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There were 186 treatment related adverse events (TRAEs) among 25 of 30 participants; 5 participants did not experience a TRAE; 163 of these occurred during combination therapy; 23 during monotherapy in 7 of 17 participants, where 10 participants did not experience a TRAE. B Conclusions: b Bendamustine, rituximab and acalabrutinib front-line therapy for WM is safe and well tolerated and initial clinical results show that this treatment induces a high percentage of VGPRs. Seventeen patients completed combination therapy, 9 completed monotherapy and 2 were followed-up at 18 months (6 months post therapy). [Extracted from the article]

The 2017 annual meeting of the American Society of Clinical Oncology took place in Chicago, Illinois, 2-6 June. At the meeting, results from key studies in the first-line treatment of indolent non-Hodgkin lymphoma (iNHL) were presented. Of those studies, two were selected for oral presentations: 9-year follow-up data from the STiL NHL1 trial, which compared the efficacy and safety of bendamustine plus rituximab (BR) with those of rituximab plus cyclophosphamide-vincristine-prednisone-doxorubicin (R-CHOP); and 5-year follow-up data from the bright study, which compared BR with R-CHOP and R-CVP (rituximab plus cyclophosphamide-vincristine-prednisone) combined. Our meeting report describes the foregoing studies and includes interviews with key investigators, plus commentaries from three Quebec hematologists on the potential effects for Canadian practice. [ABSTRACT FROM AUTHOR]

Background Bendamustine is a bifunctional alkylating agent with unique properties that distinguish it from other agents in its class. Bendamustine is used as monotherapy or in combination with other agents to treat patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL). Methods The prospective interventional open-label bend-act trial evaluated bendamustine in patients with rituximab-refractory indolent NHL (iNHL) and previously untreated CLL. Study objectives were to assess the safety and tolerability of bendamustine monotherapy and to provide patients with access to bendamustine before Health Canada approval. The study aimed to enrol up to 100 patients. All patients with iNHL received an intravenous dose of bendamustine 120 mg/m2 over 60 minutes on days 1 and 2 for up to eight 21- or 28-day treatment cycles. All patients with CLL received an intravenous dose of bendamustine 100 mg/m2 over 30 minutes on days 1 and 2 for up to six 28-day treatment cycles. Results Of 90 patients treated on study (16 with CLL and 74 with iNHL), 35 completed the study (4 with CLL and 31 with iNHL). The most common treatment-emergent adverse events (TEAES) were nausea (70%), fatigue (57%), vomiting (40%), and diarrhea (33%)--mostly grades 1 and 2. Ondansetron was the most common supportive medication used in the patients (63.5% of those with iNHL and 68.8% of those with CLL). Neutropenia (32%), anemia (23%), and thrombocytopenia (21%) were the most frequent hematologic teaes, with neutropenia being the most common grade 3 or 4 TEAE leading to dose modification. Dose delays occurred in 28 patients (31.3%) because of grade 3 or 4 teaes, with a higher incidence of dose delays being observed in inhl patients on the 21-day treatment cycle than in those on the 28-day treatment cycle (50.0% vs. 24.1%). During the study, 33 patients (36.7%) experienced at least 1 serious adverse event, and 4 deaths were reported (all in patients with iNHL). Conclusions The type and frequency of the teaes reported accorded with observations in earlier clinical trials and post-marketing experiences, thus confirming the acceptable and manageable safety profile of bendamustine. [ABSTRACT FROM AUTHOR]

Canada's agricultural emissions accounted for 60 Mt or 8% of national greenhouse gas (GHG) emissions in 2007. The estimation of CH4 emission factor (B0) from manure management systems in Canada is prone to uncertainty owing to lack of B0 values for Canadian conditions. Therefore, in this study, manure samples from six Canadian animal farms, two each of swine, beef and dairy cattle, were investigated in order to estimate their methane production potential (B0). The ultimate anaerobic biodegradability was measured with ISO standard batch fermentation. The extent of biodegradation of the manure samples with or without sodium benzoate was always greater than 60% and hence showed no inhibitory effect on methane production by the manure. The impact of use of antibiotics in the animal feed on methane production was also considered; however, no inhibitory effect on methane production could be observed. The plateau of methane production in all cases was achieved by 63 d of anaerobic digestion process and the final pH was within 6-8. The calculated B0 were in the range of 0.47-0.42, 0.21-0.19 and 0.35-0.30 for swine, beef cattle and dairy cattle, respectively. The uncertainties associated with B0 values were ± 9% for swine, ± 3% for beef cattle and, ± 6 and ± 2% for dairy cows. [ABSTRACT FROM AUTHOR]

The most common complication following spine stereotactic body radiotherapy (SBRT) is vertebral compression fracture (VCF). The purpose of this analyses was to determine if predictors of VCF vary according to presence or absence of a pre-existing (baseline) VCF. A retrospective review of a prospectively maintained institutional database of patients treated with SBRT for spinal metastases performed. The primary outcome was VCF. Clinical, dosimetric and radiographic factors were reported with descriptive statistics. The cumulative incidence of VCF was estimated using a competing risk analysis method. The impact of covariates was estimated with Cox proportional hazards model and hazard ratios (HR) generated. From 2008 – 2022, 744 patients with 1813 spinal segments were treated with spine SBRT. The median age was 64.9 years, and 19.1% had a baseline VCF. The majority of segments were treated with 24Gy (42.8%) or 28Gy (27.4%) in 2 fractions, the median dose-per fraction was 12Gy (range = 5-24), 68% were de novo (no prior radiation exposure) and 235 (13.0%) had prior surgical stabilization. 254 VCF event were observed (14%), 179 were iatrogenic and 75 associated with concurrent tumor progression. The 1-, 2- and 5-year VCF rates were 8.3%, 12%, and 15.2%, respectively. 85/254 (33.5%) occurred in those with a baseline VCF and 169/254 (66.5%) in those without. On multivariable analysis (MVA), tumor progression (HR = 2.24, 95% CI = 1.66-3.04, P <0.01), baseline VCF (HR = 1.91, 95% CI = 1.35-2.71, P <0.01), mechanical pain (HR = 2.01, 1.31-3.08, P <0.01), increasing age (HR = 1.015, 95% CI = 1.002-1.03, P <0.02), fewer consecutive segments treated (HR = 0.80, 95% CI = 0.65-0.98, P <0.03), increasing dose to 90% (D90) of the clinical target volume (CTV) as equivalent dose in 2-Gy fractions (EQD2) (CTV D90 EQD2, HR = 1.007, 95% CI = 1.002-1.01, P <0.02) predicted for VCF. Predictors common to segments treated with or without a baseline VCF included concurrent tumor progression and an increasing CTVD90 EQD2. No prior stabilization surgery, involvement of the posterior elements, fewer consecutive segments treated were unique to the baseline VCF cohort, while histology, mechanical pain and higher dose per fraction were unique predictors in the no prior VCF cohort. We report predictive factors for VCF following spine SBRT and observe distinct risk factors according to presence or absence of a baseline VCF that can guide treatment decisions. [ABSTRACT FROM AUTHOR]

The most common complication following spine stereotactic body radiotherapy (SBRT) is vertebral compression fracture (VCF). Iatrogenic VCF has been widely reported, but it has not yet been reported in the context of tumor progression. We hypothesized that predictors of VCF vary with cause, whether iatrogenic or in conjunction with local failure. A prospectively maintained institutional database of patients treated with SBRT for spinal metastases was retrospectively reviewed. The primary outcome was VCF, with or without local failure. Clinical, dosimetric and radiographic factors were reported with descriptive statistics. The cumulative incidence of iatrogenic VCF and VCF with tumor progression was estimated using a competing risk analysis method. The impact of covariates was estimated with Cox proportional hazards model and hazard ratios (HR) generated. From 2008 – 2022, 744 patients with 1813 spinal segments were treated with spine SBRT. The median age was 64.9 years and median follow up was 19.9 months. Of the 254 VCF events (14%), 179 (70.5%) were iatrogenic and 75 (29.5%) associated with concurrent tumor progression. Median time to iatrogenic VCF was 10.1 months and 9.0 months in those with tumor progression. The majority of segments that had an iatrogenic VCF or with tumor progression were treated with 24Gy in 2 fractions (41.8% and 41.3%, respectively) and the median dose per fraction was 12Gy in both (range = 5-24). The 1- and 2-year iatrogenic VCF rates were 6.8% and 9.9%, respectively, and 15.6% and 22.0% in those concurrent with tumor progression, respectively. On multivariable analysis (MVA), spinal level and increasing dose to 90% (D90) of the clinical target volume (CTV) as equivalent dose in 2-Gy fractions (EQD2) were the only predictors common to both iatrogenic VCF and those secondary to tumor progression. Risk factors that uniquely increased the risk of iatrogenic VCF were presence of a baseline VCF (HR = 1.85, 95% CI = 1.25-2.74, P = 0.002), increasing consecutive segments treated (HR = 0.76, 95% CI = 0.64-0.90, P <0.01), and older age (HR = 1.02, 95% CI = 1.002-1.03, P = 0.03). Meanwhile, epidural disease (HR = 2.84, 95% CI = 1.68-4.79, P <0.001), mechanical pain (HR = 3.33, 95% CI = 1.53-7.25, P <0.01) and fewer SBRT fractions (HR = 0.65, 95% CI = 0.45-0.93, P <0.02) were predictive of VCF in those concurrent with tumor recurrence. This first report of predictive factors for VCF following spine SBRT, according to an iatrogenic cause or concurrent with tumor progression, may improve clinical decision making in VCF management. [ABSTRACT FROM AUTHOR]

Objective: To examine perceived OR ergonomics facilitators and barriers, with a focus on the interdisciplinary team., Summary Background Data: Poor ergonomics causes musculoskeletal injuries affecting all operating room (OR) staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors., Methods: We conducted a self-administered web-based survey of OR nurses, surgeons, and anesthesiologists at a single centre (n=238). We developed a questionnaire through items generation and reduction, followed by reliability and validity testing., Results: Response rate was 53.8%. Respondents perceived that on average 80% of nurses, 70% of surgeons, and 40% anesthesiologists experienced MSK injuries, with no difference in professional groups' perceptions. Guideline ergonomics interventions were rarely used (<25%) except for specialized clothing (33%), equipment repositioning (59%), and seating (37%), though perceived beneficial by 80-90%. Reported barriers to optimal ergonomics were organizational/structural (lack of time, space, equipment, funding), whereas solutions were individual. Fear of unfavourable perception from others was a concern for 62%. Teams discussing, prioritizing, monitoring, or helping with ergonomics was indicated by <50%. Individual ergonomic adaptations were perceived as convenience by other staff., Conclusions: While structural/organizational issues are reported as barriers to ergonomics, solutions appeared as individual responsibilities. Team dynamics did not prioritize nor support ergonomics. Education tools leveraging the interdisciplinary team are warranted. This work will be supplemented by interviews and live observations to build tailored educational tools for OR teams., Competing Interests: Conflicts of interest and source of funding: None to declare. Funding was received from the Sunnybrook AFP-SHARE Fund as peer-reviewed operating grant., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Although spine stereotactic body radiation therapy (SBRT) is considered a standard of care in the mobile spine, mature evidence reporting outcomes specific to sacral metastases is lacking. Furthermore, there is a need to validate the existing sacral SBRT international consensus contouring guidelines to define the optimal contouring approach. We report mature rates of local failure (LF), adverse events, and the effect of contouring deviations in the largest experience to date specific to sacrum SBRT., Methods and Materials: Consecutive patients who underwent sacral SBRT from 2010 to 2021 were retrospectively reviewed. The primary endpoint was magnetic resonance imaging-based LF with a focus on adherence to target volume contouring recommendations. Secondary endpoints included vertebral compression fracture and neural toxicity., Results: Of the 215 sacrum segments treated in 112 patients, most received 30 Gy/4 fractions (51%), 24 Gy/2 fractions (31%), or 30 Gy/5 fractions (10%). Sixteen percent of segments were nonadherent to the consensus guideline with a more restricted target volume (undercontoured). The median follow-up was 21.4 months (range, 1.5-116.9 months). The cumulative incidence of LF at 1 and 2 years was 18.4% and 23.1%, respectively. In those with guideline adherent versus nonadherent contours, the LF rate at 1 year was 15.1% versus 31.4% and at 2 years 18.8% versus 40.0% (hazard ratio [HR], 2.5; 95% CI, 1.4-4.6; P = .003), respectively. On multivariable analysis, guideline nonadherence (HR, 2.4; 95% CI, 1.3-4.7; P = .008), radioresistant histology (HR, 2.4; 95% CI, 1.4-4.1; P < .001), and extraosseous extension (HR, 2.5; 95% CI, 1.3-4.7; P = .005) predicted for an increased risk of LF. The cumulative incidence of vertebral compression fracture was 7.1% at 1 year and 12.3% at 2 years. Seven patients (6.3%) developed peripheral nerve toxicity, of whom 4 had been previously radiated., Conclusions: Sacral SBRT is associated with high efficacy rates and an acceptable toxicity profile. Adhering to consensus guidelines for target volume delineation is recommended to reduce the risk of LF., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background and Purpose: We report outcomes following spine stereotactic body radiotherapy (SBRT) in metastatic non-small cell lung cancer (NSCLC) and the significance of programmed death-ligand 1 (PD-L1) status, epidermal growth factor receptor (EGFR) mutation and timing of immune check point inhibitors (ICI) on local failure (LF)., Materials and Methods: 165 patients and 389 spinal segments were retrospectively reviewed from 2009 to 2021. Baseline patient characteristics, treatment and outcomes were abstracted. Primary endpoint was LF and secondary, overall survival (OS) and vertebral compression fracture (VCF). Multivariable analysis (MVA) evaluated factors predictive of LF and VCF., Results: The median follow-up and OS were: 13.0 months (range, 0.5-95.3 months) and 18.4 months (95% CI 11.4-24.6). 52.1% were male and 76.4% had adenocarcinoma. Of the 389 segments, 30.3% harboured an EGFR mutation and 17.0% were PD-L1 ≥ 50%. The 24 months LF rate in PD-L1 ≥ 50% vs PD-L1 < 50% was 10.7% vs. 38.0%, and in EGFR-positive vs. negative was 18.1% vs. 30.0%. On MVA, PD-L1 status of ≥ 50% (HR 0.32, 95% CI 0.15-0.69, p = 0.004) significantly predicted for lower LF compared to PD-L1 < 50%. Lower LF trend was seen with ICI administration peri and post SBRT (HR 0.41, 95% CI 0.16-1.05, p = 0.062). On MVA, polymetastatic disease (HR 3.28, 95% CI 1.84-5.85, p < 0.0001) and ECOG ≥ 2 (HR 1.87, 95% CI 1.16-3.02, p = 0.011) significantly predicted for worse OS and absence of baseline VCF predicted for lower VCF rate (HR 0.20, 95% CI 0.10-0.39, p < 0.0001)., Conclusion: We report a significant association of PD-L1 ≥ 50% status on improved LC rates from spine SBRT in NSCLC patients., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)