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Alexander A, Gagne I, Bahl G, Kim D, Mestrovic A, Ye A, Kwan W. Late Toxicity of Prostate Ultrahypofractionated Radiation Therapy Compared With Moderate Hypofractionation in a Randomized Trial. Int J Radiat Oncol Biol Phys 2024; 119:110-118. [PMID: 38042451 DOI: 10.1016/j.ijrobp.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE We report late toxicity, quality of life (QOL), and urinary symptom score with prostate cancer radiation therapy in a randomized trial comparing moderate hypofractionation and ultrahypofrationation. METHODS AND MATERIALS Patients with intermediate and high-risk prostate cancer were randomized to either Arm 1 (70 Gy/28 fractions) or Arm 2 (36.25 Gy/5 weekly fractions). Late toxicity was evaluated using the Common Terminology Criteria for Adverse Events and Radiation Therapy Oncology Group/Subjective, Objective, Management, Analytical scales. QOL was assessed with the Expanded Prostate Inventory Composite-26 Short Form and urinary function with the International Prostate Symptom Score. RESULTS Eighty participants were randomized. Two from Arm 1 withdrew, leaving 36 patients in Arm 1 and 42 in Arm 2. There were no significant differences in baseline characteristics, except for worse International Prostate Symptom Score in Arm 2. No difference was observed in freedom from grade 3 or worse toxicity between treatments (P = .921), with only a single grade 3 event in each arm. There was no significant difference in freedom from grade 2 or worse toxicity (P = .280). No difference was observed in freedom from grade 2 or worse genitorurinary toxicity, with cumulative probabilities of 69.0% and 87.0% at 5 years for Arms 1 and 2, respectively (0.132). No difference was observed in freedom from grade 2 or worse gastrointestinal toxicity, with cumulative probabilities of 74.0% in Arm 1 and 80.0% in Arm 2 (P = .430). There were no significant differences in Expanded Prostate Inventory Composite-26 Short Form QOL between arms. CONCLUSIONS Ultrahypofrationation, delivered weekly, is well tolerated with no significant differences in freedom from late toxicity compared with moderate hypofractionation.
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Affiliation(s)
- Abraham Alexander
- BC Cancer-Victoria, Deptarment of Radiation Oncology, Victoria, Canada.
| | - Isabelle Gagne
- BC Cancer-Victoria, Deptarment of Radiation Oncology, Victoria, Canada
| | - Gaurav Bahl
- BC Cancer-Abbotsford, Department of Radiation Oncology, Abbotsford, Canada
| | - David Kim
- BC Cancer-Kelowna, Deptartment of Radiation Oncology, Kelowna, Canada
| | - Ante Mestrovic
- BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, Canada
| | - Allison Ye
- BC Cancer-Prince George, Department of Radiation Oncology, Prince George, Canada
| | - Winkle Kwan
- BC Cancer-Surrey, Department of Radiation Oncology, Surrey, Canada
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2
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Safi SA, Alexander A, Neuhuber W, Haeberle L, Rehders A, Luedde T, Esposito I, Fluegen G, Knoefel WT. Defining distal splenopancreatectomy by the mesopancreas. Langenbecks Arch Surg 2024; 409:127. [PMID: 38625602 PMCID: PMC11021282 DOI: 10.1007/s00423-024-03320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The implementation of the pathologic CRM (circumferential resection margin) staging system for pancreatic head ductal adenocarcinomas (hPDAC) resulted in a dramatic increase of R1 resections at the dorsal resection margin, presumably because of the high rate of mesopancreatic fat (MP) infiltration. Therefore, mesopancreatic excision (MPE) during pancreatoduodenectomy has recently been promoted and has demonstrated better local disease control, fueling the discussion of neoadjuvant downsizing regimes in MP + patients. However, it is unknown to what extent the MP is infiltrated in patients with distal pancreatic (tail/body) carcinomas (dPDAC). It is also unknown if the MP infiltration status affects surgical margin control in distal pancreatectomy (DP). The aim of our study was to histopathologically analyze MP infiltration and elucidate the influence of resection margin clearance on recurrence and survival in patients with dPDAC. Furthermore, the results were compared to a collective receiving MPE for hPDAC. METHOD Clinicopathological and survival parameters of 295 consecutive patients who underwent surgery for PDAC (n = 63 dPDAC and n = 232 hPDAC) were evaluated. The CRM evaluation was performed in a standardized fashion and the specimens were examined according to the Leeds pathology protocol (LEEPP). The MP area was histopathologically evaluated for cancerous infiltration. RESULTS In 75.4% of dPDAC patients the MP fat was infiltrated by vital tumor cells. The rates of MP infiltration and R0CRM- resections were similar between dPDAC and hPDAC patients (p = 0.497 and 0.453 respectively). MP- infiltration status did not correlate with CRM implemented resection status in dPDAC patients (p = 0.348). In overall survival analysis, resection status and MP status remained prognostic factors for survival. In follow up analysis. surgical margin clearance in dPDAC patients was associated with a significant improvement in local recurrence rates (5.2% in R0CRM- resected vs. 33.3 in R1/R0CRM + resected, p = 0.002). CONCLUSION While resection margin status was not affected by the MP status in dPDAC patients, the high MP infiltration rate, as well as improved survival in MP- dPDAC patients after R0CRM- resection, justify mesopancreatic excision during splenopancreatectomy. Larger scale studies are urgently needed to validate our results and to study the effect on neoadjuvant treatment in dPDAC patients.
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Affiliation(s)
- S-A Safi
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - A Alexander
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - W Neuhuber
- Institute of Anatomy I, Friedrich-Alexander University Erlangen-Nuremberg, Universitätsstr. 1, Erlangen, Germany
| | - L Haeberle
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - A Rehders
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - T Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - I Esposito
- Institute of Pathology, Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - G Fluegen
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - W T Knoefel
- Departments of Surgery (A), Heinrich-Heine-University and University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
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Baker S, Lechner L, Liu M, Chang JS, Cruz-Lim EM, Mou B, Jiang W, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Arbour G, Yu I, Tyldesley S, Olson RA. Upfront Versus Delayed Systemic Therapy in Patients With Oligometastatic Cancer Treated With SABR in the Phase 2 SABR-5 Trial. Int J Radiat Oncol Biol Phys 2024; 118:1497-1506. [PMID: 38220069 DOI: 10.1016/j.ijrobp.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The optimal sequencing of local and systemic therapy for oligometastatic cancer has not been established. This study retrospectively compared progression-free survival (PFS), overall survival (OS), and SABR-related toxicity between upfront versus delay of systemic treatment until progression in patients in the SABR-5 trial. METHODS AND MATERIALS The single-arm phase 2 SABR-5 trial accrued patients with up to 5 oligometastases across SABR-5 between November 2016 and July 2020. Patients received SABR to all lesions. Two cohorts were retrospectively identified: those receiving upfront systemic treatment along with SABR and those for whom systemic treatment was delayed until disease progression. Patients treated for oligoprogression were excluded. Propensity score analysis with overlap weighting balanced baseline characteristics of cohorts. Bootstrap sampling and Cox regression models estimated the association of delayed systemic treatment with PFS, OS, and grade ≥2 toxicity. RESULTS A total of 319 patients with oligometastases underwent treatment on SABR-5, including 121 (38%) and 198 (62%) who received upfront and delayed systemic treatment, respectively. In the weighted sample, prostate cancer was the most common primary tumor histology (48%) followed by colorectal (18%), breast (13%), and lung (4%). Most patients (93%) were treated for 1 to 2 metastases. The median follow-up time was 34 months (IQR, 24-45). Delayed systemic treatment was associated with shorter PFS (hazard ratio [HR], 1.56; 95% CI, 1.15-2.13; P = .005) but similar OS (HR, 0.90; 95% CI, 0.51-1.59; P = .65) compared with upfront systemic treatment. Risk of grade 2 or higher SABR-related toxicity was reduced with delayed systemic treatment (odds ratio, 0.35; 95% CI, 0.15-0.70; P < .001). CONCLUSIONS Delayed systemic treatment is associated with shorter PFS without reduction in OS and with reduced SABR-related toxicity and may be a favorable option for select patients seeking to avoid initial systemic treatment. Efforts should continue to accrue patients to histology-specific trials examining a delayed systemic treatment approach.
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Affiliation(s)
- Sarah Baker
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada.
| | | | - Mitchell Liu
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Jee Suk Chang
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ella Mae Cruz-Lim
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Ben Mou
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Will Jiang
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Alanah Bergman
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Devin Schellenberg
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Abraham Alexander
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Tanya Berrang
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Andrew Bang
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Nick Chng
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
| | - Quinn Matthews
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
| | - Hannah Carolan
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Fred Hsu
- University of British Columbia; BC Cancer-Abbotsford, Department of Radiation Oncology, Abbotsford, BC, Canada
| | - Stacey Miller
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
| | - Siavash Atrchian
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Elisa Chan
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Clement Ho
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Islam Mohamed
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Angela Lin
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Vicky Huang
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Ante Mestrovic
- BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Derek Hyde
- University of British Columbia; BC Cancer-Kelowna, Department of Radiation Oncology, Kelowna, BC, Canada
| | - Chad Lund
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Howard Pai
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Boris Valev
- University of British Columbia; BC Cancer-Victoria, Department of Radiation Oncology, Victoria, BC, Canada
| | - Shilo Lefresne
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | | | - Irene Yu
- University of British Columbia; BC Cancer-Surrey, Department of Radiation Oncology, Surrey, BC, Canada
| | - Scott Tyldesley
- University of British Columbia; BC Cancer-Vancouver, Department of Radiation Oncology, Vancouver, BC, Canada
| | - Rob A Olson
- University of British Columbia; BC Cancer-Prince George, Department of Radiation Oncology, Prince George, BC, Canada
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4
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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
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5
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Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
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6
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Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brudanin V, Brugnera R, Caldwell A, Cattadori C, Chernogorov A, Comellato T, D’Andrea V, Demidova EV, Marco ND, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Huang J, Hult M, Inzhechik LV, Csáthy JJ, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Kneißl R, Knöpfle KT, Kochetov O, Kornoukhov VN, Korošec M, Krause P, Kuzminov VV, Laubenstein M, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Misiaszek M, Morella M, Müller Y, Nemchenok I, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Ransom C, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Vasenko AA, Veresnikova A, Vignoli C, Sturm KV, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. An improved limit on the neutrinoless double-electron capture of 36Ar with GERDA. Eur Phys J C Part Fields 2024; 84:34. [PMID: 38229675 PMCID: PMC10788323 DOI: 10.1140/epjc/s10052-023-12280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 01/18/2024]
Abstract
The GERmanium Detector Array (Gerda) experiment operated enriched high-purity germanium detectors in a liquid argon cryostat, which contains 0.33% of 36 Ar, a candidate isotope for the two-neutrino double-electron capture (2ν ECEC) and therefore for the neutrinoless double-electron capture (0ν ECEC). If detected, this process would give evidence of lepton number violation and the Majorana nature of neutrinos. In the radiative 0ν ECEC of 36 Ar, a monochromatic photon is emitted with an energy of 429.88 keV, which may be detected by the Gerda germanium detectors. We searched for the 36 Ar 0ν ECEC with Gerda data, with a total live time of 4.34 year (3.08 year accumulated during Gerda Phase II and 1.26 year during Gerda Phase I). No signal was found and a 90% CL lower limit on the half-life of this process was established T 1 / 2 > 1.5 · 10 22 year. Supplementary Information The online version contains supplementary material available at 10.1140/epjc/s10052-023-12280-6.
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7
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Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D'Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hackenmüller S, Hemmer S, Hofmann W, Huang J, Hult M, Inzhechik LV, Janicskó Csáthy J, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lehnert B, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Miloradovic M, Mingazheva R, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Ransom C, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Final Results of GERDA on the Two-Neutrino Double-β Decay Half-Life of ^{76}Ge. Phys Rev Lett 2023; 131:142501. [PMID: 37862664 DOI: 10.1103/physrevlett.131.142501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/15/2023] [Indexed: 10/22/2023]
Abstract
We present the measurement of the two-neutrino double-β decay rate of ^{76}Ge performed with the GERDA Phase II experiment. With a subset of the entire GERDA exposure, 11.8 kg yr, the half-life of the process has been determined: T_{1/2}^{2ν}=(2.022±0.018_{stat}±0.038_{syst})×10^{21} yr. This is the most precise determination of the ^{76}Ge two-neutrino double-β decay half-life and one of the most precise measurements of a double-β decay process. The relevant nuclear matrix element can be extracted: M_{eff}^{2ν}=(0.101±0.001).
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Affiliation(s)
- M Agostini
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - A Alexander
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - G R Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - A M Bakalyarov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - M Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E Bossio
- Physik Department, Technische Universität München, Germany
| | - V Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A Chernogorov
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - P-J Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T Comellato
- Physik Department, Technische Universität München, Germany
| | - V D'Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | - E V Demidova
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
- Physik Department, Technische Universität München, Germany
| | | | | | - W Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - J Huang
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L V Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | | | - J Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - H Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I V Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K T Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - O Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V N Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - P Krause
- Physik Department, Technische Universität München, Germany
| | - V V Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - B Lehnert
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - M Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | | | - W Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G Marshall
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - M Miloradovic
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - R Mingazheva
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Neuberger
- Physik Department, Technische Universität München, Germany
| | - L Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L Pertoldi
- Physik Department, Technische Universität München, Germany
- INFN Padova, Padua, Italy
| | - P Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - C Ransom
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - L Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - C Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell'Aquila, L'Aquila, Italy
| | - S Schönert
- Physik Department, Technische Universität München, Germany
| | - J Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A-K Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M Schwarz
- Physik Department, Technische Universität München, Germany
| | | | - O Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | - M Shirchenko
- Joint Institute for Nuclear Research, Dubna, Russia
| | - L Shtembari
- Max-Planck-Institut für Physik, Munich, Germany
| | - H Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D Stukov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - S Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A A Vasenko
- Institute for Theoretical and Experimental Physics, NRC "Kurchatov Institute," Moscow, Russia
| | - A Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - T Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - C Wiesinger
- Physik Department, Technische Universität München, Germany
| | - M Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S V Zhukov
- National Research Centre "Kurchatov Institute," Moscow, Russia
| | - D Zinatulina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
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8
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Agostini M, Alexander A, Araujo G, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D’Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Hult M, Inzhechik LV, Janicskó Csáthy J, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Search for tri-nucleon decays of 76Ge in GERDA. Eur Phys J C Part Fields 2023; 83:778. [PMID: 37674593 PMCID: PMC10477131 DOI: 10.1140/epjc/s10052-023-11862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/25/2023] [Indexed: 09/08/2023]
Abstract
We search for tri-nucleon decays of 76 Ge in the dataset from the GERmanium Detector Array (GERDA) experiment. Decays that populate excited levels of the daughter nucleus above the threshold for particle emission lead to disintegration and are not considered. The ppp-, ppn-, and pnn-decays lead to 73 Cu, 73 Zn, and 73 Ga nuclei, respectively. These nuclei are unstable and eventually proceed by the beta decay of 73 Ga to 73 Ge (stable). We search for the 73 Ga decay exploiting the fact that it dominantly populates the 66.7 keV 73 m Ga state with half-life of 0.5 s. The nnn-decays of 76 Ge that proceed via 73 m Ge are also included in our analysis. We find no signal candidate and place a limit on the sum of the decay widths of the inclusive tri-nucleon decays that corresponds to a lower lifetime limit of 1.2× 1026 yr (90% credible interval). This result improves previous limits for tri-nucleon decays by one to three orders of magnitude.
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Affiliation(s)
- M. Agostini
- Department of Physics and Astronomy, University College London, London, UK
| | - A. Alexander
- Department of Physics and Astronomy, University College London, London, UK
| | - G. Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | | | - M. Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I. Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L. Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C. Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S. Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- NRNU MEPhI, Moscow, Russia
| | - A. Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L. Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V. Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E. Bossio
- Physik Department, Technische Universität München, Munich, Germany
| | - V. Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R. Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S. Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A. Chernogorov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - P.-J. Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T. Comellato
- Physik Department, Technische Universität München, Munich, Germany
| | - V. D’Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - E. V. Demidova
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N. Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E. Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F. Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A. Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A. Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C. Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P. Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V. Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K. Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Hakenmüller
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Duke University, Durham, NC USA
| | | | - W. Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L. V. Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Moscow Institute of Physics and Technology, Moscow, Russia
| | - J. Janicskó Csáthy
- Physik Department, Technische Universität München, Munich, Germany
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
| | - J. Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M. Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V. Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y. Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - H. Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T. Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K. Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I. V. Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Dubna State University, Dubna, Russia
| | - K. T. Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - O. Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V. N. Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- NRNU MEPhI, Moscow, Russia
| | - P. Krause
- Physik Department, Technische Universität München, Munich, Germany
| | - V. V. Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M. Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - M. Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B. Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G. Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C. Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | | | - W. Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G. Marshall
- Department of Physics and Astronomy, University College London, London, UK
| | - M. Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M. Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y. Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I. Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
- Dubna State University, Dubna, Russia
| | - M. Neuberger
- Physik Department, Technische Universität München, Munich, Germany
| | - L. Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K. Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L. Pertoldi
- Physik Department, Technische Universität München, Munich, Germany
- INFN Padova, Padua, Italy
| | - P. Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A. Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - L. Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S. Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N. Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - C. Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S. Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F. Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - S. Schönert
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A.-K. Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O. Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Schwarz
- Physik Department, Technische Universität München, Munich, Germany
| | | | - O. Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E. Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | | | - H. Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D. Stukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - S. Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. A. Vasenko
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C. Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K. von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - T. Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | | | - M. Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E. Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B. Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I. Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S. V. Zhukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | | | - A. Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K. Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G. Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
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9
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Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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10
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Agostini M, Alexander A, Araujo GR, Bakalyarov AM, Balata M, Barabanov I, Baudis L, Bauer C, Belogurov S, Bettini A, Bezrukov L, Biancacci V, Bossio E, Bothe V, Brugnera R, Caldwell A, Calgaro S, Cattadori C, Chernogorov A, Chiu PJ, Comellato T, D’Andrea V, Demidova EV, Di Giacinto A, Di Marco N, Doroshkevich E, Fischer F, Fomina M, Gangapshev A, Garfagnini A, Gooch C, Grabmayr P, Gurentsov V, Gusev K, Hakenmüller J, Hemmer S, Hofmann W, Hult M, Inzhechik LV, Csáthy JJ, Jochum J, Junker M, Kazalov V, Kermaïdic Y, Khushbakht H, Kihm T, Kilgus K, Kirpichnikov IV, Klimenko A, Knöpfle KT, Kochetov O, Kornoukhov VN, Krause P, Kuzminov VV, Laubenstein M, Lehnert B, Lindner M, Lippi I, Lubashevskiy A, Lubsandorzhiev B, Lutter G, Macolino C, Majorovits B, Maneschg W, Manzanillas L, Marshall G, Miloradovic M, Mingazheva R, Misiaszek M, Morella M, Müller Y, Nemchenok I, Neuberger M, Pandola L, Pelczar K, Pertoldi L, Piseri P, Pullia A, Rauscher L, Redchuk M, Riboldi S, Rumyantseva N, Sada C, Sailer S, Salamida F, Schönert S, Schreiner J, Schütt M, Schütz AK, Schulz O, Schwarz M, Schwingenheuer B, Selivanenko O, Shevchik E, Shirchenko M, Shtembari L, Simgen H, Smolnikov A, Stukov D, Sullivan S, Vasenko AA, Veresnikova A, Vignoli C, von Sturm K, Wegmann A, Wester T, Wiesinger C, Wojcik M, Yanovich E, Zatschler B, Zhitnikov I, Zhukov SV, Zinatulina D, Zschocke A, Zsigmond AJ, Zuber K, Zuzel G. Liquid argon light collection and veto modeling in GERDA Phase II. Eur Phys J C Part Fields 2023; 83:319. [PMID: 37122826 PMCID: PMC10126063 DOI: 10.1140/epjc/s10052-023-11354-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/24/2023] [Indexed: 05/03/2023]
Abstract
The ability to detect liquid argon scintillation light from within a densely packed high-purity germanium detector array allowed the Gerda experiment to reach an exceptionally low background rate in the search for neutrinoless double beta decay of76 Ge. Proper modeling of the light propagation throughout the experimental setup, from any origin in the liquid argon volume to its eventual detection by the novel light read-out system, provides insight into the rejection capability and is a necessary ingredient to obtain robust background predictions. In this paper, we present a model of the Gerda liquid argon veto, as obtained by Monte Carlo simulations and constrained by calibration data, and highlight its application for background decomposition.
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Affiliation(s)
- M. Agostini
- Department of Physics and Astronomy, University College London, London, UK
| | - A. Alexander
- Department of Physics and Astronomy, University College London, London, UK
| | - G. R. Araujo
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | | | - M. Balata
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - I. Barabanov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - L. Baudis
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - C. Bauer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - S. Belogurov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- Moscow Inst. of Physics and Technology, Dolgoprudny, Russia
| | - A. Bettini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - L. Bezrukov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - V. Biancacci
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - E. Bossio
- Physik Department, Technische Universität München, Munich, Germany
| | - V. Bothe
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - R. Brugnera
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Caldwell
- Max-Planck-Institut für Physik, Munich, Germany
| | - S. Calgaro
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | | | - A. Chernogorov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - P. -J. Chiu
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - T. Comellato
- Physik Department, Technische Universität München, Munich, Germany
| | - V. D’Andrea
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - E. V. Demidova
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Di Giacinto
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - N. Di Marco
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - E. Doroshkevich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - F. Fischer
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Fomina
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A. Gangapshev
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - A. Garfagnini
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - C. Gooch
- Max-Planck-Institut für Physik, Munich, Germany
| | - P. Grabmayr
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - V. Gurentsov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - K. Gusev
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Hakenmüller
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Duke University, Durham, NC USA
| | | | - W. Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Hult
- European Commission, JRC-Geel, Geel, Belgium
| | - L. V. Inzhechik
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Dubna State University, Dubna, Russia
| | - J. Janicskó Csáthy
- Physik Department, Technische Universität München, Munich, Germany
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
| | - J. Jochum
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - M. Junker
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - V. Kazalov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - Y. Kermaïdic
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
| | - H. Khushbakht
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - T. Kihm
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - K. Kilgus
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - I. V. Kirpichnikov
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Klimenko
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Dubna State University, Dubna, Russia
| | - K. T. Knöpfle
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- NRNU MEPhI, Moscow, Russia
| | - O. Kochetov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - V. N. Kornoukhov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - P. Krause
- Physik Department, Technische Universität München, Munich, Germany
| | - V. V. Kuzminov
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - M. Laubenstein
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - B. Lehnert
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
- Present Address: Nuclear Science Division, Berkeley, USA
| | - M. Lindner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | | | - B. Lubsandorzhiev
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - G. Lutter
- European Commission, JRC-Geel, Geel, Belgium
| | - C. Macolino
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | | | - W. Maneschg
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | | | - G. Marshall
- Department of Physics and Astronomy, University College London, London, UK
| | - M. Miloradovic
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - R. Mingazheva
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - M. Misiaszek
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - M. Morella
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
| | - Y. Müller
- Physik-Institut, Universität Zürich, Zurich, Switzerland
| | - I. Nemchenok
- Joint Institute for Nuclear Research, Dubna, Russia
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
| | - M. Neuberger
- Physik Department, Technische Universität München, Munich, Germany
| | - L. Pandola
- INFN Laboratori Nazionali del Sud, Catania, Italy
| | - K. Pelczar
- European Commission, JRC-Geel, Geel, Belgium
| | - L. Pertoldi
- Physik Department, Technische Universität München, Munich, Germany
- INFN Padova, Padua, Italy
| | - P. Piseri
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - A. Pullia
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - L. Rauscher
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - S. Riboldi
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
| | - N. Rumyantseva
- Joint Institute for Nuclear Research, Dubna, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - C. Sada
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - S. Sailer
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - F. Salamida
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
| | - S. Schönert
- Physik Department, Technische Universität München, Munich, Germany
| | - J. Schreiner
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - M. Schütt
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. -K. Schütz
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - O. Schulz
- Max-Planck-Institut für Physik, Munich, Germany
| | - M. Schwarz
- Physik Department, Technische Universität München, Munich, Germany
| | | | - O. Selivanenko
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - E. Shevchik
- Joint Institute for Nuclear Research, Dubna, Russia
| | | | | | - H. Simgen
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. Smolnikov
- Joint Institute for Nuclear Research, Dubna, Russia
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - D. Stukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | - S. Sullivan
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - A. A. Vasenko
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
| | - A. Veresnikova
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - C. Vignoli
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
| | - K. von Sturm
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
| | - A. Wegmann
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
| | - T. Wester
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - C. Wiesinger
- Physik Department, Technische Universität München, Munich, Germany
| | - M. Wojcik
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - E. Yanovich
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
| | - B. Zatschler
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - I. Zhitnikov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - S. V. Zhukov
- National Research Centre “Kurchatov Institute”, Moscow, Russia
| | | | - A. Zschocke
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - K. Zuber
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
| | - G. Zuzel
- Institute of Physics, Jagiellonian University, Cracow, Poland
| | - Gerda collaboration
- INFN Laboratori Nazionali del Gran Sasso, Assergi, Italy
- INFN Laboratori Nazionali del Gran Sasso and Gran Sasso Science Institute, Assergi, Italy
- INFN Laboratori Nazionali del Gran Sasso and Università degli Studi dell’Aquila, L’Aquila, Italy
- INFN Laboratori Nazionali del Sud, Catania, Italy
- Institute of Physics, Jagiellonian University, Cracow, Poland
- Institut für Kern- und Teilchenphysik, Technische Universität Dresden, Dresden, Germany
- Joint Institute for Nuclear Research, Dubna, Russia
- European Commission, JRC-Geel, Geel, Belgium
- Max-Planck-Institut für Kernphysik, Heidelberg, Germany
- Department of Physics and Astronomy, University College London, London, UK
- INFN Milano Bicocca, Milan, Italy
- Dipartimento di Fisica, Università degli Studi di Milano and INFN Milano, Milan, Italy
- Institute for Nuclear Research of the Russian Academy of Sciences, Moscow, Russia
- Institute for Theoretical and Experimental Physics, NRC “Kurchatov Institute”, Moscow, Russia
- National Research Centre “Kurchatov Institute”, Moscow, Russia
- Max-Planck-Institut für Physik, Munich, Germany
- Physik Department, Technische Universität München, Munich, Germany
- Dipartimento di Fisica e Astronomia, Università degli Studi di Padova, Padua, Italy
- INFN Padova, Padua, Italy
- Physikalisches Institut, Eberhard Karls Universität Tübingen, Tübingen, Germany
- Physik-Institut, Universität Zürich, Zurich, Switzerland
- Present Address: Duke University, Durham, NC USA
- Present Address: Leibniz-Institut für Kristallzüchtung, Berlin, Germany
- Present Address: Nuclear Science Division, Berkeley, USA
- Present Address: Université Paris-Saclay, CNRS/IN2P3, IJCLab, 91405 Orsay, France
- NRNU MEPhI, Moscow, Russia
- Moscow Inst. of Physics and Technology, Dolgoprudny, Russia
- Dubna State University, Dubna, Russia
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Eufemon Cereno R, Mou B, Baker S, Chng N, Arbour G, Bergman A, Liu M, Schellenberg D, Matthews Q, Huang V, Mestrovic A, Hyde D, Alexander A, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Berrang T, Bang A, Jiang W, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson RA. Should organs at risk (OARs) be prioritized over target volume coverage in stereotactic ablative radiotherapy (SABR) for oligometastases? a secondary analysis of the population-based phase II SABR-5 trial. Radiother Oncol 2023; 182:109576. [PMID: 36822355 DOI: 10.1016/j.radonc.2023.109576] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/26/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic ablative radiotherapy (SABR) for oligometastases may improve survival, however concerns about safety remain. To mitigate risk of toxicity, target coverage was sacrificed to prioritize organs-at-risk (OARs) during SABR planning in the population-based SABR-5 trial. This study evaluated the effect of this practice on dosimetry, local recurrence (LR), and progression-free survival (PFS). METHODS This single-arm phase II trial included patients with up to 5 oligometastases between November 2016 and July 2020. Theprotocol-specified planning objective was to cover 95 % of the planning target volume (PTV) with 100 % of the prescribed dose, however PTV coverage was reduced as needed to meet OAR constraints. This trade-off was measured using the coverage compromise index (CCI), computed as minimum dose received by the hottest 99 % of the PTV (D99) divided by the prescription dose. Under-coverage was defined as CCI < 0.90. The potential association between CCI and outcomes was evaluated. RESULTS 549 lesions from 381 patients were assessed. Mean CCI was 0.88 (95 % confidence interval [CI], 0.86-0.89), and 196 (36 %) lesions were under-covered. The highest mean CCI (0.95; 95 %CI, 0.93-0.97) was in non-spine bone lesions (n = 116), while the lowest mean CCI (0.71; 95 % CI, 0.69-0.73) was in spine lesions (n = 104). On multivariable analysis, under-coverage did not predict for worse LR (HR 0.48, p = 0.37) or PFS (HR 1.24, p = 0.38). Largest lesion diameter, colorectal and 'other' (non-prostate, breast, or lung) primary predicted for worse LR. Largest lesion diameter, synchronous tumor treatment, short disease free interval, state of oligoprogression, initiation or change in systemic treatment, and a high PTV Dmax were significantly associated with PFS. CONCLUSION PTV under-coverage was not associated with worse LR or PFS in this large, population-based phase II trial. Combined with low toxicity rates, this study supports the practice of prioritizing OAR constraints during oligometastatic SABR planning.
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Affiliation(s)
- Reno Eufemon Cereno
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Benjamin Mou
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Sarah Baker
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Nick Chng
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Gregory Arbour
- University of British Columbia, British Columbia, Canada
| | - Alanah Bergman
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Mitchell Liu
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Devin Schellenberg
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Quinn Matthews
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Vicky Huang
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Ante Mestrovic
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Derek Hyde
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Abraham Alexander
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Hannah Carolan
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Fred Hsu
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Abbotsford, British Columbia, Canada
| | - Stacy Miller
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Prince George, British Columbia, Canada
| | - Siavash Atrchian
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Elisa Chan
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Clement Ho
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Islam Mohamed
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Angela Lin
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Tanya Berrang
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Andrew Bang
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Will Jiang
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Prince George, British Columbia, Canada
| | - Chad Lund
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Surrey, British Columbia, Canada
| | - Howard Pai
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Boris Valev
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Victoria, British Columbia, Canada
| | - Shilo Lefresne
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Robert A Olson
- University of British Columbia, British Columbia, Canada; British Columbia Cancer, Prince George, British Columbia, Canada.
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Meshram S, Gupta S, Alexander A, Agrawal S, Lanjewar N, Meshram K, Patel A, More A, Yadav R, Muley S, Shamkuwar C, Singh A. Sleep quality in COVID-19 patients and its association with severity of COVID. Sleep Med 2022. [PMCID: PMC9300259 DOI: 10.1016/j.sleep.2022.05.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Olson R, Jiang W, Liu M, Bergman A, Schellenberg D, Mou B, Alexander A, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Berrang T, Bang A, Chng N, Matthews Q, Baker S, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresene S, Tyldesley S. Treatment With Stereotactic Ablative Radiotherapy for Up to 5 Oligometastases in Patients With Cancer: Primary Toxic Effect Results of the Nonrandomized Phase 2 SABR-5 Clinical Trial. JAMA Oncol 2022; 8:1644-1650. [PMID: 36173619 PMCID: PMC9523552 DOI: 10.1001/jamaoncol.2022.4394] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022]
Abstract
Importance After the publication of the landmark SABR-COMET trial, concerns arose regarding high-grade toxic effects of treatment with stereotactic ablative body radiotherapy (SABR) for oligometastases. Objective To document toxic effects of treatment with SABR in a large cohort from a population-based, provincial cancer program. Design, Setting, and Participants From November 2016 to July 2020, 381 patients across all 6 cancer centers in British Columbia were treated in this single-arm, phase 2 trial of treatment with SABR for patients with oligometastatic or oligoprogressive disease. During this period, patients were only eligible to receive treatment with SABR in these settings in trials within British Columbia; therefore, this analysis is population based, with resultant minimal selection bias compared with previously published SABR series. Interventions Stereotactic ablative body radiotherapy to up to 5 metastases. Main Outcomes and Measures Rate of grade 2, 3, 4, and 5 toxic effects associated with SABR. Findings Among 381 participants (122 women [32%]), the mean (SD; range) age was 68 (11.1; 30-97) years, and the median (range) follow-up was 25 (1-54) months. The most common histological findings were prostate cancer (123 [32%]), colorectal cancer (63 [17%]), breast cancer (42 [11%]), and lung cancer (33 [9%]). The number of SABR-treated sites were 1 (263 [69%]), 2 (82 [22%]), and 3 or more (36 [10%]). The most common sites of SABR were lung (188 [34%]), nonspine bone (136 [25%]), spine (85 [16%]), lymph nodes (78 [14%]), liver (29 [5%]), and adrenal (15 [3%]). Rates of grade 2, 3, 4, and 5 toxic effects associated with SABR (based on the highest-grade toxic effect per patient) were 14.2%; (95% CI, 10.7%-17.7%), 4.2% (95% CI, 2.2%-6.2%), 0%, and 0.3% (95% CI, 0%-0.8%), respectively. The cumulative incidence of grade 2 or higher toxic effects associated with SABR at year 2 by Kaplan-Meier analysis was 8%, and for grade 3 or higher, 4%. Conclusions and Relevance This single-arm, phase 2 clinical trial found that the incidence of grade 3 or higher SABR toxic effects in this population-based study was less than 5%. Furthermore, the rates of grade 2 or higher toxic effects (18.6%) were lower than previously published for SABR-COMET (29%). These results suggest that SABR treatment for oligometastases has acceptable rates of toxic effects and potentially support further enrollment in randomized phase 3 clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT02933242.
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Affiliation(s)
- Robert Olson
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Will Jiang
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Mitchell Liu
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Alanah Bergman
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Devin Schellenberg
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Benjamin Mou
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Abraham Alexander
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Hannah Carolan
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Fred Hsu
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Abbotsford, British Columbia, Canada
| | - Stacy Miller
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Siavash Atrchian
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Elisa Chan
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Clement Ho
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Islam Mohamed
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Angela Lin
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Tanya Berrang
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Andrew Bang
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Nick Chng
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Quinn Matthews
- British Columbia Cancer, Prince George, British Columbia, Canada
| | - Sarah Baker
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Vicky Huang
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Ante Mestrovic
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Derek Hyde
- British Columbia Cancer, Kelowna, British Columbia, Canada
| | - Chad Lund
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Surrey, British Columbia, Canada
| | - Howard Pai
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Boris Valev
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Victoria, British Columbia, Canada
| | - Shilo Lefresene
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- University of British Columbia, British Columbia, Canada
- British Columbia Cancer, Vancouver, British Columbia, Canada
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Bondarenko AS, Aviles J, Alexander A, Korepanov A, Mendoza R. Tomographic and centroid reconstructions of plasma emission on C-2W via enhanced 300-channel bolometry system. Rev Sci Instrum 2022; 93:103517. [PMID: 36319330 DOI: 10.1063/5.0101656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The C-2W experimental device at TAE Technologies utilizes neutral beam injection and edge biasing to sustain long-lived, stable field reversed configuration (FRC) plasma. An ongoing effort is under way to optimize the electrode biasing system, which provides boundary control to stabilize the FRC. To this end, tomography offers a powerful and non-invasive technique as tomographic reconstruction of the FRC emission profile provides an important assessment of global stability. Recently, a new signal acquisition system was implemented on a bolometer array dedicated to tomography on C-2W, significantly enhancing the signal-to-noise of the collected data. The array consists of 300 simultaneously digitized photodiode channels that respond to a broad range of wavelengths, from soft x-ray to near-infrared, as well as energetic particles, yielding 180 unique lines of sight that intersect a toroidal plane of the FRC near the mid-plane. Utilizing the collected photo-signals from a set of plasma discharges in which the electrode biasing was intentionally terminated mid-shot, time-resolved reconstruction of the plasma emissivity is achieved via pixel-based 1D and 2D tomographic algorithms, revealing sharply annular profiles with a clear magnetohydrodynamic (MHD) mode structure. In addition, reconstruction of the plasma center-of-emission trajectories via a centroid algorithm applied to the same set of discharges demonstrates a cyclical plasma wobble. Crucially, both the tomography reconstruction and centroid reconstruction indicate an n = 1 toroidal mode that reverses from the electron diamagnetic direction to the ion diamagnetic direction and grows in amplitude after bias termination, qualitatively consistent with the expected stabilizing effect of electrodes.
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Affiliation(s)
- A S Bondarenko
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - J Aviles
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - A Alexander
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - A Korepanov
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
| | - R Mendoza
- TAE Technologies, Inc., 19631 Pauling, Foothill Ranch, California 92610, USA
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15
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Kong T, Dosani M, Rauw J, Vallieres I, Alexander A. 64: Population-Based Outcomes of Gynecologic Cancer Patients Treated with Whole Brain or Stereotactic Radiotherapy for Brain Metastases. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Baker S, Mou B, Jiang W(WN, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson R. 65: Predictors of Early Polymetastatic Relapse Following Stereotactic Ablative Radiotherapy for Up to 5 Oligometastases: A Secondary Analysis of the Phase II SABR-5 Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Shahid N, Bang A, Tonseth R, Alexander A, Laumont C, Holloway C. 104: Evaluation of Post-Treatment PET Scans for Cervical Cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baker S, Jiang W(WN, Mou B, Lund C, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Chng N, Matthews Q, Benny A, Tyldesley S, Olson R. 36: Progression-Free Survival and Local Control Following Stereotactic Ablative Radiotherapy for Up to Five Oligometastases: An Analysis from the Population-Based Phase II SABR-5 Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bromma K, Dos Santos N, Barta I, Alexander A, Beckham W, Krishnan S, Chithrani DB. Enhancing nanoparticle accumulation in two dimensional, three dimensional, and xenograft mouse cancer cell models in the presence of docetaxel. Sci Rep 2022; 12:13508. [PMID: 35931743 PMCID: PMC9356051 DOI: 10.1038/s41598-022-17752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Recent clinical trials show docetaxel (DTX), given in conjunction with radiation therapy (RT) and androgen suppression, improves survival in high-risk prostate cancer. Addition of gold nanoparticles (GNPs) to this current DTX/RT protocol is expected to further improve therapeutic benefits remarkably. However, the foundation for the triple combination of RT, DTX, and GNPs must be elucidated to ensure quicker facilitation to the clinic. In this study, we explored the use of low concentrations of DTX combined with GNPs in two prostate cancer cell lines in a two-dimensional monolayer, a three-dimensional spheroid, and a mouse xenograft model. When used together, DTX and GNPs induced a nearly identical relative increase in uptake of gold in both the spheroid model and the mouse xenograft, which saw a 130% and 126% increase respectively after 24 h, showcasing the benefit of using spheroids as an in vitro model to better optimize in vivo experiments. Further, the benefits of using low concentrations of DTX combined with GNPs extended for over 72 h, allowing for less frequency in dosing when translating to the clinic. Overall, these results highlight the benefits of using DTX combined with GNPs and lays the groundwork for the translation of the triple combination of RT, GNPs, and DTX to the clinic.
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Affiliation(s)
- Kyle Bromma
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Nancy Dos Santos
- British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - Ingrid Barta
- Animal Care Services, University of British Columbia, Vancouver, BC, Canada
| | - Abraham Alexander
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Beckham
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.,British Columbia Cancer, Victoria, BC, Canada
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Devika B Chithrani
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada. .,British Columbia Cancer, Victoria, BC, Canada. .,Centre for Advanced Materials and Related Technologies (CAMTEC), University of Victoria, Victoria, BC, Canada. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
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Wahood W, Hallak H, Mushannen T, Alexander A, Brinjikji W. Abstract No. 565 Trends in utilization of endotracheal anesthesia for mechanical thrombectomy in acute ischemic stroke in the United States. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Kundapur V, Mayer M, Auer RN, Alexander A, Weibe S, Pushie MJ, Cranmer-Sargison G. Is Mini Beam Ready for Human Trials? Results of Randomized Study of Treating De-Novo Brain Tumors in Canines Using Linear Accelerator Generated Mini Beams. Radiat Res 2022; 198:162-171. [PMID: 35536992 DOI: 10.1667/rade-21-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
The main challenge in treating malignant brain neoplasms lies in eradicating the tumor while minimizing treatment-related damage. Conventional radiation treatments are associated with considerable side effects. Synchrotron generated micro-beam radiation (SMBRT) has shown to preserve brain architecture while killing tumor cells, however physical characteristics and limited facility access restrict its use. We have created a new clinical device which produces mini beams on a linear accelerator, to provide a new type of treatment called mini-beam radiation therapy (MBRT). The objective of this study is to compare the treatment outcomes of linear accelerator based MBRT versus standard radiation treatment (SRT), to evaluate the tumor response and the treatment-related changes in the normal brain with respect to each treatment type. Pet dogs with de-novo brain tumors were accrued for treatment. Dogs were randomized between standard fractionated stereotactic (9 Gy in 3 fractions) radiation treatment vs. a single fraction of MBRT (26 Gy mean dose). Dogs were monitored after treatment for clinical assessment and imaging. When the dogs were euthanized, a veterinary pathologist assessed the radiation changes and tumor response. We accrued 16 dogs, 8 dogs in each treatment arm. In the MBRT arm, 71% dogs achieved complete pathological remission. The radiation-related changes were all confined to the target region. Structural damage was not observed in the beam path outside of the target region. In contrast, none of the dogs in control group achieved remission and the treatment related damage was more extensive. Therapeutic superiority was observed with MBRT, including both tumor control and the normal structural preservation. The MBRT findings are suggestive of an immune related mechanism which is absent in standard treatment. These findings together with the widespread availability of clinical linear accelerators make MBRT a promising research topic to explore further treatment and clinical trial opportunities.
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Affiliation(s)
- V Kundapur
- Radiation Oncology, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - M Mayer
- Veterinary Radiation Oncology, Department of Small Animal clinical Sciences, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - R N Auer
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - A Alexander
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
| | - S Weibe
- Department of Clinical Imaging, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - M J Pushie
- Department of Surgery, University of Saskatchewan, Saskatoon, SK Canada S7N 0W8
| | - G Cranmer-Sargison
- Radiation Physics, Saskatchewan Cancer Agency, Saskatoon Cancer Centre, Saskatoon, SK Canada S7N4H4
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Kwan W, Bahl G, Kim D, Ye A, Gagne I, Alexander A, Hejazi S. Acute Toxicity of Ultrahypofractionation Compared to Moderate Hypofractionation in Prostate Cancer Treatment - a Randomized Trial. Int J Radiat Oncol Biol Phys 2022; 113:1036-1043. [PMID: 35417763 DOI: 10.1016/j.ijrobp.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To report on the early toxicities and quality of life (QOL) of localized prostate cancer radiotherapy in a randomized trial comparing moderate hypofractionation (MHF) to ultrahypofractionation (UHF) MATERIALS AND METHODS: Intermediate to high risk localized prostate cancer patients were randomized to radiotherapy with MHF (70 Gy in 28 daily fractions) or UHF (36.25 Gy in 5 weekly fractions). Early toxicities (CTCAE and RTOG/SOMA scales) and patient reported QOL (EPIC questionnaire) were analysed when all patients had a minimum of 6 months follow-up. RESULTS Eighty participants were randomized but two withdrew from radiotherapy. Analysis was done on 78 patients. The two arms were balanced in key patient and disease characteristics except for a statistically worse baseline urinary function in the UHF arm (IPSS > 7: 68% vs 36% p = 0.004). There are no statistically significant differences between the two arms in Grade 3 or Grade 2 toxicities: ≥ Grade 3 - MHF 8%, UHF 2% (p=0.235); ≥ Grade 2 MHF 36%, UHF 24% (p=0.235). There are also no significant differences in percentages of patients with a "minimal important change" of QOL in the Incontinence (MHF 36%, UHF 33% p =0.746), Irritative/Obstructive (MHF 56%, UHF 74% p=0.074) or Bowel domains (MHF 58%, UHF 52% p=0.508) on the EPIC questionnaire. CONCLUSIONS UHF radiotherapy for prostate cancer is well tolerated and there were no significant differences in toxicities and quality of life changes between UHF and MHF up to six months after treatment in the current trial.
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Sayed L, Valand P, Brewin M, Matthews A, Robson M, Nayaran N, Alexander A, Davies L, Scott E, Steele J, McMullen E. Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study. J Plast Reconstr Aesthet Surg 2022; 75:2127-2134. [PMID: 35367161 PMCID: PMC8855640 DOI: 10.1016/j.bjps.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/14/2022] [Indexed: 10/25/2022]
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Verma VS, Badwaik HR, Vaishnav Y, Alexander A, A A. Synthesis, Characterization, Molecular Modelling and Biological Evaluation of Substituted Benzo (h) Chromene-3-Carboxylate Derivatives as a Potential Agent for the Treatment of Hyperlipidemia. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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25
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Wong J, Huang V, Wells D, Giambattista J, Giambattista J, Kolbeck C, Otto K, Saibishkumar EP, Alexander A. Implementation of deep learning-based auto-segmentation for radiotherapy planning structures: a workflow study at two cancer centers. Radiat Oncol 2021; 16:101. [PMID: 34103062 PMCID: PMC8186196 DOI: 10.1186/s13014-021-01831-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/01/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose We recently described the validation of deep learning-based auto-segmented contour (DC) models for organs at risk (OAR) and clinical target volumes (CTV). In this study, we evaluate the performance of implemented DC models in the clinical radiotherapy (RT) planning workflow and report on user experience. Methods and materials DC models were implemented at two cancer centers and used to generate OAR and CTVs for all patients undergoing RT for a central nervous system (CNS), head and neck (H&N), or prostate cancer. Radiation Therapists/Dosimetrists and Radiation Oncologists completed post-contouring surveys rating the degree of edits required for DCs (1 = minimal, 5 = significant) and overall DC satisfaction (1 = poor, 5 = high). Unedited DCs were compared to the edited treatment approved contours using Dice similarity coefficient (DSC) and 95% Hausdorff distance (HD). Results Between September 19, 2019 and March 6, 2020, DCs were generated on approximately 551 eligible cases. 203 surveys were collected on 27 CNS, 54 H&N, and 93 prostate RT plans, resulting in an overall survey compliance rate of 32%. The majority of OAR DCs required minimal edits subjectively (mean editing score ≤ 2) and objectively (mean DSC and 95% HD was ≥ 0.90 and ≤ 2.0 mm). Mean OAR satisfaction score was 4.1 for CNS, 4.4 for H&N, and 4.6 for prostate structures. Overall CTV satisfaction score (n = 25), which encompassed the prostate, seminal vesicles, and neck lymph node volumes, was 4.1. Conclusions Previously validated OAR DC models for CNS, H&N, and prostate RT planning required minimal subjective and objective edits and resulted in a positive user experience, although low survey compliance was a concern. CTV DC model evaluation was even more limited, but high user satisfaction suggests that they may have served as appropriate starting points for patient specific edits. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01831-4.
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Affiliation(s)
- Jordan Wong
- BC Cancer - Vancouver, 600 W 10th Ave, Rm 4550, Vancouver, BC, V5Z 4E6, Canada.
| | - Vicky Huang
- BC Cancer - Fraser Valley, 13750 96th Avenue, Surrey, BC, V3V 1Z2, Canada
| | - Derek Wells
- BC Cancer - Victoria, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - Joshua Giambattista
- Saskatchewan Cancer Agency, 503-1801 Hamilton St, Regina, SK, S4P 4B4, Canada.,Limbus AI Inc, 2076 Athol Street, Regina, SK, S4T 3E5, Canada
| | | | - Carter Kolbeck
- Limbus AI Inc, 2076 Athol Street, Regina, SK, S4T 3E5, Canada
| | - Karl Otto
- Limbus AI Inc, 2076 Athol Street, Regina, SK, S4T 3E5, Canada
| | | | - Abraham Alexander
- BC Cancer - Victoria, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
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Prabhu JS, Patil S, Rajarajan S, Ce A, Nair M, Alexander A, Ramesh R, Bs S, Sridhar T. Triple-negative breast cancers with expression of glucocorticoid receptor in immune cells show better prognosis. Ann Oncol 2021; 32. [PMID: 34220400 DOI: 10.1016/j.annonc.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Glucocorticoid receptor (GR) is shown to have variable frequency of expression in invasive tumors of the breast. Investigation of additional nuclear receptors like GR in receptor negative tumors like triple negative breast cancer (TNBC) may have prognostic and therapeutic significance. Methods Expression of GR was evaluated by immunohistochemistry in 175 tumors of invasive breast cancer with long term follow up. GR Expression was separately evaluated in invasive tumor cells, stromal cells and tumor infiltrating lymphocytes (TIL's). Staining pattern was categorised as positive when more than 1% of the cells stained in each subpopulation of cells. Disease free survival was analysed between GR positive and negative status by Kaplan Meier analysis. Results Of the 175 tumors, 121 (70%) were ER positive, 53 (30%) were ER negative and 29% (51) were triple negative. 74% (130/175) tumors showed expression of GR in invasive tumor cells while (84%) 147/175 had expression in TIL's. No significant difference in distribution of GR was noted between ER positive and ER negative tumors (78% vs 66%, p-0.1). Of the TNBC's 54% (28/51) and 70% (36/51) showed expression of GR in invasive tumor and TIL's respectively. Overall, GR positive tumors had significant better survival than GR negative tumors (mean survival time of 85 vs 59 months respectively, p-0.04) Contrary to the reports that GR expression in TIL's are associated with immunosuppressive activity in model systems, TNBC's with increased expression of GR in immune cells were associated with better survival (Mean survival time 74 vs 41 months, log rank test- p-0.03). TNBC tumors which were GR negative had higher lymph node metastases (p-0.04) and none of the other clinical features like age, menopausal state, tumor size and grade were different between GR positive and negative tumors within TNBC. Conclusions Glucocorticoids (GC) are often used to alleviate the adverse symptoms during chemotherapy. Determining the GR status is of importance due to the pro cell survival effect of the glucocorticoids mediated through GR during chemotherapy. Though GC mediated effects on chemotherapy are controversial, our results indicate favourable effects in TNBC.
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Affiliation(s)
- J S Prabhu
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Patil
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - S Rajarajan
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Ce
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - M Nair
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - A Alexander
- Molecular Medicine, St Johns Research Institute, Bangalore, India
| | - R Ramesh
- Department of Surgical Oncology, St Johns Medical College Hospital, Bangalore, India
| | - S Bs
- Department of Surgical Oncology, Shankara Cancer Hospital & Research Centre, Bangalore, India
| | - T Sridhar
- Molecular Medicine, St Johns Research Institute, Bangalore, India
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Lokesh PK, Chowdhary S, Pol SA, Rajeswari M, Saxena SK, Alexander A. Quantification of biomaterial dispersion during otologic procedures and role of barrier drapes in Covid 2019 era - a laboratory model. J Laryngol Otol 2020; 134:1-6. [PMID: 33143756 PMCID: PMC7684199 DOI: 10.1017/s002221512000239x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic. OBJECTIVE To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery. METHODS The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1-10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed. RESULTS Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027). CONCLUSION Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.
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Affiliation(s)
- P K Lokesh
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S Chowdhary
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S A Pol
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - M Rajeswari
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - S K Saxena
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
| | - A Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (‘JIPMER’), Puducherry, India
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Alexander A, Serena G, González J, DeFaria W, Ciancio G. Renal transplantation using vascular conduit reconstruction in deceased kidneys with multiple renal arteries and short renal veins. Actas Urol Esp 2020; 44:623-629. [PMID: 32534829 DOI: 10.1016/j.acuro.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications. PATIENTS AND METHODS We performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient. RESULTS No post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation. CONCLUSIONS Vascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.
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Kundapur V, Mayer M, Auer R, Pushie J, Alexander A, Sheldon W. Is Microbeam Radiation Treatment Ready For Prime Time? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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30
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Shippy S, Allgood H, Messenger K, Gatson B, Alexander A, Wellehan J, Johnson A. Pharmacodynamics and pharmacokinetics of intramuscular alfaxalone in central bearded dragons (Pogona vitticeps): effect of injection site. Vet Anaesth Analg 2020. [DOI: 10.1016/j.vaa.2020.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Wong J, Huang V, Wells D, Giambattista J, Giambattista J, Kolbeck C, Otto K, Alexander A. 25: Implementation of Deep Learning-Based Auto-Segmentation for Radiotherapy Planning Structures: A Multi-Center Workflow Study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Paetkau O, Gagne IM, Alexander A. SpaceOAR© hydrogel rectal dose reduction prediction model: a decision support tool. J Appl Clin Med Phys 2020; 21:15-25. [PMID: 32250042 PMCID: PMC7324696 DOI: 10.1002/acm2.12860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/10/2020] [Accepted: 03/04/2020] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer external beam radiation therapy can result in toxicity due to organ at risk (OAR) dose, potentially impairing quality of life. A polyethylene glycol-based spacer, SpaceOAR© hydrogel (SOH), implanted between prostate gland and rectum may significantly reduce dose received by the rectum and hence risk of rectal toxicity. SOH implant is not equally effective in all patients. Determining patients in which the implant will offer most benefit, in terms of rectal dose reduction, allows for effective management of SOH resources. Several factors have been shown to be correlated with reduction in rectal dose including distance between rectum and planning treatment volume (PTV), volume of rectum in the PTV, and change in rectum volume pre- to post-SOH. Several of these factors along with other pre-SOH CT metrics were able to predict reduction in rectal dose associated with SOH implant. Rectal V55Gy metric, was selected as the dose level of interest in the context of 60 Gy in 20 fraction treatment plans. Models were produced to predict change in RV55Gy and pre-SOH hydrogel RV55Gy. These models offered R-squared between 0.81 and 0.88 with statistical significance in each model. Applying an ω 1 = 3% lower limit of pre-SOH RV55 Gy and an ω 2 = 3.5% lower limit on change in RV55 Gy, retained 60% of patients experiencing the largest rectal dose reduction from the hydrogel. This may offer a clinically useful tool in deciding which patients should receive SOH implant given limited resources. Predictive models, nomograms, and a workflow diagram were produced for clinical management of SOH implant.
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Affiliation(s)
- Owen Paetkau
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Isabelle M Gagne
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.,Department of Medical Physics, BC Cancer - Victoria, Victoria, BC, Canada
| | - Abraham Alexander
- Department of Radiation Oncology, BC Cancer - Victoria, Victoria, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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Wong J, Fong A, McVicar N, Smith S, Giambattista J, Wells D, Kolbeck C, Giambattista J, Gondara L, Alexander A. Comparing deep learning-based auto-segmentation of organs at risk and clinical target volumes to expert inter-observer variability in radiotherapy planning. Radiother Oncol 2020; 144:152-158. [DOI: 10.1016/j.radonc.2019.10.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/29/2022]
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Tan H, Hannon C, Gopalan A, Alexander A, Patel J, Bergeon D, Andreoli L, Jarski R, McKeown T, Gunaga S. 204 Screening for Balance and Vision Symptoms in Triage to Enhance Identification of Strokes in the Emergency Department. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Ge L, Alexander A, Rydelek S, Carrion R, Barrera E, Perito P, Hakky T. 029 Biomechanical Effects of Rear Tip Extenders on Inflatable Penile Implants: A Cadaveric Study. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paetkau O, Gagne IM, Pai HH, Lam J, Goulart J, Alexander A. Maximizing rectal dose sparing with hydrogel: A retrospective planning study. J Appl Clin Med Phys 2019; 20:91-98. [PMID: 30889318 PMCID: PMC6448161 DOI: 10.1002/acm2.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/21/2019] [Accepted: 02/23/2019] [Indexed: 12/14/2022] Open
Abstract
External beam radiation therapy for prostate cancer can result in urinary, sexual, and rectal side effects, often impairing quality of life. A polyethylene glycol‐based product, SpaceOAR© hydrogel (SOH), implanted into the connective tissue between the prostate gland and rectum can significantly reduce the dose received by the rectum and hence risk of rectal toxicity. The optimal way to manage the hydrogel and rectal structures for plan optimization is therefore of interest. In 13 patients, computerized tomography (CT) scans were taken pre‐ and post‐SpaceOAR© implant. A prescription of 60 Gy in 20 fractions was planned on both scans. Six treatment plans were produced per anonymized dataset using either a structure of rectum plus the hydrogel, termed composite rectum wall (CRW), or rectal wall (RW) as an inverse optimization structure and intensity modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) as a treatment technique. Dose‐volume histogram metrics were compared between plans to determine which optimization structure and treatment technique offered the maximum rectal dose sparing. RW structures offered a statistically significant decrease in rectal dose over CRW structures, whereas the treatment technique (IMRT vs VMAT) did not significantly affect the rectal dose. There was improvement seen in bladder and penile bulb dose when VMAT was used as a treatment technique. Overall, treatment plans using the RW optimization structure offered the lowest rectal dose while VMAT treatment technique offered the lowest bladder and penile bulb dose.
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Affiliation(s)
- Owen Paetkau
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada
| | - Isabelle M Gagne
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, Canada.,Department of Medical Physics, BC Cancer - Victoria, Victoria, BC, Canada
| | - Howard H Pai
- Department of Radiation Oncology, BC Cancer - Victoria, Victoria, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Lam
- Department of Radiation Oncology, BC Cancer - Victoria, Victoria, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Goulart
- Department of Radiation Oncology, BC Cancer - Victoria, Victoria, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Abraham Alexander
- Department of Radiation Oncology, BC Cancer - Victoria, Victoria, BC, Canada.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Abstract OT3-05-04: Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: IBCs that do not completely respond to chemotherapy often have dysregulated immune pathways, and novel therapies are needed to improve outcomes in recurrent/metastatic disease. One-third of IBCs express the atezolizumab target PD-L1, and cobimetinib increases PD-L1 expression; thus, we hypothesize that atezolizumab and cobimetinib may act synergistically in IBC. The FDA-approved agent eribulin is active in IBC and has anti-stem cell activity and can reverse the IBC phenotype of epithelial-to-mesenchymal transition. Hence the use of eribulin as a chemotherapy backbone in combination with other novel agents is well justified.
Trial Design: This single-arm, open-label trial is enrolling patients with recurrent IBC or de novo metastatic IBC that has progressed on at least 1 line of standard chemotherapy. During a 4-week pharmacodynamic window, patients have an upfront biopsy, receive atezolizumab and cobimetinib treatment for 4 weeks, and have a second biopsy. Triple-combination treatment then commences, with standard eribulin dosing. After 4 cycles of eribulin, patients receive maintenance targeted therapy until disease progression or intolerable toxicity.
Eligibility Criteria: Patients with metastatic IBC of any molecular subtype must have measurable disease (per RECIST 1.1) amenable to biopsy. Patients with HER2+ disease must have received both pertuzumab and T-DM1. Patients with treated stable brain metastases are allowed. Patients must have recovered from the acute effects of any prior therapies and have adequate hematologic, organ, and cardiac function. Patients with autoimmune diseases or a history of pneumonitis are ineligible.
Specific Aims: The primary objective is to determine the overall response rate (ORR) of the combination therapy. Secondary objectives include determining the safety and tolerability, clinical benefit rate, response duration, progression-free survival, 2-year overall survival rate and predictive biomarker analyses.
Statistical Methods: The trial will enroll up to 9 patients in its phase I/safety lead-in portion and up to 33 patients total. A Bayesian optimal interval design is used to efficiently determine the maximum tolerated cobimetinib dose in phase I. Patients start cobimetinib at the FDA-approved dose of 60 mg/day with a target toxicity rate is 0.3. Phase II will enroll 24 patients to determine the efficacy of the triple-combination therapy. The historical ORR in metastatic IBC is 10%; our sample size provides 80% power to detect an ORR improvement to 25%.
Accrual: The trial has enrolled 7 patients since its start in August 2017.
Citation Format: Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-04.
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Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HC Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Lane
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - ML Huang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - DS Gombos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CI Tung
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RC Allen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - TJ Kandl
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Wu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AB Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - A Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - I Wistuba
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RM Layman
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Tripathy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
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Murchison SC, Wiksyk B, Gossman S, Jensen B, Sayers D, Lesperance M, Truong PT, Alexander A. Subventricular Zone Radiation Dose and Outcome for Glioblastoma Treated Between 2006 and 2012. Cureus 2018; 10:e3618. [PMID: 30697499 PMCID: PMC6347443 DOI: 10.7759/cureus.3618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Stem cells residing in the subventricular zone (SVZ) may be related to recurrence, potentially affecting outcome in glioblastoma (GBM). This study investigated the relationship of SVZ radiation dose and survival in a large cohort treated with surgery and chemoradiotherapy (CRT). Methods Patients with GBM treated between 2006 and 2012 (n = 370) were identified. SVZs were contoured from planning computed tomography (CT) with magnetic resonance imaging (MRI) registration where available. Dose was extracted from dose volume histograms. Kaplan-Meier (KM) progression-free survival (PFS) and overall survival (OS) estimates were compared with log-rank tests for SVZ doses. Multivariate analysis (MVA) identified clinical and treatment-related factors significantly associated with outcome. Results Median follow-up was 16.4 months, 48.1% underwent gross total resection (GTR), 37.5% subtotal resection, and 14.4% biopsy without resection. Median PFS was 8.9 months (95% CI: 8.3-9.8 months), and OS was 16.5 months (95% CI: 15.2-17.6 months). PFS was significantly lower for older age (>50 years, P = 0.045), poor Karnofsky performance status (KPS, P = 0.049), multifocality (P < 0.001), and incomplete adjuvant chemotherapy (P < 0.001). Worse OS was associated with poor KPS (P = 0.001), biopsy only (P = 0.003), multifocality (P = 0.009), and failure to complete adjuvant chemotherapy (P < 0.001). SVZ dose was not associated with outcome for any of the dose levels assessed. On MVA, multifocality was associated with worse PFS (P < 0.01). Poor performance status and biopsy only were associated with worse OS (both P < 0.01). Conclusion In this analysis of a large cohort of GBM treated with surgery and CRT, increased SVZ dose was not associated with improved survival.
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Affiliation(s)
- Sonja C Murchison
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Bradley Wiksyk
- Internal Medicine, University of British Columbia, Vancouver, CAN
| | - Stacey Gossman
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Brigit Jensen
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Dorothy Sayers
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | | | - Pauline T Truong
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
| | - Abraham Alexander
- Radiation Oncology, British Columbia Cancer Agency - Vancouver Island Centre, Victoria, CAN
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Mahmood J, Alexander A, Samanta S, Soman S, Shukla H, Davila E, Carrier F, Jackson I, Vujaskovic Z. Radiation Therapy in Combination with Hyperthermia and Immunotherapy Inhibit Pancreatic Tumor Growth and Modulate Tumor Microenvironment in Mice. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rajarajan S, Prabhu J, Korlimarla A, Nair M, Alexander A, Kaluve R, Ps H, Raja U, Ramesh R, Patil S, Bs S, Ts S. MicroRNA based immune response signature identifies poor prognostic subgroup within ER negative breast cancers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy428.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Murchison SC, Martens MB, Truong P, Alexander A. Secondary mucinous carcinoma of the prostate after low dose rate brachytherapy. Can J Urol 2018; 25:9284-9287. [PMID: 29680008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Radiation induced malignancy (RIM) after treatment for prostate cancer is well documented after external beam irradiation, but less so in the setting of brachytherapy. We report a case of mucinous adenocarcinoma of the prostate, consistent with a RIM, which developed 12 years after low dose rate brachytherapy for low risk prostate adenocarcinoma. Diagnostic and therapeutic considerations of RIM are discussed. As long term survivors are followed in the community by primary care physicians and urologists, awareness of RIM as a potential late effect of brachytherapy is important to ensure that cases are diagnosed and managed appropriately.
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Affiliation(s)
- Sonja C Murchison
- Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
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Alexander A, Willey J, Sun H, Parker CA, Marx AN, Wood AL, Reddy SM, Reuben JM, Bassett RL, Le-Petross HT, Krishnamurthy S, Gong Y, Woodward WA, Valero V, Ueno NT, Lim B. Abstract OT1-02-05: A single arm phase II study of adjuvant anti-PD1 (pembrolizumab) in combination with hormonal therapy in patients with hormone receptor (HR)-positive localized inflammatory breast cancer (IBC) who did not achieve a pathological complete response (pCR) to neoadjuvant chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The pCR rate to conventional chemotherapy in hormone receptor positive IBC has historically been low (7.4% for HR+ HER2-, and 30% for HR+ HER2+), and despite the use of adjuvant endocrine therapy, the recurrence rate is still as high as 40%. To date, no targeted agent is proven to improve the efficacy of adjuvant endocrine therapy within the IBC population to improve this poor disease free survival (DFS). One plausible reason for the poor efficacy of endocrine therapy is a suppressed immune system, which allows tumor cells to avoid detection despite expression of potential immunogenic surface antigens.
Trial Design: This is a single arm trial that will enroll stage III HR+ IBC patients who have completed neoadjuvant therapy but had residual disease at mastectomy. Enrollment should be before or within 2 months of beginning endocrine therapy. Monitoring of DFS will be done with radiological imaging every 3 cycles (starting at cycle 4) as clinically indicated, per standard of care. Pembrolizumab is given on day 1 of each 21 day cycle for up to 2 years if the disease is controlled, and hormonal therapy will be administered per standard of care.
Eligibility Criteria: Clinical stage 3 IBC ER+/PR+ and HER2 negative patients who completed neoadjuvant chemotherapy and surgery with evidence of residual cancer in the breast or lymph nodes, but be clinically disease-free with good performance status at the start of study. Patients also must have adequate hematologic and organ function, and have recovered from the acute effects from prior treatments.
Specific Aims: The primary objective is to determine the disease free survival (DFS) at 2 years of patients with adjuvant therapy using Pembrolizumab in combination with standard adjuvant hormonal therapy. The secondary objective is to determine the safety and toxicity profile of this combination.
Statistical Methods: With a sample size of 37 patients, assuming that 80% are alive (20% increase from historical data) and disease-free at 2 years, and all patients are followed for >2 years after enrollment with no dropout, a 95% confidence interval around the 2-year estimate of DFS will be generated. DFS will then be compared with the historical control rate of 60% by year 2 using a one-sided exponential MLE test.
Accrual: To date we have enrolled 3 patients since activation in January 2017, and the target enrollment is 37 patients.
Contact information: For more information or to refer a patient, please contact study coordinator, Angela Alexander - aalexand@mdanderson.org
Citation Format: Alexander A, Willey J, Sun H, Parker CA, Marx AN, Wood AL, Reddy SM, Reuben JM, Bassett RL, Le-Petross HT, Krishnamurthy S, Gong Y, Woodward WA, Valero V, Ueno NT, Lim B. A single arm phase II study of adjuvant anti-PD1 (pembrolizumab) in combination with hormonal therapy in patients with hormone receptor (HR)-positive localized inflammatory breast cancer (IBC) who did not achieve a pathological complete response (pCR) to neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-05.
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Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Willey
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - H Sun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CA Parker
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AL Wood
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RL Bassett
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HT Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - WA Woodward
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
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Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Abstract P4-10-12: Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: In spite of rapid urbanization and modernization the family remains central in the socio-cultural structure of India. The individuals are enmeshed into this unit and tend to be interlinked financially, emotionally and socially. The head of this family unit tends to be a male more often than not. As is well known, despite recent attempts by the governments at the state and centre at providing health coverage for cancer through regional cancer centres, a majority have to raise the money for cancer care by themselves. We have examined the role of the family in treatment decision making and in the strategies employed to raise the money and cope with the financial stress imposed by a diagnosis of breast cancer.
Method: 378 women with breast cancer were enrolled into a longitudinal study at first diagnosis between the years 2008-2012, at two tertiary care hospitals in Bangalore, India. The median follow up as of May 31st 2017 is 78 months with only 2% loss to follow-up over the past 8 years. Follow-up was maintained by frequent meetings between a counselling psychologist (AA) and the patient and/or a family member. The frequency of meetings was monthly during the initial treatment and then quarterly over the next 5 years. Information on demographics was collected during the treatment phase and information on the psychosocial aspects was collected in non-structured interactions subsequently. This information included details of support structure, decision making, and financial arrangements.
Results: This is a predominantly urban cohort with 80% being urban. The median age of patients at first diagnosis was 55 years. Almost all of our patients (99%) had the support of one or more family members. We analysed the pattern of decision making for treatment and in half of all cases either the husband or the son were the decision makers. In an additional 15% daughters and other relatives were the primary decision makers. Approximately a third of women made the decision concerning treatment themselves, and these women tended to be college educated (51% vs 16%) and employed (53% vs 12%).
30% of the patients met the costs incurred through medical insurance plans purchased by the family. Another quarter of patients were able to meet the costs from their savings. 45% had difficulty in finding the money for treatment and 15% took personal loans while 30% had to sell land/gold ornaments or take loans against assets of these sorts. Only (3%) discontinued the treatment due to financial difficulties. As in the case of decision making those who had the financial resources tended to be more educated (41% vs 11%), and were employed (31% vs 21%).
Conclusion: The data from a predominantly urban cohort of breast cancer enrolled between 2008-2012, supports the general belief that in India the family remains the fulcrum of an individual during crises, and not surprisingly education and employment lead to both psychological and economic emancipation of women.
Citation Format: Alexander A, Kaluve R, Prabhu JS, Korlimarla A, BS S, Manjunath S, Patil S, KS G, Sridhar TS. Treatment decision making, and strategies for coping with financial stress in Indian women diagnosed with breast cancer and their families [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-12.
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Affiliation(s)
- A Alexander
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - R Kaluve
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - JS Prabhu
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - A Korlimarla
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S BS
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S Manjunath
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - S Patil
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - G KS
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
| | - TS Sridhar
- St. John's Research Institute, Bangalore, Karnataka, India; Sri. Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India; St. John's Medical College Hospital, Bangalore, Karnataka, India; Rangadore Memorial Hospital, Bangalore, Karnataka, India
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Thulborn KR, Atkinson IC, Alexander A, Singal M, Amin-Hanjani S, Du X, Alaraj A, Charbel FT. Comparison of Blood Oxygenation Level-Dependent fMRI and Provocative DSC Perfusion MR Imaging for Monitoring Cerebrovascular Reserve in Intracranial Chronic Cerebrovascular Disease. AJNR Am J Neuroradiol 2018; 39:448-453. [PMID: 29371256 DOI: 10.3174/ajnr.a5515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Loss of hemodynamic reserve in intracranial cerebrovascular disease reduces blood oxygenation level-dependent activation by fMRI and increases asymmetry in MTT measured by provocative DSC perfusion MR imaging before and after vasodilation with intravenous acetazolamide. The concordance for detecting hemodynamic reserve integrity has been compared. MATERIALS AND METHODS Patients (n = 40) with intracranial cerebrovascular disease and technically adequate DSA, fMRI and provocative DSC perfusion studies were retrospectively grouped into single vessels proximal to and distal from the circle of Willis, multiple vessels, and Moyamoya disease. The vascular territories were classified as having compromised hemodynamic reserve if the expected fMRI blood oxygenation level-dependent activation was absent or if MTT showed increased asymmetry following vasodilation. Concordance was examined in compromised and uncompromised vascular territories of each group with the Fischer exact test and proportions of agreement. RESULTS Extensive leptomeningeal collateral circulation was present in all cases. Decreased concordance between the methods was found in vascular territories with stenosis distal to but not proximal to the circle of Willis. Multivessel and Moyamoya diseases also showed low concordance. A model of multiple temporally displaced arterial inputs from leptomeningeal collateral flow demonstrated that the resultant lengthening MTT mimicked compromised hemodynamic reserve despite being sufficient to support blood oxygenation level-dependent contrast. CONCLUSIONS Decreased concordance between the 2 methods for assessment of hemodynamic reserve for vascular disease distal to the circle of Willis is posited to be due to well-developed leptomeningeal collateral circulation providing multiple temporally displaced arterial input functions that bias the perfusion analysis toward hemodynamic reserve compromise while blood oxygenation level-dependent activation remains detectable.
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Affiliation(s)
- K R Thulborn
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - I C Atkinson
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - A Alexander
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - M Singal
- From the Center for Magnetic Resonance Research (K.R.T., I.C.A., A.Alexander, M.S.)
| | - S Amin-Hanjani
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - X Du
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - A Alaraj
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
| | - F T Charbel
- Department of Neurological Surgery (S.A.-H., X.D., A.Alaraj, F.T.C.), University of Illinois Medical Center, Chicago, Illinois
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Parimi S, Tsang E, Alexander A, Mckenzie M, Bachand F, Sunderland K, Chi KN, Aparicio M, Worsley D, Tyldesley S. A population-based study of the use of radium 223 in metastatic castration-resistant prostate cancer: Factors associated with treatment completion. Can Urol Assoc J 2017; 11:350-355. [PMID: 29382449 DOI: 10.5489/cuaj.4415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Radium 223 (Ra223) given for six cycles has proven efficacy in clinical trials, but its population-level generalizability has not been well-described. The objectives of this study were to describe population-based Ra223 use in the abiraterone and enzalutamide era and identify factors associated with completion. METHODS All Ra223 patients at the British Columbia Cancer Agency between September 2013 and February 2016 were identified. Patients who completed <5 vs. ≥5 cycles were compared on patient characteristics, lines of prior therapy, prostate-specific antigen (PSA) and alkaline phosphatase (ALP) decline >30% from baseline (R30%), and survival, to identify factors associated with therapy completion. RESULTS Ninety-one patients were identified; 48 (52.7%) completed >5 cycles. Median overall survival (mOS) was 10.7 months, PSA and ALP R30% were 21% and 52%, respectively. Completion of <5 cycles was associated with higher baseline ALP (p=0.05) and lower baseline hemoglobin (Hb) levels (p=0.03). Patients in the ≥5 cycles group had longer mOS than those in the <5 cycles group (16.2 vs. 5.9 months; p<0.0001), as well as higher PSA R30% (33.3% vs. 7.0%; p=0.002) and ALP R30% (66.7% vs. 34.9%; p=0.03). Patients with ALP ≥220 and Hb ≤118 had 3.85 times the odds of not completing ≥5 cycles vs. ALP <220 and Hb >118. CONCLUSIONS Compared to clinical trials, patients in a population-based setting had more lines of therapy and shorter survival. Lower ALP and higher hemoglobin were associated with completion of >5 cycles, longer mOS, and greater incidence of PSA and ALP response.
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Affiliation(s)
- Sunil Parimi
- Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Erica Tsang
- Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Abraham Alexander
- Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Michael Mckenzie
- Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Francois Bachand
- Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Katherine Sunderland
- Genitourinary Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Kim N Chi
- Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Maria Aparicio
- Genitourinary Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Daniel Worsley
- Nuclear Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Scott Tyldesley
- Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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Einstein N, Okubanjo O, Alexander A, Putman M, Watts H. 158 Caring for a Critically Ill Simulated Left Ventricular Assist Device Patient With or Without a Cognitive Aid Improves Physician Comfort. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mahmood J, Jackson I, Pavlovic R, Zhang A, Connors C, Alexander A, Kaytor M, Vujaskovic Z. Treatment With Nano-Genistein for the Prevention of Radiation-Induced Erectile Dysfunction. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tyler SA, Zavgorodni S, Alexander A, Vallieres I. (P020) Evaluation of Noncoplanar/Coplanar Versus Coplanar Arcs in Fractionated Stereotactic Radiotherapy of Pituitary Adenomas. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.02.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nair M, Prabhu J, Remacle J, S H, Korlimarla A, Kaluve R, Alexander A, Patil S, S S, Srinivas S. Examination of the role of integrin β3 in chemoresistance by analysis of residual NACT tumor specimens and knock-in experiments. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx140.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tyldesley S, Parimi S, Tsang E, Bachand F, Aparicio M, Duncan G, Sunderland K, Olson R, Pai H, Alexander A, Lapointe V, Chi K. EP-1359: Pain response in a Population-based study of Radium-223 for Metastatic Prostate Cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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