MATERIALS AND METHODS: We searched PubMed and Scopus electronic databases to identify original studies reporting toxicity outcomes following PBT of primary NPC. Quality assessment was performed using NIH's Quality Assessment Tool. Reports were extracted for information on demographics, main results, and clinical and dose factors correlates. Meta-analysis was performed using the random-effects model.
RESULTS: Twelve studies were selected (six using mixed particle-photon beams, five performed comparisons to photon-based therapy). The pooled event rates for acute grade ≥2 toxicities mucositis, dermatitis, xerostomia weight loss are 46% (95% confidence interval [95% CI]-29%-64%, I2 = 87%), 47% (95% CI-28%-67%, I2 = 87%), 16% (95% CI-9%-29%, I2 = 76%), and 36% (95% CI-27%-47%, I2 = 45%), respectively. Only one late endpoint (xerostomia grade ≥2) has sufficient data for analysis with pooled event rate of 9% (95% CI-3%-29%, I2 = 77%), lower than intensity-modulated radiotherapy 27% (95% CI-10%-54%, I2 = 95%). For most endpoints with significant differences between the PBT and photon-based therapies, PBT resulted in better outcomes. In two studies where dose distribution was studied, doses to the organs at risk were independent risk factors for toxicities.
CONCLUSION: PBT may reduce the risk of acute toxicities for patients treated for primary NPC, likely due to dose reduction to critical structures. The pooled event rate for toxicities derived in this study can be a guide for patient counseling.
MATERIALS AND METHODS: Eighteen (18) participants who met the inclusion and exclusion criteria were scanned using a standard non-contrast MRI shoulder protocol including the PDFS pulse sequence and the PROPELLER PDFS pulse sequence using a small flex coil and a dedicated shoulder coil. Two experienced musculoskeletal (MSK) radiologists evaluated and graded the presence of artifacts on the MR images and the SNR and CNR were measured quantitatively.
RESULTS: The non-parametric Wilcoxon Signed Rank test revealed a significant reduction in motion and pulsation artifacts between the PROPELLER PDFS pulse sequence and the standard PDFS pulse sequence. In addition, the nonparametric Mann-Whitney U test revealed that the mean rank of SNR for the standard sequence was statistically significant when compared to the PROPELLER sequence for both coil types. The CNR of the PROPELLER sequence was statistically significant between fat-fluid, bone-fluid, bonetendon, bone-muscle, and muscle-fluid when using SFC and DSC.
CONCLUSION: This study proved that the PROPELLER-PDFS pulse sequence effectively eliminates motion and pulsation artifacts, regardless of the coils utilised. The PROPELLERPDFS pulse sequence can therefore be implemented into the standard MRI shoulder procedure.