Current Issue : July - September Volume : 2020 Issue Number : 3 Articles : 5 Articles
Background: There is a discrepancy about the metastatic rate of internal mammary lymph nodes (IMNs) between\nclinical and pathologic findings. We aimed to investigate the metastatic rate of IMNs and to provide\nrecommendations on target volume delineation of IMNs for adjuvant radiotherapy in breast cancer patients.\nMethods: We retrospectively analyzed data from 114 breast cancer patients treated with surgery without adjuvant\nradiotherapy who developed local and/or regional lymph node recurrence/metastasis at our institute from January\n2015 to January 2019. Patients with widely lung or pleural metastases were excluded. We first analyzed the recurrence rate\nwith the chest wall, the metastatic rate of internal mammary/anterior mediastinal, ipsilateral axillary and supraclavicular\nlymph nodes, and then investigated the distribution of the IMNs.\nResults: Among the 114 included patients, the recurrence rate with the chest wall, metastatic rate of IMNs, IMNs/anterior\nmediastinal lymph nodes, ipsilateral axillary lymph nodes, and the ipsilateral supraclavicular lymph nodes was 43, 37.7, 59.6,\n12.3, and 22.8%, respectively. The metastatic IMNs were mainly located from the first to the second intercostal space.\nHowever, metastatic lymph nodes could also be observed above the upper edge of the first rib.\nConclusions: The metastatic rate is high in the IMNs and irradiation of the internal mammary lymphatic chain is required. It\nis suggested that the upper bound of the internal mammary lymphatic chain should be up to the subclavian vein with a\n5-mm margin, thus connecting to the caudal border of supraclavicular clinical target volume in breast cancer patients at\nhigh risk of recurrence....
Breast cancer is the most frequently diagnosed cancer in women, with more than 2.1 million\nnew diagnoses worldwide every year. Personalised treatment is critical to optimising outcomes for\npatients with breast cancer. A major advance in medical practice is the incorporation of Clinical\nDecision Support Systems (CDSSs) to assist and support healthcare staff in clinical decision-making,\nthus improving the quality of decisions and overall patient care whilst minimising costs. The usage\nand availability of CDSSs in breast cancer care in healthcare settings is increasing. However,\nthere may be differences in how particular CDSSs are developed, the information they include,\nthe decisions they recommend, and how they are used in practice. This systematic review examines\nvarious CDSSs to determine their availability, intended use, medical characteristics, and expected\noutputs concerning breast cancer therapeutic decisions, an area that is known to have varying\ndegrees of subjectivity in clinical practice. Utilising the methodology of Kitchenham and Charter,\na systematic search of the literature was performed in Springer, Science Direct, Google Scholar,\nPubMed, ACM, IEEE, and Scopus. An overview of CDSS which supports decision-making in\nbreast cancer treatment is provided along with a critical appraisal of their benefits, limitations,\nand opportunities for improvement....
Background: Gemcitabine/erlotinib treatment offers limited benefit in unselected patients with pancreatic ductal\nadenocarcinoma (PDAC). Development of skin rash has been associated with favorable outcomes in patients\ntreated with gemcitabine/erlotinib. This study aimed to extend knowledge on the effectiveness of gemcitabine/\nerlotinib in metastatic PDAC in the context of clinical practice and with focus on skin rash.\nMethods: This multicenter, non-interventional study enrolled 376 patients with metastatic PDAC receiving\ngemcitabine/erlotinib. The primary endpoint was overall survival (OS) in patients with skin rash versus no skin rash.\nSecondary endpoints included progression-free survival (PFS), treatment satisfaction and safety. All data were\nanalyzed using descriptive statistics. Survival time and time to disease progression were estimated using the Kaplan-\nMeier method. Effectiveness endpoints were analyzed for subgroups by skin rash grade (no rash, rash grade 1, rash....................
Background: Whether or not double J (DJ) stenting during transurethral resection of a bladder tumour (TURBT)\nharms patients with regard to possible metachronous upper urinary tract urothelial cancer (UUTUC) development\nremains controversial. This study evaluated the impact of DJ compared to nephrostomy placement during TURBT\nfor bladder cancer (BCa) on the incidence of metachronous UUTUCs.\nMethods: We retrospectively analysed 637 patients who underwent TURBT in our department between 2008 and\n2016. BCa, UUTUC and urinary drainage data (retrograde/anterograde DJ and percutaneous nephrostomy) were\nassessed, along with the prevalence of hydronephrosis, and mortality. Chi-square and Fisherâ??s exact test was\nperformed for univariate analyses. Survival analysis was performed by the Kaplan-Meier method and log-rank tests.\nResults: UUTUC was noted in 28 out of 637 patients (4.4%), whereas only eight (1.3%) developed it\nmetachronously to BCa. Out of these, four patients received DJ stents, while four patients received no urinary\ndrainage of the upper urinary tract. Placement of urinary drainage significantly correlated with UUTUC (50.0% vs.\n17.9%; p = 0.041). DJ stenting significantly correlated with UUTUC (50.0% vs. 11%; p < 0.01), while no patient with a\nnephrostomy tube developed UUTUC. UUTUC-free survival rates were significantly lower for patients with DJ stents\nthan for all other patients (p = 0.001). Patients with or without DJ stents had similar overall survival (OS) rates (p =\n0.73), whereas patients with nephrostomy tubes had significantly lower OS rates than all other patients (p < 0.001).\nConclusions: Patients with DJ stenting during TURBT for BCa might have an increased risk of developing\nmetachronous UUTUC. This study indicated advantages in placing nephrostomy tubes rather than DJ stents;\nhowever, confirmation requires investigation of a larger cohort. Even so, the increased mortality rate in the\nnephrostomy group reflected hydronephrosis as an unfavourable prognostic factor....
Background: There is inconsistent evidence on the association between physical activity and pancreatic cancer risk\nand few studies have investigated early life or life-course physical activity. The objective of this study was to\nevaluate the association between trajectories of physical activity across the life-course and pancreatic cancer risk.\nMethods: A population-based case-control study was conducted (2011â??2013) using cases (n = 315) from the\nOntario Pancreas Cancer Study and controls (n = 1254) from the Ontario Cancer Risk Factor Study. Self-reported\nrecall of moderate and vigorous physical activity was measured at three time points: young adulthood (20sâ??30s),\nmid-adulthood (40sâ??50s) and older-adulthood (1 year prior to questionnaire completion). Physical activity\ntrajectories were identified using latent class analysis. Odds ratios (OR) and 95% confidence intervals (CI) were\nestimated from multivariable logistic regression adjusted for covariates: age, sex, race, alcohol, smoking, vegetable,\nfruit and meat consumption, and family history of pancreatic cancer.\nResults: Six life-course physical activity trajectories were identified: inactive at all ages (41.2%), low activity at all\nages (31.9%), increasingly active (3.6%), high activity in young adulthood with substantial decrease (13.0%), high\nactivity in young adulthood with slight decrease (5.0%), and persistent high activity (5.3%). Compared to the\ninactive at all ages trajectory, the associations between each trajectory and pancreatic cancer after confounder\nadjustment were: low activity at all ages (OR: 1.11; 95% CI: 0.75, 1.66), increasingly active (OR: 1.11; 95% CI: 0.56,\n2.21), high activity in young adulthood with substantial decrease in older adulthood (OR: 0.76; 95% CI: 0.47, 1.23),\nhigh activity in young adulthood with slight decrease in older adulthood (OR: 0.98; 95% CI: 0.62, 1.53), and\npersistently high activity (OR: 1.50; 95% CI: 0.86, 2.62). When time periods were evaluated separately, the OR for the\nassociation between high moderate activity in the 20sâ??30s and pancreatic cancer was 0.89 (95% CI: 0.64, 1.25) and\nsome sex differences were observed.\nConclusion: Distinct life-course physical activity trajectories were identified, but there was no evidence that any of\nthe trajectories were associated with pancreatic cancer. Future studies with larger sample sizes are needed to\nunderstand the associations between physical activity trajectories over the life-course and pancreatic cancer risk....
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