Combined Modality Therapies for High-Risk Prostate Cancer: Narrative Review of Current Understanding and New Directions.

Despite the many prospective randomized trials that have been available in the past decade regarding the optimization of radiation, hormonal, and surgical therapies for high-risk prostate cancer (PCa), many questions remain. There is currently a lack of level I evidence regarding the relative efficacy of radical prostatectomy (RP) followed by adjuvant radiation compared to radiation therapy (RT) combined with androgen deprivation therapy (ADT) for high-risk PCa. Current retrospective series have also described an improvement in biochemical outcomes and PCa-specific mortality through the use of augmented radiation strategies incorporating brachytherapy. The relative efficacy of modern augmented RT compared to RP is still incompletely understood. We present a narrative review regarding recent advances in understanding regarding comparisons of overall and PCa-specific mortality measures among patients with high-risk PCa treated with either an RP/adjuvant RT or an RT/ADT approach. We give special consideration to recent trends toward the assembly of multi-institutional series targeted at providing high-quality data to minimize the effects of residual confounding. We also provide a narrative review of recent studies examining brachytherapy boost and systemic therapies, as well as an overview of currently planned and ongoing studies that will further elucidate strategies for treatment optimization over the next decade

SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis.

High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor. SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure. The HDR brachytherapy procedure was tolerated without incident. All planning constraints were met, and the following dosimetry was achieved: Prostate – V100% = 97.3%, V150% = 35%, V200% = 14.5%; Urethra – V118% = 0%; Rectum – D2 cc = 51.6%, V75% = 0 cc. The rectum-catheter spacing was on average between 6-8 mm. Average spacing for our 10 most recent patients without SpaceOAR was 3 mm. SpaceOAR did not hinder or distort ultrasound imaging or increase treatment time. SpaceOAR successfully increases catheter-rectal wall spacing and decreases rectal dose due to improved planning capabilities, while decreasing the likelihood of rectal perforation. One application of this tool is presented to mitigate potential toxicities associated with ulcerative colitis. At five months, one week, and one day follow-up, the patient reported no bowel issues following HDR brachytherapy. © 2018 Termedia Publishing House Ltd. All Rights Reserved

Quantum entanglement, indistinguishability, and the absent-minded driver's problem

The absent-minded driver's problem illustrates that probabilistic strategies can give higher pay-offs than deterministic ones. We show that there are strategies using quantum entangled states that give even higher pay-offs, both for the original problem and for the generalized version with an arbitrary number of intersections and any possible set of pay-offs.Comment: LaTeX, 12 pages, 3 figure

Generating topological order from a 2D cluster state using a duality mapping

In this paper we prove, extend and review possible mappings between the two-dimensional Cluster state, Wen's model, the two-dimensional Ising chain and Kitaev's toric code model. We introduce a two-dimensional duality transformation to map the two-dimensional lattice cluster state into the topologically-ordered Wen model. Then, we subsequently investigates how this mapping could be achieved physically, which allows us to discuss the rate at which a topologically ordered system can be achieved. Next, using a lattice fermionization method, Wen's model is mapped into a series of one-dimensional Ising interactions. Considering the boundary terms with this mapping then reveals how the Ising chains interact with one another. The relationships discussed in this paper allow us to consider these models from two different perspectives: From the perspective of condensed matter physics these mappings allow us to learn more about the relation between the ground state properties of the four different models, such as their entanglement or topological structure. On the other hand, we take the duality of these models as a starting point to address questions related to the universality of their ground states for quantum computation.Comment: 5 Figure

The Impact of Prostate Cancer Treatment on Quality of Life: A Narrative Review with a Focus on Randomized Data.

Despite excellent oncologic outcomes, the management of localized prostate cancer remains complex and is dependent on multiple factors, including patient life expectancy, medical comorbidities, tumor characteristics, and genetic risk factors. Decades of iterative clinical trials have improved the optimization and utilization of surgical and radiation-based modalities, as well as their combinatorial use with anti-androgen and systemic therapies. While cure rates are high and converging on equivalent disease control should an upfront surgical or radiotherapeutic approach be optimized, the long-term side effects of surgical and radiation-based treatments can differ significantly in nature. Decisions regarding the selection of therapy are therefore best made in an informed and shared medical decision-making process between clinician and patient with respect to cancer control as well as adverse effects. We outline in this narrative review an understanding regarding implications of surgical and radiation treatment on quality of life after treatment, and how these data may be considered in the context of advising patients regarding the selection of therapy. This narrative review largely focuses on the quality of life data obtained from prospective randomized trials of men treated for prostate cancer. We believe this provides the best assessment of the quality of life and can be used to inform patients when making treatment decisions

Predictors and Characteristics of Rib Fracture Following SBRT for Lung Tumors

Background: The utilization of stereotactic body radiation therapy (SBRT) is increasing for primary and secondary lung neoplasms. Despite encouraging results, SBRT is associated with an increased risk of osteoradionecrosis-induced rib fracture. We aimed to (1) evaluate potential clinical, demographic, and procedure-related risk factors for rib fractures and (2) describe the radiographic features of post-SBRT rib fractures. Methods: We retrospectively identified 106 patients who received SBRT between 2015 and 2018 for a primary or metastatic lung tumor with at least 12 months of follow up. Exclusion criteria were incomplete records, previous ipsilateral thoracic radiation, or relevant prior trauma. Computed tomography (CT) images were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was employed to determine clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location). Results: A total of 106 patients with 111 treated tumors met the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total fractured ribs). The highest number of fractured ribs per patient was five. Multivariate regression identified posterolateral tumor location as the only independent risk factor for rib fracture. On CT, fractures showed discontinuity between healing edges in 77% of affected patients. Conclusions: Nearly one third of patients receiving SBRT for lung tumors experienced rib fractures, 34% of whom experienced pain. Many patients developed multiple fractures. Post-SBRT fractures demonstrated a unique discontinuity between the healing edges of the rib, a distinct feature of post-SBRT rib fractures. The only independent predictor of rib fracture was tumor location along the posterolateral chest wall. Given its increasing frequency of use, describing the risk profile of SBRT is vital to ensure patient safety and adequately inform patient expectations

Recursive quantum repeater networks

Internet-scale quantum repeater networks will be heterogeneous in physical technology, repeater functionality, and management. The classical control necessary to use the network will therefore face similar issues as Internet data transmission. Many scalability and management problems that arose during the development of the Internet might have been solved in a more uniform fashion, improving flexibility and reducing redundant engineering effort. Quantum repeater network development is currently at the stage where we risk similar duplication when separate systems are combined. We propose a unifying framework that can be used with all existing repeater designs. We introduce the notion of a Quantum Recursive Network Architecture, developed from the emerging classical concept of 'recursive networks', extending recursive mechanisms from a focus on data forwarding to a more general distributed computing request framework. Recursion abstracts independent transit networks as single relay nodes, unifies software layering, and virtualizes the addresses of resources to improve information hiding and resource management. Our architecture is useful for building arbitrary distributed states, including fundamental distributed states such as Bell pairs and GHZ, W, and cluster states.Comment: 14 page

Predictors and Characteristics of Rib Fracture Following SBRT for Lung Tumors

Background Stereotactic body radiation therapy (SBRT) is an increasingly utilized therapy for primary and metastatic lung tumors. Despite promising tumor control, SBRT is associated with increased risk of rib osteoradionecrosis leading to rib fracture. We aimed to 1) determine clinical, demographic, and procedural risk factors of osteonecrosis and 2) radiographically characterize rib osteonecrotic fractures. Methods We retrospectively identified 106 patients who underwent SBRT between 2015 and 2018 for a primary or metastatic lung neoplasm with a minimum of 12 months of follow up. Patients with incomplete records, prior ipsilateral thoracic radiotherapy, or relevant trauma were excluded. Computed tomography (CT) scans were reviewed to identify and characterize rib fractures. Multivariate logistic regression modeling was used to elucidate clinical, demographic, and procedural risk factors (e.g., age, sex, race, medical comorbidities, dosage, and tumor location). Results A total of 106 patients with 111 treated tumors satisfied the inclusion criteria, 35 (32%) of whom developed at least one fractured rib (60 total ribs). The maximum number of affected ribs per subject was five. Multivariate regression identified posterolateral location as an independent risk factor for rib fracture. Radiographically, fractures in 77% of affected subjects showed discontinuity between healing edges. Discussion Post-SBRT fractures demonstrated distinct discontinuity, a possible signal of osteoradionecrosis. Tumor location along the posterolateral chest wall was the only independent predictor of rib fracture. Given its increasing frequency of use, understanding the risk profile of SBRT is vital to maintain patient safety and appropriately inform patient expectations

Probabilistic analysis of three-player symmetric quantum games played using the Einstein-Podolsky-Rosen-Bohm setting

This paper extends our probabilistic framework for two-player quantum games to the mutliplayer case, while giving a unified perspective for both classical and quantum games. Considering joint probabilities in the standard Einstein-Podolsky-Rosen-Bohm (EPR-Bohm) setting for three observers, we use this setting in order to play general three-player non-cooperative symmetric games. We analyze how the peculiar non-factorizable joint probabilities provided by the EPR-Bohm setting can change the outcome of a game, while requiring that the quantum game attains a classical interpretation for factorizable joint probabilities. In this framework, our analysis of the three-player generalized Prisoner's Dilemma (PD) shows that the players can indeed escape from the classical outcome of the game, because of non-factorizable joint probabilities that the EPR setting can provide. This surprising result for three-player PD contrasts strikingly with our earlier result for two-player PD, played in the same framework, in which even non-factorizable joint probabilities do not result in escaping from the classical consequence of the game.Comment: 21 pages, one figure, revised in light of referees' comments, accepted for publication in Physics Letters