Our study reviewed the results of patients with hepatocellular carcinoma and Child-Pugh score 8-11 cirrhosis treated with stereotactic body radiotherapy when liver transplant was not an option.
A ...retrospective review was performed on 15 patients with Child-Pugh class B and C cirrhosis treated with stereotactic body radiotherapy. The median total dose was 35 Gy in 4-5 fractions. None were listed for a liver transplant due to either being outside of the Milan criteria or to medical contraindications.
The overall survival was 26.7% at 6 months, with a mean survival of 152 days. The mean survival with and without ascites was 3.3 months and 8.3 months, respectively.
For hepatocellular carcinoma with cirrhosis of Child-Pugh score 8 or more, prognosis after liver stereotactic body radiotherapy was suboptimal. While irradiation achieved local tumor control, progressive cirrhosis was a common cause of death. Patients without ascites at the time of radiotherapy had the best prognosis.
This article shows that in Horace's sermones (the Satires, the Epistles, and the Ars Poetica) the social dynamics of Roman patronage provide a metaphorical basis for an innovative (meta-)poetic ...discourse. It argues that the progression from the orality of the Satires to the epistolarity of the Epistles encodes an intricate dialectics between freedom and dependence (ethical, aesthetical, and political alike) and thereby reflects on the way Horace's poetry produces meaning.
The Art of Transference Kirichenko, Alexander
Mnemosyne,
01/2016, Letnik:
69, Številka:
1
Journal Article
Recenzirano
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).
Purpose: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.
e15595
Background: Total Neoadjuvant therapy (TNT) has gained acceptance in the treatment of locally advanced rectal cancer, although the optimal sequencing of therapy chemoradiation (CRT) followed ...by consolidation chemotherapy (cChT) or induction chemotherapy followed by chemoradiation (iChT), remains a subject of ongoing debate. The effect of TNT sequencing and carcinoembryonic antigen (CEA) level on progression free survival (PFS) is uncertain. We conducted a retrospective analysis to examine these issues. Methods: Patients (n = 44) with locally advanced rectal cancer from June 2016 to December 2020 were reviewed. CEA level was compared against the primary outcome of response to TNT approaches. We categorized patients into 3 groups based on pre-TNT and post-TNT (i.e. pre-surgical) CEA: normal CEA
PRE/
normal CEA
POST
, elevated CEA
PRE
/normal CEA
POST
, elevated CEA
PRE
/elevated CEA
POST.
3-Year PFS was calculated using Kaplan-Meier method. Univariable and multivariable logistic regression analyses identified characteristics predictive of PFS and clinicopathologic variables associated with TNT sequencing. Results: The study cohort had a median age of 61 years and was predominantly male (70%) and Caucasian (94%). Pre-treatment stage was either II (27%) or III (72%), with the majority (65%) undergoing iChT. Downstaging occurred in 42/44 (95%). Baseline CEA was elevated in 40.9% of patients. On multivariable, logistic regression variable associated with receipt of CRT followed by cChT included: Age > 61 years clinical T4 disease and lack of T downstaging (p < 0.05 for all).There was no difference in 3-year PFS between patients receiving iChT versus patients receiving cChT (p = 0.53). When patients were stratified according to pretreatment CEA level, no difference in 3 year PFS were noted (p = 0.46). On multivariable analysis, lack of nodal downstaging following neoadjuvant treatment was associated with higher likelihood of progression (p = 0.02). Similarly, pretreatment CEA > 4.25 ng/ml (p = 0.08) and failure of CEA to decrease by >2 ng/ml following TNT (p = 0.07) trended toward higher likelihood of progression. Conclusions: Neither TNT sequencing, nor baseline CEA predicted the PFS although the power of our study was limited. Lack of nodal downstaging was identified as a predictor of worse PFS. Further areas of study should include plasma-based assays to quantitate circulating tumor DNA and next generation sequencing to assess prognosis with different sequencing of TNT.
The Door Ajar Grewing, Farouk F; Acosta-Hughes, Benjamin; Kirichenko, Alexander
2013, Letnik:
132
eBook
When is "closure" in fact "false closure", the deceptive opposite of apparent conclusion or perfection? 2009 marked the twentieth anniversary of the publication of Don Fowler's seminal essay "First ...Thoughts on Closure: Problems and Prospects" (MD 22: 75-122), a work that contributed greatly to bringing about a broad reconsideration in Ancient literary studies of the concept of closure whether understood as an ontological feature, an aesthetic concept, an appreciative inclination on the part of a work's audience or a psychological desire of the individual to control the "text" at hand. The present volume, 'The Door Ajar: False Closure in Greek and Roman Literature and Art', seeks to mark both a debt to the ongoing influence of Fowler's work, and to frame a future discourse on false closure in particular as an artistic phenomenon.
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