49. Adjuvant treatment to surgery: Is it still a place for radio-or chemotherapy?

The two metaanalysis conducted by the Cambridge group has cent the scene for adjuvant treatment as well as the pattern of failure analysis after surgery. In the pattern of failure analysis performed after a complete resection, local failure is a race event for pathological stage I and II disease (less than 10 %). In opposite, for stage III, local failure remains an issue due to the wide range of tumor extent, from resectable disease to unresectable tumor. In contrast, distant metastasis is a common problem with figures ranging from 20 to 50%. A last issue is certainly the problem of second cancer induced by a long history of tobacco smoking rising the question of chemoprevention.To prevent distant metastasis, a systemic treatment is the logical answer. The metaanalysis suggested a slight nonsignificant benefit for a sequential Cisplatine based chemotherapy. The recent American trial of Keller et al comparing postoperative radiotherapy to a combined chemo-radiotherapy approach did not showed any difference for stage III disease: the only important prognostic factor was the type of mediastinal exploration: sampling vs. radical dissection. Several trials are on going worldwide: Anita, ALPI, and IALT… The main characteristics of those trials are to include a cisplatine based chemotherapy program and a large number of patients. This implies necessary a low efficacy; a small difference is expected. Furthermore, the already published trials showed a low compliance to chemotherapy.Is the page turned for radiotherapy in a combined approach with surgery? In view of the available randomized trials and the recent metaanalysis, a quick answer is yes. Indeed, both observed either no effect or even a detrimental impact on survival. Nevertheless, those trials were performed during the last three decades, a period of many improvements in the knowledge of the disease, in imaging procedure, in surgery and in radiotherapy. Preoperative radiotherapy may increase the resectability rate in well-selected patient: some groups are still advocating this approach for superior sulcus tumor whereas many phase II and some phase III trials are combining radiation with chemotherapy in a preoperative settings. The data available suggested a higher rate of pathological complete response but also a slight increase in morbidity. In contrast, postoperative irradiation improves the local control especially for stage III disease: this was clearly demonstrated by the Lung Cancer Study group trial, the MRC trial and the Feng trial. Furthermore, we should remember that the PORT metaanalysis suggested a differential impact according to the tumor extent: the negative impact of postoperative radiation disappeared for stage III disease (a similar observation was made by Dautzenberg et al). One possible explanation is that the therapeutic effect of postoperative radiotherapy compensated the negative impact due to a poor radiation technique (large volume, high daily dose, and cobalt machines…). Both approaches imply to use a modern radiation technique minimizing the risk of inducing severe life-threatening late effects: this is especially the case for postoperative radiotherapy due to the already loss of lung function due to the surgery and a long history of tobacco abuse. This is probably the place for a conformal radiotherapeutic approach.The last issue concerns the management of patients after induction chemotherapy followed by surgery: the current approach is to reserve postoperative radiotherapy for incomplete resection or for persistent nodal disease. Probably, another important factor may be the presence or not of nodal capsular rupture. We are certainly lacking good data on the postresection management and outcome of those patients.In conclusion, radiation has still its place for stage III disease in a combined approach with surgery and chemotherapy providing the use of an adequate radiation technique

Why does the ethnic and socio-economic composition of schools influence math achievement? The role of sense of futility and futility culture

Although a number of studies in many countries have investigated the impact of the ethnic and socio-economic composition of schools on academic performance, few studies have analyzed in detail how and why compositional features matter. This article presents an examination of whether pupils’ sense of futility and schools’ futility culture account for the impact of ethnic and socio-economic status (SES) composition of schools on the academic achievement of their pupils. Multilevel analyses of data based on a survey of 2,845 pupils (aged 10–12 years) in 68 Flemish primary schools revealed that higher proportions of immigrant and working-class pupils in a school is associated with lower levels of math achievement in both immigrant and native Belgian pupils. However, by analyzing at a deeper level, by taking control variables into account, our study found that the ethnic composition of the school no longer had a significant effect on pupils’ achievement, while the SES composition still did. Most importantly, our results indicated that the remaining impact of SES composition can be explained by pupils’ sense of futility and schools’ futility culture. The implications of these findings for educational policy are discussed

A new cluster-type statistical model for the prediction of deformation textures

An attempt was done to improve the quality of deformation texture predictions by statistical models through the introduction of "clusters" of N grains thus defining a third, intermediate length scale. The interaction between each cluster and the macroscopic length scale is of the Taylor type, whereas inside each cluster a VPSC scheme is used. Predictions of cold rolling deformation textures were quantitatively compared with experimental results for a steel alloy. The results are encouraging

Forming limit predictions for single-point incremental sheet metal forming

peer reviewedA characteristic of incremental sheet metal forming is that much higher deformations can be achieved than conventional forming limits. In this paper it is investigated to which extent the highly non-monotonic strain paths during such a process may be responsible for this high formability. A Marciniak-Kuczynski (MK) model is used to predict the onset of necking of a sheet subjected to the strain paths obtained by finite-element simulations. The predicted forming limits are considerably higher than for monotonic loading, but still lower than the experimental ones. This discrepancy is attributed to the strain gradient over the sheet thickness, which is not taken into account in the currently used MK model

Effect of FEM choices in the modelling of incremental forming of aluminium sheets

peer reviewedThis paper investigates the process of single point incremental forming of an aluminium cone with a 50-degree wall angle. Finite element (FE) models are established to simulate the process. Different FE packages have been used. Various aspects associated with the numerical choices as well as the material and process parameters have been studied. The final geometry and the reaction forces are presented as the results of the simulations. Comparison between the simulation results and the experimental data is also made

Long Term Effects of Radiation and Combined Modalities on Mouse Lung

The lung appears to be the major dose-limiting organ in radiation of the thorax. Early responses (\u3c1 week) involve the type II pneumocyte and increased surfactant biosynthesis and secretion. Later changes, which appear to be related to the surfactant response, lead to classical radiation pneumonitis, which is often fatal. Animals which survive radiation pneumonitis develop progressive fibrosis, a late-appearing response, which reduces compliance and available air space, and is usually fatal. This study centers on the fine structural changes in the lungs of LAF1 mice, 63 weeks following various radiation exposures (5-13 Gy). Doses which are subthreshold in evoking surfactant and pneumonitic responses precipitate fibrosis and atelectasis by 63 weeks, and involve type II pneumocyte sloughing and degeneration. Of the two major deterrents to lung irradiation (pneumonitis and fibrosis), these results suggest that fibrosis always follows pneumonitis, but pneumonitis is not a necessary preliminary step to fibrosis. Bleomycin elicits several morphological alterations characteristic of radiation, and, when combined with the latter, appears to exacerbate radiation effects