Local Control Research Articles

Assessment of Local and Regional Control in High-Risk Atypical (WHO Grade 2) Meningiomas Receiving Stereotactic Fractionated Radiosurgery

Assessment of Local and Regional Control in High-Risk Atypical (WHO Grade 2) Meningiomas Receiving Stereotactic Fractionated Radiosurgery

Efficacy and safety of robotic Cyberknife radiotherapy in uveal melanoma: a systematic review and meta-analysis.

This systematic review is aimed to evaluate the efficacy and safety of robotic Cyberknife radiotherapy (CKRT) in the treatment of uveal melanoma (UM). Clinical studies published in English that assessed the efficacy and safety of robotic CKRT in UM were systematically searched in PubMed, Web of Science, Cochrane and Embase from inception to July 2023. Studies reporting extraocular tumours or other radiosurgery approaches were excluded. Outcomes measured were tumour size, reflectivity, local tumour control rate, eye retention rate, survival rate, complication rate, recurrence rate, and metastasis rate. Ten eligible articles involving 2370 patients with 2372 UMs were included in evidence synthesis. Meta-analysis showed 811 of 912 patients (0.89, 95% Cl: 0.86, 0.92) maintained local control for three years, and 1448 of 1724 patients (0.84, 95% Cl: 0.81, 0.88) preserved the eye in three years. During follow-up, 91% (0.91, 95% Cl: 0.85, 0.97) patients survived and 351 of 1720 patients (0.23, 95% Cl: 0.09, 0.37) involving 1722 eyes had tumour recurrence. In addition, 1376 patients (0.79, 95% Cl: 0.77, 0.82) preserved the eyeball in five years. Following treatment, approximately 20% of patients had radiation retinopathy (95% Cl: 0.13, 0.28), 19% developed glaucoma (95% Cl: 0.11, 0.28), and 22% experienced retinal detachment (95% Cl: 0.07, 0.36). CKRT is a viable, noninvasive RT for UM. The rate of local tumour control following treatment is comparable to that of other RT approaches, providing additional options based on the patient's condition.

Transoral Laser Microsurgery Versus Radiotherapy for T1-T2 Glottic Cancer with Anterior Commissure Involvement: A Systematic Review and Meta-Analysis.

To identify the most effective treatment modality for achieving favorable outcomes in early glottic tumors with anterior commissure involvement (ACI). PubMed, Embase, Web of Science, and ScienceDirect. Random-effects proportional meta-analysis model is used to evaluate the oncological and functional outcomes of transoral laser microsurgery (TLM) versus radiation therapy (RT) in early glottic (T1-T2) cancer with ACI. From a total of 736 studies, 40 studies were included, comprising 2666 early glottic tumor patients with ACI. TLM (52%) and upfront RT (48%) were the primary treatment groups. TLM had better 5-year overall survival (OS) (84.5% [80.3%-88.0%] vs. 79.4% [75.7%-82.7%]). Similarly, TLM-treated patients had better 3-year pooled disease-free survival (DFS) compared with RT-treated patients (82.7% [77.1%-87.1%] vs. 73.3% [23.8%-96.0%]). TLM exhibited a better 5-year local control rate (LCR) than RT (77.2% vs. 71.6%). In our temporal analysis, TLM had a higher 5-year LCR than RT (78.2% vs. 63.5%) in 2001-2012, with similar rates in 2013-2024 (76.8% vs. 78.4%). TLM-treated patients had higher laryngeal preservation rates compared with RT patients (93% [90.6%-94.8%] vs. 87.6% [82.8%-91.2%]). Our meta-analysis is the first in the literature to compare the outcomes between TLM and RT-treated patients with ACI in early glottic tumors. TLM-treated patients appear to have superior 5-year OS and laryngeal preservation compared with upfront RT-treated patients. However, both TLM and RT exhibited comparable oncological outcomes in early glottic tumor patients with ACI during the recent period from 2013 to 2024. Laryngoscope, 2025.

External validation of radiobiological models for local control prediction in lung cancer patients treated with stereotactic body radiation therapy

BackgroundThe debate regarding the accuracy of radiobiological models for local control (LC) prediction in lung cancer patients undergoing stereotactic body radiation therapy (SBRT) remains unresolved. The study seeks to externally validate the predictive efficacy of radiobiological models using single-institutional SBRT database.MethodsThe cohort comprised 153 patients diagnosed with primary or metastatic lung cancer who underwent SBRT. The study employed three radiobiological models to estimate the probability of 2-year LC, including the Liu model, Klement model, and Ohri model. Furthermore, the likelihood of 3-year LC was predicted using the Liu model, Klement model, Gucken model, and Santiago model. The performance of the prediction models was assessed through the AUC values of the receiver operating characteristic (ROC) curve and the calibration plots.ResultsLocal recurrence was observed in 38.6% of patients (59/153) within two years, and in 43.1% (66/153) within three years after the radiotherapy. The ROC curves indicated discriminative power for all the 2-year and 3-year models, with the exception of the Klement model. The Ohri model showed a significantly improved discriminative ability than the Klement model for 2-year prediction, while it was not statistically significant when compared to the Liu model. However, no significant differences were found among the four models in terms of 3-year LC prediction. The calibration plots, using the Hosmer-Lemeshow goodness-of-fit test, confirmed that the predicted probabilities of the models were in agreement with the actual observation with P>0.05, except for the 2-year LC prediction using the Klement model.ConclusionConsidering the balance between prediction accuracy and model simplicity, it is recommended to utilize the Ohri model for 2-year LC prediction and either the Gucken model or Santiago model for 3-year LC prediction.

Functional and oncological outcomes of transoral laser versus robotic surgery in supraglottic squamous cell carcinoma.

To compare the surgical, functional and oncological outcomes of Transoral Laser Microsurgery (TLM) and Transoral Robotic Surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. Retrospective case series with prospective data. Tertiary Academic Medical Center. A chart-review analysis, with prospective follow-up was performed on 122 patients treated for a supraglottic squamous cell carcinoma with either TLM or TORS between 2003 and 2019. Patients were grouped according to the surgical technique used. Clinical, surgical, functional and oncological outcomes were compared, including local and regional controls, DFS, and OS, and postoperative complications. A total of 122 patients, including 47 treated with TLM and 75 with TORS. Negative margins were observed in n=12/47 (25.5%) of TLM cases and n=4/75 (5.3%) of TORS cases (p<0.05). There was no significant difference between the two techniques in terms of 5-year local and regional control, however a significant difference was found in disease-free survival and overall survival. The functional laryngeal preservation rate was 97.8% in the TLM group and 100% in the TORS group. Both techniques appear to be safe and effective, though TORS shows superiority in achieving negative margins compared to TLM. Therefore, the choice of technique should be tailored to available resources, surgical team preferences, and experience, while also considering the learning curves associated with each approach.

Semi-field experiments reveal contrasted predation and movement patterns of aquatic macroinvertebrate predators of Anopheles gambiae larvae

BackgroundMembers of the Anopheles gambiae complex are major malaria vectors in sub-Saharan Africa. Their larval stages inhabit a variety of aquatic habitats in which, under natural circumstances, they are preyed upon by different taxa of aquatic macroinvertebrate predators. Understanding the potential impact of predators on malaria vector larval population dynamics is important for enabling integrated local mosquito control programmes with a stronger emphasis on biocontrol approaches. This study experimentally evaluated the predation efficacy and foraging strategy of three common aquatic macroinvertebrate predators of An. gambiae, diving beetles (Coleoptera), backswimmers (Hemiptera), and dragonfly nymphs (Odonata) in a semi-field system in South-Eastern Tanzania.MethodsAn array of alternating small and large basins used as aquatic habitats was created in two compartments of a semi-field system and filled with well water. Field-collected adult diving beetles, backswimmers or dragonfly nymphs were randomly assigned to these habitats and Anopheles arabiensis larvae were added as prey in half of the habitats. The number of mosquito larvae consumed, predator mobility across habitats and mortality were recorded at 24, 48 and 72 h.ResultsThe presence of An. gambiae larvae in habitats significantly increased the survival of backswimmer and dragonfly nymphs, which are not mobile. In contrast, diving beetles survived well under any initial condition by preferentially flying away from habitats without prey to nearby larger habitats with prey. The larval predation rates of predacious diving beetle, backswimmer and dragonfly nymphs were stable over time at a mean of 3.2, 7.0 and 9.6 larvae consumed each day.ConclusionThis study demonstrates that aquatic macroinvertebrate predators display adaptive foraging behaviour in response to prey presence and aquatic habitat size. It also confirms the ability of these predators to significantly reduce An. gambiae larval densities in aquatic habitats, thus their potential for consideration as additional biocontrol tools for mosquito population reduction.

Induction of macrophage efferocytosis in pancreatic cancer via PI3Kγ inhibition and radiotherapy promotes tumour control

BackgroundThe immune suppression mechanisms in pancreatic ductal adenocarcinoma (PDAC) remain unknown, but preclinical studies have implicated macrophage-mediated immune tolerance. Hence, pathways that regulate macrophage phenotype are of strategic interest, with...

Defining the Optimal Dose for 3-Dimensional Conformal Accelerated Partial Breast Irradiation: 15-Year Follow-Up of a Dose-Escalation Trial.

Randomized trials have demonstrated similar local tumor control in patients treated with accelerated partial-breast irradiation (APBI) compared with whole-breast irradiation. However, the optimal APBI dose for maximizing tumor control and minimizing toxicity is uncertain. We enrolled patients ≥18 years of age with grade 1 or 2 ductal carcinoma in situ or stage I invasive breast cancer and resection margins ≥2 mm between 2003 and 2011 to a sequential dose-escalation trial using 3-dimensional conformal external beam APBI giving twice daily 4 Gy fractions with total doses of 32 Gy, 36 Gy, and 40 Gy. Most were irradiated using mini-tangents plus en-face electrons or 3 to 4 coplanar photon beams; 19 patients in the 32 Gy dose cohort were treated with protons. The trial accrued 324 patients (99, 101, and 124 in 32 Gy, 36 Gy, and 40 Gy cohorts, respectively). The median follow-up was 15.2 years. The 15-year cumulative incidence of local failure in each dose cohort was 6.9%, 5%, and 3.9% in the 32 Gy, 36 Gy, and 40 Gy cohorts, respectively (log-rank P = .21) The 10-year cumulative incidence of local failure in each dose cohort was 5.2%, 5.2%, and 2.2%, respectively (log-rank P = .2). Ten-year rates of moderate or severe fibrosis by physician assessment in each cohort were 40%, 58%, and 67%, respectively (log-rank P < .01). The 10-year rates of fair or poor cosmesis by patient self-assessment were 25%, 30%, and 49% in each cohort, respectively (log-rank P < .01); physician assessment yielded similar 10-year rates of 21%, 39%, and 61%, respectively (log-rank P < .01). There were no significant differences in local failure rates between 32 Gy, 36 Gy, or 40 Gy delivered in twice daily 4 Gy fractions, but fibrosis and cosmetic outcomes were worse for patients treated to the 2 higher doses. Hence, our study did not show the benefit of administering more than 32 Gy using this fractionation scheme.

Current Paradigm and Future Directions in the Management of Nodal Disease in Locally Advanced Cervical Cancer.

Approximately 36% of patients with cervical cancer present with regional nodal metastasis at diagnosis, which is associated with adverse survival outcomes after definitive treatment. In the modern era of chemoradiotherapy (CRT) and image-guided adaptive brachytherapy (IGABT), where excellent local control is achieved for patients with locally advanced cervical cancer (LACC), nodal failure remains a major challenge to cure. To optimize treatment outcomes for node-positive LACC and reduce the incidence of nodal failure, various treatment approaches have been explored, including methods of surgical nodal staging or dissection, RT dose escalation strategies, such as intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to involved nodes, and elective treatment of subclinical para-aortic (PAO) disease. Additionally, there is growing interest in emerging precision RT techniques, such as magnetic resonance-guided radiotherapy (MRgRT) and proton therapy, which may allow for further improvement in the therapeutic ratio. This review outlines the various methods of detection of nodal metastasis, treatment options for node-positive LACC, techniques of nodal radiotherapy and their clinical evidence in efficacy and toxicity profiles. Furthermore, recent advances in systemic therapy and promising novel therapeutic directions that may shape the management of node-positive LACC are discussed.

Comparison of the effect of early versus late surgical strategies on outcomes in patients with hand enchondromas complicated with pathological fractures.

This study aimed to evaluate the advantages and disadvantages of early versus delayed single-stage surgery in patients with hand enchondromas who developed pathological fractures, focusing on local tumor control and hand function, to determine the optimal timing for surgery. Delayed surgical curettage may offer advantages regarding both local tumor control and hand function outcomes.Thirty-five patients who developed pathological fractures due to solitary hand enchondromas and underwent surgical treatment between 2015 and 2021 were analysed. Patients were divided into two groups based on the timing of surgery. Patients who underwent surgical treatment immediately after a pathological fracture were assigned to the early-surgery group, and those who underwent surgical treatment after waiting for fracture union were assigned to the late-surgery group. Demographic data, lesion characteristics, and fixation methods were analysed. Parameters affecting outcome measurements were analysed, including visual pain scale, fracture healing time, recurrence, ROM, time to return to daily activities, and secondary surgical procedures.The study included 35 patients, of whom 24 were female, with a median age of 33 years. Fifteen patients were included in the early-surgery group and 20 in the late-surgery group, with a follow-up period of 36.3 and 38.9 months, respectively. The duration of surgery, time to fracture union, and total physical therapy duration during treatment were lower in the late-surgery group (p<0.05). At the final follow-up, the mean loss of ROM was 17.6˚ in the early-surgery group and 3.3˚ in the late-surgery group (p=0.00). The rate of secondary surgery was higher in the early-surgery group (p=0.040).In patients with hand enchondromas presenting with pathological fractures, early surgery resulted in higher complication rates, poorer functional outcomes, and an increased need for secondary surgeries.

Controlling Frost Propagation on Polymeric Surfaces Using SI‐ATRP Chemical Micropatterning

AbstractMicropatterned surfaces with both hydrophilic and hydrophobic regions are relevant for a wide range of applications from fuel cells to water harvesting systems. The preferential nucleation of water on hydrophilic regions can also be used to control frost nucleation on chemically patterned surfaces. So far, this concept has been tested on brittle silicon surfaces with only a few different sizes and shapes of hydrophilic regions. In this work, the concept of controlled icing is investigated on five polymeric surfaces with different surface energies modified by micropatterning them with three types of hydrophilic polymer brushes. Frost formation and propagation on the resulting patterned surfaces with regions of varying wettability is monitored and quantified using high‐resolution thermal imaging. The study proves that control over frost nucleation and propagation using regions of varying wettability can be achieved on commodity polymers. In addition to influencing the time and location of ice nucleation, the local patterning affects the freezing propagation mode and rate due to its impact on the continuity and thickness of molecular water layers (MWL). These results show that local control over the state of MWLs is key to controlling both ice nucleation and propagation of freezing events on surfaces.

Silicone Fiducial Markers Improve Precision in Uveal Melanoma Radiation Therapy.

Objectives: Accurate target definition, treatment planning and delivery increases local tumor control for radiotherapy by minimizing collateral damage. To achieve this goal for uveal melanoma (UM), tantalum fiducial markers (TFMs) were previously introduced in proton and photon beam radiotherapy. However, TFMs cause pronounced scattering effects in imaging that make the delineation of small tumors difficult. The aim of this study was to evaluate silicone fiducial markers (SFMs) for the guiding of stereotactic radiosurgery (SRS) for UM. Methods: In this retrospective interventional pilot case series, three patients with small UMs 3 mm or less in tumor thickness and ≤10 mm in largest basal diameter received silicone fiducial markers. The fiducial markers were punched out (3 mm) from conventional silicone encircling bands for buckle surgery. The markers were sutured onto the sclera at the tumor margins according to the use of TFMs. MRI and CT images were used for the localization of the tumor and the markers before robotic-guided SRS. Results: The silicone fiducial markers were punched out easily from the original band, better to handle than TFMs and easy to suture onto the sclera. They could be visualized in both MRI and CT, but were more visible in CT. In the absence of scattering effects, both the markers and thus the tumor boundaries could be clearly delineated. Conclusions: This is the first report that introduces fiducial markers intraoperatively shaped from conventional silicone encircling bands usually used for retinal detachment surgery. The SFMs allow more accurate tumor delineation, resulting in the more precise planning and administration of SRS when compared to TFMs. This simple modification has a major impact on a well-known treatment approach.

"Add More Arrows to Your Quiver": The Role of Adding Another Chemotherapy Drug to Fluoropyrimidine and Long Term Radiotherapy in Locally Advanced Rectal Cancer: A Systematic Review and Meta-Analysis.

Objectives: Despite optimal local control obtained with neoadjuvant chemoradiotherapy (CRT), data on overall survival (OS) and disease-free survival (DFS) of local advanced rectal cancer patients are still equivocal. This meta-analysis aimed to estimate the pathological complete response (pCR), regression rate, DFS, and OS probabilities of rectal cancer patients treated with a second chemotherapy drug added to fluoropyrimidine and long-term radiotherapy. Methods: Computerized bibliographic searches of MEDLINE, PUBMED, Web of Science and the Cochrane Central Register of Controlled Trials databases (1970-2023) were supplemented with hand searches of reference lists. Studies were included if they were randomised controlled trials (RCTs) comparing intensified chemotherapy with CRT to preoperative CRT and if they had patients with resectable, histologically proven rectal adenocarcinoma without metastases. Results: Eighteen RCTs (7695 patients) were analysed. Data on population, intervention, and outcomes were extracted from each RCT, following the intention-to-treat method, by three independent observers and combined using the DerSimonian and Laird methods. A chemotherapy with two drug and long-term radiotherapy CRT, compared to preoperative CRT (fluoropyrimidine and long-term radiotherapy), significantly increases the rate of pathological complete response (OR 1.37 (95% CI, 1.16-1.63) p = 0.0003) and the regression rate (OR 1.57 (95% CI, 1.16-2.14) p < 0.00001). Furthermore, it increases DFS (HR 0.87 (95% CI, 0.79 to 0.95) p = 0.002 and OS HR 0.84 (95% CI, 0.74 to 0.95) p = 0.007). The risk of severe adverse events (≥G3) is increased OR 1.96 (95% CI 1.35-2.85), p = 0.0005. Conclusions: In patients with resectable rectal cancer, intensified chemotherapy can reduce by 13% the risk of disease progression and by 16% the risk of death.

Longitudinal Evaluation of Vestibular Symptoms in Patients with Vestibular Schwannoma After Robotic-Guided Stereotactic Radiosurgery Using the Dizziness Handicap Inventory (DHI).

Background: Vestibular symptoms can severely affect patients with vestibular schwannomas (VSs). Studies assessing vestibular symptoms beyond clinical routine assessment in patients with VS treated by stereotactic radiosurgery (SRS) are scarce. Therefore, we employed the standardized questionnaire Dizziness Handicap Inventory (DHI) to systematically evaluate vestibular symptoms prior to and after SRS. Methods: For this retrospective single center study, we included patients who received Cyberknife® SRS for newly diagnosed unilateral VS between 2012 and 2022, and who had a minimum of two follow-up (FU) visits. Besides clinical assessment, the presence and severeness of vestibular symptoms before and after treatment was recorded by using the DHI. Overall DHI symptom scores (1-100) were classified into four grades (0 = "none", 1 = "mild", 2 = "moderate" and 3 = "severe"). The results were correlated with tumor-, patient-, and treatment-related characteristics. Results: We analyzed 128 patients with a median age of 60 years (range: 20-82) and a median FU of 36 months (range: 11-106 months). The median tumor volume was 0.99 cm3 (range: 0.04-7.1 cm3). A median marginal dose of 13 Gy (range: 12-14 Gy) was administered. The crude rate of local tumor control was 99.2%. The mean DHI total score at last follow-up (LFU, 25.5 ± 24.7; range 0-92) was significantly lower than before SRS (29.4 ± 25.3; range:0-92, p = 0.026), which was reflected in a higher proportion of patients with DHI grade "none" and a lower proportion of patients with DHI grade "severe" at LFU. Chi-square tests showed a significant correlation of the DHI grades (DHI 0-1 vs. DHI 2-3) with the absence or presence of vestibular symptoms both before SRS (p < 0.001, CI 95%) and at LFU (p = 0.038). Conclusions: The DHI is a feasible and valid instrument for measuring vestibular symptoms after SRS. In addition, the DHI enables the quantification of symptoms and can therefore serve as an important tool for outcome assessment after SRS of VS. In the present cohort, DHI scores improved significantly during FU.

Geospatial mapping of drug-resistant tuberculosis prevalence in Africa at national and sub-national levels.

To map subnational and local prevalence of drug-resistant tuberculosis (DR-TB) across Africa. We assembled a geolocated dataset from 173 sources across 31 African countries, comprising drug susceptibility test results and covariate data from publicly available databases. We used Bayesian model-based geostatistical framework with multivariate Bayesian logistic regression model to estimate DR-TB prevalence at lower administrative levels. We estimated 148,239 DR-TB cases (95% Uncertainty Interval [UI]: 17,499- 313,683) in Africa, showing significant variation by country. Eswatini and South Africa had highest case numbers, while Algeria and Egypt had the lowest. The highest DR-TB prevalence was estimated in Eswatini (53.26; 95%UI 13.13-66.12), Morocco, Tunisia, and South Africa, while the lowest prevalence was found in Gabon, the Republic of Congo, Sierra Leone, and Mali. Marked subnational variation in DR-TB prevalence was noted, where 91 subnational areas across 12 countries had prevalence rates higher than their respective national averages. Factors such as mean temperature (β=2.01; 95% CrI: 1.21, 3.42), population density (β=0.41; 95% CrI: 0.19, 0.95), and fine particulate matter (β=0.66; 95% CrI: 0.20, 0.80) were positively associated with DR-TB prevalence. The study highlights substantial national and subnational variability in DR-TB prevalence across Africa, aiding policymakers in designing localized TB control interventions.

The capacity and training needs of primary health care workers in Nyeri and Nakuru counties of Kenya: a cross-sectional study.

Health systems based on primary healthcare (PHC) have reduced costs and are effective for improved health outcomes. Kenya's health system grapples with providing equitable access to essential health services, but there is increasing commitment by the government to strengthen primary healthcare. The aim of this paper is to provide a baseline assessment of the capacity and training needs of healthcare workers (HCWs) in Nakuru and Nyeri Counties and identify priorities for intervention. A cross-sectional study was carried out among 171 healthcare workers in Nyeri and Nakuru counties. Multistage sampling was employed to select sub-counties in the first stage and health facilities by level within each sub-county in the second level. Systematic random sampling was then employed to select HCWs from each level of facility. We targeted healthcare workers of all cadres within the health facilities, and included all who consented to participating. Structured self-administered pen-and-paper questionnaires were used for data collection, and a five-point Likert scale was used to measure the perceived capacity of the healthcare workers to provide primary healthcare. As for the training needs data, the participants selected any of the 12 components that they needed training in. Descriptive statistics was employed, and stacked bar charts were used to visualize the capacity and training needs for the components of PHC adopted in Kenya. In total, we obtained questionnaires from 95 participants in Nakuru and 76 participants in Nyeri. Nakuru HCWs rated themselves higher than their Nyeri counterparts in maternal and newborn child healthcare, local endemic disease control, appropriate treatment of common diseases and injuries, provision of essential basic medication, dental health, HIV/AIDs & TB management, and primary eye care. In both counties, there were significant differences in capacity between the different levels of health facilities. We observed substantial capacity gaps for HIV/AIDs & TB management, mental health and dental health services in both counties. This study found a substantial capacity gap in several of the elements of PHC, especially in Nyeri County. Critical areas for intervention are HIV/AIDs & TB management and mental health training for both counties. Within the health system, there is need to strengthen the capacity of HCWs in lower-level health facilities to reduce the volume of referrals to secondary care facilities. We strongly recommend training programs in dental health, mental health, primary eye care, nutritional services and HIV/AIDs &TB management, that are carefully designed to emphasize skills and abilities.

Maxillectomy Guided by 3D Printing Versus Conventional Surgery for Patients with Head and Neck Cancer.

This study evaluates the impact of three-dimensional (3D) printing-guided maxillectomy compared with conventional maxillectomy on surgical precision and oncological outcomes in patients with head and neck cancer. A retrospective analysis was conducted on 42 patients undergoing maxillectomy (16 in a 3D printing-guided group and 26 in a conventional group). Patient demographics, tumor characteristics, and outcomes were compared. Survival outcomes were analyzed using the Kaplan-Meier method. The 3D printing group showed higher rates of negative resection margins (81.3% vs. 76.9%) compared with the conventional group and a trend toward improved 5-year local recurrence-free survival (87.5% vs. 58.7%, respectively) and overall survival (84.4% vs. 70.1%, respectively). However, the differences were not statistically significant. Maxillectomy guided by 3D printing may offer enhanced surgical precision and improved local control in patients undergoing head and neck cancer surgeries. Further research with larger cohorts is necessary to confirm these findings.

Enhancing low-temperature performance and suppressing cathode dissolution in aqueous zinc-ion batteries: local structure and electrochemical crosstalk control of V2O5

Enhancing low-temperature performance and suppressing cathode dissolution in aqueous zinc-ion batteries: local structure and electrochemical crosstalk control of V2O5

Synchrony dynamics of dissolved organic carbon in high‐mountain streams: Insights into scale‐dependent processes

AbstractIn high‐mountain landscapes, organic carbon (OC) is often limited and heterogeneously stored in poorly developed soils, snow, ground ice, and glaciers. Climate change influences the dynamics of OC mobilization to—and processing into—the recipient streams. Dynamics vary from seasonal (e.g., snow melt in spring) to daily (e.g., ice melt in summer) depending on the location of the streams within the catchment. Capturing the temporal richness of stream biogeochemical signals has become a reality with the advent of high‐resolution sensors. In this study, we applied wavelet analysis to high‐frequency discharge (Q) and dissolved organic carbon (DOC) measurements from nine streams in the Swiss Alps to investigate the persistence of synchrony in Q (SQ) and DOC (SDOC) among streams, and their response to drainage network position, climate, and land cover gradients across different time scales. Our findings revealed that SQ and SDOC decayed non‐linearly over the first ~ 5 km and stabilized from this point onwards, indicating that localized controls influenced synchrony within single basins, but drivers operating at regional scale acted as synchrony stabilizers. We also showed that short‐term (0–10 d) SQ and SDOC were strongly influenced by the distance between streams and network connectivity. In contrast, catchment‐related properties (i.e., altitude or land cover) were more important drivers of SQ and SDOC dynamics at longer time scales (&gt; 50 d). However, the degree to which local catchment properties controlled synchrony patterns at the longest timescales depended both on response variables (i.e., Q vs. DOC) and land cover (i.e., vegetation vs. glacier). Elucidating the most prominent timescales of SDOC is relevant given the hydrological alterations projected for high‐mountain regions. We show that glaciers impose a unique seasonal regime on DOC concentration, potentially overriding the effects of other local hydrological or biogeochemical processes during downstream transport. Consequently, SDOC dynamics in high‐mountain streams may change as glaciers shrink, thereby altering downstream opportunities for biogeochemical transformations.

1-year efficacy results after MR-guided risk-adapted stereotactic radiotherapy of infra-diaphragmatic oligometastases in a multicenter phase II trial.

The SOFT (Stereotactic ablative radiotherapy of infra-diaphragmatic sOFT tissue metastases) trial assesses the safety and efficacy of risk-adapted MR-guided stereotactic ablative radiotherapy (SABR) of infra-diaphragmatic soft tissue metastasis in patients with oligometastatic disease (OMD) (clinicaltrials.gov ID NCT04407897). This paper reports the one-year efficacy analysis and evaluates associations between local control (LC) and clinical and dosimetric parameters. This investigator-initiated, multicenter, single-arm, phase 2 study recruited patients from four MR-linac centers in Denmark and the US. Patients with De novo or recurrent OMD with ≤5 metastases in ≤3 organs and patients with induced OMD or oligoprogressive disease (OPD) with ≤3 metastases were eligible. Fractionation schemes were 45-75 Gy in 3-8 fractions. The trial included 121 patients with 147 oligometastatic lesions, primarily in the liver (41 %), lymph nodes (35 %), or adrenal glands (14 %). The median follow-up time was 13.0 months, interquartile range (IQR) (11.7,13.7) months. The 1-year LC rate was 89 %, 95 % confidence interval (CI) (83,94 %). We did not observe any statistically significant associations between LC and clinical and dosimetric parameters. The median progression-free survival was 7.1 months, 95 % CI (6.0,9.4). One- and two-year overall survival was 82.6 %, 95 % CI (76.2 %,89.7 %), and 65.1 %, 95 % CI (56.4 %,75.3 %). Sixty-one patients (50 %) were kept off systemic therapy throughout the one-year follow-up. In our study, treatment with risk-adapted, MR-guided SABR resulted in a high one-year local control and survival rate and could keep half of the patients off systemic therapy within the first year of follow-up.