Protonentherapie mit "Spot-Scanning" bei Rhabdomyosarkomen im frühen Kindesalter: Erste Erfahrungen am PSI

Ziel:: Die Durchführbarkeit und Verträglichkeit der Spot-Scanning-Protonentherapie in tiefer Sedierung bei Kindern mit Rhabdomyosarkomen (RMS) sollten geprüft werden. Patienten und Methodik:: Seit 2004 werden junge Kinder am Paul Scherrer Institut (PSI), Villigen, Schweiz, auch in tiefer Sedierung mit Protonen bestrahlt. Ausgewertet wurden Kinder unter 5 Jahren mit RMS im Bereich des Kopfes und Körperstamms. Alle Kinder waren in eine Therapieoptimierungsstudie eingeschlossen und wurden prospektiv hinsichtlich der Verträglichkeit der Bestrahlung untersucht. Ergebnisse:: Neun Kinder im medianen Alter von 1,9 Jahren wurden untersucht (sechs embryonale RMS und je ein alveoläres, undifferenziertes und nicht klassifizierbares RMS). Die Lokalisationen waren parameningeal (n = 4), orbital (n = 3), Kopf-Hals-Bereich (n = 1) und Prostata (n = 1). Bei allen Kindern lag ein IRS-Stadium III vor. Die Bestrahlung erfolgte ausschließlich mit Protonen (Gesamtdosen 46-54 CGE [Cobalt-Gray-Äquivalent]). Akuttoxizitäten Grad 3 oder 4 nach RTOG/EORTC traten ausschließlich im Bereich des Knochenmarks auf. Schlussfolgerung:: Die Protonentherapie bei RMS im frühen Kindesalter war problemlos durchführbar und hervorragend verträglich. Prospektive, standardisierte Erhebungen von Spättoxizität und Lebensqualität sind essentiel

Proton Therapy for Uveal Melanoma in 43 Juvenile Patients: Long-Term Results.

PURPOSE: To examine the metastatic and survival rates, eye retention probability, and the visual outcomes of juvenile patients after proton beam radiotherapy (PBRT) for uveal melanoma (UM). DESIGN: Retrospective case-factor matched control study. PARTICIPANTS AND CONTROLS: Forty-three patients younger than 21 years treated with PBRT for UM were compared with 129 matched adult control patients. METHODS: Information on patient demographics and clinical characteristics were recorded before and after treatment from patients' files. The control group was composed of adult patients (>21 years) matched for tumor size (largest tumor diameter, ±2 mm; height, ±2 mm) and anterior margin location (iris, ciliary body, pre-equatorial or postequatorial choroid). For each juvenile patient, 3 adults were selected. MAIN OUTCOME MEASURES: Comparing outcomes of juvenile and adult patients in terms of metastatic and eye retention rates using the log-rank statistic, relative survival using the Hakulinen method, as well as their visual outcomes. RESULTS: Forty-three juvenile and 129 control cases were reviewed. The metastatic rate at 10 years was significantly lower in juvenile UM patients than in adult controls (11% vs. 34%; P <0.01), with an associated relative survival rate of 93% versus 65% (P = 0.02). Six juvenile patients (14%) demonstrated metastases. One patient underwent enucleation because of a presumed local tumor recurrence and 4 additional patients underwent enucleation because of complications (9.3%). In the adult control group, 27% (n = 35) of matched patients demonstrated metastases, there were 2 cases of local recurrence, and 16% (n = 21) underwent enucleation because of complications. A visual acuity of more than 0.10 was maintained in most cases, without any significant differences before or after treatment observed between both groups. CONCLUSIONS: After PBRT, metastatic and survival rates are significantly better for juvenile than for adult patients with UM. Clinically, juvenile and adult eyes react similarly to PBRT, with patients having a comparable eye retention probability and maintaining a useful level of vision in most cases. This is the largest case-control study of proton therapy in juvenile eyes to date and further validates PBRT as an appropriate conservative treatment for UM in patients younger than 21 years

Justice and Tyranny: Law and the State in the Middle East

This is an offprint version of the article published in Journal of the Royal Asiatic Society Third Series, 9:375-88, made available by permission of the publisher. The version made available in Digital Common was supplied by the author.Publisher's Versiontru

A treatment planning intercomparison of proton and intensity modulated photon radiotherapy.

peer reviewedAbstract Purpose: A comparative treatment planning study has been undertaken between standard photon delivery techniques,b intensity modulated photon methods and spot scanned protons in order to investigate the merits and limitations of each of these treatment approaches. Methods: Plans for each modality were performed using CT scans and planning information for nine patients with varying indications and lesion sites and the results have been analysed using a variety of dose and volume based parameters. Results: Over all cases, it is predicted that the use of protons could lead to a reduction of the total integral dose by a factor three compared to standard photon techniques and a factor two compared to IM photon plans. In addition, in all but one Organ at Risk (OAR) for one case, protons are predicted to reduce both mean OAR dose and the irradiated volume at the 50% mean target dose level compared to both photon methods. However, when considering the volume of an OAR irradiated to 70% or more of the target dose, little difference could be shown between proton and intensity modulated photon plans. On comparing the magnitude of dose hot spots in OARs resulting from the proton and IM photon plans, more variation was observed, and the ranking of the plans was then found to be case and OAR dependent. Conclusions: The use of protons has been found to reduce the medium to low dose load (below about 70% of the target dose) to OARs and all non-target tissues compared to both standard and inversely planned photons, but that the use of intensity modulated photons can result in similar levels of high dose conformation to that afforded by protons. However, the introduction of inverse planning methods for protons is necessary before general conclusions on the relative efficacy of photons and protons can be drawn

Novel Technique of Craniospinal Axis Proton Therapy with the Spot-Scanning System: Avoidance of Patching Multiple Fields and Optimized Ventral Dose Distribution

Background and Purpose:: Conventional craniospinal irradiation (CSI) is a complex procedure carrying a high risk of adverse side effects. Still, it is indispensable for cure in a number of pediatric brain tumors. In this study, the feasibility and the potential advantage of spot-scanning proton therapy for CSI are investigated. Material and Methods:: A boy (5.5 years of age) with a recurrent medulloblastoma received CSI with a single posterior field using the spot-scanning system at Paul Scherrer Institute. Dose distribution to the targets and the organs at risk, treatment time, reproducibility of patient positioning, toxicity (according to EORTC/RTOG score), and treatment outcome were evaluated. Results:: The plan achieved a homogeneous coverage of the target volume, even using a single field. The doses to the organs ventral to the target were minimized. During treatment, grade 1 skin reaction and grade 2 central nervous system toxicity were observed. After 2 months, the boy presented with a transitory fatigue. After 24 months, he is alive and free of disease. Growth hormones and thyroid hormones are reduced. Conclusion:: These results, based on a single patient, suggest that spot-scanning proton therapy for craniospinal treatment is feasible and safe. By applying a single dorsal field, difficulties of multiple-field patching can be avoided and the ventral dose spread can be minimize

Strangers Along the Trail: Peoria’s Shaker Apostates Enter the World

In the 1830s, Peoria, Illinois, became the home of a remarkable group of immigrants whose origins were unknown to their contemporaries and overlooked by historians for nearly 150 years. They were Shaker apostates, political and religious refugees from the utopian settlement of Pleasant Hill, Kentucky, a Shaker community noted for members’ communal ownership of property, dedication to altruistic labor, and the Shaker faith that demanded strict celibacy. The apostates’ lives cover two periods: first, at Pleasant Hill, where their dedication to an ideal of religious and social perfection demanded that they abandon worldly ties and family bonds; and second, in “the World,” which called for just the opposite. Their struggles and success in both realms are remarkable and testify both to the force and success of altruistic communal initiatives and centralized power as well as the countervailing force of bonds of marriage and family, democratic decision making, and private ownership of property

Deutsch v. Attorney General

The effect of the provision in section 217 of the Criminal Code Ordinance, 1936, 1) that an unlawful omission is an omission amounting to culpable negligence to discharge a duty (of care)... is that a person can be convicted of the offence of manslaughter, defined in section 212 2) as causing the death of another person by an unlawful act or omission , only where it is proved: (a) that the lack of care on the part of the accused amounted to gross negligence , that is to say, was a serious divergence from the standard of reasonable care, and (b) that the accused acted as he did out of recklessness , that is to say, after foreseeing that his conduct was liable to endanger the life or person of another. Semble, where the negligence of the accused does not amount to gross negligence, but his recklessness expresses itself in indifference to the consequences of his omission, it is possible and also right to convict him of manslaughter as defined in section 212. The accused, an architect supervising the work of repairing the roofs of abandoned houses in a village, being in need of a certain material for the work, went with a party of workmen to dig that material out of a bank at the roadside. The bank had a portion overhanging a cavity like a roof, and the accused, who was supervising the operation, directed the workmen to dig in the cavity. Two officials of the Public Works Department passed by and warned the accused of the danger of a landfall. Notwithstanding that warning, the digging proceeded. The bank fell in and two workmen were killed. Held : the accused was guilty of manslaughter. Held further: though the sentence of six months\u27 imprisonment imposed upon the accused by the District Court was not, in the circumstances, excessive, it would nevertheless not be confirmed on appeal, the offence having been committed in January, 1950, and the appeal having been heard only in January, 1954

Attorney General v. Hornstein

Section 25(1) of the Road Transport Ordinance and section 99(1) of the Municipal Corporations Ordinance provide as follows: 25(1) A municipal...council may, with the consent of the district commissioner and the licensing authorfty, make bye-laws in regard to the following matters-... (b) the regulation by prohibition or otherwise of vehicles when stationary within the municipal... area. 99(1) A municipal council may make by-laws to enable or assist it to carry out any of the matters it is required or empowered to do under...any other Ordinance... and may by such by-laws provide for the payment of any fees...by any person...in connection with such matters. In bye-laws made by the Municipal Council of Tel-Aviv-Jaffa under the above sections provision was made for the designation by the Council of parking places , and the Mayor was empowered, after consultation with certain officials, to set apart a parking place , to regulate parking in a regulated parking place by an attendant or by means of mechanical devices, and to prescribe different scales of fees for the different regulated parking areas according to the hours of parking, the periods and types of vehicles. The by-laws also provided that a person who contravenes any of their provisions shall be liable to a fine of IL 100. The respondent was convicted by a Municipal Court of an offence against the bye-laws in that he had parked his car in a regulated parking place regulated by means of mechanical devices, namely, parking meters, without depositing the fee prescribed in the Mayor\u27s notice which appeared thereon. On appeal to the District Court the conviction was quashed on the grounds that the delegation of powers by the council to the Mayor was ultra vires the powers of the Council under the sections cited, and that the Mayor\u27s regulations regarding the duty to pay a fee at a certain rate were of a legislative character and had not been published as required by law. The Attorney-General appealed. Held, dismissing the appeal: Per Agranat J. (Silberg J. concurring), (1) the function of the Mayor in designating a parking place as a regulated parking place was of a legislative character, while the function of regulating parking thereon by an attendant or by means of mechanical devices was merely administrative in character. (2) The principle of delegatus non potest delegare is not to be regarded, even to the extent that it 11pplies to the authority of a secondary legislator, as an inflexible rule but merely as a presumption which may sometimes be rebutted, and at least one recognised qualification upon its application is that in the case of a secondary legislator upon whom full legislative authority has been conferred to regulate a number of different matters-power to make primary regulations and not merely rules of an executive nature in relation thereto it may be inferred that the Law from which this authority derives intended by implication to permit him to place upon an administrative body the task of determining when or how the regulations prescribed by such legislator should come into effect. (3) The provisions of the bye-laws therefore empowering the Mayor to prescribe regulated parking places in those places which had previously been designated as parking places by the Council itself, and having done so to determine whether parking thereon should be regulated by attendants or by means of parking meters, should be upheld. (4) The fee imposed for parking was not only of the nature of a price but also of the nature of a tax , and as the authority to levy a tax emanates from the sovereign character of the supreme legislative organ, if for this purpose it has chosen to be assisted by a subordinate law-making body, the latter must necessarily abide, even to a greater degree, by the principle of delegatus non potest delegare; and as moreover the Council could itself control the fixing of the price either by outlining a rational basis or mode of action for guiding the Mayor in prescribing the relevant scales of fees or by fixing a maximum rate for the parking fee, the determination of the scale by the Mayor alone was of no effect. Per Goitein J. (dissenting), the parking fee was not of the nature of a tax, and the Council had therefore not exceeded its powers in delegating the function of prescribing the fee to the Mayor

Attorney General v. Dizengoff & Co., Ltd.

Three different rates of exchange were introduced as a result of the variation of the official rate of exchange of lsraeli currency in 1952. The rate applicable to shipping matters necessitated an increase in the charges for port services, including those for Israel shipping, in order to avoid the charge of discrimination in favour of such shipping. The excess earnings made by the port service companies in respect of Israel shipping was, at first by agreement and later by Order, made transferable to the Ministry of Finance. The respondent resisted this arrangement in respect of its own Israel ships and refused to pay the transferable amount. The Order embodying the arrangement was given retrospective effect but as a result of doubts as to the adequacy of the Order the authorities published a Defence Regulations Order. The respondent persisted in its refusal to pay the Ministry\u27s portion of the port charges due from it. Instead the lighterage company involved assigned the debt of the respondent to the Government which unsuccessfully sued the respondent, the District Court rejecting the Government\u27s claim on the grounds that the retrospective effect of the Defence Regulations Order and the new scales payable thereunder was not binding. Held: The Ports\u27 Ordinance under which the Ports\u27 Order was made contains no express prohibition upon giving retroactive force to any Order made thereunder. References to retroactivity in the Ordinance did not touch the subject matter of the Ports\u27 Order. Notwithstanding the views sometimes expressed in English case law, there was no reason in principle for distinguishing between delegated legislation of the type of the Ports\u27 Order and local authority bye-laws, when it came to testing the validity thereof. The question of reasonableness is one aspect of excess of authority and, therefore, there can and ought to be a close parallel in the manner of judicial scrutiny of all types of delegated legislation. All the various tests employed-unreasonableness, lack of good faith, having regard to improper considerations, extraneous objects-are merely different forms of testing excess of authority or abuse of power. In the instant case, the retroactive force given to the obligation to pay the increased charges was not in the circumstances unreasonable by itself. It did not constitute an invasion of the contractual relations between the parties, since any rate that was imposed depended upon the law and not upon the bargaining powers of the parties. The period of one and a half years of retroactivity was, however, unreasonable since it involved reopening transactions wholly completed. Likewise, the contributions to the Ministry of Finance were unreasonable since they constituted an indirect and camouflaged collection of an impost which had nothing in common with the purpose of the legislature when it authorised the fixing of port charges

Jiday v. Chief Execution Officer and Sweidan

The second respondent, the wife of the petitioner, claimed maintenance against her husband in the religious court of her community, the Greek Catholic Melkite Community. The religious court gave judgment in her favour and the petitioner, her husband, appealed to the Court of Appeal of the Community. The Appellate Court confirmed the judgment and ordered the petitioner to pay his wife the sum of IL. 90.- per month as follows: IL. 60.- monthly, commencing April, 1953, and the balance from his share in his father\u27s estate, due after the father\u27s death. The second respondent duly applied to the first respondent to execute the judgment. The petitioner thereupon opposed the execution of the judgment. The Execution Officer rejected the opposition. Accordingly a petition was presented to this court and an order nisi was granted calling upon the first respondent to show cause why he should not refrain from executing the judgment of the religious court of October 22, 1953. On the return day arguments on behalf of the petitioner and the second respondent were heard. Held : that the order nisi should be discharged