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1.
Rev Sci Instrum ; 89(10): 10E110, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30399797

RESUMO

In this paper, we describe an in situ calibration technique for Coherence Imaging Spectroscopy (CIS) that measures 2-D images of ion flows on DIII-D. A low power CW diode laser that is tuneable in the range 464-468 nm along with a precision wavemeter (10-5 nm resolution) is used to characterize the interferometer phase as a function of wavelength in the region of C iii (465 nm) and He ii (468 nm). The interferometer is stabilized both mechanically and thermally to minimize drift during the calibration. Optical stirring and an integration sphere are used to obtain spatially uniform calibration images. The quality of the calibration data enables a measurement of phase versus wavelength over approximately 10 fringes of the interferometer. These coefficients can also be related to the geometry of the optics and the birefringent crystal of the interferometer. On DIII-D, the integration sphere with the laser light is inserted into the CIS optical system between shots and the laser image and wavelength are automatically recorded, providing a zero velocity reference.

2.
Rev Sci Instrum ; 89(10): 10K110, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30399959

RESUMO

Many tokamaks now use visible light cameras to observe plasma-wall interactions and integrated line emission. The DIII-D coherence imaging spectroscopy diagnostic cameras image interferograms that encode line integrated velocity. By modeling the 2D camera image pixels as line of sight integrals through an axisymmetric discrete grid, it is possible to do tomographic analysis to determine the local plasma line emissivity and parallel velocity. Methods to solve the inverse problem posed by these tangential viewing cameras are presented. The inversion begins with calculation of the sparse response matrix that encompasses all the geometry and diagnostic information and reduces the process of image formation to a sparse matrix-vector multiply. This work includes techniques for determining the detailed geometry of the camera views and methods for handling physical quantities that vary spatially. Additionally, the size of the response matrix has driven the development of capability to distribute the coarse parallel calculation across a heterogeneous cluster of computers on the Energy Sciences Network. Iterative techniques are then used to solve the sparse matrix-vector linear system.

3.
Rev Sci Instrum ; 89(9): 093502, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278733

RESUMO

Coherence Imaging Spectroscopy (CIS) has emerged as a powerful tool for investigating complex ion phenomena in the boundary of magnetically confined plasma devices. The combination of Fourier-transform interferometry and high-resolution fast-framing cameras has made it possible to make sensitive velocity measurements that are also spatially resolved. However, this sensitivity makes the diagnostic vulnerable to environmental effects including thermal drifts, vibration, and magnetic fields that can influence the velocity measurement. Additionally, the ability to provide an absolute calibration for these geometries can be impacted by differences in the light-collection geometry between the plasma and reference light source, spectral impurities, and the presence of thin-films on in-vessel optics. This paper discusses the mitigation of these effects and demonstration that environmental effects result in less than 0.5 km/s error on the DIII-D CIS systems. A diagnostic comparison is used to demonstrate agreement between CIS and traditional spectroscopy once tomographic artifacts are accounted for.

4.
Rev Sci Instrum ; 87(11): 11E126, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27910343

RESUMO

Spectrometer measurements and filter upgrades to a motional Stark effect polarimeter measuring the outer half-radius of the DIII-D tokamak helped to identify asymmetries in the polarization angle of Stark-split emission. The measured polarization angle of the π components differs and is not orthogonal to the σ component. These differences persist over a range of densities and with low levels of background light. It is suggested that the difference in the polarization angle between components is from a change in the ellipticity of the emitted light across the Stark components coupled with imperfect polarization preservation from an in-vessel mirror.

5.
Rev Sci Instrum ; 85(11): 11D855, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25430268

RESUMO

An imaging system with a wide-angle tangential view of the full poloidal cross-section of the tokamak in simultaneous infrared and visible light has been installed on DIII-D. The optical train includes three polished stainless steel mirrors in vacuum, which view the tokamak through an aperture in the first mirror, similar to the design concept proposed for ITER. A dichroic beam splitter outside the vacuum separates visible and infrared (IR) light. Spatial calibration is accomplished by warping a CAD-rendered image to align with landmarks in a data image. The IR camera provides scrape-off layer heat flux profile deposition features in diverted and inner-wall-limited plasmas, such as heat flux reduction in pumped radiative divertor shots. Demonstration of the system to date includes observation of fast-ion losses to the outer wall during neutral beam injection, and shows reduced peak wall heat loading with disruption mitigation by injection of a massive gas puff.

6.
Rev Sci Instrum ; 82(3): 033515, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21456744

RESUMO

Accurate measurement of internal magnetic field direction using motional Stark effect (MSE) polarimetry in the edge pedestal is desired for nearly all tokamak scenario work. A newly installed 500 kHz 32-channel digitizer on the MSE diagnostic of DIII-D allows full spectral information of the polarimeter signal to be recovered for the first time. Fourier analysis of this data has revealed magnetohydrodynamic (MHD) fluctuations in the plasma edge pedestal at ρ ≥ 0.92. By correlating edge localized mode fluctuations seen on lock-in amplifier outputs with MSE spectrograms, it has been shown that edge pedestal tearing mode fluctuations cause interference with MSE second harmonic instrument frequencies. This interference results in unrecoverable errors in the real-time polarization angle measurement that are more than an order of magnitude larger than typical polarimeter uncertainties. These errors can cause as much as a 38% difference in local q. By using a redundant measure of the linear polarization found at the fourth harmonic photo-elastic modulator (PEM) frequency, MHD interference can be avoided. However, because of poorer signal-to-noise the fourth harmonic signal computed polarization angle shows no improvement over the MHD polluted second harmonics. MHD interference could be avoided in future edge pedestal tokamak polarimeters by utilizing PEMs with higher fundamental frequencies and a greater separation between their frequencies.

7.
Rev Sci Instrum ; 81(10): 10D739, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21033930

RESUMO

The use of lock-in amplifiers for phase sensitive detection of motional Stark effect (MSE) diagnostic signals is of critical importance to real-time internal current profile measurements in tokamak plasmas. A digital lock-in (DLI) upgrade utilizing field programable gate array firmware has been installed on the MSE system of the DIII-D tokamak for the eventual replacement of largely obsolete analog units. While the new digital system has shown a small reduction in electronic noise over the analog, the main advantages are reduced cost, hardware simplicity, compact size, and phase tracking during plasma operations. DLI recovery of MSE polarization angles was accomplished through use of reference processing to produce only photoelastic modulator (PEM) second harmonic frequencies and electronic signal processing to maximize the fidelity of the recovered signal. A simplified discrete analytical solution was found that accurately describes the new DLI hardware. The DLI algorithm was found to cause a prohibitively large oscillating artifact atop the demodulated signal. The artifact was caused by the accumulator interval not containing an exact integer number of PEM multiplier periods. Successful MSE measurements require the minimization of this oscillating artifact amplitude. The analytical solution was used to select an appropriate accumulator interval that both reduces the artifact and maintains the greatest temporal resolution possible. Sample EFIT equilibria reconstructions and corresponding safety factor profiles showed very close agreement between the analog and digital lock-ins.

8.
Rev Sci Instrum ; 80(3): 033505, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19334920

RESUMO

A video camera system is described as that measures the spatial distribution of visible line emission emitted from the main scrape-off layer (SOL) of plasmas in the DIII-D tokamak. A wide-angle lens installed on an equatorial port and an in-vessel mirror, which intercepts part of the lens' view, provide simultaneous tangential views of the SOL on the low-field and high-field sides of the plasma's equatorial plane. Tomographic reconstruction techniques are used to calculate the two-dimensional (2D) poloidal profiles from the raw data, and one-dimensional (1D) poloidal profiles simulating chordal views of other optical diagnostics from the 2D profiles. The 2D profiles can be compared with SOL plasma simulations; the 1D profiles with measurements from spectroscopic diagnostics. Sample results are presented, which elucidate carbon transport in plasmas with toroidally uniform injection of methane and argon transport in disruption mitigation experiments with massive gas jet injection.

9.
Rev Sci Instrum ; 79(10): 10F518, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19044663

RESUMO

Motional Stark effect (MSE) measurements constrain equilibrium reconstruction of DIII-D tokamak plasmas using the equilibrium code EFIT. In 2007, two new MSE arrays were brought online, bringing the system to three core arrays, two edge arrays, and 64 total channels. We present the first EFIT reconstructions using this expanded system. Safety factor and E(R) profiles produced by fitting to data from the two new arrays and one of the other three agree well with independent measurements. Comparison of the data from the three arrays that view the core shows that one of the older arrays is inconsistent with the other two unless the measured calibration factors for this array are adjusted. The required adjustments depend on the toroidal field and plasma current direction, and on still other uncertain factors that change as the plasma evolves. We discuss possible sources of calibration error for this array.

10.
Phys Chem Chem Phys ; 9(15): 1764-73, 2007 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-17415487

RESUMO

The melting behaviour and transport properties of straight chain alkanes mono- and difunctionalized with phosphonic acid groups have been investigated as a function of their length. The increase of melting temperature and decrease of proton conductivity with increasing chain length is suggested to be the consequence of an increasing ordering of the alkane segments which constrains the free aggregation of the phosphonic acid groups. However, the proton mobility is reduced to a greater extent than the proton diffusion coefficient indicating an increasing cooperativity of proton transport with increasing length of the alkane segment. The results clearly indicate that the "spacer concept", which had been proven successful in the optimization of the proton conductivity of heterocycle based systems, fails in the case of phosphonic acid functionalized polymers. Instead, a very high concentration of phosphonic acid functional groups forming "bulky" hydrogen bonded aggregates is suggested to be essential for obtaining very high proton conductivity. Aggregation is also suggested to reduce condensation reactions generally observed in phosphonic acid containing systems. On the basis of this understanding, the proton conductivities of poly(vinyl phosphonic acid) and poly(meta-phenylene phosphonic acid) are discussed. Though both polymers exhibit a substantial concentration of phosphonic acid groups, aggregation seems to be constrained to such an extent that intrinsic proton conductivity is limited to values below sigma = 10(-3) S cm(-1) at T = 150 degrees C. The results suggest that different immobilization concepts have to be developed in order to minimize the conductivity reduction compared to the very high intrinsic proton conductivity of neat phosphonic acid under quasi dry conditions. In the presence of high water activities, however, (as usually present in PEM fuel cells) the very high ion exchange capacities (IEC) possible for phosphonic acid functionalized ionomers (IEC >10 meq g(-1)) may allow for high proton conductivities in the intermediate temperature range (T approximately 120 -160 degrees C).


Assuntos
Fontes de Energia Elétrica/tendências , Eletroquímica/métodos , Eletrólitos/química , Membranas Artificiais , Modelos Químicos , Organofosfonatos/química , Polímeros/química , Simulação por Computador , Condutividade Elétrica , Eletroquímica/tendências , Campos Eletromagnéticos , Temperatura
11.
Pediatr Blood Cancer ; 43(7): 723-8, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15390310

RESUMO

BACKGROUND: Better predictors of outcome would allow improved risk-adapted therapy for pediatric nonmetastatic osteosarcoma of the extremity. We investigated the predictive value of MR imaging-based measures of absolute and relative tumor size and volume at the time of diagnosis. We also assessed the relation of tumor size to age and histologic response. METHODS: We retrospectively abstracted demographic, treatment history, and outcome information of patients treated on a single institutional protocol. A single pediatric oncologic radiologist manually measured each primary lesion and the affected native bone in three dimensions on MR images obtained at the time of diagnosis. Eight parameters of tumor size were analyzed for their value in predicting overall survival (OS) and event-free survival (EFS). RESULTS: The median age of the 42 patients was 13.5 years (range: 5.9-18.7 years); 50% were female and 74% were Caucasian. Absolute tumor volume was an important predictor of OS (P < 0.05); absolute tumor depth (analyzed as a continuous variable) was a significant predictor of OS (P = 0.018) and EFS (P = 0.036). Relative measures of tumor size were not found to predict outcome. No relation was seen between tumor size and histologic response. CONCLUSIONS: Absolute tumor size at the time of diagnosis is significantly predictive of OS and EFS. If validated in a larger study, this indicator should be used in the design of risk-adapted treatment protocols for osteosarcoma.


Assuntos
Osteossarcoma/diagnóstico , Carga Tumoral , Adolescente , Criança , Intervalo Livre de Doença , Feminino , Humanos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Masculino , Osteossarcoma/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
12.
Cancer ; 92(1): 121-5, 2001 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-11443617

RESUMO

BACKGROUND: To the authors' knowledge, the incidence of brain metastases at the time of diagnosis in children with metastatic rhabdomyosarcoma (RMS) arising outside the head and neck region is unknown, and routine imaging to identify metastatic brain involvement is costly. METHODS: The authors retrospectively reviewed the results of computed tomography (CT) or magnetic resonance imaging (MRI) scans of the head, which was mandated by protocol, in patients with metastatic RMS arising outside the head and neck region who were enrolled on the fourth Intergroup Rhabdomyosarcoma Study (IRS-IV; 1991--1997). RESULTS: Of 100 eligible patients with metastatic RMS arising outside the head and neck region, 56 (56%) underwent head CT (n = 51) and/or MRI (n = 11) scans. Seven of these 56 patients (12.5%) had abnormal scans. Three patients with physical findings suggesting head or neck pathology underwent imaging that confirmed the presence of metastases in bone (one patient), orbit (one patient), or lymph nodes (one patient). One patient who presented with seizures had imaging findings consistent with cerebral embolic infarctions. Of three asymptomatic patients, one had bone metastases that also were identified on skeletal survey and one had bone metastases in the base of the skull that were not identified on bone scan. The remaining asymptomatic patient had a retroperitoneal paraspinal tumor with spinal canal extension and subsequently developed leptomeningeal disease dissemination. CONCLUSIONS: Brain metastases are uncommon at the time of initial diagnosis of metastatic RMS arising outside the head and neck region, and the majority of abnormalities detected on head CT or MRI scans are evident clinically or on other imaging studies. Patients with clinical findings suggesting intracranial pathology and those with paraspinal tumors may benefit from brain imaging, but cost savings may be realized by foregoing imaging in patients without these features.


Assuntos
Neoplasias Encefálicas/diagnóstico , Rabdomiossarcoma/diagnóstico , Neoplasias Encefálicas/secundário , Criança , Pré-Escolar , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Metástase Neoplásica , Rabdomiossarcoma/secundário , Tomografia Computadorizada por Raios X
13.
Cancer ; 91(12): 2230-7, 2001 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-11413510

RESUMO

BACKGROUND: The purpose of this article was to evaluate the utility of a pharmacokinetically modeled measure of regional contrast access, based on dynamic contrast-enhanced magnetic resonance imaging (MRI) studies after preoperative chemotherapy, as a predictor of disease free survival in osteosarcoma. METHODS: The kinetic parameters of a two-compartment pharmacokinetic model of MRI contrast agent accumulation were analyzed in relation to disease free survival in 31 patients who received protocol-based therapy for nonmetastatic osteosarcoma of the extremities. The modeled exchange rate of contrast between the plasma and the tumor extravascular extracellular fluid space served as a measure of regional contrast access. The prognostic impact of both the clinically accepted standard of histologic evaluation of tumor necrosis and the regional contrast access were analyzed with tumor size as an influential factor. RESULTS: Although the histologic grade of response was not a statistically significant prognostic factor in these patients (P = 0.884), regional contrast access after preoperative chemotherapy was significantly predictive of disease free survival (P = 0.035) in the Cox proportional hazards model. Lower regional access before surgery and smaller tumor size were associated with a better treatment outcome. Log-rank analyses of Kaplan-Meier curves indicated that the impact of regional access was most pronounced in patients with larger tumors (P = 0.052). Higher regional access at presentation also was associated significantly with greater decreases during therapy. CONCLUSIONS: Dynamic MRI estimates of regional contrast access after preoperative chemotherapy, when combined with tumor size, holds promise for the early identification of patients at risk of recurrence. The availability of such response predictors could facilitate the development of risk-adapted treatment approaches.


Assuntos
Neoplasias Ósseas/diagnóstico , Meios de Contraste/farmacocinética , Imageamento por Ressonância Magnética/métodos , Osteossarcoma/diagnóstico , Adolescente , Adulto , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/terapia , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Osteossarcoma/metabolismo , Osteossarcoma/mortalidade , Osteossarcoma/terapia , Prognóstico , Modelos de Riscos Proporcionais , Resultado do Tratamento
14.
Med Pediatr Oncol ; 36(6): 605-11, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11344491

RESUMO

BACKGROUND: Preclinical studies suggest a role of insulin-like growth factor-1 (IGF-1) in the proliferation of osteosarcoma cells in vivo. The purpose of this study is to address the relationship between serum levels of IGF-1 and its binding protein (IGFBP-3), and the clinical behavior and outcome of osteosarcoma in children, and to compare those levels present in osteosarcoma patients with a normal population. PROCEDURE: Serum IGF-1 and IGFBP-3 levels were determined by ELISA in 37 patients with osteosarcoma treated on the same treatment regimen (OS-91 protocol), and who had available serum samples from diagnosis. IGF-1 and IGFBP-3 levels were compared with those previously established in the normal population, matched for age and gender, and were correlated with the presence of metastatic disease, histologic response to preoperative chemotherapy, and event-free survival. RESULTS: In osteosarcoma patients the median IGF-1 level was 275 ng/ml (range, 105-613) and the median IGFBP-3 level was 3.4 mg/L (range, 2.3-5.1). IGF-1 levels differed from those in the normal population (P = 0.029); although we anticipated higher IGF-1 levels than normal children, 68% of observed standardized scores were less than 0. Furthermore, IGF-1 or IGFBP-3 levels failed to correlate with the presence of metastatic disease (P = 0.12 and P = 0.12, respectively), histologic response (Rosen-Huvos grades 3/4 vs. grades 1/2) (P = 0.95 and P = 0.71, respectively), or event-free survival (P = 0.52 and P = 0.41, respectively). There was a strong association observed between IGF-1 and IGFBP-3 levels (P < 0.001). CONCLUSIONS: In this retrospective study of 37 patients, we found that circulating levels of IGF-1 and IGFBP-3 are not predictive of the development or clinical characteristics of pediatric osteosarcoma. However, further studies on a larger patient population should be performed in order to investigate this relationship.


Assuntos
Neoplasias Ósseas/diagnóstico , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/análise , Osteossarcoma/diagnóstico , Adolescente , Adulto , Biomarcadores Tumorais/sangue , Neoplasias Ósseas/sangue , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Metástase Neoplásica , Osteossarcoma/sangue , Osteossarcoma/patologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Pediatr Radiol ; 31(4): 251-6, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11321742

RESUMO

PURPOSE: We investigated one 201Tl bone scintigraphy method as a predictor of histologic response and event-free survival (EFS) of nonmetastatic extremity osteosarcoma. MATERIALS AND METHODS: We evaluated images of the primary tumor to determine whether they exhibited a donut of avidity for 40 patients enrolled on a single institutional protocol. Participants underwent three serial 201Tl bone scintigraphy studies during preoperative neoadjuvant chemotherapy. Intra- and interobserver variability of the method was assessed, and the presence of the donut of avidity was examined as a predictor of EFS and histologic response. RESULTS: Fifty-three percent of patients were female and 75% were Caucasian; the median age at diagnosis was 13.5 years. Intraobserver agreement was moderate to very good, ranging from 0.595 to 0.865. Interobserver agreement was moderate to good for all time points, ranging from 0.576 to 0.708. There was a significant difference in EFS among patients with and without the donut-shape at any of the three time points (P = 0.049); patients whose tumors displayed a donutshape had inferior EFS. CONCLUSION: The pattern of donut avidity in extremity OS is a predictor of lower EFS, but does not correlate with histologic response to therapy.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Osteossarcoma/diagnóstico por imagem , Radioisótopos de Tálio , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/cirurgia , Terapia Combinada , Extremidades , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Osteossarcoma/tratamento farmacológico , Osteossarcoma/cirurgia , Cintilografia , Análise de Sobrevida , Resultado do Tratamento
17.
J Clin Oncol ; 19(1): 171-82, 2001 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-11134210

RESUMO

PURPOSE: To determine the activity of carboplatin/ifosfamide in patients with previously untreated osteosarcoma and to estimate patient outcomes after a multiagent chemotherapy protocol that eliminated cisplatin. PATIENTS AND METHODS: Sixty-nine patients with newly diagnosed, previously untreated osteosarcoma received three cycles of carboplatin (560 mg/m(2) x 1) and ifosfamide (2.65 g/m(2)/d x 3). Assessment of response was evaluated after two (week 6) and three (week 9) chemotherapy cycles. At week 9, histologic response was assessed. Adjuvant therapy comprised two additional carboplatin/ifosfamide cycles, doxorubicin, and high-dose methotrexate. Patients were stratified at enrollment: stratum A, resectable primary tumor without metastases; stratum B, unresectable primary tumor; and stratum C, metastatic disease at diagnosis. Week 6 response was compared with that of a historic group that received only ifosfamide during the initial window evaluation. RESULTS: The clinical and radiographic response rate to three cycles of carboplatin/ifosfamide was 67.7% (95% confidence interval, 55.0% to 78.8%). Compared with the historic population who received only ifosfamide, the combination of carboplatin and ifosfamide reduced the progressive disease rate at week 6 (31.9% v 9%, P: = .003). For patients in stratum A, the 3-year event-free survival and survival were 72.3% +/- 6.7% and 76.4% +/- 6.4%, respectively. Patients who received carboplatin-based therapy had less long-term renal toxicity and ototoxicity. CONCLUSION: This pilot trial suggests that carboplatin/ifosfamide combination chemotherapy has substantial antitumor activity. In the context of a multiagent chemotherapy protocol comprising high-dose methotrexate and doxorubicin, we found that the addition of carboplatin/ifosfamide resulted in patient outcomes comparable to trials using cisplatin-based therapy with less long-term toxicity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Osteossarcoma/tratamento farmacológico , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Carboplatina/administração & dosagem , Criança , Pré-Escolar , Intervalo Livre de Doença , Humanos , Ifosfamida/administração & dosagem , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Projetos Piloto , Taxa de Sobrevida
18.
J Pediatr Hematol Oncol ; 22(4): 321-9, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10959902

RESUMO

PURPOSE: Current treatment of the Ewing sarcoma family of tumors (ESFT) includes intensive multiagent chemotherapy with topoisomerase II inhibitors, alkylating agents, and granulocyte colony-stimulating factor (G-CSF). This treatment approach has been associated with myelodysplasia and acute myeloid leukemia. Because macrocytosis and thrombocytopenia are distinctive features of myelodysplasia, the authors evaluated a cohort of patients treated for ESFT to determine the degree and duration of macrocytosis and thrombocytopenia and their relation with the development of therapy-related hematologic malignancies. PATIENTS AND METHODS: The study group consisted of 73 patients with ESFT treated on two consecutive protocols (EW92 and EW87). Both chemotherapy regimens incorporated the same agents but differed in cumulative drug dose, dose per course, and the use of G-CSF. Platelet counts and the mean corpuscular volume (MCV) of erythrocytes were determined at diagnosis and during follow-up visits after completion of treatment. RESULTS: Patients in the EW92 group had significantly greater MCVs after treatment than did the less intensively treated EW87 group. These changes persisted throughout the 40-month observation period. Patients in the EW92 group also had lesser mean platelet counts after treatment than those in the EW87 group. MCV differences (from baseline) were inversely related to platelet counts. The cumulative incidence of treatment-related acute myeloid leukemia was 7.8%+/-4.7% at 4 years in the EW92 group and zero in the EW87 group. CONCLUSION: Patients treated for ESFT with intensive chemotherapy that includes large doses of alkylators, topoisomerase II inhibitors, and G-CSF characteristically have persistently elevated MCVs and decreased platelet counts after completion of therapy. These hematologic abnormalities may represent stem cell damage, predisposing patients to myelodysplasia and acute myeloid leukemia, but further study is needed to establish this relation.


Assuntos
Anemia Macrocítica/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Ósseas/sangue , Leucemia Mieloide/induzido quimicamente , Segunda Neoplasia Primária/induzido quimicamente , Sarcoma de Ewing/sangue , Trombocitopenia/induzido quimicamente , Adolescente , Adulto , Anemia Macrocítica/sangue , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Índices de Eritrócitos/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Lactente , Leucemia Mieloide/sangue , Masculino , Síndromes Mielodisplásicas/induzido quimicamente , Segunda Neoplasia Primária/sangue , Contagem de Plaquetas/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Sarcoma de Ewing/tratamento farmacológico , Trombocitopenia/sangue
19.
Cancer ; 88(9): 2172-80, 2000 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-10813731

RESUMO

BACKGROUND: Bone sarcomas of the head and neck are difficult to resect. The authors reviewed their institutional experience with these tumors to characterize patients' clinical findings and to assess the impact of surgical resection on outcome. METHODS: The records of the 28 patients with bone sarcomas originating in the head and neck treated at St. Jude Children's Research Hospital between March 1962 and January 1998 were reviewed. RESULTS: There were 10 males and 18 females (median age, 12.6 years) each with a single sarcoma: osteosarcoma (18), Ewing sarcoma (7), malignant fibrous histiocytoma (MFH) (2), and fibrosarcoma (1). Primary tumor sites included the maxilla (13), skull (10), mandible (2), and other sites (3). All but one patient with Ewing sarcoma had localized disease at the time of diagnosis. All patients underwent surgery: complete resection, 8; gross total resection, 4; incomplete resection, 14; and biopsy only, 2; 22 also received chemotherapy. Radiotherapy was given to all patients with Ewing sarcoma and to four patients with primary osteosarcoma. Twelve patients survived a median of 8.4 years after diagnosis, 14 died of disease, and 2 died of unrelated causes. Local disease progression was evident in 12 patients (9 with osteosarcoma, 2 with MFH, and 1 with Ewing sarcoma) who died of disease, 9 of whom had the initial treatment of biopsy alone or incomplete resection. Patients with osteosarcoma who had the initial treatment of incomplete resection or biopsy alone were more likely to experience local failure (P = 0.001) and had poorer survival (P = 0.014) than those who underwent complete or gross total resection. CONCLUSIONS: Bone sarcomas of the head and neck are rare among children and most often are localized at the time of diagnosis. Incomplete resection of osteosarcoma is associated with local failure and poor outcome. Although aggressive surgery is essential for the cure of osteosarcoma, its necessity in the treatment of Ewing sarcomas remains controversial.


Assuntos
Sarcoma/cirurgia , Neoplasias Cranianas/cirurgia , Adolescente , Adulto , Causas de Morte , Quimioterapia Adjuvante , Criança , Pré-Escolar , Progressão da Doença , Feminino , Fibrossarcoma/cirurgia , Histiocitoma Fibroso Benigno/cirurgia , Hospitais Pediátricos , Humanos , Lactente , Masculino , Neoplasias Mandibulares/cirurgia , Neoplasias Maxilares/cirurgia , Recidiva Local de Neoplasia/patologia , Osteossarcoma/cirurgia , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma de Ewing/cirurgia , Taxa de Sobrevida , Tennessee , Resultado do Tratamento
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