Impact of using different radiation therapy techniques in breat cancer: contralateral breast dose

RESUMO: O cancro de mama e o mais frequente diagnoticado a indiv duos do sexo feminino. O conhecimento cientifico e a tecnologia tem permitido a cria ção de muitas e diferentes estrat egias para tratar esta patologia. A Radioterapia (RT) est a entre as diretrizes atuais para a maioria dos tratamentos de cancro de mama. No entanto, a radia ção e como uma arma de dois canos: apesar de tratar, pode ser indutora de neoplasias secund arias. A mama contralateral (CLB) e um orgão susceptivel de absorver doses com o tratamento da outra mama, potenciando o risco de desenvolver um tumor secund ario. Nos departamentos de radioterapia tem sido implementadas novas tecnicas relacionadas com a radia ção, com complexas estrat egias de administra ção da dose e resultados promissores. No entanto, algumas questões precisam de ser devidamente colocadas, tais como: E seguro avançar para tecnicas complexas para obter melhores indices de conformidade nos volumes alvo, em radioterapia de mama? O que acontece aos volumes alvo e aos tecidos saudaveis adjacentes? Quão exata e a administração de dose? Quais são as limitações e vantagens das técnicas e algoritmos atualmente usados? A resposta a estas questões e conseguida recorrendo a m etodos de Monte Carlo para modelar com precisão os diferentes componentes do equipamento produtor de radia ção(alvos, ltros, colimadores, etc), a m de obter uma descri cão apropriada dos campos de radia cão usados, bem como uma representa ção geometrica detalhada e a composição dos materiais que constituem os orgãos e os tecidos envolvidos. Este trabalho visa investigar o impacto de tratar cancro de mama esquerda usando diferentes tecnicas de radioterapia f-IMRT (intensidade modulada por planeamento direto), IMRT por planeamento inverso (IMRT2, usando 2 feixes; IMRT5, com 5 feixes) e DCART (arco conformacional dinamico) e os seus impactos em irradia ção da mama e na irradia ção indesejada dos tecidos saud aveis adjacentes. Dois algoritmos do sistema de planeamento iPlan da BrainLAB foram usados: Pencil Beam Convolution (PBC) e Monte Carlo comercial iMC. Foi ainda usado um modelo de Monte Carlo criado para o acelerador usado (Trilogy da VARIAN Medical Systems), no c odigo EGSnrc MC, para determinar as doses depositadas na mama contralateral. Para atingir este objetivo foi necess ario modelar o novo colimador multi-laminas High- De nition que nunca antes havia sido simulado. O modelo desenvolvido est a agora disponí vel no pacote do c odigo EGSnrc MC do National Research Council Canada (NRC). O acelerador simulado foi validado com medidas realizadas em agua e posteriormente com c alculos realizados no sistema de planeamento (TPS).As distribui ções de dose no volume alvo (PTV) e a dose nos orgãos de risco (OAR) foram comparadas atrav es da an alise de histogramas de dose-volume; an alise estati stica complementar foi realizadas usando o software IBM SPSS v20. Para o algoritmo PBC, todas as tecnicas proporcionaram uma cobertura adequada do PTV. No entanto, foram encontradas diferen cas estatisticamente significativas entre as t ecnicas, no PTV, nos OAR e ainda no padrão da distribui ção de dose pelos tecidos sãos. IMRT5 e DCART contribuem para maior dispersão de doses baixas pelos tecidos normais, mama direita, pulmão direito, cora cão e at e pelo pulmão esquerdo, quando comparados com as tecnicas tangenciais (f-IMRT e IMRT2). No entanto, os planos de IMRT5 melhoram a distribuição de dose no PTV apresentando melhor conformidade e homogeneidade no volume alvo e percentagens de dose mais baixas nos orgãos do mesmo lado. A t ecnica de DCART não apresenta vantagens comparativamente com as restantes t ecnicas investigadas. Foram tamb em identi cadas diferen cas entre os algoritmos de c alculos: em geral, o PBC estimou doses mais elevadas para o PTV, pulmão esquerdo e cora ção, do que os algoritmos de MC. Os algoritmos de MC, entre si, apresentaram resultados semelhantes (com dferen cas at e 2%). Considera-se que o PBC não e preciso na determina ção de dose em meios homog eneos e na região de build-up. Nesse sentido, atualmente na cl nica, a equipa da F sica realiza medi ções para adquirir dados para outro algoritmo de c alculo. Apesar de melhor homogeneidade e conformidade no PTV considera-se que h a um aumento de risco de cancro na mama contralateral quando se utilizam t ecnicas não-tangenciais. Os resultados globais dos estudos apresentados confirmam o excelente poder de previsão com precisão na determinação e c alculo das distribui ções de dose nos orgãos e tecidos das tecnicas de simulação de Monte Carlo usados.---------ABSTRACT:Breast cancer is the most frequent in women. Scienti c knowledge and technology have created many and di erent strategies to treat this pathology. Radiotherapy (RT) is in the actual standard guidelines for most of breast cancer treatments. However, radiation is a two-sword weapon: although it may heal cancer, it may also induce secondary cancer. The contralateral breast (CLB) is a susceptible organ to absorb doses with the treatment of the other breast, being at signi cant risk to develop a secondary tumor. New radiation related techniques, with more complex delivery strategies and promising results are being implemented and used in radiotherapy departments. However some questions have to be properly addressed, such as: Is it safe to move to complex techniques to achieve better conformation in the target volumes, in breast radiotherapy? What happens to the target volumes and surrounding healthy tissues? How accurate is dose delivery? What are the shortcomings and limitations of currently used treatment planning systems (TPS)? The answers to these questions largely rely in the use of Monte Carlo (MC) simulations using state-of-the-art computer programs to accurately model the di erent components of the equipment (target, lters, collimators, etc.) and obtain an adequate description of the radiation elds used, as well as the detailed geometric representation and material composition of organs and tissues. This work aims at investigating the impact of treating left breast cancer using di erent radiation therapy (RT) techniques f-IMRT (forwardly-planned intensity-modulated), inversely-planned IMRT (IMRT2, using 2 beams; IMRT5, using 5 beams) and dynamic conformal arc (DCART) RT and their e ects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB TPS were used: Pencil Beam Convolution (PBC)and commercial Monte Carlo (iMC). Furthermore, an accurate Monte Carlo (MC) model of the linear accelerator used (a Trilogy R VARIANR) was done with the EGSnrc MC code, to accurately determine the doses that reach the CLB. For this purpose it was necessary to model the new High De nition multileaf collimator that had never before been simulated. The model developed was then included on the EGSnrc MC package of National Research Council Canada (NRC). The linac was benchmarked with water measurements and later on validated against the TPS calculations. The dose distributions in the planning target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all the techniques provided adequate coverage of the PTV. However, statistically significant dose di erences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung, heart and even the left lung than tangential techniques (f-IMRT and IMRT2). However,IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Di erences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the MC algorithms predicted. The MC algorithms presented similar results (within 2% di erences). The PBC algorithm was considered not accurate in determining the dose in heterogeneous media and in build-up regions. Therefore, a major e ort is being done at the clinic to acquire data to move from PBC to another calculation algorithm. Despite better PTV homogeneity and conformity there is an increased risk of CLB cancer development, when using non-tangential techniques. The overall results of the studies performed con rm the outstanding predictive power and accuracy in the assessment and calculation of dose distributions in organs and tissues rendered possible by the utilization and implementation of MC simulation techniques in RT TPS.

GEMINI near-infrared spectroscopic observations of young massive stars embedded in molecular clouds

K-band spectra of young stellar candidates in four Southern hemisphere clusters have been obtained with the Gemini Near-Infrared Spectrograph in Gemini South. The clusters are associated with IRAS sources that have colours characteristic of ultracompact H II regions. Spectral types were obtained by comparison of the observed spectra with those of a near-infrared (NIR) library; the results include the spectral classification of nine massive stars and seven objects confirmed as background late-type stars. Two of the studied sources have K-band spectra compatible with those characteristic of very hot stars, as inferred from the presence of C IV, N III and N V emission lines at 2.078, 2.116 and 2.100 mu m, respectively. One of them, I16177_IRS1, has a K-band spectrum similar to that of Cyg OB2 7, an O3If* supergiant star. The nebular K-band spectrum of the associated Ultra-Compact (UC) H II region shows the s-process [Kr III] and [Se IV] high excitation emission lines, previously identified only in planetary nebula. One young stellar object was found in each cluster, associated with either the main IRAS source or a nearby resolved Midecourse Space eXperiment (MSX) component, confirming the results obtained from previous NIR photometric surveys. The distances to the stars were derived from their spectral types and previously determined JHK magnitudes; they agree well with the values obtained from the kinematic method, except in the case of IRAS 15408-5356, for which the spectroscopic distance is about a factor of 2 smaller than the kinematic value.

The globular cluster kinematics and galaxy dark matter content of NGC 3923

This paper presents further results from our spectroscopic study of the globular cluster (GC) system of the group elliptical NGC 3923. From observations made with the GMOS instrument on the Gemini South Telescope, an additional 50 GC and ultra-compact dwarf (UCD) candidates have been spectroscopically confirmed as members of the NGC 3923 system. When the recessional velocities of these GCs are combined with the 29 GC velocities reported previously, a total sample of 79 GC/UCD velocities is produced. This sample extends to over 6 arcmin (>6 R-e similar to 30 kpc) from the centre of NGC 3923 and is used to study the dynamics of the GC system and the dark matter content of NGC 3923. It is found that the GC system of NGC 3923 displays no appreciable rotation, and that the projected velocity dispersion is constant with radius within the uncertainties. The velocity dispersion profiles of the integrated light and GC system of NGC 3923 are indistinguishable over the region in which they overlap. We find some evidence that the diffuse light and GCs of NGC 3923 have radially biased orbits within similar to 130 arcsec. The application of axisymmetric orbit-based models to the GC and integrated light velocity dispersion profiles demonstrates that a significant increase in the mass-to-light ratio (from M/L-V = 8 to 26) at large galactocentric radii is required to explain this observation. We therefore confirm the presence of a dark matter halo in NGC 3923. We find that dark matter comprises 17.5(-4.5)(+7.3) per cent of the mass within 1 R-e, 41.2(-10.6)(+18.2) per cent within 2 R-e and 75.6(-16.8)(+15.4) per cent within the radius of our last kinematic tracer at 6.9 R-e. The total dynamical mass within this radius is found to be 1.5(-0.25)(+0.4) x 10(12) M-circle dot. In common with other studies of large ellipticals, we find that our derived dynamical mass profile is consistently higher than that derived by X-ray observations, by a factor of around 2.

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Cardiac chymase: pathophysiological role and therapeutic potential of chymase inhibitors

On release from cardiac mast cells, alpha-chymase converts angiotensin I (Ang I) to Ang II. In addition to Ang II formation, alpha-chymase is capable of activating TGF-beta 1 and IL-1 beta, forming endothelins consisting of 31 amino acids, degrading endothelin-1, altering lipid metabolism, and degrading the extracellular matrix. Under physiological conditions the role of chymase in the mast cells of the heart is uncertain. In pathological situations, chymase may be secreted and have important effects on the heart. Thus, in animal models of cardiomyopathy, pressure overload, and myocardial infarction, there are increases in both chymase mRNA levels and chymase activity in the heart. In human diseased heart homogenates, alterations in chymase activity have also been reported. These findings have raised the possibility that inhibition of chymase may have a role in the therapy of cardiac disease. The selective chymase inhibitors developed to date include TY-51076, SUN-C8257, BCEAB, NK320, and TEI-E548. These have yet to be tested in humans, but promising results have been obtained in animal models of myocardial infarction, cardiomyopathy, and tachycardia-induced heart failure. It seems likely that orally active inhibitors of chymase could have a place in the treatment of cardiac diseases where injury-induced mast cell degranulation contributes to the pathology.

Fossil biotas from the Okanagan Highlands, southern British Columbia and northeastern Washington State: climates and ecosystems across an Eocene landscape

The late Early to early Middle Eocene Okanagan Highlands fossil sites, spanning -1000 km north-south (northeastern Washington State, southern British Columbia) provide an opportunity to reconstruct biotic communities across a broad upland landscape during the warmest part of the Cenozoic. Plant taxa from these fossil sites are characteristic of the modern eastern North American deciduous forest zone, principally the mixed mesophytic forest, but also include extinct taxa, taxa known only from eastern Asian mesothermal forests, and a small number of taxa restricted to the present-day North American west coast coniferous biome. In this preliminary report, paleoclimates and forest types are reconstructed using collections from Republic in Washington State, USA., and Princeton, Quilchena, Falkland, McAbee, Hat Creek, Horsefly, and Driftwood Canyon in British Columbia, Canada. Both leaf margin analysis (LMA) and quantitative bioclimatic analysis of identified nearest living relatives of megaflora indicated upper microthermal to lower mesothermal moist environments (MAT -10-15 degrees C, CMMT > 0 degrees C, MAP > 100 cm/year). Some taxa common to most sites suggest cool conditions (e.g., Abies, other Pinaceae; Alnus, other Betulaceae). However, all floras contain a substantive broadleaf deciduous element (e.g., Fagaceae, Juglandaceae) and conifers (e.g., Metasequoia) with the bioclimatic analysis yielding slightly higher MAT than LMA. Thermophilic (principally mesothermal) taxa include various insects, the aquatic fern Azolla, palms, the banana relative Ensete, taxodiaceous conifers, Eucommia and Gordonia, taxa which may have occurred near their climatic limits. The mixture of thermophilic and temperate insect and plant taxa indicates low-temperature seasonality (i.e., highly equable climate).

Incentive-based approaches to sustainable fisheries

The failures of traditional target-species management have led many to propose an ecosystem approach to fisheries to promote sustainability. The ecosystem approach is necessary, especially to account for fishery-ecosystem interactions, but by itself is not sufficient to address two important factors contributing to unsustainable fisheries: inappropriate incentives bearing on fishers and the ineffective governance that frequently exists in commercial, developed fisheries managed primarily by total-harvest limits and input controls. We contend that much greater emphasis must be placed on fisher motivation when managing fisheries. Using evidence from more than a dozen natural experiments in commercial fisheries, we argue that incentive-based approaches that better specify community and individual harvest or territorial rights and price ecosystem services and that are coupled with public research, monitoring, and effective oversight promote sustainable fisheries.

Application of stable isotope analysis to differentiate shrimp extracted by industrial fishing or produced through aquaculture practices.

Carbon and nitrogen stable isotope values were determined in Pacific white shrimp (Litopenaeus vannamei) with the objective of discriminating animals produced through aquaculture practices from those extracted from the wild. Farmed animals were collected at semi-intensive shrimp farms in Mexico and Ecuador. Fisheries-derived shrimps were caught in different fishing areas representing two estuarine systems and four open sea locations in Mexico and Ecuador. Carbon and nitrogen stable isotope values (13CVPDB and 15NAIR) allowed clear differentiation of wild from farmed animals. 13CVPDB and 15NAIR values in shrimps collected in the open sea were isotopically enriched (−16.99‰ and 11.57‰), indicating that these organisms belong to higher trophic levels than farmed animals. 13CVPDB and 15NAIR values of farmed animals (−19.72‰ and 7.85‰, respectively) partially overlapped with values measured in animals collected in estuaries (−18.46‰ and 5.38‰, respectively). Canonical discriminant analysis showed that when used separately and in conjunction, 13CVPDB and I5NAIR values were powerful discriminatory variables and demonstrate the viability of isotopic evaluations to distinguish wild-caught shrimps from aquaculture shrimps. Methodological improvements will define a verification tool to support shrimp traceability protocols.

Produção e avaliação de materiais de referência para nutrientes e contaminantes inorgânicos em amostras agronômicas.

A intensa busca por confiabilidade de resultados torna cada vez mais importante o papel dos materiais de referência, principalmente em química analítica, pois fornecem referências metrológicas visando assegurar a rastreabilidade de medições e ainda são fundamentais para a validação de métodos analíticos. O aumento da demanda por novos materiais de referência é gradativo em todas as áreas do conhecimento, porém os setores agropecuários e de alimentos estão entre os mais carentes. No Brasil, essa demanda é atendida somente pela importação do material a custos elevados, sendo freqüente a inexistência de materiais adequados às necessidades do país. Nesse contexto, o presente trabalho visou à produção de material de referência para nutrientes e contaminantes inorgânicos em fosfato de rocha, matéria-prima utilizada para a fabricação de fertilizantes. O material foi produzido seguindo as seguintes etapas, estabelecidas internacionalmente pelas ISO GUIAS 30 a 35: preparo e envase do material, avaliação da homogeneidade, teste de estabilidade a curto e a longos períodos e na caracterização prévia, que consistiu na montagem do ensaio colaborativo, com a distribuição do material preparado a laboratórios que se dispuseram a colaborar com o projeto. Ainda foram realizados estudos voltados ao preparo da amostra visando a rapidez e redução de uso de reagentes. A avaliação da estimativa da massa mínima, da homogeneidade e da estabilidade do material foi realizada utilizando-se como técnica de determinação a espectrometria de emissão óptica com plasma indutivamente acoplado (ICP OES). Para a determinação de fósforo foi avaliado o emprego de espectrometria de emissão com plasma induzida por laser (LIBS). Os resultados foram submetidos à análise de variância de fator único (ANOVA) e a homogeneidade e a estabilidade do material apresentaram médias dentro do intervalo de confiança de 95%. Os resultados obtidos durante o preparo e através do ensaio colaborativo possibilitaram a caracterização química e o calculo das incertezas relativas a cada etapa do preparo do material, sendo elaborada a carta controle com os resultados do material de referência e as incertezas expandidas para cada um dos analitos em estudo. Parte do trabalho foi desenvolvido junto ao National Research Council Canada (NRCC) em Ottawa no Canadá, onde foi avaliada a aplicabilidade do sistema de combustão iniciada por radiação microondas no preparo de amostras de materiais de referência nacionais anteriormente preparados, fígado bovino (RM-Agro E3001a) e forrageira (RM-Agro E1001a), para a determinação de As, Cd, Cu e Pb por espectrometria de massas com plasma indutivamente acoplado (ICP-MS), sendo obtidos resultados que poderão ser aplicados em outros materiais orgânicos e inorgânicos.