Changes in symptom clusters in patients undergoing radiation therapy

The goals of the study were to determine the occurrence rates for and the severity of symptoms at the middle, end, and 1 month after the completion of radiation therapy (RT), to determine the number and types of symptom clusters at these three time points, and to evaluate for changes over time in these symptom clusters. Symptom occurrence and severity were evaluated using the Memorial Symptom Assessment Scale (MSAS) in a sample of patients (n = 160) who underwent RT for breast or prostate cancer. At each time point, an exploratory factor analysis was done to determine the number of symptom clusters (i.e., symptom factors) based on the MSAS symptom severity ratings. The majority of the patients were male and married with a mean age of 61.1 years. The five symptoms with the highest occurrence rates across all three time points were lack of energy, pain, difficulty sleeping, feeling drowsy, and sweats. Although the number of symptoms and the specific symptoms within each symptom cluster were not identical across the three time points, three relatively similar symptom clusters (i.e., “mood-cognitive” symptom cluster, “sickness-behavior” symptom cluster, “treatment-related”, or “pain” symptom cluster) were identified in this sample. The internal consistency coefficients for the mood-cognitive symptom cluster and sickness-behavior symptom cluster were adequate at ≥0.68. Three relatively stable symptom clusters were found across RT. The majority of the symptom cluster severity scores were significantly higher in patients with breast cancer compared to patients with prostate cancer

Exceptionally high incidence of symptomatic grade 2–5 radiation pneumonitis after stereotactic radiation therapy for lung tumors

<p>Abstract</p> <p>Background</p> <p>To determine the usefulness of dose volume histogram (DVH) factors for predicting the occurrence of radiation pneumonitis (RP) after application of stereotactic radiation therapy (SRT) for lung tumors, DVH factors were measured before irradiation.</p> <p>Methods</p> <p>From May 2004 to April 2006, 25 patients were treated with SRT at the University of Tokyo Hospital. Eighteen patients had primary lung cancer and seven had metastatic lung cancer. SRT was given in 6–7 fields with an isocenter dose of 48 Gy in four fractions over 5–8 days by linear accelerator.</p> <p>Results</p> <p>Seven of the 25 patients suffered from RP of symptomatic grade 2–5 according to the NCI-CTC version 3.0. The overall incidence rate of RP grade2 or more was 29% at 18 months after completing SRT and three patients died from RP. RP occurred at significantly increased frequencies in patients with higher conformity index (CI) (p = 0.0394). Mean lung dose (MLD) showed a significant correlation with V₅–V₂₀(irradiated lung volume) (p < 0.001) but showed no correlation with CI. RP did not statistically correlate with MLD. MLD had the strongest correlation with V₅.</p> <p>Conclusion</p> <p>Even in SRT, when large volumes of lung parenchyma are irradiated to such high doses as the minimum dose within planning target volume, the incidence of lung toxicity can become high.</p

Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma

Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson’s chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33–41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ2P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05–5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available

Iodine-125 brachytherapy for brain tumours - a review

Iodine-125 brachytherapy has been applied to brain tumours since 1979. Even though the physical and biological characteristics make these implants particularly attractive for minimal invasive treatment, the place for stereotactic brachytherapy is still poorly defined

Regional Climate Shifts Caused by Gradual Global Cooling in the Pliocene Epoch

The Earth\u27s climate has undergone a global transition over the past four million years, from warm conditions with global surface temperatures about 3 °C warmer than today, smaller ice sheets and higher sea levels to the current cooler conditions. Tectonic changes and their influence on ocean heat transport have been suggested as forcing factors for that transition, including the onset of significant Northern Hemisphere glaciation 2.75 million years ago, but the ultimate causes for the climatic changes are still under debate. Here we compare climate records from high latitudes, subtropical regions and the tropics, indicating that the onset of large glacial/interglacial cycles did not coincide with a specific climate reorganization event at lower latitudes. The regional differences in the timing of cooling imply that global cooling was a gradual process, rather than the response to a single threshold or episodic event as previously suggested. We also find that high-latitude climate sensitivity to variations in solar heating increased gradually, culminating after cool tropical and subtropical upwelling conditions were established two million years ago. Our results suggest that mean low-latitude climate conditions can significantly influence global climate feedbacks

Fossil proxies of near-shore sea surface temperatures and seasonality from the late Neogene Antarctic shelf

We evaluate the available palaeontological and geochemical proxy data from bivalves, bryozoans, silicoflagellates, diatoms and cetaceans for sea surface temperature (SST) regimes around the nearshore Antarctic coast during the late Neogene. These fossils can be found in a number of shallow marine sedimentary settings from three regions of the Antarctic continent, the northern Antarctic Peninsula, the Prydz Bay region and the western Ross Sea. Many of the proxies suggest maximum spring–summer SSTs that are warmer than present by up to 5 °C, which would result in reduced seasonal sea ice. The evidence suggests that the summers on the Antarctic shelf during the late Neogene experienced most of the warming, while winter SSTs were little changed from present. Feedbacks from changes in summer sea ice covermay have driven much of the lateNeogene ocean warming seen in stratigraphic records. Synthesized late Neogene and earliest Quaternary Antarctic shelf proxy data are compared to the multi-model SST estimates of the Pliocene Model Intercomparison Project (PlioMIP) Experiment 2. Despite the fragmentary geographical and temporal context for the SST data, comparisons between the SSTwarming in each of the three regions represented in the marine palaeontological record of theAntarctic shelf and the PlioMIP climate simulations show a good concordance