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Mutsaers A, Fernandes JS, Li GJ, Ali S, Palhares DM, Chen H, Cheung P, Czarnota GJ, Karam I, Poon I, Soliman H, Vesprini D, Sahgal A, Louie AV. Uncovering the Armpit of Axillary SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e195. [PMID: 37784836 DOI: 10.1016/j.ijrobp.2023.06.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The growing use of stereotactic body radiotherapy (SBRT) in metastatic cancer has led to applications in new and unique anatomic locations, highlighting the importance of effective, safe, reproducible treatment delivery. The objective of this study was to review our institutional SBRT experience for axillary metastases (AM), focusing on outcomes, safety and process. MATERIALS/METHODS In this ethics approved single-institution retrospective review, patients treated with SBRT to AM from 2014-2022 had tumor, treatment planning, and dosimetric variables abstracted. Toxicity was assessed per Common Terminology for Adverse Events V5.0. Cumulative incidence functions were used to estimate the incidence of local failure (LF), with death as competing risk. Kaplan-Meier method was used to estimate progression-free (PFS) and overall survival (OS). RESULTS We analyzed 37 patients with 39 AM who received SBRT. Patients were predominantly female (60%), Eastern Cooperative Oncology Group performance status 0-1 (62%), and elderly (median age: 72), with a median follow-up of 14.6 months. Common primary sites included breast (n = 16, 43%), skin (n = 7, 19%), and lung (n = 5, 14%). Treatment indication included oligoprogression (n = 18, 46%), oligometastases (n = 14, 36%) and symptomatic progression (n = 7, 18%). A minority had prior overlapping radiation (n = 7, 18%) or regional surgery (n = 4, 11%), while most had prior systemic therapy (n = 26, 70%). Significant heterogeneity in simulation, planning and treatment was identified. Immobilization included 5-point thermoplastic mask (n = 12, 32%), Vacloc (n = 12, 32%) arms-up thorax bag (n = 11, 30%). 4-D CT scans were obtained in 46%, MR simulation in 21%, and intravenous contrast in 10%. Median dose was 40 Gy (interquartile range (IQR): 35-40) in 5 fractions, (BED10 = 72 Gy), over a median of 12 days (IQR: 9-14). Seventeen cases (44%) utilized a low-dose elective volume to cover remaining axilla; 14% used a high dose clinical target volume. Median planning target volume margin was 5mm (range: 3-10mm), and plans were generated with 5 different dose constraint protocols. At first radiographic assessment, 87% had partial or complete response, with a single progression. Of symptomatic patients (n = 14), 57% had complete symptom resolution and 21% had improvement. One and 2-year LF rate were 19% and 31%, respectively. Median OS was 21.0 months (95% [Confidence Interval (CI)] 17.3-not reached) and median PFS was 7.0 months (95% [CI] 4.3-11.3). Acute and late toxicities were uncommon, with two grade 3 events (1 plexopathy in a case with tumor involving brachial plexus, 1 skin ulceration) identified, and no grade 4/5. CONCLUSION In this series of AM SBRT, low rates of toxicity, and good rates of LF and symptom improvement were observed. As treatment was delivered with a variety of individual treatment differences, an institutional protocol is under development to standardize technique, optimize efficiency and improve evaluability.
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LeCompte MC, Chen H, Shaaban S, Goldstein M, Lubelski D, Kleinberg LR, Hooker T, Li H, Redmond KJ. RBE Model Based Proton Planning of Stereotactic Body Radiotherapy for Spine Metastasis: A Dosimetric Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e124-e125. [PMID: 37784677 DOI: 10.1016/j.ijrobp.2023.06.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Study of proton stereotactic body radiotherapy (SBRT) for spine metastasis is limited, largely due to theorized increased risk of spinal cord injury with higher end of range RBE. Though the 1.1 RBE constant for proton beam is clinically used, data indicate that proton RBE is variable and dependent on technical-, tissue-, and patient-factors. To better understand safety of proton SBRT for spine metastasis, we performed a dosimetric analysis comparing plans delivered by photon robotic technique versus intensity modulated proton therapy (IMPT) and accounting for RBE weighted dose. MATERIALS/METHODS A total of 9 patients with spine metastasis (3 cervical, 3 thoracic, 3 lumbar) previously treated with a frameless robotic radiosurgery system (Sunnyvale, CA) were identified. Each level contained a case with paraspinal extension, a reirradiation case, and a case with epidural extension (Bilsky grade ≥1c) as such cases in current practice often require planning target volume (PTV) under-coverage in order to meet organ at risk (OAR) dose constraints. Given these challenges, selected cases were clinically treated with 30 Gy in 5 fractions despite an institutional preference of further dose escalation. Comparative IMPT plans were generated using 30 GyE in 5 fractions and 1.1 RBE constant. IMPT plans were then made using 1.1 RBE and 45 GyE in 5 fractions: a prescription dose associated with a 2-yr local control rate of 95% on prior tumor control probability modelling. A treatment planning system was used to separately generate and optimize RBE weighted plans based on Carabe-, McNamara-, or Wedenberg models for prescription doses of 30 GyE and 45 GyE. IMPT plans used robust optimization parameters of ± 3.5% range and 2-mm setup uncertainties. PTV coverage and OAR sparing were compared using Wilcoxon signed-rank tests. RESULTS PTV coverage (PTV volume receiving prescription dose) was significantly improved with IMPT at 30 GyE / 1.1 RBE (median PTV V30: 93%) compared to CK at 30 Gy (median: 88.5%, p = .02). PTV coverage was similar when comparing CK at 30 Gy with IMPT at 45 GyE / 1.1 RBE (median PTV V45: 90%, p = .23). When comparing maximum spinal cord dose (cord Dmax), there was improved OAR sparing with IMPT at 30 GyE / 1.1 RBE (median: 17.6 GyE, p = .04) and IMPT at 45 GyE / 1.1 RBE (median: 16.1 GyE, p = .04) when respectively compared to CK at 30 Gy (median: 18 Gy). No difference was seen in cord Dmax when comparing CK at 30 Gy to RBE weighted plans at 30 GyE using Carabe- (median: 17.3 GyE, p = .22), McNamara- (median: 17.4 GyE, p = .22), or Wedenberg (median: 17.0 GyE, p = .08) model. Median cord Dmax values for RBE weighted plans at 45 GyE were numerically equivalent. The average increase in variable RBE plans' maximum dose compared to fixed RBE plans was 105.3% +/- 3.5%. CONCLUSION We report the first dosimetric analysis of proton SBRT for spine metastasis using variable RBE dose models. IMPT may provide improved target coverage and better sparing of adjacent OARs compared to CK though fixed RBE computation may underestimate maximum dose to adjacent OARs.
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Thomsen B, Vesprini D, Zeng L, Myrehaug SD, Tseng CL, Detsky J, Chen H, Zhang B, Jerzak K, Atenafu E, Maralani P, Soliman H, Sahgal A. Stereotactic Body Radiotherapy (SBRT) for Breast Cancer Spinal Metastases is Associated with Low Rates of Long-Term Local Failure (LF) and Vertebral Compression Fracture (VCF) Independent of Molecular Status. Int J Radiat Oncol Biol Phys 2023; 117:e153. [PMID: 37784740 DOI: 10.1016/j.ijrobp.2023.06.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There is limited outcome data specific to breast cancer spinal metastases following spine SBRT. This study aims to report outcomes specific to breast cancer spinal metastases receiving spine SBRT and determine the implication of biomarker status. MATERIALS/METHODS We have been maintaining a prospective database since the inception of the spine SBRT program. A retrospective review identified 168 breast cancer patients with 409 spinal segments treated with spine SBRT between January 2008 and January 2023. Molecular subtypes were grouped based on luminal A, luminal B, basal, and HER2 enriched. Patients were followed with q3-monthly full-spine MRI and a clinical assessment. The primary endpoint was MRI-based local failure (LF), and secondary endpoints were overall survival (OS) and vertebral compression fracture (VCF). RESULTS The median follow-up was 33 months (range, 3.3-123 months). Amongst the 168 patients, the majority were ECOG 0 or 1 (95%), neurologically intact (94%), polymetastatic (74%), and either luminal A (71%) or luminal B (8%). A total of 17% of patients were HER2+ve versus 83% HER2-ve. Of 409 treated segments the majority (76%) had no prior radiation or surgery (de novo), were SINS stable (60%), had either no or low-grade epidural disease (86%) and treated with 24-28 Gy in 2 fractions (73%). The LF and OS rates at 1, 3, and 5 years were 5%, 11%, and 14%, respectively, and 91%, 65%, and 45%, respectively, independent of molecular subtype on univariate analyses. The cumulative risk of VCF at 2 and 5 years was 7% and 10%, respectively. CONCLUSION We observe, in the largest breast cancer spine cohort to date, excellent long-term local control rates independent of molecular sub-group, and acceptable VCF rates.
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Yu J, Jiang L, Zhao L, Wang X, Yang X, Yang D, Zhuo M, Chen H, Zhao YD, Zhou F, Li Q, Zhu Z, Chu L, Ma Z, Wang Q, Qu Y, Huang W, Zhang M, Gu T, Liu S, Yang Y, Yang J, Yu H, Yu R, Zhao J, Shi A. High Dose Hyperfractionated Thoracic Radiotherapy vs. Standard Dose for Limited Stage Small-Cell Lung Cancer: A Multicenter, Open-Label Randomized, Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:S1. [PMID: 37784261 DOI: 10.1016/j.ijrobp.2023.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Limited stage small-cell lung cancer (LS-SCLC) is associated with poor prognosis. We aimed to assess the efficacy and safety of high-dose, hyperfractionated thoracic radiotherapy of 54 Gy in 30 fractions compared with standard dose (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC. MATERIALS/METHODS The study was an open-label, randomized, phase 3 trial, done at 16 public hospitals in China. Key inclusion criteria were patients aged 18-70 years, with previously histologically or cytologically confirmed LS-SCLC, previously untreated or received 1-2 courses of intravenous cisplatin (75 mg/m²of body-surface area, on day 1 or divided into two days of each cycle) or carboplatin (area under the curve of 5 mg/mL per min, day 1 of each cycle)and intravenous etoposide (100 mg/m²of body-surface area, on days 1-3 of each cycle), and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions or the simultaneous integrated boost VMAT (SIB-VMAT) of 54 Gy in 30 fractions to the primary lung tumor and lymph node metastases starting 0-42 days after the first chemotherapy course. Both groups of patients received thoracic radiotherapy twice per day and 10 fractions per week. Prophylactic cranial radiation (PCI, 25 Gy in 10 fractions) was implemented to patients with responsive disease. The primary endpoint was overall survival. Safety was analyzed in the as-treated population. RESULTS Between June 30, 2017, and April 6, 2021, 224 eligible patients were enrolled and randomly assigned to 54 Gy (n = 108) or 45 Gy (n = 116). Median follow-up for the primary analysis was 45 months (IQR 41-48). Median overall survival was significantly improved in the 54 Gy group (62.4 months) compared with the 45 Gy group (43.1 months; p = 0.001). Median progression-free survival was significantly improved in the 54 Gy group (30.5 months) compared with the 45 Gy group (16.7 months; p = 0.044). The most common grade 3-4 adverse events were neutropenia (30 [28%] of 108 patients in the 54 Gy group vs 27 [23%] of 116 patients in the 45 Gy group), neutropenic infections (6 [6%] vs 2 [2%]), thrombocytopenia (13 [12%] vs 12 [10%]), anemia (6 [6%] vs 4 [3%]), and esophagitis (1 [1%] vs 3 [3%]). Treatment-related serious adverse events occurred in 9 [8%] patients in the 54 Gy group and 16 [14%] patients in the 45 Gy group. There were one treatment-related deaths in 54 Gy group (myocardial infarction). CONCLUSION Compared with standard thoracic radiotherapy dose of 45 Gy, the high dose of 54 Gy improved overall survival and progression-free survival without increasing toxicities in patients with LS-SCLC, supporting twice-daily hyperfractionated thoracic radiotherapy of 54 Gy with concurrent chemotherapy is an alternative treatment option for LS-SCLC. This study is complete and registered with ClinicalTrials.gov, NCT03214003.
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Ong WL, Zeng L, Soliman H, Myrehaug SD, Detsky J, Chen H, Ruschin ME, Atenafu E, Larouche J, Maralani P, Sahgal A, Tseng CL. Outcomes Specific to Spinal Metastases with Paraspinal Disease Extension Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e142-e143. [PMID: 37784717 DOI: 10.1016/j.ijrobp.2023.06.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Spinal metastases with paraspinal disease (PD) extension are known to have worse outcomes following stereotactic body radiotherapy (SBRT). Characteristics of the PD itself have not been investigated to determine the impact on outcomes such as local control, which is the purpose of this study. MATERIALS/METHODS We retrospectively reviewed those patients who had SBRT for spinal metastases with PD disease, identified from a prospectively maintained database. Spinal metastases previously irradiated or surgical resected were excluded. The extent of PD was classified as involving the rib, neuroforamina, and muscle invasion. The gross tumor volume of PD (GTV_PD) and the clinical target volume of PD (CTV_PD) were segregated from the bony compartments based on the treatment plan contours. The outcomes of interest included the cumulative risk of local failure (LF), re-irradiation rates (ReRT), and overall survival (OS). LF and ReRT were estimated for each treated sites using the competing risk model (death as the competing risk), while OS was evaluated per patient using the Kaplan Meier method. RESULTS A total of 86 patients with 96 spinal metastases sites with PD were included. Of the 96 treated sites, 65% (62/96), 29% (28/96) and 6% (6/96) of PD spanned 1, 2, and 3 vertebral levels respectively. The median follow-up was 12.4months (range: 0.6-100months). The 6- and 12-month OS for the cohort was 81% and 51%, respectively. 33/86 (38%) patients had radioresistant cancer (gastrointestinal, renal cell carcinoma, thyroid, sarcoma, or melanoma). Involvement of rib, neuroforamina and muscle invasion were observed in 39% (37/96), 65% (62/96) and 21% (20/96) of the treated sites, respectively. Epidural disease was present in 57% (55/96) of treated sites. The median GTV_PD volume was 7cc (range: 0.3-114cc), and the median CTV_PD volume was 24cc (range: 0.4-248cc). The prescribed doses were 24 Gy/2 fractions (fx) (80%), 28 Gy/2 fx (10%) and 30 Gy/4 fx (10%). There were 84 treated sites with at least one post-treatment MRI available for LF assessment. The crude LF risk was 32% (27/84), and the 6- and 12-month cumulative LF rates were 12% and 28%, respectively. There was a trend towards an increased risk of LF when PD involved the rib (35% vs 24% at 1 year respectively, P = 0.07) and muscle (67% vs 20% at 1 year respectively; P = 0.06), but no difference in LF for neuroforamina involvement (26% vs 34% at 1 year respectively, P = 0.5). There were no differences in LF based on cancer radioresistance (P = 0.6), GTV_PD volume (P = 0.3) or CTV_PD volume (P = 0.4). Of the 96 treated sites, 14% (14/96) were re-irradiated (9 with repeat SBRT and 5 with conventional EBRT) at a median of 15 months (range: 4.7-59 months) post initial SBRT. The cumulative incidence of ReRT at 6- and 12-months were 1.2% and 7.3%, respectively. CONCLUSION PD involving adjacent rib and muscle may be associated with worse LF following SBRT. Further expansion of the cohort and dosimetric analyses are ongoing.
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Burgess L, Zeng L, Myrehaug SD, Soliman H, Tseng CL, Detsky J, Chen H, Palhares DM, Witiw CD, Zhang B, Maralani P, Sahgal A. Stereotactic Body Radiotherapy for Posterior Element Only Spinal Metastases: Outcomes and Validation of Recommended Clinical Target Volume Delineation Practice. Int J Radiat Oncol Biol Phys 2023; 117:e91. [PMID: 37786212 DOI: 10.1016/j.ijrobp.2023.06.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Spine stereotactic body radiotherapy (SBRT) results in improved local control and pain response compared to conventional external beam radiotherapy. Consensus stipulates MRI-based delineation of the clinical target volume (CTV) is critical and is based on spine segment sector involvement. The applicability of these contouring guidelines to metastases confined to the posterior elements is unknown. The purpose of this study was to determine the patterns of failure, as well as the safety of treating posterior element metastases when the vertebral body was intentionally excluded from the CTV. MATERIALS/METHODS A retrospective review of a prospectively maintained database of 605 patients and 1412 spine segments treated with spine SBRT was performed. Only treated segments involving the posterior elements alone were included for the analyses. The primary outcome was local failure, as per SPINO recommendations, and secondary outcomes included patterns of failure, toxicities. Clinical and tumor factors were reported with descriptive statistics. The cumulative risk of local failure was estimated using the Fine-Gray method, accounting for death before local failure as a competing risk. RESULTS A total of 24/605 patients and 31/1412 segments within the database were treated to the posterior elements only. Local failure occurred in 11/31 segments. The cumulative rate of local recurrence was 9.7% at 12 months and 30.8% at 24 months. Amongst local failures, the most common histologies were renal cell carcinoma (36.4%) and non-small cell lung cancer (36.4%). At baseline, 4/11 (36.4%) segments with local failure (36.4%) had epidural disease and 8/11 (72.7%) had paraspinal disease. Most local failures were treated in the de novo setting (8/11, 72.7%). 6/11 (54.5%) failed exclusively within treated CTV sectors and 5/11 (45.5%) with both treated and adjacent untreated sectors. Of these five, four had disease progression within the untreated vertebral body. No failures occurred exclusively within the untreated vertebral body. One patient (4.2%) experienced a grade 4 skin toxicity and one patient (4.2%) developed an iatrogenic Grade 1 vertebral compression fracture. CONCLUSION Posterior element alone metastases are rare. Our analyses support SBRT consensus contouring guidelines such that the vertebral body can be excluded from CTV in spinal metastases confined to the posterior elements.
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Zeng KL, Soliman H, Myrehaug SD, Tseng CL, Detsky J, Chen H, Lim-Fat MJ, Ruschin ME, Atenafu E, Keith J, Lipsman N, Heyn C, Maralani P, Das S, Pirouzmand F, Sahgal A. Outcomes Following Dose Escalated Radiotherapy for High Grade Meningioma. Int J Radiat Oncol Biol Phys 2023; 117:e161. [PMID: 37784757 DOI: 10.1016/j.ijrobp.2023.06.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Conventionally fractionated radiotherapy (RT) is a defined treatment following surgery for atypical and malignant meningioma. However, the optimal radiotherapeutic approach is not well defined. We present the results of our dose-escalation strategy. MATERIALS/METHODS Consecutive patients with a histopathologic grade 2 or 3 meningioma treated with RT were retrospectively reviewed. The primary outcome was progression-free survival (PFS), and secondary outcomes included cause-specific survival (CSS), overall survival (OS), local failure and incidence of radiation necrosis. We specifically compared the dose-escalation cohort, defined as those treated with ≥66 Gy EQD2 (equivalent dose in 2 Gy fractions, a/b = 10), to the standard dose cohort receiving <66 Gy EQD2. We defined adjuvant as RT delivered within 6 months of surgery otherwise the treatment was salvage. RESULTS A total of 118 patients with Grade 2 (111/118) or 3 (7/118) meningioma were identified. 54/118 (45.8%) received dose-escalation and 64/118 (54.2%) standard dosing. 34/54 (63.0%) dose-escalated and 45/64 (70.3%) standardly dosed were treated adjuvantly. The median follow-up was 45.4 months (IQR: 24.0-80.0 months) and median OS was 9.7 years. Post-operative residual disease was present in all dose-escalated patients, as compared to 65.6% in the standard dose cohort. PFS at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 78.9%, 72.2% and 64.6% vs. 57.2%, 49.1% and 40.8%, respectively, (p = 0.030). On multivariable (MVA) analysis, dose-escalation (HR: 0.544, 95% CI: 0.303-0.977, p = 0.042) was associated with improved PFS, whereas ≥2 surgeries (HR: 1.989, 95% CI: 1.049-3.773, p = 0.035) and older age (HR: 1.035, 95% CI:1.015-1.056, p<0.001) associated with worse PFS. The cumulative risk of local failure at 3-, 4- and 5-years in the dose-escalated vs. standard dose cohort were 16.9%, 23.8% and 31.8% vs. 39.6%, 45.6% and 53.9%, respectively, favoring dose-escalation (p = 0.016). MVA confirmed dose-escalation as predictive of a lower risk of LF (HR: 0.483, 95% CI: 0.263-0.887, p = 0.019), while ≥2 surgeries prior to RT predicted for greater LF rates (HR:2.145, 95% CI:1.220-3.771, p = 0.008). A trend was observed for prolonged CSS and OS in the dose escalation cohort (p = <0.1). Seven patients (5.9%) developed symptomatic radiation necrosis (RN) with no significant difference between the two cohorts. CONCLUSION Dose-escalated radiotherapy for high grade meningioma to at least 66 Gy is associated with significantly improved rates of local control and PFS with an acceptable risk of RN.
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Shor D, Zeng L, Holden L, Chen H, Maralani P, Heyn C, Zhang B, Myrehaug SD, Tseng CL, Detsky J, Soliman H, Sahgal A. Staged Stereotactic Radiosurgery as a Novel Adaptive Approach to Salvage Previously Irradiated Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e150. [PMID: 37784734 DOI: 10.1016/j.ijrobp.2023.06.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report outcomes specific to a novel 3 fraction (frx) staged stereotactic radiosurgery (St-SRS) regimen designed to salvage metastases previously irradiated and considered to be at high risk of radiation necrosis (RN). MATERIALS/METHODS A total of 24 patients with 55 metastases treated with our 3 frx St-SRS approach were reviewed. Prior to each frx, patients were re-simulated and planned with a new MRI to allow for treatment adaption. The primary endpoint was the cumulative incidence of local failure (LF) and secondary endpoints included tumor dynamics and RN rates. RESULTS The median follow up was 9.0 months (range: 2.7-40.1 months) and median age was 59-years (range: 32-84). Primary cancers were of breast (44%), lung (33%), melanoma (22%), and gastro-intestinal (1%) origin. Individual metastases treated with St-SRS had initially failed surgery and post-op cavity hypofractionated SRS (HSRS) for 2/55 (4%), SRS alone for 19/55 (34%), whole brain radiation (WBRT) alone for 6/55 (11%), HSRS for 2/55 (4%), and prior SRS and WBRT exposure for 28/55 (51%). 46/55 (84%) were prescribed 8 Gy, 8 Gy, 4 Gy; 8/55 (14%) had 6 Gy, 6 Gy, 4 Gy and 1/55 (2%) had 8 Gy, 8 Gy, 6 Gy. The median number of weeks between frx was 2.6 (range: 1.0-6.8). The median of the mean and maximum target doses were 9.7 Gy (range: 5.4-11.7 Gy) and 12.4 Gy (range, 7.5-16.0 Gy) respectively. The median prescription isodose line was 62% (range: 50-85%). The mean lesion volume and diameter was 3.8cc (range: 0.05-24.8cc) and 1.6cm (range: 0.2-4.4cm), respectively. The mean percent target volume coverage, Paddick Conformality Index and Gradient Index were 100% (range: 97-100%), 0.7 (range: 0.1-0.9), and 3.2 (range: 2.5-6.7), respectively. The mean volume change between staged frxs was -4.2% (range: -69.3 to +63.1%), and based on the first and last St-SRS MRI was -10.8% (range: -86.6% to +68.7%). The crude LF rate was 27%. The median time to LF was 3.4 months (range: 1.2-7.4 months). Amongst those with a LF, 7/15 (46%) were melanoma, 6/15 (40%) HER2 positive breast cancer, 1/15 (7%) gastrointestinal and 1/15 (7%) non-small cell lung carcinoma. 8/15 (53%) had prior WBRT and SRS exposure, 1/16 (7%) surgery and cavity HSRS, 5/15 (33%) SRS alone and 1/15 (7%) WBRT alone. Only asymptomatic RN events were observed in 4/55 (7%). CONCLUSION St-SRS is a promising approach to salvage previously irradiated brain metastases, including prior SRS, with a favorable rate of RN. Tumor volume dynamics between stages can be significant warranting adaptive replanning.
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Gogineni E, Chen H, Li H, Istl AC, Johnston F, Narang A, Deville C. Comparison of Estimated Late Toxicities between IMRT and IMPT when Treating Retroperitoneal Sarcoma Preoperatively with Ultra-Hypofractionation. Int J Radiat Oncol Biol Phys 2023; 117:e298-e299. [PMID: 37785090 DOI: 10.1016/j.ijrobp.2023.06.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While preoperative radiation did not improve abdominal recurrence-free survival for retroperitoneal sarcoma (RPS) in the randomized STRASS trial, it did reduce rates of local recurrence. The risk of radiation-associated toxicity is substantial, with 77% of irradiated patients experiencing grade ≥3 lymphopenia in STRASS. Thus, finding methods to mitigate the issues of delaying surgery and irradiating normal tissue may provide a path towards affording the benefits of radiation while limiting its downside. One potential solution involves the use of hypofractionation to limit delay from radiation initiation to surgery, and proton therapy to limit dose to surrounding organs at risk (OARs). We conducted a dosimetric comparison of preoperative ultra-hypofractionated intensity-modulated photon radiotherapy (IMRT) and proton therapy (IMPT) for RPS, comparing estimated rates of late toxicity using published normal tissue complication probability (NTCP) models. MATERIALS/METHODS Volumetric modulated arc therapy IMRT and IMPT plans were generated on 10 RPS patients previously treated with preoperative radiation. The prescription was 25 Gy radiobiological equivalent (GyE) to the clinical target volume (CTV) and 30 GyE to the margin-at-risk, all in five fractions. Proton doses were calculated using a radiobiological effective dose of 1.1. NTCPs were calculated for each OAR as a function of equivalent uniform dose. The ΔNTCP (difference in absolute NTCP between IMRT and IMPT plans) for each of the toxicity domains was calculated. Student T-tests were used to compare differences in dosimetric and NTCP outcomes. RESULTS CTV coverage was met for all IMRT and IMPT plans with >99% of CTVs receiving ≥100% of prescription doses. The following endpoints were significantly lower with IMPT than IMRT: mean doses to liver, bone, and all analyzed genitourinary and gastrointestinal OARs; bowel, kidney, and bone V5-V20; stomach V15; liver V5; maximum doses to stomach, spinal canal, and body; and whole-body integral dose. No OAR endpoint was significantly higher with IMPT. The average ΔNTCP for grade 3 bowel ulceration/perforation and renal toxicity was 1.9% (p = .037) and 43.0% (p = .023), respectively, favoring IMPT. Using a model-based selection threshold of any ΔNTCP >10%, 50% (n = 5) of patients would be eligible for IMPT. CONCLUSION IMPT maintained target coverage while significantly reducing dose to adjacent OARs and integral dose compared to IMRT. This translated to significantly lower risks of estimated late gastrointestinal and renal toxicities with IMPT. Further investigation is warranted to validate these findings and potential clinical benefit in the management of RPS. A prospective trial treating RPS with preoperative ultra-hypofractionated IMPT at our institution is currently being pursued (NCT05302570).
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Shor D, Zeng KL, Chen H, Louie AV, Menjak I, Atenafu E, Tseng CL, Detsky J, Larouche J, Zhang B, Soliman H, Maralani P, Myrehaug SD, Sahgal A. Molecular Status Predicts for Local Control in Patients with Non-Small Cell Lung Cancer Spinal Metastases Following Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e57-e58. [PMID: 37785740 DOI: 10.1016/j.ijrobp.2023.06.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We report outcomes after spine stereotactic body radiotherapy (SBRT) in patients with metastatic non-small cell lung cancer (NSCLC), to determine the significance of programmed death-ligand 1 (PD-L1) status and epidermal growth factor (EGFR) mutation on local failure (LF) rate. MATERIALS/METHODS A total of 165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary outcomes included overall survival (OS) and vertebral compression fracture (VCF) rates. OS was estimated using the Kaplan-Meier method. Cumulative LF and VCF rates were calculated using competing risk analysis method. Multivariable analysis (MVA) evaluated factors predictive of LF and VCF. RESULTS Median follow-up was 13 months (range, 0.5-95 months). Median OS was 18.4 months (95% CI 11.4-24.6). Median age was 67 years (range, 28.2-89.9). 52% were female, 76% had an adenocarcinoma histology and 61% had a smoking history. 49/165 (29%) had an EGFR mutation. PD-L1 status was analyzed in 109/165 (66%) patients with 16% PD-L1 ≥ 50%, 20% PD-L1 1-49% and 35% PD-L1 <1%. Of 389 segments, 79% were de novo and 21% were previously radiated. At baseline, 35% had a VCF, 27% had epidural disease, 27% had paraspinal extension, and 49% were Spinal Instability in Neoplasia Score (SINS) stable. 239/389 (61%) were treated with either 24 or 28 Gy in 2 SBRT fractions. Within 1 month of SBRT, 39/165 (24%) had a tyrosine kinase inhibitor, 27/165 (16%) immunotherapy (IO) with or without chemotherapy, and 31/165 (19%) chemotherapy alone. LF cumulative incidence at 1- and 2-years was 16.3% (95% CI 12.8-20.3%) and 25.4% (95% CI 20.9%-30%), respectively. EGFR positivity (p<0.0001), PD-L1≥50% (p = 0.013) and treatment with IO within 1 month of SBRT (p = 0.004) predicted for improved local control on MVA. The 1- and 2-year LF rate in EGFR-positive vs. negative patients were 12.9% vs. 16.6% and 17.7% vs. 28.8%, respectively, and in those PD-L1 ≥50% vs PD-L1<50% were 7.8% vs. 19.6% and 7.8% vs. 38.1% respectively. Cumulative incidence of VCF at 1- and 2-years were 6.6% (95% CI 4.4-9.4%) and 8.8% (95% CI 6.1-12.0%). MVA identified prior SBRT to the same treated segment (P<0.0001) and a baseline VCF (p<0.0001) as significant predictors. 18/389 (4.6%) had radiation-induced radiculopathy and no radiation myelopathy events detected. CONCLUSION We identify the predictive utility of EGFR mutation and PD-L1 ≥50% status on local control in NSCLC patients with spinal metastases treated with spine SBRT, and a therapeutic benefit with peri-SBRT IO.
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Chen H, Gogineni E, Li H, Han-Oh S, Jia X, Deville C, Narang A. Inaugural Experience with Real-time Gated Liver Proton SBRT and Treatment Plan Quality Improvement. Int J Radiat Oncol Biol Phys 2023; 117:e286. [PMID: 37785061 DOI: 10.1016/j.ijrobp.2023.06.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) DIBH SBRT is routinely used for liver proton therapy. While intra-fraction target motion is limited with DIBH, acquisition of DIBH CT simulations in triplicate, as is done at our institution, reveals that variation does exist between each DIBH scan. The related target position can also vary correspondingly. The most common setup uncertainty for robust proton SBRT liver plan used at our institution is 5 mm sup-inf (SI) and 3 mm radially. Real-time gated proton therapy (RGPT) has the potential to provide instantaneous feedback for intra-fraction target motion to maximize patient safety and inform optimal treatment planning. Our first RGPT liver SBRT with intra-fraction motion under deep inspiration breath hold (DIBH). The potential treatment plan quality improvement brought by RGPT is investigated. MATERIALS/METHODS The following metrics were used in establishing our RGPT proton DIBH SBRT liver program: the iso center is always set at the fiducial mark; the beam orientation is selected to achieve both good plan quality and tracking performance; daily CBCTs are acquired and verified using fiducial maker position with kV images; robust uncertainty is determined by the gating tolerance; SBRT plan has three beams with uniform dose. Target motion was monitored throughout treatment. To evaluate dose sparing for surrounding OARs, a plan with tighter gating tolerance (3 mm SI and 2 mm radially) is optimized for dosimetric comparison. Statistical analyses were conducted using a programming environment. RESULTS Each of the three proton beams were delivered using DIBH over a total of 120-140 seconds. The average beam on time were 61.4, 66.9 and 62.8 seconds. The intra-fraction motion showed that targets could move up to 3 mm within the same DIBH. The motion increased with time. The table details the mean, maximum, standard deviation, and estimated upper 95% of directional shifts for three beams. Based on these results, plan delivery efficiency was maintained even with tighter gating tolerance. The comparison plan with tight gating tolerance showed significantly less dose (-25%) to the stomach in coronal view. CONCLUSION RGPT successfully tracked fiducial marker motion for DIBH SBRT liver treatment. Despite target drift during DIBH, the uncertainty of our DIBH SBRT procedure was sufficient to cover target motion throughout treatment. Based on the target drift value, a maximum of 25 seconds for breath hold time should be employed. Utilizing a tighter gating tolerance of 3 mm SI and 2 mm radially has the potential to maintain target coverage while significantly reducing OAR dose. Aggregated RGPT-derived data may provide optimal treatment planning parameters such as variable uncertainty based on target location.
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Ong WL, Stewart J, Sahgal A, Soliman H, Tseng CL, Detsky J, Ho L, Das S, Maralani P, Lipsman N, Stanisz G, Perry J, Chen H, Atenafu E, Lau A, Ruschin ME, Myrehaug SD. Predictors of Tumor Dynamics during a 6-Week Course of Chemoradiotherapy for Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e142. [PMID: 37784716 DOI: 10.1016/j.ijrobp.2023.06.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Our prior imaging studies have shown geometrically meaningful inter-fraction tumor dynamics specific to glioblastoma (GBM). We aim to identify predictors associated with tumor dynamics during a 6-week course of concurrent chemoradiotherapy (CRT) for GBM. MATERIALS/METHODS Patients enrolled in a prospective serial magnetic resonance imaging (MRI) study were reviewed. All patients were treated with 54-60 Gy in 30 fractions. The gross tumor volume (GTV) included the surgical cavity and T1c enhanced residual tumor; clinical tumor volume (CTV) included GTV with a 15mm isotropic expansion, respecting anatomical boundaries; planning target volume (PTV) was 4mm expansion. MRIs were obtained at RT planning (F0), fraction 10 (F10), and fraction 20 (F20). Tumor dynamic metrics (relative to F0) assessed included the GTV volume (Vrel), Hausdorff distance (dH) and migration distance (dM). dH is the average distance between two datasets in metric space. dM is the maximum linear displacement of the GTV in any direction. Factors to be determined associated with tumor dynamics included: age, sex, corpus callosum (CC) involvement, extent of surgery (gross total resection (GTR), subtotal resection (STR) or biopsy alone (Bx)), MGMT methylation and IDH mutation status. RESULTS A total of 129 patients were reviewed. Median GTV was 20.9cc at F0, 17.6cc at F10 (Vrel 0.85), and 16.1cc at F20 (Vrel 0.78). Patients without CC involvement had more marked GTV volume reduction: Vrel 0.82 vs 1.02 with CC involvement at F10 (P = 0.05), and Vrel 0.77 vs 0.88 with CC involvement at F20 (P = 0.03). Patients with GTR (vs STR vs Bx) had more marked GTV volume reduction across all time points: Vrel 0.78, 0.85 and 1.07 respectively at F10 (P = 0.001), and Vrel 0.69, 0.80, 1.04 respectively at F20 (P = 0.001). The median dH was 8.1mm at F10 and 9.2mm at F20. Patients with CC involvement (vs without CC involvement) had a larger dH: 54% vs 25% had dH>10mm respectively at F10 (P = 0.03), and 73% vs 28% had dH>10mm respectively at F20 (P<0.005). Patients with a GTR had smaller dH at both F10 (P = 0.02) and F20 (P = 0.006). At F20, 20%, 47% and 37% of patients with GTR, STR and Bx had dH>10mm (P = 0.04). The median dM were 4.7mm at F10 and 4.7mm at F20. Patients with CC involvement (vs without CC involvement) had larger dM: 41% vs 12% had dM >10mm respectively at F10 (P = 0.01), and 45% vs 9% had dM >10mm respectively at F20 (P<0.001). Patients with GTR had smaller dM at F10 (P = 0.03) and F20 (P0.002). At F20, 0%, 25% and 19% of patients with GTR, STR and Bx had dM>10mm (P = 0.002). Age, sex, MGMT methylation and IDH mutation status were not associated with Vrel, dH and dM at F10 and F20. CONCLUSION We identified CC involvement and extent of surgery to be associated with tumor dynamics at F10 and F20 over the course of CRT for GBM. This offers opportunities to better select patients who may benefit from earlier/ more frequent RT replan/ adaptation to ensure adequate tumor coverage, or to reduce RT toxicities.
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Palhares DM, Zeng KL, Myrehaug SD, Tseng CL, Soliman H, Chen H, Maralani P, Larouche J, Wilson J, Ruschin ME, Zhang B, Atenafu E, Sahgal A, Detsky J. Stereotactic Body Radiotherapy (SBRT) for Sacral Metastases: Deviation from Recommended Target Volume Delineation Predicts Higher Risk of Local Failure. Int J Radiat Oncol Biol Phys 2023; 117:e143-e144. [PMID: 37784719 DOI: 10.1016/j.ijrobp.2023.06.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A international consensus recommendation was published to guide target volume delineation specific to sacral stereotactic body radiotherapy (SBRT). We report outcomes after sacrum SBRT, focusing on the impact of contouring deviation on local failure (LF) risk, with an aim to validate this guideline. MATERIALS/METHODS All patients who underwent SBRT to any level between S1 and S5 from 2010 to 2021 were identified from a prospectively maintained institutional database. The primary outcome was magnetic resonance-based LF. Secondary outcomes included vertebral compression fracture (VCF) and overall survival (OS). Cumulative LF and VCF rates were calculated per segment using the competing risk analysis method. Kaplan Meier analysis was used to estimate OS per patient. Cox proportional hazards model was used to assess predictive factors of LF, VCF, and OS. RESULTS A total of 215 treated sacral segments in 112 patients were retrospectively reviewed. The median follow-up was 13 months (range, 0.4-116.9). The median age was 64 years (range, 18-86), and 56% were male. Most patients (52%) had treatment to a single segment. The median clinical target volume (CTV) was 129.2 cc (range, 5.8-753.5). Most segments were treated with 30 Gy/4 fractions (51%), 24 Gy/2 fractions (31%), or 30 Gy/5 fractions (10%). Thirty-one percent of segments were of radioresistant histology (gastrointestinal, kidney, melanoma, sarcoma, or thyroid primary), and 51% had extraosseous disease. Sixteen percent of segments were under-contoured per consensus guidelines, with incomplete coverage of the involved sector (71%), omission of the adjacent uninvolved sector (17%), or both (11%) as the causes for deviation. The cumulative incidence of LF was 18.4% (95% CI 13.5-24.0) at 12-months and 23.1% (95% CI 17.6-29.0) at 24-months. On multivariate analysis (MVA), under-contouring (HR 2.4, 95% CI 1.3-4.7, p = 0.008), radioresistant histology (HR 2.4, 95% CI 1,4-4.1, p = 0.001), and extraosseous extension (HR 2.5, 95% CI 1.3-4.7, p = 0.005) were predictors of increased risk of LF. The LF rates at 12/24-months were 15.1%/18.8% for segments contoured per guideline versus 31.4%/40.0% for those under-contoured. The cumulative incidence of VCF was 7.1% (95% CI 4.1-11.1) at 12-months and 12.3% (95% CI 8.2-17.2) at 24-months. On MVA, female gender was the only risk factor for VCF (HR 2.3, 95% CI 1.1-5.2, p = 0.04). The median OS was 29.5 months (95% CI 17.5-59.2). On MVA, primary kidney (HR 4.7, 95% CI 1.7-12.5, p = 0.002) or lung histology (HR 3.4, 95% CI 1.3-8.5, p = 0.010), the presence of liver (HR 2.8, 95% CI 1.2-6.4, p = 0.016) or lung (HR 2.5, 95% CI 1.3-5.1, p = 0.008) metastases, ECOG performance status 2 or 3 (HR 3.3, 95% CI 1.2-8.2, p = 0.013), and the presence of sensory or motor deficit (HR 2.6, 95% CI 1.2-5.4, p = 0.012) were prognostic for worse OS. CONCLUSION Sacral SBRT is associated with high rates of efficacy and an acceptable VCF risk. Adherence to target volume delineation consensus guidelines reduces the risk of LF.
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Palhares DM, Dasgupta A, Saifuddin M, Ho L, Lu L, Prasla S, Pena MLA, Karam I, Soliman H, Szumacher E, Chow E, Chen H, Vesprini D, Sahgal A, Czarnota GJ. A Novel Strategy to Enhance Radiotherapy Efficacy: Results from the Prospective Phase I Clinical Trial of MR-Guided Focused Ultrasound-Stimulated Microbubbles (MRgFUS+MB) Treatment for Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e197. [PMID: 37784840 DOI: 10.1016/j.ijrobp.2023.06.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Preclinical in vitro and in vivo studies have demonstrated that tumor cell death can be enhanced 10- to 40-fold when radiotherapy (RT) is combined with focused-ultrasound (FUS)-stimulated microbubbles (MB) treatment. MBs are gas microspheres used as intravascular contrast agents. The acoustic exposure of MBs within the target volume causes bubbles cavitation that induces perturbation of tumor vasculature. This activates apoptotic pathways responsible for the ablative effect of stereotactic body radiotherapy, which would otherwise require high-dose radiotherapy (>8-10 Gy/fraction) to be activated. Subsequent irradiation of an MB-sensitized tumor causes increased anoxic tumor killing, which occurs in addition to canonical RT-induced DNA damage. Given the compelling results of preclinical data, we conducted a phase I clinical trial of magnetic resonance (MR)-guided FUS-stimulated MBs (MRgFUS+MB) treatment for breast cancer patients (pts). We report the safety and efficacy results of this new radio enhancement treatment. MATERIALS/METHODS This is a single-center, single-arm, investigator-initiated phase 1 clinical trial (NCT04431674). We included pts with stage I-IV breast cancer with tumor in situ for whom breast or chest wall RT was deemed adequate by a multidisciplinary team. Pts were excluded if they had contraindications for contrast-enhanced MR or MB administration. Pts underwent 2-3 MRgFUS+MB treatments throughout the RT course. We used an MR-coupled FUS-device operating at 500 KHz and 540 kPa peak negative pressure to deliver the treatment. The FUS sonicated intravenously administrated MB within the MR-guided target volume. Pts were monitored for 30-min post-procedure and subsequently treated with RT. The primary outcome was acute toxicity per Common Terminology for Adverse Events V5.0. Secondary outcomes were radiological response at 3 months and local control (LC) at 1 year. Kaplan-Meier method was used to estimate local control. All pts signed a written consent form before study participation. RESULTS We enrolled 18 females with 20 primary breast cancer treated with MRgFUS+MB therapy. The median age was 60 years (range, 44-90). The molecular subtypes consisted of basal-like (n = 3/20), luminal (n = 11/20), and HER2-enriched (n = 6/20). The prescribed dose was 20 Gy/5 fractions (n = 8/20), 30-35 Gy/5 fractions (n = 7/20), 30-40 Gy/10 fractions (n = 3/20), and 66 Gy/33 fractions (n = 2/20). The median follow-up was 9 months (range, 0.3-29). All pts completed the planned MRgFUS+MB treatments. The only MRgFUS+MB treatment-related toxicity consisted of Grade 1 allergic reaction (mild cough) 30 minutes after the last MB injection. All worst acute toxicities were radiation dermatitis (Grade 3 = 2/20, Grade 2 = 2/20, Grade 1 = 14/20). At 3 months, 75% had partial (n = 6/20) or complete (n = 9/20) response, with a single progression. The LC rate at 1 year was 86%. CONCLUSION MRgFUS+MB was a safe and efficient treatment that provided durable responses.
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Ruschin ME, Stewart J, Hudson JM, Myrehaug SD, Tseng CL, Soliman H, Chen H, Maralani P, Sahgal A, Detsky J. Dosimetric Implications of Weekly On-Line MR-Guided Adaptive Radiotherapy (RT) for Glioblastomas (GBM) Growing during RT. Int J Radiat Oncol Biol Phys 2023; 117:e713-e714. [PMID: 37786085 DOI: 10.1016/j.ijrobp.2023.06.2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The UNITED trial (NCT04726397) involves once-weekly on-line adaptive RT for patients with GBM on a 1.5T MRI-Linac (MRL). For tumors that continue to enlarge during the course of RT, we hypothesize that the adaptive strategy improves the dosimetric coverage of the target relative to a non-adaptive strategy. MATERIALS/METHODS As per the trial protocol, T1+contrast (T1c) and FLAIR MRI sequences were acquired once per week during RT to re-define and adapt the gross tumor volume (GTV) as the contrast enhanced volume, the clinical target volume (CTV) as a 5mm expansion around the GTV plus adjacent FLAIR hyperintense regions considered at-risk by the radiation oncologist, and a 3 mm PTV around the CTV. Nine UNITED patients with tumors that grew throughout RT (GTV and/or CTV) were identified. 5/9 patients were treated with 60 Gy in 30 fractions (6 weekly adaptions) and 4/9 with 40 Gy in 15 fractions (3 weekly adaptions). For the final week's GTV and CTV (GTVfinal and CTVfinal), the dosimetric outcomes of the delivered and adaptive summative plans (Dsum) were compared to dose of the baseline plan (Dbaseline) generated on Fraction 1 of treatment, the latter being indicative of the theoretical situation where no further adaption was taken. We measured the dose to 99% of the GTVfinal and CTVfinal: Dsum99 and Dbaseline99. RESULTS For each adaptive fraction, the plan was optimized to achieve an objective of D99 greater than 95% of the prescription (D99>95%) for both the GTV and CTV. The relative increase in GTVfinal and CTVfinal from baseline was on average 119% (range: 98% to 144.7%) and 128% (range: 109% to 176%), respectively. The proportion of CTVfinal that was outside the baseline plan's PTV was on average 11.5% (range: 0% to 32%). The GTVfinal did not extend beyond the baseline PTV for any of the 9 cases. GTVfinal Dsum99 was >95% for all cases while CTVfinal Dsum99 was < 95% in 2 of 9 cases (74%, and 87%). By contrast, the baseline plan, if given for all fractions with no further adaptation, yielded a D99 for CTVfinal of <95% in 5 of 9 cases (28%, 52%, 75%, 84%, and 87%). In general, coverage of the CTVfinal decreased with increasing levels of CTVfinal outside of the baseline PTV. For all 5 cases where CTVfinal D99<95% on the baseline plan, more than 10% of CTVfinal was outside of the baseline PTV. Small margin, weekly adaptive RT on an MRL for GBM maintains coverage of the GTV in the presence of tumor growth while minimizing the degree of normal brain tissue irradiated. Dosimetric impact on non-GTV/CTV brain is outside the scope of the present study. CONCLUSION Preliminary results indicate that a once weekly adaptive approach for small margin MR-guided RT improves tumor coverage for progressive tumors compared to a static (baseline) plan without adaptation.
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Li GJ, Tan H, Nusrat H, Chen H, Chang JH, Shahi J, Poon I, Tsao M, Ung YC, Cheung P, Louie AV. Safety and Efficacy of Stereotactic Body Radiotherapy for Ultra-Central Thoracic Tumors. Int J Radiat Oncol Biol Phys 2023; 117:e35-e36. [PMID: 37785212 DOI: 10.1016/j.ijrobp.2023.06.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is increasingly utilized in the management of ultra-central thoracic tumors, although concerns regarding significant toxicity remain. We sought to evaluate the toxicity and efficacy of SBRT to these tumors at our institution. MATERIALS/METHODS Patients with ultra-central lung tumors or nodes treated at our institution with SBRT between 2009 and 2019 were retrospectively reviewed. Ultra-central was defined as having the planning target volume (PTV) overlapping or abutting the central bronchial tree and/or esophagus. All SBRT plans were generated with homogenous dose distributions using target coverage objectives of ITV V100% >99%, PTV V95% >99%, and an ideal PTV Dmax <105% (strict <120%). All plans were reviewed in quality assurance rounds by a team of dosimetrists, physicists, and radiation oncologists. The primary endpoint was incidence of severe toxicity (ST), defined as SBRT-related grade ≥3 toxicities, graded using the Common Terminology Criteria for Adverse Events V5.0. Secondary endpoints included local failure (LF), progression-free survival (PFS) and overall survival (OS). Competing risk analysis was used to estimate incidence and predictors of ST and LF, with death as a competing risk. Kaplan-Meier method was used to estimate PFS and OS. RESULTS A total of 154 patients who received 162 ultra-central courses of SBRT were included, with a median follow-up of 21.5 months. Treatment intent was most commonly for oligoprogression (46%), oligometastasis (30%), followed by curative (20%). The most frequent tumor histologies were NSCLC (41%) and RCC (26%). SBRT prescription doses ranged from 30-55 Gy in 5 fractions (BED10 range 48-115 Gy). The most common prescription was 50 Gy in 5 fractions (42%). The cumulative incidence of ST was 8.9% at 3-years. The most common ST was pneumonitis (n = 4). Notable toxicities included bronchopleural fistula (n = 2, grade 3 and 4), bronchial stricture (n = 1, grade 3), and esophagitis leading to bleeding (n = 1, grade 4). There were no esophageal strictures or perforations, and no bronchial bleeds. There was 1 possible treatment related death from pneumonitis/pneumonia. Predictors of any ST included increased lung V5 Gy, decreased PTV V95%, and not having prior radiation therapy to the chest. The cumulative incidence of LF was 4.8%, 11% and 14% at 1-, 2-, and 3-years respectively. Predictors of LF included younger age, and greater volume of overlap between the PTV and esophagus. Median PFS was 8.4 months, while median OS was 3.7 years. CONCLUSION In one of the largest case series of ultra-central thoracic SBRT reported to date, homogenously prescribed SBRT plans were associated with relatively low rates of ST and LF across a variety of treatment indications. Predictors of ST should be interpreted recognizing the heterogeneity in toxicities observed. Identified predictors of both ST and LF can contribute to future work to optimize the therapeutic ratio in treatment of ultra-central thoracic tumors.
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Wang BL, Jin TW, Han YM, Shen CH, Li Q, Lin QK, Chen H. Retraction: Bio-inspired terpolymers containing dopamine, cations and MPC: a versatile platform to construct a recycle antibacterial and antifouling surface. J Mater Chem B 2023; 11:9036. [PMID: 37724447 DOI: 10.1039/d3tb90177g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Retraction of 'Bio-inspired terpolymers containing dopamine, cations and MPC: a versatile platform to construct a recycle antibacterial and antifouling surface' by B. L. Wang et al., J. Mater. Chem. B, 2015, 3, 5501-5510, https://doi.org/10.1039/C5TB00597C.
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Yang LY, Chen H, Zhao Y. [Treatment strategy of lateral canals during root canal therapy]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2023; 58:958-963. [PMID: 37659856 DOI: 10.3760/cma.j.cn112144-20230113-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
Lateral canals are small branches from the main root canal, usually extending from the dentin and cementum into the periodontal ligament, mostly located at the lower 1/3 of the apical portion. Due to the complex and varied anatomical morphology as well as the high incidence, it becomes an important factor affecting the effect of root canal therapy and a difficult point in this process. It is of great clinical significance to master the treatment strategy of lateral canals during root canal therapy. This article reviews the anatomical characteristics of lateral canals, as well as the clinical identification, treatment strategy and the laboratory detection methods of lateral canals in the process of root canal preparation, disinfection, and obturation.
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Lu AT, Fei Z, Haghani A, Robeck TR, Zoller JA, Li CZ, Lowe R, Yan Q, Zhang J, Vu H, Ablaeva J, Acosta-Rodriguez VA, Adams DM, Almunia J, Aloysius A, Ardehali R, Arneson A, Baker CS, Banks G, Belov K, Bennett NC, Black P, Blumstein DT, Bors EK, Breeze CE, Brooke RT, Brown JL, Carter GG, Caulton A, Cavin JM, Chakrabarti L, Chatzistamou I, Chen H, Cheng K, Chiavellini P, Choi OW, Clarke SM, Cooper LN, Cossette ML, Day J, DeYoung J, DiRocco S, Dold C, Ehmke EE, Emmons CK, Emmrich S, Erbay E, Erlacher-Reid C, Faulkes CG, Ferguson SH, Finno CJ, Flower JE, Gaillard JM, Garde E, Gerber L, Gladyshev VN, Gorbunova V, Goya RG, Grant MJ, Green CB, Hales EN, Hanson MB, Hart DW, Haulena M, Herrick K, Hogan AN, Hogg CJ, Hore TA, Huang T, Izpisua Belmonte JC, Jasinska AJ, Jones G, Jourdain E, Kashpur O, Katcher H, Katsumata E, Kaza V, Kiaris H, Kobor MS, Kordowitzki P, Koski WR, Krützen M, Kwon SB, Larison B, Lee SG, Lehmann M, Lemaitre JF, Levine AJ, Li C, Li X, Lim AR, Lin DTS, Lindemann DM, Little TJ, Macoretta N, Maddox D, Matkin CO, Mattison JA, McClure M, Mergl J, Meudt JJ, Montano GA, Mozhui K, Munshi-South J, Naderi A, Nagy M, Narayan P, Nathanielsz PW, Nguyen NB, Niehrs C, O'Brien JK, O'Tierney Ginn P, Odom DT, Ophir AG, Osborn S, Ostrander EA, Parsons KM, Paul KC, Pellegrini M, Peters KJ, Pedersen AB, Petersen JL, Pietersen DW, Pinho GM, Plassais J, Poganik JR, Prado NA, Reddy P, Rey B, Ritz BR, Robbins J, Rodriguez M, Russell J, Rydkina E, Sailer LL, Salmon AB, Sanghavi A, Schachtschneider KM, Schmitt D, Schmitt T, Schomacher L, Schook LB, Sears KE, Seifert AW, Seluanov A, Shafer ABA, Shanmuganayagam D, Shindyapina AV, Simmons M, Singh K, Sinha I, Slone J, Snell RG, Soltanmaohammadi E, Spangler ML, Spriggs MC, Staggs L, Stedman N, Steinman KJ, Stewart DT, Sugrue VJ, Szladovits B, Takahashi JS, Takasugi M, Teeling EC, Thompson MJ, Van Bonn B, Vernes SC, Villar D, Vinters HV, Wallingford MC, Wang N, Wayne RK, Wilkinson GS, Williams CK, Williams RW, Yang XW, Yao M, Young BG, Zhang B, Zhang Z, Zhao P, Zhao Y, Zhou W, Zimmermann J, Ernst J, Raj K, Horvath S. Universal DNA methylation age across mammalian tissues. NATURE AGING 2023; 3:1144-1166. [PMID: 37563227 PMCID: PMC10501909 DOI: 10.1038/s43587-023-00462-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/21/2023] [Indexed: 08/12/2023]
Abstract
Aging, often considered a result of random cellular damage, can be accurately estimated using DNA methylation profiles, the foundation of pan-tissue epigenetic clocks. Here, we demonstrate the development of universal pan-mammalian clocks, using 11,754 methylation arrays from our Mammalian Methylation Consortium, which encompass 59 tissue types across 185 mammalian species. These predictive models estimate mammalian tissue age with high accuracy (r > 0.96). Age deviations correlate with human mortality risk, mouse somatotropic axis mutations and caloric restriction. We identified specific cytosines with methylation levels that change with age across numerous species. These sites, highly enriched in polycomb repressive complex 2-binding locations, are near genes implicated in mammalian development, cancer, obesity and longevity. Our findings offer new evidence suggesting that aging is evolutionarily conserved and intertwined with developmental processes across all mammals.
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Ren LP, Chen H, Zhang T, Pan Q. [The effect of subclinical hypercortisolism on bone metabolism]. ZHONGHUA NEI KE ZA ZHI 2023; 62:1135-1138. [PMID: 37650188 DOI: 10.3760/cma.j.cn112138-20230207-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Hackl A, Nüsken E, Voggel J, Abo Zed SED, Binz-Lotter J, Unnersjö-Jess D, Müller C, Fink G, Bohl K, Wiesner E, Diefenhardt P, Dafinger C, Chen H, Wohlfarth M, Müller RU, Hackl MJ, Schermer B, Nüsken KD, Weber LT. The effect of mycophenolate mofetil on podocytes in nephrotoxic serum nephritis. Sci Rep 2023; 13:14167. [PMID: 37644089 PMCID: PMC10465485 DOI: 10.1038/s41598-023-41222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
Mycophenolate mofetil (MMF) is applied in proteinuric kidney diseases, but the exact mechanism of its effect on podocytes is still unknown. Our previous in vitro experiments suggested that MMF can ameliorate podocyte damage via restoration of the Ca2+-actin cytoskeleton axis. The goal of this study was to characterize podocyte biology during MMF treatment in nephrotoxic serum (NTS) nephritis (NTN). NTN was induced in three-week old wild-type mice. On day 3, half of the mice were treated with MMF (100 mg/kgBW/d p.o.) for one week. On day 10, we performed proteomic analysis of glomeruli as well as super-resolution imaging of the slit diaphragm. For multiphoton imaging of Ca2+ concentration ([Ca2+]i), the experimental design was repeated in mice expressing podocyte-specific Ca2+ sensor. MMF ameliorated the proteinuria and crescent formation induced by NTS. We identified significant changes in the abundance of proteins involved in Ca2+ signaling and actin cytoskeleton regulation, which was further confirmed by direct [Ca2+]i imaging in podocytes showing decreased Ca2+ levels after MMF treatment. This was associated with a tendency to restoration of podocyte foot process structure. Here, we provide evidence that MPA has a substantial direct effect on podocytes. MMF contributes to improvement of [Ca2+]i and amelioration of the disorganized actin cytoskeleton in podocytes. These data extend the knowledge of direct effects of immunosuppressants on podocytes that may contribute to a more effective treatment of proteinuric glomerulopathies with the least possible side effects.
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Guo L, Chen H, Zhang Y, Yan S, Chen X, Gao X. Starch granules and their size distribution in wheat: Biosynthesis, physicochemical properties and their effect on flour-based food systems. Comput Struct Biotechnol J 2023; 21:4172-4186. [PMID: 37675285 PMCID: PMC10477758 DOI: 10.1016/j.csbj.2023.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
Starch is a vital component of wheat grain and flour, characterized by two distinct granule types: A-type starch (AS) with granules larger than 10 µm in diameter, and B-type starch (BS) with granules measuring no more than 10 µm in diameter. This review comprehensively evaluates the isolation, purification, and biosynthesis processes of these types of granules. In addition, a comparative analysis of the structure and properties of AS and BS is presented, encompassing chemical composition, molecular, crystalline and morphological structures, gelatinization, pasting and digestive properties. The variation in size distribution of granules leads to differences in physicochemical properties of starch, influencing the formation of polymeric proteins, secondary and micro-structures of gluten, chemical and physical interactions between gluten and starch, and water absorption and water status in dough system. Thus, starch size distribution affects the quality of dough and final products. In this review, we summarize the up-to-date knowledge of AS and BS, and propose the possible strategies to enhance wheat yield and quality through coordinated breeding efforts. This review serves as a valuable reference for future advancements in wheat breeding.
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Aad G, Abbott B, Abbott DC, Abeling K, Abidi SH, Aboulhorma A, Abramowicz H, Abreu H, Abulaiti Y, Abusleme Hoffman AC, Acharya BS, Achkar B, Adam L, Adam Bourdarios C, Adamczyk L, Adamek L, Addepalli SV, Adelman J, Adiguzel A, Adorni S, Adye T, Affolder AA, Afik Y, Agaras MN, Agarwala J, Aggarwal A, Agheorghiesei C, Aguilar-Saavedra JA, Ahmad A, Ahmadov F, Ahmed WS, Ahuja S, Ai X, Aielli G, Aizenberg I, Akbiyik M, Åkesson TPA, Akimov AV, Al Khoury K, Alberghi GL, Albert J, Albicocco P, Alconada Verzini MJ, Alderweireldt S, Aleksa M, Aleksandrov IN, Alexa C, Alexopoulos T, Alfonsi A, Alfonsi F, Alhroob M, Ali B, Ali S, Aliev M, Alimonti G, Allaire C, Allbrooke BMM, Allport PP, Aloisio A, Alonso F, Alpigiani C, Alunno Camelia E, Alvarez Estevez M, Alviggi MG, Amaral Coutinho Y, Ambler A, Amelung C, Ames CG, Amidei D, Amor Dos Santos SP, Amoroso S, Amos KR, Amrouche CS, Ananiev V, Anastopoulos C, Andari N, Andeen T, Anders JK, Andrean SY, Andreazza A, Angelidakis S, Angerami A, Anisenkov AV, Annovi A, Antel C, Anthony MT, Antipov E, Antonelli M, Antrim DJA, Anulli F, Aoki M, Aparisi Pozo JA, Aparo MA, Aperio Bella L, Appelt C, Aranzabal N, Araujo Ferraz V, Arcangeletti C, Arce ATH, Arena E, Arguin JF, Argyropoulos S, Arling JH, Armbruster AJ, Arnaez O, Arnold H, Arrubarrena Tame ZP, Artoni G, Asada H, Asai K, Asai S, Asbah NA, Asimakopoulou EM, Assahsah J, Assamagan K, Astalos R, Atkin RJ, Atkinson M, Atlay NB, Atmani H, Atmasiddha PA, Augsten K, Auricchio S, Auriol AD, Austrup VA, Avner G, Avolio G, Axiotis K, Ayoub MK, Azuelos G, Babal D, Bachacou H, Bachas K, Bachiu A, Backman F, Badea A, Bagnaia P, Bahmani M, Bailey AJ, Bailey VR, Baines JT, Bakalis C, Baker OK, Bakker PJ, Bakos E, Bakshi Gupta D, Balaji S, Balasubramanian R, Baldin EM, Balek P, Ballabene E, Balli F, Baltes LM, Balunas WK, Balz J, Banas E, Bandieramonte M, Bandyopadhyay A, Bansal S, Barak L, Barberio EL, Barberis D, Barbero M, Barbour G, Barends KN, Barillari T, Barisits MS, Barkeloo J, Barklow T, Barnett RM, Baron P, Baron Moreno DA, Baroncelli A, Barone G, Barr AJ, Barranco Navarro L, Barreiro F, Barreiro Guimarães da Costa J, Barron U, Barros Teixeira MG, Barsov S, Bartels F, Bartoldus R, Barton AE, Bartos P, Basalaev A, Basan A, Baselga M, Bashta I, Bassalat A, Basso MJ, Basson CR, Bates RL, Batlamous S, Batley JR, Batool B, Battaglia M, Bauce M, Bauer P, Bayirli A, Beacham JB, Beau T, Beauchemin PH, Becherer F, Bechtle P, Beck HP, Becker K, Becot C, Beddall AJ, Bednyakov VA, Bee CP, Beemster LJ, Beermann TA, Begalli M, Begel M, Behera A, Behr JK, Beirao Da Cruz E Silva C, Beirer JF, Beisiegel F, Belfkir M, Bella G, Bellagamba L, Bellerive A, Bellos P, Beloborodov K, Belotskiy K, Belyaev NL, Benchekroun D, Bendebba F, Benhammou Y, Benjamin DP, Benoit M, Bensinger JR, Bentvelsen S, Beresford L, Beretta M, Berge D, Bergeaas Kuutmann E, Berger N, Bergmann B, Beringer J, Berlendis S, Bernardi G, Bernius C, Bernlochner FU, Berry T, Berta P, Berthold A, Bertram IA, Bessidskaia Bylund O, Bethke S, Betti A, Bevan AJ, Bhamjee M, Bhatta S, Bhattacharya DS, Bhattarai P, Bhopatkar VS, Bi R, Bi R, Bianchi RM, Biebel O, Bielski R, Biglietti M, Billoud TRV, Bindi M, Bingul A, Bini C, Biondi S, Biondini A, Birch-Sykes CJ, Bird GA, Birman M, Bisanz T, Biswas D, Bitadze A, Bjørke K, Bloch I, Blocker C, Blue A, Blumenschein U, Blumenthal J, Bobbink GJ, Bobrovnikov VS, Boehler M, Bogavac D, Bogdanchikov AG, Bohm C, Boisvert V, Bokan P, Bold T, Bomben M, Bona M, Boonekamp M, Booth CD, Borbély AG, Borecka-Bielska HM, Borgna LS, Borissov G, Bortoletto D, Boscherini D, Bosman M, Bossio Sola JD, Bouaouda K, Boudreau J, Bouhova-Thacker EV, Boumediene D, Bouquet R, Boveia A, Boyd J, Boye D, Boyko IR, Bracinik J, Brahimi N, Brandt G, Brandt O, Braren F, Brau B, Brau JE, Breaden Madden WD, Brendlinger K, Brener R, Brenner L, Brenner R, Bressler S, Brickwedde B, Britton D, Britzger D, Brock I, Brooijmans G, Brooks WK, Brost E, Bruckman de Renstrom PA, Brüers B, Bruncko D, Bruni A, Bruni G, Bruschi M, Bruscino N, Bryngemark L, Buanes T, Buat Q, Buchholz P, Buckley AG, Budagov IA, Bugge MK, Bulekov O, Bullard BA, Burdin S, Burgard CD, Burger AM, Burghgrave B, Burr JTP, Burton CD, Burzynski JC, Busch EL, Büscher V, Bussey PJ, Butler JM, Buttar CM, Butterworth JM, Buttinger W, Buxo Vazquez CJ, Buzykaev AR, Cabras G, Cabrera Urbán S, Caforio D, Cai H, Cai Y, Cairo VMM, Cakir O, Calace N, Calafiura P, Calderini G, Calfayan P, Callea G, Caloba LP, Calvet D, Calvet S, Calvet TP, Calvetti M, Camacho Toro R, Camarda S, Camarero Munoz D, Camarri P, Camerlingo MT, Cameron D, Camincher C, Campanelli M, Camplani A, Canale V, Canesse A, Cano Bret M, Cantero J, Cao Y, Capocasa F, Capua M, Carbone A, Cardarelli R, Cardenas JCJ, Cardillo F, Carli T, Carlino G, Carlson BT, Carlson EM, Carminati L, Carnesale M, Caron S, Carquin E, Carrá S, Carratta G, Carrio Argos F, Carter JWS, Carter TM, Casado MP, Casha AF, Castiglia EG, Castillo FL, Castillo Garcia L, Castillo Gimenez V, Castro NF, Catinaccio A, Catmore JR, Cavaliere V, Cavalli N, Cavasinni V, Celebi E, Celli F, Centonze MS, Cerny K, Cerqueira AS, Cerri A, Cerrito L, Cerutti F, Cervelli A, Cetin SA, Chadi Z, Chakraborty D, Chala M, Chan J, Chan WS, Chan WY, Chapman JD, Chargeishvili B, Charlton DG, Charman TP, Chatterjee M, Chekanov S, Chekulaev SV, Chelkov GA, Chen A, Chen B, Chen B, Chen C, Chen H, Chen H, Chen J, Chen J, Chen S, Chen SJ, Chen X, Chen X, Chen Y, Cheng CL, Cheng HC, Cheplakov A, Cheremushkina E, Cherepanova E, Cherkaoui El Moursli R, Cheu E, Cheung K, Chevalier L, Chiarella V, Chiarelli G, Chiodini G, Chisholm AS, Chitan A, Chiu YH, Chizhov MV, Choi K, Chomont AR, Chou Y, Chow EYS, Chowdhury T, Christopher LD, Chu KL, Chu MC, Chu X, Chudoba J, Chwastowski JJ, Cieri D, Ciesla KM, Cindro V, Ciocio A, Cirotto F, Citron ZH, Citterio M, Ciubotaru DA, Ciungu BM, Clark A, Clark PJ, Clavijo Columbie JM, Clawson SE, Clement C, Clercx J, Clissa L, Coadou Y, Cobal M, Coccaro A, Barrue RFC, Coelho Lopes De Sa R, Coelli S, Cohen H, Coimbra AEC, Cole B, Collot J, Conde Muiño P, Connell MP, Connell SH, Connelly IA, Conroy EI, Conventi F, Cooke HG, Cooper-Sarkar AM, Cormier F, Corpe LD, Corradi M, Corrigan EE, Corriveau F, Cortes-Gonzalez A, Costa MJ, Costanza F, Costanzo D, Cote BM, Cowan G, Cowley JW, Cranmer K, Crépé-Renaudin S, Crescioli F, Cristinziani M, Cristoforetti M, Croft V, Crosetti G, Cueto A, Cuhadar Donszelmann T, Cui H, Cui Z, Cukierman AR, Cunningham WR, Curcio F, Czodrowski P, Czurylo MM, De Sousa MJDCS, Da Fonseca Pinto JV, Da Via C, Dabrowski W, Dado T, Dahbi S, Dai T, Dallapiccola C, Dam M, D'amen G, D'Amico V, Damp J, Dandoy JR, Daneri MF, Danninger M, Dao V, Darbo G, Darmora S, Das SJ, Dattagupta A, D'Auria S, David C, Davidek T, Davis DR, Davis-Purcell B, Dawson I, De K, De Asmundis R, De Beurs M, De Castro S, De Groot N, de Jong P, De la Torre H, De Maria A, De Salvo A, De Sanctis U, De Santo A, De Vivie De Regie JB, Dedovich DV, Degens J, Deiana AM, Del Corso F, Del Peso J, Del Rio F, Deliot F, Delitzsch CM, Della Pietra M, Della Volpe D, Dell'Acqua A, Dell'Asta L, Delmastro M, Delsart PA, Demers S, Demichev M, Denisov SP, D'Eramo L, Derendarz D, Derue F, Dervan P, Desch K, Dette K, Deutsch C, Deviveiros PO, Di Bello FA, Di Ciaccio A, Di Ciaccio L, Di Domenico A, Di Donato C, Di Girolamo A, Di Gregorio G, Di Luca A, Di Micco B, Di Nardo R, Diaconu C, Dias FA, Vale TDD, Diaz MA, Diaz Capriles FG, Didenko M, Diehl EB, Diehl L, Díez Cornell S, Diez Pardos C, Dimitriadi C, Dimitrievska A, Ding W, Dingfelder J, Dinu IM, Dittmeier SJ, Dittus F, Djama F, Djobava T, Djuvsland JI, Dodsworth D, Doglioni C, Dolejsi J, Dolezal Z, Donadelli M, Dong B, Donini J, D'Onofrio A, D'Onofrio M, Dopke J, Doria A, Dova MT, Doyle AT, Draguet MA, Drechsler E, Dreyer E, Drivas-Koulouris I, Drobac AS, Du D, du Pree TA, Dubinin F, Dubovsky M, Duchovni E, Duckeck G, Ducu OA, Duda D, Dudarev A, D'uffizi M, Duflot L, Dührssen M, Dülsen C, Dumitriu AE, Dunford M, Dungs S, Dunne K, Duperrin A, Yildiz HD, Düren M, Durglishvili A, Dwyer BL, Dyckes GI, Dyndal M, Dysch S, Dziedzic BS, Earnshaw ZO, Eckerova B, Eggleston MG, Purcino De Souza EE, Ehrke LF, Eigen G, Einsweiler K, Ekelof T, Ekman PA, El Ghazali Y, El Jarrari H, El Moussaouy A, Ellajosyula V, Ellert M, Ellinghaus F, Elliot AA, Ellis N, Elmsheuser J, Elsing M, Emeliyanov D, Emerman A, Enari Y, Ene I, Epari S, Erdmann J, Ereditato A, Erland PA, Errenst M, Escalier M, Escobar C, Etzion E, Evans G, Evans H, Evans MO, Ezhilov A, Ezzarqtouni S, Fabbri F, Fabbri L, Facini G, Fadeyev V, Fakhrutdinov RM, Falciano S, Falke PJ, Falke S, Faltova J, Fan Y, Fang Y, Fanourakis G, Fanti M, Faraj M, Farbin A, Farilla A, Farooque T, Farrington SM, Fassi F, Fassouliotis D, Faucci Giannelli M, Fawcett WJ, Fayard L, Fedin OL, Fedotov G, Feickert M, Feligioni L, Fell A, Fellers DE, Feng C, Feng M, Fenton MJ, Fenyuk AB, Ferencz L, Ferguson SW, Pretel J, Ferrando J, Ferrari A, Ferrari P, Ferrari R, Ferrere D, Ferretti C, Fiedler F, Filipčič A, Filmer EK, Filthaut F, Fiolhais MCN, Fiorini L, Fischer F, Fisher WC, Fitschen T, Fleck I, Fleischmann P, Flick T, Flores L, Flores M, Flores Castillo LR, Follega FM, Fomin N, Foo JH, Forland BC, Formica A, Forti AC, Fortin E, Fortman AW, Foti MG, Fountas L, Fournier D, Fox H, Francavilla P, Francescato S, Franchini M, Franchino S, Francis D, Franco L, Franconi L, Franklin M, Frattari G, Freegard AC, Freeman PM, Freund WS, Fritzsche N, Froch A, Froidevaux D, Frost JA, Fu Y, Fujimoto M, Fullana Torregrosa E, Fuster J, Gabrielli A, Gabrielli A, Gadow P, Gagliardi G, Gagnon LG, Gallardo GE, Gallas EJ, Gallop BJ, Gamboa Goni R, Gan KK, Ganguly S, Gao J, Gao Y, Garay Walls FM, Garcia B, García C, García Navarro JE, García Pascual JA, Garcia-Sciveres M, Gardner RW, Garg D, Garg RB, Gargiulo S, Garner CA, Garonne V, Gasiorowski SJ, Gaspar P, Gaudio G, Gautam V, Gauzzi P, Gavrilenko IL, Gavrilyuk A, Gay C, Gaycken G, Gazis EN, Geanta AA, Gee CM, Geisen J, Geisen M, Gemme C, Genest MH, Gentile S, George S, George WF, Geralis T, Gerlach LO, Gessinger-Befurt P, Ghasemi Bostanabad M, Ghneimat M, Ghosal A, Ghosh A, Ghosh A, Giacobbe B, Giagu S, Giangiacomi N, Giannetti P, Giannini A, Gibson SM, Gignac M, Gil DT, Gilbert AK, Gilbert BJ, Gillberg D, Gilles G, Gillwald NEK, Ginabat L, Gingrich DM, Giordani MP, Giraud PF, Giugliarelli G, Giugni D, Giuli F, Gkialas I, Gladilin LK, Glasman C, Gledhill GR, Glisic M, Gnesi I, Go Y, Goblirsch-Kolb M, Godin D, Goldfarb S, Golling T, Gololo MGD, Golubkov D, Gombas JP, Gomes A, Gomes Da Silva G, Gomez Delegido AJ, Goncalves Gama R, Gonçalo R, Gonella G, Gonella L, Gongadze A, Gonnella F, Gonski JL, González de la Hoz S, Gonzalez Fernandez S, Gonzalez Lopez R, Gonzalez Renteria C, Gonzalez Suarez R, Gonzalez-Sevilla S, Gonzalvo Rodriguez GR, González Andana RY, Goossens L, Gorasia NA, Gorbounov PA, Gorini B, Gorini E, Gorišek A, Goshaw AT, Gostkin MI, Gottardo CA, Gouighri M, Goumarre V, Goussiou AG, Govender N, Goy C, 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Vorobev K, Vos M, Vossebeld JH, Vozak M, Vozdecky L, Vranjes N, Vranjes Milosavljevic M, Vreeswijk M, Vuillermet R, Vujinovic O, Vukotic I, Wada S, Wagner C, Wagner W, Wahdan S, Wahlberg H, Wakasa R, Wakida M, Walbrecht VM, Walder J, Walker R, Walkowiak W, Wang AM, Wang AZ, Wang C, Wang C, Wang H, Wang J, Wang P, Wang RJ, Wang R, Wang R, Wang SM, Wang S, Wang T, Wang WT, Wang WX, Wang X, Wang X, Wang X, Wang Y, Wang Y, Wang Z, Wang Z, Wang Z, Warburton A, Ward RJ, Warrack N, Watson AT, Watson MF, Watts G, Waugh BM, Webb AF, Weber C, Weber MS, Weber SA, Weber SM, Wei C, Wei Y, Weidberg AR, Weingarten J, Weirich M, Weiser C, Wells CJ, Wenaus T, Wendland B, Wengler T, Wenke NS, Wermes N, Wessels M, Whalen K, Wharton AM, White AS, White A, White MJ, Whiteson D, Wickremasinghe L, Wiedenmann W, Wiel C, Wielers M, Wieseotte N, Wiglesworth C, Wiik-Fuchs LAM, Wilbern DJ, Wilkens HG, Williams DM, Williams HH, Williams S, Willocq S, Windischhofer PJ, Winklmeier F, Winter BT, Wittgen M, Wobisch M, Wolf A, Wölker R, Wollrath J, Wolter MW, Wolters H, Wong VWS, Wongel AF, Worm SD, Wosiek BK, Woźniak KW, Wraight K, Wu J, Wu M, Wu SL, Wu X, Wu Y, Wu Z, Wuerzinger J, Wyatt TR, Wynne BM, Xella S, Xia L, Xia M, Xiang J, Xiao X, Xie M, Xie X, Xiong J, Xiotidis I, Xu D, Xu H, Xu H, Xu L, Xu R, Xu T, Xu W, Xu Y, Xu Z, Xu Z, Yabsley B, Yacoob S, Yamaguchi N, Yamaguchi Y, Yamauchi H, Yamazaki T, Yamazaki Y, Yan J, Yan S, Yan Z, Yang HJ, Yang HT, Yang S, Yang T, Yang X, Yang X, Yang Y, Yang Z, Yao WM, Yap YC, Ye H, Ye J, Ye S, Ye X, Yeh Y, Yeletskikh I, Yexley MR, Yin P, Yorita K, Young CJS, Young C, Yuan M, Yuan R, Yue L, Yue X, Zaazoua M, Zabinski B, Zaid E, Zakareishvili T, Zakharchuk N, Zambito S, Zang J, Zanzi D, Zaplatilek O, Zeißner SV, Zeitnitz C, Zeng JC, Zenger DT, Zenin O, Ženiš T, Zenz S, Zerradi S, Zerwas D, Zhang B, Zhang DF, Zhang G, Zhang J, Zhang K, Zhang L, Zhang P, Zhang R, Zhang S, Zhang T, Zhang X, Zhang X, Zhang Z, Zhang Z, Zhao H, Zhao P, Zhao T, Zhao Y, Zhao Z, Zhemchugov A, Zheng Z, Zhong D, Zhou B, Zhou C, Zhou H, Zhou N, Zhou Y, Zhu CG, Zhu C, Zhu HL, Zhu H, Zhu J, Zhu Y, Zhu Y, Zhuang X, Zhukov K, Zhulanov V, Zimine NI, Zinsser J, Ziolkowski M, Živković L, Zoccoli A, Zoch K, Zorbas TG, Zormpa O, Zou W, Zwalinski L. Strong Constraints on Jet Quenching in Centrality-Dependent p+Pb Collisions at 5.02 TeV from ATLAS. PHYSICAL REVIEW LETTERS 2023; 131:072301. [PMID: 37656838 DOI: 10.1103/physrevlett.131.072301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/04/2022] [Accepted: 11/17/2022] [Indexed: 09/03/2023]
Abstract
Jet quenching is the process of color-charged partons losing energy via interactions with quark-gluon plasma droplets created in heavy-ion collisions. The collective expansion of such droplets is well described by viscous hydrodynamics. Similar evidence of collectivity is consistently observed in smaller collision systems, including pp and p+Pb collisions. In contrast, while jet quenching is observed in Pb+Pb collisions, no evidence has been found in these small systems to date, raising fundamental questions about the nature of the system created in these collisions. The ATLAS experiment at the Large Hadron Collider has measured the yield of charged hadrons correlated with reconstructed jets in 0.36 nb^{-1} of p+Pb and 3.6 pb^{-1} of pp collisions at 5.02 TeV. The yields of charged hadrons with p_{T}^{ch}>0.5 GeV near and opposite in azimuth to jets with p_{T}^{jet}>30 or 60 GeV, and the ratios of these yields between p+Pb and pp collisions, I_{pPb}, are reported. The collision centrality of p+Pb events is categorized by the energy deposited by forward neutrons from the struck nucleus. The I_{pPb} values are consistent with unity within a few percent for hadrons with p_{T}^{ch}>4 GeV at all centralities. These data provide new, strong constraints that preclude almost any parton energy loss in central p+Pb collisions.
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Cheng Q, Chen H, Fu ZH, Li YC, Yang XY. [Bronchial tuberculosis complicated with massive hemorrhage after Dieulafoy's disease biopsy: a case report]. ZHONGHUA JIE HE HE HU XI ZA ZHI = ZHONGHUA JIEHE HE HUXI ZAZHI = CHINESE JOURNAL OF TUBERCULOSIS AND RESPIRATORY DISEASES 2023; 46:810-812. [PMID: 37536992 DOI: 10.3760/cma.j.cn112147-20230414-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Compared with simple bronchial Dieulafoy's disease, bronchial tuberculosis with Dieulafoy's disease is rarer and more complex, with non-specific clinical manifestations. In this article, we reported a case of right lateral basal segment bronchial tuberculosis complicated with Dieulafoy's disease. The clinical manifestations, microscopic features, and rescue procedures in the event of massive hemorrhage in this case were described in detail, and the shortcomings in the clinical diagnosis and treatment of this case were analyzed. The aim of this study was to improve clinicians' understanding of bronchial tuberculosis combined with Dieulafoy's disease.
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B, Collot J, Conde Muiño P, Connell SH, Connelly IA, Conroy EI, Conventi F, Cooke HG, Cooper-Sarkar AM, Cormier F, Corpe LD, Corradi M, Corrigan EE, Corriveau F, Costa MJ, Costanza F, Costanzo D, Cote BM, Cowan G, Cowley JW, Cranmer K, Crépé-Renaudin S, Crescioli F, Cristinziani M, Cristoforetti M, Croft V, Crosetti G, Cueto A, Cuhadar Donszelmann T, Cui H, Cui Z, Cukierman AR, Cunningham WR, Curcio F, Czodrowski P, Czurylo MM, De Sousa MJDCS, Da Fonseca Pinto JV, Da Via C, Dabrowski W, Dado T, Dahbi S, Dai T, Dallapiccola C, Dam M, D'amen G, D'Amico V, Damp J, Dandoy JR, Daneri MF, Danninger M, Dao V, Darbo G, Darmora S, Dattagupta A, D'Auria S, David C, Davidek T, Davis DR, Davis-Purcell B, Dawson I, De K, De Asmundis R, De Beurs M, De Castro S, De Groot N, de Jong P, De la Torre H, De Maria A, De Salvo A, De Sanctis U, De Santis M, De Santo A, De Vivie De Regie JB, Dedovich DV, Degens J, Deiana AM, Del Peso J, Del Rio F, Deliot F, Delitzsch CM, Della Pietra M, Della Volpe D, Dell'Acqua A, Dell'Asta L, Delmastro M, Delsart PA, Demers S, Demichev M, Denisov SP, D'Eramo L, Derendarz D, Derue F, Dervan P, Desch K, Dette K, Deutsch C, Deviveiros PO, Di Bello FA, Di Ciaccio A, Di Ciaccio L, Di Domenico A, Di Donato C, Di Girolamo A, Di Gregorio G, Di Luca A, Di Micco B, Di Nardo R, Diaconu C, Dias FA, Vale TDD, Diaz MA, Diaz Capriles FG, Didenko M, Diehl EB, Díez Cornell S, Diez Pardos C, Dimitriadi C, Dimitrievska A, Ding W, Dingfelder J, Dinu IM, Dittmeier SJ, Dittus F, Djama F, Djobava T, Djuvsland JI, Dodsworth D, Doglioni C, Dolejsi J, Dolezal Z, Donadelli M, Dong B, Donini J, D'Onofrio A, D'Onofrio M, Dopke J, Doria A, Dova MT, Doyle AT, Drechsler E, Dreyer E, Drobac AS, Du D, du Pree TA, Dubinin F, Dubovsky M, Duchovni E, Duckeck G, Ducu OA, Duda D, Dudarev A, D'uffizi M, Duflot L, Dührssen M, Dülsen C, Dumitriu AE, Dunford M, Dungs S, Dunne K, Duperrin A, Yildiz HD, Düren M, Durglishvili A, Dutta B, Dwyer BL, Dyckes GI, Dyndal M, Dysch S, Dziedzic BS, 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Flores M, Flores Castillo LR, Follega FM, Fomin N, Foo JH, Forland BC, Formica A, Forti AC, Fortin E, Fortman AW, Foti MG, Fountas L, Fournier D, Fox H, Francavilla P, Francescato S, Franchini M, Franchino S, Francis D, Franco L, Franconi L, Franklin M, Frattari G, Freegard AC, Freeman PM, Freund WS, Freundlich EM, Froidevaux D, Frost JA, Fu Y, Fujimoto M, Fullana Torregrosa E, Fuster J, Gabrielli A, Gabrielli A, Gadow P, Gagliardi G, Gagnon LG, Galantzan S, Gallardo GE, Gallas EJ, Gallop BJ, Gamboa Goni R, Gan KK, Ganguly S, Gao J, Gao Y, Garay Walls FM, Garcia B, García C, García Navarro JE, García Pascual JA, Garcia-Sciveres M, Gardner RW, Garg D, Garg RB, Gargiulo S, Garner CA, Garonne V, Gasiorowski SJ, Gaspar P, Gaudio G, Gauzzi P, Gavrilenko IL, Gavrilyuk A, Gay C, Gaycken G, Gazis EN, Geanta AA, Gee CM, Geisen J, Geisen M, Gemme C, Genest MH, Gentile S, George S, George WF, Geralis T, Gerlach LO, Gessinger-Befurt P, Ghasemi Bostanabad M, Ghneimat M, Ghosal A, Ghosh A, Ghosh A, Giacobbe B, Giagu S, Giangiacomi N, Giannetti P, Giannini A, Gibson SM, Gignac M, Gil DT, Gilbert BJ, Gillberg D, Gilles G, Gillwald NEK, Ginabat L, Gingrich DM, Giordani MP, Giraud PF, Giugliarelli G, Giugni D, Giuli F, Gkialas I, Gkountoumis P, Gladilin LK, Glasman C, Gledhill GR, Glisic M, Gnesi I, Go Y, Goblirsch-Kolb M, Godin D, Goldfarb S, Golling T, Gololo MGD, Golubkov D, Gombas JP, Gomes A, Gomez Delegido AJ, Goncalves Gama R, Gonçalo R, Gonella G, Gonella L, Gongadze A, Gonnella F, Gonski JL, González de la Hoz S, Gonzalez Fernandez S, Gonzalez Lopez R, Gonzalez Renteria C, Gonzalez Suarez R, Gonzalez-Sevilla S, Gonzalvo Rodriguez GR, González Andana RY, Goossens L, Gorasia NA, Gorbounov PA, Gorini B, Gorini E, Gorišek A, Goshaw AT, Gostkin MI, Gottardo CA, Gouighri M, Goumarre V, Goussiou AG, Govender N, Goy C, Grabowska-Bold I, Graham K, Gramstad E, Grancagnolo S, Grandi M, Gratchev V, Gravila PM, Gravili FG, Gray HM, Grefe C, Gregor IM, Grenier P, Grevtsov K, Grieco C, 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Search for Heavy Neutral Leptons in Decays of W Bosons Using a Dilepton Displaced Vertex in sqrt[s]=13 TeV pp Collisions with the ATLAS Detector. PHYSICAL REVIEW LETTERS 2023; 131:061803. [PMID: 37625051 DOI: 10.1103/physrevlett.131.061803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/08/2022] [Indexed: 08/27/2023]
Abstract
A search for a long-lived, heavy neutral lepton (N) in 139 fb^{-1} of sqrt[s]=13 TeV pp collision data collected by the ATLAS detector at the Large Hadron Collider is reported. The N is produced via W→Nμ or W→Ne and decays into two charged leptons and a neutrino, forming a displaced vertex. The N mass is used to discriminate between signal and background. No signal is observed, and limits are set on the squared mixing parameters of the N with the left-handed neutrino states for the N mass range 3 GeV
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