Wesley Hospital

Abstract BACKGROUND The prospective multi-site trial evaluating O-(2-[18F]-fluoroethyl)-L-tyrosine Positron Emission Tomography (FET-PET) in Glioblastoma (FIG) study is currently recruiting. This abstract aims to evaluate the impact of full central Nuclear Medicine physician (NMP) review of prospective FET-PET1 delineation of the biological target volume (BTV) for radiotherapy (RT) planning. MATERIAL AND METHODS Adult GBM participants across 11 Australian sites undergo up to 3 FET-PET studies post-surgery/pre-chemo-RT [CRT] (FET-PET1), one month post CRT (FET-PET2) and at suspected progression evaluation timepoint (FET-PET3). Group 1 participants enter at timepoint 1 (FET-PET1 with MRI1), with Group 2 at timepoint 2. Adjuvant RT target volumes are derived per standard contrast MRI. These are compared to hybrid post-hoc RT volumes incorporating the FET-PET1 NM-derived BTV utilising MiM version 7.0 to evaluate the impact of FET PET on potential treatment planning. All trial sites and NMP have passed credentialling which included three benchmarking cases involving FET1-BTV delineation. RESULTS Recruitment commenced in January 2021, with 253 (n=156 Group 1 and n=97 Group 2) participants enrolled to date, n=144 with evaluable FET-PET1 data. Trial credentialling demonstrated variations in FET-PET1-derived BTV in 25/72 (34.7%) -13 minor and 12 major. All n=144 prospective participant FET-PET1 with BTV delineation cases across 11 sites have undergone central NMP review, with 20/144 (13.9%) requiring resubmission. Reasons for resubmission/protocol deviation included incorrect imaging sequence selection within MiM workflow (n=3/20), static GTV overcontouring (n=12/20), dynamic volume of interest change in size/position during workflow (n=1/20) and static FET interpretation issues (n=3/20). Central radiation oncology review of hybrid BTV-derived RT volumes is underway. CONCLUSION The importance of credentialling and full central review of all prospective FET-PET-derived BTV delineation in FIG trial participants is demonstrated. The FIG study remains the largest prospective multi-site study of its kind addressing the impact of FET-PET on radiation planning, management of pseudoprogression and prognostication.

The tumor microenvironment (TME) is composed of a diverse and dynamic spectrum of cell types, cellular activities, and cell–cell interactions (CCI). Understanding the complex CCI within the TME is critical for advancing cancer treatment strategies, including modulating or predicting drug responses. Recent advances in omics technologies, including spatial transcriptomics and proteomics, have allowed improved mapping of CCI within the TME. The integration of omics insights from different platforms may facilitate the identification of novel biomarkers and therapeutic targets. This review discusses the latest computational methods for inferring CCIs from different omics data and various CCI and drug databases, emphasizing their applications in predicting drug responses. We also comprehensively summarize recent patents, clinical trials, and publications that leverage these cellular interactions to refine cancer treatment approaches. We believe that the integration of these CCI-focused technologies can improve personalized therapy for cancer patients, thereby optimizing treatment outcomes and paving the way for next-generation precision oncology.

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Left atrial strain (LAS) is a novel speckle-tracking technique used in the assessment of left atrial function. It has been shown to be a marker for adverse cardiac events (heart failure, myocardial ischemia, and atrial fibrillation). This study aimed to assess the role of LAS in assessing risk for diastolic dysfunction and myocardial ischemia in stress echocardiography (SE) before and after treadmill exercise. Patients undergoing routine Bruce protocol SE had LAS measurements (reservoir, conduit, and contractile strain) assessed before and after maximal treadmill exertion. Changes in LAS were measured and compared based on the result of the SE. Consecutive SE (n=420) were analyzed (mean age 62±5 years, 37% female). LAS was able to be estimated before and after stress in 367 patients, including 313 Normal SE, 32 Ischemic SE, and 22 Abnormal DST. All LAS measurements (reservoir, conduit, and contractile strain) increased significantly in Normal SE. The LAS measurements did not significantly change for patients with Ischemic SE and Abnormal DST. Using a receiver operator curve analysis and linear regression, apical 4-chamber reservoir LAS was found to be the best differentiator between Normal SE and abnormal tests (Ischemic SE and Abnormal DST). Change in LAS before and after treadmill exercise differentiated Normal SE and abnormal SE (Ischemic SE and Abnormal DST). It may represent a novel non-invasive assessment for diastolic stress echocardiography.

Australia is planning to construct a network of hydrogen (H2) pipelines to deliver H2 to hard-to-abate industries. Similarly, a network of carbon dioxide (CO2) pipelines will be required to deliver captured CO2 from industry and direct air capture (DAC) facilities to sequestration sites, and to enable beneficial use of CO2. Major universities in Australia partnered with Princeton University to prepare the Net Zero Australia Study. They created a model to determine the lowest cost physical infrastructure required for Australia to reach net zero for both domestic energy and exports. The model showed that for Australia to reach net zero using today’s technology, it could need nearly 15,000 km of H2 pipelines, 20,000 km of CO2 pipelines and approximately 8000 km of water pipelines depending on the scenario. Australia currently has approximately 42,000 km of gas pipelines. This study showed that we need to build around another 42,000 km of pipelines to achieve net zero. It has taken us over 60 years to build the first 42,000 km and now we need to build the next 42,000 in just 25 years. To efficiently transport CO2 via pipelines, it is compressed to a super-critical phase liquid which can cause long running fractures in the event of failure requiring a very different approach to their design. Similarly, H2 pipelines require a very different approach due to the potential for embrittlement and need to also provide storage. This paper describes the alternative engineering approach to designing these pipelines to safely transport and store these energy transition fluids.

The Birmingham Orthopaedic Oncology Meeting (BOOM), held in January 2024, convened 309 delegates from 53 countries to discuss and refine 21 consensus statements on the optimal management of chondrosarcoma. With representation from Europe (43%; n = 133), North America (17%; n = 53), South America (16%; n = 49), Asia (13%; n = 40), Australasia (5%; n = 16), the Middle East (4%; n = 12), and Africa (2%; n = 6), the combined experience of treating bone sarcomas among attendees totalled approximately 30,000 cases annually, equivalent to 66 years of experience in the UK alone. The meeting's process began with the formation of a local organizing committee, regional leads, and a scientific committee comprising representatives from 150 specialist units across 47 countries. Supported by major orthopaedic oncology organizations, the meeting used a modified Delphi process to develop consensus statements through online questionnaires, thematic groupings, narrative reviews, and anonymous pre-meeting polling. Strong (> 80%) consensus was achieved on 19 out of 21 statements, reflecting agreement among delegates. Key areas of consensus included the role of radiology in diagnosis and surveillance, the management of locally recurrent disease, and the treatment of dedifferentiated chondrosarcoma. Notably, there was agreement that routine chemotherapy has no role in chondrosarcoma treatment, and radiological surveillance is safe for intraosseous chondrosarcomas. Despite the overall consensus, areas of controversy remain, particularly regarding the treatment of atypical cartilage tumours and surgical margins. These unresolved issues underscore the need for further research and collaboration within the orthopaedic oncology community. BOOM represents the largest global consensus meeting in orthopaedic oncology, providing valuable guidance for clinicians managing chondrosarcoma worldwide. The consensus statements offer a reference for clinical practice, highlight key research priorities, and aim to improve patient outcomes on a global scale.

Co-axial plastic double pigtail stents (DPSs) are commonly placed through lumen apposing metal stents (LAMS) in patients with pancreatic fluid collections (PFCs) to decrease the risk of adverse events. In this meta-analysis, we have compared the outcomes of LAMS plus co-axial DPS versus LAMS alone in patients with PFCs. We reviewed several databases to identify the studies that compared outcomes of LAMS with DPS to LAMS without DPS in the treatment of PFCs. Our outcomes of interest were overall adverse events, clinical success and individual adverse events such as stent (LAMS) migration, stent occlusion, bleeding, and infection. We calculated pooled risk ratios (RR) with 95% confidence intervals (CIs) for the analysis of outcomes. We used a random effects model to analyze the data. Heterogeneity was assessed using the I 2 statistic. We included 10 studies with 685 patients. Rate of overall adverse events was significantly lower in the LAMS+DPS group compared with LAMS alone, RR (95% CI) 0.58 (0.40, 0.87). There was no significant difference in the rate of clinical success between groups, RR (95% CI) 1.03 (0.94, 1.13). We found no significant difference in rate of stent occlusion between groups. Rate of infection was significantly lower in LAMS+DPS group, RR (95% CI) 0.46 (0.24, 0.85). There was no significant difference in rate of bleeding and stent (LAMS) migration between groups. Addition of co-axial DPS to LAMS decreases the risk of adverse events in patients with PFCs and should be considered in all patients with PFCs.