Disease Control With Delayed Salvage Radiotherapy for Macroscopic Local Recurrence Following Radical Prostatectomy

Purpose: To retrospectively assess clinical outcomes and toxicity profile of prostate cancer patients treated with delayed dose-escalated image-guided salvage radiotherapy (SRT) for macroscopic local recurrence after radical prostatectomy (RP).Material and Methods: We report on a cohort of 69 consecutive patients with local recurrence after RP and no evidence of regional or distant metastasis who were referred for salvage radiotherapy between 2007 and 2016. SRT consisted of 64–66 Gy (2 Gy/fraction) to the prostatic bed followed by dose escalation to 72–74 Gy (2Gy/fraction) to the macroscopic disease. All patients received concurrent short-term androgen deprivation therapy (ADT). Biochemical recurrence-free survival (bRFS) and clinical progression-free-survival (cPFS) were depicted using Kaplan-Meier method. Multivariable Cox proportional hazards regression assessed predictors of survival outcomes. Baseline, acute, and late urinary and gastrointestinal (GI) toxicity rates were reported using CTCAE v4.03.Results: Median time from RP to SRT was 66 months (IQR: 32–124). Median pre-SRT prostate-specific antigen (PSA) was 2.7 ng/ml (IQR: 0.9–6.5). Median follow-up after SRT was 38 months (IQR: 24–66). The 3- and 5-year bRFS were 58 and 44%, respectively. The 3- and 5-year cPFS were 91 and 76%, respectively. Median time from SRT to clinical disease progression was 102 months (IQR 77.5–165). At baseline, 3 patients (4%) had grade 3 urinary symptoms. Six patients (9%) developed acute and six patients (9%) developed late grade 3 urinary toxicity. Five patients (7%) had acute grade 2 GI toxicity. No acute grade 3 GI toxicity was reported. Late grade 3 GI toxicity was reported in one patient (1.5%).Conclusions: Delayed dose-escalated SRT combined with short-course ADT for macroscopic LR after RP was associated with 44% bRFS and 76% cPFS at 5 years. Albeit improved patient stratification is warranted, these data suggest that delayed SRT provides inferior tumor control compared to early intervention

Entendendo e combatendo a obesidade em crianças e adolescentes

Considerando a preocupação com as consequências da alimentação contemporânea na saúde dos jovens na etapa atual e na vida futura, este artigo objetiva aumentar a compreensão e discutir aspectos associados ao sobrepeso e a obesidade nas primeiras etapas da vida. O artigo aborda a deseducação alimentar que se inicia no desmame e discute o estereótipo de que os “bebezões” são os mais saudáveis; além disso, explica como a televisão e a falta de atividade física, entre outros aspectos, podem contribuir como fatores de risco para o desenvolvimento de sobrepeso e obesidade. Por fim, este artigo fornece orientações para os pais e educadores com vistas à prevenção e tratamento do sobrepeso e da obesidade entre os jovens, com foco nos hábitos alimentares e na prática de atividade física

Vertedouros em degraus com pré-aeração por um defletor : características do escoamento

Stepped spillways aim to dissipate part of the upstream energy during the flow passage by the chute. However, the use of these structures is limited to a restrict range of specific discharges due to the risk of cavitation damage. As the air entrainment into the flow assists the concrete protection against the aforementioned damages, a possible solution by aerators installed along the chute, already disseminated to smooth chutes, is being studied to be used also in stepped spillways. The purpose of the present paper is to characterize a flow over a stepped chute with induced aeration by deflector and air supply by an airtight chamber trough tests conducted on a reduced scale physical model. The main regions observed during the tests are presented and were developed four equations that allow to approximately predict the location of the main regions for a given spillway.Vertedouros em degraus têm por objetivo dissipar, ao longo da calha, uma parcela da energia do escoamento. No entanto, a utilização dessas estruturas está limitada a uma restrita faixa de vazões específicas devido aos riscos de cavitação e erosão. Como a introdução de ar no escoamento permite a proteção do concreto contra os danos mencionados, uma possível solução por aeradores instalados ao longo da calha, já difundida para calhas lisas, está sendo estudada para ser utilizada também em vertedouros em degraus. A presente pesquisa tem o propósito de caracterizar um escoamento sobre vertedouros em degraus com aeração induzida por defletor e fornecimento de ar por uma câmara de ar através de ensaios realizados em um modelo físico reduzido. São apresentadas zonas e posições características do escoamento observadas durante os ensaios e também, quatro equações que permitem calcular, aproximadamente, a sua localização em um protótipo

an analysis of the ClinicalTrials.gov database

Background To evaluate the current status of prospective interventional clinical trials that includes brachytherapy (BT) procedures. Methods The records of 175,538 (100 %) clinical trials registered at ClinicalTrials.gov were downloaded on September 2014 and a database was established. Trials using BT as an intervention were identified for further analyses. The selected trials were manually categorized according to indication(s), BT source, applied dose rate, primary sponsor type, location, protocol initiator and funding source. We analyzed trials across 8 available trial protocol elements registered within the database. Results In total 245 clinical trials were identified, 147 with BT as primary investigated treatment modality and 98 that included BT as an optional treatment component or as part of the standard treatment. Academic centers were the most frequent protocol initiators in trials where BT was the primary investigational treatment modality (p < 0.01). High dose rate (HDR) BT was the most frequently investigated type of BT dose rate (46.3 %) followed by low dose rate (LDR) (42.0 %). Prostate was the most frequently investigated tumor entity in trials with BT as the primary treatment modality (40.1 %) followed by breast cancer (17.0 %). BT was rarely the primary investigated treatment modality for cervical cancer (6.8 %). Conclusion Most clinical trials using BT are predominantly in early phases, investigator-initiated and with low accrual numbers. Current investigational activities that include BT mainly focus on prostate and breast cancers. Important questions concerning the optimal usage of BT will not be answered in the near future

Portfolio of prospective clinical trials including brachytherapy: an analysis of the ClinicalTrials.gov database

Background: To evaluate the current status of prospective interventional clinical trials that includes brachytherapy (BT) procedures. Methods: The records of 175,538 (100 %) clinical trials registered at ClinicalTrials.gov were downloaded on September 2014 and a database was established. Trials using BT as an intervention were identified for further analyses. The selected trials were manually categorized according to indication(s), BT source, applied dose rate, primary sponsor type, location, protocol initiator and funding source. We analyzed trials across 8 available trial protocol elements registered within the database. Results: In total 245 clinical trials were identified, 147 with BT as primary investigated treatment modality and 98 that included BT as an optional treatment component or as part of the standard treatment. Academic centers were the most frequent protocol initiators in trials where BT was the primary investigational treatment modality (p<0.01). High dose rate (HDR) BT was the most frequently investigated type of BT dose rate (46.3 %) followed by low dose rate (LDR) (42.0 %). Prostate was the most frequently investigated tumor entity in trials with BT as the primary treatment modality (40.1 %) followed by breast cancer (17.0 %). BT was rarely the primary investigated treatment modality for cervical cancer (6.8 %). Conclusion: Most clinical trials using BT are predominantly in early phases, investigator-initiated and with low accrual numbers. Current investigational activities that include BT mainly focus on prostate and breast cancers. Important questions concerning the optimal usage of BT will not be answered in the near future

Aeração induzida em vertedouros em degraus: pressões médias, entrada de ar e comportamento do escoamento

Stepped spillways can dissipate a great amount of energy during the flow passage over the chute, however these structures have limited operation due to the risk of cavitation damage. The induced aeration may protect the concrete chute through the air concentration near the channel bottom. Furthermore, some research studies have indicated that the presence of air in flows may reduce the mean pressures. The present research aims to analyze mean pressures, air entrainment coefficient and flow behavior over a stepped spillway with aeration induced by two different deflectors, comparing the results to natural aeration flow. Despite the jet impact influence, the induced aeration does not change significantly the mean pressures compared to natural aeration flow. The air entrainment coefficient, as well as the jet impact position, is higher for the deflector with the longer extension and, although air bubbles can be seen throughout the extension of the chute due to the air entrainment through the inferior flow surface, the induced aeration did not anticipate the boundary layer inception point position.Vertedouros em degraus dissipam uma grande quantidade de energia durante a passagem do escoamento pela calha, porém essas estruturas tem sua operação limitada devido a riscos de danos por cavitação. A aeração induzida pode agir protegendo a calha de concreto através da concentração de ar próximo ao fundo do canal. Além disso, algumas pesquisas têm indicado que a presença de ar em escoamentos pode reduzir as pressões médias. A presente pesquisa tem por objetivo analisar as pressões médias, coeficiente de entrada de ar e o comportamento do escoamento sobre uma calha em degraus com dois diferentes defletores, comparando os resultados com um escoamento com aeração natural. Além da influência no ponto de impacto do jato, a aeração induzida não alterou, significantemente, as pressões medias em relação a um escoamento com aeração natural. O coeficiente de entrada de ar, assim como a posição de impacto do jato, é maior para o defletor mais extenso e, embora bolhas de ar possam ser identificadas ao longo de toda a extensão da calha, devido à entrada de ar através da superfície inferior do escoamento, a aeração induzida não antecipou a posição de afloramento da camada limite

DETERMINAÇÃO DAS CARACTERÍSTICAS DE TOXICIDADE AMBIENTAL DO PERCOLADO DE UM ATERRO DE RESÍDUOS INDUSTRIAIS PERIGOSOS (ESTUDO DE CASO)

The aim of this study was to evaluate the environmental toxicity of hazardous industrial waste from landfill leachate of the one industrial solid waste center from the Rio Grande do Sul state, Brazil. The physical and chemical characteristics, as well as the ecotoxicity with Daphnia magna and toxicity and mutagenicity with Allium cepa were determined. The results of the row leachate sample indicated that the physical and chemical characteristics are compatible with the limit values imputed for treated wastewaters. Absence of acute ecotoxicity was also detected, however a significant (P&lt;0.01) larger frequency of micronuclei was verified when compared with the results of the negative control, suggesting a genot&oacute;xico effect of this wast, although not significant alterations in the mitotic index and root growth was observed.Este estudo teve como objetivo determinar as caracter&iacute;sticas de toxicidade ambiental do res&iacute;duo percolado do aterro de res&iacute;duos industriais perigosos de uma central de res&iacute;duos industriais do estado do Rio Grande do Sul. As caracter&iacute;sticas f&iacute;sicas, qu&iacute;micas, de ecotoxicidade com Daphnia magna e toxicidade e mutagenicidade com Allium cepa foram determinadas. Os resultados indicaram caracter&iacute;sticas f&iacute;sicas e qu&iacute;micas dentro dos limites estabelecidos para efluentes tratados e aus&ecirc;ncia de ecotoxicidade aguda. Contudo, foi observada uma frequ&ecirc;ncia significativamente aumentada de micron&uacute;cleos (P &lt; 0,01) na raiz em crescimento, exposta ao percolado comparado com o controle, sugerindo um efeito genot&oacute;xico deste res&iacute;duo, apesar de n&atilde;o apresentar altera&ccedil;&otilde;es significativas no &iacute;ndice mit&oacute;tico e crescimento radicular

Chromosome instability and oxidative stress markers in patients with ataxia telangiectasia and their parents

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Definitive intensity modulated radiotherapy in locally advanced hypopharygeal and laryngeal squamous cell carcinoma: mature treatment results and patterns of locoregional failure.

PurposeTo assess clinical outcomes and patterns of loco-regional failure (LRF) in relation to clinical target volumes (CTV) in patients with locally advanced hypopharyngeal and laryngeal squamous cell carcinoma (HL-SCC) treated with definitive intensity modulated radiotherapy (IMRT) and concurrent systemic therapy.MethodsData from HL-SCC patients treated from 2007 to 2010 were retrospectively evaluated. Primary endpoint was loco-regional control (LRC). Secondary endpoints included local (LC) and regional (RC) controls, distant metastasis free survival (DMFS), laryngectomy free survival (LFS), overall survival (OS), and acute and late toxicities. Time-to-event endpoints were estimated using Kaplan-Meier method, and univariate and multivariate analyses were performed using Cox proportional hazards models. Recurrent gross tumor volume (RTV) on post-treatment diagnostic imaging was analyzed in relation to corresponding CTV (in-volume, > 95% of RTV inside CTV; marginal, 20¿95% inside CTV; out-volume, < 20% inside CTV).ResultsFifty patients (stage III: 14, IVa: 33, IVb: 3) completed treatment and were included in the analysis (median follow-up of 4.2 years). Three-year LRC, DMFS and overall survival (OS) were 77%, 96% and 63%, respectively. Grade 2 and 3 acute toxicity were 38% and 62%, respectively; grade 2 and 3 late toxicity were 23% and 15%, respectively. We identified 10 patients with LRF (8 local, 1 regional, 1 local¿+¿regional). Six out of 10 RTVs were fully included in both elective and high-dose CTVs, and 4 RTVs were marginal to the high-dose CTVs.ConclusionThe treatment of locally advanced HL-SCC with definitive IMRT and concurrent systemic therapy provides good LRC rates with acceptable toxicity profile. Nevertheless, the analysis of LRFs in relation to CTVs showed in-volume relapses to be the major mode of recurrence indicating that novel strategies to overcome radioresistance are required