text:
Contact Us
Enter Your Search:
Search tips
Search criteria
Journal titles
Results 1-25 (1375406)
« Previous
Go to page number:
Next »
Clipboard (0)
Related Articles
Short course radiotherapy with simultaneous integrated boost for stage I-II breast cancer, early toxicities of a randomized clinical trial
Van Parijs, Hilde
Miedema, Geertje
Vinh-Hung, Vincent
Verbanck, Sylvia
Adriaenssens, Nele
Kerkhove, Dirk
Reynders, Truus
Schuermans, Daniel
Leysen, Katrien
Hanon, Shane
Van Camp, Guy
Vincken, Walter
Storme, Guy
Verellen, Dirk
De Ridder, Mark
Radiation Oncology (London, England)
TomoBreast is a unicenter, non-blinded randomized trial comparing conventional radiotherapy (CR) vs. hypofractionated Tomotherapy (TT) for post-operative treatment of breast cancer. The purpose of the trial is to compare whether TT can reduce heart and pulmonary toxicity. We evaluate early toxicities.
The trial started inclusion in May 2007 and reached its recruitment in August 2011. Women with stage T1-3N0M0 or T1-2N1M0 breast cancer completely resected by tumorectomy (BCS) or by mastectomy (MA) who consented to participate were randomized, according to a prescribed computer-generated randomization schedule, between control arm of CR 25x2 Gy/5 weeks by tangential fields on breast/chest wall, plus supraclavicular-axillary field if node-positive, and sequential boost 8x2 Gy/2 weeks if BCS (cumulative dose 66 Gy/7 weeks), versus experimental TT arm of 15x2.8 Gy/3 weeks, including nodal areas if node-positive and simultaneous integrated boost of 0.6 Gy if BCS (cumulative dose 51 Gy/3 weeks). Outcomes evaluated were the pulmonary and heart function. Comparison of proportions used one-sided Fisher's exact test.
By May 2010, 70 patients were randomized and had more than 1 year of follow-up. Out of 69 evaluable cases, 32 were assigned to CR (21 BCS, 11 MA), 37 to TT (20 BCS, 17 MA). Skin toxicity of grade ≥1 at 2 years was 60% in CR, vs. 30% in TT arm. Heart function showed no significant difference for left ventricular ejection fraction at 2 years, CR 4.8% vs. TT 4.6%. Pulmonary function tests at 2 years showed grade ≥1 decline of FEV1 in 21% of CR, vs. 15% of TT and decline of DLco in 29% of CR, vs. 7% of TT (P = 0.05).
There were no unexpected severe toxicities. Short course radiotherapy of the breast with simultaneous integrated boost over 3 weeks proved feasible without excess toxicities. Pulmonary tests showed a slight trend in favor of Tomotherapy, which will need confirmation with longer follow-up of patients.
Trail registration
ClinicalTrials.gov NCT00459628
Early breast cancer; Hypofractionation; Simultaneous integrated boost (SIB); Image guided radiation treatment (IGRT); Intensity modulated radiotherapy (IMRT)
Related Articles
Uptake and Costs of Hypofractionated vs Conventional Whole Breast Irradiation After Breast Conserving Surgery in the United States, 2008–2013
Bekelman, Justin E.
Sylwestrzak, Gosia
Barron, John
Liu, Jinan
Epstein, Andrew J.
Freedman, Gary
Malin, Jennifer
Emanuel, Ezekiel J.
Based on randomized evidence, expert guidelines in 2011 endorsed shorter, hypofractionated whole breast irradiation (WBI) for selected patients with early-stage breast cancer and permitted hypofractionated WBI for other patients.
To examine the uptake and costs of hypofractionated WBI among commercially insured patients in the United States.
Retrospective, observational cohort study, using administrative claims data from 14 commercial health care plans covering 7.4%of US adult women in 2013, we classified patients with incident early-stage breast cancer treated with lumpectomy and WBI from 2008 and 2013 into 2 cohorts: (1) the hypofractionation-endorsed cohort (n = 8924) included patients aged 50 years or older without prior chemotherapy or axillary lymph node involvement and (2) the hypofractionation-permitted cohort (n = 6719) included patients younger than 50 years or those with prior chemotherapy or axillary lymph node involvement.
Hypofractionated WBI (3–5 weeks of treatment) vs conventional WBI (5–7 weeks of treatment).
Use of hypofractionated and conventional WBI, total and radiotherapy-related health care expenditures, and patient out-of-pocket expenses. Patient and clinical characteristics included year of treatment, age, comorbid disease, prior chemotherapy, axillary lymph node involvement, intensity-modulated radiotherapy, practice setting, and other contextual variables.
Hypofractionated WBI increased from 10.6%(95%CI, 8.8%–12.5%) in 2008 to 34.5%(95%CI, 32.2%–36.8%) in 2013 in the hypofractionation-endorsed cohort and from 8.1% (95%CI, 6.0%–10.2%) in 2008 to 21.2%(95%CI, 18.9%–23.6%) in 2013 in the hypofractionation-permitted cohort. Adjusted mean total health care expenditures in the 1 year after diagnosis were $28 747 for hypofractionated and $31 641 for conventional WBI in the hypofractionation-endorsed cohort (difference, $2894; 95%CI, $1610–$4234; P < .001) and $64 273 for hypofractionated and $72 860 for conventional WBI in the hypofractionation-permitted cohort (difference, $8587; 95%CI, $5316–$12 017; P < .001). Adjusted mean total 1-year patient out-of-pocket expenses were not significantly different between hypofractionated vs conventional WBI in either cohort.
Hypofractionated WBI after breast conserving surgery increased among women with early-stage breast cancer in 14 US commercial health care plans between 2008 and 2013. However, only 34.5%of patients with hypofractionation-endorsed and 21.2%with hypofractionation-permitted early-stage breast cancer received hypofractionated WBI in 2013.
Related Articles
Characterizing fatigue associated with sunitinib and its impact on health-related quality of life in patients with metastatic renal cell carcinoma
Cella, David
Davis, Mellar P
Négrier, Sylvie
Figlin, Robert A
Michaelson, M Dror
Bushmakin, Andrew G
Cappelleri, Joseph C
Sandin, Rickard
Korytowsky, Beata
Charbonneau, Claudie
Matczak, Ewa
Motzer, Robert J
Using phase 3 trial data for sunitinib versus interferon (IFN)-α in treatment-naive patients with metastatic renal cell carcinoma, retrospective analyses characterized sunitinib-associated fatigue and its impact on patient-reported health-related quality of life (HRQoL).
Patients received sunitinib at a dose of 50 mg/day on a schedule of 4 weeks on/2 weeks off (375 patients) or IFN-α at a dose of 9 MU subcutaneously 3 times per week (360 patients). HRQoL was self-assessed using the Functional Assessment of Cancer Therapy-Kidney Symptom Index–15-item (FKSI-15) questionnaire, with fatigue assessed using its Disease-Related Symptoms subscale. Fatigue was also assessed by providers using Common Terminology Criteria for Adverse Events (CTCAE). A repeated-measures model (M1) and random intercept-slope model (M2) characterized sunitinib-associated fatigue over time. Another repeated-measures model examined the relationship between HRQoL scores and CTCAE fatigue grade.
M1 demonstrated that the initial increase in patient-reported fatigue with sunitinib was worst during cycle 1, with mean values numerically better at subsequent cycles; most pairwise comparisons of consecutive CTCAE fatigue cycle means were not found to be statistically significant. M2 demonstrated that the overall trend (slope) for patient-reported and CTCAE fatigue with sunitinib was not statistically different from 0. The relationship between most HRQoL scores and CTCAE fatigue was close to linear regardless of treatment, with lower scores (worse HRQoL) corresponding to higher fatigue grade. The majority of HRQoL scores were better with sunitinib versus IFN-α for the same CTCAE fatigue grade.
Patients reported worse fatigue during the first sunitinib cycle. However, in subsequent consecutive cycles, less fatigue was reported with no statistically significant worsening. CTCAE fatigue assessment may not fully capture patient treatment experience. Cancer 2014;120:1871–1880. © 2014 American Cancer Society.
Using phase 3 trial data for sunitinib versus interferon-α in treatment-naive patients with metastatic renal cell carcinoma, retrospective analyses characterized sunitinib-associated fatigue and its impact on patient-reported health-related quality of life. Patients reported worse fatigue during the first sunitinib cycle, but in subsequent consecutive cycles less fatigue was reported with no statistically significant worsening; provider-assessed fatigue did not appear to fully capture patient treatment experience.
sunitinib; metastatic renal cell carcinoma; fatigue; health-related quality of life; phase 3
Related Articles
Fatigue and radiotherapy: (A) experience in patients undergoing treatment.
Smets, E. M.
Visser, M. R.
Willems-Groot, A. F.
Garssen, B.
Oldenburger, F.
van Tienhoven, G.
de Haes, J. C.
British Journal of Cancer
Cancer patients undergoing radiotherapy frequently report fatigue. However, knowledge of the importance of fatigue for these patients and of the factors associated with their fatigue is limited. The aim of the current investigation was to gain more insight into fatigue as related to radiotherapy by answering the following questions. First, how is the experience of fatigue best described? Secondly, to what extent is fatigue related to sociodemographic, medical (including treatment), physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue after completion of radiotherapy? Patients with different types of cancer receiving radiotherapy with curative intent (n = 250) were interviewed before and within 2 weeks of completion of radiotherapy. During treatment, patients rated their fatigue at 2-weekly intervals. Results indicate a gradual increase in fatigue over the period of radiotherapy and a decrease after completion of treatment. Fatigue scores obtained after radiotherapy were only slightly, although significantly, higher than pretreatment scores. After treatment, 46% of the patients reported fatigue among the three symptoms that caused them most distress. Significant associations were found between post-treatment fatigue and diagnosis, physical distress, functional disability, quality of sleep, psychological distress and depression. No association was found between fatigue and treatment or personality characteristics. Multivariate regression analysis demonstrated that the intensity of pretreatment fatigue was the best predictor of fatigue after treatment. In view of this finding, a regression analysis was performed to gain more insight into the variables predicting pretreatment fatigue. The degree of functional disability and impaired quality of sleep were found to explain 38% of the variance in fatigue before starting radiotherapy. Fatigue in disease-free patients 9 months after treatment is described in paper (B) in this issue.
Related Articles
Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years
Pinnarò, Paola
Soriani, Antonella
Landoni, Valeria
Giordano, Carolina
Papale, Maria
Marsella, Annelisa
Marucci, Laura
Arcangeli, Giorgio
Strigari, Lidia
Journal of Experimental & Clinical Cancer Research : CR
Accelerated hypofractionation is an attractive approach for adjuvant whole breast radiotherapy. In this study we evaluated the adverse effects at least 3 years post an accelerated hypofractionated whole breast radiotherapy schedule.
From October 2004 to March 2006, 39 consecutive patients aged over 18 years with pTis, pT1-2, pN0-1 breast adenocarcinoma who underwent conservative surgery were treated with an adjuvant accelerated hypofractionated radiotherapy schedule consisting of 34 Gy in 10 daily fractions over 2 weeks to the whole breast, followed after 1 week by an electron boost dose of 8 Gy in a single fraction to the tumour bed. Skin and lung radiation toxicity was evaluated daily during therapy, once a week for one month after radiotherapy completion, every 3 months for the first year and from then on every six months. In particular lung toxicity was investigated in terms of CT density evaluation, pulmonary functional tests, and clinical and radiological scoring. Paired t-test, Chi-square test and non-parametric Wilcoxon test were performed.
After a median follow-up of 43 months (range 36-52 months), all the patients are alive and disease-free. None of the patients showed any clinical signs of lung toxicity, no CT-lung toxicity was denoted by radiologist on CT lung images acquired about 1 year post-radiotherapy, no variation of pulmonary density evaluated in terms of normalised Hounsfield numbers was evident. Barely palpable increased density of the treated breast was noted in 9 out of 39 patients (in 2 patients this toxicity was limited to the boost area) and teleangectasia (<1/cm2) limited to the boost area was evident in 2 out of 39 patients. The compliance with the treatment was excellent (100%).
The radiotherapy schedule investigated in this study (i.e 34 Gy in 3.4 Gy/fr plus boost dose of 8 Gy in single fraction) is a feasible and safe treatment and does not lead to adjunctive acute and late toxicities. A longer follow up is necessary to confirm these favourable results.
Related Articles
Simultaneous integrated boost for adjuvant treatment of breast cancer- intensity modulated vs. conventional radiotherapy: The IMRT-MC2 trial
Askoxylakis, Vasileios
Jensen, Alexandra D
Häfner, Matthias F
Fetzner, Leonie
Sterzing, Florian
Heil, Joerg
Sohn, Christof
Hüsing, Johannes
Tiefenbacher, Uta
Wenz, Frederik
Debus, Jürgen
Hof, Holger
BMC Cancer
Radiation therapy is an essential modality in the treatment of breast cancer. Addition of radiotherapy to surgery has significantly increased local control and survival rates of the disease. However, radiotherapy is also associated with side effects, such as tissue fibrosis or enhanced vascular morbidity. Modern radiotherapy strategies, such as intensity modulated radiotherapy (IMRT), can shorten the overall treatment time by integration of the additional tumor bed boost significantly. To what extent this might be possible without impairing treatment outcome and cosmetic results remains to be clarified.
The IMRT-MC2 study is a prospective, two armed, multicenter, randomized phase-III-trial comparing intensity modulated radiotherapy with integrated boost to conventional radiotherapy with consecutive boost in patients with breast cancer after breast conserving surgery. 502 patients will be recruited and randomized into two arms: patients in arm A will receive IMRT in 28 fractions delivering 50.4 Gy to the breast and 64.4 Gy to the tumor bed by integrated boost, while patients in arm B will receive conventional radiotherapy of the breast in 28 fractions to a dose of 50.4 Gy and consecutive boost in 8 fractions to a total dose of 66.4 Gy.
Primary objectives of the study are the evaluation of the cosmetic results 6 weeks and 2 years post treatment and the 2- and 5-year local recurrence rates for the two different radiotherapy strategies. Secondary objectives are long term overall survival, disease free survival and quality of life.
Trial Registration
ClinicalTrials.gov Protocol ID: NCT01322854.
Related Articles
Fatigue After Treatment for Early Stage Breast Cancer
Jacobsen, Paul B.
Donovan, Kristine A.
Small, Brent J.
Jim, Heather S.
Munster, Pamela N.
Andrykowski, Michael A.
Evidence suggests that fatigue may be a greater problem for cancer survivors than people without cancer. The present study sought to determine whether fatigue was greater in women who had completed treatment for early-stage breast cancer relative to a demographically matched comparison group of women with no cancer history.
As part of a larger study, women with stage 0-II breast cancer were recruited before the start of chemotherapy and radiotherapy (n = 100) or radiotherapy only (n = 121). Fatigue was assessed at the end of treatment and 2, 4, and 6 months later. An age- and geographically matched sample of women with no history of cancer was recruited and assessed for comparison purposes.
Relative to comparison subjects, breast cancer survivors reported more days of fatigue in the past week at all 4 study assessments (P < .05). These differences appeared to be clinically meaningful in that a greater percentage of patients than nonpatients earned scores in the abnormal range on this measure at each assessment (P < .05). Additional analyses indicated that differences in fatigue between patients and comparison subjects were attributable primarily to heightened fatigue in women who received both chemotherapy and radiotherapy.
Findings suggest that fatigue is a greater problem for breast cancer survivors in the 6 months after completion of chemotherapy than for women with no cancer history. Future research should include longer-term follow-up to determine the persistence of fatigue in this population of survivors.
fatigue; breast cancer; adjuvant therapy; survivorship
Related Articles
Radiation induced pneumonitis following whole breast radiotherapy treatment in early breast cancer patients treated with breast conserving surgery: a single institution study
Fragkandrea, I
Kouloulias, V
Mavridis, P
Zettos, A
Betsou, S
Georgolopoulou, P
Sotiropoulou, A
Gouliamos, A
Kouvaris, I
Background: Hypofractionated Radiotherapy (RT) regimens for breast cancer, although reduce cost and time for patients and health care systems, could have a negative impact on normal underlying lung tissue. We studied and compared lung function and the post–RT radiological changes using High-Resolution Computed Tomography (HRCT) in early breast cancer patients, treated with 3-Dimentional conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime.
Patients and Methods: Between 2008 and 2009, 61 early breast cancer patients (T1-2N0M0) were randomised into two groups .Group A (n=31) received standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed. Group B (n=30) received 43.2Gy/16f/22d plus boost 10Gy/5f/1w to tumour bed. Patients of both groups were subjected to dynamic lung testing, using spirometry and gas diffusion tests on Day 0 (D0, before RT), during RT and after completion of RT at 3 and 6 months. HRCT scans were performed in all patients at baseline, and 3,6,12 months after completion of RT. Respiratory symptoms were recorded at 3 and 6 months post completion of RT. Dosimetric factors, such as Central Lung Dose (CLD), lung Volume receiving more 20 Gy (V20), D25 and Mean Lung Dose (MLD) were calculated for all patients.
Results: At 3 months after RT, the pulmonary changes were classified at HRCT as follows: 91.8 % were Grade 0, 8.19 % Grade 1, and 0 % Grade 2. At 6 months, 86.98 % were Grade 0, 11.47 % Grade 1, and 1.6 % Grade 2. At 12 months, 88.52 % were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following completion of RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and other variables (age, smoking, chemotherapy, hormonotherapy, V20).
Conclusion: Lung toxicity, as assessed with HRCT and PFTs, was minimal in both treatment arms and our results are in consistency with other published data. Hypofractionated RT was a safe modality and well tolerated by the majority of the patients. Longer follow-up is required for robust assessment of incidence of late lung fibrosis in our series.
Hypofractionated breast radiotherapy; whole breast radiotherapy; radiation pneumonitis; spirometric tests; high resolution computed tomography
Related Articles
Breast cancer (non-metastatic)
Stebbing, Justin
Delaney, Geoff
Thompson, Alastair
Clinical Evidence
Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions after breast-conserving surgery for ductal carcinoma in situ? What are the effects of treatments for primary operable breast cancer? What are the effects of interventions in locally advanced breast cancer (stage 3B)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 83 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding chemotherapy (cyclophosphamide/methotrexate/fluorouracil and/or anthracycline and/or taxane-based regimens), or hormonal treatment to radiotherapy; adjuvant treatments (aromatase inhibitors, adjuvant anthracycline regimens, tamoxifen); axillary clearance; axillary dissection plus sentinel node dissection; axillary radiotherapy; axillary sampling; combined chemotherapy plus tamoxifen; chemotherapy plus monoclonal antibody (trastuzumab); extensive surgery; high-dose chemotherapy; hormonal treatment; less extensive mastectomy; less than whole-breast radiotherapy plus breast-conserving surgery; multimodal treatment; ovarian ablation; primary chemotherapy; prolonged adjuvant combination chemotherapy; radiotherapy (after breast-conserving surgery, after mastectomy, plus tamoxifen after breast-conserving surgery, to the internal mammary chain, and to the ipsilateral supraclavicular fossa, and total nodal radiotherapy); sentinel node biopsy; and standard chemotherapy regimens.
Key Points
Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.
In women with ductal carcinoma in situ (DCIS), radiotherapy reduces local recurrence and invasive carcinoma after breast-conserving surgery. The role of tamoxifen added to radiotherapy for DCIS remains unclear because of conflicting results.
In women with primary operable breast cancer, survival may be increased by full surgical excision, tamoxifen, chemotherapy, radiotherapy, ovarian ablation, or trastuzumab (in women who over-express HER2/neu oncogene). Incomplete excision may increase the risk of local recurrence, but less-extensive mastectomy that excises all local disease is as effective as radical mastectomy at prolonging survival, with better cosmetic results. Axillary clearance (removal of all axillary lymph nodes) achieves local disease control, but has not been shown to increase survival, and can cause arm lymphoedema. Sentinel lymph node biopsy or 4-node sampling may adequately stage the axilla with less morbidity compared with axillary clearance. Adjuvant tamoxifen reduces the risk of recurrence and death in women with oestrogen-positive tumours. Primary chemotherapy may facilitate successful breast-conserving surgery instead of mastectomy. Adjuvant combination chemotherapy improves survival compared with no chemotherapy, with greatest benefit likely with anthracycline-based regimens at standard doses for 4 to 6 months.Radiotherapy decreases recurrence and mortality after breast-conserving surgery. Post-mastectomy radiotherapy for women who are node-positive or at high risk of recurrence decreases recurrence and mortality. Adjuvant aromatase inhibitors improve disease-free survival compared with tamoxifen, but their effect on overall survival is unclear. Adjuvant taxane-based regimens may improve disease-free survival over standard anthracycline-based therapy.
In women with locally advanced breast cancer, radiotherapy may be as effective as surgery or tamoxifen at increasing survival and local disease control. Adding tamoxifen or ovarian ablation to radiotherapy increases survival compared with radiotherapy alone, but adding chemotherapy may not reduce recurrence or mortality compared with radiotherapy alone.We don't know if chemotherapy alone improves survival in women with locally advanced breast cancer as we found few trials.
Related Articles
Up-to-date results of carbon-ion radiotherapy for prostate cancer
Nomiya, Takuma
Tsuji, Hiroshi
Maruyama, Katsuya
Kamada, Tadashi
Tsujii, Hirohiko
Journal of Radiation Research
2014;55(Suppl 1):i28-i29.
Carbon ion radiotherapy (C-ion RT) for prostate cancer was started in 1995 using the Heavy-Ion Medical Accelerator in Chiba (HIMAC) at the National Institute of Radiological Sciences (NIRS), Japan. After preceding phase I/II dose-escalation studies of 20 fractions over 5 weeks, a phase II study was initiated in April 2000 using the treatment techniques and the recommended dose fractionations established by the phase I/II studies. This study was also successfully completed in October 2003 when the C-ion RT for solid tumors, including the prostate cancer, was approved as 'Advanced Medicine' by the Ministry of Health, Labor, and Welfare. Since then, more than 1400 patients have been treated with C-ion RT as of February 2012, and advancement of hypofractionation has also been achieved. In this paper, the treatment outcomes in 1144 patients who underwent the established C-ion RT between April 2000 and July 2012 were analyzed.
Out of 1144 patients, 585 patients were categorized as high-risk group, which includes patients having at least one of the following conditions: T3 clinical stage, Gleason's score of 8 or higher and PSA of 20 or higher. One hundred and ninety-seven patients who met the conditions such as clinical stage of T2a or lower, Gleason's score of 6 or lower and PSA of <20 were categorized as low-risk group. Three hundred and sixty-two patients who were not included in either high- or low-risk group were categorized as intermediate-risk group. All patients were pathologically proven to have adenocarcinoma of the prostate, and Gleason's score was determined by the chief pathologist of our study group. Written consent was obtained from all patients included in the clinical study. Patients with the following conditions were not registered in the clinical trial: having distant metastases, having synchronous primary malignancy, not histologically proven cancer, without informed consent, post-operative/post-irradiation recurrence.
All patients were treated with three field irradiations (vertical one field and horizontal opposing two fields). The prostate and proximal part of the seminal vesicle were contoured as clinical target volume (CTV), and planning target volume (PTV) was set with 5–10 mm margins around the CTV. On the way of radiotherapy, a part of irradiation field of the posterior side was cut to reduce the rectal dose. The 197 patients in the low-risk group did not undergo androgen deprivation therapy (ADT), whereas the 947 patients of intermediate- and high-risk groups underwent ADT. The patients of intermediate-risk group underwent about 6 months of neoadjuvant ADT, and the patients of high-risk group also underwent about 6 months of neoadjuvant ADT and sequential adjuvant ADT for more than 18 months. The median age of all patients was 68 years, and the median follow-up time was 48.7 months (range: 3.6–151.1 months).
The 5-year overall survival rate and biochemical relapse-free rate of the entire groups was 95.7% and 91.0%, respectively. T-stage and Gleason's score were significant prognostic factors for both the biochemical control and patient survival and initial PSA was also a predictive factor for survival. Regarding the late radiation toxicity, the incidence of rectal toxicity of grade 2 or worse was 1.1% and that of genitourinary toxicity was 6.5%. These outcomes seemed to be better than those of the past publications [ 1– 4]. In addition, the incidence of toxicity in patients treated with more hypofractionated C-ion RT of 16 fractions over 4 weeks was lower than those of 20 fraction treatment. These favorable outcomes can be thought as apparent evidence of physical and biological advantages of the hypofractionated C-ion RT.
carbon-ion radiation therapy; prostate cancer; hypofractionation
Related Articles
Phase I-II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments
Scorsetti, Marta
Alongi, Filippo
Fogliata, Antonella
Pentimalli, Sara
Navarria, Pierina
Lobefalo, Francesca
Garcia-Etienne, Carlos
Clivio, Alessandro
Cozzi, Luca
Mancosu, Pietro
Nicolini, Giorgia
Vanetti, Eugenio
Eboli, Marco
Rossetti, Carlo
Rubino, Arianna
Sagona, Andrea
Arcangeli, Stefano
Gatzemeier, Wolfgang
Masci, Giovanna
Torrisi, Rosalba
Testori, Alberto
Alloisio, Marco
Santoro, Armando
Tinterri, Corrado
Radiation Oncology (London, England)
To report results in terms of feasibility and early toxicity of hypofractionated simultaneous integrated boost (SIB) approach with Volumetric Modulated Arc Therapy (VMAT) as adjuvant treatment after breast-conserving surgery.
Between September 2010 and May 2011, 50 consecutive patients presenting early-stage breast cancer were submitted to adjuvant radiotherapy with SIB-VMAT approach using RapidArc in our Institution (Istituto Clinico Humanitas ICH). Three out of 50 patients were irradiated bilaterally (53 tumours in 50 patients). All patients were enrolled in a phase I-II trial approved by the ICH ethical committee. All 50 patients enrolled in the study underwent VMAT-SIB technique to irradiate the whole breast with concomitant boost irradiation of the tumor bed. Doses to whole breast and surgical bed were 40.5 Gy and 48 Gy respectively, delivered in 15 fractions over 3 weeks. Skin toxicities were recorded during and after treatment according to RTOG acute radiation morbidity scoring criteria with a median follow-up of 12 months (range 8–16). Cosmetic outcomes were assessed as excellent/good or fair/poor.
The median age of the population was 68 years (range 36–88). According to AJCC staging system, 38 breast lesions were classified as pT1, and 15 as pT2; 49 cases were assessed as N0 and 4 as N1. The maximum acute skin toxicity by the end of treatment was Grade 0 in 20/50 patients, Grade 1 in 32/50, Grade 2 in 0 and Grade 3 in 1/50 (one of the 3 cases of bilateral breast irradiation). No Grade 4 toxicities were observed. All Grade 1 toxicities had resolved within 3 weeks. No significant differences in cosmetic scores on baseline assessment vs. 3 months and 6 months after the treatment were observed: all patients were scored as excellent/good (50/50) compared with baseline; no fair/poor judgment was recorded. No other toxicities or local failures were recorded during follow-up.
The 3-week course of postoperative radiation using VMAT with SIB showed to be feasible and was associated with acceptable acute skin toxicity profile. Long-term follow-up data are needed to assess late toxicity and clinical outcomes.
Breast cancer; Simultaneous integrated boost; Hypofractionation; Volumetric modulated arc therapy
Related Articles
Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A
Welzel, Grit
Boch, Angela
Sperk, Elena
Hofmann, Frank
Kraus-Tiefenbacher, Uta
Gerhardt, Axel
Suetterlin, Marc
Wenz, Frederik
Radiation Oncology (London, England)
Intraoperative radiotherapy (IORT) is a new treatment approach for early stage breast cancer. This study reports on the effects of IORT on radiation-related quality of life (QoL) parameters.
Two hundred and thirty women with stage I-III breast cancer (age, 31 to 84 years) were entered into the study. A single-center subgroup of 87 women from the two arms of the randomized phase III trial TARGIT-A (TARGeted Intra-operative radioTherapy versus whole breast radiotherapy for breast cancer) was analyzed. Furthermore, results were compared to non-randomized control groups: n = 90 receiving IORT as a tumor bed boost followed by external beam whole breast radiotherapy (EBRT) outside of TARGIT-A (IORT-boost), and n = 53 treated with EBRT followed by an external-beam boost (EBRT-boost). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 (QLQ-C30) and BR23 (QLQ-BR23). The mean follow-up period in the TARGIT-A groups was 32 versus 39 months in the non-randomized control groups.
Patients receiving IORT alone reported less general pain (21.3 points), breast (7.0 points) and arm (15.1 points) symptoms, and better role functioning (78.7 points) as patients receiving EBRT (40.9; 19.0; 32.8; and 60.5 points, respectively, P < 0.01). Patients receiving IORT alone also had fewer breast symptoms than TARGIT-A patients receiving IORT followed by EBRT for high risk features on final pathology (IORT-EBRT; 7.0 versus 29.7 points, P < 0.01). There were no significant differences between TARGIT-A patients receiving IORT-EBRT compared to non-randomized IORT-boost or EBRT-boost patients and patients receiving EBRT without a boost.
In the randomized setting, important radiation-related QoL parameters after IORT were superior to EBRT. Non-randomized comparisons showed equivalent parameters in the IORT-EBRT group and the control groups.
Quality of life; Targeted intraoperative radiotherapy; Breast cancer; Boost; TARGIT-A trial
Related Articles
High-dose accelerated hypofractionated three-dimensional conformal radiotherapy (at 3 Gy/fraction) with concurrent vinorelbine and carboplatin chemotherapy in locally advanced non-small-cell lung cancer: a feasibility study
Liu, Yue-E
Lin, Qiang
Meng, Fan-Jie
Chen, Xue-Ji
Ren, Xiao-Cang
Cao, Bin
Wang, Na
Zong, Jie
Peng, Yu
Ku, Ya-Jun
Chen, Yan
Radiation Oncology (London, England)
Increasing the radiotherapy dose can result in improved local control for non-small-cell lung cancer (NSCLC) and can thereby improve survival. Accelerated hypofractionated radiotherapy can expose tumors to a high dose of radiation in a short period of time, but the optimal treatment regimen remains unclear. The purpose of this study was to evaluate the feasibility of utilizing high-dose accelerated hypofractionated three-dimensional conformal radiotherapy (at 3 Gy/fraction) with concurrent vinorelbine (NVB) and carboplatin (CBP) chemotherapy for the treatment of local advanced NSCLC.
Untreated patients with unresectable stage IIIA/IIIB NSCLC or patients with a recurrence of NSCLC received accelerated hypofractionated three-dimensional conformal radiotherapy. The total dose was greater than or equal to 60 Gy. The accelerated hypofractionated radiotherapy was conducted once daily at 3 Gy/fraction with 5 fractions per week, and the radiotherapy was completed in 5 weeks. In addition to radiotherapy, the patients also received at least 1 cycle of a concurrent two-drug chemotherapy regimen of NVB and CBP.
A total of 26 patients (19 previously untreated cases and 7 cases of recurrent disease) received 60Gy-75Gy radiotherapy with concurrent chemotherapy. All of the patients underwent evaluations for toxicity and preliminary therapeutic efficacy. There were no treatment-related deaths within the entire patient group. The major acute adverse reactions were radiation esophagitis (88.5%) and radiation pneumonitis (42.3%). The percentages of grade III acute radiation esophagitis and grade III radiation pneumonitis were 15.4% and 7.7%, respectively. Hematological toxicities were common and did not significantly affect the implementation of chemoradiotherapy after supportive treatment. Two patients received high dose of 75 Gy had grade III late esophageal toxicity, and none had grade IV and above. Grade III and above late lung toxicity did not occur.
High-dose accelerated hypofractionated three-dimensional conformal radiotherapy with a dose of 60 Gy or greater with concurrent NVB and CBP chemotherapy might be feasible. However esophagus toxicity needs special attention. A phase I trial is recommended to obtain the maximum tolerated radiation dose of accelerated hypofractionated radiotherapy with concurrent chemotherapy.
Non-small-cell lung cancer; Accelerated hypofractionated radiotherapy; Concurrent chemoradiotherapy; Three-dimensional conformal radiotherapy; Vinorelbine; Carboplatin
Related Articles
Psychosocial encounters correlates with higher patient-reported functional quality of life in gynecological cancer patients receiving radiotherapy
Fang, Penny
Tan, Kay See
Grover, Surbhi
McFadien, Mary K
Troxel, Andrea B
Lin, Lilie
Radiation Oncology (London, England)
Our objective was to assess longitudinal health-related quality of life (HRQoL) in patients treated with radiotherapy for gynecologic malignancy and assess the relationship of psychosocial encounters on HRQoL.
Women with gynecologic malignancy were prospectively enrolled and HRQoL assessed before, during, and after radiotherapy treatment using validated measures. Treatment and demographic information were reviewed. Mixed-effects models were used to assess changes in quality of life (QoL) over time and association of psychologist and social worker encounters with overall QoL as well as subdomains of QoL.
Fifty-two women were enrolled and 41 completed at least one assessment. Fatigue (p = 0.008), nausea (p = 0.001), feeling ill (p = 0.007), and being bothered by side effects (p < 0.001) worsened on treatment with subsequent improvement. By follow-up, patients reported increased functional well-being (FWB) with significant decrease in worry (p = 0.003), increase in enjoyment of things usually done for fun (p = 0.003) and increase in contentment (p = 0.047). Twenty-three patients had at least one interaction with a social worker or psychologist during treatment. Each additional interaction was associated with a 2.12 increase in FWB score from before to after treatment (p = 0.002), and 1.74 increase from on to after treatment (p = 0.011). Additional interactions were not significantly associated with changes in overall FACT score (p = 0.056) or SWB (p = 0.305).
Patient-reported HRQoL significantly worsened during radiotherapy treatment with subsequent improvement, affirming transiency of treatment-induced toxicities. Our preliminary study suggests that clinically-recommended psychological and social work interventions have potential value with respect to improving patient QoL during radiotherapy. Larger studies are needed to validate our findings.
Gynecologic cancer; Radiation therapy; Patient reported outcomes; FACT-G; MDASI; Psychological support
Related Articles
Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity
Deantonio, Letizia
Gambaro, Giuseppina
Beldì, Debora
Masini, Laura
Tunesi, Sara
Magnani, Corrado
Krengli, Marco
Radiation Oncology (London, England)
A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series.
Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected.
Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85%) patients treated with hypofractionation and in 67/70 (96%) patients treated with conventional fractionation (p = 0.01). Late toxicity was observed in 8 patients (10%) in the hypofractionation group and in 10 patients (15%) in the conventional fractionation group, respectively (p = 0.4).
The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.
Related Articles
A comparative study of different dose fractionations schedule of thoracic radiotherapy for pain palliation and health-related quality of life in metastatic NSCLC
Sau, Sourav
Sau, Saikat
Dutta, Premnath
Gayen, Ganesh Chandra
Banerjee, Sanatan
Basu, Avijit
Lung India : Official Organ of Indian Chest Society
To investigate the effect of different hypo fractionated thoracic radiotherapy schedules in relation to thoracic pain relief, overall survival and post radiotherapy HRQOL in metastatic NSCLC.
Material and methods:
Stage IV NSCLC and had intra-thoracic symptoms, included in the study. Patients were randomly assigned to three treatments arms. (i) 17 Gy in 2 fractions in one week (ii) 20 Gy in five fractions in one week. (iii) 30 Gy in 10 fractions in two weeks. BPI module was used to assess pain score before and after the thoracic radiotherapy. Functional assessment of cancer therapy-G (FACT-G) used to investigate changes in HRQOL. Clinicians' assessment of symptom improvement were recorded at 2nd, 6th and 12th weeks after completion of TRT.
Pain relief, HRQOL and OS were equivalent in all the three arms. The median OS were 6 months, 5 months, 6 months in arm A, B and arm C, respectively.
Protracted palliative thoracic radiotherapy renders no added advantage of relief of symptoms, HRQOL and overall survival compared to short course palliative TRT in metastatic NSCLC.
Health-related quality of life; non-small cell lung carcinoma; overall survival; palliative thoracic radiotherapy; pain relief
Related Articles
Improving Symptom Communication Through Personal Digital Assistants: The CHAT (Communicating Health Assisted by Technology) Project
Post, Douglas M.
Shapiro, Charles L.
Cegala, Donald J.
David, Prabu
Katz, Mira L.
Krok, Jessica L.
Phillips, Gary S.
McAlearney, Ann Sheck
Lehman, Jennifer S.
Hicks, William
Paskett, Electra D.
Journal of the National Cancer Institute. Monographs
Communication problems impede effective symptom management during chemotherapy. The primary aim of this pilot randomized controlled trial was to test the effects of a personal digital assistant–delivered communication intervention on pain, depression, and fatigue symptoms among breast cancer patients undergoing chemotherapy. Secondary aims included assessment of 1) study feasibility, 2) patient and clinician responses to study participation, and 3) intervention effects on health-related quality of life (HRQoL) and communication self-efficacy.
Intervention group participants (n = 27) completed symptom inventories at baseline, once per week during treatment, and at posttreatment. Depending on symptom severity, they viewed race-concordant videos on how to communicate about pain, depression and/or fatigue, using the personal digital assistant. Symptom records were tracked and shared with clinicians. Control group participants (n = 23) received usual care. Longitudinal random effects modeling assessed the changes in average symptom scores over time. Descriptive statistics assessed study feasibility and intervention effects on HRQoL and communication self-efficacy. Postintervention focus groups, interviews, and surveys assessed responses to study participation.
Mean age of the participants was 51.0 years; 42 participants (84%) were white. In comparison with control, intervention group participants reported lower average pain severity over time (P = .015). Mean pain interference scores over time were marginally different between groups (P = .07); mean depression and fatigue scores over time were statistically nonsignificant. Feasibility outcomes and perspectives about study participation were positive. Mean pre–post decreases in HRQoL were generally higher among intervention group participants; pre–post changes in communication self-efficacy were equivalent.
Mixed findings of the study indicate the need for future research.
Related Articles
Hypofractionated helical intensity-modulated radiotherapy of the prostate bed after prostatectomy with or without the pelvic lymph nodes - the PRIAMOS trial
Krause, Sonja
Sterzing, Florian
Neuhof, Dirk
Edler, Lutz
Debus, Juergen
Herfarth, Klaus
BMC Cancer
While evidence on safety and efficacy of primary hypofractionated radiotherapy in prostate cancer is accumulating, data on postoperative hypofractionated treatment of the prostate bed and of the pelvic lymph nodes is still scarce. This phase II trial was initiated to investigate safety and feasibility of hypofractionated treatment of the prostate bed alone or with the pelvic lymph nodes.
A total of 80 prostate cancer patients with the indication for adjuvant radiotherapy will be enrolled, where 40 patients with a low risk of lymph node involvement (arm 1) and another 40 patients with a high risk of lymph node involvement (arm 2) will each receive 54 Gy in 18 fractions to the prostate bed. Arm 2 will be given 45 Gy to the pelvic lymph nodes additionally. Helical Tomotherapy and daily image guidance will be used.
This trial was initiated to substantiate data on hypofractionated treatment of the prostate bed and generate first data on adjuvant hypofractionated radiotherapy of the pelvic lymph nodes.
Trial registration
ClinicalTrials.gov; NCT01620710
Prostate cancer; Radiotherapy; Hypofractionation; Helical tomotherapy; Prostate bed; Pelvic lymph nodes
Related Articles
Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer
Montgomery, Guy H.
David, Daniel
Kangas, Maria
Green, Sheryl
Sucala, Madalina
Bovbjerg, Dana H.
Hallquist, Michael N.
Schnur, Julie B.
Journal of Clinical Oncology
The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group.
Patients and Methods
Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) –Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness).
The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13).
The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.
Related Articles
Randomized controlled trial to evaluate the effects of progressive resistance training compared to progressive muscle relaxation in breast cancer patients undergoing adjuvant radiotherapy: the BEST study
Potthoff, Karin
Schmidt, Martina E
Wiskemann, Joachim
Hof, Holger
Klassen, Oliver
Habermann, Nina
Beckhove, Philipp
Debus, Juergen
Ulrich, Cornelia M
Steindorf, Karen
BMC Cancer
Cancer-related fatigue (CRF) is one of the most common and distressing side effects of cancer and its treatment. During and after radiotherapy breast cancer patients often suffer from CRF which frequently impairs quality of life (QoL). Despite the high prevalence of CRF in breast cancer patients and the severe impact on the physical and emotional well-being, effective treatment methods are scarce.
Physical activity for breast cancer patients has been reported to decrease fatigue, to improve emotional well-being and to increase physical strength. The pathophysiological and molecular mechanisms of CRF and the molecular-biologic changes induced by exercise, however, are poorly understood.
In the BEST trial we aim to assess the effects of resistance training on fatigue, QoL and physical fitness as well as on molecular, immunological and inflammatory changes in breast cancer patients during adjuvant radiotherapy.
The BEST study is a prospective randomized, controlled intervention trial investigating the effects of a 12-week supervised progressive resistance training compared to a 12-week supervised muscle relaxation training in 160 patients with breast cancer undergoing adjuvant radiotherapy. To determine the effect of exercise itself beyond potential psychosocial group effects, patients in the control group perform a group-based progressive muscle relaxation training. Main inclusion criterion is histologically confirmed breast cancer stage I-III after lumpectomy or mastectomy with indication for adjuvant radiotherapy. Main exclusion criteria are acute infectious diseases, severe neurological, musculosceletal or cardiorespiratory disorders. The primary endpoint is cancer-related fatigue; secondary endpoints include immunological and inflammatory parameters analyzed in peripheral blood, saliva and urine. In addition, QoL, depression, physical performance and cognitive capacity will be assessed.
The BEST study is the first randomized controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during adjuvant radiotherapy. Based on the analysis of physiological, immunological and inflammatory parameters it will contribute to a better understanding of the physiological and psychosocial effects and the biological mechanisms of resistance training. The ultimate goal is the implementation of optimized intervention programs to reduce fatigue, improve quality of life and potentially the prognosis after breast cancer.
Trial registration
ClinicalTrials.gov NCT01468766
Related Articles
Improvement in quality of life measures in patients with refractory hepatitis C, responding to re-treatment with Pegylated interferon alpha -2b and ribavirin
Mathew, Abraham
Peiffer, Laurie P
Rhoades, Kathy
McGarrity, Thomas J
Health and Quality of Life Outcomes
In this paper, we report the health related quality of life (HRQOL) data from patients with hepatitis C viral infection (HCV) who were refractory to prior therapy and had re-treatment with a combination of Pegylated interferon alpha-2b and ribavirin. We hypothesized that the HRQOL will improve in those patients who attain sustained viral response similar to naïve patients undergoing treatment for HCV.
HRQOL data was obtained from 152 patients enrolled into a randomized study for re-treatment of HCV refractory to prior therapy with interferon alpha-2b in combination with ribavirin. The treatment protocol was for 48 weeks and had a high and low dose arm. The HRQOL data was collected at baseline, weeks 24 and 48 of treatment, and at 24 week follow-up after treatment. A repeated measures statistical model was used for comparing the HRQOL domain scores between the responders and non-responders and the treatment groups. The responders and non-responders were also compared to the age and sex adjusted national mean scores.
Twenty-five of the 152 (17%) patients achieved a sustained viral response. At baseline, HRQOL is lower in HCV patients compared to national norms. The norm based HRQOL domain scores for the different domains of the SF-36 instrument were as follows: physical functioning = 47.13, role-physical = 46.87, bodily pain = 48.00, general health = 44.01, vitality = 45.39, social functioning = 47.05, role-emotional = 48.88, mental health = 48.76, physical component score 43.26 and mental component score = 46.17. The scores decreased during therapy in those who would be responders and non-responders, but the pattern of change was different. During the treatment, the HRQOL domain scores of responders decrease notably in the domain of vitality. At week 48 vitality scores were worst in responders. 5 of the 8 domain scores were lower compared to baseline in non-responders. At 24 weeks post treatment follow up, HRQOL in those refractory patients who respond to re-treatment tended to be better than the national average in the domains of vitality (p = .06), social functioning (p = .06) and role-emotional (p = .03) while the non-responders improved their scores in domains of physical function and bodily pain.
We conclude that patients who are to be responders and non-responders behave differently in terms of the HRQOL domain scores when re-treated with a combination of interferon alpha 2b and ribavirin. The responders sustained a significant decrease in the domain score of vitality while 5 of the 8 domain scores decrease in non-responders at the end of treatment. At the end of follow up, in responders, the HRQOL score tended to be better than the national average notably in the domains of role-emotional, vitality and social functioning. On the other hand, in non-responders, the domain scores of physical function improve, while that of role-emotional worsened.
Related Articles
Evidence from a breast cancer hypofractionated schedule: late skin toxicity assessed by ultrasound
Landoni, Valeria
Giordano, Carolina
Marsella, Annelisa
Saracino, Biancamaria
Petrongari, Maria Grazia
Ferraro, Anna Maria
Strigari, Lidia
Pinnarò, Paola
Journal of Experimental & Clinical Cancer Research : CR
Feasibility of whole breast hypofractionated radiotherapy schedules in breast conserving therapy is recognized however concerns remain about the role of the boost dose on the overall treatment's potential toxicity. In this study we report on the possibility to quantitatively evaluate radiation induced toxicity in patients treated with an abbreviated course with major concern in the irradiated boost region.
Eighty-nine patients who underwent conservative surgery for early-stage breast cancer followed by adjuvant accelerated hypofractionated whole breast radiotherapy were included in this study to assess skin and subcutaneous tissue late toxicity by means of ultrasonographic quantitative examination. For each patient the skin thickness was measured at four positions: on the irradiated breast, in the boost region and in the corresponding positions in the contra-lateral not treated breast. All patients were scanned by the same radiologist to reduce potential inter-operator variability, the operator was blind to the scoring of the patient CTCv3 late toxicity as well as patient treatment characteristics. Ultrasound assessment and clinical evaluation were compared.
The median time between the end of adjuvant radiotherapy and ultrasound examination was 20.5 months. The measured mean skin thickness in the irradiated breast was 2.13 ± 0.72 mm while in the mirror region of the contra-lateral healthy breast was 1.61 ± 0.29 mm. The measured mean skin thickness in the irradiated boost region was 2.25 ± 0.79 mm versus 1.63 ± 0.33 mm in the corresponding region of contra-lateral healthy breast. The mean increment in skin thickness respect to the counterpart in the healthy breast was 0.52 ± 0.67 mm and 0.62 ± 0.74 mm for the breast and the boost region respectively. A significant direct correlation was found between the increment in skin thickness in the irradiated breast and in the boost region with fibrosis (G ≥ 1).
In this study results from a breast cancer hypofractionated schedule in terms of late skin toxicity are reported. In particular our study confirms that late cutaneous reactions can be reliably assed by ultrasonographic examination, also discriminating between regions irradiated at different doses, and that this instrumental evaluation is in agreement with clinical stated toxicity.
Breast cancer ultrasound tissue characterization; Radiation toxicity; Hypofractionactionated radiotherapy
Related Articles
A randomized hypofractionation dose escalation trial for high risk prostate cancer patients: interim analysis of acute toxicity and quality of life in 124 patients
Norkus, Darius
Karklelyte, Agata
Engels, Benedikt
Versmessen, Harijati
Griskevicius, Romas
De Ridder, Mark
Storme, Guy
Aleknavicius, Eduardas
Janulionis, Ernestas
Valuckas, Konstantinas Povilas
Radiation Oncology (London, England)
The α/β ratio for prostate cancer is postulated being in the range of 0.8 to 2.2 Gy, giving rise to the hypothesis that there may be a therapeutic advantage to hypofractionation. To do so, we carried out a randomized trial comparing hypofractionated and conventionally fractionated image-guided intensity modulated radiotherapy (IG-IMRT) in high-risk prostate cancer. Here, we report on acute toxicity and quality of life (QOL) for the first 124 randomized patients.
The trial compares 76 Gy in 38 fractions (5 fractions/week) (Arm 1) to 63 Gy in 20 fractions (4 fractions/week) (Arm 2) (IG-IMRT). Prophylactic pelvic lymph node irradiation with 46 Gy in 23 fractions sequentially (Arm 1) and 44 Gy in 20 fractions simultaneously (Arm 2) was applied. All patients had long term androgen deprivation therapy (ADT) started before RT. Both physician-rated acute toxicity and patient-reported QOL using EPIC questionnaire are described.
There were no differences in overall maximum acute gastrointestinal (GI) or genitourinary (GU) toxicity. Compared to conventional fractionation (Arm 1), GI and GU toxicity both developed significantly earlier but also disappeared earlier in the Arm 2, reaching significant differences from Arm 1 at week 8 and 9. In multivariate analyses, only parameter shown to be related to increased acute Grade ≥1 GU toxicity was the study Arm 2 (p = 0.049). There were no statistically significant differences of mean EPIC scores in any domain and sub-scales. The clinically relevant decrease (CRD) in EPIC urinary domain was significantly higher in Arm 2 at month 1 with a faster recovery at month 3 as compared to Arm 1.
Hypofractionation at 3.15 Gy per fraction to 63 Gy within 5 weeks was well tolerated. The GI and GU physician-rated acute toxicity both developed earlier but recovered faster using hypofractionation. There was a correlation between acute toxicity and bowel and urinary QOL outcomes. Longer follow-up is needed to determine the significance of these associations with late toxicity.
Related Articles
Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy
Faithfull, S
Corner, J
Meyer, L
Huddart, R
Dearnaley, D
British Journal of Cancer
This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention focused on coping with symptoms, and provided continuity of care and telephone support. Further work is required to improve the management of patients during and after radiotherapy. © 2001 Cancer Research Campaign http://www.bjcancer.com
radiation; acute side effects; supportive care; nurse-led clinics
Related Articles
Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis
Punglia, Rinaa S
Saito, Akiko M
Neville, Bridget A
Earle, Craig C
Weeks, Jane C
BMJ : British Medical Journal
Objectives To determine if the length of interval between breast conserving surgery and start of radiotherapy affects local recurrence and to identify factors that might be associated with delay in older women with breast cancer.
Design Retrospective cohort analysis with Cox proportional hazards models to study the association between time to radiotherapy and local recurrence, and propensity score and instrumental variable analyses to confirm findings. Logistic regression investigated factors associated with later start of radiotherapy.
Setting Linked database (Surveillance, Epidemiology, and End Results Program-Medicare) in the United States
Participants 18 050 women aged over 65 with stage 0-II breast cancer diagnosed in 1991-2002 who received breast conserving surgery and radiotherapy but not chemotherapy.
Main outcome measure Local recurrence.
Results Median time from surgery to start of radiotherapy was 34 days, with 29.9% (n=5389) of women starting radiotherapy after six weeks. Just over 4% (n=734) of the cohort experienced a local recurrence. After adjustment for clinical and sociodemographic factors, intervals over six weeks were associated with increased likelihood of local recurrence (hazard ratio 1.19, 95% confidence interval 1.01 to 1.39, P=0.033). When the interval was modelled continuously (assessing accumulation of risk by day), the effect was statistically stronger (hazard ratio 1.005 per day, 1.002 to 1.008, P=0.004). Propensity score and instrumental variable analysis confirmed these findings. Instrumental variable analysis showed that intervals over six weeks were associated with a 0.96% increase in recurrence at five years (P=0.026). In multivariable analysis, starting radiotherapy after six weeks was significantly associated with positive nodes, comorbidity, history of low income, Hispanic ethnicity, non-white race, later year of diagnosis, and residence outside the southern states of the US.
Conclusions There is a continuous relation between the interval from breast conserving surgery to radiotherapy and local recurrence in older women with breast cancer, suggesting that starting radiotherapy as soon as possible could minimise the risk of local recurrence. There are considerable disparities in time to starting radiotherapy after breast conserving surgery. Regions of the US known to have increased rates of breast conserving surgery had longer intervals before radiotherapy, suggesting limitations in capacity. Given the known negative impact of local recurrence on survival, mechanisms to ameliorate disparities and policies regarding waiting times for treatment might be warranted.
Related Articles
Results 1-25 (1375406)
« Previous
Go to page number:
Next »
Remove citation from clipboard
Add citation to clipboard
This will clear all selections from your clipboard. Do you wish proceed?
Clipboard is full! Please remove an item and try again.
Contact Us
PubMed Central Canada is a service of the
Canadian Institutes of Health Research
(CIHR) working in partnership with the National Research Council's
national science library
in cooperation with the
National Center for Biotechnology Information
at the
U.S. National Library of Medicine
(NCBI/NLM). It includes content provided to the
PubMed Central International archive
by participating publishers.


text:
This profile was last updated on . .
Is this you? Claim your profile.
Chief People Officer
Aginity LLC
Direct Phone: (224) ***-****
1007 Church Street Suite 700
Evanston, Illinois 60201
United States
Aginity is a global business intelligence application development services company. We are focused on the idea of helping our clients realize intelligent data management that can become their new foundation for a better, more competitive business model. ... more
Our Two-day Training Intensive
Vice President of Marketing
Vice President Solutions Delivery
Loras College
masters degree
Weston Jesuit
Aginity.com > Our Team
www.aginity.com [cached]
Aginity Leadership – Agile Software Product Development & Business Intelligence Analytics
www.aginity.com [cached]
www.kenflorian.com [cached]
Copyright 2009 by Ken Florian
Speaking Engagements
www.kenflorian.com [cached]
The Ken Florian Web Site is comprised of various Web pages operated by Ken Florian.
Speaking Engagements
www.kenflorian.com [cached]
Ken Florian is committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to the Ken Florian Web site and governs data collection and usage. By using the Ken Florian website, you consent to the data practices described in this statement.Collection of your Personal Information Ken Florian collects personally identifiable information, such as your e-mail address, name, home or work address or telephone number. Ken Florian also collects anonymous demographic information, which is not unique to you, such as your ZIP code, age, gender, preferences, interests and favorites. There is also information about your computer hardware and software that is automatically collected by Ken Florian. This information can include: your IP address, browser type, domain names, access times and referring Web site addresses. This information is used by Ken Florian for the operation of the service, to maintain quality of the service, and to provide general statistics regarding use of the Ken Florian Web site. Please keep in mind that if you directly disclose personally identifiable information or personally sensitive data through Ken Florian public message boards, this information may be collected and used by others. Note: Ken Florian does not read any of your private online communications. Ken Florian encourages you to review the privacy statements of Web sites you choose to link to from Ken Florian so that you can understand how those Web sites collect, use and share your information. Ken Florian is not responsible for the privacy statements or other content on Web sites outside of the Ken Florian and Ken Florian family of Web sites. Use of your Personal Information Ken Florian collects and uses your personal information to operate the Ken Florian Web site and deliver the services you have requested. Ken Florian also uses your personally identifiable information to inform you of other products or services available from Ken Florian and its affiliates. Ken Florian may also contact you via surveys to conduct research about your opinion of current services or of potential new services that may be offered. Ken Florian does not sell, rent or lease its customer lists to third parties. Ken Florian may, from time to time, contact you on behalf of external business partners about a particular offering that may be of interest to you. In those cases, your unique personally identifiable information (e-mail, name, address, telephone number) is not transferred to the third party. In addition, Ken Florian may share data with trusted partners to help us perform statistical analysis, send you email or postal mail, provide customer support, or arrange for deliveries. All such third parties are prohibited from using your personal information except to provide these services to Ken Florian, and they are required to maintain the confidentiality of your information. Ken Florian does not use or disclose sensitive personal information, such as race, religion, or political affiliations, without your explicit consent. Ken Florian keeps track of the Web sites and pages our customers visit within Ken Florian, in order to determine what Ken Florian services are the most popular. This data is used to deliver customized content and advertising within Ken Florian to customers whose behavior indicates that they are interested in a particular subject area. Ken Florian Web sites will disclose your personal information, without notice, only if required to do so by law or in the good faith belief that such action is necessary to: (a) conform to the edicts of the law or comply with legal process served on Ken Florian or the site; (b) protect and defend the rights or property of Ken Florian; and, (c) act under exigent circumstances to protect the personal safety of users of Ken Florian, or the public.
Chris Florian
Steet Toyota
Susana Florian
DC Arts and Humanities Education Collaborative
Amy Florian
Annapolis Valley Wellness Centre
José Florián
SOFTWARE shop
Baumer Florian
Grammer AG

subset: commoncrawl


text:
Sudbay Chrysler Dodge Jeep
This shop is not RepairPal Certified. Learn more
29 Causeway St
Gloucester, MA 01930 USA
Gloucester, MA 01930 USA
(888) 368-7616
This shop is not yet RepairPal Certified - Learn More
When taking your car to this shop, we recommend you take the time to:
- Ask if their technicians are ASE-certified.
- Request written estimates from multiple shops and compare them with the RepairPal estimator.
- Verify that the shop you select is willing and able to clearly explain the work being performed.
- Ask whether they warranty their repairs (and for how long).
Get an Estimate
Tell us a symptom, service or repair for your car


text:
The average salary of a(n) Office Manager in Wilkesboro, North Carolina is $54,485.
The average hourly rate of a(n) Office Manager in Wilkesboro, North Carolina is $26.19.
The average bonus of a(n) Office Manager in Wilkesboro, North Carolina is $1,727.00.
Office Manager or Retail Manager. WORKING CONDITIONS – Normal working conditions and hours of 8:00 a.m. until. Overnight travel may apply....View job on Indeed.com
Plycem USA, Inc.
Actively participates in Roaring River safety steering committee and the plant safety committee serving as secretary for both, as well as conducts plant safety...View job on Indeed.com
Generally scheduled 39 to 40 hours; Requires morning, afternoon and evening availability any day of the week. With fiscal year 2013 sales of $53.4 billion, Lowe...View job on Indeed.com
Manage workman compensationclaims Provide post-accident drug screentransportation including after hours as needed Work with site management to developand...View job on Indeed.com
Louisiana-Pacific Corporation (LP building Products)
LP Building Products is a leading global manufacturer of engineered wood products. At LP, creating new solutions for building is who we are. Since weView job on Indeed.com


text:
Hurry while stock lasts on sale ugg boots 100% Chance of Savings Better Buck Buys. We sale on sale ugg boots can you make you choose..
Stuart, FL Scripps Interactive Newspapers Group © 2014 The E.
Login Weather Mostly cloudy 82°.
More Weather Home Sections Back Featured Back News Back All News Indian River County St.
s Choice Weather Traffic Jobs Homes Cars Classifieds Weekly Ads Site Web Relevance Date HSSLC: Boots Rita Hart 9:56 AM, Apr 2, 2013 9:56 AM, Apr 2, 2013 st.
lucie county Boots is available for adoption within the Humane Society of St.
Lucie County Rita Hart Show Caption Hide Caption Previous Next FORT PIERCE Gorgeous and calm, healthy and sweet, loving and gentle.
All of this plus much more is the thing that you will get if you adopt me.
on sale ugg boots , 75FsXfyzo2t3WqX1zNNdFLxJDJHxrG6eoY404o1uwAqfbamKvRMVeY3Tm2Z1fzZ5hZladAFbS2J+
Now hunting scrape lines are usually effective as deer may very well revisit them, but no guarantee once it heats up could possibly be days later, or done during darkness.
To spike the chances a little bit more in your own favour, either you work the deer's existing scrape, or develop a mock scrape nearby, giving the buck the sense that a person else is invading his domain.
To earn a mock scrape, ensure you are an aroma free as is feasible, make certain you're wearing rubber boots and gloves.
Rough up an area a number of feet square with all your boots, and place an either buck scent or commercial mock scrape scent down.
Bankruptcy attorney las vegas packages of scent infused time release mock scrape dirt that is used in your mock scrape.
on sale ugg boots
If the rain won't go away, Why not shop today on sale ugg boots,Largest ever study provides evidence that '.
s first recorded elected MP after a sensational victory Andy McSmith 1 Homophobia in microcosm: How a savage gang attack tore one man'.
s life insurance coverage apart 2 True to life American Horror Story: Freak Show.
clowns are terrorising rural California 3 Dear young men: Your existing stereotypes of the it is actually to be a '.
really are a load of rubbish 4 Isis's teenage Austrian poster girl jihadi brides '.
on sale ugg boots
on sale ugg boots Institutions that paid fat bonuses to executives and outrageous advantages to union workers were rescued by taxpayer money after they should have gone bankrupt.
Looking forward to a health care provider will probably be like watching for bread behind the Iron Curtain.
Opt for low income citizen whose income increases by $3 a couple of hours, the minimal wage is nominally a 30% increasing amount of your pay.
For the reason that of your i always want to propose an official day in the united states to celebrate Heterosexual Pride Day.
Having an institution that is definitely "too big to fail", it is "heads, I win" with risky behavior.
Thompson it is who would really do the determiner besides of what's 'right' but the goals permissible even for think.
The faithful in the united states should continue to keep pray for your peace of Jerusalem, and offer their moral and financial support to our bros in Israel.
cheap mens ugg slippers
uggs on sale online
uggs for big kids
cheap short uggs
ugg boots on sale
womens uggs boots on sale


text:
Data VIZ
Visualizing the commit history of the Python scripting language project. Project page: http://vis.cs.ucdavis.edu/~ogawa/codeswarm/ Open source: http://code.google.com/p/codeswarm Music: "Overflight"…+ More details
There is 1 video in this album. Albums make it easy to organize a collection of videos. They can be used to display videos together, or sent to friends as a playlist. You can even arrange the order of videos in each album.
You can add a video to one of your albums or create a new album from the "+Add to…" tab on video pages.
Albums can also be used to show videos on other web sites using Vimeo Widgets.


text:
Judy Carmichael: You Can Play Authentic Stride Piano
Learn How to Play Stride Piano
Judy Carmichael
This book is available for download with iBooks on your Mac or iOS device, and with iTunes on your computer. Books can be read with iBooks on your Mac or iOS device.
Now, you can play stride piano, even if you've never attempted it before. Judy Carmichael, one of the world's top stride performers, will show you how it's done.
You've seen her on television, the Internet, at festivals, and in clubs, and now she'll share her secrets with you! You'll begin with Carmichael's tips and practice drills, which will get your fingers moving across the keyboard more easily than you ever thought possible, followed by her stride renditions of some of the world's most beloved standards.
You'll learn by listening with the 14 embedded audio tracks. These are performances of exactly what's notated on the pages. The fun and challenge of learning stride piano will push your playing to incredible new heights.
* Judy Carmichael's Stride Exercises
* Ain't Misbehavin'
* Ain't She Sweet
* Christopher Columbus
* Honeysuckle Rose
* I Got Rhythm
* I Would Do Anything for You
* Jive at Five
* Lazy River
* Little Rock Getaway
* Love Is Just Around the Corner
* Nagasaki
* Oh! Lady Be Good
* Old Fashioned Love
* Rosetta
- $17.99
- Category: Music
- Published: Apr 01, 2011
- Publisher: Alfred Music
- Seller: Alfred Music
- Print Length: 104 Pages
- Language: English


text:
I never was one for spending a lot on my children's b-day parties, except Skye's sweet 16 (also done with a budget, though). I always bought cheap ice cream and made a homemade cake. I usually used our household plates, cups, spoons and forks, even when we had a dozen people there. I would also … Continue reading
Filed under Tightwad …
Freeze Your Buns off Challenge 2008
I thought that you all would be interested in this challenge. Though you are not expected to turn the heat off entirely, you are expected to turn it down a little. The benefits are less pollution and a bit more money in your pocket. Shannon P.S. Check out the rest of the blog while you … Continue reading


text:
Photos of the Day
•January 8, 2013
A roundup of today's best photos.
A roundup of today's best photos.
donald j: I gave the Clintons a chance in the 1990s I am not scared of change and I know this country needs change I am casting my little vote for Trump, it might not work but after doing it I can honestly say to myself I did not follow the crowd which I do not do that in life. These people have prove to me they are corrupt I don't think anyone is perfect except god but by my standards Trump seems maybe a little more conscientious than the Clinton duo. This country has changed very dramatically over the course of years and I don't think it will ever be the same far too much has happened. That being said respect me or not. I don't care! TRUMP 2016!


text:
Brunswick man charged with shooting father in leg
7/19/16– A Brunswick County man is in jail—charged with shooting his father in the leg. Officers were called to Sanders Forest Drive in Shallotte last Continue Reading
7/19/16– A Brunswick County man is in jail—charged with shooting his father in the leg. Officers were called to Sanders Forest Drive in Shallotte last Continue Reading
7/19/16– A man will spend up to 28 years in prison after pleading guilty to the murder of a man at a homeless encampment in Continue Reading
7/19/16– Tonight–the Wilmington City Council will vote on the purchase of land for more police and firefighter training. The site on Hurst and Princess Place Continue Reading
7/19/16– Two Market Street motels identified as nuisance properties have agreed to make changes. Owners of the Budgetel Inn and Red Carpet Inn agreed to Continue Reading
7/18/16– Wilmington Police are investigating a shooting that left a woman injured. It happened on South 9th Street early yesterday morning. Investigators believe two groups Continue Reading
7/18/16– This week–the Wilmington City Council will make a final decision about a proposed parks bond referendum. The council must decide whether the $38 million Continue Reading
7/18/16– The Brunswick County Sheriff's Office is investigating the armed robbery of a convenience store. This happened Saturday around 5:30 am at the Handee Hugo's Continue Reading
7/18/16– New Hanover County has added a new location for recycling. Drop-offs can now be made at the Castle Hayne Boat Ramp at 6418 Orange Street. The Continue Reading
7/15/16– Investigators believe a charcoal grill is to blame for a fire that damaged four homes in Sunset Beach. Crews were callled to East Main Continue Reading
7/15/16– A lightning strike is suspected as the cause of a fire that damaged a home on Figure Eight Island. Firefighters were called to Clamdigger Continue Reading


text:
Budget Truck Rental
509 Sonderen St
O Fallon, MO 63366
Fax: 636-281-8713
Visit website
Is this your business?
Promote your business through our innovative Marketplace system! It's free to sign up!
Sign up to update your information for free! See options to post blog articles, photos and promote your listing!Log in & claim
Business ID: 26119958 | Universal ID: 18fb7b7a-a0cc-515b-8011-9bfb465d0342


text:
The Canterbury Crusaders juggernaut hit top gear at the right time as they rumbled into the Super 15 finals with a 38-6 demolition of the Coastal Sharks on Saturday.
After a slow start to the season, in which the Crusaders lost their first two matches, the seven-times champions have put themselves in contention for their first title since 2008.
They outscored the Bismarck du Plessis-led Sharks five tries to nil and continued a remarkable record of never having lost any of the 16 play-off matches they have hosted.
Whether they will also have a home final next weekend depends on whether the ACT Brumbies beat the NSW Waratahs in the other semi-final later Saturday. If the Waratahs win, the final will be in Sydney.
The talk before the match was whether the Crusaders would be able to match the feared Sharks forwards, but instead it was the Sharks who lost lineouts, scrums and eventually conceded a try from a lineout drive.
"We knew that's where the game was going to be won or lost," Crusaders captain Kieran Read said.
"We started really well and were able to put a lot of pressure on them. We played at a pretty high tempo early which probably set the scene."
No South African side has ever won a play-off match in New Zealand and the Sharks never looked like changing that record, leaving Du Plessis distraught as not only was his pack pounded but the backs had a nightmare time from well directed kicks by Israel Dagg.
"It was absolutely, extremely disappointing. Everything we worked on in the last two weeks -- we couldn't field the high balls, we didn't play in the right areas -- I'm extremely disappointed in our performance," he said.
After Dan Carter put the Crusaders on the board with a second-minute penalty, Read scored the only try of the first half when the Crusaders pounced on a wayward clearing kick by Paul Jordaan.
Nemani Nadolo ran the ball straight back at the Sharks and world player-of-the-year Read finished off the move when he swatted aside an attempted Jordaan tackle to score under the posts.
Carter landed the conversion and two further penalties while Patrick Lambie landed two penalties for the Sharks to have the Crusaders ahead 16-6 at half-time.
In the second half the Crusaders ran the heavier Sharks pack to a standstill as they produced a further four tries to Nemani Nadolo, Willi Heinz, Johnny McNicholl and Matt Todd.
Heinz try came when the Crusaders demolished a Sharks' defensive scrum and Todd scored when the Crusaders used the Sharks ace move of a lineout drive.


text:
ATLANTA More than 2,000 activists chanting and toting banners joined a march and rally on Friday to oppose the execution of Georgia death row inmate Troy Davis, convicted of the 1989 murder of a Savannah police officer.
Georgia's Board of Pardons and Paroles is slated to meet Monday to consider whether to stop Davis' execution by lethal injection, which is scheduled for next Wednesday.
"I pray that this rally will have an impact on Pardons and Paroles," said marcher Solana Plaines, from Savannah. "I hope they will do the right thing."
Davis' supporters say there is no physical evidence linking him to the crime and that key witnesses in his trial have since recanted their testimony.
"You just can't give up hope," said Ellen Kubica, who traveled from her home in Germany to attend Friday's event, which featured banners reading: "Too much doubt to execute.
Davis' supporters marched from downtown Atlanta to Ebenezer Baptist Church on Auburn Avenue for a rally.
Martin Luther King III, son of the late civil rights leader Martin Luther King Jr., joined the march. His father and grandfather were pastors at Ebenezer.
Ben Jealous, president of the National Association for the Advancement of Colored People, and the Rev. Al Sharpton, a civil rights activist and television show host, also attended.
"The only thing left to decide is whether you have the courage to do the right thing," Sharpton said, referring to the Georgia parole board.
"It is blatantly clear that there is no reason for this man to be sitting on death row," he added.
In a rare move, the U.S. Supreme Court in August 2009 ordered a new hearing for Davis to assess what he said was new evidence showing his innocence.
The justices transferred the case to a U.S. District Court in Georgia for a hearing and determination of his claims that new witnesses will clearly establish his innocence. A year later, the judge, William T. Moore Jr., rejected Davis' claims of innocence.
On Thursday, supporters of the condemned man delivered petitions bearing more than 600,000 names to the parole board.
In an opinion column published on Thursday in the Atlanta Journal Constitution newspaper, former FBI Director William Sessions called for Davis' sentence to be commuted to life in prison, saying the case was "permeated in doubt."
In an opposing column written in late 2008 and republished on Thursday, Spencer Lawton, the district attorney who prosecuted Davis, said the condemned man had a fair trial.
The claim that seven witnesses at the trial had subsequently recanted their testimony was "not believable," Lawton wrote.
Lawton said the witnesses were all cross-examined by defense attorneys during Davis' trial and denied that they had been coerced by police.
(Editing by Tim Gaynor and Peter Bohan)
Trending On Reuters
Patents & Entrepreneurial Universities
Measuring and evaluating academic innovation


text:
Anyone over a certain age automatically feels nostalgia at the sight of the fabled logo for A&P supermarkets. But behind the patina of yesteryear simplicity is a complex story of the one-time largest retailer in the world, forerunner of all the big-box enterprises that dominate commerce today. Marc Levinson tells the saga of A&P's birth, rise, dominance, and decline under the assault of many small legal woes.
Long List
The Great A&P
Tags: BUSINESS


text:
Top Definition
a girl with ginger hair who fails a lot and sits in a bed of ginger hair. they are known to laugh at computer screens and fail a lot.
she is such an ehale
de bob the ceiling fan 04 Martie 2012
Trending Now
E-mailurile sunt trimise de la email@example.com. Nu-ți vom trimite mesaje nedorite.×


text:
Islanders forward Kyle Okposo will not play for Team USA in the 2014 Olympic Games in Sochi, Russia.
Okposo was not among the 25 players named when the U.S. Men's Hockey team was announced Wednesday evening following the Maple Leafs' 3-2 shootout win over the Red Wings in the 2014 Winter Classic in Ann Arbor, Mich.
Kyle Okposo
New York Islanders
Okposo, who was also passed over in the selection of the 2010 Olympic team that earned silver in Vancouver, was considered to be a bubble player among the elite crop of forwards. According to ESPN.com's Scott Burnside's exclusive story, which details the painstaking process by which the team was constructed, Okposo did not garner much consideration:
Like [goaltender Ben] Bishop, [GM David] Poile notes that Jason Pominville and Kyle Okposo are having great seasons but haven't been given much, if any, consideration.
Still, the belief is that neither Pominville nor Okposo is built for the big ice, and their names will rarely, if ever, be heard in relation to making the team going forward.
So, the management group clearly did not feel Okposo was a strong candidate on the bigger ice surface. And it could not have helped matters that he is on a floundering Islanders squad that has had an abysmal first half.
Still, the St. Paul, Minn., native is producing at almost a point-per-game pace, with 15 goals and 25 assists in 41 games for the Islanders this season. He is second in scoring among American-born NHL forwards, trailing only Chicago's Patrick Kane, who has 23 goals and 53 points.
Okposo was not the only notable name left off the list. Defenseman Keith Yandle and goal-scorer Bobby Ryan were both snubbed as well.


text:
"The only person you are DESTINED to become is the person you DECIDE to be"
- from Mateusz M
Change the changeable, accept the unchangeable, and remove yourself from the unacceptable.
- Denis Waitley
If you change the way you look at things, the things you look at change.
- Dr Wayne Dyer
Do your work with your whole heart, and you will succeed - there's so little competition.
- Elbert Hubbard


text:
Manufacturing Area
Category: HDMI cable assemblies
MHL cable Micro-USB to VGA+Stero audio+USB cable Mobile High-Definition Link (MHL) is a kind of video standard port for connecting portable electronic devices and consumer electronics. Features: ...Keyword : MHL CABLE | usb to vga cable | usb cable | usb to audio cable | usb yga cable
Specifications high end of hdmi cable 1.All materials conform to RoHs standard 2.DigitalTransfers at rates up to 10.2 Gbps 3.High purity Oxygen Free Copp 4.OEM · High speed HDMI cable wi ...Keyword : hdmi cable
1.VGA + stereo to HDMI cable for TV, computer video and stereo application. 2.Customized products 3.Small to large quantitiesKeyword : HDMI Cable | vga cable | HDMI VGA CABLE
Category: Audio and Video Receivers
Features: 1) 5.8GHz Wireless A/V Sender with 8 selectable channels 2) 433.92MHz infrared radio-control return feature 3) Antenna(5.8GHz) is embedded into housing 4) Compatible with camcorder a ...Keyword : Audio and Video Transmission System | Audio and Video Sender
Category: Computer Cables and Cable Assemblies
Connects any DVD, TV/HDTV, VCR's, CD players, receivers and other home theater devices with digital audio coax connector. This premium cable has braid shielding with translucent smoke-colored jacket t ...Keyword : Av Cable | Communication Cable | Rca Cable | Economy Rca Cable | Audio Cable
Category: Audio Mixers & Processors
Soundcraft Mixer 32Ch 32 Mic/Line 2 stereo 4-Bus The GB2 is the latest addition to the Soundcraft GB Series, featuring 4 group busses configured as 2 stereo subgroups and an integral 6 x 2 matrix. ...Keyword : Soundcraft Mixer 32Ch 32 Mic/Line 2 Stereo 4-Bus
Category: Data Cable
1.Provides both digital video and audio in one cable 2.Provides up to 1,080p resolution with digital audio 3.Supports DisplayPort connector 4.Supports video and up to 10.8Gpbs audio bandwidth ...Keyword : DP Cable | display port cable
Category: Audio, Video and TV Systems
Specification: * Portable mini digital speaker * Popular and stylish in design * Compact and user-friendly * Good sound quality lets you indulge in your favorite music * You can also listen to F ...Keyword : stereo speaker
Category: Audio Systems
1.Nylon net fiber optical 2.Factory directly sales 3.Small order accept 4.Customized length, color 5.reply within 12 hours Optical fiber cable,toslink plug to toslink plug Charac ...Keyword : audio cable | audio toslink cable | toslink optical cable | optical fober cable
1.3 to 5M Displayport Active cable 2.Provides both digital video and audio in one cable 3.Provides up to 1,080p resolution with digital audio 4.Supports DisplayPort connector 5.Supports video ...
1.ETC Certified 2.Excellent High Frequency Performance 3.Provides both digital video and audio in one cable 4.Provides up to 1,080p resolution with digital audio 5.Supports DisplayPort connecto ...Keyword : Displayport cable
TL audio M1-F Tubetracker 12-Channel Tube Firewire Mixer The TL audio M1-F Tubetracker 12-Channel Tube Firewire Mixer is ideal for the home and project studio as well as broadcast and recording appli ...Keyword : TL Audio M1-F Tubetracker 12-Channel Tube Firewire
Category: A/V cable assemblies
Speaker wire is used to make the electrical connection between loudspeakers and audio amplifiers.
TL audio M4 16-Channel Tube Mixing Console The TL audio M4 Tube Console is the perfect solution for the modern day studio. The M4 offers you the quality of premiere TL audio outboard sound, in a des ...Keyword : TL Audio M4 16-Channel Tube Mixing Console
This USB 3.1 Type C to HDMI Converter cable can connect your new MacBook/ChromeBook ect devices with Type C port to a big screen HDTVs or projectors which with HDMI port. Simply connect the adapter to ...Keyword : usb3.1 type c to hdmi | type c converter
1.3 RCA Composite Video + audio cable 2. Get composite RCA video and audio connectors all in one cable. 3. AVA gold-plated Composite RCA Video and audio cable is specifically designed to provide s ...Keyword : AV CABLE | High End RCA Cable | AVA CABLE
Category: Cable TV Products
The principle of RCA cable FA1739 is 2*RCA plug to 2*RCA plug cable. The rca audio cable is a part of AV cable which has a competive price and high quality. 1. Wire: OD4*8mm, bare copper conductor ...Keyword : rca to rca cable | video cable to rca
Category: Coaxial cable assemblies
TV cable, CATV Coaxial cable, AV cable 1. Coaxial cable for CATV cable A: With 9.5 TV plugs or 9.5 TV plugs(angle) B: With 9.5 TV jack or 9.5 TV jack (angle) 2. Coaxial cable for TV ANTENNA, A: ...Keyword : coaxial cable | catv cable | audio cable | tv cable | AV cable
Category: Car Audio Equipment
Radio/Mp3 2 RCA audio-circuit Etr radio/SD card/USB 4*45W Power output Electronics clock Electronics EQ LCD Color Display Last position memory remote control key light
hdmi 1.3v cable with gold connector 1.HDMI to HDMI cable-high speed hdmi cable 2.Golden-plated or Nickel-plated Connector 3.30AWG,28AWG Tin connector 4.One piece in PE bag Keyword : high speed cable | hdmi cable 1.3v | cable | 1.3v cable | audio cable