RESUMEN
AIMS: Patients with breast cancer who have positive lymph nodes are currently recommended axillary node clearance (ANC) or regional nodal irradiation (RNI). ANC is associated with complications such as lymphoedema, brachial plexopathy and shoulder stiffness. The AMAROS Group showed RNI to be non-inferior to ANC with regards to survival and recurrence, and with a better quality of life. We conducted a large real-world population study to show our centre's experience with the use of RNI and to contribute to the current discussion around the management of node-positive breast cancer. MATERIALS AND METHODS: We evaluated patients who received RNI as opposed to ANC between 2006 and 2009 (n = 190). Patients had a range of cancer subtypes/grades. All had positive axillary disease, identified by axillary node sampling or sentinel lymph node biopsy. Systemic therapy was given as per standard protocol. Our data were compared with those of patients who had RNI (n = 681) in AMAROS. Patients were followed up retrospectively and overall survival, breast cancer-specific survival, distant metastasis-free survival, locoregional recurrence and toxicity were recorded, including lymphoedema, brachial plexopathy and shoulder stiffness. Survival analysis was performed on R via the Kaplan-Meier method. Univariate and multivariate analyses were also performed. Toxicity data were reported as percentages. Patients meeting POSNOC trial criteria (one to two positive sentinel lymph nodes, macrometastasis, receiving adjuvant chemotherapy) including if oestrogen receptor-positive (stratified POSNOC) were identified for subgroup analysis in the regression model. RESULTS: Locoregional recurrence was 3.16% versus AMAROS RNI of 1.82%. Overall survival was slightly lower in our population, but cancer-specific survival was higher than AMAROS. Lymphoedema rates were 5.8% versus AMAROS 11% in RNI and 23% in ANC arms, respectively. Brachial plexopathy was 1.6% and arm/shoulder stiffness 7.4%. AMAROS conducted a quality of life survey pertaining to arm/shoulder stiffness, mobility and function, which seemed to affect about 18% in the RNI arm. Univariate analysis revealed POSNOC status, especially if also oestrogen receptor-positive, to be a low risk group with hazard ratio 0.42 (0.20-0.83, P = 0.015). Extracapsular extension of lymph node metastasis was a poor prognostic factor; hazard ratio 4.39 (1.45-14.0, P = 0.009). CONCLUSION: We support the conclusion of the AMAROS trial with survival and recurrence following RNI being non-inferior to ANC, and with similarly favourable toxicity data. We support the continuing use of RNI as a treatment option for patients with node-positive breast cancer. Further research is required to answer the key questions regarding personalised management for node-positive breast cancer, with regards to de-escalation and also intensification for the patients exhibiting adverse tumour biology.
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Neuropatías del Plexo Braquial , Neoplasias de la Mama , Linfedema , Femenino , Humanos , Axila/patología , Neuropatías del Plexo Braquial/complicaciones , Neuropatías del Plexo Braquial/patología , Neoplasias de la Mama/patología , Ganglios Linfáticos/patología , Calidad de Vida , Receptores de Estrógenos , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Ensayos Clínicos como AsuntoAsunto(s)
Curriculum , Oncología Médica , Humanos , Oncología Médica/educación , Reino Unido , Competencia ClínicaRESUMEN
OBJECTIVE: Our objective was to apply next-generation sequence-based DNA barcoding to identify the remnant larval bloodmeals in wild-caught host-seeking (unengorged) Ixodes scapularis nymphs (n = 216). To infer host species identification, vertebrate DNA was amplified using universal primers for cytochrome c oxidase subunit I (COI) and sequenced using next-generation sequencing (NGS) for comparison against known barcode references. RESULTS: Bloodmeal identification was unsuccessful in most samples (99% of 216 specimens) demonstrating a very low detection rate of this assay. Sequences that surpassed quality thresholds were obtained for 41.7% of nymphs (n = 90) and of those, confident species identification was obtained for 15.6% of nymphs (n = 14). Wild host identifications were only obtained from 2 specimens, where DNA from the eastern grey squirrel (Sciurus carolinensis) was identified. Human and bovine DNA was identified in remaining nymphs and considered to be contaminants. Further optimization of the technique is required to improve detection of remnant bloodmeals in host-seeking nymphs.
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Ixodes , Animales , Bovinos , ADN , Código de Barras del ADN Taxonómico , Humanos , Ixodes/genética , Ninfa/genética , VertebradosAsunto(s)
COVID-19 , Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Quimioradioterapia , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Pandemias , SARS-CoV-2RESUMEN
AIMS: Stereotactic ablative body radiotherapy doses for peripheral lung lesions caused high toxicity when used for central non-small cell lung cancer (NSCLC). To determine a safe stereotactic ablative body radiotherapy dose for central tumours, the phase I/II Radiation Therapy Oncology Group RTOG 0813 trial used 50 Gy/five fractions as a baseline. From 2013, 50 Gy/five fractions was adopted at the Beatson West of Scotland Cancer Centre for inoperable early stage central NSCLC. We report our prospectively collected toxicity and efficacy data. MATERIALS AND METHODS: Patient and treatment characteristics were obtained from electronic medical records. Tumours were classed as moderately central or ultra-central tumours using published definitions. Toxicity was assessed in a centralised follow-up clinic at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years after treatment. RESULTS: Fifty patients (31 women, 19 men, median age 75.1 years) were identified with T1-2N0M0 moderately central NSCLC; one patient had both an ultra-central and a moderately central tumour. Eighty-four per cent were medically unfit for surgery. Forty per cent had biopsy-proven NSCLC and 60% were diagnosed radiologically using 18-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Fifty-six per cent of patients were Eastern Cooperative Oncology Group (ECOG) performance status 2 or worse. All patients received 50 Gy/five fractions on alternate days on schedule. Two patients died within 90 days of treatment, one from a chest infection, the other cause of death was unknown. There was one episode of early grade 3 oesophagitis and one grade 3 late dyspnoea. There was no grade 4 toxicity. Over a median follow-up of 25.2 months (range 1-70 months), there were 34 deaths: 18 unrelated to cancer and 16 due to cancer recurrence. The median overall survival was 27.0 months (95% confidence interval 20.6-35.9) and cancer-specific survival was 39.8 months (95% confidence interval 28.6, not reached). CONCLUSION: This study has shown that 50 Gy/five fractions is a safe dose and fractionation for early stage inoperable moderately central NSCLC, with outcomes comparable with other series, even with patients with a poor performance status.
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Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Radiocirugia/métodos , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos/efectos adversos , Dermatosis del Pie/inducido químicamente , Dermatosis de la Mano/inducido químicamente , Anciano , Amlodipino/uso terapéutico , Anticolesterolemiantes/uso terapéutico , Antihipertensivos/uso terapéutico , Atorvastatina , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/complicaciones , Carcinoma Ductal de Mama/tratamiento farmacológico , Femenino , Ácidos Heptanoicos/uso terapéutico , Humanos , Hipercolesterolemia/complicaciones , Hipercolesterolemia/tratamiento farmacológico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Pirroles/uso terapéutico , TrastuzumabAsunto(s)
Enfermedades Renales/tratamiento farmacológico , Enfermedad Aguda , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Niño , Cólico/tratamiento farmacológico , Urgencias Médicas , Femenino , Humanos , Hiperpotasemia/tratamiento farmacológico , Enfermedades Renales/prevención & control , Fitoterapia/métodos , Preparaciones de Plantas/uso terapéutico , Pielonefritis/tratamiento farmacológico , Cálculos Urinarios/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/prevención & control , Vaccinium macrocarpon , Agua/administración & dosificaciónAsunto(s)
Complicaciones del Embarazo/terapia , Literatura de Revisión como Asunto , Aborto Incompleto/tratamiento farmacológico , Anticoncepción Postcoital , Urgencias Médicas , Medicina Basada en la Evidencia , Femenino , Humanos , Trastornos de la Menstruación/tratamiento farmacológico , Náusea/tratamiento farmacológico , Embarazo , Infecciones Urinarias/tratamiento farmacológicoAsunto(s)
Adenosina , Asma/fisiopatología , Espasmo Bronquial/inducido químicamente , Urgencias Médicas , Medicina Basada en la Evidencia , Taquicardia Supraventricular/tratamiento farmacológico , Adenosina/efectos adversos , Adenosina/uso terapéutico , Adulto , Contraindicaciones , Femenino , Humanos , Infusiones Intravenosas , Factores de RiesgoRESUMEN
The incidence of side-effects of two doses of droperidol used as a prophylactic antiemetic were compared (10 vs 20 micrograms/kg). Two hundred and twenty-eight women for day case laparoscopy were recruited. Pain and nausea scores were collected in the recovery area and in the Day Surgery Unit prior to discharge. A telephone follow-up questionnaire was administered. Incidences of anxiety, restlessness and dysphoric reactions were similar in both groups (29.2% vs 29.0%). The incidence of postoperative vomiting varied from 4.4 to 7.7%. There were no significant differences between the two groups when nausea scores, incidences of vomiting and pain after discharge were compared. An unexpected finding was the significantly higher incidence of pain in the 10 micrograms/kg group. We conclude that there is no advantage in lowering the dose of droperidol below 20 micrograms/kg in this group of patients.