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Paasch C, Meyer J, Hunger R, Krollmann N, Heisler S, Mantke R. Does the angle of trocar insertion affect the fascial defect caused? A porcine model. Hernia 2024; 28:585-592. [PMID: 38319439 PMCID: PMC10997682 DOI: 10.1007/s10029-023-02952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION With an incidence of 0-5.2%, trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model. METHODS In October 2022, a total of five female pigs were euthanized. In alternating order, three bladeless and two bladed conical 12-mm trocars were inserted at an angle of 45° on each side for 60 min twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type (bladed vs. bladeless) and angle on defect size were analyzed using a mixed model regression analysis. RESULTS The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p < 0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007). CONCLUSION When conical 12-mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
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Affiliation(s)
- C Paasch
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany.
| | - J Meyer
- Department of General and Visceral Surgery, Ameos Hospital Schönebeck, Schönebeck, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - R Hunger
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - N Krollmann
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - S Heisler
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - R Mantke
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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Alden SL, Lee V, Narang AK, Meyer J, Gearhart SL, Christenson ES. Circulating Tumor DNA to Predict Radiographic and Pathologic Response to Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer. Oncologist 2024; 29:e414-e418. [PMID: 38180954 PMCID: PMC10911913 DOI: 10.1093/oncolo/oyad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/04/2023] [Indexed: 01/07/2024] Open
Abstract
Despite advances in treatment and response assessment in locally advanced rectal cancer (LARC), it is unclear which patients should undergo nonoperative management (NOM). We performed a single-center, retrospective study to evaluate post-total neoadjuvant therapy (TNT) circulating tumor DNA (ctDNA) in predicting treatment response. We found that post-TNT ctDNA had a sensitivity of 23% and specificity of 100% for predicting residual disease upon resection, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 47%. For predicting poor tumor regression on MRI, ctDNA had a sensitivity of 16% and specificity of 96%, with a PPV of 75% and NPV of 60%. A commercially available ctDNA assay was insufficient to predict residual disease after TNT and should not be used alone to select patients for NOM in LARC.
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Affiliation(s)
- Stephanie L Alden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valerie Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol K Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan L Gearhart
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Eric S Christenson
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Liu IC, Gearhart S, Ke S, Hu C, Chung H, Efron J, Gabre-Kidan A, Najjar P, Atallah C, Safar B, Christenson ES, Azad NS, Lee V, Zaheer A, Birkness-Gartman JE, Reddy AV, Narang AK, Meyer J. Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer. Surg Open Sci 2024; 18:42-49. [PMID: 38318322 PMCID: PMC10838936 DOI: 10.1016/j.sopen.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Background Total neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. However, questions remain regarding surgical outcomes and local control in patients who proceed to surgery, particularly when radiation is given first in the neoadjuvant sequence. We report on our institution's experience with patients who underwent short-course radiation therapy, consolidation chemotherapy, and surgery. Methods We retrospectively reviewed surgical specimen outcomes, postoperative complications, and local/pelvic control in a large cohort of patients with LARC who underwent neoadjuvant therapy incorporating upfront short-course radiation therapy followed by consolidation chemotherapy. Results In our cohort of 83 patients who proceeded to surgery, a complete/near-complete mesorectal specimen was achieved in 90 % of patients. This outcome was not associated with the time interval from completion of radiation to surgery. Postoperative complications were acceptably low. Local control at two years was 93.4 % for all patients- 97.6 % for those with low-risk disease and 90.4 % for high-risk disease. Conclusion Upfront short-course radiation therapy and consolidation chemotherapy is an effective treatment course. Extended interval from completion of short-course radiation therapy did not impact surgical specimen quality.
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Affiliation(s)
- I-Chia Liu
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Gearhart
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suqi Ke
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haniee Chung
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan Efron
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alodia Gabre-Kidan
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Najjar
- Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chady Atallah
- Department of Surgery, Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
| | - Bashar Safar
- Department of Surgery, Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
| | - Eric S. Christenson
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Nilofer S. Azad
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Valerie Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Narang AK, Hong TS, Ding K, Herman J, Meyer J, Thompson E, Bhutani MS, Krishnan K, Casey B, Shin EJ, Koay EJ. A Multi-Institutional Safety and Feasibility Study Exploring the Use of Hydrogel to Create Spatial Separation between the Pancreas and Duodenum in Patients with Pancreatic Cancer. Pract Radiat Oncol 2023:S1879-8500(23)00340-5. [PMID: 38043645 DOI: 10.1016/j.prro.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The administration of dose-escalated radiation for pancreatic adenocarcinoma remains challenging due to the proximity of dose-limiting stomach and bowel, particularly the duodenum for pancreatic head tumors. We explore whether endoscopic injection of a temporary, absorbable hydrogel into the pancreatico-duodenal (PD) groove is safe and feasible for the purpose of increasing spatial separation between pancreatic head tumors and the duodenum. METHODS Six patients with localized pancreatic adenocarcinoma underwent endoscopic injection of hydrogel into the PD groove. Safety was assessed based on the incidence of procedure-related adverse events resulting in a delay of radiation therapy initiation. Feasibility was defined as the ability to create spatial separation between the pancreas and duodenum, as assessed on simulation CT. RESULTS All six patients were able to undergo endoscopic injection of hydrogel into the PD groove. No device-related events were experienced at any point in follow-up. Presence of hydrogel in the PD groove was apparent on simulation CT in all six patients. Mean space created by the hydrogel was 7.7 mm +/- 2.4 mm. In three patients who underwent Whipple resection, presence of hydrogel in the PD groove was pathologically confirmed with no evidence of damage to the duodenum. CONCLUSIONS Endoscopic injection of hydrogel into the PD groove is safe and feasible. Characterization of the dosimetric benefit that this technique may offer in the setting of dose-escalated radiation should also be pursued, as should the ability of such dosimetric benefit to translate into clinically improved tumor control.
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Affiliation(s)
- Amol Kumar Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD.
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - Joseph Herman
- Dept of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - Elizabeth Thompson
- Department of Pathology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 401 N. Broadway, Baltimore, MD 21231
| | - Manoop S Bhutani
- Dept of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center,Houston, TX
| | - Kumar Krishnan
- Division of Gastroenterology, Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Brenna Casey
- Division of Gastroenterology, Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Euin Ji Shin
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eugene J Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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De Lange G, Davies J, Toso C, Meurette G, Ris F, Meyer J. Complete mesocolic excision for right hemicolectomy: an updated systematic review and meta-analysis. Tech Coloproctol 2023; 27:979-993. [PMID: 37632643 PMCID: PMC10562294 DOI: 10.1007/s10151-023-02853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/25/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Complete mesocolic excision improves lymphadenectomy for right hemicolectomy and respects the embryological planes. However, its effect on cancer-free and overall survival is questioned. Therefore, we aimed to determine the potential benefits of the technique by performing a systematic review of the literature and meta-analysis of the available evidence. METHODS Web of Science, PubMed/Medline, and Embase were searched on February 22, 2023. Original studies on short- and long-term oncological outcomes of adult patients undergoing right hemicolectomy with complete mesocolic excision as a treatment for primary colon cancer were considered for inclusion. Outcomes were extracted and pooled using a model with random effects. RESULTS A total of 586 publications were identified through database searching, and 18 from citation searching. Exclusion of 552 articles left 24 articles for inclusion. Meta-analysis showed that complete mesocolic excision increased the lymph node harvest (5 studies, 1479 patients, MD 9.62, 95% CI 5.83-13.41, p > 0.0001, I2 84%), 5-year overall survival (5 studies, 2381 patients, OR 1.88, 95% CI 1.14-3.09, p = 0.01, I2 66%), 5-year disease-free survival (4 studies, 1376 patients, OR 2.21, 95% CI 1.51-3.23, p < 0.0001, I2 0%) and decreased the incidence of local recurrence (4 studies, 818 patients, OR 0.27, 95% CI 0.09-0.79, p = 0.02, I2 0%) when compared to standard right hemicolectomy. Perioperative morbidity was similar between the techniques (8 studies, 3899 patients, OR 1.04, 95% CI 0.89-1.22, p = 0.97, I2 0%). CONCLUSION Meta-analysis of observational and randomised studies showed that right hemicolectomy with complete mesocolic excision for primary right colon cancer improves oncologic results without increasing morbidity/mortality. These results need to be confirmed by high-quality evidence and randomised trials in selected patients to assess who may benefit from the procedure.
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Affiliation(s)
- G De Lange
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - C Toso
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - G Meurette
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - F Ris
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J Meyer
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
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Bry V, Landers A, Kim JN, Meyer J. Robustness Analysis of Reference Surfaces for Surface Guided Radiation Therapy of the Breast. Int J Radiat Oncol Biol Phys 2023; 117:e645-e646. [PMID: 37785919 DOI: 10.1016/j.ijrobp.2023.06.2061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Surface guided radiation therapy (SGRT) implements an optical imaging system in radiation therapy for positioning and motion management. This system projects visible light onto a patient and the reflected light is used to generate 3D positional information so that clinicians can accurately reproduce body positions. Patient setup shifts are calculated with six degrees of freedom by a registration algorithm comparing a reference surface (RS) of the patient to a live surface map of the patient on treatment day. SGRT has been an effective tool in daily localization for the treatment of breast cancer patients. It is common for patients to have multiple RS throughout the course of their treatment to account for anatomical variation between fractions. We sought to evaluate the robustness of reference surfaces and vendor specific algorithms used for SGRT. MATERIALS/METHODS At our institution, positional shift data for five patients treated for right-sided breast cancer were retrospectively analyzed. SGRT performance was compared between RS using bilateral breasts or a single ipsilateral breast. Shift parameters were calculated over the entire treatment course for all patients with a vendor supplied software tool that offers rigid and deformable registration algorithms. The deformable algorithm was used for treatment setups, with the treatment RS encompassing both breasts plus a margin. Two robustness tests were carried out: 1) a trimmed down RS encompassing just the ipsilateral breast and 2) a comparison of deformable vs rigid registration of the clinically used RS. After obtaining translational and angular shift data, the absolute mean differences between shifts were calculated to compare differences between RS size and algorithm performance. RESULTS On average, 1.4 new RS were created per patient guided by weekly radiographic imaging to adjust for anatomical changes. The absolute value of the average of the discrepancies between shifts using the clinical RS subtracted from the trimmed external (89 fractions) were <1mm and 1° and the maximum differences were: Lateral: 2.6mm, Longitudinal: 1.4mm, Vertical: 1.1mm, Yaw: 1.1°, Roll: 1.5°, Pitch: 1.7°. Discrepancies between tracking algorithms (83 fractions) were <1.5mm and 1° and the maximum differences were: Lateral: 3.4mm, Longitudinal: 3.5mm, Vertical: 2.0mm, Yaw: 2.4°, Roll: 2.7°, Pitch: 1.9°. CONCLUSION Clinically negligible mean discrepancies were observed for both robustness tests showing that neither the reference surface size nor the algorithms investigated caused systematic variations in the shifts for this group of patients. Maximum discrepancies of up to 3 mm and 3° were found between the algorithms, which indicate some variation, but within clinical tolerance. Overall, different selection of reference surfaces and algorithms had a minor effect on clinical shifts for SGRT of the breast.
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Affiliation(s)
- V Bry
- University of Washington, Seattle, WA
| | - A Landers
- University of Washington, Seattle, WA
| | - J N Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - J Meyer
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
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Linnemann B, Blank W, Doenst T, Erbel C, Isfort P, Janssens U, Kalka C, Klamroth R, Kotzerke J, Ley S, Meyer J, Mühlberg K, Müller OJ, Noppeney T, Opitz C, Riess H, Solomayer EF, Volk T, Beyer-Westendorf J. Diagnostics and Therapy of Venous Thrombosis and Pulmonary Embolism. The revised AWMF S2k Guideline. VASA 2023; 52:1-146. [PMID: 37904504 DOI: 10.1024/0301-1526/a001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
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Talcott WJ, Ford EC, Gillespie EF, Wright JL, Lincoln H, Meyer J, Kim JN, Landers A, Moran MS, Hartvigson P, Kishore M, Burmeister JW, Pawlicki T, Evans SB. A Prospective, Multi-Institutional Study of Problematic Plan Detection during Physician Chart Rounds. Int J Radiat Oncol Biol Phys 2023; 117:e445. [PMID: 37785438 DOI: 10.1016/j.ijrobp.2023.06.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We performed a multi-institutional prospective study to determine the detection rate of problematic treatment plans (PP) at physician chart rounds (CR), and to identify factors associated with PP detection. MATERIALS/METHODS Curative intent PPs with simulated errors (representative of the most common targets of peer review) were generated. Two breast specialists selected twenty appropriate plans for inclusion and assigned them American Association of Physicists in Medicine (AAPM) Task Group 100 severity and detectability scores. The PPs were blinded and embedded at weekly virtual CR at 2 institutions over 12 months. At site A, both breast and lung cases were reviewed by a mix of breast and lung specialists during CR, and at site B, only breast cases were presented and reviewed by breast specialists. At both sites, breast plans were reviewed via slice-by-slice review in the treatment planning system (TPS), and both used a color-coded tool from the TPS to assess adherence to planning directives. Both sites had systematic approaches to case presentation (without a checklist). Site A was usually prospective CR, while site B was exclusively prospective. The following CR elements were recorded: PP detection, time of detection, length of CR, total number of cases presented, plan elements displayed, number and roles of attendees, and detector's role. Analysis was performed using simple statistics with chi-square testing. RESULTS By PP error type classification, 55.0% pertained to "target volume delineation," 25% to "non-target volume delineation or normal tissue sparing," and 20.0% to "dose prescription or written directives." Detectability was rated ≤5 (<5% likelihood of going undetected) for 60% of PPs, and severity was rated ≥7 ("at least potentially serious toxicity or tumor underdose") for only 30% of PPs. CR lasted a median of 64 minutes at site A (IQR 55-82.5) and 70 minutes at site B (IQR 52.5-81.5). PPs were presented at a median of 34 minutes (IQR 22.5-43, site A) and 41.5 minutes (IQR 23.5-56, site B) after CR start. A median of 16 cases (IQR 13-19) at site A and 32 cases (IQR 25-34.5) at site B were presented per CR session, with a median of 1 PP (site A and B) presented per session (range 1-2). The median time spent per case was 4.0 minutes (Site A) and 2.2 minutes (Site B). The median number of attendings at CR was 4 for site A (range 2-6) and 6.5 for Site B (range 5-10). PP detection rate at site A was 20% (n = 4) and at site B was 70% (n = 14) (p = 0.001). Detections were made by an attending physician in 100% (site A, n = 4) and 92.9% (Site B, n = 13) of PP detections. There were no differences in detection rate by PP error type (p = 0.78), detectability (p = 0.60) or severity score (p = 0.68), or by time PP presented after CR start (p = 0.39). CONCLUSION The effectiveness of PP detection at chart rounds can vary greatly between institutions. The study suggests possible areas for improvement but further study is needed to determine best practices.
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Affiliation(s)
- W J Talcott
- Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY
| | - E C Ford
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - E F Gillespie
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - J L Wright
- Johns Hopkins Medicine, Department of Radiation Oncology, Baltimore, MD
| | - H Lincoln
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - J Meyer
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - J N Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - A Landers
- University of Washington, Seattle, WA
| | - M S Moran
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - P Hartvigson
- University of Washington, Department of Radiation Oncology, Seattle, WA
| | - M Kishore
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | | | - T Pawlicki
- University of California, San Diego, La Jolla, CA
| | - S B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
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Erickson DPJ, Saini J, Cao N, Ford EC, Emery R, Kranz M, Goff PH, Meyer J, Wong T, Bloch C, Stewart RD, Sandison GA, Morimoto A, DeLonais-Dick A, Shaver B, Rengan R, Zeng J, Schwarz M. Adaptation of a Clinical Proton Pencil Beam Scanning System for FLASH Experiments. Int J Radiat Oncol Biol Phys 2023; 117:e664. [PMID: 37785966 DOI: 10.1016/j.ijrobp.2023.06.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To characterize a proton pencil beam scanning system for ultra-high dose rate (UHDR) irradiations and validate it with FLASH preclinical experiments. MATERIALS/METHODS After modifications to the beamline to maximize the beam current at isocenter in our gantry room, we characterized the UHDR beam in terms of: 1) Size and shape of the beam spot in three configurations; pristine beam, 75 mm water-equivalent-thickness (WET) range shifter (RS), and custom-built 135 mm WET RS mounted 310 mm upstream of the aperture in the snout housing. These configurations were analyzed to determine which one achieved the highest dose rate; 2) Beam transport efficiency and beam output. We compared the signal in the monitor chambers of the proton system with a Faraday cup and plane parallel ionization chamber (PPC05, IBA dosimetry) for beam current at the cyclotron from 7.5 nA to 800 nA; 3) Dose homogeneity, beam penumbra, and dose rate for the fields to be used in preclinical irradiations. All measurements were performed at isocenter, in air or at 1 cm depth in solid water, using the highest energy (about 230 MeV), which corresponded to a nominal range of 32.9 cm in water. We modeled the UHDR beam in our treatment planning system (TPS) to optimize the dose homogeneity and lateral penumbra of the irradiation fields. We performed the preclinical experiments in single fractions of 19 Gy (RBE), 21 Gy (RBE) and 23 Gy (RBE) (RBE = 1.1), targeting the pelvis of C57BL/6 mice and using survival as the endpoint. Each arm included 6-10 mice. The proton beam was used in transmission mode, positioning the center of the mouse pelvis at isocenter, and irradiating the pelvis with a 2x6 cm^2 field. Apertures were placed at 9cm from the isocenter to sharpen the lateral penumbra. RESULTS The range measurements with a multi-layer ionization chamber were consistent within 1 mm with the nominal range. In UHDR mode, the spot size at the isocenter varied from 4.5 mm for the pristine beam to 9.2 mm for the 135 mm RS. The spot size at isocenter remained constant when the beam intensity varied from 7.5 nA to 800 nA at the cyclotron exit. By employing the configuration with the 135 mm RS and optimizing the fields in the TPS, we achieved a dose rate of 1 Gy (RBE)/s for the conventional regime and 75(RBE) Gy/s for the UHDR regime. The monitor chambers of the proton system were affected by recombination at high dose rates: we observed about 35% higher output for the same number of monitor units delivered at 800 nA vs 7.5 nA. The delivered dose was determined with the PPC05 for each field, as this detector did not show recombination effects. When preclinical irradiations were independently monitored, the delivered dose was typically within 1% of the intended value. In three independent experiments, a dose of 21 Gy (RBE) or higher was associated with an increased survival in the UHDR arm compared to the conventional arm. CONCLUSION We adapted a clinical proton system for preclinical irradiations at UHDR. Our results confirm the presence of the FLASH effect.
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Affiliation(s)
- D P J Erickson
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - J Saini
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - N Cao
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - E C Ford
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Emery
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - M Kranz
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - P H Goff
- Department of Radiation Oncology, University of Washington / Fred Hutchinson Cancer Center, Seattle, WA
| | - J Meyer
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - T Wong
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - C Bloch
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - R D Stewart
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - G A Sandison
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - A Morimoto
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - A DeLonais-Dick
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - B Shaver
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - M Schwarz
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
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10
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Bartzsch S, Ahmed M, Bicher S, Stewart RD, Schmid TE, Combs SE, Meyer J. Equivalent Uniform Dose (EUD) and the Evaluation of Cell Survival in Spatially Fractionated Radiotherapy (SFRT). Int J Radiat Oncol Biol Phys 2023; 117:e642. [PMID: 37785912 DOI: 10.1016/j.ijrobp.2023.06.2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) SFRT has shown promise as a treatment modality to decrease normal tissue sparing without compromising tumor coverage, i.e., an increase in the therapeutic window compared to more conventional uniform radiation therapy (RT). The aim of this work is to examine and test several alternative bio-dosimetric parameters for the prediction of cell survival for normal-tissue and tumor cell lines irradiated in vitro with uniform and microbeam radiotherapy (MRT). MATERIALS/METHODS A bespoke tungsten collimator with 50 parallel, 50 µm wide slits and 400 µm slit spacing was mounted into an x-ray cabinet. Human fibroblast (MRC5) and two human tumor cell lines (LN18 and A549) were irradiated with a range of doses (< 10 Gy) for uniform and MRT (50um slits, 400um center spacing) using kV X-rays. Average, mean and valley dose as useful predictive metrics of cell survival are compared to the equivalent uniform dose (EUD) with biological parameters estimated from uniform-dose experiments. RESULTS We find that EUD, with linear-quadratic (LQ) model parameters, is more predictive for survival after SFRT than maximum, minimum or average dose. The maximum and average doses are correlated very poorly with in vitro cell survival. The difference in cell survival between uniform and MRT irradiation as a function of EUD is cell-type and dose dependent. The report results suggest that MRT is more effective at cell killing of tumor-cell lines than uniform irradiation for both tumor cell lines. However, MRT is less effective at killing normal tissue cells than uniform irradiation. CONCLUSION EUD is a superior predictor of in vitro cell survival than other metrics sometimes used in the SFRT literature, including mean dose, maximum dose, and valley dose. The reported studies provide some evidence that SFRT may increase the therapeutic ratio by producing spatial dose distributions that effectively reduce normal-tissue damage with little or no change in biological damage to tumor cells. Additional studies are needed to further extend and generalize our results and to test our conclusions against a larger dose range, low and high linear energy transfer (LET) radiations and additional cell lines.
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Affiliation(s)
- S Bartzsch
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Ahmed
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - S Bicher
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - R D Stewart
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - T E Schmid
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - S E Combs
- Department of Radiation Oncology, School of Medicine and Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Institute for Radiation Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - J Meyer
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
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11
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Gupta A, Zorzi J, Ho WJ, Baretti M, Azad NS, Griffith P, Dao D, Kim A, Philosophe B, Georgiades C, Kamel I, Burkhart R, Liddell R, Hong K, Shubert C, Lafaro K, Meyer J, Anders R, Burns III W, Yarchoan M. Relationship of Hepatocellular Carcinoma Stage and Hepatic Function to Health-Related Quality of Life: A Single Center Analysis. Healthcare (Basel) 2023; 11:2571. [PMID: 37761768 PMCID: PMC10531156 DOI: 10.3390/healthcare11182571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Health-related quality of life (HRQoL) is known to be an important prognostic indicator and clinical endpoint for patients with hepatocellular carcinoma (HCC). However, the correlation of the Barcelona Clinic Liver Cancer (BCLC) stage with HRQoL in HCC has not been previously studied. We examined the relationship between BCLC stage, Child-Pugh (CP) score, and Eastern Cooperative Oncology Group (ECOG) performance status on HRQoL for patients who presented at a multidisciplinary liver cancer clinic. HRQoL was assessed using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire. Fifty-one patients met our inclusion criteria. The FACT-Hep total and subscales showed no significant association with BCLC stages (p = 0.224). Patients with CP B had significantly more impairment in FACT-Hep than patients with CP A. These data indicate that in patients with HCC, impaired liver function is associated with reduced quality of life, whereas the BCLC stage poorly correlates with quality of life metrics. Impairment of quality of life is common in HCC patients and further studies are warranted to determine the impact of early supportive interventions on HRQoL and survival outcomes.
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Affiliation(s)
- Amol Gupta
- The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (J.Z.); (W.J.H.); (M.B.); (N.S.A.); (P.G.); (D.D.); (A.K.); (B.P.); (C.G.); (I.K.); (R.B.); (R.L.); (K.H.); (C.S.); (K.L.); (J.M.); (R.A.); (W.B.III); (M.Y.)
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12
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Wang QL, Ma C, Yuan C, Shi Q, Wolpin BM, Zhang Y, Fuchs CS, Meyer J, Zemla T, Cheng E, Kumthekar P, Guthrie KA, Couture F, Kuebler P, Kumar P, Tan B, Krishnamurthi S, Goldberg RM, Venook A, Blanke C, Shields AF, O’Reilly EM, Meyerhardt JA, Ng K. Plasma 25-Hydroxyvitamin D Levels and Survival in Stage III Colon Cancer: Findings from CALGB/SWOG 80702 (Alliance). Clin Cancer Res 2023; 29:2621-2630. [PMID: 37289007 PMCID: PMC10524689 DOI: 10.1158/1078-0432.ccr-23-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess whether higher plasma 25-hydroxyvitamin D [25(OH)D] is associated with improved outcomes in colon cancer and whether circulating inflammatory cytokines mediate such association. EXPERIMENTAL DESIGN Plasma samples were collected from 1,437 patients with stage III colon cancer enrolled in a phase III randomized clinical trial (CALGB/SWOG 80702) from 2010 to 2015, who were followed until 2020. Cox regressions were used to examine associations between plasma 25(OH)D and disease-free survival (DFS), overall survival (OS), and time to recurrence (TTR). Mediation analysis was performed for circulating inflammatory biomarkers of C-reactive protein (CRP), IL6, and soluble TNF receptor 2 (sTNF-R2). RESULTS Vitamin D deficiency [25(OH)D <12 ng/mL] was present in 13% of total patients at baseline and in 32% of Black patients. Compared with deficiency, nondeficient vitamin D status (≥12 ng/mL) was significantly associated with improved DFS, OS, and TTR (all Plog-rank<0.05), with multivariable-adjusted HRs of 0.68 (95% confidence interval, 0.51-0.92) for DFS, 0.57 (0.40-0.80) for OS, and 0.71 (0.52-0.98) for TTR. A U-shaped dose-response pattern was observed for DFS and OS (both Pnonlinearity<0.05). The proportion of the association with survival that was mediated by sTNF-R2 was 10.6% (Pmediation = 0.04) for DFS and 11.8% (Pmediation = 0.05) for OS, whereas CRP and IL6 were not shown to be mediators. Plasma 25(OH)D was not associated with the occurrence of ≥ grade 2 adverse events. CONCLUSIONS Nondeficient vitamin D is associated with improved outcomes in patients with stage III colon cancer, largely independent of circulation inflammations. A randomized trial is warranted to elucidate whether adjuvant vitamin D supplementation improves patient outcomes.
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Affiliation(s)
- Qiao-Li Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Brian M. Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Yin Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Charles S. Fuchs
- Genentech and Roche, South San Francisco, CA, USA
- Yale Cancer Center, Yale School of Medicine, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jeffrey Meyer
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Tyler Zemla
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - En Cheng
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Priya Kumthekar
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Lou & Jean Malnati Brain Tumor Institute at the Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Katherine A. Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH, USA
| | | | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | - Smitha Krishnamurthi
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | - Alan Venook
- University of California, San Francisco, CA, USA
| | - Charles Blanke
- SWOG Cancer Research Network Group Chair’s Office, Oregon Health and Science University Knight Cancer Institute, Portland, OR, USA
| | - Anthony F. Shields
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Eileen M. O’Reilly
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical Center, New York, NY, USA
| | - Jeffrey A. Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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13
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Brown JC, Ma C, Shi Q, Fuchs CS, Meyer J, Niedzwiecki D, Zemla T, Couture F, Kuebler P, Kumar P, Lewis D, Tan B, Krishnamurthi S, O'Reilly EM, Shields AF, Meyerhardt JA. Physical Activity in Stage III Colon Cancer: CALGB/SWOG 80702 (Alliance). J Clin Oncol 2023; 41:243-254. [PMID: 35944235 PMCID: PMC9839249 DOI: 10.1200/jco.22.00171] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To determine the specific types, durations, and intensities of recreational physical activity associated with the greatest improvements in disease-free survival (DFS) of patients with colon cancer. METHODS We conducted a prospective cohort study nested within a randomized multicenter trial of stage III colon cancer that compared 3 versus 6 months of fluorouracil, leucovorin, and oxaliplatin with or without celecoxib. We measured recreational physical activity in the first 3 months of chemotherapy and again 6 months after completion of chemotherapy. The primary end point was DFS. RESULTS During a median follow-up of 5.9 years, 457 of 1,696 patients experienced disease recurrence or death. For total recreational physical activity volume, the 3-year DFS was 76.5% with < 3.0 metabolic equivalent task hours per week (MET-h/wk) and 87.1% with ≥ 18.0 MET-h/wk (risk difference [RD], 10.6%; 95% CI, 4.7 to 19.4; P < .001). For light-intensity to moderate-intensity activities, the 3-year DFS was 65.7% with 0.0 h/wk and 87.1% with ≥ 1.5 h/wk (RD, 21.4%; 95% CI, 9.2 to 37.1; P < .001). For vigorous-intensity activity, the 3-year DFS was 76.0% with 0.0 h/wk and 86.0% with ≥ 1.0 h/wk (RD, 10.0%; 95% CI, 4.5 to 18.9; P < .001). For brisk walking, the 3-year DFS was 81.7% with < 1.0 h/wk and 88.4% with ≥ 3.0 h/wk (RD, 6.7%; 95% CI, 3.0 to 13.8; P < .001). For muscle strengthening activity, the 3-year DFS was 81.8% with 0.0 h/wk and 88.8% for ≥ 0.5 h/wk (RD, 7.0%; 95% CI, 3.1 to 14.2; P = .003). CONCLUSION Among patients with stage III colon cancer enrolled in a trial of postoperative treatment, larger volumes of recreational physical activity, longer durations of light- to moderate-intensity aerobic physical activity, or any vigorous-intensity aerobic physical activity were associated with the greatest improvements in DFS.
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Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, Baton Rouge, LA
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Chao Ma
- Dana-Farber/Partners CancerCare, Boston, MA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | | | | | - Tyler Zemla
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH
| | | | | | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine in St Louis, Saint Louis, MO
| | | | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY
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14
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Li H, Ger R, Narang AK, Chen H, Meyer J. Challenges and opportunities in stereotactic body proton radiotherapy of liver malignancies. J Radiosurg SBRT 2023; 9:83-90. [PMID: 38029013 PMCID: PMC10681149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023]
Abstract
Stereotactic body proton radiotherapy (SBPT) has the potential to be an effective tool for treating liver malignancies. While proton therapy enables near-zero exit dose and could improve normal tissue sparing, including liver and other surrounding structures, there are challenges in implementing the SBPT technique for proton therapy, including respiratory motion, range uncertainties, dose regimen, treatment planning, and image guidance. This article summarizes the technical and clinical challenges facing SBPT, along with the potential benefits of SBPT for liver malignancies. The clinical implementation of the technique is also described for the first six patients treated at the Johns Hopkins Proton Therapy Center using liver SBPT.
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Affiliation(s)
- Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Ger
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Amol Kumar Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
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15
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Halthore A, Fellows Z, Tran A, Deville C, Wright JL, Meyer J, Li H, Sheikh K. Treatment Planning of Bulky Tumors Using Pencil Beam Scanning Proton GRID Therapy. Int J Part Ther 2022; 9:40-49. [PMID: 36721485 PMCID: PMC9875826 DOI: 10.14338/ijpt-22-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare spatially fractionated radiation therapy (GRID) treatment planning techniques using proton pencil-beam-scanning (PBS) and photon therapy. Materials and Methods PBS and volumetric modulated arc therapy (VMAT) GRID plans were retrospectively generated for 5 patients with bulky tumors. GRID targets were arranged along the long axis of the gross tumor, spaced 2 and 3 cm apart, and treated with a prescription of 18 Gy. PBS plans used 2- to 3-beam multiple-field optimization with robustness evaluation. Dosimetric parameters including peak-to-edge ratio (PEDR), ratio of dose to 90% of the valley to dose to 10% of the peak VPDR(D90/D10), and volume of normal tissue receiving at least 5 Gy (V5) and 10 Gy (V10) were calculated. The peak-to-valley dose ratio (PVDR), VPDR(D90/D10), and organ-at-risk doses were prospectively assessed in 2 patients undergoing PBS-GRID with pretreatment quality assurance computed tomography (QACT) scans. Results PBS and VMAT GRID plans were generated for 5 patients with bulky tumors. Gross tumor volume values ranged from 826 to 1468 cm3. Peak-to-edge ratio for PBS was higher than for VMAT for both spacing scenarios (2-cm spacing, P = .02; 3-cm spacing, P = .01). VPDR(D90/D10) for PBS was higher than for VMAT (2-cm spacing, P = .004; 3-cm spacing, P = .002). Normal tissue V5 was lower for PBS than for VMAT (2-cm spacing, P = .03; 3-cm spacing, P = .02). Normal tissue mean dose was lower with PBS than with VMAT (2-cm spacing, P = .03; 3-cm spacing, P = .02). Two patients treated using PBS GRID and assessed with pretreatment QACT scans demonstrated robust PVDR, VPDR(D90/D10), and organs-at-risk doses. Conclusions The PEDR was significantly higher for PBS than VMAT plans, indicating lower target edge dose. Normal tissue mean dose was significantly lower with PBS than VMAT. PBS GRID may result in lower normal tissue dose compared with VMAT plans, allowing for further dose escalation in patients with bulky disease.
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Affiliation(s)
- Aditya Halthore
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
| | - Zachary Fellows
- Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
| | - Anh Tran
- Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
| | - Jean L. Wright
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heng Li
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
| | - Khadija Sheikh
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
,Department of Radiation Oncology, The Johns Hopkins Proton Center, Washington, DC, USA
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16
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Li D, Jia AY, Zorzi J, Griffith P, Kim AK, Dao D, Anders RA, Georgiades C, Liddell RP, Hong K, Azad NS, Ho WJ, Baretti M, Christenson E, Baghdadi A, Kamel IR, Meyer J, Ghabi E, Burkhart RA, Lafaro K, He J, Shubert C, Yarchoan M. Impact of the COVID-19 Pandemic on Liver Cancer Staging at a Multidisciplinary Liver Cancer Clinic. Ann Surg Open 2022; 3:e207. [PMID: 36590894 PMCID: PMC9782462 DOI: 10.1097/as9.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/05/2022] [Indexed: 01/03/2023] Open
Abstract
To compare liver cancer resectability rates before and during the COVID-19 pandemic. Background Liver cancers usually present with nonspecific symptoms or are diagnosed through screening programs for at-risk patients, and early detection can improve patient outcomes. In 2020, the COVID-19 pandemic upended medical care across all specialties, but whether the pandemic was associated with delays in liver cancer diagnosis is not known. Methods We performed a retrospective review of all patients evaluated at the Johns Hopkins Multidisciplinary Liver Cancer Clinic from January 2019 to June 2021 with a new diagnosis of suspected or confirmed hepatocellular carcinoma (HCC) or biliary tract cancer (BTC). Results There were 456 liver cancer patients (258 HCC and 198 BTC). From January 2019 to March 2020 (pre-pandemic), the surgical resectability rate was 20%. The subsequent 6 months (early pandemic), the resectability rate decreased to 11%. Afterward from October 2020 to June 2021 (late pandemic), the resectability rate increased to 27%. The resectability rate early pandemic was significantly lower than that for pre-pandemic and later pandemic combined (11% lower; 95% confidence interval [CI], 2%-20%). There was no significant difference in resectability rates pre-pandemic and later pandemic (7% difference; 95% CI, -3% to 16%). In subgroup analyses, the early pandemic was associated with a larger impact in BTC resectability rates than HCC resectability rates. Time from BTC symptom onset until Multidisciplinary Liver Clinic evaluation increased by over 6 weeks early pandemic versus pre-pandemic (Hazard Ratio, 0.63; 95% CI, 0.44-0.91). Conclusions During the early COVID-19 pandemic, we observed a drop in the percentage of patients presenting with curable liver cancers. This may reflect delays in liver cancer diagnosis and contribute to excess mortality related to the COVID-19 pandemic.
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Affiliation(s)
- Daniel Li
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angela Y. Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jane Zorzi
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paige Griffith
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy K. Kim
- Department of Medicine, Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Doan Dao
- Department of Medicine, Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A. Anders
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christos Georgiades
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert P. Liddell
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelvin Hong
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nilofer S. Azad
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Won Jin Ho
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marina Baretti
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric Christenson
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Azarakhsh Baghdadi
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ihab R. Kamel
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elie Ghabi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard A. Burkhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly Lafaro
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chris Shubert
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Yarchoan
- From the Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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17
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McCormack KM, Howell BR, Higgins M, Bramlett S, Guzman D, Morin EL, Villongco C, Liu Y, Meyer J, Sanchez MM. The developmental consequences of early adverse care on infant macaques: A cross-fostering study. Psychoneuroendocrinology 2022; 146:105947. [PMID: 36242820 DOI: 10.1016/j.psyneuen.2022.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
Early life adversity/stress (ELA/ELS), particularly adverse caregiving experiences such as child maltreatment (MALT), is a main risk factor for psychopathology, including psychiatric disorders such as anxiety, depression, ADHD, and substance abuse. Yet how these alterations unfold during development and the underlying mechanisms remain poorly understood, as it is difficult to prospectively and longitudinally study early developmental phases in humans, and nearly impossible to disentangle postnatal caregiving effects from heritable traits. This study examined the specific effects of "nurture" (maternal care) versus "nature" (heritable, biological maternal factors) on nonhuman primate infant socioemotional, stress neuroendocrine, and physical development. For this we used a translational and naturalistic macaque model of infant maltreatment by the mother with randomized assignment at birth to either mothers with a history of maltreating their infants (MALT group, n = 22) or to competent mothers (Control group, n = 20). Over the first 6 months of life (roughly equivalent to 2 years in humans), we examined the development of the mother-infant relationship, as well as infants' social behavior and emotional reactivity. In parallel, we assessed hypothalamic-pituitary-adrenal (HPA) axis function longitudinally, using measures of hair cortisol accumulation, and basal morning plasma cortisol. We identified broad impairments in maternal care exhibited by MALT foster mothers, beyond maltreatment (physical abuse, rejection) events, suggesting that MALT foster mothers provide an overall lower quality of care to their infants compared to Controls. MALT infants exhibited alterations in their initiations and breaks of proximity towards their mothers, as well as heightened emotional reactivity in comparison to Controls. Most striking are the HPA axis findings, with MALT infants showing higher levels of plasma cortisol across the first 6 postnatal months as well as higher hair cortisol accumulation from birth through month 6 (a signature of chronic stress) than Controls. No caregiving effects were detected on physical growth, which ruled out confounding effects of maternal nutrition, metabolism, etc. Taken together, these results suggest that the developmental trajectory of MALT and Control infants is different, marked by heightened levels of emotional reactivity, increased HPA activity and alterations in mother-infant interactions in MALT animals. These findings appear to be due to specific effects of postnatal maternal care, and not to biological/ behavioral traits inherited from the mother, or due to prenatal programming caused by prenatal stress, as the cross-fostering design controlled for these potential factors. However, we also detected a couple of interesting biological effects suggesting heritable transmission of some phenotypes. The prolonged HPA axis activation during the first 6 postnatal months of life is expected to have long-term consequences for brain, physiological, and behavioral development in MALT offspring.
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Affiliation(s)
- K M McCormack
- Department of Psychology, Spelman College, Atlanta, GA, USA; Emory National Primate Research Center, Emory University, Atlanta, GA, USA.
| | - B R Howell
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA; Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - M Higgins
- School of Nursing, Emory University, Atlanta, GA, USA
| | - S Bramlett
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - D Guzman
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - E L Morin
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - C Villongco
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Y Liu
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - J Meyer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - M M Sanchez
- Emory National Primate Research Center, Emory University, Atlanta, GA, USA; Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, USA
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Henkel A, Maracke J, Munke A, Galchenkova M, Rahmani Mashhour A, Reinke P, Domaracky M, Fleckenstein H, Hakanpää J, Meyer J, Tolstikova A, Carnis J, Middendorf P, Gelisio L, Yefanov O, Chapman H, Oberthür D. CFEL TapeDrive 2.0: a conveyor belt-based sample-delivery system for multi-dimensional serial crystallography. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322092038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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19
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Gardner L, Dewan A, Meyer J. 397 Characterization of ABCA12 gene variant by electron microscopy in an infant with an ichthyosiform dermatitis and MALT1 deficiency. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Baretti M, Zhu Q, Fu W, Meyer J, Wang H, Anders RA, Azad NS. Chemoradiation-induced alteration of programmed death-ligand 1, CD8+ tumor-infiltrating lymphocytes and mucin expression in rectal cancer. Oncotarget 2022; 13:907-917. [PMID: 35937503 PMCID: PMC9348692 DOI: 10.18632/oncotarget.28255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: DNA damage and resulting neoantigen formation is considered a mechanism for synergy between radiotherapy and PD-1/PD-L1 pathway inhibition to induce antitumor immune response. We investigated neoadjuvant chemoradiotherapy (nCRT)-induced changes in CD8+ tumor infiltrating lymphocyte, PD-L1 and mucin expression in rectal cancer patients. Materials and Methods: Tumor samples of rectal adenocarcinoma patients undergoing resection between 2008-2014 with (n = 62) or without (n = 17) nCRT treatment were collected. Sections were stained with CD8 and PD-L1 antibodies for immunohistochemistry. The prevalence of CD8+ cells was recorded in the tumor, interface tumor and background rectal side. Image analysis was used to determine the density of CD8+ lymphocytes. The percentage of PD-L1 expression was manually counted in tumor cells (TC), tumor stroma (TS) and the invasive front (IF). Mucin expression was determined as the percentage of the mucin area in the whole tumor area. Results: PD-L1 expression on TCs was identified in 7.6% (6/79) of nCRT specimens (p = 0.33) and in none of the non-nCRT patients. Median densities of CD8+ infiltrating T lymphocytes did not differ significantly between the two groups. Mucin expression was significantly higher in the nCRT cohort (p = 0.02). Higher neutrophil to lymphocytes ratio (NLR) after nCRT was associated with worse outcome (HR = 1.04, 95% CI = 1.00–1.08). Conclusions: nCRT exposure was associated with a non-significant difference in PD-L1 expression in rectal adenocarcinoma patients, possibly due to sample size limitations. Further mechanistic investigations and comprehensive immune analysis are needed to understand nCRT-induced immunologic shift in rectal cancer and to expand the applicability of checkpoint inhibitors in this setting.
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Affiliation(s)
- Marina Baretti
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Qingfeng Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Wei Fu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Hao Wang
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Robert A. Anders
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nilofer S. Azad
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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21
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Reddy AV, Hill CS, Sehgal S, Zheng L, He J, Laheru DA, Jesus-Acosta AD, Herman JM, Meyer J, Narang AK. Post-radiation neutrophil-to-lymphocyte ratio is a prognostic marker in patients with localized pancreatic adenocarcinoma treated with anti-PD-1 antibody and stereotactic body radiation therapy. Radiat Oncol J 2022; 40:111-119. [PMID: 35796114 PMCID: PMC9262702 DOI: 10.3857/roj.2021.01060] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the role of pre- and post-stereotactic body radiation therapy (SBRT) neutrophil-to-lymphocyte ratio (NLR) in patients with localized pancreatic cancer treated with anti-PD-1 (programmed cell death protein-1) antibody and SBRT. MATERIALS AND METHODS This was a retrospective review of 68 patients with borderline resectable or locally advanced pancreatic cancer treated with anti-PD-1 antibody and SBRT after multi-agent chemotherapy. Immunotherapy was administered with 5-fraction SBRT in the neoadjuvant, concurrent, or adjuvant/maintenance setting. Clinical outcomes included overall survival (OS), local progression-free survival, distant metastasis-free survival, and progression-free survival. Median pre- and post-SBRT peripheral blood markers were compared with the Mann-Whitney U test. Univariate and multivariable analyses (UVA and MVA) were performed to identify variables associated with clinical outcomes. Linear regression was performed to determine correlations between variables and peripheral blood markers. RESULTS A total of 68 patients were included in the study. The percent change between median pre- and post-SBRT absolute lymphocyte count (ALC), absolute neutrophil count, and NLR were -36.0% (p < 0.001), -5.6% (p = 0.190), and +35.7% (p = 0.003), respectively. Median OS after SBRT was 22.4 months. On UVA, pre-SBRT CA19-9 (hazard ratio [HR] = 1.001; 95% confidence interval [CI], 1.000-1.001; p = 0.031), post-SBRT ALC (HR = 0.33; 95% CI, 0.11-0.91; p = 0.031), and post-SBRT NLR (HR = 1.13; 95% CI, 1.04-1.22; p = 0.009) were associated with OS. On MVA, induction chemotherapy duration (HR = 0.75; 95% CI, 0.57-0.99; p = 0.048) and post-SBRT NLR (HR = 1.14; 95% CI, 1.04-1.23; p = 0.002) predicted for OS. Patients with post-SBRT NLR ≥3.2 had a median OS of 15.6 months versus 27.6 months in patients with post-SBRT NLR <3.2 (p = 0.009). On MVA linear regression, log10CTV had a negative correlation with post-SBRT ALC (regression coefficient = -0.314; 95% CI, -0.626 to -0.003; p = 0.048). CONCLUSION Elevated NLR after SBRT is primarily due to depletion of lymphocytes and associated with worse survival outcomes in localized pancreatic cancer treated with anti-PD-1 antibody. Larger CTVs were associated with decreased post-SBRT ALC.
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Affiliation(s)
- Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Colin S. Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Shuchi Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Lei Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Daniel A. Laheru
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Ana De Jesus-Acosta
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health, New Hyde Park, NY, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
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Reddy AV, Hill CS, Sehgal S, He J, Zheng L, Herman JM, Meyer J, Narang AK. Efficacy and Safety of Reirradiation with Stereotactic Body Radiation Therapy for Locally Recurrent Pancreatic Adenocarcinoma. Clin Oncol (R Coll Radiol) 2022; 34:386-394. [PMID: 34974972 DOI: 10.1016/j.clon.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
AIMS The purpose of this study was to report on outcomes of a cohort of patients who were treated with reirradiation with stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma. MATERIALS AND METHODS Patients treated with SBRT reirradiation for locally recurrent pancreatic adenocarcinoma from December 2009 to April 2020 were included in the study. Descriptive statistics were used to record patient demographics, tumour and treatment characteristics. Kaplan-Meier analysis was used to evaluate overall survival, local progression-free survival (LPFS), distant metastasis-free survival and progression-free survival (PFS). RESULTS In total, 27 patients were included in the study. The median follow-up time from local recurrence was 19.7 months (range 4.2-43.1 months). Most patients received five-fraction SBRT (26/27, 96%). The median overall survival after local recurrence treatment was 18.3 months (range 3.0-42.6 months), with 6-month, 1-year and 2-year overall survival rates of 88.5%, 73.1% and 33.6%. The median LPFS after local recurrence treatment was 16.2 months (range 2.3-33.6 months), with 6-month, 1-year and 2-year LPFS rates of 95.8%, 62.9% and 27.2%. Peri-SBRT chemotherapy improved LPFS (median 17.5 versus 8.5 months; P = 0.010) and overall survival (median 19.3 versus 5.5 months; P = 0.049). Tumours ≤ 3 cm in the greatest dimension showed better local control (median LPFS 19.2 versus 10.2 months; P = 0.130). There was one case (4%) of acute grade 3 pain and one case (4%) of late grade 3 gastrointestinal toxicity. CONCLUSIONS Reirradiation with five-fraction SBRT is safe, but local control remains suboptimal. Patients with smaller tumours experienced improved outcomes, as did patients whose treatment plan included the administration of peri-SBRT chemotherapy.
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Affiliation(s)
- A V Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
| | - C S Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - S Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - J He
- Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - L Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - J M Herman
- Department of Radiation Oncology, Northwell Health, New Hyde Park, New York, USA
| | - J Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - A K Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA
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Reddy AV, Hill CS, Sehgal S, He J, Zheng L, Herman JM, Meyer J, Narang AK. Stereotactic body radiation therapy for the treatment of locally recurrent pancreatic cancer after surgical resection. J Gastrointest Oncol 2022; 13:1402-1412. [PMID: 35837183 PMCID: PMC9274026 DOI: 10.21037/jgo-22-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background To report on a cohort of radiation-naïve patients with pancreatic cancer who developed isolated local recurrence following surgical resection and were subsequently treated with stereotactic body radiation therapy (SBRT). Methods Patients with pancreatic cancer who were treated with SBRT for isolated local recurrence after surgical resection were retrospectively reviewed. Clinical outcomes were calculated from completion of SBRT and included overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS). Univariate (UVA) analysis was performed to identify variables associated with clinical outcomes. Kaplan-Meier method was used for survival outcomes. Toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0. Results From September 2012 to November 2018, a total of 19 patients with localized pancreatic cancer were treated with SBRT for isolated local recurrence after initial surgical resection. No patients had prior radiation. The median biologically effective dose (BED10) was 54.8 Gy (range, 37.5-54.8 Gy). Median OS was 17.1 months, with 6-month and 1-year OS rates of 94.4% and 69.6%, respectively. Nine patients (47.4%) developed local failure after SBRT. Pattern of first failure after SBRT was distant in 7 patients (46.7%), local in 5 patients (33.3%), and synchronous distant and local in 3 patients (20.0%). One patient developed local failure after developing distant disease first. Of the 9 local failures, 3 (33.3%) were out-of-field. Median LPFS was 22.2 months, with 6-month and 1-year LPFS rates of 86.9% and 63.2%, respectively. A BED10 <54.8 Gy was associated with inferior LPFS (1-year, 25.0% vs. 80.2%, P<0.009). Median DMFS and PFS were 15.6 months. There was 1 case (5.3 %) of grade 3 gastric perforation. There were no cases of grade 4-5 toxicity events. Conclusions SBRT for locally recurrent pancreatic cancer after initial curative resection is safe and feasible. A BED10 <54.8 Gy was significantly associated with inferior local control. Further studies investigating dose escalation and optimal treatment volumes in the locally recurrent setting are warranted.
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Affiliation(s)
- Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Colin S. Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Shuchi Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Lei Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health, New Hyde Park, NY, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
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Baatz F, Herbst J, Schambach A, Hust M, Mätzig T, Meyer J, Sauer MG. CRISPR/Cas9-based generation of CAR-expressing natural
killer-like cells against acute myeloid leukemia. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Baatz
- Department of Pediatric Hematology/Oncology and Blood Stem Cell
Transplantation, Hannover Medical School, Germany
| | - J Herbst
- Department of Pediatric Hematology/Oncology and Blood Stem Cell
Transplantation, Hannover Medical School, Germany
| | - A Schambach
- Institute of Experimental Hematology, Hannover Medical School,
Germany
| | - M Hust
- Department of Biotechnology, Technische Universität
Braunschweig, Germany
| | - T Mätzig
- Institute of Experimental Hematology, Hannover Medical School,
Germany
| | - J Meyer
- Institute of Experimental Hematology, Hannover Medical School,
Germany
| | - MG Sauer
- Department of Pediatric Hematology/Oncology and Blood Stem Cell
Transplantation, Hannover Medical School, Germany
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26
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Andreev V, Arratia M, Baghdasaryan A, Baty A, Begzsuren K, Belousov A, Bolz A, Boudry V, Brandt G, Britzger D, Buniatyan A, Bystritskaya L, Campbell AJ, Cantun Avila KB, Cerny K, Chekelian V, Chen Z, Contreras JG, Cunqueiro Mendez L, Cvach J, Dainton JB, Daum K, Deshpande A, Diaconu C, Eckerlin G, Egli S, Elsen E, Favart L, Fedotov A, Feltesse J, Fleischer M, Fomenko A, Gal C, Gayler J, Goerlich L, Gogitidze N, Gouzevitch M, Grab C, Greenshaw T, Grindhammer G, Haidt D, Henderson RCW, Hessler J, Hladký J, Hoffmann D, Horisberger R, Hreus T, Huber F, Jacobs PM, Jacquet M, Janssen T, Jung AW, Jung H, Kapichine M, Katzy J, Kiesling C, Klein M, Kleinwort C, Klest HT, Kogler R, Kostka P, Kretzschmar J, Krücker D, Krüger K, Landon MPJ, Lange W, Laycock P, Lee SH, Levonian S, Li W, Lin J, Lipka K, List B, List J, Lobodzinski B, Malinovski E, Martyn HU, Maxfield SJ, Mehta A, Meyer AB, Meyer J, Mikocki S, Mondal MM, Morozov A, Müller K, Nachman B, Naumann T, Newman PR, Niebuhr C, Nowak G, Olsson JE, Ozerov D, Park S, Pascaud C, Patel GD, Perez E, Petrukhin A, Picuric I, Pitzl D, Polifka R, Preins S, Radescu V, Raicevic N, Ravdandorj T, Reimer P, Rizvi E, Robmann P, Roosen R, Rostovtsev A, Rotaru M, Sankey DPC, Sauter M, Sauvan E, Schmitt S, Schmookler BA, Schoeffel L, Schöning A, Sefkow F, Shushkevich S, Soloviev Y, Sopicki P, South D, Spaskov V, Specka A, Steder M, Stella B, Straumann U, Sun C, Sykora T, Thompson PD, Traynor D, Tseepeldorj B, Tu Z, Valkárová A, Vallée C, Van Mechelen P, Wegener D, Wünsch E, Žáček J, Zhang J, Zhang Z, Žlebčík R, Zohrabyan H, Zomer F. Measurement of Lepton-Jet Correlation in Deep-Inelastic Scattering with the H1 Detector Using Machine Learning for Unfolding. Phys Rev Lett 2022; 128:132002. [PMID: 35426724 DOI: 10.1103/physrevlett.128.132002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/20/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
The first measurement of lepton-jet momentum imbalance and azimuthal correlation in lepton-proton scattering at high momentum transfer is presented. These data, taken with the H1 detector at HERA, are corrected for detector effects using an unbinned machine learning algorithm (multifold), which considers eight observables simultaneously in this first application. The unfolded cross sections are compared with calculations performed within the context of collinear or transverse-momentum-dependent factorization in quantum chromodynamics as well as Monte Carlo event generators.
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Affiliation(s)
- V Andreev
- Lebedev Physical Institute, Moscow, Russia
| | - M Arratia
- University of California, Riverside, California 92521, USA
| | | | - A Baty
- Rice University, Houston, Texas 77005-1827, USA
| | - K Begzsuren
- Institute of Physics and Technology of the Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - A Belousov
- Lebedev Physical Institute, Moscow, Russia
| | - A Bolz
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - V Boudry
- LLR, Ecole Polytechnique, CNRS/IN2P3, Palaiseau, France
| | - G Brandt
- II. Physikalisches Institut, Universität Göttingen, Göttingen, Germany
| | - D Britzger
- Max-Planck-Institut für Physik, München, Germany
| | - A Buniatyan
- School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - L Bystritskaya
- Institute for Theoretical and Experimental Physics, Moscow, Russia
| | - A J Campbell
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - K B Cantun Avila
- Departamento de Fisica Aplicada, CINVESTAV, Mérida, Yucatán, México
| | - K Cerny
- Joint Laboratory of Optics, Palacký University, Olomouc, Czech Republic
| | - V Chekelian
- Max-Planck-Institut für Physik, München, Germany
| | - Z Chen
- Shandong University, Shandong, People's Republic of China
| | - J G Contreras
- Departamento de Fisica Aplicada, CINVESTAV, Mérida, Yucatán, México
| | | | - J Cvach
- Institute of Physics, Academy of Sciences of the Czech Republic, Praha, Czech Republic
| | - J B Dainton
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - K Daum
- Fachbereich C, Universität Wuppertal, Wuppertal, Germany
| | - A Deshpande
- Stony Brook University, Stony Brook, New York 11794, USA
| | - C Diaconu
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - G Eckerlin
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - S Egli
- Paul Scherrer Institut, Villigen, Switzerland
| | - E Elsen
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - L Favart
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - A Fedotov
- Institute for Theoretical and Experimental Physics, Moscow, Russia
| | - J Feltesse
- Irfu/SPP, CE Saclay, Gif-sur-Yvette, France
| | - M Fleischer
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - A Fomenko
- Lebedev Physical Institute, Moscow, Russia
| | - C Gal
- Stony Brook University, Stony Brook, New York 11794, USA
| | - J Gayler
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - L Goerlich
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | | | - M Gouzevitch
- Université Claude Bernard Lyon 1, CNRS/IN2P3, Villeurbanne, France
| | - C Grab
- Institut für Teilchenphysik, ETH, Zürich, Switzerland
| | - T Greenshaw
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | | | - D Haidt
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - R C W Henderson
- Department of Physics, University of Lancaster, Lancaster, United Kingdom
| | - J Hessler
- Max-Planck-Institut für Physik, München, Germany
| | - J Hladký
- Institute of Physics, Academy of Sciences of the Czech Republic, Praha, Czech Republic
| | - D Hoffmann
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | | | - T Hreus
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - F Huber
- Physikalisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - P M Jacobs
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - M Jacquet
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - T Janssen
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - A W Jung
- Department of Physics and Astronomy, Purdue University, West Lafayette, Indiana 47907, USA
| | - H Jung
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - M Kapichine
- Joint Institute for Nuclear Research, Dubna, Russia
| | - J Katzy
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - C Kiesling
- Max-Planck-Institut für Physik, München, Germany
| | - M Klein
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - C Kleinwort
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - H T Klest
- Stony Brook University, Stony Brook, New York 11794, USA
| | - R Kogler
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - P Kostka
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - J Kretzschmar
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - D Krücker
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - K Krüger
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - M P J Landon
- School of Physics and Astronomy, Queen Mary, University of London, London, United Kingdom
| | - W Lange
- Deutsches Elektronen-Synchrotron DESY, Zeuthen, Germany
| | - P Laycock
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S H Lee
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - S Levonian
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - W Li
- Rice University, Houston, Texas 77005-1827, USA
| | - J Lin
- Rice University, Houston, Texas 77005-1827, USA
| | - K Lipka
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - B List
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - J List
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | | | | | - H-U Martyn
- I. Physikalisches Institut der RWTH, Aachen, Germany
| | - S J Maxfield
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - A Mehta
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | - A B Meyer
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - J Meyer
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - S Mikocki
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - M M Mondal
- Stony Brook University, Stony Brook, New York 11794, USA
| | - A Morozov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - K Müller
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - B Nachman
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - Th Naumann
- Deutsches Elektronen-Synchrotron DESY, Zeuthen, Germany
| | - P R Newman
- School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - C Niebuhr
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - G Nowak
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - J E Olsson
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - D Ozerov
- Paul Scherrer Institut, Villigen, Switzerland
| | - S Park
- Stony Brook University, Stony Brook, New York 11794, USA
| | - C Pascaud
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - G D Patel
- Department of Physics, University of Liverpool, Liverpool, United Kingdom
| | | | - A Petrukhin
- Université Claude Bernard Lyon 1, CNRS/IN2P3, Villeurbanne, France
| | - I Picuric
- Faculty of Science, University of Montenegro, Podgorica, Montenegro
| | - D Pitzl
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - R Polifka
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - S Preins
- University of California, Riverside, California 92521, USA
| | - V Radescu
- Department of Physics, Oxford University, Oxford, United Kingdom
| | - N Raicevic
- Faculty of Science, University of Montenegro, Podgorica, Montenegro
| | - T Ravdandorj
- Institute of Physics and Technology of the Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - P Reimer
- Institute of Physics, Academy of Sciences of the Czech Republic, Praha, Czech Republic
| | - E Rizvi
- School of Physics and Astronomy, Queen Mary, University of London, London, United Kingdom
| | - P Robmann
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - R Roosen
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - A Rostovtsev
- Institute for Information Transmission Problems RAS, Moscow, Russia
| | - M Rotaru
- Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering (IFIN-HH), Bucharest, Romania
| | - D P C Sankey
- STFC, Rutherford Appleton Laboratory, Didcot, Oxfordshire, United Kingdom
| | - M Sauter
- Physikalisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - E Sauvan
- LAPP, Université de Savoie, CNRS/IN2P3, Annecy-le-Vieux, France
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - S Schmitt
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - B A Schmookler
- Stony Brook University, Stony Brook, New York 11794, USA
| | | | - A Schöning
- Physikalisches Institut, Universität Heidelberg, Heidelberg, Germany
| | - F Sefkow
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - S Shushkevich
- Lomonosov Moscow State University, Skobeltsyn Institute of Nuclear Physics, Moscow, Russia
| | - Y Soloviev
- Lebedev Physical Institute, Moscow, Russia
| | - P Sopicki
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - D South
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - V Spaskov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - A Specka
- LLR, Ecole Polytechnique, CNRS/IN2P3, Palaiseau, France
| | - M Steder
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - B Stella
- Dipartimento di Fisica Università di Roma Tre and INFN Roma 3, Roma, Italy
| | - U Straumann
- Physik-Institut der Universität Zürich, Zürich, Switzerland
| | - C Sun
- Shandong University, Shandong, People's Republic of China
| | - T Sykora
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - P D Thompson
- School of Physics and Astronomy, University of Birmingham, Birmingham, United Kingdom
| | - D Traynor
- School of Physics and Astronomy, Queen Mary, University of London, London, United Kingdom
| | - B Tseepeldorj
- Institute of Physics and Technology of the Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
- Ulaanbaatar University, Ulaanbaatar, Mongolia
| | - Z Tu
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Valkárová
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - C Vallée
- Aix Marseille Univ, CNRS/IN2P3, CPPM, Marseille, France
| | - P Van Mechelen
- Inter-University Institute for High Energies ULB-VUB, Brussels and Universiteit Antwerpen, Antwerp, Belgium
| | - D Wegener
- Institut für Physik, TU Dortmund, Dortmund, Germany
| | - E Wünsch
- Deutsches Elektronen-Synchrotron DESY, Hamburg, Germany
| | - J Žáček
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | - J Zhang
- Shandong University, Shandong, People's Republic of China
| | - Z Zhang
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
| | - R Žlebčík
- Faculty of Mathematics and Physics, Charles University, Praha, Czech Republic
| | | | - F Zomer
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, Orsay, France
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Hill C, Sehgal S, Fu W, Hu C, Reddy A, Thompson E, Hacker‐Prietz A, Le D, De Jesus‐Acosta A, Lee V, Zheng L, Laheru DA, Burns W, Weiss M, Wolfgang C, He J, Herman JM, Meyer J, Narang A. High local failure rates despite high margin-negative resection rates in a cohort of borderline resectable and locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy following multi-agent chemotherapy. Cancer Med 2022; 11:1659-1668. [PMID: 35142085 PMCID: PMC8986142 DOI: 10.1002/cam4.4527] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) for patients with borderline resectable and locally advanced pancreatic adenocarcinoma (BRPC/LAPC) remains controversial. Herein, we report on surgical, pathologic, and survival outcomes in BRPC/LAPC patients treated at a high-volume institution with induction chemotherapy (CTX) followed by 5-fraction SBRT. METHODS BRPC/LAPC patients treated between 2016 and 2019 were retrospectively reviewed. Surgical and pathological outcomes were descriptively characterized. Overall survival (OS) and progression-free survival (PFS) were analyzed using Cox proportional hazard regression. Locoregional failure and distant failure were analyzed with Fine-Gray competing risk model. RESULTS Of 155 patients, 91 (59%) had LAPC and 64 (41%) had BRPC. Almost all were treated with induction multi-agent CTX with either FOLFIRINOX (75%) or gemcitabine and nab-paclitaxel (24%) for a median duration of 4.0 months (1-18 months). All received SBRT to a median dose of 33 Gy. Among 64 BRPC patients, 50 (78%) underwent resection, of whom 48 (96%) achieved margin-negative (R0) resection. Among 91 LAPC patients, 57 (63%) underwent resection, of whom 50 (88%) achieved R0 resection. Despite the high R0 rate, 33% of patients experienced locoregional failure, which was a component of 44% of all failures. After SBRT, median OS and PFS were 18.7 and 7.7 months, respectively. After SBRT, 1- and 2-year OS probabilities were 70% and 45%, whereas, from diagnosis, they were 93% and 51%. CONCLUSIONS Although a high proportion of BRPC/LAPC patients treated with induction multi-agent CTX followed by SBRT successfully achieved R0 resection, locoregional failure remained common, highlighting the need to continue to optimize radiation delivery in this context.
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Affiliation(s)
- Colin Hill
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Shuchi Sehgal
- Philadelphia College of Osteopathic MedicinePhiladelphiaPennsylvaniaUSA
| | - Wei Fu
- Department of Biostatistics and BioinformaticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Chen Hu
- Department of Biostatistics and BioinformaticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Abhinav Reddy
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Elizabeth Thompson
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Amy Hacker‐Prietz
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Dung Le
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ana De Jesus‐Acosta
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Valerie Lee
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Lei Zheng
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Daniel A. Laheru
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - William Burns
- Department of Medical OncologyThe Sidney Kimmel Comprehensive Cancer CenterBloomberg‐Kimmel Institute for Cancer Immunotherapy at Johns HopkinsBaltimoreMarylandUSA
| | - Matthew Weiss
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Christopher Wolfgang
- Department of SurgeryZucker School of Medicine at Hofstra/NorthwellLake SuccessNew YorkUSA
| | - Jin He
- Department of Medical OncologyThe Sidney Kimmel Comprehensive Cancer CenterBloomberg‐Kimmel Institute for Cancer Immunotherapy at Johns HopkinsBaltimoreMarylandUSA
| | - Joseph M. Herman
- Department of SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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28
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Petzuch B, Benardeau A, Hofmeister L, Meyer J, Hartmann E, Pavkovic M, Mathar I, Sandner P, Ellinger-Ziegelbauer H. Urinary miRNA profiles in chronic kidney injury - Benefits of extracellular vesicle enrichment and miRNAs as potential biomarkers for renal fibrosis, glomerular injury and endothelial dysfunction. Toxicol Sci 2022; 187:35-50. [PMID: 35244176 DOI: 10.1093/toxsci/kfac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Micro-RNAs (miRNAs) are regulators of gene expression and play an important role in physiological homeostasis and disease. In biofluids miRNAs can be found in protein complexes or in extracellular vesicles (EVs). Altered urinary miRNAs are reported as potential biomarkers for chronic kidney disease (CKD). In this context we compared established urinary protein biomarkers for kidney injury with urinary miRNA profiles in obese ZSF1 and hypertensive renin transgenic rats. Additionally, the benefit of urinary EV enrichment was investigated in vivo and the potential association of urinary miRNAs with renal fibrosis in vitro. Kidney damage in both rat models was confirmed by histopathology, proteinuria, and increased levels of urinary protein biomarkers. In total 290 miRNAs were elevated in obese ZSF1 rats compared to lean controls, while 38 miRNAs were altered in obese ZSF1 rats during 14 to 26 weeks of age. These 38 miRNAs correlated better with disease progression than established urinary protein biomarkers. MiRNAs increased in obese ZSF1 rats were associated with renal inflammation, fibrosis, and glomerular injury. Eight miRNAs were also changed in urinary EVs of renin transgenic rats, including one which might play a role in endothelial dysfunction. EV enrichment increased the number and detection level of several miRNAs implicated in renal fibrosis in vitro and in vivo. Our results show the benefit of EV enrichment for miRNA detection and the potential of total urine and urinary EV-associated miRNAs as biomarkers of altered kidney physiology, renal fibrosis and glomerular injury, and disease progression in hypertension and obesity induced CKD.
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Affiliation(s)
- B Petzuch
- Bayer AG, Pharmaceuticals, Investigational Toxicology, 42096 Wuppertal, Germany.,Boehringer Ingelheim Pharma GmbH & Co. KG, Investigative Toxicology, Department of Non-Clinical Drug Safety, 88400 Biberach (Riß), Germany
| | - A Benardeau
- Novo Nordisk A/S,Cardio-Renal Biology, Måløv, Denmark
| | - L Hofmeister
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany
| | - J Meyer
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany
| | - E Hartmann
- Bayer AG, Pharmaceuticals, Toxicology, Pathology and Clinical Pathology, 42096 Wuppertal, Germany
| | - M Pavkovic
- Bayer AG, Pharmaceuticals, Investigational Toxicology, 42096 Wuppertal, Germany
| | - I Mathar
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany
| | - P Sandner
- Bayer AG, Pharmaceuticals, Cardiovascular Research, 42096 Wuppertal, Germany.,Hannover Medical School, Institute of Pharmacology, 30625 Hannover, Germany
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Roberts J, Marsh S, Moggre A, Meyer J. FLASH in the Clinic Track (Oral Presentations) OPTICAL CALORIMETRY, A PROMISING DOSIMETRY TECHNIQUE FOR FLASH RADIOTHERAPY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Retiz K, Althouse A, Meyer J, Arya S, Goodney P. Association of Smoking With Postprocedural Complications Following Open and Endovascular Interventions for Intermittent Claudication. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reddy AV, Hill CS, Sehgal S, He J, Zheng L, Herman JM, Meyer J, Narang AK. High neutrophil-to-lymphocyte ratio following stereotactic body radiation therapy is associated with poor clinical outcomes in patients with borderline resectable and locally advanced pancreatic cancer. J Gastrointest Oncol 2022; 13:368-379. [PMID: 35284125 PMCID: PMC8899739 DOI: 10.21037/jgo-21-513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/24/2021] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The purpose of this study is to report on the prognostic role of pre- and post-stereotactic body radiation therapy (SBRT) neutrophil-to-lymphocyte ratio (NLR) in a cohort of patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) who was treated with multi-agent induction chemotherapy followed by five-fraction SBRT. METHODS Patients treated with multi-agent induction chemotherapy followed by SBRT from August 2016 to January 2019 and who had laboratory values available for review were included in the study. Univariate (UVA) and multivariate analyses (MVA) were performed to determine associations between pre-/post-SBRT NLR and overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS). RESULTS A total of 156 patients were treated with multi-agent induction chemotherapy followed by SBRT and had laboratory values available for review. On UVA, chemotherapy duration ≥4 months, poorly differentiated disease, inability to undergo resection, pre-SBRT ANC ≥3.7 No./µL, pre-SBRT NLR ≥2.3, and post-SBRT NLR ≥2.6 were associated with worse OS. Patients with post-SBRT NLR ≥2.6 had a median OS of 16.7 months versus median OS not yet reached in patients with post-SBRT <2.6 (P=0.009). On MVA, poorly differentiated disease [hazard ratio (HR) =1.82, 95% CI: 1.04-3.18, P=0.035], inability to undergo resection (HR =2.17, 95% CI: 1.25-3.70, P=0.006), and post-SBRT NLR ≥2.6 (HR =2.55, 95% CI: 1.20-5.45, P=0.015) were associated with inferior OS. On UVA, baseline CA 19-9 ≥219 U/mL, pre-SBRT platelet count ≥157×1,000/µL, and post-SBRT NLR ≥2.6 were associated with inferior LPFS. Patients with post-SBRT NLR ≥2.6 had a median LPFS of 18.3 months versus median LPFS not yet reached in patients with post-SBRT <2.6 (P=0.028). On MVA, only post-SBRT NLR ≥2.6 was associated with worse LPFS (HR =3.22, 95% CI: 1.04-9.98, P=0.043). CONCLUSIONS Post-SBRT NLR ≥2.6 predicted for inferior OS and LPFS in BRPC/LAPC patients treated with multi-agent chemotherapy and SBRT. These findings highlight the importance of further elucidating the immunologic effects of radiation therapy in this setting, which may have significant implications on both radiation design as well as combination strategies.
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Affiliation(s)
- Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Colin S. Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Shuchi Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Lei Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health, New Hyde Park, NY, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
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Reddy AV, Sehgal S, Hill CS, Zheng L, He J, Herman JM, Meyer J, Narang AK. Upfront Chemotherapy Followed by Stereotactic Body Radiation Therapy with or without Surgery in Older Patients with Localized Pancreatic Cancer: A Single Institution Experience and Review of the Literature. Curr Oncol 2022; 29:308-320. [PMID: 35049702 PMCID: PMC8774377 DOI: 10.3390/curroncol29010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report on clinical outcomes and toxicity in older (age ≥ 70 years) patients with localized pancreatic cancer treated with upfront chemotherapy followed by stereotactic body radiation therapy (SBRT) with or without surgery. METHODS Endpoints included overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and toxicity. RESULTS A total of 57 older patients were included in the study. Median OS was 19.6 months, with six-month, one-year, and two-year OS rates of 83.4, 66.5, and 42.4%. On MVA, resection status (HR: 0.30, 95% CI 0.12-0.91, p = 0.031) was associated with OS. Patients with surgically resected tumors had improved median OS (29.1 vs. 7.0 months, p < 0.001). On MVA, resection status (HR: 0.40, 95% CI 0.17-0.93, p = 0.034) was also associated with PFS. Patients with surgically resected tumors had improved median PFS (12.9 vs. 1.6 months, p < 0.001). There were 3/57 cases (5.3%) of late grade 3 radiation toxicity and 2/38 cases (5.3%) of Clavien-Dindo grade 3b toxicity in those who underwent resection. CONCLUSION Multimodality therapy involving SBRT is safe and feasible in older patients with localized pancreatic cancer. Surgical resection was associated with improved clinical outcomes. As such, older patients who complete chemotherapy should not be excluded from aggressive local therapy when possible.
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Affiliation(s)
- Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA; (S.S.); (C.S.H.); (J.M.); (A.K.N.)
| | - Shuchi Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA; (S.S.); (C.S.H.); (J.M.); (A.K.N.)
| | - Colin S. Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA; (S.S.); (C.S.H.); (J.M.); (A.K.N.)
| | - Lei Zheng
- Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA;
| | - Jin He
- Department of Surgery, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA;
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health, 450 Lakeville Road, New Hyde Park, NY 11042, USA;
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA; (S.S.); (C.S.H.); (J.M.); (A.K.N.)
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21231, USA; (S.S.); (C.S.H.); (J.M.); (A.K.N.)
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Apisarnthanarax S, Barry A, Cao M, Czito B, DeMatteo R, Drinane M, Hallemeier CL, Koay EJ, Lasley F, Meyer J, Owen D, Pursley J, Schaub SK, Smith G, Venepalli NK, Zibari G, Cardenes H. External Beam Radiation Therapy for Primary Liver Cancers: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2022; 12:28-51. [PMID: 34688956 DOI: 10.1016/j.prro.2021.09.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This guideline provides evidence-based recommendations for the indications and technique-dose of external beam radiation therapy (EBRT) in hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). METHODS The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the indications, techniques, and outcomes of EBRT in HCC and IHC. This guideline is intended to cover the definitive, consolidative, salvage, preoperative (including bridge to transplant), and adjuvant settings as well as palliative EBRT for symptomatic primary lesions. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Strong recommendations are made for using EBRT as a potential first-line treatment in patients with liver-confined HCC who are not candidates for curative therapy, as consolidative therapy after incomplete response to liver-directed therapies, and as a salvage option for local recurrences. The guideline conditionally recommends EBRT for patients with liver-confined multifocal or unresectable HCC or those with macrovascular invasion, sequenced with systemic or catheter-based therapies. Palliative EBRT is conditionally recommended for symptomatic primary HCC and/or macrovascular tumor thrombi. EBRT is conditionally recommended as a bridge to transplant or before surgery in carefully selected patients. For patients with unresectable IHC, consolidative EBRT with or without chemotherapy should be considered, typically after systemic therapy. Adjuvant EBRT is conditionally recommended for resected IHC with high-risk features. Selection of dose-fractionation regimen and technique should be based on disease extent, disease location, underlying liver function, and available technologies. CONCLUSIONS The task force has proposed recommendations to inform best clinical practices on the use of EBRT for HCC and IHC with strong emphasis on multidisciplinary care. Future studies should focus on further defining the role of EBRT in the context of liver-directed and systemic therapies and refining optimal regimens and techniques.
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Affiliation(s)
| | - Aisling Barry
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Brian Czito
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Ronald DeMatteo
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Drinane
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Eugene J Koay
- Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas
| | - Foster Lasley
- Department of Radiation Oncology, GenesisCare, Rogers, Arkansas
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie K Schaub
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Grace Smith
- Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas
| | - Neeta K Venepalli
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Gazi Zibari
- Department of Transplantation Services, Willis-Knighton Medical Center, Shreveport, Louisiana
| | - Higinia Cardenes
- Department of Radiation Oncology, Weill Cornell, New York, New York
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Reddy AV, Deek MP, Jackson JF, Hill CS, Sehgal S, He J, Zheng L, Herman JM, Meyer J, Narang AK. Vertebral body and splenic irradiation are associated with lymphopenia in localized pancreatic cancer treated with stereotactic body radiation therapy. Radiat Oncol 2021; 16:242. [PMID: 34952610 PMCID: PMC8709967 DOI: 10.1186/s13014-021-01969-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The purpose of this study was to determine if vertebral body and splenic dosimetry was associated with the development of lymphopenia in patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiation therapy (SBRT). METHODS Patients with BRPC/LAPC who were treated with SBRT and who had lymphocyte counts and radiation treatment plans available for review were included in the study. Vertebral body levels T11-L3 and the spleen were retrospectively contoured for each patient. Univariate (UVA) and multivariable analyses (MVA) were performed to identify associations between vertebral body and splenic dosimetric parameters with absolute lymphocyte count (ALC) and grade ≥ 2 lymphopenia. Receiver operator characteristic curves were generated to identify dose-volume thresholds in predicting grade ≥ 2 lymphopenia. RESULTS A total of 132 patients were included in the study. On UVA and MVA, vertebral V15 (regression coefficient [β]: - 0.026, 95% CI - 0.044 to - 0.009, p = 0.003), vertebral V2.5 (β: - 0.011, 95% CI - 0.020 to - 0.002, p = 0.015), and log10PTV (β: - 0.15, 95% CI - 0.30 to - 0.005, p = 0.042) were associated with post-SBRT ALC. On UVA and MVA, vertebral V15 (odds ratio [OR]: 3.98, 95% CI 1.09-14.51, p = 0.027), vertebral V2.5 (OR: 1.04, 95% CI 1.00-1.09, p = 0.032), and spleen V10 (OR: 1.05, 95% CI 1.09-1.95, p = 0.004) were associated with development of grade ≥ 2 lymphopenia. Development of grade ≥ 2 lymphopenia was more likely in patients with vertebral V15 ≥ 5.84% (65.5% vs 34.0%, p = 0.002), vertebral V2.5 ≥ 48.36% (48.9% vs 23.8%, p = 0.005), and spleen V10 ≥ 4.17% (56.2% vs 26.9%, p < 0.001). CONCLUSIONS Increasing radiation dose to vertebral bodies and spleen were associated with the development of lymphopenia in BRPC/LAPC treated with SBRT. Optimization of vertebral body and splenic dosimetry may reduce the risk of developing lymphopenia and improve clinical outcomes in this population.
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Affiliation(s)
- Abhinav V Reddy
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA.
| | - Matthew P Deek
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Juan F Jackson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Colin S Hill
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Shuchi Sehgal
- Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA, 19131, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Lei Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Joseph M Herman
- Department of Radiation Oncology, Northwell Health, 450 Lakeville Road, New Hyde Park, NY, 11042, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Amol K Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, 401 N Broadway, Baltimore, MD, 21231, USA
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Reddy AV, Hill CS, Sehgal S, Ding D, Hacker-Prietz A, He J, Zheng L, Herman JM, Meyer J, Narang AK. Impact of somatic mutations on clinical and pathologic outcomes in borderline resectable and locally advanced pancreatic cancer treated with neoadjuvant chemotherapy and stereotactic body radiotherapy followed by surgical resection. Radiat Oncol J 2021; 39:304-314. [PMID: 34986552 PMCID: PMC8743453 DOI: 10.3857/roj.2021.00815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The purpose of this study was to determine if somatic mutations are associated with clinical and pathologic outcomes in patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who were treated with neoadjuvant chemotherapy and stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS Patients treated with neoadjuvant chemotherapy and SBRT followed by surgical resection from August 2016 to January 2019 and who underwent next generation sequencing of their primary tumor were included in the study. Next-generation sequencing was performed either in-house with a Solid Tumor Panel or with FoundationOne CDx. Univariate (UVA) and multivariable analyses (MVA) were performed to determine associations between somatic mutations and pathologic and clinical outcomes. RESULTS Thirty-five patients were included in the study. Chemotherapy consisted of modified FOLFIRINOX, gemcitabine and nab-paclitaxel, or gemcitabine and capecitabine. Patients were treated with SBRT in 33 Gy in 5 fractions. On UVA and MVA, tumors with KRAS G12V mutation demonstrated better pathologic tumor regression grade (TRG) to neoadjuvant therapy when compared to tumors with other KRAS mutations (odds ratio = 0.087; 95% confidence interval [CI], 0.009-0.860; p = 0.036). On UVA and MVA, mutations in NOTCH1/2 were associated with worse overall survival (hazard ratio [HR] = 4.15; 95% CI, 1.57-10.95; p = 0.004) and progression-free survival (HR = 3.61; 95% CI, 1.41-9.28; p = 0.008). On UVA, only mutations in NOTCH1/2 were associated with inferior distant metastasis-free survival (HR = 3.38; 95% CI, 1.25-9.16; p = 0.017). CONCLUSION In BRPC and LAPC, the KRAS G12V mutation was associated with better TRG following chemotherapy and SBRT. Additionally, NOTCH1/2 mutations were associated with worse overall survival, distant metastasis-free survival, and progression-free survival.
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Affiliation(s)
- Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Colin S. Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shuchi Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ding Ding
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Hacker-Prietz
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lei Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Meyer J, Thompson M, Ross S. 90: Improving research awareness and engagement in a pediatric cystic fibrosis center. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Elsner P, Meyer J. Elektrokauterisierung eines Compound-Naevus. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1217-1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungBei einer 34-jährigen Patientin wurde von einem Hautarzt eine klinisch als Compound-Naevus diagnostizierte Hautveränderung im Gesichtsbereich auf Wunsch der Patientin aus kosmetischen Gründen mittels Elektrokoagulation operativ entfernt. Im Nachgang kam es zur Entwicklung einer Narbe und Pigmentierung im Exzisionsbereich, sodass durch einen zweiten Hautarzt eine Nachexzision erfolgte, die ein Naevus-Rezidiv ergab.Die Schlichtungsstelle stellte fest, dass die aus kosmetischer Indikation erfolgte elektrochirurgische Therapie des Naevus im Gesicht aufgrund der problembehafteten Tiefensteuerung der Epidermiszerstörung mit zum Teil unvollständiger Gewebedestruktion und somit dem Risiko eines Rezidivnaevus nicht dem Facharztstandard entsprach und damit als fehlerhaftes ärztliches Handeln zu beurteilen sei. Die nach Rezidivoperation verbliebene Narbenbildung sei jedoch nicht als Folge der Elektrokoagulationstherapie zu bewerten.Melanozytäre Compound-Naevi ohne klinische oder auflichtmikroskopische Zeichen der Malignität oder der Dysplasie sind keine medizinische Indikation für eine Behandlung. Falls sie für Patienten kosmetisch störend sind, können sie entfernt werden, wobei die Exzision mit dermatohistologischer Untersuchung des Präparates die Methode der Wahl ist. Gewebsdestruierende Methoden könnten allenfalls dann vertretbar sein, wenn die Patienten über das verbleibende Risiko einer mangelnden Beurteilbarkeit der kompletten Entfernung der Läsion aufgeklärt und dieses in Kauf zu nehmen bereit sind. Der vorliegende Fall zeigt die Notwendigkeit einer umfassenden Aufklärung und ihrer besonderen Dokumentation bei kosmetischen dermatologischen Prozeduren.
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Affiliation(s)
- P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
| | - J. Meyer
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover
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Elsner P, Meyer J. Nachexzision eines Basalzellkarzinoms an der falschen Lokalisation. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1345-3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungEine Patientin stellte sich in der Sprechstunde einer dermatologischen Klinik wegen zweier Hautveränderungen im Bereich der Nase vor. Der behandelnde Dermatologe entfernte diese in Form tangentialer Abtragungen; die histologische Untersuchung ergab das Vorliegen eines Angiofibroms sowie eines Basalzellkarzinoms, welches nicht im Gesunden entfernt worden war. In Absprache mit der Patientin erfolgte eine Nachexzision. Diese wurde von einem zweiten Dermatologen der Klinik auf der Basis einer unklaren Dokumentation der Primärexzision an einer falschen Stelle durchgeführt.Die Patientin bemängelte die operative Behandlung; deshalb sei eine weitere Operation an der Nase erforderlich geworden. Die Schlichtungsstelle bestätigte, dass es fehlerbedingt zu einer nicht notwendigen Exzision an falscher Stelle mit entsprechender Narbenbildung sowie zu einem ohne den Fehler nicht erforderlichen weiteren Eingriff gekommen sei.Der an der falschen Lokalisation durchgeführte dermatochirurgische Eingriff („wrong site surgery“) ist ein in der Dermatochirurgie bekanntes Fehlergeschehen. Als Präventionsmaßnahme hat sich eine sog. „Time-out“ („Auszeit“) bewährt, wobei vor und ggf. während einer Operation diese unterbrochen wird zur Bestätigung des richtigen Patienten, Eingriffs und Ortes. Im vorliegenden Fall wurde die Wahl des falschen Nachexzisionsortes gefördert durch eine unklare Dokumentation der Primärexzision und eine fehlende Kommunikation zwischen den behandelnden Dermatologen über die korrekte Exzisionsstelle. Gemäß § 630 h BGB tritt eine Beweislastumkehr bei der Haftung für Behandlungs- und Aufklärungsfehler ein, wenn es sich um ein sog. „voll beherrschbares Risiko“ handelt; um ein solches handelt es sich bei einer Exzisionsstellenverwechslung. Der berichtete Fall beleuchtet gleichzeitig die Probleme der ärztlichen Arbeitsteilung; nach der sog. „horizontalen Arbeitsteilung“ darf jeder Facharzt zunächst darauf vertrauen, dass ein anderer an der Behandlung beteiligter Facharzt seine Pflichten aus dem Behandlungsvertrag korrekt erfüllt. Entstehen jedoch Zweifel, wie im vorliegenden Fall bzgl. der Dokumentation der korrekten Exzisionsstelle, darf der zweitbehandelnde Arzt nicht unbesehen handeln, sondern muss sich selbstverantwortlich der richtigen Diagnose, in diesem Fall bzgl. der Lokalisation des Basalzellkarzinoms, vergewissern. Durch eine Nachfrage beim erstbehandelnden Dermatologen wäre der Behandlungsfehler zu vermeiden gewesen.
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Affiliation(s)
- P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
| | - J. Meyer
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover
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Hanvesakul R, Boccuti A, Meyer J, Rengarajan B, Wu A, Chakrabarti D, Li W. P64.02 EMERGE 402 Phase 4 Observational Study: Safety and Outcomes in Patients With SCLC Receiving Treatment With Lurbinectedin. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Butterworth JW, Butterworth WA, Meyer J, Giacobino C, Buchs N, Ris F, Scarpinata R. A systematic review and meta-analysis of robotic-assisted transabdominal total mesorectal excision and transanal total mesorectal excision: which approach offers optimal short-term outcomes for mid-to-low rectal adenocarcinoma? Tech Coloproctol 2021; 25:1183-1198. [PMID: 34562160 DOI: 10.1007/s10151-021-02515-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Resection of low rectal adenocarcinoma can be challenging in the narrow pelvis of male patients. Transanal total mesorectal excision (TaTME) appears to offer technical advantages for distal rectal tumours, and robotic-assisted transabdominal TME (rTME) was introduced in effort to improve operative precision and ergonomics. However, no study has comprehensively compared these approaches. The aim of the present study was to perform a systematic review of the literature to compare postoperative short-term outcomes in rTME and TaTME. METHODS A systematic online search (1974-July 2020) of MEDLINE, Embase, web of science and google scholar was conducted for trials, prospective or retrospective studies involving rTME, or TaTME for rectal cancer. Outcome variables included: hospital stay; operation duration, blood loss; resection margins; proportion of histologically complete resected specimens; lymph nodes; overall complications; anastomotic leak, and 30-day mortality. RESULTS Sixty-two articles met the inclusion criteria, including 37 studies (3835 patients) assessing rTME resection, 23 studies (1326 patients) involving TaTME and 2 comparing both (165 patients). Operating time was longer in rTME (309.2 min, 95% CI 285.5-332.8) than in TaTME studies (256.2 min, 95% CI 231.5-280.9) (p = 0.002). rTME resected specimens had a larger distal resection margin (2.62 cm, 95% CI 2.35-2.88) than in TaTME studies (2.10 cm, 95% CI 1.83-2.36) (p = 0.007). Other outcome variables did not significantly differ between the two techniques. CONCLUSIONS rTME provides similar pathological and short-term outcomes to TaTME and both are reasonable surgical approaches for patients with mid-to-low rectal cancer. To definitively answer the question of the optimal TME technique, we suggest a prospective trial comparing both techniques assessing long-term survival as a primary outcome.
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Affiliation(s)
- J W Butterworth
- Kings College Hospitals, Princess Royal University Hospital, Farnborough Common, London, BR6 8ND, Kent, UK.
| | | | - J Meyer
- Division of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - C Giacobino
- Division of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - N Buchs
- Division of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - F Ris
- Division of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R Scarpinata
- Kings College Hospitals, Princess Royal University Hospital, Farnborough Common, London, BR6 8ND, Kent, UK
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Abazov VM, Abbott B, Acharya BS, Adams M, Adams T, Agnew JP, Alexeev GD, Alkhazov G, Alton A, Alves GA, Antchev G, Askew A, Aspell P, Assis Jesus ACS, Atanassov I, Atkins S, Augsten K, Aushev V, Aushev Y, Avati V, Avila C, Badaud F, Baechler J, Bagby L, Baldenegro Barrera C, Baldin B, Bandurin DV, Banerjee S, Barberis E, Baringer P, Barreto J, Bartlett JF, Bassler U, Bazterra V, Bean A, Begalli M, Bellantoni L, Berardi V, Beri SB, Bernardi G, Bernhard R, Berretti M, Bertram I, Besançon M, Beuselinck R, Bhat PC, Bhatia S, Bhatnagar V, Blazey G, Blessing S, Bloom K, Boehnlein A, Boline D, Boos EE, Borchsh V, Borissov G, Borysova M, Bossini E, Bottigli U, Bozzo M, Brandt A, Brandt O, Brochmann M, Brock R, Bross A, Brown D, Bu XB, Buehler M, Buescher V, Bunichev V, Burdin S, Burkhardt H, Buszello CP, Cafagna FS, Camacho-Pérez E, Carvalho W, Casey BCK, Castilla-Valdez H, Catanesi MG, Caughron S, Chakrabarti S, Chan KM, Chandra A, Chapon E, Chen G, Cho SW, Choi S, Choudhary B, Cihangir S, Claes D, Clutter J, Cooke M, Cooper WE, Corcoran M, Couderc F, Cousinou MC, Csanád M, Csörgő T, Cuth J, Cutts D, da Motta H, Das A, Davies G, Deile M, de Jong SJ, De La Cruz-Burelo E, De Leonardis F, Déliot F, Demina R, Denisov D, Denisov SP, De Oliveira Martins C, Desai S, Deterre C, DeVaughan K, Diehl HT, Diesburg M, Ding PF, Dominguez A, Doubek M, Drutskoy A, Druzhkin D, Dubey A, Dudko LV, Duperrin A, Dutt S, Eads M, Edmunds D, Eggert K, Ellison J, Elvira VD, Enari Y, Eremin V, Evans H, Evdokimov A, Evdokimov VN, Fauré A, Feng L, Ferbel T, Ferro F, Fiedler F, Fiergolski A, Filthaut F, Fisher W, Fisk HE, Forthomme L, Fortner M, Fox H, Franc J, Fuess S, Garbincius PH, Garcia F, Garcia-Bellido A, García-González JA, Gavrilov V, Geng W, Georgiev V, Gerber CE, Gershtein Y, Giani S, Ginther G, Gogota O, Golovanov G, Grannis PD, Greder S, Greenlee H, Grenier G, Gris P, Grivaz JF, Grohsjean A, Grünendahl S, Grünewald MW, Grzanka L, Guillemin T, Gutierrez G, Gutierrez P, Haley J, Hammerbauer J, Han L, Harder K, Harel A, Hauptman JM, Hays J, Head T, Hebbeker T, Hedin D, Hegab H, Heinson AP, Heintz U, Hensel C, Heredia-De La Cruz I, Herner K, Hesketh G, Hildreth MD, Hirosky R, Hoang T, Hobbs JD, Hoeneisen B, Hogan J, Hohlfeld M, Holzbauer JL, Howley I, Hubacek Z, Hynek V, Iashvili I, Ilchenko Y, Illingworth R, Isidori T, Ito AS, Ivanchenko V, Jabeen S, Jaffré M, Janda M, Jayasinghe A, Jeong MS, Jesik R, Jiang P, Johns K, Johnson E, Johnson M, Jonckheere A, Jonsson P, Joshi J, Jung AW, Juste A, Kajfasz E, Karev A, Karmanov D, Kašpar J, Katsanos I, Kaur M, Kaynak B, Kehoe R, Kermiche S, Khalatyan N, Khanov A, Kharchilava A, Kharzheev YN, Kiselevich I, Kohli JM, Kopal J, Kozelov AV, Kraus J, Kumar A, Kundrát V, Kupco A, Kurča T, Kuzmin VA, Lami S, Lammers S, Latino G, Lebrun P, Lee HS, Lee SW, Lee WM, Le X, Lellouch J, Li D, Li H, Li L, Li QZ, Lim JK, Lincoln D, Lindsey C, Linhart R, Linnemann J, Lipaev VV, Lipton R, Liu H, Liu Y, Lobodenko A, Lokajicek M, Lokajíček MV, Lopes de Sa R, Losurdo L, Lucas Rodríguez F, Luna-Garcia R, Lyon AL, Maciel AKA, Macrí M, Madar R, Magaña-Villalba R, Malawski M, Malbouisson HB, Malik S, Malyshev VL, Mansour J, Martínez-Ortega J, McCarthy R, McGivern CL, Meijer MM, Melnitchouk A, Menezes D, Mercadante PG, Merkin M, Meyer A, Meyer J, Miconi F, Minafra N, Minutoli S, Molina J, Mondal NK, Mulhearn M, Mundim L, Naaranoja T, Nagy E, Narain M, Nayyar R, Neal HA, Negret JP, Nemes F, Neustroev P, Nguyen HT, Niewiadomski H, Novák T, Nunnemann T, Oguri V, Oliveri E, Oljemark F, Orduna J, Oriunno M, Osman N, Österberg K, Pal A, Palazzi P, Parashar N, Parihar V, Park SK, Partridge R, Parua N, Pasechnik R, Passaro V, Patwa A, Penning B, Perfilov M, Peroutka Z, Peters Y, Petridis K, Petrillo G, Pétroff P, Pleier MA, Podstavkov VM, Popov AV, Prado da Silva WL, Prewitt M, Price D, Procházka J, Prokopenko N, Qian J, Quadt A, Quinn B, Quinto M, Raben TG, Radermacher E, Radicioni E, Rangel M, Ratoff PN, Ravotti F, Razumov I, Ripp-Baudot I, Rizatdinova F, Robutti E, Rodrigues RF, Rominsky M, Ross A, Royon C, Rubinov P, Ruchti R, Ruggiero G, Saarikko H, Sajot G, Samoylenko VD, Sánchez-Hernández A, Sanders MP, Santoro A, Santos AS, Savage G, Savitskyi M, Sawyer L, Scanlon T, Schamberger RD, Scheglov Y, Schellman H, Schott M, Schwanenberger C, Schwienhorst R, Scribano A, Sekaric J, Severini H, Shabalina E, Shary V, Shaw S, Shchukin AA, Shkola O, Simak V, Siroky J, Skubic P, Slattery P, Smajek J, Snoeys W, Snow GR, Snow J, Snyder S, Söldner-Rembold S, Sonnenschein L, Soustruznik K, Stark J, Stefaniuk N, Stefanovitch R, Ster A, Stoyanova DA, Strauss M, Suter L, Svoisky P, Szanyi I, Sziklai J, Taylor C, Tcherniaev E, Titov M, Tokmenin VV, Tsai YT, Tsybychev D, Tuchming B, Tully C, Turini N, Urban O, Uvarov L, Uvarov S, Uzunyan S, Vacek V, Van Kooten R, van Leeuwen WM, Varelas N, Varnes EW, Vasilyev IA, Vavroch O, Verkheev AY, Vertogradov LS, Verzocchi M, Vesterinen M, Vilanova D, Vokac P, Wahl HD, Wang C, Wang MHLS, Warchol J, Watts G, Wayne M, Weichert J, Welti J, Welty-Rieger L, Williams J, Williams MRJ, Wilson GW, Wobisch M, Wood DR, Wyatt TR, Xie Y, Yamada R, Yang S, Yasuda T, Yatsunenko YA, Ye W, Ye Z, Yin H, Yip K, Youn SW, Yu JM, Zennamo J, Zhao TG, Zhou B, Zhu J, Zich J, Zielinski K, Zielinski M, Zieminska D, Zivkovic L. Odderon Exchange from Elastic Scattering Differences between pp and pp[over ¯] Data at 1.96 TeV and from pp Forward Scattering Measurements. Phys Rev Lett 2021; 127:062003. [PMID: 34420329 DOI: 10.1103/physrevlett.127.062003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/19/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
We describe an analysis comparing the pp[over ¯] elastic cross section as measured by the D0 Collaboration at a center-of-mass energy of 1.96 TeV to that in pp collisions as measured by the TOTEM Collaboration at 2.76, 7, 8, and 13 TeV using a model-independent approach. The TOTEM cross sections, extrapolated to a center-of-mass energy of sqrt[s]=1.96 TeV, are compared with the D0 measurement in the region of the diffractive minimum and the second maximum of the pp cross section. The two data sets disagree at the 3.4σ level and thus provide evidence for the t-channel exchange of a colorless, C-odd gluonic compound, also known as the odderon. We combine these results with a TOTEM analysis of the same C-odd exchange based on the total cross section and the ratio of the real to imaginary parts of the forward elastic strong interaction scattering amplitude in pp scattering for which the significance is between 3.4σ and 4.6σ. The combined significance is larger than 5σ and is interpreted as the first observation of the exchange of a colorless, C-odd gluonic compound.
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Affiliation(s)
- V M Abazov
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - B Abbott
- University of Oklahoma, Norman, Oklahoma 73019, USA
| | - B S Acharya
- Tata Institute of Fundamental Research, Mumbai-400 005, India
| | - M Adams
- University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - T Adams
- Florida State University, Tallahassee, Florida 32306, USA
| | - J P Agnew
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - G D Alexeev
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - G Alkhazov
- Petersburg Nuclear Physics Institute, St. Petersburg 188300, Russia
| | - A Alton
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - G A Alves
- LAFEX, Centro Brasileiro de Pesquisas Físicas, Rio de Janeiro, RJ 22290, Brazil
| | - G Antchev
- INRNE-BAS, Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - A Askew
- Florida State University, Tallahassee, Florida 32306, USA
| | - P Aspell
- CERN, 1211 Geneva 23, Switzerland
| | - A C S Assis Jesus
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - I Atanassov
- INRNE-BAS, Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - S Atkins
- Louisiana Tech University, Ruston, Louisiana 71272, USA
| | - K Augsten
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - V Aushev
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | - Y Aushev
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | - V Avati
- AGH University of Science and Technology, 30-059 Krakow, Poland
- CERN, 1211 Geneva 23, Switzerland
| | - C Avila
- Universidad de los Andes, Bogotá 111711, Colombia
| | - F Badaud
- LPC, Université Blaise Pascal, CNRS/IN2P3, Clermont, F-63178 Aubière Cedex, France
| | | | - L Bagby
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - B Baldin
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D V Bandurin
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - S Banerjee
- Tata Institute of Fundamental Research, Mumbai-400 005, India
| | - E Barberis
- Northeastern University, Boston, Massachusetts 02115, USA
| | - P Baringer
- University of Kansas, Lawrence, Kansas 66045, USA
| | - J Barreto
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - J F Bartlett
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - U Bassler
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - V Bazterra
- University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - A Bean
- University of Kansas, Lawrence, Kansas 66045, USA
| | - M Begalli
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - L Bellantoni
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - V Berardi
- INFN Sezione di Bari, 70126 Bari, Italy
- Dipartimento Interateneo di Fisica di Bari, 70126 Bari, Italy
| | - S B Beri
- Panjab University, Chandigarh 160014, India
| | - G Bernardi
- LPNHE, Universités Paris VI and VII, CNRS/IN2P3, F-75005 Paris, France
| | - R Bernhard
- Physikalisches Institut, Universität Freiburg, 79085 Freiburg, Germany
| | - M Berretti
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - I Bertram
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - M Besançon
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - R Beuselinck
- Imperial College London, London SW7 2AZ, United Kingdom
| | - P C Bhat
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - S Bhatia
- University of Mississippi, University, Mississippi 38677, USA
| | | | - G Blazey
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - S Blessing
- Florida State University, Tallahassee, Florida 32306, USA
| | - K Bloom
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - A Boehnlein
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Boline
- State University of New York, Stony Brook, New York 11794, USA
| | - E E Boos
- Moscow State University, Moscow 119991, Russia
| | - V Borchsh
- Tomsk State University, Tomsk 634050, Russia
| | - G Borissov
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - M Borysova
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | - E Bossini
- Università degli Studi di Siena and Gruppo Collegato INFN di Siena, 53100 Siena, Italy
- CERN, 1211 Geneva 23, Switzerland
| | - U Bottigli
- Università degli Studi di Siena and Gruppo Collegato INFN di Siena, 53100 Siena, Italy
| | - M Bozzo
- INFN Sezione di Genova, 16146 Genova, Italy
- Università degli Studi di Genova, 16146 Genova, Italy
| | - A Brandt
- University of Texas, Arlington, Texas 76019, USA
| | - O Brandt
- II. Physikalisches Institut, Georg-August-Universität Göttingen, 37073 Göttingen, Germany
| | - M Brochmann
- University of Washington, Seattle, Washington 98195, USA
| | - R Brock
- Michigan State University, East Lansing, Michigan 48824, USA
| | - A Bross
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Brown
- LPNHE, Universités Paris VI and VII, CNRS/IN2P3, F-75005 Paris, France
| | - X B Bu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M Buehler
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - V Buescher
- Institut für Physik, Universität Mainz, 55099 Mainz, Germany
| | - V Bunichev
- Moscow State University, Moscow 119991, Russia
| | - S Burdin
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | | | | | | | - W Carvalho
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - B C K Casey
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | | | - S Caughron
- Michigan State University, East Lansing, Michigan 48824, USA
| | - S Chakrabarti
- State University of New York, Stony Brook, New York 11794, USA
| | - K M Chan
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - A Chandra
- Rice University, Houston, Texas 77005, USA
| | - E Chapon
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - G Chen
- University of Kansas, Lawrence, Kansas 66045, USA
| | - S W Cho
- Korea Detector Laboratory, Korea University, Seoul 02841, Korea
| | - S Choi
- Korea Detector Laboratory, Korea University, Seoul 02841, Korea
| | | | - S Cihangir
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Claes
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - J Clutter
- University of Kansas, Lawrence, Kansas 66045, USA
| | - M Cooke
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - W E Cooper
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M Corcoran
- Rice University, Houston, Texas 77005, USA
| | - F Couderc
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - M-C Cousinou
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
| | - M Csanád
- Eötvös University, 1117 Budapest, Pázmány P. sétány 1/A, Hungary
- Wigner Research Centre for Physics, RMI, 1121 Budapest, Hungary
| | - T Csörgő
- Wigner Research Centre for Physics, RMI, 1121 Budapest, Hungary
- MATE Institute of Technology KRC, 3200 Gyöngyös, Hungary
| | - J Cuth
- Institut für Physik, Universität Mainz, 55099 Mainz, Germany
| | - D Cutts
- Brown University, Providence, Rhode Island 02912, USA
| | - H da Motta
- Southern Methodist University, Dallas, Texas 75275, USA
| | - A Das
- Southern Methodist University, Dallas, Texas 75275, USA
| | - G Davies
- Imperial College London, London SW7 2AZ, United Kingdom
| | - M Deile
- CERN, 1211 Geneva 23, Switzerland
| | - S J de Jong
- Nikhef, Science Park, 1098 XG Amsterdam, Netherlands
- Radboud University Nijmegen, 6525 AJ Nijmegen, Netherlands
| | | | - F De Leonardis
- INFN Sezione di Bari, 70126 Bari, Italy
- Dipartimento di Ingegneria Elettrica e dell'Informazione-Politecnico di Bari, 70125 Bari, Italy
| | - F Déliot
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - R Demina
- University of Rochester, Rochester, New York 14627, USA
| | - D Denisov
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S P Denisov
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | | | - S Desai
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - C Deterre
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - K DeVaughan
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - H T Diehl
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M Diesburg
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - P F Ding
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - A Dominguez
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - M Doubek
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - A Drutskoy
- Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - D Druzhkin
- Tomsk State University, Tomsk 634050, Russia
- CERN, 1211 Geneva 23, Switzerland
| | - A Dubey
- Delhi University, Delhi-110 007, India
| | - L V Dudko
- Moscow State University, Moscow 119991, Russia
| | - A Duperrin
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
| | - S Dutt
- Panjab University, Chandigarh 160014, India
| | - M Eads
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - D Edmunds
- Michigan State University, East Lansing, Michigan 48824, USA
| | - K Eggert
- Case Western Reserve University, Department of Physics, Cleveland, Ohio 44106, USA
| | - J Ellison
- University of California Riverside, Riverside, California 92521, USA
| | - V D Elvira
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - Y Enari
- LPNHE, Universités Paris VI and VII, CNRS/IN2P3, F-75005 Paris, France
| | - V Eremin
- Ioffe Physical-Technical Institute of Russian Academy of Sciences, St. Petersburg 194021, Russian Federation
| | - H Evans
- Indiana University, Bloomington, Indiana 47405, USA
| | - A Evdokimov
- University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - V N Evdokimov
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - A Fauré
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - L Feng
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - T Ferbel
- University of Rochester, Rochester, New York 14627, USA
| | - F Ferro
- INFN Sezione di Genova, 16146 Genova, Italy
| | - F Fiedler
- Institut für Physik, Universität Mainz, 55099 Mainz, Germany
| | | | - F Filthaut
- Nikhef, Science Park, 1098 XG Amsterdam, Netherlands
- Radboud University Nijmegen, 6525 AJ Nijmegen, Netherlands
| | - W Fisher
- Michigan State University, East Lansing, Michigan 48824, USA
| | - H E Fisk
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Forthomme
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
- Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - M Fortner
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - H Fox
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - J Franc
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - S Fuess
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - P H Garbincius
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - F Garcia
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
| | | | | | - V Gavrilov
- Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - W Geng
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
- Michigan State University, East Lansing, Michigan 48824, USA
| | - V Georgiev
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - C E Gerber
- University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Y Gershtein
- Rutgers University, Piscataway, New Jersey 08855, USA
| | - S Giani
- CERN, 1211 Geneva 23, Switzerland
| | - G Ginther
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - O Gogota
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | - G Golovanov
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - P D Grannis
- State University of New York, Stony Brook, New York 11794, USA
| | - S Greder
- IPHC, Université de Strasbourg, CNRS/IN2P3, F-67037 Strasbourg, France
| | - H Greenlee
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G Grenier
- IPNL, Université Lyon 1, CNRS/IN2P3, F-69622 Villeurbanne Cedex, France and Université de Lyon, F-69361 Lyon CEDEX 07, France
| | - Ph Gris
- LPC, Université Blaise Pascal, CNRS/IN2P3, Clermont, F-63178 Aubière Cedex, France
| | - J-F Grivaz
- LAL, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, F-91898 Orsay Cedex, France
| | - A Grohsjean
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - S Grünendahl
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - L Grzanka
- AGH University of Science and Technology, 30-059 Krakow, Poland
| | - T Guillemin
- LAL, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, F-91898 Orsay Cedex, France
| | - G Gutierrez
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - P Gutierrez
- University of Oklahoma, Norman, Oklahoma 73019, USA
| | - J Haley
- Oklahoma State University, Stillwater, Oklahoma 74078, USA
| | - J Hammerbauer
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - L Han
- University of Science and Technology of China, Hefei 230026, People's Republic of China
| | - K Harder
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - A Harel
- University of Rochester, Rochester, New York 14627, USA
| | | | - J Hays
- Imperial College London, London SW7 2AZ, United Kingdom
| | - T Head
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - T Hebbeker
- III. Physikalisches Institut A, RWTH Aachen University, 52056 Aachen, Germany
| | - D Hedin
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - H Hegab
- Oklahoma State University, Stillwater, Oklahoma 74078, USA
| | - A P Heinson
- University of California Riverside, Riverside, California 92521, USA
| | - U Heintz
- Brown University, Providence, Rhode Island 02912, USA
| | - C Hensel
- LAFEX, Centro Brasileiro de Pesquisas Físicas, Rio de Janeiro, RJ 22290, Brazil
| | | | - K Herner
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - G Hesketh
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - M D Hildreth
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - R Hirosky
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T Hoang
- Florida State University, Tallahassee, Florida 32306, USA
| | - J D Hobbs
- State University of New York, Stony Brook, New York 11794, USA
| | - B Hoeneisen
- Universidad San Francisco de Quito, Quito 170157, Ecuador
| | - J Hogan
- Rice University, Houston, Texas 77005, USA
| | - M Hohlfeld
- Institut für Physik, Universität Mainz, 55099 Mainz, Germany
| | - J L Holzbauer
- University of Mississippi, University, Mississippi 38677, USA
| | - I Howley
- University of Texas, Arlington, Texas 76019, USA
| | - Z Hubacek
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - V Hynek
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - I Iashvili
- State University of New York, Buffalo, New York 14260, USA
| | - Y Ilchenko
- Southern Methodist University, Dallas, Texas 75275, USA
| | - R Illingworth
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Isidori
- University of Kansas, Lawrence, Kansas 66045, USA
| | - A S Ito
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | | | - S Jabeen
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M Jaffré
- LAL, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, F-91898 Orsay Cedex, France
| | - M Janda
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - A Jayasinghe
- University of Oklahoma, Norman, Oklahoma 73019, USA
| | - M S Jeong
- Korea Detector Laboratory, Korea University, Seoul 02841, Korea
| | - R Jesik
- Imperial College London, London SW7 2AZ, United Kingdom
| | - P Jiang
- University of Science and Technology of China, Hefei 230026, People's Republic of China
| | - K Johns
- University of Arizona, Tucson, Arizona 85721, USA
| | - E Johnson
- Michigan State University, East Lansing, Michigan 48824, USA
| | - M Johnson
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Jonckheere
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - P Jonsson
- Imperial College London, London SW7 2AZ, United Kingdom
| | - J Joshi
- University of California Riverside, Riverside, California 92521, USA
| | - A W Jung
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Juste
- Institució Catalana de Recerca i Estudis Avançats (ICREA) and Institut de Física d'Altes Energies (IFAE), 08193 Bellaterra (Barcelona), Spain
| | - E Kajfasz
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
| | - A Karev
- CERN, 1211 Geneva 23, Switzerland
| | - D Karmanov
- Moscow State University, Moscow 119991, Russia
| | - J Kašpar
- Institute of Physics, Academy of Sciences of the Czech Republic, 182 21 Prague, Czech Republic
- CERN, 1211 Geneva 23, Switzerland
| | - I Katsanos
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - M Kaur
- Panjab University, Chandigarh 160014, India
| | - B Kaynak
- Istanbul University, 34134 Vezneciler, Istanbul, Turkey
| | - R Kehoe
- Southern Methodist University, Dallas, Texas 75275, USA
| | - S Kermiche
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
| | - N Khalatyan
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Khanov
- Oklahoma State University, Stillwater, Oklahoma 74078, USA
| | - A Kharchilava
- State University of New York, Buffalo, New York 14260, USA
| | - Y N Kharzheev
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - I Kiselevich
- Institute for Theoretical and Experimental Physics, Moscow 117259, Russia
| | - J M Kohli
- Panjab University, Chandigarh 160014, India
| | - J Kopal
- CERN, 1211 Geneva 23, Switzerland
| | - A V Kozelov
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - J Kraus
- University of Mississippi, University, Mississippi 38677, USA
| | - A Kumar
- State University of New York, Buffalo, New York 14260, USA
| | - V Kundrát
- Institute of Physics, Academy of Sciences of the Czech Republic, 182 21 Prague, Czech Republic
| | - A Kupco
- Institute of Physics, Academy of Sciences of the Czech Republic, 182 21 Prague, Czech Republic
| | - T Kurča
- IPNL, Université Lyon 1, CNRS/IN2P3, F-69622 Villeurbanne Cedex, France and Université de Lyon, F-69361 Lyon CEDEX 07, France
| | - V A Kuzmin
- Moscow State University, Moscow 119991, Russia
| | - S Lami
- INFN Sezione di Pisa, 56127 Pisa, Italy
| | - S Lammers
- Indiana University, Bloomington, Indiana 47405, USA
| | - G Latino
- Università degli Studi di Siena and Gruppo Collegato INFN di Siena, 53100 Siena, Italy
| | - P Lebrun
- IPNL, Université Lyon 1, CNRS/IN2P3, F-69622 Villeurbanne Cedex, France and Université de Lyon, F-69361 Lyon CEDEX 07, France
| | - H S Lee
- Korea Detector Laboratory, Korea University, Seoul 02841, Korea
| | - S W Lee
- Iowa State University, Ames, Iowa 50011, USA
| | - W M Lee
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - X Le
- University of Arizona, Tucson, Arizona 85721, USA
| | - J Lellouch
- LPNHE, Universités Paris VI and VII, CNRS/IN2P3, F-75005 Paris, France
| | - D Li
- LPNHE, Universités Paris VI and VII, CNRS/IN2P3, F-75005 Paris, France
| | - H Li
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - L Li
- University of California Riverside, Riverside, California 92521, USA
| | - Q Z Li
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J K Lim
- Korea Detector Laboratory, Korea University, Seoul 02841, Korea
| | - D Lincoln
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - C Lindsey
- University of Kansas, Lawrence, Kansas 66045, USA
| | - R Linhart
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - J Linnemann
- Michigan State University, East Lansing, Michigan 48824, USA
| | - V V Lipaev
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - R Lipton
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Liu
- Southern Methodist University, Dallas, Texas 75275, USA
| | - Y Liu
- University of Science and Technology of China, Hefei 230026, People's Republic of China
| | - A Lobodenko
- Petersburg Nuclear Physics Institute, St. Petersburg 188300, Russia
| | - M Lokajicek
- Institute of Physics, Academy of Sciences of the Czech Republic, 182 21 Prague, Czech Republic
| | - M V Lokajíček
- Institute of Physics, Academy of Sciences of the Czech Republic, 182 21 Prague, Czech Republic
| | - R Lopes de Sa
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Losurdo
- Università degli Studi di Siena and Gruppo Collegato INFN di Siena, 53100 Siena, Italy
| | | | | | - A L Lyon
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A K A Maciel
- LAFEX, Centro Brasileiro de Pesquisas Físicas, Rio de Janeiro, RJ 22290, Brazil
| | - M Macrí
- INFN Sezione di Genova, 16146 Genova, Italy
| | - R Madar
- Physikalisches Institut, Universität Freiburg, 79085 Freiburg, Germany
| | | | - M Malawski
- AGH University of Science and Technology, 30-059 Krakow, Poland
| | - H B Malbouisson
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - S Malik
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - V L Malyshev
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - J Mansour
- II. Physikalisches Institut, Georg-August-Universität Göttingen, 37073 Göttingen, Germany
| | | | - R McCarthy
- State University of New York, Stony Brook, New York 11794, USA
| | - C L McGivern
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - M M Meijer
- Nikhef, Science Park, 1098 XG Amsterdam, Netherlands
- Radboud University Nijmegen, 6525 AJ Nijmegen, Netherlands
| | - A Melnitchouk
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Menezes
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - P G Mercadante
- Universidade Federal do ABC, Santo André, SP 09210, Brazil
| | - M Merkin
- Moscow State University, Moscow 119991, Russia
| | - A Meyer
- III. Physikalisches Institut A, RWTH Aachen University, 52056 Aachen, Germany
| | - J Meyer
- II. Physikalisches Institut, Georg-August-Universität Göttingen, 37073 Göttingen, Germany
| | - F Miconi
- IPHC, Université de Strasbourg, CNRS/IN2P3, F-67037 Strasbourg, France
| | - N Minafra
- University of Kansas, Lawrence, Kansas 66045, USA
| | - S Minutoli
- INFN Sezione di Genova, 16146 Genova, Italy
| | - J Molina
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - N K Mondal
- Tata Institute of Fundamental Research, Mumbai-400 005, India
| | - M Mulhearn
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - L Mundim
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - T Naaranoja
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
- Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - E Nagy
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
| | - M Narain
- Brown University, Providence, Rhode Island 02912, USA
| | - R Nayyar
- University of Arizona, Tucson, Arizona 85721, USA
| | - H A Neal
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - J P Negret
- Universidad de los Andes, Bogotá 111711, Colombia
| | - F Nemes
- Wigner Research Centre for Physics, RMI, 1121 Budapest, Hungary
- CERN, 1211 Geneva 23, Switzerland
| | - P Neustroev
- Petersburg Nuclear Physics Institute, St. Petersburg 188300, Russia
| | - H T Nguyen
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - H Niewiadomski
- Case Western Reserve University, Department of Physics, Cleveland, Ohio 44106, USA
| | - T Novák
- MATE Institute of Technology KRC, 3200 Gyöngyös, Hungary
| | - T Nunnemann
- Ludwig-Maximilians-Universität München, 80539 München, Germany
| | - V Oguri
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | | | - F Oljemark
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
- Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - J Orduna
- Brown University, Providence, Rhode Island 02912, USA
| | - M Oriunno
- SLAC National Accelerator Laboratory, Stanford, California 94025, USA
| | - N Osman
- CPPM, Aix-Marseille Université, CNRS/IN2P3, F-13288 Marseille Cedex 09, France
| | - K Österberg
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
- Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - A Pal
- University of Texas, Arlington, Texas 76019, USA
| | | | - N Parashar
- Purdue University Calumet, Hammond, Indiana 46323, USA
| | - V Parihar
- Brown University, Providence, Rhode Island 02912, USA
| | - S K Park
- Korea Detector Laboratory, Korea University, Seoul 02841, Korea
| | - R Partridge
- Brown University, Providence, Rhode Island 02912, USA
| | - N Parua
- Indiana University, Bloomington, Indiana 47405, USA
| | - R Pasechnik
- Department of Astronomy and Theoretical Physics, Lund University, SE-223 62 Lund, Sweden
| | - V Passaro
- INFN Sezione di Bari, 70126 Bari, Italy
- Dipartimento di Ingegneria Elettrica e dell'Informazione-Politecnico di Bari, 70125 Bari, Italy
| | - A Patwa
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - B Penning
- Imperial College London, London SW7 2AZ, United Kingdom
| | - M Perfilov
- Moscow State University, Moscow 119991, Russia
| | - Z Peroutka
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - Y Peters
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - K Petridis
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - G Petrillo
- University of Rochester, Rochester, New York 14627, USA
| | - P Pétroff
- LAL, Univ. Paris-Sud, CNRS/IN2P3, Université Paris-Saclay, F-91898 Orsay Cedex, France
| | - M-A Pleier
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - V M Podstavkov
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A V Popov
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - W L Prado da Silva
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - M Prewitt
- Rice University, Houston, Texas 77005, USA
| | - D Price
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - J Procházka
- Institute of Physics, Academy of Sciences of the Czech Republic, 182 21 Prague, Czech Republic
| | - N Prokopenko
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - J Qian
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A Quadt
- II. Physikalisches Institut, Georg-August-Universität Göttingen, 37073 Göttingen, Germany
| | - B Quinn
- University of Mississippi, University, Mississippi 38677, USA
| | - M Quinto
- INFN Sezione di Bari, 70126 Bari, Italy
- Dipartimento Interateneo di Fisica di Bari, 70126 Bari, Italy
| | - T G Raben
- University of Kansas, Lawrence, Kansas 66045, USA
| | | | | | - M Rangel
- LAFEX, Centro Brasileiro de Pesquisas Físicas, Rio de Janeiro, RJ 22290, Brazil
| | - P N Ratoff
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | | | - I Razumov
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - I Ripp-Baudot
- IPHC, Université de Strasbourg, CNRS/IN2P3, F-67037 Strasbourg, France
| | - F Rizatdinova
- Oklahoma State University, Stillwater, Oklahoma 74078, USA
| | - E Robutti
- INFN Sezione di Genova, 16146 Genova, Italy
| | - R F Rodrigues
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - M Rominsky
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Ross
- Lancaster University, Lancaster LA1 4YB, United Kingdom
| | - C Royon
- University of Kansas, Lawrence, Kansas 66045, USA
| | - P Rubinov
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Ruchti
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | | | - H Saarikko
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
- Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | - G Sajot
- LPSC, Université Joseph Fourier Grenoble 1, CNRS/IN2P3, Institut National Polytechnique de Grenoble, F-38026 Grenoble Cedex, France
| | - V D Samoylenko
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | | | - M P Sanders
- Ludwig-Maximilians-Universität München, 80539 München, Germany
| | - A Santoro
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ 20550, Brazil
| | - A S Santos
- LAFEX, Centro Brasileiro de Pesquisas Físicas, Rio de Janeiro, RJ 22290, Brazil
| | - G Savage
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M Savitskyi
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | - L Sawyer
- Louisiana Tech University, Ruston, Louisiana 71272, USA
| | - T Scanlon
- Imperial College London, London SW7 2AZ, United Kingdom
| | - R D Schamberger
- State University of New York, Stony Brook, New York 11794, USA
| | - Y Scheglov
- Petersburg Nuclear Physics Institute, St. Petersburg 188300, Russia
| | - H Schellman
- Northwestern University, Evanston, Illinois 60208, USA
- Oregon State University, Corvallis, Oregon 97331, USA
| | - M Schott
- Institut für Physik, Universität Mainz, 55099 Mainz, Germany
| | - C Schwanenberger
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - R Schwienhorst
- Michigan State University, East Lansing, Michigan 48824, USA
| | | | - J Sekaric
- University of Kansas, Lawrence, Kansas 66045, USA
| | - H Severini
- University of Oklahoma, Norman, Oklahoma 73019, USA
| | - E Shabalina
- II. Physikalisches Institut, Georg-August-Universität Göttingen, 37073 Göttingen, Germany
| | - V Shary
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - S Shaw
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - A A Shchukin
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - O Shkola
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | - V Simak
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - J Siroky
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - P Skubic
- University of Oklahoma, Norman, Oklahoma 73019, USA
| | - P Slattery
- University of Rochester, Rochester, New York 14627, USA
| | - J Smajek
- CERN, 1211 Geneva 23, Switzerland
| | - W Snoeys
- CERN, 1211 Geneva 23, Switzerland
| | - G R Snow
- University of Nebraska, Lincoln, Nebraska 68588, USA
| | - J Snow
- Langston University, Langston, Oklahoma 73050, USA
| | - S Snyder
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | | | - L Sonnenschein
- III. Physikalisches Institut A, RWTH Aachen University, 52056 Aachen, Germany
| | - K Soustruznik
- Charles University, Faculty of Mathematics and Physics, Center for Particle Physics, 116 36 Prague 1, Czech Republic
| | - J Stark
- LPSC, Université Joseph Fourier Grenoble 1, CNRS/IN2P3, Institut National Polytechnique de Grenoble, F-38026 Grenoble Cedex, France
| | - N Stefaniuk
- Taras Shevchenko National University of Kyiv, Kiev 01601, Ukraine
| | | | - A Ster
- Wigner Research Centre for Physics, RMI, 1121 Budapest, Hungary
| | - D A Stoyanova
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - M Strauss
- University of Oklahoma, Norman, Oklahoma 73019, USA
| | - L Suter
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - P Svoisky
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - I Szanyi
- Eötvös University, 1117 Budapest, Pázmány P. sétány 1/A, Hungary
- Wigner Research Centre for Physics, RMI, 1121 Budapest, Hungary
| | - J Sziklai
- Wigner Research Centre for Physics, RMI, 1121 Budapest, Hungary
| | - C Taylor
- Case Western Reserve University, Department of Physics, Cleveland, Ohio 44106, USA
| | | | - M Titov
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - V V Tokmenin
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - Y-T Tsai
- University of Rochester, Rochester, New York 14627, USA
| | - D Tsybychev
- State University of New York, Stony Brook, New York 11794, USA
| | - B Tuchming
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - C Tully
- Princeton University, Princeton, New Jersey 08544, USA
| | - N Turini
- Università degli Studi di Siena and Gruppo Collegato INFN di Siena, 53100 Siena, Italy
| | - O Urban
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - L Uvarov
- Petersburg Nuclear Physics Institute, St. Petersburg 188300, Russia
| | - S Uvarov
- Petersburg Nuclear Physics Institute, St. Petersburg 188300, Russia
| | - S Uzunyan
- Northern Illinois University, DeKalb, Illinois 60115, USA
| | - V Vacek
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - R Van Kooten
- Indiana University, Bloomington, Indiana 47405, USA
| | | | - N Varelas
- University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - E W Varnes
- University of Arizona, Tucson, Arizona 85721, USA
| | - I A Vasilyev
- Institute for High Energy Physics, Protvino, Moscow region 142281, Russia
| | - O Vavroch
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - A Y Verkheev
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | | | - M Verzocchi
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M Vesterinen
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - D Vilanova
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-Sur-Yvette, France
| | - P Vokac
- Czech Technical University in Prague, 116 36 Prague 6, Czech Republic
| | - H D Wahl
- Florida State University, Tallahassee, Florida 32306, USA
| | - C Wang
- University of Science and Technology of China, Hefei 230026, People's Republic of China
| | - M H L S Wang
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Warchol
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - G Watts
- University of Washington, Seattle, Washington 98195, USA
| | - M Wayne
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - J Weichert
- Institut für Physik, Universität Mainz, 55099 Mainz, Germany
| | - J Welti
- Helsinki Institute of Physics, 00014 University of Helsinki, Helsinki, Finland
- Department of Physics, 00014 University of Helsinki, Helsinki, Finland
| | | | - J Williams
- University of Kansas, Lawrence, Kansas 66045, USA
| | | | - G W Wilson
- University of Kansas, Lawrence, Kansas 66045, USA
| | - M Wobisch
- Louisiana Tech University, Ruston, Louisiana 71272, USA
| | - D R Wood
- Northeastern University, Boston, Massachusetts 02115, USA
| | - T R Wyatt
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Y Xie
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Yamada
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - S Yang
- University of Science and Technology of China, Hefei 230026, People's Republic of China
| | - T Yasuda
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - Y A Yatsunenko
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - W Ye
- State University of New York, Stony Brook, New York 11794, USA
| | - Z Ye
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H Yin
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - K Yip
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - S W Youn
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J M Yu
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - J Zennamo
- State University of New York, Buffalo, New York 14260, USA
| | - T G Zhao
- The University of Manchester, Manchester M13 9PL, United Kingdom
| | - B Zhou
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - J Zhu
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - J Zich
- University of West Bohemia, 301 00 Pilsen, Czech Republic
| | - K Zielinski
- AGH University of Science and Technology, 30-059 Krakow, Poland
| | - M Zielinski
- University of Rochester, Rochester, New York 14627, USA
| | - D Zieminska
- Indiana University, Bloomington, Indiana 47405, USA
| | - L Zivkovic
- LPNHE, Universités Paris VI and VII, CNRS/IN2P3, F-75005 Paris, France
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Alaedin M, Ghaffari MH, Sadri H, Meyer J, Dänicke S, Frahm J, Huber K, Grindler S, Kersten S, Rehage J, Muráni E, Sauerwein H. Effects of dietary l-carnitine supplementation on the response to an inflammatory challenge in mid-lactating dairy cows: Hepatic mRNA abundance of genes involved in fatty acid metabolism. J Dairy Sci 2021; 104:11193-11209. [PMID: 34253361 DOI: 10.3168/jds.2021-20226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022]
Abstract
This study aimed at characterizing the effects of dietary l-carnitine supplementation on hepatic fatty acid (FA) metabolism during inflammation in mid-lactating cows. Fifty-three pluriparous Holstein dairy cows were randomly assigned to either a control (CON, n = 26) or an l-carnitine supplemented (CAR; n = 27) group. The CAR cows received 125 g of a rumen-protected l-carnitine product per cow per day (corresponding to 25 g of l-carnitine/cow per day) from d 42 antepartum (AP) until the end of the trial on d 126 postpartum (PP). Aside from the supplementation, the same basal diets were fed in the dry period and during lactation to all cows. In mid lactation, each cow was immune-challenged by a single intravenous injection of 0.5 μg of LPS/kg of BW at d 111 PP. Blood samples were collected before and after LPS administration. The mRNA abundance of in total 39 genes related to FA metabolism was assessed in liver biopsies taken at d -11, 1, and 14 relative to LPS (d 111 PP) and also on d 42 AP as an individual covariate using microfluidics integrated fluidic circuit chips (96.96 dynamic arrays). In addition to the concentrations of 3 selected proteins related to FA metabolism, acetyl-CoA carboxylase α (ACACA), 5' AMP-activated protein kinase (AMPK), and solute carrier family 25 member 20 (SLC25A20) were assessed by a capillary Western blot method in liver biopsies from d -11 and 1 relative to LPS from 11 cows each of CAR and CON. On d -11 relative to LPS, differences between the mRNA abundance in CON and CAR were limited to acyl-CoA dehydrogenase (ACAD) very-long-chain (ACADVL) with greater mRNA abundance in the CAR than in the CON group. The liver fat content decreased from d -11 to d 1 relative to the LPS injection and remained at the lower level until d 14 in both groups. One day after the LPS challenge, lower mRNA abundance of carnitine palmitoyltransferase 1 (CPT1), CPT2, ACADVL, ACAD short-chain (ACADS), and solute carrier family 22 member 5 (SLC22A5) were observed in the CAR group as compared with the CON group. However, the mRNA abundance of protein kinase AMP-activated noncatalytic subunit gamma 1 (PRKAG1), ACAD medium-chain (ACADM), ACACA, and FA binding protein 1 (FABP1) were greater in the CAR group than in the CON group on d 1 relative to LPS. Two weeks after the LPS challenge, differences between the groups were no longer detectable. The altered mRNA abundance before and 1 d after LPS pointed to increased transport of FA into hepatic mitochondria during systemic inflammation in both groups. The protein abundance of AMPK was lower in CAR than in CON before the LPS administration. The protein abundance of SLC25A20 was neither changing with time nor treatment and the ACACA protein abundance was only affected by time. In conclusion, l-carnitine supplementation temporally altered the hepatic mRNA abundance of some genes related to mitochondrial biogenesis and very-low-density lipoprotein export in response to an inflammatory challenge, but with largely lacking effects before and 2 wk after LPS.
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Affiliation(s)
- M Alaedin
- Institute of Animal Science, Physiology Unit, University of Bonn, Katzenburgweg 7-9, 53115 Bonn, Germany
| | - M H Ghaffari
- Institute of Animal Science, Physiology Unit, University of Bonn, Katzenburgweg 7-9, 53115 Bonn, Germany
| | - H Sadri
- Department of Clinical Science, Faculty of Veterinary Medicine, University of Tabriz, 516616471 Tabriz, Iran
| | - J Meyer
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - S Dänicke
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - J Frahm
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - K Huber
- Institute of Animal Science, Functional Anatomy of Livestock, University of Hohenheim, Fruwirthstraße 35, 70593 Stuttgart, Germany
| | - S Grindler
- Institute of Animal Science, Functional Anatomy of Livestock, University of Hohenheim, Fruwirthstraße 35, 70593 Stuttgart, Germany
| | - S Kersten
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - J Rehage
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - E Muráni
- Research Institute for the Biology of Farm Animals (FBN), Research Unit Molecular Biology, Wilhelm-Stahl-Allee 2, 18196 Dummerstorf, Germany
| | - H Sauerwein
- Institute of Animal Science, Physiology Unit, University of Bonn, Katzenburgweg 7-9, 53115 Bonn, Germany.
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McGillivray E, Jain R, Ramamurthy C, Sheng J, Granina E, Yu D, Lu X, Abbas A, Dotan E, Meyer J, Fang C, Denlinger C. P-103 Associations between quality-of-life, symptom burden, and demographic characteristics in long-term esophageal and gastroesophageal junction cancer survivors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Elsner P, Meyer J. Verzögerte Diagnose und fehlerhafte Therapie von Basalzellkarzinomen. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1205-3242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEine 68-jährige Patientin wurde von einer dermatologischen Poliklinik unter der klinischen Verdachtsdiagnose von Basaliomen im Bereich der Stirn und des Ohres über 20 Monate topisch mit 5 % Imiquimod-Creme behandelt, ohne dass eine bioptische Sicherung vorgenommen wurde. Die danach erfolgte dermatohistologische Diagnostik ergab ein sklerodermiformes und ein noduläres Basalzellkarzinom. Eine operative Therapie erfolgte wegen mehrfacher mangelnder Tumorfreiheit der Exzisionsränder während multipler stationärer Aufenthalte.Die Schlichtungsstelle bejahte einen ärztlichen Behandlungsfehler. Die Exzision stellt nach Facharztstandard die Therapie der ersten Wahl des Basalzellkarzinoms dar. Auch bei Patientenwunsch nach einer narbenfreien Therapie in kosmetisch sichtbaren Bereichen ist der ärztliche Entscheid zu einer Externatherapie bei klinischer Einordnung als Basalzellkarzinom vom sklerodermiformen bzw. nodulären Typ ohne histopathologische Sicherung als vermeidbare Fehlentscheidung einzuordnen. Spätestens bei Nichtabheilung nach der Erstbehandlung mit Imiquimod-5 %-Creme hätten zwingend eine Probebiopsie und eine histologische Befundsicherung erfolgen müssen. Es lag ein Befunderhebungsmangel vor, der zu einer Umkehr der Beweislast hinsichtlich der Kausalität des Behandlungsfehlers für den eingetretenen Schaden führte. Der klinische Verdacht auf ein Basalzellkarzinom sollte zeitnah durch eine Probebiopsie oder Totalexzision dermatohistologisch bestätigt werden. Eine Therapie des Basalzellkarzinoms mit topischem Imiquimod ist nur für superfizielle Basalzellkarzinome indiziert; bei Nichtansprechen nach 12 Wochen ist eine andere Therapie zu wählen.
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Affiliation(s)
- P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
| | - J. Meyer
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover
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Meyer J, Schrenzel J, Balaphas A, Delaune V, Abbas M, Morel P, Puppa G, Rubbia-Brandt L, Bichard P, Frossard JL, Toso C, Buchs N, Ris F. Mapping of aetiologies and clinical presentation of acute colitis: Results from a prospective cohort study in a tertiary centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Our objective was to describe the aetiologies of acute colitis and to identify patients who require diagnostic endoscopy.
Methods
Patients with symptoms of gastrointestinal infection and colonic inflammation on computed tomography were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD) were excluded. Stools were screened with BD-Max and BioFire FilmArray GI panel. Faecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. The study was registered into clinicaltrials.gov (NCT02709213).
Results
One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp (n = 57, 55.3%), Escherichia coli spp (n = 8, 7.8%), Clostridium difficile (n = 23, 22.3%), Salmonella spp (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and others (n = 4, 3.9%). Eighty-six patients underwent colonoscopy, which was compatible with ischemic colitis in 18 patients (10.1%) and IBD in 4 patients (2.2%). Among patients with negative FilmArray, a faecal calprotectin >625μg/g allowed identifying patients with IBD with an area under ROC curve of 85.1%. Introduction of a diagnostic management algorithm including FilmArray and faecal calprotectin could allow decreasing unnecessary colonoscopies from 82 to 29 (corresponding to a decrease of 64.6%).
Conclusion
Computed tomography-proven colitis was mostly of infectious aetiology. Diagnostic management of patients with acute colitis should include broad molecular testing of the stools and, in patients with a calprotectin concentration >625μg/g, colonoscopy to exclude IBD.
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Affiliation(s)
- J Meyer
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - J Schrenzel
- Infectious diseases, Geneva University Hospital, Geneva, Switzerland
| | - A Balaphas
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - V Delaune
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - M Abbas
- Infectious diseases, Geneva University Hospital, Geneva, Switzerland
| | - P Morel
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - G Puppa
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - L Rubbia-Brandt
- Department of Pathology, Geneva University Hospital, Geneva, Switzerland
| | - P Bichard
- Department of Gastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - J -L Frossard
- Department of Gastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - C Toso
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - N Buchs
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - F Ris
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
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Meyer J, Cirocchi R, Di Saverio S, Ris F, Wheeler J, Davies RJ. Pre-operative iron allows correction of anaemia before abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Professional surgical societies recommend the identification and treatment of pre-operative anaemia in patients scheduled for abdominal surgery. However, the evidence supporting this recommendation has been of poor quality until the recent release of several randomized controlled trials (RCT) addressing the question. Our aim was to determine if pre-operative iron allows correction of haemoglobin concentration and decreased incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery.
Methods
MEDLINE, Embase and CENTRAL were searched for RCTs written in English and assessing the effect of pre-operative iron on the incidence of peri-operative allogeneic blood transfusion in patients undergoing major abdominal surgery. Pooled relative risk (RR), risk difference (RD) and mean difference (MD) were obtained using models with random effects. Heterogeneity was assessed using the Q-test and quantified using the I2 value.
Results
Four RCTs were retained for analysis out of 285 eligible articles. MD in haemoglobin concentration between patients with pre-operative iron and patients without pre-operative iron was of 0.81 g/dl (3 RCTs, 95% CI: 0.30 to 1.33, I2: 60%, p = 0.002). Pre-operative iron did not lead to reduction in the incidence of peri-operative blood transfusion in terms of RD (4 RCTs, RD: -0.13, 95% CI: -0.27 to 0.01, I2: 65%, p = 0.07) or RR (4 RCTs, RR: 0.57, 95% CI: 0.30 to 1.09, I2: 64%, p = 0.09).
Conclusion
Pre-operative iron significantly increases haemoglobin concentration by 0.81 g/dl before abdominal surgery but does not reduce the need for peri-operative blood transfusion. Important heterogeneity exists between existing RCTs in terms of populations and interventions. Future trials should target patients suffering from iron-deficiency anaemia and assess the effect of intervention on anaemia-related complications.
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Affiliation(s)
- J Meyer
- Colorectal Unit, Cambridge NHS Foundation Trust, Cambridge, United Kingdom
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - R Cirocchi
- Department of General Surgery and Surgical Oncology, Hospital of Terni, Terni, Italy
| | - S Di Saverio
- General Surgery, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - F Ris
- Department of Digestive Surgery, Geneva University Hospital, Geneva, Switzerland
| | - J Wheeler
- Colorectal Unit, Cambridge NHS Foundation Trust, Cambridge, United Kingdom
| | - R J Davies
- Colorectal Unit, Cambridge NHS Foundation Trust, Cambridge, United Kingdom
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Lee V, Ding D, Rodriguez C, Onners B, Narang A, Meyer J, Herman JM, Hacker-Prietz A, Burkhart RA, Burns W, He J, De Jesus-Acosta A, Klein RB, Laheru D, Le DT, Ryan A, Sugar E, Zheng L. A phase 2 study of cyclophosphamide (CY), GVAX, pembrolizumab (Pembro), and stereotactic body radiation (SBRT) in patients (pts) with locally advanced pancreas cancer (LAPC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4134 Background: Management of locally advanced pancreas cancer (LAPC) standardly involves chemotherapy with consolidative radiation and surgery in selected pts. Checkpoint inhibitors have shown limited benefit alone in pancreas cancer but may be primed by radiation and GM-CSF secreting allogeneic pancreatic cancer vaccine (GVAX). We present data from a phase 2 study for LAPC pts who have not developed metastases after standard of care chemotherapy treated with combination cyclophosphamide (CY), GVAX, pembrolizumab (pembro), and stereotactic body radiation therapy (SBRT). Methods: This is a single-arm, single institution, open-label study for pts with LAPC at diagnosis (as per NCCN guidelines, arterial involvement > 180°, or unreconstructible SMV/PV) who remained without metastatic disease after 4-8 28-day cycles FOLFIRINOX or gemcitabine/abraxane based therapy. Pts received CY (200mg/m2 IV) and pembro (200mg IV) on day 1, followed by GVAX (6 intradermal inj) on day 2 q3 wk x 2 cycles, with cycle 2 initiating concurrently with 5 days SBRT. Pts were restaged 4-6 weeks after SBRT, and if non-metastatic, pts underwent surgical resection, irreversible electroporation (IRE), or biopsy (if not undergoing surgical resection). Pts received two cycles of chemotherapy, and if metastasis free, received q3 wk CY/pembro/GVAX x 6 cycles with restaging scans q3 mos. In 5/2017, the protocol was addended to include an extended phase with q3 wk pembro x 9 cycles and q6 mo CY/GVAX x 4. Primary endpoint was distant metastasis free survival (DMFS) defined as C1D1 to distant metastases or death. Results: From Jul 2016-Jan 2021, 58 pts with LAPC were enrolled at the Johns Hopkins Hospital, 54 completed 2 cycles CY/pembro/GVAX and SBRT and were evaluable for response (2 dropouts due to thrombocytopenia, 2 due to irAE (DKA and hepatitis)), median followup was 15.8 mos. Demographics: median age 66 (range 42-84), 53% male, 84% White, 12% African American. At first restaging (N = 54), 8 (15%) had metastatic disease, 9 (17%) were unresectable, 37 (69%) were eligible for surgical resection. 35 pts proceeded to the OR (1 died of cholangitis prior to surgery and 1 declined surgery), 24 had tumors resected (44% of evaluable pts, 10 (42%) had grade 1 (marked) pathologic response), 1 IRE, 2 were unresectable, 8 were metastatic. Common related AEs were vaccine site reactions; grade 3 irAE included 1 case each of dermatitis, colitis, DKA, nephritis, and pneumonitis. DMFS was 9.7 mos [95% CI 6.3-19.3 mos]. Conclusions: We present data from a ph II study of 54 pts w LAPC treated w CY/GVAX/pembro and SBRT. Primary endpoint of DMFS > 13.6 mos not reached, however 44% of pts underwent surgical resection of whom 42% had grade 1 path response rate. Additional correlative studies are underway. Clinical trial information: NCT02648282.
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Affiliation(s)
- Valerie Lee
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
| | | | | | - Beth Onners
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph M. Herman
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy Hacker-Prietz
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard A. Burkhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William Burns
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Rachel B. Klein
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
| | - Dan Laheru
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
| | - Dung T. Le
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
| | - Amy Ryan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
| | | | - Lei Zheng
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD
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Uberoi A, Bartow-McKenney C, Zheng Q, Flowers L, Campbell A, Knight S, Chan N, Wei M, Lovins V, Bugayev J, Horwinski J, Bradley C, Meyer J, Crumrine D, Sutter C, Elias P, Mauldin E, Sutter T, Grice E. 190 Commensal microbiota regulates skin barrier function and repair via signaling through the aryl hydrocarbon receptor. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jia AY, Popovic A, Mohan AA, Zorzi J, Griffith P, Kim AK, Anders RA, Burkhart RA, Lafaro K, Georgiades C, Azad NS, Liddell RP, Baretti M, Kamel IR, Narang A, Yarchoan M, Meyer J. Development, Practice Patterns, and Early Clinical Outcomes of a Multidisciplinary Liver Cancer Clinic. Cancer Control 2021; 28:10732748211009945. [PMID: 33882707 PMCID: PMC8204642 DOI: 10.1177/10732748211009945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Multidisciplinary care has been associated with improved survival in patients with primary liver cancers. We report the practice patterns and real world clinical outcomes for patients presenting to the Johns Hopkins Hospital (JHH) multidisciplinary liver clinic (MDLC). We analyzed hepatocellular carcinoma (HCC, n = 100) and biliary tract cancer (BTC, n = 76) patients evaluated at the JHH MDLC in 2019. We describe the conduct of the clinic, consensus decisions for patient management based on stage categories, and describe treatment approaches and outcomes based on these categories. We describe subclassification of BCLC stage C into 2 parts, and subclassification of cholangiocarcinoma into 4 stages. A treatment consensus was finalized on the day of MDLC for the majority of patients (89% in HCC, 87% in BTC), with high adherence to MDLC recommendations (91% in HCC, 100% in BTC). Among patients presenting for a second opinion regarding management, 28% of HCC and 31% of BTC patients were given new therapeutic recommendations. For HCC patients, at a median follow up of 11.7 months (0.7-19.4 months), median OS was not reached in BCLC A and B patients. In BTC patients, at a median follow up of 14.2 months (0.9-21.1 months) the median OS was not reached in patients with resectable or borderline resectable disease, and was 11.9 months in patients with unresectable or metastatic disease. Coordinated expert multidisciplinary care is feasible for primary liver cancers with high adherence to recommendations and a change in treatment for a sizeable minority of patients.
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Affiliation(s)
- Angela Y Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aleksandra Popovic
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aditya A Mohan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jane Zorzi
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paige Griffith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy K Kim
- Department of Medicine, Gastroenterology and Hepatology, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert A Anders
- Department of Pathology, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A Burkhart
- Department of Surgery, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Lafaro
- Department of Surgery, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christos Georgiades
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nilofer S Azad
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert P Liddell
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marina Baretti
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Yarchoan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Elsner P, Meyer J. Kosmetische Laser- und Elektrokautertherapie ohne rechtswirksame Aufklärung. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1345-6891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungBei einer Patientin erfolgte als Selbstzahlerleistung bei einem Hautarzt die Therapie eines Spider-Naevus elektrokaustisch sowie dermaler Naevuszellnaevi mittels Erbiumlaser. Die Patientin war mit dem Behandlungsergebnis unzufrieden und bemängelte bei der zuständigen Schlichtungsstelle die Behandlung; die Laserbehandlung im Gesicht sei fehlerhaft durchgeführt worden. Die Behandlung sei nur für eine Hautveränderung abgesprochen gewesen; während des Eingriffs seien durch den behandelnden Arzt jedoch weitere Bereiche gelasert worden. Erst nach der Behandlung seien ihr mittels Spiegel ärztlicherseits die gelaserten Areale gezeigt worden.Die Schlichtungsstelle verneinte ebenso wie der konsultierte dermatologische Gutachter einen Behandlungsfehler; sowohl die Elektrokaustik als auch die Lasertherapie seien lege artis erfolgt. Die geltend gemachten Ansprüche waren aus Sicht der Schlichtungsstelle jedoch unter dem Gesichtspunkt der mangelhaften Aufklärung begründet. In den Patientenunterlagen des Hautarztes fand sich lediglich ein kursorischer Hinweis über die Möglichkeit der Entfernung der Hautveränderungen mit dem Elektrokauter und dem Erbiumlaser und über den Verlauf und die möglichen Komplikationen. Derartige Hinweise genügten nach Einschätzung der Schlichtungsstelle für die Dokumentation über die geplanten kosmetischen Behandlungsmaßnahmen und in der Folge für die rechtswirksame Einwilligung der Patientin nicht.Auch bei nach Facharztstandard korrekt durchgeführten kosmetischen Eingriffen ist auf eine rechtzeitige, umfassende Aufklärung als Voraussetzung für eine rechtswirksame Einwilligung des Patienten in den Eingriff höchsten Wert zu legen. Ohne Aufklärung und rechtswirksame Einwilligung ist der Eingriff rechtswidrig; unvermeidliche verbleibende kosmetische Beeinträchtigungen nach einem solchen Eingriff sind dann als Gesundheitsschaden zu bewerten und schadensersatzpflichtig. Neben den zivil- und möglicherweise strafrechtlichen Konsequenzen muss der Arzt auch mit berufsrechtlichen Disziplinarmaßnahmen rechnen.
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Affiliation(s)
- P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
| | - J. Meyer
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hannover
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