Cerebrovascular Reactivity and Concussion.

Cerebrovascular reactivity (CVR) reflects the change in cerebral blood flow in response to vasodilatory stimuli enabling assessment of the health of the cerebral vasculature. Recent advances in the quantitative delivery of CO2 stimuli with computer-controlled sequential gas delivery have enabled mapping of the speed and magnitude of response to flow stimuli. These CVR advances when applied to patients with acute concussion have unexpectedly shown faster speed and greater magnitude of responses unseen in other diseases that typically show the opposite effects. The strength of the CVR alterations have diagnostic potential in single subjects with AUC values in the 0.90-0.94 range.

Head and neck imaging surveillance strategy for HPV-positive oropharyngeal carcinoma following definitive (chemo)radiotherapy.

PURPOSE: To describe the utilization pattern of head and neck (HN) surveillance imaging and explore the optimal strategy for radiologic "residual" lymph node (LN) surveillance following definitive (chemo)radiotherapy (RT/CRT) in human papillomavirus (HPV)+ oropharyngeal carcinoma (OPC). METHODS: All HPV+ OPC patients who completed RT/CRT from 2012 to 2015 were included. Schedule and rationale for post-treatment HN-CT/MRI were recorded. Imaging findings and oncologic outcomes were evaluated. RESULTS: A total of 1036 scans in 412 patients were reviewed: 414 scans for first post-treatment response assessment and 622 scans for the following reasons: follow-up of radiologic "residual" LN(s) (293 scans/175 patients); local symptoms (227/146); other (17/16); unknown (85/66). Rate of scans with "unstated" reason varied significantly among clinicians (3-28%, p < 0.001) and none of them yielded any positive imaging findings. First post-treatment scans identified 192 (47%) patients with radiologic "residual" LNs. Neck dissection (ND) was performed in 28 patients: 16 immediately (6/16 positive), 10 after one follow-up scan (2/10 positive), and 2 after 2nd follow-up scan (1/2 positive). Thirty patients had >2 consecutive follow-up scans at 2-3-month intervals, and none showed subsequent imaging progression or regional failure. CONCLUSIONS: Pattern of HN imaging utilization for surveillance varied significantly among clinicians. Imaging surveillance reduces the need for ND. However, routine HN-CT/MR surveillance without clinical symptoms/signs does not demonstrate proven value in identifying locoregional failure or toxicity. Radiologic "residual" LNs without adverse features are common. If two subsequent follow-up scans demonstrate stable/regressing radiologic "residual" LNs, clinical surveillance without further imaging appears to be safe in this population.

18 F-FDG PET/CT for locoregional surveillance following definitive treatment of head and neck cancer: A meta-analysis of reported studies.

PURPOSE: To evaluate the performance of 18 F-fluorodeoxy-d-glucose positron emission tomography-computed tomography (18 F-FDG PET/CT) in identifying local failure and regional failure following curative radiotherapy or surgery for head and neck squamous cell carcinoma. METHODS: A comprehensive literature search identified studies published between January 2010 and August 2016. Diagnostic performance of 18 F-FDG PET/CT was evaluated for local failure/regional failure stratified by treatment-to-scan time interval of ≤3 versus >3 months. RESULTS: Twenty-four studies (2627 patients) were included. Compared to ≤3 months, 18 F-FDG PET/CT performed >3 months showed significantly improved sensitivity (87% vs 60%, P = 0.020) and specificity (93% vs 84%, P < 0.001) for local failure. There was no significant difference in sensitivity (79% vs 56%, P = 0.100) or specificity (95% vs 97%, P = 0.35) for regional failure >3 versus ≤3 months. CONCLUSIONS: This meta-analysis confirms high specificity but modest sensitivity of posttreatment 18 F-FDG PET/CT for local failure and regional failure. Sensitivity and specificity are significantly improved when 18 F-FDG PET/CT is performed >3 months for local failure.

Is there a role for acupuncture in the symptom management of patients receiving palliative care for cancer? A pilot study of 20 patients comparing acupuncture with nurse-led supportive care.

PURPOSE: A pilot study to document changes in symptoms after acupuncture or nurse-led supportive care in patients with incurable cancer. METHODS: Patients receiving palliative care with estimated survival of at least 3 months were screened with the Edmonton Symptom Assessment System (ESAS). Patients (n=20) with significant symptoms were randomised to receive weekly acupuncture or nurse-led supportive care for 4 weeks. ESAS scores were obtained before and after each treatment, and weekly for 6 weeks after treatment by telephone. RESULTS: 42 of 170 patients screened were eligible. 20 gave consent for recruitment. The compliance rate was 90% for acupuncture and 80% for nurse-led supportive care. Total symptom scores were reduced by an average of 22% after each acupuncture visit and by 14% after each supportive care visit. Compared with baseline, ESAS scores at the end of the follow-up period were reduced by 19% for the acupuncture arm and 26% for nurse-led supportive care. CONCLUSION: Patients appear to benefit from incorporating acupuncture in the treatment of advanced incurable cancer. Acupuncture was well tolerated with no significant or unexpected side effects. Acupuncture had an immediate effect on all symptoms, whereas nurse-led supportive care had a larger impact 6 weeks after the final session. Both interventions appear helpful to this population and warrant further study.