Maintenance Therapy with Trastuzumab in Her2 Positive Metastatic Parotid Ductal Adenocarcinoma

Salivary ductal carcinomas (SDCs) are extremely rare and aggressive malignancies, accounting for approximately 6% of all salivary gland malignancies. One distinct feature is their resemblance to ductal carcinomas of breast. A significant percentage of SDCs overexpress Her2 and the use of targeted therapy with trastuzumab can be considered in these patients. We report a rare case of long term disease control with trastuzumab in Her2 positive metastatic parotid ductal carcinoma. Our case also highlights that isolated brain metastasis should be managed aggressively to allow optimal local control when systemic disease is under remission with trastuzumab. We have also reviewed the published literature on the use of trastuzumab in SDCs

Shrinkage of the non-malignant prostate gland volume after receiving incidental radiotherapy for rectal cancer

Background: The purpose of this study was to assess the impact of coincidental radiotherapy on the volume of the non-malignant prostate gland in rectal cancer patients treated with neo-adjuvant radiotherapy. Materials and methods: In this retrospective analysis, thirty male patients with rectal cancer who had neoadjuvant radiotherapy met the inclusion criteria. These patients had pre-treatment magnetic resonance imaging (MRI) and at least one post-treatment MRI of the pelvis and the whole of their prostate volume received the full prescribed radiotherapy dose; 45 Gy in 25 fractions (n = 22), 45 Gy in 20 fractions (n = 4) and 25 Gy in 5 fractions (n = 4). Results: The median age of this patient cohort was 66 years (range: 30–87). With a median interval between pre-treatment MRI and first MRI post-treatment of 2 months (range: 1–11), the mean prostate volume reduced from 36.1 cm3 [standard deviation (SD) 14.2] pre-radiotherapy to 31.3 cm3 (SD 13.0) post radiotherapy and this difference was significant (p = 0.0004). Conclusion: Radiotherapy may cause shrinkage in volume of normal (non-malignant) prostate. Further research is required in this field, since these results may be of some comfort to men contemplating the consequences of radiotherapy on their quality of life. The authors suggest recording flow-rate and international prostate symptom score (IPSS) during rectal radiotherapy as a next step

Ceramic-Chromium Hall Sensors for Environments with High Temperatures and Neutron Radiation

Ceramic-chromium Hall sensors represent a temperature and radiation resistant alternative to Hall sensors based on semiconductors. Demand for these sensors is presently motivated by the ITER and DEMO nuclear fusion projects. The developed ceramic-chromium Hall sensors were tested up to a temperature of 550 °C and a magnetic field of 14 T. The magnitude of the sensitivity of the tested sensor was 6.2 mV/A/T at 20 °C and 4.6 mV/A/T at 500 °C. The sensitivity was observed to be weakly dependent on a temperature above 240 °C with an average temperature coefficient of 0.014%/°C and independent of the magnetic field with a relative average deviation below the measurement accuracy of 0.086%. A simulation of a neutron-induced transmutation was performed to assess changes in the composition of the chromium. After 5.2 operational years of the DEMO fusion reactor, the transmuted fraction of the chromium sensitive layer was found to be 0.27% at the most exposed sensor location behind the divertor cassette with a neutron fluence of 6.08 × 1025 n/m2. The ceramic-chromium Hall sensors show the potential to be suitable magnetic sensors for environments with high temperatures and strong neutron radiation

Ceramic-Chromium Hall Sensors for Environments with High Temperatures and Neutron Radiation

Ceramic-chromium Hall sensors represent a temperature and radiation resistant alternative to Hall sensors based on semiconductors. Demand for these sensors is presently motivated by the ITER and DEMO nuclear fusion projects. The developed ceramic-chromium Hall sensors were tested up to a temperature of 550 °C and a magnetic field of 14 T. The magnitude of the sensitivity of the tested sensor was 6.2 mV/A/T at 20 °C and 4.6 mV/A/T at 500 °C. The sensitivity was observed to be weakly dependent on a temperature above 240 °C with an average temperature coefficient of 0.014%/°C and independent of the magnetic field with a relative average deviation below the measurement accuracy of 0.086%. A simulation of a neutron-induced transmutation was performed to assess changes in the composition of the chromium. After 5.2 operational years of the DEMO fusion reactor, the transmuted fraction of the chromium sensitive layer was found to be 0.27% at the most exposed sensor location behind the divertor cassette with a neutron fluence of 6.08 × 1025 n/m2. The ceramic-chromium Hall sensors show the potential to be suitable magnetic sensors for environments with high temperatures and strong neutron radiation

Survival outcomes for patients with nasopharyngeal carcinoma in non–endemic region in the UK treated with intensity modulated based radiotherapy 65 Gy in 30 fractions ± weekly cisplatin chemotherapy

Background: Nasopharyngeal carcinoma (NPC) is rare in the UK. The aim of the current study was to investigate survival outcomes for patients with NPC treated with (chemo)radiotherapy using 65 Gy in 30 fractions in a non-endemic region. Materials and methods: All consecutive 62 patients with histology proven non-metastatic nasopharyngeal carcinoma diagnosed between January 2009 to June 2019 were included in this retrospective analysis. Results: Median age was 59 years (range:19-81). The majority of patients had stage III disease (66.1%). Induction chemotherapy was given in 21% of patients and 82.3% of patients received concomitant systemic therapy. All patients were treated with 65Gy in 30 fractions. There was disease recurrence in 17.4% patients. The 5-year disease-free, disease-specific and overall survival were 81.9%, 79.2% and 76.4%, respectively. On univariate analysis, disease recurrence was associated with N-stage (p = 0.047) and overall stage group (p = 0.023). Conclusion: To the best of authors’ knowledge, this is the first report of the use of 65Gy in 30 fractions of radiotherapy ± weekly cisplatin chemotherapy in NPC in a real-world setting. Our results are comparable to that from other non-endemic regions of the world using different dose fractionation of (chemo)radiotherapy. Future randomised control trials are warranted to compare various dose fractionations in these settings. 

Prevalence of Atrial Fibrillation and Antithrombotic Therapy in Hemodialysis Patients: Cross-Sectional Results of the Vienna InVestigation of AtriaL Fibrillation and Thromboembolism in Patients on HemoDIalysis (VIVALDI)

Background Atrial fibrillation (AF) adds significant risk of stroke and thromboembolism in patients on hemodialysis (HD). The aim of this study was to investigate the prevalence of AF in a population-based cohort of HD patients and practice patterns of antithrombotic therapy for stroke prevention in AF. Methods The Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemodialysis (VIVALDI), an ongoing prospective observational cohort study, investigates the prevalence of AF and the risk of thromboembolic events in HD patients in Vienna, Austria. We analyzed cross-sectional data of 626 patients (63.4% men, median age 66 years, approx. 73% of HD patients in Vienna), who provided informed consent. A structured interview with each patient was performed, recent and archived ECGs were viewed and medical histories were verified with electronic records. Results The overall prevalence of AF was 26.5% (166 patients, 71.1% men, median age 72 years) of which 57.8% had paroxysmal AF, 3.0% persistent AF, 32.5% permanent AF, and 6.6% of patients had newly diagnosed AF. The median CHA2DS2-VASc Score was 4 [25th-75th percentile 35]. In multivariable analysis, AF was independently associated with age (odds ratio: 1.05 per year increase, 95% confidence interval: 1.031.07), male sex (1.7, 1.12.6), history of venous thromboembolism (2.0, 1.13.6), congestive heart failure (1.7, 1.12.5), history of or active cancer (1.5, 1.02.4) and time on HD (1.08 per year on HD, 1.031.13). Antithrombotic treatment was applied in 84.4% of AF patients (anticoagulant agents in 29.5%, antiplatelet agents in 33.7%, and both in 21.1%). In AF patients, vitamin-K-antagonists were used more often than low-molecular-weight heparins (30.1% and 19.9%). Conclusions The prevalence of AF is high amongst HD patients and is associated with age, sex, and distinct comorbidities. Practice patterns of antithrombotic treatment indicate a lack of consensus for stroke prevention in HD patients with AF.(VLID)486840