Defining target volumes for stereotactic ablative radiotherapy of early-stage lung tumours: a comparison of three-dimensional 18F-fluorodeoxyglucose positron emission tomography and four-dimensional computed tomography.:PETCT versus 4DCT for SABR in Early Stage NSCLC

AIMS: High local control rates are achieved in stage I lung cancer using
stereotactic ablative radiotherapy. Target delineation is commonly based on
four-dimensional computed tomography (CT) scans. Target volumes defined by
positron emission tomography/computed tomography (PET/CT) are compared with those defined by four-dimensional CT and conventional ('three-dimensional')
(18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT.

MATERIALS AND METHODS: For 16 stage I non-small cell lung cancer tumours, six
approaches for deriving PET target volumes were evaluated: manual contouring,
standardised uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV
(35%SUV(MAX)), 41% of SUV(MAX) (41%SUV(MAX)) and two different source to
background ratio techniques (SBR-1 and SBR-2). PET-derived target volumes were compared with the internal target volume (ITV) from the modified maximum
intensity projection (MIP(MOD) ITV). Volumetric and positional correlation was
assessed using the Dice similarity coefficient (DSC).

RESULTS: PET-based target volumes did not correspond to four-dimensional CT-based target volumes. The mean DSC relative to MIP(MOD) ITV were: PET manual = 0.64, SUV2.5 = 0.64, 35%SUV(MAX) = 0.63, 41%SUV(MAX) = 0.57. SBR-1 = 0.52, SBR-2 =0.49. PET-based target volumes were smaller than corresponding MIP ITVs.

CONCLUSIONS: Conventional three-dimensional (18)F-FDG PET-derived target volumes for lung stereotactic ablative radiotherapy did not correspond well with those derived from four-dimensional CT, including those in routine clinical use
(MIP(MOD) ITV). Caution is required in using three-dimensional PET for motion
encompassing target volume delineation.

A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis

BACKGROUND AND PURPOSE: Stereotactic ablative radiotherapy (SABR) has become standard for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is no randomized evidence demonstrating benefit over more fractionated radiotherapy. We compared accelerated hypofractionation (AH) and SABR using a propensity score-matched analysis.

MATERIALS AND METHODS: From 1997-2007, 119 patients (T1-3N0M0 NSCLC) were treated with AH (48-60Gy, 12-15 fractions). Prior to SABR, this represented our institutional standard. From 2008-2012, 192 patients (T1-3N0M0 NSCLC) were treated with SABR (48-52Gy, 4-5 fractions). A total of 114 patients (57 per cohort) were matched (1:1 ratio, caliper: 0.10) using propensity scores.

RESULTS: Median follow-up (range) for the AH cohort was 36.3 (2.5-109.1) months, while that for the SABR group was 32.5 (0.3-62.6)months. Three-year overall survival (OS) and local control (LC) rates were 49.5% vs. 72.4% [p=0.024; hazard ratio (HR): 2.33 (1.28, 4.23), p=0.006] and 71.9% vs. 89.3% [p=0.077; HR: 5.56 (1.53, 20.2), p=0.009], respectively. On multivariable analysis, tumour diameter and PET staging were predictive for OS, while the only predictive factor for LC was treatment cohort.

CONCLUSIONS: OS and LC were improved with SABR, although OS is more closely related to non-treatment factors. This represents one of the few studies comparing AH to SABR for early-stage lung cancer.

Lo sabe ETC, yo lo sabré : educación vial : educación primaria segundo y tercer ciclo.

Unidad didáctica sobre el tema transversal la educación vial dirigido al alumnado del segundo y tercer ciclo de la educación primaria. El objetivo es que el alumnado adquiera hábitos de comportamiento de educación vial para disfrutar mejor de la ciudad. Contiene el manual y la guía didáctica. Los contenidos que se desarrollan son: reconocimiento de las señales de tráfico, comprensión y respeto de las normas de circulación, adquisición de hábitos de no competitividad en la circulación, circulación con vehículos de dos ruedas, reconocimiento de las limitaciones de la bicicleta, normas de utilización de los servicios de transporte público y reconocimiento de las normas de utilización de vehículos particulares.

SABR for early-stage lung cancer: Early-adoption and future directions

Early-stage lung cancer incidence among older adults is expected to increase due to demographic trends and CT-based screening, yet optimal treatment of lung cancer in the elderly remains controversial. There are several accepted strategies for treating lung cancer including surgery, conventional radiation, and stereotactic ablative body radiotherapy (SABR). However, there are currently no randomized controlled trials to help distinguish the comparative effectiveness of these various strategies. This is an unfortunate omission as lung cancer causes the most deaths among all cancers in the United States (as well as the entire world). SABR holds particular promise as it is a completely non-invasive, ambulatory technique for achieving cure without an operation, thus avoiding the risks of surgery and the associated pre-operative and post-operative costs. To provide fair view of the potential effect on SABR on controlling lung cancer in the United States, a systematic review of SABR with a focus on its achieved outcomes, toxicities, and comparison to conventional radiation and surgical options is presented. ^

Diário da Constituinte [gravação de vídeo] : [programa n. 218]

Mais da metade do substitutivo do Relator Bernardo Cabral já foi analisado. Na última reunião no Instituto Israel Pinheiro, dois temas foram amplamente discutidos: o Poder Judiciário e o fim dos "marajás" no serviço público. O Deputado Bernardo Cabral (PMDB-AM) afirma que ninguém mais ingressará no serviço público sem ser através de concurso público, que os "marajás" no serviço público serão extintos e que haverá critérios para o preenchimento de cargos de confiança. Em reunião da Comissão de Sistematização, constituintes criticam as reuniões no Instituto Israel Pinheiro. O Deputado José Genoíno (PT-SP) considera que o trabalho da Assembleia Nacional Constituinte (ANC) tem que ser feito dentro do Congresso Nacional. O Líder do Governo Carlos Santana declara que esse trabalho tem que vir para a Comissão de Sistematização. O Relator Bernardo Cabral (PMDB-AM) responde as criticas. O Presidente da ANC, Deputado Ulysses Guimarães (PMDB-SP) defende o Deputado Bernardo Cabral, dizendo que, por enquanto, o substitutivo é responsabilidade do Relator e pode ser elaborado em qualquer lugar. O Deputado Nelson Sabrá (PFL-RJ) que tomou posse na vaga do falecido Deputado Alair Ferreira (PFL-RJ), declara que é preciso condensar ainda mais os artigos da Constituição. Parlamentares do Norte, Nordeste e Centro-Oeste pedem ao Presidente da Assembleia Nacional Constituinte (ANC), Deputado Ulysses Guimarães apoio às emendas que favoreçam suas regiões. O Deputado Raimundo Bezerra (PMDB-CE) considera que a emenda mais importante é aquela que estabelece a renda a ser distribuída pela União para essas áreas. O Deputado José Dutra (PMDB-AM) afirma ser indispensável que os parlamentares marquem posição no sentido de garantir aos povos dessas regiões uma vida menos difícil do que a que têm hoje.

Diário da Constituinte [gravação de vídeo] : [programa n. 577]

Conclusão da votação pelo Plenário do capítulo Da Família. Reconhecimento da união estável e da comunidade formada por qualquer dos pais e seus descendentes como entidades familiares, para efeito da proteção do Estado. Não tratamento do aborto pelo texto constitucional. Baixa representação feminina na Assembleia Nacional Constituinte. O divórcio será permitido aos casais separados judicialmente há um ano e aos casais separados de fato há dois anos. A regulamentação do número de divórcios será feita por lei ordinária. Contemplação dos direitos da criança pela nova Carta Magna. O idoso passa a ter amparo do Estado e da sociedade. Garantia da gratuidade do transporte coletivo para pessoa maior de 65 anos de idade. Continuidade de apreciação pelos Constituintes. dos direitos dos povos indígenas.

Diário da Constituinte [gravação de vídeo] : [programa n. 582]

Expectativa de votação pelo Plenário da seção Ato das Disposições Constitucionais Transitórias. Apresentação de emenda pelo Constituinte Nelson Sabrá (PFL-RJ) sobre os reajustes das aposentadorias. Dissenso ante a data de celebração das eleições municipais. Indefinição em torno da duração do mandato do Presidente da República José Sarney. Inexistência de acordo de Líderes para votação do capítulo Dos Índios. Consenso em torno das propostas sobre o condicionamento de autorização do Congresso Nacional para o aproveitamento de recursos hídricos, a exploração, pesquisa e lavra de minerais em área indígena; regulamentação, por meio de lei ordinária,do montante de recursos para os povos indígenas oriundos das atividades de mineração.

Diário da Constituinte [gravação de vídeo] : [programa n. 497]

Fundo da Assembleia Nacional Constituinte 1987/88 - Câmara dos Deputados, Centro de Documentação e Informação, Coordenação de Arquivo.

Diário da Constituinte [gravação de vídeo] : [programa n. 591]

Defesa de realização de eleições municipais em 1988. Divergência em torno da proposta de efetivação de funcionários públicos não concursados desde que haja 5 anos de efetivo exercício na função.

Lung stereotactic body radiation therapy (SBRT) delivered over 4 or 11days: A comparison of acute toxicity and quality of life.

Abstract
PURPOSE:
The optimal duration over which lung SBRT should be delivered is unknown. We conducted a randomized pilot study in patients treated with four fractions of lung SBRT delivered over 4 or over 11days.
METHODS:
Patients with a peripheral solitary lung tumor (NSCLC or pulmonary metastasis) ?5cm were eligible. For NSCLC lung tumors ?3cm, a dose of 48Gy in 4 fractions was used, otherwise 52Gy in 4 fractions was delivered. Patients were randomized to receive treatment over 4 consecutive days or over 11days. The primary end-point was acute grade ?2 toxicity. Secondary end-points included quality of life (QOL) assessed using the EORTC QLQ-C30 and QLQ-LC13 questionnaires.
RESULTS:
Fifty four patients were enrolled. More patients in the 11day group had respiratory symptoms at baseline. 55.6% patients treated over 4days and 33.3% of patients treated over 11days experienced acute grade ?2 toxicity (p=0.085). Dyspnea, fatigue and coughing domains were worse in the 11day group at baseline. At 1 and 4months, more patients in the 4day group experienced a clinically meaningful worsening in the dyspnea QOL domain compared to the 11day group (44.5% vs 15.4%, p=0.02; 38.5% vs 12.0%, p=0.03, respectively). However, raw QOL scores were not different at these time-points between treatment groups.
CONCLUSIONS:
Grade 2 or higher acute toxicity was more common in the 4day group, approaching statistical significance. More patients treated on 4 consecutive days reported a clinically meaningful increase in dyspnea, although interpretation of these results is challenging due to baseline imbalance between treatment groups. Larger studies are required to validate these results.

Prostate stereotactic ablative body radiotherapy using a standard linear accelerator:toxicity, biochemical, and pathological outcomes

Biological dose escalation through stereotactic ablative radiotherapy (SABR) holds promise of improved patient convenience, system capacity and tumor control with decreased cost and side effects. The objectives are to report the toxicities, biochemical and pathologic outcomes of this prospective study.

Predictors of Chest Wall Toxicity after Lung Stereotactic Ablative Radiotherapy

AIMS: To determine the incidence and predictive factors of rib fracture and chest wall pain after lung stereotactic ablative radiotherapy (SABR).

MATERIALS AND METHODS: Patients were treated with lung SABR of 48-60 Gy in four to five fractions. The treatment plan and follow-up computed tomography scans of 289 tumours in 239 patients were reviewed. Dose-volume histogram (DVH) metrics and clinical factors were evaluated as potential predictors of chest wall toxicity.

RESULTS: The median follow-up was 21.0 months (range 6.2-52.1). Seventeen per cent (50/289) developed a rib fracture, 44% (22/50) were symptomatic; the median time to fracture was 16.4 months. On univariate analysis, female gender, osteoporosis, tumours adjacent (within 5 mm) to the chest wall and all of the chest wall DVH metrics predicted for rib fracture, but only tumour location adjacent to the chest wall remained significant on the multivariate model (P < 0.01). The 2 year fracture-free probability for those adjacent to the chest wall was 65.6%. Among those tumours adjacent to the chest wall, only osteoporosis (P = 0.02) predicted for fracture, whereas none of the chest wall DVH metrics were predictive. Eight per cent (24/289) experienced chest wall pain without fracture.

CONCLUSIONS: None of the chest wall DVH metrics independently predicted for SABR-induced rib fracture when tumour location is taken into account. Patients with tumours adjacent (within 5 mm) to the chest wall are at greater risk of rib fracture after lung SABR, and among these, an additional risk was observed in osteoporotic patients.

Predictive Factors for Local Control in Primary and Metastatic Lung Tumours after Four to Five Fraction Stereotactic Ablative Body Radiotherapy: A Single Institution's Comprehensive Experience

AIMS: We report the outcomes of a large lung stereotactic ablative body radiotherapy (SABR) programme for primary non-small cell lung cancer (NSCLC) and pulmonary metastases. The primary study aim was to identify factors predictive for local control.

MATERIALS AND METHODS: In total, 311 pulmonary tumours in 254 patients were treated between 2008 and 2011 with SABR using 48-60 Gy in four to five fractions. Local, regional and distant failure data were collected prospectively, whereas other end points were collected retrospectively. Potential clinical and dosimetric predictors of local control were evaluated using univariate and multivariate analyses.

RESULTS: Of the 311 tumours, 240 were NSCLC and 71 were other histologies. The 2 year local control rate was 96% in stage I NSCLC, 76% in colorectal cancer (CRC) metastases and 91% in non-lung/non-CRC metastases. Predictors of better local control on multivariate analysis were non-CRC tumours and a larger proportion of the planning target volume (PTV) receiving ≥100% of the prescribed dose (higher PTV V100). Among the 45 CRC metastases, a higher PTV V100 and previous chemotherapy predicted for better local control.

CONCLUSIONS: Lung SABR of 48-60 Gy/four to five fractions resulted in high local control rates for all tumours except CRC metastases. Covering more of the PTV with the prescription dose (a higher PTV V100) also resulted in superior local control.

Stereotactic body radiation therapy in stage I inoperable lung cancer: from palliative to curative options.

Surgery has historically been the standard of care for operable stage I non-small cell lung cancer (NSCLC). However, nearly one-quarter of patients with stage I NSCLC will not undergo surgery because of medical comorbidity or other factors. Stereotactic ablative radiotherapy (SABR) is the new standard of care for these patients. SABR offers high local tumour control rates rivalling the historical results of surgery and is generally well tolerated by patients with both peripheral and centrally located tumours. This article reviews the history of SABR for stage I NSCLC, summarises the currently available data on efficacy and toxicity, and describes some of the currently controversial aspects of this treatment.