Sparing dysphagia/aspiration related structures using novel hybrid volumetric modulated arc therapy

A Rare Case of Dual Metachronous Primary Malignancies, Chronic Myeloid Leukemia, and Tongue Carcinoma in a Patient With Long-Standing Systemic Lupus Erythematosus: A Case Report and Review of Literature

Patients with long-standing autoimmune diseases like systemic lupus erythematosus (SLE) are at a higher risk of developing hematological malignancies. However, chronic myeloid leukemia (CML) has rarely been reported in patients with SLE. Advancements in medical diagnostics and treatment have led to the life expectancy of SLE and CML patients moving closer to that of the general population, and it is not uncommon to encounter more than one malignancy in a cancer survivor. Although squamous cell carcinoma (SCC) of the skin has been reported in CML patients, mucosal SCC of the head and neck has rarely only been reported in CML survivors. The objective of this case report is to share our experience in treating a patient with dual metachronous primary malignancies, CML, and tongue carcinoma, along with long-standing SLE, managed by a multidisciplinary team.

The use of Hybrid Techniques in Whole-Breast Radiotherapy: A Systematic Review

Objectives The development of new techniques in radiotherapy (RT) provides a better planned target volume (PTV) dose distribution while further improving the protection of organs at risk (OARs). The study aims to present the dosimetric results of studies using hybrid techniques in whole-breast radiotherapy (WBRT). Methods: This systematic literature review was conducted by scanning the relevant literature in PubMed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Among the parameters are dose values for PTV and OARs beam contribute ratios, the value of monitors, and treatment times for different RT techniques. Initially, 586 articles were identified; 196 duplicate articles were removed leaving 391 articles for screening. Three-hundred and thirty-seven irrelevant articles were excluded, leaving 54 studies assessed for eligibility. A total of 22 articles met the search criteria to evaluate dosimetric results of hybrid and other RT techniques in WBRT. Results: According to the dosimetric data of the studies, hybrid intensity-modulated RT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) techniques give dosimetrically advantageous results in WBRT compared to other RT techniques. Conclusion: Hybrid techniques using appropriate beams contribute value and show great promise in improving dosimetric results in WBRT. However, there is a need for new studies showing the long-term clinical results of hybrid RT.

Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs

PURPOSE

To find an optimal arc design for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left-sided whole breast radiation therapy.

METHODS AND MATERIALS

A total of 26 left-sided early-stage breast cancer patients were selected for this study. To find the superior plan, H-VMAT with three different arc designs including, two partial arcs (2A), four partial arcs (4A) and four tangential arcs (TA) were created for each study case by combining 3DCRT and VMAT with 75% 3DCRT/25% VMAT dose proportion of prescription dose.

RESULTS

All H-VMAT plans achieved the expected target coverage. A higher conformity index and homogeneity index were achieved for 2A and 4A H-VMAT plans and significantly differ from TA H-VMAT (p < 0.003). The heart and ipsilateral lung dose parameters were comparable among all plans except heart V_40Gy which was significantly less in 4A H-VMAT plan (p < 0.05). The contralateral lung, contralateral breast, spinal cord, normal tissue doses and MU were significantly less in TA H-VMAT (p < 0.03). The beam-on time was significantly less in 2A H-VMAT (p < 0.0001).

CONCLUSION

2A and 4A H-VMAT techniques are effective in improving the PTV dosimetric parameters as well as reducing the OAR doses. Further, 2A H-VMAT delivers less MU and beam-on time compared to 4A H-VMAT.