Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy

<p>Abstract</p> <p>Purpose</p> <p>To investigate the association between dose to various anatomical structures and dysphagia among patients with head and neck cancer treated by definitive intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy.</p> <p>Methods and materials</p> <p>Thirty-nine patients with squamous cancer of the head and neck were treated by definitive concurrent chemotherapy and IMRT to a median dose of 70 Gy (range, 68 to 72). In each patient, a gastrostomy tube (GT) was prophylacticly placed prior to starting treatment. Prolonged GT dependence was defined as exceeding the median GT duration of 192 days. Dysphagia was scored using standardized quality-of-life instruments. Dose-volume histogram (DVH) data incorporating the superior/middle pharyngeal constrictors (SMPC), inferior pharyngeal constrictor (IPC), cricoid pharyngeal inlet (CPI), and cervical esophagus (CE) were analyzed in relation to prolonged GT dependence, dysphagia, and weight loss.</p> <p>Results</p> <p>At 3 months and 6 months after treatment, 87% and 44% of patients, respectively, were GT dependent. Spearman's ρ analysis identified statistical correlations (p < 0.05) between prolonged GT dependence or high grade dysphagia with IPC V65, IPC V60, IPC Dmean, and CPI Dmax. Logistic regression model showed that IPC V65 > 30%, IPC V60 > 60%, IPC Dmean > 60 Gy, and CPI Dmax > 62 Gy predicted for greater than 50% probability of prolonged GT dependence.</p> <p>Conclusion</p> <p>Our analysis suggests that adhering to the following parameters may decrease the risk of prolonged GT dependence and dysphagia: IPC V65 < 15%, IPC V60 < 40%, IPC Dmean < 55 Gy, and CPI Dmax < 60 Gy.</p

Climate Interconnectedness and Financial Stability

Climate risks directly affect a wide range of non-financial firms, and indirectly affect the financial institutions that lend to or invest in them. In this paper, we explore the influence of climate risks on financial stability of European financial institutions using network analysis and panel regressions. The determination of interconnectedness variables and the graphical representations of climate networks allow the identification of climate systemic important financial institutions and risk concentrations. Our work contributes to the development of new macroprudential metrics to capture climate risks and address climate-related risk from a systemic perspective

Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy.

PurposeTo investigate the association between dose to various anatomical structures and dysphagia among patients with head and neck cancer treated by definitive intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy.Methods and materialsThirty-nine patients with squamous cancer of the head and neck were treated by definitive concurrent chemotherapy and IMRT to a median dose of 70 Gy (range, 68 to 72). In each patient, a gastrostomy tube (GT) was prophylacticly placed prior to starting treatment. Prolonged GT dependence was defined as exceeding the median GT duration of 192 days. Dysphagia was scored using standardized quality-of-life instruments. Dose-volume histogram (DVH) data incorporating the superior/middle pharyngeal constrictors (SMPC), inferior pharyngeal constrictor (IPC), cricoid pharyngeal inlet (CPI), and cervical esophagus (CE) were analyzed in relation to prolonged GT dependence, dysphagia, and weight loss.ResultsAt 3 months and 6 months after treatment, 87% and 44% of patients, respectively, were GT dependent. Spearman's rho analysis identified statistical correlations (p &lt; 0.05) between prolonged GT dependence or high grade dysphagia with IPC V65, IPC V60, IPC Dmean, and CPI Dmax. Logistic regression model showed that IPC V65 &gt; 30%, IPC V60 &gt; 60%, IPC Dmean &gt; 60 Gy, and CPI Dmax &gt; 62 Gy predicted for greater than 50% probability of prolonged GT dependence.ConclusionOur analysis suggests that adhering to the following parameters may decrease the risk of prolonged GT dependence and dysphagia: IPC V65 &lt; 15%, IPC V60 &lt; 40%, IPC Dmean &lt; 55 Gy, and CPI Dmax &lt; 60 Gy

MARCHES MILITAIRES

Titre uniforme : [Le régiment de Sambre et Meuse]Titre uniforme : [Marches. LWV 75]. ChoixTitre uniforme : [Marche lorraine]Comprend : SAMBRE ET MEUSE / Robert PLANQUETTE et RAUSKI ; la Musique du Ier R.T. dir. Capitaine André SEMLER-COLLERY - L'ECHO DE LA ROCHOTTE / de WAELE ; la Fanfare du 30ème Chasseurs dir. Sergent-Chef TREVILLE - MARCHE DE LA LIBERATION / HOYAU et COURQUIN ; la Fanfare de Cavalerie de la Garde dir. Capitaine MONMEGE - SOUS LE BURNOUS / GOSSEZ ; la Fanfafe de Cavalerie de la Garde dir. Trompette-Major GOSSEZ - DEFILE NATIONAL / arrang. de G. BALAY ; la Musique du Ier R.T. dir. Capitaine André SEMLER-COLLERY - MARCHE DE LA GARDE CONSULAIRE A MARENGO / arrang. FURGEOT ; la Musique du 5ème R.T. dir. Capitaine Wiliam PELE - VAUCOULEURS / A. GOSSEZ ; la Fanfare de Cavalerie de la Garde dir. Trompette-Major GOSSEZ - MARCHE LORRAINE / Louis GANNE ; la Fanfare du 30ème Chasseurs dir. Sergent-Chef TREVILLE - BAYARD / WATELLE ; la Musique du 99è R.I.A. dir. Sous-lietenant J.P. COULON - CADETS DE FRANCE / G. PIHET - MARCHE DES TIRAILLEURS / F. MENICHETTI ; la Nouba du 5è R.T.A. dir. Capitaine André SEMLER-COLLERY - MARCHE DES GOSSES / arrang. MENICHETTI ; la Fanfare du 24ème Chasseurs - MARCHE FRANCALSE / LULLY ; la Musique du Ier R.I. dir. Capitaine André SEMLER-COLLERYBnF-Partenariats, Collection sonore - BelieveContient une table des matière