Saturday, April 3, 2010

Stereotactic body radiotherapy (CK) for prostate cancer

from the IV MB, by yyy60:

>>Stereotactic body radiotherapy (CK) for prostate cancer

Friday, 02 April 2010

Beyond the Abstract - Stereotactic body radiotherapy for organ-confined prostate cancer, by Alan J. Katz, MD, JD

BERKELEY, CA ( - Our paper reports on the largest series of patients treated with CyberKnife® for prostate cancer at one institution.

In the year since we compiled the data, we have continued to be encouraged by the efficacy and toxicity profile. We still have not seen a local failure in the low or intermediate risk patients, with our early group treated with 35gy having a median followup of 42 months. For two reasons, we have decreased our dose back from 36.25 Gy to 35 Gy. First, 35 Gy has been very effective, with a 36 month median PSA of 0.15, which is highly predictive of excellent long-term control according to the literature. Secondly, our 36.25 group did experience a small increase in the rate of Grade2-3 urethral toxicity.This is predictable based on the radiobiology. If the alpha-beta ratio for prostate cancer is 1.5 (that is, prostate cancer cells are highly sensitive to dose per fraction), then 35Gy in 5 fractions is the equivalent of 92 Gy in 1.8Gy fractions. This dose is on the flat part of the dose response curve, and therefore dose escalation is not necessary to maximize control. The alpha beta ratio for late complications is probably around 3, and therefore the 35Gy dose is in the 70-75 Gy range for late complications. Therefore, I believe we are on the steep part of the dose response curve for complications and the 3% increase in the dose to 36.25 predictably increased toxicity in the urethra by bringing us to almost 80 GY dose equivalent. Adjusting the dose down should and does reduce late toxicity.

We did not see a concomitant increase in rectal toxicity, probably because we spared the rectal tissues with the conformality achieved with CyberKnife® technology, and we used the radioprotector Amifostine intrarectally prior to each fraction. Our potency preservation remains at 80%.

I am especially encouraged by our excellent results with intermediate and high risk disease with CyberKnife® alone. I will be publishing a series of patients who received a CyberKnife® boost after 45Gy to the pelvis for this category. There appears to be no benefit to adding the external beam in terms of efficacy and there is slightly greater rectal toxicity. If CyberKnife® alone is optimal treatment, this will afford a wide range of prostate cancer patients the chance to reduce their treatments from 45 to 5. This would be a huge benefit to older patients, especially those that have to travel long distances for radiation therapy. In addition, there is a great cost benefit to society. Medicare reimbursement for a five day CyberKnife® treament is less than IMRT and a small fraction of the cost of Proton beam therapy.

I believe that my series and the other two series, from Naples and Stanford, provides substantial early evidence that this dose fractionation scheme is highly effective and safe when delivered with CyberKnife® technology. Since my PSA nadirs are so low, I am very optimistic that our data will hold up with more follow up over time. It should be time for those who claim this treatment to be experimental to soften their position. To date, no form of radiotherapy has been compared to another with a prospective randomized trial. Therefore, I do not believe this to be necessary before offering patients the option of CyberKnife®. However,I would welcome such a trial against IMRT,protons or brachytherapy.

Thursday, April 1, 2010

Google data center outage - ;-)

Thursday, April 01, 2010 6:49 AM

If you logged into Gmail over the last hour (or visited the Gmail homepage), you probably noticed that something looked a bit off: all the vowels are missing. We realize this makes things difficult for all of you who rely on Gmail — whether at home or at work — and we’re incredibly sorry. We take morphological issues like this extremely seriously, so we want to let you all know what happened and what we're doing about it.

At 6:01 am Pacific Time, during routine maintenance at one of our datacenters, the frontend web servers in that particular datacenter started failing to render the letter 'a' for a subset of users. As error rates escalated, the strain spread to other datacenters. We worked quickly to avoid a cascading failure of the entire alphabet by implementing a stopgap solution that limited the damage to the letters 'a,' 'e,' 'i,' 'o,' and 'u.' As a result, we're experiencing Gmail’s first temporary vowel outage. (We’re still investigating whether the letter 'y' is impacted and will post an update here shortly.)

Over the last hour we've received numerous reports of this issue via our help forums, from colleagues at Google, and via email you’ve sent us. Some of you have already found creative workarounds for communicating without vowels, like Aaron, who sent us this:

Having 80.8% of the alphabet available is significantly below the 99.9% full letter uptime reliability we strive for. Since identifying the root case of this issue, we’ve started bringing vowels back to Gmail, so you should see them back in your account within the next few hours if you don’t already. In the meantime, while you may still see this issue in Gmail's web interface, both IMAP and POP access are functioning normally. We'll post an update as soon as things are fully resolved and, again, we're v3ry s0rry.

Update (7:30 am): We’ve determined that the letter 'y' is not impacted.

Wednesday, March 31, 2010

Equinix (EQIX) Viewed As The On-Ramp For The Internet And Is Heavily Vested In Higher-level Cloud Computing, According To Industry Expert

>>Equinix (EQIX) Viewed As The On-Ramp For The Internet And Is Heavily Vested In Higher-level Cloud Computing, According To Industry Expert

March 31, 2010 - The Wall Street Transcript has just published its Data Hosting & Data Storage Report offering a timely review of the sector to serious investors and industry executives. This 32 page feature contains expert industry commentary through in-depth interviews with public company CEOs, Equity Analysts and Money Managers.


TWST: As you mentioned, cloud computing is a hot topic for the industry. What's the broader impact of this for the industry? Do you consider any particular companies to be better positioned to capitalize on the opportunities cloud computing represents?

Mr. Kelleher: There are a number of different places that are interesting to look at. One is just the simple facilities of who is providing it. I keep coming back to Terremark because I'm very impressed with their facilities and a company like Terremark is well positioned to pick up that business. Equinix doesn't do managed services, it doesn't really do the higher-level cloud computing capabilities, but Equinix has made itself the on-ramp for the Internet, with all of the connectivity that they have within their facilities. So they are all well positioned. On the product side, it's companies that are designing platforms that are specifically aimed at a virtual environment.

Equinix prepaid an approximately $109 million loan

On March 31, 2010, CHI 3, LLC (“CHI 3”), an indirect wholly-owned subsidiary of Equinix, Inc. (“Equinix”), prepaid an approximately $109 million loan (the “Loan”) evidenced by the Development Loan and Security Agreement, dated as of February 2, 2007, by and between CHI 3 and SFT I, Inc. (the “Lender”). The Loan was used for the development, design and construction of a data center located in Elk Grove Village, Illinois.

The Loan was prepaid to Lender and its assignees for an amount equal to 95.909% of the then outstanding principal balance of the Loan, plus interest and charges, totaling approximately $104.8 million. This represents a discount from principal of approximately $4.5 million.

Lender (or its affiliates) owns a data center located in El Segundo, California leased by Equinix Operating Co., Inc., and is a party to a $100 million loan to another Equinix subsidiary secured by the 32-acre Beaumeade Business Park in Ashburn, Virginia.

Tuesday, March 30, 2010

Two Possible sales in the State of Georgia later this year

from the IV MB, by erasmus:

Among the 39 Certificates of Need (CON) in various stages of the notification and approval process totaling $292 million there are 2 for CyberKnife units

Pending Review/Complete/Joined Applications

2010-004 Candler Hospital dba Lewis Cancer & Research Pavilion

New CyberKnife Unit (BATCHING) Joined (005)

Filed: 2/20/2010 Deemed Complete: 2/20/2010

Joined: 2/20/2010 60th Day Deadline: 4/20/2010

Decision Deadline: 6/19/2010

Site: 225 Candler Drive, Savannah, GA 31405 (Chatham County)

Contact: John Salandi 912-819-2498

Estimated Cost: $6,263,060

2010-005 Southeast Georgia Health System

Acquisition of a CyberKnife (BATCHING) Joined (004)

Filed: 2/20/2010 Deemed Complete: 2/20/2010

Joined: 2/20/2010 60th Day Deadline: 4/20/2010

Decision Deadline: 6/19/2010

Site: 2415 Parkwood Drive, Brunswick, GA 31520 (Glynn County)

Contact: Carlton A. DeVooght 912-466-3391

Estimated Cost: $4,787,028