Socioeconomic disadvantage and its impact on patient satisfaction at a multi-site radiation oncology center.

Purpose: Despite the importance of patient satisfaction (PS) on healthcare outcomes, the factors that influence PS in radiation oncology remain unexplored. This study assesses the influence of socioeconomic status (SES) on PS in radiation oncology, using the Area Deprivation Index (ADI) as a measure of SES. Methods: This single-institution cross-sectional study used the National Research Council (NRC) PS survey at four radiation oncology sites from 2021 to 2023. SES was measured using ADI data from the Neighborhood Atlas. Univariate (UVA) and multivariable (MVA) logistic regression analyses were conducted on recommendation scores (0-10 scale, with 9 or higher indicating a likelihood to recommend). Results: In our analysis of 7,501 survey responses, most patients were female (55.3 %), had curative treatment intent (81.5 %), and were diagnosed with breast cancer (30.4 %), with most being follow-up visits (69.0 %). Average scores for state and national ADI were 3.94 and 50.75, respectively. UVA identified factors such as curative intent (OR 1.68, p < 0.001), follow-up visits (OR 1.69, p < 0.001), and breast cancer diagnosis (OR 1.42, p = 0.018) as enhancing the likelihood of recommending the facility or provider. Those with a national ADI above the mean showed lower propensity to recommend the facility (OR 0.81, p = 0.050) or provider (OR 0.71, p = 0.002). MVA confirmed the significance of national ADI on provider recommendations (OR 0.730, p = 0.005) but not facility recommendations (OR 0.832, p = 0.089). Conclusion: Patients facing higher SES disadvantages are less inclined to recommend their healthcare provider. These results highlight the role of SES in PS assessments and advocate for further investigation into how SES impacts PS and patient-provider relationships.

Clinical Outcomes of Breast-Conserving Surgery with Synchronous 50-kV X-ray Intraoperative Partial Breast Irradiation in Patients Aged 64 Years or Older with Low-Risk Breast Cancer.

Background: Breast-conserving surgery with synchronous 50-kV X-ray intraoperative radiation therapy (TARGIT-IORT) is a convenient form of partial breast irradiation; however, the existing literature supports a wide range of local control rates. Objectives: We investigated the treatment effectiveness and toxic effects of TARGIT-IORT in a patient cohort aged 64 years or older with low-risk breast cancer. Design: Retrospective analysis. Methods: Patients who received breast-conserving surgery with synchronous TARGIT-IORT at a single institution from 2016 to 2019 were reviewed. Additional whole breast irradiation was recommended at the discretion of the treating radiation oncologist. Baseline patient demographics and treatment details were recorded. Acute and chronic toxicities, measured using the Common Terminology Criteria for Adverse Events version 3.0 or 4.0 and breast cosmetic outcomes, using the Harvard Cosmesis score, were recorded. Locoregional recurrence, distant metastasis, and overall survival were recorded, and 5-year rates were estimated using the Kaplan-Meier method. Results: 61 patients were included with a median follow-up of 3.5 years and median age of 72 years. Eight (13%) patients received additional whole breast irradiation, and fifty-four (89%) received adjuvant hormone therapy. There were no local, regional, or distance recurrences. One patient died of complications from COVID-19 infection. Grade 2 + acute and chronic toxicities were observed in 6 (12%) and 7 (14%) patients, respectively. One patient experienced a grade 3 acute toxicity. Cosmetic outcome was "excellent" or "good" in 45 (92%) patients. Conclusions: Breast TARGIT-IORT was well tolerated and conferred excellent disease control in this cohort of patients with low-risk breast cancer. While continued follow-up is required, TARGIT-IORT may be an appropriate treatment option for this population.

21 Gy single fraction prostate HDR brachytherapy: 5-year results of a single institution prospective pilot study.

PURPOSE: To present the outcome and toxicity results of a prospective trial of 21 Gy single fraction high-dose-rate (HDR) brachytherapy for men with low- or intermediate-risk prostate cancer. METHODS AND MATERIALS: Patients were treated according to an IRB-approved prospective study of single fraction HDR brachytherapy. Eligible patients had low- or intermediate-risk prostate cancer with tumor stage ≤ T2b, PSA ≤ 15, and Gleason score ≤ 7. Patients underwent trans-rectal ultrasound-guided trans-perineal implant of the prostate followed by single fraction HDR brachytherapy to a dose of 21 Gy. The primary endpoint was grade ≥ 2 urinary/GI toxicity rates. RESULTS: Twenty-six patients were enrolled with a median follow up of 5.1 years and median age of 64 years. 88.5% of patients had T1 disease, 15.4% had Gleason score 6 (84.6% Gleason 7), and median pre-treatment PSA was 5.0 ng/mL. Acute and chronic grade ≥ 2 urinary toxicity rates were 38.5% and 38.5%, respectively. There were no grade ≥ 2 acute or chronic GI toxicities. Six (23.1%) patients experienced biochemical failure, six (23.1%) patients experienced radiographic local failure, and five (19.2%) patients had biopsy-proven local failure. No patients developed regional lymph node recurrence or distant metastasis. 5-year overall survival and cause-specific survival were 96.2% and 100%, respectively. CONCLUSIONS: 21 Gy single fraction HDR brachytherapy was associated with modestly higher-than-anticipated chronic urinary toxicity, as well as high biochemical and local failure rates. The results from this prospective pilot study do not support the use of this regimen in standard clinical practice.

Low contralateral failure rate with unilateral proton beam radiotherapy for oropharyngeal squamous cell carcinoma: A multi-institutional prospective study from the proton collaborative group.

INTRODUCTION: Unilateral radiation therapy is appropriate for select patients with oropharyngeal squamous cell carcinoma (OPSCC). The use of proton beam therapy (PBT) in the unilateral setting decreases the dose to the contralateral neck and organs at risk. This study aims to evaluate contralateral recurrences in patients who received ipsilateral PBT. METHODS: We evaluated the Proton Collaborative Group database for patients treated with PBT for head and neck squamous cell carcinoma between the years 2015-2020 at 12 institutions. Dosimetric analysis was performed in five cases. RESULTS: Our analysis included 41 patients that received ipsilateral PBT with a mean follow-up of 14.7 months. 37% patients (n = 15) were treated for recurrent disease, and 63% (n = 26) were treated for de novo disease. Oropharyngeal sites included tonsillar fossa (n = 30) and base of tongue (n = 11). The median dose and BED delivered were 69.96 CGE and 84 Gy, respectively. Eight (20%) patients experienced at least one grade 3 dysphagia (n = 4) or esophagitis (n = 4) toxicity. No grade ≥ 4 toxicities were reported. There was one (2.4%) failure in the contralateral neck. The 1-year locoregional control was 88.9% and the freedom from distant metastasis was 95.5% (n = 2). The dosimetric analysis demonstrated similar ipsilateral level II cervical nodal region doses, whereas contralateral doses were higher with photon plans, mean: 15.5 Gy and 0.7CGE, D5%: 25.1 Gy and 6.6CGE. CONCLUSIONS: Our series is the first to report outcomes for patients with OPSCC receiving unilateral PBT. The contralateral neck failure rate was excellent and comparable to failure rates with photon irradiation.

Modeling moisture diffusivity, activation energy and specific energy consumption of squash seeds in a semi fluidized and fluidized bed drying.

This study investigated thin layer drying of squash seeds under semi fluidized and fluidized bed conditions with initial moisture content about 83.99% (d.b.). An experimental fluidized bed dryer was also used in this study. Air temperature levels of 50, 60, 70 and 80 °C were applied in drying samples. To estimate the drying kinetic of squash seed, seven mathematical models were used to fit the experimental data of thin layer drying. Among the applied models, Two-term model has the best performance to estimate the thin layer drying behavior of the squash seeds. Fick's second law in diffusion was used to determine the effective moisture diffusivity of squash seeds. The range of calculated values of effective moisture diffusivity for drying experiments were between 0.160 × 10(-9) and 0.551 × 10(-10) m(2)/s. Moisture diffusivity values decreased as the input air temperature decreased. Activation energy values were found to be between 31.94 and 34.49 kJ/mol for 50 °C to 80 °C, respectively. The specific energy consumption for squash seeds was calculated at the boundary of 0.783 × 10(6) and 2.303 × 10(6) kJ/kg. Increasing in drying air temperature in different bed conditions led to decrease in specific energy value. Results showed that applying the semi fluidized bed condition is more effective for convective drying of squash seeds. The aforesaid drying characteristics are useful to select the best operational point of fluidized bed dryer and to precise design of system.

High-dose-rate brachytherapy as monotherapy versus as boost in unfavorable intermediate-risk localized prostate cancer: A matched-pair analysis.

PURPOSE: High-dose-rate brachytherapy as monotherapy (HDR-M), or as a boost combined with external beam radiotherapy (HDR-B), are both suitable treatments for intermediate-risk prostate cancer. However, data directly comparing these two approaches for men with unfavorable intermediate-risk (UIR) patients are lacking. METHODS AND MATERIALS: Patients with NCCN-defined UIR prostate cancer treated from 1997 to 2020 were identified in a prospectively maintained, single institution database. HDR-M and HDR-B patients were matched using three factors: age ±3 years; Gleason score (major and minor); and clinical T stage. Biochemical failure was defined as PSA nadir (nPSA) + 2. Available acute and chronic toxicities are additionally reported. RESULTS: A total of 247 patients were identified (170 receiving HDR-B, 77 receiving HDR-M), ultimately yielding 70 matched pairs (140 patients) for inclusion. The median followup time was 5.2 years for HDR-M compared with 9.3 years for HDR-B (p < 0.001). The two cohorts had similar calculated prostate EQD2 (HDR-B 118 Gy vs. HDR-M 115 Gy, p = 0.977). No significant differences in OS, CSS, DM, LRR, or FFBF were identified. HDR-B had an increased rate of any acute grade 2+ gastrointestinal toxicity and worse acute dysuria and diarrhea. Chronic gastrointestinal and genitourinary toxicity was similar. CONCLUSIONS: These data suggest that HDR brachytherapy as monotherapy is an effective treatment option for selected patients with unfavorable intermediate-risk prostate cancer and provides a more favorable gastrointestinal toxicity profile than HDR-B. Prospective trials should be conducted to refine the selection process for this heterogeneous cohort of patients.

Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy.

Purpose: Postmastectomy radiation therapy (PMRT) reduces disease recurrence in appropriately selected patients but may compromise implant-based reconstruction. We investigated whether near-surface dose correlates with radiation-related toxic effects in these patients. Methods and Materials: Patients receiving PMRT at a single institution from 2016 to 2019 were retrospectively reviewed. Patient demographics and treatment information were collected. Three near-surface structures were retrospectively generated, bound by the chest wall tangent beam as well as the skin surface and the skin-3 mm contour (SR3), skin surface and skin-5 mm contour (SR5), or skin-5 and skin-10 mm contours. Dosimetric analysis of these near-surface contours was performed in 2 Gy intervals. Univariate and multivariate analyses were used to identify predictors of moist desquamation, grade 2+ chest wall pain, use of opiate pain medication, unplanned reconstructive surgery, and implant failure. Logistic regression for each outcome and near-surface contour was performed for receiver-operator area under the curve (AUC) analysis and the Youden J Statistic was used to determine the optimal threshold for each dosimetric parameter. Results: Of 126 patients reviewed, 109 met the study's eligibility criteria. Median follow-up was 2.3 years. Twenty-five patients (23%) underwent unplanned reconstructive surgery, and 10 (9.2%) experienced implant failure. Among clinical variables, low body mass index and history of smoking predicted unplanned surgery on univariate and multivariate analyses, and moist desquamation predicted grade 2+ chest wall pain. The top dosimetric parameters by AUC for moist desquamation, grade 2+ chest wall pain, use of opiates, unplanned reconstructive surgery, and implant failure were SR5 D10 cc (AUC = 0.701, optimal threshold 57.8 Gy, P < .001), SR3 D10 cc (AUC = 0.600, optimal threshold 56.8 Gy, P = .079), SR5 D10 cc (AUC = 0.642, optimal threshold 57.3 Gy, P = .041), SR3 V44 Gy (AUC = 0.711, optimal threshold 81%, P = .001), and SR3 V44 Gy (AUC = 0.688, optimal threshold 82%, P = .052), respectively. Conclusions: Near-surface dose correlates with moist desquamation and unplanned reconstructive surgery after PMRT. Further evaluation of prospective optimization of dosimetric parameters related to SR3 and SR5 should be considered.

Knowledge and Technology Used in Capacitive Deionization of Water.

The demand for water and energy in today's developing world is enormous and has become the key to the progress of societies. Many methods have been developed to desalinate water, but energy and environmental constraints have slowed or stopped the growth of many. Capacitive Deionization (CDI) is a very new method that uses porous carbon electrodes with significant potential for low energy desalination. This process is known as deionization by applying a very low voltage of 1.2 volts and removing charged ions and molecules. Using capacitive principles in this method, the absorption phenomenon is facilitated, which is known as capacitive deionization. In the capacitive deionization method, unlike other methods in which water is separated from salt, in this technology, salt, which is a smaller part of this compound, is separated from water and salt solution, which in turn causes less energy consumption. With the advancement of science and the introduction of new porous materials, the use of this method of deionization has increased greatly. Due to the limitations of other methods of desalination, this method has been very popular among researchers and the water desalination industry and needs more scientific research to become more commercial.

Modelling moisture diffusivity of pomegranate seed cultivars under fixed, semi fluidized and fluidized bed using mathematical and neural network methods.

BACKGROUND: Modelling moisture diffusivity of pomegranate cultivars is considered to be a major aspect of the drying process optimization. Its goal is mainly to apply the optimum drying method and conditions in which the final product meets the required standards. Temperature is the major parameter which affects the moisture diffusivity. This parameter is not equal for different cultivars of pomegranate. So modelling of moisture diffusivity is important in designing, optimizing and adjusting the dryer system. MATERIAL AND METHODS: This research studied thin layer drying of three cultivars of pomegranate seeds (Alak, Siah and Malas) under fixed, semi fluidized and fluidized bed conditions. Drying process of samples was implemented at 50, 60, 70 and 80°C air temperature levels. Second law of Fick in diffusion was utilized to compute the effective moisture diffusivity (D(eff)) of the seeds. Linear and artificial neural networks (ANNs) also were used to model D(eff) of seeds. RESULTS: Maximum and minimum values of the D(eff) were related to Malas and Alak cultivars, respectively. Three linear models were found to fit the experimental data with average R2 = 0.9350, 0.9320 and 0.9400 for Alak, Siah and Malas cultivars, respectively. The best results for neural network were related to feed forward neural network with training algorithm of Levenberg-Marquardt was appertained to the topology of 3-4-3-1 and threshold function of LOGSIG. By the use of this structure, R2 = 0.9972 was determined. CONCLUSION: A direct relationship was found between D(eff) and thickness of fleshy section of the seeds. The Siah cultivar has the highest value of D(eff). This is due to higher volume of fleshy section of the Siah cultivar. Cultivar type and air velocity have the highest and the least effect on D(eff), respectively.