PurposeThe main purpose of this work was to compare peripheral doses absorbed during stereotactic treatment of a brain lesion delivered using different devices. These data were used to estimate the risk of stochastic effects.MethodsTreatment plans were created for an anthropomorphic phantom and delivered using a LINAC with stereotactic cones and a multileaf collimator, a CyberKnife® system (before and after a supplemental shielding was applied), a TomoTherapy® system, and a Gamma Knife® unit. For each treatment, 5 Gy were prescribed to the target. Measurements were performed with thermoluminescent dosimeters inserted roughly in the position of the thyroid, sternum, upper lung, lower lung, and gonads.ResultsMean doses ranged from of 4.1 (Gamma Knife) to 62.8 mGy (LINAC with cones) in the thyroid, from 2.3 (TomoTherapy) to 30 mGy (preshielding CyberKnife) in the sternum, from 1.7 (TomoTherapy) to 20 mGy (preshielding CyberKnife) in the upper part of the lungs, from 0.98 (Gamma Knife) to 15 mGy (preshielding CyberKnife) in the lower part of the lungs, and between 0.3 (Gamma Knife) and 10 mGy (preshielding CyberKnife) in the gonads.ConclusionsThe peripheral dose absorbed in the sites of interest with a 5 Gy fraction is low. Although the risk of adverse side effects calculated for 20 Gy delivered in 5 Gy fractions is negligible, in the interest of optimum patient radioprotection, further studies are needed to determine the weight of each contributor to the peripheral dose.

The administration of 45 MBq/kg of (90)Y ibritumomab tiuxetan to 4 patients with stem cell autografting was free from extramedullary toxicity. This is in agreement with both organ doses and BEDs below the corresponding toxicity thresholds. For these clinical and dosimetric reasons, a further increase in injectable activity could have been conceivable. If the more appropriate BED parameter were chosen for toxicity limit calculations, a wider margin of increase would have been possible. Our theoretical investigation demonstrates that, in this particular case of (90)Y Zevalin therapy, the uncertainty about radiobiological parameters was not a limiting factor for a BED-based calculation of the maximum injectable activity.

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Lung cancer is the main cause of cancer-related death in the world. Non-small cell lung cancer (NSCLC) accounts for the predominance of lung cancers, in more than half of cases NSCLC' patients are already locally advanced to diagnosis. The therapeutic approach in this stage of disease is complicated and it is therefore essential to manage it in a multidisciplinary context. Surgery remains the therapy of choice, but not all patients have operable disease. For resectable patients, a multimodal approach that involves, in addition to surgery, also systemic and radiation therapy (RT), improves treatment outcomes. The treatment of choice for patients not susceptible to surgery is radiotherapy concomitant with chemotherapy.Implementation in RT techniques, the reduction of the treatment volume with the integration of targeted therapy could lead, in the future, to further improvement in local control (LC) overall survival (OS) results.RT therefore comes into play in almost all locally advanced patients. The aim of this article is to describe the role of RT with curative intent in this setting of patients.