After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients. Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5–7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy. The median interval between local excision and radiotherapy was 34 (range, 11–104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027). In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.

In this study, the characteristics of total water-soluble organic carbon (WSOC) and isolated WSOC fractions were examined to gain a better understanding of the pathway of organic aerosol production. 24 h PM_2.5 samples were collected during the summer (July 28–August 28, 2009) at an urban site in Korea. A glass column filled with XAD7HP resin was used to separate the filtered extracts into hydrophilic (WSOC_HPI) and hydrophobic (WSOC_HPO) fractions. The origins of air mass pathways arriving at the sampling site were mostly classified into three types, those originating over the East Sea of Korea that passed over the eastern inland urban and industrial regions (type I); those from the marine (western/southwestern/southern marine) and passed over the national industrial complex regions (type II); and those from northeastern China that passed through North Korea and metropolitan areas of South Korea (type III). Measurements showed an increase in the average WSOC fraction of total OC from the type II to III air mass (53 to 64%) periods. Also, higher SO₄ ^{2 −}/SO_x (=SO₂ + SO₄ ^{2 −}) was observed in the type III air mass (0.70) than those in the types I (0.49) and II (0.43). According to the average values of WSOC/OC and SO₄ ^{2 −}/SO_x, measurements suggest that the aerosols collected during the type III air mass period were more aged or photo-chemically processed than those during the types I and II air mass periods. The relationship between the SO₄ ^{2 −}/SO_x and WSOC/OC (R² = 0.64) suggests that a significant fraction of the observed WSOC at the site could be formed by an oxidation process similar to SO₄ ^{2 −} aerosols, probably the oxidation process using OH radicals, or in-cloud processing. The photochemical production of WSOC_HPO was also observed to significantly contribute to the total OC.

Objectives. To investigate the prognostic factors and treatment outcomes of primary parotid carcinoma treated with surgery and postoperative radiotherapy (PORT).Methods. We reviewed retrospectively 57 patients with primary parotid carcinoma who were treated with surgery and PORT between 2005 and 2014. Superficial parotidectomy was performed in 19 patients, total parotidectomy in 10 patients, and total parotidectomy with lymph node dissection in 28 patients PORT on the tumor bed was performed in 41 patients, while PORT on tumor bed and ipsilateral cervical lymph nodes was performed in 16 patients.Results. With a median follow-up of 66 months, the 5-year overall survival, disease-free survival, locoregional control, and distant control rates were 77.0%, 60.2%, 77.6%, and 72.8%, respectively. The 5-year overall survival by stage was 100%, 100%, 80.0%, and 46.4% in stage I, II, III, and IV, respectively. Recurrences at primary lesions were found in seven patients, while at cervical nodes in six patients. Distant recurrences were developed in 12 patients. No patient with the low and intermediate histologic grade developed distant failure. As prognostic factors, the histologic grade for overall survival (P=0.005), pathological T-stage (P=0.009) and differentiation grade (P=0.009) for disease-free survival, pathological T-stage for locoregional control (P=0.007), and lympho-vascular invasion (P=0.023) for distant recurrence were significant on multivariate analysis.Conclusion. This study revealed that differentiation grade, histologic grade, pathological T-stage, and lympho-vascular invasion were significant independent prognostic factors on clinical outcomes.

The dosimetric characteristics of MobiusFX, which uses the treatment machine log file to calculate the dose inside the patient body, were analyzed for use in the RapidArc delivery quality assurance (DQA) process. The accuracy and usefulness of MobiusFX in clinical cases was evaluated by comparing the dose calculated by MobiusFX with that calculated by the conventional measurement dose based program, 3DVH. The results of gamma evaluation with three different criteria (3%–3 mm, 4%–3 mm, 5%–3 mm) were analyzed, and the dose changes were calculated while simulating variable position errors (6 mm, 3 mm) and dosimetric output increases (6%, 3%). Although the doses calculated by each tool were not identical due to differences in the calculation algorithms, the doses calculated by MobiusFX were generally similar to those calculated by 3DVH. Based on these results, MobiusFX exhibited the required accuracy for clinical application. However, it could not determine the dosimetric output variation. It should therefore be considered a supplementary DQA tool that can verify the error in the daily treatment process, but not an ideal DQA tool that can replace conventional measurement based DQA methods.

Shinhaeng Cho, Ick Joon Cho, Yong Hyub Kim, Jea-Uk Jeong, Mee Sun Yoon, Taek-Keun Nam, Sung-Ja Ahn, Ju-Young Song. Progress in Medical Physics 2023;34:48-54. https://doi.org/10.14316/pmp.2023.34.4.48

Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) require precise small-field dosimetry, verified through patient-specific quality assurance (PSQA). This study evaluated the feasibility of using a single-crystal cadmium–zinc–telluride (Cd_0.9Zn_0.1Te, CZT) detector for PSQA in SRS and SBRT. We fabricated a CZT detector with Au electrodes and examined its fundamental characteristics, including dose linearity, dose rate dependence, energy dependence, angular dependence, source-to-surface distance (SSD) dependence, field size dependence, depth dependence, and reproducibility, under 6 and 10 MV LINAC beam irradiation and compared the results with those from a standard ionization chamber. The results revealed that the CZT detector demonstrated excellent linearity across 0–1000 cGy with minimal deviation in the low-dose region, negligible dose rate dependence, and minimal energy dependence, exhibiting a 2.2% drop at 15 MV relative to 6 MV. Its angular and SSD dependencies deviated slightly from the ionization chamber, consistent with the expected physical behaviors and correctable in clinical practice. The detector also revealed consistent performance over time with excellent reproducibility, and its depth dependence results were consistent with those of the ionization chamber. Thus, the CZT detector provides consistent performance in small-field measurements under varying conditions, satisfying the requirements for SRS and SBRT.