Degarelix as a neoadjuvant hormonal therapy for acute urinary tract toxicity associated with external beam radiotherapy for intermediate- and high-risk prostate cancer: a propensity score matched analysis.

BACKGROUND: In prostate cancer treatment, lower urinary tract symptoms significantly improve with luteinizing hormone-releasing hormone antagonists use compared with agonists. However, it is unclear whether luteinizing hormone-releasing hormone antagonists can decrease acute urinary tract toxicity during external beam radiotherapy. This study aimed to assess whether luteinizing hormone-releasing hormone antagonists used as neoadjuvant therapy reduced acute urinary tract toxicity during external beam radiotherapy compared with luteinizing hormone-releasing hormone agonists. METHODS: The study included 78 patients who underwent intensity-modulated radiation therapy for intermediate- and high-risk prostate cancer between April 2013 and January 2020. Irradiation was initiated after 3-6 months of neoadjuvant therapy. Androgen deprivation therapy was given to the intermediate-risk group for 6 months and the high-risk group for 2-3 years. The European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group toxicity grading scale was used to evaluate the urinary tract system toxicity. Relevant clinical factors were used in matching patients based on propensity scores to enable comparison between the groups. RESULTS: Each group had 27 matched patients. There was no reduction in urinary tract toxicity with the use of luteinizing hormone-releasing hormon antagonists (P = 0.624). For patients with an International Prostate Symptom Score of ≥11 at the start of treatment, 18 patients in each group were matched. Significantly lower scores were observed in the luteinizing hormone-releasing hormon antagonist group (P = 0.041). CONCLUSIONS: Luteinizing hormone-releasing hormon antagonists may reduce acute urinary tract toxicity during prostate cancer external beam radiotherapy compared with luteinizing hormone-releasing hormon agonists, in particular in patients with moderate to severe symptoms at the start of treatment.

Fine microstructure formation in steel under ultrafast heating and cooling.

This study evaluates phase transformation kinetics under ultrafast cooling using femtosecond X-ray diffraction for the operand measurements of the dislocation densities in Fe-0.1 mass% C-2.0 mass% Mn martensitic steel. To identify the phase transformation mechanism from austenite (γ) to martensite (α'), we used an X-ray free-electron laser and ultrafast heating and cooling techniques. A maximum cooling rate of 4.0 × 103 °C s-1 was achieved using a gas spraying technique, which is applied immediately after ultrafast heating of the sample to 1200 °C at a rate of 1.2 × 104 °C s-1. The cooling rate was sufficient to avoid bainitic transformation, and the transformation during ultrafast cooling was successfully observed. Our results showed that the cooling rate affected the dislocation density of the γ phase at high temperatures, resulting in the formation of a retained γ owing to ultrafast cooling. It was discovered that Fe-0.1 mass% C-2.0 mass% Mn martensitic steels may be in an intermediate phase during the phase transformation from face-centered-cubic γ to body-centered-cubic α' during ultrafast cooling and that lattice softening occurred in carbon steel immediately above the martensitic-transformation starting temperature. These findings will be beneficial in the study, development, and industrial utilization of functional steels.

Fine microstructure formation in steel under ultrafast heating.

In this study, phase transformation kinetics was directly evaluated using a femtosecond X-ray diffraction technique for operand measurements of the dislocation densities and carbon concentrations in Fe-0.1mass%C martensitic steel. To identify the reverse transformation mechanism from α' to γ, we used an X-ray free-electron laser and ultrafast heating. A maximum heating rate of 104 °C/s, which is sufficient to avoid diffusive reversion, was achieved, and the reverse transformation during ultrafast heating was successfully observed. Our results demonstrated that a fine microstructure formed because of a phase transformation in which the dislocation density and carbon concentrations remained high owing to ultrafast heating. Fe-C martensitic steels were also found to undergo a massive reverse transformation during ultrafast heating. The formation of a fine microstructure by a simple manufacturing process, without rare elements such as Ti, Nb, or Mo, can be expected. This study will help further the development of functional steels.