Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases

<p>Abstract</p> <p>Background</p> <p>Recent developments enable to deliver rotational IMRT with standard C-arm gantry based linear accelerators. This upcoming treatment technique was benchmarked in a multi-center treatment planning study against static gantry IMRT and rotational IMRT based on a ring gantry for a complex parotid gland sparing head-and-neck technique.</p> <p>Methods</p> <p>Treatment plans were created for 10 patients with head-and-neck tumours (oropharynx, hypopharynx, larynx) using the following treatment planning systems (TPS) for rotational IMRT: Monaco (ELEKTA VMAT solution), Eclipse (Varian RapidArc solution) and HiArt for the helical tomotherapy (Tomotherapy). Planning of static gantry IMRT was performed with KonRad, Pinnacle and Panther DAO based on step&shoot IMRT delivery and Eclipse for sliding window IMRT. The prescribed doses for the high dose PTVs were 65.1Gy or 60.9Gy and for the low dose PTVs 55.8Gy or 52.5Gy dependend on resection status. Plan evaluation was based on target coverage, conformity and homogeneity, DVHs of OARs and the volume of normal tissue receiving more than 5Gy (V_5Gy). Additionally, the cumulative monitor units (MUs) and treatment times of the different technologies were compared. All evaluation parameters were averaged over all 10 patients for each technique and planning modality.</p> <p>Results</p> <p>Depending on IMRT technique and TPS, the mean CI values of all patients ranged from 1.17 to 2.82; and mean HI values varied from 0.05 to 0.10. The mean values of the median doses of the spared parotid were 26.5Gy for RapidArc and 23Gy for VMAT, 14.1Gy for Tomo. For fixed gantry techniques 21Gy was achieved for step&shoot+KonRad, 17.0Gy for step&shoot+Panther DAO, 23.3Gy for step&shoot+Pinnacle and 18.6Gy for sliding window.</p> <p>V_5Gyvalues were lowest for the sliding window IMRT technique (3499 ccm) and largest for RapidArc (5480 ccm). The lowest mean MU value of 408 was achieved by Panther DAO, compared to 1140 for sliding window IMRT.</p> <p>Conclusions</p> <p>All IMRT delivery technologies with their associated TPS provide plans with satisfying target coverage while at the same time respecting the defined OAR criteria. Sliding window IMRT, RapidArc and Tomo techniques resulted in better target dose homogeneity compared to VMAT and step&shoot IMRT. Rotational IMRT based on C-arm linacs and Tomotherapy seem to be advantageous with respect to OAR sparing and treatment delivery efficiency, at the cost of higher dose delivered to normal tissues. The overall treatment plan quality using Tomo seems to be better than the other TPS technology combinations.</p

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel

Inborn errors of immunity: Manifestation, treatment, and outcome—an ESID registry 1994–2024 report on 30,628 patients

The European Society for Immunodeficiencies patient registry (ESID-R), established in 1994, is one of the world’s largest databases on inborn errors of immunity (IEI). IEI are genetic disorders predisposing patients to infections, autoimmunity, inflammation, allergies, and malignancies. Treatments include antimicrobial therapy, immunoglobulin replacement, immune modulation, stem cell transplantation, and gene therapy. Data from 194 centers in 33 countries capture clinical manifestations and treatments from birth onward, with annually expected updates. This report reviews the ESID-R’s structure, data content, and impact. The registry includes 30,628 patient datasets (aged 0–97.9 years; median follow-up: 7.2 years; total 825,568.2 patient-years), with 13,550 cases in 15 sub-studies. It has produced 84 peer-reviewed publications (mean citation rate: 95). Findings include real-world observations of IEI diagnoses, genetic causes, clinical manifestations, treatments, and survival trends. The ESID-R fosters global collaboration, advancing IEI research and patient care. This report highlights the key role of the multinational ESID-R, led by an independent medical society, in evidence-based discovery

Toward the limit of nuclear binding on the N=Z line : Spectroscopy of Cd 96

A γ-decaying isomeric state (τ1/2=197-17+19 ns) has been identified in Cd96, which is one α particle away from the last known bound N=Z nucleus, Sn100. Comparison of the results with shell-model calculations has allowed a tentative experimental level scheme to be deduced and the isomer to be interpreted as a medium-spin negative-parity spin trap based on the coupling of isoscalar (T=0) and isovector (T=1) neutron-proton pairs. The data also suggest evidence for the population of a 9+ T=1 state, which is predicted by shell-model calculations to be yrast. Such a low-lying T=1 state, which is unknown in lighter mass even-even self-conjugate nuclei, can also be interpreted in terms of the coupling of T=0 and T=1 neutron-proton pairs

Influence of stimulating an blocking CD28-specific monoclonal antibodies on differentiation and homeostasis of T cells in mouse

Die Kostimulation über den CD28 Oberflächenrezeptor spielt eine entscheidende Rolle sowohl in der Proliferation von T-Zellen, in deren Differenzierung zu Effektorzellen, als auch in der Entwicklung und Kontrolle von regulatorischen T-Zellen. Diese Schlüsselrolle macht CD28 zu einer interessanten Zielstruktur, um den Einfluss monoklonaler Antikörper auf die Entwicklung und Homöostase von T-Zellen zu analysieren. Die hier verwendeten Antikörper lassen sich funktionell in zwei verschiedene Kategorien einteilen: zum Einen in konventionelle Antikörper (E18 mAk), welche die physiologische Rezeptor-Liganden Interaktion blockieren, und zum Anderen in superagonistische Antikörper (D665 mAk), die in der Lage sind ruhende T-Zellen ohne eine Ligation des T-Zell Rezeptors voll zu aktivieren. In der vorliegenden Arbeit konnte in verschiedenen in-vitro und in-vivo Experimenten gezeigt werden, dass eine Behandlung mit dem CD28 Superagonisten keinen Einfluss auf die Differenzierung von T-Zellen im Thymus nimmt, und die Zusammensetzung der einzelnen Zellpopulationen in diesem Organ unbeeinflusst bleibt. Bei Verwendung blockierender anti-Maus CD28 mAk zeigte sich in sämtlichen Untersuchungen eine beeinträchtigte Entwicklung von regulatorischen T-Zellen innerhalb des Thymus, während die anderen Zellpopulationen unbeeinflusst blieben. Auch in Analysen peripherer Lymphknoten lag der Anteil regulatorischer T-Zellen nach Behandlung mit E18 mAk unter den Kontrollwerten. Durch eine chronische Blockade von CD28 mittels E18 mAk ließ sich die Gesamtanzahl an Tregs in peripheren Lymphknoten, Milz und Thymus drastisch senken, ohne dass es zu einem vollständigen Verschwinden dieser Zellpopulation kam. Auch die absolute Zahl an CD4 positiven T-Zellen innerhalb der peripheren Lymphknoten, Milz und Thymus der behandelten Tiere lag deutlich unter der Kontrolle. Diese Beobachtungen waren 13 Wochen nach Beendigung der Antikörper-Applikationen vollständig reversibel und zu keinem Zeitpunkt des Experimentes ergaben sich klinische oder serologische Hinweise auf die Entwicklung von Autoimmunität trotz niedriger Treg- Zahlen über mehrere Wochen.Costimulation via the CD28 receptor plays an important role not only in the proliferation of T cells and the differentiation to effector T cells, but also in the development and control of regulatory T cells (Treg). This key role makes CD28 an attractive target for analysing the influence of monoclonal antibodies on the development und homeostasis of T cells. The antibodies used in this work could be devided into two types: conventional antibodies (E18 mAb) on the one hand that are per se not stimulatory in vitro and block the interaction of CD28 with its ligands, and superagonistic antibodies (D665 mAb) on the other hand which can fully activate resting T cells even without ligation of the T-cell receptor. Different in vitro and in vivo experiments in this work could show that application of CD28 superagonists has no influence on differentiation of T cells in thymus. The composition of the single cell subsets in this organ stays completely unaffected. Treatment with conventional E18 mAb leads to an impaired development of Treg cells in thymus, while other populations stay unaffected. Similar results were obtained by analysing peripheral lymphnodes. Chronic application of E18 mAb reduces the representation of Treg cells within the CD4 T-cell compartment in peripheral lymphnodes, spleen and thymus, along with a strong reduction of the CD4 compartment at large. Importanty, however, no signs of autoimmunity were detected during or after release from anti-CD28 treatment, during which Treg numbers swiftly recover

Influence of quercetin on the global DNA methylation pattern in pigs

The plant flavonol quercetin causes multiple health-promoting effects in human and animals.</p