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Mink van der Molen DR, Batenburg MCT, Maarse W, van den Bongard DHJG, Doeksen A, de Lange MY, van der Pol CC, Evers DJ, Lansdorp CA, van der Laan J, van de Ven PM, van der Leij F, Verkooijen HM. Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer: A Randomized Clinical Trial. JAMA Oncol 2024; 10:464-474. [PMID: 38329746 PMCID: PMC10853873 DOI: 10.1001/jamaoncol.2023.6776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/29/2023] [Indexed: 02/09/2024]
Abstract
Importance Hyperbaric oxygen therapy (HBOT) is proposed as treatment for late local toxic effects after breast irradiation. Strong evidence of effectiveness is lacking. Objective To assess effectiveness of HBOT for late local toxic effects in women who received adjuvant radiotherapy for breast cancer. Design, Setting, and Participants This was a hospital-based, pragmatic, 2-arm, randomized clinical trial nested within the prospective UMBRELLA cohort following the trials within cohorts design in the Netherlands. Participants included 189 women with patient-reported moderate or severe breast, chest wall, and/or shoulder pain in combination with mild, moderate, or severe edema, fibrosis, or movement restriction 12 months or longer after breast irradiation. Data analysis was performed from May to September 2023. Intervention Receipt of 30 to 40 HBOT sessions over a period of 6 to 8 consecutive weeks. Main Outcomes and Measures Breast, chest wall, and/or shoulder pain 6 months postrandomization measured by the European Organization for Research and Treatment of Cancer QLQ-BR23 questionnaire. Secondary end points were patient-reported fibrosis, edema, movement restriction, and overall quality of life. Data were analyzed according to intention-to-treat (ITT) and complier average causal effect (CACE) principles. Results Between November 2019 and August 2022, 125 women (median [range] age at randomization, 56 [37-85] years) with late local toxic effects were offered to undergo HBOT (intervention arm), and 61 women (median [range] age at randomization, 60 [36-80] years) were randomized to the control arm. Of those offered HBOT, 31 (25%) accepted and completed treatment. The most common reason for not accepting HBOT was high treatment intensity. In ITT, moderate or severe pain at follow-up was reported by 58 of 115 women (50%) in the intervention arm and 32 of 52 women (62%) in the control arm (odds ratio [OR], 0.63; 95% CI, 0.32-1.23; P = .18). In CACE, the proportion of women reporting moderate or severe pain at follow-up was 32% (10 of 31) among those completing HBOT and 75% (9.7 of 12.9) among control participants expected to complete HBOT if offered (adjusted OR, 0.34; 95% CI, 0.15-0.80; P = .01). In ITT, moderate or severe fibrosis was reported by 35 of 107 (33%) in the intervention arm and 25 of 49 (51%) in the control arm (OR, 0.36; 95% CI, 0.15-0.81; P = .02). There were no significant differences in breast edema, movement restriction, and quality of life between groups in ITT and CACE. Conclusions and Relevance In this randomized clinical trial, offering HBOT to women with late local toxic effects was not effective for reducing pain, but was effective for reducing fibrosis. In the subgroup of women who completed HBOT, a significant reduction in pain and fibrosis was observed. A smaller than anticipated proportion of women with late local toxic effects was prepared to undergo HBOT. Trial Registration ClinicalTrials.gov Identifier: NCT04193722.
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Affiliation(s)
| | - Marilot C. T. Batenburg
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Daniel J. Evers
- Department of Surgery, Hospital Group Twente, Hengelo, the Netherlands
| | | | - Jacco van der Laan
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Peter M. van de Ven
- The Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
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Abstract
Migraine attacks are often preceded by premonitory symptoms. Prevalence rates of migraine patients reporting one or more premonitory symptoms show considerable variability and rates range between 12% and 79%. Sources of variability might be differences in study population or research design. Using a questionnaire, we retrospectively studied the prevalence of 12 predefined premonitory symptoms in a clinic-based population. Of 461 migraine patients, 374 (81%) responded. At least one premonitory symptom was reported by 86.9% and 71.1% reported two or more. The most frequently reported premonitory symptoms were fatigue (46.5%), phonophobia (36.4%) and yawning (35.8%). The mean number of premonitory symptoms per person was 3.2 (± 2.5). Women reported 3.3 premonitory symptoms compared with 2.5 symptoms in men ( P = 0.01). Age, education, migraine subtype (with or without aura) and mean attack frequency had no effect on the mean number of symptoms per individual. In conclusion, premonitory symptoms are frequently reported by migraine patients. Sensitivity and specificity of premonitory symptoms for migraine need to be assessed using prospective methods.
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Affiliation(s)
- G G Schoonman
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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Spliethoff JW, Prevoo W, Meier MA, de Jong J, Klomp HM, Evers DJ, Sterenborg HJ, Lucassen GW, Hendriks BH, Ruers TJ. Real-time In Vivo Tissue Characterization with Diffuse Reflectance Spectroscopy during Transthoracic Lung Biopsy: A Clinical Feasibility Study. Clin Cancer Res 2015; 22:357-65. [DOI: 10.1158/1078-0432.ccr-15-0807] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022]
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Evers DJ, Westerkamp AC, Spliethoff JW, Pully VV, Hompes D, Hendriks BHW, Prevoo W, van Velthuysen MLF, Porte RJ, Ruers TJM. Diffuse reflectance spectroscopy: toward real-time quantification of steatosis in liver. Transpl Int 2015; 28:465-74. [DOI: 10.1111/tri.12517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/27/2014] [Accepted: 12/30/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel J. Evers
- Department of Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Andrie C. Westerkamp
- Department of Surgery; Section HPB Surgery and Liver Transplantation; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Jarich W. Spliethoff
- Department of Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Vishnu V. Pully
- In Body Systems Department; Philips Research; Eindhoven The Netherlands
| | - Daphne Hompes
- Department of Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | | | - Warner Prevoo
- Department of Radiology; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | | | - Robert J. Porte
- Department of Surgery; Section HPB Surgery and Liver Transplantation; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Theo J. M. Ruers
- Department of Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
- MIRA Institute; University Twente; Enschede The Netherlands
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Spliethoff JW, Tanis E, Evers DJ, Hendriks BHW, Prevoo W, Ruers TJM. Monitoring of tumor radio frequency ablation using derivative spectroscopy. J Biomed Opt 2014; 19:97004. [PMID: 25239499 DOI: 10.1117/1.jbo.19.9.097004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/22/2014] [Indexed: 05/15/2023]
Abstract
Despite the widespread use of radio frequency (RF) ablation, an effective way to assess thermal tissue damage during and after the procedure is still lacking. We present a method for monitoring RF ablation efficacy based on thermally induced methemoglobin as a marker for full tissue ablation. Diffuse reflectance (DR) spectra were measured from human blood samples during gradual heating of the samples from 37 to 60, 70, and 85°C. Additionally, reflectance spectra were recorded real-time during RF ablation of human liver tissue ex vivo and in vivo. Specific spectral characteristics of methemoglobin were extracted from the spectral slopes using a custom optical ablation ratio. Thermal coagulation of blood caused significant changes in the spectral slopes, which is thought to be caused by the formation of methemoglobin. The time course of these changes was clearly dependent on the heating temperature. RF ablation of liver tissue essentially led to similar spectral alterations. In vivo DR measurements confirmed that the method could be used to assess the degree of thermal damage during RF ablation and long after the tissue cooled.
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Affiliation(s)
- Jarich W Spliethoff
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Erik Tanis
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Daniel J Evers
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Benno H W Hendriks
- Minimally Invasive Healthcare, Philips Research, High Tech Campus 34, Eindhoven 5656 AE, The Netherlands
| | - Warner Prevoo
- The Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands
| | - Theo J M Ruers
- The Netherlands Cancer Institute, Department of Surgery, Plesmanlaan 121, Amsterdam 1066CX, The NetherlandsdUniversity of Twente, MIRA Institute, Building Zuidhorst P.O. Box 217, Enschede 7500 AE, The Netherlands
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Spliethoff JW, Evers DJ, Jaspers JE, Hendriks BHW, Rottenberg S, Ruers TJM. Monitoring of tumor response to Cisplatin using optical spectroscopy. Transl Oncol 2014; 7:230-9. [PMID: 24726234 PMCID: PMC4101345 DOI: 10.1016/j.tranon.2014.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/07/2013] [Accepted: 01/02/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Anatomic imaging alone is often inadequate for tuning systemic treatment for individual tumor response. Optically based techniques could potentially contribute to fast and objective response monitoring in personalized cancer therapy. In the present study, we evaluated the feasibility of dual-modality diffuse reflectance spectroscopy-autofluorescence spectroscopy (DRS-AFS) to monitor the effects of systemic treatment in a mouse model for hereditary breast cancer. METHODS Brca1(-/-); p53(-/-) mammary tumors were grown in 36 mice, half of which were treated with a single dose of cisplatin. Changes in the tumor physiology and morphology were measured for a period of 1 week using dual-modality DRS-AFS. Liver and muscle tissues were also measured to distinguish tumor-specific alterations from systemic changes. Model-based analyses were used to derive different optical parameters like the scattering and absorption coefficients, as well as sources of intrinsic fluorescence. Histopathologic analysis was performed for cross-validation with trends in optically based parameters. RESULTS Treated tumors showed a significant decrease in Mie-scattering slope and Mie-to-total scattering fraction and an increase in both fat volume fraction and tissue oxygenation after 2 days of follow-up. Additionally, significant tumor-specific changes in the fluorescence spectra were seen. These longitudinal trends were consistent with changes observed in the histopathologic analysis, such as vital tumor content and formation of fibrosis. CONCLUSIONS This study demonstrates that dual-modality DRS-AFS provides quantitative functional information that corresponds well with the degree of pathologic response. DRS-AFS, in conjunction with other imaging modalities, could be used to optimize systemic cancer treatment on the basis of early individual tumor response.
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Affiliation(s)
- Jarich W Spliethoff
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Daniel J Evers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Janneke E Jaspers
- Division of Molecular Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Benno H W Hendriks
- Department of Minimally Invasive Healthcare, Philips Research, Eindhoven, The Netherlands
| | - Sven Rottenberg
- Division of Molecular Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo J M Ruers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; MIRA Institute, Technical University Twente, Enschede, The Netherlands
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Spliethoff JW, Evers DJ, Klomp HM, van Sandick JW, Wouters MW, Nachabe R, Lucassen GW, Hendriks BH, Wesseling J, Ruers TJ. Improved identification of peripheral lung tumors by using diffuse reflectance and fluorescence spectroscopy. Lung Cancer 2013; 80:165-71. [DOI: 10.1016/j.lungcan.2013.01.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/14/2013] [Accepted: 01/22/2013] [Indexed: 12/20/2022]
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Evers DJ, Nachabe R, Vranken Peeters MJ, van der Hage JA, Oldenburg HS, Rutgers EJ, Lucassen GW, Hendriks BHW, Wesseling J, Ruers TJM. Diffuse reflectance spectroscopy: towards clinical application in breast cancer. Breast Cancer Res Treat 2012; 137:155-65. [PMID: 23225143 DOI: 10.1007/s10549-012-2350-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 11/18/2012] [Indexed: 10/27/2022]
Abstract
Diffuse reflectance spectroscopy (DRS) is a promising new technique for breast cancer diagnosis. However, inter-patient variation due to breast tissue heterogeneity may interfere with the accuracy of this technique. To tackle this issue, we aim to determine the diagnostic accuracy of DRS in individual patients. With this approach, DRS measurements of normal breast tissue in every individual patient are directly compared with measurements of the suspected malignant tissue. Breast tissue from 47 female patients was analysed ex vivo by DRS. A total of 1,073 optical spectra were collected. These spectra were analyzed for each patient individually as well as for all patients collectively and results were compared to the pathology analyses. Collective patient data analysis for discrimination between normal and malignant breast tissue resulted in a sensitivity of 90 %, a specificity of 88 %, and an overall accuracy of 89 %. In the individual analyses all measurements per patient were categorized as either benign or malignant. The discriminative accuracy of these individual analyses was nearly 100 %. The diagnosis was classified as uncertain in only one patient. Based on the results presented in this study, we conclude that the analysis of optical characteristics of different tissue classes within the breast of a single patient is superior to an analysis using the results of a cohort data analysis. When integrated into a biopsy device, our results demonstrate that DRS may have the potential to improve the diagnostic workflow in breast cancer.
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Affiliation(s)
- Daniel J Evers
- Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Evers DJ, Nachabé R, Klomp HM, van Sandick JW, Wouters MW, Lucassen GW, Hendriks BH, Wesseling J, Ruers TJ. Diffuse Reflectance Spectroscopy: A New Guidance Tool for Improvement of Biopsy Procedures in Lung Malignancies. Clin Lung Cancer 2012; 13:424-31. [DOI: 10.1016/j.cllc.2012.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/09/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
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Nachabé R, Evers DJ, Hendriks BHW, Lucassen GW, van der Voort M, Rutgers EJ, Peeters MJV, Van der Hage JA, Oldenburg HS, Wesseling J, Ruers TJM. Diagnosis of breast cancer using diffuse optical spectroscopy from 500 to 1600 nm: comparison of classification methods. J Biomed Opt 2011; 16:087010. [PMID: 21895337 DOI: 10.1117/1.3611010] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We report on the use of diffuse optical spectroscopy analysis of breast spectra acquired in the wavelength range from 500 to 1600 nm with a fiber optic probe. A total of 102 ex vivo samples of five different breast tissue types, namely adipose, glandular, fibroadenoma, invasive carcinoma, and ductal carcinoma in situ from 52 patients were measured. A model deriving from the diffusion theory was applied to the measured spectra in order to extract clinically relevant parameters such as blood, water, lipid, and collagen volume fractions, β-carotene concentration, average vessels radius, reduced scattering amplitude, Mie slope, and Mie-to-total scattering fraction. Based on a classification and regression tree algorithm applied to the derived parameters, a sensitivity-specificity of 98%-99%, 84%-95%, 81%-98%, 91%-95%, and 83%-99% were obtained for discrimination of adipose, glandular, fibroadenoma, invasive carcinoma, and ductal carcinoma in situ, respectively; and a multiple classes overall diagnostic performance of 94%. Sensitivity-specificity values obtained for discriminating malignant from nonmalignant tissue were compared to existing reported studies by applying the different classification methods that were used in each of these studies. Furthermore, in these reported studies, either lipid or β-carotene was considered as adipose tissue precursors. We estimate both chromophore concentrations and demonstrate that lipid is a better discriminator for adipose tissue than β-carotene.
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Affiliation(s)
- Rami Nachabé
- Minimally Invasive Healthcare, Philips Research, 5656AE Eindhoven, The Netherlands.
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Nachabé R, Evers DJ, Hendriks BHW, Lucassen GW, van der Voort M, Wesseling J, Ruers TJM. Effect of bile absorption coefficients on the estimation of liver tissue optical properties and related implications in discriminating healthy and tumorous samples. Biomed Opt Express 2011; 2:600-14. [PMID: 21412465 PMCID: PMC3047365 DOI: 10.1364/boe.2.000600] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 02/09/2011] [Accepted: 02/14/2011] [Indexed: 05/08/2023]
Abstract
We investigated differences between healthy tissue and metastatic tumor from ex vivo human partial liver resections using diffuse optical spectroscopy with a fiber optic probe. We extracted various physiological and morphological parameters from the spectra. During evaluation of the residual between the measurements and a fit model based on diffusion theory, we found that bile is an additional chromophore absorbing in the visible wavelength range that was missing in our model. Consistency of the residual with the absorption spectrum of bile was noticed. An accurate measurement of the absorption coefficient of bile from various human bile samples was performed and implemented into the fit model. Having the absorption coefficient of bile as a priori knowledge in the model showed a clear improvement in terms of reducing the fitting discrepancies. The addition of this chromophore yields significantly different estimates of the amount of blood. Furthermore, the estimated bile volume fraction and reduced scattering amplitude turned out to be two main relevant discriminators between normal and metastatic liver tissues.
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Affiliation(s)
- Rami Nachabé
- Department of Minimally Invasive Healthcare, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Daniel J. Evers
- Department of Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherland
| | - Benno H. W. Hendriks
- Department of Minimally Invasive Healthcare, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Gerald W. Lucassen
- Department of Minimally Invasive Healthcare, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Marjolein van der Voort
- Department of Minimally Invasive Healthcare, Philips Research, 5656 AE Eindhoven, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Theo J. M. Ruers
- Department of Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherland
- Technical University Twente, 7500 AE Twente, The Netherlands
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Evers DJ, Verwaal VJ. Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin. Br J Surg 2011; 98:287-92. [PMID: 21046680 DOI: 10.1002/bjs.7303] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The incidence of ovarian metastases at the time of peritoneal carcinomatosis, and the influence of such metastases on survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), are unknown. METHODS This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed. RESULTS The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis. CONCLUSION When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.
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Affiliation(s)
- D J Evers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam 1066 CX, The Netherlands.
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Evers DJ, Smeenk RM, Bottenberg PD, van Werkhoven ED, Boot H, Verwaal VJ. Effect of preservation of the right gastro-epiploic artery on delayed gastric emptying after cytoreductive surgery and HIPEC: a randomized clinical trial. Eur J Surg Oncol 2011; 37:162-7. [PMID: 21216560 DOI: 10.1016/j.ejso.2010.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/30/2010] [Accepted: 12/06/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Delayed gastric emptying (DGE) is a main complication with unknown origin after a cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC). The aim of this study was to investigate if preservation of the right gastro-epiploic artery (GEA) during standard omentectomy would have a positive effect on gastric emptying after CRS-HIPEC. METHODS Forty-two patients subjected to a CRS-HIPEC were randomized into two groups perioperatively before performing an omentectomy: in Group I (N = 21) omentectomy was performed with preservation of the GEA; in Group II (N = 21) omentectomy was performed with resection of the GEA. The primary endpoint was the number of days to full oral intake of solid food. Secondary endpoints were number of days to intended occlusion of gastrostomy catheter and total hospital admission time. RESULTS No significant differences were discovered between both groups in any of the study endpoints after CRS-HIPEC. No significant differences were observed in patient or operation characteristics between the randomized groups. CONCLUSIONS No association was demonstrated between preservation of the gastro-epiploic artery during omentectomy and gastric emptying after CRS-HIPEC. The extensive intestinal manipulation or the heated intra-peritoneal chemotherapy during surgery are more plausible causes of this phenomenon. This clinical trial was registered in the Netherlands at the Central Committee on Research involving Human Subjects (CCMO) under registration number P06.0301L.
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Affiliation(s)
- D J Evers
- Department of Surgery, The Netherlands Cancer Institute NKI-AVL, Amsterdam, The Netherlands.
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Schoonman GG, Evers DJ, Ballieux BE, de Geus EJ, de Kloet ER, Terwindt GM, van Dijk JG, Ferrari MD. Is stress a trigger factor for migraine? Psychoneuroendocrinology 2007; 32:532-8. [PMID: 17459597 DOI: 10.1016/j.psyneuen.2007.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 02/07/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although mental stress is commonly considered to be an important trigger factor for migraine, experimental evidence for this belief is yet lacking. OBJECTIVE To study the temporal relationship between changes in stress-related parameters (both subjective and objective) and the onset of a migraine attack. METHODS This was a prospective, ambulatory study in 17 migraine patients. We assessed changes in perceived stress and objective biological measures for stress (saliva cortisol, heart rate average [HRA], and heart rate variability [low-frequency power and high-frequency power]) over 4 days prior to the onset of spontaneous migraine attacks. Analyses were repeated for subgroups of patients according to whether or not they felt their migraine to be triggered by stress. RESULTS There were no significant temporal changes over time for the whole group in perceived stress (p=0.50), morning cortisol (p=0.73), evening cortisol (p=0.55), HRA (p=0.83), low-frequency power (p=0.99) and high-frequency power (p=0.97) prior to or during an attack. Post hoc analysis of the subgroup of nine stress-sensitive patients who felt that >2/3 of their migraine attacks were triggered by psychosocial stress, revealed an increase for perceived stress (p=0.04) but no changes in objective stress response measures. At baseline, this group also showed higher scores on the Penn State Worry Questionnaire (p=0.003) and the Cohen Perceived Stress Scale (p=0.001) compared to non-stress-sensitive patients. CONCLUSIONS Although stress-sensitive patients, in contrast to non-stress-sensitive patients, may perceive more stress in the days before an impending migraine attack, we failed to detect any objective evidence for a biological stress response before or during migraine attacks.
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Affiliation(s)
- G G Schoonman
- Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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