Physica Medica: European Journal of Medical Physics - Volume 32 - Supplement 1 - February 2016

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minimum (Tmin) temperature parameters were recorded during hyper-
thermia treatment. The treatment goal was to reach 40–42 °C in >90% (T90)
of measured points for a duration of 60 minutes. Toxicity was evaluated
according to the CTCAE criteria. Local control was assessed on the basis of
the RECIST criteria.
Results: During hyperthermia treatment the median temperature [range]
reached was 40.5 °C [39–42.9 °C]. 2 patients (10%) had G3 toxicity and one
of these interrupted the treatment. One patient had acute cutaneous tox-
icity >G3 at 1 month. No patients had toxicity >G2 at 3 months, 2 patients
had G2 at 6 months, 5 patients had G2 toxicity at 12 months. The mean
follow-up was 15 months (range 4–43 months). 6 patients (21%) had a com-
plete response (CR), 13 patients (45%) had a partial response (PR), 7 patients
(24%) had a stable disease (SD) and 3 patients (10%) had progression disease
(PD). Univariate analysis showed that Tmean, Tmax, Tmin, and T90 pa-
rameters were not associated with local control rate.
Conclusion: Our results show that RT-HT is a useful combined treatment
with a good local control rate and a very high patient compliance.
A.62
SR-EBRT: SYNCHROTRON RADIATION EXTERNAL BEAM ROTATIONAL
RADIOTHERAPY FOR BREAST CANCER TREATMENT
P. De Lucia G. Mettivier F. Di Lillo A. Sarno P. Russ a Università
degli Studi di Napoli Federico II, Napoli, Italy; b Istituto Nazionale di Fisica
Nucleare, Napoli, Italy
Introduction: Computed tomography systems dedicated to X-ray imaging
of the breast (breast CT, or BCT) for cancer screening and diagnosis have
been developed by several groups to overcome the limits of 2D mammog-
raphy. In these scanners, the woman is prone on a table with an opening,
and each breast, in pendant position, is imaged separately. In 2012, the UC
Davis group (J. Boone) proposed the inclusion in the BCT platform of a system
for image-guided external beam radiotherapy (EBRT). They proposed the
use of the 360°-rotational summation of a collimated X-ray beam from a
320-kVp orthovoltage X-ray tube to deliver the therapeutic dose, instead
of the typical 6-MV photon beam with breast tangential fields produced
by a clinical linear accelerator. Advantages are expected for dose reduc-
tion to non-breast organs, possibility of real-time imaging, absence of patient
repositioning error in fraction dose delivery, and reduced cost of the pro-
cedure. We propose to implement EBRT in breast cancer therapy using a
monochromatic synchrotron radiation (SR) beam and dedicated setup for
irradiating the pendant breast (SR-EBRT). The same platform could be
adopted for BCT for tumor 3D localization and beam centering.
Materials and methods: For validating this technique, we developed a dedi-
cated Geant4 Monte Carlo simulation code, by comparison with literature
and measured data with a polychromatic X-ray beam.
Results: Simulations to study optimal energy and geometry indicate a 7:1
to 10:1 tumor-to-skin ratio from 60 keV to 185 keV and the possibility of
realizing dose-painting by multiple rotations.
Conclusion: A SR beam down to 60 keV can be adopted for SR-EBRT of breast
cancer, with a skin sparing factor (dose to the skin divided by dose to the
tumor) close to that of orthovoltage EBRT at 320 kVp. SR-EBRT at low energy
(60–80 keV) might be coupled to gold nanoparticle injection for dose-
enhanced breast SR-EBRT and to BCT for image-guided radiotherapy.
A.63
A MULTIMODALITY RADIOTHERAPY TESTED NETWORK PLATFORM FOR
REVIEW OF ULTRASOUND IMAGES
F. Di Rosa *, R. Costa, D. Sardina, G. Politi. Azienda Sanitaria Provinciale di
Caltanissetta, Caltanissetta, Italy
Introduction: In the recent past, we have designed and implemented a
network infrastructure to perform a real time connection and communi-
cation for the full management of two radiotherapy facilities, located in
distant geographical areas, of the same Department. All aspects of radio-
therapy (RT) treatment involve multimodality imaging techniques especially
in co-registration methods. Ultrasound (US) imaging provides real-time vol-
umetric information for target localization and verification in an image
guided radiation treatment. The application of our homemade server in-
frastructure (i.e. RT PACS), embedded with programmable SQL database,
has been extended to ultrasonography.
Materials and methods: We have tested the compatibility and the coher-
ence of data between our RT PACS and US DICOM format using the images
of US quality control (US-QC) procedures. Moreover, exploiting the poten-
tial of the RT network, we have interconnected our systemwith two analysis
software of US-QC: QA4US (freeware) and ULTRA IQ (Clinical Physics Lab)
employing acquired images of 040GSE Multi-Purpose CIRS Phantom.
Results: A full management and a complete support for US DICOM format
is achieved. TIFF, AVI and DICOM formats are compatible with our RT PACS
making it a DICOM ready system. The collaboration platform is available
on entire Hospital local area network and all data can be shared and dis-
tributed for valuating, reviewing and approving. The installation of
semiautomatic software for US-QC in our server has simplified quality as-
surance procedures providing a useful, shareable and time sparing tool of
images analysis.
Conclusions: Our platform represents an innovative, easy and reasonable
solution for Medical Physics data distribution. The system update has made
feasible the implementation and optimization of a quality assurance program
for echotomography too.
We are going to upgrade our tested system with a co-registration soft-
ware to manage and store all multimodal images in a RT Department.
A.64
RADIOTHERAPY IN BREAST CANCER WITH VOLUNTARY DEEP-
INSPIRATION BREATH-HOLD USING BRAINLAB EXACTRAC
D. Gaudino, G. Stimato, C. Di Venanzio *, A. Mameli, E. Infusino, L. Bellesi,
E. Ippolito, S. Silipigni, C. Rinaldi, S. Ramella, L. Trodella,
R.M. D’Angelillo. Università Campus Bio-Medico, Roma, Italy
Introduction: The aim of this study is to estimate the heart, lung and PTV
dosimetric constraints and the reproducibility of the treatment in left-
sided breast cancer with voluntary deep-inspiration breath-hold technique
(vDIBH) for adjuvant radiotherapy (RT).
Materials and methods: 10 women were enrolled and were shortly trained
before simulation CT-scan to hold their breath. The first scan was ac-
quired in free-breathing (FB_CT) and the second one in vDIBH (vDIBH_CT).
Target and OAR volumes were delineated and computerized treatment plan-
ning was performed in both CT scans. We compared the dose distribution
for the heart, left anterior descending coronary artery (LAD), ipsilateral lung
and PTV using mean dose and maximal dose applied to the LAD; percent-
age of the heart volume receiving at least 5 Gy (V5 Gy) and 10 Gy (V10
Gy); percentage of the ipsilateral lung volume receiving at least 20 Gy (V20
Gy). Wilcoxon test has been used to compare dosimetric parameters. The
online monitoring during EPI acquisition and treatment was made by
BrainLab Exactrac system. Daily real time (EPI), in CINE modality, was per-
formed in order to check the reproducibility of the technique. The mean
displacement was calculated for each treatment beam and for each patient.
Results: A significant reduction in heart V5 and LAD Dmax (2.71 vs 0.99 Gy
p = 0.02 and 16.56 vs 6.90 Gy p = 0.012 respectively) parameters was re-
corded for vDIBH_CT treatment plans. There were no significant differences
between vDIBH and FB treatments in lung dosimetric parameters and PTV
coverage. 1694 portal images were evaluated. During treatment, the mean
displacements observed in the longitudinal, vertical and lateral direction
were 0.132 mm (SD = 0.011), 0.013 mm (SD = 0.137), 0.116 mm (SD = 0.010).
Conclusion: vDIBH technique reduces cardiac irradiation compared with
conventional FB treatment plans. vDBIH technique can be accurately imple-
mented using BrainLab Exactrac system with high and accurate
reproducibility (mean shift < 0.15 mm).
e19 Abstracts/Physica Medica 32 (2016) e1–e70