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PSYCH 1102- Fall 2024
Shaun Nichols (2024-01)
Random Forest-Based Detection of Metastases in Clinically Scanned Lymph Nodes Using Quantitative Ultrasound Imaging
Ghahramani, E.; Hoerig, C.; Wallace, K.; Wu, M.; Mamou, J. (Elsevier, 2025-06-19)
OBJECTIVE: Quantitative ultrasound (QUS) imaging has been used to characterize the microstructural properties of tissue using information contained in the backscattered radiofrequency (RF) echo signals. QUS methods were previously applied to detect metastases in excised human lymph nodes (LNs) that were raster scanned using a 30 MHz single-element transducer ex vivo. In the current study, a QUS-based method to detect in vivo LN metastases using a clinical scanner was developed. METHODS: Parallel RF frames were captured from 46 cervical and axillary LNs in 45 patients and two backscatter coefficient-based and two envelope statistics-based QUS parameters were computed and averaged for each frame. Different combinations of these four QUS parameters, along with the LN's short-axis and short-to-long axis ratio, were used to train random forest models to classify metastatic LNs. RESULTS: The average QUS parameters and radiomics features were significantly different between metastatic and benign LNs (p‚â§10-4), except for effective scatterer diameter (p = 0.70). The best-performing random forest model, trained using a combination of QUS and radiomics features, identified metastatic LNs with an area under the receiver-operating characteristic curve of 0.91 and 67% specificity at 100% sensitivity. CONCLUSION: These results demonstrate the potential of QUS imaging using a clinical scanner for identifying metastatic LNs in vivo to help clinicians perform a more selective LN biopsy or excision.
Dual blockade of PD-1 and CTLA-4 generates long-lasting immunity against irradiated glioblastoma
De Martino, M.; Daviaud, C.; Lira, M.C.; Hernandez-Zirofsky, K.; Vanpouille-Box, C. (Elsevier, 2025-06-06)
Radiation therapy (RT) can release pro-inflammatory signals to jumpstart an anti-tumor immune response. However, glioblastoma (GBM) often recurs, suggesting that RT might not act as an immune adjuvant in this disease. A possible explanation for the lack of immune stimulation is the use of irradiation regimens that do not effectively stimulate anti-tumor immunity against GBM. Here, we tested the ability of various RT schedules to elicit type I interferon (IFN-I) response and explored its synergy with immunotherapy (IT) to trigger anti-tumor immunity against GBM.Using three murine GBM models, we show in vitro that single dose radiation ranging from 0Gy to 20Gy and fractionated radiation schedules (i.e. 3 daily fractions of 8Gy; 3x8Gy and 5 daily fractions of 6Gy; 5x6Gy) accumulates double stranded DNA and release IFN-I related cytokines in a dose-dependent fashion; with fractionated schedules being superior in triggering cancer-cell intrinsic IFN-I responses. Side-by-side comparison of various radiation regimen in vivo revealed that 5x6Gy better control GBM across the three GBM models tested. However, the addition of anti-PD1 or anti-CTLA4 to an immunogenic radiation schedule (i.e. 5x6Gy) did not prolong survival of irradiated mice. Surprisingly, only the dual blockade of PD-1 and CTLA4 promoted the expansion of proliferative T cells and conveyed immunological memory against irradiated GBM.Overall, this study demonstrates that an immunogenic radiation regimen is not sufficient to mount an anti-tumor immune response when combine with IT as monotherapy and highlights the need to combine an immunogenic irradiation with multiple IT to overcome immunosuppression of GBM.
Cancer Prognostic Awareness: Relations to Patient and Caregiver Quality of Life and Care Preferences
Krueger, E.; Mosher, C.E.; Lewson, A.; Hickman, S.E.; Wu, W.; Prigerson, H.G. (Elsevier, 2025-06-10)
CONTEXT: Patients who are prognostically aware are more likely to receive end-of-life care consistent with their values. However, prognostic awareness has shown mixed associations with patients' quality-of-life (QoL) outcomes. Theory suggests that acceptance of cancer may moderate relationships between prognostic awareness and outcomes of QoL and end-of-life treatment preferences. Patients' degree of prognostic awareness and illness acceptance may also impact their family caregivers' QoL and end-of-life treatment preferences for the patient. OBJECTIVES: To examine the potential moderating role of patient acceptance of cancer in the relationships between patient prognostic awareness and both patient and caregiver QoL and end-of-life treatment preferences. METHODS: A cross-sectional, secondary analysis was conducted using data from patients with advanced cancer (n=243) and their caregivers (n=87) in the multi-institutional Coping with Cancer-II cohort study. Patient physical, psychological, and existential QoL were examined in a moderation path analysis. Caregiver physical and psychological QoL were examined in separate linear regression analyses. Patient and caregiver end-of-life treatment preferences were examined in multiple logistic regression moderation models. RESULTS: No significant moderations were found. Greater patient illness acceptance was associated with better patient QoL outcomes and caregiver psychological QoL but was unrelated to end-of-life treatment preferences. Greater patient prognostic awareness was associated with worse patient physical QoL and both patients' and caregivers' preference for comfort care. CONCLUSION: Increasing patients' prognostic awareness and cancer acceptance may improve values-consistent end-of-life care and patient and caregiver QoL outcomes. Findings support timely conversations to promote prognostic awareness and further testing of acceptance-based interventions in advanced cancer.
Intraoperative Margin Analysis Does Not Improve Outcomes in Treatment-Naive or Neoadjuvantly-Treated Patients With Pancreatic Ductal Adenocarcinoma
Li, X.; Malik, P.; Bhalla, A.; McAuliffe, J.C.; Panarelli, N.C. (Elsevier, 2025-06-20)
The prognostic relevance of intraoperative frozen section (IOF) margin analysis for patients with pancreatic ductal adenocarcinoma (PDAC) is debatable in both those treated with upfront surgery and neoadjuvant therapy. We analyzed the impact of intraoperative and final microscopic margin clearance in neoadjuvantly treated (n=71) and treatment naive (n=109) patients with PDAC. Overall survival (OS) was longer in the treatment naive (43 months) compared to the neoadjuvant (27 months) cohort (p=0.02). Overall, 24 (34%) patients in the neoadjuvant and 22 (20%) patients in the treatment naive group had positive final margins, 13 and 10 of which were detected intraoperatively, respectively. At a median follow-up of 21 months, recurrence rates were 65% in the treatment naive and 66% in the neoadjuvant cohort and were similar regardless of margin status assessed via IOF or permanent sections. Disease free survival (DFS) was significantly shorter in treatment naive patients with positive (11 months) compared to negative (30 months) final margins (p=0.03). Neither IOF nor final margin status was significantly associated with DFS in neoadjuvantly treated patients, nor were they associated with OS in either cohort. Multivariate analysis showed that lymphovascular, and perineural invasion were significantly associated with DFS, and lymphovascular invasion was significantly associated with OS. Our results suggest that IOF of selected margins does not correlate with survival and is of limited utility in treatment naive and neoadjuvantly treated PDAC patients.