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Tuan J.,National Cancer Center Singapore | Vischioni B.,Fondazione CNAO | Fossati P.,Fondazione CNAO | Fossati P.,University of Milan | And 10 more authors.
Journal of Radiation Research | Year: 2013

We report the initial toxicity data with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). In September 2011, CNAO commenced patient treatment with scanned proton beams within two prospective Phase II protocols approved by the Italian Health Ministry. Patients with chondrosarcoma or chordoma of the skull base or spine were eligible. By October 2012, 21 patients had completed treatment. Immobilization was performed using rigid non-perforated thermoplastic-masks and customized headrests or body-pillows as indicated. Non-contrast CT scans with immobilization devices in place and MRI scans in supine position were performed for treatment-planning. For chordoma, the prescribed doses were 74 cobalt grey equivalent (CGE) and 54 CGE to planning target volume 1 (PTV1) and PTV2, respectively. For chondrosarcoma, the prescribed doses were 70 CGE and 54 CGE to PTV1 and PTV2, respectively. Treatment was delivered five days a week in 35-37 fractions. Prior to treatment, the patients' positions were verified using an optical tracking system and orthogonal X-ray images. Proton beams were delivered using fixed-horizontal portals on a robotic couch. Weekly MRI incorporating diffusion-weighted-imaging was performed during the course of proton therapy. Patients were reviewed once weekly and acute toxicities were graded with the Common Terminology Criteria for Adverse Events (CTCAE). Median age of patients = 50 years (range, 21-74). All 21 patients completed the proton therapy without major toxicities and without treatment interruption. Median dose delivered was 74 CGE (range, 70-74). The maximum toxicity recorded was CTCAE Grade 2 in four patients. Our preliminary data demonstrates the clinical feasibility of scanned proton beams in Italy. © 2013 The Author 2013. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Therapeutic Radiology and Oncology. Source


Radolovich D.K.,University of Cambridge | Aries M.J.H.,University of Cambridge | Aries M.J.H.,University of Groningen | Castellani G.,University of Cambridge | And 7 more authors.
Neurocritical Care | Year: 2011

Background Strong correlation between mean intracranial pressure (ICP) and its pulse wave amplitude (AMP) has been demonstrated in different clinical scenarios. We investigated the relationship between invasive mean arterial blood pressure (ABP) and AMP to explore its potential role as a descriptor of cerebrovascular pressure reactivity after traumatic brain injury (TBI). Methods We retrospectively analyzed data of patients suffering from TBI with brain monitoring. Transcranial Doppler blood flow velocity, ABP, ICP were recorded digitally. Cerebral perfusion pressure (CPP) and AMP were derived. A new index - pressure-amplitude index (PAx) - was calculated as the Pearson correlation between (averaged over 10 s intervals) ABP and AMP with a 5 min long moving average window. The previously introduced transcranial Doppler-based autoregulation index Mx was evaluated in a similar way, as the moving correlation between blood flow velocity and CPP. The clinical outcome was assessed after 6 months using the Glasgow outcome score. Results 293 patients were studied. The mean PAx was -0.09 (standard deviation 0.21). This negative value indicates that, on average, an increase in ABP causes a decrease in AMP and vice versa. PAx correlated strong with Mx (R 2 = 0.46, P < 0.0002). PAx also correlated with age (R 2 = 0.18, P < 0.05). PAx was found to have as good predictive outcome value (area under curve 0.71, P < 0.001) as Mx (area under curve 0.69, P < 0.001). Conclusions We demonstrated significant correlation between the known cerebral autoregulation index Mx and PAx. This new index of cerebrovascular pressure reactivity using ICP pulse wave information showed to have a strong association with outcome in TBI patients. © Springer Science+Business Media, LLC 2011. Source


Raza S.A.,Royal Marsden Hospital | Funicelli L.,Instituto Europeo Of Oncologia | Sohaib S.A.,Royal Marsden Hospital | Collins D.J.,Cancer Research UK Research Institute | And 4 more authors.
European Journal of Radiology | Year: 2012

Aim: To determine the T 2 relaxation time of colorectal hepatic metastases and changes in T 2 relaxation times following chemotherapy. Materials and methods: 42 patients with 96 hepatic colorectal metastases underwent baseline MRI. Axial T 1, T 2 and multi-echo GRASE sequences were acquired. ROIs were drawn on T 2 relaxation maps, obtained from GRASE images, encompassing metastasis and normal liver to record T 2 relaxation time values. In 11 patients with 28 metastases, MRI was repeated using same protocol at 6 weeks following chemotherapy. The median pre-treatment T 2 values of metastases and normal liver were compared using the Mann-Whitney test. The pre- and post-treatment median T 2 values of metastases were compared using the Wilcoxon-Rank test for responding (n = 16) and non-responding (n = 12) lesions defined by RECIST criteria. The change in T 2 values (ΔT 2) were compared and correlated with percentage change in lesion size. Results: There was no difference in the pre-treatment median T 2 of metastases between responding (67.3 ± 8.6) and non-responding metastases (71.4 ± 16.5). At the end of chemotherapy, there was a decrease in the median T 2 of responding lesions (61.6 ± 12.6) p = 0.83, and increase in non-responding lesions (76.2 ± 18.4) p = 0.03, but these were not significantly different from the pre-treatment values. There was no significant difference in ΔT 2 of responding and non-responding lesions (p = 0.18) and no correlation was seen between size change and ΔT 2 (coefficient = 0.3). Conclusion: T 2 relaxation time does not appear to predict response of colorectal liver metastasis to chemotherapy. © 2011 Elsevier Ireland Ltd. All rights reserved. Source


Geller A.C.,Boston University | Greinert R.,EUROSKIN E.V. | Greinert R.,ADP | Sinclair C.,Cancer Prevention Center | And 23 more authors.
Cancer Epidemiology | Year: 2010

Skin cancer incidence is increasing worldwide in white populations and mortality rates have not declined throughout most of the world. An extraordinarily high proportion of at-risk individuals have yet to be screened for melanoma but guidelines from esteemed bodies do not currently endorse population-based screening. Evidence for the effectiveness of skin cancer screening is imperative. To this end, scientists in Germany have launched a nationwide skin cancer screening campaign. Herein, we review pilot screening data from Schleswig-Holstein, discuss the launch of the major new national initiative, review issues related to evaluation of that program, and propose seven recommendations from the International Task Force on Skin Cancer Screening and Prevention that was held in Hamburg, Germany, on September 24 and 25, 2009. Source


Coelho R.F.,Global Robotics Institute | Coelho R.F.,University of Central Florida | Coelho R.F.,University of Sao Paulo | Chauhan S.,Global Robotics Institute | And 5 more authors.
European Urology | Year: 2010

Background: Positive surgical margin (PSM) after radical prostatectomy (RP) has been shown to be an independent predictive factor for cancer recurrence. Several investigations have correlated clinical and histopathologic findings with surgical margin status after open RP. However, few studies have addressed the predictive factors for PSM after robot-assisted laparoscopic RP (RARP). Objective: We sought to identify predictive factors for PSMs and their locations after RARP. Design, setting, and participants: We prospectively analyzed 876 consecutive patients who underwent RARP from January 2008 to May 2009. Intervention: All patients underwent RARP performed by a single surgeon with previous experience of >1500 cases. Measurements: Stepwise logistic regression was used to identify potential predictive factors for PSM. Three logistic regression models were built: (1) one using preoperative variables only, (2) another using all variables (preoperative, intraoperative, and postoperative) combined, and (3) one created to identify potential predictive factors for PSM location. Preoperative variables entered into the models included age, body mass index (BMI), prostate-specific antigen, clinical stage, number of positive cores, percentage of positive cores, and American Urological Association symptom score. Intra- and postoperative variables analyzed were type of nerve sparing, presence of median lobe, percentage of tumor in the surgical specimen, gland size, histopathologic findings, pathologic stage, and pathologic Gleason grade. Results and limitations: In the multivariable analysis including preoperative variables, clinical stage was the only independent predictive factor for PSM, with a higher PSM rate for T3 versus T1c (odds ratio [OR]: 10.7; 95% confidence interval [CI], 2.6-43.8) and for T2 versus T1c (OR: 2.9; 95% CI, 1.9-4.6). Considering pre-, intra-, and postoperative variables combined, percentage of tumor, pathologic stage, and pathologic Gleason score were associated with increased risk of PSM in the univariable analysis (p < 0.001 for all variables). However, in the multivariable analysis, pathologic stage (pT2 vs pT1; OR: 2.9; 95% CI, 1.9-4.6) and percentage of tumor in the surgical specimen (OR: 8.7; 95% CI, 2.2-34.5; p = 0.0022) were the only independent predictive factors for PSM. Finally, BMI was shown to be an independent predictive factor (OR: 1.1; 95% CI, 1.0-1.3; p = 0.0119) for apical PSMs, with increasing BMI predicting higher incidence of apex location. Because most of our patients were referred from other centers, the biopsy technique and the number of cores were not standardized in our series. Conclusions: Clinical stage was the only preoperative variable independently associated with PSM after RARP. Pathologic stage and percentage of tumor in the surgical specimen were identified as independent predictive factors for PSMs when analyzing pre-, intra-, and postoperative variables combined. BMI was shown to be an independent predictive factor for apical PSMs. © 2010 European Association of Urology. Source

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