Variability in the Treatment of Elderly Patients with Stage IIIA (N2) Non–Small-Cell Lung Cancer

INTRODUCTION: We evaluated treatment patterns of elderly patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC). METHODS: The use of surgery, chemotherapy, and radiation for patients with stage IIIA (T1-T3N2M0) NSCLC in the Surveillance, Epidemiology, and End Results-Medicare database from 2004 to 2007 was analyzed. Treatment variability was assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census track variables. Overall survival was analyzed using the Kaplan-Meier approach and Cox proportional hazard models. RESULTS: The most common treatments for 2958 patients with stage IIIA (N2) NSCLC were radiation with chemotherapy (n = 1065, 36%), no treatment (n = 534, 18%), and radiation alone (n = 383, 13%). Surgery was performed in 709 patients (24%): 235 patients (8%) had surgery alone, 40 patients (1%) had surgery with radiation, 222 patients had surgery with chemotherapy (8%), and 212 patients (7%) had surgery, chemotherapy, and radiation. Younger age (p < 0.0001), lower T-status (p < 0.0001), female sex (p = 0.04), and living in a census track with a higher median income (p = 0.03) predicted surgery use. Older age (p < 0.0001) was the only factor that predicted that patients did not get any therapy. The 3-year overall survival was 21.8 ± 1.5% for all patients, 42.1 ± 3.8% for patients that had surgery, and 15.4 ± 1.5% for patients that did not have surgery. Increasing age, higher T-stage and Charlson Comorbidity Index, and not having surgery, radiation, or chemotherapy were all risk factors for worse survival (all p values < 0.001). CONCLUSIONS: Treatment of elderly patients with stage IIIA (N2) NSCLC is highly variable and varies not only with specific patient and tumor characteristics but also with regional income level.

High Resolution Transmission Spectroscopy as a Diagnostic for Jovian Exoplanet Atmospheres: Constraints from Theoretical Models

We present high resolution transmission spectra of giant planet atmospheres from a coupled 3-D atmospheric dynamics and transmission spectrum model that includes Doppler shifts which arise from winds and planetary motion. We model jovian planets covering more than two orders of magnitude in incident flux, corresponding to planets with 0.9 to 55 day orbital periods around solar-type stars. The results of our 3-D dynamical models reveal certain aspects of high resolution transmission spectra that are not present in simple 1-D models. We find that the hottest planets experience strong substellar to anti-stellar (SSAS) winds, resulting in transmission spectra with net blue shifts of up to 3 km s−1, whereas less irradiated planets show almost no net Doppler shifts. Compared to 1-D models, peak line strengths are significantly reduced for the hottest atmospheres owing to Doppler broadening from a combination of rotation (which is faster for close-in planets under the assumption of tidal locking) and atmospheric winds. Finally, high resolution transmission spectra may be useful in studying the atmospheres of exoplanets with optically thick clouds since line cores for very strong transitions should remain optically thick to very high altitude. High resolution transmission spectra are an excellent observational test for the validity of 3-D atmospheric dynamics models, because they provide a direct probe of wind structures and heat circulation. Ground-based exoplanet spectroscopy is currently on the verge of being able to verify some of our modeling predictions, most notably the dependence of SSAS winds on insolation. We caution that interpretation of high resolution transmission spectra based on 1-D atmospheric models may be inadequate, as 3-D atmospheric motions can produce a noticeable effect on the absorption signatures.

ANALYTICAL MODELS OF EXOPLANETARY ATMOSPHERES. I. ATMOSPHERIC DYNAMICS VIA THE SHALLOW WATER SYSTEM

Within the context of exoplanetary atmospheres, we present a comprehensive linear analysis of forced, damped, magnetized shallow water systems, exploring the effects of dimensionality, geometry (Cartesian, pseudo-spherical, and spherical), rotation, magnetic tension, and hydrodynamic and magnetic sources of friction. Across a broad range of conditions, we find that the key governing equation for atmospheres and quantum harmonic oscillators are identical, even when forcing (stellar irradiation), sources of friction (molecular viscosity, Rayleigh drag, and magnetic drag), and magnetic tension are included. The global atmospheric structure is largely controlled by a single key parameter that involves the Rossby and Prandtl numbers. This near-universality breaks down when either molecular viscosity or magnetic drag acts non-uniformly across latitude or a poloidal magnetic field is present, suggesting that these effects will introduce qualitative changes to the familiar chevron-shaped feature witnessed in simulations of atmospheric circulation. We also find that hydrodynamic and magnetic sources of friction have dissimilar phase signatures and affect the flow in fundamentally different ways, implying that using Rayleigh drag to mimic magnetic drag is inaccurate. We exhaustively lay down the theoretical formalism (dispersion relations, governing equations, and time-dependent wave solutions) for a broad suite of models. In all situations, we derive the steady state of an atmosphere, which is relevant to interpreting infrared phase and eclipse maps of exoplanetary atmospheres. We elucidate a pinching effect that confines the atmospheric structure to be near the equator. Our suite of analytical models may be used to develop decisively physical intuition and as a reference point for three-dimensional magnetohydrodynamic simulations of atmospheric circulation.

Analytical Models of Exoplanetary Atmospheres. II. Radiative Transfer via the Two-Stream Approximation

We present a comprehensive analytical study of radiative transfer using the method of moments and include the effects of non-isotropic scattering in the coherent limit. Within this unified formalism, we derive the governing equations and solutions describing two-stream radiative transfer (which approximates the passage of radiation as a pair of outgoing and incoming fluxes), flux-limited diffusion (which describes radiative transfer in the deep interior) and solutions for the temperature-pressure profiles. Generally, the problem is mathematically under-determined unless a set of closures (Eddington coefficients) is specified. We demonstrate that the hemispheric (or hemi-isotropic) closure naturally derives from the radiative transfer equation if energy conservation is obeyed, while the Eddington closure produces spurious enhancements of both reflected light and thermal emission. We concoct recipes for implementing two-stream radiative transfer in stand-alone numerical calculations and general circulation models. We use our two-stream solutions to construct toy models of the runaway greenhouse effect. We present a new solution for temperature-pressure profiles with a non-constant optical opacity and elucidate the effects of non-isotropic scattering in the optical and infrared. We derive generalized expressions for the spherical and Bond albedos and the photon deposition depth. We demonstrate that the value of the optical depth corresponding to the photosphere is not always 2/3 (Milne's solution) and depends on a combination of stellar irradiation, internal heat and the properties of scattering both in optical and infrared. Finally, we derive generalized expressions for the total, net, outgoing and incoming fluxes in the convective regime.

ON THE EXISTENCE OF SHOCKS IN IRRADIATED EXOPLANETARY ATMOSPHERES

Supersonic flows are expected to exist in the atmospheres of irradiated exoplanets, but the question of whether shocks develop lingers. Specifically, it reduces to whether continuous flow in a closed loop may become supersonic and if some portions of the supersonic flow steepen into shocks. We first demonstrate that continuous, supersonic flow may exist in two flavors: isentropic and non-isentropic, with shocks being included in the latter class of solutions. Supersonic flow is a necessary but insufficient condition for shocks to develop. The development of a shock requires the characteristics of neighboring points in a flow to intersect. We demonstrate that the intersection of characteristics may be quantified via the knowledge of the Mach number. Finally, we examine three-dimensional simulations of hot Jovian atmospheres and demonstrate that shock formation is expected to occur mostly on the dayside hemisphere, upstream of the substellar point, because the enhanced temperatures near the substellar point provide a natural pressure barrier for the returning flow. Understanding the role of shocks in irradiated exoplanetary atmospheres is relevant to correctly modeling observables such as the peak offsets of infrared phase curves.

ON THE STABILITY OF SUPER-EARTH ATMOSPHERES

We investigate the stability of super-Earth atmospheres around M stars using a seven-parameter, analytical framework. We construct stability diagrams in the parameter space of exoplanetary radius versus semimajor axis and elucidate the regions in which the atmospheres are stable against the condensation of their major constituents, out of the gas phase, on their permanent nightside hemispheres. We find that super-Earth atmospheres that are nitrogen-dominated (Earth-like) occupy a smaller region of allowed parameter space, compared to hydrogen-dominated atmospheres, because of the dual effects of diminished advection and enhanced radiative cooling. Furthermore, some super-Earths which reside within the habitable zones of M stars may not possess stable atmospheres, depending on the mean molecular weight and infrared photospheric pressure of their atmospheres. We apply our stability diagrams to GJ 436b and GJ 1214b, and demonstrate that atmospheric compositions with high mean molecular weights are disfavored if these exoplanets possess solid surfaces and shallow atmospheres. Finally, we construct stability diagrams tailored to the Kepler data set, for G and K stars, and predict that about half of the exoplanet candidates are expected to harbor stable atmospheres if Earth-like conditions are assumed. We include 55 Cancri e and CoRoT-7b in our stability diagram for G stars

THE EFFECTS OF IRRADIATION ON HOT JOVIAN ATMOSPHERES: HEAT REDISTRIBUTION AND ENERGY DISSIPATION

Hot Jupiters, due to the proximity to their parent stars, are subjected to a strong irradiating flux that governs their radiative and dynamical properties. We compute a suite of three-dimensional circulation models with dual-band radiative transfer, exploring a relevant range of irradiation temperatures, both with and without temperature inversions. We find that, for irradiation temperatures T irr lsim 2000 K, heat redistribution is very efficient, producing comparable dayside and nightside fluxes. For T irr ≈ 2200-2400 K, the redistribution starts to break down, resulting in a high day-night flux contrast. Our simulations indicate that the efficiency of redistribution is primarily governed by the ratio of advective to radiative timescales. Models with temperature inversions display a higher day-night contrast due to the deposition of starlight at higher altitudes, but we find this opacity-driven effect to be secondary compared to the effects of irradiation. The hotspot offset from the substellar point is large when insolation is weak and redistribution is efficient, and decreases as redistribution breaks down. The atmospheric flow can be potentially subjected to the Kelvin-Helmholtz instability (as indicated by the Richardson number) only in the uppermost layers, with a depth that penetrates down to pressures of a few millibars at most. Shocks penetrate deeper, down to several bars in the hottest model. Ohmic dissipation generally occurs down to deeper levels than shock dissipation (to tens of bars), but the penetration depth varies with the atmospheric opacity. The total dissipated Ohmic power increases steeply with the strength of the irradiating flux and the dissipation depth recedes into the atmosphere, favoring radius inflation in the most irradiated objects. A survey of the existing data, as well as the inferences made from them, reveals that our results are broadly consistent with the observational trends.

From planetesimals to planets: volatile molecules

Context. Solar and extrasolar planets are the subject of numerous studies aiming to determine their chemical composition and internal structure. In the case of extrasolar planets, the composition is important as it partly governs their potential habitability. Moreover, observational determination of chemical composition of planetary atmospheres are becoming available, especially for transiting planets. Aims. The present works aims at determining the chemical composition of planets formed in stellar systems of solar chemical composition. The main objective of this work is to provide valuable theoretical data for models of planet formation and evolution, and future interpretation of chemical composition of solar and extrasolar planets. Methods. We have developed a model that computes the composition of ices in planets in different stellar systems with the use of models of ice and planetary formation. Results. We provide the chemical composition, ice/rock mass ratio and C:O molar ratio for planets in stellar systems of solar chemical composition. From an initial homogeneous composition of the nebula, we produce a wide variety of planetary chemical compositions as a function of the mass of the disk and distance to the star. The volatile species incorporated in planets are mainly composed of H2O, CO, CO2, CH3OH, and NH3. Icy or ocean planets have systematically higher values of molecular abundances compared to giant and rocky planets. Gas giant planets are depleted in highly volatile molecules such as CH4, CO, and N2 compared to icy or ocean planets. The ice/rock mass ratio in icy or ocean and gas giant planets is, respectively, equal at maximum to 1.01 ± 0.33 and 0.8 ± 0.5, and is different from the usual assumptions made in planet formation models, which suggested this ratio to be 2–3. The C:O molar ratio in the atmosphere of gas giant planets is depleted by at least 30% compared to solar value.

Gas composition of the main volatile elements in protoplanetary discs and its implication for planet formation

Context. Direct observations of gaseous exoplanets reveal that their gas envelope has a higher C/O ratio than that of the host star (e.g., Wasp 12-b). This has been explained by considering that the gas phase of the disc could be inhomogeneous, exceeding the stellar C/O ratio in regions where these planets formed; but few studies have considered the drift of the gas and planet migration. Aims. We aim to derive the gas composition in planets through planet formation to evaluate if the formation of giant planets with an enriched C/O ratio is possible. The study focusses on the effects of different processes on the C/O ratio, such as the disc evolution, the drift of gas, and planet migration. Methods. We used our previous models for computing the chemical composition, together with a planet formation model, to which we added the composition and drift of the gas phase of the disc, which is composed of the main volatile species H2O, CO, CO2, NH3, N2, CH3OH, CH4, and H2S, H2 and He. The study focusses on the region where ice lines are present and influence the C/O ratio of the planets. Results. Modelling shows that the condensation of volatile species as a function of radial distance allows for C/O enrichment in specific parts of the protoplanetary disc of up to four times the solar value. This leads to the formation of planets that can be enriched in C/O in their envelope up to three times the solar value. Planet migration, gas phase evolution and disc irradiation enables the evolution of the initial C/O ratio that decreases in the outer part of the disc and increases in the inner part of the disc. The total C/O ratio of the planets is governed by the contribution of ices accreted, suggesting that high C/O ratios measured in planetary atmospheres are indicative of a lack of exchange of material between the core of a planet and its envelope or an observational bias. It also suggests that the observed C/O ratio is not representative of the total C/O ratio of the planet.

Molecular nitrogen in comet 67P/Churyumov-Gerasimenko indicates a low formation temperature

Molecular nitrogen (N2) is thought to have been the most abundant form of nitrogen in the protosolar nebula. It is the main N-bearing molecule in the atmospheres of Pluto and Triton and probably the main nitrogen reservoir from which the giant planets formed. Yet in comets, often considered the most primitive bodies in the solar system, N2 has not been detected. Here we report the direct in situ measurement of N2 in the Jupiter family comet 67P/Churyumov-Gerasimenko, made by the Rosetta Orbiter Spectrometer for Ion and Neutral Analysis mass spectrometer aboard the Rosetta spacecraft. A N2/CO ratio of Embedded Image (2σ standard deviation of the sampled mean) corresponds to depletion by a factor of ~25.4 ± 8.9 as compared to the protosolar value. This depletion suggests that cometary grains formed at low-temperature conditions below ~30 kelvin.

Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial

BACKGROUND One of the standard options in the treatment of stage IIIA/N2 non-small-cell lung cancer is neoadjuvant chemotherapy and surgery. We did a randomised trial to investigate whether the addition of neoadjuvant radiotherapy improves outcomes. METHODS We enrolled patients in 23 centres in Switzerland, Germany and Serbia. Eligible patients had pathologically proven, stage IIIA/N2 non-small-cell lung cancer and were randomly assigned to treatment groups in a 1:1 ratio. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (100 mg/m(2) cisplatin and 85 mg/m(2) docetaxel) followed by radiotherapy with 44 Gy in 22 fractions over 3 weeks, and those in the control group received neoadjuvant chemotherapy alone. All patients were scheduled to undergo surgery. Randomisation was stratified by centre, mediastinal bulk (less than 5 cm vs 5 cm or more), and weight loss (5% or more vs less than 5% in the previous 6 months). The primary endpoint was event-free survival. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00030771. FINDINGS From 2001 to 2012, 232 patients were enrolled, of whom 117 were allocated to the chemoradiotherapy group and 115 to the chemotherapy group. Median event-free survival was similar in the two groups at 12·8 months (95% CI 9·7-22·9) in the chemoradiotherapy group and 11·6 months (8·4-15·2) in the chemotherapy group (p=0·67). Median overall survival was 37·1 months (95% CI 22·6-50·0) with radiotherapy, compared with 26·2 months (19·9-52·1) in the control group. Chemotherapy-related toxic effects were reported in most patients, but 91% of patients completed three cycles of chemotherapy. Radiotherapy-induced grade 3 dysphagia was seen in seven (7%) patients. Three patients died in the control group within 30 days after surgery. INTERPRETATION Radiotherapy did not add any benefit to induction chemotherapy followed by surgery. We suggest that one definitive local treatment modality combined with neoadjuvant chemotherapy is adequate to treat resectable stage IIIA/N2 non-small-cell lung cancer. FUNDING Swiss State Secretariat for Education, Research and Innovation (SERI), Swiss Cancer League, and Sanofi.