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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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Bioavailability Study Design: Single Versus Multiple Dose Studies01:11

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Bioavailability studies are essential for understanding how a drug is absorbed, distributed, metabolized, and excreted in the body. These studies assess the extent and rate at which the active pharmaceutical agent becomes available at the site of action. The design of bioavailability studies can involve single-dose or multiple-dose regimens, each with distinct advantages and limitations.Single-dose studies are the preferred approach due to their simplicity and reduced drug exposure for...
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Assessing Body Temperature - Rectal01:27

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Rectal temperature measurement is considered the most precise method for assessing core body temperature and typically registers higher than oral temperature. For adults, the rectal thermometer should be inserted 1 to 1.5 inches into the rectum to obtain the most accurate reading.
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Sampling Plans01:23

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Sampling is a crucial step in analytical chemistry, allowing researchers to collect representative data from a large population. Common sampling methods include random, judgmental, systematic, stratified, and cluster sampling.
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Dose Size and Dosing Frequency: Determination Methods01:21

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Determining the optimal dose size and dosing frequency in pharmacotherapy is crucial for achieving therapeutic effectiveness while minimizing adverse effects. This article explores the methodologies employed in determining these parameters, focusing on their significance and interplay to tailor dosing regimens.Dose Size: Dose size refers to the amount of a drug administered in a single dose. It is determined based on the drug's pharmacodynamics and pharmacokinetics properties and...
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Determination of Multiple Dosing Parameters: Loading and Maintenance Doses01:25

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A loading dose is an essential pharmacological strategy to rapidly achieve the target plasma drug concentration necessary for an immediate therapeutic effect. This approach is especially critical for drugs characterized by slow absorption or extended half-lives, where delaying therapeutic plasma levels could compromise treatment outcomes. By administering a loading dose, clinicians ensure a prompt onset of drug action, even for agents with complex pharmacokinetic profiles.Achieving steady-state...
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Maximizing rectal dose sparing with hydrogel: A retrospective planning study.

Owen Paetkau1, Isabelle M Gagne1,2, Howard H Pai3,4

  • 1Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.

Journal of Applied Clinical Medical Physics
|March 20, 2019
PubMed
Summary

Optimizing radiation therapy for prostate cancer, using the rectal wall (RW) structure, significantly reduces rectal dose compared to the composite rectum wall (CRW). Volumetric modulated arc therapy (VMAT) further spares the bladder and penile bulb.

Keywords:
EBRTSpaceOARhydrogelprostaterectal sparing

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Prostate Cancer Treatment

Background:

  • External beam radiation therapy for prostate cancer can cause significant urinary, sexual, and rectal side effects, impacting patient quality of life.
  • SpaceOAR© hydrogel (SOH) is a polyethylene glycol-based product implanted between the prostate and rectum to reduce rectal radiation dose and toxicity.
  • Optimal management of hydrogel and rectal structures for treatment planning is crucial for maximizing rectal dose sparing.

Purpose of the Study:

  • To compare the effectiveness of different inverse optimization structures (rectal wall vs. composite rectum wall) and treatment techniques (IMRT vs. VMAT) in minimizing rectal dose during prostate cancer radiation therapy.
  • To evaluate the impact of these planning strategies on rectal dose-volume histogram (DVH) metrics.
  • To assess potential improvements in bladder and penile bulb dose sparing with different techniques.

Main Methods:

  • Retrospective analysis of computerized tomography (CT) scans from 13 prostate cancer patients before and after SpaceOAR© hydrogel implantation.
  • Generation of six treatment plans per patient using either rectal wall (RW) or composite rectum wall (CRW) as the optimization structure, combined with intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT).
  • Comparison of dose-volume histogram (DVH) metrics between plans to determine optimal structure and technique for rectal dose sparing.

Main Results:

  • Rectal wall (RW) structures resulted in a statistically significant decrease in rectal dose compared to composite rectum wall (CRW) structures.
  • The treatment technique (IMRT vs. VMAT) did not significantly impact rectal dose.
  • Volumetric modulated arc therapy (VMAT) demonstrated an improvement in sparing the bladder and penile bulb dose.

Conclusions:

  • Utilizing the rectal wall (RW) as the optimization structure in treatment planning significantly reduces rectal dose in prostate cancer patients treated with SpaceOAR© hydrogel.
  • Volumetric modulated arc therapy (VMAT) is associated with reduced bladder and penile bulb dose, offering potential benefits for sexual and urinary function.
  • These findings support the use of RW structures and VMAT for optimizing radiation therapy plans to minimize toxicity and improve quality of life in prostate cancer patients.