Larval infestation of chronic ischaemic leg ulcer

Description

Several cases of obligatory wound myiasis have been reported in the medical literature.1–3 For a long time, such infestation was perceived as a complication of poor quality wound care in patients with chronic ulcers. There are only three cases of wound myiasis reported in the literature. Demirel et al reported on a 68-year-old male patient with larvae infestations of diabetic wound that were discovered during surgical debridement.3 Another two cases of traumatic larval infestation associated with Bowen carcinoma and with chronic leg ulcer were reported.3 Up to date, there is no report of chronic ulcer with massive larvae infestation as in this patient.

Figure 1 with video capture (video 1) demonstrates a massive larvae infestation of severe chronic ischaemic ulcer in a 60-year-old homeless male patient with HIV, who presented with unilateral leg pain without systemic or...

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Bilateral haemorrhagic basal ganglia infarction associated with early-onset group B streptococcus meningitis

A 2-day-old infant presented with poor feeding and grunting. Investigations revealed a raised C reactive protein of 164. Full septic screen was done, which subsequently confirmed a diagnosis of group B streptococcus meningitis. Baby was apyrexial and haemodynamically stable. There were no obvious neurological manifestations, and a routine cranial ultrasound scan was done, which revealed echogenic changes in the basal ganglia and thalami. MRI brain showed extensive haemorrhagic infarction within the lentiform and caudate nuclei with involvement of both posterior limbs of the internal capsule. This was followed by triventricular hydrocephalus needing shunt procedure. The clinical course was complicated by infantile spasms, which were treated with vigabatrin and steroids and subsequent global developmental delay and cerebral palsy.

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Hepatic amyloidosis: a cause of rapidly progressive jaundice

Description

An 83-year-old man presented with an acute history of weight loss and jaundice. He had a history of type 2 diabetes mellitus and hypertension. He consumed 30 units of alcohol per week.

The patient was cachectic and jaundiced with non-tender hepatomegaly and no evidence of chronic liver disease. There was evidence of hypoalbuminaemia (albumin 25 g/L, reference 34–51 g/L), hyperbilirubinaemia (bilirubin 188 μmol/L, reference <22 μmol/L) and a raised alkaline phosphatase (629 IU/L, reference 35–105 IU/L). Full blood count, coagulation tests and the remaining liver function tests were normal. An estimated Glomerular filtration rate (eGFR) was 71 mL/min/1.73 m². Autoantibodies and immunoglobulins were normal. Hepatitis viral serology was negative. Serum light chain measurements revealed kappa chain concentration of 13.3 (reference 3.3–19.4 mg/L) and lambda chain concentration of 28.5 (reference 5.7–26.6 mg/L) with a ratio of 0.47 (reference 0.26–1.75). A CT abdomen revealed hepatomegaly and ascites. He subsequently had a liver biopsy (figures 1–3

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Extraocular muscle cysticercosis: never skip steroids

DescriptionCase description

A 16-year-old girl presented with a 2-month history of recurrent (three episodes) right upper eyelid drooping and oedema (figure 1A). Examination showed fullness in the right upper eyelid along with elevation deficit. Visual acuity was 20/20 in each eye, and anterior and posterior segments were essentially within normal limits in both the eyes. To explain the cause, ultrasonography of the orbit for extraocular muscles revealed a large cyst in the superior rectus muscle along with a central hyperechoic spot corresponding to the scolex (figure 1B). Non-contrast CT of the orbit and brain revealed inflammatory thickening of the superior rectus muscle with the central cystic area harbouring the scolex without any intracranial foci (figure 1C). Based on the history and imaging findings a diagnosis of myocysticercosis was confirmed and the patient was started on tablet prednisolone 1mg/kg body weight from day 1 and tablet albendazole 15 mg/kg from day 3. The patient...

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Coats disease with exudative retinal detachment simulating cysticercus cyst: misleading ultrasonography!

Description

A 5-year-old boy was brought to our clinic when parents noticed white reflex and divergent squint in the left eye. Snellen visual acuity was 20/20 in the right eye and inaccurate projection of rays in the left eye along with a 30 prism dioptre divergent squint in the latter. Anterior segment was within normal limits in both eyes on slit lamp evaluation. As the child was uncooperative for detailed fundus examination, we performed an ocular ultrasonography. Ocular ultrasonography of the left eye showed an intraocular cystic mass with a localised hyperechoic area adjacent to cyst wall which is typical of a cysticercus cyst with scolex (figure 1). On Optomap ultra-wide-field fundus photography (Optos, Scotland, UK) we found that the cystic mass on ultrasonography was actually a localised exudative retinal detachment and the scolex-like area of hyperechogenicity was a large confluent exudate collection in the subretinal...

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Brain abscess in a patient with chronic sinusitis

Description

A middle-aged patient with a previous history of chronic sinusitis and arterial hypertension was admitted because of altered mental status. Two days earlier, symptoms such as fever, chills, nasal obstruction and headache slowly developed. On examination, the patient was febrile and with stiff neck. The remainder of the physical examination was normal. CT scan (figure 1A,B) and T1-MRI (figure 2A–C) were both performed; besides signs of sinusitis, a 2 cm right periatrial expansive lesion surrounded by vasogenic oedema was found being compatible with brain abscess. A thorough investigation was done to exclude infectious endocarditis, including echocardiography and blood cultures which were all negative. Viral serologies, including HIV, were negative. Based on the brain lesion characteristics (size and peculiar location), a conservative approach with broad-spectrum antibiotics (ceftriaxone, metronidazole and vancomycin) was initially suggested by Neurosurgery. However, 20 days after, the patient presented with neurological deterioration....

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Acute-on-chronic mesenteric ischaemia by early and diffuse atherosclerosis in a young adult patient

Description

A 48-year-old Caucasian man with gypsy ethnicity had smoking habits (35 pack-years) and previous alcohol consumption (10 g/day; abstinent for 3 years). There was no relevant personal/family cardiovascular disease, history of illicit drug abuse, non-steroidal anti-inflammatory drug use or other previous/current medications. He had a 3-year history of chronic diarrhoea (3–4 bowel movements/day), abdominal pain and weight loss (25.9% of usual weight; body mass index=13.7 kg/m²). In the last month, an exacerbation of abdominal pain occurred with excruciating postprandial episodes requiring opioid analgesia. Laboratory analysis showed leucocytosis (34.8; N: 4–11x10⁹/L), neutrophilia (90.6%), normocytic/normochromic anaemia (haemoglobin: 8.0; N: 13–17 g/dL), high Erythrocyte sedimentation rate (ESR) (54; N<20 mm/hour), faecal calprotectin (4890; n<50 mg/kg) and C-reactive protein (CRP) (10.7; N<0.5 mg/dL). Oesophagogastroduodenoscopy and ileocolonoscopy with biopsies showed multiple Helicobacter pylori-negative gastroduodenal ulcers (figure 1A,B) and non-specific mild ulceration of the terminal ileum and proximal colon, without granulomas. CT enterography showed distended small bowel loops without...

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Birt-Hogg-Dube syndrome: spontaneous pneumothorax as a first symptom

Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary autosomal dominant condition characterised by benign cutaneous lesions, lung cysts, increased risk of spontaneous pneumothorax and renal cancer. It shows great heterogenous presentation within and between affected families. We report a case of a Danish female patient with recurrent pneumothoraces as the first symptom of BHDS. Over the years, she developed skin changes, and a family history of skin changes, pneumothoraces and renal cancer was discovered. BHDS was suspected, a genetic analysis was performed and a pathogenic variation c.1285delC in FLCN gene was detected in the patient. As we stated the diagnosis BHDS, we discovered several undiagnosed family members all of them now entering a lifelong follow-up programme with abdominal imaging because of the increased risk of developing renal cancer. BHDS should be known to oncologists, dermatologists and pulmonologists as the patients most often present to these medical disciplines.

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Iatrogenic foreign body in an adult with presbyacusis

Description

Foreign bodies in the external auditory meatus are a common presentation to Otolaryngology both to clinic and as an emergency.1 Most objects referred to Otolaryngology are round and hard such as beads and are more difficult to remove.1While many patients are aware of what might be in their ear, some do not. The causative event can be missed, and the symptoms can be non-specific.2 They may present with a foreign body sensation, a feeling of fullness in the ear, otalgia and recurrent otitis externa. Many of these symptoms can be applied to a presentation of impacted cerumen.

These images refer to a 67-year-old man who presented to Otolaryngology having been referred by his General Practitioner. On presentation to the clinic, he had persistent otalgia in the left ear and reduced hearing for the past 3 months. He also described a feeling of fullness...

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Circadian Genes and Risk of Prostate Cancer in the Prostate Cancer Prevention Trial

ABSTRACT

Background: Circadian genes have been considered as a possible biological mechanism for the observed relationship between circadian rhythm disruptions and increased risk of hormone-related cancers. In the current study, we investigated the relationship between circadian gene variants and prostate cancer risk and whether reducing bioavailable testosterone modifies the circadian genes-prostate cancer relationship.

Methods: We conducted a nested case-control study among Caucasian men in the Prostate Cancer Prevention Trial (PCPT), a randomized placebo-controlled clinical trial to assess if finasteride (an androgen bioactivation inhibitor) could prevent prostate cancer. We evaluated the associations between 240 circadian gene variations and prostate cancer risk among 1,092 biopsy-confirmed prostate cancer cases and 1,089 biopsy-negative controls in the study (642 cases and 667 controls from the placebo group; 450 cases and 422 controls from the finasteride group), stratified by treatment group.

Results: Among men in the finasteride group, there were suggestive associations between NPAS2 variants and total prostate cancer risk, with one SNP remaining statistically significant after Bonferroni correction (rs746924, odds ratio [OR] = 1.5, p = 9.6 × 10⁻⁵). However, we found little evidence of increased prostate cancer risk (overall or by low/high grade) associated with circadian gene variations in men of the placebo group, suggesting potential modification of genetic effects by treatment.

Conclusions: We did not find strong evidence that circadian gene variants influenced prostate cancer risk in men who were not on finasteride treatment. There were suggestive associations between NPAS2 variants and prostate cancer risk among men using finasteride, which warrants further investigations. This article is protected by copyright. All rights reserved

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Cancers, Vol. 10, Pages 15: Acknowledgement to Reviewers of Cancers in 2017

Cancers, Vol. 10, Pages 15: Acknowledgement to Reviewers of Cancers in 2017

Cancers doi: 10.3390/cancers10010015

Authors: Cancers Editorial Office

Peer review is an essential part in the publication process, ensuring that Cancers maintains high quality standards for its published papers[...]

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Circadian Genes and Risk of Prostate Cancer in the Prostate Cancer Prevention Trial

ABSTRACT

Background: Circadian genes have been considered as a possible biological mechanism for the observed relationship between circadian rhythm disruptions and increased risk of hormone-related cancers. In the current study, we investigated the relationship between circadian gene variants and prostate cancer risk and whether reducing bioavailable testosterone modifies the circadian genes-prostate cancer relationship.

Methods: We conducted a nested case-control study among Caucasian men in the Prostate Cancer Prevention Trial (PCPT), a randomized placebo-controlled clinical trial to assess if finasteride (an androgen bioactivation inhibitor) could prevent prostate cancer. We evaluated the associations between 240 circadian gene variations and prostate cancer risk among 1,092 biopsy-confirmed prostate cancer cases and 1,089 biopsy-negative controls in the study (642 cases and 667 controls from the placebo group; 450 cases and 422 controls from the finasteride group), stratified by treatment group.

Results: Among men in the finasteride group, there were suggestive associations between NPAS2 variants and total prostate cancer risk, with one SNP remaining statistically significant after Bonferroni correction (rs746924, odds ratio [OR] = 1.5, p = 9.6 × 10⁻⁵). However, we found little evidence of increased prostate cancer risk (overall or by low/high grade) associated with circadian gene variations in men of the placebo group, suggesting potential modification of genetic effects by treatment.

Conclusions: We did not find strong evidence that circadian gene variants influenced prostate cancer risk in men who were not on finasteride treatment. There were suggestive associations between NPAS2 variants and prostate cancer risk among men using finasteride, which warrants further investigations. This article is protected by copyright. All rights reserved

http://ift.tt/2EsF0dM

Cancers, Vol. 10, Pages 15: Acknowledgement to Reviewers of Cancers in 2017

Cancers, Vol. 10, Pages 15: Acknowledgement to Reviewers of Cancers in 2017

Cancers doi: 10.3390/cancers10010015

Authors: Cancers Editorial Office

Peer review is an essential part in the publication process, ensuring that Cancers maintains high quality standards for its published papers[...]

http://ift.tt/2COMkQQ

Psychometric Testing of the Turkish Version of the Skin Cancer and Sun Knowledge Scale in Nursing Students

Abstract

The present study aimed assesses the nursing students' knowledge of skin cancer and sun and their sun protection behaviors. This descriptive cross-sectional study was performed from May to June 2014 with a convenience sample of 376 undergraduate nursing students from one nursing faculty located in Izmir. Mean age of the students was 21.56 ± 1.96 years. The mean score that the females obtained from the level of knowledge and protection behaviors scales was significantly higher than that of the males. Older age group (≥22 years) obtained higher scores on the knowledge and protection behaviors scales than younger group (≤21 years). Nursing students' knowledge of, and behavior regarding, skin cancer and sun health were insufficient. Equipping them with the necessary knowledge and behaviors related to skin cancer and sun health by developing training programs and strategies on the issue is of utmost importance.

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Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students

Abstract

Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81 %. Of the students, 85.1 % (n = 171) were female and the mean age of the students was 22.18 ± 0.78 years. Of the students, 94.5 % did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9 % on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.

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Cancer-Diagnosed Individuals’ Use of Television and the Internet as a Source for Peer Stories and Associated Emotional Responses

Abstract

When people are confronted with a potentially life-threatening disease such as cancer, they are likely to feel an urgent need for information about the disease and support from peers. Studies have shown that the mass media contain a lot of experiential information (i.e., peer stories) about cancer, either from real individuals or from fictional characters. To date, most studies have focused on using the Internet for peer support. This study aimed to extend this line of research by investigating (1) whether cancer-diagnosed individuals use both television and the Internet to access peer stories, (2) whether exposure to these stories results in different emotional outcomes, and (3) whether this differs depending on gender. A cross-sectional survey among 621 cancer-diagnosed individuals in Flanders (Belgium) showed that both television and the Internet were used as a source for following peer stories. Respondents indicated feeling fearful and concerned when following peer stories on entertainment television, but following peer stories on online forums was associated with feeling supported. These different emotional responses could be the result of the differences between these two content categories (i.e., fictional versus non-fictional peer stories). Future research should further examine these relationships by investigating the role of mass media content and how different psychological coping styles and personality traits moderate these associations.

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Health Literacy, Mammogram Awareness and Screening Among Tertiary Hospital Women Patients

Abstract

In spite of high mortality rates and prevalence, breast cancer awareness and screening is low among Turkish women. This study aimed to determine level of health literacy, mammogram awareness, and screening among tertiary hospital women patients. A cross-sectional study was conducted with 519 patients aged between 40 and 69. A questionnaire was applied to women patients including demographic characteristics, health behaviors, mammogram awareness and screening, and health literacy tool. Mammogram awareness and screening were questioned according to the Turkish Breast Cancer Screening Standard. To assess health literacy level, the Rapid Estimate of Adult Literacy in Medicine was used. Over half of the women were aware of the mammogram age and 23.1 % had a mammogram within 2 years. Limited health literacy was high among patients, and it was significantly associated with lower mammogram awareness (OR 6.53; 95% CL 1.46–9.13) and screening (OR 1.12; 95% CL 0.45–2.80). Health literacy can be an advantageous opportunity on focal point of national cancer screening. Breast cancer education program and public health campaigns should be arranged according to women health literacy level.

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Feasibility Test of a Community-Relevant Intervention Designed to Promote African American Participation in Translational, Breast Cancer Disparities Research: Know About Health Options for Women (Know HOW)

Abstract

There are marked racial differences in breast cancer, the second leading cause of death among US women. Understanding the causes of these differences is essential to eliminate breast cancer inequities. More prevalent in African American than in Caucasian women, metabolic syndrome has been associated with breast cancer outcomes. Further research is needed to understand metabolic syndrome's role in breast cancer disparities, thus novel strategies to increase minority participation in research are important. We embedded two approaches (comprehensive, focused) to increase African American participation in breast cancer research in a state-wide service program and pilot tested both approaches in rural African American women. We conducted three comprehensive and three focused outreach programs (n = 48) and assessed research participation through consent and actual provision of data for four types of data: survey, anthropometric, blood, and mammography records. The majority of participants provided written consent for all data collection procedures (96 % survey; 92 % anthropometric; 94 %, blood; 100 % mammography). There were no between group differences in consent rates. There was variation in the overall proportion of participants who provided data (96 % survey; 92 % anthropometric; 73 % blood; 40 % mammography). Women in the comprehensive approach were less likely to return for a scheduled mammogram than women in the focused approach (19 % vs 64 %, p = 0.0236). Both outreach programs promoted African American engagement in research. Differences in the provision of data by type may have been due to participant burden (i.e., time required to provide data). Study designs that embed research in service programs have promise to increase minority research participation.

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Japanese Cancer Survivors’ Awareness of and Participation in Support Groups

Abstract

Cancer survivors face many challenges, and cancer support groups provide a range of support. Several reports have shown the benefits of support groups. However, it is not clear how Japanese cancer survivors use them. This study aimed to examine cancer survivors' awareness of and reasons for participation or non-participation in cancer support groups. We conducted a cross-sectional questionnaire survey with ambulatory patients with cancer across eight designated cancer hospitals. The questionnaire covered patients' demographics, disease characteristics, participation/non-participation in cancer support groups, and reasons for participation/non-participation. In total, 569 questionnaires were distributed, and responses were received from 275 patients with cancer. Of these, 135 patients were aware of support groups and 23 had participated in a group. Patients who were aware of support groups were more likely to be young, female patients. Many patients learned about support groups from hospital notices. Most support group participants expected to receive information about the disease and treatment (91%). They also wanted to hear about other patients' experiences (73%). The most common reasons for non-participation were "no particular reason" (38%) and "family or friends support me" (27%). About half of participating patients were unaware of support groups. Even among patients who were aware, many did not attend a support group. Developing a better understanding of support group use in cancer survivors may enhance provision of adequate care based on individual needs.

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via IFTTT

Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students

Abstract

Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81 %. Of the students, 85.1 % (n = 171) were female and the mean age of the students was 22.18 ± 0.78 years. Of the students, 94.5 % did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9 % on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.

http://ift.tt/2qMbTAr

Cancer-Diagnosed Individuals’ Use of Television and the Internet as a Source for Peer Stories and Associated Emotional Responses

Abstract

When people are confronted with a potentially life-threatening disease such as cancer, they are likely to feel an urgent need for information about the disease and support from peers. Studies have shown that the mass media contain a lot of experiential information (i.e., peer stories) about cancer, either from real individuals or from fictional characters. To date, most studies have focused on using the Internet for peer support. This study aimed to extend this line of research by investigating (1) whether cancer-diagnosed individuals use both television and the Internet to access peer stories, (2) whether exposure to these stories results in different emotional outcomes, and (3) whether this differs depending on gender. A cross-sectional survey among 621 cancer-diagnosed individuals in Flanders (Belgium) showed that both television and the Internet were used as a source for following peer stories. Respondents indicated feeling fearful and concerned when following peer stories on entertainment television, but following peer stories on online forums was associated with feeling supported. These different emotional responses could be the result of the differences between these two content categories (i.e., fictional versus non-fictional peer stories). Future research should further examine these relationships by investigating the role of mass media content and how different psychological coping styles and personality traits moderate these associations.

http://ift.tt/2mkGn7X

Psychometric Testing of the Turkish Version of the Skin Cancer and Sun Knowledge Scale in Nursing Students

Abstract

The present study aimed assesses the nursing students' knowledge of skin cancer and sun and their sun protection behaviors. This descriptive cross-sectional study was performed from May to June 2014 with a convenience sample of 376 undergraduate nursing students from one nursing faculty located in Izmir. Mean age of the students was 21.56 ± 1.96 years. The mean score that the females obtained from the level of knowledge and protection behaviors scales was significantly higher than that of the males. Older age group (≥22 years) obtained higher scores on the knowledge and protection behaviors scales than younger group (≤21 years). Nursing students' knowledge of, and behavior regarding, skin cancer and sun health were insufficient. Equipping them with the necessary knowledge and behaviors related to skin cancer and sun health by developing training programs and strategies on the issue is of utmost importance.

http://ift.tt/2qJKaAo

Health Literacy, Mammogram Awareness and Screening Among Tertiary Hospital Women Patients

Abstract

In spite of high mortality rates and prevalence, breast cancer awareness and screening is low among Turkish women. This study aimed to determine level of health literacy, mammogram awareness, and screening among tertiary hospital women patients. A cross-sectional study was conducted with 519 patients aged between 40 and 69. A questionnaire was applied to women patients including demographic characteristics, health behaviors, mammogram awareness and screening, and health literacy tool. Mammogram awareness and screening were questioned according to the Turkish Breast Cancer Screening Standard. To assess health literacy level, the Rapid Estimate of Adult Literacy in Medicine was used. Over half of the women were aware of the mammogram age and 23.1 % had a mammogram within 2 years. Limited health literacy was high among patients, and it was significantly associated with lower mammogram awareness (OR 6.53; 95% CL 1.46–9.13) and screening (OR 1.12; 95% CL 0.45–2.80). Health literacy can be an advantageous opportunity on focal point of national cancer screening. Breast cancer education program and public health campaigns should be arranged according to women health literacy level.

http://ift.tt/2mkGi49

Feasibility Test of a Community-Relevant Intervention Designed to Promote African American Participation in Translational, Breast Cancer Disparities Research: Know About Health Options for Women (Know HOW)

Abstract

There are marked racial differences in breast cancer, the second leading cause of death among US women. Understanding the causes of these differences is essential to eliminate breast cancer inequities. More prevalent in African American than in Caucasian women, metabolic syndrome has been associated with breast cancer outcomes. Further research is needed to understand metabolic syndrome's role in breast cancer disparities, thus novel strategies to increase minority participation in research are important. We embedded two approaches (comprehensive, focused) to increase African American participation in breast cancer research in a state-wide service program and pilot tested both approaches in rural African American women. We conducted three comprehensive and three focused outreach programs (n = 48) and assessed research participation through consent and actual provision of data for four types of data: survey, anthropometric, blood, and mammography records. The majority of participants provided written consent for all data collection procedures (96 % survey; 92 % anthropometric; 94 %, blood; 100 % mammography). There were no between group differences in consent rates. There was variation in the overall proportion of participants who provided data (96 % survey; 92 % anthropometric; 73 % blood; 40 % mammography). Women in the comprehensive approach were less likely to return for a scheduled mammogram than women in the focused approach (19 % vs 64 %, p = 0.0236). Both outreach programs promoted African American engagement in research. Differences in the provision of data by type may have been due to participant burden (i.e., time required to provide data). Study designs that embed research in service programs have promise to increase minority research participation.

http://ift.tt/2qMbNc3

Japanese Cancer Survivors’ Awareness of and Participation in Support Groups

Abstract

Cancer survivors face many challenges, and cancer support groups provide a range of support. Several reports have shown the benefits of support groups. However, it is not clear how Japanese cancer survivors use them. This study aimed to examine cancer survivors' awareness of and reasons for participation or non-participation in cancer support groups. We conducted a cross-sectional questionnaire survey with ambulatory patients with cancer across eight designated cancer hospitals. The questionnaire covered patients' demographics, disease characteristics, participation/non-participation in cancer support groups, and reasons for participation/non-participation. In total, 569 questionnaires were distributed, and responses were received from 275 patients with cancer. Of these, 135 patients were aware of support groups and 23 had participated in a group. Patients who were aware of support groups were more likely to be young, female patients. Many patients learned about support groups from hospital notices. Most support group participants expected to receive information about the disease and treatment (91%). They also wanted to hear about other patients' experiences (73%). The most common reasons for non-participation were "no particular reason" (38%) and "family or friends support me" (27%). About half of participating patients were unaware of support groups. Even among patients who were aware, many did not attend a support group. Developing a better understanding of support group use in cancer survivors may enhance provision of adequate care based on individual needs.

http://ift.tt/2ml5mYM

Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students

Abstract

Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81 %. Of the students, 85.1 % (n = 171) were female and the mean age of the students was 22.18 ± 0.78 years. Of the students, 94.5 % did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9 % on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.

http://ift.tt/2qMbTAr

Cancer-Diagnosed Individuals’ Use of Television and the Internet as a Source for Peer Stories and Associated Emotional Responses

Abstract

When people are confronted with a potentially life-threatening disease such as cancer, they are likely to feel an urgent need for information about the disease and support from peers. Studies have shown that the mass media contain a lot of experiential information (i.e., peer stories) about cancer, either from real individuals or from fictional characters. To date, most studies have focused on using the Internet for peer support. This study aimed to extend this line of research by investigating (1) whether cancer-diagnosed individuals use both television and the Internet to access peer stories, (2) whether exposure to these stories results in different emotional outcomes, and (3) whether this differs depending on gender. A cross-sectional survey among 621 cancer-diagnosed individuals in Flanders (Belgium) showed that both television and the Internet were used as a source for following peer stories. Respondents indicated feeling fearful and concerned when following peer stories on entertainment television, but following peer stories on online forums was associated with feeling supported. These different emotional responses could be the result of the differences between these two content categories (i.e., fictional versus non-fictional peer stories). Future research should further examine these relationships by investigating the role of mass media content and how different psychological coping styles and personality traits moderate these associations.

http://ift.tt/2mkGn7X

Psychometric Testing of the Turkish Version of the Skin Cancer and Sun Knowledge Scale in Nursing Students

Abstract

The present study aimed assesses the nursing students' knowledge of skin cancer and sun and their sun protection behaviors. This descriptive cross-sectional study was performed from May to June 2014 with a convenience sample of 376 undergraduate nursing students from one nursing faculty located in Izmir. Mean age of the students was 21.56 ± 1.96 years. The mean score that the females obtained from the level of knowledge and protection behaviors scales was significantly higher than that of the males. Older age group (≥22 years) obtained higher scores on the knowledge and protection behaviors scales than younger group (≤21 years). Nursing students' knowledge of, and behavior regarding, skin cancer and sun health were insufficient. Equipping them with the necessary knowledge and behaviors related to skin cancer and sun health by developing training programs and strategies on the issue is of utmost importance.

http://ift.tt/2qJKaAo

Health Literacy, Mammogram Awareness and Screening Among Tertiary Hospital Women Patients

Abstract

In spite of high mortality rates and prevalence, breast cancer awareness and screening is low among Turkish women. This study aimed to determine level of health literacy, mammogram awareness, and screening among tertiary hospital women patients. A cross-sectional study was conducted with 519 patients aged between 40 and 69. A questionnaire was applied to women patients including demographic characteristics, health behaviors, mammogram awareness and screening, and health literacy tool. Mammogram awareness and screening were questioned according to the Turkish Breast Cancer Screening Standard. To assess health literacy level, the Rapid Estimate of Adult Literacy in Medicine was used. Over half of the women were aware of the mammogram age and 23.1 % had a mammogram within 2 years. Limited health literacy was high among patients, and it was significantly associated with lower mammogram awareness (OR 6.53; 95% CL 1.46–9.13) and screening (OR 1.12; 95% CL 0.45–2.80). Health literacy can be an advantageous opportunity on focal point of national cancer screening. Breast cancer education program and public health campaigns should be arranged according to women health literacy level.

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Feasibility Test of a Community-Relevant Intervention Designed to Promote African American Participation in Translational, Breast Cancer Disparities Research: Know About Health Options for Women (Know HOW)

Abstract

There are marked racial differences in breast cancer, the second leading cause of death among US women. Understanding the causes of these differences is essential to eliminate breast cancer inequities. More prevalent in African American than in Caucasian women, metabolic syndrome has been associated with breast cancer outcomes. Further research is needed to understand metabolic syndrome's role in breast cancer disparities, thus novel strategies to increase minority participation in research are important. We embedded two approaches (comprehensive, focused) to increase African American participation in breast cancer research in a state-wide service program and pilot tested both approaches in rural African American women. We conducted three comprehensive and three focused outreach programs (n = 48) and assessed research participation through consent and actual provision of data for four types of data: survey, anthropometric, blood, and mammography records. The majority of participants provided written consent for all data collection procedures (96 % survey; 92 % anthropometric; 94 %, blood; 100 % mammography). There were no between group differences in consent rates. There was variation in the overall proportion of participants who provided data (96 % survey; 92 % anthropometric; 73 % blood; 40 % mammography). Women in the comprehensive approach were less likely to return for a scheduled mammogram than women in the focused approach (19 % vs 64 %, p = 0.0236). Both outreach programs promoted African American engagement in research. Differences in the provision of data by type may have been due to participant burden (i.e., time required to provide data). Study designs that embed research in service programs have promise to increase minority research participation.

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Japanese Cancer Survivors’ Awareness of and Participation in Support Groups

Abstract

Cancer survivors face many challenges, and cancer support groups provide a range of support. Several reports have shown the benefits of support groups. However, it is not clear how Japanese cancer survivors use them. This study aimed to examine cancer survivors' awareness of and reasons for participation or non-participation in cancer support groups. We conducted a cross-sectional questionnaire survey with ambulatory patients with cancer across eight designated cancer hospitals. The questionnaire covered patients' demographics, disease characteristics, participation/non-participation in cancer support groups, and reasons for participation/non-participation. In total, 569 questionnaires were distributed, and responses were received from 275 patients with cancer. Of these, 135 patients were aware of support groups and 23 had participated in a group. Patients who were aware of support groups were more likely to be young, female patients. Many patients learned about support groups from hospital notices. Most support group participants expected to receive information about the disease and treatment (91%). They also wanted to hear about other patients' experiences (73%). The most common reasons for non-participation were "no particular reason" (38%) and "family or friends support me" (27%). About half of participating patients were unaware of support groups. Even among patients who were aware, many did not attend a support group. Developing a better understanding of support group use in cancer survivors may enhance provision of adequate care based on individual needs.

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Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students

Abstract

Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81 %. Of the students, 85.1 % (n = 171) were female and the mean age of the students was 22.18 ± 0.78 years. Of the students, 94.5 % did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9 % on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.

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Cancer-Diagnosed Individuals’ Use of Television and the Internet as a Source for Peer Stories and Associated Emotional Responses

Abstract

When people are confronted with a potentially life-threatening disease such as cancer, they are likely to feel an urgent need for information about the disease and support from peers. Studies have shown that the mass media contain a lot of experiential information (i.e., peer stories) about cancer, either from real individuals or from fictional characters. To date, most studies have focused on using the Internet for peer support. This study aimed to extend this line of research by investigating (1) whether cancer-diagnosed individuals use both television and the Internet to access peer stories, (2) whether exposure to these stories results in different emotional outcomes, and (3) whether this differs depending on gender. A cross-sectional survey among 621 cancer-diagnosed individuals in Flanders (Belgium) showed that both television and the Internet were used as a source for following peer stories. Respondents indicated feeling fearful and concerned when following peer stories on entertainment television, but following peer stories on online forums was associated with feeling supported. These different emotional responses could be the result of the differences between these two content categories (i.e., fictional versus non-fictional peer stories). Future research should further examine these relationships by investigating the role of mass media content and how different psychological coping styles and personality traits moderate these associations.

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Psychometric Testing of the Turkish Version of the Skin Cancer and Sun Knowledge Scale in Nursing Students

Abstract

The present study aimed assesses the nursing students' knowledge of skin cancer and sun and their sun protection behaviors. This descriptive cross-sectional study was performed from May to June 2014 with a convenience sample of 376 undergraduate nursing students from one nursing faculty located in Izmir. Mean age of the students was 21.56 ± 1.96 years. The mean score that the females obtained from the level of knowledge and protection behaviors scales was significantly higher than that of the males. Older age group (≥22 years) obtained higher scores on the knowledge and protection behaviors scales than younger group (≤21 years). Nursing students' knowledge of, and behavior regarding, skin cancer and sun health were insufficient. Equipping them with the necessary knowledge and behaviors related to skin cancer and sun health by developing training programs and strategies on the issue is of utmost importance.

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Health Literacy, Mammogram Awareness and Screening Among Tertiary Hospital Women Patients

Abstract

In spite of high mortality rates and prevalence, breast cancer awareness and screening is low among Turkish women. This study aimed to determine level of health literacy, mammogram awareness, and screening among tertiary hospital women patients. A cross-sectional study was conducted with 519 patients aged between 40 and 69. A questionnaire was applied to women patients including demographic characteristics, health behaviors, mammogram awareness and screening, and health literacy tool. Mammogram awareness and screening were questioned according to the Turkish Breast Cancer Screening Standard. To assess health literacy level, the Rapid Estimate of Adult Literacy in Medicine was used. Over half of the women were aware of the mammogram age and 23.1 % had a mammogram within 2 years. Limited health literacy was high among patients, and it was significantly associated with lower mammogram awareness (OR 6.53; 95% CL 1.46–9.13) and screening (OR 1.12; 95% CL 0.45–2.80). Health literacy can be an advantageous opportunity on focal point of national cancer screening. Breast cancer education program and public health campaigns should be arranged according to women health literacy level.

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Feasibility Test of a Community-Relevant Intervention Designed to Promote African American Participation in Translational, Breast Cancer Disparities Research: Know About Health Options for Women (Know HOW)

Abstract

There are marked racial differences in breast cancer, the second leading cause of death among US women. Understanding the causes of these differences is essential to eliminate breast cancer inequities. More prevalent in African American than in Caucasian women, metabolic syndrome has been associated with breast cancer outcomes. Further research is needed to understand metabolic syndrome's role in breast cancer disparities, thus novel strategies to increase minority participation in research are important. We embedded two approaches (comprehensive, focused) to increase African American participation in breast cancer research in a state-wide service program and pilot tested both approaches in rural African American women. We conducted three comprehensive and three focused outreach programs (n = 48) and assessed research participation through consent and actual provision of data for four types of data: survey, anthropometric, blood, and mammography records. The majority of participants provided written consent for all data collection procedures (96 % survey; 92 % anthropometric; 94 %, blood; 100 % mammography). There were no between group differences in consent rates. There was variation in the overall proportion of participants who provided data (96 % survey; 92 % anthropometric; 73 % blood; 40 % mammography). Women in the comprehensive approach were less likely to return for a scheduled mammogram than women in the focused approach (19 % vs 64 %, p = 0.0236). Both outreach programs promoted African American engagement in research. Differences in the provision of data by type may have been due to participant burden (i.e., time required to provide data). Study designs that embed research in service programs have promise to increase minority research participation.

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Japanese Cancer Survivors’ Awareness of and Participation in Support Groups

Abstract

Cancer survivors face many challenges, and cancer support groups provide a range of support. Several reports have shown the benefits of support groups. However, it is not clear how Japanese cancer survivors use them. This study aimed to examine cancer survivors' awareness of and reasons for participation or non-participation in cancer support groups. We conducted a cross-sectional questionnaire survey with ambulatory patients with cancer across eight designated cancer hospitals. The questionnaire covered patients' demographics, disease characteristics, participation/non-participation in cancer support groups, and reasons for participation/non-participation. In total, 569 questionnaires were distributed, and responses were received from 275 patients with cancer. Of these, 135 patients were aware of support groups and 23 had participated in a group. Patients who were aware of support groups were more likely to be young, female patients. Many patients learned about support groups from hospital notices. Most support group participants expected to receive information about the disease and treatment (91%). They also wanted to hear about other patients' experiences (73%). The most common reasons for non-participation were "no particular reason" (38%) and "family or friends support me" (27%). About half of participating patients were unaware of support groups. Even among patients who were aware, many did not attend a support group. Developing a better understanding of support group use in cancer survivors may enhance provision of adequate care based on individual needs.

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Predictors of emotional distress a year or more after diagnosis of cancer: A systematic review of the literature

Abstract

Objective

Why some people recover emotionally after diagnosis and treatment of cancer and others do not is poorly understood. To identify factors around the time of diagnosis that predict longer-term distress is a necessary step in developing interventions to reduce patients' vulnerability. This review identified the demographic, clinical, social, and psychological factors available at or within 3 months of diagnosis that are reliable predictors of emotional distress at least 12 months later.

Methods

A systematic search of literature for prospective studies addressing our research question and predicting a range of distress outcomes was conducted. Thirty-nine papers (reporting 36 studies) were subjected to narrative synthesis of the evidence.

Results

There was no consistent evidence that demographic, clinical, or social factors reliably predicted longer-term distress. Of the psychological factors examined, only baseline distress (significant in 26 of 30 relevant papers; 24 of 28 studies) and neuroticism (significant in all 5 papers/studies that examined it) consistently predicted longer-term distress. The heterogeneity of included studies, particularly in populations studied and methodology, precluded meta-analytic techniques.

Conclusions

This review supports current clinical guidance advising early assessment of distress as a marker of vulnerability to persistent problems. Additionally, neuroticism is also indicated as a useful marker of vulnerability. However, the review also highlights that more sophisticated research designs, capable of identifying the psychological processes that underlie the association between these marker variables and persistent distress, are needed before more effective early interventions can be developed.

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Predictors of emotional distress a year or more after diagnosis of cancer: A systematic review of the literature

Abstract

Objective

Why some people recover emotionally after diagnosis and treatment of cancer and others do not is poorly understood. To identify factors around the time of diagnosis that predict longer-term distress is a necessary step in developing interventions to reduce patients' vulnerability. This review identified the demographic, clinical, social, and psychological factors available at or within 3 months of diagnosis that are reliable predictors of emotional distress at least 12 months later.

Methods

A systematic search of literature for prospective studies addressing our research question and predicting a range of distress outcomes was conducted. Thirty-nine papers (reporting 36 studies) were subjected to narrative synthesis of the evidence.

Results

There was no consistent evidence that demographic, clinical, or social factors reliably predicted longer-term distress. Of the psychological factors examined, only baseline distress (significant in 26 of 30 relevant papers; 24 of 28 studies) and neuroticism (significant in all 5 papers/studies that examined it) consistently predicted longer-term distress. The heterogeneity of included studies, particularly in populations studied and methodology, precluded meta-analytic techniques.

Conclusions

This review supports current clinical guidance advising early assessment of distress as a marker of vulnerability to persistent problems. Additionally, neuroticism is also indicated as a useful marker of vulnerability. However, the review also highlights that more sophisticated research designs, capable of identifying the psychological processes that underlie the association between these marker variables and persistent distress, are needed before more effective early interventions can be developed.

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The synergistic role of ATP-dependent drug efflux pump and focal adhesion signaling pathways in vinorelbine resistance in lung cancer

Abstract

The vinorelbine (VRB) plus cisplatin regimen is widely used to treat non–small cell lung cancer (NSCLC), but its cure rate is poor. Drug resistance is the primary driver of chemotherapeutic failure, and the causes of resistance remain unclear. By focusing on the focal adhesion (FA) pathway, we have highlighted a signaling pathway that promotes VRB resistance in lung cancer cells. First, we established VRB-resistant (VR) lung cancer cells (NCI-H1299 and A549) and examined its transcriptional changes, protein expressions, and activations. We treated VR cells by Src Family Kinase (SFK) inhibitors or gene silencing and examined cell viabilities. ATP-binding Cassette Sub-family B Member 1 (ABCB1) was highly expressed in VR cells. A pathway analysis and western blot analysis revealed the high expression of integrins β1 and β3 and the activation of FA pathway components, including Src family kinase (SFK) and AKT, in VR cells. SFK involvement in VRB resistance was confirmed by the recovery of VRB sensitivity in FYN knockdown A549 VR cells. Saracatinib, a dual inhibitor of SFK and ABCB1, had a synergistic effect with VRB in VR cells. In conclusion, ABCB1 is the primary cause of VRB resistance. Additionally, the FA pathway, particularly integrin, and SFK, are promising targets for VRB-resistant lung cancer. Further studies are needed to identify clinically applicable target drugs and biomarkers that will improve disease prognoses and predict therapeutic efficacies.

We established vinorelbine-resistant lung cancer cells and examined its transcriptional changes, protein expressions, and activations. On the basis of these results, we focused on the focal adhesion (FA) pathway and tested the effects of gene silencing and inhibitors. In conclusion, FA pathway, particularly integrin and SFK, are promising targets for vinorelbine-resistant lung cancer.

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The synergistic role of ATP-dependent drug efflux pump and focal adhesion signaling pathways in vinorelbine resistance in lung cancer

Abstract

The vinorelbine (VRB) plus cisplatin regimen is widely used to treat non–small cell lung cancer (NSCLC), but its cure rate is poor. Drug resistance is the primary driver of chemotherapeutic failure, and the causes of resistance remain unclear. By focusing on the focal adhesion (FA) pathway, we have highlighted a signaling pathway that promotes VRB resistance in lung cancer cells. First, we established VRB-resistant (VR) lung cancer cells (NCI-H1299 and A549) and examined its transcriptional changes, protein expressions, and activations. We treated VR cells by Src Family Kinase (SFK) inhibitors or gene silencing and examined cell viabilities. ATP-binding Cassette Sub-family B Member 1 (ABCB1) was highly expressed in VR cells. A pathway analysis and western blot analysis revealed the high expression of integrins β1 and β3 and the activation of FA pathway components, including Src family kinase (SFK) and AKT, in VR cells. SFK involvement in VRB resistance was confirmed by the recovery of VRB sensitivity in FYN knockdown A549 VR cells. Saracatinib, a dual inhibitor of SFK and ABCB1, had a synergistic effect with VRB in VR cells. In conclusion, ABCB1 is the primary cause of VRB resistance. Additionally, the FA pathway, particularly integrin, and SFK, are promising targets for VRB-resistant lung cancer. Further studies are needed to identify clinically applicable target drugs and biomarkers that will improve disease prognoses and predict therapeutic efficacies.

We established vinorelbine-resistant lung cancer cells and examined its transcriptional changes, protein expressions, and activations. On the basis of these results, we focused on the focal adhesion (FA) pathway and tested the effects of gene silencing and inhibitors. In conclusion, FA pathway, particularly integrin and SFK, are promising targets for vinorelbine-resistant lung cancer.

http://ift.tt/2AL9uFS

Correction to: A comparison of clinicopathological characteristics and long-term survival outcomes between symptomatic and screen-detected breast cancer in Japanese women

Abstract

In the original publication of this article, Table 1 was published incorrectly with rows out of order under "Distant metastasis (n, %)".

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Predictors of Anxiety and Depression among Parents of Children with Cancer in Jordan

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Predictors of Anxiety and Depression among Parents of Children with Cancer in Jordan

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EZH2 promotes hepatocellular carcinoma progression through modulating miR-22/galectin-9 axis

Recent studies have shown that interferon-γ (IFN-γ)-induced galectin-9 expression in Kupffer cells plays an essential role in modulatingthe microenvironment of hepatitis-associated hepatocellular carcinoma (HC...

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Radiation Therapy to Sites of Metastatic Disease as Part of Consolidation in High-risk Neuroblastoma: Can Long-term Control be Achieved?

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Dana L. Casey, Ken L. Pitter, Brian H. Kushner, Nai-Kong V. Cheung, Shakeel Modak, Michael P. LaQuaglia, Suzanne L. Wolden
BackgroundAs part of consolidative therapy in high-risk neuroblastoma, modern protocols recommend radiation therapy (RT) both to the primary site and to sites of metastatic disease that persist after induction chemotherapy. Although there is abundant data showing excellent local control with 21 Gy directed at the primary site, there is little data describing the feasibility and efficacy of RT directed at metastatic sites of disease as part of consolidation.MethodsAll patients with neuroblastoma who received RT to metastatic sites of disease as a part of consolidative therapy at a single institution between 2000 and 2015 were reviewed. Among 159 patients, 244 metastases were irradiated.ResultsMedian follow up among surviving patients was 7.4 years. Over 85% of the irradiated metastases were treated with 21 Gy (range 10.5 Gy - 36 Gy). Tumor recurrence occurred in 43 of 244 (18%) irradiated metastases. The 5-year local control (LC) of treated metastatic sites was 81%. Metastatic sites that cleared with induction chemotherapy had improved LC compared to sites with persistent uptake on MIBG (LC 92% vs 67%, p<0.0001). LC at irradiated metastatic sites did not differ based on total number of sites irradiated or site of disease irradiated (bone vs soft tissue). Patients with bulky, resistant disease who were treated with 30-36 Gy had worse LC (p=0.02). However, on multivariate analysis, only persistence after induction chemotherapy remained a significant prognostic factor for LC (hazard ratio = 3.7, p<0.0001). Patients with LC at irradiated metastatic sites had improved overall survival (OS) compared to those who did not (OS 71% vs 50%, p<0.0001).ConclusionsResponse to chemotherapy is an important prognostic factor for LC at irradiated metastatic sites in neuroblastoma. Overall, consolidative RT appears to be an effective modality of LC. Long-term disease control can be achieved with such an approach.

Teaser

Although radiation therapy to persistent sites of metastatic disease is recommended as part of consolidative therapy for high-risk neuroblastoma, there is little data evaluating the value of this approach in achieving long-term control. Our results show that irradiation of metastatic sites of disease is effective in achieving local control, and that response to induction chemotherapy is a significant prognostic factor for control at irradiated sites.


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A Qualitative Assessment of Academic Radiation Oncology Department Chairs’ Insights on Diversity, Equity, and Inclusion: Progress, Challenges, and Future Aspirations

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rochelle D. Jones, Christina H. Chapman, Emma B. Holliday, Nafisha Lalani, Emily Wilson, James A. Bonner, Benjamin Movsas, Shalom Kalnicki, Silvia C. Formenti, Charles R. Thomas, Steve M. Hahn, Fei-Fei Liu, Reshma Jagsi
PurposeA lack of diversity has been observed in radiation oncology (RO), with women and certain racial/ethnic groups underrepresented as trainees, faculty, and practicing physicians. The authors sought to gain a nuanced understanding of how to best promote diversity, equity, and inclusion (DEI) based on the insights of RO department chairs, with particular attention given to the experiences of the few women and underrepresented minorities (URM) in these influential positions.MethodsIn March-June 2016, the authors conducted telephone interviews with 24 RO department chairs (of 27 invited). Purposive sampling was employed to invite all chairs who were women (n=13) or URM (n=3), along with 11 male chairs who were not URM. Multiple analysts coded verbatim transcripts.ResultsFive themes were identified: (1) commitment to DEI promotes quality healthcare and innovation, (2) gaps remain despite some progress with promoting diversity in RO, (3) women and URM faculty continue to experience challenges in various career domains, (4) solutions to DEI issues would be facilitated by acknowledging realities of gender and race, and (5) expansion of the career pipeline is needed.ConclusionsChairs' insights had policy-relevant implications. Bias training should broach tokenism, blindness, and intersectionality. Efforts to recruit and support diverse talent should be deliberate and proactive. Bridge programs could engage students before their application to medical school.

Teaser

This qualitative study sought to understand how to promote diversity, equity, and inclusion in radiation oncology. The authors conducted telephone interviews with department chairs, with attention to the experiences of the few women and underrepresented minorities in these positions. Chairs' insights had policy-relevant implications. Bias training should attempt to tap into the sensitive contextual areas of tokenism, blindness, and intersectionality. Efforts to recruit and support diverse talent should be deliberate and proactive. Bridge programs could engage diverse learners across the education spectrum.


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Endoscopic Surgery for Delayed Sinonasal Complications of Radiotherapy for Nasopharyngeal Carcinoma: a Subjective Outcome

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rachel Shemesh, Eran E. Alon, Iris Gluck, Arkadi Yakirevitch
BackgroundDelayed sino-nasal complications of radiotherapy include choanal stenosis, osteoradionecrosis, chronic sinusitis and intranasal synechiae. There are only sporadic reports on their surgical treatment with equivocal results.MethodsThis is a prospective case series of all patients surgically treated for delayed sino-nasal complications of radiotherapy in our institution during the last 10 years. The inclusion criteria required at least a 6-month follow up after the surgery. Included patients were asked to fill a SNOT-16 questionnaire preoperatively and 6 months after the surgery.Resultsnine patients with history of radiotherapy for nasopharyngeal carcinoma were included in our series. In all cases partial or complete subjective improvement was seen.ConclusionIn select cases, endoscopic sinus surgery may be of benefit in the treatment of delayed sino-nasal complications of radiotherapy.

Teaser

Delayed sino-nasal complications of radiotherapy include choanal stenosis, osteoradionecrosis, chronic sinusitis and intranasal synechiae. Their incidence and burden on their quality of life are underestimated. Results of our prospective study show good subjective outcome of surgical treatment of these delayed sino-nasal complications. It should encourage clinicians to be cognizant of symptoms suspicious for this pathology and to be diligent in referring the patients for further evaluation and treatment.


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Current and Future Initiatives for Radiation Oncology at the National Cancer Institute in the Era of Precision Medicine

Publication date: Available online 8 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Charles A. Kunos, C. Norman Coleman




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Patient Experiences and Clinician Views on the Role of Radiotherapy for Ductal Carcinoma In-Situ

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Dean A. Shumway, Chandler M. McLeod, Monica Morrow, Yun Li, Allison W. Kurian, Aaron Sabolch, Ann S. Hamilton, Kevin C. Ward, Steven J. Katz, Sarah T. Hawley, Reshma Jagsi
PurposeTo evaluate patient experiences with decisions regarding radiotherapy for ductal carcinoma in situ (DCIS), and to assess clinician views on the role of radiotherapy for DCIS with favorable features in the present era.MethodsA sample of women with newly diagnosed breast cancer from the population-based Georgia and Los Angeles County (LA) SEER registries were sent surveys approximately 2 months after undergoing breast conserving surgery (70% response rate). The analytic sample was limited to 538 respondents with unilateral DCIS. We also surveyed 761 surgeons and radiation oncologists treating breast cancer in those regions, of whom 539 responded (71%).ResultsAfter breast conserving surgery (BCS), 23% of patients omitted radiotherapy, with twice the rate of omission in LA relative to Georgia (31% vs 16%, p<0.001). The most common reasons for omitting radiotherapy were advice from a clinician that it wasn't needed (62%) and concern about side effects (24%). Cost and transportation were not reported as influential considerations. After covariate adjustment, low and intermediate grade disease (OR 5.5, 95% CI 2.5-12; OR 3.2, 95% CI 1.7-6.1) and LA SEER site (OR 4.3, 95% CI 2.3-8.2) were significantly associated with greater radiotherapy omission. Among responding clinicians, 62% would discuss radiotherapy omission for a patient with DCIS with favorable features. Clinicians in LA were more likely to discuss radiotherapy omission than those in Georgia (67% vs 56%, p = 0.01). Approximately one-third of clinicians would obtain the Oncotype DX DCIS Score.ConclusionsThere continues to be substantial heterogeneity in radiotherapy omission after breast conserving surgery for DCIS, with systematic differences in provider opinions across the two regions we studied. Enhanced precision of recurrence estimates, guidance from professional organizations, and better communication are needed to improve the consistency of treatment in this controversial area.

Teaser

In a population-based survey of patients with DCIS, we observed that a quarter of patients omit radiotherapy after breast conserving surgery, with a two-fold difference in the rate of radiotherapy omission between the 2 SEER regions studied. In a corresponding survey of clinicians, we observed systematic differences in opinions between the two SEER regions regarding the role of radiation.


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The radiation resistance of human multipotent mesenchymal stromal cells is independent of their tissue of origin

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Alexander Rühle, Oliver Xia, Ramon Lopez Perez, Thuy Trinh, Wiltrud Richter, Anna Sarnowska, Patrick Wuchter, Jürgen Debus, Rainer Saffrich, Peter E. Huber, Nils H. Nicolay
PurposeHuman mesenchymal stromal cells (MSCs) may aid the regeneration of ionizing radiation-induced tissue damage. They can be harvested from different tissues for clinical purposes; however, the role of the tissue source on the radiation response of human MSCs remains unknown.Methods and MaterialsHuman MSCs were isolated from adipose tissue, bone marrow and umbilical cord, and cellular survival, proliferation and apoptosis were measured after irradiation. The influence of ionizing radiation (IR) on the defining functions of MSCs was assessed, and cell morphology, surface marker expression and the differentiation potential were examined. Western blot analyses were performed to assess the activation of DNA damage signaling and repair pathways.ResultsMSCs from adipose tissue, bone marrow and umbilical cord exhibited a relative radioresistance independent of their tissue of origin. Defining properties including cellular adhesion and surface marker expression were preserved, and irradiated MSCs maintained their potential for multi-lineage differentiation irrespective of their tissue source. Analysis of activated DNA damage recognition and repair pathways demonstrated an efficient repair of IR-induced DNA double-strand breaks in MSCs from different tissues, thereby influencing the induction of apoptosis.ConclusionsThese data show for the first time that MSCs are resistant to IR and largely preserve their defining functions after irradiation irrespective of their tissue of origin. Efficient repair of IR-induced DNA double-strand breaks and consecutive reduction of apoptosis induction may contribute to the tissue-independent radiation resistance of MSCs.

Teaser

Mesenchymal stromal cells (MSCs) from different tissues may aid the regeneration of radiation-induced organ lesions; however, the influence of ionizing radiation on tissue-specific human MSCs is unknown. Here we show that the radiation resistance of MSCs is independent of their tissue of origin, and irradiated MSCs from adipose tissue, bone marrow and umbilical cord preserved their defining characteristics. Efficient repair of radiation-induced DNA damage may contribute to this radiation resistance.


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The efficacy and safety of conventional and hypofractionated high-dose radiotherapy for prostate cancer in an elderly population: a subgroup analysis of the CHHiP trial

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): James M. Wilson, David Dearnaley, Isabel Syndikus, Vincent Khoo, Alison Birtle, David Bloomfield, Ananya Choudhury, John Graham, Catherine Ferguson, Zafar Malik, Julian Money-Kyrle, Joe M. O'Sullivan, Miguel Panades, Chris Parker, Yvonne Rimmer, Christopher Scrase, John Staffurth, Andrew Stockdale, Clare Cruickshank, Clare Griffin, Emma Hall
IntroductionOutcome data on radiotherapy for prostate cancer in an elderly population are sparse. The CHHiP trial provides a large, prospectively collected, contemporary dataset in which to explore outcomes by age.Methods and MaterialsCHHiP participants received 3-6 months of androgen deprivation therapy and were randomly assigned (1:1:1) to receive 74Gy in 37 fractions (conventional fractionation), 60Gy in 20 fractions or 57Gy in 19 fractions. Toxicity was assessed using clinician-reported and patient-reported outcome (CRO/PRO) questionnaires. Participants were categorised as aged less than 75 (<75) or 75 years and older (75+).Outcomes were compared by age-group.Results491/3216 (15%) were 75+. There was no difference in biochemical or clinical failure (BCF) rates between the <75 and the 75+ group for any of the fractionation schedules. In the 75+ group BCF-free rates favoured hypofractionation and at 5 years were 74Gy: 84.7%, 60Gy: 91%, 57Gy: 87.7%. The incidence of CRO (G3) acute bowel toxicity was 2% in both age-groups. Grade 3 acute bladder toxicity was 8% and 7%. Five year cumulative incidence of CRO grade 2+ late bowel side effects was similar in both age groups. However, in the 75+ group, there was a suggestion of a higher cumulative incidence of bowel bother (≥small) with 60Gy compared to 74Gy and 57Gy. Patient-reported bladder bother was slightly higher in the 75+ group than the <75 group and there was a suggestion of a lower cumulative incidence of bladder bother with 57Gy compared to 74Gy and 60Gy in the 75+ group which was not evident in those <75.ConclusionHypofractionated radiotherapy appears to be well tolerated and effective in men over 75. The 57 Gy schedule has potential advantages in that it may moderate long term side effects without compromising treatment efficacy in this group.

Teaser

The efficacy and toxicity of radiotherapy for localised prostate cancer in CHHiP trial participants aged 75 and over was compared with patients younger than 75. There was no evidence of a difference in biochemical or clinical recurrence free survival or clinically significant toxicity between the older and younger patient groups. Hypofractionated radiotherapy is an effective and well tolerated treatment for localised prostate cancer in an elderly population with good performance status.


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The Role of Radiation Therapy in Patients with Relapsed/Refractory Hodgkin Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Louis S. Constine, Joachim Yahalom, Andrea K. Ng, David C. Hodgson, Andrew Wirth, Sarah A. Milgrom, N. George Mikhaeel, Hans Theodor Eich, Tim Illidge, Umberto Ricardi, Karin Dieckmann, Craig H. Moskowitz, Ranjana Advani, Peter M. Mauch, Lena Specht, Richard T. Hoppe
Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early and advanced stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood in order to maximize our success in treating these patients. The complexity of treating relapsed/refractory HL derives from the spectrum of primary treatment approaches currently in use that creates heterogeneity in both treatment exposure and the potential toxicities of salvage therapy. Patients can have relapsed or refractory disease after limited or aggressive primary therapy (with or without radiation therapy), at early or delayed time points, with limited or extensive disease volumes, and with varying degrees of residual morbidity from primary therapy. Their response to salvage systemic therapy can be partial or complete, and the use of consolidative stem cell transplant is variably applied. New biologics and immunotherapeutic approaches have broadened but also complicated salvage treatment approaches. Through all of this, radiation therapy remains an integral component of treatment for many patients but it must be used effectively and judiciously. The purpose of this review is to describe the different treatment scenarios and provide guidance for radiation dose, volume, and timing in patients with relapsed or refractory HL.



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A Qualitative Assessment of Academic Radiation Oncology Department Chairs’ Insights on Diversity, Equity, and Inclusion: Progress, Challenges, and Future Aspirations

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rochelle D. Jones, Christina H. Chapman, Emma B. Holliday, Nafisha Lalani, Emily Wilson, James A. Bonner, Benjamin Movsas, Shalom Kalnicki, Silvia C. Formenti, Charles R. Thomas, Steve M. Hahn, Fei-Fei Liu, Reshma Jagsi
PurposeA lack of diversity has been observed in radiation oncology (RO), with women and certain racial/ethnic groups underrepresented as trainees, faculty, and practicing physicians. The authors sought to gain a nuanced understanding of how to best promote diversity, equity, and inclusion (DEI) based on the insights of RO department chairs, with particular attention given to the experiences of the few women and underrepresented minorities (URM) in these influential positions.MethodsIn March-June 2016, the authors conducted telephone interviews with 24 RO department chairs (of 27 invited). Purposive sampling was employed to invite all chairs who were women (n=13) or URM (n=3), along with 11 male chairs who were not URM. Multiple analysts coded verbatim transcripts.ResultsFive themes were identified: (1) commitment to DEI promotes quality healthcare and innovation, (2) gaps remain despite some progress with promoting diversity in RO, (3) women and URM faculty continue to experience challenges in various career domains, (4) solutions to DEI issues would be facilitated by acknowledging realities of gender and race, and (5) expansion of the career pipeline is needed.ConclusionsChairs' insights had policy-relevant implications. Bias training should broach tokenism, blindness, and intersectionality. Efforts to recruit and support diverse talent should be deliberate and proactive. Bridge programs could engage students before their application to medical school.

Teaser

This qualitative study sought to understand how to promote diversity, equity, and inclusion in radiation oncology. The authors conducted telephone interviews with department chairs, with attention to the experiences of the few women and underrepresented minorities in these positions. Chairs' insights had policy-relevant implications. Bias training should attempt to tap into the sensitive contextual areas of tokenism, blindness, and intersectionality. Efforts to recruit and support diverse talent should be deliberate and proactive. Bridge programs could engage diverse learners across the education spectrum.


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Endoscopic Surgery for Delayed Sinonasal Complications of Radiotherapy for Nasopharyngeal Carcinoma: a Subjective Outcome

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rachel Shemesh, Eran E. Alon, Iris Gluck, Arkadi Yakirevitch
BackgroundDelayed sino-nasal complications of radiotherapy include choanal stenosis, osteoradionecrosis, chronic sinusitis and intranasal synechiae. There are only sporadic reports on their surgical treatment with equivocal results.MethodsThis is a prospective case series of all patients surgically treated for delayed sino-nasal complications of radiotherapy in our institution during the last 10 years. The inclusion criteria required at least a 6-month follow up after the surgery. Included patients were asked to fill a SNOT-16 questionnaire preoperatively and 6 months after the surgery.Resultsnine patients with history of radiotherapy for nasopharyngeal carcinoma were included in our series. In all cases partial or complete subjective improvement was seen.ConclusionIn select cases, endoscopic sinus surgery may be of benefit in the treatment of delayed sino-nasal complications of radiotherapy.

Teaser

Delayed sino-nasal complications of radiotherapy include choanal stenosis, osteoradionecrosis, chronic sinusitis and intranasal synechiae. Their incidence and burden on their quality of life are underestimated. Results of our prospective study show good subjective outcome of surgical treatment of these delayed sino-nasal complications. It should encourage clinicians to be cognizant of symptoms suspicious for this pathology and to be diligent in referring the patients for further evaluation and treatment.


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Radiation Therapy to Sites of Metastatic Disease as Part of Consolidation in High-risk Neuroblastoma: Can Long-term Control be Achieved?

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Dana L. Casey, Ken L. Pitter, Brian H. Kushner, Nai-Kong V. Cheung, Shakeel Modak, Michael P. LaQuaglia, Suzanne L. Wolden
BackgroundAs part of consolidative therapy in high-risk neuroblastoma, modern protocols recommend radiation therapy (RT) both to the primary site and to sites of metastatic disease that persist after induction chemotherapy. Although there is abundant data showing excellent local control with 21 Gy directed at the primary site, there is little data describing the feasibility and efficacy of RT directed at metastatic sites of disease as part of consolidation.MethodsAll patients with neuroblastoma who received RT to metastatic sites of disease as a part of consolidative therapy at a single institution between 2000 and 2015 were reviewed. Among 159 patients, 244 metastases were irradiated.ResultsMedian follow up among surviving patients was 7.4 years. Over 85% of the irradiated metastases were treated with 21 Gy (range 10.5 Gy - 36 Gy). Tumor recurrence occurred in 43 of 244 (18%) irradiated metastases. The 5-year local control (LC) of treated metastatic sites was 81%. Metastatic sites that cleared with induction chemotherapy had improved LC compared to sites with persistent uptake on MIBG (LC 92% vs 67%, p<0.0001). LC at irradiated metastatic sites did not differ based on total number of sites irradiated or site of disease irradiated (bone vs soft tissue). Patients with bulky, resistant disease who were treated with 30-36 Gy had worse LC (p=0.02). However, on multivariate analysis, only persistence after induction chemotherapy remained a significant prognostic factor for LC (hazard ratio = 3.7, p<0.0001). Patients with LC at irradiated metastatic sites had improved overall survival (OS) compared to those who did not (OS 71% vs 50%, p<0.0001).ConclusionsResponse to chemotherapy is an important prognostic factor for LC at irradiated metastatic sites in neuroblastoma. Overall, consolidative RT appears to be an effective modality of LC. Long-term disease control can be achieved with such an approach.

Teaser

Although radiation therapy to persistent sites of metastatic disease is recommended as part of consolidative therapy for high-risk neuroblastoma, there is little data evaluating the value of this approach in achieving long-term control. Our results show that irradiation of metastatic sites of disease is effective in achieving local control, and that response to induction chemotherapy is a significant prognostic factor for control at irradiated sites.


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Current and Future Initiatives for Radiation Oncology at the National Cancer Institute in the Era of Precision Medicine

Publication date: Available online 8 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Charles A. Kunos, C. Norman Coleman




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Patient Experiences and Clinician Views on the Role of Radiotherapy for Ductal Carcinoma In-Situ

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Dean A. Shumway, Chandler M. McLeod, Monica Morrow, Yun Li, Allison W. Kurian, Aaron Sabolch, Ann S. Hamilton, Kevin C. Ward, Steven J. Katz, Sarah T. Hawley, Reshma Jagsi
PurposeTo evaluate patient experiences with decisions regarding radiotherapy for ductal carcinoma in situ (DCIS), and to assess clinician views on the role of radiotherapy for DCIS with favorable features in the present era.MethodsA sample of women with newly diagnosed breast cancer from the population-based Georgia and Los Angeles County (LA) SEER registries were sent surveys approximately 2 months after undergoing breast conserving surgery (70% response rate). The analytic sample was limited to 538 respondents with unilateral DCIS. We also surveyed 761 surgeons and radiation oncologists treating breast cancer in those regions, of whom 539 responded (71%).ResultsAfter breast conserving surgery (BCS), 23% of patients omitted radiotherapy, with twice the rate of omission in LA relative to Georgia (31% vs 16%, p<0.001). The most common reasons for omitting radiotherapy were advice from a clinician that it wasn't needed (62%) and concern about side effects (24%). Cost and transportation were not reported as influential considerations. After covariate adjustment, low and intermediate grade disease (OR 5.5, 95% CI 2.5-12; OR 3.2, 95% CI 1.7-6.1) and LA SEER site (OR 4.3, 95% CI 2.3-8.2) were significantly associated with greater radiotherapy omission. Among responding clinicians, 62% would discuss radiotherapy omission for a patient with DCIS with favorable features. Clinicians in LA were more likely to discuss radiotherapy omission than those in Georgia (67% vs 56%, p = 0.01). Approximately one-third of clinicians would obtain the Oncotype DX DCIS Score.ConclusionsThere continues to be substantial heterogeneity in radiotherapy omission after breast conserving surgery for DCIS, with systematic differences in provider opinions across the two regions we studied. Enhanced precision of recurrence estimates, guidance from professional organizations, and better communication are needed to improve the consistency of treatment in this controversial area.

Teaser

In a population-based survey of patients with DCIS, we observed that a quarter of patients omit radiotherapy after breast conserving surgery, with a two-fold difference in the rate of radiotherapy omission between the 2 SEER regions studied. In a corresponding survey of clinicians, we observed systematic differences in opinions between the two SEER regions regarding the role of radiation.


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The radiation resistance of human multipotent mesenchymal stromal cells is independent of their tissue of origin

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Alexander Rühle, Oliver Xia, Ramon Lopez Perez, Thuy Trinh, Wiltrud Richter, Anna Sarnowska, Patrick Wuchter, Jürgen Debus, Rainer Saffrich, Peter E. Huber, Nils H. Nicolay
PurposeHuman mesenchymal stromal cells (MSCs) may aid the regeneration of ionizing radiation-induced tissue damage. They can be harvested from different tissues for clinical purposes; however, the role of the tissue source on the radiation response of human MSCs remains unknown.Methods and MaterialsHuman MSCs were isolated from adipose tissue, bone marrow and umbilical cord, and cellular survival, proliferation and apoptosis were measured after irradiation. The influence of ionizing radiation (IR) on the defining functions of MSCs was assessed, and cell morphology, surface marker expression and the differentiation potential were examined. Western blot analyses were performed to assess the activation of DNA damage signaling and repair pathways.ResultsMSCs from adipose tissue, bone marrow and umbilical cord exhibited a relative radioresistance independent of their tissue of origin. Defining properties including cellular adhesion and surface marker expression were preserved, and irradiated MSCs maintained their potential for multi-lineage differentiation irrespective of their tissue source. Analysis of activated DNA damage recognition and repair pathways demonstrated an efficient repair of IR-induced DNA double-strand breaks in MSCs from different tissues, thereby influencing the induction of apoptosis.ConclusionsThese data show for the first time that MSCs are resistant to IR and largely preserve their defining functions after irradiation irrespective of their tissue of origin. Efficient repair of IR-induced DNA double-strand breaks and consecutive reduction of apoptosis induction may contribute to the tissue-independent radiation resistance of MSCs.

Teaser

Mesenchymal stromal cells (MSCs) from different tissues may aid the regeneration of radiation-induced organ lesions; however, the influence of ionizing radiation on tissue-specific human MSCs is unknown. Here we show that the radiation resistance of MSCs is independent of their tissue of origin, and irradiated MSCs from adipose tissue, bone marrow and umbilical cord preserved their defining characteristics. Efficient repair of radiation-induced DNA damage may contribute to this radiation resistance.


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The efficacy and safety of conventional and hypofractionated high-dose radiotherapy for prostate cancer in an elderly population: a subgroup analysis of the CHHiP trial

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): James M. Wilson, David Dearnaley, Isabel Syndikus, Vincent Khoo, Alison Birtle, David Bloomfield, Ananya Choudhury, John Graham, Catherine Ferguson, Zafar Malik, Julian Money-Kyrle, Joe M. O'Sullivan, Miguel Panades, Chris Parker, Yvonne Rimmer, Christopher Scrase, John Staffurth, Andrew Stockdale, Clare Cruickshank, Clare Griffin, Emma Hall
IntroductionOutcome data on radiotherapy for prostate cancer in an elderly population are sparse. The CHHiP trial provides a large, prospectively collected, contemporary dataset in which to explore outcomes by age.Methods and MaterialsCHHiP participants received 3-6 months of androgen deprivation therapy and were randomly assigned (1:1:1) to receive 74Gy in 37 fractions (conventional fractionation), 60Gy in 20 fractions or 57Gy in 19 fractions. Toxicity was assessed using clinician-reported and patient-reported outcome (CRO/PRO) questionnaires. Participants were categorised as aged less than 75 (<75) or 75 years and older (75+).Outcomes were compared by age-group.Results491/3216 (15%) were 75+. There was no difference in biochemical or clinical failure (BCF) rates between the <75 and the 75+ group for any of the fractionation schedules. In the 75+ group BCF-free rates favoured hypofractionation and at 5 years were 74Gy: 84.7%, 60Gy: 91%, 57Gy: 87.7%. The incidence of CRO (G3) acute bowel toxicity was 2% in both age-groups. Grade 3 acute bladder toxicity was 8% and 7%. Five year cumulative incidence of CRO grade 2+ late bowel side effects was similar in both age groups. However, in the 75+ group, there was a suggestion of a higher cumulative incidence of bowel bother (≥small) with 60Gy compared to 74Gy and 57Gy. Patient-reported bladder bother was slightly higher in the 75+ group than the <75 group and there was a suggestion of a lower cumulative incidence of bladder bother with 57Gy compared to 74Gy and 60Gy in the 75+ group which was not evident in those <75.ConclusionHypofractionated radiotherapy appears to be well tolerated and effective in men over 75. The 57 Gy schedule has potential advantages in that it may moderate long term side effects without compromising treatment efficacy in this group.

Teaser

The efficacy and toxicity of radiotherapy for localised prostate cancer in CHHiP trial participants aged 75 and over was compared with patients younger than 75. There was no evidence of a difference in biochemical or clinical recurrence free survival or clinically significant toxicity between the older and younger patient groups. Hypofractionated radiotherapy is an effective and well tolerated treatment for localised prostate cancer in an elderly population with good performance status.


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The Role of Radiation Therapy in Patients with Relapsed/Refractory Hodgkin Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Louis S. Constine, Joachim Yahalom, Andrea K. Ng, David C. Hodgson, Andrew Wirth, Sarah A. Milgrom, N. George Mikhaeel, Hans Theodor Eich, Tim Illidge, Umberto Ricardi, Karin Dieckmann, Craig H. Moskowitz, Ranjana Advani, Peter M. Mauch, Lena Specht, Richard T. Hoppe
Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early and advanced stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood in order to maximize our success in treating these patients. The complexity of treating relapsed/refractory HL derives from the spectrum of primary treatment approaches currently in use that creates heterogeneity in both treatment exposure and the potential toxicities of salvage therapy. Patients can have relapsed or refractory disease after limited or aggressive primary therapy (with or without radiation therapy), at early or delayed time points, with limited or extensive disease volumes, and with varying degrees of residual morbidity from primary therapy. Their response to salvage systemic therapy can be partial or complete, and the use of consolidative stem cell transplant is variably applied. New biologics and immunotherapeutic approaches have broadened but also complicated salvage treatment approaches. Through all of this, radiation therapy remains an integral component of treatment for many patients but it must be used effectively and judiciously. The purpose of this review is to describe the different treatment scenarios and provide guidance for radiation dose, volume, and timing in patients with relapsed or refractory HL.



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Inhibition of p38 MAPK activity leads to cell type-specific effects on the molecular circadian clock and time-dependent reduction of glioma cell invasiveness

Abstract

Background

The circadian clock is the basis for biological time keeping in eukaryotic organisms. The clock mechanism relies on biochemical signaling pathways to detect environmental stimuli and to regulate the expression of clock-controlled genes throughout the body. MAPK signaling pathways function in both circadian input and output pathways in mammals depending on the tissue; however, little is known about the role of p38 MAPK, an established tumor suppressor, in the mammalian circadian system. Increased expression and activity of p38 MAPK is correlated with poor prognosis in cancer, including glioblastoma multiforme; however, the toxicity of p38 MAPK inhibitors limits their clinical use. Here, we test if timed application of the specific p38 MAPK inhibitor VX-745 reduces glioma cell invasive properties in vitro.

Methods

The levels and rhythmic accumulation of active phosphorylated p38 MAPK in different cell lines were determined by western blots. Rhythmic luciferase activity from clock gene luciferase reporter cells lines was used to test the effect of p38 MAPK inhibition on clock properties as determined using the damped sine fit and Levenberg–Marquardt algorithm. Nonlinear regression and Akaike's information criteria were used to establish rhythmicity. Boyden chamber assays were used to measure glioma cell invasiveness following time-of-day-specific treatment with VX-745. Significant differences were established using t-tests.

Results

We demonstrate the activity of p38 MAPK cycles under control of the clock in mouse fibroblast and SCN cell lines. The levels of phosphorylated p38 MAPK were significantly reduced in clock-deficient cells, indicating that the circadian clock plays an important role in activation of this pathway. Inhibition of p38 MAPK activity with VX-745 led to cell-type-specific period changes in the molecular clock. In addition, phosphorylated p38 MAPK levels were rhythmic in HA glial cells, and high and arrhythmic in invasive IM3 glioma cells. We show that inhibition of p38 MAPK activity in IM3 cells at the time of day when the levels are normally low in HA cells under control of the circadian clock, significantly reduced IM3 invasiveness.

Conclusions

Glioma treatment with p38 MAPK inhibitors may be more effective and less toxic if administered at the appropriate time of the day.

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The preventive effect of sensorimotor- and vibration exercises on the onset of Oxaliplatin- or vinca-alkaloid induced peripheral neuropathies - STOP

Abstract

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and clinically relevant side effect of chemotherapy. Approximately 50% of all leukemia, lymphoma, colorectal- and breast cancer patients are affected.

CIPN is induced by neurotoxic chemotherapeutic agents and can manifest with sensory and/or motor deficits. It is associated with significant disability and poor recovery. Common symptoms include pain, altered sensation, reduced or absent reflexes, muscle weakness, reduced balance control and insecure gait.

These symptoms not only affect activities of daily living, subsequently reducing patients' quality of life, they have far more become a decisive limiting factor for medical therapy, causing treatment delays, dose reductions, or even discontinuation of therapy, which can affect the outcome and compromise survival. To date, CIPN cannot be prevented and its occurrence presents a diagnostic dilemma since approved and effective treatment options are lacking.

Promising results have recently been achieved with exercise. We have revealed that sensorimotor training (SMT) or whole body vibration (WBV) can reduce the symptoms of CIPN and attenuate motor and sensory deficits. We furthermore detected a tendency that it may also have a preventive effect on the onset of CIPN.

Methods

We are therefore conducting a prospective, multicentre, controlled clinical trial involving 236 oncological patients receiving either oxaliplatin (N = 118) or vinca-alkaloid (N = 118) who are randomized to one of two interventions (SMT or WBV) or a treatment as usual (TAU) group. Primary endpoint is the time to incidence of neurologically confirmed CIPN. Secondary endpoints are pain, maintenance of the functionality of sensory as well as motor nerve fibres as well as the level of physical activity. The baseline assessment is performed prior to the first cycle of chemotherapy. Subsequent follow-up assessments are conducted at 12 weeks, after completion of chemotherapy, and at a 3-month follow-up. Patients who develop CIPN receive an additional assessment at this time point, as it represents the primary endpoint.

Discussion

We hypothesize that SMT and WBV prevent the onset or delay the progression of CIPN, decrease the likelihood of dose reductions or discontinuation of cancer treatment and improve patients' quality of life.

Trial registration

Deutsche Register Klinischer Studien (DRKS00006088, registered 07.05.2014).

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