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Chen CC, Wu YY, Kao JT, Chang CH, Huang SC, Shih HN. Impact of resection margin on outcome in soft-tissue sarcomas of the extremities treated with limb-sparing surgery and postoperative radiotherapy. World J Surg Oncol 2024; 22:113. [PMID: 38664776 PMCID: PMC11046795 DOI: 10.1186/s12957-024-03380-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The standard curative treatments for extremity soft tissue sarcoma (ESTS) include surgical resection with negative margins and perioperative radiotherapy. However, the optimal resection margin remains controversial. This study aimed to evaluate the outcomes in ESTS between microscopically positive margin (R1) and microscopically negative margin (R0) according to the Union for International Cancer Control (UICC) (R + 1 mm) classification. METHODS Medical records of patients with localized ESTS who underwent primary limb-sparing surgery and postoperative radiotherapy between 2004 and 2015 were retrospectively reviewed. Patients were followed for at least 5 years or till local or distant recurrence was diagnosed during follow-up. Outcomes were local and distal recurrences and survival. RESULTS A total of 52 patients were included in this study, in which 17 underwent R0 resection and 35 underwent R1 resection. No significant differences were observed in rates of local recurrence (11.4% vs. 35.3%, p = 0.062) or distant recurrence (40.0% vs. 41.18%, p = 0.935) between R0 and R1 groups. Multivariate analysis showed that distant recurrences was associated with a Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade (Grade III vs. I, adjusted hazard ratio (aHR): 12.53, 95% confidence interval (CI): 2.67-58.88, p = 0.001) and tumor location (lower vs. upper extremity, aHR: 0.23, 95% CI: 0.07-0.7, p = 0.01). Kaplan-Meier plots showed no significant differences in local (p = 0.444) or distant recurrent-free survival (p = 0.161) between R0 and R1 groups. CONCLUSIONS R1 margins, when complemented by radiotherapy, did not significantly alter outcomes of ESTS as R0 margins. Further studies with more histopathological types and larger cohorts are necessary to highlight the path forward.
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Affiliation(s)
- Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan.
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
| | - Yao-Yu Wu
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Jo-Ting Kao
- Hejiang Orthopedic Clinic, No. 200, Zhongzheng E. Rd., Zhubei City, Hsinchu County, 302, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Shih-Chiang Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
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Cotti GC, Pandini RV, Braghiroli OFM, Nahas CSR, Bustamante-Lopez LA, Marques CFS, Imperiale AR, Ribeiro U, Salvajoli B, Hoff PM, Nahas SC. Outcomes of Patients With Local Regrowth After Nonoperative Management of Rectal Cancer After Neoadjuvant Chemoradiotherapy. Dis Colon Rectum 2022; 65:333-339. [PMID: 34775415 DOI: 10.1097/dcr.0000000000002197] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical complete responders after chemoradiation for rectal cancer are increasingly being managed by a watch-and-wait strategy. Nonetheless, a significant proportion will experience a local regrowth, and the long-term oncological outcomes of these patients is not totally known. OBJECTIVE The purpose of this study was to analyze the outcomes of patients who submitted to a watch-and-wait strategy and developed a local regrowth, and to compare these results with sustained complete clinical responders. DESIGN This was a retrospective study. SETTING Single institution, tertiary cancer center involved in alternatives to organ preservation. PATIENTS Patients with a biopsy-proven rectal adenocarcinoma (stage II/III or low lying cT2N0M0 at risk for an abdominoperineal resection) treated with chemoradiation who were found at restage to have a clinical complete response. INTERVENTIONS Rectal cancer patients treated with chemoradiation who underwent a watch-and-wait strategy (without a full thickness local excision) and developed a local regrowth were compared to the remaining patients of the watch-and-wait strategy. MAIN OUTCOME MEASURES Overall survival between groups, incidence of regrowth' and results of salvage surgery. RESULTS There were 67 patients. Local regrowth occurred in 20 (29.9%) patients treated with a watch-and-wait strategy. Mean follow-up was 62.7 months. Regrowth occurred at mean 14.2 months after chemoradiation, half of them within the first 12 months. Patients presented with comparable initial staging, lateral pelvic lymph-node metastasis, and extramural venous invasion. The regrowth group had a statistically nonsignificant higher incidence of mesorectal fascia involvement (35.0% vs 13.3%, p = 0.089). All regrowths underwent salvage surgery, mostly (75%) a sphincter-sparing procedure. 5-year overall survival was 71.1% in patients with regrowth and 91.1% in patients with a sustained complete clinical response (p = 0.027). LIMITATIONS This study was limited by its retrospective evaluation of patient selection for a watch-and-wait strategy and outcomes, as well as its small sample size. CONCLUSIONS Local regrowth is a frequent event when following a watch-and-wait policy (29.9%); however, patients could undergo salvage surgical treatment with adequate pelvic control. In this series, overall survival showed a statistically significant difference from patients managed with a watch-and-wait strategy who experienced a local regrowth compared to those who did not. See Video Abstract at http://links.lww.com/DCR/B773.RESULTADOS DE LOS PACIENTES CON REBROTE LOCAL, DESPUÉS DEL MANEJO NO QUIRÚRGICO DEL CÁNCER DE RECTO, DESPUÉS DE LA QUIMIORRADIOTERAPIA NEOADYUVANTEANTECEDENTES:Los respondedores clínicos completos, después de la quimiorradiación para el cáncer de recto, se tratan cada vez más mediante una estrategia de observación y espera. No obstante, una proporción significativa experimentará un rebrote local y los resultados oncológicos a largo plazo de estos pacientes, no se conocen por completo.OBJETIVO:El propósito de este estudio, fue analizar los resultados de los pacientes sometidos a una estrategia de observación y espera, que desarrollaron un rebrote local, y comparar estos resultados con respondedores clínicos completos sostenidos.DISEÑO:Este fue un estudio retrospectivo.ENTORNO CLINICO.Institución única, centro oncológico terciario involucrado en alternativas a la preservación de órganos.PACIENTES:Pacientes con un adenocarcinoma de recto comprobado por biopsia (estadio II / III o posición baja cT2N0M0, en riesgo de resección abdominoperineal), tratados con quimiorradiación, y que durante un reestadiaje, presentaron una respuesta clínica completa.INTERVENCIONES:Los pacientes con cáncer de recto tratados con quimiorradiación, sometidos a una estrategia de observación y espera (sin una escisión local de espesor total) y que desarrollaron un rebrote local, se compararon con los pacientes restantes de la estrategia de observación y espera.PRINCIPALES MEDIDAS DE VALORACION:Supervivencia global entre los grupos, incidencia de rebrote y resultados de la cirugía de rescate.RESULTADOS:Fueron 67 pacientes. El rebrote local ocurrió en 20 (29,9%) pacientes tratados con una estrategia de observación y espera. El seguimiento medio fue de 62,7 meses. El rebrote se produjo a la media de 14,2 meses después de la quimiorradiación, la mitad de ellos dentro de los primeros 12 meses. Los pacientes se presentaron con una estadificación inicial comparable, metástasis en los ganglios linfáticos pélvicos laterales e invasión venosa extramural. El grupo de rebrote tuvo una mayor incidencia estadísticamente no significativa de afectación de la fascia mesorrectal (35,0 vs 13,3%, p = 0,089). Todos los rebrotes se sometieron a cirugía de rescate, en su mayoría (75%) con procedimiento de preservación del esfínter. La supervivencia global a 5 años fue del 71,1% en pacientes con rebrote y del 91,1% en pacientes con una respuesta clínica completa sostenida (p = 0,027).LIMITACIONES:Evaluación retrospectiva de la selección de pacientes para una estrategia y resultados de observar y esperar, tamaño de muestra pequeño.CONCLUSIONES:El rebrote local es un evento frecuente después de la política de observación y espera (29,9%), sin embargo los pacientes podrían someterse a un tratamiento quirúrgico de rescate con un adecuado control pélvico. En esta serie, la supervivencia global mostró una diferencia estadísticamente significativa de los pacientes manejados con una estrategia de observación y espera que experimentaron un rebrote local, en comparación con los que no lo hicieron. Consulte Video Resumen en http://links.lww.com/DCR/B773. (Traducción-Dr. Fidel Ruiz Healy).
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Affiliation(s)
- Guilherme Cutait Cotti
- Department of Gastroenterology, Surgical Division, University of São Paulo Medical School, São Paulo, Brazil
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Bougie O, McClintock C, Pudwell J, Brogly SB, Velez MP. Long-term follow-up of endometriosis surgery in Ontario: a population-based cohort study. Am J Obstet Gynecol 2021; 225:270.e1-270.e19. [PMID: 33894154 DOI: 10.1016/j.ajog.2021.04.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/02/2021] [Accepted: 04/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endometriosis is a chronic gynecological disease affecting approximately 10% of reproductive aged females and leads to decreased quality of life and productivity. Despite effective medical options, many women do require surgery for endometriosis. There is limited literature examining long term outcomes of endometriosis surgery. OBJECTIVE This study aimed to characterize the long-term outcomes, including recurrence of symptoms, fertility outcomes, and need for reoperation, of patients who underwent surgical management for endometriosis. STUDY DESIGN This was a population-based cohort study in which the universal coverage health database for the province of Ontario, Canada, was used to identify women aged 18 to 50 years who underwent surgery for endometriosis from April 1, 2002, through March 31, 2018. Surgery was classified as diagnostic laparoscopy, conservative or uterine preserving (minor or major, with and without ovarian preservation), or hysterectomy (with and without ovarian preservation). The outcomes were evaluated from 30 days after the index surgery to the end of the study period or at censoring. Cox proportional hazard regression models were used to estimate the hazard ratios between exposures and outcomes following adjustment for confounders. RESULTS A total of 84,885 women 2,718 (3.2%) diagnostic laparoscopy, 21,594 (25.4%) minor conservative surgery, 28,484 (33.6%); major conservative with ovarian preservation, 2,102 (2.5%) major conservative without ovarian preservation, 21,609 (25.5%) hysterectomy with ovarian preservation, and 8,378 (9.9%) hysterectomy without ovarian preservation) were included in the cohort and followed for a median of 10 years (interquartile range, 6-13 years). In the first postoperative year, women who underwent diagnostic laparoscopy were significantly more likely to require repeat surgery (adjusted hazard ratio, 1.68; 95% confidence interval, 1.51-1.87), whereas those who underwent major conservative surgery were significantly less likely to require repeat surgery (with ovarian preservation: adjusted hazard ratio, 0.44; 95% confidence interval, 0.41-0.48; without ovarian preservation: adjusted hazard ratio, 0.05; 95% confidence interval, 0.03-0.09). Among women who did not receive repeat surgery in the first year, those who underwent a diagnostic laparoscopy (adjusted hazard ratio, 0.85; 95% confidence interval, 0.76-0.95) and major conservative surgery without ovarian preservation were less likely to undergo repeat surgery (adjusted hazard ratio, 0.12; 95% confidence interval, 0.09-0.18) than those who initially had minor surgery. Compared with those who initially underwent minor surgery, patients who underwent other treatment modalities were less likely to undergo a hysterectomy (diagnostic laparoscopy: adjusted hazard ratio, 0.85; 95% confidence interval, 0.75-0.96; major surgery with ovarian preservation: adjusted hazard ratio, 0.60; 95% confidence interval, 0.57-0.64; major surgery without ovarian preservation: adjusted hazard ratio, 0.05; 95% confidence interval, 0.03-0.08). Following minor and major conservative with ovarian preservation surgery, 8,331 (38.6%) and 9,498 (33.3%) of patients sought an infertility consult within 1 year, respectively. By 5 years after the index surgery, 5,290 (29.4%) of patients who had minor conservative surgery and 4,528 (20.7%) of those who had major conservative with ovarian preservation surgery had given birth at least once. CONCLUSION Our study suggests that only a few endometriosis patients who undergo hysterectomy surgery require repeat surgery; however, up to 1 in 4 who undergo minor surgery and 1 in 5 who undergo major conservative surgery with ovarian preservation require additional endometriosis surgery. Up to 1 in 3 patients who had uterine sparing endometriosis surgery subsequently sought an infertility assessment. These findings may inform preoperative counseling in terms of recurrence of symptoms, fertility outcomes, and need for reoperation of women seeking surgical management for endometriosis. Future studies should consider the outcomes of patient satisfaction and quality of life based on the current practices for management of endometriosis.
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Affiliation(s)
- Olga Bougie
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
| | - Chad McClintock
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Susan B Brogly
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Department of Surgery, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynaecology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada
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Moten AS, von Mehren M, Reddy S, Howell K, Handorf E, Farma JM. Treatment Patterns and Distance to Treatment Facility for Soft Tissue Sarcoma of the Extremity. J Surg Res 2020; 256:492-501. [PMID: 32798997 PMCID: PMC10034971 DOI: 10.1016/j.jss.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/14/2020] [Accepted: 07/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated. METHODS Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival. RESULTS The sample included 21,763 patients. The mean age was 59.3 y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07). CONCLUSIONS Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| | - Margaret von Mehren
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sanjay Reddy
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Ouzaid I, Bernhard JC, Bigot P, Nouhaud FX, Long JA, Boissier R, Gimel P, Bodin T, Hetet JF, Méjean A, Albiges L, Bensalah K. Trends in the practice of renal surgery for cancer in France after the introduction of robotic-assisted surgery: data from the National Health Care System Registry. J Robot Surg 2020; 14:799-801. [PMID: 32350709 DOI: 10.1007/s11701-020-01076-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Idir Ouzaid
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France.
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France.
- Department of Urology, Bichat Claude Bernard Hospital, 46, rue Henri Huchard, 75018, Paris, France.
| | - Jean-Christophe Bernhard
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Pierre Bigot
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - François-Xavier Nouhaud
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Jean-Alexandre Long
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Romain Boissier
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Pierre Gimel
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Thomas Bodin
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Jean-François Hetet
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Arnaud Méjean
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Laurence Albiges
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Karim Bensalah
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
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Fong PY, Tan SH, Lim DWT, Tan EH, Ng QS, Sommat K, Tan DSW, Ang MK. Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC). PLoS One 2019; 14:e0224665. [PMID: 31747406 PMCID: PMC6867599 DOI: 10.1371/journal.pone.0224665] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/18/2019] [Indexed: 12/18/2022] Open
Abstract
Aim Treatment strategies in laryngeal squamous cell cancer (LSCC) straddle the need for long term survival and tumor control as well as preservation of laryngeal function as far as possible. We sought to identify prognostic factors affecting LSCC outcomes in our population. Methods Clinical characteristics, treatments and survival outcomes of patients with LSCC were analysed. Baseline comorbidity data was collected and age-adjusted Charlson Comorbidity Index (aCCI) was calculated. Outcomes of overall survival (OS), progression-free survival (PFS) and laryngectomy-free survival (LFS) were evaluated. Results Two hundred and fifteen patients were included, 170 (79%) underwent primary radiation/ chemoradiation and the remainder upfront surgery with adjuvant therapy where indicated. The majority of patients were male, Chinese and current/ex-smokers. Presence of comorbidity was common with median aCCI of 3. Median OS was 5.8 years. On multivariable analyses, high aCCI and advanced nodal status were associated with inferior OS (HR 1.24 per one point increase in aCCI, P<0.001 and HR 3.52; p<0.001 respectively), inferior PFS (HR 1.14; p = 0.007 and HR 3.23; p<0.001 respectively) and poorer LFS (HR 1.19; p = 0.001 and HR 2.95; p<0.001 respectively). Higher tumor (T) stage was associated with inferior OS and LFS (HR 1.61; p = 0.02 and HR 1.91; p = 0.01 respectively). Conclusion In our Asian population, the presence of comorbidities and high nodal status were associated with inferior OS, PFS and LFS whilst high T stage was associated with inferior LFS and OS.
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Affiliation(s)
- Pei Yuan Fong
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore
| | | | - Eng Huat Tan
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Quan Sing Ng
- Division of Medical Oncology, National Cancer Centre, Singapore
| | - Kiattisa Sommat
- Division of Radiation Oncology, National Cancer Centre, Singapore
| | | | - Mei Kim Ang
- Division of Medical Oncology, National Cancer Centre, Singapore
- * E-mail:
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van Groningen JT, van Hagen P, Tollenaar RAEM, Tuynman JB, de Mheen PJMV, Doornebosch PG, Tanis PJ, de Graaf EJR. Evaluation of a Completion Total Mesorectal Excision in Patients After Local Excision of Rectal Cancer: A Word of Caution. J Natl Compr Canc Netw 2019; 16:822-828. [PMID: 30006424 DOI: 10.6004/jnccn.2018.7026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 03/14/2018] [Indexed: 11/17/2022]
Abstract
Background: According to Dutch guidelines, locally excised, low-risk, pT1 or ypT0-1 rectal cancer should not necessarily be followed by completion total mesorectal excision (cTME) in contrast to rectal cancers with higher T stages or unfavorable features. This study evaluated cTME after local excision at a national level with possible determinants for decision-making. Methods: All patients in the Dutch Colorectal Audit (DCRA) who underwent local excision of rectal cancer between 2012 and 2015 were included. Guideline adherence for performing cTME was determined with univariate and multivariate analyses to identify factors related to noncompliance. Results: According to the guidelines, of 530 included patients, cTME was indicated in 283 (53%), and among those, was performed in 82 (29%). Guideline adherence for performing cTME improved significantly (P<.001), from 10% in 2012 to 44% in 2015. Lower Charlson comorbidity index in patients with high-risk pT1 rectal cancer and younger patients (aged 61-70 years vs ≥80 years) with pT≥2 rectal cancer were associated with increased performance of cTME (odds ratio [OR], 13.50; 95% CI, 1.39-131.32, and OR, 6.25; 95% CI, 1.83-21.31, respectively). Conclusions: In this population-based study from the Netherlands, only a minority of patients underwent cTME after local excision of rectal cancer with pathologic features indicating the need for further treatment according to the guidelines. Although the percentage of patients undergoing cTME increased over time, the study indicated a tendency toward rectal-preserving treatment with potential oncologic risks.
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Jain AL, Sidana A, Maruf M, Sugano D, Calio B, Wood BJ, Pinto PA. Analyzing the current practice patterns and views among urologists regarding focal therapy for prostate cancer. Urol Oncol 2019; 37:182.e1-182.e8. [PMID: 30522903 PMCID: PMC8258689 DOI: 10.1016/j.urolonc.2018.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/11/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Focal therapy (FT) for localized prostate cancer (CaP) has been shown to have encouraging short-term oncological outcomes, excellent preservation of functional outcomes and is increasing in popularity in urologic community. We aim to evaluate the preferences and practice trends among urologists regarding this treatment strategy. METHODS A 20 item online questionnaire was designed to collect information on urologists' views and use of FT. The survey was sent to the members of the Endourological Society and the American Urological Association. Multivariate logistic regression analysis was done to determine predictors for utilization of FT. RESULTS A total of 425 responses were received [American Urological Association: 319, Endourological Society: 106]. Mean age of respondents was 53(SD: 11.3) years. Although half of the respondents (50.8%) believed FT to be moderate to extremely beneficial in the treatment of CaP, only 24.2% (103) of the respondents currently utilize FT in their practice. Respondents who were fellowship trained in urologic oncology were more likely to consider FT to be at least moderately beneficial (P < 0.001). Surgeon's experience (greater than 15 years in urology practice) (P = 0.025) and seeing more than 10 patients with new CaP diagnosis per month (P = 0.002) were independent predictors of FT utilization for localized CaP. While the most common setting for utilization of FT was in patients with unilateral intermediate-risk (72.8%) CaP, a small percentage of respondents also used FT for patients with unilateral high-risk CaP and bilateral intermediate risk (21.4% and 10.7%, respectively). Most common reasons for not using FT were the lack of belief in 'index lesion theory' (63.2%), lack of experience (41.3%), lack of belief in FT's efficacy (41.1%), lack of infrastructure (35.8%), difficult salvage treatment in cases of recurrence (22.7%) and high cost (21.8%). About 57.6% would use FT more often in an office or outpatient setting if they had access to reliable and cost-effective options. CONCLUSIONS Only a quarter of our respondents utilize FT in their practice with surgeon's experience being the important independent predictor for using FT. Majority of respondents though consider FT to be beneficial in CaP management, would use it more often if provided more reliable and cost-effective options. Over time, experience and accessibility to reliable methods to perform FT may lead to further utilization of this novel treatment strategy.
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Affiliation(s)
- Amit L Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brian Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Selter J, Grossman Becht LC, Huang Y, Ananth CV, Neugut AI, Hershman DL, Wright JD. Utilization of ovarian transposition for fertility preservation among young women with pelvic malignancies who undergo radiotherapy. Am J Obstet Gynecol 2018; 219:415-417. [PMID: 29883577 DOI: 10.1016/j.ajog.2018.05.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Jessica Selter
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Lisa C Grossman Becht
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY
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10
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Hsu RCJ, Barclay M, Loughran MA, Lyratzopoulos G, Gnanapragasam VJ, Armitage JN. Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010. BJU Int 2018; 122:599-609. [PMID: 29603575 PMCID: PMC6175431 DOI: 10.1111/bju.14217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC). PATIENTS AND METHODS Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals. RESULTS Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease. CONCLUSIONS Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease.
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Affiliation(s)
- Ray C. J. Hsu
- Academic Urology GroupDepartment of SurgeryUniversity of CambridgeCambridgeUK
- Department of UrologyAddenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Matthew Barclay
- The Healthcare Improvement Studies (THIS) InstituteUniversity of CambridgeCambridgeUK
| | - Molly A. Loughran
- Transforming Cancer Services TeamNational Health ServiceLondonUK
- National Cancer Registration and Analysis ServicePublic Health EnglandLondonUK
| | - Georgios Lyratzopoulos
- The Healthcare Improvement Studies (THIS) InstituteUniversity of CambridgeCambridgeUK
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) GroupDepartment of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Vincent J. Gnanapragasam
- Academic Urology GroupDepartment of SurgeryUniversity of CambridgeCambridgeUK
- Department of UrologyAddenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - James N. Armitage
- Department of UrologyAddenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
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Martinage G, Hong AM, Fay M, Thachil T, Roos D, Williams N, Lo S, Fogarty G. Quality assurance analysis of hippocampal avoidance in a melanoma whole brain radiotherapy randomized trial shows good compliance. Radiat Oncol 2018; 13:132. [PMID: 30029684 PMCID: PMC6053726 DOI: 10.1186/s13014-018-1077-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/11/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Melanoma brain metastases (MBM) often cause morbidity and mortality for stage IV melanoma patients. An ongoing randomised phase III trial (NCT01503827 - WBRT-Mel) evaluates the role of adjuvant whole brain radiotherapy (WBRT) following local treatment of MBM. Hippocampal avoidance during WBRT (HA-WBRT) has shown memory and neurocognitive function (NCF) preservation in the RTOG-0933 phase II study. This study assessed the quality assurance of HA-WBRT within the WBRT-Mel trial according to RTOG-0933 study criteria. METHODS Hippocampal avoidance was allowed in approved centres with intensity-modulated radiotherapy capability. Patients treated by HA-WBRT were not randomized within the WBRT arm. The RTOG 0933 contouring Atlas was used to contour hippocampi. In the trial co-ordinating centre, patients were treated with volumetric modulated arc therapy using complementary arcs; similar techniques were used at other sites. Dosimetric data were extracted retrospectively and analysed in accordance with RTOG 0933 study constraints criteria. RESULTS Among the 215 patients accrued to the WBRT-Mel study between April 2009 and September 2017, 107 were randomized to the WBRT arm, 22 were treated by HA-WBRT in 4 centers. Eighteen patients were treated in the same centre. The median age was 65 years. The commonest (91%) HA-WBRT schema was 30 Gy in 10 fractions. Prior to HA-WBRT, 10 patients had been treated by surgery alone, six by radiosurgery alone, four by surgery and radiosurgery and two exclusively by simultaneous integrated boost concurrent to HA-WBRT. Twenty patients were treated with intention to spare both hippocampi and two patients had MBM close to one hippocampus and were treated with intention to spare the contralateral hippocampus. According to RTOG-0933 study criteria, 18 patients (82%) were treated within constraints and four patients (18%) had unacceptable deviation in just one hippocampus. CONCLUSIONS This dosimetric quality assurance study shows good compliance (82%) according to RTOG-0933 study dosimetric constraints. Indeed, all patients respected RTOG hippocampal avoidance constraints on at least one hippocampus. In the futureanalysis of the WBRT-Mel trial, the NCF of patients on the observation arm, WBRT arm and with HA-WBRT arm will be compared.
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Affiliation(s)
- Geoffrey Martinage
- Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia
- Centre Oscar-Lambret, Lille, France
- Mater Hospital, NSW, North Sydney, Australia
| | - Angela M Hong
- Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia
- Mater Hospital, NSW, North Sydney, Australia
- GenesisCare, Radiation Oncology, Mater Hospital, NSW, North Sydney, Australia
- Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Mike Fay
- School of Medicine and Public Health, University of Newcastle, NSW, Callaghan, Australia
- GenesisCare, Radiation Oncology, NSW, Newcastle, Australia
| | - Thanuja Thachil
- Northern Territory Radiation Oncology, Alan Walker Cancer Care Centre, NT, Darwin, Australia
| | - Daniel Roos
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, South Australia, Adelaide, Australia
| | - Narelle Williams
- Australia and New Zealand Melanoma Trials Group, NSW, North Sydney, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia
- Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Gerald Fogarty
- Melanoma Institute Australia, The University of Sydney, NSW, North Sydney, Australia.
- Mater Hospital, NSW, North Sydney, Australia.
- GenesisCare, Radiation Oncology, Mater Hospital, NSW, North Sydney, Australia.
- Central Clinical School, The University of Sydney, Camperdown, NSW, Australia.
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Huddart RA, Birtle A, Maynard L, Beresford M, Blazeby J, Donovan J, Kelly JD, Kirkbank T, McLaren DB, Mead G, Moynihan C, Persad R, Scrase C, Lewis R, Hall E. Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of selective bladder preservation versus radical cystectomy. BJU Int 2017; 120:639-650. [PMID: 28453896 PMCID: PMC5655733 DOI: 10.1111/bju.13900] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To test the feasibility of a randomised trial in muscle-invasive bladder cancer (MIBC) and compare outcomes in patients who receive neoadjuvant chemotherapy followed by radical cystectomy (RC) or selective bladder preservation (SBP), where definitive treatment [RC or radiotherapy (RT)] is determined by response to chemotherapy. PATIENTS AND METHODS SPARE is a multicentre randomised controlled trial comparing RC and SBP in patients with MIBC staged T2-3 N0 M0, fit for both treatment strategies and receiving three cycles of neoadjuvant chemotherapy. Patients were randomised between RC and SBP before a cystoscopy after cycle three of neoadjuvant chemotherapy. Patients with ≤T1 residual tumour received a fourth cycle of neoadjuvant chemotherapy in both groups, followed by radical RT in the SBP group and RC in in the RC group; non-responders in both groups proceeded immediately to RC following cycle three. Feasibility study primary endpoints were accrual rate and compliance with assigned treatment strategy. The phase III trial was designed to demonstrate non-inferiority of SBP in terms of overall survival (OS) in patients whose tumours responded to neoadjuvant chemotherapy. Secondary endpoints included patient-reported quality of life, clinician assessed toxicity, loco-regional recurrence-free survival, and rate of salvage RC after SBP. RESULTS Trial recruitment was challenging and below the predefined target with 45 patients recruited in 30 months (25 RC; 20 SBP). Non-compliance with assigned treatment strategy was frequent, six of the 25 patients (24%) randomised to RC received RT. Long-term bladder preservation rate was 11/15 (73%) in those who received RT per protocol. OS survival was not significantly different between groups. CONCLUSIONS Randomising patients with MIBC between RC and SBP based on response to neoadjuvant chemotherapy was not feasible in the UK health system. Strong clinician and patient preferences for treatments impacted willingness to undergo randomisation and acceptance of treatment allocation. Due to the few participants, firm conclusions about disease and toxicity outcomes cannot be drawn.
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Affiliation(s)
- Robert A. Huddart
- The Institute of Cancer ResearchLondonUK
- Royal Marsden NHS Foundation TrustLondonUK
| | - Alison Birtle
- Royal Preston HospitalPreston and University of ManchesterManchesterUK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Emma Hall
- The Institute of Cancer ResearchLondonUK
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13
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Borah BJ, Yao X, Laughlin-Tommaso SK, Heien HC, Stewart EA. Comparative Effectiveness of Uterine Leiomyoma Procedures Using a Large Insurance Claims Database. Obstet Gynecol 2017; 130:1047-1056. [PMID: 29016510 PMCID: PMC5683097 DOI: 10.1097/aog.0000000000002331] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery. METHODS This was a retrospective analysis of administrative claims from a large U.S. commercial insurance database. Women aged 18-54 years undergoing any of the previously mentioned leiomyoma procedures between 2000 and 2013 were included. We assessed the following outcome measures: risk of reintervention between uterine-sparing procedures, risk of other surgical procedures or complications of the index procedure, 5-year health care utilization, pregnancy rates, and reproductive outcomes. Propensity score matching along with Cox proportional hazard models were used to adjust for differences in baseline characteristics between study cohorts. RESULTS Among the 135,522 study-eligible women with mean follow-up of 3.4 years, hysterectomy was the most common first-line procedural therapy (111,324 [82.2%]) followed by myomectomy (19,965 [14.7%]), uterine artery embolization (4,186 [3.1%]) and magnetic resonance-guided focused ultrasound surgery (47 [0.0003%]). Small but statistically significant differences were noted for uterine artery embolization and myomectomy in reintervention rate (17.1% compared with 15.0%, P=.02), subsequent hysterectomy rates (13.2% compared with 11.1%, P<.01) and subsequent complications from index procedures (18.1% compared with 24.6%, P<.001). During follow-up, women undergoing myomectomy had lower leiomyoma-related health care utilization, but had higher all-cause outpatient services. Pregnancy rates were 7.5% and 2.2% among myomectomy and uterine artery embolization cohorts, respectively (P<.001) with both cohorts having similar rates of adverse reproductive outcome (69.4%). CONCLUSIONS Although the overwhelming majority of women having leiomyoma with bulk symptoms underwent hysterectomy as their first treatment procedure, among those undergoing uterine-sparing index procedures, approximately one seventh had a reintervention, and one tenth ended up undergoing hysterectomy during follow-up. Compared with women undergoing myomectomy, women undergoing uterine artery embolization had a higher risk of reintervention, lower risk of subsequent complications, but similar rate of adverse reproductive outcomes.
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Affiliation(s)
- Bijan J. Borah
- Associate Professor of Health Services Research, Mayo Clinic College of Medicine, Senior Associate Consultant, Department of Health Sciences Research, and Department of Obstetrics & Gynecology (Joint Appointment), Mayo Clinic Rochester, MN
| | - Xiaoxi Yao
- Research Fellow, Kern Center for Science of Health Care Delivery, Mayo Clinic Rochester, MN
| | - Shannon K. Laughlin-Tommaso
- Assistant Professor of Obstetrics-Gynecology, Mayo Clinic College of Medicine & Consultant, Department of Surgery and Department of Obstetrics & Gynecology, Mayo Clinic Rochester, MN
| | - Herbert C. Heien
- Senior Health Services Analyst, Kern Center for Science of Health Care Delivery, Mayo Clinic Rochester, MN
| | - Elizabeth A. Stewart
- Professor of Obstetrics-Gynecology, Mayo Clinic College of Medicine & Consultant, Department of Obstetrics & Gynecology, Mayo Clinic Rochester, MN
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14
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Pogorelić Z, Mustapić K, Jukić M, Todorić J, Mrklić I, Mešštrović J, Jurić I, Furlan D. Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients. Can J Urol 2016; 23:8594-8601. [PMID: 27995859] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The aim of this study was to analyze management and outcomes of treatment in patients with acute scrotum. MATERIAL AND METHODS From January 1990 until January 2015 case records of 558 patients who underwent surgery for acute scrotum were retrospectively reviewed. Mean age was 12 years old. Each patient was analyzed for following parameters: history data, localization of pain, physical examination, operating results and the results of follow up, age, etiology, and the time from initial symptoms to surgery. RESULTS Scrotal explorations revealed 142 cases (25%) of spermatic cord torsion, 344 (62%) torsion of the testicular appendage, 54 (10%) epididymitis, 10 (2%) testicular trauma and 8 cases (1%) of other conditions. Two peaks of incidence of spermatic cord torsion were found, the first during first year of life and the second between 13 and 15 years of life. In patients with spermatic cord torsion, median duration of symptoms in the group of salvaged testes was 6 hours; while in the group of patients who underwent orchiectomy was 46 hours. Of the total number of patients with spermatic cord torsion 40 patients (28%) underwent orchiectomy while 102 testicles (72%) were saved. There were no major complications. Acute scrotum is significantly more common in the winter. Torsion of the testis has the highest incidence in January and August. CONCLUSION Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. It is of great importance that the patient seeks immediate medical attention. If the patient arrived within 6 hours the testicle can be saved.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, Split University Hospital Centre and Split University School of Medicine, Split, Croatia
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15
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Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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16
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Gillespie EF, Matsuno RK, Xu B, Triplett DP, Hwang L, Boero IJ, Einck JP, Yashar C, Murphy JD. Geographic Disparity in the Use of Hypofractionated Radiation Therapy Among Elderly Women Undergoing Breast Conservation for Invasive Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 96:251-258. [PMID: 27473817 PMCID: PMC5014714 DOI: 10.1016/j.ijrobp.2016.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate geographic heterogeneity in the delivery of hypofractionated radiation therapy (RT) for breast cancer among Medicare beneficiaries across the United States. METHODS AND MATERIALS We identified 190,193 patients from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The study included patients aged >65 years diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency ZIP code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT. RESULTS Over the entire study period we found substantial geographic heterogeneity in the use of hypofractionated RT. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements. CONCLUSIONS This study demonstrates substantial geographic heterogeneity in the use of hypofractionated RT among elderly women with invasive breast cancer treated with lumpectomy in the United States. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared with standard fractionation, and highlights possible inefficiency in health care delivery.
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Affiliation(s)
| | | | - Beibei Xu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Daniel P Triplett
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Lindsay Hwang
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Isabel J Boero
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
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17
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Petereit D, Omidpanah A, Boylan A, Kussman P, Baldwin D, Banik D, Minton M, Eastmo E, Clemments P, Guadagnolo BA. A Multi-faceted Approach to Improving Breast Cancer Outcomes in a Rural Population, and the Potential Impact of Patient Navigation. S D Med 2016; 69:268-273. [PMID: 27443111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The mastectomy rate in rural areas of the Northern Plains of the U.S. was 64 percent from 2000 through 2005. We implemented a breast cancer patient navigation (BPN) program in May 2007 to increase breast conservation (BC) rates. METHODS We analyzed mastectomy and BC rates among our 1,466 patients with either ductal carcinoma in situ (DCIS) or stage I/II invasive breast cancer treated from 2000 through 2012. We used interrupted time series (ITS) to compare rates in treatment following implementation of BPN. In addition, breast conservation rates were compared to population data from the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS The BC rates were 56 percent for navigated patients versus 37 percent for non-navigated patients (95 percent CI for difference: 14.8 to 25.6 percent). There was a consistent annual increase in treatment with BC versus a mastectomy (+2.9 percent/year, p-trend < 0.001). The BC rate of 60 percent in 2012 now mirrors those observed in the SEER database. The ITS did not find that the change in BC rates over time was significantly attributable to implementation of the BPN. Other secular trends may have contributed to the change in BC rates over time. CONCLUSIONS A number of factors may have contributed to an increase of BC rates over time, including physician and patient education, more radiation therapy options, and possibly a dedicated breast cancer PN program. This analysis demonstrates that overall breast cancer care among this rural and medically-underserved population is improving in our region and now parallels other regions of the country.
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Sapir E, Tao Y, Feng F, Samuels S, El Naqa I, Murdoch-Kinch CA, Feng M, Schipper M, Eisbruch A. Predictors of Dysgeusia in Patients With Oropharyngeal Cancer Treated With Chemotherapy and Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 96:354-361. [PMID: 27473816 DOI: 10.1016/j.ijrobp.2016.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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: 02/16/2016] [Revised: 04/16/2016] [Accepted: 05/10/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE(S) Dysgeusia is a significant factor reducing quality of life and worsening dysphagia in patients receiving chemoradiation therapy for head and neck cancer. The factors affecting dysgeusia severity are uncertain. We investigated the effects on patient-reported dysgeusia of doses to the oral cavity, salivary output (required to dissolve food particles), and patient-reported xerostomia. METHODS AND MATERIALS Seventy-three patients with stage III to IV oropharyngeal cancer (OPC) (N=73) receiving definitive intensity modulated radiation therapy concurrently with chemotherapy participated in a prospective, longitudinal study of quality of life (QOL), including assessment of patient-reported gustatory function by taste-related questions from the Head and Neck QOL instrument (HNQOL) and the University of Washington Head and Neck-related QOL instrument (UWQOL), before therapy and periodically after treatment. At these intervals, patients also completed a validated xerostomia-specific questionnaire (XQ) and underwent unstimulated and stimulated major salivary gland flow rate measurements. RESULTS At 1, 3, 6, and 12 months after treatment, dysgeusia improved over time: severe dysgeusia was reported by 50%, 40%, 22%, and 23% of patients, respectively. Significant associations were found between patient-reported severe dysgeusia and radiation dose to the oral cavity (P=.005) and tongue (P=.019); normal tissue complication probability for severe dysgeusia at 3 months showed mean oral cavity D50 doses 53 Gy and 57 Gy in the HNQOL and WUQOL questionnaires, respectively, with curve slope (m) of 0.41. Measured salivary output was not statistically significantly correlated with severe taste dysfunction, whereas patient-reported XQ summary scores and xerostomia while eating scores were correlated with severe dysgeusia in the UWQOL tool (P=.04). CONCLUSIONS Taste impairment is significantly correlated with mean radiation dose to the oral cavity. Patient-reported xerostomia, but not salivary output, was correlated with severe dysgeusia in 1 of the 2 QOL questionnaires. Reduction in oral cavity doses is likely to improve dysgeusia.
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Affiliation(s)
- Eli Sapir
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yebin Tao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Felix Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Stuart Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Mary Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Huang B, Feng L, Zhao J. Systematic review and meta-analysis of robotic versus laparoscopic distal pancreatectomy for benign and malignant pancreatic lesions. Surg Endosc 2016; 30:4078-85. [PMID: 26743110 DOI: 10.1007/s00464-015-4723-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The number of published series on minimally invasive distal pancreatectomy has significantly increased. Robotic systems can overcome some limitations of laparoscopy. This study aimed to compare two techniques in distal pancreatectomy. METHODS Multiple electronic databases were systematically searched to identify studies (up to July 2015) that compared perioperative outcomes between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). Relative risks with 95 % confidence intervals (CIs) were estimated. RESULTS Nine studies were enrolled in this review. Four studies reported on operative time, indicating no difference between the RDP and LDP groups (WMD = 21.55, 95 % CI -65.28-108.37, P = 0.63). No significant difference between the two groups was indicated with respect to the number of patients who converted to open (OR 0.35, 95 % CI 0.11-1.13, P = 0.08), spleen preservation rate (OR 2.37, 95 % CI 0.50-11.30, P = 0.28), and transfusion rate (OR 1.30, 95 % CI 0.54-3.13, P = 0.56). In addition, no difference was indicated in the incidence of pancreatic fistulas (OR 1.05, 95 % CI 0.67-1.65, P = 0.83) and length of hospital stay between the two groups (WMD = -0.61, 95 % CI -1.40-0.19, P = 0.13). CONCLUSIONS RDP seems to be a safe and effective alternative to LDP. Large randomized controlled trials are needed to verify the results of this meta-analysis.
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Affiliation(s)
- Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Lu Feng
- Department of Emergency Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Borah BJ, Laughlin-Tommaso SK, Myers ER, Yao X, Stewart EA. Association Between Patient Characteristics and Treatment Procedure Among Patients With Uterine Leiomyomas. Obstet Gynecol 2016; 127:67-77. [PMID: 26646122 PMCID: PMC4689646 DOI: 10.1097/aog.0000000000001160] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the association between patient characteristics and the probability of undergoing any uterine-sparing procedure (endometrial ablation, myomectomy, and uterine artery embolization) compared with hysterectomy as the first uterine leiomyoma (index) procedure and the probability of undergoing a specific uterine-sparing procedure. METHODS We conducted a retrospective analysis using a commercial insurance claims database containing more than 13 million enrollees annually. Based on the index procedure performed 2004-2009, women were classified into one of the four procedure cohorts. Eligible women were aged 25-54 years on the index date, continuously insured through 1-year baseline and 1-year follow-up, and had a baseline uterine leiomyoma diagnosis. Logistic regression was used to assess the association between patient characteristics and leiomyoma procedure. RESULTS The study sample comprised 96,852 patients (endometrial ablation=12,169; myomectomy=7,039; uterine artery embolization=3,835; and hysterectomy=73,809). Patient characteristics associated with undergoing any uterine-sparing procedure compared with hysterectomy included health maintenance organization health plan enrollment, Northeast region residence, the highest income and education quintiles based on zip code, an age-race interaction, and baseline diagnoses including menstrual disorders, pelvic pain, anemia, endometriosis, genital prolapse, and infertility. Among those who had a uterine-sparing procedure, characteristics associated with undergoing uterine artery embolization or endometrial ablation compared with myomectomy included increasing age, being from the Midwest relative to the Northeast, and certain baseline conditions including menstrual disorder, pelvic pain, endometriosis, and infertility. CONCLUSION Both clinical and nonclinical factors were associated with the receipt of alternatives to hysterectomy for uterine leiomyomas in commercially insured women.
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Affiliation(s)
- Bijan J. Borah
- Associate Professor of Health Services Research, Mayo Clinic College of Medicine, Senior Associate Consultant, Department of Health Sciences Research, and Department of Obstetrics & Gynecology (Joint Appointment), Mayo Clinic Rochester, MN
| | - Shannon K. Laughlin-Tommaso
- Assistant Professor of Obstetrics-Gynecology, Mayo Clinic College of Medicine & Consultant, Department of Surgery and Department of Obstetrics & Gynecology, Mayo Clinic Rochester, MN
| | - Evan R. Myers
- Professor of Obstetrics and Gynecology, Duke University School of Medicine & Chief of the Division of Clinical and Epidemiologic Research, Department of Obstetrics & Gynecology, Durham, NC
| | - Xiaoxi Yao
- Research Fellow, Center for Science of Health Care Delivery, Mayo Clinic Rochester, MN
| | - Elizabeth A. Stewart
- Professor of Obstetrics-Gynecology, Mayo Clinic College of Medicine & Consultant, Department of Obstetrics & Gynecology, Rochester, MN
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Chow I, Hanwright PJ, Hansen NM, Leilabadi SN, Kim JYS. Predictors of 30-day readmission after mastectomy: A multi-institutional analysis of 21,271 patients. Breast Dis 2015; 35:221-231. [PMID: 26397768 DOI: 10.3233/bd-150412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Recent healthcare legislation has made unplanned hospital readmission an important metric of health care quality, and current efforts center on reducing this complication in order to avoid fiduciary penalties. OBJECTIVE There is currently a paucity of data delineating risk factors for readmission following mastectomy. To this end, we sought to develop a predictive model of unplanned readmissions following mastectomy. METHODS The 2011 and 2012 National Surgical Quality Improvement Program (NSQIP) datasets were retrospectively queried to identify patients who underwent mastectomy. Multivariate logistic regression modeling was used to identify risk factors for readmission. RESULTS Of 21,271 patients meeting inclusion criteria, 1,190 (5.59%) were readmitted. The most commonly cited reasons for readmission included surgical site complications (32.85%), infection not localized to the surgical site (2.72%), and venous thromboembolism (4.39%). Independent predictors of readmission included BMI, active smoking status, and skin-sparing mastectomy. Significantly, concurrent breast reconstruction and bilateral mastectomy were not independent predictors of readmission. CONCLUSIONS This is the first study of readmission rates after mastectomy. Awareness of specific risk factors for readmission, particularly those that are modifiable, may serve to identify and manage high risk patients, aid in the development of pre- and postoperative clinical care guidelines, and ultimately improve patient care.
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Affiliation(s)
- Ian Chow
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Philip J Hanwright
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nora M Hansen
- Lynn Sage Comprehensive Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Solmaz N Leilabadi
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Ishii K, Ogino R, Hosokawa Y, Fujioka C, Okada W, Nakahara R, Kawamorita R, Tada T, Hayashi Y, Nakajima T. Whole-pelvic volumetric-modulated arc therapy for high-risk prostate cancer: treatment planning and acute toxicity. J Radiat Res 2015; 56:141-150. [PMID: 25304328 PMCID: PMC4572588 DOI: 10.1093/jrr/rru086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 06/04/2023]
Abstract
The objectives of this study were to evaluate dosimetric quality and acute toxicity of volumetric-modulated arc therapy (VMAT) and daily image guidance in high-risk prostate cancer patients. A total of 100 consecutive high-risk prostate cancer patients treated with definitive VMAT with prophylactic whole-pelvic radiotherapy (WPRT) were enrolled. All patients were treated with a double-arc VMAT plan delivering 52 Gy to the prostate planning target volume (PTV), while simultaneously delivering 46.8 Gy to the pelvic nodal PTV in 26 fractions, followed by a single-arc VMAT plan delivering 26 Gy to the prostate PTV in 13 fractions. Image-guided RT was performed with daily cone-beam computed tomography. Dose-volume parameters for the PTV and the organs at risk (OARs), total number of monitor units (MUs) and treatment time were evaluated. Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events, version 4.0. All dosimetric parameters met the present plan acceptance criteria. Mean MU and treatment time were 471 and 146 s for double-arc VMAT, respectively, and were 520 and 76 s for single-arc VMAT, respectively. No Grade 3 or higher acute toxicity was reported. Acute Grade 2 proctitis, diarrhea, and genitourinary toxicity occurred in 12 patients (12%), 6 patients (6%) and 13 patients (13%), respectively. The present study demonstrated that VMAT for WPRT in prostate cancer results in favorable PTV coverage and OAR sparing with short treatment time and an acceptable rate of acute toxicity. These findings support the use of VMAT for delivering WPRT to high-risk prostate cancer patients.
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Affiliation(s)
- Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Yukinari Hosokawa
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Chiaki Fujioka
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Wataru Okada
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryota Nakahara
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, 4-10-10 Futyu-cho, Izumi, 594-0071, Japan
| | - Yoshiki Hayashi
- Department of Urology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
| | - Toshifumi Nakajima
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujo-minami, Nishi-ku, Osaka, 550-0025, Japan
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Wei T, Li Z, Jin J, Chen R, Gong Y, Du Z, Gong R, Zhu J. Autotransplantation of Inferior Parathyroid glands during central neck dissection for papillary thyroid carcinoma: a retrospective cohort study. Int J Surg 2014; 12:1286-90. [PMID: 25448646 DOI: 10.1016/j.ijsu.2014.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/27/2014] [Accepted: 11/01/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The management of inferior parathyroid glands during central neck dissection (CND) for papillary thyroid carcinoma (PTC) remains controversial. Most surgeons preserve inferior parathyroid glands in situ. Autotransplantation is not routinely performed unless devascularization or inadvertent parathyroidectomy occurs. This retrospective study aimed to compare the incidence of postoperative hypoparathyroidism and central neck lymph node (CNLN) recurrence in patients with PTC who underwent inferior parathyroid glands autotransplantation vs preservation in situ. METHODS This is a retrospective study which was conducted in a tertiary referral hospital. A total of 477 patients with PTC (pN1) who underwent total thyroidectomy (TT) and bilateral CND with/without lateral neck dissection were included. Patients' demographical characteristics, tumor stage, incidence of hypoparathyroidism, CNLN recurrence and the number of resected CNLN were analyzed. RESULTS Three hundred and twenty-one patients underwent inferior parathyroid glands autotransplantation (autotransplantation group). Inferior parathyroid glands were preserved in situ among 156 patients (preservation group). Permanent hypoparathyroidism rate was 0.9% (3/321) versus 3.8% (6/156) respectively (p = 0.028). Mean numbers of resected CNLN were 15 ± 3 (6-23) (autotransplantation group) versus 11 ± 3 (7-21) (preservation group) (p < 0.001). CNLN recurrence rate was 0.3% (1/321) versus 3.8% (6/156) respectively (p = 0.003). CONCLUSION Inferior parathyroid glands autotransplantation during CND of PTC (pN1) might reduce permanent hypoparathyroidism and CNLN recurrence. Further study enrolling more patients with long-term follow-up is needed to support this conclusion.
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Affiliation(s)
- Tao Wei
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Zhihui Li
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Judy Jin
- Department of Endocrine Surgery, Endocrine & Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rui Chen
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Yanping Gong
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Zhenhong Du
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Rixiang Gong
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China
| | - Jingqiang Zhu
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR. China.
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Olsen-Deeter L, Hsu CH, Nodora JN, Bouton ME, Nalagan J, Martinez ME, Komenaka IK. Factors which affect use of breast conservation and mastectomy in an underinsured Hispanic population. Surg Oncol 2014; 23:186-91. [PMID: 25443563 DOI: 10.1016/j.suronc.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/19/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite no difference in overall survival between breast conservation and mastectomy, significant variation exists between institutions and within populations. Less data exists about racial and ethnic minority populations. The current study was performed to evaluate variables that affect use of breast conservation and mastectomy in an underinsured Hispanic population. METHODS A retrospective review was performed of all patients who self-identified as of Hispanic ethnicity and underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital. Sociodemographic, clinical, and treatment variables were evaluated. All patients with documented contraindications to breast conservation were excluded. Univariate analysis and multivariate analysis were performed to identify variables which were associated with type of operation. RESULTS The average age of the 219 patients included was 50 years. Most of the patients (93%) were insured with Medicaid or uninsured and 59% presented with clinical stage 2A/B cancers. Mastectomy was performed in 33% of patients and 67% had breast conservation. In adjusted multivariate analysis higher pathologic stage (p=0.01) and English speakers (p=0.03) were associated with mastectomy. By contrast, higher BMI (p=0.03) and use of preoperative chemotherapy (p=0.01) were associated with breast conservation. CONCLUSIONS In this underinsured Hispanic population, patients with higher pathologic stage and English speaking patients were more likely to undergo mastectomy. Patients who underwent preoperative chemotherapy and who had higher BMI were more likely to undergo breast conservation.
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Affiliation(s)
| | - Chiu-Hsieh Hsu
- Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jesse N Nodora
- Moores University of California San Diego Cancer Center, San Diego, CA, USA
| | | | | | | | - Ian K Komenaka
- Maricopa Medical Center, Phoenix, AZ, USA; Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
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Tietze S, Herms M, Behrendt W, Krause J, Hamza A. [Controversies of partial nephrectomy for renal cell carcinoma : survey in the German-speaking countries]. Urologe A 2014; 53:1181-5. [PMID: 24824467 DOI: 10.1007/s00120-014-3469-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The goal of this study was to evaluate how partial nephrectomy is technically performed in Germany, Austria, and Switzerland. METHODS A one-page anonymous questionnaire was designed to evaluate the indication, the technical procedure, and the follow-up of R1 situation after partial nephrectomy. Furthermore, the size of the hospitals and their catchment areas were recorded. The questionnaire was sent to 341 clinics and a statistical analysis was performed. RESULTS The response rate was 69 %. Up to 99 % of the clinics also perform partial resection in T1b tumors. Of those responding, 58 % perform this surgery laparoscopically, and 83 % of the surgeries are performed in warm ischemia. For the follow-up, 29 % suggest imaging within the first 6 weeks. According to this survey, maximum care clinics perform laparoscopic nephrectomy more frequently (p = 0.003). CONCLUSION The survey of 236 hospitals performing partial nephrectomy shows great variability in the indication, technique, and aftercare of organ-preserving renal tumor surgery. It also shows that a large proportion of tumors >4 cm undergo organ-preserving surgery, many of them minimally invasive. The diverse handling with positive instantaneous section and R1 results suggest the need for further studies concerning long-term follow-up after minimally invasive surgery with R1 situation and renal tumors > T1a.
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Affiliation(s)
- S Tietze
- Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland,
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Levy A, Blanchard P, Temam S, Maison MM, Janot F, Mirghani H, Bidault F, Guigay J, Lusinchi A, Bourhis J, Daly-Schveitzer N, Tao Y. Squamous cell carcinoma of the larynx with subglottic extension: is larynx preservation possible? Strahlenther Onkol 2014; 190:654-60. [PMID: 24589921 DOI: 10.1007/s00066-014-0647-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 08/14/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Squamous cell carcinoma of larynx with subglottic extension (sSCC) is a rare location described to carry a poor prognosis. The aim of this study was to analyze outcomes and feasibility of larynx preservation in sSCC patients. PATIENTS AND METHODS Between 1996 and 2012, 197 patients with sSCC were treated at our institution and included in the analysis. Stage III-IV tumors accounted for 76%. Patients received surgery (62%), radiotherapy (RT) (18%), or induction chemotherapy (CT) (20%) as front-line therapy. RESULTS The 5-year actuarial overall survival (OS), locoregional control (LRC), and distant control rate were 59% (95% CI 51-68), 83% (95% CI 77-89), and 88% (95% CI 83-93), respectively, with a median follow-up of 54.4 months. There was no difference in OS and LRC according to front-line treatments or between primary subglottic cancer and glottosupraglottic cancers with subglottic extension. In the multivariate analysis, age > 60 years and positive N stage were the only predictors for OS (HR 2, 95% CI 1.2-3.6; HR1.9, 95% CI 1-3.5, respectively). A lower LRC was observed for T3 patients receiving a larynx preservation protocol as compared with those receiving a front-line surgery (HR 14.1, 95% CI 2.5-136.7; p = 0.02); however, no difference of ultimate LRC was observed according to the first therapy when including T3 patients who underwent salvage laryngectomy (p = 0.6). In patients receiving a larynx preservation protocol, the 5-year larynx-preservation rate was 55% (95% CI 43-68), with 36% in T3 patients. The 5-year larynx preservation rate was 81% (95% CI 65-96) and 35% (95% CI 20-51) for patients who received RT or induction CT as a front-line treatment, respectively. CONCLUSION Outcomes of sSCC are comparable with other laryngeal cancers when managed with modern therapeutic options. Larynx-preservation protocols could be a suitable option in T1-T2 (RT or chemo-RT) and selected T3 sSCC patients (induction CT).
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Affiliation(s)
- A Levy
- Department of Radiotherapy, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
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Novikova EG, Shevchuk AS. [Organ-sparing therapy for patients with borderline ovarian tumors]. Vopr Onkol 2014; 60:267-273. [PMID: 25033676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Contemporary possibilities of organ-sparing therapy for borderline ovarian tumors are considered. World data was analyzed on recurrence rates and fertility rates after different methods of conservative surgery. The experience with ultra-conservative surgery in patients with bilateral borderline ovarian tumors at the Onco-Gynecological clinic of the P.A. Herzen Moscow Research Oncology Institute is presented.
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von Klot C, Herrmann TR, Wegener G, Kuczyk MA, Hupe MC, Akkoyun M, Peters I, Kramer MW, Merseburger AS. Age distribution for partial and radical nephrectomy: whose nephrons are being spared? Adv Ther 2013; 30:924-32. [PMID: 24155056 DOI: 10.1007/s12325-013-0061-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/10/2013] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Nephron sparing surgery (NSS) is recommended for patients with T1 renal cell carcinoma (RCC) whenever surgically feasible. By analyzing data from all urological clinics in the whole state of Lower Saxony, Germany, regardless of clinic size or level of expertise, we investigated whether current practice reflects the need for NSS in older patients on a broader scale. METHODS From 2005 to 2010, more than 100 medical facilities and urological clinics in Lower Saxony, Germany were evaluated for their individual rates of partial nephrectomy (PN) and radical nephrectomy (RN) based on patient's age in 5-year intervals. RESULTS Sufficient data on age were available for 3,332 out of 3,693 patients with RCC undergoing surgery. PN rates for all patients and for those with T1 RCC were 19.9% and 29.5%, respectively. For all patients with RCC, the rates for PN and RN below the median age (<66.8 years) were 365 (21.9%) and 1,302 (78.1%) and above the median age were 297 (17.8%) and 1,368 (82.2%), respectively (P = 0.003). For patients with T1 RCC, the rates for PN and RN below the median age (<66.5 years) were 341 (32.6%) and 704 (67.4%) and above the median age were 277 (26.4%) and 774 (73.6%), respectively (P = 0.002). The highest rate for each type of surgery was seen in those aged 65-70 years, except for patients with T1 RCC receiving RN who were mostly operated on when aged 70-75 years. CONCLUSION The rate of PN for all patients with RCC in this series and especially for patients with T1 RCC is significantly lower in older patients, thereby not reflecting the need and understanding for NSS in the higher age segment. Broader education and teaching of NSS might improve treatment of RCC in the future.
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Affiliation(s)
- Christoph von Klot
- Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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Abstract
BACKGROUND Traditionally, thyroid surgery has been an inpatient procedure due to the risk of several well-documented complications. Recent research suggests that for selected patients, outpatient thyroid surgery is safe and feasible, with the additional potential benefit of cost savings. In recognition of these observations, we hypothesized that there would be an increase in U.S. outpatient thyroidectomies with a concurrent decline in inpatient thyroidectomies over time. METHODS Comparative cross-sectional analyses of the National Survey of Ambulatory Surgery (NSAS) and Nationwide Inpatient Sample (NIS) databases from 1996 and 2006 were performed. All cases of thyroid surgery were extracted, as well as data on age, sex, and insurance status. Diagnoses and surgical cases were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnostic and treatment codes. Hospital charges were acquired from the NIS 1996 and 2006 and NSAS 2006 releases, using imputed data where necessary. After survey weights were applied, patient characteristics, diagnoses, and procedures were compared for inpatient versus outpatient procedures. RESULTS The total number of thyroidectomies increased 39%, from 66,864 to 92,931 cases per year during the study timeframe. Outpatient procedures increased by 61%, while inpatient procedures increased by 30%. The proportion of privately insured inpatients declined slightly from 63.8% to 60.1%, while those covered by Medicare increased from 22.8% to 25.8%. In contrast, the proportion of privately insured outpatients declined sharply from 76.8% to 39.9%, while those covered by Medicare rose from 17.2% to 45.7%. These trends coincided with a small increase in the mean inpatient age from 50.2 to 52.3 years and a larger increase in the mean outpatient age from 50.7 to 58.1 years. Inflation-adjusted per-capita charges for inpatient thyroidectomies more than doubled from $9,934 in 1996 to $22,537 in 2006, while aggregate national inpatient charges tripled from $464 million to $1.37 billion. By comparison, per-capita charges for outpatient thyroidectomy totaled $7,222 in 2006. CONCLUSIONS From 1996 to 2006, there has been a concurrent modest increase in inpatient and pronounced increase in outpatient thyroidectomies in the United States, with a consequential demographic shift and economic impact.
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Affiliation(s)
- Gordon H Sun
- Robert Wood Johnson Foundation Clinical Scholars, University of Michigan, Ann Arbor, Michigan 48109-2800, USA
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Wan JF, Zhang SJ, Wang L, Zhao KL. Implications for preserving neural stem cells in whole brain radiotherapy and prophylactic cranial irradiation: a review of 2270 metastases in 488 patients. J Radiat Res 2013; 54:285-291. [PMID: 23022606 PMCID: PMC3589923 DOI: 10.1093/jrr/rrs085] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 06/01/2023]
Abstract
This study delineated the incidence of metastatic involvement of neural stem cell (NSC) regions and further aimed to explore the feasibility of selectively sparing the NSC compartments during whole brain radiotherapy (WBRT) and prophylactic cranial irradiation (PCI). A total of 2270 intracranial metastases in 488 patients were identified. Lesions were classified according to locations, including lesions in the NSC compartments (subventricular zone, SVZ, or hippocampus) and those in the rest of the brain/brainstem. The incidence of involvement of NSC regions was compared between oligometastatic patients (those with 1-4 lesions) and non-oligometastatic patients (those with 5 or more lesions) using a chi-square test. The volume of the NSC regions accounted for 2.23% of the whole brain, and the overall rate of metastatic lesions in NSC regions was 1.1% in 2270 metastases (25/2270), and 4.7% in 488 patients (23/488). Of the NSC region metastases, 7 (0.3%) involved the hippocampus and 18 (0.8%) occurred in the SVZ. Among the 7 hippocampal metastases identified in this study, 1/7 (14.3%) were found in oligometastatic patients, while 6/7 (85.7%) metastases were in non-oligometastatic patients. For metastases in the SVZ, all lesions occurred in non-oligometastatic patients with none in oligometastatic patients. Metastatic involvement of the NSC compartments was significantly lower in oligometastatic patients (0.15%, 1/670) than in non-oligometastatic patients (1.5%, 24/1600) (P < 0.001). Our retrospective review of 2270 metastases in 488 patients is that the volume of the compartments of NSC regions was 2.23% relative to the whole brain, but the incidence of involvement of the NSC compartments was 1.1%, and the vast majority of NSC lesions were found in non-oligometastatic patients. We believe our data supports selective reduction of doses for these aforementioned structures, when treating oligometastatic patients with WBRT and locally advanced-stage small-cell lung cancer patients with PCI.
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Affiliation(s)
- Jue-Feng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Sheng-Jian Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lu Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Kuai-Le Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Preininger B, Schmorl K, von Roth P, Winkler T, Matziolis G, Perka C, Tohtz S. [More muscle mass in men: explanatory model for superior outcome after total hip arthroplasty]. Orthopade 2013; 42:107-13. [PMID: 23381894 DOI: 10.1007/s00132-012-2042-4] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Men show better functional results after total hip arthroplasty (THA). The aim of this study was a patient-specific analysis of the hip joint muscles in comparison to the joint geometry. METHODS In this study 93 computed tomography (CT) scans of the pelvis (45 men, 48 women) were analyzed to determine hip joint geometry and the volume of the gluteus medius (GMV), gluteus maximus (GXV) and tensor fasciae latae (TFL) muscles. The abduction muscle volumes were analyzed with respect to patient-specific adduction moments. RESULTS The absolute total volume of the hip muscular system (TMV) was larger in men than in women (1913 ccm vs. 1479 ccm; p <0.0001). Men exhibited a more progressive increase of muscle volume as the adduction moment increases. CONCLUSIONS Men have a greater abduction muscle mass in order to balance adduction moments occurring in the hip joint and therefore have more muscle mass to compensate the inevitable intraoperative muscle damage during THA. This argument supports the extraordinary importance of muscle sparing surgical techniques in women.
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Affiliation(s)
- B Preininger
- Klinik für Orthopädie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland.
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Smith PH, Elliott VL, Raman JD. Contemporary management of small renal masses: does practice environment matter? Can J Urol 2012; 19:6438-6442. [PMID: 23040625] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Population based studies imply underutilization of renal preservation for managing small renal mass (SRMs). Limited information is available regarding the impact of practice environment on SRM treatment. We evaluated practice patterns for SRMs in the context of a urologist's practice environment. MATERIALS AND METHODS Survey instrument querying practice type (private versus academic/academic affiliation) was distributed to urologists of the Mid-Atlantic section of the American Urological Association. Physicians were presented three case scenarios (exophytic 2.5 cm SRM in a healthy 55-year-old, healthy 75-year-old, and comorbid 75-year-old patient) and were queried on management. RESULTS Of the 281 respondents who manage kidney cancer, 92 practiced in an academic environment, and 189 were private practitioners. Thirty-four percent had completed residency training within 10 years, 25% between 11-20 years, and 41% over 20 years. For SRMs in a healthy 55-year-old, over 95% of practicing nephrologists advocated nephron-sparing treatments. Nonetheless, private practitioners were more likely to perform a radical nephrectomy (6% versus 0%, p = 0.03) and less likely perform a partial nephrectomy (79% versus 91%, p = 0.01) than academic counterparts. We observed an increase in the percentage of urologists offering thermal ablation (38% versus 12%, p < 0.0001) and observation (29% versus 1%, p < 0.0001) with a corresponding decline in the use of partial nephrectomy (32% versus 83%, p < 0.0001) in the 75-year-old versus 55-year-old patient. When considering management of a SRM in 75-year-old patients (healthy or comorbid), private practitioners were more likely to offer a thermal ablative procedure when compared to academic urologists (41% versus 32%, p = 0.05). CONCLUSIONS Over 95% of urologists espouse renal preservation strategies for a SRM in a healthy, young patient. Private practitioners are more likely to perform a radical (and less likely a partial) nephrectomy in this cohort. While surveillance is increasingly utilized for SRMs in the elderly patient, private practitioners are more likely to recommend active treatment via thermal ablation when compared to academic counterparts.
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Affiliation(s)
- Paul H Smith
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA
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