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- Shraim, M. A., et al.
(författare)
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Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study
- 2022
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 163:9, s. 1812-1828
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Tidskriftsartikel (refereegranskat)abstract
- Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold); and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination-134 features, quantitative sensory testing-34, imaging and diagnostic testing-14, and pain-type questionnaires-14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.
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- Konradsson, E, et al.
(författare)
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Intracavitary Electron FLASH Radiotherapy in a Canine Cancer Patient With Oral Malignant Melanoma
- 2021
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Ingår i: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier BV. - 0360-3016. ; 111:3S, s. 31-31
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE/OBJECTIVE(S): Studies of electron FLASH radiotherapy (FLASH-RT) in companion animals are being conducted at several institutions. High energy electron beams are generally suitable for treatment of superficial cancers, but of limited use for deep-seated tumors. In this case report, the feasibility of intracavitary electron FLASH-RT is demonstrated.MATERIALS/METHODS: A canine cancer patient with a large oral malignant melanoma in the caudal part of the hard palate was palliatively treated with FLASH-RT at a modified clinical linear accelerator, using a cylindrical PMMA applicator (length 200 mm, inside diameter 50 mm). The patient had a poor prognosis, with an estimated survival of two weeks and no other available treatment options. A dose of 35 Gy was delivered to the depth of dose maximum in 26 pulses with a pulse dose rate of 4.5•105 Gy/s. The average dose rate was 280 Gy/s, corresponding to a total beam-on time of 125 months. One month after the treatment, the tumor was re-irradiated, using the same treatment parameters. The treatment head of the LINAC was fitted with a short electron applicator holder with a Cerrobend collimator at 65 cm from the source. The cylindrical PMMA applicator was aligned perpendicularly to the Cerrobend collimator using soft docking with a 1 cm gap. Prior to the treatments, the 2D dose distribution of the FLASH beam exiting the PMMA applicator was measured with radiographic film. In addition, the dosimetric effect of misalignment between the collimator and the electron applicator was studied based on intentional misalignments of 2.5°, 5°, 2.5 mm, and 5 mm.RESULTS: A partial response of the tumor and clinical improvement of the patient was observed two weeks after the first treatment. A hypopigmented area in the hard palate was observed, consistent with a grade 1 adverse event, but there were no signs of mucositis or reports of patient discomfort. However, due to the thickness of the tumor (> 3 cm), the posterior part only received a limited dose, and the tumor was still obstructing the airflow at one month post treatment. At this time, a second treatment was administered with limited normal tissue receiving full dose from both treatments. At one month post the second treatment, a partial response was achieved, and no evidence of side effects other than hypopigmentation was observed. The patient was euthanized 2.5 months after the initial therapy due to progressive disease involving the oropharynx. The dosimetric evaluation showed that a conformal dose distribution could be obtained by delivering the electron beam using a cylindrical PMMA applicator. Misalignments between the applicator and the collimator were shown to result in reduced dose homogeneity.CONCLUSION: This case report of a canine cancer patient, with a large oral malignant melanoma in the caudal part of the hard palate, has demonstrated the feasibility of intracavitary electron FLASH-RT. Two treatments of 35 Gy each, resulted in prolonged survival and increased quality-of-life.
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