thermal effusivity changes as a precursor to moist desquamation.

Skin toxicity is a ubiquitous side effect in radiotherapy and can be difficult to predict. Moist desquamation in cancer patients can decrease quality of life and occasionally demand unplanned treatment breaks thus worsening outcome. In breast cancer patients, moist desquamation occurs approximately one-third of the time, and while avenues such as intensity-modulated radiation therapy exist to decrease skin side effects, they may be prohibitively expensive to distribute widely.

A dosimetric comparison between the supine and prone positions for three-field intact breast radiotherapy.

Purpose: Supine tangential radiotherapy for the intact breast is a standard component of breast conservation management; a supraclavicular (SCV) field can be added for patients at high risk for nodal failure. Treatment in the prone position has demonstrated improvements in lung sparing, but has been limited to early-stage patients in whom radiation to only the breast was indicated. We sought to investigate the dosimetric feasibility of treating women in the prone position, using a 3-field monoisocentric technique.

Helical tomotherapy delivery of an IMRT boost in lieu of interstitial brachytherapy in the setting of gynecologic malignancy: feasibility and dosimetric comparison.

Interstitial brachytherapy is an important means by which to improve local control in gynecologic malignancy when intracavitary brachytherapy is untenable. Patients unable to receive brachytherapy have traditionally received conventional external beam radiation alone with modest results. We investigated the ability of Tomotherapy (Tomotherapy Inc.

Experience with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation.

Objectives: Phase IV study evaluated the safety and device performance of an electronic brachytherapy system (Axxent Electronic Brachytherapy System) as adjuvant therapy for early-stage breast cancer.

Methods: Patients were > or =50 years of age and had completely resected invasive ductal carcinoma or ductal carcinoma in situ (<2.0 cm), with N0 M0 and negative microscopic margins of > or =1 mm.

Tomotherapy and multifield intensity-modulated radiotherapy planning reduce cardiac doses in left-sided breast cancer patients with unfavorable cardiac anatomy.

Purpose: For patients with left-sided breast cancers, radiation treatment to the intact breast results in high doses to significant volumes of the heart, increasing the risk of cardiac morbidity, particularly in women with unfavorable cardiac anatomy. We compare helical tomotherapy (TOMO) and inverse planned intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiotherapy using opposed tangents (3D-CRT) for reductions in cardiac volumes receiving high doses.

Methods And Materials: Fifteen patients with left-sided breast cancers and unfavorable cardiac anatomy, determined by a maximum heart depth (MHD) of >or=1.

Variation in post-surgical lumpectomy cavity volume with delay in initiation of breast irradiation because of chemotherapy.

Purpose: The addition of a radiotherapy boost has been shown to improve local control in breast conservation therapy. Three dimensional planning provides more accurate targeting of the operative bed than clinical setup using the lumpectomy scar. However, contraction of the lumpectomy cavity over time may have implications for the volume of tissue included in the boost field.

Radiation recall reaction with docetaxel administration after accelerated partial breast irradiation with electronic brachytherapy.

Purpose: Accelerated partial breast irradiation (APBI) offers several advantages over whole breast irradiation. Electronic brachytherapy may further reduce barriers to breast conserving therapy by making APBI more available. However, its toxicity profile is not well characterized.

Case report and dosimetric analysis of an axillary recurrence after partial breast irradiation with mammosite catheter.

Partial breast irradiation (PBI) was designed in part to decrease overall treatment times associated with whole breast radiation therapy (WBRT). WBRT treats the entire breast and usually portions of the axilla. The goal of PBI is to treat a smaller volume of breast tissue in less time, focusing the dose around the lumpectomy cavity.

Patterns of failure after MammoSite brachytherapy partial breast irradiation: a detailed analysis.

Purpose: To report the results of a detailed analysis of treatment failures after MammoSite breast brachytherapy for partial breast irradiation from our single-institution experience.

Methods And Materials: Between October 14, 2002 and October 23, 2006, 78 patients with early-stage breast cancer were treated with breast-conserving surgery and accelerated partial breast irradiation using the MammoSite brachytherapy applicator. We identified five treatment failures in the 70 patients with >6 months' follow-up.

A dosimetric comparison of MammoSite high-dose-rate brachytherapy and Xoft Axxent electronic brachytherapy.

Purpose: Over 20,000 patients have been treated with partial breast irradiation (PBI) using the MammoSite balloon brachytherapy applicator (IBB). Recently, a new form of balloon-based PBI, Xoft Axxent electronic brachytherapy (KVB), which uses a 50-kV x-ray source, has been introduced. This analysis was undertaken to dosimetrically compare the results of treatment using these two methods of PBI.

A dosimetric comparison of three-dimensional conformal, intensity-modulated radiation therapy, and MammoSite partial-breast irradiation.

Purpose: Limited information is available comparing target volume and normal tissue dosimetry with the different techniques of partial breast irradiation (PBI). We present results of a dosimetric comparison of single catheter, balloon-based brachytherapy using the MammoSite catheter (BRT), 3D conformal radiation therapy (3DCRT), and intensity-modulated radiation therapy (IMRT).

Methods And Materials: Fifteen patients were treated using the BRT device.

Monte Carlo calculations of output factors for clinically shaped electron fields.

We report on the use of the EGS4/BEAM Monte Carlo technique to predict the output factors for clinically relevant, irregularly shaped inserts as they intercept a linear accelerator's electron beams. The output factor for a particular combination--energy, cone, insert, and source-to-surface distance (SSD)--is defined in accordance with AAPM TG-25 as the product of cone correction factor and insert correction factor, evaluated at the depth of maximum dose. Since cone correction factors are easily obtained, we focus our investigation on the insert correction factors (ICFs).

Three-dimensional photon dosimetry: a comparison of treatment of the intact breast in the supine and prone position.

Purpose: To compare the adequacy of target coverage, dose homogeneity, and volume of normal tissue irradiated in treatment of the intact breast in the supine and prone position.

Methods And Materials: Fifteen patients with early breast cancer who presented for treatment to the intact breast after excisional biopsy were studied. A specially designed device was used for the prone setup to displace the contralateral breast away from the tangential field borders.

Severe cardiotoxicity during 5-fluorouracil chemotherapy: a case and literature report.

The chemotherapeutic agent 5-fluorouracil (5-FU) is a widely accepted part of many cancer treatment protocols. Its cardiotoxic potential is known, but considered uncommon and usually not life threatening, although some cases of severe cardiotoxicity related to 5-FU have been reported. The pathogenesis of cardiotoxicity caused by 5-FU is not clear.

Concomitant cisplatin/5-FU infusion and radiotherapy in advanced head and neck cancer: 8-year analysis of results.

Background: The purpose of this study was to analyze long-term follow-up of a single institution's experience with a regimen of concomitant cisplatin/fluorouracil (5-FU) infusion and radiation given every other week. This analysis was stimulated by results of a randomized trial showing superiority for this regimen over induction cisplatin/5-FU chemotherapy followed by radiotherapy, especially in regional disease control.

Methods: All patients with stage III/IV disease who were referred by surgeons for nonoperative therapy and had a follow-up of at least 2 years were included.

Integration of surgery in multimodality therapy for esophageal cancer.

Background: While adding chemotherapy to radiation for the treatment of esophageal cancers has been shown to be beneficial, surgery usually follows treatment or is omitted. In either case, regional control remains problematic. The purpose of this study was to test the feasibility of using chemotherapy and radiation following surgery in the treatment of of esophageal cancer and to assess the impact of this approach on regional control and survival.

Continued malignant cell proliferation in head and neck tumors during cytotoxic therapy.

The effect of cytotoxic therapy on the proliferation of squamous cell carcinoma of the head and neck in vivo in patients was evaluated before and 15-35 days after the start of therapy. To accomplish this, iododeoxyuridine was administered at t = 0, and bromodeoxyuridine was administered 15-35 days later during treatment with a tumor biopsy obtained for study immediately after each pyrimidine infusion. Monoclonal antibodies specific for the halogenated pyrimidines were used to identify cells that were in the S-phase at the time of the infusions.

The dilemma of delayed cellulitis after breast conservation therapy.

Objective: To determine the clinicopathologic characteristics of patients with breast cancers in whom delayed breast cellulitis developed after conservation therapy (lumpectomy, axillary dissection, and radiation).

Background: Breast cellulitis developing after conservation therapy represents a difficult diagnostic and management dilemma because determination of its origin may be necessary before further treatment decisions can be made.

Methods: In this retrospective evaluation of 184 sequential patients with breast cancers who underwent conservation therapy, 10 study patients (5%) in whom breast cellulitis developed 3 or more months after surgery were compared with the 174 patients in whom cellulitis did not develop.

Delaying the initiation of intact breast irradiation for patients with lymph node positive breast cancer increases the risk of local recurrence.

Background: The impact of delaying irradiation to the intact breast for patients receiving chemotherapy for lymph node positive breast cancer is controversial.

Methods: From 1974 to 1989, 474 patients underwent lumpectomy and intact breast irradiation for early stage invasive breast cancer. Chemotherapy was administered to 84 patients (1 patient with bilateral breast cancer) because of positive axillary lymph nodes.

Omission of axillary lymph node dissection in early-stage breast cancer: effect on treatment outcome.

Purpose: To determine the effect omission of axillary lymph node dissection has on outcome in patients treated with breast-conserving therapy for early-stage invasive breast cancer.

Materials And Methods: The authors evaluated 492 patients with breast cancer treated with (n = 32) and without (n = 456) axillary lymph node dissection. The primary tumor characteristics of the two groups were similar, though the median age was different.

Using simulation data to predict lung geometry for inhomogeneity corrections in breast cancer treatments.

Purpose: To develop a statistical model based only on simulation measurement data, to predict the lung geometry in the central slice of the tangential radiation treatment fields for breast cancer.

Methods And Materials: A linear regression analysis was performed on 22 patients to determine the shape of lung in the central axis plane of the tangential radiation fields. Data collected include the greatest perpendicular distance (GPD) measured from the chest wall to the field border on computed tomography (CT) images, the central lung distance (CLD) measured from the posterior field border to the chest wall on the simulation portal images, and the lung contours digitized at 1 cm intervals.