Prostate cancer oligometastatic disease can be treated using stereotactic body radiotherapy (SBRT) in order to postpone start of systemic treatments such as androgen deprivation therapy (ADT). 68Ga-PSMA-PET/CT imaging allows for diagnosis of oligometastases at lower PSA values. We analysed a cohort of patients with prostate cancer lymph node oligometastases detected on PSMA-PET/CT.Ninety patients with metachronous oligometastatic prostate cancer received SBRT for 1-3 lymph node metastases diagnosed on 68Ga-PSMA-PET/CT. The primary end point was progression free survival (PFS), with disease progression defined as occurrence of either target lesion progression, new metastatic lesion or biochemical progression. Secondary outcomes were biochemical PFS (BPFS), ADT-free survival (ADT-FS), toxicity and quality of life (QoL). Baseline patient characteristics were tested for association with PFS and a preliminary risk score was created.Median follow-up was 21 months (interquartile range 10-31 months). Median PFS and BPFS were 16 and 21 months, respectively. Median ADT-FS was not reached (73% (95%-CI 62-86%) at 24 months). In multivariable analysis, younger age, higher PSA prior to SBRT and extrapelvic location were associated with shorter PFS. Grade 1 fatigue was the most predominant acute toxicity (34%). Highest grade toxicity was grade 2 for acute and late events. QoL analysis showed mild, transient increase in fatigue at 1-4 weeks after SBRT.A median PFS of 16 months was attained after SBRT for patients with PSMA-PET positive oligometastatic lymph nodes from prostate cancer. Higher pre-SBRT PSA, younger age and extrapelvic location were found to be predictors of shorter PFS.
S201 ESTRO 38robust model (fig.(d)) was large for 2 of the 5 patients (2,5), hence the benefit of robust optimization could be large.For patient 2, plans that appeared good when optimized in the original model, often violated the clinical protocol when considering different settings.This was not the case for robustly optimized plans. ConclusionDifferent settings for organ reconstruction can have a nonnegligible impact on automatically optimized plans.Robust optimization generated plans of high quality, irrespective of organ reconstructions, and therefore offers a solution to accounting for dosimetric uncertainties.
Global atmospheric concentrations of CO2, CH4 and N2O have increased markedly as a result of human activities since 1750 (30%, 150% and 17% respectively). The global increases in carbon dioxide concentration are primarily due to fossil fuel and land-use change, while those of methane and nitrous oxide are primarily due to agriculture (IPCC, 2007). Our research is part of the BSIK ME1 project that has its main focus on fen meadow ecosystems in the western part of the Netherlands. Since the 19th century these areas have been a strong net source of carbon dioxide as a result of increased peat oxidation caused by drainage. To understand the effect of natural changes and management on the green house gas emission and uptake in the areas an integral assessment of the greenhouse gases balance in these areas is required. Three experimental sites have been selected for this purpose: a restored nature reserve with relatively high ground water level and no agricultural activities (Horstermeer) a site under extensive agricultural exploitation where the ground water level will be raised in the coming years (Stein) and a site under intensive agricultural exploitation with low a ground water level (Oukoop). However, there are significant uncertainties in the estimated CH4 and N2O fluxes, mainly due to a combination of complexity of the source (i.e. spatial and temporal variation) and instrument limitations. High-frequency micrometeorological methods are an option to obtain integrated emission estimates on a hectare scale that also has continuous coverage in time. In this study, a quantum cascade laser spectrometer (Aerodyne Research Inc.) is used for eddy covariance measurements of CH4 and N2O. The system has been running continuously in Oukoop since August 2006. An automatic liquid nitrogen filling system is employed for unattended operation of the system. A sampling frequency of 10 Hz is obtained using a 1.0 GHz PC system. A precision of 2.6 and 0.3 ppb Hz-1/2 is obtained for CH4 and N2O, respectively. However, it proved to be important to calibrate the equipment frequently using a low and a high standard. Drift in the system is removed using a 120 s running mean filter. Average fluxes and standard deviations in these averages of 461 ± 485 ngC m-2s-1 (2.21 ± 2.33 mg m-2hr-1) and 38 ± 64 ngN m-2s-1 (0.22 ± 0.36 mg m-2hr-1) were observed over the period August 17th to November 6th 2006. About 40% of this total N2O emission was due to a fertilizing event. Besides these observed emissions, uptake of CH4 and N2O occurred in short events lasting at most a few hours.
To describe experience with partial nephrectomy combined with brachytherapy as part of the local management of bilateral Wilms tumor (WT) including a review of the available literature.Between 2011 and 2014, three highly selected patients (age nine months, 16 months, and 4 years) with bilateral WT (two synchronous and one metachronous) underwent enucleation and perioperative brachytherapy to the tumor bed. With a minimum follow-up of 5 years, all three patients are in continuous complete remission with preserved kidney function.Although nephron sparing surgery aiming at tumor free-margins remains the gold standard for bilateral WT, tumor enucleation followed by brachytherapy may be considered in carefully selected patients at high risk for end-stage kidney failure. Given the rarity and complexity of the procedure, concentration of care of such patients is mandatory.
Brachytherapy is treatment of choice for early stage nasal vestibule cancer. Over the years improvements were achieved by means of image guided target definition, interstitial implant techniques and also individual mold techniques. The aim of this study was to improve the technique of the implant so that the need for interstitial catheters can be limited by making use of patient individualized 3D-printed applicators.
