Search

The glomerular filtration rate (GFR) is important for assessing renal function and must be calculated reliably and reproducibly. This study aimed to compare the reliability and accuracy of GFR estimated with 99m-technetium diethylene-triamine-pentaacetate (99mTc-DTPA) versus that calculated from the effective renal plasma flow (ERPF) (GFR is 20% of ERPF) determined by the 99m-technetium ethylene dicysteine (99mTc-EC) technique. Forty-five patients suffering from cancer requiring platinum compound-based chemotherapy or from chronic renal failure were recruited. The patients were divided into two cohorts: (1) those with normal serum creatinine (SCr) levels (≤2 mg/dL) and (2) deranged SCr levels (>2 mg/dL). For all patients, the relative renal function was estimated by the 99mTc-DTPA and 99mTc-EC methods, 2–4 days apart. A 24-h urine sample for estimating 24-h creatinine clearance (CrCl) was obtained. GFR was also calculated using the Modification of Diet in Renal Disease (MDRD) formula. The GFR estimated via 24-h urine CrCl, 99mTc-DTPA, and ERPF obtained with 99mTc-EC were examined by quantile comparison plots, and all showed evidence of following a non-Gaussian distribution. For SCr values ≤2 mg/dL, the GFR estimated by the MDRD formula consistently shows significantly higher values than the GFR estimated with 99mTc-DTPA or 99mTc-EC. We found a high degree of correlation between the 99mTc-DTPA and 99mTc-EC radionuclide methods of estimating GFR. However, in patients with renal dysfunction, GFR estimated through Gates' method using a gamma camera overestimated the GFR; in these patients, calculating the GFR from the ERPF obtained with 99mTc-EC is more accurate.

Abstract Objective To compare volumetric modulated arc therapy (VMAT) with simultaneous tumor bed boost (dpSIB‐VMAT) to the whole breast and regional nodal irradiation (RNI) against standard three‐dimensional conformal radiotherapy plus RNI with sequential tumor bed boost (3D‐CRT‐seqB). Methods Thirty patients who underwent breast cancer surgery (BCS) with axillary lymph node dissection (ALND) were enrolled. Two plans were generated for each case: (1) dpSIB‐VMAT, and (2) 3D‐CRT‐seqB plans. Planning target volume (PTV)‐Breast and PTV‐Nodes were prescribed at a dose of 50 Gy in 25 fractions in both plans. PTV‐Boost was prescribed at a dose of 60 Gy in 25 fractions simultaneously in the dpSIB‐VMAT plans, whereas it was planned sequentially in the 3D‐CRT‐seqB plans at 10 Gy in 5 fractions. Dosimetric parameters were compared between the two plans. Results Both plans achieved the target coverage. Dmean of the heart was lower with dpSIB‐VMAT in left‐sided cases (7.17 ± 0.66 Gy vs. 10.12 ± 2.91 Gy; t = 4.02; p = 0.001). Ipsilateral mean lung dose (15.87 ± 1.40 Gy vs. 19.82 ± 3.20 Gy; t = 6.30; p

Introduction: Conventional Whole Pelvic Radiotherapy (WPRT) is associated with significant morbidity, especially haematological and Gastrointestinal (GI), which increases further with concurrent chemotherapy. Various studies have shown a clinical benefit of pelvic Intensity Modulated Radiotherapy (IMRT) but included a significant number of patients with intact cervix and uterus. Aim: The primary aim of the study was to record the toxicities of IMRT and the secondary aim was to detect its tolerance. Materials and Methods: This was a phase 2, single arm cohort study, conducted from August 2015 to October 2018 at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, including a total of 30 patients (23 cervical and seven endometrial cancer) who had undergone a total hysterectomy and required adjuvant pelvic irradiation. These patients were treated with pelvic IMRT using a dose of 45-50.4 Gray (Gy) at 1.8-2 Gy per fraction given as five fractions per week with/without concurrent chemotherapy (using injection cisplatin 35-40 mg/m2 per week) as per indications. Acute toxicities were recorded at weekly intervals during the treatment followed by the assessment of late toxicities at the time of each follow-up visits using Radiation Therapy Oncology Group (RTOG) radiation morbidity criteria. All outcomes were measured from the time of the start of radiotherapy to the time of acute event. Acute and late toxicities were assessed according to RTOG radiation morbidity criteria. Survival analysis was done using the Kaplan-Meier method. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) (IBM Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Results: Out of 30 patients, the highest grades of acute toxicities for skin, Lower Gastrointestinal (LGI), Genitourinary (GU), and haematological toxicities were grade 1, 2, 2 and 2, occurring in 11 (36.7%), 9 (30%), 4 (13.4%), and 1 (3.4%) of the cases, respectively. No late skin and GU toxicities were observed. Maximum late LGI toxicity was grade 1, occurring in 6.67% of the cases. Five (out of 30) patients developed treatment failures (two distant and three local). At a median follow-up of 35 months, the three year Progression Free Survival (PFS) and Overall Survival (OS) were 83.3% (all stages included). Conclusion: Considering acute and late adverse events in the form of skin, LGI, GU, and haematological toxicities, IMRT is well tolerated and has an acceptable toxicity profile even in the setting of an aggressive trimodality approach.

Introduction: We aimed to dosimetrically compare three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT) in terms of planning target volume (PTV) coverage, organ at risk (OAR) sparing, and conformity index (CI). Material and Methods: Planning data of 26 high grade glioma (HGG) patients were used. Prescribed dose for 3D-CRT was 46Gy in 23 fractions to low-risk PTV (LR-PTV) and 14 Gy in 7 fractions to high-risk PTV (HR-PTV). VMAT plans were conducted using 46 Gy in 30 fractions to LR-PTV and 60 Gy in 30 fractions to HR-PTV. Results: Tumor locations were frontal, parietal, temporal, and multi-lobed in 27%, 15%, 23%, and 35% of cases, respectively. Histology was glioblastoma multiform in 89% of patients. Mean values of PTV D95 (dose received by 95% volume) in 3D-CRT and VMAT were 96.6% and 98.8% for the LR-PTV and 97.3% and 99% for HR-PTV (PConclusion: VMAT achieved better coverage of the PTV and delivered fewer doses to bilateral optic nerve and chiasm.

IntroductionMicroarray analysis has revolutionized the role of genomic prognostication in breast cancer. However, most studies are single series studies, and suffer from methodological problems. We sought to use a meta-analytic approach in combining multiple publicly available datasets, while correcting for batch effects, to reach a more robust oncogenomic analysis.AimThe aim of the present study was to find gene sets associated with distant metastasis free survival (DMFS) in systemically untreated, node-negative breast cancer patients, from publicly available genomic microarray datasets.MethodsFour microarray series (having 742 patients) were selected after a systematic search and combined. Cox regression for each gene was done for the combined dataset (univariate, as well as multivariate - adjusted for expression of Cell cycle related genes) and for the 4 major molecular subtypes. The centre and microarray batch effects were adjusted by including them as random effects variables. The Cox regression coefficients for each analysis were then ranked and subjected to a Gene Set Enrichment Analysis (GSEA).ResultsGene sets representing protein translation were independently negatively associated with metastasis in the Luminal A and Luminal B subtypes, but positively associated with metastasis in Basal tumors. Proteinaceous extracellular matrix (ECM) gene set expression was positively associated with metastasis, after adjustment for expression of cell cycle related genes on the combined dataset. Finally, the positive association of the proliferation-related genes with metastases was confirmed.ConclusionTo the best of our knowledge, the results depicting mixed prognostic significance of protein translation in breast cancer subtypes are being reported for the first time. We attribute this to our study combining multiple series and performing a more robust meta-analytic Cox regression modeling on the combined dataset, thus discovering 'hidden' associations. This methodology seems to yield new and interesting results and may be used as a tool to guide new research.