Radiotherapy Combined with Other Treatments in Rectal Cancer

1998 ◽  
Vol 84 (2) ◽  
pp. 238-246 ◽  
Author(s):  
Vincenzo Valentini
Keyword(s):  
Rectal Cancer ◽  
Local Control ◽  
Local Control Rate ◽  
Bolus Administration ◽  
Conventional Fractionation ◽  
Fractionation Schedule ◽  
Group 5 ◽  
The Individual ◽  
Improvement In Survival ◽  
The Cost

Since the first reports in the late 1950's, a large amount of data have been collected. The analysis of the main evidence from the major randomized trials will be analyzed in this paper according to preoperative, postoperative and chemoradiation approaches. Fifteen randomized preoperative trials were reported; they have been grouped according to the fractionation schedule. In the hypofractionation group (5 Gy for fraction), all five studies that delivered 3-5 doses in one week had a significant improvement in local control and one of them also showed improvement in survival. Operative mortality was higher in the radiotherapy arm if inadequate techniques had been applied. In 3 out of 8 studies with conventional fractionation there was a significant improvement in local control, but no impact in survival was detected. No studies with total dose lower than 34 Gy had an improvement in local control. None of the six randomized postoperative studies showed an improvement in local control or survival. In all trials the local control rate was uniform; ranging from 76% to 84%. Toxicity was higher in the radiotherapy arm. One preoperative and five postoperative randomized studies that used chemoradiation were analyzed. One postoperative chemoradiation study showed a significant improvement in survival in comparison to the surgery arm, and another showed the same advantage compared to the postoperative arm. Protracted infusional administration of 5FU concomitant to radiotherapy showed better survival than bolus administration. No advantages were shown in using MeCCNU or Levamisole in two studies. Toxicity was high and related to the dose and the modality of administration of the drugs in order to adequately treat the different stages of rectal cancer, patients must be carefully selected in order to prescribe the most effective and the least toxic treatment for the individual stage; organ preservation should be an essential goal for its impact on quality of life, and the cost estimates should be taken into account.

scholarly journals Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6086
Author(s):  
Maxime Loo ◽  
Jean-Baptiste Clavier ◽  
Justine Attal Khalifa ◽  
Elisabeth Moyal ◽  
Jonathan Khalifa
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Stereotactic Radiotherapy ◽  
Local Control Rate ◽  
Dose Effect ◽  
Published Data ◽  
High Dose ◽  
Single Fraction ◽  
Fractionation Schedule

For more than two decades, stereotactic radiosurgery has been considered a cornerstone treatment for patients with limited brain metastases. Historically, radiosurgery in a single fraction has been the standard of care but recent technical advances have also enabled the delivery of hypofractionated stereotactic radiotherapy for dedicated situations. Only few studies have investigated the efficacy and toxicity profile of different hypofractionated schedules but, to date, the ideal dose and fractionation schedule still remains unknown. Moreover, the linear-quadratic model is being debated regarding high dose per fraction. Recent studies shown the radiation schedule is a critical factor in the immunomodulatory responses. The aim of this literature review was to discuss the dose–effect relation in brain metastases treated by stereotactic radiosurgery accounting for fractionation and technical considerations. Efficacy and toxicity data were analyzed in the light of recent published data. Only retrospective and heterogeneous data were available. We attempted to present the relevant data with caution. A BED10 of 40 to 50 Gy seems associated with a 12-month local control rate >70%. A BED10 of 50 to 60 Gy seems to achieve a 12-month local control rate at least of 80% at 12 months. In the brain metastases radiosurgery series, for single-fraction schedule, a V12 Gy < 5 to 10 cc was associated to 7.1–22.5% radionecrosis rate. For three-fractions schedule, V18 Gy < 26–30 cc, V21 Gy < 21 cc and V23 Gy < 5–7 cc were associated with about 0–14% radionecrosis rate. For five-fractions schedule, V30 Gy < 10–30 cc, V 28.8 Gy < 3–7 cc and V25 Gy < 16 cc were associated with about 2–14% symptomatic radionecrosis rate. There are still no prospective trials comparing radiosurgery to fractionated stereotactic irradiation.

Is RCC truly radioresistant? Local control rates of metastatic renal cell carcinoma (RCC) to the lung using stereotactic radiotherapy (SBRT).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 445-445 ◽  
Author(s):  
Basel M Altoos ◽  
Arya Amini ◽  
Maria Teresa Bourlon ◽  
Christine M. Fisher ◽  
Edward Bedrick ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Local Control ◽  
Renal Cell ◽  
Tumor Volume ◽  
Strong Predictor ◽  
Symptomatic Relief ◽  
Univariate Analysis ◽  
Local Control Rate ◽  
Conventional Fractionation

445 Background: The use of radiation therapy (RT) for renal cell carcinoma (RCC) is controversial because RCC has traditionally been considered to be “radioresistant”. Based on this concern, current studies have suggested the need for higher doses with conventional fractionation (CF) or the use of SBRT with RCC. The purpose of this study is to determine the efficacy of these modalities by comparing the radiographic and symptomatic local control (LC) rates in patients with metastatic RCC to the lung. Methods: We retrospectively analyzed the radiographic and symptomatic RT response in 27 consecutive RCC patients with 37 RCC lung lesions treated between 2005 to 2014. Twenty-six (70.2%) were treated with SBRT and eleven (29.8%) with CF. Only 9 patients (33.3%) had symptoms prior to RT. Median SBRT dose and fraction was 50 Gy (range 25-60) and 3 (range 1-6) versus CF 30 Gy (range 20-55) and 10 (range 5-22) respectively. Toxicity was evaluated by CTCAE 4.0. Results: Median follow up was 16 months (range 1-102). Rates of radiographic local control with SBRT and CF were 92.3% vs. 55.4% respectively (p=0.0016). Under univariate analysis, predictors for radiographic LR were gross tumor volume (GTV) > 20 cc (p < 0.0001), planned tumor volume (PTV) of > 100 cc (p < 0.0001), and biologic effective dose (BED) < 70 Gy (p=0.0001). Subanalysis of CF demonstrated that a BED < 54 Gy was also a strong predictor for LR (p=0.0012). Under multivariate analysis, PTV was a strong predictor for radiographic LR (odds ratio [OR] = 42.2, p=0.0492). For the 9 symptomatic patients, 3 of 4 (75%) patients in the CF arm and 4 of 5 (80%) in the SBRT arm experienced partial or complete symptomatic relief. The median time to relief of symptoms in the SBRT and CF arms were 0.5 and 2 months, respectively. All patients receiving CF had symptomatic LR compared to none in the SBRT arm (p=0.0124). One patient in the SBRT arm had grade 2 hiccups and one with grade 2 pneumonitis in the CF arm. There were no other grade 2 toxicities or higher. Conclusions: SBRT demonstrated an encouraging local control rate and was capable of safely providing symptomatic relief to patients. The traditional view of radioresistance in RCC may not apply in the era of SBRT.

Radiocurability of microscopic disease in childhood rhabdomyosarcoma with radiation doses less than 4,000 cGy.

1990 ◽  
Vol 8 (9) ◽  
pp. 1536-1542 ◽  
Author(s):  
L Mandell ◽  
F Ghavimi ◽  
T Peretz ◽  
M LaQuaglia ◽  
P Exelby
Keyword(s):  
Local Control ◽  
Primary Tumor ◽  
External Beam Radiotherapy ◽  
Local Control Rate ◽  
Cancer Center ◽  
Radiation Doses ◽  
Free Survival ◽  
Conventional Fractionation ◽  
Childhood Rhabdomyosarcoma

In an attempt to evaluate the radiocurability of microscopic disease in childhood rhabdomyosarcoma (RMS) with total tumor doses of less than 4,000 cGy, we performed a retrospective analysis of all patients with microscopic residual RMS who were treated at the Memorial Sloan-Kettering Cancer Center (MSKCC) during the years 1970 to 1987. There were 32 patients ranging in age from 3 months to 22 years (median, 6 years) with microscopic residual of either (1) a localized primary tumor (MSKCC, stage IB; Intergroup Rhabdomyosarcoma Study [IRS] group IIA), 19 patients; or (2) an involved lymph node region with the primary tumor completely resected (MSKCC stage III; IRS group IIC), 13 patients. Twenty-nine of the 32 patients presented with embryonal histology. All patients were treated with combination chemotherapy (CT) and megavoltage external beam radiotherapy (RT). The RT was delivered in either conventional fractionation of 180 to 200 cGy daily (30 patients) or hyperfractionation of 150 cGy twice daily (two patients). Fifteen patients received RT doses of less than 4,000 cGy with a range of 3,000 to 3,600 cGy and a median value of 3,100 cGy; 17 patients received 4,000 cGy or more with a range of 4,000 to 6,000 cGy and a median value of 4,600 cGy. With a median follow-up of 11 years, the relapse-free survival was 25 of 32 patients (less than 4,000 cGy, 12 of 15; greater than or equal to 4,000 cGy, 13 of 17). The RT local control rate was 30 of 32 (less than 4,000 cGy, 14 of 15; greater than or equal to 4,000 cGy, 16 of 17 [P = .94]). Our results suggest that radiation doses of below 4,000 cGy, when combined with effective multiagent CT, may be sufficient for local control of microscopic disease in childhood embryonal RMS.

THEORETICAL PRINCIPLES OF FORECASTING THE COST OF A SOFTWARE PRODUCT

2017 ◽  
Author(s):  
Pavlo Rodionov ◽  
◽  
Anna Ploskonos ◽  
Lesya Gavrutenko ◽  
◽  
...  
Keyword(s):  
Selection Process ◽  
Individual Characteristics ◽  
Successful Implementation ◽  
Software Products ◽  
Software Product ◽  
Continue Research ◽  
Cocomo Model ◽  
Factors Of Influence ◽  
The Individual ◽  
The Cost

The paper analyzes the factors that affect the amount of effort required to create a mobile application and its cost. It is established that the main factors of influence are the design of the application, its functionality, the type of mobile platform, the availability and level of testing and support, as well as the individual characteristics of the developer. Based on the analysis of information sources, the main methods and approaches to forecasting the cost of software products are identified, which include the COCOMO model, Price-to-win method, expert evaluation, algorithmic methods and the method of analogies. It is proposed to consider the method of analogies as a tool that allows you to make predictions about the cost of resources required for the successful implementation of IT projects based on the experience of similar projects. It is proved that the advantages of this method are the simplicity of its implementation and the clarity of the results obtained, which follows from the practical orientation of this tool. Among the limitations of the method of analogy is the mandatory need for reliable data relating to similar projects, as well as the difficulty of taking into account unspecified indicators. Taking into account the mentioned limitations of the method of analogies and on the basis of the analysis of scientific sources the possible directions of its optimization are determined. Thus, among the ways to improve the effectiveness of this method are those aimed at optimizing the project selection process, the data for which are used as a basis for forecasting. Attempts to improve the method of analogies by including parameters that were previously ignored by this technique seem promising. This in turn can lead to an expansion of the scope of the method of analogies and increase the accuracy of forecasts. As prospects for further research, the need to continue research in the field of optimization of the method of analogies with the subsequent practical verification of theoretical positions on the data of real projects.

Local Control of Local Excision for T1/T2 Rectal Cancer

2007 ◽  
Vol 23 (2) ◽  
pp. 87 ◽  
Author(s):  
Ki-Jae Park ◽  
Hong-Jo Choi ◽  
Young-Hoon Roh ◽  
Jong-Sok Shin ◽  
Hyung-Sik Lee
Keyword(s):  
Rectal Cancer ◽  
Local Excision ◽  
Local Control ◽  
T2 Rectal Cancer

FUNCTIONING OF THE MENTAL DEFENSES IN THE CONDUCT OF INTERROGATION WITHIN THE CRIMINAL PROCESS

2018 ◽  
Vol 28 (6) ◽  
pp. 2161-2165
Author(s):  
Hristo Ivanov Popnikolov
Keyword(s):  
Objective Assessment ◽  
Critical Conditions ◽  
Criminal Process ◽  
External Influences ◽  
Administration Of Justice ◽  
Individual Protection ◽  
The Subject ◽  
The Individual ◽  
The Cost ◽  
Subjective Side

From the subject presented in the report it is evident that the pre-trial and the court bodies may, to some extent, be influenced both by the person of the accused and by his competence to participate in the criminal process. In this regard as an expert, the psychologist can offer invaluable assistance. Each expertise would assist all actors involved in the administration of justice on their objective assessment of the offenders, the understanding of their individual protection and the inherent self-justification during procedural actions. The involvement of psychologists in the criminal process is key to establishing the truth in the investigation, because every crime as an act has a subjective side, expressed in the psychic attitude of the perpetrator to the committed act. Establishing these psychological motives is a key point in the criminal process with a view to establishing the truth.Psychological protection stabilizes the personality in the critical conditions of counteraction, related to the elimination of the experiences of tension, anxiety, stress and frustration, leading to maximum mobilization of its resources and at the same time to their overpayment. Thus, the individual who is the subject of the process action is protected against the adverse external influences, but at the cost of a lot of effort and enormous loss of nervous-mental energy, which increases his own vulnerability instead of contributing to its reduction. The appearance and functioning of psychological protection can be significantly impeded by the interaction of the investigator with the accused. Even more complicated is the situation when it breaks the communication contact that may arise in the psychological alienation and self-isolation of the accused due to the desire to protect himself.Protective psychological dominance is a real psychic activity that investigators, investigators, investigators and judges need to take into account in order to effectively deal with their task and to overcome the resistance of the investigated persons and in a time to prove in a lawful and moral way their guilt and participation in the commitment of the crimes.

Automated Control of the Microclimate in the Premises of Pig-Breeding Complexes

2020 ◽  
pp. 103-108
Author(s):  
Viktoriya Yu. Ukhanova
Keyword(s):  
Agricultural Production ◽  
Individual Characteristics ◽  
Feed Consumption ◽  
Management Systems ◽  
Research Purpose ◽  
Energy Costs ◽  
Technical Equipment ◽  
Pig Farming ◽  
The Individual ◽  
The Cost

In the pig breeding, a large share of the production cost is accounted for by the cost of electricity and heat. Reducing energy costs is one of the important tasks of the industry. It is important to identify and study modern technologies and equipment for pig farming due to the constant increase in electricity tariffs, significant energy costs for creating and maintaining a microclimate. (Research purpose) The research purpose is in an analysis of modern available technologies and equipment for agricultural production, including pig farming, allowing to reduce the cost of production. (Materials and methods) Authors used a method for determining the standard indicators of energy consumption of energy resources in the pig industry, based on the calculation and analytical method. The article presents an analyze of automated microclimate management systems in pig breeding complexes, taking into account the individual characteristics of farms produced by OWEN. (Results and discussion) Automated microclimate management systems can improve the productivity of pig farms; reduce the cost of electrical and thermal energy, reduce the number of diseases of animal from hypothermia, high humidity or temperature in the room, feed consumption; monitor the chemical composition of the air. The article considers three options for creating a microclimate in rooms with animals, taking into account the individual characteristics of enterprises. (Conclusions) The profitability of pig production depend on the level of technical equipment of farms, automation, and the use of energy-saving technologies and equipment. The use of innovations in agricultural production makes it possible to increase labor productivity up to three times, and savings due to reduced feed costs can reach several million rubles a year.

scholarly journals Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 714
Author(s):  
Isaac Aranda-Reneo ◽  
Laura Albornos-Muñoz ◽  
Manuel Rich-Ruiz ◽  
María Ángeles Cidoncha-Moreno ◽  
Ángeles Pastor-López ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Older People ◽  
Incremental Cost ◽  
Fall Risk ◽  
Community Dwelling ◽  
Effective Measure ◽  
The Individual ◽  
The Cost ◽  
Individual Training

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

Sign in / Sign up

Export Citation Format

Share Document