To access the inter- and intra-fractional tumor changes in volume, position during SBRT course, and to investigate the effects of these changes on treatment plans. This retrospective study included 52 patients of stage I NSCLC treated with SBRT (at a total dose of 48.0-50.5 Gy in four sessions), under breath-holding technique. For each fraction, CT scans were performed to localize the target and then repeated after beam delivery using CT-on rail system. The displacements of tumor position were calculated utilizing vector analysis. The intra-fractional tumor movements in left-right (LR), anterior-posterior (AP), superior-inferior (SI) directions were compared to the ITV and PTV margins. The inter-fractional shifts were also measured and compared with thresholds of 5 (mm) or 10 (mm). The changes in gross tumor volume (GTV) were assessed between the simulation and the last day. We investigate the impact of those changes on target dosimetric coverage by evaluating the homogeneity index (HI), conformity index (CI), from the plans of simulation and last SBRT day. A total of 520 CT scans were registered for analysis. The initial SBRT plan was used as a baseline for reference. There are 29% GTVs increased by 10% or more, and 30% patients had tumor shrinkage at least 10% on the last day. The intra-fractional tumor motions (mm) were 1.7 ± 1.5; 1.2 ± 1.1; and 1.2 ± 1.1 in RL, AP, SI directions, and the proportions of tumor movement out of ITV and PTV were 84.6% and 7.7% cases, respectively. The inter-fractional shifts (mm) of the tumor position were as follows: RL, 5.9 ± 3.2; AP, 2.3 ± 1.9; SI, 10.2 ± 6.7; For all fractions, the shift vectors ranged from 0 mm to 30 mm, with 58%, 14% of all fractions having dislocation ≥ 5mm, ≥ 10mm, respectively. There were statistically significant differences of HI, CI between initial plan and one utilizing the last treatment day CT images. Remarkable enlargement of GTVs and variance in tumor motion have occurred during the short SBRT period, result in limiting the quality of radiotherapy plan. Implementation of ART might be a potential solution to reduce the effect of tumor changes and improve the treatment delivery for patients with significantly increased tumor volume and movements.

The purpose of the study was to investigate the association between tumor volume changes during stereotactic body radiation therapy (SBRT) and prognoses in stage I non-small-cell lung cancer (NSCLC). This retrospective review included stage I NSCLC patients in whom SBRT was performed at a total dose of 48.0-50.5 Gy in four or five fractions. The tumor volumes observed on computed tomography (CT) simulation and on the CT performed at the last treatment session using a CT-on-rails system were measured and compared. Then, the tumor volume changes during the SBRT period were measured and assessed for their association with prognoses (overall survival, local control, lymph node metastases and distant metastases). A total of 98 patients with a mean age of 78.6 years were enrolled in the study. The T-stage was Tla in 42%, Tlb in 32% and T2a in 26% of the cases. The gross tumor volume (GTV) shrank and increased >= 10% in 23 (23.5%) and 36 (36.7%) of the cases, respectively. The 5-year local control and overall survival rates in the groups with a tumor shrinkage of >= 10% vs the group with a shrinkage of <10% were 94.7 vs 70.8% and 85.4 vs 47.6%, respectively; these differences were significant, with a P-value < 0.05. During a short SBRT period, the tumor shrank or enlarged in a small number of cases. A decrease of >= 10% in the GTV during SBRT was significantly related to better overall survival and local control.

Double hit diffuse large B cell lymphoma (DLBCL) is associated with aggressive course and poor outcomes. We herein report a patient who failed multiple chemotherapies but had complete pathologic response to ibrutinib and rituximab (IR).

The EGFR Exon 20 T790M mutation is nowadays widely mentioned in studies on the treatment of non-small cell lung cancer. Especially the secondary mutation T790M or acquired T790M mutation. Aims: I. Investigation of EGFR Exon 20 T790M mutation appears secondary to treatment with targeted therapy or chemotherapy. II.Ability to diagnose EGFR Exon 20 T790M secondary mutation of clinical specimens: Histology - Cytology - Plasma.

EGFR mutations in NSCLC therapy play a very important role. Currently, many types of specimens are used to perform EGFR mutations. At Pham Ngoc Thach Hospital with RealTime-PCR Technique on cobas @ z 480 machine has been done on a variety of clinical specimens.

Previous studies have shown that in utero stressors can lead to developmental instability (DI). This DI can possibly predispose to disease susceptibility later in life. A composite of differences in bilateral anatomic trait measurements is termed fluctuating asymmetry (FA) and serves as an indicator of DI. Evidence from our laboratory has pointed to the ulna as abnormally symmetric in persons with chronic low back pain (LBP) but not in persons with acute LBP. It was unclear from the previous study whether the duration and the severity of LBP was a factor in this abnormal asymmetry. To explore these questions we examined the relationship between FA in event-related and non-event-related causes of the LBP, which were further classified according to pain severity. A severity index was developed based on frequency of treatment for LBP. Ulna, lower arm, hand width, hand length, wrist width, and third proximal phalange lengths were measured in 109 patients with LBP and 122 controls in four hospitals and clinics in Southern California. Information on the duration and cause of the LBP was obtained by questionnaire. We postulated that the highest incidence of FA would be found in subjects with chronic LBP stemming from non-event-related causes, which might be due to developmental errors. Furthermore, we suspected that the severity of LBP would be directly related to the size of FA. Our results indicated that persons with LBP of more than 6 months9 duration had significant rightward asymmetry in the ulna (p = .04) and a trend to rightward asymmetry in the composite of six hand and arm traits (p = .056). Results indicated no difference between event-related causes, non-event-related causes, and control FA of the ulna. We also found no significant relationship between the LBP severity index and measures of FA or of directional asymmetry. These findings support the results in the previous study showing elevated rightward directional asymmetry in chronic LBP patients. Although our data do not support a relationship between ulnar asymmetry and cause and severity of LBP, other traits, not yet analyzed, may demonstrate such a relationship.