Nodal Areas Research Articles

A Radiation Therapy Contouring Atlas for Delineation of the Level I-II Axilla in the Prone Position

When patients are treated prone for whole breast irradiation (WBI), the axilla typically receives less dose than when patients are treated with WBI in the supine position. There are situations, however, where the axilla is a target as in a situation where the physician intends to treat with "high tangents" to provide good coverage of both the breast and level I-II axilla. In these scenarios, ideal target delineation when the patient is in the prone position is not well-defined. While different consensus guidelines exist for delineation of the nodal areas in the supine position, to our knowledge there are no contouring guidelines for the regional nodes in the prone position based on bone, skin, vascular and muscle landmarks. Forty-three patients treated with high tangents in the prone position from 2012-2018 were identified as representative cases. The level I and II regional nodal contours from the Radiation Therapy Oncology Group (RTOG) breast cancer atlas were adapted for prone position by a radiation oncologist and a breast radiologist based on anatomic considerations and changes observed from supine to prone positioning on diagnostic imaging. The revised nodal contours were reviewed by an expanded expert multidisciplinary panel including additional breast radiation oncologists and surgical oncologists to delineate the level I and II axilla on noncontrast computed tomography (CT) scans. We adapted the RTOG breast cancer atlas, supported by detailed figures, in order to create a CT based atlas of the level I and II axillary lymph node stations in the prone position. For the level I axilla, the cranial and caudal anatomic boundaries remain unchanged. With transition to the prone position from supine, tenting of the pectoralis major occurs displacing the muscle from the chest wall and shifting the axillary space anteromedial to the lateral border of the pectoralis major. Therefore, the anterior boundary is now defined by the plane of the anterior extent of the pectoralis major to skin. The medial boundary is defined by the plane of the lateral border of the pectoralis major and pectoralis minor including to ribs and intercostal muscles. The lateral boundary is defined by the skin, cropped by 5mm. The posterior boundary is defined by the plane of the anterior surface of the latissimus dorsi and subscapularis muscle to skin. For the level II axilla, the cranial, posterior, medial and lateral boundaries remain unchanged. With transition from supine to prone, the axilla exhibits an anterolateral shift, now laterally abutting the lateral border of the pectoralis minor. The anterior boundary is now defined as the posterior aspect of the pectoralis major muscle. The caudal boundary is where the pectoralis minor inserts into ribs. The adaptations to the RTOG breast cancer atlas for prone positioning will enable radiation oncologists to more accurately target the level I and II axilla when treating patients prone in whom the axilla is a target in addition to the breast.

IMRT in the treatment of locally advanced or inoperable NSCLC in the pre-durvalumab era: clinical outcomes and pattern of relapses, experience from the Oscar Lambret Center.

Intensity-modulated conformal radiotherapy (IMRT) has become the technique of choice for the treatment of locally advanced or inoperable non-small cell lung cancer (NSCLC). Nevertheless, this technique presents dosimetric uncertainties, particularly in treating moving targets such as pulmonary neoplasms. Moreover, it theoretically increases the risk of isolated nodal failure (INF) due to reduced incidental irradiation. The objective of this study was to evaluate the efficacy and safety of IMRT in patients with inoperable NSCLC and to describe the pattern of relapses. Patients with locally advanced NSCLC treated with radiotherapy and chemotherapy between 2015 and 2018 at the Oscar Lambret Center were retrospectively included in the study. Overall and progression-free survival were estimated using the Kaplan-Meier method. The cumulative incidence of the different components of relapse was estimated using the Kalbfleisch and Prentice method. Prognostic factors for relapse/death were investigated using the Cox model. A comparison with literature data was performed using a one-sample log-rank test. Seventy patients were included, and 65 patients (93%) had stage III disease. All the patients received chemotherapy, most frequently with cisplatin and navelbine. The dose received was 66 Gy administered in 33 fractions. The median follow-up and survival were 49.1 and 39.1 months, respectively. A total of 35 deaths and 43 relapses, including 29 with metastatic components, were reported. The overall survival rates at 1 and 2 years were 80.2% (95% confidence interval 68.3%-88.0%) and 67.2% (95% confidence interval 54.2%-77.3%), respectively. Locoregional relapse was observed in 14 patients, including two INF, one of which was located in the lymph node area adjacent to the clinical target volume. Median relapse-free survival was 15.2 months. No variable was statistically associated with the risk of relapse/death in multivariate analysis. Seven patients (10%) experienced grade 3 or higher toxicity. The use of IMRT for locally advanced or inoperable NSCLC led to favorable long-term clinical outcomes. The rate of locoregional relapse, particularly isolated lymph node failure, was low and comparable with that of the three-dimensional radiotherapy series, as was the rate of early and late toxicities.

Long-term outcomes of whole-pelvis radiation therapy using volumetric modulated arc therapy for high-risk prostate cancer†.

This study investigated the outcomes of whole-pelvis radiation therapy (WPRT) using volumetric modulated arc therapy (VMAT) for high-risk prostate cancer. We retrospectively analysed 112 patients with high-risk prostate cancer who started WPRT at our hospital between August 2011 and August 2015. The prescribed dose was 78Gy in 39 fractions to the prostate and 46.8Gy in 26 fractions to the pelvic lymph node (LN) area. All patients received long-term androgen deprivation therapy. We evaluated late gastrointestinal (GI) and genitourinary (GU) toxicities using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period for censored cases was 97 (interquartile range [IQR] = 85-108) months. The median age was 72 (IQR = 67-75) years. The high-risk and very-high-risk groups included 41 (36.6%) and 71 patients (63.4%), respectively. The median risk of LN invasion calculated by the Roach formula was 36.9 (IQR = 26.6-56.3) %. The 8-year overall survival, biochemical failure-free survival, disease-free survival and distant metastasis-free survival rates were 88.4, 91.9, 83.8 and 98.0%, respectively. Only one patient experienced common iliac LN recurrence, which was outside the pelvic irradiation area. All patients with recurrent disease were categorized into the very-high-risk group. The 8-year cumulative rates of ≥Grade 2 late GI and GU toxicities were 12.8 and 11.8%, respectively. No patients experienced Grade 4 or higher toxicities. WPRT using VMAT for high-risk prostate cancer was well tolerated and effective.

Comprehensive characteristics of rectal morphology in chickens with different types of autonomous regulation

The influence of typological features of autonomous regulation on the dimensions, structure, and blood supply of the rectum in chickens has been studied. The experimental group consisted of clinically healthy adult chickens of the Isa-Brown breed, divided into two groups using electrocardiography and variation pulsometry methods: chickens with sympathetic-tonic regulation and chickens with sympathetic-normotonic regulation. In each group, the length and diameter of the rectum, the branching of its arterial vessels, and the microscopic structure of the intestinal wall were examined. The corresponding artery provides the blood supply to the rectum, the branching of which showed no significant differences between the poultry groups. The peculiarities of autonomous regulation significantly influence the morphological structure of the intestinal wall’s mucous and muscular membranes. The serous membrane does not respond to these features. Chickens with sympathetic-tonic regulation (ST chickens) are characterized by a greater thickness of all indicated membranes and, consequently, the entire intestinal wall. Chickens with sympathetic-normotonic regulation (ST-NT chickens) have a greater thickness only in the muscular plate of the mucous membrane and its longitudinal layer. Regarding the quantity of collagen and elastic fibers, ST chickens dominate the mucous membrane’s crypt area, while ST-NT chickens dominate the muscular membrane. However, the density of connective tissue fibers in the mucous membrane is much lower than in the muscular one. The quantity and distribution of plasma cells have similar patterns in both groups. Specific morphometric compensation between two functionally related indicators is also an important aspect. In this case, larger values of one indicator are combined with smaller values of another. For example, a smaller diameter of the rectum in ST chickens is associated with its greater length; a smaller number of goblet cells on one villus corresponds to a larger area of their secretory section; a larger area of the nerve node of the intramuscular nerve plexus is combined with a smaller number of these nodes per 1 cm² of the intestinal wall. Thus, the structure of the rectum in chickens, adapting to the corresponding type of autonomous regulation, maintains the balance at the level of individual membranes and the entire intestinal wall.

Planar Delaunay Mesh Smoothing Method Based on Angle and a Deep Q-Network

Mesh quality is critical to the accuracy and efficiency of finite element calculations, and mesh smoothing is an essential means of reducing the number of poor elements and improving mesh quality. The deep Q-network-based optimization algorithm for planar Delaunay mesh (unconstrained DQN) has attracted increasing attention due to its advantages in autonomous optimization. However, the unconstrained DQN model does not constrain the movement area of the central node during the training process, and element quality easily falls into a local optimum, resulting in a low generalization of the DQN model. In this paper, an updateable iterative inner polygon is proposed as a constraint to limit the central node’s movement and control the element’s angle. Next, the performance of different neural networks when training the same dataset is analyzed, and the appropriate neural network is selected. After that, the effectiveness and generalization of the method were analyzed. Finally, the results were compared with those obtained by existing methods. The results show that the proposed algorithm can improve the minimum angle of global elements and the shape of poor elements, and the trained DQN model has a high generalization.

The importance of coordination in preventing overdiagnosis: a retrospective analysis of unabsorbed oxidized regenerated cellulose.

Oxidized regenerated cellulose (ORC) is commonly used to control small intraoperative bleedings in lung cancer surgery. However, difficulties in its absorption may lead to complications that can mimic malignancy recurrence in the affected areas, and may require further examination. Between 2015 and 2022, patients who underwent malignant tumour resection and lymph node dissection and were subsequently evaluated for suspected lymph node recurrence and underwent EBUS-guided needle biopsy were included in the study. Pathology reports of these patients showed an ORC-related foreign body type granulomatous reaction. Such reactions, caused by delayed absorption of ORC, can mimic malignancy recurrence and result in unnecessary biopsies. In a total of 13 patients (10 males), pathology was observed in 18 lymph node areas after malignant resection and lymph node dissection, and ORC was detected in subcarinal and inferior paratracheal lymph node areas in all patients. The average age of the patients was calculated as 63.1years (range 51-74). The mean SUVmax value observed in these lymph node areas on PET/CT was 5.22 (range 0-14.36). Although the SUVmax value decreased as the time between surgery and EBUS increased, no statistically significant difference was observed (p = 0.100). The study suggests that in cases of suspected unexpected lymph node recurrence in postoperative follow-up of lung cancer, it is important for clinicians to communicate with the surgeon and re-evaluate the use of ORC by reviewing the operative notes. This may help in determining an appropriate further investigation strategy.

Ethno-taxonomy and potential uses of highland bamboo (Oldeania alpina) landraces in Ethiopia

Highland bamboo (Oldeania alpina) (K. Schum.) Stapleton (syn: Yushania alpina), is a naturally distributed and cultivated species in the south, south-west, central and north-western highlands of Ethiopia. This study aimed to assess and describe bamboo landraces in Ethiopia based on their dendrometric and morphological traits, and also to understand their potential uses in a local context and identify and recommend potential landraces for wider industrial application. It was carried out in potential highland bamboo growing areas of four regional states of Ethiopia, viz., Amhara, Oromia, Sidama, and Southern Nations, Nationalities and People’s Regions. An extensive field survey was conducted using “transect walk for direct observation” across bamboo stands to collect technical information on identifiable characteristics for ethno-taxonomy, potential household uses, and workability of the culms of the different highland bamboo landraces. The study revealed about 24 landraces with some distinct morphological differences and traditional uses. A cladistic method also exposed some hierarchical dissimilarity among clusters of highland bamboo landraces. In the principal component analysis, nodal area contributed the highest variability among the landraces. The study also found the existence of differences in the preference and utilization of different highland bamboo landraces for various products and purposes based on the properties of the landraces. Based on the preferences of knowledgeable local bamboo processors and quality features observed on the landraces in each of the specific sites, we conclude that landraces such as Lala, Lodo, Tsarzo, Hinkonokita, Sella, Midasho, Ganticha, Shimiti, Demamo, Tikuro and Agade be widely promoted in new areas in the highlands. This would enable wood-based industries to produce quality end products while maintaining the diversity of landraces in the landscape.

Small tumor invasion of metastatic lymph node can develop extranodal extension in oral cancer

ObjectiveExtranodal extension (ENE) of lymph node metastasis in oral cancer has been well demonstrated to reflect tumor aggressiveness. However, there are few studies to show the association between ENE and tumor invasion status of metastatic lymph node. The purpose of this study is therefore to investigate pathological nodal factors including tumor invasion status of ENE-positive lymph node and its association with clinical outcomes in oral cavity squamous cell carcinoma (OSCC) patients. MethodsWe identified OSCC patients with at least one pathologically ENE-positive node and measured area of metastasis within lymph node (inside metastasis), and area of metastatic lymph node. We defined tumor invasion ratio (TIR) as the ratio of inside metastasis area to metastatic lymph node area. ResultsWe observed that the value of TIR had a wide variation and that metastatic lymph nodes with small TIR can develop ENE. In addition, we demonstrated that tumors with smaller TIR had significantly worse DFS (HR 3.94, [1.21–12.83]; p = 0.014), OS (HR 5.38, [1.45–19.93]; p = 0.005), and more DM (HR 10.01, [1.17–86.0]; p = 0.001) than those with larger TIR. ConclusionThis is the first study to evaluate the detailed tumor invasion status of lymph node with ENE and showed that smaller TIR can develop ENE which was associated with clinical outcomes.

Acute toxicity and quality of life in prostate cancer patients treated with definitive hypofractionated pelvic radiation therapy: a single-center report.

The objective was to report acute toxicity and quality of life in prostate cancer patients treated with definitive hypofractionated pelvic radiation therapy. Patients were designated candidates for hypofractionated pelvic radiation therapy if biopsy or imaging studies evidenced unfavorable intermediate-risk, high-risk or node-positive disease. Patients were treated using a regimen of 44 Gy to the nodal areas and simultaneous integrated boost of 60 Gy to the prostate in 20 fractions with CBCT-based imaging and volumetric arc therapy (VMAT). Patient data was obtained retrospectively; acute gastrointestinal (GI) and genitourinary (GU) toxicity was classified per Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and obtained from clinical records. Quality of life was surveyed via phone call using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-PR25. 78 patients were treated between May and December 2021. 83.33% of patients had high-risk disease, 16.67% had intermediate-risk disease, and 34.62% patients had node-positive disease. Median follow-up was 10.6 months. No patients presented acute grade >3 GI toxicity, and one patient presented grade 3 GU toxicity. 25.64% patients presented acute G2 GI toxicity and 17.95% patients presented acute G2 GU toxicity. 60.26% of patients responded to the EORTC-PR25 questionnaire. Mean scores for symptom scales were 11.26, 4.96 and 9.57 for Urinary Symptoms, Bowel Symptoms and Hormonal Treatment-Related Symptoms; mean scores for Sexual Activity and Functioning were 19.86 and 31.08, respectively. Definitive hypofractionated pelvic radiation therapy has an acceptable acute toxicity and QoL profile in this series of patients, although longer follow-up is needed to properly evaluate short and long-term toxicity. Further follow-up and patient recruitment is ongoing.

Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area.

Although previous studies have demonstrated that tumor deposits (TDs) are associated with worse prognosis in colon cancer, their clinical significance in rectal cancer has not been fully elucidated, especially in the lateral pelvic lymph node (LPLN) area. This study aimed to clarify the clinical significance of TDs, focusing on the number of metastatic foci, including lymph node metastases (LNMs) and TDs, in the LPLN area. This retrospective study involved 226 consecutive patients with cStage II/III low rectal cancer who underwent LPLN dissection. Metastatic foci, including LNM and TD, in the LPLN area were defined as lateral pelvic metastases (LP-M) and were evaluated according to LP-M status: presence (absence vs. presence), histopathological classification (LNM vs. TD), and number (one to three vs. four or more). We evaluated the relapse-free survival of each model and compared them using the Akaike information criterion (AIC) and Harrell's concordance index (c-index). Forty-nine of 226 patients (22%) had LP-M, and 15 patients (7%) had TDs. The median number of LP-M per patient was one (range, 1-9). The best risk stratification power was observed for number (AIC, 758; c-index, 0.668) compared with presence (AIC, 759; c-index, 0.665) and histopathological classification (AIC, 761; c-index, 0.664). The number of LP-M was an independent prognostic factor for both relapse-free and overall survival, and was significantly associated with cumulative local recurrence. The number of metastatic foci, including LNMs and TDs, in the LPLN area is useful for risk stratification of patients with low rectal cancer.

Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial

Most newly diagnosed oropharyngeal and hypopharyngeal cancers are treated with chemoradiotherapy with curative intent but at the consequence of adverse effects on quality of life. We aimed to investigate if dysphagia-optimised intensity-modulated radiotherapy (DO-IMRT) reduced radiation dose to the dysphagia and aspiration related structures and improved swallowing function compared with standard IMRT. DARS was a parallel-group, phase 3, multicentre, randomised, controlled trial done in 22 radiotherapy centres in Ireland and the UK. Participants were aged 18 years and older, had T1-4, N0-3, M0 oropharyngeal or hypopharyngeal cancer, a WHO performance status of 0 or 1, and no pre-existing swallowing dysfunction. Participants were centrally randomly assigned (1:1) using a minimisation algorithm (balancing factors: centre, chemotherapy use, tumour type, American Joint Committee on Cancer tumour stage) to receive DO-IMRT or standard IMRT. Participants and speech language therapists were masked to treatment allocation. Radiotherapy was given in 30 fractions over 6 weeks. Dose was 65 Gy to primary and nodal tumour and 54 Gy to remaining pharyngeal subsite and nodal areas at risk of microscopic disease. For DO-IMRT, the volume of the superior and middle pharyngeal constrictor muscle or inferior pharyngeal constrictor muscle lying outside the high-dose target volume had a mandatory 50 Gy mean dose constraint. The primary endpoint was MD Anderson Dysphagia Inventory (MDADI) composite score 12 months after radiotherapy, analysed in the modified intention-to-treat population that included only patients who completed a 12-month assessment; safety was assessed in all randomly assigned patients who received at least one fraction of radiotherapy. The study is registered with the ISRCTN registry, ISRCTN25458988, and is complete. From June 24, 2016, to April 27, 2018, 118 patients were registered, 112 of whom were randomly assigned (56 to each treatment group). 22 (20%) participants were female and 90 (80%) were male; median age was 57 years (IQR 52-62). Median follow-up was 39·5 months (IQR 37·8-50·0). Patients in the DO-IMRT group had significantly higher MDADI composite scores at 12 months than patients in the standard IMRT group (mean score 77·7 [SD 16·1] vs 70·6 [17·3]; mean difference 7·2 [95% CI 0·4-13·9]; p=0·037). 25 serious adverse events (16 serious adverse events assessed as unrelated to study treatment [nine in the DO-IMRT group and seven in the standard IMRT group] and nine serious adverse reactions [two vs seven]) were reported in 23 patients. The most common grade 3-4 late adverse events were hearing impairment (nine [16%] of 55 in the DO-IMRT group vs seven [13%] of 55 in the standard IMRT group), dry mouth (three [5%] vs eight [15%]), and dysphagia (three [5%] vs eight [15%]). There were no treatment-related deaths. Our findings suggest that DO-IMRT improves patient-reported swallowing function compared with standard IMRT. DO-IMRT should be considered a new standard of care for patients receiving radiotherapy for pharyngeal cancers. Cancer Research UK.

Experimental and FEM investigation of BCC lattice structure under compression test by using continuum damage mechanics with micro-defect closure effect

The failure of the cellular structures and the prediction of their limit load and type of failure are essential in their design and applications. The isotropic Continuum Damage Mechanics (CDM) model of Lemaitre with micro-defect closure effect was considered to simulate the mechanical response of the BCC lattice structure under a compression test. Defects caused during the manufacturing process is considered an initial damage. The simulation results of the compression tests on the 316L Stainless Steel (SS) lattice structures, which were manufactured by the Selective Laser Melting method (SLM), and the experimental results have been compared. The same study was conducted on the AlSi10Mg manufactured lattice structures. FE simulation showed that the CDM model can predict the elastic modulus and yield strength of the lattice structure with good accuracy. The stress–strain curve of the lattice structure, obtained from the FE simulation, agrees well with the experimental results before the condensation. According to the conducted experiments, the failure mechanism for the considered cases is bending dominated with high plastic deformation at the connection area of nodes and struts. The present model predicts the state of damage of the structure with good accuracy and it is in agreement with the experimental results.

Outcomes and toxicity of concurrent CDK4/6 inhibitor and locoregional radiotherapy for patients with de novo metastatic breast cancer.

The objective of the present study was to assess the outcomes and toxicity of patients treated with concurrent administration of CDK4/6 inhibitors (CDK4/6i) and locoregional radiation therapy (RT), including the breast with a boost or the thoracic wall after mastectomy and the regional lymph node areas. We retrospectively analyzed data from 27 patients with hormone receptor-positive, HER2-negative de novo metastatic breast cancer treated with CDK4/6i and concomitant locoregional RT in 2017/2022. Survival rates were calculated by Kaplan-Meier method. Prognostic factors were tested with log-rank test. CDK4/6i was used as the first systemic metastatic treatment for all the patients, and the median overall treatment time was 26 months. The median time from initiation of CDK4/6i to the start of RT was 10 months (IQR: 7-14 months). The median duration of concomitant CDK4/6i and RT administration was 21 days (IQR: 14.5-23 days). After a median follow-up of 19 months (IQR: 14-36 months), 1 patient died, 11/27 had distant metastases and 1 patient had local recurrence, respectively. The 1- and 3-years progression-free survival (PFS) were 61.4% (95% CI: 45.1%-83.7%) and 53.7% (35.8%-80.5%), respectively. The acute toxicities most observed during RT were neutropenia (44%) and dermatitis (37%). Dermatitis was significantly more frequent in patients with large target volumes (CTV > 911 cc and PTV > 1285 cc). CDK4/6i had to be discontinued in five patients during RT (due to toxicity in three cases and disease progression in two cases). One patient has developed grade 2 late pulmonary fibrosis. Finally, our study demonstrated that concurrent administration of locoregional RT and CDK4/6i did not induce severe late toxicity for most patients.

A detection method of wormhole attack in power communication sensor networks based on hops

Aiming at the problems of low accuracy of determining attack nodes and large detection error in the wormhole attack detection method of power communication sensor networks, a wormhole attack detection method based on hops is proposed. Firstly, the working process of power communication sensor network nodes is analyzed; Regard the node area as a closed circle, set the distance between nodes and communication radius in the area, and determine the wormhole attack location; Then, introduce the hop number, replace the linear distance between attack nodes with the hop distance of hop number, the centroid position is calculated by polygon calculation, the node hop distance is determined, and the wormhole attack probability is calculated; Finally, the average hop distance between wormhole attack nodes is calculated, and the path hop distance of attack behavior is corrected with the help of objective function and minimum mean square error criterion to complete attack detection. The experimental results show that the detection accuracy of this method is 98%, and the detection error is only 2.6%, so it has application value.

THE LOW‐RISK EARLY‐STAGE HODGKIN LYMPHOMA PATIENTS WITH INADEQUATE RESPONSE TO CHEMOTHERAPY. THE PRELIMINARY EXPERIENCE FROM THE RAFTING TRIAL

Introduction: Early-stage Hodgkin Lymphoma (eHL) treated with a combined modality approach (CMT): chemotherapy (CT) and radiotherapy (RT) is a highly curable disease. However, for 70% of eHL patients (pts.) CT alone might be sufficient for cure. The RAFTING trial is a phase 2, multicenter, international prospective study investigating risk-adapted treatment strategy in eHL pts. We hypothesized that CT alone will be sufficient for to cure low-risk pts. Here we would like to present the clinical characteristics of low-risk pts. for whom CT was not sufficient to achieve a complete response (CR). Methods: Treatment intensity in RAFTING is tailored to two risk categories: low or high risk. Low-risk pts. are defined by low baseline metabolic tumor volume (MTV) and negative interim PET after 2 ABVD cycles. High-risk pts. were defined by high baseline MTV and/or positive iPET2. Within the low-risk group the pts. without any risk factors according to modified EORTC (mEORTC) criteria (largest nodal mass (LNM) 5–10 cm, Age > 50 yo, ESR > 50 mm/h, ≥4 nodal areas (NA)) (group 1a) are treated with 2 ABVD cycles only whereas pts. with at least 1 risk factor (group 1b)—with 4 ABVD cycles. High-risk pts. (group 3) receive “triple” therapy (4 ABVD cycles, RT and nivolumab for 12 months; RT-NIV). In case of “limited relapse” (i.e., within initially involved lymph nodes and/or up to 3 new nodal areas) pts. receive delayed RT-NIV. Results: In a per-protocol analysis, out of 77 stratified pts. in March 2023, seven pts. (9%) with low-risk disease, had inadequate response to ABVD alone (defined as achievement less than CR or early relapse (<6 months after the end of the CT): 2 pts. from group 1a and 5 pts. from group 1b. Specifically, one pt. from Group 1a had an extended and symptomatic (B symptoms) relapse, and underwent salvage therapy with ASCT and two pts. from group 1b were withdrawn due to PI decision. While 4 pts. (1 in Group 1a and 3 in Group 1b) with less than CR (2 pts.) or early relapse (2 pts.) received RT + NIV. The most frequent risk factor among 1b pts. was LNM, which was observed in 4 pts., age >50 yo—in 2 patients, and ≥4 NA—in 1 pt. More than 1 risk factor had 2 pts. In 4 cases the confirmatory biopsy was done and was positive for HL in 3 out of 4 cases. Conclusion: The frequency of inadequate response after CT alone observed in the RAFTING trial was similar to that reported by the literature. The most frequent adverse prognostic factor presented in these small pts. subset was a LNM. Keywords: combination therapies, Hodgkin lymphoma, radiation therapy No conflicts of interests pertinent to the abstract.

¿Cuál es el fraccionamiento estándar en la irradiación del cáncer de mama?

Radiotherapy (RT) after breast-conserving surgery for breast cancer (BC) has been shown to reduce local recurrence rates and mortality. The conventional treatment of postoperative radiotherapy was 50 to 50.4 Gy, administered in 25 to 28 fractions over a period of 5 to 6 weeks. In the last 20 years, there is clinical evidence to consider hypofractionated treatment regimens safe and effective. Moderate hypofractionation, administered over 3 weeks, can be considered the standard of care after conservative surgery or mastectomy, as well as in irradiation of lymph node areas, with similar results regarding local control and survival and with effects on acute and chronic normal tissue. , similar or smaller. Ultrahypofractionated treatment, administered in 5 sessions, for 1 or 5 weeks, is a safe and effective treatment after conservative surgery and mastectomy without reconstruction. Early results have been reported that ultrahypofractionated treatment in 1 week is safe when lymph node areas are irradiated.

Baseline‐PET derived metrics are the most relevant factors for risk stratification in early‐stage nonbulky HL: preliminary results of the RAFTING trial

Introduction: The efficacy of combined-modality treatment (Tx) with chemotherapy (CT) and radiotherapy (RT) in early-stage Hodgkin Lymphoma (eHL) is offset by long-term morbidity, with a cumulative incidence of 2nd primary malignancy at 40 years of 48.5% (Schaapveld 2015). The RAFTING trial (NCT Id. 04866654) is a phase-2 prospective single-cohort international study to explore the effectiveness of a risk-adapted Tx in non-bulky stage I-IIA eHL, based on the risk of CT failure (TxF) in a single-patient (p.) basis and in a personalized medicine design. Methods: p. are first stratified in 3 classes of TxF risk, depending on (a) modified EORTC criteria (m-EORTC), in which bulky is replaced by a Large Nodal Mass (LNM), defined by a longest ∅ measuring ≥5 cm in CT or PET/CT, (b) Metabolic Tumor Volume (MTV), with a SUVmax threshold method of 41% and cutoff value of 84 ml, and (c) PET-2 result (5-point scale). Tx stratification: Group 1: PET-2 neg. & low MTV p., treated either with 2 (group 1a) or 4 (group 2b) ABVD depending on no or ≥1 m-EORTC criterion presence, addressed, once in CR, to a 3-monthly cell-free tumor DNA (ctDNA) assay (CAPPSeq. Method, Spina 2018); Group 2: group 1 p. with < CR after ABVD or in “limited” relapse (LR), defined by eHL relapse in old and up to 3 new nodal areas, addressed to Involved-Node RT (INRT) and Nivolumab (N), 240 mg. i.v. twice a month for 24 doses; Group 3: PET-2+ and/or high MTV p., treated with the triplet ABVD × 4, INRT, 20 or 30 Gy (A-RxT-N). All PET/CT scans are centrally reviewed by an expert panel. The trial primary endpoint is a 3-Y PFS ≥90% in group 1 p. The secondary endpoints are: (a) Effectiveness of RxT (36 Gy) and N (same schedule of Group 3), in rescue p. with LR (b) effectiveness of the triplet A-RxT-N in high-risk (Group 3) eHL; (c) predictive value of ctDNA in detecting an impending eHL relapse after CT alone. Results: Preliminary results of risk stratification upon enrolment of the first 104/180 (58%) of the pre-planned sample size: in a per-protocol analysis, 88/104 (85%) turned out eligible and 73 stratified for risk. Non-eligibility reasons were higher HL stage, or bulky (10 p.) and early Tx stop, for p./investigator decision: (6p.). Out of 73 p. stratified, 53 (73%) were low-risk (Group 1), and 20 (27%) high risk (Group 3). Out of 53 low-risk p., 16 were in Group 1a: one of them was addressed to salvage Tx with ASCT because of an extended relapse 3 months after CT end. As many as 37 (70%) of low-risk p. belonged to Group 1b, mostly because of the presence of a LNM; two of them had a LR (entering Group 2) and started RxT-N rescue. Twenty p. (27%) had high-risk disease, most (14) for a high MTV, and a minority (6) for a positive PET-2. Updated results will be presented. The research was funded by: Polish Medical Agency ABM Ongoing Trial Keywords: Liquid biopsy, Ongoing Trials, PET-CT No conflicts of interests pertinent to the abstract.

Diagnostic Performance of Superb Microvascular Imaging in Differentiating Benign and Malignant Axillary Lymph Nodes.

The aim was to evaluate the effectiveness of superb microvascular imaging (SMI) in axillary lymph nodes (LNs).Benign and malignant LNs diagnosed via histopathological examination constituted the study subgroups. In addition to grayscale findings for morphological evaluation, vascular patterns and appearance of internal vessels were analyzed by both power Doppler ultrasound (PDUS) and SMI. The number of vascular branches was counted, and a vascularity index (VI) was calculated by SMI.Fifty-two LNs with suspicious findings in terms of metastasis (33 malignant and 19 benign) were evaluated. Diagnostic accuracy according to vascular patterns was 82% for PDUS and 92% for SMI. In the presence of asymmetric cortical thickening, there was a significant difference between benign and malignant LNs in the number of vascular branches of both thin and thick cortical sides ( P < 0.01). Mean VI was significantly higher in the malignant group ( P < 0.05). In differentiating malignancy, when a cutoff VI value was set to 9%, sensitivity was 69.7%, and specificity was 63.2%.Evaluating the vascularity of axillary LNs by SMI is a useful tool in determining the potential of axillary metastasis, especially in the absence of typical sonographic findings. Superb microvascular imaging can beneficially be used to select the most suspicious LN and suspicious area of the LN to sample.

Analytical Model of Interaction of an Oil Pipeline with a Support of an Overpass Built in a Mountainous Area

Today, pipelines are the safest and most economical way to transport petroleum products and one of the key components of modern energy infrastructure. Nevertheless, pipeline systems are associated with certain risks that can lead to environmental disasters. The idea of carrying out this study was initiated by the results of the survey of the overpasses of the long-used oil pipelines laid in the mountainous area of the Carpathian region. Defects such as a change in the shape of the pipe and local bulges in the area of oil pipeline support nodes were detected. The explanation of the described problem is separate from the typical algorithms of design calculations, which are offered to manufacturers by current directive documents. The desire to provide an explanation and quantitative assessment of the detected defects became the main motivation for writing the article. An analytical model of the interaction of the oil pipeline with the rigid support has been developed. Additional internal loads in the cross-section of the pipe and displacement of its middle surface, which arise as a result of such interaction, are determined. The method of determining the reaction in the intermediate support of the overpass of the oil pipeline has been developed, considering the properties of the soil base in the underground sections and the mounting gap in the support node. The analytical dependence was obtained to determine the additional hoop stresses that arise in the oil pipeline due to the contact of the pipe with the support. The unambiguous relationship between the maximum additional hoop stress and the reaction in the support node was established. The dependence of additional hoop stresses on the geometric characteristics of the pipes was analyzed. The obtained research results are tested on the real structure of the overpass of the Druzhba oil pipeline, built in the Carpathians. In general, a simple engineering technique has been developed that allows analyzing the behavior of the oil pipeline support node and provides the numerical correction to the traditional strength assessment formulas, which determine the equivalent stresses in the oil pipeline.

ANALISIS PENGARUH PERTUMBUHAN KOTA KENDARI TERHADAP PENGEMBANGAN KAWASAN HINTERLAND PROPINSI SULAWESI TENGGARA

The hinterland area is one part of the nodal area concept, where the division is based on the respective functions of each region. This study aims to analyze the effect of the growth of Kendari City on the development of the hinterland area of Southeast Sulawesi Province. Research using qualitative and quantitative methods with descriptive analysis and spatial analysis The results of the study showed that there was an increase in the interaction between Kendari City and other surrounding sub-districts, namely Ranomeeto District, Sampara District, and Soropia District. The model used to measure the interaction is the gravity model, which produces the gravity number for each sub-district. The district that has the largest gravity number with Kendari City is Ranomeeto District, followed by Sampara District, and finally Soropia District. Distance has a negative relationship with the force of gravity. The closer the distance between the two areas, the greater the gravity number generated, which indicates that the interaction between the two areas is getting bigger. In general, the interaction between Kendari City and its hinterland sub-districts during 2018–2022 has increased, although the increase has slowed down. The interaction between Kendari City and three other surrounding sub-districts, namely Ranomeeto Sub-District, Sampara Sub-District, and Soropia Sub-District, can be categorized as a generative type of relationship, namely a relationship that is mutually beneficial or mutually developing between more advanced regions and the regions behind them.