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Hepatobiliary & Pancreatic Diseases... Feb 2024Stereotactic body radiotherapy (SBRT) in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue. This review aimed at... (Review)
Review
BACKGROUND
Stereotactic body radiotherapy (SBRT) in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue. This review aimed at the SBRT application in the treatment of pancreatic cancer.
DATA SOURCES
We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022. Keywords used in the search included: "pancreatic adenocarcinoma" OR "pancreatic cancer" AND "stereotactic ablative radiotherapy (SABR)" OR "stereotactic body radiotherapy (SBRT)" OR "chemoradiotherapy (CRT)". English language articles with information on technical characteristics, doses and fractionation, indications, recurrence patterns, local control and toxicities of SBRT in pancreatic tumors were included. All articles were assessed for validity and relevant content.
RESULTS
Optimal doses and fractionation have not yet been defined. However, SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT. Furthermore, the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.
CONCLUSIONS
SBRT is an effective modality for patients with pancreatic cancer, supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control. SBRT opens a possibility of improving outcomes for these patients, both in neoadjuvant treatment and with radical intent.
Topics: Humans; Pancreatic Neoplasms; Adenocarcinoma; Radiosurgery; Neoadjuvant Therapy; Chemoradiotherapy
PubMed: 36990839
DOI: 10.1016/j.hbpd.2023.03.002 -
Acta Obstetricia Et Gynecologica... Dec 2023Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral...
INTRODUCTION
Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis.
MATERIAL AND METHODS
This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression - improvement (CGI-I), 15D-measure of health-related quality of life, and Biberoglu and Behrman (B&B) score.
RESULTS
A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one-year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2-9) years, with no correlation between the severity of symptoms and the duration of the disease (p = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain-related items. Worst experienced daily pain decreased among those who returned 12-month questionnaires from median 9 to 5 (p = 0.006), average daily pain from 6 to 3.5 (p = 0.004), and least daily pain from 3 to 1 (p = 0.004). Based on the CGI questionnaire (n = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (p < 0.001), 6 months (p = 0.001) and 12 months (p = 0.018), when the results were compared to baseline values. Median B&B score also improved significantly and decreased from a baseline value of 8 (4-12) to 4.5 (0-6), p = 0.002.
CONCLUSIONS
Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients.
Topics: Humans; Female; Endometriosis; Prospective Studies; Quality of Life; Pilot Projects; Pelvic Pain; Treatment Outcome; Electric Stimulation Therapy; Chronic Pain
PubMed: 37814355
DOI: 10.1111/aogs.14690 -
Technical Innovations & Patient Support... Sep 2023Liver stereotactic body radiotherapy (SBRT) is increasingly being used to treat tumours. The purpose of this study was to compare the differences in patient positioning...
INTRODUCTION
Liver stereotactic body radiotherapy (SBRT) is increasingly being used to treat tumours. The purpose of this study was to compare the differences in patient positioning when using implanted fiducials as surrogates compared to alternative methods based on liver contour or bone registration.
MATERIAL AND METHODS
Eighteen patients treated with SBRT who underwent a fiducial placement procedure were included. Fiducial guidance was our gold standard to guide treatment in this study. After recording the displacements, when fusing the planning CT and CBCT performed in the treatment unit using fiducials, liver contour and bone reference, the differences between fiducials and liver contour and bone reference were calculated. Data from 88 CBCT were analyzed. The correlation between the displacements found with fiducials and those performed based on the liver contour and the nearest bone structure as references was determined. The mean, median, variance, range and standard deviation of the displacements with each of the fusion methods were obtained. μ, Ʃ, and σ values and margins were obtained.
RESULTS
Lateral displacements of less than 3 mm with respect to the gold standard in 92% vs. 62.5% of cases using liver contour and bone references, respectively, with 93.2% vs. 65.9% in the AP axis and SI movement in 69.3% vs. 51.1%. The errors μ, σ and Ʃ of the fusions with hepatic contour and bone reference in SI were 0.26 mm, 4 mm and 3 mm, and 0.8 mm, 5 mm and 3 mm respectively.
CONCLUSION
Our study showed that displacements were smaller with the use of hepatic contour compared to bone reference and comparable to those obtained with the use of fiducials in the lateral, AP and SI motion axes. This would justify that hepatic contouring can be a guide in the treatment of patients in the absence of fiducials.
PubMed: 37744524
DOI: 10.1016/j.tipsro.2023.100215 -
Plants (Basel, Switzerland) Jul 2023The environment is the main factor affecting variations in phytochemicals and antioxidant activity in rice. The objective of this study was to evaluate the stability of...
The environment is the main factor affecting variations in phytochemicals and antioxidant activity in rice. The objective of this study was to evaluate the stability of grain yield, phytochemicals and antioxidant capacity of six rice genotypes. Six rice genotypes were evaluated in a randomized complete block design with three replicates at three locations in Trat, Bangkok and Sakon Nakhon provinces in July-October 2019. Data on grain yield, yield components, total phenolic content, ferulic acid and antioxidant capacity were recorded. Grain yield was highest for crops grown in Bangkok, whereas antioxidant activity was highest for crops grown in Bangkok and Sakon Nakhon. Hom Nang Nual 1 and Mali Nil Boran had the highest grain yield. Riceberry had the highest grain yield in Trat; it also had high levels of total phenolic compounds, ferulic acid and antioxidant activity. Mali Nil Boran, Mali Nil Surin and Riceberry had the most stable total phenolic content, ferulic acid and antioxidant activity, respectively. Information on the levels and variability of phytochemicals in rice enables the selection of genotypes with high and stabile phytochemicals for production and rice breeding.
PubMed: 37570941
DOI: 10.3390/plants12152787 -
Cancer Diagnosis & Prognosis 2023The optimal imaging test for delineation of the gross tumor volume (GTV) in hepatocellular carcinoma has not been defined. The hypothesis is that magnetic resonance...
BACKGROUND/AIM
The optimal imaging test for delineation of the gross tumor volume (GTV) in hepatocellular carcinoma has not been defined. The hypothesis is that magnetic resonance imaging (MRI) allows for better visualization of the extent of tumor and will optimize the accuracy of tumor delineation for liver stereotactic radiotherapy compared with computed tomography (CT) only. We evaluated the interobserver agreement in GTV of hepatocellular carcinoma in a multicenter panel and compared MRI and CT in GTV delineation.
MATERIALS AND METHODS
After the institutional review boards approved the study, we analyzed anonymous CT and MRI obtained from five patients with hepatocellular carcinoma. Eight radiation oncologists at our center used CT and MRI to delineate five GTVs of liver tumors. In both CT and MRI, the GTV volumes were compared.
RESULTS
The median GTV volume on MRI was 2.4 cm (range=0.59-15.6 cm) compared to 3.5 cm (range=0.52-24.9 cm) on CT (p=0.36). The GTV volume as defined on MRI was larger or at least as large as the GTV volume on CT in two cases. Variance and standard deviation between observers in CT and MRI were minor (6 vs. 7.87 cm, and 2.5 vs. 2.8 cm respectively).
CONCLUSION
In cases with well-defined tumors, CT is easier and reproducible. In cases with no defined tumor in CT, other tools are needed and MRI can be complementary. The interobserver variability in target delineation of hepatocellular carcinoma in this study is noteworthy.
PubMed: 37405211
DOI: 10.21873/cdp.10236 -
Gut May 2024Pancreatic ductal adenocarcinoma (PDAC) has limited therapeutic options, particularly with immune checkpoint inhibitors. Highly chemoresistant 'stem-like' cells, known...
OBJECTIVE
Pancreatic ductal adenocarcinoma (PDAC) has limited therapeutic options, particularly with immune checkpoint inhibitors. Highly chemoresistant 'stem-like' cells, known as cancer stem cells (CSCs), are implicated in PDAC aggressiveness. Thus, comprehending how this subset of cells evades the immune system is crucial for advancing novel therapies.
DESIGN
We used the KPC mouse model () and primary tumour cell lines to investigate putative CSC populations. Transcriptomic analyses were conducted to pinpoint new genes involved in immune evasion. Overexpressing and knockout cell lines were established with lentiviral vectors. Subsequent coculture assays, mouse and zebrafish tumorigenesis studies, and database approaches were performed.
RESULTS
Using the KPC mouse model, we functionally confirmed a population of cells marked by EpCAM, Sca-1 and CD133 as authentic CSCs and investigated their transcriptional profile. Immune evasion signatures/genes, notably the gene peptidoglycan recognition protein 1 (PGLYRP1), were significantly overexpressed in these CSCs. Modulating PGLYRP1 impacted CSC immune evasion, affecting their resistance to macrophage-mediated and T-cell-mediated killing and their tumourigenesis in immunocompetent mice. Mechanistically, tumour necrosis factor alpha (TNFα)-regulated PGLYRP1 expression interferes with the immune tumour microenvironment (TME) landscape, promoting myeloid cell-derived immunosuppression and activated T-cell death. Importantly, these findings were not only replicated in human models, but clinically, secreted PGLYRP1 levels were significantly elevated in patients with PDAC.
CONCLUSIONS
This study establishes PGLYRP1 as a novel CSC-associated marker crucial for immune evasion, particularly against macrophage phagocytosis and T-cell killing, presenting it as a promising target for PDAC immunotherapy.
PubMed: 38754953
DOI: 10.1136/gutjnl-2023-330995 -
Foods (Basel, Switzerland) Jan 2024Parboiling influences chemical compositions in rice grains. The objectives of this study were to evaluate the change in chemical content, total phenolic content and...
Parboiling influences chemical compositions in rice grains. The objectives of this study were to evaluate the change in chemical content, total phenolic content and antioxidant capacity of landrace rice genotypes under parboiling conditions and to identify the genotypes suitable for production of parboiled rice. Landrace rice varieties used in this study consisted of Glam Feang, Glam Tonkeaw, Kawgum, Glam Luem Phua, Medmakham, Deang Sakonnakhon, Sang Yod, Kawniewd-eang, Mali Deang, KDML105 and RD6. Parboiling reduced fiber content, total phenolic content and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical-scavenging activity in rice grains. Fiber contents were 1.46% in brown rice (unpolished rice) and 1.40% in parboiled rice (24 h of soaking and 48 h of incubation). Total phenolic contents were 205.67 mg/100 g seed in brown rice and 35.34 mg/100 g seed in parboiled rice. Antioxidant capacity (DPPH) reduced from 68.45% in brown rice to 26.23% in parboiled rice. Ash content and protein content were not significantly affected by the parboiling process. Medmakham cv. had the highest total phenolic content and antioxidant capacity in brown rice and parboiled rice. Gum Leamphea cv. and Medmakham cv. were the best genotypes for ash content, protein content, total phenolic content and antioxidant capacity (DPPH) in brown rice and parboiled rice. Glam Feang cv. had the highest protein contents in brown rice and parboiled rice although it had low total phenolic content and antioxidant capacity. Cluster analysis further showed variation among genotypes, revealing distinct groupings in brown rice and parboiled rice based on chemical properties, phenolic content and antioxidant capacity. This research significantly contributes to a better understanding on how parboiling affects rice compositions and nutritional values. It emphasizes the importance of nuanced comprehension of how different rice varieties respond to parboiling, aiding informed decisions in rice processing and selection to meet specific nutritional needs.
PubMed: 38338528
DOI: 10.3390/foods13030393 -
International Journal of Surgical... Dec 2023
Topics: Humans; Dendritic Cell Sarcoma, Follicular; Dendritic Cells, Follicular; Proto-Oncogene Proteins c-mdm2
PubMed: 37016745
DOI: 10.1177/10668969231160260 -
Annals of Surgical Oncology Oct 2023Intraoperative examination of retro-areolar margin (IERM) often is used during nipple-sparing mastectomy (NSM) for cancer, but there is no robust data regarding its real...
BACKGROUND
Intraoperative examination of retro-areolar margin (IERM) often is used during nipple-sparing mastectomy (NSM) for cancer, but there is no robust data regarding its real advantage.
METHODS
Consecutive patients undergoing NSM for cancer with omission of IERM according to institutional protocols from 2016 to 2021 were retrospectively analyzed. The decision to maintain or remove the Nipple-Areola Complex (NAC) after definitive pathology was taken at the multidisciplinary meeting.
RESULTS
Among 162 women operated in the study period, the presence of neoplastic cells within 2 mm from the inked retroareolar margin (RAM) was detected at permanent pathology in 17 cases (10.5%). Nipple-Areola-Complex (NAC) was removed postoperatively in five patients (3%) for margins <1 mm, the other 12 were observed, whereas postoperative NAC necrosis required surgical removal in additional five cases (3%). The NAC was thus preserved in 152 of 162 patients (94%). At multivariate analysis, RAM ≤2 mm was associated with radiological tumor-to-nipple distance less than or equal to 1 cm (p = 0.04) and Ki67 label index ≥ 20 (p = 0.04), whereas multifocality/multicentricity showed a trend towards significance (p = 0.07). At a median follow-up of 46 months, five locoregional relapses occurred (3%), only one of them involving the NAC (0, 6%). Locoregional relapse and overall survival for patients with RAM > or < 2 mm were not different.
CONCLUSIONS
IERM is not routinely necessary during NSM for cancer, because its omission is associated with a very low return to the operating room, it is oncologically safe, and associated pitfalls are avoided. Further studies are necessary to confirm these findings.
Topics: Humans; Female; Mastectomy; Nipples; Retrospective Studies; Breast Neoplasms; Mastectomy, Subcutaneous; Mammaplasty
PubMed: 37391672
DOI: 10.1245/s10434-023-13726-7 -
Annals of Surgical Oncology May 2024Sentinel lymph node (SLN) biopsy for cN+ breast cancer patients after neoadjuvant chemotherapy (NAC) is controversial because the false-negative rate (FNR) is high....
BACKGROUND
Sentinel lymph node (SLN) biopsy for cN+ breast cancer patients after neoadjuvant chemotherapy (NAC) is controversial because the false-negative rate (FNR) is high. Identification of three or more SLNs with a dual tracer improves these results, and inclusion of a clipped lymph node (CLN) (targeted axillary dissection [TAD]) may be even more effective.
METHODS
A retrospective, single-institution analysis of consecutive cN+ patients undergoing NAC from 2019 to 2021 was performed. Patients routinely underwent placement of a clip in the positive lymph node before NAC, and TAD was performed after completion of therapy.
RESULTS
The study analyzed 73 patients, and the identification rate for CLN was 98.6% (72/73). A complete response in the lymph nodes was achieved for 43 (59%) of the 73 patients. Overall, the CLN was not a SLN in 18 (25%) of 73 cases, and for women who had one or two and those who had three or more SLNs identified, this occurred in 11 (32%) and 7 (21%) of 34 cases, respectively. Failure of SLN or TAD to identify a positive residual lymph node status after NAC occurred in 10 (15%) of 69 and 2 (3%) of 73 cases, respectively (p = 0.01). In four cases, a SLN was not retrieved (5.5%), and two of these cases had a positive CLN. In three cases, the CLN was the only positive node and did not match with a SLN, directing lymphadenectomy and oncologic management change in two cases. Therefore, 7 (10%) of 73 cases had a change in surgical or oncologic management with TAD.
CONCLUSIONS
For a conservative axillary treatment in this setting, TAD is an effective method. It is more accurate than SLN alone and allows management changes. Further studies are warranted.
Topics: Humans; Female; Breast Neoplasms; Neoadjuvant Therapy; Retrospective Studies; Lymphatic Metastasis; False Negative Reactions; Sentinel Lymph Node Biopsy; Lymph Nodes; Lymph Node Excision; Axilla; Neoplasm Staging; Sentinel Lymph Node
PubMed: 38427160
DOI: 10.1245/s10434-024-15052-y