Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Urban air quality in a coastal city: Wollongong during the MUMBA campaign

We present findings from the Measurements of Urban, Marine and Biogenic Air (MUMBA) campaign, which took place in the coastal city of Wollongong in New SouthWales, Australia. We focus on a few key air quality indicators, along with a comparison to regional scale chemical transport model predictions at a spatial resolution of 1 km by 1 km. We find that the CSIRO chemical transport model provides accurate simulations of ozone concentrations at most times, but underestimates the ozone enhancements that occur during extreme temperature events. Themodel alsomeets previously published performance standards for fine particulate matter less than 2.5 microns in diameter (PM2.5), and the larger aerosol fraction (PM10). We explore the observed composition of the atmosphere within this urban air-shed during the MUMBA campaign and discuss the different influences on air quality in the city. Our findings suggest that further improvements to our ability to simulate air quality in this coastal city can be made through more accurate anthropogenic and biogenic emissions inventories and better understanding of the impact of extreme temperatures on air quality. The challenges in modelling air quality within the urban air-shed ofWollongong, including difficulties in accurate simulation of the local meteorology, are likely to be replicated in many other coastal cities in the Southern Hemisphere

Oceanic phytoplankton are a potentially important source of benzenoids to the remote marine atmosphere

International audienceAbstract Benzene, toluene, ethylbenzene and xylenes can contribute to hydroxyl reactivity and secondary aerosol formation in the atmosphere. These aromatic hydrocarbons are typically classified as anthropogenic air pollutants, but there is growing evidence of biogenic sources, such as emissions from plants and phytoplankton. Here we use a series of shipborne measurements of the remote marine atmosphere, seawater mesocosm incubation experiments and phytoplankton laboratory cultures to investigate potential marine biogenic sources of these compounds in the oceanic atmosphere. Laboratory culture experiments confirmed marine phytoplankton are a source of benzene, toluene, ethylbenzene, xylenes and in mesocosm experiments their sea-air fluxes varied between seawater samples containing differing phytoplankton communities. These fluxes were of a similar magnitude or greater than the fluxes of dimethyl sulfide, which is considered to be the key reactive organic species in the marine atmosphere. Benzene, toluene, ethylbenzene, xylenes fluxes were observed to increase under elevated headspace ozone concentration in the mesocosm incubation experiments, indicating that phytoplankton produce these compounds in response to oxidative stress. Our findings suggest that biogenic sources of these gases may be sufficiently strong to influence atmospheric chemistry in some remote ocean regions

Comprehensive aerosol and gas data set from the Sydney Particle Study

The Sydney Particle Study involved the comprehensive measurement of meteorology, particles and gases at a location in western Sydney during February-March 2011 and April-May 2012. The aim of this study was to increase scientific understanding of particle formation and transformations in the Sydney airshed. In this paper we describe the methods used to collect and analyse particle and gaseous samples, as well as the methods employed for the continuous measurement of particle concentrations, particle microphysical properties, and gaseous concentrations. This paper also provides a description of the data collected and is a metadata record for the data sets published in Keywood et al. (2016a, line https://doi.org/10.4225/08/57903B83D6A5D \u3ehttps://doi.org/10.4225/08/57903B83D6A5D) and Keywood et al. (2016b, line https://doi.org/10.4225/08/5791B5528BD63 \u3ehttps://doi.org/10.4225/08/5791B5528BD63)

Interference of sea salt in capture vaporizer-ToF-ACSM measurements of biomass burning organic aerosols in coastal locations

The capture vaporizer (CV) was developed to reduce uncertainties in non-refractory aerosol composition measurements made using the aerosol mass spectrometer (AMS) and the aerosol chemical speciation monitor (ACSM). Use of the capture vaporizer has achieved this by improving the instruments\u27 collection efficiency to ∼1, but it has also lengthened the aerosol particles\u27 residence times in the instrument, which has changed AMS and ACSM measurements using the standard vaporizer by altering known fragmentation patterns of organic marker species and increasing the likelihood of detecting refractory particles such as sea salt at typical operating temperatures (∼550 °C). This study reports that the changes affected by the capture vaporizer leads to sea salt particles interfering with measurements of biomass burning organic aerosols (BBOA) in environments where both particle sources are present as the ACSM\u27s unit mass resolution is unable to distinguish between different molecules with the same molecular mass. Demonstration of this interference was performed using CV-Time of Flight-ACSM (CV-ToF-ACSM) measurements at two coastal Australian locations: the Kennaook-Cape Grim Baseline Air Pollution Station, Tasmania; and the site of the COALA-2020 (Characterizing Organics and Aerosol Loading over Australia 2020) campaign in New South Wales. Concentrations of BBOA marker ions m/z 60 and m/z 73 were examined at both locations, which showed two distinct branches of points: one where the two marker ions were positively correlated and one that was uncorrelated. This was due to m/z 60 also being a marker for sea salt. A threshold concentration of m/z 73 was established at each location to recognise periods where m/z 60 originated from BBOA. Lower concentrations of m/z 44 and radon when m/z 73 concentration was below the BBOA threshold indicated that m/z 60 concentration during these periods corresponded to inorganic particles of marine origin. Positive Matrix Factorization has also been shown to separate m/z 60 concentration from the two sources. This study suggests that using CV-ToF-ACSMs in coastal locations that are exposed to biomass burning smoke needs to consider sea salt interference when identifying BBOA

Urban Air Quality in a Coastal City: Wollongong during the MUMBA Campaign

We present findings from the Measurements of Urban, Marine and Biogenic Air (MUMBA) campaign, which took place in the coastal city of Wollongong in New South Wales, Australia. We focus on a few key air quality indicators, along with a comparison to regional scale chemical transport model predictions at a spatial resolution of 1 km by 1 km. We find that the CSIRO chemical transport model provides accurate simulations of ozone concentrations at most times, but underestimates the ozone enhancements that occur during extreme temperature events. The model also meets previously published performance standards for fine particulate matter less than 2.5 microns in diameter (PM2.5), and the larger aerosol fraction (PM10). We explore the observed composition of the atmosphere within this urban air-shed during the MUMBA campaign and discuss the different influences on air quality in the city. Our findings suggest that further improvements to our ability to simulate air quality in this coastal city can be made through more accurate anthropogenic and biogenic emissions inventories and better understanding of the impact of extreme temperatures on air quality. The challenges in modelling air quality within the urban air-shed of Wollongong, including difficulties in accurate simulation of the local meteorology, are likely to be replicated in many other coastal cities in the Southern Hemisphere

Measurement report: Understanding the seasonal cycle of Southern Ocean aerosols

The remoteness and extreme conditions of the Southern Ocean and Antarctic region have meant that observations in this region are rare, and typically restricted to summertime during research or resupply voyages. Observations of aerosols outside of the summer season are typically limited to long-term stations, such as Kennaook / Cape Grim (KCG; 40.7S, 144.7E), which is situated in the northern latitudes of the Southern Ocean, and Antarctic research stations, such as the Japanese operated Syowa (SYO; 69.0S, 39.6E). Measurements in the midlatitudes of the Southern Ocean are important, particularly in light of recent observations that highlighted the latitudinal gradient that exists across the region in summertime. Here we present 2 years (March 2016-March 2018) of observations from Macquarie Island (MQI; 54.5S, 159.0E) of aerosol (condensation nuclei larger than 10nm, CN10) and cloud condensation nuclei (CCN at various supersaturations) concentrations. This important multi-year data set is characterised, and its features are compared with the long-term data sets from KCG and SYO together with those from recent, regionally relevant voyages. CN10 concentrations were the highest at KCG by a factor of ∼50% across all non-winter seasons compared to the other two stations, which were similar (summer medians of 530, 426 and 468cm-3 at KCG, MQI and SYO, respectively). In wintertime, seasonal minima at KCG and MQI were similar (142 and 152cm-3, respectively), with SYO being distinctly lower (87cm-3), likely the result of the reduction in sea spray aerosol generation due to the sea ice ocean cover around the site. CN10 seasonal maxima were observed at the stations at different times of year, with KCG and MQI exhibiting January maxima and SYO having a distinct February high. Comparison of CCN0.5 data between KCG and MQI showed similar overall trends with summertime maxima and wintertime minima; however, KCG exhibited slightly (∼10%) higher concentrations in summer (medians of 158 and 145cm-3, respectively), whereas KCG showed ∼40% lower concentrations than MQI in winter (medians of 57 and 92cm-3, respectively). Spatial and temporal trends in the data were analysed further by contrasting data to coincident observations that occurred aboard several voyages of the RSV Aurora Australis and the RV Investigator. Results from this study are important for validating and improving our models and highlight the heterogeneity of this pristine region and the need for further long-term observations that capture the seasonal cycles