No abstract

The purpose of this paper is to demonstrate that an inexpensive 3D printer can be used to manufacture patient‐specific bolus for external beam therapy, and to show we can accurately model this printed bolus in our treatment planning system for accurate treatment delivery. Percent depth‐dose measurements and tissue maximum ratios were used to determine the characteristics of the printing materials, acrylonitrile butadiene styrene and polylactic acid, as bolus material with physical density of 1.04 and 1.2 g/cm3, and electron density of 3.38×1023electrons/cm3 and 3.80×1023 electrons/cm3, respectively. Dose plane comparisons using Gafchromic EBT2 film and the RANDO phantom were used to verify accurate treatment planning. We accurately modeled a printing material in Eclipse treatment planning system, assigning it a Hounsfield unit of 260. We were also able to verify accurate treatment planning using gamma analysis for dose plane comparisons. With gamma criteria of 5% dose difference and 2 mm DTA, we were able to have 86.5% points passing, and with gamma criteria of 5% dose difference and 3 mm DTA, we were able to have 95% points passing. We were able to create a patient‐specific bolus using an inexpensive 3D printer and model it in our treatment planning system for accurate treatment delivery.PACS numbers: 87.53.Jw, 87.53.Kn, 87.56.ng

Total shoulder arthroplasty (TSA) has traditionally been performed as inpatient surgery to provide adequate postoperative analgesia via intermittent opioid administration. We developed a regional model for ambulatory TSA using continuous brachial plexus nerve block (CBPNB). We asked whether this regional model would allow us to select patients to undergo outpatient TSA using CBPNB while providing similar outcomes to those patients who were managed with CBPNB and a onenight or longer inpatient hospital stay. Of 16 selected patients, eight underwent outpatient TSA/CBPNB while the other eight had an overnight hospital stay. Outcome measures included readmission, duration of CBPNB use, pain scores, adjunctive analgesia use, range of motion, and patient satisfaction. There were no readmissions. Patients used CBPNB for an average of 6 days. The average postoperative pain score was 1/10. One patient required oral analgesics while using CBPNB. All patients were very satisfied (Likert scale) and would have the surgery again. Although these data are preliminary, the development of a regional outpatient model for TSA using CBPNB permitted integration of community care and patient satisfaction and decreased length of hospital stay.

CTX-CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity.

Purpose The primary aim of this study was to quantitatively assess pulmonary radiation toxicity in patients who received thoracic radiotherapy combined with induction and/or concurrent chemotherapy with or without taxanes for esophageal cancer. Materials/Methods Subjects were 139 patients treated at The University of Texas M. D. Anderson Cancer Center for esophageal cancer and who had [18F]-fluorodeoxyglucose positron emission tomography/computed tomography imaging from November 1, 2003 to December 15, 2007, for disease restaging after chemoradiotherapy. Patients were grouped as having had (1) no taxanes, (2) induction or concurrent taxanes, and (3) both induction and concurrent taxanes. Clinical pulmonary toxicity was scored using the NCI Common Terminology Criteria for Adverse Events version 3. Linear regression was applied to the FDG uptake versus radiation dose to determine the pulmonary metabolic radiation response (PMRR) for each case. Clinical toxicity scores and PMRR among groups were evaluated for significance differences. Results The crude rates of pneumonitis symptoms were 46%, 62%, and 74% for groups 1, 2, and 3, respectively. The ANOVA test of log(PMRR) by treatment was significant (p=0.0046). Group 3 had 61% higher PMRR compared with group 1 (p=0.002). Group 2 had 38% higher PMRR compared with group 1 (p=0.015). Group 3 had 17% higher PMRR compared with group 2 (p=0.31). A PMRR enhancement ratio of 1.60 (95% CI: 1.19–2.14) was observed for group 3 versus group 1. Conclusions Patients given taxanes chemotherapy as induction and concurrent chemotherapy had significantly higher PMRR and clinical pneumonitis symptoms than did patients whose chemotherapy did not include taxanes.