29 research outputs found

    Considerable interlaboratory variation in PD-L1 positivity for head and neck squamous cell carcinoma in the Netherlands— A nationwide evaluation study

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    Aims: Patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) are eligible for first-line immune checkpoint inhibition if their tumour is positive for programmed death ligand 1 (PD-L1) determined by the combined positive score (CPS). This nationwide study, using real-world data, investigated the developing PD-L1 testing landscape in the first 3 years after introduction of the test in HNSCC and examined interlaboratory variation in PD-L1 positivity rates. Methods: Pathology reports of HNSCC patients mentioning PD-L1 were extracted from the Dutch Pathology Registry (Palga). Tumour and PD-L1 testing characteristics were analysed per year and interlaboratory variation in PD-L1 positivity rates was assessed using funnel plots with 95% confidence limits around the overall mean. Results: A total of 817 PD-L1 tests were reported in 702 patients among 19 laboratories; 85.2% of the tests on histological material were stated to be positive. The national PD-L1 positivity rate differed significantly per year during the study period (79.7–89.9%). The use of the recommended 22C3 antibody increased from 59.9 to 74.3%. A total of 673 PD-L1 tests on histological material from 12 laboratories were analysed to investigate interlaboratory variation. Four (33%) deviated significantly from the national mean of PD-L1-positive cases using CPS ≥ 1 cut-off, while two (17%) deviated significantly for CPS ≥ 20 cut-off. Conclusion: In the first 3 years of PD-L1 assessment in HNSCC, the testing landscape became more uniform. However, interlaboratory variation in PD-L1 positivity rates between Dutch laboratories was substantial. This implies that there is a need for further test standardisation to reduce this variation

    Individualized 3D-printed applicators for magnetic resonance imaging-guided brachytherapy in nasal vestibule cancer

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    Background and purpose Brachytherapy is treatment of choice for early stage nasal vestibule cancer. Over the years improvements were achieved by means of image guided target definition, interstitial implant techniques and also individual mold techniques. The aim of this study was to improve the technique of the implant so that the need for interstitial catheters can be limited by making use of patient individualized 3D-printed applicators. Materials and Methods In 19 patients 3D-printed applicators were used to deliver pulse dose rate (PDR) brachytherapy. All patients underwent computed tomography (CT) and magnetic resonance imaging (MRI). A pre-plan with tumor delineation and manually optimized catheter positions to achieve tumor coverage was made. Based on the pre-plan a 3D-printed applicator was manufactured. Dose was evaluated by several indices: Conformity Index, Healthy Tissues Conformity Index, Dose Homogeneity Index, Dose non-uniformity ratio, Conformal index and high dose (HD) index. Results A high target coverage was achieved, with a median V100%CTV of 99.1 % (range, 81.8–100 %) and median CI of 0.99 (range, 0.82–1.00), as well as a median V0.7GyGTV of 100 % (range, 93.0–100 %). The median HD was 0.39 (range, 0.20–0.83). Interstitial catheters were needed in 12 patients. None of the patients developed grade ≥ II toxicity within the median follow up of 18 months. Conclusions This study shows that using 3D-printed applicators limits the need for interstitial catheters and also limits the high doses in normal tissue

    Interobserver Agreement of PD-L1/SP142 Immunohistochemistry and Tumor-Infiltrating Lymphocytes (TILs) in Distant Metastases of Triple-Negative Breast Cancer: A Proof-of-Concept Study. A Report on Behalf of the International Immuno-Oncology Biomarker Working Group

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    Patients with advanced triple-negative breast cancer (TNBC) benefit from treatment with atezolizumab, provided that the tumor contains 651% of PD-L1/SP142-positive immune cells. Numbers of tumor-infiltrating lymphocytes (TILs) vary strongly according to the anatomic localization of TNBC metastases. We investigated inter-pathologist agreement in the assessment of PD-L1/SP142 immunohistochemistry and TILs. Ten pathologists evaluated PD-L1/SP142 expression in a proficiency test comprising 28 primary TNBCs, as well as PD-L1/SP142 expression and levels of TILs in 49 distant TNBC metastases with various localizations. Interobserver agreement for PD-L1 status (positive versus negative) was high in the proficiency test: the corresponding scores as percentages showed good agreement with the consensus diagnosis. In TNBC metastases, there was substantial variability in PD-L1 status at the individual patient level. For one in five patients, the chance of treatment was essentially random, with half of the pathologists designating them as positive and half negative. Assessment of PD-L1/SP142 and TILs as percentages in TNBC metastases showed poor and moderate agreement, respectively. Additional training for metastatic TNBC is required to enhance interobserver agreement. Such training, focusing on metastatic specimens, seems worthwhile, since the same pathologists obtained high percentages of concordance (ranging from 93% to 100%) on the PD-L1 status of primary TNBCs

    Bringing online adaptive radiotherapy to a standard C-arm linac

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    Current online adaptive radiotherapy (oART) workflows require dedicated equipment. Our aim was to develop and implement an oART workflow for a C-arm linac which can be performed using standard clinically available tools. A workflow was successfully developed and implemented. Three patients receiving palliative radiotherapy for bladder cancer were treated, with 33 of 35 total fractions being delivered with the cone-beam computed tomography (CBCT)-guided oART workflow. Average oART fraction duration was 24 min from start of CBCT acquisition to end of beam on. This work shows how oART could be performed without dedicated equipment, broadening oART availability for application at existing treatment machines

    Effect of the addition of salt to Pickering emulsion polymerizations using polymeric nanogels as stabilizers

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    Nanogels made from crosslinked block copolymer micelles are used as stabilizers in the Pickering emulsion polymerization of styrene. The effect of the addition of salt, i.e. NaCl, on the emulsion polymerization is studied. It is shown that an increase in ionic strength of the dispersing medium in these polymerizations led to the formation of latexes of larger diameters. Along with an increase in size, the morphology of these polymer colloids changed from Janus to patchy with an increase in number of nanogels adsorbed on the polymer surface, as a function of the salt concentration in water. In particular, at the highest tested ionic strength, ca. 25 mM, fully armored polymeric particles surrounded by a dense layer of adsorbed stabilizing nanogels were formed. Kinetic studies carried out at varying NaCl concentrations suggested that particle formation in the reaction followed a combination of a coagulative nucleation mechanism, characterized by a clustering process of Janus precursors to form bigger aggregates, and droplet nucleation. Preliminary film formation studies on latexes made with n-butyl acrylate as a comonomer indicated the potential of this technique for the production of coherent polymer films which included a substructure of functional nanogels

    Dispersive Solid-Phase Extraction and Solid-Phase Extraction for ppt-level PFAS Analysis in Apples: A Comparison

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    Per- and polyfluoralkyl substances (PFAS) are found in our food. Sensitive, precise, and accurate analytical methods are needed to estimate human exposure to these chemicals. A comparative study was performed between two extraction and cleanup methods (solid-phase extraction [SPE] and dispersive SPE) for the analysis of PFAS in apples. Both methods showed excellent sensitivity, precision, and accuracy. dSPE has some benefits over conventional SPE, and vice versa. The advantages and disadvantages of both methods are discussed

    Cyclic channel-shoal dynamics at the Ameland inlet: the impact on waves, tides, and sediment transport

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    Ebb-tidal deltas are shallow features seaward of tidal inlets, acting as a wave filter for the nearby barrier island and a source of sediment for the landward tidal basin. On many ebb-tidal deltas, channels rotate and shoals periodically attach to the downdrift island. This cyclic behavior can also include an alternation between one- and two-channel inlet configurations. The effect of the long-term (> years) cyclic behavior on the short-term patterns of waves, tidal currents, and sediment transport is unknown. Here, we use Delft3D/SWAN models to simulate the Dutch Ameland tidal inlet during four phases of the cycle to show that many of the physical processes on the ebb-tidal delta and in the entire tidal system are affected by the cyclic evolution of channels and shoals. In particular, the periodic variations in the channel positions appear to significantly influence the tidal asymmetry in the inlet and mean flow characteristics. As a result, the net sediment exchange between basin and sea is cyclic and follows the periodicity of the one- and two-channel inlet configuration. Moreover, we find that the wave energy dissipation on the ebb-tidal delta is enhanced by a shallow shoal or an updrift-oriented ebb-channel, which shields the coast from the incoming waves. Our results demonstrate how the cyclic channel-shoal dynamics at natural tidal inlets is likely to affect the safety functions of the ebb-tidal deltas, varying the offshore wave energy dissipation as well as adjusting the sediment pathways on the ebb-tidal delta

    The prognostic role of tumor associated macrophages in squamous cell carcinoma of the head and neck: A systematic review and meta-analysis

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    Head and neck squamous cell carcinoma (HNSCC) is an immunogenic cancer type, and tumor associated macrophages (TAMs) are a major component of the tumor microenvironment (TME). In this systematic review and meta-analysis, studies assessing tumor infiltration with CD68+, iNOS+, HLA-DR+, CD11b+, CD163+, CD206+, and CD204+TAMs were included, and correlation to survival hazard was studied. A low number of CD68+TAMs correlated to better overall survival (OS) in multivariate analysis (HR 1.36 95 %CI (1.07–1.72) P = .01). CD68+TAMs did not correlate to disease free survival (DFS), disease specific survival (DSS), progression free survival (PFS), or recurrence free survival (RFS). A low number of CD163+TAMs correlated to better OS in uni- and multivariate analysis (resp. HR 2.65 95 %CI (1.57–4.46) P = .01 and HR 2.42 95 %CI (1.72–3.41) P < .001). A low number of CD163+TAMs also correlated to better DFS and PFS, whereas a low number of CD204+TAMs only correlated to PFS. While IHC analysis of pan macrophage marker CD68 and M2-like marker CD163 both show prognostic utility in OS, CD163 is a stronger prognosticator, as indicated by multivariate meta-analysis. CD163+TAMs also correlate to DFS and PFS; outcomes that are more relevant to patients, thus showing promising results for future clinical implementation

    Inter-assay reliability of programmed cell death-ligand 1 in head and neck squamous cell carcinoma

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    OBJECTIVES: The programmed cell death-ligand 1 (PD-L1) 22C3 pharmDx assay is used as a companion diagnostic test to select head and neck squamous cell carcinoma (HNSCC) patients that may benefit from treatment with the checkpoint inhibitor pembrolizumab. Because the Dako platform is not universally available, we studied the performance of a 22C3 laboratory developed test (LDT) performed on a Ventana BenchMark Ultra compared to the 22C3 pharmDx assay. MATERIALS AND METHODS: Serial sections from tissue micro arrays (TMAs) containing tumour tissue from 97 HNSCC patients were stained with the 22C3 pharmDx assay and 22C3 LDT. All TMA cores were scored by three dedicated head and neck pathologists for PD-L1 expression. RESULTS: Substantial interobserver agreement was reported for both the standardized 22C3 pharmDx assay and the 22C3 LDT (respectively Fleiss' κ 0.62, 95% CI 0.57-0.67 and 0.63, 95% CI 0.58-0.68). Concordance between the assays was almost perfect on core and patient level (respectively Weighted κ 0.84, 95% CI 0.79-0.89 and 0.84, 95% CI 0.75-0.92). Intratumor heterogeneity between the cores per patient case was similar in both assays. CONCLUSION: After validation a 22C3 LDT is non-inferior to the standardized 22C3 pharmDx assay and can be safely used to select HNSCC patients for pembrolizumab treatment
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