The geologic, chemical, and engineering information gathered during this era formed the basis of the uranium industry of the later part of the century, while the tailings and residues came to be viewed as environmental problems during the same period. The discovery of high-grade pitchblende ores in the Belgian Congo and the subsequent opening of an extraction plant near Antwerp, Belgium, in 1992, however, created an economic climate that put an end to the American radium industry. The staffs of these plants included some of the more » finest chemists and physicists in the nation, and the highly-refined radium products found a variety of uses in medicine and industry. Major extraction plants were established in or near Denver (CO), Pittsburgh (PA), and New York City (NY) to process radium from ore that came largely from the carnotite deposits of western Colorado and eastern Utah. They are but the latest chapter in the story of an American industry that emerged and perished in the span of three decades. The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.Federally funded remedial action projects are presently underway in New Jersey and Colorado at sites containing Ra and other radionuclides from radium-uranium ore extraction plants that operated during the early twentieth century. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures. Agreement/consensus was defined as less than or equal to 3 rating points from median. Variants and procedures were evaluated by the panel using modified Delphi methodology. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma.Ĭase variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management. Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data.
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