Oxygen saturation profile in late-preterm and term infants: a prospective cohort study

OBJECTIVE

To determine oxygen saturation profile over 6 h monitoring period in healthy late-preterm and term neonates during the first 48 h of age, and to assess the impact of gestational age, birth weight and method of delivery on this profile.

STUDY DESIGN

Prospective cohort study of measurement of SpO2 over 6 h in 20 late-preterm (35 to 36 weeks gestation) and 40 term infants within 12 to 48 h of birth was conducted. Infants with cardiorespiratory symptoms or need for cardiorespiratory support at birth were excluded. Percentage time spent at SpO2 >90% and ⩽90% was calculated by gestational age and birth weight.

RESULT

Late-preterm infants and infants born weighing <2.5 kg spent approximately 7% of the time at SpO2 ⩽90%; this time decreased as gestational age and birth weight increased. Time at SpO2 >90% was significantly different between late-preterm and term infants (93% (5%) vs 96% (3%); P =0.002). Time at SpO2 >90% was not significantly different between males and females (95% (5%) vs 95% (4%), both n=30; P =0.72) or between vaginal births and cesarean births (95% (4%), n=32, vs 95% (4%), n=28; P =0.39). Cumulative time with SpO2 <90 was mean (s.d.) of 25 (18) in preterm vs 13 (10) min in term infants.

CONCLUSION

Over a 6-h period healthy late-preterm and term infants spent significant time at SpO2 ⩽90%. Lower gestation and lower birth weight were associated with higher time at SpO2 ⩽90%.

New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG)

Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.

The effect of dimensionality of nanostructured carbon on the architecture of organic-inorganic hybrid materials

The natural tendency of carbon nanotubes (CNTs) to agglomerate is an underlying reason that prevents the realization of their full potential. On the other hand, covalent functionalization of CNTs to control dispersion leads to disruption of π-conjugation in CNTs and the non-covalent functionalization leads to a weak CNT-polymer interface. To overcome these challenges, we describe the characteristics of fostering of direct nucleation of polymers on nanostructured carbon (CNTs of diameters (~2-200 nm), carbon nanofibers (~200-300 nm), and graphene), which culminates in interfacial adhesion, resulting from electrostatic and van der Waals interaction in the hybrid nanostructured carbon-polymer architecture. Furthermore, the structure is tunable through a change in undercooling. High density polyethylene and polypropylene were selected as two model polymers and two sets of experiments were carried out. The first set of experiments was carried out using CNTs of diameter ~2-5 nm to explore the effect of undercooling and polymer concentration. The second set of experiments was focused on studying the effect of dimensionality on geometrical confinements. The periodic crystallization of polyethylene on small diameter CNTs is demonstrated to be a consequence of the geometrical confinement effect, rather than epitaxy, such that petal-like disks nucleate on large diameter CNTs, carbon nanofibers, and graphene. The application of the process is illustrated in terms of fabricating a system for cellular uptake and bioimaging.

Dehiscence of the posterior and superior semicircular canal presenting in pregnancy

OBJECTIVE

We present an interesting case of superior and posterior semicircular canal dehiscence in pregnancy.

METHOD

We present a case report and a review of the world literature concerning semicircular canal dehiscence.

CASE REPORT

A 34-year-old woman presented with sound and pressure induced vertigo at 22 weeks gestation. A thinly sliced computed tomography (CT) scan of the petrous temporal bones viewed with coronal reconstructions was performed post-partum. This showed the presence of both left superior canal and posterior canal dehiscence.

CONCLUSION

To our knowledge this is the first reported case of semicircular canal dehiscence in pregnancy. The diagnosis of semicircular canal dehiscence should be suspected in pregnant patients with sound induced vertigo.

SU-E-I-11: A Novel High Resolution CT Imager for a Breast SPECT-CT System

PURPOSE

To evaluate the intrinsic characteristics of a new high resolution, large area, small bezel, digital imager developed for a dedicated SPECT-CT system for fully-3D mammotomographic imaging applications.

METHODS

A new flat panel digital imager was developed having 127μm pixels (identical to those in the Paxscan 2520) with an active 40×30cm area and 3200×2304 total pixels, which is well suited for pendant breast imaging close to the chest wall. The readout and driver ASIC TAB bonding pads were arranged on only two sides of the imager plate, to eliminate dead edge spacing. A special housing was developed to accommodate this imaging plate providing very narrow 8mm edges (bezels) on two orthogonal sides The TFT array imager was coated with 600μm thick micro-columnar CsI, which provides >90% absorption in the breast CT (60-80kVp) x-ray energy range. It provides better than 70% absorption for RQA5 (70kVp 21mm Al filter) x- ray radiation. The readout ASICs are connected to 14 bit A/D converters, and special readout ASICs with gain switching feature, which provide an additional 4bit virtual (2-3 effective) dynamic range.

RESULTS

The MTF is ∼7.5% at the 3.9 lp/mm Nyquist frequency. The NPS curves continuously decrease with increasing spatial frequencies, characteristic of scintillator based imagers. The excellent DQE (0) measured at RQA5 is ∼75% in the 0.1-1mR dose range and ∼10% at the Nyquist frequency. The imager has excellent linearity over the full dynamic range, and high contrast images are readily acquired.

CONCLUSIONS

The new 4030 flat panel imager is a high resolution, state of the art detector, ideal for breast imaging and other applications. This detector is included in the SPECT-CT device in development.

SU-E-l-01: Investigating the Dependence of 2D and 3D Scatter-To-Primary Ratios on Breast Density in Clinical Breast CT

PURPOSE

To characterize 2D and 3D scatter-to-primary ratios (SPR) and investigate the dependence of SPR on breast density based on clinicalpatient imaging on our dedicated SPECT-CT mammotomography system.

METHODS

As a part of an on-going IRB approved protocol, 7 consented women underwent a breast imaging study with our SPECT-CT system. Using a quasi-monochromatic x-ray cone beam and flat panel detector, 240 projections were obtained. 6 beam stop array (BSA) projections were also obtained over 40 degree intervals. The CT data were scatter corrected using a phantom-validated algorithm based on the BSA technique. For each projection, 2D scatter fluence was determined behind each beam stop shadow through the patient's breast, and cubic spline interpolated throughout the thresholded breast region. 2D SPRs were calculated as the average of 6 measured ratios of scatter projections to scatter corrected (primary) projections. Angular cubic spline interpolation was performed to obtain the remaining 234 azimuthal BSA projections for reconstruction correction. Corrected and uncorrected projection images were individually reconstructed and 3D SPRs calculated as the ratio of difference between primary and un-corrected volumes to primary volumes. Histograms of the reconstructed patient data-sets yielded distinct peaks representing linear attenuation coefficients of glandular+skin and fatty tissue. Percentage glandular and fatty tissue was estimated by fitting a double Gaussian to the histogram and integrating area under the curve.

RESULTS

Only 4 CT data sets devoid of motion and truncation artifacts were suitable for scatter correction. Preliminary results show that 2D SPR values peak at the center of breast volumes and were greatest (∼50%) for the most glandular breast, whereas 3D SPR values remained fairly constant throughout the breast and did not obviously correlate with density, consistent with prior phantom results.

CONCLUSIONS

2D SPR values are greater in breasts with higher glandular tissue composition, whereas 3D SPR values appear independent of breast composition. This work is funded by the National Cancer Institute of the National Institutes of Health grant RO1-CA096821, with partial support (JHP) from NIH T32-EB001040. MPT is the inventor of this CT technology, and is named as an inventor on the patent for this technology awarded to Duke University. If this technology becomes commercially successful, MPT and Duke could benefit financially.

Standardization of fetal ultrasound biometry measurements: improving the quality and consistency of measurements

OBJECTIVE

To assess whether a standardization exercise prior to commencing a fetal growth study involving multiple sonographers can reduce interobserver variation.

METHODS

In preparation for an international study assessing fetal growth, nine experienced sonographers from eight countries participated in a standardization exercise consisting of theoretical and practical sessions. Each performed a set of seven standard fetal measurements on pregnant volunteers at 20-37 weeks' gestation, and these were repeated by the lead sonographer; all measurements were taken in a blinded fashion. After this the sonographers had hands-on practice and feedback sessions on other volunteers. This process was repeated three times. Measurement differences between sonographers and the lead sonographer, expressed as a gestational-age-specific Z-score, between the first and third scans were compared using the Wilcoxon signed ranks test, and variance was assessed using Pitman's test. Interobserver agreement was also assessed using the intraclass correlation coefficient (ICC), and all images were scored for quality in a blinded fashion.

RESULTS

At baseline the level of agreement and image scoring were high. A significant reduction in the differences between sonographers and the lead sonographer were seen for fetal biometry overall (head circumference, abdominal circumference and femur length) between the first and third scans (median Z-scores, 0.46 and 0.24; P = 0.005), and a reduction in the variance was also observed (P < 0.001). The ICCs for measurement pairs for every fetal measurement showed a clear trend of increasing ICC (better agreement) with consecutive training scan sessions, although no improvement in image scores was seen.

CONCLUSION

Even for experienced sonographers, a standardization exercise before starting a study of fetal biometry can improve consistency of measurements. This could be of relevance for studies assessing fetal growth in multicenter sites.

A randomized trial of a single-dose rasburicase versus five-daily doses in patients at risk for tumor lysis syndrome

BACKGROUND

Tumor lysis syndrome (TLS) is a life-threatening disorder characterized by hyperuricemia and metabolic derangements. The efficacy of rasburicase, administered daily for 5 days, has been well established. However, the optimal duration of therapy is unknown in adults.

PATIENTS AND METHODS

We evaluated the efficacy of rasburicase (0.15 mg/kg) administered as single dose followed by as needed dosing (maximum five doses) versus daily dosing for 5 days in adult patients at risk for TLS.

RESULTS

Eighty of the 82 patients enrolled received rasburicase; 40 high risk [median uric acid (UA) 8.5 mg/dl; range, 1.5-19.7] and 40 potential risk (UA = 5.6 mg/dl; range, 2.4-7.4). Seventy-nine patients (99%) experienced normalization in their UA within 4 h after the first dose; 84% to an undetectable level (<0.7 mg/dl). Thirty-nine of 40 (98%) patients in the daily-dose arm and 34 of 40 (85%) patients in single-dose arm showed sustained UA response. Six high-risk patients within the single-dose arm required second dose for UA >7.5 mg/dl. Rasburicase was well tolerated; one patient with glucose-6-phosphate dehydrogenase deficiency developed methemoglobinemia and hemolysis.

CONCLUSIONS

Rasburicase is highly effective for prevention and management of hyperuricemia in adults at risk for TLS. Single-dose rasburicase was effective in most patients; only a subset of high-risk patients required a second dose.

A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections

BACKGROUND AND STUDY AIMS

Tubular stents have been used to accomplish endoscopic transluminal drainage, but do not impart lumen-to-lumen anchorage. We evaluated a novel lumen-apposing stent designed for enteric drainage of nonadherent lumens.

MATERIAL AND METHODS

Ex vivo benchtop testing was performed to quantify various physical and performance metrics of the stent (Axios). A simulator was developed to test the stent deployment through an echoendoscope. Survival experiments were performed on four pigs. Under endosonographic guidance, a cholecystogastrostomy tract was created and the stent was deployed across the lumens. Direct cholecystoscopy was performed. Surveillance gastroscopy was performed at weekly intervals for up to 8 weeks. Measured outcomes were procedural success, safety, and device durability and patency.

RESULTS

In benchtop testing, the Axios stent withstood various vector forces of movement, yet allowed easy removability from the simulated tissue. The stent was successfully deployed across the stomach and gallbladder lumens in all four animals without complication. Direct cholecystoscopy and contrast injection documented the absence of tissue trauma and leakage. Gastroscopy at weekly intervals showed the stent in stable position without dislodgment. The stent remained patent in all animals. The covering remained intact and there was no hyperplastic tissue ingrowth or overgrowth, or tissue injury. One stent was removed at 4 weeks. On necropsy, the gallbladders showed focal adherence to the stomach at the site of cystogastrostomy with a negative leak test.

CONCLUSIONS

The Axios stent enables the creation of a robust and reliable conduit between nonadherent lumens around the gastrointestinal tract.

A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections

BACKGROUND AND STUDY AIMS

Tubular stents have been used to accomplish endoscopic transluminal drainage, but do not impart lumen-to-lumen anchorage. We evaluated a novel lumen-apposing stent designed for enteric drainage of nonadherent lumens.

MATERIAL AND METHODS

Ex vivo benchtop testing was performed to quantify various physical and performance metrics of the stent (Axios). A simulator was developed to test the stent deployment through an echoendoscope. Survival experiments were performed on four pigs. Under endosonographic guidance, a cholecystogastrostomy tract was created and the stent was deployed across the lumens. Direct cholecystoscopy was performed. Surveillance gastroscopy was performed at weekly intervals for up to 8 weeks. Measured outcomes were procedural success, safety, and device durability and patency.

RESULTS

In benchtop testing, the Axios stent withstood various vector forces of movement, yet allowed easy removability from the simulated tissue. The stent was successfully deployed across the stomach and gallbladder lumens in all four animals without complication. Direct cholecystoscopy and contrast injection documented the absence of tissue trauma and leakage. Gastroscopy at weekly intervals showed the stent in stable position without dislodgment. The stent remained patent in all animals. The covering remained intact and there was no hyperplastic tissue ingrowth or overgrowth, or tissue injury. One stent was removed at 4 weeks. On necropsy, the gallbladders showed focal adherence to the stomach at the site of cystogastrostomy with a negative leak test.

CONCLUSIONS

The Axios stent enables the creation of a robust and reliable conduit between nonadherent lumens around the gastrointestinal tract.

Parathyroid hormone stimulates circulating osteogenic cells in hypoparathyroidism

CONTEXT

The osteoanabolic properties of PTH may be due to increases in the number and maturity of circulating osteogenic cells. Hypoparathyroidism is a useful clinical model because this hypothesis can be tested by administering PTH.

OBJECTIVE

The objective of the study was to characterize circulating osteogenic cells in hypoparathyroid subjects during 12 months of PTH (1-84) administration.

DESIGN

Osteogenic cells were characterized using flow cytometry and antibodies against osteocalcin, an osteoblast-specific protein product, and stem cell markers CD34 and CD146. Changes in bone formation from biochemical markers and quadruple-labeled transiliac crest bone biopsies (0 and 3 month time points) were correlated with measurements of circulating osteogenic cells.

SETTING

The study was conducted at a clinical research center.

PATIENTS

Nineteen control and 19 hypoparathyroid patients were included in the study.

INTERVENTION

Intervention included the administration of PTH (1-84).

RESULTS

Osteocalcin-positive cells were lower in hypoparathyroid subjects than controls (0.7 ± 0.1 vs. 2.0 ± 0.1%; P < 0.0001), with greater coexpression of the early cell markers CD34 and CD146 among the osteocalcin-positive cells in the hypoparathyroid subjects (11.0 ± 1.0 vs. 5.6 ± 0.7%; P < 0.001). With PTH (1-84) administration, the number of osteogenic cells increased 3-fold (P < 0.0001), whereas the coexpression of the early cell markers CD34 and CD146 decreased. Increases in osteogenic cells correlated with circulating and histomorphometric indices of osteoblast function: N-terminal propeptide of type I procollagen (R(2) = 0.4, P ≤ 0.001), bone-specific alkaline phosphatase (R(2) = 0.3, P < 0.001), osteocalcin (R(2) = 0.4, P < 0.001), mineralized perimeter (R(2) = 0.5, P < 0.001), mineral apposition rate (R(2) = 0.4, P = 0.003), and bone formation rate (R(2) = 0.5, P < 0.001).

CONCLUSIONS

It is likely that PTH stimulates bone formation by stimulating osteoblast development and maturation. Correlations between circulating osteogenic cells and histomorphometric indices of bone formation establish that osteoblast activity is being identified by this methodology.

Controlled and extended drug release behavior of chitosan-based nanoparticle carrier

Controlled drug release is presently gaining significant attention. In this regard, we describe here the synthesis (based on the understanding of chemical structure), structural morphology, swelling behavior and drug release response of chitosan intercalated in an expandable layered aluminosilicate. In contrast to pure chitosan, for which there is a continuous increase in drug release with time, the chitosan-aluminosilicate nanocomposite carrier was characterized by controlled and extended release. Drug release from the nanocomposite particle carrier occurred by degradation of the carrier to its individual components or nanostructures with a different composition. In both the layered aluminosilicate-based mineral and chitosan-aluminosilicate nanocomposite carriers the positively charged chemotherapeutic drug strongly bound to the negatively charged aluminosilicate and release of the drug was slow. Furthermore, the pattern of drug release from the chitosan-aluminosilicate nanocomposite carrier was affected by pH and the chitosan/aluminosilicate ratio. The study points to the potential application of this hybrid nanocomposite carrier in biomedical applications, including tissue engineering and controlled drug delivery.

A Pilot Trial of Pre-Operative (Neoadjuvant) Letrozole in Combination with Bevacizumab in Post-Menopausal Women with Newly Diagnosed Estrogen and/or Progesterone Receptor Positive Breast Cancer

Purpose Tumor content or expression of vascular endothelial growth factor (VEGF) is associated with impaired efficacy of anti-estrogen adjuvant therapy. We designed a pilot study of neoadjuvant letrozole and bevacizumab (anti-VEGF) to assess feasibility and short term efficacy in post-menopausal women with stage II/III, ER/PR positive breast cancer. Patients and Methods Patients were treated with a neo-adjuvant regimen of letrozole, 2.5mg/day (P.O.) and bevacizumab 15mg/kg Q3 weeks (I.V.) for a total of 24 weeks prior to surgical treatment of their breast cancer. Patients were followed for toxicity at 3 week intervals and tumor assessment (physical exam and tumor ultrasound) at 6 week intervals. PET scans were carried out prior to therapy and 6 weeks after initiation of therapy. Surgery was done 4 weeks after the last dose of bevacizumab. Results Twenty five evaluable patients were treated. The regimen was well tolerated except for 2 patients who were taken off-study for difficult to control hypertension. Objective clinical response occurred in 17/25 patients (68%) including 16% CR and 52% PR. The 4 patients with clinical CR had pathologic CR in their breasts (16%) although one had residual tumor cells in axillary nodes. 8/25 patients (32%) attained stage 0 or 1 status. PET scan response at 6 weeks correlated with clinical CR and breast pathologic CR at 24 weeks (p &lt; 0.0036). Conclusion Combination neo-adjuvant therapy with letrozole and bevacizumab was well tolerated and resulted in impressive clinical and pathologic responses. The Breast Cancer Translational Research Consortium has an ongoing randomized phase II trial of this regimen in this patient population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1088.

Paediatric conscious sedation: views and experience of specialists in paediatric dentistry

OBJECTIVES

The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation.

SUBJECTS AND METHODS

A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period.

RESULTS

A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training.

CONCLUSIONS

The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

Superior in vitro biological response and mechanical properties of an implantable nanostructured biomaterial: Nanohydroxyapatite-silicone rubber composite

A potential approach to achieving the objective of favorably modulating the biological response of implantable biopolymers combined with good mechanical properties is to consider compounding the biopolymer with a bioactive nanocrystalline ceramic biomimetic material with high surface area. The processing of silicone rubber (SR)-nanohydroxyapatite (nHA) composite involved uniform dispersion of nHA via shear mixing and ultrasonication, followed by compounding at sub-ambient temperature, and high-pressure solidification when the final curing reaction occurs. The high-pressure solidification approach enabled the elastomer to retain the high elongation of SR even in the presence of the reinforcement material, nHA. The biological response of the nanostructured composite in terms of initial cell attachment, cell viability and proliferation was consistently greater on SR-5wt.% nHA composite surface compared to pure SR. Furthermore, in the nanocomposite, cell spreading, morphology and density were distinctly different from that of pure SR. Pre-osteoblasts grown on SR-nHA were well spread, flat, large in size with a rough cell surface, and appeared as a group. In contrast, these features were less pronounced in SR (e.g. smooth cell surface, not well spread). Interestingly, an immunofluorescence study illustrated distinct fibronectin expression level, and stronger vinculin focal adhesion contacts associated with abundant actin stress fibers in pre-osteoblasts grown on the nanocomposite compared to SR, implying enhanced cell-substrate interaction. This finding was consistent with the total protein content and SDS-PAGE analysis. The study leads us to believe that further increase in nHA content in the SR matrix beyond 5wt.% will encourage even greater cellular response. The integration of cellular and molecular biology with materials science and engineering described herein provides a direction for the development of a new generation of nanostructured materials.

Phase II study of bevacizumab (B) plus cisplatin (C) plus intensity-modulated radiation therapy (IMRT) for locoregionally advanced head and neck squamous cell cancer (HNSCC): Preliminary results

6013

Background: For patients with locoregionally advanced HNSCC, concurrent high-dose cisplatin + radiation therapy is a historical standard of care. HNSCC tumors expressing high levels of VEGF have been associated with worse prognosis, and bevacizumab may sensitize tumors to cisplatin and radiation. Methods: Percutaneous gastrostomy (PEG) tube was placed pre-treatment for all patients. Planned treatment consisted of definitive IMRT (total, 70 Gy) with concurrent C (50 mg/m2 days 1, 2, 22, 23, 43, 44) and B (15 mg/kg days 1, 15, and 43). The initial version of the protocol called for an additional 6 months of maintenance B, but this was discontinued in an amendment after a G4 pulmonary hemorrhage event in subject 1 during maintenance treatment. 1o endpoint was 2-year PFS. Results: 42 previously untreated patients (34 M, 8 F), median age 55 (27–75), with stage III/IV, M0 HNSCC (oropharynx 39, larynx 3) enrolled. HPV status by ISH: 16 pos, 14 neg, 12 unknown). All patients have completed treatment. CTCAE v3.0 toxicities (% patients) have included: functional mucositis G3 (76 %); nausea G3 (24%); vomiting G3 (17%); neutropenia G3 (31%), G4 (10%); hemoglobin G3 (17%); hyponatremia G3 (14%). Median weight loss during treatment was 8.9 kg (2.1–26 kg). There were two deaths within 90 days of last treatment: 1 aspiration pneumonia, 1 sudden death. Median follow up is approximately 9 months (range, <3 to 24 months). Locoregional control rate is 100%. Three patients have developed distant metastasis. Estimated one-year PFS is 83% (± 10%) and estimated 1 year OS is 88% (± 6%). At a median of 8 months after completion of radiation therapy, PSS-HN scores were 100 for eating, speech, and diet in respectively 88%, 76%, and 53% of surveyed patients (n = 17). Conclusions: The addition of B to C + IMRT did not appear to increase toxicity to unacceptable levels, and preliminary efficacy results are encouraging.

[Table: see text]