Individualized Stereotactic Ablative Radiotherapy for Lung Tumors: The iSABR Phase 2 Nonrandomized Controlled Trial.

Importance: Stereotactic ablative radiotherapy (SABR) is used for treating lung tumors but can cause toxic effects, including life-threatening damage to central structures. Retrospective data suggested that small tumors up to 10 cm3 in volume can be well controlled with a biologically effective dose less than 100 Gy. Objective: To assess whether individualizing lung SABR dose and fractionation by tumor size, location, and histological characteristics may be associated with local tumor control. Design, Setting, and Participants: This nonrandomized controlled trial (the iSABR trial, so named for individualized SABR) was a phase 2 multicenter trial enrolling participants from November 15, 2011, to December 5, 2018, at academic medical centers in the US and Japan. Data were analyzed from December 9, 2020, to May 10, 2023. Patients were enrolled in 3 groups according to cancer type: initial diagnosis of non-small cell lung cancer (NSCLC) with an American Joint Committee on Cancer 7th edition T1-3N0M0 tumor (group 1), a T1-3N0M0 new primary NSCLC with a history of prior NSCLC or multiple NSCLCs (group 2), or lung metastases from NSCLC or another solid tumor (group 3). Intervention: Up to 4 tumors were treated with once-daily SABR. The dose ranged from 25 Gy in 1 fraction for peripheral tumors with a volume of 0 to 10 cm3 to 60 Gy in 8 fractions for central tumors with a volume greater than 30 cm3. Main outcome: Per-group freedom from local recurrence (same-lobe recurrence) at 1 year, with censoring at time of distant recurrence, death, or loss to follow-up. Results: In total, 217 unique patients (median [IQR] age, 72 [64-80] years; 129 [59%] male; 150 [69%] current or former smokers) were enrolled (some multiple times). There were 240 treatment courses: 79 in group 1, 82 in group 2, and 79 in group 3. A total of 285 tumors (211 [74%] peripheral and 74 [26%] central) were treated. The most common dose was 25 Gy in 1 fraction (158 tumors). The median (range) follow-up period was 33 (2-109) months, and the median overall survival was 59 (95% CI, 49-82) months. Freedom from local recurrence at 1 year was 97% (90% CI, 91%-99%) for group 1, 94% (90% CI, 87%-97%) for group 2, and 96% (90% CI, 89%-98%) for group 3. Freedom from local recurrence at 5 years ranged from 83% to 93% in the 3 groups. The proportion of patients with grade 3 to 5 toxic effects was low, at 5% (including a single patient [1%] with grade 5 toxic effects). Conclusions and Relevance: The results of this nonrandomized controlled trial suggest that individualized SABR (iSABR) used to treat lung tumors may allow minimization of treatment dose and is associated with excellent local control. Individualized dosing should be considered for use in future trials. Trial Registration: ClinicalTrials.gov Identifier: NCT01463423.

Adaptive Sampling for Sound Propagation.

Precomputed sound propagation samples acoustics at discrete scene probe positions to support dynamic listener locations. An offline 3D numerical simulation is performed at each probe and the resulting field is encoded for runtime rendering with dynamic sources. Prior work place probes on a uniform grid, requiring high density to resolve narrow spaces. Our adaptive sampling approach varies probe density based on a novel "local diameter" measure of the space surrounding a given point, evaluated by stochastically tracing paths in the scene. We apply this measure to layout probes so as to smoothly adapt resolution and eliminate undersampling in corners, narrow corridors and stairways, while coarsening appropriately in more open areas. Coupled with a new runtime interpolator based on radial weights over geodesic paths, we achieve smooth acoustic effects that respect scene boundaries as both the source or listener move, unlike existing visibility-based solutions. We consistently demonstrate quality improvement over prior work at fixed cost.

Intra-operative ultrasound guidance of vena caval umbrella placement in a super obese patient.

Morbidly obese patients are often denied the benefits of sophisticated diagnostic studies and interventions because of the maximum weight limits of available equipment. Two examples in our hospital include a limit of 227 kg (500 lb) on our CT and angiographic tables. We present a patient who was considered to be high risk for recurrent pulmonary emboli and who could not undergo preoperative vena caval umbrella placement, because his weight exceeded the limit of our angiographic table. Intraoperative placement of the umbrella was accomplished by ultrasound localization of the device. We offer this alternative as an adjuvant in the armamentarium of the bariatric surgeon.