Randomized, Double-Blind, Placebo-Controlled Phase II Study of Yeast-Brachyury Vaccine (GI-6301) in Combination with Standard-of-Care Radiotherapy in Locally Advanced, Unresectable Chordoma.

BACKGROUND: Brachyury is a transcription factor overexpressed in chordoma and is associated with chemotherapy resistance and epithelial-to-mesenchymal transition. GI-6301 is a recombinant, heat-killed Saccharomyces cerevisiae yeast-based vaccine targeting brachyury. A previous phase I trial of GI-6301 demonstrated a signal of clinical activity in chordomas. This trial evaluated synergistic effects of GI-6301 vaccine plus radiation. MATERIALS AND METHODS: Adults with locally advanced, unresectable chordoma were treated on a randomized, placebo-controlled trial. Patients received three doses of GI-6301 (80 × 107 yeast cells) or placebo followed by radiation, followed by continued vaccine or placebo until progression. Primary endpoint was overall response rate, defined as a complete response (CR) or partial response (PR) in the irradiated tumor site at 24 months. Immune assays were conducted to evaluate immunogenicity. RESULTS: Between May 2015 and September 2019, 24 patients enrolled on the first randomized phase II study in chordoma. There was one PR in each arm; no CRs were observed. Median progressive-free survival for vaccine and placebo arms was 20.6 months (95% confidence interval [CI], 5.7-37.5 months) and 25.9 months (95% CI, 9.2-30.8 months), respectively. Hazard ratio was 1.02 (95% CI, 0.38-2.71). Vaccine was well tolerated with no vaccine-related serious adverse events. Preexisting brachyury-specific T cells were detected in most patients in both arms. Most patients developed T-cell responses during therapy, with no difference between arms in frequency or magnitude of response. CONCLUSION: No difference in overall response rate was observed, leading to early discontinuation of this trial due to low conditional power to detect statistical difference at the planned end of accrual. IMPLICATIONS FOR PRACTICE: Chordoma is a rare neoplasm lacking effective systemic therapies for advanced, unresectable disease. Lack of clinically actionable somatic mutations in chordoma makes development of targeted therapy quite challenging. While the combination of yeast-brachyury vaccine (GI-6301) and standard radiation therapy did not demonstrate synergistic antitumor effects, brachyury still remains a good target for developmental therapeutics in chordoma. Patients and their oncologists should consider early referral to centers with expertise in chordoma (or sarcoma) and encourage participation in clinical trials.

ENABLE (Exportable Notation and Bookmark List Engine): an Interface to Manage Tumor Measurement Data from PACS to Cancer Databases.

Oncologists evaluate therapeutic response in cancer trials based on tumor quantification following selected "target" lesions over time. At our cancer center, a majority of oncologists use Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 quantifying tumor progression based on lesion measurements on imaging. Currently, our oncologists handwrite tumor measurements, followed by multiple manual data transfers; however, our Picture Archiving Communication System (PACS) (Carestream Health, Rochester, NY) has the ability to export tumor measurements, making it possible to manage tumor metadata digitally. We developed an interface, "Exportable Notation and Bookmark List Engine" (ENABLE), which produces prepopulated RECIST v1.1 worksheets and compiles cohort data and data models from PACS measurement data, thus eliminating handwriting and manual data transcription. We compared RECIST v1.1 data from eight patients (16 computed tomography exams) enrolled in an IRB-approved therapeutic trial with ENABLE outputs: 10 data fields with a total of 194 data points. All data in ENABLE's output matched with the existing data. Seven staff were taught how to use the interface with a 5-min explanatory instructional video. All were able to use ENABLE successfully without additional guidance. We additionally assessed 42 metastatic genitourinary cancer patients with available RECIST data within PACS to produce a best response waterfall plot. ENABLE manages tumor measurements and associated metadata exported from PACS, producing forms and data models compatible with cancer databases, obviating handwriting and the manual re-entry of data. Automation should reduce transcription errors and improve efficiency and the auditing process.

Management of epilepsy in resource-limited areas: establishing an epilepsy surgery program in Iran.

Background Of about 40 million people with epilepsy, who live in developing countries, the majority do not receive appropriate treatment. Nonetheless, there are striking disparities among the so-called developing countries, however generally speaking, access to and availability of epilepsy management programs in developing countries are very limited and therefore, the issue of developing epilepsy centers in resource-limited settings in a large scale is very essential. The surgery for epilepsy, including temporal lobotomy, lesionectomy and corpus colostomy, for patients with medically-refractory seizures, defined as failure of adequate trials of two tolerated, appropriately chosen and using antiepileptic drug to achieve sustained freedom, from seizure has been proved to be feasible and cost-effective in developing countries. However, the success of epilepsy surgery depends upon the accurate identification of good surgical candidates based on the available resources and technologies without jeopardizing safety. In the current paper, we will share our experiences of establishing an epilepsy surgery program in Iran, despite all short-comings and limitations and try to provide some answers to those challenges, which helped us establish our program.

An effective method for segmentation of MR brain images using the ant colony optimization algorithm.

Since segmentation of magnetic resonance images is one of the most important initial steps in brain magnetic resonance image processing, success in this part has a great influence on the quality of outcomes of subsequent steps. In the past few decades, numerous methods have been introduced for classification of such images, but typically they perform well only on a specific subset of images, do not generalize well to other image sets, and have poor computational performance. In this study, we provided a method for segmentation of magnetic resonance images of the brain that despite its simplicity has a high accuracy. We compare the performance of our proposed algorithm with similar evolutionary algorithms on a pixel-by-pixel basis. Our algorithm is tested across varying sets of magnetic resonance images and demonstrates high speed and accuracy. It should be noted that in initial steps, the algorithm is computationally intensive requiring a large number of calculations; however, in subsequent steps of the search process, the number is reduced with the segmentation focused only in the target area.

A pilot study of volumetric and density tumor analysis of ACC patients treated with vorinostat in a phase II clinical trial.

Rationale and objectives: Adenoid cystic carcinoma (ACC) is a rare salivary gland cancer. The vast majority of clinical trials evaluating systemic therapy efficacy in solid tumors use the Response Evaluation Criteria in Solid Tumors (RECIST) to measure response that is limited to 2 dimensional only evaluations, not taking volume or density into account. The indolent behavior ACC represents a challenge toward an appropriate evaluation of therapy response. Objectives: 1) To describe and contrast volumetric and density changes at each time-point, including changes noted from baseline to best response, to currently used 2 dimensional-only criteria (RECIST) and 2) To report the coefficient of variation in volume measurement among three reviewers on a subset of ACC patients. Materials and methods: We retrospectively assessed a cohort of 18 prospectively treated patients with ACC in a phase 2 trial with vorinostat using a volumetric (viable tumor volume, VTV) and density criteria. Three independent and blinded observers segmented target lesions across a sample of randomly selected computed tomography (CT) exams to examine inter-observer variation. Results: We found that the average coefficient of variation among observers for all target lesions was 16.1%, with lung lesions displaying a smaller variation at 14.0% (p-value >0.17). We describe examples of decrease in volume and density in several lesions despite stable disease by RECIST. Conclusion: This pilot study demonstrates that two-dimensional criteria such as RECIST may not be the best criteria to assess response to therapy, especially with evolving tools within picture archiving and communication system (PACS) that can assess volumetric size, density and texture, however, this should be prospectively studied.

Frequency and distribution of asymptomatic brain lesions in patients with ß-thalassemia intermedia.

We aimed to determine the frequency of asymptomatic brain lesions in a group of patients with ß-thalassemia intermedia (ß-TI) and to evaluate correlation of asymptomatic brain lesions with splenectomy, thrombocytosis, blood transfusions, and clinical parameters. Ninety five neurologically intact patients with ß-TI were randomly enrolled in this cross-sectional study. Diffusion-weighted imaging brain MRI was performed in every patient to detect cerebral white matter lesions (WML). We found an overall frequency of 15 (15.8 %) for WMLs, 14 (23.7 %) in splenectomized, and 1 (2.8 %) in nonsplenectomized patients. The presence of WML was significantly associated with splenectomy (P = 0.008) and thrombocytosis (P = 0.009). However, after adjustment for splenectomy, thrombocytosis was not significantly associated with the presence of WML (P > 0.05). The number of patients with regular blood transfusions and normal MRI was not significantly higher compared to those with abnormal findings (52.5 % vs. 26.7 %; P = 0.092). In untransfused patients, hydroxyurea (HU) administration was associated with a lower incidence of WML (P < 0.001). Although in univariate analysis either splenectomy or thrombocytosis showed significant correlation with the presence of single or multiple WMLs, thrombocytosis by itself did not significantly contribute in developing asymptomatic brain lesions. The lack of significant correlation between lesions and regular blood transfusions could be related to the treatment with HU in untransfused patients, which increased fetal hemoglobin levels and improved the morphology and the pathological indices of the red blood cells. Larger prospective studies are suggested for the accurate evaluation of the correlation of these factors with developing asymptomatic brain lesions.

Effects of Melissa officinalis L. on oxidative status and DNA damage in subjects exposed to long-term low-dose ionizing radiation.

The aim of this study was to determine the capability of Melissa officinalis L. (Lemon balm) infusion on improvement of oxidative stress status in radiology staff that were exposed to persistent low-dose radiation during work. The study was a before-after clinical trial performed on 55 radiology staff. They were asked to drink Lemon balm infusion which was prepared like a tea bag twice daily (1.5 g/100 mL) for 30 days. In the plasma, lipid peroxidation, DNA damage, catalase, superoxide dismutase, myeloperoxidase, and glutathione peroxidase activity were measured before and after using Lemon balm infusion.Use of Lemon balm infusion in radiology unit workers resulted in a significant improvement in plasma levels of catalase, superoxide dismutase, and glutathione peroxidase and a marked reduction in plasma DNA damage, myeloperoxidase, and lipid peroxidation. It is concluded that infusion of Lemon balm markedly improve oxidative stress condition and DNA damage in radiology staff when used as a dietary supplement for radiation protection.

Breast cancer metastasis to pituitary infandibulum.

Metastasis from breast cancer to other parts of the body is very common, but the spread of the tumor to pituitary gland, especially to infandibulum, is a rare presentation. At the time of pituitary metastasis, a majority of the patients have clinical and radiological evidence of the disease. It seems that the posterior area of the gland is the most common site of metastasis, probably due to highly rich blood supply through the hypophyseal artery. The present report introduces a case of a 55-years-old woman presented with diabetes insipidus resulting from metastasis of the tumor to pituitary infandibulum, which is a rare site for metastasis, without significant complaint resulting from metastasis to other part of the body, or other primary diseases. Further evaluation revealed that in spite of previous reports, which metastasis usually happens in end stage of cancer, the patients had primary breast cancer. In subsequent evaluations of the case, hypofunction of adenohypophysis was also detected.

TCR-engineered T cells targeting E7 for patients with metastatic HPV-associated epithelial cancers.

Genetically engineered T cell therapy can induce remarkable tumor responses in hematologic malignancies. However, it is not known if this type of therapy can be applied effectively to epithelial cancers, which account for 80-90% of human malignancies. We have conducted a first-in-human, phase 1 clinical trial of T cells engineered with a T cell receptor targeting HPV-16 E7 for the treatment of metastatic human papilloma virus-associated epithelial cancers (NCT02858310). The primary endpoint was maximum tolerated dose. Cell dose was not limited by toxicity with a maximum dose of 1 × 1011 engineered T cells administered. Tumor responses following treatment were evaluated using RECIST (Response Evaluation Criteria in Solid Tumors) guidelines. Robust tumor regression was observed with objective clinical responses in 6 of 12 patients, including 4 of 8 patients with anti-PD-1 refractory disease. Responses included extensive regression of bulky tumors and complete regression of most tumors in some patients. Genomic studies, which included intra-patient tumors with dichotomous treatment responses, revealed resistance mechanisms from defects in critical components of the antigen presentation and interferon response pathways. These findings demonstrate that engineered T cells can mediate regression of common carcinomas, and they reveal immune editing as a constraint on the curative potential of cellular therapy and possibly other immunotherapies in advanced epithelial cancer.

Triangular cord sign in detection of biliary atresia: is it a valuable sign?

BACKGROUND: Early detection of biliary atresia (BA) has a vital role in prevention of liver cirrhosis in these patients. There are some evidences that triangular cord (TC) sign, i.e., triangular structure located cranial to the portal vein bifurcation on ultrasonographic examination, is suggestive of BA in suspected cases. The aim of this study is to evaluate and compare the sensitivity, specificity, and accuracy of TC sign with other methods of diagnosis such as hepatobiliary scan. METHODS: Fifty-eight infants referred to pediatric gastroenterology ward with diagnosis of infantile cholestasis from March 2004 to March 2008 were evaluated to find the cause of cholestasis. Diagnosis was made by means of history, clinical examination, hepatobiliary scan, and liver biopsy. Ultrasonographic examination was focused on presence of TC sign in patients. If the diagnosis was in favor of BA, patient was sent for direct cholangiography as a gold-standard test for confirmation of the diagnosis. The sensitivity, specificity, and accuracy of the tests were compared with golden standard. RESULTS: Among 58 infants with infantile cholestasis, BA was diagnosed and confirmed in 10 infants (17.2%). Hepatobiliary scintigraphy had 80% sensitivity, 72.9% specificity, and 74.1% accuracy. TC sign had 70% sensitivity, 95.8% specificity, and 91.3% accuracy. CONCLUSION: TC sign is more accurate than hepatobiliary scan and has acceptable sensitivity and specificity for diagnosis of BA.

Adherence to the algorithmic approach for diagnosis of pulmonary embolism: A teaching hospital experience, Shiraz, Iran.

BACKGROUND: We evaluated to see if the algorithmic approach of pulmonary embolism (PE) [Wells' score, followed by D-dimer test and computed tomography pulmonary angiography (CTPA)] is appropriately followed in teaching hospitals of Shiraz, Iran. METHODS: From October 2012 to October 2013, we prospectively calculated Wells' score for all patients who underwent CTPA with clinical suspicion to PE; patients with low probability who had not checked the D-dimer or had low level of D-dimer were considered as non-adherent to the guideline and those with high level of D-dimer or high probability of Wells' score were labeled as adherent to the PE guideline. CTPA scans were independently reported by two radiologists. RESULTS: During study period, 364 patients underwent CTPA to rule out PE, of which 125 (34.3%) had Wells' score > 4 (high probable risk) and 239 had Wells' score ≤ 4. Amongst low probable risk patients (Wells' score ≤ 4), only 32 patients had undergone the D-dimer test (23 patients had high level of D-dimer). Based on the algorithmic approach, patients with suspected PE, patients with high probability (125 patients), and patients with low probability with elevated D-dimer level (23 patients) were considered as adherent to the PE guideline; consequently, the total adherence to PE guideline was 148 out of 364 (40.6%). CONCLUSION: We followed the algorithmic approach guideline in about 40.0% of cases; however, we should pay more attention to the algorithmic approach in patients with suspected PE.

Technical and Clinical Factors Affecting Success Rate of a Deep Learning Method for Pancreas Segmentation on CT.

PURPOSE: Accurate pancreas segmentation has application in surgical planning, assessment of diabetes, and detection and analysis of pancreatic tumors. Factors that affect pancreas segmentation accuracy have not been previously reported. The purpose of this study is to identify technical and clinical factors that adversely affect the accuracy of pancreas segmentation on CT. METHOD AND MATERIALS: In this IRB and HIPAA compliant study, a deep convolutional neural network was used for pancreas segmentation in a publicly available archive of 82 portal-venous phase abdominal CT scans of 53 men and 29 women. The accuracies of the segmentations were evaluated by the Dice similarity coefficient (DSC). The DSC was then correlated with demographic and clinical data (age, gender, height, weight, body mass index), CT technical factors (image pixel size, slice thickness, presence or absence of oral contrast), and CT imaging findings (volume and attenuation of pancreas, visceral abdominal fat, and CT attenuation of the structures within a 5 mm neighborhood of the pancreas). RESULTS: The average DSC was 78% ± 8%. Factors that were statistically significantly correlated with DSC included body mass index (r = 0.34, p < 0.01), visceral abdominal fat (r = 0.51, p < 0.0001), volume of the pancreas (r = 0.41, p = 0.001), standard deviation of CT attenuation within the pancreas (r = 0.30, p = 0.01), and median and average CT attenuation in the immediate neighborhood of the pancreas (r = -0.53, p < 0.0001 and r = -0.52, p < 0.0001). There were no significant correlations between the DSC and the height, gender, or mean CT attenuation of the pancreas. CONCLUSION: Increased visceral abdominal fat and accumulation of fat within or around the pancreas are major factors associated with more accurate segmentation of the pancreas. Potential applications of our findings include assessment of pancreas segmentation difficulty of a particular scan or dataset and identification of methods that work better for more challenging pancreas segmentations.

Augmented Radiologist Workflow Improves Report Value and Saves Time: A Potential Model for Implementation of Artificial Intelligence.

RATIONALE AND OBJECTIVES: Our primary aim was to improve radiology reports by increasing concordance of target lesion measurements with oncology records using radiology preprocessors (RP). Faster notification of incidental actionable findings to referring clinicians and clinical radiologist exam interpretation time savings with RPs quantifying tumor burden were also assessed. MATERIALS AND METHODS: In this prospective quality improvement initiative, RPs annotated lesions before radiologist interpretation of CT exams. Clinical radiologists then hyperlinked approved measurements into interactive reports during interpretations. RPs evaluated concordance with our tumor measurement radiologist, the determinant of tumor burden. Actionable finding detection and notification times were also deduced. Clinical radiologist interpretation times were calculated from established average CT chest, abdomen, and pelvis interpretation times. RESULTS: RPs assessed 1287 body CT exams with 812 follow-up CT chest, abdomen, and pelvis studies; 95 (11.7%) of which had 241 verified target lesions. There was improved concordance (67.8% vs. 22.5%) of target lesion measurements. RPs detected 93.1% incidental actionable findings with faster clinician notification by a median time of 1 hour (range: 15 minutes-16 hours). Radiologist exam interpretation times decreased by 37%. CONCLUSIONS: This workflow resulted in three-fold improved target lesion measurement concordance with oncology records, earlier detection and faster notification of incidental actionable findings to referring clinicians, and decreased exam interpretation times for clinical radiologists. These findings demonstrate potential roles for automation (such as AI) to improve report value, worklist prioritization, and patient care.

Phase I Study of Cabozantinib and Nivolumab Alone or With Ipilimumab for Advanced or Metastatic Urothelial Carcinoma and Other Genitourinary Tumors.

PURPOSE: We assessed the safety and efficacy of cabozantinib and nivolumab (CaboNivo) and CaboNivo plus ipilimumab (CaboNivoIpi) in patients with metastatic urothelial carcinoma (mUC) and other genitourinary (GU) malignances. PATIENTS AND METHODS: Patients received escalating doses of CaboNivo or CaboNivoIpi. The primary objective was to establish a recommended phase II dose (RP2D). Secondary objectives included objective response rate (ORR), progression-free survival (PFS), duration of response (DoR), and overall survival (OS). RESULTS: Fifty-four patients were enrolled at eight dose levels with a median follow-up time of 44.6 months; data cutoff was January 20, 2020. Grade 3 or 4 treatment-related adverse events (AEs) occurred in 75% and 87% of patients treated with CaboNivo and CaboNivoIpi, respectively, and included fatigue (17% and 10%, respectively), diarrhea (4% and 7%, respectively), and hypertension (21% and 10%, respectively); grade 3 or 4 immune-related AEs included hepatitis (0% and 13%, respectively) and colitis (0% and 7%, respectively). The RP2D was cabozantinib 40 mg/d plus nivolumab 3 mg/kg for CaboNivo and cabozantinib 40 mg/d, nivolumab 3 mg/kg, and ipilimumab 1 mg/kg for CaboNivoIpi. ORR was 30.6% (95% CI, 20.0% to 47.5%) for all patients and 38.5% (95% CI, 13.9% to 68.4%) for patients with mUC. Median DoR was 21.0 months (95% CI, 5.4 to 24.1 months) for all patients and not reached for patients with mUC. Median PFS was 5.1 months (95% CI, 3.5 to 6.9 months) for all patients and 12.8 months (95% CI, 1.8 to 24.1 months) for patients with mUC. Median OS was 12.6 months (95% CI, 6.9 to 18.8 months) for all patients and 25.4 months (95% CI, 5.7 to 41.6 months) for patients with mUC. CONCLUSION: CaboNivo and CaboNivoIpi demonstrated manageable toxicities with durable responses and encouraging survival in patients with mUC and other GU tumors. Multiple phase II and III trials are ongoing for these combinations.

Cytologic findings in pigmented melanotic schwannoma: a case report.

BACKGROUND: Psammomatous melanotic schwannoma (PMS) is a rare pigmented neural tumor most commonly occurring in the paraspinal region. This rare tumor can cause diagnostic difficulties in imprint cytology due to cellular details masked by heavy melanin pigments. CASE: A 37-year-old man presented with an 8-month history of lower back pain with no stigmata of Carney's syndrome on physical examination. Radiologic studies showed a 3.5-cm epidural mass in the region of the left L2 nerve root. Imprint smears from the biopsied tissue fragment revealed mainly epithelioid cells with prominent nucleoli and variable amounts of cytoplasmic brown pigment, indicating a pigmented tumor with neuronal origin PMS, which was confirmed by histologic and immunohistochemical studies of the resected tumor. CONCLUSION: PMS is a rare entity, and it is important to differentiate PMS from other pigmented tumors in the spinal canal, such as melanocytoma and malignant melanoma. It should be included in the differential diagnosis to avoid overtreatment.

Bilateral renal lymphangiomatosis: sonographic findings.

Renal lymphangiomatosis is an exceedingly rare disorder characterized by developmental malformation of the lymphatic system surrounding the kidneys. We report a case of bilateral renal lymphangiomatosis in a 21-year-old man who underwent abdominal sonographic examination that revealed numerous cystic areas of various sizes around both kidneys with extension along the renal hilum. Subsequent abdominal CT examination demonstrated bilateral, multilocular, fluid-filled cystic masses with thin walls in the perirenal and peripelvic region. MRI of the patient revealed bilaterally enlarged kidneys with multiple hyperintense lesions in both perirenal spaces and the peripelvic area on T2-weighted images. These cystic spaces appeared hypointense on T1-weighted images with no enhancement in postcontrast images. The diagnosis of renal lymphangiomatosis was made based on typical imaging findings.

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery and delayed contrast-enhanced brain MRI in multiple sclerosis.

RATIONALE AND OBJECTIVES: In brain MRI of multiple sclerosis (MS) patients, enhancement of the lesions is usually evaluated in early contrast-enhanced T1-weighted images (CE-T1WI). The objective of this study is to determine the sensitivity of contrast-enhanced fluid-attenuated-inversion-recovery (CE-FLAIR) and delayed contrast-enhanced MRI in evaluation of MS brain lesions. MATERIALS AND METHODS: Brain MRI examination including early and delayed CE-T1WI and early and delayed CE-FLAIR images was performed for 46 patients with clinically definite MS disease. Number, size, location, degree, and pattern of enhancement of the enhanced lesions in each sequence were recorded separately. RESULTS: A total number of 87 enhanced lesions was detected in 30 patients. Early CE-T1WI could detect only 63 lesions (72.4% of total) in 24 patients, while delayed CE-T1WI and early and delayed CE-FLAIR images showed 85 (97.7%), 84 (96.6%), and 81 (93.1%) lesions in 28, 28, and 26 patients, respectively. A greater degree of enhancement and larger lesion size were observed in the additional sequences compared with the early CE-T1WI. CONCLUSIONS: The sensitivity of early CE-T1WI for the detection of enhanced MS lesions is significantly lower than that for other additional sequences. Delayed CE-FLAIR images could not add significant information to other sequences. Therefore, early CE-FLAIR and delayed CE-T1WI brain MRI can be considered as part of the evaluation of MS patients, especially if, despite clinically suspected active disease, no enhanced lesion is found in the routine CE-T1WI.

Effect of low-level laser therapy on fracture healing in rabbits.

BACKGROUND AND AIMS: The purpose of this study was to investigate the effect of low-level laser therapy (LLLT) on radial bone fracture gap healing in a rabbit model. MATERIALS SUBJECTS AND METHODS: Thirty male white New Zealand rabbits under general anesthesia had a 3mm slice of radial bone surgically removed. Fifteen rabbits were treated by 830 nm laser at 4 J/cm2 and 15 were used as non-treated controls. Callus development was assessed by X-ray and radiographs every 7 days for 3 weeks. RESULTS: Significant radiologic changes were observed in both groups against time (P > 0.001) or from week to week (P > 0.05). However, there was no statistical difference in radiologic scores after week 2 (P = 0.087) or week 3 (P = 0.077) between control and laser treated bone. CONCLUSIONS: Findings suggest that in this study, laser treatment did not enhance callus formation nor reduce repair time of complete fracture of the radius in rabbits.