Characterizing beef and sheep farming systems to customize sustainability interventions and policy implementation.

Agricultural systems tend to be characterised by large diversity, therefore, solving socio-economic and environmental problems in agriculture requires targeted and contextualised policies. However, policies often fail to recognize this heterogeneity in their design or implementation. This can result in the use of sector-wide characteristics and, consequently, generic policies that are not tailored to specific farming systems. In this context, farm typologies can be a useful tool, as they help to identify differences and commonalities in highly heterogeneous groups. In this study, we focused on the Irish beef and sheep farming sectors and used a wide range of structural, socio-economic, and environmental indicators to develop a farm typology. This resulted in the identification of six distinct farm types: Small Cattle Farms, Extensive Sheep Farms, Medium-size Sheep Farms, Medium-size Cattle Farms, Medium-size Mixed Farms, and Intensive Cattle Farms. We then analysed the socio-economic and environmental performance of these six farm types and discussed the potential variation of the implementation and impact of currently proposed policies and interventions among farm types. We argue that failing to consider different farm types within policies can make their farm-level implementation unsuccessful and thus hinder the achievement of sector-wide sustainability goals. The approach we developed in this manuscript could also be applicable to other sectors and locations, and could help guide the design of more successful targeted policies.

Microglia and macrophages in glioblastoma: landscapes and treatment directions.

Glioblastoma is the most common primary malignant tumour of the central nervous system and remains uniformly and rapidly fatal. The tumour-associated macrophage (TAM) compartment comprises brain-resident microglia and bone marrow-derived macrophages (BMDMs) recruited from the periphery. Immune-suppressive and tumour-supportive TAM cell states predominate in glioblastoma, and immunotherapies, which have achieved striking success in other solid tumours have consistently failed to improve survival in this 'immune-cold' niche context. Hypoxic and necrotic regions in the tumour core are found to enrich, especially in anti-inflammatory and immune-suppressive TAM cell states. Microglia predominate at the invasive tumour margin and express pro-inflammatory and interferon TAM cell signatures. Depletion of TAMs, or repolarisation towards a pro-inflammatory state, are appealing therapeutic strategies and will depend on effective understanding and classification of TAM cell ontogeny and state based on new single-cell and spatial multi-omic in situ profiling. Here, we explore the application of these datasets to expand and refine TAM characterisation, to inform improved modelling approaches, and ultimately underpin the effective manipulation of function.

The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review.

INTRODUCTION: Lifestyle factors are expected to contribute to the persistence and burden of low-back pain (LBP). However, there are no systematic reviews on the (cost-)effectiveness of combined lifestyle interventions for overweight or obese people with LBP. AIM: To assess whether combined lifestyle interventions are (cost-)effective for people with persistent LBP who are overweight or obese, based on a systematic review. DESIGN: Systematic review METHOD: PubMed, Cochrane, Embase, CINAHL, PsycINFO and the Wiley/Cochrane Library were searched from database inception till January 6th 2023. Two independent reviewers performed study selection, data-extraction and risk of bias scoring using the Cochrane RoB tool 2 and/or the Consensus Health Economic Criteria list. GRADE was used to assess the level of certainty of the evidence. RESULTS: In total 2510 records were screened, and 4 studies on 3 original RCTs with 216 participants were included. Low certainty evidence (1 study) showed that combined lifestyle interventions were not superior to usual care for physical functioning, pain and lifestyle outcomes. Compared to usual care, moderate certainty evidence showed that healthcare (-$292, 95%CI: 872; -33), medication (-$30, 95% CI -65; -4) and absenteeism costs (-$1000, 95%CI: 3573; -210) were lower for the combined lifestyle interventions. CONCLUSION: There is low certainty evidence from 3 studies with predominantly small sample sizes, short follow-up and low intervention adherence that combined lifestyle interventions are not superior to physical functioning, pain and lifestyle outcomes compared to usual care, but are likely to be cost-effective.

Influence of urbanization on stream fish assemblages in three microbasins in the Upper Paraná River Basin / Influência da urbanização em assembleias de peixes de riachos em três microbacias na bacia do Alto Rio Paraná

Abstract The colonization pattern of fish assemblages in streams is often studied in the context of environmental filters. On the other hand, when fish assemblages are subjected to anthropogenic effects, variables associated with environmental quality assume more importance. Therefore, this work evaluated the richness and composition of fish from streams sampled at different urbanization levels, aiming to determine any direct effects on the structure of fish assemblages. To accomplish this, samples were collected from 2003 to 2011 at 31 sites distributed among 3 microbasins in the Rio Ivinhema Basin, Alto Rio Paraná. Based on environmental variables, physicochemical of the water and analysis of the use and occupation of the soil, the microbasins were classified into different urbanization levels (low, medium and high). A total of 4,320 individuals were sampled, out of which 57 fish species were recorded. Sampled sites with medium urbanization level presented higher richness compared to sampled sites with high urbanization level which presented lower richness. Species richness in these sites was explained mainly by water temperature and water velocity. Results confirmed that urbanization does directly affect environmental integrity, which, in turn, can lead to the homogenization of stream assemblages.

Resumo Estudos sobre assembleias de peixes em riachos enfatizam o papel dos filtros ambientais associados ao padrão de colonização das assembleias, por outro lado, quando a assembleia está sujeita aos efeitos antropogênicos, as variáveis ambientais associadas à qualidade ambiental assumem maior importância. Dessa forma, o objetivo deste estudo foi analisar a riqueza e a composição de peixes de riachos amostrados em diferentes níveis de urbanização, buscando evidenciar se o efeito reflete diretamente na estrutura das assembleias. As amostragens foram realizadas em 31 locais distribuídos em três microbacias na bacia Rio Ivinhema, Alto Rio Paraná, no período de 2003 a 2011. Com base nas variáveis ambientais, físico-químicos da água e análise do uso e ocupação do solo as microbacias foram classificadas em diferentes níveis de urbanização (baixo, médio e alto). Foram amostrados um total 4.320 indivíduos, dos quais foram registradas 57 espécies de peixes. Os locais amostrados com influência média da urbanização apresentaram maior riqueza de espécies, entretanto, os locais amostrados com alta influência da urbanização apresentaram menor riqueza de espécies. Dessa forma, constatamos que a urbanização influencia diretamente na integridade ambiental, que pode levar a homogeneização das assembleias de riachos.

Influence of urbanization on stream fish assemblages in three microbasins in the Upper Paraná River Basin / Influência da urbanização em assembleias de peixes de riachos em três microbacias na bacia do Alto Rio Paraná

The colonization pattern of fish assemblages in streams is often studied in the context of environmental filters. On the other hand, when fish assemblages are subjected to anthropogenic effects, variables associated with environmental quality assume more importance. Therefore, this work evaluated the richness and composition of fish from streams sampled at different urbanization levels, aiming to determine any direct effects on the structure of fish assemblages. To accomplish this, samples were collected from 2003 to 2011 at 31 sites distributed among 3 microbasins in the Rio Ivinhema Basin, Alto Rio Paraná. Based on environmental variables, physicochemical of the water and analysis of the use and occupation of the soil, the microbasins were classified into different urbanization levels (low, medium and high). A total of 4,320 individuals were sampled, out of which 57 fish species were recorded. Sampled sites with medium urbanization level presented higher richness compared to sampled sites with high urbanization level which presented lower richness. Species richness in these sites was explained mainly by water temperature and water velocity. Results confirmed that urbanization does directly affect environmental integrity, which, in turn, can lead to the homogenization of stream assemblages.

Estudos sobre assembleias de peixes em riachos enfatizam o papel dos filtros ambientais associados ao padrão de colonização das assembleias, por outro lado, quando a assembleia está sujeita aos efeitos antropogênicos, as variáveis ambientais associadas à qualidade ambiental assumem maior importância. Dessa forma, o objetivo deste estudo foi analisar a riqueza e a composição de peixes de riachos amostrados em diferentes níveis de urbanização, buscando evidenciar se o efeito reflete diretamente na estrutura das assembleias. As amostragens foram realizadas em 31 locais distribuídos em três microbacias na bacia Rio Ivinhema, Alto Rio Paraná, no período de 2003 a 2011. Com base nas variáveis ambientais, físico-químicos da água e análise do uso e ocupação do solo as microbacias foram classificadas em diferentes níveis de urbanização (baixo, médio e alto). Foram amostrados um total 4.320 indivíduos, dos quais foram registradas 57 espécies de peixes. Os locais amostrados com influência média da urbanização apresentaram maior riqueza de espécies, entretanto, os locais amostrados com alta influência da urbanização apresentaram menor riqueza de espécies. Dessa forma, constatamos que a urbanização influencia diretamente na integridade ambiental, que pode levar a homogeneização das assembleias de riachos.

Influence of urbanization on stream fish assemblages in three microbasins in the Upper Paraná River Basin

Abstract The colonization pattern of fish assemblages in streams is often studied in the context of environmental filters. On the other hand, when fish assemblages are subjected to anthropogenic effects, variables associated with environmental quality assume more importance. Therefore, this work evaluated the richness and composition of fish from streams sampled at different urbanization levels, aiming to determine any direct effects on the structure of fish assemblages. To accomplish this, samples were collected from 2003 to 2011 at 31 sites distributed among 3 microbasins in the Rio Ivinhema Basin, Alto Rio Paraná. Based on environmental variables, physicochemical of the water and analysis of the use and occupation of the soil, the microbasins were classified into different urbanization levels (low, medium and high). A total of 4,320 individuals were sampled, out of which 57 fish species were recorded. Sampled sites with medium urbanization level presented higher richness compared to sampled sites with high urbanization level which presented lower richness. Species richness in these sites was explained mainly by water temperature and water velocity. Results confirmed that urbanization does directly affect environmental integrity, which, in turn, can lead to the homogenization of stream assemblages.

Resumo Estudos sobre assembleias de peixes em riachos enfatizam o papel dos filtros ambientais associados ao padrão de colonização das assembleias, por outro lado, quando a assembleia está sujeita aos efeitos antropogênicos, as variáveis ambientais associadas à qualidade ambiental assumem maior importância. Dessa forma, o objetivo deste estudo foi analisar a riqueza e a composição de peixes de riachos amostrados em diferentes níveis de urbanização, buscando evidenciar se o efeito reflete diretamente na estrutura das assembleias. As amostragens foram realizadas em 31 locais distribuídos em três microbacias na bacia Rio Ivinhema, Alto Rio Paraná, no período de 2003 a 2011. Com base nas variáveis ambientais, físico-químicos da água e análise do uso e ocupação do solo as microbacias foram classificadas em diferentes níveis de urbanização (baixo, médio e alto). Foram amostrados um total 4.320 indivíduos, dos quais foram registradas 57 espécies de peixes. Os locais amostrados com influência média da urbanização apresentaram maior riqueza de espécies, entretanto, os locais amostrados com alta influência da urbanização apresentaram menor riqueza de espécies. Dessa forma, constatamos que a urbanização influencia diretamente na integridade ambiental, que pode levar a homogeneização das assembleias de riachos.

Interrater agreement of contouring of the neurovascular bundles and internal pudendal arteries in neurovascular-sparing magnetic resonance-guided radiotherapy for localized prostate cancer.

BACKGROUND AND PURPOSE: Radiation damage to neural and vascular tissue, such as the neurovascular bundles (NVBs) and internal pudendal arteries (IPAs), during radiotherapy for prostate cancer (PCa) may cause erectile dysfunction. Neurovascular-sparing magnetic resonance-guided adaptive radiotherapy (MRgRT) aims to preserve erectile function after treatment. However, the NVBs and IPAs are not routinely contoured in current radiotherapy practice. Before neurovascular-sparing MRgRT for PCa can be implemented, the interrater agreement of the contouring of the NVBs and IPAs on pre-treatment MRI needs to be assessed. MATERIALS AND METHODS: Four radiation oncologists independently contoured the prostate, NVB, and IPA in an unselected consecutive series of 15 PCa patients, on pre-treatment MRI. Dice similarity coefficients (DSCs) for pairwise interrater agreement of contours were calculated. Additionally, the DCS of a subset of the inferior half of the NVB contours (i.e. approximately prostate midgland to apex level) was calculated. RESULTS: Median overall interrater DSC for the left and right NVB was 0.60 (IQR: 0.54 - 0.68) and 0.61 (IQR: 0.53 - 0.69) respectively and for the left and right IPA 0.59 (IQR: 0.53 - 0.64) and 0.59 (IQR: 0.52 - 0.64) respectively. Median overall interrater DSC for the inferior half of the left NVB was 0.67 (IQR: 0.58 - 0.74) and 0.67 (IQR: 0.61 - 0.71) for the right NVB. CONCLUSION: We found that the interrater agreement for the contouring of the NVB and IPA improved with enhancement of the MRI sequence as well as further training of the raters. The agreement was best in the subset of the inferior half of the NVB, where a good agreement is clinically most relevant for neurovascular-sparing MRgRT for PCa.

Seminal vesicle intrafraction motion during the delivery of radiotherapy sessions on a 1.5 T MR-Linac.

PURPOSE: To evaluate seminal vesicle (SV) intrafraction motion using cinematic magnetic resonance imaging (cine-MR) during the delivery of online adaptive MR-Linac radiotherapy fractions, in preparation of MR-guided extremely hypofractionated radiotherapy for intermediate to high-risk prostate cancer patients. MATERIAL AND METHODS: Fifty prostate cancer patients were treated with 5 × 7.25 Gy on a 1.5 Tesla MR-Linac. 3D Cine-MR imaging was started simultaneously and acquired over the full beam-on period. Intrafraction motion in this cine-MR was determined for each SV separately with a previously validated soft-tissue contrast-based tracking algorithm. Motion statistics and coverage probability for the SVs and prostate were determined based on the obtained results. RESULTS: SV motion was automatically determined during the beam-on period (approx. 10 min) for 247 fractions. SV intrafraction motion shows larger spread than prostate intrafraction motion and increases over time. This difference is especially evident in the anterior and cranial translation directions. Significant difference in rotation about the left-right axis was found, with larger rotation for the SVs than the prostate. Intra-fraction coverage probability of 99% can be achieved when using 5 mm isometric expansion for the left and right SV and 3 mm for the prostate. CONCLUSION: This is the first study to investigate SV intrafraction motion during MR-guided RT sessions on an MR-Linac. We have shown that high quality 3D cine-MR imaging and SV tracking during RT is feasible with beam-on. The tracking method as described may be used as input for a fast replanning algorithm, which allows for intrafraction plan adaptation.

Geometrical imaging accuracy, image quality and plan quality for prostate cancer treatments on a 1.5 T MRLinac in patients with a unilateral hip implant.

Purpose.To assess the feasibility of prostate cancer radiotherapy for patients with a hip implant on an 1.5 T MRI-Linac (MRL) in terms of geometrical image accuracy, image quality, and plan quality.Methods.Pretreatment MRI images on a 1.5 T MRL and 3 T MRI consisting of a T2-weighted 3D delineation scan and main magnetic field homogeneity (B0) scan were performed in six patients with a unilateral hip implant. System specific geometrical errors due to gradient nonlinearity were determined for the MRL. Within the prostate and skin contour,B0inhomogeneity, gradient nonlinearity error and the total geometrical error (vector summation of the prior two) was determined. Image quality was determined by visually scoring the extent of implant-born image artifacts. A treatment planning study was performed on five patients to quantify the impact of the implant on plan quality, in which conventional MRL IMRT plans were created, as well as plans which avoid radiation through the left or right femur.Results.The total maximum geometrical error in the prostate was <1 mm and the skin contour <1.7 mm; in all cases the machine-specific gradient error was most dominant. TheB0error for the MRlinac MRI could partly be predicted based on the pre-treatment 3 T scan. Image quality for all patients was sufficient at 1.5 T MRL. Plan comparison showed that, even with avoidance of the hips, in all cases sufficient target coverage could be obtained with similar D1cc and D5cc to rectum and bladder, while V28Gy was slightly poorer in only the rectum for femur avoidance.Conclusion.We showed that geometrical accuracy, image quality and plan quality for six prostate patients with a hip implant or hip fixation treated on a 1.5 T MRL did not show relevant deterioration for the used image settings, which allowed safe treatment.

Influence of urbanization on stream fish assemblages in three microbasins in the Upper Paraná River Basin.

The colonization pattern of fish assemblages in streams is often studied in the context of environmental filters. On the other hand, when fish assemblages are subjected to anthropogenic effects, variables associated with environmental quality assume more importance. Therefore, this work evaluated the richness and composition of fish from streams sampled at different urbanization levels, aiming to determine any direct effects on the structure of fish assemblages. To accomplish this, samples were collected from 2003 to 2011 at 31 sites distributed among 3 microbasins in the Rio Ivinhema Basin, Alto Rio Paraná. Based on environmental variables, physicochemical of the water and analysis of the use and occupation of the soil, the microbasins were classified into different urbanization levels (low, medium and high). A total of 4,320 individuals were sampled, out of which 57 fish species were recorded. Sampled sites with medium urbanization level presented higher richness compared to sampled sites with high urbanization level which presented lower richness. Species richness in these sites was explained mainly by water temperature and water velocity. Results confirmed that urbanization does directly affect environmental integrity, which, in turn, can lead to the homogenization of stream assemblages.

Proton-electron mass ratio from laser spectroscopy of HD+ at the part-per-trillion level.

Recent mass measurements of light atomic nuclei in Penning traps have indicated possible inconsistencies in closely related physical constants such as the proton-electron and deuteron-proton mass ratios. These quantities also influence the predicted vibrational spectrum of the deuterated molecular hydrogen ion (HD+) in its electronic ground state. We used Doppler-free two-photon laser spectroscopy to measure the frequency of the v = 0→9 overtone transition (v, vibrational quantum number) of this spectrum with an uncertainty of 2.9 parts per trillion. By leveraging high-precision ab initio calculations, we converted our measurement to tight constraints on the proton-electron and deuteron-proton mass ratios, consistent with the most recent Penning trap determinations of these quantities. This results in a precision of 21 parts per trillion for the value of the proton-electron mass ratio.

Anatomically-adaptive multi-modal image registration for image-guided external-beam radiotherapy.

Image-guided radiotherapy (IGRT) allows observation of the location and shape of the tumor and organs-at-risk (OAR) over the course of a radiation cancer treatment. Such information may in turn be used for reducing geometric uncertainties during therapeutic planning, dose delivery and response assessment. However, given the multiple imaging modalities and/or contrasts potentially included within the imaging protocol over the course of the treatment, the current manual approach to determining tissue displacement may become time-consuming and error prone. In this context, variational multi-modal deformable image registration (DIR) algorithms allow automatic estimation of tumor and OAR deformations across the acquired images. In addition, they require short computational times and a low number of input parameters, which is particularly beneficial for online adaptive applications, which require on-the-fly adaptions with the patient on the treatment table. However, the majority of such DIR algorithms assume that all structures across the entire field-of-view (FOV) undergo a similar deformation pattern. Given that various anatomical structures may behave considerably different, this may lead to the estimation of anatomically implausible deformations at some locations, thus limiting their validity. Therefore, in this paper we propose an anatomically-adaptive variational multi-modal DIR algorithm, which employs a regionalized registration model in accordance with the local underlying anatomy. The algorithm was compared against two existing methods which employ global assumptions on the estimated deformations patterns. Compared to the existing approaches, the proposed method has demonstrated an improved anatomical plausibility of the estimated deformations over the entire FOV as well as displaying overall higher accuracy. Moreover, despite the more complex registration model, the proposed approach is very fast and thus suitable for online scenarios. Therefore, future adaptive IGRT workflows may benefit from an anatomically-adaptive registration model for precise contour propagation and dose accumulation, in areas showcasing considerable variations in anatomical properties.

Prostate intrafraction motion during the preparation and delivery of MR-guided radiotherapy sessions on a 1.5T MR-Linac.

PURPOSE: To evaluate prostate intrafraction motion using MRI during the full course of online adaptive MR-Linac radiotherapy (RT) fractions, in preparation of MR-guided extremely hypofractionated RT. MATERIAL AND METHODS: Five low and intermediate risk prostate cancer patients were treated with 20 × 3.1 Gy fractions on a 1.5T MR-Linac. Each fraction, initial MRI (Pre) scans were obtained at the start of every treatment session. Pre-treatment planning MRI contours were propagated and adapted to this Pre scan after which plan re-optimization was started in the treatment planning system followed by dose delivery. 3D Cine-MR imaging was started simultaneously with beam-on and acquired over the full beam-on period. Prostate intrafraction motion in this cine-MR was determined with a previously validated soft-tissue contrast based tracking algorithm. In addition, absolute accuracy of the method was determined using a 4D phantom. RESULTS: Prostate motion was completely automatically determined over the full on-couch period (approx. 45 min) with no identified mis-registrations. The translation 95% confidence intervals are within clinically applied margins of 5 mm, and plan adaption for intrafraction motion was required in only 4 out of 100 fractions. CONCLUSION: This is the first study to investigate prostate intrafraction motions during entire MR-guided RT sessions on an MR-Linac. We have shown that high quality 3D cine-MR imaging and prostate tracking during RT is feasible with beam-on. The clinically applied margins of 5 mm have proven to be sufficient for these treatments and may potentially be further reduced using intrafraction plan adaptation guided by cine-MR imaging.

In-depth characterization of polyolefin plastomers/elastomers (ethylene/1-octene copolymers) through hyphenated chromatographic techniques.

The chemical composition distribution (CCD) of three single site made ethylene/1-octene copolymers was investigated through offline-hyphenation of solvent gradient interaction chromatography (SGIC) with 1H NMR. Thus, a clear, non-linear correlation between SGIC elution time and chemical composition was found under the specific measurement conditions applied here. The application of 1H NMR as detection allowed to determine the CCD with unprecedented accuracy. 2D-LC of the copolymers revealed the correlation between CCD and molar mass distribution (MMD) in a quantitative manner. Furthermore, this approach allowed a comparison between the response behavior of an evaporative light scattering detector (ELSD, semi-quantitative, commonly applied in SGIC) and that of an infrared (IR) detector (quantitative, commonly applied in SEC). As a result, it could be shown that ELSD results are close to IR results for the system investigated here, in other words, the often-criticized semi-quantitative response behavior of the ELSD is affecting results in an acceptable manner.

Fast contour propagation for MR-guided prostate radiotherapy using convolutional neural networks.

PURPOSE: To quickly and automatically propagate organ contours from pretreatment to fraction images in magnetic resonance (MR)-guided prostate external-beam radiotherapy. METHODS: Five prostate cancer patients underwent 20 fractions of image-guided external-beam radiotherapy on a 1.5 T MR-Linac system. For each patient, a pretreatment T2-weighted three-dimensional (3D) MR imaging (MRI) scan was used to delineate the clinical target volume (CTV) contours. The same scan was repeated during each fraction, with the CTV contour being manually adapted if necessary. A convolutional neural network (CNN) was trained for combined image registration and contour propagation. The network estimated the propagated contour and a deformation field between the two input images. The training set consisted of a synthetically generated ground truth of randomly deformed images and prostate segmentations. We performed a leave-one-out cross-validation on the five patients and propagated the prostate segmentations from the pretreatment to the fraction scans. Three variants of the CNN, aimed at investigating supervision based on optimizing segmentation overlap, optimizing the registration, and a combination of the two were compared to results of the open-source deformable registration software package Elastix. RESULTS: The neural networks trained on segmentation overlap or the combined objective achieved significantly better Hausdorff distances between predicted and ground truth contours than Elastix, at the much faster registration speed of 0.5 s. The CNN variant trained to optimize both the prostate overlap and deformation field, and the variant trained to only maximize the prostate overlap, produced the best propagation results. CONCLUSIONS: A CNN trained on maximizing prostate overlap and minimizing registration errors provides a fast and accurate method for deformable contour propagation for prostate MR-guided radiotherapy.

Dosimetric impact of soft-tissue based intrafraction motion from 3D cine-MR in prostate SBRT.

To investigate the dosimetric impact of intrafraction translation and rotation motion of the prostate, as extracted from daily acquired post-treatment 3D cine-MR based on soft-tissue contrast, in extremely hypofractionated (SBRT) prostate patients. Accurate dose reconstruction is performed by using a prostate intrafraction motion trace which is obtained with a soft-tissue based rigid registration method on 3D cine-MR dynamics with a temporal resolution of 11 s. The recorded motion of each time-point was applied to the planning CT, resulting in the respective dynamic volume used for dose calculation. For each treatment fraction, the treatment delivery record was generated by proportionally splitting the plan into 11 s intervals based on the delivered monitor units. For each fraction the doses of all partial plan/dynamic volume combinations were calculated and were summed to lead to the motion-affected fraction dose. Finally, for each patient the five fraction doses were summed, yielding the total treatment dose. Both daily and total doses were compared to the original reference dose of the respective patient to assess the impact of the intrafraction motion. Depending on the underlying motion of the prostate, different types of motion-affected dose distributions were observed. The planning target volumes (PTVs) ensured CTV_30 (seminal vesicles) D99% coverage for all patients, CTV_35 (prostate corpus) coverage for 97% of the patients and GTV_50 (local boost) for 83% of the patients when compared against the strict planning target D99% value. The dosimetric impact due to prostate intrafraction motion in extremely hypofractionated treatments was determined. The presented study is an essential step towards establishing the actual delivered dose to the patient during radiotherapy fractions.

Frequency and prognosis of associated malignancies in 504 patients with lymphomatoid papulosis.

BACKGROUND: Lymphomatoid papulosis (LyP) can be associated with other haematological malignancies (HM), but reported percentages vary from 20% to over 50%. OBJECTIVE: To evaluate the frequency and prognostic significance of associated HM and non-HM in LyP patients. METHODS: In this multicentre cohort study, the complete Dutch LyP population was included from the Dutch Cutaneous Lymphoma Registry between 1985 and 2018. Clinical and histopathological information was retrieved from every individual patient. RESULTS: After a median follow-up of 120 months (range, 6-585), an associated HM was observed in 78/504 (15.5%) patients. Most common associated HM were mycosis fungoides (MF; n = 31) and anaplastic large-cell lymphoma (ALCL; n = 29), while 19 patients had another HM of B-cell (n = 14) or myeloid origin (n = 5). Even after a 25-year follow-up period, percentages of associated HM did not exceed 20%. Thirty-nine of 465 patients (8.4%) without a prior or concurrent associated HM developed an associated HM during follow-up, after a median of 68 months (range of 3-286 months). Nine of 78 patients died of associated HM, including 6/22 patients developing extracutaneous ALCL, while all patients with associated MF or skin-limited ALCL had an excellent prognosis. Compared with the general population, LyP patients showed an increased risk (relative risk, 2.8; 95% confidence intervals, 2.4-3.3) for non-HM, in particular cutaneous squamous cell carcinoma, melanoma and intestinal/lung/bladder cancer. CONCLUSIONS: An associated HM was reported in 15.5% of the LyP patients, particularly MF and ALCL. Although the frequency of associated HM is lower than suggested and the prognosis of most patients with associated HM is excellent, a small subgroup will develop aggressive disease, in particular extracutaneous ALCL. Furthermore, LyP patients have a higher risk of developing other malignancies. Clinicians should be aware of these risks, and LyP patients require close monitoring.