Brain and Neck Tumors Among Physicians Performing Interventional Procedures

Brain cancer patients with the poorest prognosis -- those with a type of deadly tumor known as glioblastoma multiforme (GBM) -- may survive longer with a drug that chokes off a tumor's blood supply.According to a new study by researchers at Duke's Preston Robert Tisch Brain Tumor Center, a combination of bevacizumab -- commonly known as Avastin -- and a standard chemotherapy agent, may increase the amount of time GBM patients can survive without tumor growth, and may significantly increase their overall survival."For this study, we looked at patients whose tumors had returned after initial treatment, and we found that this drug combination could significantly improve outcomes for these people, who are typically given about three to six months to live," said James J. Vredenburgh, M.D., a neuro-oncologist at Duke and lead investigator on the study. "These results represent tremendous hope for these patients and their families."The researchers published their findings in the October 20, 2007 issue of the Journal of Clinical Oncology and an editorial accompanied the publication. The study was funded by the National Institutes of Health, the Preston Robert Tisch Brain Tumor Research Fund and the Bryan Cless Research Fund.In this pilot study, researchers administered a combination of bevacizumab and irinotecan, a standard chemotherapeutic agent, to 35 patients whose GBMs had returned. Each patient had already been treated with a standard therapy regimen, possibly including surgery, radiation and chemotherapy.Almost half saw no tumor progression after six months, and almost 80 percent were still alive six months after diagnosis.Patients with recurrent GBM who are treated with standard therapies, such as chemotherapy alone, have tumor progression at six months in about 75 percent of cases and fewer than 50 percent are alive after six months."Historically, when GBM recurred, there had typically been very little else we could do," said Vredenburgh. "We had one patient on this trial who had been already been told to get his affairs in order; he started the trial and over a year later he's still here, so this is very promising."Bevacizumab has been heralded as a success in treating several types of cancer, including colorectal and lung cancers. It is one member of a class of drugs called anti-angiogenics, which work by stunting the otherwise rapid growth of blood vessels that feed a tumor's growth and spread."We speculate that bevacizumab and irinotecan each attack a particular characteristic of the tumor independently or they work together, with the bevacizumab suppressing the growth of blood vessels which makes the tumor more susceptible to the chemotherapy," Vredenburgh said. "Further studies will tease out the exact mechanism of the therapy's success and we also hope to study the effectiveness of this treatment in patients with newly diagnosed GBM."About 8,000 to 10,000 new cases of GBM are diagnosed each year in the United States, and GBMs account for about half of all primary brain tumors, according to Accelerate Brain Cancer Cure, a not-for-profit organization dedicated to hastening the discovery of effective treatments for brain cancer. Less than 30 percent of patients diagnosed with primary GBMs are alive one year after diagnosis, and after 10 years, only 2.3 percent are still alive.Even when GBMs are effectively treated with surgery or medicines, they return in more than 90 percent of all cases.Other study authors include Annick Desjardins, James Herndon II, Jennifer Marcello, David Reardon, Jennifer Quinn, Jeremy Rich, Sith Sathornsumetee, Sridharan Gururangan, John Sampson, Melissa Wagner, Leighann Bailey, Darell Bigner, Allan Friedman and Henry Friedman.CONTACT: Lauren Shaftel, (919) 684-4966, shaft001@mc.duke.edu

As I have done several times in the past, this month I invited a member of the Society, Dr. James Goldstein, to participate in the development of this President's Page. For the past several years, Jim has been one of the key individuals involved in an effort to define better the occupational risks associated with working in a cardiac catheterization laboratory. This effort has steadily gained momentum, now involves several other professional societies, and has led to the formation of the Joint Inter-Society Task Force on Occupational Hazards in the Catheterization Laboratory. If you work in a cardiac catheterization laboratory, and would like to continue for your entire career, the efforts of this task force are of considerable importance to you. For this reason, I am highlighting their activity in this President's Page. The intense and demanding work environment of an interventional cardiologist imposes several potential risks to our health. The hazards of accumulated radiation exposure have been known for years, but the other potential risks have been ill-defined and under-appreciated [1-3]. The physical stresses inherent in this career choice also appear to be associated with a predilection to orthopedic injuries, attributable in great part to the cumulative adverse effects of bearing the weight of leaded apparel [4]. All of us likely know of a colleague with chronic back or neck problems who had to "retire" from wearing lead, but the prevalence of such health problems was never clearly defined. In 2004, Goldstein et al. published the results of a survey conducted by the Interventional Committee of the Society [5]. The results should be disturbing, especially for those young in the field. Although one often walks out of the catheterization laboratory after a busy day feeling internal satisfaction over a job well done, standing for long hours bearing the weight of a heavy lead apron is a strain, especially on the spine, back, and neck. Not uncommonly such injuries cause considerable pain, missed days of work, surgery, or in some cases, curtailed careers. Observational studies indicate the occupational risk involved in the practice of interventional medicine, particularly with regard to orthopedic problems [6, 7]. Prior authors have called attention to a distinct occupational hazard labeled "interventionalists disc disease" [4], attributing these spinal orthopedic injuries to the cumulative effects of wearing leaded aprons and poorly designed catheterization laboratory environments that promote awkward ergonomic postures (e.g., monitors placed in awkward viewing positions and not in the natural line of sight). In the 2004 SCAI survey, nearly half of the 424 respondents reported spine problems [5], an incidence dramatically higher than the 2.3% incidence of chronic back conditions in standard populations [8]. Of those reporting spine problems, 70% were in the lumbosacral and 30% in the cervical area. Over one third indicated their spine problems had caused them to miss work. One fourth of the respondents reported problems related to their hips, knees, or ankles. The survey also found a significant relationship between the number of years worked in the cardiac catheterization laboratory and the incidence of spine problems. Physicians who had logged ≥ 21 years in the lab after fellowship reported an alarming 60% incidence of spine problems compared with 26% who were working <5 years after completing fellowship. Although these data could be subject to reporting bias in that those affected by orthopedic problems are more likely to respond to such a survey, other survey data collected from radiologists suggest we are not alone [6, 7]. Furthermore, compared with orthopedic surgeons who occasionally wear a leaded apron and rheumatologists who do not wear lead, invasive cardiologists have a greater incidence of spine problems [4]. Also of great concern to physicians performing invasive procedures requiring X-ray exposure are the potential adverse effects of occupational radiation exposure, which may over time be associated with an increased incidence of cataracts and cancers [1, 2, 9]. Extrapolating from basic principles of radiation safety that link the likelihood of disease to the extent of cumulative radiation exposure, it might be expected that physicians exposed to radiation in their work environment in the present era would be at substantially higher risk of such illnesses. Compared with diagnostic catheterization alone, coronary interventions last longer, frequently require the use of imaging views that are unfavorable for operator exposure, and thus require the use of more radiation. Concerns over radiation exposure to the modern interventional cardiologist were elegantly articulated by Dr. David Clark [10], who wrote: "There is ongoing concern about how experienced interventionalists and younger ones with long careers ahead of them can avoid the potential ravages of X-ray exposure. On a monthly, yearly, and lifetime basis, how much radiation exposure is acceptable, and how much radiation exposure puts an individual at increased risk of which complications?" Most important, he asked the following question: "At what lifetime level of exposure should one consider retiring from laboratory practice in order to diminish the chance of radiation illness?" Unfortunately, data on radiation health hazards and present policies regarding acceptable exposure levels are based on limited data predominantly accrued during the "low-volume, lesser-radiation exposure" era when only diagnostic catheterization was performed. At present, there are no data on the long-term health effects of cumulative radiation exposure in the higher-volume, increased-radiation exposure interventional era. SCAI's survey of members was inconclusive on the risks related to radiation-associated problems [5]. Potential radiation-related illnesses reported in the survey included cataracts in 5% and any cancer in 6% of the respondents. A history of nephrolithiasis was reported in 8% of those responding to the survey. Further comparative and longitudinal studies will be necessary to determine whether there is an increased incidence of radiation-related complications in interventional proceduralists. What is the true incidence of orthopedic and radiation-associated problems? What are the mechanisms contributing to orthopedic problems (leaded aprons, working in an upright position, non-ergonomic equipment designs, etc.)? Are there individual operator factors associated with development of orthopedic and radiation-associated problems (number of cases per year over a career, laboratory risk factors such as shielding and lab designs)? The evolution of interventional cardiology has required industry to keep pace with substantial improvements in the imaging chain, many of which have the potential to lower our exposure to ionizing radiation. However, during the past 30 years, there have been few developments in the other aspects of cardiac catheterization laboratory design, particularly with regard to innovations focused on the safety and comfort of the operators and staff. Clearly, there is a substantial need for such innovations designed to minimize radiation exposure and reduce the incidence and severity of orthopedic complications. If the same ingenuity has led to some of the incredible innovations that have transformed the practice of interventional medicine can be applied to enhancing workplace safety, then the daily job of an interventional cardiologist would undoubtedly be more comfortable and healthier. In the coming months, you will likely hear more about the efforts of the Joint Inter-Society Task Force and may even be contacted to participate in the next round of data collection. Every day, I receive several requests for information or my opinion about some product. Like you, I suspect many of these last only until I locate the delete key or wad up the mailing and attempt a 3-pointer into the trash can. However, I urge you to watch carefully for material from this task force. Sadly, it may already be too late for some of our colleagues to avoid the occupational hazards we now appreciate. Let's all now commit to working together to make our working environment better for those who will follow us. Please send your thoughts and ideas to me at president@scai.org. Dr. Goldstein and I would be grateful to hear from you on this important topic.

AIMS The two-week-wait (2WW) referral pathway was set up by the Department of Health to improve early diagnosis and overall survival of cancer. Brain tumours, however, present with non-specific neurological symptoms. As such, this study set out to evaluate the efficacy of the 2WW pathway in detecting brain cancer in patients referred by primary care. METHOD Data from 217 patients referred via the 2WW pathway from January to September 2021 were extracted retrospectively, using the electronic health record system within the University College London NHS Foundation Trust. Details of the diagnoses, imaging results, and follow-up treatments were analysed. RESULTS Of the 217 patients referred with a suspected brain tumour, 0 patients received a new diagnosis of brain cancer. However, 4 cases of benign tumours were newly diagnosed through the 2WW pathway, with an additional 17 cases of benign tumours being referred for further management, having been detected on previous external imaging. 9 cases of known malignant brain tumours were referred for on-going management, having been treated previously elsewhere. CONCLUSION The 2WW pathway does not detect new cases of brain cancer. It is rather being used as a means of rapid referral of patients in primary care with benign tumours or previously identified brain cancer. This study therefore suggests that the initial aspiration of detecting brain cancer earlier via this pathway has not been fulfilled, but it is a useful tool for GPs to refer patients with brain tumours into Neuro-oncology services.

Tumor.

In the United States, 22020 new cases of cancer in central nervous system (CNS) are expected to occur in 2010 (CBTRUS 2010). Although the incidence of cancers in CNS is much lower than that of malignancies in other organs such as lung, breast and colorectal cancers, CNS cancers are the second lethal cancer for males younger than 40 years (Jemal et al. 2010). In addition, with the unconstraint growth, brain cancers can often involve eloquent area. As a result, the neurological and psychological deficits may severely damage the health-related quality of life (QOL) in patients with brain cancers. Improvement of QOL and the prognosis of brain cancers is the goal of both physicians and basic investigators. Glioblastoma multiforme (GBM) is the most frequent primary brain cancer, accounting for 17% of all primary tumours in CNS. In the past five decades, despite the advances in the fields of neurosurgery, radiotherapy and pharmaceutics, the prognosis of patients with GBM remains dismal, with a 5-year survival of only 9.8%(Stupp et al. 2009). The nature of extensive proliferation, diffuse infiltration and resistance to conventional treatments makes the chance to cure GBM slim. Exploration of mechanisms underlying therapeutic resistance of GBM and developing novel strategies against GBM are of urgent necessity. The emergence of brain tumour stem cell (BTSC) theory is a great breakthrough in the field of neuro-oncology. BTSC theory assumes that brain tumour is a hierarchy of cancer cells maintained by a small population of cells sharing characteristics of normal embryonic and somatic stem cells. BTSC theory is confirmed by the isolation of BTSCs from established brain tumour cell lines and freshly surgical samples. Accumulated evidence suggests that BTSCs are responsible for the initiation, progression, recurrence and treatment resistance. Therefore, BTSCs are promising therapeutic targets. In this chapter, we aim to summarize advances in BTSC biology with the focus on the treatment strategies against BTSCs.

Glioblastoma multiforme (GBM) is a malignant brain tumor characterized by rapid growth and extensive invasiveness. Overexpression of insulin-like growth factor-binding protein-2 (IGFBP-2) has been reported in GBM. However, it remains to be determined how IGFBP-2 is involved in the progression of GBM. We utilized short hairpin-RNA (shRNA) expression retroviral vectors to inactivate the IGFBP-2 gene permanently in two human GBM cell lines, U251 and YKG-1. The stable knockdown of IGFBP-2 resulted in decreased invasiveness, decreased saturation density of the cells in vitro, and decreased tumorigenicity in nude mice. Transcriptional profiling of both lines revealed several genes that were significantly down-regulated by inactivation of IGFBP-2. One such gene was CD24, which has been implicated in progression of various cancers. Indeed, CD24 was expressed in most GBM cases and the inactivation of CD24 in GBM cells suppressed cellular invasiveness, as was the case for IGFBP-2. Forced overexpression of CD24 led to increased invasiveness of both IGFBP-2-inactivated GBM cell lines and also A172, a human GBM cell line with low endogenous CD24. Further supporting the inter-relationship between IGFBP-2 and CD24, knockdown of IGFBP-2 suppressed the CD24 promoter activity. Moreover, both CD24 promoter activity and in vitro invasiveness were restored in knockdown cells by transfection with an IGFBP-2 expression plasmid. These results indicate that CD24 is modulated by IGFBP-2 and contributes to IGFBP-2-enhanced invasiveness of GBM cells.

Interventional cardiologists who work in cardiac catheterisation laboratories are exposed to low doses of ionising radiation that could pose a health hazard. DNA damage is considered to be the main initiating event by which radiation damage to cells results in development of cancer. We report on four interventional cardiologists, all with brain malignancies in the left hemisphere. In a literature search, we found five additional cases and thus present data on six interventional cardiologist and three interventional radiologists who were diagnosed with brain tumours. All worked for prolonged periods with exposure to ionising radiation in the catheterisation laboratory. In interventional cardiologists and radiologists, the left side of the head is known to be more exposed to radiation than the right. A connection to occupational radiation exposure is biologically plausible, but risk assessment is difficult due to the small population of interventional cardiologists and the low incidence of these tumours. This may be a chance occurrence, but the cause may also be radiation exposure. Scientific study further delineating occupational risks is essential. Since interventional cardiologists have the highest radiation exposure among health professionals, major awareness of radiation safety and training in radiological protection are essential and imperative, and should be used in every procedure.

OBJECT Two of the more common infantile brain tumors, glioblastoma multiforme (GBM) and desmoplastic infantile tumors (DITs), can be difficult to distinguish on MRI. Both tumors occur in the supratentorial compartment and both have solid and cystic components. Differentiating between the 2 on MRI studies could assist the surgeon in discussions with family and child management. The authors report on their institutional experience with both tumors, focusing on radio-graphic features, especially the diffusion studies, which might be useful in distinguishing between infantile GBM and DIT. METHODS A retrospective review was undertaken of all infantile brain tumors treated at British Columbia's Children's Hospital between 1982 and 2012, and cases of GBM and DIT were recorded. Only cases that had imaging were included in the study. A literature review was completed to identify reported cases of infantile GBM and DIT. Only reports that described or included radiological studies (particularly MRI) of the tumors were included. Certain radiographic features of the tumors were reviewed, including location, size, consistency, pattern of enhancement, and features on MR diffusion studies. RESULTS Of 70 cases of infantile brain tumors, 2 GBM cases and 3 DIT cases (all 3 of which were desmoplastic infantile gangliogliomas [DIGs]) met the inclusion criteria. The radiological studies obtained in all 5 cases were reviewed by a neuroradiologist. All 5 patients had supratentorial tumors with cystic-solid consistency. Diffusion MRI studies showed restricted diffusion in the 2 GBM cases, but no evidence of restricted diffusion in the DIG tumors. The GBM tumors were heterogeneously enhancing, and the DIG tumors showed avid and homogeneous enhancement. The literature review revealed 29 cases of infantile GBM and 32 cases of DIG/DIT that met the inclusion criteria. The tumors were large in both groups. The tumors were cystic-solid in consistency in 10 of 30 (33%) of GBM cases and 28 of 32 (87.5%) of DIT cases. The contrast enhancement was heterogeneous in 9 of 30 (30%) GBM cases, and it was homogeneous and avid in 27 of 32 (84%) of DIT cases. Diffusion studies were recorded in 2 published infantile GBM cases, and in both of them diffusion was restricted. The authors only found 1 report that discussed DIG tumor features on MR diffusion studies, but the interpretation was difficult and unclear. CONCLUSIONS Magnetic resonance imaging, especially diffusion-weighted imaging, may be a useful aid in distinguishing between infantile GBM and DIT tumors, with infantile GBM demonstrating restricted diffusion.

Data from 2 Australian cancer registries covering a population of 1.7 million people were combined for the purposes of analysing brain cancer incidence, mortality and survival patterns for the time period 1978 through 1992. A total of 1,752 cases of primary brain cancer were registered, representing age-standardised incidence rates of 6.7 per 100,000 in men and 4.6 in women. Histological confirmation was available for 94% of cases. The incidence rate among persons aged 75 or over was higher during 1986-1992 than during 1978-1985, the rate for men increasing from 16.3 to 26.2 and that for women increasing from 9.7 to 18.0. The largest increases in this age group occurred for cases of glioblastoma multiforme. During the study period, 1,411 brain cancer deaths were notified to the 2 registries at age-standardised rates of 5.3 in men and 3.4 in women. Mortality rates among persons aged 75 years or older were higher during 1986-1992 than 1978-1985, increasing from 15.7 to 28.4 in men and from 10.1 to 15.3 in women. Only among men aged 15-49 years was a decline in mortality rates observed, from 3.3 to 2.4. Survival analyses indicated that age and histological type were the most powerful prognostic indicators. There was no improvement in 5-year survival for any of the age groups or histological types. An improvement in 36-month survival was noted for the 15-49 year age group diagnosed with gliomas other than glioblastoma multiforme.

The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.

Background: Unit-Specific influences may determine the amount of sedation given to patients and lead to deviations in patient satisfaction and clinical outcomes due to vague guidelines (4). This study aims to compare medication utilization, clinical outcomes and patient satisfaction in order to determine safety and efficacy of nurse administrated conscious sedation. Methods: Data from outpatient procedures in Cardiac Catherization Lab (Cath Lab) and Interventional Radiology (IR) departments were collected including comorbidities, labs, procedural characteristics, clinical outcomes, and post-sedation questionnaires. Results: Mean age was 63 ± 14 years and 124 (54.9%) were males. Cath Lab n=132 and IR n=94. Procedure duration(min) was found to be longer in the Cath Lab 55 (37,81), than in IR 24 (16,45), p-value of &lt;0.001. The American Society of Anesthesiologist (ASA) scores of Cath Lab 26(21%), IR 29(30.9%), p-value (0.1). Total amount of versed (mg) given in the Cath Lab 2 (1,2), significantly less than IR 3 (1,4.5) with a p-value of &lt;0.01. Total amount of fentanyl (mcg) for Cath Lab 50(50,100), and IR 100 (50,100) with a p-value of &lt;0.01. Median time between 1 st and 2 nd dose of versed in Cath Lab 0 (0,1), IR 9 (5, 16). Median time between 2 nd and 3 rd dose of versed for Cath Lab 0 (0,0), IR 6 (0,13.5) with a p-value &lt;0.001. Median time between 1 st and 2 nd dose of fentanyl in Cath Lab 1 (0,14.8), IR 12.5 (6.8, 24) with a p-value &lt;0.001. Median time between 2 nd and 3 rd dose of fentanyl for Cath Lab 0 (0,0), IR 0,(0,15), p-value &lt;0.001. Median second dose of versed in Cath Lab 0 (0,1), IR 1 (1,1). Median second dose of fentanyl in Cath Lab 25 0 (0,25), IR 25 (25,50), p-value &lt;0.001. Post-Sedation Questionnaire completed by 57 patients, Cath Lab n=30, IR n=27. Patients that felt uncomfortable during their procedure in Cath Lab 11(36.7%), compared to IR 1 (3.7%). The choice of sedation that patient would choose if undergoing a similar procedure again if under general anesthesia Cath Lab 6(20%), IR 0(0%), p-value 0.03. Patients stated that they would recommend conscious sedation to others based on their previous experience, Cath Lab 24 (80%), IR 27(100%). Conclusion: Patients receiving conscious sedation while undergoing procedures in both the Cath Lab and IR were found to have no adverse outcomes and were considered safe. The procedural duration of catheterization procedures was significantly longer than IR with no adverse outcomes, but patients in the Cath lab received less sedation medication and were found to be less satisfied with their procedure. Patients from Cath Lab received less initial sedation medication and rarely received an additional dose. Cath Lab patients were more likely to not recommended conscious sedation to others (20%), and 6 (20%) stated they would rather undergo a similar procedure under general anesthesia; 36.7% of Cath Lab patients stated that they were uncomfortable during the procedure.

Objective: To determine the prevalence of brain and neck neoplasms among Interventional Cardiologists.&#x0D; Study Design: Analytical Cross-sectional study.&#x0D; Place and Duration of Study: Department of Cardiology/Interventional Cardiology of two Tertiary Cardiac Care Centers of Rawalpindi and Lahore Pakistan from Mar 2021 to Apr2022.&#x0D; Methodology: By using the non-probability, consecutive sampling technique, fifty Interventional Cardiologists’ (n=50) of both genders between 35-75 years of age, working in the cardiac catheterization labs for more than 10-years are enrolled after their informed consents. The data was collected from the interviews of Interventional cardiologists, from the shared medical records and also from the family members and colleagues. The Interventional cardiologists were enquired about any neurological signs and symptoms particularly in relation to the head and neck malignancy and also asked about undergoing any CT/MRI or PET scan of head and neck region in the past or recent time. Descriptive statistics for data was computed byusing the SPSS version-25. &#x0D; Results: The mean age of the Interventional Cardiologists of tertiary cardiac care center of Rawalpindi was 50.40±7.77years while of Lahore was 49.16±8.89 years. There were 47(94.0%) males and 03(6.0%) females, from both the Institutes. The mean duration of working in cardiac catheterization labs was 17.92±4.57 years. The head and neck neoplasm’s among Interventional Cardiologists was observed in 01(2%) case.&#x0D; Conclusion: The research study concluded that the prevalence of head and neck neoplasms among Interventional Cardiologists is very low (2%). But still it is the need of hour to be more careful about radiation exposure among the Interventional Cardiologists working for long hours in the cardiac catheterization labs, to lessen down the chances of head and neck malignancy.

Objective.Monoenergetic high-energy Bragg peak (monoBP) proton therapy has emerged as promising candidates for conformal FLASH radiotherapy (FLASH-RT). However, the beam-specific proton modulation devices are needed for dose conformality. Meanwhile, the beam switching time could disrupt ultra-high dose rate (UHDR), thereby compromising the FLASH effect. This study aims to propose a novel monoBP conformal FLASH-RT methodology with the only utilization of universal range shifter (URS).Approach.An optimization algorithm, which optimized both URS thickness and dose distribution, was implemented based on multi-field optimization. Two proton FLASH techniques with 218 MeV proton beams were investigated for 10 brain and 10 lung cancer cases: (1) URS-modulated monoBP FLASH plan, and (2) transmission beam (TB) FLASH plan. All plans were optimized under the same optimization constraints with robust scenarios. Delivery parameters, dose, and dose rate metrics of the two plans were analyzed and compared.Main Results.Both modalities achieved similar dose coverage, withD98%of target meeting the clinical requirement for brain (BP: 98.2 ± 0.7%, TB: 98.6 ± 0.5%) and lung (BP: 97.8 ± 0.3%, TB: 98.7 ± 0.5%) cancer cases. However, compared to TB strategy, the BP FLASH plans reduced theDmeanof normal tissue for brain (BP: 16.6 ± 3.1 Gy, TB: 19.7 ± 5.4 Gy, p < 0.05) and lung (BP: 3.3 ± 1.7 Gy, TB: 4.2 ± 1.8 Gy,p< 0.05) cases. For dose-averaged dose rate, theV40Gy/s_DADRof both modalities reached 100% in brain and lung cancer cases; while for averaged dose rate, theV40Gy/s_ADRwas 37.4%and 26.6%for BP plans in brain and lung cancer cases, respectively, and was 61.5% and 61.3% for TB plans in brain and lung cancer cases, respectively.Significance.A monoBP conformal FLASH-RT methodology was proposed, utilizing only a fixed URS. The proposed monoBP FLASH-RT reached the requirement of FLASH effect, while demonstrating better dose protection, compared to the TB FLASH-RT.

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1585:"<h3>Introduction</h3> National guidance mandates urgent specialist referral for suspected brain and CNS (central nervous system) cancer cases, with target for assessment within 14 days.^{1, 2} Referrals are actively tracked on a cancer tracking system with patients highlighted who are about to breach the 14 day target. Knowledge about the effectiveness of such red flag referral pathways to neurology is lacking in Northern Ireland. <h3>Methods</h3> A retrospective audit was conducted looking at red flag referrals to neurology in a single health trust in Northern Ireland over 5 years (the Western Health and Social Care Trust). A simultaneous retrospective audit of incidental CNS oncology cases over the same time period was also performed in the same Trust. <h3>Results</h3> Over 5 years from January 2016-December 2020, there were 399 red flag referrals to neurology. 6 patients (1.5%) went on to have a new brain/CNS neoplasm diagnosis, with 50% of these 6 presenting to the emergency department (ED) and being diagnosed prior to neurology review. Of the 145 CNS oncology cases over this 5 year period, 77%, (112 of 145) of cases presented via the emergency department/acute stroke pathways. <h3>Conclusions</h3> Red flag neurology referrals have very small probability of detecting brain/CNS cancer. Actual brain cancer cases typically require emergency admission for work up. Guidelines for primary care referrals for suspected neuro-oncology require revision in light of poor performance of promoted pathways Marymccullagh93{at}gmail.com ";}

On average, there are about 300,000 new cases of brain cancer each year. Studies have shown that brain and central nervous system tumors are among the top ten causes of death. Due to the extent of this problem and the percentage of patients suffering from brain tumors, innovative therapeutic treatment methods are constantly being sought. One such innovative therapeutic method is photodynamic therapy (PDT). Photodynamic therapy is an alternative and unique technique widely used in dermatology and other fields of medicine for the treatment of oncological and nononcological lesions. Photodynamic therapy consists of the destruction of cancer cells and inducing inflammatory changes by using laser light of a specific wavelength in combination with the application of a photosensitizer. The most commonly used photosensitizers include 5-aminolevulinic acid for the enzymatic generation of protoporphyrin IX, Temoporfin-THPC, Photofrin, Hypericin and Talaporfin. This paper reviews the photosensitizers commonly used in photodynamic therapy for brain tumors. An overview of all three generations of photosensitizers is presented. Along with an indication of the limitations of the treatment of brain tumors, intraoperative photodynamic therapy and its possibilities are described as an alternative therapeutic method.