![]() ![]() They are more suitable for things like logos. These store an exact pixel-by-pixel representation of the image, but require more space. We do not recommend using JPEG files for rasterized vector art, as the compression artifacts substantially degrade the quality of the image near edges. It has excellent compression characteristics and has the nice feature that the user may specify what level of compression they desire, trading off fidelity for file size. One of the most widely-used image formats. They are also commonly used on the web to save bandwidth. They are best suited to photographs and other images where perfect accuracy is not important. These have smaller file sizes but do not store a perfect copy of the image. Some of the most common are: JPEG, PNG, GIF, BMP, and TIFF.īroadly speaking, they fall into two categories: Lossy formats Trial Registration ClinicalTrials.There is a large number of different bitmap formats. No grade 5 adverse events occurred.Ĭonclusions and Relevance This phase 2 randomized clinical trial demonstrated that while safe, adding subablative stereotactic radiotherapy of a limited number of metastatic lesions to ICI monotherapy failed to show improvement in PFS or OS. Acute treatment-related toxic effects of any grade and grade 3 or higher occurred in 79% and 18% of patients in the control arm vs 78% and 18% in the experimental arm, respectively. Between the control and experimental arms, no improvement in median OS was observed (11.0 vs 14.3 months hazard ratio, 0.82 95% CI, 0.48-1.41 P = .47), and objective response rate was not statistically significantly different (22% vs 27% P = .56), despite a local control rate of 75% in irradiated patients. With a median (range) follow-up of 12.5 (0.7-46.2) months, median PFS was 2.8 months in the control arm compared with 4.4 months in the experimental arm (hazard ratio, 0.95 95% CI, 0.58-1.53 P = .82). Seven patients allocated to the experimental arm did not complete the study-prescribed radiotherapy course due to early disease progression (n = 5) or intercurrent illness (n = 2). Results Among 96 patients included in the analysis (mean age, 66 years 76 female), 72 (75%) had more than 3 tumor lesions and 65 (68%) had received at least 1 previous line of systemic treatment at time of inclusion. Efficacy was assessed in the intention-to-treat population, while safety was evaluated in the as-treated population. Key secondary end points included overall survival (OS), objective response rate, local control rate, and toxic effects. Main Outcomes and Measures The primary end point was progression-free survival (PFS) as per immune Response Evaluation Criteria in Solid Tumors. Randomization was stratified according to tumor histologic findings and disease burden (3 and fewer or more than 3 cancer lesions). Interventions Patients were randomized (1:1) to receive anti–PD-1/PD-1 ligand 1 ICIs alone as per standard of care (control arm) or combined with stereotactic body radiotherapy 3 × 8 gray to a maximum of 3 lesions prior to the second or third ICI cycle, depending on the frequency of administration (experimental arm). ![]() ![]() Data analyses were performed between April 2022 and March 2023. Of those, 3 patients (1 in the control arm vs 2 in the experimental arm) withdrew consent and thus were not included in the analysis. A total of 99 patients were randomly assigned to either the control arm (n = 52) or the experimental arm (n = 47). Patients 18 years or older with locally advanced or metastatic melanoma, renal cell carcinoma, urothelial carcinoma, head and neck squamous cell carcinoma, or non–small cell lung carcinoma were eligible. Objective To assess the addition of radiotherapy to ICIs compared with ICI monotherapy in patients with advanced solid tumors.ĭesign, Setting, and Participants This open-label, multicenter, randomized phase 2 trial was conducted in 5 Belgian hospitals and enrolled participants between March 2018 and October 2020. Hypofractionated radiotherapy has the potential to improve the therapeutic ratio of ICIs. Importance Although immune checkpoint inhibitors (ICIs) targeting programmed cell death 1 (PD-1) and PD-1 ligand 1 have improved the outcome for many cancer types, the majority of patients fails to respond to ICI monotherapy.
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