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To create a magnetic resonance image (MRI)-based atlas of prostate bed recurrence for prostate cancer patients undergoing salvage radiotherapy (sRT) after radical prostatectomy and to evaluate the consistency of contouring guidelines for the prostatic fossa clinical target volume (PF-CTV) delineation. Patients with biochemical recurrence and prostate bed lesions at MRI before sRT were included. A reference patient was identified and the lesion(s) of each patient was mapped by a deformable co-registration among T2 weighted (T2w) images. The structure sets were combined to create a 3D recurrence incidence map, overlapped on T2w reference set, then transferred to the planning CT. The volume and the location of the lesions were extracted. On the reference CT, 5 PF-CTV contouring strategies were implemented: Radiation Therapy Oncology Group (RTOG); European Organization for Research and Treatment of Cancer (EORTC); Francophone Group of Urological Radiotherapy (GFRU); Faculty of Radiation Oncology Genito-urinary Group (FROGG) and Princess Margaret Hospital (PMH). Coverage was assessed after identifying the centroid of each lesion: if the centroid was included in the PF-CTV, the coverage was considered complete (fully covered-FC), otherwise uncovered (UC). The coverage was evaluated for each contouring strategy and compared with the chi-squared test; the strength of the correlation was assessed with the phi coefficient. A total of 112 patients with 124 recurrences were identified. The lesions were located at the vesicourethral anastomosis (VUA), around the bladder neck (BN) and beyond the bladder (RV) in 63, 36 and 25 cases. Regardless the contouring strategy, 89.1% of the lesions were FC. Coverage was higher (p<0.001) for BN (95.6%) over RV (83.2%) and VUA (73.7%) lesions. FC/UC rates were 66.1%/33.9%, 83.9%/16.1%, 89.5%/10.5%, 83.1%/16.9%, 87.1%/12.9% for EORTC, FROGG, GFRU, RTOG and PMH, respectively. At pair-wise comparison, the EORTC definition had lower coverage (p<0.001) and was poorly correlated to the other strategies (phi values ranging 0.385-0.540, p <0.001). Conversely, the correlations between the other definitions were >0.700, the highest between PMH-FROG (0.812, p<0.001). After selecting VUA lesions only (N = 63), the probability of FC was 60.3%, 74.6%, 82.5%, 71.4% and 79.4% for EORTC, FROGG, GFRU, RTOG and PMH, respectively. The EORTC definition performed poorly than GFRU (p = 0.006) and PMH (p = 0.020). When considering lesions above the VUA (N = 61), the performance improved (FC: 72.1%, 93.4%, 96.7%, 95.1% and 95.1% for EORTC, FROGG, GFRU, RTOG and PMH, respectively) but the EORTC was significantly less covering and its correlation with the others was ≤ 0.1. According to the criterium of coverage our data do not support the use of the EORTC definition. Here we provide an MRI-based atlas of prostatic bed recurrence that can optimize sRT contours. [ABSTRACT FROM AUTHOR]

Introduction: The taxonomy of Cirratulidae is not easy due to the diagnostic characters currently accepted change through ontogeny, in some cases, there are even difficulties to separate juveniles from adults. Among the Cirratulus species cited, described and considered as valid for Argentina are Cirratulus jucundus (Kinberg, 1866), Cirratulus patagonicus (Kinberg, 1866) and Cirratulus mianzanii Saracho Bottero, Elías & Magalhães, 2017. Objetive: This study made a revision of Cirratulus includes material deposited in the Museo de Ciencias Naturales de La Plata (MLP) and specimens collected privately by J.M. Orensanz that was donated to the laboratory of Bioindicadores Bentónicos of the National University of Mar del Plata. Methods: The specimens were examined with optical equipment (microscope and stereomicroscope) and also by a scanning electron microscope (SEM). Results: A complete examination of the material, revealed a higher number of species than those already mentioned. In the present work, three new species are described from the intertidal and subtidal areas of the Argentine continental shelf: Cirratulus orensanzii n. sp.; Cirratulus knipovichana n. sp. and Cirratulus alfonsinae n. sp. Conclusions: The knowledge about the taxonomy of the family as well as the updating of the geographic registries contributes to the biodiversity of the region, which is of great importance to carry out both ecological studies and conservation plans. [ABSTRACT FROM AUTHOR]

Among the polychaetes, the family Cirratulidae is one of the most challenging taxonomically because most of the currently used diagnostic characters change during ontogeny. It is therefore necessary to use a combination of characters to make an accurate identification. The present work is the first of a planned revision of the genus Cirratulus from coastal zones of Argentina. The examined material came from the two largest natural history museums of the country, and showed several morphotypes. Some specimens corresponded to described species, but others were undoubtedly undescribed. Among the previously known Cirratulidae, Cirratulus jucundus (Kinberg, 1866) and Cirratulus patagonicus (Kinberg, 1866), formerly distributed for Antarctica are now also present in coastal continental areas of Argentina. The new species Cirratulus mianzanii sp. nov. is described from subtidal areas off Peninsula Valdés, Patagonia. This species is distinguished from its congeners by the segmental origin of both tentacular filaments and first pair of branchiae in the junction between the peristomium and first chaetiger. Branchiae arise some distance from the notopodium but not at the dorsal midline of the body. Ventral groove present along the body, with a fine dark midline. Capillary chaetae are serrate seen under an optical microscope, and the segmental origin of neuro- and notopodial spines is different from other species of the genus. [ABSTRACT FROM PUBLISHER]

Abstract: The technical and economic evaluation of a project should involve not only the technological aspects but also the factors related to the interference of the construction site with the population and roads or to the interaction of the operation with the environment. This paper, through the use of the Analytic Hierarchy Process, compares two different excavation alternatives, microtunnelling and trench excavation, for an urban sewer construction project. [Copyright &y& Elsevier]

To investigate both the pattern of failure and the opportunity of a repeated radiotherapy course after salvage radiation therapy (sRT) for prostate cancer (PC). At our Institution, all patients (pts) who develop a further biochemical failure (BF) after both radical prostatectomy and subsequent sRT are offered re-staging with prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) first, and, if negative, with multiparametric magnetic resonance imaging (mpMRI) of the prostatic fossa. In the present study we included the pts who satisfied all the following criteria since March 2023: no pathologically positive nodes at surgery; no distant disease at re-staging PET/CT before sRT; subsequent BF after sRT defined as Prostate-specific antigen (PSA) > 0.20 ng/ml on 2 consecutive measures; presence of recurrent disease at either PSMA PET/CT and/or mpMRI. Pts without detectable disease at imaging were disregarded. The site(s) of failure (FS) was (were) classified as Local (LS) if within the prostatic fossa, Regional (RS) if within the pelvic nodes up to the common iliacs excluded, and Distant (DS) if outside the pelvis. Oligorecurrence was defined as a maximum of 5 FS on imaging. After co-registering the positive re-staging imaging and the planning CT at sRT, we assessed whether each FS was outside (OFS) or inside (IFS) the previously treated volume and we estimated the mean equivalent dose in 2 Gy fraction (EDmean2) received by each IFS. Fifty-six consecutive pts were included. 29 (52%) pts had received prostatic fossa sRT only and 27 (48%) pts also whole pelvis sRT. Only 5 pts (9%) had undergone concurrent androgen deprivation therapy at sRT. Median PSA nadir after sRT was 0.06 ng/ml (IQR 0.01-0.3 ng/ml) and occurred after 7.8 months (IQR: 4-16.5 months). All pts were restaged with PSMA PET/CT and 21 pts (38%) with mpMRI. We found an overall number of 83 recurrences at a median time of 41 months after sRT (IQR 19.9-65.2 months). At failure, the median PSA was 0.63 ng/ml (IQR 0.4-1.2 ng/ml) and the median PSA doubling time was 8.3 months (IQR 4.3-12.3 months). All patients were oligorecurrent. Failures were distributed as follows: 39 (47%) DS, 26 (31%) RS and 18 (22%) LS. 60 (72%) were OFS, whereas 23 (28%) were IFS; of the latter ones, 14 were LS, 7 RS and 2 DS, with a median EDmean2 of 75.2 Gy (IQR 73-78.7 Gy), 50 Gy (IQR 45.4-51.6 Gy) and 53.1 Gy (IQR 57.6-48.6 Gy), respectively. All LS had undergone a staging mpMRI at sRT and 13 (72%) occurred in a previously positive prostatic fossa. All patients are oligorecurrent at the time of a BF post-sRT. Moreover, most of the failures do occur outside a previously treated volume. For both reasons, a second course of definitive/ablative RT is potentially indicated. Surprisingly, the prostatic fossa is a relatively frequent site of failure especially when containing macroscopic disease and despite the high dosage at sRT. [ABSTRACT FROM AUTHOR]

The purpose of this study was to report the results of a mature phase II study. This was a prospective study at a single institution that were enrolling patients with T1 glottic cancer. The true vocal cords (TVCs) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. The remaining parts of the TVCs as well the rest of the larynx was tentatively spared. SBRT was delivered by a LINAC-based approach using multiple arcs (VMAT). Toxicity was scored by CTCAE and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the voice handicap index (VHI) at regular intervals. A generalized linear mixed model was used to analyze longitudinal functional data and the actuarial approach was used to report late toxicity prevalence rates. The planned sample size, 75 patients, was calculated to reject the hypothesis of a 2-yr local control (LC) of 85% against the alternative hypothesis of 95%. The median follow-up time is 40 months (IQR: 31.5-47.3 months). Accrual was discontinued after 33 patients due to concerns on late toxicity rates on both the mucosa and the cartilages. Median age was 66 yrs (IQR: 60-71 yrs). T stage was as follows: T1a: 23 pts (69.7%); T1b: 10 pts (30.3%). Only two patients never smoked, while of the remaining ones, 13 (41.9%) kept smoking after SBRT despite appropriate counseling. At last, follow up, all patients are alive and without evidence of disease but one patient who died 21.3 months after SBRT for intercurrent causes. The observed local control rate of 100% allows to reject the null hypothesis because, according to the binomial distribution, the probability of not observing at least one recurrence out of the accrued 33 patients is <0.5% if a 2-yr LR ≤85% would be true. All but 5 patients developed transient confluent mucositis of the treated volume with a prevalence peak at 19 days after SBRT. Six patients (18.2%) developed soft tissue necrosis (N = 4) or cartilage necrosis (N = 2) after a median time of 14.9 months from SBRT (range: 9.1-24.5 months). The actuarial prevalence of any necrosis is 3.0%, 1.3% and 0.8% at 12, 24 and 36 months after SBRT, respectively, with a peak at 6.1% between 9.9 and 11.9 months. All 4 soft tissue events healed with conservative therapy after a median time of 2.5 months (range: 1-12.2 months). One patient with chondronecrosis refused total laryngectomy and is alive with persistent toxicity 22.9 months after its onset; the other patient underwent endoscopic removal of the necrotic arytenoid and he is alive without evidence of disease or further complications more than 2 years afterwards. Patient reported outcomes (VHI) will be presented as well. SBRT to 36/30 Gy in 3 fractions is highly effective in controlling T1 true vocal cord carcinoma, but necrosis, though mostly transient, is a concern. Based on the present results, a reduction in total doses is justified and a novel phase II study is ongoing. [ABSTRACT FROM AUTHOR]

To investigate predictors of biochemical failure after salvage radiotherapy (sRT) in the context of a presumed local failure at dynamic contrast-enhancement-magnetic resonance imaging (DCE-MRI) post radical prostatectomy (RP). All patients referred for sRT at our Institution with a biochemical failure after RP have been consistently offered restaging with both PET/CT and multiparametric MRI since January 2014. Those with a presumed local failure at DCE-MRI as well as no regional/distant disease at PET/CT (either choline and/or PSMA) were selected for the present study. Exclusion criteria were history of androgen deprivation (AD) before sRT and positive nodes at RP. All patients underwent 3T DCE-MRI without endorectal coil and the lesion(s) transferred to the planning CT after co-registration. sRT consisted in 73.5 Gy to the presumed local lesion and 66-69 Gy to the prostatic bed in 30 fxs. Pelvic nodes (PN) were covered to 54 Gy/30 fxs in selected patients. The endpoint of the study was the development of a biochemical failure after sRT defined as a 0.2 ng/ml PSA rise above the nadir. Various covariates (age, pre-RP PSA, pT and pN stages at RP, margins status at RP, ISUP grade group, time from RP to sRT, PSA doubling time, PSA detectability after RP, PSA at sRT, the location, number and volume of the detected recurrence(s), AD use, PN coverage, EUA risk category) were investigated at univariate analysis (UVA) on the time to biochemical failure (bNED-survival). Covariates with a p value <0.2 at UVA were entered a Cox proportional hazards regression analysis. Up to June 2020, 146 patients satisfying all selection criteria have been treated with sRT. Median (IQR) PSA at sRT was 0.60 ng/ml (0.38-1.05 ng/ml) and only 17 patients (11.6%) received AD along with sRT. A total of 168 local lesions have been detected, 92 (54.8%), 40 (23.8%) and 36 (21.4%) at the vesicourethral anastomosis (VUA), the bladder neck and the retrovesical space, respectively. At the median (IQR) follow-up of 48.1 months (31.3-60.6 months), 22 biochemical failures have been observed for a 4-yr bNED survival of 84.4% (95%CI: 77.9-90.9%). On UVA, bNED-survival after sRT was significantly more likely for patients with VUA-only lesions (VUA-only vs others, HR=0.307, 95%CI: 0.120-0.784, p=0.014) and with smaller lesions (for every cc, HR: 1.071, 95%CI: 1.025-1.119, p=0.002). These associations remained significant (p< 0.01) on multivariate analysis as well. For patients with VUA-only disease or with lesions smaller than 0.5cc, 4-yr bNED survival rates were 90.7% (95%CI: 83.4-98.0%) and 90.6% (95%CI: 83.9-97.3%), respectively. The 46 patients with both favorable features had a 4-yr bNED rate of 94.6% (95%CI: 87.3-100%). These data support local restaging with DCE-MRI before sRT in the setting of a biochemical failure after RP. Patients with VUA-only and/or small volume lesions have an excellent outcome after dose-escalated sRT. [ABSTRACT FROM AUTHOR]