In our trial, only 24 (34%) of 70 patients had T1a primary tumour and received single-session stereotactic ablative body radiotherapy (SABR) with a median tumour size of 3·3 cm (lower bound IQR of ...3·0 cm). The use of local progression defined by Response Evaluation Criteria in Solid Tumours (version 1.1) at 1 year was queried by both letters. SS declares salary support from Cancer Council Victoria via the Colebatch Fellowship; grants or contracts from Varian, Bayer Pharmaceuticals, and Merck Sharp Dohme; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from AstraZeneca, Varian, and Roche Pharmaceuticals; a leadership or fiduciary role on the American Society of Radiation Oncology Science Council, Advanced Radiotherapy Techniques committee of the International Association for the Study of Lung Cancer, and Board of Directors of the Radiosurgery Society during the past 36 months.
•In this research work the prediction of diabetes is made using grey wolf optimization technique is implemented.•The dataset is taken from UCI repository and the name of the dataset is PIMA INDIAN ...DIABETIC dataset.•In order to predict the diabetes disease, Fuzzy rules are combined with grey wolf optimization technique.•The methodology has three layers of decision-making named as (α),(β), (δ) along with fuzzy rules to make a prediction.•The performance of the proposed algorithm gives better result than the existing algorithm.
Diabetes disease increased with a high rate due to unhealthy lifestyle, work culture, and lacking of physical activity. Diabetes is an incurable and chronic disease but early sugar monitoring and diagnosis prevent from the harmful effects. In this research work diabetes prediction model is presented which is based on the grey wolf optimization with fuzzy logics. This work has been done by using the concept of artificial intelligence in which model learns the fuzzy rule and then optimized according to the GWO algorithm.
Highlights • Current clinical and preclinical data of the abscopal effect is summarized. • The abscopal effect is linked with the immunogenic properties of irradiation. • Radiotherapy has a potential ...synergy with immune agents. • The issues that come with combining radiotherapy and immune agents are addressed.
Approximately 1–15% of patients with metastatic castration-resistant prostate cancer eventually develop spinal cord compression (SCC) during their disease.1,2 Guidelines recommend urgent ...investigation in case of clinical suspicion to diagnose and treat SCC with surgical decompression or radiotherapy, or both.3 However, a third of patients with asymptomatic metastatic castration-resistant prostate cancer have radiological signs of SCC by MRI,4 which raises the question of whether screening followed by treatment of asymptomatic SCC might prevent the development of clinical symptoms of pain and debilitating neurological deficits. In The Lancet Oncology, David Dearnaley and colleagues5 report the open-label, randomised, phase 3 PROMPTS trial of 420 men with metastatic castration-resistant prostate cancer undergoing observation versus screening spinal MRI and pre-emptive treatment for radiological SCC.5 The primary outcome was time to clinical SCC and incidence at 12 months in the screening group versus observation only. 61 (31%) of 200 patients with assessable scans in the screening group had radiological SCC and the majority were treated prophylactically with radiotherapy; however, only 27 (44%) of 61 screen-positive patients underwent follow-up MRI at 12 months, a challenging follow-up schedule that could be exacerbated further in a real-world scenario. Zephyr/Science Photo Library SS is supported by a Cancer Council Victoria Colebatch Fellowship; has received grants or contracts from Varian, Reflexion, and Bayer Pharmaceuticals; has received honoraria for speakers bureaus from AstraZeneca; is a board member for Radiosurgery Society; is a member of the Genitourinary working party of the TransTasman Radiation Oncology Group; and is a member of the advanced radiotherapy technology committee for the International Association for the Study of Lung Cancer.
Conventional external beam radiotherapy is the standard palliative treatment for spinal metastases; however, complete response rates for pain are as low as 10–20%. Stereotactic body radiotherapy ...delivers high-dose, ablative radiotherapy. We aimed to compare complete response rates for pain after stereotactic body radiotherapy or conventional external beam radiotherapy in patients with painful spinal metastasis.
This open-label, multicentre, randomised, controlled, phase 2/3 trial was done at 13 hospitals in Canada and five hospitals in Australia. Patients were eligible if they were aged 18 years and older, and had painful (defined as ≥2 points with the Brief Pain Inventory) MRI-confirmed spinal metastasis, no more than three consecutive vertebral segments to be included in the treatment volume, an Eastern Cooperative Oncology Group performance status of 0–2, a Spinal Instability Neoplasia Score of less than 12, and no neurologically symptomatic spinal cord or cauda equina compression. Patients were randomly assigned (1:1) with a web-based, computer-generated allocation sequence to receive either stereotactic body radiotherapy at a dose of 24 Gy in two daily fractions or conventional external beam radiotherapy at a dose of 20 Gy in five daily fractions using standard techniques. Treatment assignment was done centrally by use of a minimisation method to achieve balance for the stratification factors of radiosensitivity, the presence or absence of mass-type tumour (extraosseous or epidural disease extension, or both) on imaging, and centre. The primary endpoint was the proportion of patients with a complete response for pain at 3 months after radiotherapy. The primary endpoint was analysed in the intention-to-treat population and all safety and quality assurance analyses were done in the as-treated population (ie, all patients who received at least one fraction of radiotherapy). The trial is registered with ClinicalTrials.gov, NCT02512965.
Between Jan 4, 2016, and Sept 27, 2019, 229 patients were enrolled and randomly assigned to receive conventional external beam radiotherapy (n=115) or stereotactic body radiotherapy (n=114). All 229 patients were included in the intention-to-treat analysis. The median follow-up was 6·7 months (IQR 6·3–6·9). At 3 months, 40 (35%) of 114 patients in the stereotactic body radiotherapy group, and 16 (14%) of 115 patients in the conventional external beam radiotherapy group had a complete response for pain (risk ratio 1·33, 95% CI 1·14–1·55; p=0·0002). This significant difference was maintained in multivariable-adjusted analyses (odds ratio 3·47, 95% CI 1·77–6·80; p=0·0003). The most common grade 3–4 adverse event was grade 3 pain (five 4% of 115 patients in the conventional external beam radiotherapy group vs five (5%) of 110 patients in the stereotactic body radiotherapy group). No treatment-related deaths were observed.
Stereotactic body radiotherapy at a dose of 24 Gy in two daily fractions was superior to conventional external beam radiotherapy at a dose of 20 Gy in five daily fractions in improving the complete response rate for pain. These results suggest that use of conformal, image-guided, stereotactically dose-escalated radiotherapy is appropriate in the palliative setting for symptom control for selected patients with painful spinal metastases, and an increased awareness of the need for specialised and multidisciplinary involvement in the delivery of end-of-life care is needed.
Canadian Cancer Society and the Australian National Health and Medical Research Council.
Radiotherapy toxicity De Ruysscher, Dirk; Niedermann, Gabriele; Burnet, Neil G ...
Nature reviews. Disease primers,
02/2019, Letnik:
5, Številka:
1
Journal Article
Recenzirano
Radiotherapy is used in >50% of patients with cancer, both for curative and palliative purposes. Radiotherapy uses ionizing radiation to target and kill tumour tissue, but normal tissue can also be ...damaged, leading to toxicity. Modern and precise radiotherapy techniques, such as intensity-modulated radiotherapy, may prevent toxicity, but some patients still experience adverse effects. The physiopathology of toxicity is dependent on many parameters, such as the location of irradiation or the functional status of organs at risk. Knowledge of the mechanisms leads to a more rational approach for controlling radiotherapy toxicity, which may result in improved symptom control and quality of life for patients. This improved quality of life is particularly important in paediatric patients, who may live for many years with the long-term effects of radiotherapy. Notably, signs and symptoms occurring after radiotherapy may not be due to the treatment but to an exacerbation of existing conditions or to the development of new diseases. Although differential diagnosis may be difficult, it has important consequences for patients.
Abstract An “abscopal” effect occurs when localized irradiation perturbs the organism as a whole, with consequences that can be either beneficial or detrimental. Mechanistic explanations of this ...effect are challenging. From the oncologist’s perspective, the term refers to distant tumor regression after localized irradiation. On the other hand, from a biologist’s point of view, abscopal effects include induction of genomic instability, cell death, and oncogenic transformation in normal tissues. This conceptual dichotomy is explored in this review, with a focus on clinically documented cases of anti-tumor abscopal effects and abscopal effects in normal tissues. This review also outlines several suggested mechanisms for abscopal effects.
Urinary toxicity is common following pelvic radiotherapy and can have a substantial negative effect on survivorship. Due to its prevalence and the increasing number of related clinical trials, ...localised prostate cancer radiotherapy is a useful illustrative tool to explore urinary toxicity. A good understanding of the interplay between anatomy, radiation-sensitive cell populations, and treatment sequencing is necessary for optimal outcomes. Emerging evidence suggests that the prostatic urethra is a radiation-sensitive structure, not only for stricture development, but also chronic irritative symptoms. Tools now exist not only to identify the urethra, but also to direct radiation dose away from the urethra, with early data suggesting that this reduces moderate-to-severe late urinary toxicity. Coupled with new evidence supporting dominant nodule microboosting and ultrahypofractionation as emerging standards of care, urethral sparing radiotherapy is a powerful tool against radiation induced urinary toxicity while also maximising disease control.
In this paper, we design a Spider Monkey-based Elman Spike Neural Network (SM-ESNN) to identify intrusion threats in Software Defined Networks (SDN). Utilizing analysis of multidimensional Internet ...Protocol (IP) flows to find intrusion and flooding assaults against central controllers. Moreover, information is first gathered from the ISCXIDS2012 dataset and updated to the SDN's secure defensive system. The developed software defense system has two sub-modules: a detection module and a mitigation module. The developed technique's key benefit is improving SDN security by quickly and accurately identifying and stopping assaults. First, the proposed SM-ESNN method is implemented in Python. The assessment measures in this scenario include accuracy, specificity, sensitivity, precision, and false alarm rate (FAR). Furthermore, the suggested SM-ESNN approach obtained improved average performances of 98.24% accuracy, 97.34% specificity, 98.68% sensitivity, and 98.33% precision, which highlights its efficiency in detecting the attacks.
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