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Abstract: Sarcomas are rare tumours that commonly derive from neoplastic transformation of mesenchymal tissues. Only a small percentage of these malignancies are located in the spine. The gold standard of treatment is a multidisciplinary approach with the surgery being the most important tool. An en-bloc resection with free margins followed by radiotherapy seems to assure the best overall survival. Among the newest treatment modalities, certainly, the adrontherapy is the most interesting and promising kind of radiotherapy that uses the physical bullet properties (Bragg peak) of protons such as carbon ions to treat lesions. We present a case of a gentleman with a C2-C3 low grade osteosarcoma treated, after a biopsy tissue sample, with hadrontherapy alone. At 6 years follow up the tumour seems to be well under control. Keywords: Osteosarcoma, sarcomas, traditional radiotherapy, protom beam therapy, hadrontherapy. Download Full Article |
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Abstract: Functional nanomaterials have inspired revolutionary methods for cancer early diagnosis, treatment, and prevention. For instance, the imaging property of nanomaterials with high resolution and sensitivity can be used for noninvasive detection of cancer and visualization of drug transport. Meanwhile, the therapeutic property of nanomaterials with controllable fashion will increase therapy efficacy and decrease adverse side effect. Thus, compared to traditional treatment approaches, the nanomaterials which combines imaging and therapeutic functionalities, will be more suitable for cancer theranostics. This review introduces several types of inorganic nanoparticles, including silica nanoparticles, upconversion nanoparticles, iron oxide nanoparticles and gold nanoparticles, which can been explored as theranostic nanoplatforms for simultaneous cancer imaging and therapy. We also cover the ongoing challenges of these nanoparticles in clinical applications. Keywords: Theranostic, inorganic nanomaterials, silica nanoparticles, upconversion nanoparticles, iron oxide nanoparticles, gold nanoparticles. Download Full Article |
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Abstract: Purpose: Desire to improve efficiency and throughput inspired a review of the frequency and scope of our physics chart check procedures. Departmental policy mandates review of a patient’s treatment plan prior to port-filming, after first treatment and “weekly” every 3-5 fractions. This study examined the effectiveness of the “after-first” physics check with respect to improving patient safety and clinical efficiency. Methods and Materials: A shared spreadsheet was created to record errors discovered during patient-specific chart review following the first fraction of treatment and before the second fraction. First, entries were recorded and categorized from August 2014 through February 2015. Frequencies were assessed month-to-month. Next, utilizing these results, a continuous quality improvement (CQI) process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a dose tracking checklist item in the pre-treatment plan check assessment. A two-sided Fisher’s exact test was used to determine if there was a nonrandom association between the checklist implementation and incidence of dose tracking errors. Results: Analysis of recorded errors indicated an overall error rate of 3.4% over the 13 month period. The majority of errors related to discrepancies in documentation, followed by prescription, plan deficiency, and dose tracking-related errors. A two-sided Fisher’s exact test revealed a statistically significant decrease in dose tracking-related errors after implementing the checklist item (p = 0.0322, significance level = 0.05). Conclusions: This work indicates that this redundant secondary check is an effective QA process in our department. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 3% error rate suggests the need for continuous quality improvement and periodical re-training on errors noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency. Keywords: Error analysis, chart checks, continuous quality improvement. Download Full Article |
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Abstract: Factors influencing the cancer therapy efficiency in both photothermal therapy (PTT) and photodynamic therapy (PDT) using nanogold particles and photosensitizers, respectively, are analyzed. In PTT, heat diffusion kinetics is used to calculate the temperature increase resulted from the nanogold absorption of light energy, whereas photochemical kinetics is used to find the efficacy of PDT, or the generation rate of reactive oxygen species. The critical factors of the PTT/PDT synergistic efficacy include: the concentration of the initiator (nanogold or photosensitizers) in the treated medium, the wavelength and energy of the light applied to the medium. Optimal parameters are calculated for maximum PDT efficacy. In PTT, diode laser (at 810 nm) is used to heat nanogolds (rod-shape or core-shell). In PDT, photosensitizers of riboflavin, 5-ALA, methylene blue and indocyanine green may be used with the associate light at wavelength of (365, 430 nm), (530-670 nm) and (780-850 nm) respectively. Both single light or dual light in infrared or visible wavelength are proposed to activate the photosensitizers or nanogolds. Optimization is required for maximum synergistic efficacy. Keywords: Lasers, optimal, modeling, heat diffusion, photochemical kinetics. Download Full Article |
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Abstract: Background: Head and Neck Mucosal Melanoma (HNMM) is rare, accounting 1% of all melanomas in USA, and 6% in Japan. Melanoma’s development is a complex process involving activation of proto-oncogenes and loss of tumor suppressors. Bcl-2 oncogene encodes a family of anti-apoptotic proteins and it is overexpressed in melanomas. On the other hand, proto-oncogene C-myc is a transcriptional factor and plays crucial role both in driving cell proliferation and promoting apoptosis, its overexpression has been associated to melanoma progression. Moreover, oncogene SOX10 cooperates with other transcription factors to direct the development and differentiation of melanocytes. These three nuclear markers are associated to melanoma’s metastatic risk. Methods: We studied of BCL-2; C-myc and SOX10 proteins in 19 Formalin Fixed Paraffin Embedded cases of HNMM from Yale School of Medicine and 10 cases from University of São Paulo by Alkalin Phosphatase immunohistochemistry technique. Results: We considered as positive expression when over 25% of tumor cells were immunostained. We observed 27/29 were positive to Bcl-2 and 28/29 cases showed SOX10 expression (both markers showing immunostaining in over 75% of tumor cells). However, we noticed variable expression for C-myc in 15/29 of HNMM cases. Conclusions: According to ours results, we suggest that BCL-2 and SOX10, should be good adjuctive biomarkers for HNMM, however lower expression of C-myc has not shown to play main role in the HNMM development, thus further molecular biology studies should corroborate this present study. Keywords: Mucosal melanoma, C-myc, SOX10, Bcl-2. Download Full Article |