2019 17 2 65 367

Methods to evaluate the performance of kilovoltage cone-beam computed tomography in the three-dimensional reconstruction space 2 2 Background: Cone-beam computed tomography (CBCT) scanners for image-guided radiotherapy are in clinical use today, but there has been no consensus on uniform acceptance to verify the CBCT image quality yet. The present work proposed new methods to fully evaluate the performance of CBCT in its three-dimensional (3D) reconstruction space. Materials and Methods: Compared to the traditional methods with only two-dimensional axial slice evaluated, the new methods were designed to evaluate the CBCT image quality not only in the axial slices but also along three dimensions and three sections. Image parameters were evaluated by scanning the corresponding phantom. Results: The new methods demonstrated the high spatial resolution, the image uniformity, the high CT numbers linearity, geometric accuracy and relatively poor performance in low contrast resolution, compared to the results of plan CT. Additionally, the spatial resolution, the CT number linearity and the image uniformity proved to be more superior along the z direction and in the cross-section. Furthermore, the spatial resolution and the CT value linearity decreased gradually when deviating from the center of rotation axis and accelerates the reduction towards the periphery area, suggesting that locating the target within the range of 4 cm around the isocenter during radiotherapy ensure the optimal spatial resolution and the CT value linearity.  Conclusion: Results indicate that the proposed three-dimensional image quality evaluation holds the potential to complement existing standards to provide sufficient information for the CBCT image performance and thereby guiding the clinical applications of CBCT.  189 202 2019/04/23 1398/2/3 2019/04/23 1398/2/3 J. Zhang J. Zhang Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China Z.R. Bao Z.R. Bao Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China X.T. Huang X.T. Huang Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China D.Z. Jiang D.Z. Jiang Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China C.H. Xie C.H. Xie Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China Y.F. Zhou Y.F. Zhou Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China H. Liu H. Liu Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; and Hubei Radiotherapy Quality Control Center, Wuhan University, Hubei, China liuhui69_wh@hotmail.com Image quality CBCT three-dimensional. Dawson LA and Jaffray DA (2007) Advances in image-guided radiation therapy. Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology, 25(8): 938-946.##2. Ed JLM (2011) IMRT, IGRT, SBRT: advances in the treatment planning and delivery of radiotherapy. Karger Ag.##3. Gupta T and C Anand N (2012) Image-guided radiation therapy: Physician's perspectives. Journal of Medical Physics, 37(4): 351-355.## 4. Zehtabian M, Faghihi R, Mosleh-Shirazi MA, Shakibafard AR, Mohammadi M, Baradaran-Ghahfarokhi M (2012) A Fast Model For Prediction Of Respiratory Lung Motion For Image-guided radiotherapy: A Feasibility Study. Int J Radiat Res, 10(2): 73-81.## 5. Mahdavi SR,  Jazayeri Gharehbagh E, Mofid B,  Jafari  AH,  Nikoofar AR (2017) Accuracy of the dose delivery in prostate cancer patients-using an electronic portal imaging device (EPID). Int J Radiat Res, 15(1): 39-47.## 6. Dawson LA and Sharpe MB (2006) Image-guided radiotherapy: rationale, benefits, and limitations. Lancet Oncology, 7(10): 848-858.## 7. Herman MG (2005) Clinical use of electronic portal imaging. Journal name??, 15(3): 157-167.## 8. Lattanzi J, Mcneely S, Hanlon A, Das I, Schultheiss TE, Hanks GE (2012) Daily CT localization for correcting portal errors in the treatment of prostate cancer. Atmospheric Measurement Techniques Discussions, 41(5): 7899-7921.## 9. Meeks SL, Harmon JF, Langen KM, Willoughby TR, Wagner TH, Kupelian PA (2005) Performance characterization of megavoltage computed tomography imaging on a helical tomotherapy unit. Medical Physics, 32(8): 2673-2681.##10. Jaffray DA and Siewerdsen JH (2000) Cone-beam computed tomography with a flat-panel imager: Initial performance characterization. Medical Physics, 27: 1311-1323.##11. Pouliot J, Bani-Hashemi A, Chen J, Svatos M, Ghelmansarai F, Mitschke M, et al. (2005) Low-dose megavoltage cone-beam CT for radiation therapy. Int J Radiat Oncol Biol Phys, 61(2): 552-560.##12. Johnston H, Hilts M, Beckham W, Berthelet E (2008) 3D ultrasound for prostate localization in radiation therapy: a comparison with implanted fiducial markers. Medical Physics, 35(6): 2403-2413.##13. Lattanzi J, Mcneeley S, Das I, Schultheiss TE, Hanks GE (1999) A comparison of daily CT localization to a daily ultrasound-based system in prostate cancer. Int J Radiat Oncol Biol Phys, 43(4): 719-725.##14. Baroni G, Ferrigno G, Orecchia R, Pedotti A (2000) Real-time three-dimensional motion analysis for patient positioning verification. Radiotherapy & Oncology, 54(1): 21-27.##15. Yin FF, Guan H, Lu W (2005) A technique for on-board CT reconstruction using both kilovoltage and megavoltage beam projections for 3D treatment verification. Medical Physics, 32(9): 2819-2826.##16. Cranmer-Sargison G, Kundapur V, Tu D, Ternes S, Vachhrajani H, Sidhu NP (2011) Using kV-kV and CBCT imaging to evaluate rectal cancer patient position when treated prone on a newly available belly board. Medical Dosimetry, 37(2): 117-121.##17. Yoo S, Kim G, Hammoud R, Elder E, Pawlicki T, Guan H, et al. (2006) A quality assurance program for the on-board imager®. Medical Physics, 33(11): 4431.##18. Siewerdsen JH and Jaffray DA (2001) Cone-beam computed tomography with a flat-panel imager: Magnitude and effects of X-ray scatter. Medical Physics, 28(2): 220-231.##19. Arai Y, Tammisalo E, Iwai K, Hashimoto K, Shinoda K (1999) Development of a compact computed tomographic apparatus for dental use. Dentomaxillofacial Radiology, 28(4): 378-379.##20. Bissonnette J, Balter PA, Dong L, Langen KM, Lovelock DM, Miften M, et al. (2012) Quality assurance for image-guided radiation therapy utilizing CT-based technologies: A report of the AAPM TG-179. Medical Physics, 39(4): 1946-1963.##21. Bissonnette JP, Moseley DJ, Jaffray DA (2008) A quality assurance program for image quality of cone-beam CT guidance in radiation therapy. Med Phys , 35(5): 1807-1815.##22. Steiding C, Kolditz D, Kalender WA (2014) A quality assurance framework for the fully automated and objective evaluation of image quality in cone-beam computed tomography. Medical Physics, 41(3): 31901.##23. Fahrig R, Dixon R, Payne T, Morin RL, Ganguly A, Strobel N (2006) Dose and image quality for a cone-beam C-arm CT system. Medical Physics, 33(12): 70-73.##24. Mackie TR, Kapatoes J, Ruchala K, Lu W, Wu C, Olivera G, et al. (2003) Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys, 56(1): 89-105.##25. Yu L, Vrieze TJ, Bruesewitz MR, Kofler JM, Delone DR, Pallanch JF, et al. (2010) Dose and image quality evaluation of a dedicated cone-beam CT system for high-contrast neurologic applications. American Journal of Roentgenology, 194(2): 193-201.##26. Kwan AL, Boone JM, Yang K, Huang SY (2007) Evaluation of the spatial resolution characteristics of a cone-beam breast CT scanner. Med Phys, 34(1): 275-281.##27. Morin O, Chen J, Descovich M, Hashemi AB, Descovich M, Pouliot J (2009) Physical performance and image optimization of megavoltage cone-beam CT. Medical Physics, 36(4): 1421.##28. Ding GX, Duggan DM, Coffey CW, Deeley M, Hallahan DE, Cmelak, A, et al. (2007) A study on adaptive IMRT treatment planning using kV cone-beam CT. Radiotherapy and Oncology, 85(1): 116-125.##29. Létourneau D, Wong JW, Oldham M, Gulam M, Watt L, & Jaffray D. A, et al. (2005) Cone-beam-CT guided radiation therapy: technical implementation. Radiotherapy and Oncology. ; 75(3): 279-286.##30. Cheng HCY, Wu VWC, Liu ESF, Kwong DLW (2011) Evaluation of Radiation Dose and Image Quality for the Varian Cone Beam Computed Tomography System. Int J Radiat Oncol Biol Phys, 80(1): 291-300.##31. Stock M and Pasler MW (2009) Image quality and stability of image-guided radiotherapy (IGRT) devices: A comparative study. Radiotherapy and Oncology, 93(1): 1-7.##32. Sumida I, Yamaguchi H, Kizaki H, Yamada Y, Koizumi M, & Yoshioka, Y, et al. (2014) Evaluation of imaging performance of megavoltage cone-beam CT over an extended period. Journal of Radiation Research, 55(1): 191-199.##33. Smith BD (1985) Image Reconstruction from Cone-Beam Projections: Necessary and Sufficient Conditions and Reconstruction Methods. IEEE Transactions on Medical Imaging, 4(1): 14-25.##34. Grangeat P (1991) Mathematical framework of cone beam 3D reconstruction via the first derivative of the radon transform: Lecture Notes in Mathematics, 1466-1497.##35. 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Therapeutic effects of high intensity focused ultrasound for in patients with benign uterine tumors with regard to lifestyle and obstetric characteristics 2 2 Background: The present investigation compared the decrease in the volume of benign tumor before and after High Intensity Focused Ultrasound (HIFU) treatment to evaluate the therapeutic effects of HIFU. in terms of Lifestyle and obstetric characteristics of in patients with Benign Uterine Tumors. Materials and Methods: To collect the data on each patients’ lifestyle and obstetric characteristics, a survey was conducted on 55 patients with benign uterine tumors who had undergone HIFU treatment for three months. Results: Regarding obstetric characteristics, the longer the period of discontinuation of contraceptive pills, the higher the therapeutic effects of HIFU. Regarding lifestyle, the decrease in the benign tumor volume was more when the patient did not exercise during the treatment period, and was a non-smoker (p<0.05). Conclusion: The results of the present investigation may provide valuable basic data for increasing the understanding of the factors that heighten the therapeutic effects of HIFU, thereby contributing to the development of novel therapeutic strategies. 203 208 2019/04/232019/04/23 1398/2/3 2019/04/232019/04/23 1398/2/3 J.Y. Park J.Y. Park Department of Radiology, Incheon Christian Hospital, Incheon, Korea J.H. Jung J.H. Jung Department of Biomedical Engineering and Research Institute of Biomedical Engineering, Catholic University, Seoul, Korea S. Kim S. Kim Department of Radiological Science, Gachon University Medical campus, Incheon, Korea ksc@gachon.ac.kr High intensity focused ultrasound benign uterine tumors life style obstetric characteristics. Hindley J, Gedroyc WM, Regan L, et al. (2004) MRI guidance of focused ultrasound therapy of uterine fibroids: Early results. AJR Am J Roentgenol, 183(6): 1713-1719.##Stewart EA, Gostout B, Rabinovici J, et al. (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol, 110(2): 279-287.##Manyonda IT and Gorti M (2008) Costing magnetic resonance-guided focused ultrasound surgery, a new treatment for symptomatic fibroids. BJOG, 115(5): 551-553.##Chen CY and Ward JP (2014) A mathematical model of the growth of uterine Myomas. Bull Math Biol, 76(12): 3088-3121.##Bakas P, Liapis A, Vlahopoulos S, Giner M, Logotheti S, Creatsas G, et al. (2008) Estrogen receptor alpha and beta in uterine fibroids: a basis for altered estrogen responsiveness. Fertil Steril, 90(5): 1878–1885.##Templeman C1, Marshall SF, Clarke CA, Henderson KD, Largent J, Neuhausen S, et al. (2009) Risk factors for surgically removed fibroids in a large cohort of teachers. Risk factors for surgically removed fibroids in a large cohort of teachers. Fertil Steril, 92(4): 1436-1446.##He Y, Zeng Q, Dong S, Qin L, Li G, Wang P (2013) Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case control study in China. Asia Pac J Clin Nutr, 22(1): 109–117.##Wise LA, Radin RG, Kumanyika SK, Ruiz-Navarez EA, Palmer JR, Rosenberg L (2014) Prospective study of dietary fat and risk of uterine leiomyomata. Am J Clin Nutr, 99(5): 1105–1116.##Choi JH, Kim JK (2010) Influences of health-related factors on uterine Myoma. Journal of the Korea Contents Association, 10(1): 325-333.##Park JY, Lee JS, Cho JH, Kim SC (2016) Effects of high-intensity-focused ultrasound treatment on benign uterine tumor. J Korean Med Sci, 31(8): 1279–1283.##Lee JS, Hong GY, Park BJ, Kim TE (2015) Ultrasound-guided high-intensity focused ultrasound treatment for uterine fibroid & adenomyosis: A single center experience from the Republic of Korea. Ultrasonics Sonochemistry, 27: 682–687.##Wang W, Wang Y, Wang T, Wang J, Wang L, Tang J (2012) Safety and efficacy of US-guided high-intensity focused ultrasound for treatment of submucosal fibrosids. European Radiology, 22(11): 2553-2558.##Zhou M, Chen JY, Tang LD, Chen WZ, Wang ZB (2011) Ultrasound-guided high-intensity focused ultrasound ablation for adenomyosis: the clinical experience of a single center. Fertility & Sterility, 95: 900-905.##Marshall LM, Spiegelman D, Goldman MB, et al. (1998) A prostective study of reproductive factors and oral contraceptive use in relation to the risk of Uterine leiomyoma. Fertil. Steril, 70(3): 432-439.##Choi JH and Kim JK (2011) Analysis of correlation for uterine Myoma and stress by ultrasonography. Journal of the Korea contents association, 11(1): 277-283.##Parker WH ( 2007) Etiology, symptomatology, and diagnosis of uterine myomas. Fertility and Sterility, 87(4): 725-736.##Ahrendt HJ, Tylkoski H, Rabe T, Szczes A, Friedrich C, Roehl FW, Kitay A, Roemer T, Foth D (2016) Prevalence of uterine myomas in women in Germany: data of an epidemiological study. Arch Gynecol Obstet, 293(6): 1243-1253. ##Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM (2007) Association of Physical Activity with Development of Uterine Leiomyoma. Am J Epidemiol, 165(2): 157-163.##Zhao WP, Chen JY, Chen WZ (2016) Dynamic contrast-enhanced MRI serves as a predictor of HIFU treatment outcome for uterine fibroids with hyperintensity in T2-weighted images. Exp Ther Med, 11(1): 328-334.##McCullough DJ, Stabley JN, Siemann DW, Behnke BJ (2014) Modulation of blood flow, hypoxia, and vascular function in orthotopic prostate tumors during exercise. J Natl Cancer Inst. 106(4): dju036.##Okolo S (2008) Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol, 22(4): 571–588.##Parker WH (2007) Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril, 87(4): 725–36.##Wong JY, Gold EB, Johnson WO, Lee JS (2016) Circulating sex hormones and risk of uterine fibroids: Study of women's health across the nation (SWAN). J Clin Endocrinol Metab, 101 (1): 123-130.##Chiaffarino F, Ricci E, Cipriani S, Chiantera V, Parazzini F (2016) Cigarette smoking and risk of uterine myoma: systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 197: 63-71. ## ##

Low kilovolt “prospective ECG-triggering” vs. “retrospective ECG-gating” coronary CTA: comparison of image quality and radiation dose 2 2 Background: To compare image quality and radiation doses of low kilovolt (kV) “prospective ECG-triggering” (PT) and standard “retrospective ECG-gating” (RG) coronary computed tomography (CT) angiography. Materials and Methods: A total of 101 consecutive patients (76 males, 25 females; mean age: 55.44 ± 8.28 years) with low-to-intermediate risk status for coronary artery disease and with a body mass index (BMI) of <30 kg/m² were prospectively included in the study. The images were acquired with a 64-detector (128-slice) CT using the tube current modulation technique. The PT CT technique (100 kV, heart rate [HR]<70) was applied in 59 patients, while the RG CT technique (120 kV, HR≥70-90) was applied in 42 patients. The study was approved by the ethics committee. All patients provided informed written consent.  Results: No significant difference was found between age, sex and BMI of both groups (p > 0.05). The mean image quality score was 2.87 ± 0.25 for the low kV PT CT technique and 2.73 ± 0.31 for the RG CT technique, which was statistically significant (p < 0.05). No statistically significant difference was found between groups for signal-noise and contrast-noise ratios (p > 0.05). The mean effective dose was 1.43 ± 0.3 mSv for low kV PT CT technique and 8.20±2.36 mSv for the RG CT technique (p < 0.001). Conclusion: In the low kV PT CT technique, the radiation dose is significantly reduced without loss of image quality. This technique can reliably be used in patients with BMI<30 kg/m² and HR less than 70 bpm. 209 216 2019/04/232019/04/232019/04/23 1398/2/3 2019/04/232019/04/232019/04/23 1398/2/3 G. Gokalp G. Gokalp Department of Radiology, Uludag University Medical Faculty, Gorukle, Bursa, Turkey drgokhangokalp@yahoo.com Prospective ECG-triggering kilovolt coronary CTA. Pflederer T, Rudofsky L, Ropers D, et al. (2009) Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenology, 192:1045-1050.##Earls JP, Berman EL, Urban BA, et al. (2008) Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology, 246:742-753. ##Abdulla J, Abildstrom SZ, Gotzsche O, et al. (2007) 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J, 28: 3042-3050.##Shuman WP, Branch KR, May JM, et al. (2008) Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose. Radiology, 248: 431-437.##Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA, 298: 317–323.##Hausleiter J, Meyer T, Hadamitzky M, et al. (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation, 113: 1305–1310.##Neofotistou V, Vano E, Padovani R, et al. (2003) Preliminary reference levels in interventional cardiology. Eur Radiol, 13: 2259–2263.##Ko SM, Kim NR, Kim DH, Song MG, Kim JH (2010) Assessment of image quality and radiation dose in prospective ECG-triggering coronary CT angiography compared with retrospective ECG-gated coronary CT angiography. Int J Cardiovasc Imaging, 1:93-101.##Stolzmann P, Leschka S, Scheffel H, et al. (2008) Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with low radiation dose. Radiology, 249: 71–80.##McCollough CH, Primak AN, Saba O, et al. (2007) Dose performance of a 64-channel dual-source CT scanner. Radiology, 243:775–784.##Achenbach S, Marwan M, Ropers D, et al. (2010) Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggering high-pitch spiral acquisition. Eur Heart J, 31: 340-346.##Achenbach S, Giesler T, Ropers D, et al. (2003) Comparison of image quality in contrast-enhanced coronary-artery visualization by electron-beam tomography and retrospectively electrocardiogram-gated multislice spiral computed tomography. Invest Radiol, 38: 119–128.##Ferencik M, Nomura CH, Maurovich-Horvat P, et al. 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AJR Am J Roentgenol, 189: 567-573.##Tan SK, Yeong CH, Raja Aman RRA, et al. (2018) Low tube voltage prospectively ECG-triggered coronary CT angiography: a systematic review of image quality and radiation dose. Br J Radiol 91(1088): 20170874. ##Feng Q, Yin Y, Hua X, Zhu R, Hua J, Xu J (2010) Prospective ECG triggering versus low-dose retrospective ECG-gated 128-channel CT coronary angiography: comparison of image quality and radiation dose. Clin Radiol, 65: 809-814. ## ##

A Monte Carlo simulation study on the effectiveness of electron filters designed for telecobalt radiation therapy treatment 2 2 Background: The aim of present study was to analyze the effectiveness of electron filters in the Telecobalt radiotherapy treatment by simulation technique.  Materials and Methods: The BEAMnrc Monte Carlo code was used to simulate the electron filters of thickness of 0.5 gm/cm2 below the trimmer bar for 35 × 35 cm2 field size in Theratron Equinox-80 telecobalt unit. The electron filters were made of an aluminum, copper, nickel, tin, PMMA, and lead with single or composite materials. The radiation beams at treatment distance were analyzed by generating profiles for photon and electron along the X-axis of radiation field.  Results: The electron energy fluence for unfiltered beam was 0.32% of the photon energy. The photon energy fluence intensity reduction due to filter was 3.7%. The filters with low atomic number have shown poor electron contamination removal efficiency. The tin, copper and nickel were found effective filters, removing nearly 38% of contaminant electron energy. The lead filter is equally effective as tin, however the high energy electrons emitted from filter due to “photo peaks” adds significant dose at 3.0 to 4.0 mm depth. Conclusion: The tin filter dominates over to other filters on the subject of surface dose reduction and depth of dose maximum (dmax). It reduces the surface dose by 9.6% and 13.9 % of unfiltered beam for 15 × 15 and 20 × 20 cm2 field sizes respectively. 217 227 2019/04/232019/04/232019/04/232019/04/23 1398/2/3 2019/04/232019/04/232019/04/232019/04/23 1398/2/3 R. Shukla R. Shukla Department of Radiotherapy, GGS Medical College, Faridkot, India N.P. Patel N.P. Patel Department of Radiotherapy, Pt. B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, India nppatel03@hotmail.com H.P. Yadav H.P. Yadav Department of Radiotherapy, GGS Medical College, Faridkot, India V. Kaushal V. Kaushal Department of Radiotherapy, Pt. B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, India Telecobalt electron contamination electron filters surface dose Monte Carlo simulation. Ravichandran R (2009) Has the time come for doing away with Cobalt-60 teletherapy for cancer treatments. J Med Phys, 34 (2): 63-65. ##Kumar R, Sharma SD, Phurailatpam R, Deshpande DD, Kannan S (2005) Performance characteristics of indigenously developed Bhabhatron-I telecobalt unit. J Med Phys, 30: 41-7.##Schreiner LJ, Joshi CP, Darko J, Kerr A, Salomons G, Dhanesar S (2009) The role of Cobalt-60 in modern radiation therapy: Dose delivery and image guidance. J Med Phys, 34(3): 133-36.##Sahani G, Sharma SD, Dash Sharma PK, Sharma DN, Hussain SA (2013) Monte Carlo simulation based study of a proposed multilief collimator for a telecobalt machine. Med Phys, 40(2): 0217051-11.##Joshi CP, Dhanesar S, Darko J, Kerr A, Vidyasagar PB and Shreiner LJ (2008) Practical and clinical considerations in Cobalt-60 tomotherapy. Souvenir and Book of Absracts, ICMP: Mumbai; 13-4.##Rogers DWO, Ewart GM, Bielajew AF (1988) Calculation of electron contamination in a cobalt-60 therapy beam. Proceeding of the symposium on dosimetry in radiotherapy. IAEA, 1: 303-12.##Leung Philip MK, Johns HE (1977) Use of electron filters to improve buildup characteristics of large fields from cobalt-60 beams. Med Phys, 4: 441-44.##Huang D, Williams S, Chaney E, Long F (1983) Evaluation of lead acrylic as a filter for contamination electrons in megavoltage photon beams. Med Phys, 10: 93-95.##Bova FJ and Hill LW (1983) Surface doses for acrylic versus lead acrylic blocking trays for Co-60, 8-MV, and 17-MV photons. Medical Physics, 10: 254-56.##Attix FH, Lopez F, Owolabi S, Paliwal BR (1983) Electron contamination in Co-60 gamma-ray beams. Med Phys, 10: 301-06.## Nilsson B (1985) Electron contamination from different materials in high energy photon beams. Physics in Medicine and Biology, 30(2): 139-52.##Biggs PJ and Ling CC (1979) Electrons as the cause of the observed dmax shift with the field size in high energy photon beams. Med Phys, 6: 291-95.##Ling CC and Biggs PJ (1979) Improving the buildup and depth-dose characteristics of high energy photon beams by using electron filters. Med Phys, 6: 296-301.##Rao BM, Prasad SG, Parthasaradhi K, Lee Y, Ruparel R, Garces R (1988) Investigations on the near surface dose for three 10 MV X-ray beam accelerators with emphasis on the reduction of electron contamination. Med Phys, 15: 246-49.##Parthasaradhi K, Prasad SG, Rao BM, Lee Y, Ruparel R, Garces R (1989) Investigation on the reduction of electron contamination with a 6 MV X-ray beam. Med Phys, 16: 123-25.##Ciesielski B, Reinstein LE, Wielopolski L, Meek A (1989) Dose enhancement in the buildup region by lead, aluminum, and lucite absorbers for 15 MV photon beam. Med Phys, 16: 609-13.##Li XA and Rogers DWO (1994) Reducing electron contamination for photon beam-quality specification. Med Phys, 21(6): 791-97.##Roger DWO (1999) Correcting for electron contamination at dose maximum in photon beams. Med Phys, 26 (4): 533-37.##Kawrakow I (2000) Accurate condensed history Monte Carlo simulation of electron transport. EGSnrc, the new EGS4 version. Med Phys, 27: 485 – 98. ##Rogers DWO, Faddegon BA, Ding GX, Ma CM, Wei JS, Mackie TR (1995) BEAM: a Monte Carlo code to simulate radiotherapy treatment units. Med Phys, 22: 503−25. ##Ma CM and Rogers DWO (2006) BEAMDP as a General Purpose utility. NRCC Report PIRS-509(E) revA.##Rogers DWO, Walters B, Kawrakow I (2005) BEAMnrc user’s manual. NRCC Report PIRS-0509(A). NRCC, Ottawa. ##Kawrakow I and Rogers DWO (2003) EGSnrc Code System. NRCC report PIRS-701; 194-239. ##Ma CM, Rogers DWO, and Walters B (2001) DOSXYZnrc User’s Manual. NRC Report PIRS 509b (revF).##Patel NP, Shukla R, Balasubramanian N, Atri R, Dhull AK, Yadav HP, Kaushal V (2016) Radiation beam characterization and dosimetry of Theratron Equinox-80 telecobalt machine using BEAMnrc Monte Carlo simulation code. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 5(4): 298-316.## ##

Ameliorative effects of Hesperidin on radiation induced brain injury in rats 2 2 Background: Extensive research has been focused on radiation induced brain injury. Animal and human studies have shown that flavonoids have remarkable toxicological profiles. This study aims to investigate the neuroprotective effects of hesperidin in an experimental radiation induced brain injury. Materials and Methods: 32 adult male Wistar-Albino rats were randomly divided into 4 groups (control, hesperidin, radiation, and radiation+hesperidin groups; 8 rats in each group). 200 mg/kg  doses of hesperidin were administered to the animals in the hesperidin and radiation+ hesperidin groups, radiation and radiation+ hesperidin groups were exposed to a dose of 20 Gy cranium region. Tissue samples, and biochemical levels of tissue injury markers in four groups were compared. Results: In all measured parameters of oxidative stress, administration of hesperidin significantly demonstrated favorable effects. Both plasma and tissue levels of malondialdehyde and total antioxidant status significantly changed in favor of antioxidant activity. Histopathological evaluation of the tissues also demonstrated significant decrease in cellular degeneration and infiltration parameters after hesperidin administration. Conclusion: This Hesperidin demonstrated significant neuroprotection after radiation induced brain injury. Further studies with different experimental settings including neurological outcome are required to achieve conclusive results. 229 236 2019/04/232019/04/232019/04/232019/04/232019/04/23 1398/2/3 2019/04/232019/04/232019/04/232019/04/232019/04/23 1398/2/3 A. Kale A. Kale Department of Neurosurgery, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey aydemirkale@gmail.com Ö. Pişkin Ö. Pişkin Department of Anesthesiology and Reanimation, Bülent Ecevit University Faculty of Medicine,Zonguldak, Turkey. Y. Baş Y. Baş Department of Pathology, Hitit University Faculty of Medicine, Çorum, Turkey B.G. Aydın B.G. Aydın Department of Anesthesiology and Reanimation, Bülent Ecevit University Faculty of Medicine,Zonguldak, Turkey. M. Can M. Can Department of Biochemistry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey Ö. Elmas Ö. Elmas Department of Radiation Oncology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey Ç. Büyükuysal Ç. Büyükuysal Department of Biostatistics, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey Radiation brain injury hesperidin neuroprotection. Mildenberger M, Beach TG, McGeer EG, Ludgate CM (1990) An animal model of prophylactic cranial irradiation: histologic effects at acute, early and delayed stages. Int J Radiat Oncol Biol Phys, 18(5): 1051-60.##Cihan YB, Arsav V, Göcen E (2011) Royal Jelly in the Prevention of Radiation-Induced Brain Damages. Journal of Neurological Sciences, [Turkish] 29: 475-486.##Behin A and Delattre JY (2004) Complications of radiation therapy on the brain and spinal cord. Semin Neurol, 24: 405–417.##Yang L, Yang J, Li G, Li Y, Wu R, Cheng J, Tang Y (2017) Pathophysiological Responses in Rat and Mouse Models of Radiation-Induced Brain Injury. Mol Neurobiol, 54(2): 1022-1032.##Hopewell JW (1979) Late radiation damage to the central nervous system: a radiobiological interpretation. Neuropathol Appl Neurobiol, 5: 329–343.##Gorman AM, McGowan A, O'Neill C, Cotter T (1996) Oxidative stress and apoptosis in neurodegeneration. J Neurol Sci, 139: 45–52.##Sezen O, Ertekin MV, Demircan B, Karslioğlu I, Erdoğan F, Koçer I, Calik I, Gepdiremen A (2008) Vitamin E and L-carnitine, seperately or in combination, in the prevention of radiation-induced brain and retinal damages. Neurusurgica Review, 31: 205-213.##Steen RG, Spence D, Wu S, Xiong X, Kun LE, Merchant TE (2001) Effect of therapeutic ionizing radiation on the human brain. Ann Neurol, 50: 787-795.##Kondziolka D, Somoza S, Martinez AJ, Jacobsohn J, Maitz A, Lunsford LD, Flickinger JC (1997) Radioprotective effects of the 21-Aminosteroid U- 74389G for stereotactic radiosurgery. Neurosurg, 41: 203-208.##Erol FS, Topsakal C, Ozveren MF, Kaplan M, Ilhan N, Ozercan IH, Yildiz OG (2004) Protective effects of melatonin and vitamin E in brain in damage due to gamma radiation: an experimental study. Neurosurg Rev, 27: 65-69. ##Rice-Evans CA, Miller NJ, Paganga G (1996) Structure-antioxidant activity relationships of flavonoids and phenolic acids. Free Radic Biol Med, 20: 933–956 4. ##Rice-Evans C (2001) Flavonoid antioxidants. Curr Med Chem, 8: 797–8075. ##Gaur V and Kumar A (2010) Hesperidin pre-treatment attenuates NO-mediated cerebral ischemic reperfusion injury and memory dysfunction. Pharmacol Rep, 62: 635–648.##Kamisli S, Ciftci O, Kaya K, Cetin A, Kamisli O, Ozcan C (2015) Hesperidin protects brain and sciatic nerve tissues against cisplatin-induced oxidative, histological and electromyographical side effects in rats. Toxicol Ind Health, 31(9): 841-51.##Shagirtha K and Pari L (2011) Hesperetin, a citrus flavonone, protects potentially cadmium induced oxidative testicular dysfunction in rats. Ecotoxicol Environ Saf, 74(7): 2105-11.##Youdim KA, Dobbie MS, Kuhnle G, Proteggente AR, Abbott NJ, Rice-Evans C (2003) Interaction between flavonoids and the blood–brain barrier: in vitro studies. J Neurochem, 85(1): 180–192.##Rong Z, Pan R, Xu Y, Zhang C, Cao Y, Liu D (2013) Hesperidin pretreatment protects hypoxia-ischemic brain injury in neonatal rat. Neuroscience, 255: 292-9.##Hwang SL, Shih PH, Yen GC (2012) Neuroprotective effects of citrus flavonoids. J Agric Food Chem, 60(4): 877-85.##Oztanir MN, Ciftci O, Cetin A, Aladag MA (2014) Hesperidin attenuates oxidative and neuronal damage caused by global cerebral ischemia/reperfusion in a C57BL/J6 mouse model. Neurol Sci, 35(9): 1393-9.##Li M, Lin XF, Lu J, Zhou BR, Luo D (2016) Hesperidin ameliorates UV radiation-induced skin damage by abrogation of oxidative stress and inflammatory in HaCaT cells. J Photochem Photobiol B, 165: 240-245.##Chang CY, Lin TY, Lu CW, Huang SK, Wang YC, Chou SS, Wang SJ (2015) Hesperidin inhibits glutamate release and exerts neuroprotection against excitotoxicity induced by kainic acid in the hippocampus of rats. Neurotoxicology, 50: 157-69.##Menze ET, Tadros MG, Abdel Tawab AM, Khalifa AE (2012) Potential neuroprotective effects of hesperidin on 3-nitropropionic acid-induced neurotoxicity in rats. Neurotoxicology, 33(5): 1265-75.##Nones J, E Spohr TC, Gomes FC (2011) Hesperidin, a flavone glycoside, as mediator of neuronal survival. Neurochem Res, 36(10): 1776-84. ##Raza SS, Khan MM, Ahmad A, Ashafaq M, Khuwaja G, Tabassum R, Javed H, Siddiqui MS, Safhi MM, Islam F (2011) Hesperidin ameliorates functional and histological outcome and reduces neuroinflammation in experimental stroke. Brain Res, 28; 1420: 93-105. ##Saija A, Scalese M, Lanza M, Marzullo D, Bonina F, Castelli F (1995) Flavonoids as antioxidant agents, importance of their interaction with biomembranes. Free Radic Biol Med, 19(4): 481–486.##Kim JY, Jung KJ, Choi JS, Chung HY (2004) Hesperetin, a potent antioxidant against peroxynitrite. Free Radic Res, 38(7): 761–769.##Jung HA, Jung MJ, Kim JY, Chung HY, Choi JS (2003) Inhibitory activity of flavonoids from Prunus davidiana and other flavonoids on total ROS and hydroxyl radical generation. Arch Pharm Res, 26(10): 809–815.##Durak MA, Parlakpinar H, Polat A, Vardi N, Ekici K, Ucar M, Ozhan O, Yildiz A, Pasahan R (2017) Protective and therapeutic effects of molsidomine on radiation induced neural injury in rats. Biotech Histochem, 92(1): 68-77.##Ishisaka A, Ichikawa S, Sakakibara H, Piskula MK, Nakamura T, Kato Y, Ito M, Miyamoto K, Tsuji A, Kawai Y and Terao J (2011) Accumulation of orally administered quercetin in brain tissue and its antioxidative effects in rats. Free Radic Biol Med, 1;51(7): 1329-36. ##Panagiotakos G, Alshamy G, Chan B, Abrams R, Greenberg E, Saxena A, Bradbury M, Edgar M, Gutin P, Tabar V (2007) Long-term impact of radiation on the stem cell and oligodendrocyte precursors in the brain.PLoS One, 11(2): e588.##Ott M, Gogvadze V, Orrenius S, Zhivotovsky B (2007) Mitochondria, oxidative stress and cell death. Apoptosis, 12(5): 913–922.##Costa LG, Garrick JM, Roquè PJ, Pellacani C (2016) Mechanisms of Neuroprotection by Quercetin: Counteracting Oxidative Stress and More. Oxid Med Cell Longev, ?: 2986796.##Hwang SL and Yen GC (2008) Neuroprotective effects of the citrus flavanones against H2O2-induced cytotoxicity in PC12 cells. J Agric Food Chem, 56(3): 859-64.##Vafeiadou K, Vauzour D, Lee HY, Rodriguez-Mateos A, Williams RJ, Spencer JP (2009) The citrus flavanone naringenin inhibits inflammatory signalling in glial cells and protects against neuroinflammatory injury. Arch Biochem Biophys, 1;484(1):100-9.##Halliwell B and Chirico S (1993) Lipid peroxidation: its mechanism, measurement, and significance. Am J Clin Nutr, 57(5): 715S–724S. ## ##

Evaluating the effects of esophageal and breast cancer radiotherapy on the cardiac function and determining the relationship between the dosimetric parameters and ejection fraction changes 2 2 Background: In the radiotherapy of patients with esophagus and breast cancer, the heart receives a significant dose of radiation that might cause heart complications. Thefore, the aim of the current study was to evaluate the effects of esophagus and left breast cancer radiotherapy on the cardiac function and to determine the relationship between the dosimetric parameters and ejection fraction (EF) changes. Materials and Methods: Patients with esophageal (n=13) and left breast cancer (n=21) enrolled at our radiotherapy center from March to October 2017. Echocardiography tests were obtained from patients, before and six months after the radiotherapy. Dosimetric parameters were extracted from treatment planning system. The assessed outcomes included pre- and post-radiation EF ratios and percentage change in the EF following radiation.  Results: The mean ± standard deviations of EFs in patients with breast cancer before and six months after treatment were 55.95%±3.2% and 53.10%±6.30% respectively, which were not statistically significant (P = 0.07). In patients with esophagus cancer, the mean ± standard deviations of pretreatment and post-treatment EFs were 56.76%±3.44% and 52.09%±3.88% respectively, which were statistically significant (P = 0.005). Conclusion: The results of our study showed a significant variation of EFs in esophageal cancer patients following radiotherapy, while breast cancer patients treated with radiotherapy showed no significant change. In patients with esophagus cancer, there was a significant correlation between the variation of EFs and volume of heart receiving radiation doses ≥30 Gy (≥V30). Therefore,  to avoid reduction in EF, the use of V20 as a dose-volume constraint is recommended.   237 244 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/4 1398/2/14 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/4 1398/2/14 B. Goldoost B. Goldoost Department of Medical Physics, Urmia University of Medical Sciences, Urmia, Iran N. Jabbari N. Jabbari Solid Tumor Research Center, Department of Medical physics and Imaging, Urmia University of Medical Sciences, Urmia, Iran njabbarimp@gmail.com O. Esnaashari O. Esnaashari Omid Research and Treatment Center, Urmia, Iran K. Mostafanezhad K. Mostafanezhad Omid Research and Treatment Center, Urmia, Iran Radiation therapy cardiac function breast cancer esophagus cancer echocardiography. ##Hosseinzadeh M, Eivazi Ziaei J, Mahdavi N,  Aghajari P, Vahidi M, Fateh A, et al. (2014) Risk factors for breast cancer in Iranian women: a hospital-based case-control study in tabriz, iran. J breast cancer, 17: 236-243.##Ma NY, Cai XW, Fu XL, Li Y, Zhou XY, Wu XH, et al. (2014) Safety and efficacy of nimotuzumab in combination with radiotherapy for patients with squamous cell carcinoma of the esophagus. Int J Clin Oncol, 19: 297-302.##Sadjadi A, Marjani H, Semnani S, Nasseri-Moghaddam S (2010) Esophageal cancer in Iran: A review. Middle East J Cancer, 1: 5-14.##Lund M, von Döbeln GA, Nilsson M, Winter R, Lundell L, Tsai JA, et al. (2015) Effects on heart function of neoadjuvant chemotherapy and chemoradiotherapy in patients with cancer in the esophagus or gastroesophageal junction–a prospective cohort pilot study within a randomized clinical trial. Radiother Oncol, 10: 16.##Bouillon K, Haddy N, Delaloge S, Garbay JR, Garsi JP, Brindel P, et al. (2011) Long-term cardiovascular mortality after radiotherapy for breast cancer. J American Coll Cardiol, 57: 445-452.##Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE, et al. (2007) Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol, 25: 3031-3037.##Tripp P, Malhotra H, Javle M, Shaukat A, Russo R, De Boer S, et al. (2005) Cardiac function after chemoradiation for esophageal cancer: comparison of heart dose-volume histogram parameters to multiple gated acquisition scan changes. Dis Esophagus, 18: 400-405.##Mukherjee S, Aston D, Minett M, Brewster AE, Crosby TD (2003) The significance of cardiac doses received during chemoradiation of oesophageal and gastro–oesophageal junctional cancers. Clin Oncol (R Coll Radiol), 15: 115-120.##Hatakenaka M, Yonezawa M, Nonoshita T, Nakamura K, Yabuuchi H, Shioyama Y, et al. (2012) Acute cardiac impairment associated with concurrent chemoradiotherapy for esophageal cancer: magnetic resonance evaluation. Int J Radiat Oncol Biol Phys, 83: e67-e73.##Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L (2015) Recommendations for cardiac chamber quantification by  echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr,  28(1): 1-39.e14. ##Shirai K, Tamaki Y, Kitamoto Y, Murata K, Satoh Y, Higuchi K, et al. (2011) Dose–volume histogram parameters and clinical factors associated with pleural effusion after chemoradiotherapy in esophageal cancer patients. Int J Radiat Oncol Biol Phys, 80: 1002-1007.##Martel MK, Sahijdak WM, Ten Haken RK, Kessler ML, Turrisi AT (1998) Fraction size and dose parameters related to the incidence of pericardial effusions. Int J Radiat Oncol Biol Phys, 40: 155-161.##Fukada J, Shigematsu N, Takeuchi H, Ohashi T, Saikawa Y, Takaishi H, et al. (2013) Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients. Int J Radiat Oncol Biol Phys, 87: 487-493.##Canney P, Sanderson R, Deehan C, Wheldon T (2001) Variation in the probability of cardiac complications with radiation technique in early breast cancer. Br J Radiol, 74: 262-265.##Nellessen U, Zingel M, Hecker H, Bahnsen J, Borschke D (2010) Effects of radiation therapy on myocardial cell integrity and pump function: which role for cardiac biomarkers? Chemotherapy 56: 147-152.##Marı́n J, Marı́n E, Gutiérrez-Iñiguez MA,  Avendaño C, Rodríguez-Martínez MA (2000) Mechanisms involved in the hemodynamic alterations in congestive heart failure as a basis for a rational pharmacological treatment. Pharmacol Ther, 88: 15-31.##Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol, 176: 289-296.##Rehani MM, Bongartz G, Kalender W, Golding SJ, Gordon L, Murakami T, et al. (2000) Managing patient dose in computed tomography. Ann ICRP, 30: 7-45.##Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. (2014) Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 15: 1063-1093.##Nasrollah J, Mikaeil M, Omid E, Mojtaba SS, Ahad Z (2014) Influence of the intravenous contrast media on treatment planning dose calculations of lower esophageal and rectal cancers. J Cancer Res Ther, 10: 147-152.##Molazadeh M, Saberi H, Rahmatnezhad L,  Molani A, Jabbari N (2013) Evaluation The Effect Of Photon Beam Energies On Organ At Risk Doses In Three-Dimensional Conformal Radiation Therapy. Res J App Sci Eng Technol, 6: 2110-2117.##Mackie T, Scrimger J, Battista J (1985) A convolution method of calculating dose for 15‐MV X-rays. Med Phys, 12: 188-196.##Ahnesjö A (1989) Collapsed cone convolution of radiant energy for photon dose calculation in heterogeneous media. Med Phys, 16: 577-592.##IAEA (International Atomic Energy Agency) (2008) Commissioning of radiotherapy treatment planning systems: testing for typical external beam treatment techniques. Vienna: IAEA, TECDOC 1583.##Mahmoudi R, Jabbari N, Aghdasi M, Khalkhali HR (2016) Energy Dependence of Measured CT Numbers on Substituted Materials Used for CT Number Calibration of Radiotherapy Treatment Planning Systems. PLoS One, 8;11(7): e0158828.##International Commission on Radiation Units and Measurements (1999) Prescribing, Recording, and Reporting Photon Beam Therapy (supplement to ICRU Report 50). ICRU Report 62. Bethesda, MD. International Commission of Radiation Units and Measurements.##Wambersie A and Landgerg T (1999) ICRU report 62: prescribing, recording and reporting photon beam therapy. ICRU Publ Bethesda MD.##Savage DE, Constine LS, Schwartz RG, Rubin P (1990) Radiation effects on left ventricular function and myocardial perfusion in long term survivors of Hodgkin's disease. Int J Radiat Oncol Biol Phys, 19: 721-727.##Galderisi M, Marra F, Esposito R, Lomoriello VS, Pardo M, de Divitiis O (2007) Cancer therapy and cardiotoxicity: the need of serial Doppler echocardiography. Cardiovasc Ultrasound, 5: 4.##Rodemann HP and Bamberg M (1995) Cellular basis of radiation-induced fibrosis. Radiother Oncol, 35: 83-90.##Sporn LA, Rubin P, Marder V, Wagner D (1984) Irradiation induces release of von Willebrand protein from endothelial cells in culture. Blood, 64: 567-570.##Meinardi MT, Gietema JA, van der Graaf WT, van Veldhuisen DJ, Runne MA, Sluiter WJ,  et al. (2000) Cardiovascular morbidity in long-term survivors of metastatic testicular cancer. J Clin Oncol, 18: 1725-1732.## ##

Natural radioactivity in ceramic tiles and associated radiological hazards 2 2 Background: The natural radioactivity levels in ceramic tiles produced in Turkey were determined and the related radiological hazards were assessed. Materials and Methods: The natural radioactivity levels (226Ra, 232Th and 40K) in the ceramic tiles were measured using high-purity germanium detector system (HPGe) and the related radiological hazards were assessed by radium equivalent activity (Raeq), external hazard index (Hex), representative level index (Iγ), absorbed dose rate (D) and annual effective dose (AED). Results: The average activity concentrations of 226Ra, 232Th and 40K radionuclides in the ceramic tiles were found to be 36.59 ± 2.64, 51.23 ± 2.81 and 420.81 ± 12.87 Bq/kg, respectively. These values are less than the world average values except the activity values of 232Th. Again, the averages of radiological hazard parameters (Raeq, Hex, D and AED) found for all ceramic tiles were found lower than the world averages. Conclusion: The present results was compared with the literature and the international reference values. This study shows that the investigated ceramic tiles can be used safely in constructions and do not create significant radiological hazard when used in constructions. 245 252 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/11 1398/2/21 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/11 1398/2/21 S. Dizman S. Dizman Recep Tayyip Erdogan University, Faculty of Sciences and Arts, Department of Physics, Rize, Turkey serdar.dizman@erdogan.edu.tr R. Keser R. Keser Recep Tayyip Erdogan University, Faculty of Sciences and Arts, Department of Physics, Rize, Turkey Ceramic tile natural radioactivity radiological hazard Turkey. Jankovic R, Rajacic M, Rakic T, Todorovic D (2013) Natural radioactivity in imported ceramic tiles used in Serbia. Process Appl Ceram, 7: 123–127.##UNSCEAR (Sources, effects and risks of ionizing radiation. United Nations Scientific Committee on Effects of Atomic Radiation) (1988) UNSCEAR 1988 report to the general assembly with annexes, United Nations, New York.##Ravisankar R, Raghu Y, Chandrasekaran A, Suresh Gandhi M, Vijayagopal P, Venkatraman B (2016) Determination of natural radioactivity and the associated radiation hazards in building materials used in Polur, Tiruvannamalai District, Tamilnadu, India using gamma ray spectrometry with statistical approach. J Geochemical Explor, 163: 41-52.##Lu X, Chao S, Yang F (2014) Determination of natural radioactivity and associated radiation hazard in building materials used in Weinan, China. Radiat Phys Chem, 99: 62–67.##Uosif M, Omer M, Ali N, Hefni M (2015) Radiological Hazard Resulting from using Ceramic Tile in Egypt. Int J Adv Sci Technol, 80: 19–30.##Ceramic sector report (2015) Republic of Turkey Ministry of Science, Industry and Technology (SIT). Ceramic sector report Volume 1.##Grigorescu EL, Sahagia M, Razdolescu AC, Luca A, Ivan C (2002) Standardization of Eu-152. Appl Radiat Isot, 56: 435–439.##IAEA (International Atomic Energy Agency) (1989) Measurement of radionuclides in food and the environment. IAEA Technical Report Series No. 295.##Beretka J and Mathew PJ (1985) Natural radioactivity of Australian building materials, waste and by-products. Health Phys, 48: 87–95.##Krieger R (1981) Radioactivity of construction materials, Betonw Fert Technol, 47: 468–473.##EC (European Commission) (1999) Radiological protection principles concerning the natural radioactivity of building materials. Radiation Protection 112.##UNSCEAR (United Nations Scientific Committee on Effects of Atomic Radiation) (2000) Sources, effects and risks of ionizing radiation. UNSCEAR 2000 report to the general assembly with annexes, United Nations, New York.##Kumar A, Kumar M, Singh B, Singh S (2003) Natural activities of 238U, 232Th and 40K in some Indian building materials. Radiat Meas, 36: 465–469.##Xinwei L (2004) Radioactivity level in Chinese building ceramic tile. Radiat Prot Dosimetry, 112: 323–327.##Ahmed NK (2005) Measurement of natural radioactivity in building materials in Qena city, Upper Egypt. J Environ Radioact, 83: 91–99.##Amin SA and Naji M (2013) Natural radioactivity in different commercial ceramic samples used in Yemeni buildings. Radiat Phys Chem, 86: 37–41.##Ngachin M, Garavaglia M, Giovani C, Kwato Njock MG, Nourreddine A (2007) Assessment of natural radioactivity and associated radiation hazards in some Cameroonian building materials. Radiat Meas, 42: 61–67.##Righi S, Guerra R, Jeyapandian M, Verità S, Albertazzi A (2009) Natural radioactivity in Italian ceramic tiles. Radioprotection, 44: 413–419.##Turhan S, Arikan IH, Demirel H, Güngör N (2011) Radiometric analysis of raw materials and end products in the Turkish ceramics industry. Radiat Phys Chem, 80: 620–625.##Fathivand AA, Amidi J, Hafezi S (2007) Natural radioactivity concentration in raw materials used for manufacturing refractory products. Int J Radiat Res, 4(4): 201-204.## ##

Dosimetric influence of Flattening Filter (FF) and Flattening Filter Free (FFF) 6 and 10 MV photon beams on Volumetric Modulated Arc Therapy (VMAT) planning in case of prostate carcinoma 2 2 Background: In the treatment of prostate cancer, radiotherapy is the potential to increase second primary cancers such as bladder and rectal cancers. The reasons for this potential are more monitor units (MUs), therefore a larger total body dose because of leakage radiation, a bigger volume of normal tissue is exposed to lower radiation doses. This study was designed to compare the integral dose of using Flattening Filter (FF) and Flattening Filter-Free (FFF) 6 and 10 MV photon beams via volumetric modulated arc therapy (VMAT) for prostate cancer patients. Materials and Methods: Twenty prostate cancer patients were selected retrospectively for this planning study. VMAT plans were developed using the Eclipse (Varian Medical System, Palo Alto, California, USA) Treatment Planning System (TPS) with 6 MV FF, 6 MV FFF, 10 MV FF and 10 MV FFF for each patient. Conformity index (CI), homogeneity index (HI), Integral dose (ID), the volume receiving 5 Gy (V5%) and monitor units (MUs) were compared. Results: The use of 10 MV FF had 206 liter*Gy integral dose to Body-CTV volume. Using 10 MV FFF had 204 liter*Gy integral dose to normal structures. When 10 MV FF or 10 MV FFF were used instead of 6 MV FF and 6 MV FFF integral dose decreased as -7% and -8%, respectively. The dosimetric difference were statistically significant (p<0.05). The use of 10 MV FFF rather than 10 MV FF had limited influence on the integral dose for rectum, bladder, penile bulb and femoral heads. Conclusion: This study showed that high energy photons (10 MV FF, 10 MV FFF) have lower integral dose than low energy photons (6 MV FF, 6 MV FFF). The relationship between low energies, high energies and integral doses is significant, although there is no significant relationship between V5% doses of all energies. In comparison to different treatment plans, we showed that V5% alone did not provide enough information when possible secondary cancer risks were calculated.  253 263 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/12 1398/2/22 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/12 1398/2/22 A. Cakir A. Cakir Istanbul Bilgi University, Sisli-Istanbul, Turkey aydin.cakir@bilgi.edu.tr Z. Akgun Z. Akgun Istanbul Memorial Hospital Radiation Oncology Department, Sisli-Istanbul, Turkey E. Kaytan Saglam E. Kaytan Saglam Istanbul University Oncology Institute, Istanbul, Turkey Integral radiation dose secondary cancer flattening filter free beam volumetric modulated arc therapy prostate cancer. ##Cahlon O, Zelefsky MJ, Shippy A, Chan H, Fuks Z, Yamada Y, Hunt M, Greenstein S, Amols H (2008) Ultra-high dose (86.4Gy) IMRT for localized prostate cancer: toxicity and biochemical outcomes. Int J Radiat Oncol Biol Phys, 71: 330-337. ##Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A, Amols HI (2008) Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys, 70:1124-1129.##Hall EJ, Wuu C (2003) Radiation-induced second cancers: The impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys, 56: 83-88.##Preston D, Shimizu Y, Pierce D, Suyama A, Mabuchi K (2003) Studies of mortality of atomic bomb survivors. Report 13: solid cancer and non-cancer mortality, 1950-1977. Radiat Res, 160: 381-407.##Hall EJ (2006) Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Ooncol Biol Phys, 65: 1-7.##National council on radiation protection and measurements. Limitation of exposure to ionizing radiation. NCRP report 116. National council on radiation protection and measurements; 1993.##Ashman JB, Zelefsky MJ, Hunt MS, Leibel SA, Fuks Z (2005) Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys, 63: 765-71.##Luxton G, Hancock SL, Boyer AL (2004) Dosimetry and radiobiologic model comparison of IMRT and 3D conformal radiotherapy in treatment of carcinoma of the prostate. Int J Radiat Oncol Biol Phys, 59: 267-284.##Zelefsky MJ, Fuks Z, Happersett L, Lee HJ, Ling CC, Hunt M, Wolfe T, Venkatraman ES, Jackson A, Skwarchuk M, Leibel SA (2000) Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol, 55: 241-249.##Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, McKenzie M, Morris J, Otto K (2008) Volumetric modulated arc therapy for delivery of prostate radiotherapy: Comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys, 72: 996-1001.##Mahdavi SRM, Jazayeri Gharehbagh E, Nikoofar AR, Mofid B, Vasheghani M, Saedi D (2017) Radiation treatment planning for prostate cancer: A new dosimetric comparison of five and seven fields IMRT plans. Int J Radiat Res, 15: 177-183##Kry SF, Salehpour M, Followill DS, Stovall M, Kuban DA, White RA, Rosen II (2005) The calculated risk of fatal secondary malignancies from intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys, 62: 1195-1203.##Pasquier D, Cavillon F, Lacornerie T, Touzeau C,Tresch E, Lartigau E (2013) A dosimetric comparison of tomotherapy and volumetric modulated arc therapy in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy. Int J Radiat Oncol Biol Phys, 85: 549-554.##Wu VW, Kwong DL, Sham JS (2004) Target dose conformity in 3-dimensional conformal radiotherapy and intensity modulated radiotherapy. Radiother Oncol, 71: 201-206.##Brenner DJ, Curtis RE, Hall EJ, Ron E (2000) Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer, 88: 398-406.##Otto K (2008).Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys, 35: 310-317.##Shepard DM, Cao D, Afghan MK, Earl MA (2007) An arc-sequencing algorithm for intensity modulated arc therapy. Med Phys, 34: 464-470.##Ottolenghi A, Smyth V, Trott KR (2011) The risk to healthy tissues from the use of existing and emerging techniques for radiation therapy. Radiat Prot Dosim, 143: 533-535.##Ruben JD, Davis S, Evans C, Jones P, Gagliardi F, Haynes M, Hunter A (2008) The effect of intensity modulated radiotherapy on radiation-induced second malignancies. Int J Radiat Oncol Biol Phys, 70: 1530-1536.##Zelefsky MJ, Pei X, Teslova T, Kuk D, Magsanoc JM, Kollmeier M, Cox B, Zhang Z (2012) Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific survival outcomes according to the initial treatment intervention. BJU Int, 110:1696-1701.##Budäus L, Bolla M, Bossi A, Cozzarini C, Crook J, Widmark A, Wiegel T (2012) Functional Outcomes and Complications Following Radiation Therapy for Prostate Cancer: A Critical Analysis of the Literature. Eur Urol, 61:112-127.##Chung JB, Kim JS, Eom KY, Kim IA, Kang SW, Lee JW, Kim JY, Suh TS (2015) Comparison of VMAT-SABR treatment plans with flattening filter (FF) and flattening filter-free (FFF) beam for localized prostate cancer. J App Clin Med Phys, 16:302-313.##Cakir A, Akgun Z, Fayda M, Agaoglu F (2015) Comparison of three dimensional conformal radiation therapy, intensity modulated radiation therapy and volumetric modulated arc therapy for low radiation exposure of normal tissue in patients with prostate cancer. Asian Pac J Cancer Prev, 16: 3365-3370.##Romanenko A, Morimura K, Wanibuchi H, Wei M, Zaparin W, Vinnichenko W, Kinoshita A, Vozianov A, Fukushima S (2003) Urinary bladder lesions induced by persistent chronic low-dose ionizing radiation. Cancer Sci, 94: 328-333.##Xu XG, Bednarz B and Paganetti H (2008) A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction. Phys Med Biol, 53: 193-241.##Shaffer R, Morris WJ, Moiseenko V, Welsh M, Crumley C, Nakano S, Schmuland M, Pickles T, Otto K (2009) Volumetric modulated Arc therapy and conventional intensity-modulated radiotherapy for simultaneous maximal intraprostatic boost: a planning comparison study. Clin Oncol, 21: 401-407.##Wolff JM, Mason M (2012) Drivers for change in the management of prostate cancer-guidelines and new treatment techniques. BJU Int, 109: 33-41.##Tsai CL, Wu JK, Chao HL, Tsai YC, Cheng JC (2011) Treatment and dosimetric advantages between VMAT, IMRT, and helical tomotherapy in prostate cancer. Medical Dosimetry, 36: 264- 271.##Rechner LA, Howell RM, Zhang R, Etzel C, Lee AK, Newhauser WD (2012) Risk of radiogenic second cancers following volumetric modulated arc therapy and proton arc therapy for prostate cancer. Phys Med Biol, 57: 7117-7132.## ##

Intensified neoadjuvant radio-chemotherapy for locally advanced rectal cancer: mono-istitutional experience and long-term results 2 2 Background: Purpose: The purpose of our study is to demonstrate that intensified neoadjuvant chemo-radiotherapy (CRT) treatment in locally advanced rectal cancer (LARC), aimed at further enhancing the complete pathological response and local disease control, is feasible and well tolerated.  Materials and Methods: From January 2011 to December 2015, 62 patients (women 21, men 41, mean age 61,5, range 36-84) with LARC (cT2-3 cN0-2) were enrolled in our institution. All patients performed an intensified neo-adjuvant CRT treatment according to the following scheme: FOLFOX4 induction chemotherapy for 3 cycles, followed by a concomitant radio-chemotherapy, with concomitant boost pelvic radiotherapy to a total dose to the primary of 54 Gy and daily continuous infusion of 5-Fluorouracil. After 6-8 weeks pts were re-evaluated by means of colonoscopy, body TC and pelvic MRI. Results: Intensified CRT compliance was 90%. Grade I-II proctitis according to CTCAE v4.0 was 43%, grade III diarrhea was 10%, grade I-II genito-urinary toxicity was 29%. Eleven patients (19%) had a complete pathological response (pCR), 37 patients had a partial response. Sixty patients received surgery, two refused it: sphincter-saving procedure was performed in 85% of patients, Miles’ surgery in 15% of them. Fifty-nine patients are alive, after a median follow-up time of 43 months. Six patients experienced a distant metastatic disease, and two patients a local relapse. Conclusion: This study has shown that the intensification of preoperative systemic therapy, together with intensification of radiotherapy, was feasible, well tolerated and has obtained high rates of local disease control (96,5%), with 19% of pCR rate. 265 273 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/12 1398/2/22 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/12 1398/2/22 C. Spatola C. Spatola UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy cor_spatola@hotmail.com L. Raffaele L. Raffaele UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy A. Tocco A. Tocco UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy G. Acquaviva G. Acquaviva UOC Radioterapia, AOE Cannizzaro, via Messina 829, 95125 Catania R. Milazzotto R. Milazzotto UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy R. Bevilacqua R. Bevilacqua UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy V. Salamone V. Salamone UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy P.V. Foti P.V. Foti UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy P. Milone P. Milone UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy A. Basile A. Basile UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy A. Di Cataldo A. Di Cataldo UOC Chirurgia Digerente Colorettale, AOU Policlinico-VE di Catania G. Privitera G. Privitera UOC Radiodiagnostica e Radioterapia oncologica, AOU Policlinico-VE, via S.Sofia 78, 95125 Catania, Italy Intensified radio-chemotherapy locally advanced rectal cancer concomitant boost radiotherapy. 1. Heald RJ and Ryall RD(1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet, 1: 1479-1482.##2. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJT, Pahlman L, Glimelius B, van Krieken JHJM, Leer JWH, van de Velde CJH (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med, 345: 638-646.##3. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC, Parmar M (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet, 373: 811-820.##4. Bosset JF , Collette L , Calais G ,  Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med, 355:1114-1123.##5. Gérard JP,  Conroy T,  Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, Untereiner M, Leduc B, Francois E, Maurel J, Seitz JF, Buecher B, Mackiewicz R, Ducreux M, Bedenne L. (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol, 24: 4620-4625.##6. Andre T,  Boni C,  Navarro M, Tabernero J, Hickish T, Topham C, Bonetti A, Clingan P, Bridgewater J, Rivera F, de Gramont A (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II and III colon cancer in the MOSAIC trial. J Clin Oncol, 27: 3109-3116.##7. Jakobsen A, Ploen J, Vuong T, Appelt A, Lindebjerg J, Rafaelsen SR (2012) Dose-effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int J Radiat Oncol Biol Phys, 84(4):949–54. ##8. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al. (2010) AJCC cancer staging manual (7th ed). New York, NY: Springer.##9. Foti PV, Privitera G, Piana S, Palmucci S, Spatola C, Bevilacqua R, Raffaele L, Salamone V, Caltabiano R, Magro G, Li Destri G, Milone P, Ettorre GC (2016) Locally advanced rectal cancer: Qualitative and quantitative evaluation of diffusion-weighted MR imaging in the response assessment after neoadjuvant chemo-radiotherapy. European Journal of Radiology Open, 3: 145–152. ##10. Cancer Therapy Evaluation Program (2006) Common Terminology Criteria for Adverse Events, Version 3.0. Available from: URL: http://ctep.cancer.gov.##11. Spatola C, Militello C, Tocco A, Salamone V, Raffaele L, Migliore M, Pagana A, Milazzotto R, Chillura I, Pergolizzi S, Privitera G (2016) Intensity-modulated radiotherapy for relapsed malignant pleural mesothelioma. Future Oncology, 12(23s): 67–71. ##12. 12. Spatola C., Tocco A., Milazzotto R et al. Role, timing and technique of radiotherapy in pediatric pleuropulmonarysynovial sarcoma. Future Oncol. (2016), 12 (23s): pp. 73-77.##13. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med, 351: 1731-1740.##14. Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati G, Artale S, Tagliagambe A, Ambrosini G, Rosetti P, Bonetti A, Negru ME, Tronconi MC, Luppi G, Silvano G, Corsi DC, Bo- chicchio AM, Chiaulon G, Gallo M, Boni L (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol, 29: 2773-2780. ##15. Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Laffay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Montoto- Grillot C, Conroy T (2010) Comparison of two neoadjuvant chemo- radiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol, 28: 1638-1644.##16. 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Cumulative radiation exposure dose of diagnostic imaging studies in breast cancer patients 2 2 Background: Breast cancer is a common disease in radiation oncology. We evaluated the radiation dose received by breast cancer patients, an often-neglected concern. Materials and Methods: The total effective radiation dose in 101 breast cancer patients was calculated by summing the effective doses of individual diagnostic imaging tests from the first hospital visit to the initiation of radiotherapy. The effective dose from general radiography and computed tomography (CT) was estimated using tissue-weighting factors and dose-length products. The effective dose from isotopes (18F-fluorodeoxyglucose and 99m         Tc-methylene diphosphonate) was estimated from the radioactivity of each isotope using dose coefficients. The patient radiation exposures were analyzed using radiologic records in the Picture Archiving and Communication System. Results: The median duration from initial imaging to the initiation of radiotherapy was 4.5 months (range: 0.7–13.4 months). When comparing the average effective doses associated with each diagnostic modality, CT, positron emission tomography-CT, bone scanning and radiography occupied 64%, 21%, 10% and 5% of the total effective dose, respectively. Comparison of the total effective dose according to clinical factors (age, AJCC stage, T stage, N stage, operation method, and cancer location) by multivariate analysis revealed that only T stage was significantly correlated with the total effective dose (p = 0.004). The median total effective dose was 71.5 mSv (range: 11.9–131.9 mSv). Conclusion: The radiation dose received from diagnostic testing in breast cancer patients is not negligible. We need to systematically collect and manage the doses received by patients from medical procedures. 275 281 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/12 1398/2/22 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/12 1398/2/22 J.S. Choi J.S. Choi Radiation Oncology, Korea University Medical Center, Guro hospital, Republic of Korea C.H. Rim C.H. Rim Y.B. Kim Y.B. Kim Radiation Oncology, Korea University Medical Center, Guro hospital, Republic of Korea happykyb@daum.net D.S. Yang D.S. Yang Radiation Oncology, Korea University Medical Center, Guro hospital, Republic of Korea irionmphage@gmail.com Effective dose Radiation exposure Cumulative dose Breast cancer. ##1. Bar-Shalom R, Yefremov N, Guralnik L, et al. (2003) Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nuc Med, 44(8): 1200-1209.##2. Do KH and Jung SE (2016) Current status of medical radiation exposure in Korea - recent efforts to develop a radiation exposure control system focused on justification and optimization. Ann ICRP, 45(1 Suppl): 113-121.##3. Lee SY, Lim HS, Han MS (2011) The evaluation of patients’ radiation dose during TACE of interventional radiology. J Radio Sci Technol, 34: 209-214.##4. ICRP. 1990 (1991) Recommendations of the International Commission on Radiological Protection. ICRP publication 60. Stockholm, Sweden: ICRP.##5. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review. 1975-2010. National Cancer Institute. Bethesda, M.D. http://seer.cancer.gov/csr/1975_2010/, based on November 2012 SEER data submission, posted to the SEER web site, April 2013##6. Llovet JM and Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology, 37(2): 429-442.##7. Brambilla M, De Mauri A, Lizio D, et al. (2014) Estimated radiation risk of cancer from medical imaging in haemodialysis patients. Nephro. Dial Transplant, 29(9): 1680-1686.##8. Miller DL, Kwon D, Bonavia GH (2009) Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. practice. Radiology, 253(3): 753-764.##9. Chung JW (2007) Korea Food & Drug Administration. Evaluation of patient dose in interventional radiology. Seoul: Korea Food & Drug Administration.##10. Park C, Song JH, Kim YT, Yim NY, Kim JK, Kim JH, et al. (2013) Cumulative radiation exposures during diagnosis and treatments with diagnostic radiology tools: in patients with hepatocellular carcinoma. J Korean Soc Radiol, 69(3): 243-250.##11. Edge SB, Byrd DR, Carducci MA, et al, eds. (2009) American Joint Committee on Cancer (AJCC) Cancer Staging Manual. 7th ed. New York: Springer.##12. Sandström S, Ostensen H, Pettersson H (2003) The WHO manual of diagnostic imaging: radiographic technique and projections. Vol. 2. World Health Organization.##13. Dance DR, Skinner CL, Young KC et al. (2000) Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol. Phys Med Biol, 45(11): 3225-3240.##14. Huda W, Ogden KM, Khorasani MR (2008) Converting dose-length product to effective dose at CT. Radiology, 248(3): 995-1003.##15. Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K (2003) Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950 - 1997. Radiation Research, 160: 381-407.##16. Ozasa K, Shimizu Y, Suyama A, Kasagi F, Soda M, Grant EJ, Sakata R, Sugiyama H, Kodama K (2012) Studies of the mortality of atomic bomb survivors, Report 14, 1950 - 2003: an overview of cancer and noncancer diseases. Radiation Research, 177(3): 229-243.##17. Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K (2007) Solid cancer incidence in atomic bomb survivors: 1958 - 1998. Radiation Research, 168(1): 1-64.##18. National Research Council (2006) Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2.##19. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2010) IARC monographs on the evaluation of carcinogenic risks to humans. Ingested nitrate and nitrite, and cyanobacterial peptide toxins. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 94: v.##20. United Nations Scientific Committee on the Effects of Atomic Radiation (2009) Effects of ionizing radiation: UNSCEAR 2006 Report to the General Assembly, with scientific annexes. Vol. 2. United Nations Publications.##21. Valentin J (2006) Low-dose extrapolation of radiation-related cancer risk. London: Elsevier.##22. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de González A, Miglioretti DL (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med, 169(22): 2078-2086.##23. Jung SE (2008) Korea Food & Drug Administration. Evaluation study of patient radiation dose in CT. Seoul: Korea Food & Drug Administration.##24. Schmidt MA and Payne GS (2015) Radiotherapy planning using MRI. Phys Med Biol, 60(22): R323.##25. (a) Cianfrocca M and Goldstein LJ (2004) Prognostic and predictive factors in early-stage breast cancer. Oncologist, 9(6): 606-616; (b) Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D. ##26. Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, Deming SL (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. J Am Med Assoc, 295(21): 2492-2502.##27. Bor D, Sancak T, Olgar T, Elcim Y, Adanali A, Sanlidilek U, Akyar S (2004) Comparison of effective doses obtained from dose–area product and air kerma measurements in interventional radiology. Br J Radio, 77(916): 315-322. ## ##

Retrograde superselective intra-arterial chemoradiotherapy for squamous cell carcinoma of the buccal mucosa 2 2 Background: The aim of this retrospective study was to evaluate the therapeutic outcomes and organ preservation in patients with squamous cell carcinoma of the buccal mucosa treated with radiotherapy and retrograde superselective intra-arterial chemotherapy. Materials and Methods: Between April 2006 and March 2016, 28 patients (3 with stage II; 8 with stage III; and 17 with stage IV) with squamous cell carcinoma of the buccal mucosa were treated with definitive intra-arterial chemoradiotherapy. The median follow-up for all patients was 39months (range, 4-123months ). Catheterization of the tumor feeding arteries from the superficial temporal and/or occipital arteries was performed. Treatment consisted of radiotherapy (total 50-70 Gy) and daily concurrent superselective    intra-arterial chemotherapy (docetaxel, 50-70 mg/m2, cisplatin, total 125-175 mg/m2) for 5-7 weeks. Results: After intra-arterial chemoradiotherapy, primary site complete response was achieved in 25 (89.3%) of 28 cases. Three-year local control and overall survival rates were 82.1% and 85.4%, respectively. Grade 3 or 4 toxicities included mucositis in 96.4%, and dermatitis in 28.6% of patients. Grade 3 toxicities included dysphagia in 35.7%, neutropenia in 28.6%, anemia in 10.7%, and fever in 7.1% of patients. Conclusion: Retrograde superselective intra-arterial chemoradiotherapy for squamous cell carcinoma of the buccal mucosa provided good local control and overall survival. 283 291 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/20 1398/2/30 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/20 1398/2/30 J.T. Koizumi J.T. Koizumi Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan S. Minamiyama S. Minamiyama Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan Y. Hayashi Y. Hayashi Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan K. Osawa K. Osawa Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan N. Ohashi N. Ohashi Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan T. Ohya T. Ohya Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan M. Iida M. Iida Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan T. Iwai T. Iwai Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan S. Oguri S. Oguri Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan M. Hirota M. Hirota Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan M. Kioi M. Kioi Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan K. Mitsudo K. Mitsudo Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa 236-0004 Japan mitsudo@yokohama-cu.ac.jp Carcinoma of the buccal mucosa Chemoradiotherapy Intra-arterial infusion Oral cancer Organ preservation. ##Ariyoshi Y, Shimahara M, Omura K, Yamamoto E,·Mizuki H, Chiba H, et al. (2008) Epidemiological study of malignant tumors in the oral and maxillofacial region: survey of member institutions of the Japanese Society of Oral and Maxillofacial Surgeons, 2002. Int J Clin Oncol, 13: 220-8.##Camilon PR, Stokes WA, Fuller CW, Nguyen SA, Lentsch EJ (2014) Does buccal cancer have worse prognosis than other oral cavity cancers? Laryngoscope, 124: 1386–91.##DeConde A, Miller ME, Palla B, Lai C, Elashoff D, Chhetri D, et al. (2012) Squamous cell carcinoma of buccal mucosa: a 40-year review. American Journal of Otolaryngology, 33: 673-7.##Fang QG, Shi S, Li ZN, Zhang X, Liua FY, Xu ZF, et al. (2013) Squamous cell carcinoma of the buccal mucosa: Analysis of clinical presentation, outcome and prognostic factors. Mol Clin Oncol, 1: 531-4.##Coppen C, de Wilde PC, Pop LA, van den Hoogen FJ, Merkx MA (2006) Treatment results of patients with a squamous cell carcinoma of the buccal mucosa. Oral Oncol, 42: 795– 9.##Diaz EM Jr, Holsinger FC, Zuniga ER, Roberts DB, Sorensen DM (2003) Squamous cell carcinoma of the buccal mucosa: one institution's experience with 119 previously untreated patients. Head Neck, 25: 267–73.##Mitsudo K, Shigetomi T, Fujimoto Y, Nishiguchi H, Yamamo to N, Furue H, et al. (2011) Organ preservation with daily concurrent chemoradiotherapy using superselective intra-arterial infusion via a superficial temporal artery for T3 and T4 head and neck cancer. Int J Radiat Oncol Biol Phys, 79: 1428-35.##Mitsudo K, Koizumi T, Iida M, Iwai T, Nakashima H, Oguri S, et al. (2014) Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: analysis of therapeutic results in 112 cases. Radiother Oncol, 111:306-10.##Minamiyama S, Mitsudo K, Hayashi Y, Iida M, Iwai T, Nakashima H, et al. (2017) Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for T2-4N0 tongue cancer: control of occult neck metastasis. Oral Surg Oral Med Oral Pathol Oral Radiol, 124:16-23.##Hayashi Y, Mitsudo K, Sakuma K, Iida M, Iwai T, Nakashima H, et al. (2017) Clinical outcomes of retrograde intra-arterial chemotherapy concurrent with radiotherapy for elderly oral squamous cell carcinoma patients aged over 80 years old. Radiat Oncol, 12: 112.##Mitsudo K, Hayashi Y, Minamiyama S, Ohashi N, Iida M, Iwai T, et al. (2018) Chemoradiotherapy using retrograde superselective intra-arterial infusion for tongue cancer: analysis of therapeutic results in 118 cases. Oral Oncol, 79: 71-77.##Sobin LH, Gospodarowicz MK, Wittekind C (2009) International :union: against cancer. TNM Classification of Malignant Tumors 7th ed. New York, NY: Wiley-Blackwell, 25-9.##Tohnai I, Fuwa N, Hayashi Y, Kaneko R, Tomarua Y, Hibino Y, et al. (1998) New superselective intra-arterial infusion via superficial temporal artery for cancer of the tongue and tumour tissue platinum concentration after carboplatin (CBDCA) infusion. Oral Oncol, 34: 387-90.##Fuwa N, Ito Y, Matsumoto A, Kamata M, Kodaira T, Furutani K, et al. (2000) A combination therapy of continuous superselective intraarterial carboplatin infusion and radiation therapy for locally advanced head and neck carcinoma. Phase I study. Cancer, 89: 2099-105.##Iwai T, Fuwa N, Hirota M, Mitsudo K, Tohnai I (2014) Secure surgical method for catheter placement via the occipital artery to achieve retrograde superselective intra-arterial chemotherapy for advanced oral cancer: Alternative to approach via the superficial temporal artery. Indian J Otolaryngol Head Neck Surg, 66: 205-7.##Iqbal H, Jamshed A, Bhatti AB, Hussain R, Jamshed S, Irfan M, et al. (2015) Five-year follow-up of concomitant accelerated hypofractionated radiation in advanced squamous cell carcinoma of the buccal mucosa: a retrospective cohort study. Biomed Res Int, 963574. doi: 10.1155/2015/963574.##Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, et al. (2011) Prognostic factors in patients with buccal squamous cell carcinoma: 10-Year Experience. J Oral Maxillofac Surg, 69: 396-404.##Liao CT, Wen YW, Yang LY, Lee SR, Ng SH, Liu TW, et al. (2017) Comparative clinical outcomes of Taiwanese patients with resected buccal and tongue squamous cell carcinomas. Oral Oncol, 67: 95–102.##Russi EG, Corvo R, Merlotti A, Alterio D, Franco P, Pergolizzi S, et al. (2012) Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: Review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev, 38(8): 1033-49.##Pikus L, Levine MS, Yang YX, RubesinSE, Katzka DA, Laufer I, et al. (2003) Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. Am J Roentgenol, 180(6): 1613-6.##Heukelom J, Lopez-Yurda M, Balm AJ, Wijers OB, Buter J, Gregor,T, et al. (2016) Late follow-up of the randomized radiation and concomitant high-dose intra-arterial or intravenous cisplatin (RADPLAT) trial for advanced head and neck cancer. Head Neck, 38: E488-E93. ## ##

Early toxicity of moderate hypofractionated volumetric modulated Arc radiotherapy for localized prostate cancer 2 2 Background: Based on the radiation biology model of prostate cancer, hypofractionated radiotherapy can improve the treatment outcomes without increasing toxicity. Although hypofractionated radiotherapy is implemented over a short period of time, it is more convenient and cheaper compared with conventional fractionated treatment. The aim of this study was to investigate the early toxicity of moderate hypofractionated schedules with volumetric modulate arc radiotherapy (VMAT) for localized prostate. Materials and Methods: Between 2014-2017, 41 patients were treated using the volumetric modulated arc radiotherapy (VMAT) technique with image guided radiotherapy. The target volume for low risk patient (2.4%) was the prostate alone, and that for intermediate (43.9%) and high risk patients (53.7%) was prostate and two thirds of the seminal vesicles. A prescription dose of 70 Gy in 2.5 Gy daily for 28 treatment was used. Radiotherapy-related toxicity was scored according to the Common Terminology Criteria for Adverse Events 4.0 criteria. Results: Early genitourinary (GU) toxicity was recorded for grades 0, 1, 2 and 3 in 7 (17.1%), 25 (61.0%), 9 (21.9%) and 0 patients, respectively. Most common GU toxicities were urinary frequency and urgency. Early gastrointestinal (GI) toxicity was observed for grade 0, 1 and 2 in 35 (85.4%), 6 (14.6%) and 0 patients, respectively. Most common GI toxicity was rectal discomfort but interventional therapy was not indicated. Conclusion: The moderate hypofractionated VMAT radiation therapy with precise dose delivery technique appeared safe with low early toxicity. Longer follow up is needed to assess late toxicity and tumor control probability. 293 300 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/20 1398/2/30 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/20 1398/2/30 H.J. Kim H.J. Kim Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Korea cancerovercome@gmail.com J.S. Lee J.S. Lee Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Korea W.C. Kim W.C. Kim Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Korea Prostate cancer acute toxicity hypofractionation volumetric modulated arc therapy radiotherapy. 1. Turner EL, Metcalfe C, Donovan JL, Noble S, Sterne JA, Lane JA, E IW, Hill EM, Down L, Ben-Shlomo Y, Oliver SE, Evans S, Brindle P, et al. (2016) Contemporary accuracy of death certificates for coding prostate cancer as a cause of death: Is reliance on death certification good enough? A comparison with blinded review by an independent cause of death evaluation committee. Br J Cancer, 115: 90–4. ##2. Arcangeli S, Scorsetti M, Alongi F (2012) Will SBRT replace conventional radiotherapy in patients with low-intermediate risk prostate cancer? A review. Crit Rev Oncol Hematol, 84: 101-8. ##3. Lukka H, Hayter C, Julian JA, Warde P, Morris WJ, Gospodarowicz M, Levine M, Sathya J, Choo R, Prichard H, Brundage M, Kwan W (2005) Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol, 23: 6132-8.##4. Yeoh EE, Botten RJ, Butters J, Di Matteo AC, Holloway RH, Fowler J (2011) Hypofractionated versus conventionally fractionated radiotherapy for prostate carcinoma: final results of phase III randomized trial. Int J Radiat Oncol Biol Phys, 81: 1271-8.##5. Arcangeli S, Strigari L, Gomellini S, Saracino B, Petrongari MG, Pinnaro P, Pinzi V, Arcangeli G (2012) Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. Int J Radiat Oncol Biol Phys, 84: 1172-8.##6. Kuban DA, Nogueras-Gonzalez GM, Hamblin L, Lee AK, Choi S, Frank SJ, Nguyen QN, Hoffman KE, McGuire SE, Munsell MF (2010) Preliminary Report of a Randomized Dose Escalation Trial for Prostate Cancer using Hypofractionation. Int J Radiat Oncol Biol Phys, 78(3) supplement: S58-S9.##7. Strigari L, Arcangeli G, Arcangeli S, Benassi M (2009) Mathematical model for evaluating incidence of acute rectal toxicity during conventional or hypofractionated radiotherapy courses for prostate cancer. Int J Radiat Oncol Biol Phys, 73: 1454-60.##8. Brenner DJ and Hall EJ (1999) Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys, 43: 1095–101.##9. Zhang P, Happersett L, Hunt M, Jackson A, Zelefsky M, Mageras G (2010) Volumetric modulated arc therapy: planning and evaluation for prostate cancer cases. Int J Radiat Oncol Biol Phys, 76: 1456–62.##10. Mohler J, Bahnson RR, Boston B, Busby JE, D'Amico A, Eastham JA, Enke CA, George D, Horwitz EM, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Macvicar G, Plimack ER, Pow-Sang JM, Roach M, 3rd, Rohren E, Roth BJ, Shrieve DC, Smith MR, Srinivas S, Twardowski P, Walsh PC (2010) NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw, 8: 162-200. ##11. Palma D, Vollans E, James K, et al. (2008) Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys, 72: 996-1001.##11. Zietman AL, DeSilvio ML, Slater JD, et al. (2005) Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA, 294: 1233-9.##12. Peeters ST, Heemsbergen WD, Koper PC, et al. (2006) Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol, 24: 1990-6.##13. Dearnaley DP, Jovic G, Syndikus I, et al. (2014) Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol, 15: 464-73.##14. Kuban DA, Tucker SL, Dong L, et al. (2008) Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys, 70: 67-74.##15. Eade TN, Hanlon AL, Horwitz EM, Buyyounouski MK, Hanks GE, Pollack A (2007) What dose of external-beam radiation is high enough for prostate cancer? Int J Radiat Oncol Biol Phys, 68: 682-9.##16. National Comprehensive Cancer Network (2017) NCCN guidelines for patients: prostate cancer [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; c2017 [cited 2017 Feb 21]. Available from: http://www.nccn.org/patients/ guidelines/prostate/files/assets/common/downloads/files/ prostate.pdf.##17. Ray KJ, Sibson NR, Kiltie AE (2015) Treatment of breast and prostate cancer by hypofractionated radiotherapy: potential risks and benefits. Clin Oncol (R Coll Radiol), 27: 420-6.##18. Tucker SL, Thames HD, Michalski JM, et al. (2011) Estimation of alpha/beta for late rectal toxicity based on RTOG 94-06. Int J Radiat Oncol Biol Phys, 81: 600-5.##19. Miralbell R, Roberts SA, Zubizarreta E, Hendry JH (2012) Dosefractionation sensitivity of prostate cancer deduced from radiotherapy outcomes of 5,969 patients in seven international institutional datasets: α/β = 1.4 (0.9-2.2) Gy. Int J Radiat Oncol Biol Phys, 82: e17-24.##20. Proust-Lima C, Taylor JM, Secher S, et al. (2011) Confirmation of a low α/β ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated measures model for PSA dynamics. Int J Radiat Oncol Biol Phys, 79: 195-201.##21. Arcangeli G, Saracino B, Gomellini S, Petrongari MG, Arcangeli S, Sennelli S, Marzi S, Landoni V, Fowler J, Strigari L (2010) A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer. Int J Radiat Oncol Biol Phys, 78: 11–18.##22. Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, Stoyanova R, Movsas B, Greenberg RE, Uzzo RG, Ma C, Buyyounouski MK (2013) Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol, 31: 3860-8.##23. Krupa P, Ticha H, Kazda T, Dymackova R, Zitterbartova J, Odlozilikova A, Kominek L, Bobek L, Kudlacek A, Slampa P (2016) Early toxicity of hypofractionated radiotherapy for prostate cancer. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 160: 435-41. ##24. Tramacere F, Arcangeli S, Pignatelli A, Castagna R, Portaluri M (2015) Hypofractionated Dose Escalated 3D Conformal Radiotherapy for Prostate Cancer: Outcomes from a Mono-Institutional Phase II Study. Anticancer Res, 35: 3049-54.##25. Jereczek-Fossa BA, Zerini D, Fodor C, Santoro L, Cambria R, Garibaldi C, Tagaste B, Vavassori A, Cattani F, Alterio D, Gherardi F, Serafini F, Rocco B, Musi G, De Cobelli O, Orecchia R (2011) Acute toxicity of imageguided hypofractionated radiotherapy for prostate cancer: nonrandomized comparison with conventional fractionation. Urol Oncol, 29: 523-32.##26. Aluwini S, Pos F, Schimmel E, van Lin E, Krol S, van der Toorn PP, de Jager H, Dirkx M, Alemayehu WG, Heijmen B, Incrocci L (2015) Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): acute toxicity results from a randomised non-inferiority phase 3 trial. Lancet Oncol, 16: 274-83. ##27. Viani GA, da Silva LB, da Silva BB, Crempe YB, Martins VS, Ferrari RJ, Polo MC, Rossi BT, Suguikawa E, Zulliani GC, Stefano EJ (2013) Acute toxicity profile in prostate cancer with conventional and hypofractionated treatment. Radiat Oncol, 8: e94.##28. Alongi F, Cozzi L, Arcangeli S, Iftode C, Comito T, Villa E, Lobefalo F, Navarria P, Reggiori G, Mancosu P, Clerici E, Fogliata A, Tomatis S, Taverna G, Graziotti P, Scorsetti M (2013) Linac based SBRT for prostate cancer in 5 fractions with VMAT and flattening filter free beams: preliminary report of a phase II study. Radiat Oncol, 8: 171. ## ##

Characterization of Am-Be neutron source based PGNAA setup using aqueous solutions of Chlorine and Boron 2 2 Background: A 5 Ci 241Am-Be radio isotopic neutron source-based prompt gamma neutron activation analysis (PGNAA) setup was designed for estimation of minimum detectable concentration (MDC) of elements in aqueous solutions. Materials and Methods: Performance variables related to PGNAA setup (source to sample distance, sample to detector distance and volume of water) were optimized experimentally. Characterization of the setup was done by chlorine and boron elements using sodium chloride (NaCl) and boric acid (H3BO3) compounds respectively. Results: PGNAA setup was calibrated for different concentrations of Cl and B in aqueous solution. The chlorine concentration was varied over 1.2 g/L, 2.4 g/L, 3.6 g/L, 4.8 g/L, 6.0 g/L and 7.2 g/L in water samples while boron concentration was varied over 0.1 g/L, 0.2 g/L, 0.3 g/L, 0.4 g/L and 0.5 g/L. The MDC of chlorine and boron were calculated for various characteristic prompt gamma energies. Estimated MDC of chlorine and boron are 175 ± 53 ppm at prompt gamma energy 6110 keV and 3 ± 0.95 ppm at prompt gamma energy 478 keV respectively. Conclusion: In the present work, PGNAA setup was developed and characterized for the in-situ analysis of aqueous solutions using a 5 Ci Am-Be neutron source. The chlorine concentration was varied from 1.2 to 7.2 g/L and boron concentrations were varied from 0.1 to 0.5 g/L. The setup shows linear response for both chlorine and boron for wide energy range. The obtained results were also compared with other previous published work. It shows good agreement with present results.    301 308 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/20 1398/2/30 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/20 1398/2/30 D. Meena D. Meena Department of Physics, University of Rajasthan, 302004 Jaipur, India S.K. Gupta S.K. Gupta Department of Physics, University of Rajasthan, 302004 Jaipur, India shail2405@gmail.com H.S. Palsania H.S. Palsania Department of Physics, University of Rajasthan, 302004 Jaipur, India N. Jakhar N. Jakhar Department of Physics, University of Rajasthan, 302004 Jaipur, India N. Chejara N. Chejara Department of Physics, University of Rajasthan, 302004 Jaipur, India P. Meena P. Meena Department of Zoology, University of Rajasthan, 302004 Jaipur, India PGNAA minimum detection concentration 241Am-Be neutron source HPGe detector. 1. Alfassi ZB and Chung C (1995) Prompt Gamma Neutron Activation Analysis, CRC Press, Boca Raton, Florida.##2. Greenberg R R, Bode P, Fernandes D N, Elisabete A (2011) Neutron activation analysis: A primary method of measurement. Spectrochimica Acta Part B : Atomic Spectroscopy, 66 (3): 193-241.##3. Da-Qian H, Wen-Bao J, Zhou J, Can C, Jia-Tong L, Hong-Tao W (2016) Heavy metals detection in sediments using PGNAA method. Appl Radiat Isot, 112: 50–54.##4. Yongsheng L, Wenbao J, Daqian H, Qing S, Can C, Haojia Z, et al. (2015) A new Am–Be PGNAA setup for element determination in aqueous solution. Appl Radiat Isot, 95: 233–238.##5. Idiri Z, Mazrou H, Amokrane A, Bedek S (2010) Characterization of an Am–Be PGNAA set-up developed for in situ liquid analysis: Application to domestic waste water and industrial liquid effluents analysis. Nucl Instrum Meth Phys B, 268(2):213–218.##6. Naqvi AA, Garwan MA, Nagadi MM, Maslehuddin M, Al-Amoudi OSB, Khateeb-ur-Rehman (2009) Non-destructive analysis of chlorine in fly ash cement concrete. Nucl Instrum Meth Phys A, 607(2): 446–450.##7. Révay Z and Molnár GL (2003) Standardization of the prompt gamma activation analysis method. Radiochimica Acta, 91(6): 361–369.##8. Khelfi R, Idiri Z, Omari L, Seghir M (1999) PGNAA of bulk concrete samples with an Am-Be neutron source. Appl Radiat Iso, 51(1): 9-13.##9. Panjeh H, Najafabadi R I, Ketter John (2013) Utilization of 241Am-Be neutron source in PGNAA setup used in cement raw material analysis. Int J Sci Adv Tech, 3: 25-33.##10. Da-Qian H, Jiang Z, Jia W, Cheng C,Wang H, Li J (2016) The background influence of cadmium detection in saline water using PGNAA technique. J Radioanal Nucl Chem, 310(1): 27-31. ##11. Fantidis JS (2015) Antoniadis A Optimization study for BNCT facility based on a DT neutron generator. Int J Radiat Res 13(1): 13-27.##12.Wen BJ, Da-Qian H, Can C, HaoJia Z , Qing S (2014) Optimization of PGNAA set-up for the elements detection in aqueous solution. Sci China Tech Sci, 57(3):625-629.##13. Radioactive Products – The Radiochemical Center – Amersham (1969/70):183.##14. IEEE Standard Association, IEEE Standard (325-1996) Standard Test Procedures for Germanium Gamma ray Detectors. ##15. Turhan Ş  (2007) Efficiency calibration of an HPGe detector in the 0.1–2.5 MeV energy range for Am-Be neutron source-based PGAA applications. J Radioanal Nucl Chem, 273: 443-450.##16. Nikolov J, Medic Z, Jovancevic N, Hansman J, Todorovic N, Krmar M (2014) Applicability of the Ge(n,γ) reaction for estimating thermal neutron flux. Physics Procedia, 59: 71 – 77.##17. Gedcke DA (2001) ORTEC Application Note AN59, How Counting Statistics Controls Detection Limits and Peak Precision. www.ortec-online.com. ##18.International Atomic Energy Agency PGAA Database Files, https://www-nds.iaea.org/pgaa/databases.htm.##19. Naqvi AA, Maslehuddin M, Garwan MA, Nagadi MM, Al-Amoudi OSB, Raashid M, et al. (2010) Effect of silica fume addition on the PGNAA measurement of chlorine in concrete. Applied Radiation and Isotopes 68: 412–417.##20. Naqvi AA, Al-Anezi MS, Kalakada Z, Matouq FAA, Maslehuddin M, Gondal AA, Isab AA, et al. (2012 ) Response tests of a LaCl3:Ce scintillation detector with low energy prompt gamma rays from boron and cadmium. Applied Radiation and Isotopes, 70: 882–887.##21. Khelifi R, Amokrane A, Bode P (2007) Detection limits of pollutants in water for PGNAA using Am-Be source. Nucl Instrum Phys Res, 262: 329-332.##22. Wen B J, Can C, Qing S, Daqian H, Yongsheng L, Yan Z, et al. 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The role of neutrophil-to-lymphocyte ratio (NLR) in predicting small bowel toxicity and outcome for rectal cancer patients who received chemoradiotherapy 2 2 Background: In this study, we explored the relationship between                  neutrophil-to-lymphocyte ratio (NLR) and grade 3 or higher treatment related small bowel toxicity and treatment outcome of patients with rectal cancer undergoing capecitabine and concurrent intensity modulated radiotherapy (IMRT). Materials and Methods: From the year of 2012 to 2013, 117 rectal cancer patients who received concurrent chemoradiotherapy in our hospital were enrolled in this study. The association of baseline NLR level with grade 3 or higher treatment related small bowel toxicity and treatment outcome, including overall survival (OS) and progression free survival (PFS) were analyzed.  Results: The optimal cut-off value of the NLR was determined to be 2.2 for the OS according to the receiver operating characteristic (ROC) analysis. A higher level of the baseline NLR was associated with hypoalbuminemia (P= 0.018). No relationship between NLR level and grade 3 or higher acute as well as late treatment related small bowel toxicity was found. A multivariate Cox model revealed that lymph node metastasis (p= 0.013), distant metastasis (p< 0.001), and high NLR level (p = 0.032) were significant predictors for poor OS. Nevertheless, a relationship between NLR level and PFS was not found. Conclusion: This study show that higher baseline NLR level could not predict treatment related small bowel toxicity of rectal cancer patients who received capecitabine and concurrent IMRT. It is very gratifying to see that NLR is a useful predictor for treatment outcome of these patients. 309 315 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/20 1398/2/30 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/20 1398/2/30 X.H. Bai X.H. Bai Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China G.L. Zou G.L. Zou Graduated School, Ningxia Medical University, Yinchuan 750004, Ningxia, China Z. Ding Z. Ding Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China R. Zhao R. Zhao Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China H. Zhe H. Zhe Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China Y.Y. Wang Y.Y. Wang Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China fdwyy1981@hotmail.com Neutrophil-to-lymphocyte ratio (NLR) rectal cancer small Bowel toxicity prognosis. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin, 66: 7-30.##2. Roedel C, Becker H, Fietkau R, Graeven U, Hohenberger W, Hothorn T, Lang-Welzenbach M, Liersch T, Staib L, Christiansen H, Wittekind C, Sauer RGerman Rectal Cancer Study G (2011) Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial. J Clin Oncol, 29: LBA3505.##3. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LCParmar M (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet, 373: 811-20.##4. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab RGerman Rectal Cancer Study G (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med, 351: 1731-40.##5. Baglan KL, Frazier RC, Yan D, Huang RR, Martinez AARobertson JM (2002) The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys, 52: 176-83.##6. Gunnlaugsson A, Kjellen E, Nilsson P, Bendahl PO, Willner JJohnsson A (2007) Dose-volume relationships between enteritis and irradiated bowel volumes during 5-fluorouracil and oxaliplatin based chemoradiotherapy in locally advanced rectal cancer. Acta Oncol, 46: 937-44.##7. Xu B, Guo Y, Chen Y, Lu H, Tang T, Yue Z, Guan G, Chi PLin C (2015) Is the irradiated small bowel volume still a predictor for acute lower gastrointestinal toxicity during preoperative concurrent chemo-radiotherapy for rectal cancer when using intensity-modulated radiation therapy? Radiat Oncol, 10: 257.##8. Hanahan DWeinberg RA (2011) Hallmarks of cancer: the next generation. Cell, 144: 646-74.##9. Takeuchi S, Baghdadi M, Tsuchikawa T, Wada H, Nakamura T, Abe H, Nakanishi S, Usui Y, Higuchi K, Takahashi M, Inoko K, Sato S, Takano H, Shichinohe T, Seino KHirano S (2015) Chemotherapy-Derived Inflammatory Responses Accelerate the Formation of Immunosuppressive Myeloid Cells in the Tissue Microenvironment of Human Pancreatic Cancer. Cancer Res, 75: 2629-40.##10. Richards CH, Roxburgh CS, Anderson JH, McKee RF, Foulis AK, Horgan PGMcMillan DC (2012) Prognostic value of tumour necrosis and host inflammatory responses in colorectal cancer. Br J Surg, 99: 287-94.##11. Kobayashi S, Stice JP, Kazmin D, Wittmann BM, Kimbrel EA, Edwards DP, Chang CYMcDonnell DP (2010) Mechanisms of progesterone receptor inhibition of inflammatory responses in cellular models of breast cancer. Mol Endocrinol, 24: 2292-302.##12. Lamb GW, McArdle PA, Ramsey S, McNichol AM, Edwards J, Aitchison MMcMillan DC (2008) The relationship between the local and systemic inflammatory responses and survival in patients undergoing resection for localized renal cancer. BJU Int, 102: 756-61.##13. Dong YW, Shi YQ, He LWSu PZ (2016) Prognostic significance of neutrophil-to-lymphocyte ratio in rectal cancer: a meta-analysis. Onco Targets Ther, 9: 3127-34.##14. Moon SH, Kim DY, Park JW, Oh JH, Chang HJ, Kim SY, Kim TH, Park HC, Choi DH, Chun HK, Kim JH, Park JHYu CS (2012) Can the new American Joint Committee on Cancer staging system predict survival in rectal cancer patients treated with curative surgery following preoperative chemoradiotherapy? Cancer, 118: 4961-8.##15. Lu NN, Jin J, Wang SL, Wang WH, Song YW, Liu YP, Ren H, Fang H, Liu XF, Yu ZHLi YX (2015) Postoperative Capecitabine with Concurrent Intensity-Modulated Radiotherapy or Three-Dimensional Conformal Radiotherapy for Patients with Stage II and III Rectal Cancer. PLoS One, 10: e0124601.##16. Shen L, Zhang H, Liang L, Li G, Fan M, Wu Y, Zhu JZhang Z (2014) Baseline neutrophil-lymphocyte ratio (>/=2.8) as a prognostic factor for patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Radiat Oncol, 9: 295.##17. Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga YUeno M (2015) Prognostic Impact of Neutrophil-to-Lymphocyte Ratio in Patients with Advanced Low Rectal Cancer Treated with Preoperative Chemoradiotherapy. Dig Surg, 32: 496-503.##18. Liu H, Liu G, Bao Q, Sun W, Bao H, Bi L, Wen W, Liu Y, Wang Z, Yin X, Bai YHu X (2010) The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in rectal carcinoma. J Gastrointest Cancer, 41: 116-20.##19. Kim IY, You SHKim YW (2014) Neutrophil-lymphocyte ratio predicts pathologic tumor response and survival after preoperative chemoradiation for rectal cancer. BMC Surg, 14: 94.##20. 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Sperm DNA damage in mice irradiated with various doses of X-rays alone or in combination with actinomycin D or bleomycin sulfate: an in vivo study 2 2 Background: DNA damage in male germ cells due to exposure to environmental and manmade physico-chemical genotoxic agents is considered as the main cause of male infertility. The aim of this study was to evaluate the effects of combined modalities (radiotherapy and chemotherapy) routinely used for cancer treatment on mouse sperm chromatin in vivo. Materials and Methods: Forty-eight mice were divided into 12 groups: 3 irradiation (1, 2, and 4 Gy), 2 drug [Actinomycin-D (ACTD) and Bleomycin (BLM)], 3 ACTD/irradiation, 3 BLM/irradiation, and a control. Mice received intratesticular injection of 7µg/25 g of Actinomycin-D and Bleomycin before irradiation with X-rays. Forty-eight hours after irradiation, mice were sacrificed and epididymis and testes were removed. Sperm DNA damage was assessed with the use of alkaline comet assay. Moreover, morphology, and motility of sperms were investigated microscopically.  Results: Result showed that drug alone had slight but not significant effect on sperm DNA damage, but significantly increased when combined with irradiation. There was a significant difference between the experimental and the control group in DNA sperm damage, but no significant differences were observed in sperm morphology (p>0.05). In the drug+4Gy group, DNA damage increased dramatically compared to the controls (p<0.01), morphology changes increased to about six times that of controls. Conclusion: Results indicate that X-ray induced DNA damage and morphological changes in sperms in a dose dependent manner. Low doses of drugs led to potentiation of radiation effect. This might be indicative of necessity for radiation protection of testes when are in field of radiotherapy.   317 323 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/28 1398/3/7 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/28 1398/3/7 H. Saghaei H. Saghaei Department of Radiology, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran H. Mozdarani H. Mozdarani Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran mozdarah@modares.ac.ir A. Mahmoudzadeh A. Mahmoudzadeh Department of Bioscience and Biotechnology, Malek-Ashtar University of Technology, Tehran, Iran Ionizing radiation chemotherapeutics mouse sperm DNA damage comet assay. ##1. 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Singh S, Joshi S, Khole V (2001) Immunochemical and functional characterization of a polyclonal antibody to human sperm antigen. Indian J Exp Biol, 39(3): 209–17. ##12. Nili HA, Mozdarani H, Aleyasin A (2009) Correlation of sperm DNA damage with protamine deficiency in Iranian subfertile men. Reprod Biomed Online, 18(4): 479–85. ##13. Beumer TL, Roepers-Gajadien HL, Gademan LS, Rutgers DH, de Rooij DG (1997) P21(Cip1/WAF1) expression in the mouse testis before and after X irradiation. Mol Reprod Dev, 47(3): 240–7. ##14. Makker K, Agarwal A, Sharma R (2009) Oxidativ stress & male infertility. Indian J Med Res, 129(4):357–67. ##15. Wang X, Sharma RK, Sikka SC, Thomas AJJ, Falcone T, Agarwal A (2003) Oxidative stress is associated with increased apoptosis leading to spermatozoa DNA damage in patients with male factor infertility. Fertil Steril, 80(3): 531–5. ##16. Spermon JR, Ramos L, Wetzels AMM, Sweep CGJ, Braat DDM, Kiemeney LALM, et al. (2006) Sperm integrity pre- and post-chemotherapy in men with testicular germ cell cancer. Hum Reprod, 21(7): 1781–6. ##17. Howell SJ and Shalet SM (2005) Spermatogenesis after cancer treatment: damage and recovery. J Natl Cancer Inst Monogr, (34): 12–7. ##18. Bieber AM, Marcon L, Hales BF, Robaire B (2006) Effects of chemotherapeutic agents for testicular cancer on the male rat reproductive system, spermatozoa, and fertility. J Androl, 27(2): 189–200. ##19. Tripathi DN, Pawar AA, Vikram A, Ramarao P, Jena GB (2008) Use of the alkaline comet assay for the detection of transplacental genotoxins in newborn mice. Mutat Res, 653(1-2): 134-9.##20. Mozdarani H and Mozdarani S (2016) De novo cytogenetic alterations in spermatozoa of subfertile males might be due to genome instability associated with idiopathic male infertility: Experimental evidences and Review of the literature. AIMS Genetics, 3(4): 219- 238.##21. 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Radiosensitizing effect of deferoxamine on human glioma cells 2 2 ABSTRACT Background: Tumor cells exhibit an increased requirement for iron to support their rapid proliferation. Deferoxamine (DFO), an iron chelator, has been reported to have anti-proliferative effects on cancer cells through induction of apoptosis and cell cycle arrest. X-rays also induce apoptosis and cell cycle arrest. However, limited information is available regarding the effect of iron depletion on radiotherapy. In this study, the radiosensitizing effect of DFO was investigated in human glioma U251 cells. Materials and Methods: U251 cells were pretreated with DFO before exposure to X-rays. The radiosensitizing effect of DFO on U251 cells was evaluated with a clonogenic formation assay. Apoptosis and autophagy were measured to explore the model of cell death during DFO radiosensitization. Intracellular calcium levels, cell cycle, and ROS levels were examined to study the mechanism of the cell death.  Results: We found that DFO enhanced X-ray-induced growth inhibition of U251 cells. Increased protective autophagy, occurring in U251 cells the first day of being treated with DFO and X-rays, rendered the radiosensitivity enhancement of DFO insignificant. However, the radiosensitizing effect was clear from the fourth day, which was attributed to the increase of apoptosis and decrease of protective autophagy. Further investigation revealed that the high level of apoptosis induced by DFO plus X-rays was dependent on the level of cytoplasmic calcium because the apoptosis was inhibited by [1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid], a cytoplasmic calcium chelator. Conclusion: Our results clearly demonstrate that DFO can enhance the radiosensitivity of U251 cells by increased calcium-dependent apoptosis. 325 333 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/29 1398/3/8 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/29 1398/3/8 X. Zhang X. Zhang Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China zhangxiaohong@nuaa.edu.cn Z. Zhou Z. Zhou Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China Y. Miao Y. Miao Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China Z. Liu Z. Liu Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China F. Chen F. Chen Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China X. Hu X. Hu Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China J. Feng J. Feng Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China H. Chen H. Chen Department of Radiotherapy, Jiangning Hospital of Nanjing, Nanjing, Jiangsu, P. R. China P. Liu P. Liu Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing, Jiangsu, P. R. China H. Zhang H. Zhang Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, P. R. China Radiosensitivity Deferoxamine Apoptosis Autophagy Intracellular calcium. ##Bergs Judith WJ, Wacher MG, Hehlgan S, Piiper A, Multhoff G, Rodel C, Rodel F (2015) The role of recent nanotechnology in enhancing the efficacy of radiation therapy. Biochim Biophys Acta, 1856: 130-143. ##Aisen P, Enns C, Wessling-Resnick M (2001) Chemistry and biology of eukaryotic iron metabolism. Int J Biochem Cell Biol, 33: 940-959.##Siegers CP, Bumann D, Trepkau HD, Schadwinkel B, Baretton G (1992) Influence of dietary iron overload on cell proliferation and intestinal tumorigenesis in mice. Cancer Lett, 65: 245-249.##Stevens RG, Graubard BI, Micozzi MS, Neriishi K, Blumberg BS (1994) Moderate elevation of body iron level and increased risk of cancer occurrence and death. Int J Cancer, 56: 364-369.##Faulk WP, His BL, Stevens PJ (1980) Transferrin and transferrin receptors in carcinoma of the breast. 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Quantification and modelling of the dosimetric impact of the treatment couch in volumetric modulated arc therapy (VMAT) 2 2 Background: As the volumetric modulated arc therapy (VMAT) becoming a main role of treatment ways, the effect of couch top becomes more significant. It is imperative to re-evaluate the couches that previously may have been considered of no importance during early treatment techniques. The impact of couch top on radiation delivery was explored and the couch model was tested with the aim of reducing the couch absorption influences.  Materials and Methods: Attenuation measurements were performed in a cylindrical phantom with an ionization chamber positioned at the isocenter. Couch model was obtained by importing its actual CT scan, and the accuracy was evaluated by comparing percentage deviation at 2 and 5 mm voxel grid size. Effects on surface dose were measured using EBT3 film with the constant SSD at different depths and beam energies at the gantry angle 180° and 0°, respectively. Results: Couch top increases surface dose from 45.9 % to 95.8 % , from 35.0 % to 87.9 % and from 29.2% to 73.9 % for 10 cm ×10 cm field at 6 ,10 and 18 MV, respectively. Due to the couch absorption the case of vertebral metastasis VMAT plan D50 of the PTV changed from 30 Gy to 29.3 Gy. Couch model with uniform electron density of 0.18g/cm3 demonstrated an excellent agreement between measured and TPS computed dose. Conclusion: The treatment couch presence between the patient and beam source significantly alters dose in the patient. Modelling the couch in the Monaco TPS can adequately predict the altered dose distribution.   335 344 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/29 1398/3/8 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/29 1398/3/8 R.H. Zhang R.H. Zhang Department of Biomedical Engineering,Tianjin University, Tianjin, China J. Fleckenstein J. Fleckenstein Department of Radiation Oncology, Mannheim Medical Center, Germany Y.L. Gao Y.L. Gao The Physical Examination Center, Hebei General Hospital, Shijiazhuang, China M.C. Miao M.C. Miao Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China Z.F. Chi Z.F. Chi Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China W.W. Bai W.W. Bai Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China baiwenwen2006@126.com volumetric-modulated arc therapy treatment planning system attenuation buildup Couchtop. ##1. Meara SJ and Langmack KA (1998) An investigation into the use of carbon fibre for megavoltage radiotherapy applications. Phys Med Biol, 43(5): 1359-1366.##2. De Ost B, Vanregemorter J, Schaeken B, Van den Weyngaert D (1997) The effect of carbon fibre inserts on the build-up and attenuation of high energy photon beams. Radiother Oncol, 45(3): 275-277.##3. Vieira SC, Kaatee RSJP, Dirkx MLP, Heijmen BJM (2003) Two-dimensional measurement of photon beam attenuation by the treatment couch and immobilization devices using an electronic portal imaging device. Med Phys, 30(11): 2981-2987.##4. Pulliam KB, Howell RM, Followill D, Luo D, White RA, Kry SF (2011) The clinical impact of the couch top and rails on IMRT and arc therapy. Phys Med Biol, 56(23): 7435-7447.##5. Li H, Lee AK, Johnson JL, Zhu RX, Kudchadker RJ (2011) Characterization of dose impact on IMRT and VMAT from couch attenuation for two Varian couches. J Appl Clin Med Phys, 12(3): 3471.##Yu CX and Tang G (2011) Intensity-modulated arc therapy: principles, technologies and clinical implementation. Phys##Med Biol, 56(5): R31-54.##7. Webb S and McQuaid D (2009) Some considerations concerning volume-modulated arc therapy: a stepping stone towards a general theory. Phys Med Biol, 54(14): 4345-4360.##8. Olch AJ, Gerig L, Li H, Mihaylov I, Morgan A (2014) Dosimetric effects caused by couch tops and immobilization devices: report of AAPM Task Group 176. Med Phys, 41(6): 061501.##9. Yu CY, Chou WT, Liao YJ, Lee JH, Liang JA, Hsu SM (2017) Impact of radiation attenuation by a carbon fiber couch on patient dose verification. Sci Rep, 7(43336).##10. Savini A, Bartolucci F, Fidanza C, Rosica F, Orlandi G (2016) Modeling of couch transmission in the RayStation treatment planning system. 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Small cell carcinoma of the uterine cervix with cerebellar metastasis: A special case report with literature review 2 2 Background: Small cell carcinoma of the uterine cervix is a highly malignant form of cancer in women, characterized by its high propensity for rapid extra-pelvic distant metastasis and poor prognosis. The best treatment strategy for this type of cancer is still controversial. Case presentation: We report here a case of small cell carcinoma of the uterine cervix treated by extensive total hysterectomy followed by adjuvant chemoradiotherapy. A 45-year-old Chinese woman was diagnosed with stage IIA small cell carcinoma of the uterine cervix. The patient suffered from head metastasis following a diagnosis made fifteen months prior. Conclusion: We describe the optimal treatment and prognostic factors of this tumour. The stage of the tumour, main treatment, prognostic factors and outcome of this disease are presented with a review of the related literature. 345 353 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/292019/05/29 1398/3/8 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/292019/05/29 1398/3/8 J.H. Zhu J.H. Zhu Department of Oncology, Nanjing Medical University, Nanjing, China Q.C. Hu Q.C. Hu Department of Radiation Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (East Branch) K. Gu K. Gu Department of Radiation Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (East Branch) drguke@163.com C. Shen C. Shen Department of Obstetrics and Gynecology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (East Branch) R. Yang R. Yang Department of Obstetrics and Gynecology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (East Branch) S.J. Ji S.J. Ji Department of Radiation Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (East Branch) Q.Q. Che Q.Q. Che Department of Radiation Oncology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital (East Branch) Cerebellar metastasis small cell carcinoma uterine cervix treatment prognostic factor. ##Viswanathan AN, Deavers MT, Jhingran A, et al. (2004) Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence. Gynecologic Oncology, 93(1): 27-33.##Crowder S and Tuller E. (2007) Small cell carcinoma of the female genital tract. Seminars in Oncology, 34(1): 57.##D'Antonio A, Addesso M, Caleo A, et al. (2015) Small cell neuroendocrine carcinoma of the endometrium with pulmonary metastasis: A clinicopathologic study of a case and a brief review of the literature. Annals of Medicine & Surgery, 5(S1): 114.##Wentz WB and Reagan JW (1959) Survival in cervical cancer with respect to cell type. Cancer, 12(2): 384-388.##5. Zhou J, Wu SG, Sun JY, et al. (2017) Clinicopathological features of small cell carcinoma of the uterine cervix in the surveillance, epidemiology, and end results database. Oncotarget, 8(25): 40425.##Ishikawa M, Kasamatsu T, Tsuda H, et al. (2018) Prognostic factors and optimal therapy for stages I-II neuroendocrine carcinomas of the uterine cervix: A multi-center retrospective study. Gynecologic Oncology, 2018, 148(1): 139-146.##Abeler VM, Holm R, Nesland JM et al. (1994) Small cell carcinoma of the cervix. A clinicopathologic study of 26 patients[J]. 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(1991) Randomized trial of cyclophosphamide, doxorubicin, and vincristine versus cisplatin and etoposide versus alternation of these regimens in small-cell lung cancer. Journal of the National Cancer Institute, 83(12): 855.##Zivanovic O, Jr LM, Park KJ, et al. (2009) Small cell neuroendocrine carcinoma of the cervix: Analysis of outcome, recurrence pattern and the impact of platinum-based combination chemotherapy. Gynecologic Oncology, 112(3): 590-593.##Kuji S, Hirashima Y, Nakayama H, et al. (2013) Diagnosis, clinicopathologic features, treatment, and prognosis of small cell carcinoma of the uterine cervix; Kansai Clinical Oncology Group/Intergroup study in Japan. Gynecologic Oncology, 129(3): 522-527.##Tian WJ, Zhang MQ, Shui RH (2012) Prognostic factors and treatment comparison in early-stage small cell carcinoma of the uterine cervix. Oncology Letters, 3(1): 125.##Hoskins PJ, Swenerton KD, Pike JA, et al. (2003) Small-cell carcinoma of the cervix: fourteen years of experience at a single institution using a combined-modality regimen of involved-field irradiation and platinum-Based combination chemotherapy. Journal of Clinical Oncology, 21(18): 3495-501.##Chen TC, Huang HJ, Wang TY, et al. (2015) Primary surgery versus primary radiation therapy for FIGO stages I-II small cell carcinoma of the uterine cervix: A retrospective Taiwanese Gynecologic Oncology Group study. Gynecologic Oncology, 137(3): 468.##Viswanathan AN, Deavers MT, Jhingran A, et al. (2004) Small cell neuroendocrine carcinoma of the cervix: outcome and patterns of recurrence. Gynecologic Oncology, 93(1): 27-33.##Chen J, Macdonald OK, Gaffney DK (2008) Incidence, mortality, and prognostic factors of small cell carcinoma of the cervix. Obstetrics & Gynecology, 111(6): 1394.##Lee SW, Nam JH, Kim DY, et al. 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(2015) Prognostic factors of surgically treated early-stage small cell neuroendocrine carcinoma of the cervix. International Journal of Gynecological Cancer, 25(7).##Wang Z, Wu L, Yao H, et al. (2015) Clinical analysis of 32 cases with neuroendocrine carcinoma of the uterine cervix in early-stage disease. Zhonghua Fu Chan Ke Za Zhi, 50(3): 198.##Lee SW, Lim KT, Bae DS, et al. (2015) A multicenter study of the importance of systemic chemotherapy for patients with small-cell neuroendocrine carcinoma of the uterine cervix. Gynecologic & Obstetric Investigation, 79(3): 172-178.##Zhou J, Yang HY, Wu SG, et al. (2016) The local treatment modalities in FIGO stage I-II small-cell carcinoma of the cervix are determined by disease stage and lymph node status. Cancer Medicine, 5(6): 1108-1115.##Wang KL, Chang TC, Jung SM, et al. (2012) Primary treatment and prognostic factors of small cell neuroendocrine carcinoma of the uterine cervix: a Taiwanese Gynecologic Oncology Group study. 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The use of EBT3 film and Delta4 for the dosimetric verification of EclipseTM treatment planning system in a heterogeneous chest phantom: an IMRT technique 2 2 Background: This study aimed to evaluate the dose calculation accuracy of EclipseTM treatment planning system (TPS) in a heterogeneous chest phantom with the intensity modulated radiotherapy (IMRT) technique using EBT3 film and Delta4. Materials and Methods: Two IMRT plans (A and B) were prepared for radiotherapy of the heterogeneous chest phantom. Plan A was between the left lung and the surrounding soft tissue and plan B was carried out on the soft tissue. EBT3 film and Delta4 were used for dose measurement in the phantom. EclipseTM TPS was also used for dose calculation. Finally, the gamma index values of the TPS with film and TPS with Delta4 were obtained. A 95% passing rate of gamma index with the passing criterion of 3mm/3% and a dose threshold of 20% as the standard criterion was considered in this study. Furthermore, the passing rates of gamma indices of the film and Delta4 were compared with each other via Bland-Altman analysis. Results: The mean passing rate of gamma index with standard passing criterion between the TPS calculations and film measurements was 96.95±0.22%, while it was equal to 97.7±0.56% and 98.45±0.21% between the TPS calculations and 2D and 3D Delta4 measurements, respectively. Additionally, the differences between the passing rates of gamma indices of the film and Delta4 were less than 5%. Conclusion: The findings demonstrate that the accuracy of dose calculations of EclipseTM TPS in a heterogeneous chest phantom with the IMRT technique is within the standard passing criterion. Furthermore, it can be concluded that there is a good agreement between the film and Delta4, as IMRT QA devices. 355 361 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/292019/05/292019/05/29 1398/3/8 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/292019/05/292019/05/29 1398/3/8 R. Abedi Firouzjah R. Abedi Firouzjah Department of Medical Physics, Faculty of medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran A. Nickfarjam A. Nickfarjam Department of Medical Physics, Faculty of medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran a.nickfarjam@ssu.ac.ir M. Bakhshandeh M. Bakhshandeh Radiation Technology Department, Allied Medical Sciences Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran B. Farhood B. Farhood Departments of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran Delta4 EBT3 film Heterogeneous phantom IMRT ##1. Farhood B, Toossi MTB, Ghorbani M, Salari E, Knaup C (2017) Assessment the accuracy of dose calculation in build-up region for two radiotherapy treatment planning systems. J Cancer Res Ther, 13: 968-73.##2. Bhardwaj A, Sharma S, Oinam A, Kehwar T, Chakarvarti S (2007) 3-Dimensional conformal radiotherapy versus intensity modulated radiotherapy for localized prostate cancer: Dosimetric and radiobiologic analysis. Iran J Radiat Res, 5:1-8.##3. Bahreyni Toossi MT, Soleymanifard S, Farhood B, Farkhari A, Knaup C (2018) Evaluation of electron dose calculations accuracy of a treatment planning system in radiotherapy of breast cancer with photon-electron technique. J Cancer Res Ther, 14: 1110-1116.##4. Khan FM and Gibbons JP (2014) Khan's the physics of radiation therapy: Lippincott Williams & Wilkins, Philadelphia, USA.##5. Mahdavi S, Gharehbagh EJ, Nikoofar A, Mofid B, Vasheghani M, Saedi D (2017) Radiation treatment planning for prostate cancer: A new dosimetric comparison of five and seven fields IMRT plans. Int J Radiat Res, 15: 177-83.##6. Borca VC, Pasquino M, Russo G, Grosso P, Cante D, Sciacero P, et al. (2013) Dosimetric characterization and use of GAFCHROMIC EBT3 film for IMRT dose verification. J Appl Clin Med Phys, 14: 158-71.##7. Yarahmadi M, Nedaie H, Allahverdi M, Asnaashari Kh SO (2013) Small photon field dosimetry using EBT2 Gafchromic film and Monte Carlo simulation. Int J Radiat Res, 11: 215-24.##8. Banci Buonamici F, Compagnucci A, Marrazzo L, Russo S, Bucciolini M (2007) An intercomparison between film dosimetry and diode matrix for IMRT quality assurance. Med Phys, 34: 1372-9.##9. Sadagopan R, Bencomo JA, Martin RL, Nilsson G, Matzen T, Balter PA (2009) Characterization and clinical evaluation of a novel IMRT quality assurance system. J Appl Clin Med Phys, 10: 104-19.##10. Chandraraj V, Stathakis S, Manickam R, Esquivel C, Supe SS, Papanikolaou N (2011) Comparison of four commercial devices for RapidArc and sliding window IMRT QA. J Appl Clin Med Phys, 12: 338-49.##11. Hayashi N, Malmin RL, Watanabe Y (2014) Dosimetric verification for intensity-modulated arc therapy plans by use of 2D diode array, radiochromic film and radiosensitive polymer gel. J Radiat Res, 55: 541-52.##12. Niroomand‐Rad A, Blackwell CR, Coursey BM, Gall KP, Galvin JM, McLaughlin WL, et al. (1998) Radiochromic film dosimetry: recommendations of AAPM radiation therapy committee task group 55. Med Phys, 25: 2093-115.##13. Devic S (2011) Radiochromic film dosimetry: past, present, and future. Phys Med, 27: 122-34.##14. Bedford JL, Lee YK, Wai P, South CP, Warrington AP (2009) Evaluation of the Delta4 phantom for IMRT and VMAT verification. Phys Med Biol, 54: 167-76.##15. ScandiDos. Delta 4 user manual. Uppsala S. Available from: https://delta4family.com/products [Last cited on 2019 April 04].##16. Low DA, Harms WB, Mutic S, Purdy JA (1998) A technique for the quantitative evaluation of dose distributions. Med Phys, 25: 656-61.##17. Bland JM and Altman DG (2010) Statistical methods for assessing agreement between two methods of clinical measurement. Int J Nurs Stud, 47:931-6.##18. Hauri P, Verlaan S, Graydon S, Ahnen L, Klöck S, Lang S (2014) Clinical evaluation of an anatomy‐based patient specific quality assurance system. J Appl Clin Med Phys, 15: 181-90.##19. Kan MW, Leung LH, So RW, Yu PK (2013) Experimental verification of the Acuros XB and AAA dose calculation adjacent to heterogeneous media for IMRT and RapidArc of nasopharygeal carcinoma. Med Phys, 40: 031714.##20. Sini C, Broggi S, Fiorino C, Cattaneo GM, Calandrino R (2015) Accuracy of dose calculation algorithms for static and rotational IMRT of lung cancer: a phantom study. Phys Med, 31: 382-90.##21. Raiasekaran D, Jeevanandam P, Sukumar P, Ranganathan A, Johnjothi S, Nagarajan V (2015) A study on correlation between 2D and 3D gamma evaluation metrics in patient-specific quality assurance for VMAT. Med Dosim, 39: 300-8.##22. Banci Buonamici F, Compagnucci A, Marrazzo L, Russo S, Bucciolini M (2007) An intercomparison between film dosimetry and diode matrix for IMRT quality assurance. Med Phys, 34: 1372-9. ## ##

Comparison of “heart and lung volume absorbed dose” between electron and photon boost radiotherapy after breast conserving surgery 2 2 Background: Breast conserving surgery (BCS) followed by radiotherapy (RT) has been widely accepted as the standard treatment in early stages of invasive breast cancer. The standard technique of RT includes whole breast irradiation (WBI). Additional tumor bed boost irradiation has also an important role in the local tumor control. But there are various controversial delivery methods. The aim of the present study was to compare electron and photon boost techniques in terms of heart and lung volume absorbed dose. Materials and Methods: Thirty patients with breast cancer were selected. All patients had undergone BCS and had been treated by WBI and boost irradiation. After delineation of gross tumor volume (GTV) two CT based 3D conformal boost plans by photon and electron were created for each patient. In each plan coverage index (CI), external volume index (EI), conformity index (COIN) and, lung volume absorbed dose (LVAD) and heart volume absorbed dose (HVAD) of at least 2Gy were measured. Statistical analysis was done using SPSS 17. Data were compared using a nonparametric test (Mann-Whitney) and p values <0.05 were considered significant. Results: Photon boost showed statistically significant superior results in terms of mean CI (P=0.002) and COIN (P=0.005). Results of EI revealed no significant difference between two methods (P=0.171). The heart (p=0.01) and lung (P<0.005) volume received 2Gy was lower in photon therapy in comparison with electron therapy. Conclusion: Our results demonstrated that the heart and lung volume absorbed dose is significantly higher in electron boost technique. 363 367 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/292019/05/292019/05/292019/05/29 1398/3/8 2019/04/232019/04/232019/04/232019/04/232019/04/232019/05/42019/05/112019/05/122019/05/122019/05/122019/05/202019/05/202019/05/202019/05/202019/05/282019/05/292019/05/292019/05/292019/05/292019/05/29 1398/3/8 H.R. Hashemifard H.R. Hashemifard Oncology Department, Vasei Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran R. Anbiaee R. Anbiaee Oncology Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran A. Arbabi A. Arbabi Oncology Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran S. Bitarafan S. Bitarafan Iranian Center of Neurological Research, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran D. Soltani D. Soltani Iranian Center of Neurological Research, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran E. Pirayesh E. Pirayesh Nuclear Medicine Department, Shohada Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Elahe_Pirayesh@yahoo.com Absorbed dose breast neoplasm electron photon radiotherapy. ##Haffty BG, Buchholz TA, Perez CA (2008) Early stage breast cancer. In: principles and practice of radiation oncology, (Halperin EC, Perez CA, Brady LW, eds.), Lippincott Williams and Wilkins, Philadelphia, USA.##Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V (2006) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trial. 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