SummaryBackground Friedreich's ataxia (FA) is a progressive, multisystem, degenerative disorder caused by a reduction in frataxin. Loss of frataxin results in mitochondrial dysfunction and oxidative damage in patients and model systems. Previous studies have indicated that the antioxidant idebenone (5 mg/kg daily) reduces cardiac hypertrophy, but defi nite improvement in neurological function has not been shown.

PurposeTo report toxicity and early survival data for IDEAL-CRT, a trial of dose-escalated concurrent chemoradiotherapy (CRT) for non-small cell lung cancer.Patients and MethodsPatients received tumor doses of 63 to 73 Gy in 30 once-daily fractions over 6 weeks with 2 concurrent cycles of cisplatin and vinorelbine. They were assigned to 1 of 2 groups according to esophageal dose. In group 1, tumor doses were determined by an experimental constraint on maximum esophageal dose, which was escalated following a 6 + 6 design from 65 Gy through 68 Gy to 71 Gy, allowing an esophageal maximum tolerated dose to be determined from early and late toxicities. Tumor doses for group 2 patients were determined by other tissue constraints, often lung. Overall survival, progression-free survival, tumor response, and toxicity were evaluated for both groups combined.ResultsEight centers recruited 84 patients: 13, 12, and 10, respectively, in the 65-Gy, 68-Gy, and 71-Gy cohorts of group 1; and 49 in group 2. The mean prescribed tumor dose was 67.7 Gy. Five grade 3 esophagitis and 3 grade 3 pneumonitis events were observed across both groups. After 1 fatal esophageal perforation in the 71-Gy cohort, 68 Gy was declared the esophageal maximum tolerated dose. With a median follow-up of 35 months, median overall survival was 36.9 months, and overall survival and progression-free survival were 87.8% and 72.0%, respectively, at 1 year and 68.0% and 48.5% at 2 years.ConclusionsIDEAL-CRT achieved significant treatment intensification with acceptable toxicity and promising survival. The isotoxic design allowed the esophageal maximum tolerated dose to be identified from relatively few patients.

This article discusses the use of assessed quality of life scores for organization and systems‐level monitoring and reporting, quality improvement, and research. Information presented is based on the experiences of policy makers, service/supports providers, and researchers who have used an eight‐domain quality of life model and the measurement of domain‐referenced indicators. In reference to each use, we provide examples, identify critical issues, and suggest a number of practice guidelines.

Objective: To ascertain the progress being made towards the implementation of stereotactic ablative body radiotherapy (SABR) treatment in the UK, to obtain details of current practice in centres with an active treatment programme and to assess the projected future provision. Methods: In August 2012, an online questionnaire was sent to all 65 UK radiotherapy institutions. The included questions covered the current number of patients being treated and the intended number of patients for each clinical site; immobilization and motion management methods; CT scanning protocols; target and organ-atrisk delineation; treatment planning; image-guidance and treatment protocols; and quality assurance methods.Results: 48/65 (74%) institutions responded by the end of November 2012, with 15 indicating an active SABR programme. A further four centres indicated that a SABR protocol had been established but was not yet in clinical use. 14 of the 29 remaining responses stated an intention to develop a SABR programme in the next 2 years. Conclusion: The survey responses confirm that SABR provision in the UK is increasing and that this should be expected to continue in the next 2 years. A projection of the future uptake would suggest that by the end of 2014, UK SABR provision will be broadly in line with international practice.Stereotactic ablative body radiotherapy (SABR) uses hypofractionated dose schedules (three to eight fractions) and high-precision treatment delivery to improve local control of disease. The radiobiological rationale for hypofractionation, that delivery of a few large fractions over a short overall treatment time will achieve a greater therapeutic ratio than delivery of standard treatment regimes of 20 or more fractions, is indicated in numerous studies for a range of clinical indications.1,2 This evidence is most robust in patients with non-small-cell lung cancer (NSCLC), where a recent systematic review found 2-year survival and local control rates after SABR of 70% and 91%, respectively.3 Despite the lack of randomized trial evidence, SABR is now a recognized standard of care for inoperable patients with early-stage peripheral lung tumours, 4 while a recent systematic review of the use of SABR for treatment of central lung tumours found local control rates .85% for biologically equivalent tumour doses .100 Gy, with low rates of treatmentrelated toxicity.5 These promising outcomes have led to suggestions that SABR could be an acceptable alternative to surgery in operable patients with NSCLC, potentially enabling a balance to be struck between the risk of morbidity and mortality of lobectomy, with the increased risk of locoregional recurrence from SABR. [6][7][8]

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