Clinical Profile and Treatment Outcomes in Patients Treated with Intensity-Modulated Radiotherapy (IMRT) for Carcinoma Nasopharynx: A Retrospective Analysis

Objective. To retrospectively evaluate the clinical outcome of carcinoma nasopharynx patients treated with the IMRT technique. Methods. Eighty-one nasopharyngeal carcinoma patients who were treated with IMRT with or without chemotherapy between the period January 2011 and December 2014 at a comprehensive tertiary cancer center, Kerala, India, were included in the study. The mean age was 43 years (range 13–77 years), and majority of the patients were males (67.9%). The stagewise distribution of disease at presentation was 2 (2.5%) in stage I, 19 in stage II (23.5%), 31 (38.3%) in stage III, and 29 (35.8%) in stage IV. All patients were treated using simultaneous integrated boost (SIB) schedule using IMRT with 6 MV photon to a dose of 66 Gy in 30 fractions, 2.2 Gy per fraction prescribed to high-risk PTV; 60 Gy in 30 fractions, 2 Gy per fraction to intermediate risk PTV; and 54 Gy in 30 fractions, 1.8 Gy per fraction to low-risk PTV. Concurrent chemotherapy with cisplatin was offered to patients with stage II and above disease. Neoadjuvant chemotherapy with cisplatin and 5FU was given to patients with initially advanced disease (T3, T4, N2, and N3). Survival estimates were generated using the Kaplan–Meier method. The univariate analysis was performed using log-rank tests. Results. The 5-year locoregional control (LRC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 87.5%, 87%, 61.6%, and 62.5%, respectively. The 5-year OS was 100% for stage I (n = 2), 67% for stage II (n = 19), 70.4% for stage III (n = 31), and 68.1% for stage IV (n = 29). The DFS at 5 years was 100% for stage I, 61.1% for stage II, 56.2% for stage III, and 84.8% for stage IV disease. The univariate analysis showed that age, nodal stage, and use of induction chemotherapy showed an improved trend towards OS, though the results were not statistically significant. The predominant pattern of failure in the present study was distant metastasis. Most patients who developed distant metastasis in our study had either an advanced T stage or N3 disease at presentation. Conclusion. The present study shows our initial experience with IMRT for nasopharyngeal carcinoma. The compliance to RT was good in this study. The 5-year LRC and OS rate of nasopharyngeal carcinoma patients treated with IMRT were 87.5% and 62.5%. Distant metastasis was the main pattern of failure.

Libido Sentiendi, Libido Sciendi, Libido Dominandi

This chapter offers a report from the front lines where the battle for self-achieved happiness and well-being (or flourishing) is decidedly not going well. After counter-reports of success from those in the field are examined, secular reasons are offered for thinking that these reports are very likely to be unreliable and so lack the power to trump the mountain of evidence for the view that there are precious few who flourish when drawing only on the resources of their own willpower, creativity, and ingenuity. But it’s not due to lack of trying; people want desperately to enjoy happiness and well-being. The real causes of failure, it is argued, are found in the noetic effects of sin—particularly in inordinate self-love and self-deception, but also (especially in those who have been further harmed and humiliated by relentless and systemic oppression) in insufficient self-love and the lack of safety, resources, and opportunities. The tale to be told is not merely a chronicle of failed bids at happiness and well-being ultimately grounded in our shared condition of sin; it is also a tale of the unhappiness that visits so many of those who fall into this pattern of failure. This portion of the story will be informed and structured by the seven capital vices (also known as the seven deadly sins), and it will culminate in a sustained examination and exploration of the sin of sloth.

Pattern of failure in prostate cancer previously treated with radical prostatectomy and post-operative radiotherapy: a secondary analysis of two prospective studies using novel molecular imaging techniques

Background Prostate Membrane Specific Antigen (PSMA) positron emission tomography (PET) and multiparametric MRI (mpMRI) have shown high accuracy in identifying recurrent lesions after definitive treatment in prostate cancer (PCa). In this study, we aimed to outline patterns of failure in a group of post-prostatectomy patients who received adjuvant or salvage radiation therapy (PORT) and subsequently experienced biochemical recurrence, using 18F-PSMA PET/CT and mpMRI. Methods PCa patients with biochemical failure post-prostatectomy, and no evident site of recurrence on conventional imaging, were enrolled on two prospective trials of first and second generation 18F-PSMA PET agents (18F-DCFBC and 18F-DCFPyL) in combination with MRI between October 2014 and December 2018. The primary aim of our study is to characterize these lesions with respect to their location relative to previous PORT field and received dose. Results A total of 34 participants underwent 18F-PSMA PET imaging for biochemical recurrence after radical prostatectomy and PORT, with 32/34 found to have 18F-PSMA avid lesions. On 18F-PSMA, 17/32 patients (53.1%) had metastatic disease, 8/32 (25.0%) patients had locoregional recurrences, and 7/32 (21.9%) had local failure in the prostate fossa. On further exploration, we noted 6/7 (86%) of prostate fossa recurrences were in-field and were encompassed by 100% isodose lines, receiving 64.8–72 Gy. One patient had marginal failure encompassed by the 49 Gy isodose. Conclusions 18F-PSMA PET imaging demonstrates promise in identifying occult PCa recurrence after PORT. Although distant recurrence was the predominant pattern of failure, in-field recurrence was noted in approximately 1/5th of patients. This should be considered in tailoring radiotherapy practice after prostatectomy. Trial registrationwww.clinicaltrials.gov, NCT02190279 and NCT03181867. Registered July 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02190279 and June 8 2017, https://clinicaltrials.gov/ct2/show/NCT03181867.

Baroness Charlotta Castelli Glembay – Was she hypersexual?

Hypersexuality disorder (or sexual addiction or excessive sexual drive or compulsive sexual behaviour disorder) is a controversial condition that is present in the International Classification of Disease but not in the Diagnostic and Statistical Manual for Mental Disorders. It is defined as a clinical syndrome characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. The condition is more prevalent in men than in women. Some medical conditions were described in fictional literature before their formal recognition in medicine, like Huntington disease, Pickwick syndrome, and Munchausen syndrome. The aim of this article is to analyse the fictional character of Charlotta Castelli Glembay from Miroslav Krleža’s play Messrs Glembays from 1928. Krleža presented a woman with a sexual drive that could be described as uncontrollable, organic (physical) in origin, and different from love and affection (that she also experienced, but only with one particular man). The author gave a special name for her condition – erotic intelligence. This sexual behaviour has distressing and devastating consequences. This paper will argue that the play depicts hypersexuality disorder in a woman, with a designation of its aetiology. In concordance with the prevailing attitudes of the time (the early 20th century), hypersexuality in women had negative attributions.