What is the association of preoperative biopsy with recurrence and survival in retroperitoneal sarcoma? A systematic review by the Australia and New Zealand Sarcoma Association clinical practice guidelines working party.

Preoperative biopsy for retroperitoneal sarcoma (RPS) enables appropriate multidisciplinary treatment planning. A systematic review of literature from 1990 to June 2022 was conducted using the population, intervention, comparison and outcome model to evaluate the local recurrence and overall survival of preoperative biopsy compared to those that had not. Of 3192 studies screened, five retrospective cohort studies were identified. Three reported on biopsy needle tract seeding, with only one study reporting biopsy site recurrence of 2 %. Two found no significant difference in local recurrence and one found higher 5-year local recurrence rates in those who had not been biopsied. Three studies reported overall survival, including one with propensity matching, did not show a difference in overall survival. In conclusion, preoperative core needle biopsy of RPS is not associated with increased local recurrence or adverse survival outcomes.

Hypofractionated re-irradiation with bevacizumab for relapsed chemorefractory glioblastoma after prior high dose radiotherapy: a feasible option for patients with large-volume relapse.

PURPOSE: There remains no standard of care for patients with recurrent and chemorefractory glioblastoma. Re-irradiation (reRT) provides an additional management option. However, published series predominantly focus on small reRT volumes utilizing stereotactic hypofractionated regimens. Concerns regarding toxicity have limited utilisation of reRT for larger recurrences, however this may be mitigated with use of bevacizumab (BEV). METHODS AND MATERIALS: A prospective database of patients managed with the EORTC-NCIC (Stupp) protocol 60 Gy chemoradiotherapy protocol for glioblastoma between 2007 and 2021 was reviewed for those patients receiving reRT for chemorefractory relapse. Serial MRI and PET were used to establish true progression and exclude patients with pseudoprogression or radionecrosis from reRT. The primary endpoint was overall survival (OS) from date of reRT. Prognostic factors were also assessed. RESULTS: 447 patients managed for glioblastoma under the Stupp protocol were identified, of which 372 had relapsed and were thus eligible for reRT. 71 patients underwent reRT. Median relapse-free survival from diagnosis for the reRT and overall cohorts were similar at 11.6 months (95%CI:9.4-14.2) and 11.8 months (95%CI:9.4-14.2) respectively. 60/71 (85%) reRT patients had received BEV prior to reRT and continued concurrent BEV during reRT. Of the 11 patients not managed with BEV during reRT, 10 required subsequent salvage BEV. ReRT patients were younger (median 53 vs. 59 years, p < 0.001), had better performance status (86% vs. 69% ECOG 0-1, p = 0.002) and more commonly had MGMT promoter-methylated tumours (54% vs. 40%, p = 0.083) compared to non-reRT patients. Median reRT PTV volume was 135cm3 (IQR: 69-207cm3). Median OS from reRT to death was 7.1 months (95%CI:6.3-7.9). Patients aged < 50, 50-70 and > 70 years had post-reRT median OS of 7.7, 6.4 and 6.0 months respectively (p = 0.021). Median post-reRT survival was longer for patients with ECOG performance status 0-1 compared to 2-3 (8.1 vs. 6.3 months, p = 0.039). PTV volume, site of relapse, MGMT promoter-methylation status and extent of initial surgical resection were not associated with post-reRT survival. ReRT was well-tolerated. Out of the 6 patients (8%) admitted to hospital after reRT, only one was for reRT toxicity. This was a CTCAE grade 3 radiation necrosis event in a patient managed without prior BEV. CONCLUSION: Patients with recurrent glioblastoma who have been previously treated with 60 Gy radiotherapy have a meaningful survival benefit from large volume re-irradiation which is well tolerated. ReRT should not be ignored as a salvage treatment option in patients with chemorefractory progressive disease.

A cross-sectional study of sun-related behaviours in the internet era.

OBJECTIVES: To identify the use and purchasing behavior of sunscreen products over the internet by Australian females, and factors contributing to these. METHODS: A cross sectional study of 1065 Australian female participants aged 18 and over was performed in August 2019, utilizing an online questionnaire to collect descriptive data regarding current demographics and behaviors in sunscreen product use, online sunscreen product purchasing, sunscreen product preferences and barriers to use, and sun exposure behaviors. RESULTS: 57% of 1065 participants have used the internet for sunscreen product recommendations, and 41% have made online purchases of local or international sunscreen products. Participants are more likely to check the ingredients regularly when buying them online (38%) than when purchasing them while overseas (31%).Internet use for sunscreen recommendations and purchasing was significantly impacted by the level of education (p < 0.001), age (<0.001), time in Australia (p < 0.001) and ethnicity (p < 0.001). Checking listed active ingredients when purchasing international sunscreen products online was significantly affected by the level of education (p = 0.02). CONCLUSION: There is a large proportion of Australian women who use the internet for recommendations or purchasing of sunscreen containing products. Active ingredients should be clearly listed when advertised on the internet, especially for international sunscreens.

Perils & pearls of purchasing sun protection over the internet: A google project.

BACKGROUND/PURPOSE: Sunscreen use has been shown to reduce the incidence of skin cancers. Internet purchasing allows access to internationally sourced sunscreens, despite varying accepted active ingredients and regulations around the world. AIMS/OBJECTIVES: To determine the compliance of international sunscreen products advertised on the internet with the current Australian sunscreen standard (AS/NZS 2604:2012). MATERIALS AND METHODS: Six sunscreen-related search queries were executed on Google between January-November 2018. Qualitative analysis of the search results to determine compliance with the current Australian sunscreen standard (AS/NZS 2604:2012) was performed by collecting descriptive data, including listed active ingredients of each advertised product. These were compared against the AS/NZS 2604:2012 list of permitted active ingredients. The compliance status of each product, and reasons for non-compliance were annotated. A multiple regression contingency table test was performed to determine whether compliance was associated with the products' country of origin, and a post hoc analysis was performed to identify countries with significant differences in discrepancy in compliance rate. RESULTS: Execution of the sunscreen-related search queries on Google generated 1350 results. Only 613 of the 1291 (47.5%) included products were compliant with the AS/NZS 2604:2012 permitted sunscreen active ingredients. 552 of 1291 products were non-compliant due to insufficient information advertised. Australia, India and South Korea had significantly lower than expected compliance rates. CONCLUSIONS: Online marketing of sunscreen products from other countries has a significantly lower than expected compliance rate with the AS/NZS 2604:2012 permitted sunscreen active ingredients, with many lacking the disclosure of the active ingredients. Advertising regulations for online suppliers need to be tightened to ensure that online consumers purchasing sunscreen products can make informed decisions, as the international E-commerce market rapidly expands.

Cutaneous manifestation of IgG4-related disease mimicking dermatitis artefacta.

Dermatitis artefacta is a self-inflicted cutaneous disease presenting as sharply delineated ulcers, usually in accessible sites such as the head and neck. IgG4-related disease (IgG4-RD) is a recently recognised immune-mediated condition causing a fibroinflammatory process, resulting in the formation of tumefactive lesions in various organs, rarely presenting primarily in the skin. We report a case of cutaneous IgG4-RD clinically presenting as dermatitis artefacta.

Cosmetic Versus Medicine: How Does Your Country Define Sunscreen?

Skin cancer (melanoma and non-melanoma) is the most commonly diagnosed cancer in the United States of America, and non-melanoma skin cancer is the most common cause of Australian hospitalisations with cancer as the principle diagnosis, having a huge cost to the country's health care system. Primary and secondary skin cancer prevention is globally inadequate, with only 3 in 10 American adults using sun protection routinely. Evidence suggests that regular sunscreen use in Australians prevents both melanoma and non-melanoma skin cancers, and American research has found that daily sunscreen use reduced the incidence of melanoma - the most skin cancer deaths - by half. Despite this, in many countries and regions around the world, a major ongoing divergence remains on the classification of sunscreen as either a cosmetic product or a form of medical therapy, which in turn affects the consumers' attitudes towards the use of sunscreen. This is also affected by the increasing use of the internet, which has made the purchasing of products internationally convenient and easy for consumers worldwide, including sunscreen products, which are frequently marketed online. There is variation between each country or region and their regulations of sunscreen affect the consequent labelling claims of sunscreen products. This affects the unsuspecting consumer's choices in purchasing sun protection, which may be misinformed. Australia, Canada, and the US are the only countries to classify sunscreen as a form of medical therapy. This paper explores the current classification of sunscreen products in countries and regions around the world and discusses the impact of these discrepancies and similarities on the attitudes of consumers towards sunscreen use. Finally, we make suggestions on changes that can be made to encourage sunscreen use and safe sunscreen purchasing. J Drugs Dermatol. 2018;17(8):899-904.

Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium.

Smoking is an established risk factor for pancreatic cancer; however, detailed examination of the association of smoking intensity, smoking duration, and cumulative smoking dose with pancreatic cancer is limited. The authors analyzed pooled data from the international Pancreatic Cancer Cohort Consortium nested case-control study (1,481 cases, 1,539 controls). Odds ratios and 95% confidence intervals were calculated by using unconditional logistic regression. Smoking intensity effects were examined with an excess odds ratio model that was linear in pack-years and exponential in cigarettes smoked per day and its square. When compared with never smokers, current smokers had a significantly elevated risk (odds ratio (OR) = 1.77, 95% confidence interval (CI): 1.38, 2.26). Risk increased significantly with greater intensity (> or =30 cigarettes/day: OR = 1.75, 95% CI: 1.27, 2.42), duration (> or =50 years: OR = 2.13, 95% CI: 1.25, 3.62), and cumulative smoking dose (> or =40 pack-years: OR = 1.78, 95% CI: 1.35, 2.34). Risk more than 15 years after smoking cessation was similar to that for never smokers. Estimates of excess odds ratio per pack-year declined with increasing intensity, suggesting greater risk for total exposure delivered at lower intensity for longer duration than for higher intensity for shorter duration. This finding and the decline in risk after smoking cessation suggest that smoking has a late-stage effect on pancreatic carcinogenesis.