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Manuela Farris,1,2 Carlo Bastianelli,1 Elena Rosato,1 Ivo Brosens,3 Giuseppe Benagiano1 1Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy; 2The Italian Association for Demographic Education, Rome, Italy; 3Faculty of Medicine, KU Leuven, Leuven, Belgium Abstract: Uterine fibroids are the most common gynecological disorder, classically requiring surgery when symptomatic. Although attempts at finding a nonsurgical cure date back to centuries, it is only around the middle of the last century that serious attempts at a medical treatment were carried out. Initially, both progestins and estrogen–progestin combinations have been utilized, although proof of their usefulness is lacking. A major step forward was achieved when peptide analogs of the GnRH were introduced, first those with superagonist properties and subsequently those acting as antagonists. Initially, the latter produced side effects preventing their routine utilization; eventually, this problem was overcome following the synthesis of cetrorelix. Because both types of analogs produce hypoestrogenism, their use is limited to a maximum of 6 months and, for this reason, today they are utilized as an adjuvant treatment before surgery with overall good results. Over the last decade, new, nonpeptidic, orally active GnRH-receptor blockers have also been synthesized. One of them, Elagolix, is in the early stages of testing in women with fibroids. Another fundamental development has been the utilization of the so-called selective progesterone receptor modulators, sometimes referred to as “antiprogestins”. The first such compound to be applied to the long-term treatment of fibroids was Mifepristone; today, this compound is mostly used outside of Western Countries, where the substance of choice is Ulipristal acetate. Large clinical trials have proven the effectiveness of Ulipristal in the long-term medical therapy of fibroids, although some caution must be exercised because of the rare occurrence of liver complications. All selective progesterone receptor modulators produce unique endometrial changes that are today considered benign, reversible, and without negative consequences. In conclusion, long-term medical treatment of fibroids seems possible today, especially in premenopausal women. Keywords: uterine myomas, progestin, gonadotropin-releasing hormone receptor blockers, selective progesterone receptor modulators, antiestrogens

Abstract As Supply Chain Management has evolved, doctoral programs have struggled to produce enough new people with doctorate degrees to keep up with demand and to replace tenure-track faculty who [...]

Peer review (PR) is a critical component of radiation oncology practice, but the methods by which this is carried out are highly variable. There has been a substantial change in the format and structure of inter- and intra-disciplinary meetings with the recent rise in virtual/hybrid teleconferencing. We surveyed NCI National Community Oncology Research Program (NCORP) sites to better understand the format, structure, and content of radiation oncology PR. A one-time survey was distributed to ROs across 42 NCORP community sites through the Wake Forest NCORP Research Base (UG1CA189824) between January and February 2024. The survey explored the routine PR practices of radiation oncologists. Twenty-eight radiation oncologists from 13 NCORP sites, all indicated that they participate in routine PR. Years of practice were 0-5 in 25%, 6-10 years in 36%, and >10 years in 39%. The frequency of PR meetings was weekly in 22 of 26, daily in 2, and every other week in 2. The participants were limited to radiation oncologists at all responding practices; no practices included interdisciplinary collaboration with radiologists in their PR. The format of PR was a hybrid of in-person/virtual at 13 practices, virtual only (no in-person/hybrid option) at 10, in-person only (no virtual/hybrid option) at 4, with 1 not reported. Six practices reported using some form of asynchronous PR (PR performed independently without the treating physician). The timing of PR was reported by 27 and included after treatment planning is complete (n = 19), after contouring but before plan creation/dose calculation (n = 2), and a mix of both (n = 6). For those reporting a mix of PR timing, the median percent of cases that underwent PR before dose calculation was 15% (range = 5-60) with the remaining 85% (range = 40-95) reviewed after plan completion. Components of the plans subject to PR (reported as the number reviewing each component, out of the 28 respondents) included contours (23), targets/organs at risk (25), dose distributions (26), dose-volume histograms (26), prescription dose/fractionation (27), diagnostic imaging (12), pathology data (13), and treatment intent (23). Other components reviewed included informed consent (1) and morbidity and mortality conference (1). Peer review in radiation oncology is a universal practice with more heterogeneity in the meeting format than is in the content reviewed. Most practices are performing PR after treatment planning is complete. Additional focus on the timing and format of radiotherapy plan PR is necessary to develop best practices to optimize safety and ensure comprehensive PR. [ABSTRACT FROM AUTHOR]

Stereotactic body radiation therapy (SBRT) for peripheral lung tumors can result in high radiation doses to surrounding ribs. Pre-clinical studies have shown single fraction doses of 2-10 Gy increase osteoclast activity and lead to bone loss. We conducted a randomized, double-blind, placebo-controlled trial to evaluate whether early suppression of osteoclast activity could mitigate SBRT-induced rib fractures. Between July 2019 and February 2022, 84 patients were enrolled. Eligible patients had lung tumors within 2 cm of chest wall and were randomized 1:1 to receive either a single dose of risedronate (150mg) or placebo delivered 7 to 21 days before SBRT (48-60 Gy in 3-10 fractions). Chest wall pain (CWP) was graded using modified CTCAE v5 assessed every 3 months after SBRT up to 1 year. Following a minimum period of one year post drug administration, a thoracic radiologist assessed all accessible imaging follow-up for fracture incidence. Seventy-six patients (38 placebo 38 risedronate) with 81 treated lung lesions were included in this analysis with a median follow-up of 26.3 months with a maximum of 43.4 months. Follow-up was measured from the end date of SBRT to the date of last available CT chest or date fracture detection. A total of 25 patients (33%) developed rib fractures. Median (range) values for rib (dose in EQD2, a/b = 3) and chest wall (3 cm thickness) structures are as follows: rib D0.03cc, 215 Gy (range = 52-373); rib D2cc, 101 (26-252); chest wall V30, 20 cc (0.5-314). There was no significant difference in fracture rates between risedronate and placebo groups - 13 risedronate group (34.2%) vs 12 in placebo arm (31.6%) (p = 0.2). Among those who fractured, the median time to fracture was 14.2 mo (95% CI = 9.8 - 16.9 mo) [range 5.9 - 43.4 mo] with 9 patients developing fracture within 1 year from the end of SBRT. Patients receiving risedronate had a significantly lower rate of grade 2+ CWP within 1 year post SBRT completion compared to patients who received placebo: 18% versus 42% respectively (P = 0.045), Among patients who did not develop a detectable fracture, the rate of G2+ CWP was (12 % vs 34.6% P = 0.06) favoring the risedronate arm, and similarly among those who did develop fractures, the incidence of G2+ CWP was 31% vs 58% (p = 0.17). For patients receiving SBRT for peripheral lung tumors, the use of prophylactic risedronate, when compared to placebo, did not reduce the incidence of treatment-induced rib fractures. The use of risedronate, however, lowered the risk of G2+ CWP. The suggested protective impact of risedronate against G2 or higher CWP may point to a nerve and osteoclast cross talk mechanism contributing to the development of SBRT-induced CWP. Alternatively, risedronate may have partially reduced osteoclast activity, preventing the accumulation of microfractures that could have contributed to pain. Further investigations into the appropriate dose and type of antiresorptive agent to specifically counteract bone loss and prevent pain or fracture after thoracic SBRT are warranted [ABSTRACT FROM AUTHOR]

Provides a link between marketing theory and application in helping students use what is taught to attain employment goals. Presents proposals from marketing concepts, as well as practical ways to encourage students to see themselves as assets and market themselves accordingly. (Author/JOW)