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SAGE Open Medicine 2020In this study, we evaluated the use and the contribution of radiopharmaceuticals to the field of lung neoplasms imaging using positron emission tomography/computed... (Review)
Review
INTRODUCTION
In this study, we evaluated the use and the contribution of radiopharmaceuticals to the field of lung neoplasms imaging using positron emission tomography/computed tomography.
METHODS
We conducted review of the current literature at PubMed/MEDLINE until February 2020. The search language was English.
RESULTS
The most widely used radiopharmaceuticals are the following:Experimental/pre-clinical approaches: (18)F-Misonidazole (18F-MISO) under clinical development, D(18)F-Fluoro-Methyl-Tyrosine (18F-FMT), 18F-FAMT (L-[3-18F] (18)F-Fluorothymidine (18F-FLT)), (18)F-Fluoro-Azomycin-Arabinoside (18F-FAZA), (68)Ga-Neomannosylated-Human-Serum-Albumin (68Ga-MSA) (23), (68)Ga-Tetraazacyclododecane (68Ga-DOTA) (as theranostic agent), (11)C-Methionine (11C-MET), 18F-FPDOPA, αβ integrin, Ga-RGD, Cu-DOTA-RGD, F-Alfatide, Folate Radio tracers, and immuno-positron emission tomography radiopharmaceutical agents.Clinically approved procedures/radiopharmaceuticals agents: (18)F-Fluoro-Deoxy-Glucose (18F-FDG), (18)F-sodium fluoride (18F-NaF) (bone metastases), and (68)Ga-Tetraazacyclododecane (68Ga-DOTA). The quantitative determination and the change in radiopharmaceutical uptake parameters such as standard uptake value, metabolic tumor volume, total lesion glycolysis, FAZA tumor to muscle ratio, standard uptake value tumor to liver ratio, standard uptake value tumor to spleen ratio, standard uptake value maximum ratio, and the degree of hypoxia have prognostic and predictive (concerning the therapeutic outcome) value. They have been associated with the assessment of overall survival and disease free survival. With the positron emission tomography/computed tomography radiopharmaceuticals, the sensitivity and the specificity of the method have increased.
CONCLUSION
In terms of lung cancer, positron emission tomography/computed tomography may have clinical application and utility (a) in personalizing treatment, (b) as a biomarker for the estimation of overall survival, disease free survival, and (c) apply a cost-effective patient approach because it reveals focuses of the disease, which are not found with the other imaging methods.
PubMed: 33062275
DOI: 10.1177/2050312120961594 -
Metabolism: Clinical and Experimental Nov 2019Cholesterol efflux is the initial step in the reverse cholesterol transport pathway by which excess cholesterol in peripheral cells is exported and subsequently packaged...
Cholesterol efflux is the initial step in the reverse cholesterol transport pathway by which excess cholesterol in peripheral cells is exported and subsequently packaged into high-density lipoprotein (HDL) particles. Adiponectin is the most abundantly secreted adipokine that possesses anti-inflammatory and vasculoprotective properties via interaction with transmembrane receptors, AdipoR1 and AdipoR2. Evidence suggests that low levels of adiponectin may be a useful marker for atherosclerotic disease. A proposed anti-atherogenic mechanism of adiponectin involves its ability to promote cholesterol efflux. We performed a systematic review of the role of adiponectin in cholesterol efflux and HDL biogenesis, and of the proteins and receptors believed to be implicated in this process. Nineteen eligible studies (7 clinical, 11 fundamental, 1 clinical + fundamental) were identified through Ovid Medline, Ovid Embase, and Pubmed, that support the notion that adiponectin plays a key role in promoting ABCA1-dependent cholesterol efflux and in modulating HDL biogenesis via activation of the PPAR-γ/LXR-α signalling pathways in macrophages. AdipoR1 and AdipoR2 are suggested to also be implicated in this process, however the data are conflicting/insufficient to establish any firm conclusions. Once the exact mechanisms are unravelled, adiponectin may be critical in defining future treatment strategies directed towards increasing HDL functionality and ultimately reducing atherosclerotic disease.
Topics: ATP Binding Cassette Transporter 1; Adiponectin; Animals; Biological Transport; Cholesterol; Humans; Lipoproteins, HDL; Liver; Macrophages; Receptors, Adiponectin
PubMed: 31377319
DOI: 10.1016/j.metabol.2019.153953 -
Journal of Neuro-oncology Aug 2021Since frameless stereotactic radiosurgery (SRS) techniques have been recently introduced, hypofractionated SRS (HF-SRS) for large brain metastases (BMs) is gradually...
PURPOSE
Since frameless stereotactic radiosurgery (SRS) techniques have been recently introduced, hypofractionated SRS (HF-SRS) for large brain metastases (BMs) is gradually increasing. To verify the efficacy and safety of HF-SRS for large BMs, we aimed to perform a systematic review and compared them with SF-SRS.
METHODS
We systematically searched the studies regarding SF-SRS or HF-SRS for large (> 2 cm) BM from databases including PubMed, Embase, and the Cochrane Library on July 31, 2018. Biologically effective dose with the α/β ratio of 10 (BED), 1-year local control (LC), and radiation necrosis (RN) were compared between the two groups, with the studies being weighted by the sample size.
RESULTS
The 15 studies with 1049 BMs that described 1-year LC and RN were included. HF-SRS tended to be performed in larger tumors; however, higher mean BED (50.1 Gy versus 40.4 Gy, p < 0.0001) was delivered in the HF-SRS group, which led to significantly improved 1-year LC (81.6 versus 69.0%, p < 0.0001) and 1-year overall survival (55.1 versus 47.2%, p < 0.0001) in the HF-SRS group compared to the SF-SRS group. In contrast, the incidence of radiation toxicity was significantly decreased in the HF-SRS group compared to the SF-SRS group (8.0 versus 15.6%, p < 0.0001).
CONCLUSION
HF-SRS results in better LC of large BMs while simultaneously reducing RN compared to SF-SRS. Thus, HF-SRS should be considered a priority for SF-SRS in patients with large BMs who are not suitable to undergo surgical resection.
Topics: Brain Neoplasms; Humans; Radiosurgery; Treatment Outcome
PubMed: 34268640
DOI: 10.1007/s11060-021-03805-8 -
Clinical Orthopaedics and Related... Nov 2016Polyetheretherketone (PEEK) and its composites are polymers resistant to fatigue strain, radiologically transparent, and have mechanical properties suitable for a range... (Review)
Review
BACKGROUND
Polyetheretherketone (PEEK) and its composites are polymers resistant to fatigue strain, radiologically transparent, and have mechanical properties suitable for a range of orthopaedic applications. In bulk form, PEEK composites are generally accepted as biocompatible. In particulate form, however, the biologic response relevant to joint replacement devices remains unclear. The biologic response to wear particles affects the longevity of total joint arthroplasties. Particles in the phagocytozable size range of 0.1 µm to 10 µm are considered the most biologically reactive, particularly particles with a mean size of < 1 µm. This systematic review aimed to identify the current evidence for the biologic response to PEEK-based wear debris from total joint arthroplasties.
QUESTIONS/PURPOSES
(1) What are the quantitative characteristics of PEEK-based wear particles produced by total joint arthroplasties? (2) Do PEEK wear particles cause an adverse biologic response when compared with UHMWPE or a similar negative control biomaterial? (3) Is the biologic response affected by particle characteristics?
METHODS
Embase and Ovid Medline databases were searched for studies that quantified PEEK-based particle characteristics and/or investigated the biologic response to PEEK-based particles relevant to total joint arthroplasties. The keyword search included brands of PEEK (eg, MITCH, MOTIS) or variations of PEEK types and nomenclature (eg, PAEK, CFR-PEEK) in combination with types of joint (eg, hip, knee) and synonyms for wear debris or immunologic response (eg, particles, cytotoxicity). Peer-reviewed studies, published in English, investigating total joint arthroplasty devices and cytotoxic effects of PEEK particulates were included. Studies investigating devices without articulating bearings (eg, spinal instrumentation devices) and bulk material or contact cytotoxicity were excluded. Of 129 studies, 15 were selected for analysis and interpretation. No studies were found that isolated and characterized PEEK wear particles from retrieved periprosthetic human tissue samples.
RESULTS
In the four studies that quantified PEEK-based particles produced using hip, knee, and spinal joint replacement simulators, the mean particle size was 0.23 µm to 2.0 µm. The absolute range reported was approximately 0.01 µm to 50 µm. Rod-like carbon particulates and granular-shaped PEEK particles were identified in human tissue by histologic analysis. Ten studies, including six animal models (rat, mouse, and rabbit), three cell line experiments, and two human tissue retreival studies, investigated the biologic response to PEEK-based particles. Qualitative histologic assessments showed immunologic cell infiltration to be similar for PEEK particles when compared with UHMWPE particles in all six of the animal studies identified. However, increased inflammatory cytokine release (such as tumor necrosis factor-α) was identified in only one in vitro study, but without substantial suppression in macrophage viability. Only one study tested the effects of particle size on cytotoxicity and found the largest unfilled PEEK particles (approximately 13 µm) to have a toxic effect; UHMWPE particles in the same size range showed a similar cytotoxic effect.
CONCLUSIONS
Wear particles produced by PEEK-based bearings were, in almost all cases, in the phagocytozable size range (0.1-10 µm). The studies that evaluated the biologic response to PEEK-based particles generally found cytotoxicity to be within acceptable limits relative to the UHMWPE control, but inconsistent when inflammatory cytokine release was considered.
CLINICAL RELEVANCE
To translate new and advanced materials into clinical use more quickly, the clinical relevance and validity of preclinical tests need to be improved. To achieve this for PEEK-based devices, human tissue retrieval studies including subsequent particle isolation and characterization analyses are required. In vitro cell studies using isolated wear particles from tissue or validated joint replacement simulators, instead of manufactured particles, are also required.
Topics: Animals; Arthroplasty, Replacement; Benzophenones; Cytokines; Foreign-Body Reaction; Humans; Inflammation Mediators; Joint Prosthesis; Ketones; Particle Size; Phagocytosis; Polyethylene Glycols; Polyethylenes; Polymers; Prosthesis Design; Prosthesis Failure; Risk Factors; Stress, Mechanical; Treatment Outcome
PubMed: 27432420
DOI: 10.1007/s11999-016-4976-z -
Journal of the American Academy of... Mar 2021
Meta-Analysis
Incidence of dermatologic adverse events in patients with cancer treated with concurrent immune checkpoint inhibitors and radiation therapy: A systematic review and meta-analysis.
Topics: Chemoradiotherapy; Clinical Trials as Topic; Drug Eruptions; Humans; Immune Checkpoint Inhibitors; Incidence; Neoplasms; Radiodermatitis
PubMed: 33137440
DOI: 10.1016/j.jaad.2020.10.071 -
Radiotherapy and Oncology : Journal of... Mar 2018To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND AND PURPOSE
To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin.
MATERIALS AND METHODS
Studies including patients with T1-2 N0 SCCs/BCCs treated with definitive EBRT/BT and ≥10 months follow-up were analyzed. The primary endpoint was post-treatment cosmesis, categorized as "good," "fair," or "poor." The secondary endpoint was LR. Mixed effects regression models were used to estimate weighted linear relationships between biologically equivalent doses with α/β = 3 (BED) and cosmetic outcomes.
RESULTS
A total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88-100%) vs 79% (95% CI: 60-82%), p < 0.05. Similar results were found for "good" cosmesis at BED >100 Gy. No difference in "poor" cosmesis was noted at any BED. LR was <7% for both at one year.
CONCLUSION
BT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.
Topics: Aged; Brachytherapy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Dose Fractionation, Radiation; Humans; Radiotherapy Dosage; Skin Neoplasms
PubMed: 29370985
DOI: 10.1016/j.radonc.2017.12.029 -
The Journal of Urology Nov 2015Despite established evidence for using patient decision aids, use with newly diagnosed patients with prostate cancer remains limited partly due to variability in aid...
PURPOSE
Despite established evidence for using patient decision aids, use with newly diagnosed patients with prostate cancer remains limited partly due to variability in aid characteristics. We systematically reviewed decision aids for newly diagnosed patients with prostate cancer.
MATERIALS AND METHODS
Published peer reviewed journal articles, unpublished literature on the Internet and the Ottawa decision aids web repository were searched to identify decision aids designed for patients with prostate cancer facing treatment decisions. A total of 14 aids were included in study. Supplementary materials on aid development and published studies evaluating the aids were also included. We studied aids designed to help patients make specific choices among options and outcomes relevant to health status that were specific to prostate cancer treatment and in English only. Aids were reviewed for IPDAS (International Patient Decision Aid Standards) and additional standards deemed relevant to prostate cancer treatment decisions. They were also reviewed for novel criteria on the potential for implementation. Acceptable interrater reliability was achieved at Krippendorff α = 0.82.
RESULTS
Eight of the 14 decision aids (57.1%) were developed in the United States, 6 (42.8%) were print based, 5 (35.7%) were web or print based and only 4 (28.5%) had been updated since 2013. Ten aids (71.4%) were targeted to prostate cancer stage. All discussed radiation and surgery, 10 (71.4%) discussed active surveillance and/or watchful waiting and 8 (57.1%) discussed hormonal therapy. Of the aids 64.2% presented balanced perspectives on treatment benefits and risks, and/or outcome probabilities associated with each option. Ten aids (71.4%) presented value clarification prompts for patients and steps to make treatment decisions. No aid was tested with physicians and only 4 (28.6%) were tested with patients. Nine aids (64.2%) provided details on data appraisal and 4 (28.6%) commented on the quality of evidence used. Seven of the 8 web or computer based aids (87.5%) provided patients with the opportunity to interact with the aid. All except 1 aid scored above the 9th grade reading level. No evidence on aid implementation in routine practice was available.
CONCLUSIONS
As physicians look to adopt decision aids in practice, they may base the choice of aid on characteristics that correlate with patient socioeconomic and educational status, personal practice style and practice setting.
Topics: Decision Making; Disease Management; Humans; Male; Patient Participation; Prostatic Neoplasms
PubMed: 26055824
DOI: 10.1016/j.juro.2015.05.093 -
Supportive Care in Cancer : Official... Oct 2019Head and neck cancer (HNC) is a relatively common cancer which causes a significant health burden, impacting individuals physically and psychologically. HNC treatment...
PURPOSE
Head and neck cancer (HNC) is a relatively common cancer which causes a significant health burden, impacting individuals physically and psychologically. HNC treatment may result in facial disfigurement, eating and communication difficulties, and body image disturbances. We aimed to (1) identify HNC-specific patient-reported outcome measures (PROMs) used to assess body image, (2) evaluate their conceptual coverage, (3) appraise their development process and psychometric properties, and (4) determine appropriate body image PROM(s) for use in the HNC setting.
METHODS
Online databases were searched (July 2007-July 2017) for studies that assessed body image in patients with HNC. Studies were screened for eligibility. In addition, we searched three PROM databases for relevant PROMs. From available body image frameworks, we compiled a conceptual schema consisting of 18 clinically relevant body image issues important in the HNC setting, against which PROMs were assessed. Selected measures were appraised for psychometric characteristics, content, and readability.
RESULTS
A total of 245 records were retrieved. 18 studies with PROMs met our inclusion criteria, reporting eight PROMs. The PROM databases searched yielded 62 measures. After screening, eleven measures were short-listed and appraised. The Derriford Appearance Scale (DAS)-59, DAS-24, and body image scale (BIS) cover > 55% of issues within the body image conceptual schema; were developed based on literature, patient interviews, and clinician opinions; and have evidence of internal consistency (Cronbach alpha > 0.7), validity, and responsiveness.
CONCLUSIONS
We recommend the DAS-24 and BIS as having adequate coverage of HNC-related issues, and suitable for use in future research.
Topics: Body Image; Databases, Factual; Head and Neck Neoplasms; Humans; Patient Reported Outcome Measures; Psychometrics
PubMed: 31203508
DOI: 10.1007/s00520-019-04919-6 -
Journal of Medical Imaging and... Dec 2019Alpha emitters have always promised to deliver potential benefit in cancer therapy. Using the example of radium-223 (Xofigo) and the paradigm of ionising radiation, this...
Alpha emitters have always promised to deliver potential benefit in cancer therapy. Using the example of radium-223 (Xofigo) and the paradigm of ionising radiation, this review looks at targeted alpha therapy from the perspective of a radiation oncologist.
Topics: Alpha Particles; Humans; Male; Prostatic Neoplasms; Radiation Oncology; Radioisotopes; Radium
PubMed: 31427257
DOI: 10.1016/j.jmir.2019.06.044 -
International Journal of Radiation... Mar 2018Randomized trials of altered dose/fractionation for external beam radiation therapy are meta-analyzed with the aim of establishing the dose response and fractionation... (Meta-Analysis)
Meta-Analysis
PURPOSE
Randomized trials of altered dose/fractionation for external beam radiation therapy are meta-analyzed with the aim of establishing the dose response and fractionation sensitivity.
METHODS AND MATERIALS
Studies were identified through PubMed through April 1, 2017. Studies of any-risk prostate cancer patients and any modification of external beam radiation therapy were included. The outcomes and comparisons collected were hazard ratios for biochemical no evidence of disease (bNED) and overall survival (OS). Trial-by-trial estimates of the steepness of the dose-response curve for bNED were performed for dose-escalation trials, followed by inverse variance weighting. The steepness was used to extract estimates of α/β, which were subsequently synthesized. Both analyses were performed assuming no effect of overall treatment time and were repeated assuming a loss of 0.31 Gy/d for a protracted treatment time. Finally, all trials were included in the analyses of the dose response for fractionation-corrected doses. This analysis was repeated for OS. Finally, the per-trial effect on OS was compared to the effect on bNED.
RESULTS
We identified 13 randomized trials involving 10,184 patients. The dose response for bNED from dose-escalation trials was γ = 0.62 (95% confidence interval [CI] 0.37-0.87) and γ = 0.87 (95% CI 0.53-1.21) without and with the overall treatment time effect, respectively. The corresponding estimates of α/β from 8 fractionation trials (7946 patients) were 1.2 Gy (95% CI 0.8-1.7) and 2.7 Gy (95% CI 1.6-3.8). The heterogeneity in the data can be explained by the shallower dose response for bNED in trials with effective doses in the experimental arm >80 Gy equivalent dose in 2-Gy fractions (EQD2) (P = .04). No indication was found of a dose response for OS or a correlation with improvement in bNED.
CONCLUSIONS
The reported data of moderate hypofractionation are consistent with a low α/β value with narrow CIs. Dose-escalation trials have demonstrated a dose response for bNED. Escalating doses to >80 Gy EQD2 might not improve bNED. A correlation between benefit in bNED and OS was not found.
Topics: Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Humans; Male; Prostatic Neoplasms; Radiation Tolerance; Randomized Controlled Trials as Topic
PubMed: 29485063
DOI: 10.1016/j.ijrobp.2017.12.011