Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study.

PURPOSE: To characterize the significance of patient-level influences, including smoking history, on oncologic outcomes in human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC). MATERIALS AND METHODS: A bi-institutional retrospective cohort study of previously untreated, HPV+ OPC patients who underwent curative treatment from 1/1/2008 to 7/1/2018 was performed. The primary outcome was disease-free survival (DFS) and the primary exposure was ≤10 versus >10-pack-year (PY)-smoking history. RESULTS: Among 953 OPC patients identified, 342 individuals with HPV+ OPC were included. The median patient age was 62 years, 33.0% had a > 10-PY-smoking history, 60.2% had AJCC8 stage I disease, and 35.0% underwent primary surgery. The median follow-up was 49 months (interquartile range [IQR] 32-75 months). Four-year DFS-estimates were similar among patients with ≤10-PY-smoking history (78.0%, 95% CI:71.7%-83.1%) compared to >10-PYs (74.8%; 95% CI:65.2%-82.0%; log-rank:p = 0.53). On univariate analysis, >10-PY-smoking history did not correlate with DFS (hazard ratio[HR]:1.15;95% CI:0.74-1.79) and remained nonsignificant when forced into the multivariable model. On adjusted analyses, stage, treatment paradigm, and age predicted DFS. Neither >10-PYs, nor any other definition of tobacco use (e.g., current smoker or > 20-PYs) was predictive of DFS, overall survival, or disease-specific survival. Conversely, age nonsignificantly and significantly predicted adjusted DFS (adjusted HR[aHR]:1.02,95% CI:0.997-1.05, p = 0.08), overall survival (aHR 1.05; 95% CI: 1.02-1.08; p = 0.002) and disease-specific survival (aHR 1.04;95% CI: 0.99-1.09;p = 0.09). CONCLUSION: Other than age, patient-level influences may not be primary drivers of HPV+ OPC outcomes. Although limited by its modest sample size, our study suggests the significance of smoking has been overstated in this disease. These findings and the emerging literature collectively do not support risk-stratification employing the >10-PY threshold. LEVEL OF EVIDENCE: Level 4.

High pressure, high flow rate batch mixing apparatus for high throughput experiments.

An automated, high pressure, high flow rate batch mixing apparatus has been designed and constructed for rapid, stable, and repeatable mixing of multiple gases and vapors. The apparatus operates as an intermittent batch mixer with cycles of topping off fresh mixture to maintain pressure in an accumulator tank until consumed in an experimental apparatus. At high duty cycles, the apparatus can also function at steady state. This style of mixing is suitable for experiments such as high repetition rate shock tubes and other devices with intermittent flow demands. It is compact and portable, facilitating use in locations such as synchrotron light sources. The entire apparatus is heated to permit the mixing of vapors from species with low volatilities. The apparatus is fully automated and runs for extended periods with the only intervention being to refresh reagent supplies. The accuracy and repeatability of the apparatus were verified by periodic gas sampling and analysis with gas chromatography. Multi-component mixtures spanning a wide range of complexity, dilution, and volatility of constituents have been prepared. The compositions of the majority of the mixture were found to be stable over several filling cycles, repeatable, and with the proper calibration of set-point conditions, accurate. Challenges were encountered preparing a mixture from multi-component liquids, and potential solutions are discussed.

Initiation reactions in the high temperature decomposition of styrene.

The thermal decomposition of styrene was investigated in a combined experimental, theory and modeling study with particular emphasis placed on the initial dissociation reactions. Two sets of shock tube/time-of-flight mass spectrometry (TOF-MS) experiments were performed to identify reaction products and their order of appearance. One set of experiments was conducted with a miniature high repetition rate shock tube at the Advanced Light Source at Lawrence Berkeley National Laboratory using synchrotron vacuum ultraviolet photoionization. The other set of experiments was performed in a diaphragmless shock tube (DFST) using electron impact ionization. The datasets span 1660-2260 K and 0.5-12 atm. The results show a marked transition from aromatic products at low temperatures to polyacetylenes, up to C8H2, at high temperatures. The TOF-MS experiments were complemented by DFST/LS (laser schlieren densitometry) experiments covering 1800-2250 K and 60-240 Torr. These were particularly sensitive to the initial dissociation reactions. These reactions were investigated theoretically and revealed the dissociation of styrene to be a complex multichannel process with strong pressure and temperature dependencies that were evaluated with multi-well master equation simulations. Simulations of the LS data with a mechanism developed in this work are in excellent agreement with the experimental data. From these simulations, rate coefficients for the dissociation of styrene were obtained that are in good agreement with the theoretical predictions. The simulation results also provide fair predictions of the temperature and pressure dependencies of the products observed in the TOF-MS studies. Prior experimental studies of styrene pyrolysis concluded that the main products were benzene and acetylene. In contrast, this study finds that the majority of styrene dissociates to create five styryl radical isomers. Of these, α-styryl accounts for about 50% with the other isomers consuming approximately 20%. It was also found that C-C bond scission to phenyl and vinyl radicals consumes up to 25% of styrene. Finally the dissociation of styrene to benzene and vinylidene accounts for roughly 5% of styrene consumption. Comments are made on the apparent differences between the results of this work and prior literature.

Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: A systematic review.

OBJECTIVE: To assess the effectiveness of physical activity interventions in improving objective and patient-reported outcomes in HNC survivors. INTRODUCTION: Multiple guidelines recommend that head and neck cancer (HNC) survivors participate in regular physical activity. Physical activity is associated with improved outcomes and mortality in healthy individuals as well as in certain cancer populations. However, the effectiveness of physical activity interventions in HNC survivors is inadequately understood. METHODS AND RESULTS: Our literature search through December 2018 identified 2,392 articles. After de-duplication, title and abstract review, full-text review and bibliographic search, 20 studies met all inclusion criteria. Inclusion criteria included any full-body physical activity intervention in HNC survivors that did not target discrete organ sites or functions (e.g. swallowing). Study cohorts included 749 predominantly male participants with a mean age range of 48-63 years. At their conclusion, physical activity interventions were associated with at least one significant improvement in an objective or patient-reported outcome in 75% of studies. Aerobic capacity and fatigue were the most commonly improved outcomes. None of the included studies evaluated associations with survival or recurrence. Although traditional aerobic and resistance interventions were more common, a greater proportion of alternative physical activity (yoga and Tai Chi) interventions demonstrated improved objective and patient-reported outcomes. CONCLUSION: Physical activity interventions in HNC survivors often conferred some improvement in objective and patient-reported outcomes. Additional highly-powered, randomized controlled studies are needed to establish the optimal type, intensity, and timing of physical activity interventions as well as their impact on oncologic outcomes.

An experimental and theoretical study of the high temperature reactions of the four butyl radical isomers.

The high temperature gas phase chemistry of the four butyl radical isomers (n-butyl, sec-butyl, iso-butyl, and tert-butyl) was investigated in a combined experimental and theoretical study. Organic nitrites were used as convenient and clean sources of each of the butyl radical isomers. Rate coefficients for dissociation of each nitrite were obtained experimentally and are at, or close to, the high pressure limit. Low pressure experiments were performed in a diaphragmless shock tube with laser schlieren densitometry at post-shock pressures of 65, 130, and 260 Torr and post-shock temperatures of 700-1000 K. Additional experiments were conducted with iso-butyl radicals at 805 K and 8.7 bar to elucidate changes in mechanism at higher pressures. These experiments were performed in a miniature shock tube with synchrotron-based photoionization mass spectrometry. The mass spectra confirmed that scission of the O-NO bond is the primary channel by which the precursors dissociate, but they also provided evidence of a minor channel (<7.7%) through HNO loss and formation of an aldehyde. These high pressure experiments were also used to determine the disproportionation/recombination ratio for iso-butyl radicals as 0.3. Reanalysis of the lower-temperature literature and the present data yielded rate constants for the disproportionation reaction, iso-butyl + iso-butyl = iso-butene + iso-butane. A chemical kinetics model was developed for the reactions of the butyl isomers that included new paths for highly energized adducts. These adducts are formed by the addition of H, CH3 or C2H5 to the butyl radicals. Accompanying theoretical investigations show that chemically activated pathways are competitive with stabilization of the adduct by collision under the conditions of the laser schlieren experiments. These calculations also show that at 10 bar and T < 1000 K stabilization is the only important reaction, but at higher temperatures, even at 10 bar, chemically activated product channels should also be considered. Branching fractions and rate coefficients are presented for these reactions. This study also highlights the importance of the radical structure for determining branching ratios for disproportionation and recombination of alkyl radicals, and these were facilitated by theoretical calculations of recombination rate coefficients for the four butyl radical isomers. The results reveal previously unknown features of butyl radical chemistry under conditions that are relevant to a wide range of applications and reaction mechanisms are presented that incorporate pressure dependent rate coefficients for the key steps.

Fundamentals of Radiation Oncology for Neurologic Imaging.

Although the physical and biologic principles of radiation therapy have remained relatively unchanged, a technologic renaissance has led to continuous and ever-changing growth in the field of radiation oncology. As a result, medical devices, techniques, and indications have changed considerably during the past 20-30 years. For example, advances in CT and MRI have revolutionized the treatment planning process for a variety of central nervous system diseases, including primary and metastatic tumors, vascular malformations, and inflammatory diseases. The resultant improved ability to delineate normal from abnormal tissue has enabled radiation oncologists to achieve more precise targeting and helped to mitigate treatment-related complications. Nevertheless, posttreatment complications still occur and can pose a diagnostic challenge for radiologists. These complications can be divided into acute, early-delayed, and late-delayed complications on the basis of the time that they manifest after radiation therapy and include leukoencephalopathy, vascular complications, and secondary neoplasms. The different irradiation technologies and applications of these technologies in the brain, current concepts used in treatment planning, and essential roles of the radiation oncologist in the setting of brain disease are reviewed. In addition, relevant imaging findings that can be used to delineate the extent of disease before treatment, and the expected posttreatment imaging changes are described. Common and uncommon complications related to radiation therapy and the associated imaging manifestations also are discussed. Familiarity with these entities may aid the radiologist in making the diagnosis and help guide appropriate management. ©RSNA, 2020.

Probing combustion chemistry in a miniature shock tube with synchrotron VUV photo ionization mass spectrometry.

Tunable synchrotron-sourced photoionization time-of-flight mass spectrometry (PI-TOF-MS) is an important technique in combustion chemistry, complementing lab-scale electron impact and laser photoionization studies for a wide variety of reactors, typically at low pressure. For high-temperature and high-pressure chemical kinetics studies, the shock tube is the reactor of choice. Extending the benefits of shock tube/TOF-MS research to include synchrotron sourced PI-TOF-MS required a radical reconception of the shock tube. An automated, miniature, high-repetition-rate shock tube was developed and can be used to study high-pressure reactive systems (T > 600 K, P < 100 bar) behind reflected shock waves. In this paper, we present results of a PI-TOF-MS study at the Advanced Light Source at Lawrence Berkeley National Laboratory. Dimethyl ether pyrolysis (2% CH3OCH3/Ar) was observed behind the reflected shock (1400 < T5 < 1700 K, 3 < P5 < 16 bar) with ionization energies between 10 and 13 eV. Individual experiments have extremely low signal levels. However, product species and radical intermediates are well-resolved when averaging over hundreds of shots, which is ordinarily impractical in conventional shock tube studies. The signal levels attained and data throughput rates with this technique are comparable to those with other synchrotron-based PI-TOF-MS reactors, and it is anticipated that this high pressure technique will greatly complement those lower pressure techniques.

Recombination of allyl radicals in the high temperature fall-off regime.

The recombination of allyl radicals (C3H5), generated from the dissociation of 1,5-hexadiene or allyl iodide dilute in krypton, has been investigated in a diaphragmless shock tube using laser schlieren densitometry, LS, (900-1700 K, 10 ± 1, 29 ± 3, 57 ± 3, and 120 ± 4 Torr). The LS density gradient profiles were simulated and excellent agreement was found between simulations and experimental profiles. Rate coefficients for C3H5I → C3H5 + I and C3H5 + C3H5 → C6H10 were obtained and showed strong fall-off. Second order rate coefficients for allyl radical recombination were determined as k(1a,124Torr) = (2.6 ± 0.8) × 10(55)T( -12.995) exp(-8426/T), k(1a,57Torr) = (1.7 ± 0.5) × 10(60)T( -14.49) exp(-9344/T), and k(1a,30Torr) = (7.5 ± 2.3) × 10(66)T( -15.935) exp(-10192/T) cm(3) mol(-1)s(-1). The contribution of a disproportionation channel in allyl radical reactions was assessed, and the best agreement was obtained with no more than 5% disproportionation. Notably, because both the forward and back reactions of C6H10 ⇌ C3H5 + C3H5 were measured, utilizing two different precursors, the equilibrium constant of this reaction could be found, suggesting an entropy of formation of 1,5-hexadiene, 87.3 cal mol(-1 )K(-1), which is significantly smaller than that group additivity predicts, but larger than other reference literature values.

Single pulse shock tube study of allyl radical recombination.

The recombination and disproportionation of allyl radicals has been studied in a single pulse shock tube with gas chromatographic measurements at 1-10 bar, 650-1300 K, and 1.4-2 ms reaction times. 1,5-Hexadiene and allyl iodide were used as precursors. Simulation of the results using derived rate expressions from a complementary diaphragmless shock tube/laser schlieren densitometry study provided excellent agreement with precursor consumption and formation of all major stable intermediates. No significant pressure dependence was observed at the present conditions. It was found that under the conditions of these experiments, reactions of allyl radicals in the cooling wave had to be accounted for to accurately simulate the experimental results, and this unusual situation is discussed. In the allyl iodide experiments, higher amounts of allene, propene, and benzene were found at lower temperatures than expected. Possible mechanisms are discussed and suggest that iodine containing species are responsible for the low temperature formation of allene, propene, and benzene.

Shock tube investigation of CH3 + CH3OCH3.

The title reaction has been investigated in a diaphragmless shock tube by laser schlieren densitometry over the temperature range 1163-1629 K and pressures of 60, 120, and 240 Torr. Methyl radicals were produced by dissociation of 2,3-butanedione in the presence of an excess of dimethyl ether. Rate coefficients for CH(3) + CH(3)OCH(3) were obtained from simulations of the experimental data yielding the following expression which is valid over the range 1100-1700 K: k = (10.19 ± 3.0)T(3.78) exp((-4878/T)) cm(3) mol(-1)s(-1). The experimental results are in good agreement with estimates by Curran and co-workers [Fischer, S. L.; Dryer, F. L.; Curran, H. J. Int. J. Chem. Kinet.2000, 32 (12), 713-740. Curran, H. J.; Fischer, S. L.; Dryer, F. L. Int. J. Chem. Kinet.2000, 32 (12), 741-759] but about a factor of 2.6 lower than those of Zhao et al. [Zhao, Z.; Chaos, M.; Kazakov, A.; Dryer, F. L. Int. J. Chem. Kinet.2008, 40 (1), 1-18].