Hypofractionated Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost and Simultaneous Integrated Protection in Pancreatic Ductal Adenocarcinoma.

AIMS: To evaluate the safety and feasibility of stereotactic body radiation therapy (SBRT) with simultaneous integrated boost (SIB) and simultaneous integrated protection (SIP) in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. MATERIALS AND METHODS: Patients receiving SBRT following induction chemotherapy from January 2017 to December 2018 were included in this observational analysis. SBRT was delivered in five consecutive daily fractions by administering 30 Gy to the planning target volume while simultaneously delivering a 50 Gy SIB to the tumour-vessel interface. SIP was created by lowering the dose to 25 Gy on the overlap area between the planning target volume and the planning organ at risk volume. The primary end point was acute and late gastrointestinal grade ≥3 toxicity. Secondary end points were freedom from local progression, overall survival and progression-free survival (PFS). RESULTS: Fifty-nine consecutive patients (27 borderline resectable and 32 locally advanced) were included. Fifty-eight patients (98.3%) completed the SBRT planned treatment and 35 patients (59.4%) received surgical resection following SBRT. No acute or late grade ≥3 SBRT-related adverse events were observed. The median follow-up time was 15.1 months in the overall cohort and 18.1 months in censored patients. One- and 2-year freedom from local progression rates were 85% and 80% versus 79.7% and 60.6% in resected and unresected patients, respectively (P = 0.33). The median overall survival and PFS were 30.2 months and 19 months from diagnosis and 19.1 months and 10.7 months from SBRT in the entire cohort. Resected patients had improved 2-year overall survival rates (72.5% versus 49%, P = 0.012) and median PFS (13 months versus 5 months; P < 0.001) relative to unresected patients. There was no survival difference between borderline resectable and locally advanced patients. CONCLUSIONS: SBRT with SIB/SIP had an excellent toxicity profile and could be administered safely on pancreatic ductal adenocarcinoma patients, even in a total neoadjuvant setting.

Serotonin 1A receptor-mediated signaling through ERK and PKCα is essential for normal synaptogenesis in neonatal mouse hippocampus.

Aberrant expression of the presynaptic serotonin 1A receptor (5-HT(1A)-R) because of a polymorphism in the 5-HT(1A)-R gene is associated with severe depression in human, whereas its absence up to postnatal day 21 (P21) in the forebrain of mice results in heightened anxiety in adulthood. These observations collectively indicate that the 5-HT(1A)-R has a crucial role in brain development. To understand the mechanistic underpinnings of this phenomenon, we used organotypic slice cultures of hippocampi from C57BL6 mice (C57) at P15, which coincides with the peak of neonatal synaptogenesis. Stimulation of the hippocampal 5-HT(1A)-R caused a dramatic increase in PSD95 expression and dendritic spine and synapse formation through sequential activation of the mitogen-activated protein kinase isozymes Erk1/2 and protein kinase C (PKC). Intrahippocampal infusion of 5-HT(1A)-R agonists and signaling inhibitors at P15 revealed that the same pathway through PKCα augments PSD95 expression and synaptogenesis in vivo in 24 h in both C57 as well as Swiss Webster mice. Furthermore, intrahippocampal infusion of the antidepressant fluoxetine, a serotonin reuptake inhibitor, also augmented PSD95 expression and synaptogenesis through the same pathway. This increased synaptogenesis was observed even 5 days after treatment. Finally, compared with the wild type, the 5-HT(1A)-R(-/-) mice harbor significantly less synapses in the hippocampus, but infusion of the PKC-stimulator and Alzheimer drug bryostatin into the 5-HT(1A)-R(-/-) mice to bypass the non-existent 5-HT(1A)-R boosted PSD95 expression and synaptogenesis. The elucidated signaling cascade explains how 5-HT(1A)-R regulates hippocampal sculpting and function, which may determine the affective phenotype of an adult.

Radiation dose saving through the use of cone-beam CT in hearing-impaired patients.

PURPOSE: Bionic ear implants provide a solution for deafness. Patients treated with these hearing devices are often children who require close follow-up with frequent functional and radiological examinations; in particular, multislice computed tomography (MSCT). Dental volumetric cone-beam CT (CBCT) has been reported as a reliable technique for acquiring images of the temporal bone while delivering low radiation doses and containing costs. The aim of this study was to assess, in terms of radiation dose and image quality, the possibility of using CBCT as an alternative to MSCT in patients with bionic ear implants. MATERIALS AND METHODS: One hundred patients (mean age 26 years, range 7-43) with Vibrant SoundBridge implants on the round window underwent follow-up: 85 with CBCT and 15 with MSCT. We measured the average tissue-absorbed doses during both MSCT and CBCT scans. Each scan was focused on the temporal bone with the smallest field of view and a low-dose protocol. In order to estimate image quality, we obtained data about slice thickness, high- and low-contrast resolution, uniformity and noise by using an AAPM CT performance phantom. RESULTS: Although the CBCT images were qualitatively inferior to those of MSCT, they were sufficiently diagnostic to allow evaluation of the position of the implants. The effective dose of MSCT was almost three times higher than that of CBCT. CONCLUSIONS: Owing to low radiation dose and sufficient image quality, CBCT could be considered an adequate technique for postoperative imaging and follow-up of patients with bionic ear implants.