BackgroundPainful plantar heel spur (PPHS) is a benign disorder with painful heels as a result of plantar calcaneal bone spur. Exact etiological factors are still unclear. Treatment typically consists of osteoarthritis tretment schedules and surgical techniques. External radiotherapy is another treatment option. This study is aimed to determine effectiveness and treatment outcomes of external radiotherapy in patients with PPHS.MethodsSixty-two patients with PPHS were analysed for radiotherapy success and other possible prognostic factors. All patients were treated with Co-60 units from parallel opposed lateral portals, to a total dose of 8 Gy. Responses to radiotherapy was assessed by visual analogue scale (VAS) of pain. Follow-up completed in December 2012 with 28 months median duration (range 22 to 35 months). Age, sex, patient number, spur settlement site, prior treatments, time interval between diagnosis and radiotherapy, pain scores (before and after radiotherapy), plantar fat-pillow thickness (PFPT; thickness of the plantar fat pad) and Böhler’s angle estimations were analysed.ResultsStudy included 53 female and 9 male patients with median age 57 (range 43–70). Time interval between PPHS diagnosis and radiotherapy were median 33 months (range10-60). Radiotherapy response time interval were 6 months (range 3–10 months). Responses to radiotherapy were no response in 13 patients (21%), partial response in 13 patients (21%)- pain relief below 50% and complete response - no pain in 36 patients (58%) respectively. Median PFPT of patients were 3.5 cm (range 1.20–4.50 cm). Complete response rate was statistically significant in patients whom PFPT is greater than 3.5 cm. The Böhler’s angle range is about 20–40 deg. Complete response rates were higher in patients with degree of Böhler’s Angle 30 and below.ConclusionsSimplicity of treatment, lack of acute adverse effects and low cost, seem to make radiotherapy one of the safest, cheapest and also an effective treatment modality for PPHS.

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IntroductionAmeloblastoma is a benign but locally aggressive tumor of odontogenic epithelial tissue. Reports of radiotherapy treatment modalities are limited in the literature.Case presentationA thirty-five year old male presented with complaints of headache radiating to his face for about six months and impaired vision. The patient’s Positron Emission Tomography (PET) showed a mass in the left maxillary sinus extending to the nasal cavity and invading the adjacent tissues. An R2 (macroscopic residual tumor) surgical resection performed to debulk the tumor. Due to the recurrence and residual mass, the patient was treated with helical tomotherapy. At 2 months post-radiotherapy, patient’s vision returned to normal. PET scan showed a significant reduction in lesion size 12 months post-radiation.ConclusionIn cases of ameloblastic carcinoma with, post-surgical recurrence or patients not suitable for surgical treatment, helical tomotherapy can be an effective treatment option.

Background: Despite advances in radiotherapy, overall survival of glioblastoma multiforme (GBM) patients is still poor. Moreover dosimetrical analyses with these newer treatment methods are insufficient. The current study is aimed to compare intensity modulated radiation therapy (IMRT) linear accelerator (linac) and helical tomotherapy (HT) treatment plans for patients with prognostic aggressive brain tumors. Material and Methods: A total of 20 GBM patient plans were prospectively evaluated in both linac and HT planning systems. Plans are compared with respect to homogenity index, conformity index and organs at risk (OAR) sparing effects of the treatments. Results: Both treatment plans provided good results that can be applied to GBM patients but it was concluded that if the critical organs with relatively lower dose constraints are closer to the target region, HT for radiotherapeutical application could be preferred. Conclusion: Tomotherapy plans were superior to linear accelerator plans from the aspect of OAR sparing with slightly broader low dose ranges over the healthy tissues. In case a clinic has both of these IMRT systems, employment of HT is recommended based on the observed results and future re-irradiation strategies must be considered.

This study aims to evaluate inter-fractional set-up errors in patients treated with distinct immobilization equipment (thermoplastic mask, knee-fix and feet-fix, wing board and vac-lok) for four anatomical regions including brain, head and neck (HN), thorax and pelvis. Data of randomly selected 140 patients who were treated for four anatomical regions were obtained using Hi-Art Helical Tomotherapy (HT) system. Pre-treatment planning was based on automatic registration readings of computed tomography (CT) and mega-voltage computed tomography (MVCT) on a daily basis. Distinct immobilization equipment was used for varying anatomical regions. Individual mean set-up error (M), systematic error (Σ), and random error (σ) values were calculated through daily translational and rotational deviation values. The size of translational, systematic and random error was 1.31 -4.93 mm for brain, 2.28 -4.88 mm for HN, 4.04 -9.90 mm for thorax, and 6.34 -14.68 mm for pelvis. Rotational values were as follows: 0.06˚ -0.73˚ for brain, 0.42˚ -0.6˚ for HN, 0.48˚ -1.14˚ for thorax and 0.65˚ -1.05˚ for pelvis. The highest translational, systematic and random error value was obtained from the pelvic regional. The highest standard and random error value in pitch and roll was produced in the rotational direction of the pelvis (0.05˚ and 0.71˚), while the highest error value in yaw was (1.14˚) produced from thorax. Inter-fractional set-up errors were most commonly produced in the pelvis, followed by thorax. Our study results suggest that the highest systematic and random errors are found for thorax and pelvis. Distinct immobilization equipment was important in these results. Safety margins around the clinical target volume (CTV) are changeable for different anatomical regions. A future work could be developed to new equipment for immobilization because of the reduced margins CTV.

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