Non-small cell lung cancer with a single metastasis, the new stage M1b; does the site matter?

Non-small cell lung cancer (NSCLC) patients with a solitary metastasis are considered to have a more favourable prognosis compared to those with multiple metastases. This is also shown in the 8th tumor, node, metastases edition for lung cancer (TNM8): patients with M1b (single extrapulmonary metastasis) have a superior prognosis than those with M1c disease (multiple metastases). Although not described in the TNM8, site of single metastatic disease may reflect tumour biology and may be of important prognostic value. We report a case of a patient with squamous cell NSCLC and a single skeletal muscle metastasis with a remarkably aggressive disease course

A Phase I Study of Concurrent Individualized, Isotoxic Accelerated Radiotherapy and Cisplatin–Vinorelbine–Cetuximab in Patients With Stage III Non–Small-Cell Lung Cancer

Background:In this open-label phase I study, the maximum-tolerated dose of cetuximab with concurrent chemoradiotherapy (C-CRT) in stage III non–small-cell lung cancer together with individualized, isotoxic accelerated radiotherapy (RT) was investigated.Methods:Patients with stage III non–small-cell lung cancer, World Health Organization performance status 0–1, forced expiratory volume in 1 second more than 50%, carbon monoxide diffusing capacity more than 50%, weight loss less than 10%, and no severe comorbidity were enrolled. Patients without progression after one to two cycles of gemcitabine–carboplatin were included and treated with cetuximab 400 mg/kg d7 and 250 mg/kg weekly together with RT and cisplatin (50 mg/m2 d1, 8; 40 mg/m2 d22)–vinorelbine for 5 weeks. Vinorelbine was escalated in three steps; (1) 10 mg/m2 d1, 8 and 8 mg/m2 d22, 29; (2) 20 mg/m2 d1, 8 and 8 mg/m2 d22, 29; (3) 20 mg/m2 d1, 8; 15 mg/m2 d22, 29. An individualized prescribed RT dose based on normal tissue dose constraints was applied (e.g., mean lung dose 19 Gy). The primary endpoint was the maximum-tolerated dose 3 months after the end of C-CRT; secondary endpoints were toxicity and metabolic response as assessed by positron emission tomography.Results:Between September 2007 and October 2010, 25 patients (12 men, 13 women, mean age 59 years) were included. The mean RT dose was 62 ± 6.6 Gy. The vinorelbine dose could be escalated to dose level 3. Twelve of 25 patients experienced greater than or equal to grade 3 toxicity (esophagitis 3, rash 1, diarrhea 1, cough 1, dyspnea 1, vomiting 1, and pulmonary embolism 1). No dose-limiting toxicities were observed. One patient with a complete pathological response in dose level 3 developed a fatal hemoptysis 4 months after RT. Metabolic remissions were observed in 19 of 22 patients.Conclusion:C-CRT with cetuximab and cisplatin–vinorelbine is safe to deliver at full dose. The recommended phase II dose is therefore cetuximab 400 mg/m2 d7 and 250 mg/m2 weekly, cisplatin 50 mg/m2 d1, 8; 40 mg/m2 d22 and vinorelbine 20 mg/m2 d1, 8; 15 mg/m2 d22, 29 for 5 weeks together with RT

Power engineering challenges in Zambia

The paper presents a review of current power engineering challenges in Zambia in relevance to the required potential necessary for the country’s modern economic development. An outline of the energy sector is provided. The driving need for enhancing the development of the energy sector is highlighted, accounted by the country’s annual increase of GDP, leading to an increase in electricity demand. Possible mitigations are suggested, with the development of Zambia's rich potential in renewable energy, as well as upgrading the operating power plants and constructing more off-grid and on-grid generating facilities

PET imaging of hypoxia using [F-18]HX4: a phase I trial

 Download the images using these instructions and this DOI : 10.1007/s00259-010-1437-x Background and purposeNon-invasive PET imaging of tumour hypoxia could help in the selection of those patients who could benefit from chemotherapy or radiation with specific antihypoxic treatments such as bioreductive drugs or hypoxic radiosensitizers. In this phase I trial, we aimed to determine the toxicity of [18F]HX4, a member of the 2-nitroimidazole family, at different dose levels. The secondary aim was to analyse image quality related to the HX4 dose and the timing of imaging.MethodsPatients with a..