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I'm here, just getting into the holiday swing...
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Saturday, November 02, 2013
I can feel the sheer force of all the eye rolls when I say this, but we put up our tree today. I know, it's early, it isn't even Thanksgiving, blah blah blah. Fact o' the matter is that not much makes me happier than looking at our lit Christmas tree. And if I'm going to go to the trouble of putting one up, I want lots of time to enjoy it. Dh rolled his eyes when I asked him to help me put it up, but he knew resistance was futile. Here's our little tree...
We decided to put up a small one this year. We had a really big one last year that was prelit and half the lights went out and we just chucked it and bought this one. 4' with lights, that's all I need. So now we have our little tree all decorated and lit up, and it makes me smile every time I look at it.
We didn't do anything on Halloween except grocery shop. Generally we at least curl up on the futon and watch a scary movie, but by the time we got the shopping done and everything put away, it wasn't too long until dh had to get ready for work. So we just hung out all evening. It was a terrible, horrible day. Rainy and windy and nasty. Sucked for the kids that wanted to go treating. {Although I did hear from friends who had some lil visitors that a few determined ghosts and goblins got out there and treated, rain be damned!}
Halloween night we went out for dinner. Last night I made Asian tuna patties with mac'n'cheese, spinach and corn. The tuna patties turned out really well, I was pleased. It was a new recipe. A SparkRecipe, of course, cause 95% of the things I make are SparkRecipes. Other than making dinner, I didn't do a lot. We went out to the store to get the things we forgot the day before {never fails}, and that was pretty much it.
Today, I made pork chops, mashed potatoes and green beans for dinner. Turned out yummy, but it was nothing special. Just threw the pork chops on George and grilled 'em. And then we ate them with ketchup, cause we're classy like that. I made some diet cupcakes that turned out pretty good, too. The icing isn't diet, so I've been spreading it on mine VERY thinly. And then we did our decorating. Now we're just sitting here relaxing on our computers and half watching a football game. {I actually only saw the last half of the Buckeye game, but it was a 56-0 blowout by them, so it wasn't a nail biter.}
Now I have to admit... I'm not doing very well with my dieting. I'm not doing terribly, but I'm not doing fabulously either. I'm eating more than I should, but it's food I'm cooking at home in a healthy way and not sacks of fast food, so it's not a total loss. I seem to have traded in health mojo for holiday mojo and my brain seems to think I can't have both. I'm working on it, though.
Tomorrow I'm going for a walk with The Buddy. It will be good for me to get out and get a little exercise. I haven't really done that this week, so I'm determined to start next week off much better. I still haven't made it to the pool, and it will be another week cause of an unexpected expense that sucked up my gym money. Bah. But I'm making it my goal to get outside and walk at least 3 times next week. Even if my eating isn't at 100%, I should still be moving. My other goal for the week is to focus on eating more produce and less other stuff. Honestly, that's my biggest problem. I should have had WAY more veggies and way less mashed potatoes tonight. Tomorrow I'm making spinach, feta, turkey muffins, creamed rice and LOTS of veggies, and maybe a salad too.
Okay, wow... this has turned into a long post! I hope everyone had a great Halloween, and is getting a healthy, happy, early start to the holiday season!
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Hi! That's nice you put your tree up. So glad you are cooking some good food and getting some exercise. I ate like a pig today and feel like one tonight. Stress=emotional eating for me. My SIL has his surgery in the morning. I just pray it goes well. I'll be so relieved when it's over! Have a really great night!
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Glad you are making it to the pool..
BTW, I just got my Christmas cards out and will be starting them early,, working too many hours to wait until next month,,then I mail them out on Dec. 1.
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Rebecca Henriksen, VP of Enrollment and Student Services at Thunderbird School of Global Management, was named to the board of directors of AIESEC US, the world's largest student-run organization, active in over 2500 universities across more than 113 countries.
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High school is hell for Yota Moteuchi. He's so unpopular his fellow students have a nickname for him: "Dateless." That doesn't stop him from falling in love with one of them. His gentle classmate Moemi is everything he wants - but is she in love with someone else?
Story and art by Masakazu Katsura.
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Scrabble word: REALES
In which Scrabble dictionary does REALES exist?
Definitions of REALES in dictionaries:
- adj - having actual existence
- noun - a former monetary unit of Spain
- noun - a former monetary unit of Portugal and Brazil
There are 6 letters in REALES: A E E L R S
Scrabble words that can be created with an extra letter added to REALES
All anagrams that could be made from letters of word REALES plus a wildcard: REALES?
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SCRABBLE is the registered trademark of Hasbro and J.W. Spear & Sons Limited. Our scrabble word finder and scrabble cheat word builder is not associated with the Scrabble brand - we merely provide help for players of the official Scrabble game. All intellectual property rights to the game are owned by respective owners in the U.S.A and Canada and the rest of the world. Anagrammer.com is not affiliated with Scrabble. This site is an educational tool and resource for Scrabble & Words With Friends players.


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H.R. 749: Passenger Rail Reform and Investment Act of 2015
Passed 316/101
Rep. Bera [D-CA7]: Yea
Mar 4, 2015 3:05 p.m.Representative from California's 7th District
Dates | Title | State / District |
Representative | California's 7th District |
See Also: Bera's Official Website | @RepBera | OpenSecrets | VoteSmart | Bioguide | C-SPAN
Our unique analysis of the bills Bera has sponsored and cosponsored provides insight into his position in the House of Representatives.
Each dot in the chart below is a member of the House of Representatives. The dots are positioned horizontally according to our progressive—conservative ideology score and vertically according to our leadership score (leaders toward the top). Bera is shown as a purple triangle. (analysis methodology)
Ami Bera sits on the following committees:
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From Jan 2013 to Mar 2015, Bera missed 9 of 1,316 roll call votes, which is 0.7%. This is better than the median of 2.2% among the lifetime records of representatives currently serving. The chart below reports missed votes over time.
The information on this page is originally sourced from a variety of materials, including:
H.R. 749: Passenger Rail Reform and Investment Act of 2015
Passed 316/101
Rep. Bera [D-CA7]: Yea
Mar 4, 2015 3:05 p.m.On Motion to Recommit with Instructions: H.R. 749: Passenger Rail Reform and Investment Act of 2015
Failed 184/232
Rep. Bera [D-CA7]: Aye
Mar 4, 2015 2:57 p.m.H.Amdt. 72 (McClintock) to H.R. 749: Page 2, line 3, through page 3, line 10, strike section 101.
Failed 147/272
Mar 4, 2015 2:40 p.m.Sponsor: Rep. Ami Bera [D-CA7]
This bill was referred to the House Committee on the Judiciary which will consider it before sending it to the House floor for consideration.
Mar 4, 2015


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Ergonomic Monitor Arm
This flexible and ergonomic monitor arm is designed to mount to any desk.
- Reaches from 16-in up to 22-in
- Weight capacity is 30 lbs
Materials: | Steel & Aluminum | |
Warranty | 5 Years | |
Type of Ergonomic Accessory | Computer Accessories, Monitor Arms |
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Weight Capacity: | 30lbs |
Maximum Height: | 4 inches |
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Width: | 20 inches |
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Featured news
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(IN)SECURE Magazine issue 45 released
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10-14-2007 | #1 |
Drink up yall, its the Texans!
Join Date: Apr 2007
Age: 48
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Money Leagues
I've been playing on a Fantasy League at work for a couple of years now. We have fun with it and we play for money - $75 entry with $1 free agent & trade adds. Pay out is $10 for the highest score each week and a 75/25% payout at the end for 1st and 2nd place.
I don't think its an expensive league but one of the guys complained this year. I'm curious, what is the money like on your league(s)? PS: If you're in a non-gambling league then comment on if you think this is an expensive league. |
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Richard ZiglarElizabethtown man arrested for food stamp fraudSubmitted by WWAY on Tue, 10/01/2013 - 1:35pm.READ MORE:
A Bladen County man is in jail charged with illegally selling a food stamp card.
Elizabethtown Police arrested Richard Ziglar, 51, recently, and charged him with felony selling an Electronic Food and Nutrition Benefit (EBT) card.
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From Wikipedia, the free encyclopedia - View original article
Wade Hampton III | |
Wade Hampton during the Civil War | |
United States Senator from South Carolina | |
In office March 4, 1879 – March 3, 1891 | |
Preceded by | John J. Patterson |
Succeeded by | John L. M. Irby |
77th Governor of South Carolina | |
In office December 14, 1876 – February 26, 1879 | |
Lieutenant | William Dunlap Simpson |
Preceded by | Daniel Henry Chamberlain |
Succeeded by | William Dunlap Simpson |
Member of the South Carolina Senate from Richland District | |
In office November 22, 1858 – October 8, 1861 | |
Preceded by | John Smith Preston |
Succeeded by | Edward John Arthur |
Member of the South Carolina House of Representatives from Richland District | |
In office November 22, 1852 – November 22, 1858 | |
Personal details | |
Born | Charleston, South Carolina | March 28, 1818
Died | April 11, 1902 Columbia, South Carolina | (aged 84)
Political party | Democratic |
Alma mater | South Carolina College |
Profession | planter, soldier, politician |
Committees | United States railroad commissioner 1893-1897 |
Military service | |
Allegiance | Confederate States of America |
Service/branch | Confederate States Army |
Years of service | 1861–65 |
Rank | Lieutenant General |
Commands | Hampton's Legion Cavalry Corps, Army of Northern Virginia |
Battles/wars | American Civil War |
Wade Hampton III | |
Wade Hampton during the Civil War | |
United States Senator from South Carolina | |
In office March 4, 1879 – March 3, 1891 | |
Preceded by | John J. Patterson |
Succeeded by | John L. M. Irby |
77th Governor of South Carolina | |
In office December 14, 1876 – February 26, 1879 | |
Lieutenant | William Dunlap Simpson |
Preceded by | Daniel Henry Chamberlain |
Succeeded by | William Dunlap Simpson |
Member of the South Carolina Senate from Richland District | |
In office November 22, 1858 – October 8, 1861 | |
Preceded by | John Smith Preston |
Succeeded by | Edward John Arthur |
Member of the South Carolina House of Representatives from Richland District | |
In office November 22, 1852 – November 22, 1858 | |
Personal details | |
Born | Charleston, South Carolina | March 28, 1818
Died | April 11, 1902 Columbia, South Carolina | (aged 84)
Political party | Democratic |
Alma mater | South Carolina College |
Profession | planter, soldier, politician |
Committees | United States railroad commissioner 1893-1897 |
Military service | |
Allegiance | Confederate States of America |
Service/branch | Confederate States Army |
Years of service | 1861–65 |
Rank | Lieutenant General |
Commands | Hampton's Legion Cavalry Corps, Army of Northern Virginia |
Battles/wars | American Civil War |
Wade Hampton III (March 28, 1818 – April 11, 1902) was a Confederate cavalry leader during the American Civil War and afterward a Democratic Party politician from South Carolina.
Near the end of the Reconstruction, he was elected as 77th Governor of South Carolina, serving 1876-1879, and later was elected as a U.S. Senator. His election as governor was marked by extensive violence by the Red Shirts, a paramilitary group that served the Democratic Party to work to disrupt elections and suppress black voting in the state. They contributed to the Democrats regaining control of the state government.
Hampton was born at 54 Hasell St. in Charleston, South Carolina, the eldest son of Wade Hampton II (1791–1858), known as "Colonel Wade Hampton", and Ann (née Fitzsimmons) Hampton. His mother was from a wealthy family in Charleston.[1]
The senior Hampton was an officer of dragoons in the War of 1812, and an aide to General Andrew Jackson at the Battle of New Orleans. The boy was the grandson of Wade Hampton (1754–1835), lieutenant colonel of cavalry in the American War of Independence, member of the U.S. House of Representatives, and brigadier general in the War of 1812. After the war, his father had built a fortune on land speculation in the Southeast, and was said to own the highest number of slaves in the South (more than 3,000). His uncle, James Henry Hammond, was elected to the U.S. House of Representatives and as Governor of South Carolina, and in the late 1850s to the U.S. Senate.
Hampton grew up in a wealthy planter family, receiving private instruction. He had four younger sisters. His was an active outdoor life; he rode horses and hunted, especially at his family's North Carolina summer retreat, High Hampton.[2] The youth was known for taking hunting trips alone into the woods, hunting American black bears with only a knife. Some accounts credit him with killing as many as 80 bears.[3]
In 1836 Hampton graduated from South Carolina College (now the University of South Carolina), and was trained for the law, although he never practiced. His father assigned certain plantations to him for his management in South Carolina and Mississippi.[1] The younger man also became active in state politics.
He was elected to the South Carolina General Assembly in 1852 and served as a Senator from 1858 to 1861. After Hampton's father died in 1858, the son inherited his vast fortune, the plantations, and one of the largest holdings of slaves in the South.
Although Hampton was conservative on issues of secession and slavery, and he had opposed the division of the Union as a legislator, when war began, he was loyal to his state. He resigned from the Senate and enlisted as a private in the South Carolina Militia; however, the governor of South Carolina insisted that Hampton accept a colonel's commission, although he had no military experience at all. The elite were commissioned based on their social standing. Hampton organized and partially financed the unit known as "Hampton's Legion", which consisted of six companies of infantry, four companies of cavalry, and one battery of artillery. He personally financed all of the weapons for the Legion.
Despite his lack of experience and relatively advanced age of 42, Hampton was a natural cavalryman—brave, audacious, and already a superb horseman. Of officers without previous military experience, he was one of two to achieve the rank of lieutenant general (the other being Nathan Bedford Forrest).
Hampton first saw combat in July 1861, at the First Battle of Bull Run, where he deployed his Legion at a decisive moment, giving the brigade of Thomas J. "Stonewall" Jackson time to reach the field. He was wounded the first of five times during the war when he led a charge against a federal artillery position, and a bullet creased his forehead.
On May 23, 1862, Hampton was promoted to brigadier general, while commanding a brigade in Stonewall Jackson's division in the Army of Northern Virginia. In the Peninsula Campaign, at the Battle of Seven Pines on May 31, 1862, he was severely wounded in the foot, but remained on his horse while it was being treated, still under fire. Hampton returned to duty in time to lead a brigade at the end of the Seven Days Battles, although the brigade was not significantly engaged.
After the Peninsula Campaign, General Robert E. Lee reorganized his cavalry forces as a division under the command of J.E.B. Stuart, who selected Hampton as his senior subordinate, to command one of two cavalry brigades. During the winter of 1862, around the Battle of Fredericksburg, Hampton led a series of cavalry raids behind enemy lines and captured numerous prisoners and supplies without suffering any casualties, earning a commendation from General Lee. In November 1862, he captured 137 men of the 3rd Pennsylvania Cavalry at Hartwood Presbyterian Church.[4] During the Battle of Chancellorsville, Hampton's brigade was stationed south of the James River, so saw no action.
In the Gettysburg Campaign, Hampton was slightly wounded in the Battle of Brandy Station, the war's largest cavalry battle. His brigade then participated in Stuart's wild adventure to the northeast, swinging around the Union army and losing contact with Lee. Stuart and Hampton reached the vicinity of Gettysburg, Pennsylvania, late on July 2, 1863. While just outside of town, Hampton was confronted by a Union cavalryman pointing a rifle at him from 200 yards. Hampton charged the trooper before he could fire his rifle, but another trooper blindsided Hampton with a saber cut to the back of his head. On July 3, Hampton led the cavalry attack to the east of Gettysburg, attempting to disrupt the Union rear areas, but colliding with Union cavalry. He received two more saber cuts to the front of his head, but continued fighting until he was wounded again with a piece of shrapnel to the hip. He was carried back to Virginia in the same ambulance as General John Bell Hood.
On August 3, 1863, Hampton was promoted to major general and received command of a cavalry division. His wounds from Gettysburg were slow in healing, so he did not actually return to duty until November. During the Overland Campaign of 1864, Stuart was killed at the Battle of Yellow Tavern and Hampton was given command of the Cavalry Corps on August 11, 1864. He distinguished himself in his new role at the bloody Battle of Trevilian Station, defeating Maj. Gen. Philip Sheridan's cavalry, and in fact, lost no cavalry battles for the remainder of the war. In September, Hampton conducted what became known as the "Beefsteak Raid", where his troopers captured over 2400 head of cattle and over 300 prisoners behind enemy lines.
In October 1864, near Petersburg, Virginia, Hampton sent his son, Thomas Preston, a lieutenant and an aide to his father, to deliver a message. Shortly afterward, Hampton and his other son, Wade IV, rode in the same direction. Before traveling 200 yards, they came across Preston's body, and as young Wade dismounted, he was also shot. Thomas Preston died from his wound.[5]
While Lee's army was bottled up in the Siege of Petersburg, in January 1865, Hampton returned to South Carolina to recruit additional soldiers. He was promoted to lieutenant general on February 14, 1865, but eventually surrendered to the Union along with General Joseph E. Johnston's Army of Tennessee at Bennett Place in Durham, North Carolina. Hampton was reluctant to surrender, and nearly got into a personal fight with Union Brig. Gen. Judson Kilpatrick (often called "Kill-Cavalry") at the Bennett Farm.
After the war, Hampton suffered devastating financial losses. His boyhood home, Millwood, near Columbia, was burned by Maj. Gen. William T. Sherman's Union soldiers. He later was expected to spend monies to help supply Union soldiers during Reconstruction. His many slaves were freed without compensation, and Hampton's overseers struggled to deal with free labor and sharecropping. Together with Lt. Gen. Jubal A. Early, Hampton became a proponent of the Lost Cause movement. He worked to explain the Confederacy's loss of the war, and deeply regretted the loss of his secure life before the war. He strongly resented the use of black Federal troops by the Federal government as occupying units in the state during Reconstruction.
Hampton was offered the nomination for governor in 1865, but refused because he felt Northerners would be suspicious of a former Confederate general seeking political office only months after the end of the Civil War. Hampton campaigned to ask supporters not to vote for him in the gubernatorial election. In 1868, he became the chairman of the state Democratic Party central committee. That year, the Radical Republicans took the election.
He essentially ceased most overt political activity until 1876. Like many other elite Southerners, Hampton gave tacit support to the Ku Klux Klan, which had independent chapters of insurgents arising throughout the South. He helped raise money for legal defense funds after the Federal government started to enforce anti-Klan legislation to suppress the violence of its members against freedmen and white Republicans. He was not known to have active involvement within the organization.[6] Hampton supported Matthew Calbraith Butler in the Union Reform campaign of 1870.
Other insurgent groups formed to replace the KKK. In South Carolina and other states, groups of men calling themselves "rifle clubs" formed to act as law enforcement in the years after the war. Since the mid-1870s, the Democratic paramilitary group known as the Red Shirts had developed chapters in most South Carolina counties (they had originated in Mississippi), and were not dissimilar to rifle clubs. These groups acted as "the military arm of the Democratic Party."[7] These armed supporters of Hampton openly disrupted Republican meetings and worked to suppress black voting in the state by violence and intimidation.[8] By 1876, there were estimated to be 20,000 men who were members of rifle clubs in the state.[9]
Hampton opposed the Radical Republican Reconstruction policies in the South. He re-entered South Carolina politics in 1876, running in opposition to Reconstruction. Hampton, a Democrat, ran against Republican incumbent governor Daniel Henry Chamberlain.
Hampton used Grace Piexotto's "Big Brick House", a prominent brothel located at 11 Fulton Street in Charleston, to assure complete privacy for the Red Shirts' meetings; it mainly served as campaign headquarters.[10] The 1876 South Carolina gubernatorial election is thought to be the bloodiest in the history of the state. The Red Shirts had used violence and intimidation in every county to suppress black Republican voting. "An anti-Reconstruction historian later estimated that 150 Negroes were murdered in South Carolina during the campaign."[11]
Both parties claimed victory. For over six months, there were two legislatures in the state, both claiming to be authentic. Eventually, the South Carolina Supreme Court ruled Hampton was the winner of the election. The election of the first Democratic governor in South Carolina since the end of the Civil War, as well as the national election of Rutherford B. Hayes as President, signified the end of Reconstruction in the South. In 1877 the US government withdrew its troops from the South.
After the election, Hampton became known as the "Savior of South Carolina". He was reelected in 1878; the Red Shirts gave support but less violence was required.[8] Two days later, he was thrown from a mule while deer hunting and broke his right leg. Several weeks later, his right leg was amputated due to complications arising from this injury.
Despite refusing to announce his candidacy for the Senate, Hampton was elected to the United States Senate by the General Assembly on the same day as his leg was amputated. He resigned from the governorship to serve two terms in the Senate, until 1891. He was among Bourbon Democrats who appealed to some freedmen in support of his win.[12] Benjamin Tillman won the seat in the state elections of 1890.
From 1893 to 1897, Hampton served as United States Railroad Commissioner, appointed by President Grover Cleveland. In 1899, his home in Columbia, was destroyed by fire. An elderly man, he then had limited funds and limited means to find a new home. Over his strong protests, a group of friends raised enough funds to build him one.[citation needed]
He was an hereditary member of the South Carolina Society of the Cincinnati.
In 1890, Hampton's niece Caroline, an operating room nurse, married William Halsted, later known as the "father of American surgery" for his contributions. He had developed the surgical glove to try to protect Caroline's skin from the harsh surgical sterilization chemicals.[citation needed]
Wade Hampton died in Columbia and is buried there in Trinity Cathedral Churchyard.
Statues of him were erected in the South Carolina State House building and the United States Capitol. An equestrian statue by Frederick W. Ruckstull was erected on the grounds of the South Carolina State House in 1906.[citation needed]
To honor Hampton for his leadership in the Civil War and the redemption of the state, the General Assembly created Hampton County from Beaufort County in 1878. The town of Hampton Courthouse, later shortened to Hampton, was incorporated on December 23, 1879, to serve as the county seat of Hampton County. Across South Carolina many towns and cities renamed streets for him. At least eight municipalities in South Carolina have a street named "Wade Hampton" (Beaufort, Charleston, Duncan, Greenville, Greer, Hampton, Taylors, and Walterboro) and approximately 47 towns in the state have streets named "Hampton". Two high schools in South Carolina are named Wade Hampton High School, one in Greenville and the other in Varnville. A residence hall at Hampton's alma mater, the University of South Carolina, is called the Wade Hampton. There is a Hampton Park in Charleston and a Hampton Park in Columbia named after Hampton. The historic Hampton Heights neighborhood in Spartanburg is also named after him. In 1964, Wade Hampton Academy was charted in Orangeburg; the school later merged with Willington Academy in 1986 to become Orangeburg Preparatory Schools, Inc.
In 1913, Judge John Randolph Tucker named the Wade Hampton Census Area in Alaska to commemorate his father-in-law. An artillery battery was named after Wade Hampton at Fort Crockett, built on Galveston Island, Texas. The Wade Hampton Battery was one of four coastal artillery batteries and contained two 10-inch guns. During World War II, the SS Wade Hampton, a Liberty ship named in honor of the general, was sunk off the coast of Greenland by a German U-boat.
In Greenville County, South Carolina, the section of U.S. Route 29 that connects Greenville to Spartanburg is called Wade Hampton Boulevard. There is also a fire district (Wade Hampton Fire Department) named in his honor placed on the east side of Greenville, adjoining the Greenville city limits that includes Wade Hampton High School.
Hampton appears in How Few Remain, the first novel in Harry Turtledove's Southern Victory Series, an alternate history wherein the South won the American Civil War. In it, Hampton prepares to lead a coup against Confederate States President James Longstreet after Longstreet announces plans to end slavery. Later in the series, in the novel American Empire: Blood and Iron, Hampton's fictional grandson, Wade Hampton V is elected President of the C.S. in 1921, but is assassinated shortly after by a member of the Freedom Party, an organization that resembles the Brown Shirts.
In Margaret Mitchell's novel Gone with the Wind, Scarlett O'Hara's first husband, Charles Hamilton, serves in Hampton's regiment, dying of measles only seven weeks later. As it was fashionable (according to Mitchell) to name baby boys after their fathers' commanding officers, Scarlett's son by Charles is therefore named Wade Hampton Hamilton.
In the North and South trilogy by John Jakes, the character Charles Main serves with Hampton's cavalry throughout the Civil War.
Wade Hampton and his sons appear in Merritt Parmelee Allen's novel Johnny Reb published in 1952 by Longmans, Green and Co. The novel begins right before the war and shows both Hampton's style and character. The book chronicles the adventures the Hamptons and a neighbor boy Ezra Todd have in Hampton's Legion and includes the Beefsteak Raid, the incident of Wade Hampton engaging the Union sniper and the death of his son Preston.
Wikimedia Commons has media related to Wade Hampton III. |
Wikisource has original works written by or about: Wade Hampton III |
Political offices | ||
Preceded by Daniel Henry Chamberlain | Governor of South Carolina 1877–1879 | Succeeded by William Dunlap Simpson |
United States Senate | ||
Preceded by John J. Patterson | U.S. Senator (Class 3) from South Carolina 1879–1891 Served alongside: Matthew C. Butler | Succeeded by John L. M. Irby |


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Did you see the reportSubmitted by SurfCityTom on Tue, 05/24/2011 - 4:50am.
on the evening news? The interior shots were quick and passing. But, if I was not mistaken, the kitchen appliances were stainless steel. Take a trip to Lowes and view the cost differential between normal appliances and stainless steel. And these are subsidized housing? »
Reply |


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Welcome to Fashiolista! Discover, save & share the greatest fashion findsfrom anywhere on the web! Sign in with Facebook
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Pronunciation: /diːk(ə)nˈtamɪneɪt/
Definition of decontaminate in English:
Neutralize or remove dangerous substances, radioactivity, or germs from (an area, object, or person): they tried to decontaminate nearby villages
More example sentences
- The emergency services sealed off the area and decontaminated the affected staff.
- The box and the depot area were decontaminated and the powder removed for testing.
- Staff at Broomfield Hospital's accident and emergency department are being given special training on how to decontaminate victims of any biological, chemical, radioactive or nuclear incident.
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Ronald Snell
Memorial services for Ronald Snell of Chokio will be held Friday, Feb. 20, 2009 at 10:30 AM at the Pedersen Funeral Home in Morris, MN. Reverend Robert Amundson will be officiating. Visitation will be held Thursday from 4 to 7 PM at the Pedersen Funeral Home in Morris and for one hour prior to services on Friday. Burial will be at Summit Cemetery in Morris.
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the "and Company" makes all the difference
Click below to like this Track:
Nice guitar work in this!! Agree with the other comments referring to a Dire Straits feel here. Very interesting theme.( Luke 22:42) Really enjoyed this!!
Great Guitar Virtuoso here - Drums seems a "little" rushed which add a tenseness to it (intentional?) - I hear a Dire Straits influence in this Song - Keep on Pluckin'!
Some nice guitar work here. I really like the interplay of the acoustic guitar with the electric guitar. Cool idea. Great Title, Up. Have not heard that before. Nice work. Thumbs.
Nice dark feel to this song and I love that guitar work. Great work; well done.
Can deffo hear the Dire Straits comparison :) Wasn't keen on the drums, personally but everything else sits well and as always a great vocal :) Some very tasty guitar by Mike :) Toe tapper for sure. Drums sat better with me the more I listen just the start sounded like you had 2 drummers. Cool! Peace,Ricky. PS the part were the drums fall out was quality.
Hi David and guys. Love this version - the keys are top notch as is everything else. Dave Rave is also right about your bass playing - another fine perfoamance and song David - loved playing on this. Thanks for the opportunity.
Blown away with the intro, what with that bluesy feel!! Here come the great vocals!! This is, without doubt, a brilliant track and something I could listen to, time and again!! The intro seems to fade away into the great essence of it all!! Many levels in this one, all of which I dig!! Thumbs up Dave!! Happy New Year Bud!! Baz
Realised i'm late to this one too - stunning guitar work on the intro and throughout - put me in mind of Dire Straits.The vocal melody is very strong and catchy. Impressive sound DJC. Merry Xmas from The Nerks.
Nice opening riff on guitar - enough to make anyone shake out those nails and start dancing to the beat. Get's my vote for longest intro too LOL. I do get the feeling I've heard an earlier incarnation of this so lemme know dude. Yeah definitely. Some really nice different colours going on on the guitar - I'm a sucker for that of course and it works a treat on this. Production is pretty good too and Randy's drumming is keeping time really well. Damned all-round (no pun) great song dude. A bit harsh into the quiet chorus at 4min14 is my only crit dude. Well done and thumzup.
One of your best David! Love everything about it. Randy, Mike and Doc doing great. Love that bg organ, give it a classic feel. Another DJC slice of life.....
Very nice song all around. Really like the production that shows off all the talent here and boy that's a lot and then some. I love that raw chorus that's such a trademark of DJC I've always loved and this so proves why.
Another version of this has been on your page before... or am I losing the plot? Whichever, I thoroughly enjoyed Up, its a real singalong song played by a great band, taking a DL, thanks David, thumbs up. Gibbo
This sounds good Dave...I mean really good! It rockets along and 'up' - wards with some damn purpose. Cool bass work too...as I recognise appreciatively :-) ..but those lead gits are the ding-dong cream on the topping! A Bloody great song in every way!! keithmas
the band you assembled, and your own chops...wow...David...got it all in this sparkling sound..lead fills to haunt...beats to move...vocal to lay it out...awesome reconstruction of this tune that drew me because of the theology :) Wow Guys!
Blimey David didn't realise you are such a good bassist!!!
Dave this is great man! You've got the mix perfect. Everything is in it's right place... What i can say about that lyric... oh DAM!!! Very original idea my friend and the backing band really gave it there all... Love that solo by Michael... Great track buddy
I had this "realisation" just yesterday, mentioning to a friend, that perhaps all Religion (belief in a creator God) is due to human inability to accept non-continuence of any form of "life" after the material/organic negation oof out earthy existence, in other words WE created a "father" God to deal with this existential crisis, not the other way round????? Cheers? Andrew
Starts with an `F` ends in `Awesome` I seriously loved this and jammed along on my piano. i`m no rock keyboard player but Man I wish I could rock like you boys this is seriously great fun i`m missing out on Who says this place needs more Dance music when we have this :) Ant
The "and Company" indeed makes all the difference! I'm David Joel Carter, a songwriter from Tulsa, Oklahoma, pleased to meet ya! There's a solo piece or two of mine in here, but these are mostly collaborations with family and friends, local and in the UK. The "band" changes with almost every song, there's quite a bit of variety here, and some really amazing talent. Too many to mention, as I'd fear I would leave someone out, but one fellow I really must mention is the guy I go to on a regular basis for most of the lead guitar heard on these songs, Michael Round (mykyndryd).
Also gotta give a big shout-out to my wife Yvonne Carter, who not only puts up with having to listen to me work these tunes over and over, she's been known to jump in and add her charming vocals to a few of them.


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Why do you love your Focus Stereo?
I personally Love getting into my car and being able to listen to all types of music and still have the ability to crank my stereo system to almost 150 Db to scare people 3 cars in front of me
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My Genealogy Home PageUpdated March 7, 2003 |
John J McDermott 7 Gailosa Lane Hot Springs village Hot Springs Village, AR 71909 United States |
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Tags: Carolina Asphalt Pavement Association
A new white paper: Jobs in the Asphalt Pavement Industry
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Home Join MLPCA Events FAQ Officers Former Officers Roster Links Contact Us |
Welcome!The Michigan License Plate Collectors Association (founded 1969) is an organization dedicated to the license plate collecting hobby, and the promotion of fraternizing with other license plate collectors for good fellowship and the furtherance of the hobby, as well as the bringing together of those who share a common interest in the collecting of Michigan and other locals license plates. MLPCA is the largest individual state license plate collectors organization in the US. MLPCA has approximately 250+ current members from 16 states and Canada. Our twice a year license plate meets (April & September) normally draw approximately 100 members and guests. The MLPCA newsletter, published six times annually (bi-monthly), has about 10 to 12 pages full of articles, pictures and advertising. If you are interesting in getting more involved in the collecting of Michigan license plates, we'd love to have you join us. |


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Bình Mỹ, An Giang
From Wikipedia, the free encyclopedia
Bình Mỹ | |
Rural commune and village | |
Country | Vietnam |
Province | An Giang |
District | Châu Phú |
Time zone | Indochina Time (UTC+07:00) |
Bình Mỹ is a rural commune (xã) and village of the Châu Phú District of An Giang Province, Vietnam.
Coordinates: 10°31′41″N 105°16′46″E / 10.5281°N 105.2794°E
This article about a location in An Giang Province, Vietnam is a stub. You can help Wikipedia by expanding it. |


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XBOXFACES is holding another one of their contests. This time it is holiday themed? Maybe.. Anyway looks like all cash prizes this time.. SO check out the thread.
Their contests are always fun
XBOX Contest Starting at 9PM
By mcdirt, Dec 17 2011 11:53 PM
#1 CAGiversary!
Posted 17 December 2011 - 11:53 PM
Posted 18 December 2011 - 08:39 AM
thanks for posting this. i came in 2nd and won $40! here's to hoping i actually get the prize.
#3 Xenaphobic, Warrior Princess
Posted 18 December 2011 - 04:14 PM
You'll get the prize in a few weeks. I came in third once, but I didn't think it was worth the five or six hours of constantly refreshing. :(


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The France-Stanford Center for Interdisciplinary Studies offers three types of fellowships.
Application Deadline for AY 2015-2016: February 17, 2015.
Application Deadline for AY 2015-2016: March 15, 2015.
> Visiting Student Researcher Fellowship
> Visiting Junior Scholar Fellowship
Questions about fellowships can be directed to the Center's Director, Amalia Kessler (email@example.com) or the Program Coordinator, Isabelle Collignon (firstname.lastname@example.com).


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Erica Archer is a native of Portland, Maine. In 2010 she was awarded the Wine Spirit and Education Trust Level Three Advanced Certification in Wines and Spirits (with merit), became a Sommelier in the American Court of Master Sommeliers, and received her Certified Wine Professional award from the Culinary Institute of America in St. Helena, California. In 2009, she was awarded the Wine Spirit and Education Trust Level Two Certification in Wines and Spirits (with distinction).
Erica is the principal of Wine Wise, a wine education and events service. Wine Wise takes us beyond a typical wine tasting by leading us in a discussion about a series of wines, what makes them unique and representative of their region and further. An educational event teams the wines with delicious local foods, the catalyst to a pairing discussion in a fun and interactive environment. Erica is also able to create custom and unique events for corporate or private parties and consult with you on a dynamic and pleasing wine list.


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Using fluorodeoxyglucose positron emission tomography to assess tumor volume during radiotherapy for non-small-cell lung cancer and its potential impact on adaptive dose escalation and normal tissue sparing.
ABSTRACT To quantify changes in fluorodeoxyglucose (FDG)-avid tumor volume on positron emission tomography/computed tomography (PET/CT) during the course of radiation therapy and examine its potential use in adaptive radiotherapy for tumor dose escalation or normal tissue sparing in patients with non-small-cell lung cancer (NSCLC).
As part of a pilot study, patients with Stage I-III NSCLC underwent FDG-PET/CT before radiotherapy (RT) and in mid-RT (after 40-50 Gy). Gross tumor volumes were contoured on CT and PET scans obtained before and during RT. Three-dimensional conformal RT plans were generated for each patient, first using only pretreatment CT scans. Mid-RT PET volumes were then used to design boost fields.
Fourteen patients with FDG-avid tumors were assessed. Two patients had a complete metabolic response, and 2 patients had slightly increased FDG uptake in the adjacent lung tissue. Mid-RT PET scans were useful in the 10 remaining patients. Mean decreases in CT and PET tumor volumes were 26% (range, +15% to -75%) and 44% (range, +10% to -100%), respectively. Designing boosts based on mid-RT PET allowed for a meaningful dose escalation of 30-102 Gy (mean, 58 Gy) or a reduction in normal tissue complication probability (NTCP) of 0.4-3% (mean, 2%) in 5 of 6 patients with smaller yet residual tumor volumes.
Tumor metabolic activity and volume can change significantly after 40-50 Gy of RT. Using mid-RT PET volumes, tumor dose can be significantly escalated or NTCP reduced. Clinical studies evaluating patient outcome after PET-based adaptive RT are ongoing.
- Shankar Siva, Michael MacManus, Tomas Kron, Nickala Best, Jai Smith, Pavel Lobachevsky, David Ball, Olga Martin[Show abstract] [Hide abstract]
ABSTRACT: Lung inflammation leading to pulmonary toxicity after radiotherapy (RT) can occur in patients with non-small cell lung cancer (NSCLC). We investigated the kinetics of RT induced plasma inflammatory cytokines in these patients in order to identify clinical predictors of toxicity.PLoS ONE 10/2014; 9(10):e109560. · 3.53 Impact Factor - SourceAvailable from: Jeho Jeong[Show abstract] [Hide abstract]
ABSTRACT: High fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in tumors has often been correlated with increasing local failure and shorter overall survival, but the radiobiological mechanisms of this uptake are unclear. We explore the relationship between FDG-PET uptake and tumor radioresistance using a mechanistic model that considers cellular status as a function of microenvironmental conditions, including proliferating cells with access to oxygen and glucose, metabolically active cells with access to glucose but not oxygen, and severely hypoxic cells that are starving. However, it is unclear what the precise uptake levels of glucose should be for cells that receive oxygen and glucose versus cells that only receive glucose. Different potential FDG uptake profiles, as a function of the microenvironment, were simulated. Predicted tumor doses for 50% control (TD50) in 2 Gy fractions were estimated for each assumed uptake profile and for various possible cell mixtures. The results support the hypothesis of an increased avidity of FDG for cells in the intermediate stress state (those receiving glucose but not oxygen) compared to well-oxygenated (and proliferating) cells.Computational and Mathematical Methods in Medicine 01/2014; 2014:847162. · 1.02 Impact Factor - International journal of radiation oncology, biology, physics 11/2014; 90(3):490–492. · 4.59 Impact Factor
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Using FDG-PET to Assess Tumor Volume During Radiotherapy
for Non-Small Cell Lung Cancer and its Potential Impact on
Adaptive Dose Escalation and Normal Tissue Sparing
Mary Feng, M.D.1, Feng-Ming Kong, M.D., Ph.D.1, Milton Gross, M.D.2, Shaneli Fernando,
M.D.1, James A. Hayman, M.D.1, and Randall K. Ten Haken, Ph.D.1
1Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
2Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA.
Purpose—Fluorodeoxyglucose–positron emission tomography (FDG-PET) has improved target
definition in non-small cell lung cancer (NSCLC), but few data exist regarding changes during
radiotherapy. The purpose of this study was to quantify changes in FDG-avid tumor volume and
examine its potential use in adaptive radiotherapy for tumor dose escalation or normal tissue
Methods and Materials—As part of a pilot study, fourteen patients with stage I-III NSCLC
underwent FDG-PET-CT prior to radiation (RT) and mid-RT (after 40–50 Gy). Gross tumor
volumes (GTVs) were contoured on CT and PET scans obtained before and during RT. 3D
conformal RT plans were generated for each patient first using only pre-treatment CT scans. Mid-
RT PET volumes were then used to design boost fields.
Results—Fourteen patients with FDG-avid tumors were assessed. Two patients had a complete
metabolic response, two patients had slightly increased FDG-uptake in the adjacent normal tissue.
Mid-RT PET scans were useful in 10 remaining patients. Mean decreases in CT and PET tumor
volumes were 26% (range: +15% to −75%) and 44% (range:+10% to −100%) respectively.
Designing boosts based on mid-RT PET allowed for meaningful dose escalation of 30–102 Gy
(mean 58 Gy), or normal tissue complication probability (NTCP) reduction of 0.4–3% (mean 2%)
in 5 of 6 patients with smaller, yet residual, tumor volumes.
Conclusions—Tumor metabolic activity and volume can change significantly after 40–50 Gy of
RT. Using mid-RT PET volumes, tumor dose can be significantly escalated or NTCP reduced.
Clinical studies evaluating patient outcome after PET-based adaptive radiotherapy are ongoing.
Lung cancer; dose escalation; PET; adaptive therapy
Corresponding author: Feng-Ming Kong, M.D., Ph.D. University of Michigan, Department of Radiation Oncology, 1500 East Medical
Center Drive, UH B2C490 SPC 0500, Ann Arbor, MI 48109. Phone: 734-769-7426. Fax: 734-763-7370. email@example.com.
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Conflicts of Interest Notification
No actual or potential conflicts of interest exist.
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Author Manuscript
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Published in final edited form as:
Int J Radiat Oncol Biol Phys. 2009 March 15; 73(4): 1228–1234. doi:10.1016/j.ijrobp.2008.10.054.
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Despite improvements in radiotherapy and chemotherapy in the past decade, the outcome for
patients with non-small cell lung cancer (NSCLC) remains quite poor. Recent data suggest
that higher doses of radiation can improve local control and overall survival.1–3 However,
delivering doses over 70 Gy to traditionally-defined planning target volumes (PTVs) is not
often possible due to normal tissue constraints, specifically the risk of pneumonitis and lung
We have recently reported results of a pilot study investigating the role of FDG-PET during
a course of radiotherapy.4 Despite long-held pre-conceptions that FDG-PET would be
uninterpretable until several months after radiotherapy, this imaging modality was
successfully used to assess interval response (changes of maximum FDG-activity) to
radiotherapy and found it to correlate with overall response to the full course of
We hypothesize that by incorporating information from metabolic imaging during treatment,
we may be able to 1) assess the volume of residual FDG-avid tumor and 2) adapt radiation
plans to allow for dose escalation to these residual areas of disease in patients with
significant volume reduction. This may potentially allow for delivery of higher doses of
radiation to more patients, and ultimately improved outcomes. Here we present results of a
proof of concept treatment planning study utilizing FDG-PET-CT obtained during treatment
to design a boost for the remainder of therapy.
Methods and Materials
Integrated PET and CT
As part of an IRB-approved prospective pilot study, 15 patients with stage I-III NSCLC
underwent FDG-PET/CT scans before and during treatment, as described previously.4
Fourteen patients with FDG-avid tumors were included in this study. Briefly, 60 minutes
after injection of 8–10 mCi of 18F-fluorodeoxyglucose, images were acquired of the patients
in treatment position on a flat table top. CT images were attained in 5mm intervals during
quiet respiration. PET/CT scans were acquired within 2 weeks prior to RT and after the
delivery of 40–50 Gy of treatment. This time point was chosen as a balance between
allowing adequate dose to be delivered to the targets to see a response and allowing for the
possibility of adapting the radiation plan based on this new information. Contrast-enhanced
CT scans were also obtained in standard treatment position, in the inhale, exhale, and free-
breathing states.
Target delineation and treatment planning
CT and PET-CT datasets were transferred to our in-house treatment planning system,
UMPLAN. The CT portion of the PET-CT was registered to the patient's original treatment
planning CT. This simultaneously aligned the PET. Gross tumor volumes (GTVs) for
primary tumors and involved lymph nodes were delineated and agreed upon by 2 radiation
oncologists on all CT and PET images. For CT images, standard lung and soft tissue
windows were used for lung primaries and mediastinal nodes, respectively. For PET GTV
definition, autocontouring was used, with the threshold set to approximate the size of the
composite inhale-exhale tumor on CT. The same threshold value was used for the PET
obtained during RT for each patient. These volumes were contoured by the same physician
(MF) and their consistency was double checked by another physician (FMK) for both pre
and mid-RT scans. Volume differences between pre-and mid-RT scans were calculated.
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Four conformal treatment plans were generated for each patient (Table 1). First, a standard
plan was constructed, encompassing the composite pre-treatment CT and PET volumes and
appropriate for an unaltered full treatment course, with a maximum normal tissue
complication probability (NTCP) of 15% for pneumonitis or maximum PTV dose of 90 Gy.
A dose of 90 Gy was chosen as it can be safely delivered with concurrent chemotherapy
based on a University of North Carolina study. 19 For these plans, PTVs were defined as the
composite of the pretreatment PET and CT at inhale and exhale plus 1cm for microscopic
extension and set-up variability. For comparison to this standard scenario, three additional
adaptive treatment plans were generated, in each case boosting only the midpoint PET-PTV
(imaged at 40–50 Gy) after completion of a first course to the original volumes. In the first
adaptive scenario, dose to the midpoint PET volume started after delivery of 46 Gy to the
original PTV up to a revised, composite PET-PTV dose limit of 90 Gy or composite NTCP
of up to 15%. In the last two adaptive scenarios, dose to the midpoint PET volume started
after delivery of 60 Gy to the original PTV, but the 90 Gy dose limit was eliminated and the
boosts were limited to either a) the same composite NTCP as was computed for the original
complete treatment or b) a composite plan NTCP of 15%. For plan comparison, maximum
achievable dose to the boost PTV and NTCP were calculated.
Tumor volume
Analysis of CT and PET data revealed 21 separate CT-defined targets (including primary
tumors and involved lymph nodes), 17 of which were FDG avid. During treatment, the CT-
GTV changed by a mean and median of −26% and −25% (standard deviation 22%, range
+15% to −75%) and −46 cc and −14 cc (standard deviation 62 cc, range 2 to −203cc),
respectively. The CT-GTV decreased in all patients except one, who had a minimal 2cc
increase in volume (Figure 1).
PET obtained during treatment was interpretable in 12 out of 14 patients, including 15 total
lesions. In 2 patients, higher FDG-activity was seen during radiation therapy in the normal
lung within the treatment fields, making delineation of a PET-GTV impossible with our
current thresholding techniques (Figure 2). Three lesions (2 patients) had a complete
response, as defined as normalization of activity to that of the mediastinal blood pool after
40–50 Gy of radiation. The PET-GTV decreased in 10 patients and increased in 4 patients,
by 5cc, 10cc, 13cc, and 22cc, respectively. For the 4 patients with increased PET volumes,
one had a tumor located adjacent to the chest wall, and the second had a significant amount
of collapsed lung. For both of these cases, the FDG-activities were less intense and the
FDG-avid volumes were difficult to define. The third patient had a significantly increased
SUV reading from the mediastinal blood pool during RT (3.3) as compared to pre RT(2.5),
also likely due to technical variation. The 4th patient developed a new FDG-avid nodule,
which was included in the during RT PET volume from the autocontouring. Overall, PET-
GTV changed by a mean and median of −44% and −58% (standard deviation 48%, range 10
to −100%) and −34 and −7cc (standard deviation 66%, range 22–158cc), respectively
(Figure 3). A typical case is shown in Figure 4. Overall, 6 patients (without including 2
patients with complete response) had sufficient reductions in PET-GTV during treatment to
adapt boost plans.
Boost after 46 Gy
In four of six patients, all targets were able to receive 90 Gy without exceeding an NTCP of
15% (range 3.3–7.7%). Adapting therapy after 46 Gy to boost only residual areas of FDG-
avidity allowed for a reduction of NTCP or dose escalation in all patients (Table 2 and
Figures 5a and b). With total dose limited to 90 Gy, NTCP decreased by a mean of 1.8%
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(range 0.3–3.4%). With standard plans based only on pre-treatment tumor volumes, two of
six cases were limited below 60Gy due to an NTCP constraint of 15% and bulky tumors.
One patient was planned to 48 Gy with an NTCP of 14.9%, while another was planned to 52
Gy with an NTCP of 15%. In the case which would have been limited to 52 Gy using a
single plan, adaptation based on PET obtained during treatment allowed dose escalation to
84 Gy, with an NTCP of 14.6%. In the case which would be been limited to 48 Gy, dose
could not be escalated, but NTCP was slightly reduced from 14.9 to 13.4%.
Boost after 60 Gy
In the four patients initially planned to 90Gy using pre-treatment volumes, constructing a
60–90 Gy boost-PTV based on PET obtained during treatment allowed for a mean NTCP
reduction of 1.8%, range of 0.6–2.7 % (Table 2 and Figures 5a and c). If dose was escalated
to the maximum possible in these same cases, still keeping the NTCP below 15%, total dose
would be 120, 134, 146, and 192 Gy, representing a mean of 64% increase (range 33–
Patients with non-small cell lung cancer have a poor prognosis, even when treated with
aggressive chemotherapy and radiation, with local recurrence rates commonly reported in
the 15–40% range.5–8 Due to these dismal results, the concept of dose escalation for lung
cancer is quite appealing. Several retrospective reviews have suggested a dose response for
local control.9–11 In a Memorial Sloan-Kettering study, there was a 36% decrease in local
failure for a 10 Gy increase in dose for patients with stage III disease.10 Another Memorial
Sloan-Kettering study has reported that overall survival was significantly improved in
patients who received 80 Gy or more in their dose escalation study.3 At Washington
University, dose of 70 Gy or higher was associated with significantly improved local
control.11 In addition to improving local control, recent studies suggest that higher doses
may improve overall survival. In a University of Michigan dose escalation trial for patients
with stage I–III NSCLC, 5 year overall survivals for patients receiving 63–69 Gy, 74–84 Gy,
and 92–103 Gy were 4%, 22%, and 28%, respectively, with p<0.0001.1 A one Gy escalation
was associated with a 3% reduction from risk of death. A recent study from the University
of Michigan also reported more significant radiation dose effect in patients with larger
tumors in early stage NSCLC, and specifically that doses of 66 Gy or higher may overcome
this negative effect of high tumor volume.2
Delivery of high doses of radiation is often quite challenging, especially in cases with a high
burden of disease, due to the risk for radiation lung toxicity. Often 60–66 Gy is the
maximum dose possible, and sometimes even this carries a significant (>15%) risk for
radiation pneumonitis. Commonly used parameters to evaluate the risk of radiation lung
toxicity include normal lung volume exceeding 20 Gy (V20), mean lung dose, and
NTCP.12–14 Also, it has recently been suggested that a nomogram combining superior-to-
inferior tumor position and mean lung dose may better predict the risk of radiation
pneumonitis,15 as inferiorly located tumors had a higher risk of pneumonitis than superiorly
located tumors.16 NTCP reduction from a mid-PET based adaptive plan may have the
potential to decrease radiation lung toxicity.
Using 3D conformal RT, dose escalation is achievable with relative ease in patients with
small tumors. However, it is more challenging in patients with higher stages of disease and
larger tumors. For these patients, it is equally, if not more important, to devise a way to
deliver higher doses of radiation. Bradley, et al demonstrated that tumor volume is a
prognostic factor for survival in Washington University's experience with 207 lung cancer
patients treated between 1991 and 1998.11 Although dose escalation can easily be
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accomplished in select patients with favorable tumor geometry,17 in other patients, even
with highly conformal therapy and without elective nodal irradiation, it is usually not
possible to treat all areas of gross disease above 66 Gy while keeping the risk of
pneumonitis within acceptable limits.
Adaptive therapy
Strategies to escalate radiation dose in patients with large stage III NSCLC have been
limited. One method to allow for dose escalation is an approach taken by Socinski, et al in
North Carolina.18 In their phase I dose escalation trial, they treated stage III patients with
induction chemotherapy prior to delivering concurrent chemoradiotherapy. Initial radiation
fields encompassed all areas of pre-chemotherapy disease to 40–50 Gy, with boost volumes
covering only post-chemotherapy volumes. With this volume reduction, they were able to
deliver up to 90 Gy to areas of residual disease after induction therapy, yet keep within
acceptable V20 parameters. Only 1 of 29 patients enrolled in the trial developed
pneumonitis (grade 3). Treatment results reported favorably, with median survival of 24
We have presented a different strategy to allow for dose escalation. Rather than use
induction chemotherapy, we treated most patients with upfront concurrent chemoradiation
for stage III disease.19–21 We also used FDG-PET to delineate boost targets. It has been a
widely held belief that FDG-PET cannot be obtained until several months after radiation due
to inflammatory changes which could make interpretation difficult or impossible. However,
we have previously demonstrated that, in the majority of cases, PET obtained during
radiation can identify areas of residual metabolically active tumor.4 Additionally, this PET
response measured by maximum standard uptake value (SUV) correlates with final PET
response 3 months after completion of treatment. In this study, PET obtained after 40–50 Gy
of radiation demonstrated a decrease in the maximum activity and the size of the
metabolically active area in the majority of patients, with a complete metabolic response in 2
patients. The strategy of initiating an adaptive boost after 46 Gy allowed delivery of a
therapeutic dose to the targets in 1 patient who would otherwise be limited by NTCP to only
52 Gy. We have also demonstrated that with a PET-defined boost after 46 or 60 Gy, tumor
dose can be significantly escalated, up to 113%.
This study builds on our recently reported finding that FDG-PET obtained after 40–50Gy of
radiation is predictive of eventual outcome.4 In this study we have shown proof of concept
that PET can be used to identify areas of disease which may need intensification of
treatment and that significant dose escalation can be accomplished using 3D conformal RT.
However, there are a few challenges with the paradigm of a PET-based adaptive approach.
First, it could only be applied to 6 of 14 patients in our study; 2 had a complete metabolic
response, 2 had non-specific lung inflammation in the radiation field which hindered tumor
delineation, and 4 had no reduction in FDG-avid volumes. The volume determination of
complete responders was challenging. Should the threshold value be decreased on the mid-
RT scan in such cases that mildly active tumors can still be defined (i.e., the PET tumor
volume could have been defined in reference to the adjacent lung activity instead of the
initial activity of the pre-RT scan)? For the tumors with slightly increased volumes, should
an enlarged volume be used for adaptive plan, though such a change may be shown as global
positivity in the treatment field, likely due to inflammation? Obviously, some of increased
volume may be partially related to the technique used for contouring. Special attention
should be paid to such details if the during PET is used for contouring the boost target for
adaptive planning.
The optimal timing to perform a during PET is not clear. One would think that performing a
PET earlier during the course of treatment such as 20–30 Gy or 30–40 Gy rather than 40–50
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Gy may help these cases. However, a study from the Netherlands reported a non-significant
increase (p=0.05) at day 7 (a mean dose of 20 Gy) and a significant decrease (p=0.02) in
maximum FDG-activity at day 14 (after a mean dose of 38 Gy) and 70 days after
radiotherapy (p<0.01) after a total mean dose of 63 Gy in an overall treatment time of 22
days. Researchers from this study did not think the transient increase at day 7 was likely due
to inflammatory changes.22 Additionally, at this time, we are uncertain about the minimum
dose required to completely sterilize initial areas of gross disease which have lost PET-
positivity after a period of treatment. The loss of detectable PET activity does not
necessarily correlate with cell death or complete response in tumors, delivering only 46 Gy
to gross disease which became PET-negative at that time theoretically could lead to
increased local recurrences. The conservative answer is that all areas of pre-treatment gross
disease should still receive 60 Gy. However, this would limit potential target dose escalation
and normal tissue sparing in some cases. It is possible that only 46 Gy is necessary for
control of tumors which are no longer metabolically active at that time. Due to this
uncertainty, in this study we constructed 2 composite plans for each patient, one
conservative plan delivering 60 Gy to all areas of initial disease prior to boosting areas of
residual PET positive areas, and another plan delivering only 46 Gy prior to the boost. Of
course we found that we could achieve higher cumulative doses or lower NTCP by starting
the boost plan earlier. There has been a suggestion that radiosensitization provided by
concurrent chemotherapy in head and neck cancer may add the equivalent of 10 Gy.23 If this
is the case for lung cancer, starting a boost at 46 Gy may be reasonable if concurrent
chemotherapy is given. Pathologic correlates in animal models may help answer these
One has to be cautioned that this study is limited by the selection of patients for the adaptive
plans. Due to the difficulty of autothreshold delineation for the tumors located centrally and/
or adjacent to the chest wall and the presence of complete metabolic responses after 40–50
Gy, we were only able to confidently assess the PET-GTVs and plan for adaptive measures
in 6 cases. To accurately define the tumor volume on PET scan is an important topic of
study, and is beyond the scope of the current study. Several other uncertainties exist
including selecting the correct thresholding taking into account source-to-background ratio
and tumor size. Certainly more work is needed in the area of pathologic correlation with
FDG-PET activity.24–28 Currently the best strategy to outline the PET tumor volume is
unknown and should be tested in animal models as well as clinical trials with careful
attention paid to radiation dose and patterns of failure.
In summary, this limited study suggests FDG-avid tumor volumes reduced significantly
after 40–50 Gy of RT in some patients. In those patients, using mid-RT PET GTVs, tumor
dose can be significantly escalated or lung NTCP reduced. Further study of using this
strategy to escalate radiation dose is ongoing in our institution.
This study was presented during the 2005 Radiological Society of North America (RSNA) annual meeting and won
the Resident In Training Award from the American Association of Women Radiologists (MF). The project was
partially supported by a seed grant from the RSNA and a Young Investigator Award from the American Society of
Clinical Oncology in 2004 (FMK).
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Figure 1.
a and b. Change in size of CT-defined GTVs. Panel a reports data on the percentage of the
initial volumes. Please note one patient may have more than one lesion (GTV). Panel b
reports data on absolute change in cc.
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Figure 2.
a and b. Non-specific inflammation in the radiation field limited tumor delineation on PET-
CTs performed during treatment on 2 patients. a. Axial slice through tumor in pretreatment
PET. b. Same slice through tumor in during-treatment PET. The arrow indicates radiation-
induced lung inflammation.
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Figure 3.
a and b. Change in size of PET-defined GTVs. Panel A reports the changes relative to the
percentage of the initial volumes. Please note one patient may have more than one PET
detectable lesion (GTV). Panel B reports data on absolute change in cc.
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Figure 4.
a and b. An example of the change in PET tumor volume between pre-treatment and after
40–50 Gy of radiation.
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Figure 5.
a, b, and c. Dose colorwash of axial sections from a standard plan (a), composite plan with
adapted boost after 46 Gy (b), and composite plan with adapted boost after 60 Gy (c). For
adaptive composite plans, isodose distributions are projected onto the pre-treatment scan.
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