Large anatomical variations can be observed during the treatment course intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), leading to potential dose variations. Adaptive ...radiotherapy (ART) uses one or several replanning sessions to correct these variations and thus optimize the delivered dose distribution to the daily anatomy of the patient. This review, which is focused on ART in the HNC, aims to identify the various strategies of ART and to estimate the dosimetric and clinical benefits of these strategies.
We performed an electronic search of articles published in PubMed/MEDLINE and Science Direct from January 2005 to December 2016. Among a total of 134 articles assessed for eligibility, 29 articles were ultimately retained for the review. Eighteen studies evaluated dosimetric variations without ART, and 11 studies reported the benefits of ART.
Eight in silico studies tested a number of replanning sessions, ranging from 1 to 6, aiming primarily to reduce the dose to the parotid glands. The optimal timing for replanning appears to be early during the first two weeks of treatment. Compared to standard IMRT, ART decreases the mean dose to the parotid gland from 0.6 to 6 Gy and the maximum dose to the spinal cord from 0.1 to 4 Gy while improving target coverage and homogeneity in most studies. Only five studies reported the clinical results of ART, and three of those studies included a non-randomized comparison with standard IMRT. These studies suggest a benefit of ART in regard to decreasing xerostomia, increasing quality of life, and increasing local control. Patients with the largest early anatomical and dose variations are the best candidates for ART.
ART may decrease toxicity and improve local control for locally advanced HNC. However, randomized trials are necessary to demonstrate the benefit of ART before using the technique in routine practice.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
We discuss the thermodynamics behind self-organizing Benzoquinone (BQ) particles on air–water interface. Experiments (Satterwhite-Warden et al., 2015; Chen et al., 2019; Satterwhite-Warden et al., ...2019) reveal that BQ particles undergo rapid transient flocking behavior as they move around on the liquid surface. Flocks are seen to vary in size and their formation and stability appears to be dependent upon their shape. It is hypothesized that self organization of particles is a result of surface tension gradients in the two dimensional liquid surface resulting from the slow dissolution of the BQ particles. The current paper uses a mass-action kinetic framework to study the flocking of particles. Two dynamical models, with and without a reservoir, are proposed and analyzed through the thermodynamic lens of free energy, which informs us about dominant and spontaneous ‘reactions’ or flock formations in the system. Results of the model are in good agreement with experiment, revealing that irregular shaped BQ particles do indeed show far greater propensity to form flocks compared with regularly shaped particles and validating the mass-action framework as an appropriate tool to investigate this system.
•A new mass-action based approach to model the self-organization of BQ particles on a liquid surface.•A thermodynamic argument for stability of the observed states based on the Gibbs free energy of the system.•Ability to capture essential differences in the dynamics based on the shape of the BQ particles.•Addition of another system displaying end-directed behavior which can be explained using nonequilibrium thermodynamics.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Highlights • SUVMax is a poor predictive parameter when compared with volumetric parameters (MTV, TLG). • MTV and/or TLG pre-treatment are well correlated with clinical outcome. • MTV had a better ...predictive value than GTV and/or AJCC staging.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Purpose
The aims of this multicentre retrospective study of locally advanced head and neck cancer (LAHNC) treated with definitive radiotherapy were to (1) identify positron emission tomography (PET)-
...18
F-fluorodeoxyglucose (
18
F-FDG) parameters correlated with overall survival (OS) in a training cohort, (2) compute a prognostic model, and (3) externally validate this model in an independent cohort.
Materials and methods
A total of 237 consecutive LAHNC patients divided into training (
n
= 127) and validation cohorts (
n
= 110) were retrospectively analysed. The following PET parameters were analysed: SUV
Max
, metabolic tumour volume (MTV), total lesion glycolysis (TLG), and SUV
Mean
for the primary tumour and lymph nodes using a relative SUV
Max
threshold or an absolute SUV threshold. Cox analyses were performed on OS in the training cohort. The c-index was used to identify the highly prognostic parameters. A prognostic model was subsequently identified, and a nomogram was generated. The model was externally tested in the validation cohort.
Results
In univariate analysis, the significant PET parameters for the primary tumour included MTV (relative thresholds from 6 to 83% and absolute thresholds from 1.5 to 6.5) and TLG (relative thresholds from 1 to 82% and absolute thresholds from 0.5 to 4.5). For the lymph nodes, the significant parameters included MTV and TLG regardless of the threshold value. In multivariate analysis, tumour site, p16 status, MTV35% of the primary tumour, and MTV44% of the lymph nodes were independent predictors of OS. Based on these four parameters, a prognostic model was identified with a c-index of 0.72. The corresponding nomogram was generated. This prognostic model was externally validated, achieving a c-index of 0.66.
Conclusions
A prognostic model of OS based on primary tumour and lymph node MTV, tumour site, and p16 status was proposed and validated. The corresponding nomogram may be used to tailor individualized treatment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
To ensure business continuity in the post-COVID-19 era, decision-makers should reconfigure their traditional supply chain (SC) networks, assisted by the development and implementation of cutting-edge ...technologies. Recently, Industry 5.0 (I5.0) has gained increasing attention as a paradigm offering salient features for the creation of resilient and inclusive operations by ensuring long-standing SC sustainability. However, there has been insufficient analysis of the challenges of implementing I5.0 in SCs. Therefore, this study aims to understand the challenges of implementing I5.0 when managing the impact of SC disruptions due to the COVID-19 pandemic in an emerging economy. Both qualitative and quantitative methods were used for this research. First, the challenges to I5.0 implementation were identified through a literature review and experts’ feedback. Those challenges were examined and prioritised using the Best-Worst Method (BWM). Second, the contextual relationships amongst these challenges were analysed using interpretive structural modelling (ISM) with cross-impact matrix multiplication applied to classification (MICMAC) analysis. Findings showed that to adopt I5.0 initiatives successfully in order to manage the post-COVID-19 impact on SC sustainability, the active involvement of senior managers is required in the execution process. Findings also showed that financial support and funding (e.g., tax reduction, short loans, etc.) from investors and the government play a pivotal role in enabling sustainability in SCs. Finally, the challenges were classified using MICMAC analysis to provide valuable insights for managing future disruptions. This study is expected to help managers and decision-makers successfully overcome the challenges of implementing I5.0 in SCs and thus improve SC sustainability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Purpose In the context of locally advanced oropharyngeal cancer (LAOC) treated with definitive radiotherapy (RT) (combined with chemotherapy or cetuximab), the aims of this study were: (1) ...to identify PET-FDG parameters correlated with overall survival (OS) from a first cohort of patients; then (2) to compute a prognostic score; and (3) finally to validate this scoring system in a second independent cohort of patients. Materials and methods A total of 76 consecutive patients (training cohort from Rennes) treated with chemoradiotherapy or RT with cetuximab for LAOC were used to build a predictive model of locoregional control (LRC) and OS based on PET-FDG parameters. After internal calibration and validation of this model, a nomogram and a scoring system were developed and tested in a validation cohort of 46 consecutive patients treated with definitive RT for LAOC in Lausanne. Results In multivariate analysis, the metabolic tumour volume (MTV) of the primary tumour and the lymph nodes were independent predictive factors for LRC and OS. Internal calibration showed a very good adjustment between the predicted OS and the observed OS at 24 months. Using the predictive score, two risk groups were identified (median OS 42 versus 14 months, p < 0.001) and confirmed in the validation cohort from Lausanne (median OS not reached versus 26 months, p = 0.008 ). Conclusions This is the first report of a PET-based nomogram in oropharyngeal cancer. Interestingly, it appeared stronger than the classical prognostic factors and was validated in independent cohorts markedly diverging in many aspects, which suggest that the observed signal was robust.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The aim of this study was to define the pattern of relapse of postoperative prostate cancer in patients by using 68Ga-labeled prostate-specific membrane antigen positron-emission tomography/computed ...tomography (68Ga-PSMA PET/CT).
Forty patients received a (68Ga)-PSMA PET/CT for biochemical failure. Following the Radiation Therapy Oncology Group (RTOG) guidelines, the pelvic clinical target volume has been contoured. Bone metastases were considered as outside the clinical target volume. Two subgroups of patients were defined, patients having relapse: (1) inside, or (2) outside the clinical target volume.
Globally, eight patients out of 32 presented with a positive lymph node failure inside the clinical target volume according to RTOG guidelines (25%), 22 patients had nodal relapses outside this clinical target volume (68.75%) and in two patients nodal relapses occurred both inside and outside of the clinical target volume (6.25%). Overall, 36 positive lymph node lesions were identified: of these, 23 nodal relapses were identified within the clinical target volume contoured according to RTOG and/or at the lomboaortic level (63%). To cover 95% of these 23 relapses, a hypothetical clinical target volume should encompass the nodal regions of the RTOG-defined clinical target volume as well as the paraaortic lymph node level up to T12-L1.
Most of the patients in the present study, presented with distant lymph node and/or bone metastases. Therefore, larger target volumes should be adopted to treat at least 95% of lymph node regions at risk for an occult relapse.
L’objectif de cette étude était de définir les modalités de rechute postopératoire des cancers de la prostate à l’aide de la tomographie par émission de positons–scanographie (TEP-CT) avec l’antigène membranaire spécifique de la prostate marqué au gallium 68.
Quarante patients ont eu une TEP-scanographie pour une rechute biochimique d’un cancer de la prostate opéré. Nous avons défini le volume cible anatomoclinique pelvien en suivant les recommandations du Radiation Therapy Oncology Group (RTOG)),. Les rechutes métastatiques osseuses ont été considérées comme en dehors de ce volume cible anatomoclinique. Deux sous-groupes de rechutes ont été définis: celles dans le volume cible anatomoclinique et celles en-dehors.
Globalement, huit rechutes sur 32 ganglionnaires (25 %) étaient dans le volume cible anatomoclinique délinéé selon les recommandations du RTOG, 22 en dehors (68,75 %) et deux dedans et en dehors (6,25 %). En tout, 36 lésions ganglionnaires positives ont été identifiées, 23 dans le volume cible anatomoclinique délinéé selon les recommandations du RTOG et/ou au niveau lomboaortique (63 %). Pour traiter 95 % de ces 23 rechutes, un volume cible anatomoclinique hypothétique plus large serait nécessaire, et il devrait englober les aires ganglionnaires du volume cible anatomoclinique préconisé par le RTOG ainsi que les ganglions plomboaortiques jusqu’à T12-L1.
La plupart des patients inclus dans cette étude étaient atteints de métastases ganglionnaires et/ou osseuses à distance du volume cible anatomoclinique délinéé selon les recommandations du RTOG. En conséquence, des volumes cibles plus importants devraient être adoptés pour traiter au moins 95 % des régions ganglionnaires présentant un risque potentiel de rechute.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
9.
In reply to Gandaglia et al De Bari, B; Arcangeli, S; Alongi, F
Annals of oncology
25, Issue:
9
Journal Article
Peer reviewed
Open access
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Because of the massive globalization process, market volatility, and today's ever-changing business environment, managing grain supply chains (GSCs) is becoming increasingly challenging. In addition, ...the ongoing Russia–Ukraine conflict is causing significant disruptions in global supply chains, adding to the challenges imposed by the COVID-19 pandemic in the last couple of years. The ongoing socio-economic disruptions have created a ripple effect in the global supply chains worldwide, especially in emerging economies, which also happen to be the major global exporters of food grains. In this regard, the key enablers of the GSC must be identified to address the impact of the ripple effect and ensure sustainability and food security. This paper addresses these challenges and amalgamates the knowledge on ripple effects, sustainability, and food security. The study aims to identify, prioritize, and delineate the systemic interrelationships among enablers to address the ripple effect of GSC in emerging economies like Bangladesh. A multi-method approach integrating Pareto analysis, total interpretive structural modeling (TISM), and matrice d'impacts croisés multiplication appliquée à un classement (MICMAC) was employed for this purpose. The findings of this study indicate that geological sourcing diversification, governing cash flow to avoid the liquidity crisis, and supplier clustering according to disruptive risks are the most significant enablers. The insights from this study can potentially assist industry leaders and GSC practitioners in making strategic decisions to achieve sustainability in the grain management sector and thus improve future food security in emerging economies.
•Explored the interaction of enablers to mitigate the ripple effect in the grain supply chain.•An integrated approach combining Pareto analysis, TISM, and MICMAC has been utilized.•Geological sourcing diversification is the most significant enabler.•Findings can help the policy-makers to achieve sustainability and ensure food security.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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