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Background/Aim: To compare implant sparing irradiation with conventional radiotherapy (RT) using helical (H) and TomoDirect (TD) techniques in breast cancer patients undergoing immediate breast reconstruction (IBR). Patients and Methods: The dosimetric parameters of 40 patients with retropectoral implants receiving 50.4 Gy delivered in 28 fractions were analyzed. Three plans were created: H plan using conventional planning target volume (PTV) that included the chest wall, skin, and implant; TD plan using conventional PTV; and Hs plan using implantsparing PTV. The H, TD, and Hs plans were compared for PTV doses, organ-at-risk (OAR) doses, and treatment times. Results: Dose distribution in the Hs plan was less homogeneous and uniform than that in the H and TD plans. The TD plan had lower lung, heart, contralateral breast, spinal cord, liver, and esophagus doses than the Hs plan. Compared to the Hs plan, the H plan had lower lung volume receiving 5Gy (V5) (39.1±3.9 vs. 41.2±3.9 Gy; p<0.001), higher V20 (12.3±1.3 vs. 11.5±2.6 Gy; p=0.02), and higher V30 (7.5±1.6 vs. 4.4±1.7 Gy; p<0.001). H plan outperformed Hs plan in heart dosimetric parameters except V20. The Hs plan had significantly lower mean implant doses (43.4±2.1 Gy) than the H plan (51.4±0.5 Gy; p<0.001) and the TD plan (51.9±0.6 Gy; p<0.001). Implementing an implant sparing technique for silicone dose reduction decreases lung doses. Conclusion: Conventional H and TD plans outperform the implant sparing helical plan dosimetrically. Because capsular contracture during RT is unpredictable, long-term clinical outcomes are required to determine whether silicon should be spared. [ABSTRACT FROM AUTHOR]

Background: We analyzed a dose escalation of 36.25 Gy to the entire prostate and a dose increment up to 40 Gy with 1.25 Gy increments to intraprostatic lesion (IPL) using simultaneous integrated boost (SIB) in five fractions. Materials and methods: Eighteen low- and intermediate-risk prostate cancer patients treated with 1.5T MR-Linac were retrospectively evaluated. The same planning computed tomography (CT) images generated four plans: no SIB, 37.5 Gy SIB, 38.75 Gy SIB, and 40 Gy SIB. In four plans, planning target volume (PTV) doses, organ at risk (OAR) doses, and PTV-SIB homogeneity index (HI), gradient index (GI) and conformity index (CI) were compared. Results: All plans met the criteria for PTV and PTV-SIB coverage. PTV 40 Gy plan has higher maximum PTV and PTV-SIB doses than other plans. The PTV HI was significantly higher in the SIB 40 Gy plan (0.135 ± 0.007) compared to SIB 38.75 Gy plan (0.099 ± 0.007; p = 0.001), SIB 37.5 Gy (0.067 ± 0.008; p < 0.001), and no SIB plan (0.049 ± 0.010; p < 0.001), while there were no significant differences in HI, GI and CI for PTV-SIB between three plans. Four rectum and bladder plans had similar dosimetric parameters. The urethra D5 was significantly higher in SIB 40 Gy plan compared to no SIB plan (37.7 ± 1.1 Gy vs. 37.0 ± 0.7 Gy; p = 0.009) and SIB 37.5 Gy plan (36.9 ± 0.8 Gy; p = 0.008). There was no significant difference in monitor units between the four consecutive plans. Conclusions: Ultra-hypofractionated dose escalation to IPL up to 40 Gy in 5 fractions with a 1.5-T MR-linac is dosimetrically feasible, potentially paving the way for clinical trials. [ABSTRACT FROM AUTHOR]

Background: We examined the effects of reducing the planning target volume (PTV) margin in MR‐guided radiotherapy (MRgRT) on the distribution of radiation dose to target volumes and organs‐at‐risk (OARs). Thus, we compared MR‐Linac (MRL) plans with and without reduced margin and intensity‐modulated radiotherapy (IMRT) plan with conventional linac for low‐risk prostate cancer patients receiving 36.25 Gy in five fractions of ultra‐hypofractionated radiation therapy. Materials and Methods: Twenty low‐risk prostate cancer patients treated with 1.5 T MR‐Linac were evaluated. The same planning CT images were used for four plans: the MRL‐R plan with reduced margin planning target volume (PTV‐R) and the MRL‐N plan with normal margin PTV (PTV‐N), which is also used for IMRT plan. In four plans, PTV doses, organs‐at‐risk (OARs) doses, the homogeneity index (HI), and monitor units were compared. Results: All plans met the criteria for PTV coverage and OARs dose constraints. The maximum and mean PTV doses were significantly higher in the MRL‐R and MRL‐N plans compared to the IMRT plan. The HI was lowest in the IMRT plan (0.040 ± 0.013) and highest in the MRL‐N plan (0.055 ± 0.012; p < 0.001). There was no significant difference in the PTV dosimetric parameters between the MRL‐R and the MRL‐N plans. The high doses in the rectum was significantly lower in the MRL‐R compared to other plans. The bladder V36.25 Gy was significantly lower in the MRL‐R plan (2.43 ± 1.87 Gy) compared to MRL‐N (4.50 ± 2.42 Gy; p < 0.001), and IMRT plans (4.76 ± 2.77 Gy; p < 0.001). There was no significant difference in the low‐dose volumes of the body, maximum femur doses, or monitor units across each plan. Conclusions: Ultra‐hypofractionated MR‐guided RT with 1.5 T MRL is dosimetrically feasible for patients with prostate cancer. The improved soft tissue contrast and the online adaptive plan for 1.5 T MR‐Linac allows for PTV margin reduction resulted in a significant dose reduction in OARs. [ABSTRACT FROM AUTHOR]

Purpose: We examined the prognostic significance of early changes in primary tumor SUV measured with Gallium-68-labeled prostate-specific membrane antigen positron emission tomography ([68Ga]Ga-PSMA-11-PET/CT) and serum PSA values after neoadjuvant androgen deprivation treatment (nADT) in high-risk prostate cancer (PCa) patients treated with definitive radiotherapy (RT). Methods: The clinical data and SUV parameters of 71 PCa patients were reviewed retrospectively. The serum PSA and primary tumor SUV values were calculated before and after the start of ADT. Using univariable and multivariable analyses, the prognostic factors predicting biochemical disease free survival (bDFS) and prostate cancer specific survival (PCSS) were investigated. In addition, logistic regression analysis was used to identify predictors of biochemical failure (BF). Results: All but one patient responded with a 98.8% reduction in serum PSA (21.8 ng/mL vs. 0.3 ng/mL; p < 0.001), and 64 patients (91.1%) had a median 66.6% decrease in primary tumor SUV after ADT (13.2 vs. 4.8, p < 0.001). The primary tumor SUV response rate was significantly higher in patients with Gleason score (GS) of 7 than in patients with GS > 7 (59.5% vs. 40.5%; p = 0.04), and it was significantly lower in patients with inadequate treatment response than in those with complete (CR) or partial response (PR) (1.1% vs. 66.1%; p < 0.001). There was a strong and significant correlation (Spearman = 0.41, p < 0.001) and a high concordance (91.5%) between PSA response and SUV response after ADT. With a median follow-up time of 76.1 months, the 5-year bDFS and PCSS rates were 77.2% and 92.2%, respectively. Nineteen patients (26.7%) patients had recurrence at a median of 44.6 months after the completion of RT. In multivariate analysis, lymph node metastasis, GS greater than 7, and SD/PD after nADT were independent predictors of worse bDFS. However, no significant factor for PCSS was identified. In the multivariable logistic regression analysis, advanced age, GS of > 7 disease, lymph node metastasis, and SD or PD after nADT were independent predictors of BF. Conclusion: These results imply that the metabolic response measured with [68Ga]Ga-PSMA-11-PET/CT after nADT could be used to predict progression in high-risk PCa patients treated with definitive RT. [ABSTRACT FROM AUTHOR]

An ultra fast liquid chromatographic (UFLC) method using fluorimetric detection for the quantitation of Febuxostat (FEB) in human serum was developed by precolumn derivatization with 4- bromomethyl-7-methoxy coumarin (BrMmC). The derivatization was catalyzed with dibenzo-18-crown-6-ether to produce a fluorescent derivative which was determined through fluorescence measurement with excitation at 320 nm and emission at 395 nm wavelengths. A C18 column with 100 cm  4.6 mm, 3 µm particule size was used for the UFLC separation procedure. A mixture of acetonitrile: methanol: 0.05 M aqueous ammonium acetate (pH 5.0) (40:40:20, v/v/v) was used as mobile phase. During the procedure, the flow rate was maintained at 0.5 mL/min. A calibration curve was then plotted as 0.005–3.0 µg/mL with a detection limit of 0.0022 µg/mL and quantification limit of 0.0073 µg/mL. The mean recovery to reveal the accuracy and relative standard deviation (RSD) that indicates the precision of the method were found out to be 85.20 % and less than 3.52 %, respectively. The utility of the new method has been demonstrated by measuring the pharmacokinetics of FEB by administration of 80 mg tablets to a healthy female volunteer, aged 42. [ABSTRACT FROM AUTHOR]