Salvage Radiotherapy Strategy and Its Prognostic Significance for Patients With Locally Recurrent Cervical Cancer After Radical Resection: a Retrospective 10-year Analysis

Background: Salvage radiotherapy modes for treating patients with local cervical cancer recurrence after radical surgery are controversial. Therefore, we aimed to evaluate the clinical efficacy and prognostic significance of two radiotherapy modes—involved-field radiotherapy combined with regional lymph nodes (regional radiotherapy) and involved-field radiotherapy alone (local radiotherapy)—in these patients.Methods: We retrospectively enrolled patients with local recurrence who underwent radical surgery without radiotherapy for early-stage cervical cancer from January 2010 to January 2020. Clinical outcomes were analyzed using the Kaplan–Meier method and a Cox proportional hazards model.Results: Forty-four patients underwent intensity-modulated radiotherapy (IMRT)-based salvage treatment. The 5-year overall survival and progression-free survival rates were 64% and 60.2%, respectively. Sixteen of 18 patients with stump recurrence and 15 of 26 patients with pelvic and abdominal cavity recurrence received regional radiotherapy, while others received local radiotherapy. Univariate analysis showed that patients with stump recurrence, who underwent regional radiotherapy, and with a lower systemic inflammation response index (SIRI) had better prognosis than their counterparts. Patients aged < 51 years, with stump recurrence, recurrence time ≤ 24 months, recurrence site=1, and a lower SIRI who received regional radiotherapy had a better prognosis than patients who received local radiotherapy. SIRI correlated with the recurrence site and radiotherapy mode.Conclusion: Locally recurrent cervical cancer treated with IMRT-based salvage therapy has a good prognosis. Recurrence site, SIRI, and the radiotherapy mode significantly influenced prognosis. Regional radiotherapy may be suitable for patients with stump recurrence, recurrence time ≤ 24 months, and one recurrence site.

Cancer of Pharyngoesophageal Junction: A Different Subtype From Hypopharyngeal and Cervical Esophageal Cancer?

BackgroundSquamous cell cancers in the hypopharynx (HP) and cervical esophagus (CE) are different diseases with different staging systems and treatment approaches. Pharyngoesophageal junction (PEJ) tumor involves both the hypopharynx and the cervical esophagus simultaneously, but few reports focused on PEJ tumors. This study aimed to clarify clinical characteristics and the treatment approaches of PEJ tumors.Patients and MethodsA total of 222 patients with squamous cell carcinoma in the HP, PEJ, and CE were collected between January 2008 and June 2018 in Fudan University Shanghai Cancer Center. We compared different lymph node metastatic patterns of three diseases above and the survival of different tumor locations, different lymph node metastasis, and different radiotherapy approaches.ResultsFor HP, PEJ, and CE cancer, the upper and middle cervical lymph node metastatic rates were 85.7%, 47.1%, and 5.8%, respectively; the lower cervical lymph node metastatic rates were 36.7%, 42.9%, and 35.0%, respectively; and the mediastinal lymph node metastatic rates were 2.0%, 72.9%, and 80.6%, respectively. The 3-year overall survival rates were 69.5% in the HP group, 52.0% in the PEJ group, and 69.6% in the CE group (p = 0.024). No survival differences were found between the involved-field-irradiation and elective-node-irradiation subgroups among PEJ tumors (p = 0.717 for OS and p = 0.454 for PFS, respectively).ConclusionHP cancers had a high prevalence in all cervical lymph node metastases, while CE cancers had a lower prevalence in the cervical and mediastinal lymph node metastases. PEJ cancer had the combined metastatic patterns of both HP and CE cancers. Involved field irradiation was feasible in chemoradiotherapy for PEJ cancers.

An Integrated Remote-Sensing and GIS Approach for Mapping Past Tin Mining Landscapes in Northwest Iberia

Northwest Iberia can be considered as one of the main areas where tin was exploited in antiquity. However, the location of ancient tin mining and metallurgy, their date and the intensity of tin production are still largely uncertain. The scale of mining activity and its socio-economical context have not been truly assessed, nor its evolution over time. With the present study, we intend to present an integrated, multiscale, multisensor and interdisciplinary methodology to tackle this problem. The integration of airborne LiDAR and historic aerial imagery has enabled us to identify and map ancient tin mining remains on the Tinto valley (Viana do Castelo, northern Portugal). The combination with historic mining documentation and literature review allowed us to confirm the impact of modern mining and define the best-preserved ancient mining areas for further archaeological research. After data processing and mapping, subsequent ground-truthing involved field survey and geological sampling that confirmed cassiterite exploitation as the key feature of the mining works. This non-invasive approach is of importance for informing future research and management of these landscapes.

Predicted Risks of Cardiovascular Disease Following Chemotherapy and Radiotherapy in the UK NCRI RAPID Trial of Positron Emission Tomography–Directed Therapy for Early-Stage Hodgkin Lymphoma

PURPOSE The contemporary management of early-stage Hodgkin lymphoma (ES-HL) involves balancing the risk of late adverse effects of radiotherapy against the increased risk of relapse if radiotherapy is omitted. This study provides information on the risk of radiation-related cardiovascular disease to help personalize the delivery of radiotherapy in ES-HL. METHODS We predicted 30-year absolute cardiovascular risk from chemotherapy and involved field radiotherapy in patients who were positron emission tomography (PET)–negative following three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy within a UK randomized trial of PET-directed therapy for ES-HL. Cardiac and carotid radiation doses and chemotherapy exposure were combined with established dose-response relationships and population-based mortality and incidence rates. RESULTS Average mean heart dose was 4.0 Gy (range 0.1-24.0 Gy) and average bilateral common carotid artery dose was 21.5 Gy (range 0.6-38.1 Gy), based on individualized cardiovascular dosimetry for 144 PET-negative patients receiving involved field radiotherapy. The average predicted 30-year radiation-related absolute excess overall cardiovascular mortality was 0.56% (range 0.01%-6.79%; < 0.5% in 67% of patients and > 1% in 15%), whereas average predicted 30-year excess incidence was 6.24% (range 0.31%-31.09%; < 5% in 58% of patients and > 10% in 24%). For cardiac disease, the average predicted 30-year radiation-related absolute excess mortality was 0.42% (0.79% with mediastinal involvement and 0.05% without) and for stroke, it was 0.14%. CONCLUSION Predicted excess cardiovascular risk is small for most patients, so radiotherapy may provide net benefit. However, for a minority of patients receiving high doses of radiation to cardiovascular structures, it may be preferable to consider advanced radiotherapy techniques to reduce doses or to omit radiotherapy and accept the increased relapse risk. Individual assessment of cardiovascular and other risks before treatment would allow personalized decision making about radiotherapy in ES-HL.

Involved Site Radiotherapy Extends Time to Premature Menopause in Infra-Diaphragmatic Female Hodgkin Lymphoma Patients – An Analysis of GHSG HD14- and HD17-Patients

IntroductionConsolidation radiotherapy in intermediate stage Hodgkin´s lymphoma (HL) has been the standard of care for many years as involved field radiotherapy (IFRT) after chemotherapy. It included initially involved region(s). Based on randomized studies, radiation volumes could be reduced and involved site radiation therapy (ISRT) became the new standard. ISRT includes the initially affected lymph nodes. In young adults suffering from HL, infertility and hypogonadism are major concerns. With regard to these questions, we analyzed the influence of modern radiotherapy concepts such as consolidating ISRT in infradiaphragmatic involvement of HL after polychemotherapy.Patients and MethodsFive hundred twelve patients treated within German Hodgkin Study Group (GHSG) HD14 and HD17 trials were evaluated. We analyzed log-adjusted follicle-stimulating-hormone (FSH)- and luteinizing-hormone (LH)-levels of HD14-patients with infradiaphragmatic radiotherapy (IDRT) in comparison with HD14-patients, who had a supradiaphragmatic radiotherapy (SDRT). In a second step, we compared IFRT with ISRT of female HD17 patients regarding the effects on ovarian function and premature menopause.ResultsWe analyzed FSH- and LH-levels of 258 female and 241 male patients, all treated with IFRT. Of these 499 patients, 478 patients had SDRT and 21 patients had IDRT. In a multiple regression model, we could show that log-adjusted FSH (p=0.0006) and LH values (p=0.0127) were significantly higher after IDRT than after SDRT. The effect of IDRT on gonadal function was comparable to two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPesc). We compared the effect of IFRT with ISRT in thirteen female HD17 patients with infradiaphragmatic (ID) involvement. The mean ovarian dose after ISRT was significantly lower than after IFRT. The calculated proportion of surviving non-growing follicles (NGFs) increased significantly from 11.87% to 24.48% in ISRT compared to IFRT, resulting in a significantly longer calculated time to menopause. The younger the age at therapy, the greater the absolute time gain until menopause.ConclusionInfradiaphragmatic IFRT impairs gonadal function to a similar extent as two cycles of BEACOPPesc. In comparison, the use of ISRT target volume definition significantly reduced radiation dose to the ovaries and significantly extends the time interval from treatment to premature menopause.

Indoor Thermal Environment of Various Semi-Enclosed Atrium Configurations of Institutional Building in Tropical Climate

The consideration of local climate is essential for the application of atrium in building. Different strategies and approaches in atrium configuration are required for different climates in ensuring its effectiveness. Nevertheless, the final aim is still similar which is to provide a comfortable environment for the users. Hence, this study was executed to examine the effects of top and side configurations on the indoor thermal environment of semi-enclosed atrium in the tropical climate. The methodologies involved field measurement and questionnaire survey. The field measurements were executed at two different configurations of semi-enclosed atriums in the tropical climate of Malaysia. Meanwhile, the questionnaire surveys were executed simultaneously with the field measurements in obtaining the users’ thermal sensation and satisfaction. The findings indicated that the top configuration had more influence to the indoor thermal environment compared to the side configuration as it determined the amount of solar heat penetration into the atrium area. Meanwhile, the side configuration influenced the air velocity inside the atrium. The Faculty of Engineering and Built Environment’s atrium that has opaque top finishes was found to have the average indoor operative temperature of less than 30 °C throughout the day, though the average outdoor air temperature was more than 30 °C. It also had more hours with neutral thermal sensation felt by the users compared to the Faculty of Economics and Management’s atrium that has transparent materials for the top finishes. The study is useful in guiding the selection of appropriate strategy for an atrium in tropical climate

Dendroclimatic Analysis of Central Appalachian Red Spruce in West Virginia

We conducted dendroclimatic analyses and constructed future growth projections for red spruce (Picea rubens Sarg.) throughout the central Appalachians in the state of West Virginia. This study involved field sampling of 18 sites across red spruce’s range throughout Monongahela National Forest in 6 regions based on pairwise combinations of three latitudinal groups (north, central, and southern latitudes) with two aspects (north and south aspect). Each combination of latitudinal group and aspect was referred to as a landscape cluster. Growth was negatively impacted by high summer temperature stress, but responded favorably to high fall temperatures. The results also suggested that red spruce was likely impacted by the degree of winter harshness in all landscape clusters. In the northern latitudinal landscape clusters, red spruce responded favorably to warm spring temperatures by allowing an early start to the growing season. Growth projections under a future climate change scenario show that future expected increases in mean and maximum monthly temperatures will have negative effects on future spruce growth. The forecasting results suggested that red spruce in northern latitudes on south aspects or central latitudes on north aspects are the landscape clusters that will likely be the most resilient to future climate change. Dendroclimatic results and future growth projections can assist with identifying locations that are most suitable for future red spruce restoration activities.

SFD Promotion Initiative: Cap-Haïtien, Haiti

The Shit Flow Diagram (SFD) graphic is an advocacy tool that aims to assist technical and non-technical stakeholders to implement plans and programs related to urban sanitation. The SFD methodology is increasingly being used to analyze the extent of safely managed sanitation in urban areas, providing a valuable picture of the prevailing sanitation conditions, from containment to disposal. As such, it is a widely recognized advocacy and decision support tool that aims to understand, communicate, and visualize how wastewater and fecal sludge move within a city or town. As stated on the SuSanA website, the SFD methodology offers “a new and innovative way to engage sanitation experts, political leaders, and civil society in coordinated discussions about excreta management in their city”. The production and publication of an SFD report for Cap-Haitien (Haiti) would help to visualize the current sanitation situation in the city, resulting in a potential to shift current activities and efforts towards more efficient investments in the places along the sanitation chain that need more attention, improving the urban sanitation situation and the surrounding environment of the city. The structure of this SFD report consists of an executive summary and the SFD report. The latter includes: i) general city information describing its main characteristics; ii) sanitation service outcomes, with a thorough explanation of the SFD graphic outcome and the assumptions made; iii) the service delivery context analysis, which contains information on the regulatory framework of water and sanitation at country and city levels, and describes the city plans, budget and future projects to improve the sanitation situation and; iv) a detailed description of the surveys, Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) conducted, as well as the key stakeholders involved, field visits carried out and references used to develop this SFD report.