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Introduction: Proton beam therapy (PBT) reduces normal organ dose compared to intensity-modulated radiation therapy (IMRT) for patients with major salivary gland tumors. It is not known whether this dosimetric advantage is clinically meaningful for reducing acute toxicity. Methods: We evaluated treatment parameters and acute toxicity outcomes of patients with major salivary gland cancers enrolled on the Proton Collaborative Group REG001-09 trial (NCT01255748). Results: One-hundred and five patients with a median age of 61 years were included. The majority had parotid (N = 90) versus submandibular gland (N = 15) tumors. The patients were treated across seven institutions in the United States between 2010 and 2017, most commonly in the postoperative setting (70.5%) although a minority were treated definitively (29.5%). Median PBT dose was 66.5 GyE in 33 fractions; only one patient was prescribed less than 50 GyE. Chemotherapy was given concurrently to 20%. Median follow-up was 14.3 months. Acute grade 2 or higher toxicity included nausea (1.5%), dysgeusia (4.8%), xerostomia (7.6%), mucositis (10.5%) and dysphagia (10.5%). Conclusions: PBT should be strongly considered when ipsilateral radiation therapy is indicated for major salivary gland cancer based on a considerably lower incidence of acute grade 2 or higher toxicity in this analysis compared to historical IMRT outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of prostate motion on dose coverage in proton therapy. Methods and Materials: A total of 120 prostate positions were analyzed on 10 treatment plans for 10 prostate patients treated using our low-risk proton therapy prostate protocol (University of Florida Proton Therapy Institute 001). Computed tomography and magnetic resonance imaging T2-weighted turbo spin-echo scans were registered for all cases. The planning target volume included the prostate with a 5-mm axial and 8-mm superoinferior expansion. The prostate was repositioned using 5- and 10-mm one-dimensional vectors and 10-mm multidimensional vectors (Points A–D). The beam was realigned for the 5- and 10-mm displacements. The prescription dose was 78 Gy equivalent (GE). Results: The mean percentage of rectum receiving 70 Gy (V70) was 7.9%, the bladder V70 was 14.0%, and the femoral head/neck V50 was 0.1%, and the mean pelvic dose was 4.6 GE. The percentage of prostate receiving 78 Gy (V78) with the 5-mm movements changed by −0.2% (range, 0.006–0.5%, p > 0.7). However, the prostate V78 after a 10-mm displacement changed significantly (p < 0.003) with different movements: 3.4% (superior), −5.6% (inferior), and −10.2% (posterior). The corresponding minimal doses were also reduced: 4.5 GE, −4.7 GE, and −11.7 GE (p ≤ 0.003). For displacement points A–D, the clinical target volume V78 coverage had a large and significant reduction of 17.4% (range, 13.5–17.4%, p < 0.001) in V78 coverage of the clinical target volume. The minimal prostate dose was reduced 33% (25.8 GE), on average, for Points A–D. The prostate minimal dose improved from 69.3 GE to 78.2 GE (p < 0.001) with realignment for 10-mm movements. Conclusion: The good dose coverage and low normal doses achieved for the initial plan was maintained with movements of ≤5 mm. Beam realignment improved coverage for 10-mm displacements. [Copyright &y& Elsevier]

Abstract: Purpose. : Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States. Age has been associated with worse outcome in univariate analysis. However, the patterns of failure and associated risk factors in older patients remain unclear. We reviewed our institution''s experience to assess the effect of age in a population of endometrial cancer patients treated with surgery and adjuvant radiation therapy. Methods. : From 1992–2002, 243 endometrial cancer patients underwent a total abdominal hysterectomy and adjuvant radiation. Forty-nine patients with stage I–II (occult) endometrial adenocarcinoma (no clear cell or serous papillary) were treated postoperatively with vaginal intracavitary high-dose rate (HDR) brachytherapy alone using Iridium-192 (median dose 30 Gy) to a median length of 4 cm. Forty-eight patients with stage I–III endometrial adenocarcinoma (no clear cell or papillary serous) were treated with postoperative pelvic RT (median dose 45 Gy) and intracavitary HDR brachytherapy (median dose 20 Gy). One hundred forty-six patients underwent postoperative whole abdomino-pelvic irradiation (WAPI) secondary to unfavorable histology (clear cell or serous papillary) or two of the following: deep myometrial invasion, grade 3, or FIGO stage III. Age was analyzed as a continuous and a categorical variable. The age of 63 year split the age group using various statistical analyses. Results. : Median follow-up of all patients was 4.2 years. Patients grouped by age of ≤63 years or older had similar FIGO stage (P = 0.5), grade (P = 0.09), treatment modality (P = 0.7), and lymphovascular space invasion (LVSI) (P = 0.6). Twenty-five percent (60/243) of patients developed recurrence. Of these failures, 15% (15/102) were age ≤63 years and 32% (45/141) were age >63 years at diagnosis (P = 0.02). For all patients, the 5-year event-free survival (EFS), cause specific survival (CSS), and overall survival (OS) were 64%, 82%, and 72%, respectively. Five-year EFS for patients age ≤63 years and >63 years was 76% vs. 55% (P < 0.001). Five-year OS for age ≤63 years and >63 years was 85% vs. 63% (P < 0.001). Five-year CSS for age ≤63 years and >63 years was 91% vs. 75% (P = 0.003). Various factors were analyzed to determine an association with age. Older patients with stage III–IVA had significantly more failures than patients less than age 63 (P = 0.002). Older patients (>63 years) were found to have serous papillary histology (28%) more often than younger patients (15%) (P = 0.02). Greater depth of invasion was associated with older age (P = 0.01). On univariate analysis, older age (P = 0.003), LVSI (P = 0.002), FIGO stage (P < 0.001), grade (P < 0.001), and depth of invasion (P = 0.03) predicted for failure. On Cox multivariate analysis, older age (P = 0.006, HR 2.83), higher FIGO stage (P = 0.001, HR 1.96), and higher grade (P = 0.002, HR 2.66) were significant prognostic factors for recurrence. No difference was seen between the two age groups from date of surgery and start of radiation. The duration of therapy was not different between the two groups. Conclusions. : Older endometrial cancer (age >63 years) patients have a significantly decreased overall survival, cause-specific survival, and greater risk of recurrence following postoperative RT independent of other prognostic factors and/or treatment technique. The impact of treatment-related variables did not alter the age-related outcome. [Copyright &y& Elsevier]

Background: Critical administration threshold (≥3 units of packed red blood cells/h or CAT+) has been proposed as a new definition for massive transfusion (MT) that includes volume and rate of blood transfusion. CAT+ has been shown to eliminate survivor bias and be a better predictor of mortality than the traditional MT (>10 units/24h). End-tidal CO2 (ET CO2) negatively correlates with lactate and is an early predictor of shock in trauma patients. We conducted a pilot study to test the hypothesis that low ET CO2 on admission predicts CAT+.Methods: ET CO2 via capnography and serum lactate were prospectively collected on admission for 131 patients requiring trauma team activation. Demographic data were obtained from patient charts. Excluded were patients with isolated head injuries, traumatic arrests, or pre-hospital intubations. CAT± status was determined for each hour up to 6h from admission as described; likewise, MT± status was determined up to 24h from admission.Results: After exclusion criteria, 67 patients were analyzed. Mean age was 41.2 (SD 18.5). Thirty-three patients had a blunt mechanism of injury (49%), median ISS was 9 (interquartile range 4-19), and there were 6 deaths (9%). ET CO2 and lactate were negatively correlated by Spearman rank-based correlation (rho=-0.41, p=0.0006). Twenty-one (31%) and 8 (12%) patients were CAT+ and traditional MT+, respectively. There were a significantly greater proportion of patients with ISS>15, ET CO2 <35, or who died found to be CAT+. A binomial logistic regression model adjusting for age, SBP <90, HR, and ISS >15 revealed ET CO2 < 35 to be independently predictive of CAT+ (OR 9.24, 95% CI 1.51-56.57, p=0.016).Conclusions: This pilot study demonstrated that low ET CO2 had strong association with standard indicators for shock and was predictive of patients meeting CAT+ criteria in the first 6h after admission. Further study to verify these results and to elucidate CAT criteria's association with mortality will require a larger sample size. [ABSTRACT FROM AUTHOR]

Asian citrus psyllid, Diaphorina citri Kuwayama, is the vector of "Huanglongbing" disease. Different insecticides are used to control the vector by a government containment program to prevent dissemination of disease in citrus growing areas in Mexico. Increased selection pressure on field populations can result in resistance to insecticides. The goal of this study was to determine susceptibility baselines in a laboratory strain of Asian citrus psyllid susceptible to 11 insecticides from five toxicological groups and determine diagnostic doses to test in eight populations from Tahiti lime, Citrus latifolia Tan., and Mexican lime, Citrus aurantifolia Swingle, orchards with different patterns of insecticide use. Resistance ratios were calculated in comparison with data from a susceptible strain in a laboratory in Florida. Most calculated LD50 and LD95 values corresponded well with mortalities caused by diagnostic doses. Asian citrus psyllids from Apatzingan, Michoacan were very resistant to imidacloprid, 4265.6-fold; dimethoate, 106.5-fold; chlorpyriphos, 26.5-fold; and slightly to thiamethoxam, 13.8-fold. At Cofradia de Morelos, Colima, resistance to imidacloprid was 25.6-fold. Resistance to imidacloprid (17.5-fold) and thiamethoxam (12.0-fold) was detected at Cerro de Ortega, Colima. Similar resistance was observed at Tepic, Nayarit, to imidacloprid (13.8-fold) and thiamethoxam (19.3-fold). Psyllids at Casimiro Castillo, Jalisco were resistant to chlorpyriphos (20.6-fold). At El Limon, Jalisco, resistance was found only to thiamethoxam (14.2-fold). Results are similar to those found by Tiwari et al. (2011, 2013) in Florida; however, resistance to neonicotinoids and organophosphates was greater in Asian citrus psyllids in Mexico than those in Florida. [ABSTRACT FROM AUTHOR]