Prediction of plan adaptation in head and neck cancer proton therapy using clinical, radiographic, and dosimetric features.

PURPOSE: Because proton head and neck (HN) treatments are sensitive to anatomical changes, plan adaptation (re-plan) during the treatment course is needed for a significant portion of patients. We aim to predict re-plan at plan review stage for HN proton therapy with a neural network (NN) model trained with patients' dosimetric and clinical features. The model can serve as a valuable tool for planners to assess the probability of needing to revise the current plan. METHODS AND MATERIALS: Mean beam dose heterogeneity index (BHI), defined as the ratio of the maximum beam dose to the prescription dose, plan robustness features (clinical target volume (CTV), V100 changes, and V100 > 95% passing rates in 21 robust evaluation scenarios), as well as clinical features (e.g., age, tumor site, and surgery/chemotherapy status) were gathered from 171 patients treated at our proton center in 2020, with a median age of 64 and stages from I-IVc across 13 HN sites. Statistical analyses of dosimetric parameters and clinical features were conducted between re-plan and no-replan groups. A NN was trained and tested using these features. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of the prediction model. A sensitivity analysis was done to determine feature importance. RESULTS: Mean BHI in the re-plan group was significantly higher than the no-replan group (p < .01). Tumor site (p < .01), chemotherapy status (p < .01), and surgery status (p < .01) were significantly correlated to re-plan. The model had sensitivities/specificities of 75.0%/77.4%, respectively, and an area under the ROC curve of .855. CONCLUSION: There are several dosimetric and clinical features that correlate to re-plans, and NNs trained with these features can be used to predict HN re-plans, which can be used to reduce re-plan rate by improving plan quality.

Postabsorptive urinary hydroxyproline test in patients with metastatic bone disease from breast cancer.

Postabsorptive urine hydroxyproline (HYPRO) excretion ("spot" HYPRO test) was compared with the 24-hour urine excretion of HYPRO in 45 patients with breast cancer and nine normal subjects on a low-gelatin diet. A good correlation was observed between the results of these two tests in both groups. Patients with skeletal metastasis showed a higher spot HYPRO value than those without bone involvement and the number of lesions by bone scanning correlated with the values of spot HYPRO. In 20 of 22 patients with bone metastasis followed up for three to 19 months, spot HYPRO values correlated well with the evolution of bone disease. We conclude that the spot HYPRO test is a simple, inexpensive, and accurate method for the diagnosis and follow-up of patients with skeletal metastasis from breast cancer.

Treatment of renal cell carcinoma by in situ partial nephrectomy and extracorporeal operation with autotransplantation.

During a 10-year period, 33 patients underwent in situ enucleation, in situ partial nephrectomy, or an extracorporeal operation for low-grade (1 or 2), low-stage (I or II), bilateral or solitary renal cell carcinoma. Only one patient (3%) (who had undergone in situ partial nephrectomy) had local recurrence; the projected 5-year rates of nonprogression of disease and survival from death due to cancer only were 76% and 87%, respectively. A group of patients who were closely matched for grade and stage of renal cell cancer underwent traditional transabdominal radical nephrectomy during the same time interval and had rates of nonprogression and survival similar to those of the conservative surgical group. Thus, in selected patients with low-grade, low-stage renal cell cancer, conservative surgical treatment (that is, renal parenchyma-saving procedures) can produce favorable results without the side effects (such as renal failure) associated with ablative renal operations.

Carcinoma of scrotum.

Twelve patients with carcinoma of the scrotum were evaluated: 9 with squamous carcinoma and 3 with basal cell carcinoma. The presenting complaint was a visible skin lesion; the interval between awareness of this lesion and diagnosis averaged 3.3 years. Three of the 12 patients were black, although this disease previously has been considered rare in blacks. No occupation predominated among the patients in this series, and scrotal carcinoma today may occur as a result of nonspecific factors such as poor hygiene and chronic irritation, rather than industrial exposure. Only 5 of 12 patients were disease-free after treatment; 5 of the others died of squamous carcinoma, 1 died of a postoperative complication, and 1 was lost to follow-up. The most significant correlative with survival was stage at initial diagnosis, indicating the need for a high index of suspicion regarding lesions of the scrotum.

Simultaneous, contralateral hypernephroma and renal transitional cell carcinoma.

The second case of simultaneous, contralateral hypernephroma and renal transitional cell carcinoma is described. Methods of managing bilateral renal tumors are reviewed.

Cystectomy for superficial bladder cancer.

One hundred nine patients with Stage O or A bladder cancer unmanageable transurethrally underwent radical cystectomy and ileal conduit urinary diversion without lymphadenectomy. Fifty-six were also given planned preoperative radiation therapy. Five-year survival rate was 76 per cent for the entire group. Irradiation eradicated all of the tumor (Po) in 36 per cent of patients, no patient Po after irradiation had recurrent disease, and local recurrence was noted in only 3.5 per cent of the irradiated patients compared with 9.4 per cent of those not irradiated. Urethral cancer was present in 9 per cent of our patients, a finding that does not support our previous impression that patients with multifocal bladder cancer or tumors involving the prostatic urethra had a higher than average incidence of urethral carcinoma.

Testicular tumor in blacks.

Although testicular tumors are less common in blacks than in whites, they do occur and must be considered in making a differential diagnosis of scrotal masses. At The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston, 19 black men were treated for testicular tumor between 1944 and 1980, representing 1.4 per cent of the total of 1,380 patients treated for testicular tumor. Since blacks made up 7.9 per cent of all patients treated at UT M. D. Anderson Hospital, blacks with testicular tumor were seen about one-fifth as often as would be expected if there were no racial variation in the incidence of the disease. Twelve patients had a diagnosis of seminoma, five embryonal carcinoma, one teratocarcinoma, and one interstitial cell tumor. The majority of patients had metastatic disease at the time of diagnosis. Five of 12 patients with seminoma and 5 of 6 with nonseminomatous cancer died of disease. Prognosis today, however, is no worse for blacks than for whites.

Automatic spring-loaded biopsy gun with ultrasonic control for renal transplant biopsy.

The automatic spring-loaded biopsy gun with 18-gauge needle was used to perform 20 renal transplant biopsies. A total of 35 needle passes were used during the 20 biopsies to obtain 31 cores of renal tissue (ratio of successful cores to passes 0.88). Nineteen of 20 biopsies (95%) resulted in renal tissue sufficient for diagnosis. One patient experienced gross hematuria that required blood transfusion and resulted in temporary ureteral clot obstruction. We believe the automatic spring-loaded biopsy gun with ultrasonic control allows rapid, accurate, and safe histologic assessment of the renal allograft, and we recommend this system for routine use.

Acalculous cystinuria.

We compared quantitative urinary cystine values in stone-forming family members and unaffected relatives based on an index stone-forming patient. A family pedigree of 39 members was identified. Quantitative urinalyses and serum biochemical profiles were collected with the subjects on similar diets over 72 hours. Detailed medical histories were obtained. Three family members are stone-forming cystinuric patients with a mean urinary cystine excretion of 496 mg/g of creatinine per day. Six persons without a history of stones (mean age 50) had a mean urinary cystine excretion of 364 mg/g of creatinine per day. Thirty-four family members had elevated urinary cystine concentrations (mean 151 mg/g of creatinine per day), and only two family members had normal urinary cystine excretion. Fifteen subjects with elevated urinary cystine values (> 150 mg/g of creatinine per day) had no history of urinary stones despite a mean age of 44 years. Urinary electrolytes and volumes were similar in the stone-forming and non-stone-forming groups. Thirty-nine per cent of the persons from this family pedigree had elevated quantitative urinary cystine concentrations and no history of urinary stones despite a mean age of 44 years. Acalculous cystinuria is an elevated urinary cystine concentration without evidence of urinary stone disease. Despite abnormal urinary cystine excretion, acalculous cystinuria does not necessarily culminate in clinical urinary stone disease.

An unusual pelivc mass: cystic fibroadenoma of the prostate.

Cystic fibroadenoma is an extremely rare benign lesion of the prostate. Herein we report a case of such a lesion in a 52-year-old man initially thought to have locally advanced prostate cancer.

Improving results in primary diabetic renal transplantation.

One hundred seventeen patients with renal failure resulting from insulin-dependent diabetes mellitus received primary renal allografts from June 1970 to April 1983. Factors significantly associated with improved graft and patient survival were LRD sources (in particular, HLA-identical) and splenectomy. Variables such as transfusions, age, sex, and the administration of ALG were not significantly associated with transplant outcome. However, survival of patients and grafts has improved in recent years and continues to compare favorably with hemodialysis results. Although splenectomy might be the most important variable responsible for the improvement of our recent results, the use of ALG for rejection episodes might have contributed substantially to the improvement. Early transplantation, not analyzed in this study, might prove to be the most significant variable in the outcome of transplantation in patients with diabetic renal failure.

Urinary stone disease: a practical guide to metabolic evaluation.

Urolithiasis is the third most common affliction of the urinary tract, after infections and diseases of the prostate. Approximately 10% of the North American population will have at least one urinary calculus by age 70. A thorough history and physical examination will usually confirm the diagnosis of urinary stone disease. A simplified laboratory evaluation may be performed for patients with a single stone episode. A more extensive evaluation is required for patients with recurrent, metabolically active stones and patients at high risk (ie, cystine stone formers and those who develop bladder dysfunction or nephrosclerosis). Intravenous pyelography with tomography remains the gold standard for imaging of the urinary tract to confirm the diagnosis and formulate a treatment plan.

Effect of growth hormone or chromium picolinate on swine metabolism and inflammatory cytokine production after endotoxin challenge exposure.

OBJECTIVE: To determine whether recombinant porcine somatotropin (PST) or chromium picolinate (CrP) affected cytokine production and metabolism in swine after endotoxin challenge exposure. ANIMALS: 20 Poland China X Landrace pigs, 5/group. PROCEDURE: Pigs were given CrP-supplemented feed at body weight of 20 kg; PST treatment began at 60 kg, and both treatments continued through body weight of 90 kg. At 90 kg, pigs were challenge exposed with 20 micrograms of lipopolysaccharide (LPS)/kg of body weight. Blood samples were obtained at various times through 24 hours after LPS challenge exposure. RESULTS: In all pigs not given PST, glucose concentration decreased 2 to 4 hours after LPS. In PST-treated pigs, blood glucose concentration was decreased at 6 to 8 hours after LPS. Plasma insulin concentration paralleled changes in glucose concentration. Nonesterified fatty acid concentration was high 2 to 24 hours after LPS in pigs not given PST and at 6 to 24 h in PST-treated pigs. Plasma urea nitrogen concentration was high at 6 to 24 hours after LPS in pigs not given PST. The urea nitrogen values in PST-treated pigs were lower at all times. Serum aspartate transaminase activity was high 6 to 24 hours after LPS in pigs not given PST, whereas PST treatment prevented the increase in this enzyme activity. In untreated (PST) pigs, plasma bilirubin (total and direct) concentrations were high 4 to 8 hours after LPS and returned to normal at 24 hours. The PST- and CrP-treated pigs maintained normal plasma bilirubin concentrations. Interleukin 6 activity was unaffected by CrP and PST treatments. Treatment with CrP and PST decreased the tumor necrosis factor alpha response to LPS, compared with that in control pigs. CONCLUSIONS: PST, and to a lesser extent CrP, provide protection against the adverse metabolic effects of LPS-induced septic shock.

The effects of dietary calcium, phosphorus, and protein on the performance and nutrient utilization of broiler chickens.

The effects of varying dietary Ca, available phosphorus (AP), and protein on 5- to 17-day performance (growth and feed efficiency), Ca and P contents of tibia and plasma, ME, and N utilization of broiler chickens were investigated in three experiments. In Experiment 1, high dietary Ca (24.3 versus 11.8 g/kg) reduced performance, N digestibility, and ME, whereas N retention was not affected. Reducing dietary protein (186 or 203 versus 217 g/kg) reduced performance and N retention but increased ME. In Experiment 2, high dietary Ca (25.3 versus 10.7 g/kg) reduced performance, tibia Ca, and plasma P and increased plasma total Ca; whereas the diet with both high Ca (25.3 g/kg) and high AP (9.8 versus 4.3 g/kg) reduced only performance. Reducing dietary protein from 206 to 166 g/kg diet reduced growth but improved feed efficiency and tibia P content. In Experiment 3, a diet containing 25.6 g of Ca and 4.9 or 10.7 g of AP compared with a diet containing 11.2 g of Ca and 4.9 g of AP/kg of diet reduced performance. Reducing dietary protein from 236 to 215 g/kg of diet decreased performance. It was concluded that high dietary Ca reduced growth performance and feed efficiency and that altering the dietary protein from 166 to 236 g/kg of diet did not overcome the growth depression effect of high Ca or of high Ca and AP diets.

Quantitative review of optimum amino acid intakes for young laying pullets.

Data relating egg output to daily intakes of lysine, methionine, tryptophan, isoleucine and valine have been analysed using both published and unpublished sources. Amino acid requirements in mg/d for individual pullets were estimated by the following equations: (Table: see text) where E = egg output in g/d and W = body weight in kg. Response curves for flocks of pullets were calculated using the Reading model and optimum intakes were derived for various body weights, egg outputs and ratios of input costs to output values. Estimates of amino acid maintenance requirements were related to reported values for the adult cockerel and the amino acid requirement for egg output was related to the digestibility of amino acids and the composition of egg protein. Procedures are suggested for deriving response coefficients for other essential amino acids.