FDG-PET/CT imaging for staging and radiotherapy treatment planning of head and neck carcinoma

<p>Abstract</p> <p>Background</p> <p>Positron emission tomography (PET) has a potential improvement for staging and radiation treatment planning of various tumor sites. We analyzed the use of ¹⁸F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) images for staging and target volume delineation of patients with head and neck carcinoma candidates for radiotherapy.</p> <p>Methods</p> <p>Twenty-two patients candidates for primary radiotherapy, who did not receive any curative surgery, underwent both CT and PET/CT simulation. Gross Tumor Volume (GTV) was contoured on CT (CT-GTV), PET (PET-GTV), and PET/CT images (PET/CT-GTV). The resulting volumes were analyzed and compared.</p> <p>Results</p> <p>Based on PET/CT, changes in TNM categories and clinical stage occurred in 5/22 cases (22%). The difference between CT-GTV and PET-GTV was not statistically significant (p = 0.2) whereas the difference between the composite volume (PET/CT-GTV) and CT-GTV was statistically significant (p < 0.0001).</p> <p>Conclusion</p> <p>PET/CT fusion images could have a potential impact on both tumor staging and treatment planning.</p

Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

<p>Abstract</p> <p>Background</p> <p>A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series.</p> <p>Methods</p> <p>Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected.</p> <p>Results</p> <p>Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85%) patients treated with hypofractionation and in 67/70 (96%) patients treated with conventional fractionation (p = 0.01). Late toxicity was observed in 8 patients (10%) in the hypofractionation group and in 10 patients (15%) in the conventional fractionation group, respectively (p = 0.4).</p> <p>Conclusions</p> <p>The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.</p

Antioxidant properties and chemical composition relationship of Europeans and Brazilians propolis

The antioxidant activity of ethanol extracts of propolis, bee glue, of various climate and orographic characteristics, col- lected from Italy, Brazil and Russia, was evaluated measuring their inhibitory action on peroxidation of linoleic acid, radical scavenging ability towards 2,2’-diphenyl-1-picrylhydrazyl, total phenolic content and reducing capacity by en- zymatic and Folin method respectively. Propolis samples were chemically characterized by HPLC-MS/MS in order to find a possible correlation between antioxidant activity and polyphenols composition and quantification. The results obtained indicate that Italian and Russian propolis samples have similar polyphenolic composition and, as a consequence, almost similar antioxidant activity, while Brazilian propolis evidence lower polyphenolic and antioxidant characteristics. Climate and orography reasons of these differences are also suggested

What has vaccination against COVID-19 in CKD patients taught us?

Effective vaccination strategies are of crucial importance to protecting patients who are vulnerable to infections, such as patients with chronic kidney disease. This is because the decreased efficiency of the immune system in chronic kidney disease impairs vaccine-induced immunisation. COVID-19 has prompted investigation of the immune response to SARS-CoV-2 vaccines in chronic kidney disease and in kidney transplant recipients in an effort to improve efficacy. The seroconversion rate after two vaccine doses is reduced, especially in kidney transplant recipients. Furthermore, although the seroconversion rate in chronic kidney disease patients is as high as in healthy subjects, anti-spike antibody titres are lower than in healthy vaccinated individuals, and these titres decrease rapidly. Although the vaccine-induced anti-spike antibody titre correlates with neutralising antibody levels and with protection against COVID-19, the protective prognostic significance of their titre is decreased due to the emergence of SARS-CoV-2 variants other than the Wuhan index virus against which the original vaccines were produced. Cellular immunity is also relevant, and because of cross-reactivity to the spike protein, epitopes of different viral variants confer protection against newly emerging variants of SARS-CoV-2. A multi-dose vaccination strategy is the most effective way to obtain a sufficient serological response. In kidney transplant recipients, a 5-week discontinuation period from antimetabolite drugs in concomitance with vaccine administration may also increase the vaccine's efficacy. The newly acquired knowledge obtained from COVID-19 vaccination is of general interest for the success of other vaccinations in chronic kidney disease patients

Concomitant chemo-radiotherapy for unresectable oesophageal cancer: A mono-institutional study on 40 patients

Background/AimTo analyse clinical response, overall (OS) and disease free survival (DFS) and toxicity in patients with unresectable oesophageal cancer treated by concomitant chemo-radiotherapy (CRT).Materials and methodsForty patients with stage IIa–IVa biopsy proven oesophageal carcinoma were treated with CRT. All patients were studied with endoscopy and CT and judged unresectable after multidisciplinary discussion. CRT consisted of 3 cycles of cisplatin 100[[ce:hsp sp="0.25"/]]mg/m2 or carboplatin 300[[ce:hsp sp="0.25"/]]mg/m2 on day 1 and 5-fluorouracil 1000[[ce:hsp sp="0.25"/]]mg/m2 as a continuous infusion of 96[[ce:hsp sp="0.25"/]]h associated with concurrent 3D-conformal RT. By using 15[[ce:hsp sp="0.25"/]]MeV X-rays, a total dose of 60–66[[ce:hsp sp="0.25"/]]Gy was delivered with daily fractions of 1.8–2.0[[ce:hsp sp="0.25"/]]Gy.ResultsComplete response (CR), partial response (PR) and no response (NR) were observed in 50%, 20% and 20% of cases, respectively. Of the 20 patients with CR, 15 developed loco-regional recurrent disease. OS and DFS rates at 3 and 5 years were 38%, 8%, 49% and 10%, respectively. Total radiation dose ≥60[[ce:hsp sp="0.25"/]]Gy improved loco-regional control and complete response (CR vs. PR[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]NR; p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.004) influenced both DFS and loco-regional control. Grade 3 gastrointestinal and haematological acute toxicity occurred in 3/40 patients (7.5%). One patient developed grade 4 renal failure. Late toxicity was reported in 2/40 patients (5.0%), consisting of grade 3 radiation pneumonitis.ConclusionsConcomitant CRT for unresectable oesophageal cancer can result in an acceptable loco-regional control with limited toxicity. Response after treatment and total radiation dose influenced the outcome

DNA Methyltransferase Gene Polymorphisms for Prediction of Radiation-induced Skin Fibrosis after Treatment of Breast Cancer: a Multifactorial Genetic Approach

This study was conducted to investigate the role of four polymorphic variants of DNA methyltransferase genes as risk factors for radiation-induced fibrosis in breast cancer patients. We also assessed their ability to improve prediction accuracy when combined with mitochondrial haplogroup H, which we previously found to be independently associated with a lower hazard of radiation-induced fibrosis

Atypical hemolytic uremic syndrome: Unique clinical presentation linked to rare CFHR5 mutation

In adults, the diagnosis and the clinical management of atypical hemolytic uremic syndrome is still a challenge for hematologists. Here, we report a case of a 40-year-old previously healthy man presented to the emergency department with fever (39.6◦C) and bilateral persistent foot pain. He has been 2 days earlier by his primary care doctor due to lower extremities pain and a sensation of low body temperature during physical activity. At admission, he was found diaphoretic, apyretic (reported paracetamol intake at home), tachycardic, with marbled lower limbs and lack of sensitivity in both feet. The patient’s history was negative for recurrent infections, kidney diseases, immune-rheumatological, or cardiovascular disorders. He smoked 20 cigarettes/day