[Discontinuation of psychotropic medication: a critical review of the evidence].

Background: Pharmacotherapy is an effective treatment strategy for psychiatric disorders. Nevertheless, many patients discontinue their medication at some point. Evidence-based practices for patients, clinicians, and policymakers to discontinue psychotropic medication properly are therefore important.

Dosimetry and Monte Carlo modelling of the Papillon+ contact X-ray brachytherapy device.

Purpose: This study aimed to develop and validate a Monte Carlo (MC) model for the Papillon+ contact x-ray brachytherapy (CXB) device, producing 50 kilovolt (kV) X-rays, specifically focusing on its application with a 25 mm diameter rectal applicator for contact therapy.

Material And Methods: The validation process involved depth dose and transverse dose profile measurements using EBT3 gafchromic films positioned in a plastic water low energy range phantom. The half-value layer (HVL) was further measured and derived from the simulated X-ray spectra.

Discontinuation of psychotropic medication: a synthesis of evidence across medication classes.

Pharmacotherapy is an effective treatment modality across psychiatric disorders. Nevertheless, many patients discontinue their medication at some point. Evidence-based guidance for patients, clinicians, and policymakers on rational discontinuation strategies is vital to enable the best, personalized treatment for any given patient.

Inter-observer variability in library plan selection on iterative CBCT and synthetic CT images of cervical cancer patients.

Introduction: In the Library-of-Plans (LoP) approach, correct plan selection is essential for delivering radiotherapy treatment accurately. However, poor image quality of the cone-beam computed tomography (CBCT) may introduce inter-observer variability and thereby hamper accurate plan selection. In this study, we investigated whether new techniques to improve the CBCT image quality and improve consistency in plan selection, affects the accuracy of LoP selection in cervical cancer patients.

ESTRO-ACROP guideline: Recommendations on implementation of breath-hold techniques in radiotherapy.

The use of breath-hold techniques in radiotherapy, such as deep-inspiration breath hold, is increasing although guidelines for clinical implementation are lacking. In these recommendations, we aim to provide an overview of available technical solutions and guidance for best practice in the implementation phase. We will discuss specific challenges in different tumour sites including factors such as staff training and patient coaching, accuracy, and reproducibility.

Quality assurance and safety of hippocampal avoidance prophylactic cranial irradiation in the multicenter randomized phase III trial (NCT01780675).

Objective: NCT01780675, a multicenter randomized phase III trial of prophylactic cranial irradiation (PCI) versus PCI with hippocampal sparing in small cell lung cancer (SCLC) investigated neurocognitive decline and safety. As part of quality assurance, we evaluated if hippocampal avoidance (HA)-PCI was performed according to the NCT01780675 trial protocol instructions, and performed a safety analysis to study the incidence and location of brain metastases for patients treated with HA-PCI.

Methods: This retrospective analysis evaluated the quality of the irradiation given in the randomized controlled trial (RCT) comparing SCLC patients receiving PCI with or without hippocampal avoidance, using intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT).

Web Search Query Volume Correlates With Prescription Volumes of Antidepressants and Antipsychotics in the Netherlands and United Kingdom: An Explorative Study.

Background: The significant increase in Internet availability has resulted in a rise in search queries on health-related topics. Previous research has demonstrated the potential for analyzing web search query volume for nonpsychotropic prescription drugs, while studies on psychotropic drugs remain scarce. The aims of this study were to expand upon this scarce knowledge by investigating the relationship between web search query volumes and prescription volumes of antidepressants and antipsychotics in the United Kingdom and the Netherlands and to gain insight in topics of concern, such as withdrawal symptoms and discontinuation.

Anatomical evaluation of deep-learning synthetic computed tomography images generated from male pelvis cone-beam computed tomography.

Background And Purpose: To improve cone-beam computed tomography (CBCT), deep-learning (DL)-models are being explored to generate synthetic CTs (sCT). The sCT evaluation is mainly focused on image quality and CT number accuracy. However, correct representation of daily anatomy of the CBCT is also important for sCTs in adaptive radiotherapy.

[A severe, reversible encephalopathy after prolonged use of valproic acid].

Valproic acid is an effective mood stabilizer, registered for the treatment of bipolar disorder and epilepsy. Side effects of valproic acid are transient and generally well tolerated. A rare side effect is a valproic acid-induced encephalopathy.

[Underexposed, potential lethal gastrointestinal adverse events associated with clozapine use].

Clozapine is an effective antipsychotic with antidopaminergic, anticholinergic and antiserotonergic effects. Due to potential adverse events, agranulocytosis being the most feared, patients using clozapine need to be closely monitored. A lesser known but equally common and potential lethal adverse effect is clozapine-induced gastrointestinal hypomotility (CIGH), which can cause a paralytic ileus, gut mucosal ischemia or aspiration pneumonia.

Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results.

Background: The STAR-TReC trial is an international multi-center, randomized, phase II study assessing the feasibility of short-course radiotherapy or long-course chemoradiotherapy as an alternative to total mesorectal excision surgery. A new target volume is used for both (chemo)radiotherapy arms which includes only the mesorectum. The treatment planning QA revealed substantial variation in dose to organs at risk (OAR) between centers.

R117H-CFTR function and response to VX-770 correlate with mRNA and protein expression in intestinal organoids.

Introduction: Variability in disease severity and CFTR modulator responses exists between patients with identical CFTR genotypes. Here, we characterized transcription, translation and function of R117H-CFTR using intestinal organoids and correlated them with in vitro responses to ivacaftor (VX-770).

Methods: Organoids were generated from individuals possessing at least one R117H-CFTR allele.

Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer.

Purpose: The purpose of this study was to analyze the effect of 2D conventional brachytherapy (CBT) compared to 3D MRI-guided brachytherapy (IGBT) with and without the use of interstitial needles on local control, overall survival, and toxicity in patients treated for cervical cancer with radiation or chemoradiation.

Material And Methods: A retrospective analysis was performed of biopsy-proven FIGO IB-IVA cervical cancer patients, treated with primary radiation or chemoradiation, followed by brachytherapy (BT) between January 1997 and July 2016. Endpoints were local control, overall survival, and toxicity.

Cone-Beam CT-based position verification for oesophageal cancer: Evaluation of registration methods and anatomical changes during radiotherapy.

Purpose: To evaluate different registration methods, setup margins and number of corrections for CBCT-based position verification for oesophageal cancer and to evaluate anatomical changes during the course of radiotherapy treatment.

Methods: From 50 patients, 440 CBCT-scans were registered automatically using a soft tissue or bone registration algorithm and compared to the clinical match. Moreover, relevant anatomical changes were monitored.

Heart position variability during voluntary moderate deep inspiration breath-hold radiotherapy for breast cancer determined by repeat CBCT scans.

Voluntary moderate deep inspiration breath hold (vmDIBH) in left-sided breast cancer radiotherapy reduces cardiac dose. The aim of this study was to investigate heart position variability in vmDIBH using CBCT and to compare this variability with differences in heart position between vmDIBH and free breathing (FB). For 50 patients initial heart position with respect to the field edge (HP-FE) was measured on a vmDIBH planning CT scan.

A comprehensive evaluation of treatment accuracy, including end-to-end tests and clinical data, applied to intracranial stereotactic radiotherapy.

Background And Purpose: A methodology is presented to quantify the uncertainty associated with linear accelerator-based frameless intracranial stereotactic radiotherapy (SRT) combining end-to-end phantom tests and clinical data.

Methods And Materials: The following steps of the SRT chain were analysed: planning computed tomography (CT) and magnetic resonance (MR) scans registration, target volume delineation, CT and cone beam CT (CBCT) registration and intrafraction-patient displacement. The overall accuracy was established with an end-to-end test.

A quality assurance tool for helical tomotherapy using a step-wedge phantom and the on-board MVCT detector.

The purpose of this study was to develop and evaluate filmless quality assurance (QA) tools for helical tomotherapy by using the signals from the on-board megavoltage computed tomography (MVCT) detector and applying a dedicated step-wedge phantom. The step-wedge phantom is a 15 cm long step-like aluminum block positioned on the couch. The phantom was moved through the slit beam and MVCT detector signals were analyzed.

Dose to fingertips of staff preparing stranded iodine-125 seeds for permanent prostate implants.

The aim of this study is to measure radiation dose to the fingertips of occupationally exposed workers handling stranded iodine-125 seeds during prostate implants. The doses were measured by thermoluminescence dosimetry at the nail of the index finger of both hands in three hospitals in the Netherlands. In all hospitals, measurements were carried out during the preparation of stranded IBt seeds, type Intersource(®) 1251L.

Radiotherapy combined with hyperthermia for primary malignant melanomas of the esophagus.

Primary malignant melanoma of the esophagus (PMME) forms about 0.1% of all primary esophageal cancers. Treatment options are very limited for patients unfit for surgery.

Improving locoregional hyperthermia delivery using the 3-D controlled AMC-8 phased array hyperthermia system: a preclinical study.

Background: The aim of this study is preclinical evaluation of our newly developed regional hyperthermia system providing 3-D SAR control: the AMC-8 phased array consisting of two rings, each with four 70 MHz waveguides. It was designed to achieve higher tumour temperatures and improve the clinical effectiveness of locoregional hyperthermia.

Methods: The performance of the AMC-8 system was evaluated with simulations and measurements aiming at heating a centrally located target region in rectangular (30 x 30 x 110 cm) and elliptical (36 x 24 x 80 cm) homogeneous tissue equivalent phantoms.

Preoperative chemoradiation combined with regional hyperthermia for patients with resectable esophageal cancer.

Purpose: To analyse the treatment results of neo-adjuvant chemoradiation combined with regional hyperthermia in patients with resectable esophageal cancer.

Patients And Methods: Between August 2003 and December 2004, 28 patients entered a phase II study combining chemoradiation over a 4.5-week period with five sessions of regional hyperthermia.

Influence of daily setup measurements and corrections on the estimated delivered dose during IMRT treatment of prostate cancer patients.

Purpose: To evaluate the impact of marker-based position verification, using daily imaging and an off-line correction protocol, by calculating the delivered dose to prostate, rectum and bladder.

Methods: Prostate cancer patients (n=217) were treated with IMRT, receiving 35 daily fractions. Plans with five beams were optimized taking target coverage (CTV, boost) and organs-at-risk (rectum and bladder) into account.

Relation between body size and temperatures during locoregional hyperthermia of oesophageal cancer patients.

Purpose: To analyse the relation between patients' body size and temperatures during locoregional hyperthermia for oesophageal cancer.

Methods: Patients were treated with neo-adjuvant chemoradiotherapy plus hyperthermia, given with the AMC-4 waveguide system. Temperatures were measured at tumour location in the oesophageal lumen using multisensor thermocouple probes.

Artefacts in intracavitary temperature measurements during regional hyperthermia.

For adequate hyperthermia treatments, reliable temperature information during treatment is essential. During regional hyperthermia, temperature information is preferably obtained non-invasively from intracavitary or intraluminal measurements to avoid implant risks for the patient. However, for intracavitary or intraluminal thermometry optimal tissue contact is less natural as for invasive thermometry.

Theoretical comparison of intraluminal heating techniques.

Introduction: This study compared simulated temperature distributions of intraluminal heating devices, concerning penetration and homogeneity. A hot water balloon, a 434-MHz monopole and a 915-MHz dipole antenna, both with incorporated cooling, and a 27-MHz applicator were investigated.

Methods: The hot water balloon had an inlet temperature of 45 degrees C and a flow rate of 7.