Total Radiation Dose Research Articles

Robotic-Assisted Versus Fluoroscopic-Guided Surgery on the Accuracy of Spine Pedicle Screw Placement: A Systematic Review and Meta-Analysis.

Spinal fusion is a common method by which surgeons decrease instability and deformity of the spinal segment targeted. Pedicle screws are vital tools in fusion surgeries and advancements in technology have introduced several modalities of screw placement. Our objective was to evaluate the accuracy of pedicle screw placement in robot-assisted (RA) versus fluoroscopic-guided (FG) techniques. The PubMed and Cochrane Library databases were systematically reviewed from January 2007 through to August 8, 2022, to identify relevant studies. The accuracy of pedicle screw placement was determined using the Gertzbein-Robbins (GR) classification system. Facet joint violation (FJV), total case radiation dosage, total case radiation time, total operating room (OR) time, and total case blood loss were collected. Twenty-one articles fulfilled the inclusion criteria. Successful screw accuracy (GR Grade A or B) was found to be 1.02 (95% confidence interval: 1.01 - 1.04) times more likely with the RA technique. In defining accuracy solely based on the GR Grade A criteria, screws placed with RA were 1.10 (95% confidence interval: 1.06 - 1.15) times more likely to be accurate. There was no significant difference between the two techniques with respect to blood loss (Hedges' g: 1.16, 95% confidence interval: -0.75 to 3.06)or case radiation time (Hedges' g: -0.34, 95% CI: -1.22 to 0.53). FG techniques were associated withshorter operating room times (Hedges' g: -1.03, 95% confidence interval: -1.76 to -0.31), and higher case radiation dosage (Hedges' g: 1.61, 95% confidence interval: 1.11 to 2.10).This review suggests that RA may slightly increase pedicle screw accuracy and decrease per-case radiation dosage compared to FG techniques. However, total operating times for RA cases are greater than those for FG cases.

Sarcopenic Obesity in Cervical Carcinoma: A Strong and Independent Prognostic Factor beyond the Conventional Predictors (ESTHER Study-AFRAID Project).

Locally advanced cervical cancer represents a significant treatment challenge. Body composition parameters such as body mass index, sarcopenia, and sarcopenic obesity, defined by sarcopenia and BMI ≥ 30 kg/m2, have been identified as potential prognostic factors, yet their overall impact remains underexplored. This study assessed the relationship between these anthropometric parameters alongside clinical prognostic factors on the prognosis of 173 cervical cancer patients. Survival outcomes in terms of local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were analyzed using Kaplan regression methods-Meier and Cox. Older age, lower hemoglobin levels, higher FIGO (International Federation of Gynecology and Obstetrics) stages, and lower total radiation doses were significantly associated with worse outcomes. Univariate analysis showed a significant correlation between BMI and the outcomes examined, revealing that normal-weight patients show higher survival rates, which was not confirmed by the multivariate analysis. Sarcopenia was not correlated with any of the outcomes considered, while sarcopenic obesity was identified as an independent negative predictor of DFS (HR: 5.289, 95% CI: 1.298-21.546, p = 0.020) and OS (HR: 2.645, 95% CI: 1.275-5.488, p = 0.009). This study highlights the potential of sarcopenic obesity as an independent predictor of clinical outcomes. These results support their inclusion in prognostic assessments and treatment planning for patients with advanced cervical cancer.

Image fusion guidance for left subclavian artery in situ fenestration during thoracic endovascular repair.

To evaluate the feasibility and clinical benefit of utilizing image fusion for thoracic endovascular repair (TEVAR) with in situ fenestration (ISF-TEVAR). Between January 2020 and December 2020, we prospectively collected 18 consecutive cases with complex thoracic aortic lesions who underwent image fusion guided ISF-TEVAR. As a control group, 18 patients were collected from historical medical records from June 2019 to December 2019. The fusion group involved the use of 3D fusion of CTA and fluoroscopic images for real-time 3D guidance, and the control group involved the use of only regular fluoroscopic images for guidance. The total contrast medium volume, hand-injected contrast medium volume, overall operative time, radiation dose and fluoroscopy time were compared between the two groups. Accuracy was measured based on preoperative CTA and intraoperative digital subtraction angiography. 3D fusion imaging guidance was successfully implemented in all patients in the fusion group. Hand-injected contrast medium volume and overall operative time were significantly lower in the fusion group than in the control group (p = .028 and p = .011). Compared with the control group, the fusion group showed a significant reduction in time and radiation dose-area product (DAP) for fluoroscopy (p = .004 and p = .010). No significant differences in total radiation dose (DAP) or total contrast medium volume were observed (p = .079 and p = .443). Full accuracy was achieved in 8 cases (44%), with a mean deviation of 2.61mm ± 3.1 (range 0.0-8.4mm). 3D image fusion for ISF-TEVAR was associated with a significant reduction in hand-injected contrast medium, time and radiation exposure for fluoroscopy and overall operative time. The image fusion guidance showed potential clinical benefits towards improved treatment safety and accuracy for complex thoracic endovascular interventions.

Robotic Stereotactic Body Radiotherapy for Spine Metastasis Pain Relief

Spinal metastasis may occur in 40–70% of patients with cancer. Symptoms can vary from pain to spinal cord compression (SCC) and can affect their quality of life (QoL). Stereotactic body radiotherapy (SBRT) allows dose escalation of spinal tumor metastases, minimizing doses to organs at risk and improving pain control. The aim of this study is to retrospectively describe our institution’s experience with robotic SBRT (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA) for spinal metastases, in terms of feasibility, oncological results, toxicities, and pain relief observed. In total, 25 patients with 43 lesions were assessed, most of them with dorsal metastases (48.8%). The median total dose was 27 Gy (16–35 Gy), the median number of fractions administered was 3 (1–5), and the median dose per fraction was 9 Gy. Pain was evaluated using the visual analogue scale at baseline and at the end of treatment. The statistically significant reduction in pain (p < 0.01) was associated with the total dose of radiotherapy delivered (p < 0.01). Only one patient developed grade 3 dermatitis. Female gender, adenocarcinoma tumors, and lack of previous surgery were associated with better response to SBRT (p < 0.05). Robotic spine SBRT is feasible, well-tolerated, and improves patients’ QoL through a statistically significant reduction in pain, so it should be offered to patients at an early stage in their process.

Dual-energy computed tomography in the early evaluation of acute radiation pneumonia

ObjectiveTo investigate the value of dual-energy dual-source computed tomography (DSCT) in evaluating pulmonary perfusion changes before and after radiotherapy for esophageal cancer, and its clinical use in the early diagnosis of acute radiation pneumonia (ARP).MethodsWe selected 45 patients with pathologically confirmed esophageal cancer who received radiotherapy (total irradiation dose of 60 Gy). Dual-energy DSCT scans were performed before and after radiotherapy and the normalized iodine concentrations (NIC) in the lung fields of the areas irradiated with doses of > 20 Gy, 10–20 Gy, 5–10 Gy, and < 5 Gy were measured. We also checked for the occurrence of ARP in the patients, and the differences in NIC values and NIC reduction rates before and after radiotherapy were calculated and statistically analyzed.ResultsA total of 16 of the 45 patients developed ARP. The NIC values in the lung fields of all patients decreased at different degrees after radiotherapy, and the NIC values in the area where ARP developed, decreased significantly. The rate of NIC reduction and incidence rate of ARP increased gradually with the increasing irradiation dose, and the inter-group difference in NIC reduction rate was statistically significant (P < 0.05). Based on the receiver operating characteristic (ROC) curve analysis, the areas under the curves of NIC reduction rate versus ARP occurrence in the V5-10 Gy, V10-20 Gy, and V> 20 Gy groups were 0.780, 0.808, and 0.772, respectively. Sensitivity of diagnosis was 81.3%, 75.0%, and 68.8% and the specificity was 65.5%, 82.8%, and 79.3%, when taking 12.50%, 16.50%, and 26.0% as the diagnostic thresholds, respectively. The difference in NIC values in the lung fields of V<5 Gy before and after radiotherapy was not statistically significant (P > 0.05).ConclusionThe dual-energy DSCT could effectively evaluate pulmonary perfusion changes after radiotherapy for esophageal cancer, and the NIC reduction rate was useful as a reference index to predict ARP and provide further reference for decisions in clinical practice.

Assessing and improving radiation safety in cardiac catheterization: a study from Cairo University Hospital

BackgroundCatheter laboratories are high-radiation exposure environments, especially during X-ray procedures like percutaneous transluminal coronary angioplasty and electrophysiological studies. Radiation exposure poses risks of stochastic (e.g., cancer) and deterministic (e.g., skin changes) effects. This study assessed radiation safety and health practices in a cardiac catheterization unit to optimize radiation safety. A cross-sectional study in Cairo University Hospital (March–September 2019) evaluated 700 patients and healthcare workers. Real-time radiation measurements, educational lectures, and radiation protection measures were implemented in three phases. Data on radiation exposure, procedures, and compliance were collected and analyzed.ResultsThe total procedure time and fluoroscopy time per cardiologist did not significantly differ between phases, but there was a statistically significant reduction in the mean total cumulative radiation doses between Phase I and Phase III for cardiologists (P = 0.013). Among nurses and technicians, there was no significant difference in radiation doses between the two phases. Significant correlations were found between operators' radiation doses, procedure time, and fluoroscopy time. Patients' radiation doses decreased significantly from Phase I to Phase III, with correlations between dose, procedure time, and gender. Compliance with radiation protection measures was suboptimal.ConclusionsCompliance with radiation safety standards in the cardiac catheterization unit at the Cairo University Hospital needs improvement. The study highlights the importance of adhering to radiation safety principles and optimizing protective measures to reduce radiation exposure for both patients and healthcare personnel. Despite low compliance, significant reductions in radiation doses were achieved with increased awareness and adherence to specific protection measures. Future efforts should focus on enhancing radiation safety protocols and organ-specific radiation impact assessments.

Research on performance ratio composition and standard energy efficiency ratio correction method of photovoltaic power station

The performance ratio (PR) of the system is used to quantify the power generation efficiency of the photovoltaic power generation system. The size of the index is affected by many factors. After the environmental impact is compensated, the standard energy efficiency ratio (PRstc) of the system is obtained. PRstc is an important index for evaluating the power generation efficiency of photovoltaic power stations. Improving the accuracy of PRstc is conducive to improving the state evaluation and analysis capabilities of power stations, providing a theoretical basis for comparative analysis of photovoltaic power stations in different regions, and improving the scientific operation and maintenance of power stations. The PRstc calculation method of the industry standard NB / T 10394-2020 does not consider the influence of the change of the power temperature coefficient of the component and the weak light response of the photovoltaic cell, which ultimately leads to the calculation result less than the actual value. In order to reduce the error in the calculation of PRstc, the mathematical relationship between PR and power loss of photovoltaic power station is discussed. The calculation method of power loss caused by the change of environmental factors is proposed, and the PRstc is calculated by using the variation. Finally, the PRstc is calculated according to the actual operation data of photovoltaic power station, and compared with the calculation method of industry standard NB / T 10394-2020. The results show that when the total irradiation dose is high, the difference between the two PRstc values is less than 2 %. When the total irradiation is low, the calculation result is larger than that of the standard method, and the difference between the two increases with the decrease of the total irradiation. Due to the consideration of the change of power generation caused by the characteristics of photovoltaic modules, the error caused by the change of power temperature coefficient and weak light response of modules is reduced, which is more advantageous than the calculation method of industry standard.

ОЦЕНКА РАДИАЦИОННОЙ ОБСТАНОВКИ ПРИ КРАТКОВРЕМЕННЫХ ПОЛЕТАХ НА ЛУНУ

Background: The issue of assessing the features of factors affecting the formation of radiation doses of astronauts while in orbit of the Moon and on its surface remains insufficiently studied, which is important for ensuring the anti-radiation safety of astronauts on lunar missions. Purpose: To analyze the factors influencing the formation of the radiation dose of astronauts at the stage of finding the spacecraft in orbit of the Moon and the lander on its surface. Material and methods: The features of the dose load levels on astronauts at the stages of the Moon’s orbit and on the Moon’s surface are analyzed and generalized, calculation methods are used taking into account the orbit of the spacecraft around the Moon, the anti-radiation properties of the materials of the lander and spacesuit and the time spent in them during a short-term lunar mission. Results: The total radiation doses of astronauts for 14 days, calculated according to dosimetric measurements during the years of low solar activity (2009 and 2018‒2019), are 19.5‒23.2 mSv for astronauts staying in a spacecraft in lunar orbit, and from 22,7 to 24,0 mSv for astronauts on the Lunar surface, depending on the mass thickness of the protection at the maximum permissible 250 mSv for 1 month. An increase in the mass thickness of the anti-radiation protection of the lander in the equivalent of aluminum from 1.5 to 3-5 g/cm2 and the lunar spacesuit in the equivalent of aluminum from 0.2 to 0.5‒1 g/cm2 will reduce the total radiation dose of astronauts no more than 1.3 times during a 14-day stay on the surface of the moon. The results indicate that in order to minimize the radiation doses that astronauts receive during a lunar mission, it is important to take into account the forecast of solar activity in order to optimize the launch time of the spacecraft in the «windows» with minimal levels of radiation exposure. Conclusion: When predicting radiation hazard levels for astronauts during a short-term lunar mission, it is necessary to assess the levels of exposure to cosmic ionizing radiation both in the orbit of the Moon, depending on the lunar trajectory of the spacecraft, and on the surface of the Moon, taking into account the time spent in the lunar module and in a spacesuit, as well as levels of solar activity. It is important to take into account the analyzed features of the formation of cosmonauts’ radiation doses while orbiting the Moon and on its surface when predicting the time limits of the lunar mission, anti-radiation protection of astronauts and their compliance with the regulatory limits of exposure.

Consequence-based security for microreactors

Assuring physical security for Micro Modular Reactors (MMRs) will be key to their licensing. Economic constraints however require changes in how the security objectives are achieved for MMRs. A promising new approach is the so-called performance based (PB) approach wherein the regulator formally sets general security objectives and leaves it to the licensee to set their own specific acceptance criteria to meet those objectives.To implement the PB approach for MMRs, one performs a consequence-based analysis (CBA) whose objective is to study hypothetical malicious attacks on the facility, assuming that intruders take control of the facility and perform any technically possible action within a limited time before an offsite security force can respond. The scenario leading to the most severe radiological consequences is selected and studied to estimate the limiting impact on public health. The CBA estimates the total amount of radionuclides that would be released to the atmosphere in this hypothetical scenario to determine the total radiation dose to which the public would be exposed. The predicted radiation exposure dose is then compared to the regulatory dose limit for the site.This paper describes application of the CBA to four different MMRs technologies.

TRImodal DEfinitive invasive vagiNal carcinoma Treatment (TRIDENT protocol): how a standardized approach may change prognostic outcomes

ObjectiveVaginal carcinoma is a rare malignancy accounting for 1–2% of all gynecological cancers. Surgery has a limited role, while definitive radiotherapy–chemotherapy followed by interventional radiotherapy is considered a valid alternative....

Evaluation of the Relationship Between Papillary Thyroid Cancer and Radiation Exposure

Introduction: It has been identified ionizing radiation as the definitive cause of cancer in humans. One third of the tumors that develop after radiation exposure are malignant, with papillary thyroid cancer (PTC) being the most common cancer type. This study aimed to investigate the relationship between total radiation dose (TRD) received during imaging tests and thyroid cancer occurrence in patients diagnosed with PTC.&#x0D; Material and Method: The study was designed to retrospectively review the data of adult patients aged ≥ 18 years who were diagnosed with PTC between 2005 and 2022. Patients diagnosed with a condition other than PTC were excluded from the study&#x0D; Result: 307 patients with papillary thyroid cancer were 256 (83.4%) women, with a mean age of 44.7 ± 13.5 years. A statistically significant relationship was observed between TRD and multifocality (p = 0.02). Tumor size (r = 0,2, p = 0.07) weakly correlated with TRD. And TRD (OR: 0.9, 95% CI: 1.0-1.1, p: 0.006) according to multifocalty were found to be significant. &#x0D; Discussion: This study found an association between TRD taken during imaging tests and multifocality. As a result, the authors aimed to remind clinicians that the disease may progress more aggressively and that thyroid cancer may develop in patients exposed to radiation as a result of excessive imaging tests

Factors associated with cavity formation after stereotactic body radiation therapy for peripheral early-stage lung cancer.

This retrospective study aimed to identify the factors associated with cavity formation after SBRT in peripheral early-stage lung cancer patients. We analyzed the occurrence of cavity changes after SBRT. We examined 99 cases with T1-T2aN0 peripheral non-small cell lung cancer treated with SBRT from 2004 to 2021. Patients underwent respiratory function tests, including diffusing capacity for carbon monoxide (DLco), before treatment. The median observation period was 35months (IQR 18-47.5months). Treatment involved fixed multi-portal irradiation in 67% of cases and VMAT in 33%. The total radiation doses ranged from 42 to 55Gy, delivered over 4 to 5 fractions. Cavity formation occurred in 14 cases (14.1%), appearing a median of 8months after SBRT. The cavity disappeared in a median of 4months after formation. High DLco and total radiation dose were identified as factors significantly associated with cavity formation. There have been no confirmed recurrences to date, but one patient developed a lung abscess. Although cavity formation after SBRT for peripheral early-stage lung cancer is infrequent, it can occur. This study showed high DLco and total radiation dose to be factors significantly associated with cavity formation. These findings can be applied to optimizing radiation therapy (RT) and improving patient outcomes. Further research is needed to determine the optimal radiation dose for patients with near-normal DLco for whom surgery is an option. This study provides valuable insights into image changes after RT.

Incorporation of total ionizing dose effects into a compact model for p-GaN gate high electron mobility transistors

Total ionizing dose (TID) characteristics of p-GaN gate high electron mobility transistors (HEMTs) under different bias conditions are explored in this work. Potential mechanism accounting for the TID response of p-GaN gate HEMTs is analyzed, based on which a TID effects model is developed. The TID effects model describes the relationship among threshold voltage of p-GaN gate HEMTs, total radiation dose, and electric field inside the p-GaN cap layer. Furthermore, an approach incorporating the TID effects model into Advanced Spice Model for HEMT (ASM-HEMT) is proposed, the reliability of which is validated by the well-fitted modeled results in comparison with the measured ones. This approach makes it possible to probe into the impact of TID effects on p-GaN gate HEMTs from the perspective of circuit level, which provides a basis for the follow-up GaN-based circuit design.

The Diagnostic Yield of Cone Beam CT Combined With Radial-Endobronchial Ultrasound for the Diagnosis of Peripheral Pulmonary Nodules: Systematic Review and Meta-Analysis

BackgroundIdentification of peripheral pulmonary nodules (PPNs) are becoming increasingly common with modern imaging and lung cancer screening programs. Navigational bronchoscopy has been developed to augment the diagnostic yield of sampling these nodules. Cone beam computed tomography (CBCT) is one navigational tool which can be used alongside the historical gold standard of fluoroscopy and radial endobronchial ultrasound (r-EBUS). Research questionsTo assess the diagnostic yield and safety profile of combining CBCT with r-EBUS for the diagnosis of PPNs. Study design and methodsEmbase, PubMed and Cochrane Central were searched in March 2023. Eligible studies used CBCT with r-EBUS as the primary navigation technique. The primary outcome; diagnostic yield, was analysed using random effects meta-analysis. Additional subgroup analysis was based on the use of additional navigational technologies. Risk of bias was assessed using the Critical Appraisal Skills programme (CASP) tool for diagnostic studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the quality of outcomes. ResultsFourteen studies (n=865 patients, n=882 lesions) were included. The risk of bias was significant as assessed using the CASP tool, which identified multiple confounders. The pooled diagnostic yield of combined CBCT and r-EBUS guided biopsy for the diagnosis of PPNs was 80% (95%CI 76-84%). Subgroup analysis of diagnostic yield for CBCT and r-EBUS alone was 80% (95%CI 76-83%). The diagnostic yield of CBCT, r-EBUS combined with additional navigational technology (electromagnetic navigational bronchoscopy, virtual bronchoscopic navigation and robotic assisted bronchoscopy) was 80% (95%CI 73-87%). The quality of outcomes was assessed as low to very low using the GRADE tool. There was a 2.01% pneumothorax rate and 1.08% bleeding rate. Although heterogeneously reported, total radiation dose was between 19.59Gycm2 and 85.9Gycm2 resulting in an approximate effective dose range of 3.1 to 13.8mSv InterpretationCBCT and r-EBUS for the diagnosis of PPN’s has a high diagnostic yield and acceptable safety profile. Studies showed moderate heterogeneity with significant bias and hence generalizability of the study is limited and further prospective trials are required. Trial RegistrationProspero CRD42023410221

Morphofunctional characteristics of the pancreas after N-acetylcysteine administration in an acute postradiation pancreatitis model

BACKGROUND: The development of effective nondrug and drug-based methods for protecting humans and animals from the effects of ionizing radiation remains important. A morphofunctional assessment of changes in the pancreatic parenchyma is required to determine the degree of radiosensitization of acinar cells and islet cells outside the tumor and during electron treatment of cancer of nearby organs, such as the colon and stomach.&#x0D; AIM: Morphofunctional assessment of the pancreas after N-acetylcysteine administration in a model of acute radiation-induced pancreatitis.&#x0D; MATERIALS AND METHODS: Wistar rats (Rattus Wistar; n=40) were divided into three experimental groups: control group I (n=10); II (n=10) — fractional irradiation with electrons in a total dose of 25 Gy; III (n=10) — administration of N-acetylcysteine before electron irradiation; and IV (n=10) — administration of N-acetylcysteine. A week after the last fraction, animals from all groups were removed from the experiment.&#x0D; RESULTS: A week after electron irradiation, a disruption in histoarchitecture was found in group II due to signs of acute postradiation pancreatitis. Increases in glucose, amylase, and malondialdehyde levels were associated with decreases in insulin and superoxide dismutase levels. In group III, the depth and range of damage to the pancreas were less evident with N-acetylcysteine administration.&#x0D; CONCLUSIONS: After a week of local irradiation with electrons at a total irradiation dose of 25 Gy, the histoarchitecture of the pancreas is disrupted, resulting in acute postradiation pancreatitis. N-acetylcysteine reduces the depth and range of radiation-induced damage while increasing the effectiveness of antioxidant protection.

Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis

BACKGROUND CONTEXTAdolescent idiopathic scoliosis (AIS) is a common condition, often requiring surgical correction. Computed tomography (CT) based navigation technologies, which rely on ionizing radiation, are increasingly being utilized for surgical treatment. Although this population is highly vulnerable to radiation, given their age and female predominance, there is little available information elucidating modeled iatrogenic cancer risk. PURPOSETo model lifetime cancer risk associated with the use of intraoperative CT-based navigation for surgical treatment of AIS. STUDY DESIGN/SETTINGThis retrospective cross-sectional study took place in a quaternary care academic pediatric hospital in the United States. PATIENT SAMPLEAdolescents aged 10–18 who underwent posterior spinal fusion for a diagnosis of AIS between July 2014 and December 2019. OUTCOMES MEASURESEffective radiation dose and projected lifetime cancer risk associated with intraoperative doses of ionizing radiation. METHODSClinical and radiographic parameters were abstracted, including total radiation dose during surgery from flat plate radiographs, fluoroscopy, and intraoperative CT scans. Multivariable regression analysis was used to assess differences in radiation exposure between patients treated with conventional radiography versus intraoperative navigation. Radiation exposure was translated into lifetime cancer risk using well-established algorithms. RESULTSIn total, 245 patients were included, 119 of whom were treated with navigation. The cohort was 82.9% female and 14.4 years of age. The median radiation exposure (in millisieverts, mSv) for fluoroscopy, radiography, and navigation was 0.05, 4.14, and 8.19 mSv, respectively. When accounting for clinical and radiographic differences, patients treated with intraoperative navigation received 8.18 mSv more radiation (95%CI: 7.22–9.15, p<.001). This increase in radiation projects to 0.90 iatrogenic malignancies per 1,000 patients (95%CI 0.79–1.01). CONCLUSIONSOurs is the first work to define cancer risk in the setting of radiation exposure for navigated AIS surgery. We project that intraoperative navigation will generate approximately one iatrogenic malignancy for every 1,000 patients treated. Given that spine surgery for AIS is common and occurs in the context of a multitude of other radiation sources, these data highlight the need for radiation budgeting protocols and continued development of lower radiation dose technologies. LEVEL OF EVIDENCETherapeutic, III.

Camrelizumab combined with concurrent chemoradiotherapy for locally recurrent esophageal cancer: A single-arm, open-label study.

371 Background: Local recurrence is the main failure pattern after radical treatment of esophageal cancer. There is no uniform treatment specification for such patients(pts) so far. The combination of immune checkpoint inhibitors and concurrent chemoradiotherapy (CCRT) has emerged as a novel strategy to treat esophageal cancer. This research was to evaluate the efficacy and safety of camrelizumab (ICI targeting PD-1) combined with CCRT in the treatment of locally recurrent esophageal cancer. Methods: This open clinical study planned to enroll 62 pts with locally recurrent esophageal cancer following radical treatment who aged 18-75 years with ECOG performance status of 0-1. Pts received the following treatments: camrelizumab (200 mg q2w, continuous medication until disease progression, intolerable toxicity, or withdrawal); simultaneous radiotherapy (the total radiation dose was 50-50.4 Gy, which was given by 25-28 fractions, 5 fractions per week, with 1.8-2 Gy for each fraction); chemotherapy (capecitabine, 625mg/m2, bid, oral, d1-5, qw, total 5 weeks). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety. Results: Between Feb 2022 and Jul 2023, 14 pts with a median age of 71 years old had been enrolled. Among the evaluable pts, the ORR was 69.2% (9/13), the DCR was 100.0% (13/13). With a median follow-up of 16.0 months (95% CI 13.5-18.5), the median PFS was 7.6 months (95% CI 4.2–11.0), the median OS was 18.6 months (95% CI NE–37.6) in the full analysis set. The incidence of any grade adverse events (AEs) was 100.0% and that of grade ≥3 AEs was 57.1% of 14 pts. The most common AEs included lymphocyte count decreased (11/14, 78.6%), neutrophil count decreased (5/14, 35.7%), white blood cell count decreased (5/14, 35.7%) and anemia (5/14, 35.7%). The most grade ≥3 AE was lymphocyte count decreased (6/14, 42.9%). No new safety signals or treatment-related deaths were observed. Conclusions: Current results suggested the promising efficacy and acceptable safety of camrelizumab combined with CCRT in pts with locally recurrent esophageal cancer. The study enrollment is ongoing, and further survival and safety data will be reported in the future. Clinical trial information: NCT04390945 .

Consolidative thoracic radiation therapy for extensive-stage small cell lung cancer in the era of first-line chemoimmunotherapy: preclinical data and a retrospective study in Southern Italy.

Consolidative thoracic radiotherapy (TRT) has been commonly used in the management of extensive-stage small cell lung cancer (ES-SCLC). Nevertheless, phase III trials exploring first-line chemoimmunotherapy have excluded this treatment approach. However, there is a strong biological rationale to support the use of radiotherapy (RT) as a boost to sustain anti-tumor immune responses. Currently, the benefit of TRT after chemoimmunotherapy remains unclear. The present report describes the real-world experiences of 120 patients with ES-SCLC treated with different chemoimmunotherapy combinations. Preclinical data supporting the hypothesis of anti-tumor immune responses induced by RT are also presented. A total of 120 ES-SCLC patients treated with chemoimmunotherapy since 2019 in the South of Italy were retrospectively analyzed. None of the patients included in the analysis experienced disease progression after undergoing first-line chemoimmunotherapy. Of these, 59 patients underwent TRT after a multidisciplinary decision by the treatment team. Patient characteristics, chemoimmunotherapy schedule, and timing of TRT onset were assessed. Safety served as the primary endpoint, while efficacy measured in terms of overall survival (OS) and progression-free survival (PFS) was used as the secondary endpoint. Immune pathway activation induced by RT in SCLC cells was explored to investigate the biological rationale for combining RT and immunotherapy. Preclinical data supported the activation of innate immune pathways, including the STimulator of INterferon pathway (STING), gamma-interferon-inducible protein (IFI-16), and mitochondrial antiviral-signaling protein (MAVS) related to DNA and RNA release. Clinical data showed that TRT was associated with a good safety profile. Of the 59 patients treated with TRT, only 10% experienced radiation toxicity, while no ≥ G3 radiation-induced adverse events occurred. The median time for TRT onset after cycles of chemoimmunotherapy was 62 days. Total radiation dose and fraction dose of TRT include from 30 Gy in 10 fractions, up to definitive dose in selected patients. Consolidative TRT was associated with a significantly longer PFS than systemic therapy alone (one-year PFS of 61% vs. 31%, p<0.001), with a trend toward improved OS (one-year OS of 80% vs. 61%, p=0.027). Multi-center data from establishments in the South of Italy provide a general confidence in using TRT as a consolidative strategy after chemoimmunotherapy. Considering the limits of a restrospective analysis, these preliminary results support the feasibility of the approach and encourage a prospective evaluation.

Busulfan with 400 centigray of total body irradiation and higher dose fludarabine: An alternative regimen for hematopoietic stem cell transplantation in pediatric acute lymphoblastic leukemia.

Hematopoietic stem cell transplantation can be curative for children with difficult-to-treat leukemia. The conditioning regimen utilized is known to influence outcomes. We report outcomes of the conditioning regimen used at the Alberta Children's Hospital, consisting of busulfan (with pharmacokinetic target of 3750μmol*min/L/day ±10%) for 4days, higher dose (250mg/m2 ) fludarabine and 400centigray (cGy) of total body irradiation. This retrospective study involved children receiving transplant for acute lymphoblastic leukemia (ALL). It compared children who fell within the target range for busulfan with those who were either not measured or were measured and fell outside this range. All other treatment factors were identical. Twenty-nine children (17 within target) were evaluated. All subjects engrafted neutrophils with a median [interquartile range] time of 14days [8-30days]. The cumulative incidence of acute graft-versus-host disease was 44.8% [95% confidence interval, CI: 35.6%-54.0%], while chronic graft-versus-host disease was noted in 16.0% [95% CI: 8.7%-23.3%]. At 2years, the overall survival was 78.1% [95% CI: 70.8%-86.4%] and event-free survival was 74.7% [95% CI: 66.4%-83.0%]. Cumulative incidence of relapse was 11.3% [95% CI: 5.1%-17.5%]. There were no statistically significant differences in between the group that received targeted busulfan compared with the untargeted group. Our conditioning regiment for children with ALL resulted in outcomes comparable to standard treatment with acceptable toxicities and significant reduction in radiation dose. Targeting busulfan dose in this cohort did not result in improved outcomes.

Risk of central nervous system tumour incidence in a cohort of workers chronically exposed to ionising radiation.

The aim of the present study was to assess the risk of primary central nervous system (CNS) tumour incidence in a cohort of 22,377 Mayak Production Association workers chronically exposed to ionising radiation. There were 96 primary CNS tumours, including 42 cases of glioma and 44 cases of meningioma, registered during the whole follow-up period (1948-2018). The study demonstrated that the risk of primary CNS tumour incidence was associated with sex, attained age, calendar period, tall body height, age at the beginning of exposure, and facility type. There was no association found between risk of CNS tumour incidence and body mass index, smoking (males) and alcohol consumption status. The study did not find an effect of the total external gamma radiation dose absorbed in the brain on risk of CNS tumour incidence irrespective of whether an adjustment for the total external neutron dose absorbed in the brain was included or not. Excess relative risk per 1Gy of external gamma brain dose was 0.05 (95% confidence interval (CI) -0.30; 0.70) for all CNS tumours, -0.18 (95% CI -; 0.44) for gliomas, and 0.38 (95% CI -0.32; 2.08) for meningiomas without adjustment for total neutron brain dose. There was no effect modification by sex, attained age, age at hire or facility.