Publication date: Available online 23 December 2017
Source:Radiotherapy and Oncology
Author(s): Lauren Henke, Rojano Kashani, Clifford Robinson, Austen Curcuru, Todd DeWees, Jeffrey Bradley, Olga Green, Jeff Michalski, Sasa Mutic, Parag Parikh, Jeffrey Olsen
Purpose/objectivesSBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies.Materials/methodsTwenty patients with oligometastatic or unresectable primary liver (n = 10) and non-liver (n = 10) abdominal malignancies underwent SMART. Initial plans prescribed 50 Gy/5 fractions (BED 100 Gy) with goal 95% PTV coverage by 95% of prescription, subject to hard OAR constraints. Daily real-time online-adaptive plans were created as needed, based on daily setup MR-image-set tumor/OAR "anatomy-of-the-day" to preserve hard OAR constraints, escalate PTV dose, or both. Treatment times, patient outcomes, and dosimetric comparisons between initial and adaptive plans were prospectively recorded.ResultsOnline adaptive plans were created at time of treatment for 81/97 fractions, due to initial plan violation of OAR constraints (61/97) or observed opportunity for PTV dose escalation (20/97). Plan adaptation increased PTV coverage in 64/97 fractions. Zero Grade ≥ 3 acute (<6 months) treatment-related toxicities were observed.DiscussionSMART is clinically deliverable and safe, allowing PTV dose escalation and/or simultaneous OAR sparing compared to non-adaptive abdominal SBRT.
http://ift.tt/2C03Y4j
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Σάββατο 23 Δεκεμβρίου 2017
Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen
MRI evaluation of sacral chordoma treated with carbon ion radiotherapy alone
Source:Radiotherapy and Oncology
Author(s): Lorenzo Preda, Davide Stoppa, Maria Rosaria Fiore, Giulia Fontana, Sofia Camisa, Roberto Sacchi, Michele Ghitti, Gisela Viselner, Piero Fossati, Francesca Valvo, Viviana Vitolo, Maria Bonora, Alberto Iannalfi, Barbara Vischioni, Alessandro Vai, Edoardo Mastella, Guido Baroni, Roberto Orecchia
Background and purposeTo compare RECIST 1.1 with volume modifications in patients with sacral chordoma not suitable for surgery treated with carbon ions radiotherapy (CIRT) alone. To evaluate patients pain before and after CIRT. To detect if baseline Apparent Diffusion Coefficient values (ADC) from Diffusion Weighted sequences could predict response to treatment.Material and methodsPatients included had one cycle of CIRT and underwent MRI before and after treatment. For each MRI, lesion maximum diameter and volume were obtained, and ADC values were analyzed within the whole lesion volume. Patients pain was evaluated with Numerical Rating Scale (NRS), considering the upper tumor level at baseline MRIs.Results39 patients were studied (mean follow-up 18 months). Considering RECIST 1.1 there was not a significant reduction in tumor diameters (p = 0.19), instead there was a significant reduction in tumor volume (p < 0.001), with a significant reduction in pain (p = 0.021) if the tumors were above vertebrae S2–S3 at baseline MRIs. The assessment of baseline ADC maps demonstrated higher median values and more negative skewness values in progressive disease (PD) patients versus both partial response (PR) and stable disease (SD).ConclusionsLesion volume measurement is more accurate than maximum diameter to better stratify the response of sacral chordoma treated with CIRT. Preliminary results suggest that baseline ADC values could be predictive of response to CIRT.
http://ift.tt/2D4i18e
Editorial Board
Source:Critical Reviews in Oncology/Hematology, Volume 121
http://ift.tt/2BKOkNh
Mucins: Structural diversity, biosynthesis, its role in pathogenesis and as possible therapeutic targets
Source:Critical Reviews in Oncology/Hematology
Author(s): Suresh Sulekha Dhanisha, Chandrasekharan Guruayoorappan, Sudarsanan Drishya, Prathapan Abeesh
Mucins are the main structural components of mucus that create a selective protective barrier for epithelial surface and also execute wide range of other physiological functions. Mucins can be classified into two types, namely secreted mucins and membrane bounded mucins. Alterations in mucin expression or glycosylation and mislocalization has been seen in various types of pathological conditions such as cancers, inflammatory bowel disease and ocular disease, which highlight the importance of mucin in maintaining homeostasis. Hence mucins can be used as attractive target for therapeutic intervention. In this review, we discuss in detail about the structural diversity of mucins; their biosynthesis; its role in pathogenesis; regulation and as possible therapeutic targets.
http://ift.tt/2zpjBj2
The ethical plausibility of the ‘Right To Try’ laws
Source:Critical Reviews in Oncology/Hematology
Author(s): D. Carrieri, F.A. Peccatori, G. Boniolo
'Right To Try' (RTT) laws originated in the USA to allow terminally ill patients to request access to early stage experimental medical products directly from the producer, removing the oversight and approval of the Food and Drug Administration. These laws have received significant media attention and almost equally unanimous criticism by the bioethics, clinical and scientific communities. They touch indeed on complex issues such as the conflict between individual and public interest, and the public understanding of medical research and its regulation. The increased awareness around RTT laws means that healthcare providers directly involved in the management of patients with life-threatening conditions such as cancer, infective, or neurologic conditions will deal more frequently with patients' requests of access to experimental medical products.This paper aims to assess the ethical plausibility of the RTT laws, and to suggest some possible ethical tools and considerations to address the main issues they touch.
http://ift.tt/2BHHkRw
Non pharmacological interventions and non-fentanyl pharmacological treatments for breakthrough cancer pain: a systematic and critical review
Source:Critical Reviews in Oncology/Hematology
Author(s): Sebastiano Mercadante
Background: Oral opioids or other pharmacological or non-pharmacological interventions are often suggested in the management of breakthrough cancer pain (BTcP). The aim of this systematic and critical review was to analyse and critically comment the evidence of any non-fentanyl therapies proposed for BTcP.MethodsA systematic literature search was carried out to find studies providing clinical data on any treatment excluding fentanyl products.ResultsNo data exist about the use of oral opioids. Some information is available on parenteral morphine in a large sample of patients and episodes of BTcP. For other treatments, including methadone, nitrous oxide, anti-inflammatory drugs, samarium, and gabapentin the existing data, observational and obtained in a small number of patients do not provide useful information to be generalized. Only ketamine, a drug difficult to use for many physicians, particularly in determined setting, provided some evidence according a randomized controlled double-blind study.ConclusionsRecommendations suggesting the use of oral opioids or other pharmacological and non-pharmacologic interventions for BTcP, are not based on any, even minimal evidence. These treatments are worthwhile of further investigation, particularly in determined conditions that should fit the pharmacokinetics of oral opioids.
http://ift.tt/2znYBcg
Scholar : Chinese Journal of Stomatological Research(Electronic Version), Year 2017, Issue 04 -New Issue Alert.
Scholar : Chinese Journal of Stomatology, Year 2017, Issue 11 -New Issue Alert.
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Scholar : Chinese Journal of Otology, Year 2017, Issue 04 -New Issue Alert.
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Scholar : Journal of Otology, Year 2017, Issue 04 -New Issue Alert.
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Scholar : Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Year 2017, Issue 11 -New Issue Alert.
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Scholar : Chinese Journal of Otorhinolaryngology In Integrative Medicine, Year 2017, Issue 05 -New Issue Alert.
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Scholar : Chinese Journal of Ophthalmology and otorhinolaryngology, Year 2017, Issue 05 -New Issue Alert.
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Scholar : Chinese Scientific Journal of Hearing and Speech Rehabilitation, Year 2017, Issue 05 -New Issue Alert.
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Scholar : chinese Journal of Practical Stomatology, Year 2017, Issue 10 -New Issue Alert.
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Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an un...
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