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Liposomal silibinin as a potential radioprotector of human lymphocytes in the treatment of non-small cell lung cancer 2 2 Background: This study aimed to investigate the radioprotective effect of liposomal silibinin (Lip-SIL) on human lymphocytes in the treatment of non-small lung cancer cells using a combined method of cell viability assay and cytokinesis-block micronucleus assay for a better evaluation of whether one active compound is suitable to be used as a radioprotector in radiotherapy or not. Materials and Methods: Firstly, Lip-SIL was prepared by the lipid film hydration method combined with sonication. Secondly, penetration of Lip-SIL into cells was observed by fluorescence microscopy. Finally, the potential application of Lip-SIL as a radioprotector of human lymphocytes in the treatment of non-small cell lung cancer was evaluated using the above combined method with A549 cell line as a model. Results: The successfully prepared Lip-SIL had a spherical shape and good physical characteristics (particle size of approximately 83.9 nm, zeta potential of -20.6 mV, encapsulation efficiency of 28.8 % and payload of 5.1 %). At a SIL concentration of 10 µg/mL, Lip-SIL exhibited the highest radioprotection for lymphocytes, but showed no radioprotection or even increased genotoxicity in human lung cancer A549 cells. Conclusion: Lip-SIL is a potential protector of human lymphocytes during radiotherapy in the treatment of non-small lung cancer. Moreover, the results of this study also imply that the radioprotection ability of bioactive compounds for normal cells is not only based on their scavenging activity on reactive oxygen species (ROS) but also on their mechanisms of intracellular activations.     521 529 2022/07/19 1401/4/28 2019/01/15 1397/10/25 M.H. Nguyen M.H. Nguyen Center of Radiation Technology and Biotechnology, Nuclear Research Institute, Dalat city, Lam-dong province, Vietnam jackminhhiep@yahoo.com N.D. Pham N.D. Pham Center of Radiation Technology and Biotechnology, Nuclear Research Institute, Dalat city, Lam-dong province, Vietnam Q.T. Che Q.T. Che Center of Radiation Technology and Biotechnology, Nuclear Research Institute, Dalat city, Lam-dong province, Vietnam T.H.N. Nguyen T.H.N. Nguyen Department of Biology, Dalat University, Dalat city, Lam-dong province, Vietnam N.B.D. Vu N.B.D. Vu Center of Radiation Technology and Biotechnology, Nuclear Research Institute, Dalat city, Lam-dong province, Vietnam T.N.M. Tran T.N.M. Tran Center of Radiation Technology and Biotechnology, Nuclear Research Institute, Dalat city, Lam-dong province, Vietnam T.K. Trinh T.K. Trinh Department of Biology and Environment, Yersin University, Dalat city, Lam-dong province, Vietnam N.A. Trinh N.A. Trinh Department of Agriculture and Aquaculture, Tra Vinh University, Tra Vinh province, Vietnam B.N. Pham B.N. Pham Center of Radiation Technology and Biotechnology, Nuclear Research Institute, Dalat city, Lam-dong province, Vietnam V.D. Le V.D. Le The Agriculture and Rural Development Department of Tra Vinh Liposomes lung cancer radioprotection radiotherapy silibinin. Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA Cancer J Clin, 70: 7-30.##https://doi.org/10.3322/caac.21601##Azzam EI, Jay-Gerin JP, Pain D (2012) Ionizing radiation-induced metabolic oxidative stress and prolonged cell injury. Cancer Lett, 327: 48-60.##Abratt RP and Morgan GW (2002) Lung toxicity following chest irradiation in patients with lung cancer. Lung Cancer, 35: 103-109.##Kong FM, Hayman JA, Griffith KA, Kalemkerian GP, Arenberg D, Lyons S, Turrisi A, Lichter A, Fraass B, Eisbruch A, Lawrence TS, Haken RKT (2006) Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): predictors for radiation pneumonitis and fibrosis. Int J Radiat Oncol Biol Phys, 65: 1075-1086.##Nguyen MH, Duy PN, Dong B, Nguyen THN, Bui CB, Hadinoto K (2017) Radioprotective activity of curcumin-encapsulated liposomes against genotoxicity caused by gamma Cobalt-60 irradiation in human blood cells. Int J Radiat Biol, 93: 1267-1273.##Xie X, Gong S, Jin H, Yang P, Xu T, Cai Y, Guo C, Zhang R, Lou F, Yang W, Wang H (2020) Radiation-induced lymphopenia correlates with survival in nasopharyngeal carcinoma: impact of treatment modality and the baseline lymphocyte count. Radiat Oncol, 15: 65.##Yamamori T, Yasui H, Yamazumi M, Wada Y, Nakamura Y, Nakamura H, Inanami O (2012) Ionizing radiation induces mitochondrial reactive oxygen species production accompanied by upregulation of mitochondrial electron transport chain function and mitochondrial content under control of the cell cycle checkpoint. Free Radical Biol Med, 53: 260-270.##https://doi.org/10.1016/j.freeradbiomed.2012.08.556##Li L, Zeng J, Gao Y, He D (2010) Targeting silibinin in the antiproliferative pathway. Expert Opin Investig Drugs, 19: 243-255.##Aprotosoaie AC, Trifan A, Gille E, Petreus T, Bordeianu G, Miron A (2015) Can phytochemicals be a bridge to develop new radioprotective agents?. Phytochem Rev, 14: 555-566.##Gupta OP, Sing S, Bani S, Sharma N, Malhotra S, Gupta BD, Banerjee SK, Handa SS (2000) Anti-inflammatory and anti-arthritic activities of silymarin acting through inhibition of 5-lipoxygenase. Phytomedicine, 7: 21-24.##Singh RP, Deep G, Chittezhath M, Kaur M, Dwyer-Nield LD, Malkinson AM, Agarwal R (2006) Effect of silibinin on the growth and progression of primary lung tumors in mice. J Natl Cancer Inst, 98: 846-855.##Naso LG, Ferrer EG, Butenko N, Cavaco I, Lezama L, Rojo T, Etcheverry SB, Williams PAM (2011) Antioxidant, DNA cleavage, and cellular effects of silibinin and a new oxovanadium (IV)/Silibinin complex. J Biol Inorg Chem, 16: 653-668.##Mateen S, Raina K, Agarwal R (2013) Chemopreventive and anti-cancer efficacy of SIL against growth and progression of lung cancer. Nutr Cancer, 65: 3-11.##Tiwari P, Kumar A, Ali M, Mishra KP (2010) Radioprotection of plasmid and cellular DNA and Swiss mice by silibinin. Mutat Res, 695: 55-60.##Nguyen HM, Yu H, Dong B, Hadinoto K (2016) A supersaturating delivery system of silibinin exhibiting high payload achieved by amorphous nano-complexation with chitosan. Eur J Pharm Sci, 89: 163-171.##Wu JW, Lin LC, Hung SC, Chi CW, Tsai TH (2007) Analysis of silibinin in rat plasma and bile for hepatobiliary excretion and oral bioavailability application. J Pharm Biomed Anal, 45: 635-641.##Fatehi D, Mohammadi M, Shekarchi B, Shabani A, Seify M, Rostamzadeh A (2018) Radioprotective effects of Silymarin on the sperm parameters of NMRI mice irradiated with gamma-rays. J Photochem Photobiol B, 178: 489-495.##Lutsenko SV, Gromovykh TI, Krasnyuk II, Vasilenko IA, Feldman NB (2018) Antihepatotoxic activity of Liposomal silibinin. Bionanosci, 8: 581-586.##Redon CE, Dickey JS, Bonner WM, Sedelnikova OA (2009) γ-H2AX as a biomaker of DNA induced by ionizing radiation in human peripheral blood lymphocytes and artificial skin. Adv Space Res, 43: 1171-1178.##Whitlon DS, Baas PW (1992) Improved methods for using glass coverslips in cell culture and electron microscopy. J Histochem Cytochem, 40: 875-877.##Ak T and Gülçin I (2008) Antioxidant and radical scavenging properties of curcumin. Chem Biol Interact, 174: 27-37.##Gülçin I (2007) Comparison of in vitro antioxidant and antiradical activities of L-tyrosine and L-Dopa. Amino Acids, 32: 431-438.##Fenech M (2010) The lymphocytes cytokinesis-block micronucleus cytome assay and its application in radiation biodosimetry. Health Phys, 98: 234-243.##Strober W (2015) Trypan blue exclusion test of cell viability. Curr Protoc Immunol, 111: A3.B.1-A3.B.3.##Ochi AM, Amoabediny G, Rezayat S, Akbarzadeh A, Ebrahimi B (2015) Design and preparation of encapsulated nano-liposome controlled release including silibinin anti-cancer herbal drug (nano phytosome). JSSU, 23: 2000-2012.##Ducat E, Evrard B, Peulen O, Piel G (2011) Cellular uptake of liposomes monitored by confocal microscopy and flow cytometry. J Drug Del Sci Tech, 21: 469-477.##Jian Y, Azadeh B, Geert D, Jeroen B, René CLO, Alexander K (2016) Drug delivery via cell membrane fusion using lipopeptide modified liposomes. ACS Cent Sci, 2: 621-630.##Gao X, Yue T, Tian F, Liu Z, Zhang X (2017) Erythrocyte membrane skeleton inhibits nanoparticle endocytosis. AIP Adv, 7: 065303.##Amiri B, Ebrahimi-Far M, Saffari Z, Akbarzadeh A, Soleimani E, Chiani M (2016) Preparation, characterization and cytotoxicity of silibinin containing nanoniosomes in T47 human breast carcinoma cells. Asian Pac J Cancer Prev, 17: 3835-3838.##Poljsak B, Suput D, Milisav I (2013) Achieving the balance between ROS and antioxidants: when to use the synthetic antioxidants. Oxid Med Cell Longev, 956792.##Nambiar DK, Rajamani P, Deep G, Jain AK, Agarwal R, Singh RP (2015) Silibinin preferentially radiosensitizes prostate cancer by inhibiting DNA repair signaling. Mol Cancer Ther, 14: 2722-2734.##Loguercio C and Festi D (2011) Silybin and the liver: From basic research to clinical practice. World J Gastroenterol, 17: 2288-2301.##Zhou B, Wu LJ Tashiro S, Onodera S, Uchiumi F, Ikejima T (2006) Silibinin protects rat cardiac myocyte from isoproterenol-induced DNA damage independent on regulation of cell cycle. Biol Pharm Bull, 29: 1990-1995.##Xu S, Zhang H, Wang A, Ma Y, Gan Y, Li G (2020) Silibinin suppresses epithelial-mesenchymal transition in human non-small cell lung cancer cells by restraining RHBDD1. Cell Mol Biol Lett, 25: 36.##Zhang X, Zhao Y, Wang C, Ju H, Liu W, Zhang X, Miao S, Wang L, Sun Q, Song W (2018) Rhomboid domain-containing protein 1 promotes breast cancer progression by regulating the p-Akt and CDK2 levels. Cell Commun Signal, 16: 65.## ##

Comparison of lumbar spine metastasis plans involving different stereotactic radiotherapy devices 2 2 Background: We compare plans involving two different stereotactic radiotherapy devices: Cyberknife (CK) and Helical Tomotherapy (HTT) and their results on the lumbarvertebra targets. Materials and Methods: Ten simulation tomographs of the first lumbar vertebra were selected from among the tomographies of patients who had previously undergone SBRT for any reason. In each planning tomography, two separate clinical target volumes (CTV) were drawn at the first lumbar vertebra, we used 2%, 95% and 98% doses of the target volume (D2, D95, D98) in the plan evaluation. The 2% dose of the planning target volume (PTV) was used for comparison with the hot spot; the 95% dose coverage of CTV was used for the target coverage comparison, and the 98% dose of the target volume was used for the dose volume histogram "shoulder" metric definitionTheHomogeneity Index (HI), new Conformity Index (nCI) and Gradient Index (GI) were evaluated for each planning system and target. Results: In both groups, CTV1 and CTV2, when compared with D95, the coverage for HTT was found statistically significantly higher. D98 was found to be statistically significantly higher with HTT. In both targets, the CKplans were found to have a higher hot area (D2), and inhomogeneous plans were obtained when compared to HTT. The NCI results were similar, and GI was higher with HTT. Conclusion: In lumbar vertebra stereotactic radiotherapy, more inhomogeneous plans were obtained with Cyberknife than with the Helical Tomotherapy device. A better gradient index was achieved with Cyberknife, while better coverage was achieved on the HTT plan.     531 535 2022/07/192022/07/20 1401/4/29 2019/01/152022/07/19 1401/4/28 N. Isık N. Isık Lutfi Kirdar Kartal Egitim ve Arastirma Hastanesi, Radyasyon Onkolojisi Klinigi, Istanbul, Turkey nacisik@hotmail.com E. Algül E. Algül Lutfi Kirdar Kartal Egitim ve Arastirma Hastanesi, Radyasyon Onkolojisi Klinigi, Istanbul, Turkey G. Yaprak G. Yaprak Lutfi Kirdar Kartal Egitim ve Arastirma Hastanesi, Radyasyon Onkolojisi Klinigi, Istanbul, Turkey A. Özen A. Özen Lutfi Kirdar Kartal Egitim ve Arastirma Hastanesi, Radyasyon Onkolojisi Klinigi, Istanbul, Turkey Vertebra metastasis stereotactic body radiotherapy (SBRT) cyberknife helical tomotherapy (HTT). Ryu S, Pugh SL, Gerszten PC, Yin FF, Timmerman RD, Hitchcock YJ, et al. (2014) RTOG 0631 phase 2/3 study of image guided stereotactic radiosurgery for localized (1-3) spine metastases: phase 2 results. Practical Radiation Oncology, 4(2): 76-81.##Husain ZA, Sahgal A, De Salles A, Funaro M, Glover J, Hayashi M, et al. (2017) Stereotactic body radiotherapy for de novo spinal metastases: systematic review. Journal of neurosurgery. Spine, 27(3): 295-302.##Aljabab S, Vellayappan B, Vandervoort E, Bahm J, Zohr R, Sinclair J, et al. (2018) Comparison of four techniques for spine stereotactic body radiotherapy: Dosimetric and efficiency analysis. Journal of Applied Clinical Medical Physics, 19(2): 160-167.##Jabbari S, Gerszten PC, Ruschin M, Larson DA, Lo SS, Sahgal A (2016) Stereotactic body radiotherapy for spinal metastases: Practice Guidelines, Outcomes, and Risks. Cancer Journal (Sudbury, Mass.), 22(4): 280-289.##Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, Sheehan J, et al. (2012) International spine radiosurgery consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys, 83(5): e597-e605.##Sahgal A, Weinberg V, Ma L, Chang E, Chao S, Muacevic A, et al. (2013) Probabilities of radiation myelopathy specific to stereotactic body radiation therapy to guide safe practice. Int J Radiat Oncol Biol Phys, 85(2): 341-347.##Hodapp N (2012) The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol, 188(1): 97-99.##Hanna G, Murray L, Patel R, Jain S, Aitken KL, Franks KN, et al. (2018) UK consensus on normal tissue dose constraints for stereotactic radiotherapy. Royal College of Radiologists, Great Britain. Clinical Oncology, 30(1): 5-14.##Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, et al. (2010) Stereotactic body radiation therapy: the report of AAPM Task Group 101. Medical Physics, 37(8): 4078-4101.##Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R, Martin L (1993) Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys, 27(5): 1231-1239.##Nakamura JL, Verhey LJ, Smith V, Petti PL, Lamborn KR, Larson DA, et al. (2001) Dose conformity of gamma knife radiosurgery and risk factors for complications Int J Radiat Oncol Biol Phys, 51(5): 1313-1319.##Ma L, Sahgal A, Cozzi L, Chang E, Shiu A, Letourneau D, et al. (2010) Apparatus-dependent dosimetric differences in spine stereotactic body radiotherapy. Technology in Cancer Research & Treatment, 9(6): 563-574.##Nalichowski A, Kaufman I, Gallo J, Bossenberger T, Solberg T, Ramirez E, et al. (2017) Single fraction radiosurgery/stereotactic body radiation therapy (SBRT) for spine metastasis: A dosimetric comparison of multiple delivery platforms. Journal of Applied Clinical Medical Physics, 18(1): 164-169.##Yang J, Ma L, Wang XS, Xu WX, Cong XH, Xu SP, Ju ZJ, Du L, Cai BN, Yang J (2016) Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases. Medical dosimetry: Official Journal of the American Association of Medical Dosimetrists, 41(2): 105-112.##Gallo JJ, Kaufman I, Powell R, Pandya S, Somnay A, Bossenberger T, et al. (2015) Single-fraction spine SBRT end-to-end testing on TomoTherapy, Vero, TrueBeam, and CyberKnife treatment platforms using a novel anthropomorphic phantom. Journal of Applied Clinical Medical Physics, 16(1): 5120.## ##

Effectiveness of postoperative radiotherapy excluding the common iliac lymph nodes in patients with node-negative cervical carcinoma 2 2 Background: To evaluate whether excluding the common iliac lymph nodes from the clinical target volume (CTV) during radiotherapy is effective in node-negative patients after cervical cancer surgery. Materials and Methods: Between January 2014 and December 2017, 29 patients who underwent radiotherapy after curative surgery for cervical carcinoma were included in this study. We included 19 and 10 patients in the CTV group with common iliac lymph nodes (CTVL) and those without (CTVs), respectively. We retrospectively investigated the correlation among CTV, treatment outcome, and adverse events. Results: The median follow-up period was 30.4 (range, 2–55) months. The 3-year overall survival (OS) and progression-free survival (PFS) rates of the CTVL group were 95.0% and 85.0%, respectively, and those of the CTVs group were 100% and 88.9%, respectively. The 3-year OS and PFS rates were not significantly different between both groups (log-rank; P=0.414 and 0.657, respectively). Three CTVL patients and 1 CTVs patient had recurrences. However, there was no significant difference in the recurrence rate between both groups (P=1.0). Conclusion: CTV excluding the common iliac lymph nodes in postoperative radiotherapy may be effective in patients with node-negative postoperative cervical cancer.     537 541 2022/07/192022/07/202022/07/20 1401/4/29 2019/01/152022/07/192022/07/19 1401/4/28 T. Saito-Zama T. Saito-Zama Department of Radiology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-Ku, Tokyo, Japan R. Mikami R. Mikami Department of Radiology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-Ku, Tokyo, Japan mikami-r@tokyo-med.ac.jp T. Itonaga T. Itonaga Department of Radiology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-Ku, Tokyo, Japan M. Okubo M. Okubo Department of Radiology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, Japan S. Sugahara S. Sugahara Department of Radiology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, Japan K. Saito K. Saito Department of Radiology, Tokyo Medical University, 6-7-1, Nishi-shinjuku, Shinjuku-Ku, Tokyo, Japan Clinical target volume postoperative radiotherapy cervical carcinoma common iliac lymph nodes treatment outcome. 1. Li X, Yin Y, Sheng X (2015) Distribution pattern of lymph node metastases and its implication in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer. Radiat Oncol, 10: 40.##Abu-Rustum NR and Yashar CM (2021) National comprehensive cancer network. NCCN Clinical Practice Guidelines in Oncology Cervical Cancer. version 1. 2021. Available at: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed [October 2, 2020].##Rotman M, Sedlis A, Piedmonte MR (2006) A Phase III randomized trial of postoperative pelvic irradiation in stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys, 65:169-176.##Ohara K, Tsunoda H, Nishida M (2003) Use of small pelvic field instead of whole pelvic field in postoperative radiotherapy for node-negative, high-risk stages I and II cervical squamous cell carcinoma. Int J Gynecol Cancer, 13: 170-176.##https://doi.org/10.1136/ijgc-00009577-200303000-00012##Rose BS, Aydogan B, Liang Y (2011) Normal tissue complication probability modeling of acute hematologic toxicity in cervical cancer patients treated with chemoradiotherapy. Int J Radiat Oncol Biol Phys, 79(3): 800-807.##Mell LK, Tiryaki H, Ahn KH (2008) Dosimetric comparison of bone marrow-sparing intensity-modulated radiotherapy versus conventional techniques for treatment of cervical cancer. Int J Radiat Oncol Biol Phys, 71(5): 1504-1510.##Chen MF, Tseng CJ, Tseng CC (2007) Clinical outcome in posthysterectomy cervical cancer patients treated with concurrent Cisplatin and intensity-modulated pelvic radiotherapy: comparison with conventional radiotherapy. Int J Radiat Oncol Biol Phys, 67: 1438-1444.##Small W Jr, Bosch WR, Harkenrider MM (2021) NRG Oncology/RTOG consensus guidelines for delineation of clinical target volume for intensity modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer: An update. Int J Radiat Oncol Biol Phys, 109: 413-424.##Kasuya G, Toita T, Furutani K (2013) Distribution patterns of metastatic pelvic lymph nodes assessed by CT/MRI in patients with uterine cervical cancer. Radiat Oncol, 8: 139.##Mauch P, Constine L, Greenberger J (1995) Hematopoietic stem cell compartment: Acute and late effects of radiation therapy and chemotherapy. Int J Radiat Oncol Biol Phys, 31: 1319-1339.##Mell LK, Kochanski JD, Roeske JC (2006) Dosimetric predictors of acute hematologic toxicity in cervical cancer patients treated with concurrent cisplatin and intensity-modulated pelvic radiotherapy. Int J Radiat Oncol Biol Phys, 66: 1356-1365.##Lewis S, Chopra S, Naga P (2018) Acute hematological toxicity during post-operative bowel sparing image-guided intensity modulated radiation with concurrent cisplatin. Br J Radiol, 91: 20180005.##Hayman JA, Callahan JW, Herschtal A (2011) Distribution of proliferating bone marrow in adult cancer patients determined using FLT-PET imaging. Int J Radiat Oncol Biol Phys, 79: 847-852.##Ohara K, Tsunoda H, Satoh T (2004) Use of the small pelvic field instead of the classic whole pelvic field in postoperative radiotherapy for cervical cancer: reduction of adverse events. Int J Radiat Oncol Biol Phys, 60: 258-264.## ##

Evaluation the health effects of low doses gamma irradiations on liver of obese rats 2 2 Background: Low-dose ionizing radiation has major health impacts in a variety of fields, including radiation therapy. However, all potential applications are currently subject to public interest. Aims: This study is an endeavor to evaluate the role of low dose gamma irradiation against the adverse effects of obesity in obese rats. Materials and Methods: Thirty-six rats were divided into 4 equal groups;”G1” is a normal control group; ”G2” received a high-fat diet for 16 weeks to induce obesity; ”G3” rats also received a high-fat diet for 16 weeks in addition to being exposed to 0.5 Gray γ- radiation for 2 weeks, two twice a week (accumulated dose =4×0.5=2 Gray); “G4”  were normal rats, but also exposed to 0.5 Gray  γ- radiation for 2 weeks, twice a week (accumulated dose =4×0.5=2 Gray). Rats were anaesthetized at the end of the experiment, and blood samples as well as liver tissues were collected for both biochemical and histological studies. Results: There are harmful effects on the liver of obese rats, which include elevated levels of liver weight, liver functions, Malondialdehyde and lipids and diminished glutathione, as well as increased levels of C reactive protein and lipase in “G2” compared to “G1”. In contrast, low-dose fractionated gamma irradiation has a significant reduction in these harmful effects of obesity. Conclusions: The findings of the current study suggest that fractionated low-dose gamma irradiation plays a significant role against the harmful effects of obesity, and thus could augment and support the aim of current study by drawing attention to the health impacts of low-doses gamma irradiation. 543 549 2022/07/192022/07/202022/07/202022/07/20 1401/4/29 2019/01/152022/07/192022/07/192022/07/19 1401/4/28 H.A. Abd Elmonem H.A. Abd Elmonem Biological Applications Department., Nuclear Research Center (NRC), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt S.N.A. Mater S.N.A. Mater Biological Applications Department., Nuclear Research Center (NRC), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt SH.M. Eldeighdye SH.M. Eldeighdye Biological Applications Department., Nuclear Research Center (NRC), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt shaimaa122019@yahoo.com Obesity gamma rays C reactive protein glutathione lipase liver function. Alexander V, Alexander K, Oksana Z, Yehoshua S (2018) Health impacts of low-dose ionizing radiation. Current Scientific Debates and Regulatory Issues; Dose-Response, 16(3): 1-27.##Mutscheller A (1925) Physical standards of protection against Roentgen Ray Dangers. AJR Am J Roentgenol, 13(1): 65-69.##Howell RW (2016) Physical considerations for understanding responses of biological systems to low doses of ionizing radiation: nucleosome clutches constitute a heterogeneous distribution of target volumes. Health Phys, 110(3): 283-286.##Feinendegen LE (2005) Evidence for beneficial low level radiation effects and radiation hormesis. Br J Radiol, 78(925): 3-7.##Feinendegen LE, Pollycove M, Sondhaus CA (2004) Responses to low doses of ionizing radiation in biological systems. Nonlinearity Biol Toxicol Med, 2(3): 143-171.##Pollycove M and Feinendegen LE (2003) Radiation-induced versus endogenous DNA damage: possible effect of inducible protective responses in mitigating endogenous damage. Hum Exp Toxicol, 22(6): 290-306.##Azzam EI, Colangelo NW, Domogauer JD, Sharma N, de Toledo SM (2016) Is ionizing radiation harmful at any exposure? An echo that continues to vibrate. Health Phys, 110(3): 249-251.##Scott BR, Haque M, Di Palma J (2007) Biological basis for radiation hormesis in mammalian cellular communities. Int J Low Radiat, 4(1): 1-16.##Szumiel (2012) Radiation hormesis: Autophagy and other cellular mechanisms. Int J Radiat Biol, 88(9): 619-628.##Calabrese EJ (2014) Hormesis: a fundamental concept in biology. Microb Cell, 1(5): 145-149.##Kojima S, Nakayama K, Ishida H (2004) Low dose gamma-rays activate immune functions via induction of glutathione and delay tumor growth. J Radiat Res, 45(1): 33-39.##Durovic B, Spasic-Jokic V, Durovic B (2008) Influence of occupational exposure to low-dose ionizing radiation on the plasma activity of superoxide dismutase and glutathione level. Vajnosanit Pregl, 65: 613-618.##Yamaoka K Edamatsu R, Mori A (1991) Increased SOD activities and decreased lipid peroxide levels induced by low dose X irradiation in rat organs. Free Radic Biol Med, 11(3): 299-306.##Avti PK, Pathak CM, Kumar S, Kaushik G, Kaushik T, Farooque A, Khanduja KL, Sharma SC (2005) Low dose gamma-irradiation differentially modulates antioxidant defense in liver and lungs of Balb/c mice. Int J Radiat Biol, 81(12): 901-911.##Vargas-Robles H, Rios A, Arellano-Mendoza M, Escalante BA, Schnoor M (2015) Antioxidative diet supplementation reverses high-fat dietinduced increases of cardiovascular risk factors in mice. Oxid Med Cell Longev, 2015: 1-9.##Keshi SB, Debashree S, Krishnendu M (2016) High-fat diet- induced oxidative stress and its impacts on metabolic syndrome: A review. Asian J Pharm Clin Res, 9(1): 47-52.##Pessayre D, Berson A, Fromenty B, Mansouri A (2001) Mitochondria in steatohepatitis. Semin Liver Dis, 21(1): 57-69.##Bernardis LL (1970) Prediction of carcass fat, water and lean body mass from Lee's nutritive ratio in rats with hypothalamic obesity. Experientia, 26(7): 789-90.##Beutler E, Duron O, Kelly MB (1963) Improved method for the determination of blood glutathione. J Lab Clin Med, 61: 882-888.##Ohkawa H, Ohishi W, Yagi K (1979) Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem, 95(2): 351-358.##Drury RA and Wallington EA (1980) Carleton's histological techniques 5th edition, Oxford University Press, New York, 195.##Shore RE, Beck HL, Boice JD (2018) Implications of recent epidemiologic studies for the linear nonthreshold model and radiation protection. J Radiol Prot, 38(3): 1217-1233.##Feinendegen LE (2005) Evidence for beneficial low level radiation effects and radiation hormesis. Br J Radiol, 78(925): 3-7.##Liu SZ (2010) Biological effects of low level exposures to ionizing radiation: theory and practice. Hum Exp Toxicol, 29(4): 275-80.##McLaren L (2007) Socioeconomic status and obesity. Epidemiol Rev, 29: 29-48.##Akiyama T, Tachibana I, Shirohara H (1996) High-fat hypercaloric diet induces obesity, glucose intolerance and hyperlipidemia in normal adult male Wistar rat. Diabetes Res and Clin Pract, 31(1): 27-35.##Pessayre D, Berson A, Fromenty B, Mansouri A (2001) Mitochondria in steatohepatitis. Semin Liver Dis, 21(1): 57-69.##Cardoso AR, Kakimoto PA, Kowaltowski AJ (2013) Diet-sensitive sources of re- active oxygen species in liver mitochondria: role of very long chain acyl-CoA dehydrogenases. PLoS One, 8(10): e77088.##Djordjevic VB (2004) Free radicals in cell biology. Int Rev Cytol, 237: 57-89.##Jain A, Martensson J, Stole E, Auld PA, Meister A (1991) Glutathione deficiency leads to mitochondrial damage in the brain. (USA). Proc Natl Acad Sci, 88(5): 1913-1917.##Valko M, Rhodes CJ, Moncol J, Izakovic M, Mazur M (2006) Free radicals, metals and antioxidants in oxidative stress-induced cancer. Chem Biol Interact, 160(1): 1-40.##Maturu P, Vaddi DR, Pannuru P, Nallanchakravarthula V (2010) Alterations in erythrocyte membrane fluidity and Na+/K+-ATPase activity in chronic alcoholics. Mol Cell Biochem, 339(1-2): 35-42.##Anzai K, Ban N, Ozawa T, Tokonami S (2012) Fukushima Daiichi Nuclear Power Plant accident: facts, environmental contamination, possible biological effects, and countermeasures. J Clin Biochem Nutr, 50(1): 2-8.##Azzam EI, Colangelo NW, Domogauer JD, Sharma N, de Toledo SM (2016) Is ionizing radiation harmful at any exposure? An echo that continues to vibrate. Health Phys, 110(3):249-251.##Scorletti E and Byrne CD (2013) Omega-3 fattyacids, hepaticlipid metabolism,and nonalcoholic fatty liver disease. Annu Rev Nutr, 33: 231-248.##Chad AG, Lee H, Brookes PS, Yisang Y (2014) Decreasing mitochondrial fission alleviates hepaticsteatosis in a murine model of non-alcoholic fatty liver diseaseLiver Physiol. Am J Physiol Gastrointest, 307: 632-641.##Nanji AA, French SW, Freeman JB (1985) Serum alanine aminotransferase to aspartate aminotransferase ratio and degree of fatty liver in morbidly obese patients. Enzyme, 36(4): 266-269.##Finco DR (1989) Clinical biochemistry of domestic animals. NY: Academic Press, Inc. 1989##Abraham P, Wilfred G, Ramakrishna B (2002) Oxidative damage to the hepatocellular proteins after chronic ethanol intake in the rat. Clin Chim Acta, 325(1-2): 117-125.##Rippe C, Erlanson-Albertsson C (1998) Identification of enterostatin and the relationship between lipase and colipase in various species. Nutr Neurosci, 1(2): 111-117.##Weisberg SP, Leibel R, Tortoriello DV (2008) Dietary curcumin significantly improves obesity-associated inflammation and diabetes in mouse models of diabesity. Endocrinology, 149(7): 3549-3558.##Rahman MM, Varghese Z, Moorhead JF (2001) Paradoxical increase in nitric oxide synthase activity in hypercholesterolaemic rats with impaired renal function and decreased activity of nitric oxide. Nephrol Dial Transplant, 16(2): 262-268.##Liu SZ (2006) Cancer control related to stimulation of immunity by low-dose radiation. Dose Response, 5(1): 39-47.##Lieber CS, Leo MA, Mak KM (2004) Model of nonalcoholic steatohepatitis. Am J Clin Nutr, 79(3): 502-9.##Brent A, Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: Summary of an AASLD Single Topic Conference. Hepatology, 37(5): 1202- 1219.##Gaiva MH, Couto RC, Oyama LM (2003) Diets rich in polyunsaturated fatty acids: effect on hepatic metabolism in rats. Nutrition, 19(2): 144-9.##Calabrese EJ, Bachmann KA, Bailer AJ (2007) Biological stress response terminology: integrating the concepts of adaptive response and preconditioning stress within a hormetic dose- response framework. Toxicol Appl Pharmacol, 222(1): 122-128.## ##

Second primary cancer risk in cervical cancer patients after definitive radiotherapy: a nationwide population-based study 2 2 Background: Although radiotherapy (RT) is an important treatment modality for cervical cancer, it can cause cancer. However, the risk of second primary cancer (SPC) tends to be ignored during RT for cervical cancer. We analyzed the prevalence and incidence patterns of SPC in cervical cancer patients that underwent definitive RT. Materials and Methods: The insurance claims data of cervical cancer patients that underwent definitive RT from 2007 to 2012 were analyzed. Standardized incidence ratios (SIRs) were used to estimate the relative risks of SPC. In addition, odds ratios were estimated by unconditional Poisson regression and adjusted for age at cervical cancer diagnosis, chemotherapy, and comorbidities. Results: Median patient age was 59.4 years. SIRs for bladder, ovary, and uterine cancer were 6.72 (95% confidence intervals (CI) 3.36–12.03, p < 0.001), 7.12 (95% CI 4.22–11.25, p < 0.0001), and 8.44 (95% CI 5.08–13.18, p < 0.001), respectively. The SIRs of all organs in the pelvic irradiation field were significantly increased. SIRs for breast and stomach cancer were 0.5 (95% CI 0.22–0.99, p = 0.0441) and 0.8 (95% CI 0.43–1.37, p = 0.5331), respectively. SIRs were not affected by chemotherapy, age, or comorbidities. Conclusion: RT increases the incidence of SPC in cervical cancer patients. In particular, SPC rates of organs in the irradiation field were higher than those of organs outside the irradiation field. If SPC risk were quantified with respect to irradiation dose, it could be utilized in clinical practice. 551 544 2022/07/192022/07/202022/07/202022/07/202022/07/20 1401/4/29 2019/01/152022/07/192022/07/192022/07/192022/07/19 1401/4/28 I. Seo I. Seo Departments of Microbiology and Radiation Oncology, School of Medicine, Dongguk University, Gyeongsangbuk-do, Republic of Korea H. Jang H. Jang Departments of Radiation Oncology, School of Medicine, Dongguk University, Gyeongsangbuk-do, Republic of Korea opencagejhs@gmail.com Cervical cancer second primary cancer radiotherapy. 1. Shrestha AD, Neupane D, Vedsted P, Kallestrup P (2018) Cervical cancer prevalence, incidence and mortality in low and middle income countries: A systematic review. Asian Pac J Cancer Prev, 19(2): 319-324.##Daniyal M, Akhtar N, Ahmad S, Fatima U, Akram M, Asif HM (2015) Update knowledge on cervical cancer Incidence and prevalence in Asia. Asian Pac J Cancer Prev, 16(9): 3617-3620.##Papatla K, Halpern MT, Hernandez E, Brown J, Benrubi D, Houck K, Chu C, Rubin S (2019) Second primary anal and oropharyngeal cancers in cervical cancer survivors. Am J Obstet Gynecol, 221(5): 478 e471-478 e476.##Lim MC, Won YJ, Lim J, Kim YJ, Seo SS, Kang S, Lee ES, Oh JH, Kim JY, Park SY (2016) Second primary cancer after diagnosis and treatment of cervical cancer. Cancer Res Treat, 48(2): 641-649.##Rombouts AJM, Hugen N, Elferink MAG, Poortmans PMP, Nagtegaal ID, de Wilt JHW (2020) Increased Risk for Second Primary Rectal Cancer after Pelvic Radiation Therapy. Eur J Cancer, 124: 142-151.##Jhamad S, Aanjane R, Jaiswal S, Jain S, Bhagat P (2018) Second primary cancer after radiotherapy for cervical cancer. J Midlife Health, 9(4): 207-209.##Sale KA, Wallace DI, Girod DA, Tsue TT (2004) Radiation-induced malignancy of the head and neck. Otolaryngol Head Neck Surg, 131(5): 643-645.##Cahan WG and Woodard HQ, et al. (1948) Sarcoma Arising in Irradiated Bone; Report of 11 Cases. Cancer, 1(1): 3-29.##https://doi.org/10.1002/1097-0142(194805)1:13.0.CO;2-7##Ferrandina G, Mantegna G, Petrillo M, Fuoco G, Venditti L, Terzano S, Moruzzi C, Lorusso D, Marcellusi A, Scambia G (2012) Quality of life and emotional distress in early stage and locally advanced cervical cancer patients: A Prospective, Longitudinal Study. Gynecol Oncol, 124(3): 389-394.##Benard VB, Watson M, Saraiya M, Harewood R, Townsend JS, Stroup AM, Weir HK, Allemani C (2017) Cervical cancer survival in the United States by race and stage (2001-2009): Findings from the Concord-2 Study. Cancer, 123(24): 5119-5137.##Benson R, Pathy S, Kumar L, Mathur S, Dadhwal V, Mohanti BK (2019) Locally advanced cervical cancer - neoadjuvant chemotherapy followed by concurrent chemoradiation and targeted therapy as maintenance: A phase II study. J Cancer Res Ther, 15(6): 1359-1364.##Datta NR, Stutz E, Liu M, Rogers S, Klingbiel D, Siebenhuner A, Singh S, Bodis S (2017) Concurrent chemoradiotherapy Vs. radiotherapy alone in locally advanced cervix cancer: A systematic review and meta-analysis. Gynecol Oncol, 145(2): 374-385.##Hall EJ and Wuu CS (2003) Radiation-induced second cancers: The Impact of 3d-Crt and Imrt. Int J Radiat Oncol Biol Phys, 56(1): 83-88.##Storm HH (1988) Second primary cancer after treatment for cervical cancer. Late effects after radiotherapy. Cancer, 61(4): 679-688.##https://doi.org/10.1002/1097-0142(19880215)61:43.0.CO;2-S##Kleinerman RA, Boice JD, Jr., Storm HH, Sparen P, Andersen A, Pukkala E, Lynch CF, Hankey BF, Flannery JT (1995) Second primary cancer after treatment for cervical Cancer. An international cancer registries study. Cancer, 76(3): 442-452.##https://doi.org/10.1002/1097-0142(19950801)76:33.0.CO;2-L##Lee B, Ahn SH, Kim H, Son J, Sung J, Han Y, Huh SJ, Kim JS, Kim DW, Yoon M (2016) Secondary cancer-incidence risk estimates for external radiotherapy and high-dose-rate brachytherapy in cervical cancer: Phantom study. J Appl Clin Med Phys, 17(5): 124-132.##Li CI, Nishi N, McDougall JA, Semmens EO, Sugiyama H, Soda M, Sakata R, Hayashi M, Kasagi F, Suyama A, Mabuchi K, Davis S, Kodama K, Kopecky KJ (2010) Relationship between radiation exposure and risk of second primary cancers among atomic bomb survivors. Cancer Research, 70(18): 7187-7198.##Elsamadicy AA, Babu R, Kirkpatrick JP, Adamson DC (2015) Radiation-induced malignant gliomas: A Current Review. World Neurosurg, 83(4): 530-542.##Grantzau T, Mellemkjaer L, Overgaard J (2013) Second primary cancers after adjuvant radiotherapy in early breast cancer patients: A national population based study under the Danish breast cancer cooperative group (Dbcg). Radiother Oncol, 106(1): 42-49.##Papatla K, Houck KL, Hernandez E, Chu C, Rubin S (2019) Second primary uterine malignancies after radiation therapy for cervical cancer. Arch Gynecol Obstet, 300(2): 389-394.##Teng CJ, Huon LK, Hu YW, Yeh CM, Chao Y, Yang MH, Chen TJ, Hung YP, Liu CJ (2015) Secondary primary malignancy risk in patients with cervical cancer in Taiwan: A nationwide population-based study. Medicine (Baltimore), 94(43): e1803.##Hung H, You J, Chiang J, Hsieh P, Chiang S, Lai C, Tasi W, Yeh C, Chern Y, Hsu Y (2020) Clinicopathological characteristics and outcomes of metachronous rectal cancer in patients with a history of cervical cancer with and without remote radiotherapy: Reports of 45 cases. Medicine (Baltimore), 99(30): e21328.##Zhang W, Becciolini A, Biggeri A, Pacini P, Muirhead CR (2011) Second malignancies in breast cancer patients following radiotherapy: A Study in Florence, Italy. Breast Cancer Res, 13(2): R38.## ##

Efficacy of Hematoporphyrin mediated photo-sonodynamic therapy on mice breast cancer 2 2 Background: A combination of photodynamic and sonodynamic therapy (PSDT) may be a non-invasive method for cancer treatment, which incorporates a combination of low-intensity ultrasound, laser radiation, and a sensitizer agent. The goal of this research was to evaluate the effect of PSDT with Hematoporphyrin-encapsulated Mesoporous silica nanoparticles (HP-MSNs) as a sensitizer in the management of mice breast adenocarcinoma. Materials and Methods: One hundred and fifty-six female mice (tumor grafted) were separated into 26 groups; including sham, laser (650 nm), 4 groups of laser + HP or MSN-HP (2.5 and 5 mg/kg), 4 groups of laser + ultrasound (1and 3 MHz; 1, 2 W/cm2), 16 groups of PSDT + HP or HP-MSN. The tumor growth factors were used to assess the procedure findings. Results: The results indicate that PSDT with an injection of HP or HP-MSN is effective in delaying tumor growth (P<0.05). Overall comparison of data showed a non-significant difference between PSDT with HP-MSN groups. The time of T2 and T5 in the groups of PSDT with HP-MSN were increased in comparison with sham and that of PSDT with HP groups (P<0.05). The tumor growth inhibition ratio increased in all PSDT groups. This increase was transient and declined over 30 days of treatment. PSDT + HP-MSN had Grade I, while other groups had Grade III malignancy in the histological study. Conclusion: The research gave profound findings involving the employ of PSDT with HP-MSN as a photo/sonosensitizer for treating breast adenocarcinoma implanted in mice.     555 561 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/20 1401/4/29 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 S. Moshfegh S. Moshfegh Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran M. Jadidi M. Jadidi Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran Jadidim@semums.ac.ir H. Hasanzadeh H. Hasanzadeh Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran R. Nasr R. Nasr Biotechnology Research Center, Semnan University of Medical Sciences, Semnan, Iran M. Mirmohammadkhani M. Mirmohammadkhani Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran Photodynamic therapy sonodynamic therapy laser ultrasound breast cancer. Dougherty TJ, Gomer CJ, Henderson BW, Jori G, Kessel K, Korbelik M, et al. (1998) Photodynamic Therapy. J Natl Cancer Inst, 90(12): 889-905.##dos Santos AF, de Almeida DRQ, Terra LF, Baptista MS, Labriola L (2019) Photodynamic therapy in cancer treatment - an update review. J Cancer Metastasis Treat, 5:25.##Sibata CH, Colussi VC, Oleinick NL, Kinsella TJ (2000) Photodynamic therapy: a new concept in medical treatment. Braz J Med Biol Res, 33(8): 869-880.##Gallardo-Villagrá n M, Leger DY,Liagre B, Therrien B (2019) Photosensitizers used in the photodynamic therapy of rheumatoid arthritis. Int J Mol Sci, 20: 3339.##Alison RR and Moghissi K (2013) Photodynamic therapy (PDT): PDT mechanisms. Clin Endosc, 46: 24-29.##McHale AP, Callan JF, Nomikou N, Fowley C, Callan B (2016) Sonodynamic therapy: concept, mechanism and application to cancer treatment. Adv Exp Med Biol, 880: 429-50.##Wan GY, Liu Y, Chen BW, Liu YY, Wang YS, Zhang N (2016) Recent advances of sonodynamic therapy in cancer treatment. Cancer Biol Med, 13(3): 325-338.##Lafond M, Yoshizawa S, Umemura S (2019) Sonodynamic therapy - Advances and challenges in clinical translation. J Ultrasound Med, 38: 567-580.##Rosenthal I, Sostaric JZ, Riesz P (2004) Sonodynamic therapy- a review of the synergistic effects of drugs and ultrasound. Ultrasonics sonochemistry, 11(6): 349-363.##Shibaguchi H, Tsuru H, Kuroki M, Kuroki M (2011) Sonodynamic cancer therapy: A non-invasive and repeatable approach using low-intensity ultrasound with a sonosensitizer. Anticancer Research, 31: 2425-2430.##Hasanzadeh H, Mokhtari-Dizaji M, Bathaie SZ, Hassan ZM, Shahbazfar AA (2014) Dual-frequency ultrasound activation of nanomicellar doxorubicin in targeted tumor chemotherapy. J Med Ultrasonics, 41: 139-150.##Zheng Y, Zhang Y, Ao M, Zhang P, Zhang H, Li P, et al. (2012) Hematoporphyrin encapsulated PLGA microbubble for contrast enhanced ultrasound imaging and sonodynamic therapy. Journal of microencapsulation, 29(5): 437-444.##Yang K-N, Zhang C-Q, Wang W, Wang PC, Zhou J-P, Liang X-J (2014) PH-responsive mesoporous silica nanoparticles employed in controlled drug delivery systems for cancer treatment. Cancer Biol Med, 11: 34-43.##Xu Z, Liu S, Kang Y, Wang M (2015) Glutathione-and pH-responsive nonporous silica prodrug nanoparticles for controlled release and cancer therapy. Nanoscale, 7: 5859-5868.##Hong L, Artem M. Pliss AM, Zhan Y, Zheng W, Xia J, et al. (2020) Perfluoropolyether nanoemulsion encapsulating chlorin e6 for sonodynamic and photodynamic therapy of hypoxic tumor. Nanomaterials, 10: 2058.##Miyoshi N., Kundu SK, Tuziuti T, Yasui K, Shimada I, Ito I (2016) Combination of sonodynamic and photodynamic therapy against cancer would be effective through using a regulated size of nanoparticles. Nanosci Nanoeng, 4(1): 1-11.##Mai B, Wang X, Liu Q , Zhang K, Wang P (2020) The application of DVDMS as a sensitizing agent for sono-/photo-therapy. Frontiers in Pharmacology, 11(19): 1-10.##Zhang W, Li K, Lu J, Peng Z, Wang X, Li Q, et al. (2017) Sonodynamic and photodynamic therapy in breast cancer - A pilot study. Int J Complement Alt Med, 9(5): 00313.##Wang T, Zhang L, Su Z, Wang C, Liao Y, Fu Q (2011) Multifunctional hollow mesoporous silica nanocages for cancer cell detection and the combined chemotherapy and photodynamic therapy. ACS appl mater interfaces, 3(7):2479-2486.##Borah BM, Cacaccio J, Durrani FA, Bshara W, Turowski SG, Spernyak JA, et al. (2020) Sonodynamic therapy in combination with photodynamic therapy shows enhanced long‑term cure of brain tumor. Scientific Reports, 10: 21791.##An YW, Liu HQ, Zhou ZQ, Wang JC, Jiang GY, Li ZW, et al. (2020) Sinoporphyrin sodium is a promising sensitizer for photodynamic and sonodynamic therapy in glioma. Oncology Reports, 4: 1596-1604.##Yu X, Trase I, Ren M, Duval K, Guo X, Chen Z (2016) Design of nanoparticle-based carriers for targeted drug delivery. Journal Nanomaterials, Article ID: 1087250,15.##Vazquez NI, Gonzalez Z, Ferrari B, Castro Y (2017) Synthesis of mesoporous silica nanoparticles by sol-gel as nanocontainer for future drug delivery applications. Boletín Sociedad Española Cerámica Vidrio, 56: 139-145.##Jafari S, Jadidi M, Hasanzadeh H, Khani T, Nasr R, Semnani V (2020) Sonodynamic therapy of mice breast adenocarcinoma with HP-MSN. Iran J Sci Technol Trans Sci, 44(3): 651-660.##Alamolhoda M, and Mokhtari-Dizaji M (2015) Evaluation of fractionated and repeated sonodynamic therapy by using dual-frequency for murine model of breast adenocarcinoma. J Ther Ultrasound, 3(10): 1-9.##Bloom HJ and Richardson WW (1957) Histological grading and prognosis in breast cancer: a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer, 11: 359-77.##Banerjee SM, El-Sheikh S, Malhotra A, Mosse CA, Parker S, Williams NR, et al. (2020) Photodynamic therapy in primary breast cancer. J Clin Med, 9(483): 1-11.##Aggrawal N, Santiago AM, Kessel D, Sloane BF (2015) Photodynamic therapy as an effective therapeutic approach in MAME models of inflammatory breast cancer. Breast Cancer Res Treat, 154(2): 251-262.##Silva ZS, Bussadori SK, Fernandes KPS, Huang YY, Hamblin MR (2015) Animal models for photodynamic therapy (PDT). Biosci Rep, 35(6): e00265.##Vega DL, Lodge P, Vivero-Escoto JL (2016) Redox-responsive porphyrin-based polysilsesquioxane nanoparticles for photodynamic therapy of cancer cells. Int J Mol Sci, 17(56): 1-16.##Barati AH, Mokhtari-Dizaji M, Mozdarani H, Bathaie Z, Hassan MH (2007) Effect of exposure parameters on cavitation induced by low-level dual-frequency ultrasound. Ultrason Sonochem, 14(6):783-89.##Sandala KC, Chaturvedi PK, SEo UM, Kim JM, Jo YS, Lee YK, et al. (2014) Sono-photodynamic combination therapy: a review on sensitizers. Anticancer Research, 34: 4657-4664.##Wang W, Jiao Y, Shao Y (2018) Mesoporous silica nanoparticles for dual-mode chemo-sonodynamic therapy by low-energy ultrasound. Materials (Basel), 11(10): 2041.##Canavese G, Ancona A, Racca L, Canta M, Dumontel B, Barbaresco F, et al. (2018) Nanoparticle-assisted ultrasound: A special focus on sonodynamic therapy against cancer. Chem Eng J, 15(340): 155-172.##Li Q, Wang X, Wang P, Zhang K, Wang H, Feng X, et al. (2014) Efficacy of Chlorin e6-mediated sono-photodynamic therapy on 4T1 cells. Cancer Biotherapy and Radiopharmceuticals, 29: 42-52.##Huang Z, Moseley H, FInstP, FIPEM, Bown S, FRCP (2010) Rationale of combined PDT and SDT modalities for treating cancer patients in terminal stage: the proper use of photosensitizer. Integrative Cancer Therapies, 9(4): 317- 319.## ##

Clinical implementation of a PRIMO Monte Carlo-based dose verification and quality assurance model for stereotactic body radiotherapy (SBRT) treatment plans of the lung 2 2 Background: Natural The validation and clinical implementation of the PRIMO Monte Carlo (MC) model of Clinac®iX Linear accelerator as an independent dose verification and quality assurance (QA) tool for the SBRT lung treatment plans. Materials and Methods: An independent MC based dose verification was performed for ten volumetric modulated arc therapy (VMAT) SBRT treatment plans.The plans generated in the Varian Eclipse treatment planning system (TPS) were recalculated with a PRIMO MC system for identical beam parameters.The log file-based QA was performed by comparing the TPS dose against the dose reconstructed from machine log files and the results were cross-verified with the Mobius3D® verification system. The dose-volume histogram (DVH) based plan comparison and 3D global gamma analysis were carried out. The statistical significance of the differences was tested with the Wilcoxon signed-rank test with a significance level of P < 0.05. Results: No statistically significant differences were observed in PTV and organs at risk (OARs) DVH parameters except for the PTVmax dose for both TPS vs PRIMO independent dose check and TPS vs PRIMO dynalog based QA. The 3D gamma analysis results show a minimum pass rate of 95% between TPS and PRIMO. Mobius3D® results showed a slightly higher percentage variation in the mean dose to PTV and OARs and a slightly lower gamma pass than TPS vs PRIMO results. Conclusion: This study showed that a validated MC model of PRIMO could be used as an effective tool for independent dose verification and machine log-files-based quality assurance of VMAT SBRT plans.       563 570 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/20 1401/4/29 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 B. Sarin B. Sarin Department of Physics, Noorul Islam Centre for Higher Education, Kumaracoil, Kanyakumari, Tamil Nadu, India sreesarin@gmail.com B. Bindhu B. Bindhu Department of Physics, Noorul Islam Centre for Higher Education, Kumaracoil, Kanyakumari, Tamil Nadu, India B. Saju B. Saju Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India P. Raghukumar P. Raghukumar Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India R.K. Nair R.K. Nair Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India Monte Carlo independent secondary dose check PRIMO dynalog. 1. Ojala JJ, Kapanen M K, Hyödynmaa SJ, Wigren TK, Pitkänen MA (2014) Performance of dose calculation algorithms from three generations in lung SBRT: comparison with full Monte Carlo‐based dose distributions. Journal of Applied Clinical Medical Physics, 15(2): 4-18.##Fogliata A and Cozzi L (2017) Dose calculation algorithm accuracy for small fields in non-homogeneous media: the lung SBRT case. Physica Medica, 44: 157-162.##Kung JH, Chen GTY, Kuchnir FK (2000) A monitor unit verification calculation in intensity modulated radiotherapy as a dosimetry quality assurance. Medical Physics, 27(10): 2226-2230.##Sun B, Rangaraj D, Boddu S, Goddu M, Yang D, Palaniswaamy G, et al. (2012) Evaluation of the efficiency and effectiveness of independent dose calculation followed by machine log file analysis against conventional measurement based IMRT QA. Journal of Applied Clinical Medical Physics, 13(5): 140-154.##Chan S, Lau S, Lee K, Kam K, Yu K, Chan A (2013) An application of trajectory log for volumetric intensity modulated arc therapy (VIMAT) plan quality assurance in a digitally integrated and controlled linear accelerator. Int J Radiat Oncol Biolo Phys, 87(2): S711.##Olasolo-Alonso J, Vázquez-Galiñanes A, Pellejero-Pellejero S, Pérez-Azorín JF (2017) Evaluation of MLC performance in VMAT and dynamic IMRT by log file analysis. Physica Medica, 33: 87-94.##Teke T, Bergman AM, Kwa W, Gill B, Duzenli C, Popescu IA (2010) Monte Carlo based, patient‐specific RapidArc QA using Linac log files. Medical Physics, 37(1): 116-123.##McGarry CK, Agnew CE, Hussein M, Tsang Y, Hounsell AR, Clark CH (2016) The use of log file analysis within VMAT audits. The British Journal of Radiology, 89(1062): 20150489.##Rodriguez M and Brualla L (2019) Treatment verification using Varian's dynalog files in the Monte Carlo system PRIMO. Radiation Oncology, 14(1): 1-7.##Hodapp N (2012) The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft...[et al], 188(1): 97-99.##Kerns JR, Childress N, Kry SF (2014) A multi-institution evaluation of MLC log files and performance in IMRT delivery. Radiation Oncology, 9(1): 1-10.##Hernandez V, Abella R, Calvo JF, Jurado‐Bruggemann D, Sancho I, Carrasco P (2015) Determination of the optimal tolerance for MLC positioning in sliding window and VMAT techniques. Medical physics, 42(4): 1911-1916.##Bush K, Townson R, Zavgorodni S (2008) Monte Carlo simulation of RapidArc radiotherapy delivery. Physics in Medicine & Biology, 53(19): N359.##McDonald DG, Jacqmin DJ, Mart CJ, Koch NC, Peng JL, Ashenafi MS, et al. (2017) Validation of a modern second‐check dosimetry system using a novel verification phantom. Journal of Applied Clinical Medical Physics, 18(1): 170-177.##Clemente‐Gutiérrez F and Pérez‐Vara C (2015) Dosimetric validation and clinical implementation of two 3D dose verification systems for quality assurance in volumetric‐modulated arc therapy techniques. Journal of Applied Clinical Medical Physics, 16(2): 198-217.##Andreo P (1991) Monte Carlo techniques in medical radiation physics. Physics in Medicine & Biology, 36(7): 861.##Verhaegen F and Seuntjens J (2003) Monte Carlo modelling of external radiotherapy photon beams. Physics in Medicine & Biology, 48(21): R107.##Ceberg S, Gagne I, Gustafsson H, Scherman JB, Korreman SS, Kjær-Kristoffersen F, et al. (2010) RapidArc treatment verification in 3D using polymer gel dosimetry and Monte Carlo simulation. Physics in Medicine & Biology, 55(17): 4885.##Gagne, I. M., Ansbacher, W., Zavgorodni, S., Popescu, C., & Beckham, W. A. (2008). A Monte Carlo evaluation of RapidArc dose calculations for oropharynx radiotherapy. Physics in Medicine & Biology, 53(24), 7167.##Rodriguez M, Sempau J, Brualla L (2013) PRIMO: A graphical environment for the Monte Carlo simulation of Varian and Elekta linacs. Strahlentherapie und Onkologie, 189(10): 881-886.##Baro J, Sempau J, Fernández-Varea JM, Salvat F (1995) PENELOPE: an algorithm for Monte Carlo simulation of the penetration and energy loss of electrons and positrons in matter. Nuclear Instruments and Methods in Physics Research Section B: Beam Interactions with Materials and Atoms, 100(1): 31-46.##Sempau J, Badal A, Brualla L (2011) A PENELOPE‐based system for the automated Monte Carlo simulation of clinacs and voxelized geometries-application to far‐from‐axis fields. Medical Physics, 38(11): 5887-5895.##Sempau J, Wilderman SJ, Bielajew AF (2000) DPM, a fast, accurate Monte Carlo code optimized for photon and electron radiotherapy treatment planning dose calculations. Physics in Medicine & Biology, 45(8): 2263.##Rodriguez M, Sempau J, Brualla L (2012) A combined approach of variance-reduction techniques for the efficient Monte Carlo simulation of linacs. Physics in Medicine & Biology, 57(10): 3013.##Sarin B, Bindhu B, Saju B, Nair RK (2020) Validation of PRIMO monte carlo model of clinac® ix 6mv photon beam. Journal of Medical Physics, 45(1): 24.##Brualla L, Rodríguez M, Sempau J (2018) PRIMO User's Manual Version 0.3. 1.1600. Strahlenklinik, Hufelandstrasse, 55.##Videtic GM, Hu C, Singh AK, Chang JY, Parker W, Olivier KR, et al. (2015) A randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer: NRG Oncology RTOG 0915 (NCCTG N0927). Int J Radiat Oncol Biol Phys, 93(4): 757-764.##Low DA, Harms WB, Mutic S, Purdy JA (1998) A technique for the quantitative evaluation of dose distributions. Medical Physics, 25(5): 656-661.##Feuvret L, Noël G, Mazeron JJ, Bey P (2006) Conformity index: a review. Int J Radiat Oncol Biol Physics, 64(2): 333-342.##Paddick I and Lippitz B (2006) A simple dose gradient measurement tool to complement the conformity index. Journal of Neurosurgery, 105(Supplement), 194-201.##Paganini L, Reggiori G, Stravato A, Palumbo V, Mancosu P, Lobefalo F, et al. (2019) MLC parameters from static fields to VMAT plans: an evaluation in a RT-dedicated MC environment (PRIMO). Radiation Oncology, 14(1): 1-13.##Sottiaux A, Baltieri V, Monseux A, Leclercq C, Vanache D, Peiffer F, et al. (2018) 35 Monte Carlo dose calculation of VMAT clinical treatment plans for Novalis TrueBeam STx linac using PRIMO. Physica Medica, 56: 20-21.##Tsuruta Y, Nakata M, Nakamura M, Matsuo Y, Higashimura K, Monzen H, et al. (2014) Dosimetric comparison of Acuros XB, AAA, and XVMC in stereotactic body radiotherapy for lung cancer. Medical Physics, 41(8Part1): 081715.##Ojala J and Kapanen M (2015) Quantification of dose differences between two versions of Acuros XB algorithm compared to Monte Carlo simulations-the effect on clinical patient treatment planning. J Applied Clinical Medical Physics, 16(6): 213-225.##Bush K, Gagne IM, Zavgorodni S, Ansbacher W, Beckham W (2011) Dosimetric validation of Acuros® XB with Monte Carlo methods for photon dose calculations. Medical Physics, 38(4): 2208-2221.##Han C, Yi J, Zhu K, Zhou Y, Ai Y, Zheng X, et al. (2020) Cross verification of independent dose recalculation, log files based, and phantom measurement‐based pretreatment quality assurance for volumetric modulated arc therapy. J Applied Clinical Medical Physics, 21(11): 98-104.##Han T, Mikell JK, Salehpour M, Mourtada F (2011) Dosimetric comparison of Acuros XB deterministic radiation transport method with Monte Carlo and model‐based convolution methods in heterogeneous media. Medical Physics, 38(5): 2651-2664.##Agnew A, Agnew CE, Grattan MWD, Hounsell AR, McGarry CK (2014) Monitoring daily MLC positional errors using trajectory log files and EPID measurements for IMRT and VMAT deliveries. Physics in Medicine & Biology, 59(9): N49.##Chen L, Huang B, Huang X, Cao W, Sun W, Deng X (2018) Clinical evaluation for the difference of absorbed doses calculated to medium and calculated to water by Monte Carlo method. Radiation Oncology, 13(1): 1-9.##Fogliata A, De Rose F, Stravato A, Reggiori G, Tomatis S, Scorsetti M, et al. (2018) Evaluation of target dose inhomogeneity in breast cancer treatment due to tissue elemental differences. Radiation Oncology, 13(1): 1-7.## ##

Evaluation and analysis of radiation exposure to normal tissues during gamma knife radiosurgery for vestibular schwannoma 2 2 Background: A follow-up study of gamma knife radiosurgery has shown that postoperative radiation necrosis, radiation-induced edema, and malignant metastasis may occur. This may be due to secondary radiation exposure, therefore, it becomes necessary to actively reduce exposure to normal organs. Materials and Methods: In this study, the secondary radiation dose to the surrounding normal organs was measured during gamma-knife radiosurgery for vestibular schwannoma disease. Using a human pediatric phantom and a glass dosimeter, a treatment plan was established according to the tumor volume, and then the exposure dose to important normal organs in both eyes, thyroid gland, sternum, and both lungs was measured. Results: According to this study, the cancer occurrence probability due to secondary exposure was calculated to be 7 cases per 100,000 people up to the case of the eye and thyroid gland. Exposure doses of 100.2±0.79 mGy or more were measured in both eyes, which is approximately 1000 times that of a chest X-ray or a flight from Seoul to New York. This indicates exposure through gamma knife surgery. The dose to the thyroid gland was 12.7±0.05 mGy, which exceeds the effective dose of 10 mSv in abdominal computed tomography. Conclusion: By measuring the secondary exposure dose to normal organs during gamma-knife surgery for vestibular schwannoma disease, it was confirmed that the eyes and thyroid gland were exposed dangerously. Therefore, for pediatric patients specifically, a treatment plan that actively reduces secondary exposure is required.     571 578 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/20 1401/4/29 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 J.A. Lee J.A. Lee Department of Bio-medical Science, Korea University, Sejong 30019, Korea S.R. Kim S.R. Kim Department of Bio-medical Science, Korea University, Sejong 30019, Korea S.H. Yoon S.H. Yoon Department of Bio-medical Science, Korea University, Sejong 30019, Korea J.S. Kim J.S. Kim Department of Bio-medical Science, Korea University, Sejong 30019, Korea H.J. Yang H.J. Yang Department of Bio-medical Science, Korea University, Sejong 30019, Korea yangh@korea.ac.kr G.H. Kim G.H. Kim Yonsei University Health System, Severance Hospital Yonsei Gamma Knife Center, Seoul 03788, Korea Gamma knife radiosurgery secondary radiation exposure secondary cancer Vestibular schwannoma. Di Betta E, Fariselli L, Bergantin A, Locatelli F, Del Vecchio A, Broggi S, et al. (2010) Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments. Med Phys, 37(7): 3587-3594.##Labby ZE, Barraclough B, Bayliss RA, Besemer AE, Dunkerley DAP and Howard SP (2018) Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. J Appl Clin Med Phys, 19(5): 368-374.##Choi K and Cho JK (2021) Development and statistical assessment of a radiation safety literacy measurement tool. Int J Radiat Res, 19(1):41-48.##Cooksey R, Wu SY, Klesse L, Oden JD, Bland RE, Hodges JC, et al. (2019) Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors. J Investig Med, 67(2): 295-302.##Hess CB, Thompson HM, Benedict SH, Seibert JA, Wong K, Vaughan AT, et al. (2016) Exposure risks among children undergoing radiation therapy: considerations in the era of image guided radiation therapy. Int J Radiat Oncol Biol Phys, 94(5): 978-992.##Wolf A, Naylor K, Tam M, Habibi A, Novotny J, Liščák R, et al. (2019) Risk of radiation-associated intracranial malignancy after stereotactic radiosurgery: a retrospective, multicentre, cohort study. Lancet Oncol, 20(1): 159-164.##Kourinou KM, Mazonakis M, Lyraraki E, Stratakis J and Damilakis J (2013) Scattered dose to radiosensitive organs and associated risk for cancer development from head and neck radiotherapy in pediatric patients. Phys Med, 29(6): 650-655.##Athar BS and Paganetti H (2011) Comparison of second cancer risk due to out-of-field doses from 6-MV IMRT and proton therapy based on 6 pediatric patient treatment plans. Radiother Oncol, 98(1): 87-92.##Nazemi-Gelyan H, Hasanzadeh H, Makhdumi Y, Abdollahi S, Akbari F, Varshoee-Tabrizi F, et al (2015) Evaluation of organs at risk's dose in external radiotherapy of brain tumors. Iran J Cancer Prev, 8(1): 47-52.##Shinya Y, Hasegawa H, Shin M, Sugiyama T, Kawashima M, Takahashi W, et al (2019) Long-term outcomes of stereotactic radiosurgery for vestibular schwannoma associated with neurofibromatosis type 2 in comparison to sporadic schwannoma. Cancers, 11(10): 1498.##O'Connor MK (2017) Risk of low-dose radiation and the BEIR VII report: A critical review of what it does and doesn't say. Phys Med, 43: 153-158.##Castinetti F, Brue T, Morange I, Carron R and Régis J (2017) Gamma Knife radiosurgery for hypothalamic hamartoma preserves endocrine functions. Epilepsia, 58(2): 72-76.##Zeverino M, Jaccard M, Patin D, Ryckx N, Marguet M, Tuleasca C, et al. (2017) Commissioning of the Leksell gamma Knife® Icon™. Med Phys, 44(2): 355-363.##Ei-Shehaby AMN, Reda WA, Abdel Karim KM, Emad Eldin RM and Nabeel AM (2017) Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors. Surg Neurol Int, 8: 258.##Modorati GM, Dagan R, Mikkelsen LH, Andreasen S, Ferlito A and Bandello F (2020) Gamma knife radiosurgery for uveal melanoma: a retrospective review of clinical complications in a tertiary referral center. Ocul Oncol Pathol, 6(2): 115-122.##ICRP Publication 103, The 2007 Recommendations of the International Commission on Radiological Protection. Publication 103-Annals of the ICRP 37:(2-4)-Free_extract.pdf##Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M, et al. (2014) A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys, 88(4): 899-906.##ICRP Publication 135, Diagnostic reference levels in medical imaging. ICRP Publication 46, 1 2017,##Chun SM, Lim YJ, Leem W, Kim TS, Rhee BA (2001) Gamma knife radiosurgery for low grade glioma - long-term follow-up results. J Korean Neurosurg Soc, 30(2): 273-280.##Paddick I, Cameron A, Dimitriadis A (2021) Extracranial dose and the risk of radiation-induced malignancy after intracranial stereotactic radiosurgery: is it time to establish a therapeutic reference level?. Acta Neurochir (Wien), 163(4): 971-979.##Fallows P, Wright G, Harrold N, Bownes P (2018) A comparison of the convolution and TMR10 treatment planning algorithms for Gamma Knife® radiosurgery. J Radiosurg SBRT, 5(2): 157-167.##Menzel HG and Harrison J (2012) Effective dose: a radiation protection quantity. Ann ICRP, 41(3-4): 117-123.##Ha MN (2011) Radiation Exposure and Cancer. J Clin Otolaryngol Head Neck Surg, 22(2): 275-281.##Carinou E, Ginjaume M, O'Connor U, Kopec R and Sans Merce MS (2014) Sta tus of eye lens radiation dose monitoring in European hospitals. J Radiol Prot, 34(4): 729-739.##Boal TJ, Pinak M (2015) Dose limits to the lens of the eye: International Basic Safety Standards and related guidance. Annals of the ICRP, 44(1): 112-117.##Dauer LT, Ainsbury EA, Dynlacht J, Hoel D, Klein BEK, Mayer D, et al. (2017) Guidance on radiation dose limits for the lens of the eye: overview of the recommendations in NCRP Commentary No. 26. Int J Radiat Biol, 93(10): 1015-1023.##Elmtalab S and Abedi I (2021) Investigating the out-of-field doses and estimating the risk of secondary thyroid cancer in high-grade gliomas radiation therapy with modulated intensity and 3D-conformal: a phantom study. Int J Radiat Res 19(3): 569-574.##Iglesias ML, Schmidt A, Ghuzlan AA, Lacroix L, Vathaire F, Chevillard S, et al. (2017) Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab, 61(2): 180-187.##Koo E, Henderson MA, Dwyer M, Skandarajah AR, et al. (2020) Radiation-Associated Thyroid Cancer Surveillance and Management in a Cohort of Late Effects Patients. World J Surg, 44: 3028-3035.##Taylor AJ, Croft AP, Palace AM, Winter DL, Reulen RC, Stiller CA, Stevens MC, Hawkins MM, et al. (2009) Risk of thyroid cancer in survivors of childhood cancer: Results from the British Childhood Cancer Survivor Study. Int J Cancer 125: 2400-2405.##Rampinelli C, Marco P, Origgi D, Maisonneuve P, Casiraghi M, Veronesi G, Spaggiari L, Bellomi M, et al. (2017) Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-benefit analysis. The bmj 356-347.##Higuchi Y, Yamamoto M, Serizawa T, Aiyama H, Sato Y and Barfod BE (2018) Modern management for brain metastasis patients using stereotactic radiosurgery: literature review and the authors' gamma knife treatment experiences. Cancer Manag Res, 10: 1889-1899.## ##

Identifying features and severity of 2019 coronavirus disease (COVID-19) on admission based on thoracic computer tomography 2 2 Background: To investigate the computer tomography (CT) features of 2019 coronavirus disease (COVID-19)-related pneumonia and its value for identifying severity. Materials and Methods: Seventy-three patients with COVID-19 were divided into severe and nonsevere groups. CT signs were divided into two states: presence and absence; involvement range was divided into four grades; and affected lobes were divided into two states: ≥3 lobes and < 3 lobes; laboratory indices were divided into two states: normal and abnormal; co-occurrence of signs was divided into three states: ground-glass opacity (GGO) plus consolidation, only GGO, or only consolidation. The numbers of patients were respectively recorded. Statistical analysis was performed through the χ2 test, followed by multivariate logistic regression analysis. Results: Some indicators differed, including pure GGO (p<0.001), GGO with focal consolidation (p=0.009), patchy consolidation (p=0.004), sheeted consolidation (p<0.001), fibrotic appearance (p=0.020), involvement grade (p<0.001), affected lobes (p=0.027), pleural effusion (p=0.001), subpleural line (p=0.015), crazy paving signs (p<0.001), halo signs (p=0.020), thickened bronchial walls (p<0.001), air bronchi signs (p=0.003), lesions in mid/inner zone (p<0.001), liver function (p=0.044), interleukin-6 (p<0.001), c-reactive protein (p<0.001), lymphocyte count (p<0.001), and age (p=0.036). Pure GGO (OR:30.711, HR:1.292~729.882, p=0.034) and involvement grade (OR:0.017, HR:0.001~0.342, p=0.008) were independent risk factors. Conclusion: On admission, CT signs of COVID-19-related pneumonia were diverse but characteristic, and some CT findings may be potential warning factors for severity, while a lack of GGO and extensive pneumonia may be independent risk factors. 579 585 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/1 1401/1/12 Z. Mo Z. Mo Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Heifei 230031, People Republic of China Q. Zhang Q. Zhang Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Heifei 230031, People Republic of China X.W. Luo X.W. Luo Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Heifei 230031, People Republic of China zhangyu105fsk@163.com Y. Zhang Y. Zhang Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Heifei 230031, People Republic of China T. Qin T. Qin Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Heifei 230031, People Republic of China Y.Z. Zhu Y.Z. Zhu Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Heifei 230031, People Republic of China 2019 coronavirus disease pneumonia Tomography X-ray compute. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. (2020) Time Course of Lung Changes on Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology, 295(3): 715-721.##Coronaviridae Study Group of the International Committee on Taxonomy of Viruses (2020) The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol, 5(4): 536-544.##Jiang S, Shi Z, Shu Y, Song J, Gao GF, Tan W, et al. (2020) A distinct name is needed for the new coronavirus. Lancet, 395(10228): 949.##Wu Z and McGoogan JM (2020) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA, 323(13): 1239-1242.##Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. (2020) Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med, 382(18): 1708-1720.##Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. (2020) Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet, 395(10224): 565-574.##Yu WB, Tang GD, Zhang L, Corlett RT (2020) Decoding the evolution and transmissions of the novel pneumonia coronavirus (SARS-CoV-2 / HCoV-19) using whole genomic data. Zool Res, 41(3): 247-257.##He X, Zheng J, Ren J, Zheng G, Liu L (2020) Chest high-resolution computed tomography imaging findings of coronavirus disease 2019 (Covid-19) pneumonia. Int J Radiat Res, 18(2): 343-349.##Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. (2020) Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology, 296(2): E32-E40.##Wang YXJ, Liu WH, Yang M, Chen W (2020) The role of CT for Covid-19 patient's management remains poorly defined. Ann Transl Med, 8(4): 145.##Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. (2020) Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology, 295(1): 210-217.##Lieveld AWE, Azijli K, Teunissen BP, van Haaften RM, Kootte RS, van den Berk IAH, et al. (2021) Chest CT in COVID-19 at the ED: Validation of the COVID-19 Reporting and Data System (CO-RADS) and CT severity score: a prospective, multicenter, observational study. Chest, 159(3):1126-1135.##Zhang K, Liu X, Shen J, Li Z, Sang Y, Wu X, et al. (2020) Clinically applicable Ai system for accurate diagnosis, quantitative measurements, and prognosis of COVID-19 pneumonia using computed tomography. Cell, 182(5): 1360.##https://doi.org/10.1016/j.cell.2020.04.045##Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. (2019) Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med, 200(7): e45-e67.##Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology, 246(3): 697-722.##Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. (2020) CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology, 295(1): 202-207.##Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. (2020)A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res, 7(1): 4.##Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. (2020) Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol, 30(6): 3306-3309.##Cheng ZJ and Shan J (2020) 2019 Novel coronavirus: where we are and what we know. Infection, 48(2): 155-163.##https://doi.org/10.20944/preprints202001.0381.v1##Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY (2020) Pulmonary pathology of Early-phase (2020) 2019 novel coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer. J Thorac Oncol, 15(5): 700-704.##Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. (2020) Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 8(4): 420-422.##Alves GR, Marchiori E, Irion K, Nin CS, Watte G, Pasqualotto AC, et al. (2016) The halo sign: HRCT findings in 85 patients. J Bras Pneumol, 42(6): 435-439.##Godoy MC, Viswanathan C, Marchiori E, Truong MT, Benveniste MF, Rossi S, et al. (2012) The reversed halo sign: update and differential diagnosis. Br J Radiol, 85(1017): 1226-1235.##Ooi GC and Daqing M (2003) SARS: radiological features. Respirology, 8(1): S15-9.##Ajlan AM, Ahyad RA, Jamjoom LG, Alharthy A, Madani TA (2014) Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings. AJR Am J Roentgenol, 203(4): 782-787.##Bradley BT and Bryan A (2019) Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella. Semin Diagn Pathol, 36(3): 152-159.##Liu J, Zheng X, Tong Q, Li W, Wang B, Sutter K, et al. (2020) Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. J Med Virol, 92(5): 491-494.## ##

Study on the physical factors related to the exposure dose to organs at risk from radiotherapy for cervical cancer patients 2 2 Background: This research was performed to analyze the relationship among the physical factors of cervical cancer patients and the V40-x (volume of the x receiving 40 Gy, x is replaced by bladder or rectum below). In addition, the methods to control the factors affecting these related physical parameters are comprehensively discussed so that the side effects of radiotherapy can be reduced. Materials and Methods: Sixty cervical cancer patients treated with volume-modulated-arc therapy (VMAT) were selected. Related physical parameters of the planning target volume (PTV), rectum, and bladder were collected. The Spearman analysis method was used to discuss the relationship between the physical parameters and V40-x. Results: The parameter of Dmax-rectum (max dose of rectum) and Vbladder (volume of the bladder) were significantly negatively correlated with V40-rectum and V40-bladder, respectively. In addition, we found three dosimetric parameters and four parameters were significantly positively correlated with V40-rectum and V40-bladder. A reduction in V40-x of the organs at risk (OARs) was also displayed in the redesigned planning dose images and the dose-volume histograms (DVH). Conclusions: It is recommended that patients maintain a filled bladder during localization and radiotherapy. It is also recommended that patients maintain an empty rectum during localization and radiotherapy to ensure the stability of the target. According to the correlation of the physical parameters obtained from the results, medical physics can reduce the V40-x more easily during planning design by specifically controlling some physical parameters, and this can reduce radiation toxicity more effectively. 587 591 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/1 1401/1/12 W. Zhang W. Zhang Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China 234866208@qq.com Y. Cao Y. Cao Department of Radiology, Fujian Medical University Xiamen Humanity Hospital, Xiamen, China X. Ni X. Ni Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China Y. Tong Y. Tong Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China Cervical cancer physical factors organs at risk related analysis. Nishimura Y and Komaki R (2015) Intensity-modulated radiation therapy. Springer Japan; 2015, Book.##Zhi L, Zhang S, Xin J, et al. (2020) Non-rigid magnetic resonance image registration for cervical cancer radiation therapy evaluation using hybrid features. Int J Radiat Res, 18(1): 13-22.##Howlader N, Noone AM, Krapcho M, et al. (2020) SEER Cancer statistics review, (CSR) 1975-2017. Bethesda, MD: National Cancer Institute.##Zhao D, Qiu H, Zhang H, et al. (2017) Treatment results of adjuvant pelvic radiotherapy after radical hysterectomy for low-risk Stage IB1-IIA cervical cancer. Jap J Clin Oncol, 47(11): 1024-1030.##Colombo N, Carinelli S, Colombo A, et al. (2017) Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology Official Journal of the European Society for Medical Oncology, 23(7): 27.##Ebrahimi TF, Gholamhosseinian H, Layegh M, et al. (2008) Determining rectal dose through cervical cancer radiotherapy by 9 MV photon beam using TLD and XR type T GAFCHROMIC® Film. Int J Radiat Res, 6(3): 129-134.##Tharavichitkul E, Klunkin P, Lorvidhaya V, Sukthomya V, Chakrabhandu S, Pukanhaphan N, Chitapanarux I, Galalae R (2012) The effect of two HDR intracavitary brachytherapy schedukes in radiotherapy fir cervical cancer. Journal of Thai Society of Therapeutic Radiology and Oncology, 16 (Suppl):78-85.##Yaq P and Qingl R (2015) The side effects of intensity‐modulated radiotherapy in the treatment of uterine cervical neoplasms. Journal of Modern Oncology, 5: 716-719.##Mundt AJ, Mell LK, Roeske JC (2003) Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys, 56: 1354-1360.##Özseven A and Elif Özkan E (2020) Dosimetric evaluation of field-in-field and sliding-window IMRT in endometrium cancer patients with a new approach for the conformity index. Int J Radiat Res，18(4): 853-862.##Yanl C and Xiaoz W (2017) Analysis of influencing factors of adverse reactants in IMRT for cervical cancer. Journal of Hebei Medical University, 11(38): 106-110.##Cao Y, Tang D, Xiang Y, Men L, Hong J (2021) Study on the appropriate timing of postoperative adaptive radiotherapy for high-grade glioma. Cancer Management and Research, 13: 3561-3572.##Han C, Yu W, Zheng X, et al. (2018) Composite QA for intensity-modulated radiation therapy using individual volume-based 3D gamma indices. J Radiat Res, 59(5): 669-676.##Xiong Q, Zhang T, Su S (2021) Efficacy of the inducing chemotherapy combined with synchronized chemotherapy and radiotherapy on the local advanced cervical cancer. Int J Radiat Res，19(4): 1001-1007.##Chen W, Bai P, Li J, et al. (2014) Study on the Changes of Volume and Spatial Location in target and Organ at Risk for Cervical Cancer during image-guided IMRT. China Cancer, 23(012): 1044-1048.##Naik A, Gurjar OP, Bagdare P, Gupta KL, Mittal HK (2016) Dosimetric comparison between intensity modulated radiotherapy and three dimensional conformal radiotherapy planning in patients with locally advanced cervical carcinoma. Int J Radiat Res，14(3): 189-196.##Tong Y, Luo D, Zhang W, et al. (2017) Dosimetric comparison of fixed field static intensity-modulated radiotherapy with dynamic intensity-modulated radiotherapy and volumetric modulated arc therapy in postoperative radiotherapy for cervical cancer. Qilu Medical Journal, 32(1): 4.##Yan L and Lingl K (2015) Impacts of bladder status on target volume and OAR in intensity-modulated radiotherapy for cervical cancer. Anhui Medicine, 36(6): 656-659.##Wang H, Cheng G, Zhao Z, et al. Dosimetric optimization of postoperative radiotherapy for cervical cancer. Chinese Journal of Radiation Oncology, 2(6): 22-25.##Buchali A, KoswigS, Dinges S, Rosenthal P, Salk J, Lackner G, et al. (1999). Impact of the filling status of the bladder and rectum on their integral dose distribution and the movement of the uterus in the treatment planning of gynaecological cancer. Radiotherapy & Oncology, 52(1): 29-34.##Gandhi AK, Sharma DN, Rath GK, Julka PK, Subramani V, Sharma, et al. (2013) Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma: a prospective randomized study. Int J Radiat Oncol Biol Phys, 87(3): 542-548.##Zhang Z, He W, Yang L, et al. (2021) Dosimetric comparison between the use of insertion needles and Fletcher applicator in brachytherapy for cervical cancer. Int J Radiat Res, 19(4): 819-827.##Mo Y, Long Y, Fu J, et al. (2013) Effect of adjusted radiotherapy plan on radiation dose of target area and organ at risk during IMRT treatment of cervical cancer. Shandong Medicine, 53(6): 122-126.## ##

Dosimetric comparison of perineal and intra-vaginal interstitial template in image guided high dose rate brachytherapy for carcinoma cervix 2 2 Background: The purpose of this study is to introduce a novel brachytherapy template called the Medanta anterior oblique‑lateral oblique template (MAOLOT), which has been designed for carcinoma cervix, and conduct its dosimetric comparison with Martinez universal perineal interstitial template (MUPIT). Materials and Methods: Ten patients were chosen for this study with twelve intracavitary (IC) and/or interstitial (IS) applications. Plans were generated with basal points (BP), target points (TP), and inverse plan simulated annealing (IPSA) along with local graphical optimization (LGrO). Dosimetric and volumetric quantifiers including conformal index (COIN), dose non-uniformity ratio (DNR), dose homogeneity index (DHI), target dose homogeneity index (TDHI), and overdose volume index (OVI) were evaluated. Results: IPSA provided a better solution for DNR (range 0.25-0.48, p=0.04) in MUPIT and BP+LGrO method was appreciable (p=0.08) in OVI. Mean doses of D90, D95, and D98 of targets of LGrO plan were greater than their respective counterparts. Dose to 1cc and 2cc bladder was the highest for IPSA+LGrO plans as compared to forward optimization plans. Better COIN values were obtained for BP and TP plans with LGrO (p=0.043 (BP+LGrO), p=0.022 (TP+LGrO)). Mean EQD2 dose of 1cc and 2cc bladder was the highest for the IPSA plan as compared to other forward optimization plans. Conclusion: In IC+IS application, small adjustments using LGrO improves the target coverage and reduces the normal structure dose. IPSA provides better results if plan evaluation is performed carefully. MAOLOT creates the intracavitary and interstitial dose distribution, which is comparable to MUPIT. 593 600 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/1 1401/1/12 V. Kaliyaperumal V. Kaliyaperumal Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India venkphysics@gmail.com S. Banerjee S. Banerjee Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India T. Kataria T. Kataria Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India S.K. Abraham S.K. Abraham Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India M. Veni S M. Veni S Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India S. Tamilselvan S. Tamilselvan Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India D. Gupta D. Gupta Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India K. Dayanithi K. Dayanithi Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India D. Manigandan D. Manigandan Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India S.R. Mishra S.R. Mishra Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India S.S. Bisht S.S. Bisht Division Of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Gurgaon, Haryana, India Image guided brachytherapy optimization intracavitary interstitial cervical cancer. Torre LA, Islami F, Siegel RL, Ward EM, Jemal A (2017) Global cancer in women: Burden and Trends. Cancer Epidemiol Biomarkers Prev, 26(4): 444-457.##Cihoric N, Tsikkinis A, Tapia C, Aebersold DM, Zlobec I, Lössl K (2015) Dose escalated intensity modulated radiotherapy in the treatment of cervical cancer. Radiat Oncol, 24(10): 240.##Baltas D (2006) The physics of modern brachytherapy for oncoloogy. 1st ed. New York: Taylor & Francis.##Murakami N, Kobayashi K, Kato T, Nakamura S, Wakita A, Okamoto H, et al. (2016) The role of interstitial brachytherapy in the management of primary radiation therapy for uterine cervical cancer. J Contemp Brachytherapy, 8(5): 391-398.##Goyal MK, Rai DV, Manjhi J, Barker JL, Heintz BH, Shide KL, et al. (2017) Study of dosimetric and spatial variations due to applicator positioning during inter-fraction high-dose rate brachytherapy in the treatment of carcinoma of the cervix: A three dimensional dosimetric analysis. Int J Radiat Res, 15(4): 377-382.##Martinez A, Cox RS, Edmundson GK (1984) A multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies, Int J Radiat Oncol Biol Phys, 10(2): 297-305.##Nandwani PK, Vyas RK, Neema JP, Suryanarayan UK, Bhavsar DC, Jani KR (2007) Retrospective analysis of role of interstitial brachytherapy using template (MUPIT) in locally advanced gynecological malignancies. J Cancer Res Ther, 3(2): 111-5.##Sharma PK, Swamidas JV, Mahantshetty U, Deshpande DD, Manjhi J, Rai DV (2014) Dose optimization in gynecological 3D image based interstitial brachytherapy using martinez universal perineal interstitial template (MUPIT) -an institutional experience. J Med Phys, 39(3): 197-202.##Jamema SV, Sharma S, Mahantshetty U, Engineer R, Shrivastava SK, Deshpande DD (2011) Comparison of IPSA with dose-point optimization and manual optimization for interstitial template brachytherapy for gynecologic cancers. Brachytherapy, 10(4): 306-12.##Palled SR, Radhakrishna NK, Manikantan S, Khanum H, Venugopal BK, Vishwanath L (2020) Dosimetric comparison of manual forward planning with uniform dwell times versus volume-based inverse planning in interstitial brachytherapy of cervical malignancies. Rep Pract Oncol Radiother, 25(6): 851-855.##Shwetha B, Ravikumar M, Katke A, Supe SS, Venkatagiri G, Ramanand N, et al. (2010) Dosimetric comparison of various optimization techniques for high dose rate brachytherapy of interstitial cervix implants. J Appl Clin Med Phys, 11(3): 3227.##Banerjee S, Kaliyaperumal V, Kataria T, Kamaraj D (2022) The Medanta AOLO template for locally advanced cancer cervix brachytherapy: design and clinical implementation. J Contemp Brachytherapy, 12(1): 44-47.##Meigooni AS (2004) Recent developments in brachytherapy source dosimetry. Int J Radiat Res, 2(3): 97-105.##Rivard MJ, Coursey BM, DeWerd LA, Hanson WF, Huq MS, Ibbott GS, et al. (2004) Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations. Med Phys, 31(3): 633-74.##Viswanathan AN, Beriwal S, De Los Santos JF, Demanes DJ, Gaffney D, Hansen J, et al. (2012) American Brachytherapy Society. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: high-dose-rate brachytherapy. Brachytherapy, 11(1): 47-52.##Haie-Meder C, Pötter R, Van Limbergen E, Briot E, De Brabandere M, Dimopoulos J, et al. (2005) Gynaecological (GYN) GEC-ESTRO Working Group. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol, 74(3): 235-45.##Wu A, Ulin K, Sternick ES (1988) A dose homogeneity index for evaluating 192Ir interstitial breast implants. Med Phys, 15(1): 104-7.##Major T, Polgár C, Fodor J, Somogyi A, Németh G (2002) Conformality and homogeneity of dose distributions in interstitial implants at idealized target volumes: a comparison between the Paris and dose-point optimized systems. Radiother Oncol, 62(1): 103-11.##Fröhlich G, Geszti G, Vízkeleti J, Ágoston P, Polgár C, Major T. (2019) Dosimetric comparison of inverse optimisation methods versus forward optimisation in HDR brachytherapy of breast, cervical and prostate cancer. Strahlenther Onkol, 195(11): 991-1000.##Chakrabarti B, Basu-Roy S, Kar SK, Das S, Lahiri A (2017) Comparison of dose volume parameters evaluated using three forward planning - optimization techniques in cervical cancer brachytherapy involving two applicators. J Contemp Brachytherapy, 9(5): 431-445.##Jamema SV, Kirisits C, Mahantshetty U, Trnkova P, Deshpande DD, Shrivastava SK, et al. (2010) Comparison of DVH parameters and loading patterns of standard loading, manual and inverse optimization for intracavitary brachytherapy on a subset of tandem/ovoid cases. Radiother Oncol, 97(3): 501-6.##Yoshio K, Murakami N, Morota M, Harada K, Kitaguchi M, Yamagishi K, et al. (2013) Inverse planning for combination of intracavitary and interstitial brachytherapy for locally advanced cervical cancer. J Radiat Res, 54(6): 1146-52.##Kubicky CD, Yeh BM, Lessard E, Joe BN, Speight JL, Pouliot J, et al. (2008) Inverse planning simulated annealing for magnetic resonance imaging-based intracavitary high-dose-rate brachytherapy for cervical cancer. Brachytherapy, 7(3): 242-7.##Kumar M, Thangaraj R, Alva RC, Koushik K, Ponni A, Achar JM (2019) Impact of different dose prescription schedules on EQD2 in high-dose-rate intracavitary brachytherapy of carcinoma cervix. J Contemp Brachytherapy, 11(2):189-193.## ##

Clinical outcomes of adjuvant radiotherapy for nodal negative T1 and T2 breast cancer 2 2 Background: The objective of this study was to determine the long-term results of postoperative radiotherapy (RT) in patients with node-negative T1–T2 breast cancer and the prognostic factors affecting these results. Materials and Methods: We retrospectively evaluated 382 node-negative breast cancer patients (pT1a–c, T2) treated with surgery. All patients underwent postoperative RT and 80% of patients received hormone therapy. Prognostic variables included patient characteristics, disease characteristics, and intervention factors. The primary endpoint was overall survival (OS). Survival curves were estimated using the Kaplan–Meier method. Differences in observed survival distributions among patient subgroups were evaluated using a two-sided long-rank test. We applied univariate and multivariate Cox models to evaluate predictive factors. Statistical significance was evaluated at a level of P < 0.05. Results: The median follow-up was 143 months. The 10-, 15-, and 20-year OS rates were 92%, 86%, and 80%, respectively. Univariate analysis showed that age (< 45, 45–65, > 65 years; P < 0.0001), comorbidity (P = 0.008), menopausal status (P = 0.03), and tumor stage (T1a–c, T2; P = 0.006) (table 1) were significant predictors of OS. Multivariate analysis showed that age (< 45, 45–65, > 65; P = 0.01) and tumor stage (T1a–c, T2; P < 0.0001) were independent predictors of OS. At age 15 years, the OS rate of patients with T1b, T1c, or T2 stage cancer was 87.5%, 81%, or 77%, respectively. Conclusions: Age and tumor stage were independent prognostic factors for women with node-negative early breast cancer. 601 605 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/1 1401/1/12 I.A. Cetin I.A. Cetin Marmara University, Faculty of Medicine Department of Radiation Oncology Fevzi Cakmak Mah, Istanbul, Turkey ilknurcet@gmail.com S.U. Akay S.U. Akay Marmara University, Faculty of Medicine Department of Radiation Oncology Fevzi Cakmak Mah, Istanbul, Turkey H.B.C. Ozkok H.B.C. Ozkok Anadolu Medical Center, Gebze, Kocaeli, Turkey M. Sengoz M. Sengoz Department of Radiation Oncology, Acıbadem University, Istanbul, Turkey Early-stage breast cancer prognostic factors radiotherapy survival. Siegel RL, Miller KD, Jemal A. Cancer statistics (2016) Cancer statistics. CA Cancer J Clin, 66(1): 7e30.##Clark RM, McCullogh PB, Levine MN, Lipa M, Wilkinson RH, Mahoney LJ, et al. (1992) Randomized clinical trial to assess the effectiveness of breast irriditation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst, 84: 683-689.##Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, et al. (1993) Radiotherapy after breast-preserving surgery in women with localised cancer of the breast. New Engl J Med, 328(22): 1587-1591.##Liljegren G, Holmberg L and Adami HO (1994) Sector resection with or without postoperative radiotherapy for stage I breast cancer: five-year results of a randomized trial. J Natl Cancer Inst, 86: 717-722.##Fisher B, Andersson S, Redmond CK, Wolmark N, Wickerham DL and Cronin WM (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med, 333: 1456-1461.##Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M, et al. (1995) Breast conservation is a safe method in patients with small cancer of the breast: Long-term results of three randomized trials on 1,973 patients. Eur J Cancer, 31A (10): 1574-1579.##Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Harnett AN (1996) Randomized controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Lancet, 348: 708-713.##https://doi.org/10.1016/S0140-6736(96)02133-2##Early Breast Cancer Trialists Collaborative Group (1995) Effects of radiotherapy and surgery in early breast cancer. N Engl J Med, 333: 1444-1455.##Kurtz JM, Almaric R, Brandone H, Ayme Y, Jacquemier J, Pietra JC, et al. (1989) Local recurrence after breast-conserving surgery and radiotherapy. Cancer, 63: 1912-1917.##https://doi.org/10.1002/1097-0142(19890515)63:103.0.CO;2-Y##van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, et al. (1992) Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Eur J Cancer, 28A (4/5): 801-805.##Renton SC, Gazet JC, Ford HT, Corbishley C and Sutcliffe R (1996) The importance of resection margin in conservative surgery for breast cancer. Eur J Surg Oncol, 22: 17-22.##Liljegren G, Holmberg L, Bergh J, Lindgren A, Tabar L, Nordgren H, et al. (1999) 10-year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: A randomized trial. J Clin Oncol, 17: 2326-2333.##Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, et al. (1998) Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol, 16: 441-452.##Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 347(16): 1233-41.##Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 347(16):1227-32.##Abi-Raad R, Boutrus R, Wang R, Niemierko A, Macdonald S, Smith B, et al. (2011) Patterns and risk factors of locoregional recurrence in T1-T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys, 81(3): e151-7.##Truong PT, Lesperance M, Culhaci A, Kader HA, Speers CH, Olivotto IA (2005) Patient subsets with T1- T2, node-negative breast cancer at high locoregional recurrence risk after mastectomy. Int J Radiat Oncol Biol Phys, 62(1): 175-82.##Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. (2015) for the MA.20 Study Investigators. Regional nodal irradiation in early-stage breast cancer. New England Journal of Medicine, 373(4): 307-16.##Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. (2015) EORTC Radiation Oncology and Breast Cancer Groups. Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer. N Engl J Med, 373(4): 317-27.##Leitner SP, Swern AS, Weinberger D, Duncan LJ, Hutter RV (1995) Predictors of recurrence for patients with small (one centimeter or less) localized breast cancer (T1a,b N0 M0). Cancer, 76: 2266-2274.##https://doi.org/10.1002/1097-0142(19951201)76:113.0.CO;2-T##Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, Rouzier R, Broglio KR, Hortobagyi GN, et al. (2007) Overall survival and cause specific mortality of patients with stage T1a, bN0M0 breast carcinoma. J Clin Oncol, 25: 4952-4960.##Fisher B, Dignam J, Tan-Chiu E, Anderson S, Fisher ER, Wittliff JL, et al. (2001) Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes. J Natl Cancer Inst, 93: 112-120.##https://doi.org/10.1093/jnci/93.18.1421##Kennedy T, Stewart AK, Bilimoria KY, Patel-Parekh L, Sener SF, Winchester DP (2007) Treatment trends and factors associated with survival in T1aN0 and T1bN0 breast cancer patients. Ann Surg Oncol, 14: 2918-2927.##Lee AK, Loda M, Mackarem G, Bosari S, DeLellis RA, Heatley GJ, et al. (1997) Lymph node negative invasive breast carcinoma 1 centimeter or less in size (T1a, bN0M0): clinicopathologic features and outcome. Cancer, 79: 761-771.##https://doi.org/10.1002/(SICI)1097-0142(19970215)79:43.0.CO;2-Y##Trignani M, DI Carlo C, Cefalogli C, Nuzzo M, Ursini LA, Caravatta L, et al. (2017) Outcomes in Patients with pT1-T2, pN0-N1 Breast cancer After Conservative Surgery and Whole-breast Radiotherapy. In-vivo, 31(1): 151-158.##Ferguson NL, Bell J, Heidel R, Lee S, Vanmeter S, Duncan L, et al. (2013) Prognostic value of breast cancer subtypes, Ki-67 proliferation index, age, and pathologic tumor characteristics on breast cancer survival in Caucasian women. Breast J, 19: 22-30.##Mamtani A, Patil S, Stempel M, Morrow M (2017) Are There Patients with T1-T2, Node-Negative Breast Cancer Who Are "High-Risk" for Locoregional Recurrence? Cancer, 123(14): 2626-2633.##Truong PT, Bernstein V, Lesperance M, Speers CH, Olivotto IA (2006) Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg, 191: 749-755.##Fyles AW, McCready DR, Manchul LA, et al. (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med, 351: 963-970.##Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, et al. (2004) Cancer and Leukemia Group B; Radiation Therapy Oncology Group; Eastern Cooperative Oncology Group. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med, 351: 971-977.##VanderWalde A and Hurria A (2012) Early breast cancer in the older woman. Clin Geriatr Med, 28(1): 1-20.## ##

Influence of lesion size on differential diagnosis of benign and malignant breast lesions by real-time two-dimensional shear wave elastography 2 2 Background: The aim of this study was to evaluate the influence of lesion size on the performance of real-time two-dimensional shear wave elastography (2D-SWE) in the diagnosis of breast lesions. Materials and Methods: A total of 118 consecutive female patients with 129 breast lesions (50 malignant and 79 benign) who underwent surgical excision and/or core biopsy were studied. The lesions were categorized into three subgroups according to their size: (1) group 1: < 1.0 cm3; (2) group 2: 1.0–4.0 cm3; (3) group 3: > 4.0 cm3. The maximum elasticity (Emax), mean elasticity (Emean), and their standard deviation (SD) in the three subgroups were compared and analyzed in terms of the cutoff values acquired by pathological results. Results: The lesion size significantly differed between benign and malignant masses (P < 0.05). Malignant lesions exhibited significantly elevated values of Emax, Emean, and SD, compared with benign lesions in the three subgroups. The optimal threshold was higher for larger malignant and benign lesions (P < 0.05). In malignant lesions, the SWE parameters in group 1 were significantly different from those in groups 2 and 3. The area under the receiver operating characteristics curve (AUROC) of SD was higher than that of Emax and Emean in all three subgroups. Conclusion: The values of 2D-SWE parameters  increase with the increase in size of a breast mass, and the adjustment of the threshold based on lesion size yields a more accurate diagnosis. Among the SWE parameters, SD has the best diagnostic performance.  607 613 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/1 1401/1/12 W. Qu W. Qu Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, GuangDe Road, Hefei, Anhui, 230011, China N. He N. He Department of Ultrasound, Anhui Provincial Hospital Affiliated to Anhui Medical University (First Affiliated Hospital of the University of Science and Technology of China), Lujiang Road, Hefei, Anhui,230001, China henianan71@qq.com X. Yang X. Yang Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, GuangDe Road, Hefei, Anhui, 230011, China C. Yuan C. Yuan Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, GuangDe Road, Hefei, Anhui, 230011, China G. Zhang G. Zhang Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, GuangDe Road, Hefei, Anhui, 230011, China J. Wei J. Wei Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, GuangDe Road, Hefei, Anhui, 230011, China X. Zheng X. Zheng Department of Ultrasound, Anhui Medical University Affiliated Hefei Hospital, Hefei Second People's Hospital, GuangDe Road, Hefei, Anhui, 230011, China Ultrasound shear wave elastography breast lesions BI-RADS. 1. Harbeck N and Gnant M (2017) Breast cancer. Lancet, 389(10074): 1134-1150.##DeSantis CE, Ma J, Goding Sauer A, Newman LA, Jemal A (2017) Breast cancer statistics, 2017, racial disparity in mortality by state. CA-Cancer J Clin, 67(6): 439-448.##Chen WQ, Li H, Sun KX, Zheng RS, He J (2018) Report of Cancer Incidence and Mortality in China, 2014. Zhonghua Zhong Liu Za Zhi, 40(1): 5-13.##Du Y-R, Wu Y, Chen M, Gu X-G (2018) Application of contrast-enhanced ultrasound in the diagnosis of small breast lesions. Clin Hemorheol Micro, 70(3): 291-300.##Marino MA, Riedl CC, Bernathova M, Bernhart C, Baltzer PAT, Helbich TH, Pinker K (2018) Imaging phenotypes in women at high risk for breast cancer on mammography, ultrasound, and magnetic resonance imaging using the fifth edition of the breast imaging reporting and data system. Eur J Radiol, 106: 150-159.##Fernandes J, Sannachi L, Tran WT, Koven A, Watkins E, Hadizad F, Gandhi S, Wright F, Curpen B, El Kaffas A, Faltyn J, Sadeghi-Naini A, Czarnota G (2019) Monitoring breast cancer response to neoadjuvant chemotherapy using ultrasound strain elastography. Transl Oncol, 12(9): 1177-1184.##Kim JY, Shin JK, Lee SH (2015) The breast tumor strain ratio is a predictive parameter for axillary lymph node metastasis in patients with invasive breast cancer. Am J Roentgenol, 205(6): W630-W638.##Suvannarerg V, Chitchumnong P, Apiwat W, Lertdamrongdej L, Tretipwanit N, Pisarnturakit P, et al. (2019) Diagnostic performance of qualitative and quantitative shear wave elastography in differentiating malignant from benign breast masses, and association with the histological prognostic factors. Quant Imaging Med Surg, 9(3): 386-398.##Luo S, Yao G, Hong Z, Zhang S, Wang W, Zhang J, et al. (2019) Qualitative classification of shear wave elastography for differential diagnosis between benign and metastatic axillary lymph nodes in breast cancer. Front Oncol, 9: 533.##Hong S, Woo OH, Shin HS, Hwang S-Y, Cho KR, Seo BK (2017) Reproducibility and diagnostic performance of shear wave elastography in evaluating breast solid mass. Clin Imag, 44: 42-45.##Skerl K, Vinnicombe S, Giannotti E, Thomson K, Evans A (2015) Influence of region of interest size and ultrasound lesion size on the performance of 2D shear wave elastography (SWE) in solid breast masses. Clin Radiol, 70(12): 1421-1427.##Lin X, Chang C, Wu C, Chen Q, Peng Y, Luo B, Tang L, Li J, Zheng J, Zhou R, Cui G, Li A, Wang X, Qian L, Zhang J, Wen C, Gay J, Zhang H, Li A, Chen Y (2018) Confirmed value of shear wave elastography for ultrasound characterization of breast masses using a conservative approach in Chinese women: a large-size prospective multicenter trial. Cancer Manag Res, 10: 4447-4458.##Giannotti E, Vinnicombe S, Thomson K, McLean D, Purdie C, Jordan L, Evans A (2016) Shear-wave elastography and greyscale assessment of palpable probably benign masses: Is biopsy always required? Br J Radiol, 89(1062): 20150865.##Cong R, Li J, Wang X (2017) Comparing performance of combinations of shear wave elastography and B-mode ultrasound in diagnosing breast masses: Is it influenced by mass size? Ultrasound Med Biol, 43(10): 2133-2143.##Huang Y, Li F, Han J, Peng C, Li Q, Cao L, Liu Y, Zhou J (2019) Shear wave elastography of breast lesions: Quantitative analysis of elastic heterogeneity improves diagnostic performance. Ultrasound Med Biol, 45(8): 1909-1917.##Chang JM, Moon WK, Cho N, Yi A, Koo HR, Han W, Noh D-Y, Moon H-G, Kim SJ (2011) Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat, 129(1): 89-97.##Kim SJ, Ko KH, Jung HK, Kim H (2015) Shear wave elastography: Is it a valuable additive method to conventional ultrasound for the diagnosis of small (≤2 cm) breast cancer? Medicine, 94(42): e1540.##Ng WL, Rahmat K, Fadzli F, Rozalli FI, Mohd-Shah MN, Chandran PA, Westerhout CJ, Vijayananthan A, Abdul Aziz YF (2016) Shearwave elastography increases diagnostic accuracy in characterization of breast lesions. Medicine, 95(12): e3146.##Evans A, Sim YT, Thomson K, Jordan L, Purdie C, Vinnicombe SJ (2016) Shear wave elastography of breast cancer: Sensitivity according to histological type in a large cohort. Breast, 26: 115-118.##Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja O, et al. (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Eur J Ultrasound, 34(3): 238-253.##Barr RG, Nakashima K, Amy D, Cosgrove D, Farrokh A, Schafer F, et al. (2015) WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: Breast. Ultrasound Med Biol, 41(5): 1148-1160.##Chamming's F, Latorre-Ossa H, Le Frère-Belda MA, Fitoussi V, Quibel T, Assayag F, et al. (2013) Shear wave elastography of tumour growth in a human breast cancer model with pathological correlation. Eur Radiol, 23(8): 2079-2086.##Youk JH, Gweon HM, Son EJ, Kim J-A, Jeong J (2013) Shear-wave elastography of invasive breast cancer: correlation between quantitative mean elasticity value and immunohistochemical profile. Breast Cancer Res Treat, 138(1): 119-126.##Park SY, Choi JS, Han B-K, Ko EY, Ko ES (2017) Shear wave elastography in the diagnosis of breast non-mass lesions: factors associated with false negative and false positive results. Eur Radiol, 27(9): 3788-3798.##Sadigh G, Carlos RC, Neal CH, Wojcinski S, Dwamena BA (2013) Impact of breast mass size on accuracy of ultrasound elastography vs. conventional B-mode ultrasound: a meta-analysis of individual participants. Eur Radiol, 23(4): 1006-1014.##Bayat M, Denis M, Gregory A, Mehrmohammadi M, Kumar V, Meixner D, et al. (2017) Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation. PloS One, 12(3): e0172801.##Hari S, Paul SB, Vidyasagar R, Dhamija E, Adarsh AD, Thulkar S, et al. (2018) Breast mass characterization using shear wave elastography and ultrasound. Diagn Interv Imag, 99(11): 699-707.##Vicini FA, Cecchini RS, White JR, Arthur DW, Julian TB, Rabinovitch RA, et al. (2019) Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: a randomised, phase 3, equivalence trial. Lancet, 394(10215): 2155-2164.##Martelotto LG, Ng CKY, Piscuoglio S, Weigelt B, Reis-Filho JS (2014) Breast cancer intra-tumor heterogeneity. Breast Cancer Res, 16(3): 210.##Gweon HM, Youk JH, Son EJ, Kim J-A (2013) Visually assessed colour overlay features in shear-wave elastography for breast masses: quantification and diagnostic performance. Eur Radiol, 23(3): 658-663.##Tian J, Liu Q, Wang X, Xing P, Yang Z, Wu C (2017) Application of 3D and 2D quantitative shear wave elastography (SWE) to differentiate between benign and malignant breast masses. Sci Rep, 7(1): 41216.## ##

Monte Carlo simulation of a new proton therapy technique using bio-nanoparticles and high energy proton beams 2 2 Background: Currently, many researchers focus their work on the effects of bio-nanoparticles inside the tumor during proton therapy. Indeed, these bio-nanoparticles enhance the absorbed dose especially if they have been settled at the Bragg peak zone. The main goal of this study is to give a new technique that improves and facilitates the clinical protocol during proton therapy for brain tumors by adding nanoparticles to the tumor and using a rotary accelerator with high energy (200 MeV). Materials and Methods: With the use of the Monte Carlo Geant4 code, we simulated a proton therapy of a tumor located in the center of a human head containing bio-nanoparticles. The proton beam energy was chosen large enough to avoid having Bragg's peak at head level. Results: The results revealed that there was an optimization in the deposited energy at the tumor, at the same time the deposited energy at healthy tissue was less compared to ordinary proton therapy. It also showed that the platinum is the most effective bio-nanoparticles used in this work. Conclusion: The addition of bio-nanoparticles to tumors and the use of a high-energy (200 MeV) rotary accelerator improve and facilitate proton therapy. This new technique allows the direction angle of the proton beam to be changed regardless of the position of the tumor, making it effective against moving tumors and preserving healthy tissue. In addition, the dose deposited in the tumor can be increased just by pivoting the head of the accelerator around the organ. 615 619 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/19 1401/4/28 M. Ouar M. Ouar Laboratoire d'Analyse et d'Application des Rayonnements (LAAR), Department de Genie physique, Université des Sciences et de la Technologie d’Oran Mohamed-Boudiaf USTO-MB, El Mnaouar, BP 1505, Bir El Djir 31000, Oran, Algérie mohammed.ouar@univ-usto.dz A.S. Amine Dib A.S. Amine Dib Laboratoire d'Analyse et d'Application des Rayonnements (LAAR), Department de Genie physique, Université des Sciences et de la Technologie d’Oran Mohamed-Boudiaf USTO-MB, El Mnaouar, BP 1505, Bir El Djir 31000, Oran, Algérie M.N. Belkaid M.N. Belkaid Laboratoire d'Analyse et d'Application des Rayonnements (LAAR), Department de Genie physique, Université des Sciences et de la Technologie d’Oran Mohamed-Boudiaf USTO-MB, El Mnaouar, BP 1505, Bir El Djir 31000, Oran, Algérie A.H. Belbachir A.H. Belbachir Laboratoire d'Analyse et d'Application des Rayonnements (LAAR), Department de Genie physique, Université des Sciences et de la Technologie d’Oran Mohamed-Boudiaf USTO-MB, El Mnaouar, BP 1505, Bir El Djir 31000, Oran, Algérie Monte Carlo simulation proton therapy bio-nanoparticles rotary accelerator. Bray F, Ferlay J, Soerjomataram I, et al. (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin, 68(6): 394-424.##Armoogum KS and Thorp N (2015) Dosimetric comparison and potential for improved clinical outcomes of paediatric CNS patients treated with protons or IMRT. Cancers 7: 706-722.##Peach K, Finst P, Wilson P, Jones B (2011) Accelerator science in medical physics. The British Journal of Radiology, 84: S4-S10.##Nikolai K and Lev D (2011) Biodistribution and toxicity of engineered gold nanoparticles: a review of in vitro and in-vivo studies. Chem So Rev, 40: 1647-1671.##Lorenzo T (2021) Physical aspects of gold nanoparticles as cancer killer therapy. Indian J Phys, 95: 225-234.##Tabbakh F and Hosmane NS (2020) Enhancement of radiation effectiveness in proton therapy: Comparison between fusion and fission methods and further approaches. Sci Rep, 10: 5466.##Dimitriou NM, Tsekenis G, Balanika EC, et al. (2016) Gold nanoparticles, radiations and the immune system: Current insights into the physical mechanisms and the biological interactions of this new alliance towards cancer therapy. Nuclear Instruments and Methods in Physics Research B, 373: 126-139.##Kim JK, Seo S-J, Kim H-T, et al. (2012) Enhanced proton treatment in mouse tumors through proton irradiated nanoradiator effects on metallic nanoparticles. Phys Med Biol, 57: 8309-8323.##Rezaei H, Zabihzadeh M, Ghorbani M, et al. (2017) Evaluation of dose enhancement in presence of gold nanoparticles in eye brachytherapy by 103Pd source. Australas Phys Eng Sci Med, 40: 545-553.##Rahman WN, Bishara N, Ackerly T, et al. (2009) Enhancement of radiation effects by gold nanoparticles for superficial radiation therapy, Nanomed. Nanotech, 5: 136-142.##Lacombe S, Porcel E, Scifoni E (2017) Particle therapy and nanomedicine: state of art and research perspectives. Cancer Nano 8, 9##Wayne D Newhauser and Rui Zhang (2015) The physics of proton therapy. Phys Med Biol, 60: R155-R209.##Liu H and Chang JY (2011) Proton therapy in clinical practice. Chin J Cancer, 30: 5.##Fracchiolla F, Lorentini S, Widesott L, et al. (2015) Characterization and validation of a Monte Carlo code for independent dose calculation in proton therapy treatments with pencil beam scanning. Phys Med Biol, 60: 8601-8619.##Sea A, John A, Amako K, et al. (2003) Geant4-a simulation toolkit. Nucl Instrum Methods Phys Res A, 506: 250-303.##Allison J, Amako K, Apostolakis J, et al. (2016) Recent developments in Geant4. Nucl Instrum Methods Phys Res A, 835: 186-225.##Bernal MA and Liendo JA (2009) An investigation on the capabilities of the PENELOPE MC code in nanodosimetry. Med Phys, 36(2): 620-5.##Report 85 (2011) Fundamental quantities and units forionizing radiation. J ICRU, 11(1): 1-31.##IAEA TRS 461 Relative Biological Effectiveness in Ion Beam Therapy, International Atomic Energy Agency, 2008.##De Napoli M, Agodi C, Battistoni G, et al. (2012) Carbon fragmentation measurements and validation of the Geant4 nuclear reaction models for hadrontherapy. Phys Med Biol, 57(22): 7651-7671.##Jerimy CP and Wayne DN (2005) Calculations of neutron dose equivalent exposures from range-modulated proton therapy beams. Phys Med Biol, 50: 3859-3873.##Ono Takashi, Yabuuchi Tomonori, Nakamura Tatsuya, et al. (2017) High dose hypofractionated proton beam therapy is a safe and feasible treatment for central lung cancer. Radiol Oncol, 51(3): 324-330.##Cho J, Gonzalez-Lepera C, Manohar N, et al. (2016) Quantitative investigation of physical factors contributing to gold nanoparticle-mediated proton dose enhancement. Phys Med Biol, 61: 2562-2581.##Ferguson S, Ahmad S, Ali I (2020) Simulation study of proton arc therapy with the compact single-room MEVION-S250 proton therapy system. Journal of Radiotherapy in Practice, 19(4): 1- 8.##Belamri C, Amine Dib AS, Ahmed HB (2016) Monte Carlo simulation of proton therapy using bio-nanomaterials. Journal of Radiotherapy in Practice, 15: 290-295.## ##

Monte Carlo simulations of gamma-rays shielding with phthalonitrile - tungsten borides composites 2 2 Background: Recently, it has been demonstrated that thermosetting polymer composites have excellent gamma-rays shielding properties. Among them, phthalonitrile composites are the best suitable materials to replace the traditional shielding materials such as lead and concrete. Furthermore, tungsten-boride as high Z-material is an effective ionizing radiation shield. Materials and Methods: The gamma rays shielding properties of the phthalonitrile matrix (PH) reinforced with tungsten-boride (WB) at 661, 1172, and 1332 keV photon energies were investigated using MCNPX code and XCOM tool kit and compared to those of concrete as conventional shielding material and epoxy composites. MCNPX geometry was defined along the z-axis and described in the input file. The number of emitted photons was fixed at 107 at the source, which is supposed to be a monoenergetic point. Results: The simulated mass attenuation coefficients results are in good agreement with those calculated using the XCOM tool kit. Also, it was observed that at 661 keV photon energy, the shielding performances in term of Half-Value-Layer (HVL) are enhanced by3.08% and 22.01% for 30% and 50% of tungsten-boride concentrations compared to 30% of PbO concentration in the Epoxy-Clay composite and concrete respectively. Conclusion: In this study, the outstanding results of gamma-rays shielding properties of Phthalonitrile/WB composites (PHWB) obtained using MCNPX code and XCOM can be used for future experimental gamma-rays shielding approaches at a wide range of energy. 621 626 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/19 1401/4/28 M. Al Hassan M. Al Hassan College of Materials Science and Chemical Engineering, Harbin Engineering University, Harbin 150001, Heilongjiang, China wlwb@163.com W.B. Liu W.B. Liu College of Materials Science and Chemical Engineering, Harbin Engineering University, Harbin 150001, Heilongjiang, China J. Wang J. Wang College of Materials Science and Chemical Engineering, Harbin Engineering University, Harbin 150001, Heilongjiang, China M.M.M. Ali M.M.M. Ali College of Nuclear Sciences and Technology, Harbin Engineering University, Harbin, 150001, Heilongjiang, China A. Rawashdeh A. Rawashdeh Jordan Atomic Energy Commission, Jordan Research and Training Reactor, Jordan Phthalonitrile MCNPX XCOM radiation protection efficiency gamma-rays. Gong C, Tang X, Fatemi S, Yu H, Shao W, Shu D, et al. (2018) A Monte Carlo study of SPECT in boron neutron capture therapy for a heterogeneous human phantom. Int J Radiat Res, 16(1): 1-12.##Aghaz A, Faghihi R, Mortazavi SMJ, Haghparast A (2016) Radiation attenuation properties of shields containing micro and Nano WO3 in diagnostic X-ray energy range. Int J Radiat Res, 14(2): 127-131.##Mahdavi M, Mahdavi SRM, Ataei G (2013) Dose enhancement effect of gold nanoparticles on MAGICA polymer gel in mega voltage radiation therapy. Int J Radiat Res, 11(1): 55-61.##Vagheian M, Sardari D, Saramad S, Ochbelagh DR (2020) Experimental and theoretical investigation into X-ray shielding properties of thin lead films. Int J Radiat Res, 18(2): 263-274.##Mehnati P, Arash M, Zakerhamidi MS, Ghavami M (2019) Designing and construction of breast shields using silicone composite of Bismuth for chest CT. Int J Radiat Res, 17(3): 499-504.##Acun H, Bozkurt A, Kemikler G (2017) Dosimetric investigation of high dose rate Ir-192 source with Monte Carlo method. Int J Radiat Res, 15(3): 241-249.##Ahbrizal T, Tengku F, Jubri Z, Rajab NF, Rahim KA, Anum Y, et al. (2013) Gelam honey protects against gamma-irradiation damage to antioxidant enzymes in human diploid fibroblasts. Molecules, 18(2): 2200-11.##Tekin HO, Singh VP, Altunsoy EE, Manici T (2017) Mass attenuation coefficients of human body organs using MCNPX Monte Carlo code. Iran J Med Phys, 14(4): 229-40.##Choi Y, Park MH, Lee K (2019) Tissue engineering strategies for intervertebral disc treatment using functional polymers. Polymers (Basel), 11(5): 872.##Mortazavi SMJ, Kardan M, Sina S, Baharvand H, Sharafi N (2016) Design and fabrication of high density borated polyethylene nanocomposites as a neutron shield. Int J Radiat Res, 14(4): 379-383.##Zagho M, Abd E, Hussein E (2018) Recent overviews in functional polymer composites for biomedical applications. Polymers, 10(7): 739.##Akkurt I and Canakci H (2011) Radiation attenuation of boron doped clay for 662 , 1173 and 1332 keV gamma rays. Int J Radiat Res, 9(1): 37-40.##Fantidis JG (2015) The comparison between simple and advanced shielding materials for the shield of portable neutron sources. Int J Radiat Res, 13(4): 287-295.##Tekin HO and Manici T (2017) Simulations of mass attenuation coefficients for shielding materials using the MCNP-X code. Nucl Sci Tech, 95(09): 1-4.##Kiani MA, Ahmadi SJ, Outokesh M, Adeli R (2019) Study on physico-mechanical and gamma-ray shielding characteristics of new ternary nanocomposites. Appl Radiat Isot, 143: 141-8.##Derradji M, Wang J, Liu W (2016) High performance ceramic-based phthalonitrile micro and nanocomposites. Materials Letters, 2016(06): 110.##Derradji M, Wang J, Liu WB (2018) Phthalonitrile resins and composites properties. Elsevier, Book 2018. 405 pages.##Hanqi Zhang, Bing Wang YW and HZ (2020) Novolac/phenol-containing phthalonitrile blends: Curing characteristics and composite mechanical properties. Polymers (Basel), 12(126): 1-15.##Derradji M, Henniche A, Wang J, Dayo AQ, Ouyang J, Liu W, et al. (2018) High performance nanocomposites from Ti3SiC2 MAX phase and phthalonitrile resin. Polym Compos, 2018: 1-7.##Qadeer A, Cao X, Cai W, Song S, Wang J, Zegaoui A, et al. (2018) Synthesis of benzophenone-center bisphenol-A containing phthalonitrile monomer ( BBaph ) and its copolymerization with P-a benzoxazine. Reactive and Functional Polymers, 129(2017): 46-52.##Derradji M, Zegaoui A, Medjahed A, Dayo AQ, Wang J, Arse YB, et al. (2018) Cost effective surface-modified basalt fibers-reinforced phthalonitrile composites with improved mechanical properties and advanced nuclear shielding efficienc. Polym Compos, 40(S1): 1-8.##Qadeer A, Wang A, Derradji M, Kiran S, Zegaoui A (2018) Copolymerization of mono and difunctional benzoxazine monomers with bio-based phthalonitrile monomer : Curing behaviour , thermal , and mechanical properties. React Funct Polym, 131: 156-63.##Derradji M, Zegaoui A, Xu Y, Wang A, Qadeer A, Wang J, et al. (2018) Toward advanced gamma rays radiation resistance and shielding e ffi ciency with phthalonitrile resins and composites.##Nuclear Instruments and Methods in Physics Research, 421: 13-7.##Medjahed A, Derradji M, Zegaoui A, Wu R, Li B (2019) Mechanical and gamma rays shielding properties of a novel fi ber-metal laminate based on a basalt/phthalonitrile composite and an Al-Li alloy. Compos Struct, 210: 421-9.##Liang Y, Yuan X, Zhang W (2011) Thermodynamic identification of tungsten borides. Phys Rev B, 83: 220101(R).##Li Q, Zhou D, Zheng W, Ma Y, Chen C (2013) Global structural optimization of tungsten borides. Phys Rev Lett, 110(136403): 1-5.##Demir E, Karabas M, Sonmez S, Tugrul AB, Ovecoglu ML, Buyuk B (2017) Comparison of radiation properties of tungsten and additive metal coatings on 321 stainless steel substrate. Acta Physica Polonica Series a, 131(1): 71-73.##Chen Y, He D, Qin J, Kou Z, Wang S, Wang J (2010) Ultrahieh-pressure densification of nanocrystalline WB ceramics. J Mater Res, 25(4): 637-40.##Teng M, Pinwen Z, xiaohui Y (2021) Progress in functional studies of transition metal borides. Chinese Phys B, 30(10): 25.##Singh VP, Shirmardi SP, Medhat M, Badiger NM (2015) Determination of mass attenuation coefficient for some polymers using Monte Carlo simulation. Vacuum, 119: 1-5.##Brown FB and Mosteller RD (2004) MCNP5 workshop-PHYSOR-2004. American Nucler Society, 137 p.##Gimm JH and Hubbell MJ (1987) BXCOM: Photon cross sections on a personal computer, U.S Department of commerce. Center for Radiation Research National Bureau of Standards Gaithersburg, MD 20899 Available from:http://physics.nist.gov/xcom. Issued June 1978, p. 32.##Orz PEML, Ag B, Owae FRKT, Ag B, Nke WAE, Ag B, et al. (2012) Phthalic Acid and Derivatives. In: Ullmann's Encyclopedia of Industrial Chemistry, p. 131-79.##Biswas R, Sahadath H, Sattar A, Huq MF (2016) Calculation of gamma-ray attenuation parameters for locally developed shielding material: Polyboron. J Radiat Res Appl Sci, 9(1): 26-34.##Pelowitz DB (2011) MCNPX (TM) USER ' S MANUAL. Scientific Research, p. 1-645.##Alavian H and Tavakoli-anbaran H (2019) Study on gamma shielding polymer composites reinforced with different sizes and proportions of tungsten particles using MCNP code. Prog Nucl Energy, 115: 91-8.##Dong Y, Chang S-Q, Zhang H-X, Chao R, Bin K, Dai M-Z, Dai Y-D (2012) Effects of WO3 particle size in WO3/Epoxy resin radiation radiation shielding material. Chinese Phys Lett, 29(10): 1-4.##Malekie S and Hajiloo N (2017) Comparative study of micro and nano size WO3/E44 epoxy composite as gamma radiation shielding using MCNP and experiment. Chinese Physics Letters, 34(10): 1-9.##Chrzanowska J, Kurpaska L, Hoffman J (2016) Fabrication and characterization of superhard tungsten boride layers deposited by radio frequency magnetron sputtering Article. Ceram Int, 42(10): 12221-12230.##Pan J, Zhen C, Wang L, Liu G, Cheng H (2017) WB crystals with oxidized surface as counter electrode in dye-sensitized solar cells. Sci Bull, 62(2): 114-8.##Kvashnin AG, Zakaryan H, Zhao C, Duan Y (2018) New tungsten borides , their stability and outstanding mechanical properties. J Phys Chem Lett, 12: 3470-3477.## ##

A Study on the correlation between brain functional and structural changes and altered cognitive function after radiotherapy for nasopharyngeal carcinoma 2 2 Background: To explore the changes of brain function and structure after radiotherapy (RT) for nasopharyngeal carcinoma (NPC), to investigate their correlation with altered cognitive function and to promote the recognition of radiation-induced brain injury (RBI). Materials and Methods: Resting-state functional MRI (rs-fMRI) and three dimensional (3D) T1-weighted imaging scans were conducted on 32 patients and 34 healthy subjects. Cognitive function was assessed in all subjects using multiple cognitive scales. Differences in regional homogeneity (ReHo) and brain gray matter (GM) volumes between groups were analyzed using the DPARSF package and VBM methods. Results: ReHo in Cerebelum_Crus2_L of the NPC patients was significantly higher than that in the controls, and was significantly correlated with memory, general cognitive function, and executive ability. The GM volumes in right fusiform gyrus (FFG.R), left temporal pole: middle temporal gyrus (TPOmid.L), left inferior temporal gyrus (ITG.L), Cerebelum_6_L, and left middle frontal gyrus (MFG.L) in the patients were significantly reduced compared with the controls, and were markedly correlated with multiple cognitive scale scores. Conclusion: Damage to brain after radiotherapy mostly involving the temporal lobe and cerebellum, manifested by a compensatory increase in ReHo and a decrease in GM volume, both of which were significantly correlated with multiple cognitive impairments. ReHo and brain GM volume can be considered as sensitive biomarkers to monitor RBI. 627 633 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/3 1401/5/12 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/19 1401/4/28 C-H. Qin C-H. Qin Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China S-J. Qiu S-J. Qiu Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China H-Z. Wang H-Z. Wang Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China F-H. Duan F-H. Duan Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China D-L. Wu D-L. Wu Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China X. Leng X. Leng Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China lengxi1022@163.com Radiation-induced brain injury resting-state functional magnetic resonance brain gray matter volume cognitive function. Get persistent links for your reference list or bibliography.##Copy and paste the list, we’ll match with our metadata and return the links.##Members may also deposit reference lists here too.##1. Xia C, Yu XQ, Zheng R, et al. (2017) Spatial and temporal patterns of nasopharyngeal carcinoma mortality in China, 1973-2005. Cancer Lett, 401: 33-38.##Li Y, Huang X, Jiang J, et al. (2018) Clinical variables for prediction of the therapeutic effects of bevacizumab monotherapy in nasopharyngeal carcinoma patients with radiation-induced brain necrosis. Int J Radiat Oncol Biol Phys, 100: 621-629.##Lin X, Tang L, Li M, et al. (2021) Irradiation-related longitudinal white matter atrophy underlies cognitive impairment in patients with nasopharyngeal carcinoma. Brain Imaging Behav, 15: 2426-2435.##Makale MT, McDonald CR, Hattangadi-Gluth JA, et al. (2017) Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours. Nat Rev Neurol, 13: 52-64.##Yang Y, Lin X, Li J, et al. (2019) Aberrant brain activity at early delay stage post-radiotherapy as a biomarker for predicting neurocognitive dysfunction late-delayed in patients with nasopharyngeal carcinoma. Front Neurol, 10: 752.##Leng X, Qin C, Lin H, et al. (2021) Altered Topological Properties of Static/Dynamic Functional Networks and Cognitive Function After Radiotherapy for Nasopharyngeal Carcinoma Using Resting-State fMRI. Front Neurosci, 15: 690743.##Zuo XN and Xing XX (2014) Test-retest reliabilities of resting-state FMRI measurements in human brain functional connectomics: a systems neuroscience perspective. Neurosci Biobehav Rev, 45: 100-118.##Zhao Z, Tang C, Yin D, et al. (2018) Frequency-specific alterations of regional homogeneity in subcortical stroke patients with different outcomes in hand function. Hum Brain Mapp, 39: 4373-4384.##Lin WC, Hsu TW, Chen CL et al (2015) Resting State-fMRI with ReHo Analysis as a Non-Invasive Modality for the Prognosis of Cirrhotic Patients with Overt Hepatic Encephalopathy. PLoS One, 10: e0126834.##Nguyen KP, Raval V, Treacher A, et al. (2021) Predicting Parkinson's disease trajectory using clinical and neuroimaging baseline measures. Parkinsonism Relat Disord, 85: 44-51.##Chan YL, Leung SF, King AD, et al. (1999) Late radiation injury to the temporal lobes: morphologic evaluation at MR imaging. Radiology, 213: 800-807.##Chong VF, Fan YF, Mukherji SK (2000) Radiation-induced temporal lobe changes: CT and MR imaging characteristics. AJR Am J Roentgenol, 175: 431-436.##Norris AM, Carrington BM, Slevin NJ (1997) Late radiation change in the CNS: MR imaging following gadolinium enhancement. Clin Radiol, 52: 356-362.##Lv X, He H, Yang Y, et al. (2019) Radiation-induced hippocampal atrophy in patients with nasopharyngeal carcinoma early after radiotherapy: a longitudinal MR-based hippocampal subfield analysis. Brain Imaging Behav, 13: 1160-1171.##Guo Z, Han L, Yang Y, et al. (2018) Longitudinal brain structural alterations in patients with nasopharyngeal carcinoma early after radiotherapy. Neuroimage Clin, 19: 252-259.##Chapman CH, Nagesh V, Sundgren PC, et al. (2012) Diffusion tensor imaging of normal-appearing white matter as biomarker for radiation-induced late delayed cognitive decline. Int J Radiat Oncol Biol Phys, 82: 2033-2040.##Diamond A (2013) Executive functions. Annu Rev Psychol, 64: 135-168.##Muir RT, Lam B, Honjo K, et al. (2015) Trail making test elucidates neural substrates of specific poststroke executive dysfunctions. Stroke, 46: 2755-2761.##Zhao Q, Guo Q, Liang X, et al. (2015) Auditory Verbal Learning Test is Superior to Rey-Osterrieth Complex Figure Memory for Predicting Mild Cognitive Impairment to Alzheimer's Disease. Curr Alzheimer Res, 12: 520-526.##Chen X, Hu N, Wang Y, et al. (2020) Validation of a brain-computer interface version of the digit symbol substitution test in healthy subjects. Comput Biol Med, 120: 103729.##Chao-Gan Y and Yu-Feng Z (2010) DPARSF: A MATLAB Toolbox for "Pipeline" Data Analysis of Resting-State fMRI. Front Syst Neurosci, 4: 13.##Whitwell JL (2009) Voxel-based morphometry: an automated technique for assessing structural changes in the brain. J Neurosci, 29: 9661-9664.##Qiu Y, Guo Z, Han L, et al. (2018) Network-level dysconnectivity in patients with nasopharyngeal carcinoma (NPC) early post-radiotherapy: longitudinal resting state fMRI study. Brain Imaging Behav, 12: 1279-1289.##Gazdzinski LM, Cormier K, Lu FG, et al. (2012) Radiation-induced alterations in mouse brain development characterized by magnetic resonance imaging. Int J Radiat Oncol Biol Phys, 84: e631-638.##Mulderink TA, Gitelman DR, Mesulam MM, et al. (2002) On the use of caffeine as a contrast booster for BOLD fMRI studies. Neuroimage, 15: 37-44.##Diserbo M, Agin A, Lamproglou I, et al. (2002) Blood-brain barrier permeability after gamma whole-body irradiation: an in-vivo microdialysis study. Can J Physiol Pharmacol, 80: 670-678.##Xu X, Huang H, Tu Y, et al. (2021) Celecoxib Alleviates Radiation-Induced Brain Injury in Rats by Maintaining the Integrity of Blood-Brain Barrier. Dose Response, 19: 15593258211024393.##Hu F, Li T, Wang Z, et al. (2017) Use of 3D-ASL and VBM to analyze abnormal changes in brain perfusion and gray areas in nasopharyngeal carcinoma patients undergoing radiotherapy. Biomed Res, 28: 7879-85.##Chen Q, Lv X, Zhang S, et al. (2020) Altered properties of brain white matter structural networks in patients with nasopharyngeal carcinoma after radiotherapy. Brain Imaging Behav, 14: 2745-2761.##Wang HZ, Qiu SJ, Lv XF, et al. (2012) Diffusion tensor imaging and 1H-MRS study on radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy. Clin Radiol, 67: 340-345.##Xiong WF, Qiu SJ, Wang HZ, et al. (2013) 1H-MR spectroscopy and diffusion tensor imaging of normal-appearing temporal white matter in patients with nasopharyngeal carcinoma after irradiation: initial experience. J Magn Reson Imaging, 37: 101-108.##Cao S, Nie J, Zhang J, et al. (2021) The Cerebellum Is Related to Cognitive Dysfunction in White Matter Hyperintensities. Front Aging Neurosci, 13: 670463.##Ahmadian N, van Baarsen K, van Zandvoort M, et al. (2019) The Cerebellar Cognitive Affective Syndrome-a Meta-analysis. Cerebellum, 18: 941-950.##Schmahmann JD (2019) The cerebellum and cognition. Neurosci Lett, 688:62-75##Ding Z, Zhang H, Lv XF et al. (2018) Radiation-induced brain structural and functional abnormalities in presymptomatic phase and outcome prediction. Hum Brain Mapp, 39: 407-427.##Lv XF, Zheng XL, Zhang WD, et al. (2014) Radiation-induced changes in normal-appearing gray matter in patients with nasopharyngeal carcinoma: a magnetic resonance imaging voxel-based morphometry study. Neuroradiology, 56: 423-430.##Nagtegaal SHJ, David S, Snijders TJ, et al. (2020) Effect of radiation therapy on cerebral cortical thickness in glioma patients: Treatment-induced thinning of the healthy cortex. Neurooncol, Adv 2: vdaa060.##Lin J, Lv X, Niu M, et al. (2017) Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy. Neuroimage Clin, 14: 610-621.##Leng X, Fang P, Lin H, et al. (2017) Structural MRI research in patients with nasopharyngeal carcinoma following radiotherapy: A DTI and VBM study. Oncol Lett, 14: 6091-6096.##Sestieri C, Corbetta M, Romani GL, et al. (2011) Episodic memory retrieval, parietal cortex, and the default mode network: functional and topographic analyses. J Neurosci, 31: 4407-4420.##Astle DE, Luckhoo H, Woolrich M, et al. (2015) The Neural Dynamics of Fronto-Parietal Networks in Childhood Revealed using Magnetoencephalography. Cereb Cortex, 25: 3868-3876.## ##

Preparation, molecular modeling and in-vivo evaluation of 99-mTc-Oseltamivir as a tumor diagnostic agent 2 2 Background: Radiolabeling process has a very important role in prediction of in-vivo biodistribution. Moreover, biodistribution is considered the backbone of the recent discovery of anti-cancer drugs.Technetium-99m has been the most utilized radionuclide in nuclear medicine due to its optimal physical characteristics. Materials and Methods: Oseltamivir(Osel) was radiolabeled by technetium-99m under reductive conditions directly.1.5 mg of Osel was followed by 25 μg of SnCl2. H2O, 200 μl buffer pH 4 at 60ºC reaction temperature, and the reaction time was 30 minutes. In-vivo biodistribution of 99mTc-Oseltamivir (99mTc-Osel) tracer was studied using tumor-bearing Albino mice compared to control. The radiochemical purity percentage was calculated using the ascending paper chromatography technique and also, confirmed by paper electrophoresis before the in-vivo biodistribution in mice.99mTc-Osel tracer was further analyzed utilizing high performance liquid chromatography analysis .Spartan software for molecular modeling is used for optimizing the different complex patterns of Osel with 99mTc where energy was minimized using the semi-empirical method with a PM3 basis set. Result: 99mTc-Osel tracer was synthesized with a good yield of 98.7±0.34% at the optimized conditions and the preparation exhibited in-vitro stability up to 3 h. In vivo biodistribution studies showed high uptake in tumor cells with the target to the non-target ratio of 4.55±0.2 after 3 h. post- injection. Conclusion: 99mTc-Osel tracer focuses on the tumor site with a high percentage appropriate to use 99mTc-Osel as a useful tool for tumor imaging. 635 642 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/19 1401/4/28 S.B. Challan S.B. Challan Labeled Compounds Department, Hot Lab. Center, Egyptian Atomic Energy Authority, Cairo, Egypt S.I. Khater S.I. Khater Cyclotron Project, Nuclear Research Center, Egyptian Atomic Energy Authority, Cairo, Egypt sabkhater@yahoo.com A.M. Rashad A.M. Rashad Radioactive Isotopes and Generators Department, Hot Lab. Center, Egyptian Atomic Energy Authority, Cairo, Egypt Oseltamivir technetium-99m spartan in-vivo biodistrbution. Schunemann HJ, Hill SR, Kakad M, Bellamy R, Uyeki TM, Hayden FG (2007) WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus. The Lancet Infectious Diseases, 7(1): 21-31.##Ward P, Small I, Smith J, Suter P, Dutkowski R (2005) Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic. Journal of Antimicrobial Chemotherapy, 55: (S1, i5-i21).##Reddy LH, Sharma RK, Murthy RS, (2004) Enhanced tumour uptake of doxorubicin loaded poly (butyl cyanoacrylate) nanoparticles in mice bearing Dalton's lymphoma tumour. J Drug Target, 12: 443-451.##Amin AM, El-Azony KM, Ibrahim IT (2009) Application of 99Mo/99mTc alumina generator in the labeling of metoprolol for diagnostic purposes. J Labell Compd Radiopharm, 52: 467-472.##Wilson JC and von Itzstein M (2003) Recent strategies in the search for new anti-influenza therapies. Current Drug Targets, 4(5):3 89-408. PMID: 12816348.##Seddon BM and Workman P (2003) The role of functional and molecular imaging in cancer drug discovery and development. Br J Radiol, 76(2): S128-38.##Chidambaram M, Manavalan R, KathiresanK (2011) Nanotherapeutics to overcome conventional cancer chemotherapy limitations. J Pharm PharmSci, 14(1): 67-77.##Garraway LA and Janne PA (2012) Circumventing cancer drug resistance in the era of personalized medicine. Cancer Discov, 2(3): 214-26.##Cunningham VJ, Parker CA, Rabiner EA, Gee AD, Gunn RN (2005) PET studies in drug development: methodological considerations. Drug Discov Today Technol, 2: 311-5.##Rischin D, Hicks RJ, Fisher R, Binns D, Corry J, Porceddu S, Peters LJ (2006) Trans-Tasman radiation oncology group study 98.02. Prognostic significance of (18F)-misonidazole positron emission tomography-detected tumor hypoxia in patients with advanced head and neck cancer randomly assigned to chemoradiation with or without tirapazamine: a sub study of Trans-Tasman Radiation Oncology Group Study 98.02. J ClinOncol, 24(13): 2098-104.##Altiparmak B, Lambrecht FY, Bayrak E, Durkan K, (2010) Design and synthesis of 99mTc-citro-folate for use as a tumor targeted radiopharmaceutical. Int J Pharm, 400(1-2): 8-14.##Stypinski D, McQuarrie SA, McEwan AJB, Wiebe LI (2018) Pharmacokinetics and scintigraphic imaging of the hypoxia imaging agent (123I) IAZA in healthy adults following exercise based cardiac stress. Pharmaceutics 10: 25.##Hesselewwod S and Leubg E (1994) Drug interactions with radiopharmaceuticals. Eur J Nucl Med, 21: 348.##Early PJ and Sodee DB (1995) Principles and practice of nuclear medicine. Mosby- Year Book, Inc., Toronto, 877.##Saha GB (1998) Fundamentals of nuclear pharmacy. Springer-Verlag, New York, pp.: 331.##Sampson CB., (1996), Complications and difficulties in radiolabelling blood cells: a review. Nucl Med Commun, 17(8): 648-58.##Richardson VJ, Jeyasingh K, Jewkes RF (1977), Properties of 99mTechnetium labeled liposomes innormal and tumor bearing rats. BiochemSoc Trans, 5: 290-291.##Cheng CH, Meares CF, Godwin DA (1983) Application of nuclear and radiochemistry, Lambrecht, R.M. and Morcos, N., Eds., New York: Pergamon.##Abd El-Ghany EA (1998) Preparation and evaluation of freeze dried kits for 99mTc labeling, M.Sc. Thesis, Faculty of Pharmacy, Cairo Univ. (Egypt).##Gandomkar M, Najafi R, Mazidi M, Mirfallah SH, Goudarzi M (2009) Three different procedures in labeling of Ubiquicidin with technetium 99m: a comparative study. Int J Radiat Res, 7(2): 97-104.##Massoud A, Safaa BC, Maziad N (2021) Characterization of polyvinylpyrrolidone (PVP) with technetium-99m and its accumulation in mice. Part a: Journal of Macromolecular Science, Pure and Applied Chemistry, 58(6): 408-418.##Challan SB and Massoud A (2017) Radiolabeling of grapheme oxide by Technetium-99m for infection imaging in rats. J Radioanal Nucl Chem, 314(3): 2189.##Challan SB, Fawzy AM, Massoud A (2020) Synthesis of radioiodinatedcarnosine for hepatotoxicity imaging induced by carbon tetrachloride and its biological assessment in rats. Radiochem Acta, 108: 397-408.##Ibrahim T, Walyb MA, El-Tawoosy M (2012) Synthesis, Labeling, and Biological Evaluation of 2-{(Benzyl (cyanomethyl) amino)methyl}-3-(ethoxycarbonyl)-quinoxaline 1,4-Dioxide in Ascites Bearing Mice. Radiochemistry, 54(4): 395-40.##Nagarajan JSK and Muralidharan S (2009) A validated RP-HPLC method for estimation of Oseltamivir in pharmaceutical formulation. Der Pharmacia Lettre, 1(1): 162-168.##Motaleb MA, Farouk N, El-Kolaly MT, et al. (2007) Synthesis of 99m Tc-L-carnitine as a model for tumor imaging.##Arab J Nucl SciAppl, 40(2): 101.##NDong C, Tate JA, Kett WC, Batra J, Demidenko E, Lewis LD, Hoopes PJ, Gerngross TU, Griswold KE (2015) Tumor cell targeting by iron oxide nanoparticles is dominated by different factors In-vitro versus In-vivo. plos one, 10(2): 1-18.##Jagetia GC and Rao SK (2006) Evaluation of antineoplastic activity Guduchi (Tinosporacordifolia) in Ehrlich Ascites Carcinoma bearing mice. Biological and Pharmaceutical Bulletin, 29: 460-66.##Konan YN, Cerny R, Favet J, Berton M, Gurny R, Allemann E (2003) Preparation and characterization of sterile sub-200 nm meso-tetra (4-hydroxylphenyl)porphyrin-loaded nanoparticles for photodynamic therapy. Eur J Pharm Biopharm, 55: 115-124.##Nour SA, Abdelmalak NS, Naguib MJ, Rashed HM, Ibrahim AB (2016) Intranasal brain-targeted clonazepam polymeric micelles for immediate control of status epilepticus: In-vitro optimization, ex vivo determination of cytotoxicity, in vivo biodistribution and pharmacodynamics studies. Drug Deliv, 23: 3681-3695.##Mohamed KO, Nissan YM, El-Malah AA, Ahmed WA, Ibrahim DM, Sakr TM, Motaleb MA (2017) Design, Synthesis and Biological Evaluation of Some Novel Sulfonamide Serivatives as Apoptotic Agents. Eur J Med Chem, 135: 424-433.##Breeman WA, Hofland LJ, Bakker WH, van der Pluij M, Van Koetsveld PM, de Jong M, Setyono-Han B, Kwekkeboom DJ, Visser TJ, Lamberts SW, Krenning EP (1993) Radioiodinatedsomatostatin analogue RC-160: preparation, biological activity, in-vivo application in rats and comparison with (123I-Tyr3)octreotide. Eur J Nucl Med, 20: 1089-1094.##Al-wabli RI, Sakr, TM, Khedr MA, Adli ASA, Motaleb MA, Zaghary WA (2016) Platelet-12 lipoxygenase targeting via newly synthesized curcumin derivative radiolabeled with technetium-99m. Chem Cent J, 10: 73.##Tubergen K, Corlija M, VolkertWA, Holmes RA (1991) Sensitivity of technetium- 99m-d, 1-HMPAO to radiolysis in aqueous solutions. J Nucl Med, 32: 111-115.##Motaleb MA, Ibrahem IT, Ayoub VR, Geneidi AS (2016) Preparation and biological evaluation of 99mTc-ropinirole as a novel radiopharmaceutical for brain imaging. J Label CompdRadiopharm, 59: 147-152.##Geskovski N, Kuzmanovska S, Simonoska Crcarevska M, Calis S, Dimchevska S, Petrusevska M, Zdravkovski P, Goracinova K (2013) Comparative biodistribution studies of technetium-99 m radiolabeled amphiphilic nanoparticles using three different reducing agents during the labeling procedure. J Labelled Comp Radiopharm, 56(14): 689-95.##Sanad MH, Farouk N, Fouzy ASM (2017) Radiocomplexation and bioevaluation of 99mTc nitrido-piracetam as a model for brain imaging. Radiochimica Acta, 105(9): 729-737.##Sanad MH, El-Bayoumy ASA, Ibrahim AA (2017) Comparative biological evaluation between 99mTc (CO) 3 and 99mTc-Sn (II) complexes of novel quinoline derivative: a promising infection radiotracer. J RadioanalNucl Chem, 311: 1-14.##Srivastava SC and Richards P (1983) Technetium-labled compounds. In Radiotracers for Medical Applications, CRC Series in Radiotracers in Bioliology and Medicine, 1st ed.; Rayudu, G.V.S., Ed.; CRC Press: Boca Raton, FL, USA.##Sakr TM, Khedr MA, Rashed HM, Mohamed ME (2018) In Silico-Based Repositioning of Phosphinothricin as a Novel Technetium-99m Imaging Probe with Potential Anti-Cancer Activity. Molecules, 23: 496.##Satpati D, Korde A, Venkatesh M, Banerjee S (2009) Preparation and bioevaluation of a 99mTc-labeled chlorambucil analog as a tumor targeting agent. Appl Radiat Isot, 67: 1644-1649.##Zhang J, Yu Q, Huo J, Pang Y, Yang S, He Y, Tang T, Yang C, Wang X (2010), Synthesis and biodistribution of a novel 99mTc-DMSA metronidazole ester as a potential tumor hypoxia imaging agent. J Radioanal Nucl Chem, 283: 481-485.##Sakr TM, El-Safoury DM, Awad GAS, Motaleb MA (2013) Biodistribution of 99mTc-sunitinib as a potential radiotracer for tumor hypoxia imaging. J Label Compd Radiopharm, 56: 392-395.##El-Sharawy DM, Khater SI, Essam HM, Noheir HS, Hossam MH, Elmaidomy AH (2021) 99mTc-Luteolin: Radiolabeling, In Silico ADMET and Biological Evaluation as a Natural Tracer Tumor imaging. J Radiat Res and Appl Sci, 14(1): 125-132.## ##

Extreme hypofractıonated radiosurgery in recurrent inoperable High-Grade Ultra-Large gliomas 2 2 Background: To elucidate the efficacy and toxicity of brain re-radiotherapy for recurrent large inoperable gliomas using radiosurgery. Materials and Methods: Between 2014 and 2018, extreme hypofractionated radiosurgery was performed using Accuray’s Cyberknife® system on 14 lesions (12 patients)  grade 4 recurrence lesions of 6 patients with anaplastic astrocytoma and 6 patients with glioblastoma who had previously undergone surgery and cranial radiotherapy and had a local-regional recurrence. Six patients (8 lesions) were given a biologic effective dose (BED10) of 48 Gy and lower, and six patients were given a BED10 of 59.5 Gy and higher. The Response Assessment in Neuro-Oncology Criteria (RANO) were used for tumor response, and the Common Terminology for Adverse Events (CTCAE) was used for adverse effect assessment. The primary endpoint was determined as overall survival, and first treatment and salvage treatment time. Results: The median age of the patients was 43 years, and the median Karnofsky Performance Status (KPS) was 70. The median time from the first radiotherapy to death was 34 months. The median time from the previous radiotherapy was 29.5 months (R:17-40). The median survival was 10 months for those with recurrence before 29.5 months and 11 months for those with recurrence after 29.5 months. The median total tumor volume was 29.224 mL (~30 mL). One grade 4 toxicity was observed. Conclusion: Radiosurgery can be used effectively as salvage therapy in ultra-large inoperable gliomas. 643 648 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 T. Berber T. Berber Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey tanjuberber@hotmail.com I. Harmankaya I. Harmankaya Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey F. Aksaray F. Aksaray Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey Y. Büyükpolat Y. Büyükpolat Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey F. Adatepe F. Adatepe Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey B.D. Yilmaz B.D. Yilmaz Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey S.T. Dinçer S.T. Dinçer Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey G. Coşgun G. Coşgun Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey Ç. Numanoglu Ç. Numanoglu Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey M.N. Güven M.N. Güven Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey M.E. Gül M.E. Gül Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey C. Yildirim C. Yildirim Istanbul University Faculty of Medicine, Radiation Oncology Department, Istanbul, Turkey A.A. Erken A.A. Erken Okmeydani Training and Research Hospital, Radiation Oncology Department, Istanbul, Turkey Re-irradiation radiosurgery high-grade glioma salvage hypofractionated recurrent. Ostrom QT, Gittleman H, Liao P, et al. (2017) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro Oncol, 19(5): v1-v88.##Stupp R, Mason WP, Van Den Bent MJ, et al. (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med, 352(10): 987-96.##Chen L, Guerrero-Cazares H, Ye X, et al. (2013) Increased subventricular zone radiation dose correlates with survival in glioblastoma patients after gross total resection. Int J Radiat Oncol Biol Phys, 86(4): 616-22.##Oppitz, U, Maessen, D, Zunterer, H, et al. (1999) 3D-recurrence-patterns of gliobastomas after CT-planned postoperative irradiation. Radiother Oncol, 53(1): 53-7.##Stupp R, Hegi ME, Mason WP, et al. (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol, 10(5): 459-66.##Diksin M, Smith SJ, Rahman R (2017) The molecular and phenotypic basis of the glioma invasive perivascular niche. Int J Mol Sci, 18(11): 2342.##Trone J-C, Vallard A, Sotton S, et al. (2020) Survival after hypofractionation in glioblastoma: a systematic review and meta-analysis. Radiation Oncology, 15: 1-10.##Bloch O, Han SJ, Cha S, et al. (2012) Impact of extent of resection for recurrent glioblastoma on overall survival. J Neurosurg Sci, 117(6): 1032-8.##Scoccianti S, Perna M, Olmetto E, et al. (2020) Local treatment for relapsing glioblastoma: A decision-making tree for choosing between reirradiation and second surgery. Critical Reviews in Oncology/Hematology, 2020: 103184.##Combs SE, Widmer V, Thilmann C, et al. (2005) Stereotactic radiosurgery (SRS) treatment option for recurrent glioblastoma multiforme (GBM). Cancer, 104(10): 2168-73.##Reynaud T, Bertaut A, Farah W, et al. (2018) Hypofractionated stereotactic radiotherapy as a salvage therapy for recurrent high-grade gliomas: Single-center experience. Technol Cancer Res Treat, 17: 1533033818806498.##Eren G, Zorlu F, Yazici G, et al. (2021) Stereotactic radiosurgery and fractionated stereotactic radiosurgery in patients with recurrent glial tumors. Int J Hemato Oncol, 31(4): 255-63.##Gutin PH, Iwamoto FM, Beal K, et al. (2009) Safety and efficacy of bevacizumab with hypofractionated stereotactic irradiation for recurrent malignant gliomas. Int J Radiat Oncol Biol Phys, 75(1): 156-63.##Fogh SE, Andrews DW, Glass J, et al. (2010) Hypofractionated stereotactic radiation therapy: an effective therapy for recurrent high-grade gliomas. J Clin Oncol, 28(18): 3048.##Tsien C, Pugh S, Dicker A, et al. (2019) Randomized phase II trial of re-irradiation and concurrent bevacizumab versus bevacizumab alone as treatment for recurrent glioblastoma (NRG Oncology/RTOG 1205): initial outcomes and rt plan quality report. Oral Scientific Session, 105(1): S78.##Pirzkall A, McKnight TR, Graves EE, et al. (2001) MR-spectroscopy guided target delineation for high-grade gliomas. Int J Radiat Oncol Biol Phys, 50(4): 915-28.##Wen PY, Macdonald DR, Reardon DA, et al. (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol, 28(11): 1963-72.##Atkinson TM, Ryan SJ, Bennett AV, et al. (2016) The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer, 24(8): 3669-76.##Kaplan EL and Meier P (1958) Nonparametric estimation from incomplete observations. Journal of the American statistical association. J American Statistical Association 53(282): 457-81.##Сох D (1972) Regression models and life-tables. Journal of the Royal Statistical Society. Series B, 34(2): 187-220.##Shaw E, Scott C, Souhami L, et al. (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Physics, 47(2): 291-8.##Dirks P, Bernstein M, Muller P, et al. (1993) The value of reoperation for recurrent glioblastoma. Canadian journal of surgery, 36(3): 271-5.##Oppenlander ME, Wolf AB, Snyder LA, et al. (2014) An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity. Journal of Neurosugery, 120(4): 846-53.##Scoccianti S, Francolini G, Carta GA, et al. (2018) Re-irradiation as salvage treatment in recurrent glioblastoma: a comprehensive literature review to provide practical answers to frequently asked questions. Crit Rev Oncol Hematol, 126: 80-91.##Clarke J, Neil E, Terziev R, et al. (2017) Multicenter, phase 1, dose escalation study of hypofractionated stereotactic radiation therapy with bevacizumab for recurrent glioblastoma and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys , 99(4): 797-804.##Yaprak G, Isık N, Gemici C, et al. (2020) Stereotactic radiotherapy in recurrent glioblastoma: a valid salvage treatment option. Stereotact Funct Neurosurg, 98(3): 167-75.##Yazici G, Cengiz M, Ozyigit G, et al. (2014) Hypofractionated stereotactic reirradiation for recurrent glioblastoma. J Neurooncol, 120(1): 117-23.##Kazmi F, Soon YY, Leong YH, et al. (2019) Re-irradiation for recurrent glioblastoma (GBM): a systematic review and meta-analysis. J Neurooncol, 142(1): 79-90.##De Wit M, De Bruin H, Eijkenboom W, et al. (2004) Immediate post-radiotherapy changes in malignant glioma can mimic tumor progression. Neurology, 63(3): 535-7.##Lederman, G, Wronski, M, Arbit, E, et al. (2000) Treatment of recurrent glioblastoma multiforme using fractionated stereotactic radiosurgery and concurrent paclitaxel. Am J Clin Oncol, 23(2): 155-9.##Hudes RS, Corn BW, Werner-Wasik M, et al. (1999) A phase I dose escalation study of hypofractionated stereotactic radiotherapy as salvage therapy for persistent or recurrent malignant glioma. Int J Radiat Oncol Biol Phys, 43(2): 293-8.##Hasan S, Chen E, Lanciano R, et al. (2015) Salvage fractionated stereotactic radiotherapy with or without chemotherapy and immunotherapy for recurrent glioblastoma multiforme: a single institution experience. Radiation Oncology, 5: 106.##Vordermark D, Kölbl O, Ruprecht K, et al. (2005) Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma. BMC Cancer, 5(1): 1-7.##Voynov G, Kaufman S, Hong T, et al. (2002) Treatment of recurrent malignant gliomas with stereotactic intensity modulated radiation therapy. American J Clinical Oncology, 25(6): 606-11.##Shepherd SF, Laing RW, Cosgrove VP, et al. (1997) Hypofractionated stereotactic radiotherapy in the management of recurrent glioma. Int J Radiat Oncol Biol Phys, 37(2): 393-8.##Ruben JD, Dally M, Bailey M, et al. (2006) Cerebral radiation necrosis: incidence, outcomes, and risk factors with emphasis on radiation parameters and chemotherapy. Int J Radiat Oncol Biol Physics, 65(2): 499-508.##Blonigen BJ, Steinmetz RD, Levin L, et al. (2010) Irradiated volume as a predictor of brain radionecrosis after linear accelerator stereotactic radiosurgery. Int J Radiat Oncol Biol Physics, 77(4): 996-1001.##Hudes RS, Corn BW, Werner-Wasik M, et al. (1999) A phase I dose escalation study of hypofractionated stereotactic radiotherapy as salvage therapy for persistent or recurrent malignant glioma. Int J Radiat Oncol Biol Phys, 43(2): 293-8.##Hall WA, Djalilian HR, Sperduto PW, et al. (1995) Stereotactic radiosurgery for recurrent malignant gliomas. Journal of clinical oncology, 13(7): 1642-8.##Pannullo SC, Fraser JF, Moliterno J, et al. (2011) Stereotactic radiosurgery: a meta-analysis of current therapeutic applications in neuro-oncologic disease. Journal of neuro-oncology, 103(1): 1-17.## ##

Effects of timing in the applications of radiotherapy after transverse rectus abdominis musculocutaneous flap in rats 2 2 Background: The present study aimed to investigate flap status in relation to the timing of radiotherapy (RT) in an experimental rat model of irradiated transverse rectus abdominis musculocutaneous (TRAM) flap. Materials and Methods: Fifty-six adult male Sprague-Dawley experiments were separated in seven groups in terms of flap surgery and RT. The groups comprised sham group, control (Ctrl) group, RT group, and RT plus surgery (RT+Surg) group, which was further separated in four groups depending on the timing of postoperative RT as RT+Surg-10 (RT on postoperative 10th day), RT+Surg-20 (RT on postoperative 20th day), RT+Surg-30 (RT on postoperative 30th day), and RT+Surg-40 (RT on postoperative 40th day). All the rats were sacrificed 8 weeks after the RT administration for histopathological analysis. Results: Compared with the RT+Surg-10 and RT+Surg-20 groups, the hyalinization and collagenization scores in RT+Surg-30 were determined to be significantly lower. Fibrosis scores were lower in the RT+Surg-30 group compared with the RT+Surg-20 group, whereas significantly lower inflammation scores were determined in the RT + Surg-40 group and significantly higher dermal thickness in the RT+Surg-30 group compared with the RT+Surg-10 group. Conclusions: The findings from this model of irradiated flap revealed the significance of the time lag among flap application and postoperative RT for histopathological outcome, emphasized the potential role of at least a 30- to 40-day interval between surgery and RT in achieving more favorable flap status. 649 655 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 O. Binicier O. Binicier Private Clinic, Bursa, Turkey P.K. Caskan P.K. Caskan University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey E. Kapi E. Kapi University of Health Sciences, Adana Faculty of Medicine, Health Application and Research Center, Department of Plastic, Reconstructive and Aesthetic Surgery, Adana, Turkey eminkapi@gmail.com M. Bozkurt M. Bozkurt University of Health Sciences, Bagcilar Health Application and Research Center, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey S.B. Zincircioğlu S.B. Zincircioğlu Dicle University, Faculty of Medicine, Department of Radiation Oncology, Diyarbakir, Turkey 6University of Pittsburgh, Little Lab, Pittsburgh, Pennsylvania, USA Y. Kulahcı Y. Kulahcı University of Pittsburgh, Little Lab, Pittsburgh, Pennsylvania, USA C.T. Selcuk C.T. Selcuk Dicle University, Faculty of Medicine, Department of Plastic, Reconstructive an Aesthetic Surgery, Diyarbakir, Turkey O. Satici O. Satici Dicle University, Faculty of Medicine, Department of Biostatistics, Diyarbakir, Turkey TRAM flap rat timing of irradiation experimental histopathological outcomes. Wang SL, Fang H, Song YW, Wang WH, Hu C, Liu YP, Jin J, Liu XF, Yu ZH, Ren H, Li N, Lu NN, Tang Y, Qi SN, Sun GY, Peng R, Li S, Chen B, Yang Y, Li YX (2019) Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol, 20: 352-360.##Liu L, Yang Y, Guo Q, Ren B, Peng Q, Zou L, Zhu Y, Tian Y (2020) Comparing hypofractionated to conventional fractionated radiotherapy in postmastectomy breast cnacer: a meta-analysis and systemic review. Radiat Oncol, 15: 17.##Castaneda SA and Strasser J (2017) Updates in the treatment of breast cancer with radiotherapy. Surg Oncol Clin N Am, 26: 371-382.##Al Maksoud A, Moneer M and Barsoum AK (2017) Combined TRAM flap with latissimus dorsi myocutaneous flap for reconstruction of a large breast post-radiation induced necrosis. J Surg Case Rep, 11: 2017:rjx079.##Kunkler IH and Chua BH (2021) Postmastectomy radiotherapy: a review. Curr Opin Oncol, 33: 547-552.##Atisha DM, Comizio RC, Telischak KM, Higgins JH, Collins ED (2010) Interval inset of TRAM flaps in immediate breast reconstruction: a technical refinement. Ann Plast Surg, 65: 524-527.##Lee HH, Hou MF, Wei SY, Lin SD, Luo KH, Huang MY, Ou-Yang F, Huang CJ (2016) Comparison of long-term outcomes of postmastectomy radiotherapy between breast cancer patients with and without immediate flap reconstruction. PLoS One, 11: e0148318.##Lucca AF, Brasolin AG1, Feitosa RG, Simoes e Silva Enokihara MM, Gomes HF, Ferreira LM (2014) Histological modification in TRAM flap in rats treated with pentoxifylline. Acta Cir Bras, 29: 34-37.##Gart MS, Smetona JT, Hanwright PJ, Fine NA, Bethke KP, Khan SA, Wang E, Kim JY (2013) Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg, 216: 229-238.##Walsh SM, Lowery AJ, Prichard RS, McDermott EW, Evoy D, Geraghty J (2014) Postmastectomy radiotherapy: indications and implications. Surgeon, 12: 310-315.##Berbers J, van Baardwijk A, Houben R, Heuts E, Smidt M, Keymeulen K, Bessems M, Tuinder S, Boersma L (2014) 'Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature. Eur J Cancer, 50: 2752-2762.##Ho TB, Wood WC, Mspt PDS (2019) Breast reconstruction in the setting of postmastectomy radiotherapy: Controversies and disparities. Oncology (Williston Park), 33: 688845.##Livi L, Meattini I, Cataldo VD, Cardillo CDL, Scotti V, Sanchez L, Nori J, Agresti B, Iermano C, Pasquetti EM, Bianchi S, Cataliotti L, Biti G (2010) Postmastectomy radiotherapy in breast cancer adjuvant treatment. Minerva Chir, 65: 527-536.##Rocco N, Catanuto G, Nava MB (2018) Radiotherapy and breast reconstruction. Minerva Chir, 73: 322-328.##Rimler J, McNally R, Moore R, Park DJ, Wirth GA and Paydar KZ (2015) The effects of radiation therapy on perfusion of free versus pedicle transverse rectus abdominis myocutaneous (TRAM) flaps in-vivo. J Plast Reconstr Aesthet Surg, 68: 1774-1776.##Browne JP, Jeevan R, Gulliver-Clarke C, Pereira J, Caddy CM, van der Meulen JHP (2017) The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer. Cancer, 123: 3460-3467.##Panchal H and Matros E (2017) Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg, 140: 7S-13S.##Ho AY, Hu ZI, Mehrara BJ, Wilkins EG (2017) Radiotherapy in the setting of breast reconstruction: types, techniques, and timing. Lancet Oncol, 18: e742-e753.##Berry T, Brooks S, Sydow N, Djohan R, Nutter B, Lyons J, Dietz J (2010) Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Oncol, 17: 202-210.##Chatterjee JS, Lee A, Anderson W, Baker L, Stevenson JH, Dewar JA, Thompson AM (2009) Effect of postoperative radiotherapy on autologous deep inferior epigastric perforator flap volume after immediate breast reconstruction. Br J Surg, 96: 1135-1140.##Fischer JP, Selber JC, Nelson JA, Cleveland E, Kovach SJ, Wu LC, Kanchwala S, Serletti JM (2013) Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps. Plast Reconstr Surg, 131: 195-203.##Kulahci Y, Duman H, Zor F, Bozkurt M, Guden M, Gunhan O, Celasun B, Sengezer M (2010) The effect of external beam irradiation timing on skin graft survival. Eur Surg Res, 44: 142-151.##Potter S, Brigic A, Whiting PF (2010) Reporting clinical outcomes of breast reconstruction: a systematic review. J Natl Cancer Inst, 103: 31-46.##Pomahac B, Recht A, May JW, Hergrueter CA, Slavin SA (2006) New trends in breast cancer management: is the era of immediate breast reconstruction changing? Ann Surg, 244: 282-288.##Jankau J (2015) Free TRAM flap model. In: Plastic and Reconstructive Surgery: Experimental Models and Research Designs, (Siemionow MZ, ed), Springer-Verlag., London, England.##Ozgentas HE, Shenaq S, Spira M (1994) Development of TRAM fl ap model in the rat and study of vascular dominance. Plast Reconstr Surg, 94: 1012-1017.##https://doi.org/10.1097/00006534-199412000-00015##https://doi.org/10.1097/00006534-199412000-00017##Bernstein EF, Sullivan FJ, Mitchell JB, Salomon GD, Glatstein E (1993) Biology of chronic radiation effect on tissues and wound healing. Clin Plast Surg, 20: 435-453.##Gorodetsky R, McBridge WH, Withers HR (1988) Assay of radiation effects in Mouse skin as expressed in wound healing. Radiat Res, 116: 135-144.##Gorodetsky R, Mou XD, Fisher DR, Taylor JM, Withers HR (1990) Radiation effect in mouse skin: dose fractionation and wound healing. J Radiat Oncol Biol Phys, 18: 1077-1081.##Tadjalli HE, Evans GR, Gürlek A, Beller TC, Ang KK, Stephens LC (1999) Skin graft survival after external beam irradiation. Plast Reconstr Surg, 103: 1902-1908.##Mericli AF, Das A, Best R, Rodeheaver P, Rodeheaver G, Lin KY (2015) Deferoxamine mitigates radiation-induced tissue injury in a rat irradiated TRAM flap model. Plast Reconstr Surg, 135: 124-134.##Lin KY, Patterson JW, Simmons J, Long MD, Schultz RO, Amiss LR, Molloy JA, Kelly MD (2001) Effects of external beam irradiation on the TRAM fl ap: an experimental model. Plast Reconstr Surg, 107: 1190-1197.##https://doi.org/10.1097/00006534-200104150-00014##Angelos PC, McCarn KE, Winn SR, Ghanem T, Kaurin DS, Holland J, Wax MK (2010) Development of an irradiated rodent model to study flap revascularization. Arch Facial Plast Surg, 12: 119-1122.##https://doi.org/10.1001/archfaci.2010.16##Yun JH, Diaz R, Orman AG (2018) Breast reconstruction and radiation therapy. Cancer Control, 25: 10732748187995489.##Shumway DA, Momoh AO, Sabel MS, Jagsi R (2020) Integration of breast reconstruction and postmastectomy radiotherapy. J Clin Oncol, 38: 2329-2340.##Nahabedian MY (2011) Discussion: immediate free flap reconstruction of advanced-stage breast cancer: is it safe? Plast Reconstr Surg, 128: 42-43.##Roge M, Thureau S, Thariat J, Rivera S (2020) Postoperative radiotherapy after immediate breast reconstruction. Cancer Radiother, 24: 645-648.##Hsieh TY, Lin YN, Lin SD, Lai CS, Chang KP, Lee SS, Huang SH, Hou MF, Chen FM, O-U Yang F (2014) Immediate transverse rectus abdominis musculocutaneous flap reconstruction is associated with improved cancer-specific survival in locally advanced breast cancer. Ann Plast Surg, 73: 31-36.##Whelan TJ, Olivotto I, Ackerman I (2011) An intergroup trial of regional nodal irradiation in early breast cancer. Am Soc Clin Oncol, 20: 13-17.##Avino A, Raducu L, Brinduşe LA, Jecan CR, Lascar I (2020) Timing between breast reconstruction and oncologic mastectomy-one center experience. Medicina (Kaunas), 56: 86.##Meattini I, Becherini C, Bernini M, Bonzano E, Criscitiello C, de Rose F, de Santis MC, Fontana A, Franco P, Gentilini OD, Livi L, Meduri B, Parisi S, Pasinetti N, Prisco A, Rocco N (2021) Breast reconstruction and radiation therapy: an Italian expert Delphi consensus statements and critical review. Cancer Treat Rev, 99: 102236.##Anavekar NS, Rozen WM, le Roux CM, Ashton MW (2011) Achieving autologous breast reconstruction for breast cancer patients in the setting of post-mastectomy radiotherapy. J Cancer Surviv, 5: 1-7.##Froud PJ, Mates D, Jackson JS, Phillips N, Andersen S, Jackson SM, Bryce CJ, Olivotto IA (2000) Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence. Int J Radiat Oncol Biol Phys, 46: 363-372.##Recht A, Come SE, Gelman RS, Goldstein M, Tishler S, Gore SM, Abner AL, Vicini FA, Silver B, Connolly JL (1991) Integration of conservative surgery, radiotherapy and chemotherapy for the treatment of early stage, node-positive breast cancer: sequencing, timing and outcome. J Clin Oncol, 9: 1662-1667.## ##

Potential implications of the radiation-induced bystander effect for spatially fractionated radiotherapy: A theoretical simulation study 2 2 Background: It has been found that the bystander effect plays a key role in the survival of cells exposed to highly non-uniform radiation beams. However, the linear-quadratic (LQ) model cannot predict these effects well. The present study aimed to explore the potential impact of the radiation-induced signaling effects on treatment plans for spatially fractionated radiation therapy (SFRT) using a numerical radiobiological model. Materials and Methods: Two tomotherapy-based SFRT plans were created using commercially available software in this work. The tumor response to these plans was modeled by both the conventional LQ model and a bystander model incorporating the indirect effect of radiation. We have investigated how dose-volume histograms (DVHs), dose distribution, equivalent uniform dose (EUD), and mean dose change with radiation-induced signaling effects. Results: When the intercellular signaling effects are included in the predictive survival model, the cell-killing within the low-dose regions of GRID fields increases. This leads to an increase in the EUD and means dose. These effects are more striking for the LATTICE radiotherapy plan, which contains high dose gradients in three dimensions. Conclusion: Incorporating radiation-induced signals in tumor cells response to SFRT significantly deviates from the LQ model predictions. Therefore, it is recommended to use the radiobiological models which take both the signaling and radiation effects into account to predict survival in highly modulated radiation beams, especially in LATTICE radiotherapy. 657 664 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 F. Mahmoudi F. Mahmoudi Department of Medical Physics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran D. Shahbazi-Gahrouei D. Shahbazi-Gahrouei Department of Medical Physics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran shahbazi24@yahoo.com N. Chegeni N. Chegeni Department of Medical Physics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran M. Saeb M. Saeb Department of Medical Physics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran V. Sadeghi V. Sadeghi Department of Biomedical Engineering, Faculty of Advanced Medical Technology, Isfahan University of Medical Sciences, Isfahan, Iran S. Hemati S. Hemati Department of Radiation Oncology, Faculty of Medicine, Seyyed Al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran GRID therapy spatially fractionated radiotherapy (SFRT) tomotherapy bystander effect LATTICE radiotherapy. 1. Mahmoudi F, Shahbazi-Gahrouei D, Chegeni N (2021) The role of the spatially fractionated radiation therapy in the management of advanced bulky tumors. PJMPE, 27(2): 123-35.##Gholami S, Nedaie HA, Longo F, Ay MR, Wright S, Meigooni AS (2016) Is grid therapy useful for all tumors and every grid block design? J Appl Clin Med Phys, 17(2).##Gholami S, Nedaie HA, Longo F, Ay MR, Dini SA, Meigooni AS (2017) Grid block design based on monte carlo simulated dosimetry, the linear quadratic and Hug-Kellerer radiobiological models. Journal of Medical Physics, 42(4): 213.##Zhang H, Zhong H, Barth RF, Cao M, Das IJ (2014) Impact of dose size in single fraction spatially fractionated (grid) radiotherapy for melanoma. Medical physics, 41(2): 021727.##Meigooni AS, Dou K, Meigooni NJ, Gnaster M, Awan S, Dini S, et al. (2006) Dosimetric characteristics of a newly designed grid block for megavoltage photon radiation and its therapeutic advantage using a linear quadratic model. Medical physics, 33(9): 3165-73.##Sheikh K, McNutt T, Bell L, Moore J, Hrinivich W, Teslow T, et al. (2018) Comparison of Treatment Planning Approaches for Spatially Fractionated Irradiation of Deep Tumors. Int J Radiat Oncol Biol Phys, 102(3): e499.##Sathishkumar S, Dey S, Meigooni AS, Regine WF, Kudrimoti M, Ahmed MM, et al. (2002) The impact of TNF-α induction on therapeutic efficacy following high dose spatially fractionated (GRID) radiation. Technol Cancer Res Treat, 1(2): 141-7.##Kanagavelu S, Gupta S, Wu X, Philip S, Wattenberg MM, Hodge JW, et al. (2014) In vivo effects of lattice radiation therapy on local and distant lung cancer: potential role of immunomodulation. Radiat Res, 182(2): 149-62.##Asur RS, Sharma S, Chang C-W, Penagaricano J, Kommuru IM, Moros EG, et al. (2012) Spatially fractionated radiation induces cytotoxicity and changes in gene expression in bystander and radiation adjacent murine carcinoma cells. Radiat Res, 177(6): 751-65.##Asur R, Butterworth KT, Penagaricano JA, Prise KM, Griffin RJ (2015) High dose bystander effects in spatially fractionated radiation therapy. Cancer Lett, 356(1): 52-7.##Pakniyat F, Nedaie HA, Mozdarani H, Mahmoudzadeh A, Salimi M, Griffin RJ, et al. (2020) Enhanced response of radioresistant carcinoma cell line to heterogeneous dose distribution of grid; the role of high-dose bystander effect. Int J Radiat Biol, 96(12): 1585-96.##Pakniyat F, Gholami S, Nedaie H, Mozdarani H, Mahmoudzadeh A, Salimi M (2020) Demonstration of bystander response in high dose technique of grid using theoretical calculation by linear quadratic model along with experimental investigations. Int J Radiat Res, 18(3): 495-504.##Zwicker RD, Meigooni A, Mohiuddin M (2004) Therapeutic advantage of grid irradiation for large single fractions. IJROBP, 58(4): 1309-15.##Peng V, Suchowerska N, Rogers L, Claridge Mackonis E, Oakes S, McKenzie DR (2017) Grid therapy using high definition multileaf collimators: realizing benefits of the bystander effect. Acta Oncol, 56(8): 1048-59.##Peng V, Suchowerska N, Esteves ADS, Rogers L, Mackonis EC, Toohey J, et al. (2018) Models for the bystander effect in gradient radiation fields: Range and signalling type. Journal of Theoretical Biology, 455: 16-25.##Butterworth KT, McGarry CK, Trainor C, McMahon SJ, O'Sullivan JM, Schettino G, et al. (2012) Dose, dose-rate and field size effects on cell survival following exposure to non-uniform radiation fields. Phys Med Biol, 57(10): 3197.##Mahmoudi F, Chegeni N, Bagheri A, Asl JF, Batiar MT (2021) Impact of radiobiological models on the calculation of the therapeutic parameters of Grid therapy for breast cancer. Applied Radiation and Isotopes, 174: 109776.##Yan Y, Dou Y, Weng X, Wallin A (2010) SU‐GG‐T‐256: An Enhanced DICOM‐RT Viewer. Medical Physics, 37(6Part19): 3244.##Sheikh K, Hrinivich WT, Bell LA, Moore JA, Laub W, Viswanathan AN, et al. (2019) Comparison of treatment planning approaches for spatially fractionated irradiation of deep tumors. J Appl Clin Med Phys, 20(6): 125-33.##Zhang X, Penagaricano J, Yan Y, Liang X, Morrill S, Griffin RJ, et al. (2016) Spatially fractionated radiotherapy (GRID) using helical tomotherapy. J Appl Clin Med Phys, 17(1).##Zhang X, Penagaricano J, Yan Y, Sharma S, Griffin R, Hardee M, et al. (2014) Application of spatially fractionated radiation (GRID) to helical tomotherapy using a novel TOMOGRID template. Technol Cancer Res Treat: tcrtexpress. 2013.600261.##McMahon SJ, Butterworth KT, McGarry CK, Trainor C, O'Sullivan JM, Hounsell AR, et al. (2012) A computational model of cellular response to modulated radiation fields. IJROBP, 84(1): 250-6.##McMahon SJ, Butterworth KT, Trainor C, McGarry CK, O'Sullivan JM, Schettino G, et al. (2013) A kinetic-based model of radiation-induced intercellular signalling. PLoS One, 8(1): e54526.##McMahon SJ, McGarry CK, Butterworth KT, Jain S, O'Sullivan JM, Hounsell AR, et al. (2015) Cellular signalling effects in high precision radiotherapy. Physics in Medicine and Biology, 60(11): 4551.##Partridge M (2008) A radiation damage repair model for normal tissues. Phys Med Biol, 53(13): 3595.##Ebert MA, Suchowerska N, Jackson MA, McKenzie DR (2010) A mathematical framework for separating the direct and bystander components of cellular radiation response. Acta Oncol, 49(8): 1334-43.##Huhn JL, Regine WF, Valentino JP, Meigooni AS, Kudrimoti M, Mohiuddin M (2006) Spatially fractionated GRID radiation treatment of advanced neck disease associated with head and neck cancer. Technol Cancer Res Treat, 5(6): 607-12.##Peñagarícano JA, Moros EG, Ratanatharathorn V, Yan Y, Corry P (2010) Evaluation of spatially fractionated radiotherapy (GRID) and definitive chemoradiotherapy with curative intent for locally advanced squamous cell carcinoma of the head and neck: initial response rates and toxicity. IJROBP, 76(5): 1369-75.##Butterworth KT, McGarry CK, Trainor C, O'Sullivan JM, Hounsell AR, Prise KM (2011) Out-of-field cell survival following exposure to intensity-modulated radiation fields. IJROBP, 79(5): 1516-22.##Butterworth KT, Ghita M, McMahon SJ, Mcgarry CK, Griffin RJ, Hounsell AR, et al. (2017) Modelling responses to spatially fractionated radiation fields using preclinical image-guided radiotherapy. Brit J Radiol, 90(1069): 20160485.## ##

Optimizing the neural network training algorithm in predicting kerma in mammography 2 2 Background: In regard to the enhanced use of mammography screening tests for screening breast cancer, some concerns on the enhancement of the patient's absorbed dose have increased as well. Therefore, the assessment of the patient's dose before mammography is very important, and being aware of the dose level by its estimation can be helpful before radiation. Materials and Methods: To this end, an artificial neural network (ANN) was used in this study to estimate the entrance surface air kerma (ESAK). A phantom with similar characteristics of the breast tissue was also used to collect the required data and the network was trained using some measurable parameters. To conduct the current research, multilayer perceptron (MLP) neural network architecture with training algorithms of LMBP, SCGBP, Rprop, BFGS, and GDBP, as well as radial basis function (RBF) neural network were used. Results: The results show that the neural network with BFGS training algorithm and 38 hidden layer neurons has the best performance with 7.40% root mean square error (RMSE) and coefficient of determination (R2) was obtained as 0.91. Conclusion: According to the results of this study, there is a good correlation between the estimated network output and the measured values of the ESAK. The present method will remove the limitations and costs associated with the preparation process of dosimeter instruments. 665 670 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 M. Nabipour M. Nabipour Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran M.R. Deevband M.R. Deevband Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran mdeevband@sbmu.ac.ir A. Asgharzadeh Alvar A. Asgharzadeh Alvar Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran N. Soleimani N. Soleimani School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran Breast mammography screening entrance surface air kerma estimation MLP neural network RBF neural network. 1. Howlader N, Noone AM, Krapcho M (2021) SEER Cancer Statistics Review. National Cancer Institute, posted to the SEER website. Cited 2021 Apr 19. Available from: https://seer.cancer.gov/csr.##gco.iarc.fr [internet]. International Agency for Research on Cancer. Posted to The Global Cancer Observatory Website. 2020 [cited 2021 March 11]. Available from: https://gco.iarc.fr/today/home##Iranmakani S, Mortezazadeh T, Sajadian F, Ghaziani MF, Ghafari A, Khezerloo D, et al. (2020) A review of various modalities in breast imaging: technical aspects and clinical outcomes. Egypt J Radiol Nucl Med, 51: 57.##Dance DR, Skinner CL, Carlsson GA (1999) Breast dosimetry. Appl Radiat Isot, 50(1): 185-203.##Osteras BH, Skaane P, Gullien R, Martinsen ACT (2018) Average glandular dose in paired digital mammography and digital breast tomosynthesis acquisitions in a population based screening program: Effects of measuring breast density, air kerma and beam quality. Phys Med Biol, 63(3): 035006.##Yaffe MJ and Mainprize JG (2010) Risk of radiation-induced breast cancer from mammographic screening. Radiology, 258(1): 98-105.##Nosratieh A, Hernandez A, Shen SZ, Yaffe MJ, Seibert JA, Boone JM (2015) Mean glandular dose coefficients (DgN) for x-ray spectra used in contemporary breast imaging systems. Phys Med Biol, 60(18): 7179-90.##Delis H, Spyrou G, Panayiotakis G, Tzanakos G (2005) a Monte Carlo simulation program for dose related studies in mammography. Eur J Radiol, 54(3): 371-6.##Nigapruke K, Puwanich P, Phaisangittisakul N, Youngdee W (2010) Monte Carlo simulation of average glandular dose and an investigation of influencing factors. J Radiat Res, 51(4): 441-8.##Kave Z, Deevband MR, Ghorbanee M (2018) Effect of heterogeneous breast tissue on average glandular dose in mammography using simulation. Q J Sch Med Shahid Beheshti Univ Med Sci, 42(1): 34-9.##Suleiman ME, Brennan PC, McEntee MF (2017) Mean glandular dose in digital mammography: a dose calculation method comparison. J Med Imaging (Bellingham), 4(1): 013502.##Boone JM (1999) Glandular breast dose for monoenergetic and high-energy X-ray beams. Radiology, 213: 23-37.##Stanton L, Villafana T, Day JL, Lightfoot DA (1984) Dosage evaluation in mammography. Radiology, 150(2): 577-84.##Alvar AA, Deevband MR, Ashtiyani M (2017) Neutron spectrum unfolding using radial basis function neural networks. Appl Radiat Isot, 129: 35-41.##Massera RT and Tomal A (2021) Breast glandularity and mean glandular dose assessment using a deep learning framework: Virtual patients study. Phys Medica, 83: 264-77.##Dance DR, Skinner CL, Young KC, Beckett JR, Kotre CJ (2000) Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol. Phys Med Biol, 45(11): 3225-40.##Hagan MT, Demuth HB, Beale MH, De Jesús O (2014) Neural Network Design; 2nd Edition, eBook, Frisco, Texas.##Yee PV and Haykin SS (2001) Regularized radial basis function networks: theory and applications. John Wiley.##Haykin S (1999) Neural networks: a comprehensive foundation second edition. Pearson Education.##Hartman EJ, Keeler JD, Kowalski JM (1990) Layered neural networks with Gaussian hidden units as universal approximations. Neural Comput MIT Press, 2(2): 210-5.##Buhmann MD (2003) Radial basis functions theory and implementations. Cambridge University Press.##Bayram S, Ocal Me, Laptali Oral E, Atis Cd (2016) Comparison of multi-layer perceptron (MLP) and radial basis function (RBF) for construction cost estimation: The case of Turkey. J Civ Eng Manag. Taylor & Francis, 22(4): 480-490.##Avriel M (2003) Nonlinear programming: analysis and methods. Dover Publications.##Mohammadi A, Faghihi R, Mehdizadeh S, Hadad K (2005) Total absorbed dose of critical organs in mammography, assessment and comparison of Monte-Carlo method and TLD. Biomed Tech, 50(1): 393-4.##Čceke D, Kunosic S, Kopric M, Lincender L (2009) Using neural network algorithms in prediction of mean glandular dose based on the measurable parameters in mammography. Acta Inform Medic, 17(4): 194-7.## ##

Evaluation of activity concentration of natural radionuclides and lifetime cancer risk in soil samples at two tertiary institutions in Owerri, Imo State, Nigeria 2 2 Background: Environmental radioactivity measurement of soil samples from the densely populated community has become imperative considering the radiological exposure associated with primordial radionuclides. Materials and Method: Sixty soil samples were collected at different locations within Alvan Ikoku Federal College of Education (AIFCE) and Federal Polytechnic Nekede (FPN), Owerri. Radioactivity measurements were carried out by the method of gamma-ray spectrometry with thallium doped sodium iodide [NaI(Tl)] detector. Results: The mean activity concentrations of 88.41±1.51, 20.69±3.56 and 25.04±0.71 Bqkg-1 for 40K, 226Ra and 232Th, respectively, were obtained in soil samples of AIFCE, while 92.97±1.50, 20.48±3.21 and 22.36±0.70 Bqkg-1 for 40K, 226Ra and 232Th, respectively, were obtained in soil samples of FPN. These values are below the average world value of 420, 32 and 45 Bqkg-1 for 40K, 226Ra and 232Th, respectively, as recorded in UNSCEAR 2000 report. The calculated absorbed dose, annual effective dose and other radiological hazard indices were below the recommended safe limit. The mean calculated values of the excess lifetime cancer risk for AIFCE and FPN are 0.12±0.03 and 0.11±0.03, respectively. Conclusion: Based on the results from the present study, it is evidence that the activity concentrations and other radiological parameters are within the world’s safe limit, indicating that soil samples from the AIFCE and FPN, Owerri are free from radioactive contamination and do not pose a threat to the two communities. 671 678 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 B.C. Eke B.C. Eke Department of Physics, School of Physical Sciences, Federal University of Technology, Owerri, Nigeria U.M. Ukewuihe U.M. Ukewuihe Department of Physics, School of Physical Sciences, Federal University of Technology, Owerri, Nigeria I.R. Akomolafe I.R. Akomolafe Department of Physical Sciences, Faculty of Natural Science, Redeemer's University, Ede, Nigeria idowurakomolafe@gmail.com Radiological risks natural radioactivity soil samples Nigeria. UNSCEAR (2000) United Nations Scientific Committee on the effect of Atomic Radiation: Exposures from natural radiation sources. Report to General Assembly, with Scientific Annexes. United Nations, New York##Ramasamy V, Suresh G, Meenakshisundaram V, Gajendran V (2009) Evaluation of natural radionuclide content in river sediments and excess lifetime cancer risk due to gamma radioactivity. Res J Environ Earth Sci, 1: 6-10.##Taskin, H, Karavus M, Ay P, Topuzoglu A, Hindiroglu S, Karahan G (2009) Radionuclide concentrations in soil and lifetime cancer risk due to the gamma radioactivity in Kirklareli, Turkey. J Environmental Radioactivity, 100: 49-53.##Emelue HU, Jibiri NN, Eke BC (2014) Excess Lifetime Cancer Risk due to Gamma Radiation in and Around Warri Refining and Petrochemical Company in Niger Delta, Nigeria. British Journal of Medicine & Medical Research, 4(13): 2590-2598.##Brenner JD and Sachs RK (2006) Estimating radiation-induced cancer risk at very low doses: rationale for using a linear no-threshold approach. Radiation Environ Biology, 44: 253-256.##Ibrahim FA and Mohammad IA (2009) Soil radioactivity levels and radiation hazard assessment in the highlands of Northern Jordan. Radiation Measurements, 44: 102-110.##Mehta R, Badhan K, Sonkawade RG, kansal S, Singh S (2010) Analysis of terrestrial natural radionuclides in soil samples and assessment of average effective dose. Indian Journal of Pure and Applied Physics, 48: 805-808.##Eke BC, Jibiri NN, Anusionwu BC, Orji CE, Emelue HU (2015) Baseline Measurements of natural radioactivity in soil samples from the Federal University of Technology, Owerri, South-East, Nigeria. British J Applied Sciences & Technology, 5(2): 142 -149.##Obed RI, Farai IP, Jibiri NN (2005) Population dose distribution due to soil radioactivity concentration levels in 18 cities across. Nigeria J Radiol Prot, 25: 305-312.##Jibiri NN and Akomolafe IR (2016). Radiological assessment and geochemical characterization of the sediments of Awba Dam, University of Ibadan, Nigeria. Radiat Prot Environ, 39: 222-32.##Jibiri NN and Emelue HU (2008) Soil radionuclide concentrations and radiological assessment in and around a refining and petrochemical company in Warri, Niger Delta, Nigeria. Journal of Radiological Protection, 28: 361-368.##Beretka J and Matthew PJ (1985) Natural radioactivity of Australian building materials, industrial waste, and by-products. Health Physics, 48: 87-95.##Farai IP, Obed RI, Jibiri NN (2006) Soil radioactivity and incidence of cancer in Nigeria. Journal of Environmental Radioactivity, 90: 29-36.##Jibiri NN and Okeyode I (2011) Activity concentrations of natural radionuclides in the sediments of Ogun River, Southwestern Nigeria. Radiation Protection Dosimetry, 147(4): 555-64.##Nwankwo CU, Ogundare FO, Folley DE (2015) Radioactivity concentration variation with depth and assessment of worker's doses in selected mining sites. J Radiat Res Appl Sci, 8: 216-220.##UNSCEAR (1988) United Nations Scientific Committee on the Effect of Atomic Radiation Sources, effects and risks of ionizing radiation report to the general assembly with annexes. United States publication E88ix 17 (United Nations) New York.##Ridha AA and Hasan HA (2016) Cancer Risk Due to the Natural Radioactivity in Cigarette Tobacco. Detection, 4: 54-65. http://dx.doi.org/10.4236/detection.2016.43008.##International Commission on Radiological Protection, ICRP (1991). Series Report of the 1990 recommendations of the ICRP, Publication No. 60. Ann. ICRP, 21: 1-3.##Kolo MT, Amin YM, Khandaker MU, Abdullah WHB (2017) Radionuclide concentrations and excess lifetime cancer risk due to gamma radioactivity in tailing enriched soil around Maiganga coalmine, Northeast Nigeria. Int J Radiat Res, 15 (1): 71-80.##Egunyinka OA, Olowookere CJ, Jibiri NN, Babalola IA, Obed RI (2009) An evaluation of 238U, 40K, and 232Th concentrations in the top soil of the university of Ibadan (UI), Southwestern Nigeria. The Pacific Journal of Science and Technology, 10: 742-752.##Suresh GM, Ravisankar R, Rajalakshmi A, Sivakumar S, Chandrasekaran A, Anand DP (2014) Measurements of natural gamma radiation in beach sediments of north east coast of Tamilnadu, India by gamma-ray spectrometry with multivariate statistical approach. J Radiat Res Appl Sci, 7(1): 7-17.##Ugbede FO, Okoye ONN, Akpolile AF, Oladele BB (2021) Baseline Radioactivity in the Soil of Evangel Take-Off Campus, Evangel University, Nigeria, and its Associated Health Risks. Chemistry Africa, 4: 703-713.##Arafa W (2004) Specific activity and hazards of granite samples collected from the Eastern Desert of Egypt. J Environ Radioact, 75(3): 315-327.##Avwiri GO and Ononugbo CP (2012) Natural radioactivity levels in surface soil of Ogba/Egbema/Ndoni oil and gas fields. Energy Sci Technol, 4(2): 92-101.##Gbadamosi MR, Banjoko OO, Abudu KA, Ogunbanjo OO, Ogunneye AL (2017) Radiometric evaluation of excessive lifetime cancer probability due to naturally occurring radionuclides in wastes dumpsites soils in Agbara, Southwest, Nigeria. J Assoc Arab Uni Basic Appl Sci, 24: 315-324.##Ali MMM, Zhao H, Rawashdeh A, Mohammed YA, Al Hassan M (2021) Assessment of radiation hazard indices for sand samples from Ma'rib in Yemen. Int J Radiat Res, 19(3): 615-623.##Aladeniyi K, Olowookere C, Oladele BB (2019) Measurement of natural radioactivity and radiological hazard evaluation in the soil samples collected from Owo, Ondo State, Nigeria. J Radiat Res Appl Sci, 12(1): 200-209.##Olagbaju PO, Okeyode IC, Alatise OO, Bada BS (2021) Background radiation level measurement using hand-held dosimeter and gamma spectrometry in Ijebu-Ife, Ogun State Nigeria. Int J Radiat Res, 19(3): 591-598.##Akpan AE, Paul ND, Uwah EJ (2016) Ground radiometric investigation of natural radiation levels and their radiological effects in Akpabuyo, Nigeria. J Afr Earth Sci, 123: 185-192.##Zhou Z, Yang Z, Sun Z, Liao Q, Guo Y, Chen J (2020) Multidimensional pollution and potential ecological and health risk assessments of radionuclides and metals in the surface soils of a uranium mine in East China. J Soils Sediments, 20: 775-791.##Sivakumar R (2014) An assessment of natural radioactivity levels and radiation hazards in the soil of Coonoor, South India. Environ Earth Sci, 72: 5063-5071.##Ebaid YY, El-Tahawy MS, El-Lakany AA, Garcia SR, Brooks GH (2000) Environmental radioactivity measurements of Egyptian soils. J Radioanal Nucl Chem, 243(2): 543-550.##Mohammed NK and Mazunga MS (2013) Natural radioactivity in soil and water from Likuyu village in the neighborhood of Mkuju uranium deposit. Int J Analyt Chem, 2013: 501856.##Taqi AH, Shaker AM, Battawy AA (2018) Natural radioactivity assessment in soil samples from Kirkuk city of Iraq using HPGe detector. Int J Radiat Res, 16(4): 455-463.## ##

Correlation in high resolution computed tomography signs with pathological subtype and differentiation degree of lung adenocarcinoma 2 2 Background: To study the relationship between high-resolution computed tomography (HRCT) signs and the pathological subtypes and differentiation degree of lung adenocarcinoma. Materials and Methods: We retrospectively reviewed HRCT images of 394 lung adenocarcinoma cases and compared the diversity of images among preinvasive lesions (PILs), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) and the differentiation degrees of IAC by Kruskal-Wallis and χ2 tests. Results: There were significant differences in the size, density and incidences of the pleura traction sign, spicule sign, lobulation sign, tumor vascular sign, bronchial cutoff sign, air bronchogram sign and cavity sign of PILs, MIA and IAC (χ2=2.172~247.077, P<0.05). The incidences of all these signs (except for the cavity sign) in IAC were higher than those in the other two groups (P<0.05). There were no significant differences in margin irregularity or vacuole signs among PILs, MIA and IAC (P>0.05). There were significant differences in the size, density, and incidences of margin irregularity, the pleura traction sign, the spicule sign, the lobulation sign, the tumor vascular sign, the bronchial cutoff sign and the cavity sign in the three differentiated subgroups (χ2=6.818~63.331, P<0.05).  No significant differences were found in the air bronchogram sign and vacuole sign among the three differentiated subgroups (P>0.05). Conclusions: HRCT signs of lung adenocarcinoma are closely related to the pathological subtype and differentiation degree and have great value in helping predict tumor types and devise clinical treatment plans. 679 685 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 L. Duan L. Duan Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, China W. Shan W. Shan Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, China L. Guo L. Guo Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, China guolili163@163.com G. Bo G. Bo Department of Medical Imaging, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, 223300, China Lung adenocarcinoma computed tomography sign pathology differentiation. Boyle P and Levin B (2008) World cancer report 2008[M]. IARC Press, International agency for research on cancer, 2008.##Torre LA, Bray F, Siegel RL, et al. (2015) Global cancer statistics 2012. CA Cancer J Clin, 65(2): 87-108.##Blom JW, Osanto S, Rosendaal FR (2004) The risk of a venous thrombotic event in lung cancer patients: higher risk for adenocarcinoma than squamous cell carcinoma. J Thromb Haemost, 2(10): 1760-5.##Coroller TP, Grossmann P, Hou Y, et al. (2015) CT-based radiomic signature predicts distant metastasis in lung adenocarcinoma. Radiother Oncol, 114(3): 345-50.##Travis WD, Brambilla E, Noguchi M, et al. (2011) International association for the study of lung cancer/American thoracic society/European respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary. Journal of Thoracic Oncology, 6(2): 244-85.##Fujimoto Y, Togo S, Tulafu M, et al. (2015) Variation in the expression levels of predictive chemotherapy biomarkers in histological subtypes of lung adenocarcinoma: an immunohistochemical study of tissue samples. Int J Clin Exp Pathol, 8(9): 10523-33.##Shimamura Y, Sasaki S, Shimohira M, et al. (2018) New technique of percutaneous CT fluoroscopy-guided marking before video-assisted thoracoscopic surgery for small lung lesions: feasibility of using a 25-gauge needle without local anaesthesia. The British Journal of Radiology, 91: 20170692.##Gu J, Lu C, Guo J, et al. (2013) Prognostic significance of the IASLC/ATS/ERS classification in Chinese patients-a single institution retrospective study of 292 lung adenocarcinoma. J Surg Oncol, 107(5): 474-80.##Chen L, Yang S, Wang HJ, et al. (2018) A competing round-robin prediction model for histologic subtype prediction of lung adenocarcinomas based on thoracic computed tomography. Int Soci for Optics and Photonics, 10578: 105782M.##Cohen J G, Reymond E, Medici M, et al. (2018) CT-texture analysis of subsolid nodules for differentiating invasive from in-situ and minimally invasive lung adenocarcinoma subtypes. Diagn Interv Imaging, 99(5): 291-9.##Ko JP, James S, Opeyemi I, et al. (2016) Lung adenocarcinoma: Correlation of quantitative CT findings with pathologic findings. Radiology, 280(3): 931-9.##Eriguchi D, Shimada Y, Imai K, et al. (2018) Predictive accuracy of lepidic growth subtypes in early-stage adenocarcinoma of the lung by quantitative CT histogram and FDG-PET. Lung Cancer, 125: 14-21.##Linning E, Lin L, Li L, et al. (2019) Radiomics for classification of lung cancer histological subtypes based on nonenhanced computed tomography. Acad Radiol, 26(9): 1245-52.##Xiaoli XU, Sui X, Zhong W, et al. (2018) Diagnostic value of quantitative dual-source CT dual-energy iodine maps combined with morphological CT features in assessing histological subtypes of lung cancer. Chinese Journal of Radiology, 52(11): 823-8.##Winer-Muram HT (2006) The solitary pulmonary nodule. Radiology, 239(1): 34-49.##Jeong YJ, Yi CA, Lee KS (2008) Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol, 188(1): 183-95.##Moon Y, Sung SW, Lee KY, et al. (2016) Pure ground-glass opacity on chest computed tomography: predictive factors for invasive adenocarcinoma. Journal of Thoracic Disease, 8(7): 1561.##Heidinger BH, Anderson KR, Nemec U, et al. (2017) Lung adenocarcinoma manifesting as pure ground-glass nodules: correlating CT size, volume, density, and roundness with histopathologic invasion and size. Journal of Thoracic Oncology, 12(8): 1288-98.##Eguchi T, Yoshizawa A, Kawakami S, et al. (2014) Tumor size and computed tomography attenuation of pulmonary pure ground-glass nodules are useful for predicting pathological invasiveness. PLoS, 9(5).##Henschke CI, Yankelevitz DF, Naidich DP, et al. (2004) CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans. Radiology, 231(1): 164-8.##Cho J, Ko SJ, Kim SJ, et al. (2014) Surgical resection of nodular ground-glass opacities without percutaneous needle aspiration or biopsy. BMC Cancer, 14(1): 838.##Oda S, Awai K, Liu D, et al. (2008) Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. American J Roentgenology, 190(5): 1363-8.##Gao F, Li M, Ge X, et al. (2013) Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels. European Radiology, 23(12): 3271-7.##She Y, Zhao L, Dai C, et al. (2017) Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study. Oncotarget, 8(10): 17229.##Yoshino I, Nakanishi R, Kodate M, et al. (2000) Pleural retraction and intra-tumoral air-bronchogram as prognostic factors for stage I pulmonary adenocarcinoma following complete resection. International Surgery, 85(2): 105-12.##Meng Y, Liu CL, Cai Q, et al. (2019) Contrast analysis of the relationship between the HRCT sign and new pathologic classification in small ground glass nodule-like lung adenocarcinoma. Radiol Med, 124(1): 8-13.##Zhang Y, Shen Y, Qiang JW, et al. (2016) HRCT features distinguishing pre-invasive from invasive pulmonary adenocarcinomas appearing as ground-glass nodules. Eur Radiol, 26(9): 2921-8.##Wang X, Duan H, Li X, et al. (2020) A prognostic analysis method for non-small cell lung cancer based on the computed tomography radiomics. Phys Med Biol, 65(4): 045006.##Wang X, Lv L, Zheng Q, et al. (2018) Differential diagnostic value of 64-slice spiral computed tomography in solitary pulmonary nodule. Exp Ther Med, 15(6): 4703-8.##Wahidi MM, Govert JA, Goudar RK, et al. (2007) Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 132(3): 94S-107S.##Lee SM, Park CM, Goo JM, et al. (2013) Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology, 268(1): 265-73.##Xiang W, Xing Y, Jiang S, et al. (2014) Morphological factors differentiating between early lung adenocarcinomas appearing as pure ground-glass nodules measuring≤ 10 mm on thin-section computed tomography. Cancer Imaging, 14(1): 33.##Si MJ, Tao XF, Du GY, et al. (2016) Thin-section computed tomography-histopathologic comparisons of pulmonary focal interstitial fibrosis, atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma with pure ground-glass opacity. European Journal of Radiology, 85(10): 1708-15.##Zheng B, Zhou X, Chen J, et al. (2015) A modified model for preoperatively predicting malignancy of solitary pulmonary nodules: an Asia cohort study. Ann Thorac Surg, 100(1): 288-94.##Yang ZG, Sone S, Takashima S, et al. (2001) High-resolution CT analysis of small peripheral lung adenocarcinomas revealed on screening helical CT. AJR Am J Roentgenol, 176(6): 1399-407.##Liang J, Xu XQ, Xu H, et al. (2015) Using the CT features to differentiate invasive pulmonary adenocarcinoma from pre-invasive lesion appearing as pure or mixed ground-glass nodules. Br J Radiol, 88(1053): 20140811.##Liu LH, Liu M, Wei R, et al. (2015) CT findings of persistent pure ground glass opacity: can we predict the invasiveness. Asian Pac J Cancer Prev, 16(5): 1925-8.## ##

Safety of daily fractionated thoracic radiosurgery 2 2 Background: The optimal inter-fraction interval in fractionated thoracic radiosurgery remains unclear. Several institutions maintain at least a 48-hour interval between each radiosurgery fraction. However, evidence supporting such radiosurgery schedule is lacking. Since 2014, we have performed daily fractionated thoracic radiosurgery without interruption. In this study, we evaluated the safety of daily administration of fractionated thoracic radiosurgery in patients with primary or metastatic lung cancer. Materials and methods: Patients who received radical or salvage fractionated radiosurgery for treatment of primary or metastatic lung cancer were included in this study. All patients received fractionated radiosurgery divided into 2-4 fractions administered daily without interruption. Radiosurgery-induced toxicities were evaluated. Results: Eighty-eight patients and 94 lung masses were treated. Radiosurgery-induced leukopenia and grade 5 toxicity did not occur. One patient experienced radiosurgery-induced grade 4 pneumonitis and dyspnea. Grade 3 pneumonitis, dyspnea, and fatigue developed in 23 (24.5%), 2 (2.1%), and 2 (2.1%) patients, respectively. Four (4.3%) patients experienced rib fracture. Dyspnea, fatigue, nausea, and pneumonitis were more common and severe in patients with central lung lesions. In contrast, dermatitis and rib fracture developed only in patients with peripheral lung lesions. Conclusions: Daily fractionated radiosurgery is safe and well-tolerated in patients with primary or metastatic lung cancer. For patient convenience and better treatment outcomes, daily-fractionated thoracic radiosurgery can be considered. 687 692 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/10 1401/5/19 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 M. Kong M. Kong Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea kongmoonkyoo@khu.ac.kr Y.J. Lim Y.J. Lim Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea Dose fractionation lung neoplasm radiosurgery safety toxicity. 1. Blomgren H, Lax I, Naslund I, Svanstrom R (1995) Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol, 34(6): 861-70.##Uematsu M, Shioda A, Tahara K, Fukui T, Yamamoto F, Tsumatori G, et al. (1998) Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: a preliminary experience. Cancer, 82(6): 1062-70.##https://doi.org/10.1002/(SICI)1097-0142(19980315)82:63.0.CO;2-G##Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA, 303(11): 1070-6.##Taremi M, Hope A, Dahele M, Pearson S, Fung S, Purdie T, et al. (2012) Stereotactic body radiotherapy for medically inoperable lung cancer: prospective, single-center study of 108 consecutive patients. Int J Radiat Oncol Biol Phys, 82(2): 967-73.##Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, et al. (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol, 16(6): 630-7.##Videtic GM, Reddy CA, Sorenson L (2013) A prospective study of quality of life including fatigue and pulmonary function after stereotactic body radiotherapy for medically inoperable early-stage lung cancer. Support Care Cancer, 21(1): 211-8.##Fakiris AJ, McGarry RC, Yiannoutsos CT, Papiez L, Williams M, Henderson MA, et al. (2009) Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys, 75(3): 677-82.##Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G, Lax I, et al. (2009) Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol, 27(20): 3290-6.##Videtic GM, Stephans K, Reddy C, Gajdos S, Kolar M, Clouser E, et al. (2010) Intensity-modulated radiotherapy-based stereotactic body radiotherapy for medically inoperable early-stage lung cancer: excellent local control. Int J Radiat Oncol Biol Phys, 77(2): 344-9.##Kong M, Sung JY, Lee SH (2020) Reactive oxygen species modulator 1 is Associated with Poor Survival in Patients with Non-Small Cell Lung Cancer After Stereotactic Fractionated Radiosurgery: A Retrospective Pilot Study. Onco Targets Ther, 13: 8173-80.##Kim MS, Kim W, Park IH, Kim HJ, Lee E, Jung JH, et al. (2015) Radiobiological mechanisms of stereotactic body radiation therapy and stereotactic radiation surgery. Radiat Oncol J, 33(4): 265-75.##https://doi.org/10.1016/j.ijrobp.2015.07.1217##Qiu B, Aili A, Xue L, Jiang P, Wang J (2020) Advances in radiobiology of stereotactic ablative radiotherapy. Front Oncol, 10: 1165.##Brown JM, Carlson DJ, Brenner DJ (2014) The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys, 88(2): 254-62.##Fowler JF, Welsh JS, Howard SP (2004) Loss of biological effect in prolonged fraction delivery. Int J Radiat Oncol Biol Phys, 59(1): 242-9.##Song CW, Griffin RJ, Lee YJ, Cho H, Seo J, Park I, et al. (2019) Reoxygenation and Repopulation of Tumor Cells after Ablative Hypofractionated Radiotherapy (SBRT and SRS) in Murine Tumors. Radiat Res, 192(2): 159-68.##Steel GG, McMillan TJ, Peacock JH (1989) The 5Rs of radiobiology. Int J Radiat Biol, 56(6): 1045-8.##Goldstein M and Kastan MB (2015) The DNA damage response: implications for tumor responses to radiation and chemotherapy. Annu Rev Med, 66: 129-43.##Hall EJ and Brenner DJ (1993) The radiobiology of radiosurgery: rationale for different treatment regimes for AVMs and malignancies. Int J Radiat Oncol Biol Phys, 25(2): 381-5.##Uematsu M, Shioda A, Suda A, Fukui T, Ozeki Y, Hama Y, et al. (2001) Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. Int J Radiat Oncol Biol Phys, 51(3): 666-70.##Xia T, Li H, Sun Q, Wang Y, Fan N, Yu Y, et al. (2006) Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable Stage I/II non-small-cell lung cancer. Int J Radiat Oncol Biol Phys, 66(1): 117-25.##Potters L, Kavanagh B, Galvin JM, Hevezi JM, Janjan NA, Larson DA, et al. (2010) American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys, 76(2): 326-32.##Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. (2006) Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol, 24(30): 4833-9.##Abel S, Hasan S, Horne ZD, Colonias A, Wegner RE (2019) Stereotactic body radiation therapy in early-stage NSCLC: historical review, contemporary evidence and future implications. Lung Cancer Manag, 8(1): LMT09.##Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, et al. (2015) LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective. Br J Radiol, 88(1051): 20150036.## ##

Dosimetric beam matching analysis of MV photons and electrons therapy 2 2 Background: For various practical reasons in radiotherapy practice, it is very advantageous to have linear accelerators dosimetrically matched. The present work assesses the extent of beam matching by investigating the similarity of dosimetric data from three Clinac-iX accelerators in photons (6, 18 MV) and electrons (6, 9, 12, 16 and 20 MeV) mode. Materials and Methods: The following study is based on detailed comparisons of measured and determined parameters such as percent depth doses (PDDs), cross-plane beam profiles, flatness, symmetry, penumbra and dosimetric leaf gap, MLCT interleaf transmission factor, quality index, Relative output factor, in addition of depth R50, therapeutic range R90 and particle range Rp of electron beam. Results: The current measured data, for both photons and electrons, exhibited satisfactory degree of agreement among the three Clinac-iX. For 6 MV and 18 MV photons energies the maximum deviation of percentage depth does not exceed 0.4 %. For electron depth dose measurements (dmax, R50, R90, Rp) the results revealed a maximum deviation of 0.54 mm for all electron energies and applicators. As a direct clinical application, a left breast and prostate cancer cases were planned on the three Clinac-iX machines and compared for their dose volume histograms. Conclusion: In clinical applications, the patient’s treatment can be shifted from one Clinac-iX to another without reducing the treatment quality in the case of periodic preventive maintenance or interruption of the functioning of the Clinacs; the treatment can be preserved without having to replan. 693 700 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/14 1401/5/23 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 S. Khoudri S. Khoudri Physics Department, Faculty of Sciences, Laboratory of Optoelectronic and Devices, University Ferhat Abbas Sétif 1, Algeria saad.khoudri@univ-setif.dz Z. Chaoui Z. Chaoui Physics Department, Faculty of Sciences, Laboratory of Optoelectronic and Devices, University Ferhat Abbas Sétif 1, Algeria Breast Beam-matching Clinac-iX Medical Linear Accelerator photon beam data electron beam data dosimetric leaf gap MLC. Hrbacek J, Depuydt T, Nulens A, Swinnen A, Van den Heuvel F (2007) Quantitative evaluation of a beam-matching procedure using one-dimensional gamma analysis. Medical Physics, 34(7): 2917-2927.##Sarkar B, Manikandan A, Nandy M, et al. (2013) A mathematical approach to beam matching. British J Radiology, 86 (1031): 20130238.##Sjöström D, Bjelkengren U, Ottosson W, Behrens C F (2009) A beam-matching concept for medical linear accelerators. Acta Oncologica (Stockholm, Sweden), 48(2): 192-200.##Bhangle J R, Narayanan V K, Kumer N K, Vaitheeswaran R (2011) Dosimetric analysis of beam-matching procedure of two similar accelerators. J Medical Physics, 36: 176-180.##Attalla EM, Abou-Elenein HS, Ammar H, Eldoseky I (2014) Dosimetric evaluation of a beam matching procedure. Chinese-German J Clinical Oncology, 13(2): 89-93.##Seonghee K, Chung JB, Eom KY, Song C, Kim IA, Kim JS (2019) Possibility of interchanging patients for beam matched linear accelerators from the same vendor. Journal of the Korean Physical Society, 75(8): 628-635.##Krishnappan C, Radha CA, Balaji K, et al. (2018) Evaluation of beam matching accuracy among six linacs from the same vendor. Radiological Physics and Technology, 11(4): 423-433.##Chetty IJ, Curran B, Cygler JE, et al. (2007) Report of the AAPM TG No.105: Issues associated with clinical implementation of Monte Carlo-based photon and electron external beam treatment planning. Medical Physics, 34: 4818-53.##Cao X, Liu M, Zhai F, Li N, Bao C, Liu Y, Chen G (2021) The effects of set-up errors on dose distribution in radiotherapy treatment for lung cancer. Int J Radiat Res, 19(3): 515-520.##Mijnheer B, Olszewska A, Fiorino C, et al. (2004) Quality assurance of treatment planning systems. Practical examples for non-IMRT photon beams. ESTRO, Booklet 7.##Venselaar J, Welleweerd H, Mijnheer B (2001) Tolerances for the accuracy of photon beam dose calculations of treatment planning systems. Radiotherapy and Oncology, 60: 191-201.##Ahnesjô A and Aspradakis M (1999) Dose calculations for external photon beams in radiotherapy. Physics in Medecine and Biology 44: 99- 155.##Wambersie A (2001) What accuracy is required and can be achieved in radiation therapy (Review of Radiobiological and Clinical Data). Radiochimica Acta, 89: 255-64.##Mijnheer BJ, Battermann JJ, Wambersie A (1987) What degree of accuracy is required and can be achieved in photon and neutron therapy? Radiotherapy and Oncology, 8: 237-52.##ICRU Report 24 (1976) Determination of absorbed dose in a patient irradiated by beams of X- or gamma rays in radiotherapy procedures. International Commission on Radiation Units and Measurements. Washington, D.C, USA;##Goitein M (1983) Nonstandard deviations. Medical Physics, 10: 709-11.##Goitein M (1985) Calculation of the uncertainty in the dose delivered during radiation therapy. Medical Physics, 12: 608-12.##Watts RJ (1999) Comparative measurements on a series of accelerators by the same vendor. Medical Physics, 26: 2581-5.##Eclipse Algorithm Reference guide version 11.0.31 (2009) iso 13485(P/N B502612R03A) Varian Medical System UKLtd.##Das I J, Cheng C-W, Watts R J et al (2008) Accelerator beam data commissioning equipment and procedures: Report of the TG-106 of the Therapy Physics Committee of the AAPM. Medical Physics, 35(9): 4186.##Alagar AG, Mani GK, Karunakaran K (2016) Percentage depth dose calculation accuracy of model-based algorithms in high energy photon small fields through heterogeneous media and##comparison with plastic scintillator dosimetry. Journal of Applied Clinical Medical Physics, 17: 132‑ 42.##Das IJ, Francescon P, Moran JM, et al. (2021) Megavoltage photon beam dosimetry in small fields and non‑equilibrium conditions. AAPM Task Group Report 155.##Laub WU and Wong T (2003) The volume effect of detectors in the dosimetry of small fields used in IMRT. Medical Physics, 30: 341-347.##Le Roy M, de Carlan L, Delaunay F, et al. (2011) Assessment of small volume ionization chambers as reference dosimeters in high-energy photon beams. Physics in Medicine and Biology, 56: 5637-5650.##Musolino SV (2001) Absorbed dose determination in external beam radiotherapy: An international code of practice for dosimetry based on standards of absorbed dose to water (TRS 398). Health Physics, 81(5): 592-593.##Nath R, Biggs PJ, Bova FJ, et al. (1994) AAPM Code of Practice for Radiotherapy Accelerators: AAPM Radiation Therapy Task Group No. 45. Medical Physics, 21: 1093-1121.##Alipour H, Hadad K, Faghihi R (2019) Investigation of physical penumbra definition in treatment planning. Int J Radiat Res, 17(3): 493-497.##Hassn S, Deiab NA, Aly AH (2020) Dosimetric study of photon beam characteristics with 2d array and water phantom measurement Int J Radiat Res, 18(1): 167- 172.##Szpla S, Cao F, Kohli K (2014) On Using the Dosimetric Leaf Gap to Model the Rouned Leaf Ends in VMAT/Rapidarc Arc Plans. Journal of Applied Clinical Medical Physics, 15: 4484.##Gloria P (2013) Commissioning measurements for photon beam data on three true beam accelerators and comparison with trilogy and clinac2100 linear accelerators. Journal of Applied Clinical Medical Physics, 14: 4077.##Followill DS and Davis IGS (2004) Comparison of electron beam characteristics from multiple accelerators. Int J Radiat Oncol Biol Physics, 59(3): 905.##Fenoglietto P, Khodri M, Nguyen D, Josserand-Pietri F, Aillères N (2016) Twin machines validation for VMAT treatments using electronic portal imaging device: a multicenter study. Radiation Oncology, 11: 2.##Beyer GP (2013) Commissioning measurements for photon beam data on three true beam linear accelerators, and comparison with trilogy and Clinac 2100 linear accelerators. Journal of Applied Clinical Medical Physics, 14(1): 4077.## ##

Dosimetric comparison of large field widths in helical tomotherapy for intracranial stereotactic radiosurgery 2 2 Background: The Helical Tomotherapy (HT) technique has been introduced for use in Stereotactic Radiosurgery (SRS). Previously, the smallest field width (FW) has been recommended for optimum results, which would require a long beam-on time (BoT). The uncertainty of the intrafraction could be maximized during the delivery by this BoT. This study then investigated the plan qualities and dosimetric parameters among different FWs and treatment modes. Materials and Methods: Fifteen patients previously treated by the HT technique with fixed-FW 10 mm (FW10f) were selected. The treatment planning systems of TomoTherapy involved other plans that employed fixed-FW 25 mm (FW25f) and dynamic-FW 25 mm (FW25d). The plan quality indexes and the dosimetric parameters of the large FWs (FW 25 mm) were compared according to the FW10f benchmark and then analyzed by relevant statistics. Results: The plan quality indexes and the dosimetric parameters revealed no significant differences between FW10f and FW25d. Accordingly, FW25f revealed a significant difference in the FW10f values in some indexed parameters. The maximum dose on the right optic nerves and the value of the integral dose revealed a significant difference between FW10f and FW25f. The BoT of the FW10f presented the longest treatment time when compared with the other FWs. Conclusion: The outcomes of this investigation clearly ensure that the performance of FW25d is comparable with that of FW10f in terms of the plan qualities and the dosimetric parameters. Notably, the short BoT of this FW might benefit the minimization that is associated with intrafraction uncertainty. 701 707 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/142022/08/14 1401/5/23 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 A. Watcharawipha A. Watcharawipha Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand I. Chitapanarux I. Chitapanarux Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand imjai@hotmail.com B. Jia-Mahasap B. Jia-Mahasap Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Dynamic jaws field width stereotactic radiosurgery helical tomotherapy. 1. Sio TT, Jang S, Lee SW, Curran B, Pyakuryal AP, Sternick ES (2014) Comparing Gamma Knife and CyberKnife in patients with brain metastases. J Appl Clin Med Phys, 15(1): 14-26.##Mori Y, Nakazawa H, Hashizume C, Tsugawa T, Murai T (2019) Dosimetric comparison of hypofractionated stereotactic radiotherapy by three different modalities for benign skull base tumors adjacent to functioning optic pathways. Int J Radiat Res, 17(4): 519-530.##Wowra B, Muacevic A, Tonn JC (2009) Quality of radiosurgery for single brain metastases with respect to treatment technology: a matched-pair analysis. J Neurooncol, 94(1): 69-77.##Shao Y, Chen H, Wang H, Cheng Y, Zhu Z, Zhuo W, et al. (2022) Target dose accuracy of single-isocenter stereotactic body radiation therapy for multiple lung lesions. Int J Radiat Res, 20(1): 241-244.##Yip HY, Mui WLA, Lee JWY, Fung WWK, Chan JMT, Chiu G, et al. (2013) Evaluation of radiosurgery techniques-cone-based linac radiosurgery vs tomotherapy-based radiosurgery. Med Dosim, 38(2): 184-189.##Lee TF, Chao PJ, Wang CY, Lan JH, Huang YJ, Hsu HC, et al. (2011) Dosimetric comparison of helical tomotherapy and dynamic conformal arc therapy in stereotactic radiosurgery for vestibular schwannomas. Med Dosim, 36(1): 62-70.##Bijina T, Ganesh K, Subbulakshmi B, Pichandi A (2020) Dosimetric comparison of single and double collimator stereotactic body radiotherapy plans using Cyber Knife for carcinoma prostate. Int J Radiat Res, 18(2): 209-217.##Murai T, Hayashi A, Manabe Y, Sugie C, Takaoka T, Yanagi T, et al. (2016) Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system. Br J Radiol, 89(1066): 20160374.##Agostinelli S, Garelli S, Gusinu M, Zeverino M, Cavagnetto F, Pupillo F, et al. (2018) Dosimetric analysis of Tomotherapy-based intracranial stereotactic radiosurgery of brain metastasis. Phys Med, 52: 48-55.##Holmes TW, Hudes R, Dziuba S, Kazi A, Hall M, Dawson D (2008) Stereotactic image-guided intensity modulated radiotherapy using the HI-ART II helical tomotherapy system. Med Dosim, 33(2): 135-148.##Soisson ET, Hoban PW, Kammeyer T, Kapatoes JM, Westerly DC, Basavatia A, et al. (2011) A technique for stereotactic radiosurgery treatment planning with helical tomotherapy. Med Dosim, 36(1): 46-56.##Yawichai K, Chitapanarux I, Wanwilairat S (2016) Helical tomotherapy optimized planning parameters for nasopharyngeal cancer. J Phys Conf Ser, 694: 012002.##Mangesius J, Seppi T, Weigel R, Arnold CR, Vasilijevic D, Goebel G, et al. (2019) Intrafractional 6D head movement increases with time of mask fixation during stereotactic intracranial RT-sessions. Radiat Oncol, 14(1): 231.##Saw CB, Gillette C, Peters CA, Koutcher L (2018) Clinical implementation of radiosurgery using the Helical TomoTherapy unit. Med Dosim, 43(3): 284-290.##Hodapp N (2012) The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlenther Onkol, 188(1): 97-99.##Paddick I (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg, 93(3): 219-222.##Wagner TH, Bova FJ, Friedman WA, Buatti JM, Bouchet LG, Meeks SL (2003) A simple and reliable index for scoring rival stereotactic radiosurgery plans. Int J Radiat Oncol Biol Phys, 57(4): 1141-1149.##Li T, Irmen P, Liu H, Shi W, Alonso-Basanta M, Zou W, et al. (2019) Dosimetric Performance and Planning/Delivery Efficiency of a Dual-Layer Stacked and Staggered MLC on Treating Multiple Small Targets: A Planning Study Based on Single-Isocenter Multi-Target Stereotactic Radiosurgery (SRS) to Brain Metastases. Front Oncol, 9: 7.##Yaparpalvi R, Garg MK, Shen J, Bodner WR, Mynampati DK, Gafar A, et al. (2018) Evaluating which plan quality metrics are appropriate for use in lung SBRT. Br J Radiol, 91(1083): 20170393.##Zhang J, Peng Y, Ding S, Zhu J, Liu Y, Chen M, et al. (2020) Comparison of Different Combinations of Irradiation Mode and Jaw Width in Helical Tomotherapy for Nasopharyngeal Carcinoma. Front Oncol, 10: 598.## ##

Comparisons of various water-equivalent materials with water phantom using the Geant4/GATE simulation program 2 2 Background: The aim of this study was to compare the dosimetric properties of various water- equivalent phantom materials, such as solid water WT1 (WT1), solid water RMI457 (RMI457), plastic water, virtual water, polymethyl methacrylate (PMMA), polystyrene and A150, with water phantom. Materials and Methods: Percentage depth dose values were obtained with IBA Blue Phantom2 and solid water phantom (RW3) used in clinical radiotherapy. The measurements were carried out at 6 and 18 MV photon energies with a field size of 10 x 10 cm2 and source-skin distance (SSD) at 100 cm. Simulations for the commercial solid phantoms were performed under these same conditions using Geant4 Application for Tomographic Emission (Geant4/GATE) simulation code. Results: PMMA (3.66±1.43) % and A150 (2.40±2.20)% phantom materials were determined to have a low rate of water equivalence at 6 MV photon energy while WT1 (-2.80±2.17)% and plastic water (-2.04±2.13)% phantom materials showed a low rate of water equivalence at 18 MV photon energy. Solid water WT1 (0.13±1.11)% and RMI457 (-0.29±0.91)% phantom materials were seen to be good water-equivalent materials at 6 MV photon energy, while PMMA (-0.08±1.39)% and A150 (-1.08±1.53)% were the closest equivalent materials to  water at 18 MV photon energy. Conclusion: All the materials examined in this study were found to be suitable for the daily dosimetric measurements in clinical applications. The most appropriate choice would seem to be to use water phantom for the dosimetric measurements in radiotherapy clinics depending on the possibilities and time. 709 714 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/142022/08/142022/08/17 1401/5/26 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/19 1401/4/28 T. Şahmaran T. Şahmaran Hatay Mustafa Kemal University, Kırıkhan Vocational School, 31000 Hatay, Turkey tsahmaran@gmail.com A. Kaşkaş A. Kaşkaş Ankara University, Department of Physics Faculty of Science, 06100 Tandogan Ankara, Turkey Radiotherapy phantom materials water-equivalence Geant4 GATE. International Atomic Energy Agency (2000) Absorbed dose determination in external beam radiotherapy: an international code of practice for dosimetry based on standards of absorbed dose to water. IAEA Technical Reports Series. No. 398.##Podgorsak EB (2005) Radiation Oncology Physics: A handbook for teachers and students. International Atomic Energy Agency. Vienna. Austria##Almond PR, Biggs PJ, Coursey BM, Hanson WF, Hug MS, Nath R, Rogers DW (1999) AAPM's TG-51 protocol for clinical reference dosimetry of high energy photon and electron beams. Medical Physics, 26(9): 1847-1870.##Ramaseshan R, Kohli K, Cao F, Heaton R (2008) Dosimetric evaluation of plastic water diagnostic therapy. Journal of Applıed Clinical Medical Physics, 9(2): 98-111.##Zuber SH, Yusof MFM, Hashikin NAA, Samson DO, Aziz MZA, Hashim (2021) A Rhizophora spp. as potential phantom material in medical physics applications-A review. Radiation Physics and Chemistry, 189.##Ramos SMO, Thomas S, Berdeguez MBT, Sa LV, Souza SAL (2017) Anthropomorphic phantoms-potential for more studies and training in radiology. Int J Radiol Radiat Ther, 2(4): 1-5.##American Association of Physicists in Medicine (AAPM) (1983) A protocol for the determination of absorbed dose from high-energy photon and electron beams. Task Group 21. Medical Physics, 10(6): 741-771.##Samson DO, Jafri MZM, Shukri A, Hashim R, Sulaiman O, Aziz MZA, Yusof FM (2020) Measurement of radiation attenuation parameters of modified defatted soy flour-soy protein isolate-based mangrove wood particleboards to be used for CT phantom production. Radiat Environ Biophys, 59: 483-501.##Dohm OS, Christ G, Nüsslin F, Schüle E, Bruggmoser G (2001) Electron dosimetry based on the absorbed dose to water concept: A comparison of the AAPM TG-51 and DIN 6800-2 protocols. Medical Physics, 28(64): 2258-64.##Huq MS and Andreo P (2001) Reference dosimetry in clinical high-energy photon beams: Comparison of the AAPM TG-51 and AAPM TG-21 dosimetry protocols. Medical Physics, 28(1): 46-54.##Hill RF, Brown S, Baldock C (2008) Evaluation of the water equivalence of solid phantoms using gamma ray transmission measurements. Radiation Measurements, 43(7): 1258-64.##Seuntjens J. Olivares M. Evans M. Podgorsak E (2005) Absorbed dose to water reference dosimetry using solid phantoms in the context of absorbed-dose protocols. Medical Physics, 32(9): 2945-33.##Hong JW, Lee HK, Cho JH (2015) Comparison of the photon charge between water and solid phantom depending on depth. Int J Radiat Res, 13(3): 229-234.##Gargetta MA, Briggsa AR, Bootha JT (2020) Water equivalence of a solid phantom material for radiation dosimetry applications. Physics and Imaging in Radiation Oncology, 14: 43-47.##Hill R, Holloway L, Baldock CA (2005) Dosimetric evaluation of water equivalent phantoms for kilovoltage X-ray beams. Physics in Medicine and Biology, 50(21): 331-344.##White DR, Speller RD, Taylor PM (1981) Evaluating performance characteristics in computerized tomography. The British J Radiology, 54(639): 221-231.##Allahverdi M, Nisbet A, Thwaites DI (1999) An evaluation of epoxy resin phantom materials for megavoltage photon dosimetry. Physics in Medicine and Biology, 44(5): 1125-32.##Saitoh H, Myojoyama A, Tomaru T, Fukuda K, Fujisaki T, Abe S (2002) A study on properties of water substitute solid phantom using EGS code. Proceedings of the Tenth EGS4 Users Meeting in Japan. KEK Proceedings, 18: 55-64.##Tello VM, Tailor RC, Hanson WF (1995) How water equivalent are water-equivalent solid materials for output calibration of photon and electron beams? Medical Physics, 22(7): 1177-89.##Nilsson B, Montelius A, Andreo P, Johansson J (1997) Correction factors for parallel-plate chambers used in plastic phantoms in electron dosimetry. Physics in Medicine and Biology, 42(11): 2101-18.##Hill RF, Kuncic Z, Baldock C (2010) The water equivalence of solid phantoms for low energy photon beams. Medical Physics, 37(8): 4355-63.##Samson DO, Shukri A, Jafri MZM, Hashim R, Aziz MZA, Yusof MFM (2021) Development of radiation dosimetric phantoms made from SPC/NaOH/IA-PAE/Rhizophora spp. particleboards. Int J Radiat Res, 19(4): 801-811.##Vahabi SM, Bahreinipour M, Zafarghandi MS (2017) Determining the mass attenuation coefficients for some polymers using MCNP code: A comparison study. Vacuum, 136: 73-76.##Kumer T, Kumar Das P, Khatun R, Rahman A, Akter S, Kumar Roy S (2021) Comparative Studies of Absolute Dose in Water Phantom. Solid Water Phantom and MatriXX with MULTICube Phantom. International Journal of Medical Physics. Clinic Engin and Radiat Oncol, 10: 169-17.##Ababneh B, Tajuddin AA, Hashim R, Shuaib IL (2016) Investigation of mass attenuation coefficient of almond gum bonded Rhizophora spp. particleboard as equivalent human tissue using XRF technique in the 16.6-25.3 keV photon energy. Australas Phys Eng Sci Med, 39(4): 871-876.##Followill DS, Tailor RC, Tello VM, Hanson WF (1998) An empirical relationship for determining photon beam quality in TG-21 from a ratio of percent depth doses. Medical Physics, 25: 1202-05.##International Commission on Radiation Units and Measurements (1984) Stopping Powers for Electrons and Positrons ICRU Report 37.##International Commission on Radiation Units and Measurements (1989) Tissue Substitutes in Radiation Dosimetry and Measurement. ICRU Report 44.##International Atomic Energy Agency (1997) The Use of Plane-parallel Ionization Chambers in High-energy Electron and Photon Beams. An International Code of Practice for Dosimetry. IAEA Technical Reports Series No. 381.##Borcia C and Mihailescu D (2007) Are water-equivalent materials used in electron beams dosimetry really water equivalent? Rom J Phys, 53(7-8): 851-863.##Tuğrul T and Eroğul O (2019) Analysis of water-equivalent materials used during irradiation in the clinic with XCOM and BEAMnrc. J Radiat Res and Appli Sci, 12(1): 455-459.##https://physics.nist.gov/cgi-bin/Star/compos.pl?matno=099.##Duran-Nava OE, Torres-Garcia ER, Oros-Pantoja R, Hernandez-Oviedo JO (2019) Monte Carlo simulation and experimental evaluation of dose distributions produced by a 6 MV medical linear accelerator. Journal of Physics Conference Series. 1221.##Sahmaran T and Kaskas A (2020) The effect of the trace elements concentrations on the cancerous and healthy tissues in radiotherapy. International Journal of Medical Physics. Clinic Engine and Radiat Oncol, 9: 110-124.##Cameron M, Cornelius I, Cutajar DL, Davis JA, Rosenfeld AB (2017) Comparison of phantom materials for use in quality assurance of microbeam radiation therapy. J Synchrotron Rad, 24: 1-11.##Tekın HO, Sayyed MI, Erguzel TT, Karahan M, Kılıcoglu O, Mesbahı A, Kara U (2018) Investigatıon of water equivalance and shieldıng properties of different solid phantoms using mcnpx code. Digest J Nanomaterials and Biostructures, 13(2): 551-62.##Diteko K, Mkhize TD, Mohlapholi MS (2020) Validating the percentage depth doses using two different phantom materials. Insights Med Phys, 5: 1-7.##Aslam A, Kakakhel MB, Shahid SA, Younas L, Zareen S (2016) Soft tissue and water substitutes for megavoltage photon beams: An EGSnrc-based evaluation. J Applied Clinical Medical Physics, 17(1): 408-15.##Araki F (2017) Dosimetric properties of a solid water high equivalency (SW557) phantom for megavoltage photon beams. Physica Medica, 39: 132-136.## ##

Radiation therapy in Nepal: Current status and future priorities 2 2 Radiation Therapy is a critical component of cancer treatment. During the course of their illness, at least half of cancer patients will require radiotherapy. It is primarily used as an adjuvant treatment after surgery, as a definitive treatment in inoperable tumors, and it also plays an important role in palliative care, such as pain management. Because establishing a radiation facility is a large undertaking, low-income countries such as Nepal have few radiation facilities. People must travel for hours to get to the closest Radiation Therapy Center, and hospitals are congested, so treatment takes months. Disease progression and untimely cancer mortality occur as a result of the delay in treatment and the paucity of standard radiation facilities. The purpose of this research is to determine the current state of radiation therapy infrastructures, human resources, and educational institutions, as well as to establish future development priorities. 715 717 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/142022/08/142022/08/172022/08/28 1401/6/6 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192019/01/15 1397/10/25 S. Thakur S. Thakur Department of Radiation Oncology, Chitwan Medical College, Bharatpur, Nepal drsubhashonco@gmail.com A. Kumar Thakur A. Kumar Thakur Department of Radiation Oncology, Chitwan Medical College, Bharatpur, Nepal S. Chawla S. Chawla Department of Radiation Oncology, Chitwan Medical College, Bharatpur, Nepal Radiation therapy low-income country Nepal. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. (2021) Cancer statistics for the year 2020: an overview. Int J Cancer, 2021.##Cancer today [Internet]. gco.iarc.fr. [cited 2022 May 4]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/524-##Poudel KK, Huang Z, Neupane PR (2016) Trend of cancer incidence in Nepal from 2003 to 2012. Asian Pacific Journal of Cancer Prevention, 17(4): 2171-5.##Begg AC, Stewart FA, Vens C (2011) Strategies to improve radiotherapy with targeted drugs. Nature Reviews Cancer, 11(4): 239-53.##Delaney G, Jacob S, Featherstone C, Barton M (2005) The role of radiotherapy in cancer treatment. Cancer, 104(6): 1129-37.##Barnett GC, West CML, Dunning AM, Elliott RM, Coles CE, Pharoah PDP, et al. (2009) Normal tissue reactions to radiotherapy: towards tailoring treatment dose by genotype. Nature Reviews Cancer [Internet], 9(2): 134-42.##Adhikari KP, Jha LN, Galan MP (2012) Status of radiation protection at different hospitals in Nepal. Journal of Medical Physics / Association of Medical Physicists of India [Internet], 2012 [cited 2021] 37(4): 240-4.##Karn A (2017) Current status of availability of radiotherapy machines in Nepal. Journal of Clinical Oncology, 35(15): e18042-2.##Gyawali B, Sharma S, Shilpakar R, Dulal S, Pariyar J, Booth CM, et al. (2020) Overview of Delivery of Cancer Care in Nepal: Current Status and Future Priorities. JCO Global Oncology, 2020(6): 1211-7.## ##

Postoperative low-dose external radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee: A case report and literature review 2 2 Background: Pigmented villonodular synovitis (PVNS) is a rare benign proliferative <a href="D://APP%E5%AE%89%E8%A3%85%E5%8C%85/Youdao/Dict/8.9.3.0/resultui/html/index.html#/javascript:;">disease of the synovium which most commonly affects the knee. It is regarded as a benign disease, but has a local invasion. Postoperative adjuvant radiotherapy is very necessary for PVNS, but there is no consensus on the total dose of radiotherapy. Case presentation: A 22-year-old young male with diffuse PVNS of right knee was referred to our hospital with ongoing right knee swelling and limitation of motion of the knee. Preoperative magnetic resonance imaging (MRI) showed synovium of the joint was obviously thickened with multiple nodular low signals of long T1 and short T2 which is the typical characteristic of PVNS. The patient was treated with arthroscopic synovectomy combined with adjuvant postoperative low-dose external radiotherapy (20 Gy). Conclusions: Based on related literature about radiotherapy of PVNS, arthroscopic synovectomy combined with postoperative low-dose external radiotherapy is an ideal treatment and prevents the recurrence for PVNS of the knee. 719 722 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/142022/08/142022/08/172022/08/282022/08/28 1401/6/6 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192019/01/152022/07/19 1401/4/28 J. Lai J. Lai Department of Oncology, Jiujiang First People’s Hospital, Jiujiang, Jiangxi 332000, People’s Republic of China haixin27691@foxmail.com S. Hu S. Hu Department of Infectious Diseases, Jiujiang Third People’s Hospital, Jiujiang, Jiangxi 332000, People’s Republic of China Y. Luo Y. Luo Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang 322000, People‘s Republic of China R. Zheng R. Zheng Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang 322000, People‘s Republic of China P. Chen P. Chen Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang 322000, People‘s Republic of China F. He F. He Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang 322000, People‘s Republic of China Case report Pigmented villonodular synovitis PVNS Radiotherapy. Fałek A, Niemunis-Sawicka J, Wrona K, Szczypiór G, Rzepecka-Wejs L, Cięszczyk K, et al. (2018) Pigmented villonodular synovitis. Folia medica Cracoviensia, 58(4): 93-104.##Jendrissek KA, Hotfiel T, Swoboda B, Söder S, Janka R (2016) Pigmentierte villonoduläre Synovialitis. Z Rheumatol, 75(2): 157-165.##Fang Y and Zhang Q (2020) Recurrence of pigmented villonodular synovitis of the knee: A case report with review of literature on the risk factors causing recurrence. Medicine, 99(16): e19856.##Jaffe HL, Lichtenstein L, Suro CJ (1941) Pigmented villonodular synovitis, bursitis and tenosynovitis. Arch Pathol, 31: 731-765.##Bernthal NM, Ishmael CR, Burke Z (2020) Management of Pigmented Villonodular Synovitis (PVNS): an Orthopedic Surgeon's Perspective. Curr Oncol Rep, 22(6): 63.##Temponi EF, Barros A, Paganini VO, Barbosa V, Badet R, Carvalho Júnior LH (2017) Diffuse pigmented villonodular synovitis in knee joint: diagnosis and treatment. Rev Bras Ortop, 52(4): 450-457.##De Ponti A, Sansone V, Malcherè M (2003) Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy, 19(6): 602-607.##Schumacher HR (2010) A case of villonodular synovitis of the shoulder in an adolescent: imaging and pathologic diagnosis. Revista Brasileira de Reumatologia, 50(4): 478-480.##Addicott BT, Jose J, Kaplan LD, Clifford PD (2009) Imaging series. Pigmented villonodular synovitis. Am J Orthop, 38(12): 635-636.##Sharma H, Jane MJ, Reid R (2005) Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Current Orthopaedics, 19(3): 215-222.##Mollon B, Lee A, Busse JW, Griffin AM, Ferguson PC, Wunder JS, et al. (2015) The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Joint J, 97-B (4): 550-557.##Blanco CE, Leon HO, Guthrie TB (2001) Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee. Arthroscopy, 17(5): 527-531.##Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW (2002) Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am, 84(12): 2192-2202.##Berger B, Ganswindt U, Bamberg M, Hehr T (2007) External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 67(4): 1130-1134.##Horoschak M, Tran PT, Bachireddy P, West RB, Mohler D, Beaulieu CF, et al. (2009) External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 75(1): 183-187.##Heyd R, Micke O, Berger B, Eich HT, Ackermann H, Seegenschmiedt MH, et al. (2010) Radiation therapy for treatment of pigmented villonodular synovitis: results of a national patterns of care study. Int J Radiat Oncol Biol Phys, 78(1): 199-204.##Park G, Kim YS, Kim JH, Lee SW, Song SY, Choi EK, et al. (2012) Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee: 4 recurrences in 23 patients followed for mean 9 years. Acta orthopaedica, 83(3): 256-260.##Li W, Sun X, Lin J, Ji W, Ruan D (2015) Arthroscopic synovectomy and postoperative assisted radiotherapy for treating diffuse pigmented villonodular synovitis of the knee: An observational retrospective study. Pak J Med Sci, 31(4): 956-960.##de Carvalho LH, Jr Soares LF, Gonçalves MB, Temponi EF, de Melo Silva O (2012) Long-term success in the treatment of diffuse pigmented villonodular synovitis of the knee with subtotal synovectomy and radiotherapy. Arthroscopy, 28(9): 1271-1274.## ##

Evaluation of intracranial aneurysm: Comparison between ZTE-MRA and 3D-TOF-MRA 2 2 The high incidence of intracranial aneurysms and the high mortality rate after rupture highlight the requirement and importance for early and accurate visualization of the aneurysm profile for subsequent patient treatment. Here we report a patient with an intracranial aneurysm who underwent digital subtraction angiography (DSA), zero echo time MRA (ZTE-MRA), and three-dimensional time-of-flight MRA (3D-TOF-MRA) on admission and after operation. The imaging quality and accuracies of ZTE-MRA and 3D-TOF-MRA were compared with DSA, the gold standard, in pre-operative and post-operative evaluation of intracranial aneurysms. Comparison of the two MRAs, ZTE-MRA has greater advantages in imaging.     723 725 2022/07/192022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/07/202022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/32022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/102022/08/142022/08/142022/08/172022/08/282022/08/282022/08/28 1401/6/6 2019/01/152022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/04/12022/04/12022/04/12022/04/12022/04/12022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192022/07/192019/01/152022/07/192022/07/19 1401/4/28 J. Lyu J. Lyu Department of Radiology, Affiliated Second Hospital, Dalian Medicial University, Dalian 116000, People's Republic of China L. Sha L. Sha Department of Radiology, Affiliated Second Hospital, Dalian Medicial University, Dalian 116000, People's Republic of China drshalin@163.com X. Qi X. Qi Department of Radiology, Affiliated Second Hospital, Dalian Medicial University, Dalian 116000, People's Republic of China Z. Chen Z. Chen Department of Radiology, Affiliated Second Hospital, Dalian Medicial University, Dalian 116000, People's Republic of China Intracranial aneurysm zero echo time magnetic resonance angiography spin labeling time leap. 1. Liu Z, Ajimu K, Yalikun N, Zheng Y, Xu F (2019) Potential therapeutic strategies for intracranial aneurysms targeting aneurysm pathogenesis. Front Neurosci, 13: 1238.##Marbacher S, Halter M, Vogt DR, et al. (2021) Value of 3-dimensional digital subtraction angiography for detection and classification of intracranial aneurysm remnants after clipping. Oper Neurosurg (Hagerstown), 21(2): 63-72.##Gottwald LM, Toger J, Markenroth Bloch K, et al. (2020) High Spatiotemporal Resolution 4D Flow MRI of Intracranial Aneurysms at 7T in 10 Minutes. AJNR Am J Neuroradiol, 41(7): 1201-8.##Howard BM, Hu R, Barrow JW, Barrow DL (2019) Comprehensive review of imaging of intracranial aneurysms and angiographically negative subarachnoid hemorrhage. Neurosurg Focus, 47(6): E20.##Zhu C, Wang X, Eisenmenger L, et al. (2019) Surveillance of unruptured intracranial saccular aneurysms using noncontrast 3D-black-blood MRI: Comparison of 3D-TOF and contrast-enhanced MRA with 3D-DSA. AJNR Am J Neuroradiol, 40(6): 960-6.##Igase K, Igase M, Matsubara I, Sadamoto K (2018) Mismatch between TOF MR angiography and CT angiography of the middle cerebral artery may be a critical sign in cerebrovascular dynamics. Yonsei Med J, 59(1): 80-4.##Shang S, Ye J, Luo X, Qu J, Zhen Y, Wu J (2017) Follow-up assessment of coiled intracranial aneurysms using zTE MRA as compared with TOF MRA: a preliminary image quality study. Eur Radiol, 27(10): 4271-80.##Song Y, Qi P, Huang J, et al. (2020) Application of zero echo time MR angiography in follow-up of intracranial aneurysm remnant and in-stent lumen after embolization: a comparison study with digital subtraction angiography. Acta Radiol, 61(4): 480-6.##Marciano D, Soize S, Metaxas G, Portefaix C, Pierot L (2017) Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography. J Neuroradiol, 44(1): 44-51.##Shang S, Ye J, Dou W, et al. (2019) Validation of Zero TE-MRA in the Characterization of Cerebrovascular Diseases: A Feasibility Study. AJNR Am J Neuroradiol, 40(9): 1484-90.##Wu H, Block WF, Turski PA, Mistretta CA, Johnson KM (2013) Noncontrast-enhanced three-dimensional (3D) intracranial MR angiography using pseudocontinuous arterial spin labeling and accelerated 3D radial acquisition. Magn Reson Med, 69(3): 708-15.## ##