Purpose: Currently, there is an intense debate on variations in intra-cerebral radiosensitivity and relative biological effectiveness (RBE) in proton therapy of primary brain tumours. Here, both effects were retrospectively investigated using late radiation-induced brain injuries (RIBI) observed in follow-up after proton therapy of patients with diagnosed glioma.
Methods: In total, 42 WHO grade 2-3 glioma patients out of a consecutive patient cohort having received (adjuvant) proton radio(chemo)therapy between 2014 and 2017 were eligible for analysis. RIBI lesions (symptomatic or clinically asymptomatic) were diagnosed and delineated on contrast-enhanced T1-weighted magnetic resonance imaging scans obtained in the first two years of follow-up. Correlation of RIBI location and occurrence with dose (D), proton dose-averaged linear energy transfer (LET) and variable RBE dose parameters were tested in voxel- and in patient-wise logistic regression analyses. Additionally, anatomical and clinical parameters were considered. Model performance was estimated through cross-validated area-under-the-curve (AUC) values.
Results: In total, 64 RIBI lesions were diagnosed in 21 patients. The median time between start of proton radio(chemo)therapy and RIBI appearance was 10.2 months. Median distances of the RIBI volume centres to the cerebral ventricles and to the clinical target volume border were 2.1 mm and 1.3 mm, respectively. In voxel-wise regression, the multivariable model with D, D × LET and periventricular region (PVR) revealed the highest AUC of 0.90 (95 % confidence interval: 0.89-0.91) while the corresponding model without D × LET revealed a value of 0.84 (0.83-0.86). In patient-level analysis, the equivalent uniform dose (EUD, a = 11) in the PVR using a variable RBE was the most prominent predictor for RIBI with an AUC of 0.63 (0.32-0.90).
Conclusions: In this glioma cohort, an increased radiosensitivity within the PVR was observed as well as a spatial correlation of RIBI with an increased RBE. Both need to be considered when delivering radio(chemo)therapy using proton beams.
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http://dx.doi.org/10.1016/j.radonc.2022.11.011 | DOI Listing |
Med Phys
December 2024
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Background: Rapid planning is of tremendous value in proton pencil beam scanning (PBS) therapy in overcoming range uncertainty. However, the dose calculation of the dose influence matrix (D) in robust PBS plan optimization is time-consuming and requires substantial acceleration to enhance efficiency.
Purpose: To accelerate the D calculations in PBS therapy, we developed an AI-D engine integrated into our in-house treatment planning system (TPS).
Patient Prefer Adherence
December 2024
CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.
Purpose: Proton-pump inhibitor (PPI) therapy stands as the primary treatment for upper gastrointestinal symptoms, yet poor adherence often results in treatment failure. Given that patients experiencing these symptoms frequently seek assistance at community pharmacies, the development of collaborative tools with primary care is becoming imperative. The objective was to assess the effectiveness of a pharmaceutical intervention, as demonstrated by a collaborative model between primary care and community pharmacies, in enhancing adherence to PPI among patients experiencing upper gastrointestinal symptoms.
View Article and Find Full Text PDFNeurooncol Adv
October 2024
Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Background: Ependymomas of the spinal cord are rare among children and adolescents, and the individual risk of disease progression is difficult to predict. This study aims to evaluate the prognostic impact of molecular typing on pediatric spinal cord ependymomas.
Methods: Eighty-three patients with spinal ependymomas ≤22 years registered in the HIT-MED database (German brain tumor registry for children, adolescents, and adults with medulloblastoma, ependymoma, pineoblastoma, and CNS-primitive neuroectodermal tumors) between 1992 and 2022 were included.
Vonoprazan is a novel acid blocker with greater potency than proton pump inhibitors. A Japanese study reported no significant safety concerns over 5 years of Vonoprazan use; however, elevated serum gastrin and increased parietal cell and foveolar hyperplasia were observed, and long-term safety data beyond 5 years are limited. We report a case that used Vonoprazan for 6 years, complicated by significant gastric epithelial changes during treatment and acute duodenal mucosal lesions following its discontinuation.
View Article and Find Full Text PDFProc (Bayl Univ Med Cent)
November 2024
Division of Gastroenterology and Hepatology, Case Western Reserve University, Cleveland, Ohio, USA.
Introduction: There is a paucity of information regarding providers' attitudes toward gastric-protective strategies with concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs). We aimed to assess gastric-protective strategies used upon prescribing NSAIDs and providers' awareness of societal guidelines for preventing NSAID-induced gastric complications.
Methods: A standardized 10-item questionnaire was sent to all orthopedic providers in North Carolina and South Carolina.
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