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Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
The main objective of this study is to assure the quality of cervical cancer treatment plans using an electronic portal imaging device (EPID) in RapidArc techniques.
Materials and Methods:
Fifteen cases of cervical cancer patients undergoing RapidArc technique were selected to evaluate the quality assurance (QA) of their treatment. The computed tomography (CT) of each patient was obtained with 3-mm-slice thickness and transferred to the Eclipse treatment planning system. The prescribed dose (PD) of 50·4 Gy with 1·8 Gy per fraction to planning target volume (PTV) was used for each patient. The aim of treatment planning was to achieve 95% of PD to cover 97%, and dose to the PTV should not receive 105% of the PD. All RapidArc plans were created using the AAA algorithm and treated on Varian DHX using 6 MV photon beam, with two full arcs. Gamma analysis was used to evaluate the quality of the treatment plans with accepting criteria of 95% at 3%/3 mm.
In this study, maximum and average gamma values were 2·53 ± 0·409 and 0·195 ± 0·059 showing very small deviation and indicating the smaller difference between both predicted and portal doses. Gamma Area changes from > 0·8 to > 1·2. SD increased to 5·4% and mean standard error increased to 4·67%.
On the basis of these outcomes, we can summarise that the EPID is a useful tool for QA in standardising and evaluating RapidArc treatment plans of cervical cancer in routine clinical practice.
It is shown that an electron, positron and ion plasma can be self-organized to a double Beltrami state – the superposition of two force-free states. The scale parameters which determine the nature of the self-organized structures are found to depend on the number densities of the plasma species. The loss of equilibrium in slowly evolving double Beltrmi states is investigated. The effects of density ratios, helicities, positron flows and energy on equilibrium are investigated. It is found that the double Beltrami state transforms to a single Beltrami state at the termination of equilibrium. It is also shown that much of the magnetic energy converts to the flow kinetic energy through catastrophic transformation.
The microstructure homogeneity and variability in mechanical properties of 316L stainless steel components fabricated using selective laser melting (SLM) have been investigated. The crack free, 99.9% dense samples were made starting from SS316L alloy powder, and the melt pool morphology was analysed using optical and scanning electron microscopy. Extremely fast cooling rates after laser melting/solidification process, accompanied by slow diffusion of alloying elements, produced characteristic microstructures with colonies of cellular substructure inside grains, grown along the direction of the principal thermal gradient during laser scanning. In some areas of the microstructure, a significant number of precipitates were observed inside grains and at grain boundaries. Micro hardness measurements along the build direction revealed slight but gradual increase in hardness along the sample height. Uniaxial tensile tests of as manufactured samples showed the effect of un-melted areas causing scatter in room-temperature mechanical properties of samples extracted from the same SLM build. The ultimate tensile strength (UTS) varied from 458MPa to 509MPa along with a variation in uniform elongation from 3.3% to 14.4%. The UTS of a sample exposed to the Cl- rich corrosion environment at 46oC temperature revealed a similar strength as of the original sample, indicating good corrosion resistance of SLM samples under those corrosion conditions.
Two-photon absorption (TPA) of Au-ion irradiated glasses in the femtosecond regime has been analyzed by an open-aperture Z scan technique. Three types of glasses, namely GIL49, BK7, and Glass B were irradiated by using 1700 keV Au+ ion beams. Samples were post-annealed at 600°C for 5 h. Penetration depth and distribution of Au+ ions having 1700 keV energy within glass substrates were estimated by transport of ions in matter (TRIM) simulations. Detailed calculations with full-damage cascades were performed for each sample, taking into account the chemical composition of glass substrates. TRIM results reveal that there is no significant change in ion range, straggling, and ion distribution with the change in the substrate composition. However, Z scan results showed a difference in TPA coefficients for all three glasses. Extent of crosslinking within each of irradiated sample, owing to its chemical composition, may have affected their TPA coefficients.
We use irradiation with 50-MeV Cu-ions to create vortex pinning defects in high-temperature superconducting Y1Ba2Cu3O7-x coated conductors using a beam-rastering approach that allows for the uniform irradiation of large ample areas. Our samples contain barium zirconate nanorods as pre-existing vortex pinning defects. By irradiating the samples at angles of 0o, 15oand 30o from the crystallographic c-axis we explore the interplay between pre-existing and irradiation-induced pinning and find that irradiation at 30o leads to a moderate enhancement of Jc at 5 K at high fields (greater than 2 Tesla). In contrast, Jc was suppressed for all temperatures and fields for other angles of irradiation. Optimized particle irradiation procedures offer a way for improving the performance of high-temperature superconducting wires for use in high magnetic fields without the need for changing wire synthesis protocols.
Radiotherapy is an option to treat high-grade laryngeal dysplasia. This study aimed to evaluate the use of intensity-modulated radiotherapy, 55 Gy in 20 daily fractions, in treating this disease.
Acute toxicity was evaluated in all 14 patients treated. In 10 patients, functional voice outcome was measured using the Voice Handicap Index, and the Grade, Roughness, Breath, Asthenia, Strain (‘GRBAS’) scale. These measurements were performed pre-treatment and three months after intensity-modulated radiotherapy.
All but one patient managed to complete radiotherapy. Acute toxicity was significant (one patient developed grade 4 and three patients developed grade 3 dysphagia). Four patients required hospital admission. In 9 out of 10 patients, radiotherapy improved voice quality.
This radiotherapy regimen using intensity-modulated radiotherapy for laryngeal dysplasia is feasible and provided excellent functional outcome, but acute toxicity was significant. Dose de-escalation can be considered in the framework of clinical trials.
The main objective of this research work is to compare the dosimertic effect on lower and upper oesophagus cancer treatment using 3D conformal radiotherapy as well as to evaluate the doses administered to the organs at risk.
Materials and methods
In this study, a cohort of 30 oesophageal cancer patients between the ages of 45 and 67 years registered during March 2017 to February 2018 was considered. These patients were treated through 3D conformal radiotherapy using four-field technique. Beam energy of 15 MV from Varian DHX linear accelerator was used. The given 30 patients were divided into two groups. The 1st group of 15 patients with upper oesophagus cancer was prescribed 5000 cGy doses, and the 2nd group of remaining 15 patients with lower oesophagus cancer was prescribed 4500 cGy. Computed tomography scans of every patient were obtained and then transmitted to Eclipse TPS for generating treatment plans. All radiotherapy plans were evaluated through various dosimetric indices. Statistical analysis software SPSS was utilised to get the values of means standard error and standard deviation of these indices for the treatment plan evaluation.
Uniformity index (UI) calculated for first group of patients showed difference of 7·4% from ideal value. A difference of 7% between ideal and calculated UI value was observed in 2nd group of patients. The values of other dosimetric indices like coverage, homogeneity, moderate dose homogeneity index (mDHI) and radical dose homogeneity index (rDHI) were found in limits specified by the Radiation Therapy and Oncology Group. The maximum difference of 6% was observed between the coverage mean values of 1st and 2nd group treatment plans.
For oesophageal cancer, 3D conformal radiotherapy using four-field treatment plans shows homogeneous distribution of dose around the target and limits the dose to organ at risk.
This study reported the justification and selection of acceptable γ criteria with respect to low (6 MV) and high (15 MV) photon beams for intensity-modulated radiation therapy quality assurance (IMRT QA) using the Gafchromic external beam therapy 3 (EBT3) film.
Materials and methods
Five-field step-and-shoot IMRT was used to treat 16 brain IMRT patients using the dual-energy DHX-S linear accelerator (Varian Medical System, Palo Alto, CA, USA). Dose comparisons between computed values of the treatment planning system (TPS) and Gafchromic EBT3 film were evaluated based on γ analysis using the Film QA Pro software. The dose distribution was analysed with gamma area histograms (GAHs) generated using different γ criteria (3%/2 mm, 3%/3 mm and 5%/3 mm) for the 6 and 15 MV photon beams, to optimise the best distance-to-agreement (DTA) criteria with respect to the beam energy.
From the comparison between the dose distributions acquired from the TPS and EBT3 film, a DTA criterion of 3%/2 mm showed less dose differences (DDs) with passing rates up to 93% for the 6 MV photon beams, while for the 15 MV a relaxed DTA criterion of 5%/3 mm was consistent with the DD acceptability criteria with a 95% passing rate.
Our results suggested that high-energy photon beams required relaxed DTA criteria for the brain IMRT QA, while low-energy photon beams showed better results even with tight DTA criteria.
This exploration is intended to analyse the dosimetric characteristics of proton beams of multiple energies using different snout sizes.
Materials and methods
A synchrotron was used for the extraction of eight proton beam energies (100–250 MeV). Dosimetric measurements were taken in a water phantom that was irradiated with a proton beam emanating from the gantry system at angles 0, 90, 180 and 270 degree using a large and a medium snout. The range of beam energies in the phantom, their corresponding centre modulation depth (CMD) and the width of spread out Bragg peak (SOBP) were measured by Markus chamber. Double scattering technique was employed for the creation of SOBPs.
The range of proton beams varied from 4·3 cm for 100 MeV beam to 28·5 cm for 250 MeV beam with the medium snout and from 4·3 cm for 100 MeV to 25 cm for 250 MeV beam with large snout in the water phantom. SOBP width showed a variation from 4 to 10 cm with medium and large snout. While determining the output with medium snout, the discrepancy of 1·1% was observed between the maximum and minimum mean values of output for all the given set of energies and angles. There occurred a difference of 0·9% between the maximum and minimum mean values of output with the large snout. Beam output at SOBP centre was 12% higher with large snout as compared to that with medium snout for all the given beam energies. Flatness and symmetry were found within ±2·5% tolerance limits with medium and large snouts.
Flatness and symmetry were found within explicit limits with both medium and large snouts. Large snout produced higher beam output than that of medium snout at the centre of SOBP. This exploration can be extended to the determination of beam output, flatness and symmetry with a small snout.
To verify dose delivery and quality assurance of volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer.
The Imaging and Radiation Oncology Core Houston (IROC-H) H&N phantom with thermoluminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS, the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerned organs according to IROC-H prescription. The treatment plan was optimised using adoptive convolution algorithm to improve dose homogeneity and conformity. The dose calculation was performed using C.C Convolution algorithm and a Varian True Beam linear accelerator was used to deliver the treatment plan to the H&N phantom. The delivered radiation dose to the phantom was measured through TLDs and GafChromic external beam radiotherapy 2 (EBT2) films. The dosimetric performance of the VMAT delivery was studied by analysing percent dose difference, isodose line profile and gamma analysis of the TPS-computed dose and linac-delivered doses.
The percent dose difference of 3.8% was observed between the planned and measured doses of TLDs and a 1.5-mm distance to agreement (DTA) was observed by comparing isodose line profiles. Passed the gamma criteria of 3%/3 mm was with good percentages.
The dosimetric performance of VMAT delivery for a challenging H&N radiotherapy can be verified using TLDs and films embedded in an anthropomorphic H&N phantom.
Sesbania [Sesbania cannabina (Retz.) Pers.] is a problematic emerging weed species in Australian cotton-farming systems. However, globally, no information is available regarding its seed germination biology, and better understanding will help in devising superior management strategies to prevent further infestations. Laboratory and glasshouse studies were conducted to evaluate the impact of various environmental factors such as light, temperature, salt, osmotic and pH stress, and burial depth on germination and emergence of two Australian biotypes of S. cannabina. Freshly harvested seeds of both biotypes possessed physical dormancy. A boiling-water scarification treatment (100±2 C) of 5-min duration was the optimum treatment to overcome this dormancy. Once dormancy was broken, the Dalby biotype exhibited a greater germination (93%) compared with the St George biotype (87%). The nondormant seeds of both biotypes showed a neutral photoblastic response to light and dark conditions, with germination marginally improved (6%) under illumination. Maximum germination of both biotypes occurred under an alternating temperature regime of 30/20 and 35/25 C and under constant temperatures of 32 or 35 C, with no germination at 8 or 11 C. Seed germination of both biotypes decreased linearly from 87% to 14% with an increase in moisture stress from 0.0 to −0.8 MPa, with no germination possible at −1.0 MPa. There was a gradual decline in germination for both biotypes when imbibed in a range of salt solutions of 25 to 250 mM, with a 50% reduction in germination occurring at 150 mM. Both biotypes germinated well under a wide range of pH values (4.0 to 10.0), with maximum germination (94%) at pH 9.0. The greatest emergence rate of the Dalby (87%) and St George (78%) biotypes was recorded at a burial depth of 1.0 cm, with no emergence at 16.0 cm. Deep tillage seems to be the best management strategy to stop S. cannabina’s emergence and further infestation of cotton (Gossypium hirsutum L.) fields. The findings of this study will be helpful to cotton agronomists in devising effective, sustainable, and efficient integrated weed management strategies for the control of S. cannabina in cotton cropping lands.
This work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.
Materials and Methods
A Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.
The measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.
Results of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.
This study is primarily aimed at the analysis of various dose homogeneity indices (HIs) essential for the evaluation of therapeutic plans by employing intensity-modulated radiation therapy (IMRT) on patients with cervix cancer. Also integral dose (ID) to healthy surrounding organs is computed.
Materials and methods
Effectiveness of different HIs (A, B, C, D) was explored for IMRT plans using 15 MV photon beam. In total, 18 patients were selected at random for treatment of cervix cancer, and dose of 5,040 cGy was delivered in 28 equal fractions.
The study was undertaken to compare four HI formulas and coefficient of determination between each set of HI was known by calculating R2 value. Mean±SD of HI A, HI B, HI C and HI D were 1·12±0·02, 0·13±0·04, 0·10±0·02 and 0·99±0·03, respectively. Mean value of ID for rectum is 3·16 and for bladder is 10·3.
Our data suggested that HI calculated using four formulas provided good plan quality. The results advocate that all the studied HIs can be effectively used for assessment of uniformity inside the target volume. However, values of HI C were closest to ideal value as compared with other three formulas; hence, it is considered a better measure to compute homogeneity of dose within target volume. The ID gives satisfactory results for surrounding normal tissues such as rectum and bladder and significant critical tissue sparing was achieved by using IMRT technique.
The purpose of this study was to analyse the comparison of intensity-modulated radiation therapy quality assurance (IMRT QA) using Gafchromic® EBT3 film, Electronic portal imaging device (EPID) and MapCHECK®2.
Pretreatment authentication is the main apprehension in advanced radiation therapy treatment plans such as IMRT.
Materials and methods
A total of 20 patients were planned on Eclipse treatment planning system using 6 and 15 MV separately.
Gamma index of EBT3 film results shows the following average passing rates: 97% for 6 MV and 96·6% for 15 MV using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm for brain. However, by using ±5% of 3 mm and ±3% of 3 mm criteria, the average passing rates were 95·4% on 6 MV and 95·2% on 15 MV for prostate. For EPID, the results show the average passing rates as 97·8% for 6 MV and 97·2% for 15 MV in for brain. In cases in which ±5% of 3 mm and ±3% of 3 mm were used, the average passing rates were 96·6% for 6 MVand 96·1% for 15 MV for prostate. MapCHECK®2 results show average passing rates of 96·4% for 6 and 96·2% for 15 MV, respectively, for brain using criteria of ±5% of 3 mm, ±3% of 3 mm and ±3% of 2 mm, whereas for ±5% of 3 mm and ±3% of 3 mm the average rates are 95·2% for 6 and 94·7% for 15 MV in prostate.
The EPID results are better than the other methods, and hence EPID can be used effectively for IMRT pretreatment verifications.
To determine the feasibility of an anthropomorphic breast polyurethane-based three-dimensional (3D) dosimeter with cavity to measure dose distributions and skin dose for a commercial strut-based applicator strut-adjusted volume implant (SAVI™) 6–1.
Materials and methods
An anthropomorphic breast 3D dosimeter was created with a cavity to accommodate the SAVI™ strut-based device. 2 Gy was prescribed to the breast dosimeter having D95 to planning target volume evaluation (PTV_EVAL) while limiting 125% of the prescribed dose to the skin. Independent dose distribution verification was performed with GAFCHROMIC® EBT2 film. The dose distribution from the 3D dosimeter was compared to the distributions from commercial brachytherapy treatment planning system (TPS) and film. Point skin doses, line profiles and dose–volume histogram (DVHs) for the skin and PTV_EVAL were compared.
The maximum difference in skin dose for TPS and the 3D dosimeter was 4% whereas 41% between the TPS and EBT2 film. The maximum dose difference for line profiles between TPS, 3D dosimeter, and film was 4·1%. DVHs of skin and PTV_EVAL for TPS and 3D dosimeter differed by a maximum of 4% at 5 mm depth and skin differed by a maximum 1·5% between TPS and 3D dosimeter. The criterion for gamma analysis comparison was 92·5% at ±5%±3 mm criterion. The TPS demonstrated at least ±5% comparability in predicting dose to the skin, PTV_EVAL and normal breast tissue.
3D anthropomorphic polyurethane dosimeter with cavity gives comparable results to the TPS dose predictions and GAFCHROMIC® EBT2 film results in the context of HDR brachytherapy.
A modified H-shaped metamaterial is imparted in this paper that has a multiple band coverage for reflection and transmission coefficient. The proposed structure exhibits triple band coverage for the permittivity and permeability. Two split ring resonators (SRR) are connected with the substantial H-shaped structure. The 12 × 12 mm2 structure has been printed on FR-4 and a correlation is made between the basic unit-cell and array structures. A comparison is made among 1 × 2, 2 × 2, and 4 × 4 array structures with 1 × 2, 2 × 2, and 4 × 4 unit-cell configurations to validate the performance of the proposed metamaterial. A great transmission coefficient having a band of 13 GHz with a 500 MHz band gap in the middle is demonstrated for all of these configurations. The effective parameters of the resonators cover C, X, and Ku bands independently with double-negative phenomena at X and Ku bands with a frequency range of about 2.5 GHz. The reflection and transmission coefficients of the unit cell are obtained by CST microwave studio. Having an auspicious design and wide range double-negative characteristics, this structure can be applied to satellite communication.
In the recent years, many benchmark author profiling corpora have been developed for various genres including Twitter, social media, blogs, hotel reviews and e-mail, etc. However, no such standard evaluation resource has been developed for Short Messaging Service (SMS), a popular medium of communication, which is very useful for author profiling. The primary aim of this study is to develop a large multilingual (English and Roman Urdu) benchmark SMS-based author profiling corpus. The proposed corpus contains 810 author profiles, wherein each profile consists of an aggregation of SMS messages as a single document of an author, along with seven demographic traits associated with each author profile: gender, age, native language, native city, qualification, occupation and personality type (introvert/extrovert). The secondary aims of this study include the following: (1) annotating the proposed corpus for code-switching annotations at the lexical level (approximately 0.69 million tokens are manually annotated for code-switching) and (2) applying the stylometry-based method (groups of sixty-four features) and the content-based method (twelve features) for gender identification in order to demonstrate how our proposed corpus can be used for the development and evaluation of various author profiling methods. The results show that the content-based character 5-gram feature outperformed all the other features by obtaining the accuracy score of 0.975 and F1 score of 0.947 for gender identification while using the entire corpus. Furthermore, our proposed corpora (SMS–AP–18 and code-switched SMS–AP–18) are freely and publicly available for research purpose.