Comparing robust proton versus online adaptive photon radiotherapy for short-course treatment of rectal cancer.

Background And Purpose: Image-guided proton beam therapy (IG-PBT) and cone-beam CT (CBCT)-based online adaptive photon radiotherapy (oART) have potentials to restrict radiation toxicity. They are both hypothesised to reduce therapy limiting bowel toxicity in the multimodality treatment of locally advanced rectal cancer (LARC). This study aimed to quantify the difference in relevant dose-volume metrics for these modalities.

The Efficacy of Echocardiography-guided Cardiac Implantable Electronic Devices Implantation to reduce Device Related Tricuspid Regurgitation: Long-term Follow-up.

Background: Cardiac implantable electronic devices (CIEDs) with endocardial leads crossing the tricuspid valve can lead to or worsen tricuspid regurgitation (TR), causing substantial morbidity and mortality. Despite a recent randomized controlled study revealing a low short-term incidence of device-related TR (DRT) post-CIED implantation, uncertainties persist regarding the efficacy of intra-procedural 2-dimensional transthoracic echocardiography (2DTTE) in preventing long-term TR.

Objectives: To conduct a long-term follow-up study on patients with CIED implants based on a previous study conducted at our hospital.

Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy.

Importance: Stratifying patients with biochemical recurrence (BCR) after primary treatment for prostate cancer based on the risk of prostate cancer-specific mortality (PCSM) is essential for determining the need for further testing and treatments.

Objective: To evaluate the association of BCR after radical prostatectomy or radiotherapy and its current risk stratification with PCSM.

Design, Setting, And Participants: This population-based cohort study included a total of 16 311 male patients with 10 364 (64%) undergoing radical prostatectomy and 5947 (36%) undergoing radiotherapy with curative intent (cT1-3, cM0) and PSA follow-up in Stockholm, Sweden, between 2003 and 2019.

[COMPLETE ATRIOVENTRICULAR BLOCK DUE TO PULMONARY EMBOLISM].

Pulmonary embolism, a common and potentially fatal clinical condition, occurs when a blood thrombus becomes lodged in the pulmonary vasculature and creates an acute increment in the pulmonary vascular resistance, which, in turn, creates a right ventricular strain. Among the more familiar electrocardiographic manifestations in acute pulmonary embolism is sinus tachycardia, right bundle branch block and ST-T abnormalities in the right precordium leads. Complete heart block or any type of bradycardia is uncommon.

Validation of automated post-adjustments of HDR prostate brachytherapy treatment plans by quantitative measures and oncologist observer study.

Purpose: The aim was to evaluate a postprocessing optimization algorithm's ability to improve the spatial properties of a clinical treatment plan while preserving the target coverage and the dose to the organs at risk. The goal was to obtain a more homogenous treatment plan, minimizing the need for manual adjustments after inverse treatment planning.

Materials And Methods: The study included 25 previously treated prostate cancer patients.

Development of a consensus-based delineation guideline for locally recurrent rectal cancer.

Background And Purpose: Neoadjuvant chemoradiotherapy (nCRT) is used in locally recurrent rectal cancer (LRRC) to increase chances of a radical surgical resection. Delineation in LRRC is hampered by complex disease presentation and limited clinical exposure. Within the PelvEx II trial, evaluating the benefit of chemotherapy preceding nCRT for LRRC, a delineation guideline was developed by an expert LRRC team.

Autosegmentation based on different-sized training datasets of consistently-curated volumes and impact on rectal contours in prostate cancer radiation therapy.

Background And Purpose: Autosegmentation techniques are emerging as time-saving means for radiation therapy (RT) contouring, but the understanding of their performance on different datasets is limited. The aim of this study was to determine agreement between rectal volumes by an existing autosegmentation algorithm and manually-delineated rectal volumes in prostate cancer RT. We also investigated contour quality by different-sized training datasets and consistently-curated volumes for retrained versions of this same algorithm.

Left Atrial Strain: Clinical Use and Future Applications-A Focused Review Article.

Atrial cardiomyopathy represents a process of structural and functional changes affecting the atria and leading eventually to clinical manifestation of atrial fibrillation and risk of stroke. Multimodality imaging provides a comprehensive evaluation of atrial remodeling and plays a crucial role in the decision-making process in treatment strategy. This paper summarizes the current state of knowledge on the topic of left atrial strain imaging using two-dimensional speckle tracking echocardiography (2D-STE).

Echocardiography-guided Cardiac Implantable Electronic Device Implantation to Reduce Device Related Tricuspid Regurgitation: A Prospective Controlled Study.

Background: Endocardial leads of permanent pacemakers (PPM) and implantable defibrillators (ICD) across the tricuspid valve (TV) can lead to tricuspid regurgitation (TR) or can worsen existing TR with subsequent severe morbidity and mortality.

Objectives: To evaluate prospectively the efficacy of intraprocedural 2-dimentional-transthoracic echocardiography (2DTTE) in reducing/preventing lead-associated TR.

Methods: We conducted a prospective randomized controlled study comparing echocardiographic results in patients undergoing de-novo PPM/ICD implantation with intraprocedural echo-guided right ventricular (RV) lead placement (Group 1, n=56) versus non-echo guided implantation (Group 2, n=55).

Evaluation of left atrial remodeling by 2D-speckle-tracking echocardiography versus by high-density voltage mapping in patients with atrial fibrillation.

Background: Strain imaging during left atrial (LA) reservoir phase (LASr) is used as a surrogate for LA structural remodeling and fibrosis. Atrial fibrillation (AF) patients with >5% low-voltage zones (LVZs) obtained by 3D-electro-anatomical-mapping have higher recurrence rate post-ablation. We investigated the relationship between LA remodeling using two-dimensional-speckle-tracking echocardiography (2D-STE) and high-density voltage mapping in AF patients.

A Nordic-Baltic perspective on indications for proton therapy with strategies for identification of proper patients.

The beneficial effects of protons are primarily based on reduction of low to intermediate radiation dose bath to normal tissue surrounding the radiotherapy target volume. Despite promise for reduced long-term toxicity, the percentage of cancer patients treated with proton therapy remains low. This is probably caused by technical improvements in planning and delivery of photon therapy, and by high cost, low availability and lack of high-level evidence on proton therapy.

Initial experience with introducing national guidelines for CT- and MRI-based delineation of organs at risk in radiotherapy.

A fundamental problem in radiotherapy is the variation of organ at risk (OAR) volumes. Here we present our initial experience in engaging a large Radiation Oncology (RO) community to agree on national guidelines for OAR delineations. Our project builds on associated standardization initiatives and invites professionals from all radiotherapy departments nationwide.

Quantitative evaluation of potential irradiation geometries for carbon-ion beam grid therapy.

Purpose: Radiotherapy using grids containing cm-wide beam elements has been carried out sporadically for more than a century. During the past two decades, preclinical research on radiotherapy with grids containing small beam elements, 25 μm-0.7 mm wide, has been performed.

Development of an interlaced-crossfiring geometry for proton grid therapy.

Background: Grid therapy has in the past normally been performed with single field photon-beam grids. In this work, we evaluated a method to deliver grid therapy based on interlacing and crossfiring grids of mm-wide proton beamlets over a target volume, by Monte Carlo simulations.

Material And Methods: Dose profiles for single mm-wide proton beamlets (1, 2 and 3 mm FWHM) in water were simulated with the Monte Carlo code TOPAS.

Microbeam radiation therapy - grid therapy and beyond: a clinical perspective.

Microbeam irradiation is spatially fractionated radiation on a micrometer scale. Microbeam irradiation with therapeutic intent has become known as microbeam radiation therapy (MRT). The basic concept of MRT was developed in the 1980s, but it has not yet been tested in any human clinical trial, even though there is now a large number of animal studies demonstrating its marked therapeutic potential with an exceptional normal tissue sparing effect.

A national approach for automated collection of standardized and population-based radiation therapy data in Sweden.

Purpose: To develop an infrastructure for structured and automated collection of interoperable radiation therapy (RT) data into a national clinical quality registry.

Materials And Methods: The present study was initiated in 2012 with the participation of seven of the 15 hospital departments delivering RT in Sweden. A national RT nomenclature and a database for structured unified storage of RT data at each site (Medical Information Quality Archive, MIQA) have been developed.

Proton Grid Therapy: A Proof-of-Concept Study.

In this work, we studied the possibility of merging proton therapy with grid therapy. We hypothesized that patients with larger targets containing solid tumor growth could benefit from being treated with this method, proton grid therapy. We performed treatment planning for 2 patients with abdominal cancer with the suggested proton grid therapy technique.

Beta-tubulin III expression in prostate cancer.

Objective: Beta-tubulin isotype III is a microtubule component associated with resistance to chemotherapy and poor outcome in various cancers. This study aimed to investigate its expression in prostate cancer and its role as a prognostic factor in this setting.

Material And Methods: A tissue microarray was constructed of 289 prostate cancers from radical prostatectomy specimens with a median follow-up of 48.

Clinical significance of intratumoral CD8+ regulatory T cells in prostate carcinoma.

Objective: To explore Foxp3, a member of the forkhead box family of transcription factors, which is a major gene for regulatory T (Treg) cell development of CD4+CD25+ or CD8+CD25+ phenotype.

Study Design: We constructed tissue microarrays from 82 patients after radical prostatectomy (RP). Three cores of neoplastic tissue and 3 from normal/inflammatory tissue were taken.

Expression of redox pathway enzymes in human prostatic tissue.

Objective: To evaluate the involvement of thioredoxin reductase (TxnR), thioredoxin (Trx) and peroxiredoxins (Prdx) in prostate cancer (PCa) and to assess the potential prognostic importance of these redox-regulated pathways.

Study Design: Expression of the isoforms TxnR2, Trx1 and Prdx2 was studied by immunohistochemistry on tissue microarrays (TMAs). In a prognostic TMA, 294 primary cases of PCa with a median follow-up of 49 months were stained for Trx1 and Prdx2.

Distribution of Foxp3-, CD4- and CD8-positive lymphocytic cells in benign and malignant prostate tissue.

Foxp3 is a transcription factor that inhibits antitumor immune response and is expressed in regulatory T cells (Tregs). High levels of Tregs have been reported in several human cancers. This study investigates the distribution of cells positive for Foxp3, CD4 and CD8 in benign prostatic tissues and prostatic carcinoma.

Individualized immune monitoring of cardiac transplant recipients by noninvasive longitudinal cellular immunity tests.

Background: Common immunosuppression strategies after heart transplantation (HTx) are based on accepted target drug levels, disregarding that drug levels do not correlate with the individual patient's pharmacokinetics or with the actual immunosuppressive drug effect on the patient. The Immuknow assay is used for immune monitoring and management of organ transplant recipients. This study evaluated the Immuknow assay for longitudinal immune monitoring of HTx patients throughout various clinical settings.

Endothelin-1 expression in prostate cancer and high grade prostatic intraepithelial neoplasia.

Objective: To investigate the prognostic value of endothelin-1 (ET-1), a vasoconstrictor involved in differentiation and growth of cancer, in prostate cancer.

Study Design: A tissue microarray was constructed of 287 prostate cancers from radical prostatectomy (RP) specimens with median follow-up of 48.9 months.