Electrochemotherapy in dogs and cats-A review.

Electrochemotherapy (ECT) is a treatment modality that combines the electroporation of cell membranes with chemotherapy to facilitate the transport of non-permeant molecules into cells. Several canine and feline studies have shown promising results, suggesting that ECT can be a valid adjuvant or alternative treatment option for some tumours. The objective of this paper is to provide a bibliographic review of the principles and applications of ECT in veterinary medicine and to compare to its use in human medicine.

Evaluation of treatment planning system accuracy in estimating the stopping-power ratio of immobilization devices for proton therapy.

Purpose: To assess treatment planning system (TPS) accuracy in estimating the stopping-power ratio (SPR) of immobilization devices commonly used in proton therapy and to evaluate the dosimetric effect of SPR estimation error for a set of clinical treatment plans.

Methods: Computed tomography scans of selected clinical immobilization devices were acquired. Then, the water-equivalent thickness (WET) and SPR values of these devices based on the scans were estimated in a commercial TPS.

Is a weekly qualitative picket fence test sufficient? A proposed alternate EPID-based weekly MLC QA program.

Purpose: Well-designed routine multileaf collimator (MLC) quality assurance (QA) is important to assure external-beam radiation treatment delivery accuracy. This study evaluates the clinical necessity of a comprehensive weekly (C-Weekly) MLC QA program compared to the American Association of Physics in Medicinerecommended weekly picket fence test (PF-Weekly), based on our seven-year experience with weekly MLC QA.

Methods: The C-Weekly MLC QA program used in this study includes 5 tests to analyze: (1) absolute MLC leaf position; (2) interdigitation MLC leaf position; (3) picket fence MLC leaf positions at static gantry angle; (4) minimum leaf-gap setting; and (5) volumetric-modulated arc therapy delivery.

Isotretinoin treatment of 12 dogs with epitheliotropic lymphoma.

Background: Epitheliotropic lymphoma is an uncommon cutaneous malignancy of T lymphocytes. Limited information is available regarding the treatment and outcome of dogs with this disease.

Objectives: To evaluate the treatment outcome and toxicity profile of isotretinoin in dogs with epitheliotropic lymphoma.

Electrochemotherapy as a treatment option for feline nasal melanoma.

Case Summary: A 4-year-old domestic shorthair cat presented to North Downs Specialist Referrals for treatment of a 7 mm melanoma of the nasal planum. Two treatments of electrochemotherapy using intravenous bleomycin as a chemotherapeutic agent were administered. The tumour was no longer visible after treatment.

Toxicity of zoledronic acid after intravenous administration: A retrospective study of 95 dogs.

Background: There is a paucity of veterinary literature on the safety or outcome of zoledronic acid (ZA) use in dogs for either bone pain or hypercalcemia.

Hypothesis/objectives: The primary aim was to report the adverse events in dogs receiving intravenous administration of ZA.

Animals: Ninety-five dogs with ZA use.

Comparison of the dosimetric accuracy of proton breast treatment plans delivered with SGRT and CBCT setups.

Purpose: To compare the dosimetric accuracy of surface-guided radiation therapy (SGRT) and cone-beam computed tomography (CBCT) setups in proton breast treatment plans.

Methods: Data from 30 patients were retrospectively analyzed in this IRB-approved study. Patients were prescribed 4256-5040 cGy in 16-28 fractions.

Technical Note: A fast inverse direct aperture optimization algorithm for volumetric-modulated arc therapy.

Purpose: In a recent article, our group proposed a fast direct aperture optimization (DAO) algorithm for fixed-gantry intensity-modulated radiation therapy (IMRT) called fast inverse direct aperture optimization (FIDAO). When tested on fixed-gantry IMRT plans, we observed up to a 200-fold increase in the optimization speed. Compared to IMRT, rotational volumetric-modulated arc therapy (VMAT) is a much larger optimization problem and has many more delivery constraints.

Clozapine toxicity: a cautionary palliative care tale.

Objective: This case report presents an unusual case of clozapine toxicity secondary to reduced smoking habit mimicking a patient approaching end of life.

Methods: It is a cautionary tale for palliative care specialists, perhaps unaware of the effect of cigarette smoke on metabolism of this antipsychotic, to be aware of.

Results: Following specialist advice and change of antipsychotic medication, this patient's condition improved to the point that he was discharged from the hospice.

A fast inverse direct aperture optimization algorithm for intensity-modulated radiation therapy.

Purpose: The goal of this work was to develop and evaluate a fast inverse direct aperture optimization (FIDAO) algorithm for IMRT treatment planning and plan adaptation.

Methods: A previously proposed fluence map optimization algorithm called fast inverse dose optimization (FIDO) was extended to optimize the aperture shapes and weights of IMRT beams. FIDO is a very fast fluence map optimization algorithm for IMRT that finds the global minimum using direct matrix inversion without unphysical negative beam weights.

Tracey judgement and hospice DNACPR orders: steady as she goes or seismic change?

Objectives: The 2014 Court of Appeals decision with respect to Tracey vs Cambridge University Hospital ('the Tracey judgement') changed the requirements for discussing Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions with patients. This study is a retrospective case note review aiming to identify any changes in practice around discussing DNACPR decisions in hospices following the judgement.

Methods: 150 case notes from 2013 (before the Tracey judgement) were compared with 150 case notes from 2015 (following the Tracey judgement).

Patient-specific calibration of cone-beam computed tomography data sets for radiotherapy dose calculations and treatment plan assessment.

Purpose: In this work, we propose a new method of calibrating cone beam computed tomography (CBCT) data sets for radiotherapy dose calculation and plan assessment. The motivation for this patient-specific calibration (PSC) method is to develop an efficient, robust, and accurate CBCT calibration process that is less susceptible to deformable image registration (DIR) errors.

Methods: Instead of mapping the CT numbers voxel-by-voxel with traditional DIR calibration methods, the PSC methods generates correlation plots between deformably registered planning CT and CBCT voxel values, for each image slice.

Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men.

To compare the efficacy of digital rectal examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandom-E or Tandem-R assays) and digital rectal examination. Quadrant biopsies were performed if the PSA level was greater than 4 μg./l.

Does place of death vary by deprivation for patients known to specialist palliative care services?

Objectives: Referral to, and usage of, specialist palliative care (SPC) services are not equitable and social deprivation may be a contributory factor in this. Deprivation may also affect the place of death of patients with cancer. No study, however, has investigated whether inequalities persist following referral to SPC services.

Evaluation of unified intensity-modulated arc therapy for the radiotherapy of head-and-neck cancer.

Purpose: Recently our group developed a unified intensity-modulated arc therapy (UIMAT) technique which allows for the simultaneous inverse-optimization and the combined delivery of volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). The aim of this study was to evaluate the dosimetric benefits of UIMAT plans for radiation treatment of complex head-and-neck cancer cases.

Methods And Materials: A retrospective treatment planning study was performed on 30 head-and-neck cases, 15 of which were treated clinically with VMAT while the other 15 were treated with step-and-shoot IMRT.

Feasibility of a unified approach to intensity-modulated radiation therapy and volume-modulated arc therapy optimization and delivery.

Purpose: To study the feasibility of unified intensity-modulated arc therapy (UIMAT) which combines intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) optimization and delivery to produce superior radiation treatment plans, both in terms of dose distribution and efficiency of beam delivery when compared with either VMAT or IMRT alone.

Methods: An inverse planning algorithm for UIMAT was prototyped within the pinnacle treatment planning system (Philips Healthcare). The IMRT and VMAT deliveries are unified within the same arc, with IMRT being delivered at specific gantry angles within the arc.

Dosimetric planning study of respiratory-gated volumetric modulated arc therapy for early-stage lung cancer with stereotactic body radiation therapy.

Purpose: To evaluate the dosimetric potential of respiratory-gated volumetric modulated arc therapy (VMAT) to reduce the dose to normal lung when treating early-stage non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT).

Methods And Materials: Twenty patients with inoperable stage I/II NSCLC with motion greater than 5 mm were retrospectively planned with 4-dimensional computed tomography-based gated and nongated VMAT. Each plan was optimized using two 225° arcs with 10-MV flattening filter-free beams with maximum dose rate of 2400 MU/min.

Sustainable competitive advantage for accountable care organizations.

In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors.

Selection of optimal prostate specific antigen cutoffs for early detection of prostate cancer: receiver operating characteristic curves.

A prospective clinical trial of prostate cancer screening was conducted at 6 university centers including 6,630 men 50 years old or older who underwent a serum prostate specific antigen (PSA) determination and digital rectal examination. Biopsies were performed if the PSA level was greater than 4.0 ng.

Accuracy of digital rectal examination and transrectal ultrasonography in localizing prostate cancer.

Not all prostate cancers are sonographically hypoechoic or palpable on digital rectal examination, and suspicious areas on transrectal prostatic ultrasonography or digital rectal examination often are not cancer. We present quadrant biopsy results from a multicenter prostate cancer screening study in which men were evaluated with prostate specific antigen (PSA) and digital rectal examination. If the PSA level was elevated (greater than 4.

Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men.

To compare the efficacy of digital rectal examination and serum prostate specific antigen (PSA) in the early detection of prostate cancer, we conducted a prospective clinical trial at 6 university centers of 6,630 male volunteers 50 years old or older who underwent PSA determination (Hybritech Tandem-E or Tandem-R assays) and digital rectal examination. Quadrant biopsies were performed if the PSA level was greater than 4 micrograms/l or digital rectal examination was suspicious, even if transrectal ultrasonography revealed no areas suspicious for cancer. The results showed that 15% of the men had a PSA level of greater than 4 micrograms/l, 15% had a suspicious digital rectal examination and 26% had suspicious findings on either or both tests.