The effect of lower urinary tract substructure doses on side effects of cervical cancer image-guided adaptive brachytherapy

OBJECTIVE

Image-Guided Adaptive Brachytherapy (IGABT) provides a survival advantage in locally advanced cervical cancer (LACC). Although side effects are seen less with this technique, dose parameters that cause urinary side effects are still questionable. We aim to investigate whether the radiotherapy doses of the lower urinary tract substructures (LUSS) affect the urinary system side effects (USSE) of cervical cancer external beam radiotherapy (EBRT) and the IGABT.

METHODS

LUSS (bladder, trigone, bladder neck, and urethra) doses were calculated in 40 patients diagnosed with LACC and receiving primary EBRT, IGABT, and concomitant chemotherapy. D0.1cc, D2cc, and D50% values were examined by contouring the bladder, trigone, bladder neck, and urethra from the intracavitary BT planning computed tomography (CT) images taken every 4 BT fractions, retrospectively. Besides, late USSE (urgency, dysuria (recurrent), frequency, obstruction, incontinence, hematuria, fistula, cystitis) were queried and categorized according to Common Toxicity Criteria for Adverse Events version 5.0.

STATISTICAL ANALYSIS USED

The Chi-square and Fisher's exact tests, Mann-Whitney U-test.

RESULTS

For the whole study population, for both incontinence and dysuria, trigone (D50%), urethra (D50%, D0.1cc,), and bladder neck (D50%, D0.1cc, D2cc) volume and hot spot doses remained significant. For cystitis, urethra (D50%, D0.1cc,) and bladder neck doses (D0.1cc, D50%, D2cc) are worth investigating.

CONCLUSIONS

Although USSE is less common in the intensity-modulated radiation therapy and IGABT era, it may be meaningful to take the doses of LUSS into account when planning IGABT. In addition, delineation of LUSS using only CT seems feasible. More proof is needed to determine delineation technique and dose constraints for LUSS for IGABT.

Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain

BACKGROUND

Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP.

OBJECTIVE

This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP.

METHODS

In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire.

RESULTS

The pain scores of the SSNB group decreased more significantly (p< 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment (p< 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups.

CONCLUSION

TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

Evaluation of the voluntary deep inspiration breath-hold reproducibility in left-sided breast radiotherapy

PURPOSE

Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together.

MATERIAL/METHOD

A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images.

RESULTS

The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured fractions are statistically different; 16.3 vs. 20.8 mm for the planning and measured fractions (p < 0.001), which indicates that the variability of BHL is significantly different.

CONCLUSION

While reproducibility testing shows good agreement for inter-fractional breath-hold level, the variability between planning and fractions is relatively poor.

A Case of Hypopharyngeal Cancer Associated With Fanconi Anemia: A Helical Tomotherapy Experience

Fanconi anemia (FA) is a disease that could be accompanied by multiple abnormalities, such as growth retardation, bone marrow abnormalities, and cancer susceptibility. Among the FA patients, head and neck squamous cell cancer (HNSCC) is the most observed solid cancer. The life expectancy of patients with FA has increased with recent medical advances. Furthermore, HNSCC is diagnosed in 3% of FA patients, and half of these patients die because of their HNSCC. The median age of HNSCC patients with FA is 31, and according to the literature HNSCC incidence of FA, patients is more than 700-fold of the normal population. Here, we reported the treatment details and challenges we faced during hypopharyngeal cancer treatment in a FA patient.

Species distribution, genetic diversity and antimicrobial susceptibility of Campylobacter isolates recovered from the preputial cavity of healthy rams in Turkey

AIMS

Campylobacter sp. are important causes of reproductive disease in ruminants worldwide. Although healthy bulls are well-known carriers for infection of cows, the role of rams as a potential source for infecting ewes is unclear. This study aimed to determine prevalence, species distribution, genetic diversity and antimicrobial susceptibility profiles of Campylobacter sp. isolated from the preputial cavity of healthy rams.

METHODS AND RESULTS

The material of this prospective study comprised 191 swab samples taken from the preputial cavity of healthy rams. Enrichment and membrane filtration were employed for the isolation of Campylobacter. Presumptive isolates were confirmed as Campylobacter by phenotypic and molecular tests. 16S rRNA gene sequence analysis was used for the definitive identification of the isolates at species level, and genotyping was performed using pulsed-field gel electrophoresis (PFGE). The susceptibility of the Campylobacter sp. isolates to various antibiotics was determined by the disk diffusion test. In all, 27 of the 191 (14·13%) swab samples were found to be positive for Campylobacter sp. (28 isolates were recovered in total). Per phenotypic and genotypic analyses, one isolate was identified as Campylobacter mucosalis and the remaining 27 isolates were identified as Campylobacter sputorum bv. faecalis. The PFGE analysis of the C. sputorum biovar faecalis isolates produced 17 clusters and 24 different pulsotypes, indicating high genetic heterogeneity. All 28 isolates were found to be susceptible to all of the antibiotics tested.

CONCLUSIONS

Healthy rams may be an important reservoir of different Campylobacter species in the preputium.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study demonstrated for the first time that healthy rams can carry different Campylobacter sp. including genetically diverse C. sputorum bv. faecalis and C. mucosalis in the preputial cavity. Further investigation on the potential implication of this finding on sheep reproductive health (e.g. infectious infertility, and abortion) and overall epidemiology of Campylobacter may be warranted.

Perosomus elumbis in a Holstein calf infected with bovine viral diarrhea virus

The detection of bovine viral diarrhea virus (BVDV) in a female Holstein calf presented with perosomus elumbis, a congenital anomaly, is reported here. A cow with dystocia was evaluated and an abnormal dead calf was detected during vaginal examination. The calf was retrieved via caesarean section and exhibited abnormalities characteristic of PE, such as vertebral and pelvic malformations. These abnormalities were further confirmed using radiographic and necropsy examinations. At necropsy cerebellar hypoplasia was an additional finding, which is a typical lesion associated with bovine virus diarrhea (BVD). Several tissue samples from the calf were tested for the presence of antigens of BVDV and bovine herpesvirus-1 (BHV-1) by ELISA. In addition, sera samples from the dam and calf were tested for the presence of antibodies against BVDV, BHV-1, and bluetongue disease virus (BTV) using a virus neutralization assay. Results indicated that the calf was congenitally infected with BVDV, whereas there was no evidence for the presence of BHV-1 and BTV. In the dam’s serum no antibodies against BVDV, BHV-1, and BTV were detected. Even though the etiology of perosomus elumbis is unknown, BVDV, which causes fetal anomalies at early gestation in cows, may have been a contributing factor in this case.

Lung stereotactic ablative radiotherapy (SABR): dosimetric considerations for chest wall toxicity

OBJECTIVE

To investigate chest wall pain in patients with peripheral early stage lung cancer treated with stereotactic ablative radiotherapy (SABR), and to identify factors predictive of Common Terminology Criteria of Adverse Events Grade 2 + chest wall pain.

METHODS

Patients who received 55 Gy in five fractions were included. A chest wall structure was retrospectively defined on planning scans, and chest wall dosimetry and tumour-related factors recorded. Logistic regression was performed to identify factors predictive of ≥Grade 2 chest wall pain.

RESULTS

182 patients and 187 tumours were included. There were 20 (10.9%) episodes of ≥Grade 2 chest wall pain. Multivariate logistic regression demonstrated that the maximum dose received by 1 cm(3) of chest wall (Dmax1 cm(3)) and tumour size were significant predictors of ≥Grade 2 chest wall pain [Dmax1 cm(3) odds ratio : 1.104, 95% confidence interval : 1.012-1.204, p = 0.025; tumour size (mm) odds ratio : 1.080, 95% confidence interval : 1.026-1.136, p = 0.003]. This model was an adequate fit to the data (Hosmer and Lemeshow test non-significant) and a fair discriminator for chest wall pain (area under receiver-operating characteristic curve: 0.74). Using the multivariate logistic regression model, parameters for Dmax1 cm(3) are provided, which predict <10% and <20% risks of ≥Grade 2 chest wall pain for different tumour sizes.

CONCLUSION

Grade 2+ chest wall pain is an uncommon side effect of lung SABR. Larger tumour size and increasing Dmax1 cm(3) are significant predictors of ≥Grade 2 chest wall pain. When planning lung SABR, it is prudent to try to avoid hot volumes in the chest wall, particularly for larger tumours.

ADVANCES IN KNOWLEDGE

This article demonstrates that Grade 2 or greater chest wall pain following lung SABR is more common when the tumour is larger in size and the Dmax1 cm(3) of the chest wall is higher. When planning lung SABR, the risk of chest wall pain may be reduced if maximum doses are minimized, particularly for larger tumours.

Whole Brain Radiotherapy Combined with Stereotactic Radiosurgery versus Stereotactic Radiosurgery Alone for Brain Metastases

BACKGROUND

The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) combined with streotactic radiosurgery versus stereotactic radiosurgery (SRS) alone for patients with brain metastases.

MATERIALS AND METHODS

This was a retrospective study that evaluated the results of 46 patients treated for brain metastases at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiation Oncology Department, between January 2012 and January 2015. Twenty-four patients were treated with WBRT+SRS while 22 patients were treated with only SRS.

RESULTS

Time to local recurrence was 9.7 months in the WBRT+SRS arm and 8.3 months in SRS arm, the difference not being statistically significant (p= 0.7). Local recurrence rate was higher in the SRS alone arm but again without significance (p=0,06).

CONCLUSIONS

In selected patient group with limited number (one to four) of brain metastases SRS alone can be considered as a treatment option and WBRT may be omitted in the initial treatment.

Multimodality imaging with CT, MR and FDG-PET for radiotherapy target volume delineation in oropharyngeal squamous cell carcinoma

Background

This study aimed to quantify the variation in oropharyngeal squamous cell carcinoma gross tumour volume (GTV) delineation between CT, MR and FDG PET-CT imaging.

Methods

A prospective, single centre, pilot study was undertaken where 11 patients with locally advanced oropharyngeal cancers (2 tonsil, 9 base of tongue primaries) underwent pre-treatment, contrast enhanced, FDG PET-CT and MR imaging, all performed in a radiotherapy treatment mask. CT, MR and CT-MR GTVs were contoured by 5 clinicians (2 radiologists and 3 radiation oncologists). A semi-automated segmentation algorithm was used to contour PET GTVs. Volume and positional analyses were undertaken, accounting for inter-observer variation, using linear mixed effects models and contour comparison metrics respectively.

Results

Significant differences in mean GTV volume were found between CT (11.9 cm³) and CT-MR (14.1 cm³), p < 0.006, CT-MR and PET (9.5 cm³), p < 0.0009, and MR (12.7 cm³) and PET, p < 0.016. Substantial differences in GTV position were found between all modalities with the exception of CT-MR and MR GTVs. A mean of 64 %, 74 % and 77 % of the PET GTVs were included within the CT, MR and CT-MR GTVs respectively. A mean of 57 % of the MR GTVs were included within the CT GTV; conversely a mean of 63 % of the CT GTVs were included within the MR GTV. CT inter-observer variability was found to be significantly higher in terms of position and/or volume than both MR and CT-MR (p < 0.05). Significant differences in GTV volume were found between GTV volumes delineated by radiologists (9.7 cm³) and oncologists (14.6 cm³) for all modalities (p = 0.001).

Conclusions

The use of different imaging modalities produced significantly different GTVs, with no single imaging technique encompassing all potential GTV regions. The use of MR reduced inter-observer variability. These data suggest delineation based on multimodality imaging has the potential to improve accuracy of GTV definition.

Trial registration

ISRCTN Registry: ISRCTN34165059. Registered 2nd February 2015.

The Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Oropharyngeal Carcinoma Treated with Chemoradiotherapy

BACKGROUND

The aim of the study is to investigate the prognostic role of pre-treatment of markers of the systemic inflammatory response (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and albumin) in patients with oropharyngeal carcinoma treated with chemoradiotherapy.

METHODS

A total of 251 patients with oropharyngeal squamous cell cancer treated with chemoradiotherapy between 2004 and 2010 were retrospectively identified. NLR, PLR, and albumin were recorded from baseline blood parameters. NLR threshold of >5 and PLR thresholds of ≤150, >150 and ≤300, and >300 were used for analysis.

RESULTS

Median follow-up was 46 months (range 9–98). The 3 year overall survival, local control, regional control, and distant control were 70%, 85%, 87%, and 87%, respectively. On multivariate analysis, locoregional control was associated with T stage (HR 3.3 (95% CI 1.5–6.9), P = 0.002) and NLR (HR 2.1 (95% CI 1.1–3.9), P = 0.023). Overall survival was associated with T stage (HR 2.47 (95% CI 1.45–4.2), P = 0.001) and grade (HR 0.61 (95% CI 0.38–0.99), P = 0.048). PLR and albumin were not significantly associated with disease outcomes or survival.

CONCLUSIONS

The NLR is an independent prognostic factor for locoregional control in oropharyngeal cancer treated with chemoradiotherapy.

Comparison of synchronisation and fertility after different modifications of the ovsynch protocol in cyclic dairy cows

The objectives of this study were to evaluate the effects of (1) double doses of PGF2α administration or (2) an exogenous progesterone (CIDR) applied concurrently with, or (3) the day after, first GnRH of Ovsynch (GnRH-1), on synchronisation and fertility during the Ovsynch protocol. All cows (n = 378) received the Ovsynch protocol (GnRH-7d-PGF2α-56h-GnRH-18h-TAI). The 'OVS' group (n = 105) received only the Ovsynch protocol. The 'OVS-PGF' group (n = 118, GnRH-7d-PGF2α-12h-PGF2α-44h-GnRH-18h-TAI) received an extra dose of PGF2α 12 h later on Day 7. The 'OVS-7CIDR' group (n = 78, GnRH+CIDR-7d-PGF2α-56h-GnRH-18h-TAI) received a CIDR for 7 days between GnRH-1 and PGF2α. In the 'OVS-6CIDR' group (n = 77, GnRH-24h-CIDR-6d-PGF2α-56h-GnRH-18h-TAI), CIDR was applied one day after GnRH-1 and removed 6 days later. When all cows were evaluated, the responses to GnRH-2 were higher (P = 0.005) in cows that responded to GnRH-1 (95.4%) compared to the cows that did not respond (87.6%). The pregnancy rates at 31 and 62 days for each group were 48.6% and 42.9% in the OVS, 54.2% and 52.5% in the OVS-PGF, 52.6% and 48.7% in the OVS-7CIDR, and 55.8% and 49.3% in the OVS-6CIDR groups. Thus, none of the three different treatments has an effect on increasing the out-comes of the Ovsynch protocol in cyclic lactating dairy cows.

Scrotal skin metastasis from rectum adenocarcinoma

Cutaneous metastases of rectal adenocarcinoma is a rare phenomenon. We present a 65 year-old man with a painless nodule on the scrotal skin. Excisional biopsy of the nodules revealed a metastasis from rectum adenocarcinoma. Afterwards, the left scrotum was treated with a radiation therapy and the patient also received a salvage chemotherapy. The patient is still alive without any distant metastasis after the therapy, which was initiated 12 months ago.

Sliding hernias in female children

INTRODUCTION

Articles published in the English language report that 15-20% of the inguinal hernias in female children are sliding hernias. These studies do not specify the age at moment of surgery, neither the age distribution of sliding hernia. We retrospectively evaluated inguinal canal pathologies to answer these questions.

MATERIAL AND METHOD

We retrospectively evaluated the records of the patients operated on at the Pediatric Surgery Clinics of the Ordu, Usak and Denizli State Hospitals and the Afyon Obstetrics and Gynecology Hospital.

RESULTS

A total of 3105 cases had been operated on for an inguinal hernia between January 2008 and December 2010 and 673 (21.6%) were female. The most common age at surgery was between 0 and 1 years (26.5%). A sliding hernia was found in 22.4% (n = 151) of all cases. The sliding hernia rate was 45.8 (n = 82) and 14.9% (n = 69) in children younger and older than 1 year of age respectively (p < 0.05). The most frequently sliding organ in both groups was the ovary, followed by the fallopian tubes.

CONCLUSION

A sliding hernia is more common in female children under the age of 1 year and surgical treatment should be planned within a short period once the diagnosis is made. In addition, this recent statistical value for subjects aged 0 to 1 year and over 1 year can be used in new clinical studies.

Optic nerve glioma treatment with fractionated stereotactic radiotherapy

In the current report, the authors present a case of optic nerve glioma treated with fractionated stereotactic radiotherapy (FSRT). An 11-year-old girl was referred to our clinic with increasing proptosis over a 1-year period. At that time orbital MRI revealed a 20 × 17-mm mass in the right retroorbital lipomatous tissue, and FSRT was delivered to the tumor using the CyberKnife. During the 1.5-year follow-up, ophthalmological examinations did not indicate any treatment-related severe toxicity, and posttreatment MRI demonstrated marked regression of the lesion to 13 × 10 mm. Given the scarcity of reports on this subject, the authors support more extended studies of the CyberKnife for the effective treatment of this relatively common childhood tumor.

Perosomus elumbis in a Holstein calf infected with bovine viral diarrhea virus

The detection of bovine viral diarrhea virus (BVDV) in a female Holstein calf presented with perosomus elumbis, a congenital anomaly, is reported here. A cow with dystocia was evaluated and an abnormal dead calf was detected during vaginal examination. The calf was retrieved via caesarean section and exhibited abnormalities characteristic of PE, such as vertebral and pelvic malformations. These abnormalities were further confirmed using radiographic and necropsy examinations. At necropsy cerebellar hypoplasia was an additional finding, which is a typical lesion associated with bovine virus diarrhea (BVD). Several tissue samples from the calf were tested for the presence of antigens of BVDV and bovine herpesvirus-1 (BHV-1) by ELISA. In addition, sera samples from the dam and calf were tested for the presence of antibodies against BVDV, BHV-1, and bluetongue disease virus (BTV) using a virus neutralization assay. Results indicated that the calf was congenitally infected with BVDV, whereas there was no evidence for the presence of BHV-1 and BTV. In the dam's serum no antibodies against BVDV, BHV-1, and BTV were detected. Even though the etiology of perosomus elumbis is unknown, BVDV, which causes fetal anomalies at early gestation in cows, may have been a contributing factor in this case.

The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer

PURPOSE

The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients.

MATERIALS AND METHODS

This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-Turkish version and UW-QOL-Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires.

RESULTS

The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed.

CONCLUSIONS

The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.

Comparison of responses to Ovsynch between Holstein-Friesian and Swedish Red cows

The Ovsynch protocol was designed to synchronize ovulation, thereby allowing timed artificial insemination (TAI) of all cows without detection of estrus. However, the effectiveness of Ovsynch in different breeds of dairy cows has not been previously compared. The aim of this study was to compare the response to Ovsynch in cycling lactating Holstein-Friesian (HF) and Swedish Red (SR) dairy cows. A total of 495 cyclic cows (n=347 HF, n=148 SR) were housed together and treated with Ovsynch (GnRH-7 d-PGF2α-56 h-GnRH-16 to 18 h-TAI). Ovulatory responses, synchronization rate, maximal follicle size at the time of AI, and percentage of pregnant cows per AI (P/AI at 31 and 62 d after AI) were compared between breeds. Ultrasonography was performed during Ovsynch at first GnRH, PGF2α, at time of AI, and 7 d after AI. Ovulatory response and synchronization rate were similar in HF versus SR cows (60.2 vs. 62.2%; 88.4 vs. 88.5%, respectively). Cows that ovulated to the first GnRH of Ovsynch had smaller follicle size at AI (15.9±0.1 vs. 16.4±0.2 mm). Maximal follicle size at AI was greater for HF (16.4±2.2 mm) than SR (15.5±2.3 mm) cows. The P/AI was greater for SR than HF cows at the 62-d pregnancy diagnosis (56.1 vs. 46.1%). In addition, pregnancy loss between 31 and 62 d of pregnancy was greater in HF (10.1%) than SR (3.5%) cows. Fertility was less in HF cows during the hot season (57.7 in cold vs. 38.1% in the hot season), whereas such a decrease was not observed in SR (60.0 in cold vs. 53.5% in the hot season) cows. Thus, although the GnRH treatments of Ovsynch were equally effective in SR and HF cows, pregnancy outcomes (P/AI at d 62 and pregnancy survival) were greater in SR than HF cows, and P/AI in SR cows was not compromised during the hot season as was found for HF cows.

Adsorption of natural organic matter from waters by iron coated pumice

Natural pumice particles were used as granular support media and coated with iron oxides to investigate their adsorptive natural organic matter (NOM) removal from waters. The impacts of natural pumice source, particle size fraction, pumice dose, pumice surface chemistry and specific surface area, and NOM source on the ultimate extent and rate of NOM removal were studied. All adsorption isotherm experiments were conducted employing the variable-dose completely mixed batch reactor bottle-point method. Iron oxide coating overwhelmed the surface electrical properties of the underlying pumice particles. Surface areas as high as 20.6m(2)g(-1) were achieved after iron coating of pumice samples, which are above than those of iron coated sand samples reported in the literature. For all particle size fractions, iron coating of natural pumices significantly increased their NOM uptakes both on an adsorbent mass- and surface area-basis. The smallest size fractions (<63 microm) of coated pumices generally exhibited the highest NOM uptakes. A strong linear correlation between the iron contents of coated pumices and their Freundlich affinity parameters (K(F)) indicated that the enhanced NOM uptake is due to iron oxides bound on pumice surfaces. Iron oxide coated pumice surfaces preferentially removed high UV-absorbing fractions of NOM, with UV absorbance reductions up to 90%. Control experiments indicated that iron oxide species bound on pumice surfaces are stable, and potential iron release to the solution is not a concern at pH values of typical natural waters. Based on high NOM adsorption capacities, iron oxide coated pumice may be a promising novel adsorbent in removing NOM from waters. Furthermore, due to preferential removal of high UV-absorbing NOM fractions, iron oxide coated pumice may also be effective in controlling the formation of disinfection by-products in drinking water treatment.