We compared the rate and severity of fatigue in patients who completed stereotactic body radiation therapy (SBRT) to the liver daily (QD) compared with every other day (QOD).
From 2010 to 2017, 91 ...patients with Child Pugh (CP) A (n = 57) or CP-B (n = 34) cirrhosis who completed 100 SBRT sessions to 110 hepatocellular carcinoma (HCC) lesions were analyzed in this study. Confounding variables with fatigue such as CP-C cirrhosis, Eastern Cooperative Oncology Group score >2, or a history of ascites or encephalopathy were excluded. Fatigue was assessed against several treatment- and patient-related variables with univariate and propensity score-matched multivariate analysis. The median follow-up time was 18 months.
Patients with HCC and Barcelona-Clinic Liver Cancer stages 0 (n = 10), A (n = 32), and B (n = 58), and a median age of 62 years were analyzed. The median tumor diameter was 3 cm (1.1-11 cm). The Eastern Cooperative Oncology Group performance status score was 0 (n = 44), 1 (n = 43), or 2 (n = 13). The median dose was 45 Gy in 5 fractions, and 65 treatments were QD and 45 QOD. Grades 1 and 2 fatigue developed in 49% and 14% of treatments, respectively. Among the patients who were treated daily, 78% developed Grade 1 or 2 fatigue compared with 44% who were treated QOD (odds ratio: 4.52; P = .001). Grade 2 fatigue occurred in 22% of patients compared with 7.3% for QD and QOD treatment, respectively (odds ratio: 3.83; P = .048). There was no difference in fatigue rate for time of treatment (morning or afternoon), dose, treated volume, CP score, Barcelona-Clinic Liver Cancer stage, or performance status, which were not associated with any level of fatigue. There was no difference in local control between QD and QOD treatments.
Compared with traditional daily treatment fractions, SBRT that is delivered QOD to cirrhotic patients with HCC may reduce the risk of fatigue.
Traditionally, three-dimensional conformal radiation therapy (3D-CRT) is used for neoadjuvant chemoradiation in locally advanced rectal cancer. Intensity-modulated radiation therapy (IMRT) was later ...developed for more conformal dose distribution, with the potential for reduced toxicity across many disease sites. We sought to use the National Cancer Database (NCDB) to examine trends and predictors for IMRT use in rectal cancer.
We queried the NCDB from 2004 to 2015 for patients with rectal adenocarcinoma treated with neoadjuvant concurrent chemoradiation to standard doses followed by surgical resection. Odds ratios were used to determine predictors of IMRT use. Univariable and multivariable Cox regressions were used to determine potential predictors of overall survival (OS). Propensity matching was used to account for any indication bias.
Among 21,490 eligible patients, 3,131 were treated with IMRT. IMRT use increased from 1% in 2004 to 22% in 2014. Predictors for IMRT use included increased N stage, higher comorbidity score, more recent year, treatment at an academic facility, increased income, and higher educational level. On propensity-adjusted, multivariable analysis, male gender, increased distance to facility, higher comorbidity score, IMRT technique, government insurance, African-American race, and non-metro location were predictive of worse OS. Of note, the complete response rate at time of surgery was 28% with non-IMRT and 21% with IMRT.
IMRT use has steadily increased in the treatment of rectal cancer, but still remains only a fraction of overall treatment technique, more often reserved for higher disease burden.
Nowadays, with patented technologies for the production of goods, the possibility of reducing their cost in order to maintain a competitive position in the commodity markets is supported by the ...rational organization of transportation. Thus, the transport component in the final cost of transported goods is reduced. At the same time, when using the same handling, lifting and transporting equipment from a limited number of global manufacturers, the possibility of reducing the cost of transport operations (both shipping and handling, including loading/unloading) depends only on their rational use. One of the mechanisms for rationalizing the loading and unloading operations carried out by container terminals is the rationalization of cargo plans of the serviced container ships. The versatility of their development is determined, first of all, by high requirements for the safety of navigation, which determine the provision of the necessary stability, unsinkability, the absence of a heel and difference that interfere with the work, the required sitting of the ship in the water, etc. On the other hand, the rational placement of containers in the slots and on the hatches covers of the container ships, corresponding to the voyage rotation (the sequence of visiting terminals on the trip in progress), provides an increase in the share of productive movements of handling, lifting and transporting equipment, reduces the required time for a ship to be under loading and unloading operations, which reduces the time of a group of ship trips on a string. Such calculations are complicated by the fact that the handling equipment used during the loading and unloading operations on a separate ship operates conditionally autonomously, each unit - for its own section of the ship (“bay”). Thus, the task can be solved only in a complex manner, coupled with the task of cranes allocation over the berth. The paper studies the issues of cargo planning of liner container ships from the standpoint of reducing the time of ship’s turnaround time due to rational assignment and use of port handling equipment.
A 1.5T MRI combined with a linear accelerator (Unity®, Elekta; Stockholm, Sweden) is a device that shows promise in MRI-guided stereotactic body radiation treatment (SBRT). Previous studies utilized ...the manufacturer’s pre-set MRI sequences (i.e., T2 Weighted (T2W)), which limited the visualization of pancreatic and intra-abdominal tumors and organs at risk (OAR). Here, a T1 Weighted (T1W) sequence was utilized to improve the visualization of tumors and OAR for online adapted-to-position (ATP) and adapted-to-shape (ATS) during MRI-guided SBRT. Twenty-six patients, 19 with pancreatic and 7 with intra-abdominal cancers, underwent CT and MRI simulations for SBRT planning before being treated with multi-fractionated MRI-guided SBRT. The boundary of tumors and OAR was more clearly seen on T1W image sets, resulting in fast and accurate contouring during online ATP/ATS planning. Plan quality in 26 patients was dependent on OAR proximity to the target tumor and achieved 96 ± 5% and 92 ± 9% in gross tumor volume D90% and planning target volume D90%. We utilized T1W imaging (about 120 s) to shorten imaging time by 67% compared to T2W imaging (about 360 s) and improve tumor visualization, minimizing target/OAR delineation uncertainty and the treatment margin for sparing OAR. The average time-consumption of MRI-guided SBRT for the first 21 patients was 55 ± 15 min for ATP and 79 ± 20 min for ATS.
BACKGROUND:Surgery remains the standard of care in rectal cancer. Select patients will not undergo surgery for reasons such as medical inoperability or a watch-and-wait approach and instead are ...managed with definitive chemoradiation.
OBJECTIVE:We used the National Cancer Database to identify overall survival and predictors thereof in the nonoperative management of patients with rectal cancer.
DESIGN:This was a retrospective review.
SETTINGS:This study used deidentified data from the National Cancer Database.
PATIENTS:We queried the national cancer database from 2004 to 2014 for stage 1 to 3 rectal adenocarcinoma treated with only chemotherapy and radiation to definitive doses. Dose escalated therapy was defined as >54 Gy.
MAIN OUTCOME MEASURES:Univariable and multivariable analyses were performed to identify sociodemographic, treatment, and tumor characteristics predictive of dose escalation and overall survival. Propensity-adjusted Cox proportional hazard ratios for survival were used to account for indication bias.
RESULTS:Among the 6311 patients eligible for the study, 11% were treated with doses >54 Gy. Earlier stage and increased age/comorbidity patients were more likely to receive dose escalation, and patients with more recent treatment and treatment at an academic facility were less likely. The median follow-up time was 31 months (range, 2–154 mo). Three- and 5-year overall survival rates for all patients were 60% and 46%. Patients treated with dose escalation had a median survival of 33 months compared with 56 months for those treated with ≤54 Gy (p < 0.0001).
LIMITATIONS:The main limitation is the inherent selection bias present in National Cancer Database studies. Important treatment details and outcomes as they relate to a definitive chemoradiation approach in rectal cancer are lacking. Salvage therapy was also not recorded, which in this population could be surgery.
CONCLUSIONS:In this analysis, dose escalation in the nonoperative management of rectal cancer was associated with a lower overall survival compared with more conventional doses. Careful patient selection and enrollment on appropriate clinical trials may be warranted in the nonoperative setting. See Video Abstract at http://links.lww.com/DCR/B15.
LA QUIMIORRADIACIÓN DEFINITIVA PARA EL CÁNCER RECTAL¿HAY LUGAR PARA EL AUMENTO DE LA DOSIS? UN ESTUDIO DE BASE DE DATOS NACIONAL DEL CÁNCER:La cirugía sigue siendo el estándar en el tratamiento del cáncer rectal. Algunos pacientes no son quirúrgicos por razones como, no ser operables o con el enfoque de ver y esperar, y en su lugar son tratados con la quimiorradiación definitiva.Utilizamos la base de datos nacional del cáncer para identificar la supervivencia general y los factores predictivos de la misma, en el tratamiento no quirúrgico de pacientes con cáncer rectal.Esta fue una revisión retrospectiva.Utilizamos los datos identificados en la base de datos nacional del cáncer.Se consultó la base de datos nacional del cáncer del 2004–2014, para adenocarcinoma rectal en estadio 1–3, tratada únicamente con quimioterapia y radiación hasta la dosis definitiva. La terapia de aumento de la dosis se definió como >54 Gy.Se realizaron análisis univariables y multivariables para identificar características sociodemográficas, de tratamiento y predictivas del aumento de la dosis y supervivencia en general. Los índices de riesgo proporcionales de Cox ajustados a la propensión para la supervivencia, se utilizaron para tener en cuenta el sesgo de indicación.Entre los 6311 pacientes elegibles para el estudio, el 11% fue tratado con dosis >54 Gy. Los pacientes en estadios tempranos y con mayor edad/comorbilidad, tenían más probabilidades de recibir aumento de la dosis, y menos propensos los pacientes con tratamientos recientes y de centros académicos. El tiempo medio de seguimiento fue de 31 meses (2–154 meses). Las tasas de supervivencia global de tres y cinco años para todos los pacientes, fueron respectivamente del 60% y 46%. Los pacientes tratados con aumento de la dosis, tuvieron una supervivencia media de 33 meses, en comparación con los 56 meses para los pacientes tratados con ≤54 Gy (p < 0,0001).La principal limitación es el inherente sesgo en la selección, presente en los estudios de la base de datos nacional del cáncer. Faltan los detalles importantes del tratamiento y los resultados en relación con el enfoque definitivo de quimiorradiación en cáncer rectal. Tampoco se registró la terapia de rescate, que en esta población podría ser la cirugía.En este análisis, el aumento de la dosis en el manejo no quirúrgico del cáncer rectal, se asoció con una menor supervivencia global, en comparación con la dosis más convencional. La cuidadosa selección del paciente y la inscripción en los apropiados ensayos clínicos, pueden estar justificados en el entorno no quirúrgico. Vea el Resumen del Video en http://links.lww.com/DCR/B15.
Stereotactic body radiation therapy (SBRT) and proton beam therapy (PBT) generally are safe and effective for non-operative hepatocellular carcinoma (HCC). To date, data comparing the two modalities ...are limited. We aimed to identify the practice patterns and outcomes of nonsurgical HCC cases treated definitively with either SBRT or PBT.
We queried the National Cancer Database for T1-2N0 HCC patients receiving PBT or SBRT from 2004 to 2015. Patients were excluded for any treatment other than non-palliative external beam radiotherapy. A multivariable binomial regression model identified patterns of SBRT/PBT use, and propensity-matched multivariable Cox regression assessed correlates of survival.
A total of 71 patients received PBT and 918 patients received SBRT (median follow-up 45 months). SBRT was used in 1.8% of nonoperative early stage HCC cases in 2004 and 4.2% of cases in 2015, whereas PBT was used in 0.1-0.2% of cases every year. The median biologically effective dose (BED) for SBRT and PBT was 100 Gy10 and 98 Gy10, respectively (OR =0.70, P=0.17). Factors predictive of receiving PBT included: white race, higher comorbidity score, higher education, metropolitan residence, tumors >5 cm and recent treatment (all P<0.05). Both PBT (HR =0.48, 95% CI: 0.29-0.78) and BED ≥100 Gy10 (HR =0.61, 95% CI: 0.38-0.98) were independent predictors for longer survival.
Although not implying causation and requiring prospective corroboration, PBT was independently associated with longer survival than SBRT, despite being delivered to HCC patients with multiple poor prognostic factors. PBT may also allow for safer BED escalation, which also independently associated with outcomes.
(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor ...Centers-Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m,
= 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m,
< 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone.
Modular, Multi-Function Digital-RF Receiver Systems Gupta, D; Kirichenko, D E; Dotsenko, V V ...
IEEE transactions on applied superconductivity,
06/2011, Letnik:
21, Številka:
3
Journal Article, Conference Proceeding
Recenzirano
Superconductor digital receiver systems of increasing functionality, modularity and user-friendliness have been developed. The modular design methodology ensures that within its input-output and heat ...load capacity, the system can be reconfigured to perform a different function by changing the chip module and by reprogramming FPGA-based digital signal processors. One of the systems (ADR-004), originally equipped with a 10 × 10 mm 2 channelizing receiver chip for signals intelligence application, was reconfigured with a 5 × 5 mm 2 1.1-GHz bandpass ADC chip to perform world's first multi-net Link-16 demonstration at a U.S. Navy facility. Substantial improvements in system integration have been obtained in each successive generation of digital-RF receiver systems. The latest (third) generation system (ADR-005), hosting a 5 × 5 mm 2 7.5-GHz bandpass ADC chip and an FPGA channelizer, successfully repeated the over-the-air SATCOM demonstration performed previously using a 1-cm 2 single-chip bandpass digital receiver with an on-chip superconductor channelizer. This system ran error-free for over 12 hours with and without a low-noise amplifier. To our knowledge, this is the first time an X-band SATCOM receiver has been operated without analog amplification and down-conversion in a military application.
The box selectivity in operational stack of container terminal is a quite common and long studied question. The pure random choice is governed by the theory of probability offering some combinatorial ...estimations. The introduction of operational rules like import/export separation, storage by shipping lines, sorting by rail or truck transportation etc., as well as the most notorious ‘sinking’ effect, i.e. covering of boxes arrived earlier by next cargo parties – all these blur the clear algebraiс picture and lead to appearance of many heuristic outlooks of the problem. A new impetus to this problem in last decades was given by the rapid development of IT, AI and simulation techniques. There are quite many examples of the models described in the scientific publication reflecting many real and arbitrary terminals, which embed very advanced and complicated mechanisms reflecting selected features and strategies. Unfortunately, these models usually are created ad hoc, with some pragmatic objectives and under the demand of closest possible proximity to the simulating objects. There are much less models designated to pure scientific study of the deep inner mechanisms responsible for the primal behavior of the operating container stack, enabling to introduce step by step new rules and restrictions, providing regular proving of every next stage’s adequacy and easy to use. This paper describes one attempt of this kind to create a new theoretical tool to put into the regular toolkit of the container terminal designer. The study starts with mathematical (combinatorial) considerations, proceeds with some restrictions caused by physical and technological characteristics, and ends up with the simulation model, which adequacy is confirmed by practical results.
AIM To evaluate the control, survival, and hepatic function for Child Pugh(CP)-A patients after Stereotactic body radiotherapy(SBRT) in hepatocellular carcinoma(HCC).METHODS From 2009 to 2016, 40 ...patients with Barcelona Liver Clinic(BCLC) stages 0-B HCC and CP-A cirrhosis completed liver SBRT. The mean prescription dose was 45 Gy(40 to 50 Gy in 4-5 fractions). Local relapse, defined as recurrence within the planning target volume was assessed with intravenous multiphase contrast computed tomography or magnetic resonance imaging every 4-6 mo after completion of SBRT. Progression of cirrhosis was evaluated by CP and Model for End Stage Liver Disease scores every 3-4 mo. Toxicities were graded per the Common Terminology Criteria for Adverse Events(v4.03). Median follow-up was 24 mo.RESULTS Forty-nine HCC lesions among 40 patients were analyzed in this IRB approved retrospective study. Median tumor diameter was 3.5 cm(1.5-8.9 cm). Six patients with tumors ≥ 5 cm completed planned selected transarterial chemoembolization(TACE) in combination with SBRT. Eight patients underwent orthotropic live transplant(OLT) with SBRT as a bridging treatment(median time to transplant was 12 mo, range 5 to 23 mo). The Pathologic complete response(PCR) rate in this group was 62.5%. The 2-year in-field local control was 98%(1 failure). Intrahepatic control was 82% and 62% at 1 and 2 years, respectively. Overall survival(OS) was 92% and 60% at 1 and 2 years, with a median survival of 41 mo per Kaplan Meier analysis. At 1 and 2 years, 71% and 61% of patients retained CPA status. Of the patients with intrahepatic failures, 58% developed progressive cirrhosis, compared to 27% with controlled disease(P = 0.06). Survival specific to hepatic failure was 92%, 81%, and 69% at 12, 18, and 24 mo. There was no grade 3 or higher toxicity. On univariate analysis, gross tumor volume(GTV) < 23 cc was associated with freedom from CP progression(P = 0.05), hepatic failure-specific survival(P = 0.02), and trended with OS(P = 0.10).CONCLUSION SBRT is safe and effective in HCC with early cirrhosis and may extend waiting time for transplant in patients who may not otherwise be immediate candidates.
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