Erectile function preservation after radiotherapy using a dose-optimization approach on sexual structures for localized prostate cancer.

PURPOSE: Erectile function preservation is an important quality of life factor in patients treated for prostate cancer. A dose-optimization approach on sexual structures was developed and evaluated to limit erectile dysfunction after radiotherapy. MATERIALS AND METHODS: Twenty-three men with localized prostate cancer and no erectile dysfunction were enrolled in the study. All patients received a prescription dose between 76 and 78Gy. Computed tomography/magnetic resonance image registration was used to delineate the prostatic volume and the sexual structures: internal pudendal arteries (IPA), penile bulb and corpus cavernosum. Erectile function was evaluated using the 5-items International Index of Erectile Function (IIEF-5) score every 6 months during the 2 years after radiotherapy and once a year afterwards. No erectile dysfunction, mild erectile dysfunction and severe erectile dysfunction were defined if the IIEF-5 scores were 20-25, 17-19 and < 17, respectively. RESULTS: The mean follow-up was 4.5 years. The mean age of the patients was 66.3 years. At 2 years, 67% of the patients had no erectile dysfunction, 11% had mild erectile dysfunction and 22% had severe erectile dysfunction. No significant difference was found between the patients with and without erectile dysfunction (IIEF-5≥20 and IIEF-5<20, respectively) for any of the parameters: dosimetric values (internal pudendal arteries, penile bulb, corpus cavernosum), age, comorbidity and smoking status. The biochemical-relapse free survival was 100% at 2 years. CONCLUSION: This approach with dose-optimization on sexual structures for localized prostate cancer found excellent results on erectile function preservation after radiotherapy, with 78% of the patients with no or mild erectile dysfunction at 2 years.

Quantification and purification of isotopic contamination at the ReAccelerator of the Facility for Rare Isotope Beams.

At the ReAccelerator within the Facility for Rare Isotope Beams, a combination of an interchangeable aluminum foil and a silicon detector was developed to quantify isobaric contamination in rare isotope beams. The device is simple to operate and is now used routinely. In this article, we describe the system and show an application of the device to determine the level of contamination of an Si-32 rare isotope beam by stable S-32. In addition, we describe how the new diagnostic device helped confirm an enhancement of the beam purity prior to beam delivery to experiments.

[Relationship between doses to anatomical structures and erectile dysfunction after radiotherapy for prostate cancer: A systematic review]. / Relations entre doses dans les structures anatomiques et dysfonction érectile après radiothérapie pour un cancer de la prostate : revue systématique de la littérature.

PURPOSE: During prostatic radiotherapy, damage to several anatomical structures could be the cause of erectile dysfunction: corpora cavernosa, internal pudendal arteries, penile bulb, and neurovascular bundles. Numerous studies have analysed the correlations between the dose received by these structures and erectile function. The objective of this article is to make a systematic review on current knowledge. MATERIALS AND METHODS: A systematic review was performed in the Medline database using the search engine PubMed. Keywords for the search included: erectile dysfunction, penile bulb, corpora cavernosa, cavernosum, neurovascular bundles, radiation therapy, cancer, prostate cancer. The selected articles must study a correlation between erectile dysfunction and the dose received by anatomical structures. A total of 152 articles were identified. Of these 152 articles, 45 fulfilled the defined selection criteria. RESULTS: For corpora cavernosa, seven studies were identified, only two studies demonstrated a significant correlation between the dose received by corpora cavernosa and the occurrence of erectile dysfunction. For penile bulb, only 15 of 23 studies showed a correlation. A mean dose on the penile bulb greater than 20Gy was found to be predictive of erectile dysfunction. None of the eight trials concerning neurovascular bundles succeeded to show a correlation between dose and erectile dysfunction. Only one study evaluated the relationship between the dose received by internal pudendal arteries and erectile dysfunction but was found to be negative. However, vessels-sparing studies showed good results on erectile function preservation without compromising the target volume. CONCLUSION: We currently have little data to show a correlation between erectile dysfunction and sexual structures. It would be necessary to have additional prospective studies evaluating the impact of an optimization on these sexual structures on erectile dysfunction.

Tumour and normal tissue radiosensitivity.

The place of personalized treatments is highly increasing in medical and radiation oncology. During the last decades, a huge number of assays have been developed to predict responses of normal tissues and tumours. These tests have not yet been included into daily clinical practice but the recent developments of radiation oncology are paving the way of personalized strategies including the risk of tumour recurrence and normal tissue reactions. Concerning tumor radiosensitivity prediction, no test are currently used, even if the radiosensitivity index and the genome-based model for adjusting radiotherapy dose assays seem the most promising with level II of evidence. Commercial developments are under progress. Concerning normal tissue radiosensitivity prediction, single nucleotide polymorphims of prostate cancer patients and radiation-induced CD8 T-lymphocyte apoptosis breast and prostate assays are of level I of evidence. They can be proposed before the beginning of radiotherapy in order to propose personalized treatments according to both risks of tumour and normal tissue radiosensitivity. Commercial developments are also under way.

[Stereotactic ablative body radiotherapy: Which machine for which therapeutic indication? A focus on prostate cancer]. / Radiothérapie stéréotaxique extracrânienne : quelle machine pour quelle indication ? Stéréotaxie prostatique.

For the last decade, stereotactic body radiotherapy has become a leading treatment for localized prostate cancer. It can be delivered using a wide array of radiotherapy machines. However, although numerous clinical studies, both prospective and retrospective, have been published, the different techniques have never been properly compared. This article aims at giving an overview of the published trials, and at pointing out the major differences between the machines, from a clinical (efficacy end toxicity), technical and radiobiological point of view.

Measuring the difference in nuclear charge radius of Xe isotopes by EUV spectroscopy of highly charged Na-like ions.

The difference in the mean-square nuclear charge radius of xenon isotopes was measured utilizing a method based on extreme ultraviolet spectroscopy of highly charged Na-like ions. The isotope shift of the Na-like D1 (3s 2 S 1/2 - 3p 2 P 1/2) transition between the 124Xe and 136Xe isotopes was experimentally determined using the electron-beam ion-trap facility at the National Institute of Standards and Technology. The mass-shift and the field-shift coefficients were calculated with enhanced precision by the relativistic many-body perturbation theory and multiconfiguration Dirac-Hartree-Fock method. The mean-square nuclear charge radius difference was found to be δ〈r 2〉136,124 = 0.269(42) fm2. Our result has smaller uncertainty than previous experimental results and agrees with the literature values.

Advanced penile cancer with iliac lymph node involvement treated with radiation and concurrent gemcitabine.

Penile cancer is a rare entity with only 2000 new cases a year in the United States. Even though early stage penile cancer has an excellent prognosis, patients with positive pelvic lymph nodes have an overall 5-year survival rate under 10%. There is no consensus for the management of pelvic node-positive patients, although most guidelines are in favour of pelvic lymph node dissection for patients with two or more positive nodes, followed by adjuvant chemotherapy. We describe here the case of a patient with numerous metastatic lymph nodes at diagnosis, treated with chemoradiation (66Gy with concurrent gemcitabine) after failure of first-line chemotherapy and still alive and disease-free 7 years after diagnosis.

[Esthesioneuroblastoma: A single institution's experience and general literature review]. / Esthésioneuroblastome : étude rétrospective et revue de la littérature.

PURPOSE: Olfactory neuroblastoma or esthesioneuroblastoma is a rare entity among head and neck neoplasms. In this paper, we report the experience of our institution and compare it with a comprehensive review of the literature. PATIENTS AND METHODS: We retrospectively analysed clinical and treatment data of patients referred to the Lyon Sud University Hospital (France) for histologically proven olfactive esthesioneuroblastoma. RESULTS: Ten patients treated between 1993 and 2015 have been analysed. Disease stage at diagnosis, according to the Kadish staging system, was C in 90% of cases. Median follow-up was 136 months. Ten-year overall survival was 90%. Five- and ten-year progression-free survival were 70% and 50%. Nine patients (90%) underwent surgical resection first. Seven of the nine patients who underwent resection (77%) received adjuvant three-dimensional (3D)-conformal radiotherapy (n=7), intensity-modulated radiotherapy (n=1), or volumetric arctherapy (n=1). The mean dose to the tumour volume was 61Gy. None of the patients received elective nodal irradiation. Two patients received concurrent chemotherapy. Five patients (50%) presented with disease recurrence, which was local (n=1), nodal (n=2) and cerebral (n=2). CONCLUSION: Our results are consistent with the literature. Because of the lack of prospective study and the low number of cases in the literature, each institution's experience is of the utmost important to improve standardised management of these tumours.

[Management of neuroendocrine prostate carcinoma: Literature review]. / Prise en charge des carcinomes neuroendocrines de prostate : revue de la littérature.

Neuroendocrine prostate carcinoma is a rare entity causing both diagnostic and therapeutic issues. There are basically four histological forms (adenocarcinoma with neuroendocrine differentiation, carcinoid tumors, small cell neuroendocrine carcinomas, large cell neuroendocrine carcinomas), which can be pure or mixed associated with prostatic carcinoma. There is no consensus on the management or the prognosis of these various tumor subtypes. We conducted a literature review aiming to determine the potential therapeutic implications.

Recent charge-breeding developments with EBIS/T devices (invited).

Short breeding times, narrow charge state distributions, low background, high efficiency, and the flexible time structure of the ejected low-emittance ion pulses are among the most attractive features of electron beam ion source or trap (EBIS/T) based charge breeders. Significant progress has been made to further improve these properties: Several groups are working to increase current densities towards 10(3) or even 10(4) A/cm(2). These current densities will become necessary to deliver high charge states of heavy nuclei in a short time and/or provide sufficient space-charge capacity to handle high-current ion beams in next-generation rare-isotope beam (RIB) facilities. Efficient capture of continuous beams, attractive because of its potential of handling highest-current ion beams, has become possible with the development of high-density electron beams of >1 A. Requests for the time structure of the charge bred ion pulse range from ultra-short pulses to quasi-continuous beams. Progress is being made on both ends of this spectrum, by either dividing the extracted charge in many pulse-lets, adjusting the extraction potential for a near-uniform long pulse, or adding dedicated devices to spread the ion bunches delivered from the EBIS/T in time. Advances in EBIS/T charge state breeding are summarized, including recent results with NSCL's ReA EBIS/T charge breeder.

[Intensity-modulated radiation therapy and stereotactic body radiation therapy for head and neck tumors: evidence-based medicine]. / Radiothérapie avec modulation d'intensité et radiothérapie stéréotaxique des tumeurs ORL : médecine fondée sur les preuves.

Over the last decade, there have been many technical advances in radiation therapy, such as the spread of intensity-modulated conformal radiotherapy, and the rise of stereotactic body radiation therapy. By allowing better dose-to-target conformation and thus better organs at risk-sparing, these techniques seem very promising, particularly in the field of head and neck tumors. The present work aims at analyzing the level of evidence and recommendation supporting the use of high-technology radiotherapy in head and neck neoplasms, by reviewing the available literature.

[Use of erythropoiesis stimulating agents]. / Utilisation des facteurs de croissance érythrocytaires.

Anemia is fairly common in lung neoplasms and adequate management can influence both the prognosis and the quality of life of patients. Anemia can stem from diverse mechanisms, and its management must include the search for correctable causes (iron deficiency, inflammation, disease- or treatment-related), and their subsequent treatment. Use of erythropoiesis stimulating agents, namely recombinant erythropoietin, results in hemoglobin increase, fewer blood transfusions, and better quality of life. However, there is also a significant increase in thromboembolic risk associated with this treatment, and their effect on overall survival is still debated. Thus, their use must be restricted to patients treated with palliative intent, receiving chemotherapy but no radiotherapy, with a baseline hemoglobin level under 100 g/L, and target hemoglobin level must not exceed 120 g/L.

First charge breeding of a rare-isotope beam with the electron-beam ion trap of the ReA post-accelerator at the National Superconducting Cyclotron Laboratory.

An electron-beam ion trap (EBIT) charge breeder is being brought into operation at the National Superconducting Cyclotron Laboratory at Michigan State University. The EBIT is part of the ReA post-accelerator for reacceleration of rare isotopes, which are thermalized in a gas "stopping" cell after being produced at high energy by projectile fragmentation. The ReA EBIT has a distinctive design; it is characterized by a high-current electron gun and a two-field superconducting magnet to optimize the capture and charge-breeding efficiency of continuously injected singly charged ion beams. Following a brief overview of the reaccelerator system and the ReA EBIT, this paper presents the latest commissioning results, particularly, charge breeding and reacceleration of the highly charged rare isotopes, (76)Ga(24 +, 25 +).

A high-current electron gun for the electron beam ion trap at the National Superconducting Cyclotron Laboratory.

The Electron Beam Ion Trap (EBIT) in NSCL's reaccelerator ReA uses continuous ion injection and accumulation. In order to maximize capture efficiency and minimize breeding time into high charge states, the EBIT requires a high-current/high current-density electron beam. A new electron gun insert based on a concave Ba-dispenser cathode has been designed and built to increase the current transmitted through the EBIT's superconducting magnet. With the new insert, stable EBIT operating conditions with 0.8 A of electron beam have been established. The design of the electron gun is presented together with calculated and measured perveance data. In order to assess the experimental compression of the electron beam, a pinhole CCD camera has been set up to measure the electron beam radius. The camera observes X-rays emitted from highly charged ions, excited by the electron beam. Initial tests with this camera setup will be presented. They indicate that a current density of 640 A/cm(2) has been reached when the EBIT magnet was operated at 4 T.

Urinary determination of 2-isopropyl-4-methyl-6-hydroxypyrimidine in case of non fatal poisoning with diazinon.

We reported one non fatal case (42 month old boy) of intoxication with diazinon following accidental ingestion. Diazinon and three of its metabolites (2 common metabolites with other organophosphate pesticides: diethylphosphate and diethylthiophosphate; one specific metabolite: 2-isopropyl-4-methyl-6-hydroxypyrimidine) were determined in serum and in urine, respectively, using three liquid chromatography-tandem mass spectrometry methods. Diazinon was detected in serum while its metabolites were detected in urine. The concentrations of diazinon and its common metabolites were compared to concentrations previously described in literature in the same intoxication context and were discussed. The concentration of the specific metabolite was compared to concentrations highlighted in occupational exposure, because to the best of our knowledge, we reported here the first urinary concentration of this metabolite in an acute intoxication context.

Elucidation of the anomalous A=9 isospin quartet behavior.

Recent high-precision mass measurements of 9Li and 9Be, performed with the TITAN Penning trap at the TRIUMF ISAC facility, are analyzed in light of state-of-the-art shell model calculations. We find an explanation for the anomalous isobaric mass multiplet equation behavior for the two A=9 quartets. The presence of a cubic d=6.3(17) keV term for the J(π)=3/2(-) quartet and the vanishing cubic term for the excited J(π)=1/2(-) multiplet depend upon the presence of a nearby T=1/2 state in 9B and 9Be that induces isospin mixing. This is contrary to previous hypotheses involving purely Coulomb and charge-dependent effects. T=1/2 states have been observed near the calculated energy, above the T=3/2 state. However, an experimental confirmation of their J(π) is needed.

[Chronic central nervous system effects of pesticides: state-of-the-art]. / Effets chroniques des pesticides sur le système nerveux central : état des connaissances épidémiologiques.

BACKGROUND: Given the neurotoxic properties of pesticides, suggested by experimental results and clinical observations, many epidemiological studies have investigated neurological effects following acute or chronic exposure to pesticides. This review provides an overview of current knowledge about pesticide effects on the central nervous system: neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis), cognitive disorders, and psychiatric disorders (mood disorders, anxiety, depression and suicide). RESULTS: Parkinson's disease, the most widely studied in relation with pesticide exposure, particularly with insecticides and herbicides, was observed to be a risk factor of the disease. Evidence is scarce for Alzheimer's disease and amyotrophic lateral sclerosis, but quite consistent. Cognitive and psychiatric disorders were often observed in relation with organophosphate insecticide exposure. Cognitive disorders were found associated with acute and chronic exposures, and psychiatric disorders mostly with poisonings. These epidemiologic studies were limited by a lack of detailed and reliable exposure assessment. The role of genetic susceptibilities has been recently observed, but must be further investigated.

First direct mass measurement of the two-neutron halo nucleus 6He and improved mass for the four-neutron halo 8He.

The first direct mass measurement of {6}He has been performed with the TITAN Penning trap mass spectrometer at the ISAC facility. In addition, the mass of {8}He was determined with improved precision over our previous measurement. The obtained masses are m({6}He)=6.018 885 883(57) u and m({8}He)=8.033 934 44(11) u. The {6}He value shows a deviation from the literature of 4σ. With these new mass values and the previously measured atomic isotope shifts we obtain charge radii of 2.060(8) and 1.959(16) fm for {6}He and {8}He, respectively. We present a detailed comparison to nuclear theory for {6}He, including new hyperspherical harmonics results. A correlation plot of the point-proton radius with the two-neutron separation energy demonstrates clearly the importance of three-nucleon forces.

Initial commissioning results with the NSCL Electron Beam Ion Trap.

The ReA reaccelerator is being added to the National Superconducting Cyclotron Laboratory (NSCL) fragmentation facility in order to provide exotic rare-isotope beams, not available at the Isotope Separation On-Line facilities, in the several-MeV/u energy range. The first stage of the NSCL reaccelerator complex, consisting of an EBIT charge breeder, a room-temperature radiofrequency quadrupole (RFQ) accelerator, and superconducting linear accelerator modules, has been completed and is being put into operation. Commissioning of the EBIT has started by extracting charge-bred residual gas ions, ions created from a Ne gas jet directed across the EBIT's electron beam and ions captured from an external test ion source. Charge-bred ions from the Ne gas jet have been extracted as a pulse and accelerated through the RFQ and the two cryomodules.