MA05.10 The Pathologic Response of Locally Advanced NSCLC Treated with Concomitant Chemoradiation to 60 Gy in Image Guided Radiation Therapy (IGRT)
Sarit AppelJair BarDamien UrbanAmir OnnMarina PerelmanYaacov Richard LawrenceA Ben-NunOry HaisraelyZvi SymonT. Rabin El EzraEdith M. MaromSender LibermanEfrat Ofek
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Concomitant
Image-guided radiation therapy
Cone beam CT (CBCT) is one of the main imaging devices adopted in image guided radiotherapy (IGRT). However, as a respective advanced radiotherapy technology, it limits the contribution of IGRT when the IGRT is performed in default IGRT workflow, since the imaging characteristics, registration methods, evaluation criterion, and even crucial organs at risks (OARs) are different as the tumor site changes. In this paper, we propose a novel specialized IGRT workflow based on the subtypes of diagnosis site. Three site-specific IGRT workflow, for head and neck site, chest site and abdomen site are stated separately, organized with preparation of reference images and structures, parameters setting of image acquisition and reconstruction, image registration, registration results assessment, positioning correction, changing frequency of IGRT practice, as well as review and analysis of IGRT data. The responsibilities of radiotherapy team (oncologists, medical physicists and radiotherapy therapists) in site-specific IGRT workflow are also demonstrated.
Image-guided radiation therapy
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Our image‐guided radiation therapy (IGRT) protocol for post‐prostatectomy patients involves acquiring a kV cone beam computed tomography (CBCT) dataset at each fraction and shifting the treatment couch to align the surgical clips. This IGRT strategy requires significant resources, and delivers non‐negligible dose to normal tissues. The objective of this work is to evaluate this IGRT protocol against two alternative strategies in terms of the dose‐volume statistics for target and organ at risk regions. Our method involves deforming the planning CT to the CBCT dataset acquired at each fraction, computing dose on the deformed dataset, and inversely transforming the dose back onto the original planning CT dataset. The treatments of six patients were evaluated assuming three IGRT scenarios: no IGRT, daily IGRT using the clinically employed couch shifts, and alternating day IGRT. The doses delivered to the clinical target volumes are within approximately 3.2, 1.3, and 2.1% of the plan for the non‐IGRT, daily, and alternating day IGRT protocols, respectively. Doses to relevant portions of the organs at risk deviate from the plan by up to 10.5, 13.1 and 10.7% for non‐IGRT, daily IGRT, and alternating day IGRT protocols, respectively. Some cases do not differ significantly between IGRT and non‐IGRT protocols in terms of cumulative DVHs, highlighting the difficult task of correcting prostate bed deformations via the treatment couch translations. In general, the alternating day IGRT protocol was found to result in a clinically insignificant deviation in delivered dose while providing a significant reduction in resource use and patient imaging dose.
Image-guided radiation therapy
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Nephrology
Uremic Toxins
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Image-guided radiation therapy
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ve To provide hand surgery with the regularity of concomitant relationship between the arteries and veins of the hand. Method Concomitant relationship between the arteries and veins of the hand were observed in 10 sides decicolor cast specimens and stuffing specimens perfused with hyperchlororinylacetic ether or emulsoid respectively. Results Compactly concomitant relationship was observed in the superficialand the deep arcus vasculosi, the palmal metacarpal vessels and the common palmal digital vessels. In the palm and the opisthenar, the superficial vessels were not concomitant or not compactly concomitant, so were the vessels of the maniphalanx. Conclusions The distribution regularity between the arteries and veins of the hand are showed as follows: Like a network, vessels are not concomitant in the superficial laminae of the hand. However, deeper to the partes profunda of the hand, more compactly concomitant relationship between the arteries and veins. The vessels of the maniphalanx are not concomitant or not compactly concomitant
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Concomitant
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Image-guided radiation therapy
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For a period of six years, concomitant disorders were registered at annual routine examinations of 226 residents of a central institution for mentally retarded. Only in six patients were no concomitant disorders found. 19.5% displayed concomitant disorders from one type of disease, 30.5% displayed two or more concomitant disorders from two types of disease, and as many as 47.3% displayed concomitant disorders from three or more types of disease. The residents examined showed particularly high occurrences of various deformities, mental disorders, and diseases of the nervous system, sense organs and musculo-skeletal system. The most frequent singular disorders were epilepsy, cerebral palsy and deformities of the back and foot.
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Mentally retarded
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To describe the clinical characteristics in classical trigeminal neuralgia (TN) with concomitant persistent pain and to investigate whether TN with concomitant persistent pain represents a distinct phenotype.There has been much debate about the possible pathophysiological and clinical importance of concomitant persistent pain in TN. This has led to subgrouping of TN into forms with and without concomitant persistent pain in the recent 3rd International Classification of Headache Disorders beta classification.In this cross-sectional study, data on the clinical characteristics were systematically and prospectively collected from consecutive TN patients.A total of 158 consecutive TN patients were included. Concomitant persistent pain was present in 78 patients (49%). The average intensity of concomitant persistent pain was 4.6 (verbal numerical rating scale). The concomitant persistent pain was present at onset or early in the disease course. Patients with concomitant persistent pain were on average 6.2 (P = .008) years younger at onset, but the 2 groups had the same duration of disease (P = .174). There was a preponderance of women in TN with (P < .001) but not in TN without concomitant persistent pain (P = .820). Right-sided pain was more prevalent than left-sided in TN without (P = .007) but not in TN with concomitant persistent pain (P = .907). TN with concomitant persistent pain more frequently had sensory abnormalities (P < .001) and less frequently responded to sodium channel blockers (P = .001). There were no significant differences in other clinical characteristics.Concomitant persistent pain is very prevalent in TN and is not a consequence of paroxysmal pain. Findings support that the 3rd International Classification of Headache Disorders beta division of TN with and without concomitant persistent pain is clinically and scientifically important.
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