•The 3-year OS rate for the whole group was 10%.•The 3-year OS of resected group was 43% versus 6.5% in unresected group (p = 0.03).•Of 7 operated patients, 2 had complete pathological response and 4 ...partial response.
Purpose: To report the long-term outcome of a multicenter phase II study with FOLFIRINOX followed by stereotactic body radiotherapy (LAPC-1 trial) in patients with locally advanced pancreatic cancer (LAPC). Materials and methods: Patients with histological confirmation of LAPC inoperable at diagnosis were enrolled. Induction therapy with 8 cycles of FOLFIRINOX was administered. If no disease progression was found after chemotherapy, patients received stereotactic body radiotherapy (SBRT) at a total dose of 40 Gy in 5 fractions. Results: In LAPC-1 trial, 50 patients were included, but due to disease progression in 11 patients under chemotherapy, 39 patients received stereotactic SBRT after FOLFIRINOX treatment. In whole population, the 1- and 3-year overall survival (OS) were 62% and 10%, respectively. Median follow-up was 13 months. The SBRT group had median OS of 18 months (95% CI 13.2-21.5) versus 5 months (95% CI 4.1-6.7) in non-SBRT group (p<0.001). After chemoradiotherapy, seven patients underwent surgery achieving a radical resection. Patients who underwent surgery had a 3-years OS of 43% compared to 6.5% in the unresected group (p=0.03). Four patients developed grade ≥ 3 adverse events during SBRT. Conclusions: Long-term survival has been found in patients with LAPC underwent FOLFIRINOX followed by SBRT. This approach increased the probability of a radical surgery. The resected patients achieved a significant better survival compared to unresected group.
•This phase II trial shows that ablative SBRT for thoracic nodes metastases is safe and effective.•A risk-adaptive strategy that prioritizes organs at risk is a good compromise.•SBRT can defer the ...need for systemic therapy with a median time of 19,8 months.
Oligometastases in mediastinal nodes are increasingly prevalent, posing challenges for treatment with stereotactic body radiotherapy (SBRT) due to proximity to organs at risk (OARs). We report the results of a single prospective observational phase II trial on ablative SBRT for medically inoperable thoracic nodes metastases (NCT02970955).
Since 2017, patients with < 3 nodal metastases were evaluated by the tumor board and included if deemed inoperable. SBRT was delivered using risk adaptive approach based on number, site and size of metastatic nodes (50 Gy/5fractions, 60 Gy/8fractions, 70 Gy/10 fractions). Planning target volume (PTV) partial underdosage was allowed. The primary end point was local control (LC) at 12 months. Secondary end points were: acute and late toxicities, overall survival (OS), progression free survival (PFS), and time to next systemic therapy (TTNS).
Between 03/2017–11/2021, 32 patients (41 nodal metastases) were included. NSCLC (13pts), breast (5pts) and colorectal cancer (4pts) were the most represented primary tumour. In 66 % cases, partial PTV undercoverage was necessary. LC at 1 and 2 years was 93.5 % and 82.3 %, respectively. Treatment was well-tolerated with no acute or late toxicity ≥ G3. Median OS was 59.7 months. OS at 1 and 2 years was 96.9 % and 83.8 % respectively. Median PFS was 12.2 months. PFS at 1 and 2 years was 53.1 % and 31.3 %, respectively.
This trial supported the feasibility and safety of ablative SBRT for thoracic nodes metastases thanks to risk adaptive approach allowing to delay of new systemic therapies. Larger studies are needed to confirm these observations.
Stereotactic body radiotherapy (SBRT) is characterized by the delivery of high doses of ionizing radiation in few fractions. It is highly effective in achieving local control, and, due to the high ...biological effective dose administered, it seems to overcome the radioresistance of renal cell carcinoma (RCC). Thus, SBRT could constitute a treatment option for the management of localized RCC in patients who are not surgical candidates. In this paper, we report an overview about data from the current evidence about SBRT in patients affected by localized RCC.
A non-systematic review was performed, including data from both retrospective and prospective studies focusing on the use of SBRT for localized RCC and its biological rationale. Furthermore, ongoing trials on this issue are reported.
Currently, SBRT might be considered a treatment alternative in inoperable patients affected by primary RCC. Currently, dose-escalation to 48 Gy in 3–4 fractions are effective and well tolerated. Emerging role of immune therapies in RCC patients warrant further studies to explore interactions between SBRT and immune response.
Due to the absence of consensus on metastases-directed treatment in kidney cancer, we conducted an analysis of patients treated with stereotactic radiotherapy (SRT) on cranial or extracranial ...metastases to classify them in survival class risk according to pre-treatment characteristics.
We included oligometastatic kidney cancer patients treated with SRT on up to five metastases. Concomitant systemic treatment was allowed. End points included overall survival and the binary classification tree approach with recursive partitioning analysis was applied to stratify patients into overall survival risk groups.
In total, 129 patients were treated on 242 metastases. The brain was the most common site (34.71%), followed by lung (25.62%). With a median follow-up of 19.4 months, 1- and 3-year overall survival were 82.62 and 55.11%. The recursive partitioning analysis identified four prognostic classes. Class 1 included patients aged ≤ 65 years treated on extracranial metastases, with 3-year overall survival of 82.66%. Class 2 included patients aged > 65 years, without history of metastatic bone disease, treated on extracranial metastases, with a 3-year overall survival of 67.91%. Patients aged > 65 years and a history of bone disease, treated on extracranial metastases, were classified as class 3, with a 3-year overall survival of 37.50%. Class 4 included patients treated on brain metastases, with a 3-year overall survival of 9.70%.
We produced a stratification model that can predict survival of oligometastatic kidney cancer patients treated with metastases-directed SRT. Site of disease, patient’s age and presence of bone disease can help clinicians in the decision-making process.
•There is a lack of consensus on the role of local treatments for the management of metastatic kidney cancer.•We classified in survival risk-group metastatic kidney cancer patients treated with stereotactic radiotherapy on cranial or extracranial metastases.•Class 1, with best survival, included patients ≤ 65 years with extracranial metastases. Class 2 included patients > 65 years, without history of metastatic bone disease, with extracranial metastases.•Patients > 65 years and history of bone disease, treated on extracranial metastases, were classified as Class 3. Class 4 with worst survival included patients treated on brain metastases.
Penile metastasization is an uncommon condition, mostly derived from primitive advanced abdominal cancers, with disabling symptoms. Palliative treatment, in reason of poor prognosis patients, is ...frequently surgical with destructive management. We report two cases of penile metastasis, from primitive prostatic adenocarcinoma and primitive urothelial carcinoma, effectively managed with radiation treatment at our institution. A three-dimensional conformal radiation therapy with 42Gy to the planning target volume in 14 fractions was delivered. Radiation treatment was safely delivered, with low toxicity profile and achieved adequate symptoms control without compromising genitourinary functions. Radiation therapy should be considered in management of rare penile metastases.
La métastase pénienne est une affection rare, principalement dérivée de cancers abdominaux évolués primitifs, avec des symptômes invalidants. Le traitement palliatif, en raison du pronostic défavorable, est souvent chirurgical avec une prise en charge destructive. Nous rapportons deux cas de métastases péniennes, d’adénocarcinome prostatique primitif et de carcinome urothélial primitif, gérées efficacement par radiothérapie dans notre établissement. Une radiothérapie conformationnelle tridimensionnelle de 42Gy dans le volume cible prévisionnel en 14 fractions a été délivrée. La radiothérapie a été administrée en toute sécurité, avec un faible profil de toxicité et a permis un contrôle adéquat des symptômes sans compromettre les fonctions génito-urinaires. La radiothérapie doit être envisagée dans la prise en charge des rares métastases péniennes.
This paper describes the innovative optical design of the Metis coronagraph for the Solar Orbiter ESA-NASA mission. Metis is a multi-wavelength, externally occulted telescope for the imaging of the ...solar corona in both the visible and ultraviolet wavelength ranges. Metis adopts a novel occultation scheme for the solar disk, that we named “inverse external occulter”, for reducing the extremely high thermal load on the instrument at the spacecraft perihelion. The core of the Metis optical design is an aplanatic Gregorian telescope common to both the visible and ultraviolet channels. A suitable dichroic beam-splitter, optimized for transmitting a narrow-band in the ultraviolet (121.6 nm, HI Lyman-α) and reflecting a broadband in the visible (580–640 nm) spectral range, is used to separate the two optical paths. Along the visible light optical path, a liquid crystal electro-optical modulator, used for the first time in space, allows making polarimetric measurements.
In this work, we present an investigation of the wind in the solar corona that has been initiated by observations of the resonantly scattered ultraviolet emission of the coronal plasma obtained with ...UVCS-SOHO, designed to measure the wind outflow speed by applying Doppler dimming diagnostics. Metis on Solar Orbiter complements the UVCS spectroscopic observations that were performed during solar activity cycle 23 by simultaneously imaging the polarized visible light and the H
I
Lyman-
α
corona in order to obtain high spatial and temporal resolution maps of the outward velocity of the continuously expanding solar atmosphere. The Metis observations, taken on May 15, 2020, provide the first H
I
Lyman-
α
images of the extended corona and the first instantaneous map of the speed of the coronal plasma outflows during the minimum of solar activity and allow us to identify the layer where the slow wind flow is observed. The polarized visible light (580–640 nm) and the ultraviolet H
I
Ly
α
(121.6 nm) coronal emissions, obtained with the two Metis channels, were combined in order to measure the dimming of the UV emission relative to a static corona. This effect is caused by the outward motion of the coronal plasma along the direction of incidence of the chromospheric photons on the coronal neutral hydrogen. The plasma outflow velocity was then derived as a function of the measured Doppler dimming. The static corona UV emission was simulated on the basis of the plasma electron density inferred from the polarized visible light. This study leads to the identification, in the velocity maps of the solar corona, of the high-density layer about ±10° wide, centered on the extension of a quiet equatorial streamer present at the east limb – the coronal origin of the heliospheric current sheet – where the slowest wind flows at about 160 ± 18 km s
−1
from 4
R
⊙
to 6
R
⊙
. Beyond the boundaries of the high-density layer, the wind velocity rapidly increases, marking the transition between slow and fast wind in the corona.
Aims
68
Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA ...PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported.
Results
92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (
p
= 0.004) and TTR < 29.5 months (
p
= 0.003).
Conclusions
PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging.
The Solar Orbiter mission Müller, D.; St. Cyr, O. C.; Zouganelis, I. ...
Astronomy and astrophysics (Berlin),
10/2020, Letnik:
642
Journal Article
Recenzirano
Odprti dostop
Aims.
Solar Orbiter, the first mission of ESA’s Cosmic Vision 2015–2025 programme and a mission of international collaboration between ESA and NASA, will explore the Sun and heliosphere from close up ...and out of the ecliptic plane. It was launched on 10 February 2020 04:03 UTC from Cape Canaveral and aims to address key questions of solar and heliospheric physics pertaining to how the Sun creates and controls the Heliosphere, and why solar activity changes with time. To answer these, the mission carries six remote-sensing instruments to observe the Sun and the solar corona, and four in-situ instruments to measure the solar wind, energetic particles, and electromagnetic fields. In this paper, we describe the science objectives of the mission, and how these will be addressed by the joint observations of the instruments onboard.
Methods.
The paper first summarises the mission-level science objectives, followed by an overview of the spacecraft and payload. We report the observables and performance figures of each instrument, as well as the trajectory design. This is followed by a summary of the science operations concept. The paper concludes with a more detailed description of the science objectives.
Results.
Solar Orbiter will combine in-situ measurements in the heliosphere with high-resolution remote-sensing observations of the Sun to address fundamental questions of solar and heliospheric physics. The performance of the Solar Orbiter payload meets the requirements derived from the mission’s science objectives. Its science return will be augmented further by coordinated observations with other space missions and ground-based observatories.
Context.
The Metis coronagraph on board Solar Orbiter offers a new view of coronal mass ejections (CMEs), observing them for the first time with simultaneous images acquired with a broad-band filter ...in the visible-light interval and with a narrow-band filter around the H
I
Ly-
α
line at 121.567 nm, the so-called Metis UV channel.
Aims.
We show the first Metis observations of a CME, obtained on 16 and 17 January 2021. The event was also observed by the EUI/FSI imager on board Solar Orbiter, as well as by other space-based coronagraphs, such as STEREO-A/COR2 and SOHO/LASCO/C2, whose images are combined here with Metis data.
Methods.
Different images are analysed here to reconstruct the 3D orientation of the expanding CME flux rope using the graduated cylindrical shell model. This also allows us to identify the possible location of the source region. Measurements of the CME kinematics allow us to quantify the expected Doppler dimming in the Ly-
α
channel.
Results.
Observations show that most CME features seen in the visible-light images are also seen in the Ly-
α
images, although some features in the latter channel appear more structured than their visible-light counterparts. We estimated the expansion velocity of this event to be below 140 km s
−1
. Hence, these observations can be understood by assuming that Doppler dimming effects do not strongly reduce the Ly-
α
emission from the CME. These velocities are comparable with or smaller than the radial velocities inferred from the same data in a similar coronal structure on the east side of the Sun.
Conclusions.
The first observations by Metis of a CME demonstrate the capability of the instrument to provide valuable and novel information on the structure and dynamics of these coronal events. Considering also its diagnostics capabilities regarding the conditions of the ambient corona, Metis promises to significantly advance our knowledge of such phenomena.
PDF
