Contribution of lymph node staging method and prognostic factors in malignant ovarian sex cord-stromal tumors: a world wide database analysis

Publication date: Available online 6 April 2018
Source:European Journal of Surgical Oncology
Author(s): Jieyu Wang, Jun Li, Ruifang Chen, Xin Lu
ObjectiveTo investigate the clinicopathologic prognostic factors in patients with malignant sex cord-stromal tumors (SCSTs) with lymph node dissection, and at the same time, to evaluate the influence of the log odds of positive lymph nodes (LODDS) on their survival.MethodsPatients diagnosed with malignant SCSTs who underwent lymph node dissection were extracted from the 1988-2013 Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier curves. The Cox proportional hazards regression model was used to identify independent predictors of survival.Results576 patients with malignant SCSTs and with lymphadenectomy were identified, including 468 (81.3%) patients with granulosa cell tumors (GCTs) and 80 (13.9%) patients with Sertoli-Leydig cell tumors (SLCTs). 399 (69.3%) patients and 118 (20.5%) patients were in the LODDS˂-1 group and -1≤LODDS˂-0.5 group, respectively. The 10-year OS rate was 80.9% and CSS was 87.2% in the LODDS˂-0.5 group, whereas the survival rates for other groups were 68.5% and 73.3%. On multivariate analysis, age 50 years or less (p˂0.001), tumor size of 10cm or less (p˂0.001), early-stage disease (p<0.001), and GCT histology (p≤0.001) were the significant prognostic factors for improved survival. LODDS ˂-0.5 was associated with a favorable prognosis (OS: p = 0.051; CSS:P = 0.055).ConclusionsYounger age, smaller tumor size, early stage, and GCT histologic type are independent prognostic factors for improved survival in patients with malignant SCST with lymphadenectomy. Stratified LODDS could be regarded as an effective value to assess the lymph node status, and to predict the survival status of patients.



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Engineering improved balance confidence among older adults with complex health care needs: Learning from the Muscling Up Against Disability study

Publication date: Available online 5 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sharon Hetherington, Tim Henwood, Paul Swinton, Justin Keogh, Paul Gardiner, Anthony Tuckett
ObjectiveTo investigate the associations of balance confidence with physical and cognitive markers of wellbeing among older adults receiving government-funded aged care services, and whether progressive resistance plus balance training could positively influence change.DesignIntervention study.SettingCommunity-based older-adult-specific exercise clinic.ParticipantsOlder adults (N=245) with complex care needs who were receiving government aged care support.Intervention24 weeks of twice-weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists.Main Outcome MeasuresThe primary measure was the Activity-specific Balance Confidence score. Secondary measures included the Short Physical Performance Battery, fall history, hierarchical timed balance tests, Geriatric Anxiety Index, Geriatric Depression Score, FRAIL scale and EuroQol 5D 3L.ResultsAt baseline, higher physical performance (r = 0.54, p < .01) and quality of life (r = 0.52, p < .01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r = -0.55, p < .01). Change in balance confidence following the exercise intervention was accompanied by improved physical performance (+12%) and decreased frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention.ConclusionsThis study shows that reduced physical performance and quality of life, and increasing frailty, are predictive of poor balance confidence among older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented, that reduces frailty and increases physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of wellbeing determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls among older adults.



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The Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome–A Systematic Review

Publication date: Available online 5 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bionka MA. Huisstede, Manon S. Randsdorp, Janneke van den Brink, Thierry PC. Franke, Bart W. Koes, Peter Hoogvliet
ObjectiveTo present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS).Data SourcesThe Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).Data Selection and ExtractionTwo reviewers independently selected the studies, extracted the data on pain (VAS), function or recovery and assessed the methodological quality.Data SynthesisA best-evidence synthesis was performed to summarize the results of the included studies. Four reviews and nine RCTs were included. For oral pain medication strong and moderate evidence was found for the effectiveness of oral steroids versus placebo in the short-term. Moderate evidence was found in favor of oral steroids versus splinting in the short-term. No evidence was found for the effectiveness of oral steroids in the long-term. For corticosteroid injections, strong evidence was found in favor of a corticosteroid injection versus a placebo injection and moderate evidence was found in favor of corticosteroid injection versus oral steroids in the short-term. Also in short-term, moderate evidence was found in favor of a local versus a systematic corticosteroid injection. Higher doses of corticosteroid injections seem to be more effective in the midterm, however the benefits of corticosteroid injections were not maintained in the long-term.ConclusionThe reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particular in the short-term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long-term.



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A contemporary analysis of radiotherapy effect in surgically treated retroperitoneal sarcoma

Publication date: Available online 6 April 2018
Source:Radiotherapy and Oncology
Author(s): Sebastiano Nazzani, Marco Bandini, Michele Marchioni, Felix Preisser, Zhe Tian, Denis Soulières, Emanuele Montanari, Gloria Motta, Pietro Acquati, Alberto Briganti, Shahrokh F. Shariat, Firas Abdollah, Luca Carmignani, Pierre I. Karakiewicz
Background and purposeContemporary data regarding the benefit of radiotherapy in surgically treated retroperitoneal sarcoma are scarce. The aim of the study was to evaluate the effect of radiotherapy on cancer specific mortality in surgically treated patients according to tumor size, histological subtype and grade.Material and methodsWithin Surveillance, Epidemiology, and End Results database (2004–2014), we identified 1226 patients with non-metastatic retroperitoneal sarcoma. Univariable and multivariable logistic regression models tested for predictors of radiotherapy delivery. Univariable and multivariable Cox regression models tested the effect of radiotherapy on cancer specific mortality in the overall population. Subgroup analyses explored the result of tumor grade and tumor size on radiotherapy effect. All analyses were repeated after adjustment according to inverse probability of treatment. Additionally, all analyses were subjected to 1000 bootstrap resamples for internal validation.ResultsRadiotherapy was delivered in 372 patients (30.3%). In univariable and multivariable logistic regression models high grade (OR: 1.46, CI:1.12–1.90; p = 0.006), and leiomyosarcoma histologic subtype (OR: 2.14, CI: 1.55–2.95; p < 0.001) predicted radiotherapy delivery. In the overall population multivariable Cox regression models showed lower cancer specific mortality (HR: 0.73, CI: 0.55–0.96; p = 0.025) with radiotherapy. In subgroup analyses multivariable Cox regression models showed radiotherapy benefit predominantly in high grade, large tumor size retroperitoneal sarcomas (HR 0.51: C.I.: 0.30–0.86; p = 0.02).ConclusionsIn this retrospective report, delivery of radiotherapy was associated with lower cancer specific mortality in high grade, large tumor size retroperitoneal sarcoma patients. Our findings are predominantly representative of liposarcomas and leiomyosarcomas that accounted for 90% of study population. Further study is needed to evaluate the role of radiotherapy in retroperitoneal sarcoma patients.



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Fatigue, insomnia and hot flashes after definitive radiochemotherapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: An analysis from the EMBRACE study

Publication date: Available online 5 April 2018
Source:Radiotherapy and Oncology
Author(s): Stéphanie Smet, Richard Pötter, Christine Haie-Meder, Jacob C. Lindegaard, Ina Schulz-Juergenliemk, Umesh Mahantshetty, Barbara Segedin, Kjersti Bruheim, Peter Hoskin, Bhavana Rai, Fleur Huang, Rachel Cooper, Erik van Limbergen, Kari Tanderup, Kathrin Kirchheiner
ObjectiveTo evaluate the pattern of manifestation of fatigue, insomnia and hot flashes within the prospective, observational, multi-center EMBRACE study.MethodsMorbidity was prospectively assessed according to CTCAE v.3 and patient-reported outcome with EORTC QLQ-C30/CX24 at baseline and regular follow-up. Analyses of crude incidence, prevalence rates and actuarial estimates were performed.ResultsA total of 1176 patients were analyzed with a median follow-up of 27 months. At baseline, CTCAE G1/G2 prevalence rates for fatigue were 29%/6.2%, for insomnia 18%/3.1% and for hot flashes 7.9%/1.6% with respective 3-year prevalence rates of 29%/6.8%, 17%/4.4% and 19%/5.9%. Similar patterns of manifestation were seen in patient-reported EORTC outcomes. The 3-year actuarial estimates for G ≥ 3 CTCAE fatigue, insomnia and hot flashes were 5.5%, 4.7% and 1.9%. Younger age was associated with significantly higher risk for fatigue, insomnia and hot flashes.ConclusionFatigue, insomnia and hot flashes occurred mainly in the mild to moderate range. Fatigue and insomnia were already present before treatment and showed minor fluctuations or recovery during follow-up, whereas hot flashes showed a considerable increase after treatment. More research is needed to evaluate contributing risk factors in order to define intervention strategies.



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Functional-guided radiotherapy using knowledge-based planning

Publication date: Available online 5 April 2018
Source:Radiotherapy and Oncology
Author(s): Austin M. Faught, Lindsey Olsen, Leah Schubert, Chad Rusthoven, Edward Castillo, Richard Castillo, Jingjing Zhang, Thomas Guerrero, Moyed Miften, Yevgeniy Vinogradskiy
Background and purposeThere are two significant challenges when implementing functional-guided radiotherapy using 4DCT-ventilation imaging: (1) lack of knowledge of realistic patient specific dosimetric goals for functional lung and (2) ensuring consistent plan quality across multiple planners. Knowledge-based planning (KBP) is positioned to address both concerns.Material and methodsA KBP model was created from 30 previously planned functional-guided lung patients. Standard organs at risk (OAR) in lung radiotherapy and a ventilation contour delineating areas of high ventilation were included. Model validation compared dose-metrics to standard OARs and functional dose-metrics from 20 independent cases that were planned with and without KBP.ResultsA significant improvement was observed for KBP optimized plans in V20Gy and mean dose to functional lung (p = 0.005 and 0.001, respectively), V20Gy and mean dose to total lung minus GTV (p = 0.002 and 0.01, respectively), and mean doses to esophagus (p = 0.005).ConclusionThe current work developed a KBP model for functional-guided radiotherapy. Modest, but statistically significant, improvements were observed in functional lung and total lung doses.



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Role of adjuvant external beam radiotherapy and chemotherapy in one versus two or more node-positive vulvar cancer: A National Cancer Database study

Publication date: Available online 6 April 2018
Source:Radiotherapy and Oncology
Author(s): Nicholas R. Rydzewski, Margaux J. Kanis, Eric D. Donnelly, John R. Lurain, Jonathan B. Strauss
Background and purposeInguinal lymph node involvement is considered the most important prognostic risk factor for survival in vulvar cancer. However, controversy exists concerning the optimal adjuvant therapy for node-positive disease. This study sought to identify the optimal adjuvant therapy for each subset of women with node-positive disease.Material and methodsThe National Cancer Database (NCDB) was queried to identify women with inguinal node positive vulvar cancer. Survival analysis was performed using log-rank test, the Kaplan–Meier estimates, and Cox proportional hazards to both clarify prognosis and identify the benefit of each treatment modality in individual subsets of women.ResultsA total of 2779 women with inguinal node positive vulvar cancer were identified. On multivariate Cox model hazard ratio, radiotherapy yielded a survival advantage for women with one positive node (HR 0.81, p = 0.027) and two or more positive nodes (HR = 0.59, p < 0.001). The addition of chemotherapy to radiotherapy yielded an incremental improvement in survival for women with 2 or more positive nodes (HR = 0.79, p = 0.022) but not women with 1 positive node (HR = 0.93, p = 0.605).ConclusionsAll patients with node positive disease benefited from radiotherapy. By contrast, only those with 2 or more positive nodes benefited from the addition of chemotherapy to radiotherapy.



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