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Some receptors remain unoccupied even when an agonist produces a maximal response. Such empty ones are called spare receptors. In presence of spare receptors the maximum effect of an agonist drug is achieved with fewer than 100% of the receptors being occupied. To determine the presence of spare receptors, scientists often compare the concentration of the drug needed to produce 50% of the maximum effect (EC50) with the concentration of the drug needed to occupy 50% of the receptors (Kd). If the...
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A nursing care plan can present in two forms: informal and formal. Informal is a care plan for the individual use of the nurse and goals they wish to accomplish during their shift. Informal care plans are not included in the patient chart. A formal nursing care plan is a written or computerized guide that organizes patient care. It is further subdivided into two: standardized and individualized care plans. Standardized care plans are pre-populated care plans for specific patient populations,...
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4π plan optimization for cortical-sparing brain radiotherapy.

Vyacheslav L Murzin1, Kaley Woods2, Vitali Moiseenko1

  • 1Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|March 10, 2018
PubMed
Summary
This summary is machine-generated.

4π radiotherapy significantly improves brain sparing and reduces radiation dose to normal tissues compared to standard IMRT. This approach may decrease the likelihood of cognitive decline by reducing cortical atrophy.

Keywords:
Brain sparingCortical atrophyIntracranial radiotherapyNTCPNon-coplanar IMRT

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Area of Science:

  • Radiation Oncology
  • Neuro-oncology
  • Medical Physics

Background:

  • Incidental irradiation of normal brain tissue during radiotherapy can lead to cognitive decline.
  • Damage to the healthy cortex is a potential mechanism for this cognitive impairment.
  • Non-coplanar radiotherapy techniques offer potential for cortical sparing.

Purpose of the Study:

  • To compare normal brain sparing and the probability of cortical atrophy between 4π radiation therapy planning and standard fixed-gantry intensity-modulated radiotherapy (IMRT).

Main Methods:

  • Re-planning of 13 brain tumor patients' original IMRT plans using 4π optimization and optimized IMRT.
  • Comparison of homogeneity index, gradient measure, and doses to organs at risk (OARs) including cortex, white matter, brainstem, optics, and hippocampus.
  • Modeling the probability of cortical atrophy based on established dose-response curves.

Main Results:

  • 4π significantly improved homogeneity index and gradient measure compared to optimized IMRT.
  • 4π reduced doses to OARs, including a 14-15% reduction in hippocampal equivalent uniform dose (EUD).
  • 4π significantly decreased the probability of cortical atrophy (grades 1-3) compared to both original and optimized IMRT.

Conclusions:

  • 4π radiotherapy enhances cortical sparing and reduces radiation doses to critical brain structures and white matter.
  • Superior dose homogeneity in 4π planning contributes to improved OAR sparing.
  • Reduced radiation dose to the cortex with 4π may lower the incidence of cortical atrophy and subsequent cognitive decline.