Σάββατο 10 Δεκεμβρίου 2016

LJM716 in Japanese patients with head and neck squamous cell carcinoma or HER2-overexpressing breast or gastric cancer

Abstract

Purpose

Human epidermal growth factor receptor 3 (HER3) has been identified as an important component of many receptor tyrosine kinase-driven cancers. LJM716 is a human IgG monoclonal antibody that binds HER3, trapping it in an inactive conformation. In this study, a phase I dose escalation was performed with a primary objective to establish the maximum tolerated dose and/or the recommended dose of LJM716 in Japanese patients with selected advanced solid tumors. Secondary objectives included the evaluation of the safety and tolerability, preliminary antitumor activity, and pharmacokinetics of LJM716 in Japanese patients.

Methods

LJM716 was administered intravenously at doses of 10, 20, or 40 mg/kg once weekly, in 28-day cycles, to 12 patients with HER2-amplified breast cancer or gastric cancer, or with esophageal squamous cell carcinoma or squamous cell carcinoma of the head and neck, regardless of HER2 status.

Results

The maximum tolerated dose was not reached, and the recommended dose was established at 40 mg/kg. No dose-limiting toxicities were observed in the first cycle. The most frequently reported adverse events were diarrhea, fatigue, stomatitis, pyrexia, and paronychia. One unconfirmed partial response was observed in a patient with breast cancer, and 50% of the patients achieved stable disease as the best overall response. Exposure increased with ascending dose, and half-life was estimated to be 11–14 days. No anti-LJM716 antibodies were detected.

Conclusions

LJM716 was well tolerated in Japanese patients, and a degree of tumor shrinkage was observed.

Clinical trial information

ClinicalTrials.gov NCT01911936.



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Phase II trial of capecitabine plus modified cisplatin (mXP) as first-line therapy in Japanese patients with metastatic gastric cancer (KSCC1104)

Abstract

Purpose

Capecitabine plus cisplatin (XP) is a standard therapy for metastatic gastric cancer (mGC). However, while results from previous phase III trials suggested that the cisplatin dosage should be reduced in Japanese patients, no clinical data exist to support this. Here, we conducted a multicenter study to evaluate the efficacy and safety of modified XP (mXP) in Japanese patients with mGC.

Methods

Patients with previously untreated mGC received mXP (cisplatin 60 mg/m2 on day 1 plus capecitabine 1000 mg/m2 twice daily on days 1–14) every 3 weeks. The primary endpoint was the Response Evaluation Criteria in Solid Tumors-confirmed overall response rate (ORR). A sample size of 40 was planned for a threshold ORR of 30% and an expected value of 50%, with a one-sided α of 0.05 and a beta of approximately 0.2.

Results

Forty-two patients were enrolled. One patient did not fulfill the eligibility criteria; therefore, a total of 41 patients were assessed. The results were as follows: complete response in 2 patients, partial response in 16, stable disease in 14, progressive disease in 8, and no evaluation in 1. The confirmed ORR was 43.9% (95% confidence interval 28.7–59.1%). The median progression-free survival and median overall survival were 4.6 and 11.3 months, respectively. The most common grade 3 or 4 adverse events were neutropenia (37.5%), anemia (24.4%), anorexia (24.4%), and nausea (12.2%).

Conclusions

First-line chemotherapy with mXP in Japanese patients with mGC did not reach its primary objective. However, it did show a promising response rate and an acceptable tolerability profile.



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Efficacy and safety of everolimus and sunitinib in patients with gastroenteropancreatic neuroendocrine tumor

Abstract

Purpose

Efficacy of targeted agents, such as everolimus and sunitinib, has been demonstrated in prospective trials on patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Considering the heterogeneous clinicopathological characteristics of neuroendocrine tumors (NETs), evaluation of treatment outcomes in a real-world setting is necessary.

Methods

Clinical records of 44 patients with GEP-NET who were treated with everolimus or sunitinib between March 2007 and October 2014 were retrospectively reviewed. Considering the distinct characteristics of pancreatic NETs (pNETs) and non-pancreatic gastrointestinal NETs (GI-NETs), efficacy analysis was performed separately.

Results

Pancreas was the most common primary site (n = 28, 64%), followed by rectum (n = 10, 23%) and stomach (n = 3, 7%). Sunitinib and everolimus were administered in 27 (61%) and 17 (39%) patients, respectively. In patients with pNET, median progression-free survival (PFS) with everolimus and sunitinib was 16.6 months (95% CI 8.0–25.1) and 8.0 months (95% CI 0.0–17.4), respectively (p = 0.51). Among non-pancreatic GI-NET patients, median PFS with everolimus and sunitinib was 14.7 months (95% CI 2.4–27.0) and 1.7 months (95% CI 0.5–3.0), respectively (p = 0.001). Compared to patients treated with everolimus, tumor grade 3 (30 vs. 0%) and history of prior cytotoxic chemotherapy (70 vs. 50%) were more common in patients treated with sunitinib.

Conclusions

Both everolimus and sunitinib were effective in GEP-NET patients. Outcomes of everolimus therapy in GEP-NETs were consistent with those reported elsewhere. Poor efficacy of sunitinib in non-pancreatic GI-NETs may be attributable to the baseline characteristics associated with poor clinical outcomes.



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Use of retinoic acid/aldehyde dehydrogenase pathway as potential targeted therapy against cancer stem cells

Abstract

A large number of studies have investigated possible drug resistance mechanisms of cancer cells and suggested strategies to overcome it. In this review, we outline the role and function of aldehyde dehydrogenase (ALDH) activity in multiple cellular functions and in cancer stem cells (CSCs) and focus on the role of retinoic acid (RA), one of the products of ALDH isozymes. We discuss our observation that ATRA and other RAs can suppress ALDH activity and decrease different ALDH isozyme proteins and result in detrimental effects on cell proliferation, invasion and chemotherapy sensitivity. We review the known uses of different RAs in the treatment of cancers. We review the use of RAs in combination with chemo-/radiotherapy and the major signaling pathways affected in different tumor types. We provide follow-up on studies that may have used our prior observation with the aim of targeting the CSCs. We conclude with summary of the findings and potential impact of published studies on future use of RAs in the targeting of CSCs and drug resistance.



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LJM716 in Japanese patients with head and neck squamous cell carcinoma or HER2-overexpressing breast or gastric cancer

Abstract

Purpose

Human epidermal growth factor receptor 3 (HER3) has been identified as an important component of many receptor tyrosine kinase-driven cancers. LJM716 is a human IgG monoclonal antibody that binds HER3, trapping it in an inactive conformation. In this study, a phase I dose escalation was performed with a primary objective to establish the maximum tolerated dose and/or the recommended dose of LJM716 in Japanese patients with selected advanced solid tumors. Secondary objectives included the evaluation of the safety and tolerability, preliminary antitumor activity, and pharmacokinetics of LJM716 in Japanese patients.

Methods

LJM716 was administered intravenously at doses of 10, 20, or 40 mg/kg once weekly, in 28-day cycles, to 12 patients with HER2-amplified breast cancer or gastric cancer, or with esophageal squamous cell carcinoma or squamous cell carcinoma of the head and neck, regardless of HER2 status.

Results

The maximum tolerated dose was not reached, and the recommended dose was established at 40 mg/kg. No dose-limiting toxicities were observed in the first cycle. The most frequently reported adverse events were diarrhea, fatigue, stomatitis, pyrexia, and paronychia. One unconfirmed partial response was observed in a patient with breast cancer, and 50% of the patients achieved stable disease as the best overall response. Exposure increased with ascending dose, and half-life was estimated to be 11–14 days. No anti-LJM716 antibodies were detected.

Conclusions

LJM716 was well tolerated in Japanese patients, and a degree of tumor shrinkage was observed.

Clinical trial information

ClinicalTrials.gov NCT01911936.



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Introducing: The Red Journal Gray Zone

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): David A. Palma, Sue S. Yom, Katherine Egan Bennett, June Corry, Anthony L. Zietman




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Meetings

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1





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The Tonsillar Fossa Battleground

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Sue S. Yom




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Histologic Subtype in Core Lung Biopsies of Early-Stage Lung Adenocarcinoma is a Prognostic Factor for Treatment Response and Failure Patterns After Stereotactic Body Radiation Therapy

Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Jonathan E. Leeman, Andreas Rimner, Joseph Montecalvo, Meier Hsu, Zhigang Zhang, Donata von Reibnitz, Kelly Panchoo, Ellen Yorke, Prasad S. Adusumilli, William Travis, Abraham J. Wu
PurposeStereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype.Methods and MaterialsWe identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non–high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score–weighted Cox regression models.ResultsThe median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non–high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival.ConclusionsThe outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype determined from core biopsies is a prognostic factor and could have important implications for patient selection, adjuvant treatment, biopsy methods, and clinical trial design.



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Try to Avoid Tri-Modality Treatment

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Nooshin Hashemi Sadraei, Bradley J. Huth




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In Regard to Perrier et al

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Alexandre Escande, Dirk Van Gestel, Thomas Lacornerie, Vincent Marchesi, Carmen Florescu, Alain Guemnie-Tafo, Didier Peiffert, Albert Lisbona, Eric Deutsch, Xavier Mirabel




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Surgery plus PORT

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Sandro V. Porceddu




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Transoral Robotic Surgery and the Standard of Care

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Gregory S. Weinstein




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Issue Highlights

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1





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Robotic Surgery plus Chemo-Radiation Therapy

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Marshall Posner, Vishal Gupta




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Clinical Trial or Unilateral RT with Cisplatin

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Louis B. Harrison




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Zoledronic Acid in First-Line Treatment of Prostate Cancer

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Michael Pinkawa




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In Regard to Ramroth et al

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Francesco Fiorica




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Biomathematical Optimization of Radiation Therapy in the Era of Targeted Agents

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Clemens Grassberger, Jacob G. Scott, Harald Paganetti




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Stereotactic Body Radiation Therapy and the Influence of Chemotherapy on Overall Survival for Large (≥5 Centimeter) Non-Small Cell Lung Cancer

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Vivek Verma, Matthew T. McMillan, Surbhi Grover, Charles B. Simone
PurposeStereotactic body radiation therapy (SBRT) for ≥5 cm lesions is poorly defined, largely owing to the low sample sizes in existing studies. The present analysis examined the SBRT outcomes and assessed the effect of chemotherapy in this population.Methods and MaterialsThe National Cancer Data Base was queried for primary non-small cell lung cancer ≥5 cm treated with SBRT (≤10 fractions). Patient, tumor, and treatment parameters were extracted. The primary outcome was overall survival (OS). Statistical methods involved Kaplan-Meier analysis and multivariable Cox proportional hazards modeling.ResultsFrom 2004 to 2012, data from 201 patients were analyzed. The median follow-up was 41.1 months. The median tumor size was 5.5 cm (interquartile range 5.0-6.0), with cT2a, cT2b, and cT3 disease in 24.9%, 53.2%, and 21.9%, respectively. The median total SBRT dose and fractionation was 50 Gy in 4 fractions, and 92.5% of the patients underwent SBRT with ≤5 fractions. The median OS was 25.1 months. Of the 201 patients, 15% received chemotherapy. The receipt of chemotherapy was associated with longer OS (median 30.6 vs 23.4 months; P=.027). On multivariable analysis, worse OS was seen with increasing age (hazard ratio [HR] 1.03; P=.012), poorly differentiated tumors (HR 2.06; P=.049), and T3 classification (HR 2.13; P=.005). On multivariable analysis, chemotherapy remained independently associated with improved OS (HR 0.57; P=.039).ConclusionsSBRT has utility in the setting of tumors ≥5 cm, with chemotherapy associated with improved OS in this subset. These hypothesis-generating data now raise the necessity of performing prospective analyses to determine whether chemotherapy confers outcome benefits after SBRT.



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Adverse Events Involving Radiation Oncology Medical Devices: Comprehensive Analysis of US Food and Drug Administration Data, 1991 to 2015

Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Michael J. Connor, Deborah C. Marshall, Vitali Moiseenko, Kevin Moore, Laura Cervino, Todd Atwood, Parag Sanghvi, Arno J. Mundt, Todd Pawlicki, Abram Recht, Jona A. Hattangadi-Gluth
PurposeRadiation oncology relies on rapidly evolving technology and highly complex processes. The US Food and Drug Administration collects reports of adverse events related to medical devices. We sought to characterize all events involving radiation oncology devices (RODs) from the US Food and Drug Administration's postmarket surveillance Manufacturer and User Facility Device Experience (MAUDE) database, comparing these with non–radiation oncology devices.Methods and MaterialsMAUDE data on RODs from 1991 to 2015 were sorted into 4 product categories (external beam, brachytherapy, planning systems, and simulation systems) and 5 device problem categories (software, mechanical, electrical, user error, and dose delivery impact). Outcomes included whether the device was evaluated by the manufacturer, adverse event type, remedial action, problem code, device age, and time since 510(k) approval. Descriptive statistics were performed with linear regression of time-series data. Results for RODs were compared with those for other devices by the Pearson χ2 test for categorical data and 2-sample Kolmogorov-Smirnov test for distributions.ResultsThere were 4234 ROD and 4,985,698 other device adverse event reports. Adverse event reports increased over time, and events involving RODs peaked in 2011. Most ROD reports involved external beam therapy (50.8%), followed by brachytherapy (24.9%) and treatment planning systems (21.6%). The top problem types were software (30.4%), mechanical (20.9%), and user error (20.4%). RODs differed significantly from other devices in each outcome (P<.001). RODs were more likely to be evaluated by the manufacturer after an event (46.9% vs 33.0%) but less likely to be recalled (10.5% vs 37.9%) (P<.001). Device age and time since 510(k) approval were shorter among RODs (P<.001).ConclusionsCompared with other devices, RODs may experience adverse events sooner after manufacture and market approval. Close postmarket surveillance, improved software design, and manufacturer–user training may help mitigate these events.



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Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Luca Ceriani, Maurizio Martelli, Maria K. Gospodarowicz, Umberto Ricardi, Andrés J.M. Ferreri, Annalisa Chiappella, Caterina Stelitano, Monica Balzarotti, Maria E. Cabrera, David Cunningham, Attilio Guarini, Pier Luigi Zinzani, Luca Giovanella, Peter W.M. Johnson, Emanuele Zucca
PurposeTo assess the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.Methods and MaterialsAmong 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.ResultsThe CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.ConclusionsAll the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual 18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.



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In Reply to Escande et al

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Lionel Perrier, Magali Morelle, Marius Huguet, Sophie Dussart, Philippe Giraud




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Erratum to Guo W, Du S, Yang L, et al. Stat3 activation mediates stem cell, DNA repair, and immunosuppressive properties in crizotinib-resistance EML4-ALK-rearranged lung cancer. Int J Radiat Oncol Biol Phys 2016;96:S76-S77

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1





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Multi-institutional randomized trial testing the utility of an interactive 3-dimensional contouring atlas among radiation oncology residents

Publication date: Available online 9 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Erin F. Gillespie, Neil Panjwani, Daniel W. Golden, Jillian Gunther, Tobias R. Chapman, Jeffrey V. Brower, Robert Kosztyla, Grant Larson, Pushpa Neppala, Vitali Moiseenko, Julie Bykowski, Parag Sanghvi, James D. Murphy
PurposeThe delivery of safe and effective radiation therapy relies on accurate target delineation, particularly in the era of highly conformal treatment techniques. Current contouring resources are fragmented and can be cumbersome to use. This study reports on the efficacy and usability of a web-based contouring atlas compared to existing contouring resources in a randomized trial.MethodsWe enrolled radiation oncology residents onto a two-phase contouring study. All residents contoured a T1N1 nasopharyngeal cancer case using currently available resources. Participants were then randomized to re-contour the case with access to existing resources or to an interactive web-based contouring atlas (eContour.org). Contour analysis was performed using conformation number and simultaneous truth and performance level estimation (STAPLE). At the completion of the second contouring session, residents completed a multiple choice question (MCQ) knowledge test and a 10-item System Usability Scale.ResultsTwenty-four residents from five institutions completed this study. Compared to residents using currently available resources, residents using eContour had improved contour agreement with both the consensus (0.63 vs. 0.52, p = 0.02) and expert (0.58 vs. 0.50, p = 0.01) contours for the high risk clinical target volume, and greater agreement with the expert contour for the contralateral parotid (0.44 ± 0.12 vs. 0.56 ± 0.08, p = 0.003). Residents using eContour demonstrated greater knowledge of contour delineation and radiographic anatomy on a multiple-choice question test (89% vs. 77%, p=0.03). Usability (89 vs. 66, p<0.0001), and satisfaction (4.1 vs. 3.0, p=0.002) were higher for eContour compared to existing resources.ConclusionThis study demonstrates the capacity of an interactive 3-dimensional contouring atlas to improve quality of resident target delineation in radiation oncology. Further research is needed to define the utility of easily accessible interactive educational reference tool to improve adherence to contouring-based guidelines and quality of care in routine clinical practice.



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Introducing: The Red Journal Gray Zone

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): David A. Palma, Sue S. Yom, Katherine Egan Bennett, June Corry, Anthony L. Zietman




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Meetings

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1





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The Tonsillar Fossa Battleground

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Sue S. Yom




http://ift.tt/2glyZDk

Histologic Subtype in Core Lung Biopsies of Early-Stage Lung Adenocarcinoma is a Prognostic Factor for Treatment Response and Failure Patterns After Stereotactic Body Radiation Therapy

Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Jonathan E. Leeman, Andreas Rimner, Joseph Montecalvo, Meier Hsu, Zhigang Zhang, Donata von Reibnitz, Kelly Panchoo, Ellen Yorke, Prasad S. Adusumilli, William Travis, Abraham J. Wu
PurposeStereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype.Methods and MaterialsWe identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non–high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score–weighted Cox regression models.ResultsThe median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non–high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival.ConclusionsThe outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype determined from core biopsies is a prognostic factor and could have important implications for patient selection, adjuvant treatment, biopsy methods, and clinical trial design.



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Try to Avoid Tri-Modality Treatment

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Nooshin Hashemi Sadraei, Bradley J. Huth




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In Regard to Perrier et al

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Alexandre Escande, Dirk Van Gestel, Thomas Lacornerie, Vincent Marchesi, Carmen Florescu, Alain Guemnie-Tafo, Didier Peiffert, Albert Lisbona, Eric Deutsch, Xavier Mirabel




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Surgery plus PORT

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Sandro V. Porceddu




http://ift.tt/2glF1np

Transoral Robotic Surgery and the Standard of Care

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Gregory S. Weinstein




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Issue Highlights

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1





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Robotic Surgery plus Chemo-Radiation Therapy

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Marshall Posner, Vishal Gupta




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Clinical Trial or Unilateral RT with Cisplatin

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Louis B. Harrison




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Zoledronic Acid in First-Line Treatment of Prostate Cancer

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Michael Pinkawa




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In Regard to Ramroth et al

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Francesco Fiorica




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Biomathematical Optimization of Radiation Therapy in the Era of Targeted Agents

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Clemens Grassberger, Jacob G. Scott, Harald Paganetti




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Adverse Events Involving Radiation Oncology Medical Devices: Comprehensive Analysis of US Food and Drug Administration Data, 1991 to 2015

Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Michael J. Connor, Deborah C. Marshall, Vitali Moiseenko, Kevin Moore, Laura Cervino, Todd Atwood, Parag Sanghvi, Arno J. Mundt, Todd Pawlicki, Abram Recht, Jona A. Hattangadi-Gluth
PurposeRadiation oncology relies on rapidly evolving technology and highly complex processes. The US Food and Drug Administration collects reports of adverse events related to medical devices. We sought to characterize all events involving radiation oncology devices (RODs) from the US Food and Drug Administration's postmarket surveillance Manufacturer and User Facility Device Experience (MAUDE) database, comparing these with non–radiation oncology devices.Methods and MaterialsMAUDE data on RODs from 1991 to 2015 were sorted into 4 product categories (external beam, brachytherapy, planning systems, and simulation systems) and 5 device problem categories (software, mechanical, electrical, user error, and dose delivery impact). Outcomes included whether the device was evaluated by the manufacturer, adverse event type, remedial action, problem code, device age, and time since 510(k) approval. Descriptive statistics were performed with linear regression of time-series data. Results for RODs were compared with those for other devices by the Pearson χ2 test for categorical data and 2-sample Kolmogorov-Smirnov test for distributions.ResultsThere were 4234 ROD and 4,985,698 other device adverse event reports. Adverse event reports increased over time, and events involving RODs peaked in 2011. Most ROD reports involved external beam therapy (50.8%), followed by brachytherapy (24.9%) and treatment planning systems (21.6%). The top problem types were software (30.4%), mechanical (20.9%), and user error (20.4%). RODs differed significantly from other devices in each outcome (P<.001). RODs were more likely to be evaluated by the manufacturer after an event (46.9% vs 33.0%) but less likely to be recalled (10.5% vs 37.9%) (P<.001). Device age and time since 510(k) approval were shorter among RODs (P<.001).ConclusionsCompared with other devices, RODs may experience adverse events sooner after manufacture and market approval. Close postmarket surveillance, improved software design, and manufacturer–user training may help mitigate these events.



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Stereotactic Body Radiation Therapy and the Influence of Chemotherapy on Overall Survival for Large (≥5 Centimeter) Non-Small Cell Lung Cancer

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Vivek Verma, Matthew T. McMillan, Surbhi Grover, Charles B. Simone
PurposeStereotactic body radiation therapy (SBRT) for ≥5 cm lesions is poorly defined, largely owing to the low sample sizes in existing studies. The present analysis examined the SBRT outcomes and assessed the effect of chemotherapy in this population.Methods and MaterialsThe National Cancer Data Base was queried for primary non-small cell lung cancer ≥5 cm treated with SBRT (≤10 fractions). Patient, tumor, and treatment parameters were extracted. The primary outcome was overall survival (OS). Statistical methods involved Kaplan-Meier analysis and multivariable Cox proportional hazards modeling.ResultsFrom 2004 to 2012, data from 201 patients were analyzed. The median follow-up was 41.1 months. The median tumor size was 5.5 cm (interquartile range 5.0-6.0), with cT2a, cT2b, and cT3 disease in 24.9%, 53.2%, and 21.9%, respectively. The median total SBRT dose and fractionation was 50 Gy in 4 fractions, and 92.5% of the patients underwent SBRT with ≤5 fractions. The median OS was 25.1 months. Of the 201 patients, 15% received chemotherapy. The receipt of chemotherapy was associated with longer OS (median 30.6 vs 23.4 months; P=.027). On multivariable analysis, worse OS was seen with increasing age (hazard ratio [HR] 1.03; P=.012), poorly differentiated tumors (HR 2.06; P=.049), and T3 classification (HR 2.13; P=.005). On multivariable analysis, chemotherapy remained independently associated with improved OS (HR 0.57; P=.039).ConclusionsSBRT has utility in the setting of tumors ≥5 cm, with chemotherapy associated with improved OS in this subset. These hypothesis-generating data now raise the necessity of performing prospective analyses to determine whether chemotherapy confers outcome benefits after SBRT.



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Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Luca Ceriani, Maurizio Martelli, Maria K. Gospodarowicz, Umberto Ricardi, Andrés J.M. Ferreri, Annalisa Chiappella, Caterina Stelitano, Monica Balzarotti, Maria E. Cabrera, David Cunningham, Attilio Guarini, Pier Luigi Zinzani, Luca Giovanella, Peter W.M. Johnson, Emanuele Zucca
PurposeTo assess the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma.Methods and MaterialsAmong 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3.ResultsThe CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence.ConclusionsAll the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual 18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.



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In Reply to Escande et al

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1
Author(s): Lionel Perrier, Magali Morelle, Marius Huguet, Sophie Dussart, Philippe Giraud




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Erratum to Guo W, Du S, Yang L, et al. Stat3 activation mediates stem cell, DNA repair, and immunosuppressive properties in crizotinib-resistance EML4-ALK-rearranged lung cancer. Int J Radiat Oncol Biol Phys 2016;96:S76-S77

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Publication date: 1 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 1





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Multi-institutional randomized trial testing the utility of an interactive 3-dimensional contouring atlas among radiation oncology residents

Publication date: Available online 9 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Erin F. Gillespie, Neil Panjwani, Daniel W. Golden, Jillian Gunther, Tobias R. Chapman, Jeffrey V. Brower, Robert Kosztyla, Grant Larson, Pushpa Neppala, Vitali Moiseenko, Julie Bykowski, Parag Sanghvi, James D. Murphy
PurposeThe delivery of safe and effective radiation therapy relies on accurate target delineation, particularly in the era of highly conformal treatment techniques. Current contouring resources are fragmented and can be cumbersome to use. This study reports on the efficacy and usability of a web-based contouring atlas compared to existing contouring resources in a randomized trial.MethodsWe enrolled radiation oncology residents onto a two-phase contouring study. All residents contoured a T1N1 nasopharyngeal cancer case using currently available resources. Participants were then randomized to re-contour the case with access to existing resources or to an interactive web-based contouring atlas (eContour.org). Contour analysis was performed using conformation number and simultaneous truth and performance level estimation (STAPLE). At the completion of the second contouring session, residents completed a multiple choice question (MCQ) knowledge test and a 10-item System Usability Scale.ResultsTwenty-four residents from five institutions completed this study. Compared to residents using currently available resources, residents using eContour had improved contour agreement with both the consensus (0.63 vs. 0.52, p = 0.02) and expert (0.58 vs. 0.50, p = 0.01) contours for the high risk clinical target volume, and greater agreement with the expert contour for the contralateral parotid (0.44 ± 0.12 vs. 0.56 ± 0.08, p = 0.003). Residents using eContour demonstrated greater knowledge of contour delineation and radiographic anatomy on a multiple-choice question test (89% vs. 77%, p=0.03). Usability (89 vs. 66, p<0.0001), and satisfaction (4.1 vs. 3.0, p=0.002) were higher for eContour compared to existing resources.ConclusionThis study demonstrates the capacity of an interactive 3-dimensional contouring atlas to improve quality of resident target delineation in radiation oncology. Further research is needed to define the utility of easily accessible interactive educational reference tool to improve adherence to contouring-based guidelines and quality of care in routine clinical practice.



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Phase I/II Randomized Trial of Sorafenib and Bevacizumab as First-Line Therapy in Patients with Locally Advanced or Metastatic Hepatocellular Carcinoma: North Central Cancer Treatment Group Trial N0745 (Alliance)

Abstract

Background

Angiogenesis has been a major target of novel drug development in hepatocellular carcinoma (HCC). It is hypothesized that the combination of two antiangiogenic agents, sorafenib and bevacizumab, will provide greater blockade of angiogenesis.

Objective

To determine the optimal dose, safety, and effectiveness of dual anti-angiogenic therapy with sorafenib and bevacizumab in patients with advanced HCC.

Patients and Methods

Patients with locally advanced or metastatic HCC not amenable for surgery or liver transplant were eligible. The phase I starting dose level was bevacizumab 1.25 mg/kg day 1 and 15 plus sorafenib 400 mg twice daily (BID) days 1-28. In the phase II portion, patients were randomized to receive bevacizumab and sorafenib at the maximum tolerated dose (MTD) or sorafenib 400 mg BID.

Results

Seventen patients were enrolled in the phase I component. Dose-limiting toxicities included grade 3 hand/foot skin reaction, fatigue, hypertension, alanine/aspartate aminotransferase increase, dehydration, hypophosphatemia, creatinine increase, hypoglycemia, nausea/vomiting, and grade 4 hyponatremia. Seven patients were enrolled in the phase II component at the MTD: sorafenib 200 mg BID days 1-28 and bevacizumab 2.5 mg/kg every other week; 57% (4/7) had grade 3 AEs at least possibly related to treatment. No responses were observed in the phase II portion. Estimated median time to progression and survival were 8.6 months (95% CI: 0.4-16.3) and 13.3 months (95% CI 4.4 – not estimable), respectively.

Conclusions

The MTD of the combination is sorafenib 200 mg twice daily on days 1-28 plus bevacizumab 2.5 mg/kg on days 1 and 15 of a 28-day cycle. In the phase II portion of the trial, concerns regarding excessive toxicity, low efficacy, and slow enrollment led to discontinuation of the trial. (Clinical Trials ID: NCT00867321.)



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Phase I/II Randomized Trial of Sorafenib and Bevacizumab as First-Line Therapy in Patients with Locally Advanced or Metastatic Hepatocellular Carcinoma: North Central Cancer Treatment Group Trial N0745 (Alliance)

Abstract

Background

Angiogenesis has been a major target of novel drug development in hepatocellular carcinoma (HCC). It is hypothesized that the combination of two antiangiogenic agents, sorafenib and bevacizumab, will provide greater blockade of angiogenesis.

Objective

To determine the optimal dose, safety, and effectiveness of dual anti-angiogenic therapy with sorafenib and bevacizumab in patients with advanced HCC.

Patients and Methods

Patients with locally advanced or metastatic HCC not amenable for surgery or liver transplant were eligible. The phase I starting dose level was bevacizumab 1.25 mg/kg day 1 and 15 plus sorafenib 400 mg twice daily (BID) days 1-28. In the phase II portion, patients were randomized to receive bevacizumab and sorafenib at the maximum tolerated dose (MTD) or sorafenib 400 mg BID.

Results

Seventen patients were enrolled in the phase I component. Dose-limiting toxicities included grade 3 hand/foot skin reaction, fatigue, hypertension, alanine/aspartate aminotransferase increase, dehydration, hypophosphatemia, creatinine increase, hypoglycemia, nausea/vomiting, and grade 4 hyponatremia. Seven patients were enrolled in the phase II component at the MTD: sorafenib 200 mg BID days 1-28 and bevacizumab 2.5 mg/kg every other week; 57% (4/7) had grade 3 AEs at least possibly related to treatment. No responses were observed in the phase II portion. Estimated median time to progression and survival were 8.6 months (95% CI: 0.4-16.3) and 13.3 months (95% CI 4.4 – not estimable), respectively.

Conclusions

The MTD of the combination is sorafenib 200 mg twice daily on days 1-28 plus bevacizumab 2.5 mg/kg on days 1 and 15 of a 28-day cycle. In the phase II portion of the trial, concerns regarding excessive toxicity, low efficacy, and slow enrollment led to discontinuation of the trial. (Clinical Trials ID: NCT00867321.)



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The Protective Effects of Polysaccharides from Agaricus blazei Murill Against Cadmium-Induced Oxidant Stress and Inflammatory Damage in Chicken Livers

Abstract

This study aimed to assess the protective roles of polysaccharides from Agaricus blazei Murill (ABP) against cadmium (Cd)-induced damage in chicken livers. A total of 80 Hy-Line laying chickens (7 days old) were randomly divided into four groups (n = 20). Group I (control) was fed with a basic diet and 0.2 ml saline per day, group II (Cd-treated group) was fed with a basic diet containing 140 mg/kg cadmium chloride (CdCl2) and 0.2 ml saline per day, group III (Cd + ABP-treated group) was fed with a basic diet containing 140 mg/kg CdCl2 and 0.2-ml ABP solution (30 mg/ml) per day via oral gavage, and group IV (ABP-treated group) was fed with 0.2-ml ABP solution (30 mg/ml) per day via oral gavage. The contents of Cd and malondialdehyde (MDA), the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX), the messenger RNA (mRNA) levels of inflammatory cytokines and heat shock proteins (HSPs), the protein levels of HSPs, and the histopathological changes of livers were evaluated on days 20, 40, and 60. The results showed that Cd exposure resulted in Cd accumulating in livers and inhibiting the activities of antioxidant enzymes (SOD and GSH-PX). Cd exposure caused histopathological damage and increased the MDA content, the mRNA levels of inflammatory cytokines (TNF-α, IL-1β, and IL-6) and HSPs (HSP27, HSP40, HSP60, HSP70, and HSP90) and the protein levels of HSPs (HSP60, HSP70, and HSP90). ABP supplementation during dietary exposure to Cd reduced the histopathological damage and decreased the contents of Cd and MDA and the expression of inflammatory cytokines and HSPs and improved the activities of antioxidant enzymes. The results indicated that ABP could partly ameliorate the toxic effects of Cd on chicken livers.



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The Protective Effects of Polysaccharides from Agaricus blazei Murill Against Cadmium-Induced Oxidant Stress and Inflammatory Damage in Chicken Livers

Abstract

This study aimed to assess the protective roles of polysaccharides from Agaricus blazei Murill (ABP) against cadmium (Cd)-induced damage in chicken livers. A total of 80 Hy-Line laying chickens (7 days old) were randomly divided into four groups (n = 20). Group I (control) was fed with a basic diet and 0.2 ml saline per day, group II (Cd-treated group) was fed with a basic diet containing 140 mg/kg cadmium chloride (CdCl2) and 0.2 ml saline per day, group III (Cd + ABP-treated group) was fed with a basic diet containing 140 mg/kg CdCl2 and 0.2-ml ABP solution (30 mg/ml) per day via oral gavage, and group IV (ABP-treated group) was fed with 0.2-ml ABP solution (30 mg/ml) per day via oral gavage. The contents of Cd and malondialdehyde (MDA), the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX), the messenger RNA (mRNA) levels of inflammatory cytokines and heat shock proteins (HSPs), the protein levels of HSPs, and the histopathological changes of livers were evaluated on days 20, 40, and 60. The results showed that Cd exposure resulted in Cd accumulating in livers and inhibiting the activities of antioxidant enzymes (SOD and GSH-PX). Cd exposure caused histopathological damage and increased the MDA content, the mRNA levels of inflammatory cytokines (TNF-α, IL-1β, and IL-6) and HSPs (HSP27, HSP40, HSP60, HSP70, and HSP90) and the protein levels of HSPs (HSP60, HSP70, and HSP90). ABP supplementation during dietary exposure to Cd reduced the histopathological damage and decreased the contents of Cd and MDA and the expression of inflammatory cytokines and HSPs and improved the activities of antioxidant enzymes. The results indicated that ABP could partly ameliorate the toxic effects of Cd on chicken livers.



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Diaphragm-Sparing Nerve Blocks for Shoulder Surgery.

Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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