Search

Eine Strahlentherapie kleiner Zielvolumina mit sehr hohen Einzeldosen auf 1 bis ca. 12 Fraktionen verteilt – unter Bildfuhrung und in tumorabladierender Absicht durchgefuhrt – wird bei extrakraniellen Tumoren oder Metastasen als extrakranielle Stereotaxie („stereotactic body radiation therapy“ [SBRT]) bezeichnet. Strahlenbiologisch werden neben der Schadigung der DNA der Tumorzellen auch die Tumorgefase okkludiert und immunologische Effekte ausgelost. Die sichere Durchfuhrung der SBRT bedeutet einen sehr hohen physikalisch-technischen Aufwand, um eine ausreichende Schonung der gesunden Organe gewahrleisten zu konnen. Klinisch bietet die SBRT weite Einsatzmoglichkeiten in der kurativen Therapie (z. B. beim nichtkleinzelligen Bronchialkarzinom im Stadium I). Zudem ist sie eine konservative, effektive und gut vertragliche Option zur Behandlung einzelner Metastasen und ein optimaler Kombinationspartner in der Therapie oligometastasierter Tumorstadien.

Background: Despite the available diagnostics and treatment, tuberculosis (TB) is a serious infectious disease currently occurring. Even some high-income countries in the world do not fully control it at this time. The reason for this situation is the lack of elimination programs to address the situation. The aim of the update of the prediction data was to create a presumption of TB development in Slovakia by 2040. Methods: We used the time series prediction method with exponential equalization. The basis for the calculation were historical data on the incidence of TB from 1960 to 2018 in Slovakia (data for the last 58 yr). This time series has a clearly declining level. In view of this trend, we have set a threshold, whether and when the incidence in the future will fall below 5.0 patients per 100,000 inhabitants. Results: In case of a favorable development, the limit of our incidence drop below 5.0 cases per 100 000 inhabitants in 2022, when the incidence will be 4.91 per 100 000 inhabitants. In 2040, the predicted incidence of TB should be 1.78 per 100 000 inhabitants. A gradual decline may also be related to a decrease in the population of the Slovak Republic. Conclusion: Slovakia belongs to those countries of the world where TB is under control. Increased surveillance of high-risk communities through community interventions and countries' readiness for global migration can help to influence factors that may aggravate the epidemiological situation of TB.

Radiotherapy of small targets with very high single doses administered in 1 to approximately 12 fractions-carried out under image guidance and with the intention of "tumour ablation"-is called stereotactic body radiation therapy (SBRT) for extracranial tumours or metastases. Radiobiologically, besides damaging the DNA of the tumour cells, the tumour vessels are also occluded and immunological effects are triggered. The safe performance of SBRT requires a very high physical-technical effort in order to ensure sufficient protection of healthy organs. Clinically, SBRT offers a wide range of applications in curative therapy (e.g. non-small-cell lung cancer stage I). Furthermore, it is a conservative, effective and well-tolerated option for the treatment of individual metastases and an optimal combination partner in the therapy of oligometastatic tumours.Eine Strahlentherapie kleiner Zielvolumina mit sehr hohen Einzeldosen auf 1 bis ca. 12 Fraktionen verteilt – unter Bildführung und in tumorabladierender Absicht durchgeführt – wird bei extrakraniellen Tumoren oder Metastasen als extrakranielle Stereotaxie („stereotactic body radiation therapy“ [SBRT]) bezeichnet. Strahlenbiologisch werden neben der Schädigung der DNA der Tumorzellen auch die Tumorgefäße okkludiert und immunologische Effekte ausgelöst. Die sichere Durchführung der SBRT bedeutet einen sehr hohen physikalisch-technischen Aufwand, um eine ausreichende Schonung der gesunden Organe gewährleisten zu können. Klinisch bietet die SBRT weite Einsatzmöglichkeiten in der kurativen Therapie (z. B. beim nichtkleinzelligen Bronchialkarzinom im Stadium I). Zudem ist sie eine konservative, effektive und gut verträgliche Option zur Behandlung einzelner Metastasen und ein optimaler Kombinationspartner in der Therapie oligometastasierter Tumorstadien.

Intensity-modulated radiotherapy (IMRT) techniques are now standard practice. IMRT or volumetric-modulated arc therapy (VMAT) allow treatment of the tumor while simultaneously sparing organs at risk. Nevertheless, treatment plan quality still depends on the physicist’s individual skills, experiences, and personal preferences. It would therefore be advantageous to automate the planning process. This possibility is offered by the Pinnacle3 treatment planning system (Philips Healthcare, Hamburg, Germany) via its scripting language or Auto-Planning (AP) module. AP module results were compared to in-house scripts and manually optimized treatment plans for standard head and neck cancer plans. Multiple treatment parameters were scored to judge plan quality (100 points = optimum plan). Patients were initially planned manually by different physicists and re-planned using scripts or AP. Script-based head and neck plans achieved a mean of 67.0 points and were, on average, superior to manually created (59.1 points) and AP plans (62.3 points). Moreover, they are characterized by reproducibility and lower standard deviation of treatment parameters. Even less experienced staff are able to create at least a good starting point for further optimization in a short time. However, for particular plans, experienced planners perform even better than scripts or AP. Experienced-user input is needed when setting up scripts or AP templates for the first time. Moreover, some minor drawbacks exist, such as the increase of monitor units (+35.5% for scripted plans). On average, automatically created plans are superior to manually created treatment plans. For particular plans, experienced physicists were able to perform better than scripts or AP; thus, the benefit is greatest when time is short or staff inexperienced.

Intensity-modulated radiotherapy (IMRT) techniques are now standard practice. IMRT or volumetric-modulated arc therapy (VMAT) allow treatment of the tumor while simultaneously sparing organs at risk. Nevertheless, treatment plan quality still depends on the physicist's individual skills, experiences, and personal preferences. It would therefore be advantageous to automate the planning process. This possibility is offered by the PinnacleAP module results were compared to in-house scripts and manually optimized treatment plans for standard head and neck cancer plans. Multiple treatment parameters were scored to judge plan quality (100 points = optimum plan). Patients were initially planned manually by different physicists and re-planned using scripts or AP.Script-based head and neck plans achieved a mean of 67.0 points and were, on average, superior to manually created (59.1 points) and AP plans (62.3 points). Moreover, they are characterized by reproducibility and lower standard deviation of treatment parameters. Even less experienced staff are able to create at least a good starting point for further optimization in a short time. However, for particular plans, experienced planners perform even better than scripts or AP. Experienced-user input is needed when setting up scripts or AP templates for the first time. Moreover, some minor drawbacks exist, such as the increase of monitor units (+35.5% for scripted plans).On average, automatically created plans are superior to manually created treatment plans. For particular plans, experienced physicists were able to perform better than scripts or AP; thus, the benefit is greatest when time is short or staff inexperienced.