Prostatectomy Bed Image-guided Dose-escalated Salvage Radiotherapy (SPIDER): An International Multicenter Retrospective Study

BACKGROUND

Management of macroscopic local recurrence (MLR) after radical prostatectomy is a challenging situation with no standardized approach.

OBJECTIVE

The objective of our study was to assess the efficacy and safety of functional image-guided salvage radiotherapy (SRT) in patients with MLR in the prostate bed.

DESIGN, SETTING, AND PARTICIPANTS

In this international multicenter retrospective study across 16 European centers, eligible patients were initially treated by radical prostatectomy (RP) with or without pelvic lymph node dissection for localized or locally advanced adenocarcinoma of the prostate.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Prostate-specific antigen (PSA) measured 4 wk after RP was <0.1 ng/ml. All patients presented a biochemical relapse after RP defined by an increase in PSA level of ≥0.2 ng/ml on two successive measures. Only patients with an MLR lesion in the prostatectomy bed visualized on functional imaging (multiparametric magnetic resonance imaging, positron emission tomography/computed tomography [PET/CT] choline, or PET/CT prostate-specific membrane antigen) were eligible. Patients with lymph node, bone, or visceral dissemination at restaging imaging (CT and/or bone scintigraphy and/or magnetic resonance imaging and/or PET) were excluded. Dose escalation was defined as a dose of >66 Gy prescribed to the prostate bed or to MLR. Toxicities were classified using the Common Terminology Criteria for Adverse Events scale, version 4.03. The primary endpoint was progression-free survival (PFS). Secondary outcomes were metastasis-free survival (MPFS), biochemical progression-free survival, and overall survival. Genitourinary (GU) and gastrointestinal (GI) toxicities were analyzed.

RESULTS AND LIMITATIONS

Between January 2000 and December 2019, 310 patients received at least one dose escalation on MLR and 25 patients did not receive any dose escalation. The median PSA level before SRT was 0.63 ng/ml (interquartile range [IQR], 0.27-1.7). The median follow-up was 54 mo (IQR, 50-56). Five-year PFS and MPFS were 70% (95% confidence interval [CI]: [64; 75]) and 84% (95% CI: [78; 88]), respectively. Grade ≥2 GU and GI late toxicities were observed in 43 (12%) and 11 (3%) patients, respectively. When the prescribed dose on the MLR lesion was ≥72 Gy, an improvement in 5-yr PFS was found for patients received at least one dose escalation (73% [95% CI: 65-79]) vs 60% [95% CI: 48; 70]; p = 0.03).

CONCLUSIONS

In this contemporary study integrating functional imaging data, we found potential efficacy of SRT with dose escalation ≥72 Gy for patients with MLR in the prostate bed and with an acceptable toxicity profile. Prospective data exploring this MLR dose escalation strategy are awaited.

PATIENT SUMMARY

In this report, we looked at the outcomes from salvage radiotherapy for prostate cancer and macroscopic relapse in a large European population. We found that outcomes varied with prostate-specific antigen at relapse, Gleason score, and dose escalation. We found potential efficacy of salvage radiotherapy with dose escalation for macroscopic relapse in the prostate bed, with an acceptable toxicity profile.

Abstract 3478: Feasibility of single-cell transcriptomic profiling of pleural effusions from advanced-stage cancer patients

The pleura is a frequent metastatic site during the evolution of cancers, which can lead to a symptomatic accumulation of pleural fluid that contains tumor and immune cells. To improve patients’ comfort this fluid is removed via chest draining, and the recovered liquid is generally considered as biological waste. Here, we aim to develop an optimized protocol for single-cell sequencing of floating cells in pleural effusion from advanced-stage cancer patients. To date, pleural effusion samples have been obtained from treatment-naïve, advanced-stage cancer patients (lung n= 8, breast n= 3; ovary n=4, others n=4). After red blood cell lysis, 768 cells/sample were isolated using the image-based cellenONE technology. Single-cell RNA sequencing was performed using SORT-seq. Bioinformatic analysis was done using an in-house pipeline on cells passing these filters: &gt;200 detected genes per cell, &gt;500 UMIs per cell, &lt;25% of UMIs mapping on mitochondrial genes and &lt;20% of spike-in reads. Pleural samples exhibited very heterogeneous data quality, which was reflected in a marked difference in the quality control (Qc) metrics between the samples but was not influenced by tumor type. After Qc filtering, the median number of analyzable cells/sample (mNAC) was 153 [5 - 460], for which the median number of expressed genes/cell per sample (mNEG) was 2,431 [1,022 - 4,026]. The time elapsed between patient sample collection and the initiation of single-cell sorting likely impacted data quality (&gt;3h: mNAC: 99; mNEG: 1,553) compared to samples processed more rapidly (&lt;3h: mNAC: 169; mNEG: 2,492), although not reaching statistical significance. A higher isolation frequency and recovery rate during single-cell sorting resulted in the capture of higher quality cells. The duration of single-cell isolation varied between 11’ and 100’ (median: 21’) and was dependent on the initial cell concentration. No significant differences were observed in terms of cell diameter or elongation with regards to cancer type. However, cell diameter was correlated with mNAC. For cell type inference, we used SingleR with the Human Pan-Cancer Atlas database as reference. Epithelial cells were the most predominant cell type in these samples, followed by subpopulations of monocytes and macrophages. A combination of the “mean variance” and “rank based” methods was used to obtain the list of the most variable genes, to define expression clusters and discern samples by cancer type. Calculation of the enrichment of transcriptomic signatures and therapy response signatures (i.e., IFN-gamma) was used to apprehend the potential biological differences between samples and cell subpopulations. Results will be presented at the conference. This protocol is currently applicable to analyze floating cells from pleural effusions and is expected to provide a complementary source for the molecular profiling of advanced-stage cancers.

Citation Format: Sandra Ortiz-Cuaran, Lucas Michon, Marion Godefroy, Joyce Levy, Osman Osman, Maxime Boussageon, Aurélie Swalduz, Maurice Pérol, Bruno Russias, François Monjaret, Pierre Saintigny. Feasibility of single-cell transcriptomic profiling of pleural effusions from advanced-stage cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3478.

Automated computer-aided diagnosis of splenic lesions due to abdominal trauma

BACKGROUND

Computer-aided detection in the setting of trauma presents unique challenges due to variations in shape and attenuation of the injured organs based on the timing and severity of the injury.  We developed and validated an automated computer-aided diagnosis algorithm to detect splenic lesions such as laceration, contusion, subcapsular hematoma, perisplenic hematoma, and active extravasation using computed tomography (CT) images in patients sustaining blunt or penetrating abdominal trauma.

METHODS

We categorized the splenic pathologies into three groups: contusion/laceration, hematoma, and active extravasation. We first analyzed the spleen and perisplenic region by estimating the mean value and standard deviation of the spleen. We determined adaptive threshold values based on the histogram of the area and detected the lesions after morphological operations and volumetric comparisons.

RESULTS

The overall performance of the three computer-aided diagnosis (CAD) algorithms is an accuracy of 0.80, sensitivity of 0.95, specificity of 0.67, and a diagnostic odds ratio (DOR) of 40 with a 95 % confidence interval (CI): 14 to 117. The CAD of perisplenic hematoma had the highest diagnosis rates with an accuracy of 0.90, a sensitivity of 0.95,  specificity of 0.80, and DOR of 76 with a 95 % CI:  13 to 442.

CONCLUSIONS

We developed a new algorithm to detect post-traumatic splenic lesions automatically and with high accuracy. Our method could potentially lead to the automated diagnosis of all traumatic abdominal pathologies. HIPPOKRATIA 2018, 22(2): 80-85.

Fracture risk in long term care: a systematic review and meta-analysis of prospective observational studies

BACKGROUND

The risk factors associated with fractures have been well-characterized in community dwelling populations, but have not been clearly defined in long-term care (LTC) settings. The objective of this review was to identify risk factors for fractures in LTC settings.

METHODS

We searched MEDLINE, the Cochrane Library, EMBASE and CINAHL up to June 2014, scanned reference lists of articles and consulted with experts in the field to identify relevant prospective cohort studies that evaluated risk factors associated with fracture incidence in LTC. We included studies that assessed the association between risk factors included in the WHO-Fracture Risk Assessment Tool (FRAX®) or other predictors relevant to LTC (psychotropic medications, cognitive impairment, mobility, and falls). All articles were screened and extracted by two authors. Available data on the association between a given risk factor and fracture incidence were pooled when possible. We used the GRADE criteria to provide a summary of evidence. The GRADE approach defines the quality of a body of evidence as the extent to which one can be confident that an estimate of effect or association is close to the quantity of specific interest.

RESULTS

We identified 13 prospective cohort studies which examined fracture incidence among LTC residents. Most predictors showed moderate increases in fracture risk, but the quality of the evidence was often low. Moderate quality evidence showed that prior fractures and falls may moderately increase the risk of fractures. Being a woman and cognitive impairment are probably associated with a small increase. The effect of mobility and psychotropic medication use is still uncertain primarily due to the various definitions used in the studies and difficulty summarising the results.

CONCLUSIONS

In addition to criteria used in the FRAX assessment tool, such as a previous fracture and female gender, we found that falls and cognitive impairment are also associated with a small to moderate increases in the risk of fractures in LTC. Developing an assessment tool that includes risk factors that are specific to LTC may improve the identification of individuals who can benefit from fracture prevention programs in these settings.

Midwakh/dokha tobacco use in the Middle East: much to learn

Many alternative tobacco products (ATPs), such as hookahs, have grown in popularity and use beyond their locale of origin and are therefore becoming a significant global public health concern. This article provides an overview of an under-reported and understudied ATP, dokha, which is smoked in a midwakh pipe. It describes the state of tobacco control in the Arabian Gulf region where midwakh smoking appears to be most common, the history of midwakh and dokha use, and what is known about midwakh smoking from the published literature. On the basis of the stark lack of data on midwakh use, we suggest priority areas to focus future research. Preliminary data and observations from health providers and the public health sector suggest that midwakh smoking may pose challenges to the tobacco control efforts in the Arabian Gulf region. If it is emerging as a new ATP outside this region, there could be a significant impact on tobacco control strategies globally.

Microfluidic immunomagnetic cell separation using integrated permanent micromagnets

In this paper, we demonstrate the possibility to trap and sort labeled cells under flow conditions using a microfluidic device with an integrated flat micro-patterned hard magnetic film. The proposed technique is illustrated using a cell suspension containing a mixture of Jurkat cells and HEK (Human Embryonic Kidney) 293 cells. Prior to sorting experiments, the Jurkat cells were specifically labeled with immunomagnetic nanoparticles, while the HEK 293 cells were unlabeled. Droplet-based experiments demonstrated that the Jurkat cells were attracted to regions of maximum stray field flux density while the HEK 293 cells settled in random positions. When the mixture was passed through a polydimethylsiloxane (PDMS) microfluidic channel containing integrated micromagnets, the labeled Jurkat cells were selectively trapped under fluid flow, while the HEK cells were eluted towards the device outlet. Increasing the flow rate produced a second eluate much enriched in Jurkat cells, as revealed by flow cytometry. The separation efficiency of this biocompatible, compact micro-fluidic separation chamber was compared with that obtained using two commercial magnetic cell separation kits.

Prenatal diagnosis for thalassaemia in Egypt: what changed parents' attitude?

OBJECTIVES

To present the current status of the prenatal diagnosis services and results from the largest thalassaemia center in Egypt treating 3000 patients. Traditionally, prenatal diagnosis has not been successful in reducing the births of affected children in Egypt, because the majority of women undergoing prenatal diagnosis continued to have affected pregnancies.

METHODS

Seventy-one pregnant mothers at risk for β-thalassaemia underwent prenatal diagnosis by chorionic villus sampling (n=57) or amniocentesis (n=14) between 11 to 14 weeks of gestation. Molecular characterization of fetal DNA by reverse dot blot hybridization and polymerase chain reaction-amplification refractory mutation system techniques was conducted in all cases.

RESULTS

Twenty-four women (33.8%) were found to have affected fetuses; 100% of these women opted to terminate the pregnancy. The change in attitude towards termination of pregnancy was related to in-depth counseling of the religious aspects towards prenatal diagnosis and termination of pregnancy. Forty-eight women (66.2%) with normal or carrier fetuses for β-thal requested human leukocyte antigen typing of the fetal material to determine if the fetus was a human leukocyte antigen match for their existing thalassaemic siblings.

CONCLUSION

This study demonstrates that prenatal diagnosis is feasible and acceptable in Egypt, a Muslim country, provided an in-depth discussion, which also addresses the religious considerations of prevention, is held with the couples.

Management of febrile children in a paediatric emergency department

OBJECTIVES

To study the determinants and appropriateness of hospitalisation of febrile children in a paediatric emergency department.

DESIGN

An observational prospective study.

SETTING AND SUBJECTS

Patients presenting to the emergency department of the Edinburgh Royal Hospital for Sick Children over nine consecutive weeks.

METHODS

Clinical and laboratory data were collected from patients presenting with an infectious illness. A three point scale was used to assess both the degree of severity of illness and the probability of bacteraemic illness. Patients who received the following therapies in hospital were identified: intravenous antibiotics, intravenous fluids, oxygen therapy, upper airway suctioning or nasogastric feeding. The clinical and laboratory characteristics of patients admitted to the hospital were studied.

RESULTS

A third of the five thousand and twenty one patients seen presented with an infectious illness. Of these, 42% were febrile, while 22% had a high temperature (> 38.5 degrees C). Forty one per cent were hospitalised and of these only 44% received one or more of the treatments mentioned above. Only the illness-severity--score predicted the requirement for such treatment. This clinical scoring was also a powerful predictor of bacterial infection. The positive predictive value of a high temperature (> 38.5 degrees C) in predicting bacterial infection was 40%. The negative and positive predictive values for neutrophilia (> 10 x 10(9)/1) were 47% and 77% respectively. Forty three per cent of the admitted patients were investigated with blood culture and 2.5% of blood cultures were positive for a pathogenic organism. There were no Hib isolates. The positive and negative predictive values of a high temperature for bacteraemic illness were 5% and 99% respectively.

CONCLUSION

A large proportion of paediatric patients is perhaps unnecessarily hospitalised. Inappropriate hospitalisation may be prevented by the development and implementation of guidelines based on objective criteria. Enhancement of the role of ambulatory paediatrics in the care of febrile children may be more cost-effective than anticipatory hospitalisation.

Conformation and interactions of the packaged double-stranded DNA genome of bacteriophage T7

The structure of the packaged double-stranded DNA genome of bacteriophage T7 was compared to that of unpackaged T7 DNA using digital difference Raman spectroscopy. Spectral data were obtained at 25 degrees C from native T7 virus (100 mg/mL), empty T7 capsids (50 mg/mL), and purified T7 DNA (40 mg/mL) in buffer containing 200 mM NaCl, 10 mM MgCl2, and 10 mM Tris at pH 7.5. At these conditions, the local conformation of T7 DNA was not affected by packaging. Specifically, the local B-form secondary structure of unpackaged T7 DNA, including furanose C2'-endo pucker, anti glycosyl torsion, Watson-Crick base pairing, and base stacking, were essentially fully (> 98%) retained when the genome was condensed within the viral capsid. However, the average electrostatic environment of T7 DNA phosphates was altered dramatically by packaging as revealed by large perturbations in the Raman bands associated with localized vibrations of the DNA phosphate groups. The change in the phosphate environment was attributed to Mg2+ ions that were packaged with the genomic DNA, and the observed Raman perturbations of genomic DNA were equivalent to those generated by a 50-100-fold increase in Mg2+ concentration in aqueous phosphodiester model compounds. The T7 data were qualitatively and quantitatively similar to those observed previously for packaged DNA of bacteriophage P22 and imply that genomic DNAs of T7 and P22 are both organized in a similar fashion within their respective capsids. The results show that the condensed genome does not contain kinks or folds that would disrupt the local B conformation by more than 2%. The present findings are discussed in relation to previously proposed models for condensation and organization of double-stranded and single-stranded viral DNA.

Oxygen free radical in human osteoarthritis

The xanthine oxidase catalysed release of superoxide free radicals (O2-) from endogenous hypoxanthine was determined in homogenates of synovium obtained from three groups of patients, those undergoing primary or revision total hip replacement (THR) for osteoarthritis and those undergoing arthroscopy of the knee for semilunar disc injuries. The concentrations of hypoxanthine in homogenates obtained during THR were found to be significantly higher than those in the group with semilunar disc injuries. The results suggest that there is a greater predisposition to free radical release and tissue damage in osteoarthritis.