Aims: In patients undergoing locoregional radiotherapy (RT) for breast cancer including the internal mammary chain (IMC), VMAT has been shown to be superior to tangential-field radiotherapy in terms of target coverage and minimising dose to heart and lungs. In this study we describe and validate organ motion-based robust optimisation for generating breast and locoregional lymph node VMAT plans that are robust to inter-fractional changes.
Materials And Methods: In this retrospective study of five patients with left-sided breast cancer requiring locoregional breast radiotherapy including the IMC, non-robust plans were generated in the nominal scenario (planning-CT) and corresponding robust plans were created by optimising over a range of simulated CTs representing worst-case scenario shape changes to the breast. Both plans were re-calculated on CBCT images (n = 67) acquired prior to RT to generate estimates of delivered fractional dose. Plan robustness to inter-fractional changes was assessed in terms of the estimated target coverage and OAR dose.
Results: Organ motion-based robust optimisation was able to generate clinically acceptable treatment plans in the nominal scenario on the planning CT with no significant differences to OAR dose between the robust and non-robust planning techniques. All plans (robust and non-robust) achieved the mandatory target coverage requirements. Estimates of delivered dose demonstrated a significant improvement in breast target coverage for the robust plans compared to non-robust plans. For the breast CTV, 92% of the robust plans achieved the optimal D98% > 95% clinical goal as compared to 71% of the non-robust plans (p < 0.01). 94% of robust plans achieved acceptable superficial breast coverage, as compared to 55% for the non-robust technique.
Conclusions: Organ motion-based robust optimisation VMAT is able to produce clinically acceptable organ-at-risk sparing plans for locoregional breast radiotherapy (including the IMC) that are robust to inter-fractional changes, therefore reducing the likelihood of reactive adaptive re-planning.
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http://dx.doi.org/10.1016/j.ctro.2019.04.004 | DOI Listing |
JAMA Netw Open
December 2024
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Importance: Commercial prices for hospital care are high and vary widely in the US. Employers and state policymakers are exploring reference-based pricing (RBP) to set their payment rates as multiples of Medicare prices; understanding the range of commercial price variation within a hospital is important for calculating the appropriate price targets that are effectively low to generate savings but also feasible and viable to local hospital markets.
Objective: To examine within-hospital maximum-to-minimum commercial hospital price gaps negotiated by 5 national insurers and estimate plan savings if the minimum prices within each hospital are used as new payment level.
Metabolic reprogramming is a hallmark of cancer, enabling tumor cells to adapt to and exploit their microenvironment for sustained growth. The liver is a common site of metastasis, but the interactions between tumor cells and hepatocytes remain poorly understood. In the context of liver metastasis, these interactions play a crucial role in promoting tumor survival and progression.
View Article and Find Full Text PDFHealth Care Transit
November 2024
Children's Health of Orange County, Orange, CA, USA.
Purpose: Many youth with medical conditions also have co-occurring mental health concerns. Limited attention has been given to the mental health transition needs of these youth. We explore bringing transition readiness assessment into the mental health care of youth with co-occurring disorders.
View Article and Find Full Text PDFThe urban environment impacts residents' health and well-being in many ways. Environmental benefits and risks may be interactively and inequitably distributed across different populations in cities, and these patterns may change over time. Here, we assess the spatial distribution of environmental risks and benefits in pairs, considering synergies and trade-offs, in an illustrative metropolitan area (Metro Vancouver) in Canada in the years 2006 and 2016.
View Article and Find Full Text PDFFront Public Health
December 2024
Capital Normal University, Beijing, China.
Introduction: This study investigates gender-based disparities in self-rated health among older individuals in the Chinese workforce, utilizing data from the China Health and Retirement Longitudinal Study (CHARLS). Understanding these health gaps is crucial for crafting effective health policies and interventions in light of the rapidly aging population.
Materials And Methods: Data from the 2020 CHARLS survey, comprising Chinese individuals aged 45 and above, were analyzed, focusing on older adults actively employed.
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