Baseline Karnofsky performance status is independently predictive of death within 30 days of intracranial radiation therapy completion for metastatic disease

IntroductionFor patients with brain metastases, palliative radiation therapy (RT) has long been a standard of care for improving quality of life and optimizing intracranial disease control. The duration of time between completion of palliative RT and patient death has rarely been evaluated.MethodsA compilation of two prospective institutional databases encompassing April 2015 through December 2018 was used to identify patients who received palliative intracranial radiation therapy. A multivariate logistic regression model characterized patients adjusting for age, sex, admission status (inpatient versus outpatient), Karnofsky Performance Status (KPS), and radiation therapy indication.Results136 consecutive patients received intracranial palliative radiation therapy. Patients with baseline KPS <70 (OR = 2.2; 95%CI = 1.6–3.1; p < 0.0001) were significantly more likely to die within 30 days of treatment. Intracranial palliative radiation therapy was most commonly delivered to provide local control (66% of patients) or alleviate neurologic symptoms (32% of patients), and was most commonly delivered via whole brain radiation therapy in 10 fractions to 30 Gy (38% of patients). Of the 42 patients who died within 30 days of RT, 31 (74%) received at least 10 fractions.ConclusionsOur findings indicate that baseline KPS <70 is independently predictive of death within 30 days of palliative intracranial RT, and that a large majority of patients who died within 30 days received at least 10 fractions. These results indicate that for poor performance status patients requiring palliative intracranial radiation, hypofractionated RT courses should be strongly considered.     

Neck emphysema in a HNSCC cancer patient undergoing concurrent radiotherapy and cetuximab

BackgroundLung toxicity in patients undergoing cetuximab and radiotherapy (Cetux-RT) for head and neck squamous cell carcinoma (HNSCC) has been reported in literature and represents a serious side effect of concurrent therapies.MethodsWe report a case of a HNSCC patient that developed neck emphysema during the course of Cetux-RT. The patient was an old male (80 years old) in a good performance status, with an oropharyngeal cancer (T4aN3a).ResultsDuring RT, cone-beam computed tomography (CBCT) showed bilateral neck emphysema that was confirmed at restaging CT. We decided to stop the treatment and to treat the neck emphysema with conservative strategies. After one week CT was repeated and the neck emphysema had improved, so we decided to complete the RT treatment.ConclusionsPatients undergoing Cetux-RT must be properly selected, whereas IGRT imaging must be viewed carefully in order to permit an early diagnosis and careful management of the patients.     

Medical physics graduate education in Mexico and its relation to the advances in radiation oncology

AimTo evaluate the state of graduate education in medical physics and progress in radiation oncology (RO) equipment in Mexico since 2000, when conferring degrees from two master’s-degree programs in Medical Physics began.BackgroundMedical physics is a Health Profession and there are international recommendations for education, training, and certification. Both programs follow these education guidelines. The most common clinical occupation of graduates is in RO services. Techniques in Mexican RO include traditional and high-precision procedures.MethodsAcademic and occupational information about the programs and their graduates were obtained from official websites. Graduates were invited to respond to a survey that requested information about their present job. We obtained data on RO equipment and human resources from public databases and estimated staffing requirements of medical physicists (MPs).ResultsMedical physics programs have graduated a total of 225 MPs. Half of them work in a clinical environment and, of these, about 90 work in RO services. MPs with M.Sc. degrees constitute 36% of the current MP workforce in RO, estimated to be 250 individuals. Survey responses pointed out the main merits and limitations of the programs. The number of MPs in RO has increased fivefold and the number of linacs sixfold in 15 years. The present number of MPs is insufficient, according to published guidelines.ConclusionAll MPs in RO services with advanced modalities must be trained following international recommendations for graduate education and post-graduation clinical training. Education and health institutions must find incentives to create more graduate programs and clinical residencies.     

载氢-纳米氧化铈微泡对小鼠造血系统抗辐射作用的分析

为探讨载氢-纳米氧化铈微泡对小鼠辐射损伤的防护作用。本研究检测载氢-纳米氧化铈微泡的表征,并将60只BALB/c小鼠随机分为正常对照组、照射对照组、载氢-纳米氧化铈微泡组。小鼠经6Gy x射线一次性全身照射(剂量率2 Gy/min)。于照射后3 d和8 d处死小鼠,检测其外周血细胞数、脾脏和胸腺指数、骨髓和脾脏组织病理学变化。结果显示,照射后3 d和8 d,与正常对照组相比,载氢-纳米氧化铈微泡组和照射对照组的白细胞均明显下降,相比照射对照组,载氢-纳米氧化铈微泡组有改善(p<0.05或p<0.01);而载氢-纳米氧化铈微泡组和照射对照组的红细胞数和血红蛋白均略有下降,但差异无统计学意义。与正常对照组相比,微泡组的胸腺指数、脾脏指数均有下降,和照射对照组相比,载氢-纳米氧化铈微泡组的胸腺指数明显改善(p<0.05或p<0.01)。照射后3 d,与正常对照组相比,照射对照组的骨髓细胞较少,存在细胞碎片,载氢-纳米氧化铈微泡组骨髓细胞数量略有减少,存在细胞核松散现象。而照射后8 d,与正常对照组相比,照射对照组的骨髓细胞几乎找不到,载氢-纳米氧化铈微泡组骨髓细胞有一定数量,存在细胞凋亡现象。本研究表明,载氢-纳米氧化铈微泡通过保护造血组织、改善造血功能,对机体起到一定的辐射防护作用。     

Likelihood-based experimental design for estimation of ED50

In selecting the best dosage choice for the estimation of ED50, it is natural to try to minimize the length of the confidence intervals. In this presentation, the dose allocation that minimizes the length of the likelihood-based confidence intervals is presented and compared with alternative allocations that have been proposed based on the length of different types of confidence intervals, such as those based on the asymptotic variance or on Fieller's Theorem. Effective strategies to deal with the parameter dependence of these allocations are explored. A series of experiments to evaluate the effect of small doses per fraction on the radiation tolerance of the rat cervical spinal cord provide the motivation and an illustration for the proposed procedures.     

The track structures of ionizing particles and their application to radiation biophysics

A new approach to the interpretation of the effects of radiation on cells is described, in which sample particle tracks are constructed using a Monte Carlo computer program and the exposure of cellular targets to these tracks is simulated using a second program known as BIOPHYS. Data on the shapes and DNA contents of the cell nuclei are obtained from the literature. It is assumed that the sensitive material is DNA, and that the target is divided into cubes of approximately 2 nm (the diameter of the DNA helix) per side; the numbers of these cubes containing different numbers of ionizations are derived. Two different methods of analysing the output of BIOPHYS are described. In the first, it is assumed that lethality is caused by the occurrence of a number of ionizations equal to or greater than a certain threshold in one cube; in the second method, it is assumed that only two ionizations are required, in different parts of the cube, but that only some fraction of the cube is sensitive. These models have been applied to the interpretation of the variation of radiosensitivity with a linear energy transfer (LET) of spores of Bacillus subtilis exposed wet and dry, and good fits to the published experimental data were obtained using both models. Fits to experimental data for a range of other cell lines will be presented in a second paper. Received: 5 August 1998 / Accepted in revised form: 28 April 1999     

A registry for exposure and population health in the Altai region affected by fallout from the Semipalatinsk nuclear test site

A registry of the rural population in the Altai region exposed to fallout from nuclear tests at the Semipalatinsk test site (STS) was established more than four decades after the first Soviet nuclear explosion on August 29, 1949. Information about individuals living in an exposed and a control area was collected using all available local sources, such as kolkhoz documentation, school registries, medical treatment records and interviews with residents. As a result, a database comprising an exposed group of 39 179 individuals from 53 Altai region villages, 6769 external and 3303 internal controls was compiled. For several settlements, effective dose estimates reached the level of 1.5 Sv, while the average effective dose estimate in the exposed group was 340 mSv. Dosimetric data, vital status information and health records gathered at rayon and village medical facilities are held in the registry. Cause-of-death information for deceased residents is obtained from death registration forms archived at the Altai region vital statistics office. At present, a follow-up of approximately 40% of the population exposed in 1949 has been done. More will be added by searching for migrants to the larger towns of the Altai region, i.e. Barnaul, Rubtsovsk and Biisk. In order to assess the influence of radiation exposure, analytical studies with a case-control design for stomach and lung cancer are currently being prepared. The number of known cases is sufficient to detect an odds ratio of 1.5 at the 95% confidence level. Epidemiological studies in populations affected by fallout from STS may be equally important to the atomic bomb survivors’ study for the direct quantification of radiation effects. The range of exposure rates experienced will extend the acute high-dose-rate findings from Hiroshima/Nagasaki towards acute and protracted lower exposures, which are more relevant for radiation protection issues. Received: 3 March 1999 / Accepted in revised form: 8 June 1999     

The tumor suppressor p53 can reduce stable transfection in the presence of irradiation

The tumor suppressor p53 is believed to play an essential role in maintaining genome stability. Although it is currently unknown how p53 is involved in this important biological safeguard, several previous publications indicate that p53 can help to maintain genome integrity through the recombination-mediated DNA repair process. The integration of linearized plasmid DNA into the host chromosome utilizes the same repair process, and the frequency can be measured by clonogenic assays in which cells that were stably transfected by plasmid integration can be scored by their colony-forming abilities. To gain insight into whether p53 has a direct role in plasmid integration into the host chromosome, we determined the frequency of stable transfection with CHO cells expressing either wild-type or mutant p53 in the presence and absence of irradiation. We found that low-dose irradiation (50 to 100 cGy) increased stable transfection frequencies in CHO cells regardless of their p53 status. However, the increase of transfection frequency was significantly lower in CHO cells expressing wild-type p53. Our data thus suggest that wild-type p53 can suppress plasmid DNA integration into the host genome. This p53 function may play a direct and significant role in maintaining genome stability.     

射线诱导在体造血细胞凋亡的量时效关系的研究

以4—10Gy射线在体损伤的小鼠为模型,应用DNA电泳和流式细胞术等方法证实细胞凋亡是射线损伤在体骨髓造血细胞的途径之一,发现射线诱导的造血细胞凋亡有明显的量效和时效关系。4、6、8和10Gy照射后,细胞凋亡发生率均表现为升高-降低过程,各剂量诱导的凋亡发生率峰值分别出现在照后12、8、4和4h,6和8Gy诱导的凋亡发生率已达最高水平,约为30％,10Gy诱导的凋亡反而要低。上述结果表明,诱导细胞凋亡是射线损伤骨髓造血细胞的一个重要途径,而且凋亡的发生率受照射剂量和照后时间的影响。因此,深入研究射线诱导的细胞凋亡,将有助于揭示射线损伤造血功能的机理。     

雪莲对正常及辐射损伤小鼠巨噬细胞功能的影响

本文研究了５０％雪莲水煎剂对正常及５ＧＹ６０Ｃｏ一次性全身照射ＢＡＬＢ／Ｃ小鼠巨噬细胞功能的影响,结果表明：口服５０％雪莲水煎剂能增强巨噬细胞吞噬鸡血球及分泌肿瘤坏死因子（ＴＮＦ）的能力,与相应对照组比较具有显著性差异,提示中药雪莲具有扶正固本提高机体防御机能及促进辐射损伤修复的作用。为该药的临床应用提供了科学依据。