Stereotactic ablative body radiotherapy with a central high dose using CyberKnife for metastatic lung tumors.

BACKGROUND: The CyberKnife system features a robotically-positioned linear accelerator to deliver real-time image-guided stereotactic ablative body radiotherapy (SABR). It achieves steep dose gradients using irradiation from hundreds of different directions and increases the central dose of the gross tumor volume (GTV) without increasing the marginal dose to the planning target volume. We evaluated the effectiveness and safety of SABR with a central high dose using CyberKnife for metastatic lung tumors. METHODS: A total of 73 patients with 112 metastatic lung tumors treated with CyberKnife were retrospectively analyzed. Local control, progression-free survival, and overall survival were calculated using the Kaplan-Meier method. The median age was 69.2 years. The most common primary sites were the uterus (n = 34), colorectum (n = 24), head and neck (n = 17), and esophagus (n = 16). For peripheral lung tumors, the median radiation dose was 52 Gy in 4 fractions, whereas for centrally located lung tumors, it was 60 Gy in 8-10 fractions. The dose prescription was defined as 99% of the solid tumor components of the GTV. The median maximum dose within the GTV was 61.0 Gy. The GTV and planning target volume were enclosed conformally by the 80% and 70% isodose lines of the maximum dose, respectively. The median follow-up period was extended to 24.7 months; it was 33.0 months for survivors. RESULTS: The 2-year local control, progression-free survival, and overall survival rates were 89.1%, 37.1%, and 71.3%, respectively. Toxicities of grade ≥ 2 were noted as grade 2 and 3 radiation pneumonitis in one patient each. The two patients with grade 2 or higher radiation pneumonitis had both received simultaneous irradiation at two or three metastatic lung tumor sites. No toxicity of grade ≥ 2 was observed in patients with metastasis in one lung only. CONCLUSIONS: SABR with a central high dose using CyberKnife for metastatic lung tumors is effective with acceptable toxicity. TRIAL REGISTRATION: Number: 20557, Name: Stereotactic ablative radiotherapy using CyberKnife for metastatic lung tumor, URL: http://www.radonc.med.osaka-u.ac.jp/pdf/SBRT.pdf , Date of registration: April 1, 2021 (retrospectively registered), Date of enrollment: May 1, 2014.

Gastric-Type Adenocarcinoma of the Uterine Cervix Associated with Poor Response to Definitive Radiotherapy.

We aimed to evaluate the response to definitive radiotherapy (RT) for cervical cancer based on histological subtypes and investigate prognostic factors in adenocarcinoma (AC). Of the 396 patients treated with definitive RT between January, 2010 and July, 2020, 327 patients met the inclusion criteria, including 275 with squamous cell carcinoma (SCC) and 52 with AC restaged based on the 2018 International Federation of Gynecology and Obstetrics staging system. Patient characteristics, response to RT, and prognoses of SCC and AC were evaluated. The complete response (CR) rates were 92.4% and 53.8% for SCC and AC, respectively (p < 0.05). Three-year overall survival and progression-free survival (PFS) rates of SCC were significantly higher than those of AC (88.6% vs. 74.1%, p < 0.05 and 76.3% vs. 59.3%, p < 0.05, respectively). Among the AC population, univariate and multivariate analyses were performed to examine prognostic factors associated with non-complete response (CR). In the multivariate analysis, gastric-type adenocarcinoma (GAS) was associated with non-CR in AC (adjusted odds ratio, 12.2; 95% confidence interval 1.0−145.6; p < 0.05). The 3-year PFS rate in patients with GAS was significantly lower than that in patients with other histological types of AC (44.4% vs. 66.7%, p < 0.05). Definitive RT for cervical cancer was significantly less effective for AC than for SCC. GAS was the only independent prognostic factor associated with non-CR in AC.

Effects of Heat Stress on Heart Rate Variability in Free-Moving Sheep and Goats Assessed With Correction for Physical Activity.

Heart rate variability (HRV) is the heart beat-to-beat variation under control of the cardiovascular function of animals. Under stressed conditions, cardiac activity is generally regulated with an upregulated sympathetic tone and withdrawal of vagal tone; thus, HRV monitoring can be a non-invasive technique to assess stress level in animals especially related to animal welfare. Among several stress-induced factors, heat stress is one of the most serious causes of physiological damage to animals. The aim of this study was to assess the effects of heat stress on HRV in small ruminants under free-moving conditions. In three experimental periods (June, August, and October), inter-beat intervals in sheep and goats (three for each) in two consecutive days were measured. HRV parameters were calculated from the inter-beat interval data by three types of analyses: time domain, frequency domain, and non-linear analyses. The temperature-humidity index (THI) was used as an indicator of heat stress, and vectorial dynamic body acceleration (VeDBA) was calculated to quantify the physical activity of the animals tested. First, we investigated correlations of THI and VeDBA with HRV parameters; subsequently, THI was divided into five categories according to the values obtained (≤ 65, 65-70, 70-75, 75-80, and >80), and the effects of the THI categories on HRV parameters were investigated with and without correcting for the effects of physical activity based on the VeDBA. The results indicated that HRV significantly decreased with increasing THI and VeDBA. For non-linear HRV parameters that were corrected for the effects of physical activity, it was suggested that there would be a threshold of THI around 80 that strongly affected HRV; high heat stress can affect the autonomic balance of animals non-linearly by inducing the sympathetic nervous system. In conclusion, to assess psychophysiological conditions of unrestrained animals by HRV analysis, the confounding effect of physical activity on HRV should be minimized for a more precise interpretation of the results.