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Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.Conclusions: In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.

BACKGROUND: Large part of patients of stage IB non-small cell lung cancer (IB NSCLC) may suffer recurrence after surgery. This study is to determine risk factors and establish a nomogram for postoperative recurrence and to provide a reference for adjuvant chemotherapy selection in patients with stage IB NSCLC. METHODS: A total of 394 patients with postoperative stage IB NSCLC who visited Fujian Medical University Union Hospital between January 2010 and June 2016 were selected. Patients were divided into training and validation cohorts based on the time of diagnosis. Independent risk factors were identified using a Cox proportional hazards regression model. A nomogram was created to predict recurrence-free survival (RFS) and was validated with an independent cohort. The predictive ability of the nomogram was evaluated using the concordance index (C-index) and calibration curve. RFS between the high- and low-risk groups was determined using Kaplan-Meier curves, and subgroup analysis of chemotherapy was performed. RESULTS: Visceral pleura invasion, micropapillary structures, tumor size, preoperative serum carcinoembryonic antigen (CEA) level, preoperative serum cytokeratin-19 fragments (Cyfra21-1) level, and postoperative histology were identified as independent risk factors for stage IB NSCLC recurrence. Discrimination of the nomogram showed good prognostic accuracy and clinical applicability, with a C-index of 0.827 and 0.866 in the training and validation cohorts, respectively. The difference in RFS between the high- and low-risk groups in both cohorts was significant (P

The role of postoperative radiation therapy (PORT) in stage III N2 nonsmall cell lung cancer patients remains controversial. PORT is still widely used among European thoracic radiation oncology experts with a clear decrease in its use for patients with completely resected pN+ NSCLC after the presentation of LungART trial results at ESMO 2020. The full publication of the LungART trial hopefully will shed additional light on the dilemma of the decision-making process for PORT in completely resected pN+ patients and identify the appropriate patients who might benefit from PORT.Background: The role of postoperative radiation therapy (PORT) in stage III N2 NSCLC is controversial. We analyzed decision-making for PORT among European radiation oncology experts in lung cancer. Methods: Twenty-two experts were asked before and after presentation of the results of the LungART trial to describe their decision criteria for PORT in the management of pN+ NSCLC patients. Treatment strategies were subsequently converted into decision trees and analyzed. Results: Following decision criteria were identified: extracapsular nodal extension, incomplete lymph node resection, multistation lymph nodes, high nodal tumor load, poor response to induction chemotherapy, ineligibility to receive adjuvant chemotherapy, performance status, resection margin, lung function and cardiopulmonary comorbidities. The LungART results had impact on decision-making and reduced the number of recommendations for PORT. The only clear indication for PORT was a R1/2 resection. Six experts out of ten who initially recommended PORT for all R0 resected pN2 patients no longer used PORT routinely for these patients, while four still recommended PORT for all patients with pN2. Fourteen experts used PORT only for patients with risk factors, compared to eleven before the presentation of the LungART trial. Four experts stated that PORT was never recommended in R0 resected pN2 patients regardless of risk factors. Conclusion: After presentation of the LungART trial results at ESMO 2020, 82% of our experts still used PORT for stage III pN2 NSCLC patients with risk factors. The recommendation for PORT decreased, especially for patients without risk factors. Cardiopulmonary comorbidities became more relevant in the decision-making for PORT. (C) 2021 Elsevier Inc. All rights reserved.

Purpose The LAP07 multicenter randomized study assessed whether chemoradiation therapy increases overall survival versus continuation chemotherapy in patients whose locally advanced pancreatic cancer was controlled after 4 months of induction chemotherapy. This analysis investigated whether failure to adhere to radiation therapy (RT) guidelines influenced survival and toxicity. Methods and Materials This is a planned analysis of secondary objectives in the framework of a randomized international phase 3 trial. The protocol included detailed written RT guidelines. All participating institutions undertook an initial benchmark case to check adherence to protocol guidelines. Centers with major deviation were not allowed to include patients until they achieved a significant improvement and rigorously followed the guidelines. On-trial RT quality assurance consisted of a central review of treatment plan with dose-volume histograms for each patient. Adherence to guidelines was graded as per protocol (PP), minor deviation (MiD), or major deviation (MaD). Results Fifty-seven benchmark cases were evaluated, 26% were classified as PP, 60% were MiD, and 14% were MaD. Among the 442 included patients, 133 patients were randomized in the chemoradiation therapy arm, and 117 patients were assessable for RT quality analysis. RT quality was graded as PP in 38.5% of patients, MiD in 43.6% of patients, and MaD in 17.9% of patients. The most frequent protocol violations were dose distribution heterogeneities. Median overall survival was 17 months with PP and MiD versus 13.4 months with MaD (hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.99-2.71; P = .055). There was no difference in terms of progression-free survival (HR, 1.09; 95% CI, 0.66-1.8; P = .72). Patients with MaD had more nausea than patients treated PP or with MiD (P = .0045). Conclusions MaD was associated with a trend for worst survival. There was no difference in terms of progression-free survival. Because of the low rate of major deviations, their effects on the LAP07 trial results may be negligeable.

Background: Whole brain radiotherapy (WBRT) is a common treatment option for brain metastases secondary to non-small cell lung cancer (NSCLC). Data from the QUARTZ trial suggest that WBRT can be omitted in selected patients and treated with optimal supportive care alone. Nevertheless, WBRT is still widely used to treat brain metastases secondary to NSCLC. We analysed decision criteria influencing the selection for WBRT among European radiation oncology experts. Methods: Twenty-two European radiation oncology experts in lung cancer as selected by the European Society for Therapeutic Radiation Oncology (ESTRO) for previous projects and by the Advisory Committee on Radiation Oncology Practice (ACROP) for lung cancer were asked to describe their strategies in the management of brain metastases of NSCLC. Treatment strategies were subsequently converted into decision trees and analysed for agreement and discrepancies. Results: Eight decision criteria (suitability for SRS, performance status, symptoms, eligibility for targeted therapy, extra-cranial tumour control, age, prognostic scores and "Zugzwang" (the compulsion to treat)) were identified. WBRT was recommended by a majority of the European experts for symptomatic patients not suitable for radiosurgery or fractionated stereotactic radiotherapy. There was also a tendency to use WBRT in the ALK/EGFR/ROS1 negative NSCLC setting. Conclusion: Despite the results of the QUARTZ trial WBRT is still widely used among European radiation oncology experts. Keywords: Decision tree; Decision-making; NSCLC; QUARTZ; WBRT.

Many major technical developments have occurred during the last decades in radiotherapy: our efficacy has improved with less toxicity. Nowadays, it allows us to challenge the role of surgery as a local modality for lung cancer both for early, advanced and even metastatic disease. In the present paper, we will mainly discuss the role of SBRT for stage I lung cancer, the place of conventional radiotherapy for stage III and we will review the current treatment of small cell lung cancer from a radiation oncologist perspective.

Background: Due to conflicting results between major trials the role of prophylactic cranial irradiation (PCI) in stage IV small cell lung cancer (SCLC) is controversial.Methods: We obtained a list of 13 European experts from both the European Society for Therapeutic Radiation Oncology (ESTRO) and the International Association for the Study of Lung Cancer (IASLC). The strategies in decision making for PCI in stage IV SCLC were collected. Decision trees were created representing these strategies. Analysis of consensus was performed with the objective consensus methodology.Results: The factors associated with the recommendation for the use of PCI included the fitness of the patient, young age and good response to chemotherapy. PCI was recommended by the majority of experts for non-elderly fit patients who had at least a partial response (PR) to chemotherapy (for complete remission (CR) 85% of radiation oncologists and 69% of medical oncologists, for PR: 85% of radiation oncologists and 54% of medical oncologists). For patients with stable disease after chemotherapy, PCI was recommended by 6 out of 13 (46%) radiation oncologists and only 3 out of 13 medical oncologists (23%). For elderly fit patients with CR, a majority recommended PCI (62%) and no consensus was reached for patients with PR.Conclusion: European radiation and medical oncologists specializing in lung cancer recommend PCI in selected patients and restrict its use primarily to fit, non-elderly patients who responded to chemotherapy. (C) 2018 Elsevier B.V. All rights reserved.

The typical textures developed in aluminium alloys for deep drawing applications are less favourable as those in competing steel sheet material. The {111} fibre texture in steel, associated to high r-values, is favourable to this purpose, but the typical textures of the aluminium materials, the {001} "cube" texture component and the β-fibre component, are not. Asymmetric rolling (ASR) as part of the production process generates a shear component at the expense of the unfavourable components. Modelling was tried out as a possible tool to fine-tune the process parameters. A multiscale FEM model (with a built-in polycrystal deformation model to predict the texture) was used to this purpose. The effect of the shear component on the resulting texture is discussed in function of the values of the process variables, as well as its effect on the resulting plastic anisotropy parameters (r and q values).

Preoperative and postoperative radiotherapy (PORT) with or without chemotherapy has been used in non-small cell lung cancer (NSCLC) for decades. Numerous trials have investigated the potential survival benefit of this strategy, but despite greater knowledge of the disease, considerable technological developments in imaging and radiotherapy, and significant progress in surgery, many questions remain unsolved. In this review, we summarize the current knowledge on this problem and discuss issues which still require elucidation., SCOPUS: re.j, info:eu-repo/semantics/published

Purpose Baseline neutrophil count may predict overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC). Methods and Materials The international multicenter randomized LAP07 phase 3 trial has enrolled 442 patients with LAPC. We analyzed the prognostic value of both baseline neutrophilia (neutrophil count >7 g/L) and elevated or increasing neutrophil count as (1) neutrophilia or (2) increased absolute neutrophil count after induction chemotherapy versus baseline for OS, progression-free survival, and local control (LC). A Cox proportional hazard model was used to assess elevated or increasing neutrophil count status by randomly assigned treatment interactions for each endpoint. Results Among the 442 patients, 47 patients (11%) with baseline neutrophilia had worse OS (median 8.9 vs 13.3 months; P = .01). After induction chemotherapy, among the 235 patients whose blood counts were available, 90 patients (38%) had elevated or increasing neutrophil count associated with poorer OS in univariate (median 14.4 vs 17.9 months; P = .001) and multivariate analysis (P = .004). Elevated or increasing neutrophil count was also predictive of a decreased benefit of chemoradiation therapy on LC. In 126 patients without elevated or increasing neutrophil count, 1-year LC was 80% in the chemoradiation arm versus 54% in the chemotherapy arm (P Conclusions In this study, baseline neutrophilia and increased absolute neutrophil count were associated with worse OS in this large series of patients with LAPC. In addition, the counts were an independent prognosis factor and a strong predictive LC biomarker for chemoradiation therapy benefit. An assessment of neutrophils counts can help to improve the selection of patients who might benefit from chemoradiation therapy after induction chemotherapy.

BACKGROUND: The role of prophylactic cranial irradiation (PCI) and thoracic radiotherapy (TRT) is unclear in resected small cell lung cancer (SCLC).METHODS: Thirteen European radiotherapy experts on SCLC were asked to describe their strategies on PCI and TRT for patients with resected SCLC. The treatment strategies were converted into decision trees and analyzed for consensus and discrepancies.RESULTS: For patients with resected SCLC and positive lymph nodes most experts recommend prophylactic cranial irradiation and thoracic radiotherapy. For elderly patients with resected node negative SCLC, most experts do not recommend thoracic radiotherapy or prophylactic cranial irradiation.CONCLUSION: PCI and TRT are considered in patients with resected SCLC and these treatments should be discussed with the patient in the context of shared decision-making.

Radiotherapy (RT) plays a major role in the treatment of small cell lung cancer (SCLC). Therefore, the ACROP committee was asked by ESTRO to provide recommendations on target volume delineation for standard clinical scenarios in definitive (chemo)-radiotherapy (CRT), adjuvant RT for stages I-III SCLC and consolidation thoracic RT for stage IV disease. The aim of these guidelines is to standardise and optimise the process of RT treatment planning for clinical practice and prospective studies. The process for the development of the guidelines included the evaluation of a structured questionnaire followed by a consensus discussion, voting and writing process within the committee. Firstly, we provide recommendations for both the imaging to be performed as part of the diagnostic work-up and for the RT planning process. Secondly, recommendations are made for target volume delineation including delineation of the primary gross tumour volume (GTV) and lymph node GTV and clinical tumour volume (CTV) expansion in the context of definitive and adjuvant RT. With regard to internal target volume (ITV) and planning target volume (PTV) definitions, we make recommendations about the management of geometric uncertainties and target motion. Finally, we provide our opinions on organ at risk (OAR) delineation and organisational issues to be considered. (C) 2020 Published by Elsevier B.V.

A parametric study is presented which employs a new anisotropic constitutive law in order to study the influence of anisotropic plasticity on the deformation field of the ASymmetric Rolling (ASR) process. A version of the FACET method is presented where an analytical yield function is restricted to the subspace of the stress and strain rate space relevant for 2D FEA, but can still accurately reproduce the plastic anisotropy of an underlying Crystal Plasticity (CP) model. The influence of anisotropy on the deformation field and corresponding texture evolution is examined in terms of the changes in texture component volume fractions and formation of texture gradients. It is found that a material with the anisotropy of a sharp cold rolled aluminium alloy is more beneficial than that of a recrystallised hot rolled aluminium alloy, and this influence of anisotropy suggests that ASR may be best carried out in the latest stages of cold rolling. ispartof: Comptes Rendus Mecanique vol:346 issue:8 pages:724-742 status: published

BACKGROUND: Paraganglioma of the head and neck (HNPGL) are rare often benign tumors. Surgery and radiation therapy (RT) are the main treatment choices. We present an analysis of outcome and toxicity after RT from 13 institutions of the Rare Cancer Network.METHODS: Data were collected using a questionnaire concerning patients' characteristics, treatment, and outcome. A total of 81 patients with 82 HNPGL were analyzed.RESULTS: The median follow-up was 48 months (1-456). Sixty-two lesions were treated with conventional RT and 20 lesions with stereotactic RT. Local control (LC) was achieved in 69 out of 77 lesions. Late toxicity occurred in 17 patients. Patients treated with stereotactic RT experienced neither disease progression nor late toxicity. Four patients with a follow-up longer than 20 years experienced disease progression.CONCLUSION: RT for HNPGL offered good local control with acceptable toxicity. Stereotactic RT might offer better results. Long-term follow-up is required.

Purpose Intrathoracic sarcomas (ITS) are considered rare tumors and have a dismal prognosis. We investigated outcomes and risk factors for local control (LC), disease-free survival (DFS), and overall survival (OS) in patients with resected nonmetastatic ITS treated with or without adjuvant radiation therapy (RT) and/or chemotherapy. Methods and Materials Patients from the Rare Cancer Network database were studied. A Kaplan-Meier estimate was used to assess survival curves, and Cox proportional hazards regression was used to assess risk factors for LC, DFS, and OS. Results Between 2000 and 2017, 121 patients met inclusion criteria. The primary site was lung in 30%, mediastinum in 34%, and pleura in 36%. Thirty-nine percent and 32% received RT and chemotherapy. Median follow-up was 34 months (range, 2-141). LC, DFS, and OS at 10 years were 52%, 18.7%, and 7.2%, respectively. In multivariate analysis, RT (P = .003) and R1 margin status (P = .041) retained a significant association with LC. Only R1 resection (P = .002) remained associated with an increased risk of death in multivariate analysis. Overall, 7 patients (6%) developed grade 3 treatment-related chronic toxicity events. Conclusions This joint analysis revealed that OS remains modest in this group of patients, mainly given by the high risk of local and distant failure. Our results suggest that resected ITS can benefit from adjuvant RT.

Background: The role of consolidative thoracic radiotherapy (TRT) in stage IV small cell lung cancer (SCLC) is not uniformly accepted.Methods: We obtained a list of 13 European medical oncologists from the International Association for the Study of Lung Cancer (IASLC) and 13 European radiation oncologists from the European Society for Therapeutic Radiation Oncology (ESTRO). The strategies in decision making for TRT in stage IV SCLC were collected. Decision trees were created representing these strategies. Frequencies of recommending TRT were analysed for various parameter combinations based on the objective consensus methodology.Results: The factors associated with the recommendation for TRT included fitness of the patient, limited extrathoracic tumour burden, initial bulky thoracic disease and response to chemotherapy. The highest consensus for TRT was in fit patients with limited extrathoracic tumour burden and initial bulky disease with either a complete extrathoracic response or partial thoracic response (92% recommend TRT). For these patients the recommendations were the same for medical and radiation oncologists. In the setting of partial response (intra- and extra-thoracically) without initial bulky thoracic disease radiation oncologists were more likely to recommend TRT than medical oncologists. For unfit patients or for patients with poor overall response to chemotherapy, the majority did not recommend TRT.Conclusion: European radiation and medical oncologists specializing in lung cancer recommend TRT in selected patients with stage IV SCLC and restrict its use primarily to fit patients who responded to chemotherapy with limited extrathoracic tumour burden. (C) 2019 Elsevier B.V. All rights reserved.

Purpose Stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT), and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are treatment options for brain metastases in patients with EGFR-mutant non-small-cell lung cancer (NSCLC). This multi-institutional analysis sought to determine the optimal management of patients with EGFR-mutant NSCLC who develop brain metastases and have not received EGFR-TKI. Materials and Methods A total of 351 patients from six institutions with EGFR-mutant NSCLC developed brain metastases and met inclusion criteria for the study. Exclusion criteria included prior EGFR-TKI use, EGFR-TKI resistance mutation, failure to receive EGFR-TKI after WBRT/SRS, or insufficient follow-up. Patients were treated with SRS followed by EGFR-TKI, WBRT followed by EGFR-TKI, or EGFR-TKI followed by SRS or WBRT at intracranial progression. Overall survival (OS) and intracranial progression-free survival were measured from the date of brain metastases. Results The median OS for the SRS (n = 100), WBRT (n = 120), and EGFR-TKI (n = 131) cohorts was 46, 30, and 25 months, respectively ( P.001). On multivariable analysis, SRS versus EGFR-TKI, WBRT versus EGFR-TKI, age, performance status, EGFR exon 19 mutation, and absence of extracranial metastases were associated with improved OS. Although the SRS and EGFR-TKI cohorts shared similar prognostic features, the WBRT cohort was more likely to have a less favorable prognosis ( P = .001). Conclusion This multi-institutional analysis demonstrated that the use of upfront EGFR-TKI, and deferral of radiotherapy, is associated with inferior OS in patients with EGFR-mutant NSCLC who develop brain metastases. SRS followed by EGFR-TKI resulted in the longest OS and allowed patients to avoid the potential neurocognitive sequelae of WBRT. A prospective, multi-institutional randomized trial of SRS followed by EGFR-TKI versus EGFR-TKI followed by SRS at intracranial progression is urgently needed.

Experimental investigations of asymmetric rolling of sheet alloys demonstrate that this process may be used to alter the crystallographic texture by the introduction of shear components. Such texture components are desirable for their potential to improve the formability of aluminium alloys in deep drawing, because they do not transform to the detrimental cube component after recrystallisation. It is however not precisely known how the process parameters affect the texture evolution and the formation of texture gradients. The results of a parametric finite element study of the deformation field and the texture evolution arising during a single pass of asymmetric cold rolling are presented together with an assessment of the impact of texture gradients on the macroscopic anisotropy determined by multi-scale modelling. The modelling approach is validated with textures measured for a single pass of asymmetric rolling of an aluminium sheet alloy. The study targets an industrially feasible process window and presents the relationships found between shear texture volume fractions, texture heterogeneity, plastic anisotropy and several types of process parameters (geometric, contact and material). ispartof: International Journal of Material Forming vol:11 issue:2 pages:297-309 status: published

Objective To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention (SGI) based on support with those of a 15-session multiple-component structured manualized group intervention (MGI) combining support with cognitive-behavioral and hypnosis components. Methods Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion. Results Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self-relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence–related coping strategies (P = .022), and greater reduction in fear of recurrence–related psychological distress (P = .017) compared with the SGI group. Conclusions This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer.

Objectives:To report characteristics, treatment, and outcomes for an international cohort of patients with extraskeletal osteosarcoma (ESOS).Materials and Methods:Through the Rare Cancer Network, retrospective data on patients with ESOS were collected. Patient characteristics, multimodality treatmen

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The present chapter presents the different treatment approaches for locally advanced non small cell lung cancer including radiation alone, targeted agents, combining chemotherapy and radiotherapy, the trimodality approach including surgery and prophylactic cranial irradiation. The chapter presents a large review of the different approaches outlining the progress made during the last years as well as discussing the option to be explored in the near future. Clearly, we have moved with the years from the classical radiotherapy approach using moderate dose and one daily fraction to chemoradiotherapy with or without surgery for selected cases. There are still many questions such as the optimal radiation schedule using classical or altered fractionation with or without adding chemotherapy, the role of new technical developments such as protons or stereotactic body radiotherapy (SBRT), the place of targeted agents, the role of PCI, how to use all the modern imaging technique and how to optimize the treatment for elderly or fraile patients. The management of a locally advanced lung cancer requires a true multimodal approach and a multidisciplinary discussion on each individual case to offer the best option. Last but not least, the quality of life remains a major issue to be preserved.

Purpose This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Methods Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and 4 months later for the waiting list group. Assessments included an audio recording of a radiotherapy planning session to assess team members' communication skills and expression of concerns of patients with breast cancer (analyzed with content analysis software) and an adapted European Organisation for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. Results Two hundred thirty-seven radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P = .003) and more supportive skills (P = .050) and provided more setting information (P = .010). Over time, patients interacting with members of the trained teams asked more open questions (P = .022), expressed more emotional words (P = .025), and exhibited a higher satisfaction level regarding nurses' interventions (P = .028). Conclusion The 38-hour training program facilitated transfer of team member learned communication skills to the clinical practice and improved patients' satisfaction with care.

This review of pain management in lung cancer is based on the presentation of four cases of thoracic oncology patients with pain at various stages of their disease. The approach will be multidisciplinary, involving a thoracic oncologist, radiologist, thoracic and orthopaedic spine surgeon, radiation therapist, pain medicine specialist, and palliative care specialist. This multispecialty approach to the management of different painful presentations in thoracic oncology will demonstrate the complexity of each case and the improved patient outcomes which result from the involvement of different disciplines working in concert.In the USA, Europe and other countries, palliative care specialists often become rapidly involved in the management of these patients, coordinating social care and providing psychological support.Thoracic and orthopaedic spine subspecialists provide surgical methods to control tumour invasion, and improve quality of life and preservation of function in settings of even diffuse metastatic disease. Similarly, thoracic oncology and radiation therapists utilise both therapeutic and palliative chemotherapeutic and radiation therapy regimens to prolong and improve quality of life.The pain medicine specialist can, in addition to medication management, offer a variety of interventional approaches including unique drug delivery systems such as epidural analgesia, regional anaesthesia techniques, and intrathecal pumps, as well as neuromodulation techniques and neurolytic or neuroablative procedures.In the USA, these specialists complete an additional fellowship year in pain medicine following the completion of an anaesthesiology, physical medicine and rehabilitation, neurology or psychiatry residency. These programmes are accredited by the Accreditation Council for Graduate Medical Education, or ACGME (www.acgme.org).

Brain metastases are a major problem in the management of small cell lung cancer (SCLC) with an incidence rising to 50% at 2 years. Prophylactic cranial irradiation (PCI) has shown through randomized trials and meta-analysis to decrease the incidence of brain metastases by 25% leading to a 5% survival benefit at 3 years for patients in complete response to the initial therapy. The major concern with PCI is the risk of inducing neurologic symptoms, especially cognitive functions, and an impaired quality of life. In extensive disease SCLC, an active surveillance with magnetic resonance imaging (MRI) has questioned the value of routine PCI challenging its use for limited disease. In this paper, we will review some main limitations of the different randomized trials, the impact of new technologies and the data available on the possibility to omit (or not) PCI for limited disease., info:eu-repo/semantics/published

A series of mechanical tests in different specimen orientations was performed to study the anisotropic behavior of an IF steel (DC06). State-of-the-art polycrystalline models Alamel [1], VPSC [2], as well as the classical FC Taylor model were employed to predict flow stress curves. A two-stage Voce law was used to describe the single crystal shear stress-accumulated shear strain relationship. In this approach, the textural hardening and the dislocation hardening are effectively modeled separately. Results demonstrate that both the Alamel and VPSC models could reproduce the flow stress curves adequately. Also, the quantitative agreement of texture prediction is used to validate the model predictions. It is concluded that the better performance of grain interaction models compared to the FC Taylor model is mainly due to an improved prediction of the slip inside the constituting grains, and not in particular due to an improved prediction of texture evolution.

Thick plate and sheet materials are often characterised by an inhomogeneous distribution of properties such as yield strength and anisotropy throughout their thickness. Forming of these materials involves further heterogeneous evolution of these properties. A recently developed computational framework [1, now allows these heterogeneities to be modelled via a hierarchical multi-scale material modelling scheme: the evolution of texture and plastic anisotropy can be tracked and individually updated at every integration point in a finite element model, in a computationally efficient manner. In this paper we present the application of this multi-scale model to a benchmark forming simulation, the three point bending test of thick plate steels. A number of hot rolled high strength low alloy steels were considered, two of which are presented here. The results of the simulations are validated against experimental results. Comparison is made between computed and experimental deformed shapes and strain fields, using data acquired by digital image correlation. Predictions of heterogeneously evolved textures are compared with experimental macro-textures, acquired by XRD, at key locations in the final deformed samples. Such models for plate steel forming simulations that are able to provide accurate predictions of deformation textures and derived quantities in the entire volume of the material can be crucial to study further processing steps and properties of the final product.

A multi-camera stereo digital image correlation (MC-DIC) set-up is presented to obtain full displacement and strain fields of a sheet-metal specimen subjected to an Erichsen test. The set-up is composed of several conventional stereo DIC systems (two camera set-up), each of which tracks the deformation of an aspect of the specimen. The individual measurements, including the geometries and the displacements, are then converted to the same reference frame to integrate into a global view. Afterwards, the strain is calculated based on the composed displacement field. It is found that the geometry and the displacement fields of the bulged specimen are ideally stitched, and smooth strain fields are obtained. The influences of the reference frame transformation and the stitching procedure on the MC-DIC measurement are investigated. A rigid motion test is performed to validate the displacement measurement. It is discussed that the global field is more reliable than the individual measurements for this test set-up.

Objectives To assess if induction radiochemotherapy followed by consolidation chemotherapy (arm A) will improve survival in comparison with the same chemotherapy given as induction followed by consolidation concurrent radiochemotherapy (arm B) in patients with unresectable non-metastatic non-small cell lung cancer (NSCLC). Patients and methods Chemotherapy consisted in a combination of cisplatin with docetaxel, with one initial course for each patient, two courses in single modality therapy and weekly administration during chest irradiation (66 Gy). Results A total of 125 patients were randomised before early closure of the study because of poor accrual and an unplanned blind interim analysis which suggested that the continuation of the study would have been futile. Mature survival results showed no significant difference between both modalities with median survival times, respectively in arms A and B, of 19.6 months and 18.3 months, two years survival rates of 44% and 44% and five years survival rates of 23% and 26%. Toxicity was acceptable. Conclusions Our randomised study did not demonstrate survival difference between induction concurrent radiochemotherapy followed by consolidation chemotherapy and induction chemotherapy followed by consolidation concurrent radiochemotherapy.

To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention (SGI) based on support with those of a 15-session multiple-component structured manualized group intervention (MGI) combining support with cognitive-behavioral and hypnosis components.Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion.Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self-relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence-related coping strategies (P = .022), and greater reduction in fear of recurrence-related psychological distress (P = .017) compared with the SGI group.This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer.

Conventionally, the mechanical strength of clinched connections is determined by a single shear lap test and/or a pull-out test. However, in most practical applications a combination of shear and pull-out is exerted on the clinched joint. This paper deals with the development of an Arcan-like device which enables to introduce various shear/tensile ratios in a clinched assembly. An experimental survey of the multi-axial behaviour of a non-cutting single-stroke round clinched connection of two DC05 sheets, which is mild deep drawing steel, is conducted with this modified Arcan setup. These experimental results are used to check the validity of numerical models that predict the strength under multi-axial loading. Since the forming of a clinch is a fairly complex sheet metal operation, a good knowledge of the plastic material properties and the frictional behaviour is of the utmost importance to perform a sufficiently accurate FEA simulation. The impact of these factors on the multi-axial loading behaviour of the DC05–DC05 connection is investigated. ispartof: International Journal of Material Forming vol:6 issue:4 pages:437-451 status: published

Quasi-static tensile tests and high strain rate split Hopkinson bar tensile experiments were used to mechanically characterize a commercially available Ti6Al4V alloy. The material was tested along different directions as to assess the influence of the initial crystallographic texture on the mechanical behaviour. In order to circumvent the problem of the limited thickness of the base material, special usage was made of the Linear Friction Welding technique. The results of the experiments were afterwards compared to the numerical results of a crystal plasticity code based on the viscoplastic self-consistent approach, taking into account twinning as an active deformation mode. © 2012 Trans Tech Publications, Switzerland., 7th International Conference on Processing and Manufacturing of Advanced Materials, THERMEC'2011, 1 August 2011 through 5 August 2011, Quebec City, QC

Several multilevel plasticity models that make use of the crystallographic texture have been developed in the past for the prediction of deformation textures. State-of-the-art models that consider grain interaction, such as Alamel and VPSC, are known to give superior deformation texture predictions compared to the well-known (full constraint) Taylor model. In this paper, these models are assessed on a different basis, namely their ability to predict plastic anisotropy in single-phase steel sheet. A wide range of mechanical tests is considered: uniaxial tension, plane strain tension, simple shear and sheet normal compression. Furthermore, the sensitivity of the anisotropy predictions is analyzed, considering the variability in textures measured by routine XRD. The considered grain interaction models clearly produce improved predictions of plastic anisotropy over the Taylor model.

Cup drawing of sheet material (carbon steel DC06 and aluminium alloy AA3103-O) is simulated using a Finite Element (FE) method configured as a hierarchical multi-scale model. It performs a two-way simulation of the interactions between the metal flow and the crystallographic textures of the polycrystalline material. In this, the evolution of the deformation textures is simulated by the Taylor and ALAMEL models, and this in every integration point of the FE mesh. The resulting textures have been compared with experimentally measured ones at different positions within the work-piece. An anisotropic constitutive model is used based on the Facet model identified from the current texture in every location by means of the Taylor and/or ALAMEL model. The updating procedure has been highly optimized. Simulated and experimental results (cup profiles, deformation textures) are compared. The effect of texture updating is assessed.

The twinning behavior of a commercial Ti-6Al-4V alloy is studied using a combined experimental and numerical approach. An extensive microstructural investigation was performed to identify and quantify the active twin systems. The mechanical behavior as a function of initial texture and strain rate was then modeled using a visco-plastic self-consistent crystal plasticity code (VPSC7). Earlier obtained quasi-static and dynamic data served to fit the parameters of the model, giving good agreement. However, even if the model gave qualitatively good predictions of the stress-strain curves and the texture evolution for the different loadings, the calculated twin fractions differed considerably of the experimental results.

Aluminium alloys for car body manufacturing often show a specific type of band-shaped surface roughening upon stretching, called “ridging” or “roping”. Experimental research as well as modelling attempts have indicated that the evolving surface roughness profiles cannot be understood based on banding of individual surface texture components, like cube or Goss, only. Therefore, it is proposed to study banding on the “mesoscopic” level of texture banding rather than on the “microscopic” one of orientation banding. In mechanical terms, such patterning in the texture would lead to patterning in, for instance, the Lankford coefficient (r-value), so that the mechanical response can be calculated on an intermediate length scale. The present contribution presents a method for calculating r-value patterning from Electron Backscatter diffraction (EBSD) orientation maps. In a first test case of a strongly ridging AA6xxx sheet, indeed patterning in the r-value is found which corresponds to reported patterning of the surface roughness.

Despite decades of research, therapeutic advances in non-small cell lung cancer (NSCLC) have progressed at a painstaking slow rate with few improvements in standard surgical resection for early stage disease and chemotherapy or radiotherapy for patients with advanced disease. In the past 18 months, however, we seemed to have reached an inflexion point: therapeutic advances that are centred on improvements in the understanding of patient selection, surgery that is undertaken through smaller incisions, identification of candidate mutations accompanied by the development of targeted anticancer treatments with a focus on personalised medicine, improvements to radiotherapy technology, emergence of radiofrequency ablation (RFA), and last but by no means least, the recognition of palliative care as a therapeutic modality in its own right. The contributors to this review are a distinguished international panel of experts who highlight recent advances in each of the major disciplines.

During metal forming, the mechanical properties in all locations of the part evolve, usually in a heterogeneous way. In principle, this should be taken into account when performing finite element (FE) simulations of the forming process, by modeling the evolution of the mechanical properties in every integration point of the FE mesh and coupling the result back to the FEshell. This is the meaning of the term ‘full-field modeling.’ The issue is developed further with focus on the evolution of texture and plastic anisotropy. It is explained that in principle, such fullfield modeling would require a gigantic computational effort which (at least at present) would be out of reach of most research organizations. A methodology is then presented to overcome this difficulty by using efficient models for texture updating and for texture-based plastic anisotropy, and by optimizing the overall calculation scheme without sacrificing the accuracy of the texture prediction. Some of the first results (obtained for cup drawing of anisotropic deep drawing steel) are shown, including comparison to experimental results. Possible future applications of the method are proposed.

Some metal sheet forming processes may induce an amount of plastic shear over the sheet thickness. This paper investigates how formability of anisotropic sheet metal is affected by such through-thickness shear (TTS). The Marciniak-Kuczynski (MK) model framework, a commonly used analytical tool to predict the limit of sheet formability due to the onset of localized necking, is extended in this paper in order to explicitly account for TTS in anisotropic metal sheets. It is a continuation of previous work by the present authors (Eyckens et al., 2009), in which TTS is incorporated for isotropic sheet. This is achieved by the introduction of additional force equilibrium and geometric compatibility equations that govern the connection between matrix and groove in the MK model. Furthermore, in order to integrate plastic anisotropy, a material reference frame available in recent literature is incorporated, as well as a particular model for anisotropic yielding that relies on virtual testing of anisotropic properties (Facet plastic potential), since out-of-plane anisotropy related to TTS cannot be measured experimentally. It is found that formability may be increased by TTS, depending on the direction onto which it is imposed by the forming process. TTS is thus a relevant aspect of the formability in, for instance, sheet forming processes in which sliding contact with friction between sheets and forming tools occur. ispartof: International Journal of Plasticity vol:27 issue:10 pages:1577-1597 status: published

The determination of strain fields based on displacement components obtained via 2D-DIC is subject to several errors that originate from various sources. In this contribution, we study the impact of a non-perpendicular camera alignment to a planar sheet metal specimen’s surface subject to biaxial loading conditions. The errors are estimated in a numerical experiment. To this purpose, deformed images - that were obtained by imposing finite element (FE) displacement fields on an undeformed image - are numerically rotated for various Euler angles. It is shown that a 3D-DIC stereo configuration induces a substantial compensation for the introduced image-plane displacement gradients. However, higher strain accuracy and precision are obtained - up to the level of a perfect perpendicular alignment - in a proposed ”rectified” 2D-DIC setup. This compensating technique gains benefit from both 2D-DIC (single camera view, basic amount of correlation runs, no cross-camera matching nor triangulation) and 3D-DIC (oblique angle compensation).

Digital image correlation (DIC) involves certain errors during correlation, which are highly influenced by factors, e.g. image qualities, DIC parameters, and furthermore, degrees of deformation or strain states. In this contribution, attention is paid to the influence of strain states on the uncertainty of DIC, including the magnitude and the heterogeneity of the strains. A series of 2D-DIC numerical experiments are carried out on tensile specimens associated with finite element analysis (FEA). The specimens are made of 3 materials, i.e. steel DC06, steel DX54D+Z, and aluminium alloy Al6016, and cut into 3 different geometries, i.e. standard and 2 complex designs. Initial images were taken from these real specimens, which were all painted manually with random speckle patterns. Deformed images were obtained by imposing FE displacement fields on these undeformed initial images. Consequently, the errors source from imaging system are avoided, and only intrinsic errors of DIC itself are taken into account. The hardening behaviours of those materials in 3 different orientations were introduced to FEA for simulation, namely rolling direction (RD), transverse direction (TD) and 45o w.r.t. RD (45o). In FEA, homogeneous and heterogeneous strain states are achieved through applying uniaxial tension on two ends of the standard and complex specimens, respectively. The strain states are characterized by different material properties and geometries of specimens. DIC calculation are performed at various load steps to investigate the influence of the magnitude of the strain. Errors of the fields are compared among the different specimens to study the influence of the heterogeneity. In this contribution, the qualities of the speckle patterns are considered, since different patterns are applied to each experiment.

Clinching is a mechanical joining technique which involves severe local plastic deformation of two or more sheet metal parts resulting in a permanent mechanical interlock or joint. The required forming load and energy can be determined with the aid of the finite element method. However, a good knowledge of the elasto-plastic properties is of utmost importance to perform a sufficiently accurate simulation. This paper presents two alternative material tests to identify the hardening behaviour of sheet metal beyond the point of maximum uniform elongation. In addition, the material tests were applied to DC05 and the identified material behaviour is evaluated through the prediction of the forming load during clinching.

Clinching, commonly referred to as press-joining, is a mechanical joining technique which involves severe local plastic deformation of two or more sheet metal parts resulting in a permanent mechanical interlock or joint. This interlock is achieved by using simple tools like a die, a punch and a blank holder. Since no additional elements are used, the strength of the clinched connection is entirely determined by the clinch geometry, and, consequently, by the geometry of die and punch. As a result, for each combination of material and sheet thickness an optimal geometry of the tools can be derived. This can be done either through extensive experimental testing or, more cost-effectively, with the aid of numerical simulations. However, for these results to be useful they have to be able to reproduce the experimental strength of the connection. In this paper we investigate the possibility of predicting the shear and pull-out strength of a clinched sheet metal assembly using FEA. Numerical difficulties associated with these simulations and the preceding forming operation are discussed. A comparison between experimental data and simulation is provided.

In plastically deforming polycrystals, grains interact with their surroundings resulting in heterogeneous deformation fields both at inter- and intragrain level. When the crystal plasticity finite element method (CPFEM) is employed to predict such heterogeneity, splitting of grains is occasionally observed. In the present study, detailed local strain analysis is performed in such subdivided grain and its neighbors. The role of local interactions at the grain boundaries and of the initial orientation of the grain is investigated. It is shown that a hard grain surrounded by relatively softer grains is prone to subdivide when subjected to opposing shears.

We assessed the impact of internal mammary chain radiotherapy (IMC RT) to the radiation dose received by the heart in terms of heart dose-volume histogram (DVH). Thirty-six consecutive breast cancer patients presenting with indications for IMC RT were enrolled in a prospective study. The IMC was treated by a standard conformal RT technique (50 Gy). For each patient, a cardiac DVH was generated by taking into account the sole contribution of IMC RT. Cardiac HDV were compared according to breast cancer laterality and the type of previous surgical procedure, simple mastectomy or breast conservative therapy (BCT). The contribution of IMC RT to the heart dose was significantly greater for patients with left-sided versus right-sided tumors (13.8% and 12.8% for left-sided tumors versus 3.9% and 4.2% for right-sided tumors in the BCT group and the mastectomy group, respectively; p < 0.0001). There was no statistically significant difference in IMC contribution depending on the initial surgical procedure. IMC RT contributes to cardiac dose for both left-sided and right-sided breast cancers, although the relative contribution is greater in patients with left-sided tumors.