Robotic radiosurgery/Radiotherapy is increasingly adopted in clinics, and quality assurance (QA) of CyberKnife’s variable-aperture Iris<sup>TM</sup> collimators requires sub-millimeter precision. Conventi...Robotic radiosurgery/Radiotherapy is increasingly adopted in clinics, and quality assurance (QA) of CyberKnife’s variable-aperture Iris<sup>TM</sup> collimators requires sub-millimeter precision. Conventional film-based QA for the 12 Iris<sup>TM</sup> cone sizes (ranging from 5 to 60 mm) is both time consuming (120 minutes for all or 30 minutes for 3 cone sizes) and highly experience dependent. To improve the efficiency, a high-resolution 2D diode detector array, sampling every 2.5 mm, was evaluated for Iris<sup>TM</sup> aperture size QA. This study focused on a spatial frequency analysis, a dose profile reconstruction, and a sensitivity study to beam size variances. Dose profiles of the 12 cones scanned with a high-resolution diode in a water tank were utilized as the gold standard for comparison. Spatial Fourier transform of these profiles were analyzed to explore applicable sampling frequency. Next, the dose profiles were artificially sampled with a 2.5 mm gap, and then interpolated using a Python-based cubic B-spline. Finally, sensitivity of the diode array system to various field sizes was measured by changing source to detector distance. We found, utilizing the diodes system, QA time was reduced to less than 10 minutes. Spatial frequency of the dose profile showed little contribution beyond 0.2 mm<sup>-1</sup>, so a Nyquist sampling of 0.4 mm<sup>-1</sup> is appropriate for dose verification, corresponding to a 2.5 mm gap. Dose profiles were reconstructed using Cubic B-spline with good agreements to nominal for cones 7.5 mm and larger. The measured Iris<sup>TM</sup> size using the SRS MapCheck had a standard error of ±0.12 mm. Primarily, the 2D Diode array with a spatial resolution 0.4 mm<sup>-1</sup> is appropriate for dose verification for these cones above 7.5 mm, and its application would substantially improve Iris<sup>TM</sup> QA efficiency.展开更多
BACKGROUND Esophagectomy is a pivotal curative modality for localized esophageal or esophagogastric junction cancer(EC or EJC).Postoperative anastomotic leakage(AL)remains problematic.The use of fibrin sealant(FS)may ...BACKGROUND Esophagectomy is a pivotal curative modality for localized esophageal or esophagogastric junction cancer(EC or EJC).Postoperative anastomotic leakage(AL)remains problematic.The use of fibrin sealant(FS)may improve the strength of esophageal anastomosis and reduce the incidence of AL.AIM To assess the efficacy and safety of applying FS to prevent AL in patients with EC or EJC.METHODS In this single-arm,phase II trial(Clinicaltrial.gov identifier:NCT03529266),we recruited patients aged 18-80 years with resectable EC or EJC clinically staged as T1-4aN0-3M0.An open or minimally invasive McKeown esophagectomy was performed with a circular stapled anastomosis.After performing the anastomosis,2.5 mL of porcine FS was applied circumferentially.The primary endpoint was the proportion of patients with AL within 3 mo.RESULTS From June 4,2018,to December 29,2018,57 patients were enrolled.At the data cutoff date(June 30,2019),three(5.3%)of the 57 patients had developed AL,including two(3.5%)with esophagogastric AL and one(1.8%)with gastric fistula.The incidence of anastomotic stricture and other major postoperative complications was 1.8%and 17.5%,respectively.The median time needed to resume oral feeding after operation was 8 d(Interquartile range:7.0-9.0 d).No adverse events related to FS were recorded.No deaths occurred within 90 d after surgery.CONCLUSION Perioperative sealing with porcine FS appears safe and may prevent AL after esophagectomy in patients with resectable EC or EJC.Further phase III studies are warranted.展开更多
ARASENS is an international phase III trial demonstrating the beneficial role of darolutamide,a novel antiandrogen,when added to docetaxel and androgen deprivation therapy(ADT),with improvement in overall survival in ...ARASENS is an international phase III trial demonstrating the beneficial role of darolutamide,a novel antiandrogen,when added to docetaxel and androgen deprivation therapy(ADT),with improvement in overall survival in men with metastatic castration-sensitive or hormone-sensitive prostate cancer.Darolutamide is a nonsteroidal androgen receptor antagonist that has been previously shown to improve metastasis-free survival in nonmetastatic castration-resistant prostate cancer.ARASENS showed that the risk of death was 32.5%lower in those who received additional darolutamide compared to ADT and docetaxel alone.Darolutamide also improved other secondary endpoints including time to castrate-resistant disease,time to pain progression,time to first skeletal-related event,and subsequent initiation of therapy.ARASENS,therefore,shows that darolutamide,in addition to ADT and docetaxel,as a form of upfront systemic intensification of“triplet”therapy for patients deemed chemotherapy-fit,represents a new standard of care for men with metastatic hormone-sensitive or castrate-sensitive prostate cancer and is anticipated to further change the landscape of treatment for this population of patients.展开更多
Signaling through the vitamin D receptor has been shown to be biologically active and important in a number of preclinical studies in prostate and other cancers. Epidemiologic data also indicate that vitamin D signali...Signaling through the vitamin D receptor has been shown to be biologically active and important in a number of preclinical studies in prostate and other cancers. Epidemiologic data also indicate that vitamin D signaling may be important in the cause and prognosis of prostate and other cancers. These data indicate that perturbation of vitamin D signaling may be a target for the prevention and treatment of prostate cancer. Large studies of vitamin D supplementation will be required to determine whether these observations can be translated into prevention strategies. This paper reviews the available data in the use of vitamin D compounds in the treatment of prostate cancer. Clinical data are limited which support the use of vitamin D compounds in the management of men with prostate cancer. However, clinical trials guided by existing preclinical data are limited.展开更多
Chemotherapy in prostate cancer （PCa） has undergone dramatic landscape changes. While earlier studies utilized varying chemotherapy regimens which were found to be largely palliative in nature and hardly resulted in...Chemotherapy in prostate cancer （PCa） has undergone dramatic landscape changes. While earlier studies utilized varying chemotherapy regimens which were found to be largely palliative in nature and hardly resulted in durable or meaningful responses, docetaxel resulted in the first chemotherapy agent that showed improvement in overall survival in metastatic castration-resistant prostate cancer （mCRPC）. However, combination chemotherapy or any agents added to docetaxel have failed to yield incremental benefits. The improvement in overall survival as well as secondary endpoints of prostate-specific antigen （PSA） and time to recurrence when using docetaxel in the metastatic hormone-sensitive state has changed the standard of care for treatment of newly diagnosed de novo metastatic PCa. There are also promising results in locally advanced PCa and high-risk PCa in both the neoadjuvant and adjuvant settings. This review summarizes the historical as well as the more contemporary use of chemotherapeutic agents in PCa in varying states and phases of disease.展开更多
PROSPER is an international Phase III trial demonstrating the beneficial role of enzalutamide,an androgen receptor antagonist,in prolonging metastasisfree survival in men with nonmetastatic castration-resistant prosta...PROSPER is an international Phase III trial demonstrating the beneficial role of enzalutamide,an androgen receptor antagonist,in prolonging metastasisfree survival in men with nonmetastatic castration-resistant prostate cancer.The trial showed that the median metastasis-free survival was 21.9 months longer for those treated with enzalutamide(36.6 months)compared to those treated with placebo(14.7 months).Enzalutamide also showed prolonged time to PSA progression,PSA response,and time to initiating additional antineoplastic therapy although overall survival is not yet reached.Enzalutamide is the second antiandrogen(next to apalutamide)that has gained the United States Food and Drug Administration(US FDA)label indication for use in the setting of nonmetastatic castration-resistant prostate cancer.展开更多
ARAMIS is an international PhaseⅢtrial demonstrating the beneficial role of darolutamide,a novel anti-androgen that has been found to prolong metastasis-free survival in men with nonmetastatic castration-resistant pr...ARAMIS is an international PhaseⅢtrial demonstrating the beneficial role of darolutamide,a novel anti-androgen that has been found to prolong metastasis-free survival in men with nonmetastatic castration-resistant prostate cancer.展开更多
The proPSMA trial is a Phase III multicentric trial that examined the role of gallium-68-prostate-specific membrane an tigen(PSMA)-p o sitro n em issio n tomography/computed tomography(PET/CT)scan versus conventional ...The proPSMA trial is a Phase III multicentric trial that examined the role of gallium-68-prostate-specific membrane an tigen(PSMA)-p o sitro n em issio n tomography/computed tomography(PET/CT)scan versus conventional CT and bone scan to determine the presence of distant disease prior to curative-intent treatment with surgery or radiation for men with highrisk prostate cancer.The findings showed the superiority of PSMA PET/CT scan with 27%better accuracy and sensitivity at 92%versus conventional CT and bone scans.展开更多
The last decade has seen remarkable advances in the treatment of prostatecancer. Until 2010, only docetaxel had demonstrated the ability to improve the survival in metastatic castration-resistant prostate cancer （mC...The last decade has seen remarkable advances in the treatment of prostatecancer. Until 2010, only docetaxel had demonstrated the ability to improve the survival in metastatic castration-resistant prostate cancer （mCRPC）.展开更多
文摘Robotic radiosurgery/Radiotherapy is increasingly adopted in clinics, and quality assurance (QA) of CyberKnife’s variable-aperture Iris<sup>TM</sup> collimators requires sub-millimeter precision. Conventional film-based QA for the 12 Iris<sup>TM</sup> cone sizes (ranging from 5 to 60 mm) is both time consuming (120 minutes for all or 30 minutes for 3 cone sizes) and highly experience dependent. To improve the efficiency, a high-resolution 2D diode detector array, sampling every 2.5 mm, was evaluated for Iris<sup>TM</sup> aperture size QA. This study focused on a spatial frequency analysis, a dose profile reconstruction, and a sensitivity study to beam size variances. Dose profiles of the 12 cones scanned with a high-resolution diode in a water tank were utilized as the gold standard for comparison. Spatial Fourier transform of these profiles were analyzed to explore applicable sampling frequency. Next, the dose profiles were artificially sampled with a 2.5 mm gap, and then interpolated using a Python-based cubic B-spline. Finally, sensitivity of the diode array system to various field sizes was measured by changing source to detector distance. We found, utilizing the diodes system, QA time was reduced to less than 10 minutes. Spatial frequency of the dose profile showed little contribution beyond 0.2 mm<sup>-1</sup>, so a Nyquist sampling of 0.4 mm<sup>-1</sup> is appropriate for dose verification, corresponding to a 2.5 mm gap. Dose profiles were reconstructed using Cubic B-spline with good agreements to nominal for cones 7.5 mm and larger. The measured Iris<sup>TM</sup> size using the SRS MapCheck had a standard error of ±0.12 mm. Primarily, the 2D Diode array with a spatial resolution 0.4 mm<sup>-1</sup> is appropriate for dose verification for these cones above 7.5 mm, and its application would substantially improve Iris<sup>TM</sup> QA efficiency.
基金Supported by Fundamental Research Funds for the Central Universities,No.17ykzd30National Natural Science Foundation of China,No.81972614+1 种基金Guangdong Esophageal Cancer Institute Science and Technology Program,No.M201601Health&Medical Collaborative Innovation Project of Guangzhou City,China,No.201803040018.
文摘BACKGROUND Esophagectomy is a pivotal curative modality for localized esophageal or esophagogastric junction cancer(EC or EJC).Postoperative anastomotic leakage(AL)remains problematic.The use of fibrin sealant(FS)may improve the strength of esophageal anastomosis and reduce the incidence of AL.AIM To assess the efficacy and safety of applying FS to prevent AL in patients with EC or EJC.METHODS In this single-arm,phase II trial(Clinicaltrial.gov identifier:NCT03529266),we recruited patients aged 18-80 years with resectable EC or EJC clinically staged as T1-4aN0-3M0.An open or minimally invasive McKeown esophagectomy was performed with a circular stapled anastomosis.After performing the anastomosis,2.5 mL of porcine FS was applied circumferentially.The primary endpoint was the proportion of patients with AL within 3 mo.RESULTS From June 4,2018,to December 29,2018,57 patients were enrolled.At the data cutoff date(June 30,2019),three(5.3%)of the 57 patients had developed AL,including two(3.5%)with esophagogastric AL and one(1.8%)with gastric fistula.The incidence of anastomotic stricture and other major postoperative complications was 1.8%and 17.5%,respectively.The median time needed to resume oral feeding after operation was 8 d(Interquartile range:7.0-9.0 d).No adverse events related to FS were recorded.No deaths occurred within 90 d after surgery.CONCLUSION Perioperative sealing with porcine FS appears safe and may prevent AL after esophagectomy in patients with resectable EC or EJC.Further phase III studies are warranted.
文摘ARASENS is an international phase III trial demonstrating the beneficial role of darolutamide,a novel antiandrogen,when added to docetaxel and androgen deprivation therapy(ADT),with improvement in overall survival in men with metastatic castration-sensitive or hormone-sensitive prostate cancer.Darolutamide is a nonsteroidal androgen receptor antagonist that has been previously shown to improve metastasis-free survival in nonmetastatic castration-resistant prostate cancer.ARASENS showed that the risk of death was 32.5%lower in those who received additional darolutamide compared to ADT and docetaxel alone.Darolutamide also improved other secondary endpoints including time to castrate-resistant disease,time to pain progression,time to first skeletal-related event,and subsequent initiation of therapy.ARASENS,therefore,shows that darolutamide,in addition to ADT and docetaxel,as a form of upfront systemic intensification of“triplet”therapy for patients deemed chemotherapy-fit,represents a new standard of care for men with metastatic hormone-sensitive or castrate-sensitive prostate cancer and is anticipated to further change the landscape of treatment for this population of patients.
文摘Signaling through the vitamin D receptor has been shown to be biologically active and important in a number of preclinical studies in prostate and other cancers. Epidemiologic data also indicate that vitamin D signaling may be important in the cause and prognosis of prostate and other cancers. These data indicate that perturbation of vitamin D signaling may be a target for the prevention and treatment of prostate cancer. Large studies of vitamin D supplementation will be required to determine whether these observations can be translated into prevention strategies. This paper reviews the available data in the use of vitamin D compounds in the treatment of prostate cancer. Clinical data are limited which support the use of vitamin D compounds in the management of men with prostate cancer. However, clinical trials guided by existing preclinical data are limited.
文摘Chemotherapy in prostate cancer （PCa） has undergone dramatic landscape changes. While earlier studies utilized varying chemotherapy regimens which were found to be largely palliative in nature and hardly resulted in durable or meaningful responses, docetaxel resulted in the first chemotherapy agent that showed improvement in overall survival in metastatic castration-resistant prostate cancer （mCRPC）. However, combination chemotherapy or any agents added to docetaxel have failed to yield incremental benefits. The improvement in overall survival as well as secondary endpoints of prostate-specific antigen （PSA） and time to recurrence when using docetaxel in the metastatic hormone-sensitive state has changed the standard of care for treatment of newly diagnosed de novo metastatic PCa. There are also promising results in locally advanced PCa and high-risk PCa in both the neoadjuvant and adjuvant settings. This review summarizes the historical as well as the more contemporary use of chemotherapeutic agents in PCa in varying states and phases of disease.
文摘PROSPER is an international Phase III trial demonstrating the beneficial role of enzalutamide,an androgen receptor antagonist,in prolonging metastasisfree survival in men with nonmetastatic castration-resistant prostate cancer.The trial showed that the median metastasis-free survival was 21.9 months longer for those treated with enzalutamide(36.6 months)compared to those treated with placebo(14.7 months).Enzalutamide also showed prolonged time to PSA progression,PSA response,and time to initiating additional antineoplastic therapy although overall survival is not yet reached.Enzalutamide is the second antiandrogen(next to apalutamide)that has gained the United States Food and Drug Administration(US FDA)label indication for use in the setting of nonmetastatic castration-resistant prostate cancer.
文摘ARAMIS is an international PhaseⅢtrial demonstrating the beneficial role of darolutamide,a novel anti-androgen that has been found to prolong metastasis-free survival in men with nonmetastatic castration-resistant prostate cancer.
文摘The proPSMA trial is a Phase III multicentric trial that examined the role of gallium-68-prostate-specific membrane an tigen(PSMA)-p o sitro n em issio n tomography/computed tomography(PET/CT)scan versus conventional CT and bone scan to determine the presence of distant disease prior to curative-intent treatment with surgery or radiation for men with highrisk prostate cancer.The findings showed the superiority of PSMA PET/CT scan with 27%better accuracy and sensitivity at 92%versus conventional CT and bone scans.
文摘The last decade has seen remarkable advances in the treatment of prostatecancer. Until 2010, only docetaxel had demonstrated the ability to improve the survival in metastatic castration-resistant prostate cancer （mCRPC）.
