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Siva S, Wallace N, Hardcastle N, Kothari G, Crombag L, Rangamuwa K, Annema J, Lee P, Dieleman EM, Jennings B, Yo S, Nguyen P, Bashirzadeh F, Fielding D, Yasufuku K, Ost D, Irving L, Steinfort D. Dosimetric Impact of Systematic Mediastinal Staging via Endobronchial Ultrasound for Patients with Locally Advanced Lung Cancer: The SEISMIC Trial. Int J Radiat Oncol Biol Phys 2023; 117:S29. [PMID: 37784468 DOI: 10.1016/j.ijrobp.2023.06.290] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The SEISMIC trial aims to find the best method for mediastinal staging in patients with lung cancer receiving chemoradiotherapy. Currently, CT or PET-CT scans are standard in clinical practice, but histological evaluation of the mediastinum is performed on a case-by-case basis. The study will examine the effect of systematic histological evaluation using Endobronchial Ultrasound (EBUS) on radiotherapy target volumes. The hypothesis of this study is that differences in staging between the diagnostic PET-CT and EBUS would result in reduced tumor coverage and/or increased doses to organs at risk (OAR). MATERIALS/METHODS SEISMIC is a prospective multicenter international cohort study. Patients were enrolled from Australia, the Netherlands, USA and Canada after regional IRB approvals. Patients were treated with 4DCT simulation. Two iGTV and PTV target volumes were delineated for each patient with discordant staging according to both PET-CT and EBUS, as were OARs. Two VMAT plans were generated for each patient based on either PET-CT or EBUS target volumes using knowledge-based planning methodology. Plans aimed to achieve institutional guidelines for target coverage and OAR dose constraints, with a prescribed dose of 60 Gy in 30 fractions. Target coverage and OAR doses for the PET- and EBUS-defined volumes were compared. RESULTS In 156 patients, EBUS showed a larger extent of disease than PET in 18 (11.5%) and a smaller extent of lymph node (LN) involvement than PET in 49 (31.4%). Out of 67 patients with PET-EBUS discordant results, 25 underwent upfront radiotherapy and were included in the study. EBUS revealed PET-occult LN involvement in 11/25 patients (44%). In these patients, 10/11 patients received <95% of the prescribed dose to PET-occult LN iGTVs; the median [range] minimum dose to the EBUS iGTV was 9.2 Gy [0.1 - 57.9 Gy]. When planning based on EBUS LN involvement, all patients received ≥95% of the prescribed dose to the iGTV (the median [range] minimum dose to the EBUS iGTV was 58.9 Gy [58.1 - 60.5 Gy]). This resulted in increased median [range] doses to OARs; mean lung dose increased by 1.1 Gy [0.3 - 8.4 Gy], esophagus mean dose increased by 3.6 Gy [0.2 - 24.8 Gy], and mean heart dose increased by 0.5 Gy [-0.6 - 8.5 Gy]. CONCLUSION Systematic endoscopic evaluation of the mediastinum had a significant effect on tumor coverage in a clinically meaningful proportion of cases and consequent plan adaptation impacted on organ-at-risk (OAR) doses. Results suggest systematic mediastinal LN staging should be considered in all patients prior to curative-intent radiotherapy. CLINICAL TRIAL ID ACTRN12617000333314.
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Affiliation(s)
- S Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - N Wallace
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - N Hardcastle
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - G Kothari
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - L Crombag
- Department of Pulmonology, Amsterdam UMC, Amsterdam, Netherlands
| | - K Rangamuwa
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J Annema
- Department of Pulmonology, Amsterdam UMC, Amsterdam, Netherlands
| | - P Lee
- MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - E M Dieleman
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, Netherlands
| | - B Jennings
- Department of Lung and Sleep, Monash Health, Melbourne, VIC, Australia
| | - S Yo
- Department of Lung and Sleep, Monash Health, Melbourne, VIC, Australia
| | - P Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, VIC, Australia
| | - F Bashirzadeh
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - D Fielding
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, VIC, Australia
| | - K Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - D Ost
- MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - L Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - D Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Yo S, Wimaleswaran H, Deshpande S, Cheung T, Buzacott H, Serraglio C, Wong AM, Landry S, Thomson L, Edwards B, Mansfield D, Joosten S, Hamilton G. Sleeping position during unattended home polysomnography compared to habitual sleeping position and the potential impact on measured sleep apnea severity. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1213] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Patel H, Yo S, Nanayakkara S, Selkrig L, Kaye D, Mariani J, Naughton M. Chronotropic Incompetence in Patients with Cardiac Rhythm Devices Undergoing Evaluation for Cardiac Transplantation. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.200] [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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Nishio J, Iwasaki H, Ishiguro M, Ohjimi Y, Yo S, Isayama T, Naito M, Kikuchi M. Supernumerary ring chromosome in a Bednar tumor (pigmented dermatofibrosarcoma protuberans) is composed of interspersed sequences from chromosomes 17 and 22: a fluorescence in situ hybridization and comparative genomic hybridization analysis. Genes Chromosomes Cancer 2001; 30:305-9. [PMID: 11170290] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Cytogenetic analysis of Bednar tumor (pigmented dermatofibrosarcoma protuberans) has not been reported previously. Here, we report the identification of a supernumerary ring chromosome in a Bednar tumor by chromosome painting with fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH). Chromosome painting with FISH demonstrated that the supernumerary ring chromosome was composed of discontinuous, interwoven sequences from chromosomes 17 and 22. Amplification of chromosomes 17 and 22 sequences was confirmed by CGH. These results indicate that Bednar tumor and dermatofibrosarcoma protuberans are characterized by the same chromosomal features. To our knowledge, this is the first report that the ring chromosome in Bednar tumor is composed of amplified material from chromosomes 17 and 22.
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Affiliation(s)
- J Nishio
- Department of Pathology, School of Medicine, Fukuoka University, Japan
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Sakai Y, Miyasaka Y, Yo S, Nagayama K, Fukasaku T, Kusano F, Sakuma I, Maekawa N, Sazaki N, Tazawa J. [New combination therapy with FTM [5-FU, pirarubicin (THP) and MMC] for treatment of inoperable advanced gastric cancer]. Gan To Kagaku Ryoho 1997; 24:2233-8. [PMID: 9422067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Clinical usefulness of a new combination FTM therapy consisting of 5-FU, Pirarubicin (THP) and MMC for the treatment of advanced gastric cancers was investigated. 5-FU, THP or MMC was administered at a dose of 600 mg/m2 on day 1, 8, 22 and 29, 30 mg/m2 on days 1 and 22, and 10 mg/m2 on day one only of each course, respectively. Eighteen patients with inoperable advanced gastric cancer were treated with FTM. All drugs were investigated by intravenously by one shot. The tumor response rate was 50% [9 of 18 showed PR]. The survival rate was higher in responders than in nonresponders (18.1% vs 11.1%) (p < 0.05). Side effects in the gastrointestinal tract were minimal. Cardiotoxicity and nephrotoxicity were not detected, but myelosuppression was prominent in most cases. G-CSF was given in sixteen patients (88%), and platelet transfusion was performed in two patients (11%). New combination FTM therapy is an effective treatment regimen even for advanced inoperable gastric cancer.
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Affiliation(s)
- Y Sakai
- Dept. of Internal Medicine, Tsuchiura Kyodo General Hospital
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Shiramizu M, Yo S, Hirai H, Hatase T, Yano S, Tsunawaki A, Yakushiji M, Kato T. [Studies on the management of CIN accompanied by infertility]. Nihon Sanka Fujinka Gakkai Zasshi 1985; 37:1064-70. [PMID: 4031565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We performed cytological examinations on 863 of the 969 patients (89.3%). In the final diagnosis, 4 patients had carcinoma in situ (0.5%) and 1 patient had microinvasive carcinoma (0.1%). Therefore, it is important to perform cytological examinations on infertility out-patient s, and conduct routine cytological examinations when infertility treatment is being continued over long periods. The detection rate for the 18 patients who required detailed examination did not differ between primary and secondary infertility, or with the period of infertility or the factor causing infertility. The follow up after conization should be done carefully, and the patient should be encouraged to become pregnant as early as possible. Unlike fertile women, in infertile women, conization should be performed, even in the case of carcinoma in situ, provided: There is a specialist well-experienced in cytology, colposcopy, and histology; the patient and family are fully satisfied with the physician's explanation; the physician can maintain good contact with the patient and family and continue to provide adequate follow up treatment, and the lesion is in the ectocervix, and the whole lesion can be removed by conization without leaving intact foci.
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Abstract
During the past 27 years from 1944 to 1970 splenectomy was performed on 53 patients including 33 idiopathic thrombocytopenic purpura (ITP), 13 hereditary spherocytosis and 7 hypoplastic anemia. Their clinical and laboratory findings in immediate and late postoperative periods were compared with those received medical treatment alone. In the chronic form of ITP the effect of medical treatment alone is only transitory and not curative. Splenectomy seems to be the treatment of choice in this situation which produces long term favorable results regardless of patient's response to preoperative steroid treatment. In hereditary spherocytosis the improvement in the morphology of red blood cells was limited after splenectomy, but considerable improvement was achieved in hemolytic tendency. Therefore, splenectomy would be the first choice. In hypoplastic anema splenectomy did not produce, in general, favorable results as compared in ITP or hereditary spherocytosis. However, when the patient responded to steroid treatment preoperatively, splenectomy could have reduced the frequency and amount of blood transfusion. Splenectomy would then be contemplated in such situations.
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