Prospective study of HDR brachytherapy (BT), external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT): 10-years experience of an MRI-guided approach

OBJECTIVES

To evaluate the predictive factors for biochemical failure and distant metastases in a prospective cohort of patients with localized prostate cancer treated with the combination of HDR BT and EBRT.

METHODS AND MATERIALS

Patients with intermediate (IR) or high-risk (HR) prostate adenocarcinoma received a single fraction of HDR of 15 Gy combined with RT of 37.5 Gy in 15 fractions. ADT duration was used depending on risk-group. Descriptive analyses were performed. Univariate and multivariate Hazard Ratios were obtained. Finally, the Kaplan-Meier model was used to describe the survival of the events of interest.

RESULTS

309 patients were treated prospectively (199 were IR and 110 HR). Median age was 72 years; 58.3 % were MRI stage ≤ T2c, 34.1 % T3a and 7.6 % T3b; ISUP-grade 1-3 in 78.9 % and ISUP 4-5 in 21.1 %. 71.8 % of patients had ≤ 50 % positive-cores in biopsy and 28.2 % had > 50 %. Median pre-treatment PSA was 9.9 ng/mL. After a median follow-up of 88 months, 41 patients presented biochemical failure and 18 developed distant metastases. Multivariate cox-regression analyses found that MR-T3b Stage (HR 3.88, p = 0.001) and ADT use (HR 3.99, p = 0.03) were the only predictive factors for biochemical failure and the number of positive cores (>50 %) the only independent predictive factor of distant metastases (HR 4.36, p = 0.002).

CONCLUSIONS

Patients with mpMRI evidence of invasion of the SV and involvement of more than 50% of the cores in the prostate biopsy are patients with a higher risk of presenting a biochemical recurrence or developing metastasis due to their prostate cancer, respectively.

Sites in the United States contaminated with radioactivity

Over the century that radioactive materials have been mined, processed, produced, and utilized, many sites across the United States have become contaminated. Such sites include bases and installations of the Department of Defense, weapons production and research facilities of the Department of Energy, properties under the authority of other Federal agencies, privately-owned and governmental facilities that are licensed by the Nuclear Regulatory Commission and its Agreement States, and sites licensed by or the responsibility of states. This review reports on aspects of work by the Environmental Protection Agency, the Department of Defense, the Department of Energy, the Nuclear Regulatory Commission, and others to identify sites contaminated with radioactive materials. It also describes the principal programs that have been instituted to deal with them.

The integrated exposure uptake biokinetic model for lead in children: independent validation and verification

The U.S. Environmental Protection Agency employs a model, the integrated exposure biokinetic (IEUBK) model for lead in children, for the assessment of risks to children posed by environmental lead at hazardous waste sites. This paper describes results of an effort to verify the consistency of the documentation with the computer model and to test the computer code using a group that is independent from those involved in the model development. This review concluded that the IEUBK model correctly calculates the equations specified in the IEUBK model theory documentation. However, several issues were identified on model documentation, model performance, and the C++ programming language code (i.e., IEUBK model source code) documentation. These issues affect the ability of an independent reviewer to understand the workings of the IEUBK model but not the model's reliability. As a result of these findings, recommendations have been provided for updating documentation to the model as well as associated adjustments to the model documentation.

Renal graft survival in children with early acute rejection

Acute rejection episodes (AREs) are an important cause of morbidity and mortality in children following renal transplantation. For the purpose of this study, the diagnosis of early rejection was established when it developed within the first 6 months post-transplantation. The impact of an early ARE on patient and graft survival areas was studied in 44 patients who received their grafts between January 1987 and December 1995. Group I (GI) was comprised of 25 patients who developed 30 ARE. They were compared to 19 age- and sex-matched controls without ARE, group II (GII), who were transplanted during the same time-period and received similar long-term immunosuppressive triple therapy, oral prednisone, azathioprine and cyclosporine A. The ARE was confirmed by renal biopsy in 83% of the cases. Morbidity, mortality and graft function were assessed statistically at baseline, 12 and 24 months after transplantation. Seven GI patients lost their grafts during an ARE; in 4 cases death that was related to opportunistic infections presenting during or soon after anti-rejection therapy, whereas 3 patients who survived lost their grafts due to thromboses or infections, also as a consequence of ARE. The GI graft survival rates were 76% and 72% at 12 and 24 months post-transplant, respectively, whereas the graft survival rate of GII patients was 100% at both evaluation periods. The patient survival rate was 84% in GI and 100% in GII patients at 24 months. No statistically significant differences of renal function were found between and/or within groups at 12 and 24 months. Recipients of living related donor (LRD) and cadaveric donor (CD) kidneys were evaluated independently of the group to which they were allocated. The acute rejection ratio (number of AREs/number of transplants) was 0.61 in LRD and 0.38 in CD (differences non-significant). This study concludes that AREs are an important cause of patient and graft loss, with opportunistic infections being a major threat to be considered during aggressive anti-rejection therapy. The renal function was normal after long-term follow-up in both groups of patients, regardless of ARE.

[Histopathological malignancy and prognosis of laryngeal cancer]

Two series of patients with laryngeal squamous cell carcinoma who underwent surgery for curative purposes were studied. Sixty patients were analyzed prospectively and 71 were analyzed retrospectively for clinical and pathological parameters of prognostic value. Clinical parameters (tumor site, T and N stage, patient age, alcohol and tobacco use, primary tumor or neck surgery) and histological parameters (tumor size, number of metastatic lymph nodes, T and N stage, WHO differentiation, Jakobsson and Glanz malignancy scores) were recorded and analyzed by multivariate analysis to find factors related independently with death from the tumor. In the retrospective study, the presence of positive surgical margins obscured other factors. In the prospective study, T and N stage and the Glanz and Jacobsson scores (in biopsies) were independently related with prognosis. Malignancy grading systems such as those of Jakobsson and Glanz should be included in treatment planning for patients with laryngeal carcinoma.

Ultrasonography is more effective than computed tomography in excluding invasion of the carotid wall by cervical lymphadenopathies

Twelve patients with head and neck cancer, bulky lymphadenopathies, and clinical suspicion of carotid artery infiltration, had preoperative CT and US. The results of both techniques were correlated with surgical findings (one case of invasion and 11 of non-invasion), to evaluate the role of CT and US in the preoperative diagnosis of tumor invasion of the carotid wall. While CT showed a high level of failures (11 false positives and one true positive), US (one true positive, one false negative, and 10 true negatives) appears to be an easy and helpful method for predicting non-invasion of the carotid wall. However, the usefulness of US in detecting invasion cannot be evaluated, due to the limited number of positive cases.