Abstract P5-14-12: Cosmetic outcome is better after intraoperative radiotherapy compared with external beam radiotherapy: An objective assessment of patients from a randomized controlled trial

The randomised controlled TARGeted Intraoperative radioTherapy (TARGIT) Trial has demonstrated non-inferiority between the novel technique of TARGIT (intra-operative radiotherapy with Intrabeam ®) and conventional whole-breast external beam radiotherapy (EBRT) in women with early breast cancer, in terms of the primary outcome measure of risk of local relapse within the treated breast. As there are very low recurrence rates, cosmesis becomes an increasingly important outcome of breast conserving treatment with both surgery and radiotherapy. This study was performed to determine if the single high dose of TARGIT compared with EBRT leads to impaired cosmesis.

A validated, objective assessment software tool for evaluation of cosmetic outcome was used. Frontal digital photographs were taken at baseline (before radiotherapy) and annually thereafter for up to five years. The photographs were analysed by BCCT.core which produces a composite score based on symmetry, colour and scar.

A total of 342 patients were assessed, all over 50 years old with a median age at baseline of 64 years (IQR 59 to 68). The BCCT.core scores were dichotomised into Excellent and Good (EG), and Fair and Poor (FP). There were statistically significant increases in the odds of having an outcome of EG for patients in the TARGIT group compared with the EBRT group at year 1 (OR = 2.07, 95%CI 1.12 to 3.85, p = 0.021) and year 2 (OR = 2.11, 95%CI 1.0 to 4.45, p = 0.05).

This objective assessment of aesthetic outcome in patients from a randomised setting demonstrates that those treated with targeted intraoperative radiotherapy have a superior cosmetic result compared with those patients who received conventional whole-breast external beam radiotherapy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-12.

Comparison of the Danish Prostatic Symptom Score with the International Prostatic Symptom Score, the Madsen-Iversen and Boyarsky symptom indexes. ALFECH Study Group

OBJECTIVE

To compare the Danish Prostatic Symptom Score (DAN-PSS) with the International Prostatic Symptom Score (IPSS). Madsen-Iversen and Boyarsky symptom indexes in a clinical setting, and to evaluate the potential significance of any differences in information obtained from these questionnaires.

PATIENTS AND METHODS

The study comprised two substudies: in the first, 205 patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), a Madsen-Iversen score > 6 and a maximum flow rate of < 10 mL/s were randomized to receive either placebo or alfuzosin in a double-blind study of 16 weeks. The symptoms were assessed using the Madsen-Iversen, DAN-PSS and the IPSS questionnaires. In the second, 138 patients with LUTS suggestive of BOO were selected for treatment with transurethral microwave thermotherapy (TUMT, 52 degrees C for 60 min, microwave energy 200 kJ) and their symptoms assessed using the Boyarsky and the DAN-PSS questionnaires. Patients were then followed for one year. Rank correlation coefficients and regression lines were calculated using Spearman's non-parametric test. The relative changes, i.e. responsiveness, calculated for the DAN-PSS, IPSS and Boyarsky indexes were compared pairwise using the Wilcoxon-Pratt test.

RESULTS

The DAN-PSS, IPSS and Madsen-Iversen indexes were correlated on a pairwise basis. The DAN-PSS and IPSS indexes have significant construct validity in terms of correlation with the Madsen-Iversen system (Spearman's correlation coefficient, rs = 0.51 and rs = 0.45, respectively). The DAN-PSS and the IPSS indexes were correlated (rs = 0.61). The DAN-PSS was more sensitive than the IPSS to changes after pharmacological treatment, with scores decreasing 70% and 29% (P < 0.05), respectively, after treatment with an alpha-blocker for 4 months, and 50% and 29% (P < 0.05), respectively, after 4 months on placebo treatment. Finally, the responsiveness of the Boyarsky and DAN-PSS indexes to TUMT showed that the DAN-PSS system was significantly more responsive than the Boyarsky index, with scores decreasing 57% and 15% (P < 0.05), respectively, after one year.

CONCLUSIONS

The DAN-PSS index is more sensitive than the IPSS, Madsen-Iversen and Boyarsky symptom indexes, incorporates important outcome events, includes a patient-weighting of each symptom, thereby reflecting better the patients' global assessment of outcome.

Radiation-associated angiosarcoma of the small bowel. A case of multiploidy and a fulminant clinical course. Case report

Angiosarcoma developing in unusual sites such as the gastrointestinal tract is not uncommonly associated with a known eliciting factor. Thus, among hitherto reported cases of angiosarcoma of the small bowel, five were radiation-associated. One additional example of ileal angiosarcoma induced by therapeutic irradiation of endometrial carcinoma is herein reported as a reminder of this causal association. DNA analyses of the primary growth as well as the metastatic deposits showed at least four aneuploid cell clones indicating genetic instability. This observation corresponds to the consistently poor prognosis of radiation-associated angiosarcoma of the small bowel.

Symptomatic outcome of transurethral prostatectomy, alpha-blockade and placebo in the treatment of benign prostatic hyperplasia. Evaluation of treatment with the Danish Prostatic Symptom Score (DAN-PSS-1) system. The ALFECH Study Group

To assess the symptomatic outcome following transurethral prostatectomy (TURP), alpha-blockade and placebo treatment in uncomplicated benign prostatic hyperplasia (BPH), 260 patients were evaluated with the recently formulated Danish Prostatic Symptom Score (DAN-PSS-1) system: 205 were randomized to either the selective alpha-blocker alfuzosin or placebo and 55 underwent TURP. Following TURP, the DAN-PSS-1 score was reduced by 80% after 6-10 weeks (visit 2) and by 100% after 12-16 weeks (visit 3). In the alfuzosin group the corresponding reductions were 40% and 65% (p < 0.02 vs. placebo). In the placebo group the reduction was 25% at visit 2, with no further fall demonstrated thereafter. During alfuzosin treatment the bother score (impact of symptoms on quality of life) fell more than the symptom score. During placebo treatment there was no reduction in symptom score. We conclude that the DAN-PSS-1 questionnaire sensitively identifies clinically important responses to treatment of BPH.

Validation of the self-administered Danish Prostatic Symptom Score (DAN-PSS-1) system for use in benign prostatic hyperplasia

OBJECTIVE

To validate the Danish Prostatic Symptom Score (DAN-PSS-1), a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom.

METHODS

Using published results from several comparisons of other symptom scoring systems with DAN-PSS-1, the test-retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN-PSS-1 system were assessed.

RESULTS

The system was internally consistent (Cronbach's alpha = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%) and the questionnaire was well understood by the patients. The DAN-PSS-1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen-Iversen score system (Spearman's correlation coefficient, rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The DAN-PSS-1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transurethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treatment with an alpha-blocker.

CONCLUSIONS

The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow-up after intervention.

Physical and chemical processes of sulphur dioxide in the plume from an oil-fired power station

The Danish contribution to the EUROCOP COST 61a project is described. Work concerned the physical and chemical reactions of sulphur dioxide released from a power station. The investigation was based on the application of two tracers. Inactive, inert SF6 is used to monitor the dispersion of and deposition from the plume; it was intended to use radioactive 35SO2 to determine the degree of oxidation of sulphur released from the stack; so far, however, public reaction has prevented the use of a release of activity in field experiments. The report describes the construction and testing of airborne instruments for continuous registration of sulphur dioxide, nitrogen oxides, ozone and the tracer SF6, as well as for measurements of temperature and humidity. Sulphur samples were collected on filter paper in a specially constructed low volume air sampler, and the subsequentchemical analysis in the laboratory is described. Finally, the problem of navigation is treated. It is shown that nitrogen oxides may be used as an internal tracer in plume experiments. Preliminary experiments based on inactive analysis only indicated an overall half-life for SO2 in the plume of about half an hour.

Air pollution in copenhagen. Part I. Element analysis and size distribution of aerosols

Aerosols were monitored in Greater Copenhagen in the period June 1973 to July 1974. Size-fractionated cascade impactor samples and unfractionated filter samples were regularly collected and analyzed by neutron activation analysis, spark emission spectroscopy or proton-induced X-ray emission spectroscopy. Concentrations were determined of the following elements: Al, Si, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br, Mo, Cd, Sn, Sb, and Pb. All elements showed orders-of-magnitude fluctuations; the mean concentrations were roughly the same as in other large cities. In relation to proposed air quality standards, Pb was the most critical component. Statistical analysis of variation patterns, size distributions and interelement correlations indicate that automotive exhaust is the source of Br and Pb; fuel-oil combustion is the main source of V and Ni (and partly of S); soil dust raised by wind or by human activity (e. g. traffic) is the main source of Al, Si, Ca, Ti, and Fe.