Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
Evolution of Hypofractionated Radiotherapy in Breast Cancerkoustavmajumder1986
Hypofractionated radiotherapy in breast cancer is one of the major evolution. It started few decades back. We have to know its history and radiobiological perspective. In this presentation I have tried to cover as much as possible. It would be helpful for all Radiation Oncologist specially the trainees.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
Evolution of Hypofractionated Radiotherapy in Breast Cancerkoustavmajumder1986
Hypofractionated radiotherapy in breast cancer is one of the major evolution. It started few decades back. We have to know its history and radiobiological perspective. In this presentation I have tried to cover as much as possible. It would be helpful for all Radiation Oncologist specially the trainees.
This presentation is intended to refer while doing planning of SBRT Prostate for all practical aspects from Simulation - contouring - planning - treatment. I am sure it will be very useful presentation for any radiation oncologist who are willing to start workflow of SBRT Prostate in the department of radiation oncology
Learning Objectives:
Understand convection-enhanced delivery and its implication for brain tumour treatment
Understand how gold nanoparticles can be used to construct radiation nanomedicine
Learn how to evaluate the safety, toxicity, and effectiveness of radiation nanomedicines
Overview:
Glioblastoma is a devastatingly aggressive type of brain tumour with a low median, and 5-year survival that has lacked new treatment options, in part due to the inability of therapeutic agents to cross the blood-brain barrier. Convection Enhanced Delivery (CED), a clinical neurosurgical strategy has been used to locoregionally deliver various therapeutic agents within the brain. Radiotherapeutic agents, such as 177Lu-labeled gold nanoparticles (177Lu-AuNP), hold promise for treatment of glioblastoma when administered by CED. Intratumoural injections of 177Lu-AuNP administered by CED was evaluated in an orthotopic xenograft mouse model of glioblastoma. SPECT/CT and biodistribution studies were used to evaluate the fate of the 177Lu-AuNP after injection. These results were used to estimate organ radiation absorbed doses. Normal tissue toxicity was evaluated to confirm the safety of the injections. Magnetic resonance imaging and bioluminescence imaging were used to monitor tumour growth after administration of 177Lu-AuNP, and median survival was estimated.
High Risk disease is defined as “apparent localized cancer that has a high propensity of micro-metastatic disease” (cancer that is not visible on convention radiography, such as bone and CT scans). These cancers, once removed via radiation or surgery, are likely to "return," but in fact, they were never removed in the first place because the cancer cells were outside the treated region.
Therefore, successful eradication of high risk disease requires both aggressive local control and systemic treatment with androgen deprivation therapy and extended field radiation. This lecture will review the most up-to-date data on dose-intensity radiation therapy, pelvic radiation, surgery with adjuvant radiation, and adjuvant hormone therapy. Finally, data on experimental chemotherapy and abiraterone (Zytiga) will be presented.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Hypofractionation in breast cancer
1. Hypofractionation in breast cancer
Dr Dodul Mondal
MD, DNB
All India Institute of Medical Sciences, New Delhi
Dodul Mondal
2. Rationale
Standard radiotherapy after BCS or mastectomy for early breast cancer is 50Gy
in 25 daily fractions over 5weeks (followed by 10-16Gy boost if required)
So, Why to shift to Hypofractionation???
Has to be at least equally effective for oncologic outcome
Cosmesis has to be at least equally good
Patient convenience
Can reduce burden on treatment machine
Can it serve better to provide care to more patients?
Dodul Mondal
3. Radiobiology-Fractionation
If α ⁄β ratio of tumor is high (often 10 or greater) and α⁄β ratio of
normal tissue is low (often < 5), lower dose per fraction
(hyperfractionation) is preferred
e.g., HNSCC, Ca lung
If α⁄β ratio of tumor is < normal tissue then a larger dose per fraction
(hypofractionation) is preferred
e.g., prostate cancer, breast cancer
α⁄β= SENSITIVITY TO FRACTION SIZE
Dodul Mondal
4. So, there is a chance that high dose per fraction may be an alternative,
as good, if not better than conventional fractionation…
SCIENCE
BUT
EVIDENCE???
Dodul Mondal
5. Hypofractionation in Breast cancer: Evidence
Hypo-fractionated with dose >2Gy was not popular because of fear of
increased late effect and impaired cosmesis.
Initial hypofractionation studies of 1970s failed to address adequate total dose
adjustment with high dose per fraction excessive late toxicity*
Schedules with lower total dose delivered in fewer, larger fractions were
popular in UK and Canada for several decades e.g. 40Gy/15#/3wk
Retrospective studies suggested similar outcome in terms of local control and
cosmesis.
* Bates TD, Br J Radiol. 1988 Jul;61(727):625-30.
Dodul Mondal
6. Case Series and Cohort Studies Evaluating
Hypofractionation for Whole-Breast Irradiation
Dodul Mondal
8. Local recurrence free survival
Breast appearance
Survival at five years
Late skin toxicity at five years
Late radiation toxicity in subcutaneous tissue
Unconventional fractionation regimens did not affect breast appearance or
toxicity, nor appear to affect local cancer relapse
Dodul Mondal
10. Whelan et al JNCI 2002
I
N
I
T
I
A
L
R
E
S
U
L
T Dodul Mondal
11. Cosmetic outcome and local control: Initial result
Arms Baseline 3 year 5 year
LRC AT 5
YEAR
SWBI 83%(604) 77%(498) 79%(423) 97.2%
AHBI 84%(616) 77%(518) 78%(448) 96.8%
Whelan et al JNCI 2002
Dodul Mondal
16. Royal Marsden-GOC Trial… initial hypothesis
Arm Dose (Gy) No of
Fractions
Dose/fx
(Gy)
Duration
(weeks)
Control Arm 50 25 2 5
Test Arm1 42.9 13 3.3 5
Test Arm2 39 13 3 5
Radiotherapy and Oncology 75 (2005) 9–17
α⁄β= 3
Dodul Mondal
30. Forest plot of late normal tissue effects assessed as moderate/marked by patients and
mild/marked from photographs
Dodul Mondal
31. UK FAST
trial
2003-2007
No of
patients
Total dose
(Gy)
No of
fractions
Fraction size
(Gy)
Time (week)
302 50 25 2 5
308 30 5 6 5
305 28.5 5 5.7 5
Extreme hypofractionation1: UK FAST trial
Dodul Mondal
35. Extreme hypofractionation2: UK FAST Forward trial
40.05Gy/15fx/3week
CONTROL TEST1 TEST2
27 Gy/5 fx/1week
All patients under 40 years
40-49 years with grade 3 tumours and/or LVI.
50-59 years with adverse prognostic factor,
grade or LVI
26 Gy/5 fx/1week
± Sequential Boost
10Gy/5Fx or 16Gy/8fx
Dodul Mondal
38. 367 women
≥70 years
Nonmetastatic T1 or T2
Breast-conserving surgery with or without lymph
node dissection followed by and adjuvant RT
50 Gy (25 fractions, 5 weeks) ± boost OR
Median follow-up 93 months
(9–140)
The 5- and 7-year CSS, LRFS,
and MFS rates were similar in
both groups
HYPOFRACTIONATION is
an acceptable alternative 32.5 Gy (five fractions of 6.5 Gy, once
weekly). No Boost Dodul Mondal
39. At this time, published data support the feasibility of hypofractionated RNI and the need
for a prospective randomized trial addressing clinical outcomes and toxicity of
hypofractionated RNI compared with standard fractionation RNIDodul Mondal
40. Overview of hypofractionation trials
Trials Total Dos(Gy) No .of Fraction Fraction Size (Gy) Time(Week)
Ontario
COG
50 25 2 5
42.5 16 2.65 3
RMH-GOC
50 25 2 5
42.9 13 3.3 5
39 13 3 5
START A
50 25 2 5
41.6 13 3.2 5
39 13 3 5
START B
50 25 2 5
40 15 2.67 3
UK FAST
TRIAL
50 25 2 5
30 5 6 5
28.5 5 5.7 5
SUMMARY OF PUBLISHED TRIALS
Dodul Mondal
42. NRG ONCOLOGY RTOG 1005
A PHASE III TRIAL OF ACCELERATED WHOLE BREAST
IRRADIATION WITH HYPOFRACTIONATION PLUS CONCURRENT
BOOST VERSUS STANDARD WHOLE BREAST IRRADIATION PLUS
SEQUENTIAL BOOST FOR EARLY-STAGE BREAST CANCER
Dodul Mondal
47. Yat Tsang et al. Interim Analysis of Treatment Plans in the IMPORT HIGH (CR UK/06/003) Trial, 2014
Dodul Mondal
48. Hypofractionation in early breast cancer: as good
as conventional fractionation, if not better
Similar locoregional control, survival
Cosmesis is good to excellent
Multiple RCTs, Robust data
Convenient to patients
So, more cost effective
Means to provide necessary care to more patients?
Time to change practice
Dodul Mondal