Evolution and Evaluation of a Structured Applied Physics Course for Radiation Oncology and Radiation Physics Trainees.

We sought to supplement medical physics textbook knowledge and clinical learning with case-based discussions. To our knowledge, this is the first report on a structured combined applied physics curriculum for radiation oncology (RO) and medical physics (MP) trainees. We reviewed our yearly applied physics course given from the years 2016-2021 inclusive. The number of applied physics trainees ranged from 7 to 14 per year (2-9 RO and 3-6 MP residents per year). Each session was taught by a pair of (RO and MP) faculty members. Twenty-nine case-based sessions were given yearly (2016 to 2019). Because of the COVID-19 pandemic restrictions, the course was shortened to 8 case-based sessions in 2020 and 2021. For the years 2016-2021, the mean and median teaching evaluation scores were 4.65 and 5, respectively (range 2-5), where 1 represents worse teaching quality and 5, the best teaching quality. For the year 2021, 2 questions relating to the video virtual format (implemented due to the covid-19 pandemic), revealed consistent high scores with the mean and median responses of 4.14 and 5, respectively (range 1-5). The results from the teaching evaluation scores indicate that the trainees highly valued the teaching sessions and teachers. Our experience indicates that a case-based applied physics course was delivered successfully with continued high teaching evaluation scores. A video virtual platform for an applied physics course could be useful, especially for small programs without a structured applied physics curriculum.

Predictors of recurrence after radiotherapy for non-melanoma skin cancer.

Predictive factors of recurrence were examined in 448 non-melanoma skin cancers (72% basal cell carcinoma, 28% squamous cell carcinoma) treated with radiotherapy. The overall recurrence rate was 15.8% at a median follow-up of 18.4 months. In multivariate analysis, significant factors for recurrence were age (p = 0.0197), tumour size 2 cm or greater (p = 0.0095), immunosuppression (p = 0.0082), and treatment modality (p = 0.0009).

Phosphorus concentration and loading reductions following changes in fertilizer application and formulation on managed turf.

Excess phosphorus, particularly in surface waters can lead to severe eutrophication. Identifying source areas, quantifying contributions, and evaluating management practices are required to address current and future water quality concerns. A before-after study was conducted from 2003-2010 on a sub-watershed of Northland Country Club Golf Course in Duluth, MN to demonstrate the impacts of two different phosphorus management approaches (Period 1: traditional application and timing using commercially available synthetic blends; Period 2: reduced rate, low dose applications, and organic formulations). Outflow median dissolved reactive phosphorus (DRP) and total phosphorus (TP) stream concentrations were significantly less in Period 2 compared to Period 1. There was no statistical difference in the mean TP loading in Period 1 (0.25 kg ha(-1) year(-1)) compared to Period 2 (0.20 kg ha(-1) year(-1)) or between the DRP loading in Period 1 (0.15 kg ha(-1) year(-1)) compared to Period 2 (0.09 kg ha(-1) year(-1)). However, by switching to organic phosphorus formulations and reducing application rates by greater than 75%, substantial reduction in DRP and TP concentrations was achieved. Based on these findings it is recommended that turf managers (parks and recreation to golf courses) explore the feasibility of altering their fertility management related to phosphorus by including organic formulations, low dose applications, and overall rate reductions. Additionally, it is recommended that the fertilizer industry develop and make more readily available commercial blends with lesser to zero amounts of phosphorus.

Equivalence of the boson peak in glasses to the transverse acoustic van Hove singularity in crystals.

We compare the atomic dynamics of the glass to that of the relevant crystal. In the spectra of inelastic scattering, the boson peak of the glass appears higher than the transverse acoustic (TA) singularity of the crystal. However, the density of states shows that they have the same number of states. Increasing pressure causes the transformation of the boson peak of the glass towards the TA singularity of the crystal. Once corrected for the difference in the elastic medium, the boson peak matches the TA singularity in energy and height. This suggests the identical nature of the two features.

Stream water nutrient enrichment in a mixed-use watershed.

Eutrophic conditions, in both saline and freshwater systems, result from nutrient export from upstream watersheds. The objective of this study was to quantify the surface runoff losses of nitrate-nitrogen (NO3-N), total nitrogen (TN), dissolved reactive phosphorus (DRP), and total phosphorus (TP) resulting from prevailing practices on a managed golf course. Inflow and outflow discharge waters on a sub-area of Northland Country Club (NCC) located in Duluth, Minnesota were measured for both quantity and quality from April through November from 2003 to 2008. Nutrient losses were detectable throughout the year, had a seasonal trend, and routinely exceeded recommended levels to minimize eutrophication. The median outflow TN concentration (1.04 mg L⁻¹) was significantly greater (p < 0.05) than the median inflow (0.81 mg L⁻¹) concentration. Similarly, the median outflow TP concentration (0.03 mg L⁻¹) was significantly greater (p < 0.05) than the median inflow concentration (0.02 mg L⁻¹). Maximum recorded concentrations during the study period were 1.9 mg L⁻¹ NO3-N, 3.93 mg L⁻¹ TN, 0.34 mg L⁻¹ DRP, and 1.11 mg L⁻¹ TP. Mean annual export coefficients at NCC were 0.7 kg ha⁻¹ NO3-N (1.7% of applied), 4.43 kg ha⁻¹ TN (10.7% of applied), 0.14 kg ha⁻¹ DRP (2.6% of applied), and 0.25 kg ha⁻¹ TP (4.6% of applied). The findings of this study highlight the need for adopting conservation practices aimed at reducing offsite nutrient transport.

Chlorothalonil and 2,4-D losses in surface water discharge from a managed turf watershed.

Managed turf sites (golf courses) are the most intensively managed landscapes in the urban environment. Yet, long-term watershed scale studies documenting the environmental transport of agrichemicals applied to these systems are rare. The objective of this study was to quantify the surface discharge losses of two commonly applied pesticides (chlorothalonil and 2,4-D) resulting from prevailing practices on a managed golf course. Inflow and outflow discharge waters on a subarea of Northland Country Club located in Duluth, MN were measured for both quantity and quality from April through November from 2003 to 2008. The median chlorothalonil outflow concentration (0.58 microg L(-1)) was significantly greater (p < 0.05) than the inflow concentration, which was below the detection limit (0.07 microg L(-1)). Similarly, the median outflow 2,4-D concentration (0.85 microg L(-1)) was significantly greater (p < 0.05) than the inflow concentration (0.31 microg L(-1)). Chlorothalonil concentrations occasionally exceeded acute toxicity levels (7.6 microg L(-1)) reported for rainbow trout. No 2,4-D concentrations exceeded any human or aquatic species published toxicity level; however, the maximum measured 2,4-D concentration (67.1 microg L(-1)), which rarely occurred, did approach the 70 microg L(-1) maximum contaminant level (MCL) for that compound. Losses of both pesticides were detectable throughout the annual sampling period. Mean annual chlorothalonil loading was 10.5 g ha(-1) or 0.3% of applied, while mean annual 2,4-D loading was 4.9 g ha(-1) or 0.5% of applied. The findings of this study provide quantifiable evidence of agrichemical transport resulting from typical turfgrass management and highlight the need for implementation of best management practices to combat the offsite transport of agrichemicals used in professional turf management.

Ecosystem scale carbon dioxide balance of two grasslands in Hungary under different weather conditions.

The carbon balance of the sandy pasture (Bugac) and the mountain meadow (Mátra) varied between -171 and 96 gC m(-2) year-1, and -194 and 14 gC m(-2) year(-1), respectively, during the study period (2003-2009). Large part of interannual variability of net ecosystem exchange (NEE) was explained by the variation of the annual sum of precipitation in the sandy grassland ecosystem, while this relationship was weaker in the case of the mountain meadow on heavy clay soil. These different responses are largely explained by soil texture characteristics leading to differences in soil water contents available to plants at the two grasslands. The grassland on heavy clay soil was more sensitive to temporal distribution of rainfall for the same reason. The mountain meadow therefore seems to be more vulnerable to droughts, while the sandy grassland is better adapted to water shortage. The precipitation threshold (annual sum), below which the grassland turns into source of carbon dioxide on annual basis, is only 50-80 mm higher than the 10 years average precipitation sum. In extremely dry years (2003, 2007 and 2009), even the sandy grassland ecosystem was not stable enough to maintain its sink character.

Treating recurrent cases of squamous cell carcinoma with radiotherapy.

Patients with chronic lymphocytic leukemia (CLL) are at a significantly increased risk of developing cutaneous squamous cell carcinoma (SCC), in part because of their impaired immunosurveillance. Here, we report the cases of 4 patients with CLL who had locally aggressive cutaneous scc managed with radiotherapy for local recurrence following surgical excision. All tumours were located in the head-and-neck region. All patients initially achieved complete regression of disease; however, 2 had local recurrence a mean of 8 months after treatment completion. One patient died from progressive SCC. Our findings agree with the high rates reported in literature of multiple tumours, local recurrence, metastases, and mortality from scc in patients with cll. Radiotherapy plays an important role in patient management, and it is the recommended treatment modality when complete surgical excision of disease would result in anatomic and functional defects. Radiotherapy is often used in the case of local recurrence after one or more attempts at surgical excision. Dose escalation through intensity-modulated radiotherapy, hyperfractionation, or novel treatment techniques such as high-intensity focused ultrasound may be explored to improve local control of scc lesions. To optimize patient outcomes, cutaneous SCC arising in patients with a history of cll should be managed and followed in a multidisciplinary clinic, with regular skin surveillance and prompt treatment.

Asymmetric alloy formation at the Fe-on-Ti and Ti-on-Fe interfaces.

The Fe-on-Ti and Ti-on-Fe interfaces were studied experimentally by Mössbauer spectroscopy (MS), transmission electron microscopy (TEM) and x-ray reflectometry (XRR) on Ti/Fe/Ti trilayers grown on Si(1 1 1) substrates by vacuum evaporation. The nanoscale structure and composition were explored in cross sections using TEM, the layer structure and the interface widths by specular x-ray reflectometry. MS was applied to identify the interface alloy phases and to determine the pure and alloyed Fe layer fractions. The experimental results were compared with molecular dynamics (MD) simulations of layer growth on Fe or Ti underlayers of different orientations. The concentration distributions provided by MD simulations show an asymmetry at the interfaces in the layer growth direction. The transition is atomically sharp at the Ti-on-Fe interface for the (0 0 1) and (1 1 0) crystallographic orientations of the Fe underlayer, while it spreads over a few atomic layers for Fe(1 1 1) underlayer and for all studied Ti underlayer orientations at the Fe-on-Ti interface. MS and XRR data on Ti/Fe/Ti trilayers confirm the asymmetry between the bottom and top Fe interface, but the inferred interface widths considerable exceed those deduced from the MD simulations.

Nutrient flux in storm water runoff and baseflow from managed turf.

The urban landscape is comprised of many land uses, none more intensively managed than turfgrass; however, quantification of nutrient losses from specific land uses within urban watersheds, specifically golf courses is limited. Nitrate (NO(3)-N) and dissolved reactive phosphorus (DRP) were measured on a golf course in Austin, TX, USA from April 1, 1998 to March 31, 2003. NO(3)-N and DRP concentrations measured in storm flow were significantly greater exiting the course compared to those entering the course. Significant differences were also measured in baseflow NO(3)-N concentrations. The measured loading from the course was 4.0kg NO(3)-Nha(-1)yr(-1) (11% of applied) and 0.66kg DRPha(-1)yr(-1) (8% of applied). The resulting concentrations contributed by the course were 1.2mgL(-1) NO(3)-N and 0.2mgL(-1) DRP. At these levels, NO(3)-N poses minimal environmental risk. However, the DRP concentration is twice the recommended level to guard against eutrophication.

Nutrient load generated by storm event runoff from a golf course watershed.

Turf, including home lawns, roadsides, golf courses, parks, etc., is often the most intensively managed land use in the urban landscape. Substantial inputs of fertilizers and water to maintain turf systems have led to a perception that turf systems are a major contributor to nonpoint source water pollution. The primary objective of this study was to quantify nutrient (NO(3)-N, NH(4)-N, and PO(4)-P) transport in storm-generated surface runoff from a golf course. Storm event samples were collected for 5 yr (1 Apr. 1998-31 Mar. 2003) from the Morris Williams Municipal Golf Course in Austin, TX. Inflow and outflow samples were collected from a stream that transected the golf course. One hundred fifteen runoff-producing precipitation events were measured. Median NO(3)-N and PO(4)-P concentrations at the outflow location were significantly (p < 0.05) greater than like concentrations measured at the inflow location; however, median outflow NH(4)-N concentration was significantly less than the median inflow concentration. Storm water runoff transported 1.2 kg NO(3)-N ha(-1) yr(-1), 0.23 kg NH(4)-N ha(-1) yr(-1), and 0.51 kg PO(4)-P ha(-1) yr(-1) from the course. These amounts represent approximately 3.3% of applied N and 6.2% of applied P over the contributing area for the same period. NO(3)-N transport in storm water runoff from this course does not pose a substantial environmental risk; however, the median PO(4)-P concentration exiting the course exceeded the USEPA recommendation of 0.1 mg L(-1) for streams not discharging into lakes. The PO(4)-P load measured in this study was comparable to soluble P rates measured from agricultural lands. The findings of this study emphasize the need to balance golf course fertility management with environmental risks, especially with respect to phosphorus.

Treatment of Refractory Gastrointestinal Bleeding in Patients With Portal Hypertension: A Case Series and Treatment Algorithm.

In patients with portal hypertension, ectopic varices can develop at any site along the gastrointestinal tract outside the classically described gastroesophageal location. Like esophageal variceal hemorrhage, bleeding from ectopic varices can be life-threatening. Diagnosis and treatment of ectopic varices can be challenging; to date, no effective treatment algorithm has been described. A systematic teamwork approach to diagnosing and treatment of ectopic varices is required to successfully manage hemorrhage from ectopic varices.

Prophylaxis of radiation-associated mucositis in conventionally treated patients with head and neck cancer: a double-blind, phase III, randomized, controlled trial evaluating the clinical efficacy of an antimicrobial lozenge using a validated mucositis scoring system.

PURPOSE: Mucositis occurs in almost all patients treated with radiotherapy for head and neck cancer. The aim of this multicenter, double-blind, prospective, randomized trial was to evaluate the clinical efficacy of an economically viable antimicrobial lozenge (bacitracin, clotrimazole, and gentamicin [BcoG]) in the alleviation of radiation-induced mucositis in patients with head and neck cancer. PATIENTS AND METHODS: One hundred thirty-seven eligible patients were randomized to treatment with either antimicrobial lozenge (69 patients) or placebo lozenge (68 patients). The primary end point of the study was the time to development of severe mucositis from the start of radiotherapy. Secondary end points included severity and duration of mucositis, pain measurement, radiation therapy interruption, and quality of life. Mucositis was scored using a validated mucositis scoring system. RESULTS: Toxicity profiles were similar between the two arms of the study. The median time to development of severe mucositis from the start of radiotherapy was 3.61 weeks on BCoG and 3.96 weeks on placebo (P =.61). There were no statistically significant differences between the arms in the extent of severe mucositis as measured by physician, in oral toxicities as recorded by patients, or in radiotherapy delays. CONCLUSION: This study was conducted on the basis of a pilot study that demonstrated the BCoG lozenge to be tolerable and microbiologically efficacious. A validated mucositis scoring system was used. However, in this group of patients treated with conventional radiotherapy, the lozenge did not impact significantly on the severity of mucositis. Whether such a lozenge would be beneficial in treatment situations where rate of severe mucositis is higher (ie, in patients treated with unconventional fractionation or with concomitant chemotherapy) is unknown.

Differential responses of human monocytes and macrophages to IL-4 and IL-13.

The primary interleukin-4 (IL-4) receptor complex on monocytes (type I IL-4 receptor) includes the 140-kDa alpha chain (IL-4R alpha) and the IL-2 receptor gamma chain, gamma(c), which heterodimerize for intracellular signaling, resulting in suppression of lipopolysaccharide (LPS)-inducible inflammatory mediator production. The activity of IL-13 on human monocytes is very similar to that of IL-4 because the predominant signaling chain (IL-4R alpha) is common to both receptors. In fact, IL-4R alpha with IL-13R alpha1 is designated both as an IL-13 receptor and the type II IL-4 receptor. When the anti-inflammatory activities of IL-4 and IL-13 were investigated on synovial fluid macrophages and compared with the responses by monocytes isolated from the patients at the same time as joint drainage, the response profiles differed with some responses similar in the two cell populations, others reduced on the inflammatory cells. Similar differences were recorded in the response profiles to IL-4 and IL-13 by monocytes and monocytes cultured for 7 days in macrophage colony-stimulating factor (M-CSF) or granulocyte-macrophage CSF (GM-CSF) (monocyte-derived macrophages, MDMac). MDMac have reduced gamma(c) mRNA levels and reduced expression of the functional 64-kDa gamma(c). There was a similar loss of IL-13R alpha1 mRNA on monocyte differentiation. In turn, there was a significant reduction in the ability of IL-4 and IL-13 to activate STAT6. These findings suggest that different functional responses to IL-4 and IL-13 by human monocytes and macrophages may result from reduced expression of gamma(c) and IL-13R alpha1.

Hearts from mice lacking desmin have a myopathy with impaired active force generation and unaltered wall compliance.

OBJECTIVE: Desmin intermediate filaments are key structures in the cytoskeleton of cardiac muscle. Since they are associated with Z-discs and intercalated discs, they may have a role in sarcomere alignment or force transmission. We have explored the mechanical function of the desmin filaments in the cardiac wall by comparing desmin-deficient (Des-/-) and wild-type (Des+/+) mice. METHODS: The Langendorff technique was used to examine the contractility of the whole heart. Rate of force generation, Ca(2+)-sensitivity and force per cross-sectional area were measured in skinned ventricle muscle preparations. RESULTS: Des-/- mice have a cardiomyopathy with increased heart weight. Diastolic pressure was increased at all filling volumes in the Des-/- group. Since passive wall stress (i.e. force per area) was unchanged, the alteration in diastolic pressure is a consequence of the thicker ventricle wall. Developed pressure, rate of pressure increase and developed wall stress were significantly reduced, suggesting that active force generation of the contractile apparatus is reduced in Des-/-. Concentrations of actin and myosin in the ventricle were unaltered. Measurements in skinned muscle preparations showed a lower active force development with unaltered Ca(2+)-sensitivity and rate of tension development. CONCLUSION: It is suggested that the intermediate filaments have a role in active force generation of cardiac muscle, possibly by supporting sarcomere alignment or force transmission. The desmin filaments do not contribute the passive elasticity of the ventricle wall. Des-/- mice provide a model for genetic cardiomyopathy where the main factor contributing to altered cardiac performance is a decrease in active force generation, possibly in combination with a loss of functional contractile units.

Accelerated radiotherapy with delayed concomitant boost in locally advanced squamous cell carcinoma of the head and neck.

PURPOSE: To determine the toxicity, maximum tolerated dose (MTD), and clinical effectiveness of a 5-week course of accelerated radiotherapy with delayed concomitant boost in locally advanced squamous cell carcinoma of the head and neck (SCCHN). METHODS AND MATERIALS: Thirty-five patients with untreated T3T4NM0 or TN2 (> 3 cm) N3M0 SCC of the oral cavity, oropharynx, hypopharynx, or larynx were entered in the study between January 1994 and October 1997. The initial target volume was treated with conventional daily fractions. A small field boost covering gross disease was added as a second daily fraction during the last 2 weeks of the 5-week schedule, using a minimum interfraction interval of 6 h. The study was initiated using 180-cGy fractions to deliver a total dose of 63 Gy over 33-35 days. A classical dose escalation strategy was planned to increase the delivered dose in steps using minimum cohorts of three patients, up to a maximum of 70 Gy in 200-cGy fractions. RESULTS: In the dose escalation study, 4 patients were entered at level 1 (63 Gy), 9 at level 2 (65 Gy), and 8 at level 3 (67 Gy). One patient was withdrawn at level 2 because of unstable angina, and 1 at level 3 because of uncontrolled diabetes. One patient at level 3 failed to complete treatment because of radiation toxicity. RTOG Grade 3 mucositis, dermatitis, or pharyngitis was documented in 1 (25%), 5 (63%), and 7 (100%) evaluable patients at levels 1, 2, and 3, respectively. Grade 4 reactions were documented in 1 patient at each level. One patient at level 3 died 5 weeks post-treatment of unknown causes. Two additional patients at level 3 died of progressive disease and RT toxicity. Sixty-five Gy (level 2) was chosen as the MTD. In the MTD study, 14 additional patients were entered at level 2, providing a total of 22 evaluable patients with a median follow-up of 21 months (range 12-41 months). Grade 3 mucositis, dermatitis, or pharyngitis were documented in 11 (50%), 8 (36%), and 6 (27%) patients, respectively. One patient developed Grade 4 mucositis. A complete response was recorded in 16 (77%). Three of 5 patients with uncontrolled disease and 3 of 3 patients with recurrent disease underwent salvage surgery with no postoperative complications. Radiotherapy controlled disease above the clavicles in 14 (68%). Ultimate locoregional control was achieved in 17 (77%). The disease-free, overall, and cause-specific survival of all patients entered at level 2 was 56%, 76%, and 80%, respectively, at 2 years. Late complications have been limited to 3 patients (trismus, chronic mucosal ulcer, and soft tissue necrosis). CONCLUSION: A 5-week course of accelerated radiotherapy with delayed concomitant boost can deliver 65 Gy with acceptable toxicity, encouraging rates of complete response, and locoregional control, and no compromise of salvage surgery in patients with locally advanced SCCHN. The regimen is worthy of further study in a Phase III trial.

The prognostic significance of tracheostomy in carcinoma of the larynx treated with radiotherapy and surgery for salvage.

PURPOSE: To determine retrospectively the prognostic significance of airway compromise necessitating tracheostomy in carcinoma of the larynx managed with radical radiotherapy and surgery for salvage (RRSS). METHODS AND MATERIALS: The charts of 270 patients managed with RRSS at the Toronto-Sunnybrook Regional Cancer Centre between June 1980 and December 1990 were reviewed. Airway compromise necessitating tracheostomy was documented in 26 patients prior to radiotherapy and 3 patients during radiotherapy. Of 29, 27 had T3T4 primaries. Patients have been followed for a median of 5 years. RESULTS: Patients managed without tracheostomy had a 2-year disease-free survival of 74% compared to 41% for those managed with tracheostomy. The adverse impact of airway compromise was more marked in patients with glottic primaries (78% vs. 32%, p = 0.0001) than those with supraglottic primaries (64% vs. 47%, p = 0.18). Tracheostomy was identified in univariate analysis, but not in multivariate analysis, as having a statistically significant impact on local control and local-regional control. Radiotherapy controlled disease above the clavicles in 185 of 267 (69%) evaluable patients. 83% of isolated local-regional failures underwent salvage surgery. Among those managed without tracheostomy, ultimate local-regional control (LRC) was achieved in 161 (94%) of 172 glottic primaries and 54 (81%) of 67 supraglottic primaries. Among those managed with tracheostomy, ultimate LRC was achieved in 9 (69%) of 13 glottic primaries and 12 (80%) of 15 supraglottic primaries. In a subset analysis of 76 patients with T3T4 primaries, there was no statistically significant difference in larynx preservation, disease-free survival, or cause-specific survival between those managed with and without tracheostomy. CONCLUSION: Airway compromise necessitating tracheostomy is an adverse prognostic factor in patients with carcinoma of the larynx. However, larynx preservation is possible in over 40% of those undergoing tracheostomy and radiotherapy with no compromise of cause-specific survival. The need for pretreatment tracheostomy should not rule out the possibility of RRSS.

Comparing treatment outcomes of radiotherapy and surgery in locally advanced carcinoma of the larynx: a comparison limited to patients eligible for surgery.

PURPOSE: The use of radical radiotherapy and surgery for salvage (RRSS) in locally advanced squamous cell carcinoma (SCC) of the larynx is controversial. In the absence of randomized studies, it is unclear if RRSS can match the rates of locoregional control and survival reported for primary surgery in this setting. The aim of this study was to compare treatment outcomes of radiotherapy and surgery in comparable patients with CS III-IV SCC of the larynx. METHODS AND MATERIALS: Eighty-two patients with untreated T2N+M0 or T3T4NM0 SCC of the larynx were treated with a policy RRSS at the Toronto-Sunnybrook Regional Cancer Centre between June 1980 and December 1990. The medical records at presentation were reviewed independently by a panel of three surgical oncologists blinded as to treatment outcome to determine patient suitability for laryngectomy and neck dissection using eligibility criteria adopted by recent clinical trials. Treatment outcomes for surgery-eligible patients were compared to results of comparably staged patients in the surgical literature since 1980. RESULTS: Sixty-three patients (77%) were eligible for study. With a median follow-up of 3 years, radiotherapy controlled the primary in 8/20 evaluable glottic primaries and 21/41 evaluable supraglottic primaries. Forty-five percent of patients surviving 5 years retained a functional larynx. Sixteen of 29 relapsing patients were salvaged with surgery. Disease above the clavicles was controlled in 65% of T3T4N0N+ glottic primaries (compared to a published range of 53% to 79%) and 82% of T3N0 glottic primaries (compared to a published range of 69% to 84%). The 5-year overall survival of patients with T3T4 glottic cancer was 54% compared to a published range of 50% to 63%. The cause-specific survival (CSS) of patients with T3N0 glottic primaries (86% at 1 year and 73% at 2 years) was identical to the only published report of CSS in the surgical literature. CONCLUSION: A policy of RRSS offers a good chance of laryngeal conservation without compromising ultimate locoregional control or survival when compared to primary laryngectomy and neck dissection in patients with locally advanced carcinoma of the larynx meeting the surgical eligibility of clinical trials.

Observer variation in contouring gross tumor volume in patients with poorly defined non-small-cell lung tumors on CT: the impact of 18FDG-hybrid PET fusion.

PURPOSE: To quantify interobserver variation in gross tumor volume (GTV) localization using CT images for patients with non-small-cell lung carcinoma and poorly defined tumors on CT and to determine whether variability would be reduced if coregistered 2-[18F]fluoro-2-deoxy-d-glucose (FDG)-hybrid positron emission tomography (PET) with CT images were used. METHODS AND MATERIALS: Prospectively, 30 patients with non-small-cell lung carcinoma had CT and FDG-hybrid PET examinations in radiation treatment position on the same day. Images were coregistered using eight fiducial markers. Guidelines were established for contouring GTVs. Three radiation oncologists performed localization independently. The coefficient of variation was used to assess interobserver variability. RESULTS: The size of the GTV defined showed great variation among observers. The mean ratios of largest to smallest GTV were 2.31 and 1.56 for CT only and for CT/FDG coregistered data, respectively. The addition of PET reduced this ratio in 23 of 30 cases and increased it in 7. The mean coefficient of variation for GTV based on the combined modalities was significantly smaller (p < 0.01) than that for CT data only. CONCLUSIONS: High observer variability in CT-based definition of the GTV can occur. A more consistent definition of the GTV can often be obtained if coregistered FDG-hybrid PET images are used.

Nontraumatic osteonecrosis after chemotherapy for testicular cancer: a systematic review.

Nontraumatic osteonecrosis is a well-documented late complication of chemotherapy for hematologic malignancies, with prolonged corticosteroid exposure implicated. Reports of this treatment complication in patients treated with chemotherapy for solid tumors are sparse. We reviewed our institutional experience and the published medical literature to explore an association between chemotherapy for testicular cancer and the occurrence of nontraumatic osteonecrosis. Two databases of men with testicular cancer were reviewed. Search of the medical literature included MEDLINE, CANCERLIT, and EMBASE. Two of 107 men with testicular cancer treated with chemotherapy at our center were identified with nontraumatic osteonecrosis. Literature review identified 14 reports describing patients with 39 solid tumors with osteonecrosis after chemotherapy. Of 38 adults, 28 had testicular cancer and 6 had breast cancer. All patients with testicular cancer had received cisplatin, vinblastine, and bleomycin, or bleomycin, etoposide, and cisplatin. Twenty-seven of 28 had received corticosteroids. Diagnosis was subacute in three and delayed a mean of 26 months (range, 12-47 months) in 26. The femoral head was involved in 26 patients, with bilateral involvement in 18. Crude incidence was 1.5% (95% CI, 0.9-2.1). Nontraumatic osteonecrosis is an infrequent but disabling late complication of cancer chemotherapy reported most commonly in adult patients with testicular cancer. Corticosteroid exposure makes this association plausible.