Search

Purpose: To examine the impact of ethnicity, Spanish language preference, socioeconomic status, and treatment setting on utilization of supportive services before radiotherapy (RT) among head and neck cancer patients and to determine whether a lack of these services is associated with an increased rate of adverse events. Methods and Materials: Demographic, staging, and treatment details were retrospectively collected for patients treated at a safety-net hospital (n = 56) or adjacent private academic hospital (n = 183) from January 1, 2014, to June 30, 2016. Supportive care services evaluated were limited to speech/swallowing therapy and nutrition therapy. Adverse events and performance measures examined included weight loss during RT, gastric tube placement, emergency department visits, hospital admissions, and missed RT days. Results: On multivariable analysis, patients receiving treatment at the safety-net hospital were less likely to receive speech/swallowing services. Receiving speech/swallowing therapy before treatment was associated with less weight loss during treatment, and in conjunction with nutrition therapy, was associated with fewer missed RT days. Conclusion: Safety-net hospital treatment was associated with a lack of utilization of pre-RT speech/swallowing therapy which in turn was associated with increased weight loss. Interventions aimed at improving utilization of these services would improve treatment tolerance and patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Small randomized trials have not shown an overall survival (OS) difference among local treatment modalities for patients with extremity soft‐tissue sarcomas (E‐STS) but were underpowered for OS. We examine the impact of local treatment modalities on OS and sarcoma mortality (SM) using two national registries. The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program were analyzed separately to identify patients with stage II‐III, high‐grade E‐STS diagnosed between 2004 and 2013 and treated with (1) amputation alone, (2) limb‐sparing surgery (LSS) alone, (3) preoperative radiation therapy (RT) and LSS, or (4) LSS and postoperative RT. Multivariable analyses (MVAs) and 1:1 matched pair analyses (MPAs) examined treatment impacts on OS (both databases) and SM (SEER only). From the NCDB and SEER, 7828 and 2937 patients were included. On MVAs, amputation was associated with inferior OS and SM. Relative to LSS alone, both preoperative RT and LSS (HR, 0.70; 95% CI: 0.62‐0.78) and LSS and postoperative RT (HR, 0.69; 95% CI: 0.63‐0.75) improved OS in NCDB analyses with confirmation by SEER. Estimated median survivals from MPA utilizing NCDB data were 7.2 years with LSS alone (95% CI: 6.5‐8.9 years) vs 9.8 years (95% CI: 9.0‐11.2 years) with LSS and postoperative RT. A MPA comparing preoperative RT and LSS to LSS alone found median survivals of 8.9 years (95% CI: 7.9‐not estimable) and 6.6 years (95% CI: 5.4‐7.8 years). Optimal high‐grade E‐STS management includes LSS with preoperative or postoperative RT as evidenced by superior OS and SM. [ABSTRACT FROM AUTHOR]

Background Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). Objective To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). Design, setting, and participants A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. Interventions WPRT and/or ADT in addition to PBRT. Outcome measurements and statistical analyses FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. Results and limitation Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% ( p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p = 0.012). No significant differences in DM cumulative incidence were found. Conclusions For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. Patient summary We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning). [ABSTRACT FROM AUTHOR]

Purpose: To assess rates of burnout among US radiation oncology residents and evaluate program/resident factors associated with burnout.Methods and Materials: A nationwide survey was distributed to residents in all US radiation oncology programs. The survey included the Maslach Burnout Index-Human Services Survey (MBI-HSS) as well as demographic and program-specific questions tailored to radiation oncology residents. Primary endpoints included rates of emotional exhaustion, depersonalization, and personal accomplishment from MBI-HSS subscale scores. Binomial logistic models determined associations between various residency/resident characteristics and high burnout levels.Results: Overall, 232 of 733 residents (31.2%) responded, with 205 of 733 (27.9%) completing the MBI-HSS. High levels of emotional exhaustion and depersonalization were reported in 28.3% and 17.1%, respectively; 33.1% experienced a high burnout level on at least 1 of these 2 MBI-HSS subscales. Low rates of personal accomplishment occurred in 12% of residents. Twelve residents (5.9%) reported feeling "at the end of my rope" on a weekly basis or more. On multivariable analysis there was a statistically significant inverse association between perceived adequacy of work-life balance (odds ratio 0.37; 95% confidence interval 0.17-0.83) and burnout.Conclusions: Approximately one-third of radiation oncology residents have high levels of burnout symptoms, consistent with previous oncology literature, but lower levels than those among physicians and residents of other specialties. Particularly concerning was that more than 1 in 20 felt "at the end of my rope" on a weekly basis or more. Targeted interventions to identify symptoms of burnout among radiation oncology residents may help to prevent the negative downstream consequences of this syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To review the literature on use of radiation as a salvage option after local-only failure following initial treatment with radiation. Methods: PubMed was searched from inception to June 2012 using terms designed to include relevant articles on salvage radiation as a treatment for local-only failures after radiation. Results: Eighteen separate studies were found which demonstrated widely different patient populations, treatment methods, follow-up periods, and reporting. Only one phase II prospective study was found with no randomized controlled trials. Biochemical disease-free survival (bDFS) at four to 5 years ranged from 20 to 75 %. Patient selection may have influenced these varying rates since some studies with lower bDFS had higher risk populations. Factors associated with improved bDFS included post-treatment prostate-specific antigen (PSA) nadir of <0.5 ng/mL, pre-salvage PSA <6, Gleason score ≤7, and PSA doubling time (PSADT) >10 months. Overall survival ranged from 54 to 94 %, and disease-specific survival ranged from 74 to 100 %. The crude rate of grade 3–4 genitourinary toxicities among all studies was 13 % (range 0–47 %), and the crude rate of grade 3–4 gastrointestinal toxicities was 5 % (range 0–20 %). Incontinence rates were low among reviewed studies at 4 % (range 0–29 %). Conclusions: Brachytherapy represents a reasonable salvage option for patients with local recurrence after initial radiotherapy for prostate cancer. However, rates of toxicities, as in other salvage treatments, can be fairly high, and the likelihood of death from prostate recurrence variable. Prospective studies are needed to better define the efficacy and toxicity of this treatment modality. [ABSTRACT FROM AUTHOR]

A self-consistent numerical Poisson-Schrödingerdrift-diffusion solver is described for simulation of multiple-quantum-well (MQW) Al[sub x]Ga[sub 1-x]As-GaAs solar cells. The rates of escape, capture, and recombination of photoexcited carriers in quantum wells embedded in the intrinsic region of a p-i-n device are self-consistently incorporated in the model. The performance of the device for various quantum-well configurations is investigated and the device characteristics are related to the dynamics of capture, escape, absorption, and recombination of carriers in the quantum wells. Our results show that the incorporation of MQWs in the intrinsic region of a p-i-n solar cell can improve the conversion efficiency of non-optimal devices, if the device is designed based on careful consideration of the behavior of the photoexcited carriers in the quantum wells. Specifically, we found out that an Al[sub 0.1]Ga[sub 0.9]As-GaAs cell with multiple quantum wells of 150 Å is more efficient than an identical single bandgap Al[sub 0.1] Ga[sub 0.9]As cell with no quantum wells, but less efficient than a single bandgap GaAs cell without such quantum wells. [ABSTRACT FROM AUTHOR]

Abstract: A self-consistent model for escape and capture of carriers in quantum wells is described. The model accounts for carrier dynamics in the quantum wells by calculating the rates of escape and capture of photo-excited carriers in the wells, and including these rates in a self-consistent solution of the Poisson, Schrödinger, and drift–diffusion equations. The results obtained are in good agreement with those experimentally measured or theoretically calculated by others. Furthermore, the escape and capture rates calculated are in compliance with the requirements of detailed balance theory. [Copyright &y& Elsevier]

Reliability is an important consideration during semiconductor technology development, which ensures that the performances of devices, circuits, and systems are maintained over a specified period of time, leading to successful products. Device reliability is at the core of overall product reliability, which continues to remain an important area of research and has attracted the attention of IEEE Transactions on Electron Devices (T-ED) authors and readers throughout the years. Device reliability can be classified into two broad areas: gradual drift of device performance over time or sudden failure, and both are of importance for logic, memory, RF, and power devices. Different aspects of device reliability are usually reported, such as the development of electrical or physical characterization methods, investigation and modeling of a particular phenomenon, impact of material and processes on reliability, and development of reliability tolerant technologies. [ABSTRACT FROM AUTHOR]