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At least 883 records · Page 49

Stereotactic Radiation Therapy can Safely and Durably Control Sites of Extra-Central Nervous System Oligoprogressive Disease in Anaplastic Lymphoma Kinase-Positive Lung Cancer Patients Receiving Crizotinib

Purpose: To analyze the durability and toxicity of radiotherapeutic local ablative therapy (LAT) applied to extra-central nervous system (eCNS) disease progression in anaplastic lymphoma kinase-positive non-small cell lung cancer (NSCLC) patients. Methods and Materials: Anaplastic lymphoma kinase-positive NSCLC patients receiving crizotinib and manifesting ≤4 discrete sites of eCNS progression were classified as having oligoprogressive disease (OPD). If subsequent progression met OPD criteria, additional courses of LAT were considered. Crizotinib was continued until eCNS progression was beyond OPD criteria or otherwise not suitable for further LAT. Results: Of 38 patients, 33 progressed while taking crizotinib. Of these, 14 had eCNS progression meeting OPD criteria suitable for radiotherapeutic LAT. Patients with eCNS OPD received 1-3 courses of LAT with radiation therapy. The 6- and 12-month actuarial local lesion control rates with radiation therapy were 100% and 86%, respectively. The 12-month local lesion control rate with single-fraction equivalent dose >25 Gy versus ≤25 Gy was 100% versus 60% (P=.01). No acute or late grade >2 radiation therapy-related toxicities were observed. Median overall time taking crizotinib among those treated with LAT versus those who progressed but were not suitable for LAT was 28 versus 10.1 months, respectively. Patients continuing to take crizotinib for >12 months versus ≤12 months had a 2-year overall survival rate of 72% versus 12%, respectively (P<.0001). Conclusions: Local ablative therapy safely and durably eradicated sites of individual lesion progression in anaplastic lymphoma kinase-positive NSCLC patients receiving crizotinib. A dose–response relationship for local lesion control was observed. The suppression of OPD by LAT in patients taking crizotinib allowed an extended duration of exposure to crizotinib, which was associated with longer overall survival.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Survival and Neurocognitive Outcomes After Cranial or Craniospinal Irradiation Plus Total-Body Irradiation Before Stem Cell Transplantation in Pediatric Leukemia Patients With Central Nervous System Involvement

Purpose: To evaluate survival and neurocognitive outcomes in pediatric acute lymphoblastic leukemia (ALL) patients with central nervous system (CNS) involvement treated according to an institutional protocol with stem cell transplantation (SCT) and a component of craniospinal irradiation (CSI) in addition to total-body irradiation (TBI) as preparative regimen. Methods and Materials: Forty-one pediatric ALL patients underwent SCT with TBI and received additional cranial irradiation or CSI because of CNS leukemic involvement. Prospective neurocognitive testing was performed before and after SCT in a subset of patients. Cox regression models were used to determine associations of patient and disease characteristics and treatment methods with outcomes. Results: All patients received a cranial radiation boost; median total cranial dose was 24 Gy. Eighteen patients (44%) received a spinal boost; median total spinal dose for these patients was 18 Gy. Five-year disease-free survival (DFS) for all patients was 67%. Those receiving CSI had a trend toward superior DFS compared with those receiving a cranial boost alone (hazard ratio 3.23, P=.14). Patients with isolated CNS disease before SCT had a trend toward superior DFS (hazard ratio 3.64, P=.11, 5-year DFS 74%) compared with those with combined CNS and bone marrow disease (5-year DFS 59%). Neurocognitive testing revealed a mean post-SCT overall intelligence quotient of 103.7 at 4.4 years. Relative deficiencies in processing speed and/or working memory were noted in 6 of 16 tested patients (38%). Pre- and post-SCT neurocognitive testing revealed no significant change in intelligence quotient (mean increase +4.7 points). At a mean of 12.5 years after transplant, 11 of 13 long-term survivors (85%) had completed at least some coursework at a 2- or 4-year college. Conclusion: The addition of CSI to TBI before SCT in pediatric ALL with CNS involvement is effective and well-tolerated. Craniospinal irradiation plus TBI is worthy of further protocol investigation in children with CNS leukemia.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Treatment of Children With Central Nervous System Primitive Neuroectodermal Tumors/Pinealoblastomas in the Prospective Multicentric Trial HIT 2000 Using Hyperfractionated Radiation Therapy Followed by Maintenance Chemotherapy

Purpose: The prognosis for children with central nervous system primitive neuroectodermal tumor (CNS-PNET) or pinealoblastoma is still unsatisfactory. Here we report the results of patients between 4 and 21 years of age with nonmetastatic CNS-PNET or pinealoblastoma diagnosed from January 2001 to December 2005 and treated in the prospective GPOH-trial P-HIT 2000-AB4. Methods and Materials: After surgery, children received hyperfractionated radiation therapy (36 Gy to the craniospinal axis, 68 Gy to the tumor region, and 72 Gy to any residual tumor, fractionated at 2 × 1 Gy per day 5 days per week) accompanied by weekly intravenous administration of vincristine and followed by 8 cycles of maintenance chemotherapy (lomustine, cisplatin, and vincristine). Results: Twenty-six patients (15 with CNS-PNET; 11 with pinealoblastoma) were included. Median age at diagnosis was 11.5 years old (range, 4.0-20.7 years). Gross total tumor resection was achieved in 6 and partial resection in 16 patients (indistinct, 4 patients). Median follow-up of the 15 surviving patients was 7.0 years (range, 5.2-10.0 years). The combined response rate to postoperative therapy was 17 of 20 (85%). Eleven of 26 patients (42%; 7 of 15 with CNS-PNET; 4 of 11 with pinealoblastoma) showed tumor progression or relapse at a median time of 1.3 years (range, 0.5-1.9 years). Five-year progression-free and overall survival rates (±standard error [SE]) were each 58% (±10%) for the entire cohort: CNS-PNET was 53% (±13); pinealoblastoma was 64% (±15%; P=.524 and P=.627, respectively). Conclusions: Postoperative hyperfractionated radiation therapy with local dose escalation followed by maintenance chemotherapy was feasible without major acute toxicity. Survival rates are comparable to those of a few other recent studies but superior to those of most other series, including the previous trial, HIT 1991.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Comprehensive Craniospinal Radiation for Controlling Central Nervous System Leukemia

Purpose: To determine the benefit of radiation therapy (RT) in resolution of neurologic symptoms and deficits and whether the type of RT fields influences central nervous system (CNS) control in adults with CNS leukemia. Methods and Materials: A total of 163 adults from 1996 to 2012 were retrospectively analyzed. Potential associations between use of radiation and outcome were investigated by univariate and multivariate analysis. Results: The median survival time was 3.8 months after RT. Common presenting symptoms were headache in 79 patients (49%), cranial nerve VII deficit in 46 (28%), and cranial nerve II deficit in 44 (27%). RT was delivered to the base of skull in 48 patients (29%), to the whole brain (WB) in 67 (41%), and to the craniospinal axis (CS) in 48 (29%). Among 149 patients with a total of 233 deficits, resolution was observed in 34 deficits (15%), improvement in 126 deficits (54%), stability in 34 deficits (15%), and progression in 39 deficits (17%). The 12-month CNS progression-free survival was 77% among those receiving CS/WB and 51% among those receiving base of skull RT (P=.02). On multivariate analysis, patients who did not undergo stem cell transplantation after RT and base of skull RT were associated with worse CNS progression-free survival. Conclusions: Improvement or resolution of symptoms occurred in two thirds of deficits after RT. Comprehensive radiation to the WB or CS seems to offer a better outcome, especially in isolated CNS involvement.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Outcomes and Acute Toxicities of Proton Therapy for Pediatric Atypical Teratoid/Rhabdoid Tumor of the Central Nervous System

Purpose: Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system is a rare cancer primarily affecting children younger than 5 years old. Because patients are young and receive intensive chemotherapy, there is concern regarding late radiation toxicity, particularly as survival rates improve. Therefore, there is interest in using proton therapy to treat these tumors. This study was undertaken to investigate outcomes and acute toxicities associated with proton therapy for AT/RT. Methods and Materials: The records of 31 patients with AT/RT treated with proton radiation from October 2008 to August 2013 were reviewed. Demographics, treatment characteristics, and outcomes were recorded and analyzed. Results: Median age at diagnosis was 19 months (range, 4-55 months), with a median age at radiation start of 24 months (range, 6-62 months). Seventeen patients received local radiation with a median dose of 50.4 GyRBE (range, 9-54 GyRBE). Fourteen patients received craniospinal radiation; half received 24 GyRBE or less, and half received 30.6 GyRBE or more. For patients receiving craniospinal radiation, the median tumor dose was 54 GyRBE (range, 43.2-55.8 GyRBE). Twenty-seven patients (87%) completed the planned radiation. With median follow-up of 24 months for all patients (range, 3-53 months), median progression-free survival was 20.8 months and median overall survival was 34.3 months. Five patients (16%) developed clinical findings and imaging changes in the brainstem 1 to 4 months after radiation, consistent with radiation reaction; all cases resolved with steroids or bevacizumab. Conclusions: This is the largest report of children with AT/RT treated with proton therapy. Preliminary survival outcomes in this young pediatric population are encouraging compared to historic results, but further study is warranted.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Patterns of Care in Proton Radiation Therapy for Pediatric Central Nervous System Malignancies

Purpose: Proton beam therapy (PBT) potentially allows for improved sparing of normal tissues, hopefully leading to decreased late side effects in children. Using a national registry, we sought to perform a patterns-of-care analysis for children receiving PBT for primary malignancies of the central nervous system (CNS). Methods and Materials: Using the National Cancer Data Base, we identified pediatric patients with primary CNS malignancies that were diagnosed between 2004 and 2012. We used a standard t test for comparison of means and χ{sup 2} testing to identify differences in demographic and clinical characteristics. Univariate and multivariate logistical regression was applied to identify predictors of PBT use. Results: We identified 4637 pediatric patients receiving radiation therapy from 2004 to 2012, including a subset of 267 patients treated with PBT. We found that PBT use increased with time from <1% in 2004 to 15% in 2012. In multivariate logistical regression, we found the following to be predictors of receipt of PBT: private insurance, the highest income bracket, younger age, living in a metropolitan area, and residing >200 miles from a radiation treatment facility (P<.05). Conclusions: We noted the proportion of children receiving PBT to be significantly increasing over time from <1% to 15% from 2004 to 2012. We also observed important disparities in receipt of PBT based on socioeconomic status. Children from higher-income households and with private insurance were more likely to use this expensive technology. As we continue to demonstrate the potential benefits of PBT in children, efforts are needed to expand the accessibility of PBT for children of all socioeconomic backgrounds and regions of the country.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Reirradiation for Recurrent Pediatric Central Nervous System Malignancies: A Multi-institutional Review

Purpose: Reirradiation has been proposed as an effective modality for recurrent central nervous system (CNS) malignancies in adults. We evaluated the toxicity and outcomes of CNS reirradiation in pediatric patients. Methods and Materials: The data from pediatric patients <21 years of age at the initial diagnosis who developed a recurrent CNS malignancy that received repeat radiation therapy (RT) across 5 facilities in an international pediatric research consortium were retrospectively reviewed. Results: Sixty-seven pediatric patients underwent CNS reirradiation. The primary diagnoses included medulloblastoma/primitive neuroectodermal tumor (n=20; 30%), ependymoma (n=19; 28%), germ cell tumor (n=8; 12%), high-grade glioma (n=9; 13%), low-grade glioma (n=5; 7%), and other (n=6; 9%). The median age at the first course of RT was 8.5 years (range 0.5-19.5) and was 12.3 years (range 3.3-30.2) at reirradiation. The median interval between RT courses was 2.0 years (range 0.3-16.5). The median radiation dose and fractionation in equivalent 2-Gy fractions was 63.7 Gy (range 27.6-74.8) for initial RT and 53.1 Gy (range 18.6-70.1) for repeat RT. The relapse location was infield in 52 patients (78%) and surrounding the initial RT field in 15 patients (22%). Thirty-seven patients (58%) underwent gross or subtotal resection at recurrence. The techniques used for reirradiation were intensity modulated RT (n=46), 3-dimensional conformal RT (n=9), stereotactic radiosurgery (n=4; 12-13 Gy × 1 or 5 Gy × 5), protons (n=4), combined modality (n=3), 2-dimensional RT (n=1), and brachytherapy (n=1). Radiation necrosis was detected in 2 patients after the first RT course and 1 additional patient after reirradiation. Six patients (9%) developed secondary neoplasms after initial RT (1 hematologic, 5 intracranial). One patient developed a secondary neoplasm identified shortly after repeat RT. The median overall survival after completion of repeat RT was 12.8 months for the entire cohort and 20.5 and 8.4 months for patients with recurrent ependymoma and medulloblastoma after reirradiation, respectively. Conclusions: CNS reirradiation in pediatric patients could be a reasonable treatment option, with moderate survival noted after repeat RT. However, prospective data characterizing the rates of local control and toxicity are needed.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Unraveling the 2021 Central Tennessee flood event using a hierarchical multi-model inundation modeling framework

Flood prediction systems need hierarchical atmospheric, hydrologic, and hydraulic models to predict rainfall, runoff, streamflow, and floodplain inundation. The accuracy of such systems depends on the error propagation through the modeling chain, sensitivity to input data, and choice of models. In this study, we used multiple precipitation forcings (hindcast and forecast) to drive hydrologic and hydrodynamic models to analyze the impacts of various drivers on the estimates of flood inundation depth and extent. We implement this framework to unravel the August 2021 extreme flooding event that occurred in Central Tennessee, USA. We used two radar-based quantitative precipitation estimates (STAGE4 and MRMS) as well as quantitative precipitation forecasts (QPF) from the National Weather Service Weather Prediction Center (WPC) to drive a series of models in the hierarchical framework, including the Variable Infiltration Capacity (VIC) land surface model, the Routing Application for Parallel Computation of Discharge (RAPID) river routing model, and the AutoRoute and TRITON inundation models. An evaluation with observed high-water marks demonstrates that the framework can reasonably simulate flood inundation. Despite the complex error propagation mechanism of the modeling chain, we show that inundation estimates are most sensitive to rainfall estimates. Most notably, QPF significantly underestimates flood magnitudes and inundations leading to unanticipated severe flooding for all stakeholders involved in the event. Finally, we discuss the implications of the hydrodynamic modeling framework for real-time flood forecasting.

54 ENVIRONMENTAL SCIENCES↗

2700 years of Mediterranean environmental change in central Italy: a synthesis of sedimentary and cultural records to interpret past impacts of climate on society

We report abrupt climate change in the past is thought to have disrupted societies by accelerating environmental degradation, potentially leading to cultural collapse. Linking climate change directly to societal disruption is challenging because socioeconomic factors also play a large role, with climate being secondary or sometimes inconsequential. Combining paleolimnologic, historical, and archaeological methods provides for a more secure basis for interpreting the past impacts of climate on society. We present pollen, non-pollen palynomorph, geochemical, paleomagnetic and sedimentary data from a high-resolution 2700 yr lake sediment core from central Italy and compare these data with local historical documents and archeological surveys to reconstruct a record of environmental change in relation to socioeconomic history and climatic fluctuations. Here we document cases in which environmental change is strongly linked to changes in local land management practices in the absence of clear climatic change, as well as examples when climate change appears to have been a strong catalyst that resulted in significant environmental change that impacted local communities. During the Imperial Roman period, despite a long period of stable, mild climate, and a large urban population in nearby Rome, our site shows only limited evidence for environmental degradation. Warm and mild climate during the Medieval Warm period, on the other hand, led to widespread deforestation and erosion. The ability of the Romans to utilize imported resources through an extensive trade network may have allowed for preservation of the environment near the Roman capital, whereas during medieval time, the need to rely on local resources led to environmental degradation. Cool wet climate during the Little Ice Age led to a breakdown in local land use practices, widespread land abandonment and rapid reforestation. Our results present a high-resolution regional case study that explores the effect of climate change on society for an under-documented region of Europe.

58 GEOSCIENCES↗

Advances in central receivers for concentrating solar applications

This paper provides a review of current state-of-the-art commercial central receiver systems and emerging technologies intended to increase the outlet temperature to >700 °C. Research on particle-based, gas-based, and liquid-based receiver designs that can achieve these higher temperatures are discussed. Particle-based technologies include directly irradiated designs (free-falling, obstructed, centrifugal) and enclosed designs (gravity fed, fluidized). New gas-based receivers include micro-channel designs and light-trapping configurations that increase the surface area, heat transfer, and solar absorptance to enable higher fluxes and pressures. Liquid-based receivers and materials that are reviewed include high-temperature halide salts (chlorides and fluorides), carbonate salts, and liquid metals (sodium and lead bismuth). Advantages and challenges associated with each of the technologies and receiver designs are presented.

14 SOLAR ENERGY↗

Therapeutic targeting of membrane-associated proteins in central nervous system tumors

The activity of the most complex system, the central nervous system (CNS) is profoundly regulated by a huge number of membrane-associated proteins (MAP). A minor change stimulates immense chemical changes and the elicited response is organized by MAP, which acts as a receptor of that chemical or channel enabling the flow of ions. Slight changes in the activity or expression of these MAPs lead to severe consequences such as cognitive disorders, memory loss, or cancer. CNS tumors are heterogeneous in nature and hard-to-treat due to random mutations in MAPs; like as overexpression of EGFRvIII/TGFβR/VEGFR, change in adhesion molecules α5β3 integrin/SEMA3A, imbalance in ion channel proteins, etc. Extensive research is under process for developing new therapeutic approaches using these proteins such as targeted cytotoxic radiotherapy, drug-delivery, and prodrug activation, blocking of receptors like GluA1, developing viral vector against cell surface receptor. The combinatorial approach of these strategies along with the conventional one might be more potential. Henceforth, our review focuses on in-depth analysis regarding MAPs aiming for a better understanding for developing an efficient therapeutic approach for targeting CNS tumors.

60 APPLIED LIFE SCIENCES↗

Bound state solution of Dirac equation for Hulthen plus trigonometric Rosen Morse non-central potential using Romanovski polynomial

The bound state solutions of Dirac equation for Hulthen and trigonometric Rosen Morse non-central potential are obtained using finite Romanovski polynomials. The approximate relativistic energy spectrum and the radial wave functions which are given in terms of Romanovski polynomials are obtained from solution of radial Dirac equation. The angular wave functions and the orbital quantum number are found from angular Dirac equation solution. In non-relativistic limit, the relativistic energy spectrum reduces into non-relativistic energy.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Analytical solutions of a generalized non-central potential in N-dimensions

We present that N-dimensional non-relativistic wave equation for the generalized non-central potential with arbitrary angular momentum is analytically solvable in the hyperspherical coordinates. Asymptotic iteration method as a different approach is applied to obtain N-dimensional energy eigenvalues and the corresponding eigenfunctions. In hyperspherical coordinates, the wave function solutions are obtained in terms of hypergeometric functions and Jacobi polynomials. The bound states of quantum systems under consideration for some special cases, such as Hartmann and Makarov potentials, have been discussed in N-dimensions.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Performance Assessment of Pakistani Central Receiver Plant Case Study Using Aimpoint Strategy Optimization Tools

Pakistan has a high potential for both photovoltaic and Concentrated Solar Power (CSP) deployment to meet its energy requirements. Previous feasibility studies have shown that a variety of CSP technologies are both technically and economically viable in the Pakistani climate and can significantly mitigate the country's current lack of grid reliability. This work aims to enhance the performance of a previously designed Central Receiver System (CRS) plant for Pakistan using state-of-the-art aimpoint optimization methods. Results from our case study show that optimized aiming strategies have increased practicality due to their adherence to flux limitations on the receiver, and offer ~2.4% more thermal energy delivered to the receiver for the Pakistani case study compared to modern performance characterization software, translating to up to 149 additional hours of nameplate-capacity production to address the shortfall in an electricity-starved market.

central receiver system↗

Desmearing small-angle scattering data by central moment expansions

This article proposes a robust method for desmearing 1D small-angle scattering (SAS) intensity profiles. Using the central-moment-expansion technique, smearing in SAS intensity profiles is achieved in a model-free manner, eliminating the need for presumptive input during the desmearing. This innovative approach enables data analysis of SAS data without the resolution being convoluted with the structural model, thereby facilitating faster implementation and performance of fitting functions directly from the scattering models.

42 ENGINEERING↗

Desmearing small-angle scattering data by central moment expansions of instrument resolution

This study introduces an enhanced numerical technique tailored specifically for refining 1D small-angle scattering (SAS) intensity profiles affected by smearing. Our primary objective is to address the resolution blurring commonly encountered in SAS data, particularly in systems with clearly defined correlation peaks whose spread aligns with the width of the resolution function at corresponding Q positions. Unlike previous approaches that expanded the SAS intensity using central moment expansion, the new method focuses on expanding the resolution function itself, thus eliminating artificial oscillations observed in smeared spectra due to limitations inherent in our earlier algorithm. This method is straightforward to implement, computationally efficient and consistently performs well in numerical benchmarking. To illustrate its effectiveness, we present a case study of a lamellar phase characterized by distinct peaks in its small-angle neutron scattering intensities.

central moment expansions↗

Desmearing two-dimensional small-angle neutron scattering data by central moment expansions

Resolution smearing is a critical challenge in the quantitative analysis of two-dimensional small-angle neutron scattering (SANS) data, particularly in studies of soft-matter flow and deformation using SANS. Here, we present a central moment expansion technique to address smearing in anisotropic scattering spectra, offering a model-free desmearing methodology. By accounting for directional variations in resolution smearing and enhancing computational efficiency, this approach reconstructs desmeared intensity distributions from smeared experimental data. Computational benchmarks using interacting hard-sphere fluids and Gaussian chain models validate the accuracy of the method, while simulated noise analyses confirm its robustness under experimental conditions. Experimental validation using rheological SANS data from shear-induced micellar structures demonstrates the practicality and effectiveness of the proposed algorithm. The desmearing technique provides a powerful tool for advancing the quantitative analysis of anisotropic scattering patterns, enabling precise insights into the interplay between material microstructure and macroscopic flow behavior.

anisotropic scattering spectra↗

Sci—Fri PM: Dosimetry—04: Radiation out-of-field dose in the treatment of pediatric central nervous system malignancies

Children diagnosed with central nervous system (CNS) malignancies often receive radiotherapy, which can cause radiogenic late effects. In order to identify and reduce the risk of these late effects, we must understand the radiation doses that these children receive. Modern treatment planning systems accurately estimate the absorbed dose within the treatment fields but poorly estimate the dose outside them. The purpose of our study was to measure the out-of-field dose for children receiving localized radiotherapy for CNS cancer and apply an analytical model for estimating dose as a function of distance from the field edge. Radiation fields designed for a 12-year-old boy treated in our clinic were applied to an anthropomorphic phantom containing more than 200 thermoluminescent dosimeters. A double-Gaussian function of absorbed dose versus distance from the field edge (i.e., 50% isodose line) was applied, and parameters were allowed to vary and were fit to the model by minimizing the root mean square deviation, RMSD. The fitted model accurately predicted the dose from distances of 4 cm to 50 cm (RMSD = 0.54 cGy/Gy), but the model was not useful in estimating dose for distances less than 4 cm because of wide variation in measured dose, and the double-Gaussian model failed by systematically underestimating the dose beyond 50 cm. In conclusion, the double-Gaussian model may be applicable for points at distances from the field edge between 4 cm and 50 cm, where most children's radiosensitive tissues are located, but for points beyond 50 cm, an improvement should be investigated.

60 APPLIED LIFE SCIENCES↗