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- Nanotechnology Cancer Therapy and Treatment - National Cancer Institute
- Radiotherapy Optimization
- Taking care of yourself during treatment
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Your cancer care team can tell you about your treatment, likely side effects, and things you need to do to take care of yourself. They can also talk to you about any other medical concerns you have. Tell them about any changes in the way you feel and any side effects you have, including skin changes, tiredness, diarrhea, or trouble eating.
Be sure that you understand any home care instructions and know who to call if you have more questions. Also be sure you know what to do if you need help after office hours, in case you have problems at night or on the weekend. Fatigue is feeling tired physically, mentally, and emotionally. Most people start to feel tired after a few weeks of radiation therapy. This happens because radiation treatments destroy some healthy cells as well as the cancer cells.
Fatigue usually gets worse as treatment goes on.
Stress from being sick and daily trips for treatment can make fatigue worse. Managing fatigue is an important part of care. Fatigue caused by radiation treatment or the cancer itself is different from the fatigue of everyday life, and it might not get better with rest. It can last a long time and can get in the way of your usual activities. But it will usually go away over time after treatment ends. Only you know if you have fatigue and how bad it is.
Nanotechnology Cancer Therapy and Treatment - National Cancer Institute
No lab tests or x-rays can diagnose or describe your level of fatigue. The best measure of fatigue comes from your own report to your cancer care team. You can describe your level of fatigue as none, mild, moderate, or severe.
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Or you can use a scale of 0 to 10, where a 0 means no fatigue, and a 10 is the worst fatigue you could imagine. Be sure to talk with them if:. If you need to take time off from work, talk to your employer. You may also have some rights that will help you keep your job.
Your skin in the radiation treatment area might look red, irritated, swollen, blistered, sunburned, or tanned. After a few weeks, your skin might become dry, flaky, or itchy, or it may peel. This is sometimes called radiation dermatitis. They can suggest ways to ease the discomfort, lessen further irritation, and prevent infection. Most skin reactions slowly go away after treatment ends.
In some cases, though, the treated skin will stay darker and might be more sensitive than it was before. But hair is only lost in the area being treated. Most people find that their hair grows back after treatment ends, but it can be hard to deal with hair loss. When it does grow back, your hair may be thinner or a different texture than it was before. Ask your cancer care team if you have any questions or concerns about hair loss.
If you do lose your hair, your scalp may be tender and you may want to cover your head. Your local American Cancer Society office may be able to help you get wigs or hats. Rarely, radiation therapy can lower white blood cell or platelet counts. These blood cells help your body fight infection and prevent bleeding. If your blood tests show low blood counts, your treatment might be stopped for a week or so to allow your blood counts to return to normal.
See Understanding Your Lab Test Results to learn more about blood cells and what changes in the numbers of these cells means. Radiation to the mouth or throat, or parts of the digestive system like the stomach or intestines might cause eating and digestion problems. However, the rectum and the femoral head DVHs are noticeably lower with energy-based inverse optimization. The screen captures on the right-hand side show the DVH-derived left and the energy-derived right isodoses. This difference in the lower dose region is also evident from the DVH overlay on the left-hand side of the figure.
Figure 2. Dose—volume histogram DVH left and isodose plots in three different plains right for one case.
The right-hand side outlines the isodoses from 7, cGy prescription dose to 2, cGy in 1, cGy intervals. The axial, the sagittal, and the coronal cuts are through the isocenter, located in the centroid of the PTV.
1stclass-ltd.com/wp-content/android/3807-handy-orten-beste.php The comparisons of all tallied dose indices are presented in Figure 3. The quantities obtained from the DVH-optimized plans were used as a reference in this normalization, since DVH-based optimization is modern day standard of care. The normalization of the DIs allows the use of a common scale for all patients since the absolute DIs vary from patient to patient due to prescription doses, optimization convergence, and patient anatomy 17 , In order to further aid the comparisons, one is plotted on the figure by a dashed line.
If a normalized DI is greater than 1 then the DVH optimization results in lower absolute value for that quantity and vice versa. The top two panels of the figure show that for rectum and bladder, the sparing, achievable with energy-based optimization, increases as the fractional volume of the OAR increases. The average dosimetric differences between the optimization schemes in bladder for instance are 1. The trend for the rectum is identical, namely, the differences become larger as the fractional VOI becomes larger.
Rectum and bladder are in direct proximity to the PTV, and thereby, small fractions of those anatomical structures could receive doses as high as the prescription dose. Therefore, the dose differences for small volumes of those anatomical structures are relatively small. The bottom panel of Figure 3 shows that the sparing of the femoral heads with energy-based optimization is far superior than the sparing with DVH-based optimization.
In only 2 out of 50 tallied DIs for the femoral heads, the normalized values are at or above 1 patients 16 and 18, left and right femoral heads, respectively. Figure 3. Comparison of all normalized dose indices for the organs at risk OARs. Details on the index normalization are presented in the text. The top, middle, and bottom panels outline the results for all tallied OAR doses for bladder, rectum, and femoral heads, respectively. In addition to the commonly used dose indices described above, integral doses were also compared. The entire irradiated volume was delineated.
The PTV for each patient was subtracted from this irradiated volume, and the integral doses for each optimization scheme were calculated for each optimization scheme. The normalized with respect to the DVH-optimization results integral doses are plotted on the top panel of the figure.
As it is clear from the plot, all integral doses for the energy-based optimization are lower, which is in contract to the DIs, where not in all cases the energy-derived DIs were better than the DVH-derived DIs. The results of the statistical significance tests are presented in Table 1. In the first column, a description of the tallied quantity is given.
In the second column of the table, the corresponding average value derived from the DVH-optimized plans is presented. The last column of the table is the ratio between the numbers from third and second columns, therefore, indicating the percent statistically significant difference between the two optimization schemes.
Taking care of yourself during treatment
These findings are exemplified on the DVHs presented in Figure 2. For that particular patient, the bladder doses are not much different, but the rectal doses show how with decreasing dose the DVH resulting from the energy optimization is lower than the DVH derived from the DVH-optimized plan. Table 1. Prostate region is considered to be rather homogenous.
In reality, however, this is not the case.
Therefore, exploiting the density variation through energy-based inverse optimization turns out to be advantageous with respect to dose—volume-based optimization as in the DVH case. Therefore, the use of voxel mass explicitly in the optimization objectives is a logical step in the study and the evolution of the optimization objective functions.
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This may be particularly relevant to serial structures where usually maximum doses are of primary concern. The availability of several objective functions for a single OAR DVH case allows more flexibility in shaping maximum dose than in the case with only one available objective function energy case. There are several potential solutions which can be utilized for amelioration of this deficiency of the energy-based approach.
One possibility would be to specify an additional to the energy based objective for each serial structure where the point maximum dose to the OAR is limited. Alternative option would be to use a DVH-based objective for the OAR, where the dose to a small fraction of the volume i. A third option would be to introduce an additional objective function, which is based on modification of Eq. This modification will minimize integral dose only for voxels that have doses above certain user-defined threshold.
To our knowledge, integral dose has not been related to normal tissue complications. Dose—volume parameters, however, are well known to clinicians because of the vast clinical experience, which has been gathered since the introduction of DVHs 9 , Therefore, integral dose cannot solely be used for radiotherapy plan evaluation. Energy-based optimization appears to be a useful alternative for inverse optimization, while the clinical guidelines and clinical trial protocols in terms of established DVH metrics and guidelines should be followed.
Another comparison performed in this investigation was between the MUs, the integral doses, and the surface skin doses resulting from each optimization scheme. In comparison, the quantities resulting from the energy-based plans were Integral doses within the entire irradiated volume were calculated for each patient and each optimization approach. In all cases without exception, the integral dose derived from the energy-based plan was lower than the integral dose derived from the DVH plans. The differences ranged from 0.
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As it was mentioned above, there is no evidence in the literature what the effect of those integral dose differences might be. Finally, in order to estimate the surface doses, a 0. The maximum and average skin doses were calculated on patient-by-patient basis. These findings indicate that energy-based optimization delivers slightly lower dose to skin.
However, only in four cases, the actual skin dose was over 3, cGy and only in two cases around 3, cGy. Even in these extreme scenarios, the maximum skin dose is about cGy per day over the course of treatment. The calculations do not account for patient daily repositioning, which will smear out the maximum dose somewhat, thereby decreasing it. Furthermore, if the skin dose is of a concern, the number of beams may be increased, therefore, spreading out the entrance dose, which would decrease the skin dose further.
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The results of this study presented herein indicate that this novel inverse optimization framework, based on the exploration of quantitative imaging information derived from the CT data, is capable of improving normal tissue sparing when compared to the standard of care.