Hypofractionated Radiotherapy for Hematological Malignancies during COVID-19 Pandemic and Beyond

PURPOSE/OBJECTIVE(S)

Conventionally fractionated radiotherapy (RT) has shown to have excellent local control in hematological malignancies (HM). Up to date there is none or scant literature about the use of hypofractionated radiotherapy (HFRT) for the treatment of HM, this single institution study analyzed the efficacy of HFRT in HM. We hypothesized that HFRT in HM will result in a similar local tumor control that has been reported with standard fractionated RT.

MATERIALS/METHODS

In this retrospective study, we analyzed the data from patients within the provincial cancer registry diagnosed with HM treated with a curative intent using HFRT regimens suggested by International Lymphoma Radiation Oncology Group between 2020-2022 during the COVID-19 pandemic. Primary outcome of the study was overall response rate (ORR), measured as complete response (CR), partial response (PR) or stable disease (SD) within the irradiated field determined radiologically or clinically post completion of RT. Secondary end point was freedom from local progression (FFLP), calculated from the date of initiation of RT to the first date among in-field progression, death, and last follow-up. Summary statistics were used to describe cohort and treatment characteristics. FFLP was calculated by 1 minus cumulative incidence accounting for competing risk (i.e., death).

RESULTS

Of the 36 patients included for analysis, 18 were aggressive non-Hodgkin lymphoma (NHL), 9 were indolent NHL, 6 were Hodgkin lymphoma (HL) and 3 were other HM. Among them 25 had consolidation RT and 11 had definitive RT. HFRT daily dose per fraction ranged from 2.67 Gy to 5 Gy and total dose regimens ranged from 18 Gy to 42.5 Gy in 6 - 17 fractions and median equivalent dose in 2 Gy fractions (EQD2) for alpha/beta = 10Gy was 36 Gy (±7.5). ORR for the entire cohort was 94.4%. With a median follow up of 13.2 months, FFLP at one year for the entire cohort was 91.5% and death without infield progression was 8.7%. Among the 4 patients who had in radiation field recurrence, 2 had aggressive NHL and 2 had HL. No grade 3 or 4 acute toxicities were reported.

CONCLUSION

This retrospective study using HFRT showed an ORR and FFLP comparable to historical studies using standard fractionation. Further long-term follow-up is warranted to confirm these findings.

Effects of metals and persistent organic pollutants on the fitness and health of juveniles of the endangered european sturgeon Acipenser sturio Exposed to W1ater and sediments of the garonne and dordogne rivers

The last remaining population of European sturgeon (Acipenser sturio) lives in the Gironde-Garonne-Dordogne (France) catchment (GGD). Captive young individuals are released into the GGD hydrosystem each year, as part of a restocking programme. This study aims to assess the health status of juveniles A. sturio to current conditions in the GGD hydrosystem, to evaluate their capacity to survive and grow in a moderately anthropized ecosystems. 3-month-old farmed sturgeons were exposed for one month in experimental conditions that mimic the environmental conditions in the Garonne and Dordogne rivers, followed by five months of depuration. After one month of exposure, fish exposed to Dordogne and Garonne waters bioaccumulated higher levels of metals and persistent organic pollutants, displayed a reduced hepato-somatic index, and had depleted levels of lipids and glycogen content in their liver, when compared with the Reference group. However, metabolic and swimming performance, as well as the costs of swimming were not impaired. After the 5 months depuration, a significant decrease of K was observed for all exposure conditions. HSI also decreased with time. The overall health status and adaptive capacity of juvenile A. sturio appeared to be maintained over the experimental 6 months' period. Juveniles of A. sturio seem to have the adaptive capacity to survive and grow in the GGD hydrosystem, after being released as part of a restocking programme.

A microrobotic platform actuated by thermocapillary flows for manipulation at the air-water interface

Future developments in micromanufacturing will require advances in micromanipulation tools. Several robotic micromanipulation methods have been developed to position micro-objects mostly in air and in liquids. The air-water interface is a third medium where objects can be manipulated, offering a good compromise between the two previously mentioned ones. Objects at the interface are not subjected to stick-slip due to dry friction in air and profit from a reduced drag compared with those in water. Here, we present the ThermoBot, a microrobotic platform dedicated to the manipulation of objects placed at the air-water interface. For actuation, ThermoBot uses a laser-induced thermocapillary flow, which arises from the surface stress caused by the temperature gradient at the fluid interface. The actuated objects can reach velocities up to 10 times their body length per second without any on-board actuator. Moreover, the localized nature of the thermocapillary flow enables the simultaneous and independent control of multiple objects, thus paving the way for microassembly operations at the air-water interface. We demonstrate that our setup can be used to direct capillary-based self-assemblies at this interface. We illustrate the ThermoBot's capabilities through three examples: simultaneous control of up to four spheres, control of complex objects in both position and orientation, and directed self-assembly of multiple pieces.

Contact line stick-slip motion and meniscus evolution on micrometer-size wavy fibres

HYPOTHESIS

The architecture of complex-shaped fibres affects the motion of the contact line and the evolution of its associated menisci when a fibre is immersed into a liquid. Understanding and predicting the motion of the contact line is critical in the design of complex-shaped fibres for many engineering applications as well as for surface science. While wetting on classic circular cylinders has been well studied, singularities during the wetting process of complex-shaped fibres are not yet well understood.

EXPERIMENTS

The dynamic wetting behaviour of axisymmetric sinus-shaped fibres immersed vertically in a liquid volume was investigated. Fibres were 3D-printed down to micrometre dimensions, and the Wilhelmy method was used in parallel with meniscus shape analysis. Moreover, a quasi-static theoretical model predicting the contact line movement and free energy of the system evolution on these fibres is also proposed.

FINDINGS

The observation of liquid advancing and receding fronts highlighted a stick-slip motion of the meniscus depending on both the fibre surface curvature and its intrinsic wettability. The model predicts that the behaviour of the seemingly pinned and then jumping contact line, with associated changes in apparent contact angles, can be explained by the interplay between a constant local contact angle and the movement of the bulk liquid, leading to the storage of energy which is suddenly released when the contact line passes a given point of fibre curvature. Besides, acceleration/deceleration events that take place before and after the jumps are experimentally observed in good agreement with the model.

Incidence of spinal disease and role of spinal radiotherapy in multiple myeloma

Background

Spinal disease (spd) in multiple myeloma (mm) can be a major source of morbidity in newly diagnosed patients and long-term survivors. We retrospectively assessed the incidence of spinal disease in patients newly diagnosed with myeloma, its effect on survival, and the possible effect of spinal radiation therapy (rt).

Methods

Patients diagnosed with mm between 2010 and 2014 were identified through the provincial cancer registry. Plain radiography, computed tomography, and magnetic resonance imaging were reviewed to detect and document the type of spd. Data related to rt and systemic therapy were collected. Kaplan-Meier and time-varying Cox regression models were used to describe overall survival.

Results

Of 306 identified patients with newly diagnosed mm, 51% had spd, including 17% with lytic disease, 68% with compression fractures, and 15% with spinal cord compression. Of the patients with spd, 61% received spinal rt. Of those patients, 84% received spinal rt within 3 months after their diagnosis. Median dose was 20 Gy. Most patients (89.2%) received chemotherapy, and 22.5% underwent autologous stem-cell transplantation. Only 6 of the patients treated with spinal rt received re-irradiation to the same site. Overall survival was similar for patients with and without spd. On multivariate analysis, spinal rt had no effect on survival.

Conclusions

In patients newly diagnosed with mm, spd is a common presentation. With current systemic therapy, the presence of spd had no adverse effect on overall survival. The effect of spinal rt on overall survival was nonsignificant.

Baseline Edmonton Symptom Assessment System and survival in metastatic renal cell carcinoma

Background

Baseline symptom burden as measured using the Edmonton Symptom Assessment System (esas), a patient-reported, validated, and reliable tool measuring symptom severity in 9 separate domains, might yield prognostic information in patients receiving treatment for metastatic renal cell carcinoma (mrcc) and might add to the existing prognostic models.

Methods

In this retrospective single-centre cohort study, we included patients receiving first-line sunitinib therapy for mrcc between 2008 and 2012. Baseline variables included information relevant to the pre-existing prognostic models and pre-treatment esas summation scores (added together across all 9 domains), with higher scores representing greater symptom burden. We used Kaplan-Meier curves and Cox regression modelling to determine if symptom burden can provide prognostic information with respect to overall survival.

Results

We identified 68 patients receiving first-line therapy for mrcc. Most had intermediate- or poor-risk disease based on both the Memorial Sloan Kettering Cancer Center (mskcc) and the International Metastatic Renal Cell Carcinoma Database Consortium (imdc) models. The median baseline esas summation score was 16 (range: 6-57). In univariable analysis, the hazard ratio for overall survival was 1.270 (p = 0.0047) per 10-unit increase in summation esas. In multivariable analysis, the hazard ratio was 1.208 (p = 0.0362) when controlling for mskcc risk group and 1.240 (p = 0.019) when controlling for imdc risk group.

Conclusions

Baseline symptom burden as measured by esas score appears to provide prognostic information for survival in patients with mrcc. Those results should encourage the investigation of patient-reported symptom scales as potential prognostic indicators for patients with advanced cancer.

River Continuity Restoration and Diadromous Fishes: Much More than an Ecological Issue

Ecosystem fragmentation is a serious threat to biodiversity and one of the main challenges in ecosystem restoration. River continuity restoration (RCR) has often targeted diadromous fishes, a group of species supporting strong cultural and economic values and especially sensitive to river fragmentation. Yet it has frequently produced mixed results and diadromous fishes remain at very low levels of abundance. Against this background, this paper presents the main challenges for defining, evaluating and achieving effective RCR. We first identify challenges specific to disciplines. In ecology, there is a need to develop quantitative and mechanistic models to support decision making, accounting for both direct and indirect impacts of river obstacles and working at the river catchment scale. In a context of dwindling abundances and reduced market value, cultural services provided by diadromous fishes are becoming increasingly prominent. Methods for carrying out economic quantification of non-market values of diadromous fishes become ever more urgent. Given current challenges for rivers to meet all needs sustainably, conflicts arise over the legitimate use of water resources for human purposes. Concepts and methods from political science and geography are needed to develop understandings on how the political work of public authorities and stakeholders can influence the legitimacy of restoration projects. Finally, the most exciting challenge is to combine disciplinary outcomes to achieve a multidisciplinary approach to RCR. Accordingly, the co-construction of intermediary objects and diagrams of flows of knowledge among disciplines can be first steps towards new frameworks supporting restoration design and planning.

On the cohesion of fluids and their adhesion to solids: Young's equation at the atomic scale

Using large-scale molecular dynamics simulations, we model a 9.2nm liquid bridge between two solid plates having a regular hexagonal lattice and analyse the forces acting at the various interfaces for a range of liquid-solid interactions. Our objective is to study the mechanical equilibrium of the system, especially that at the three-phase contact line. We confirm previous MD studies that have shown that the internal pressure inside the liquid is given precisely by the Laplace contribution and that the solid exerts a global force at the contact line in agreement with Young's equation, validating it down to the nanometre scale, which we quantify. In addition, we confirm that the force exerted by the liquid on the solid has the expected normal component equal to γ_lvsinθ⁰, where γ_lv is the surface tension of the liquid and θ⁰ is the equilibrium contact angle measured on the scale of the meniscus. Recent thermodynamic arguments predict that the tangential force exerted by the liquid on the solid should be equal to the work of adhesion expressed as Wa⁰=γ_lv(1+cosθ⁰). However, we find that this is true only when any layering of the liquid molecules close to liquid-solid interface is negligible. The force significantly exceeds this value when strong layering is present.

Ovarian cancer in Manitoba: trends in incidence and survival, 1992-2011

BACKGROUND

Because the International Cancer Benchmarking Partnership, in a study of diagnosis years between 1995 and 2007, showed lower-than-expected survival for Manitoba's ovarian cancer patients, we undertook an analysis to describe the features of ovarian cancer diagnosed in Manitoba during a 20-year period. We also determined the most recent trends in survival to see if the previous results were sustained.

METHODS

In this retrospective cohort study, ovarian cancer cases diagnosed during 1992-2011 were extracted from the Manitoba Cancer Registry. The incidence of ovarian cancer was calculated for the overall group and for age, morphology, residence, treatment, and stage. Trends over time, with a particular focus on changes that might correlate with poor survival, were analyzed. The 1- and 3-year relative survival rates were also calculated.

RESULTS

The incidence of ovarian cancer did not vary over time (p = 0.640), even when stratified by age or morphology groups. Use of adjuvant chemotherapy decreased (p = 0.005) and use of neoadjuvant chemotherapy increased over time (p = 0.002). Diagnoses of stage iv cancers declined over time (p < 0.020). Trends in incidence did not coincide with previously observed decreases in relative survival.

CONCLUSIONS

A decline in diagnoses of stage iv ovarian cancer could be responsible for a recent increase in relative survival. However, sample size might have limited power in some analyses, and the previously reported decrease in relative survival might have been due to a random fluctuation in the data. Future efforts will focus on continued monitoring of the patterns of ovarian cancer presentation and outcomes in Manitoba.

Comparing a thyroid prognostic nomogram to the existing staging systems for prediction risk of death from thyroid cancers

OBJECTIVE

Thyroid prognostic nomogram can be applied across different histological types for predicting the individualized risk of death from thyroid cancer. The objective of this study was to compare the strength of our recently published thyroid prognostic nomogram with 12 existing staging systems to predict the risk of death from thyroid cancer.

METHOD

This study included 1900 thyroid cancer patients, from a population based cohort of 2296 patients, on whom adequate staging information was available. Competing risk sub-hazard models were used to compare 12 pre-existing prognostic models with the nomogram model. Their relative strengths for prediction of patients' individualized risks of death from thyroid cancer were compared using Akaike information criterion (AIC), delta AIC, and concordance index. R version 3.2.2 was used to analyze the data.

RESULTS

Our cohort of 450 males and 1450 females included 1796 (93.4%) differentiated thyroid cancers. Amongst the compared models, thyroid prognostic nomogram model appeared to be better than other models for predicting the risk of death from all non-anaplastic thyroid cancer (concordance index = 94.4), differentiated thyroid cancer (concordance index = 94.1) and papillary thyroid cancer (concordance index = 94.7). The difference from next best staging systems was most pronounced in non-anaplastic thyroid cancer (delta AIC = 114.8), followed by differentiated thyroid cancer (delta AIC = 35.6) and papillary thyroid cancer (delta AIC = 8.4).

CONCLUSIONS

Thyroid prognostic nomogram model was found to be better than the other models compared for predicting risk of death from thyroid cancer.

Simulation-based study comparing multiple imputation methods for non-monotone missing ordinal data in longitudinal settings

The application of multiple imputation (MI) techniques as a preliminary step to handle missing values in data analysis is well established. The MI method can be classified into two broad classes, the joint modeling and the fully conditional specification approaches. Their relative performance for the longitudinal ordinal data setting under the missing at random (MAR) assumption is not well documented. This article intends to fill this gap by conducting a large simulation study on the estimation of the parameters of a longitudinal proportional odds model. The two MI methods are also illustrated in quality of life data from a cancer clinical trial.

Locomotor performance in highly-trained young soccer players: does body size always matter?

To examine the effects of body size on locomotor performance, 807 15-year-old French and 64 Qatari soccer players participated in the present study. They performed a 40-m sprint and an incremental running test to assess maximal sprinting (MSS) and aerobic speeds, respectively. French players were advanced in maturity, taller, heavier, faster and fitter than their Qatari counterparts (e.g., Cohen's d=+1.3 and + 0.5 for body mass and MSS). However, when adjusted for body mass (BM), Qatari players had possibly greater MSS than French players (d=+0.2). A relative age effect was observed within both countries, with the players born in the first quarter of the year being taller, heavier and faster that those born during the fourth quarter (e.g., d=+0.2 for MSS in French players). When directly adjusted for BM, these MSS differences remained (d=+0.2). Finally, in both countries, players selected in National teams were taller, heavier, faster and fitter than their non-selected counterparts (e.g., d=+0.6 for MSS in French players), even after adjustments for body size (d=+0.5). Differences in locomotor performances between players with different phenotypes are likely mediated by differences in body size. However, when considering more homogeneous player groups, body dimensions are unlikely to substantially explain the superior locomotor performances of older and/or international players.

Extended adjuvant temozolomide with cis-retinoic acid for adult glioblastoma

OBJECTIVE

To determine the toxicity and effectiveness of 24 months of adjuvant temozolomide (tmz) with cis-retinoic acid (cra) for patients with glioblastoma.

METHODS

This retrospective population-based review considered the charts of all patients diagnosed with glioblastoma in Manitoba and referred to a provincial cancer centre during 2002-2008. Consecutive patients came from a population-based referral centre and provincial cancer registry. All patients were treated according to the local standard of care with surgical resection followed by concurrent radiotherapy and tmz 75 mg/m(2) daily, followed by tmz 150-200 mg/m(2) for days 1-5, repeated every 28 days for up to 24 cycles, and cra 50 mg/m(2) twice daily for days 1-21, repeated every 28 days. The main outcome measures were safety, tolerability, and effectiveness of long-term tmz and cra.

RESULTS

Of 247 patients diagnosed with glioblastoma in Manitoba during the study period, 116 started concurrent chemoradiotherapy, and 80 received adjuvant tmz. Of the patients who started concurrent chemoradiotherapy, 80 began adjuvant chemotherapy. Patients completed a median of 5.5 cycles of tmz and 3 cycles of cra. Grade 3 or 4 hematologic toxicity was noted in 16% of patients. Median overall survival was 15.1 months, and 26.7% of patients remained alive at 2 years.

CONCLUSIONS

Extended adjuvant tmz and cra is well tolerated. However, the population-based effectiveness of this regimen is similar to the clinical trial efficacy of 6 months of adjuvant tmz. Future studies in glioblastoma should incorporate duration of adjuvant chemotherapy into the study design.

Effect of substrate wettability in liquid dielectrophoresis (LDEP) based droplet generation: theoretical analysis and experimental confirmation

The generation of droplets for biological reactions at the microscale can be achieved by many techniques, among which the so-called liquid dielectrophoresis technique (LDEP). This is not a new process, but the parameters influencing actuation voltage still need further insight: size and geometry (electrodes width and gap, dielectric thickness), materials (dielectric constant), liquids (surface tension, dielectric constant, conductivity), working conditions (voltage, frequency) and substrate wettability (contact angle). This large experimental space is firstly reduced using non dimensional numbers and then studied in a systematic way thanks to the design of experiments. The contact angle influence is explained thanks to a new analytical model. To summarize, this paper recalls analytical models used to predict the voltage threshold required to develop a liquid rivulet from a mother drop, taking the contact angle into account and providing a large set of experimental results.

Co-localisation of host plant resistance QTLs affecting the performance and feeding behaviour of the aphid Myzus persicae in the peach tree

The architecture and action of quantitative trait loci (QTL) contributing to plant resistance mechanisms against aphids, the largest group of phloem-feeding insects, are not well understood. Comparative mapping of several components of resistance to the green peach aphid (Myzus persicae) was undertaken in Prunus davidiana, a wild species related to peach. An interspecific F(1) population of Prunus persica var. Summergrand × P. davidiana clone P1908 was scored for resistance (aphid colony development and foliar damage) and 17 aphid feeding behaviour traits monitored by means of the electrical penetration graph technique. Seven resistance QTLs were detected, individually explaining 6.1-43.1% of the phenotypic variation. Consistency was shown over several trials. Nine QTLs affecting aphid feeding behaviour were identified. All resistance QTLs except one co-located with QTLs underlying aphid feeding behaviour. A P. davidiana resistance allele at the major QTL was associated with drastic reductions in phloem sap ingestion by aphids, suggesting a phloem-based resistance mechanism. Resistance was also positively correlated with aphid salivation into sieve elements, suggesting an insect response to restore the appropriate conditions for ingestion after phloem occlusion. No significant QTL was found for traits characterising aphid mouthpart activity in plant tissues other than phloem vessels. Two QTLs with effects on aphid feeding behaviour but without effect on resistance were identified. SSR markers linked to the main QTLs involved in resistance are of potential use in marker-assisted selection for aphid resistance. Linking our results with the recent sequencing of the peach genome may help clarify the physiological resistance mechanisms.