Stereotactic body radiotherapy (SBRT) has been used as an alternative to surgical intervention to treat primary malignanices of the lung as well as lesions from other primaries. In this study, we ...evaluate the safety and efficacy of SBRT in treating lung metastases from colorectal cancer (CRC).
We reviewed 22 patients that underwent lung SBRT for metastases from CRC. Almost all patients received chemotherapy before and after undergoing SBRT. Outcomes that were analyzed included overall survival, distant failure and progression-free survival, as well as the effects of biologically effective dose (BED) and KRAS status on local control.
Seven females and 15 males underwent SBRT to lung metastases from CRC. The median Eastern Cooperative Oncology Group status was one (0-2). The median dose was 48 Gy (40-54 Gy) in 5 fx (4-8 fx) and the median number of nodules treated with SBRT was one (1-3). Median follow-up was 28.5 months from SBRT and 79 months (9-145) from primary diagnosis. Local control at 1 and 3 years was 75 and 58%, respectively. There was a trend toward improved local control with increasing biologically effective dose (BED
> 100; p = 0.07). Cancers that were positive for the KRAS mutation had increased local control at 12 months, 100 versus 75% (p = 0.0199). Median OS from the primary diagnosis of CRC and from SBRT was 79 and 31 months, respectively. There were no predictors for OS. There were no episodes of acute or late grade 3 or higher toxicity.
The results of this study add to the growing body of literature to support SBRT for lung metastases, specifically those patients with limited lung metastases from CRC. The choice of radiation dose remains important, even in metastatic disease, as highlighted by the trend toward improved local control with increasing BED
.
BACKGROUNDNeoadjuvant chemoradiotherapy (nCRT) followed by resection and postoperative multi-agent chemotherapy (maChT) is the standard of care for locally advanced rectal cancer. Using this ...approach, maChT administration can be delayed for several months, leading to concern for distant metastases. To counteract this, a novel treatment approach known as total neoadjuvant therapy (TNT) has gained popularity, in which patients receive both maChT and nCRT prior to resection. We utilized the National Cancer Database to examine temporal trends in TNT usage, and any potential effect on survival. AIMTo study the temporal trends in the usage of TNT and evaluate its efficacy compared to neoadjuvant chemoradiation. METHODSWe queried the National Cancer Database for patients with locally advanced rectal cancer, Stage II-III, from 2004-2015 treated with nCRT or TNT. TNT was defined as maChT initiated ≥ 90 d prior to nCRT initiation. Overall survival was calculated from the date of diagnosis to the date of last contact or death using Kaplan-Meier curves to present the cumulative probability of survival, with log-rank statistics to assess significance. Multivariable cox regression was used to identify predictors of survival and propensity score analysis accounted for bias. RESULTSWe identified 9066 eligible patients, with 8812 and 254 patients receiving neoadjuvant chemoradiation followed by maChT and TNT, respectively. Nodal involvement, stage III disease, and treatment in recent years were predictive of TNT use. There was greater use of TNT with more advanced stage, specifically > 1 node involved (odds ratio OR = 2.88, 95% confidence interval CI: 2.11-3.93, P < 0.01) and stage III disease (OR = 2.88, 95%CI: 2.11-3.93, P < 0.01). From 2010 to 2012 the use of TNT increased (OR = 2.41, 95%CI: 1.27-4.56, P < 0.01) with a greater increase from 2013 to 2015 (OR = 6.62, 95%CI: 3.57-12.25, P < 0.01). Both the TNT and neoadjuvant chemoradiation arms had a similar 5-year survival at 76% and 78% respectively. Multivariable analysis with propensity score demonstrated that increased age, high comorbidity score, higher grade, African American race, and female gender had worse overall survival. CONCLUSIONOur data demonstrates a rising trend in TNT use, particularly in patients with worse disease. Patients treated with TNT and nCRT had similar survival. Randomized trials evaluating TNT are underway.
The operation efficiency of a port with an approach channel to a great extent depends on decisions made by the port authority and harbor master over the channel scheduling. Currently there are no ...formal methods which allow to evaluate the influence of the channel schedule on the ship turnaround time, especially when the throughput capacity is restricted. The relevant system has a complex structure that rules out common mathematical methods. The paper studies some typical structures of these systems and offers an approach for developing adequate simulation models. These models enable the conduct of comparative studies of different variants of approach channel scheduling and serve as a toolkit to support the decision-making procedure for harbor master and port operators.
OBJECTIVE:The relationship between microsatellite instability (MSI) and response to neoadjuvant chemoradiation in rectal cancer is not well understood.
BACKGROUND:We utilized the National Cancer ...Database (NCDB) to investigate the association between MSI and pathologic complete response (pCR) in this patient population.
METHODS:We analyzed 5086 patients between 2010 and 2015 with locally advanced rectal cancer who were tested for MSI and treated definitively with chemoradiation followed by surgery. Primary comparison groups were between 4450 MSI-negative(−) and 636 MSI-positive(+) patients. Multivariable regression analysis was conducted to identify demographic, therapeutic, and clinical characteristics predictive of pCR. Cox proportional-hazard ratios were used for survival.
RESULTS:All patients were treated with definitive chemoradiation (median dose 50.4 Gy) followed by resection within 4 months. MSI(+) patients were associated with earlier year of diagnosis and higher-grade tumors (P < 0.05).The overall pCR rate was 8.6%, including 8.9% for MSI(−) and 5.9% for MSI(+) tumors (P = 0.01). Along with lower T stage, MSI(+) cases were significantly associated with a reduced pCR rate (odds ratio 0.65, 95% confidence interval 0.43–0.96) with multivariable analysis. The 5-year survival for patients with pCR was 93% compared with 73% without it (<0.001).
CONCLUSION:Microsatellite instability was independently associated with a reduction in pCR for locally advanced rectal cancer after neoadjuvant chemoradiation in this NCDB-based analysis.
Multi-Band Digital-RF Receiver Sarwana, S; Kirichenko, D E; Dotsenko, V V ...
IEEE transactions on applied superconductivity,
06/2011, Letnik:
21, Številka:
3
Journal Article, Conference Proceeding
Recenzirano
A software radio receiver that can be programmed to operate in multiple wide frequency bands is required for many communication and intelligence applications. We have designed a variety of multi-band ...receivers, comprising a set of band-specific analog-to-digital converters (ADCs) for direct digitization of RF bands and a digital switch matrix for band selection, in two flavors: as a single superconductor integrated circuit chip and also as a multi-chip module. In addition to the ADCs and the switch, these include a 1:16 deserializer and output drivers to facilitate transport of the digitized RF data to room temperature electronics for further processing and analysis. In the single IC flavor, up to four bandpass delta-sigma ADCs minimizing quantization noise in their respective bands were integrated on the same chip and operated at clock rates up to 20 GHz. In the multi-chip module (MCM) implementation, a 1-cm × 1-cm universal active carrier was designed to accommodate any two 2.5-mm × 2.5-mm flipped chips, each containing a single ADC front-end. This standardized approach facilitates customization of two-band ADCs by selecting from a growing library of ADC front-ends, which currently cover bands ranging from HF (0-30 MHz) to Ka-band (20-21 GHz). These Multi-band MCMs and single chip ADC's were fabricated, assembled and tested.
Optimization strategies of container terminals Kuznetsov, Alexander L.; Kirichenko, Alexander V.; Semenov, Anton D. ...
Scientific Journal of Gdynia Maritime University,
09/2020, Letnik:
1, Številka:
115
Journal Article
Recenzirano
Odprti dostop
One of the main tasks of operational management of modern container terminals is effective utilization of existing technological resources. The search for possible variants of terminal activity ...optimization requires constant analysis of transport process technology and development of technical and technological approaches to increase the effectiveness of resources utilization. One of the possible solutions provided by terminal operational systems is the application of different strategies of container stack organization and container selectivity. At the same time, the complicated character of input and output container flow makes the effectiveness of these strategies doubtful. The paper states that this particular manner of container service is different from traditional ones, i.e. FIFO and FILO. As output container flow is randomly distributed the manner of container service can be considered as First In/Random Out. The paper also considers different strategies that are applied in practice and analyzes its influence on the productivity of handling equipment. The results of these strategies simulation modeling are represented. The results prove that no strategy can provide a productivity with theoretical selectivity; any strategy provides slowed intensity of operations. At the same time, it is proved that the only optimization strategy which increases the productivity of handling equipment is the organization of terminal activity whereby containers can be selected from the stack not in requirement sequence, but in order of its position in a stack.
Inspired by insights of modern cognitive science, this article investigates the use of self-referential metaphors in Pindar's epinicians and demonstrates that these metaphors serve to enhance the ...cognitive effect of the rhetoric of praise. The starting point of the argument is the (dis)analogy between the self-referential deixis that religious hymns use to map aetiological myths to their performance context and the self-referential metaphors that Pindar uses to blend the observable context of the victory celebration with the context of the original victory. It is to emphasize the 'presentification' of the victory in the context of the victory celebration (and beyond) that Pindar employs the analogy between poetry and visual arts—presenting his poems either as architectural structures commemorating multiple layers of the past (Olympian 6) or as victor statues endowed with speech and movement (Nemean 5).
This article discusses the most memorable works of art described in Virgil's Aeneid (the paintings at the temple in Carthage, the doors of the temple in Cumae, the shield of Aeneas, and the baldric ...of Pallas) as visual models for the poem's organization of its own intertextual memory. The multi-dimensionality of memory enacted in the viewing of these pictorial programmes emerges as a metaphorical visualization of the semantic density created by the overlapping intertexts within the narrative itself and, what is more, urges the reader to perceive works of Augustan monumental art as embodiments of a similarly complex universe of memory.
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