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DOE OSTI2026

Peridynamic modeling of cementitious materials for nuclear waste management

Radioactive and hazardous waste generated from fuel processing plants, nuclear reactors, and hospitals, requires effective management strategies. Cementitious materials are widely applied for these needs, serving as structural materials, reactive barriers, or waste forms. In these applications cracking poses a significant risk to performance, driven by inconsistent shrinkage of the components and the varying strength and permeability of their interfaces. Traditional modeling approaches face challenges in representing the complex fracture behavior of cementitious materials due to the reliance on spatial derivatives and difficulties with mesh generation. Here, to overcome these limitations, we employ peridynamics, a novel continuum mechanics formulation that uses integrals to describe mechanical equilibrium, avoiding discontinuities associated with traditional methods. Through incorporation of a bi-linear softening model and quasistatics, an experimentally validated model for Portland cement concrete samples was created. Mechanical parameters, including compressive strength and elastic modulus were validated and variation due to aggregate packing was evaluated. Additionally, sensitivity analysis of the peridynamic parameters to the bulk material properties was established. The results lay the groundwork for evaluating the impact of unique conditions of cementitious waste forms that can be assessed to improve the reliability of waste management strategies.

Aggregates↗
DOE OSTI2017

Healthcare Building Sustainability Assessment tool - Sustainable Effective Design criteria in the Portuguese context

Tools and methods to improve current practices and quality in the healthcare building sector are necessary to support decision-making at different building life cycle phases. Furthermore, Healthcare Building Sustainability Assessment (HBSA) Methods are based on criteria organised into different levels, such as categories and indicators. These criteria highlight aspects of significant importance when designing and operating a sustainable healthcare building. To bring more objectivity to the sustainability assessments, the standardisation bodies (CEN and ISO) proposed core indicators that should be used in the evaluation of the environmental, societal and economic performances of buildings. Nevertheless, relying on state of the art analysis, it is possible to conclude that there are aspects of major importance for the operation of healthcare buildings that are not considered in the HBSA methods. Thus, the aim of this paper is to discuss the context of sustainability assessment methods in the field of healthcare buildings and to present a proposal for the incorporation of Sustainable-Effective Design (SED) criteria in a new HBSA method. The used research method is innovative since in the development of the list of sustainability criteria it considers the opinion of main healthcare buildings' stakeholders, the existing healthcare assessment methods and the ISO and CEN standardisation works in the field of the methods to assess the sustainability of construction works. As a result, the proposed method is composed of fifty-two sustainability indicators that cover the different dimensions of the sustainability concept to support decision making during the design of a new or retrofitted healthcare building in urban areas. - Highlights: •A new system to assess the sustainability of healthcare buildings is presented. •We propose a method to develop the list of sustainability indicators for hospitals. •We propose a new concept – Sustainable-Effective Design (SED). •The system is adapted to the Portuguese building sector sustainability contexts. •The approach can be used to develop similar systems in other countries.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2021

Using non-invasive MEMS pressure sensors for measuring building envelope air leakage

Micro-electromechanical systems (MEMS)-based sensors have seen significant improvements in accuracy and cost over the past several years, and due to the need for altitude sensing in unmanned aerial vehicles and wearable technologies, absolute pressure sensors have shown the most dramatic improvements. This paper investigates applications of MEMS sensors in commercial buildings, including pairing two absolute pressure sensors to determine differential pressures between different locations in and around buildings. Differential pressure measurements are commonly made in commercial buildings for a number of applications, including static pressure measurements for variable-speed supply fan control, air balancing in hospitals, and for envelope and duct air leakage testing. This paper focuses specifically on envelope air-leakage testing applications of these sensors. The use of continuous pressure measurements in addition to one-time non-intrusive outdoor airflow measurements of rooftop packaged units is investigated. A comparison with standardized leakage testing indicated that continuous measurements with MEMS pressure-sensors were able to estimate envelope leakage to within 3–16% of the standardized test result. In addition, the magnitude and stability of differential pressure differences that can be resolved with absolute pressure sensors are also investigated in the laboratory and the field. Results show that the sensors can be effectively used for pressures seen in low rise buildings with rooftop units.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2021

Opportunities for installed combined heat and power (CHP) to increase grid flexibility in the U.S.

Increasing use of renewable energy requires sufficient grid flexibility to address uncertainty and variability in electricity generation. Previous studies suggest that combined heat and power (CHP) systems may support grid flexibility but they do not consider operating hours. In this paper, we used CHP operating data and determined annual and monthly availability of the installed CHP capacity from various sectors (e.g., utility, independent power producer, commercial, and industrial) in all seven U.S. independent system operators (ISOs) and regional transmission organizations (RTOs). Also, we estimated hourly CHP availability installed in five facility types (i.e., hospitals, universities, hotels, offices, and manufacturing) in the state of New York. The results show that regardless of ISO/RTO, sector, or season, more than 40% of the installed CHP capacity (0.7–8.7 GW) was not fully utilized in 2019; the results are similar for 2018. This available CHP capacity accounted for up to 9% of the ISO/RTO's peak electric demand, which may yield cost savings up to $16 billion by avoiding installation costs of new natural gas combustion or combined-cycle turbines. To exploit the available CHP capacity to enhance grid flexibility, we recommend different policy implications including flexible contract lengths between CHP owners and grid operators, improved market designs, and simplified interconnection standards.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2022

The impacts of COVID-19 on clean energy labor markets: Evidence from multifaceted analysis of public health interventions and COVID-health factors

COVID-19 pandemic has affected clean energy labor market. Using real-time job vacancy data, this study analyzes the impacts of the pandemic on the U.S. clean energy labor market in 2020, including biomass, energy efficiency (EE), electric vehicle (EV), power/microgrid, solar, and wind industries. This study identifies how COVID-health factors and public health interventions influence clean energy job availability during the early COVID pandemic. Overall, California had the most energy jobs and experienced a significant decrease in April 2020. EV and solar had the highest percentages of job vacancies during the pandemic in general. Still, lockdowns had the most severe influence on EE and wind jobs. Stay-at-home orders negatively affected clean energy job vacancies in biomass, EV, power/microgrid, and wind. Social-gathering restrictions, however, did not have much influence. Increased COVID tests at the state level had the strongest and most positive influence on clean energy job postings, indicating the importance of a state's ability to manage public health infrastructure or crisis issues. COVID hospitalizations negatively influenced the job vacancies in biomass and wind but did not affect the other four sectors; conversely, as COVID death numbers increased, the number of jobs in biomass, EV, power grid, solar, and wind decreased, but not in EE jobs.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2014

Cashew nut roasting: Chemical characterization of particulate matter and genotocixity analysis

Background: Particulate matter (PM) is potentially harmful to health and related to genotoxic events, an increase in the number of hospitalizations and mortality from respiratory and cardiovascular diseases. The present study conducted the first characterization of elemental composition and polycyclic aromatic hydrocarbon (PAH) analysis of PM, as well as the biomonitoring of genotoxic activity associated to artisanal cashew nut roasting, an important economic and social activity worldwide. Methods: The levels of PM{sub 2.5} and black carbon were also measured by gravimetric analysis and light reflectance. The elemental composition was determined using X-ray fluorescence spectrometry and PAH analysis was carried out by gas chromatography–mass spectrometry. Genotoxic activity was measured by the Tradescantia pallida micronucleus bioassay (Trad-MCN). Other biomarkers of DNA damage, such as nucleoplasmic bridges and nuclear fragments, were also quantified. Results: The mean amount of PM{sub 2.5} accumulated in the filters (January 2124.2 µg/m{sup 3}; May 1022.2 µg/m{sup 3}; September 1291.9 µg/m{sup 3}), black carbon (January 363.6 µg/m{sup 3}; May 70 µg/m{sup 3}; September 69.4 µg/m{sup 3}) and concentrations of Al, Si, P, S, Cl, K, Ca, Ti, Cr, Mn, Fe, Ni, Cu, Zn, Se, Br and Pb were significantly higher than the non-exposed area. Biomass burning tracers K, Cl, and S were the major inorganic compounds found. Benzo[k]fluoranthene, indene[1,2,3-c,d]pyrene, benzo[ghi]perylene, phenanthrene and benzo[b]fluoranthene were the most abundant PAHs. Mean benzo[a]pyrene-equivalent carcinogenic power values showed a significant cancer risk. The Trad-MCN bioassay revealed an increase in micronucleus frequency, 2–7 times higher than the negative control and significantly higher in all the months analyzed, possibly related to the mutagenic PAHs found. Conclusions: This study demonstrated that artisanal cashew nut roasting is a serious occupational problem, with harmful effects on workers' health. Those involved in this activity are exposed to higher PM{sub 2.5} concentrations and to 12 PAHs considered potentially mutagenic and/or carcinogenic. The Trad-MCN with T. pallida was sensitive and efficient in evaluating the genotoxicity of the components and other nuclear alterations may be used as effective biomarkers of DNA damage. - Highlights: • The cashew nut roasting generated high concentrations of particulate matter fine. • The biomass burning tracers K, Cl, S were the major inorganic compounds found. • It was identified 12 PAHs considered to be potentially mutagenic and/or carcinogenic. • The genotoxic potential of this activity was confirmed by the Trad MCN assay. • This activity is a serious occupational problem with harmful effects to health workers.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2017

Placental biomarkers of PAH exposure and glutathione-S-transferase biotransformation enzymes in an obstetric population from Tijuana, Baja California, Mexico

Environmental exposures along the US-Mexico border have the potential to adversely affect the maternal-fetal environment. The purpose of this study was to assess placental biomarkers of environmental exposures in an obstetric population at the California-Baja California border in relation to detoxifying enzymes in the placenta and nutritional status. This study was conducted on consenting, full-term, obstetric patients (n=54), delivering in a hospital in Tijuana, Baja California (BC), Mexico. Placental polyaromatic hydrocarbon (PAH)-DNA adducts were measured in addition to placental glutathione-S-transferase (GST) activity and genotype, maternal serum folate, and maternal and umbilical cord blood lead and cadmium levels. A questionnaire was administered to the mothers to determine maternal occupation in a maquiladora, other exposures, and obstetric indicators. In univariate analysis, maternal serum folate levels were inversely correlated with total PAH-DNA adducts (rho=−0.375, p=0.007); adduct #1 (rho=−0.388, p=0.005); and adduct #3 (rho =−0.430, p=0.002). Maternal lead levels were significantly positively correlated with cord blood lead levels (rho=0.512, p<0.001). Cadmium levels were generally very low but significantly higher in mothers exposed to environmental tobacco smoke (ETS) (either at work or at home, n=10). In multivariate analysis, only maternal serum folate levels remained as a significant negative predictor of total DNA-PAH adducts levels in placenta. These findings affirm that placental tissue is a valuable and readily available source of human tissue for biomonitoring; and indicate that further study of the role of nutrition in detoxification and mitigation of environmental exposures in pregnant women is warranted. - Highlights: • Maternal-fetal environment susceptible to toxic exposures at US-Mexico border. • Lower serum folate was correlated with higher PAH-DNA adduct levels at birth. • Placental DNA adducts in GST mu (-) cord blood were higher than GST(+) genotype. • Blood lead levels in Mexican women were higher than reported to NHANES. • Cadmium levels in mothers exposed to ETS correlated with total PAH-DNA adducts.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Urinary concentrations of cyclohexane-1,2-dicarboxylic acid monohydroxy isononyl ester, a metabolite of the non-phthalate plasticizer di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH), and markers of ovarian response among women attending a fertility center

Di(isononyl)cyclohexane-1,2-dicarboxylate (DINCH), a non-phthalate plasticizer, was introduced commercially in 2002 as an alternative to ortho-phthalate esters because of its favorable toxicological profile. However, the potential health effects from DINCH exposure remain largely unknown. We explored the associations between urinary concentrations of metabolites of DINCH on markers of ovarian response among women undergoing in vitro fertilization (IVF) treatments. Between 2011 and 2015, 113 women enrolled a prospective cohort study at the Massachusetts General Hospital Fertility Center and provided up to two urine samples prior to oocyte retrieval. The urinary concentrations of two DINCH metabolites, cyclohexane-1,2-dicarboxylic acid monohydroxy isononyl ester (MHiNCH) and cyclohexane-1,2-dicarboxylic acid monocarboxyisooctyl ester (MCOCH), were quantified by isotope dilution tandem mass spectrometry. We used generalized linear mixed models to evaluate the association between urinary metabolite concentrations and markers of ovarian response, accounting for multiple IVF cycles per woman via random intercepts. On average, women with detectable urinary MHiNCH concentrations, as compared to those below LOD, had a lower estradiol levels (−325 pmol/l, p=0.09) and number of retrieved oocytes (−1.8, p=0.08), with a stronger association among older women. However, urinary MHiNCH concentrations were unrelated to mature oocyte yield and endometrial wall thickness. In conclusion, we found suggestive negative associations between urinary MHiNCH concentrations and peak estradiol levels and number of total oocyte yields. This is the first study evaluating the effect of DINCH exposure on human reproductive health and raises the need for further experimental and epidemiological studies to better understand the potential effects of this chemical on health. - Highlights: • Women with detectable urinary MHiNCH concentrations had a lower estradiol levels and number of retrieved oocytes. • The negative association between urinary MHiNCH concentrations and total oocyte yield was stronger in older women. • Urinary MHiNCH concentrations were unrelated to mature oocyte yield and endometrial wall thickness.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2017

Low-level arsenic exposure via drinking water consumption and female fecundity - A preliminary investigation

High level arsenic exposure is associated with reproductive toxicity in experimental and observational studies; however, few data exist to assess risks at low levels. Even less data are available to evaluate the impact of low level arsenic exposure on human fecundity. Our aim in this pilot study was a preliminary evaluation of associations between low level drinking water arsenic contamination and female fecundity. This retrospective study was conducted among women previously recruited to a hospital-based case-control study of spontaneous pregnancy loss in Timiá¹£ County, Romania. Women (n=94) with planned pregnancies of 5–20 weeks gestation completed a comprehensive physician-administered study questionnaire and reported the number of menstrual cycles attempting to conceive as the time to pregnancy (TTP). Drinking water samples were collected from residential drinking water sources and we determined arsenic levels using hydride generation-atomic absorption spectrometry (HG-AAS). Multivariable Cox-proportional hazards regression with Efron approximation was employed to evaluate TTP as a function of drinking water arsenic concentrations among planned pregnancies, adjusted for covariates. There was no main effect for drinking water arsenic exposure, yet the conditional probability for pregnancy was modestly lower among arsenic exposed women with longer TTPs, relative to women with shorter TTPs, and relative to unexposed women. For example, 1 µg/L average drinking water arsenic conferred 5%, 8%, and 10% lower likelihoods for pregnancy in the 6th, 9th, and 12th cycles, respectively (P=0.01). While preliminary, our results suggest that low level arsenic contamination in residential drinking water sources may further impair fecundity among women with longer waiting times; however, this hypothesis requires confirmation by a future, more definitive study. - Highlights: • We assessed low level drinking water arsenic as a predictor of fecundability. • Arsenic did not affect time to pregnancy among women conceiving quickly. • Arsenic increased time to pregnancy among women taking longer to conceive. • Low level drinking water arsenic may adversely impact women with lower fecundity.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2025

Risk of Mortality in Family Members of Men Seeking Fertility Assessment

Objective: To assess mortality in family members of men seeking fertility assessment. Subfertility serves as a biomarker for overall somatic health, and poor semen quality is associated with increased risk of hospitalization and mortality from chronic conditions. However, it is unclear if these risks extend to family members of men with low sperm count. Design: Retrospective cohort study. Subjects: Family members, up to third-degree relatives, of men in the Subfertility, Health and Assisted Reproduction and the Environment cohort who underwent a semen analysis as part of a fertility assessment 1996–2017. Relatives of men with a recorded total sperm count who lived in Utah for ≥1 year 1904–2017 were included in the analysis (N = 22,280 families). Exposure: Individuals were classified by family membership. Families were classified as relatives of azoospermic (0M), oligozoospermic (<39M), or normozoospermic (≥39M) men. The average total sperm count of the proband (male relative) with fertility assessment was also included as a continuous exposure measure. Main Outcome Measures: The main outcomes were all-cause and cause-specific mortality risk by sex, age, and degree of relation: first-, second-, and third-degree. Cox proportional hazard models were used to test the association between fertility classification and mortality, controlling for sex, race/ethnicity, and birth year. Results: A total of 666,437 relatives of men with fertility assessment (N deaths = 183,974) were included in the analysis. Relative to normozoospermia families, all-cause mortality risk increased in oligozoospermia families (hazard ratio [HR] oligozoospermia , 1.03; 95% confidence interval [CI], 1.01–1.05). Close relatives, first- (HR oligozoospermia , 1.17; 95% CI, 1.07–1.28) and second-degree relatives (HR azoospermia , 1.11; 95% CI, 1.04–1.20; HR oligozoospermia , 1.05; 95% CI,1.01–1.09), of azoospermic and oligozoospermic men had the highest all-cause and cause-specific mortality risk, including death attributed to cardiovascular disease or congenital birth conditions. Conclusion: Our results suggest that familial all-cause and cause-specific mortality risk differ by fertility phenotype. Families of azoospermic and oligozoospermic men showed significantly increased risk, particularly for close relatives. This study provides further evidence that shared genetic and/or environmental factors could influence both fertility and somatic health.

Male fertility↗
DOE OSTI2026

Technoeconomic analysis of hydrogen storage using 1,4-butanediol (BDO)/γ-butyrolactone (GBL) as a stationary backup power system

Liquid organic hydrogen carriers (LOHCs) are compounds that store and release hydrogen in stable forms at high density. While one-way carriers such as methanol and ammonia have gained attention, their economic advantages are often realized from their use as an export product and direct use as a fuel. Liquid carrier materials that can instead be cycled for energy storage have promise for stationary power applications. In particular, the reversible LOHC system 1,4-butanediol (BDO, H 2 -rich) and gamma-butyrolactone (GBL, H 2 -lean) has a lower enthalpy of dehydrogenation compared to conventional cyclic hydrocarbons and can utilize non-precious metal copper-based catalysts. Here, in this study, BDO/GBL system capital and operating expenses are characterized for vapor phase versus liquid phase hydrogenation and dehydrogenation in a 10 MW backup power application corresponding to sizing of Tier 2 datacenters as well as other critical infrastructure such as hospitals. Costs are benchmarked against two incumbent technologies: a well-established methylcyclohexane/toluene carrier system and compressed gas storage. BDO/GBL storage costs are found to differ substantially between operating modes, with liquid phase hydrogenation coupled with liquid phase dehydrogenation leading to the lowest LCOS of $\$$4.58/kg H 2 in the absence of byproduct formation. In this bounding case, LCOS for the BDO/GBL system is lower than for MCH/TOL ($\$$6.97/kg H 2 ) and compressed gas ($\$$8.48/kg H 2 at 170 bara and $\$$12.05/kg H 2 at 350 bara). However, escalating costs of carrier replacement due to byproduct formation (ranging from an added $\$$6–11/kg H 2 ) illustrate the need for highly selective catalysts to ensure BDO/GBL carrier viability.

BDO/GBL↗
DOE OSTI2021

COVID 19 vaccine distribution solution to the last mile challenge: Experimental and simulation studies of ultra-low temperature refrigeration system

Most COVID-19 vaccines require ambient temperature control for transportation and storage. Both Pfizer and Moderna vaccines are based on mRNA and lipid nanoparticles requiring low temperature storage. The Pfizer vaccine requires ultra-low temperature storage (between -80 °C and -60 °C), while the Moderna vaccine requires -30 °C storage. Pfizer has designed a reusable package for transportation and storage that can keep the vaccine at the target temperature for 10 days. However, the last stage of distribution is quite challenging, especially for rural or suburban areas, where local towns, pharmacy chains and hospitals may not have the infrastructure required to store the vaccine. Also, the need for a large amount of ultra-low temperature refrigeration equipment in a short time period creates tremendous pressure on the equipment suppliers. In addition, there is limited data available to address ancillary challenges of the distribution framework for both transportation and storage stages. As such, there is a need for a quick, effective, secure, and safe solution to mitigate the challenges faced by vaccine distribution logistics. The study proposes an effective, secure, and safe ultra-low temperature refrigeration solution to resolve the vaccine distribution last mile challenge. Furthermore, the approach is to utilize commercially available products, such as refrigeration container units, and retrofit them to meet the vaccine storage temperature requirement. Both experimental and simulation studies are conducted to evaluate the technical merits of this solution with the ability to control temperature at -30 °C or -70 °C as part of the last mile supply chain for vaccine candidates.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2011

Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

Purpose: We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials: Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radiotherapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results: In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm{sup 3} were 18.02 times more likely to progress than those with tumor volumes of 1 cm{sup 3} or greater (odds ratio, 18.02; 95% confidence interval, 4.25-76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions: Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the 'no salvage surgery needed' and 'no additional treatment needed' criteria for treatment success need to be complemented by the radiologic data.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Randomized Trial of Oral Misoprostol Treatment for Cervical Ripening Before Tandem Application in Cervix Cancer

Purpose: To investigate the efficacy of oral misoprostol administered to facilitate tandem application to the cervix as a part of brachytherapy in patients with cervical cancer. Methods and Materials: Eighty patients with cervical cancer who had been planned to undergo brachytherapy at Dr. Luetfi Kirdar Kartal Training and Research Hospital were evaluated in a double-blind, prospective, randomized trial. Patients were divided randomly into two groups of 40 patients. The first and second groups received 400 {mu}g of misoprostol orally and placebo, respectively, 3 h before tandem application. The two groups were compared in terms of age, diameter of tumor, parity, age at first intercourse, amount of bleeding and pain at first tandem application, length of endometrial cavity measured by hysterometer, and size of Hegar dilators used for cervical dilatation. Results: Of all cases, 63.6%, 16.3%, 10%, 6.3%, 2.5%, and 1.3% were Stage IIB, IIIB, IIIA, IVA, IIA and IIC, respectively. Mean ({+-}SD) age (range) was 49.3 {+-} 13.1 (25-83) years and 56.6 {+-} 13.2 (30-78) years in the study and control groups, respectively (p = 0.015). Age at first intercourse, diameter of tumor, parity, amount of bleeding at first tandem application, and length of endometrial cavity measured by hysterometer were not significantly different between the two groups. Pain score was significantly higher in the control group (p < 0.001). Application was significantly easier in the study group compared with controls (p < 0.001). Average size of initial Hegar dilators used for cervical dilatation was significantly higher in the study group compared with controls (p = 0.017). Conclusion: Administration of misoprostol 400 {mu}g orally for cervical ripening before tandem application facilitates the procedure, increases patient tolerability and comfort, and may decrease complication rates.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT)

Purpose: Approximately 30% of patients with cancer receive bone metastases, of which 50% are in the spine. Approximately 20% present with unstable lesions requiring surgical intervention, followed by fractionated radiotherapy over 2-4 weeks to prevent early regrowth. Because of the limited survival time of patients with metastatic cancer, novel treatment concepts shortening the overall treatment time or hospitalization are desirable. In this study, we established a novel approach for intraoperative radiotherapy during kyphoplasty (Kypho-IORT), a method that combines stabilizing surgery and radiotherapy within one visit, after estimating the percentage of eligible patients for this treatment. Methods and Materials: To estimate the percentage of eligible patients, 53 planning CTs (897 vertebrae) of patients with spinal metastases were evaluated. The number of infiltrated vertebrae were counted and classified in groups eligible or not eligible for Kypho-IORT. The Kypho-IORT was performed in a donated body during a standard balloon kyphoplasty using the INTRABEAM system and specially designed applicators. A single dose of 10 Gy (in 10 mm) was delivered over 4 min to the vertebra. This was verified using two ionization chambers and a Monte Carlo simulation. Results: The estimation of eligible patients resulted in 34% of the evaluated patients, and thus 34% of patients with instable spinal metastases are suitable for Kypho-IORT. This study shows also that, using the approach presented here, it is possible to perform an IORT during kyphoplasty with an additional 15 min operation time. The measurement in the donated body resulted in a maximum dose of 3.8 Gy in the spinal cord. However, the Monte Carlo depth dose simulation in bone tissue showed 68% less dose to the prescription depth. Conclusion: We present for the first time a system using an x-ray source that can be used for single-dose IORT during kyphoplasty. The described Kypho-IORT can decrease the overall treatment time for up to 34% of patients who usually receive radiotherapy for spinal metastases.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Proton Radiotherapy for Pediatric Bladder/Prostate Rhabdomyosarcoma: Clinical Outcomes and Dosimetry Compared to Intensity-Modulated Radiation Therapy

Purpose: In this study, we report the clinical outcomes of 7 children with bladder/prostate rhabdomyosarcoma (RMS) treated with proton radiation and compare proton treatment plans with matched intensity-modulated radiation therapy (IMRT) plans, with an emphasis on dose savings to reproductive and skeletal structures. Methods and Materials: Follow-up consisted of scheduled clinic appointments at our institution or direct communication with the treating physicians for referred patients. Each proton radiotherapy plan used for treatment was directly compared to an IMRT plan generated for the study. Clinical target volumes and normal tissue volumes were held constant to facilitate dosimetric comparisons. Each plan was optimized for target coverage and normal tissue sparing. Results: Seven male patients were treated with proton radiotherapy for bladder/prostate RMS at the Massachusetts General Hospital between 2002 and 2008. Median age at treatment was 30 months (11-70 months). Median follow-up was 27 months (10-90 months). Four patients underwent a gross total resection prior to radiation, and all patients received concurrent chemotherapy. Radiation doses ranged from 36 cobalt Gray equivalent (CGE) to 50.4 CGE. Five of 7 patients were without evidence of disease and with intact bladders at study completion. Target volume dosimetry was equivalent between the two modalities for all 7 patients. Proton radiotherapy led to a significant decrease in mean organ dose to the bladder (25.1 CGE vs. 33.2 Gy; p = 0.03), testes (0.0 CGE vs. 0.6 Gy; p = 0.016), femoral heads (1.6 CGE vs. 10.6 Gy; p = 0.016), growth plates (21.7 CGE vs. 32.4 Gy; p = 0.016), and pelvic bones (8.8 CGE vs. 13.5 Gy; p = 0.016) compared to IMRT. Conclusions: This study provides evidence of significant dose savings to normal structures with proton radiotherapy compared to IMRT and is well tolerated in this patient population. The long-term impact of these reduced doses can be tested in future studies incorporating extended follow-up, objective outcome measures, and quality-of-life analyses.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Number and Location of Positive Nodes, Postoperative Radiotherapy, and Survival After Esophagectomy With Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma

Purpose: To analyze influences of the number and location of positive lymph nodes and postoperative radiotherapy on survival for patients with thoracic esophageal squamous cell carcinoma (TE-SCC) treated with radical esophagectomy with three-field lymphadenectomy. Methods and Materials: A total of 945 patients underwent radical esophagectomy plus three-field lymph node dissection for node-positive TE-SCC at Fujian Provincial Tumor Hospital between January 1993 and March 2007. Five hundred ninety patients received surgery only (S group), and 355 patients received surgery, followed 3 to 4 weeks later by postoperative radiotherapy (S+R group) to a median total dose of 50 Gy in 25 fractions. We assessed potential associations among patient-, tumor-, and treatment-related factors and overall survival. Results: Five-year overall survival rates were 32.8% for the entire group, 29.6% for the S group, and 38.0% for the S+R group (p = 0.001 for S vs. S+R). Treatment with postoperative radiotherapy was particularly beneficial for patients with {>=}3 positive nodes and for those with metastasis in the upper (supraclavicular and upper mediastinal) region or both the upper and lower (mediastinal and abdominal) regions (p < 0.05). Postoperative radiotherapy was also associated with lower recurrence rates in the supraclavicular and upper and middle mediastinal regions (p < 0.05). Sex, primary tumor length, number of positive nodes, pathological T category, and postoperative radiotherapy were all independent predictors of survival. Conclusions: Postoperative radiotherapy was associated with better survival for patients with node-positive TE-SCC, particularly those with three or more positive nodes and positive nodes in the supraclavicular and superior mediastinal regions.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Identification of a High-Risk Group Among Patients With Oral Cavity Squamous Cell Carcinoma and pT1-2N0 Disease

Purpose: In the American Joint Committee on Cancer 2010 classification system, pT1-2N0 oral cavity squamous cell carcinoma (OSCC) is considered an early-stage cancer treatable with surgery alone (National Comprehensive Cancer Network 2010 guidelines). Our aim was to evaluate the feasibility of surgery alone for pT1-2N0 OSCC patients. Methods and Materials: Among 1279 previously untreated OSCC patients referred to our hospital between January 1996 and May 2008, we identified 457 consecutive patients with pT1-2N0 disease. All had radical tumor excision with neck dissection. A total of 387 patients showing pathologic margins greater than 4 mm and treated by surgery alone were included in the final analysis. All were followed up for at least 24 months after surgery or until death. The 5-year rates of control, distant metastasis, and survival were the main outcome measures. Results: The 5-year rates in the entire group of pT1-2N0 patients were as follows: local control, 91%; neck control, 92%; distant metastases, 1%; disease-free survival, 85%; disease-specific survival, 93%; and overall survival, 84%. Multivariate analysis identified poor differentiation and pathologic tumor depth of 4 mm or greater as independent risk factors for neck control, disease-free survival, and disease-specific survival. A scoring system using poor differentiation and tumor depth was formulated to define distinct prognostic groups. The presence of both poorly differentiated tumors and a tumor depth of 4 mm or greater resulted in significantly poorer 5-year neck control (p < 0.0001), disease-free (p < 0.0001), disease-specific (p < 0.0001), and overall survival (p = 0.0046) rates. Conclusion: The combination of poor differentiation and pathologic tumor depth of 4 mm or greater identified a subset of pT1-2N0 OSCC patients with poor outcome, who may have clinical benefit from postoperative adjuvant radiotherapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗