Androgen Deprivation Therapy Combined With Particle Therapy for Prostate Cancer: A Systematic Review

PurposeThere is high-level evidence for addition of androgen deprivation therapy to photon-based radiotherapy of the prostate in intermediate- and high-risk prostate cancer. Little is known about the value of ADT in particle therapy of prostate cancer. We are conducting a systematic review on biochemical disease-free survival, overall survival, and morbidity after combined particle therapy and ADT for prostate cancer.MethodsA thorough search in PubMed, Embase, Scopus, and Web of Science databases were conducted, searching for relevant studies. Clinical studies on prostate cancer and the treatment combination of particle therapy and androgen deprivation therapy were included. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO (CRD42021230801).ResultsA total of 298 papers were identified. Fifteen papers reporting on 7,202 patients after proton or carbon-ion therapy for localized prostate cancer where a fraction or all patients received ADT were selected for analysis. Three thousand five hundred and nineteen (49%) of the patients had received combined ADT and particle therapy. Primarily high-risk (87%), to a lesser extent intermediate-risk (34%) and low-risk patients (12%) received ADT. There were no comparative studies on the effect of ADT in patients treated with particles and no studies identified ADT as an independent prognostic factor related to survival outcomes.ConclusionsThe review found no evidence to support that the effects on biochemical disease-free survival and morbidity of combining ADT to particle therapy differs from the ADT effects in conventional photon based radiotherapy. The available data on the topic is limited

Philosophical Practice as Self-modification: An Essay on Michel Foucault’s Critical Engagement with Philosophy

This essay argues that what makes Michel Foucault’s oeuvre not only stand apart but also cohere is an assiduous philosophical practice taking the form of an ongoing yet concrete self-modification in the medium of thought. Part I gives an account of three essential aspects of Foucault’s conception of philosophical activity. Beginning with his famous characterization of philosophy in terms of ascēsis, it moves on to articulate his characterization of philosophical practice as a distinct form of meditation, differing from both Cartesian meditation and Hegelian meditation, as it aims to stand vigil for the day to come and operates as a preface to transgression. Part II begins the articulation of crucial traits left implicit in this understanding of philosophy by turning to Foucault’s in-depth investigation of philosophy in Antiquity during his lectures at the Collège de France in the 1980s. First, it develops how philosophy here begins to constitute and distinguish itself by establishing itself as an activity that has a privileged relationship to truth and truth-telling as an unremitting, existentially determining challenge for the philosopher. Further, it instantiates how Platonism elaborates the need for a sustained ‘auto-ascetic’ ethical non-compliant differentiation as the condition of possibility for accessing and stating truth, and then describes how the assertion of an ethical differentiation and attitude in Cynicism takes the form of an insistent combat for another world in this world. Finally, it underlines how the ethical-practical philosophical work upon oneself in Antiquity is developed in an ongoing critical and political exchange with others. Part III indicates how ethical differentiation according to Foucault remains an essential precondition for the practice of philosophy and is further developed in the modern age. This is particularly perspicuous in Kant’s determination of the Enlightenment, in the attitude of modernity exemplified by Baudelaire, and in the history of revolt since the beginning of early Modernity. On this background, Part IV develops how philosophy as an ongoing meditative practice of self-modification leads to an affirmative critique, confirming the virtuality of this world in order to investigate the potentiality in the examined. In this manner, the essay presents Foucault’s philosophical practice as well as an outline of the history of ideas of a seemingly alternate, yet still agenda-setting conception of philosophical practice today

Foucault’s historical mappings of the networks of social reality

This article advances the ‘dispositive’ (le dispositif) as a key conception in Foucault’s work. As developed in his annual lectures in 1978 and 1979, the dispositive represents a crucial constituent of societal analysis on par with the familiar analytics of power/knowledge and the governmentality perspective – indeed it forms a lesser known intermediary between these. Foucault’s dispositional analysis articulates a history of connected social technologies that we have constructed to relate to each other. Expounding these points, the article distinguishes various dispositional prototypes and develops key ‘socio-ontological’ implications of the analy-sis. Reinstating the proper analytical status of the dispositive contributes to the reception of the important notion; the interpretation of Foucault’s entire oeuvre; and a resourceful approach to the study of contemporary societal problems

Identitets-, Byggelinie- og Servitutattest

En Identitet-, Byggelinie- og Servitutattest er en attest, som anvendes til at atteste-re for et byggeris lovlige placering. Attesten knytter sig til et behov og der gives ingen retningslinjer i nogen lov, der præciserer, hvordan attesten skal udarbejdes. Attesten har i praksis opnået en grad af udbredelse, der gør, at det synes væsentligt at undersøge, hvorledes attestens anvendelse og indhold forholder sig til lan-dinspektørens professionelle ansvar. Derfor valgte en specialegruppe på Aalborg Universitet i foråret 2017 at undersøge emnet og denne artikel er blevet til i et efterfølgende samarbejde mel-lem specialegruppen og Aalborg Universitet med henblik på at formidle resultaterne. Undersøgelsen blev bygget op omkring den juridiske metode, hvilket afspejles i artiklen, der på denne ene side undersøger praksis og på den anden side reglen

Intrafraction tumor motion monitoring and dose reconstruction for liver pencil beam scanning proton therapy.

BACKGROUND Pencil beam scanning (PBS) proton therapy can provide highly conformal target dose distributions and healthy tissue sparing. However, proton therapy of hepatocellular carcinoma (HCC) is prone to dosimetrical uncertainties induced by respiratory motion. This study aims to develop intra-treatment tumor motion monitoring during respiratory gated proton therapy and combine it with motion-including dose reconstruction to estimate the delivered tumor doses for individual HCC treatment fractions. METHODS Three HCC-patients were planned to receive 58 GyRBE (n=2) or 67.5 GyRBE (n=1) of exhale respiratory gated PBS proton therapy in 15 fractions. The treatment planning was based on the exhale phase of a 4-dimensional CT scan. Daily setup was based on cone-beam CT (CBCT) imaging of three implanted fiducial markers. An external marker block (RPM) on the patient's abdomen was used for exhale gating in free breathing. This study was based on 5 fractions (patient 1), 1 fraction (patient 2) and 6 fractions (patient 3) where a post-treatment control CBCT was available. After treatment, segmented 2D marker positions in the post-treatment CBCT projections provided the estimated 3D motion trajectory during the CBCT by a probability-based method. An external-internal correlation model (ECM) that estimated the tumor motion from the RPM motion was built from the synchronized RPM signal and marker motion in the CBCT. The ECM was then used to estimate intra-treatment tumor motion. Finally, the motion-including CTV dose was estimated using a dose reconstruction method that emulates tumor motion in beam's eye view as lateral spot shifts and in-depth motion as changes in the proton beam energy. The CTV homogeneity index (HI) The CTV homogeneity index (HI) was calculated as . RESULTS The tumor position during spot delivery had a root-mean-square error of 1.3 mm in left-right, 2.8 mm in cranio-caudal and 1.7 mm in anterior-posterior directions compared to the planned position. On average, the CTV HI was larger than planned by 3.7%-points (range: 1.0-6.6%-points) for individual fractions and by 0.7%-points (range: 0.3-1.1%-points) for the average dose of 5 or 6 fractions. CONCLUSIONS A method to estimate internal tumor motion and reconstruct the motion-including fraction dose for PBS proton therapy of HCC was developed and demonstrated successfully clinically

A year of pandemic for European particle radiotherapy:A survey on behalf of EPTN working group

OBJECTIVES: To provide an overview of the impact of the pandemic on the clinical activity and take a snapshot of the contingent challenges that European particle therapy centers are called to face, we surveyed the members of the European Particle Therapy Network (EPTN). MATERIAL AND METHODS: A 52-question survey was conducted from 4th April 2021 to 30th July 2021 using the Google Forms platform. Three dedicated sections analysed the clinical context of each participating institution, the staff management, and the clinical changes in the oncological workflow. RESULTS: Out of the 23 contacted European hubs of particle radiotherapy, a total of 9 (39%) responded to the survey. The number of in-person first evaluations and follow-up visits decreased, but telemedicine was implemented. Multidisciplinary tumour board discussions continued during the outbreak using web-based solutions. A delay in cancer diagnosis and oncological staging leading to an increment in more advanced diseases at first presentation was generally observed. Even if the total number of treatments (photons and particles) in the responding institutions showed a trend of decrease, there was or a stable situation or slight increase in particle treatments. The clinical treatment choices followed the national and international scientific recommendations and were patient/disease-oriented. Hypofractionation and short-schedule of chemotherapy, when applicable, were preferred. CONCLUSIONS: Our findings show a rapid and effective reaction of European particle RT hubs to manage the healthcare crisis. Considering the new waves and virus variants, the vaccination campaign will hopefully reduce the oncological impacts and consequences of the prolonged outbreak