Comparative Analysis of Efficacy, Toxicity, and Patient-Reported Outcomes in Rectal Cancer Patients Undergoing Preoperative 3D Conformal Radiotherapy or VMAT

Background

Locally advanced rectal cancer (LARC) patients are usually treated within a multimodal therapy regime, in which the tumor resection plays the major role. This treatment ideally includes 5-fluorouracile (5FU)-based chemoradiation (CRT) leading to significantly improved local control rates. Local therapy as radiotherapy (RT) is required to be adapted referring to side effects and efficacy. Purpose of this study is the comparison of dosimetric parameters, acute and late toxicity, and quality of life in terms of patient-reported outcome (PRO) in patients treated with VMAT or 3D conformal radiotherapy (3DCRT) for LARC.

Methods

Pelvic RT for LARC was performed with a prescription dose of 45 Gy in 1.8 Gy per fraction, 50.4 Gy in 1.8 Gy per fraction, or 50 Gy in 2 Gy per fraction. Chemotherapy included 5FU or 5FU/Oxaliplatin or Capecitabine-based RT. Acute and late toxicity were evaluated via National Institute Common Terminology Criteria for Adverse Events version (CTCAE) v4.03 and the Scoring System Late effects of Normal Tissue. Quality of life was established via EORTC QLQCR29.

Results

After a median follow-up of 38 months (VMAT) and 78 months (3DCRT) there was no significant difference in progression-free survival (p = 0,85) but a significant difference in overall survival (p = 0.032). Regarding dose–volume parameters, patients treated with VMAT plans had a lower V20 of the bladder than 3DCRT-treated patients (p = 0.004). VMAT plans can also reduce Dmean of the right (p = 0.002) and left (p < 0.001) femoral head. Acute side effects between the VMAT and 3DCRT patients showed no significant difference. But concerning long-term effects, VMAT-treated patients had a significant lower appearance of high grade anal incontinence (p = 0.032). Quality of life (PRO) showed no significant different between the patients except of hair loss and worrying about weight.

Conclusion

VMAT treatment of LARC in preoperative CRT revealed a reduction of dose to organs at risk (OARs) as bladder and femoral heads. However, no changes in acute and long-term toxicity profiles were detectable. For late toxicity and quality of life data longer follow-up times are required.

Body positions used by healthy and frail older adults to rise from the floor

OBJECTIVE

The purpose of this study was to describe how older adults, particularly more physically impaired older adults, might differ from healthy controls in the body positions used to rise from the floor.

DESIGN

Cross-sectional analysis of young, healthy older, and congregate housing older women.

SETTING

University-based laboratory and congregate housing facility.

PARTICIPANTS

Healthy young university student controls (n = 22, mean age 23 years); healthy old adults living independently in the community (n = 24, mean age 73 years); and congregate housing older adults (n = 29, mean age 81 years).

INTERVENTION

Videotaping and timing of rising from a supine position on the floor to standing.

MAIN OUTCOME MEASURES

In addition to the time taken to rise from the floor, 10 specific trunk and extremity positions used during the rise, termed Intermediate Positions (IP), were identified.

RESULTS

The Young controls had the fastest rise time and used the fewest number of IP, whereas the Congregate residents had the slowest rise time and used the most IP, with the Healthy old adults intermediate in both time and IP use. Prevalence of certain IP, together with correlational and factor analyses, suggest that use of Sit and Crouch was the most preferred rise strategy for the Young controls, whereas use of Tuck, Crouch-Kneel, All Fours, and Bearwalk was the most preferred rise strategy among the Congregate residents. The Healthy old used IP common to both Young and Congregate residents, reflecting a rise strategy intermediate to the latter groups. A substantial subset of the Congregate residents (38%) were unable to rise without assistance and appeared to use certain preparatory positions (Sit, Kneel, Tuck) but were unable to get into presumably more challenging positions (Crouch-Kneel, All Fours, Bearwalk).

CONCLUSIONS

With increasing age and physical impairment, body positions used during rising from the floor suggest a preference for maintaining upper and lower extremity contact with the floor, presumably minimizing the lower extremity strength requirements to rise and maximizing stability and postural control. These intermediate body positions may be useful as the basis for training older adults to rise from the floor.

Rising from the floor in older adults

OBJECTIVE

The primary goal was to determine the ability of older adults to rise from the floor. A secondary goal was to explore how rise ability might differ based on initial body positions and with or without the use of an assistive device.

DESIGN

Cross-sectional analysis of young, healthy older, and congregate housing older adults.

SETTING

University-based laboratory and congregate housing facility.

PARTICIPANTS

Young adult controls (12 men and 12 women, mean age 23 years), healthy older adults (12 men and 12 women, mean age 73 years), and congregate housing older adults (32 women and 6 men, mean age 80 years). The healthy older adult women (n = 12, mean age 75 years) and a subset of the congregate housing women (n = 27, mean age 81 years) were identified for further analyses.

INTERVENTION

Videotaping and timing of rising from the floor from controlled initial body positions (supine, on side, prone, all fours, and sitting) and with or without the use of a furniture support.

MAIN OUTCOME MEASURES

Whether subjects were successful in rising, and if they were, the time taken to rise. Subjects also rated their perceived difficulty of the task as compared to the reference task, rising from a supine position.

RESULTS

Older adults have more difficulty rising from the floor than younger adults. The healthy old took twice as long as the young to rise, whereas the congregate old took two to three times as long as the healthy old to rise. Although all young and healthy old rose from every position, a subset of the congregate housing residents was unable to rise from any position, 24% when attempting to rise without a support and 13% when attempting to rise with a support. Congregate old were most likely to be successful when rising from a side-lying position while using the furniture for support. The more able congregate old, as well as the young and healthy old, rose more quickly and admitted to the least difficulty when rising from the all fours position.

CONCLUSIONS

The inability to rise from the floor is relatively common in congregate housing older adults. Based on the differences between groups in time to complete the rise, determining the differences in rise strategies, and the underlying biomechanical requirements of rising from different positions with or without a support would appear to be useful. These data may serve as the foundation for future interventions to improve the ability to rise from the floor.

Fine-needle aspiration of breast masses

Evaluation of breast masses is a frequent dilemma encountered by a primary care physician. Adding fine-needle aspiration biopsy to the work-up of these lesions adds an inexpensive, highly accurate test with high patient acceptance. At our institution a technique using a butterfly needle has yielded a sensitivity of 91% and a specificity of 100%.

[Determining the threshold level for sensibility responses to galvanic potentials in the oral cavity]

The presence of different alloys in the oral cavity may produce potential differences of up to 900 mV. In the majority of the patients this phenomenon presents no problems. Occasionally, however, disturbing sensations, such as "metallic taste", "twinging or stabbing" and "minute electric shock" are reported. In finding out on the threshold level for discomforting sensations due to galvanic potentials in different probands, a special battery operated device was developed. Using a pair of electrodes connected to metallic restorations in the mouth, this device enabled the application and adjustment of direct current voltage and a superimposed pulse spectrum to evoke sensible reactions. The trials were conducted with 102 probands. The mean value for the threshold of sensation was above 1000 mV. In solitary cases, however, the threshold level was as low as 250 mV. This method may be used as a diagnostic aid to the objective assessment of complaints due to galvanic effects in the oral cavity and for the selection of a suitable metal in sensitive patients.