Risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutated patients: an evidence-based approach on what women should know

Publication date: Available online 28 September 2017
Source:Cancer Treatment Reviews
Author(s): F. De Felice, C. Marchetti, S. Boccia, A. Romito, C. Sassu, MG. Porpora, L. Muzii, V. Tombolini, P. Benedetti Panici
This review is focused on the ovarian cancer risk reduction management in BRCA mutation carriers and is intended to assist with clinical decision-making. Obviously, treatment decisions must be based on the available evidence. Despite risk-reducing salpingo-oophorectomy is firmly recommended, several separate questions can be raised to address the variety of intense controversy of this approach. A special emphasis lies in the effective preventive surgical measure against ovarian cancer risk, in an attempt to detect the optimal timing and mitigate the impact on patients. The long term implications of risk-reducing salpingo-oophorectomy as well as hormone replacement therapy are also actively debated. This is expected to represent an opportunity for improved management modelling of BRCA mutated patients.



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Trends in prescribing systemic treatment and overall survival for non-small cell lung cancer stage IIIB/IV in the Netherlands: 2008–2012

Publication date: December 2017
Source:Cancer Epidemiology, Volume 51
Author(s): Bas J.M. Peters, Christine M. Cramer-vd Welle, Arthur A.J. Smit, Franz M.N.H. Schramel, Ewoudt M.W. van de Garde
BackgroundThe present study aims to give a detailed overview of day-to-day practice in the systemic treatment of NSCLC stage IIIB/IV and its clinical outcomes in six large teaching hospitals in the Netherlands in the period 2008–2012.MethodsA retrospective observational cohort study was conducted in the Care for Outcome registry. Patients diagnosed with stage IIIB/IV NSCLC were included and drug data were collected. Outcomes included percentage of patients treated with systemic treatment, percentage of different first line treatment options, survival, and number and percentage of switches, dose reductions (<80% of the initial dose), and early discontinuation (<4 cycles). Descriptive analyses were conducted per hospital, year of diagnosis and several patient characteristics. Predictors for early discontinuation were explored in a logistic regression model.ResultsOverall, 47,9% of 2158 patients that were included received systemic treatment and 33,7% of those received second line treatment. Treatment frequencies were different between age categories, disease stage, PS and hospital (p<0.001). Half of the patients received <4 cycles and dose reductions were found for 20% of all patients. Interhospital differences were observed for early discontinuation and the number of switches. PS2-3 was associated with early discontinuation (OR 1.97 (p=0,007). Median survival was not different between hospitals and years of diagnosis.DiscussionWe provided detailed overview of day-to-day systemic treatment of NSCLC for six hospitals that (a) can fuel interhospital discussion to streamline treatment towards best practice and (b) can serve as reference data for follow-up of the adoption of novel systemic treatment options for advanced lung cancer.



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Trends in prescribing systemic treatment and overall survival for non-small cell lung cancer stage IIIB/IV in the Netherlands: 2008–2012

Publication date: December 2017
Source:Cancer Epidemiology, Volume 51
Author(s): Bas J.M. Peters, Christine M. Cramer-vd Welle, Arthur A.J. Smit, Franz M.N.H. Schramel, Ewoudt M.W. van de Garde
BackgroundThe present study aims to give a detailed overview of day-to-day practice in the systemic treatment of NSCLC stage IIIB/IV and its clinical outcomes in six large teaching hospitals in the Netherlands in the period 2008–2012.MethodsA retrospective observational cohort study was conducted in the Care for Outcome registry. Patients diagnosed with stage IIIB/IV NSCLC were included and drug data were collected. Outcomes included percentage of patients treated with systemic treatment, percentage of different first line treatment options, survival, and number and percentage of switches, dose reductions (<80% of the initial dose), and early discontinuation (<4 cycles). Descriptive analyses were conducted per hospital, year of diagnosis and several patient characteristics. Predictors for early discontinuation were explored in a logistic regression model.ResultsOverall, 47,9% of 2158 patients that were included received systemic treatment and 33,7% of those received second line treatment. Treatment frequencies were different between age categories, disease stage, PS and hospital (p<0.001). Half of the patients received <4 cycles and dose reductions were found for 20% of all patients. Interhospital differences were observed for early discontinuation and the number of switches. PS2-3 was associated with early discontinuation (OR 1.97 (p=0,007). Median survival was not different between hospitals and years of diagnosis.DiscussionWe provided detailed overview of day-to-day systemic treatment of NSCLC for six hospitals that (a) can fuel interhospital discussion to streamline treatment towards best practice and (b) can serve as reference data for follow-up of the adoption of novel systemic treatment options for advanced lung cancer.



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Periprosthetic total knee fracture after remote reconstruction of the anterior cruciate ligament: a case report

Distal femoral fracture is a rare, but significant, postoperative complication of anterior cruciate ligament reconstruction. However, there has not been a reported case of periprosthetic total knee arthroplast...

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Five-field IMRT Class solutions and dosimetric planning guidelines for implementing accelerated partial breast irradiation

Publication date: Available online 28 September 2017
Source:Practical Radiation Oncology
Author(s): Sarah Quirk, Petra Grendarova, Michael Roumeliotis
PurposeA comprehensive set of planning guidelines was developed to aid in reproducible dosimetric results for external beam accelerated partial breast irradiation (APBI). Methodology for development of class solutions for dosimetric planning of the APBI technique, including dose constraint recommendations, is presented for target coverage and conformity as well as normal tissues.Methods and MaterialsA conservative patient setup was simulated on a TrueBeam™ linear accelerator and a comprehensive arrangement of gantry and couch angles were measured for clearance. This provided the foundation for available beam arrangements to develop reproducible and conformal five-field IMRT partial breast plans. Forty patients were planned. Patient plans were assessed according to anatomy specific features, such as laterality and seroma location within the breast.Results and DiscussionClearance tables are presented to give permissible gantry and couch orientations according to measurements facilitated by patient simulation. Beam arrangement class solutions are presented for left and right-sided APBI patients. Dosimetric recommendations are made based on the results of 40 patient plans. The median and range, describing target coverage and target conformity are reported, as well as normal tissue constraints for ipsilateral lung, ipsilateral breast, heart, liver, and contralateral breast. In all cases, the dose recommendations were at least as strict as multi-institutional accelerated partial breast irradiation trials. In the case of ipsilateral lung and ipsilateral breast, the planning recommendations are more stringent.ConclusionsAccelerated partial breast irradiation using a five-field IMRT technique was comprehensively developed and evaluated to provide recommendations yielding highly conformal and reproducible treatment plans. This provides a clear method to implement external beam APBI planning and delivery.



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via IFTTT

Five-field IMRT Class solutions and dosimetric planning guidelines for implementing accelerated partial breast irradiation

Publication date: Available online 28 September 2017
Source:Practical Radiation Oncology
Author(s): Sarah Quirk, Petra Grendarova, Michael Roumeliotis
PurposeA comprehensive set of planning guidelines was developed to aid in reproducible dosimetric results for external beam accelerated partial breast irradiation (APBI). Methodology for development of class solutions for dosimetric planning of the APBI technique, including dose constraint recommendations, is presented for target coverage and conformity as well as normal tissues.Methods and MaterialsA conservative patient setup was simulated on a TrueBeam™ linear accelerator and a comprehensive arrangement of gantry and couch angles were measured for clearance. This provided the foundation for available beam arrangements to develop reproducible and conformal five-field IMRT partial breast plans. Forty patients were planned. Patient plans were assessed according to anatomy specific features, such as laterality and seroma location within the breast.Results and DiscussionClearance tables are presented to give permissible gantry and couch orientations according to measurements facilitated by patient simulation. Beam arrangement class solutions are presented for left and right-sided APBI patients. Dosimetric recommendations are made based on the results of 40 patient plans. The median and range, describing target coverage and target conformity are reported, as well as normal tissue constraints for ipsilateral lung, ipsilateral breast, heart, liver, and contralateral breast. In all cases, the dose recommendations were at least as strict as multi-institutional accelerated partial breast irradiation trials. In the case of ipsilateral lung and ipsilateral breast, the planning recommendations are more stringent.ConclusionsAccelerated partial breast irradiation using a five-field IMRT technique was comprehensively developed and evaluated to provide recommendations yielding highly conformal and reproducible treatment plans. This provides a clear method to implement external beam APBI planning and delivery.



http://ift.tt/2fwliDO

Embolization of a cavernous carotid fistula through the vein of Labbe: a new alternative transvenous access route

Endovascular treatment of carotid cavernous fistulas (CCFs) via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. A 61-year-old woman presented with a symptomatic CCF with all but one of the venous access routes to the CCF thrombosed, leaving an engorged superficial middle cerebral vein (SMCV) as the only venous outflow from the cavernous sinus. Access to the CCF was made possible after careful navigation of the sigmoid sinus, the vein of Labbé and the SMCV, bypassing the need for surgical access to the SMCV or for a direct transorbital puncture. The CCF was completely occluded by coiling and Onyx embolization. The patient made an uneventful recovery, with resolution of her symptoms. To the best of our knowledge, this access route has not been previously reported in the treatment of CCFs.

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