Background: Cancer is the second most common cause of death worldwide. Economic evaluation of cancer treatment to reduce costs can save the health care system millions of dollars while optimizing care. Therefore, this systematic review aimed to study the economic evaluation of cancer treatment using intermediate intensity radiation therapy (IMRT) compared to conventional 3D conformal radiation therapy (3D-CRT). Methods: Literatures from PubMed, Embase, Cochran Library, Google scholar, Scopus and Iranian databases were retrieved since Jan 2000 to Apr 2020 for eligible English studies. The quality of the studies was evaluated using Cheers' checklist and then the textual data were analyzed manually by content analysis method. Results: Overall, 1790 articles were retrieved, of which 12 studies were reviewed. The article quality score ranged from 14. 5 to 23 out of a maximum of 24 points. Eleven studies referred to cost-effectiveness analysis and one study referred to cost-utility analysis. Studies have been conducted in the United States, Canada, Australia, Brazil, the Netherlands, the United Kingdom, and Hungary. IMRT appears to be a cost-effective treatment strategy for rectal cancer, soft tissue sarcoma, and localized carcinoma of the pharynx, and for prostate cancer in terms of prolonging survival, but it is a cost-effective treatment strategy for head cancer. In addition, the neck was not in India's cancer control program. Conclusion: The results can help to decide whether to use radiation therapy and radiotherapy in the standard treatment path. Furthermore, they underline that IMRT treatment technique was cost effective for a long-time care service.

60-year-old woman was treated for a brain metastasis. The pa ent received intensity-modulated radia on therapy (SIB-IMRT) dose of 30 Gy for the whole brain and 40 Gy delivered simultaneously to individual brain metastases in 10 frac ons. The present report inves gated the influence of applied novel prepared treatment plan, among others the frac ona on protocol on the electroencephalogram (EEG) record.

Background: Intensity Modulated radiation therapy (IMRT) is extensively used in the treatment of malignancies. Clarkson’ s method is one of the leading methods for dose calculation at open points present in irregular fields. Objective: The aim of this study is to generalize the Clarkson’ s method for dose calculation at points under compensator filters in IMRT method and its application in IMRT quality control as well. Material and Methods: In this experimental study, compensator filters were designed in two forms: flat filter and block piled-up compensator. The measurements for the compensator filters and open fields in 5 and10 cm depths at energy levels (6, 10 and 18 MV) and in fields with different dimensions were performed using “ Mapcheck2” dosimeter. The aim of performing calculations is to derive the theoretical dose by the generalized Clarkson’ s equation and comparing it with data resulted from the measurement for confirming the Clarkson’ s equation presented. Results: These results demonstrate the data derived from the generalized Clarkson’ s method are in good agreement with the data resulted from measurement; the highest error of the proposed equation was 3% for flat filter, and less than 5% for block-piled-up filter. Higher error in the block-piled-up filter compared with the flat filter was due to the presence of leakage between these blocks. Conclusion: The results of this study demonstrated that the presented equation is reliable and valid, and the proposed equation can be applied for dose calculation at all points under the compensator filter or the shielded areas.

Background: In head and neck radiotherapy, immobilization devices can affect dose delivery. In this study, a comprehensive end-to-end test was developed to evaluate the accuracy of radiotherapy treatment. Materials and Methods: An Alderson radiation therapy (ART) anthropomorphic phantom with EBT3 film was used to mimic the actual patient treatment process. Ten patients treated for nasopharyngeal carcinomas with IMRT were retrospectively selected. For each patient, the treatment plan, as well as the targets and OARs was transplanted onto the phantom, and the IMRT plan was subsequently recalculated to the phantom with EBT3 film. Two quality assurance (QA) plans were generated, namely “ Plan-with” wherein the immobilization device was contoured and “ Plan-without” wherein it was omitted. EBT3 measurements were compared with the results of the TPS calculation. Results: With different gamma calculation criteria applied, the results obtained for Plan-with were closer to the dose measured with the EBT3 film. Moreover, 1. 8% deviation was observed in the posterior neck skin dose for Plan-with when compared to the film measurements while the value was 33. 1% lower for Plan-without. When compared to Plan-without, each target volume in Plan-with exhibited a 1– 4% reduction in the maximum dose (D2%), minimum dose (D98%) and mean dose (Dmean). Conclusion: Immobilization devices decrease the radiation dose to target volumes while increasing the skin dose and should be included within the body contour to ensure an accurate planning dose. The end-to-end IMRT test using an ART anthropomorphic phantom is a valuable tool to identify discrepancies between calculated and delivered radiation doses.

Background: In this study, a comparison between various types of radiotherapy treatment for parotid gland cancer was performed to achieve the optimal treatment technique.Methods: Treatment planning and countering performed with TiGRT software for 15 patents with parotid gland cancer. Six techniques were performed and compared. Finally, by comparing the dose volume histograms (DVH), average dose received by each organ was determined and the best method was introduced. Techniques were as: 1. an ipsilateral wedge pair technique using 6 MV photons; 2. a 3-field anteroposterior (AP) (wedged) posteroanterior (PA) (wedged) and lateral portal technique using 6 MV photons; 3. a mixed beam technique using 6 MV photons and 12 MeV electrons (1: 4 weighting); 4. a mixed beam technique using 6 MV photons and 15 MeV electrons (1: 4 weighting); 5: four 6 MV photon beams with different gantry angles; and 6. similar to fifth technique with an additional small ring around the tumor tissue. Findings: intensity-modulated arc therapy (IMRT) techniques five and six delivered maximum dose to the target and minimum dose to organ at risks (OAR). Among 3-D conformal radiotherapy techniques (CRT), technique number two delivered more amount of dose to the target than techniques number three and four. The dose delivered to the contrary parotid gland was negligible for intensity-modulated arc therapy techniques.Conclusion: intensity-modulated arc therapy techniques are most appropriate methods for treating cancer of the parotid gland and the sixth technique delivered better dose distribution in the tumor and healthy tissues. Second D conformal radiotherapy technique delivered higher average dose to the target.

Background: intensity-modulated radiation therapy (IMRT) is one of the best methods in the treatment of optic nerve sheath meningioma (ONSM) with tumor growth control and visual stabilization. In this study, various IMRT techniques were evaluated from the point of view of dose fall-off beyond the target boundaries to achieve the optimal technique. Methods: The optimization of 3 IMRT techniques was performed using 3, 5, and 7 fields with 6 MV photons in 15 patients with ONSM using Prowess Panther treatment planning system. To evaluate treatment plans, in addition to data extracted from dose-volume histogram (DVH) and evaluation of target coverage indices, differential and cumulative dose gradient indices (DGIs) were calculated and compared between the three techniques. Findings: The maximum and the mean dose received by the tumor increased with increasing number of IMRT fields. The uniformity (UI) and homogeneity (HI) indices were significantly different between the 3-field and 7-field techniques; and the conformity index (CI) was close to ideal value (0. 99) in 7-field technique. Difference of differential dose gradient index (dDGI) was negligible between the three techniques, and only at the 45% isodose level, there was a significant difference between the 5-and 7-field techniques. Cumulative dose gradient index (cDGI) showed smaller values in 7-field technique than the other two techniques. Conclusion: The three IMRT techniques have no considerable statistical difference in dose fall-off rate beyond tumor boundaries; and their choice in the treatment of ONSM depends on the physician's discretion based on the whole patient's conditions.

Background: Thyroid cancer is one of the most common secondary malignancies as a result of receiving therapeutic doses to the head and neck. In this study, the probability of secondary thyroid cancer risk due to neutron contamination of 15 MV Siemens Linear Accelerator (LINAC) in brain tumor 3D-Conformal radiation therapy (3D-CRT) was calculated. Methods: Neutron fluence and neutron dose were measured at different points at the treatment table using an energy-independent neutron detector consisting of a sphere moderator and a Boron Trifluoride (BF3) counter, and the neutron dose equivalent to the thyroid was determined to calculate the probability of secondary cancer risk. Findings: The neutron dose equivalent was obtained at the central axis (0. 304 mSv/Gy) and at 4 cm (0. 285 mSv/Gy), 15 cm (0. 229 mSv/Gy), 45 cm (0. 125 mSv/Gy), and 150 cm (0. 02 mSv/Gy) inferior. The neutron dose equivalent reaching the thyroid for the total prescribed dose was 12. 366 mSv. According to that, the probability of secondary thyroid cancer risk was obtained as 0. 001%. Conclusion: The thyroid dose in high-energy radiation therapy of brain tumor cannot cause significant biological damage. Therefore, the risk of secondary thyroid cancer due to neutron contamination is relatively low.

Background: This study aimed to determine hippocampal absorbed dose in radiotherapy of high-grade brain glioma using dose painting method and to compare it with intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT).Methods: In Milad hospital radiotherapy section in Isfahan, Iran, images from 24 patients with high-grade brain glioma were acquired. All radiotherapy volumes for patients were defined and then, at risk organ was contoured. There were 4 planning target volumes (PTVs) defined for each patient. PTV4 just has been defined for dose painting method and the given dose was increased up to 72 Gy in this method. Finally for each patient, by using treatment planning system characteristics, 3 methods were simulated and the optimal technique was represented. Findings: The average hippocampus-received dose was 4.772, 4.174, and 5.668 Gy in 3D-CRT, IMRT, and dose painting methods, respectively. Increasing the dose in dose painting method by 1.2% than in IMRT method resulted in 1.357% increasing in hippocampal-absorbed dose; considering the hippocampal tolerance dose, it would not cause serious injury and in return tumors, would be controlled more effectively.Conclusion: In this study, the importance of multi-parametric magnetic resonance imaging (MRI) in dose painting method was achieved. As by using these images for determining the different parts of tumor, tumor-received dose significantly increased; while the organs around the tumor received no serious damage.