Medically inoperable endometrial cancer in patients with a high body mass index (BMI): Patterns of failure after 3-D image-based high dose rate (HDR) brachytherapy.

Background And Purpose: High BMI is a reason for medical inoperability in patients with endometrial cancer in the United States. Definitive radiation is an alternative therapy for these patients; however, data on patterns of failure after definitive radiotherapy are lacking. We describe the patterns of failure after definitive treatment with 3-D image-based high dose rate (HDR) brachytherapy for medically inoperable endometrial cancer.

Accelerated Partial Breast Irradiation: A Safe, Effective, and Convenient Early Breast Cancer Treatment Option.

Accelerated partial breast irradiation (APBI) is an excellent treatment option for many women with early stage breast cancer. Patient selection criteria include age over 40, status post lumpectomy, breast cancer (invasive or in situ disease) measuring <3 cm, negative margins (at least 2 mm), negative lymph nodes, and no lymphovascular space invasion. APBI is effective, well tolerated, and convenient.

Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer.

Purpose: The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize recent advances and to generate general guidelines for the management of medically inoperable endometrial cancer patients with radiation therapy.

Methods: Recent advances in the literature were summarized and reviewed by a panel of experts. Panel members participated in a series of conference calls and were surveyed to determine their current practices and patterns.

Outpatient-based high-dose-rate interstitial brachytherapy for gynecologic malignancies.

Purpose: To evaluate outpatient-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) in the treatment of gynecologic malignancies.

Methods And Materials: Between December 2006 and July 2012, 50 patients were treated with twice-daily outpatient-based HDR iridium-192 ISBT at our institution. Thirty-two patients had vaginal cancers, 13 vulvar, 3 urethral, and 2 cervical cancers.

Essentials and guidelines for clinical medical physics residency training programs: executive summary of AAPM Report Number 249.

There is a clear need for established standards for medical physics residency training. The complexity of techniques in imaging, nuclear medicine, and radiation oncology continues to increase with each passing year. It is therefore imperative that training requirements and competencies are routinely reviewed and updated to reflect the changing environment in hospitals and clinics across the country.

Outcomes of iodine-125 plaque brachytherapy for uveal melanoma with intraoperative ultrasonography and supplemental transpupillary thermotherapy.

Purpose: To assess the impact on local tumor control of intraoperative ultrasonographic plaque visualization and selective application of transpupillary thermotherapy (TTT) in the treatment of posterior uveal melanoma with iodine-125 (I-125) episcleral plaque brachytherapy (EPB).

Methods And Materials: Retrospective analysis of 526 patients treated with I-125 EPB for posterior uveal melanoma. Clinical features, dosimetric parameters, TTT treatments, and local tumor control outcomes were recorded.

Comparison of apparent diffusion coefficient maps to T2-weighted images for target delineation in cervix cancer brachytherapy.

Purpose: T2-weighted (T2W) magnetic resonance imaging (MRI) has been used for target delineation in cervix cancer brachytherapy. The objective of this study was to examine the feasibility of using diffusion-weighted magnetic resonance imaging (DWI) for target delineation as compared against T2W imaging.

Material And Methods: Fifteen cervix cancer patients, implanted with tandem and ovoid applicators, underwent T2W turbo-spin echo imaging and DWI with a maximum diffusion factor of 800 sec/mm(2) on a 1.

Improve definition of titanium tandems in MR-guided high dose rate brachytherapy for cervical cancer using proton density weighted MRI.

Background: For cervical cancer patients treated with MR-guided high dose rate brachytherapy, the accuracy of radiation delivery depends on accurate localization of both tumors and the applicator, e.g. tandem and ovoid.

RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal.

Purpose: A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811.

Methods And Materials: T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.

Tumor volume and subvolume concordance between FDG-PET/CT and diffusion-weighted MRI for squamous cell carcinoma of the cervix.

Purpose: To compare [(18)F]fluorodeoxyglucose (FDG)/positron emission tomography (PET)/computed tomography (CT) and magnetic resonance imaging (MRI) for evaluating patients with cervical cancer. We compared tumor characteristics on FDG-PET and apparent diffusion coefficient (ADC) maps on diffusion-weighted MRI (DWI) to evaluate concordance of two functional imaging techniques.

Materials And Methods: Twenty women with cervical cancer underwent pretreatment FDG-PET/CT and pelvic MRI.

Use of serial CT imaging for the quality assurance of MammoSite therapy.

Purpose: As experience with the MammoSite device for accelerated partial breast irradiation (APBI) has increased, more centers are starting to use three-dimensional (3D) treatment planning to generate plans with multiple nonequally weighted dwell positions. This report presents the use of serial computed tomography (CT) imaging, in addition to planar or ultrasound imaging, for the quality assurance of an APBI treatment using the elliptical MammoSite.

Methods And Materials: CT images of a patient implanted with a 4cmx6cm elliptical MammoSite balloon were acquired.

Quality assurance for clinical implementation of an electromagnetic tracking system.

The Calypso Medical 4D localization system utilizes alternating current electromagnetics for accurate, real-time tumor tracking. A quality assurance program to clinically implement this system is described here. Testing of the continuous electromagnetic tracking system (Calypso Medical Technologies, Seattle, WA) was performed using an in-house developed four-dimensional stage and a quality assurance fixture containing three radiofrequency transponders at independently measured locations.

Estimation of setup uncertainty using planar and MVCT imaging for gynecologic malignancies.

Purpose: This prospective study investigates gynecologic malignancy online treatment setup error corrections using planar kilovoltage/megavoltage (KV/MV) imaging and helical MV computed tomography (MVCT) imaging.

Methods And Materials: Twenty patients were divided into two groups. The first group (10 patients) was imaged and treated using a conventional linear accelerator (LINAC) with image-guidance capabilities, whereas the second group (10 patients) was treated using tomotherapy with MVCT capabilities.

Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes.

Purpose: To describe a more aggressive treatment technique allowing dose escalation to positive para-aortic lymph nodes (PALN) in patients with cervical cancer, by means of positron emission tomography (PET)/computed tomography (CT)-guided intensity-modulated radiation therapy (IMRT). Here, we describe methods for simulation and planning of these treatments and provide objectives for target coverage as well as normal tissue sparing to guide treatment plan evaluation.

Methods And Materials: Patients underwent simulation on a PET/CT scanner.

Fiducial-based translational localization accuracy of electromagnetic tracking system and on-board kilovoltage imaging system.

Purpose: The Calypso medical four-dimensional localization system uses AC electromagnetics, which do not require ionizing radiation, for accurate, real-time tumor tracking. This investigation compared the static and dynamic tracking accuracy of this system to that of an on-board imaging kilovoltage X-ray system for concurrent use of the two systems.

Methods And Materials: The localization accuracies of a kilovoltage imaging system and a continuous electromagnetic tracking system were compared.

Treatment planning guidelines regarding the use of CT/PET-guided IMRT for cervical carcinoma with positive paraaortic lymph nodes.

Purpose: Computed tomography (CT)/positron emission tomography (PET)-guided intensity-modulated radiotherapy of the paraaortic lymph nodes (PALNs) has been proposed for patients with cervical carcinoma and paraaortic metastasis. This investigation attempted to determine the guidelines regarding the selection of appropriate treatment parameters (e.g.

Surface and buildup dose characteristics for 6, 10, and 18 MV photons from an Elekta Precise linear accelerator.

Understanding head scatter characteristics of photon beams is vital to properly commission treatment planning (TP) algorithms. Simultaneously, having definitive surface and buildup region dosimetry is important to optimize bolus. The Elekta Precise linacs have unique beam flattening filter configurations for each photon beam (6, 10, and 18 MV) in terms of material and location.

PET-guided IMRT for cervical carcinoma with positive para-aortic lymph nodes-a dose-escalation treatment planning study.

Purpose: To evaluate a treatment planning method for dose escalation to the para-aortic lymph nodes (PALNs) based on positron emission tomography (PET) with intensity-modulated radiotherapy (IMRT) for cervical cancer patients with PALN involvement. One goal of this process was not to modify the traditional treatment of the pelvic region.

Methods And Materials: PET images for 4 cervical cancer patents with PALN involvement were registered with their corresponding CT scans.

Dosimetry of therapeutic photon beams using an extended dose range film.

For intensity modulated radiation therapy (IMRT) dose distribution verification, multidimensional measurements are required to quantify the steep dose-gradient regions. High resolution, two-dimensional dose distributions can be measured using radiographic film. However, the photon energy response of film is known to be a function of depth, field size, and photon beam energy, potentially reducing the accuracy of dose distribution measurements.

Peripheral dose distributions for a linear accelerator equipped with a secondary multileaf collimator and universal wedge.

The American Association of Physicists in Medicine Task Group 36 (AAPM TG-36) data can be used to estimate peripheral dose (PD) distributions outside the primary radiation field. However, the report data does not apply to linear accelerators equipped with a multileaf collimator (MLC) and universal wedge (UW). Tertiary multileaf collimators have been shown to significantly affect PD distributions and TG-36 reported data.