Three Years of Salvage IMRT for Prostate Cancer: Results of the Montpellier Cancer Center

Background. To assess the feasibility of salvage intensity-modulated radiation Therapy (IMRT) and to examine clinical outcome. Patients and Methods. 57 patients were treated with salvage IMRT to the prostate bed in our center from January, 2007, to February, 2010. The mean prescription dose was 68 Gy in 34 fractions. Forty-four patients received concomitant androgen deprivation. Results. Doses to organs at risk were low without altering target volume coverage. Salvage IMRT was feasible without any grade 3 or 4 acute gastrointestinal or urinary toxicity. With a median follow-up of 21 months, one grade 2 urinary and 1 grade ≥2 rectal late toxicities were reported. Biological relapse-free survival was 96.5% (2.3% (1/44) relapsed with androgen suppression and 7.7% (1/13) without). Conclusion. Salvage IMRT is feasible and results in low acute and chronic side-effects. Longer follow-up is warranted to draw conclusions in terms of oncologic control

Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults

Objective: To provide a management approach for adults with calcium channel blocker poisoning. Data Sources, Study Selection, and Data Extraction: Following the Appraisal of Guidelines for Research & Evaluation II instrument, initial voting statements were constructed based on summaries outlining the evidence, risks, and benefits. Data Synthesis: We recommend 1) for asymptomatic patients, observation and consideration of decontamination following a potentially toxic calcium channel blocker ingestion (1D); 2) as first-line therapies (prioritized based on desired effect), IV calcium (1D), high-dose insulin therapy (1D-2D), and norepinephrine and/or epinephrine (1D). We also suggest dobutamine or epinephrine in the presence of cardiogenic shock (2D) and atropine in the presence of symptomatic bradycardia or conduction disturbance (2D); 3) in patients refractory to the first-line treatments, we suggest incremental doses of high-dose insulin therapy if myocardial dysfunction is present (2D), IV lipid-emulsion therapy (2D), and using a pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block without significant alteration in cardiac inotropism (2D); 4) in patients with refractory shock or who are periarrest, we recommend incremental doses of high-dose insulin (1D) and IV lipid-emulsion therapy (1D) if not already tried. We suggest venoarterial extracorporeal membrane oxygenation, if available, when refractory shock has a significant cardiogenic component (2D), and using pacemaker in the presence of unstable bradycardia or high-grade arteriovenous block in the absence of myocardial dysfunction (2D) if not already tried; 5) in patients with cardiac arrest, we recommend IV calcium in addition to the standard advanced cardiac life-support (1D), lipid-emulsion therapy (1D), and we suggest venoarterial extracorporeal membrane oxygenation if available (2D). Conclusion: We offer recommendations for the stepwise management of calcium channel blocker toxicity. For all interventions, the level of evidence was very low

AMÉLIORER LES SERVICES D’ÉVALUATION PSYCHOSOCIALE OFFERTS AUX PERSONNES RÉFUGIÉES À LEUR ARRIVÉE AU QUÉBEC

Cet article porte sur la pertinence des services d’évaluation psychosociale offerts dans le cadre du programme Passerelle aux personnes réfugiées, dès leur arrivée au Québec. Selon un devis de recherche qualitatif, 28 participants originaires d’Afghanistan et d’Afrique subsaharienne, et deux travailleuses sociales, ont été rencontrés lors d’entretiens en groupe ou en individuel. Des recommandations proposées par les participants pour améliorer l’évaluation psychosociale sont présentées et discutées à la lumière de celles faites par des chercheurs. L’exhaustivité de l’évaluation et les courts délais de temps prévus pour l’effectuer sont notamment questionnés, ainsi que l’efficacité de cette mesure pour pallier les iniquités d’accès aux services de santé et psychosociaux.This article concerns the relevance of psychosocial assessment services offered to refugees as part of the program Passerelle upon their arrival in Quebec. Using a qualitative research design, 28 participants coming from Afghanistan and sub-Saharan Africa, and two social workers, were interviewed through focus group or individual interviews. Recommendations proposed by the participants in order to improve the psychosocial assessment are presented. These recommendations are discussed based on recommendations drawn from scientific literature. Among others, the completeness of the assessment and the short timeframe available to conduct it are questioned, as well as the efficiency of this measure to tackle the inequities of access to health and psychosocial services

Eight years of IMRT quality assurance with ionization chambers and film dosimetry: experience of the montpellier comprehensive cancer center

Abstract Background To present the results of quality assurance (QA) in IMRT of film dosimetry and ionization chambers measurements with an eight year follow-up. Methods All treatment plans were validated under the linear accelerator by absolute and relative measures obtained with ionization chambers (IC) and with XomatV and EDR2 films (Kodak). Results The average difference between IC measured and computed dose at isocenter with the gantry angle of 0° was 0.07 ± 1.22% (average ± 1 SD) for 2316 prostate, 1.33 ± 3.22% for 808 head and neck (h&n), and 0.37 ± 0.62% for 108 measurements of prostate bed fields. Pelvic treatment showed differences of 0.49 ± 1.86% in 26 fields for prostate cases and 2.07 ± 2.83% in 109 fields of anal canal. Composite measurement at isocenter for each patient showed an average difference with computed dose of 0.05 ± 0.87% for 386 prostate, 1.49 ± 1.86% for 158 h&n, 0.37 ± 0.34% for 23 prostate bed, 0.80 ± 0.28% for 4 pelvis, and 2.31 ± 0.56% for 17 anal canal cases. On the first 250 h&n analyzed by film in absolute dose, the average of the points crossing a gamma index 3% and 3 mm was 93%. This value reached 99% for the prostate fields. Conclusion More than 3500 beams were found to be within the limits defined as validated for treatment between 2001 and 2008.</p

Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: a comparison of conventional and IMRT plans

<p>Abstract</p> <p>Background</p> <p>To compare the dosimetric advantage of three different intensity-modulated radiation therapy (IMRT) plans to a three dimensional (3D) conventional radiation treatment for anal cancer with regards to organs-at-risk (OAR) avoidance, including iliac bone marrow.</p> <p>Methods</p> <p>Five patients with T1-3 N0-1 anal cancer and five with T4 and/or N2-3 tumors were selected. Clinical tumor volume (CTV) included tumor, anal canal and inguinal, peri-rectal, and internal/external iliac nodes (plus pre-sacral nodes for T4/N2-3 tumors). Four plans were generated: (A) AP/PA with 3D conformal boost, (B) pelvic IMRT with conformal boost (C) pelvic IMRT with IMRT boost and (D) IMRT with simultaneous integrated boost (SIB). The dose for plans (A) to (C) was 45 Gy/25 followed by a 14.4 Gy/8 boost, and the total dose for plan (D) (SIB) was 59.4 Gy/33. Coverage of both PTV and the volume of OAR (small bowel, genitalia, iliac crest and femoral heads) receiving more than 10, 20, 30, and 40 Gy (V10, V20, V30, V40) were compared using non parametric statistics.</p> <p>Results</p> <p>Compared to plan (A), IMRT plans (B) to (D) significantly reduced the V30 and V40 of small bowel, bladder and genitalia for all patients. The V10 and V20 of iliac crests were similar for the N0-1 group but were significantly reduced with IMRT for the N2-3/T4 group (V20 for A = 50.2% compared to B = 33%, C = 32.8%, D = 34.3%). There was no statistical difference between 2-phase (arm C) and single-phase (SIB, arm D) IMRT plans.</p> <p>Conclusion</p> <p>IMRT is superior to 3D conformal radiation treatment for anal carcinoma with respect to OAR sparing, including bone marrow sparing.</p

Plant Pollinator Networks along a Gradient of Urbanisation

International audienceBackground: Habitat loss is one of the principal causes of the current pollinator decline. With agricultural intensification, increasing urbanisation is among the main drivers of habitat loss. Consequently studies focusing on pollinator community structure along urbanisation gradients have increased in recent years. However, few studies have investigated how urbanisation affects plant-pollinator interaction networks. Here we assessed modifications of plant-pollinator interactions along an urbanisation gradient based on the study of their morphological relationships.Methodology/Principal Findings: Along an urbanisation gradient comprising four types of landscape contexts (semi-natural, agricultural, suburban, urban), we set up experimental plant communities containing two plant functional groups differing in their morphological traits (“open flowers” and “tubular flowers”). Insect visitations on these communities were recorded to build plant-pollinator networks. A total of 17 857 interactions were recorded between experimental plant communities and flower-visitors. The number of interactions performed by flower-visitors was significantly lower in urban landscape context than in semi-natural and agricultural ones. In particular, insects such as Syrphidae and solitary bees that mostly visited the open flower functional group were significantly impacted by urbanisation, which was not the case for bumblebees. Urbanisation also impacted the generalism of flower-visitors and we detected higher interaction evenness in urban landscape context than in agricultural and suburban ones. Finally, in urban context, these modifications lowered the potential reproductive success of the open flowers functional group.Conclusions/Significance: Our findings show that open flower plant species and their specific flower-visitors are especially sensitive to increasing urbanisation. These results provide new clues to improve conservation measures within urbanised areas in favour of specialist flower-visitors. To complete this functional approach, studies using networks resolved to the species level along urbanised gradients would be required