Management of non-metastatic anal cancer in the elderly: ancillary study of the French multicenter prospective cohort FFCD-ANABASE

BACKGROUND

Standard care for non-metastatic squamous cell carcinoma of the anus (SCCA) is chemoradiotherapy, data about elderly patients are scarce.

METHODS

All consecutive patients treated for non-metastatic SCCA from the French multicenter FFCD-ANABASE cohort were included. Two groups were defined according to age: elderly (≥75 years) and non-elderly (<75).

RESULTS

Of 1015 patients, 202 (19.9%) were included in the elderly group; median follow-up was 35.5 months. Among the elderly, there were more women (p = 0.015); frailer patients (p < 0.001), fewer smokers (p < 0.001) and fewer HIV-infected (p < 0.001) than in the non-elderly group. Concomitant chemotherapy and inguinal irradiation were less frequent (p < 0.001 and p = 0.04). In the elderly group; 3-year overall survival (OS), recurrence-free survival (RFS) and colostomy-free survival (CFS) were 82.9%, 72.4% and 78.0%, respectively; complete response rate at 4-6 months was 70.3%. There were no differences between groups for all outcomes and toxicity. In multivariate analyses for the elderly, PS ≥ 2 and locally-advanced tumors were significantly associated with poor OS (HR = 3.4 and HR = 2.80), RFS (HR = 2.4 and HR = 3.1) and CFS (HR = 3.8 and HR = 3.0); and treatment interruption with poor RFS (HR = 1.9).

CONCLUSION

In the FFCD-ANABASE cohort, age did not influence tumor and tolerance outcomes of non-metastatic SCCA. Optimal curative treatment should be offered to elderly patients.

Treatment, outcome, and prognostic factors in non-metastatic anal cancer: The French nationwide cohort study FFCD-ANABASE

INTRODUCTION

International guidelines regarding the treatment of squamous cell carcinoma of the anus (SCCA) recommend intensity-modulated radiotherapy (IMRT) combined with mitomycin-based chemotherapy (CT). The French FFCD-ANABASE cohort aimed at evaluating clinical practices, treatment, and outcomes of SCCA patients.

METHODS

This prospective multicentric observational cohort included all non-metastatic SCCA patients treated in 60 French centers from January 2015 to April 2020. Patients and treatment characteristics, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed.

RESULTS

Among 1015 patients (male: 24.4 %; female: 75.6 %; median age: 65 years), 43.3 %presented with early-stage(T1-2, N0) and 56.7 % with locally advanced stage (T3-4 or N + ) tumors. IMRT was used for 815 patients (80.3 %) and a concurrent CT was administered in 781 patients, consisting of mitomycin-based CT for 80 %. The median follow-up was 35.5 months. DFS, CFS, and OS at 3 years were 84.3 %, 85.6 %, and 91.7 % respectively in the early-stage group compared to 64.4 %, 66.9 %, and 78.2 % in the locally-advanced group (p < 0.001). In multivariate analyses, male gender, locally-advanced stage, and ECOG PS ≥ 1 were associated with poorer DFS, CFS, and OS. IMRT was significantly associated with a better CFS in the whole cohort and almost reached significance in the locally-advanced group.

CONCLUSION

Treatment of SCCA patients showed good respect for current guidelines. Significant differences in outcomes advocate for personalized strategies by either de-escalation for early-stage tumors or treatment intensification for locally-advanced tumors.

Phytostabilization of arsenic in soils with plants of the genus Atriplex established in situ in the Atacama Desert

In the ChiuChiu village (Atacama Desert, Chile), there is a high concentration of arsenic (As) in the soil due to natural causes related to the presence of volcanoes and geothermal activity. To compare the levels of As and the growth parameters among plants of the same genus, three species of plants were established in situ: Atriplex atacamensis (native of Chile), Atriplex halimus, and Atriplex nummularia. These soils have an As concentration of 131.2 ± 10.4 mg kg(-1), a pH of 8.6 ± 0.1, and an electrical conductivity of 7.06 ± 2.37 dS m(-1). Cuttings of Atriplex were transplanted and maintained for 5 months with periodic irrigation and without the addition of fertilizers. The sequential extraction of As indicated that the metalloid in these soils has a high bioavailability (38 %), which is attributed to the alkaline pH, low organic matter and Fe oxide content, and sandy texture. At day 90 of the assay, the As concentrations in the leaves of A. halimus (4.53 ± 1.14 mg kg(-1)) and A. nummularia (3.85 ± 0.64 mg kg(-1)) were significantly higher than that in A. atacamensis (2.46 ± 1.82 mg kg(-1)). However, the three species accumulated higher levels of As in their roots, indicating a phytostabilization capacity. At the end of the assay, A. halimus and A. nummularia generated 30 % more biomass than A. atacamensis without significant differences in the As levels in the leaves. Despite the difficult conditions in these soils, the establishment of plants of the genus Atriplex is a recommended strategy to generate a vegetative cover that prevents the metalloid from spreading in this arid area through the soil or by wind.

Relationships and redundancies of selected hemodynamic and structural parameters for characterizing virtual treatment of cerebral aneurysms with flow diverter devices

BACKGROUND AND PURPOSE

To quantify the relationship and to demonstrate redundancies between hemodynamic and structural parameters before and after virtual treatment with a flow diverter device (FDD) in cerebral aneurysms.

METHODS

Steady computational fluid dynamics (CFD) simulations were performed for 10 cerebral aneurysms where FDD treatment with the SILK device was simulated by virtually reducing the porosity at the aneurysm ostium. Velocity and pressure values proximal and distal to and at the aneurysm ostium as well as inside the aneurysm were quantified. In addition, dome-to-neck ratios and size ratios were determined. Multiple correlation analysis (MCA) and hierarchical cluster analysis (HCA) were conducted to demonstrate dependencies between both structural and hemodynamic parameters.

RESULTS

Velocities in the aneurysm were reduced by 0.14m/s on average and correlated significantly (p<0.05) with velocity values in the parent artery (average correlation coefficient: 0.70). Pressure changes in the aneurysm correlated significantly with pressure values in the parent artery and aneurysm (average correlation coefficient: 0.87). MCA found statistically significant correlations between velocity values and between pressure values, respectively. HCA sorted velocity parameters, pressure parameters and structural parameters into different hierarchical clusters. HCA of aneurysms based on the parameter values yielded similar results by either including all (n=22) or only non-redundant parameters (n=2, 3 and 4).

CONCLUSION

Hemodynamic and structural parameters before and after virtual FDD treatment show strong inter-correlations. Redundancy of parameters was demonstrated with hierarchical cluster analysis.

Cellular and molecular portrait of eleven human glioblastoma cell lines under photon and carbon ion irradiation

This study aimed to examine the cellular and molecular long-term responses of glioblastomas to radiotherapy and hadrontherapy in order to better understand the biological effects of carbon beams in cancer treatment. Eleven human glioblastoma cell lines, displaying gradual radiosensitivity, were irradiated with photons or carbon ions. Independently of p53 or O(6)-methylguanine-DNA methyltransferase(1) status, all cell lines responded to irradiation by a G2/M phase arrest followed by the appearance of mitotic catastrophe, which was concluded by a ceramide-dependent-apoptotic cell death. Statistical analysis demonstrated that: (i) the SF2(2) and the D10(3) values for photon are correlated with that obtained in response to carbon ions; (ii) regardless of the p53, MGMT status, and radiosensitivity, the release of ceramide is associated with the induction of late apoptosis; and (iii) the appearance of polyploid cells after photon irradiation could predict the Relative Biological Efficiency(4) to carbon ions. This large collection of data should increase our knowledge in glioblastoma radiobiology in order to better understand, and to later individualize, appropriate radiotherapy treatment for patients who are good candidates.

Estimation of scattered radiation in digital breast tomosynthesis

Digital breast tomosynthesis (DBT) is a promising technique to overcome the tissue superposition limitations found in planar 2D x-ray mammography. However, as most DBT systems do not employ an anti-scatter grid, the levels of scattered radiation recorded within the image receptor are significantly higher than that observed in planar 2D x-ray mammography. Knowledge of this field is necessary as part of any correction scheme and for computer modelling and optimisation of this examination. Monte Carlo (MC) simulations are often used for this purpose, however they are computationally expensive and a more rapid method of calculation is desirable. This issue is addressed in this work by the development of a fast kernel-based methodology for scatter field estimation using a detailed realistic DBT geometry. Thickness-dependent scatter kernels, which were validated against the literature with a maximum discrepancy of 4% for an idealised geometry, have been calculated and a new physical parameter (air gap distance) was used to estimate more accurately the distribution of scattered radiation for a series of anthropomorphic breast phantom models. The proposed methodology considers, for the first time, the effects of scattered radiation from the compression paddle and breast support plate, which can represent more than 30% of the total scattered radiation recorded within the image receptor. The results show that the scatter field estimator can calculate scattered radiation images in an average of 80 min for projection angles up to 25° with equal to or less than a 10% error across most of the breast area when compared with direct MC simulations.

Mobile technology and social media in the clinical practice of young radiation oncologists: results of a comprehensive nationwide cross-sectional study

PURPOSE

Social media and mobile technology are transforming the way in which young physicians are learning and practicing medicine. The true impact of such technologies has yet to be evaluated.

METHODS AND MATERIALS

We performed a nationwide cross-sectional survey to better assess how young radiation oncologists used these technologies. An online survey was sent out between April 24, 2013, and June 1, 2013. All residents attending the 2013 radiation oncology French summer course were invited to complete the survey. Logistic regressions were performed to assess predictors of use of these tools in the hospital on various clinical endpoints.

RESULTS

In all, 131 of 140 (93.6%) French young radiation oncologists answered the survey. Of these individuals, 93% owned a smartphone and 32.8% owned a tablet. The majority (78.6%) of the residents owning a smartphone used it to work in their department. A total of 33.5% had more than 5 medical applications installed. Only 60.3% of the residents verified the validity of the apps that they used. In all, 82.9% of the residents had a social network account.

CONCLUSIONS

Most of the residents in radiation oncology use their smartphone to work in their department for a wide variety of tasks. However, the residents do not consistently check the validity of the apps that they use. Residents also use social networks, with only a limited impact on their relationship with their patients. Overall, this study highlights the irruption and the risks of new technologies in the clinical practice and raises the question of a possible regulation of their use in the hospital.

[Task sharing with radiotherapy technicians in image-guided radiotherapy]

The development of accelerators with on-board imaging systems now allows better target volumes reset at the time of irradiation (image-guided radiotherapy [IGRT]). However, these technological advances in the control of repositioning led to a multiplication of tasks for each actor in radiotherapy and increase the time available for the treatment, whether for radiotherapy technicians or radiation oncologists. As there is currently no explicit regulatory framework governing the use of IGRT, some institutional experiments show that a transfer is possible between radiation oncologists and radiotherapy technicians for on-line verification of image positioning. Initial training for every technical and drafting procedures within institutions will improve audit quality by reducing interindividual variability.

Atriplex atacamensis and Atriplex halimus resist As contamination in Pre-Andean soils (northern Chile)

The Pre-Andean area of Chile exhibits saline soils of volcanic origin naturally contaminated with arsenic (As), and we hypothesise that revegetation with resistant species may be a valid alternative for soil management in this area. Thus, the xerophytic and halophytic shrubs Atriplex halimus and Atriplex atacamensis were cultivated in containers for 90 days in Pre-Andean soil, As-soil, (111±19 mg As kg(-1), pH8.4±0.1) or control soil (12.7±1.1 mg As kg(-1), pH7.8±0.1) to evaluate As accumulation and resistance using stress bioindicators (chlorophylls, malondialdehyde (MDA) and total thiols). Sequential extraction of As-soil indicated that 52.3% of As was found in the most available fraction. The As distribution was significantly different between the species: A. halimus translocated the As to leaves, whilst A. atacamensis retained the As in roots. At 30 and 90 days, A. halimus showed similar As concentrations in the leaves (approximately 5.5 mg As kg(-1)), and As increased in stems and roots (up to 4.73 and 16.3 mg As kg(-1), respectively). In A. atacamensis, As concentration was lower (2.6 in leaves; 3.2 in stems and 6.9 in roots in mg As kg(-1)). Both species exhibited a high concentration of B in leaves (362-389 mg kg(-1)). If the plants are used for animal feed, it should be considered that A. halimus accumulates higher concentration of As and B in the leaves than A. atacamensis. Neither plant growth nor stress bioindicators were negatively affected by the high levels of available As, with the exception of MDA in the leaves of A. halimus. The results indicate that these plants resist contamination by arsenic, accumulating mainly the metalloid in the roots and can be recommended to generate plant cover in As-contaminated soils in the Pre-Andean region, under saline conditions controlled, preventing the dispersion of this metalloid via wind and leaching.

The French Society of Young Radiation Oncologists: History, goals and perspective

The SFjRO was created ten years ago to promote radiation oncology teaching in France. Our society has now more than 120 members from all around the country. Each year, two national courses are organized where all members are invited.

[Toxicity of radiation therapy and antiangiogenics combination: a case report]

The combined administration of antiangiogenic agents (AA) and radiation is being evaluated. No AA has yet received Marketing Authorization in this indication. However, they are widely used in medical oncology and criteria for stopping their administration in case of irradiation have not been defined. We report the case of a 63-year-old man experiencing grade 2 skin toxicity while on radiation treatment and sorafenib (400mg twice daily) for a metastatic lesion developing between the vastus medialis muscle and the cortical of the mid-diaphysis of the right femur. Toxicity occurred at 21Gy, for a total dose of 36Gy (12 fractions of 3Gy). Cutaneous symptoms rapidly disappeared after treatment discontinuation. Radiotherapy alone was resumed after a few days and the total dose could be delivered, with good tolerance. At 2-month follow-up, the intramuscular lesion had regressed. Several other cases of patients with poor tolerance to the association of AA and radiotherapy have been reported. Further studies of the effectiveness and tolerance of the combination treatment are needed before indications for AA can be extended to other diseases.

Effects of larval exposure to sublethal concentrations of methoxyfenozide in Spodoptera frugiperda (J.E. Smith)

Methoxyfenozide is an ecdysone agonist, the most new class of insect growth regulators. Most studies of the toxicity of ecdysone agonists on lepidopteran pests have been conducted during the larval stages, and little has been published regarding its sublethal effects in the surviving individuals. In this study, the lethal and sublethal effects of methoxyfenozide on the fall armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) were assessed. For this, fifth instars of this pest were continuously fed, until pupation, with artificial diet containing 0.24 and 0.35 mg of active ingredient/kg diet, which correspond to the LC10 and LC25 values, respectively, for this insecticide. Larval mortality reached 8% and 26% in the low and high concentration groups, respectively, on the seventh day of the experiment. A progressive larval mortality of 12% for the LC10 and 60% for the LC25 was observed before pupation. Treated larvae exhibited lower pupal weights, higher pupal mortality, presence of deformed pupae, and more deformed adults than untreated larvae. The incorporation of methoxyfenozide into the diet had a significant effect on the timing of larval development. Both male and female treated larvae lived about seven days longer than the controls for both concentrations tested. Finally, S. frugiperda adults that resulted from fifth instars treated with methoxyfenozide were not affected in their sex ratio. Our results suggest that the combination of lethal and sublethal effects of methoxyfenozide may have important implications for the population dynamics of the fall armyworm.

Assessment of total mercury levels in Clarias gariepinus from the Sagua la Grande River, Cuba

Total mercury levels (Thg) were quantified in Clarias gariepinus captured from the Sagua la Grande River (Cuba) in the vicinity of an active chlor-alkali plant, and relationships among place of capture; fish size, weight, and sex; and THg levels were assessed. THg levels ranged from 67 to 375 ng/g ww in collected fish, never exceeding the Cuban recommended maximum limit for fish consumption of 500 ng/g ww. No significant correlation was observed between mercury levels and fish allometric characteristics (p < 0.05); however, levels were significantly higher in fish captured below the chlor-alkali facility, suggesting a connection between mercury bioaccumulation and plant discharges.

Endobronchial metastases from colorectal adenocarcinomas: clinical and endoscopic characteristics and patient prognosis

BACKGROUND

Endobronchial metastases (EBM) secondary to extrapulmonary solid malignant tumours are rare but may occur. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. This study aimed to evaluate the clinical and bronchoscopic aspects of EBM from colorectal carcinomas and the prognosis of the patients.

METHODS

EBM were diagnosed in 7 patients with colorectal carcinomas between 2004 and 2005. All patients underwent colorectal resection at the time of primary tumour diagnosis. Bronchial involvement was proved by bronchoscopy, and the metastatic nature of the lesions was confirmed histopathologically in all patients. EBM patients were compared with a control group of 7 patients with pulmonary metastases from colorectal cancer.

RESULTS

Median age at time of colorectal carcinoma was 55 years in EBM patients and 57 years in controls. Distressing airway symptoms caused by EBM were relieved by use of newer intrabronchial therapies: radiotherapy, brachytherapy and cryotherapy. One patient underwent metastasis resection. The median survival after diagnosis of EBM was 18.9 months. All patients had pulmonary metastases. The median survival after diagnosis of pulmonary metastasis from colorectal carcinoma was 55.7 months in EBM patients and 12.7 months in controls (p < 0.005).

DISCUSSION

EBM are generally underdiagnosed in patients with colorectal carcinoma. Bronchoscopy is not part of the standard evaluation of these patients. Physicians must be more attentive to pulmonary symptoms, even when patients' pulmonary metastases are known. Various management options are available for localized endobronchial tumours.

CONCLUSION

On average, EBM are diagnosed about 5 years after the diagnosis of the primary tumour, which is a relatively long lead time. Although this metastatic location usually implies a very negative prognosis regarding life expectancy, it did not seem to significantly reduce survival in our patients. Local treatments allow substantial improvement of pulmonary symptoms.

Intimal Thickening after Placement of a Neuroform Stent. Its Incidence and Relation to Angiographic Follow-up Results of Aneurysm Embolization

SUMMARY

Little attention has been given to the intimal thickening of the parent artery associated with the use of Neuroform stent. The purposes of this study were are to analyze quantifyanalyze the incidence of the parent artery intimal thickening the incidence and pattern of luminal changes, to to see somedetermine possible predictors of the phenomenonof the intimal thickening, to to evaluate the its effectthe phenomenonrestenosis on the aneurysm treatment results. We reviewed the initial and six-month followup angiographic images in 32 intracranial aneurysm patients treated with Neuroform stent and coilsin wide-necked aneurysm treatment. The initial embolization results were evaluated by the Raymond and Roy classification. The angiographic changes from immediate post-embolization to the six-month follow-up were classified as 'improved', 'unchanged' and 'worse'. The occurrencerates of parent artery intimal thickening was observed. Any perceivable change in the stented segment of the parent artery was considered as 'intimal thickening' and any change of >/=50% as 'significant thickening'. Fisher exact tests and logistic regression analysis were applied to determine the relation between the occurrence of the intimal thickening and several variables. The incidence of the intimal thickening was 18.8% (6/32) and of significant thickening, 3.1% (1/32). The change in angiographic occlusion of the aneurysm was 'improved' in 40.6% (13/32), 'unchanged' in 37.5% (12/32), and 'worse' in 21.9% (7/32). Among the variables, patient's age (>/=55) and follow-up angiographic results ('improved') correlated with the occurrence of the intimal thickening. Of notable finding was all six cases with intimal thickening of the parent artery were associated with 'improved' in their followup angiographic result. Neuroform-associated intimal thickening usually occurs in younger patients and is frequently associated with improved angiographic result of the aneurysm embolization on follow-up.