Radiation-Induced Neoplasms

Pictured: MRI images of the brain for neurological Six months after treatment with the radiopharmaceutical therapy, 77.8% of patients with meningioma were alive and had not experienced further disease progression, beating the 26% benchmark established in earlier studies. Phase II data presented Sunday at the American Society for Radiation Oncology annual meeting suggest Novartis’ Lutathera may improve progression-free survival in patients with tough-to-treat meningioma brain tumors. Lutathera is a combination of a radionuclide, 177Lu, and a peptide that binds to somatostatin receptors. The combination enables the targeted delivery of radiation therapy. Lutathera received FDA approval for use against gastroenteropancreatic neuroendocrine tumors in 2018. Novartis has yet to expand the label to cover additional diseases but Lutathera is potentially applicable to other tumors that express somatostatin. That potential informed a Phase II trial led by Kenneth Merrell, a radiation oncologist at the Mayo Clinic Alix School of Medicine. The study was designed to show if Lutathera could be an option for people with meningioma, a brain tumor, who progress after treatment with surgery or radiation. Researchers have reported recurrence rates of 40% to 80% for certain grade meningiomas. As the tumor recurs, patients quickly run out of safe and effective salvage treatments. Because nearly all meningiomas express somatostatin, the Mayo Clinic oncologist identified Lutathera as a drug that could provide people with another option. “There is no standard of care or proven option for managing refractory meningioma,” Merrell said in a statement. “Many of these patients continue to experience aggressive tumor growth and significant related complications, and ultimately the illness may prove fatal. It is a very challenging prognosis to manage, and in many cases, we are left with only supportive measures.” The single-arm study enrolled 20 people with surgery- and radiation-refractory meningioma to receive four administrations of Lutathera eight weeks apart. Six months after treatment, 77.8% of the patients were alive and had not experienced further disease progression. The researchers said earlier studies had established 26% as the benchmark for progression-free survival (PFS) after six months. Median PFS in the Lutathera study was 10.7 months. The trial had yet to reach median overall survival at the time of the ASTRO analysis. One year after treatment, 88.5% of patients were alive. No patients experienced grade 4 or 5 adverse events, the most severe side effects, that were attributable to the treatment. Ten patients had moderate, grade 3 hematologic adverse events. There was also one case each of grade 3 hepatitis and seizure that were at least possibly attributable to treatment. Five people stopped taking Lutathera, in two cases because of possible treatment-related adverse events.

Delivering high-quality emergency care for kids may mean fewer CT scans, according to a new study. The research validates intra-abdominal injury (IAI) and traumatic brain injury (TBI) prediction rules established by the Pediatric Emergency Care Applied Research Network (PECARN). Delivering high-quality emergency care for kids may mean fewer CT scans, according to a new study from UC Davis Health's Department of Emergency Medicine. The research -- published in The Lancet Child & Adolescent Health Journal -- validates intra-abdominal injury (IAI) and traumatic brain injury (TBI) prediction rules established by the Pediatric Emergency Care Applied Research Network (PECARN). The IAI and TBI prediction rules were created by co-principal investigators Nathan Kuppermann, chair of Emergency Medicine, and James Holmes, executive vice chair of Emergency Medicine. They sought to decrease inappropriate computed tomography (CT) use in injured children. According to the Centers for Disease Control and Prevention (CDC), trauma is the leading cause of death in children in the United States. Among pediatric traumatic deaths, TBI has been the most common cause and IAI accounts for 30% of cases. Currently, CT scanning is the standard for diagnosing IAIs and TBIs. However, the procedure is associated with lethal ionizing radiation-inducing malignancies, or cancer, at an estimated rate of one per 500 abdominal CT scans in children younger than five years of age. In adolescents, the figure is one per 600 scans. "A CT scan can be a useful diagnostic tool for diagnosing and treating patients, but it also has risks of radiation-induced malignancy," explained Kuppermann. "By validating these evidence-based rules, we hope to decrease unnecessary CT imaging of children with head or abdominal trauma and increase patient safety by decreasing the risks of potential malignancies." Benefits of IAI and TBI rules The study was conducted at six pediatric trauma centers. However, prior evidence suggests the PECARN IAI and TBI rules can be safely implemented in community hospitals. By utilizing the IAI and TBI rules, community hospitals can increase the readiness of their emergency departments to care for acutely sick and injured children. "The care a child receives in the emergency department can set them on a path to survival or not," explained Holmes. "These rules can increase readiness of emergency departments to ensure that every child receives high-quality emergency care." Additionally, authors of the study believe these results could impact racial and ethnic differences in medical imaging use in emergency departments throughout the United States. "Evidence shows there are racial, ethnic and demographic disparities in medical imaging use in emergency departments," said Kuppermann. "Providing clinicians an evidence-based protocol to follow can standardize and prevent any differences in care." Methods and findings of the study The investigators conducted a prospective cohort study in six Level-1 pediatric trauma centers. They studied the cases of children younger than 18 years with blunt abdominal or minor head trauma. Enrolled children were evaluated if they were positive or negative for the previously derived PECARN prediction rules prior to knowledge of CT results. Overall, 7,542 patients with blunt abdominal trauma and 19,999 patients with head trauma were enrolled in the study. The IAI rule had an accuracy rate of 100% (145/145) for patients needing a CT scan and a negative predictive value of 100% (3,488/3,488). The TBI rule for patients younger than 2 years had an accuracy rate of 100% (42/42) for patients needing a CT scan and a negative predictive value of 100% (2,940/2,940). For children 2 years-and-older, the TBI rule had an accuracy rate of 98.8% (168/170) for patients needing a CT scan and a negative predictive value of 99.97% (6,015/6,017). Neither of the two children with TBIs misclassified by the TBI rule required neurosurgery or other therapy beyond hospital observation. "With this robust validation, these clinical prediction rules should now be widely disseminated and implemented into clinical practice," said Holmes. "Widespread use may further decrease unnecessary CT scans in injured children." Other participating centers in the study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development included Children's Medical Center, Dallas, UT Health Houston, Rady Childrens Hospital San Diego. Children's Hospital, Los Angeles and UCSF Benioff Children's Hospital, Oakland.

The new collaboration aims to advance accelerator science technologies for multidisciplinary real-world applications SINGAPORE, Sept. 20, 2023 /PRNewswire/ -- The Centre for Ion Beam Applications (CIBA), a multidisciplinary research centre at the National University of Singapore (NUS), has recently been designated as an International Atomic Energy Agency (IAEA) Collaborating Centre for Research and Development of Accelerator Science and Multidisciplinary Applications. A Memorandum of Understanding was signed by both parties on 13 September 2023 to formalise the four-year collaboration. CIBA is the first Collaborating Centre in Singapore that has been selected and recognised by IAEA and joins a selected group of high standard technical centres with outstanding contributions in nuclear science and technology in the world. Additionally, CIBA is leading an IAEA Coordinated Research Project (CRP) on single-cell imaging and irradiation using accelerator-based techniques for applications in radiobiology and cancer treatment. The first research coordination meeting for the CRP project was hosted at CIBA on from 18 to 22 September 2023. The IAEA, an autonomous international organisation within the United Nations system, is the international centre for cooperation in the nuclear field. The Agency engages with its Member States and multiple partners worldwide to promote the safe, secure and peaceful application of nuclear science and technologies. Apart from CIBA, there are currently 66 active IAEA Collaborating Centres across the world. Based at the Department of Physics under the Faculty of Science, CIBA conducts cutting-edge research on proton- or ion-based technologies to develop new real-world applications in areas such as materials science, biomedical research and communication technologies. As IAEA's Collaborating Centre, CIBA will provide a platform for access and utilisation of its state-of-the-art research infrastructure and offer its expertise to conduct a wide range of research projects related to accelerator science. The Collaborating Centre will also develop technologies for real-world applications, such as improving batteries for electric cars, better cancer treatment and diagnosis, determining item origin and authenticity, as well as detection of toxic substances. Another mission of the Collaborating Centre is to enhance knowledge transfer through training and networking. "The designation of NUS CIBA as an IAEA Collaborating Centre is a testament to our researchers' quality innovations and expertise. The Collaborating Centre will investigate highly relevant research topics, from materials science to radiobiology, using accelerator-based technologies. We look forward to working with IAEA to spur knowledge transfer and capacity building through local, regional and global research partnerships to develop solutions to real-world problems," said Professor Koh Lian Pin, Vice Dean (Research and Development) at the NUS Faculty of Science. Dr Najat Mokhtar, IAEA Deputy Director General and Head of the Department of Nuclear Sciences and Applications, added, "CIBA has been a pioneer in nuclear microscopy, ion beam analysis, nanofabrication and cell irradiation for many years. The IAEA Collaborating Centre will leverage CIBA's phenomenal research facilities to build capacity and transfer knowledge in Singapore, in Asia and beyond." Since 2000, IAEA and CIBA have collaborated on many fronts through conducting research studies, organising expert lectures and training courses, as well as sharing of knowledge about accelerator science technologies and advancements. The designation of CIBA as an IAEA Collaborating Centre is a recognition of the longstanding collaboration between both parties. "While we have embarked on many collaborative programmes with IAEA in the past, the institution of this Collaborating Centre is an important milestone. CIBA is excited about this opportunity to synergise our strong capabilities and expertise in the research and development of ion-based technologies with IAEA's world-class research infrastructure and research activities. We expect that this partnership will lead to cutting-edge scientific advances and technologies that is expected to create a positive impact," said Associate Professor Jeroen A. van Kan, Director of CIBA. With CIBA as the core partner, the new Collaborating Centre comprises two other NUS research institutes: the Singapore Nuclear Research and Safety Initiative (SNRSI) and the Singapore Synchrotron Light Source (SSLS), will jointly support the Collaborating Centre's activities. Focus areas and real-world impact The Collaborating Centre will focus on four thematic areas: Ion beams for materials science applications The Collaborating Centre will be developing ways to use ion beams to identify the elemental composition and structure of materials. Research in this area will cover a range of applications, such as lithium detection methods for developing advanced batteries for electric cars, and methods to detect foreign elements in microelectronics, environmental and biomedical samples. Advanced ion beam techniques are also highly relevant for space applications and integrated circuit (IC) fault detection. Microscopy and nanofabrication The Collaborating Centre will make use of proton beam writing techniques, developed by CIBA, to fabricate nanofluidic lab-on-chip platform technologies to enable molecular biology analysis such as genetic sequencing. In addition, researchers plan to further develop the single ion fluorescence technology. This involves detecting the light produced by a single ion, a field highly relevant for radiobiology and cancer research. Forensics and heritage sciences The Collaborating Centre will develop and optimise nuclear and X-ray (synchrotron-based) methods for analysing samples of forensic and cultural interest. Research in this area will look into the best preparation methods for forensic and/or heritage samples and quantification strategies – such as data processing methods, analytical databases for forensic purposes, and protocols for authentication and classifying of artefacts – to better characterise samples in forensic casework situations. Areas such as the composition, structure, origin of materials and techniques used to create cultural heritage objects will be investigated. Accelerators for radiobiology The Collaborating Centre also aims to research on improving particle accelerators used for radiobiology applications, with the ultimate goal of enhancing proton beam therapy for tumour eradication to achieve more targeted cancer treatment. SNRSI will take part in radiobiology and forensic collaborative projects and contribute to the development of nuclear knowledge through education programmes, conferences and workshops. SSLS, on the other hand, will provide high resolution analytical investigations with high sensitivity imaging technologies based on X-ray absorption and fluorescence spectroscopy. In addition, SSLS will bring their international collaborative network into the project and provide beamtime for the project activities and partners of the Collaborating Centre. Enhancing knowledge transfer Further to conducting research and training workshops in the four research areas, the Collaborating Centre will also serve as an avenue to make knowledge of accelerator and nuclear science technologies accessible to students. The Collaborating Centre will provide undergraduate and postgraduate students with opportunities to learn more about accelerator-based and other nuclear science techniques through summer school courses and research projects. Advancing cancer treatment through cell imaging and irradiation Accelerator techniques play an important role in the study of radiation effects in biological cells and provide important information on DNA damage and response that can potentially be translated to clinical trials and improved health outcomes for radiation-based therapies. Recent developments such as high-resolution ion beam and synchrotron-based X-ray microscopy, as well as sub-cellular targeting techniques, present opportunities for further research. Addressing this research potential, CIBA led and hosted the first research coordination meeting in Singapore for an IAEA CRP on Single-Cell Imaging and Irradiation in September 2023. The main goal of the project is to develop accelerator technology for improved and better tailored tumour control by proton beam therapy, one of the most advanced forms of radiation cancer treatment available. Novel quantum science-based detectors will be developed for bio-imaging, which will allow scientists to non-invasively view biological functions in real time. The CRP brings together scientists from 12 countries, including IAEA Collaborating Centres like CIBA, to discuss and plan activities and collaborative research to advance the understanding of fundamental questions in radiobiology and cancer treatment. The project will be conducted over five years, until 2028. The CRP's research areas include analysing cellular responses to precisely targeted subcellular irradiation; investigating the uptake of nanoparticles to enhance radio-sensitisation facilitated by high-resolution imaging and irradiation; developing protocols for preparing samples of live and fixed cell specimens; and creating novel hardware and software systems tailored to accelerator beamlines for radiobiology and imaging. Read more at: SOURCE National University of Singapore