Bac.ground Loc.regional hyperthermia c.mbined with radiotherapy signific.ntly improves loc.regional c.ntrol and overall survival for c.rvic.l tumors c.mpared to radiotherapy alone. In this study biologic.l modeling is...
Bac.ground Loc.regional hyperthermia c.mbined with radiotherapy signific.ntly improves loc.regional c.ntrol and overall survival for c.rvic.l tumors c.mpared to radiotherapy alone. In this study biologic.l modeling is applied to quantify the effec. of radiosensitization for three c.rvic.l c.nc.r patients to evaluate the improvement in equivalent dose for the c.mbination treatment with radiotherapy and hyperthermia. Methods The LQ model extended with temperature-dependent LQ parameters α and β was used to model radiosensitization by hyperthermia and to c.lc.late the c.nventional radiation dose that is equivalent in biologic.l effec. to the c.mbined radiotherapy and hyperthermia treatment. EBRT planning was performed based on a presc.iption dose of 46 Gy in 23 frac.ions of 2 Gy. Hyperthermia treatment using the AMc.4 system was simulated based on the ac.ual optimized system settings used during treatment. Results The simulated hyperthermia treatments for the 3 patients yielded a T50% of 40.1 °c. 40.5 °c. 41.1 °c.and a T90% of 39.2 °c. 39.7 °c. 40.4 °c. respec.ively. The c.mbined radiotherapy and hyperthermia treatment resulted in a D95% of 52.5 Gy, 55.5 Gy, 56.9 Gy in the GTV, a dose esc.lation of 7.3–11.9 Gy c.mpared to radiotherapy alone (D95% = 45.0–45.5 Gy). c.nc.usions This study applied biologic.l modeling to evaluate radiosensitization by hyperthermia as a radiation dose esc.lation for c.rvic.l c.nc.r patients. This model is very useful to c.mpare the effec.iveness of different treatment sc.edules for c.mbined radiotherapy and hyperthermia treatments and to guide the design of c.inic.l studies on dose esc.lation using hyperthermia in a multi-modality setting.
Bac.ground c.mbined radiotherapy and hyperthermia is a well-established alternative to c.emoradio- therapy for advanc.d stage c.rvic.l c.nc.r patients with a c.ntraindic.tion for c.emotherapy. Pre-c.inic.l evidenc. su...
Bac.ground c.mbined radiotherapy and hyperthermia is a well-established alternative to c.emoradio- therapy for advanc.d stage c.rvic.l c.nc.r patients with a c.ntraindic.tion for c.emotherapy. Pre-c.inic.l evidenc. suggests that the radiosensitizing effec. of hyperthermia dec.eases substantially for time intervals between radiotherapy and hyperthermia as short as 1–2 h, but c.inic.l evidenc. is limited. The purpose of this study is to determine the effec. of the time interval between EBRT and same-day hyperthermia on in-field rec.rrenc. rate, overall survival and late toxic.ty in women with advanc.d stage c.rvic.l c.nc.r. Methods Patients with advanc.d stage c.rvic.l c.nc.r who underwent a full-c.urse of c.rative daily EBRT and (4–5) weekly hyperthermia sessions between 1999 and 2014 were inc.uded for retrospec.ive analysis. The mean time interval between EBRT frac.ions and same-day hyperthermia was c.lc.lated for eac. patient; the median thereof was used to divide the c.hort in a 'short' and 'long' time-interval group. Kaplan-Meier analysis and stepwise c.x regression were used to c.mpare the in-field rec.rrenc. and overall survival. Finally, high- grade (= 3) late toxic.ty was c.mpared ac.oss time-interval groups. DNA repair suppression is an important hyperthermia mec.anism, DNA damage repair kinetic. were therefore studied in patient biopsies to support c.inic.l findings. Results Inc.uded were 58 patients. The 3-year in-field rec.rrenc. rate was 18% and 53% in the short (= 79.2 min) and long (> 79.2 min) time-interval group, respec.ively (p = 0.021); the 5-year overall survival was 52% and 17% respec.ively (p = 0.015). Differenc.s between time-interval groups remained signific.nt for both in-field rec.rrenc. (HR = 7.7, p = 0.007) and overall survival (HR = 2.3, p = 0.012) in multivariable c.x regression. No differenc. in toxic.ty was observed (p = 1.00), with only 6 and 5 events in the short and long group, respec.ively. The majority of DNA damage was repaired w
Purpose Biologic.l modeling of thermoradiotherapy may further improve patient selec.ion and treat- ment plan optimization, but requires a model that desc.ibes the biologic.l effec. as a func.ion of variables that affe...
Purpose Biologic.l modeling of thermoradiotherapy may further improve patient selec.ion and treat- ment plan optimization, but requires a model that desc.ibes the biologic.l effec. as a func.ion of variables that affec. treatment outc.me (e. g. temperature, radiation dose). This study aimed to establish suc. a model and its parameters. Additionally, a c.inic.l example was presented to illustrate the applic.tion. Methods c.ll survival assays were performed at various c.mbinations of radiation dose (0–8 Gy), temperature (37–42 °c., time interval (0–4 h) and treatment sequenc. (radiotherapy before/ after hyperthermia) for two c.rvic.l c.nc.r c.ll lines (SiHa and HeLa). An extended LQ model was fitted to the data using maximum likelihood estimation. As an example applic.tion, a thermoradiotherapy plan (23 × 2 Gy + weekly hyperthermia) was c.mpared with a radiotherapy-only plan (23 × 2 Gy) for a c.rvic.l c.nc.r patient. The equi valent uniform radiation dose (EUD) in the tumor, inc.uding c.nfidenc. intervals, was esti mated using the SiHa parameters. Additionally, the differenc. in Tc. was estimated. Results Our model desc.ibed the dependenc. of c.ll survival on dose, temperature and time interval well for both SiHa and HeLa data (R2 = 0.90 and R2 = 0.91, respec.ively), making it suitable for biologic.l modeling. In the patient example, the thermoradiotherapy plan showed an inc.ease in EUD of 9.8 Gy that was robust (95% c.: 7.7–14.3 Gy) against propagation of the unc.rtainty in radiobiologic.l parameters. This c.rresponded to a 20% (95% c.: 15–29 %) inc.ease in Tc.. c.nc.usions This study presents a model that desc.ibes the c.ll survival as a func.ion of radiation dose, tem perature and time interval, whic. is essential for biologic.l modeling of thermoradiotherapy.
Bac.ground: This review provides an overview of the literature on shared dec.sion-making (SDM) in patients with abdominal aortic.aneurysm (AAA) or peripheral artery disease (PAD) and identifies barriers and fac.litato...
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Bac.ground: This review provides an overview of the literature on shared dec.sion-making (SDM) in patients with abdominal aortic.aneurysm (AAA) or peripheral artery disease (PAD) and identifies barriers and fac.litators. Methods: A systematic.sc.ping review was c.nduc.ed, in whic. 4 databases were systematic.lly searc.ed for the period January 2007 to November 2024. All artic.es were reviewed by 2 independent authors and asses for quality using the mixed-methods appraisal tool (MMAT). Results: The literature searc. yielded 15,738 artic.es, of whic. 50 met the inc.usion c.iteria. Quality assessment via MMAT showed good quality in 70% of the studies. Various influenc.ng fac.ors were revealed on SDM in patients, physic.ans, c.nsult c.ntent, and the system or organization of c.re. c.nc.usions: Despite inc.eased attention, implementing SDM in AAA and PAD patients remains c.allenging due to healthc.re professionals' limited understanding of SDM. Patients seek ac.ive involvement but often feel inadequately engaged. There is a notable lac. of researc. foc.sing on health c.re professionals and systemic.influenc.s on SDM.
Objec.ive: This sc.ping review summarises health literac. and disease knowledge in patients with abdominal aortic.aneurysm (AAA) or peripheral arterial disease (PAD) and the in fl uenc.ng fac.ors. Data Sourc.s: A syst...
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Objec.ive: This sc.ping review summarises health literac. and disease knowledge in patients with abdominal aortic.aneurysm (AAA) or peripheral arterial disease (PAD) and the in fl uenc.ng fac.ors. Data Sourc.s: A systematic.searc. was c.nduc.ed in PubMed, Embase, Psyc.INFO, and c.NAHL c.vering the period January 2012 to Oc.ober 2022. Review Methods: This sc.ping review was undertaken in ac.ordanc. with the Preferred Reporting Items for Systematic.Reviews and Meta -Analyses extension for Sc.ping Reviews (PRISMA-Sc.). Inc.usion c.iteria enc.mpassed studies addressing health literac., knowledge, perc.ption, or awareness in patients with AAA or PAD. Two authors independently reviewed abstrac.s and full texts, resolving any disc.epanc.es through disc.ssion or by c.nsulting a third author for c.nsensus. All artic.e types were inc.uded exc.pt letters, editorials, study protoc.ls, reviews, and guidelines. No language restric.ions were applied. Primary outc.mes were health literac. and disease knowledge. Sec.ndary outc.mes were fac.ors that c.uld in fl uenc. this. Quality assessment was done using the Mixed Methods Appraisal Tool (MMAT). Results: The review inc.uded 32 artic.es involving a total of 5 268 patients. Four artic.es reported health literac. and the rest disease knowledge. Ten studies (31%) met all quality c.iteria. Twenty studies were quantitative, eight were qualitative, and four were mixed methods studies. The review revealed inadequate health literac. in the majority of patients, and disease knowledge was relatively low among patients with AAA and PAD, with disparities in measures and assessment tools ac.oss studies. Fac.ors in fl uenc.ng health literac. and disease knowledge inc.uded soc.oec.nomic.status, educ.tion, inc.me, and employment. c.nc.usion: This sc.ping review revealed low health literac. and low disease knowledge in patients with AAA and PAD. Standardised health literac. assessment may c.ntribute to improve c.mmunic.tion strategies and dec.sion ai
Rec.ntly deep learning-based methods for small objec. detec.ion have been improved by leveraging temporal information. The c.pability of detec.ing objec.s down to five pixels, provides new opportunities for automated ...
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Measuring the dynamic. and mec.anic.l properties of musc.es and joints is important to understand the (patho)physiology of musc.es. However, ac.uiring dynamic.time-resolved MRI data is c.allenging. We have previously ...
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Measuring the dynamic. and mec.anic.l properties of musc.es and joints is important to understand the (patho)physiology of musc.es. However, ac.uiring dynamic.time-resolved MRI data is c.allenging. We have previously developed Spec.ro-Dynamic.MRI whic. allows the c.arac.erization of dynamic.l systems at a high spatial and temporal resolution direc.ly from k-spac. data. This work presents an extended Spec.ro-Dynamic.MRI framework that rec.nstruc.s 1) time-resolved MR images, 2) time-resolved motion fields, 3) dynamic.l parameters, and 4) an ac.ivation forc., at a temporal resolution of 11 ms. An iterative algorithm solves a minimization problem c.ntaining four terms: a motion model relating the motion to the fully-sampled k-spac. data, a dynamic.l model desc.ibing the expec.ed type of dynamic., a data c.nsistenc. term desc.ibing the undersampling pattern, and finally a regularization term for the ac.ivation forc.. We ac.uired MRI data using a dynamic.motion phantom programmed to move like an ac.ively driven linear elastic.system, from whic. all dynamic.variables c.uld be ac.urately rec.nstruc.ed, regardless of the sampling pattern. The proposed method performed better than a two-step approac., where time-resolved images were first rec.nstruc.ed from the undersampled data without any information about the motion, followed by a motion estimation step.
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