Search

Michael Mix,1 Sean Tanny,1 Tamara Nsouli,1 Ryan Alden,1 Rishabh Chaudhari,2 Russell Kincaid,1 Paula F Rosenbaum,3 Jeffrey A Bogart,1 Paul Aridgides1 1Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA; 2Department of Radiation Oncology, University of Cincinnati/University Hospital Barrett Cancer Center, Cincinatti, OH 45267, USA; 3Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USACorrespondence: Michael MixDepartment of Radiation Oncology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USATel +1 315 464-5276Email mixm@upstate.eduIntroduction: The treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT).Patients and methods: Patients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed.Results: A total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54–60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events.Conclusion: In this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.Keywords: SBRT, IMRT, stereotactic ablative radiation therapy, SABR, radiotherapy

Paul Aridgides,1 Tamara Nsouli,1 Rishabh Chaudhari,1 Russell Kincaid,1 Paula F Rosenbaum,2 Sean Tanny,1 Michael Mix,1 Jeffrey Bogart1 1Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA; 2Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA Purpose: To report the outcomes of stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) according to respiratory motion management method. Methods: Patients with stage I NSCLC who received SBRT from 2007 to 2015 were reviewed. Computed tomography (CT) simulation with four-dimensional CT was performed for respiratory motion assessment. Tumor motion >1 cm in the craniocaudal direction was selectively treated with advanced respiratory management: either respiratory gating to a pre-specified portion of the respiratory cycle or dynamic tracking of an implanted fiducial marker. Comparisons were made with internal target volume approach, which treated all phases of respiratory motion. Results: Of 297 patients treated with SBRT at our institution, 51 underwent advanced respiratory management (48 with respiratory gating and three with tumor tracking) and 246 underwent all-phase treatment. Groups were similarly balanced with regard to mean age (P=0.242), tumor size (P=0.315), and histology (P=0.715). Tumor location in the lower lung lobes, as compared to middle or upper lobes, was more common in those treated with advanced respiratory management (78.4%) compared to all-phase treatment (25.6%, P

Jared Deck,1 Marissa Hartley,1 Mohammad Akhter,1 Dongliang Wang,2 Jeffrey A Bogart,1 Michael D Mix1 1Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA; 2Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USACorrespondence: Jared Deck, Department of Radiation Oncology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13202, USA, Tel +1 (315)-464-5276, Email deckj@upstate.eduBackground: Prior studies suggest lymphopenia, systemic immune-inflammatory index, and tumor response all impact clinical outcomes in Stage III NSCLC. We hypothesized that tumor response after CRT would be associated with hematologic metrics and might predict clinical outcomes.Materials and Methods: Patients with stage III NSCLC treated at a single institution between 2011 and 2018 were retrospectively reviewed. Pre-treatment gross tumor volume (GTV) was recorded then reassessed at 1– 4 months post-CRT. Complete blood counts before, during and after treatment were recorded. Systemic immune-inflammation index (SII) was defined as neutrophil × platelet/lymphocyte. Overall survival (OS) and progression free survival (PFS) were calculated using Kaplan-Meier estimates, and compared with Wilcoxon tests. A multivariate analysis of hematologic factors impacting restricted mean survival was then performed using pseudovalue regression, accounting for other baseline factors.Results: 106 patients were included. After median follow-up of 24 months, median PFS and OS were 16 and 40 months, respectively. Within the multivariate model, baseline SII was associated with OS (p = 0.046) but not PFS (p = 0.09), and baseline ALC correlated with both PFS and OS (p = 0.03 and p = 0.02, respectively). Nadir ALC, nadir SII, and recovery SII were not associated with PFS or OS.Conclusion: In this cohort of patients with stage III NSCLC, baseline hematologic factors were associated with clinical outcomes including baseline ALC, baseline SII and recovery ALC. Disease response was not well correlated with hematologic factors or clinical outcomes.Keywords: lymphopenia, myelosuppression, chemoradiation, tumor response

Background and objectives: Liver lesions are a relatively common incidental finding in computer tomography (CT) of the abdomen. The current gold standard is liver biopsy, which has the downside of respecting only a small part of the total lesion volume. Furthermore, this invasive method carries interventional risks like bleeding or infection. Therefore, an image-based biomarker would be highly desirable. Conventional “radiomics” methods have often been utilized for similar problems, but the results are often not reproducible. This is mainly due to sampling errors and interobserver variability, but also the seemingly complex nature of the problem. We present a new approach that implements cutting-edge research in machine learning which is nevertheless cheap and easily applicable in a routine clinical setting. To achieve this, we use convolutional neural networks (CNN) to predict the histopathological findings from liver lesions from preoperative liver CT. Methods: After splitting the study population into a training and test set we trained a CNN to predict the histopathological tumor type from CT data. Results: The developed CNN workflow is able to predict liver tumor histology from routine CT images. We also evaluated in how far transfer learning and data augmentation can help in solving this problem and implemented the developed workflow in a clinical routine setting. Conclusion: We propose a robust semiautomatic end-to-end classification workflow for the prediction of the histopathological type of tumor lesions based on abdominal CT and a deep convolutional neural network model. In our cohort, the model shows reliable and accurate results even with limited computational resources.

Background and objectives: Both hepatic functional reserve and the underlying histology are important determinants in the preoperative risk evaluation before major hepatectomies. In this project we developed a new approach that implements cutting-edge research in machine learning and nevertheless is cheap and easily applicable in a routine clinical setting is needed. Methods: After splitting the study population into a training and test set we trained a convolutional neural network to predict the liver function as determined by hepatobiliary mebrofenin scintigraphy and single photon emission computer tomography (SPECT) imaging. Results: We developed a workflow for predicting liver function from routine CT imaging data using convolutional neural networks. We also evaluated in how far transfer learning and data augmentation can help to solve remaining manual data pre-processing steps and implemented the developed workflow in a clinical routine setting. Conclusion: We propose a robust semiautomatic end-to-end classification workflow for abdominal CT scans for the prediction of liver function based on a deep convolutional neural network model that shows reliable and accurate results even with limited computational resources.

Background: Stereotactic ablative body radiotherapy (SBRT, SABR) is being increasingly applied because of its high local efficacy, e.g., for small lung tumors. However, the optimum dosage is still under discussion. Here, we report data on 45 lung lesions [non-small cell lung cancer (NSCLC) or metastases] in 39 patients treated between 2009 and 2010 by SABR.Patients and Methods: SABR was performed with total doses of 35 Gy (5 fractions) or 37.5 Gy (3 fractions) prescribed to the 60% isodose line encompassing the planning target volume. Three-monthly follow-up CT scans were supplemented by FDG-PET/CT if clinically indicated.Results: The median follow-up was 17 months. Local progression-free survival rates were 90.5% (all patients), 95.0% (NSCLC), and 81.8% (metastases) at 1 year. At 2 years, the respective local progression-free survival rates were 80.5%, 95.0%, and 59.7%. Overall survival rates were 71.1% (all patients), 65.4% (NSCLC), and 83.3% (metastases) at 1 year. Overall survival rates at 2 years were 52.7%, 45.9%, and 66.7%, respectively. Acute side effects were mild.Conclusion: With the moderate dose schedule used, well-tolerated SABR led to favorable local tumor control as in other published series. Standardization in reporting the dose prescription for SABR is needed to allow comparison of different series in order to determine optimum dosage. [ABSTRACT FROM AUTHOR]

Twenty German cancer patients (56.9+/-12.7 years old) without brain metastasis underwent neurological PET. The acquired brain data were compared to the data of ten age and sex-matched controls (53.6+/-15. 7). Scores of Zung's Self-rating Depression Scale (SDS) obtained from 15 out of the 20 patients suggested they might be mildly depressed. Scores of Taylor's Manifest Anxiety Scale (MAS), used for additional psychological evaluation, were close to normal distribution. Hypometabolic areas in the German cancer patients were compared with those demonstrated in our previous study in Japanese cancer patients. Common findings in both studies were observed in the limbic structures, such as the anterior and posterior cingulate gyri, the basolateral frontal cortices, as well as in the basal ganglia (especially the caudate nucleus) and frontal cortex. These results are in accordance with many previous PET studies on major depression. The results show that the positron emission tomography and (18)F-fluoro-deoxyglucose ((18)FDG-PET) brain mapping results could be partially reproduced, and suggest that PET brain mapping of cancer patients has a potential clinical application to the field of psycho-oncology and cancer patient care. [ABSTRACT FROM AUTHOR]

Small animal Positron Emission Tomography (PET) should provide accurate quantification of regional radiotracer concentrations and high spatial resolution. This is challenging for non-pure positron emitters with high positron endpoint energies, such as I-124: On the one hand the cascade gammas emitted from this isotope can produce coincidence events with the 511 keV annihilation photons leading to quantification errors. On the other hand the long range of the high energy positron degrades spatial resolution. This paper presents the implementation of a comprehensive correction technique for both of these effects. The established corrections include a modified sinogram-based tail-fitting approach to correct for scatter, random and cascade gamma coincidences and a compensation for resolution degradation effects during the image reconstruction. Resolution losses were compensated for by an iterative algorithm which incorporates a convolution kernel derived from line source measurements for the microPET Focus 120 system. The entire processing chain for these corrections was implemented, whereas previous work has only addressed parts of this process. Monte Carlo simulations with GATE refid="ref1"/ and measurements of mice with the microPET Focus 120 show that the proposed method reduces absolute quantification errors on average to 2.6% compared to 15.6% for the ordinary Maximum Likelihood Expectation Maximization algorithm. Furthermore resolution was improved in the order of 11-29% depending on the number of convolution iterations. In summary, a comprehensive, fast and robust algorithm for the correction of small animal PET studies with I-124 was developed which improves quantitative accuracy and spatial resolution. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study was to evaluate the impact of [18F]fluorodeoxy-D-glucose positron emission tomography (FDG-PET) on the primary staging of patients with small-cell lung cancer (SCLC). Methods: FDG-PET was performed in 120 consecutive patients with SCLC during primary staging. In addition, brain examinations with both FDG-PET and cranial magnetic resonance imaging (MRI) or computed tomography (CT) were performed in 91 patients. Results of FDG-PET were compared with those of conventional staging procedures. FDG-PET detected markedly increased FDG uptake in the primary tumours of all 120 patients (sensitivity 100%). Results: Complete agreement between FDG-PET results and other staging procedures was observed in 75 patients. Differences occurred in 45 patients at 65 sites. In 47 sites the FDG-PET results were proven to be correct, and in ten, incorrect. In the remaining eight sites, the discrepancies could not be clarified. In 14/120 patients, FDG-PET caused a stage migration, correctly upstaging ten patients to extensive disease and downstaging three patients by not confirming metastases of the adrenal glands suspected on the basis of CT. Only 1/120 patients was incorrectly staged by FDG-PET, owing to failure to detect brain metastases. In all cases the stage migration led to a significant change in the treatment protocol. Sensitivity of FDG-PET was significantly superior to that of CT in the detection of extrathoracic lymph node involvement (100% vs 70%, specificity 98% vs 94%) and distant metastases except to the brain (98% vs 83%, specificity 92% vs 79%). However, FDG-PET was significantly less sensitive than cranial MRI/CT in the detection of brain metastases (46% vs 100%, specificity 97% vs 100%). Conclusion: The introduction of FDG-PET in the diagnostic evaluation of SCLC will improve the staging results and affect patient management, and may reduce the number of tests and invasive procedures. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that scintigraphic regional myocardial perfusion defects during exercise in patients with normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory in response to cold pressor testing.Methods: 38 patients were classified into two groups according to the presence or absence of exercise induced scintigraphic myocardial perfusion defects. A cold pressor test was done in all patients during routine coronary angiography, followed by dynamic positron emission tomography to establish coronary blood flow mediated vasoreactivity of the epicardial coronary artery and the myocardial territories supplied by the left anterior descending, left circumflex, and right coronary arteries.Results: 28 patients had regional myocardial perfusion defects while 10 had normal scintigraphic imaging. The three dimensional scintigraphic fusion image revealed 49 regional myocardial perfusion defects with a mean (SD) reversibility of the original stress defect of 20 (3)%. In patients with exercise induced regional myocardial perfusion defects, the responses of epicardial luminal area and regional myocardial blood flow (RMBF) to cold pressor testing were reduced compared with patients with normal perfusion imaging (epicardial luminal area: 5.2 (1.2) to 4.2 (0.86) mm2 v 4.7 (0.5) to 5.8 (0.5) mm2; RMBF: 0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.15) to 1.38 (0.26) ml/g/min; p < or = 0.03, respectively). In patients with regional abnormal scintigraphic perfusion, the corresponding RMBF response to cold pressor testing was more severely impaired than the mean myocardial blood flow in the remaining two vascular territories, but the difference was not significant (0.75 (0.16) to 0.78 (0.20) ml/g/min v 0.75 (0.10) to 0.87 (0.12) ml/g/min; NS). The endothelium independent increase in RMBF induced by glyceryl trinitrate did not differ between patients with exercise induced myocardial perfusion defects and those with normal perfusion images (0.75 (0.16) to 0.94 (0.09) ml/g/min v 0.75 (0.15) to 0.94 (0.09) ml/g/min; NS). There was a highly significant correlation between the endothelium dependent responses of RMBF to cold pressor testing and the severity of exercise induced scintigraphic regional myocardial perfusion defects (r = 0.95, p = 0.001).Conclusions: Exercise induced scintigraphic regional myocardial perfusion defects in patients with angina but normal coronary angiography may be related to abnormal endothelium dependent vasoreactivity of the corresponding myocardial territory. [ABSTRACT FROM AUTHOR]

Diagnostic imaging for suspected tumour recurrence of primary colorectal cancer frequently lacks specificity and sensitivity. The impact of whole body 18F-FDG-positron-emission tomography (PET) on detection of local recurrences and hepatic or pulmonary metastases was evaluated in a prospective study. Results were compared with computed tomography (CT), ultrasonography, magnetic resonance imaging and conventional chest X-ray. The study included 71 patients (77 investigations) with suspected local recurrence, hepatic metastases or unexplained raised level of the tumour marker carcinoembryonic antigen (CEA). The results demonstrate that 18F-FDG-PET was clearly superior to CT with regard to detection of hepatic metastases. Sensitivity was 1.0 and specificity 0.98 compared with 0.87 and 0.91 for CT. In four cases, 18F-FDG-PET clarified otherwise unclear local recurrences. In five patients, 18F-FDG-PET showed pulmonary metastases that had previously been unknown. In a total of 16 patients (20.8%), 18F-FDG-PET provided additional information leading to a change of the treatment strategy. 18F-FDG-PET clearly has the ability to detect colorectal tumour recurrence and its metastases in a whole body format. Therefore, it may be applied in the follow-up of patients with primary colorectal cancer. Despite the costs, it is certainly recommended for patients with an otherwise unclear increase of CEA level or with unproven local recurrence. [ABSTRACT FROM AUTHOR]

The occurrence, prevalence, seasonality and histopathological progression of a cellular disorder, thought to be a haemic neoplasm, were studied in subpopulations of Mytilus edulis inhabiting different sites in Yaquina Bay, Oregon, from 1976-1981. There were significant differences in the occurrence of the disorder that were related to geographical location. In the subpopulation with the highest levels of the disease, the prevalence rates ranged from 0 to 20 % with a 5-year mean of 9.8 %. There was a statistically significant relationship between prevalence and season. During the 5-year study period, there was a consistent pattern characterized by highest prevalences during January to March followed by a period of decline to lower levels during the summer and early autumn, after which there was an increase. Data analyses revealed that there was no seasonal histopathological progression of the disorder. Numbers of stage 1 (early), 2, 3 and 4 (advanced) cases were not related to season but occurred in a random manner throughout the entire year. [ABSTRACT FROM AUTHOR]

The circulating haemocytes of the tanner crab, Chionocetes bairdi, were studied and classified as hyalinocytes, intermediate granulocytes and eosinophilic granulocytes. Differential haemocyte counts of normal crabs and crabs infected with an apparently pathogenic unnamed ascomycete fungus revealed a shift in the hyalinocyte-granulocyte ratio in infected crabs. There was a highly significant increase in the percentage of granulocytes and a corresponding decrease in hyalinocytes in infected crabs. This shift was thought to be caused by a marked increase in the relative number of eosinophilic granulocytes. There was also a highly significant statistical relationship between the severity of the internal fungus infection, established by histopathological analysis of the major organ systems, and the increased number of circulating eosinophilic granulocytes. The results of the study indicate that differential haemocyte counts may be a valuable tool in monitoring the health of C. bairdi populations. [ABSTRACT FROM AUTHOR]

Alterations of the cell surface during the vegetative cell cycle of the unicellular green alga Chlamydomonas reinhardtii were investigated using polyclonal antibodies against the purified and subsequently deglycosylated insoluble cell wall component and against a 100 kDa polypeptide of the deglycosylated, chaotrope-soluble wall fraction, respectively. Both antibodies recognized epitopes within the non-glycosylated domains of a ‘150 kDa’ chaotrope-soluble glycoprotein (=GP3B) localized in the outer layers of the C. reinhardtii cell wall. Immunofluorescence studies indicated that both antibodies reacted with the surface of ‘late’ sporangia (harvested 1 h before liberation of the zoospores), but not with the cell surfaces of released zoospores, growing cells and young sporangia, respectively. After pretreatment with aqueous LiCl, however, the cell surfaces of zoospores, growing cells and young sporangia became accessible to these particular antibodies. Highly purified preparations of the insoluble wall fraction revealed strong immunofluorescence with both antibodies but not with the corresponding preimmune sera. Based on these data, we concluded that the antigenic sites of the insoluble glycoprotein framework of the C. reinhardtii wall are masked by LiCl-soluble glycoproteins in single cell stages and young sporangia, but not or to a lesser extent in the case of the mother walls of ‘late’ sporangia. The conclusion was supported by findings that (I) the multilayered structure of the mother-cell wall was disturbed in ‘late’, but not in young sporangia and that (II) the amounts of chaotropesoluble cell wall glycoproteins present in the LiCl-extracts from intact sporangia decreased during ripening of the sporangia. [ABSTRACT FROM AUTHOR]