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Intra-islet glucagon signalling regulates beta-cell connectivity, first-phase insulin secretion and glucose homoeostasis. Mol Metab 2024:101947. [PMID: 38677509 DOI: 10.1016/j.molmet.2024.101947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/26/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is characterised by the loss of first-phase insulin secretion. We studied mice with β-cell selective loss of the glucagon receptor (Gcgrfl/fl X Ins-1Cre), to investigate the role of intra-islet glucagon receptor signalling on pan-islet calcium activity and insulin secretion. METHODS Metabolic profiling was conducted on Gcgrβ-cell-/- and littermate controls. Crossing with GCaMP6f (STOP flox) animals further allowed for β-cell specific expression of a fluorescent calcium indicator. These islets were functionally imaged in vitro and in vivo. Wild-type mice were transplanted with islets expressing GCaMP6f in β-cells into the anterior eye chamber and placed on a high fat diet. Part of the cohort received a glucagon analogue (GCG-analogue) for 40 days and the control group were fed to achieve weight matching. Calcium imaging was performed regularly during the development of hyperglycaemia and in response to GCG-analogue treatment. RESULTS Gcgrβ-cell-/- mice exhibited higher glucose levels following intraperitoneal glucose challenge (control 12.7 mmol/L ± 0.6 vs. Gcgrβ-cell-/- 15.4 mmol/L ± 0.0 at 15 min, p = 0.002); fasting glycaemia was not different to controls. In vitro, Gcgrβ-cell-/- islets showed profound loss of pan-islet [Ca2+]I waves in response to glucose which was only partially rescued in vivo. Diet induced obesity and hyperglycaemia also resulted in a loss of co-ordinated [Ca2+]I waves in transplanted islets. This was reversed with GCG-analogue treatment, independently of weight-loss (n = 8). CONCLUSION These data provide novel evidence for the role of intra-islet GCGR signalling in sustaining synchronised [Ca2+]I waves and support a possible therapeutic role for glucagonergic agents to restore the insulin secretory capacity lost in T2D.
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Alerting providers to hospitalized persons with dementia using the electronic health record. J Am Geriatr Soc 2024; 72:822-827. [PMID: 37937688 DOI: 10.1111/jgs.18673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND While patients with dementia entering the hospital have worse outcomes than those without dementia, early detection of dementia in the inpatient setting is less than 50%. We developed and assessed the positive predictive value (PPV) and feasibility of a novel electronic health record (EHR) banner to identify patients with dementia who present to the inpatient setting using data from the medical record. METHODS We developed and implemented an EHR algorithm to flag hospitalized patients age ≥65 years with potential cognitive impairment in the Epic EHR system using dementia ICD-10 codes, FDA-approved medications, and the use of the term "dementia" in the emergency department physician note. Medical records were reviewed for all patients who were flagged with an EHR banner from October 2022 to May 2023. RESULTS A total of 344 individuals were identified who had a banner on their chart of which 280 (81.4%) were either diagnosed with dementia or were on an FDA-approved dementia medication. Forty-three individuals who had confirmed dementia were identified by a medication only (15.4%). Of the patients without confirmed dementia, the majority (N = 33, 9.6%) had a diagnosis of altered mental status, cognitive dysfunction, or mild cognitive impairment. Only 31 individuals (9.0%) had no indication of dementia or cognitive decline in their problem list, past medical history, or medication list. CONCLUSIONS We found that it was feasible to implement an EHR algorithm for prospective dementia identification with a high PPV. These types of algorithms provide an opportunity to accurately identify hospitalized older individuals for inclusion in quality improvement projects, clinical trials, pay-for-performance programs, and other initiatives.
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Focal Brachytherapy for Localized Prostate Cancer: Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e388. [PMID: 37785306 DOI: 10.1016/j.ijrobp.2023.06.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Advances in image-guided brachytherapy have increased the interest in focal brachytherapy (F-BT) approaches to optimize disease control, while reducing the toxicities associated whole gland treatments for prostate cancer (PCa). In this study we performed a systematic review to report biochemical control (BC), and genitourinary (GU) and gastrointestinal (GI) toxicity rates in patients with localized prostate cancer treated with F-BT as a definitive or salvage modality. MATERIALS/METHODS This project was registered in the PROSPERO database (ID CRD42022320921). A comprehensive literature search was conducted in Cochrane Central databases, Cochrane Database of Systematic Reviews, Embase Classic +Embase, and Medline ALL, all from the OvidSP platform and Web of Science from Clarivate, from each database's inception to July 2022. Search was restricted to English and included terms: focal brachytherapy/prostate cancer, partial brachytherapy/prostate cancer. In total, 14862 articles were identified. Manuscripts that not related to focal or partial prostate brachytherapy, review papers and studies not reporting BC were excluded. After eliminating duplicates, and studies deemed irrelevant by consensus among three independent reviewers, 44 articles remained for in-depth review and data extraction. RESULTS Thirty studies that included BC outcomes were included for this analysis, comprising 1556 patients treated with F-BT for PCa. Of these, 1094 (70%) and 462 (30%) underwent F-BT as definitive monotherapy or salvage, respectively; while 585 (38%) and 971 (62%) received HDR or LDR, respectively. For F-BT as monotherapy, the most commonly prescribed dose for HDR was 19 Gy in 1 fraction (range 19-24 Gy), and for LDR, 145 Gy (90-160Gy). Whereas for salvage F-BT, most common dose schedule of HDR was 19Gy in 1 fraction (19-27GY) and LDR 145Gy (144-145Gy). BC random effects estimate for F-BT monotherapy at 1-, 2-, 3-, and 5-years were 100% (P = 1.0), 96% (P = 0.45), 91% (P = 0.45) and 87% (P< 0.01), respectively. Whereas BC random effects estimate for salvage at 1-, 2-, 3-, and 5-years were 91% (P = 0.86), 68% (0.17), and 57% (P = 0.20), respectively. GI and GU grade 3-4 crude toxicity rates for monotherapy and salvage ranged from 0-3.33% and 0-17%, respectively. CONCLUSION Over the last decade, there has been increasing interest in F-BT approaches, both as monotherapy and in the salvage setting. BC and toxicity profiles of F-BT appear favorable, and future studies directly comparing with whole-gland treatments are warranted.
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MR-Guided HDR Brachytherapy Boost in Localized Prostate Cancer - Results of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:e397. [PMID: 37785327 DOI: 10.1016/j.ijrobp.2023.06.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Dose escalation in localized prostate cancer using brachytherapy combined with external beam radiation (EBRT) has demonstrated improved biochemical control compared to EBRT alone. However, ultrasound guided LDR brachytherapy might be associated with increased GU toxicity. We report the results of a prospective study of MR-guided HDR brachytherapy (MRgHDR) in combination with EBRT for localized prostate cancer. MATERIALS/METHODS Intermediate- (IR) and high-risk (HR) prostate cancer patients were eligible. Patients received either 15Gy single fraction or 10Gy x 2 fractions using MRgHDR technique, followed by EBRT (37.5 Gy, [prostate only] -IR or 45-46 Gy - [prostate + pelvic nodes] -HR). Toxicity (CTCAE v4) and HRQoL (EPIC) were recorded at 1, 3 and 6 months, then at 1, 2, 3, and 5 years. Androgen deprivation therapy (ADT) was used according to the appropriate disease risk category. Biochemical failure was defined according to Phoenix definition (nadir+2). RESULTS From 2010-2018, 120 patients were enrolled, 53 (44%) had IR and 67 (56%) had HR disease. Median age was 69 years (range, 46-78), median PSA was 12.1 ng/ml (3.2-148). ADT was used in 84 (70%) of patients, of whom 51 (60%) patients received <1 year and 33 (40%) received >1 year of ADT. A single fraction of 15Gy was given to 94 patients (78%) and the remaining 26 patients (22%) received 10Gy x 2 fractions. EBRT dose was 37.5Gy in 52 (43%) patients while 67 (56%) received 45-46Gy. One patient received only the first fraction of 10Gy, declined the second fraction and subsequently received 60Gy EBRT to the prostate. The median follow up was 58 months (11-134). Overall, 5-year biochemical control was 90% while it was 95% and 86% for IR and HR, respectively. At 5 years 7% patient had nodal or distant relapse or both. While the 5-yr distant control rates were 95% and 91% in the IR, HR, respectively. Acute grade ≥2 GU and GI toxicity was 6.7% and 5% respectively. Acute toxicity trended back to baseline by 6 months in all patients except one. Late grade ≥ 2 GU and GI worst toxicity was seen in 10% and 4.2%, respectively. As with acute toxicity, late toxicity tended to improve over time. Only one patient experienced severe toxicity (Grade 3 GU - frequency) at 6 months but subsequently this resolved. HRQol will be reported separately. CONCLUSION MRgHDR brachytherapy boost in conjunction with EBRT provides comparable biochemical outcomes compared to the literature. Severe toxicity rates were minimal. Further follow-up will determine if these outcomes are sustained.
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Stereotactic Ablative Radiotherapy for Oligo-Progressive Cancers: Results of the Randomized Phase II STOP Trial. Int J Radiat Oncol Biol Phys 2023; 117:S58. [PMID: 37784530 DOI: 10.1016/j.ijrobp.2023.06.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the metastatic setting, there is uncertain benefit to localized eradication of one or more lesions that are progressing despite systemic therapy. This randomized phase II trial examined if patients with ≤5 sites of oligoprogression benefited from the addition of stereotactic ablative radiotherapy (SABR) to standard of care (SOC) systemic therapy. MATERIALS/METHODS Eligibility criteria included age ≥18 years, ECOG performance status 0-2, and oligoprogressive disease, defined as 1-5 lesions actively progressing while on systemic therapy. Patients were required to have at least 3 months of disease stability/response on systemic therapy prior to oligoprogression. After stratifying by type of systemic therapy (cytotoxic vs. non-cytotoxic), patients were randomized 2:1 to SABR to all progressing lesions plus SOC (SABR arm) vs. SOC alone (SOC arm). The trial began exclusive to non-small cell lung cancer but did not meet accrual goals and was expanded in 2019 to include all non-hematologic malignancies. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life (QOL), toxicity, and duration of current systemic agent post-SABR. RESULTS Between February 2017 and June 2021, 90 patients with 125 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 patients randomized to SABR and 31 to SOC. Median age was 67 years (IQR: 61-73 years) and 39 (43%) were female. The most common primary sites were lung (44% of patients), genitourinary (23%) and breast (13%), with the most common oligo-progressive locations being lung (43%), bone (19%), lymph nodes (14%), and liver (13%). In the SABR arm, the most common fractionations were 35 Gy/5 (38% of lesions) and 50 Gy/5 (18%). Protocol adherence in the SOC arm was suboptimal: 3 patients (10%) withdrew immediately after randomization, and 7 additional patients (23%) received high-dose or ablative therapies. Median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs. 4.3 months in the SOC arm; however, the curves cross and 2-year PFS was 9% vs. 24% respectively, p = 0.91). Median OS was 31.2 months vs. 27.4 months, respectively (p = 0.22). Lesional control with SABR was 71% vs. 39% with SOC (p = 0.002). Median duration of post-randomization first-line systemic therapy was 10.3 months vs. 7.6 months, respectively (p = 0.71). Treatment was well-tolerated with 2 (3.4%) grade 3 treatment-related toxicities in the SABR arm and no grade 4/5 related events in either arm. QOL did not differ between arms. CONCLUSION Despite being a well-tolerated treatment providing superior lesional control, SABR for oligoprogression did not improve PFS or OS. Results may have been impacted by withdrawals and desire for ablative treatments on the SOC arm, and this lack of equipoise may make accrual to phase III trials difficult, although larger studies in select sub-populations are desired. (NCT02756793).
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Outcomes of Head and Neck Cutaneous Angiosarcoma Treated in the IMRT Era. Int J Radiat Oncol Biol Phys 2023; 117:e620-e621. [PMID: 37785859 DOI: 10.1016/j.ijrobp.2023.06.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Clinical behavior, natural history, and varied presentations of cutaneous angiosarcomas of the head and neck region (HN), in conjunction with its rarity, have rendered standardization of treatment elusive. We aimed to assess outcomes and patterns of failure for patients treated with surgery and radiation (Sx+RT), and radiation alone (RT). MATERIALS/METHODS A retrospective review of all HN angiosarcoma patients amenable for upfront Sx or RT in our institution between 2004-2018 was completed. Generally, treatment included Sx when feasible, and RT for large or extensive/ill-defined tumors. Demographic, tumor characteristics, local (LC), regional (RC), distant control (DC), and overall survival (OS), as well as patterns (in-field, marginal, out-of-field) of local failure at 5-year were estimated. Univariate analysis (UVA) was conducted to assess association with outcomes. RESULTS A total of 33 patients were eligible (14 Sx+RT and 19 RT). Tumor locations were: scalp (16, 48%). face (n = 12, 36%), and overlapping (5, 15%). Lesion types were: nodular (n = 23, 70%), flat (n = 4, 12%) and mixed (n = 6, 18%). Tumor size was larger in the RT group (median: 10.00 vs 2.85 cm, p<0.01). RT and Sx+RT patients had otherwise similar baseline characteristics: median age 74.3; male 70%; and ECOG performance status ≤1 85%. RT dose fractionations ranged from 50-70 Gy in 25-35 fractions in the RT group and 50-66 Gy in 25-33 fractions in the Sx+RT group. Four (12%) patients received neoadjuvant chemotherapy. Median follow up was 5.5 years. Five-year LC, RC, DC, and OS for RT vs Sx+RT groups were 68% vs 85% (p = 0.28); 95% vs 86% (p = 0.89); 79% vs 86% (p = 0.39); and 45% vs 55% (p = 0.71), respectively. The in-field/marginal/out-of-field local failure rate at 5 years were 16% vs 7% (p = 0.46), 26% vs 15% (p = 0.41), and 13% vs 0% (p = 0.24) for the RT vs Sx+RT groups, respectively. UVA showed that scalp location and ulceration/bleeding were strong adverse features for OS. Bone invasion was significantly associated with lower DC (Table). Lesion type (nodular/flat/mixed), tumor size, and treatment type (Sx+RT vs RT), were not significantly associated with LC or pattern of local failure. CONCLUSION Scalp tumors, as compared to face, portended poorer prognosis, and ulceration/bleeding and bone invasion were associated with increased distant metastases. Sx+RT was the preferred treatment modality when possible and typically used for smaller and better defined tumors. RT was reserved for larger and extensive/ill-defined disease; despite this, in the IMRT era, RT achieves reasonable rates of control, markedly superior to historical series.
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Long-Term Biochemical Control of a Prospective Cohort of Prostate Cancer Patients Treated With Interstitial Brachytherapy Versus Radical Prostatectomy. Clin Oncol (R Coll Radiol) 2023; 35:262-268. [PMID: 36737311 DOI: 10.1016/j.clon.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/05/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
AIMS To report long-term oncological outcomes of men treated prospectively as part of the American College of Surgeons Oncology Group phase III Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial (SPIRIT) at our institution. MATERIALS AND METHODS In 2003-2004, patients eligible for SPRIT attended a multidisciplinary educational session, following which they could choose radical prostatectomy, low dose rate brachytherapy (LDR-BT) or randomisation to SPIRIT. Biochemical failure was determined by the accepted definitions of a prostate-specific antigen (PSA) level ≥0.2 ng/ml after radical prostatectomy and the Phoenix definition of PSA ≥2 ng/ml above the nadir after LDR-BT. A sensitivity analysis, using a PSA >0.5 ng/ml to define biochemical failure after LDR-BT and a threshold PSA ≥0.2 ng/ml, was carried out to test the robustness of the results. To account for the competing risk of death, Gray's test was used to test the equality of the cumulative incidence function of biochemical failure between treatment groups. The Kaplan-Meier method was used to estimate overall survival and prostate cancer-specific survival. A P-value ≤0.05 was considered statistically significant. RESULTS Of 156 patients, 100 received LDR-BT (15 after randomisation) and 56 underwent radical prostatectomy (15 after randomisation). The median follow-up was 12.6 and 14.7 years for LDR-BT and radical prostatectomy, respectively. The median age was 60 years; the median pre-treatment PSA was 5.5 (interquartile range 4.3-7.1). No significant differences in patient characteristics were found between groups. Two patients received adjuvant radiotherapy after radical prostatectomy. The cumulative incidence function of biochemical failure was 0%, 1.1% and 2.4% at 5, 10 and 15 years, respectively, in the LDR-BT arm versus 8.5%, 15.8% and 15.8% in the radical prostatectomy arm (P < 0.001). These results were consistent when varying the definition of biochemical failure defined as PSA ≥0.5 ng/ml (P = 0.01). At 15 years, overall survival was higher in patients treated with radical prostatectomy compared with those treated with LDR-BT; however, no statistical difference was found in prostate cancer-specific survival. CONCLUSION In low-risk prostate cancer patients, LDR-BT offers excellent long-term oncological outcomes comparable with radical prostatectomy, in addition to the previously reported advantage for LDR-BT in urinary and sexual quality of life domains and patient satisfaction.
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HDR Focal Boost with Whole Gland SBRT in Localized Prostate Cancer: Assessment of Acute Toxicity and Early Quality of Life. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Salvage Prostate Brachytherapy in Radiorecurrent Prostate Cancer: An International Delphi Consensus Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Focal MR-Guided High-Dose-Rate Brachytherapy for Localized Prostate Cancer: A Prospective Clinical Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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O-311 Evaluating the Reproductive Potential of Azoospermic Men by Profiling the Genome of Surgically Retrieved Spermatozoa. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
Can whole exome sequencing of surgically retrieved spermatozoa from azoospermic men pinpoint mutations related to the etiology of their infertility and ability to support pregnancy?
Summary answer
Identifying key germline mutations involved in spermatogenesis helps explain reproductive failure, regardless of the etiology of the azoospermia.
What is known already
Azoospermia accounts for approximately 15% of male factor infertility cases. Although it can be caused by pre-testicular factors, the most recognized forms are testicular and post-testicular. Post-testicular azoospermia is mainly attributed to a mechanical obstruction, whereas testicular azoospermia, the most challenging form, is characterized by scattered functional germinal epithelia that may fail to support the meiotic process during sperm development. To elucidate the etiology of this condition, genetic studies on somatic cells have been carried out. Here, we perform whole exome sequencing (WES) on surgically retrieved spermatozoa to preferentially detect germline mutations that may be passed on to offspring.
Study design, size, duration
Over 3 years, we recruited patients undergoing epididymal sperm aspiration for acquired obstructive azoospermia (OA; n = 19) or testicular biopsy for nonobstructive azoospermia (NOA; n = 11). Eight men were included as fertile controls. Copy number variants (CNVs) and gene mutation profiles were obtained through WES and compared between the OA and NOA cohorts, followed by sub-analyses within those two categories according to whether they generated a clinical pregnancy (fertile) or not (infertile), while controlling for maternal age.
Participants/materials, setting, methods
Spermatozoal DNA was extracted and amplified from the surgically retrieved specimens (concentration, 742±520 ng/ul; quality, 1.7±0.1 nm). CNVs and gene mutations were detected using CLC Genomic Server 9.0. Genes were considered duplicated or deleted when the read depth was >1.5 or < 0.5 times the median read depth in the control. Common mutations were compared between the OA and NOA cohorts, as well as according to the couples’ clinical outcomes. Female partners had negative infertility workups.
Main results and the role of chance
Of 30 men (paternal age, 42.3±7yrs), 19 OA men underwent epididymal sperm retrievals (concentration, 1.1±4x106/ml, 9±12% motility), while 11 NOA men underwent testicular biopsies (concentration, 0.03±0.4x106/ml, 0.5±1% motility). WES did not indicate a significant difference in sperm aneuploidy between the two etiologies (OA, 1.7%; NOA, 1.8%) compared to the control (1.1%).
In OA patients, only 3 housekeeping-related genes were deleted, while in the NOA cohort, 5 genes involved in RNA transcription (POLR2L), apoptosis (AP5M1), and basic spermiogenic functions (AP1S2, AP1G2, APOE) were deleted.
OA patients and their partners (maternal age, 36.8±4yrs) underwent 19 ICSI cycles resulting in a delivery rate of 47.4% (9/19). Those able to reproduce (n = 9) shared a mutation in ZNF749, specifically affecting sperm production. The infertile men (n = 10) all shared a PRB1 deletion, controlling essential DNA replication.
NOA men and their partners (maternal age, 38.2±2yrs) underwent 11 ICSI cycles, yielding a delivery rate of 72.7% (8/11). The fertile men (n = 8) all shared a MPIG6B deletion, involved in stem cell lineage differentiation. All of their infertile counterparts (n = 3) presented gene deletions not only involved in spermato/spermio-genesis (n = 4) but, most importantly, also superimposed with those encoding early embryonic development (MBD5, CCAR1, PMEPA1, POLK, REC8, REPIN1, MAPRE3, ARL4C).
Limitations, reasons for caution
Although maternal age was controlled for, confounding factors related to the female partner cannot entirely be excluded. While men unable to reproduce shared common gene mutations providing information about their condition, these findings still need to be confirmed in larger observations.
Wider implications of the findings
By performing WES, we were able to identify specific mutations associated with compromised embryo developmental competence of surgically retrieved spermatozoa. DNA sequencing technologies help identify gametes capable of sustaining a pregnancy even in the most severe form of male infertility, laying the groundwork for precision medicine in this field.
Trial registration number
N/A
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PD-0571 Determining interobserver variability in prostate bed CTV target delineation using MRI. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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PO-1708 Application of dose accumulation for PTV margin design in MR-guided adaptive prostate SBRT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03672-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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PD-0329 Impact of Bladder Volume Changes on Prostate Position during MR-Guided Online Adaptive SBRT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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OC-0784 Assessment of intraprostatic tumour motion in prostate radiotherapy on the MR-Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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OC-0783 Is full adaptation needed for prostate stereotactic body radiotherapy? A dosimetric comparison. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A Free Listing Assessment of Sexual Function and Relationships for Penile Prosthesis and Intracavernosal Injection Therapy for Erectile Dysfunction. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Safety of minimizing intensity of follow-up on active surveillance for clinical stage I testicular germ cell tumors. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Propensity matched comparison of radical cystectomy with trimodality therapy for muscle invasive bladder cancer (MIBC): A multi-institutional study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Trimodal therapy versus radical cystectomy for T2 bladder cancer: real-world evidence from Ontario. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Local Control in Tumor-Targeted Dose Escalation for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Intermittent Androgen Deprivation Therapy Plus Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Physician and Patient Reported Morbidity After MR-Guided Salvage Brachytherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Metastasis-directed therapy for oligorecurrent prostate cancer: A pooled analysis of prospective trials. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Long Term Biochemical Control of a Prospective Cohort of Prostate Cancer Patients Treated with Interstitial Brachytherapy Versus Radical Prostatectomy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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PO-1213: Pelvic radiotherapy in node positive bladder cancer – outcomes in a selected cohort. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Outcomes after Normal Tissue-Adopted 5 Fraction (Fr) Stereotactic Body Radiotherapy (SBRT) for Extra-Cranial Oligometastases - A Prospective Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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PO-1219: Primary Bladder Sarcoma: a multiinstitutional experience from the Rare Cancer Network. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Preliminary Results Of MR-Guided Brachytherapy Boost To External Beam Radiotherapy For Intermediate And High Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Role of lactate dehydrogenase (LDH) in identifying relapse for patients with stage I testis cancer on active surveillance. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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P-04-21 Self -Power Building Through Sexuality Education for Out-Home-Care Teenagers in Taiwan. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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0734 Does Noise Masking Improve Sleep Consolidation In Patients Weaning From Prolonged Mechanical Ventilation? Sleep 2020. [DOI: 10.1093/sleep/zsaa056.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sound masking is a noise reduction strategy that adds a mixed-frequency blend of ambient sound to the environment and may improve sleep. Critically ill patients often cite noise as one of the main factors preventing sleep while they are cared for in an intensive care unit (ICU). The effect of sound masking on sleep in patients weaning from prolonged mechanical ventilation is unknown.
Methods
12-hour overnight polysomnography was obtained in eight patients undergoing weaning from prolonged mechanical ventilation. None had hearing impairment, delirium, sedation or agitation. In random order, patients were exposed to sound masking half of the recording time. Noise events were defined a 10dB increase from baseline or any sound peak over 75dB. Arousals or awakenings were attributed to noise if they occurred within 5 seconds of the noise event.
Results
Environmental sound was 61.7± 0.9 dB (mean±SE) during sound masking and 55.9±1.4 dB during no sound masking. During sound masking, there were fewer sound events per hour of sleep when compared to no sound masking (4.1/hr vs 9.3/hr p=0.03). The percentage of sound events leading to a subsequent arousal or awakening with sound masking was less than during no sound masking:11% vs 22% (p=0.04). Arousal index and fragmentation index (arousal and awakenings/hr of sleep) were similar between the two conditions. In a post-study survey, five patients reported improved sleep quality with sound masking while the remaining three reported no difference.
Conclusion
Sound masking decreases sound-induced arousal from sleep in patients being weaned from prolonged mechanical ventilation.
Support
Veterans Administration Research Service
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DRIVE: Defining Radiorecurrent Intraprostatic Target Volumes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Preliminary Results of a Two Stage Phase II Study of 18F-DCFPyL PET-MR for Enabling Oligometastases Ablative Therapy in Subclinical Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Use of Combined Hormone Therapy with Post-Operative Radiation Treatment for Prostate Cancer: Impact of Randomized Trials On Clinical Practice. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Selective Use of Radiation-Based Management in Localized Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Boom boom pow: Shock-facilitated aqueous alteration and evidence for two shock events in the Martian nakhlite meteorites. SCIENCE ADVANCES 2019; 5:eaaw5549. [PMID: 31517047 PMCID: PMC6726442 DOI: 10.1126/sciadv.aaw5549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
Abstract
Nakhlite meteorites are ~1.4 to 1.3 Ga old igneous rocks, aqueously altered on Mars ~630 Ma ago. We test the theory that water-rock interaction was impact driven. Electron backscatter diffraction demonstrates that the meteorites Miller Range 03346 and Lafayette were heterogeneously deformed, leading to localized regions of brecciation, plastic deformation, and mechanical twinning of augite. Numerical modeling shows that the pattern of deformation is consistent with shock-generated compressive and tensile stresses. Mesostasis within shocked areas was aqueously altered to phyllosilicates, carbonates, and oxides, suggesting a genetic link between the two processes. We propose that an impact ~630 Ma ago simultaneously deformed the nakhlite parent rocks and generated liquid water by melting of permafrost. Ensuing water-rock interaction focused on shocked mesostasis with a high density of reactive sites. The nakhlite source location must have two spatially correlated craters, one ~630 Ma old and another, ejecting the meteorites, ~11 Ma ago.
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Comprehensive Stereotactic Radiotherapy for Oligometastatic Prostate Cancer (CROP). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions. PHYSICAL REVIEW LETTERS 2019; 123:022301. [PMID: 31386493 DOI: 10.1103/physrevlett.123.022301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 04/27/2019] [Indexed: 06/10/2023]
Abstract
The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3 GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1 GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5 GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.
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OC-0070 Radiation Therapy for Retroperitoneal Liposarcoma – A report from TARPSWG. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sarcoidosis Associated Pulmonary Hypertension: Correlation of Cascular Morphologic Changes with Hemodynamic Data in Explanted Lungs. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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EP-1513 Patient-reported adverse events following trans-rectal ultrasound-guided prostate marker insertion. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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PV-0147 MRI-guided salvage HDR brachytherapy for locally recurrent prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Impact of neoadjuvant chemotherapy on bladder recurrences in patients managed with trimodal therapy (TMT) for muscle-invasive bladder cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31532-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Clinical Application of a Novel Voxel- and Machine Learning-Based Automated Planning Method for Prostate Volumetric Arc Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Free PSA Ratio as a Predictor of Adverse Outcomes after Curative-Intent External Beam Radiation Therapy for Prostate Cancer: A Novel Application of an "Old" Biomarker. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Do blastulation rates correlate with embryo ploidy? a comparison of 1,552 IVF cycles with preimplantation genetic testing stratified by age and percent blastulation. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Natural cycle frozen blastocyst transfer after a failed fresh embryo transfer: do we have to wait? Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Randomised Phase II Feasibility Trial of Image-guided External Beam Radiotherapy With or Without High Dose Rate Brachytherapy Boost in Men with Intermediate-risk Prostate Cancer (CCTG PR15/ NCT01982786). Clin Oncol (R Coll Radiol) 2018; 30:527-533. [PMID: 29903505 DOI: 10.1016/j.clon.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/01/2022]
Abstract
AIMS We conducted a multicentre feasibility study to assess the ability to randomise patients between image-guided radiotherapy (IGRT) and IGRT + high dose rate (HDR) brachytherapy boost and to adhere to appropriate radiation quality assurance standards. MATERIALS AND METHODS The primary end point was to determine the ability to randomise 60 patients over an 18 month period. Arm 1 (IGRT) patients received 78 Gy in 39 fractions or 60 Gy in 20 fractions (physician's preference), whereas arm 2 (IGRT + HDR) received 37.5 Gy in 15 fractions with HDR boost of 15 Gy. The secondary end points included >grade 3 acute genitourinary and gastrointestinal toxicity, using Common Terminology Criteria for Adverse Events version 4.0 at 3 months, validation of a prospectively defined radiation oncology quality assurance to assess treatment compliance. All analyses were descriptive; no formal comparisons between treatment arms were carried out. RESULTS Between April 2014 and September 2015, 57 National Comprehensive Cancer Network (NCCN)-defined intermediate-risk prostate cancer patients were randomised between IGRT alone (arm 1; n = 29) and IGRT plus HDR brachytherapy boost (arm 2; n = 28). Overall, 93% received the treatment as randomised. There were four patients (one on IGRT arm 1 and three patients on the IGRT + HDR arm 2) who were treated differently from randomisation assignment. For the 29 patients receiving IGRT (arm 1), there were 14 cases reported with minor deviations and three with major deviations. For patients on IGRT + HDR (arm 2), there were 18 cases reported with minor deviations and two with major deviations. At 3 months in the IGRT group (arm 1), one patient reported grade 3 diarrhoea, whereas in the IGRT + HDR group (arm 2), two patients reported grade 3 haematuria. No other gastrointestinal and genitourinary toxicities were reported. CONCLUSION The pilot study showed the feasibility of randomisation between treatment with IGRT alone versus IGRT + HDR boost. Treatment compliance was good, including adherence to quality assurance standards.
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PV-0473: Dosimetry, safety, efficacy and QoL in a study of 5-fraction SBRT for oligometastatic (OM) cancers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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