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At least 847 records · Page 47
All sourcesNASA NTRSDOE OSTI
DOE OSTI2012

Uterine Artery Embolization Combined with Local Methotrexate and Systemic Methotrexate for Treatment of Cesarean Scar Pregnancy with Different Ultrasonographic Pattern

Purpose: This study was designed to compare the effectiveness of systemic methotrexate (MTX) with uterine artery embolization (UAE) combined with local MTX for the treatment of cesarean scar pregnancy (CSP) with different ultrasonographic pattern, and to indicate the preferable therapy in CSP patients. Methods: The results of 21 CSP cases were reviewed. All subjects were initially administrated with systemic MTX (50 mg/m{sup 2} body surface area). UAE combined with local MTX was added to the patients who had failed systemic MTX. The transvaginal ultrasonography data were retrospectively assessed, and two different ultrasonographic patterns were found: surface implantation and deep implantation of amniotic sac. The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively. Ultrasound scan and serum {beta}-hCG were monitored during follow-up. Data were analyzed with the Student's t test. Results: Nine patients were successfully treated with systemic MTX. The remaining 12 cases were successfully treated with additional UAE combined with local MTX. According to the classification by Vial et al. of CSP on ultrasonography, most surface implanted CSPs (8/11, 72.7%) could be successfully treated with systemic MTX, whereas most deeply implanted CSPs (9/10, 90%) had failed systemic MTX but still could be successfully treated with additional UAE combined with local MTX. All patients recovered without severe side effects. Most patients with a future desire for reproduction achieved subsequent pregnancy. Conclusions: For CSP patients suitable for nonsurgical treatment, UAE combined with local MTX would be the superior option compared with systemic MTX in the cases with deep implantation of amniotic sac.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Spectral reflectance reconstruction with the locally weighted linear model

Spectral reflectance reconstruction by the local linear model has many advantages such as simple model structure, fast calculation speed and less chance to be over-fitting. However, local linear model often suffers from the outliers and prone to be under-fitting. In this paper, we propose a locally weighted linear model for spectral reflectance reconstruction. It improves the contribution of the local neighbors with higher similarity to the test point, which can reduce the influence of noisy points and redundant points. Experimental results show that the locally weighted linear model can effectively reduce the reconstruction error.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
DOE OSTI2025

Laser-induced selective local patterning of vanadium oxide phases

The same elements can form different compounds with widely different physical properties. Synthesis of a single-phase material is commonly achieved by controlling experimental conditions. Synthesizing materials that incorporate multiple specific spatially distributed chemical phases is often challenging, especially if different phases must be organized into well-defined spatial patterns. Here, we present an efficient solid reaction laser annealing (SRLA) approach to directly write regions of different local chemical compositions. We demonstrate the practical utility of our approach by locally writing microscale patterns of distinct chemical phases in vanadium oxide thin films. Specifically, we achieved the controlled local recrystallization of a uniform V 2 O 3 matrix into VO 2 , V 3 O 5 , and V 4 O 7 regions exhibiting sharp 1st- and 2nd-order metal–insulator phase transitions over a wide range of critical temperatures, i.e., a characteristic feature of select vanadium oxides that is extremely sensitive to even minute structural or compositional imperfections. We utilized the local chemical phase writing to pattern spiking oscillators with distinct electrical behavior directly in the thin film sample without employing elaborate lithography fabrication. Our laser tuning local chemical composition opens a pathway to synthesize a wide range of artificially micropatterned composite materials, with precision and control unattainable in conventional material synthesis methods.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗
DOE OSTI2011

Geometry of the electron local observables

We show that the complete set of the second power identities for the electron local observables consists of 36 equations. The identities connect the products of the electron bilinear forms and, being considered as geometrically meaningful equations in 3D Euclidean space, are separated over the groups of equations for the scalar, vector and tensor quantities. Considering the complete set of identities as a set of the second power equations, we solve the equations and find the irreducible representation for the electron local observables. The representation defines the 16 electron local observables as functions of 7 basic parameters and can be formulated in 6 various forms. The basic parameters include scalar and pseudoscalar, the time components of a 4-vector and a 4-pseudovector, and three Euler angles which define the angular position of a local 3D frame with respect to the 3D laboratory frame. These 7 parameters completely define the space components of the 4-vector and the 4-pseudovector, as well as the polar and axial vectors. The developed representation shows that the analysis of the any electron wave packet can be considerably simplified by the reduction of the number of analyzed real functions from 16 to 7. As an example, we present the structure of the local observables defined by the irreducible representation in a case of a traveling electron wave. - Highlights: > Complete set of bilinear identities for the electron observables is derived. > Irreducible representation for the electron observables is found. > The representation defines the electron observables as functions of 7 parameters.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
DOE OSTI2015

Invariant currents and scattering off locally symmetric potential landscapes

We study the effect of discrete symmetry breaking in inhomogeneous scattering media within the framework of generic wave propagation. Our focus is on one-dimensional scattering potentials exhibiting local symmetries. We find a class of spatially invariant nonlocal currents, emerging when the corresponding generalized potential exhibits symmetries in arbitrary spatial domains. These invariants characterize the wave propagation and provide a spatial mapping of the wave function between any symmetry related domains. This generalizes the Bloch and parity theorems for broken reflection and translational symmetries, respectively. Their nonvanishing values indicate the symmetry breaking, whereas a zero value denotes the restoration of the global symmetry where the well-known forms of the two theorems are recovered. These invariants allow for a systematic treatment of systems with any local symmetry combination, providing a tool for the investigation of the scattering properties of aperiodic but locally symmetric systems. To this aim we express the transfer matrix of a locally symmetric potential unit via the corresponding invariants and derive quantities characterizing the complete scattering device which serve as key elements for the investigation of transmission spectra and particularly of perfect transmission resonances. -- Highlights: •We show that local discrete symmetries yield invariant currents. •Bloch and parity theorems are generalized when the associated symmetries are broken. •Formulation of scattering via the symmetry-induced invariant currents. •We provide sum rules for the invariant currents characterizing perfect transmission.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
DOE OSTI2018

Localization of gravitino field on branes

In this paper, we investigate the localization of a bulk gravitino field on the scalar-tensor branes and compare the result with that in the Randall–Sundrum-1 (RS1) model. The coupled chiral equations for the Kaluza–Klein (KK) modes of the gravitino field are obtained by fixing the gauge Ψ{sub 5}=0 and using the chiral KK decompositions. It is shown that, in the RS1 model for the left- and right-handed zero modes of the gravitino field, only one of them can be localized near one brane. For the massive modes, both chiral modes survive and the lower KK modes are localized near the IR brane from the four-dimensional physical coordinate point of view. However, for the scalar-tensor brane model, the localization of the gravitino chiral zero modes depends on the coupling parameter λ, and they will be not localized around anyone brane within a certain range of the parameter λ, which is quite different from the RS1 model. Furthermore, we also give the corresponding mass spectra of the massive KK gravitinos in the scalar-tensor model.

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗
DOE OSTI2021

Anisotropy of localized states in an anisotropic disordered medium

Highlights: • Mobility edges of the Anderson transition are unaffected by anisotropy alone. • The critical exponent of the Anderson localization transition is also unaffected. • Anderson localized eigenstates in an anisotropic medium retain substantial anisotropy. • Their anisotropy is weaker than expected from purely geometric considerations. • Modes with the longest lifetimes are found to be the most anisotropic. We study Anderson localization of a scalar wave in an ensemble of resonant point scatterers embedded in an anisotropic background medium. For uniaxial anisotropy of moderate strength, the mobility edges and the critical exponent of the localization transition are found to be unaffected by the anisotropy provided that the determinant of the anisotropy tensor is kept equal to one upon introducing the anisotropy. Localized modes have anisotropic spatial shapes although their anisotropy is weaker than the one expected from purely geometric considerations. The modes with the longest lifetimes are found to be the most anisotropic and their anisotropy increases with the size of the disordered medium.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
DOE OSTI2012

Nuclear localization of DMP1 proteins suggests a role in intracellular signaling

Highlights: Black-Right-Pointing-Pointer Nuclear localization of DMP1 in various cell lines. Black-Right-Pointing-Pointer Non-synchronized cells show either nuclear or cytoplasmic localization of DMP1. Black-Right-Pointing-Pointer Nuclear DMP1 is restricted to the nucleoplasm but absent in the nucleolus. -- Abstract: Dentin matrix protein 1 (DMP1) is highly expressed in odontoblasts and osteoblasts/osteocytes and plays an essential role in tooth and bone mineralization and phosphate homeostasis. It is debatable whether DMP1, in addition to its function in the extracellular matrix, can enter the nucleus and function as a transcription factor. To better understand its function, we examined the nuclear localization of endogenous and exogenous DMP1 in C3H10T1/2 mesenchymal cells, MC3T3-E1 preosteoblast cells and 17IIA11 odontoblast-like cells. RT-PCR analyses showed the expression of endogenous Dmp1 in all three cell lines, while Western-blot analysis detected a major DMP1 protein band corresponding to the 57 kDa C-terminal fragment generated by proteolytic processing of the secreted full-length DMP1. Immunofluorescent staining demonstrated that non-synchronized cells presented two subpopulations with either nuclear or cytoplasmic localization of endogenous DMP1. In addition, cells transfected with a construct expressing HA-tagged full-length DMP1 also showed either nuclear or cytoplasmic localization of the exogenous DMP1 when examined with an antibody against the HA tag. Furthermore, nuclear DMP1 was restricted to the nucleoplasm but was absent in the nucleolus. In conclusion, these findings suggest that, apart from its role as a constituent of dentin and bone matrix, DMP1 might play a regulatory role in the nucleus.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Basic amino acid residues located in the N-terminal region of BEND3 are essential for its nuclear localization

BEN domain-containing protein 3 (BEND3) has recently been reported to function as a heterochromatin-associated protein in transcriptional repression in the nucleus. BEND3 should have nuclear localization signals (NLSs) to localize to the nucleus in light of its molecular weight, which is higher than that allowed to pass through nuclear pore complexes. We here analyzed the subcellular localization of deletion/site-directed mutants of human BEND3 by an immunofluorescence assay in an attempt to identify the amino acids essential for its nuclear localization. We found that three basic amino acid residues located in the N-terminal region of BEND3 (BEND3{sub 56–58}, KRK) are essential, suggesting that these residues play a role as a functional NLS. These results provide valuable information for progressing research on BEND3. - Highlights: • BEND3 localizes to the nucleus. • The N-terminal 60 amino acids region of BEND3 contains NLS. • Amino acids located between 56 and 58 of BEND3 (KRK) are part of NLS. • KRK motif is highly conserved among BEND3 homologs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2022

Geometric prior of multi-resolution yielding manifolds and the local closest point projection for nearly non-smooth plasticity

Elastoplasticity models often introduce a scalar-valued yield function to implicitly represent the boundary between elastic and plastic material states. Here this paper introduces a new alternative where the yield envelope is represented by a manifold of which the topology and the geometry are learned from a set of data points in a parametric space (e.g. principal stress space, π-plane). Here, deep geometric learning enables us to reconstruct a highly complex yield envelope by breaking it down into multiple coordinate charts. The global atlas that consists of these coordinate charts in return allows us to represent the yield surface via multiple overlapping patches, each with a specific local parametrization. This setup provides several advantages over the classical implicit function representation approach. For instance, the availability of coordinate charts enables us to introduce an alternative stress integration algorithm where the trial stress may project directly on a local patch and hence circumvent the issues related to non-smoothness and the lack of convexity of yield surfaces. Meanwhile, the local parametric approach also enables us to predict hardening/softening locally in the parametric space, even without complete knowledge of the yield surface. Comparisons between the classical yield function approach on the non-smooth plasticity and anisotropic cam-clay plasticity model are provided to demonstrate the capacity of the models for highly precise yield surface and the feasibility of the implementation of the learned model in the local stress integration algorithm.

42 ENGINEERING↗
DOE OSTI2024

Direct numerical simulations of turbulent premixed cool flames: Global and local flame dynamics analysis

The cool flame dynamics, especially in turbulent flows, is of great interest for both practical application and fundamental research. Here, in this study, a series of direct numerical simulations of turbulent premixed n-C 7 H 16 /O 2 /O 3 /N 2 cool flames are performed, with the focus on the influence of turbulence intensity (u'/S L , where S L is the laminar flame speed) on the flame structure as well as the global and local cool flame dynamics. It is found that the cool flame front is considerably wrinkled by turbulence at high u'/S L , leading to significantly thickened turbulent cool flame brush and largely altered local reactivity compared with the reference laminar flame. However, the turbulent flame structure in the temperature space is found to be insensitive to u'/S L . Besides, with increasing u'/S L , the normalized turbulent cool flame speed (S L /S L ) is monotonically increased, attributed to substantial augmentation on the flame surface area (A T /A L ), while the stretching factor (I 0 ) remains almost constant and is smaller than 1. The underlying mechanisms for such variations are revealed through local flame dynamics analysis. Specifically, the local flame displacement speed S d is found to be strongly negatively correlated with flame curvature; meanwhile, such negative correlation and the probability distribution function (PDF) of flame curvature are barely influenced by u'/S L , leading to a weak dependence of I 0 on u'/S L . In contrast, the PDF of the tangential strain rate is found to span a much wider range and shift to the positive side as u'/S L increases, suggesting that the enhanced tangential strain rate is the main cause for the increase in surface area of the turbulent premixed cool flame. Finally, the influence of equivalence ratio on above findings is found to be insignificant, indicating that although the local reactivity of turbulent premixed cool flames is altered due to the differential diffusion, the resultant flame- stretch interaction is insensitive to the equivalence ratio. This study presents some unique cool flame dynamics that are distinct from hot flames, which can help improve the understanding and modeling of turbulent cool flames.

Cool flames↗
DOE OSTI2021

Empirical prediction of saline water atomization pressure loss and spray phase change using local flow pressure analysis

A pressure analysis technique was developed to obtain spray spatial evaporation profile in a thermal desalination process. The technique can replace temperature-based evaporation measurement methods that are challenged by liquid-phase interference. It also provides an alternative to optical methods with high cost and complexity. Fundamental analysis was developed to determine local humidity ratios from changes in local static and dynamic pressures. The analysis was applied to data obtained from an external mixing air-assist atomizer. An empirical model was developed for the pressure loss in atomization process and was used in the analysis of humidity ratio. The results were used to develop empirical correlations for local humidity ratio in spray mediums using inlet conditions. Utilizing inlet conditions to predict evaporation profiles is an important contribution as it eliminates the need to take local spray measurements. Obtaining local data is often difficult and expensive; Our method and correlation circumvent the need for that. Finally, the correlations presented in this paper apply to saline water sprays with total dissolved salt of 0-10 wt%. The salinity-specific correlations are accurate to within ±10% of experimental data. The individual models were aggregated into a unified correlation for salinities within 0-10 wt%. The unified correlation is accurate to within ±18% of experimental data.

42 ENGINEERING↗
DOE OSTI2015

Deformation-induced spatiotemporal fluctuation, evolution and localization of strain fields in a bulk metallic glass

Deformation behavior and local strain evolutions upon loading and unloading of a bulk metallic glass (BMG) were systematically investigated by in situ digital image correlation (DIC). Distinct fluctuations and irreversible local strains were observed before the onset of macroscopic yielding. Statistical analysis shows that these fluctuations might be related to intrinsic structural heterogeneities, and that the evolution history and characteristics of local strain fields play an important role in the subsequent initiation of shear bands. Effects of sample size, pre-strain, and loading conditions were systematically analyzed in terms of the probability distributions of the resulting local strain fields. It is found that a higher degree of local shear strain heterogeneity corresponds to a more ductile stressestrain curve. Implications of these findings are discussed for the design of new materials.

36 MATERIALS SCIENCE↗
DOE OSTI2011

Single-Fraction Stereotactic Body Radiation Therapy and Sequential Gemcitabine for the Treatment of Locally Advanced Pancreatic Cancer

Purpose: This Phase II trial evaluated the toxicity, local control, and overall survival in patients treated with sequential gemcitabine and linear accelerator-based single-fraction stereotactic body radiotherapy (SBRT). Methods and Materials: Twenty patients with locally advanced, nonmetastatic pancreatic adenocarcinoma were enrolled on this prospective single-institution, institutional review board-approved study. Gemcitabine was administered on Days 1, 8, and 15, and SBRT on Day 29. Gemcitabine was restarted on Day 43 and continued for 3-5 cycles. SBRT of 25 Gy in a single fraction was delivered to the internal target volume with a 2- 3-mm margin using a nine-field intensity-modulated radiotherapy technique. Respiratory gating was used to account for breathing motion. Follow-up evaluations occurred at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT. Results: All patients completed SBRT and a median of five cycles of chemotherapy. Follow-up for the 2 remaining alive patients was 25.1 and 36.4 months. No acute Grade 3 or greater nonhematologic toxicity was observed. Late Grade 3 or greater toxicities occurred in 1 patient (5%) and consisted of a duodenal perforation (G4). Three patients (15%) developed ulcers (G2) that were medically managed. Overall, median survival was 11.8 months, with 1-year survival of 50% and 2-year survival of 20%. Using serial computed tomography, the freedom from local progression was 94% at 1 year. Conclusion: Linear accelerator-delivered SBRT with sequential gemcitabine resulted in excellent local control of locally advanced pancreatic cancer. Future studies will address strategies for reducing long-term duodenal toxicity associated with SBRT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Ten-Year Outcomes: The Clinical Utility of Single Photon Emission Computed Tomography/Computed Tomography Capromab Pendetide (Prostascint) in a Cohort Diagnosed With Localized Prostate Cancer

Purpose: To evaluate the clinical utility of capromab pendetide imaging with single photon emission computed tomography coregistration with computed tomography (SPECT/CT) in primary prostate cancer (CaP) for pretreatment prognostic staging and localization of biologic target volumes (BTV) for individualized image-guided radiotherapy dose escalation (IGRT-DE). Methods and Materials: Patients consecutively presenting for primary radiotherapy (February 1997 to December 2002), having a clinical diagnosis of localized CaP, were evaluated for tumor stage using conventional staging and SPECT/CT (N = 239). Distant metastatic uptake (mets) were identified by SPECT/CT in 22 (9.2%). None of the suspected mets could be clinically confirmed. Thus, all subjects were followed without alteration in disease management. The SPECT/CT pelvic images defined BTV for IGRT-DE (+150% brachytherapy dose) without (n = 150) or with (n = 89) external radiation of 45 Gy. The National Comprehensive Cancer Network criteria defined risk groups (RG). The median survivor follow-up was 7 years. Biochemical disease-free survival (bDFS) was reported by clinical nadir +2 ng/mL (CN+2) criteria. Statistical analyses included Kaplan-Meier, multivariate analysis, and Concordance-index models. Results: At 10-year analyses, overall survival was 84.8% and bDFS was 84.6%. With stratification by RG, CN+2 bDFS was 93.5% for the low-RG (n = 116), 78.7% for the intermediate-RG (n = 94), and 68.8% for the high-RG (n = 29), p = 0.0002. With stratification by pretreatment SPECT/CT findings, bDFS was 65.5% in patients with suspected mets (n = 22) vs. 86.6% in patients with only localized uptake (n = 217), p = 0.0014. CaP disease-specific survival (DSS) was 97.7% for the cohort. With stratification by SPECT/CT findings, DSS was 86.4% (with suspected mets) vs. 99.0% (localized only), p = 0.0001. Using multivariate analysis, the DSS hazard ratio for SPECT/CT findings (mets vs. localized) was 3.58 (p = 0.0026). Concordance-index tests, based on all data, by CN+2 bDFS criteria were 0.710 for RG alone and 0.773 for SPECT/CT + RG. Conclusions: Through long-term outcomes we demonstrate statistically significant bDFS and DSS predictive value for pretreatment capromab pendetide SPECT/CT imaging in primary CaP. Dual clinical utility is demonstrated, using SPECT/CT to define BTV for individualized IGRT-DE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Localization Accuracy of the Clinical Target Volume During Image-Guided Radiotherapy of Lung Cancer

Purpose: To evaluate the position and shape of the originally defined clinical target volume (CTV) over the treatment course, and to assess the impact of gross tumor volume (GTV)-based online computed tomography (CT) guidance on CTV localization accuracy. Methods and Materials: Weekly breath-hold CT scans were acquired in 17 patients undergoing radiotherapy. Deformable registration was used to propagate the GTV and CTV from the first weekly CT image to all other weekly CT images. The on-treatment CT scans were registered rigidly to the planning CT scan based on the GTV location to simulate online guidance, and residual error in the CTV centroids and borders was calculated. Results: The mean GTV after 5 weeks relative to volume at the beginning of treatment was 77% {+-} 20%, whereas for the prescribed CTV, it was 92% {+-} 10%. The mean absolute residual error magnitude in the CTV centroid position after a GTV-based localization was 2.9 {+-} 3.0 mm, and it varied from 0.3 to 20.0 mm over all patients. Residual error of the CTV centroid was associated with GTV regression and anisotropy of regression during treatment (p = 0.02 and p = 0.03, respectively; Spearman rank correlation). A residual error in CTV border position greater than 2 mm was present in 77% of patients and 50% of fractions. Among these fractions, residual error of the CTV borders was 3.5 {+-} 1.6 mm (left-right), 3.1 {+-} 0.9 mm (anterior-posterior), and 6.4 {+-} 7.5 mm (superior-inferior). Conclusions: Online guidance based on the visible GTV produces substantial error in CTV localization, particularly for highly regressing tumors. The results of this study will be useful in designing margins for CTV localization or for developing new online CTV localization strategies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

The Impact of Hypofractionated Whole Breast Radiotherapy on Local Relapse in Patients With Grade 3 Early Breast Cancer: A Population-Based Cohort Study

Purpose: To determine whether patients with Grade 3 early breast cancer have an inferior rate of local disease control at 10 years with hypofractionated radiotherapy compared with more conventionally fractionated schedules. Methods and Materials: Local relapse rates were compared between patients receiving hypofractionated radiotherapy or conventionally fractionated radiotherapy to the whole breast in a population-based cohort of women with early-stage (T1-T2, N0, M0) Grade 3 breast cancers diagnosed between 1990 and 2000 and referred to the British Columbia Cancer Agency. Cumulative rates of local relapse were estimated using a competing risk method, and factors significant on univariate analysis were included with fractionation group in a multivariate model. The primary end point was local control at 10 years. Results: A total of 1,335 patients with Grade 3 tumors were treated with adjuvant radiotherapy, 252 with conventional fractionation, and 1,083 with a hypofractionated schedule. The 10-year cumulative incidence of local relapse was 6.9% in the hypofractionated group and 6.2% in the conventionally fractionated group (p = 0.99). Conclusions: There is no evidence that hypofractionation is inferior to conventional fractionation for breast conserving therapy in patients with Grade 3 breast cancer in this large population-based series after 10 years of follow-up.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2012

Sequencing of Local Therapy Affects the Pattern of Treatment Failure and Survival in Children With Atypical Teratoid Rhabdoid Tumors of the Central Nervous System

Purpose: To assess the pattern of treatment failure associated with current therapeutic paradigms for childhood atypical teratoid rhabdoid tumors (AT/RT). Methods and Materials: Pediatric patients with AT/RT of the central nervous system treated at our institution between 1987 and 2007 were retrospectively evaluated. Overall survival (OS), progression-free survival, and cumulative incidence of local failure were correlated with age, sex, tumor location, extent of disease, and extent of surgical resection. Radiotherapy (RT) sequencing, chemotherapy, dose, timing, and volume administered after resection were also evaluated. Results: Thirty-one patients at a median age of 2.3 years at diagnosis (range, 0.45-16.87 years) were enrolled into protocols that included risk- and age-stratified RT. Craniospinal irradiation with focal tumor bed boost (median dose, 54 Gy) was administered to 18 patients. Gross total resection was achieved in 16. Ten patients presented with metastases at diagnosis. RT was delayed more than 3 months in 20 patients and between 1 and 3 months in 4; 7 patients received immediate postoperative irradiation preceding high-dose alkylator-based chemotherapy. At a median follow-up of 48 months, the cumulative incidence of local treatment failure was 37.5% {+-} 9%; progression-free survival was 33.2% {+-} 10%; and OS was 53.5% {+-} 10%. Children receiving delayed RT ({>=}1 month postoperatively) were more likely to experience local failure (hazard ratio [HR] 1.23, p = 0.007); the development of distant metastases before RT increased the risk of progression (HR 3.49, p = 0.006); and any evidence of disease progressionbefore RT decreased OS (HR 20.78, p = 0.004). Disease progression occurred in 52% (11/21) of children with initially localized tumors who underwent gross total resection, and the progression rate increased proportionally with increasing delay from surgery to RT. Conclusions: Delayed RT is associated with a higher rate of local and metastatic disease progression in children with AT/RT. Current treatment regimens for pediatric patients with AT/RT are distinctly age stratified; novel protocols investigating RT volumes and sequencing are needed.

62 RADIOLOGY AND NUCLEAR MEDICINE↗