Cerebellar degeneration in primary Sjögren syndrome

Neurological manifestations are reported as a consequence of primary Sjögren syndrome (PSS). Any part of the brain and peripheral nervous system can be involved in PSS. However, cerebellar degeneration and atrophy associated with PSS have been rarely reported. Our report describes a 22-year-old woman who presented with cerebellar ataxia, arthritis and arthralgia. Evaluation of her symptoms, autoantibodies and salivary gland pathology was in favour of the diagnosis of Sjögren syndrome. Also, her brain MRI revealed cerebellar degeneration. There are only four patients reported to be affected by cerebellar atrophy associated with PSS. Administration of high doses of methylprednisolone and cyclophosphamide leads to substantial improvement in the cerebellar symptoms of this case. In addition, after 2 months of follow-up, the patient's ataxia recovered significantly. It could be concluded that in addition to neurological degenerative disorders, in some cases cerebellar atrophy could also be associated with autoimmune conditions such as PSS.

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Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis

A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.

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Lupus of the larynx: when bamboo nodes lead to diagnosis...

Description 

An 18-year-old patient consulted complaining of dysphonia for 3 months associated with severe weakness, headache and diffuse articular pain, with haematoma at the slightest trauma.

Laryngoscopy showed a submucosal oval lesion in the middle third of the two vocal folds resembling bamboo joint nodes (figure 1). Laboratory analysis showed the presence of antinuclear antibodies, antidouble-stranded DNA, antinucleosome, anti-SSA (117), anti-SSB (115) and anti-Sm (25) antibodies associated with thrombocytopaenia, haemolytic anaemia and severe ADAMTS-13 deficiency (under 5%). The patient was admitted to the hospital for monitoring, plasma exchange and glucocorticoid therapy. The diagnosis of systemic lupus erythematosus was made. The laryngeal lesions were bamboo nodes. The patient received Solu-Medrol 500 mg/day and prednisone 60 mg/day combined with speech therapy. The bamboo nodes partially regressed under treatment with a marked improvement of the voice. A few months later, laryngeal injection of triamcinolone 40 mg under local anaesthesia was performed with a favourable...

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Small bowel obstruction caused by vas deferens: a first documented report

Small bowel obstruction (SBO) is one of the most common causes for an acute surgical admission. Most of the time SBO is a result of common causes such as postoperative adhesions. However, rare and unusual causes of SBO do exist which can be challenging for surgeons. We report a first documented case of SBO caused by a remnant of the vas deferens in a 24-year-old patient with a history of gastroschisis and left orchidectomy. Clinical presentation, investigations, imaging and management of this case are described. To summarise, clinicians should keep an open mind in dealing with patients with intestinal obstruction due to the rare and atypical causes.

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Avascular necrosis: a growing concern for the HIV population

A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. After decompression therapy, the left femoral head collapsed and patient underwent a left total hip arthroplasty. Her postsurgical course was complicated by the left sciatic nerve neuropathy for which she is currently being managed with duloxetine. She has yet to follow-up with her orthopaedic surgeon for further evaluation.

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Radiological appearance of primary extracranial meningioma of the pelvis in a middle-aged woman

Description 

A 47-year-old woman came with the complaints of on-and-off constipation for 6 months with the inability to pass stool for 2 days. She also complained of poor urinary stream and increased urine frequency for 1 year and had a history of hysterectomy with bilateral salpingo-oophorectomy. Her general and systemic examinations were unremarkable. Abdominal radiograph revealed diffuse opacification of the pelvis with left lateral displacement and compression of the rectal shadow (figure 1A). CT of abdomen and pelvis (figure 1B–F) revealed a large, well-defined heterogeneously enhancing lobulated lesion in the presacral region and central pelvis showing multiple coarse calcifications within. The lesion was abutting the distal sigmoid colon and rectum causing their left lateral displacement with luminal compression and loss of intervening fat plane. There was resultant dilatation of the large and distal small bowel loops suggestive of intestinal obstruction. The fat plane between the lesion and the...

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Small intestinal bacterial overgrowth (SIBO) and vitamin K-responsive coagulopathy: a previously unrecorded association

A 17-year-old woman, with a history of three operations on the upper gut in early life and intermittent diarrhoea, presented with a history of epistaxis and leg ecchymosis for the previous 3 months. Initial investigation revealed mild anaemia, low serum albumin, moderately elevated aminotransferases and an exceedingly prolonged prothrombin time (PT) which was promptly shortened to normal by intravenous vitamin K. Additional investigations revealed a grossly abnormal glucose hydrogen breath test, a dilated duodenum and deficiencies of vitamins A, D and E. Repeated courses of antimicrobial agents caused prompt but transient shortening of PT and eventually a duodenal–jejunal anastomosis was performed. Since then, up to 36 months later, the patient has been in good general health and PT has been consistently normal with no vitamin K supplementation. Small intestinal bacterial overgrowth has previously been associated with several conditions but this is the first description of its association with vitamin K-responsive coagulopathy.

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Melanoma with rhabdomyosarcomatous differentiation

Melanoma with rhabdomyosarcomatous differentiation is an extremely rare observation with a review of the literature revealing fewer than 15 previously identified cases. The authors describe a case of a 72-year-old man with a cutaneous lesion of the left scalp that was diagnosed as malignant melanoma on biopsy and wide excision. One month later, a punch biopsy of the excisional area revealed rhabdomyosarcomatous proliferation. Re-examination of the wide-excision specimen with muscle markers revealed areas of neoplastic melanoma cells consistent with rhabdomyosarcomatous differentiation.

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Lipschütz ulcer and group A streptococcal tonsillitis

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae. Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare.

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Ombitasvir/paritaprevir/ritonavir plus dasabuvir regimen may be used safely in combination with sirolimus for the treatment of chronic hepatitis C

The era of direct acting antivirals has revolutionised the management of chronic hepatitis C infection and improved patient outcomes. The optimal management of patients who require liver transplantation remains a matter of ongoing discussion. Treatment in the post-transplantation setting may be complicated by significant drug–drug interactions between antiviral agents and standard immune suppressive treatment regimens. We describe what we believe to be the first reported case of a patient successfully treated for CHC with ombitasvir/paritaprevir/ritonavir plus dasabuvir, while taking sirolimus following liver transplantation.

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Isolated hepatobiliary tuberculosis: a diagnostic challenge

Hepatobiliary system involvement is frequently seen as part of disseminated tubercular infection. But primary isolated hepatobiliary tuberculosis with no evidence of tuberculosis elsewhere in the body is extremely rare. Isolated hepatobiliary tuberculosis can cause diagnostic dilemma as the clinical, laboratory and imaging features are non-specific in majority of the cases. We report the case of a 50-year-old woman who presented with hepatobiliary tuberculosis with no pulmonary or extra hepatic involvement. Liver function tests were abnormal and ultrasonography (USG), CT and MR cholangiopancreatography showed multiple focal lesions in the liver. The diagnosis of tuberculosis was confirmed by a USG-guided biopsy of the liver lesions. In endemic regions with the presence of supportive imaging findings, in the appropriate clinical setting, the possibility of hepatic tuberculosis should be considered and diagnosis has to be confirmed with histopathological examination.

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IgG4-related periarteritis in the coronary artery and subclinical pericarditis assessed the presence and monitoring of therapy response by PET and CT scan

Description 

A 70-year-old woman suffered from bilateral lacrimal gland enlargement from 2 years ago (figure 1). Geranium-enhanced MRI disclosed diffuse enlargement of bilateral eyelids indicating IgG4-related disease (IgG4RD), especially Mikulicz's disease. Laboratory tests showed elevation of serum IgG4 concentration and histopathological findings of the lacrimal glands showed IgG4-positive cell infiltration and obliterated veins by inflammatory cells, which consist of lymphocytes and plasma cells (obliterative phlebitis).

Figure 1

Bilateral lacrimal gland enlargement with predominance of right ones observed as a representative pathophysiological finding in this patient with IgG4-related disease.

Then, she was diagnosed with IgG4RD. We performed chest CT as screening for comorbidities of Mikulicz's disease. Chest CT revealed left circumflex artery (LCX) wall thickening. Coronary CT showed thickening of the left anterior descending artery and LCX. For suppressing physiological myocardial uptake, the patient was asked to restrict carbohydrate intake 24 hours before...

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Unexpected early complication of implantable-cardioverter defibrillator

A 41-year-old woman was visiting Oxford, where she had a sudden cardiac arrest. Cardiopulmonary resuscitation was started by a bystander until the paramedics arrived, who found her in ventricular fibrillation, and delivered three shocks. After 28 min she had return of spontaneous circulation. Emergency coronary angiography revealed normal coronary arteries. Echocardiography followed by a cardiac MRI showed non-dilated left ventricles with no evidence of late gadolinium enhancement. She had a single-chamber implantable-cardioverter defibrillator (ICD). A chest CT showed sternal fracture and subsegmental pulmonary embolism, for which she was anticoagulated and was discharged.

Several days later, the patient presented to another hospital with atypical chest pain and dizziness. She had haemodynamic instability and echocardiography showed the ICD lead perforating through the right ventricle, with a large pericardial effusion and tamponade, for which pericardiocentesis was done. Afterwards, the patient had repositioning of the ICD lead safely.

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Mastectomy skin flap thickness

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Stuart A. Robertson, Ramsey I. Cutress




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Prehabilitation and functional recovery for colorectal cancer patients

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Enrico Maria Minnella, Francesco Carli
Cancer and its treatments are associated with functional decline that has impactful consequences on quality of life, and care continuum. Thus, optimizing perioperative functional capacity has been identified as a research and clinical priority in cancer care. The process of enhancing physical fitness before an operation to enable the patient to withstand the stress of surgery has been termed prehabilitation. Main elements are preoperative exercise, nutrition therapy, and anxiety-reduction techniques. Given the growing body of evidence on prehabilitation efficacy, this narrative review will summarize the rational underlying preoperative interventions, and propose a structured clinical pathway aimed at optimizing preoperative functional capacity.



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Obesity as a determinant of perioperative and postoperative outcome in patients following colorectal cancer surgery: a population-based study (2009–2016)

Publication date: Available online 6 June 2018
Source:European Journal of Surgical Oncology
Author(s): Youri Q.M. Poelemeijer, Niki Lijftogt, Robin Detering, Marta Fiocco, Rob A.E.M. Tollenaar, Michel W.J.M. Wouters
BackgroundObesity is an increasing problem worldwide that can influence perioperative and postoperative outcomes. However, the relationship between obesity and treatment-related perioperative and short-term postoperative morbidity after colorectal resections is still subject to debate.StudyPatients were selected from the DCRA, a population-based audit including 83 hospitals performing colorectal cancer (CRC) surgery. Data regarding primary resections between 2009 and 2016 were eligible for analyses. Patients were subdivided into six categories: underweight, normal weight, overweight and obesity class I, II and III.ResultsOf 71,084 patients, 17.7% with colon and 16.4% with rectal cancer were categorized as obese. Significant differences were found for the 30-day overall postoperative complication rate (p < 0.001), prolonged hospitalization (p < 0.001) and readmission rate (colon cancer p < 0.005; rectal cancer p < 0.002) in obese CRC patients. Multivariate analysis identified BMI ≥ 30 kg/m² as independent predictor of a complicated postoperative course in CRC patients. Furthermore, obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate. No significant differences in performance were observed in postoperative outcomes of morbidly obese CRC patients between hospitals performing bariatric surgery and hospitals that did not.ConclusionThe real-life data analysed in this study reflect daily practice in the Netherlands and identify obesity as a significant risk factor in CRC patients. Obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate in obese CRC patients. No differences were observed between hospitals performing bariatric surgery and hospitals that did not.



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Anatomic versus non-anatomic resection for hepatocellular carcinoma: A systematic review and meta-analysis

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Dimitrios Moris, Diamantis I. Tsilimigras, Ioannis D. Kostakis, Ioannis Ntanasis-Stathopoulos, Kevin N. Shah, Evangelos Felekouras, Timothy M. Pawlik
ObjectiveThe relative benefit of anatomic resection (AR) versus non-anatomic resection (NAR) of HCC remains poorly defined. We sought to evaluate the available evidence on oncologic outcomes, as well as the clinical efficacy and safety of AR versus NAR performed as the primary treatment for HCC patients.Material and methodsA systematic review and meta-analysis was conducted using Medline, ClinicalTrials.gov and Cochrane library through April 15th, 2017. Only clinical studies comparing AR versus NAR were deemed eligible.ResultsA total of 43 studies were considered eligible (total 12,429 patients: AR, n = 6839 (55%) versus NAR, n = 5590 (45%)). Blood loss was higher among patients undergoing AR (mean difference: +229.74 ml, 95% CI: 97.09–362.38, p = 0.0007), whereas resection margin was slightly wider following AR versus NAR (mean difference: +0.29 cm, 95% CI: 0.15–0.44, p < 0.0001). No difference was noted for perioperative complications (RR: 0.95, 95% CI: 0.81–1.11, p = 0.49) and perioperative mortality (RR: 0.91, 95% CI: 0.43–1.95, p = 0.82). AR was associated with a disease-free survival (DFS) benefit at 1- (HR: 0.79, 95% CI: 0.68–0.92, p = 0.002), 3- (HR: 0.87, 95% CI: 0.78–0.95, p = 0.004) and 5-years (HR: 0.87, 95% CI: 0.82–0.93, p < 0.0001). AR also was associated with a decreased risk of death at 5-years (HR: 0.88, 95% CI: 0.79–0.97, p = 0.01).ConclusionDespite the high heterogeneity among studies, the data demonstrated that AR had comparable perioperative morbidity and mortality versus NAR. AR seemed to offer an advantage versus NAR in terms of DFS and OS among patients undergoing resection of HCC – especially among patients without cirrhosis. Thus, AR should be considered the preferred surgical option for patients with HCC when feasible.



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Routine portal vein resection for pancreatic adenocarcinoma shows no benefit in overall survival

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Fritz Klein, Finja Berresheim, Matthäus Felsenstein, Thomas Malinka, Uwe Pelzer, Timm Denecke, Johann Pratschke, Marcus Bahra
BackgroundExtended pancreatic resections including resections of the portal (PV) may nowadays be performed safely. Limitations in distinguishing tumor involvement from inflammatory adhesions however lead to portal vein resections (PVR) without evidence of tumor infiltration in the final histopathological examination. The aim of this study was to analyze the impact of these "false negative" resections on operative outcome and long-term survival.Methods40 patients who underwent pancreatic resection with PVR for pancreatic adenocarcinoma (PA) without tumor infiltration of the PV (PVR-group) were identified. In a 1:3 match these patients were compared to 120 patients after standard pancreatic resection without PVR (SPR-group) with regard to operative outcome and overall survival.ResultsSurvival analysis revealed that median survival was significantly shorter in the PVR group (311 days) as compared to the SPR group (558 days), (p = 0.0011, hazard ratio 1.98, 95% CI: 1.31–2.98). Also postoperative complications ≥ Clavien III occurred significantly more often in the PVR group (37.5% vs. 20.8%).ConclusionsRadical resection affords the best chance for long-term survival in patients with PA. Based on the results of this study a routine resection of the PV as recently proposed may however not be recommended.



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Announcements

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7





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Editorial Board

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7





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Oncoplastic breast surgery for the management of ductal carcinoma in situ (DCIS): is it oncologically safe? A retrospective cohort analysis

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Francesca De Lorenzi, Julien Di Bella, Patrick Maisonneuve, Nicole Rotmensz, Giovanni Corso, Roberto Orecchia, Marco Colleoni, Giovanni Mazzarol, Mario Rietjens, Pietro Loschi, Stefano Marcelli, Paolo Veronesi, Viviana Galimberti
BackgroundFew data exist in literature regarding oncoplastic surgery (ONC) and ductal carcinoma in situ (DCIS). The role of ONC in the treatment of DCIS has not been elucidated yet: no case-control study has yet been published on the issue and no long-term oncologic results are reported.MethodsUsing the European Institute of Oncology (IEO) institutional breast cancer data base we investigated the oncologic safety of ONC for DCIS comparing a consecutive series of 44 patients who have underwent ONC followed by external irradiation for DCIS (Group A-study group) with 375 patients who received conservation alone followed by external irradiation for DCIS (Group B control group) in the same period. We excluded patients presenting with secondary tumors or local relapses and those requiring re-excision or completion mastectomy for positive margins. Primary endpoints were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR) within the study group and comparison with the control group.ResultsEvents rates and death rates were similar in the two groups. The average annual rate of invasive IBTR in group A and B was 1.6% and 1.0% respectively. No difference in the rate of lymphnode metastasis, distant metastasis, contralateral breast cancer, other primary cancer or death was observed across the two groups.ConclusionsOur findings suggest the safety of ONC and irradiation for the management of DCIS extending the indications for conservation in DCIS patients otherwise treated with mastectomy. It provides the best available evidence supporting ONC as a valid treatment option for the management of DCIS.



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Patient reported outcome measures in breast cancer patients

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): M. Lagendijk, L.S.E. van Egdom, C. Richel, N. van Leeuwen, C. Verhoef, H.F. Lingsma, L.B. Koppert
IntroductionIn the International Consortium for Health Outcome Measures (ICHOM) breast cancer outcome set Patient Reported Outcome Measurements (PROMs) form an important but rather innovative part. Few data exist on scores per type of breast surgery and how to use scores in surgical practice. We evaluated PROM scores as well as satisfaction with and expectations of the use of PROMs in breast cancer patients using the national and local patient advocate society.MethodsThrough an online survey patients were asked to report age, type of breast cancer surgery (whether Breast Conserving Therapy (BCT), mastectomy, autologous or implant breast reconstruction) and time since surgery. PROMs (EORTC-QLQ-C30/BR23 and BREAST-Q postoperative modules) were compared for the different surgeries. Additional comparison was made with literature normative and reference scores. Three questions evaluated satisfaction with PROMs and expectations.Results496 patients completed all PROMs and 487 the satisfaction/expectation-questions. Significantly reduced physical functioning was reported following BCT as compared to other surgeries and literature reference values. Satisfaction scores were higher following autologous reconstruction and lower following implant reconstruction as compared to BCT. PRO scores were comparable to normative and references scores except for the 'physical functioning' (BREAST-Q) scores that reported lower in the present study. Ninety-four percent of the participants was (highly) satisfied with future PROM use.ConclusionsStatistical significant differences were found for PROMs following different types of breast surgery. The significance of these results should become clearer trough collection of future data. The great majority of participants considered PROMs as (highly) acceptable and reacted positively on their proposed future use.



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In-hospital length of stay after major surgical oncological procedures

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Sebastiano Nazzani, Felix Preisser, Elio Mazzone, Zhe Tian, Francesco A. Mistretta, Shahrokh F. Shariat, Fred Saad, Markus Graefen, Derya Tilki, Emanuele Montanari, Stefano Luzzago, Alberto Briganti, Luca Carmignani, Pierre I. Karakiewicz
Background and objectivesEnhanced recovery after surgery protocols (ERAS) have been developed and implemented as of 2001. However, no previous analyses targeted length of stay (LOS) changes over time after major surgical oncological procedures (MSOPs).MethodsBetween 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 assessable patients were identified. We examined temporal trends of LOS after ten MSOPs, as well as LOS determinants and the impact of LOS on total hospital charges (THCGs). Univariable and multivariable linear, log-linear, logistic (MLR) and Poisson regression (MPR) analyses were used.ResultsMean and median LOS were respectively 6 and 4 days (IQR 2–7). During the study span, LOS decreased [Estimated annual percentage change (EAPC): −1.89%, p = 0.0002]. Of the ten examined MSOPs, nine showed a decrease that ranged from −4.47% in prostatectomy to −0.7% in mastectomy. Conversely, no decrease in LOS was recorded for colectomy (EAPC:+0.37, p = 0.015). In MPR analyses, robotic [Relative risk (RR):0.68, p = 0.0003] and laparoscopic (RR: 0.90, p < 0.0001) surgical approaches were associated with shorter LOS. LOS was directly related to THCGs.ConclusionsSince the implementation of ERAS protocols, LOS has decreased for nine out of ten MSOPs in a significant fashion. Although these gains may appear marginal on an annual basis, their cumulative effect, over the study span, ranges for 7.7%–49.2%, which can hardly be interpreted as marginal. LOS decrease directly translates in THCGs savings.



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Outcomes of open versus laparoscopic surgery in patients with colon cancer

Publication date: Available online 6 June 2018
Source:European Journal of Surgical Oncology
Author(s): José M. Quintana, Ane Antón-Ladislao, Nerea González, Santiago Lázaro, Marisa Baré, Nerea Fernández de Larrea, Maximino Redondo, Eduardo Briones, Antonio Escobar, Cristina Sarasqueta, Susana García-Gutierrez
ObjectiveThere is limited information on health service use or patient-reported outcomes when comparing the effectiveness of laparoscopic with that of open surgery. The aim was to compare the effectiveness of laparoscopic with that of open surgery up to 2 years after intervention in patients with colon cancer.MethodsProspective cohort study of patients with colon cancer who underwent surgery (laparoscopic or open surgery) between June 2010 and December 2012, at 22 hospitals. Main outcomes of the study were mortality, complications, reoperation, readmission, and patient-reported outcome measures (PROMs), as measured using the Hospital Anxiety and Depression Scale, Duke-UNC, EuroQol-5D, and European Organisation for Research and Treatment of Cancer-Q30 and Q29 at baseline, and 30 days and 1 and 2 years after surgery. Multivariable multilevel logistic regression and generalized linear models were used in analyses after adjusting for specific propensity scores developed for each outcome and time point.ResultsIn the multivariable analysis, the complication rates up to 30 days (infectious, surgical, and medical) and 1 year (surgical), and readmission rate at 30 days and at 2 years were higher among patients who underwent open surgery than among those who underwent laparoscopic surgery. There were no differences between the two surgical approaches in all other parameters assessed and in changes of all PROMs.ConclusionsThough in most outcomes both surgical approaches provide similar results up to 2 years after intervention, still the rates of some complications and readmission, mainly up to 30 days, are higher in open surgery.



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Evaluation of liquid biopsies for detection of emerging mutated genes in metastatic colorectal cancer

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Hiroyasu Furuki, Takeshi Yamada, Goro Takahashi, Takuma Iwai, Michihiro Koizumi, Seiichi Shinji, Yasuyuki Yokoyama, Kohki Takeda, Nobuhiko Taniai, Eiji Uchida
BackgroundDetection of gene mutations is important for planning molecular targeted therapy. Although most gene mutations are concordant between primary colon cancers and their liver metastases, new mutations can emerge in metastases. The liquid biopsy is a newly developed, gene analytic method to detect mutations in metastatic tumors. In this prospective study, we evaluated the applicability of liquid biopsies in the detection of mutations in primary and metastatic tumors.MethodsWe included 22 patients with liver metastases from colorectal cancer and extracted DNA from primary colorectal tumors, metastatic liver tumors, and peripheral blood (liquid biopsy). Next-generation sequencing (NGS) and digital PCR were performed to detect mutations in these three sample types.ResultsWe found a total of 36 different mutations in samples from primary tumors, liver metastases, and liquid biopsies using NGS. Twenty-eight of these mutations were found in all three types of samples, whereas liquid biopsy did not identify four mutations that had been found in both primary tumors and liver metastases, but did identify four mutations that were found in liver tumors but not in primary tumors. The sensitivity of liquid biopsies for detecting mutations in liver metastases was 64% (23/36) using NGS and 89% (32/36, P = 0.02) using dPCR. The specificities of NGS and dPCR were 100% (23/23) and 100% (32/32), respectively.ConclusionsEmerging mutations, which are not found in primary tumors, can be detected in their metastases and liquid biopsies.



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Quality of life and cost effectiveness in a randomized trial of patients with colorectal cancer and peritoneal metastases

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): P.H. Cashin, H. Mahteme, I. Syk, J.E. Frödin, B. Glimelius, W. Graf
BackgroundThe aim was to compare health-related quality-of-life (HRQOL) and cost-effectiveness between cytoreductive surgery with intraperitoneal chemotherapy (CRS + IPC) and systemic chemotherapy for patients with colorectal peritoneal metastases.MethodsPatients included in the Swedish Peritoneal Trial comparing CRS + IPC and systemic chemotherapy completed the EORTC QLQ-C30 and SF-36 questionnaires at baseline, 2, 4, 6, 12, 18, and 24 months. HRQOL at 24 months was the primary endpoint. EORTC sum score, SF-36 physical and mental component scores at 24 months were calculated and compared for each arm and then referenced against general population values. Two quality-adjusted life-year (QALY) indices were applied (EORTC-8D and SF-6D) and an incremental cost-effectiveness ratio (ICER) per QALY gained was calculated. A projected life-time ICER per QALY gained was calculated using predicted survival according to Swedish population statistics.ResultsNo statistical differences in HRQOL between the arms were noted at 24 months. Descriptively, survivors in the surgery arm had higher summary scores than the general population at 24 months, whereas survivors in the chemotherapy arm had lower scores. The projected life-time QALY benefit was 3.8 QALYs in favor of the surgery arm (p=0.06) with an ICER per QALY gained at 310,000 SEK (EORTC-8D) or 362,000 SEK (SF-6D) corresponding to 26,700–31,200 GBP.ConclusionThe HRQOL in patients with colorectal peritoneal metastases undergoing CRS + IPC appear similar to those receiving systemic chemotherapy. Two-year survivors in the CRS + IPC arm have comparable HRQOL to a general population reference. The treatment is cost-effective according to NICE guidelines.

Teaser

Synopsis: This study reports the health-related quality-of-life and cost-effectiveness between surgical treatment and systemic chemotherapy treatment in a randomized setting for patients with colorectal cancer and peritoneal metastases. The surgical treatment has good quality-of-life and is cost-effective.


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Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Maciej Nowacki, Mohammad Alyami, Laurent Villeneuve, Frederic Mercier, Martin Hubner, Wouter Willaert, Wim Ceelen, Marc Reymond, Denis Pezet, Catherine Arvieux, Vladimir Khomyakov, Laura Lay, Sergio Gianni, Wojciech Zegarski, Naoual Bakrin, Olivier Glehen
BackgroundPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new drug delivery method offered in selected patients suffering from non-resectable peritoneal carcinomatosis (PC). As reported experience is still limited, we conducted a survey among active PIPAC centers aiming to report their technical approach and clinical findings.MethodsAn online survey was sent to active PIPAC centers worldwide. The questionnaire consisted of 34 closed questions and was conducted over a period of 3 months beginning in March 2017.ResultsNine out of 15 contacted centers completed the questionnaire totaling 832 PIPAC procedures in 349 patients. Most common indications for PIPAC were PC from gastric, ovarian and colorectal origin. The mean time between each PIPAC procedure was 6–8 weeks. Seven of nine (77.8%) centers evaluate the PCI at every PIPAC procedure. At least four tissue samples for histopathology analysis were retrieved in 5 (55.6%). All centers (100%) use the same chemotherapy protocol: oxaliplatin at a dosage of 92mg/m² for PC of colorectal origin and a combination of cisplatin and doxorubicin at a dosage of 7.5mg/m² and 1.5mg/m², respectively, for other types of PC. Eight centers (88.9%) perform routine radiological evaluation before first PIPAC and after third PIPAC.ConclusionThese data confirm that PIPAC procedures are homogeneously performed in established centers. Standardization of the procedure will facilitate future international multicenter prospective clinical trials.



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Downregulation of RFX1 predicts poor prognosis of patients with small hepatocellular carcinoma

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Yingjun Liu, Peng Jiang, Gangcheng Wang, Xiaonyong Liu, Suxia Luo
ObjectiveRegulatory factor X1 (RFX1) deletion has been reported to be correlated with poor prognosis of some types of cancer. The present study aimed to investigate the prognostic value of RFX1 in HCC, especially in small hepatocellular carcinoma.MethodsImmunohistochemical assay was used to investigate RFX1 expression in 221 HCC tissues and another validation cohort of 71 small HCC samples. We also performed in vitro experiments to investigate if RFX1 regulated invasive capacity of HCC cells and expression of epithelial-mesenchymal transition (EMT) markers.ResultsWe found that RFX1 expression was significantly lower in HCC tissues compared to the corresponding non-tumor tissues. Further survival analysis suggested that the downregulation of RFX1 correlated with poor prognosis and a high recurrence risk in HCC patients, particularly in small HCC patients. Furthermore, another validation cohort of small HCC samples confirmed that downregulation of RFX1 in HCC tissues predicted high recurrence risk and poor prognosis for early stage HCC patients. In vitro studies suggested that knocking down RFX1 facilitated HCC cell invasion, while overexpression of RFX1 reduced the invasion of HCC cells. Western blot assays also indicated that RFX1 regulated expression of some EMT markers. Knocking down RFX1 decreased E-cadherin and increased vimentin expression, while RFX1 overexpression enhanced E-cadherin and decreased vimentin expression.ConclusionsOur study demonstrated that RFX1 downregulation is a new predictive marker of high recurrence risk and poor prognosis of HCC; It has potential to help guide treatment for postoperative HCC patients, especially for small HCC patients.



https://ift.tt/2xWeZp8

Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Jon Zabaleta, Tomohiko Iida, Pierre E. Falcoz, Samer Salah, José R. Jarabo, Arlene M. Correa, Maria G. Zampino, Takashi Matsui, Sukki Cho, Francesco Ardissone, Kazuhiro Watanabe, Michel Gonzalez, Pascal Gervaz, Jose I. Emparanza, Víctor Abraira
ObjectivesTo assess the impact of a history of liver metastases on survival in patients undergoing surgery for lung metastases from colorectal carcinoma.MethodsWe reviewed recent studies identified by searching MEDLINE and EMBASE using the Ovid interface, with the following search terms: lung metastasectomy, pulmonary metastasectomy, lung metastases and lung metastasis, supplemented by manual searching. Inclusion criteria were that the research concerned patients with lung metastases from colorectal cancer undergoing surgery with curative intent, and had been published between 2007 and 2014. Exclusion criteria were that the paper was a review, concerned surgical techniques themselves (without follow-up), and included patients treated non-surgically. Using Stata 14, we performed aggregate data and individual data meta-analysis using random-effect and Cox multilevel models respectively.ResultsWe collected data on 3501 patients from 17 studies. The overall median survival was 43 months. In aggregate data meta-analysis, the hazard ratio for patients with previous liver metastases was 1.19 (95% CI 0.90–1.47), with low heterogeneity (I² 4.3%). In individual data meta-analysis, the hazard ratio for these patients was 1.37 (95% CI 1.14–1.64; p < 0.001). Multivariate analysis identified the following factors significantly affecting survival: tumour-infiltrated pulmonary lymph nodes (p < 0.001), type of resection (p = 0.005), margins (p < 0.001), carcinoembryonic antigen levels (p < 0.001), and number and size of lung metastases (both p < 0.001).ConclusionsA history of liver metastases is a negative prognostic factor for survival in patients with lung metastases from colorectal cancer. We registered the meta-analysis protocol in PROSPERO (CRD42015017838).



https://ift.tt/2Jh2MAj

Comparison of pathological complete response rates after neoadjuvant short-course radiotherapy or chemoradiation followed by delayed surgery in locally advanced rectal cancer

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Sieske Hoendervangers, Alice M. Couwenberg, Martijn P.W. Intven, Wilhelmina M.U. van Grevenstein, Helena M. Verkooijen
IntroductionPatients with locally advanced rectal cancer (LARC) who are unfit for chemoradiation (CRT), are often offered short-course radiotherapy followed by delayed surgery (SCRT-delay). This entails a lower radiation dose, no chemotherapy and a shorter treatment period. This may lower their chances for complete tumor response and, as such, organ-sparing approaches. The purpose of this study was to compare the pathological complete response (pCR) rates between neoadjuvant CRT and SCRT-delay in patients with LARC in a nationwide database from the Netherlands.MethodsIn the population based Netherlands Cancer Registry, clinical stage III rectal cancer patients, diagnosed between 2008 and 2014, who underwent CRT or SCTR-delay were selected. pCR (ypT0N0), near pCR (ypT0-1N0), and tumor and nodal downstaging were compared between the treatment groups using multivariable logistic regression analysis.Results386 patients underwent SCRT-delay and 3659 patients underwent CRT. The pCR-rate in the SCRT-delay group was significantly lower compared to the CRT-group (6.4% vs. 16.2%, p < 0.001). After adjustment for clinical tumor stage, clinical nodal stage and time interval to surgery, SCRT-delay patients were significantly less likely to reach pCR (adjusted odds ratio 0.3, 95%CI 0.2–0.5). Also, near-pCR (ypT0–1N0) as well as tumor and nodal downstaging was observed less often in the SCRT-delay group.ConclusionCompared to patients treated with neoadjuvant CRT, those receiving SCRT and delayed surgery are less likely to develop pCR. Novel neoadjuvant treatment strategies for patients not fit enough for CRT are needed to increase their eligibility for organ-sparing treatments.



https://ift.tt/2LwgSuD

Concentrations of cisplatin and doxorubicin in ascites and peritoneal tumor nodules before and after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal metastasis

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Clemens B. Tempfer, Ziad Hilal, Askin Dogan, Miriam Petersen, Günther A. Rezniczek
IntroductionPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new means of delivering chemotherapy into the abdomen of patients with peritoneal carcinomatosis (PC). The amount of drug uptake in ascites and peritoneum after PIPAC is unknown.MethodsRetrospective cohort study of women with PC from gynecological tumors comparing the concentrations of cisplatin and doxorubicin in ascites and peritoneum before and after PIPAC. Concentrations were measured using gas chromatography. Peritoneal tumor samples were assessed for histological tumor regression.Results59 PIPAC procedures were performed in 32 women with PC. The concentrations of doxorubicin and cisplatin in ascites significantly increased after PIPAC (140.2 ± 671.5 vs 9035.7 ± 5328.6 ng/ml; p < 0.0001 and 95.2 ± 106.4 vs 24,770.8 ± 11,710.8 ng/ml; p < 0.0001, respectively). Concentrations of doxorubicin and cisplatin in peritoneal tissue also significantly increased after PIPAC (5.1 ± 0.7 vs 19.2 ± 38.6 ng/g; p = 0.007, and 81.9 ± 7.8 vs 131.5 ± 134.4 ng/g; p = 0.005, respectively). On an individual patient level, a significant uptake (>2-fold) of doxorubicin and cisplatin was observed in 57/59 (97%) and 58/59 (98%) of cases in ascites and in 23/59 (39%) and 13/59 (22%) of cases in the peritoneum. Uptake of cisplatin and doxorubicin were significantly correlated (Spearman correlation coefficient: 0.33; p = 0.011). After repeated PIPACs, doxorubicin uptake increased in peritoneal tumor tissue (p = 0.008).ConclusionsPIPAC leads to a significant chemotherapy uptake in both ascites and peritoneum, suggesting a bimodal cytotoxic effect of PIPAC via direct tissue uptake into peritoneal tumor nodules and via ascites. Consecutive PIPAC applications lead to peritoneal accumulation of doxorubicin, suggesting a cumulative cytotoxic effect of doxorubicin after repeated PIPACs.



https://ift.tt/2JdpVng

Tumor response after long interval comparing 5x5Gy radiation therapy with chemoradiation therapy in rectal cancer patients

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): A.J.M. Rombouts, N. Hugen, R.H.A. Verhoeven, M.A.G. Elferink, P.M.P. Poortmans, I.D. Nagtegaal, J.H.W. de Wilt
BackgroundIn the era of organ preserving strategies in rectal cancer, insight into the efficacy of preoperative therapies is crucial. The goal of the current study was to evaluate and compare tumor response in rectal cancer patients according to their type of preoperative therapy.MethodsAll rectal cancer patients diagnosed between 2005 and 2014, receiving radiation therapy (RT, 5 × 5Gy; N = 764) or chemoradiation therapy (CRT; N = 5070) followed by total mesorectal excision after an interval of 5–15 weeks were retrieved from the nationwide Netherlands Cancer registry. Logistic regression was used for multivariable analysis.ResultsMedian age of patients treated with RT was 76 years (range 28–92) compared to 64 years (range 21–92) for patients treated with CRT (P < 0.001). Patients treated with RT had a significantly lower clinical stage (P < 0.001). A complete pathologic response (ypT0N0) was found in 9.3% of patients treated with RT, significantly less than in patients treated with CRT (17.5%; odds ratio [OR] 0.37, 95% confidence interval [CI] 0.24–0.57). A good response (ypT0-1N0) was observed in 17.5% of patients treated with RT and in 22.6% of patients treated with CRT (OR 0.70, 95% CI 0.51–0.95). Histological subtype, clinical stage and distance to anus were identified as independent predictors for tumor response.ConclusionsDespite a more advanced clinical stage, complete pathologic response was more common in patients treated with CRT than in patients treated with RT. Prospective trials are needed to establish the differences in other outcome parameters, including the impact on organ preserving strategies.



https://ift.tt/2LsK5X3

Reply to: Mastectomy skin flap thickness

Publication date: July 2018
Source:European Journal of Surgical Oncology, Volume 44, Issue 7
Author(s): Gustavo Nader Marta, Philip Poortmans, Alfredo C. de Barros, José Roberto Filassi, Ruffo Freitas-Junior, Riccardo A. Audisio, Max Senna Mano, Sarkis Meterissian, Sarah M. DeSnyder, Thomas A. Buchholz, Tarek Hijal




https://ift.tt/2Jkod3P

Stachydrine suppresses viability & migration of astrocytoma cells via CXCR4/ERK & CXCR4/Akt pathway activity

Future Oncology, Ahead of Print.


https://ift.tt/2sMOXPc

Safety of HTX-019 (intravenous aprepitant) and fosaprepitant in healthy subjects

Future Oncology, Ahead of Print.


https://ift.tt/2kVFwtk

Anthropometric factors and non-Hodgkin’s lymphoma risk: Systematic review and meta-analysis of prospective studies

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Khemayanto Hidayat, Hui-Juan Li, Bi-Min Shi
The associations between anthropometric factors and non-Hodgkin's lymphoma (NHL) risk remain inconclusive. A meta-analysis was performed to clarify these associations. PubMed and Web of Science were searched for relevant prospective observational studies. A random-effects model was used to generate the summary relative risks (RRs) with 95% confidence intervals (CIs). A total of 22 prospective cohort studies, with over 20,000 NHL cases, were included in the present meta-analysis. The summary RRs of NHL risk were 1.06 (95% CI 1.03, 1.09) for each 5 kg/m² increase in body mass index (BMI), 1.11 (95% CI 1.07, 1.16) for each 5 kg/m² increase in BMI in early adulthood (aged 18-21 years), 1.05 (95% CI 1.01, 1.09) for each 10 kg increase in weight, 1.21 (95% CI 1.15, 1.28) for each 10 kg increase in weight in early adulthood (aged 18-21 years), and 1.13 (95% CI 1.10, 1.17) for each 10 cm increase in height. No association was found for waist circumference (WC) and waist-to-hip ratio. By subtypes, all anthropometric factors (but not WC) were associated with an increased risk of diffuse large B-cell lymphoma. Chronic lymphocytic leukemia/small lymphocytic lymphoma was positively associated with BMI in early adulthood and with height, whereas follicular lymphoma was only positively associated with height. In summary, BMI and weight in early adulthood may be more relevant to NHL development than current BMI and weight. These findings emphasize the importance of maintaining a healthy weight throughout the life-course, starting from early life, for NHL prevention. Increased NHL risk with taller stature, which may reflect cumulative exposure to hormones/growth factors and nutrition status in early life, further supports the relevance of early life exposure in the etiology of NHL.



https://ift.tt/2sAyi1M

A revisited concept. Tumors: Wounds that do not heal

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Domenico Ribatti, Roberto Tamma
In 1986, Harold F. Dvorak, Professor of Pathology at Harvard Medical School Boston, published an essay in the New England Journal of Medicine entitled "Tumors: Wounds that do not heal" pointed out that similarities exist between tumor stroma generation and wound healing. Cancers share many features in common with tissue regeneration, including immune response, cell proliferation, cell migration, tissue remodeling, and cell death. In this review article, I analyzed the importance and the limits of this important concept, which confirm the close relationship between apparently different biological processes.



https://ift.tt/2Ltm9Ty

TAFRO SYNDROME: CRITICAL REVIEW FOR CLINICIANS AND PATHOLOGISTS

Publication date: Available online 6 June 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Paydas Semra
TAFRO is an acrostic and includes thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis (R) and organomegaly (O) (Takai et al., 2013). TAFRO syndrome has been described firstly by Takai in Japanese patients. However TAFRO cases have been reported from US, Europe and other countries (Takai et al., 2010; Iwaki et al., 2016; Abdo et al., 2014). Three major and at least one minor criteria and exclusion of infectious, rheumatologic and neoplastic diseases are required for the diagnosis of TAFRO. In fact TAFRO must be thought in clinically undiagnosed and unsolved problemmatic cases.



https://ift.tt/2JnT8Im

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group, Published online: 07 June 2018; doi:10.1038/s41416-018-0090-1

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

https://ift.tt/2JhAq9l

The advantage of Flash radiotherapy confirmed in mini-pig and cat-cancer patients

Background: Previous studies using FLASH radiotherapy (RT) in mice showed a marked increase of the differential effect between normal tissue and tumors. To stimulate clinical transfer, we evaluated whether this effect could also occur in higher mammals. Methods: Pig skin was used to investigate a potential difference in toxicity between irradiation delivered at ultra-high dose rate called FLASH-RT and irradiation delivered at conventional dose rate called Conv-RT. A clinical-phase-I single-dose escalation trial (25-41 Gy) was performed in six cat-patients with locally-advanced T2/T3N0M0 squamous-cell-carcinoma of the nasal planum, to determine the maximal tolerated dose and progression-free survival of single-dose FLASH-RT. Results: Using respectively depilation and fibronecrosis as acute and late endpoints, a protective effect of FLASH-RT was observed (≥ 20% dose-equivalent difference vs Conv-RT). Three cats experienced no acute toxicity, whereas three exhibited moderate/mild transient mucositis and all cats had depilation. With a median follow-up of 13.5 months, the progression free survival (PFS) at 16 months was 84%. Conclusion: Our results confirmed the potential advantage of FLASH-RT and provide a strong rational for further evaluating FLASH-RT in human patients.

https://ift.tt/2Hr2DEE

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

https://ift.tt/2sSFEgP

Standardised pain management decreases expenses on analgesics: results from a 5-year programme at a university hospital

No abstract available

https://ift.tt/2szOfFO

Severe and persistent morphine-induced respiratory depression associated with ATP-Binding Cassette Subfamily B Member 1 and catechol-O-methyltransferase genetic defects: A case report

No abstract available

https://ift.tt/2xVk15g

Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes?: A systematic review and meta-analysis

BACKGROUND Much uncertainty exists as to whether peri-operative goal-directed therapy is of benefit. OBJECTIVES To discover if peri-operative goal-directed therapy decreases mortality and morbidity in adult surgical patients. DESIGN An updated systematic review and random effects meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase and the Cochrane Library were searched up to 31 December 2016. ELIGIBILITY CRITERIA Randomised controlled trials enrolling adult surgical patients allocated to receive goal-directed therapy or standard care were eligible for inclusion. Trauma patients and parturients were excluded. Goal-directed therapy was defined as fluid and/or vasopressor therapy titrated to haemodynamic goals [e.g. cardiac output (CO)]. Outcomes included mortality, morbidity and hospital length of stay. Risk of bias was assessed using Cochrane methodology. RESULTS Ninety-five randomised trials (11 659 patients) were included. Only four studies were at low risk of bias. Modern goal-directed therapy reduced mortality compared with standard care [odds ratio (OR) 0.66; 95% confidence interval (CI) 0.50 to 0.87; number needed to treat = 59; N = 52; I2 = 0.0%]. In subgroup analysis, there was no mortality benefit for fluid-only goal-directed therapy, cardiac surgery patients or nonelective surgery. Contemporary goal-directed therapy also reduced pneumonia (OR 0.69; 95% CI, 0.51 to 0. 92; number needed to treat = 38), acute kidney injury (OR 0. 73; 95% CI, 0.58 to 0.92; number needed to treat = 29), wound infection (OR 0.48; 95% CI, 0.37 to 0.63; number needed to treat = 19) and hospital length of stay (days) (−0.90; 95% CI, −1.32 to −0.48; I2 = 81. 2%). No important differences in outcomes were found for the pulmonary artery catheter studies, after accounting for advances in the standard of care. CONCLUSION Peri-operative modern goal-directed therapy reduces morbidity and mortality. Importantly, the quality of evidence was low to very low (e.g. Grading of Recommendations, Assessment, Development and Evaluation scoring), and there was much clinical heterogeneity among the goal-directed therapy devices and protocols. Additional well designed and adequately powered trials on peri-operative goal-directed therapy are necessary.

https://ift.tt/2sD6JoA

Low anaesthetic waste gas concentrations in postanaesthesia care unit: A prospective observational study

BACKGROUND Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S) The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN A prospective observational study. SETTING Two different PACUs of the Hannover Medical School (Hannover, Germany) were evaluated in this study. The rooms differed in dimensions, patient numbers and room ventilation settings. PATIENTS During the observation period, sevoflurane anaesthesia was performed in 65 of 140 patients monitored in postanaesthesia unit one and in 42 of 70 patients monitored in postanaesthesia unit two. MAIN OUTCOME MEASURES Absolute trace gas room concentrations of sevoflurane measured with a compact, closed gas loop high-resolution ion mobility spectrometer. RESULTS Traces of sevoflurane could be detected in 805 out of 970 samples. Maximum concentrations were 0.96 ± 0.20 ppm in postanaesthesia unit one, 0.82 ± 0.07 ppm in postanaesthesia unit two. Median concentration was 0.12 (0.34) ppm in postanaesthesia unit one and 0.11 (0.28) ppm in postanaesthesia unit two. CONCLUSION Low trace amounts of sevoflurane were detected in both PACUs equipped with controlled air exchange systems. Occupational exposure limits were not exceeded.

https://ift.tt/2JndMZ9

Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery: A systematic review and meta-analysis

BACKGROUND Hydroxyethyl starch (HES) solutions have shown their efficiency for intravascular volume expansion. A safety recommendation limiting their use in adult patients has recently been made. OBJECTIVE To assess the efficacy and adverse effects of HES when administered intra-operatively to paediatric patients. DESIGN Systematic review with meta-analyses. Data were analysed using classical mean differences [and their 95% confidence intervals (CIs)] and trial sequential analysis. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification was performed for all outcomes. Reviewers extracted valid data, including perioperative total fluid intakes, mortality, renal function, coagulation tests, blood loss and length of hospital and ICU stay. DATA SOURCES Searches were performed in databases (Pubmed, Embase, Cochrane central register of controlled trials), clinical trials register, and open access journals not indexed in major databases. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) published before December 2016 involving paediatric patients who received 6% low molecular weight HES. RESULTS Nine RCTs involving 530 peri-operative paediatric patients were analysed. Compared with other fluids, HES did not significantly modify the amount of peri-operative fluid administered [mean difference 0.04; 95% CI (−1.76 to 1.84) ml kg−1], urine output [mean difference −33; 95% CI (−104 to 38) ml kg−1] or blood loss [mean difference −0.09; (−0.32 to 0.15) ml kg−1]. Trial sequential analysis determined that the outcomes for peri-operative fluid and urine output were underpowered. All results were graded as very low quality of evidence. CONCLUSION Intravascular volume expansion with low molecular weight 6% HES did not appear to modify renal function, blood loss or transfusion when administered to children during the peri-operative period. However, given the lack of statistical power and the very low GRADE quality of evidence, more high-quality RCTs are needed to explore these outcomes.

https://ift.tt/2sBvHVH

Anaesthesia and orphan diseases: anaesthetic management of a patient with X-linked Charcot–Marie–Tooth disease type 1

No abstract available

https://ift.tt/2JkgEpC

Opioid-related genetic polymorphisms do not influence postoperative opioid requirement: A prospective observational study

BACKGROUND Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics. DESIGN A single centre prospective study. SETTING University Hospital, Paris, France, from 2 January 2007 to 15 November 2011. PATIENTS A total of 438 white adults scheduled for major orthopaedic surgery (spine, hip and knee) under general anaesthesia. The main exclusion criteria were receiving opioids for chronic pain, nonopioid drugs within 2 days prior to surgery, pregnancy, renal insufficiency, sleep apnoea obstruction syndrome, morbid obesity, severe hepatic impairment, cognitive dysfunction. INTERVENTIONS Assays of plasma concentrations of morphine and metabolites (morphine 3-glucuronide and morphine 6-glucuronide) were performed and common polymorphisms in four candidate genes [OPRM1 A118G rs1799971; P-glycoprotein (ABCB1) T3435C (rs1045642) and G2677T/A (rs2032582); COMT Val 158 Met (rs4680)] were analysed. Morphine was titrated by staff in the postanaesthesia care unit (PACU) and in the ward patient-controlled intravenous analgesia was used for 24 h. MAIN OUTCOME MEASURES The dose of morphine required to achieve pain relief and the influence of SNP in genes involved in morphine pharmacodynamics and kinetics on morphine dose requirements. Secondary endpoints were the concentrations of morphine, morphine 6-glucuronide and morphine 3-gluguronide, the proportion of patients requiring a rescue analgesic and the proportion of morphine-related adverse events. RESULTS A total of 404 patients completed the study to final analysis. The mean ± SD morphine dose to achieve pain relief was 15.8 ± 8.8 mg in the PACU and 22.7 ± 18.6 mg during patient-controlled intravenous administration. Morphine-related adverse events were observed in 37%. There was no relationship between any genetic polymorphisms and morphine dose, morphine 3-gluguronide and morphine 6-glucuronide concentration, morphine-related adverse events or pain level. In the PACU only, P-glycoprotein polymorphisms (ex-21; ex-26) were significantly associated with morphine concentration but the prediction of the model was poor (R2 = 0.04) CONCLUSION No major relationship has been demonstrated between SNP of OPRM1, ABCB1, COMT and morphine requirement, pain level or adverse effects in the postoperative period. TRIAL REGISTRATION NCT00822549 (www.clinicaltrials.gov).

https://ift.tt/2JhERRu

Peri-operative goal-directed therapy: A definitive answer remains elusive

No abstract available

https://ift.tt/2xP0Gm7

Toll-like receptor 4 deficient mice do not develop remifentanil-induced mechanical hyperalgesia: An experimental randomised animal study

BACKGROUND Drugs with antagonistic actions on the Toll-like receptor 4 (Tlr4), such as naloxone at ultra low doses, have been used to inhibit opioid-induced hyperalgesia in rodents suggesting the involvement of this receptor and pathway on opioid-induced hyperalgesia. OBJECTIVE The aim of this study was to determine whether mice without the Tlr4 gene (Tlr4−/−) would not develop remifentanil-induced hyperalgesia. DESIGN An experimental randomised animal study. SETTING Experimental Unit, Complutense University of Madrid, Madrid, Spain. ANIMALS Twelve adult female wild-type mice and 12 adult Tlr4−/− mice. INTERVENTIONS Under sevoflurane anaesthesia, a 1-h, constant rate subcutaneous infusion of remifentanil (4 μg kg−1 min−1) or 0.9% saline. MAIN OUTCOME MEASURES Mechanical nociceptive thresholds were evaluated using a von Frey hair test before (baseline) and on days 5, 6 and 7 after treatment. Hyperalgesia was considered to be a decrease in the mechanical nociceptive threshold. Changes in mechanical nociceptive thresholds in the different groups were compared with one-sided paired t tests. RESULTS Baseline mechanical nociceptive thresholds were similar in all groups (2.2 ± 0.1 g). Remifentanil produced a 24% decrease in mechanical nociceptive thresholds in the wild-type mice (1.7 ± 0.0 g, averaged over 3 days, P = 0.00021), whereas the nociceptive thresholds were not changed in Tlr4−/− mice (2.2 ± 0.1 g, P = 0.857) or in mice receiving 0.9% saline (Tlr4−/−, 2.2 ± 0.1 g, P = 0.807; wild-type, 2.2 ± 0.1 g, P = 0.962). CONCLUSION Tlr4 receptor involvement is suggested in the development of remifentanil-induced hyperalgesia in mice. TRIAL REGISTRATION CEA-UCM 107/2012.

https://ift.tt/2JdZHBf

Fasting before elective surgery does not result in hypovolaemia: A prospective, observational study

No abstract available

https://ift.tt/2Jo6jsL

Patient factors and outcomes associated with the withdrawal or withholding of life-sustaining therapies in mechanically ventilated brain-injured patients: An observational multicentre study

BACKGROUND Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. OBJECTIVES To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. DESIGN A retrospective observational multicentre study. SETTINGS Twenty French ICUs in 18 university hospitals. PATIENTS A total of 793 mechanically ventilated brain-injured adult patients. INTERVENTIONS None. MAIN OUTCOME MEASURES Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. RESULTS A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P 

https://ift.tt/2JesQMB

Anaesthesia and orphan diseases: difficult tracheal intubation in a child with Frank–ter Haar syndrome

No abstract available

https://ift.tt/2xNPFkR

Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled study in secondary schools in Germany

BACKGROUND Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. OBJECTIVE(S) The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. DESIGN Randomised-interventional controlled study. SETTING Four secondary schools in Germany. PARTICIPANTS Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. INTERVENTION The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). MAIN OUTCOME MEASURES Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. RESULTS Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P 

https://ift.tt/2Jcph9A

Evaluation of transversus abdominis plane block in open appendectomy in paediatrics: Comparison of ropivacaine in two different concentrations

No abstract available

https://ift.tt/2xOZNtN

For beginners in anaesthesia, self-training with an audiovisual checklist improves safety during anaesthesia induction: A randomised, controlled two-centre study

BACKGROUND Beginners in residency programmes in anaesthesia are challenged because working environment is complex, and they cannot rely on experience to meet challenges. During this early stage, residents need rules and structures to guide their actions and ensure patient safety. OBJECTIVE We investigated whether self-training with an electronic audiovisual checklist app on a mobile phone would produce a long-term improvement in the safety-relevant actions during induction of general anaesthesia. DESIGN, SETTING AND PARTICIPANTS During the first month of their anaesthesia residency, we randomised 26 residents to the intervention and control groups. The study was performed between August 2013 and December 2014 in two university hospitals in Germany. INTERVENTION In addition to normal training, the residents of the intervention group trained themselves on well tolerated induction using the electronic checklist for at least 60 consecutive general anaesthesia inductions. MAIN OUTCOME MEASURES After an initial learning phase, all residents were observed during one induction of general anaesthesia. The primary outcome was the number of safety items completed during this anaesthesia induction. Secondary outcomes were similar observations 4 and 8 weeks later. RESULTS Immediately, and 4 weeks after the first learning phase, residents in the intervention group completed a significantly greater number of safety checks than residents in the control group 2.8 [95% confidence interval (CI) 0.4 to 5.1, P = 0.021, Cohen's d = 0.47] and 3.7 (95% CI 1.3 to 6.1, P = 0.003, Cohen's d = 0.61), respectively. The difference between the groups had disappeared by 8 weeks: mean difference in the number of safety checks at 8 weeks was 0.4, 95% CI −2.0 to 2.8, P = 0.736, Cohen's d = 0.07). CONCLUSION The use of an audiovisual self-training checklists improves safety-relevant behaviour in the early stages of a residency training programme in anaesthesia.

https://ift.tt/2sCwXaT

Supraglottic airways: One size does not fit all

No abstract available

https://ift.tt/2xP0aEH

Polymorphisms in genes related to inflammation and obesity and colorectal adenoma risk

Molecular Carcinogenesis, EarlyView.


https://ift.tt/2JhtSrh

Nummularic acid, a triterpenoid, from the medicinal plant Fraxinus xanthoxyloides, induces energy crisis to suppress growth of prostate cancer cells

Molecular Carcinogenesis, EarlyView.


https://ift.tt/2JkoUpC

Issue Information ‐ Ed Board

Molecular Carcinogenesis, Volume 57, Issue 7, Page 815-815, July 2018.


https://ift.tt/2JhtGIz

A novel mechanism of the M1‐M2 methionine adenosyltransferase switch‐mediated hepatocellular carcinoma metastasis

Molecular Carcinogenesis, EarlyView.


https://ift.tt/2JkoKi0

miR-570 Inhibits Proliferation, Angiogenesis, and Immune Escape of Hepatocellular Carcinoma

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


https://ift.tt/2sDZNaQ

HER2-Based Immunotherapy for Breast Cancer

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


https://ift.tt/2JkozDm

Late toxicity in the randomized multicenter HYPRO trial for prostate cancer analyzed with automated treatment planning

Assess to what extent the use of automated treatment planning would have reduced organ-at-risk dose delivery observed in the randomized HYPRO trial for prostate cancer, and estimate related toxicity reductions. Investigate to what extent improved plan quality for hypofractionation scheme as achieved with automated planning can potentially reduce observed enhanced toxicity for the investigated hypofractionation scheme to levels observed for conventional fractionation scheme.

https://ift.tt/2M6YFF0

Radiation in Central Nervous System Leukemia: Guidelines from the International Lymphoma Radiation Oncology Group

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Chelsea C. Pinnix, Joachim Yahalom, Lena Specht, Bouthaina Shbib Dabaja
Durable control of systemic disease in blood and bone marrow has significantly improved survival among patients with leukemia, but extramedullary relapse in the central nervous system can still pose therapeutic challenges for which radiation therapy can have an important role. The objective of this document is to discuss the current role of radiation therapy for patients with leukemia in the central nervous system.



https://ift.tt/2xOuCyE

The Future of Artificial Intelligence in Radiation Oncology

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Reid F. Thompson, Gilmer Valdes, Clifton David Fuller, Colin M. Carpenter, Olivier Morin, Sanjay Aneja, William D. Lindsay, Hugo J.W.L. Aerts, Barbara Agrimson, Curtiland Deville, Seth A. Rosenthal, James B. Yu, Charles R. Thomas




https://ift.tt/2M5uZrz

Simulation as More Than a Treatment Planning Tool: A Systematic Review of the Literature on Radiation Oncology Simulation-Based Medical Education

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Michael K. Rooney, Fan Zhu, Erin F. Gillespie, Jillian R. Gunther, Ryan P. McKillip, Matthew Lineberry, Ara Tekian, Daniel W. Golden
This study systematically reviewed the literature to characterize the role of simulation-based medical education (SBME) in radiation oncology and develop a framework for future SBME interventions. Most studies meeting inclusion criteria described successful learning outcomes with a minority self-identifying as SBME. The majority of studies targeted attending physicians and residents as learners and focused on contouring. There is opportunity for expansion and increased awareness of SBME in the context of radiation oncology curriculum development.



https://ift.tt/2xQf39I

Therapeutic effects of human umbilical cord–derived mesenchymal stem cells on canine radiation-induced lung injury

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yuhui Hao, Yonghong Ran, Binghui Lu, Jiayin Li, Jiaojiao Zhang, Chunjing Feng, Jinhui Fang, Ruoyu Ma, Zhihui Qiao, Xiaotian Dai, Wei Xiong, Jing Liu, Qi Zhou, Jie Hao, Rong Li, Jianwu Dai
ObjectiveTo investigate the effect of human umbilical cord–derived mesenchymal stem cell (MSC) transplantation on canine radiation-induced lung injury.MethodsBeagle dogs received localized 15-Gy radiation to the right lower lung from X-rays to establish the model of radiation-induced lung injury. After 180 days, dogs were divided into two groups (4/ group). The MSC group received intratracheal MSC transplantation, and the saline group received the same volume of normal saline by lavage. The effect of MSC transplantation on lung injury was then evaluated during 180 days after transplantation.ResultsAt 180 days after 15-Gy radiation, canine arterial blood oxygen partial pressure was significantly decreased, and the levels of hydroxyproline and transforming growth factor-β (TGF-β) in peripheral blood were significantly increased, whereas that of TGF-α was significantly decreased. Computed tomography (CT) evaluation revealed visible honeycomb shadows in the right middle and lower pulmonary pleurae. Then, the blood oxygen partial pressure of the MSC group gradually increased over time, whereas the levels of hydroxyproline and TGF-β in the peripheral blood showed a decreasing trend, and TGF-α levels gradually increased, which differed significantly from the results observed in the saline group. In addition, CT and pathological examination showed that the degree of lung injury in the MSC group was milder. The MSC group also showed significantly increased pulmonary superoxide dismutase levels and significantly decreased TNF-α, IL-1, and hyaluronic acid levels. Further study confirmed that MSC transplantation inhibited the activation of TGF-β/Smad2/3 in lung tissues, and in vitro experiments showed that medium conditioned with MSCs effectively inhibited the increase in Smad2/3 levels induced by TGF-β1.ConclusionCanine radiation-induced lung injury could be observed at 180 days after radiation at 15 Gy. MSC transplantation can reduce oxidative stress, inflammatory reactions, and TGF-β/Smad2/3 pathway activation, thereby reducing lung injury.

Teaser

Radiation-induced lung injury is a common complication following radiotherapy for thoracic tumours. Our studies show that canine radiation-induced lung injury could be observed at 180 days after X-ray radiation at 15 Gy, and intratracheal mesenchymal stem cell (MSC) transplantation can reduce oxidative stress, inflammatory reactions, and TGF-β/Smad2/3 pathway activation, thereby reducing lung injury. This finding provides a basis for the application of MSCs in clinical transplantation therapies for radiation-induced lung injury.


https://ift.tt/2M5QbOk

Radiation Therapy Is Associated With An Increased Incidence Of Cardiac Events In Small-Cell Lung Cancer Patients

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Matthew J. Ferris, Renjian Jiang, Madhusmita Behera, Suresh S. Ramalingam, Walter J. Curran, Kristin A. Higgins
PurposeCardiac radiation dose was a predictor of inferior overall survival (OS) in the non-small-cell lung cancer trial RTOG 0617. We examined the association between radiation therapy (RT) and cardiac events (CE) for small cell lung cancer (SCLC) patients.Methods and MaterialsThe US population-based Surveillance, Epidemiology, and End Results (SEER) Program and Medicare claims databases were queried for rates of CE among SCLC patients treated with chemotherapy (CTX) +/- RT. Propensity score matching (PSM) and multivariate analysis (MVA) were conducted. Patients were matched for actual/theoretical RT start date (to prevent immortal time bias) and then full PSM balanced clinical characteristics. Cumulative incidence function curves were generated.ResultsFrom 2000 – 2011, 7,060 patients were included: 2,892 limited-stage (LS-SCLC) and 4,168 extensive-stage (ES-SCLC). Grouping LS-SCLC and ES-SCLC together, the incidence of CE for the CTX + RT and CTX-only groups was 44.1 vs. 39.0% at 60 months (P = 0.008). After PSM (5,286 patients), the incidence of CE for the CTX + RT and CTX-only groups was 43.0 vs. 38.6% at 60 months (P = 0.033). Analysis of only LS-SCLC (2,016 patients) demonstrated the incidence of CE for CTX + RT vs. CTX-only groups was 50.3 vs. 42.0% at 60 months (P = 0.0231). MVA again demonstrated association between CE and RT (HR 1.20; 95% CI 1.06 – 1.37; P = 0.005). After PSM (1,614 patients), the incidence of CE for CTX + RT vs. CTX-only groups was 51.7 vs. 41.6% at 60 months (P = 0.0042).ConclusionsSCLC patients are at significant risk of developing CE post-treatment; RT is associated with an absolute increase in the rate of CE at 5-years of approximately 5% for all SCLC patients, and up to 10% for LS-SCLC patients. Cardiac risk management and cardiac-sparing RT techniques should be further evaluated for SCLC patients.

Teaser

Among small-cell lung cancer patients, we found baseline rates of cardiac events are about 40% at 5-years in the US population. Treatment with radiation therapy contributes to an absolute increase in this rate of cardiac events at 5-years of approximately 5% for all patients (limited-stage and extensive-stage both), and up to 10% for the limited-stage population.


https://ift.tt/2JlUX8w

Cognitive and Adaptive Outcomes Following Proton Radiation for Pediatric Patients with Brain Tumors

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Margaret B. Pulsifer, Haley Duncanson, Julie Grieco, Casey Evans, Irene Delgado Tseretopoulos, Shannon MacDonald, Nancy J. Tarbell, Torunn I. Yock
PurposeRadiation therapy is integral in treatment of pediatric brain tumors, but is associated with negative long-term sequelae. Proton radiotherapy (PRT), which enables better focusing of radiation to tumors, may entail fewer sequelae. This prospective study examined cognitive and adaptive functioning in children and young adults treated with PRT.Methods and Materials155 patients were assessed using age-appropriate measures for cognitive and adaptive functioning at start of or during PRT (baseline) and follow-up. Mean age at baseline was 8.9 years; mean follow-up interval was 3.6 years. Diagnoses included medulloblastoma, craniopharyngioma, ependymoma, glial, germ cell, and others. The sample was divided by age at baseline: <6 years (37%) and ≥6 years (63%), and by PRT field: craniospinal irradiation (CSI) (39%) and focal irradiation (61%).ResultsMean IQ and adaptive scores were in the average range at baseline and follow-up. Overall, mean IQ declined from 105.4 to 102.5 (P = 0.005); however, only the younger/CSI group showed significant decline. CSI patients, regardless of age, appeared particularly vulnerable in IQ, processing speed, and working memory. Adaptive skills were stable across the four age-by-treatment field groups.ConclusionsAt a mean of 3.6 years after PRT, IQ declined slightly for the group, largely due to significant IQ decline in younger patients treated with CSI. No significant change was seen in patients <6 years treated with focal PRT or in older patients. Adaptive skills remained stable across age and treatment type.

Teaser

Radiation therapy for brain tumors is associated with declines in intelligence (IQ) and adaptive functioning. Proton radiotherapy (PRT), which limits dose to normal tissue, could improve outcome. This study assessed 155 pediatric patients aged 1–22.5 years at PRT initiation and a mean of 3.6 years thereafter. IQ declined slightly for the group, largely due to significant decline in patients <6 years treated with craniospinal irradiation. Adaptive skills remained stable across age and treatment type.


https://ift.tt/2M2TZzO

Effect of host immune status on the efficacy of radiotherapy and recurrence-free survival among 805 Merkel cell carcinoma patients

Publication date: Available online 5 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yolanda D. Tseng, Macklin H. Nguyen, Kelsey Baker, Maclean Cook, Mary Redman, Kristina Lachance, Shailender Bhatia, Jay J. Liao, Smith Apisarnthanarax, Paul T. Nghiem, Upendra Parvathaneni
PurposeMerkel cell carcinoma (MCC) patients with chronic immunosuppression (IS) have worse outcomes, but the mechanisms are not well understood. We hypothesized that these differences may be mediated in part by differential response to treatment and evaluated whether RT efficacy is altered among IS compared with immune competent (IC) MCC patients.MethodsAmong 805 MCC patients, recurrence-free survival (RFS) and patterns of first recurrence were compared between 89 IS and 716 IC patients with stage I-III MCC treated with curative-intent. We used a Fine and Gray's competing risk multivariable analysis to estimate associations with RFS.ResultsIS and IC MCC patients had similar demographic and disease characteristics. Most (77% IC,86% IS) were irradiated (median, 50.4Gy IC, 50.3Gy IS), although more IS patients were irradiated to the primary site (97% vs 81%). With a median follow-up of 54.4 months, IS patients had inferior RFS (2-year 30% vs 57%; p<0.0001) and higher local recurrence as the first site of relapse (25% vs 12%; p=0.0002). The association between RT and RFS differed by immune status (interaction p=0.01). While RT was associated with significantly improved RFS among IC patients (HR 0.56, 95% CI 0.44-0.72), no difference in RFS was observed with RT among IS patients (HR 1.49, 95% CI 0.70-3.17).ConclusionsRadiotherapy efficacy at current, standard RT doses for MCC is impaired among immunosuppressed MCC patients. While a strong link between durability of RT response and immune function does not appear to be evident in most cancers, our results may reflect an especially dynamic interaction between immune status and RT efficacy in MCC.

Teaser

The impact of chronic immunosuppression on RT efficacy was evaluated among non-metastatic Merkel cell carcinoma (MCC) patients treated with curative-intent. Despite higher proportions of immunosuppressed MCC patients receiving RT to the primary site compared with immune-competent MCC patients, immunosuppressed MCC patients experienced increased local failures as first relapse (25% versus 12%; p=0.0002) and lower recurrence-free survival (2-year 30% versus 57%;p<0.0001). The efficacy of conventional radiotherapy on tumor control may be impaired in an immunosuppressed host.


https://ift.tt/2xOSSkl

Two potentially lethal conditions of probable immune origin occurring in a pregnant woman: a case report

Thrombotic thrombocytopenic purpura and peripartum cardiomyopathy are potentially lethal complications of pregnancy. We describe a case in which both of these developed in the same patient. The etiologies of b...

https://ift.tt/2sMF046

Presentation and management of the delayed type of hypersensitivity reaction with bendamustine

Bendamustine, an alkylating agent with cytotoxic properties, has been increasingly employed in the treatment of chronic lymphocytic leukemia (CLL) either as a single agent or combination with rituximab. Although rarely reported, they can potentially cause hypersensitivity reactions with serious consequences. The objective of the case report was to offer a safe and effective bendamustine desensitization protocol to patients with a hypersensitivity reaction to this drug. We report a case of a patient with a CLL who developed a type IV hypersensitivity reaction to bendamustine and who was successfully treated by drug desensitization. A 51-year-old man with CLL was started on chemotherapy with bendamustin–rituximab developed a type IV hypersensitivity reaction 3 days later. A desensitization protocol was developed for the second cycle of bendamustine. This protocol was well tolerated, and no hypersensitivity reaction was observed. The desensitization protocol allowed us to continue the treatment, and to achieve a favorable response of the CLL. Patients with a hypersensitivity reaction to bendamustine can safely receive bendamustine by our rapid desensitization protocol. Correspondence to Sufana Shikdar, MD, MPH, Department of Internal Medicine, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA Tel: +1 646 841 7938; fax: +1 610 237 4261; e-mail: sufana.shikdar@gmail.com Received April 2, 2018 Accepted May 21, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2JehtnH

Strategies for screening and early detection of anal cancers: A narrative and systematic review and meta‐analysis of cytology, HPV testing, and other biomarkers

Cancer Cytopathology, EarlyView.


https://ift.tt/2szu5vg

Immediate histopathologic follow‐up of Cervista and Aptima high‐risk HPV assays in women with LSIL cytology

Cancer Cytopathology, EarlyView.


https://ift.tt/2sLxjeD

Cytopathologic features of SMARCB1 (INI‐1)‐deficient sinonasal carcinoma

Cancer Cytopathology, EarlyView.


https://ift.tt/2kTmOT7

A developmental perspective on existential distress and adaptation to advanced disease

Psycho-Oncology, EarlyView.


https://ift.tt/2kUeGBL

Mind‐body interventions for fear of cancer recurrence: A systematic review and meta‐analysis

Psycho-Oncology, EarlyView.


https://ift.tt/2HpOPKG

A scoping review of studies exploring physical activity among adolescents and young adults diagnosed with cancer

Psycho-Oncology, EarlyView.


https://ift.tt/2kUzYiK

Latent class analysis differentiation of adjustment disorder and demoralization, more severe depressive and anxiety disorders, and somatic symptoms in patients with cancer

Psycho-Oncology, EarlyView.


https://ift.tt/2sPmecG

Cancer‐related suicide: A biopsychosocial‐existential approach to risk management

Psycho-Oncology, EarlyView.


https://ift.tt/2kPg3BA

Issue Information

Psycho-Oncology, Volume 27, Issue 6, Page 1465-1466, June 2018.


https://ift.tt/2sLs6Ug

Genomics and Personalized Medicine: What Everyone Needs to Know. Michael Snyder. New York: Oxford University Press, 2016. 184 pp. $74.00 hardcover and $16.95 paperback

Psycho-Oncology, Volume 27, Issue 6, Page 1670-1670, June 2018.


https://ift.tt/2kPgbRA

Corrigendum

Psycho-Oncology, Volume 27, Issue 6, Page 1671-1671, June 2018.


https://ift.tt/2sLrVs4

NeuroCog FX study: A multicenter cohort study on cognitive dysfunction in patients with early breast cancer

Psycho-Oncology, EarlyView.


https://ift.tt/2sznr8E

Psychological distress in lung cancer survivors at least 1 year after diagnosis—Results of a German multicenter cross‐sectional study

Psycho-Oncology, EarlyView.


https://ift.tt/2sMZ8De

Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app‐delivered mindfulness training

Psycho-Oncology, EarlyView.


https://ift.tt/2kR06L6

Effects of physical activity on psychological well‐being outcomes in breast cancer survivors from prediagnosis to posttreatment survivorship

Psycho-Oncology, EarlyView.


https://ift.tt/2sLMXGJ

Utilization of health care services in cancer patients with elevated fear of cancer recurrence

Psycho-Oncology, EarlyView.


https://ift.tt/2szn8L2

The role of posttraumatic stress and posttraumatic growth on online information use in breast cancer survivors

Psycho-Oncology, EarlyView.


https://ift.tt/2sMnmgS

In This Issue

Cancer Science, Volume 109, Issue 6, Page 1742-1742, June 2018.


https://ift.tt/2HplNe9

Japanese Society of Medical Oncology Clinical Guidelines: Molecular Testing for Colorectal Cancer Treatment, Third Edition

Cancer Science, Volume 109, Issue 6, Page 2074-2079, June 2018.


https://ift.tt/2kS3g1e

Issue Information

Cancer Science, Volume 109, Issue 6, Page 1739-1741, June 2018.


https://ift.tt/2HobdnV

Collagen type I induces EGFR‐TKI resistance in EGFR‐mutated cancer cells by mTOR activation through Akt‐independent pathway

Cancer Science, Volume 109, Issue 6, Page 2063-2073, June 2018.


https://ift.tt/2sAwJBg

Osimertinib in Japanese patients with EGFR T790M mutation‐positive advanced non‐small‐cell lung cancer: AURA3 trial

Cancer Science, Volume 109, Issue 6, Page 1930-1938, June 2018.


https://ift.tt/2sLOCfF

Comparison of human papillomavirus genotyping and cytology triage, COMPACT Study: Design, methods and baseline results in 14 642 women

Cancer Science, Volume 109, Issue 6, Page 2003-2012, June 2018.


https://ift.tt/2kS3a9S

Long noncoding RNA NORAD regulates transforming growth factor‐β signaling and epithelial‐to‐mesenchymal transition‐like phenotype

Cancer Science, EarlyView.


https://ift.tt/2sJPVf6

Pretreatment evaluation of fluorescence resonance energy transfer‐based drug sensitivity test for patients with chronic myelogenous leukemia treated with dasatinib

Cancer Science, EarlyView.


https://ift.tt/2kTCfuA

Endoscopic near infrared photoimmunotherapy using a fiber optic diffuser for peritoneal dissemination of gastric cancer

Cancer Science, Volume 109, Issue 6, Page 1902-1908, June 2018.


https://ift.tt/2HplxMd

β‐arrestin1‐medieated inhibition of FOXO3a contributes to prostate cancer cell growth in vitro and in vivo

Cancer Science, Volume 109, Issue 6, Page 1834-1842, June 2018.


https://ift.tt/2sB0hPf

Aberrant methylation of EYA4 promotes epithelial‐mesenchymal transition in esophageal squamous cell carcinoma

Cancer Science, Volume 109, Issue 6, Page 1811-1824, June 2018.


https://ift.tt/2HoaZgz

Tumor‐infiltrating neutrophils predict prognosis and adjuvant chemotherapeutic benefit in patients with biliary cancer

Cancer Science, EarlyView.


https://ift.tt/2sB7fng

Machine-learning-derived classifier predicts absence of persistent pain after breast cancer surgery with high accuracy

Abstract

Background

Prevention of persistent pain following breast cancer surgery, via early identification of patients at high risk, is a clinical need. Supervised machine-learning was used to identify parameters that predict persistence of significant pain.

Methods

Over 500 demographic, clinical and psychological parameters were acquired up to 6 months after surgery from 1,000 women (aged 28–75 years) who were treated for breast cancer. Pain was assessed using an 11-point numerical rating scale before surgery and at months 1, 6, 12, 24, and 36. The ratings at months 12, 24, and 36 were used to allocate patents to either "persisting pain" or "non-persisting pain" groups. Unsupervised machine learning was applied to map the parameters to these diagnoses.

Results

A symbolic rule-based classifier tool was created that comprised 21 single or aggregated parameters, including demographic features, psychological and pain-related parameters, forming a questionnaire with "yes/no" items (decision rules). If at least 10 of the 21 rules applied, persisting pain was predicted at a cross-validated accuracy of 86% and a negative predictive value of approximately 95%.

Conclusions

The present machine-learned analysis showed that, even with a large set of parameters acquired from a large cohort, early identification of these patients is only partly successful. This indicates that more parameters are needed for accurate prediction of persisting pain. However, with the current parameters it is possible, with a certainty of almost 95%, to exclude the possibility of persistent pain developing in a woman being treated for breast cancer.

https://ift.tt/2JleBRY

Cover Image, Volume 117, Number 5, April 1, 2018

Journal of Surgical Oncology, Volume 117, Issue 5, Page i-i, April 1, 2018.


https://ift.tt/2M4sg1S

Hepatic artery infusion of melphalan in patients with liver metastases from ocular melanoma

Journal of Surgical Oncology, Volume 117, Issue 5, Page 940-946, April 1, 2018.


https://ift.tt/2xPHF2S

Issue Information ‐ TOC

Journal of Surgical Oncology, Volume 117, Issue 5, Page 814-818, April 1, 2018.


https://ift.tt/2M6ODU2

Long‐term outcomes of 530 esophageal squamous cell carcinoma patients with minimally invasive Ivor Lewis esophagectomy

Journal of Surgical Oncology, Volume 117, Issue 5, Page 957-969, April 1, 2018.


https://ift.tt/2JjmVlu

Issue Information ‐ Ed Board

Journal of Surgical Oncology, Volume 117, Issue 5, Page 813-813, April 1, 2018.


https://ift.tt/2M2Sxxu

Neoadjuvant chemotherapy or chemoradiotherapy for adenocarcinoma of the esophagus

Journal of Surgical Oncology, EarlyView.


https://ift.tt/2Jn2yUg

Issue Information

Cancer, Volume 124, Issue 12, Page 2459-2468, June 15, 2018.


https://ift.tt/2JfpE39

Combined therapies improve survival in aggressive prostate cancer

Cancer, Volume 124, Issue 12, Page 2470-2470, June 15, 2018.


https://ift.tt/2Jns0Jt

Higher radiation doses do not improve survival in men with intermediate‐risk disease

Cancer, Volume 124, Issue 12, Page 2471-2471, June 15, 2018.


https://ift.tt/2Jfptov

First person: Hagop Kantarjian, MD

Cancer, Volume 124, Issue 12, Page 2469-2469, June 15, 2018.


https://ift.tt/2Jn1xMf

Optimizing colorectal cancer screening by race and sex: Microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline

Cancer, EarlyView.


https://ift.tt/2sz2dI2

The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline

Cancer, EarlyView.


https://ift.tt/2xPFI6y

How I treat older patients with acute myeloid leukemia

Cancer, Volume 124, Issue 12, Page 2472-2483, June 15, 2018.


https://ift.tt/2JgrfG7

Muscle radiodensity and mortality in patients with colorectal cancer

Cancer, EarlyView.


https://ift.tt/2JlFzsP

Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib

Cancer, EarlyView.


https://ift.tt/2JfQgRT

Fusion status in patients with lymph node‐positive (N1) alveolar rhabdomyosarcoma is a powerful predictor of prognosis: Experience of the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG)

Cancer, EarlyView.


https://ift.tt/2JpS1HV

Genetic polymorphisms of Th2 interleukins, history of asthma or eczema and childhood acute lymphoid leukaemia: Findings from the ESCALE study (SFCE)

Publication date: August 2018
Source:Cancer Epidemiology, Volume 55
Author(s): A. Bonaventure, L. Orsi, J. Rudant, S. Goujon-Bellec, G. Leverger, A. Baruchel, Y. Bertrand, B. Nelken, M. Pasquet, G. Michel, N. Sirvent, P. Chastagner, S. Ducassou, C. Thomas, C. Besse, D. Hémon, J. Clavel
BackgroundPrevious studies on the putative role of allergy in the aetiology of childhood leukaemia have reported contradictory results. The present study aimed to analyse the relation between a medical history of asthma or eczema and childhood acute lymphoid leukaemia (ALL) in light of potential candidate gene-environment interactions.MethodsAnalyses were based on a subset of 434 cases of ALL and 442 controls successfully genotyped and of European ancestry children enrolled in a French population-based case-control study conducted in 2003–2004. Information about medical history was obtained during a standardized interview with the mothers. Candidate polymorphisms in genes of the Th2 cytokines IL4, IL10, IL13 and IL4-receptor, were genotyped or imputed.ResultsNone of the variant alleles were directly associated with childhood acute lymphoid leukaemia. A medical history of asthma or eczema was reported more often in the control group (OR = 0.7 [0.5–1.0]). This association was mostly seen in the group of children not carrying the IL13-rs20541 variant allele (Interaction Odds Ratio IOR 1.9, p-interaction = 0.07) and in those carrying the IL10 triple variant haplotype (IOR 0.5, p-interaction = 0.04). No interaction was observed with the candidate polymorphisms in IL4 and IL4R.ConclusionThis study provides a new insight into the relationship between allergic symptoms and childhood acute lymphoid leukaemia, by suggesting this inverse association could be limited to children carrying certain genetic polymorphisms. If confirmed, these results could help better understand the biological mechanisms involved in the development of childhood acute lymphoid leukaemia.



https://ift.tt/2sBMCXU

Issue Information

International Journal of Cancer, Volume 143, Issue 2, Page 227-233, 15 July 2018.


https://ift.tt/2JzWOKq

Issue Information

International Journal of Cancer, Volume 143, Issue 2, Page 449-450, 15 July 2018.


https://ift.tt/2Lq8c8Q

Defibrotide for the treatment of hepatic veno‐occlusive disease/sinusoidal obstruction syndrome following nontransplant‐associated chemotherapy: Final results from a post hoc analysis of data from an expanded‐access program

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2JdQk4q

The changing clinical pattern of endemic Burkitt lymphoma in Western Africa: Experience from a tertiary center in Ghana

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xLEcSM

Pediatric pancreatic neoplasms: The time is nigh for collaboration across continents

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2JdM2de

Can myocardial remodeling be a useful surrogate predictor of myocardial iron load? A 3D echocardiographic multicentric study

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2Jm4tsh

Increased apoptosis and peripheral blood mononuclear cell suppression of bone marrow mesenchymal stem cells in severe aplastic anemia

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2JdQglc

Use of ROTEM in correction of unexpected oozing in a child with a preexisting normal coagulation profile undergoing splenectomy

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xKCAJi

Misclassification of self‐reported smoking in adult survivors of childhood cancer

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2Jeymid

A phase I window, dose escalating and safety trial of metformin in combination with induction chemotherapy in relapsed refractory acute lymphoblastic leukemia: Metformin with induction chemotherapy of vincristine, dexamethasone, PEG‐asparaginase, and doxorubicin

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2Jm4fBr

EBV‐positive B‐cell lymphoma manifestation of the liver in an infant with RAG1 severe combined immunodeficiency disease

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2JiCa2d

Dose–volume metrics and their relation to memory performance in pediatric brain tumor patients: A preliminary study

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xKCuRW

Age dependency of primary tumor sites and metastases in patients with Ewing sarcoma

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2sCcL93

Autologous stem‐cell transplant for metastatic renal medullary carcinoma

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xKCu4o

A novel approach to reducing admissions for children with sickle cell disease in pain crisis through individualization and standardization in the emergency department

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2swE8Bx

Diagnosis and management of chronic and refractory immune cytopenias in children, adolescents, and young adults

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xN4STf

A multiyear quality improvement project to increase influenza vaccination in a pediatric oncology population undergoing active therapy

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2sH3D3h

Hematopoietic stem cell transplantation for sickle cell disease: Progress and challenges

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xXkqUP

Poikiloderma with neutropenia in a Tunisian patient with a novel C16orf57 gene mutation

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2syZkXI

Sickle Cell Clinical Research and Intervention Program (SCCRIP): A lifespan cohort study for sickle cell disease progression from the pediatric stage into adulthood

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2xKCl0Q

Cisplatin‐induced nephrotoxicity in patients with advanced neuroblastoma

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2JdM1Gc

Psychosocial determinants of physical activity and dietary behaviors in adolescents and young adults with cancer and survivors

Pediatric Blood &Cancer, EarlyView.


https://ift.tt/2Jm4eNT

Posterior fossa lipoma without T1 hyperintensity in foetal magnetic resonance imaging performed in the third trimester

https://ift.tt/2syPjK6

Cancers, Vol. 10, Pages 187: Evolving Treatment Strategies for Elderly Leukemia Patients with IDH Mutations

Cancers, Vol. 10, Pages 187: Evolving Treatment Strategies for Elderly Leukemia Patients with IDH Mutations

Cancers doi: 10.3390/cancers10060187

Authors: Michael J. Buege Adam J. DiPippo Courtney D. DiNardo

Acute myeloid leukemia (AML) is a debilitating and life-threatening condition, especially for elderly patients who account for over 50% of diagnoses. For over four decades, standard induction therapy with intensive cytotoxic chemotherapy for AML had remained unchanged. However, for most patients, standard therapy continues to have its shortcomings, especially for elderly patients who may not be able to tolerate the complications from intensive cytotoxic chemotherapy. New research into the development of targeted and alternative therapies has led to a new era in AML therapy. For the nearly 20% of diagnoses harboring a mutation in isocitrate dehydrogenase 1 or 2 (IDH1/2), potential treatment options have undergone a paradigm shift away from intensive cytotoxic chemotherapy and towards targeted therapy alone or in combination with lower intensity chemotherapy. The first FDA approved IDH2 inhibitor was enasidenib in 2017. In addition, IDH1 inhibitors are in ongoing clinical studies, and the oral BCL-2 inhibitor venetoclax shows preliminary efficacy in this subset of patients. These new tools aim to improve outcomes and change the treatment paradigm for elderly patients with IDH mutant AML. However, the challenge of how to best incorporate these agents into standard practice remains.

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