A comparison of dose-response characteristics of four NTCP models using outcomes of radiation-induced optic neuropathy and retinopathy

<p>Abstract</p> <p>Background</p> <p>Biological models are used to relate the outcome of radiation therapy to dose distribution. As use of biological models in treatment planning expands, uncertainties associated with the use of specific models for predicting outcomes should be understood and quantified. In particular, the question to what extent model predictions are data-driven or dependent on the choice of the model has to be explored.</p> <p>Methods</p> <p>Four dose-response models--logistic, log-logistic, Poisson-based and probit--were tested for their ability and consistency in describing dose-response data for radiation-induced optic neuropathy (RION) and retinopathy (RIRP). Dose to the optic nerves was specified as the minimum dose, <it>D_min</it>, received by any segment of the organ to which the damage was diagnosed by ophthalmologic evaluation. For retinopathy, the dose to the retina was specified as the highest isodose covering at least 1/3 of the retinal surface (<it>D_33%</it>) that geometrically covered the observed retinal damage. Data on both complications were modeled separately for patients treated once daily and twice daily. Model parameters <it>D₅₀</it>and <it>γ </it>and corresponding confidence intervals were obtained using maximum-likelihood method.</p> <p>Results</p> <p>Model parameters were reasonably consistent for RION data for patients treated once daily, <it>D₅₀</it>ranging from 94.2 to 104.7 Gy and <it>γ </it>from 0.88 to 1.41. Similar consistency was seen for RIRP data which span a broad range of complication incidence, with <it>D₅₀</it>from 72.2 to 75.0 Gy and <it>γ </it>from 1.51 to 2.16 for patients treated twice daily; 72.2-74.0 Gy and 0.84-1.20 for patients treated once daily. However, large variations were observed for RION in patients treated twice daily, D₅₀from 96.3 to 125.2 Gy and <it>γ </it>from 0.80 to 1.56. Complication incidence in this dataset in any dose group did not exceed 20%.</p> <p>Conclusions</p> <p>For the considered data sets, the log-logistic model tends to lead to larger <it>D₅₀</it>and lower <it>γ </it>compared to other models for all datasets. Statements regarding normal tissue radiosensitivity and steepness of dose-response, based on model parameters, should be made with caution as the latter are not only model-dependent but also sensitive to the range of complication incidence exhibited by clinical data.</p

Dosimetric comparison study between intensity modulated radiation therapy and three-dimensional conformal proton therapy for pelvic bone marrow sparing in the treatment of cervical cancer.

The objective was to compare intensity-modulated radiation therapy (IMRT) with 3D conformal proton therapy (3DCPT) in the treatment of cervical cancer. In particular, each technique's ability to spare pelvic bone marrow (PBM) was of primary interest in this study. A total of six cervical cancer patients (3 postoperative and 3 intact) were planned and analyzed. All plans had uniform 1.0 cm CTV-PTV margin and satisfied the 95% PTV with 100% isodose (prescription dose = 45 Gy) coverage. Dose-volume histograms (DVH) were analyzed for comparison. The overall PTV and PBM volumes were 1035.9 ± 192.2 cc and 1151.4 ± 198.3 cc, respectively. In terms of PTV dose conformity index (DCI) and dose homogeneity index (DHI), 3DCPT was slightly superior to IMRT with 1.00 ± 0.001, 1.01 ± 0.02, and 1.10 ± 0.02, 1.13 ± 0.01, respectively. In addition, 3DCPT demonstrated superiority in reducing lower doses (i.e., V30 or less) to PBM, small bowel and bladder. Particularly in PBM, average V10 and V20 reductions of 10.8% and 7.4% (p = 0.001 and 0.04), respectively, were observed. However, in the higher dose range, IMRT provided better sparing (&gt; V30). For example, in small bowel and PBM, average reductions in V45 of 4.9% and 10.0% (p = 0.048 and 0.008), respectively, were observed. Due to its physical characteristics such as low entrance dose, spread-out Bragg peak and finite particle range of protons, 3DCPT illustrated superior target coverage uniformity and sparing of the lower doses in PBM and other organs. Further studies are, however, needed to fully exploit the benefits of protons for general use in cervical cancer

Effectiveness of intensive medical therapy in type B aortic dissection: A single-center experience

ObjectiveAlthough the mainstay of managing acute descending thoracic aortic dissection (ADTAD) remains medical, certain patients will require emergency surgery for complications of rupture or ischemia. This study evaluates factors that affect outcome and determines which patients previously treated surgically would have been eligible for endovascular repair.MethodsA single-institution retrospective study was conducted of patients who presented with clinical signs of ADTAD that was confirmed by magnetic resonance angiography (MRA) or computed tomography (CT). All patients were admitted to the intensive care unit (ICU) and medically managed to maintain systolic blood pressure <120 mm Hg and heart rate <70 beats/min. Two treatment groups were identified: group 1 received medical treatment only; group 2 received medical treatment plus emergency surgery. Patient demographic and clinical data were correlated with 30-day group mortality and morbidity and need for emergency surgery. The MRA and CT scan images of group 2 were retrospectively reviewed to determine if currently available endovascular treatment could have been done. The Fisher exact test was used to compare between the groups, and P < .05 was considered significant.ResultsBetween 1991 and 2005, 83 patients (55 men) were treated for ADTAD. The mean age was 67 years (range, 38 to 85). Sixty-eight patients (82%) had hypertension, three (3.6%) had Marfan syndrome, and 51 (62%) were smokers. Twenty-five (32%) of the patients were receiving β-blocker therapy before the onset of their symptoms. Back pain was the most common initial symptom (72.2%). Emergency surgery was required in 19 patients (23%): 12 for rupture or impending rupture, four for mesenteric ischemia, and three for lower extremity ischemia. The need for emergency surgery was significantly higher in smokers (P = .03), in patients >70 years old (P = .035), and in patients who were not receiving β-blocker therapy before the onset of symptoms (P = .023). The combined overall morbidity rate was 33%, and the mortality rate was 9.6%. Morbidity in group 2 was 64% and significantly higher than the 23% in group 1 (P = .00227). The mortality rate was also higher in group 2 at 31.5% compared with group 1 at 1.6% (P = .0004). Factors affecting the overall mortality included age >70 years (P = .057), previous abdominal aortic aneurysm repair (P = .018), tobacco use (P = .039), and the presence of leg pain at initial presentation (P = .013). As determined from the review of radiologic data, 11 of 13 patients with scans available for review in group 2 could have been treated with currently available endovascular grafts.ConclusionsIntensive medical therapies are effective in preventing early mortality associated with ADTAD. Predictably, the need for emergency surgery carries a high morbidity and mortality rate. Most patients in this series requiring emergency surgery could have been candidates for endovascular therapy had it been available

Simulated Fire Behavior and Fine-Scale Forest Structure Following Conifer Removal in Aspen-Conifer Forests in the Lake Tahoe Basin, USA

Quaking aspen is found in western forests of the United States and is currently at risk of loss due to conifer competition at within-stand scales. Wildfires in these forests are impactful owing to conifer infilling during prolonged fire suppression post-Euro-American settlement. Here, restoration cuttings seek to impact wildfire behavior and aspen growing conditions. In this study, we explored how actual and hypothetical cuttings with a range of conifer removal intensity altered surface fuel and overstory structure at stand and fine scales. We then simulated wildfires, examining fire behavior and effects on post-fire forest structures around aspen trees. We found that conifer removal constrained by lower upper diameter limits (\u3c56 cm) had marginal effects on surface fuel and overstory structure, likely failing to enhance resource conditions sufficiently to sustain aspen. Increasing the diameter limit also led to a higher likelihood of fire spread and a higher rate of spread, owing to greater within-canopy wind speed, though crown fire activity decreased. Our simulations suggest heavier treatments could facilitate reintroduction of fire while also dampening the effects of wildfires on forest structure. Cutting specifications that relax diameter limits and remove a substantial portion of conifer overstory could better promote aspen restoration and mitigate fire hazard

The Fire and Smoke Model Evaluation Experiment—A Plan for Integrated, Large Fire–Atmosphere Field Campaigns

The Fire and Smoke Model Evaluation Experiment (FASMEE) is designed to collect integrated observations from large wildland fires and provide evaluation datasets for new models and operational systems. Wildland fire, smoke dispersion, and atmospheric chemistry models have become more sophisticated, and next-generation operational models will require evaluation datasets that are coordinated and comprehensive for their evaluation and advancement. Integrated measurements are required, including ground-based observations of fuels and fire behavior, estimates of fire-emitted heat and emissions fluxes, and observations of near-source micrometeorology, plume properties, smoke dispersion, and atmospheric chemistry. To address these requirements the FASMEE campaign design includes a study plan to guide the suite of required measurements in forested sites representative of many prescribed burning programs in the southeastern United States and increasingly common high-intensity fires in the western United States. Here we provide an overview of the proposed experiment and recommendations for key measurements. The FASMEE study provides a template for additional large-scale experimental campaigns to advance fire science and operational fire and smoke models

Investigation of Firebrand Generation from an Experimental Fire : Development of a Reliable Data Collection Methodology

An experimental approach has been developed to quantify the characteristics and flux of firebrands during a management-scale wildfire in a pine-dominated ecosystem. By characterizing the local fire behavior and measuring the temporal and spatial variation in firebrand collection, the flux of firebrands has been related to the fire behavior for the first time. This linkage is seen as the first step in risk mitigation at the wildland urban interface (WUI). Data analyses allowed the evaluation of firebrand flux with respect to observed fire intensities for this ecosystem. Typical firebrand fluxes of 0.82–1.36 pcs m−2 s−1 were observed for fire intensities ranging between 7.35±3.48 MW m−1 to 12.59±5.87 MW m−1. The experimental approach is shown to provide consistent experimental data, with small variations within the firebrand collection area. Particle size distributions show that small particles of area 0.75–5×10−5 m2 are the most abundant (0.6–1 pcs m−2 s−1), with the total flux of particles >5×10−5 m2 equal to 0.2–0.3 pcs m−2 s−1. The experimental method and the data gathered show substantial promise for future investigation and quantification of firebrand generation and consequently a better description of the firebrand risk at the WUI

Clarifying the meaning of mantras in wildland fire behaviour modelling: reply to Cruz <i>et al.</i> (2017)

International audienceIn a recent communication, Cruz et al. (2017) called attention to several recurring statements (mantras) in the wildland fire literature regarding empirical and physical fire behaviour models. Motivated by concern that these mantras have not been fully vetted and are repeated blindly, Cruz et al. (2017) sought to verify five mantras they identify. This is a worthy goal and here we seek to extend the discussion and provide clarification to several confusing aspects of the Cruz et al. (2017) communication. In particular, their treatment of what they call physical models is inconsistent, neglects to reference current research activity focussed on combined experimentation and model development, and misses an opportunity to discuss the potential use of physical models to fire behaviour outside the scope of empirical approaches

Utilization of remote sensing techniques for the quantification of fire behavior in two pine stands

Quantification of field-scale fire behavior is necessary to improve the current scientific understanding of wildland fires and to develop and test relevant, physics-based models. In particular, detailed descriptions of individual fires are required, for which the available literature is limited. In this work, two such field-scale experiments, carried out in pine stands under mild conditions, are presented. A particular focus was placed on non-intrusive measurement, as the capabilities of advanced remote sensing techniques, along with more traditional approaches, are explored. A description of the fires is presented, with spread occurring predominantly in the surface fuels with intensities in the range of 200–4400 kW m-1, and punctuated by isolated regions of crown fire. The occurrence of crown fire is investigated and linked to regions of greater canopy density, and it is found that the total fire intensity may increase locally to as much as 21,000 kW m-1. The light winds do not appear to play a direct role in the changes in fire behavior, while fuel structure may be important. The measurements described herein provided a reasonable overall description of the fires, however, the current resolution (both spatial and temporal) falls short of definitively explaining some transitional aspects of the fire behavior, and future improvements are suggested