Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients.

BACKGROUND: We sought to assess the influence of the clinical introduction of new radiotherapy technologies on glioblastoma patients' outcomes. METHODS: Newly diagnosed glioblastoma patients treated with 60 Gy and temozolomide (2005-2014) were analyzed. The patients' GTV and CTV were defined based on MR (n = 521) or FET-PET/MR (n = 190), and were treated using conformal radiotherapy (CRT, n = 159) or image-guided volumetric modulated arc therapy with hippocampal sparing (IG-VMAT, n = 362). Progression-free survival (PFS) was assessed using the McDonald criteria. Associations between clinical data, dosimetry data, treatment technology, for PFS and overall survival (OS) were explored. RESULTS: The PFS (7 months) and OS (15 months) were unaffected by CRT, IG-VMAT and FET-PET technology. Mean brain dose was correlated with tumor volume, and was lower for IG-VMAT vs. CRT (p < 0.001). Larger mean brain dose was associated with inferior PFS (univariate/multivariate Cox models, p < 0.001) and OS (univariate, p < 0.001). Multivariate Cox models revealed association of larger mean brainstem dose (p < 0.001), BTV (p = 0.045), steroid use at baseline (p = 0.003), age (p = 0.019) and MGMT status (p = 0.022) with lower OS. CONCLUSIONS: Introduction of hippocampal-sparing IG-VMAT technology appeared to be safe, and may have reduced toxicity and cognitive impairment. Larger mean brain dose was strongly associated with inferior PFS and OS.

Toxicity and efficacy of lomustine and bevacizumab in recurrent glioblastoma patients.

The combination of lomustine and bevacizumab is a commonly used salvage treatment for recurrent glioblastoma (GBM). We investigated the toxicity and efficacy of lomustine plus bevacizumab (lom-bev) in a community-based patient cohort and made a comparison to another frequently used combination therapy consisting of irinotecan plus bevacizumab (iri-bev). Seventy patients with recurrent GBM were treated with lomustine 90 mg/m2 every 6 weeks and bevacizumab 10 mg/kg every 2 weeks. Toxicity was registered and compared to the toxicity observed in 219 recurrent GBM patients who had previously been treated with irinotecan 125 mg/m2 and bevacizumab 10 mg/kg every 2 weeks. The response rate was 37.1% for lom-bev and 30.1% for iri-bev. Median progression-free survival (PFS) was 23 weeks for lom-bev and 21 weeks for iri-bev (p = 0.9). Overall survival (OS) was 37 weeks for lom-bev and 32 weeks for iri-bev (p = 0.5). Lom-bev caused a significantly higher frequency of thrombocytopenia (11.4% grade 3-4) compared to iri-bev (3.5% grade 3-4). Iri-bev patients had more gastrointestinal toxicity with regard to nausea, vomiting, diarrhea, constipation and stomatitis. Within the limitations of the study lom-bev is a well-tolerated treatment for recurrent GBM, although hematological toxicity may be a dose limiting factor. No significant differences between lom-bev and iri-bev were observed with regard to PFS or OS. The differences in toxicity profiles between lom-bev and iri-bev could guide treatment decision in recurrent GBM therapy as efficacy is equal and no predictive factors for efficacy exist.

Pontiac fever at a sewage treatment plant in the food industry.

BACKGROUND AND OBJECTIVES: During a hot and humid summer period workers became ill with fever and flu-like symptoms after repairing a decanter for sludge concentration at a sewage treatment plant. The work took place over a period of 10 days in a small closed room, while another decanter was in operation and was consequently emitting aerosol to the environment, to which the workers were exposed. The aim of this study was to determine the cause of this outbreak of febrile illness so that additional cases could be prevented. METHODS: All 5 patients were seen and examined in the Department of Occupational Medicine. Furthermore 2 of the workers had recurrent illness and were examined during hospitalization. As Pontiac fever (nonpneumonic legionellosis) was suspected, antibodies to legionellae were measured in blood samples. After positive antibody titers to Legionella pneumophila were found, samples of the sludge were collected for legionellae culture. RESULTS AND CONCLUSIONS: The clinical picture agreed with that described for Pontiac fever, and positive antibody titers to L. pneumophila serogroup 1 were found in blood from all 5 patients. L. pneumophila serogroup 1 was cultured in high amounts from sludge from the decanter. It was concluded that the fever was caused by L. pneumophila emitted to the environment by the uncovered decanter. Procedures for preventing new cases were established.

Secular trends in serum cholesterol, high density lipoproteins and triglycerides 1964-1987.

Total mortality from cardiovascular disease in Denmark has decreased over the last 20 years for women and the last ten years for men. The possible role of simultaneous changes in serum total cholesterol has been investigated. Secular trends in serum cholesterol, high density lipoprotein cholesterol, and triglycerides, 1964-1987, are presented on the basis of four studies of 30-, 40-, 50- and 60-year-old men and women, some 8737 subjects in all. A significant decrease of 1% per year in total serum cholesterol (p less than 0.05) in both sexes and in all age groups up to 1982 was detected followed by a subsequent stabilization, 1982-1987. The decrease is not a result of methodological bias. The impact of storage at -20 degrees C for 13-24 months compared to immediate analysis of sera was studied as well as differences in analysis methods over time. The fall in population cholesterol levels might be associated with changes in polyunsaturated/saturated fat (P/S) ratio rather than total fat content of the diet, but other lifestyle changes have taken place as well.

Extraction from bone powder: collagen, calcium and phosphate.

A method for the estimation of the extraction rate is shown and exemplified by preliminary data from extraction of collagen, calcium and phosphate with EDTA and neutral salt solution. The initial extraction rate was high, even with neutral salt solution, and optimal extraction efficiency was obtained within 24 h.

Survival of microorganisms and helminth eggs in green pills and cobs processed from a green crop irrigated with sewage.

A grass crop which was contaminated with domestic sewage was dried in a hot air drying plant in order to observe the effect of the drying on pathogenic bacteria, virus and parasite eggs. The investigation showed, that pathogenic bacteria and virus were reduced with a factor 10(5)--10(6), and that parasite eggs were reduced with at least a factor 200, which is sufficient to secure that grasis irrigated with sewage and pre-served with hot air drying is used without hygienic risks.

Risk of infection from heavily contaminated air.

In a factory processing shea nuts the dust concentrations were found to be up to 145 mg/m3 [80% respirable (1--5 micrometer)]. Bacterial examination of the dust revealed that under the worst conditions observed a worker might inhale 350,000 bacteria per 8 h. Of these, 3,000 were Ps. aeruginosa and 1,500 Salmonella spp. of nine different types. The possible health effects of these findings are discussed.

A comparison of tetrathionate broth and Rappaport's medium as enrichment media for Salmonella.

Tetrathionate broth (Müller-Kauffmann) and Rappaport's medium were compared in isolating Salmonella from meat- and bone-meal, receiving waters, sewage, and sludge. The results (Table I) show no difference in isolations from meat- and bone-meal, receiving waters, or sewage, while in studying sludge isolations were significantly less frequent from Rappaport's medium than from tetrathionate broth. The Salmonella positive plates, however, were easier to read when inoculated from Rappaport's medium than from tetrathionate broth.

A shortcut method for estimation of Escherichia coli in Sewage and receiving water.

A simplified method not yet widespread in Scandinavia for the assessment of E. coli in sewage and recipients with McConkey broth for 24 hours at 44 degrees C is recommended. 87 pairs of samples were examined at 37 degrees C and later at 44 degrees C, and directly at 44 degrees C. Also the reduction of the incubation time from 48 to 24 hours was studied. Direct incubation gave a loss of half a tube per sample, while shortening of the incubation period from 48 to 24 hours gave a smaller loss. The proposed alteration of the procedure for the examination of sewage and recipients means a slight loss of precision but this is more than compensated for by the possibility of examining more samples. The survey of the recipients can therefore be better and the control more effective.

Salmonella types isolated from the gulf of Aarhus compared with types from infected human beings, animals, and feed products in Denmark.

A 2-year examination for Salmonella was conducted in the gulf of Aarhus, which receives waste water from local industries and from about 100,000 inhabitants. An approximately rectilinear relationship is shown between the most probable number of Escherichia coli and species of Salmonella. Salmonella species can be demonstrated with the same frequency in inlets and outlets of the treatment plants. Data on the distribution of Salmonella types in the gulf of Aarhus and in Oeresound outside Copenhagen (1 million inhabitants) in 1966 and 1968 and the distribution in man, animals, and feeding stuff during the period 1960 to 1968 in Denmark as a whole are shown. This indicates that the classical chain of infection (feed stuff-animals-food-man) is without importance in Denmark, and that a great nlumber of the human cases may be due to increasing communication, because severa of the demonstrated types have been found neither in feed stuff nor in animals in this period. We suggest that E. coli counts, currently used in examination of waters receiving effluents of streams and sewage treatment plants, should be supplemented at intervals with qualitative Salmonella examinations.