The SRS/SBRT Scientific Meeting 2014, Minneapolis, MN, USA, 7-10 May 2014. The Radiosurgery Society(®), a professional medical society dedicated to advancing the field of stereotactic radiosurgery ...(SRS) and stereotactic body radiotherapy (SBRT), held the international Radiosurgery Society Scientific Meeting, from 7-10 May 2014 in Minneapolis (MN, USA). This year's conference attracted over 400 attendants from around the world and featured over 100 presentations (46 oral) describing the role of SRS/SBRT for the treatment of intracranial and extracranial malignant and nonmalignant lesions. This article summarizes the meeting highlights for SRS/SBRT treatments, both intracranial and extracranial, in a concise review.
Electromagnetic navigation bronchoscopy (ENB) is a minimally invasive technology that guides endoscopic tools to pulmonary lesions. ENB has been evaluated primarily in small, single-center studies; ...thus, the diagnostic yield in a generalizable setting is unknown.
NAVIGATE is a prospective, multicenter, cohort study that evaluated ENB using the superDimension navigation system (Medtronic, Minneapolis, Minnesota). In this United States cohort analysis, 1215 consecutive subjects were enrolled at 29 academic and community sites from April 2015 to August 2016.
The median lesion size was 20.0 mm. Fluoroscopy was used in 91% of cases (lesions visible in 60%) and radial endobronchial ultrasound in 57%. The median ENB planning time was 5 minutes; the ENB-specific procedure time was 25 minutes. Among 1157 subjects undergoing ENB-guided biopsy, 94% (1092 of 1157) had navigation completed and tissue obtained. Follow-up was completed in 99% of subjects at 1 month and 80% at 12 months. The 12-month diagnostic yield was 73%. Pathology results of the ENB-aided tissue samples showed malignancy in 44% (484 of 1092). Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy were 69%, 100%, 100%, and 56%, respectively. ENB-related Common Terminology Criteria for Adverse Events grade 2 or higher pneumothoraces (requiring admission or chest tube placement) occurred in 2.9%. The ENB-related Common Terminology Criteria for Adverse Events grade 2 or higher bronchopulmonary hemorrhage and grade 4 or higher respiratory failure rates were 1.5% and 0.7%, respectively.
NAVIGATE shows that an ENB-aided diagnosis can be obtained in approximately three-quarters of evaluable patients across a generalizable cohort based on prospective 12-month follow-up in a pragmatic setting with a low procedural complication rate.
Apoptosis induced by chemotherapeutic drugs is blocked by activation of nuclear factor-κB (NF-κB) in some cancer cell lines. Therefore, inhibition of NF-κB by adenoviral delivery of an IκBα ...super-repressor (Ad.IκBα-SR) should make esophageal cancer cells more sensitive to 5- fluorouracil (5-FU) and taxotere chemotherapy.
SEG1 and BIC1 human esophageal cancer cells were studied. Chemotherapy-induced NF-κB activation was assessed by luciferase reporter assay and by electrophoretic mobility shift assay (EMSA). Cell growth inhibition was assessed by cell proliferation assay. Apoptosis was determined by flow cytometry and caspase 3/7 assay.
5-FU and taxotere significantly induced NF-κB activation as measured by luciferase reporter assay (
P < 0.005) and EMSA. In both cell lines, Ad.IκBα-SR enhanced apoptosis by caspase 3/7 assay as compared to chemotherapy alone. In SEG1 cells, pre-treatment with Ad.IκBα-SR followed by 5-FU (0.25 m
m) or taxotere (0.01 ug/ml), led to an increased apoptosis of 183% and 55%, respectively (
P < 0.005). Similarly, apoptosis in BIC1 cells was significantly increased by pre-treatment with Ad.IκBα followed by 5-FU (0.1 m
m) or taxotere (0.01ug/ml) (
P < 0.005). Growth inhibition in both cell lines was also significantly increased by pre-treatment with Ad.IκBα followed by 5-FU (0.01 m
m) or taxotere (0.001 ug/ml) (
P < 0.0005).
Treatment with 5-FU or taxotere induced NF-κB activation in human esophageal cancer cells. Inhibition of NF-κB by Ad.IκBα-SR increased their sensitivity to 5-FU and taxotere chemotherapy. Therefore, these results may provide the basis for novel clinical approaches using cytoxic therapy with NF-κB inhibition to improve outcome in patients with esophageal cancer.
The molecular mechanisms of immune cell apoptosis during sepsis remain unclear. Two young adult baboons (Papio sp.) received a lethal dose of live Escherichia coli and were sacrificed at either 16 ...(for animal welfare concerns) or 24 h post-septic shock. An additional baboon, which received no bacteria, served as a control. Necropsy was performed immediately with subsequent immunohistochemical staining of lymphoid tissue. Immunohistologic analysis of tissues from the septic baboons revealed marked systemic lymphocyte apoptosis occurring in all lymphoid tissues examined. Focally, pyknotic and karyorrhectic lymphocytes demonstrated activation of a mitochondrial-dependent cell death pathway (active caspase 9 and apoptosis-inducing factor). Other regions demonstrated apoptotic lymphocytes with activation of a death receptor-dependent cell pathway (Fas ligand). Thus, we have demonstrated for the first time in primates that overwhelming gram-negative bacteremia produces an early and profound lymphocyte death that occurs through multiple cell death pathways. Bacteremic shock in the baboon may be an appropriate model for studying experimental therapies aimed at blocking lymphocyte apoptosis because their response appears comparable to humans dying from sepsis.
Introduction: The aim of this study was to determine whether late patterns of pulmonary fibrosis are related to specific radiation doses administered during thoracic stereotactic body radiation ...therapy (SBRT).
Methods: The records of all patients treated with SBRT for either pulmonary metastases or inoperable primary lung tumours at the University of Alabama at Birmingham from November 2005 to July 2008 were reviewed. Patients selected for analysis had diagnostic chest computed tomography (CT) scans acquired at least 180 days after completion of therapy. CT scans acquired at follow‐up were co‐registered with the original treatment planning CT scans for 12 eligible patients (17 lesions), and late‐occurring pulmonary imaging abnormalities (IAs) were contoured. Dosimetric parameters analysed include D80, D90, V18 and Vprescription dose of the IA and V14 and V18 of the lung.
Results: Late pulmonary IAs were identified in 11 treated areas from nine patients. Late IAs could not be identified in six treated areas from three patients secondary to emphysema, tumour progression and severe atelectasis, respectively. The mean doses to 80% (D80) and 90% (D90) of the IAs were 18.4 and 14.5 Gy, respectively (ranges: 5.6–27.8 and 3.3–22.4 Gy). On average, 79.4% (range: 45.6–97.5%) of the IA received at least 18 Gy, while an average of 19.3% (range: 0.2–42.2%) received the prescription dose. On average, only 4.2% (range: 1.1–7.8%) of the lungs received 18 Gy.
Conclusion: Imaging abnormalities consistent with pulmonary fibrosis are common after SBRT and are well approximated by the 18 Gy isodose distribution. The clinical ramification of these findings should be evaluated in future studies.
Improved digital video cameras and high-resolution video displays have greatly enhanced laparoscopic surgery. However, the size and distance of the video display and the location of the monitor ...continue to be impediments in laparoscopy, providing unsatisfactory operative visualization and causing the development of neck and back strain in surgeons performing long procedures. The purpose of this study was to evaluate the use of a face-mounted binocular high-resolution video display by means of standardized measurements of laparoscopic skill, and to compare procedure speed and surgeon satisfaction with the binocular display, open operative visualization, and standard laparoscopic monitor views.
The surgical faculty and resident trainees (n = 22) underwent two standardized laparoscopic psychometric skills tests of fine motor control and bimanual operative facility. Testing was performed first with the use of laparoscopic instruments in direct view of the participants; sufficient repetitions were allowed so that plateau levels were obtained in task speed. Video camera-based imaging displayed on the face-mounted binocular video display and a standard video monitor were then used to repeat identical tests. Test times were compared between the open view, face-mounted display (FMD) view, and standard laparoscopic monitor view groups. A Likert-scale based assessment was conducted to examine operator impressions of neck and back strain, visual acuity, and overall satisfaction.
Performance with the standard laparoscopic monitor was significantly slower than with the direct view on both fine motor (mean, 85.0 +/- 7.1 s vs. 56.4 +/- 5.7 s; P <.0001) and bimanual (mean, 80.8 +/- 7.0 s vs. 40.2 +/- 2.6 s; P =.009) psychometric skills tests. The FMD view performance was significantly faster than the standard laparoscopic monitor performance for both the bimanual (mean, 72.2 +/- 7.6 s vs. 85.0 +/- 7.2 s; P =.001) and fine motor (mean, 59.3 +/- 4.7 s vs. 80.8 +/- 7.0 s; P =.004) tests. The scores on a Likert Scale satisfaction survey of the use of the FMD unit for neck and back strain (mean, 4.27 +/- 0.20), visual acuity (mean, 3.93 +/- 0.10), and overall satisfaction (mean, 4.16 +/- 0.20) were high (scale: 1, worst; 5, ideal).
A face-mounted high-resolution video display unit reduces neck and back strain and improves both visualization and overall satisfaction in comparison with standard laparoscopic display monitors; surgical performance is better than with standard laparoscopic imaging as assessed by standardized psychometric skills testing.
Purpose
To assess the long‐term stability of the anchored radiofrequency transponders and compare displacement rates with other commercially available lung fiducial markers. We also sought to ...describe late toxicity attributable to fiducial implantation or migration.
Materials and methods
The transponder cohort was comprised of 17 patients at our institution who enrolled in a multisite prospective clinical trial and underwent bronchoscopic implantation of three anchored transponders into small (2–2.5 mm) airways. We generated a comparison cohort of 34 patients by selecting patients from our institutional lung SBRT database and matching 2:1 based on the lobe containing tumor and proximity to the bronchial tree. Assessment of migration was performed by rigidly registering the most recent follow‐up CT scan to the simulation scan, and assessing whether the relative geometry of the fiducial markers had changed by more than 5 mm. Toxicity outcomes of interest were hemoptysis and pneumothorax.
Results
The median follow‐up of patients in the transponder cohort was 25.3 months and the median follow‐up in the comparison cohort was 21.7 months. When assessing the most recent CT, all fiducial markers were within 5 mm of their position at CT simulation in 11 (65%) patients in the transponder group as compared to 23 (68%) in the comparison group (P = 0.28). One case of hemoptysis was identified in the transponder cohort, and bronchoscopy confirmed bleeding from recurrent tumor; no cases of hemoptysis were noted in the comparison cohort. No case of pneumothorax was noted in either group.
Conclusion
No significant difference in the rates of fiducial marker retention and migration were noted when comparing patients who had anchored transponders placed into small airways and a 2:1 matched cohort of patients who had other commercially available lung fiducial markers placed. In both groups, no late or chronic toxicity appeared to be related to the implanted fiducial markers.
Each year, AORN strives to provide the very best in perioperative nursing education at its annual meeting. At the AORN Surgical Conference & Expo 2016, attendees will receive continuing education ...that focuses on current issues and trends, evidence-based practice and research, and health care initiatives relative to the advancement of perioperative practice. Several of the distinguished speakers from the 2016 schedule have graciously agreed to participate in interviews about their upcoming sessions to provide a sample of the extensive educational offerings from which attendees will be able to choose.
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