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Feasibility of Adaptive Radiation Therapy for Human-Papilloma Virus-Positive Oropharyngeal Cancer Patients Using MR-Guided RT
Human-papilloma virus (HPV)-positive oropharyngeal cancer (OPC) is a potentially curable disease with a rising incidence in the United States. Despite improved radiation therapy (RT) techniques, toxicities remain a concern. Adaptive RT (ART) can reduce radiation to organs-at-risk (OARs) without sacrificing tumoricidal dose to target volumes, but there are barriers to routine implementation. These include (1) technical barriers to ART and (2) timing of ART for shrinking tumor volumes or changes in body contours (such as weight loss or contracture of OARs). Magnetic resonance (MR)-Linacs allow for frequent, online, and standardized plan adaption, made possible by improved visualization of tumors and OARs as well as an integrated planning system. This study aims to: (1) develop an ART workflow protocol using an online adapt-to-shape approach on our MR-Linac while (2) identifying barriers to performance (such as treatment times and the influence to quality of life) and (3) characterizing quantitative imaging biomarkers during RT.
Sixteen eligible participants with non-metastatic HPV+ OPC will be enrolled. All participants will undergo simulation on our institution's MR-Linac. Participants will receive concurrent chemoRT with a dose prescription of 70 Gy in 35 fractions on the MR-Linac. ART planning will occur every 5th fraction of RT (i.e. the 6th, 11th, 16th, 21st, 26th, and 31st fractions). At 3-months follow-up, participants will undergo another MRI scan on the MR-Linac. The primary endpoint is to assess the accuracy of ART by (1) calculating the percent difference between initial and weekly ART plans and (2) confirming accuracy of deformable imaging registration. Secondary endpoints include (1) treatment times, calculated from guidelines set by the MR-Linac Consortium Head and Neck Tumor Site, as well as (2) quality of life measurements using study questionnaires (i.e. EORTC QLQs Core 30 and H&N43) at all study timepoints. As an exploratory endpoint, quantitative imaging biomarkers of tumor and nodal volume regression will be descriptively characterized.
This study is a trial-in-progress and has not reached pre-specified endpoints for analysis.
MR-Linacs are underutilized in the treatment of OPC patients, despite previous validation of clinically acceptable head and neck RT plans. For OPC patients, replanning is often static (i.e. at one timepoint), offline, and limited in standardization. This work will help clarify the role of MR-guided ART in HPV+ OPC: its feasibility, quality, and overall patient experience
Trichoderma populations from alkaline agricultural soil in the Nile valley, Egypt, consist of only two species
Fungal genus Hypocrea/Trichoderma: from barcodes to biodiversity* §
Hypocrea/Trichoderma is a genus of soil-borne or wood-decaying fungi containing members important to mankind as producers of industrial enzymes and biocontrol agents against plant pathogens, but also as opportunistic pathogens of immunocompromised humans and animals, while others can cause damage to cultivated mushroom. With the recent advent of a reliable, BarCode-aided identification system for all known taxa of Trichoderma and Hypocrea, it became now possible to study some of the biological fundamentals of the diversity in this fungal genus in more detail. In this article, we will therefore review recent progress in (1) the understanding of the geographic distribution of individual taxa; (2) mechanisms of speciation leading to development of mushroom diseases and facultative human mycoses; and (3) the possible correlation of specific traits of secondary metabolism and molecular phylogeny