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Sample records for clinical oncology therapy

  1. A critical appraisal of the clinical utility of proton therapy in oncology

    Directory of Open Access Journals (Sweden)

    Wang D

    2015-10-01

    Full Text Available Dongxu WangDepartment of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAAbstract: Proton therapy is an emerging technology for providing radiation therapy to cancer patients. The depth dose distribution of a proton beam makes it a preferable radiation modality as it reduces radiation to the healthy tissue outside the tumor, compared with conventional photon therapy. While theoretically beneficial, its clinical values are still being demonstrated from the increasing number of patients treated with proton therapy, from several dozen proton therapy centers around the world. High equipment and facility costs are often the major obstacle for its wider adoption. Because of the high cost and lack of definite clinical evidence of its superiority, proton therapy treatment faces criticism on its cost-effectiveness. Technological development is causing a gradual lowering of costs, and research and clinical studies are providing further evidence on its clinical utility.Keywords: proton therapy, radiation, cancer, oncology

  2. Music therapy services in pediatric oncology: a national clinical practice review.

    Science.gov (United States)

    Tucquet, Belinda; Leung, Maggie

    2014-01-01

    This article presents the results of a national clinical practice review conducted in Australia of music therapy services in pediatric oncology hospitals. Literature specifically related to music therapy and symptom management in pediatric oncology is reviewed. The results from a national benchmarking survey distributed to all music therapists working with children with cancer in Australian pediatric hospitals are discussed. Patient and family feedback provided from a quality improvement activity conducted at a major pediatric tertiary hospital is summarized, and considerations for future growth as a profession and further research is proposed. PMID:25027188

  3. Single-Cell Sequencing Technology in Oncology: Applications for Clinical Therapies and Research

    Directory of Open Access Journals (Sweden)

    Baixin Ye

    2016-01-01

    Full Text Available Cellular heterogeneity is a fundamental characteristic of many cancers. A lack of cellular homogeneity contributes to difficulty in designing targeted oncological therapies. Therefore, the development of novel methods to determine and characterize oncologic cellular heterogeneity is a critical next step in the development of novel cancer therapies. Single-cell sequencing (SCS technology has been recently employed for analyzing the genetic polymorphisms of individual cells at the genome-wide level. SCS requires (1 precise isolation of the single cell of interest; (2 isolation and amplification of genetic material; and (3 descriptive analysis of genomic, transcriptomic, and epigenomic data. In addition to targeted analysis of single cells isolated from tumor biopsies, SCS technology may be applied to circulating tumor cells, which may aid in predicting tumor progression and metastasis. In this paper, we provide an overview of SCS technology and review the current literature on the potential application of SCS to clinical oncology and research.

  4. Compliance with therapeutic guidelines in Radiation Therapy Oncology Group prospective gastrointestinal clinical trials

    International Nuclear Information System (INIS)

    Background: This report analyzes the adherence to radiation therapy protocol guidelines in contemporary Radiation Therapy Oncology Group (RTOG) gastrointestinal trials. We aim to provide insight into current standards and compliance of radiation therapy field design and administration. Methods: From 1994 to 2006, the Gastrointestinal Cancer Committee of the RTOG initiated and completed 15 phase I–III clinical trials utilizing radiation therapy in the multimodality treatment of gastrointestinal cancers. In each protocol, details for planning and executing radiation therapy were outlined and each protocol contained scoring criteria for these components of radiation therapy, characterized according to per-protocol, variation acceptable and deviation unacceptable. Review of treatment planning and implementation was performed in all studies following therapy completion. Results: Radiation therapy planning and implementation was reviewed in 2309 of 2312 (99.9%) patients. The mean rate of compliance over all for the 15 protocols was 65% (total of the 2309 analyzed patients). The mean variation acceptable rate was 21% whereas the mean deviation unacceptable rate was 5%. The mean “other” rate (no RT given or incomplete RT due to death, progression or refusal) was 8%. Two of the 15 trials (13%) had deviation unacceptable rates >10%. In four studies incorporating pre-treatment review of radiation therapy planning and treatment, compliance with protocol therapy was enhanced. Conclusions: The fidelity of radiation planning and execution detailed in protocol to actual therapy is heterogeneous, with a mean per-protocol rate of 65%. As clinical trials evolve, available technology should permit efficient pre-treatment review processes, thus facilitating compliance to protocol therapy. These analyses should also permit prospective analysis of outcome measures by compliance to therapy.

  5. The role of radiation therapy in pediatric oncology as assessed by cooperative clinical trials

    International Nuclear Information System (INIS)

    Major advances have been made in pediatric oncology, and many are due to the advent of the cooperative clinical trial. This important research tool was originally developed for the testing of various therapeutic strategies for the management of children with acute leukemia. Such trials were eminently successful, as the consistently better long-term survival rates for children with this hitherto uniformly lethal disease can attest. The method soon found favor for the investigation of patients with so-called solid tumors. These trails were originally concerned with the elucidation of the value of various chemotherapeutic agents. Radiation therapists soon became involved, however, and this discipline became more heavily represented in study design and data analyses. Much radiation therapy information has been gained, some through prospective, randomized clinical investigations and some through retrospective reviews of roentgen therapy as it was employed in protocols accenting other aspects of care. Voluminous, important radiation therapy data have been deduced through the latter retrospective kinds of analyses, but this review will be confined largely to the published results of prospective, randomized cooperative clinical trials where radiation therapy was a governing variable. Certain investigations of historical interest will also be cited together with other results that established important principles even though not so rigorous in design

  6. RADIATION THERAPY ONCOLOGY GROUP TRANSLATIONAL RESEARCH PROGRAM STEM CELL SYMPOSIUM : INCORPORATING STEM CELL HYPOTHESES INTO CLINICAL TRIALS

    NARCIS (Netherlands)

    Woodward, Wendy A.; Bristow, Robert G.; Clarke, Michael F.; Coppes, Robert P.; Cristofanilli, Massimo; Duda, Dan G.; Fike, John R.; Hambardzumyan, Dolores; Hill, Richard P.; Jordan, Craig T.; Milas, Luka; Pajonk, Frank; Curran, Walter J.; Dicker, Adam P.; Chen, Yuhchyau

    2009-01-01

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease si

  7. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    Science.gov (United States)

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  8. Sociodemographic analysis of patients in radiation therapy oncology group clinical trials

    International Nuclear Information System (INIS)

    Purpose: To assess the degree to which the sociodemographic characteristics of patients enrolled in Radiation Therapy Oncology Group (RTOG) clinical trails are representative of the general population. Methods and Materials: Sociodemographic data were collected on 4016 patients entered in 33 open RTOG studies between July 1991 and June 1994. The data analyzed included educational attainment, age, gender, and race. For comparison, we obtained similar data from the U.S. Department of Census. We also compared our RTOG data with Surveillance Epidemiology and End Results (SEER) data for patients who received radiation therapy, to determine how RTOG patients compared with cancer patients in general, and with patients with cancers at sites typically treated with radiotherapy. Results: Overall, the sociodemographic characteristics of patients entered in RTOG trials were similar to those of the Census data. We found that, in every age group of African-American men and at nearly every level of educational attainment, the proportion of RTOG trial participants mirrored the proportion in the census data. Significant differences were noted only in the youngest category of African-American men, where the RTOG accrues more in the lower educational categories and fewer with college experience. For African-American women, we found a similar pattern in every age group and at each level of educational attainment. As with men, RTOG trials accrued a considerably larger proportion of younger, less educated African-American women than the census reported. Using SEER for comparison, the RTOG enrolled proportionately more African-American men to trials all cancer sites combined, and for prostate and head and neck cancer. In head and neck trials, the RTOG enrolled nearly twice as many African-American men than would be predicted by SEER data. In lung cancer trials, RTOG underrepresented African-American men significantly; however, there was no difference for brain cancer trials. There were

  9. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    International Nuclear Information System (INIS)

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  10. [Dignity therapy in oncology].

    Science.gov (United States)

    Ripamonti, Carla Ida

    2016-04-01

    In oncology, little is known about dignity, dignity-related distress and the issues that influence the sense of dignity for patients. Dignity is personal, subject to changes depending on the experience and the path of life. In oncology some patients feel that their dignity is directly related to the disease, to physical and emotional symptoms, to the highest level of physical and cognitive autonomy and to the continuity of the self. Patient dignity inventory (PDI) is a validate tool designed to measure various sources of dignity-related distress among patients nearing the end of life and serve as a screening tool to assess a broad range of issues that influence the sense of dignity. Dignity therapy is a novel focused psychotherapy consisting in a brief semi-structured interview, audio-recorded and transcribed in order to obtain the "generativity document". The patients are invited to tell about their life history, and to leave words of guidance and offer instructions to pass along to their son, daughters, husband, wife, parents, others. The generativity document is the result of process of emotional and existential care for the patients and a gift for everybody will receive it. PMID:27093325

  11. American Society of Clinical Oncology

    Science.gov (United States)

    ... Media Policy Sponsor Policy Terms of Use American Society of Clinical Oncology Genitourinary Cancers Symposium Call for ... or cosponsored by ASCO View Event 13th Asian Society for Neuro-Oncology (ASNO) Meeting/9th COGNO Annual ...

  12. The role of radiation therapy in childhood acute leukemia. A review from the viewpoint of basic and clinical radiation oncology

    International Nuclear Information System (INIS)

    Radiation therapy has been playing important roles in the treatment of childhood acute leukemia since the 1970s. The first is the preventive cranial irradiation for central nervous system therapy in acute lymphoblastic leukemia. The second is the total body irradiation as conditioning before bone marrow transplantation for children with acute myeloid leukemia in first remission and with acute lymphoblastic leukemia in second remission. Although some late effects have been reported, a part of them could be overcome by technical improvement in radiation and salvage therapy. Radiation therapy for children might have a successful outcome on a delicate balance between efficiencies and potential late toxicities. The role of radiation therapy for childhood acute leukemia was reviewed from the standpoint of basic and clinical radiation oncology in this paper. (author)

  13. Radiation Therapy Oncology Group Translational Research Program Stem Cell Symposium: Incorporating Stem Cell Hypotheses into Clinical Trials

    International Nuclear Information System (INIS)

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease sites. This report summarizes the major topics discussed and the future directions that research should take. Major conclusions of the symposium were that the flow cytometry of multiple markers in fresh tissue would remain the standard technique of evaluating cancer-initiating cells and that surrogates need to be developed for both experimental and clinical use.

  14. Introduction to veterinary clinical oncology

    Energy Technology Data Exchange (ETDEWEB)

    Weller, R.E.

    1991-10-01

    Veterinary clinical oncology involves a multidisciplinary approach to the recognition and management of spontaneously occurring neoplasms of domestic animals. This requires some knowledge of the causes, incidence, and natural course of malignant disease as it occurs in domestic species. The purpose of this course is to acquaint you with the more common neoplastic problems you will encounter in practice, so that you can offer your clients an informed opinion regarding prognosis and possible therapeutic modalities. A major thrust will be directed toward discussing and encouraging treatment/management of malignant disease. Multimodality therapy will be stressed. 10 refs., 3 tabs.

  15. Breast-conserving therapy as a model for creating new knowledge in clinical oncology

    International Nuclear Information System (INIS)

    New knowledge can be derived from various kinds of studies. Studies of innovative approaches are the basis for progress. Some advances in treatment are so obvious that they do not need formal testing; e.g., penicillin for pneumococcal infection. For comparing interventions with small differences in efficacy or in groups without predictable outcome, prospective randomized trials are the 'gold standard'. However, randomized trials are cumbersome, expensive, and potentially difficult for both patients and physicians. Retrospective studies are less valid scientifically because they are more likely to suffer from bias, misclassification, confounding variables, and the use of multiple comparisons. Retrospective studies can be made more valid by first specifying the study design and analysis, but are generally most useful to generate hypotheses to be tested more formally. Retrospective studies can be particularly useful in improving outcome by identifying 'problems' and their causes. An important issue for radiation oncologists in doing retrospective studies is the difficulty of assessing an effect on local tumor control in diseases in which there are competing risks of local and distant failure. Many of these points will be illustrated in studies from the Joint Center for Radiation Therapy. Studies of innovative approaches, retrospective reviews and prospective randomized clinical trials have all been useful in establishing breast-conserving therapy as a safe and effective treatment for patients with early-stage breast cancer. Several studies of innovative breast-conserving therapy beginning in the 1960's showed favorable results. Based on this experience, a series of randomized clinical trials were initiated, beginning in the early 1970's, formally comparing mastectomy and breast-conserving therapy. These trials firmly established that the two forms of local treatment provide equivalent survival. Additional retrospective studies have also been useful in establishing

  16. Topics in clinical oncology. 15

    International Nuclear Information System (INIS)

    The monograph comprising primarily papers on topical subjects of oncology and cancer research, contains also a selection of papers presented at the 2. Congress of the Czechoslovak Society of Nuclear Medicine and Radiation Hygiene. Seven papers were selected on behalf of their subject related to clinical oncology. All of them were iputted in INIS; five of them deal with the scintiscanning of the skeleton of cancer patients, one with radioimmunodetection of tumors, and one with radionuclide lymphography. (A.K.)

  17. The Radiation Therapy Oncology in the context of oncological practice

    International Nuclear Information System (INIS)

    This work is about the radiation therapy oncology in the context of oncological practice. The radiotherapy is a speciality within medicine that involves the generation, application and dissemination of knowledge about the biology, causes, prevention and treatment of the cancer and other pathologies by ionising radiation

  18. American society of clinical oncology update on the role of bisphosphonates and bone health issues in women with breast cancer Part II. Bisphosphonates in the adjuvant therapy of breast cancer

    Directory of Open Access Journals (Sweden)

    I. V. Vysotskaya

    2014-09-01

    Full Text Available American society of clinical oncology update on the roleof bisphosphonates and bone health issues in women with breast cancer Part II. Bisphosphonates in the adjuvant therapy of breast cancer

  19. Raman Spectroscopy for Clinical Oncology

    Directory of Open Access Journals (Sweden)

    Michael B. Fenn

    2011-01-01

    Full Text Available Cancer is one of the leading causes of death throughout the world. Advancements in early and improved diagnosis could help prevent a significant number of these deaths. Raman spectroscopy is a vibrational spectroscopic technique which has received considerable attention recently with regards to applications in clinical oncology. Raman spectroscopy has the potential not only to improve diagnosis of cancer but also to advance the treatment of cancer. A number of studies have investigated Raman spectroscopy for its potential to improve diagnosis and treatment of a wide variety of cancers. In this paper the most recent advances in dispersive Raman spectroscopy, which have demonstrated promising leads to real world application for clinical oncology are reviewed. The application of Raman spectroscopy to breast, brain, skin, cervical, gastrointestinal, oral, and lung cancers is reviewed as well as a special focus on the data analysis techniques, which have been employed in the studies.

  20. Radioimmunoimaging in clinical oncology

    International Nuclear Information System (INIS)

    In the thesis radiolabeled antibodies were tested for screening of cancer in patients without previous knowledge of tumour histopathology. They were tested as well targeting known cancer, sometimes in unknown clinical stage. Methods for detection enhancement utilizing double-tracer techniques and alternative routes of administration were also investigated. (385 refs., 11 tabs.)

  1. Systemic Therapy in Men With Metastatic Castration-Resistant Prostate Cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline

    Science.gov (United States)

    Basch, Ethan; Loblaw, D. Andrew; Oliver, Thomas K.; Carducci, Michael; Chen, Ronald C.; Frame, James N.; Garrels, Kristina; Hotte, Sebastien; Kattan, Michael W.; Raghavan, Derek; Saad, Fred; Taplin, Mary-Ellen; Walker-Dilks, Cindy; Williams, James; Winquist, Eric; Bennett, Charles L.; Wootton, Ted; Rumble, R. Bryan; Dusetzina, Stacie B.; Virgo, Katherine S.

    2014-01-01

    Purpose To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). Methods The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. Results When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 (223Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. Recommendations Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or 223Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to

  2. Clinical Oncology Assistantship Program for Medical Students.

    Science.gov (United States)

    Neilan, Barbara A.; And Others

    1985-01-01

    The Clinical Oncology Assistantship Program at the University of Arkansas for Medical Sciences is described, along with student reactions to the program. The summer elective program involves cancer lectures (one week) and clinical exposure (nine weeks) in medical, surgical, and pediatric oncology services, as well as self-directed learning…

  3. Interstitial photodynamic laser therapy in interventional oncology

    International Nuclear Information System (INIS)

    Photodynamic therapy (PDT) is a well-investigated locoregional cancer treatment in which a systemically administered photosensitizer is activated locally by illuminating the diseased tissue with light of a suitable wavelength. PDT offers various treatment strategies in oncology, especially palliative ones. This article focuses on the development and evaluation of interstitial PDT for the treatment of solid tumors, particularly liver tumors. The PDT is mostly used for superficial and endoluminal lesions like skin or bladder malignancies and also more frequently applied for the treatment of lung, esophageal, and head and neck cancer. With the help of specially designed application systems, PDT is now becoming a practicable option for solid lesions, including those in parenchymal organs such as the liver. After intravenous treatment with the photosensitizer followed by interstitial light activation, contrast-enhanced computed tomography shows the development of therapy-induced necrosis around the light-guiding device. With the use of multiple devices, ablation of liver tumors seems to be possible, and no severe side effects or toxicities related to the treatment are reported. PDT can become a clinically relevant adjunct in the locoregional therapy strategies. (orig.)

  4. Evidence-based integrative medicine in clinical veterinary oncology.

    Science.gov (United States)

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. PMID:25174902

  5. Impact of radiation research on clinical trials in radiation oncology

    International Nuclear Information System (INIS)

    The authors present an outline review of the history of the formation of the cooperative group called International Clinical Trials in Radiation Oncology (ICTRO), and the following areas are briefly discussed together with some projections for the direction of clinical trials in radiation oncology into the 1990s:- radiosensitizers, radioprotectors, and their combination, drug-radiation interactions, dose/time/fractionation, hyperthermia, biological response modifiers and radiolabelled antibodies, high LET, particularly neutron therapy, large field irradiation and interoperative irradiation, research studies on specific sites. (U.K.)

  6. Mind-body therapies in integrative oncology.

    Science.gov (United States)

    Elkins, Gary; Fisher, William; Johnson, Aimee

    2010-12-01

    There is growing interest in mind-body therapies as adjuncts to mainstream cancer treatment, and an increasing number of patients turn to these interventions for the control of emotional stress associated with cancer. Increased research funding has enabled many such interventions to be evaluated for their efficacy, including studies of mind-body interventions to reduce pain, anxiety, insomnia, anticipatory, and treatment-related nauseas, hot flashes, and improved mood. Mind-body treatments evaluated for their utility in oncology include relaxation therapies, biofeedback, meditation and hypnosis, yoga, art and music therapy, tai chi, and qigong. Although studies are not always methodologically sound and results mixed, a growing number of well-designed studies provide convincing evidence that mind-body techniques are beneficial adjuncts to cancer treatment. The evidence is sufficient to recommend further investigation and adoption of these techniques in mainstream oncology care. PMID:21116746

  7. [Genetic therapy in oncology: ethical aspects].

    Science.gov (United States)

    Bucci, L M; Fazio, V M

    2001-01-01

    The more advanced oncologic therapies are directing toward new frontiers, on account of the remarkable undesirable effects of chemio- and radio-therapies. This new therapeutic experiences are of type biological (vaccines), or genic (substitution again genes with shutters meaning-tumoral). This therapies involve, to be effected, some ethical shrewdnesses: choice of the patient, the engineering modality of the genes, the transfer of the genes in cells of the exclusively somatic line, the elimination of the pathogenic risk of the vector virus, the obligatory use of sterile rooms, the attention to the administration of the drug, a legal issue of the judgment of notoriety. PMID:11725612

  8. Selenium in Oncology: From Chemistry to Clinics

    Directory of Open Access Journals (Sweden)

    Oliver Micke

    2009-10-01

    Full Text Available The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that Se has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. Our own clinical study involving 48 patients suggest that selenium has a positive effect on radiation-associated secondary lymphedema in patients with limb edemas, as well as in the head and neck region, including endolaryngeal edema. Another randomized phase III study of our group was performed to examine the cytoprotective properties of selenium in radiation oncology. The aim was to evaluate whether sodium selenite is able to compensate a preexisting selenium deficiency and to prevent radiation induced diarrhea in adjuvant radiotherapy for pelvic gynecologic malignancies. Through this study, the significant benefits of sodium selenite supplementation with regards to selenium deficiency and radiotherapy induced diarrhea in patients with cervical and uterine cancer has been shown for the first time in a prospective randomized trial. Survival data imply that supplementation with

  9. Selenium in oncology: from chemistry to clinics.

    Science.gov (United States)

    Micke, Oliver; Schomburg, Lutz; Buentzel, Jens; Kisters, Klaus; Muecke, Ralph

    2009-01-01

    The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that Se has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. Our own clinical study involving 48 patients suggest that selenium has a positive effect on radiation-associated secondary lymphedema in patients with limb edemas, as well as in the head and neck region, including endolaryngeal edema. Another randomized phase III study of our group was performed to examine the cytoprotective properties of selenium in radiation oncology. The aim was to evaluate whether sodium selenite is able to compensate a preexisting selenium deficiency and to prevent radiation induced diarrhea in adjuvant radiotherapy for pelvic gynecologic malignancies. Through this study, the significant benefits of sodium selenite supplementation with regards to selenium deficiency and radiotherapy induced diarrhea in patients with cervical and uterine cancer has been shown for the first time in a prospective randomized trial. Survival data imply that supplementation with selenium does not

  10. Elemente de terapie oncologică la animale / Elements of oncological therapy animals

    OpenAIRE

    Andreia B. Chirila; Eugenia Dumitrescu; Florin Muselin; Romeo T. Cristina

    2015-01-01

    This bibliographic essay is an attempt to recall the main elements applicable in the oncologic therapy useful also in veterinary medicine. In the paper are presented: the pharmacological principles of chemotherapy, radiotherapy, oncologic surgery, nanoterapia and some modern methodologies (photodynamic therapy, cryotherapy, electrochimioterapia, vascular disruption agents). The last chapter is dedicated to phytotherapy, as alternative therapy in oncology with the presentation of the main plan...

  11. Cardiovascular safety monitoring during oncology drug development and therapy.

    Science.gov (United States)

    Turner, J Rick; Panicker, Gopi Krishna; Karnad, Dilip R; Cabell, Christopher H; Lieberman, Ronald; Kothari, Snehal

    2014-01-01

    Assessments of cardiac and cardiovascular toxicity are prominent components of drug safety endeavors during drug development and clinical practice. Oncologic drugs bring several challenges to both domains. First, during drug development, it is necessary to adapt the ICH E14 "Thorough QT/QTc Study" because the cytotoxic nature of many oncologics precludes their being administered to healthy individuals. Second, appropriate benefit-risk assessments must be made by regulators: given the benefit these drugs provide in life-threatening illnesses, a greater degree of risk may be acceptable when granting marketing authorization than for drugs for less severe indications. Third, considerable clinical consideration is needed for patients who are receiving and have finished receiving pharmacotherapy. Paradoxically, although such therapy has proved very successful in many cases, with disease states going into remission and patients living for many years after cessation of treatment, cardiotoxicities can manifest themselves relatively soon or up to a decade later. Oncologic drugs have been associated with various off-target cardiovascular responses, including cardiomyopathy leading to heart failure, cardiac dysrhythmias, thromboembolic events, and hypertension. Follow-up attention and care are, therefore, critical. This article reviews the process of benefit-risk estimation, provides an overview of nonclinical and preapproval clinical assessment of cardiovascular safety of oncology drugs, and discusses strategies for monitoring and management of patients receiving drugs with known cardiotoxicity risk. These measures include cardiac function monitoring, limitation of chemotherapy dose, use of anthracycline analogs and cardioprotectants, and early detection of myocardial cell injury using biomarkers. PMID:24451296

  12. American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology.

    Science.gov (United States)

    Zon, Robin T; Frame, James N; Neuss, Michael N; Page, Ray D; Wollins, Dana S; Stranne, Steven; Bosserman, Linda D

    2016-03-01

    The use of clinical pathways in oncology care is increasingly important to patients and oncology providers as a tool for enhancing both quality and value. However, with increasing adoption of pathways into oncology practice, concerns have been raised by ASCO members and other stakeholders. These include the process being used for pathway development, the administrative burdens on oncology practices of reporting on pathway adherence, and understanding the true impact of pathway use on patient health outcomes. To address these concerns, ASCO's Board of Directors established a Task Force on Clinical Pathways, charged with articulating a set of recommendations to improve the development of oncology pathways and processes, allowing the demonstration of pathway concordance in a manner that promotes evidence-based, high-value care respecting input from patients, payers, and providers. These recommendations have been approved and adopted by ASCO's Board of Directors on August 12, 2015, and are presented herein. PMID:26759491

  13. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    International Nuclear Information System (INIS)

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  14. Music therapy: a valuable adjunct in the oncology setting.

    Science.gov (United States)

    Mahon, Emily M; Mahon, Suzanne M

    2011-08-01

    Music therapy is the supervised and therapeutic use of music by a credentialed therapist to promote positive clinical outcomes. It can be a valuable form of complementary medicine in the oncology setting to decrease patient stress and anxiety, relieve pain and nausea, provide distraction, alleviate depression, and promote the expression of feelings. The music therapist assesses the patient and consults other members of the multidisciplinary team to create a therapeutic treatment plan. Music therapists design music sessions based on patients' needs and their intended therapeutic goals. Patients can participate actively or passively in individual or group sessions. Only a credentialed music therapist can provide safe and beneficial music therapy interventions. PMID:21810567

  15. Clinical oncology in resource-limited settings

    OpenAIRE

    Buonaguro, Franco M.; Gueye, Serigne N; Wabinga, Henry R; Ngoma, Twalib A.; Vermorken, Jan B; Mbulaiteye, Sam M

    2013-01-01

    Infectious Agents and Cancer is introducing a new section of Clinical Oncology with the main objective of stimulating debate through articles published in the section. Infectious diseases have been the major causes of morbidity and mortality in human populations, and have dominated the medical approach to clinical and public health. Successful efforts to control mortality from acute infections have paved the way for chronic, mostly indolent, infections to become major causes of morbidity. Can...

  16. Bacteriophages and medical oncology: targeted gene therapy of cancer.

    Science.gov (United States)

    Bakhshinejad, Babak; Karimi, Marzieh; Sadeghizadeh, Majid

    2014-08-01

    Targeted gene therapy of cancer is of paramount importance in medical oncology. Bacteriophages, viruses that specifically infect bacterial cells, offer a variety of potential applications in biomedicine. Their genetic flexibility to go under a variety of surface modifications serves as a basis for phage display methodology. These surface manipulations allow bacteriophages to be exploited for targeted delivery of therapeutic genes. Moreover, the excellent safety profile of these viruses paves the way for their potential use as cancer gene therapy platforms. The merge of phage display and combinatorial technology has led to the emergence of phage libraries turning phage display into a high throughput technology. Random peptide libraries, as one of the most frequently used phage libraries, provide a rich source of clinically useful peptide ligands. Peptides are known as a promising category of pharmaceutical agents in medical oncology that present advantages such as inexpensive synthesis, efficient tissue penetration and the lack of immunogenicity. Phage peptide libraries can be screened, through biopanning, against various targets including cancer cells and tissues that results in obtaining cancer-homing ligands. Cancer-specific peptides isolated from phage libraries show huge promise to be utilized for targeting of various gene therapy vectors towards malignant cells. Beyond doubt, bacteriophages will play a more impressive role in the future of medical oncology. PMID:25012686

  17. Clinical PET: changing the practice of oncology

    International Nuclear Information System (INIS)

    disease, we have been able to demonstrate that PET has a high and appropriate impact on management. Our group have recently published data on the clinical impact of PET in specific diseases including the staging of NSCLC, the restaging of NSCLC, the staging of cervical cancer, the restaging of colorectal cancer, the diagnosis of solitary pulmonary nodules, evaluation of lymphoma and malignant melanoma. The uptake of FDG in inflammatory conditions, leading to false positive results, is regarded as one of the major limitations of this tracer in oncological settings. In an attempt to address this limitation agents that look at biological processes more specific to cancers than is glycolytic metabolism, have been evaluated. These include amino acid analogues that trace protein synthesis, thymidine analogues that evaluate cellular proliferation, and markers of cellular sterol metabolism. An additional feature of cancers is the presence of hypoxia. PET tracers such as F-18 fluoromisonidazole have been shown to be taken up in a high percentage of some tumours that clinical and experimental evidence suggests are likely to be hypoxic and because of this, more resistant to conventional therapies. Additional potential limitation of FDG is the potential for an increase in uptake during the process of apoptosis, an energy requiring process, that may limit the utility of early scanning to determine therapeutic response. The so-called 'metabolic flare' has been described as actually being predictive of therapeutic response in breast cancer patients treated by hormone manipulation. Due to issues related to synthesis times and providing adequate tracer amounts for several studies at least, we have focussed on fluorinated PET tracers rather than shorter-lived tracers using carbon-11. Currently the Peter MacCallum Cancer Institute Centre for Molecular Imaging has active clinical research trials using the cellular proliferative tracer, F-18 fluorothymidine (FLT), and the hypoxia markers F-18

  18. Off-label use of targeted therapies in oncology

    Science.gov (United States)

    Levêque, Dominique

    2016-01-01

    Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product characteristics. In oncology, off-label prescribing of targeted therapies may occur in patients with other tumor types expressing the same target. Agents associated to phenotypic approaches such as therapies against the tumoral vasculature (anti-angiogenic drugs) and new immunotherapies (checkpoint inhibitors) also carry the potential of alternative indications or combinations. Off-label use of targeted therapies is little documented and appears to be in the same range than that regarding older drugs with wide variations among agents. When compared with older agents, off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support, reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling, when applicable. PMID:27081648

  19. Topics in clinical oncology. 14

    International Nuclear Information System (INIS)

    The symposium proceedings contain 39 papers. All papers were inputted in INIS. The subjects of the papers were the use of computers in radiotherapy planning, and clinical dosimetry, equipment and quality assurance, biological radiation effects and radiation protection problems in radiotherapy. (J.P.)

  20. Clinical oncology in Malaysia: 1914 to present

    OpenAIRE

    Lim, GCC

    2006-01-01

    A narration of the development of staff, infrastructure and buildings in the various parts of the country is given in this paper. The role of universities and other institutions of learning, public health, palliative care, nuclear medicine and cancer registries is described together with the networking that has been developed between the government, non-governmental organisations and private hospitals. The training of skilled manpower and the commencement of the Master of Clinical Oncology in...

  1. Penile Cancer: Clinical Practice Guidelines in Oncology

    OpenAIRE

    Clark, Peter E.; Philippe E. Spiess; Agarwal, Neeraj; Biagioli, Matthew C.; Eisenberger, Mario A.; Greenberg, Richard E.; Herr, Harry W.; Inman, Brant A.; Kuban, Deborah A.; Kuzel, Timothy M.; Lele, Subodh M.; Michalski, Jeff; Pagliaro, Lance; Pal, Sumanta K.; Patterson, Anthony

    2013-01-01

    Squamous cell carcinoma of the penis represents approximately 0.5% of all cancers among men in the United States and other developed countries. Although rare, it is associated with significant disfigurement, and only half of the patients survive beyond 5 years. Proper evaluation of both the primary lesion and lymph nodes is critical, because nodal involvement is the most important factor of survival. The NCCN Clinical Practice Guidelines in Oncology for Penile Cancer provide recommendations o...

  2. Clinical Oncology-A New Era

    Institute of Scientific and Technical Information of China (English)

    Biyun Qian; Dan Su; Herbert Yu

    2007-01-01

    Rapid growth in biomedical research coupled with dramatic advancement in biotechnology has significantly improved our understanding of the molecular basis involving cancer development and progression.This improvement has led to the discovery of new molecular markers for cancer diagnosis and prognosis as well as new molecular targets for cancer treatment and intervention.Continuous emergence of some new developing area in molecular profiling,new therapeutic agents,tissue microenvironment and systems biology have made significant progress in clinical oncology.Clinical research and investigation that focus on these new developments have begun to show exciting results that indicate future promises in improving patient management and survival.

  3. Evolution and accomplishments of the radiation therapy oncology group

    International Nuclear Information System (INIS)

    Purpose: The Radiation Therapy Oncology Group (RTOG) recently completed its first quarter century as a cooperative clinical cancer research organization. It is timely and appropriate to document its origins, evolution, and accomplishments. Methods and Materials: The historical review of the RTOG called upon written and oral documentation. Results: The RTOG is the most enduring product of the Committee for Radiation Therapy Studies (CRTS). Although not one of the original 17 clinical trials groups developed by the National Cancer Institute in 1956, the RTOG has pursued trials suggested by laboratory findings including the oxygen effect, intrinsic radiosensitivity, proliferation kinetics of normal and tumor cells, and interactions with other cytotoxic agents. Improvements in survival have been demonstrated for patients with carcinoma of the esophagus and cervix, and nonsmall cell carcinomas of the lung. The national and international radiation oncology communities have benefited from standards and quality control/assurance guidelines for established and new modalities. A growing number of institutions in North America participate in RTOG trials. Conclusion: The RTOG is an important clinical research resource, which has contributed to improved outcome for patients with many forms of cancer. It has become increasingly productive and widely adopted and endorsed by oncologists throughout North America

  4. Clinical applications of PET in oncology.

    Science.gov (United States)

    Rohren, Eric M; Turkington, Timothy G; Coleman, R Edward

    2004-05-01

    Positron emission tomography (PET) provides metabolic information that has been documented to be useful in patient care. The properties of positron decay permit accurate imaging of the distribution of positron-emitting radiopharmaceuticals. The wide array of positron-emitting radiopharmaceuticals has been used to characterize multiple physiologic and pathologic states. PET is used for characterizing brain disorders such as Alzheimer disease and epilepsy and cardiac disorders such as coronary artery disease and myocardial viability. The neurologic and cardiac applications of PET are not covered in this review. The major utilization of PET clinically is in oncology and consists of imaging the distribution of fluorine 18 fluorodeoxyglucose (FDG). FDG, an analogue of glucose, accumulates in most tumors in a greater amount than it does in normal tissue. FDG PET is being used in diagnosis and follow-up of several malignancies, and the list of articles supporting its use continues to grow. In this review, the physics and instrumentation aspects of PET are described. Many of the clinical applications in oncology are mature and readily covered by third-party payers. Other applications are being used clinically but have not been as carefully evaluated in the literature, and these applications may not be covered by third-party payers. The developing applications of PET are included in this review. PMID:15044750

  5. AWARENESS OF PHYSICAL THERAPY REHABILITATION FOR BREAST CANCER RELATED LYMPHEDEMA AMONG MEDICAL ONCOLOGY TEAM - A SURVEY

    OpenAIRE

    Mullai; Dhinakaran; Chanchal Gautam; Clarence Samuel

    2013-01-01

    Objective:To analyses the awareness of physical therapy rehabilitation for breast cancer related lymphedemaamong medical oncology team member.Method and materials:The data was contents of 12 custom made questionnaires which distributed and collectedfrom 34 medical oncology team members who are working in CMC & H, DMC & H, Chandigarh PGI,Results:Nearly 100 % of clinical oncologist and Radiation oncologist were aware about physical therapyrehabilitation and nearly 80% of Surgeon and Physician w...

  6. Translational medicine promising personalized therapy in oncology

    Institute of Scientific and Technical Information of China (English)

    Yi-Xin ZENG; Xiao-Shi ZHANG; Qiang LIU

    2010-01-01

    @@ Translational medicine has newly emerged to bridge the gap between bench-related basic science research and bedside clinical practice. From early diagnosis to late-stage disease treatment, translational medicine has transformed the clinical practice by making personalized medicine possible. Attributing to the progress in translational medical research, cancer therapy has evolved from non-specific cytotoxic drugs against both tumor and normal proliferating cells to more specific small molecule chemical and immunotherapy approaches.

  7. Art Therapy with an Oncology Care Team

    Science.gov (United States)

    Nainis, Nancy A.

    2005-01-01

    Oncology nurses are particularly vulnerable to "burnout" syndrome due to the intensity of their work and the ongoing losses they experience while providing oncology care to their patients. High levels of stress in the workplace left untended lead to high job turnover, poor productivity, and diminished quality of care for patients. Attention to…

  8. Split-course radiation therapy of carcinoma of the base of the tongue: results of a prospective national collaborative clinical trial conducted by the Radiation Therapy Oncology Group

    International Nuclear Information System (INIS)

    One hundred forty-one patients with carcinoma of the base of tongue were randomized to receive either continuous course radiotherapy (6600 rad in 30/33 fractions over 7-8 weeks) or split course therapy (3000 rad in 10 fractions over 2 weeks, a three-week rest, 3000 rad in 10 fractions over 2 weeks). Both treatment groups tolerated the treatment well, but the continuous course group required more treatment modifications. The results of therapy, as judged by control of primary tumor, control of metastatic lymph nodes, time to failure and overall survival were comparable in the two treatment groups

  9. Gene therapy imaging in patients for oncological applications

    International Nuclear Information System (INIS)

    Thus far, traditional methods for evaluating gene transfer and expression have been shown to be of limited value in the clinical arena. Consequently there is a real need to develop new methods that could be repeatedly and safely performed in patients for such purposes. Molecular imaging techniques for gene expression monitoring have been developed and successfully used in animal models, but their sensitivity and reproducibility need to be tested and validated in human studies. In this review, we present the current status of gene therapy-based anticancer strategies and show how molecular imaging, and more specifically radionuclide-based approaches, can be used in gene therapy procedures for oncological applications in humans. The basis of gene expression imaging is described and specific uses of these non-invasive procedures for gene therapy monitoring illustrated. Molecular imaging of transgene expression in humans and evaluation of response to gene-based therapeutic procedures are considered. The advantages of molecular imaging for whole-body monitoring of transgene expression as a way to permit measurement of important parameters in both target and non-target organs are also analyzed. The relevance of this technology for evaluation of the necessary vector dose and how it can be used to improve vector design are also examined. Finally, the advantages of designing a gene therapy-based clinical trial with imaging fully integrated from the very beginning are discussed and future perspectives for the development of these applications outlined. (orig.)

  10. A clinical intranet model for radiation oncology

    International Nuclear Information System (INIS)

    Purpose: A new paradigm in computing is being formulated from advances in client-server technology. This new way of accessing data in a network is referred to variously as Web-based computing, Internet computing, or Intranet computing. The difference between an internet and intranet being that the former is for global access and the later is only for intra-departmental access. Our purpose with this work is to develop a clinically useful radiation oncology intranet for accessing physically disparate data sources. Materials and Methods: We have developed an intranet client-server system using Windows-NT Server 4.0 running Internet Information Server (IIS) on the back-end and client PCs using a typical World Wide Web (WWW) browser. The clients also take advantage of the Microsoft Open Database Connectivity (ODBC) standard for accessing commercial database systems. The various data sources used include: a traditional Radiation Oncology Information (ROIS) System (VARiS 1.3tm); a 3-D treatment planning system (CAD Plantm); a beam scanning system (Wellhoffertm); as well as an electronic portal imaging device (PortalVisiontm) and a CT-Simulator providing digitally reconstructed radiographs (DRRs) (Picker AcQsimtm). We were able to leverage previously developed Microsoft Visual C++ applications without major re-writing of source code for this. Results: With the data sources and development materials used, we were able to develop a series of WWW-based clinical tool kits. The tool kits were designed to provide profession-specific clinical information. The physician's tool kit provides a treatment schedule for daily patients along with a dose summary from VARiS and the ability to review portal images and prescription images from the EPID and Picker. The physicists tool kit compares dose summaries from VARiS with an independent check against RTP beam data and serves as a quick 'chart-checker'. Finally, an administrator tool kit provides a summary of periodic charging

  11. Clinical microdialysis in neuro-oncology: principles and applications

    Institute of Scientific and Technical Information of China (English)

    J. Clay Goodman

    2011-01-01

    Clinical microdialysis allows a discrete volume of the brain to be sampled for neurochemical analysis of neurotransmitters, metabolites, biomarkers, and drugs. The technique can be safely used in humans intraoperatively, in the intensive care unit, and in ambulatory settings. Microdialysis probes, micropumps, and analytical equipment are commercially available and have been used extensively for neurochemical monitoring in traumatic brain injury, stroke, and subarachnoid hemorrhage. There has been very limited use of micredialysis in neuro-oncology, but this technique has groat promise in the study of the basic neurochemistry of brain tumors, alterations in neurochemistry in response to therapy, and the pharmacokinetics of chemotherapeutic agents. Microdialysis probes may also be used to deliver drugs while simultaneously permitting monitoring of neurochemical changes induced by this therapy.

  12. Tracking the 2015 Gastrointestinal Cancers Symposium: bridging cancer biology to clinical gastrointestinal oncology

    Directory of Open Access Journals (Sweden)

    Aprile G

    2015-05-01

    Full Text Available Giuseppe Aprile,1 Francesco Leone,2,3 Riccardo Giampieri,4 Mariaelena Casagrande,1 Donatella Marino,2,3 Luca Faloppi,4 Stefano Cascinu,4 Gianpiero Fasola,1 Mario Scartozzi5,6 1Department of Oncology, University and General Hospital, Udine, Italy; 2Medical Oncology Department, University of Turin, 3Institute for Cancer Research and Treatment, Candiolo, Turin, Italy; 4Medical Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Universita Politecnica delle Marche, Ancona, Italy; 5Medical Oncology Department, University of Cagliari, 6General Hospital, Cagliari, Italy Abstract: The 2015 Gastrointestinal Cancers Symposium (San Francisco, CA, USA; January 15–17 is the world-class conference co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, the American Gastroenterological Association Institute, and the Society of Surgical Oncology, in which the most innovative research results in digestive tract oncology are presented and discussed. In its twelfth edition, the meeting has provided new insights focusing on the underpinning biology and clinical management of gastrointestinal malignancies. More than 3,400 health care professionals gathered from all over the world to share their experiences on how to bridge the recent novelties in cancer biology with everyday medical practice. In this article, the authors report on the most significant advances, didactically moving on three different anatomic tracks: gastroesophageal malignancies, pancreatic and biliary cancers, and colorectal adenocarcinomas. Keywords: colorectal cancer, gastric cancer, ramucirumab, pembrolizumab, target therapy, onartuzumab, AMG 337

  13. Periodontium destruction associated with oncology therapy. Five case reports

    International Nuclear Information System (INIS)

    Radiation treatment to the head and neck and cytotoxic chemotherapy can produce deleterious side effects to the periodontium that are generally transient in nature, reversible, and do not result in permanently visible defects. However, combinations of the malignant disease itself, the direct and indirect effects of medical therapy and associated oral infections, along with local trauma can lead to periodontal tissue destruction with resulting permanent architectural defects. Five case reports illustrate destructive alterations of the periodontium that were associated with oncology therapy. Proposed guidelines for periodontal treatment of compromised individuals undergoing oncology therapies are suggested

  14. Development of radiolabelled vitamin B12 and derivatives on oncology and tumor therapy

    International Nuclear Information System (INIS)

    Current study and clinical application of the radiolabelled Vitamin B12 and derivative are summarized. The biological activity of Vitamin B12 and the application of 111In, 10B, 99Tcm (Re) labelling derivatives on oncology and tumor therapy are mainly reviewed

  15. NEURO-ONCOLOGIC PHYSICAL THERAPY FOR THE OLDER PERSON

    Science.gov (United States)

    Ching, Willie; Luhmann, Melissa

    2011-01-01

    Due to the uncertainty of the course of diagnoses, patients with neuro-oncological malignancies present challenges to the physical therapist. At times, the presentation of impairments and disabilities of these patients with neuro-oncological diagnoses do not necessarily coincide with the involved area of the brain or spinal cord. It is our intention to provide guidance to the physical therapist who will be working with these patients with neuro-oncological diagnoses, in hopes that their encounters will be more productive and meaningful. This article describes a brief overview of common central nervous system malignancies, its medical treatment, as well as possible complications and side effects that would need to be considered in rehabilitating these patients. Special consideration is given to the elderly patients with neuro-oncological diagnoses. Pertinent physical therapy assessments and interventions are discussed. PMID:22049262

  16. Scenario drafting for early technology assessment of next generation sequencing in clinical oncology

    NARCIS (Netherlands)

    Joosten, S.E.P.; Retel, V.P.; Coupé, V.M.H.; Heuvel, van den M.M.; Harten, van W.H.

    2016-01-01

    Background Next Generation Sequencing (NGS) is expected to lift molecular diagnostics in clinical oncology to the next level. It enables simultaneous identification of mutations in a patient tumor, after which targeted therapy may be assigned. This approach could improve patient survival and/or assi

  17. Guide to clinical PET in oncology: Improving clinical management of cancer patients

    International Nuclear Information System (INIS)

    Positron emission tomography (PET) has an approximately 50 year-history. It was developed as a tool of medical science to quantitatively measure metabolic rates of bio-substances in vivo and in particular the number of receptors in neuroscience. Until the late 1990s PET was, in most cases, research oriented activity. In 2001, positron emission tomography/X ray computed tomography (PET/CT) hybrid imaging system became commercially available. An era of clinical PET then emerged, in which PET images were utilized for clinical practice in the treatment and diagnosis of cancer patients. PET imaging could recognize areas of abnormal metabolic behaviour of cancers in vivo, and the addition of CT imaging underlines the site of malignancy. More accurate and precise interpretation of cancer lesions can therefore be performed by PET/CT imaging than PET or CT imaging alone. Clinical PET, in particular with fluorine-18-fluorodeoxyglucose (18F-FDG), has already proven itself to have considerable value in oncology. The indications include malignant lymphoma and melanoma, head and neck cancers, oesophageal cancer, breast cancer, lung cancer and colorectal cancer, and it is still being expanded. The roles of clinical PET could be for 1) preoperative staging of cancers, 2) differentiation between residual tumour and scarring, 3) demonstration of suspected recurrences, 4) monitoring response to therapy, 5) prognosis and 6) radiotherapy treatment planning. Clinical PET can be used to illustrate exactly which treatment should be applied for a cancer patient as well as where surgeons should operate and where radiation oncologists should target radiation therapy. An almost exponential rise in the introduction of clinical PET, as well as the installation of PET/CT has been seen throughout the world. Clinical PET is currently viewed as the most powerful diagnostic tool in its field. This IAEA-TECDOC presents an overview of clinical PET for cancer patients and a relevant source of

  18. Contract research organizations in oncology clinical research: Challenges and opportunities.

    Science.gov (United States)

    Roberts, Daniel A; Kantarjian, Hagop M; Steensma, David P

    2016-05-15

    Contract research organizations (CROs) represent a multibillion dollar industry that is firmly embedded in the contemporary clinical trial process. Over the past 30 years, and especially within the last decade, the reach of CROs has extended to service all phases of drug trials in an increasingly global research environment. The presence of CROs is particularly noticeable in medical oncology because of the large number of investigational compounds developed to treat cancer that are currently undergoing testing in human subjects. Although limited data are available with which to objectively define the effects that CROs have had on the clinical trial process, with the expansion of these organizations, several reports have called into question whether ethical and professional standards in research conduct are at times secondary to economic considerations. CROs can add considerable value to the clinical trial process, but difficulty communicating with CRO representatives and time spent answering trivial data queries generated by CROs are current obstacles for study site personnel interacting with CROs. Further study of the effect of the CRO industry on the clinical trial process is needed to ensure efficient data collection and patient safety while collaboratively developing novel therapies in an expedited fashion. Cancer 2016;122:1476-82. © 2016 American Cancer Society. PMID:27018651

  19. Clinical Training of Medical Physicists Specializing in Radiation Oncology

    International Nuclear Information System (INIS)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  20. Reinventing Diagnostics for Personalized Therapy in Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Banerjee, Diponkar [Centre for Translational and Applied Genomics (CTAG), Provincial Health Services Authority (PHSA) Laboratories, Vancouver, British Columbia (Canada); Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Pathology, British Columbia Cancer Agency (BCCA), 600 West 10th Avenue, Vancouver, British Columbia, V5Z4E6 (Canada)

    2010-06-02

    Human cancers are still diagnosed and classified using the light microscope. The criteria are based upon morphologic observations by pathologists and tend to be subject to interobserver variation. In preoperative biopsies of non-small cell lung cancers, the diagnostic concordance, even amongst experienced pulmonary pathologists, is no better than a coin-toss. Only 25% of cancer patients, on average, benefit from therapy as most therapies do not account for individual factors that influence response or outcome. Unsuccessful first line therapy costs Canada CAN $1.2 billion for the top 14 cancer types, and this extrapolates to $90 billion globally. The availability of accurate drug selection for personalized therapy could better allocate these precious resources to the right therapies. This wasteful situation is beginning to change with the completion of the human genome sequencing project and with the increasing availability of targeted therapies. Both factors are giving rise to attempts to correlate tumor characteristics and response to specific adjuvant and neoadjuvant therapies. Static cancer classification and grading systems need to be replaced by functional classification systems that not only account for intra- and inter- tumor heterogeneity, but which also allow for the selection of the correct chemotherapeutic compounds for the individual patient. In this review, the examples of lung and breast cancer are used to illustrate the issues to be addressed in the coming years, as well as the emerging technologies that have great promise in enabling personalized therapy.

  1. Reinventing Diagnostics for Personalized Therapy in Oncology

    International Nuclear Information System (INIS)

    Human cancers are still diagnosed and classified using the light microscope. The criteria are based upon morphologic observations by pathologists and tend to be subject to interobserver variation. In preoperative biopsies of non-small cell lung cancers, the diagnostic concordance, even amongst experienced pulmonary pathologists, is no better than a coin-toss. Only 25% of cancer patients, on average, benefit from therapy as most therapies do not account for individual factors that influence response or outcome. Unsuccessful first line therapy costs Canada CAN $1.2 billion for the top 14 cancer types, and this extrapolates to $90 billion globally. The availability of accurate drug selection for personalized therapy could better allocate these precious resources to the right therapies. This wasteful situation is beginning to change with the completion of the human genome sequencing project and with the increasing availability of targeted therapies. Both factors are giving rise to attempts to correlate tumor characteristics and response to specific adjuvant and neoadjuvant therapies. Static cancer classification and grading systems need to be replaced by functional classification systems that not only account for intra- and inter- tumor heterogeneity, but which also allow for the selection of the correct chemotherapeutic compounds for the individual patient. In this review, the examples of lung and breast cancer are used to illustrate the issues to be addressed in the coming years, as well as the emerging technologies that have great promise in enabling personalized therapy

  2. Regulatory and clinical considerations for biosimilar oncology drugs

    Science.gov (United States)

    Bennett, Charles L; Chen, Brian; Hermanson, Terhi; Wyatt, Michael D; Schulz, Richard M; Georgantopoulos, Peter; Kessler, Samuel; Raisch, Dennis W; Qureshi, Zaina P; Lu, Z Kevin; Love, Bryan L; Noxon, Virginia; Bobolts, Laura; Armitage, Melissa; Bian, John; Ray, Paul; Ablin, Richard J; Hrushesky, William J; Macdougall, Iain C; Sartor, Oliver; Armitage, James O

    2015-01-01

    Biological oncology products are integral to cancer treatment, but their high costs pose challenges to patients, families, providers, and insurers. The introduction of biosimilar agents—molecules that are similar in structure, function, activity, immunogenicity, and safety to the original biological drugs—provide opportunities both to improve healthcare access and outcomes, and to reduce costs. Several international regulatory pathways have been developed to expedite entry of biosimilars into global marketplaces. The first wave of oncology biosimilar use was in Europe and India in 2007. Oncology biosimilars are now widely marketed in several countries in Europe, and in Australia, Japan, China, Russia, India, and South Korea. Their use is emerging worldwide, with the notable exception of the USA, where several regulatory and cost barriers to biosimilar approval exist. In this Review, we discuss oncology biosimilars and summarise their regulatory frameworks, clinical experiences, and safety concerns. PMID:25456378

  3. Endoscopic ultrasound-fine needle injection for oncological therapy

    Institute of Scientific and Technical Information of China (English)

    Jeremy; Kaplan; Amaara; Khalid; Natalie; Cosgrove; Ayesha; Soomro; Syed; Mohsin; Mazhar; Ali; A; Siddiqui

    2015-01-01

    The minimal invasiveness and precision of endoscopicultrasound(EUS) has lead to both its widespread use as a diagnostic and staging modality for gastrointestinal and pancreaticobiliary malignancies, and to its expand-ing role as a therapeutic modality. EUS-guided celiac plexus neurolysis is now a well-accepted modality for palliation of pain in patients with pancreatic cancer. EUS-guided ablation, brachytherapy, fiducial marker placement, and antitumor agent injection have been described as methods of performing minimally invasive oncological therapy. EUS-fine needle injection may be performed as adjunctive, alternative, or palliative treatment. This review summarizes the studies to date that have described these methods. A literature search using the Pub Med/MEDLINE databases was performed. While most published studies to date are limited with disappointing outcomes, the concept of a role of EUS in oncological therapy seems promising.

  4. Chest CT for suspected pulmonary complications of oncologic therapies: how I review and report.

    Science.gov (United States)

    Diederich, Stefan

    2016-01-01

    In cancer patient during or following oncologic therapies with respiratory symptoms and pulmonary pathology at chest CT the differential diagnosis includes infection, therapy-induced disease and tumour progression.Although CT morphology may be typical or even pathognomonic in some conditions the diagnosis is usually made by a synopsis of imaging, clinical and laboratory features.Close communication with referring colleagues and a good knowledge of potential side effects of therapeutic concepts, their time course and CT morphology is crucial in the differential diagnosis.This review describes a personal approach to the radiological diagnosis of therapy-induced pulmonary abnormalities in cancer patients. PMID:27067027

  5. FDG PET/CT in clinical oncology. Case based approach with teaching points

    International Nuclear Information System (INIS)

    Organized according to the role of FDG PET/CT in the evaluation and management of oncology patients. 100 informative cases reflecting the issues that clinicians address in their daily practice. Ideal for all newcomers to the field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians. FDG PET/CT has rapidly emerged as an invaluable combined imaging modality that can identify tumors on the basis of not only anatomical alterations but also metabolic activity, thus allowing the detection of lesions that would otherwise be too small to distinguish. This book, comprising a collection of images from oncology cases, is organized according to the role of FDG PET/CT in the evaluation and management of oncology patients, and only secondarily by organ or tumor entity. In this way, it reflects the issues that clinicians actually address in their daily practice, namely: identification of an unknown or unsuspected primary; determination of the extent of disease; evaluation of response to therapy; and surveillance after response, i.e., detection of recurrent disease. In total, 100 cases involving different primary tumors are presented to illustrate findings in these different circumstances. FDG PET/CT in Clinical Oncology will be of great value to all newcomers to this field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians.

  6. FDG PET/CT in clinical oncology. Case based approach with teaching points

    Energy Technology Data Exchange (ETDEWEB)

    Mihailovic, Jasna [Novi Sad Univ. (Serbia). Dept. of Nuclear Medicine; Goldsmith, Stanley J. [Weill Cornell Medical College, New York, NY (United States). Div. of Nuclear Medicine and Molecular Imging; Killeen, Ronan P. [St. Vincents Univ. Hospital, Dublin (Ireland)

    2012-07-01

    Organized according to the role of FDG PET/CT in the evaluation and management of oncology patients. 100 informative cases reflecting the issues that clinicians address in their daily practice. Ideal for all newcomers to the field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians. FDG PET/CT has rapidly emerged as an invaluable combined imaging modality that can identify tumors on the basis of not only anatomical alterations but also metabolic activity, thus allowing the detection of lesions that would otherwise be too small to distinguish. This book, comprising a collection of images from oncology cases, is organized according to the role of FDG PET/CT in the evaluation and management of oncology patients, and only secondarily by organ or tumor entity. In this way, it reflects the issues that clinicians actually address in their daily practice, namely: identification of an unknown or unsuspected primary; determination of the extent of disease; evaluation of response to therapy; and surveillance after response, i.e., detection of recurrent disease. In total, 100 cases involving different primary tumors are presented to illustrate findings in these different circumstances. FDG PET/CT in Clinical Oncology will be of great value to all newcomers to this field, whether medical students, radiology, nuclear medicine, or oncology fellows, or practicing physicians.

  7. Energy Therapies in Advanced Practice Oncology: An Evidence-Informed Practice Approach

    OpenAIRE

    Potter, Pamela J.

    2013-01-01

    Advanced practitioners in oncology want patients to receive state-of-the-art care and support for their healing process. Evidence-informed practice (EIP), an approach to evaluating evidence for clinical practice, considers the varieties of evidence in the context of patient preference and condition as well as practitioner knowledge and experience. This article offers an EIP approach to energy therapies, namely, Therapeutic Touch (TT), Healing Touch (HT), and Reiki, as supportive interventions...

  8. The characteristic of complications of radionuclide therapy by samarium oksabifor at oncologic patients

    International Nuclear Information System (INIS)

    On the basis of data of clinical-laboratory evaluation of 30 oncologic patients with bone metastasis the account and the analysis of complications of radio nuclide therapy (RNT) by samarium-oksabifor are carried out. It is defined that RNT 153Sm increases efficiency of complex palliative treatment of patients with bone metastasis, has high tolerability and isn't followed by intensifying of frequency of radial reactions and complications

  9. Cancer-related fatigue. Clinical practice guidelines in oncology.

    Science.gov (United States)

    2003-07-01

    increase support, restorative therapies to decrease cognitive alterations and improve mood state, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs, such as antidepressants for depression or erythropoietin for anemia. A few clinical reports of the use of psychostimulants suggest the need for further research on these agents as potential treatment modalities in managing fatigue. Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly and systematically, educates and counsels patients regarding strategies for coping with fatigue, and uses institutional fatigue management experts for referral of patients with unresolved fatigue. PMID:19761067

  10. Mixture dynamics: Combination therapy in oncology.

    Science.gov (United States)

    Gabrielsson, Johan; Gibbons, Francis D; Peletier, Lambertus A

    2016-06-10

    In recent years combination therapies have become increasingly popular in most therapeutic areas. We present a qualitative and quantitative approach and elucidate some of the challenges and solutions to a more optimal therapy. For tumor growth this involves the study of semi-mechanistic cell-growth/kill models with multiple sites of action. We introduce such models and analyze their dynamic properties using simulations and mathematical analysis. This is done for two specific case studies, one involving a single compound and one a combination of two compounds. We generalize the notion of Tumor Static Concentration to cases when two compounds are involved and develop a graphical method for determining the optimal combination of the two compounds, using ideas akin to those used in studies employing isobolograms. In studying the dynamics of the second case study we focus, not only on the different concentrations, but also on the different dosing regimens and pharmacokinetics of the two compounds. PMID:27050307

  11. Clinical oncology - comparison of two-dimensional and three-dimensional acquisition in oncological patients

    International Nuclear Information System (INIS)

    Full text: The 3D acquisition mode presents the possibility of shorter scan times with decreased injection dose. In the present study, the clinical results in two-dimensional (2D) and three-dimensional (3D) acquisition mode were compared. We report our data of 3D PET imaging for clinical oncological patients using a Siemens ECAT Exact 47. 50 oncological patients were observed with F-18-FDG in a 2D whole body (WB) routine scan (5 or 6 bed positions). The 2D-FDG-PET studies are performed in 2D emission for 8 min and in 2D transmission for 2 min followed by one bedposition scan in 3D technique (5 min 3D emission scan and a 2 min transmission scan ) in a region with detected lesion. Both 2D and 3D data were reconstructed using iterative reconstruction (2 iterations with 8 subsets). A visual interpretation of contrast, identifiability, geometrical form and a quantitative evaluation (SUV and metabolic extension) was performed. No clinically relevant differences in detection of lesions between 2D and 3D mode were found by the qualitative and quantitative analysis. The contrast, geometrical form and the SUV compared side by side showed small differences. Based on this preliminary results, it seems that 3D technique is equal with 2D in clinical oncological PET with reduction in WB scan time. (author)

  12. Medical Oncology Pharmacy: A New Role for the Clinical Pharmacist

    Science.gov (United States)

    Morris, Carl R.; Hickman, Mary Johne

    1977-01-01

    The University of Tennessee has established a training program for clinical pharmacists dealing with cancer chemotherapy patients. Health-care settings are described in which these individuals can contribute as unique health-care team members in oncology. (Author/LBH)

  13. Advances in Radiation Therapy in Pediatric Neuro-oncology.

    Science.gov (United States)

    Bindra, Ranjit S; Wolden, Suzanne L

    2016-03-01

    Radiation therapy remains a highly effective therapy for many pediatric central nervous system tumors. With more children achieving long-term survival after treatment for brain tumors, late-effects of radiation have become an important concern. In response to this problem, treatment protocols for a variety of pediatric central nervous system tumors have evolved to reduce radiation fields and doses when possible. Recent advances in radiation technology such as image guidance and proton therapy have led to a new era of precision treatment with significantly less exposure to healthy tissues. These developments along with the promise of molecular classification of tumors and targeted therapies point to an optimistic future for pediatric neuro-oncology. PMID:26271789

  14. Monitoring cancer stem cells: insights into clinical oncology

    Directory of Open Access Journals (Sweden)

    Lin SC

    2016-02-01

    Full Text Available ShuChen Lin,1,* YingChun Xu,2,* ZhiHua Gan,1 Kun Han,1 HaiYan Hu,3 Yang Yao,3 MingZhu Huang,4 DaLiu Min1 1Department of Oncology, Shanghai Sixth People’s Hospital East Campus, Shanghai Jiao Tong University, 2Department of Oncology, Renji Hospital, Shanghai Jiao Tong University, 3Department of Oncology, The Sixth People’s Hospital, Shanghai Jiao Tong University, 4Department of Medical Oncology, Cancer Hospital of Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Cancer stem cells (CSCs are a small, characteristically distinctive subset of tumor cells responsible for tumor initiation and progression. Several treatment modalities, such as surgery, glycolytic inhibition, driving CSC proliferation, immunotherapy, and hypofractionated radiotherapy, may have the potential to eradicate CSCs. We propose that monitoring CSCs is important in clinical oncology as CSC populations may reflect true treatment response and assist with managing treatment strategies, such as defining optimal chemotherapy cycles, permitting pretreatment cancer surveillance, conducting a comprehensive treatment plan, modifying radiation treatment, and deploying rechallenge chemotherapy. Then, we describe methods for monitoring CSCs. Keywords: cancer stem cells, glycolytic inhibition, watchful waiting, rechallenge, immunotherapy

  15. Role of oncology clinical pharmacist: a case of life-saving interventions

    OpenAIRE

    Osama M. Al-Quteimat; Al-Badaineh, Mariam A.

    2013-01-01

    The oncology clinical pharmacist (CP) has a crucial role in cancer patient care through improving medication use including chemotherapy and other high alert medications. As part of multidisciplinary team CP has major role in assuring safe, effective and cost-effective drug therapy. Herein we report a case of 45 years old male patient diagnosed with diffuse large B-cell lymphoma (DLBCL), treated with high dose methotrexate (MTX) as prophylaxis for central nervous system (CNS) lymphoma, and fol...

  16. Translating clinical trials from human to veterinary oncology and back

    OpenAIRE

    Fürdös, Irene; Fazekas, Judit; Singer, Josef; Jensen-Jarolim, Erika

    2015-01-01

    In human medicine clinical trials are legally required for drug development and approval. In contrast, clinical trials in small animal cancer patients are less common and legally perceived as animal experiments. Comparative oncology has been recognized as a method to speed up the development of medications by introducing animal patients with naturally developing tumours. In such cases, using animal patients would generate more robust data, as their spontaneous disease resembles the “real life...

  17. Eva Between Anxiety and Hope: Integrating Anthroposophic Music Therapy in Supportive Oncology Care

    Science.gov (United States)

    Ben-Arye, Eran; Ben-Arye, Yotam; Barak, Yael

    2015-01-01

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient’s involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients’ supportive care. PMID:26973967

  18. Eva between anxiety and hope: integrating anthroposophic music therapy in supportive oncology care

    Directory of Open Access Journals (Sweden)

    Eran Ben-Arye

    2015-11-01

    Full Text Available Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient’s involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients’ supportive care.

  19. Eva Between Anxiety and Hope: Integrating Anthroposophic Music Therapy in Supportive Oncology Care.

    Science.gov (United States)

    Ben-Arye, Eran; Ben-Arye, Yotam; Barak, Yael

    2015-11-30

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient's involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients' supportive care. PMID:26973967

  20. When subatomic physics research meets clinical oncology

    OpenAIRE

    2012-01-01

    New but costly forms of hadron therapy to treat certain cancers raise important questions about how much health systems can afford to pay, but for some cancers, including many child cancers, they are among the most promising treatments we have. Gary Humphreys reports.

  1. Clinical application of PET/MRI in oncology.

    Science.gov (United States)

    Sotoudeh, Houman; Sharma, Akash; Fowler, Kathryn J; McConathy, Jonathan; Dehdashti, Farrokh

    2016-08-01

    Hybrid imaging with integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) combines the advantages of the high-resolution anatomic data from MRI and functional imaging data from PET, and has the potential to improve the diagnostic evaluation of various types of cancers. The clinical oncologic applications of this newest hybrid imaging technology are evolving and substantial efforts are underway to define the role of PET/MRI in routine clinical use. The current published literature suggests that PET/MRI may play an important role in the evaluation of patients with certain types of malignancies, involving anatomic locations such as the pelvis and the liver. The purpose of this article is to review the current published PET/MRI literature in specific body oncologic applications. In addition, PET/MRI protocols and some of the technical issues of this hybrid imaging will be briefly discussed. J. Magn. Reson. Imaging 2016;44:265-276. PMID:27007987

  2. A Randomized Trial (Irish Clinical Oncology Research Group 97-01) Comparing Short Versus Protracted Neoadjuvant Hormonal Therapy Before Radiotherapy for Localized Prostate Cancer.

    LENUS (Irish Health Repository)

    Armstrong, John G

    2010-08-24

    PURPOSE: To examine the long-term outcomes of a randomized trial comparing short (4 months; Arm 1) and long (8 months; Arm 2) neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer. METHODS AND MATERIALS: Between 1997 and 2001, 276 patients were enrolled and the data from 261 were analyzed. The stratification risk factors were prostate-specific antigen level >20 ng\\/mL, Gleason score >\\/=7, and Stage T3 or more. The intermediate-risk stratum had one factor and the high-risk stratum had two or more. Staging was done from the bone scan and computed tomography findings. The primary endpoint was biochemical failure-free survival. RESULTS: The median follow-up was 102 months. The overall survival, biochemical failure-free survival. and prostate cancer-specific survival did not differ significantly between the two treatment arms, overall or at 5 years. The cumulative probability of overall survival at 5 years was 90% (range, 87-92%) in Arm 1 and 83% (range, 80-86%) in Arm 2. The biochemical failure-free survival rate at 5 years was 66% (range, 62-71%) in Arm 1 and 63% (range, 58-67%) in Arm 2. CONCLUSION: No statistically significant difference was found in biochemical failure-free survival between 4 months and 8 months of neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer.

  3. RTOG Sarcoma Radiation Oncologists Reach Consensus on Gross Tumor Volume and Clinical Target Volume on Computed Tomographic Images for Preoperative Radiotherapy of Primary Soft Tissue Sarcoma of Extremity in Radiation Therapy Oncology Group Studies

    Energy Technology Data Exchange (ETDEWEB)

    Wang Dian, E-mail: dwang@mcw.edu [Medical College of Wisconsin, Milwaukee, WI (United States); Bosch, Walter [Washington University, St. Louis, MO (United States); Roberge, David [McGill University, Montreal, Quebec (Canada); Finkelstein, Steven E. [Moffitt Cancer Center, Tampa, FL (United States); Petersen, Ivy; Haddock, Michael [Mayo Clinic, Rochester, MN (United States); Chen, Yen-Lin E.; Saito, Naoyuki G. [Roswell Park Cancer Institute, Buffalo, NY (United States); Kirsch, David G. [Duke University, Durham, NC (United States); Hitchcock, Ying J. [University of Utah, Salt Lake City, UT (United States); Wolfson, Aaron H. [University of Miami Miller School of Medicine, Miami, FL (United States); DeLaney, Thomas F. [Massachusetts General Hospital, Boston, MA (United States)

    2011-11-15

    Objective: To develop a Radiation Therapy Oncology Group (RTOG) atlas delineating gross tumor volume (GTV) and clinical target volume (CTV) to be used for preoperative radiotherapy of primary extremity soft tissue sarcoma (STS). Methods and Materials: A consensus meeting was held during the RTOG meeting in January 2010 to reach agreement about GTV and CTV delineation on computed tomography (CT) images for preoperative radiotherapy of high-grade large extremity STS. Data were presented to address the local extension of STS. Extensive discussion ensued to develop optimal criteria for GTV and CTV delineation on CT images. Results: A consensus was reached on appropriate CT-based GTV and CTV. The GTV is gross tumor defined by T1 contrast-enhanced magnetic resonance images. Fusion of magnetic resonance and images is recommended to delineate the GTV. The CTV for high-grade large STS typically includes the GTV plus 3-cm margins in the longitudinal directions. If this causes the field to extend beyond the compartment, the field can be shortened to include the end of a compartment. The radial margin from the lesion should be 1.5 cm, including any portion of the tumor not confined by an intact fascial barrier, bone, or skin surface. Conclusion: The consensus on GTV and CTV for preoperative radiotherapy of high-grade large extremity STS is available as web-based images and in a descriptive format through the RTOG. This is expected to improve target volume consistency and allow for rigorous evaluation of the benefits and risks of such treatment.

  4. Selenium in Oncology: From Chemistry to Clinics

    OpenAIRE

    Oliver Micke; Lutz Schomburg; Jens Buentzel; Klaus Kisters; Ralph Muecke

    2009-01-01

    The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a con...

  5. AWARENESS OF PHYSICAL THERAPY REHABILITATION FOR BREAST CANCER RELATED LYMPHEDEMA AMONG MEDICAL ONCOLOGY TEAM - A SURVEY

    Directory of Open Access Journals (Sweden)

    Mullai

    2013-10-01

    Full Text Available Objective:To analyses the awareness of physical therapy rehabilitation for breast cancer related lymphedemaamong medical oncology team member.Method and materials:The data was contents of 12 custom made questionnaires which distributed and collectedfrom 34 medical oncology team members who are working in CMC & H, DMC & H, Chandigarh PGI,Results:Nearly 100 % of clinical oncologist and Radiation oncologist were aware about physical therapyrehabilitation and nearly 80% of Surgeon and Physician were aware about it (p<0.05. Relatively fewteam members(53% sent their patients to out patient department of physiotherapy and mostly (47% not sent (p< 0.03.Conclusion:Medical oncology team was aware of role of physiotherapist for breast cancer related lymphedema.But they were concentrating only shoulder activity not in decongestive exercises So, it is importantthat awarenessabout physical therapy techniques and its effects to the medical professionals is necessary and alsoinclusion ofphysical therapist in the rehabilitation team make lot of difference in the quality of life of Lymphedema patients

  6. Long-Term Recurrence of Nonmelanoma Skin Cancer after Topical Methylaminolevulinate Photodynamic Therapy in a Dermato-Oncology Department

    OpenAIRE

    Cabete, J; Rafael, M; Cravo, M; Moura, C.; Sachse, F; Pecegueiro, M

    2015-01-01

    BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynam...

  7. Long-term recurrence of nonmelanoma skin cancer after topical methylaminolevulinate photodynamic therapy in a dermato-oncology department*

    OpenAIRE

    Cabete, Joana; Rafael, Margarida; Cravo, Mariana; Moura, Cecília; Sachse, Fernanda; Pecegueiro, Manuela

    2015-01-01

    BACKGROUND Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therap...

  8. Integrating pain metrics into oncology clinical trials.

    Science.gov (United States)

    Cleeland, Charles S; O'Mara, Ann; Zagari, Martin; Baas, Carole

    2011-11-01

    Cancer-related pain is highly prevalent and often severe, and as a result is often one of the defining experiences for patients with malignancy. Patients and patients' families almost always live with the ever-present reality that cancer treatment and progression may be accompanied by pain. For patients nearing the end of life, most fear that their final days will be spent living with the terrible effects of the disease, the most important of which is pain. Despite this, there is far less systematic research on the mechanisms of cancer-related pain or on the development of new agents to reduce or eliminate pain in cancer patients compared with research to combat the disease itself. Further, even when the focus of research is treatment of the tumor, the effects of anticancer treatments on pain are often underreported in publications and other forums. To illustrate the relative drought in the cancer pain control area, there have been no new drugs approved for cancer-related pain in recent years. A number of methodologic and logistical challenges that hinder the ability to assess pain response in clinical trials are discussed in this article. Possible ways to address these challenges are also discussed. PMID:22046026

  9. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for

  10. Reiki as a clinical intervention in oncology nursing practice.

    Science.gov (United States)

    Bossi, Larraine M; Ott, Mary Jane; DeCristofaro, Susan

    2008-06-01

    Oncology nurses and their patients are frequently on the cutting edge of new therapies and interventions that support coping, health, and healing. Reiki is a practice that is requested with increasing frequency, is easy to learn, does not require expensive equipment, and in preliminary research, elicits a relaxation response and helps patients to feel more peaceful and experience less pain. Those who practice Reiki report that it supports them in self-care and a healthy lifestyle. This article will describe the process of Reiki, review current literature, present vignettes of patient responses to the intervention, and make recommendations for future study. PMID:18515247

  11. Clinical exercise interventions in pediatric oncology: a systematic review.

    Science.gov (United States)

    Baumann, Freerk T; Bloch, Wilhelm; Beulertz, Julia

    2013-10-01

    Studies in pediatric oncology have shown a positive effect of physical activity on disease- and treatment-related side effects. Although several reviews have approved the benefits of therapeutic exercise for adult cancer patients, no systematic review exists summarizing the evidence of physical activity in pediatric oncology. We identified a total of 17 studies using the PubMed database and Cochrane library. To evaluate the evidence, we used the evaluation system of the Oxford Center for Evidence-Based Medicine 2001. The findings confirm that clinical exercise interventions are feasible and safe, especially with acute lymphoblastic leukemia (ALL) patients and during medical treatment. No adverse effects have been reported. Positive effects were found on fatigue, strength, and quality of life. Single studies present positive effects on the immune system, body composition, sleep, activity levels, and various aspects of physical functioning. Child-specific aspects such as cognitive abilities, growth, adolescence, and reintegration into peer-groups, school, and sports have barely been taken into consideration. The evidence for exercise interventions in pediatric oncology is rated level "3." Although the results are very promising, future research of high methodological quality and focusing on child-specific aspects is needed to establish evidence-based exercise recommendations, particularly for childhood cancer patients. PMID:23857296

  12. Role of French teams in the development of clinical and translational research in radiation oncology

    International Nuclear Information System (INIS)

    Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment. (authors)

  13. New evidence-based adaptive clinical trial methods for optimally integrating predictive biomarkers into oncology clinical development programs

    Institute of Scientific and Technical Information of China (English)

    Robert A.Beckman; Cong Chen

    2013-01-01

    Predictive biomarkers are important to the future of oncology; they can be used to identify patient populations who will benefit from therapy,increase the value of cancer medicines,and decrease the size and cost of clinical trials while increasing their chance of success.But predictive biomarkers do not always work.When unsuccessful,they add cost,complexity,and time to drug development.This perspective describes phases 2 and 3 development methods that efficiently and adaptively check the ability of a biomarker to predict clinical outcomes.In the end,the biomarker is emphasized to the extent that it can actually predict.

  14. Clinical Positioning Space: Residents' Clinical Experiences in the Outpatient Oncology Clinic.

    Science.gov (United States)

    Williams, Lars H; Christensen, Mette K; Rytter, Carsten; Musaeus, Peter

    2015-09-01

    In this article, we present a case study of residents' clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents' social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients' and nurses' storylines about who should take responsibility for treatment. PMID:25288406

  15. Next-Generation Sequencing in Clinical Oncology: Next Steps Towards Clinical Validation

    Directory of Open Access Journals (Sweden)

    Nigel C. Bennett

    2014-11-01

    Full Text Available Compelling evidence supports the transition of next generation sequencing (NGS technology from a research environment into clinical practice. Before NGS technologies are fully adopted in the clinic, they should be thoroughly scrutinised for their potential as powerful diagnostic and prognostic tools. The importance placed on generating accurate NGS data, and consequently appropriate clinical interpretation, has stimulated much international discussion regarding the creation and implementation of strict guidelines and regulations for NGS clinical use. In the context of clinical oncology, NGS technologies are currently transitioning from a clinical research background into a setting where they will contribute significantly to individual patient cancer management. This paper explores the steps that have been taken, and those still required, for the transition of NGS into the clinical area, with particular emphasis placed on validation in the setting of clinical oncology.

  16. NEURO-ONCOLOGIC PHYSICAL THERAPY FOR THE OLDER PERSON

    OpenAIRE

    Ching, Willie; Luhmann, Melissa

    2011-01-01

    Due to the uncertainty of the course of diagnoses, patients with neuro-oncological malignancies present challenges to the physical therapist. At times, the presentation of impairments and disabilities of these patients with neuro-oncological diagnoses do not necessarily coincide with the involved area of the brain or spinal cord. It is our intention to provide guidance to the physical therapist who will be working with these patients with neuro-oncological diagnoses, in hopes that their encou...

  17. Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas

    Energy Technology Data Exchange (ETDEWEB)

    Gay, Hiram A., E-mail: hgay@radonc.wustl.edu [Washington University School of Medicine, St Louis, MO (United States); Barthold, H. Joseph [Commonwealth Hematology and Oncology, Weymouth, MA (United States); Beth Israel Deaconess Medical Center, Boston, MA (Israel); O' Meara, Elizabeth [Radiation Therapy Oncology Group, Philadelphia, PA (United States); Bosch, Walter R. [Washington University School of Medicine, St Louis, MO (United States); El Naqa, Issam [Department of Radiation Oncology, McGill University Health Center, Montreal, Quebec (Canada); Al-Lozi, Rawan [Washington University School of Medicine, St Louis, MO (United States); Rosenthal, Seth A. [Radiation Oncology Centers, Radiological Associates of Sacramento, Sacramento, CA (United States); Lawton, Colleen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Lee, W. Robert [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Sandler, Howard [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Zietman, Anthony [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Myerson, Robert [Washington University School of Medicine, St Louis, MO (United States); Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Willett, Christopher [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Kachnic, Lisa A. [Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA (United States); Jhingran, Anuja [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Portelance, Lorraine [University of Miami, Miami, FL (United States); Ryu, Janice [Radiation Oncology Centers, Radiological Associates of Sacramento, Sacramento, CA (United States); and others

    2012-07-01

    Purpose: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa{sub R}, Adnexa{sub L}, Prostate, SeminalVesc, PenileBulb, Femur{sub R}, and Femur{sub L}. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.

  18. Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas

    International Nuclear Information System (INIS)

    Purpose: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, AdnexaR, AdnexaL, Prostate, SeminalVesc, PenileBulb, FemurR, and FemurL. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.

  19. PROCESSES FOR QUALITY IMPROVEMENTS IN RADIATION ONCOLOGY CLINICAL TRIALS

    OpenAIRE

    FitzGerald, TJ; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Giulia Cicchetti, M.; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

    2008-01-01

    Quality assurance in radiation therapy has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials data acquisition was non-uniform and inconsistent; computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of radiation therapy, ev...

  20. Functional imaging in oncology. Clinical applications. Vol. 2

    Energy Technology Data Exchange (ETDEWEB)

    Luna, Antonio [Case Western Reserve Univ., Cleveland, OH (United States). Dept. of Radiology; MRI Health Time Group, Jaen (Spain); Vilanova, Joan C. [Girona Univ. (Spain). Clinica Girona - Hospital Sta. Caterina; Hygino da Cruz, L. Celso Jr. (ed.) [CDPI and IRM, Rio de Janeiro (Brazil). Dept. of Radiology; Rossi, Santiago E. [Centro de Diagnostico, Buenos Aires (Argentina)

    2014-06-01

    Easy-to-read manual on new functional imaging techniques in oncology. Explains current clinical applications and outlines future avenues. Includes numerous high-quality illustrations to highlight the major teaching points. In the new era of functional and molecular imaging, both currently available imaging biomarkers and biomarkers under development are expected to lead to major changes in the management of oncological patients. This two-volume book is a practical manual on the various imaging techniques capable of delivering functional information on cancer, including diffusion MRI, perfusion CT and MRI, dual-energy CT, spectroscopy, dynamic contrast-enhanced ultrasonography, PET, and hybrid modalities. This second volume considers the applications and benefits of these techniques in a wide range of tumor types, including their role in diagnosis, prediction of treatment outcome, and early evaluation of treatment response. Each chapter addresses a specific malignancy and is written by one or more acclaimed experts. The lucid text is complemented by numerous high-quality illustrations that highlight key features and major teaching points.

  1. Functional imaging in oncology. Clinical applications. Vol. 2

    International Nuclear Information System (INIS)

    Easy-to-read manual on new functional imaging techniques in oncology. Explains current clinical applications and outlines future avenues. Includes numerous high-quality illustrations to highlight the major teaching points. In the new era of functional and molecular imaging, both currently available imaging biomarkers and biomarkers under development are expected to lead to major changes in the management of oncological patients. This two-volume book is a practical manual on the various imaging techniques capable of delivering functional information on cancer, including diffusion MRI, perfusion CT and MRI, dual-energy CT, spectroscopy, dynamic contrast-enhanced ultrasonography, PET, and hybrid modalities. This second volume considers the applications and benefits of these techniques in a wide range of tumor types, including their role in diagnosis, prediction of treatment outcome, and early evaluation of treatment response. Each chapter addresses a specific malignancy and is written by one or more acclaimed experts. The lucid text is complemented by numerous high-quality illustrations that highlight key features and major teaching points.

  2. Radiation oncology

    International Nuclear Information System (INIS)

    The Radiation Oncology Division has had as its main objectives both to operate an academic training program and to carry out research on radiation therapy of cancer. Since fiscal year 1975, following a directive from ERDA, increased effort has been given to research. The research activities have been complemented by the training program, which has been oriented toward producing radiation oncologists, giving physicians short-term experience in radiation oncology, and teaching medical students about clinical cancer and its radiation therapy. The purpose of the research effort is to improve present modalities of radiation therapy of cancer. As in previous years, the Division has operated as the Radiation Oncology Program of the Department of Radiological Sciences of the University of Puerto Rico School of Medicine. It has provided radiation oncology support to patients at the University Hospital and to academic programs of the University of Puerto Rico Medical Sciences Campus. The patients, in turn, have provided the clinical basis for the educational and research projects of the Division. Funding has been primarily from PRNC (approx. 40%) and from National Cancer Institute grants channeled through the School of Medicine (approx. 60%). Special inter-institutional relationships with the San Juan Veterans Administration Hospital and the Metropolitan Hospital in San Juan have permitted inclusion of patients from these institutions in the Division's research projects. Medical physics and radiotherapy consultations have been provided to the Radiotherapy Department of the VA Hospital

  3. Phase 0 clinical trials in oncology new drug development

    Directory of Open Access Journals (Sweden)

    Umesh Chandra Gupta

    2011-01-01

    Full Text Available Research focus of pharmaceutical industry has expanded to a larger extent in last few decades putting many more new molecules, particularly targeted agents, for the clinical development. On the other hand, researchers are facing serious challenges due to high failure rates of new molecules in clinical studies. The United States Food and Drug Administration (FDA in combination with academia and industry experts identified many factors responsible for failures of new molecules, and with a vision of taking traditional drug development model toward an innovative paradigm shift, issued regulatory guidance on conduct of exploratory investigational new drug (exploratory IND studies, often called as phase 0 clinical trials, requiring reduced preclinical testing, which has special relevance to life-threatening diseases such as cancer. Phase 0 trials, utilizing much lower drug doses, provide an opportunity to explore the clinical behavior of new molecules very early in the drug development pathway, helping to identify the promising candidates and eliminating non-promising molecules, thus improving the efficiency of overall drug development with significant savings of resources. Being non-therapeutic in nature, these studies, however, pose certain ethical challenges requiring careful study designing and informed consent process. This article reviews the insights and perspectives for the feasibility, utility, planning, designing and conduct of phase 0 clinical trials, in addition to ethical issues and industrial perspective focused at oncology new drug development.

  4. Toward a Broader Role for Occupational Therapy in Supportive Oncology Care.

    Science.gov (United States)

    Sleight, Alix G; Duker, Leah I Stein

    2016-01-01

    Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. PMID:27295001

  5. Clinical PET/CT Atlas: A Casebook of Imaging in Oncology

    International Nuclear Information System (INIS)

    Integrated positron emission tomography/computed tomography (PET/CT) has evolved since its introduction into the commercial market more than a decade ago. It is now a key procedure, particularly in oncological imaging. Over the last years in routine clinical service, PET/CT has had a significant impact on diagnosis, treatment planning, staging, therapy, and monitoring of treatment response and has therefore played an important role in the care of cancer patients. The high sensitivity from the PET component and the specificity of the CT component give this hybrid imaging modality the unique characteristics that make PET/CT, even after over 10 years of clinical use, one of the fastest growing imaging modalities worldwide. This publication combines over 90 comprehensive cases covering all major indications of fluorodeoxyglucose (18F-FDG)-PET/CT as well as some cases of clinically relevant special tracers. The cases provide an overview of what the specific disease can look like in PET/CT, the typical pattern of the disease’s spread as well as likely pitfalls and teaching points. This PET/CT Atlas will allow professionals interested in PET/CT imaging to embrace the variety of oncological imaging by providing clinically relevant teaching files on the effectiveness and diagnostic quality of FDG-PET/CT imaging in routine applications

  6. Increasing Minority Enrollment Onto Clinical Trials: Practical Strategies and Challenges Emerge From the NRG Oncology Accrual Workshop.

    Science.gov (United States)

    Brooks, Sandra E; Muller, Carolyn Y; Robinson, William; Walker, Eleanor M; Yeager, Kate; Cook, Elise D; Friedman, Sue; Somkin, Carol P; Brown, Carol Leslie; McCaskill-Stevens, Worta

    2015-11-01

    Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery. PMID:26464496

  7. PET-Based Personalized Management in Clinical Oncology: An Unavoidable Path for the Foreseeable Future.

    Science.gov (United States)

    Basu, Sandip; Alavi, Abass

    2016-07-01

    It is imperative that the thrust of clinical practice in the ensuing years would be to develop personalized management model for various disorders. PET-computed tomography (PET-CT) based molecular functional imaging has been increasingly utilized for assessment of tumor and other nonmalignant disorders and has the ability to explore disease phenotype on an individual basis and address critical clinical decision making questions related to practice of personalized medicine. Hence, it is essential to make a concerted systematic effort to explore and define the appropriate place of PET-CT in personalized clinical practice in each of malignancies, which would strengthen the concept further. The potential advantages of PET based disease management can be classified into broad categories: (1) Traditional: which includes assessment of disease extent such as initial disease staging and restaging, treatment response evaluation particularly early in the course and thus PET-CT response adaptive decision for continuing the same regimen or switching to salvage schedules; there has been continuous addition of newer application of PET based disease restaging in oncological parlance (eg, Richter transformation); (2) Recent and emerging developments: this includes exploring tumor biology with FDG and non-FDG PET tracers. The potential of multitracer PET imaging (particularly new and novel tracers, eg, 68Ga-DOTA-TOC/NOC/TATE in NET, 68Ga-PSMA and 18F-fluorocholine in prostate carcinoma, 18F-fluoroestradiol in breast carcinoma) has provided a scientific basis to stratify and select appropriate targeted therapies (both radionuclide and nonradionuclide treatment), a major boost for individualized disease management in clinical oncology. Integrating the molecular level information obtained from PET with structural imaging further individualizing treatment plan in radiation oncology, precision of interventions and biopsies of a particular lesion and forecasting disease prognosis. PMID

  8. Old but new methods in radiation oncology. Hyperbaric oxygen therapy

    International Nuclear Information System (INIS)

    The presence of hypoxic tumor cells is widely regarded as one of the main reasons behind the failure to control malignant tumors with radiotherapy treatments. Since hyperbaric oxygenation (HBO) improves the oxygen supply to the hypoxic tumor cells, HBO therapy has previously been used in combination with simultaneous radiotherapy to treat malignant tumors. In some clinical trials, significant improvements in local control and survival have been seen in cancers of the head and neck and the uterine cervix. However, the delivery of simultaneous HBO therapy and radiotherapy is both complex and time-consuming, with some trials reporting increased side effects. As a result, the regimen of HBO therapy in combination with simultaneous radiotherapy has yet to be used as a standard treatment for malignant tumors. In recent years, however, radiotherapy immediately after HBO therapy has been emerging as an attractive approach for overcoming hypoxia in cancer treatment. Several studies have reported that radiotherapy immediately after HBO therapy was safe and seemed to be effective in patients with high-grade gliomas. Also, this approach may protect normal tissues from radiation injury. To accurately estimate whether the delivery of radiotherapy immediately after HBO therapy can be beneficial in patients with high-grade gliomas and other cancers, further prospective studies are warranted. (author)

  9. Economic analysis of a phase III clinical trial evaluating the addition of total androgen suppression to radiation versus radiation alone for locally advanced prostate cancer (Radiation Therapy Oncology Group protocol 86-10)

    International Nuclear Information System (INIS)

    Purpose: To evaluate the cost-effectiveness of adding hormone therapy to radiation for patients with locally advanced prostate cancer, using a Monte Carlo simulation of a Markov Model. Methods and Materials: Radiation Therapy Oncology Group (RTOG) protocol 86-10 randomized patients to receive radiation therapy (RT) alone or RT plus total androgen suppression (RTHormones) 2 months before and during RT for the treatment of locally advanced prostate cancer. A Markov model was designed with Data Pro (TreeAge Software, Williamstown, MA). The analysis took a payer's perspective. Transition probabilities from one state of health (i.e., with no disease progression or with hormone-responsive metastatic disease) to another were calculated from published rates pertaining to RTOG 86-10. Patients remained in one state of health for 1 year. Utility values for each health state and treatment were obtained from the literature. Distributions were sampled at random from the treatment utilities according to a second-order Monte Carlo simulation technique. Results: The mean expected cost for the RT-only treatments was $29,240 (range, $29,138-$29,403). The mean effectiveness for the RT-only treatment was 5.48 quality-adjusted life years (QALYs) (range, 5.47-5.50). The mean expected cost for RTHormones was $31,286 (range, $31,058-$31,555). The mean effectiveness was 6.43 QALYs (range, 6.42-6.44). Incremental cost-effectiveness analysis showed RTHormones to be within the range of cost-effectiveness at $2,153/QALY. Cost-effectiveness acceptability curve analysis resulted in a >80% probability that RTHormones is cost-effective. Conclusions: Our analysis shows that adding hormonal treatment to RT improves health outcomes at a cost that is within the acceptable cost-effectiveness range

  10. Minimal-invasive core needle biopsy of head and neck malignancies: Clinical evaluation for radiation oncology

    International Nuclear Information System (INIS)

    Background and purpose: Neck masses are common presentations of cancer and require tissue sampling to establish a diagnosis prior to the institution of adequate therapy. The purpose of this study was to evaluate the specific use and potential advantages of core needle biopsy (CNB) for radiation oncology in the head and neck. Materials and methods: We performed a retrospective analysis of 346 CNB procedures implemented in 165 patients with cervicofacial masses over a period of 56 months. Seventy-three patients had a history of malignancy, 43 had previously received radiation. Results: High-quality tissue cores were obtained from all patients. The target lesion was correctly sampled in 92.1% of patients. Final diagnosis was malignant in 115 patients, of whom 78 received radiotherapy. One biopsy result was false-negative. CNB was equally successful in the pre-irradiated patients and enabled institution of therapy in 92.3% of lymphoma patients. Conclusions: CNB is an efficient tool for tissue sampling of head and neck masses. The potential advantages of CNB for radiation oncology over fine needle aspiration and open surgical biopsy are discussed. CNB enables clinicians to make optimal therapeutic strategies and facilitates prompt referral to the relevant clinical team, both at initial presentation and during follow-up

  11. Effects of Age Expectations on Oncology Social Workers' Clinical Judgment

    Science.gov (United States)

    Conlon, Annemarie; Choi, Namkee G.

    2014-01-01

    Objective: This study examined the influence of oncology social workers' expectations regarding aging (ERA) and ERA with cancer (ERAC) on their clinical judgment. Methods: Oncology social workers (N = 322) were randomly assigned to one of four vignettes describing a patient with lung cancer. The vignettes were identical except for the…

  12. Relationship Between Mood Disturbance and Sleep Quality in Oncology Outpatients at the Initiation of Radiation Therapy

    Science.gov (United States)

    Van Onselen, Christina; Dunn, Laura B.; Lee, Kathryn; Dodd, Marylin; Koetters, Theresa; West, Claudia; Paul, Steven M.; Aouizerat, Bradley E.; Wara, William; Swift, Patrick; Miaskowski, Christine

    2010-01-01

    Purpose of the research The purpose of this study was to describe the occurrence of significant mood disturbance and evaluate for differences in sleep quality among four mood groups (i.e., neither anxiety nor depression, only anxiety, only depression, anxiety and depression) prior to the initiation of radiation therapy (RT). Methods and sample Patients (n=179) with breast, prostate, lung, and brain cancer were evaluated prior to the initiation of RT using the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale, and the Spielberger State Anxiety Inventory. Differences in sleep disturbance among the four mood groups were evaluated using analyses of variance. Key results While 38% of the patients reported some type of mood disturbance, 57% of the patients reported sleep disturbance. Patients with clinically significant levels of anxiety and depression reported the highest levels of sleep disturbance. Conclusions Overall, oncology patients with mood disturbances reported more sleep disturbance than those without mood disturbance. Findings suggest that oncology patients need to be assessed for mood and sleep disturbances. PMID:20080444

  13. A national radiation oncology medical student clerkship survey: Didactic curricular components increase confidence in clinical competency

    Science.gov (United States)

    Jagadeesan, Vikrant S.; Raleigh, David R.; Koshy, Matthew; Howard, Andrew R.; Chmura, Steven J.; Golden, Daniel W.

    2014-01-01

    Purpose/Objectives Students applying to radiation oncology residency programs complete one or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first year radiation oncology resident are evaluated. Methods and Materials An anonymous, internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012–2013 academic year. The survey was composed of three main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results The survey response rate was 37% (70/188). Respondents reported 191 unique clerkship experiences. 27% of respondents (19/70) completed at least one clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent’s confidence to function as a first- year radiation oncology resident (Wilcoxon rank-sum p = 0.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman’s rho p = 0.48) or confidence to function as a first year resident (Spearman’s rho p = 0.43). Conclusions Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation

  14. A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency

    International Nuclear Information System (INIS)

    Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results

  15. Application of next-generation sequencing in clinical oncology to advance personalized treatment of cancer

    Institute of Scientific and Technical Information of China (English)

    Yan-Fang Guan; Gai-Rui Li; Rong-Jiao Wang; Yu-Ting Yi; Ling Yang; Dan Jiang; Xiao-Ping Zhang; Yin Peng

    2012-01-01

    With the development and improvement of new sequencing technology,next-generation sequencing (NGS) has been applied increasingly in cancer genomics research over the past decade.More recently,NGS has been adopted in clinical oncology to advance personalized treatment of cancer.NGS is used to identify novel and rare cancer mutations,detect familial cancer mutation carriers,and provide molecular rationale for appropriate targeted therapy.Compared to traditional sequencing,NGS holds many advantages,such as the ability to fully sequence all types of mutations for a large number of genes (hundreds to thousands) in a single test at a relatively low cost.However,significant challenges,particularly with respect to the requirement for simpler assays,more flexible throughput,shorter turnaround time,and most importantly,easier data analysis and interpretation,will have to be overcome to translate NGS to the bedside of cancer patients.Overall,continuous dedication to apply NGS in clinical oncology practice will enable us to be one step closer to personalized medicine.

  16. Vitamin-B12 deficiency following therapy in gynecologic oncology

    International Nuclear Information System (INIS)

    Vitamin-B12 deficiency results from inadequate absorption of the vitamin by the distal ileum and depletion of available stores. Both radiotherapy and intestinal resection can contribute to development of this condition. The significance of this problem in gynecologic oncology is discussed and two patients are described

  17. Intensive therapy in combined and multimodality treatment of oncologic patients

    International Nuclear Information System (INIS)

    Consideration is given to the factors, occurred in various combinations, which create conditions for development of critical states at any stage of combined and multimodality treatment (radiotherapy, chemotherapy and operative intervention). It is shown that intensive thermapy is aimed at prevention and removal of critical state syndromes in oncologic patients (hypovolemia, distortions of blood rheology, acute respiratory and cardiovascular insufficiency etc)

  18. Who Enrolls Onto Clinical Oncology Trials? A Radiation Patterns of Care Study Analysis

    International Nuclear Information System (INIS)

    Purpose: To identify factors significantly influencing accrual to clinical protocols by analyzing radiation Patterns of Care Study (PCS) surveys of 3,047 randomly selected radiotherapy (RT) patients. Methods and Materials: Patterns of Care Study surveys from disease sites studied for the periods 1992-1994 and 1996-1999 (breast cancer, n = 1,080; prostate cancer, n = 1,149; esophageal cancer, n = 818) were analyzed. The PCS is a National Cancer Institute-funded national survey of randomly selected RT institutions in the United States. Patients with nonmetastatic disease who received RT as definitive or adjuvant therapy were randomly selected from eligible patients at each institution. To determine national estimates, individual patient records were weighted by the relative contribution of each institution and patients within each institution. Data regarding participation in clinical trials were recorded. The factors age, gender, race, type of insurance, and practice type of treating institution (academic or not) were studied by univariate and multivariate analyses. Results: Overall, only 2.7% of all patients were accrued to clinical protocols. Of these, 57% were enrolled on institutional review board-approved institutional trials, and 43% on National Cancer Institute collaborative group studies. On multivariate analysis, patients treated at academic facilities (p = 0.0001) and white patients (vs. African Americans, p = 0.0002) were significantly more likely to participate in clinical oncology trials. Age, gender, type of cancer, and type of insurance were not predictive. Conclusions: Practice type and race significantly influence enrollment onto clinical oncology trials. This suggests that increased communication and education regarding protocols, particularly focusing on physicians in nonacademic settings and minority patients, will be essential to enhance accrual

  19. Individualization of anticancer therapy; molecular targets of novel drugs in oncology

    Directory of Open Access Journals (Sweden)

    Katarzyna Regulska

    2012-11-01

    Full Text Available Deregulation of cellular signal transduction, caused by gene mutations, has been recognized as a basic factor of cancer initiation, promotion and progression. Thus, the ability to control the activity of overstimulated signal molecules by the use of appropriate inhibitors became the idea of targeted cancer therapy, which has provided an effective tool to normalize the molecular disorders in malignant cells and to treat certain types of cancer. The molecularly targeted drugs are divided into two major pharmaceutical classes: monoclonal antibodies and small-molecule kinase inhibitors. This review presents a summary of their characteristics, analyzing their chemical structures, specified molecular targets, mechanisms of action and indications for use. Also the molecules subjected to preclinical trials or phase I, II and III clinical trials evaluating their efficiency and safety are presented. Moreover, the article discusses further perspectives for development of targeted therapies focusing on three major directions: systematic searching and discovery of new targets that are oncogenic drivers, improving the pharmacological properties of currently known drugs, and developing strategies to overcome drug resistance. Finally, the role of proper pharmacodiagnostics as a key to rational anticancer therapy has been emphasized since the verification of reliable predictive biomarkers is a basis of individualized medicine in oncology

  20. [Evidence and recommendations for oncologic clinical exercise - a personalized treatment concept for cancer patients].

    Science.gov (United States)

    Baumann, Freerk Theeagnus; Hallek, Michael; Meyer, Janika; Galvão, Daniel Abido; Bloch, Wilhelm; Elter, Thomas

    2015-09-01

    Oncological treatments can lead to acute and chronic cancer related toxicities. In recent years, a large number of clinical studies have reported positive effects of exercise to the bio-psycho-social regeneration of cancer patients. However, very few evidence-based programs have been implemented into practice with little opportunity for cancer patients to engage in such programs. Reviews and RCT studies on exercise and cancer are showing that specific exercise programs have a positive impact on fatigue syndrome, urinary incontinence, lymphedema, polyneuropathy, arthralgia, and androgen deprivation related toxicities. With the increasing evidence for exercise oncology interventions, recommendations arising from clinical trials should be translated into clinical practice and this should be viewed as an important next step in this fast moving field of exercise oncology. For that the personalized treatment concept "Oncologic clinical exercise" (OTT) was developed. PMID:26402184

  1. Contribution for Invitation for The Chinese-German Journal of Clinical Oncology

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    The Chinese-German Journal of Clinical Oncology isan international, professional, academic periodical on on-cology, co-edited by China and Germany. With the au-thors from around the world, especially from China, thejournal focuses on introducing clinical experience in diag-nosis and treatment and leading scientific research a-chievement in the tumor domain, in addition to reportingbasic theory research which help to teach the clinicalpractice of oncology and closely connect with the disci-pline. All manuscripts are published in English: the jour-nal is issued quarterly, with the International SerialStandard Number (ISSN) 1610-1979/CN/42-1654/R.

  2. An exploration of oncology specialist nurses’ roles in nurse-led chemotherapy clinics

    OpenAIRE

    Farrell, Carole Denise

    2014-01-01

    The purpose of this study was to investigate nurses’ roles within nurse-led chemotherapy clinics. There has been a rapid expansion and development of nursing roles and responsibilities in oncology, but little understanding of how roles are enacted and their impact on patient experiences and outcomes. This was a two stage approach comprising a survey of UK oncology specialist nurses followed by an ethnographic study of nurses’ roles in nurse led chemotherapy clinics. Ethics approval was obtain...

  3. Lack of timely accrual information in oncology clinical trials: a cross-sectional analysis

    OpenAIRE

    Mitchell, Aaron P.; Bradford R Hirsch; Abernethy, Amy P

    2014-01-01

    Background Poor accrual is a significant barrier to the successful completion of oncology clinical trials; half of all phase 3 oncology trials close due to insufficient accrual. Timely access to accrual data fosters an understanding of successful trial design and can be used to inform the design of new clinical trials prospectively. Accrual statistics are available within research networks, such as the cancer cooperative groups, but comprehensive data reflecting the overall portfolio of cance...

  4. Adjuvant and Salvage Radiation Therapy After Prostatectomy: American Society for Radiation Oncology/American Urological Association Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Valicenti, Richard K., E-mail: Richard.valicenti@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California, Davis School of Medicine, Davis, California (United States); Thompson, Ian [Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas (United States); Albertsen, Peter [Division of Urology, University of Connecticut Health Center, Farmington, Connecticut (United States); Davis, Brian J. [Department of Radiation Oncology, Mayo Medical School, Rochester, Minnesota (United States); Goldenberg, S. Larry [Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia (Canada); Wolf, J. Stuart [Department of Urology, University of Michigan, Ann Arbor, Michigan (United States); Sartor, Oliver [Department of Medicine and Urology, Tulane Medical School, New Orleans, Louisiana (United States); Klein, Eric [Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, Ohio (United States); Hahn, Carol [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Michalski, Jeff [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Roach, Mack [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Faraday, Martha M. [Four Oaks, Inc (United States)

    2013-08-01

    Purpose: The purpose of this guideline was to provide a clinical framework for the use of radiation therapy after radical prostatectomy as adjuvant or salvage therapy. Methods and Materials: A systematic literature review using PubMed, Embase, and Cochrane database was conducted to identify peer-reviewed publications relevant to the use of radiation therapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. Results: Guideline statements are provided for patient counseling, use of radiation therapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a restaging evaluation. Conclusions: Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invastion, positive surgical margins, extraprostatic extension) and salvage radiation therapy to patients with prostate-specific antigen (PSA) or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiation therapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiation therapy as well as the potential benefits of preventing recurrence. The decision to administer radiation therapy should be made by the patient and the multidisciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. The American Society for Radiation Oncology and American Urological Association websites show this guideline in its entirety, including the full literature review.

  5. Adjuvant and Salvage Radiation Therapy After Prostatectomy: American Society for Radiation Oncology/American Urological Association Guidelines

    International Nuclear Information System (INIS)

    Purpose: The purpose of this guideline was to provide a clinical framework for the use of radiation therapy after radical prostatectomy as adjuvant or salvage therapy. Methods and Materials: A systematic literature review using PubMed, Embase, and Cochrane database was conducted to identify peer-reviewed publications relevant to the use of radiation therapy after prostatectomy. The review yielded 294 articles; these publications were used to create the evidence-based guideline statements. Additional guidance is provided as Clinical Principles when insufficient evidence existed. Results: Guideline statements are provided for patient counseling, use of radiation therapy in the adjuvant and salvage contexts, defining biochemical recurrence, and conducting a restaging evaluation. Conclusions: Physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at prostatectomy (ie, seminal vesicle invastion, positive surgical margins, extraprostatic extension) and salvage radiation therapy to patients with prostate-specific antigen (PSA) or local recurrence after prostatectomy in whom there is no evidence of distant metastatic disease. The offer of radiation therapy should be made in the context of a thoughtful discussion of possible short- and long-term side effects of radiation therapy as well as the potential benefits of preventing recurrence. The decision to administer radiation therapy should be made by the patient and the multidisciplinary treatment team with full consideration of the patient's history, values, preferences, quality of life, and functional status. The American Society for Radiation Oncology and American Urological Association websites show this guideline in its entirety, including the full literature review

  6. The evolving role of radiation therapy in paediatric oncology, Philadelphia, USA, 19-21 January 1995

    International Nuclear Information System (INIS)

    A summary of a conference reviewing recent developments and changes in the use of radiation therapy in paediatric oncology is reported. Although the use of radiation therapy has resulted in improved cure rates, the long-term complications of radiation in a paediatric population are recognised. More intensive systemic therapy and the increasing availability of prognostic data, including biological markers to tailor therapy to the individual patient, has resulted in a more selective use of radiation therapy. Changes in the management of specific tumour types are discussed

  7. Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy

    Directory of Open Access Journals (Sweden)

    Inchingolo Francesco

    2012-12-01

    Full Text Available Abstract Introduction Grafting of autologous adipose tissue can be recommended in some cases of facial plastic surgery. Rhabdomyosarcoma is a type of cancer that can also affect the orbit. Enucleation of the eye can cause atrophy of the corresponding hemiface and decreased orbital growth. Case report We report a case of a female patient with a medical history of surgical enucleation of the right eyeball, who had received rhabdomyosarcoma radiation therapy in her youth. The patient presented with a depression in the right zygomatic region. We took a dermal-fat flap from the abdominal region, which had been previously treated. Results The surgical outcome, 48 hours, and much clearly 31 days after the surgery, revealed that the right zygomatic region had returned to its proper anatomical shape, although there were still signs of postoperative edema. Discussion Very damaged tissues, like those exposed to radiation therapy, are generally not suitable for grafting of adipose tissue. Conclusions In the described case, we achieved a technically and aesthetically satisfying result despite the patient's medical history involving several perplexities about the use of autologous dermal-fat tissues, because of prior radiation therapy exposure. The clinical case shows that even a region exposed to radiation therapy can be a valid receiving bed for dermal-fat grafting.

  8. Measurement of nurses' workload in an oncology outpatient clinic

    Directory of Open Access Journals (Sweden)

    Célia Alves de Souza

    2014-02-01

    Full Text Available The growing demand and the degree of patient care in oncological outpatient services, as well as the complexity of treatment have had an impact on the workload of nurses. This study aimed at measuring the workload and productivity of nurses in an oncological outpatient service. An observational study using a work sampling technique was conducted and included seven nurses working in an oncological outpatient service in the south-eastern region of Brazil. A total of 1,487 intervention or activity samples were obtained. Nurses used 43.2% of their time on indirect care, 33.2% on direct care, 11.6% on associated activities, and 12% on personal activities. Their mean productivity was 88.0%. The findings showed that nurses in this service spend most of their time in indirect care activities. Moreover, the productivity index in this study was above that recommended in the literature.

  9. Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    International Nuclear Information System (INIS)

    Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT

  10. Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Yahalom, Joachim, E-mail: yahalomj@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Li, Ye-Xiong [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Tsang, Richard [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

    2015-05-01

    Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT.

  11. Endoscopic laser therapy of erosive-ulcerous and inflammatory damages of patients in oncological hospital

    Science.gov (United States)

    Efimov, Oleg N.; Kuvshinov, Yu. P.; Poddubny, Boris K.; Kartasheva, E. O.; Ungiadze, G. V.; Ponomarev, Igor V.; Mazurov, S. T.

    1996-01-01

    The results of laser therapy present in 374 patients with erosive-ulcerous and inflammatory damages of respiratory organs and of gastro-intestinal tract after oncological operations. Two types of laser namely endoscopic laser on the basis of He-Ne and Cu laser were used as sources of radiation. It was shown high therapeutic effectiveness of laser therapy. This method may be recommended for the above-mentioned category of the patients.

  12. Project reconversion Service Hospital Radiation Oncology Clinics-Medical School

    International Nuclear Information System (INIS)

    Introduction: The Health Sector operates within the framework of Social Policy and it is therefore one of the ways of distribution of public benefit, like Housing, Education and Social Security. While public spending on health has grown in recent years, its distribution has been uneven and the sector faces funding and management problems. The Service Hospital Radiation Oncology has reduced its health care liavility , lack technological development and unsufficient human resources and training. Aim: developing an inclusive reform bill Service Hospital Radiation Oncology .Material and Methods: This project tends to form a network institutional, introducing concepts of evidence-based medicine, risk models, cost analysis, coding systems, system implementation of quality management (ISO-9000 Standards). Proposes redefining radiotherapy centers and their potential participation in training resource development goals humanos.Promueve scientific research of national interest. Separate strictly administrative function, management and teaching. The project takes into account the characteristics of demand, the need to order it and organize around her, institutional network system and within the Hospital das Clinicas own related services related to Service Hospital Radiation Oncology , Encourages freedom of choice, and confers greater equity in care. The project would managed by the Hospital Clínicas. Conclusions: We believe this proposal identifies problems and opportunities, Service Hospital Radiation Oncology proposes the development of institutional network under one management model

  13. Clinical Training of Medical Physicists Specializing in Radiation Oncology (French Ed.)

    International Nuclear Information System (INIS)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  14. Clinical Training of Medical Physicists Specializing in Radiation Oncology (Spanish Ed.)

    International Nuclear Information System (INIS)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  15. Clinical Training of Medical Physicists Specializing in Radiation Oncology (Russian Ed.)

    International Nuclear Information System (INIS)

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasing technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for radiation therapy. There is a general and growing awareness that radiation medicine is increasingly dependant on well trained medical physicists that are based in the clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase academic educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognised by the members of the Regional Cooperative Agreement (RCA) for research, development and training related to nuclear sciences for Asia and the Pacific. Consequently a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in the Asia Pacific region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in radiation therapy was started in 2005 with the appointment of a core drafting committee of regional and international experts. Since 2005 the IAEA has convened two additional consultant group meetings including additional experts to prepare the present publication. The publication drew heavily, particularly in the initial stages, from the experience and documents of the Clinical Training Programme for Radiation Oncology Medical Physicists as developed by the Australasian College of Physical Scientists and Engineers in Medicine. Their

  16. Feasibility of Economic Analysis of Radiation Therapy Oncology Group (RTOG) 91-11 Using Medicare Data

    International Nuclear Information System (INIS)

    Purpose: The specific aim of this analysis was to evaluate the feasibility of performing a cost-effectiveness analysis using Medicare data from patients treated on a randomized Phase III clinical trial. Methods and Materials: Cost data included Medicare Part A and Part B costs from all providers-inpatient, outpatient, skilled nursing facility, home health, hospice, and physicians-and were obtained from the Centers for Medicare and Medicaid Services for patients eligible for Medicare, treated on Radiation Therapy Oncology Group (RTOG) 9111 between 1992 and 1996. The 47-month expected discounted (annual discount rate of 3%) cost for each arm of the trial was calculated in 1996 dollars, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. Overall and disease-free survival was also discounted 3%/year. The analysis was performed from a payer's perspective. Incremental cost-effectiveness ratios were calculated comparing the chemotherapy arms to the radiation alone arm. Results: Of the 547 patients entered, Medicare cost data and clinical outcomes were available for 66 patients. Reasons for exclusion included no RTOG follow-up, Medicare HMO enrollment, no Medicare claims since trial entry, and trial entry after 1996. Differences existed between groups in tumor characteristics, toxicity, and survival, all which could affect resource utilization. Conclusions: Although we were able to test the methodology of economic analysis alongside a clinical trial using Medicare data, the results may be difficult to translate to the entire trial population because of non-random missing data. Methods to improve Medicare data capture and matching to clinical trial samples are required.

  17. Integrative oncology drug discovery accompanied by preclinical translational research as prerequisite for clinical development.

    Science.gov (United States)

    Hoffmann, Jens

    2014-06-01

    The molecular heterogeneity of cancer calls for individualized therapies to become the standard of care. It is now generally accepted that target-specific compounds require specific new development programs. But, even for new drugs with general mode of action (i.e., chemotherapy), tailored treatment approaches, such as specific schedules or combinations, have been shown to improve the therapeutic outcome. Therefore, the preclinical development of new therapeutic agents needs, next to the "classical pharmacodynamic studies", the implementation of integrative translational research (TR) as early as possible. New TR approaches, starting already at target identification and validation (TIV) will allow to defining the optimal patient population for clinical development, to tailor individual treatment of the tumor disease and to choose a rational basis among the manifold options for treatment combinations. We will discuss several examples from TR studies, which have initially been started to evaluate the molecular mode of action and to recognize mechanisms which can lead to resistance. Research was extended later to identify predictive response biomarkers and establish a rationale for combination with different therapies. A detailed gene expression analysis of lung cancer cells and apoptotic pathway interference studies in colon cancer cells provided insight in the molecular mechanisms of action. These new findings are correlated with results from other studies performed during the preclinical development program. We discuss pros and cons, successes and failures of our integrative preclinical development program and provide recommendations for future oncology projects. PMID:25841411

  18. Contribution Invitation of The Chinese-German Journal of Clinical Oncology

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ The Chinese-German Journal of Clinical Oncology is an international professional academic periodical on oncology, being co-edited by China and Germany. The Journal, with the authors from around world, especially from China, is dominated in introducing the clinical experience of diagnosis and treatment as well as leading scientific research achievement in the tumor domain, in addition to report basic theory researches which help instruct the clinical practice of oncology and closely connect with the discipline. All the manuscripts are published in English, quarterly issued both internal and external, 64 -80pages, big 16 opens domains, art paper in offset printing, with lay-out by international customs, unified issuing number: ISSN 1610-1979 (Paper) 1613-9089 (Online)/CN 42-1654/R.

  19. Clinical trends and outcomes of male breast cancer: Experience of a tertiary oncology centre in India

    Directory of Open Access Journals (Sweden)

    Anindya Mukherjee

    2014-08-01

    Full Text Available Purpose: Because of its rarity in any oncology centre, the clinical trends of male breast cancer specific to its geographical distribution have remained relatively unexplored. This study was done to analyze the clinico-pathological data, treatment given and survival patterns of male breast cancer patients visiting our tertiary medical centre and compare our results with available literature. Methods: All male breast cancer patients registered at our clinic from 2003 to 2009 were included. Frequency distribution analysis of the demographic and clinico-pathological data and treatment variables was done. Treatment outcome was examined from Kaplan-Meir survival estimates. Results: Thirty-three male breast cancer patients were encountered. The median age of presentation was sixty years. Mostly (87.9% they presented with lump in breast or axilla and were clinically staged to be ‘3’ (57.6%.Obesity and alcohol were the commonest risk factors identified. Modified radical mastectomy was the commonest (69.6% definitive therapy rendered with (only for clinically staged 3 patients or without neo-adjuvant chemotherapy. Infiltrating ductal carcinoma was identified in most cases. Twenty-two patients received adjuvant chemotherapy and twenty-four received adjuvant radiotherapy. Eighteen (54.5% patients were hormone-receptor positive and received tamoxifen. The median Overall survival (OS and Progression-free survival (PFS came out to be 14.3 months (standard error, SE of 1.185; 95% confidence interval, CI 12-16.6 and 15.7 (SE 5.35, 95% CI 5.2-26.19 months respectively.Conclusion: Male breast cancers usually carry a poor prognosis due to presentation at later stages. Most of our results correlate with previous literature. Multi-centric prospective studies are required to validate the etiological factors and prognostic determinants of survival.-----------------------------Cite this article as: Mukherjee A, Saha A, Chattopadhyay S, Sur P. Clinical trends and

  20. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

    Directory of Open Access Journals (Sweden)

    Carmel Jacobs

    Full Text Available BACKGROUND: Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS: Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS: Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice

  1. QIN. Promise and pitfalls of quantitative imaging in oncology clinical trials

    OpenAIRE

    Kurland, Brenda F; Gerstner, Elizabeth R.; Mountz, James M; Schwartz, Lawrence H.; Ryan, Christopher W.; Graham, Michael M.; Buatti, John M.; Fennessy, Fiona M.; Eikman, Edward A.; Kumar, Virendra; Forster, Kenneth M.; Wahl, Richard L.; Lieberman, Frank S.

    2012-01-01

    Quantitative imaging using CT, MRI, and PET modalities will play an increasingly important role in the design of oncology trials addressing molecularly targeted, personalized therapies. The advent of molecularly targeted therapies, exemplified by antiangiogenic drugs, creates new complexities in the assessment of response. The Quantitative Imaging Network (QIN) addresses the need for imaging modalities which can accurately and reproducibly measure not just change in tumor size, but changes in...

  2. Family therapy and clinical psychology

    OpenAIRE

    Carr, Alan

    1995-01-01

    The results of a survey of 111 clinical psychologists in the Republic of Ireland along with some comparable data from US and UK surveys were used to address a series of questions about the link between family therapy and clinical psychology. Family therapy was not a clearly identifiable sub-specialty within clinical psychology in Ireland. Family therapy theoretical models were used by more than a quarter of the Irish sample to conceptualize their work but by less than a tenth of US and UK res...

  3. Radiation therapy oncology group: 3-D CRT quality assurance guidelines

    International Nuclear Information System (INIS)

    Purpose: Guidelines to conduct multi-institutional three-dimensional conformal radiation therapy (3-D CRT) clinical trials are needed as the modality emerges from a single institution procedure to a research tool in multi-institution clinical group trials. The guidelines are used (1) to ensure that participating institutions have the proper equipment and appropriate techniques to administer 3D CRT; (2) to define a standard data set to be submitted to a review center for each treated patient to assess protocol compliance; and (3) to establish a quality assurance (QA) review process of the submitted data. Materials and Methods: Computer hardware and software components have been implemented which allow the digital data transfer (via either the Internet or magnetic tape), display, manipulation, and storage of a 3D CRT protocol patient treatment planning and image data set for QA review. Each participating institution is required to complete a 3D CRT Facility Questionnaire and submit it to the RTOG 3-D QA Center prior to enrolling patients on a 3-D CRT protocol. In addition, a protocol 'dry run' test has been designed to demonstrate each participating institutions' ability to submit a protocol compliant data set prior to placing patients on a 3D CRT study. This dry run test involves the digital transfer of all protocol required data and the supporting hard copy documentation excepting simulation or portal films/images. Results: The 3D CRT Facility Questionnaire includes descriptions of: (1) linac model, collimation system and energies to be used; (2) isocenter accuracy for gantry, collimator, and couch rotations; (3) type of immobilization repositioning system and patient motion studies if required by protocol (set-up uncertainty, organ movement); and (4) treatment verification system(s). The 3-D RTP system must have the following capabilities: (1) ability to handle at least 40 axial CT slices; (2) beam's-eye-view (BEV) display; (3) calculate 3-D dose matrices; (4

  4. Laser therapy and phototherapy in complex treatment of children's oncological diseases

    Science.gov (United States)

    Tsigankin, V. I.; Balakirev, S. A.; Atroshchenko, V. I.; Belousov, N. N.; Ivanov, Andrei V.

    1996-01-01

    The application of the laser therapy and phototherapy with utilization of High Intensive Impulse Laser Therapeutic Unit and High Intensive Impulse Light Therapeutic Unit has created new side prospects in treatment of side-effects and complications when treating oncological diseases and a great number of non-tumoral diseases of adults as well as children. The application of the laser therapy and phototherapy in complex treatment of children's oncological diseases has shown that this method has a significant antiinflammatory and anaesthetic effect as well as powerful regenerative influence on tissues. Its application decreases considerably the duration of treatment of complications when treating children's malignant tumors and enables to keep to scheduled terms of complex treatment.

  5. Proton therapy in clinical practice

    Institute of Scientific and Technical Information of China (English)

    Hui Liu; Joe Y. Chang

    2011-01-01

    Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.

  6. Staff attitudes and expectations about music therapy: pediatric oncology versus neonatal intensive care unit.

    Science.gov (United States)

    Bouhairie, Annie; Kemper, Kathi J; Martin, Kathleen; Woods, Charles

    2006-01-01

    Music is commonly used to reduce stress, but it has not been universally adopted in inpatient and outpatient settings. We compared the attitudes of staff in the neonatal intensive care unit (NICU) and the pediatric outpatient hematology oncology unit (PEDS ONC) toward music therapy. A cross-sectional survey of NICU staff was performed in the winter of 2003 and of PEDS ONC staff in the summer of 2005. Eligible subjects were 187 NICU and 20 PEDS ONC staff members. Surveys were distributed by e-mail, in person, and in staff mail boxes. Data were analyzed using simple descriptive statistics, chi-square test, and logistic regression. t-Tests and chi-square test were used to compare responses in the two units. The response rate was 75% in the NICU and 100% in PEDS ONC unit. Staff in the two locations were similar: the mean age of the staff was 37 years in NICU and 40 years in the PEDS ONC (p>.1); over 80% of the staff were female in both units and most (70% in the NICU, 75% in PEDS ONC) reported some previous musical training . Most agreed that music enjoyed by patients could reduce stress (86% in the NICU, 100% in PEDS ONC) and improve sleep (79% in the NICU, 95% in PEDS ONC). Attitudes toward music in both clinical settings were significantly associated with prior musical training , experience, and profession. Staff in both the NICU and PEDS ONC hold favorable attitudes toward music for patients. Staff attitudes in both inpatient and outpatient settings are not barriers to providing music therapy. PMID:19442339

  7. Clinical databases in physical therapy.

    OpenAIRE

    Swinkels, I.C.S.; Ende, C.H.M. van den; Bakker, D.; Wees, Ph.J van der; Hart, D.L.; Deutscher, D.; Bosch, W.J.H. van den; Dekker, J.

    2007-01-01

    Clinical databases in physical therapy provide increasing opportunities for research into physical therapy theory and practice. At present, information on the characteristics of existing databases is lacking. The purpose of this study was to identify clinical databases in which physical therapists record data on their patients and treatments and to investigate the basic aspects, data sets, output, management, and data quality of the databases. Identification of the databases was performed by ...

  8. Postgraduate Training in Clinical Oncology. Report on a WHO Working Group (The Hague, The Netherlands, December 6-8, 1978).

    Science.gov (United States)

    World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

    The 1978 report of the Working Group of Postgraduate Training in Clinical Oncology, convened by the World Health Organization (WHO) Regional Office for Europe in collaboration with the government of The Netherlands, is presented. The groups analyzed models of postgraduate training in clinical oncology and evaluated their suitability in relation to…

  9. Making the right software choice for clinically used equipment in radiation oncology

    International Nuclear Information System (INIS)

    The customer of a new system for clinical use in radiation oncology must consider many options in order to find the optimal combination of software tools. Many commercial systems are available and each system has a large number of technical features. However an appraisal of the technical capabilities, especially the options for clinical implementations, is hardly assessable at first view. The intention of this article was to generate an assessment of the necessary functionalities for high precision radiotherapy and their integration in ROKIS (Radiation oncology clinic information system) for future customers, especially with regard to clinical applicability. Therefore we analysed the clinically required software functionalities and divided them into three categories: minimal, enhanced and optimal requirements for high conformal radiation treatment

  10. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems

    Science.gov (United States)

    Wolfenden, Andrew

    2012-01-01

    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  11. Photodynamic therapy in clinical practice

    OpenAIRE

    E. V. Filonenko; L. G. Serova

    2016-01-01

    The review is on opportunities and possibilities of application of photodynamic therapy in clinical practice. The advantages of this method are the targeting of effect on tumor foci and high efficiency along with low systemic toxicity. The results of the set of recent Russian and foreign clinical trials are represented in the review. The method is successfully used in clinical practice with both radical (for early vulvar, cervical cancer and pre-cancer, central early lung cancer, esophageal a...

  12. Assessing the Value of an Optional Radiation Oncology Clinical Rotation During the Core Clerkships in Medical School

    International Nuclear Information System (INIS)

    Purpose: Few medical students are given proper clinical training in oncology, much less radiation oncology. We attempted to assess the value of adding a radiation oncology clinical rotation to the medical school curriculum. Methods and Materials: In July 2010, Jefferson Medical College began to offer a 3-week radiation oncology rotation as an elective course for third-year medical students during the core surgical clerkship. During 2010 to 2012, 52 medical students chose to enroll in this rotation. The rotation included outpatient clinics, inpatient consults, didactic sessions, and case-based presentations by the students. Tests of students’ knowledge of radiation oncology were administered anonymously before and after the rotation to evaluate the educational effectiveness of the rotation. Students and radiation oncology faculty were given surveys to assess feedback about the rotation. Results: The students’ prerotation test scores had an average of 64% (95% confidence interval [CI], 61–66%). The postrotation test scores improved to an average of 82% (95% CI, 80–83%; 18% absolute improvement). In examination question analysis, scores improved in clinical oncology from 63% to 79%, in radiobiology from 70% to 77%, and in medical physics from 62% to 88%. Improvements in all sections but radiobiology were statistically significant. Students rated the usefulness of the rotation as 8.1 (scale 1–9; 95% CI, 7.3–9.0), their understanding of radiation oncology as a result of the rotation as 8.8 (95% CI, 8.5–9.1), and their recommendation of the rotation to a classmate as 8.2 (95% CI, 7.6–9.0). Conclusions: Integrating a radiation oncology clinical rotation into the medical school curriculum improves student knowledge of radiation oncology, including aspects of clinical oncology, radiobiology, and medical physics. The rotation is appreciated by both students and faculty.

  13. American Society of Clinical Oncology Statement: Human Papillomavirus Vaccination for Cancer Prevention.

    Science.gov (United States)

    Bailey, Howard H; Chuang, Linus T; duPont, Nefertiti C; Eng, Cathy; Foxhall, Lewis E; Merrill, Janette K; Wollins, Dana S; Blanke, Charles D

    2016-05-20

    American Society of Clinical Oncology (ASCO), the leading medical professional oncology society, is committed to lessening the burden of cancer and as such will promote underused interventions that have the potential to save millions of lives through cancer prevention. As the main providers of cancer care worldwide, our patients, their families, and our communities look to us for guidance regarding all things cancer related, including cancer prevention. Through this statement and accompanying recommendations, ASCO hopes to increase awareness of the tremendous global impact of human papillomavirus (HPV) -caused cancers, refocus the discussion of HPV vaccination on its likely ability to prevent millions of cancer deaths, and increase HPV vaccination uptake via greater involvement of oncology professionals in ensuring accurate public discourse about HPV vaccination and calling for the implementation of concrete strategies to address barriers to vaccine access and acceptance. PMID:27069078

  14. American Society of Clinical Oncology Policy Statement Update: Genetic and Genomic Testing for Cancer Susceptibility.

    Science.gov (United States)

    Robson, Mark E; Bradbury, Angela R; Arun, Banu; Domchek, Susan M; Ford, James M; Hampel, Heather L; Lipkin, Stephen M; Syngal, Sapna; Wollins, Dana S; Lindor, Noralane M

    2015-11-01

    The American Society of Clinical Oncology (ASCO) has long affirmed that the recognition and management of individuals with an inherited susceptibility to cancer are core elements of oncology care. ASCO released its first statement on genetic testing in 1996 and updated that statement in 2003 and 2010 in response to developments in the field. In 2014, the Cancer Prevention and Ethics Committees of ASCO commissioned another update to reflect the impact of advances in this area on oncology practice. In particular, there was an interest in addressing the opportunities and challenges arising from the application of massively parallel sequencing-also known as next-generation sequencing-to cancer susceptibility testing. This technology introduces a new level of complexity into the practice of cancer risk assessment and management, requiring renewed effort on the part of ASCO to ensure that those providing care to patients with cancer receive the necessary education to use this new technology in the most effective, beneficial manner. The purpose of this statement is to explore the challenges of new and emerging technologies in cancer genetics and provide recommendations to ensure their optimal deployment in oncology practice. Specifically, the statement makes recommendations in the following areas: germline implications of somatic mutation profiling, multigene panel testing for cancer susceptibility, quality assurance in genetic testing, education of oncology professionals, and access to cancer genetic services. PMID:26324357

  15. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Mazur, Lukasz M., E-mail: lukasz_mazur@ncsu.edu [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Biomedical Engineering, North Carolina State University, Raleigh, North Carolina (United States); Mosaly, Prithima R. [Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Jackson, Marianne; Chang, Sha X.; Burkhardt, Katharin Deschesne; Adams, Robert D.; Jones, Ellen L.; Hoyle, Lesley [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Xu, Jing [Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Rockwell, John; Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

    2012-08-01

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  16. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    International Nuclear Information System (INIS)

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  17. Current practices and guidelines for clinical next-generation sequencing oncology testing

    Institute of Scientific and Technical Information of China (English)

    Samuel P. Strom

    2016-01-01

    Next-generation sequencing (NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing.

  18. Multi-scale Modeling in Clinical Oncology: Opportunities and Barriers to Success.

    Science.gov (United States)

    Yankeelov, Thomas E; An, Gary; Saut, Oliver; Luebeck, E Georg; Popel, Aleksander S; Ribba, Benjamin; Vicini, Paolo; Zhou, Xiaobo; Weis, Jared A; Ye, Kaiming; Genin, Guy M

    2016-09-01

    Hierarchical processes spanning several orders of magnitude of both space and time underlie nearly all cancers. Multi-scale statistical, mathematical, and computational modeling methods are central to designing, implementing and assessing treatment strategies that account for these hierarchies. The basic science underlying these modeling efforts is maturing into a new discipline that is close to influencing and facilitating clinical successes. The purpose of this review is to capture the state-of-the-art as well as the key barriers to success for multi-scale modeling in clinical oncology. We begin with a summary of the long-envisioned promise of multi-scale modeling in clinical oncology, including the synthesis of disparate data types into models that reveal underlying mechanisms and allow for experimental testing of hypotheses. We then evaluate the mathematical techniques employed most widely and present several examples illustrating their application as well as the current gap between pre-clinical and clinical applications. We conclude with a discussion of what we view to be the key challenges and opportunities for multi-scale modeling in clinical oncology. PMID:27384942

  19. Recent advances in gastrointestinal oncology - updates and insights from the 2009 annual meeting of the American Society of Clinical Oncology

    Directory of Open Access Journals (Sweden)

    Hsueh Chung-Tsen

    2010-03-01

    Full Text Available Abstract We have reviewed the pivotal presentations related to gastrointestinal malignancies from 2009 annual meeting of the American Society of Clinical Oncology with the theme of "personalizing cancer care". We have discussed the scientific findings and the impact on practice guidelines and ongoing clinical trials. Adding trastuzumab to chemotherapy improved the survival of patients with advanced gastric cancer overexpressing human epidermal growth factor receptor 2. Gemcitabine plus cisplatin has become a new standard for first-line treatment of advanced biliary cancer. Octreotide LAR significantly lengthened median time to tumor progression compared with placebo in patients with metastatic neuroendocrine tumors of the midgut. Addition of oxaliplatin to fluoropyrimidines for preoperative chemoradiotherapy in patients with stage II or III rectal cancer did not improve local tumor response but increased toxicities. Bevacizumab did not provide additional benefit to chemotherapy in adjuvant chemotherapy for stage II or III colon cancer. In patients with resected stage II colon cancer, recurrence score estimated by multigene RT-PCR assay has been shown to provide additional risk stratification. In stage IV colorectal cancer, data have supported the routine use of prophylactic skin treatment in patients receiving antibody against epidermal growth factor receptor, and the use of upfront chemotherapy as initial management in patients with synchronous metastasis without obstruction or bleeding from the primary site.

  20. An exploration of the experience of compassion fatigue in clinical oncology nurses.

    Science.gov (United States)

    Perry, Beth; Toffner, Greg; Merrick, Trish; Dalton, Janice

    2011-01-01

    Compassion fatigue (CF) is "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers' stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided. PMID:21661623

  1. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

    Science.gov (United States)

    Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations. PMID:26870963

  2. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    Directory of Open Access Journals (Sweden)

    Bryan A Loy

    Full Text Available Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011 and after (2013 the payment method introduction using relative risks (RR. After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05. For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008 from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20. These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  3. Integrating Personalized Medicine in the Canadian Environment: Efforts Facilitating Oncology Clinical Research.

    Science.gov (United States)

    Syme, Rachel; Carleton, Bruce; Leyens, Lada; Richer, Etienne

    2015-01-01

    There is currently a rapid evolution of clinical practices based on the introduction of patient stratification and molecular diagnosis that is likely to improve health outcomes. Building on a strong research base, complemented by strong support from clinicians and health authorities, the oncology field is at the forefront of this evolution. Yet, clinical research is still facing many challenges that need to be addressed in order to conduct necessary studies and effectively translate medical breakthroughs based on personalized medicine into standards of care. Leveraging its universal health care system and on resources developed to support oncology clinical research, Canada is well positioned to join the international efforts deployed to address these challenges. Available resources include a broad range of structures and funding mechanisms, ranging from direct clinical trial support to post-marketing surveillance. Here, we propose a clinical model for the introduction of innovation for precision medicine in oncology that starts with patients' and clinicians' unmet needs to initiate a cycle of discovery, validation, translation and sustainability development. PMID:26565702

  4. Appearance of febrile neutropenia episodes after cytostatic therapy on oncology patients

    International Nuclear Information System (INIS)

    Treatment of oncology patient using cytotoxic drugs has the neutropenia and its infectious complications as the commonest dose-limiting toxicity. Its appearance provokes dose delays and reduction during post-chemotherapy cycles, as well as the quality of life deterioration of patients. Oncology Medicine Group including the Pharmacy Service carried out a study to analyze the appearance of febrile neutropenia after cytotoxic therapy administration, and the presence of other factors that may to increase the risk to these reactions. A total of 42 patients were studied admitted with febrile neutropenia after above therapy from February to August, 2007. Biomedical variables from included patient group were achieved and the previously applied cytostatic therapy. The prevalent age-group was those patients aged over 50 and predominance of male sex and advanced stages with associated affections. The more frequent tumor locations were in breast, lung, and non-Hodgkin lymphoma. The cytostatic agent more used in cases of febrile neutropenia was Adriamycin (71.4 %) followed by Cyclophosphamide (52.4 %). The factors more associated with febrile neutropenia appearance were: Anthracycline chemotherapy, age over 50, advanced stages, and presence of associated diseases

  5. Geographic Miss: A Cause of Treatment Failure in Radio-Oncology Applied to Intracoronary Radiation Therapy

    OpenAIRE

    Sabaté, Manel; Costa, Marco; Kozuma, Ken; Kay, Ian Patrick; Giessen, Wim; Coen, Veronique; Ligthart, Jürgen; Serrano, Pedro; Levendag, Peter; Serruys, Patrick

    2000-01-01

    textabstractBACKGROUND: A recognized limitation of endovascular beta-radiation therapy is the development of new stenosis at the edges of the irradiated area. The combination of injury and low-dose radiation may be the precursor of this phenomenon. We translated the radio-oncological concept of "geographic miss" to define cases in which the radiation source did not fully cover the injured area. The aims of the study were to determine the incidence and causes of geographic miss and evaluate th...

  6. The use of small-size PMB-6E betatron for radiation therapy of oncologic patients

    International Nuclear Information System (INIS)

    Results of applying the smallsize betatron PMB-6E for radiation therapy of oncologic patients, are presented. The application of the betatron is most advisable in cases of tumors of skin, soft tissues, red lip edge, in some patients with mouth mucosa cancer, as well as in cases of local relapse of mammary gland cancer and other surface tumors. One of the limitations for the treatment of tumors of mouth mucosa with fast neutrons are the dimensions of the pathological hotbed, which exceed the diameter of collimators or a considerable depth of infiltration in the surrounding tissues

  7. Processes for Quality Improvements in Radiation Oncology Clinical Trials

    International Nuclear Information System (INIS)

    Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials

  8. Processes for quality improvements in radiation oncology clinical trials.

    Science.gov (United States)

    FitzGerald, T J; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Cicchetti, M Giulia; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

    2008-01-01

    Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials. PMID:18406943

  9. Photoacoustic Imaging in Oncology: Translational Preclinical and Early Clinical Experience.

    Science.gov (United States)

    Valluru, Keerthi S; Wilson, Katheryne E; Willmann, Jürgen K

    2016-08-01

    Photoacoustic imaging has evolved into a clinically translatable platform with the potential to complement existing imaging techniques for the management of cancer, including detection, characterization, prognosis, and treatment monitoring. In photoacoustic imaging, tissue is optically excited to produce ultrasonographic images that represent a spatial map of optical absorption of endogenous constituents such as hemoglobin, fat, melanin, and water or exogenous contrast agents such as dyes and nanoparticles. It can therefore provide functional and molecular information that allows noninvasive soft-tissue characterization. Photoacoustic imaging has matured over the years and is currently being translated into the clinic with various clinical studies underway. In this review, the current state of photoacoustic imaging is presented, including techniques and instrumentation, followed by a discussion of potential clinical applications of this technique for the detection and management of cancer. (©) RSNA, 2016. PMID:27429141

  10. Radiation doses to personnel in clinics for gynecologic oncology

    International Nuclear Information System (INIS)

    Radium or Cesium is used for radiotherapy of gynecologic cancer at six clinics in Sweden. This report gives a survey of the radiation doses the personnel is exposed to. The measurement were performed using TL-dosimeters. The dose equivalents for different parts of the body at specific working moments was deduced as well as the effective dose equivalent and the collective dose equivalent. 1983 the total collective dose equivalent for the six clinics was 1.3 manSv, which corresponds to 3.9 manmSv/g equivalent mass of Radium used at the treatments. (With 11 tables and 10 figures) (L.E.)

  11. Clinical and Outcome Research in oncology The need for integration

    Directory of Open Access Journals (Sweden)

    Apolone Giovanni

    2003-04-01

    Full Text Available Abstract Cancer is one of the main healthcare problems in Europe. Although significant progress has recently been made, long-term survival is still disappointing for most common solid tumours. The explosion of information has strengthened the need to create and sustain coordinated interaction between technology, biology, clinical research, clinical practice and health policy. A simple process based on automatic and passive translation from bench to clinical research and eventually to the bed side is usually assumed but cannot be taken for granted. A critical role might be played by Outcome Research (OR, defined as the discipline that describes, interprets, and predicts the impact of various influences, especially interventions, on final endpoints (from survival to satisfaction with care that matter to decision makers (from patients to society at large, with special emphasis on the use of patient-reported outcomes (PRO. Recently, under pressure from several parts of society, the FDA, recognizing the need for faster drug approval, has modified existing regulations and created new rules to allow anti-cancer drugs to be approved more quickly and, in certain but quite common circumstances, single arm trials and surrogate endpoints to be used as measures of clinical benefit. In this context, the faster approval process may lead to drugs being marketed without there being a complete picture of how effective or safe they are. The FDA move to speed up drug approval, together with the use of not fully validated surrogate endpoints, give OR the unique opportunity to help understand the value of drugs that have received accelerated approval. Despite this opportunity, OR has yet to demonstrate its role in this specific setting and provide proof of the validity, reliability and added value of its primary endpoint measures when evaluated in a broader context. The implementation of lines of OR in the development and evaluation of anti-cancer drugs hinges upon

  12. Cancer stem cells in basic science and in translational oncology: can we translate into clinical application?

    OpenAIRE

    Schulenburg, Axel; Blatt, Katharina; Cerny-Reiterer, Sabine; Sadovnik, Irina; Herrmann, Harald; Marian, Brigitte; Grunt, Thomas W.; Zielinski, Christoph C.; Valent, Peter

    2015-01-01

    Since their description and identification in leukemias and solid tumors, cancer stem cells (CSC) have been the subject of intensive research in translational oncology. Indeed, recent advances have led to the identification of CSC markers, CSC targets, and the preclinical and clinical evaluation of the CSC-eradicating (curative) potential of various drugs. However, although diverse CSC markers and targets have been identified, several questions remain, such as the origin and evolution of CSC,...

  13. Electronic clinical decision support systems attitudes and barriers to use in the oncology setting.

    LENUS (Irish Health Repository)

    Collins, I M

    2012-03-02

    BACKGROUND: There is little evidence regarding attitudes to clinical decision support systems (CDSS) in oncology. AIMS: We examined the current usage, awareness, and concerns of Irish medical oncologists and oncology pharmacists in this area. METHODS: A questionnaire was sent to 27 medical oncologists and 34 oncology pharmacists, identified through professional interest groups. Respondents ranked concerns regarding their use of a CDSS on a scale from 1 to 4, with 4 being most important. RESULTS: Overall, 67% (41\\/61) responded, 48% (13\\/27) of oncologists and 82% (28\\/34) of pharmacists surveyed. Concerns included "difficulty defining complex clinical situations with a set of rules" (mean ± SD) (3.2 ± 0.9), "ensuring evidence base is up to date and relevant" (3.2 ± 0.9) and "lack of clinically relevant suggestions" (2.9 ± 0.9). Ninety-three percent reported using a CDSS but 54% were unaware of this. CONCLUSION: While there are benefits to using a CDSS, concerns must be addressed through user education. This may be a starting point for a user-centred design approach to the development of future local systems through a consultative process.

  14. Clinical oncologic applications of PET/MRI: a new horizon

    OpenAIRE

    Partovi, Sasan; Kohan, Andres; Rubbert, Christian; Vercher-Conejero, Jose Luis; Gaeta, Chiara; Yuh, Roger; Zipp, Lisa; Herrmann, Karin A.; Robbin, Mark R.; Lee, Zhenghong; Muzic, Raymond F.; Faulhaber, Peter; Ros, Pablo R

    2014-01-01

    Positron emission tomography/magnetic resonance imaging (PET/MRI) leverages the high soft-tissue contrast and the functional sequences of MR with the molecular information of PET in one single, hybrid imaging technology. This technology, which was recently introduced into the clinical arena in a few medical centers worldwide, provides information about tumor biology and microenvironment. Studies on indirect PET/MRI (use of positron emission tomography/computed tomography (PET/CT) images softw...

  15. Clinically relevant drug–drug interactions in oncology

    OpenAIRE

    Mcleod, Howard L.

    1998-01-01

    Although anticancer agents are one of the most toxic classes of medication prescribed today, there is relatively little information available about clinically relevant drug–drug interactions. Pharmacokinetic drug interactions have been described, including alterations in absorption, catabolism, and excretion. For example, an increased bioavailability of 6-mercaptopurine has been observed when combined with either allopurinol or methotrexate, leading to increased toxicity in some patients. Ind...

  16. Pretreatment factors significantly influence quality of life in cancer patients: A Radiation Therapy Oncology Group (RTOG) analysis

    International Nuclear Information System (INIS)

    Purpose The purpose of this analysis was to assess the impact of pretreatment factors on quality of life (QOL) in cancer patients. Methods and Materials Pretreatment QOL (via Functional Assessment of Cancer Therapy [FACT], version 2) was obtained in 1,428 patients in several prospective Radiation Therapy Oncology Group (RTOG) trials including nonmetastatic head-and-neck (n = 1139), esophageal (n = 174), lung (n = 51), rectal (n = 47), and prostate (n = 17) cancer patients. Clinically meaningful differences between groups were defined as a difference of 1 standard error of measurement (SEM). Results The mean FACT score for all patients was 86 (20.7-112) with SEM of 5.3. Statistically significant differences in QOL were observed based on age, race, Karnofsky Performance Status, marital status, education level, income level, and employment status, but not by gender or primary site. Using the SEM, there were clinically meaningful differences between patients ≤50 years vs. ≥65 years. Hispanics had worse QOL than whites. FACT increased linearly with higher Karnofsky Performance Status and income levels. Married patients (or live-in relationships) had a better QOL than single, divorced, or widowed patients. College graduates had better QOL than those with less education. Conclusion Most pretreatment factors meaningfully influenced baseline QOL. The potentially devastating impact of a cancer diagnosis, particularly in young and minority patients, must be addressed

  17. Nervous Plexopathies in oncologic patients: Anatomical, clinical and radiological Considerations

    International Nuclear Information System (INIS)

    Lumbosacral or brachial plexopathies are lesions of two or more roots of the same plexus. They are very frequent in cancer patients and are usually due to extra spinal involvement of these roots, by a primary or secondary neoplasm. The CT scan is very useful in the evaluation of patients with this disease. In the article anatomic al aspects, the main clinical symptoms and signs, and the performance of CT scan are reviewed with all these elements it is possible to make a diagnosis

  18. Clinical perspectives of cancer stem cell research in radiation oncology

    International Nuclear Information System (INIS)

    Radiotherapy has a proven potential to eradicate cancer stem cells which is reflected by its curative potential in many cancer types. Considerable progress has been made in identification and biological characterisation of cancer stem cells during the past years. Recent biological findings indicate significant inter- and intratumoural and functional heterogeneity of cancer stem cells and lead to more complex models which have potential implications for radiobiology and radiotherapy. Clinical evidence is emerging that biomarkers of cancer stem cells may be prognostic for the outcome of radiotherapy in some tumour entities. Perspectives of cancer stem cell based research for radiotherapy reviewed here include their radioresistance compared to the mass of non-cancer stem cells which form the bulk of all tumour cells, implications for image- and non-image based predictive bio-assays of the outcome of radiotherapy and a combination of novel systemic treatments with radiotherapy

  19. Role of American Society of Clinical Oncology in low- and middle-income countries.

    Science.gov (United States)

    Patel, Jyoti D; Galsky, Matthew D; Chagpar, Anees B; Pyle, Doug; Loehrer, Patrick J

    2011-08-01

    The American Society of Clinical Oncology (ASCO) is a global community of health care professionals whose stated purpose is to "make a world of difference" by improving cancer care around the world. Unfortunately, cancer survival rates vary significantly among countries with differing financial and infrastructural resources. Because ASCO is a professional oncology society committed to conquering cancer through research, education, prevention, and delivery of high-quality patient care, it is ideally suited to address this issue. ASCO could bring together oncology professionals and other necessary stakeholders from around the world to improve cancer care and lessen suffering for patients worldwide. As part of the ongoing commitment of ASCO to the future of cancer care, the Leadership Development Program was created to foster the leadership skills of early and midcareer oncologists and provide these participants with a working knowledge of the depth and breadth of the organization. As participants in the inaugural class of the ASCO Leadership Development Program, we were charged with investigating how ASCO might favorably affect cancer prevention and treatment in resource-poor countries in a cost-effective, scalable, and sustainable fashion. ASCO can significantly influence cancer care in low- and middle-income countries through a comprehensive approach that promotes cancer awareness and education, improves clinical practice by identifying and removing barriers to delivery of quality cancer care, and fosters innovation to initiate novel solutions to complex problems. PMID:21709190

  20. Mucosal malignant melanoma - a clinical, oncological, pathological and genetic survey.

    Science.gov (United States)

    Mikkelsen, Lauge H; Larsen, Ann-Cathrine; von Buchwald, Christian; Drzewiecki, Krzysztof T; Prause, Jan U; Heegaard, Steffen

    2016-06-01

    Mucosal melanomas constitute 1.3% of all melanomas and they may develop in any mucosal membrane. Conjunctival melanomas (0.5/million/year) and melanomas in the sinonasal cavity (0.5/million/year) are the most common, followed by anorectal melanomas (0.4/million/year) and melanomas in the oral cavity (0.2/million/year). Anorectal melanoma occurs slightly more often in females, whereas oral melanoma has a male predilection. Mucosal melanoma most commonly develops in a patient's sixth or seventh decade of life, and no differences between races have been found except for sinonasal melanoma and conjunctival melanoma, which are very rare in Black people. The symptoms are not tumour-specific and are related to the organ system affected, and the disease is most often diagnosed at an advanced clinical stage. The diagnosis of a primary tumour is difficult, and metastatic cutaneous melanoma and choroidal melanoma must be excluded. Mutations in KIT are frequently found, while BRAF and NRAS mutations are rarely found - except in conjunctival melanomas that carry BRAF mutations. Mutations in the TERT promotor region are also found in mucosal melanomas. Complete surgical resection with free margins is the treatment of choice. The prognosis is poor, with the 5-year survival rate ranging from 0% (gastric melanoma) to 80% (conjunctival melanoma). PMID:27004972

  1. Approval procedures for clinical trials in the field of radiation oncology

    International Nuclear Information System (INIS)

    Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection (Bundesamt fuer Strahlenschutz, BfS). For studies in the field of radiation oncology, differentiation between use of radiation for ''medical care (Heilkunde)'' versus ''medical research'' frequently leads to contradictions. The aim of this article is to provide principle investigators, individuals, and institutions involved in the process, as well as institutional review or ethics committees, with the necessary information for this assessment. Information on the legal frame and the approval procedures are also provided. A workshop was co-organized by the German Society for Radiation Oncology (DEGRO), the Working Party for Radiation Oncology (ARO) of the German Cancer Society (DKG), the German Society for Medical Physics (DGMP), and the German Cancer Consortium (DKTK) in October 2013. This paper summarizes the results of the workshop and the follow-up discussions between the organizers and the BfS. Differentiating between ''Heilkunde'' which does not need to be approved by the BfS and ''medical research'' is whether the specific application of radiation (beam quality, dose, schedule, target volume, etc.) is a clinically established and recognized procedure. This must be answered by the qualified physician(s) (''fachkundiger Arzt'' according to German radiation protection law) in charge of the study and the treatments of the patients within the study, taking into consideration of the best available evidence from clinical studies, guidelines and consensus papers. Among the important parameters for assessment are indication, total dose, and fractionation. Radiation treatments applied outside clinical trials do not require approval by the BfS, even if they are applied within a randomized or nonrandomized clinical trial

  2. Imaging Opportunities in Radiation Oncology

    International Nuclear Information System (INIS)

    Interdisciplinary efforts may significantly affect the way that clinical knowledge and scientific research related to imaging impact the field of Radiation Oncology. This report summarizes the findings of an intersociety workshop held in October 2008, with the express purpose of exploring 'Imaging Opportunities in Radiation Oncology.' Participants from the American Society for Radiation Oncology (ASTRO), National Institutes of Health (NIH), Radiological Society of North America (RSNA), American Association of physicists in Medicine (AAPM), American Board of Radiology (ABR), Radiation Therapy Oncology Group (RTOG), European Society for Therapeutic Radiology and Oncology (ESTRO), and Society of Nuclear Medicine (SNM) discussed areas of education, clinical practice, and research that bridge disciplines and potentially would lead to improved clinical practice. Findings from this workshop include recommendations for cross-training opportunities within the allowed structured of Radiology and Radiation Oncology residency programs, expanded representation of ASTRO in imaging related multidisciplinary groups (and reciprocal representation within ASTRO committees), increased attention to imaging validation and credentialing for clinical trials (e.g., through the American College of Radiology Imaging Network (ACRIN)), and building ties through collaborative research as well as smaller joint workshops and symposia.

  3. Neurologic complications in oncology

    Directory of Open Access Journals (Sweden)

    Andrea Pace

    2010-06-01

    Full Text Available Neurologic side effects related to cancer therapy are a common problem in oncology practice. These complications can negatively affect the management of the patient, because they can inhibit treatment and diminish quality of life. Therefore specific skills are required to recognise symptoms and clinical manifestations. This review focuses on the most common neurologic complications to improve physician’s familiarity in determining the aetiology of these symptoms.

  4. Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG)

    International Nuclear Information System (INIS)

    Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced volumes and doses is addressed, integrating modern imaging with 3-dimensional (3D) planning and advanced techniques of treatment delivery. The previously applied extended field (EF) and original involved field (IF) techniques, which treated larger volumes based on nodal stations, have now been replaced by the use of limited volumes, based solely on detectable nodal (and extranodal extension) involvement at presentation, using contrast-enhanced computed tomography, positron emission tomography/computed tomography, magnetic resonance imaging, or a combination of these techniques. The International Commission on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom optimal imaging is available, is explained. A new concept, involved site radiation therapy (ISRT), is introduced as the standard conformal therapy for the scenario, commonly encountered, wherein optimal imaging is not available. There is increasing evidence that RT doses used in the past are higher than necessary for disease control in this era of combined modality therapy. The use of INRT and of lower doses in early-stage HL is supported by available data. Although the

  5. Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG)

    Energy Technology Data Exchange (ETDEWEB)

    Specht, Lena, E-mail: lena.specht@regionh.dk [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen (Denmark); Yahalom, Joachim [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Christie Hospital NHS Trust, Manchester (United Kingdom); Berthelsen, Anne Kiil [Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen (Denmark); Constine, Louis S. [Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York (United States); Eich, Hans Theodor [Department of Radiation Oncology, University of Münster (Germany); Girinsky, Theodore [Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif (France); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Mauch, Peter [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States); Mikhaeel, N. George [Department of Clinical Oncology and Radiotherapy, Guy' s and St Thomas' NHS Foundation Trust, London (United Kingdom); Ng, Andrea [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States)

    2014-07-15

    Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced volumes and doses is addressed, integrating modern imaging with 3-dimensional (3D) planning and advanced techniques of treatment delivery. The previously applied extended field (EF) and original involved field (IF) techniques, which treated larger volumes based on nodal stations, have now been replaced by the use of limited volumes, based solely on detectable nodal (and extranodal extension) involvement at presentation, using contrast-enhanced computed tomography, positron emission tomography/computed tomography, magnetic resonance imaging, or a combination of these techniques. The International Commission on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom optimal imaging is available, is explained. A new concept, involved site radiation therapy (ISRT), is introduced as the standard conformal therapy for the scenario, commonly encountered, wherein optimal imaging is not available. There is increasing evidence that RT doses used in the past are higher than necessary for disease control in this era of combined modality therapy. The use of INRT and of lower doses in early-stage HL is supported by available data. Although the

  6. Quality Research in Radiation Oncology Analysis of Clinical Performance Measures in the Management of Gastric Cancer

    International Nuclear Information System (INIS)

    Background: The specific aim was to determine national patterns of radiation therapy (RT) practice in patients treated for stage IB-IV (nonmetastatic) gastric cancer (GC). Methods and Materials: A national process survey of randomly selected US RT facilities was conducted which retrospectively assessed demographics, staging, geographic region, practice setting, and treatment by using on-site record review of eligible GC cases treated from 2005 to 2007. Three clinical performance measures (CPMs), (1) use of computed tomography (CT)-based treatment planning; (2) use of dose volume histograms (DVHs) to evaluate RT dose to the kidneys and liver; and (3) completion of RT within the prescribed time frame; and emerging quality indicators, (i) use of intensity modulated RT (IMRT); (ii) use of image-guided tools (IGRT) other than CT for RT target delineation; and (iii) use of preoperative RT, were assessed. Results: CPMs were computed for 250 eligible patients at 45 institutions (median age, 62 years; 66% male; 60% Caucasian). Using 2000 American Joint Committee on Cancer criteria, 13% of patients were stage I, 29% were stage II, 32% were stage IIIA, 10% were stage IIIB, and 12% were stage IV. Most patients (43%) were treated at academic centers, 32% were treated at large nonacademic centers, and 25% were treated at small to medium sized facilities. Almost all patients (99.5%) underwent CT-based planning, and 75% had DVHs to evaluate normal tissue doses to the kidneys and liver. Seventy percent of patients completed RT within the prescribed time frame. IMRT and IGRT were used in 22% and 17% of patients, respectively. IGRT techniques included positron emission tomography (n=20), magnetic resonance imaging (n=1), respiratory gating and 4-dimensional CT (n=22), and on-board imaging (n=10). Nineteen percent of patients received preoperative RT. Conclusions: This analysis of radiation practice patterns for treating nonmetastatic GC indicates widespread adoption of CT

  7. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology

    International Nuclear Information System (INIS)

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  8. [Rethinking clinical research in surgical oncology. From comic opera to quality control].

    Science.gov (United States)

    Evrard, Serge

    2016-01-01

    The evidence base for the effectiveness of surgical interventions is relatively poor and data from large, randomized prospective studies are rare with often a poor quality. Many efforts have been made to increase the number of high quality randomized trials in surgery and theoretical proposals have been put forward to improve the situation, but practical implementation of these proposals is seriously lacking. The consequences of this policy are not trivial; with very few patients included in surgical oncology trials, this represents wasted opportunity for advances in cancer treatment. In this review, we cover the difficulties inherent to clinical research in surgical oncology, such as quality control, equipoise, accrual, and funding and promote alternative designs to the randomized controlled trial. Although the classic randomized controlled trial has a valid but limited place in surgical oncology, other prospective designs need to be promoted as a new deal. This new deal not only implicates surgeons but also journal editors, tender jury, as well as regulatory bodies to cover legal gaps currently surrounding surgical innovation. PMID:26610367

  9. Mind-body therapies: evidence and implications in advanced oncology practice.

    Science.gov (United States)

    Mayden, Kelley D

    2012-11-01

    The idea that thoughts and emotions influence health outcomes is an ancient concept that was initially abandoned by Western medicine researchers. Today, researchers are showing a renewed interest in the interactions of the mind and body and the role these interactions play in disease formation and recovery. Complementary and alternative interventions, such as mind-body therapies, are increasingly being used by cancer survivors for disease prevention, immune system enhancement, and symptom control. Traditional training has not been structured to provide advanced practitioners with an in-depth knowledge of the clinical applications of mind-body therapies. The aim of this article is to acquaint the reader with common mind-body modalities (meditation/mindfulness-based stress reduction, relaxation therapy, cognitive-behavioral therapy, hypnosis, biofeedback, music therapy, art therapy, support groups, and aromatherapy) and to examine important evidence in support of or against their clinical application. PMID:25031967

  10. Molecular imaging in oncology

    Energy Technology Data Exchange (ETDEWEB)

    Schober, Otmar; Riemann, Burkhard (eds.) [Universitaetsklinikum Muenster (Germany). Klinik fuer Nuklearmedizin

    2013-02-01

    Considers in detail all aspects of molecular imaging in oncology, ranging from basic research to clinical applications in the era of evidence-based medicine. Examines technological issues and probe design. Discusses preclinical studies in detail, with particular attention to multimodality imaging. Presents current clinical use of PET/CT, SPECT/CT, and optical imagingWritten by acknowledged experts. The impact of molecular imaging on diagnostics, therapy, and follow-up in oncology is increasing significantly. The process of molecular imaging includes key biotarget identification, design of specific molecular imaging probes, and their preclinical evaluation, e.g., in vivo using small animal studies. A multitude of such innovative molecular imaging probes have already entered clinical diagnostics in oncology. There is no doubt that in future the emphasis will be on multimodality imaging in which morphological, functional, and molecular imaging techniques are combined in a single clinical investigation that will optimize diagnostic processes. This handbook addresses all aspects of molecular imaging in oncology, ranging from basic research to clinical applications in the era of evidence-based medicine. The first section is devoted to technology and probe design, and examines a variety of PET and SPECT tracers as well as multimodality probes. Preclinical studies are then discussed in detail, with particular attention to multimodality imaging. In the third section, diverse clinical applications are presented, and the book closes by looking at future challenges. This handbook will be of value to all who are interested in the revolution in diagnostic oncology that is being brought about by molecular imaging.

  11. An ICT infrastructure to integrate clinical and molecular data in oncology research

    OpenAIRE

    Segagni Daniele; Tibollo Valentina; Dagliati Arianna; Zambelli Alberto; Priori Silvia G; Bellazzi Riccardo

    2012-01-01

    Abstract Background The ONCO-i2b2 platform is a bioinformatics tool designed to integrate clinical and research data and support translational research in oncology. It is implemented by the University of Pavia and the IRCCS Fondazione Maugeri hospital (FSM), and grounded on the software developed by the Informatics for Integrating Biology and the Bedside (i2b2) research center. I2b2 has delivered an open source suite based on a data warehouse, which is efficiently interrogated to find sets of...

  12. Conformal radiation therapy: technical requirements and clinical applications

    International Nuclear Information System (INIS)

    Conformal radiation therapy represents a considerable and attractive challenge in oncology. Its aim is mainly to improve local control by increasing the dose with an acceptable rate of complications. This work overviews the world literature on this subject. The technical and theoretical requirements are highlighted. These requirements include a precise definition of the target volume by digital imaging (essentially CT scan), but also clear view of the target volume and the organs at risk, a specific collimation of the beam, 3-D dose calculations, optimization procedures, and a rigid immobilization of the patient with verification of his position. Moreover, the clinical applications of conformal radiation therapy are reviewed and discussed. (authors). 80 refs., 1 tab

  13. Evolution of modern nuclear medicine tumor-imaging diagnostics in clinical oncology

    International Nuclear Information System (INIS)

    The evolution of current nuclear medicine diagnostic is closely related to the technical progress in imaging equipment development, and application of radiopharmaceuticals (Rphs) with a different tumor-uptake mechanism. It is the aim of the study to present groups of tumor-imaging Rphs differing by tumor uptake mechanisms, used in clinical oncology. The obtained results are described, and compared with the ones reported by other researchers. Sensitivity and specificity of Rphs for cardio-scintigraphy with 99mTc - MIBI and 201Tl are relatively high, amounting to 93.7% and 60% respectively, in the various tumors. These indicators depend on the stage, location, histopathology, level of malignancy and biological activity of the neoplasm. 99mTc - MIBI scintigraphy is endowed with considerable diagnostic potential for assaying multiple drug resistance (MDR), and is also a good criterion for its elimination following anti-MDR therapy. The obtained results show that radioimmunoscintigraphy (RIS) using different radiolabeled monoclonal antibodies (MoAb) have high sensitivity and specificity respectively: 86% and 80% in ovarian carcinoma with B72.3 antiTAG; 68.6% and 92.5% in colorectal carcinoma with B73.2 antiTAG, antiCEA, antiCA 19-9; 92% and 83% in breast cancer with antiCEA, 86.8% and 67-69% in malignant melanoma with 225.28s. Receptor scintigraphy may reach up to 86% sensitivity and 100% specificity in tumors saturated with somatostatin receptors. Positron emission tomography (PET) with 18F-FDG enhances the metabolic activity of tumor cells, and attains tumor-detecting rate amounting to 97%. Tumor imaging evolution characterized by the introduction and practical implementation of different Rphs, visualizing the functional and biochemical activity of tumor cells in the primary neoplasm, sentinel lymph nodes and distant metastases. radiolabelling of a variety of new biochemical substances, including DNA and RNA, drugs and lysosomes contributes to a successful imaging of

  14. Selected clinically established and scientific techniques of diffusion-weighted MRI. In the context of imaging in oncology

    International Nuclear Information System (INIS)

    Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that was established in the clinical routine primarily for the detection of brain ischemia. In the past 15 years its clinical use has been extended to oncological radiology, as tumor and metastases can be depicted in DWI due to their hypercellular nature. The basis of DWI is the Stejskal-Tanner experiment. The diffusion properties of tissue can be visualized after acquisition of at least two diffusion-weighted series using echo planar imaging and a specific sequence of gradient pulses. The use of DWI in prostate MRI was reported to be one of the first established applications that found its way into internationally recognized clinical guidelines of the European Society of Urological Radiology (ESUR) and the prostate imaging reporting and data system (PI-RADS) scale. Due to recently reported high specificity and negative predictive values of 94 % and 92 %, respectively, its regular use for breast MRI is expected in the near future. Furthermore, DWI can also reliably be used for whole-body imaging in patients with multiple myeloma or for measuring the extent of bone metastases. New techniques in DWI, such as intravoxel incoherent motion imaging, diffusion kurtosis imaging and histogram-based analyses represent promising approaches to achieve a more quantitative evaluation for tumor detection and therapy response. (orig.)

  15. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Kevin L., E-mail: kevinmoore@ucsd.edu; Moiseenko, Vitali [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92093 (United States); Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 26504 (Greece); McNutt, Todd R. [Department of Radiation Oncology and Molecular Radiation Science, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Mutic, Sasa [Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri 63110 (United States)

    2014-01-15

    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy.

  16. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    International Nuclear Information System (INIS)

    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy

  17. Modern Radiation Therapy for Primary Cutaneous Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    International Nuclear Information System (INIS)

    Primary cutaneous lymphomas are a heterogeneous group of diseases. They often remain localized, and they generally have a more indolent course and a better prognosis than lymphomas in other locations. They are highly radiosensitive, and radiation therapy is an important part of the treatment, either as the sole treatment or as part of a multimodality approach. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques that form the focus of these guidelines. The International Lymphoma Radiation Oncology Group has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the International Lymphoma Radiation Oncology Group steering committee on the use of radiation therapy in primary cutaneous lymphomas in the modern era

  18. Modern Radiation Therapy for Primary Cutaneous Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Specht, Lena, E-mail: lena.specht@regionh.dk [Departments of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Dabaja, Bouthaina [Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Wilson, Lynn D. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Stanford, California (United States)

    2015-05-01

    Primary cutaneous lymphomas are a heterogeneous group of diseases. They often remain localized, and they generally have a more indolent course and a better prognosis than lymphomas in other locations. They are highly radiosensitive, and radiation therapy is an important part of the treatment, either as the sole treatment or as part of a multimodality approach. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques that form the focus of these guidelines. The International Lymphoma Radiation Oncology Group has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the International Lymphoma Radiation Oncology Group steering committee on the use of radiation therapy in primary cutaneous lymphomas in the modern era.

  19. The Clinical Development of Molecularly Targeted Agents in Combination With Radiation Therapy: A Pharmaceutical Perspective

    International Nuclear Information System (INIS)

    Summary: This paper explores historical and current roles of pharmaceutical industry sponsorship of clinical trials testing radiation therapy combinations with molecularly targeted agents and attempts to identify potential solutions to expediting further combination studies. An analysis of clinical trials involving a combination of radiation therapy and novel cancer therapies was performed. Ongoing and completed trials were identified by searching the (clinicaltrials.gov) Web site, in the first instance, with published trials of drugs of interest identified through American Society of Clinical Oncology, European CanCer Organisation/European Society for Medical Oncology, American Society for Radiation Oncology/European Society for Therapeutic Radiology and Oncology, and PubMed databases and then cross-correlated with (clinicaltrials.gov) protocols. We examined combination trials involving radiation therapy with novel agents and determined their distribution by tumor type, predominant molecular mechanisms examined in combination to date, timing of initiation of trials relative to a novel agent's primary development, and source of sponsorship of such trials. A total of 564 studies of targeted agents in combination with radiation therapy were identified with or without concomitant chemotherapy. Most studies were in phase I/II development, with only 36 trials in phase III. The tumor site most frequently studied was head and neck (26%), followed by non-small cell lung cancer. Pharmaceutical companies were the sponsors of 33% of studies overall and provided support for only 16% of phase III studies. In terms of pharmaceutical sponsorship, Genentech was the most active sponsor of radiation therapy combinations (22%), followed by AstraZeneca (14%). Most radiation therapy combination trials do not appear to be initiated until after drug approval. In phase III studies, the most common (58%) primary endpoint was overall survival. Collectively, this analysis suggests that such

  20. Radiation Therapy Planning for Early-Stage Hodgkin Lymphoma: Experience of the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Maraldo, Maja V., E-mail: dra.maraldo@gmail.com [Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen (Denmark); Dabaja, Bouthaina S. [Department of Radiation Oncology, MD Anderson Cancer Center, Texas (United States); Filippi, Andrea R. [Department of Oncology, University of Torino School of Medicine, Torino (Italy); Illidge, Tim [Department of Oncology, Christie Hospital, Manchester (United Kingdom); Tsang, Richard [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Ricardi, Umberto [Department of Oncology, University of Torino School of Medicine, Torino (Italy); Petersen, Peter M.; Schut, Deborah A. [Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen (Denmark); Garcia, John [Department of Radiation Oncology, MD Anderson Cancer Center, Texas (United States); Headley, Jayne [Department of Oncology, Christie Hospital, Manchester (United Kingdom); Parent, Amy; Guibord, Benoit [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Ragona, Riccardo [Department of Oncology, University of Torino School of Medicine, Torino (Italy); Specht, Lena [Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen (Denmark)

    2015-05-01

    Purpose: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs). Methods: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013. Results: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient. Conclusions: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.

  1. Radiation Therapy Planning for Early-Stage Hodgkin Lymphoma: Experience of the International Lymphoma Radiation Oncology Group

    International Nuclear Information System (INIS)

    Purpose: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs). Methods: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013. Results: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient. Conclusions: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs

  2. Academic Career Selection and Retention in Radiation Oncology: The Joint Center for Radiation Therapy Experience

    International Nuclear Information System (INIS)

    Purpose: The United States healthcare system has witnessed declining reimbursement and increasing documentation requirements for longer than 10 years. These have decreased the time available to academic faculty for teaching and mentorship. The impact of these changes on the career choices of residents is unknown. The purpose of this report was to determine whether changes have occurred during the past decade in the proportion of radiation oncology trainees from a single institution entering and staying in academic medicine. Methods and Materials: We performed a review of the resident employment experience of Harvard Joint Center for Radiation Therapy residents graduating during 13 recent consecutive years (n = 48 residents). The outcomes analyzed were the initial selection of an academic vs. nonacademic career and career changes during the first 3 years after graduation. Results: Of the 48 residents, 65% pursued an academic career immediately after graduation, and 44% remained in academics at the last follow-up, after a median of 6 years. A later graduation year was associated with a decrease in the proportion of graduates immediately entering academic medicine (odds ratio, 0.78; 95% confidence interval, 0.65-0.94). However, the retention rate at 3 years of those who did immediately enter academics increased with a later graduation year (p = 0.03). Conclusion: During a period marked by notable changes in the academic healthcare environment, the proportion of graduating Harvard Joint Center for Radiation Therapy residents pursuing academic careers has been declining; however, despite this decline, the retention rates in academia have increased

  3. Application of organ tolerance dose-constraints in clinical studies in radiation oncology

    International Nuclear Information System (INIS)

    In modern radiation oncology, tolerance dose-constraints for organs at risk (OAR) must be considered for treatment planning, but particularly in order to design clinical studies. Tolerance dose tables, however, only address one aspect of the therapeutic ratio of any clinical study, i.e., the limitation of adverse events, but not the desired potential improvement in the tumor effect of a novel treatment strategy. A sensible application of ''tolerance doses'' in a clinical situation requires consideration of various critical aspects addressed here: definition of tolerance dose, specification of an endpoint/symptom, consideration of radiation quality and irradiation protocol, exposed volume and dose distribution, and patient-related factors of radiosensitivity. The currently most comprehensive estimates of OAR radiation tolerance are in the QUANTEC compilations (2010). However, these tolerance dose values must only be regarded as a rough orientation and cannot answer the relevant question for the patients, i.e., if the study can achieve a therapeutic advantage; this can obviously be answered only by the final scientific analysis of the study results. Despite all limitations, the design of clinical studies should currently refer to the QUANTEC values for appreciation of the risk of complications, if needed supplemented by one's own data or further information from the literature. The implementation of a consensus on the safety interests of the patients and on an application and approval process committed to progress in medicine, with transparent quality-assuring requirements with regard to the structural safeguarding of the study activities, plays a central role in clinical research in radiation oncology. (orig.)

  4. Evolución de la terapia ocupacional en el campo de la oncología = Occupational therapy evolution in oncology field

    Directory of Open Access Journals (Sweden)

    Navarrete Salas, E

    2006-09-01

    Full Text Available Resumen:El objetivo de lasiguiente revisión bibliográfica fue conocer la trayectoria de la Terapia Ocupacional (T.O. en el área oncológica durante las últimas 4 décadas. Para ello se realizó una búsqueda en las bases de datos MEDLINE, EMBASE, CINALH y AMED, con los descriptores Terapia Ocupacional, oncología y cáncer, tanto en el título como en el abstract; se excluyeron los artículos que no estuviesen en idioma inglés o español.Los resultados arrojaron un total de 68 publicaciones de T.O. y cáncer, con una curva sostenida de crecimiento en el número de trabajos publicados. En cuanto a tipo de cáncer predominan las publicaciones que aluden a cáncer en general, aunque destaca el interés por estudiar pacientes con cáncer mamario. La metodología predominante es descriptiva aunque en las últimas 2 décadas los trabajos publicados con metodología cualitativa alcanzaron un 30% del total. Destaca el foco puesto en los pacientes (86% de las publicaciones, aunque también hay trabajos referidos al equipo de salud oncológica (14%. Se comprueba además que la gran mayoría de las publicaciones corresponde a intervenciones de T.O. (80%. En conclusión, pese a que el número total de publicaciones de T.O. en oncología es reducido, nuestra revisión bibliográfica permite afirmar que existe un creciente y sostenido interés por explorar este tipo de patologías e integrar activamente los equipos de salud oncológica Abstract:The aim of following bibliographical review was to know which path of the Occupational Therapy (O.T. has been in the oncology area during the last 4 decades. A research was carried out in the databases MEDLINE, EMBASE, CINALH and AMED, with key words Occupational Therapy, oncology and cancer, as much in the title as in the abstract; only articles in English or Spanishwere included. Results threw a total of 68 publications of O.T. and cancer, with a sustained curve of growth in the number of published papers

  5. Bioluminescent imaging: a critical tool in pre-clinical oncology research.

    LENUS (Irish Health Repository)

    O'Neill, Karen

    2010-02-01

    Bioluminescent imaging (BLI) is a non-invasive imaging modality widely used in the field of pre-clinical oncology research. Imaging of small animal tumour models using BLI involves the generation of light by luciferase-expressing cells in the animal following administration of substrate. This light may be imaged using an external detector. The technique allows a variety of tumour-associated properties to be visualized dynamically in living models. The increasing use of BLI as a small-animal imaging modality has led to advances in the development of xenogeneic, orthotopic, and genetically engineered animal models expressing luciferase genes. This review aims to provide insight into the principles of BLI and its applications in cancer research. Many studies to assess tumour growth and development, as well as efficacy of candidate therapeutics, have been performed using BLI. More recently, advances have also been made using bioluminescent imaging in studies of protein-protein interactions, genetic screening, cell-cycle regulators, and spontaneous cancer development. Such novel studies highlight the versatility and potential of bioluminescent imaging in future oncological research.

  6. Clinically unsuspected pulmonary embolism-an important secondary finding in oncology CT

    International Nuclear Information System (INIS)

    AIM: To determine the rate of finding incidental pulmonary embolisms (PE) at staging or follow-up chest computed tomography (CT) in oncology patients. MATERIALS AND METHODS: Three hundred and eighty-five consecutive chest CT examinations, performed in patients with cancer, were prospectively assessed during a 9-month period between October 2003 and June 2004. These were spiral acquisitions between 5 and 8 mm collimation acquired 25 s after intravenous contrast medium administration. PE was diagnosed if a filling defect was seen in the central pulmonary arteries on two or more consecutive slices. RESULTS: Ten of 385 (2.6%) of these patients had incidentally detected PE. This was not attributable to any specific malignancy or chemotherapeutic regimen. These emboli were all central, between the main pulmonary artery and the lobar level. Although the significance of these findings in patients not clinically suspected of having PE could be contentious, all the patients were started on therapeutic anticoagulation as a result of this observation. CONCLUSION: Over one in 40 oncology patients have incidental central PE visible on the CT images performed to assess their malignancy. Formal review of the pulmonary arteries, using a work station, is advised in patients with malignancy

  7. Results of the 2005-2008 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States: Clinical Training and Resident Working Conditions

    International Nuclear Information System (INIS)

    Purpose: To document clinical training and resident working conditions reported by chief residents during their residency. Methods and Materials: During the academic years 2005 to 2006, 2006 to 2007, and 2007 to 2008, the Association of Residents in Radiation Oncology conducted a nationwide survey of all radiation oncology chief residents in the United States. Chi-square statistics were used to assess changes in clinical training and resident working conditions over time. Results: Surveys were completed by representatives from 55 programs (response rate, 71.4%) in 2005 to 2006, 60 programs (75.9%) in 2006 to 2007, and 74 programs (93.7%) in 2007 to 2008. Nearly all chief residents reported receiving adequate clinical experience in commonly treated disease sites, such as breast and genitourinary malignancies; and commonly performed procedures, such as three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Clinical experience in extracranial stereotactic radiotherapy increased over time (p < 0.001), whereas clinical experience in endovascular brachytherapy (p <0.001) decreased over time. The distribution of gynecologic and prostate brachytherapy cases remained stable, while clinical case load in breast brachytherapy increased (p = 0.006). A small but significant percentage of residents reported receiving inadequate clinical experience in pediatrics, seeing 10 or fewer pediatric cases during the course of residency. Procedures involving higher capital costs, such as particle beam therapy and intraoperative radiotherapy, and infrequent clinical use, such as head and neck brachytherapy, were limited to a minority of institutions. Most residency programs associated with at least one satellite facility have incorporated resident rotations into their clinical training, and the majority of residents at these programs find them valuable experiences. The majority of residents reported working 60 or fewer hours per week on required clinical duties

  8. Ethical issues of clinical trials in paediatric oncology from 2003 to 2013: a systematic review.

    Science.gov (United States)

    Dupont, Jean-Claude K; Pritchard-Jones, Kathy; Doz, François

    2016-05-01

    A state-of-the art approach to the debates on ethical issues is key in order to gain guidance on research practices involving sick children and adolescents, as well as to identify research avenues in which it might be worth cooperating, to generate better or supplementary evidence. Based on a systematic literature search using MEDLINE, we report the main ethical developments in paediatric oncology clinical trials from 2003-13. The present knowledge about normative and empirical ethical demands in this setting is quantified and summarised in a list of 46 issues. This list primarily aims to provide readers with a comprehensive account of the main decision nodes and professional attitudes that enable families to make a safe, competent, and satisfactory decision about their child's enrolment, or non-participation, in cancer clinical trials. Our systematic Review shows how important it is for professionals to engage in a constant reflection on optimum trial designs, on the effect of offering trial participation on key family dynamics, and on the ways to understand families' needs and values accurately. In view of present scientific developments, we further emphasise the need to enhance societal awareness about research in children and adolescents, to prevent so-called research fatigue in small populations due to multiple solicitations or inadequate legal demands, and to reassess longstanding ethical certainties in the strictest view of promoting sick children's interests. This systematic Review allows a series of questions to be drawn to guide and encourage collective and individual endeavours that should lead to constant improvements in our research practices in paediatric clinical oncology research. PMID:27301046

  9. Design and characterization of the beam monitor detectors of the Italian National Center of Oncological Hadron-therapy (CNAO)

    International Nuclear Information System (INIS)

    A new hadron-therapy facility implementing an active beam scanning technique has been developed at the Italian National Center of Oncological Hadron-therapy (CNAO). This paper presents the design and the characterization of the beam monitor detectors developed for the on-line monitoring and control of the dose delivered during a treatment at CNAO. The detectors are based on five parallel-plate transmission ionization chambers with either a single large electrode or electrodes segmented in 128 strips (strip chambers) and 32×32 pixels (pixel chamber). The detectors are arranged in two independent boxes with an active area larger than 200×200 mm2 and a total water equivalent thickness along the beam path of about 0.9 mm. A custom front-end chip with 64 channels converts the integrated ionization channels without dead-time. The detectors were tested at the clinical proton beam facility of the Paul Scherrer Institut (PSI) which implements a spot scanning technique, each spot being characterized by a predefined number of protons delivered with a pencil beam in a specified point of the irradiation field. The short-term instability was measured by delivering several identical spots in a time interval of few tenths of seconds and is found to be lower than 0.3%. The non-uniformity, measured by delivering sequences of spots in different points of the detector surface, results to be lower than 1% in the single electrode chambers and lower than 1.5% in the strip and pixel chambers, reducing to less than 0.5% and 1% in the restricted 100×100 mm2 central area of the detector.

  10. Testing for anaplastic lymphoma kinase rearrangement to target crizotinib therapy: oncology, pathology and health economic perspectives.

    Science.gov (United States)

    Lee, James A; Bubendorf, Lukas; Stahel, Rolf; Peters, Solange

    2013-05-01

    Crizotinib is a first-in-class oral anaplastic lymphoma kinase (ALK) inhibitor targeting ALK-rearranged non-small-cell lung cancer. The therapy was approved by the US FDA in August 2011 and received conditional marketing approval by the European Commission in October 2012 for advanced non-small-cell lung cancer. A break-apart FISH-based assay was jointly approved with crizotinib by the FDA. This assay and an immunohistochemistry assay that uses a D5F3 rabbit monoclonal primary antibody were also approved for marketing in Europe in October 2012. While ALK rearrangement has relatively low prevalence, a clinical benefit is exhibited in more than 85% of patients with median progression-free survival of 8-10 months. In this article, the authors summarize the therapy and alternative test strategies for identifying patients who are likely to respond to therapy, including key issues for effective and efficient testing. The key economic considerations regarding the joint companion diagnostic and therapy are also presented. Given the observed clinical benefit and relatively high cost of crizotinib therapy, companion diagnostics should be evaluated relative to response to therapy versus correlation alone whenever possible, and both high inter-rater reliability and external quality assessment programs are warranted. PMID:23617353

  11. The roots of modern oncology: from discovery of new antitumor anthracyclines to their clinical use.

    Science.gov (United States)

    Cassinelli, Giuseppe

    2016-06-01

    In May 1960, the Farmitalia CEO Dr. Bertini and the director of the Istituto Nazionale dei Tumori of Milan Prof. Bucalossi (talent scout and city's Mayor) signed a research agreement for the discovery and development up to clinical trials of new natural antitumor agents. This agreement can be considered as a pioneering and fruitful example of a translational discovery program with relevant transatlantic connections. Owing to an eclectic Streptomyces, found near Castel del Monte (Apulia), and to the skilled and motivated participants of both institutions, a new natural antitumor drug, daunomycin, was ready for clinical trials within 3 years. Patent interference by the Farmitalia French partner was overcome by the good quality of the Italian drug and by the cooperation between Prof. Di Marco, director of the Istituto Ricerche Farmitalia Research Laboratories for Microbiology and Chemotherapy, and Prof. Karnofsky, head of the Sloan-Kettering Cancer Institute of New York, leading to the first transatlantic clinical trials. The search for daunomycin's sister anthracyclines led to the discovery and development of adriamycin, one of the best drugs born in Milan. This was the second act prologue of the history of Italian antitumor discovery and clinical oncology, which started in July 1969 when Prof. Di Marco sent Prof. Bonadonna the first vials of adriamycin (doxorubicin) to be tested in clinical trials. This article reviews the Milan scene in the 1960s, a city admired and noted for the outstanding scientific achievements of its private and public institutions in drugs and industrial product discovery. PMID:27103205

  12. Cancer pain management by radiotherapists: a survey of radiation therapy oncology group physicians

    International Nuclear Information System (INIS)

    Purpose: Radiation Therapy Oncology Group (RTOG) physicians were surveyed to determine their approach to and attitudes toward cancer pain management. Methods and Materials: Physicians completed a questionnaire assessing their estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of pain management, and their report of how they manage pain in their own practice setting. Results: Eighty-three percent believed the majority of cancer patients with pain were undermedicated. Forty percent reported that pain relief in their own practice setting was poor or fair. Assessing a case scenario, 23% would wait until the patient's prognosis was 6 months or less before starting maximal analgesia. Adjuvants and prophylactic side effect management were underutilized in the treatment plan. Barriers to pain management included poor pain assessment (77%), patient reluctance to report pain (60%), patient reluctance to take analgesics (72%), and staff reluctance to prescribe opioids (41%). Conclusions: Physicians' perceptions of barriers to cancer pain management remain quite stable over time, and physicians continue to report inadequate pain treatment education. Future educational efforts should target radiation oncologists as an important resource for the treatment of cancer pain

  13. Strategic Plans to Promote Head and Neck Cancer Translational Research Within the Radiation Therapy Oncology Group: A Report From the Translational Research Program

    International Nuclear Information System (INIS)

    Head and neck cancer is the fifth most common cancer in the United States, with an overall survival rate of approximately 40-50%. In an effort to improve patient outcomes, research efforts designed to maximize benefit and reduce toxicities of therapy are in progress. Basic research in cancer biology has accelerated this endeavor and provided preclinical data and technology to support clinically relevant advances in early detection, prognostic and predictive biomarkers. Recent completion of the Human Genome Project has promoted the rapid development of novel 'omics' technologies that allow more broad based study from a systems biology perspective. However, clinically relevant application of resultant gene signatures to clinical trials within cooperative groups has advanced slowly. In light of the large numbers of variables intrinsic to biomarker studies, validation of preliminary data for clinical implementation presents a significant challenge and may only be realized with large trials that involve significant patient numbers. The Radiation Therapy Oncology Group (RTOG) Head and Neck Cancer Translational Research Program recognizes this problem and brings together three unique features to facilitate this research: (1) availability of large numbers of clinical specimens from homogeneously treated patients through multi-institutional clinical trials; (2) a team of physicians, scientists, and staff focused on patient-oriented head-and-neck cancer research with the common goal of improving cancer care; and (3) a funding mechanism through the RTOG Seed Grant Program. In this position paper we outline strategic plans to further promote translational research within the framework of the RTOG

  14. The clinical case for proton beam therapy

    International Nuclear Information System (INIS)

    Over the past 20 years, several proton beam treatment programs have been implemented throughout the United States. Increasingly, the number of new programs under development is growing. Proton beam therapy has the potential for improving tumor control and survival through dose escalation. It also has potential for reducing harm to normal organs through dose reduction. However, proton beam therapy is more costly than conventional x-ray therapy. This increased cost may be offset by improved function, improved quality of life, and reduced costs related to treating the late effects of therapy. Clinical research opportunities are abundant to determine which patients will gain the most benefit from proton beam therapy. We review the clinical case for proton beam therapy. Proton beam therapy is a technically advanced and promising form of radiation therapy

  15. The clinical case for proton beam therapy

    Directory of Open Access Journals (Sweden)

    Foote Robert L

    2012-10-01

    Full Text Available Abstract Over the past 20 years, several proton beam treatment programs have been implemented throughout the United States. Increasingly, the number of new programs under development is growing. Proton beam therapy has the potential for improving tumor control and survival through dose escalation. It also has potential for reducing harm to normal organs through dose reduction. However, proton beam therapy is more costly than conventional x-ray therapy. This increased cost may be offset by improved function, improved quality of life, and reduced costs related to treating the late effects of therapy. Clinical research opportunities are abundant to determine which patients will gain the most benefit from proton beam therapy. We review the clinical case for proton beam therapy. Summary sentence Proton beam therapy is a technically advanced and promising form of radiation therapy.

  16. The evolution of radiation therapy oncology group (RTOG) protocols for nonsmall cell lung cancer

    International Nuclear Information System (INIS)

    Over the past 2 decades, the Radiation Therapy Oncology Group (RTOG) has played a significant role in clarifying the role of radiation therapy (RT) in the treatment of nonsmall cell lung cancer (NSCLC). RTOG lung cancer research has evolved over this time period through a systematic succession of investigations. For unresectable NSCLC, the dependence of local tumor control and survival on total dose of standard fractionation RT, as well as pretreatment performance characteristics, was demonstrated in initial RTOG trials. Subsequently, further radiation dose intensification was tested using altered fractionation RT to total doses up to 32% higher than standard RT to 60 Gy, given as either hyperfractionation or accelerated fractionation, while attempting to retain acceptable normal tissue toxicity. These higher doses required rethinking of established RT techniques and limitations, as well as careful surveillance of acute and late toxicity. A survival advantage was shown for hyperfractionation to 69.6 Gy, in favorable performance patients, compared to 60 Gy. Further testing of high dose standard RT will use three-dimensional, conformal techniques to minimize toxicity. RTOG further extended the theme of treatment intensification for unresectable NSCLC by evaluating combined chemotherapy (CT) and RT. Improved local control and survival was shown for induction CT followed by standard RT to 60 Gy, compared to standard RT (60 Gy) and altered fractionation RT (69.6 Gy). The intent of current studies is to optimize dose and scheduling of combined CT and standard RT, as well as combined CT and altered fractionation RT. Noncytotoxic RT adjuvants, such as hypoxic cell sensitizers, nonspecific immune stimulants, and biologic response modifiers have also been studied. Resectable NSCLC has also been an RTOG focus, with studies of preoperative and postoperative RT, CT, and CT/RT, including the prognostic value of serum and tissue factors. RTOG studies have yielded incremental

  17. Impact of an oncology palliative care clinic on access to home care services.

    Science.gov (United States)

    Jang, Raymond W; Burman, Debika; Swami, Nadia; Kotler, Jennifer; Banerjee, Subrata; Ridley, Julia; Mak, Ernie; Bryson, John; Rodin, Gary; Le, Lisa W; Zimmermann, Camilla

    2013-08-01

    Home care (HC) is important for patients with cancer as performance status declines. Our study of 1224 patients at a Canadian cancer center examined the impact of an oncology palliative care clinic (OPCC) on HC referral. The HC referral frequency was calculated before and after the first OPCC consultation, in total and according to performance status (Palliative Performance Scale, PPS). Characteristics associated with HC referral were investigated. After the first OPCC consultation, there was an increase in HC referral from 39% (477 of 1224; 49% of those with PPS ≤60) to 69% (841 of 1224; 88% of those with PPS ≤60). Factors independently associated with HC referral were poor PPS (P < .001) and older age (P = .003). Thus OPCC involvement resulted in markedly increased HC referrals, particularly for older patients with poor performance status. PMID:22777408

  18. Research biopsies in the context of early phase oncology studies: clinical and ethical considerations

    Directory of Open Access Journals (Sweden)

    Matilde Saggese

    2013-08-01

    Full Text Available The Personalized Medicine approach in oncology is a direct result of an improved understanding of complex tumor biology and advances in diagnostic technologies. In recent years, there has been an increased demand for archival and fresh tumor analysis in early clinical trials to foster proof-of-concept biomarker development, to understand resistance mechanisms, and ultimately to assess biological response. Although phase I studies are aimed at defining drug safety, pharmacokinetics, and to recommend a phase II dose for further testing, there is now increasing evidence of mandatory tumor biopsies even at the earliest dose-finding stages of drug development. The increasing demand for fresh tumor biopsies adds to the complexity of novel phase I studies and results in different challenges, ranging from logistical support to ethical concerns. This paper investigates key issues, including patients’ perceptions of research biopsies, the need for accurate informed consent, and alternative strategies that may guide the drug development process.

  19. Research biopsies in the context of early phase oncology studies: clinical and ethical considerations

    Directory of Open Access Journals (Sweden)

    Matilde Saggese

    2013-04-01

    Full Text Available The ‘Personalised medicine’ approach in oncology is a direct result of improved understanding of complex tumour biology and advances in diagnostic technologies. In recent years there has been an increased demand for archival and fresh tumour analysis in early clinical trials to foster-proof-of-concept biomarker development, understand resistance mechanisms and ultimately to assess biological response. Although phase-1 studies are aimed to define drug safety, pharmacokinetics and to recommend a phase-2 dose for further testing, there is now increasing evidence of mandatory tumour biopsies even at the earliest dose-finding stages of drug development. The increasing demand for fresh tumour biopsies adds to the complexity of novel phase-1 studies and results in different challenges ranging from logistical support to ethical concerns. This paper investigates key issues including patients’ perceptions towards research biopsies, the need for accurate informed consent and alternative strategies that may guide in the drug development process.

  20. Clinical guidance on the perioperative use of targeted agents in solid tumor oncology.

    Science.gov (United States)

    Mellor, James D; Cassumbhoy, Michelle; Jefford, Michael

    2011-06-01

    The use of targeted anti-cancer agents is increasing. It is common to utilize a multi-modal treatment approach towards solid tumors, often including surgical resection, and it has become apparent that some targeted agents can impair wound healing or cause an increased risk of perioperative complications. This article reviews targeted agents used in solid tumor oncology with an emphasis on clinically relevant details. Overall, the evidence of targeted agents causing surgical complications is limited. The greatest amount of evidence exists for bevacizumab causing perioperative complications, possibly due to its extended half-life. There are limited data for cetuximab, sorafenib and sunitinib and very little for other solid tumor targeted agents. Our findings suggest that there should be heightened pharmacovigilence around targeted agents with respect to perioperative complications and increased post-surgical support for patients to aid early detection of postoperative complications until definitive data become available. PMID:21585689

  1. The prognostic value of nestin expression in newly diagnosed glioblastoma: Report from the Radiation Therapy Oncology Group

    International Nuclear Information System (INIS)

    Nestin is an intermediate filament protein that has been implicated in early stages of neuronal lineage commitment. Based on the heterogeneous expression of nestin in GBM and its potential to serve as a marker for a dedifferentiated, and perhaps more aggressive phenotype, the Radiation Therapy Oncology Group (RTOG) sought to determine the prognostic value of nestin expression in newly diagnosed GBM patients treated on prior prospective RTOG clinical trials. Tissue microarrays were prepared from 156 patients enrolled in these trials. These specimens were stained using a mouse monoclonal antibody specific for nestin and expression was measured by computerized quantitative image analysis using the Ariol SL-50 system. The parameters measured included both staining intensity and the relative area of expression within a specimen. This resulted into 3 categories: low, intermediate, and high nestin expression, which was then correlated with clinical outcome. A total of 153 of the 156 samples were evaluable for this study. There were no statistically significant differences between pretreatment patient characteristics and nestin expression. There was no statistically significant difference in either overall survival or progression-free survival (PFS) demonstrated, although a trend in decreased PFS was observed with high nestin expression (p = 0.06). Although the correlation of nestin expression and histologic grade in glioma is of considerable interest, the presented data does not support its prognostic value in newly diagnosed GBM. Further studies evaluating nestin expression may be more informative when studied in lower grade glioma, in the context of markers more specific to tumor stem cells, and using more recent specimens from patients treated with temozolomide in conjunction with radiation

  2. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

    OpenAIRE

    Lalla, Rajesh V.; Bowen, Joanne; Barasch, Andrei; Elting, Linda; Epstein, Joel; Keefe, Dorothy M.; McGuire, Deborah B.; Migliorati, Cesar; Nicolatou‐Galitis, Ourania; Peterson, Douglas E.; Raber‐Durlacher, Judith E.; Sonis, Stephen T.; Elad, Sharon; ,

    2014-01-01

    BACKGROUND Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis. METHODS A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewer...

  3. Non-surgical management of early breast cancer in the United Kingdom: follow-up. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.

    Science.gov (United States)

    Maher, E J

    1995-01-01

    Follow-up of operable breast cancer patients takes up a significant proportion of British oncologists' time, with 90% seeing 5-50 patients each week. Procedures vary greatly, but, in patients treated by surgery and radiotherapy, care is usually shared, with alternating visits to see each team. Currently, the general practitioner has sole responsibility for follow-up in less than 3% of patients. They tend to be followed up in general, rather than specialist, clinics. There is almost universal agreement that routine blood tests, radiographs and scans are not indicated as part of routine follow-up, but the role of mammography in evaluating an irradiated breast remains a source of debate. Just over a half of the oncologists surveyed order baseline mammography of both treated and contralateral breasts, usually between 6 and 12 months after local excision and radiotherapy, with further follow-up 1-3-yearly thereafter. Ten per cent of the participating oncologists never suggest follow-up mammography. Patients tend to be followed in oncology clinics at 3-4-monthly intervals for the first 2 years, 6-monthly in the third and fourth years and, thereafter, yearly. Fifteen per cent of oncologists discharge patients at 5 years, with the discharge rate rising to 43% at 10 years; around one-third modify follow-up according to the age of the patient. The aims of follow-up were seen to include detection of curable disease, but other goals were perceived as equally important (e.g. detection of iatrogenic problems, audit, counselling, education and the provision of early palliation of incurable and metastatic disease. Breast cancer is no longer seen as an absolute contraindication to either pregnancy or the use of hormone replacement therapy (HRT); however, oncologists are uncertain about the appropriate use of HRT, either alone or with tamoxifen. This audit highlights a number of research areas: the identification of the appropriate site and skill-mix for follow-up of patients

  4. Design, development of water tank-type lung phantom and dosimetric verification in institutions participating in a phase I study of stereotactic body radiation therapy in patients with T2N0M0 non-small cell lung cancer: Japan Clinical Oncology Group trial (JCOG0702)

    International Nuclear Information System (INIS)

    A domestic multicenter phase I study of stereotactic body radiotherapy (SBRT) for T2N0M0 non-small cell lung cancer in inoperable patients or elderly patients who refused surgery was initiated as the Japan Clinical Oncology Group trial (JCOG0702) in Japan. Prior to the clinical study, the accuracy of dose calculation in radiation treatment-planning systems was surveyed in participating institutions, and differences in the irradiating dose between the institutions were investigated. We developed a water tank-type lung phantom appropriate for verification of the exposure dose in lung SBRT. Using this water tank-type lung phantom, the dose calculated in the radiation treatment-planning system and the measured dose using a free air ionization chamber and dosimetric film were compared in a visiting survey of the seven institutions participating in the clinical study. In all participating institutions, differences between the calculated and the measured dose in the irradiation plan were as follows: the accuracy of the absolute dose in the center of the simulated tumor measured using a free air ionization chamber was within 2%, the mean gamma value was ≤0.47 on gamma analysis following the local dose criteria, and the pass rate was >87% for 3%/3 mm from measurement of dose distribution with dosimetric film. These findings confirmed the accuracy of delivery doses in the institutions participating in the clinical study, so that a study with integration of the institutions could be initiated

  5. THERAPIES FOR CROHN'S DISEASE: a clinical update.

    Science.gov (United States)

    Sobrado, Carlos Walter; Leal, Raquel Franco; Sobrado, Lucas Faraco

    2016-01-01

    The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease. PMID:27438429

  6. Next-Generation Sequencing in Clinical Oncology: Next Steps Towards Clinical Validation

    OpenAIRE

    Nigel C Bennett; Farah, Camile S.

    2014-01-01

    Compelling evidence supports the transition of next generation sequencing (NGS) technology from a research environment into clinical practice. Before NGS technologies are fully adopted in the clinic, they should be thoroughly scrutinised for their potential as powerful diagnostic and prognostic tools. The importance placed on generating accurate NGS data, and consequently appropriate clinical interpretation, has stimulated much international discussion regarding the creation and implementatio...

  7. MET targeted therapy for lung cancer: clinical development and future directions

    Directory of Open Access Journals (Sweden)

    Feng Y

    2012-08-01

    Full Text Available Yan Feng,1,2 Patrick C Ma1–31Translational Hematology and Oncology Research, 2Solid Tumor Oncology, 3Aerodigestive Oncology Translational Research, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USAAbstract: MET, the receptor for hepatocyte growth factor, has been identified as a novel promising target in various human malignancies, including lung cancer. Research studies have demonstrated that MET signaling plays important physiologic roles in embryogenesis and early development, whereas its deregulation from an otherwise quiescent signaling state in mature adult tissues can lead to upregulated cell proliferation, survival, scattering, motility and migration, angiogenesis, invasion, and metastasis in tumorigenesis and tumor progression. The MET pathway can be activated through ligand (hepatocyte growth factor, HGF or MET receptor overexpression, genomic amplification, MET mutations, and alternative splicing. A number of novel therapeutic agents that target the MET/hepatocyte growth factor pathway have been tested in early-phase clinical studies with promising results. Phase III studies of MET targeting agents have recently been initiated. This paper will review the MET signaling pathway and biology in lung cancer, and the recent clinical development and advances of MET/hepatocyte growth factor targeting agents. Emphasis will be placed on discussing various unanswered issues and key strategies needed to optimize further clinical development of MET targeting personalized lung cancer therapy.Keywords: MET, HGF, lung cancer, targeted therapy

  8. Clinical cancer advances 2007: major research advances in cancer treatment, prevention, and screening--a report from the American Society of Clinical Oncology.

    Science.gov (United States)

    Gralow, Julie; Ozols, Robert F; Bajorin, Dean F; Cheson, Bruce D; Sandler, Howard M; Winer, Eric P; Bonner, James; Demetri, George D; Curran, Walter; Ganz, Patricia A; Kramer, Barnett S; Kris, Mark G; Markman, Maurie; Mayer, Robert J; Raghavan, Derek; Ramsey, Scott; Reaman, Gregory H; Sawaya, Raymond; Schuchter, Lynn M; Sweetenham, John W; Vahdat, Linda T; Davidson, Nancy E; Schilsky, Richard L; Lichter, Allen S

    2008-01-10

    A MESSAGE FROM ASCO'S PRESIDENT: For the third year, the American Society of Clinical Oncology (ASCO) is publishing Clinical Cancer Advances: Major Research Advances in Cancer Treatment, Prevention, and Screening, an annual review of the most significant cancer research presented or published over the past year. ASCO publishes this report to demonstrate the important progress being made on the front lines of clinical cancer research today. The report is intended to give all those with an interest in cancer care-the general public, cancer patients and organizations, policymakers, oncologists, and other medical professionals-an accessible summary of the year's most important cancer research advances. These pages report on the use of magnetic resonance imaging for breast cancer screening, the association between hormone replacement therapy and breast cancer incidence, the link between human papillomavirus and head and neck cancers, and the use of radiation therapy to prevent lung cancer from spreading. They also report on effective new targeted therapies for cancers that have been historically difficult to treat, such as liver cancer and kidney cancer, among many others. A total of 24 advances are featured in this year's report. These advances and many more over the past several years show that the nation's long-term investment in cancer research is paying off. But there are disturbing signs that progress could slow. We are now in the midst of the longest sustained period of flat government funding for cancer research in history. The budgets for the National Institutes of Health and the National Cancer Institute (NCI) have been unchanged for four years. When adjusted for inflation, cancer research funding has actually declined 12% since 2004. These budget constraints limit the NCI's ability to fund promising cancer research. In the past several years the number of grants that the NCI has been able to fund has significantly decreased; this year, in response to just the

  9. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

    Energy Technology Data Exchange (ETDEWEB)

    Velde, Joris van de [Ghent University, Department of Anatomy, Ghent (Belgium); Ghent University, Department of Radiotherapy, Ghent (Belgium); Vercauteren, Tom; Gersem, Werner de; Vandecasteele, Katrien; Vuye, Philippe; Vanpachtenbeke, Frank; Neve, Wilfried de [Ghent University, Department of Radiotherapy, Ghent (Belgium); Wouters, Johan; Herde, Katharina d' ; Kerckaert, Ingrid; Hoof, Tom van [Ghent University, Department of Anatomy, Ghent (Belgium)

    2014-07-15

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.) [German] Ziel der Studie war

  10. Older Age Predicts Decreased Metastasis and Prostate Cancer-Specific Death for Men Treated With Radiation Therapy: Meta-Analysis of Radiation Therapy Oncology Group Trials

    International Nuclear Information System (INIS)

    Purpose: The impact of age on prostate cancer (PCa) outcome has been controversial; therefore, we analyzed the effect of age on overall survival (OS), distant metastasis, prostate cancer-specific death (PCSD), and nonprostate cancer death (NPCD) on patients with locally advanced PCa. Methods and Materials: Patients who participated in four Radiation Therapy Oncology Group (RTOG) phase III trials, 8531, 8610, 9202, and 9413, were studied. Cox proportional hazards regression was used for OS analysis, and cumulative events analysis with Fine and Gray’s regression was used for analyses of metastasis, PCSD, and NPCD. Results: Median follow-up of 4,128 patients with median age of 70 (range, 43-88 years) was 7.3 years. Most patients had high-risk disease: cT3 to cT4 (54%) and Gleason scores (GS) of 7 (45%) and 8 to 10 (27%). Older age (≤70 vs. >70 years) predicted for decreased OS (10-year rate, 55% vs. 41%, respectively; p 70 years remained associated with decreased OS (hazard ratio [HR], 1.56 [95% confidence interval [CI], 1.43-1.70] p < 0.0001) but with decreased metastasis (HR, 0.72 [95% CI, 0.63-0.83] p < 0.0001) and PCSD (HR, 0.78 [95% CI, 0.66-0.92] p < 0.0001). Finally, the impact of the duration of androgen deprivation therapy as a function of age was evaluated. Conclusions: These data support less aggressive PCa in older men, independent of other clinical features. While the biological underpinning of this finding remains unknown, stratification by age in future trials appears to be warranted.

  11. Validation and Simplification of the Radiation Therapy Oncology Group Recursive Partitioning Analysis Classification for Glioblastoma

    International Nuclear Information System (INIS)

    Purpose: Previous recursive partitioning analysis (RPA) of patients with malignant glioma (glioblastoma multiforme [GBM] and anaplastic astrocytoma [AA]) produced six prognostic groups (I-VI) classified by six factors. We sought here to determine whether the classification for GBM could be improved by using an updated Radiation Therapy Oncology Group (RTOG) GBM database excluding AA and by considering additional baseline variables. Methods and Materials: The new analysis considered 42 baseline variables and 1,672 GBM patients from the expanded RTOG glioma database. Patients receiving radiation only were excluded such that all patients received radiation+carmustine. 'Radiation dose received' was replaced with 'radiation dose assigned.' The new RPA models were compared with the original model by applying them to a test dataset comprising 488 patients from six other RTOG trials. Fitness of the original and new models was evaluated using explained variation. Results: The original RPA model explained more variations in survival in the test dataset than did the new models (20% vs. 15%) and was therefore chosen for further analysis. It was reduced by combining Classes V and VI to produce three prognostic classes (Classes III, IV, and V+VI), as Classes V and VI had indistinguishable survival in the test dataset. The simplified model did not further improve performance (explained variation 18% vs. 20%) but is easier to apply because it involves only four variables: age, performance status, extent of resection, and neurologic function. Applying this simplified model to the updated GBM database resulted in three distinct classes with median survival times of 17.1, 11.2, and 7.5 months for Classes III, IV, and V+VI, respectively. Conclusions: The final model, the simplified original RPA model combining Classes V and VI, resulted in three distinct prognostic groups defined by age, performance status, extent of resection, and neurologic function. This classification will be used

  12. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring

    International Nuclear Information System (INIS)

    The goal of this work was to validate the Radiation Therapy Oncology Group (RTOG)-endorsed guidelines for brachial plexus (BP) contouring by determining the intra- and interobserver agreement. Accuracy of the delineation process was determined using anatomically validated imaging datasets as a gold standard. Five observers delineated the right BP on three cadaver computed tomography (CT) datasets. To assess intraobserver variation, every observer repeated each delineation three times with a time interval of 2 weeks. The BP contours were divided into four regions for detailed analysis. Inter- and intraobserver variation was verified using the Computerized Environment for Radiation Research (CERR) software. Accuracy was measured using anatomically validated fused CT-magnetic resonance imaging (MRI) datasets by measuring the BP inclusion of the delineations. The overall kappa (κ) values were rather low (mean interobserver overall κ: 0.29, mean intraobserver overall κ: 0.45), indicating poor inter- and intraobserver reliability. In general, the κ coefficient decreased gradually from the medial to lateral BP regions. The total agreement volume (TAV) was much smaller than the union volume (UV) for all delineations, resulting in a low Jaccard index (JI; interobserver agreement 0-0.124; intraobserver agreement 0.004-0.636). The overall accuracy was poor, with an average total BP inclusion of 38 %. Inclusions were insufficient for the most lateral regions (region 3: 21.5 %; region 4: 12.6 %). The inter- and intraobserver reliability of the RTOG-endorsed BP contouring guidelines was poor. BP inclusion worsened from the medial to lateral regions. Accuracy assessment of the contours showed an average BP inclusion of 38 %. For the first time, this was assessed using the original anatomically validated BP volume. The RTOG-endorsed BP guidelines have insufficient accuracy and reliability, especially for the lateral head-and-neck regions. (orig.)

  13. External evaluation of the Radiation Therapy Oncology Group brachial plexus contouring protocol: several issues identified

    International Nuclear Information System (INIS)

    The aims of the study were to evaluate interobserver variability in contouring the brachial plexus (BP) using the Radiation Therapy Oncology Group (RTOG)-approved protocol and to analyse BP dosimetries. Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computed-tomography images and anteroposterior digitally reconstructed radiographs) and quantitatively (by volumetric and statistical analyses). Dose–volume histograms of BPs were calculated and compared. We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper, with a mean volume of 20.8cc (range 11–40.7 cc) compared with 33±4cc (25.1–39.4cc). The average values of mean dose, maximum dose, V60Gy, V66Gy and V70Gy for patients treated with conventional radiotherapy and IMRT were 42.2Gy versus 44.8Gy, 64.5Gy versus 68.5Gy, 6.1% versus 7.6%, 2.9% versus 2.4% and 0.6% versus 0.3%, respectively. This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping, especially when using IMRT, the RTOG atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term brachial-plexus regions (BPRs) to represent regions where BPs are likely to be present. Consequently, BPRs should in principle be contoured generously.

  14. Coenzyme Q10 therapy in current clinical practice

    Directory of Open Access Journals (Sweden)

    Abhishek Soni

    2015-04-01

    Full Text Available Coenzyme Q10 (CoQ10 is a naturally occurring, lipid soluble, essential compound and is also known as ubiquinone. CoQ10 acts as an intermediate of the electron transport chain situated in membrane of mitochondria and vital for ATP production and cellular respiration. CoQ10 also serves as an intercellular antioxidant. All the clinical use of CoQ10 are based upon these two functions. CoQ10 levels are altered in a number of oncological as well as non-oncological diseases. Furthermore, recent data indicate that CoQ10 has an impact on the expression of many genes involved in metabolism, cellular transport, transcription control, and cell signaling, making CoQ10 a potent gene regulator. CoQ10 supplementation is useful in diseases associated with CoQ10 deficiency which includes primary and secondary CoQ10 deficiencies, fibromyalgia, diabetes mellitus, mitochondrial diseases, neurodegenerative diseases, cardiovascular disease, cancer, male infertility and periodontal disease. Clinical presentations of severe CoQ10 deficiency include severe infantile multisystemic disease, encephalomyopathy, isolated myopathy cerebellar ataxia and Leigh syndrome with growth retardation. Oral CoQ10 administration can correct CoQ10 deficiency since it increases CoQ10 tissue levels. CoQ10 therapy has no serious side effects in humans and new formulations have been developed that increase CoQ10 absorption and tissue distribution. Future trends involving CoQ10 in many diseases needs more clinical trials for better understanding of CoQ10 efficacy. [Int J Res Med Sci 2015; 3(4.000: 817-825

  15. Phase II study of topotecan plus cranial radiation for glioblastoma multiforme: results of Radiation Therapy Oncology Group 9513

    International Nuclear Information System (INIS)

    Purpose: A Phase II trial was conducted by the Radiation Therapy Oncology Group (RTOG) to compare the survival of patients with glioblastoma multiforme treated with topotecan combined with standard cranial radiotherapy (RT) for matched patients treated in prior RTOG studies. A secondary objective was to document the acute and late toxicities of this combination of chemotherapy and RT. Methods and Materials: Eighty-seven patients with histologically confirmed glioblastoma multiforme received standard cranial RT (60 Gy/30 fractions in 6 weeks) plus topotecan 1.5 mg/m2 per day i.v. for 5 d/wk every 3 weeks for 3 cycles. Eighty-four patients were evaluated, of whom 60 (71%) were ≥50 years, 44 (52%) were men, and 61 (73%) had a Karnofsky performance status of ≥80. Twenty-nine percent of patients had undergone biopsies, 48% partial resections, and 21% gross total resections. Two resections were unspecified as to the extent of tumor removal. Fourteen percent of patients were recursive partitioning analysis Class III, 46% were Class IV, 35% were Class V, and 5% were Class VI. Results: The median survival was 9.3 months. Sixty-seven patients (80%) had progression. The 1-year survival rate was 32%. One patient remained alive without recurrence. RTOG 9513 patients were matched with patients in an RTOG clinical trial database from previous clinical trials. The matching variables were age, Karnofsky performance status, mental status, and prior surgery. No statistically significant difference was found between the survival of the study patients and that of the matched patients from the RTOG database. Fifty-four percent of patients had Grade IV acute toxicity. The toxicity was primarily hematologic. Four patients had Grade III late central nervous system toxicities. Conclusion: Topotecan administered at a dose of 1.5 mg/m2 per day i.v. for 5 d/wk every 3 weeks for 3 cycles given concurrently with standard cranial RT for glioblastoma does not produce a statistically

  16. Behavior therapy: a clinical update.

    Science.gov (United States)

    Black, J L; Bruce, B K

    1989-11-01

    Through refinements from research and judicious combination with other therapies, behavior therapy has become increasingly relevant in the treatment of psychiatric disorders. After outlining the four models that serve as a framework for behavior therapy (classical conditioning, operant conditioning, social learning theory, and cognitive behavior modification), the authors provide an update for clinicians on developments in the behavioral treatment of anxiety disorders, sexual disorders, depression, and schizophrenia. Most advances have been made in the treatment of anxiety disorders, including definition of variables for successful use of exposure to phobic stimuli in the treatment of phobic disorders and the use of flooding for post-traumatic stress disorder. By becoming better acquainted with cognitive and behavioral therapies, clinicians may be able to offer their patients more effective treatment options. PMID:2680882

  17. Gene therapy in clinical medicine

    OpenAIRE

    Selkirk, S

    2004-01-01

    Although the field of gene therapy has experienced significant setbacks and limited success, it is one of the most promising and active research fields in medicine. Interest in this therapeutic modality is based on the potential for treatment and cure of some of the most malignant and devastating diseases affecting humans. Over the next decade, the relevance of gene therapy to medical practices will increase and it will become important for physicians to understand the basic principles and st...

  18. Perceptions and Referral Trends into Phase I Oncology Trials: Results of a Clinical Survey

    Directory of Open Access Journals (Sweden)

    Andre Brunetto

    2011-01-01

    Full Text Available Introduction. A survey was sent to referring oncologists (ROs to explore the reasons behind their referral patterns and perceptions of Phase I studies before and after being provided with outcome data from advanced colorectal cancer (ACRC patients who participated in Phase I trials at the Royal Marsden Hospital (RMH. Results. The response rate was 32/50 (64%. The most common reason for referral was exhaustion of standard treatments (31%, and the main reason for referring to the RMH was proximity to patients (28%. The most frequent clinical parameter assessed prior to referral was performance status (93%. ROs spent a median of 15 min (range: 5–45 min discussing general aspects of Phase I trials. In the second part of the questionnaire, after reviewing clinical outcome data of ACRC patients who participated in Phase I trials, 47% would change their approach, specifically, spend more time to discuss risks and benefits of Phase I trials (9%, consider prognostic factors before referral (13%, and increase the number of referrals (25%. Conclusion. This is the first report focusing on communication between ROs and a specialist Phase I unit. Outcome reporting can improve communication with ROs and importantly has the potential for better patient selection considered for Phase I oncology trials.

  19. Clinical Application of Heat-Acupuncture Therapy

    Institute of Scientific and Technical Information of China (English)

    Guan Zunhui; Wang Xinzhong

    2006-01-01

    @@ Heat-acupuncture therapy refers to a therapeutic method with which a GZH heat-acupuncture apparatus is used to warm the needle inserted in the human body, and to keep the needle in a constant temperature. It has been proved by clinical researches over 20 years that the heat-acupuncture therapy can yield a joint therapeutic effect of acupuncture,moxibustion, moxibustion with warming needle and fire needle, thus raising the clinical therapeutic effects in treating certain diseases.

  20. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials

    Science.gov (United States)

    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher

    2016-01-01

    Objective Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. Methods We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Results Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. Conclusion No failure risk rate per development phase is available for ATMPs. The discontinuation rate may

  1. Phase II Radiation therapy oncology group trial of weekly paclitaxel and conventional external beam radiation therapy for supratentorial glioblastoma multiforme

    International Nuclear Information System (INIS)

    Purpose: Fractionated external beam radiotherapy (EBRT) ± carmustine (BCNU) is the standard of care for patients with glioblastoma multiforme (GBM), but survival results remain poor. Preclinical studies indicate synergy between RT and paclitaxel (TAX) in astrocytoma cell lines. Phase I studies in GBM have demonstrated a maximum tolerated dose for TAX of 225 mg/m2/3 h/week x 6, during EBRT, with no exacerbation of typical RT-induced toxicities. The Radiation Therapy Oncology Group (RTOG) therefore mounted a Phase II study to determine the feasibility and efficacy of conventional EBRT and concurrent weekly TAX at its MTD. Patients and Methods: Sixty-two patients with histologic diagnosis of GBM were enrolled from 8/16/96 through 3/21/97 in a multi-institutional Phase II trial of EBRT and TAX 225 mg/m2/3 h (1-3 h before EBRT), administered the first treatment day of each RT week. Total EBRT dose was 60 Gy (200 cGy/fraction), 5 days per week. A smaller treatment field, to include gross disease plus a margin only, was used after 46 Gy. Results: Sixty-one patients (98%) were evaluable. Median age was 55 years (range, 28-78). Seventy-four percent were ≥50 years. Recursive partitioning analysis (RPA) Classes III, IV, V, VI included 10 (17%), 21 (34%), 25 (41%), and 5 (8%) patients, respectively. Gross total resection was performed in only 16%. There was no Grade 3 or 4 neutropenia or thrombocytopenia. Hypersensitivity reactions precluding further use of TAX occurred in 4 patients. There were 2 instances of late neurotoxicity (4% Grade 3 or 4). Ninety-one percent of patients received treatment per protocol. Seventy-seven percent completed prescribed treatment (6 weeks). Of 35 patients with measurable disease, CR/PR was observed in 23%, MR in 17%, and SD in 43%. Seventeen percent demonstrated progression at first follow-up. Median potential follow-up time is 20 months. Median survival is 9.7 months, with median survivals for RPA classes III, IV, V, and VI of 16.3, 10.2, 9

  2. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

    DEFF Research Database (Denmark)

    Lalla, Rajesh V; Bowen, Joanne; Barasch, Andrei;

    2014-01-01

    BACKGROUND: Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines...... clinicians provide evidence-based management of mucositis secondary to cancer therapy....... criteria. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible...

  3. Clinical Application of Photodynamic Therapy

    Institute of Scientific and Technical Information of China (English)

    LIU Hui-long; LIU Duan-qi

    2005-01-01

    Photodynamic therapy(PDT) is a new medical technology, the study on photodynamic therapy was in full swing in the past two decade. Scientists have made great progress in it. Photosensitizer,oxygen and light source play important role in photodynamic therapy.PDT is a light activated chemotherapy. A photon is adsorbed by a photosensitizer which moves the drug into an excited state. The excited drug can then pass its energy to oxygen to create a chemical radical called "singlet oxygen". Singlet oxygen attacks cellular structures by oxidation. Such oxidative damage might be oxidation of cell membranes or proteins. When the accumulation of oxidative damage exceeds a threshold level,the cell begins to die.Photodynamic therapy allows selective treatment of localized cancer. PDT involves administration of a photosensitizer to the patients, followed by delivery of light to the cancerous region. The light activates the agent which kills the cancer cells. Without light,the agent is harmless.As a new therapy,photodynamic Therapy has great Advantage in treating cancers. 1. PDT avoids systemic treatment. The treatment occurs only where light is delivered, hence the patient does not undergo go needless systemic treatment when treating localized disease. Side-effects are avoided, from losing hair or suffering nausea to more serious complications. 2. PDT is selective. The photosensitizing agent will selectively accumulate in cancer cells and not in surrounding normal tissues.Hence ,there is selective targeting of the cancer and sparing of surrounding tissues.3. when surgery is not possible. PDT kills cancer cells but does not damage collagenous tissue structures,and normal cells will repopulate these structures. Hence,if a patient has cancer in a structure that cannot be removed surgically(eg. ,the upper bronchi of the lung) ,PDT can still treat the site. 4. PDT is repeatable. Unilke radiation therapy, PDT can be used again and again. Hence,it offers a means of longterm management

  4. Implementing and Integrating a Clinically-Driven Electronic Medical Record (EMR for Radiation Oncology in a Large Medical Enterprise

    Directory of Open Access Journals (Sweden)

    John Paxton Kirkpatrick

    2013-04-01

    Full Text Available Purpose/Objective: While our department is heavily invested in computer-based treatment planning, we historically relied on paper-based charts for management of Radiation Oncology patients. In early 2009, we initiated the process of conversion to an electronic medical record (EMR eliminating the need for paper charts. Key goals included the ability to readily access information wherever and whenever needed, without compromising safety, treatment quality, confidentiality or productivity.Methodology: In February, 2009, we formed a multi-disciplinary team of Radiation Oncology physicians, nurses, therapists, administrators, physicists/dosimetrists, and information technology (IT specialists, along with staff from the Duke Health System IT department. The team identified all existing processes and associated information/reports, established the framework for the EMR system and generated, tested and implemented specific EMR processes.Results: Two broad classes of information were identified: information which must be readily accessed by anyone in the health system versus that used solely within the Radiation Oncology department. Examples of the former are consultation reports, weekly treatment check notes and treatment summaries; the latter includes treatment plans, daily therapy records and quality assurance reports. To manage the former, we utilized the enterprise-wide system , which required an intensive effort to design and implement procedures to export information from Radiation Oncology into that system. To manage "Radiation Oncology" data, we used our existing system (ARIA, Varian Medical Systems. The ability to access both systems simultaneously from a single workstation (WS was essential, requiring new WS and modified software. As of January, 2010, all new treatments were managed solely with an EMR. We find that an EMR makes information more widely accessible and does not compromise patient safety, treatment quality or confidentiality

  5. The script concordance test in radiation oncology: validation study of a new tool to assess clinical reasoning

    International Nuclear Information System (INIS)

    The Script Concordance test (SCT) is a reliable and valid tool to evaluate clinical reasoning in complex situations where experts' opinions may be divided. Scores reflect the degree of concordance between the performance of examinees and that of a reference panel of experienced physicians. The purpose of this study is to demonstrate SCT's usefulness in radiation oncology. A 90 items radiation oncology SCT was administered to 155 participants. Three levels of experience were tested: medical students (n = 70), radiation oncology residents (n = 38) and radiation oncologists (n = 47). Statistical tests were performed to assess reliability and to document validity. After item optimization, the test comprised 30 cases and 70 questions. Cronbach alpha was 0.90. Mean scores were 51.62 (± 8.19) for students, 71.20 (± 9.45) for residents and 76.67 (± 6.14) for radiation oncologists. The difference between the three groups was statistically significant when compared by the Kruskall-Wallis test (p < 0.001). The SCT is reliable and useful to discriminate among participants according to their level of experience in radiation oncology. It appears as a useful tool to document the progression of reasoning during residency training

  6. Designing for Anxiety Therapy, Bridging Clinical and Non-Clinical

    DEFF Research Database (Denmark)

    Bertelsen, Olav Wedege; Kramp, Gunnar

    2012-01-01

    In this position paper we discuss, in terms of the concept of boundary objects, how a mobile application, the MIKAT.app, bridge between clinical intervention in anxiety therapy, and life and coping strategies outside the clinic and across phases of being a person suffering from, or having suffered...... from anxiety. Thereby, we hope to provide a counterpoint in the discussion on illness trajectories....

  7. Nuclear medicine and oncology. Hopes and challenging issues of drugs development: the usefulness of positron emission tomography (PET). An application to targeted therapy

    International Nuclear Information System (INIS)

    Thanks to breakthroughs in drug design, new kinds of treatment in oncology have been developed. These new molecules target usually a precise molecular pathway proved to be involved in the development of a malignant disease. This led to the concept of targeted therapy. Therefore, the accurate selection of patients who may experience a clinical benefit of such treatments, and the way to assess the response are still challenging issues. Molecular imaging with radiolabeled compounds seemed to be a very promising tool, as for example PET with F-18 Fluorodeoxyglucose (FDG) which allows to assess and to predict the response to a tyrosine kinase inhibitors more efficiently than conventional imaging tools. FDG is only a surrogate marker of cell proliferation. New F18 radiolabeled molecules provide more specific information about tumor biology, such as receptor expression, DNA and protein synthesis, rate of hypoxia.... The common tools (clinical and radiological assessment) are no longer sufficient to predict the clinical efficacy of these new drugs. Molecular imaging should be added in the design of clinical trials in order to detect earlier pharmaco-dynamic effects, to select responding patients and to provide proofs of efficacy of these non-cytotoxic compounds. Molecular imaging databases have to be created and cross-matched to tumor sample collections, providing consequently new 'dynamic' pathological resources. This requires that all these new F18 radiolabeled molecules have to be readily available and easy to be implemented in clinical trials. (author)

  8. Monitoring of patients in the Oncology department of the Clinical Hospital

    International Nuclear Information System (INIS)

    An important number of patients that visit the Oncology department o the Clinicas Hospital lost sight at some stage of their evolution. Our objective was to quantify the proportion of patients who are lost and describe the time spent in the service and its relationship with variables such as age, sex, origin of the patient and progress of the disease, for which we performed a descriptive observational study with an analytical component of 435 stories clinics patients with confirmed diagnosis of cancer, treated from January 2001 to December 2004, in order to have a minimum of 5 years of follow-up potential. Data were processed with Excel 2003. Patients had between 15-85 years old with a mean and median of 52 ± 14 years DS. Two hundred Seventy women and 165 were men, 232 were from the metropolitan area. The time of length of service was 0-114 months with a median of 8 and an average DS 21 months ± 27 months. As of December 2009 31 117 patients had died 36 remained in control and 282 were lost from sight. We found no relationship between age (p = 0.1) nor the state of progress of the disease at diagnosis (p = 0.21) If there were significant differences with greater probability of loss tracking men (p = 0.009) and from sites outside the metropolitan area (p = 0.04). The number of patients who are lost is very large and we must develop strategies more effective monitoring

  9. IAEA training course series TCS-37 clinical training of medical physicists specializing in radiation oncology

    International Nuclear Information System (INIS)

    Training program IAEA TCS-37 (Training course series No.37) 'Clinical Training Specializing in Radiation Oncology (2009)' was fixed to practical training syllabus at faculty and graduate course of medical physics of a university. TCS-47 for diagnostic radiology (2010) and TCS-50 for nuclear medicine (2011) were also involved in the syllabus. These training courses had been developed by IAEA RCA RAS6038 project since 2002. In this paper, first, comparison with other training programs in the world was made in terms of (1) Degree of extent of subject or field, (2) Concreteness or specificity, (3) Degree of completion, (4) Method of certification and (5) Practicability. IAEA TCS series got the most points among ten programs such as EMERALD/EMIT, AAPM rpt. No.90 and CAMPEP accredited programs. Second, TCS-37, TCS-47 and TCS-50 were broken down to 6, 5 and 6 subjects of training course respectively. Third, each subject was further broken down to 15 times of training schedule where every time was composed by 3 hours of training. Totally 45 hours of a subject were assigned to one semester for getting one unit of credit. Seventeen units should be credited up to three years in graduate course to finish the whole program. (author)

  10. American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility.

    Science.gov (United States)

    2003-06-15

    As the leading organization representing cancer specialists involved in patient care and clinical research, the American Society of Clinical Oncology (ASCO) reaffirms its commitment to integrating cancer risk assessment and management, including molecular analysis of cancer predisposition genes, into the practice of oncology and preventive medicine. The primary goal of this effort is to foster expanded access to, and continued advances in, medical care provided to patients and families affected by hereditary cancer syndromes. The 1996 ASCO Statement on Genetic Testing for Cancer Susceptibility set forth specific recommendations relating to clinical practice, research needs, educational opportunities, requirement for informed consent, indications for genetic testing, regulation of laboratories, and protection from discrimination, as well as access to and reimbursement for cancer genetics services. In updating this Statement, ASCO endorses the following principles: Indications for Genetic Testing: ASCO recommends that genetic testing be offered when 1) the individual has personal or family history features suggestive of a genetic cancer susceptibility condition, 2) the test can be adequately interpreted, and 3) the results will aid in diagnosis or influence the medical or surgical management of the patient or family members at hereditary risk of cancer. ASCO recommends that genetic testing only be done in the setting of pre- and post-test counseling, which should include discussion of possible risks and benefits of cancer early detection and prevention modalities. Special Issues in Testing Children for Cancer Susceptibility: ASCO recommends that the decision to offer testing to potentially affected children should take into account the availability of evidence-based risk-reduction strategies and the probability of developing a malignancy during childhood. Where risk-reduction strategies are available or cancer predominantly develops in childhood, ASCO believes that

  11. Genetic Risk Assessment for Women with Epithelial Ovarian Cancer: Referral Patterns and Outcomes in a University Gynecologic Oncology Clinic

    OpenAIRE

    Petzel, Sue v.; Vogel, Rachel Isaksson; Bensend, Tracy; Leininger, Anna; Argenta, Peter A.; Geller, Melissa A.

    2013-01-01

    Little is known about genetic service utilization and ovarian cancer. We identified the frequency and outcome of genetic counseling referral, predictors of referral, and referral uptake for ovarian cancer patients. Using pathology reports, we identified all epithelial ovarian cancer patients seen in a university gynecologic oncology clinic (1/04–8/06). Electronic medical records (EMR) were used to document genetic service referral, time from diagnosis-to-referral, point-in-treatment at referr...

  12. GNOSIS: Guidelines for neuro-oncology: Standards for investigational studies—reporting of phase 1 and phase 2 clinical trials

    Science.gov (United States)

    Chang, Susan M.; Reynolds, Sharon L.; Butowski, Nicholas; Lamborn, Kathleen R.; Buckner, Jan C.; Kaplan, Richard S.; Bigner, Darell D.

    2005-01-01

    We present guidelines to standardize the reporting of phase 1 and phase 2 neuro-oncology trials. The guidelines are also intended to assist with accurate interpretation of results from these trials, to facilitate the peer-review process, and to expedite the publication of important and accurate manuscripts. Our guidelines are summarized in a checklist format that can be used as a framework from which to construct a phase 1 or 2 clinical trial. PMID:16212807

  13. Invited Commentary: “Risk Factors for Renal Cell Cancer in a Japanese Population” Published in Clinical Medicine: Oncology

    OpenAIRE

    Esther Uña Cidon

    2009-01-01

    The well-written and researched article reported in Clinical Medicine: Oncology by Dr. Washio and Dr. Mori entitled “Risk factors for renal cell cancer in a Japanese population”1 makes evident the differences in incidence and mortality rates from renal cell carcinoma (RCC) between different populations and highlights the relevance of carrying out epidemiological studies, investigating additional risk factors which may explain the differences.

  14. Invited Commentary: “Risk Factors for Renal Cell Cancer in a Japanese Population” Published in Clinical Medicine: Oncology

    Directory of Open Access Journals (Sweden)

    Esther Uña Cidon

    2009-01-01

    Full Text Available The well-written and researched article reported in Clinical Medicine: Oncology by Dr. Washio and Dr. Mori entitled “Risk factors for renal cell cancer in a Japanese population”1 makes evident the differences in incidence and mortality rates from renal cell carcinoma (RCC between different populations and highlights the relevance of carrying out epidemiological studies, investigating additional risk factors which may explain the differences.

  15. Tracers in oncology. Preclinical and clinical evaluation; Innovative Tracer in der onkologischen Diagnostik. Praeklinische und klinische Evaluierung

    Energy Technology Data Exchange (ETDEWEB)

    Krause, B.J.; Schwarzenboeck, S.; Schwaiger, M. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2010-07-01

    In oncology, PET and PET/CT with tracers beyond FDG target more specific biological processes, such as proliferation ({sup 18}F-3'-fluoro-3'-deoxy-L-thymidine; {sup 18}F-FLT), tumour hypoxia ({sup 18}F-fluoromisonidazol; {sup 18}F-FMISO) and phospholipid metabolism (radioactively labelled choline derivates). FLT is a thymidine analogue which can be labelled with {sup 18}F. PET with {sup 18}F-FLT enables to non-invasively image and to quantify the proliferation fraction of tumours. Proliferation dependent accumulation of FLT has been demonstrated for a variety of solid and haematologic neoplasms including lung cancer, breast cancer, gastric cancer, colorectal cancer and malignant lymphoma. Furthermore, FLT has been suggested as surrogate marker for the assessment of response to treatment, especially when targeted drugs are utilized. PET imaging in particular has emerged as a promising non-invasive tool to accurately characterize tumour oxygenation. The great promise of PET/CT is its potential as a single imaging modality for whole body staging that provides anatomical and biological information on the disease as a whole. It allows a more precise estimation of the hypoxic tumour volume as well as comparisons on a voxel-by-voxel basis (parametric mapping). PET and PET/CT with hypoxia tracers thus offer the potential to optimize and individualize therapy for patients suffering from cancer. PET- and PET/CT-studies using {sup 11}C- or {sup 18}F-labeled choline derivates recently have shown promising results for re-staging prostate cancer in patients with biochemical recurrence and advanced prostate cancer. In patients with biochemical recurrence of prostate cancer after primary therapy the detection rate of {sup 11}C-choline- PET/CT shows a positive relationship with serum PSA-levels. In these patients {sup 11}C-choline PET/CT allows not only to diagnose but also to localize recurrent disease with implications on disease management (localised vs. systemic

  16. The usage of three-dimensional nanostructurized biomaterials in experimental and clinical oncology

    Institute of Scientific and Technical Information of China (English)

    Sergeeva; N.; S.; Reshetov; I.; V.; Sviridova; I.; K.; Kirsanova; V.; A.; Achmedova; S.; A.; Barinov; S.; M.; Komlev; V.; S.; Samoylovich; M.; I.; Belyanin; A.; F.; Kleshcheva; S.; M.; Elinson; V.; M.

    2005-01-01

    The usage of biotransplants for substitution of tissue defects (in particular in reconstructive surgery in oncology) require both he suitable cell cultures and different biomaterials with definite and regulate properties.……

  17. The usage of three-dimensional nanostructurized biomaterials in experimental and clinical oncology

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ The usage of biotransplants for substitution of tissue defects (in particular in reconstructive surgery in oncology) require both he suitable cell cultures and different biomaterials with definite and regulate properties.

  18. Preliminary Toxicity Analysis of 3-Dimensional Conformal Radiation Therapy Versus Intensity Modulated Radiation Therapy on the High-Dose Arm of the Radiation Therapy Oncology Group 0126 Prostate Cancer Trial

    Energy Technology Data Exchange (ETDEWEB)

    Michalski, Jeff M., E-mail: jmichalski@radonc.wustl.edu [Department of Radiation Oncology Washington University Medical Center, St. Louis, Missouri (United States); Yan, Yan [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Watkins-Bruner, Deborah [Emory University School of Nursing, Atlanta, Georgia (United States); Bosch, Walter R. [Department of Radiation Oncology Washington University Medical Center, St. Louis, Missouri (United States); Winter, Kathryn [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Galvin, James M. [Department of Radiation Oncology Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Bahary, Jean-Paul [Department of Radiation Oncology Centre Hospitalier de l' Université de Montréal-Notre Dame, Montreal, QC (Canada); Morton, Gerard C. [Department of Radiation Oncology Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON (Canada); Parliament, Matthew B. [Department of Oncology Cross Cancer Institute, Edmonton, AB (Canada); Sandler, Howard M. [Department of Radiation Oncology Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California (United States)

    2013-12-01

    Purpose: To give a preliminary report of clinical and treatment factors associated with toxicity in men receiving high-dose radiation therapy (RT) on a phase 3 dose-escalation trial. Methods and Materials: The trial was initiated with 3-dimensional conformal RT (3D-CRT) and amended after 1 year to allow intensity modulated RT (IMRT). Patients treated with 3D-CRT received 55.8 Gy to a planning target volume that included the prostate and seminal vesicles, then 23.4 Gy to prostate only. The IMRT patients were treated to the prostate and proximal seminal vesicles to 79.2 Gy. Common Toxicity Criteria, version 2.0, and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late morbidity scores were used for acute and late effects. Results: Of 763 patients randomized to the 79.2-Gy arm of Radiation Therapy Oncology Group 0126 protocol, 748 were eligible and evaluable: 491 and 257 were treated with 3D-CRT and IMRT, respectively. For both bladder and rectum, the volumes receiving 65, 70, and 75 Gy were significantly lower with IMRT (all P<.0001). For grade (G) 2+ acute gastrointestinal/genitourinary (GI/GU) toxicity, both univariate and multivariate analyses showed a statistically significant decrease in G2+ acute collective GI/GU toxicity for IMRT. There were no significant differences with 3D-CRT or IMRT for acute or late G2+ or 3+ GU toxicities. Univariate analysis showed a statistically significant decrease in late G2+ GI toxicity for IMRT (P=.039). On multivariate analysis, IMRT showed a 26% reduction in G2+ late GI toxicity (P=.099). Acute G2+ toxicity was associated with late G3+ toxicity (P=.005). With dose–volume histogram data in the multivariate analysis, RT modality was not significant, whereas white race (P=.001) and rectal V70 ≥15% were associated with G2+ rectal toxicity (P=.034). Conclusions: Intensity modulated RT is associated with a significant reduction in acute G2+ GI/GU toxicity. There is a trend for a

  19. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

    OpenAIRE

    Chen, RC; Rumble, RB; Loblaw, DA; Finelli, A.; Ehdaie, B; Cooperberg, MR; Morgan, SC; Tyldesley, S; Haluschak, JJ; Tan, W.; Justman, S; Jain, S

    2016-01-01

    To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommenda...

  20. A Research Agenda for Radiation Oncology: Results of the Radiation Oncology Institute’s Comprehensive Research Needs Assessment

    International Nuclear Information System (INIS)

    Purpose: To promote the rational use of scarce research funding, scholars have developed methods for the systematic identification and prioritization of health research needs. The Radiation Oncology Institute commissioned an independent, comprehensive assessment of research needs for the advancement of radiation oncology care. Methods and Materials: The research needs assessment used a mixed-method, qualitative and quantitative social scientific approach, including structured interviews with diverse stakeholders, focus groups, surveys of American Society for Radiation Oncology (ASTRO) members, and a prioritization exercise using a modified Delphi technique. Results: Six co-equal priorities were identified: (1) Identify and develop communication strategies to help patients and others better understand radiation therapy; (2) Establish a set of quality indicators for major radiation oncology procedures and evaluate their use in radiation oncology delivery; (3) Identify best practices for the management of radiation toxicity and issues in cancer survivorship; (4) Conduct comparative effectiveness studies related to radiation therapy that consider clinical benefit, toxicity (including quality of life), and other outcomes; (5) Assess the value of radiation therapy; and (6) Develop a radiation oncology registry. Conclusions: To our knowledge, this prioritization exercise is the only comprehensive and methodologically rigorous assessment of research needs in the field of radiation oncology. Broad dissemination of these findings is critical to maximally leverage the impact of this work, particularly because grant funding decisions are often made by committees on which highly specialized disciplines such as radiation oncology are not well represented.

  1. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    International Nuclear Information System (INIS)

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control

  2. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Illidge, Tim, E-mail: Tim.Illidge@ics.manchester.ac.uk [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Yahalom, Joachim [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Aleman, Berthe [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Berthelsen, Anne Kiil [Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Constine, Louis [Departments of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York (United States); Dabaja, Bouthaina [Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dharmarajan, Kavita [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ng, Andrea [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States); Ricardi, Umberto [Radiation Oncology Unit, Department of Oncology, University of Torino, Torino (Italy); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

    2014-05-01

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.

  3. MEDICINAL VESICULATION THERAPY AND ITS CLINICAL APPLICATION

    Institute of Scientific and Technical Information of China (English)

    WANG Wei; LIU Haijing; SUN Zhanling

    2002-01-01

    In this paper, the authors introduce medicinal vesiculation therapy from its origin, points for attention in clinical application, and their individual experiences. In clinical application, the authors advocate: ① avoid using drugs that are over-irritating in the property, and strictly controlling the dose of drugs end the duration of application,②) in selection of drugs, some factors as patients' conditions, the season, the geographic location, etc. should be taken into account. In the present paper, 3 typical cases of bronchial asthma, tonsil swelling and facial paralysis treated with medicinal vesiculation therapy are introduced. Clinical practice demonsetrates that this therapy is economical,simple and convenient and fairly effective in treatment of some chronic diseases.

  4. Clinical Significance of Myocardial Uptake on F-18 FDG PET/CT Performed in Oncologic Patients

    International Nuclear Information System (INIS)

    F-18 fluorodeoxyglucose (FDG) uptake of myocardium is influenced by various factors. Increased glycolysis, and subsequent increased F-18 FDG uptake has been reported in ischemic cardiomyopathy. However, clinical significance of incidentally found myocardial F-18 FDG uptake has not been clarified. We retrospectively reviewed the degree and pattern of myocardial uptake in patients without history of ischemic heart disease who underwent torso F-18 FDG PET/CT for evaluation of neoplastic disease. From January 2005 to June 2009, 77 patients who underwent F-18 FDG PET/CT and Tc-99m sestamibi stress/rest SPECT within 3 months were enrolled. Of 77 patients, 55 (71.4%) showed increased F-18 FDG uptake in the myocardium. In this population, 40 showed uniform uptake pattern, while 15 showed focal uptake. In patients with uniform uptake, 17 showed decreased uptake in the septum without perfusion defect on myocardial SPECT. Remaining 23 patients showed uniform uptake, with 1 reversible perfusion defect and 1 fixed perfusion defect. In 15 patients with focal uptake, 9 showed increased F-18 FDG uptake in the base, and only 1 of them showed reversible perfusion defect on myocardial SPECT. In the remaining 6 focal uptake group, 4 had reversible perfusion defect in the corresponding wall, and 1 had apical hypertrophy. We demonstrated that septal defect pattern and basal uptake pattern in the myocardium may represent normal variants. Focal myocardial uptake other than normal variants on oncologic torso F-18 FDG PET/CT with routine fasting protocol may suggest ischemic heart disease, thus further evaluation is warranted

  5. Clinical aspects of boron neutron capture therapy

    International Nuclear Information System (INIS)

    Boron neutron capture therapy is potentially useful in treating malignant tumors of the central nervous system and is technically possible. Additional in vitro and in vivo testing is required to determine toxicities, normal tissue tolerances and tissue responses to treatment parameters. Adequate tumor uptake of the capture agent can be evaluated clinically prior to implementation of a finalized treatment protocol. Phase I and Phase II protocol development, clinical pharmacokinetic studies and neutron beam development

  6. The role of stereotactic ablative radiotherapy in oncological and non-oncological clinical settings: highlights from the 7th Meeting of AIRO--Young Members Working Group (AIRO Giovani).

    Science.gov (United States)

    Franco, Pierfrancesco; De Bari, Berardino; Ciammella, Patrizia; Fiorentino, Alba; Chiesa, Silvia; Amelio, Dante; Pinzi, Valentina; Bonomo, Pierluigi; Vagge, Stefano; Fiore, Michele; Comito, Tiziana; Cecconi, Agnese; Mortellaro, Gianluca; Bruni, Alessio; Trovò, Marco; Filippi, Andrea Riccardo; Greto, Daniela; Alongi, Filippo

    2014-01-01

    Stereotactic ablative radiotherapy is a modern cancer treatment strategy able to deliver highly focused radiation in one or a few fractions with a radical intent in several clinical settings. Young radiation oncologists need a constant and tailored update in this context to improve patient care in daily clinical practice. A recent meeting of AIRO Giovani (AIRO--Young Members Working Group) was specifically addressed to this topic, presenting state-of-the-art knowledge, based on the latest evidence in this field. Highlights of the congress are summarized and presented in this report, including thorough contributions of the speakers dealing with the role of stereotactic ablative radiotherapy in both oncological and non-oncological diseases, divided according to anatomical and clinical scenarios: intra-cranial settings (brain malignant primary tumors, metastases, benign tumors and functional disorders) and extra-cranial indications (lung primary tumors and metastases, thoracic re-irradiation, liver, lymph node and bone metastases, prostate cancer). With literature data discussed during the congress as a background, stereotactic ablative radiotherapy has proved to be a consolidated treatment approach in specific oncological and non-oncological scenarios, as well as a promising option in other clinical settings, requiring a further prospective validation in the near future. We herein present an updated overview of stereotactic ablative radiotherapy use in the clinic. PMID:25688503

  7. Optimal Decision Rules for Biomarker-Based Subgroup Selection for a Targeted Therapy in Oncology

    Directory of Open Access Journals (Sweden)

    Johannes Krisam

    2015-05-01

    Full Text Available Throughout recent years, there has been a rapidly increasing interest regarding the evaluation of so-called targeted therapies. These therapies are assumed to show a greater benefit in a pre-specified subgroup of patients—commonly identified by a predictive biomarker—as compared to the total patient population of interest. This situation has led to the necessity to develop biostatistical methods allowing an efficient evaluation of such treatments. Among others, adaptive enrichment designs have been proposed as a solution. These designs allow the selection of the most promising patient population based on an efficacy analysis at interim and restricting recruitment to these patients afterwards. As has recently been shown, the performance of the applied interim decision rule in such a design plays a crucial role in ensuring a successful trial. In this work, we investigate the situation when the primary outcome of the trial is a binary variable. Optimal decision rules are derived which incorporate the uncertainty about the treatment effects. These optimal decision rules are evaluated with respect to their performance in an adaptive enrichment design in terms of correct selection probability and power, and are compared to proposed ad hoc decision rules. Our methods are illustrated by means of a clinical trial example.

  8. Microarray analysis in clinical oncology: pre-clinical optimization using needle core biopsies from xenograft tumors

    International Nuclear Information System (INIS)

    DNA microarray profiling performed on clinical tissue specimens can potentially provide significant information regarding human cancer biology. Biopsy cores, the typical source of human tumor tissue, however, generally provide very small amounts of RNA (0.3–15 μg). RNA amplification is a common method used to increase the amount of material available for hybridization experiments. Using human xenograft tissue, we sought to address the following three questions: 1) is amplified RNA representative of the original RNA profile? 2) what is the minimum amount of total RNA required to perform a representative amplification? 3) are the direct and indirect methods of labeling the hybridization probe equivalent? Total RNA was extracted from human xenograft tissue and amplified using a linear amplification process. RNA was labeled and hybridized, and the resulting images yielded data that was extracted into two categories using the mAdb system: 'all genes' and 'outliers'. Scatter plots were generated for each slide and Pearson Coefficients of correlation were obtained. Results show that the amplification of 5 μg of total RNA yields a Pearson Correlation Coefficient of 0.752 (N = 6,987 genes) between the amplified and total RNA samples. We subsequently determined that amplification of 0.5 μg of total RNA generated a similar Pearson Correlation Coefficient as compared to the corresponding original RNA sample. Similarly, sixty-nine percent of total RNA outliers were detected with 5 μg of amplified starting RNA, and 55% of outliers were detected with 0.5 μg of starting RNA. However, amplification of 0.05 μg of starting RNA resulted in a loss of fidelity (Pearson Coefficient 0.669 between amplified and original samples, 44% outlier concordance). In these studies the direct or indirect methods of probe labeling yielded similar results. Finally, we examined whether RNA obtained from needle core biopsies of human tumor xenografts, amplified and indirectly

  9. Biomarkers in T cell therapy clinical trials

    Directory of Open Access Journals (Sweden)

    Kalos Michael

    2011-08-01

    Full Text Available Abstract T cell therapy represents an emerging and promising modality for the treatment of both infectious disease and cancer. Data from recent clinical trials have highlighted the potential for this therapeutic modality to effect potent anti-tumor activity. Biomarkers, operationally defined as biological parameters measured from patients that provide information about treatment impact, play a central role in the development of novel therapeutic agents. In the absence of information about primary clinical endpoints, biomarkers can provide critical insights that allow investigators to guide the clinical development of the candidate product. In the context of cell therapy trials, the definition of biomarkers can be extended to include a description of parameters of the cell product that are important for product bioactivity. This review will focus on biomarker studies as they relate to T cell therapy trials, and more specifically: i. An overview and description of categories and classes of biomarkers that are specifically relevant to T cell therapy trials, and ii. Insights into future directions and challenges for the appropriate development of biomarkers to evaluate both product bioactivity and treatment efficacy of T cell therapy trials.

  10. Drug interactions in female oncologic inpatients: differences among databases

    OpenAIRE

    Patricia Moriel; Jorge Augusto Siqueira; Renata Cavalcanti Carnevale; Caroline de Godoi Rezende Costa; Aline Aparecida da Cruz; Nice Maria Oliveira da Silva; Adélia Corina Bernardes; Roberta Paro Carvalho; Priscila Gava Mazzola

    2013-01-01

    The aim of the present study was to quantify drug interactions in prescriptions for women undergoing supportive therapy in an oncology setting at a women’s hospital in Brazil and compare the information provided by different databases regarding these drug interactions. A convenience sample was selected of prescriptions for patients diagnosed with breast or gynecological tumors hospitalized in the clinical oncology and surgery wards from April to June 2009. DRUGDEX/M...

  11. Ion beam therapy fundamentals, technology, clinical applications

    CERN Document Server

    2012-01-01

    The book provides a detailed, up-to-date account of the basics, the technology, and the clinical use of ion beams for radiation therapy. Theoretical background, technical components, and patient treatment schemes are delineated by the leading experts that helped to develop this field from a research niche to its current highly sophisticated and powerful clinical treatment level used to the benefit of cancer patients worldwide. Rather than being a side-by-side collection of articles, this book consists of related chapters. It is a common achievement by 76 experts from around the world. Their expertise reflects the diversity of the field with radiation therapy, medical and accelerator physics, radiobiology, computer science, engineering, and health economics. The book addresses a similarly broad audience ranging from professionals that need to know more about this novel treatment modality or consider to enter the field of ion beam therapy as a researcher. However, it is also written for the interested public an...

  12. Individually-tailored procedures of breast cancer therapy

    International Nuclear Information System (INIS)

    On the basis of clinical evaluation of 1007 case histories of breast cancer supplied from the Kazakh Republican Oncological Dispensary, Research Institute of Oncology and Radiation and Municipal Oncological Dispensary (Alma-Ata, 1960-1977), individually-tailored methods of therapy were developed. The procedures are based on such criteria as age, stage, localization, anatomical and histological characteristics of tumor

  13. GENE THERAPY, RECENT DEVELOPMENT AND FUTURE PROSPECTS IN GASTROINTESTINAL ONCOLOGY: A REVIEW ARTICLE

    Directory of Open Access Journals (Sweden)

    Kotla Ramya Sree and Mudavath Hanumanaik

    2013-02-01

    Full Text Available The introduction of nucleic acids into cells has as a purpose of medical condition or disease. Currently, gene therapy studies a broad range of potential therapeutic interventions, including the body's immune reaction to tumours, new blood vessels in the heart to alleviate heart attacks and to stop HIV-replication in patients with AIDS1 .There is also renewed emphasis on the gene therapy of genetic diseases, such as haemophilia A and B, and cystic fibrosis. Human gene therapy experimentation raises many issues. In this review article, background of gene therapy, introduction, genetic diseases, gene function, germ line gene therapy, hurdles in gene therapy, methods for gene therapy, ex vivo, in vitro and in vivo-gene therapy, risks associated with gene therapy, have been given.

  14. DEGRO 2009. Radiation oncology - medical physics - radiation biology. Abstracts

    International Nuclear Information System (INIS)

    The special volume of the journal covers the abstracts of the DEGRO 2009 meeting on radiation oncology, medical physics, and radiation biology, covering the following topics: seldom diseases, gastrointestinal tumors, radiation reactions and radiation protection, medical care and science, central nervous system, medical physics, the non-parvicellular lung carcinomas, ear-nose-and throat, target-oriented radiotherapy plus ''X'', radio-oncology - young academics, lymphomas, mammary glands, modern radiotherapy, life quality and palliative radiotherapy, radiotherapy of the prostate carcinoma, imaging for planning and therapy, the digital documentation in clinics and practical experiences, NMR imaging and tomography, hadrons - actual status in Germany, urinal tract oncology, radiotoxicity

  15. [Introduction of a clinical protocol for extravasation at the National Institute of Oncology, Budapest, Hungary].

    Science.gov (United States)

    Bartal, Alexandra; Mátrai, Zoltán; Rosta, András; Szûcs, Attila

    2011-03-01

    Extravasation of cytostatics occurs when an infusion containing a cytotoxic drug leaks into the surrounding perivascular and subcutaneous tissues. Incidence of cytostatic extravasation is found to be 0.1-6% according to the literature. Depending on the severity of complications, pain, loss of function in the extremities, or in extreme cases tissue necrosis necessitating an amputation may develop, drawing consequences like delay or interruption of the chemotherapy. Extent of complications is greatly influenced by the type of medication administered, general condition of the patient, and professional preparedness of staff providing the oncological health service. The protocol recently implemented in the National Institute of Oncology is a short, compact guidance for physicians and nurses providing oncological care, so by quick and adequate management of extravasation cases, severe complications could be prevented. More complex practical guidelines including algorithms could be created as a result of a wider collaboration, with the help of which oncological health professionals could easily cope with this rare problem. The authors describe in their review the implementation of the use of dry warm and cold packs, dymethylsulfoxide and hyaluronidase and their function within the algorithm of extravasation treatment. PMID:21617787

  16. Influence of bromodeoxyuridine radiosensitization on malignant glioma patient survival: a retrospective comparison of survival data from the Northern California oncology group (NCOG) and radiation therapy oncology group trials (RTOG) for glioblastoma multiforme and anaplastic astrocytoma

    International Nuclear Information System (INIS)

    Purpose: To examine the effect of treatment using Bromodeoxyuridine (BrdU) during radiation therapy on malignant glioma patient survival by comparing historical survival data from several large clinical trials. Methods: A retrospective analysis of patient data from Radiation Therapy Oncology Group (RTOG) trials 74-01, 79-18, and 83-02 and the Northern California Oncology Group (NCOG) study 6G-82-1 was conducted. Patient data was supplied by both groups, and analyzed by the RTOG. Pretreatment characteristics including age, extent of surgery, Karnofsky Performance Status (KPS), and histopathology were collected; the only treatment variable evaluated was the use of BrdU during radiation therapy. Radiation dose, dose-fractionation schedule, use of chemotherapy, and/or type of chemotherapy was not controlled for in the analyses. Univariate and multivariate analyses were conducted to examine the potential treatment effect of BrdU on patient survival. Results: Data from 334 patients treated with BrdU on NCOG 6G-82-1 and 1743 patients treated without BrdU on 3 RTOG studies was received. Patients were excluded from the review if confirmation of eligibility could not be obtained, if the patient was ineligible for the study they entered, if central pathology review was not done, or if radiotherapy data was not available. Patients treated according to the RTOG studies had to start radiotherapy within 4 weeks of surgery; no such restriction existed for the NCOG studies. To ensure comparability between the studies, patients from the NCOG studies who began treatment longer than 40 days from surgery were also excluded. The final data set included 296 cases from the NCOG studies (89%) and 1478 cases from the RTOG studies (85%). For patients with glioblastoma multiforme (GBM) the median survival was 9.8 months in the RTOG studies and 13.0 months in the NCOG trial (p < 0.0001). For patients with AA the median survival was 35.1 months for the RTOG studies and 42.8 months in the NCOG

  17. Coenzyme Q10 therapy in current clinical practice

    OpenAIRE

    Abhishek Soni; Monica Verma; Vivek Kaushal; Ghalaut, Veena S.

    2015-01-01

    Coenzyme Q10 (CoQ10) is a naturally occurring, lipid soluble, essential compound and is also known as ubiquinone. CoQ10 acts as an intermediate of the electron transport chain situated in membrane of mitochondria and vital for ATP production and cellular respiration. CoQ10 also serves as an intercellular antioxidant. All the clinical use of CoQ10 are based upon these two functions. CoQ10 levels are altered in a number of oncological as well as non-oncological diseases. Furthermore, recent dat...

  18. Analysis of radiation therapy oncology group (RTOG) head and neck database

    International Nuclear Information System (INIS)

    In addition to its treatment studies, the RTOG has also directed its attention to the identification of tumor- and treatment-related factors that potentially influence the outcome of disease. In 1977, RTOG opened a Registry Study for patients with head and neck cancer to establish a large data base for evaluating disease outcome after radiation treatment with and without other treatment modalities. All patients with head and neck tumors treated by participating RTOG institutions between February 1977 and February 1980 were entered, except for those patients who were entered in other RTOG clinical trails. The following data points on each patient were prospectively collected: location of the primary site, American Joint Committee on Cancer (AJC) T state and N stage, age, sex, Karnofsky performance score (KPS), tumor histology, tumor differentiation as scored at the participating institution, extent for tumor infiltration, details of treatment delivery, and outcome. The 1976 TNM staging system, according to the American Joint Committee for Cancer Staging and End Results Reporting (AJC), was used. The findings from the Registry Study for previously untreated patients with squamous cell carcinoma whose initial treatment plan was radiation therapy alone is critically important to the radiation therapist because it provides baseline data to evaluate reported results with any new adjuvant treatment program. This data base also assists the RTOG in designing future studies

  19. Clinical Applications of Volumetric Modulated Arc Therapy

    International Nuclear Information System (INIS)

    Purpose: To present treatment planning case studies for several treatment sites for which volumetric modulated arc therapy (VMAT) could have a positive impact; and to share an initial clinical experience with VMAT for stereotactic body radiotherapy (SBRT). Methods and Materials: Four case studies are presented to show the potential benefit of VMAT compared with conformal and intensity-modulated radiotherapy (IMRT) techniques in pediatric cancer, bone marrow-sparing whole-abdominopelvic irradiation (WAPI), and SBRT of the lung and spine. Details of clinical implementation of VMAT for SBRT are presented. The VMAT plans are compared with conventional techniques in terms of dosimetric quality and delivery efficiency. Results: Volumetric modulated arc therapy reduced the treatment time of spine SBRT by 37% and improved isodose conformality. Conformal and VMAT techniques for lung SBRT had similar dosimetric quality, but VMAT had improved target coverage and took 59% less time to deliver, although monitor units were increased by 5%. In a complex pediatric pelvic example, VMAT reduced treatment time by 78% and monitor units by 25% compared with IMRT. A double-isocenter VMAT technique for WAPI can spare bone marrow while maintaining good delivery efficiency. Conclusions: Volumetric modulated arc therapy is a new technology that may benefit different patient populations, including pediatric cancer patients and those undergoing concurrent chemotherapy and WAPI. Volumetric modulated arc therapy has been used and shown to be beneficial for significantly improving delivery efficiency of lung and spine SBRT.

  20. Tumor thrombus of inferior vena cava in patients with renal cell carcinoma – clinical and oncological outcome of 50 patients after surgery

    Directory of Open Access Journals (Sweden)

    Kocot Arkadius

    2012-06-01

    Full Text Available Abstract Background To evaluate oncological and clinical outcome in patients with renal cell carcinoma (RCC and tumor thrombus involving inferior vena cava (IVC treated with nephrectomy and thrombectomy. Methods We identified 50 patients with a median age of 65 years, who underwent radical surgical treatment for RCC and tumor thrombus of the IVC between 1997 and 2010. The charts were reviewed for pathological and surgical parameters, as well as complications and oncological outcome. Results The median follow-up was 26 months. In 21 patients (42% distant metastases were already present at the time of surgery. All patients underwent radical nephrectomy, thrombectomy and lymph node dissection through a flank (15 patients/30%, thoracoabdominal (14 patients/28% or midline abdominal approach (21 patients/42%, depending upon surgeon preference and upon the characteristics of tumor and associated thrombus. Extracorporal circulation with cardiopulmonary bypass (CPB was performed in 10 patients (20% with supradiaphragmal thrombus of IVC. Cancer-specific survival for the whole cohort at 5 years was 33.1%. Survival for the patients without distant metastasis at 5 years was 50.7%, whereas survival rate in the metastatic group at 5 years was 7.4%. Median survival of patients with metastatic disease was 16.4 months. On multivariate analysis lymph node invasion, distant metastasis and grading were independent prognostic factors. There was no statistically significant influence of level of the tumor thrombus on survival rate. Indeed, patients with supradiaphragmal tumor thrombus (n = 10 even had a better outcome (overall survival at 5 years of 58.33% than the entire cohort. Conclusions An aggressive surgical approach is the most effective therapeutic option in patients with RCC and any level of tumor thrombus and offers a reasonable longterm survival. Due to good clinical and oncological outcome we prefer the use of CPB with extracorporal

  1. Soft Tissue Sarcoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology.

    Science.gov (United States)

    von Mehren, Margaret; Randall, R Lor; Benjamin, Robert S; Boles, Sarah; Bui, Marilyn M; Conrad, Ernest U; Ganjoo, Kristen N; George, Suzanne; Gonzalez, Ricardo J; Heslin, Martin J; Kane, John M; Koon, Henry; Mayerson, Joel; McCarter, Martin; McGarry, Sean V; Meyer, Christian; O'Donnell, Richard J; Pappo, Alberto S; Paz, I Benjamin; Petersen, Ivy A; Pfeifer, John D; Riedel, Richard F; Schuetze, Scott; Schupak, Karen D; Schwartz, Herbert S; Tap, William D; Wayne, Jeffrey D; Bergman, Mary Anne; Scavone, Jillian

    2016-06-01

    Soft tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Guidelines for Soft Tissue Sarcoma (available at NCCN.org) provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as intra-abdominal/retroperitoneal STS, gastrointestinal stromal tumor, desmoid tumors, and rhabdomyosarcoma. This manuscript discusses guiding principles for the diagnosis and staging of STS and evidence for treatment modalities that include surgery, radiation, chemoradiation, chemotherapy, and targeted therapy. PMID:27283169

  2. Bioinformatics for precision medicine in oncology: principles and application to the SHIVA clinical trial

    OpenAIRE

    Servant, Nicolas; Roméjon, Julien; Gestraud, Pierre; La Rosa, Philippe; Lucotte, Georges; Lair, Séverine; Bernard, Virginie; Zeitouni, Bruno; Coffin, Fanny; Jules-Clément, Gérôme; Yvon, Florent; Lermine, Alban; Poullet, Patrick; Liva, Stéphane; POOK, Stuart

    2014-01-01

    Precision medicine (PM) requires the delivery of individually adapted medical care based on the genetic characteristics of each patient and his/her tumor. The last decade witnessed the development of high-throughput technologies such as microarrays and next-generation sequencing which paved the way to PM in the field of oncology. While the cost of these technologies decreases, we are facing an exponential increase in the amount of data produced. Our ability to use this information in daily pr...

  3. Emerging molecular targets in oncology: clinical potential of MET/hepatocyte growth-factor inhibitors

    OpenAIRE

    Smyth EC; Sclafani F; Cunningham D

    2014-01-01

    Elizabeth C Smyth, Francesco Sclafani, David Cunningham Department of Gastrointestinal Oncology, Royal Marsden Hospital, Sutton, UK Abstract: The MET/hepatocyte growth-factor (HGF) signaling pathway plays a key role in the processes of embryogenesis, wound healing, and organ regeneration. Aberrant activation of MET/HGF occurs through multiple mechanisms including gene amplification, mutation, protein overexpression, and abnormal gene splicing interrupting autocrine and paracrine regulatory f...

  4. Prediction tools in surgical oncology.

    Science.gov (United States)

    Isariyawongse, Brandon K; Kattan, Michael W

    2012-07-01

    Artificial neural networks, prediction tables, and clinical nomograms allow physicians to transmit an immense amount of prognostic information in a format that exhibits comprehensibility and brevity. Current models demonstrate the feasibility to accurately predict many oncologic outcomes, including pathologic stage, recurrence-free survival, and response to adjuvant therapy. Although emphasis should be placed on the independent validation of existing prediction tools, there is a paucity of models in the literature that focus on quality of life outcomes. The unification of tools that predict oncologic and quality of life outcomes into a comparative effectiveness table will furnish patients with cancer with the information they need to make a highly informed and individualized treatment decision. PMID:22583992

  5. Immunotherapy and radiation therapy: considerations for successfully combining radiation into the paradigm of immuno-oncology drug development.

    Science.gov (United States)

    Sharon, Elad; Polley, Mei-Yin; Bernstein, Michael B; Ahmed, Mansoor

    2014-08-01

    As the immunotherapy of cancer comes of age, adding immunotherapeutic agents to radiation therapy has the potential to improve the outcomes for patients with a wide variety of malignancies. Despite the enormous potential of such combination therapy, laboratory data has been lacking and there is little guidance for pursuing novel treatment strategies. Animal models have significant limitation in combining radiation therapy with immunotherapy and some of the limitations of preclinical models are discussed in this article. In addition to the preclinical challenges, radiation therapy and immunotherapy combinations may have overlapping toxicities, and for both types of therapy, early and late manifestations of toxicity are possible. Given these risks, special attention should be given to the design of the specific Phase I clinical trial that is chosen. In this article, we describe several Phase I design possibilities that may be employed, including the 3 + 3 design (also known as the cohort of 3 design), the continual reassessment method (CRM), and the time-to-event continual reassessment method (TITE-CRM). Efficacy end points for further development of combination therapy must be based on multiple factors, including disease type, stage of disease, the setting of therapy and the goal of therapy. While the designs for future clinical trials will vary, it is clear that these two successful modalities of therapy can and should be combined for the benefit of cancer patients. PMID:25003314

  6. Practicing radiation oncology in the current health care environment - Part II: Designing a radiation oncology department and setting up a clinical practice program

    International Nuclear Information System (INIS)

    Objective: Identify the business practices necessary to develop a successful radiation oncology department in the current health care environment. Course content will be of interest to new practitioners establishing first time programs or joining existing groups as well as experienced radiation oncologists who are challenged with redesigning programs to be competitive. Course Content: During this session, the following topics will be discussed: 1) Space planning and equipment selection 2) Personnel; creating efficiencies while promoting productivity 3) Professional and Technical Billing; establishing proper fee structures and coding procedures 4) Utilizing benchmarking as a tool to improve operations 5) Information technology in radiation oncology 6) Current and Future Trends: a) Oncology networks b) Reimbursement: managed care and capitation c) Downsizing d) Relative Value Units

  7. {sup 99m}Tc-HYNIC-Annexin A5 in Oncology: Evaluating Efficacy of Anti-Cancer Therapies

    Energy Technology Data Exchange (ETDEWEB)

    Schaper, Frédéric L.W.V.J.; Reutelingsperger, Chris P., E-mail: c.reutelingsperger@maastrichtuniversity.nl [Department of Biochemistry, Cardiovascular Research Institute Maastricht, MUMC, Universiteitssingel 50, 6200 MD Maastricht (Netherlands)

    2013-05-15

    Evaluation of efficacy of anti-cancer therapy is currently performed by anatomical imaging (e.g., MRI, CT). Structural changes, if present, become apparent 1–2 months after start of therapy. Cancer patients thus bear the risk to receive an ineffective treatment, whilst clinical trials take a long time to prove therapy response. Both patient and pharmaceutical industry could therefore profit from an early assessment of efficacy of therapy. Diagnostic methods providing information on a functional level, rather than a structural, could present the solution. Recent technological advances in molecular imaging enable in vivo imaging of biological processes. Since most anti-cancer therapies combat tumors by inducing apoptosis, imaging of apoptosis could offer an early assessment of efficacy of therapy. This review focuses on principles of and clinical experience with molecular imaging of apoptosis using Annexin A5, a widely accepted marker for apoptosis detection in vitro and in vivo in animal models. {sup 99m}Tc-HYNIC-Annexin A5 in combination with SPECT has been probed in clinical studies to assess efficacy of chemo- and radiotherapy within 1–4 days after start of therapy. Annexin A5-based functional imaging of apoptosis shows promise to offer a personalized medicine approach, now primarily used in genome-based medicine, applicable to all cancer patients.

  8. 99mTc-HYNIC-Annexin A5 in Oncology: Evaluating Efficacy of Anti-Cancer Therapies

    International Nuclear Information System (INIS)

    Evaluation of efficacy of anti-cancer therapy is currently performed by anatomical imaging (e.g., MRI, CT). Structural changes, if present, become apparent 1–2 months after start of therapy. Cancer patients thus bear the risk to receive an ineffective treatment, whilst clinical trials take a long time to prove therapy response. Both patient and pharmaceutical industry could therefore profit from an early assessment of efficacy of therapy. Diagnostic methods providing information on a functional level, rather than a structural, could present the solution. Recent technological advances in molecular imaging enable in vivo imaging of biological processes. Since most anti-cancer therapies combat tumors by inducing apoptosis, imaging of apoptosis could offer an early assessment of efficacy of therapy. This review focuses on principles of and clinical experience with molecular imaging of apoptosis using Annexin A5, a widely accepted marker for apoptosis detection in vitro and in vivo in animal models. 99mTc-HYNIC-Annexin A5 in combination with SPECT has been probed in clinical studies to assess efficacy of chemo- and radiotherapy within 1–4 days after start of therapy. Annexin A5-based functional imaging of apoptosis shows promise to offer a personalized medicine approach, now primarily used in genome-based medicine, applicable to all cancer patients

  9. 99mTc-HYNIC-Annexin A5 in Oncology: Evaluating Efficacy of Anti-Cancer Therapies

    Directory of Open Access Journals (Sweden)

    Chris P. Reutelingsperger

    2013-05-01

    Full Text Available Evaluation of efficacy of anti-cancer therapy is currently performed by anatomical imaging (e.g., MRI, CT. Structural changes, if present, become apparent 1–2 months after start of therapy. Cancer patients thus bear the risk to receive an ineffective treatment, whilst clinical trials take a long time to prove therapy response. Both patient and pharmaceutical industry could therefore profit from an early assessment of efficacy of therapy. Diagnostic methods providing information on a functional level, rather than a structural, could present the solution. Recent technological advances in molecular imaging enable in vivo imaging of biological processes. Since most anti-cancer therapies combat tumors by inducing apoptosis, imaging of apoptosis could offer an early assessment of efficacy of therapy. This review focuses on principles of and clinical experience with molecular imaging of apoptosis using Annexin A5, a widely accepted marker for apoptosis detection in vitro and in vivo in animal models. 99mTc-HYNIC-Annexin A5 in combination with SPECT has been probed in clinical studies to assess efficacy of chemo- and radiotherapy within 1–4 days after start of therapy. Annexin A5-based functional imaging of apoptosis shows promise to offer a personalized medicine approach, now primarily used in genome-based medicine, applicable to all cancer patients.

  10. 99mTc-HYNIC-Annexin A5 in Oncology: Evaluating Efficacy of Anti-Cancer Therapies.

    Science.gov (United States)

    Schaper, Frédéric L W V J; Reutelingsperger, Chris P

    2013-01-01

    Evaluation of efficacy of anti-cancer therapy is currently performed by anatomical imaging (e.g., MRI, CT). Structural changes, if present, become apparent 1-2 months after start of therapy. Cancer patients thus bear the risk to receive an ineffective treatment, whilst clinical trials take a long time to prove therapy response. Both patient and pharmaceutical industry could therefore profit from an early assessment of efficacy of therapy. Diagnostic methods providing information on a functional level, rather than a structural, could present the solution. Recent technological advances in molecular imaging enable in vivo imaging of biological processes. Since most anti-cancer therapies combat tumors by inducing apoptosis, imaging of apoptosis could offer an early assessment of efficacy of therapy. This review focuses on principles of and clinical experience with molecular imaging of apoptosis using Annexin A5, a widely accepted marker for apoptosis detection in vitro and in vivo in animal models. 99mTc-HYNIC-Annexin A5 in combination with SPECT has been probed in clinical studies to assess efficacy of chemo- and radiotherapy within 1-4 days after start of therapy. Annexin A5-based functional imaging of apoptosis shows promise to offer a personalized medicine approach, now primarily used in genome-based medicine, applicable to all cancer patients. PMID:24216991

  11. Negative pressure wound therapy: clinical utility

    Directory of Open Access Journals (Sweden)

    Sandoz H

    2015-04-01

    Full Text Available Heidi Sandoz Accelerate CIC, Mile End Hospital, London, UK Abstract: Negative pressure wound therapy (NPWT, also known as topical negative pressure therapy, has been increasingly used in health care for the management of a wide variety of wounds over the last 2–3 decades. It is an advanced therapy that can be helpful to accelerate wound healing in both acute and chronic wounds by delivering negative pressure (suction to the wound bed. More recent advancements in the application of NPWT have provided clinicians with wider choices of utilization. There are now devices available that can deliver irrigation to the wound bed, be used for closed surgical incisions, or are disposable and highly portable. Systematic reviews considering NPWT have been published previously. These usually focus on one wound group or device and fail to offer practical clinical guidance due to the scrutiny offered to the evidence via a systematic review process. Here, an overview of the history of NPWT, the varieties of device available, their wide clinical application, and the evidence to support its use are explored in a pragmatic way. Keywords: negative pressure, wound, incision, healing, pain 

  12. Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences

    Science.gov (United States)

    Pfeiffer, Yvonne; Taxis, Katja

    2016-01-01

    Background Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. Objective To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. Methods In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. Results Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking—more frequently than ‘carrying out checks independently’ (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. Conclusions Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be

  13. Imaging in oncology. Terms and definitions

    International Nuclear Information System (INIS)

    Oncologic imaging includes the morphological description of the primary tumor region for an accurate classification of the tumor and lymph node stage and whether distant metastases have occurred according to the TNM staging system. Knowing the stage of the disease helps to plan the treatment and to estimate the prognosis. In clinical routine this is accomplished by conventional imaging techniques, such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Additionally, oncologic imaging is essential in treatment monitoring to visualize and quantify the effect of cancer therapy according to response evaluation criteria in solid tumors (RECIST) and World Health Organization (WHO) criteria. The tremendous development in oncology and technical innovations in imaging represent a particular challenge for radiology. (orig.)

  14. Standardizing Naming Conventions in Radiation Oncology

    International Nuclear Information System (INIS)

    Purpose: The aim of this study was to report on the development of a standardized target and organ-at-risk naming convention for use in radiation therapy and to present the nomenclature for structure naming for interinstitutional data sharing, clinical trial repositories, integrated multi-institutional collaborative databases, and quality control centers. This taxonomy should also enable improved plan benchmarking between clinical institutions and vendors and facilitation of automated treatment plan quality control. Materials and Methods: The Advanced Technology Consortium, Washington University in St. Louis, Radiation Therapy Oncology Group, Dutch Radiation Oncology Society, and the Clinical Trials RT QA Harmonization Group collaborated in creating this new naming convention. The International Commission on Radiation Units and Measurements guidelines have been used to create standardized nomenclature for target volumes (clinical target volume, internal target volume, planning target volume, etc.), organs at risk, and planning organ-at-risk volumes in radiation therapy. The nomenclature also includes rules for specifying laterality and margins for various structures. The naming rules distinguish tumor and nodal planning target volumes, with correspondence to their respective tumor/nodal clinical target volumes. It also provides rules for basic structure naming, as well as an option for more detailed names. Names of nonstandard structures used mainly for plan optimization or evaluation (rings, islands of dose avoidance, islands where additional dose is needed [dose painting]) are identified separately. Results: In addition to its use in 16 ongoing Radiation Therapy Oncology Group advanced technology clinical trial protocols and several new European Organization for Research and Treatment of Cancer protocols, a pilot version of this naming convention has been evaluated using patient data sets with varying treatment sites. All structures in these data sets were

  15. "Green Oncology": the Italian medical oncologists' challenge to reduce the ecological impact of their clinical activity.

    Science.gov (United States)

    Bretti, Sergio; Porcile, Gianfranco; Romizi, Roberto; Palazzo, Salvatore; Oliani, Cristina; Crispino, Sergio; Labianca, Roberto

    2014-01-01

    For decades Western medicine has followed a biomedical model based on linear thinking and an individualized, disease-oriented doctor-patient relationship. Today this framework must be replaced by a biopsychosocial model based on complexity theory and a person-oriented medical team-patient relationship, taking into account the psychological and social determinants of health and disease. However, the new model is already proving no longer adequate or appropriate, and current events are urging us to develop an ecological model in which the medical team takes into account both individual illness and population health as a whole, since we are all part of the biosphere. In recent years, the rising costs of cancer treatment have raised a serious issue of economic sustainability. As the population of our planet, we now need to rapidly address this issue, and everyone of us must try to reduce their ecological footprint, measured as CO2 production. Medical oncologists need to reduce the ecological footprint of their professional activity by lowering the consumption of economic resources and avoiding environmental damage as much as possible. This new paradigm is endorsed by the Italian College of Hospital Medical Oncology Directors (CIPOMO). A working group of this organization has drafted the "Green Oncology Position Paper": a proposal of Italian medical oncology (in accordance with international guidelines) that oncologists, while aiming for the same end results, make a commitment toward the more appropriate management of health care and the careful use of resources in order to protect the environment and the ecosphere during the daily exercise of their professional activities. PMID:25076260

  16. Eva between anxiety and hope: integrating anthroposophic music therapy in supportive oncology care

    OpenAIRE

    Eran Ben-Arye; Yotam Ben-Arye; Yael Barak

    2015-01-01

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music ther...

  17. Heidelberg Ion Therapy Center (HIT): Initial clinical experience in the first 80 patients

    International Nuclear Information System (INIS)

    The Heidelberg Ion Therapy Center (HIT) started clinical operation in November 2009. In this report we present the first 80 patients treated with proton and carbon ion radiotherapy and describe patient selection, treatment planning and daily treatment for different indications. Patients and methods. Between November 15, 2009 and April 15, 2010, 80 patients were treated at the Heidelberg Ion Therapy Center (HIT) with carbon ion and proton radiotherapy. Main treated indications consisted of skull base chordoma (n = 9) and chondrosarcoma (n = 18), malignant salivary gland tumors (n=29), chordomas of the sacrum (n = 5), low grade glioma (n=3), primary and recurrent malignant astrocytoma and glioblastoma (n=7) and well as osteosarcoma (n = 3). Of these patients, four pediatric patients aged under 18 years were treated. Results. All patients were treated using the intensity-modulated rasterscanning technique. Seventy-six patients were treated with carbon ions (95%), and four patients were treated with protons. In all patients x-ray imaging was performed prior to each fraction. Treatment concepts were based on the initial experiences with carbon ion therapy at the Gesellschaft fuer Schwerionenforschung (GSI) including carbon-only treatments and carbon-boost treatments with photon-IMRT. The average time per fraction in the treatment room per patient was 29 minutes; for irradiation only, the mean time including all patients was 16 minutes. Position verification was performed prior to every treatment fraction with orthogonal x-ray imaging. Conclusion. Particle therapy could be included successfully into the clinical routine at the Dept. of Radiation Oncology in Heidelberg. Numerous clinical trials will subsequently be initiated to precisely define the role of proton and carbon ion radiotherapy in radiation oncology.

  18. Heidelberg Ion Therapy Center (HIT): Initial clinical experience in the first 80 patients

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E. (Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)), E-mail: Stephanie.Combs@med.uni-heidelberg.de; Ellerbrock, Malte; Haberer, Thomas (Heidelberger Ionenstrahl Therapiezentrum (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg (Germany)) (and others)

    2010-10-15

    The Heidelberg Ion Therapy Center (HIT) started clinical operation in November 2009. In this report we present the first 80 patients treated with proton and carbon ion radiotherapy and describe patient selection, treatment planning and daily treatment for different indications. Patients and methods. Between November 15, 2009 and April 15, 2010, 80 patients were treated at the Heidelberg Ion Therapy Center (HIT) with carbon ion and proton radiotherapy. Main treated indications consisted of skull base chordoma (n = 9) and chondrosarcoma (n = 18), malignant salivary gland tumors (n=29), chordomas of the sacrum (n = 5), low grade glioma (n=3), primary and recurrent malignant astrocytoma and glioblastoma (n=7) and well as osteosarcoma (n = 3). Of these patients, four pediatric patients aged under 18 years were treated. Results. All patients were treated using the intensity-modulated rasterscanning technique. Seventy-six patients were treated with carbon ions (95%), and four patients were treated with protons. In all patients x-ray imaging was performed prior to each fraction. Treatment concepts were based on the initial experiences with carbon ion therapy at the Gesellschaft fuer Schwerionenforschung (GSI) including carbon-only treatments and carbon-boost treatments with photon-IMRT. The average time per fraction in the treatment room per patient was 29 minutes; for irradiation only, the mean time including all patients was 16 minutes. Position verification was performed prior to every treatment fraction with orthogonal x-ray imaging. Conclusion. Particle therapy could be included successfully into the clinical routine at the Dept. of Radiation Oncology in Heidelberg. Numerous clinical trials will subsequently be initiated to precisely define the role of proton and carbon ion radiotherapy in radiation oncology.

  19. In-house prepared diagnostic radiopharmaceuticals for nuclear oncology - step towards development of the radionuclide therapy

    International Nuclear Information System (INIS)

    Full text: In this paper we present our experience with in-house prepared radiopharmaceuticals for diagnosis of malignant diseases as a step towards development the radionuclide therapy. This work has a very important social and economic impact for our country, especially to improve the diagnosis of patient with malignant diseases, and to develop the treatment and therapy of this patients. At the present we have a clinical application of : Bone scan - [99mTc] methylenediphosphonate - for staging of bone disease particularly in prostate, breast and lung cancer; MIBI scan - [99mTc] MIBI - localization of active disease in thyroid cancer, parathyroid and in brest cancer cases; Pentavalent DMSA - [99mTc] DMSA(V) - localization of tumours (medullar thyroid cancer); MIBG scan - [131I] MIBG - localization of neuroendocrine tumours that take up norepinephrine, and in progress; Octreotide scan - [99mTc]-DOTA TOC - localization of tumours with somatostatin receptors (pancreatic tumours, carcinoid tumours, medullar thyroid cancer, neuroblastoma); Monoclonal antibodies scan - [99mTc] anti CEA - staging of tumour that express specific antigens (colorectal and prostate cancers). The aim of our work is to establish the protocols of preparation and application of 99mTc DMSA (V) and 131I MIBG. The radiopharmaceutical DMSA(V) was in house prepared as asterile, pyrogen-free, freezed product under nitrogen. Each vial contain DMSA-1.0 mg and Stannous chloride dehydrate 0.4 mg with the final PH 2.0. Before labelling the kit was reconstituied by the addition of 0.5 ml sterile, pyrogen-free 3.5% NaHCO3. Reconstitution and labelling was performed by addition of sterile, pirogen-free, isotonic sodium 99mTc pertechnetate - 6 ml final volume. The product contains no antimicrobial preservative. After incubation of 15 min. and before use, limpidity of the solution after preparation, pH (∼8) and radioactivity was checked. The quality control of this radiopharmaceutical was effected by: 1

  20. Clinical impact of Positron Emission Tomography (PET) on oncological patients and their potentially application context

    International Nuclear Information System (INIS)

    (PET) Positron Emission Tomography is a technique of nuclear medicine that has ability of detecting cancer through mechanisms based on molecular alterations of neoplastic processes. This review describes the PET Oncology applications and discusses the potential application of this technology in the sanitary and national academic framework . The most widely used in Oncology plotter is an analogue of laglucosa labelled with fluo: 18F-2-fluoro-2-Deoxy-D-glucose (FDG). In this way, the PET detects tumour retention of FDG, due to the highest glycolytic of cancer cells. In addition, the PET allow the study of the entire body at the same exploratory and some teams are coupled to systems of axial tomography (PET-CT). By ET-FDG, it is possible to diagnose, staging and restaged the majority of cancers, with diagnostic accuracy close to 90 per cent higher than the values provided by the conventional imaging techniques such. It is also possible to know early response to cancer treatments and obtain relevant medical prognosis information. (author)

  1. Integrated 18FDG PET/CT: Utility and Applications in Clinical Oncology

    Directory of Open Access Journals (Sweden)

    Nieves Gómez-León

    2008-01-01

    Full Text Available Accurate diagnosis and staging are essential for an optimal management of cancer patients. Positron emision tomography with 2-deoxy-2-fluorine-18-fluoro-D-glucose (18FDG-PET and, more recently, 18FDG-PET/computed tomography (18FDG-PET/CT have emerged as powerful imaging tools in oncology, because of the valuable functional information they provide. The combined acquisition of PET and CT has synergistic advantages over its isolated constituents and minimizes their limitations. It decreases examination times by 25%–40%, leads to a higher patient throughput and unificates two imaging procedures in a single session. There is evidence that 18FDG-PET/CT is a more accurate test than either of its components for the evaluation of various tumors. It is a particularly valuable tool for detection of recurrence, especially in asymptomatic patients with rising tumor markers and those with negative or equivocal findings on conventional imaging tests. Yet, there are some limitations and areas of uncertainty, mainly regarding the lack of specificity of the 18FDG uptake and the variable 18FDG avidity of some cancers. This article reviews the advantages, limitations and main applications of 18FDG-PET/CT in oncology, with especial emphasis on lung cancer, colorectal cancer, lymphomas, melanoma and head and neck cancers.

  2. A web-based 'patterns of care study' system for clinical radiation oncology in Korea: development, launching, and characteristics

    International Nuclear Information System (INIS)

    We report upon a web-based system for Patterns of Care Study (PCS) devised for Korean radiation oncology, This PCS was designed to establish standard tools for clinical quality assurance, to determine basic parameters for radiation oncology processes, to offer a solid system for cooperative clinical studies and a useful standard database for comparisons with other national databases. The system consisted of a main server with two back-ups in other locations. The program uses a Linux operating system and a MySQL database. Cancers with high frequencies in radiotherapy departments in Korea from 1998 to 1999 were chosen to have a developmental priority. The web-based clinical PCS system for radiotherapy in www.pcs.re.kr was developed in early 2003 for cancers of the breast, rectum, esophagus, larynx and lung, and for brain metastasis. The total number of PCS study items exceeded one thousand. Our PCS system features user-friendliness, double entry checking, data security, encryption, hard disc mirroring, double back-up, and statistical analysis. Alphanumeric data can be input as well as image data. In addition, programs were constructed for IRB submission, random sampling of data, and departmental structure. For the first time in the field of PCS, we have developed a web-based system and associated working programs. With this system, we can gather sample data in a short period and thus save, cost, effort and time. Data should be performed to validate input data. We propose that this system should be considered as a standard method for PCS or similar types of data collection systems

  3. What Medical Oncologist Residents Think about the Italian Speciality Schools: A Survey of the Italian Association of Medical Oncology (AIOM) on Educational, Clinical and Research Activities

    Science.gov (United States)

    Moretti, Anna; De Angelis, Carmine; Lambertini, Matteo; Cremolini, Chiara; Imbimbo, Martina; Berardi, Rossana; Di Maio, Massimo; Cascinu, Stefano; La Verde, Nicla

    2016-01-01

    Background and objectives Relevant heterogeneity exists among Postgraduate Schools in Medical Oncology, also within the same country. In order to provide a comprehensive overview of the landscape of Italian Postgraduate Schools in Medical Oncology, the Italian Association of Medical Oncology (AIOM) undertook an online survey, inviting all the residents to describe their daily activities and to express their overall satisfaction about their programs. Methods A team composed of five residents and three consultants in medical oncology prepared a 38 items questionnaire that was published online in a reserved section, accessible through a link sent by e-mail. Residents were invited to anonymously fill in the questionnaire that included the following sub-sections: quality of teaching, clinical and research activity, overall satisfaction. Results Three-hundred and eleven (57%) out of 547 invited residents filled in the questionnaire. Two-hundred and twenty-three (72%) participants declared that attending lessons was frequently difficult and 153 (49%) declared they did not gain substantial improvement in their knowledge from them. Fifty-five percent stated that they did not receive lessons on palliative care. Their overall judgment about didactic activity was low in 63% of the interviewed. The satisfaction for clinical activity was in 86% of cases good: 84% recognized that, during the training period, they acquired a progressive independence on patients' management. About research activity, the majority (79%) of participants in the survey was actively engaged in managing patients included in clinical trials but the satisfaction level for the involvement in research activities was quite low (54%). Overall, 246 residents (79%) gave a positive global judgment of their Medical Oncology Schools. Conclusions The landscape of Italian Postgraduate Schools in Medical Oncology is quite heterogeneous across the country. Some improvements in the organization of teaching and in the

  4. Magnetic resonance guided focalized ultrasound thermo-ablation: A promising oncologic local therapy

    International Nuclear Information System (INIS)

    Pain management of bone metastases is usually made using systemic and local therapy. Even though radiations are nowadays the gold standard for painful metastases, innovations regarding minimally invasive treatment approaches have been developed because of the existing non-responder patients [1]. Indeed, cementoplasty and thermo-ablations like radiofrequency or cryotherapy have shown to be efficient on pain [2-4]. Among thermo-therapy, magnetic resonance guided focalized ultrasound is now a new non-invasive weapon for bone pain palliation. (authors)

  5. Ki-67 Is an Independent Predictor of Metastasis and Cause-Specific Mortality for Prostate Cancer Patients Treated on Radiation Therapy Oncology Group (RTOG) 94-08

    Energy Technology Data Exchange (ETDEWEB)

    Verhoven, Bret [University of Wisconsin Carbone Cancer Center, Madison, Wisconsin (United States); Yan, Yan [RTOG Statistical Center, Philadelphia, Pennsylvania (United States); Ritter, Mark, E-mail: ritter@humonc.wisc.edu [University of Wisconsin Carbone Cancer Center, Madison, Wisconsin (United States); Khor, Li-Yan [Case Medical Center, Cleveland, Ohio (United States); Hammond, Elizabeth [LDS Hospital, Salt Lake City, Utah (United States); Jones, Christopher [Radiological Associates of Sacramento, Sacramento, California (United States); Amin, Mahul [Cedars-Sinai Medical Center, Los Angeles, California (United States); Bahary, Jean-Paul [Centre Hospitalier de l' Université de Montréal-Notre Dame, Montreal, Ontario (Canada); Zeitzer, Kenneth [Albert Einstein Medical Center, Philadelphia, Pennsylvania (United States); Pollack, Alan [University of Miami Miller School of Medicine, Miami, Florida (United States)

    2013-06-01

    Purpose: The association of Ki-67 staining index (Ki67-SI) with overall survival (OS), disease-specific mortality (DSM), distant metastasis (DM), and biochemical failure (BF) was examined in men with favorable- to intermediate-risk prostate cancer receiving radiation therapy (RT) alone or with short-term androgen deprivation (ADT) in Radiation Therapy Oncology Group (RTOG) 94-08. Methods and Materials: 468 patients (23.6%) on RTOG 94-08 had sufficient tissue for Ki67-SI analysis. The median follow-up time was 7.9 years. Ki67-SI was determined by immunohistochemistry and quantified manually and by image analysis. Correlative analysis versus clinical outcome was performed using the third quartile (≥Q3) cutpoint. A proportional hazards multivariable analysis (MVA) dichotomized covariates in accordance with trial stratification and randomization criteria. Results: In MVAs adjusted for all treatment covariates, high Ki67-SI (≥Q3) was correlated with increased DSM (hazard ratio [HR] 2.48, P=.03), DM (HR 3.5, P=.002), and BF (HR 3.55, P<.0001). MVA revealed similar Ki67-associated hazard ratios in each separate treatment arm for DSM, DM, and BF; these reached significance only for DM in the RT-alone arm and for BF in both arms. Ki67-SI was not a significant predictor of intraprostatic recurrence assessed by repeated biopsy 2 years after treatment. Patients with a high or low Ki67-SI seemed to experience a similar relative benefit from the addition of ADT to radiation. Conclusions: High Ki67-SI independently predicts for increased DSM, DM, and protocol BF in primarily intermediate-risk prostate cancer patients treated with RT with or without ADT on RTOG 94-08 but does not predict for local recurrence or for increased relative benefit from ADT. This and prior studies lend support for the use of Ki67-SI as a stratification factor in future trials.

  6. Ki-67 Is an Independent Predictor of Metastasis and Cause-Specific Mortality for Prostate Cancer Patients Treated on Radiation Therapy Oncology Group (RTOG) 94-08

    International Nuclear Information System (INIS)

    Purpose: The association of Ki-67 staining index (Ki67-SI) with overall survival (OS), disease-specific mortality (DSM), distant metastasis (DM), and biochemical failure (BF) was examined in men with favorable- to intermediate-risk prostate cancer receiving radiation therapy (RT) alone or with short-term androgen deprivation (ADT) in Radiation Therapy Oncology Group (RTOG) 94-08. Methods and Materials: 468 patients (23.6%) on RTOG 94-08 had sufficient tissue for Ki67-SI analysis. The median follow-up time was 7.9 years. Ki67-SI was determined by immunohistochemistry and quantified manually and by image analysis. Correlative analysis versus clinical outcome was performed using the third quartile (≥Q3) cutpoint. A proportional hazards multivariable analysis (MVA) dichotomized covariates in accordance with trial stratification and randomization criteria. Results: In MVAs adjusted for all treatment covariates, high Ki67-SI (≥Q3) was correlated with increased DSM (hazard ratio [HR] 2.48, P=.03), DM (HR 3.5, P=.002), and BF (HR 3.55, P<.0001). MVA revealed similar Ki67-associated hazard ratios in each separate treatment arm for DSM, DM, and BF; these reached significance only for DM in the RT-alone arm and for BF in both arms. Ki67-SI was not a significant predictor of intraprostatic recurrence assessed by repeated biopsy 2 years after treatment. Patients with a high or low Ki67-SI seemed to experience a similar relative benefit from the addition of ADT to radiation. Conclusions: High Ki67-SI independently predicts for increased DSM, DM, and protocol BF in primarily intermediate-risk prostate cancer patients treated with RT with or without ADT on RTOG 94-08 but does not predict for local recurrence or for increased relative benefit from ADT. This and prior studies lend support for the use of Ki67-SI as a stratification factor in future trials

  7. Quality of life in oncology with emphasis upon neuro-oncology.

    Science.gov (United States)

    Choucair, Ali K

    2007-01-01

    Quality of life, as a science has been steadily gaining importance in both clinical practice as well as research. Despite major progress in the development of validated and clinically-relevant health-related quality of life (HRQOL) measures, we still face many challenges in bridging the gap between what we know and how to apply it in clinical practice: in making the transfer from the mere collection of QOL data to its utilization in improving patient outcome through interventional symptomatic therapy. This manuscript traces the development of QOL as a science to its potential utility in both clinical care and clinical research, as well as an outcomes measure. The emphasis has been placed upon quality of life in oncology with special attention to neuro-oncology. PMID:17127306

  8. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for testicular germ cell tumors

    Directory of Open Access Journals (Sweden)

    Mohammed Alotaibi

    2016-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with testicular germ cell tumors. It is categorized according to the stage of the disease using the tumor-node-metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with testicular germ cell tumors.

  9. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer

    Directory of Open Access Journals (Sweden)

    Ashraf Abusamra

    2016-01-01

    Full Text Available This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.

  10. Routine administration of standardized questionnaires that assess aspects of patients quality of life in medical oncology clinics: A systematic review

    International Nuclear Information System (INIS)

    Purpose: Increasing interest in the Quality of Life outcomes in cancer patients led to increase implementation of their use in routine clinical practice. The aim of this systemic review is to review the scientific evidence behind recommending the use of quality of life (QoL) scales routinely in outpatient evaluation. Methods: Systematic review for all published randomized controlled trials in English language between January 1, 1990 till December 31, 2012. Out of 487 articles (476 identified by electronic search + 11 articles identified by manual search), six trials satisfied the eligibility criteria: (1) the study was a randomized controlled trial (RCT) with randomization of patients or health care providers; (2) the findings of the administered questionnaire or scale (the intervention) were given to health care provider, and compared to standard care with no questionnaire administered (the control); (3) study was conducted in outpatient oncology clinics; and (4) an outcome was measured that related to (i) QoL improvement, (ii) reduction in morbidity, (iii) reduction in stress for the patients, (iv) improvement in communication between patients and health care provider, or (v) improved patient satisfaction. Assessment for the quality of the study was done using the GRADE methodology. Results: Serious methodological issues were affecting most of the trials. Overall the evaluation of the quality of the evidence from these identified trials suggests that there is a weak recommendation to use QoL scales in routine oncology practice to improve communication between physicians and patients. Conclusion: The routine use of such tools in the outpatient settings at improving the patient outcome or satisfaction cannot be recommended based on the available evidence. The potential harm with the excess use of resources needed to implement, collect, store, analyse, and present such data to health care providers should be also considered. Further research and better designed

  11. Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

    Science.gov (United States)

    Beisecker, Analee E.; And Others

    1994-01-01

    Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

  12. Mind-Body Therapies: Evidence and Implications in Advanced Oncology Practice

    OpenAIRE

    Mayden,, Kelley D.

    2012-01-01

    The idea that thoughts and emotions influence health outcomes is an ancient concept that was initially abandoned by Western medicine researchers. Today, researchers are showing a renewed interest in the interactions of the mind and body and the role these interactions play in disease formation and recovery. Complementary and alternative interventions, such as mind-body therapies, are increasingly being used by cancer survivors for disease prevention, immune system enhancement, and symptom con...

  13. Heterogeneous Optimization Framework: Reproducible Preprocessing of Multi-Spectral Clinical MRI for Neuro-Oncology Imaging Research.

    Science.gov (United States)

    Milchenko, Mikhail; Snyder, Abraham Z; LaMontagne, Pamela; Shimony, Joshua S; Benzinger, Tammie L; Fouke, Sarah Jost; Marcus, Daniel S

    2016-07-01

    Neuroimaging research often relies on clinically acquired magnetic resonance imaging (MRI) datasets that can originate from multiple institutions. Such datasets are characterized by high heterogeneity of modalities and variability of sequence parameters. This heterogeneity complicates the automation of image processing tasks such as spatial co-registration and physiological or functional image analysis. Given this heterogeneity, conventional processing workflows developed for research purposes are not optimal for clinical data. In this work, we describe an approach called Heterogeneous Optimization Framework (HOF) for developing image analysis pipelines that can handle the high degree of clinical data non-uniformity. HOF provides a set of guidelines for configuration, algorithm development, deployment, interpretation of results and quality control for such pipelines. At each step, we illustrate the HOF approach using the implementation of an automated pipeline for Multimodal Glioma Analysis (MGA) as an example. The MGA pipeline computes tissue diffusion characteristics of diffusion tensor imaging (DTI) acquisitions, hemodynamic characteristics using a perfusion model of susceptibility contrast (DSC) MRI, and spatial cross-modal co-registration of available anatomical, physiological and derived patient images. Developing MGA within HOF enabled the processing of neuro-oncology MR imaging studies to be fully automated. MGA has been successfully used to analyze over 160 clinical tumor studies to date within several research projects. Introduction of the MGA pipeline improved image processing throughput and, most importantly, effectively produced co-registered datasets that were suitable for advanced analysis despite high heterogeneity in acquisition protocols. PMID:26910516

  14. Nanotechnology in Radiation Oncology

    OpenAIRE

    Wang, Andrew Z.; Tepper, Joel E.

    2014-01-01

    Nanotechnology, the manipulation of matter on atomic and molecular scales, is a relatively new branch of science. It has already made a significant impact on clinical medicine, especially in oncology. Nanomaterial has several characteristics that are ideal for oncology applications, including preferential accumulation in tumors, low distribution in normal tissues, biodistribution, pharmacokinetics, and clearance, that differ from those of small molecules. Because these properties are also wel...

  15. A Phase 3 Trial of 2 Years of Androgen Suppression and Radiation Therapy With or Without Adjuvant Chemotherapy for High-Risk Prostate Cancer: Final Results of Radiation Therapy Oncology Group Phase 3 Randomized Trial NRG Oncology RTOG 9902

    International Nuclear Information System (INIS)

    Purpose: Long-term (LT) androgen suppression (AS) with radiation therapy (RT) is a standard treatment of high-risk, localized prostate cancer (PCa). Radiation Therapy Oncology Group 9902 was a randomized trial testing the hypothesis that adjuvant combination chemotherapy (CT) with paclitaxel, estramustine, and oral etoposide plus LT AS plus RT would improve overall survival (OS). Methods and Materials: Patients with high-risk PCa (prostate-specific antigen 20-100 ng/mL and Gleason score [GS] ≥7 or clinical stage ≥T2 and GS ≥8) were randomized to RT and AS (AS + RT) alone or with adjuvant CT (AS + RT + CT). CT was given as four 21-day cycles, delivered beginning 28 days after 70.2 Gy of RT. AS was given as luteinizing hormone-releasing hormone for 24 months, beginning 2 months before RT plus an oral antiandrogen for 4 months before and during RT. The study was designed based on a 6% improvement in OS from 79% to 85% at 5 years, with 90% power and a 2-sided alpha of 0.05. Results: A total of 397 patients (380 eligible) were randomized. The patients had high-risk PCa, 68% with GS 8 to 10 and 34% T3 to T4 tumors, and median prostate-specific antigen of 22.6 ng/mL. The median follow-up period was 9.2 years. The trial closed early because of excess thromboembolic toxicity in the CT arm. The 10-year results for all randomized patients revealed no significant difference between the AS + RT and AS + RT + CT arms in OS (65% vs 63%; P=.81), biochemical failure (58% vs 54%; P=.82), local progression (11% vs 7%; P=.09), distant metastases (16% vs 14%; P=.42), or disease-free survival (22% vs 26%; P=.61). Conclusions: NRG Oncology RTOG 9902 showed no significant differences in OS, biochemical failure, local progression, distant metastases, or disease-free survival with the addition of adjuvant CT to LT AS + RT. The trial results provide valuable data regarding the natural history of high-risk PCa treated with LT AS + RT and have implications for

  16. A Phase 3 Trial of 2 Years of Androgen Suppression and Radiation Therapy With or Without Adjuvant Chemotherapy for High-Risk Prostate Cancer: Final Results of Radiation Therapy Oncology Group Phase 3 Randomized Trial NRG Oncology RTOG 9902

    Energy Technology Data Exchange (ETDEWEB)

    Rosenthal, Seth A., E-mail: rosents@sutterhealth.org [Radiation Oncology, Sutter Cancer Centers, Roseville, California (United States); Hunt, Daniel [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Sartor, A. Oliver [Tulane University Medical Center, New Orleans, Louisiana (United States); Pienta, Kenneth J. [Johns Hopkins School of Medicine, Baltimore, Maryland (United States); Gomella, Leonard [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Grignon, David [Indiana University, Bloomington, Indiana (United States); Rajan, Raghu [McGill University, Montreal, Quebec (Canada); Kerlin, Kevin J. [Community Clinical Oncology Program, Southeast Cancer Control Consortium, Inc, Winston-Salem, North Carolina (United States); Jones, Christopher U. [Radiation Oncology, Sutter Cancer Centers, Roseville, California (United States); Radiological Associates of Sacramento, Sacramento, California (United States); Dobelbower, Michael [University of Alabama at Birmingham Medical Center, Birmingham, Alabama (United States); Shipley, William U. [Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Zeitzer, Kenneth [Albert Einstein Medical Center, Bronx, New York (United States); Hamstra, Daniel A. [University of Michigan Medical Center, Ann Arbor, Michigan (United States); Donavanik, Viroon [Christiana Care Health Services, Inc, Wilmington, Delaware (United States); Rotman, Marvin [State University of New York Health Science Center–Brooklyn, Brooklyn, New York (United States); Hartford, Alan C. [Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (United States); Michalski, Jeffrey [Washington University, St. Louis, Missouri (United States); Seider, Michael [Akron City Hospital, Akron, Ohio (United States); Kim, Harold [Wayne State University, Detroit, Michigan (United States); and others

    2015-10-01

    Purpose: Long-term (LT) androgen suppression (AS) with radiation therapy (RT) is a standard treatment of high-risk, localized prostate cancer (PCa). Radiation Therapy Oncology Group 9902 was a randomized trial testing the hypothesis that adjuvant combination chemotherapy (CT) with paclitaxel, estramustine, and oral etoposide plus LT AS plus RT would improve overall survival (OS). Methods and Materials: Patients with high-risk PCa (prostate-specific antigen 20-100 ng/mL and Gleason score [GS] ≥7 or clinical stage ≥T2 and GS ≥8) were randomized to RT and AS (AS + RT) alone or with adjuvant CT (AS + RT + CT). CT was given as four 21-day cycles, delivered beginning 28 days after 70.2 Gy of RT. AS was given as luteinizing hormone-releasing hormone for 24 months, beginning 2 months before RT plus an oral antiandrogen for 4 months before and during RT. The study was designed based on a 6% improvement in OS from 79% to 85% at 5 years, with 90% power and a 2-sided alpha of 0.05. Results: A total of 397 patients (380 eligible) were randomized. The patients had high-risk PCa, 68% with GS 8 to 10 and 34% T3 to T4 tumors, and median prostate-specific antigen of 22.6 ng/mL. The median follow-up period was 9.2 years. The trial closed early because of excess thromboembolic toxicity in the CT arm. The 10-year results for all randomized patients revealed no significant difference between the AS + RT and AS + RT + CT arms in OS (65% vs 63%; P=.81), biochemical failure (58% vs 54%; P=.82), local progression (11% vs 7%; P=.09), distant metastases (16% vs 14%; P=.42), or disease-free survival (22% vs 26%; P=.61). Conclusions: NRG Oncology RTOG 9902 showed no significant differences in OS, biochemical failure, local progression, distant metastases, or disease-free survival with the addition of adjuvant CT to LT AS + RT. The trial results provide valuable data regarding the natural history of high-risk PCa treated with LT AS + RT and have implications for

  17. Audit of high energy therapy beams in hospital oncology departments by the National Radiation Laboratory

    International Nuclear Information System (INIS)

    In 1993 the output of every high energy radiotherapy beam used clinically in New Zealand was measured by National Radiation Laboratory (NRL) staff using independent dosimetry equipment. The purpose of this was to audit the dosimetry that is used by hospital physicists for the basis of patient treatments, and to uncover any errors that may be clinically significant. This report analyses the uncertainties involved in comparing the NRL and hospital measurements, and presents the results of the 1993 audit. The overall uncertainty turns out to be about 1.5%. The results for linear accelerator photon beams are consistent with a purely random variation within this uncertainty. Electron beams show some small errors beyond the expected uncertainty. Gamma beams have the potential to be the most accurately measured, but in practice are less accurately measured than linear accelerator beams. None of the disagreements indicated an error of clinical significance. 8 refs., 3 figs., 2 tabs

  18. Lupus: novel therapies in clinical development.

    Science.gov (United States)

    Chugh, Preeta Kaur

    2012-04-01

    There have been significant advancements in understanding the immunopathogenesis of systemic lupus erythematosus. However, the developments in therapeutics have been rather slow. Belimumab, a B lymphocyte stimulator (BLyS) inhibitor has been approved for the treatment of this disease after more than 50 years. Numerous biological agents are being developed which target the B cells, T cells, and various cytokines. Among anti-B cell therapy, drugs target CD20+ cells (ocrelizumab, SBI-087), CD22+ cells (epratuzumab) \\or the receptors of tumor necrosis factor (TNF) superfamily (atacicept, LY2127399, A-623). Monoclonal antibodies targeting interferon alpha (IFN-α) and gamma (IFN-γ) and interleukins (IL-6, 10) are being investigated for SLE. Novel targets include toll like receptors, phosphodiesterases, CD40 ligand and retinoid receptors. This review discusses various drugs which are in different phases of clinical trials and hold promise for patients suffering from this chronic debilitating disease. PMID:22385876

  19. The results of combined therapy malignant neoplasms of maxillary sinus at Oncology Center in Poznan

    International Nuclear Information System (INIS)

    Between 1985-1989 22 patients with malignant neoplasma maxillary sinus have been treated. At the first stage the surgical resection of maxilla was performed. Most of the patients (77%) had histopathological diagnosis of carcinoma planoepitheliale, 13% carcinoma solidum and 4% carcinoma adenoides cysticum. All patients had adjuvant therapy by Co-60 irradiation. Single fraction dose of 2 Gy/T 5 times a week up to total dose of 60-70 Gy/T has been applied. In the follow-up period of minimum 36 months the free-symptoms survival rate of 18%. (author)

  20. Understanding the molecular target therapy and it's approved synchronous use with radiation therapy in current Indian oncology practice

    International Nuclear Information System (INIS)

    The molecular targeted drugs (MTD) are of two types; large and small. The large molecular targeted drugs (LMTD) cannot cross the cancer cell membrane whereas those that cross the cancer cell membrane are nicknamed small molecular target drugs (SMTD). India has availability of almost all MTD originals approved by USA Food and Drug administration. However a few LMTD like inj vectibix, inj Zevalin, Inj Bexar etc.; and SMTD like cap Tipifarnib approved for AML, are not available in India currently although approved and available in USA. The MTD may he used alone as singlet; along with chemotherapy as doublet or triplet; or along with radiation and chemotherapy combo (nicknamed chemo-radiation-bio therapy). The molecular target therapy approved by USA and/or European FDA and currently available in India and used along with radiation therapy with or without chemotherapy, indication wise are; Brain Tumor Inj Nimotuzumab (LMTD) and Inj bevacizumab (LMTD) in Glioblasoma Multiforme; for Carcinoma Head and neck Inj Cetuximab and Inj Nimotuzumab (LMTT), Tab Geftinib (SMTD). (author)

  1. Instruction in medical ethics during clinical training for medical students. Report on experience in radio-oncology

    International Nuclear Information System (INIS)

    The article gives a review of the current state of education in medical ethics in Germany. The issue is considered from the viewpoint of radio-oncology. Both the pertinent literature and our own experience in teaching medical ethics are presented. In October 2003, medical ethics was integrated into the curriculum of medicine. The aim was to train competence in the field of personal attitudes and to intensify skills of moral reasoning. Our own experiences are positive, which is in accordance with the reports of other working groups. Most of the students were interested in education in medical ethics and looked upon ethical training as being an important part of their studies. Medical students are interested in ethical education during the clinical period of their studies, which has been taken into account since the actual change of the curriculum. Radio-oncologists as specialists in other clinical fields can offer important contributions when they discuss clinical cases from the viewpoint of medical ethics. The long-term effect of such an education will become the subject of future research. (orig.)

  2. Dosimetric comparison of the linear accelerators at the University Clinic of Radiotherapy and Oncology in Skopje, Macedonia

    International Nuclear Information System (INIS)

    In radiotherapy practice, for various practical reasons it is important to know whether two or more linear accelerators (linacs) are dosimetric matched and whether the patient’s treatment can be shifted from one linac to another without reducing the treatment quality. This work presents the data from the dosimetric comparison of the two Varian Clinacs 23EX and one Varian Clinac iX at the University Clinic of Radiotherapy and Oncology in Skopje. Both Percentage Depth Dose (PDD) and Beam Profile (BP) curves were compared for the photon energies (6MV, 15MV) in use at the clinic. The comparison was performed using the IBA OmniPro Accept 7.4™ software. The results from the comparison of the PDD curves showed that in the clinically significant region the dose differences were smaller than 1%. The results from the comparison of the in line and cross line BP curves showed that in the flattened area the dose differences were smaller than 2.5%, while in the penumbra region they were usually between 2% and 8%, but sometimes up to 21%. This suggests that for treatments where the influence of the penumbra region is small, the three linacs may be considered to be dosimetric matched. For treatments where the influence of the penumbra region is greater, the patient can be switched to another machine only after recalculation of the treatment plan. (Author)

  3. A Bayesian Dose-finding Design for Oncology Clinical Trials of Combinational Biological Agents.

    Science.gov (United States)

    Cai, Chunyan; Yuan, Ying; Ji, Yuan

    2014-01-01

    Treating patients with novel biological agents is becoming a leading trend in oncology. Unlike cytotoxic agents, for which efficacy and toxicity monotonically increase with dose, biological agents may exhibit non-monotonic patterns in their dose-response relationships. Using a trial with two biological agents as an example, we propose a dose-finding design to identify the biologically optimal dose combination (BODC), which is defined as the dose combination of the two agents with the highest efficacy and tolerable toxicity. A change-point model is used to reflect the fact that the dose-toxicity surface of the combinational agents may plateau at higher dose levels, and a flexible logistic model is proposed to accommodate the possible non-monotonic pattern for the dose-efficacy relationship. During the trial, we continuously update the posterior estimates of toxicity and efficacy and assign patients to the most appropriate dose combination. We propose a novel dose-finding algorithm to encourage sufficient exploration of untried dose combinations in the two-dimensional space. Extensive simulation studies show that the proposed design has desirable operating characteristics in identifying the BODC under various patterns of dose-toxicity and dose-efficacy relationships. PMID:24511160

  4. Multisystemic Therapy: Clinical Foundations and Research Outcomes

    Directory of Open Access Journals (Sweden)

    Scott W. Henggeler

    2012-07-01

    Full Text Available Multisystemic therapy (MST is an intensive family and community-based treatment for adolescents presenting serious antisocial behavior and their families. Using a home-based model of service delivery to overcome barriers to service access and a strong quality assurance system to promote treatment fidelity, MST therapists address known risk factors (i.e., at individual, family, peer, school, and community levels strategically and comprehensively. The family is viewed as central to achieving favorable outcomes, and mediation research supports the emphasis of MST on promoting family functioning as the key mechanism of clinical change. Importantly, 22 MST outcome studies have been published, many of which are independent randomized clinical trials, and the vast majority, including those conducted in Europe, support the capacity of MST to reduce youth antisocial behavior and out-of-home placements. Such outcomes, combined with the advocacy of many juvenile justice stakeholders, have led to the transport of MST programs to more than 500 sites, including 10 nations in Europe.

  5. New hepatitis C therapies in clinical development

    Directory of Open Access Journals (Sweden)

    Vermehren Johannes

    2011-07-01

    Full Text Available Abstract With the current standard of care for the treatment of chronic hepatitis C, a combination of pegylated interferon alfa and ribavirin, sustained virologic response rates can be achieved in approximately 50% of patients only. Improved understanding of the viral life cycle has led to the identification of numerous potential targets for novel, direct-acting antiviral compounds. Inhibitors of the NS3/4A protease are currently the most advanced in clinical development. Recently completed phase 3 studies of the two protease inhibitors telaprevir and boceprevir, each given in combination with standard of care, yielded sustained virologic response rates in the range of 66-75% in treatment-naive patients and 59-66% in treatment-experienced patients with HCV genotype 1 infection. Studies of second-generation protease inhibitors, with the potential advantage of improved potency, drug metabolism and pharmacokinetics profile, are already underway. Inhibitors of the HCV NS5A protein and NS5B polymerase are potentially active across different HCV genotypes and have shown promising antiviral efficacy in early clinical studies. Other emerging mechanisms include silymarin components and inhibitors of cell proteins required for HCV replication. While improved formulations of current HCV therapies are also being developed, future hopes lie on the combination of direct-acting antivirals with the eventual possibility of interferon-free treatment regimens.

  6. Performances of the scanning system for the CNAO center of oncological hadron therapy

    CERN Document Server

    Giordanengo, S; Attili, A; Pardo, J; Russo, G; Taddia, G; Monaco, V; Garella, M A; Zampieri, A; Fabbricatore, P; Cirio, R; Voelker, F; Sacchi, R; Bourhaleb, F; Marchetto, F; Burini, F; Incurvati, M; Ansarinejad, A; Peroni, C

    2010-01-01

    In hadron therapy one of the most advanced methods for beam delivery is the active scanning technique which uses fast scanning magnets to drive a narrow particle beam across the target. The Centro Nazionale di Adroterapia Oncologica (CNAO) will treat tumours with this technique. The CNAO scanning system includes two identical dipole magnets for horizontal and vertical beam deflection, each one connected to a fast power supply. The dose delivery system exploits a set of monitor chambers to measure the fluence and position of the beam and drives the beam during the treatment by controlling the sequence of currents set by the power supplies. A test of the dynamic performance of the scanning system has been performed using a Hall probe to measure the field inside the magnet and the results are presented in this paper. (C) 2009 Elsevier B.V. All rights reserved.

  7. Mutation Profiling of Clinically Advanced Cancers Using Next-Generation Sequencing for Targeted Therapy: A Lifespan Experience.

    Science.gov (United States)

    Friedman, Kenneth; Resnick, Murray B; Safran, Howard

    2015-10-01

    The application of modern molecular tests such as next-generation sequencing (NGS) to human malignancies has led to better understanding of tumor biology and the design of targeted molecular therapies. In the research setting, important genomic alterations in tumors have been discovered with potential therapeutic implications but data regarding the impact of this technology in a real world oncology practice is limited. As a result, we decided to review the results of NGS in 144 advanced-stage cancer patients referred to the oncology practices of Lifespan-affiliated centers in Rhode Island. Most cancers revealed genomic alterations in genes commonly mutated in cancer. However, several unexpected genomic alterations were discovered in certain cancers with potential therapeutic intervention. Most cancers contained "actionable" genomic alterations despite being of advanced stage. Our experience demonstrates that application of NGS in the clinical setting contributes both to increasing the therapeutic armamentarium as well as our understanding of tumor biology. PMID:26422540

  8. [Clinical perfectionism and cognitive behavioral therapy].

    Science.gov (United States)

    Papadomarkaki, E; Portinou, S

    2012-01-01

    The present study constitutes a brief literature overview, in which the term of clinical perfectionism, its etiopathology, its assessment and its relation to psychopathology, as well as the therapeutic interventions based on the Cognitive Behavioral Model are discussed. According to Frost, perfectionism is associated with one's desire to achieve the greatest degree of performance and it is accompanied by an extremely strict evaluation of that particular performance. The relationship with oneself as well as the relationship with others are both characterised by high standards and demands which tend to exhaust one individual and dramatically toughen the development of proximity with the others. Perfectionism, as a personality trait, presents functional and dysfunctional elements for a person. Dysfunctional, clinical perfectionism -a term recently coined by researchers- has been linked to a number of disorders, such as social phobia, obsessive-compulsive disorder, eating disorders -anorexia and bulimia nervosa- depression and personality disorders. From a perfectionist's point of view, perfection exists and its attaintment is feasible. The existence of a particularly high and often unrealistic goal can lead the person to severe disappointment when this specific goal is not finally reached. A person with functional perfectionism is possible to set another, more achievable, goal next time, while a person with clinical perfectionism will interpret this failure as a sign of personal inadequacy and will either make another attempt to reach the same goal or will abandon the effort altogether. A sense of weakness and subsequent negative automatic thoughts are the aftermath of both the first and the second choice. Cognitive Behavioral Therapy focuses on the realisation that clinical perfectionism is undesirable, on the dispute of negative automatic thoughts and on the replacement of unfunctional cognitive schemas with other, more functional ones. In the therapeutic process

  9. Technology for Innovation in Radiation Oncology.

    Science.gov (United States)

    Chetty, Indrin J; Martel, Mary K; Jaffray, David A; Benedict, Stanley H; Hahn, Stephen M; Berbeco, Ross; Deye, James; Jeraj, Robert; Kavanagh, Brian; Krishnan, Sunil; Lee, Nancy; Low, Daniel A; Mankoff, David; Marks, Lawrence B; Ollendorf, Daniel; Paganetti, Harald; Ross, Brian; Siochi, Ramon Alfredo C; Timmerman, Robert D; Wong, John W

    2015-11-01

    Radiation therapy is an effective, personalized cancer treatment that has benefited from technological advances associated with the growing ability to identify and target tumors with accuracy and precision. Given that these advances have played a central role in the success of radiation therapy as a major component of comprehensive cancer care, the American Society for Radiation Oncology (ASTRO), the American Association of Physicists in Medicine (AAPM), and the National Cancer Institute (NCI) sponsored a workshop entitled "Technology for Innovation in Radiation Oncology," which took place at the National Institutes of Health (NIH) in Bethesda, Maryland, on June 13 and 14, 2013. The purpose of this workshop was to discuss emerging technology for the field and to recognize areas for greater research investment. Expert clinicians and scientists discussed innovative technology in radiation oncology, in particular as to how these technologies are being developed and translated to clinical practice in the face of current and future challenges and opportunities. Technologies encompassed topics in functional imaging, treatment devices, nanotechnology, and information technology. The technical, quality, and safety performance of these technologies were also considered. A major theme of the workshop was the growing importance of innovation in the domain of process automation and oncology informatics. The technologically advanced nature of radiation therapy treatments predisposes radiation oncology research teams to take on informatics research initiatives. In addition, the discussion on technology development was balanced with a parallel conversation regarding the need for evidence of efficacy and effectiveness. The linkage between the need for evidence and the efforts in informatics research was clearly identified as synergistic. PMID:26460989

  10. Verification of newly upgraded radiation therapy treatment planning system XIO CMS at the Institute of Oncology Vojvodina

    International Nuclear Information System (INIS)

    Verification of newly installed or upgraded treatment planning system (TPS) is highly recommended and number of protocols and guidelines have been published by professional organizations. In these guidelines, a number of functionalities of TPS are needed to be checked, such as how it handles patient anatomical information, inhomogeneities, beam geometry, accessories, etc. One of the important aspect is the ability to reproduce measured dose distribution by the dose calculation algorithms. The purpose of calculation accuracy verification for treatment planning system is to ensure the agreement between planned and delivered radiation dose to a patient, and to minimize the likelihood of accidents in radiotherapy. Within the framework of IAEA TC project SRB 6 006 the upgrade of TPS at the Institute of oncology Vojvodina has been performed. After TPS upgrade the following checks have been performed: - CT number to the relative electron density conversion table; -verification of accelerator input data which was entered upon first installation of the TPS at the institution, with the newly re-measured data; - treatment planning for the number of clinical test cases were performed on semi anthropomorphic phantom, and compared to measured data; - measurements with ion chamber were done in the same phantom and compared with TPS calculated values; - corrective actions were done for the data observed as erroneous; comparison of algorithm previously used at the institution (convolution) and the superposition, which is used after the upgrade. The measurements were performed in the CIRS Thorax phantom, described in literature. The phantom was scanned twice using local CT. For the first scan the relative electron densities reference plugs were inserted to obtain CT numbers to the relative electron density conversion curve. The curve obtained, was not significantly different from the default CT to ED table already used at the institution, so the old table was kept in use. The second

  11. Basal Cell Skin Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology.

    Science.gov (United States)

    Bichakjian, Christopher K; Olencki, Thomas; Aasi, Sumaira Z; Alam, Murad; Andersen, James S; Berg, Daniel; Bowen, Glen M; Cheney, Richard T; Daniels, Gregory A; Glass, L Frank; Grekin, Roy C; Grossman, Kenneth; Higgins, Susan A; Ho, Alan L; Lewis, Karl D; Lydiatt, Daniel D; Nehal, Kishwer S; Nghiem, Paul; Olsen, Elise A; Schmults, Chrysalyne D; Sekulic, Aleksandar; Shaha, Ashok R; Thorstad, Wade L; Tuli, Malika; Urist, Marshall M; Wang, Timothy S; Wong, Sandra L; Zic, John A; Hoffmann, Karin G; Engh, Anita

    2016-05-01

    Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial comorbidity and be difficult to manage. Assessment of risk is a key element of management needed to inform treatment selection. The overall management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option. Many superficial therapies for BCC have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy. Two hedgehog pathway inhibitors were recently approved by the FDA for systemic treatment of advanced and metastatic BCC, and others are in development. The NCCN Guidelines for Basal Cell Skin Cancer, published in full herein, include recommendations for selecting among the various surgical approaches based on patient-, lesion-, and disease-specific factors, as well as guidance on when to use radiation therapy, superficial therapies, and hedgehog pathway inhibitors. PMID:27160235

  12. Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes

    International Nuclear Information System (INIS)

    Purpose: To evaluate pre-operative prognostic risk factors to predict oncologic outcome of Salvage High-Intensity Focused Ultrasound (S-HIFU) for radiorecurrent prostate cancer (PCa). Methods and materials: A total of 290 men with biopsy-confirmed locally radiorecurrent PCa, underwent S-HIFU. D’Amico risk group before external beam radiotherapy (EBRT), Prostate Specific Antigen (PSA), estimated Gleason score prior HIFU and post HIFU biopsies were analyzed for predictive utility of local cancer control, cancer-specific, metastasis free, and progression free survival rates (PFSR). Results: Local cancer control with negative biopsy results was obtained in 81% of the 208 patients who underwent post-S-HIFU biopsies. Median PSA nadir was 0.14 ng/ml and 127 patients did not require androgen deprivation therapy (ADT). The mean follow up was 48 months for cancer-specific survival rates. The cancer-specific and metastasis-free survival rates at 7 years were 80% and 79.6% respectively. The PFSR was significantly influenced by: the pre-HIFU PSA level (hazard ratio (HR): 1.09, 95% CI 1.04–1.13), a Gleason score ⩾8 versus ⩽6 (HR: 1.17, 95% CI 1.03–1.3), and a previous ADT (HR: 1.28, 95% CI 1.09–1.46). The rates of recto-urethral fistula (0.4%) and grade II/III incontinence (19.5%) indicate significant reduction in serious side effects with use of dedicated post-radiation acoustic parameters compared with standard parameters. Conclusion: S-HIFU is an effective curative option for radiorecurrent PCa with acceptable morbidity for localized radiorecurrent PCa, but should be initiated early following EBRT failure. Use of prognostic risk factors can optimize patient selection.

  13. Clinical Oral Examinations: Assessment of Competency in Radiation Therapy

    OpenAIRE

    Leech, Michelle; POOLE, CLAIRE; CRAIG, AGNELLA; COFFEY, MARY ANNE; NI CHUINNEAGAIN, SIOBHAN

    2009-01-01

    Matching assessment strategies to learning outcomes in radiation therapy education is of the utmost importance. Assessing clinical competence requires that `competence? be clearly defined prior to the start of any clinical programme. In this article, we report on our experience in using clinical oral examinations in assessing competence in second year undergraduate radiation therapy students. The shortcomings of clinical oral examinations such as `leaking? of the agenda are addressed and more...

  14. Quality assurance standards drive improvements in the profile of radiation therapy departments participating in trials of the EORTC Radiation Oncology Group

    International Nuclear Information System (INIS)

    Background and purpose: The Facility Questionnaire (FQ) of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group (EORTC-ROG) evaluates the human, technical and organizational resources at each EORTC member institution. The purpose of this study is to use the FQ database to assess the improvement of radiation therapy (RT) structures and resources within the EORTC compared to the previous surveys performed by our group. Material and methods: We report the content of the current FQ database, completed online by 156 EORTC candidate member institutions from 22 countries between February 2011 and February 2013. Results are compared to FQ-published data from 1992 and 2007. Results: The average number of patients per year per EORTC institution is 2381 (range 350–12,000) an 18.2% increase compared to the 2007 figures. From 2007 to 2013 the average number of radiation oncologists, physicists and radiation technologists per EORTC institution has increased by 27% (from 8.5 to 10.8), 41% (from 5.2 to 7.4) and 38% (from 26.1 to 36.1) respectively. Consequently the number of patients per year per radiation oncologist has decreased from 258 to 243, for physicists from 426 to 354 and for radiation technologists from 107 to 86. One hundred and forty-six (94%) and 101 (65%) institutions can now deliver IMRT and SBRT, compared to 77 (79%) and 53 (54%) in 2007. Conclusions: The standards set by the EORTC-ROG are met by a continually improving number of institutions, helping to safeguard use of advanced technologies in EORTC-ROG clinical trials

  15. What do we know about the mechanisms of the time factor in oncological therapy?

    International Nuclear Information System (INIS)

    Background: Experimental studies and prospective randomized clinical trials have demonstrated a detrimental effect of prolongation of overall treatment time on local tumor control. Methods: In a brief review of the literature, possible mechanisms of the time factor are discussed. Results and Conclusions: The mechanisms of the time factor in cancer treatment are complex and, at present, not fully understood. In experimental tumors, rapid proliferation of clonogenic cells during fractionated irradiation and treatment gaps has been determined as a major cause of the time factor in radiotherapy. Also, chemotherapy can stimulate repopulation of experimental tumors by clonogenic cells. Besides repopulation of clonogenic tumor cells, other factors such as the deterioration of the tumor vasculature with increasing tumor hypoxia might contribute to the time factor. (orig.)

  16. Preclinical models in radiation oncology

    International Nuclear Information System (INIS)

    As the incidence of cancer continues to rise, the use of radiotherapy has emerged as a leading treatment modality. Preclinical models in radiation oncology are essential tools for cancer research and therapeutics. Various model systems have been used to test radiation therapy, including in vitro cell culture assays as well as in vivo ectopic and orthotopic xenograft models. This review aims to describe such models, their advantages and disadvantages, particularly as they have been employed in the discovery of molecular targets for tumor radiosensitization. Ultimately, any model system must be judged by its utility in developing more effective cancer therapies, which is in turn dependent on its ability to simulate the biology of tumors as they exist in situ. Although every model has its limitations, each has played a significant role in preclinical testing. Continued advances in preclinical models will allow for the identification and application of targets for radiation in the clinic

  17. Phase 2 Study of Temozolomide-Based Chemoradiation Therapy for High-Risk Low-Grade Gliomas: Preliminary Results of Radiation Therapy Oncology Group 0424

    International Nuclear Information System (INIS)

    Purpose: Radiation Therapy Oncology Group (RTOG) 0424 was a phase 2 study of a high-risk low-grade glioma (LGG) population who were treated with temozolomide (TMZ) and radiation therapy (RT), and outcomes were compared to those of historical controls. This study was designed to detect a 43% increase in median survival time (MST) from 40.5 to 57.9 months and a 20% improvement in 3-year overall survival (OS) rate from 54% to 65% at a 10% significance level (1-sided) and 96% power. Methods and Materials: Patients with LGGs with 3 or more risk factors for recurrence (age ≥40 years, astrocytoma histology, bihemispherical tumor, preoperative tumor diameter of ≥6 cm, or a preoperative neurological function status of >1) were treated with RT (54 Gy in 30 fractions) and concurrent and adjuvant TMZ. Results: From 2005 to 2009, 129 evaluable patients (75 males and 54 females) were accrued. Median age was 49 years; 91% had a Zubrod score of 0 or 1; and 69%, 25%, and 6% of patients had 3, 4, and 5 risk factors, respectively. Patients had median and minimum follow-up examinations of 4.1 years and 3 years, respectively. The 3-year OS rate was 73.1% (95% confidence interval: 65.3%-80.8%), which was significantly improved compared to that of prespecified historical control values (P<.001). Median survival time has not yet been reached. Three-year progression-free survival was 59.2%. Grades 3 and 4 adverse events occurred in 43% and 10% of patients, respectively. One patient died of herpes encephalitis. Conclusions: The 3-year OS rate of 73.1% for RTOG 0424 high-risk LGG patients is higher than that reported for historical controls (P<.001) and the study-hypothesized rate of 65%

  18. Phase 2 Study of Temozolomide-Based Chemoradiation Therapy for High-Risk Low-Grade Gliomas: Preliminary Results of Radiation Therapy Oncology Group 0424

    Energy Technology Data Exchange (ETDEWEB)

    Fisher, Barbara J., E-mail: barbara.fisher@lhsc.on.ca [London Regional Cancer Program, London, Ontario (Canada); Hu, Chen [Radiation Therapy Oncology Group-Statistical Center, Philadelphia, Pennsylvania (United States); Macdonald, David R. [London Regional Cancer Program, London, Ontario (Canada); Lesser, Glenn J. [Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina (United States); Coons, Stephen W. [Barrow Neurological Institute, Phoenix, Arizona (United States); Brachman, David G. [Arizona Oncology Services Foundation, Phoenix, Arizona (United States); Ryu, Samuel [Henry Ford Hospital, Detroit, Michigan (United States); Werner-Wasik, Maria [Thomas Jefferson University Hospital Center, Philadelphia, Pennsylvania (United States); Bahary, Jean-Paul [Centre Hospitalier de l' Université de Montréal-Notre Dame, Montreal, Quebec (Canada); Liu, Junfeng [GCE Solutions, Inc., Bloomington, Illinois (United States); Chakravarti, Arnab [The Ohio State University, The James, Columbus, Ohio (United States); Mehta, Minesh [University of Maryland Medical Systems, Baltimore, Maryland (United States)

    2015-03-01

    Purpose: Radiation Therapy Oncology Group (RTOG) 0424 was a phase 2 study of a high-risk low-grade glioma (LGG) population who were treated with temozolomide (TMZ) and radiation therapy (RT), and outcomes were compared to those of historical controls. This study was designed to detect a 43% increase in median survival time (MST) from 40.5 to 57.9 months and a 20% improvement in 3-year overall survival (OS) rate from 54% to 65% at a 10% significance level (1-sided) and 96% power. Methods and Materials: Patients with LGGs with 3 or more risk factors for recurrence (age ≥40 years, astrocytoma histology, bihemispherical tumor, preoperative tumor diameter of ≥6 cm, or a preoperative neurological function status of >1) were treated with RT (54 Gy in 30 fractions) and concurrent and adjuvant TMZ. Results: From 2005 to 2009, 129 evaluable patients (75 males and 54 females) were accrued. Median age was 49 years; 91% had a Zubrod score of 0 or 1; and 69%, 25%, and 6% of patients had 3, 4, and 5 risk factors, respectively. Patients had median and minimum follow-up examinations of 4.1 years and 3 years, respectively. The 3-year OS rate was 73.1% (95% confidence interval: 65.3%-80.8%), which was significantly improved compared to that of prespecified historical control values (P<.001). Median survival time has not yet been reached. Three-year progression-free survival was 59.2%. Grades 3 and 4 adverse events occurred in 43% and 10% of patients, respectively. One patient died of herpes encephalitis. Conclusions: The 3-year OS rate of 73.1% for RTOG 0424 high-risk LGG patients is higher than that reported for historical controls (P<.001) and the study-hypothesized rate of 65%.

  19. Approval procedures for clinical trials in the field of radiation oncology; Genehmigungsverfahren klinischer Studien im Bereich der Radioonkologie

    Energy Technology Data Exchange (ETDEWEB)

    Simon, Monique; Buettner, Daniel [Deutsches Konsortium fuer Translationale Krebsforschung (DKTK), Dresden (Germany); Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany); Medizinische Fakultaet und Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Klinik fuer Strahlentherapie und Radioonkologie und OncoRay - Nationales Zentrum fuer Strahlenforschung in der Onkologie, Dresden (Germany); Habeck, Matthias; Habeck, Uta; Brix, Gunnar [Bundesamt fuer Strahlenschutz (BfS), Fachbereich Strahlenschutz und Gesundheit, Neuherberg (Germany); Krause, Mechthild; Baumann, Michael [Deutsches Konsortium fuer Translationale Krebsforschung (DKTK), Dresden (Germany); Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany); Medizinische Fakultaet und Universitaetsklinikum Carl Gustav Carus, Technische Universitaet Dresden, Klinik fuer Strahlentherapie und Radioonkologie und OncoRay - Nationales Zentrum fuer Strahlenforschung in der Onkologie, Dresden (Germany); Helmholtz-Zentrum Dresden - Rossendorf, Institut fuer Radioonkologie und OncoRay - Nationales Zentrum fuer Strahlenforschung in der Onkologie, Dresden (Germany); Willich, Normann [Universitaetsklinikum Muenster, Klinik fuer Strahlentherapie - Radioonkologie, Muenster (Germany); Wenz, Frederik [Universitaetsmedizin Mannheim, Medizinische Fakultaet Mannheim, Universitaet Heidelberg, Klinik fuer Strahlentherapie und Radioonkologie, Mannheim (Germany); Schmidberger, Heinz [Universitaetsmedizin Mainz, Klinik fuer Radioonkologie und Strahlentherapie, Mainz (Germany); Debus, Juergen [Universitaetsklinikum Heidelberg, Klinik fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Noelling, Torsten

    2015-12-15

    Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection (Bundesamt fuer Strahlenschutz, BfS). For studies in the field of radiation oncology, differentiation between use of radiation for ''medical care (Heilkunde)'' versus ''medical research'' frequently leads to contradictions. The aim of this article is to provide principle investigators, individuals, and institutions involved in the process, as well as institutional review or ethics committees, with the necessary information for this assessment. Information on the legal frame and the approval procedures are also provided. A workshop was co-organized by the German Society for Radiation Oncology (DEGRO), the Working Party for Radiation Oncology (ARO) of the German Cancer Society (DKG), the German Society for Medical Physics (DGMP), and the German Cancer Consortium (DKTK) in October 2013. This paper summarizes the results of the workshop and the follow-up discussions between the organizers and the BfS. Differentiating between ''Heilkunde'' which does not need to be approved by the BfS and ''medical research'' is whether the specific application of radiation (beam quality, dose, schedule, target volume, etc.) is a clinically established and recognized procedure. This must be answered by the qualified physician(s) (''fachkundiger Arzt'' according to German radiation protection law) in charge of the study and the treatments of the patients within the study, taking into consideration of the best available evidence from clinical studies, guidelines and consensus papers. Among the important parameters for assessment are indication, total dose, and fractionation. Radiation treatments applied outside clinical trials do not require approval by the BfS, even if they are applied within a randomized or nonrandomized clinical trial

  20. A short perspective on gene therapy: Clinical experience on gene therapy of gliomablastoma multiforme

    OpenAIRE

    Wirth, Thomas

    2011-01-01

    More than two decades have passed since the first gene therapy clinical trial was conducted. During this time, we have gained much knowledge regarding gene therapy in general, but also learned to understand the fear that persists in society. We have experienced drawbacks and successes. More than 1700 clinical trials have been conducted where gene therapy is used as a means for therapy. In the very first trial, patients with advanced melanoma were treated with tumor infiltrating lymphocytes ge...

  1. Clinical Prediction Rules for Physical Therapy Interventions: A Systematic Review

    OpenAIRE

    Beneciuk, Jason M.; Bishop, Mark D; George, Steven Z.

    2009-01-01

    Background and Purpose: Clinical prediction rules (CPRs) involving physical therapy interventions have been published recently. The quality of the studies used to develop the CPRs was not previously considered, a fact that has potential implications for clinical applications and future research. The purpose of this systematic review was to determine the quality of published CPRs developed for physical therapy interventions.

  2. Case management in oncology rehabilitation (CAMON: The effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. A study protocol for a randomized controlled clinical trial in oncology rehabilitation

    Directory of Open Access Journals (Sweden)

    Bardheci Katarina

    2011-04-01

    Full Text Available Abstract Background Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. Methods The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A. Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Discussion Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the

  3. Clinical trials of conformal therapy - physics aspects

    International Nuclear Information System (INIS)

    If Conformal Therapy (CFRT) hadn't existed, physicists would have invented it! So many of the concepts involved are physicist ones: 3-D dose calculation/planning, Beam's-Eye-View, Dose-Volume Histograms, Multileaf Collimators, Computer-Controlled Delivery, Megavoltage Imaging, Optimization, Inverse Planning, Tomotherapy, Biological Modeling, even Protons. All the above developments, many of them involving fairly expensive technology, are on trial. If we wish to be able to use and to continue development of these physicist tools in the future then it has to be demonstrated conclusively that CFRT results in improved clinical outcome. Physicists should therefore be in the front line of planning, executing and evaluating Clinical Trials of Conformal Therapy, by which I mean Randomized, Prospective Phase-III trials i.e. ones that have improved complication-free local control/survival as their endpoint. A prospective, randomized trial to assess the effect of reducing the volume of irradiated normal tissue on acute side-effects in pelvic radiotherapy (93% prostate or bladder ca.) has been carried out at our centre, on 266 patients. In both arms a 3-field, 6 MV x-ray technique was used with identical dose prescriptions; in the conventional arm rectangular fields were employed whereas in the conformal arm the fields were shaped with customized blocks drawn according to the Beam's-Eye-View of the target volume. Substantial differences in normal-tissue volumes (rectum, bladder etc.) were achieved: mean High-Dose Volume (∼ PTV) of 690 cm3 for the conformal technique vs 940 cm3 conventionally. Comprehensive quality-of-life questionnaire were completed before the start of treatment, weekly during and for 3 weeks after the end of treatment and then monthly for a further 2 months. A clear pattern of an increase during followed by a decrease after treatment in symptoms relating to bowel and bladder functions was observed for the patient group as a whole. However, a very extensive

  4. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  5. Patient satisfaction at haematology and oncology clinics in the Free State & Northern Cape

    Directory of Open Access Journals (Sweden)

    W.R. Davies

    2002-09-01

    Full Text Available The Free State and Northern Cape make up some 40% of the land area of South Africa, while being home to only 10% of the total population. Haematology and Oncotherapy outreach clinics were established in Kimberley, Bethlehem and Welkom to provide a more accessible service to the thinly spread population. A previous study showed these clinics to be cost-effective, but we had no idea how the patients experience them. Our aim was to obtain information about the demographics of the patients, the logistical support of the clinics, the medical needs of the patients and how they experience the clinics. This can help us to improve the service. A questionnaire was tested in a pilot study. The demographic questions covered age, sex and ethnicity. The logistical questions dealt with distance travelled to the clinic, mode of transport, length of time as a patient and cost. The medical need questions dealt with type of disease, treatment received, type of doctor seen and origin of referral. The questions about experience covered satisfaction with the service, staff, waiting times and involvement of non-governmental organizations. Of the 95 patients interviewed 42% were from the haematology clinics. The mean age was 59.5 and the male: female ratio was 0.6:1. Forty-six percent of the patients spoke Afrikaans and 31 % spoke South Sotho. The black:white ratio was 1:1. Twenty-eight percent used the government ambulances (of whom 80% were satisfied and 56% used their own cars. The median payment at a clinic was R20 (R0 to R200. Only 19% of patients were paying privately. Ninety-five percent of the patients were follow-ups, with the median length of follow-up being 24 months (1 to 468. The patients were mainly referred by local hospitals. Twentytwo percent of the patients had chronic haematological malignancies, while 68% had solid tumours. Thirty-seven percent of the patients received drugs to take home and only 6% got intravenous chemotherapy. Consultants saw 44

  6. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    DEFF Research Database (Denmark)

    Illidge, Tim; Specht, Lena; Yahalom, Joachim;

    2014-01-01

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning...... tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of...... reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT...

  7. Clinical Trials of Immunogene Therapy for Spontaneous Tumors in Companion Animals

    Directory of Open Access Journals (Sweden)

    Gerardo Claudio Glikin

    2014-01-01

    Full Text Available Despite the important progress obtained in the treatment of some pets’ malignancies, new treatments need to be developed. Being critical in cancer control and progression, the immune system’s appropriate modulation may provide effective therapeutic options. In this review we summarize the outcomes of published immunogene therapy veterinary clinical trials reported by many research centers. A variety of tumors such as canine melanoma, soft tissue sarcomas, osteosarcoma and lymphoma, feline fibrosarcoma, and equine melanoma were subjected to different treatment approaches. Both viral and mainly nonviral vectors were used to deliver gene products as cytokines, xenogeneic tumor associated antigens, specific ligands, and proapoptotic regulatory factors. In some cases autologous, allogenic, or xenogeneic transgenic cytokine producing cells were assayed. In general terms, minor or no adverse collateral effects appeared during this kind of therapies and treated patients usually displayed a better course of the disease (longer survival, delayed or suppressed recurrence or metastatic spread, and improvement of the quality of life. This suggests the utility of these methodologies as standard adjuvant treatments. The encouraging outcomes obtained in companion animals support their ready application in veterinary clinical oncology and serve as preclinical proof of concept and safety assay for future human gene therapy trials.

  8. Clinical trials of immunogene therapy for spontaneous tumors in companion animals.

    Science.gov (United States)

    Glikin, Gerardo Claudio; Finocchiaro, Liliana María Elena

    2014-01-01

    Despite the important progress obtained in the treatment of some pets' malignancies, new treatments need to be developed. Being critical in cancer control and progression, the immune system's appropriate modulation may provide effective therapeutic options. In this review we summarize the outcomes of published immunogene therapy veterinary clinical trials reported by many research centers. A variety of tumors such as canine melanoma, soft tissue sarcomas, osteosarcoma and lymphoma, feline fibrosarcoma, and equine melanoma were subjected to different treatment approaches. Both viral and mainly nonviral vectors were used to deliver gene products as cytokines, xenogeneic tumor associated antigens, specific ligands, and proapoptotic regulatory factors. In some cases autologous, allogenic, or xenogeneic transgenic cytokine producing cells were assayed. In general terms, minor or no adverse collateral effects appeared during this kind of therapies and treated patients usually displayed a better course of the disease (longer survival, delayed or suppressed recurrence or metastatic spread, and improvement of the quality of life). This suggests the utility of these methodologies as standard adjuvant treatments. The encouraging outcomes obtained in companion animals support their ready application in veterinary clinical oncology and serve as preclinical proof of concept and safety assay for future human gene therapy trials. PMID:25506617

  9. DEGRO 2009. Radiation oncology - medical physics - radiation biology. Abstracts; DEGRO 2009. Radioonkologie - Medizinische Physik - Strahlenbiologie. Abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-06-15

    The special volume of the journal covers the abstracts of the DEGRO 2009 meeting on radiation oncology, medical physics, and radiation biology, covering the following topics: seldom diseases, gastrointestinal tumors, radiation reactions and radiation protection, medical care and science, central nervous system, medical physics, the non-parvicellular lung carcinomas, ear-nose-and throat, target-oriented radiotherapy plus ''X'', radio-oncology - young academics, lymphomas, mammary glands, modern radiotherapy, life quality and palliative radiotherapy, radiotherapy of the prostate carcinoma, imaging for planning and therapy, the digital documentation in clinics and practical experiences, NMR imaging and tomography, hadrons - actual status in Germany, urinal tract oncology, radiotoxicity.

  10. The Effects of Pain, Gender, and Age on Sleep/Wake and Circadian Rhythm Parameters in Oncology Patients at the Initiation of Radiation Therapy

    OpenAIRE

    Buffum, David; Koetters, Theresa; Cho, Maria; Macera, Liz; Steven M. Paul; West, Claudia; Aouizerat, Bradley; Dunn, Laura; Dodd, Marylin; Lee, Kathryn; Cooper, Bruce; Wara, William; Swift, Patrick; Miaskowski, Christin

    2010-01-01

    To date, no studies have evaluated for differences in subjective and objective measures of sleep disturbance in oncology outpatients with and without pain. This descriptive study recruited 182 patients from two radiation therapy (RT) departments at the time of the patient’s simulation visit. Approximately 38% of the sample reported moderate to severe pain (i.e., worst pain intensity of 6.2 ± 2.4). After controlling for age, patients with pain reported worse sleep quality and more sleep distur...

  11. Factors influencing radiation therapy student clinical placement satisfaction

    OpenAIRE

    Bridge, Pete; Carmichael, Mary-Ann

    2014-01-01

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clini...

  12. Hyperthermia - its actual role in radiation oncology. Pt. 3. Clinical rationale and results in deep seated tumors

    International Nuclear Information System (INIS)

    Combined hyperthermia and radiation therapy has been reported to yield higher complete and durable responses than radiotherapy alone in superficial tumors. In deep seated tumors the effect of the combined treatment is still under research. The literature and own clinical data are reviewed with regard to biological and physical fundamentals and clinical results. Clinical phase I to II studies have applied regional hyperthermia in the abdomen, the pelvic region and the extremities. Usually primary advanced, persistent or local recurrent and metastatic tumors were selected for treatment either due to poor response to conventional therapy or for effective palliation. The clinical data are presented concerning the following topics: Invasive thermometry, temperature parameter in tumor and normal tissue, toxicity, tumor response, treatment planning, clinical trials and prognostic factors. Clinical results of thermoradiotherapy for advanced or recurrent rectal cancer, cervical cancer and soft tissue sarcomas are reviewed in detail. In addition, the prognostic relevance of temperature parameters and physiological conditions such as global tumor perfusion are discussed. (orig.)

  13. [Communication in the context of phase I clinical trials in oncology: implementation and evaluation of training programs].

    Science.gov (United States)

    Rouby, Pascal; Hollebecque, Antoine; Bahleda, Ratislav; Deutsch, Eric; Gomez-Rocca, Carlos; Angevin, Eric; de La Motte Rouge, Thibault; Soria, Jean-Charles; Dauchy, Sarah

    2015-02-01

    Communication training programs in oncology have demonstrated some efficacy to improve doctors' communication skills. The goal of our study was to evaluate the impact of such training in the particular context of phase I clinical trials. Self-satisfaction and self-efficacy scales evaluating doctor-patient communication was completed by 6 medical oncologists (3 juniors and 3 seniors) before and after their communication training for a total of sixty visits. Two types of visit have been distinguished: the visits between the oncologist and the patient alone (a dual situation) and those with a third party (a trilateral situation). For all the doctors in dual and trialateral situations, self-efficacy scores improved significantly after training. This improvement was more pronounced for juniors oncologists in trilateral situations. Before training, satisfactory scores were worst in duel versus trilateral situations (P=0.01). This was particularly pronounced for junior compared to senior doctors (P=0.035). After training, in trilateral situations, the satisfaction scores of junior doctors matched that of the senior doctors. The communication training programs appear to benefit junior oncologists to a greater extent in trilateral situations. PMID:25609484

  14. Guidelines for treatment naming in radiation oncology.

    Science.gov (United States)

    Denton, Travis R; Shields, Lisa B E; Hahl, Michael; Maudlin, Casey; Bassett, Mark; Spalding, Aaron C

    2015-01-01

    Safety concerns may arise from a lack of standardization and ambiguity during the treatment planning and delivery process in radiation therapy. A standardized target and organ-at-risk naming convention in radiation therapy was developed by a task force comprised of several Radiation Oncology Societies. We present a nested-survey approach in a community setting to determine the methodology for radiation oncology departments to standardize their practice. Our Institution's continuous quality improvement (CQI) committee recognized that, due to growth from one to three centers, significant variability existed within plan parameters specific to patients' treatment. A multidiscipline, multiclinical site consortium was established to create a guideline for standard naming. Input was gathered using anonymous, electronic surveys from physicians, physicists, dosimetrists, chief therapists, and nurse managers. Surveys consisted of several primary areas of interest: anatomical sites, course naming, treatment plan naming, and treatment field naming. Additional concepts included capitalization, specification of later-ality, course naming in the event of multiple sites being treated within the same course of treatment, primary versus boost planning, the use of bolus, revisions for plans, image-guidance field naming, forbidden characters, and standard units for commonly used physical quantities in radiation oncology practice. Guidelines for standard treatment naming were developed that could be readily adopted. This multidisciplinary study provides a clear, straightforward, and easily implemented protocol for the radiotherapy treatment process. Standard nomenclature facilitates the safe means of communication between team members in radiation oncology. The guidelines presented in this work serve as a model for radiation oncology clinics to standardize their practices. PMID:27074449

  15. Negative pressure wound therapy: clinical utility

    OpenAIRE

    Sandoz H

    2015-01-01

    Heidi Sandoz Accelerate CIC, Mile End Hospital, London, UK Abstract: Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy, has been increasingly used in health care for the management of a wide variety of wounds over the last 2–3 decades. It is an advanced therapy that can be helpful to accelerate wound healing in both acute and chronic wounds by delivering negative pressure (suction) to the wound bed. More recent advancements in the application of NP...

  16. Negative pressure wound therapy: clinical utility

    OpenAIRE

    Sandoz H

    2015-01-01

    Heidi Sandoz Accelerate CIC, Mile End Hospital, London, UK Abstract: Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy, has been increasingly used in health care for the management of a wide variety of wounds over the last 2–3 decades. It is an advanced therapy that can be helpful to accelerate wound healing in both acute and chronic wounds by delivering negative pressure (suction) to the wound bed. More recent advancements in the application o...

  17. Clinical impact of new radiation therapy techniques

    International Nuclear Information System (INIS)

    Full text: The cornerstone of external beam radiation therapy is the delivery of a therapeutic dose to the target tissues. Traditional '2D' techniques broadly rely on the physician to assimilate the clinical information (history, examination, and radiographs) to define the target volume which is then localized via fluoroscopy on a traditional simulator. This approach required an in-depth understanding of the relationship between surface anatomy, radiographically visible anatomy (i.e. bones on simulator films) and three dimensional soft tissue anatomy. Radiation therapy treatment beams were generally limited to orientations wherein the physician/planner could understand the three dimensional relationship between the internal structures and their projection onto a simulator film. Three dimensional treatment planning allowed the more direct incorporation of three dimensional imaging information into the planning process. The 3D relationship between internal targets and normal tissues seen on 3D imaging (e.g. computed tomography - CT), were therefore more accurately known. This facilitated the use of 'non-standard' beam orientations, and more conformal shaping of the treatment beams. Software allows incorporation of multi-modality three dimensional imaging with, for example, positron emission tomography (PET), magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT). Therefore, the vast anatomic/functional information from multiple three dimensional imaging modalities can be used in concert to facilitate accurate treatment delivery. Software allows such three dimensional information to be displayed and viewed from any orientation. Beam orientations and shapes are then chosen to encompass the target yet minimize, as possible, normal tissue exposure. Thus, 3D tools allow three dimensional anatomic information to be more accurately incorporated into the planning process. In almost all instances, the target is fully encompassed within each

  18. [Spondyloarthropathies--clinical evaluation and physical therapy].

    Science.gov (United States)

    Vlak, Tonko

    2004-01-01

    Spondyloarthropathy is a group of chronic autoimmune disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, acute anterior uveitis and undifferentiated spondyloarthropathies. The spondyloarthropathies share common clinical, radiological, and genetic features that are clearly distinct from other inflammatory rheumatic diseases. The major goal in the management of patients with rheumatic disorders is to control or cure the disease and to preserve and control function and health status. To measure treatments' efficacy standardized assessment of organ morphology, function, and of health status are required. The instruments for measuring health status or quality of life cover a variety of dimensions of health, including physical, social, and emotional functioning. Measurements used to evaluate the efficacy of treatments in ankylosing spondylitis include spinal and chest movement, duration and severity of morning stiffness, and quality of sleep. Health status indices such as the HAQ or AIMS are not readily applicable to spondyloarthropaties. It is reason to use some others: 1. Functional status measure S-HAQ for patients with spondylitis by adding five items to the HAQ, to cover the activities identified as most problematic; 2. Functional index for the assessment of ankylosing spondylitis (Dougados Functional Index - DFI) - it is valid and reliable and shows sufficient responsiveness; S-HAQ appears at least as sensitive to change as the Dougados Index; 3. The Leeds Disability Questionnaire assesses disability in ankylosing spondylitis, inquiring about four areas of function: mobility, bending down, reaching up and neck movements, and postures; 4. The Bath Ankylosing Spondylitis Functional Index (BASFI) 10 item self-administered questionnaire to assess function and activities of daily living in patients with ankylosing spondylitis. Physical therapy is one of the most important way to

  19. Clinical application of interventional therapy of hyperthyroidism

    International Nuclear Information System (INIS)

    Objective: To study the safety and efficiency of interventional therapy of hyperthyroidism. Methods: 70 cases of hyperthyroidism were selected and treated with embolization of the thyroid gland artery. The efficacy and complications of the therapy were observed. Results: The therapy was effect in 60 of all the 70 patients, while failed in 1 patient and relapsed in 9 cases. Specifically speaking, 2 of them hyperthyroidism crisis occurred in 2 cases, hypoparathyroidism occurred in 1 case and hypothyroidism occurred in 2 cases. Conclusion: Intervention therapy of hyperthyroidism is of advantage such as good effect, safety, microtrauma, little complication. (authors)

  20. ASCO 2007: “Translating Research into Practice”. Report from the 34th Annual Meeting of the American Society of Clinical Oncology

    Directory of Open Access Journals (Sweden)

    Camillo Porta

    2011-12-01

    Full Text Available This year, for the 34th time in its history, the mastodontic machinery of the American Society of Clinical Oncology (ASCO once again welcomed thousand of members and participants from all over the world to the Society’s annual meeting, which, this year, took place in the ample and well-appointed, McCormick’s Convention Center in Chicago, Illinois...

  1. PET in oncology

    Energy Technology Data Exchange (ETDEWEB)

    Dresel, Stefan (ed.) [HELIOS Klinikum Berlin-Buch, Berlin (Germany). Klinik fuer Nuklearmedizin

    2008-07-01

    In the management of oncologic diseases, modern imaging modalities contribute heavily to the decision of which form of treatment - local or systemic, surgical or interdisciplinary - will be most efficient. The addition of functional image information to conventional staging procedures helps improve the diagnostic pathway. The information needed for therapeutic management and for follow-up can be provided by correlative imaging such as positron emission tomography (PET) and computed tomography (CT) or PET/CT. This book is a comprehensive compilation of the accumulated knowledge on PET and PET/CT in oncology, covering the entire spectrum from solidly documented indications, such as staging and monitoring of lung and colorectal cancer, to the application of PET/CT in head and neck surgery, gynecology, radiation therapy, urology, pediatrics etc. It is aimed at nuclear medicine and radiology specialists as well as physicians interested in the possibilities and limitations of PET and PET/CT in oncology. (orig.)

  2. Phase III clinical evaluation of gadoteridol injection: Experience in pediatric neuro-oncologic MR imaging

    International Nuclear Information System (INIS)

    Twenty-two pediatric patients with known CNS neoplasms underwent magnetic resonance (MR) imaging before and after intravenous injection of 0.1 mmol/kg gadoteridol injection as part of a Phase IIIB open label multicenter clinical trial. Intravenous adminstration of this neutral, nonionic contrast agent was found to be safe in children. No clinically relevant changes in vital signs or laboratory values were attributed to the administration of gadoteridol injection. There were no systemic complaints. The imaging characteristics of gadoteridol in pediatric CNS disease appeared similar to those of gadopentetate dimeglumine. The very low toxicity, inherent to this nonionic low osmolal paramagnetic contrast formulation may allow administration of increased doses at increased infusion rates for an increased number of indications with improved sensitivity. (orig.)

  3. Next-generation mTOR inhibitors in clinical oncology: how pathway complexity informs therapeutic strategy.

    LENUS (Irish Health Repository)

    Wander, Seth A

    2011-04-01

    Mammalian target of rapamycin (mTOR) is a PI3K-related kinase that regulates cell growth, proliferation, and survival via mTOR complex 1 (mTORC1) and mTORC2. The mTOR pathway is often aberrantly activated in cancers. While hypoxia, nutrient deprivation, and DNA damage restrain mTORC1 activity, multiple genetic events constitutively activate mTOR in cancers. Here we provide a brief overview of the signaling pathways up- and downstream of mTORC1 and -2, and discuss the insights into therapeutic anticancer targets - both those that have been tried in the clinic with limited success and those currently under clinical development - that knowledge of these pathways gives us.

  4. Clinical trial designs for evaluating the medical utility of prognostic and predictive biomarkers in oncology

    OpenAIRE

    Simon, Richard

    2010-01-01

    Physicians need improved tools for selecting treatments for individual patients. Many diagnostic entities hat were traditionally viewed as individual diseases are heterogeneous in their molecular pathogenesis and treatment responsiveness. This results in the treatment of many patients with ineffective drugs, incursion of substantial medical costs for the treatment of patients who do not benefit and the conducting of large clinical trials to identify small, average treatment benefits for heter...

  5. Gene Therapy in Cardiac Surgery: Clinical Trials, Challenges, and Perspectives.

    Science.gov (United States)

    Katz, Michael G; Fargnoli, Anthony S; Kendle, Andrew P; Hajjar, Roger J; Bridges, Charles R

    2016-06-01

    The concept of gene therapy was introduced in the 1970s after the development of recombinant DNA technology. Despite the initial great expectations, this field experienced early setbacks. Recent years have seen a revival of clinical programs of gene therapy in different fields of medicine. There are many promising targets for genetic therapy as an adjunct to cardiac surgery. The first positive long-term results were published for adenoviral administration of vascular endothelial growth factor with coronary artery bypass grafting. In this review we analyze the past, present, and future of gene therapy in cardiac surgery. The articles discussed were collected through PubMed and from author experience. The clinical trials referenced were found through the Wiley clinical trial database (http://www.wiley.com/legacy/wileychi/genmed/clinical/) as well as the National Institutes of Health clinical trial database (Clinicaltrials.gov). PMID:26801060

  6. The opinion of clinical staff regarding painfulness of procedures in pediatric hematology-oncology: an Italian survey

    OpenAIRE

    Cesaro Simone; Frigo Anna C; Sainati Laura; Benini Franca; Po' Chiara; Farina Maria I; Agosto Caterina

    2011-01-01

    Abstract Background Beliefs of caregivers about patient's pain have been shown to influence assessment and treatment of children's pain, now considered an essential part of cancer treatment. Painful procedures in hematology-oncology are frequently referred by children as the most painful experiences during illness. Aim of this study was to evaluate professionals' beliefs about painfulness of invasive procedures repeatedly performed in Pediatric Hemato-Oncology Units. Methods Physicians, nurse...

  7. Postmenopausal hormone replacement therapy--clinical implications

    DEFF Research Database (Denmark)

    Ravn, S H; Rosenberg, J; Bostofte, E

    1994-01-01

    The menopause is defined as cessation of menstruation, ending the fertile period. The hormonal changes are a decrease in progesterone level, followed by a marked decrease in estrogen production. Symptoms associated with these hormonal changes may advocate for hormonal replacement therapy. This...... review is based on the English-language literature on the effect of estrogen therapy and estrogen plus progestin therapy on postmenopausal women. The advantages of hormone replacement therapy are regulation of dysfunctional uterine bleeding, relief of hot flushes, and prevention of atrophic changes in...... the urogenital tract. Women at risk of osteoporosis will benefit from hormone replacement therapy. The treatment should start as soon after menopause as possible and it is possible that it should be maintained for life. The treatment may be supplemented with extra calcium intake, vitamin D, and maybe...

  8. Thirty years since foundation of the department of gynaecology at the Institute of Clinical Oncology in Bratislava

    International Nuclear Information System (INIS)

    In 1949, the department of gynaecology was set up. After a brief historical draft describing the development of the oncological center, we draw attention to the advantages of its multidisciplinary structure demonstrated in our cooperation with that of radiotherapy. The kinds of treatment and their results are reported with regard to the carcinomas of the cervix, corpus and vulva. Radiotherapy of the carcinoma of the cervix using a modified Stockholm method covers two sessions, with an interval of two to three weeks during which 60 mg radium (= 1600 mgh) intrauterine and twice 30 mg radium (= 1600 mgh) intravaginal are applied for 26.5 hours combined with a percutaneous irradiation of the parametries with 3500 to 4000 rad (gammatron, 60Co; betatron, 42 MeV). We prefer surgical therapy for the carcinoma of the cervix in the Ia, Ib and IIa stages up to the age of 65. We operated on 604 patients between 1957 and 1978, all of them receiving additional radiotherapy, a third preoperative irradiation. Carcinoma of the corpus has rarely been treated surgically in account of the negative selection of our patients. The radiotherapeutic procedure mostly applied is the tamponade of the uterine cavum whereby twelfe 10-mg radium tubes are applied in two sessions for 25 hours, 6000 mgh in all, plus a vaginal implant of 1500 mgh in stage-I cases, and in stage-II cases 3000 mgh intravaginally and a percutaneous telecobalt-dose of 3000 to 4000 rad. Carcinoma of the vulva is, if possible, primarily to be treated surgically by radical vulvectomy and lymphadenectomy of the inguinal and subinguinal lymphodes. Postoperative radiotherapy is carried out, when the lymphodes are positive. (orig.)

  9. Thirty years since foundation of the department of gynaecology at the Institute of Clinical Oncology in Bratislava

    Energy Technology Data Exchange (ETDEWEB)

    Manka, I. (Komenskeho Univerzita, Bratislava (Czechoslovakia). Gynaecological Dept.)

    1980-09-01

    In 1949, the department of gynaecology was set up. After a brief historical draft describing the development of the oncological center, we draw attention to the advantages of its multidisciplinary structure demonstrated in our cooperation with that of radiotherapy. The kinds of treatment and their results are reported with regard to the carcinomas of the cervix, corpus and vulva. Radiotherapy of the carcinoma of the cervix using a modified Stockholm method covers two sessions, with an interval of two to three weeks during which 60 mg radium (= 1600 mgh) intrauterine and twice 30 mg radium (= 1600 mgh) intravaginal are applied for 26.5 hours combined with a percutaneous irradiation of the parametries with 3500 to 4000 rad (gammatron, /sup 60/Co; betatron, 42 MeV). We prefer surgical therapy for the carcinoma of the cervix in the Ia, Ib and IIa stages up to the age of 65. We operated on 604 patients between 1957 and 1978, all of them receiving additional radiotherapy, a third preoperative irradiation. Carcinoma of the corpus has rarely been treated surgically in account of the negative selection of our patients. The radiotherapeutic procedure mostly applied is the tamponade of the uterine cavum whereby twelfe 10-mg radium tubes are applied in two sessions for 25 hours, 6000 mgh in all, plus a vaginal implant of 1500 mgh in stage-I cases, and in stage-II cases 3000 mgh intravaginally and a percutaneous telecobalt-dose of 3000 to 4000 rad. Carcinoma of the vulva is, if possible, primarily to be treated surgically by radical vulvectomy and lymphadenectomy of the inguinal and subinguinal lymphodes. Postoperative radiotherapy is carried out, when the lymphodes are positive.

  10. Factors influencing radiation therapy student clinical placement satisfaction

    International Nuclear Information System (INIS)

    Introduction: Radiation therapy students at Queensland University of Technology (QUT) attend clinical placements at five different clinical departments with varying resources and support strategies. This study aimed to determine the relative availability and perceived importance of different factors affecting student support while on clinical placement. The purpose of the research was to inform development of future support mechanisms to enhance radiation therapy students’ experience on clinical placement. Methods: This study used anonymous Likert-style surveys to gather data from years 1 and 2 radiation therapy students from QUT and clinical educators from Queensland relating to availability and importance of support mechanisms during clinical placements in a semester. Results: The study findings demonstrated student satisfaction with clinical support and suggested that level of support on placement influenced student employment choices. Staff support was perceived as more important than physical resources; particularly access to a named mentor, a clinical educator and weekly formative feedback. Both students and educators highlighted the impact of time pressures. Conclusions: The support offered to radiation therapy students by clinical staff is more highly valued than physical resources or models of placement support. Protected time and acknowledgement of the importance of clinical education roles are both invaluable. Joint investment in mentor support by both universities and clinical departments is crucial for facilitation of effective clinical learning

  11. Advances in radiation oncology in new millennium in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Seung Jae [College of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of); Park, Charn Il [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2000-06-01

    The objective of recent radiation therapy is to improve the quality of treatment and the after treatment quality of life. In Korea, sharing the same objective, significant advancement was made due to the gradual increase of patient number and rapid increase of treatment facilities. The advancement includes generalization of three-dimensional conformal radiotherapy (3D-CRT), application of linac-based stereotactic radiosurgery (SRS), and furthermore, the introduction of intensity modulated radiation therapy (IMRT). Authors in this paper prospectively review the followings: the advancement of radiation oncology in Korea, the recent status of four-dimensional radiation therapy. IMRT, the concept of the treatment with biological conformity, the trend of combined chemoradiotherapy, the importance of internet and radiation oncology information management system as influenced by the revolution of information technology, and finally the global trend of telemedicine in radiation oncology. Additionally, we suggest the methods to improve radiotherapy treatment, which include improvement of quality assurance (QA) measures by developing Koreanized QA protocol and system, regional study about clinical protocol development for phase three clinical trial, suggestion of unified treatment protocol and guideline by academic or research societies, domestic generation of treatment equipment's or system, establishment of nationwide data base of radiation-oncology-related information, and finally pattems-of-care study about major cancers.

  12. Advances in radiation oncology in new millennium in Korea

    International Nuclear Information System (INIS)

    The objective of recent radiation therapy is to improve the quality of treatment and the after treatment quality of life. In Korea, sharing the same objective, significant advancement was made due to the gradual increase of patient number and rapid increase of treatment facilities. The advancement includes generalization of three-dimensional conformal radiotherapy (3D-CRT), application of linac-based stereotactic radiosurgery (SRS), and furthermore, the introduction of intensity modulated radiation therapy (IMRT). Authors in this paper prospectively review the followings: the advancement of radiation oncology in Korea, the recent status of four-dimensional radiation therapy. IMRT, the concept of the treatment with biological conformity, the trend of combined chemoradiotherapy, the importance of internet and radiation oncology information management system as influenced by the revolution of information technology, and finally the global trend of telemedicine in radiation oncology. Additionally, we suggest the methods to improve radiotherapy treatment, which include improvement of quality assurance (QA) measures by developing Koreanized QA protocol and system, regional study about clinical protocol development for phase three clinical trial, suggestion of unified treatment protocol and guideline by academic or research societies, domestic generation of treatment equipment's or system, establishment of nationwide data base of radiation-oncology-related information, and finally pattems-of-care study about major cancers

  13. Personalized oncology

    DEFF Research Database (Denmark)

    Tuxen, Ida Viller; Jønson, Lars; Santoni-Rugiu, Eric;

    2014-01-01

    . Only a limited number of patients will benefit from the treatment. However, introducing genomic mapping to select patients for early clinical trials with targeted molecular therapy according to the genomic findings, may lead to a better outcome for the patient, an enrichment of phase 1 trials, and...... thereby accelerated drug development. The overall advantage is to determine which mutation profiles correlate with sensitivity or lack of resistance to specific targeted therapies. The utility and current limitations of genomic screening to guide selection to Phase 1 clinical trial will be discussed....... of genes simultaneously, personalized molecular medicine has become an option. New treatments are being investigated in phase 1 trials around the world. Traditionally, the goal of phase 1 studies was to determine the optimal dose and assess dose-limiting toxicity of a potential new experimental drug...

  14. A risk management approach for imaging biomarker-driven clinical trials in oncology.

    Science.gov (United States)

    Liu, Yan; deSouza, Nandita M; Shankar, Lalitha K; Kauczor, Hans-Ulrich; Trattnig, Siegfried; Collette, Sandra; Chiti, Arturo

    2015-12-01

    Imaging has steadily evolved in clinical cancer research as a result of improved conventional imaging methods and the innovation of new functional and molecular imaging techniques. Despite this evolution, the design and data quality derived from imaging within clinical trials are not ideal and gaps exist with paucity of optimised methods, constraints of trial operational support, and scarce resources. Difficulties associated with integrating imaging biomarkers into trials have been neglected compared with inclusion of tissue and blood biomarkers, largely because of inherent challenges in the complexity of imaging technologies, safety issues related to new imaging contrast media, standardisation of image acquisition across multivendor platforms, and various postprocessing options available with advanced software. Ignorance of these pitfalls directly affects the quality of the imaging read-out, leading to trial failure, particularly when imaging is a primary endpoint. Therefore, we propose a practical risk-based framework and recommendations for trials driven by imaging biomarkers, which allow identification of risks at trial initiation to better allocate resources and prioritise key tasks. PMID:26678215

  15. Associations between clinical and sociodemographic data and patterns of communication in pediatric oncology

    Directory of Open Access Journals (Sweden)

    Marina Kohlsdorf

    2016-01-01

    Full Text Available Abstract Pediatric communication directly contributes to treatment adherence, fewer symptoms, better clinical responses, healthier treatment adaptation and management of psychosocial issues. This study aimed to evaluate associations between the clinical and sociodemographic data of caregivers and children and the communicative patterns of pediatricians. Three oncohematology physicians and 44 child-caregiver dyads took part, with audio recording of 146 medical consultations. The physicians interacted more often with older children, offering more guidance, clarifying doubts, and asking for information. The number of questions from children and caregivers was positively correlated with the physician’s communicative behaviors. However, there was no association between the age of the children and the number of doubts of the patients. The diagnosis, treatment time, family income, marital status and caregiver’s level of education were associated with the amount of interaction provided by physicians to the children and caregivers. This study offers subsides relevant to psychosocial interventions that may improve communication in pediatric oncohematology settings.

  16. Brief Introduction of NCCN Clinical Practice Guidelines for Adolescent and Young Adult Oncology

    Directory of Open Access Journals (Sweden)

    HUANG Xin-en

    2014-09-01

    Full Text Available Cancer is always a main factor threatening human’s health and life, and its incidence and mortality are gradually increasing in recent years. However, some advances have been made with the unremitting efforts and exploration human made and the improvement is mainly made in cancer treatment of young children and older adults, while little in adolescent and young adult (AYA patients, who are generally defined as individuals of 15 to 39 years old at the time of initial cancer diagnosis due to many factors. To highlight the issues of this unique population, National Comprehensive Cancer Network (NCCN absorbs a large amount of information and previous researches and develops a set of clinical practice guidelines. Though the guidelines are more supportive care guidelines than treatment guidelines, they give us the opportunity to learn the latest international developments in AYA treatment and more survival chance for the treatment of AYA patients.

  17. Clinical Effectiveness of Hyperbaric Oxygen Therapy in Complex Wounds

    OpenAIRE

    Opasanon, Supaporn; PONGSAPICH, WARUT; Taweepraditpol, Sitthichoke; Suktitipat, Bhoom; Chuangsuwanich, Apirag

    2015-01-01

    Hyperbaric Oxygen (HBO, HBO2) Therapy is a non-invasive therapy. It has been applied as adjuvant treatment in many medical conditions over the past 50 years. Different treatment protocols have been proven effective for specifically indicated conditions. To evaluate the clinical effectiveness of Hyperbaric Oxygen (HBO) Therapy as an adjunctive treatment for patients with complex wounds. In this prospective cohort study, 40 patients with complex wounds were included. All patients received HBO. ...

  18. Hematoporphyrin-mediated photodynamic therapy for treatment of head and neck cancer: clinical update 1996

    Science.gov (United States)

    Schweitzer, Vanessa G.

    1996-04-01

    From 1983 to 1996 Phase II and III clinical studies at Henry Ford Hospital demonstrated complete or partial responses in 55 of 56 patients treated with hematoporphyrin-derivative or PHOTOFRIN-mediated photodynamic therapy (HPD-PDT) for a variety of benign and malignant upper aerodigestive tract disease: (1) superficial 'condemned mucosa' or 'field cancerization' of the oral cavity and larynx (7 cases); (2) Stage III/IV head and neck cancer (25 cases); (3) mucocutaneous AIDS-associated Kaposi's sarcoma of the upper aerodigestive tract and non AIDS-related Kaposi's sarcoma of the lower extremity (15 cases); (4) recurrent laryngotracheal papillomatosis (3 cases); (5) severe dysplasia/adenocarcinoma or squamous cell carcinoma in situ in Barrett's esophagus (4 cases); (6) partial or completely obstructing terminal esophageal cancer (9 cases). At the time of this report, HPD-PDT produced complete responses in 24 patients (follow up 6 months to 9 years) with 'field cancerization' (CIS, T1N0M0) of the oral cavity and larynx (6 cases), adenocarcinoma in situ in Barrett's esophagus (3 cases), mucocutaneous Kaposi's sarcoma (12 cases), obstructing esophageal carcinoma (1 case), and stage IV squamous cell carcinoma of the nasopharynx (1 case), and radiation therapy or solar-induced basal cell/squamous cell carcinomas (2 cases). PDT treatment protocols, results, complications, and application as adjunct or primary oncologic therapy for head and neck cancer are reviewed in this article.

  19. Clinical usefulness of 99mTc-EDDA/HYNIC-TOC scintigraphy in oncological diagnostics: a preliminary communication

    International Nuclear Information System (INIS)

    This study assessed the clinical usefulness of a new technetium-99m labelled somatostatin analogue from the standpoint of oncological diagnostics. The study group comprised 40 patients in whom malignant neoplasms (32 primary and 8 metastatic) had been diagnosed. Among the primary tumours there were 21 cases of lung cancer (2 small cell and 19 non-small cell), seven pituitary adenomas (five hormonally active and two inactive), one liposarcoma, two carcinoids and one breast carcinoma. The metastatic tumours consisted of three malignant melanomas, one phaeochromocytoma, one prostatic cancer, one leiomyosarcoma, one pancreatic carcinoma ectopically secreting ACTH and one carcinoid of the thymus. The radiopharmaceutical 99mTc-EDDA/HYNIC-Tyr3-octreotide was administered i.v. at an activity of 740-925 MBq. The imaging comprised a whole-body scan and a single-photon emission tomography acquisition. Positive scintigrams were obtained in all cases of small cell and non-small cell lung cancer, four out of five hormonally active pituitary adenomas, one out of two cases of carcinoid, the liposarcoma and the breast cancer. Neoplastic metastases were visualised in two out of three patients with melanoma and in patients with phaeochromocytoma, ACTH-secreting pancreatic carcinoma and thymic carcinoid. Scintigrams were negative in both hormonally inactive pituitary adenomas, in one case of metastatic malignant melanoma, in the leiomyosarcoma and in the case of metastasis from prostatic carcinoma. The results of this pilot study indicate that 99mTc-EDDA/HYNIC-TOC is a potentially useful radiopharmaceutical for imaging of a wide range of primary and metastatic tumours. Special attention should be paid to the successful imaging of all cases of non-small cell lung cancer. (orig.)

  20. Initial clinical experience with a radiation oncology dedicated open 1.0T MR-simulation.

    Science.gov (United States)

    Glide-Hurst, Carri K; Wen, Ning; Hearshen, David; Kim, Joshua; Pantelic, Milan; Zhao, Bo; Mancell, Tina; Levin, Kenneth; Movsas, Benjamin; Chetty, Indrin J; Siddiqui, M Salim

    2015-01-01

    The purpose of this study was to describe our experience with 1.0T MR-SIM including characterization, quality assurance (QA) program, and features necessary for treatment planning. Staffing, safety, and patient screening procedures were developed. Utilization of an external laser positioning system (ELPS) and MR-compatible couchtop were illustrated. Spatial and volumetric analyses were conducted between CT-SIM and MR-SIM using a stereotactic QA phantom with known landmarks and volumes. Magnetic field inhomogeneity was determined using phase difference analysis. System-related, in-plane distortion was evaluated and temporal changes were assessed. 3D distortion was characterized for regions of interest (ROIs) 5-20 cm away from isocenter. American College of Radiology (ACR) recommended tests and impact of ELPS on image quality were analyzed. Combined ultrashort echotime Dixon (UTE/Dixon) sequence was evaluated. Amplitude-triggered 4D MRI was implemented using a motion phantom (2-10 phases, ~ 2 cm excursion, 3-5 s periods) and a liver cancer patient. Duty cycle, acquisition time, and excursion were evaluated between maximum intensity projection (MIP) datasets. Less than 2% difference from expected was obtained between CT-SIM and MR-SIM volumes, with a mean distance of Dixon sequences yielded detectability between bone and air. For 4D MRI, faster breathing periods had higher duty cycles than slow (50.4% (3 s) and 39.4% (5 s), p MRI for a patient demonstrated acceptable image quality in ~ 7 min. MR-SIM was integrated into our workflow and QA procedures were developed. Clinical applicability was demonstrated for 4D MRI and UTE imaging to support MR-SIM for single modality treatment planning. PMID:26103190

  1. From Patient-Specific Mathematical Neuro-Oncology to Precision Medicine

    Directory of Open Access Journals (Sweden)

    Anne eBaldock

    2013-04-01

    Full Text Available Gliomas are notoriously aggressive, malignant brain tumors that have variable response to treatment. These patients often have poor prognosis, informed primarily by histopathology. Mathematical neuro-oncology (MNO is a young and burgeoning field that leverages mathematical models to predict and quantify response to therapies. These mathematical models can form the basis of modern precision medicine approaches to tailor therapy in a patient-specific manner. Patient specific models (PSMs can be used to overcome imaging limitations, improve prognostic predictions, stratify patients and assess treatment response in silico. The information gleaned from such models can aid in the construction and efficacy of clinical trials and treatment protocols, accelerating the pace of clinical research in the war on cancer. This review focuses on the growing translation of PSM to clinical neuro-oncology. It will also provide a forward-looking view on a new era of patient-specific mathematical neuro-oncology.

  2. Performance in quasi-firms: an example from the Community Clinical Oncology Program.

    Science.gov (United States)

    Lacey, L M; Hynes, D M; Kaluzny, A D

    1992-01-01

    In this analysis, the authors examined the effects of different sets of process, structure, and environmental variables on the performance of the CCOP as a quasi-firm. Specifically, they distinguished between internal organizational processes, structural, and size characteristics of the CCOP and the organizational environment created by prior NCI program experience and the relationship within the quasi-firm. The analysis revealed that these sets of organizational and environmental characteristics have differential effects on treatment accrual. The strongest predictors are those associated with the quasi-firm relationship between the CCOP and its chosen research bases. Any definitive policy implications for the design of organizational network relationships--especially the CCOPs--will require further analysis. Particular attention needs to be given to the longitudinal nature of the relationships and the ability of these organizational and environmental factors to affect other aspects of performance. Several points have been made within this initial assessment. First, the structural character of the CCOP and its relationship to its organizational environment are important factors affecting accrual performance. The subtleties of this multivariate model are not as important as simply demonstrating that the various internal and external characteristics of these organizations as quasi-firms simultaneously affect their ability to accrue patients to clinical trials. Secondly, the importance of research base relations, and particularly the significant role of nurses, needs to be emphasized. While CCOPs were originally designed as a network of physicians and hospitals, it appears that an infrastructure of professionally active nurses working within a larger organizational environment is critical to success--at least as defined by accrual to treatment protocols. Finally, the failure of prior experience with other NCI community programs to affect CCOP accrual performance

  3. African American Participation in Oncology Clinical Trials-Focus on Prostate Cancer: Implications, Barriers, and Potential Solutions.

    Science.gov (United States)

    Ahaghotu, Chiledum; Tyler, Robert; Sartor, Oliver

    2016-04-01

    In the United States, the incidence and mortality rates of many cancers, especially prostate cancer, are disproportionately high among African American men compared with Caucasian men. Recently, mortality rates for prostate cancer have declined more rapidly in African American versus Caucasian men, but prostate cancer is still the most common cancer and the second leading cause of cancer deaths in African American men in the United States. Compared with Caucasian men, prostate cancer occurs at younger ages, has a higher stage at diagnosis, and is more likely to progress after definitive treatments in African American men. Reasons for racial discrepancies in cancer are multifactorial and potentially include socioeconomic, cultural, nutritional, and biologic elements. In addition to improving access to novel therapies, clinical trial participation is essential to adequately establish the risks and benefits of treatments in African American populations. Considering the disproportionately high mortality rates noted in these groups, our understanding of the natural history and responses to therapies is limited. This review will explore African American underrepresentation in clinical trials with a focus on prostate cancer, and potentially effective strategies to engage African American communities in prostate cancer research. Solutions targeting physicians, investigators, the community, and health care systems are identified. Improvement of African American participation in prostate cancer clinical trials will benefit all stakeholders. PMID:26786562

  4. Radical nephroureterectomy for pathologic T4 upper tract urothelial cancer: can oncologic outcomes be improved with multimodality therapy?

    Directory of Open Access Journals (Sweden)

    Ramy F. Youssef

    2013-09-01

    Full Text Available Purpose To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU and regional lymph node dissection (LND on oncologic outcomes. Materials and Methods Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results The study included 69 patients, 42 males (61% with median age 73 (range 43-98. Median follow-up was 17 months (range: 6-88. Lymphovascular invasion was found in 47 (68% and regional lymph node metastases were found in 31 (45%. Peri-operative chemotherapy was utilized in 29 (42% patients. Patients treated with peri-operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y-DFS: 35% vs. 10%; P = 0.02 and 3Y-CSS: 28% vs. 14%; P = 0.08. In multivariate Cox regression analysis, administration of peri-operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01, and cancer specific mortality (HR: 0.5, P = 0.06. Conclusions Pathological T4 UTUC is associated with poor prognosis. Peri-operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

  5. How Effective Are Spiritual Care and Body Manipulation Therapies in Pediatric Oncology? A Systematic Review of the Literature

    OpenAIRE

    Thomas G. Poder; Lemieux, Renald

    2013-01-01

    Background: The effects of cancer and associated treatments have a considerable impact on the well-being and quality of life of pediatric oncology patients. To support children and their families, complementary and alternative medicines are seen by nurses and doctors as practical to integrate to the services offered by hospitals. Objective: The purpose of this paper is to examine if the practice of complementary and alternative medicine, specifically spiritual care and treatments based on bod...

  6. Therapy of nephrolithiasis: where is the evidence from clinical trials?

    Science.gov (United States)

    Pachaly, Maria Aparecida; Baena, Cristina Pellegrino; Carvalho, Mauricio de

    2016-03-01

    The prevalence of kidney stone disease is increasing worldwide with significant health and economic burden. Newer research is finding that stones are associated with several serious morbidities. Yet, few randomized clinical trials or high quality observational studies have assessed whether clinical interventions decrease the recurrence of kidney stones. Therefore, in this review we analyze the available evidence on medical expulsive therapy for ureteral stones; describe the evidence about non-pharmacological stone therapy including dietary modifications and citrus juice-based therapy; and discuss the efficacy of thiazide diuretics for the treatment of hypercalciuria in recurrent nephrolithiasis. PMID:27049371

  7. The clinical applicability of music therapy research

    DEFF Research Database (Denmark)

    Wigram, Anthony Lewis

    practitioners in all three areas (and beyond) can demonstrate, through previous and current research, that the music therapy service and interventions they provide are relevant and effective (Ansdell, Pavicevic & Proctor, 2004; Gold, Voracek and Wigram, 2004; Vink, 2003; Wigram 2002). Documentation of research...

  8. Vibration therapy: clinical applications in bone

    Science.gov (United States)

    Thompson, William R.; Yen, Sherwin S.; Rubin, Janet

    2015-01-01

    Purpose of review The musculoskeletal system is largely regulated through dynamic physical activity and is compromised by cessation of physical loading. There is a need to recreate the anabolic effects of loading on the musculoskeletal system, especially in frail individuals who cannot exercise. Vibration therapy is designed to be a nonpharmacological analogue of physical activity, with an intention to promote bone and muscle strength. Recent findings Animal and human studies suggest that high-frequency, low-magnitude vibration therapy improves bone strength by increasing bone formation and decreasing bone resorption. There is also evidence that vibration therapy is useful in treating sarcopenia, which confounds skeletal fragility and fall risk in aging. Enhancement of skeletal and muscle strength involves regulating the differentiation of mesenchymal stem cells to build these tissues; mesenchymal stem cell lineage allocation is positively promoted by vibration signals. Summary Vibration therapy may be useful as a primary treatment as well as an adjunct to both physical and pharmacological treatments, but future studies must pay close attention to compliance and dosing patterns, and importantly, the vibration signal, be it low-intensity vibration (1g) marketed as a training exercise. PMID:25354044

  9. CLINICAL EXPERIENCE WITH METABOLIC THERAPY FOR BRAIN ISCHEMIA

    Directory of Open Access Journals (Sweden)

    M. Kh. Shurdumova

    2013-01-01

    Full Text Available The paper describes clinical experience with metabolic therapy, including neuroprotective drugs and antioxidants, for cerebrovascular diseases.It gives the results of basic Russian and foreign clinical studies of ethylmethylhydroxypyridoxine succinate and choline alfoscerate and discusses their efficacy and routes of administration.

  10. CLINICAL EXPERIENCE WITH METABOLIC THERAPY FOR BRAIN ISCHEMIA

    Directory of Open Access Journals (Sweden)

    M. Kh. Shurdumova

    2014-07-01

    Full Text Available The paper describes clinical experience with metabolic therapy, including neuroprotective drugs and antioxidants, for cerebrovascular diseases.It gives the results of basic Russian and foreign clinical studies of ethylmethylhydroxypyridoxine succinate and choline alfoscerate and discusses their efficacy and routes of administration.

  11. Treatment of pediatric patients and young adults with particle therapy at the Heidelberg Ion Therapy Center (HIT): establishment of workflow and initial clinical data

    International Nuclear Information System (INIS)

    To report on establishment of workflow and clinical results of particle therapy at the Heidelberg Ion Therapy Center. We treated 36 pediatric patients (aged 21 or younger) with particle therapy at HIT. Median age was 12 years (range 2-21 years), five patients (14%) were younger than 5 years of age. Indications included pilocytic astrocytoma, parameningeal and orbital rhabdomyosarcoma, skull base and cervical chordoma, osteosarcoma and adenoid-cystic carcinoma (ACC), as well as one patient with an angiofibroma of the nasopharynx. For the treatment of small children, an anesthesia unit at HIT was established in cooperation with the Department of Anesthesiology. Treatment concepts depended on tumor type, staging, age of the patient, as well as availability of specific study protocols. In all patients, particle radiotherapy was well tolerated and no interruptions due to toxicity had to be undertaken. During follow-up, only mild toxicites were observed. Only one patient died of tumor progression: Carbon ion radiotherapy was performed as an individual treatment approach in a child with a skull base recurrence of the previously irradiated rhabdomyosarcoma. Besides this patient, tumor recurrence was observed in two additional patients. Clinical protocols have been generated to evaluate the real potential of particle therapy, also with respect to carbon ions in distinct pediatric patient populations. The strong cooperation between the pediatric department and the department of radiation oncology enable an interdisciplinary treatment and stream-lined workflow and acceptance of the treatment for the patients and their parents

  12. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology; Evaluation des pratiques professionnelles. Pertinence des indications de la tomographie a emission de positons en cancerologie

    Energy Technology Data Exchange (ETDEWEB)

    Le Stanc, E.; Tainturier, C. [Hopital Foch, Service de Medecine Nucleaire, 92 - Suresnes (France); Swaenepoel, J. [Hopital Foch, Cellule Qualite, 92 - Suresnes (France)

    2009-09-15

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  13. The importance of pharmacist providing patient education in oncology.

    Science.gov (United States)

    Avery, Mia; Williams, Felecia

    2015-02-01

    The world's increasing diversity requires health care professionals to adjust delivery methods of teaching to accommodate different cultural values and beliefs. The ability to communicate effectively across languages and various cultural practices directly affects patient education outcomes. Pharmacist should be aware of varying modalities and considerations when counseling a patient diagnosed with cancer and undergoing chemotherapy. In more recent years, the medical profession has seen an increase in patient outcomes due to using the multidisciplinary team approach and has benefited by implementing Medication Therapy Management (MTM) programs at various institutions. For the clinical pharmacist, this would mean documentation for these services should be precise and accurate based on the specific patients needs. There are several factors involved in the care and therapy of the patient with cancer. Clinical oncology pharmacist should be aware of the ever-changing role in oncology and be able to implement new practices at their facility for better patient outcomes. PMID:25540194

  14. Diabetic encephalopathy: Pathogenesis, clinical manifestations, therapy approaches

    Directory of Open Access Journals (Sweden)

    I. Kh. Khairullin

    2014-07-01

    Full Text Available The paper considers the epidemiology, morphology, and clinical manifestations of diabetic encephalopathy. It shows the differences of diabetic encephalopathy in types 1 and 2 diabetes mellitus. Pathogenetic treatment options for diabetic encephalopathy are given.

  15. Diabetic encephalopathy: Pathogenesis, clinical manifestations, therapy approaches

    OpenAIRE

    I. Kh. Khairullin; S. T. Zyangirova; Yu. N. Isayeva; O. R. Esin

    2014-01-01

    The paper considers the epidemiology, morphology, and clinical manifestations of diabetic encephalopathy. It shows the differences of diabetic encephalopathy in types 1 and 2 diabetes mellitus. Pathogenetic treatment options for diabetic encephalopathy are given.

  16. Diabetic encephalopathy: Pathogenesis, clinical manifestations, therapy approaches

    Directory of Open Access Journals (Sweden)

    I. Kh. Khairullin

    2012-01-01

    Full Text Available The paper considers the epidemiology, morphology, and clinical manifestations of diabetic encephalopathy. It shows the differences of diabetic encephalopathy in types 1 and 2 diabetes mellitus. Pathogenetic treatment options for diabetic encephalopathy are given.

  17. Bacteriophage Therapy: Advances in Formulation Strategies and Human Clinical Trials.

    Science.gov (United States)

    Vandenheuvel, Dieter; Lavigne, Rob; Brüssow, Harald

    2015-11-01

    Recently, a number of phage therapy phase I and II safety trials have been concluded, showing no notable safety concerns associated with the use of phage. Though hurdles for efficient treatment remain, these trials hold promise for future phase III clinical trials. Interestingly, most phage formulations used in these clinical trials are straightforward phage suspensions, and not much research has focused on the processing of phage cocktails in specific pharmaceutical dosage forms. Additional research on formulation strategies and the stability of phage-based drugs will be of key importance, especially with phage therapy advancing toward phase III clinical trials. PMID:26958930

  18. NRG Oncology Radiation Therapy Oncology Group 0822: A Phase 2 Study of Preoperative Chemoradiation Therapy Using Intensity Modulated Radiation Therapy in Combination With Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@mgh.harvard.edu [Massachusetts General Hospital, Boston, Massachusetts (United States); Moughan, Jennifer [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Garofalo, Michael C. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Bendell, Johanna [Sarah Cannon Research Institute, Nashville, Tennessee (United States); Berger, Adam C. [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Oldenburg, Nicklas B.E. [North Main Radiation Oncology, Providence, Rhode Island (United States); Anne, Pramila Rani [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Perera, Francisco [London Regional Cancer Program/Western Ontario, London, Ontario (Canada); Lee, R. Jeffrey [Intermountain Medical Center, Salt Lake City, Utah (United States); Jabbour, Salma K. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Nowlan, Adam [Piedmont Hospital, Atlanta, Georgia (United States); DeNittis, Albert [Main Line Community Clinical Oncology Program, Wynnewood, Pennsylvania (United States); Crane, Christopher [University of Texas-MD Anderson Cancer Center, Houston, Texas (United States)

    2015-09-01

    Purpose: To evaluate the rate of gastrointestinal (GI) toxicity of neoadjuvant chemoradiation with capecitabine, oxaliplatin, and intensity modulated radiation therapy (IMRT) in cT3-4 rectal cancer. Methods and Materials: Patients with localized, nonmetastatic T3 or T4 rectal cancer <12 cm from the anal verge were enrolled in a prospective, multi-institutional, single-arm study of preoperative chemoradiation. Patients received 45 Gy with IMRT in 25 fractions, followed by a 3-dimensional conformal boost of 5.4 Gy in 3 fractions with concurrent capecitabine/oxaliplatin (CAPOX). Surgery was performed 4 to 8 weeks after the completion of therapy. Patients were recommended to receive FOLFOX chemotherapy after surgery. The primary endpoint of the study was acute grade 2 to 5 GI toxicity. Seventy-one patients provided 80% probability to detect at least a 12% reduction in the specified GI toxicity with the treatment of CAPOX and IMRT, at a significance level of .10 (1-sided). Results: Seventy-nine patients were accrued, of whom 68 were evaluable. Sixty-one patients (89.7%) had cT3 disease, and 37 (54.4%) had cN (+) disease. Postoperative chemotherapy was given to 42 of 68 patients. Fifty-eight patients had target contours drawn per protocol, 5 patients with acceptable variation, and 5 patients with unacceptable variations. Thirty-five patients (51.5%) experienced grade ≥2 GI toxicity, 12 patients (17.6%) experienced grade 3 or 4 diarrhea, and pCR was achieved in 10 patients (14.7%). With a median follow-up time of 3.98 years, the 4-year rate of locoregional failure was 7.4% (95% confidence interval [CI]: 1.0%-13.7%). The 4-year rates of OS and DFS were 82.9% (95% CI: 70.1%-90.6%) and 60.6% (95% CI: 47.5%-71.4%), respectively. Conclusion: The use of IMRT in neoadjuvant chemoradiation for rectal cancer did not reduce the rate of GI toxicity.

  19. Clinical applications of cellular therapy products

    OpenAIRE

    Serpil Yanbakan

    2015-01-01

    Adult stem cells have the potential to differentiate into multiple cell types and have usage about lots of regenerative medicine research fields. Especially bone marrow-derived mesenchymal stem cells have a wide range of case presentation. New discoveries about stem cell biology will progress new options about cellular therapy products and isolation of different stem cell types will increase hope for treatment of important illness such as Parkinson’s disease, diabetes, malign brain tumors. It...

  20. Multisystemic Therapy: Clinical Foundations and Research Outcomes

    OpenAIRE

    Henggeler, Scott W.

    2012-01-01

    Multisystemic therapy (MST) is an intensive family and community-based treatment for adolescents presenting serious antisocial behavior and their families. Using a home-based model of service delivery to overcome barriers to service access and a strong quality assurance system to promote treatment fidelity, MST therapists address known risk factors (i.e., at individual, family, peer, school, and community levels) strategically and comprehensively. The family is viewed as central to achieving ...

  1. Clinical Studies of Biofield Therapies: Summary, Methodological Challenges, and Recommendations.

    Science.gov (United States)

    Jain, Shamini; Hammerschlag, Richard; Mills, Paul; Cohen, Lorenzo; Krieger, Richard; Vieten, Cassandra; Lutgendorf, Susan

    2015-11-01

    Biofield therapies are noninvasive therapies in which the practitioner explicitly works with a client's biofield (interacting fields of energy and information that surround living systems) to stimulate healing responses in patients. While the practice of biofield therapies has existed in Eastern and Western cultures for thousands of years, empirical research on the effectiveness of biofield therapies is still relatively nascent. In this article, we provide a summary of the state of the evidence for biofield therapies for a number of different clinical conditions. We note specific methodological issues for research in biofield therapies that need to be addressed (including practitioner-based, outcomes-based, and research design considerations), as well as provide a list of suggested next steps for biofield researchers to consider. PMID:26665043

  2. Racial Differences in CYP3A4 Genotype and Survival Among Men Treated on Radiation Therapy Oncology Group (RTOG) 9202: A Phase III Randomized Trial

    International Nuclear Information System (INIS)

    Purpose: Inherited genotypes may explain the inferior outcomes of African American (AA) men with prostate cancer. To understand how variation in CYP3A4 correlated with outcomes, a retrospective examination of the CYP3A4*1B genotype was performed on men treated with Radiation Therapy Oncology Group (RTOG) 92-02. Methods and Materials: From 1,514 cases, we evaluated 56 (28.4%) of 197 AA and 54 (4.3%) of 1,274 European American (EA) patients. All patients received goserelin and flutamide for 2 months before and during RT (STAD-RT) ± 24 months of goserelin (long-term androgen deprivation plus radiation [LTAD-RT]). Events studied included overall survival and biochemical progression using American Society for Therapeutic Radiology and Oncology consensus guidelines. Results: There were no differences in outcome in patients in with or without CYP3A4 data. There was an association between race and CYP3A4 polymorphisms with 75% of EAs having the Wild Type compared to only 25% of AA men (p <0.0001). There was no association between CYP3A4 classification or race and survival or progression. Conclusions: The samples analyzed support previously reported observations about the distribution of CYP3A4*1B genotype by race, but race was not associated with poorer outcome. However, patient numbers were limited, and selection bias cannot be completely ruled out

  3. Clinical relevance of model based computer-assisted diagnosis and therapy

    Science.gov (United States)

    Schenk, Andrea; Zidowitz, Stephan; Bourquain, Holger; Hindennach, Milo; Hansen, Christian; Hahn, Horst K.; Peitgen, Heinz-Otto

    2008-03-01

    The ability to acquire and store radiological images digitally has made this data available to mathematical and scientific methods. With the step from subjective interpretation to reproducible measurements and knowledge, it is also possible to develop and apply models that give additional information which is not directly visible in the data. In this context, it is important to know the characteristics and limitations of each model. Four characteristics assure the clinical relevance of models for computer-assisted diagnosis and therapy: ability of patient individual adaptation, treatment of errors and uncertainty, dynamic behavior, and in-depth evaluation. We demonstrate the development and clinical application of a model in the context of liver surgery. Here, a model for intrahepatic vascular structures is combined with individual, but in the degree of vascular details limited anatomical information from radiological images. As a result, the model allows for a dedicated risk analysis and preoperative planning of oncologic resections as well as for living donor liver transplantations. The clinical relevance of the method was approved in several evaluation studies of our medical partners and more than 2900 complex surgical cases have been analyzed since 2002.

  4. Cisplatin and derivatives with radiation therapy: for what clinical use?

    International Nuclear Information System (INIS)

    Since its discovery by Rosenberg in 1965, cisplatin and its derivatives have appeared as the most important chemotherapeutic agents, particularly for their radiosensitizing properties and their clinical use with radiation. In spite of numerous preclinical and clinical studies, optimal schedules of platin and radiotherapy combination have to be defined. The first part of this overview will describe biological mechanisms of interaction between radiation therapy and platinum derivatives. The second part will report the major clinical impact of their association. (author)

  5. The opinion of clinical staff regarding painfulness of procedures in pediatric hematology-oncology: an Italian survey

    Directory of Open Access Journals (Sweden)

    Cesaro Simone

    2011-06-01

    Full Text Available Abstract Background Beliefs of caregivers about patient's pain have been shown to influence assessment and treatment of children's pain, now considered an essential part of cancer treatment. Painful procedures in hematology-oncology are frequently referred by children as the most painful experiences during illness. Aim of this study was to evaluate professionals' beliefs about painfulness of invasive procedures repeatedly performed in Pediatric Hemato-Oncology Units. Methods Physicians, nurses, psychologists and directors working in Hemato-Oncology Units of the Italian Association of Pediatric Hematology-Oncology (AIEOP were involved in a wide-nation survey. The survey was based on an anonymous questionnaire investigating beliefs of operators about painfulness of invasive procedures (lumbar puncture, bone marrow aspirate and bone marrow biopsy and level of pain management. Results Twenty-four directors, 120 physicians, 248 nurses and 22 psychologists responded to the questionnaire. The score assigned to the procedural pain on a 0-10 scale was higher than 5 in 77% of the operators for lumbar puncture, 97.5% for bone marrow aspiration, and 99.5% for bone marrow biopsy. The scores assigned by nurses differed statistically from those of the physicians and directors for the pain caused by lumbar puncture and bone marrow aspiration. Measures adopted for procedural pain control were generally considered good. Conclusions Invasive diagnostic-therapeutic procedures performed in Italian Pediatric Hemato-Oncology Units are considered painful by all the caregivers involved. Pain management is generally considered good. Aprioristically opinions about pain depend on invasiveness of the procedure and on the professional role.

  6. Targeted therapies for non-small-cell lung cancer: biology, rationale, and preclinical results from a radiation oncology perspective

    International Nuclear Information System (INIS)

    The epidermal growth factor receptor (EGFR) is overexpressed in the majority of non-small-cell lung cancers (NSCLCs). This presents an opportune target for new treatment strategies designed to selectively interfere with the cancer cell growth cycle. Recent investigations into the biology of the EGFR and its downstream signaling pathways have reminded us of the complexity of cancer cell communications from the cytoplasm to the nucleus. Multiple pathways are activated with stimulation of the autocrine and paracrine EGFR loop, from the ras-raf-MEK activation of ERK 1/2 to the P13K-Akt pathway, each playing an important role in cancer cell survival, invasion, and angiogenesis. Preclinical studies have demonstrated that molecules targeting the EGFR, either through extracellular blockade or intracellular interference with the EGFR-associated tyrosine kinase, reversibly or irreversibly, inhibit cancer cell growth. Potent antitumor effects have been observed in human tumor xenograft models. Preclinical studies have also demonstrated cooperative effects when anti-EGFR agents are combined with radiation or chemotherapy. Many of these agents have now entered into advanced human clinical trials with modest dose-related toxicity despite chronic administration. Encouraging response rates with single-agent targeted therapy have been reported in heavily pretreated patients with advanced NSCLC. In addition, agents targeting the angiogenic pathway, which plays a key role in the regulation of angiogenesis, may play an important role in enhancing the efficacy of anti-EGFR agents. This article will focus on the biology, rationale, and preclinical studies with targeted anti-EGFR and antiangiogenic therapies for the management of NSCLC

  7. American Society of Clinical Oncology policy statement update: tobacco control--reducing cancer incidence and saving lives. 2003.

    Science.gov (United States)

    2003-07-15

    As an international medical society dedicated to cancer prevention, the American Society of Clinical Oncology (ASCO) advocates a fundamental reform of United States and international policy toward addictive tobacco products. ASCO's goal is the immediate reduction of tobacco use and ultimate achievement of a tobacco-free world. The centerpiece of ASCO's policy is the recommendation for an independent commission to study the tobacco problem in all of its dimensions: social, medical, legal, and economic (both domestically and globally). The commission membership should include broad-based representation and expertise on tobacco issues. In ASCO's view, tobacco control efforts to date have been less than successful because they are too fragmented and incremental, leaving many important issues unaddressed. A more comprehensive solution could flow from this study, including input from a variety of government agencies involved with public health, agriculture, First Amendment and other legal considerations, and international trade. The study, within defined time limits, should culminate in a report that outlines a strategy for achieving immediate reduction of tobacco use and ultimate achievement of a tobacco-free world, including explicit plans and a timetable for implementation. Although this comprehensive approach to tobacco control will take many years to implement even under the best of circumstances, there are certain measures that could be undertaken immediately with meaningful impact on tobacco usage. These include: Increasing efforts to discourage tobacco use, particularly among the young Raising federal excise taxes by at least $2 per pack and encouraging states to consider tobacco taxes as a first resort in revenue enhancement Ensuring that tobacco settlement funds be devoted only to health-related projects, including medical treatment, biomedical research, and tobacco prevention efforts Requiring disclosure of all ingredients in tobacco products Comprehensively

  8. Radiation oncology physics: A handbook for teachers and students

    International Nuclear Information System (INIS)

    Radiotherapy, also referred to as radiation therapy, radiation oncology or therapeutic radiology, is one of the three principal modalities used in the treatment of malignant disease (cancer), the other two being surgery and chemotherapy. In contrast to other medical specialties that rely mainly on the clinical knowledge and experience of medical specialists, radiotherapy, with its use of ionizing radiation in the treatment of cancer, relies heavily on modern technology and the collaborative efforts of several professionals whose coordinated team approach greatly influences the outcome of the treatment. The radiotherapy team consists of radiation oncologists, medical physicists, dosimetrists and radiation therapy technologists: all professionals characterized by widely differing educational backgrounds and one common link - the need to understand the basic elements of radiation physics, and the interaction of ionizing radiation with human tissue in particular. This specialized area of physics is referred to as radiation oncology physics, and proficiency in this branch of physics is an absolute necessity for anyone who aspires to achieve excellence in any of the four professions constituting the radiotherapy team. Current advances in radiation oncology are driven mainly by technological development of equipment for radiotherapy procedures and imaging; however, as in the past, these advances rely heavily on the underlying physics. This book is dedicated to students and teachers involved in programmes that train professionals for work in radiation oncology. It provides a compilation of facts on the physics as applied to radiation oncology and as such will be useful to graduate students and residents in medical physics programmes, to residents in radiation oncology, and to students in dosimetry and radiotherapy technology programmes. The level of understanding of the material covered will, of course, be different for the various student groups; however, the basic

  9. Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

    Energy Technology Data Exchange (ETDEWEB)

    Tokumaru, Sunao, E-mail: tokumaru@cc.saga-u.ac.jp [Department of Heavy Particle Therapy and Radiation Oncology, Saga University, Saga (Japan); Toita, Takafumi [Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa (Japan); Oguchi, Masahiko [Radiation Oncology Department, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kato, Shingo [Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Matsuyama (Japan); Shikama, Naoto [Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tuskuba (Japan); Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita (Japan); Kagami, Yoshikazu [Department of Radiology, Showa University School of Medicine, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); and others

    2012-10-01

    Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria for Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.

  10. Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

    International Nuclear Information System (INIS)

    Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria for Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.

  11. Clinical applications of PD-1-based therapy: a focus on pembrolizumab (MK-3475 in the management of melanoma and other tumor types

    Directory of Open Access Journals (Sweden)

    Gangadhar TC

    2015-04-01

    Full Text Available Tara C Gangadhar,1 April KS Salama2 1Division of Hematology/Oncology, Department of Medicine, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA; 2Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA Abstract: Preclinical work has led to an increased understanding of the immunomodulatory mechanisms involved in the regulation of the antitumor response in a variety of tumor types. PD-1 (programmed death 1 appears to be a key checkpoint involved in immune suppression in the tumor microenvironment, even in diseases not previously thought to be sensitive to immune manipulation. More recently, the subsequent clinical development of PD-1-based therapy has resulted in a major breakthrough in the field of oncology. Pembrolizumab, a humanized highly selective IgG4 anti-PD-1 monoclonal antibody, was recently approved for the treatment of advanced melanoma based on promising early-phase clinical data. Encouraging results have also been seen in other malignancies, and PD-1-targeted therapies are likely to markedly change the treatment landscape. Future work will center on rationally designed combination strategies in order to potentiate the antitumor immune response and overcome mechanisms of resistance. Keywords: PD-1, cancer, pembrolizumab, nivolumab, immunotherapy, antitumor activity 

  12. Combination of radiation injuries: pathogenesis, clinic, therapy

    International Nuclear Information System (INIS)

    Modern notions on combined radiation injuries (CRI) are presented. Characteristic of injurious factors of nuclear explosion and common regularities of the CRI origination is given. The data on the CRI clinical peculiarities, diagnostics and treatment, principles of medical assistance for the injured on the stages of medical evacuation and recommendations on rehabilitation are presented

  13. Radiobiological and clinical aspects of neutron therapy

    International Nuclear Information System (INIS)

    Radiobiological investigations and their interpretation are discussed. The history of neutrontherapy, the results of RBE-investigations in man as well as clinical results are given. The hypothesis on reaction of human tissue and tumours towards neutron irradiation is presented. (A.S.)

  14. Clinical application of photon activation therapy

    International Nuclear Information System (INIS)

    Despite small improvements in median survival, high-grade astrocytoma remains a lethal disease with only anecdotal long-term survivors. The Brain Tumor Study Group Protocols have confirmed the value of radiation therapy and have further demonstrated that a dose-response relationship exists with doses of 5000, 5500, and 6000 cGy. However, 6000 cGy remains the upper limit of dose tolerated if external radiation therapy is used. Therefore the authors propose to combine the advantages of brachytherapy and sensitizers with halogenated pyrimidines (IUDR). By using stereotactically placed radiation sources with energies slightly above the K absorption edge of iodine they expect to obtain a significant further increase in therapeutic effect. This is due to enhancement of the physical dose, which is, furthermore, of higher biological effectiveness. Responsible for this effect are Auger electrons created in the process, which deposit their energy within the diameter of the nucleus. The dose delivered by Auger electrons is in many respects comparable with high-LET radiation. Since selective uptake of IUDR in brain tumor cells is assumed, the dose enhancement would localize itself into the tumor. Normal brain tolerance should be little, if at all, affected since normal brain would receive only low-LET radiation from the implanted samarium sources

  15. Analysis of NF-B Pathway Proteins in Pediatric Hodgkin Lymphoma: Correlations with EBV Status and Clinical Outcome—A Children's Oncology Group Study

    OpenAIRE

    Horton, Terzah M.; Sheehan, Andrea M.; Dolores López-Terrada; Hutchison, Robert E.; Sonia Narendra; Meng-Fen Wu; Hao Liu

    2012-01-01

    Constitutively active nuclear factor-κB (NF-κB) is integral to the survival of Hodgkin/Reed-Sternberg cells (H/RS) in Hodgkin lymphoma (HL). To investigate NF-κB pathway proteins in pediatric HL, we utilized a tissue microarray compiled from 102 children enrolled in the Children's Oncology Group intermediate-risk clinical trial AHOD0031 (56 male, 78 Caucasian, median age 15 years (range 1–20 years), 85 nodular sclerosing subtype, 23 Epstein-Barr virus (EBV) positive, and 24 refractory/relapse...

  16. Web-based documentation system with exchange of DICOM RT for multicenter clinical studies in particle therapy

    Science.gov (United States)

    Kessel, Kerstin A.; Bougatf, Nina; Bohn, Christian; Engelmann, Uwe; Oetzel, Dieter; Bendl, Rolf; Debus, Jürgen; Combs, Stephanie E.

    2012-02-01

    Conducting clinical studies is rather difficult because of the large variety of voluminous datasets, different documentation styles, and various information systems, especially in radiation oncology. In this paper, we describe our development of a web-based documentation system with first approaches of automatic statistical analyses for transnational and multicenter clinical studies in particle therapy. It is possible to have immediate access to all patient information and exchange, store, process, and visualize text data, all types of DICOM images, especially DICOM RT, and any other multimedia data. Accessing the documentation system and submitting clinical data is possible for internal and external users (e.g. referring physicians from abroad, who are seeking the new technique of particle therapy for their patients). Thereby, security and privacy protection is ensured with the encrypted https protocol, client certificates, and an application gateway. Furthermore, all data can be pseudonymized. Integrated into the existing hospital environment, patient data is imported via various interfaces over HL7-messages and DICOM. Several further features replace manual input wherever possible and ensure data quality and entirety. With a form generator, studies can be individually designed to fit specific needs. By including all treated patients (also non-study patients), we gain the possibility for overall large-scale, retrospective analyses. Having recently begun documentation of our first six clinical studies, it has become apparent that the benefits lie in the simplification of research work, better study analyses quality and ultimately, the improvement of treatment concepts by evaluating the effectiveness of particle therapy.

  17. [Sudeck disease--pathology, clinical aspects and therapy].

    Science.gov (United States)

    Schulz, R H; Buch, K

    1998-06-01

    In our opinion the etiology of Sudeck's disease (acute reflex bone atrophy) plays a decisive role in therapeutic planning. The therapy is based on clinical and radiological findings. Physiotherapy addresses the symptom complex of pain, hyperemia, edema formation, and limitations of movement which act in a vicious circle and its intensity is modified according to the prevailing clinical and possibly also radiological findings. A strict coupling of the therapy to a classification according to stage is not recommended. Pharmacological therapy is merely a supporting element and focuses on the sympathetic overexcitability. The best therapy for Sudeck's disease is prophylaxis. Interventions collected under the general term early functional mobilization are, especially after surgical measures, a major factor in the avoidance of neurovegetative dysregulation in the sense of sympathetic reflex dystrophy. PMID:9738286

  18. [From "Karzinos" to modern urologic oncology : A long way from the first surgical procedures to targeted therapy].

    Science.gov (United States)

    Konert, J

    2016-08-01

    Cancer can be traced back to the Iron Age. Both the ancient Egyptians and Hippocrates dealt with the disease. Urological tumor treatment is an integral part of urology and has undergone interesting developments. Today, it comprises all possible forms of treatment-from radical surgery to the most modern radiological therapies, including antihormal therapy, chemotherapy, and modern targeted therapy. PMID:27422312

  19. Clinical applications of continuous infusion chemotherapy ahd concomitant radiation therapy

    International Nuclear Information System (INIS)

    This book presents information on the following topics: theoretical basis and clinical applications of 5-FU as a radiosensitizer; treatment of hepatic metastases from gastro intestingal primaries with split course radiation therapy; combined modality therapy with 5-FU, Mitomycin-C and radiation therapy for sqamous cell cancers; treatment of bladder carcinoma with concomitant infusion chemotherapy and irradiation; a treatment of invasiv bladder cancer by the XRT/5FU protocol; concomitant radiation therapy and doxorubicin by continuous infusion in advanced malignancies; cis platin by continuous infusion with concurrent radiation therapy in malignant tumors; combination of radiation with concomitant continuous adriamycin infusion in a patient with partially excised pleomorphic soft tissue sarcoma of the lower extremeity; treatment of recurrent carcinoma of the paranasal sinuses using concomitant infusion cis-platinum and radiation therapy; hepatic artery infusion for hepatic metastases in combination with hepatic resection and hepatic radiation; study of simultaneous radiation therapy, continuous infusion, 5FU and bolus mitomycin-C; cancer of the esophagus; continuous infusion VP-16, bolus cis-platinum and simultaneous radiation therapy as salvage therapy in small cell bronchogenic carcinoma; and concomitant radiation, mitomycin-C and 5-FU infusion in gastro intestinal cancer

  20. Clinical results of radiation therapy for thymoma

    Energy Technology Data Exchange (ETDEWEB)

    Masunaga, Shin-ichiro; Ono, Koji; Hiraoka, Masahiro; Sasai, Keisuke; Kitakabu, Yoshizumi; Abe, Mitsuyuki (Kyoto Univ. (Japan). Faculty of Medicine); Takahashi, Masaji; Tsutsui, Kazushige; Fushiki, Masato

    1992-05-01

    From August 1968 to December 1989, 58 patients with thymoma were treated by radiotherapy using cobalt-60 gamma ray. Eleven cases were treated by radiothrapy alone, 1 by preoperative radiotheapy, 43 by postoperative radiotherapy, and 3 in combination with intraoperative radiotherapy. The following points were clarified: (a) Postoperative and intraoperative radiotherapy were effective; (b) For postoperative radiotherapy, operability was the major factor influencing survival and local control, and Stage I and II tumors resected totally or subtotally as well as Stage III tumors resected totally were good indications for such therapy; (c) The patients with complicating myasthenia gravis had a longer survival time and better local control rate than those without it. Radiation pneumonitis was observed in 17 patients, and none of them died of this complication. In all cases in combination with intraoperative radiotherapy, dry desquamation was observed within the irradiated field. (author).

  1. [Celiac disease : Pathogenesis, clinics, epidemiology, diagnostics, therapy].

    Science.gov (United States)

    Schuppan, Detlef

    2016-07-01

    Celiac disease is induced by the consumption of gluten containing cereals (wheat, spelt, barley, rye). With a prevalence of ~ 1 %, it is the most common non-infectious chronic inflammatory intestinal disease worldwide. It manifests in all age groups, either classically with abdominal pain, diarrhoea and growth failure or weight loss, more commonly with indirect consequences of malabsorption, such as anaemia and osteoporosis, or with associated autoimmune diseases like type 1 diabetes, autoimmune thyroiditis or dermatitis herpetiformis. The pathogenesis of celiac disease is well explored. Gluten, the cereal storage protein, is not completely digested and reaches the intestinal mucosa where it activates inflammatory T cells, which cause atrophy of the resorptive villi. This T‑cell activation requires a genetic predisposition (the molecules HLA-DQ2 or -DQ8 on antigen-presenting immune cells). Moreover, the enzyme tissue transglutaminase (TG2) which is released in the mucosa increases the immunogenicity of the gluten peptides by a deamidation reaction. The test for serum antibodies to the autoantigen TG2 is one of the best diagnostic markers in medicine, which in combination with endoscopically obtained biopsies, secures the diagnosis of celiac disease. Despite these tools celiac disease is severely underdiagnosed, with 80-90 % of those affected being undetected. The untreated condition can lead to grave complications. These include the consequences of malabsorption, cancers (especially intestinal T‑cell lymphoma), and likely also the promotion of autoimmune diseases. The therapy of celiac disease, a strict gluten-free diet, is difficult to maintain and not always effective. Alternative, supporting pharmacological therapies are urgently needed and are currently in development. PMID:27273303

  2. The administration of music therapy training clinics: a descriptive study.

    Science.gov (United States)

    Abbott, Elaine A

    2006-01-01

    A two-part study was conducted to describe issues and administrative practices related to university and college affiliated music therapy training clinics. First, all 72 AMTA academic directors were surveyed in order to discover (a) which programs had a clinic, and (b) the reasons why other directors did not operate a clinic. Second, 12 survey respondents, who reported that they were involved with a training clinic, participated in in-depth interviews discussing: (a) their motivations for establishing a clinic, (b) the possible effects of a clinic on the community, (c) the individuals and groups involved in clinic operations, d) clinic space and equipment, (e) policy and procedure topics, (f) specific administrative practices related to clients and students, (g) finances, (h) research (i) quality assurance, (j) dual roles, and (k) liability issues. The administrative practices described by the interviewees varied greatly across clinics and provided a wealth of information that could be considered both useful and thought provoking for those interested in operating a music therapy clinic. PMID:16671838

  3. Report on the International Colloquium on Cardio-Oncology (Rome, 12–14 March 2014)

    Science.gov (United States)

    Ewer, Michael; Gianni, Luca; Pane, Fabrizio; Sandri, Maria Teresa; Steiner, Rudolf K; Wojnowski, Leszek; Yeh, Edward T; Carver, Joseph R; Lipshultz, Steven E; Minotti, Giorgio; Armstrong, Gregory T; Cardinale, Daniela; Colan, Steven D; Darby, Sarah C; Force, Thomas L; Kremer, Leontien CM; Lenihan, Daniel J; Sallan, Stephen E; Sawyer, Douglas B; Suter, Thomas M; Swain, Sandra M; van Leeuwen, Flora E

    2014-01-01

    Cardio-oncology is a relatively new discipline that focuses on the cardiovascular sequelae of anti-tumour drugs. As any other young adolescent discipline, cardio-oncology struggles to define its scientific boundaries and to identify best standards of care for cancer patients or survivors at risk of cardiovascular events. The International Colloquium on Cardio-Oncology was held in Rome, Italy, 12–14 March 2014, with the aim of illuminating controversial issues and unmet needs in modern cardio-oncology. This colloquium embraced contributions from different kind of disciplines (oncology and cardiology but also paediatrics, geriatrics, genetics, and translational research); in fact, cardio-oncology goes way beyond the merging of cardiology with oncology. Moreover, the colloquium programme did not review cardiovascular toxicity from one drug or the other, rather it looked at patients as we see them in their fight against cancer and eventually returning to everyday life. This represents the melting pot in which anti-cancer therapies, genetic backgrounds, and risk factors conspire in producing cardiovascular sequelae, and this calls for screening programmes and well-designed platforms of collaboration between one key professional figure and another. The International Colloquium on Cardio-Oncology was promoted by the Menarini International Foundation and co-chaired by Giorgio Minotti (Rome), Joseph R Carver (Philadelphia, Pennsylvania, United States), and Steven E Lipshultz (Detroit, Michigan, United States). The programme was split into five sessions of broad investigational and clinical relevance (what is cardiotoxicity?, cardiotoxicity in children, adolescents, and young adults, cardiotoxicity in adults, cardiotoxicity in special populations, and the future of cardio-oncology). Here, the colloquium chairs and all the session chairs briefly summarised what was said at the colloquium. Topics and controversies were reported on behalf of all members of the working group

  4. Clinical applications of gene therapy for primary immunodeficiencies.

    Science.gov (United States)

    Cicalese, Maria Pia; Aiuti, Alessandro

    2015-04-01

    Primary immunodeficiencies (PIDs) have represented a paradigmatic model for successes and pitfalls of hematopoietic stem cells gene therapy. First clinical trials performed with gamma retroviral vectors (γ-RV) for adenosine deaminase severe combined immunodeficiency (ADA-SCID), X-linked SCID (SCID-X1), and Wiskott-Aldrich syndrome (WAS) showed that gene therapy is a valid therapeutic option in patients lacking an HLA-identical donor. No insertional mutagenesis events have been observed in more than 40 ADA-SCID patients treated so far in the context of different clinical trials worldwide, suggesting a favorable risk-benefit ratio for this disease. On the other hand, the occurrence of insertional oncogenesis in SCID-X1, WAS, and chronic granulomatous disease (CGD) RV clinical trials prompted the development of safer vector construct based on self-inactivating (SIN) retroviral or lentiviral vectors (LVs). Here we present the recent results of LV-mediated gene therapy for WAS showing stable multilineage engraftment leading to hematological and immunological improvement, and discuss the differences with respect to the WAS RV trial. We also describe recent clinical results of SCID-X1 gene therapy with SIN γ-RV and the perspectives of targeted genome editing techniques, following early preclinical studies showing promising results in terms of specificity of gene correction. Finally, we provide an overview of the gene therapy approaches for other PIDs and discuss its prospects in relation to the evolving arena of allogeneic transplant. PMID:25860576

  5. FDG PET/CT in oncology: 'raising the bar'

    Energy Technology Data Exchange (ETDEWEB)

    Patel, C.N. [Departments of Radiology and Nuclear Medicine, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford (United Kingdom); Goldstone, A.R.; Chowdhury, F.U. [Departments of Radiology and Nuclear Medicine, St James' s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Scarsbrook, A.F., E-mail: andrew.scarsbrook@leedsth.nhs.u [Departments of Radiology and Nuclear Medicine, St James' s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom)

    2010-07-15

    Integrated positron-emission tomography/computed tomography (PET/CT) with 2-[{sup 18}F]-fluoro-2-deoxy-D-glucose (FDG) has revolutionized oncological imaging in recent years and now has a firmly established role in a variety of tumour types. There have been simultaneous step-wise advances in scanner technology, which are yet to be exploited to their full potential in clinical practice. This article will review these technological developments and explore how refinements in imaging protocols can further improve the accuracy and efficacy of PET/CT in oncology. The promises, and limitations, of emerging oncological applications of FDG PET/CT in radiotherapy planning and therapy response assessment will be explored. Potential future developments, including the use of FDG PET probes in oncological surgery, advanced data analysis techniques, and the prospect of integrated PET/magnetic resonance imaging (PET/MRI) will be highlighted.

  6. Erythromelalgia : Clinical aspects, pathology and therapy

    OpenAIRE

    2012-01-01

    List of papers. Papers I-IV and Appendix I-II are removed from the thesis due to copyright restrictions. Paper I Lalgaard OM, Seem E, Kvernebo K: Erythromelalgia: a clinical study of 87 cases. J Int Med 242:191-7, 1997 doi:10.1046/j.1365-2796.1997.00185.x Paper II Kalgaard OM, Clausen OP, Mellbye OJ, Hovig T, Kvernebo K: Nonspecific capillary proliferation and vasculopathy indicate skin hypoxia in erythromelalgia. Arch Dermatol 147(3):309-14,2011 doi:10.10...

  7. Clinical analysis of interventional therapy for adenomyosis

    International Nuclear Information System (INIS)

    Objective: To assess clinical effects of transcatheter uterine arterial embolization (TUAE) on adenomyosis. Methods: From Oct. 1999 to Jun. 2001, TUAE was performed on 46 cases with adenomyosis whose clinical symptoms could not be controlled by drugs. By using Seldinger's method, iodine oil and PVA were injected in double uterine arteries. High pressure sterilized gelfoam particles were used to embolize the arteries. Results: After interventional treatment, the volume of menstruation decreased 30%-70% for all patients. Mean decreasing value was (54.2 +- 20.2)%, t test value 5.85 (P 3 to (129.3 +- 56.6) cm3 (30% - 66%). t test value is 2.86 (P 3 to (48.2 +- 18.7) cm3 (32.1% - 98.6%). t test value is 3.9 (P < 0.01). The blood flow within the uterine focus decreased obviously which was detected by colour Doppler flow imaging. Conclusion: TUAE is proved to be therapeutically effective for adenomyosis in short-term

  8. Pathotropic nanoparticles for cancer gene therapy Rexin-G IV: three-year clinical experience.

    Science.gov (United States)

    Gordon, Erlinda M; Lopez, Francisco F; Cornelio, Gerardo H; Lorenzo, Conrado C; Levy, John P; Reed, Rebecca A; Liu, Liqiong; Bruckner, Howard W; Hall, Frederick L

    2006-11-01

    Metastatic cancer is a life-threatening illness with a predictably fatal outcome, thereby representing a major unmet medical need. In 2003, Rexin-G became the world's first targeted injectable vector approved for clinical trials in the treatment of intractable metastatic disease. Uniquely suited, by design, to function within the context of the human circulatory system, Rexin-G is a pathotropic (disease-seeking) gene delivery system bearing a designer killer gene; in essence, a targeted nanoparticle that seeks out and selectively accumulates in metastatic sites upon intravenous infusion. The targeted delivery of the cytocidal gene to primary tumors and metastatic foci, in effective local concentrations, compels both cancer cells and tumor-associated neovasculature to self-destruct, without causing untoward collateral damage to non-target organs. In this study: i) we report the results of three distinctive clinical studies which demonstrate the initial proofs of concept, safety, and efficacy of Rexin-G when used as a single agent for advanced or metastatic cancer, ii) we introduce the quantitative foundations of an innovative personalized treatment regimen, designated the 'Calculus of Parity', based on a patient's calculated tumor burden, iii) we propose a refinement of surrogate end-points commonly used for defining success in cancer therapy, and iv) we map out a strategic plan for the accelerated approval of Rexin-G based on the oncologic Threshold of Credibility paradigm being developed by the Food and Drug Administration. PMID:17016635

  9. Pecularities of clinical photodynamic therapy of cancer

    Science.gov (United States)

    Stranadko, Eugeny P.; Skobelkin, Oleg K.; Litvin, Grigory D.; Astrakhankina, Tamara A.

    1996-01-01

    The analysis of the results of photodynamic therapy (PDT) for treating malignant neoplasms of the skin, mammary glands, tongue, oral mucous, lower lip, larynx, lungs, urinary bladder rectum and other locations has been made. During 1992 - 1995 478 tumoral foci in 125 patients have been treated with PDT. All patients were previously treated with conventional techniques without effect or they were not treated due to contraindications either because of severe accompanying diseases or because of old age. A part of the patients had PDT because of recurrences or intradermal metastases in 1 - 2 years after surgical, radial or combined treatment. Two home-made preparations were used as photosensitizers: Photohem (hematoporphyrine derivative) and Photosense (aluminum sulfonated phthalocyanine). Light sources were: the argon pumped dye laser (`Innova-200', `Coherent') and home-made laser devices: copper-vapor laser-pumped dye laser (`Yakhroma-2', Frjazino), gas-discharge unit `Ksenon' (wavelength 630 nm), gold-vapor laser (wavelength 627.8 nm) for Photohem; while for Photosense sessions we used solid-state laser on ittrium aluminate `Poljus-1' (wavelength 670 nm). Up to now we have follow-up control data within 2 months and 3 years. Positive effect of PDT was seen in 92% of patients including complete regression of tumors in 66.4% and partial in 25.6%. Currently, this new perspective technique of treating malignant neoplasms is successfully being used in Russia; new photosensitizers and light sources for PDT and fluorescent tumor diagnostics are being developed as well.

  10. Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology.

    Science.gov (United States)

    Apte, Sachin M; Patel, Kavita

    2016-01-01

    With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

  11. Does Cancer Literature Reflect Multidisciplinary Practice? A Systematic Review of Oncology Studies in the Medical Literature Over a 20-Year Period

    International Nuclear Information System (INIS)

    Purpose: Quality cancer care is best delivered through a multidisciplinary approach requiring awareness of current evidence for all oncologic specialties. The highest impact journals often disseminate such information, so the distribution and characteristics of oncology studies by primary intervention (local therapies, systemic therapies, and targeted agents) were evaluated in 10 high-impact journals over a 20-year period. Methods and Materials: Articles published in 1994, 2004, and 2014 in New England Journal of Medicine, Lancet, Journal of the American Medical Association, Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology, Radiotherapy and Oncology, International Journal of Radiation Oncology, Biology, Physics, Annals of Surgical Oncology, and European Journal of Surgical Oncology were identified. Included studies were prospectively conducted and evaluated a therapeutic intervention. Results: A total of 960 studies were included: 240 (25%) investigated local therapies, 551 (57.4%) investigated systemic therapies, and 169 (17.6%) investigated targeted therapies. More local therapy trials (n=185 [77.1%]) evaluated definitive, primary treatment than systemic (n=178 [32.3%]) or targeted therapy trials (n=38 [22.5%]; P<.001). Local therapy trials (n=16 [6.7%]) also had significantly lower rates of industry funding than systemic (n=207 [37.6%]) and targeted therapy trials (n=129 [76.3%]; P<.001). Targeted therapy trials represented 5 (2%), 38 (10.2%), and 126 (38%) of those published in 1994, 2004, and 2014, respectively (P<.001), and industry-funded 48 (18.9%), 122 (32.6%), and 182 (54.8%) trials, respectively (P<.001). Compared to publication of systemic therapy trial articles, articles investigating local therapy (odds ratio: 0.025 [95% confidence interval: 0.012-0.048]; P<.001) were less likely to be found in high-impact general medical journals. Conclusions: Fewer studies evaluating local therapies, such as surgery and radiation, are published in

  12. Does Cancer Literature Reflect Multidisciplinary Practice? A Systematic Review of Oncology Studies in the Medical Literature Over a 20-Year Period

    Energy Technology Data Exchange (ETDEWEB)

    Holliday, Emma B. [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ahmed, Awad A. [Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (United States); Yoo, Stella K. [Department of Radiation Oncology, University of Southern California, Los Angeles, California (United States); Jagsi, Reshma [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Hoffman, Karen E., E-mail: KHoffman1@mdanderson.org [Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2015-07-15

    Purpose: Quality cancer care is best delivered through a multidisciplinary approach requiring awareness of current evidence for all oncologic specialties. The highest impact journals often disseminate such information, so the distribution and characteristics of oncology studies by primary intervention (local therapies, systemic therapies, and targeted agents) were evaluated in 10 high-impact journals over a 20-year period. Methods and Materials: Articles published in 1994, 2004, and 2014 in New England Journal of Medicine, Lancet, Journal of the American Medical Association, Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology, Radiotherapy and Oncology, International Journal of Radiation Oncology, Biology, Physics, Annals of Surgical Oncology, and European Journal of Surgical Oncology were identified. Included studies were prospectively conducted and evaluated a therapeutic intervention. Results: A total of 960 studies were included: 240 (25%) investigated local therapies, 551 (57.4%) investigated systemic therapies, and 169 (17.6%) investigated targeted therapies. More local therapy trials (n=185 [77.1%]) evaluated definitive, primary treatment than systemic (n=178 [32.3%]) or targeted therapy trials (n=38 [22.5%]; P<.001). Local therapy trials (n=16 [6.7%]) also had significantly lower rates of industry funding than systemic (n=207 [37.6%]) and targeted therapy trials (n=129 [76.3%]; P<.001). Targeted therapy trials represented 5 (2%), 38 (10.2%), and 126 (38%) of those published in 1994, 2004, and 2014, respectively (P<.001), and industry-funded 48 (18.9%), 122 (32.6%), and 182 (54.8%) trials, respectively (P<.001). Compared to publication of systemic therapy trial articles, articles investigating local therapy (odds ratio: 0.025 [95% confidence interval: 0.012-0.048]; P<.001) were less likely to be found in high-impact general medical journals. Conclusions: Fewer studies evaluating local therapies, such as surgery and radiation, are published in

  13. Use of complementary therapies by patients attending musculoskeletal clinics.

    OpenAIRE

    Chandola, A; Young, Y.; McAlister, J.; Axford, J S

    1999-01-01

    Patients with musculoskeletal disorders commonly seek treatment outside orthodox medicine (complementary therapy). In patients attending hospital clinics we investigated the prevalence of such behaviour and the reasons for it. Patients attending rheumatology and orthopaedic clinics who agreed to participate were interviewed on the same day by means of a structured questionnaire in three sections: the first section about demographic characteristics; the second about the nature and duration of ...

  14. The effects of Reiki therapy on pain and anxiety in patients attending a day oncology and infusion services unit.

    Science.gov (United States)

    Birocco, Nadia; Guillame, Camilla; Storto, Silvana; Ritorto, Giuliana; Catino, Cristiana; Gir, Nisha; Balestra, Lucia; Tealdi, Giancarla; Orecchia, Cristina; Vito, Giovanna De; Giaretto, Lorena; Donadio, Michela; Bertetto, Oscar; Schena, Marina; Ciuffreda, Libero

    2012-06-01

    Reiki is a system of natural healing techniques administered by laying of hands and transferring energy from the Reiki practitioner to the recipient. We investigated the role of Reiki in the management of anxiety, pain and global wellness in cancer patients. Building on the results of a pilot project conducted between 2003 and 2005 by a volunteer association at our hospital, a wider, 3-year study was conducted at the same center. The volunteer Reiki practitioners received 2 years of theory and practical training. The study population was 118 patients (67 women and 51 men; mean age, 55 years) with cancer at any stage and receiving any kind of chemotherapy. Before each session, the nurses collected the patient's personal data and clinical history. Pain and anxiety were evaluated according to a numeric rating scale by the Reiki practitioners. Each session lasted about 30 min; pain and anxiety scores were recorded using a Visual Analog Scale (VAS), together with a description of the physical feelings the patients perceived during the session. All 118 patients received at least 1 Reiki treatment (total number, 238). In the subgroup of 22 patients who underwent the full cycle of 4 treatments, the mean VAS anxiety score decreased from 6.77 to 2.28 (P <.000001) and the mean VAS pain score from 4.4 to 2.32 (P = .091). Overall, the sessions were felt helpful in improving well-being, relaxation, pain relief, sleep quality and reducing anxiety. Offering Reiki therapy in hospitals could respond to patients' physical and emotional needs. PMID:21998438

  15. Clinical features, epidemiology, and therapy of lymphangioleiomyomatosis

    Directory of Open Access Journals (Sweden)

    Taveira-DaSilva AM

    2015-04-01

    only affect the activity of mTOR complex 1, therapies targeting RhoA GTPases with simvastatin, which inhibits Rho GTPases and promotes apoptosis, are being investigated. As in the case of cancer, LAM may be best treated with multiple drugs targeting signaling pathways considered important in the pathogenesis of disease.   Keywords: lymphangioleiomyomatosis, tuberous sclerosis, TSC1 and TSC2 mutations, mammalian target of rapamycin signaling pathway

  16. The current state of the art in three dimensional oncologic imaging: an overview

    International Nuclear Information System (INIS)

    Purpose: To provide an overview of the methods and clinical applications of three dimensional (3D) medical imaging in the oncologic patient. Methods and Materials: We briefly outline the techniques currently used to create 3D medical images with an emphasis on their strengths and shortcomings as they relate to oncologic imaging and radiation therapy planning. We then discuss some of the most important and promising oncologic applications of 3D imaging and suggest likely future directions in this rapidly developing field. Results: Since the first application of 3D techniques to medical data over a decade ago, 3D medical images have evolved from relatively crude representations of musculoskeletal abnormalities to detailed and accurate representations of a variety of soft tissue, vascular, and oncologic pathology. The rapid development of both computer hardware and software coupled with the application of 3D techniques to a variety of imaging modalities have expanded the clinical applications of this technology dramatically. Conclusions: 3D medical images are clinically practical tools for oncologic evaluation and effective radiation therapy planning

  17. Transcatheter therapies for resistant hypertension: Clinical review

    Institute of Scientific and Technical Information of China (English)

    Adil; Lokhandwala; Abhijeet; Dhoble

    2014-01-01

    Resistant hypertension(RHTN) is a commonly encountered clinical problem and its management remains a challenging task for healthcare providers. The prevalence of true RHTN has been difficult to assess due to pseudoresistance and secondary hypertension. Atherosclerotic renal artery stenosis(RAS) has been associated as a secondary cause of RHTN. Initial studies had shown that angioplasty and stenting for RAS were a promising therapeutic option when added to optimal medical management. However, recent randomized controlled trials in larger populations have failed to show any such benefit. Sympathetic autonomic nervous system dysfunction is commonly noted in individuals with resistant hypertension. Surgical sympathectomy was the treatment of choice for malignant hypertension and it significantly improved mortality. However, postsurgical complications and the advent of antihypertensive drugs made this approach less desirable and it was eventually abandoned. Increasing prevalence of RHTN in recent decades has led to the emergence of minimally invasive interventions such as transcatheter renal denervation for better control of blood pressure. It is a minimally invasive procedure which uses radiofrequency energy for selective ablation of renal sympathetic nerves located in the adventitia of the renal artery. It is a quick procedure and has a short recovery time. Early studies in small population showed significant reduction in blood pressure. The most recent Symplicity HTN-3 study, which is the largest randomized control trial and the only one to use a sham procedure in controls, failed to show significant BP reduction at 6 mo.

  18. Clinical Implementation Of Adaptive Radiation Therapy

    International Nuclear Information System (INIS)

    In radiotherapy, treatment position error has been one of the major limits in either increasing treatment conformality or decreasing the marginal misses. There have been two strategies to reduce the effect of treatment position error on tumor treatment. The first one incorporates the possible uncertainties into pretreatment planning to demonstrate the effects of dose variation. The second strategy establishes different decision rules to reduce the magnitude of position error by repositioning the patients. This has been investigated by many researchers due to the advent of electronic portal imaging devices. Another strategy may be beneficial to the radiation treatment outcome, which we have termed 'adaptive radiotherapy'. Initially, adaptive radiotherapy uses patient population data to identify the sensitivity of different treatment sites to positional variation. Then, it uses the position error measured from each individual patient during the process of treatment delivery to adaptively modify the treatment parameters. For example, the MLC field can be reshaped to improve the treatment through either increasing possibility of dose escalation or reducing a possibility of the marginal misses. Our work demonstrates how to use an on-line imaging system and a MLC to implement this adaptive process in the radiotherapy clinic. The practical considerations and requirements (computer software, hardware and networks) are also discussed. A retrospective study for prostate and lung treatments is used to demonstrate the potential gain from this procedure

  19. Commercial Clinical Application of Boron Neutron Capture Therapy

    International Nuclear Information System (INIS)

    CRADA No. 95-CR-09 among the LITCO--now Bechtel BWXT Idaho, LLC; a private company, Neutron Therapies Limited Liability Company, NTL formerly Ionix Corporation; and Washington State University was established in 1996 to further the development of BNCT. NTL has established a laboratory for the synthesis, under US FDA approved current Good Manufacturing Practices (cGMP) guidelines, of key boron intermediates and final boron agents for BNCT. The company has focused initially on the development of the compound GB-10 (Na2B10H10) as the first boron agent of interest. An Investigational New Drug (IND) application for GB-10 has been filed and approved by the FDA for a Phase I human biodistribution trial in patients with non-small cell lung cancer and glioblastoma multiforme at UW under the direction of Professor Keith Stelzer, Principal Investigator (PI). These trials are funded by NTL under a contract with the UW, Department of Radiation Oncology, and the initial phases are nearing completion. Initial results show that boron-10 concentrations on the order of 100 micrograms per gram (100 ppm) can be achieved and maintained in blood with no indication of toxicity

  20. Commercial Clinical Application of Boron Neutron Capture Therapy

    Energy Technology Data Exchange (ETDEWEB)

    N/A

    1999-09-03

    CRADA No. 95-CR-09 among the LITCO--now Bechtel BWXT Idaho, LLC; a private company, Neutron Therapies Limited Liability Company, NTL formerly Ionix Corporation; and Washington State University was established in 1996 to further the development of BNCT. NTL has established a laboratory for the synthesis, under US FDA approved current Good Manufacturing Practices (cGMP) guidelines, of key boron intermediates and final boron agents for BNCT. The company has focused initially on the development of the compound GB-10 (Na{sub 2}B{sub 10}H{sub 10}) as the first boron agent of interest. An Investigational New Drug (IND) application for GB-10 has been filed and approved by the FDA for a Phase I human biodistribution trial in patients with non-small cell lung cancer and glioblastoma multiforme at UW under the direction of Professor Keith Stelzer, Principal Investigator (PI). These trials are funded by NTL under a contract with the UW, Department of Radiation Oncology, and the initial phases are nearing completion. Initial results show that boron-10 concentrations on the order of 100 micrograms per gram (100 ppm) can be achieved and maintained in blood with no indication of toxicity.

  1. Development of Clinical Database System Specialized for Heavy Particle Therapy.

    Science.gov (United States)

    Mukai, Masami; Ando, Yutaka; Yokooka, Yuki; Okuda, Yasuo; Seki, Masayoshi; Kimura, Masahiro; Tsuji, Hiroshi; Kamada, Tadashi

    2015-01-01

    We have developed a data archiving system for study of charged particle therapy. We required a data-relation mechanism between electronic medical record system (EMR) and database system, because it needs to ensure the information consistency. This paper presents the investigation results of these techniques. The standards in the medical informatics field that we focus on are Integrating the Healthcare Enterprise (IHE) and 2) Health Level-7 (HL7) to archive the data. As a main cooperation function, we adapt 2 integration profiles of IHE as follows, 1) Patient Administration Management (PAM) Profile of IHE-ITI domain for patient demographic information reconciliation, 2) Enterprise Schedule Integration(ESI) profile of IHE-Radiation Oncology domain for order management between EMR and treatment management system(TMS). We also use HL7 Ver2.5 messages for exchanging the follow-up data and result of laboratory test. In the future, by implementation of this system cooperation, we will be able to ensure interoperability in the event of the EMR update. PMID:26262235

  2. Nuclear medical oncology; Nuklearmedizinische Onkologie

    Energy Technology Data Exchange (ETDEWEB)

    Krause, Bernd J.; Buck, Andreas K.; Schwaiger, Markus (eds.) [Technische Univ. Muenchen (Germany). Nuklearmedizinische Klinik und Poliklinik

    2007-07-01

    Modern nuclear oncology is based on molecular imaging techniques and radiotherapy. The book is aimed to integrate efficiently nuclear medical diagnostics and therapy into oncologic patient management. The book covers the following topics: Chapter 1: basics: instrumentation (SPECT, PET, PET/CT), digital image processing, radiopharmaceuticals, radiation protection, nuclear medical dosimetry, radiotherapy planning. Chapter 2: diagnostics: PET and PET/CT, skeleton metastases diagnostics, lymphoma diagnostics in case of mammary carcinomas and malign melanoma, MIBG (metaiodobenzylguanidin) diagnostics. Chapter 3: therapy: Radiotherapy of thyroid carcinomas, radioimmunotherapy of malign melanomas and in haematology, MIBG therapy, radiotherapy of neuroendocrine tumors, radiotherapy of skeleton metastases, intercavitary and locoregional therapy, 32{sup 3}2 phosphor therapy of polycythaemia vera.

  3. Family therapy training on a clinical psychology programme

    OpenAIRE

    CARR, ALAN

    2007-01-01

    The report describes the intake interviewing exercise in a family therapy training unit developed for postgraduates in clinical psychology. The teaching method includes pre-class reading, video modelling, and simulated practice with live feedback. The academic material and other similar practice exercises are contained in the core textbook for this unit.

  4. In-Home Parent-Child Interaction Therapy: Clinical Considerations

    Science.gov (United States)

    Masse, Joshua J.; McNeil, Cheryl B.

    2008-01-01

    Parent-Child Interaction Therapy (PCIT) is an empirically-supported behavioral parent training program designed to be administered in a clinic or laboratory-based setting. Recently, an empirical investigation revealed that in-home PCIT produced comparable results as the PCIT trials conducted in more controlled environments (this issue).…

  5. HYPERMOBILITY SYNDROME: CLINICAL MANIFESTATIONS, DIFFERENTIAL DIAGNOSIS, THERAPY APPROACHES

    OpenAIRE

    N. A. Shostak; N. G. Pravdyuk

    2016-01-01

    Connective tissue dysplasia (CTD) represents special ontogenetic abnormality which is a complex problem of contemporary medicine. The principles of differential diagnosis of various forms of CTD are considered. A clinical estimation and therapy approaches are discussed with focus on hypermobility syndrome as one of undifferentiated form of CTD.

  6. HYPERMOBILITY SYNDROME: CLINICAL MANIFESTATIONS, DIFFERENTIAL DIAGNOSIS, THERAPY APPROACHES

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2016-01-01

    Full Text Available Connective tissue dysplasia (CTD represents special ontogenetic abnormality which is a complex problem of contemporary medicine. The principles of differential diagnosis of various forms of CTD are considered. A clinical estimation and therapy approaches are discussed with focus on hypermobility syndrome as one of undifferentiated form of CTD.

  7. Clinical considerations of anticoagulation therapy for patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Shu ZHANG

    2012-01-01

    Atrial fibrillation (AF) increases the risk of stroke.New anticoagulation agents have recently provided alternative and promising approaches.This paper reviews the current state of anticoagulation therapy in AF patients,focusing on various clinical scenarios and on comparisons,where possible,between western and eastern populations.

  8. Diagnosis and treatment of pancreatic cancer. Oncology overview

    International Nuclear Information System (INIS)

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Radiological diagnosis of pancreatic cancer; Biopsy and cytology in the diagnosis of pancreatic cancer; Pathology and morphology of pancreatic cancer; Staging and prognosis of pancreatic cancer; Biological and immunological markers in the diagnosis of pancreatic cancer; Surgical treatment of pancreatic cancer; Drug therapy of pancreatic cancer; Radiation therapy of pancreatic cancer; Selected studies on the epidemiology of pancreatic cancer; Clinical correlates and syndromes associated with pancreatic neoplasia

  9. Relevance of circulating nucleosomes and oncological biomarkers for predicting response to transarterial chemoembolization therapy in liver cancer patients

    Directory of Open Access Journals (Sweden)

    Durner Jürgen

    2011-05-01

    Full Text Available Abstract Background Transarterial chemoembolization (TACE therapy is an effective locoregional treatment in hepatocellular cancer (HCC patients. For early modification of therapy, markers predicting therapy response are urgently required. Methods Here, sera of 50 prospectively and consecutively included HCC patients undergoing 71 TACE therapies were taken before and 3 h, 6 h and 24 h after TACE application to analyze concentrations of circulating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1, alpha fetoprotein (AFP, C-reactive protein (CRP and several liver biomarkers, and to compare these with radiological response to therapy. Results While nucleosomes, CYFRA 21-1, CRP and some liver biomarkers increased already 24 h after TACE, percental changes of nucleosome concentrations before and 24 h after TACE and pre- and posttherapeutic values of AFP, gamma-glutamyl-transferase (GGT and alkaline phosphatase (AP significantly indicated the later therapy response (39 progression versus 32 no progression. In multivariate analysis, nucleosomes (24 h, AP (24 h and TACE number were independent predictive markers. The risk score of this combination model achieved an AUC of 81.8% in receiver operating characteristic (ROC curves and a sensitivity for prediction of non-response to therapy of 41% at 97% specificity, and of 72% at 78% specificity. Conclusion Circulating nucleosomes and liver markers are valuable tools for early estimation of the efficacy of TACE therapy in HCC patients.

  10. Relevance of circulating nucleosomes and oncological biomarkers for predicting response to transarterial chemoembolization therapy in liver cancer patients

    International Nuclear Information System (INIS)

    Transarterial chemoembolization (TACE) therapy is an effective locoregional treatment in hepatocellular cancer (HCC) patients. For early modification of therapy, markers predicting therapy response are urgently required. Here, sera of 50 prospectively and consecutively included HCC patients undergoing 71 TACE therapies were taken before and 3 h, 6 h and 24 h after TACE application to analyze concentrations of circulating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), alpha fetoprotein (AFP), C-reactive protein (CRP) and several liver biomarkers, and to compare these with radiological response to therapy. While nucleosomes, CYFRA 21-1, CRP and some liver biomarkers increased already 24 h after TACE, percental changes of nucleosome concentrations before and 24 h after TACE and pre- and posttherapeutic values of AFP, gamma-glutamyl-transferase (GGT) and alkaline phosphatase (AP) significantly indicated the later therapy response (39 progression versus 32 no progression). In multivariate analysis, nucleosomes (24 h), AP (24 h) and TACE number were independent predictive markers. The risk score of this combination model achieved an AUC of 81.8% in receiver operating characteristic (ROC) curves and a sensitivity for prediction of non-response to therapy of 41% at 97% specificity, and of 72% at 78% specificity. Circulating nucleosomes and liver markers are valuable tools for early estimation of the efficacy of TACE therapy in HCC patients

  11. Clinical study for symptomatic cerebral vasospasm treated by endovascular therapy

    International Nuclear Information System (INIS)

    Objective: To observe the treatment effect for cerebral vasospasm by endovascular therapy. Methods: Five patients with subarachnoid hemorrhage were reported, in which aneurysms had been clipped and super-selective intra-arterial infusion of papaverine (IAP) and percutaneous transluminal angioplasty (PTA) were employed for the treatment of symptomatic cerebral vasospasm. Results: Satisfactory clinical outcome was obtained in 4 patients in which endovascular therapies were used within 2 hours after the onset, whereas moderate deficits remained in 1 patient treated in 10 hours. Conclusion: In patients with aneurysmal subarachnoid hemorrhage in whom conservative therapy including hypertensive, hypervolemic therapy and calcium channel blocker nimodipine has failed, PTA and IAP have become a valuable therapeutic alternative and can get a better effect if used as early as possible

  12. Vectors for Inhaled Gene Therapy in Lung Cancer. Application for Nano Oncology and Safety of Bio Nanotechnology

    Directory of Open Access Journals (Sweden)

    Konstantinos Zarogoulidis

    2012-08-01

    Full Text Available Novel aerosol therapeutic modalities have been investigated for lung cancer. Inhaled gene therapy has presented safety and effectiveness previously in cystic fibrosis. However, safety concerns have been raised regarding the safety of non-viral vectors for inhaled gene therapy in lung cancer, and therefore small steps have been made towards this multifunctional treatment modality. During the last decade, numerous new nanocomplexes have been created and investigated as a safe gene delivery nano-vehicle. These formulations are multifunctional; they can be used as either local therapy or carrier for an effective inhaled gene therapy for lung cancer. Herein, we present current and future perspectives of nanocomplexes for inhaled gene therapy treatment in lung cancer.

  13. Pharmacological foundations of cardio-oncology.

    Science.gov (United States)

    Minotti, Giorgio; Salvatorelli, Emanuela; Menna, Pierantonio

    2010-07-01

    Anthracyclines and many other antitumor drugs induce cardiotoxicity that occurs "on treatment" or long after completing chemotherapy. Dose reductions limit the incidence of early cardiac events but not that of delayed sequelae, possibly indicating that any dose level of antitumor drugs would prime the heart to damage from sequential stressors. Drugs targeted at tumor-specific moieties raised hope for improving the cardiovascular safety of antitumor therapies; unfortunately, however, many such drugs proved unable to spare the heart, aggravated cardiotoxicity induced by anthracyclines, or were safe in selected patients of clinical trials but not in the general population. Cardio-oncology is the discipline aimed at monitoring the cardiovascular safety of antitumor therapies. Although popularly perceived as a clinical discipline that brings oncologists and cardiologists working together, cardio-oncology is in fact a pharmacology-oriented translational discipline. The cardiovascular performance of survivors of cancer will only improve if clinicians joined pharmacologists in the search for new predictive models of cardiotoxicity or mechanistic approaches to explain how a given drug might switch from causing systolic failure to inducing ischemia. The lifetime risk of cardiotoxicity from antitumor drugs needs to be reconciled with the identification of long-lasting pharmacological signatures that overlap with comorbidities. Research on targeted drugs should be reshaped to appreciate that the terminal ballistics of new "magic bullets" might involve cardiomyocytes as innocent bystanders. Finally, the concepts of prevention and treatment need to be tailored to the notion that late-onset cardiotoxicity builds on early asymptomatic cardiotoxicity. The heart of cardio-oncology rests with such pharmacological foundations. PMID:20335321

  14. Radiobiology in clinical radiation therapy - Part II: Current practice and new horizons

    International Nuclear Information System (INIS)

    Objective: This course is designed for residents in radiation oncology, preparing for their boards. The principles described in Part I are used to explain current practices in radiation oncology and as a basis for new initiatives. The multifraction regimens used in conventional radiotherapy were developed empirically, but can be understood in terms of radiobiological principles. Dividing the dose into many fractions reduces biological effectiveness due to repair of sublethal damage; this occurs in both tumors and normal tissues. Fractionation allows re-oxygenation to occur in tumors and so increases the effectiveness of a given total dose. Fractionation also leads to sensitization by reassortment of cycling tumor cells into radiosensitive phases of the cycle. Laboratory research also provides a rationale for modifications of existing fractionation protocols. The dose response relationship for late responding tissues is more 'curved' than for acute or early effects. Consequently the use of multiple fractions allows a greater separation of early and late effects in normal tissues. This has led to the introduction of hyperfractionation and accelerated treatment. Both involve two treatments per day (BID) but based on quite different rationales. The limitation of protraction is cell proliferation in the tumor, which may be accelerated as the tumor shrinks. Measurements of cell kinetics can identify fast growing tumors that may benefit from accelerated treatment. Hypoxia was early identified as a cause of resistance to cell killing by x-rays. This led to the development of electron affinic compounds as radiosensitizers of hypoxic cells. The new trend is the development of bioreductive drugs that are specifically cytotoxic to hypoxic cells i.e. hypoxic cytotoxins, but which still need to be combined with radiation. Fast neutrons were initially introduced, too, in an attempt to overcome the perceived problems of hypoxia, but clinical trials now are based on the premise

  15. Clinical study on sulpyrin therapy for radiation pneumonitis

    Energy Technology Data Exchange (ETDEWEB)

    Yagi, Susumu; Watanabe, Masatoshi; Hashiguchi, Kohji; Kimura, Masashi; Sumi, Masaru; Umeki, Shigenobu; Hara, Hiroki; Soejima, Rinzo (Kawasaki Medical School, Kurashiki, Okayama (Japan))

    1990-11-01

    Radiation therapy is an effective treatment for cancer, however, irradiation of the chest may cause radiation pneumonitis as a severe pulmonary complication. Although this condition is responsive to steroid therapy, it is well known that therapy is an increased vulnerability to various infections in patients receiving long-term steroid therapy and exacerbation of the disease associated with a reduction in the dose. In this study, 10 patients with radiation pneumonitis received 3 divided daily oral of 0.9{similar to}1.2 g/day (15 mg/kg) of sulpyrin. The patients' fever disappeared within a few days after the beginning of treatment. Pneumonitis was roentgenographically stabilized, although the fibrotic and atrophic changes continued. No exacerbation of the disease was observed even after discontinuation of the therapy and the outcomes of all patients was satisfactory. These results suggest that sulpyrin was clinically effective for radiation pneumonitis, probably resulting from an anti-inflammatory effect due to prostaglandin synthesis inhibition. In the acute phase of radiation pneumonitis, the introduction of steroids appears to be delayed. This sulpyrin therapy may be a useful alternative for cases in which the steroid therapy in contraindicated. (author).

  16. Clinical radionuclide therapy dosimetry: the quest for the ''Holy Gray''

    International Nuclear Information System (INIS)

    Radionuclide therapy has distinct similarities to, but also profound differences from external radiotherapy. This review discusses techniques and results of previously developed dosimetry methods in thyroid carcinoma, neuro-endocrine tumours, solid tumours and lymphoma. In each case, emphasis is placed on the level of evidence and practical applicability. Although dosimetry has been of enormous value in the preclinical phase of radiopharmaceutical development, its clinical use to optimise administered activity on an individual patient basis has been less evident. In phase I and II trials, dosimetry may be considered an inherent part of therapy to establish the maximum tolerated dose and dose-response relationship. To prove that dosimetry-based radionuclide therapy is of additional benefit over fixed dosing or dosing per kilogram body weight, prospective randomised phase III trials with appropriate end points have to be undertaken. Data in the literature which underscore the potential of dosimetry to avoid under- and overdosing and to standardise radionuclide therapy methods internationally are very scarce. In each section, particular developments and insights into these therapies are related to opportunities for dosimetry. The recent developments in PET and PET/CT imaging, including micro-devices for animal research, and molecular medicine provide major challenges for innovative therapy and dosimetry techniques. Furthermore, the increasing scientific interest in the radiobiological features specific to radionuclide therapy will advance our ability to administer this treatment modality optimally. (orig.)

  17. External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

    International Nuclear Information System (INIS)

    Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs

  18. Bibliometric Analysis: Mirror Therapy as an Occupational Therapy Intervention Strategy in the Clinical Setting

    OpenAIRE

    Elvis Siprián Castro Alzate; Karen Aguía Rojas; Leidy Vanessa Linares Murcia; Laura Yanquén Castro; Vanessa Reyes Villanueva

    2016-01-01

    Objective: To determine the national and international scientific evidence regarding the use of mirror therapy, as an occupational therapy intervention tool in the clinical setting, in order to acquire knowledge and implement this strategy in professional practice. Materials and methods: A descriptive study was conducted in which the research strategy was held through medical subject headings (MeSH), such as “mirror neuron”, ”occupational therapy”, “physical rehabilitation” and “motor imagery...

  19. Red Blood Cell Antibodies in Hematology/Oncology Patients: Interpretation of Immunohematologic Tests and Clinical Significance of Detected Antibodies.

    Science.gov (United States)

    Hendrickson, Jeanne E; Tormey, Christopher A

    2016-06-01

    Red blood cell (RBC) transfusion is a cornerstone of the management of patients with hematology/oncology disorders. However, a potentially deleterious consequence of transfusion is the development of alloantibodies against blood group antigens present on RBCs. Such alloantibodies can be an obstacle in providing compatible units for transfusion. Providers in this arena must fully understand the testing performed by blood banks, as well as the consequences of detected antibodies. This article reviews immunohematologic tests, describes how autoimmune hemolytic anemia is classified by autoantibodies; outlines RBC alloimmunization rates, and presents strategies to prevent/mitigate the impact of RBC alloimmunization. PMID:27113001

  20. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: Toxicity and clinical outcome

    International Nuclear Information System (INIS)

    Purpose: To assess survival, local control, and toxicity of intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the anal canal. Methods and Materials: Seventeen patients were treated with nine-field IMRT plans. Thirteen received concurrent 5-fluorouracil and mitomycin C, whereas 1 patient received 5-fluorouracil alone. Seven patients were planned with three-dimensional anteroposterior/posterior-anterior (AP/PA) fields for dosimetric comparison to IMRT. Results: Compared with AP/PA, IMRT reduced the mean and threshold doses to small bowel, bladder, and genitalia. Treatment was well tolerated, with no Grade ≥3 acute nonhematologic toxicity. There were no treatment breaks attributable to gastrointestinal or skin toxicity. Of patients who received mitomycin C, 38% experienced Grade 4 hematologic toxicity. IMRT did not afford bone marrow sparing, possibly resulting from the clinical decision to prescribe 45 Gy to the whole pelvis in most patients, vs. the Radiation Therapy Oncology Group-recommended 30.6 Gy whole pelvic dose. Three of 17 patients, who did not achieve a complete response, proceeded to an abdominoperineal resection and colostomy. At a median follow-up of 20.3 months, there were no other local failures. Two-year overall survival, disease-free survival, and colostomy-free survival are: 91%, 65%, and 82% respectively. Conclusions: In this hypothesis-generating analysis, the acute toxicity and clinical outcome with IMRT in the treatment of anal cancer is encouraging. Compared with historical controls, local control is not compromised despite efforts to increase conformality and reduce normal structure dose

  1. Non-surgical management of early breast cancer in the United Kingdom: the role and practice of radiotherapy. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.

    Science.gov (United States)

    Price, P; Yarnold, J R

    1995-01-01

    This paper reports on the delivery of radiotherapy to the primary site and lymphatic pathways in the management of early stage breast cancer. Radiotherapists were clear that their aim of locoregional radiotherapy was to reduce local recurrence. However, variation in policies for delivery were seen: 80% of radiotherapists did not always give radiotherapy routinely following wide local excision as part of breast conserving management; instead they withheld it selectively for a number of reasons. Only 66% routinely used breast boosts. There was a range of indications for giving radiotherapy to the lymphatic pathways; there was also variation in the management of incompletely or marginally excised primary tumours. Most sources of variation in the practice of radiotherapy in the management of women with early stage breast cancer appeared to arise from scientific uncertainty. However, organizational issues influenced many decisions. These scientific uncertainties and organizational issues are best addressed in the context of multidisciplinary breast clinics. PMID:8845315

  2. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    Directory of Open Access Journals (Sweden)

    de Vries Martine C

    2011-09-01

    Full Text Available Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1 a narrative review of (primarily qualitative studies on parents' and physicians' experiences of the pediatric oncology research practice, and (2 comparison of these experiences with existing theoretical ethical concepts about (pediatric research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Results Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist. True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the

  3. Nano-oncologicals new targeting and delivery approaches

    CERN Document Server

    Alonso, Maria Jose

    2014-01-01

    This authoritative volume focuses on emerging technologies in cancer nano medicine, characterized by their multi-functionality and potential to address simultaneously diverse issues of clinical relevance in the treatment of cancer. The book consists of sixteen chapters divided into six sections: 1) Biological Barriers in Cancer; 2) Tumor Targeting; 3) Targeting the Immune System; 4) Gene Therapy; 5) Nano theranostics and 6) Translational Aspects of Nano-Oncologicals. The volume starts with an introduction describing the biological barriers associated with cancer therapy and highlighting ways

  4. Application of PET-CT imaging in pediatric oncology

    International Nuclear Information System (INIS)

    Pediatric oncology is one of the important cause of children death. PET-CT, which can provide functional and anatomical images in the same scanning session, has a high sensitivity and specialty in the diagnosis of tumors. During the examination of children, careful preparation and individualized dosage are the keys to make it. PET-CT has a great value in making the personal therapy strategy during the clinical activity, including staging, grading, evaluation of therapy, and the items of prognosis and follow-up. (authors)

  5. Robot-Assisted Gynecologic Oncology Surgery

    Medline Plus

    Full Text Available ... inches. That's a best -- it used to be traditional oncology incisions would be at least from the ... we can identify those who may need additional therapy. Fortunately, with uterine cancer, about three out of ...

  6. Proton therapy - A systematic review of clinical effectiveness

    International Nuclear Information System (INIS)

    Background and purpose: Proton therapy is an emerging treatment modality for cancer that may have distinct advantages over conventional radiotherapy. This relates to its ability to confine the high-dose treatment area to the tumour volume and thus minimizing radiation dose to surrounding normal tissue. Several proton facilities are currently operating or under planning world-wide - in the United States, Asia and Europe. Until now no systematic review assessing the clinical effectiveness of this treatment modality has been published. Materials and methods: A systematic review of published studies that investigated clinical efficacy of proton therapy of cancer. Results: We included 54 publications: 4 randomized controlled trials (RCTs) reported in 5 publications, 5 comparative studies and 44 case series. Two RCTs addressed proton irradiation as a boost following conventional radiation therapy for prostate cancer, where one demonstrated improved biochemical local control for the highest dose group without increased serious complication rates. Proton therapy has been used to treat a large number of patients with ocular tumours, but except for one low quality RCT, no proper comparison with other treatment alternatives has been undertaken. Proton therapy offers the option to deliver higher radiation doses and/or better confinement of the treatment of intracranial tumours in children and adults, but reported studies are heterogeneous in design and do not allow for strict conclusions. Conclusion: The evidence on clinical efficacy of proton therapy relies to a large extent on non-controlled studies, and thus is associated with low level of evidence according to standard heath technology assessment and evidence based medicine criteria

  7. Experimental radiotherapy and clinical radiobiology. Vol. 22. Proceedings

    International Nuclear Information System (INIS)

    The proceedings of the 25th symposium on experimental radiotherapy and clinical radiobiology include papers on the following issues: radiotherapy individualization based on imaging; pre-clinic imaging and new experimental methods; methods and models, micromilieu and metabolism, combined therapy; secondary tumors following radiotherapy; radiogenic effects in normal tissue; resistance mechanism of tumors and normal tissue; personalized radio-oncology - which biological data are needed; pre-clinic and personalized radio-oncology; biomarkers - pre-clinic and translational; translational examinations for personalized radio-oncology.

  8. Vectors for Inhaled Gene Therapy in Lung Cancer. Application for Nano Oncology and Safety of Bio Nanotechnology

    OpenAIRE

    Konstantinos Zarogoulidis; Goldberg, Eugene P.; Wolfgang Hohenforst-Schimdt; Haidong Huang; Kalliopi Domvri; Konstantinos Porpodis; Karamanos, Nikos K.; Paul Zarogouldis

    2012-01-01

    Novel aerosol therapeutic modalities have been investigated for lung cancer. Inhaled gene therapy has presented safety and effectiveness previously in cystic fibrosis. However, safety concerns have been raised regarding the safety of non-viral vectors for inhaled gene therapy in lung cancer, and therefore small steps have been made towards this multifunctional treatment modality. During the last decade, numerous new nanocomplexes have been created and investigated as a safe gene delivery nano...

  9. Radiolanthanides in therapeutic nuclear oncology

    International Nuclear Information System (INIS)

    Radiolanthanides such as Holmium-166 (T1/2 26.8h), Samarium-153 (T1/2 46.3h) and Lutetium-177 (T1/2 6.7 days) all have beta emissions suitable for radiopharmaceutical therapy, bone marrow ablation and for pain palliation of skeletal metastases. They also emit gamma photons of energies which permit quantitative imaging on conventional gamma cameras which facilitates calculation of dosimetry in individual patients. The range of half-lives has the potential to match the irradiation of tumour cells to the residence time of the radiopharmaceutical thus minimising radiotoxicity to normal tissues. Relative ease and low cost of production of these radiolanthanides in rectors such as HIFAR at ANSTO render radiolanthanides a practical option for radiopharmaceutical treatment of cancer for patients in whom conventional therapy has failed. Radioimmunotherapy of cancer using various monoclonal antibodies targeted to specific tumor-cell antigens has been performed with Samarium-153, Holmium-166 and Lutetium-177-labelled antibodies in human tumor xenographs in nude mice and in clinical trials. The development of a large animal model of human cancer will be described, in particular in relation to improving the accuracy of prediction of dosimetry and preclinical evaluation of efficacy and toxicity of radiolanthanides in therapeutic nuclear oncology

  10. Clinical pharmacist interventions to support adherence to thrombopreventive therapy

    DEFF Research Database (Denmark)

    Hedegaard, Ulla

    The three papers in the thesis were based on two randomised controlled trials (RCTs) on in-hospital clinical pharmacist interventions for improvement of adherence to thrombopreventive therapy in two different populations: outpatients with hypertension and patients with acute stroke/transient isch......The three papers in the thesis were based on two randomised controlled trials (RCTs) on in-hospital clinical pharmacist interventions for improvement of adherence to thrombopreventive therapy in two different populations: outpatients with hypertension and patients with acute stroke...... targeted patients with hypertension or stroke in a hospital care setting. Thus, the aim of this thesis was to develop and evaluate in-hospital pharmacist interventions including MI to improve adherence to primary and secondary thrombopreventive therapy. The first study was a RCT, which investigated the...... persistence to specific thrombopreventive medications and a combined clinical endpoint of cardiovascular death, stroke or acute myocardial infarction. The second RCT included 532 patients with hypertension from three hospital outpatient clinics. The study examined the effectiveness of an intervention very...

  11. Calculation of the structural shielding of the radiotherapy treatment room equipped with a linear accelerator type Tomo therapy Hi-Art in the Oncology Center of Chihuahua, Mexico

    International Nuclear Information System (INIS)

    . In this work these specific methodologies are used for the structural shielding calculations of the tomo therapy equipment installed in the Oncology Center of Chihuahua. These calculation methodologies consider the primary radiation, of leakage, disperse, second dispersion and leakage dispersion. The obtained results indicate that due to the lead barrier of the primary beam, the main component that contributes to the shielding requirements of the installation is the leakage radiation. On the other hand, the component that more affects of the door shielding is the dispersion component in the patient. (Author)

  12. Combination therapy with methotrexate and 5-fluorouracil: a prospective randomized clinical trial of order of administration.

    Science.gov (United States)

    Coates, A S; Tattersall, M H; Swanson, C; Hedley, D; Fox, R M; Raghavan, D

    1984-07-01

    Because of biochemical and tissue culture evidence casting doubt on the physiologic relevance of reported synergy afforded by sequential administration of methotrexate (MTX) followed by 5-fluorouracil (5-FU), a randomized controlled clinical trial was conducted in 108 patients with advanced cancer, including 70 with squamous cell carcinoma (SCC) of the head and neck, nine with SCC of other primary sites, 24 with colorectal, and five with gastric adenocarcinomas. Patients were randomized to receive weekly therapy consisting of MTX followed one hour later by 5-FU, or 5-FU followed one hour later by MTX. There was a trend to higher tumor response rates in patients treated with MTX before 5-FU (45% v 33% overall; 65% v 39% in patients with previously untreated head and neck cancer), but these differences were not significant, either by chi-square test or by multivariate stepwise logistic regression. The trend in survival favoring the reverse sequence of 5-FU before MTX was not significant in univariate analyses. Stepwise multivariate Cox model analysis showed that Eastern Cooperative Oncology Group performance status at study entry was the major prognostic factor for survival (P less than 0.001), but among the 70 patients with head and neck cancer, the sequence of drug administration was the only other significant prognostic factor for survival, and favored the sequence of 5-FU followed by MTX (P less than 0.025). PMID:6376719

  13. Clinical study of interventional therapy for acute cerebral infarction

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical efficacy and safety of interventional therapy for acute cerebral infarction. Method: Using urokinase, 35 patients with acute cerebral infarction within 24 hours were treated by intra-artery thrombolytic therapy. Europe stroke scale (ESS), Barthel index (BI) were used to evaluate the recovery of neurological functions. Result: ESS score increase rapidly after thrombolytisis, and there were significant difference between the two teams. Thirteen of 13 cases treated within 6 hours from onset showed complete/partial recanalization in cerebral angiography and intraparenchymal hemorrhagic rate were 0%, twenty-six of 35 cases treated within 24 hours showed complete/partial recanalization and intraparenchymal hemorrhagic rate were 5.71%. Conclusion: Interventional therapy for acute cerebral infarction within 6h were safe and effective. (authors)

  14. Teaching Effectiveness: Preparing Occupational Therapy Students for Clinical Practice

    Directory of Open Access Journals (Sweden)

    Jane C. OBrien PhD, MS.MEdL, OTR/L

    2013-06-01

    Full Text Available Medical educators must examine the ability of teaching methodologies to prepare students for clinical practice. Two types of assessment methods commonly used in medical education include the Short Objective Structured Clinical Examination (OSCE and the Integrated Performance Procedural Instrument (IPPI. The use of these methods in occupational therapy (OT education is less understood. With the increasing number of students enrolled in programs, faculty face challenges to examine how clinical competence is established using data to determine teaching effectiveness. This study examines two educational methodologies used in OT curriculum: the long written case study (IPPI and short performance-based OSCE. The authors describe the effectiveness of each examination as it relates to student performance in clinical practice (as measured by the Fieldwork Performance Evaluation [FWPE]. The findings obtained from separate focus group sessions with faculty and students further provide insight into the advantages and disadvantages of the educational methodologies.

  15. American Society of Clinical Oncology policy statement: opportunities in the patient protection and affordable care act to reduce cancer care disparities.

    Science.gov (United States)

    Moy, Beverly; Polite, Blase N; Halpern, Michael T; Stranne, Steven K; Winer, Eric P; Wollins, Dana S; Newman, Lisa A

    2011-10-01

    Patients in specific vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. The Patient Protection and Affordable Care Act provides both opportunities and challenges for addressing cancer care disparities and access to care. The American Society of Clinical Oncology (ASCO) advocates for policies that ensure access to cancer care for the underserved. Such policies include insurance reform and the reduction of economic barriers to quality health care. Building on ASCO's prior statement on disparities in cancer care (2009), this article summarizes elements of the health care law that are relevant to cancer disparities and provides recommendations for addressing major provisions in the law. It outlines specific strategies to address insurance reform, access to care, quality of care, prevention and wellness, research on health care disparities, and diversity in the health care workforce. ASCO is committed to leading efforts toward the improvement of cancer care among the most vulnerable patients. PMID:21810680

  16. CLINICAL COMPARATIVE STUDY OF SUMATRIPTAN VERSUS ERGOTAMINE THERAPY IN MIGRAINE

    OpenAIRE

    Giriraja; Pavitra,; Bindumathi

    2015-01-01

    BACKGROUND Migraine is a common neurological problem accounting for large morbidity and disability. Ergotamine and triptans are mainly used to terminate the attack of severe migraine. To study the clinical comparison between sumatriptan and ergotamine in migraine patients. AIM This study compared the safety efficacy and pharmacoeconomics of triptans verses ergotamine therapy. MATERIALS AND METHODS Study sample included 100 patients of either gender aged 1...

  17. Bioimpedance-based respiratory gating method for oncologic positron emission tomography (PET) imaging with first clinical results

    International Nuclear Information System (INIS)

    Respiratory motion may cause significant image artefacts in positron emission tomography/computed tomography (PET/CT) imaging. This study introduces a new bioimpedance-based gating method for minimizing respiratory artefacts. The method was studied in 12 oncologic patients by evaluating the following three parameters: maximum metabolic activity of radiopharmaceutical accumulations, the size of these targets as well as their target-to-background ratio. The bioimpedance-gated images were compared with non-gated images and images that were gated with a reference method, chest wall motion monitoring by infrared camera. The bioimpedance method showed clear improvement as increased metabolic activity and decreased target volume compared to non-gated images and produced consistent results with the reference method. Thus, the method may have great potential in the future of respiratory gating in nuclear medicine imaging.

  18. Bioimpedance-based respiratory gating method for oncologic positron emission tomography (PET) imaging with first clinical results

    Science.gov (United States)

    Koivumäki, T.; Vauhkonen, M.; Teuho, J.; Teräs, M.; Hakulinen, M. A.

    2013-04-01

    Respiratory motion may cause significant image artefacts in positron emission tomography/computed tomography (PET/CT) imaging. This study introduces a new bioimpedance-based gating method for minimizing respiratory artefacts. The method was studied in 12 oncologic patients by evaluating the following three parameters: maximum metabolic activity of radiopharmaceutical accumulations, the size of these targets as well as their target-to-background ratio. The bioimpedance-gated images were compared with non-gated images and images that were gated with a reference method, chest wall motion monitoring by infrared camera. The bioimpedance method showed clear improvement as increased metabolic activity and decreased target volume compared to non-gated images and produced consistent results with the reference method. Thus, the method may have great potential in the future of respiratory gating in nuclear medicine imaging.

  19. Factors which influence quality of life in patients with non-small cell lung cancer (NSCLC): A radiation therapy oncology group study (RTOG 89-01)

    International Nuclear Information System (INIS)

    Purpose: Prospectively evaluate the quality of life (QOL) of patients with NSCLC participating in a randomized phase III study conducted by the RTOG and Eastern Cooperative Oncology Group. Determine the factors which influence QOL during and post therapy. Materials and Methods: From (4(90)) to (4(94)) to 75 patients (pts) were randomized on RTOG 89-01 between a regimen containing radiation therapy (RT) versus a regimen containing surgery (S). All pts received induction vinblastine and cisplatin, followed by either S or RT and consolidation chemotherapy (CT). Pts were given the self-assessment QOL forms prior to the start of therapy, post induction CT, post RT or S, and periodically during follow-up. Two questionnaires were used: Functional Assessment of Cancer Therapy for lung cancer patients (FACT-L) and Functional Living Index-Cancer (FLIC). The FACT-L consists of 44 questions covering 6 domains (physical, social, and emotional well-being, relationship with physician, fulfilment, and lung cancer specific concerns), FLIC contains 22 questions summing to one total score. Results: 51 pts participated in the QOL endpoint, 24 were excluded: 3 pts refused, institution did not administer QOL questionnaires in 9 pts, 3 completed QOL after start of therapy, 1 institution refused to participate, 5 questionnaires were incomplete/unusable, 1 pt could not read English, and 2 were ineligible for treatment. Participation in QOL was not predicted by any pretreatment characteristic. Women had worse pretreatment QOL (p<0.005, by FLIC) and more problems with disease-related symptoms (p<0.005, by FACT) than men. Pts with KPS 90-100 had better pretreatment QOL than pts with KPS 60-80 (p<0.025, FLIC). Neither race, marital status, education level, age, prior weight loss, nor disease symptoms statistically significantly influenced pretreatment QOL. Initial QOL did not predict overall survival. FACT-L was reported on 25 pts post induction CT. Follow-up FACT-L was available on 12 pts

  20. Treatment of pediatric patients and young adults with particle therapy at the Heidelberg Ion Therapy Center (HIT: establishment of workflow and initial clinical data

    Directory of Open Access Journals (Sweden)

    Combs Stephanie E

    2012-10-01

    Full Text Available Abstract Background To report on establishment of workflow and clinical results of particle therapy at the Heidelberg Ion Therapy Center. Materials and methods We treated 36 pediatric patients (aged 21 or younger with particle therapy at HIT. Median age was 12 years (range 2-21 years, five patients (14% were younger than 5 years of age. Indications included pilocytic astrocytoma, parameningeal and orbital rhabdomyosarcoma, skull base and cervical chordoma, osteosarcoma and adenoid-cystic carcinoma (ACC, as well as one patient with an angiofibroma of the nasopharynx. For the treatment of small children, an anesthesia unit at HIT was established in cooperation with the Department of Anesthesiology. Results Treatment concepts depended on tumor type, staging, age of the patient, as well as availability of specific study protocols. In all patients, particle radiotherapy was well tolerated and no interruptions due to toxicity had to be undertaken. During follow-up, only mild toxicites were observed. Only one patient died of tumor progression: Carbon ion radiotherapy was performed as an individual treatment approach in a child with a skull base recurrence of the previously irradiated rhabdomyosarcoma. Besides this patient, tumor recurrence was observed in two additional patients. Conclusion Clinical protocols have been generated to evaluate the real potential of particle therapy, also with respect to carbon ions in distinct pediatric patient populations. The strong cooperation between the pediatric department and the department of radiation oncology enable an interdisciplinary treatment and stream-lined workflow and acceptance of the treatment for the patients and their parents.

  1. The Cardio-oncology Program: A Multidisciplinary Approach to the Care of Cancer Patients With Cardiovascular Disease.

    Science.gov (United States)

    Parent, Sarah; Pituskin, Edith; Paterson, D Ian

    2016-07-01

    Improved cancer survivorship has resulted in a growing number of Canadians affected by cancer and cardiovascular disease. As a consequence, cardio-oncology programs are rapidly emerging to treat cancer patients with de novo and preexisting cardiovascular disease. The primary goal of a cardio-oncology program is to preserve cardiovascular health to allow the timely delivery of cancer therapy and achieve disease-free remission. Multidisciplinary programs in oncology and cardiology have been associated with enhanced patient well-being and improved clinical outcomes. Because of the complex needs of these multisystem patients, a similar model of care is gaining acceptance. The optimal composition of the cardio-oncology team will typically involve support from cardiology, oncology, and nursing. Depending on the clinical scenario, additional consultation from dietetics, pharmacy, and social services might be required. Timely access to consultation and testing is another prerequisite for cardio-oncology programs because delays in treating cardiac complications and nonadherence to prescribed cancer therapy are each associated with poor outcomes. Recommended reasons for referral to cardio-oncology programs include primary prevention for those at high risk for cardiotoxicity and the secondary treatment of new or worsening cardiovascular disease in cancer patients and survivors. Management is multifaceted and can involve lifestyle education, pharmacotherapy, enhanced cardiovascular surveillance, and support services, such as exercise training. The lack of evidence to guide clinical decisions and recommendations in cardio-oncology is a major challenge and opportunity for health care professionals. Large multicentre prospective registries are needed to adequately power risk model calculations and generate hypotheses for novel interventions. PMID:27343743

  2. Application of computer assisted tomography in gynaecological oncology

    International Nuclear Information System (INIS)

    The non invasive radiologic technique of computed tomography has been employed since 1978 at the University Women's Clinic and Radiologic Clinic, Graz. One hundred and fourty six examinations of the pelvis, abdomen and chest were performed on 63 oncologic patients. The method was employed for the preoperative detection and measurement of the size of benign and malignant neoplasms; in tumour staging and assessment of therapeutic response. The results suggest that CT might be the best method for the assessment of response to cytotoxic therapy of ovarian cancer. (orig.)

  3. Towards secondary use of heterogeneous radio-oncological data for retrospective clinical trials: service-oriented connection of a central research database with image analysis tools

    Science.gov (United States)

    Bougatf, Nina; Bendl, Rolf; Debus, Jürgen

    2015-03-01

    Our overall objective is the utilization of heterogeneous and distributed radio-oncological data in retrospective clinical trials. Previously, we have successfully introduced a central research database for collection of heterogeneous data from distributed systems. The next step is the integration of image analysis tools in the standard retrieval process. Hence, analyses for complex medical questions can be processed automatically and facilitated immensely. In radiation oncology recurrence analysis is a central approach for the evaluation of therapeutic concepts. However, various analysis steps have to be performed like image registration, dose transformation and dose statistics. In this paper we show the integration of image analysis tools in the standard retrieval process by connecting them with our central research database using a service-oriented approach. A concrete problem from recurrence analysis has been selected to prove our concept exemplarily. We implemented service-oriented data collection and analysis tools to use them in a central analysis platform, which is based on a work flow management system. An analysis work flow has been designed that, at first, identifies patients in the research database fulfilling the inclusion criteria. Then the relevant imaging data is collected. Finally the imaging data is analyzed automatically. After the successful work flow execution, the results are available for further evaluation by a physician. As a result, the central research database has been connected successfully with automatic data collection and image analysis tools and the feasibility of our service-oriented approach has been demonstrated. In conclusion, our approach will simplify retrospective clinical trials in our department in future.

  4. Cell therapy for intervertebral disc repair: advancing cell therapy from bench to clinics

    Directory of Open Access Journals (Sweden)

    LM Benneker

    2014-05-01

    Full Text Available Intervertebral disc (IVD degeneration is a major cause of pain and disability; yet therapeutic options are limited and treatment often remains unsatisfactory. In recent years, research activities have intensified in tissue engineering and regenerative medicine, and pre-clinical studies have demonstrated encouraging results. Nonetheless, the translation of new biological therapies into clinical practice faces substantial barriers. During the symposium "Where Science meets Clinics", sponsored by the AO Foundation and held in Davos, Switzerland, from September 5-7, 2013, hurdles for translation were outlined, and ways to overcome them were discussed. With respect to cell therapy for IVD repair, it is obvious that regenerative treatment is indicated at early stages of disc degeneration, before structural changes have occurred. It is envisaged that in the near future, screening techniques and non-invasive imaging methods will be available to detect early degenerative changes. The promises of cell therapy include a sustained effect on matrix synthesis, inflammation control, and prevention of angio- and neuro-genesis. Discogenic pain, originating from "black discs" or annular injury, prevention of adjacent segment disease, and prevention of post-discectomy syndrome were identified as prospective indications for cell therapy. Before such therapy can safely and effectively be introduced into clinics, the identification of the patient population and proper standardisation of diagnostic parameters and outcome measurements are indispensable. Furthermore, open questions regarding the optimal cell type and delivery method need to be resolved in order to overcome the safety concerns implied with certain procedures. Finally, appropriate large animal models and well-designed clinical studies will be required, particularly addressing safety aspects.

  5. Reflections on clinical reasoning in mental health occupational therapy: the case of the occupational therapy dynamic method

    OpenAIRE

    Taís Quevedo Marcolino

    2014-01-01

    The Clinical Reasoning Study supported by the American Occupational Therapy Association/AOTA and the American Occupational Therapy Foundation/AOTF in the United States in the late 1980s, had inaugurated the scientific production in the field and offered an initial framework on clinical reasoning for understanding and conducting clinical cases in Occupational Therapy. Most of the researches in this field have focused on reasoning processes, and point out the need to understand the contents of ...

  6. Cognition and Quality of Life After Chemotherapy Plus Radiotherapy (RT) vs. RT for Pure and Mixed Anaplastic Oligodendrogliomas: Radiation Therapy Oncology Group Trial 9402

    International Nuclear Information System (INIS)

    Purpose: Radiation Therapy Oncology Group 9402 compared procarbazine, lomustine, and vincristine (PCV) chemotherapy plus radiation therapy (PCV + RT) vs. RT alone for anaplastic oligodendroglioma. Here we report longitudinal changes in cognition and quality of life, effects of patient factors and treatments on cognition, quality of life and survival, and prognostic implications of cognition and quality of life. Methods and Materials: Cognition was assessed by Mini Mental Status Examination (MMSE) and quality of life by Brain-Quality of Life (B-QOL). Scores were analyzed for survivors and within 5 years of death. Shared parameter models evaluated MMSE/B-QOL with survival. Results: For survivors, MMSE and B-QOL scores were similar longitudinally and between treatments. For those who died, MMSE scores remained stable initially, whereas B-QOL slowly declined; both declined rapidly in the last year of life and similarly between arms. In the aggregate, scores decreased over time (p = 0.0413 for MMSE; p = 0.0016 for B-QOL) and were superior with age <50 years (p < 0.001 for MMSE; p = 0.0554 for B-QOL) and Karnofsky Performance Score (KPS) 80-100 (p < 0.001). Younger age and higher KPS were associated with longer survival. After adjusting for patient factors and drop-out, survival was longer after PCV + RT (HR = 0.66, 95% CI = 0.49-0.9, p = 0.0084; HR = 0.74, 95% CI = 0.54-1.01, p = 0.0592) in models with MMSE and B-QOL. In addition, there were no differences in MMSE and B-QOL scores between arms (p = 0.4752 and p = 0.2767, respectively); higher scores predicted longer survival. Conclusion: MMSE and B-QOL scores held steady in the upper range in both arms for survivors. Younger, fitter patients had better MMSE and B-QOL and longer survival.

  7. Are Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm Applicable to Other Malignancies—Assessment of Nodal Distribution in Gynecological Malignancies

    International Nuclear Information System (INIS)

    Purpose: Intensity modulated radiation therapy is used to reduce dose to adjacent critical structures while maintaining adequate target coverage, but it requires precise target localization. We report the 3-dimensional distribution of para-aortic (PA) lymph nodes (LN) in pelvic malignancies. We propose a guideline to accurately define the PA LN by anatomic landmarks and compare our data with published guidelines for pancreatic cancer. Methods and Materials: A retrospective analysis was performed on 46 patients with pelvic malignancies and positive PA LNs. Positive LNs were defined based on size and morphology or fluorodeoxyglucose avidity. All PA LNs were characterized into 3 groups based on location: left PA (between aorta and left psoas muscle), aortocaval (between aorta and inferior vena cava), and right paracaval (between inferior vena cava and right psoas muscle). Patients with retrocrural LNs were also analyzed. Results: One hundred thirty-three positive PA LNs were evaluated. The majority of the PA LNs were in the left PA (59%) and aortocaval (35) regions, and only 8% were in the right paracaval region. All patients with positive right paracaval LNs also had involved left PA LNs, with only 1 exception. The highest PA LN involvement was at the level of the renal vessels and was seen in 28% of patients. Of these patients with disease extending to renal vessels, 38% had retrocrural LN involvement. Conclusions: The nodal contouring for the PA region should not be defined by a fixed circumferential margin around the vessels. The left PA and aortocaval spaces should be covered adequately because these are common locations of PA LNs. For microscopic disease superiorly, contouring should extend up to renal vessels rather than a fixed bony landmark. For patients who have nodal involvement at renal vessels, one can consider including retrocrural LNs. Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm are not applicable to

  8. 75 FR 54351 - Cell and Gene Therapy Clinical Trials in Pediatric Populations; Public Workshop

    Science.gov (United States)

    2010-09-07

    ... HUMAN SERVICES Food and Drug Administration Cell and Gene Therapy Clinical Trials in Pediatric... public workshop entitled ``Cell and Gene Therapy Clinical Trials in Pediatric Populations.'' The purpose... therapy clinical researchers, and other stakeholders regarding best practices related to cell and...

  9. Multimodality treatment of primary nonresectable intrahepatic cholangiocarcinoma with I-131 anti-CEA: A radiation therapy oncology group study

    International Nuclear Information System (INIS)

    Thirty-seven patients (57% with metastasis and/or who has previously undergone chemotherapy) with primary unresectable intrahepatic cholangiocarcinoma were prospectively treated with external beam radiation therapy, chemotherapy, and I-131 anti-carcinoembryonic antigen (CEA) antibody. The regimen led to partial remission in 26.6% of patients, according to CT scan digitized tumor volume analysis, and in 33.3% (25.9% with partial remission, 7.4% with complete emission) according to physical examination findings. Therapy began with whole liver irradiation (2.1 Gy, 0.3 Gy per fraction, delivered 4 days a week, with 10-MV photons) and, on alternate days, chemotherapy (Adriamycin, 15 mg, + 5-fluorouracil [5-FU], 500 mg). One month later, Adriamycin, 15 mg, + 5-FU, 500 mg, was administered on day 0; 20 mCi of I-131 anti-CEA on day 1; and 10 mCi of I-131 anti-CEA on day 6. Tumor effective half-life was 3-5 days. Median tumor dose (20 mCi + 10 mCi) was 6.2 Gy. Antibody therapy was administered in 2-month cycles. Grade IV thrombocytopenia and leukopenia each occurred in 3.2% of patient administrations. Median survival for the entire group was 6.5 months; for responders, it was 15.2 months. The longest partial remission is presently more than 4 years

  10. Medical Student–Reported Outcomes of a Radiation Oncologist–Led Preclinical Course in Oncology: A Five-Year Analysis

    International Nuclear Information System (INIS)

    Purpose: There is a recognized need for more robust training in oncology for medical students. At our institution, we have offered a core dedicated oncology block, led by a radiation oncologist course director, during the second year of the medical school curriculum since the 2008-2009 academic year. Herein, we report the outcomes of the oncology block over the past 5 years through an analysis of student perceptions of the course, both immediately after completion of the block and in the third year. Methods and Materials: We analyzed 2 separate surveys. The first assessed student impressions of how well the course met each of the course's learning objectives through a survey that was administered to students immediately after the oncology block in 2012. The second was administered after students completed the oncology block during the required radiology clerkship in the third year. All questions used a 5-level Likert scale and were analyzed by use of a Wilcoxon signed-rank test. Results: Of the 169 students who took the oncology course in 2012, 127 (75.1%) completed the course feedback survey. Over 73% of students agreed or strongly agreed that the course met its 3 learning objectives. Of the 699 medical students who took the required radiology clerkship between 2010 and 2013, 538 participated in the second survey, for a total response rate of 77%. Of these students, 368 (68.4%) agreed or strongly agreed that the course was effective in contributing to their overall medical education. Conclusion: Student perceptions of the oncology block are favorable and have improved across multiple categories since the inception of the course. Students self-reported that a dedicated preclinical oncology block was effective in helping identify the basics of cancer therapy and laying the foundation for clinical electives in oncology, including radiation oncology

  11. Medical Student–Reported Outcomes of a Radiation Oncologist–Led Preclinical Course in Oncology: A Five-Year Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Ankit; Koottappillil, Brian; Shah, Bhartesh; Ahuja, Divya; Hirsch, Ariel E., E-mail: Ariel.hirsch@bmc.org

    2015-07-15

    Purpose: There is a recognized need for more robust training in oncology for medical students. At our institution, we have offered a core dedicated oncology block, led by a radiation oncologist course director, during the second year of the medical school curriculum since the 2008-2009 academic year. Herein, we report the outcomes of the oncology block over the past 5 years through an analysis of student perceptions of the course, both immediately after completion of the block and in the third year. Methods and Materials: We analyzed 2 separate surveys. The first assessed student impressions of how well the course met each of the course's learning objectives through a survey that was administered to students immediately after the oncology block in 2012. The second was administered after students completed the oncology block during the required radiology clerkship in the third year. All questions used a 5-level Likert scale and were analyzed by use of a Wilcoxon signed-rank test. Results: Of the 169 students who took the oncology course in 2012, 127 (75.1%) completed the course feedback survey. Over 73% of students agreed or strongly agreed that the course met its 3 learning objectives. Of the 699 medical students who took the required radiology clerkship between 2010 and 2013, 538 participated in the second survey, for a total response rate of 77%. Of these students, 368 (68.4%) agreed or strongly agreed that the course was effective in contributing to their overall medical education. Conclusion: Student perceptions of the oncology block are favorable and have improved across multiple categories since the inception of the course. Students self-reported that a dedicated preclinical oncology block was effective in helping identify the basics of cancer therapy and laying the foundation for clinical electives in oncology, including radiation oncology.

  12. Mathematical oncology 2013

    CERN Document Server

    Gandolfi, Alberto

    2014-01-01

    With chapters on free boundaries, constitutive equations, stochastic dynamics, nonlinear diffusion–consumption, structured populations, and applications of optimal control theory, this volume presents the most significant recent results in the field of mathematical oncology. It highlights the work of world-class research teams, and explores how different researchers approach the same problem in various ways. Tumors are complex entities that present numerous challenges to the mathematical modeler. First and foremost, they grow. Thus their spatial mean field description involves a free boundary problem. Second, their interiors should be modeled as nontrivial porous media using constitutive equations. Third, at the end of anti-cancer therapy, a small number of malignant cells remain, making the post-treatment dynamics inherently stochastic. Fourth, the growth parameters of macroscopic tumors are non-constant, as are the parameters of anti-tumor therapies. Changes in these parameters may induce phenomena that a...

  13. How Clinical Instructors Can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement

    Science.gov (United States)

    Cole, Beverley; Wessel, Jean

    2008-01-01

    Purpose: There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. Methods: Subjects were…

  14. Relationship between biologic tissue heterogeneity and absorbed dose distribution in therapy of oncologic patients with cyclotron U-120 fast neutrons

    International Nuclear Information System (INIS)

    Effect of biological tissue heterogeneity on the absorbed dose distribution of U-120 cyclotron fast neutron beam was studied by estimation and experimental method. It was found that adipose and bone tissues significantly changes the pattern of neutron absorbed dose distribution in patient body. Absorbed dose in adipose layer increase by 20% as compared to the dose in soft biological tissue. Approximation method for estimation of the absorbed dose distribution of fast neutrons in heterogeneities was proposed which could be applied in the dosimetric planning of U-120 cyclotron neutron therapy of neoplasms

  15. Theragnostic oncology - integrated surgery and radiochemotherapy

    International Nuclear Information System (INIS)

    Present paper is the review of actual knowledge in the field of molecular biology, radiobiology and therapy of malignant tumours and individual heterogeneity of molecular signatures, and chemo- and radiosensitivity is documented. Clinical applicability some of the evidence based standards protocols and dogmas is questioned. It is pointed out that equal doses of radiation or chemotherapeutic agents do always not kill the same rate of cancer cells and a large variations in the initial tumours volume within a given TNM stage of disease need different, but not the same, doses of radiation or chemotherapy. Actual knowledge and experience lead to the suggestion that a key factor for effective therapy is its intensity. Classic sequential treatment modalities with unprogrammed time intervals between respective methods of therapy should be replaced by individually planned integrated combined therapy with a known sequence and timing. This is called theragnostic oncology, which means the use of knowledge and experience to establish individual combined therapy producing the highest therapeutic gain and the lowest risk of serious late complications. (authors)

  16. Clinical applications of laser therapy on the dental practice

    Science.gov (United States)

    Pinheiro, Antonio L. B.

    2004-09-01

    Dental practice consists of a series of laboring procedures which demands the use of several types of equipment and materials. Usually patient"s fears brings additional burden to the Dentists. The use of Lasers for treating and diagnosis in Dentistry is quite new comparing to other medical areas. Initially Laser technology was used as an alternative method for treating dental caries in order to substitute the use of the drill. Lately surgical Lasers have shown themselves very useful for treating several pathologies and began to be used as a powerful tool on the treatment of several conditions affecting the maxillofacial complex and later on, the era of the use of Laser therapy began. The advent of the diode Lasers made possible the introduction of small units at the dental office and Laser therapy was used to improve healing and later included also caries diagnosis. This paper discuss the use of Laser therapy on Restorative Dentistry, Periodondology, Oral and Maxillofacial Surgery, Oral implantology and other. Clinical and laboratorial experience has demonstrated that Laser therapy does improve the healing of both mineralized and soft tissues, reduces pain and inflammation, and also reduces both cost and length of the dental treatment.

  17. Variation in the Definition of Clinical Target Volumes for Pelvic Nodal Conformal Radiation Therapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Purpose: We conducted a comparative study of clinical target volume (CTV) definition of pelvic lymph nodes by multiple genitourinary (GU) radiation oncologists looking at the levels of discrepancies amongst this group. Methods and Materials: Pelvic computed tomography (CT) scans from 2 men were distributed to 14 Radiation Therapy Oncology Group GU radiation oncologists with instructions to define CTVs for the iliac and presacral lymph nodes. The CT data with contours were then returned for analysis. In addition, a questionnaire was completed that described the physicians' method for target volume definition. Results: Significant variation in the definition of the iliac and presacral CTVs was seen among the physicians. The minimum, maximum, mean (SD) iliac volumes (mL) were 81.8, 876.6, 337.6 ± 203 for case 1 and 60.3, 627.7, 251.8 ± 159.3 for case 2. The volume of 100% agreement was 30.6 and 17.4 for case 1 and 2 and the volume of the union of all contours was 1,012.0 and 807.4 for case 1 and 2, respectively. The overall agreement was judged to be moderate in both cases (kappa = 0.53 (p < 0.0001) and kappa = 0.48 (p < 0.0001). There was no volume of 100% agreement for either of the two presacral volumes. These variations were confirmed in the responses to the associated questionnaire. Conclusions: Significant disagreement exists in the definition of the CTV for pelvic nodal radiation therapy among GU radiation oncology specialists. A consensus needs to be developed so as to accurately assess the merit and safety of such treatment.

  18. Different Clinical Utility of Oropharyngeal Bacterial Screening prior to Percutaneous Endoscopic Gastrostomy in Oncological and Neurological Patients

    Directory of Open Access Journals (Sweden)

    Radek Kroupa

    2014-01-01

    Full Text Avai