Stereotactic body radiation therapy (SBRT) of adrenal gland metastases in oligometastatic and oligoprogressive disease

BackgroundStereotactic body radiation therapy (SBRT) as a form of noninvasive treatment that is becoming increasingly used to manage cancers with adrenal gland metastases. There is a paucity of data on safety and efficacy of this modality. The aim of the study was to evaluate the safety and efficacy of adrenal gland SBRT in oligometastatic and oligoprogressive disease.Materials and methodsIn this retrospective study, we performed a single-institution analysis of 26 adrenal lesions from 23 patients with oligometastatic or oligoprogressive disease treated from 2013 to 2019 with the goal of achieving durable local control. Palliative cases were excluded. Radiation dosimetry data was collected. Kaplan Meier product estimator and Cox proportional hazards regression analysis were used for statistical analysis.ResultsThe median dose was 36 Gy in 3 fractions (range: 24–50 Gy and 3–6 fractions) with a median biologically effective dose (BED10) of 72 (range: 40–100). 1-year local control rate was 80% and median local control was not achieved due to a low number of failures. 1- and 2-year overall survival rates were 66% and 32%. Toxicity was mild with only one case of grade 2 nausea and no grade 3–5 toxicity. Higher neutrophil to lymphocyte ratio was associated with worse overall survival and a trend toward worse progression-free survival. In addition, worse performance status and lower BED10 were associated with worse survival. No such association could be shown for primary tumor location, histology, size or stage.ConclusionAdrenal SBRT for oligometastatic or oligoprogressive disease is a safe and effective form of treatment.     

Contents Volume 26 (2000)

Volume Contents

Contents Volume 26 (2000)     

Structure of the nervous system in the tornaria larva of<Emphasis Type="Italic"> Balanoglossus proterogonius</Emphasis> (Hemichordata: Enteropneusta) and its phylogenetic implications

The tornaria larva of hemichordates occupies a central position in phylogenetic discussions on the relationships between Echinodermata, Hemichordata, and Chordata. Dipleurula-type larvae (tornaria and echinoderm larvae) are considered to be primary in the life cycle and thus provide a model for the ancestral animal common to all three taxa (the theory of W. Garstang). If the similarities between tornaria and the larvae in Echinodermata result from homology, their nervous systems should be basically similar as well. The present study utilizes anti-serotonin and FMRFamide antisera together with laser scanning microscopy, and transmission electron microscopy, to describe in detail the nervous system of the tornaria of Balanoglossus proterogonius. Serotonin immunoreactive neurons were found in the apical and esophageal ganglia, and in the stomach epithelium. FMRFamide immunoreactive neurons, probably sensory in nature, were detected in the apical ganglion and in the equatorial region of the stomach epithelium. At the ultrastructural level, the apical organ consists of a columnar epithelium of monociliated cells and includes a pair of symmetrical eyespots. The apical ganglion is located at its base and has a well-developed neuropil. Different types of neurons are described in the apical organ, esophagus, and stomach. Comparison with larvae in Echinodermata shows several significant differences in the way the larval nervous system is organized. This calls into question the homology between tornariae and echinoderm larvae. The possibility of convergence between the two larval types is discussed.     

A new rodent species of the genus Mus (Rodentia: Muridae) confirms the biogeographical uniqueness of the isolated forests of southern Ethiopia

Organisms Diversity & Evolution - The Ethiopian highlands represent the largest part of the Eastern Afromontane Biodiversity Hotspot (EAMBH). Their fauna and flora are largely unique....     

Integrin alphaIIbbeta3:ligand interactions are linked to binding-site remodeling

This study tested the hypothesis that high-affinity binding of macromolecular ligands to the alphaIIbbeta3 integrin is tightly coupled to binding-site remodeling, an induced-fit process that shifts a conformational equilibrium from a resting toward an open receptor. Interactions between alphaIIbbeta3 and two model ligands-echistatin, a 6-kDa recombinant protein with an RGD integrin-targeting sequence, and fibrinogen's gamma-module, a 30-kDa recombinant protein with a KQAGDV integrin binding site-were measured by sedimentation velocity, fluorescence anisotropy, and a solid-phase binding assay, and modeled by molecular graphics. Studying echistatin variants (R24A, R24K, D26A, D26E, D27W, D27F), we found that electrostatic contacts with charged residues at the alphaIIb/beta3 interface, rather than nonpolar contacts, perturb the conformation of the resting integrin. Aspartate 26, which interacts with the nearby MIDAS cation, was essential for binding, as D26A and D26E were inactive. In contrast, R24K was fully and R24A partly active, indicating that the positively charged arginine 24 contributes to, but is not required for, integrin recognition. Moreover, we demonstrated that priming--i.e., ectodomain conformational changes and oligomerization induced by incubation at 35 degrees C with the ligand-mimetic peptide cHarGD--promotes complex formation with fibrinogen's gamma-module. We also observed that the gamma-module's flexible carboxy terminus was not required for alphaIIbbeta3 integrin binding. Our studies differentiate priming ligands, which bind to the resting receptor and perturb its conformation, from regulated ligands, where binding-site remodeling must first occur. Echistatin's binding energy is sufficient to rearrange the subunit interface, but regulated ligands like fibrinogen must rely on priming to overcome conformational barriers.