Dose escalated intensity modulated radiotherapy in the treatment of cervical cancer.

PURPOSE Standard dose of external beam radiotherapy seems to be insufficient for satisfactory control of loco-regionally advanced cervical cancer. Aim of our study is to evaluate the outcome as well as early and chronic toxicities in patients with loco-regionally advanced cervical cancer, treated with dose escalated intensity modulated radiotherapy (IMRT) combined with cisplatin chemotherapy. MATERIAL AND METHODS Thirty-nine patients with cervical carcinoma FIGO stage IB2 - IVA were treated with curative intent between 2006 and 2010. The dose of 50.4 Gy was prescribed to the elective pelvic nodal volume. Primary tumors < 4 cm in diameter (n = 6; 15.4 %) received an external beam radiotherapy (EBRT) boost of 5.4 Gy, primary tumors > 4 cm in diameter (n = 33; 84.6 %) received an EBRT boost of 9 Gy. Patients with positive lymph nodes detected with (18)FDG-PET/CT (n = 22; 56.4 %) received a boost to a total dose of 59.4 - 64.8 Gy. The para-aortic region was included in the radiation volume in 8 (20.5 %) patients and in 5 (12.8 %) patients the para-aortic macroscopic lymph nodes received an EBRT boost. IMRT was followed with a 3D planned high dose rate intrauterine brachytherapy given to 36 (92.3 %) patients with a total dose ranging between 15-18 Gy in three fractions (single fraction: 4-6.5 Gy). Patients without contraindications (n = 31/79.5 %) received concomitantly a cisplatin-based chemotherapy (40 mg/kg) weekly. Toxicities were graded according to the common terminology criteria for adverse events (CTCAE v 4.0). RESULTS Mean overall survival for the entire cohort was 61.1 months (±3.5 months). Mean disease free survival was 47.2 months (±4.9 months) and loco-regional disease free survival was 55.2 months (±4.4 months). 65 % of patients developed radiotherapy associated acute toxicities grade 1, ca. 30 % developed toxicities grade 2 and just two (5.2 %) patients developed grade 3 toxicities, one acute diarrhea and one acute cystitis. 16 % of patients had chronic toxicities grade 1, 9 % grade 2 and one patient (2.6 %) toxicities grade 3 in the form of vaginal dryness. CONCLUSION Dose escalated IMRT appears to have a satisfactory outcome with regards to mean overall survival, disease free and loco-regional disease free survival, whereas the treatment-related toxicities remain reasonably low.

Chromium uptake and adsorption in marine phytoplankton - Implications for the marine chromium cycle

Using the radioisotope 51Cr, we investigated the controls of cellular Cr accumulation in an array of marine phytoplankton grown in environmentally relevant Cr concentrations (1–10 nM). Given the affinity of Cr(III) for amorphous Fe-hydroxide mineral surfaces, and the formation of these mineral phases on the outside of phytoplankton cells, extracellular Cr was monitored in a model diatom species (Thalassiosira weissflogii) as extracellular Fe concentrations varied. Extracellular Cr in T. weissflogii increased with increasing extracellular Fe, demonstrating that Cr may be removed from seawater via extracellular adsorption to phytoplankton. Short-term Cr(VI) and Cr(III) uptake experiments performed with T. weissflogii demonstrated that Cr(III) was the primary oxidation state adsorbing to cells and being internalized by them. Cellular Cr:C ratios (<0.5 μmol Cr mol C−1) of the eight phytoplankton species surveyed were significantly lower than previously reported Cr:C ratios in marine particles with a high biogenic component (10–300 μmol Cr mol C−1). This indicates that Cr(III) likely accumulates in marine particles due to uptake and/or adsorption. Mass balance calculations demonstrate that surface water Cr deficits can be explained via loss of Cr(III) to exported particles, thereby providing a mechanism to account for the nutrient depth profile for Cr in modern seawater. Given the large fractionation of stable Cr isotopes during Cr(VI) reduction, Cr(III) associated with exported organic carbon is likely enriched in lighter isotopes. Most sedimentary Cr isotope studies have thus far neglected internal fractionating processes in the marine Cr cycle, but our data indicate that loss of Cr to exported particles may be traced in the sedimentary d53Cr record.

STUDIES OF THE MOLECULAR MECHANISMS OF CHROMOSOME ABERRATION FORMATION (DNA REPAIR, CROSSLINKS, MITOMYCIN C)

The objective of this research has been to study the molecular basis for chromosome aberration formation. Predicated on a variety of data, Mitomycin C (MMC)-induced DNA damage has been postulated to cause the formation of chromatid breaks (and gaps) by preventing the replication of regions of the genome prior to mitosis. The basic protocol for these experiments involved treating synchronized Hela cells in G(,1)-phase with a 1 (mu)g/ml dose of MMC for one hour. After removing the drug, cells were then allowed to progress to mitosis and were harvested for analysis by selective detachment. Utilizing the alkaline elution assay for DNA damage, evidence was obtained to support the conclusion that Hela cells can progress through S-phase into mitosis with intact DNA-DNA interstrand crosslinks. A higher level of crosslinking was observed in those cells remaining in interphase compared to those able to reach mitosis at the time of analysis. Dual radioisotope labeling experiments revealed that, at this dose, these crosslinks were associated to the same extent with both parental and newly replicated DNA. This finding was shown not to be the result of a two-step crosslink formation mechanism in which crosslink levels increase with time after drug treatment. It was also shown not to be an artefact of the double-labeling protocol. Using neutral CsCl density gradient ultracentrifugation of mitotic cells containing BrdU-labeled newly replicated DNA, control cells exhibited one major peak at a heavy/light density. However, MMC-treated cells had this same major peak at the heavy/light density, in addition to another minor peak at a density characteristic for light/light DNA. This was interpreted as indicating either: (1) that some parental DNA had not been replicated in the MMC treated sample or; (2) that a recombination repair mechanism was operational. To distinguish between these two possibilities, flow cytometric DNA fluorescence (i.e., DNA content) measurements of MMC-treated and control cells were made. These studies revealed that the mitotic cells that had been treated with MMC while in G(,1)-phase displayed a 10-20% lower DNA content than untreated control cells when measured under conditions that neutralize chromosome condensation effects (i.e., hypotonic treatment). These measurements were made under conditions in which the binding of the drug, MMC, was shown not to interfere with the stoichiometry of the ethidium bromide-mithramycin stain. At the chromosome level, differential staining techniques were used in an attempt to visualize unreplicated regions of the genome, but staining indicative of large unreplicated regions was not observed. These results are best explained by a recombinogenic mechanism. A model consistent with these results has been proposed.^

Improving Cervical Cancer Nodal Boost Radiation Therapy by Quantifying Uncertainties and Exploring Advanced Radiation Therapy Modalities

Radiation therapy for patients with intact cervical cancer is frequently delivered using primary external beam radiation therapy (EBRT) followed by two fractions of intracavitary brachytherapy (ICBT). Although the tumor is the primary radiation target, controlling microscopic disease in the lymph nodes is just as critical to patient treatment outcome. In patients where gross lymphadenopathy is discovered, an extra EBRT boost course is delivered between the two ICBT fractions. Since the nodal boost is an addendum to primary EBRT and ICBT, the prescription and delivery must be performed considering previously delivered dose. This project aims to address the major issues of this complex process for the purpose of improving treatment accuracy while increasing dose sparing to the surrounding normal tissues. Because external beam boosts to involved lymph nodes are given prior to the completion of ICBT, assumptions must be made about dose to positive lymph nodes from future implants. The first aim of this project was to quantify differences in nodal dose contribution between independent ICBT fractions. We retrospectively evaluated differences in the ICBT dose contribution to positive pelvic nodes for ten patients who had previously received external beam nodal boost. Our results indicate that the mean dose to the pelvic nodes differed by up to 1.9 Gy between independent ICBT fractions. The second aim is to develop and validate a volumetric method for summing dose of the normal tissues during prescription of nodal boost. The traditional method of dose summation uses the maximum point dose from each modality, which often only represents the worst case scenario. However, the worst case is often an exaggeration when highly conformal therapy methods such as intensity modulated radiation therapy (IMRT) are used. We used deformable image registration algorithms to volumetrically sum dose for the bladder and rectum and created a voxel-by-voxel validation method. The mean error in deformable image registration results of all voxels within the bladder and rectum were 5 and 6 mm, respectively. Finally, the third aim explored the potential use of proton therapy to reduce normal tissue dose. A major physical advantage of protons over photons is that protons stop after delivering dose in the tumor. Although theoretically superior to photons, proton beams are more sensitive to uncertainties caused by interfractional anatomical variations, and must be accounted for during treatment planning to ensure complete target coverage. We have demonstrated a systematic approach to determine population-based anatomical margin requirements for proton therapy. The observed optimal treatment angles for common iliac nodes were 90° (left lateral) and 180° (posterior-anterior [PA]) with additional 0.8 cm and 0.9 cm margins, respectively. For external iliac nodes, lateral and PA beams required additional 0.4 cm and 0.9 cm margins, respectively. Through this project, we have provided radiation oncologists with additional information about potential differences in nodal dose between independent ICBT insertions and volumetric total dose distribution in the bladder and rectum. We have also determined the margins needed for safe delivery of proton therapy when delivering nodal boosts to patients with cervical cancer.

(Table 5) Experimental hydrodynamic parameters for different soil types obtained in the Lüchow-Dannenberg district, Lower Saxony

In three typical sandy soils of Northern Germany the mobility of radioactive fission products of technetium, iodine, ruthenium and zirconium have been investigated in dependence of the hydrodynamic and physico-chemical soil properties. The laboratory experiments, which simulated fall-out events, used soil columns (1 m length, 30 cm diameter) taken as undisturbed as possible. By measurements of the breakthrough curves in the percolate and of the depth distribution of radionuclides in the soil columns after 6 months the average transport velocity could be determined. These values could be compared with the average water velocity measured by 3H tagging. Three qualitative mobility relations were observed: Ranker: Tc > Ru > I > Zr; Podsol: Tc > Ru > I > Zr; Brown forest soil: Tc = Ru > I > Zr. Relations between some physico-chemical soil properties and the retardation of radionuclides due to adsorption could be observed (eg. retardation of iodine and technetium by organic substances). The average retardation factors of the radionuclides and the hydrodynamic soil parameters are used in a model which gives a quantitative assessment of the hazard of groundwater contamination by a fall-out event in areas covered with comparable soils.

Geochemical and biogeochemical parameters of bottom sediments from the area of the Spitsbergen (Svalbard) Archipelago

Quantitative characteristics for rates of diagenetic processes in the upper (0-30 cm) layer of sedimentary deposits in the area of the Spitsbergen (Svalbard) Archipelago (78°-80°N) were obtained by lithologo-geochemical, radioisotope (35S, 14C), and stable isotope (d34S, d13C) studies. It was proved that rates of diagenetic processes in polar deposits at 123-395 m depth affected by the East Spitsbergen ''warm'' current are mostly determined by bioproductivity and are commensurate with rates of processes in shelf deposits of temperate latitudes. High contents of migratory methane (up to 263 ml/dm**3) and isotopically-light organic carbon (Corg, d13C = -30 per mil PDB) were found in the 1 m layer of shelf deposits (at 123 m sea depth) with low bacterial in situ production of methane. It was shown that methane is not utilized in the deposits by the methanotrophic bacterial community and it may be supplied to the water mass and, probably, to the atmosphere.

Age and chemical composition of volcanic rocks and minerals from the Vityaz Ridge

This paper reports results of geological studies carried out during two marine expeditions of R/VAkademik M.A. Lavrent'ev (Cruises 37 and 41) in 2005 and 2006 at the underwater Vityaz Ridge. Dredging has yielded various rocks from the basement and sedimentary cover of the ridge within three polygons. On the basis of radioisotope age determinations, petrochemical, and paleontological data all the rocks have been subdivided into the following complexes: volcanic rock of Paleocene, Eocene, Late Oligocene, Middle Miocene, and Pliocene-Pleistocene; volcanogenic-sedimentary rocks of Late Cretaceous - Early Paleocene, Paleogene (undifferentiated), Oligocene - Early Miocene, and Pliocene-Pleistocene. Determinations of age and chemical composition of the rocks have enabled to specify formation conditions of the complexes and to trace geological evolution of the Vityaz Ridge. Presence of young Pliocene-Pleistocene volcanites allows to conclude about the modern tectono-magmatic activity of the central part of the Pacific slope of the Kuril Islands.

Geochemistry on manganese nodules from Timor

Fossil Mn nodules of Cretaceous age from western Timor exhibit chemical, structural and radioisotope compositions consistent with their being of deep-sea origin. These nodules show characteristics similar to nodules now found at depths of 3,500-5,000 m in the Pacific and Indian Oceans. Slight differences in the fine structure and chemistry of these nodules and modern deep-sea nodules are attributed to diagenetic alteration after uplift of enclosing sediments.