Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results

<p>Abstract</p> <p>Background</p> <p>The first-line treatment of a pelvic recurrence in a previously irradiated area is surgery. Unfortunately, few patients are deemed operable, often due to the location of the recurrence, usually too close to the iliac vessels, or the associated surgical morbidity. The objective of this study is to test the viability of robotic image-guided radiotherapy as an alternative treatment in inoperable cases.</p> <p>Methods</p> <p>Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife^®for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria.</p> <p>Results</p> <p>Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities.</p> <p>Conclusions</p> <p>Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.</p

Apport du réhaussement lobulé dans le suivi tomodensitométrique des métastases hépatiques traitées par CyberKnife®

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Acute hemodialysis effects on doppler echocardiographic indices

Conventional echocardiographic (ECHO) parameters of systolic and diastolic func-tion of the left ventricular (LV) have been shown to be load dependent. However, the impact of pre-load reduction on tissue Doppler (TD) parameters of LV function is incompletely understood. To evaluate the effect of a single hemodialysis (HD) session on LV systolic and diastolic function using pulsed Doppler echocardiography and pulsed tissue Doppler imaging (TDI), we studied 81chronic HD patients (40 males; mean age 52.4 ± 16.4 years) with these tools. ECHO parameters were obtained 30 min before and 30 min after HD. Fluid volume removed by HD was 1640 ± 730 cm [3] . HD led to reduction in LV end-diastolic volume (P <0.001), end-systolic volume (P <0.001), left atrium area (P <0.001), peak early (E-wave) trans-mitral flow velocity (P <0.001), the ratio of early to late Doppler velocities of diastolic mitral inflow (P <0.001) and aortic time velocity integral (P <0.001). No significant change in peak S velocity of pulmonary vein flow after HD was noted. Early and late diastolic (E′) TDI velocities and the ratio of early to late TDI diastolic velocities (E′/A′) on the lateral side of the mitral annulus decreased signi-ficantly after HD (P = 0.013; P = 0.007 and P = 0.008, respectively). Velocity of flow progres-sion (Vp) during diastole was not affected by pre-load reduction. Pulmonary artery systolic pressure and the diameter of the inferior vena cava decreased significantly (P <0.001 and P <0.001, respectively) after HD. We conclude that most of the Doppler-derived indices of diastolic function are pre-load-dependent and velocity of flow progression was minimally affected by pre-load reduction in HD patients

Cosmetic emulsion from virgin olive oil: Formulation and bio-physical evaluation

The present study aimed to formulate and subsequently evaluate a topical skin-care cream (o/w emulsion) from virgin olive oil versus its vehicle (base). A formulation containing 3% virgin olive oil was developed by entrapping it in the oily phase of oil-in-water (o/w) emulsion. The base form did not contain natural oil. Lemon oil was incorporated to improve the odor. Both the base and formulation were stored at 8°C (in refrigerator) and at 25, 40 and 55°C (in incubator) for a period of four weeks to investigate their stability. The evaluation parameters consisted of color, smell, phase separation, centrifugation, liquefaction, and pH. The microbiological stability of the formulations was also evaluated. The findings indicate that the formulations with olive oil were efficient against the proliferation of various spoilage microorganisms, including aerobic plate counts as well as Pseudomonas aeruginosa, Staphylococcus aureus, and yeast and mould counts. Organoleptic stability of the creams was achieved during four weeks. The results presented in this study showed good stability throughout the experimental period. The newly formulated cream of virgin olive oil proved to exhibit a number of promising properties and attributes that might open new opportunities for the construction of more efficient, safe, and cost-effective skin-care, cosmetic, and pharmaceutical products.Key words: Virgin olive oil, o/w emulsion, stability, pH

Lobulated Enhancement Evaluation in the Follow-Up of Liver Metastases Treated by Stereotactic Body Radiation Therapy

ObjectiveThe Response Evaluation Criteria in Solid Tumors (RECIST) can have limitations when used to evaluate local treatments for cancer, especially for liver malignancies treated by stereotactic body radiation therapy (SBRT). The aim of this study was to validate the relationship between the occurrence of lobulated enhancement (LE) and local relapse and to evaluate the utility of this relationship for predicting local progression.Patients and MethodsImaging data of 59 lesions in 46 patients, including 281 computed tomographic (CT) scans, were retrospectively and blindly reviewed by 3 radiologists. One radiologist measured the lesion size, for each CT and overall, to classify responses using RECIST threshold criteria. The second studied LE occurrence. A third radiologist was later included and studied LE occurrence to evaluate the interobserver consistency for LE evaluation.ResultsThe mean duration of follow-up was 13.6 months. LE was observed in 16 of 18 progressive lesions, occurring before size-based progression in 50% of cases, and the median delay of LE detection was 3.2 months. The sensitivity of LE to predict progression was 89%, and its specificity was 100%. The positive predictive value was 100%, the negative predictive value was 95.3%, and the overall accuracy was 97%. The probability of local progression-free survival at 12 months was significantly higher for lesions without LE compared with all lesions: 0.80 (CI 95%: 0.65-0.89) versus 0.69 (CI 95%: 0.54-0.80), respectively. The overall concordance rate between the 2 readers of LE was 97.9%.ConclusionResponse assessment of liver metastases treated by SBRT can be improved by including LE. This study demonstrates the diagnostic and predictive utility of LE for assessing local progression at a size still eligible for local salvage treatment

Kaplan Meier curves for local control and overall survival.

<p>Kaplan Meier curves for local control and overall survival.</p