Irradiation for Inoperable Carcinoma of the Lung and High Performance Status

JAMA ◽  
1980 ◽  
Vol 244 (17) ◽  
pp. 1931 ◽  
Author(s):  
James D. Cox
Keyword(s):  
High Performance ◽  
Performance Status ◽  
High Performance Status

scholarly journals Direct Oral Anticoagulant Therapy for Isolated Distal Deep Vein Thrombosis Associated with Cancer in Routine Clinical Practice

2021 ◽  
Vol 10 (20) ◽  
pp. 4648
Author(s):  
Yutaka Ogino ◽  
Tomoaki Ishigami ◽  
Ryosuke Sato ◽  
Hidefumi Nakahashi ◽  
Yugo Minamimoto ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Oral Anticoagulant ◽  
High Performance ◽  
Oral Anticoagulant Therapy ◽  
Performance Status ◽  
Routine Clinical Practice ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Advanced Cancer Stage ◽  
High Performance Status

Background: The efficacy and bleeding complications of direct oral anticoagulant (DOAC) therapy for isolated distal deep vein thrombosis (IDDVT) associated with cancer in routine clinical practice remain unclear. Moreover, prior studies on prolonged therapy for IDDVT are limited. Methods: This retrospective study enrolled 1641 consecutive patients with acute venous thromboembolism (VTE) who had received oral anticoagulant therapy, including warfarin or DOAC, between April 2014 and September 2018 in our institutions. In these patients, 200 patients with cancer-associated IDDVT were evaluated. Results: Mean follow-up period was 780 ± 593 days. Major bleeding and VTE recurrence were observed in 22 (11.0%) and 11 (5.5%) patients, respectively. In multivariate analysis, statistically significant factors correlated with major bleeding were advanced cancer stage, high performance status, stomach cancer, and gallbladder cancer; those correlated with all-cause death were advanced cancer stage, high performance status, liver dysfunction, pancreatic cancer, and major bleeding. Cumulative events of major bleeding and recurrence between patients with prolonged DOAC therapy (≥90 days) and those with nonprolonged therapy were not significantly different. Conclusions: Preventing major bleeding is important because it is a significant risk factor for all-cause death. Major bleeding and recurrent events were comparable between prolonged and nonprolonged therapy.

scholarly journals RADT-23. IMPACT OF REIRRADIATION UTILIZING STEREOTACTIC RADIOSURGERY ON RECURRENT GLIOBLASTOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii186-ii186
Author(s):  
O’Dell Patrick ◽  
H Nickols ◽  
R LaRocca ◽  
K Sinicrope ◽  
D Sun ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Median Survival ◽  
High Performance ◽  
Performance Status ◽  
Treatment Options ◽  
Methylation Status ◽  
Initial Therapy ◽  
Recurrent Glioblastoma ◽  
Control Group ◽  
The Impact

Abstract BACKGROUND Patients who have recurrent glioblastoma have limited treatment options. We conducted a retrospective review of patients with recurrent glioblastoma treated with standard initial radiation and temozolomide with tumor treating fields to investigate whether reirradiation using radiosurgery would be associated with improved outcomes. METHODS We reviewed the records of 54 consecutively treated patients with recurrent glioblastoma with ECOG 0 or 1 at recurrence and conducted Kaplan-Meier analysis with Log-rank testing to determine significance between groups. RESULTS We identified 24 patients who were treated without radiation therapy (control) while 30 patients underwent re-irradiation using radiosurgery (ReSRS) with a median total dose of 25Gy in five fractions. All patients had completed standard initial therapy, and there was no difference in the time to recurrence between the two groups (10 months for control, 15 months for ReSRS, [P = 0.17, HR for progression 0.65 (95% CI 0.38-1.13)]. A larger proportion of patients in the control arm (54%) had subtotal or gross total resection of the recurrence compared with the ReSRS group (44%, P < 0.05). The majority of patients had recurrence confirmed with biopsy (18/22 in control group, 25/31 in the ReSRS group). MGMT methylation status did not differ between control vs ReSRS (29% vs. 27%). ReSRS was associated with improved median survival from the time of first recurrence of 11.6 months versus 3.8 months in the control arm [P< 0.0001, HR for death 0.33 (95% CI 0.18-0.6)]. CONCLUSIONS In a group of patients with high performance status diagnosed with recurrent glioblastoma, reirradiation with stereotactic radiosurgery was associated with nearly one year median survival after recurrence. Additional analyses are warranted to determine the impact of concurrent systemic therapies with irradiation and underlying tumor or patient factors to predict outcomes.

Phase I evaluation of a water-soluble etoposide prodrug, etoposide phosphate, given as a 5-minute infusion on days 1, 3, and 5 in patients with solid tumors.

1994 ◽  
Vol 12 (9) ◽  
pp. 1902-1909 ◽  
Author(s):  
D R Budman ◽  
L N Igwemezie ◽  
S Kaul ◽  
J Behr ◽  
S Lichtman ◽  
...  
Keyword(s):  
High Performance ◽  
Peak Plasma ◽  
Performance Status ◽  
Plasma Concentrations ◽  
Maximum Tolerated Dose ◽  
Water Soluble ◽  
High Dose ◽  
Maximum Plasma ◽  
Rapid Infusion ◽  
Etoposide Phosphate

PURPOSE To determine the toxicities, maximum-tolerated dose (MTD), and pharmacology of etoposide phosphate, a water-soluble etoposide derivative, administered as a 5-minute intravenous infusion on a schedule of days 1, 3, and 5 repeated every 21 days. PATIENTS AND METHODS Thirty-six solid tumor patients with a mean age of 63 years, performance status of 0 to 1, WBC count > or = 4,000/microL, and platelet count > or = 100,000/microL, with normal hepatic and renal function were studied. Doses evaluated in etoposide equivalents were 50, 75, 100, 125, 150, 175, and 200 mg/m2/d. Etoposide in plasma and urine and etoposide phosphate in plasma were measured by high-performance liquid chromatography (HPLC). Eleven of 36 patients were treated with concentrated etoposide phosphate at 150 mg/m2/d. RESULTS Grade I/II nausea, vomiting, alopecia, and fatigue were common. Leukopenia (mainly neutropenia) occurred at doses greater than 75 mg/m2, with the nadir occurring between days 15 and 19 posttreatment. All effects were reversible. Hypotension, bronchospasm, and allergic reactions were not observed in the first 25 patients. The MTD due to leukopenia was determined to be between 175 and 200 mg/m2/d. In 11 patients treated with concentrated etoposide phosphate, no local phlebitis was noted, but two patients did develop allergic phenomena. The conversion of etoposide phosphate to etoposide was not saturated in the dosages studied. Etoposide phosphate had peak plasma concentrations at 5 minutes, with a terminal half-life (t1/2) of 7 minutes. Etoposide reached peak concentrations at 7 to 8 minutes, with a t1/2 of 6 to 9 hours. Both etoposide phosphate and etoposide demonstrated dose-related linear increases in maximum plasma concentration (Cmax) and area under the curve (AUC). CONCLUSION Etoposide phosphate displays excellent patient tolerance in conventional dosages when administered as a 5-minute intravenous bolus. The suggested phase II dose is 150 mg/m2 on days 1, 3, and 5. The ability to administer etoposide phosphate as a concentrated, rapid infusion may prove of value both in the outpatient clinic and in high-dose regimens.

First-line drug selection versus sequential treatment in advanced pancreatic cancer: Does it really matter? Multi-institutional Canadian perspective.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 673-673
Author(s):  
Ivan Barrera ◽  
Neha Papneja ◽  
Jill Ranger ◽  
Abhishek Papneja ◽  
Petr Novotny ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Performance ◽  
Performance Status ◽  
Advanced Pancreatic Cancer ◽  
Rank Test ◽  
First Line ◽  
Log Rank Test ◽  
Canadian Perspective ◽  
Grade 3 ◽  
Line Drug

673 Background: Folfirinox (FFX) and Gemcitabine with nab-Paclitaxel (GN) are both proven to be superior to Gemcitabine (G) in the first line treatment (1LTx) for advanced pancreatic cancer (APC). Yet, the optimal 1LTx selection nor sequential Tx (ST) has not been fully established. Therefore, the best choice for 1LTx is a matter of debate often influenced by access to drugs. This analysis was conducted to compare outcomes based on 1Ltx selection and ST in APC. Methods: We assessed patients (pts) with APC who received either FFX or GN as 1LTx during 2010-2019 at three Canadian institutions. As well as the ST used. The main objective was to assess survival. Kaplan method and log-rank test were used for survival curves. Results: This retrospective study included 231 pts; 1LTx included 143 pts on FFX and 88 pts on GN. FFX pts were predominantly male; 89(62.2%) vs 46(52.3%) and slightly younger (median age 62 vs 66) than GN. WHO performance status (PS) of 0 were 38 (28.4%) vs 14 (16.5%) and 1 were 90 (67.2%) vs 65 (76.5%) respectively. There were more grade 3-4 toxicity in FFX vs GN group: GI 55 (38.5%) vs 15 (17%) and hematologic 51 (35.4%) vs 20 (22.7%) respectively. Grade 3-4 neutropenia rates were similar in both regimens. The median PFS of FFX was 5.5 months (95% CI: 5.0-6.7) vs 5.1 (95% CI: 3.8-7.1) with GN (p=0.37). The median OS with FFX was 9.3 months (95% CI: 7.5-11.1) vs 10.2 (95% CI: 6.8-11.3) with GN (p=0.81). There were not statically significant. Table shows Tx frequency across 4LTx. 2LTx and beyond regimens included G, GN, FFX, Capecitabine, Irinotecan liposome plus 5-FU, Irinotecan and clinical trials. Conclusions: Our results revealed that pts who received 1LTx FFX or GN had similar PFS and OS even though 1LTx FFX group was younger with better PS, allowing to continue 2-4LTx more frequently when compare with 1LTx GN group. Therefore, 1LTx selection appear to have more impact in our pts rather than ST, whereas GN is less toxic and seems a preferable 1LTx choice for most pts. FFX could be reserved for young high-performance pts. [Table: see text]

scholarly journals 149 Myocardial performance in opera singers

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Laura Stefani ◽  
Marco Corsi ◽  
Goffredo Orlandi
Keyword(s):  
High Performance ◽  
Positive Impact ◽  
Performance Status ◽  
Myocardial Performance ◽  
Paired Data ◽  
Deformation Parameters ◽  
Echocardiographic Evaluation ◽  
High Level ◽  
Opera Singers ◽  
The Impact

Abstract Aims Opera singers are subjected to continuous exercise in the cardiopulmonary district, however the impact on cardiac performance has not been studied in depth. In addition to the standard echo parameters, the deformation one offer the possibility to evaluate more clearly the myocardial performance. Objective was to verify the impact of singing in heart’s performance by the evaluation of traditional and particularly deformation parameters as strain, rotation, and twist. Methods and results A population of 17 OS (opera singers, aged 50 ± 5 years) (M/F: 7/9; 5 sopranos; 2 tenors; 2 contraltos; 2 basses) have been submitted to an echocardiographic evaluation (MLX8exp Release F100001) by standard 2D and deformation parameters (Figure 1). The data expressed as mean as SD were compared to an high level athletes (A) group (M 16) regularly trained. T-Student test for paired data was used and P < 0.05 was considered significant. All the 2D standard systo-diastolic parameters were within the normal range and the pulmonary pressure (PP) as well in both. In SO group were: LVDd: 47.31 ± 3.77 mm; LVSd: 30.48 ± 4.42 mm; E/A: 1.07 ± 0.32; RV: 27.63 ± 4.50 mm; in A group: LVDd: 50.81 ± 2.97 mm; LVSd: 31.44 ± 4.26 mm; E/A: 2.68 ± 1.67; RV: 27.63 ± 4.50 mm. As expected Cardiac mass index (CMI) was significantly greater in athletes, while the ejection fraction (EF) resulted to be higher in OS. Despite the deformation parameters were not different among the two groups, with the exclusion of GLS expressing a major value in athletes, on the contrary the rotational parameters resulted, in OS group similar to the athletes and in agreement with an high performance status. Conclusions OS show an high myocardial performance as athletes. The data obtained are suggestive for a positive impact of regular training as an opera singers. Deformation parameters highlight the fitness status in this particular group. Classic music singing seems to have a training effect on the heart. Further studies will be necessary to confirm this hypothesis

Planning practices: a multiple case study in the high-performing banks

2017 ◽  
Vol 30 (4) ◽  
pp. 487-500 ◽  
Author(s):  
Mohammad Sihab Ridwan
Keyword(s):  
Strategic Planning ◽  
High Performance ◽  
Planning Process ◽  
Performance Status ◽  
Business Environment ◽  
Research Approach ◽  
Research Information ◽  
Decision Style ◽  
Content Type ◽  
High Performing

Purpose The purpose of this paper is to investigate the strategic planning practices applied in the high-performing banking industry in the Indonesian context and how decision style facilitates successful planning. Design/methodology/approach This study employed a qualitative research approach as the framework for this study to get a genuine explanation of the perspectives of participants researched about strategic planning. The data collection method used in-depth semi-structured and unstructured interviews of both key informants and non-planning members in each identified bank. Three banks were selected because of their commitment in strategic planning and their high-performance status. This study used research information from a panel of experts to first define a bank as high performing in the first instance, and then to select the three top performing banks for the study. Findings This study has provided useful findings about the strategic planning practices in the high-performing banks. The key findings comprise the fact that all three banks in this study have carried out the usual and main strategic planning activities presented in this study: the vital role of the CEO in strategic planning has been proven, and planning flexibility in the strategic planning process has been identified, among other related findings. Originality/value This study provides a useful research model for investigating strategic planning practices both in the relatively stable and predictable business environment and turbulent and unpredictable business environment. This study, to the best of the authors’ knowledge, is the first to investigate the issue in the Indonesian context.

Serious illness communication practices in glioblastoma care at an academic medical center.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 28-28
Author(s):  
Lauren Reed-Guy ◽  
Tyler D. Alexander ◽  
Gregory Biggiani ◽  
Stephen P. Miranda ◽  
Nina O'Connor
Keyword(s):  
High Performance ◽  
Hospital Admissions ◽  
Medical Center ◽  
Performance Status ◽  
Academic Medical Center ◽  
Median Number ◽  
Primary Brain Tumor ◽  
Average Life Expectancy ◽  
Code Status ◽  
Academic Medical

28 Background: Glioblastoma (GBM) is an aggressive primary brain tumor with a disease course marked by both cognitive and physical decline. Early conversations about end-of-life (EOL) preferences are important given the average life expectancy of 14 months. Little is known about patterns of communication in GBM. Objective: To describe current practices surrounding EOL conversations in GBM patients at an academic medical center. Methods: We reviewed the medical records of 240 patients treated for GBM at the University of Pennsylvania who died between 2017 and 2019. We systematically identified and characterized EOL conversations, as defined by documented discussions of prognosis, goals of care, EOL planning and/or code status. Results: Patients in this study were predominantly male, white, privately insured and had relatively high performance status (median KPS 80 at initiation of therapy). Median survival was 487 days and 96% of patients received both chemotherapy and radiation. Nearly all patients (96%) had at least one EOL conversation documented. The median number of documented conversations per patient was 4. The first EOL conversation occurred at a median of 24 days after diagnosis (range 0 to 3,883) and 362 days before death (0 to 2,401). The last EOL conversation occurred at a median of 32 days before death (0 to 1,514). EOL conversations took place earlier among older patients, with each additional year of age at diagnosis associated with a first conversation 8 days earlier (95% CI: -12 to -4 days; p<0.01). At least one EOL conversation occurred at an outpatient visit for 89% of patients; 33% had conversations during hospital admissions; and 38% had EOL conversations via telephone. Medical oncology was the most common specialty to document EOL conversations (89% of patients), followed by palliative care (19%), radiation oncology (13%) and neurosurgery (10%). Conclusions: EOL conversations appear to have occurred relatively early and often, but further work is needed to evaluate the quality of documented discussions and to determine whether this pattern is unique to this single center or widespread. The variety in provider specialty and conversation setting reflects the complexity of the care environment in GBM.

A High Performance Energy Analyzer for Use in Electron Scanning Microscopy

1969 ◽  
Vol 27 ◽  
pp. 14-15
Author(s):  
A. V. Crewe ◽  
M. Isaacson ◽  
D. Johnson
Keyword(s):  
High Performance ◽  
Vertical Plane ◽  
Median Plane ◽  
Electron Gun ◽  
Uniform Field ◽  
Loss Mechanism ◽  
Electron Scanning Microscopy ◽  
Sector Type ◽  
Double Focusing ◽  
Electron Energy Loss

A double focusing magnetic spectrometer has been constructed for use with a field emission electron gun scanning microscope in order to study the electron energy loss mechanism in thin specimens. It is of the uniform field sector type with curved pole pieces. The shape of the pole pieces is determined by requiring that all particles be focused to a point at the image slit (point 1). The resultant shape gives perfect focusing in the median plane (Fig. 1) and first order focusing in the vertical plane (Fig. 2).

Vacuum System to Minimize the Specimen Contamination of High-Performance EM

1977 ◽  
Vol 35 ◽  
pp. 68-69
Author(s):  
N. Yoshimura ◽  
K. Shirota ◽  
T. Etoh
Keyword(s):  
Electron Microscope ◽  
High Speed ◽  
High Performance ◽  
High Vacuum ◽  
Vacuum System ◽  
Pump System ◽  
Pumping System ◽  
Diffusion Pump ◽  
Almost All ◽  
Cascade Type

One of the most important requirements for a high-performance EM, especially an analytical EM using a fine beam probe, is to prevent specimen contamination by providing a clean high vacuum in the vicinity of the specimen. However, in almost all commercial EMs, the pressure in the vicinity of the specimen under observation is usually more than ten times higher than the pressure measured at the punping line. The EM column inevitably requires the use of greased Viton O-rings for fine movement, and specimens and films need to be exchanged frequently and several attachments may also be exchanged. For these reasons, a high speed pumping system, as well as a clean vacuum system, is now required. A newly developed electron microscope, the JEM-100CX features clean high vacuum in the vicinity of the specimen, realized by the use of a CASCADE type diffusion pump system which has been essentially improved over its predeces- sorD employed on the JEM-100C.

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