Inflammatory bowel disease (IBD) is a relative contraindication to external beam radiation therapy (EBRT) for prostate cancer patients due to fear of increased risk of gastrointestinal (GI) toxicity. ...High-dose-rate (HDR) brachytherapy, capable of minimizing radiation dose to surrounding tissues, is a feasible alternative. Given limited data, this study examined the safety profile of HDR brachytherapy in this setting.
We conducted a retrospective review of patients with localized prostate cancer and IBD treated with HDR brachytherapy at the University of California San Francisco (UCSF), between 2010 and 2022. Eligibility criteria included biopsy-proven prostate cancer, no distant metastases, absence of prior pelvic radiotherapy, IBD diagnosis, and at least one follow-up visit post-treatment.
Eleven patients were included, with a median follow-up of 28.7 months. The median dose administered was 2700 cGy (range, 1500-3150 cGy) over 2 fractions (range, 1-3 fractions). Two patients also received EBRT. Rectal spacers (SpaceOAR) were applied in seven patients. All patients experienced acute genitourinary (GU) toxicity, ten of which were grade 1 and one was grade 2. Eight patients experienced late grade 1 GU toxicity, and three patients had late grade 2 GU toxicity. GI toxicities were similarly low-grade, with six grade 1 acute toxicity, no grade 2 or higher acute toxicity, six grade 1 late toxicity, and one late grade 2 GI toxicity. No grade 3 or higher acute or late GI or GU toxicities were reported.
HDR brachytherapy appears to be a safe and tolerable treatment modality for patients with prostate cancer and IBD, with minimal acute and late GI and GU toxicity. These findings warrant multi-institutional validation due to small sample size.
Pulmonary rehabilitation (PR) is an evidence-based measure to benefit chronic obstructive pulmonary disease (COPD) patients. Many patients have benefitted from our robust university hospital-based PR ...program. We have objectively assessed the benefit of our PR program for COPD patients in Eastern North Carolina.
We used retrospective chart review to collect data from all the patients who completed PR from January 1, 2012 through December 31, 2013. Data collection included quality-of-life scores using short-form 36 (SF-36) and 6-minute walk distance (6MWD) to measure exercise capacity before and after PR. We also collected data on COPD exacerbation frequency 1 year before and 1 year after PR. The data were analyzed using the statistical software Statistical Package for the Social Sciences version 22.0.
We analyzed data from 51 patients with 4 categories of COPD: mild (n = 2), moderate (n = 12), severe (n = 23), and very severe (n = 14). The PR program resulted in improvement in 6MWD of an average of 263.8 feet (P < .01) and a decrease in COPD exacerbation frequency by 0.3 events per year (P < .05). There were mixed results for quality-of-life scores.
Our study was conducted at 1 center and thus involved a single COPD patient population with limited sample size. We did not follow patients long term to see whether the benefits were sustained.
Our PR program resulted in a positive impact on exercise capacity, COPD exacerbation rate, and some aspects of quality of life.
A secondary analysis of 2 randomized Radiation Therapy Oncology Group trials demonstrated that age ≥70 years was a favorable prognostic factor among men treated with external beam radiation therapy ...(EBRT). In contrast, several series based on men undergoing radical prostatectomy (RP) suggested that older age was an unfavorable prognostic factor. Our study was initiated to determine whether these observations reflect a true but paradoxical underlying age-related treatment-dependent biological phenomenon. We conducted a systematic review (PubMed, January 1, 1999-January 30, 2023) evaluating the effect of age on cancer-specific outcomes after definitive local treatment with either RP or EBRT. Our main objective was to assess possible interactions between age (using a cutoff of 70 +/- 5 years) and treatment type, with regard to adverse cancer-specific outcomes (eg, pathology, biochemical failure, distant metastasis, or prostate cancer-specific survival). Forty-five studies were selected for inclusion in this systematic review, including 30 and 15 studies with patients treated with RP and EBRT, respectively. Among patients treated with RP, 10 (50%) of these studies suggested that older age was associated with worse outcome(s) after RP. None suggested that age was a favorable prognostic factor after RP. Among the EBRT-based studies, 8 (53%) suggested that older age was associated with better outcomes, with an additional 3 studies (21%) trending to support a better outcome. None of these studies involving EBRT suggested that older age was an adverse prognostic factor. This systematic review suggests that age using a categorical cutoff of 70 +/- 5 years may be an adverse prognostic factor for men undergoing RP but a favorable prognostic factor for men treated with EBRT. Further research is needed to validate these findings.
Deep inspiration breath-hold (DIBH) has been established to decrease normal tissue radiation dose in breast cancer.
Forty-nine patients had two CT scans during DIBH or free breathing. Chest-wall ...position, setup verification and breath-hold monitoring were performed. Cone-beam CT and a surface image system were used for verification.
A total of 1617 breath-holds were analyzed in 401 fractions. The mean time bit was 6.01 min. The mean breaths-holds per fraction was 4.96. The median for intra-breath hold variability was 3 mm. No patient stopped treatment for intolerance. Clinical target volume margins were calculated as 0.36, 0.36 and 0.32 for the three translational positions. The mean saved volume was 26.3%.
Voluntary DIBH is feasible, tolerable and easy to apply for children with Hodgkin lymphoma involving the mediastinum.
A history of prior pelvic radiation therapy (RT) for rectal cancer is a relative contraindication for definitive RT for prostate cancer. High-dose-rate (HDR) brachytherapy can significantly limit the ...dose to surrounding tissues compared to external beam RT. However, there is limited data surrounding its safety in patients with prior pelvic RT.
A retrospective chart review was performed at the University of California, San Francisco to identify patients diagnosed with prostate cancer with a history of pelvic RT for rectal cancer who were treated with high-dose-rate brachytherapy (HDR-BT) between 2006 and 2022. Inclusion criteria were biopsy-confirmed prostate cancer with no evidence of distant disease on clinical examination or imaging, and at least one post-treatment clinic appointment.
Seven patients were treated with salvage HDR-BT at a median interval of 17.7 years after RT for rectal cancer. HDR-BT doses included 3600 cGy in six fractions (n = 5), 2700 cGy in 2 fractions (n=1), or 2800 cGy in four fractions (n = 1). There was no acute grade ≥2 gastrointestinal toxicity, and 1 patient developed late grade 2 rectal bleeding. Two patients developed acute grade 2 genitourinary toxicity consisting of urinary frequency and urgency, which persisted through long-term follow up. At a median follow up of 29.5 months after HDR brachytherapy, one patient developed regional and distant failure, and another had seminal vesicle recurrence.
HDR-BT is a safe treatment for patients with prostate cancer who previously received RT for rectal cancer. Further studies are needed to better characterize the long-term toxicity of HDR-RT in this population.
•One-third of pediatric tumor patients require radiotherapy.•High pediatric radiotherapy utilization rate in a middle-income country.•Pediatric soft tissue sarcoma requires the highest radiotherapy ...utilization rate.•Palliative radiotherapy is frequently used for brainstem glioma patients.•Palliative radiotherapy is underutilized in childhood cancers.
Although the radiotherapy utilization rate (RUR) is determined for most adult cancers, it is seldom reported in childhood tumors, particularly in low- and middle-income countries (LMIC) where the majority of pediatric cancer patients reside. This study aims to investigate the real-life RUR for pediatric tumors in a large LMIC center.
The electronic files of patients treated at a single institution during 2010–2017 were reviewed and the RUR was defined as the percentage of patients who received at least one radiotherapy (RT) course from the total number of patients.
A total of 4390 out of 13,305 pediatric cancer patients received at least one RT course with a RUR of 33%. The curative, salvage, and palliative RURs were 27.8%, 2%, and 5.7%, respectively. There was a considerable variation in the RUR between various tumors, ranging from 0% in choroid plexus papilloma and other rare tumors to 100% in intracranial germinoma. Moreover, the RUR varied among different stages within each tumor type. Overall, 753 patients received 920 palliative RT courses (range 1–9) at a median dose of 30 Gy. The most commonly irradiated metastatic sites were the bone (34%) and the brain (9.8%).
This is the first analysis to provide valuable insights into the RUR for childhood tumors. Together with population-based pediatric cancer registries, this will help decipher pediatric RT needs and deficits. Additionally, the underutilization of palliative RT calls for multidisciplinary palliative care provision for pediatric cancer patients.
Abstract 5085
Anemia is the most common hematological abnormality in cancer patients. Unfortunately, it is often under-recognized and under-treated. The pathogenesis of cancer anemia is complex and ...most of the time multifactorial; involving factors related to the tumor itself or its therapy. Recombinant human erythropoietin stimulating agents (ESA) was widely used to prevent and treat cancer and chemotherapy-related anemia. However, many recent studies involving patients with different kind of cancers at different stages of their disease suggested a negative impact on disease progression and survival when such ESA were used to keep Hemoglobin (Hb) at a higher level. The US Food and Drug Administration (FDA) announced revisions and warning to restrict ESA indications. This report describes the prevalence of anemia in cancer patients and its management given the recent confusion and uncertainties.
We retrospectively reviewed all consecutive adult cancer patients admitted to regular medical units between Jan and Dec, 2008. Patients admitted to Leukemia, Bone Marrow Transplantation and Intensive Care Units were excluded. Demographic features, reasons for admission, primary cancer diagnosis and disease stage were determined. All patients with Hb value < 12 g/dL at any time during admission were considered anemic. Treatment offered for anemia was also reviewed. Subsequent admissions for the same patients during the study period were also followed up.
959 patients (51% males, median age 55 years, range 18- 91) admitted 1862 times were included. Reasons for admission at time of enrollment included chemotherapy (23%), infections including neutropenic fever (20%), palliative and supportive care (15%). Other reasons included pulmonary, neurological, renal and electrolyte imbalances. Primary cancer diagnosis included: Gastrointestinal (21%), Breast (16%), Lymphoma and Multiple Myeloma (16%), and Lung (11%). At time of enrollment, 55% of patients had advanced stage disease. Anemia at any time during admission was detected in 755 (78.7%) patients. Mean Hb value for anemic patients was 9.51 g/dL (range 3.5-11.9, median 9.6). Severe anemia (Hb < 8) was documented in 16.7%, moderate anemia (Hb 8-10) in 41.9% and mild anemia (Hb > 10) in 41.5% of the patients. Majority (69%) of the patients were not offered any treatment for their anemia. Among the total group, blood transfusion was offered for 25%, supplements (including iron, folate and or vitamin B12) for 3.3%. ESA were offered for only 1.1%. Few patients (2.1%) had combined treatment. Mean Hb value at which treatment was started was 8 g/dL, while mean Hb for the patients who were not treated was 10.2 g/dL. Most of the patients (94%) with severe anemia, 32% with the moderate, and 5% of the patients with mild anemia were treated as shown in the table.
Severity of anemiaMildModerateSevereTotalTotal313(41.5%)316(41.9%)126(16.7%)755Treated16(5.1%)102(32.3%)119(94.4%)237(31.4%)Blood Transfusion5(1.6%)73(23.1%)110(87.3%)188(24.9%)Supplements8(2.6%)16(5.1%)1(0.8%)25(3.3%)Erythropoietin3(1.0%)5(1.6%)08(1.1%)Combination08(2.5%)8(6.3%)16(2.1%)
Anemia among adult cancer patients admitted to regular medical units is quiet common. Given the recent FDA warning and the many confusing studies, the prevalence of anemia in cancer patients was found to be high; many of such patients were not offered any treatment. The threshold to start treatment was highly dependent on its severity. Blood transfusion was the most common treatment method. Quality improvement projects should be implemented to better recognize and treat anemia in cancer patients.
No relevant conflicts of interest to declare.
In this research electrochemical treatment was used to treat Al-Sin water that feed Banias thermal station boilers for generate electricity. The effect of the operating parameters such as type of ...electrodes, initial pH,inter electrode distance, electrolysis time and current density on the effectiveness of electrochemical processing were studied in reducing the concentration of total dissolved solids (TDS), NaCl concentration, and electrical conductivity. The experiments were carried out in a batch mode. Results revealed that in the optimum conditions (current density=500A/m2, distance between electrodes =10mm) the total dissolved solids, conductivity, and NaCl concentration were reduced by (97%), (94%) and (92%) respectively after one hour of treatment process by using aluminum electrodes.
BACKGROUND AND OBJECTIVES Anemia in cancer patients is common, but often under-recognized and under-treated. Erythropoiesis stimulating agents (ESAs) are widely used to prevent and treat cancer and ...chemotherapy-related anemia, but recent studies suggest a negative impact on disease progression and survival associated with their use. this retrospective study describes the prevalence of anemia in cancer patients and recent trends in its management given the negative studies. PATIENTS AND METHODS All consecutive adult cancer patients (n = 959) admitted to regular medical units over one year were reviewed. Patients with a hemoglobin (Hb) value < 12 g/dL on admission were considered anemic. Information on the primary tumor, main reasons for admission and treatment given were collected. RESULTS At the time of enrollment, anemia was detected in 755 (78.7%) patients. The mean hb value for anemic patients was 9.5 g/dL prevalence and severity of anemia varied according to tumor type and reason for admission. the majority (68.6%) of the anemic patients were not offered treatment. The mean Hb value at which treatment was started was 8.0 g/dL Anemia treatment was related to its severity; treatment rates were 94.4%, 32.9%, and 5.0% in patients with severe, moderate and mild anemia, respectively ( P < .0001). blood transfusion was used the most while ESAS were rarely used. length of hospital stay was affected by the presence of anemia (7.2 days in anemic patients vs. 4.85 days in nonanemic patients) ( P < .001). CONCLUSIONS Blood transfusion was used the most for cancer-related anemia, while ESAs were rarely used. The majority of patients with moderate anemia were not treated, including patients on active chemotherapy. better guidelines addressing anemia management in this subgroup of patients are highly needed.
The current study examined the effect of the linguistic status of the verbal previewing strategy on the outcomes of reading comprehension tasks among second (
N
= 25, age 7.08 ± .3), and sixth-grade ...students (
N
= 25, age 11.75 ± .25), with typical reading development. The texts for each group were carefully matched and were divided into three conditions of verbal previewing: (a) Standard Arabic previewing (hereafter: StA previewing); (b) spoken Arabic previewing (hereafter: SpA previewing); (c) without previewing. The results showed that for the second-grade readers, SpA previewing had a significant contribution to the reading comprehension outcomes compared to the other conditions of previewing while for the sixth-grade readers; StA previewing had a significant contribution to the outcomes of reading comprehension. The findings were explained according to the assumption that relatively native Arab speaking students develop a progressive change toward activation of StA representations for verbal learning. Such representations become more efficient as a result of the dominant exposure to StA during performing reading and writing tasks.
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