Current Issue : January-March Volume : 2022 Issue Number : 1 Articles : 5 Articles
Background: Radiation‐induced xerostomia is one of the most prevalent adverse effects of head and neck cancer treatment, and it could seriously affect patients’ qualities of life. It results primarily from damage to the salivary glands, but its onset and severity may also be influenced by other patient‐, tumour‐, and treatment‐related factors. We aimed to build and validate a predictive model for acute salivary dysfunction (aSD) for locally advanced nasopharyngeal carcinoma (NPC) patients by combining clinical and dosimetric factors. Methods: A cohort of consecutive NPC patients treated curatively with IMRT and chemotherapy at 70 Gy (2–2.12 Gy/fraction) were utilised. Parotid glands (cPG, considered as a single organ) and the oral cavity (OC) were selected as organsat‐ risk. The aSD was assessed at baseline and weekly during RT, grade ≥ 2 aSD chosen as the endpoint. Dose‐volume histograms were reduced to the Equivalent Uniform Dose (EUD). Dosimetric and clinical/treatment features selected via LASSO were inserted into a multivariable logistic model. Model validation was performed on two cohorts of patients with prospective aSD, and scored using the same schedule/scale: a cohort (NPC_V) of NPC patients (as in model training), and a cohort of mixed non‐NPC head and neck cancer patients (HNC_V). Results: The model training cohort included 132 patients. Grade ≥ 2 aSD was reported in 90 patients (68.2%). Analyses resulted in a 4‐variables model, including doses of up to 98% of cPG (cPG_D98%, OR = 1.04), EUD to OC with n = 0.05 (OR = 1.11), age (OR = 1.08, 5‐year interval) and smoking history (OR = 1.37, yes vs. no). Calibration was good. The NPC_V cohort included 38 patients, with aSD scored in 34 patients (89.5%); the HNC_V cohort included 93 patients, 77 with aSD (92.8%). As a general observation, the incidence of aSD was significantly different in the training and validation populations (p = 0.01), thus impairing calibration‐in‐the‐large. At the same time, the effect size for the two dosimetric factors was confirmed. Discrimination was also satisfactory in both cohorts: AUC was 0.73, and 0.68 in NPC_V and HNC_V cohorts, respectively. Conclusion: cPG D98% and the high doses received by small OC volumes were found to have the most impact on grade ≥ 2 acute xerostomia, with age and smoking history acting as a dose‐modifying factor. Findings on the development population were confirmed in two prospectively collected validation populations....
Context: Breast cancer affects more than 2 million women a year worldwide. Improved treatments have made it possible to increase survival rates with more and more patients having time to develop secondary locations. Nasosinus metastases from this cancer are rare. Two recently treated breast cancer patients developed metastases to the sphenoidal and maxillary sinuses. These cases gave rise to an examination of the incidence of this disease, its diagnosis, the therapeutic means envisaged and the fate of these patients. Method: We report the diagnostic and therapeutic data of two patients suffering from breast cancer and presenting metastases at the nasosinus level, with a focus on the interest of radiotherapy in palliative care. Results: The two patients aged 56 and 60 presented in the course of their breast cancer secondary localizations in the sphenoidal and maxillary sinus confirmed by endoscopy and histology. All the cases presented massive lesions associated with other secondary bone locations in particular. After local radiotherapy and systemic chemotherapy treatment, one patient died 5 months after her diagnosis and the other was alive 16 months later. Conclusion: Nasal and sinus metastases from breast cancer are rare and have a poor prognosis as disseminated disease, they do not respond well to conventional systemic therapies even if palliative radiotherapy allows local control....
Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians’ perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient–physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients’ financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician–patient discourse regarding all aspects of treatment....
Surgery, chemotherapy and radiotherapy are the gold standard treatments used for cancer. Side effects from medical radiation can be significant, particularly external beam therapy to the breast, and head and neck regions causing fibrosis, secondary skin cancer, hair loss, oral mucositis and neuropathic pain. There is significant psychological stress, depression, anxiety and loss of self esteem particularly for female patients. Similar types of space radiation are known to damage the health of astronauts. Current treatments for scarring, tissue loss, hair loss and neuropathic pain are a high priority but inadequate. Regenerative medicine is a new and comprehensive approach to potentially treat complex medical conditions from radiation damage. Regenerative medicine combines a systematic evidence based approach with the use of herbal medicine, stem cells, peptides and 3D tissue engineering. These fields use sophisticated technology to identify the respective molecular mechanisms of upregulation and protection of healthy cells and down regulation of cancer cells. The regenerative medicine strategies of stem cells and plant polyphenols suggest there is significant potential for rapid clinical translation to alleviate the side effects associated with radiotherapy....
Due to the high effectiveness of cancer screening and therapies, the diagnosis of second primary cancers (SPCs) has increased in women with endometrial cancer (EC). However, previous studies providing adequate evidence to support screening for SPCs in endometrial cancer are lacking. This study aimed to develop effective risk prediction models of second primary endometrial cancer (SPEC) in women with obesity (body mass index (BMI) > 25) and included datasets on the incidence of SPEC and the other risks of SPEC in 4480 primary cancer survivors from a hospitalbased cancer registry database. We found that obesity plays a key role in SPEC. We used 10 independent variables as predicting variables, which correlated to obesity, and so should be monitored for the early detection of SPEC in endometrial cancer. Our proposed scheme is promising for SPEC prediction and demonstrates the important influence of obesity and clinical data representation in all cases following primary treatments. Our results suggest that obesity is still a crucial risk factor for SPEC in endometrial cancer....
Loading....