ab.com, free download arctis 2017 full.Contemporary treatment of metastatic bone disease.
Locoregional radiotherapy (RT) is the mainstay of treatment for patients with oligometastatic bone disease (OMD) from a variety of solid tumors. For decades, RT was administered using a high-dose (≥30 Gy) and short-course (3-8 wk) approach, often combined with systemic chemotherapy. More recently, targeted treatment options have emerged and have been incorporated into clinical practice. RT dose is now frequently escalated to ≥35 Gy in 1-5 fractions, delivered with or without concurrent systemic chemotherapy. These changes in treatment approach have been driven by two interrelated concerns. First, higher RT doses may be associated with less efficacy due to their indirect cytotoxic effect rather than direct killing of cancer cells. In turn, this may result in more local recurrences. Secondly, longer RT treatment courses may be associated with greater toxicity, particularly as the number of fractions delivered increases. This may have considerable implications for patient management. It has recently been suggested that a tumor cell kill probability of ≥0.25 (i.e., half of all tumor cells killed per fraction) is required to achieve a positive clinical outcome. For the vast majority of primary tumor sites, this fraction size is well below 0.25. For this reason, the current approach to RT for OMD is still most often based on toxicity rather than efficacy. The long-term, retrospective results of randomized trials to evaluate this approach are awaited.Kaleiwa-Konohe Bridge
The Kaleiwa-Konohe Bridge is a reversible contra-flow bascule bridge spanning the Hōnohā Channel on the Hāna Highway on the island of Oahu in Hawaii. The concrete towers on both sides of the Hāna Highway were constructed in 1969 and the bridge was completed in 1970. It is the southernmost bridge on the highway, located at mile marker 121.
The bridge is located at a point where the Hāna Highway crosses the Hōnohā Channel, a northward continuation of the Māmalahoa Channel of the Waiheʻe Channel System that separates the two main islands of the Hawaiian archipelago.
The bridge was designed by the Hawaii Department of Transportation in 1969, after pressure from the County of Maui, in order to connect the residents of the islands of Oahu and Maui by providing
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